The 13th Step - 4: A Wild (Wild?) West

Episode Date: June 6, 2023

How did 13th stepping become so common in the recovery world and who can hold people accountable? Lauren looks into the history of the addiction treatment industry; goes in search of the people, government agencies, and industry groups that are supposed to oversee it; and does a deep dive into its most pervasive cultural force: AA and the 12 steps. She finds a lot of good intentions, alongside a lot of problems.The 13th Step is a production of New Hampshire Public Radio’s Document team. More at 13thsteppodcast.org.To support investigative journalism like The 13th Step at NHPR, click here.

When it first happened, I thought like I was the only one. Which seemed ridiculous to think, but like I did, I was like, it must just because we have the mutual friend or whatever. Like, if he did this all the time, he wouldn't own a treatment center. So when I found out that like as I'm hush hush over here, this is like a known thing that he does around the female recovery community of New Hampshire and Maine, I definitely got my wheels turning as to how and why he's still there without a tarnish on his name. I don't know.

The only things I could think of were like aggression and money. Because the only two things that ever get people's silence, if you will. Like fear. It's fear based. It's either fear or he's keeping your lights on. This is the 13th step. I'm Lauren Chuljian. How did Eric Spofford get away with it? Elizabeth, who you just heard, isn't the only person whose wheels have been turning on that question.

I've spent the last few years trying to answer it. How is it possible that the CEO of an Addiction Treatment Center allegedly harasses and abuses employees and former clients and the only sort of accountability he seems to face is a few people quit? Let's get one small piece of the answer out of the way. As far as I can tell, no one reported Eric's offered to the police. This is not surprising. I mean, most people don't call the police

to report sexual misconduct. That's a well-documented fact. And people who have used drugs don't usually see the police as helpful. Their drug use is illegal. Police officers often equal arrests and jail. So all this to say, the police were not coming. But the police shouldn't be our only chance at accountability here, especially given the

stakes of the problem. Substance use disorder is a public health emergency. A thing politicians tell us is a national priority, especially now. As one person in the Addiction field told me recently, the population of people who need treatment is larger and sicker than ever. Just getting someone in active addiction through the door of a treatment facility can feel like a miracle. The idea that additional harm could be on the other side.

There has to be someone or something that should have stepped in here, right? To figure this out, I started by doing what I always do, working the phones. I called academics at Harvard and Stanford, advocates, researchers, employees up and down the organization chart at treatment facilities. And pretty quickly, I realized my specific question, how Eric Spofford got away with a ledge sexual misconduct, was tightly wound up with a much bigger question.

How does anyone get away with unethical behavior in the addiction treatment industry? Because unfortunately, this industry has lived through a lot of bad stuff. Insurance fraud, your analysis fraud, misleading marketing, patient brokering, and straight up dangerous care. So while I've been trying to understand what happened in Eric's situation,

I've also learned a lot about how the industry deals or fails to deal with all sorts of unethical behavior. This is Robin Piper. Robin is a CEO and clinical director of a facility in Florida that treats substance use disorder. It's called Turning Point of Tampa, and Robin's been in charge for more than two decades. So she's had a front row seat to both the positive changes and the dark times that this industry has experienced. I think it's getting better, but it's not where it needs to be by any stretch of the imagination. Okay, so we're not Wild Wild West.

We're still the Wild West. I can't give Robin credit for this Wild West bit. It's such a common description of the industry. It's become a cliche. But Robin is the person who really helped kickstart my understanding of where that term comes from. I asked Robin my specific question about Eric Spofford in sexual misconduct. And she told me, if you really want to understand why that happens in the recovery world, actually the term she uses is unhealthy boundaries.

If you want to know why that happens, here's where you have to start. Our field has a lot of people in it who got into it because of their own recovery. And there's nothing wrong with that. I'm in recovery. But they don't always have the education or the training that they need in order to do their job not only correctly but appropriately. Appropriately. Unhealthy boundaries can simply mean not maintaining a professional distance or worse. You know, it's really well known if you put down one coping skill like alcohol and drugs

and you know, you feel horrible and you're picking anything up that makes you feel good. And it's not hard to figure out that new relationships and flirting and being attracted to somebody makes you feel good. Robin stresses that, of course, if you work in the addiction field, having lived experience can be helpful. But in my reporting, I found some treatment centers hire people less than a year into their recovery.

Granite recovery centers did. One source told me, two years is the industry standard, but clearly not everyone follows that. Robin says, recovery requires a lot of hard, introspective work. And she thinks there are some people who don't put in the time. And then, they go work for a treatment center or open their own. So they have really unhealthy boundaries, and they don't see it as a profession, as much as a calling,

would say, if you want to be positive about that. So they don't know how to conduct themselves, and they still have their own issues. We deal with a vulnerable population, where unhealthy boundaries are more lethal and more dangerous. What Robin's suggesting here is that additional education and professional development is especially important for people in recovery. And this is something I heard over and over from almost everyone I interviewed for this episode.

This industry lacks professionalization. For example, Robin is in recovery, but she also has two master's degrees. She was a clinician before she became a CEO. She's a licensed mental health counselor. And when you study to get a counseling license, for example, you learn all about basic ethical standards, such as you can't date your client, and the profession is guided by those rules. This all may seem like a no-brainer, but we are stomping right on a major nerve in the recovery world here. Remember this

line from Eric Spofford? Nobody is more qualified to help addicts besides recovered addicts. Robin asked me, does Eric Spoffer have a master's degree in administration? Oh no, oh no. Are they a licensed mental health counselor? Do they have that kind of training and education to raise them to that level of professionalism that running an organization like this really does require? Do you have to have survived addiction in order to treat it? Is being in recovery

qualification enough for a job? With any other disease, these would be totally insane questions to ask. It's like saying that a cancer survivor, right? Hey, I'm a cancer survivor. Let me tell you what kind of chemotherapy you should have. This is Mark Mishik. He used to be the president and CEO of Hazelden Betty Ford in Minnesota. Probably the most famous treatment center there is. Well, everyone would go, well, that's silly. Why would we ever agree to that? So why do we agree to it here?

Why is that okay in this particular field? Why is it okay? The short answer is stigma. Here's Robin Piper again. I think the medical community has always put us over there on the side of those troubled people. For most of our country's history, the prevailing belief about addiction was that it was a choice, a moral failing. We figured why help people who choose to drink or use drugs? We were so wrong about that, by the way.

For most of the 20th century, mainstream medicine either grudgingly treated or refused to treat people with substance use disorder. And multiple times in history, we've decided that our criminal justice system was better suited to solve this problem than the medical system. So people with substance use disorder were basically left to treat themselves. There is a long history of people in recovery stepping up where the rest of us had failed. We've certainly made progress. There's more money, there's much more attention for mainstream medicine these days, and addiction

is now widely defined as a chronic disease. But there's still a long way to go. Mark Mishik, the former head of Hazelden Betty Ford, he told me that everyone in the field has a story ready that describes this very thing. You'll get invited to a hospital and they'll be like, hey, you work in addiction treatment. Can you teach our board of trustees about the opioid crisis? Sure, Mark will say. We can do that.

So, I'll go in or one of my colleagues will go in. We'll meet with the CEO or the leadership team and then go, hey, do you want to see our treatment facility? So yeah, great. Let's see your treatment facility. So there'll be this shiny new palace that they build for heart care and cancer, right? We'll get in a van and we'll go out and visit a building

in the industrial area. We'll visit a remodeled motel on the edge of town and that'll be their treatment facility, right? And it's just sad. A remodeled motel on the edge of town. What I'm going with this is there's been a lack of attention. There's been a lack of understanding and so the resources that are needed to have really quality standards, to have people that are up to speed, to have health care executives that understand the field,

it's been lacking. All right. So we've got some answers to how someone gets away with unethical behavior in this industry. This is an underprioritized, stigmatized industry that isn't very professionalized. But what about oversight? Aren't there authorities that should oversee or regulate this industry? Robin Piper, Turning Point of Tampa CEO, laid it out for me.

So there's two regulatory bodies for most people in the treatment industry, the state that licenses them, or the agency within the state, and they have to be accredited. Now this is where I thought I'd start getting some real accountability answers. Anytime I've talked about the sexual misconduct allegations against Eric Spofford, inevitably someone goes, oh, so did the state step in? So let's start there. From what I've gathered, states seem to be the number one regulatory body over addiction treatment.

But I quickly ran into this. Here's Mark Mishik again. Most states have got really, really loose lacks regulations around substance use disorders. So the reason these people can thrive then is that there's not a lot of fences around them. Not only that, but there's no standard approach. To lead El Sabawi is a law professor at Florida International University.

She specializes in addiction and public health. I do think it depends on the state that you're in. Some states do regulate their substance use treatment programs significantly more than others. So in places that's more regulated and others that's a wild, wild, wild, less. Told you there's that phrase again. Even if you have regulations, if you don't have ways for people to easily and quickly identify how to report abuses. The regulation on the books alone is not going to help. So I set out to understand the system here in New Hampshire.

Here's what I learned. In this state, residential treatment facilities are regulated by DHHS, the Department of Health and Human Services. That means they license the facilities, and there are pages and pages of rules that lay out the process. But as far as oversight, it leaves a lot to be desired. Let's take the example of granite recovery centers.

DHHS has explained to me that there are two ways the agency might catch wrongdoing, annual inspections and complaints. I tracked down what public inspection records I could, and I found that while Eric's bofford was in charge, some of the granite recovery centers' properties did get dinged during their annual inspections. But the things they got in trouble for're employee paperwork problems, like missing signatures

on hiring forms, not exactly a bombshell. As far as complaints, if they received one and investigated it, DHHS says they can't tell us, because complaints are confidential per New Hampshire law. I discovered something else about state oversight. To lead El Subawi explained it this way. When you have cases where you have entrepreneurs that are running treatment systems, there is no professional oversight or professional misconduct review. In many states, that kind of review would come from licensing boards. In New Hampshire, for example, the facility

has to have a medical director who has a license, but the CEO, no license required. You just have to pass a criminal background check. But Robin Piper told me, if she did something unethical, there's still a pathway for accountability, because she's not just a CEO. I'm a licensed mental health counselor. If I did something like that, you could call my licensing agency. You could call the Department of Health in the state of Florida and file a complaint against me, or one of my doctors who were doing that or one of my licensed therapists. At least they would do an investigation, right?

I'm going to get a letter. I'm going to have to respond to at least there's something that happens. If let's say the CEO or another therapist is in licensed, who you're going to be important to. If you're not personally licensed through whether a physician or a therapist, then there's nothing. None of this gives me a lot of confidence that state agencies are well equipped to root out unethical behavior, and it's even more complicated in Eric's case.

DHHS told me that if someone filed a complaint alleging sexual harassment or assault, that's criminal, so they would send it to the state attorney general. We filed a public records request to see what complaints the AG investigated related to GRC. And we found eight. Some billing disputes, some complaints about the quality of care, some issues with COVID protocol, but nothing about harassment or sexual assault. Now, or sexual assault. Now Robin mentioned a second place oversight exists in this field, Accreditation. If you look at a treatment company's website, you'll often see a stamp that shows the company

has been accredited. When you'll see a lot, it the commission on accreditation of rehabilitation facilities, or CARF for short. I got on the phone with Mike Johnson, managing director of Behavioral Health at CARF. A accreditation is kind of an ongoing quality improvement activity where. Here's what I learned from Mike.

Accreditation is voluntary, but it's a big deal. The federal government differs to agencies like CARF for quality assurance. That stamp is also supposed to provide confidence to clients and their families. And some insurance will only cover treatment by accredited companies. Treatment facilities pay for accreditation, and the accreditors do surveys of their facilities. But it's not a one-size-fits-all situation. So, we have standards, right, and they have to meet most of them is kind of the easiest way to say it, but an organization, when they get a survey report at the end of a survey,

it says, you didn't meet this standard, you didn't meet this one, you didn't meet this one, you didn't meet this one, you didn't meet this one, which you also did enough to be able to be accredited. Mike says there are some companies that succeed at all the standards and a few that are so bad carf will refuse accreditation, but the focus seems to be on improvement. I think Mike felt like I expected too much of him and carf. I feel like people would like to have like they want to be able to point to whether it's the state law or it's a accreditation or it's something else. They want to be able to say, aha, you know, you failed to uncover this.

For example, carf standards call for facilities to have written ethical codes of conduct. And in the section on leadership, that includes, quote, setting boundaries. But Carf surveyors aren't coming around to treatment centers every day to make sure that's happening. That's not the job. Mike says if someone reported wrongdoing to them, then maybe Carf could help. Maybe. Let's say that he's the owner. Like if it's the CEO of a not-for-profit organization and there's a board to be able to go to, there's something to be done. It's harder when it's a privately owned company. A privately owned company. Granite Recovery Centers is a private for-profit company.

If Karp had received a complaint about Eric, who at GRC would they have brought it to? GRC sort of had a board of directors for the last two years before Eric sold the company, but it was just three people, and one of them was Eric. As the former HR director Nancy Bork told me, Eric really answered to no one. To be honest, I felt like I was going around in circles, but I kept working the phones. Someone suggested I call the National Association of Addiction Treatment Providers, the NWATP. It's a non-profit group that lobbies Congress provides research, suggests best practices that sort of thing.

So I reached out to the CEO. Now, I don't know what I expected him to sound like. Stiff, maybe? Is that rude? But I definitely did not expect this guy. So always remember, we got a biological, psychological, social, and spiritual disease. We got four components to this fucker. This is Marvin Ventrell.

And it turns out he was a good person to call, because he has been trying to crack down on unethical behavior in the treatment industry for a while. It started as soon as he took over NWATP in 2015. Immediately, as I identified our priorities, one of those priorities was ethical and professional behavior in the field because we were certainly hearing a lot of complaints. And we were seeing them.

We run into really uncomfortable marketing practices, unprofessional marketing practices, sleazy marketing practices, and then ultimately illegal marketing practices, right? So there's a continuum of bad behavior. This was 2015. A time when the industry was being flooded with money. People were opening up addiction treatment facilities all over the country, and not all of them were great places, to say the least.

And the chance to make a ton of money without a lot of oversight is what led to those sleazy illegal things Marvin is talking about. Marvin runs a membership organization. So he was somewhat limited in what he and his colleagues could actually do to crack down on this stuff. But they did a fair amount.

In 2016, they put out stricter ethics rules and basically cleaned up their membership rules. But there's still so much more to be done. Marvin would be the first to say it. In fact, he was apparently multitasking while I was interviewing him. By the way, I just searched Green Mountain and Granite and they don't seem to appear anywhere that God in our database.

So if I search Granite, I get some facilities in Arizona, oh shit, New Hampshire. Did you see this? No. Well, if we got a problem, we'll deal with it. So this is what happens. So we have a center that pays its dues in Salem. Yeah, that's their main office building. All right, well, we're going to have to look at this.

This made me a little nervous. When Marvin and I had this conversation, I was at the beginning of my reporting journey. I told him about the allegations, but I was still months away from publishing. I had called Marvin to learn about accountability. I wasn't trying to start something. I even told Marvin, maybe can I just call my editor real quick? All right, well let's just talk around a couple things. If this is happening, I want to stop it.

I don't, I want to help these women. That's my first concern, not anything else. And I want to to if he's doing this I he we need to get him out. The least of my concerns is getting it but I don't want to say it that way. Yes, getting him out of the NW ATP roster if this is happening but I have no intention of just saying that's my solution as they can't be an NW ATP member. This has to be stopped. Marvin told me he'd get back in touch, see what he could find out. I wasn't sure what would happen, but I wasn't intrigued.

Marvin was the first person with some standing in the industry who seemed to be concerned. In the meantime, I kept reporting, went off in lots of different directions, but after a while I circled back to see if Marvin had an update. He did. He wanted to connect me with a guy at his office named Peter Thomas. Peter is the director of Quality Assurance at the NATP. Ethics complaints are part of his job. So Peter and I got on a Zoom call.

Yeah, I went back through and reviewed some of the emails that Mark had with you. And Peter looked a little nervous. This was a little bit of a difficult position for us. And what I said to Mark when he asked if I would talk to you is it's one where I think we took a prudent approach, but it emotionally does not feel good. Prudent, but emotionally does not feel good. While we believe the allegations reported, we didn't have a direct patient or person who had been harmed that made a report

to us. So we didn't feel that we could take action against a member based on a third-hand report from the media. And so that's a difficult position. And I think all of us emotionally want to be able to take action in these cases when there's there's any allegation, especially when they're pretty serious like this. But in this case, without a direct report, we didn't feel that we could take action. Right. So, yeah, this is where it gets so confusing because obviously none of these victims reported it to anybody. It just found its way to me, you know? And so it feels like it's kind of on the person who's been harmed to report it, but we all know that like that's not how the world works sometimes. Yeah. So then it's, so trying to figure out like,

who's responsible for holding this place accountable has become really confusing, you know? I'd say that it's not only confusing, but it's really frustrating. And to add to this frustration, Peter found out that GRC's membership with NATP had actually lapsed. It hadn't paid its dues. So even if, say, employee B had called NATP herself around this time, there would have been

no membership for them to revoke. Peter says there are only two entities that hold real power to do something about this. Maybe you've heard of them. The states and the accrediting organizations. This whole journey I was on. To understand the system, it felt like what I was really doing is just running into wall after wall after wall. You can hear it in my voice as I tried to wrap things up with Robin Piper, the CEO of the

Addiction Treatment Company in Florida. I was feeling kind of deflated. I mean this is why this topic is depressing because I don't know if I'm going to be able to give a, here's how we fix it, answer at the end of the story. Yeah, I wish I had a, here's how you fix it. I can tell you one thing, I don't think it's a quick fix. If it fixes out there, it's a result of years of new laws being passed and regulations being implemented, and then there being some teeth in the consequences of not following

those laws and regulations. But even if there are teeth, would that solve the particular problem I found of sexual misconduct? Here's Mike Johnson again from the accrediting organization, CARF. In any space, in any business, anywhere, if a person wants to be a bad actor, they can probably figure out a way to be a bad actor. I take your point. Like, you see that I'm trying to search for answers here as to

how this could have happened. And I think what you're saying is, like, welcome to the world. Yeah, I mean, there's some of that, right? I'm saying some of that, but I'm also saying part of it is that because we kept the treatment system outside of the like, insulated from the rest of the healthcare system for all this time, and it was left up to people in recovery to help other people in recovery. Not everybody that gets into recovery is going to be the best role model for other people. And here we are again.

I want to be really clear here. My point in reporting this episode was not to discourage anyone from going to addiction treatment. That was something of few experts I talked to on this journey were really wary of, and that is the absolute last thing I want to do. Help is out there. The addiction treatment world is full of well-meaning, qualified people. They might be frustrated by the limits of this industry, and they may sometimes be forced

to do things that emotionally don't feel good, but they're trying. Coming up, there's one last piece of the puzzle that explains how people get away with bad behavior in this industry. It's not about rules or regulations. It's about a powerful cultural force that has helped millions get sober. I'm talking about alcoholics anonymous, the 12 steps, and what makes it so powerful can also make it dangerous. Hey, this is Jason Moon. I helped make the 13th step. It has been three years since we started this project. And I can tell you, it took a lot of work and a lot of resources. It is so worth it. But we can't do this work without your help. If you're in a position to do so, please consider making a donation to New Hampshire Public Radio.

To give now, click the link in the show notes, and thank you for supporting local long-form investigative journalism. Even if you've never been to a 12-step meeting yourself, it's pretty likely you've seen a Hollywood version of one. There's the badly lit church basement version, with folding chairs in a circle, or sometimes a podium is involved and someone steps up to speak. Well, here you are. All know I'm wailing and I'm an addict. It's always an intimate scene, a place where people can be vulnerable, share their deepest darkest secrets.

Because everyone listening is there to support you. I lost a good wife, bad girlfriend, and the respect to anyone that ever tried to loan me money or do me a favor. I'm going to share a really original opinion here, but I love the wire, the HBO classic, and there are a lot of 12 step meeting scenes across the five seasons of the wire. This one looks to be in a church basement. Like in so many other films or TV shows, 12-step meetings are portrayed as the answer to someone's long, painful journey with addiction. That's because in real life, AA has made recovery possible for millions of people.

I think you have to really look at AA as something that is like the church. This is Holly Whitaker. She wrote the book Quit Like a Woman. It's a memoir about Holly's recovery that also takes a hard look at AA. Like, it is an institution, and it's belief system, it's tenants, it's book, it's practices, you know, AA changed the landscape, it helped people who otherwise there was no help for, and really humanized people that were struggling

with addiction. Remember how I mentioned that for much of the 20th century, mainstream medicine basically didn't treat people with substance use disorder? In the 1930s, the creation of alcoholics anonymous began to fill that void. Holly says at the time, AA was a really progressive idea. It's a fellowship, a free social program, guided by a list of spiritual principles. It's founders known as Bill W. and Dr. Bob. They discovered that the best way to maintain their own recovery was by working with other alcoholics.

And since then, AA has exploded. It now exists in more than 180 countries. You can find a 12-step meeting in the most rural corners of America. You can even attend a 12-step meeting during the separate of every fish concert. And today, around two thirds of addiction treatment programs in America use the 12 steps. AA is the foundation that our addiction treatment system stands on. But that foundation, as I've learned, is imperfect. It's aging. There are cracks that have only widened as society has progressed forward, and understanding what those cracks are. That will help us nail down the final piece of why sexual misconduct happens in this industry. Because as long as there has been alcoholics

anonymous, there has also been 13th stepping. One of the biggest critiques that is thrown at the 12 steps is that it has always struggled to make real room for women. This is a program that was developed by white men and for white men. And that, as we well know, is a well-worn problem in this country, that is very hard to shake. In fact, in the 1930s, many early AA members did not even believe women could be alcoholics. So, women weren't allowed to be members for a while. The primary reason women weren't allowed, as one historian put it, was because of the quote, potential disruptiveness of the sexual dynamic that might emerge within the groups. So if a woman did come around, you know, they were asked to do things like make the coffee

and make curtains for the room or do certain sort of traditional female things, but stayed sort of in the background. Dr. Stephanie Covington is an author and clinician. Addiction is her specialty. She started her career in the 80s. She had recently stopped drinking and realized there really wasn't much help available for women specifically. In this country, this 12 steps have been a cornerstone of addiction treatment, but all

the official literature uses only male pronouns, and it only basically women are supposed to translate and make it work for them, and I thought, hmm, I think we need a book of our own. So Stephanie wrote a book called a woman's way through the 12 steps. Stephanie believes the 12 steps can work. They just need an asterisk. And I think it would say, um, hello, the way that cisgender white men experience addiction. That's not the way everyone else experiences it. For example, research has shown that women with substance use disorders are more likely than men to have experienced sexual or physical abuse or have experienced or witnessed abuse as a child.

And yet, the 12 steps don't address trauma at all. We realized for some people they actually began using alcohol and other drugs as a way to deal with the symptoms of trauma. So for some people, the trauma is quite connected to their addiction. And so the fact that you think that you can provide treatment and never discuss trauma just doesn't make basic sense to me. Writer Holly Whitaker says the 12 steps as designed made perfect sense for the original white male members. The first step of AA is to admit you are powerless over alcohol.

And then you're supposed to humble yourself to confess your weaknesses. Holly told me that still resonates with a lot of people. There are people for which that is a good philosophy. It's a good approach. If you are a man with an inflated ego, like please go to AA, right? Like please, you know, go in and, and like, check yourself. But as Holly puts it, the idea of giving up power, that only makes sense if you have power to begin with. Those that have power are the ones that are at the top of the current structure, which is cis, white male.

Um, and those that don't is, you know, like everybody else, you know, and like with lower rungs on the letter based on what intersections of identity you are. A lack of power, Holly says, can sometimes lead to addiction. It's not what solves it. This by the way, is a very common critique of the 12 steps. In fact, I heard the same thing from another writer I spoke with, Gabrielle Glazer, to identify powerlessness over alcohol as the way you're going to get better, it just didn't make sense to me.

Gabrielle Glazer also wrote a book about women and alcohol called Her Best Cap Secret, Why Women Drink, and How They Can Re-Gain Control. And she doesn't believe AA is well suited for women. AA tells you to get rid of your ego. AA tells you that you need more humility. You need to knock yourself down a peg. If a woman had a relapse or spoke about something that was troubling, the first response was

one of blame. What was your part in it? The program is loaded with, in my opinion, self-loathing and blame. One example that Gabrielle really struggles with is working the fourth step. That's the one where you take a moral inventory, listing out as the big book calls them, our emotional deformities, so that you can move toward correcting them.

Part of that journey is doing what's known as sex conduct work. Your fourth step inventory should include any sexual experience that you have guilt or shame about, and with your sponsor, you consider what was my part in those experiences. I have to say, this really surprised me. I've learned a lot about trauma in the past few years, and a big part of healing is understanding that whatever happened to you is not your fault. But depending on how your sponsor interprets the fourth step, this part of the program can be re-traumatizing.

I met a woman named Nicole, who went to a 12-step-based addiction treatment center. And as part of her fourth step work, she was encouraged to search for her part in her sexual trauma. Nicole told me, quote, taking that and turning it into writing about how I'm a fucked up person was so painful and harmful.

So here we have a program that was developed with only white cis men in mind. That doesn't acknowledge huge parts of the experience of addiction can even be retraumatizing for some people. But it's easy for me and Gabrielle to talk about these things intellectually. We are two women who don't have substance use disorder. We can raise our eyebrows at the problems with AA and then go on with our lives.

Holly Whitaker is in recovery and she will tell you, it's a whole other thing when you're a person who is actually trying to get sober. She tried AA, she thinks everyone should, but for many of the reasons we've just discussed, it did not feel like a good fit. So Holly stopped going. She sought recovery elsewhere. She loves Alan Carz book called the easy way to control alcohol. She went to therapy, she developed a meditation practice, and eventually she stopped drinking. But her friends and family were not convinced. In it gave Holly a new perspective on the power of AA as a cultural institution.

Every single person that found out I wasn't going to AA during that period of my life absolutely made me think that if I didn't go I was going to die. that if I didn't go, I was gonna die. Or I was just like a bad person, totally in denial. Ego, ego, ego. Later, Holly grudgingly agreed to go to an AA meeting with some friends. She was about a year sober at the time. She tried to tell her friends, when I go to meetings now, people can tell immediately. I don't work the program anymore. Sure enough, a woman in a bathroom came up to me and, you know, and was just like made friends with me, like, seemed really interested. So she hadn't seen me around.

And I knew, no, I wasn't new. And oh, if you're not new, what are you doing? If you don't go to meetings and I told her what I did. And then, and then at nowhere, she just said, do you know, you're going to drink again, you know? And I just, excuse myself, and she ran after me yelling, like, are you scared, little girl? Like are you scared that you know what I'm saying is true?

And I was like, yes, I'm terrified that what you're saying is true. I am terrified that if I do this wrong, I'm gonna drink again. terrified, but if I do this wrong, I'm going to drink again. That is a powerful force. That makes it hard to believe in yourself, no matter how far you've come. I'm 10 years sober from alcohol. To this day, if somebody comes up to me and says, if I'm around people and most of them believe A-A is the only way,

and they know I don't go to A. This just happened a few months ago. I will doubt myself because it is so powerful when you were around people that all think one thing and most of our society thinks this thing. And you are the outlier. It's really hard, especially if you're a woman or especially if you're at any intersection where you are not supposed to trust yourself, to trust yourself that you know what's right. This is not an environment that makes it easy to stand up for yourself. When everyone around is telling you not to trust your instincts, to give up your power.

Shut up, follow the rules, don't complain, you know, like do your work, keep your set, you know, like all of that, which is when you take that and extrapolate that into like the entire system, you understand why people with addictions are treated as inhumane as they're treated and not trusted and are perfect victims. Perfect victims. Perfect victims. Here's Gabrielle Glazer again. So you walk into these meetings, you acknowledge to the crowd in a very vulnerable position

that you were powerless over alcohol. That also makes you vulnerable to the strangers in the room who might not have your best interests at heart. And there are a lot of sexual and financial predators who are attracted to AA for this very reason. You can be a newcomer to the organization unaware of this history and the tolerance for this 13th stepping for this sexual abuse within the organization and find yourself the victim of it. And because the program itself traffics in a lot of self-blame. You find yourself blaming yourself once again for any sort of sexual impropriety that may have been fallen you. What is remarkable to me, I guess, is that we know it's

a vulnerable time, and yet what's being done to help protect that kind of vulnerable space from. That's why we recommend women go to women's meetings and not co-ed meetings, for example. That's Stephanie Cubington again. This is a pretty common suggestion. Just go to the meetings where men aren't. It's up to you to find a meeting that feels most comfortable. Because AA is not going to do it for you.

AA was designed to be a decentralized organization. There's no CEO or ethics board, and anyone can start a group. That means truly anyone can join. And no one's in charge. The big book says God is the sole authority in AA. There is a general services office of AA that distributes information and offers suggestions. For example, if someone

is sexually harassed by another member, the GSO suggests the group should work it out on their own. I think it's safe to say, given all we've learned in the past few episodes about early recovery, how hard it is to report wrongdoing, never mind be believed, that approach is not based in reality. When I was researching the history of AA, I found a wild story. It was in the Go To book about about addiction treatment called slaying the dragon. Seriously, ask anyone in the addiction world about this book, they'll know slaying the dragon. The author, William White, he wrote that one of the first women to seek help from AA, known as Lill, she was 13th-step. And then he writes, quote, Lill, like many of the women who contacted AA in the early years, did not get sober during

this period. Lil was just the beginning. In 2014, Gabrielle Glazer went on a media tour, telling reporters about her new book, including the parts where she critiques AA, and the chapter she wrote about 13th stepping. One night, I turned on my computer. I'd been on a radio show.

I turned on my computer. And I had hundreds. I think there were more than 300 messages from women who had listened to it. And I was day-loved with messages from women who had been sexually abused, either in rehab or by their sponsors. And they had not been believed.

This, and they were so ashamed and traumatized by this, they didn't really have anybody to talk to about it. I felt like I was running a rape crisis hotline, and I felt terrible. I understood that what I had uncovered was maybe just the tip of the iceberg. There's one last thing I want to tell you about 12-step culture. There is a loud, powerful resistance to change. There are definitely corners of the community that have evolved.

Shout out to gayandsober.org, for example. They have an incredible meeting directory that identifies meetings for LGBTQ plus people all over the world. There are also groups for black people who feel unsafe in white spaces. You can even go to a group for atheists if you're not into AA's emphasis on a higher power. But all three women you've heard from here, Gabrielle, Holly, Stephanie, they all told me it is not easy to come out publicly and suggest that the 12 steps aren't perfect. Even if you've seen them work for people and just added to them like Stephanie has.

Over the years I've gotten several emails and phone calls from people telling me that women were going to die because of the work I was doing. For example, if they read a woman's way through the 12 steps and didn't read the big book, they weren't going to get into recovery and they were going to die, or if they focused on trauma and not on the core issue of addiction, they were going to die. It was ridiculous. And that's what it's like to want to improve on the 12 steps. Imagine if you're Gabrielle and you've openly condemned them.

Gabrielle wrote an article for the Atlantic a few years back, criticizing all of AA, not just how it works for women. She went on MSNBC to talk about it. And afterwards, there were hundreds of tweets that called from my head. There were death threats. I don't even want to repeat to what the death threats were. And Holly Whitaker, she didn't have it much better. When you wrote this piece for The New York Times,

did you get pushback? Did I get pushback? Let's see. I wouldn't call it pushback. I would say I got canceled within the recovery community. But Holly had a feeling this was coming. It makes complete and perfect sense to me.

When something did save your life and there's also not much around to save your life from this really specific thing. And not only that, you find community in it and a group of people that are gonna accept you no matter what, you know? Like you, of course you're gonna, like of course when that thing gets threatened

and you believe that it's the thing that saved your life, it feels like a part of, like it feels like your own sobriety is being threatened, feels like your own recovery is being threatened. And I think that that's like one of the big dangers of, you know, the recovery world is that conflation of believing you're not powerful, but your, but your program is.

The thing that saved your life. This is why it's hard to have a conversation about any wrongdoing in any part of the addiction world. Why it's hard to talk openly about sexual misconduct and 13th stepping. But if we don't talk about sexual misconduct, unhealthy boundaries, any of it, then we're never going to stop people from doing it. Next time, on the 13th step, two women who spoke up and kept going and going and going and finally caught a bad guy. The 13th step is reported and produced by me, Lauren Chuljian. Jason Moon contributed reporting. He also wrote the music you hear in this show and mixed all the episodes. Allison McAdam is our editor, additional editing from senior editor Katie Culinary and news director Dan Barich.

Fact checking by Daniel Sulemon, Sarah Plore created our artwork at our website, 13thStepPodcast.org. That's the number 13. Sigmund Schutz is our lawyer. NHPR's director of podcast is Rebecca LeVoy. Special thanks for this episode. Go to Kise McDermott, Taylor Quimbee, Ariana Life, Max Green, Ilya Maritz, Linda Richter, Mark McGovern, John Kelly, Kimberly Johnson, Dave Aaron Burke, Phillip Hampill, Kathy Bogart, Claire Tragaser, William L. White, and Mary Ryan Woods.

The 13th step is a production of the document team at New Hampshire Public Radio. you