The Bad Science of “The Sober Truth”

The Sober Truth is a book that was published in March of 2014. It is written by Dr. Lance Dodes (a psychiatrist) and his son. It is a polemical attack on Alcoholics Anonymous that is not based on fact, but a series of anecdotal stories.

Back in March, The Atlantic published an article/review of the book that asserted the Dodes’ book as truth rather than opinion. That article made the rounds on social media and was discussed and (slightly) debated within the treatment community. Not surprisingly, it has been used by people who are in treatment programs as a reason why they should not go to AA or NA (it is a good example of confirmation bias).

Yesterday, a more informed review appeared in The New York Times. Dr. Richard Friedman, the author, asserts that The Sober Truth is both biased and bad science:

The Sober Truth asserts that addiction can be treated with psychodynamic psychotherapy, which focuses on unconscious feelings and thoughts. But while there is some scientific data for cognitive behavior therapy in addiction, there is little to no evidence that psychodynamic therapy is effective for any type of drug abuse. The authors’ blanket claim of efficacy for their own cherished treatment, in the absence of credible data, is the very flaw for which they harshly criticize A.A.

But the book’s most glaring deficiency is the authors’ dismissive attitude and misunderstanding about the role of neuroscience in addiction.

Those looking for a scientifically accurate and nuanced understanding of addiction and its treatment will not find it in this book.”

There are some people who get clean and sober just by going to AA meetings. Other people need more help. That includes individual counseling (cognitive behavioral therapy and/or motivational interviewing have the best results), group counseling, family therapy, transitional and/or recovery housing, recovery supports, higher education, vocational training and in some cases, medication. These different types of treatment work very well with 12-step meetings.

We know more than we did 10 years ago, and we knew more then than we knew 30 years ago. The treatment field continues to improve. As we move forward, we will continue to get a better understanding of how the brain works. We need to continue to get more public and private funding for prevention, treatment and especially recovery support services. This can be done by encouraging quality research and reducing the stigma of addiction and recovery. Unfortunately, Dr. Dodes’ work does neither. In fact, he has violated the Hippocratic Oath – he has done harm.