Rehab Recovery Quotes

Karl Marx: "Religion is the opiate of the masses." Carrie Fisher: "I did masses of opiates religiously.

Whether I or anyone else accepted the concept of alcoholism as a disease didn't matter; what mattered was that when treated as a disease, those who suffered from it were most likely to recover.

At the bottom of every person's dependency, there is always pain, Discovering the pain and healing it is an essential step in ending dependency.

Hit the bottom and get back up; or hit the bottle and stay down.

I found the prospect daunting, but somehow comforting, too, because the counselors insisted it could be done, and, after all, many of them were recovering alcoholics themselves.

You are not an alcoholic or an addict. You are not incurably diseased. You have merely become dependent on substances or addictive behavior to cope with underlying conditions that you are now going to heal, at which time your dependency will cease completely and forever.

Addiction denied is recovery delayed.

I’ve been married but I’m not anymore. And I still believe in love.

I spent the rest of that day and most of the night thinking about all the hundreds of people I had met in rehabs and sober living houses and on the streets. We were all medicating our fears and our pain!

It's the causes, not the dependent person, that must be corrected. That's why I see the United States' War on Drugs as being fought in an unrealistic manner. This war is focused on fighting drug dealers and the use of drugs here and abroad, when the effort should be primarily aimed at treating and curing that causes that compel people to reach for drugs.

It takes a strong person to stand up to his or her fate and overcome the obstacles that stand in the way of freedom and success, but I believe in you.

And it hits me, the reason for all the metaphors in recovery. Because the bald truth would be too terrifying. What she's saying is I may need an all-new career and all-new friends.

AA purports to be open to anyone, as it is stated in Tradition Tree, "The only requirement for AA membership is a desire to stop drinking," but it isn't open to everyone. It's open only to those who are willing to publicly declare themselves to be alcoholics or addicts and who are willing to give up their inherent right of independence by declaring themselves powerless over addictive drugs and alcohol, as stated in Step One, "We admitted we are powerless over alcohol- that our lives had become unmanageable.

Think about the stigma that is attached to the idea that alcoholism is a disease, an incurable illness, and you have it. That's a terrible thing to inflict on someone. Labeling alcoholism as a disease, a cause unto itself, simply no longer fits with what we know today about its causes.

We know that you don't want to be a drunk and you don't want to be hooked on addictive drugs. You do it because you can't cope with your life without some sort of support, even if that support is damaging.

We recognize that you've used substances to try to regain your lost balance, to try to feel the way you did before the need arose to use addictive drugs or alcohol. We know that you use substances to alter your mood, to cover up your sadness, to ease your heartbreak, to lighten your stress load, to blur your painful memories, to escape your hurtful reality, or to make your unbearable days or nights bearable.

To give up power to change for the better is inherently distasteful to everyone, and to force people to affirm that they are addicts or alcoholics so they can speak in a meeting is shameful and demoralizing.

Daisy says you spent your first tour cheating on your wife and dealing with alcoholism and drug addiction, possibly a heroin addiction. She says you’re in recovery now but that you missed the birth of your first daughter because you were in rehab.

Whether the underlying cause of your dependency is a chemical imbalance, unresolved events from the past, beliefs you hold that are inconsistent with what is true, an inability to cope with current conditions, or a combination of these four causes, know this: not only are all the causes of dependency within you, but all the solutions are within you as well.

Staying sober is easy once you have been successful in healing the underlying conditions that were responsible for your dependency in the first place.

A positive approach gives you control over any circumstances. Be positive to start your rehab. The results won't let you down. Be positive to overcome your fear and you will win.

The punishment approach and bad consequences approach to treatment is the kind of thinking that is prevalent in every residential substance abuse treatment center in the United States of which I'm aware.

The treatment must fit the malady and the malady is not alcoholism or addiction, or addictive drugs and alcohol. Once the correct cause is diagnosed, healing will take place and hoped-for cure will come about.

We wouldn't have much need of a war if people stopped using drugs. It's like taking up a fight against the use of headache remedies; it will never work until the condition causing people's headache pain is healed.

...It's hard for me to lie to myself. It comes natural for me to deceive others but I can never quite be convincing enough to lie to myself, I wish it wasn't so. Rehab for my eating disorder would have been a lot easier...

Fewer than one-quarter of heroin addicts who receive abstinence-only counseling and support remain clean two or more years. The recovery rate is higher, roughly 40 to 60 percent, among those who get counseling, support group, and medication-assisted treatment such as methadone, buprenorphine, or naltrexone. “We know from other countries that when people stick with treatment, outcomes can be even better than fifty percent,” Lembke, the addiction specialist, told me. But most people in the United States don’t have access to good opioid-addiction treatment, she said, acknowledging the plethora of cash-only MAT clinics that resemble pill-mill pain clinics as well as rehabs that remain staunchly anti-MAT.

A patient complains of feeling nervous or fearful. These feelings and behaviors suggest that the patient has an anxiety disorder, and the doctor prescribes whatever drug will most probably work for an anxiety disorder. However, there's no conclusive way to tell that this patient definitely has an anxiety disorder. Even if the doctor did get the diagnosis correct, there's a great deal of variation regarding which drug class (for example, anti-anxiety drugs versus antidepressants) a particular individual will respond to and which drug within a class (for example, Prozac versus Zoloft) will work best. If the drug doesn't work, the doctor will try the next one on the list and so on, thus delaying treatment success and complicating the process with the mix-and-match type of treatment.

The first week is the hardest. Then little by little the world opens up, and you realize there are all these people around you with their own needs that have nothing to do with you. Then you forget, and everything’s about you again. And maybe that cycle continues for the rest of your life. Maybe the world keeps expanding and contracting. Maybe you know you’re well when it finally stays the same size.

On September tenth, after a busy day at the parish, and without any forethought, I stopped at a liquor store before I headed upstate to the Villa. I wouldn’t allow myself to recognize the insanity of drinking a bottle of wine as I drove to a rehab facility. I flashbacked to my father’s beer cans, in paper bags, between his legs as he drove. I was sure God was tapping on my shoulder, but I wasn’t responding. I coasted comfortably on autopilot, one of the most dangerous modes a human being can find themselves.

What kind of rehab is this? I can’t share a room with a man.” Jericho narrows his eyes at me but waves me off. “You signed off on it, Coldfox. We pair you up with a roommate ideal for your treatment plan. I know this seems odd, but our rehab has among the highest recovery rate. Like I mentioned before, we’re unorthodox. And didn’t you say you enjoyed sex earlier? Well, here you go. Liam Waters,” he says sarcastically.

Jeevan Aas provides a comprehensive recovery program to get rid of addiction, helps the addicted individual to fight against the addiction. The centre is the best Nasha Mukti Kendra in Himachal also helps to deal with the problems and difficulties caused by it. Jeevan Aas has a great team of experts who are well experienced to serve the best quality service and completely understands the feeling and situations of the addicts, takes the utmost care of patients.

Block said. “I mean, he’s a professor emeritus. He’s never watched a football game in my conscious memory. The whole picture—it wasn’t the guy I thought I knew.” But the conversation proved critical, because after surgery he developed bleeding in the spinal cord. The surgeons told her that in order to save his life they would need to go back in. But the bleeding had already made him nearly quadriplegic, and he would remain severely disabled for many months and likely forever. What did she want to do? “I had three minutes to make this decision, and I realized, he had already made the decision.” She asked the surgeons whether, if her father survived, he would still be able to eat chocolate ice cream and watch football on TV. Yes, they said. She gave the okay to take him back to the operating room. “If I had not had that conversation with him,” she told me, “my instinct would have been to let him go at that moment because it just seemed so awful. And I would have beaten myself up. Did I let him go too soon?” Or she might have gone ahead and sent him to surgery, only to find—as occurred—that he was faced with a year of “very horrible rehab” and disability. “I would have felt so guilty that I condemned him to that,” she said. “But there was no decision for me to make.” He had decided. During the next two years, he regained the ability to walk short distances. He required caregivers to bathe and dress him. He had difficulty swallowing and eating. But his mind was intact and he had partial use of his hands—enough to write two books and more than a dozen scientific articles. He lived for ten years after the operation. Eventually, however, his difficulties with swallowing advanced to the point where he could not eat without aspirating food particles, and he cycled between hospital and rehabilitation facilities with the pneumonias that resulted. He didn’t want a feeding tube. And it became evident that the battle for the dwindling chance of a miraculous recovery was going to leave him unable ever to go home again. So, just a few months before I’d spoken with Block, her father decided to stop the battle and go home. “We started him on hospice care,” Block said. “We treated his choking and kept him comfortable. Eventually, he stopped eating and drinking. He died about five days later.

I like thinking,” she added, “that the forest sounds the same as it did millions of years ago, and it will sound the same millions of years from now. I find the endlessness comforting. It puts my small problems into perspective. Like looking at the stars at night and realizing that everything I worried about all day is utterly insignificant compared to the vastness of the universe.

You look like you could be the love child of a grizzly bear and a navy destroyer.

You can’t just walk up to a stand of unsuspecting oaks and start touching. They’d think you’re getting fresh with them.

Post-Rehab Advice: 5 Things to Do After Getting Out of Rehab Getting yourself into rehab is not the easiest thing to do, but it is certainly one of the most important things you can ever do for your well-being. However, your journey to self-healing does not simply end on your last day at rehab. Now that you have committed your self to sobriety and wellness, the next step is maintaining the new life you have built. To make sure that you are on the right track, here are some tips on what you should do as soon as you get back home from treatment. 1. Have a Game Plan Most people are encouraged to leave rehab with a proper recovery plan. What’s next for you? Envision how you want yourself to be after the inpatient treatment. This is a crucial part of the entire recovery process since it will be easier to determine the next phase of treatment you need. 2. Build Your New Social Life Finishing rehab opens endless opportunities for you. Use it to put yourself out in the world and maybe even pursue a new passion in life. Keep in mind that there are a lot of alcohol- and drug-free activities that offer a social and mental outlet. Meet new friends by playing sports, taking a class or volunteering. It is also a good opportunity for you to have sober friends who can help you through your recovery. 3. Keep Yourself Busy One of the struggles after rehab is finding purpose. Your life in recovery will obviously center on trying to stay sober. To remain sober in the long term, you must have a life that’s worth living. What drives you? Begin finding your purpose by trying out things that make you productive and satisfied at the same time. Get a new job, do volunteer work or go back to school. Try whatever is interesting for you. 4. Pay It Forward As a person who has gone through rehab, you are in the perfect place to help those who are in the early stages of recovery. Join a support group and do not be afraid to tell your story. Reaching out to other recovering individuals will also help keep your mind off your own struggles, while being an inspiration to others. 5. Get Help If You’re Still Struggling Research proves that about half of those in recovery will relapse, usually within the treatment’s first few months. However, these numbers do not necessarily mean that rehab is a waste of time. Similar to those with physical disabilities who need continuous therapy, individuals recovering from addiction also require ongoing support to stay clean and sober. Are you slipping back to your old ways? Do not let pride or shame take control of your mind. Life throws you a curveball sometimes, and slipping back to old patterns does not mean you are hopeless. Be sure to have a sober friend, family, therapist or sponsor you could trust and call in case you are struggling. Remember that building a drug- and alcohol-free life is no walk in the park, but you will likely get through it with the help of those who are dear to you.

Bottom lines are addictive behaviours that we make a conscious choice not to repeat. For example, a recovering cocaine addict would create a bottom line that they will not use a mind- or mood-altering substance to deliberately get high. A recovering sex addict might create a bottom line not to watch pornography or not to have sex without any emotional or spiritual connection. Bottom lines are a symbol of our intentions and are very useful at a practical level to address addictions. In many recovery communities, twelve-step fellowships and addiction rehabs, there is also a concept called ‘top lines’.

Alcohol & Drug Rehab in Arizona Settling on the choice to go to a liquor and medication recovery in Arizona can be excellent. There are various individuals in our state doing engaging in addictions, and for them, it is evidently miserable. They may not consider their choices for recuperation, or they may feel that recovery essentially doesn't work. At SpringBoard Recovery, we need individuals to comprehend that help is accessible. While there are various individuals with addictions in Arizona, there are additionally various individuals who have recouped effectively. It requires some endeavor and work, at any rate for the individuals who are happy to contribute the exertion, they can encounter a regular presence that is liberated from substance misuse. HOW SERIOUS IS THE NEED FOR REHAB IN ARIZONA? Liquor and remedy recovery focus in Arizona are regular. There are various individuals here who battle with medication and liquor addictions. Endless these people feel like they have no longing. They can't perceive any approach to manage quit utilizing, in like manner, they offer up to being dynamic in their addictions for the remainder of their lives. We need individuals to comprehend that there is want and recuperation is conceivable. By and large, we need to investigate what the assessments need to state about the essential for recovery programs in Arizona.

In rehabilitation there is no elevator. You have to take every step meaning one step at a time.

(seriously, rehabs should stop using that book).

Rehabilitation is an equalizing process. No one much cares what you did before; they’re focused on what you can do now and how you can learn to live independently once again. Going from an acute hospital to a rehabilitation environment represents what current sociological jargon calls a “paradigm shift”: at an acute hospital, you are sick and being taken care of. But once you arrive at a good rehab hospital like Magee, you go from being a passive patient to becoming an active participant in your own recovery.

There’s no reason why the other patients—the ones who didn’t write out recovery plans—couldn’t have behaved the same way. All the patients had been exposed to the same admonitions and warnings at the hospital. They all knew exercise was essential for their recovery. They all spent weeks in rehab. But the patients who didn’t write out any plans were at a significant disadvantage, because they never thought ahead about how to deal with painful inflection points. They never deliberately designed willpower habits. Even if they intended to walk around the block, their resolve abandoned them when they confronted the agony of the first few steps.

Rehab San Diego Psyclarity Health. We are a luxury rehab & detox center for alcohol or drug addiction treatment in beautiful Los Angeles, California We believe the journey to recovery doesn’t have to be difficult, that’s why we offer a full spectrum approach to treatment. Recovery is a journey, and we are here to make sure your loved one starts it right. At Psyclarity, we believe in treating addiction by implementing a comprehensive, evidence-based treatment program that is custom-tailored to each individual's needs. The compassionate team here takes care of our patients through each step of their recovery journey. Get started on the path to permanent sobriety today.

You start drinking alcohol, then alcohol starts drinking you.

Your Journey To Recovery Begins Here. Welcome to Our Florida Drug & Alcohol Rehab Center. We're Committed to Your Recovery. Florida Drug and Alcohol Rehab & Medical Detox, PHP/IOP.

Whenever I get too high and mighty, my wife has a subtle way of bringing my feet back down to earth. “You couldn’t even quit drinking when you weren’t thirsty,” she reminds me.

Personalized therapy means being open and tailoring care to each patient’s unique qualities. This approach is especially beneficial for addressing complex issues rooted in an individual’s upbringing and experiences. Get in touch with Rehab Center NJ. Our goal at New Life Recovery Center in Montville, New Jersey, is to help people and families who are struggling with alcoholism and drug addiction find healing and long-term recovery. Our mission is to assist you in achieving a higher quality of life by supporting you as you recover from drug abuse addiction at a treatment clinic in New Jersey.

Drown in drinks, and life is lost. Drink up life, and drinks are lost.

The support of close friends didn’t end when I flew back to the United States as a paralytic. I had a band of brothers waiting for me there who were willing and ready to join me in the trenches. I call them the Jerk Crew and they were an important part of my healing and recovery. They stood by me, day in and day out, as I went through rehab, keeping me company and enduring my many mood swings and not-so-positive outpourings of emotion as I struggled to come to terms with my paralysis.

I am determined not to try to cover up loneliness, anxiety, or other suffering by losing myself in consumption. I will contemplate interbeing and consume in a way that preserves peace, joy, and well-being in my body and consciousness, and in the collective body and consciousness of my family, my society, and the Earth.

Overcome Addiction And Live Sober. "Recovery is possible for those struggling with addiction. Our facility offers a full continuum of care to help those who are caught in the grips of addiction to break free and enjoy a life filled with infinite possibilities.

In constraint-induced movement therapy, stroke patients wear a sling on their good arm for approximately 90 percent of waking hours for fourteen straight days. On ten of those days, they receive six hours of therapy, using their seemingly useless arm: they eat lunch, throw a ball, play dominoes or cards or Chinese checkers, write, push a broom, and use standard rehab equipment called dexterity boards. “It is fairly contrary to what is typically done with stroke patients,” says Taub, “which is to do some rehabilitation with the affected arm and then, after three or four months, train the unaffected arm to do the work of both arms.” Instead, for an intense six hours daily, the patient works closely with therapists to master basic but crucial movements with the affected arm. Sitting across a pegboard from the rehab specialist, for instance, the patient grasps a peg and labors to put it into a hole. It is excruciating to watch, the patient struggling with an arm that seems deaf to the brain’s commands to extend far enough to pick up the peg; to hold it tightly enough to keep it from falling back; to retract toward the target hole; and to aim precisely enough to get the peg in. The therapist offers encouragement at every step, tailoring the task to make it more attainable if a patient is failing, then more challenging once the patient makes progress. The reward for inserting a peg is, of course, doing it again—and again and again. If the patient cannot perform a movement at first, the therapist literally takes him by the hand, guiding the arm to the peg, to the hole—and always offering verbal kudos and encouragement for the slightest achievement. Taub explicitly told the patients, all of whose strokes were a year or more in the past, that they had the capacity for much greater use of their arm than they thought. He moved it for them and told them over and over that they would soon do the same. In just two weeks of constraint-induced movement therapy with training of the affected arm, Taub reported in 1993, patients regained significant use of a limb they thought would forever hang uselessly at their side. The patients outperformed control patients on such motor tasks as donning a sweater, unscrewing a jar cap, and picking up a bean on a spoon and lifting it to the mouth. The number of daily-living activities they could carry out one month after the start of therapy soared 97 percent. That was encouraging enough. Even more tantalizing was that these were patients who had long passed the period when the conventional rehab wisdom held that maximal recovery takes place. That, in fact, was why Taub chose to work with chronic stroke patients in the first place. According to the textbooks, whatever function a patient has regained one year after stroke is all he ever will: his range of motion will not improve for the rest of his life.

Codependents dереnd оn аnоthеr'ѕ аррrоvаl аnd ассерtаnсе • Cоdереndеntѕ fоrgivе bеfоrе rehab iѕ соmрlеtеd

And it hits me, the reason for all the metaphors in recovery. Because the bald truth would too terrifying. What she's saying is I may need an all-new career and all-new friends. p 85

As anyone who’s been in rehab or sat in AA meetings will tell you, addiction doesn’t give a fuck who you are. It doesn’t care what you do or where you’ve been or what you’ve done. I know this because the billionaire’s son with no teeth reminds me. We’re an unlikely collection of people who would otherwise never meet, all in various states of disrepair and dishevelment. Shaving is the least of your worries when you’re trying to kick a heroin habit. No matter how much you pay for luxurious surroundings, recovery is hard, and if you think it’s easy, you’re probably not really serious about it.

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Alcoholics Anonymous was proclaimed the correct treatment for alcoholism over seventy-five years ago despite the absence of any scientific evidence of the approach’s efficacy, and we have been on the wrong path ever since. Today, almost every treatment center, physician, and court system in the country uses this model. Yet it has one of the worst success rates in all of medicine: between 5 and 10 percent, hardly better than no treatment at all. Most of the expensive, famous rehab centers that base their treatment on the Twelve Steps likewise have offered no evidence for their effectiveness. Most of them don’t even study their own outcomes.

In the seventy-six years since AA was created, 12-step programs have expanded to include over three hundred different organizations, focusing on such diverse issues as smoking, shoplifting, social phobia, debt, recovery from incest, even vulgarity. All told, more than five million people recite the Serenity Prayer at meetings across the United States every year.

Going to rehab” is likewise a common refrain in music and film, where it is almost always uncritically presented as the one true hope for beating addiction.

Every year, our state and federal governments spend over $15 billion on substance-abuse treatment for addicts, the vast majority of which are based on 12-step programs. There is only one problem: these programs almost always fail.

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober.

In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism.

AA began as a nonprofessional attempt to grapple with the alcoholism of its founders. It arose and took its famous twelve steps directly from the Oxford Group, a fundamentalist religious organization founded in the early twentieth century.

AA spread like wildfire through a country desperate for hope at the end of Prohibition and in the midst of the Great Depression.

AA has managed to survive, in part, because members who become and remain sober speak and write about it regularly. This is no accident: AA’s twelfth step expressly tells members to proselytize for the organization: “Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Adherence to this step has created a classic sampling error: because most of us hear only from the people who succeeded in the program, it is natural to conclude that they represent the whole. In reality, these members speak for an exceptionally small percentage of addicts.

AA makes inflated claims about itself. Its foundational document, Alcoholics Anonymous (commonly referred to as the “Big Book” and a perennial best seller), spells out a confident ethos regularly endorsed by AA members: "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest." In other words, the program doesn’t fail; you fail. Imagine if similar claims were made in defense of an ineffective antibiotic. Imagine dismissing millions of people who did not respond to a new form of chemotherapy as “constitutionally incapable” of properly receiving the drug. Of course, no researchers would make such claims in scientific circles—if they did, they would risk losing their standing. In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient. Not so for Alcoholics Anonymous.

Addiction is not a moral defect, and to suggest that does a great disservice to people suffering with this disorder.

The degradation woven through these steps also seems unwittingly designed to exacerbate, rather than relieve, the humiliating feelings so common in addiction. If moral self-flagellation could cure addiction, we could be sure there would be precious few addicts.

There is nothing inherently wrong with apologizing to those who have been harmed, directly or indirectly, by the consequences of addiction. The problem is the echo once more of the fundamentalist religious principle: that the path to recovery is to cleanse oneself of sin.

People suffering with addictions as a rule tend to be well aware of the many “wrongs” they have committed. Awareness of this fact doesn’t help the problem.

I have met and listened to a very large number of people who have “failed” at AA and some who continue to swear by it, despite repeated recidivism.

He also found himself increasingly resentful of the “tally system” that AA uses to measure sobriety: every time he “slipped” and had a drink, he “went back to zero.” All the chips he’d earned—the tokens given by AA for milestone periods of sobriety—became meaningless. This system compounded his sense of shame and anger, leading him to wonder why he lacked the willpower or fortitude to master the incredible force of his alcoholism.

He found a few “old-timers” who believed wholly in the program and who encouraged him to dismiss the great majority of people who fell through the cracks. They just weren’t ready to stop, he was reassured.

When Dominic entered my office, he had accepted as empirical truth that he was a deeply flawed individual: amoral, narcissistic, and unable to turn himself over to a Higher Power. How else to explain the swath of destruction he had cut through his own life and the lives of those who loved him? His time in AA had also taught him that his deeper psychological life was immaterial to mastering his addiction. He had a disease; the solution was in the Twelve Steps. When he was ready to quit, he would. It took eight months of psychotherapy before Dominic stopped drinking for good. Although he remained in therapy for several years after that, the key that unlocked his addiction was nothing more complex or ethereal than an understanding of what his addiction really was and how it really worked.

Once he understood the connection between his lifelong feelings and his urges to drink, he was able to view them with some perspective for the first time.

[He had] supplanted the notion of a Higher Power with something far more personally empowering: sophisticated self-awareness.

More than anything, AA offers a comforting veneer of actionable change: it is something you can do.

For an organization that has expressly denied religious standing and publicly claims a secular—even scientific—approach, it is curious that AA retains these explicit references to a spiritual power whose care might help light the way toward recovery. Even for addicts who opt to interpret this step secularly, the problem persists: why can’t this ultimate power lie within the addict?

[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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.)

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.

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.

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.

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.

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.

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.

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.

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.