Authors: Lance Dodes
of addicts as counselors, 142–144
addiction switches, 85, 93, 108
addiction treatment studies, 29–57.
See
also specific studies
; claims of 12-step
programs and, 34–36; Cochrane
Collaboration review, 36–40; compliance
effect, 32–33, 39, 40, 41–42; controlled
(randomized) (
See
controlled studies);
definition of success, 33–34; demographics
of, 49; designing perfect
study, 150–151, 158–160; determining
actual success rates, 1–2, 52–53, 73–74;
dropout rates and, 44–50; evidence-
based studies as mirage, 151–157;
failure of, 147–160; failure to study
psychology of addiction, 152–153;
human studies, special considerations in,
29–31; of identical twins, 89;
ineffectiveness of AA, 56–57; lack of,
147–151; longitudinal, 41, 42, 43–44,
151; observational (See observational
studies); problem of spontaneous
remission, 53–55; project MATCH,
55–56, 150; publication of, limited in
scope, 148, 157–158; question of spirituality,
124–125; role of motivation,
50–52; statistics ineffectual in, 157–158
addicts: as addiction counselors, 69–70,
142–144; character defects of, 141–142,
145; demeaning treatment of, 99–100,
137–138, 143–144; need for individual
evaluation of, 132–133
“adventure therapy,” 9, 59, 64
Alcoholic Foundation, 21, 22, 24
Alcoholics Anonymous (AA), 11–28.
See also
Wilson, William Griffith
(“Bill”); actual success rates, 1–2,
122; antipathy to medical profession,
22–23; “Big Book” of (See
Alcoholics
Anonymous
[Wilson]); challenges to
dogma of, 131; on character defects of
addicts, 141–142, 145; claimed success
rates, 23–24, 34, 36–40; condemnation
of drug therapy, 106, 109, 117;
conditioning to guilt feelings, 118–119;
as contrived culture, 120; as cult,
100–102, 103; cult of personality in,
118; demeaning treatment of addicts,
99–100, 137–138, 143–144; dropout
rates from, 44–50; exposure to, during
hospitalization, 111, 113, 116; failures
(case studies), 7–9; failure to diagnose
depression, 99–100, 105, 115–120, 121;
as fellowship, 123–124; foundational
beliefs of, 131–132; founding of, 19–20;
inflated claims made by, 3–4; intensive
involvement with, 48, 50, 52–53;
as monopoly in treatment industry,
2–4, 131, 155; myths perpetuated by
(See addiction myths); negative effects
of, 56–57; newcomers to, 105–108;
personal safety at risk in, 107–108;
psychology of successes, 122, 127–133;
recognition by medical establishment,
24–26; within rehabilitation centers,
58, 60–61; religion and (See religion);
role of group dynamics, 123–124; roots
of, 17–19; self-promotion by, 22–24;
sexually predatory behavior in, 108,
117–118, 130; as social network, 121,
122, 132, 139–140; spirituality as factor
in, 124–127; spreading influence of,
26–28; steps in, 4–6, 128–129; studies
of (See addiction treatment studies;
specific studies
); successes of, 122–133;
suicide by members, 102–103, 108–109,
110; unsound theories of treatment,
130, 132; views held by (See moralistic
views of AA)
Alcoholics Anonymous
(Wilson), 3, 4, 16,
21, 27; AMA critique of, 24; moralistic
approach of, 142; on salvation
through surrender, 135–136
“Alcoholics Anonymous” (Alexander),
22–24
alcoholism: as addiction, 81; as behavior,
34; “disease theory” of, 25, 26, 100, 112,
155, 159; as disproof of neurobiological
model, 87; early “cures” for, 12–13, 14;
emotional trauma and, 112–115; family
history of, 14–15; personal relationships
ruined by, 116; spontaneous
remission rate, 54; treatments prior
to AA, 11–14; vilification as moral
weakness, 13
“alcoholism gene,” 88
Alexander, Jack, 22–24
American Journal on Addictions
, 147,
149–150
American Medical Association (AMA),
11, 24
American Psychiatric Association, 64
American Public Health Association, 26
Anderson, Philip, 156
anger, reduction of, 126
apologies, 5–6
Austen Riggs Center, 77
automatic behavior, 88
Avorn, Jerry, 40
Battle Creek Sanitarium, 78
Bauer, W. W., 26
Bayes, Thomas, 153, 154
Bayesian theory, 154, 156
behavioral psychiatry, 155
“Belladonna Cure,” 18–19
Betty Ford Center, 58; AA-based treatment,
60–61; claims of, 76; costs of
treatment, 71; daily schedule, 65–66;
“enhancements” to treatment, 59, 64
“Big Book.”
See Alcoholics Anonymous
(Wilson)
biochemical depression, 83
biological (biochemical) theories of
addiction: behaviors of biochemical
origin, 156; as fallacy, 152, 155–156;
flawed studies of, 147–148; neurobiology, 85–88
Bonaduce, Danny, 76
Brandsma study, 34–35, 36, 42
Breaking Addiction
(Dodes), 94, 159
“Cadillac” rehabs.
See
rehabilitation
centers
case reports.
See also
individual experiences:
of failures of AA, 7–9; on
psychology of addiction, 90–91, 93;
value of, 157–158
causality, 44
Celebrity Rehab
(TV series), 56, 60, 76
Census Bureau, US, 52
Chemical Dependency Recovery Program, 46–47
Churchill, Winston, 128
Cochrane Collaboration, 1–2, 36–40
Cochrane Review
, 37
cognitive behavioral therapy (CBT),
158, 159
collective organizations, 57
compliance effect, in observational studies,
32–33, 39, 40, 41–42
Comprehensive Alcohol Abuse and Alcoholism
Prevention Treatment and
Rehabilitation Act of 1970, 27
compulsion model of addiction, 83–85,
89–90
compulsive behaviors: as displacement,
89–90; multiple, 15–16, 93
concordance.
See
correlation
confrontation as tactic, 70
control attribute of rehab centers, 63
control groups: in designing perfect
study, 159; in human studies, 29–30;
lacking in observational studies,
44, 47
controlled studies, 31; of AA and TSF,
34–36, 37; designing perfect study,
150–151, 158–160; high cost of, 36,
158–159; observational studies compared, 29–32
conversion experiences: as basis of AA,
19–20; Jung as proponent of, 18; of
Marty Mann, 24–25; of Wilson, 2,
17, 18–19; of Wilson’s grandfather,
14–15, 18
correlation(s): Bayes’ theorem applied
to, 154; in observational studies, 30–31,
38–39; in twin studies, 89
cost of controlled studies, 36, 158–159
cost of rehab programs, 9–10; effectiveness
of treatment and, 70–72; lowering
in ideal programs, 80; as scam,
114–115; set by insurance carriers,
62–63
“cures” for alcoholism, 12–13, 14
Dana-Farber Cancer Institute, 77
data: disaggregation of, 40; elided, 42–43,
72–74, 151
Dawson, Deborah, 33
decision making, psychological significance
of, 87–88, 90–91
demeaning treatment of addicts: in
AA, 99–100; all addicts as “drunks,”
137–138; insanity myth and, 144; peer-
group attitudes, 139–140; in 12-step
model, 143–144
demographics of studies, 49
denial myth, 144–145
depression: AA misdiagnosis of, 99–100,
105, 115–120, 121; causes of, 83
detoxification services, 63
“disease theory” of alcoholism, 25, 26,
100, 112, 155, 159
displacement(s): addiction as, 91–92, 127;
compulsions as, 89–90; direct action
contrasted, 92
Dr. Rogers’ Hydropathic Sanitarium and
Congenial Home, 78–79
Dowling, Fr. Edward, 16
dropouts: not included in outcome
reports, 72–74, 75; poor results for, 52;
program effectiveness and, 44–50
drugs: drug courts, 28; heroin addiction,
83–84, 86–87; prescription, AA condemnation
of, 106, 109, 117; tolerance
to, 81; withdrawal from, 82
“drunks,” all addicts treated as, 137–138
emergent behaviors, 156
Emrick study, 35
engagement with programs, 51
“equine-assisted therapy,” 9, 59, 64
“evidence-based” science: failure to
study psychology of addiction, 152–
153; problems with studies, 151–152;
researcher prejudice in, 153–154; worship of, 152
failure of treatment: by AA (See Alcoholics
Anonymous [AA]); addiction
counselors and, 69–70, 142–144;
addiction myths and (
See
addiction
myths); case stories of (
See
individual
experiences); clinical depression
undiagnosed, 99–100, 105, 115–120, 121;
coercion of patients, 97–98; confrontational
tactics, 70; consequences of,
7–9, 76–77; demeaning treatment
of addicts, 99–100, 137–138, 143–144;
dropouts, 44–50, 52, 72–74, 75; early
“cures” for alcoholism, 12–13, 14; guilt
feelings and, 99–100, 116, 118–119;
“hitting bottom” as excuse for, 135;
lack of individual treatment, 65–68,
137–138; moralistic excuses for, 5–6,
13, 98–99, 110; need for individual
evaluations, 132–133; for newcomers
to AA, 105–108; 90/90 prescription
and, 140–141; “one-size-fits-all” view
and, 137–138; problems with treatment
studies (See addiction treatment studies);
in rehabilitation centers, 9–10,
76–77; relapses, 137; suicides, 102–103,
108–109, 110; TSF as setup for failure,
103, 105–106, 114; unsound theories
and, 130, 132
federal government, 1, 13, 159
Fernside Center, 61
Fingarette, Herbert, 53
Fiorentine study, 43, 53; compliance effect
error in, 40; correlation in, 38–39;
multiple regression analysis used in,
39–40
Gamblers Anonymous, 56
Gelber, Richard, 45, 49
genetic loading, 88, 89
genetic theory of addiction, 88–89, 147,
155–156
Grapevine
, 26
group therapy: general attributes of,
123–124; ideal construction of, 79; in
rehab programs, 67–68
guilt feelings, 116; AA conditioning to,
118–119; self-demeaning statements,
99–100
Harris study, 52–53, 124–125
“hazardous” drinking, 49, 75–76
Hazelden Treatment Center, 9, 10;
costs of treatment, 71; daily schedule,
66–67; history of, 58; “Minnesota
Model” of treatment, 60; outcomes
reported by, 72, 74
The Heart of Addiction
(Dodes), 89,
90–91, 156
helplessness: addiction as reversal of,
91–92, 127; admission of, 4, 5; combating
feelings of, 7–9; direct response to,
94–95; in “disease theory” of alcoholism,
25; in psychology of addiction,
145; rage at, 92; surrender to “higher
power” and, 136
heroin addiction, 83–84, 86–87
higher brain functions, 87–88
“higher power,” 127–131; in AA steps,
128–129; consequences of identifying
with, 130–131; identification with powerful
figures, 127–128; illusory nature
of, 129–130; surrendering to, 135–136
“hitting bottom,” 134–135
Horvath, Arthur, 26–27
hospitalization: exposure to AA during,
111, 113, 116; inebriate hospitals, 13; as
part of “rehab,” 60–67
humility, 130
identical-twin studies of addiction, 89
impaired physician programs, 28
independent testing, 43
individual experiences, 96–121; AA as
cult, 100–102, 103; AA misdiagnosis of
depression, 99–100, 105, 115–120; alcoholism
and emotional trauma, 112–115;
demeaning treatment in AA, 99–100;
dissatisfaction with 12-step philosophy,
98–99; feelings of coercion, 97–98;
negativity of AA, 105–107; psychology
of addiction, 90–91, 93; rigidity of AA,
109–110; “13th-stepping,” 108, 117–118,
130; 12-step based rehab, 103–104;
warning signs for suicide, 102–103
individual therapy: in ideal rehab,
79; missing from rehab programs,
65–68; “one-size-fits-all” treatment
contrasted, 137–138; in psychiatric
centers, 68
inebriate hospitals, 13
“Inquiry into the Effects of Ardent Spirits
on the Human Mind and Body”
(Rush), 11–12
insanity myth, 144
insurance carriers, 62–63
intensive involvement with program, 48,
50, 52–53
Intervention
(TV series), 1, 60
Ioannidis, John, 153, 154, 155
James, William, 18
Jellinek, E. M., 25–26
Johnson, Lyndon B., 27
Journal of Addiction Medicine
, 148
Journal of Addictive Behaviors
, 72, 74–75
Journal of Consulting and Clinical Psychology
, 47
Journal of Drug and Alcohol Dependence
,
147
Journal of Inebriety
, 14