More on Dr. Johnson's Critique of 12-step Programs

Letters to the editor in response:

The pros and cons of 12-step rehab

Thursday, August 12, 2010

I take issue with Bankole A. Johnson's Aug. 8 Outlook commentary, "12 steps to nowhere," which essentially devalued alcohol rehabilitation in order to sell "effective medicine" to treat alcoholism.

I have been treating alcoholism in the Defense Department and the Navy for 33 years. Alcoholics Anonymous works for us. Both the Defense Department and the Navy have used AA and Twelve Step Facilitation Treatment for 40 years and have a recovery rate five years after treatment of about 75 percent. The Navy has some experience with drinking -- and it knows how to treat alcoholism. Our lives depend on it. Marines like to go to war sober.

Dr. Johnson is paid to develop drugs as the primary treatment for alcoholism. However, he knows so little about how AA works and takes quotes from the Big Book completely out of context.

Two million sober members of AA, most not on medication, will see his article and know how wrong he is for them.

Ronald Earl Smith, Bethesda
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The writer is a captain in the Navy's medical corps and a senior psychiatrist and psychoanalyst at the National Naval Medical Center.

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I attended 150 12-step meetings in 90 days (versus the prescribed 90 meetings in 90 days) and have not been to a meeting since, in about 12 years. I also have had no alcohol in that time. The pros and cons of 12-step rehab

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I agree with everything Bankole Johnson said about the problems with 12-step rehabilitation. However, he failed to appreciate that if AA works for only a minority of people who try it, for that group "it works if you work it." Let others try something else.

If Dr. Johnson and his colleagues find a better cure, more power to them. Only do not let them or anyone say that AA does not work. It does for countless thousands, and at virtually no cost but time and effort.

Philip Saunders, Dunn Loring

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In his commentary, Bankole Johnson stated that "no experimental studies have unequivocally demonstrated the effectiveness" of the 12-step approach to addiction.

In an experimental study in 2006 conducted at the Veterans Affairs Palo Alto Health Care System, randomly selected addicted patients who received a structured introduction to Alcoholics Anonymous and Narcotics Anonymous had a more than 60 percent greater reduction in the severity of their substance abuse problems six months later than did patients not receiving such an introduction. In a different experimental study, also in 2006, of a 12-step-oriented sober-living home, addicted individuals were, relative to those receiving other forms of care, twice as likely to be abstaining from substance use and three times as likely to not be incarcerated.
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Both of these widely cited studies were funded by major, peer-reviewed federal research grants and were published in high-profile peer-reviewed journals.

Dr. Johnson's failure to mention them resulted in a mischaracterization of what research has established about the effectiveness of the 12-step approach.

Keith Humphreys, Palo Alto, Calif.