A group of people sat in a circle in a wooden shed outside at a large country house in the south of England. The door was ajar and the light was on. A counsellor asked if anyone could name any treatment methods for addiction other than the 12 steps.
A patient was offered cognitive behavioural therapy.
The counsellor said that the other methods came and went. Only the 12 steps work.
This was questionable to say the least. A series of moments in which I was told things I didn't understand defined my stay in a 12-step rehab for substance misuse. I was not in a place to argue.
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I was told on my check-in that I have a disease that is progressive, fatal and incurable and that I have a one in three chance of dying from it. I was in desperate need of a solution after my life fell apart over the course of a year.
The events that led to me going to rehab are not clear. There was a painful break up. I was hit by a truck in October of 2015. When I was 15 I discovered a way to deal with difficult emotions, and when I was signed off work, with my hand in a cast, I turned to it. I started drinking and taking recreational drugs to numb the pain of my parents divorce and the confusion I experienced around being gay.
This didn't feel right. I had cultivated self-acceptance. The root of my problems were my moral weaknesses.
My nemesis was to be proved by crystal meth. I have tried all the drugs. It's something else with meth. It has ripped through the gay scene, where it is used in conjunction with sex. The fun started as a mistake and quickly got out of hand.
I made the decision to move back in with my family temporarily so that I could clean up. My face was pressed against the window as I was in the car outside of the drug recovery service. Valium helped me carry on functioning for a while, I was dependent on it. I tried to quit at home, but felt like I was falling apart. It triggered a return to using crystal meth as an pain killer. I was all ears when someone suggested I go to the Priory. My family encouraged me to pick up the phone.
A woman answered. She said it would cost between £10,000 and $28,000 for a month's stay. I chose a small facility at the bottom of the scale because I was desperate. I didn't have to share a dorm because I had an en suite room. My parents arranged a loan for a family member. I have to pay back the privilege.
Why do I have to admit that I have a disease? Jon Tonks is a photographer for The Guardian.
I felt like I was going to my own funeral on the way to the clinic. We should stop in Chichester for lunch. I wasn't in the mood for a meal. I became aware that my situation was being pathologised. The doctor asked if he had ever injected. I said I have.
I asked if I would be allowed a glass of wine with dinner. The answer was no, like most rehabs, it enforced abstinence. I would spend the next 28 days with other patients, each on their own journey. The alcoholics I met were mostly from the home counties.
I was a mess. I was eager to get on with the work. Six hours of group therapy were included in the weekdays. In the evening, we might have yoga or acupuncture. The food was not bad. We started the day in the living room with bookshelves filled with ornaments. We would sit on the sofas in the half-light of the north-facing windows and read from the books that were usually about big Christian themes expressed through metaphors of eagles swooping or geological features to be overcome. I asked at check-in if I could have a Qu'ran with the Bible, but was told that the Bible was enough and that I had a crush on a Muslim boy. The Priory said that a Qu'ran is available at the clinic on request and that the voluntary 12-step programme is open to people of all faiths and none.
Group therapy was the same as before. There is a copy of the steps on the wall. We admitted that we were powerless over our addiction and that our lives had become unmanageable. We have to turn our life and will over to the care of God. We have to make a moral inventory of ourselves. We must admit to God, to ourselves, and to another human being the exact nature of our wrongs. So it continued.
This didn't feel right. I had spent a lifetime cultivating self-acceptance. The root of my problems were my moral flaws. My only salvation was to establish a relationship with God.
The gallows humor in rehab is amazing, we all messed up our lives so badly that the only thing left to do was laugh.
I sat in that shed and took turns reading aloud from the homework we had to do. We would feed on each other's problems: broken homes, failed marriages, misspent youth. The counsellors, most of them "12-steppers", gave examples of when things were going wrong and then gave words of encouragement and encouragement again and again until a solution appeared from between the clouds. The remedy for every problem was to work the steps.
I was given shots of B12 in my backside every night for the first week and it was useful for alcoholics. We smoked a lot. One fellow in the hospital said that he would leave with a drink problem and a smoker. There were messages of support and platitudes on the walls of the smoking shed. We told stories of our former lives to give a glimpse into the world we left behind. The gallows humor in rehab is immense, I will give it that: the one unifying factor of those present was that we had all messed up our lives so severely, or were on the verge of doing so, that the only thing left to do was laugh. I will never forget the story of a patient who got so drunk that she mistook a household appliance for her boyfriend and hid on the floor. I think she is dead.
Some of the ancillary staff smoked with them. They would also praise the virtues of the steps. I sat in the shed with the nurse. He reminisced about the good old days of mental health care when the golden rule was: "When in doubt, knock them out."
I asked, "But if I have a disease, why do I not admit it?" Surely I am not guilty? I was willing to make a commotion. It is amazing how quickly one can adapt to a thought system. A lot of the time, rehabilitation counsellors are provided with the "12-step facilitation" manual. One of the counsellors gestured to me to swallow the key. The counsellor told me that the more questions I asked, the less this would work. The experience was tiring. I was reminded of a family member rubbing the nose of my childhood kitten when I was filling out another sheet. How your use caused you harm was asked in the worksheet. You broke your own moral code if youDescribe three times your using. A lot of the time, stumped for answers, I would cram in anything, hoping the act of confession alone would keep me clean.
I was told that I needed to accept a higher power in order to stay clean. It could be anything. We were told by the counsellors to turn our will and our lives over to God, by checking every life decision we have made with another recovering addiction or a 12-step therapist. This seemed too much. I was willing to give it a try because I wanted to get this right for my student.
There is not much evidence to show that the 12-step programme works. The gold standard for assessing medical research was established in 2006 and 2020. There was no evidence that the method helped recovering alcoholics. In the second, AA adherents were slightly more likely to be sober after a year than those following other methods, but they did no better on other metrics, such as a reduction in the severity of drinking among people who did not find full recovery.
The Department of Health and Social Care published research into how best to treat addiction in The Orange Book. The 12 steps are mentioned a few times, but only as part of a menu of other options for patients to choose from. I asked Dr Emily Finch, one of the addiction experts who worked on the report, why they didn't get more attention. There is no evidence that they work. This is not to say that they don't work. The social skills that are taught in 12 steps are not the only active ingredient. People use their time more effectively. I have many patients who say the steps worked for them, but that is not the case in the scientific evidence.
I spoke to a former 12-stepper who left AA after developing severe OCD. Jon Tonks is a photographer for The Guardian.
How did we end up in a place where a quasi-religious treatment method is seen as a panacea for addiction? The 12-step method was founded in 1939 by Bill Wilson and Robert Smith after Wilson claimed that God had visited him during a stay in hospital. The method provided a convenient remedy for the issue of problem drinkers in auritanical society. The American Medical Association labelled the 12 steps of Alcoholics Anonymous a curious combination of propaganda and religious advice, based on the principles of the Oxford Group, a fundamentalist Christian organisation. On the AA website, it states that there is room for people of all shades of belief and non-belief. The 12-step model is still growing, with at least 50 "fellowships" for everything from sex addiction to gambling.
The idea of addiction being a disease was first introduced in 1960 by a scientist and 12-step adherent. Maia Szalavitz is an author and journalist who is a former 12-step member. She says that if you were told to get on your knees, find a higher power, take moral inventory and make amends, you would think you had found a doctor.
The perception that the 12 steps work as a sampling bias is described by Dr Lance Dodes. He says that you don't hear from those who fail. The success rate of 12-step fellowships is estimated by Dodes. For every person you see at a meeting, there are 18 or 19 who have sat there before, and for whom the method hasn't worked. Thanks to Marty Mann, an early adherent and PR woman who took the method to Hollywood, where it would feature in films such as Billy Wilder's 1945 classic The Lost Weekend and many since, 12-step fellowship is still an enduring place in the public consciousness.
Dodes believes that the approach of turning our will and lives over to the care of God has caused a lot of harm to a lot of people. The biggest danger for him is the insistence that the individual failing to take responsibility is the main cause of relapse. Dodes and his son wrote The Sober Truth, a book aimed at debunking the science of AA. Whose fault is it if it doesn't work? It is your fault. He warns that people lose years, decades of their life to the programme and develop additional problems. I spoke to at least one former 12-stepper who had left AA after developing severe OCD, something I identify with since trying to live by the unrealistic demands of the programme.
I stayed clean for 13 months after leaving rehab. I followed the advice and hid in my room.
12-step rehabs are still doing well. The rates of addiction are increasing. Dame Carol Black warned in a review that public drug recovery services are on their knees and that drug-related deaths in England and Wales are at an all-time high. In England, many local authorities have had their budgets slashed for addiction services as they struggle to balance the books.
The 12-step model is used in the clinics of The Priory. A hospital spokesman tells me that the 12-step set of guiding principles has been used successfully for more than 80 years to help millions overcome problems including drug and alcohol addiction. It's wrong to suggest that it leads to frequent relapse. Recovery from addiction can be difficult and can happen for some. The programmes do work for many people in the groups we have.
There are 118 private residential substance misuse services in England. Providers must make sure that they get consent legally, and staff must provide sufficient information about treatment options and risks, according to the CQC. This is exactly what I didn't do. Patients are given a variety of treatment options, along with information about expected outcomes, in order for them to choose what is best for them. ineffectual treatment is made for not doing so. Patients are free to question any part of the programme, or even to leave treatment and find an alternative which is more appropriate to their needs and beliefs, according to a spokesman for the Priory.
Half of the rehabs in the UK offer only 12-step treatment, but the other half follow The Orange Book and the principle of informed consent to give patients a range of therapeutic options. These institutions should not be immune to criticism. Anyone could set up a rehabilitation center. The industry was highlighted in a report by the CQC. The Health and Social Care Act 2o12 has been found to be in violation by 49 clinics. One rehab that was run by the Priory was struck off because it did not know how to help clients through opiate or alcohol addictions. The clinic that I attended was rated good by the Care Quality Commission, and the majority of its healthcare sites in the UK are rated good or outstanding. I received treatment in order to improve the patient experience at the clinic, and it will take on board my concerns.
Many in the 12-step community don't want to go to rehabs because they charge for something that should be free. Szalavitz says that rehabilitations are a rip-off because they give away what you can get for free.
After leaving rehab, I stayed clean for 13 months. I followed the advice I was given and went to five 12-step meetings a week. I attended a 12-step meeting every day for the first three months. I had internalised that I could not see the wood for the trees anymore. I went to rehab every Wednesday. I noticed that some of the people I had been with were dropping away. After eight months, I realized that only three of the 25 people I shared time with were still there.
It wasn't long before the cracks started to show for me as well. I shared a flat with a friend in London. I hid in my room because I was afraid of a relapse. I continued to attend meetings and prayed at the suggestion of a mentor. I became more controlling. I had an eating disorder when I was a teenager. I stopped eating sugar, wheat and dairy. I became more interested in exercise. Life was dull. I went further down a dark rabbit hole, hoping that the spiritual awakening promised by the programme would happen at the next bend.
I entered a dark place when my life fell away. I told the mentor that I was suicidal after a three-week spell in which I contemplated killing myself. He told me that the requirement to find faith in a higher power wasn't strong enough. I needed to attend more meetings. I felt like I was broken. I felt alone.
If I killed myself, my parents would have been told that it was the disease that got him.
For a year, I bounced in and out of meetings. I felt like I was back to normal. I had never taken antidepressants before.
I went on a bender rather than kill myself. First wine and then crystal meth. I was conscious of two things, the first being that I had promised myself I would never drink or take drugs again, and the second being that since leaving rehab, I had only thought of recovery, what I was doing right, what I was doing wrong.
After that, I went to a lot of 12-step meetings. I started seeing a therapist and focused on the issues that had led to me using in the first place. I told her that I was in recovery from my addiction and that I had taken antidepressants for the first time in my life. I was off-boarded by the faulty thinking instilled in me by the 12-step programmes. The damage done to my life during that time is immense, and it went through a trapdoor. Being a gay man, I felt the idea of beingdiseased was particularly difficult for me to accept. I was aware that homosexuality had been classified as a mental disorder until 1987 after being legalised.
The treatment I received stood in the way of accessing care that suited me, as well as the audacity of diagnosing people with a life-threatening disease that I don't believe exists. I would have saved myself a lot of time and money if I had been given genuine choice as a patient. I had to work through the trauma of my rehabilitation experience, which was delivered in a way that was unwieldy and dispassionate, as well as the insistence that it was the only way I could live.
