The Heart of Addiction

The following is an excerpt from a book I just finished titled, "The Heart of Addiction" by Lance Dodes, M.D.

As you know, 12-step programs have helped some people, but they also have significant limitations, many of which I have already discussed. I will first briefly review some of the limitations and problems of 12-step programs, then discuss how and why they can be helpful for those who make use of them.

To begin with, as a one-size-fits-all approach, these programs tend to be uninterested and unhelpful in understanding the individual emotional factors that determine addictive behavior. Just as serious, they tend to shame those who do not benefit from their approach. People who do not improve are regularly told that they have not "gotten it" or have not "worked the program" hard enough.

Making people feel foolish or bad if they do not benefit is consistent with AA's uncritical attitude toward itself. Unlike professional approaches, there is no effort within 12-step programs to advance their understanding of the treatment of addiction, alter their program based on its results, or suggest other treatment if theirs is not working well. Such an approach would obviously be unacceptable in any medical, psychological, or other professional treatment. It reflects the self-reinforcing nature of having a group of people all of whom believe in the same program. Without attempting to understand their successes and failures, AA and other 12-step programs are insular by nature. Put another way, these programs do not seem to recognize the nature of their "sampling bias." By attending only to their own success stories, they create an impression that everyone outside their group, if they only believed or worked hard enough, would do as well with their approach.

A corollary of this is that a number of people who have done well in AA have written or talked about it, while, needless to say, one does not see many articles from people who have not been able to benefit from AA. (You could consider this entire blog an article to that effect.) This is another kind of sampling bias, unscientifically tilting public impression toward the correctness and usefulness of AA. One particularly unfortunate result of this has been its influence on people in positions of authority to make health care decisions.

Some of the traditions and advice of 12-step programs are also harmful. For example, advice such as try to avoid being angry is particularly unwise counsel to give to someone struggling to understand and master an addiction. Likewise, myths of needing to surrender your willpower, or that you should count your days of sobriety - both tenets of AA - are also frequently unhelpful or even harmful. Surrendering your willpower suggests that because you have an addiction you should give up on your ability to manage it, and is the opposite of what is needed if you are to use your understanding to actively take control over it. Counting sober days contains the moralistic and often destructive idea of returning to zero after a slip, which inappropriately gives the message that you have failed and that you deserve this harsh punishment. As I said earlier, many people have told me of how injured they have felt by this, with its punitive character sometimes even precipitating further addictive behavior.

Indeed, there is quite a bit of unfortunate moralizing in 12-step programs. For example, in step four, you are directed to take a "fearless moral inventory" of yourself. From a positive standpoint, this may be helpful to some people who have difficulty examining themselves. But this also carries the unmistakable message that having an addiction means that you had better spend time looking at your moral failings, as if either addiction or the emotional factors contributing to it were at heart moral issues.

After my last slip, I found myself sliding into a deep depression as many of the above factors came into play for me. I once again felt like an abject failure and that my moral character must be so flawed as to render me hopeless. I was on the verge of totally giving up. Thank god I have the sense to continue to seek the answers that will fit for me. I know there are scores of people out there, who like me, continue to struggle with their addictions; who, like me, were indoctrinated that the 12-steps were the only viable option; and who, like me, know without a doubt that that program will not work for them.

I went on-line and ordered three books, two of which I have now read and one still to come. I have found "The Heart of Addiction" to be the most helpful thus far, but the other one has many good ideas which I will be discussing here in the coming weeks, along with more of Dr. Dode's understanding of addiction. He is one of the most thoughtful, compassionate, and practical writers about addiction that I have come across in a long time. A welcome advocate for us "12-step failures."

I have moved forward with seeking professional help, but it's through the state mental health department and may yet take a couple of weeks to obtain an appointment. I hope that the therapist I'm assigned will be willing to explore new treatment options with me and I have decided that if they don't, I will seek assistance elsewhere.

Sometimes it's very difficult for me to write about my experiences with AA because I have many good friends who have maintained sobriety with the 12-steps. Not only do I have no desire to alienate these people, I want and need them in my life. But it's time for me to work through all of this and I think finally time to express the whisperings of my own heart without restriction. As a matter of fact, I think that is what lies at the heart of my addiction.