January is a big month for winter sports and post-Christmas sales. It's also -- as people who treat substance abuse know -- a big month for drinkers who want to quit. The holidays are over and bank accounts are thin, but addicts can't stop partying. Many choose January to ask, at long last, for help. But what sort of help is the most useful? (See "The Year in Medicine 2008: From A to Z.")
For decades, the primary approach to rehabilitation in the U.S. has been 12-step programs like Alcoholics Anonymous (AA). Twelve-step doctrine defines addiction in a contradictory way: as a medical problem, like a lifelong illness, with a spiritual solution (surrendering to a higher power). The model has become so culturally hegemonic that it's hard for many to imagine any other way to stop getting drunk or doing drugs -- or gambling, overeating or watching porn, for that matter. When we see Anne Hathaway's character in the film Rachel Getting Married at a 12-step meeting or when we watch D-list celebrities work the steps on VH1's new reality show Celebrity Rehab Presents Sober House, it's easy to think 12-step is not only the best way to get well, but the only way. There's a growing body of evidence, however, that suggests that's not so.