A response to Dr. Lance Dodes
By Michael Brock
Part I
The Same Old Song
On June 18, 2014 I received an email in my inbox from an online discussion about addiction on LinkedIn. Ordinarily I ignore these emails as I’m sure we all spend too much time sifting through the ever increasing barrage of information — or disinformation — we are deluged with on a daily basis from various media. For whatever reason, I chose to read this particular email, referencing an article in an online publication called The Fix, about a book by Dr. Lance Dodes and his son, Zachary Dodes called, The Sober Truth. The article, AA Critic Lights another Fire (Including New Section), by John Lavitt, is an interview with the book’s co-author, disparaging the AA 12-Step program and suggesting that psychodynamic therapy might be better suited to the needs of most people with substance abuse issues. My reaction was different from what it might have been a few decades ago; I found myself agreeing with some points and disagreeing with others. However, it occurred to me that I have been evaluating and treating substance abuse as well as other conditions for 37 years, and might have something to contribute to the discussion.
After starting my career in substance abuse treatment, I branched off into a general practice, then specialized in family law forensics for several years. I published a book on the subject in 2008 when I was doing a lot of child custody evaluations, many of which involved sexual abuse allegations. However, in recent years I have gone back to the substance abuse field, doing some treatment, but focusing mostly on driver’s license restoration evaluations. The most interesting things about this particular line of work are: first, I now see people who are on the way up, vs. on the way down or (best case scenario) hitting bottom in a treatment center; and, secondly, I see people who have stopped at various stages of the abuse/addiction cycle, and through various means. These factors make the work more enjoyable, and also offer a somewhat different perspective on the process of both addiction and recovery.
I looked at the Dodes interview from this standpoint and thought it might be beneficial if someone familiar with the issues responded to his comments without anger at either his opinion of AA, or at AA itself, as I noticed many of the readers’ comments expressed. For what it’s worth, the following are my impressions of Dr. Dodes answers to the interviewer’s questions. It’s also worth noting that the interviewer seemed to be quite knowledgeable about AA and clarified errors of fact in Dodes statements, but did not interject personal opinion.
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The first question was why Dodes thought anti-AA sentiment came up regularly in the news, and how Dodes’ work was different from the run of the mill AA bashing. Dodes responded that he thought AA had been successful and other books on treatment of alcoholism had faded away because, “the people who are pro-AA and are getting something out of it — the people who are devoted to it in a quasi-religious sort of way — have a huge influence. Many of them are successful in other ways and they have risen to positions of prominence. This has always been the case as we reviewed in the book…”
Here Dodes has the cart before the horse. “The people who are devoted to AA in a quasi-religious manner” are the core members of AA, given that (as Dodes points out) AA is a quasi-religious organization. However, it is more the case that prominent people have been drawn to AA because of its success than that AA is successful because it has attracted successful people. In the beginning (1935), all of AA’s members were virtually unknown, and today, besides successes, there are also many famous failures of AA or AA style treatment. John Berryman was in Hazelden several times and Truman Capote had been in AA. Recently, Phillip Seymour Hoffman, died during a relapse after a couple of decades of sobriety in a 12-step group.
But the saying is that “nothing succeeds like success.” AA attracts the successful because of its success. People like Eric Clapton, who is not only open about his AA involvement, but also founded a treatment center based on AA principles, could afford just about any treatment there is, but found that what worked for him was the 12-step approach. Interestingly, in his autobiography he points out that he was able to get off heroin through the help of some religious friends, but never quit alcohol and cocaine until he went to treatment at Hazelden, which is AA oriented. He is clear that he felt AA had more to offer him than conventional religion, and seems to somewhat disparage the earlier help that was part of his journey of recovery. There may be reasons for this which we’ll explore later.
Dodes continues, “On the other hand, it’s also true that…Most people with addictions do not belong to 12-step programs, and many of those people have tried them and failed…you’ll see book after book about how AA saved my life, but you won’t see any books about how AA didn’t save my life. People don’t write those books and no one reads them.”
Duh, who reads books about “How I failed” at anything? Or how my religion failed me? People want to read books about success, the triumph of human spirit, how I overcame the odds to become successful at (fill in the blank). But the reason that a lot of people write books and make movies about how I recovered1 through AA is that a lot of people recover through AA. If there are so many people recovering through other means, why aren’t some of them writing books about it? and setting up treatment centers? Sure, there are a few (and a great many people who quit abusing substance before they become hard-core addicts), but not as many as in a 12-Step program, or you’d hear more about them, and meet more of them.
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AA doesn’t claim to be a sure path to success for everyone, though it does suggest that many of those who don’t succeed may be constitutionally unable to achieve rigorous self-honesty. Dodes doesn’t like this because he relates it to the quasi-religious nature of AA. Perhaps, like many scientists, he believes that religion is a personal matter to be kept separate from the study of human behavior. It’s worth noting that Dodes rejects both the belief in a Higher Power and the self-examination aspects of AA, and says that where it is effective it is effective solely because of the support network. That AA is a religion based treatment that works is a problem for both science and law, since the benefits of faith (despite arguments to the contrary) are not scientifically quantifiable, and referrals to AA clearly violate the principle of separation between church and state.
Bill Wilson claimed that even the severely mentally or emotionally disturbed could recover from addiction if they had the capacity to be honest. This may be an extravagant claim, but I really don’t know how anyone who works with addicts could fail to see this lack of self-honesty that is so characteristic of the problem. Recently, I saw a man who did prison time for “DUI causing serious injury.” I asked him, as part of the Michigan Alcohol Screening Test if he ever felt bad about his drinking. He said, “No.” I saw another client who was a PhD in nuclear physics. He had three DUIs. I asked him if he could always predict his behavior after the first drink. He said, “Yes.”
Confronting dishonesty and dysfunctional behavior while respecting the client is essential to effectively treating addiction, and (arguably) to treating any behavioral condition. Not to see or confront the client’s personal responsibility in his own problem is to do him a grave disservice. Dodes talks in the article about treatment for one of his clients, whose Percodan addiction was caused by her failure to confront her husband’s unrealistic demands. This is very politically correct, and I’m sure some people will love it, but my clients are virtually always their own worst enemy. The notion that the problem lies outside themselves is a sure sign of more trouble ahead.
Dodes is a psychodynamic therapist and traditional Freudian therapy has pretty much fallen out of favor these days. Perhaps it’s because the format of exploring past trauma as an explanation of current dysfunction makes it too easy for patients to blame their troubles on their upbringing and feel sorry for themselves, rather than seeing how they now perpetuate their own suffering and that of others. A friend of mine and fellow therapist (but definitely not a religious person) once observed that, “’The sins of the fathers really are visited on the children down to the third and fourth generation.’2 After that there is so much dysfunction they stop reproducing.” I would agree this is frequently the case unless and until someone breaks the chain of dysfunction; and, also, dysfunction frequently includes addictive behaviors.
That said, there are reasons no one really understands about why some addicts achieve a successful recovery and some don’t. The process of recovery is difficult. The more advanced the addiction process, the more difficult recovery is, for many reasons. Much is said and written about the physical aspects of addiction, but these are relatively minor and easy to treat. True, the physical consequences of advanced addiction are serious and often fatal, but most alcoholics and drug addicts have been through the sobering up process many times before they reach that stage. It is the mental pull of the substance, and the belief that use can be controlled that continues to draw those dependent on substances back to their drug of choice. Add to this the damage that addicts have already done to themselves, their lives, their self-esteem, their loved ones, employers, careers and virtually everyone with whom they have contact and who is dependent on them responding to life in a sober, mature way, and it is often impossible for him to think that he could ever repair the damage he has done and look himself in the mirror without disgust.
Then there are people like Dr. Dodes who are well meaning, to be sure, but who don’t seem to understand that one drink generally leads to another and inevitably to one drink too many, and to behaviors that not only destroy the fragile self-esteem the alcoholic is rebuilding, but also dash the hopes of everyone in his life that things could really be different this time. Are there exceptions that prove the rule? Probably. But if the odds are stacked against you, is it really wise to repeat the experiment of the first drink? To try controlled drinking? AA tells people that if they don’t take the first drink they don’t have to worry about when to stop, and that’s true. It’s not like food or sex; one can live a full life without alcohol. But to downplay the difficulty of quitting drinking or drugs and rebuilding one’s life is to underestimate your enemy; and as Lao Tzu said, “There is no greater danger than to underestimate your enemy.”3
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It may be true that there are many, and perhaps a majority of people with addictions who are not in a 12-step group, and that, “Many of those have tried them and failed.” But it might be wise to divide these people into two groups, the people for whom a 12-step group was part of their journey to abstinence which they eventually achieved in some other way, and those who have rejected AA, either because they have chosen to remain actively addicted, or in spite of the fact that they have found no adequate substitute to keep them sober.
I see a lot of the first group when I am doing driver’s license evaluations. Typically these are people who have been partiers in their youth and got caught a couple of times for drinking and driving. Often, they have gone before a judge, who recognizes that they are not criminals in the usual sense. That is to say, there is nothing malicious in their drinking and driving. They are somewhat different, therefore, from the guy who hits an old woman over the head with a ball peen hammer so he can grab her purse with the last five dollars she has in the world. Judges see treatment and/or AA as an alternative to jail for these people. It is also less expensive for the taxpayer, makes room in the jail for more dangerous criminals, and sometimes succeeds in sobering the person up and keeping them “out of the court’s hair.”
It does not always take a lifetime of AA for these people to get the message that they either shouldn’t drink at all, or at least shouldn’t drink and drive. They are often people with relatively normal lives, jobs, families and not many problems related to substances except for their drinking and driving. In AA, they may encounter people who have been to prison for felony DUI, or sold their bodies on the street for crack. Some people in the early stages of abuse/dependence may be “scared straight” by this experience. They get the message and just simply quit doing substances. Sometimes it is a combination of run-ins with the law, getting some counseling and/or AA, becoming a parent (or being in danger of losing a spouse), and just wanting a better life that brings them to the conclusion they should quit substances before the problem becomes any worse.
Even with these people, however, (often referred to by AA members as “high-bottom” drunks) it is rarely the case that they can resume drinking without problems. One very discouraging type of client for any therapist to treat is the person who really seems to be getting their life on track, but who periodically relapses into active drinking or drug use and incurs some kind of setback. They pick up another DUI, the spouse gets disgusted and leaves, the employer is downsizing and he is expendable, or some other substance related consequence results in the interruption of forward momentum. The acts of one night sets the person back years, or creates a mess that will take years to clean up, or can never be cleaned up.
Even when a person is able to clean up and do something remarkable with his life, the damage done through drinking is often irreparable, though it is rare for an addict to acknowledge the true extent of the damage he or she has done. Eugene O’Neill was able to recover for his alcoholism and remain sober for the latter part of his life, during which time he wrote the plays which have endured and for which he is most famous, including Long Day’s Journey into Night, the story of his addicted family of origin. He attributed his recovery to a combination of psychotherapy, a reawakening of his religious (Catholic) faith, and his relationship with third wife, Carlotta. But despite his artistic success, his children were deeply damaged, all becoming addicts themselves. Both of his sons committed suicide, and he disowned his daughter and his grandchildren when she married Charlie Chaplin. Typical of the self-centeredness of the alcoholic (a characteristic that does not disappear simply because someone stops drinking), O’Neill could see his daughter’s behavior only from the perspective of how it reflected on him, apparently taking no responsibility for how much damage he had inflicted on her. That he could defend himself against this responsibility is a testament to the human capacity for denial. The guilt would have driven most alcoholics back to the bottle.
Addicts who can’t or won’t accept AA, though they lack a substitute that will keep them sober and help them rebuild their lives, are another matter. Regardless of what method of treatment or self-help is used, there are going to be a lot of people who cannot be reached. I am reminded of the novel, The Life of Pi, by Yann Martel. Though overall the book has the tone of absurdist humor, the author says he is going to tell you a story to make you believe in God, and he makes some serious points. Early in the book, the main character finds himself alone on a life raft with a Bengal tiger after the ship he was on sank in the Pacific. He says he realized one thing right away: when confronted with an impossible situation most people will immediately throw in the towel. A second, smaller group will make a half-hearted effort before giving up. But there is a third, much smaller group that will do anything it takes to survive. He realized intuitively that he was in the last group.
These are the people Bill Wilson was referring to when he distinguished between people who are trying to get by with “half-measures”4 and those who are willing to go to any length to achieve sobriety. He acknowledged that many people, looking at the rigorous program of spiritual and moral regeneration outlined in the 12-Steps would say, “What an order! I can’t go through with it!” He offers the comfort of saying that no one works a perfect program, but there is no denying that he is asking for total commitment. It is axiomatic that nothing worthwhile in life is easily achieved. I recall telling my daughter as a child that everything in life is more difficult and takes longer than you expect it to. It is as Lao Tzu has said: “He who expects everything to be easy, will find everything difficult; he who expects everything to be difficult, will find everything easy.”5
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One client of mine had been in psychotherapy for a year and a half before going to AA and nothing in his life had changed. He told a God he wasn’t sure existed that if there was a better way to live he was willing to try it. Two things had happened; he was admitting defeat and expressing a willingness to do whatever worked. The honesty of that prayer allowed him an immediate change of psyche. He was able to see and admit for the first time that alcohol was his primary problem. Yes, he had underlying issues, but they were never going to be dealt with as long as he was still drinking. He told me,
“I picked up the phone and called an atheist psychiatrist who had become a friend of mine when he came to a production of a play I wrote.”
The doctor said, “The best available solution for most people is AA.”
I said, “Isn’t that a religious program?”
He said, “Well, they say it’s spiritual not religious, but God’s a big part of it.”
“Well, aren’t you an atheist?”
“I never told you that. I just said that I was all the God I would ever need.”
“Whatever. So why are you sending me to a religious program?” (Despite the prayer, there was a part of him that still thought he was too smart for any solution based on God or religion.)
“Well, for most people it seems to be what works best.”
“Shouldn’t I go somewhere and dry out,” my client asked?
“Do you have any insurance,” the doctor asked?
“No.”
“Then there’s no place for you to go. (He didn’t qualify for free treatment.) Besides, they would just dry you out and send you to AA. I don’t think you’ll have serious withdrawal symptoms, so just avoid stimulants and accept that you’ll have some difficulty sleeping for a few nights.”
When he went to AA he got sober right away, but didn’t start working the steps until he fell off “the pink cloud” after a few weeks of just going to meetings. He told someone with long term sobriety that the meetings weren’t working as well as they had in the beginning and asked if the AA member had any suggestions. He said, “Have you looked at the steps?”
My client told me, “I looked at the steps and thought, ‘What an order.’ But I didn’t say, ‘I can’t go through with it.’ I knew I would.”
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Dodes says that a lot of scientists and researchers have jumped on the bandwagon and are trying to prove AA’s effectiveness scientifically, but these studies “are riddled with errors and the science that supposedly is supporting AA is no good…The problem is that, because of the power structure, we prescribe AA for everyone and that’s just a mistake.”
How one would ever be able to scientifically quantify the effectiveness of AA or any form of substance abuse or mental health treatment is beyond me. There are so many variables there would be no way to account for all of them, and, therefore, any scientific conclusions would be suspect, as they are with anyone’s claims about the efficacy of any given mental health/substance abuse treatment. But since AA is anonymous, there is no official record of anything, so the effort becomes ludicrous. Still, Dr. Dodes has to have a little bit of common sense. Does he really think that anyone having experience with the destructiveness of addiction is going to refer to someone who says in print that something less than complete and permanent abstinence is an acceptable solution? If an alcoholic tells you he’s having only two drinks a day, would you really believe him? How would you know for sure? One of my clients told me with a straight face he had only three drinks the night he was arrested and blew .24, “I shouldn’t have drank on an empty stomach,” he said.
I tell my clients who are going for driver’s license reinstatement that the last thing a hearing officer wants to see is your picture on the news for killing four kids while driving drunk after he gave you back your license. This has happened, and I know that this is why the State of Michigan requires at least a year of abstinence and prefers that a person is in a support group before they give them back a license after two DUIs. The streets are a little safer than they used to be6, and part of this is because the process of license restoration was taken out of the courts in Michigan and given to the Secretary of State, whose hearing officers don’t have to worry about elections, and who tend to be much less lenient that circuit court judges.
Similarly, regardless of the laws, employers don’t want you anywhere near their equipment/vehicles/assembly lines or whatever if you have any amount of a mood altering chemical in your system that is not specifically prescribed to you by a physician (and maybe not then). They simply do not want the liability, and who can blame them? It is not AA that has made AA the standard by which all substance abuse treatment is judged. If those responsible for making the decisions had a better option than to refer to AA or AA oriented treatment facilities, and if they had some experience of success referring to these other options, they would do it. If the rich and famous had better options, they would take them. As for AA itself, their 10th Tradition says, “Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never to be drawn into public controversy.”7
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1“Recovered” is the term used in the AA literature. The purpose was to distinguish sober alcoholics from “cured” alcoholics. Today, the term frequently used is recovering,” for the same purpose, to indicate that the process of healing is never complete.
2Exodus 20:5 NIV
3 Lao Tzu, Tao Te Ching, #69
4Alcoholics Anonymous, P. 59
5Lao Tzu, Tao Te Ching, #63
6List of motor vehicle deaths in U.S. by year
http://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in_U.S._by_year
7Twelve Steps and Twelve Traditions of AA, P. 176
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Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte, Michigan. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; 313-802-0863, fax/phone 734-692-1082; e-mail, michaelgbrock@ comcast.net; website, michaelgbrock.com.
