My favorite two sentences in the Alcoholics Anonymous literature are: “Alcoholics Anonymous does not demand that you believe anything. All of its twelve steps are but suggestions.” When a drunk at the end of his tether, Bill Wilson, founded Alcoholics Anonymous in the late 1930s—a spiritual program based on meeting with other addicts—there was a fundamental humility to his ideology: It might work for some.

But that sentiment is often forgotten in the rooms of AA itself, where I spent a lot of time getting sober. There I found that what are suggestions to some are fundamentalist Scripture to others. In the rooms of AA, suggestions and traditions can sometimes feel more like ironclad laws, and when I inadvertently trespassed upon those laws, I was humiliated and rebuked. The predominantly AA-based culture of rehab in America has become one of imposition and tautology: If the program doesn’t work for you, then you didn’t work the program. If you succeed in staying sober, then you did a good job working the program; ergo, the program works.

In the rooms of AA, suggestions and traditions can sometimes feel more like ironclad laws.

In Anne M. Fletcher’s excellent and exhaustive book, she finds that almost all rehabs adhere to this intransigent dogma. Some just have better views, higher thread counts, and more horses (you know, for equine therapy). There is no individualized treatment. You check in, detox, and then go to addiction-education lectures, group therapy, and AA twelve-step meetings. “I often found myself wondering, ‘Where’s the counseling?’” writes Fletcher. Patients attend these group gatherings for 28 to 90 days, and are then released back into the real world. Problem is, the real world is teeming with temptations, and most people relapse. So what do we do with them? More rehab! Because it isn’t the rehab that has failed; it is you. Fletcher’s multi-year-long dive into the realities of rehabs is deeply unsettling. “Once you’ve seen any substance abuse program, you have seen the great majority of them,” Tom McClellan, co-founder of the Treatment Research Institute, tells Fletcher.

How did this come about? Addiction was stigmatized so fervently and for so long that for decades there was no body of science to advise desperate addicts. In that vacuum, McClellan says, the field “grew its own program.” The twelve steps of AA became the template treatment for just about every compulsive behavior there is, from Narcotics Anonymous to Debtors Anonymous. Meanwhile, as AA grew, a movement was brewing in Minnesota: rehabilitation. In the 1950s, a recovering alcoholic, Austin Ripley, began a sanitarium for alcoholics based on AA principles out on a farm in Minnesota. (It became Hazelden, perhaps today’s most well-known rehab.) Soon enough, this Minnesota model attracted more people from AA, and the prototype for modern-day rehab was born, guided by, as Fletcher writes, “the folk wisdom of recovering people, particularly through the perspectives of Alcoholics Anonymous and related twelve-step programs.”

To be sure, that folk wisdom has benefitted millions, including myself. Striving for honesty, communing with people who don’t judge, admitting when you’re wrong, working on the content of your character, learning humility, being of service to others—these are deeply valuable principles, ones this alcoholic needed to find after years of boozy nonchalance. In fact, the steps could be beneficial to anyone.