Dear Lindsay Lohan (Failure to Beat Addiction is Not Your Fault)

I’ve wanted to write a letter to Lindsay Lohan for a while now.

Her failed attempts with rehab point to a failed approach in our treatments and institutions to help the addict recover. I wish Lindsay could have found her way to the office of a qualified therapist (and maybe now she has). That we continue to blame and shame the addict (and publicly in her case) is wrong. Yes, I advocate that we take a 100% responsibility for our experiences. This can, and often does mean, recognizing when the environment or people who are claiming to help you cause you harm. And with this personal awareness of where the fault in a failed treatment lies, change your approach, find better help, move on.

Lindsay, there is help for you. I am not saying it is with any particular approach, or person. But there is help out there. To all the Lindsay Lohans out there: if you have tried AA or similar approaches, and failed, don’t take the “failure” as yours. You are in the majority. AA is a “one size fits all” recovery program that only helps a small minority. In fact, it fits very few. Sadly, most rehab programs are based on, or borrow from, the AA model.

There’s no question that 12-step programs have saved people’s lives. But sending everyone with an addiction to AA or its cousins is simply bad treatment that does harm to the 90% who cannot make use of such programs, and are led to believe they are the ones who are failures, because the program is never wrong. It is time to change the national discussion about what is appropriate treatment for addiction, and I hope this book will provide a starting place. – Lance M. Dodes, MD, The Sober Truth

Back in 1982, for both my Master’s research and personal investigation, I went in search of self-help groups for families with a mentally ill loved one. (I have a brother with chronic schizophrenia.) I attended groups specifically for families of the mentally ill as well as other formats, many which used the 12-step model. I also interviewed hundreds of siblings and adult children of those with mental illness. I didn’t find one group that wasn’t either dysfunctional or downright dangerous to the seeker. There was nothing out there for siblings or adult children of the mentally ill in particular. My investigations led me to study and develop healthy group dynamics and to write my first book, Hidden Victims: Hidden Healers: An Eight Stage Healing Process for Friends & Family of the Mentally Ill (Doubleday, 1989).

There is a remarkable curative power to meeting in groups with others who share some common intention of recovery or well-being. Just so, a program can only be useful when it allows for individual and personal ways to explore the addiction (or issue). I have had several clients come to me devastated and on the brink of total hopelessness as a result of attending a program such as the 12 steps. The program having not worked for them, they were blamed by the facilitators for their lack of commitment to recovery. Any group or program that insists on agreed-upon rules and dogma is going to have a huge failure rate. But it is the program failing the individual.

I describe the stunning facts about the current national treatment approach for addiction. AA has a success rate between 5% and 10%. An exhaustive scientific review by the prestigious Cochrane Collection, of all AA studies over 40 years, found even worse results, concluding that, “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism. – Lance M. Dodes, MD, The Sober Truth: Debunking the Bad Science Behind the 12-Step Programs and the Rehab Industry

Here is a synopsis of each chapter in Dodes’s book just quoted, one I recommend for all the “failed” addicts out there (as well as any therapist working with addicts):

CH 1: The Problem – Despite its low success rate, AA’s methods and assumptions have been systematized into our medical diagnosis and treatment systems as well as our legal system. Dodes goes over each of AA’s 12 steps and explains why none of them has any relevance in treating addictions.

“But is there anything that works?” is a question often asked. Dodes responds, “Yes, there is.”

CH 2: The Rise of AA – AA may not be the best way to treat alcoholism, but its founders had a marketing genius and (albeit accidental) method within their midst: Bill Wilson.

CH 3: Does AA work? – In Dode’s words: “Most studies … are observational in nature, with few controlled studies that might help us determine the results … an objective calculation puts AA’s success rate at 5-8%. Those controlled, randomized studies that HAVE been done reveal an even more discouraging picture: no proof that AA is effective at all.”

CH 4: The Business of Rehab – As one addiction researcher put it, “Anybody can make any claim they want and get away with it. It’s essentially an unregulated industry.”

And those therapists who spent their college careers within such a model make a lot of false claims.

CH 5: So What does Work to Treat Addiction? – Dodes points to how addictions are in reality compulsions that involve alcohol or/and drugs. He recommends psychotherapy to bring about insight into the underlying triggers and then seeking guidance to help redirect one’s choices once a compulsion to drink or take drugs is triggered.

CH 6: What the Addicts Say – The author asked readers of his blog to submit first-hand accounts, both positive and negative, of their experiences with 12-step programs. Non-edited, there are 10 testimonials of people who responded to a query he posted on his blog.

CH 7: Why Does AA Work When It Does? – The restorative influence of group dynamics. (But even this is only for the few and not the many.)

CH 8: The Myths of Addiction – He challenges 11 slogans used in AA, starting with “You have to hit bottom before you can get well,” and why they’re not valid or helpful. I heard him speak on public radio and found his challenges to these slogans insightful and humorous.

CH 9: The Failure of Addiction Research and Designing the Perfect Study – Dodes describes the difficulties in getting valid studies published in the U.S. He says if he doesn’t give proper credence to the 12 steps, his papers are rejected. He published his latest article in England.

On his radio interview he didn’t encourage his approach in particular. He advocated for the addict to search for alternatives to the 12 steps and for therapists to offer a variety of techniques when working with the addict.

Lance Dodes and Zachary Dodes have the guts to take on clearly, perceptively, and with solid scientific grounding the nude king of American addiction treatment: AA and the 12 steps. Not only do these shibboleths yield no benefit for the mass of alcoholics and addicts in America, they leave cold—even harm—far more people than they help. Read this book! — Stanton Peele, Ph.D., author of Recover!

Finally, Dear Lindsay: Consider starting with one of Dr. Dodes’s books (and my guess is he would see you in confidence although on his website he says he is not taking new clients). My door is open to you too. There are many inner and outer doors that lead to sobriety and happiness. Mostly, don’t give up. Whatever you do, don’t give up on yourself. One resource I found that helped me facilitate profound and lasting transformation within the groups I offer is Parker J. Palmer’s book, A Hidden Wholeness: A Journey Toward An Undivided Life. I recommend this for anyone intending to heal the brokenness within as well anyone who is entering any kind of group for help.

A small circle of limited duration that is intentional about its process will have a deeper, more life-giving impact than a large, ongoing community that is shaped by the norms of conventional culture. – Parker Palmer, A Hidden Wholeness

There is a wisdom, sometimes latent, in us all. Claim that inner truth Lindsay, and see even more doors open.

But this I can claim: every time we get in touch with the true source we carry within, there is net moral gain for all concerned. Even if we fail to follow its guidance fully, we are nudged a bit further in that direction. And the next time we are conflicted between inner truth and outer reality, it becomes harder to forget or deny that we have an inner teacher who wants to lay a claim on our lives. – Parker Palmer, A Hidden Wholeness