Joseph Nowinski - If You Work It, It Works!: The Science Behind 12 Step Recovery

Praise for If You Work It, It Works!

In this book, Joe Nowinski once again proves his ability to integrate the science and experience of Alcoholics Anonymous and to explain both in clear, unpretentious language.

Keith Humphreys, Professor of Psychiatry, Stanford University

While opinions abound regarding whether AA and Twelve Step treatments for addiction are helpful, there is now a rigorous body of scientific evidence on which to base valid conclusions about their effectiveness and cost-effectiveness, as well as the mechanisms through which they confer benefit. In this book, Dr. Nowinski has done a great service by summarizing, synthesizing, and skillfully interpreting many of the landmark studies that demonstrate not only that AA and Twelve Step treatments are still relevant in twenty-first-century addiction health care, they are among the most effective interventions currently available.

John F. Kelly, Elizabeth R. Spallin Associate Professor of Psychiatry in Addiction Medicine, Harvard Medical School

Joe makes the design and findings from complex research studies understandable to the lay reader, without dumbing it down, and with just the right amount of detail. The book thus represents a valuable new resource for anyone interested in a comprehensive summary of what we know about AA in terms of its effectiveness, its mechanisms of action, and its role in the existing arsenal of tools to support recovery.

Lee Kaskutas, Senior Scientist, Alcohol Research Group, Public Health Institute

Hazelden Betty Ford Foundation

Center City, Minnesota 55012

hazelden.org

2015 by Joseph Nowinski

All rights reserved. Published 2015

No part of this publication, either print or electronic, may be reproduced in any form or by any means without the express written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement.

ebook 978-1-61649-574-9

Library of Congress Cataloging-in-Publication Data is on file with the Library of Congress.

Editors notes

The names, details, and circumstances may have been changed to protect the privacy of those mentioned in this publication.

This publication is not intended as a substitute for the advice of health care professionals.

Alcoholics Anonymous, AA, and the Big Book are registered trademarks of Alcoholics Anonymous World Services, Inc.

19 18 17 16 15 1 2 3 4 5 6

Developmental editor: Sid Farrar

Production editor: Mindy Keskinen

Cover design by Theresa Gedig

Interior design by Terri Kinne

Typesetting by Bookmobile Design & Digital Publisher Services

Also by Joseph Nowinski

The Family Recovery Program

The Twelve Step Facilitation Handbook

The Twelve Step Facilitation Outpatient Program

Twelve Step Facilitation for the Dually Diagnosed Client

with Robert Doyle, MD

Almost Alcoholic: Is My or My Loved Ones Drinking a Problem?

For my parents

Joseph and Helen Nowinski who showed me how to walk the walk... and that has made all the difference.

Contents

I would like to acknowledge my editor, Sid Farrar of Hazelden Publishing, for his support for this as well as a previous book. Thanks, Sid, for being an excellent sounding board for ideas as well as a steadfast advocate for this book.

As little as two decades ago, rigorous scientific research on the Alcoholics Anonymous (AA) Twelve Step program of recovery was all but nonexistent. It was so lacking, in fact, that a panel of experts convened by the Institute of Medicine of the National Academies (IOM) published this conclusion in 1989:

Alcoholics Anonymous, one of the most widely used approaches to recovery in the United States, remains one of the least rigorously evaluated.

The IOM report went on to call for well-designed research studies aimed at evaluating the AA program. That is when fate crossed my path. Having received some training in the Twelve Step model of recovery, I had developed an adolescent treatment program rooted in that model and subsequently wrote a book about the experience. I was then invited to develop a parallel program for adults that would be used in a major national treatment outcome study. That study and its results will be included in the research well review here.

Suffice it to say that since the IOM report and the first published results of that national study, research on the AA program has proliferated, to the point where it is no longer true that AA is the least rigorously studied (or objectively evaluated) approach to recovery in the United States. However, to date much of the hard evidence regarding AA has been reported solely in academic journals, where it remains largely inaccessible to the general public. This book remedies that situation, shedding light on AA for all to see how it works. With that in mind, lets begin our tour of the science of Twelve Step recovery.

It is hard to find someone who does not have an opinion about Alcoholics Anonymousfrom those who say it has been their salvation to those who dismiss it as a harmful cult. Many people remain either skeptical or downright critical of AA. I know this from reading books and articles the critics have penned, and also from the responses I sometimes get to the blogs I post on sites such as The Huffington Post and Psychology Today.

Ive come to divide these critics into two broad categories: those who claim that their criticism of the Twelve Step model is based on scientific evidence; and those whose criticism is merely their opinionsometimes based on disappointing personal experiences. Here is an example, written in response to a blog I posted about how some college students drink heavily before going to a party (frontloading). Under the subject heading Do you ever frontload? the commenter bitingly added,

Then maybe youre an alcoholic. Another item to add to the alcoholism self-assessment checklist. You might have a problem so go to AA.

Well, seriously we dont need more reasons to send people to AA, which is an unproven treatment and often just makes the problem worse (by requiring that the attendee admit powerlessness to their cravings among other things).

Frontloading is often just a way to save money, like the above commenter says, or to arrive at the party in a better mood, which is a perfectly good reason to drink. The real problem is chronic excessive drinking (front, back, or mid-loaded), which is normally a sign of an underlying psychological issue. In most cases its just a phase that young people go through and does not lead to alcoholism.

In the blog I had never mentioned AA, nor did I suggest that these students were destined to become alcoholics. Rather, I was writing about the increased risks associated with frontloading, such as fights, vandalism, and sexual assault. That did not deter this commentator, however, from gratuitously asserting that AA is an unproven treatment that often just makes the problem worse.