Rehab Sobriety Quotes

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

Drunkards have a problem, not with sobriety, but with reality.

Be your OWN celebrity!

I look back at the dismal statistics I was given years ago by a nurse about the success rates for rehab of meth addicts—single-digit success. I understand that it’s unrealistic to think that many addicts will stay sober forever after one or two or three or however many tries at sobriety, but maybe the more meaningful statistic is this, related by one of the lecturers at a rehab: “More than half of the people who enter rehab are sober ten years out, which doesn’t mean that they haven’t been in and out of sobriety.

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.

Procrastination has been a boon to my sobriety. I keep thinking I'd like to go out and get really trashed some night--but not tonight. It's really a variant of "One Step at a Time.

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The gaining, or maintaining, of some reputations was, or is, made possible by the loss of sobriety.

Same as me,” she said. “The PAC is great—don’t get me wrong. I wouldn’t be where I am without what they did for me. But rehab, regardless of the place, is only the beginning. Eventually, you come down from the mountaintop. You forget about the benefits of sobriety and want a drink. Have you thought about having one yet?

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.

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?

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.

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.

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.

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.

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.

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.

[The inebriate hospitals]’ philosophy, not so different from today’s rehabilitation facilities, was that people could detoxify, heal, and eventually flourish if they were deprived of any alcohol for a period of time, often up to one year. But the inebriate hospitals were somewhat different from today’s palatial rehabs in one important way: patients were often subjected to cold showers and typically housed alongside society’s cast-offs—the blind, those suffering from syphilis, the mentally ill, orphans, even prisoners.

The inebriate hospitals also adopted another new procedure for alcoholism: prefrontal lobotomy. This, painfully, failed to cure the “disease” of alcoholism, with one account famously relating that, “[f]ollowing the procedure, the patient dressed and, pulling a hat down over his bandaged head, slipped out of the hospital in search of a drink.

As his biographer put it, “[Bill Wilson] was compulsive, given to emotional extremes. . . . Even after he stopped drinking, he was still a heavy consumer of cigarettes and coffee. He had a sweet tooth, a large appetite for sex, and a major enthusiasm for LSD and, later, for niacin, a B-complex vitamin.” Indeed, he was such a heavy smoker that the effects of tobacco would rob him of his mobility and, eventually, his life. One account recalls that he continued to smoke even in his old age when he needed frequent doses of oxygen just to make it through the day. Friends who arrived at the house reported seeing him struggling to decide whether he should take oxygen or smoke another cigarette. The cigarette won every time. A similar pattern arose around a different behavior: serial adultery. Wilson’s need to sleep with women outside his marriage was legendary—so much so that AA members eventually put together a “Founder’s Watch” committee designed to steer him away from any tempting young women at the numerous events he attended.

It is essentially impossible to separate Wilson’s passion for the spiritual from his founding of AA, despite the organization’s frequent protestations that it is nonreligious in nature. Of course, Alcoholics Anonymous members have every possible view about religion. But the organization is clearly permeated with Wilson’s religious beliefs.

[Bill] Wilson himself said twenty years following his conversion that he “wanted every alcoholic to be able to say, as he could, that their belief in God was ‘no longer a question of faith’ but ‘the certainty of knowledge [gained] through evidence.

One day while lying prone and feeling despair during his fourth admission to Towns Hospital, [Bill] Wilson is reported to have cried out, “I’ll do anything! Anything at all! If there be a God, let Him show Himself!” He described seeing a bright light, feeling euphoric, then a great calm. Armed with the certitude and wonder that this moment produced in him, Wilson never drank again.

[Bill Wilson] rarely mentioned in retelling this story that he was being treated at the time by the “Belladonna Cure,” a chemical cocktail that included the known hallucinogens atropine and scopolamine. Perhaps more importantly, we should notice this story’s startling similarity to his grandfather’s. Just like the older man, Wilson claimed that he’d been transported to a mountaintop, where he experienced a nearly word-for-word reenactment of the same sensations—“uplift” and “spirit”—that his grandfather spoke about more or less continuously during Wilson’s childhood. Despite these clues that more prosaic forces may have been at work, Wilson believed for the rest of his life that he had been touched by God, and he was absolutely certain that divine experience had forever liberated him from the urge to drink.

Many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction. Some renowned programs even have “equine therapists” available to treat addiction—a fairly novel credential in this context, to put it kindly. Sadly, there is no evidence that these additional “treatments” serve any purpose other than to provide momentary comfort to their clientele—and cover for the programs' astronomical fees, which can exceed $90,000 a month.

Why do we tolerate this industry? One reason may sound familiar: in rehab, one feels that one is doing something, taking on a life-changing intervention whose exorbitant expense ironically reinforces the impression that epochal changes must be just around the corner. It is marketed as the sort of cleansing experience that can herald the dawn of a new era. How many of us have not indulged this fantasy at one time or another—the daydream that if we could just put our lives “on pause” for a while and retreat somewhere pastoral and lovely, we could finally make sense of all our problems? Alas, the effect is temporary at best. Many patients begin using again soon after they emerge from rehab, often suffering repeated relapses. The discouragement that follows these failures can magnify the desperation that originally brought them to help’s door. What’s especially shocking is how the rehab industry responds to these individuals: they simply repeat their failed treatments, sometimes dozens of times. Repeat stays in rehab are very common, and readmission is almost always granted without any special consideration or review. On second and subsequent stays, the same program is offered, including lectures previously attended.

Any serious treatment center would study its own outcomes to modify and improve its approach. But rehabs generally don’t do this. For example, only one of the three best-known facilities has ever published outcome studies (Hazelden); neither Betty Ford nor Sierra Tucson has checked to see if their treatment is producing any results for at least the past decade. Hazelden’s follow-up studies looked at just the first year following discharge and showed disappointing results, as we will see later. Efforts by journalists to solicit data from rehabs have also been met with resistance, making an independent audit of their results almost impossible and leading to the inevitable conclusion that the rest of the programs either don't study their own outcomes or refuse to publish what they find.

At the threshold of AA’s invention, America carried a population of alcoholics deeply fatigued by many decades of barbaric treatment, imprisonment, and isolation; rattled by errant snake oil “cures”; and suffused with a widespread sense of hopelessness. Bill Wilson was just such an alcoholic.

[Bill] Wilson wrote: “The early AA got its ideas of self-examination, acknowledgment of character defects, restitution for harm done, and working with others straight from the Oxford Group and directly from Sam Shoemaker, their former leader in America, and from nowhere else.” Although Wilson felt indebted to the Oxford Group for many things, he would eventually break from the organization.

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.

[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.

Dominic’s family lost close to $200,000—their total retirement savings—on this string of ineffectual programs.

Rehab owns a special place in the American imagination. Our nation invented the “Cadillac” rehab, manifested in such widely celebrated brand names as Hazelden, Sierra Tucson, and the Betty Ford Center. Ask the average American about any of these institutions and you will likely hear a response tinged with reverence—these are the standard-bearers, our front line against addiction. The fact that they are all extraordinarily expensive is almost beside the point: these rehabs are fighting the good fight, and they deserve every penny we’ve got. Unfortunately, nearly all these programs use an adaptation of the same AA approach that has been shown repeatedly to be highly ineffective.