Response to Wilenbring Article on Addiction by Lance Dodes


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(Lance Dodes’s photo by  Zachary Dodes from the NPR website)

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2 Comments on “Response to Wilenbring Article on Addiction by Lance Dodes”

  1. Joe Schap Says:

    Wow, more AA bashing. This piece is a little less crazy than the first one, but still follows in it’s footsteps in calling AA “ineffective.” First of all before anyone can sit in judgement of AA, let them offer their treatment program FOR FREE. AA is a group of recovered persons who help others get sober at no charge. Maybe if they charged the exorbitant fees that most treatment programs charge, they would have the means to do battle in the academic marketplace. But they don’t. And not only that, they do not participate in outcome research due to anonymity issues. So I’m always sceptical of supposed research of AA effectiveness. Second, AA is not responsible for anyone being “sent to AA.” I believe most members of AA don’t have high hopes for people court or otherwise ordered to attend. AA is for people ready to get sober and unable to stop drinking. The “Big Book,” AA’s guide, suggests that members realizing they are dealing with someone who hasn’t made a decision to get sober leave that person alone so as not to damage a later opportunity. For people who are not sure about getting sober, that’s your work therapists. AA picks up with the skills to help someone stay sober. Getting a person to that point was never a part of AA. Finally, I think people should be familiar with a program before disparaging it. Dr. Dodes makes the brilliant observation that “addiction is just a symptom.” This sounds a lot like “liquor is but a symptom” that appears in the “Big Book” in 1939. Most of the observations in both of these articles have been common knowledge in AA for years. Maybe it would be helpful to look to AA for insight rather than just assuming that it is old and worthless. I’m especially surprised to hear that in this context. People have offered many of the same criticisms of analysis.

  2. Tamar Schwartz Says:

    Comment from Lance Dodes:

    Letter to the Journal:

    There are several serious factual and logical errors in Dr. Schap’s comment. He values AA because it is free, without appreciating that a free program which causes great harm is does not deserve to be valued. AA has been repeatedly shown to have only a 5-8% success rate (no matter how that term is defined), but the real problem, overlooked entirely by Dr. Schap, is that the 90% of people who attend AA are actually harmed. Anyone who has even passing familiarity with the world of people suffering with addiction knows of the thousands of cases of people who have lost years and decades of their lives following AA’s insane advice to “work the program harder” and “go to more meetings” when their program isn’t helping. No professional organization (and no health organization with a sense of public responsibility) would ever tell people who cannot be helped to come more and more. Beyond this, the message of these self-serving messages is obviously to blame the individual; it is their problem that they are not “working” hard enough. Free or not, a program that blames members for its failure to be useful while insisting they stay in it is an affront to ethical and public health standards.

    A second problem is Dr. Schap’s labeling criticism of AA as “bashing” and claiming no data about AA can possibly be reliable. He needs to review the extensive literature on the subject. In our book (“The Sober Truth”) we did exactly that, and while much of the literature in this field is deeply flawed by its pro-AA bias, we were able to statistically determine the success rates I’ve cited on the basis of decades of this data.

    A third problem is that Dr. Schap, incredibly for a psychoanalyst, writes that “AA picks up with the skills to help someone stay sober.” One would hope that he understands that addiction is a psychological symptom, like other psychologically-based compulsive behaviors, for which skills taught in a quasi-religious group like AA are unlikely to be sensible or useful (as the data has showed).

    Finally, for a psychoanalyst to cite AA’s “Big Book” as a legitimate reference to understand anything about addiction is deeply dismaying. The Big Book and its backbone of steps, beliefs and claims are derived from the early 20th century fundamentalist belief system called The Oxford Group, to which its author Bill Wilson belonged. It has no scientific or veridical value.

    One wonders why criticism of AA provokes such fulminating responses as that from Dr. Schap. Certainly, one factor is that those who have been helped by attachment to AA, or whose careers depend on a belief in AA, are understandably defensive of it. But we must hope that professionals with psychological training will be able to respectfully acknowledge evidence that demonstrates the problems in their position.

    Lance Dodes, M.D.

    Lance Dodes, M.D.

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