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A response to Dr. Lance Dodes,  Part VI: Solutions for the 1%

This article is the sixth installment of an extended response to an interview with Dr. Dodes, professor emeritus at Harvard school of psychiatry, by John Lavitt. The book and the interview essentially dismisses 12 step groups, the current substance abuse treatment industry, and the science that supports them, without proposing any concrete alternatives. Moreover, Dodes quotes his own science rather selectively and sometimes inaccurately.  Prior sections of the piece are available online.

Levitt then asks Dodes the legitimate question of whether Dodes has a sufficient solution to replace the 12-Step programs. Wouldn’t years of therapy leave many people “out in the cold?” What about the homeless? Addicts who can’t afford therapy? AA welcomes these people. “Are you considering the possibility of pro bono work to help such people?”

Dodes says Levitt is missing the point. He is proposing psychodynamic therapy, not psychoanalysis. “Yes, it takes time, and I have no apology for that. When it comes to the first case I mentioned in the book, it only took him eight months to stop drinking through this therapy. I find these negative comments about the time incredible because people on average usually take ten years to stop drinking. That’s just the statistics. People in AA would never claim that they get people cured in eight months. Eight months is not a long time for a lifetime condition…”

AA would never claim they have cured anyone. What sober AA members have is a “daily reprieve contingent on the maintenance of [their] spiritual progress.”[i] But people progress at their own rates; everyone is on their own timetable. A lot of that has to do with their physical and mental condition when they walk through the doors of AA. Some quit right away and some never quit. Anyone’s progress in any kind of therapy is contingent in large measure on the investment that they have in that treatment. And what influence does previous therapy have on future therapy?

One client, who was seeing me for other life issues, felt that he learned nothing in the insight therapy he did for 18 months before getting sober. His drinking actually progressed during that time period to the point that he was drinking more, not less; though his therapist told him that if he was alcoholic he would have to quit drinking for therapy to be helpful. He thought that applied to other people, not him. (Exceptionality is a common trait of alcoholics.)

He got sober the day he walked into AA. Looking back, he decided that therapy was part of his getting ready to do what he needed to do. It was a half-measure that led him ultimately to a total commitment. Similarly, when Eric Clapton got help from religious friends to quit heroin long before he quit using alcohol and cocaine, it was a step on the road to recovery. And many recovered addicts have these stories. A number of them continue to use marijuana long after they quit drinking alcohol.

Sometimes, AA is the end of the journey, but for some it may be a stepping stone back to a healthy social network, the religion of their youth, or therapy they find more helpful. Sometimes clients tell me, “You’ve really helped me, but those AA people are all really full of shit! They all go to the meetings and get their slips signed, then head out to the bar.” OK, are you staying sober and rebuilding your life without it? Can’t argue with success. But maybe if you were not finding the positive people at AA it’s because you were not looking for them.

Sometimes when people call to schedule a driver’s license eval they want to know if they should go back to AA before the hearing. Sometimes the attorney said it would be a good idea. I tell them, first of all, that I am not their legal advisor, and if their lawyer said to do it, they should do it. Moreover, my eval is evidence, and all evidence should go through their attorney. But if they are not represented by legal counsel I tell them no.

“You tell me you’ve been sober five years. In the prognosis section of the eval we’ll have you tell your story; all the reasons you are a good bet to stay sober and not endanger others behind the wheel. Hearing officers know that if you are truly abstinent and have turned your life around, it will be better on a variety of fronts; you’ll have better relationships, do a better job at work (or have a better job), have more money in your pocket, be upgrading your skills by going back to school, have better self-esteem, better mental and physical health, and a more optimistic outlook on life.

“If you are going to tell them you are in AA, you have to know the steps and be able to discuss them knowledgably, the Serenity Prayer, some of the traditions, have a sponsor (with a phone number), and tell them where you are regarding working through the steps. You have to know who Bill and Bob are, why Akron is important, and know which drink gets you drunk. By the way, what is step five? Don’t know? You’re gone. My suggestion is, make the case for what you’ve done and are doing, not what you’re not doing. They will know if you are blowing smoke.”

It only takes two DUIs at .08 to lose your driver’s license in Michigan these days. Many who do this are abusers or early stage alcoholics. Some of them are just kids who were being wild and crazy. Some of them learn from a couple of bumps on the head. Some learn from jail. Judge James Kandrevas ran a sobriety court out of Southgate’s 28th district in MI, and I was on the team. He used to like to say that, “Jail is therapeutic.” In one way it’s therapeutic for the same reason treatment centers are therapeutic; it gets addicts off the street and away from their supply. It gives them time to think about where they want their lives to go, and interrupts their patterns. There is more than one path to the waterfall.

Dodes admits, therapy is costly and not widely available. His ad in Psychology Today, says that his fee is $300+ an hour, and therapy would presumably be more than one (therapeutic 45 min) hour a week. Even if it were only weekly however, that’s $1200 a month. So, except for the well-off, he has no real alternative to AA to suggest, not only to the poor, but to what’s left of the middle class.  (Eight months of therapy? Try getting eight sessions out of your managed care insurance carrier!) But Dodes says AA teaches people who can’t get it that “they are failures…celebrities go in and out of rehab or in and out of AA and they return to drinking. They are always condemned…Why couldn’t they stick with the program?”

What AA actually says is, “Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty.”[ii]

It should be noted that (AA co-founder) Bill Wilson had been unemployable for years when he was visited by Ebby Thatcher with the “God solution.” The first members of AA were chronic, low bottom drunks who were in Akron Hospital for serious withdrawal symptoms or medical consequences of advanced alcoholism. That is a much different population than either Dodes or I see today. They were facing imminent death from their condition and had tried everything else. Wilson knew that not every alcoholic could be saved, but only those who were convinced there was no other way would make a serious effort. Moreover, he was very open about the fact that he needed them as much as they needed him.

As far as condemnation of people who can’t get the AA program, the only place I see that kind of condemnation is in the scandal sheets at the checkout counter at the supermarket. These condemnations are covered along with which celebrity is cheating on his wife, and how an ex-president is planning to have a sex change operation, complete with ovaries so he can have his androgynous extraterrestrial lover’s baby and create a hybrid super race that will take over the world in 30 minutes because they breed so fast and already speak every known dialect of every language at birth. Who buys or reads this stuff?

I’ve never heard anyone called a failure by another recovered alcoholic because they could not get AA. What they say to those having difficulty is, “Keep coming, it gets better.” “Don’t quit before the miracle happens.” “Meeting makers make it.” But I’ve never heard of anyone getting crap at the AA tables for a relapse. I was very surprised when I first learned that you could have a slip and go back to AA; that there was no censure, no punishment, and they didn’t even have to go to confession and make an act of contrition, promising to “sin no more and to avoid the near occasion of sin,” when they suspected they might, or knew they probably would.

A client of mine remembered telling the people at his first meeting that, “I thought they had a good thing and I wanted to quit, but I couldn’t ‘take the pledge.’ They told me that was not required, just try to stay sober for one day. One day has turned into 30 years, but I didn’t really believe that was going to happen either. Other people had their slips and when I was ready, I was going to have mine. But first I wanted to finish school, then buy a car, move out of the Cass Corridor, get a decent job, get married, buy a house…Finally it dawned on me that all these things were happening because I was sober, and that if I drank again I would start going backwards.

“Sponsors are another matter. A sponsor would get into someone’s face and say,

‘Do it!’

I told my sponsor, ‘I’m not comfortable doing that yet.’

‘God didn’t save you to be comfortable; he saved you for service!’

‘What?’

‘Losers do what they want to do; winners do what they have to do.’”

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Dr. Abraham Low told his patients, “Do the thing you fear and hate to do. The only way to become more comfortable is to face, tolerate and bear discomfort.” The first sentence of Scott Peck’s popular self-help book, The Road Less Traveled says, “Life is difficult.” If you tell people life is easy—that there’s an easier softer way to get what you want—you are doing them a grave disservice. The white coach in the film Remember the Titans tries to soften the blow of the black coach’s rebuke to one of the players. The black coach (Denzel Washington) says, “You know you’re not helping them when you do that, don’t you? You’re crippling them! You’re crippling them for life!”

Not everybody needs to get AA or be in AA, but everyone’s journey is difficult, and no matter how privileged or disadvantaged one’s upbringing, they will not find satisfaction in life without doing the difficult, seemingly impossible task with which they are confronted. I remember very little from middle school, but I remember graduation, and (the principal) Mr. Zinnicus’ speech to the parents. The theme was, “Don’t take the struggle out of kids’ lives.” We do ourselves, our children, and our clients in AA a disservice if we tell them to expect life to be easy, or that “almost is good enough.”

When Lavitt questions whether Dodes plans to do some pro-bono work for people who don’t want to go to AA and would like therapy, Dodes sidesteps the issues, saying it’s too bad that there isn’t more low cost therapy available, but that low cost therapy tends not to be that good.

“If you go into a free clinic and you say that you have an addiction, nine out of ten times you will be sent to the addiction part of it that is run by an AA person and his credentials may not be any good. He may be a recovering person and believe that is a credential, but it is not. He may have some training, but the fact is that the best trained people—people with social work degrees, psychology degrees—tend not to work at these places because they pay badly. I’m not saying that’s the way the world should be, but it’s a fact.” He goes on to say it would be great if qualified people would work for low wages and the poor could have quality treatment. He once ran a low-fee gambling clinic, but apparently doesn’t do that anymore. “I am in favor of helping everybody, but I don’t believe that since psychotherapy is expensive is a reason to knock it, it just should be made more widely available.” (But apparently not by him.)

The days when being a recovered alcoholic was a credential are long gone, but apparently Dodes is not aware of that. Therapists in low cost clinics are usually Masters Level credentialed, though they may also be recovered substance abusers. Whatever kind of therapy you do, you take people where they’re at or it makes you crazy. You can’t shove AA down anyone’s throat. As far as good people in any low-paying jobs, they tend not to stay there. That is one of the reasons people tend to leave the teaching field, and why fewer people are going into mental health. The need to make enough money to buy a home in a good neighborhood, send my kid to college, and save for retirement were some of the reasons why I went from working in a substance abuse clinic to private practice, from private practice to forensic work, and why I quit taking any insurance.

The bottom line is that Dodes does not have a solution for anyone who can’t afford his fees. He is preaching to the one percent who can afford him, but the truth is that most of them will wind up in AA too, because whatever the real success rate is, it’s probably higher than anything else. In any event, he has no solution for those who can’t afford his very expensive therapy. He says that very clearly. So, while those who are angry about being forced to go to AA or AA based therapy by the court will quote Dodes’ books and statistics about why they should not have to go, he is not offering either them or the courts any alternative. If you can’t afford him, it’s not his concern.

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[i] Alcoholics Anonymous, P. 85

[ii] Alcoholics Anonymous, Chapter 5, P. 58

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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.

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