Addiction treatments have historically emphasized adapting individuals to a predetermined recovery model, most commonly 12-step methodology. Triple Modular Recovery argues that addiction treatment has been missing something more fundamental than a singular recovery method: its first comprehensive recovery framework.
Ultimately, recovery is a design problem.
Drawing on more than twenty years of experience redesigning complex systems, Author Dan Shreve approaches addiction from an engineer’s perspective. Triple Modular Recovery reverses the recovery equation by presenting a comprehensive framework designed to help individuals build an effective strategy tailored to their unique needs using the best available scientific evidence.
Addressing both substance and behavioral addictions, the Triple Modular Recovery framework is intended to complement, rather than replace, existing recovery tools by helping readers identify which approaches are most likely to work for them.
Recovery methods already exist in abundance. What's been missing is a framework that explains how to choose, combine, and adaptthose methods based on an individual’s challenges, preferences, and circumstances. Rather than asking readers to adopt a single philosophy or program, Triple Modular Recovery examines the science of addiction and explores the strengths and limitations of today’s most common recovery approaches, organizing evidence-based strategies into a powerful customizable framework.
Addiction treatments have historically emphasized adapting individuals to a predetermined recovery model, most commonly 12-step methodology. Triple Modular Recovery argues that addiction treatment has been missing something more fundamental than a singular recovery method: its first comprehensive recovery framework.
Ultimately, recovery is a design problem.
Drawing on more than twenty years of experience redesigning complex systems, Author Dan Shreve approaches addiction from an engineer’s perspective. Triple Modular Recovery reverses the recovery equation by presenting a comprehensive framework designed to help individuals build an effective strategy tailored to their unique needs using the best available scientific evidence.
Addressing both substance and behavioral addictions, the Triple Modular Recovery framework is intended to complement, rather than replace, existing recovery tools by helping readers identify which approaches are most likely to work for them.
Recovery methods already exist in abundance. What's been missing is a framework that explains how to choose, combine, and adaptthose methods based on an individual’s challenges, preferences, and circumstances. Rather than asking readers to adopt a single philosophy or program, Triple Modular Recovery examines the science of addiction and explores the strengths and limitations of today’s most common recovery approaches, organizing evidence-based strategies into a powerful customizable framework.
“If no problem is recognized, there is no recognition of the need for improvement.”
- Masaaki Imai
Life — like the people who live it — can be complex and simple, beautiful and ugly, wondrous and maddening, all at the same time. Reality is both absolute and absolutely confounding. For example, it’s natural to think that falsehoods hide the truth while facts reveal it, but sometimes the inverse is true: falsehoods can reveal the truth while facts can create a falsehood.
Everyone has heard this notorious untruth: “You don’t have to get me anything for Valentine’s Day.” Translation: “Technically you don’t have to do anything, but if you truly care about me you’ll want to make my Valentine’s Day special.” That’s a falsehood revealing the truth. One person is being false in order to determine how the other person truly feels. In other words, what is literally being said is different from what is actually being said. Is that fair? Debatable. Is that wise? Highly debatable. Is that reality? Great friggityfuck yes. Here, then, is an example of facts creating a falsehood:
Leading causes of death in the US in 2021
Heart disease: 695,547
Cancer: 605,213
COVID-19: 416,893
Accidents (unintentional injuries): 224,935
Stroke (cerebrovascular diseases): 162,890
Chronic lower respiratory diseases: 142,342
Alzheimer’s disease: 119,399
Diabetes: 103,294
Chronic liver disease and cirrhosis: 56,585
Nephritis, nephrotic syndrome, and nephrosis: 54,358
The data above came from the Centers for Disease Control and Prevention (CDC) and it is a simple statement of fact. No reasonable person would debate it, yet it’s a perfect example of life’s duality. It is literally correct, but it completely obscures the actual truth. Here’s another simple statement of fact from the CDC:
Deaths due to excessive alcohol use in the US in 2021
As of 2021, excessive alcohol use was responsible for 178,000 deaths per year in the US.
Two thirds of the deaths (about 117,000) are due to chronic conditions that develop from long-term alcohol use, including various types of cancer, heart disease, liver disease, and alcohol use disorder (AUD).
One third of these deaths (about 61,000) happen from drinking too much on one occasion, such as from motor vehicle crashes, poisonings involving substances in addition to alcohol, and suicides.
Something is wrong with this picture. If the CDC says that in the US excessive drinking was responsible for 178,000 deaths in 2021, why doesn’t excessive drinking appear on the CDC’s 2021 list of leading causes of death in the US? How can two sets of seemingly contradictory data from the same source both be true?
This is another example of the literal truth and the actual truth being different. Drinking was the root cause of 178,000 deaths in 2021, not the direct cause. Liver disease killed your uncle, but he got liver disease from years of excessive drinking. A car accident killed your coworker, but the accident was caused by a drunk driver. When the alcohol-related deaths due to heart disease, cancer, and accidents are removed from those categories in the CDC’s leading cause of death chart and properly attributed to addiction, a shocking reality becomes clear: in 2021 excessive drinking was the fourth leading cause of death in the US, and the true scale of the addiction problem is even greater. Alcohol abuse is just one form of substance addiction. According to the CDC, 2021 also saw 106,699 deaths from drug overdoses, primarily fentanyl and methamphetamine. Drug overdose deaths have quadrupled in the last 20 years and this trend is accelerating rapidly.
Like I said, life can be both wondrous and maddening. Truth can be obscured by facts. Addiction and addiction treatment are both complex and simple. What is addiction, how do we treat it, and how successful are our treatments? More to the point, how the hell can I save my own life or the life of my loved one from addiction? These are basic questions with surprisingly complex answers. The good news is that sobriety — like truth — can be found if you’re willing to wade through the misconceptions and falsehoods that flood the world of recovery.
Where to Begin
It’s impossible to talk about addiction recovery without talking about Alcoholics Anonymous, because their twelve-step methodology has become the defacto addiction treatment of the land, and indeed the world. Even people who have never struggled with addiction know that addiction is a disease and if you can’t control your drinking you need to get to an AA meeting. They’ve been told these things for decades by news articles, popular culture, and addiction experts alike. Today just about every addiction you can imagine,from drugs to sex to gambling to eating. has it’s own Anonymous twelve-step program. There are thousands of online meetings available to those in recovery and thousands more in-person meetings taking place every day. You’d be hard pressed to find a town in the United States without an AA presence. Most cruise ships even offer a “Friends of Bill” meeting to aid those trying to stay sober in the face of the prodigious drinking common on vacation liners. But despite its ubiquitous acceptance, Alcoholics Anonymous’ twelve-step recovery model is troubling in a variety of ways.
For example, Alcoholics Anonymous evangelizes their solution to people who are in a state of desperation, which AA calls “hitting rock bottom”, when the consequences of their addictive behavior are crashing down on their heads. In a moment when the person struggling with addiction is consumed by terror — seemingly without control of their own behavior and fearing the loss of their loved ones, their career, and all the good things in the life they’ve built — Alcoholics Anonymous steps in to offer salvation in exchange for unquestioning adherence to their twelve-step program.
I think most people would agree that high quality decisions are made with a calm mind that has considered the facts surrounding an issue thoroughly. Conversely, decisions made when one is caught up in frantic, intense emotion are almost always poor decisions. Let me illustrate this dichotomy with a story from my own life. I was once walking through the woods and stumbled upon a bear, who reared up on his hind legs and let out a terrifying roar just a few feet away from me. Fearing for my life and suddenly flushed with adrenaline, I raced back to the cabin I was staying in, running faster and further than I ever had before. Do you you know what I didn’t do once I had slammed the cabin door shut behind me? Purchase real estate, decide on my college major, or propose marriage. I didn’t do any of those things because it would have been batshit insane to make a life-altering decision while swept up in such an intense emotional state.
Ask yourself how many good decisions you’ve made — has anyone made — when consumed by panic and desperation? Intense emotion is a terrible decision making tool because it leaves no room for rational analysis. How many excitement-driven impulse purchases have you regretted? How many words have you spoken in anger that you wish you could take back? How much junk food have you mindlessly consumed while swept up in stress or sadness? Why then is a mindset of intense desperation a prerequisite for successful adoption of the AA program? That’s troubling to me, and the history of Alcoholics Anonymous and their solution for alcoholism raises many more concerns.
So, let’s start at the beginning and build a thorough understanding of AA and the twelve-step addiction recovery model. Where did Alcoholics Anonymous come from? How does the program work? How did it come to dominate the modern recovery landscape? Most importantly, how often does its treatment succeed? In reality, how effective is AA?
We all know that addiction is a major problem. What most people don’t know is how bad we are at solving it. This is the hidden problem within the problem: addiction treatment desperately needs to be improved. Nearly a century of statistical evidence shows that the vast majority people who attempt to find sobriety using twelve-step methodology aren’t able to do so. If you tried to get sober in Alcoholics Anonymous but didn’t succeed, it’s time to ask yourself if you failed the program or if the program failed you.
Flashpoint
The year 1939 was a pivotal turning point for one of the most challenging health care issues of the time: alcoholism. During the 1930s, the medical community was generally resistant to treating alcoholics as they had no effective means of addressing their issues. The success rate for a seriously addicted alcoholic’s recovery was essentially zero. Alcoholics were hopeless degenerates, as contemptible as they were incurable, or so the prevalent thinking of the time went. The wildly unpopular Prohibition Era had recently ended and its spectacular failure was fresh in the minds of the US population, so the will to advance treatments for alcoholics was nonexistent. Thus, severe addicts were typically locked up in the psych wards of hospitals and written off as lost causes.
There were a few exceptions among medical professionals who took pity on the suffering of addicts, yet they had no clear path forward to advance the treatment of addiction; doctors could do little more than console the loved ones of the sick and dying. Into this hopeless void stepped Alcoholics Anonymous, confidently offering salvation from the seemingly certain doom of alcohol addiction.
In 1939, Alcoholics Anonymous, a.k.a. “The Big Book”, was published. It was written by Bill Wilson, one of the co-founders of Alcoholics Anonymous, and it serves as the foundational text for the AA program. Bill founded the Alcoholics Anonymous organization in 1935 along with Dr. Robert Smith, commonly referred to as Dr. Bob. Early success and steady growth inspired Wilson to codify the program in Alcoholics Anonymous. The book details the twelve steps of recovery and shares personal stories from early AA members of their recovery from alcohol addiction.
After suffering with alcoholism for years, Bill had eventually found sobriety in the Oxford Group, a Christian organization that held absolute surrender to God was the only cure to the selfishness and moral depravity that caused addiction. He was recruited into the group after a surprise visit from a friend and former drinker who “got religion” and recovered within the Oxford Group. Wilson was an atheist at the time and balked at the notion of organized religion, so his friend advised him to “choose his own conception of God” instead. Wilson was desperate to escape alcoholism and the notion of a non-religious God gave him enough latitude to move forward.
The Oxford Group was — in a word — bananas. Their stated aim was to achieve world peace. That sounds like a fine goal on its face, but shit gets weird fast when you hear what they actually had to say. Below are the words of Oxford Group founder Frank Buchman:
“The secret is God-control. The only sane people in an insane world are those controlled by God. God-controlled personalities make God-controlled nationalities. This is the aim of the Oxford Group. The true patriot gives his life to bring his nation under God’s control. Those who oppose that control are public enemies.”
To convert anyone “too insane” to join the Oxford Group of their own free will, members employed the “Five Cs” method as documented in their founder’s manuscript, Soul Surgery. The methodology was textbook psychological manipulation. The Five Cs involved befriending the subject to win their confidence, leveraging trust to elicit a confession of their weakness and unworthiness, building the subject’s conviction by encouraging feelings of intense guilt, converting them to “obedience” within the Oxford Group as a means to ease their guilt over their own unworthiness, and finally tasking the newly minted recruit to employ the same creepy tactics to convert others, or continuance as the Oxford Group called it.
While a regular attendee of Oxford Group meetings, Wilson continued to consume alcohol in excess and often arrived at meetings drunk. He soon found himself hospitalized for alcoholism under the care of Dr. William Silkworth (who would later pen a letter included in “The Doctor’s Opinion” at the beginning of Alcoholics Anonymous). Despairing over his alcoholism, Bill fell to his knees in his hospital room and begged God for salvation.
In this moment of desperation, Wilson underwent what he called an “authentic spiritual experience” that ended his atheism. He described a flash of light that consumed him and the feeling of God’s presence enveloping his body. Wilson was filled with a “cleansing wind”, after which his desire to drink was miraculously gone. Bill Wilson was cured!
If only life were so black-and-white. It’s true that Bill Wilson never drank again, but he struggled throughout his life with addiction to caffeine, nicotine, and sex even after he abandoned drinking (more on that in chapter five). The simple fact of the matter is that Bill Wilson stopped drinking but he never stopped being an addict. He suffered from cross addiction, which is when the cessation of one addictive behavior gives rise to a different addiction. While Wilson’s experience of spiritual transformation was no doubt genuine, it’s clear that it wasn’t a comprehensive antidote for his addictive tendencies, and there are several reasons to question its underlying nature.
First, it may well have been a hallucination, given that under Silkworth’s care Wilson received hourly doses of the hallucinogen Atropa belladonna — commonly known as deadly nightshade. Second, the details of Wilson’s spiritual experience exactly match the details of a sobriety-inducing spiritual transformation described to Bill in his youth by the grandfather who raised him. Yes, Wilson’s experience might have been a spiritual encounter with the Divine as he wholeheartedly believed it was, but it’s also entirely plausible that his vision was a drug-fueled hallucination based on his own memories. Regardless, the idea that an authentic spiritual experience could eliminate addictive cravings became a central tenet of Alcoholics Anonymous.
In time, Wilson felt compelled to start Alcoholics Anonymous because he believed an organization was needed to focus solely on alcoholism as opposed to the Oxford Group’s wider mission. This was both a practical and strategic decision. The Catholic Church had become critical of the Oxford Group and Wilson didn’t want to risk alienating current or future Catholic AA members. It seems likely Bill was also motivated to distance himself and his organization from founder Frank Buchman, whose proclamation of “I thank heaven for a man like Adolf Hitler” in a 1936 newspaper article was met with widespread rebuke.
Despite the troubling tactics of the Oxford Group and even more troubling beliefs of its founder, AA and the twelve steps were deeply influenced by Oxford Group philosophy and methodology. Their fingerprints can be seen throughout AA’s twelve steps and the text of Alcoholics Anonymous. While the existence of the twelve steps is widely known today, few are actually familiar with the details of the solution to addiction they lay out. Here, then, is AA’s treatment for alcoholism verbatim :
We admitted we were powerless over alcohol — that our lives had become unmanageable.
Came to believe that a Power greater than ourselves could restore us to sanity.
Made a decision to turn our will and our lives over to the care of God as we understood Him.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked Him to remove our shortcomings.
Made a list of all persons we had harmed, and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take personal inventory and when we were wrong promptly admitted it.
Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
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.
The twelve steps form the core of the Alcoholics Anonymous methodology, but there are some other important tools and principles at work. First and foremost among them is the disease theory of addiction. A central concept of Alcoholics Anonymous is that addiction is a disease. The Big Book describes it as a “physical allergy” and a “mental obsession,” arguing that these elements put the management of alcoholism beyond reach for the addict. In the first chapter of Alcoholics Anonymous, Dr. Silkworth is quoted:
“The phenomenon of craving is limited to this class [alcoholics] and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all.”
In addition to the physical allergy, The Big Book discusses a mental aspect that it calls “the obsession of the mind.” This is described as a compulsive thought process that drives the alcoholic to drink even when they know that drinking will lead to negative consequences. Their obsession leads to the first drink, which then triggers the physical craving. Trapped by both a mental illness and a physical ailment, the addict has no hope of overcoming addiction without divine intervention.
Another central concept in AA is sponsorship, although neither the twelve steps nor the text of The Big Book ever mentions it. A sponsor is another member of Alcoholics Anonymous with at least one year of sobriety who takes new members under their wing and works the twelve steps with them. While the relationship between sponsor and sponsee may grow close over time, it is very much founded in tough love. An AA sponsor is more coach or drill sergeant than friend — their role is to provide guidance and instruction, not comfort. You got yourself into this mess, so now your job is to listen, do as you’re told, and put in the work necessary for sobriety, all day every day. As Alcoholics Anonymous puts it: “Every day is a day when we must carry the vision of God’s will into all of our activities.”
Many people are surprised to learn that faith in God is a requirement in Alcoholics Anonymous. While AA does not endorse any particular religion, the solution to alcoholism offered by the twelve steps is firmly rooted in theism; in the belief that a God exists who is capable of removing alcohol cravings from the addict. Alcoholics Anonymous staunchly insists it is a “spiritual” organization since it adheres to no specific organized religion. However, the use of the term “spiritual” is a semantic error at best and disingenuous at worst given that faith in God is undeniably required in AA.
God is referenced in seven of the twelve steps. God with a capital G is specifically called “God” 277 times in Alcoholics Anonymous. The Big Book also contains 107 specific pronouns — He, Him, His, Himself — which are similarly capitalized and therefore unquestionably refer to God. Counting the additional places where Alcoholics Anonymous contains references to a Creator — calling Him “Creator,” “Maker,” “Father,” “Father of Light,” and “Spirit” — God is specifically mentioned in The Big Book more than 400 times.
To say all that and then label yourself spiritual instead of theistic is high level equivocation. It’s a paper-thin veil meant to make the program more appealing to addicts who do not embrace a religious faith — as was the case with Wilson himself — and to avoid excluding potential members already devoted to a specific religion. Get them through AA’s front door, the thinking goes, and eventually they’ll come around. One needs only read the “To Agnostics” chapter in The Big Book to see this clumsy ruse plainly laid out in Bill Wilson’s own words.
All of that being said, AA’s spiritual gamesmanship is not their biggest problem. While the Alcoholics Anonymous treatment of God is certainly odd, it’s their disease theory of addiction that makes the program deeply problematic. Simply put, addiction is not a disease. That’s not my personal opinion; it is a long-established and verifiable medical fact. Ultimately, AA’s misdiagnosis of the root cause of addiction and popularization of the idea that addiction is a disease has done far more damage than their solution has repaired.
A Historic Failure of Basic Logic
Upon its publication, the scientific community dismissed Alcoholics Anonymous. The Journal of the American Medical Association wrote that AA’s Big Book was of “no scientific merit or interest,” describing it as “a curious combination of organizing propaganda and religious exhortation.” However, the founders of Alcoholics Anonymous were undeterred. Bill Wilson and Dr. Bob were fervent in their belief that they had discovered the key to combating alcoholism: addicts helping addicts by working the twelve steps together, beating the “physical allergy” of addiction with the “spiritual toolset” described in Alcoholics Anonymous.
While laudably driven to help other addicts, Wilson’s enthusiasm blinded him to a basic logical fallacy in his thinking: confirmation bias. A confirmation bias is when a person favors information that supports their existing beliefs, seeking out and interpreting data favorable to the conclusions they’ve already reached. This is an unconscious bias that we all exhibit to some extent. Having triumphantly escaped from alcohol addiction himself, Wilson knew he must be right about its cause and solution.
This critical early misstep would ultimately lead to Alcoholics Anonymous seeking out evidence to confirm a conclusion that its proponents had already accepted as fact: addiction is a physical disease and only God can cure it. As is always the case with confirmation bias, any evidence that did not support the program’s tenets would be ignored, rejected, or attacked as heresy. Instead of an honest search for the most effective alcoholism treatment, the history of addiction treatment in America would become a story of the staggering opportunity cost incurred when logic, reason, and the scientific method are displaced by fervent devotion.
Despite AA’s methodology having no foundation in medical science, some in the medical community were more than happy to be relieved of the burden of treating addiction and thus encouraged patients to embrace the Alcoholics Anonymous program. Charles Towns, who founded the hospital where Bill Wilson first achieved sobriety, had seen its effects on Wilson and his growing following firsthand. Early results were positive and AA seemed like a promising solution, so Towns offered to fund an alcoholism treatment program to be run out of his hospital under Bill’s direction.
Convinced that the program would only be effective if was conducted by former drinkers based on their first hand experiences rather than by medical doctors or professional counselors, Wilson turned down the offer. To his thinking, the success of the fledgling AA organization depended on the model of addicts helping addicts. As time would tell, Wilson’s vision of recovery programs based on the twelve steps, staffed by Alcoholics Anonymous members instead of trained professionals, would ultimately become the dominant model for addiction recovery in the United States. But to reach a wider audience, AA would need funding.
John D. Rockefeller Jr. was a strong proponent of the recently failed policy of alcohol prohibition, and he was still convinced that alcohol posed a grave threat to the nation. The AA program’s combination of spirituality and science was appealing to Rockefeller, so he provided $5,000 of early funding. It wasn’t enough to spread the program nationwide, but it was sufficient to enable Bill Wilson and Bob Smith to dedicate their full attention to rehabilitating alcoholics.
Around the same time, the American Association for the Advancement of Science also met with Rockefeller to address the problem of alcoholism. The AAAS was a large, highly respected society of the top scientists in the US, and they had just formed the Research Council on Problems of Alcohol. The goal of the RCPA was to identify and fund the best scientific research on alcoholism, then recommend the most promising treatments and policies. In the words of the executive director of the AAAS:
“If we are to find a way out, it can only be through the development of a complete factual basis on which can be built some effective plan of action.”
Sound logic, wise judgment, and steadfast patience are indeed the foundation of true and lasting progress. They are also wildly unpopular, much like the subject of alcoholism itself. The executive director’s words fell on deaf ears: Rockefeller gave the Research Council on Problems of Alcohol absolutely nothing.
The US government similarly declined to fund the AAAS, as did the vast majority of philanthropic funding organizations. While the problem of alcoholism was great, the public will to face it was weak in the wake of the recently failed Prohibition movement. The Carnegie Foundation eventually gave the RCPA a $25,000 grant, far short of the millions they had hoped to secure. It was enough to get started, but little more. By their third year of existence, the Research Council on Problems of Alcohol was on life support and desperately needed an infusion of funding to continue. In their hour of need, an unlikely source of salvation emerged: the alcohol industry itself.
Unsurprisingly, the offer from alcohol producers and distributors to fund the RCPA came with conditions. All proposed studies of alcohol itself were to be shelved in favor of studies on “the disease of alcoholism”, despite there being no scientific evidence that such a disease existed. The concept of alcoholism as both a physical malady and a defect of character on the part of the individual who was drinking, while clearly contradictory, fit perfectly with the Alcoholics Anonymous model. For alcohol producers the benefit of this mindset was clear: it neatly shifted the blame for alcoholism from the suppliers and promoters of alcohol to the consumers of it.
The table was now set for decades to come in terms of how alcoholism would be thought of and addressed: not based on science, evidence, or logic, but rather on the preferences of a few bad actors and the blind faith of well-meaning zealots who would spread the disease theory of addiction across the nation.
Player Two Has Entered The Game
Marty Mann is a largely unknown figure within Alcoholics Anonymous. The names of founders Bill Wilson and Dr. Bob crop up often in AA meetings, but Mann is never mentioned. Yet she deserves perhaps more credit for making the organization into the juggernaut it is today than the founders themselves.
Mann grew up a privileged young woman among Chicago’s elite, attending prestigious schools and moving with effortless charm through high society. An aspiring novelist, Mann was a gifted speaker skilled in presenting herself and her ideas in an appealing manner. However, Marty Mann struggled with alcoholism for years as a young woman.
Appearances were very important in her family, and her diagnosis with the “lower-class” disease of tuberculosis as she was about to enter high school was a potential embarrassment. She was unceremoniously shipped off to a sanitarium in California to recover from TB. Mann felt persecuted for a health condition she could not control and the feeling of injustice was burned in her mind. She was also secretly a lesbian, a lifestyle deeply frowned upon in the early 20th century. Hiding her true self to spare her family shame became a central feature of Mann’s teenage years and early adulthood, and the resulting mental trauma fueled a drinking habit that quickly grew out of control.
By her early thirties Mann was drinking nonstop. A drunken fall from a balcony landed her in traction for six months, but even that could not slow her addiction. She had friends sneak whiskey into the hospital and drank it through a straw because her jaw was wired shut. Later, following two failed suicide attempts Mann was hospitalized for a year and received every available alcoholism treatment, but it was of no use. Marty’s drinking continued unabated until her doctor brought her a copy of the as-yet-unpublished Alcoholics Anonymous.
Early in the book, Bill Wilson recounts the flash of light and profound spiritual transformation that freed him from alcoholism. Reading the book, Mann had a profound spiritual experience of her own. Angered by The Big Book’s ceaseless references to God and language clearly meant for men, she flung the Alcoholics Anonymous manuscript across her hospital room. While retrieving the book she became fixated on five words on the page it lay open to: “We cannot live with anger.” Mann would later recount immediately falling to her knees to pray upon seeing the words, and then being filled with light and serenity. While she would have several relapses in the coming years, this moment was a major turning point in Mann’s recovery from alcohol abuse.
Now a fervent believer in the Alcoholics Anonymous program, Marty Mann traveled to New York and connected with Bill Wilson, who became her AA sponsor. Some members of Alcoholics Anonymous were skeptical of Mann due to her age and gender, but the fiery woman would not be deterred. Informed by her experience with TB in her teenage years, Mann was determined to fight both the disease of addiction and the social stigma that came with it.
When Mann proposed a nationwide education program on alcoholism and AA’s twelve-step cure, Wilson wholeheartedly encouraged her to pursue her vision. Alcoholics Anonymous’ own twelve traditions state that the organization grows “by attraction rather than promotion”, yet Mann would turn out to be nothing less than a one-woman PR war machine. All she needed was a little ammunition in the form of scientific support for AA’s disease theory and its treatment for alcoholism. No such support existed at the time — a fact which apparently gave Mann no pause whatsoever — so she sought to partner with a respected scientific organization that would lend veracity to her message. She found exactly what she needed at Yale University.
Howard Haggard, one of most well-known scientists at that time, had founded a program for the study of alcohol at Yale along with his young scientific protégé, Elvin “Bunky” Jellinek . Haggard was a former member of the Research Council on Problems of Alcohol and a vocal opponent of Prohibition, advocating instead for moderation in drinking. He quit the RCPA after they accepted the liquor industry’s money and the restrictions on future alcohol-related research that came with it .
Neither Haggard nor Jellinek embraced the idea that alcoholism was a disease; that was another major reason why they had departed the RCPA. Yet when Mann pitched Jellinek on her plan to shift public opinion on alcoholism, he saw a valuable ally who could support the Yale program’s efforts to change the country’s dialog around alcohol. Jellinek sold Haggard on not just supporting Mann’s campaign but fully funding it and incorporating her strategy into the Yale program.
With the heft of Yale’s legitimacy behind her, in 1944 Mann created the National Committee for Education on Alcoholism, proudly touting the inclusion of Alcoholics Anonymous founders Bill Wilson and Dr. Robert Smith on the organization’s advisory board. Media-savvy from the beginning, Marty Mann announced the launch of the NCEA organization to much fanfare from newspapers, dramatically revealing that she was herself an alcoholic. Mann flew in the face of common stereotypes of addicts — she wasn’t dirty, sickly, or degenerate. She wasn’t worn and weary from years surviving on the fringes of society. Rather, Marty was young, stylish, attractive, healthy, and intelligent. She presented a compelling contrast to the preconceived idea that most people held of alcoholics as being hopeless wretches who deserved disdain. She wasn’t bad, she was just ill! Mann emerged from obscurity to share the good news that alcoholism was a disease and that Alcoholics Anonymous was the cure.
It was like a bucket of cold water being dumped onto the head of a tired old idea. The press woke up, wide-eyed and alert, and drank in this fresh view of addiction. Major articles began to appear in a wide array of publications. Marty Mann’s message was out in the world, spreading like wildfire, and she fanned the flames tirelessly. She crisscrossed the country giving hundreds of speeches and interviews, delivering her message to over 25 million people. From the inception of Alcoholics Anonymous in 1935 to the launch of Mann’s NCEA in 1944, fewer than 10 articles per year were published on the subject of alcoholism as a disease. After one year of operation, Mann raised that number to 15 in 1945. It rose again to 22 in 1946. For the next twenty years, the annual number of articles about alcoholism as a disease would remain in the double digits. The disease theory of addiction was now firmly rooted in the public consciousness, yet it remained scientifically unsupported.
In 1948 the addiction treatment industry as we know it today began to take shape. The first treatment center based on AA’s principles of addicts treating addicts, the aptly named Pioneer House, opened in Minnesota. While Minnesota’s Civil Service commission required professional counselors to have a master’s degree, the Pioneer House lobbied for the creation of a new alcoholic counselor position that would require only two years of sobriety and a high school diploma.
Many scoffed at the idea of non-professional treatment counselors, but the concept nevertheless took root out of sheer practicality. “A workforce had to be created – and created quickly,” psychologist William White wrote in Slaying the Dragon: The History of Addiction Treatment and Recovery in America. The rest of the US soon followed suit, allowing non-professional counselors to be employed by addiction treatment centers and thereby enabling them to proliferate rapidly across the nation. “The growth of the overall field was staggering,” wrote White. “Alcoholics and addicts became less people in need of treatment and more a crop to be harvested for their financial value.”
In the meantime, Mann pressed forward in her campaign to find scientific support for the claim that alcoholism was a disease. In time, she grew exasperated with Haggard’s Yale program for failing to produce the desired evidence — which stubbornly continued to not exist. Patience waned and nerves frayed on both sides, ultimately leading to Mann and Yale parting company.
Mann’s organization began operating under a new name, the National Council on Alcoholism (NCA). By the early 1950s, Mann had a new financial backer in Brinkley Smithers, the wealthy son of IBM’s founder and a recovering alcoholic himself. Now well-funded, Marty Mann set her sights on the American Medical Association, knowing that if she could get the AMA to acknowledge alcoholism as a disease, her organization would finally have the scientific cachet she had long sought.
In 1952 the AMA created the Council on Mental Health, and in 1954 the CMH created the Committee on Alcoholism. The committee was headed by Dr. Marvin Block, who was a Mann ally and proponent of the disease theory of alcoholism. While the CMH couldn’t persuade the AMA to fully endorse the disease theory of addiction, in 1956 they managed to sway the AMA into issuing a declaration that alcoholism was a “serious health problem” and that the alcoholic was “a sick individual.” Though hardly an unequivocal endorsement of the disease theory of alcoholism, Bunky Jellinek nevertheless declared it as such. Now parted from Yale, Jellinek insisted that the declaration “constitutes, of course, the formal acceptance of the disease conception of alcoholism by the American medical profession as a whole.”
Mann’s National Council on Alcoholism saw their opportunity and pounced; Brinkley Smithers commissioned Jellinek to write a book that would formalize the assertion that alcoholism was a disease. In 1960, that labor bore fruit when The Disease Concept of Alcoholism was published. It became an instant classic in the alcoholism world, and to this day it’s frequently cited by a large number of treatment programs. Critically, however, the book lacked the support of verifiable scientific data for the premise that addiction was a disease. Undeterred by an objective reality that did not adhere to AA’s worldview, Jellinek turned to equivocation instead of facts and focused on making a semantic argument. Most of the The Disease Concept of Alcoholism is spent splitting hairs about the meaning of the words “illness” and “disease,” concluding with Jellinek declaring that “a disease is what the medical community recognizes as such.”
This is yet another classic logical fallacy: appealing to authority. While appealing to credible experts can sometimes be reasonable, it becomes a logical fallacy when no supporting evidence or compelling reasoning accompanies the claim. In other words, a statement from a recognized authority can lend credence to a position supported by verifiable evidence, but that authority’s words are not in and of themselves compelling evidence for that position. Even if you have a PhD, “Trust me, bro!” is not a solid foundation for effective medical policy.
The NCA and Alcoholics Anonymous ignored the flimsy substance of Jellinek’s book and instead began proudly touting the existence of The Disease Concept of Alcoholism. The powers that be in the circles of US addiction recovery swallowed it hook, line, and sinker. That the book offered nothing in the way of scientific support seemed to matter not at all; its existence was proof enough for those people and organizations that had already been evangelizing for decades that alcoholism was a disease. It would be entirely fair to say that in this case judging a book by its cover shaped the lives and deaths of millions of Americans for years to come. Jellinek’s book legitimized the disease theory of addiction and set the stage for AA’s twelve-step methodology to become the dominant addiction treatment in the United States.
To recap: Marty Mann’s National Council on Alcoholism got the American Medical Association to state that alcoholism was a health problem via a committee created and headed by doctors associated with the NCA. Bunky Jellinek squinted hard and interpreted that statement as an endorsement of the disease theory of addiction, so the NCA paid him to write a book saying as much even though his argument rested entirely on a basic logical fallacy.
Cluster-fuckery, thy name is the disease theory of addiction.
I would find it hilarious that something so plainly stupid had actually worked if it weren’t also an utter tragedy for the effective treatment of an often-deadly condition. The motivations of those involved in this debacle were undoubtedly pure, but as the saying goes the road to hell is paved with good intentions. The good-hearted but misguided actions of Bill Wilson, Marty Mann, and their respective organizations accelerated the world down the wrong road in pursuit of a disease that never existed. In doing so, they unwittingly denied effective treatment to millions of addicts who desperately needed it. Every year that passes with the disease theory of addiction still driving U.S. addiction treatment strategy compounds this quiet catastrophe.
Let’s Just Be Friends
Everybody knows what the “friend zone” is. Many guys have been there and many gals have put someone there. For men, it’s the ultimate purgatory; a low self-esteem limbo where your true longing is eternally dangled just beyond your reach. For women who put men there, the friend zone acts as a solar panel for their ego, absorbing an endless supply of male validation while requiring nothing in return. As long as the man remains entranced by the faint whiff of pussy artfully wafted his way, the woman can suck him dry of time, attention, emotional support, and sometimes even money. It is a fundamentally parasitic relationship, with one party demanding complete subservience while the other desperately hopes that their loyalty will eventually be rewarded. It won’t be for the vast majority of men in the friend zone.
In effect, Alcoholics Anonymous has put addicts and addiction recovery itself in the friend zone by trapping us in a fruitless loop pursuing a flawed cure for a imaginary disease. Bewitched by a whiff of sobriety, all but a lucky few addicts have been denied the warm, velveteen depths of actual recovery. Instead, millions are forced to repeatedly listen to AA’s horseshit disease theory and endless moral proselytizing while silently enduring the painful ache of their addictive cravings.
With the disease theory of addiction now solidly — if fallaciously — established in the US, the adoption of the AA recovery model swiftly spread nationwide. By the mid-1960s, fresh funding had arrived to drive the rapid expansion of addiction treatment centers in the form of medical insurance. James Kemper, an alcoholic who got sober in AA, became president of his father’s company, Kemper Insurance, in 1961. Driven by his desire to help others achieve sobriety, Kemper instituted an internal program to help his employees who were fighting addiction. In time, he found that this approach offered financial benefits as well: costs fell because fewer employees were being replaced due to drinking problems, and fewer costly mistakes were being made, particularly at the executive level where one bad decision could cost the company millions of dollars. Kemper Insurance began offering alcoholism coverage to corporate clients, and other major insurance companies soon followed suit. By the 1980s, medical coverage for alcohol treatment was the industry standard.
In 1970, the US government itself poured fuel on the fire of the growing addiction treatment industry when Congress passed the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. It led to the creation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which would spend $1 billion over the next 10 years to develop AA-inspired twelve-step alcoholism treatment services across the country. This national network of treatment facilities cemented twelve-step recovery as America’s alcoholism treatment strategy, and Alcoholics Anonymous as the gold standard of recovery programs.
As a result, US courts began referring those arrested on alcohol-related charges to addiction treatment centers and AA itself as an alternative to incarceration. This practice became commonplace during the 1980s as an increasing number of movies and television programs popularized Alcoholics Anonymous and its twelve-step recovery program to a wider audience. Eventually, everyone “knew” that alcoholism was a disease and AA was the cure. Now firmly rooted in the zeitgeist of American culture, Alcoholics Anonymous would remain largely unchallenged and the state of alcoholism treatment would continue largely unchanged to the present day.
By 2020, there were over 16,000 substance abuse treatment facilities in the US alone, serving roughly 1.5 million patients per day. Addiction treatment centers are evenly split between non-profit and for-profit organizations, both charging $20,000 to $80,000 for a month of inpatient treatment depending on the amenities offered by the program. It should come as no surprise that people desperate to save their own lives or the lives of people they love are willing to pay anything for salvation.
Rehabilitation centers are highly profitable not only because people are willing to pay a premium to escape addiction, but also because treatment facilities are not staffed by expensive licensed professionals. Rather, rehab centers are largely staffed by non-professional addicts in recovery whose “expertise” is derived almost exclusively from their own experience in the Alcoholics Anonymous program. Addiction treatment centers do not require expensive medical equipment, and few if any actual doctors are employed by them. It is troubling that resolution of a problem as complex and difficult as addiction rests in the hands of the most affordable personnel instead of the most qualified.
More troubling still is that addiction rehabilitation centers are not required to measure or demonstrate the effectiveness of the treatments they offer. How often do the patients at these expensive, non-professional treatment programs achieve lasting sobriety? The answer to that question will determine whether they’re saving addicts or taking advantage of them.
Even more troubling is that addiction treatment centers are financially incentivized to not be effective; the more often addicts return to treatment, the more profitable the rehab programs become. Most people I personally met in rehab had been in treatment multiple times. I went to rehab twice myself, and one person I met was attending rehab for the seventeenth time! At some point we have to start asking how well the current approach is working.
For a program that’s been active for nearly a century and grown into the United States’ primary alcohol addiction treatment, its surprisingly difficult to determine a success rate for Alcoholics Anonymous. First we have to answer the question of what constitutes successful recovery from addiction. Thankfully AA makes that answer perfectly clear: the singular goal of their program is complete and total abstinence, which is achieved by actively working the twelve-step program every day. Abstinence through attendance is the only measure of success used by Alcoholics Anonymous, which famously gives chips to their members as they achieve one month sober, three months sober, six months sober, etc. With even one drink, the counter resets to zero.
How do you maintain perfect sobriety? By working the twelve program steps over and over, every day of your life, for as long as you live. You are quickly taught in AA meetings that if you stop coming to meetings and stop working the steps, alcoholism will soon find it’s way back into your life. So, how often do Alcoholics Anonymous participants achieve the stated goals of remaining in the program while staying completely abstinent?
Beginning in 1968, Alcoholics Anonymous’ general service board began conducting (completely unscientific) surveys of its membership every three to four years. In 1989 AA analyzed the results of all five surveys completed to that point and calculated that fully 95% of meeting attendees drop out of the program in less than one year. Right off the bat, that’s a striking number. If success in the program requires lifelong participation, then a 95% dropout rate equates to a 95% failure rate. But it gets worse. Of those 5% who remain in the program, 36% of respondents were still drinking a year after joining. Let’s put those numbers together: if we multiply the 64% sobriety rate by the 5% retention rate, the one year abstinence success rate for the Alcoholics Anonymous program is around 3%. In other words for every 100 people that begin AA, just 3 are still in the program and sober one year later. Alcoholics Anonymous fails to achieve it’s own defined measure of success 97% of the time.
Despite AA’s membership survey lacking academic rigor, these findings are so extreme that they should have set off alarm bells within the organization. They did not. Completely disregarding the massive dropout rate, the 1968 survey report proudly states that “60% reported that they had not had a drink for one year or more. This is one indication that A.A. works.” It would have been more accurate for them to state that “AA works 60% of the time for the 5% of attendees that remain in the program after one year,” but that doesn’t paint nearly as rosy a picture. If an accurate description of your success rate sounds eerily similar to the defense of Sex Panther cologne mounted in the movie Anchorman, things aren’t going great.
Alcoholics Anonymous had been “successfully” operating for over three decades by 1968. One would think they’d be pretty good at guiding alcoholics out of addictive drinking by then, so how could their one-year success rate be just 3%? Why is AA’s treatment failing the vast majority of drinkers who try it?
According to Alcoholics Anonymous the treatment isn’t failing the patients, but rather the patients are failing the treatment. As evidenced by AA’s characterization of their 60% abstinence rate, when someone achieves sobriety in their program AA gets all the credit. When someone does not, however, the drinker gets all the blame. The text of Alcoholics Anonymous dismisses those who don’t succeed in the program directly:
“They 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.”
While the fame and esteem of Alcoholics Anonymous has greatly advanced in the ninety-plus years since its foundation, the text, tools, and processes of AA have remained wholly unchanged. This is a point of great pride within the Alcoholics Anonymous organization; they see it as evidence of resolve and steadfastness. It should be a point of immeasurable shame. When you keep doing something that doesn’t work over and over that’s not resolve; it’s stubbornness. The AA program almost never works yet they refuse to do anything to improve it, and they have the gall to pat themselves on the back for their staunchness. I love and respect the people in Alcoholics Anonymous, but I am profoundly disappointed in the program itself.
A Tale of Two Treatments
Over the last century, consider the lives that would have been saved, the marriages that would have been preserved, and the children who would have gone untraumatized by absentee parents and broken homes had the success of alcohol abuse and addiction treatment been steadily improved upon. What if Alcoholics Anonymous had put their efforts into being the most effective alcoholism treatment possible instead of spending the better part of a century trying to prove themselves right about their disease theory of addiction?
At the beginning of this chapter I noted that Alcoholics Anonymous was published in 1939, and as we’ve seen that the tools and strategies of their program have remain just as fixed as their success rate. 1939 was also the year when modern open-heart surgery began to develop. At the time, the survival rate for open-heart procedures was just 5% because surgeons had no way to circulate blood throughout the patient’s body while the heart was being repaired. Dr. John Gibbon began developing the heart-lung machine to solve this problem. Years of development, testing, and improvements led to Dr. Gibbon performing the first successful open-heart surgery in 1953, during which the heart was stopped completely while his machine continue to circulate the patient’s blood.
This breakthrough was followed by many others over subsequent decades. Gibbon’s heart-lung machine made cardiac bypass surgery possible, allowing doctors to route the flow of blood around hopelessly clogged arteries. It allowed for the development of pacemaker devices that could be implanted in patients to eliminate dangerously irregular heartbeats. Minimally invasive surgeries were pioneered, laser surgery was introduced, and stent implants were developed.
Today, the success rate for open-heart surgery is over 95%. Since 1939, millions of people have had the opportunity to live rich, rewarding lives because humanity saw a problem, developed a solution, and never stopped improving upon it. This is how the science of healthcare is supposed to work.
Thomas Sowell is an economist, social theorist, and author who’s widely regarded as one of the most influential intellectuals of the 20th and 21st centuries. He is a frequent critic of counterproductive government policies founded on good intentions that nevertheless produce negative impacts. His worldview, neatly encapsulated in the following quote, rings remarkably true for Alcoholics Anonymous and addiction recovery: “A bad solution is worse than none at all.”
This is what I mean when I say that ineffective twelve-step programs “friend zone” the recovery world. Instead of continuously improving addiction treatment we’re stuck in limbo, fixated on repeating solutions that don’t work instead of looking for new solutions that do. Enough is fucking enough! It’s high time that the attention-whoring Alcoholics Anonymous organization and the gold diggers in the addiction rehabilitation industry either put out or get out. The powers that be must start improving addiction treatment or get out of the way so that someone else can. They have promised the world a solution to alcoholism and addiction for the better part of a century but all they’ve delivered is half-assed theories and shitty results.
A common refrain within the world of addiction treatment is that successful addiction recovery requires embracing three core principles: practicing rigorous authenticity, doing uncomfortable work, and surrendering the outcome. Rigorous authenticity means being honest with others and with ourselves, especially when it’s uncomfortable to speak the truth. The uncomfortable truth is that we have been working under a false premise. Addiction is not a disease and treating it as such endangers those who most need help. Human lives are on the line. We must be certain we’re doing everything possible to help, a mark we’re falling well short of today. It’s only when we choose to embrace verifiable facts, design treatment strategies around hard data, and commit to continuous improvement that we are doing our best to address a problem. Only when we’ve done everything possible to solve a problem can we surrender the outcome.
Warpath
We are losing the war on addiction because our forces have been misled by bad intelligence. We’re attacking where the enemy isn’t; fighting a disease that doesn’t exist. That desperately needs to change. Lives are being lost every day, and we’ve wasted too much time already. I’m hardly the first person to see things this way.
The founder of Alcoholics Anonymous, Bill Wilson himself, was removed as the leader of the organization in the 1950s for trying to evolve it into something more than the “spiritual kindergarten” he’d created in his early sobriety (his words, not mine). He attempted to revise both the text of Alcoholics Anonymous as well as the twelve steps themselves, only to learn that the organization he created had grown completely out of his control:
“As to changing the steps themselves, or even the text of the AA book, I am assured by many that I could certainly be excommunicated if a word were touched. It is a strange fact of human nature that when a spiritually centered movement starts and finally adopts certain principles, these finally freeze absolutely solid.”
Excommunicated feels like an odd turn of phrase for non-religious organization, but I digress.
“It would be a product of false pride to believe that Alcoholics Anonymous is a cure-all, even for alcoholism. Here we must remember our debt to the men of medicine. Here we must be friendly and, above all, open minded toward every new development in the medical or psychological art that promises to be helpful to sick people. We should always be friendly to those in the fields of alcoholic research, rehabilitation, and education.”
Wilson concluded:
“Let us constantly remind ourselves that the experts in religion are the clergymen; that the practice of medicine is for physicians, and that we, the recovered alcoholics, are their assistants.”
AA says there’s no need to change strategies because they insist that their current strategy is perfect — any failure is the fault of the addicts themselves. The government’s own agency, the NIAAA, has deeply invested in the disease theory of addiction, which has very shaky scientific foundations to say the least and has produced no significant improvements with respect to the effective treatment of alcohol abuse disorder. Pharmaceutical companies are making millions on medications that moderate the symptoms of alcohol addiction, so seriously pursuing a cure would go against their best interests. The same thing can be said of addiction treatment centers: repeat customers are great for business! Successful treatment, on the other hand, would be a financial disaster for rehabilitation facilities. In other words, no one in a position to help has any incentive to improve.
The truth of the matter is that the war on addiction isn’t really being fought at all; there’s no widespread will to press forward in the fight against addiction. Real lives are at stake, and right now society is disturbingly content to let addicts get mowed down in droves. The very organizations charged with combating this grave threat are willfully ignoring their own shortcomings and doing little if anything to improve the situation.
We’ve been holding position for far too long in our fight against addiction. It is time to advance! The powers that be in the world of addiction recovery are asleep at the wheel. If addicts want salvation we’re going to have to save ourselves. If you’re struggling with an addictive substance or behavior, this is your call to war. There are millions of addicts today, and there are millions more coming in the future. I cannot accept saving so few of them. I’m not having it, and neither should you! You’re better than that, you’re worth more than that, and you deserve a practical and effective method of combating addiction. Let’s build it together.
This self-help memoir gives an honest and unflinching inventory of problems addicts may face in treatment and during recovery.
The author's experience centers on alcohol abuse, but provide the names of other recovery programs to consider out in the real world.
Without treatment, addiction's destructive emotional and physical cost affects more than just the addicted person.
I
t is obvious he conducted a literature review to discuss the success rates of complete abstinence programs and explain his selection criteria. While not a robust set of various treatment programs, the basic information provides guidance on what to seek in a treatment program. He highlights his concerns about the variation in results.
The reason he takes time in explaining the criteria and results is that he wants to ensure everyone understands them. Later on, he explains why complete abstinence must be the goal. He provides resources on meetings to attend; he developed an app to help a person set goals in their recovery journey.
The author rejects the disease concept, describing it this way: "Addiction is a psychological compulsion created when a person feels powerless to escape intractable pain (page 167)."
He took great care in structuring the book, stating his reasons for his distrust of AA (Alcoholics Anonymous) using an overview of its history and data on the results of abstinence using AA meetings and a sponsor. Meeting attendance is crucial to continued sobriety.
He stresses that finding a good mental health counselor is essential during the healing process. His well-reasoned facts and personal experience bear this out.
The biggest obstacle to maintaining sobriety is breaking the ongoing habit of substance use rather than avoiding uncomfortable feelings. Daily practice and types of support are necessary.
He recounts his treatment journey, sharing diary entries that lay bare the deep-seated pain, shame, and fear that can trigger a relapse. Developing healthy ways to heal from that suffering is possible, but only if the person feels safe, has a trusted support community filled with mentors and friends whom they can reach out to when needed.
The last chapter contains a to-do manual emphasizing SMART goals and the importance of finding a community. The section where he uses his project management experience to explain why abstinence-only approaches must be the number-one goal is direct and effective.
This book is well-researched and thorough. My one complaint is that the author's excessive use of profanity defeats the excellent points he makes and lowers credibility. He wrote this book to help others who have resisted recovery interventions or have relapsed and who require more support to stay abstinent.
I received an ARC copy in exchange for a review.