In his new book, released today, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (co-written with Zachary Dodes), he casts a critical eye on 12-step hegemony; dissecting the history, philosophy, and ultimate efficacy of TSF, lending special scrutiny to its flagship program.

“Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” writes Dodes. “About one of every 15 people who enter these programs is able to become and stay sober.”

This contrasts with AA’s self-reported figures: A 2007 internal survey found that 33 percent of members said they had been sober for more than a decade. Twelve percent claimed sobriety for five to 10 years, 24 percent were sober for one to five years, and 31 percent were sober for under a year. Of course, those don’t take into account the large number of alcoholics who never make it through their first year of meetings, subsequently never completing the 12 steps (the definition of success, by AA’s standards).

A report published by Alcoholism Treatment Quarterly in 2000 analyzed AA membership surveys taken from 1968 through 1996. On average, 81 percent of newcomers stopped attending meetings within the first month. After 90 days, only 10 percent remained. That figure was halved after a full year.

Additionally, there’s AA’s barefaced religious affiliations to consider. True, the 12 steps have been worded in such a way as to suggest a certain amount of leeway in which God (or “higher power”) one ultimately surrenders to; but AA is a self-identified Christian organization with a significant portion of its methodology rooted in prayer. As it says in AA’s founding literature, known as the Big Book, “To some people we need not, and probably should not, emphasize the spiritual feature on our first approach. We might prejudice them. At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God.”

So how did AA gain such a place of privilege in American health-culture? How did a regimen so overtly religious in nature, with a 31 percent success rate at best, a five to 10 percent success rate at worst, and a five percent overall retention rate become the most trusted method of addiction-treatment in the country, and arguably the world? It’s a central question Dodes seeks to answer in The Sober Truth. And he begins at the very beginning.

According to Dodes, when the Big Book was first published in 1939, it was met with wide skepticism in the medical community. The AMA called it “a curious combination of organizing propaganda and religious exhortation.” A year later, the Journal of Nervous and Mental Diseases described it as “a rambling sort of camp-meeting confession of experiences … Of the inner meaning of alcoholism there is hardly a word. It is all surface material.”