Al Anon Quotes

“One bedrock tenet of the Oxford Group, however, would influence AA for years to come: an absolute opposition to medical or psychological explanations for human failings and thus a complete prohibition on professional treatment of any kind.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“[They] also developed some theories of their own, including the notion that alcoholics were “in a state of insanity rather than a state of sin.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“When Bill Wilson sat down to write Alcoholics Anonymous, he first prayed for guidance. The Twelve Steps themselves reportedly came to him in a single inspiration. (He identified the number twelve with the Twelve Apostles, and felt that this was a fitting number.)”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“So devoted were AA’s early members to burnishing the reputation of their fledgling organization, in fact, that when when one member, Morgan R., secured an interview on a widely popular radio show, members kept him locked in a hotel room “for several days under 24 hour watch” out of fear that he would drink before the show. When the interview went off successfully, another early backer, Hank P., mailed twenty thousand postcards to doctors, urging them to purchase Alcoholics Anonymous.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Silkworth, a supporter of AA from its inception, was quoted [as saying], "We all know that the alcoholic has an urge to share his troubles. . . . But the psychoanalyst, being of human clay, is not often a big enough man for that job. The patient simply cannot generate enough confidence in him. But the patient can have enough confidence in God—once he has gone through the mystical experience of recognizing God. And upon that principle the Alcoholic Foundation rests. The medical profession, in general, accepts the principle as sound.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“[Jack Alexander] underscor[ed] what remains a widely held belief among many AA members: that only an alcoholic can help another alcoholic: “A bridge of confidence is thereby erected, spanning a gap, which has baffled the physician, the minister, the priest, or the hapless relatives. . . . Only an alcoholic can squat on another alcoholic’s chest for hours with the proper combination of discipline and sympathy.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“When the Big Book was first published in 1939, the American Medical Association, bewildered by its tone and inflated claims, called the work “a curious combination of organizing propaganda and religious exhortation. . . . [T]he one valid thing in the book is the recognition of the seriousness of addiction to alcohol. Other than this, the book has no scientific merit or interest.” The Journal of Nervous and Mental Diseases went even further in 1940, calling AA a “regressive mass psychological method” and a “religious fervor,” writing: “The big, big book, i.e. big in words, is a rambling sort of camp-meeting confession of experiences, told in the form of biographies of various alcoholics who had been to a certain institution and have provisionally recovered, chiefly under the influence of the ‘big brothers of the spirit.’ Of the inner meaning of alcoholism there is hardly a word. It is all surface material.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Throughout AA’s history, its members have often embraced any literature that references disease, whether degenerative, genetic, or biochemical. AA favors the term disease because it fits with the description of alcoholism as a disease in its own literature. It also supports the foundational notion that an addict’s behavior is uncontrollable (“We admitted we were powerless over alcohol”). Ultimately the mechanism of the disease (and whether it is strictly logical to embrace it, given AA’s own views) has been less important than the word itself.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Harry Tiebout, [Bill] Wilson’s personal therapist [assured] the collected members that AA was “not just a miracle but a way of life which is filled with eternal value.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“It wasn’t long before the court systems began to mandate AA attendance for drug and alcohol offenders. AA won a landmark decision in 1966 when two decisions from a federal appeals court upheld the disease concept of alcoholism and the court’s use of it, despite the fact that there was scant precedent for a US court of law to assign itself the power of medical diagnosis. Although later decisions would rule court-mandated 12-step attendance unconstitutional, judges still refer people to AA as part of sentencing or as a condition of probation. Dr. Arthur Horvath, a past president of the Division on Addictions of the American Psychological Association, summarizes the current legal status of this practice: "If you have been convicted of an offense related to addiction, it is common to be ordered to attend support groups, treatment, or both. It has also been common that you would be ordered, not just to a support group, but to Alcoholics Anonymous (AA) specifically, or to another 12-step based group. Based on recent court decisions, if you have been ordered to attend a 12-step group or 12-step based treatment by the government (the order could be coming from a court, prison officer, probation or parole officer, licensing board or licensing board diversion program, or anyone authorized to act on behalf of the government), you have the right not to attend them. However, you can still be required to attend some form of support group, and some type of treatment. These court decisions are based on the finding that AA is religious enough that being required to attend it would be similar to requiring someone to attend church. Five US Circuit Courts of Appeal (the 2nd, 3rd, 7th, 8th, and 9th) have made similar rulings. . . . The 2nd Circuit Court decision states that AA “placed a heavy emphasis on spirituality and prayer, in both conception and in practice,” that participants were told to “pray to God,” and that meetings began and adjourned with “group prayer.” The court therefore had “no doubt” that AA meetings were “intensely religious events.” Although some have suggested that AA is spiritual but not religious, the court found AA to be religious.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“A recent paper looking at state-sponsored physician health groups (for doctors who have problems with addiction) found that “[r]egardless of setting or duration, essentially all treatment provided to these physicians (95%) was 12-step oriented.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Examining this history, it is clear that AA has been extraordinarily effective at influencing public opinion and policy toward a favorable view of its ideas. What is missing from this account is notable as well: these strides were achieved without any triggering event, such as a well-designed study, that might support the organization’s claims of efficacy. Most of AA’s claims were simply grandfathered in, collecting legitimacy in a sort of echo chamber of reciprocal mentions that often featured the same handful of names.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Human research tends to cleave into two major “kingdoms”: observational studies and controlled studies. Observational studies observe and compare groups of people. This research is conducted passively; in other words, without interventions or controls. Any significant differences that emerge between the populations studied—say, finding that people who drink more diet soda tend to have a higher incidence of depression than people who don’t—can’t prove anything but may be used to generate hypotheses about what is causing this difference. Yet people still assume the obvious when confronted with a correlation of this sort. In the diet soda study, which was actually run by the National Institute of Health and widely reported, many people jumped to the conclusion that depression must be caused by something in the soda. But a moment of creative consideration turns up several other plausible possibilities. What if the people who drink diet soda are simply more judgmental about their body appearance and generally more prone to self-criticism? What if, since drinking more diet soda correlates with a history of being overweight, the depression arises physiologically from the effects of obesity, or as a result of the cluster of health problems that go along with it, such as obstructive sleep apnea and diabetes? What if people who are depressed simply crave sweet things, as evidence suggests? And what of the fact that diet soda drinkers tend to cluster more in urban areas: is there something about this environment that promotes depression? Strong correlation is tantalizing, a just-so homily that satisfies our need for simple explanations. It feels definitive and self-apparent, especially given the huge number of subjects typically involved in such studies. The NIH study that produced the diet soda finding, for instance, had 260,000 subjects. Headlines are driven and public health advice administered whenever a major observational study unearths a provocative new correlation. But it turns out that the record of observational studies like these for generating accurate medical advice is, in a word, abysmal.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Why do purely observational studies fail so often despite finding such clear associations? The diet soda example tells the tale. All of those alternative theories I mentioned can be boiled down to a single, devastating possibility: what if diet soda drinkers are just fundamentally different from regular soda drinkers, in any of the ways I mentioned, and this difference colors everything about the way they live and behave? Scientists call this the selection effect, or selection bias. When human beings are free to behave as they always have—free to willfully choose their behavior—there is no meaningful way to find a control group of comparable subjects.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“A growing body of evidence strongly suggests that people who do things faithfully and regularly for their own well-being, such as taking a multivitamin, exercising daily, or eating a certain diet, are, in fact, fundamentally different from people who don’t. People who adhere to, or comply with, medical advice are more likely to take care of themselves in numerous other ways as well: "Quite simply, people who comply with their doctors’ orders when given a prescription are different and healthier than people who don’t. This difference may be ultimately unquantifiable.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“The compliance effect can lead researchers and reporters who study interventions to falsely credit a pill or diet with improving our health—“Look, people who take fish oil pills live longer than the rest of us!”—when the truth may be far more subtle: the kind of people who take supplements in a disciplined way are already healthier to begin with, with a better prognosis for every disease.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“The compliance effect has led to some famously strange epidemiological results. One long-term study showed that people who took a placebo were half as likely to die as those who did not. Was the placebo protecting them in some way the researchers had failed to anticipate? Hardly. It turned out that simply taking the placebo regularly was a signpost for a wholly different lifestyle. The pill takers were simply more actively engaged in their health across the board.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“A poor understanding of these issues—the need for randomization, the difference between correlation and causation, and the power of the compliance effect—has colored much of the research that has been conducted to date about the effectiveness of 12-step membership and attendance.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Deborah Dawson of the National Institute on Alcohol Abuse and Alcoholism, Division of Biometry and Epidemiology, once lamented the lack of credible data in the study of addiction treatment: “Few, if any, studies have assessed the impact of different types of treatment on both the probability and rapidity of recovery, i.e. on person-years of dependence averted.”5 Her principal complaint: the lack of controls in most AA studies.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Analyzing the available data about AA requires that we begin with a clear definition of success. Success, after all, can mean any number of things. Should one measure it in days of sobriety? Weeks without a binge episode? What if people who are making substantive progress slip and have one drink during an otherwise successful period of time: Should they “go back to zero,” as is the practice in many AA chapters? What if they stop drinking but acquire a gambling problem instead?”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Disease is usually a binary system: either you’ve got it or you don’t. Pneumonia: got it or you don’t. HIV: got it or you don’t. Multiple sclerosis, polio, emphysema—all of these are yes-or-no propositions. But alcoholism is not, in fact, a disease: it is a behavior, or perhaps a collection of behaviors. And because nobody can say for sure whether a behavior has ever been eliminated for good without a crystal ball, we must first establish a baseline definition of what success looks like in the treatment of addiction. I’ll propose this simple definition: A treatment for alcoholism may be called successful if an individual no longer drinks in a way that is harmful in his or her life.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“A review of all such reports between 1976 and 1989 was performed by C. D. Emrick (of the School of Medicine of the University of Colorado) and colleagues. The researchers concluded: "The effectiveness of AA as compared to other treatments for “alcoholism” has yet to be demonstrated. Reliable guidelines have not been established for predicting who among AA members will be successful. . . . Caution was raised against rigidly referring every alcohol-troubled person to AA.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“In a paper published in the New England Journal of Medicine, the oldest continuously published medical journal in the world and widely considered the world’s most prestigious, D. C. Walsh and his co-researchers “randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at AA meetings, and a choice of options. The findings were notable: On seven measures of drinking and drug use . . . we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often . . . by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). These results led the researchers to issue a warning in their final recommendations: “An initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“In 2006, the Cochrane Collaboration undertook a characteristically careful and detailed look at studies of AA and 12-step recovery. First, the researchers recapped what had been determined to date: "[A] meta-analysis [historic analysis of previous studies] by Kownacki (1999) identified severe selection bias in the available studies, with the randomised studies yielding worse results [for AA] than non-randomised studies. This meta-analysis is weakened by the heterogeneity of patients and interventions that are pooled together. Emrick 1989 performed a narrative review of studies about characteristics of alcohol-dependent individuals who affiliate with AA and concluded that the effectiveness of AA as compared to other treatments for alcoholism was not clear and therefore needed to be demonstrated." The Collaboration then identified eight high-quality, controlled, randomized studies, with 3,417 subjects in all. Their conclusion was unambiguous: “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“What troubles many good scientists about research like the Fiorentine paper is that studying the people who choose to attend AA is an almost perfect recipe for generating the compliance effect error. AA members who frequently attend meetings may be demonstrating the same sort of self-care qualities that the placebo takers do. They may be, in effect, the Boy Scouts, or “eager patients,” of the addict population. Nobody who has looked at this data would dispute that people who attend AA most often and stay the longest are more likely to improve than the dropouts. The question is whether AA is driving this outcome or benefiting from a correlation instead. Is it possible that the kind of people who stay in 12-step programs are already more likely to improve? Would they be equally likely to do so in any treatment, or even no treatment at all? At heart, the dilemma facing AA research is whether people stay in AA because they’re the type of people who will stick with a program no matter what it is and who would have stuck with it even if it were of no help to them at all.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Visit a therapist and AA together, the data suggests, and you are likely to do better than you would with therapy alone. But visit a therapist for one year and then try AA, and you won’t do any better than if you had just stayed in therapy.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Unsurprisingly, they found that the people who stuck with either treatment—AA or professional treatment—did significantly better than those who did not. These were the compliers.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“People who stayed in AA for fewer than six months had worse outcomes than people who never entered AA at all. This finding seems to mirror the Brandsma data: AA attendees seem to get worse before they get better. One theory is that the finding is nothing but noise—the standard statistical turbulence that can foul any short-term study. But if the data are real and repeatable, then they suggest something the Moos researchers perhaps did not consider: that AA might do more harm than good for the people who choose to attend but do not buy into the program.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“Why do large observational studies such as that of Fiorentine and Moos seem to suggest that AA is effective, while smaller controlled studies like those of the Brandsma, Walsh, and others included in the Cochrane Review do not? The likely explanation is simple: people stay in AA if they’re getting better and leave if they aren’t. This is understandable. If you are able to stop drinking, then continuing to attend AA is a comfortable and affirming choice. If you struggle with drinking and can’t make use of the AA approach, then you are less likely to keep attending. Over the long term, the people who remain in AA are, by definition, the success stories. But they represent a very small slice of the people who start there; as we will see shortly, the dropout rate from AA is extremely high. These facts—that AA works for the diehards and fails for the dropouts—are perennially misunderstood by the press and even by some researchers. Proponents of the program proudly point to the fact that people who stay in AA tend to be sober, ignoring the tautological nature of this claim. Reviewing this logic, Harvard biostatistics professor Richard Gelber said, “The main problem is the self-fulfilling prophesy: the longer people stick with AA the better they are, hence AA must be working. It is like saying the longer you live, the older you will be when you die.” As we will soon see, this fundamental error in logic undergirds nearly every claim of AA’s efficacy.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

“In 2008, J. McKellar (writing as lead author, with Ilgen, Moos, and Moos as coauthors) concluded that “clinicians should focus on keeping patients engaged in AA.” This recommendation is even more dogmatic than Moos and Moos suggested in their original paper. In fact, this paper itself notes that pressuring people to attend AA is usually unhelpful: “a significant number of substance abuse patients never attend self-help groups after discharge,” that is, when no longer mandated to attend.”
― Lance Dodes, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry