“Keep coming back, it works if you work it!” This is what is chanted at the end of every meeting, but what if you have “worked it” and you still keep going back and getting drunk or loaded? Now, most people in the program will say things like, “Well, you must not have really done the steps right,” or “You didn’t go to enough meetings,” or “You didn’t pray to your Higher Power,” or “You know you did something wrong or else you would still be sober!” But what if the truth was that you did nothing “wrong,” that in reality you did not fail the Program, but rather the Program was just not a right fit for you, and in fact, it fails for most people? Hopefully even this little bit of knowledge would start to alleviate some of the guilt and shame that many carry due to numerous relapses and going in and out 12-step programs for many years.
Since what you are told from your very first 12-step meeting is, “Your only options are to get sober using our Program, or it’s jails, institutions or death,” you tend to stop thinking for yourself, (since it was your “best thinking that got you here“), stop questioning, and just follow what other’s tell you to do. This would be fine if this is what worked… but unfortunately, evidence is proving otherwise.
The 12-step success rate is showing to be approximately 3 percent. Yes, that’s right… only 3 percent! (Brown,Treatment Doesn’t Work, 1991). Here are some more startling statistics (Based on Alcoholics Anonymous World Services' own statistics).:
*45% of the people who attend Alcoholics Anonymous meetings never return after their first meeting.
*81% of AA attendees are gone after one month
*90% are gone after three months
*93% are gone (7% remain) after 6 months
*95% never return after the first year.
So there is a 5% retention rate for the first year. Note that the claimed five percent of A.A. newcomers who are still coming back after one year (and sober, we hope) is exactly the same number as the normal rate of spontaneous remission among alcoholics. A number of studies have found that a small percentage of alcoholics improve to the point of remission of problems associated with alcohol consumption, and we call this spontaneous remission. The preponderance of studies suggests that a spontaneous remission rate for alcoholism of at least one-year duration is about 4-18 percent. Successful treatment would, therefore, have to produce rates of improvement significantly above this probable range of spontaneous remission. Alcoholics Anonymous comes nowhere near exceeding a 4 to 18 percent per year recovery rate. Harvard Medical Schoolreported that in the long run, the rate of spontaneous remission in alcoholics is slightly over 50 percent. That would put the annual rate of spontaneous remission to be around 5 percent. Yet the claimed success rate of Alcoholics Anonymous does not even exceed that much lower rate.
If we subtract the usual spontaneous remission rate from A.A.'s claimed success rate, we get zero percent for A.A.'s actual effective cure rate. A.A. didn't make anybody quit drinking — those who quit were the ones who were going to quit anyway. They would have quit anyway, no matter what treatment they were receiving, or even no treatment at all! So, an alcoholism treatment program that seems to have a 5% success rate probably really has a zero percent success rate, and it is just taking credit for the spontaneous remission that is happening anyway. And a program that has less than a five percent success rate, like four or three, may really have anegativesuccess rate — it is actually keeping some people from succeeding in getting clean and sober. Any success rate that is less than the usual rate of spontaneous remission indicates a program that is a real disaster and is hurting the participants.
Yet even with all of this research, 93-97% of conventional drug rehabs and alcohol treatment centers are still 12-step or AA based, so those who leave AA to look elsewhere, such as conventional alcohol and drug treatment for solutions, are essentially rejoining AA!
AA hardly sounds like a “proven method,” let alone one that works for most people. So, if only about 5% of the people are getting the help that they need, what about the 95% of the people who are not being helped? That is the purpose of this article… to provide much needed awareness to individuals, rehabilitation centers, hospitals, sober livings, and even 12-step programs themselves so that people with substance abuse problems can actually start be helped. The bottom line is this… is the goal to get alcoholics and addicts into AA or NA or CA, or is it to actually get them some help?
Professor (and Doctor) George E. Vaillant of Harvard University is an enthusiastic advocate of Twelve-Step treatment, and is currently a non-alcoholic member of the Alcoholics Anonymous World Services, Inc. (AAWS) Board of Trustees. So he really wanted to prove the effectiveness of AA. To study the effectiveness of various methods of treating alcoholism, Vaillant compiled forty years of clinical studies. Vaillant and the director William Clark also conducted an eight-year longitudinal study of their own where Vaillant reported having followed 100 patients who had undergone twelve-step treatment. He compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. Fully 95% of the treated patients relapsed sometime during the eight-year period that Vaillant followed them.
After initial discharge, only five patients in the clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of their treatment were no better than the natural history of the disease (spontaneous remission). What Professor Vaillant, a Trustee of Alcoholics Anonymous World Services, Inc. — in other words, one of the highest-ranking A.A. leaders — is candidly, clearly describing is a zero-percent success rate for his A.A.-based treatment program. And it was even worse than no help: The A.A.-treated group, with the death rate of 29%, had the highest death rate of any kind of program, significantly higher than all of the other programs. And those five people out of the hundred in the A.A.-treated clinic sample who successfully stayed sober for 8 years are just the result of that same old five percent spontaneous remission rate at work, again.
Remember that these terrible numbers were reported by a Trustee of Alcoholics Anonymous World Services, Inc., by a real true believer in A.A., by someone who loves A.A. and was trying hard to make it look good, not by some harsh critic of A.A. who might be suspected of bias, or of fudging the numbers to make A.A. look bad.
Let me mention that I think 12-step programs are great for those individuals who it does work for, (or at least seems to work for—again, it might just be the work of spontaneous remission rather than the program itself that is working). I have seen it change many lives for the better, including my dad, who has now had 15 years of continuous sobriety, maintaining his sobriety from his very first meeting. It is also a great fellowship to share experiences, strength and hope. So, in no way am I anti-AA. However, it has become clear to me that substance abuse is not a “one size fits all” problem, and therefore, there can not be a "one-size-fits-all" solution.
The National Institute of Drug Abuse, NIDA, has even gone on record to emphasize that no single addiction treatment method is right for everyone. They claim that matching treatment services to each individual’s specific needs is critical to success. In addition, research studies indicate that even the most severely addicted individuals can participate actively in their own treatment, and that active participation is essential for good outcomes. According to the NIDA, counseling, either individual or group, and other behavioral therapies are critical components of effective treatment for addiction. It’s interesting to note that participation in a 12-step program was never mentioned anywhere in this research based guide which discussed the principles of effective treatment.
Reliance on outdated and ineffective treatment methods has created an environment that fully expects individuals to fail, and fail again until such time that rock bottom has been reached. It is often said that once an individual has reached rock bottom that there is only one way to go, UP. The problem with that philosophy is that for many people, the ultimate rock bottom is death. (Vacovsky, Executive Director, American Council on Alcoholism, May 12, 2005).
Vacovsky goes on to write:
“Many, (if not indeed most) alcohol dependent individuals have lost faith in themselves, and more importantly hope for the future. It is common for such individuals to have numerous attempts at sobriety, most often using 12-step methods. They have been programmed to accept themselves as hopeless and powerless, with their chance for recovery being slim to none… It is up to the individual to determine what the most appropriate treatment is. It is up to the treatment community to provide options that set up individuals to succeed, rather than be expected to fail."
Sadly, Americans are largely unaware that such options even exist. At least, the general public is. While the public is being told that “turning your will and life over to the care of God as you understand Him,” as AA suggests, is the only treatment for their illness, scientifically based research has been going on for decades. Results of this research are threefold:
- We now have options for treatment that are based on science rather than fundamentalist religion;<br>
- Gives back choice and a sense of control to the individual, which is proving to be extremely important and<br>
- We now have evidence that is in direct contradiction to the traditional view of problem drinking.
What, exactly, is the research finding? Here is what some of the experts in the addiction field have found:
- Well-designed research conducted over more than three decades has conclusively demonstrated that problem drinking will not inevitably get progressively worse, and that this is one attribute of being a “disease” of alcoholism is simply wrong. Some problem drinkers “progress,” but the vast majority don’t.<br>
- What most Americans believe about drinking problems and their treatment is substantially inaccurate.<br>
- Drinking problems do not occur as a result of a disease. It is a learned behavior, and additional learning can therefore modify behavior.<br>
- For no other “disease” do so many physicians, psychologists and counselors themselves believe in the non-research-based myths of problem drinking, ignoring the research of their own peers in developing their treatment plans.<br>
- “Problem drinkers in the United States are faced with a daunting dilemma when they seek help. They can either accept the prevailing myth that abstinence is the only effective means to resolve a drinking problem, or they can be accused of being “in denial…”<br>
- Insistence by treatment programs to only offer abstinence has been shown to deter many problem drinkers from seeking treatment.<br>
- Individualizing treatment is crucial.<br>
- Chronic “relapsers” can actually be harmed by the 12-step model view that once a slip has started, you are powerless to stop; the stronger one’s belief in this is the longer and more damaging the relapses are.<br>
- The confrontation and treating alcoholics and addicts like children commonly thought necessary to help them actually often hinders any change.<br>
- Many providers deliberately resist change because they have too much of an attachment to their own ideas of what should work, claiming, “I know what worked for me, and I’m sure that it can work for everyone else as long as they just do what I say.”<br>
- The only way to resolve a problem with alcohol is to abstain for life is wrong for the majority of people. A substantial proportion becomes moderate drinkers even when achieving abstinence is the primary focus of treatment.<br>
- Dr. Patricia Owen, Director of Research of the Hazelden Foundation, who was a long-time supporter of abstinence-only treatment, referred to these individuals as “in recovery without abstinence” and acknowledged their presence in large numbers among a sample of Hazelden graduates.
Of course, not even all scientists agree on the nature of and best treatments for alcohol abuse. But this is the twenty-first century, and no one would disagree that all patients suffering with an alcohol or drug problem have a right, just like any other patient suffering with any other problem, to be fully informed of the available options, the risks or areas of uncertainty, and, after reviewing the relevant information, in consultation with one or more providers, choose a course of action. This is simply good, ethical medicine. Should people struggling with substance abuse issues accept anything less?
It is also important to acknowledge that recovery programs are not necessary to discover how to quit and stay quit. The following is from the Harvard Medical School’s Mental Health Letter, the August/September 1996 issue:
Most recovery from alcoholism is not the result of treatment. Only 20% of alcohol abusers are ever treated… Alcohol addicts, like heroin addicts, have a tendency to mature out of their addiction…
In a group of self-treated alcoholics, more than half said that they had simply thought it over and decided that alcohol was bad for them. Another group said health problems and frightening experiences such as accidents and blackouts persuaded them to quit… Others have recovered by changing their circumstances with the help of a new job or a new love or under the threat of a legal crisis or the breakup of a family. Support from a husband or wife was important in sustaining the resolution.
Study results from addiction researchers, Doctors Linda and Mark Sobell, confirm Harvard’s 20% treatment statistic:
Surveys found that over 77 percent of those who had overcome an alcohol problem had done so without treatment. In an earlier study… a sizable majority of alcohol abusers, 82 percent, recovered on their own.
However, even though it is possible to recover on your own, you may want a recovery program, or at least a licensed professional for support. The good news is that many more treatment programs are starting to provide more evidence-based options beyond just the traditional 12-step approach, and this list is growing everyday. You can find a complete, comprehensive directory of over 100 professionals and drug and alcohol programs all over the U.S. and abroad that will provide you with many options in Melanie Solomon's newly released 2nd Edition of "AA Not the Only Way; Your One Stop Resource Guide to 12-Step Alternatives."
Leading U.S. addiction expert Dr. Marc Kern states, “I have long awaited this directory of addiction treatment alternatives. It represents what I believe to be the future of the field. It is a pioneering effort to organize this unique body of knowledge. A directory of this type was never available before.”
Dr. Frederick Rotgers, another leading addiction expert explains, “The problem is finding treatment providers who provide these alternative, evidence-based approaches. Melanie Solomon has taken a wonderful step toward making that process, of identifying alternatives to traditional treatments, easier.”
It is finally time to stop living in the dark ages of recovery, educate people about all of their choices and alternatives that are out there and maybe start making a dent in the alcohol and drug use problem that millions are facing each day instead of continuing to perpetuate it. If you are one of those people who still believe that the 12-steps are the “only way” to recover, I implore you to have an open mind. In fact, Bill W., one of the co-founders of AA said, "It would be a product of false pride to claim that A.A. is a cure-all, even for alcoholism." Bill W. repeatedly said that "our hats are off to you if you can find a better way" and "If [those seeking a different cure] can do better by other means, we are glad."
