Critiquing Success: The Irony of 12 Step Attacks
At CORE, we stand by Bill Wilson’s belief that our foremost responsibility is to provide newcomers with a thorough presentation of the 12 Step program. This mission lies at the very heart of our work.
CORE’s purpose is to guide individuals toward lasting freedom from the chains of substance abuse. We do more than offer a support group or temporary refuge; we lead clients on a comprehensive and transformative journey that has been tried and proven for more than eight decades. The 12 Step program, recognized as the gold standard in recovery, continues to be the most effective evidence-based method for achieving long-term sobriety. Its success is not only reflected in countless individual stories but also substantiated by consensus scientific research.
Our commitment extends beyond guiding clients through their recovery journeys. We also feel a deep responsibility to stay informed about the latest literature on addiction and recovery, especially perspectives and critiques of the 12 Steps. These viewpoints have the potential to influence the recovery paths of our clients.
Many potential clients approach CORE burdened by more than just addiction. They often carry a complex history of previous treatment experiences—having cycled through multiple rehabs, hospitals, and sessions with physicians and counselors. Along the way, they’ve gathered various pieces of information—some helpful, some benign, and others potentially harmful—that shape their beliefs and attitudes toward recovery.
In this article, we aim to address two particularly misleading and harmful claims about the 12 Steps: that they are “not evidence-based” and that they have been shown to be ineffective in helping anyone recover. Such misinformation can be deadly if it steers people away from the most effective recovery program available.
What could motivate someone to make such claims? More often than not, it’s to promote and sell an alternative approach to recovery. Substance abuse treatment has become big business in America, with the federal government alone spending over $44 billion last year on prevention and treatment programs. Desperate people are willing to spend money, lots of money, and there is a large industry out there responding to that demand. Steering persons in need away from the 12 Steps has become a common business practice.
Take, for example, the “harm reduction” people who assure addicts that they can smoke marijuana daily and still be exemplary parents, or even maintain a heroin addiction while being loving and responsible spouses. For addicts who find life without drugs intolerable, such overtures appear to be an attractive, easier and softer alternative to working the 12 Step program, which leads to abstinence. Telling potential customers that the 12 Steps are scientifically suspect, or not evidence-based, becomes part of the sales pitch.
Egregiously, such criticism also comes from credentialed persons who should know better. One example is Harvard professor Lance Dodes. Dodes published a book, The Sober Truth: Debunking the Bad Science Behind 12 Step Programs, specifically intending to challenge and discredit the 12 Steps. We use his work as an example precisely because it illustrates irresponsible and misleading claims.
At the outset, Dodes claims that the 12 Steps have been in use for decades “despite the absence of any scientific evidence of the approach’s efficacy, and we have been on the wrong path ever since.” These are bold claims, and Dodes makes the mistake of relying on Cochrane Systematic Reviews as the lynchpin for his entire argument.
Such reliance inadvertently highlights the dangers of making unfounded claims. The irony is striking, since he plays his reliance on Cochrane to full effect, telling the reader “Yet one group exists solely to sort through the glut of studies and help caregivers tune out poorly designed or reported research.” That one group is Cochrane, whose mission “is quite simply to focus only on studies with proper protocols and minimal bias and to assemble the strongest data.” Cochrane’s goal, he says, “is to vet all the science out there and tell us what can actually be verified.”
After making this dramatic introduction, Dodes then cites a Cochrane study. Yet, after his book’s publication, Cochrane released a definitive study finding the exact opposite of Dodes’ main premise. Cochrane found that programs designed to increase AA participation “lead to higher rates of continuous abstinence over months and years, when compared to other active treatment approaches such as cognitive behavioral therapy”!
Cochrane’s findings completely undermine Dodes’ central argument, discrediting his book from the very beginning. We think his failure to anticipate the subsequent, definitive study calls into question his motives—was he genuinely interested in contributing to the recovery discussion, or was he simply trying to discredit a program that has helped millions, simply to promote his own?
As the book progresses, Dodes also failed to recognize Cochrane’s critique of its prior review, which pointed out a lack of “quantity and quality” in earlier studies. One wonders how Dodes could have missed that. The omission is so significant that it casts doubt on Dodes’ entire endeavor.
By his own admission, Dodes is bound to the standards of rigorous scientific inquiry. However, in light of the undisputable evidence supporting the effectiveness of the 12 Steps, his criticisms are not just misleading—they’re disingenuous. Ignoring the substantial body of research that affirms the 12 Steps as a proven and effective path to recovery turns out to be a grave injustice to those seeking help.
In light of the foregoing, CORE reaffirms its commitment to providing our clients with the most effective, evidence-based therapy available. The 12 Steps, far from being outdated or unsupported by science, remain the gold standard in recovery, with the imprimatur of Cochrane Systematic Reviews affirming their superiority over other treatments.
Although we specifically criticize Dodes’ book here, others certainly make these same specious claims about the 12 Steps, and all of them are doing a grave disservice to those evaluating treatment options. At CORE, clients who want evidence-based therapy can rest assured that the 12 Steps offer not just evidence-based support but the best and most comprehensive recovery approach available today. Our clients deserve nothing less.