A doctor speaks out about the 12 steps

Dear Stanton:

I've read The Truth about Addiction, Diseasing of America, and The Meaning of Addiction. It was so refreshing to read these books, like a cool breeze off the lake on a hot summer day in Chicago. Most psychiatrists and psychologists who write, particularly the New Age variety, quote themselves. Your books, on the other hand, are scholarly works—well thought out; exhaustively researched; and eloquently worded. I've been troubled by the recovery and twelve-step movements for some time, but I couldn't find the right words to describe my misgivings until I read these books. This is brilliant stuff.

My introduction to inpatient chemical dependency treatment came in my first year of medical school in 1981. We eager, young students in short white coats were taken to a reputable, local recovery hospital to observe treatment in action. Thirty patients gathered in a circle and started off: "I'm Bob, and I'm an alcoholic, etc..." The director of the program, a born-again type, had a developmentally disabled woman tell the group about her resolution to get help—I have no idea what sort—in the future if she felt she needed it. He made her say this again loudly so everyone in the group could hear it. Then he made her stand on her chair and shout it three time at the top of her lungs so that "everyone within a city block" could hear it. I was very disturbed by that scene. It was hard to watch this particular person being humiliated, and I knew that if she called for help, she probably wouldn't get it. The whole thing was surreal. Later, the director beatifically smiled and said something about "the disease," its severity, and the need for drastic treatment. (If I treated any group of truly diseased people like that, say a group of diabetics, I'd lose my license.) "Gee," I thought to myself, "this is the way addicts have to be treated." We all towed the twelve-step line as students and residents. Medical schools don't select contrarian thinkers.

It seems to me that there is a streak of sadism in the neo-Puritan American variety of drug treatment. I've seen it repeatedly. I'm not sure where this comes from. My hunch is that some health professionals with sadistic urges tend to gravitate toward substance abuse treatment since this is the one area in which they can act out on their sadistic wishes, be coercive, and still be seen as healers. One staff member from the now defunct US Naval Hospital in Long Beach said, "We give our addicts a swift kick in the pants to get them headed in the right direction." If one wants see oneself as Mother Teresa or Albert Schweitzer, but unconsciously wants to kick people in the pants, substance treatment would be a good place to go. Tough Love, and all that.

I'm just starting out in private practice. Let me know in advance if you're going to put this up at your site. American Orthodox Recovery is a religion which doesn't flinch at burning heretics! Who knows, in a few years, it might be the official state religion of the US.

John [...], MD.