Research Versus the Cult

95% of rehab in the U.S., inpatient or outpatient, amounts to simply charging people to attend AA. As invented by Hazelden and the Johnson Institute in the 1950s, the idea was to sell AA – which wasn’t going to sell itself – and, because AA efficacy rate was 5% or less, they would be able to recycle clients endlessly, or at least until they died.

The plan worked beyond the Minnesota Model’s originators’ wildest dreams and grew into a more than $35 BILLION annually industry that sells guaranteed failure. Imagine conning people into spending that kind of money on a product guaranteed not to work? And not just buying it once but repeatedly? And blaming the buyer for failure? And conning TV shows and novelists into promoting the scam?

That’s what a cult does, though neither Charles Manson nor Jim Jones had anything like the Steppers’ success.

What does research have to say?

Research says self-medication is a choice, albeit one that tends to evolve because it’s an easy choice that offers temporary relief from any number of conditions.

The “cure”? Address the real underlying condition(s) and the symptom of self-medication will go away.

The problem with this rather obvious solution? It requires some effort, some short term discomfort, some change in life style, and – these days – ignoring what everyone has been brainwashed into believing, namely, that AA works and is “the only way.”

The first is true for the <5% for whom the Steps “work,” the emotionally infantile and, of course, the predators who run rehab programs. The second, “the only way,” is discredited by there being at least three dozen “ways” that work better, including doing nothing.

Unhappily, we are all somewhat short-term focused and not too good at deferred gratification. If nearly half of us will use any excuse to avoid the momentary discomfort of getting a shot to prevent a life-threatening disease, what are the odds of actually signing up to weeks or months of effort to fix a problem we are, at best, ambivalent about fixing?

Especially when the cult grants freedom from responsibility for our drinking (Step 1: Powerless over alcohol) past, present and future?

And rehab promises to be not only effortless but a spa-like vacation in Malibu or Tucson, or …?

Yes, we are confronted weekly by the fact that we are selling a service no one really wants, in a format no one is thrilled with, and we aren’t even offering absolution.


Still, if you are rational, you know that part of the appeal of the cult is that it won’t work. You get to keep you alcohol, but you can pretend you tried – both to yourself and those around you. Not to mention that you get to use AA the same way you use alcohol. Escape, escape, escape.

No big unknowns like changing your life might entail – never mind that changing your life might be for the better. We’re basically pessimistic and we overlook positive possibilities.

And we get to hang onto our sacred “security of familiar miseries.” Yes, better the misery we know than the possibility of a joy we’ve never felt in a very long time, if ever.

So I hope I have talked you out of working with us to, as one client put it, “get a grip and get a life.” God only knows where that might lead as some 500 clients, over the past 15 could attest.