Changing the Signs on the Doors

International Journal of Drug Policy 12 (2001) 265–272

Review essay

Changing the Signs on the Doors�

Peter WebsterQuartier Les Vignes, 06260 Au�are Puget-Theniers, France

www.elsevier.com/locate/drugpo

In the foreword to Resisting 12-Step Coer-cion co-author Charles Bufe notes that in theU.S. there are annually between one andone-and-one-half million persons forced bythe courts into 12-step treatment programssuch as Alcoholics Anonymous, NarcoticsAnonymous, Marijuana Anonymous andother such carbon-copy organisations. Yet inthe introduction to the book, A. ThomasHorvath, President of the American Psycho-logical Association’s Division on Addictions,laments that ‘‘scientific knowledge has littleimpact on addiction treatment in the UnitedStates… [W]e have a treatment system whichis almost entirely based on an approach thathas little evidence of success…’’

Drug War reformers in the U.S. have nev-ertheless been actively campaigning for ‘treat-ment not incarceration’, and even the DrugCzar and his U.S. Office of National DrugControl Policy have echoed the mantra inresponse to increasing criticism of policieswhich have imprisoned millions of nonviolent

drug-law offenders, strangled the justice sys-tem, and produced widespread abuse andcorruption in law-enforcement and prisonmanagement. A major theme of Resisting12-Step Coercion makes clear, however, thatthe ‘treatment’ alternative being promoted isnot voluntary, informed-consent proceduresuch as is required by both law and ethics formedical treatments in general, nor does this‘treatment’ consist of a scientifically-justifiedrange of medical and/or psychiatric tech-niques, but primarily a coerced diversion ofthose who would otherwise he destined forprison to an alternative that may be as ethi-cally dubious and counterproductive as im-prisonment itself.

Public opinion has also jumped aboard thebandwagon. The November 2000 Californiaelection referendum, Proposition 36, won alandslide victory despite negative editorialsand dire warnings from politicians, prosecu-tors, judges, prison guards, and law-enforce-ment. The bill mandates the ‘treatment notincarceration’ paradigm in a state which hasbeen spending more on imprisonment thanhigher education, (a propaganda sound-bitewidely used to garner support for the initia-tive). The strongly-supported nation-wide

� Resisting 12-Step Coercion: How To Fight Forced Partic-ipation in AA, NA, or 12-Step Treatment. Edited by StantonPeele and Charles Bufe, with Archie Brodsky (2000), SeeSharp Press, Tucson, Arizona, 2000. ISBN 1-884365-17-5

E-mail address: [email protected] (P. Webster).

0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved.

PII: S 0955 -3959 (01 )00090 -1

P. Webster / International Journal of Drug Policy 12 (2001) 265–272266

‘Drug Court’ system has similarly promotedthe new paradigm for dealing with drug ar-restees, providing them with the ‘choice’ of‘treatment’ over prison.1 The movement hasgrown mostly as a response to the paralysisof justice brought about by wildly increasingnumber of drug cases on court docketseverywhere.

While it may be obvious how U.S conser-vatives, arch-prohibitionists, and the religiousright can be comfortable substituting one co-ercion for another and calling it reform, andobvious as well that public opinion can oftenbe stampeded in practically any direction atall, the wisdom of the leading reform organi-sations in joining this movement is far fromobvious. In many instances it seems, reformleaders have jumped on the treatment band-wagon for the perception that it remains po-litically out-of-bounds to direct an attack onthe core problem itself, Substance Prohibi-tion. Although self-elected treatment or coun-selling for drug problems should obviously bemuch more widely available than at present,and it is surely utter folly and morally repug-nant— if not criminal— to imprison peoplemerely for their bad habits, investing themajor part of the American public’s recentwillingness to reconsider drug policy into anavenue that retains coercion and provides analternative that is conspicuously lacking insupport from scientific research seems a poorif not dangerous strategy. For the larger re-form movement the existence of many re-

spected individuals who do argue for endingProhibition—such as Governor Johnson ofNew Mexico, William F. Buckley, MiltonFriedman, Thomas Szasz and many others—seems merely to provide a necessary per-ceived extreme to balance radicalprohibitionism in the ongoing propagandaand public opinion war, supposedly legitimis-ing the middle-ground of ‘moderate reform’.

Concerning the passage of Proposition 36in California, which can be seen as the trend-setting legislation for the treatmentparadigm, Ethan Nadelmann of The Linde-smith Center commented in the AlamedaTimes-Star (December 2, 2000):

In California, voters overwhelmingly en-dorsed Proposition 36, the ‘‘treatment in-stead of incarceration’’ ballot initiative thatshould result in tens of thousands of nonvi-olent drug-possession offenders being di-verted from jail and prison into programsthat may help them get their lives to-gether… The new law may do more toreverse the unnecessary incarceration ofnonviolent citizens than any other law en-acted anywhere in the country in decades…

Joseph D. McNamara, retired police chiefof San Jose, California, also a leading DrugWar critic, wrote even more glowingly ofProposition 36 in the San Jose MercuryNews, (November 26, 2000)

Some day, I believe, the passage of Propo-sition 36 may be compared to the collapseof the Soviet Union and the tearing clownof the Berlin Wall… Proposition 36 andother drug-ballot initiatives passed byAmerican voters during recent years aresignals of a similar erosion, signs that thepublic commitment to the ‘‘war on drugs’’is deteriorating…

1 A recent news article indicates, however, that ‘treatment’regimes have become so onerous a choice that many chooseinstead to do time in prison. An example is given of a druguser facing either 90 days in the county jail or 3 years oftreatment and probation ‘‘doing urine tests for dope monthafter month stretching into years, people looking over [my]shoulder, messing in [my] business, waiting for [me] to trip upagain and send [me] back to the courthouse where the punish-ment will be even worse if [I] get ‘revoked’.’’ (Houston Press,December 14, 2000, ‘‘Tough on Drugs: Prisons are Filled withUsers who Pick Jail over Probation and Treatment.’’).

P. Webster / International Journal of Drug Policy 12 (2001) 265–272 267

Many news columnists of note have alsopublished opinion pieces lauding the public’swisdom for approving the ‘treatment not in-carceration’ measure and congratulating thepublic for being way ahead of the politicianson drug policy reform. To what extent re-form leaders see the tactic as merely a con-venient way to get a foot in the door of themonstrous edifice of Substance Prohibition,or whether some or many of them genuinelyview the new paradigm as an avenue of sig-nificant social progress is not clear. Fromthe frying pan into the fire, I say. Mandat-ing treatment rather than prison while fail-ing to examine the raison d’etre, the motives,techniques, and failure rate of the ‘treatmentindustry’, may well lead to folly as great anddestructive as Substance Prohibition itself.

If there are now a million or more co-erced into ineffective and often dehumanis-ing ‘treatment’ yearly in the U.S., what willthe figure be when the new paradigm takeshold nation-wide? Are we to assume thatcasual users and small-time ‘dealers’ of mari-juana who now make up the great majority ofdrug-law arrestees will be forced into monthsor years of quasi-religious 12-step programs,demanding of them admissions of powerless-ness over their ‘addictions’, and pledges to a‘higher power’ for eternal abstinence fromusing a substance less addictive than choco-late or coffee and far less harmful thancigarettes? Millions smoke cannabis becauseit is enjoyable, or medically, socially or artis-tically useful to them, and imprisoning such‘criminals’ is very close to being seen byworld opinion as a gross error and injustice,if not crime against humanity. Calling suchpeople ‘addicts’ and shunting them into 12-step programs may yet be even more sinis-ter, for such ‘medicalisation’ of the‘problem’ will surely be a setback, allowingthe drug inquisitors to appear to have thebest interests of society at heart, yet con-

tinue with their inquisition unimpeded.And considering that interrupting the sup-

ply of nonviolent drug offenders to prisonswill depopulate them significantly, how willall the shiny new prisons be filled? How willthe powerful prison guard unions ensure thelivelihood of their members, the police drug-squads and SWAT teams, and the DEAcontinue to enjoy their overweening powerand bloated budgets? The title of my essaymay seem a kafkaesque answer to suchquestions, but looking back over manydecades of unrelenting escalation of U.S.Prohibitionism, optimism of any sort forU.S. federal government leadership towardsane drug policy, or even noninterference to-ward state-initiated effective and humanedrug policy seems woefully misplaced (I amthinking here of the strenuous federal effortsto block implementation of medical mari-juana provisions passed in several states).‘Treatment not incarceration’ as nationalpolicy risks yet greater justification and pub-lic approval for stigmatising and removingfrom society those whose personal choicesinvolve politically-incorrect, ‘un-American’drugs, and doing so in a way that seems‘medical’ and scientifically justified. ‘Untilthese sick are cured, and can accept to livein the real world of responsibilities and du-ties, we will out of the good of our ownhearts ensure that they get the treatmentthey need, for as long as it takes,’ seems afar more dangerous collective mind-set than‘lock them up so they will know of ourdisapproval.’ The lack of success for treat-ment noted by Dr Horvath above willmerely confirm the necessity to continue todemonise drug users ad infinitum, as the‘treatments’ will accomplish little save topacify the public and political conscience ofthe nation. ‘Even with our best and mostexpensive treatments, they do not becomecured’. The Therapeutic State looms everlarger in America, let us be warned:


The therapeutic state is a totalitarianstate—all the more so for masking itstyranny as therapy.—Thomas Szasz

In Resisting 12-Step Coercion we havewhat at first seems a self-help manual forthose unfortunate U.S. citizens taking abusefrom the business end of the treatmentparadigm. Although the book is oriented to-ward ‘treatment’ stemming from court actionrelated to alcohol use and abuse, it will be ofsimilar value to the even greater numbers of‘treatment’ candidates created by the prolifer-ation of drug courts and ‘treatment legisla-tion’ such as California’s Proposition 36.While it is surely a handbook for the coerced,and a sourcebook for legal representatives ofthe coerced as well, drug policy reformersand researchers should not be misled: theself-help manual format of Resisting 12-StepCoercion is in many ways also an effectivevehicle for some powerful and penetratinganalyses of what is wrong with U.S. sub-stance-abuse policy today. The book shouldthus also be read as a self-help manual bythose in the drug-policy reform movement inthe U.S., showing them how and why thecurrent ‘treatment not incarceration’ strategyis a big mistake. And it should be read byEuro-reformers as an inside view of what isgoing on in the U.S., as a warning of what isto come world-wide if we do little or nothingto repudiate U.S. ‘leadership’ on drug policy.The book’s in-depth examination of the U.S.treatment industry, its history, methods, andcurrent status, as well as a thorough de-bunk-ing of the research which supposedly sup-ports the treatment paradigm, should openthe eyes of many to what is surely an impend-ing disaster. In Stanton Peele’s words, ‘‘[O]urview in writing this book is that compulsorytreatment is wrong and ineffective. Our goal

is to support—even to encourage— individu-als to resist the therapeutic state. In no areais its emergence—once a science-fiction topic,as in A Clockwork Orange—more real thanin present-day substance abuse treatment.’’

The arguments and examples in Resisting12-Step Coercion proceed at a furious pace:by the end of the Introduction by ThomasHorvath, the Preface by Stanton Peele, andthe Foreword by Charles Bufe—14 pages oftext in total—I was already in such a state ofoutrage about the folly of the present ‘rush totreatment’ that I doubted I would be able toreview the book dispassionately. Chapter 1lays the foundation for the book’s goal ofexposing and resisting the looming Therapeu-tic State by providing an overview of alco-holism and substance-abuse treatment inAmerica, revealing the sparseness of evencommon sense—not to mention successother than monetary— in what has become a‘big business’. The arguments are pepperedwith examples of cases of coerced treatmentas hair-raising as tales from other famousinstances of state or religious power gonehaywire. Here is but one typical case (pp.42–42):

But what is the experience of 12-step treat-ment like for those coerced into it? ArchieBrodsky and Stanton Peele describe a typi-cal case, that of a married woman in her50s called ‘‘Marie’’. She received a DUI[driving under the influence of alcohol] ci-tation after being stopped at a policecheckpoint, and chose to pay $500 to at-tend 12-step outpatient treatment ratherthan lose her license for a year:

Marie’s treatment consisted of weeklycounseling sessions, plus weekly A.A.meetings, for more than 4 months… AtA.A. meetings, Marie listened to ceaselessstories of suffering and degradation, stories


replete with phrases like ‘‘descent into hell’’and ‘‘I got down on my knees and prayedto a higher power’’. For Marie, A.A. wasakin to a fundamentalist revival meeting.

In the counseling program… Marie re-ceived the same A.A. indoctrination andmet with counselors whose only qualifica-tion was membership in A.A. These truebelievers told all the DWIs (driving whilstintoxicated) that they had the permanent‘‘disease’’ of alcoholism, the only cure forwhich was lifetime abstinence and A.A.membership—all this based on one drunk-driving arrest!

In keeping with the self-righteous, evange-listic spirit of the program, any objectionto its requirements was treated as ‘‘denial’’.The program’s dictates extended intoMarie’s private life: she was told to abstainfrom all alcohol during ‘‘treatment,’’ a pro-scription enforced by the threat of urinaly-sis. As Marie found her entire lifecontrolled by the program, she concludedthat ‘‘the power these people attempt towield is to compensate for the lack ofpower within themselves… I find it uncon-scionable that the criminal justice systemhas the power to coerce American citizensto accept ideas that are anathema to them.It is as if I were a citizen of a totalitarianregime being punished for politicaldissent.’’

In spite of near-universal public and jour-nalistic subscription in the U.S. to the idea ofaddiction as a medical disease, and institu-tions full of Ph.D.’s insisting there can be noother explanation, Peele and his co-authorspoint out in chapter 1 an important andcurious fact: the disease model of addiction isnot only the essential ideology of the 12-step

treatment industry, but largely a historicaloutgrowth of it. That a supposedly scientifictheory of addiction should have its rootsdeep into the doctrinaire soil of a quasi-reli-gious movement should arouse much suspi-cion about its truth and applicability, to saythe least. The chapter’s brief foray into thehistory of AA and ‘addiction science’ under-mines the legitimacy of the entire discipline,for we see the central tenets of the diseasemodel of addiction relentlessly exposed forwhat they are: mythology, and a blatant mis-use of the terms and concepts of medicalscience for covert religious and moral pur-poses. The way is thus prepared for the fol-lowing chapters in which 12-step programsare themselves examined with a witheringscrutiny, and compared with little-used butfar more effective methods for assisting thosewith substance abuse problems.

Chapter 2 reviews the extensive research onsubstance abuse treatment and the efficacy of12-step regimes, and it is the evidence in thischapter that puts into perspective the currentclaims for the effectiveness of treatment overincarceration. The widely-quoted RANDstudies, for instance, have claimed impressiveresults for treatment. The 1997 RAND studyby Rydell et al. (1997) is frequently men-tioned: ‘‘Treatment was found to be seventimes more cost-effective than domestic lawenforcement, 10 times more effective thaninterdiction, and 23 times more effective thanattacking drugs at their source.’’ (Massing,1998) Massing goes on to say, ‘‘Every studyof drug treatment has arrived at the sameconclusion: whatever the type of program orthe drug involved, treatment produces im-pressive reductions in both drug consumptionand criminal activity, at a relatively lowcost.’’ (p. 51). The evidence presented byPeele and co-authors reveals that eitherMassing and other treatment mavens havenot read the research, or do not understandit.


Firstly, note that all instances of ‘effec-tive’ should more honestly read ‘cost-effec-tive’ in the above quote, and this musttarnish somewhat the idea that the welfareof people is what is under study. Even so,this sounds like a powerful argument forDrug Courts, treatment legislation, and thetreatment paradigm in general. Here is whatPeele and his co-authors have to say: ‘‘Weagree that imprisonment for drug use and/or drug abuse is a ridiculous and self-de-feating policy, but to rate the effectivenessof treatment in comparison with a nonsensi-cal policy is meaningless.’’ Of note also isthat if cost-effectiveness is the goal, suchstudies ignore totally what the projectedcost-effectiveness of ending Prohibitionmight be. The money being spent on Prohi-bition is surely many times over what wouldbe needed to provide self-elected treatmentof all sorts, religious or otherwise, to allthose who believed such treatment couldhelp them overcome their personal badhabits, compulsions or ‘addictions’ to any-thing under the sun. Considering the wealthof historical evidence for the self-defeatingnature of prohibitions, it is a curious igno-rance on the part of supposedly scientificstudies to pretend that Substance Prohibi-tion is a given, a part of the landscape ofhuman existence rather than a quite recentaberration of societies and power structuresgone authoritarian and Puritanical. The lackof scientific justification for prohibitionistpolicies is even more glaring than the lackof scientific justification for U.S. addictiontreatment noted by Dr Horvath.

Ironically, substance abuse treatmentsthat ha�e shown significant evidence of suc-cess exist in the U.S., and these are com-pared with 12-step methods in Chapter 2.But well above 90% of treatment programsapproved by Drug Courts or treatment leg-islation are of the 12-step variety, and it is

not an exaggeration to say that ‘12-step-ism’pervades the entire treatment industry. Peeleprovides a clue to the mystery: ‘treatment’ is�ery ‘big business,’ to the tune of $l0-bil-lion-a-year, and likely to grow even bigger.And as the research presented in the bookshows, it seems for the most part that treat-ment programs having the best rate of suc-cess are the cheapest and simplest! A lookat meta-analyses of alcoholism treatment inthe U.S. reveals that ‘‘expensive, commonlyused treatments… (in the U.S., read 12-stepinpatient and outpatient treatment), wereamong the least effective…and…almost allof the therapies consistently supported instudies as effective, such as the communityreinforcement approach, marital therapy,and social skills training, were low cost ormedium-low cost.’’ As with so much else inAmerica today, ‘follow the money’ if youwant to know what is going on.

Chapter 3 establishes that AA and other12-step programs are doctrinaire, religiously-oriented programs which can have no scien-tific basis to justify their predominance overother more effective substance abuse treat-ments. Both the history of AA and the or-ganisational and procedural details of itspresent manifestation in many guises suchas Narcotics Anonymous, Cocaine Anony-mous, Marijuana Anonymous, et al. leaveno doubt about this. Chapter 4 provides athorough review of U.S. court cases involv-ing forced attendance at AA and its clones,with the goal of providing legal leverage forthose facing such court mandated treatment.Interestingly, four higher-court decisionssince 1996 have ruled that forced 12-stepattendance violates the First Amendment ofthe U.S. Constitution, which forbids anygovernment body from requiring or encour-aging religious observance of any type. Thusthere would seem adequate precedent for re-sisting coerced 12-step treatment, yet, as


always in legal proceedings, especially in theU.S., the devil is in the detail, and it remainsarduous and time-consuming to fight the sys-tem. And with regard to employer-mandatedtreatment, rapidly becoming a major source oftreatment candidates for 12-step programs, nosuch Constitutional protection applies. Thesummary of chapter 4 provides good advice onhow best to use court precedents and decisions.

Chapter 5 examines the issue of informedconsent, ‘‘missing in action in addiction treat-ment’’ as the title of the chapter claims. Al-though the principle of informed consent formedical treatment has become firmly estab-lished in law as well as clinical ethics, Peele andBrodsky note that it is almost completelyignored in addiction treatment. On the onehand we hear widespread claims by doctors andresearchers that addiction is a ‘medical diseaselike any other’ but when it comes to applyingthe accepted principles and ethics of medicineto the ‘disease’, suddenly the treatments canbecome compulsory and court-ordered, andneed not have any scientific proof of effective-ness! Peele and Brodsky attribute this irrationalsituation to

the ideologically charged nature of drug andalcohol abuse/dependency. Here the legaland ethical tenets of the clinical professions,like their scientific foundations, are honoredin the breach rather than the observance…The failure to implement a true medicalmodel across the board has occurred in partbecause the prevailing model of addictiontreatment in the U.S. is primarily rooted notin science but in religion, or in quasi-religious‘‘spritual’’ folklore. As such, its practitionerspromote it—and it has largely been ac-cepted—as received wisdom, not as an issuefor empirical study.

As the arguments and examples in Resisting

12-Step Coercion adequately demonstrate, thestate of ‘addiction science’ in the U.S. is suchthat it resembles not so much a science as a cultreligion, and a not very appealing or elevatingone at that. The post WW-II position of theU.S. as world saviour and economic engine ofplenty undoubtedly contributes strongly to theautomatic respect paid to its institutions andendeavours, so much so that in instances whereU.S. leadership should be severely questioned,mistrusted, and even repudiated, often it is not.In no other area is the lack of questioning byworld opinion more important to the future ofhumanity than in drug policy and its associatedsupporting institutional establishments, al-though we would not suspect this from coverageprovided in newspapers and TV news or doc-umentary broadcasts. American style Prohibi-tionism has over the space of a century infectedthe perceptions and institutions of an entirecivilisation and made what surely will somedaybe seen as an atrocity seem normal, a stupidityof great magnitude seem rational and benefi-cial.

The presentation of evidence in Resisting12-Step Coercion gives the impression of animportant legal case being argued, and indeed,chapter 7 is a ‘‘Summary of Legal and ClincialObjections to Compulsory AA, 12-Step, andAbstinence Treatment’’ addressed to the ‘Deci-sion Makers’ likely to be involved with mandat-ing ‘treatment’ for substance-abuse arrestees.In a larger sense, this book might be consideredan important legal argument in the court ofworld opinion, and the necessary and obviousverdict, that the U.S. has led us down a verydangerous road, must be delivered, and soon.As Joseph D. McNamara recently said of U.S.drug policy (The Sacramento Bee, 26 December2000),

Either we are going to become a militarydictatorship or we are going to get over thisnonsense. In the long run this is a policy thatsimply cannot survive the test of freedom.


References

Massing Michael. The Fix. New York: Simon andSchuster, 1998.

Rydell CP, Caulkins JP, Everingham SMS. Enforce-ment or Treatment? Modeling the relative efficacyof alternatives for controlling cocaine. Santa Mon-ica, California: RAND Corporation, 1997.

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Changing the Signs on the Doors