Saturday, August 18, 2012

Letters, we get letters. Or, 12 steps to heaven*... not.

I received an emailed note from a gentleman named Michael, who was kind enough to give me permission to print it and respond to it on the blog...knowing, of course, that I'd do my best to defeat his logic. I publish Michael's thoughts here unedited except for typos and minor grammatical stuff:
I started to read your book, but I couldn't make it past page 20. By that point you had trashed AA and the other 12-step programs so many times and in so many ways, I couldn't go further. I've been a member of many 12-step programs for 24 years, and your ignorance of their value is stunning. I'm going to share some of what you might call psycho-babble, but you've missed the point of the program so badly, I have no choice.

Substance abuse winds up to be, finally, a problem of isolation. In many cases it's just you, alone, in a room with a bottle, a needle, or a crack pipe. The 12-step programs promote the idea that "what we cannot do alone we can do together." You discover immediately that you have hundreds of friends who actually give a damn what happens to you. All the programs function the same way, AA, CA, NA, Pills Anonymous, Smokers Anonymous (one of the biggest). Sure, it may"appear" to have a high dropout rate. But you know what, they come back, cause they know they're always welcome, without judgment, It makes you feel you're part of something bigger than yourself. It's not a religious program, it's a spiritual one. You take what you need and discard the rest. The program is a bridge back to life, and once you cross the bridge, it's not necessary to constantly re-enforce it by going to meetings forever. I haven't been to a regular meeting in 12 years. But the principles live with me every day. They offer tools to help you cope with everyday life.

So though the rest of your book may be amusing, your failure to really do thorough research on the 12-step programs, cancels any trust I have that you've done anything more than just collect a bunch of soundbites and published them.
For starters, rather than repeat myself (too much), I invite readers to review this post, which I wrote back in 2007. From here on, keep in mind that I'm not out to play GOTCHA by picking apart Michael's note, which was clearly heartfelt and well-argued. I just think that in making his points, he often ends up making my points. In my experience, this is often true of defenders of the recovery movement.

For starters, Michael writes: "The 12-step programs promote the idea that 'what we cannot do alone we can do together.' " In truth, the 12-steps (unwittingly) promote many things...and to my mind, the sense of shared impotence is at least as striking a feature of these programs as the sense of common purpose against a shared foe. Michael himself tells us that he has been involved with 12-steps for 24 years. Twenty-four years. If alcoholism is indeed the disease we now culturally recognize it to be...what disease requires a 24-year (-and counting) cure? But wait, I already know the answer to this one: You are never cured, in the ironic lingo of recovery. (Doesn't recovery presuppose, at some point...a recovery?) And that may be the problem in a nutshell. If you persuade people that they're hopeless, that there's no way out (except entrusting yourself to some nebulous higher power and the attaboys of like-minded friends), you create precisely the sort of helplessness I had in mind when I penned SHAM's subtitle. This is all the more true in a group setting. (Why do you think every poor-man's Tony Robbins dreams wetly of the day when he can lure a few hundred people to some hotel ballroom? In mass psychology there is strength: not your strength, but the guru's!)

And so I would say to Michael, if my ignorance of these programs' value is stunning, then perhaps his ignorance of their dangers is sad.

Rather than just continue to be snarky, I will focus on Michael's other main allegation: that I haven't done my research on 12-steps. Oh yes I have. And in this case, research does not consist of simply talking to people who relapse and keep coming back for more (which would not truly be research—it would be opinion polling—and which, in itself, again, makes one question the value of the therapy). Research consists of analyzing the cure rates put out by AA and looking at objective studies of the genre. Had Michael made it past page 20—to, say, Chapter 8, "You are All Diseased," he would have encountered a fairly thorough review of the literature on addiction and recovery. And there have been even more startling physiology-based findings about the true nature of addiction since SHAM was published. In time, such findings almost always yield new interventions. (This is a pretty good overview of addiction and the various therapeutic least in the UK. But I suppose their addicts are pretty much like our own.)

Michael would have found that AA has not even come close to meeting its burden of proof in terms of documenting its efficacy; he would have found a consistent pattern of obstructionism and deceit on AA's part. But why should that surprise anyone? After all, the "philosophical core" of AA, and the rest of the 12-step universe, was pulled out of thin air by a couple of guys who had about as much business reinventing the world's approach to addiction as I have conceiving a new approach to neuroscience. (But wait, why shouldn't I conceive a new approach to neuoscience? I had a stroke. Doesn't that qualify me as an expert on neuroscience? ... Then why take advice on alcoholism from drinkers?)

And then we have the point I sought to make in my still-born letter to Harper's, which I blogged about here. This goes back to the impact that 12-step programs tend to have on a disciple's self-image. The addictions/disabilities, or imagined addictions/disabilities, propagate: You start out an alcoholic, then you're a codependent, then pne day you're a card-carrying member of underearner's anonymous. Are all of these things legitimate flaws that require treatment? Or do suggestible people who may, may have one basic maladjustment become psychological hypochondriacs, conceiving themselves hapless victims of each new syndrome that comes into vogue, by being chronically exposed to that kind of thinking? I'm just askin'.


Last but not least, although Narconon is not a 12-step, I think it's well worth looking into NBC's  investigation of the Scientologist-run program. It suggests that apart from being ineffective, Recovery-land is also rife with abuse. 


UPDATE, Saturday afternoon, August 18: I promised to give Michael the final word(s) on the subject, and he has chosen to exercise that privilege as follows:
Thank you for posting my letter.
I'm not going to play shot for shot with you, it's meaningless. You just don't get "it." And I'm not talking about Erhard's Seminar Training.

It may just be as simple an issue as that maybe you're not a substance abuse addict who's had to go in search of answers and solutions for himself.
I gotta tell ya, you're really cynical. I watched that Rock Center piece last Thurs, on Narconon: $30,000 to be hustled by Scientology. And you can't come back unless you pay another $30,000. Twelve-step programs you can keep coming back. That's the principle of the whole program. I've been to rehab: 30 days, $2500.00. Good launching pad. Works for some, fails for others. Twelve-step program costs a dollar donation. And any rehab worth a dime follows the format of the 12-step programs, and encourages meeting when you leave the rehab.
My final word about them is that they give you tools to function in recovery, that will last for the rest of your life. I know because I meet many people that don't have those tools and are so lost in their day to day functions.

* I'll use any excuse to make an allusion to a Miles Davis classic. Non-jazzophiles, take a listen; you might like.


Dimension Skipper said...

I won't comment on the AA-ish stuff much because I really can't, not having any personal experience of such since I do not drink alcoholic beverages (or do illegal drugs, etc), never have (unless you count the very occasional ceremonial sips of champagne or wine and the like).

All I can say is that I know a few people who do go to AA and swear by it. It seems to work for them, so that's a good thing for them personally, regardless of whether or not the foundations of the program are sound and based in any sort of valid science or psychology.

I certainly understand the concept of folks with similar issues congregating to support one another, bolster their confidence and willpower, commiserate over setbacks, whatever. It's a protective group mentality whereby non-members just simply cannot understand and very often say and do the worst things possible in their misguided ways of "helping." There are many things in life where the best ones to talk to or seek advice from are those who have truly been there, done that. So in that sense, I would at least rank AA-ish groups higher on the non-SHAM spectrum than many of the for-profit new wage "self-made" gurus dispensing obvious platitudes and seeming "cleverisms."

So anyway... since you brought up neuroscience and emerging addiction concepts or treatments, here's a very recent news item at

Heroin Addiction Blocked Via Immune System

. . .

The team focused its research efforts on the immune receptor known as Toll-Like receptor 4 (TLR4). “Opioid drugs such as morphine and heroin bind to TLR4 in a similar way to the normal immune response to bacteria,” he explained.

“The problem is that TLR4 then acts as an amplifier for addiction.”

“The drug (+)-naloxone automatically shuts down the addiction,” he continued. “It shuts down the need to take opioids, it cuts out behaviors associated with addiction, and the neurochemistry in the brain changes. Dopamine, which is the chemical important for providing that sense of ‘reward’ from the drug, is no longer produced.”

The new research “fundamentally changes what we understand about opioids, reward and addiction,” added Dr. Linda Watkins, a professor in the Center for Neuroscience at UC Boulder. “We’ve suspected for some years that TLR4 may be the key to blocking opioid addiction, but now we have the proof.”

The drug used to block addiction, (+)-naloxone, is a non-opioid mirror image drug that was created by biochemist Dr. Kenner Rice in the 1970s, she explained.

“We believe this will prove extremely useful as a co-formulated drug with morphine, so that patients who require relief for severe pain will not become addicted but still receive pain relief,” she said.

. . .

I admit to some skepticism, though, only because of the paragraph I highlighted in bold...

If the drug was developed in the 70s, why is it only now being investigated for this useful application? The article does not explain and I admit I did not try to search the web for any further details.

Steve Salerno said...

The fact that people swear by something does not necessarily mean that "it works." But I am happy for anyone who successfully manages a substance addiction via any method.

Interesting stuff, DimSkip. Thanks.

a/good/lysstener said...

This is one area where I definitely have a bone to pick with you. If something helps people battling serious problems, as clearly was the case with Michael and many others, why be so down on it? It's like you're just waiting to pounce.

Anonymous said...

Salerno, you are a hard-hearted SOB, you know that?

RevRon's Rants said...

For beginners, let me acknowledge that I am an ex-addict. I realize that this goes against the grain of the 12-step model, but I neither partake of nor am tempted by drugs any longer. I didn't beat my addiction with the help of a program; I honestly thought I was dying, and sequestered myself at a friend's farm to do just that. After a couple of horrific weeks, I realized that I wasn't dying, but drying out. And I haven't visited Mr. Jones since.

But that is what worked for me. Others swear by 12-step programs, and I figure if it worked for them, great. The one phenomenon I've noticed that I found particularly significant is that those who seem healthiest are those who used the program to get past a critical point, then moved beyond it. I was once in a relationship with a self-proclaimed alcoholic repeated the 12 steps a couple of times every year, and who believed that without doing so, she would relapse. On the other hand, I've spent the better part of the last 20 years with a woman who went through the program, quit drinking, and then moved on. Want to guess which one is a happier person, and more pleasant to be around?

Bottom line is that each of us uses the tools that we find most effective, whether the tool be to surround yourself with supportive people, or to crawl into a hole and wait for the punch line to one of life's little jokes. But as you state, Steve, recovery that must be sustained for many years isn't really recovery; In my perspective, it's actually the transference of addiction from one thing to another, no more a "cure" than is replacing a heroin habit with methadone treatment.

I make no claim to be any kind of model, and have no doubt that I'll be struggling with my own demons as long as I live. But I'd hate to think how unsatisfying my life would be, were addiction to drugs or recovery among those demons. The overarching objective, as I see it, is to use whatever tools work for you, but to remain vigilant to the very real possibility that the tools can become a disease in their own right.

Anonymous said...

Michael seems to be one of the nicest, RATIONAL whack jobs I've ever met.

Three cheers for an absolutely classic example of oppositional logic and courtesy.

Other than that, I'm afraid I consider your stuff to be informative (and probably correct), but Michael wins the exchange on the basic principal "If it works, who cares why".

Steve Salerno said...

Anon: If it works, who cares why? Can you not see many personal and social settings where that logic is not only questionable, but downright dangerous?

amen said...

But logically also, the previous anon has specifically applied his accolade to Michael, not 'many personal and social settings.'

You are moving the parameters of the argument just to win a scammy, non relevant point--shame on you.

Steve Salerno said...

All right, I am duly...shamed. SHAMMed?

RevRon's Rants said...

Well, Steve, now you know what it was like for me, growing up in a house with chihuahuas constantly yapping and nipping at your heels. :-)

Jenny said...

Don't let the shamers get you down! I found this posting very thought-provoking and relevant to my own life situation. I worked in a rehab facility that operated on the principles of the 12-step model and have had the same lingering doubts about it all along. The main goal of the treatment is to learn more appropriate (less harmful) coping skills. That's it. Coping skills. Learn those, and you've got the gist of it. Next patient, please. It's useful information, but it's also common sense that is readily available outside of the rehab facility.

Anonymous said...