EThere were eight of us sitting in a circle in a wooden shed, an outbuilding of a large country house, somewhere in the south of England. The door was ajar and spring light flooded the room. “Can anyone name other treatments for addiction thanthe 12 steps?” asked a consultant.
„Cognitive Behavioral Therapy?” given to a patient.
"These other methods come and go," the consultant said with a wave of his hand. "But it's only the 12 steps that really work."
Later I found that questionable, to say the least. My 28-day stay at 12-step rehab while being treated for substance abuse was marked by a series of situations where I was told things that just didn't feel right. But I was in no position to disagree.
Upon checking in I was told that I had a progressive, fatal, incurable disease and that I had a one in three chance of dying from it. My life had collapsed so dramatically over the past year that I was desperate for solutions.
The events that led me to rehab are a blur. There was a painful separation, a redundancy. In October 2015 I was hit by a truck. When work was done, my hand in a cast, and dealing with difficult emotions, I resorted to a coping mechanism I discovered when I was 15. I felt when my parents got divorced and the confusion I experienced because I was gay.
But the meth should prove my enemy. I've really tried every drug. Methamphetamine, however, is different. It has torn apart the gay scene, where it is used in connection with sex, in an epidemic dubbed "Chemsex“. What started when a bit of misguided fun quickly got out of hand.
Now, at 29, I've made the decision to move back in with my family—temporarily, I assured myself—to clean up. Shortly thereafter, I was sitting in the car in front of the local Drug Services, curled up in a ball, my face pressed against the window. I was addicted to Valium; helped me keep working, at least for a while. I tried to do a detox at home but I was sobbing and felt like I was falling apart. This sparked a return to meth use as a pain reliever and bouts of severe paranoia. When someone finally suggested that I go to the priory's rehabilitation facility, I was all ears. Encouraged by my desperate family, I picked up the phone.
A woman answered. When she went through my options she said it would cost between £10,000 and £28,000 a month. I was desperate so I settled on a small facility on the lower end of the scale, at £13,000. I had a room with a private bathroom and didn't have to share a dorm. My parents received a soft loan from a family member. A privilege, I know; but I have to pay back.
On the way to the clinic I had the distinct feeling that I was being led to my own funeral. My mother suggested stopping in Chichester for lunch. But I wasn't in the mood for a happy meal. Upon checking in, I realized that my situation was being pathologized. "Have you injected yet?" asked the doctor. "I have," I replied.
Before my mom left, I asked, "Do you think I could have a glass of wine with dinner?" The answer was no. Like most rehabilitation, this one required abstinence. I would spend the next 28 days with about 25 other patients, each on their own seven, 14, or 28 day trips. I met some colorful characters, but they were mostly middle-aged alcoholics from their home counties.
I was a mess There was a lot to do and I wanted to get started. The weekdays consisted of six hours of group therapy. In the evening we can do acupuncture or yoga. The meal was okay. After a hot breakfast, we started the day in the living room, which was lined with shelves full of ornaments. Sitting on Chesterfield sofas in the dim half-light emanating from the north-facing windows, we shared a reading from the Daily Reflections of Alcoholics Anonymous and Narcotics Anonymous, which usually focused on major Christian themes, illustrated through metaphors of flying or geological Metaphors were expressed in eagles. features to overcome. I had asked upon check-in if I could have a Quran to go with the Bible next to my bed (I heard it was better to read and I had a crush on a Muslim boy) but was told in no uncertain terms that the Bible went further than that make. (When contacted for this article, the Priory said a Qur'an was available "upon request" at the clinic, adding that the "voluntary 12-step program that we administer is open to people of all faiths and no... diversity of religious affiliation.
Group therapy was similar. A copy of the 12 steps hung on the wall. The first step was, "We admitted that we were powerless over our addiction and that we could no longer manage our lives." Third step, that we "commit our lives and will to the care of God as we understand Him." Step Four: Take a "penetrating and fearless moral inventory of ourselves." And in Step Five, we confess "to God, to ourselves, and to another human being the exact nature of our mistakes." It was like this.
That didn't feel right. I've spent my whole life cultivating self-acceptance. Now I've been told that the root of my problems is my own moral flaws. And my only escape from this life-threatening situation was to establish a relationship with God.
I sat in this shed and took turns with my fellow inmates to read aloud the worksheets we filled out every night and every morning. We spoke to each other about the problems we had: broken families, failed marriages, wasted youth. The consultants, most of them “12 Steps”, intervened with words of encouragement and examples when it seemed to them that something was going wrong and then something did emerge: a solution that appeared from between the clouds. "Working the Steps" was prescribed as a remedy for all problems.
For the first week, I got vitamin B12 injections in my back every night:apparently useful for alcoholics. We all smoke a lot. As a colleague at the hospital put it, "I came in with a drinking problem and I'm going to leave an 'alcoholic' - and a smoker'." The walls of the smoking shed were adorned with messages of support and empty platitudes from our ancestors. Here we tell stories from our past lives and give insights into the worlds we are leaving behind. Admittedly, the black humor in rehab is immense: the only unifying element of those present was that we had all screwed up our lives so badly, or were about to do so, that all we could do was laugh. I will never forget the story of a patient when she got so drunk that she mistook a device for her boyfriend and snuggled up to him on the floor. She's dead now I think.
Support staff — nurses, caregivers, and security personnel, some of whom were recovering addicts — smoked with us. They would also extol the virtues of the 12 steps. One night I was in the shed with a nurse on the night shift. Holding a skinny roller, he recalled the good old days of mental health care when the golden rule he shared with a chuckle was, "When in doubt, knock 'em down."
"Bbut if I have an illness,” I asked, looking at the first step, “why am I admitting it? Surely I'm not to blame for anything?” I was ready to cause trouble. But it's amazing how quickly someone adapts to a thought system when everyone around them is praising it. Rehabilitation counselors are often given "12-Step Relief" manuals that provide instructions on how to combat dissident patients. In this case, one of the advisors just motioned for me to close my lips and swallow the key. Later, a counselor took me aside and told me that the more questions I asked, the "less it would work". The experience was generally exhausting. As I filled out more worksheets, I remembered a family member rubbing my childhood cat's nose with his own shit. "Describe how its use has harmed you," the worksheet asked. "Describe three times that its use caused you to break your own moral code." Most of the time I fiddled with everything for answers, hoping that only the act of confessing would keep me clean.
Accepting a higher power was crucial to my chances of staying clean, I was told. This "higher power" could be anything. The counselors advised "surrendering our wills and our lives to God" by reviewing every life decision we've ever made with another recovering addict or a 12-step therapist. That felt hard. But as a straight-A student with my life on the line, I was willing to try; I was particularly interested in getting this right.
DDespite extensive research, there is very little reliable evidence that the 12-step program works better than other interventions. There were two Cochrane reviews, the gold standard for evaluating medical research2006e2020. The initial review found no evidence that the method helped alcoholic recovery. In the second review, whose results replaced the first, AA adherents were slightly more likely to be sober at one year than those following other methods, including cognitive behavioral therapy, but they performed lower on several other metrics, such as: B. a reduction, does not fare better in the severity of alcohol consumption in people who have not experienced full recovery and mitigation of the negative side effects of excessive alcohol consumption.
In 2017, the Department of Health and Social Care released a report calledthe orange book,with research on how addiction can best be treated. He mentions the 12 steps a few times, but only as a treatment offered to willing patients as part of a "menu" of other options to choose from. I asked dr. Emily Finch, one of 28 addiction experts who worked on the report, explains why she received so few mentions. "There is very little evidence that they work," she says. "That doesn't mean they don't work. The active ingredient for most people in 12 Steps isn't necessarily about the theory, it's about things like the soft skills it teaches people. It helps people use their time more productively. I have many patients who say the steps have worked for them, but that's not necessarily backed by scientific evidence."
So how did we get to a place where an almost religious approach to treatment is considered gospel, especially in the US when it comes to addiction treatment? The 12-Step Method was co-founded by Bill Wilson (with Robert Smith) in 1939 after what he says God visited him in a "flash of light" during a hospital stay. The method provided a convenient remedy for the "problem drinker" problem in a Puritan society just before Prohibition. Based on the principles ofOxford Group, a fundamentalist Christian organization of which Wilson—a salesman with no medical training—was a member, Alcoholics Anonymous, the first iteration of the 12 Steps, was described at the time as "an odd combination of organized propaganda and religious exhortation," according to the American Medical Association. The AA website states, "There is room in AA for people of all shades of faith and disbelief," adding that many believe in God, while others are atheists or agnostics..The 12-step model continues to spread to this dayat least 50 "bags"Catering to everything from overeating to sex addiction, gambling and procrastination.
the idea ofaddiction as a diseaseIt was first introduced in 1960 by a scientist and 12-Step devotee, EM Jellinek, who gave the method pseudo-medical legitimacy. The mismatch between medicalization and a "spiritual" solution is uncomfortable, says Maia Szalavitz, author and journalist, former member of the 12 Steps. She says: "If you went into treatment for depression, cancer or schizophrenia and someone told you to get on your knees, find a higher power, take a moral inventory and make amends, you would think you had found a charlatan. "
The American addiction expert Dr. Lance Dodes, describes the perception that the 12 steps work as a "sampling" bias. "You don't hear from those who fail," he says. Dodes estimates the success rate of 12-level scholarships forstay at around 5-8%. This means that for every person you see in a meeting, there are 18 or 19 people who have been there before and the method didn't work for them. However, 12-Step grants have an enduring place in the public consciousness, thanks in large part to Marty Mann, an early adopter and publicist.who brought the method to Hollywood, where he appeared in films such as Billy Wilder's 1945 classicThe Lost Weekendand many since.
Dodes argues that the approach of turning our wills and lives over to God's care when we should have sought psychotherapeutic help "has done a great deal of harm to many people." The greatest danger to him is that the 12-step program insists that relapse is due to the individual not taking responsibility. "The 12-step bags say, 'It works if you work,'" says Dodes, who wrote with her son Zacharythe sober truth, aiming to debunk the science of AA. "But if it doesn't work, whose fault is it? It's your fault.” He warns that people “lose years, decades of their lives on the program” and develop additional problems like OCD. I have spoken to at least one former 12-stepper who left AA after developing severe OCD I can relate to this as I try to live up to the unrealistic demands of the "program" and constantly worry that I might be doing something "wrong".
However, 12-step rehabs continue to thrive. Addiction rates are increasing. In a review of drug treatment services, Dame Carol Black warned that there are public drug rehabilitation services"on your knees", while drug-related deaths in England and Wales are onan all-time high. Across England, many local authorities have turned around their addiction support budgetsshortened since 2015while boards struggle to balance the books.
Das Prioratsupports the use of the 12-step model in its clinics. "The 12-Step Guiding Principles are recognized around the world and have been used successfully for over 80 years to help millions of people overcome problems, including drug and alcohol addiction," said a hospital spokesman. "It's just wrong to suggest that this leads to frequent relapses. However, it is recognized that recovery from addiction can be difficult and, unfortunately, relapses can occur for some. We have robust follow-up groups and it shows the programs are working for a lot of people.”
Today there are 118 private substance abuse services in England registered with the Care Quality Commission (CQC). A CQC spokesperson told me, "Providers need to ensure they're obtaining consent legally... Staff need to provide adequate information about treatment options and risks, and ensure service users have an opportunity to make an informed choice." But it does exactly that I don't think I did. Informed consent involves giving patients a range of treatment options along with information about expected results to choose what they believe is best and right. Otherwise, the treatment will be ineffective. A Priory spokesperson says, "Patients have the right to question some or all elements of the program, or even to refuse treatment, and seek an alternative that they feel better meets their needs and beliefs."
While around half of UK rehabilitation clinics only offer 12-step treatment, the other half adhere more closely to Orange Book guidelines and the principle of informed consent, giving patients a range of treatment options. This is not to say that these institutions should be immune to criticism. Until 2014, the sector was not regulated: anyone could start a “rehabilitation”. In 2017 the CQC was issueda reportHighlighting serious concerns for the industry. He warned that 49 of the 68 clinics inspected were in breach of the Health and Social Care Act 2012. A rehabilitation not operated by the Priory was closed after it was discovered that it did not know how to serve customersthrough an opiate or alcohol detox. Priory points out that the clinic I visited has a CQC rating of 'good' and that 86.5% of their UK healthcare sites are rated good or excellent. He adds that he will address my concerns about the treatment I received "to improve the patient's experience at the clinic."
Ironically, many in the 12-Step community shy away from rehab, complaining that they are asking for something that should be "given for free." "Rehabs are the definition of theft," says Szalavitz, "paying for what you can get for free in 12-step meetings."
EUI stayed clean for 13 months after getting out of rehab. I followed the advice I received there to the letter. I contacted the consultants by phone and stuck to the schedule I had set: five 12-step meetings per week. I did "90 out of 90": I attended a 12-step meeting every day for the first three months. In the end I could no longer see the bush through the trees: I had internalized "the program". I went to rehab every Wednesday for follow-up care. After a short time I noticed those with whom I had fallen out. After eight months, I attended a follow-up session and noticed that only three of the 25 I shared it with were still in attendance.
It didn't take long for the cracks to appear on me too. I had moved back to London into a flat I shared with a friend. It wasn't long before I was locked in my room because I was reluctant to see people for fear of relapsing. I continued to attend meetings; I prayed at the suggestion of aNarcotics AnonymousMentor. But I also became pious and controlling. The undiagnosed eating disorder I had as a teenager has returned. I eliminated sugar, wheat and dairy. I became picky about sports. Life was joyless. And all the while, I ducked further down a dark rabbit hole, hoping that what the program promised would be just about enough of a "spiritual awakening." on the next bend.
As my old life faded, I entered a very dark place. After a three-week period of having thoughts of killing myself, I told the mentor that I was having suicidal thoughts. He told me this showed that my step two - the requirement to find trust in a "higher power" - wasn't strong enough. I needed to reinvest in the program and attend more meetings. I felt broken. But worse, I felt alone.
I remember thinking at the time that if I had killed myself and my parents had asked what was going on - maybe at the rehab center - they would have said, "It was the disease that got him."
Instead of killing myself, I went for a stroll. First wine, then meth. I was aware of two things: that I had promised myself I would never drink or do drugs again; and that since leaving rehab, all I've thought about is recovery - the 12 steps; what did I do right, what did I do wrong.
After that, I was in and out of 12-step meetings for a year. Eventually, I started seeing a therapist and focused on the issues that drove me to use in the first place. I told her that I felt like I was "in recovery from recovery"; I took antidepressants for the first time in my life. I went through a period of great cognitive dissonance as I worked through the flawed thinking instilled in me by 12-step programs. The damage done to my life during this time is immense: personal finances, friendships, job prospects all went through a trapdoor. As a gay man, I feel that the idea of being "sick" was particularly difficult for me to accept. Growing up with the threat of HIV, I knew that homosexuality was classified as a mental disorder even after it was legalized in 1987.
Aside from being audacious in diagnosing people with a life-threatening illness that I don't believe exists, I feel that the treatment I received prevented access to the treatment that was right for me. If I had a real choice as a patient, it would have saved me a lot of time and money. I had to process the trauma of my rehab experience: the stubborn and dispassionate way the 12-Step Method was handed to me and the seeming insistence that it was the only way to live.
not uk,Action against addictioncan be reached on 0300 330 0659. In the USASAMHSAThe national hotline is 800-662-4357. In Australia it isNational Alcohol and Drugs Hotlineis at 1800 250 015; Relatives and friends can seek helpFamily Drug Support Australienem 1300 368 186.