“Breaking Addiction: A 7-Step Handbook for Ending Any Addiction,” by Lance Dodes, MD (Harper Paperbacks, March, 2011)

Reviewed by Charles M. Young

Designed so the average drunk can sober up by having a spiritual experience, the Twelve Steps can inspire an almost religious commitment among adherents. The feeling is, “We’ve got the answer. Let’s not mess it up with anything else.” This vibe goes back to the founding of AA in 1935 and there was a certain wisdom in it. Psychology then had no understanding of addiction and no treatment to offer. AA didn’t claim to understand it either (the disease was “cunning, baffling and powerful”), but did offer a method to stop drinking that worked for some.

This situation changed dramatically in the late ‘80s when John Bradshaw did a series of lectures on PBS about family systems theory and combined it with an evangelical fervor for 12-step programs. AA membership swelled. The term “inner child” was often heard at meetings for a few years. Millions of people started looking at their families in a new way. It was exciting for a while, and then it petered out.

In 2002, Lance Dodes, a Harvard-trained psychiatrist, published a book titled “The Heart of Addiction,” which offered a new paradigm of understanding. Addiction, he said, is displacement, which means that the addictive act is a substitute response to unacceptable feelings of powerlessness and shame that arise in a situation that has personal symbolism for the addict. The addict perceives that directly facing the cause of this intolerable feeling is impermissible, and he resorts to the addictive act to repair the feeling of powerlessness and restore his sense of having control over his life. Thus the mechanism of addiction is the same, whether you are drinking, shooting up or looking at Internet porn.

Remarkably clear and jargon-free, “The Heart of Addiction” made a strong case for displacement, but Dodes received a somewhat mixed response from the set-in-its-ways treatment community. He had some minor criticisms of AA (where Bradshaw had been exclusively rhapsodic) and his emphasis was on the moment of the decision to drink, rather than the consequences. That was especially hard for 12-steppers to understand, since almost every AA meeting is built around scaring you away from the next drink by having someone describe the horrible consequences of alcoholism.

Dodes is now back with “Breaking Addiction: A 7-Step Handbook for Ending Any Addiction.” It deserves an audience in and out of 12-step programs. Where “The Heart of Addiction” emphasized the case for displacement, “Breaking Addiction” is more what to do about it. Like its predecessor, “Breaking Addiction” is lucid and concise and has more short stories that read like mysteries, as addicts of various kinds try to figure out when and why the compulsion/decision arose.

The message is quite hopeful. Dodes’ steps are mostly a common sense guide to self-knowledge, a means of seeing and understanding the emotions that compel the decision to drink. When you see that, you are able to address the intolerable situation directly, or at least more directly than a drink would, and when you do that you are free. Where there is no displacement, there is no addiction. Key insight: “When seeking alternatives to addictive behavior, you don’t need to come up with the best possible alternative. You only need to come up with an action that addresses your predicament more directly than the addictive act.”

In other words: progress not perfection. Any open-minded 12-step person can learn something here, and be grateful that addiction, while still cunning and powerful, is a lot less baffling.