“The Thirteenth Step”: Not What You’re Probably Thinking

The Thirteenth Step by NIH bigwig and addictions expert Dr. Markus Heilig is not about what you might think—if you’re aware, that is, of the practice of “13th stepping,” an unapproved activity that can occur when someone in a 12-step program for over a year hits on someone with less time/sobriety than that.

Moreover, there actually is no designated step beyond the traditional 12.

Heilig’s subtitle, Addiction in the Age of Brain Science, serves the book’s content better. As described by Bob Grant, The Scientist:

Through a series of case studies of real patients, the author elucidates the brain structure and function that underlie relapse, drug-seeking behavior, and other addiction-related phenomena. But as complete as the science seems, there are still obstacles to implementing therapies based on its findings. ‘Prejudice, stigma, and financial interests conspire to prevent science-based treatments from reaching patients who need them,’ Heilig writes.

Kirkus Reviews tells us the author of The Thirteenth Step is “a specialist in the field of neuropsychopharmacology” and adds that “Heilig subscribes to the view that ‘addiction is inherently a chronic, relapsing disease, not much different from…hypertension, diabetes, or asthma’.”

Some of the myth-busting points Heilig gets across in The Thirteenth Step:

  • People don’t have to claim powerlessness as a prelude to recovery.
  • There are other worthy goals besides complete abstinence.
  • It’s untrue “(t)hat taking a single drink is just as bad as taking 10.”

He argues that most of today’s commonly used treatment strategies are outdated, including what are commonly known as “interventions” and programs that involve detox only.

What’s more effective in his view? Two examples are CBT (cognitive-behavioral therapy) and the antirelapse medications that exist for alcohol, heroin, and nicotine.

Selected Reviews of The Thirteenth Step

Kirkus Reviews: “Heilig writes compassionately of the problems of patients caught in the grip of addiction whose lives often spiral out of control despite their struggle to remain sober. There are ‘two perspectives’ he writes, ‘of science and humanism,’ which ‘are inseparable in any area of medicine, but perhaps most so in psychiatry and addiction medicine’.”

Rajita Sinha, PhD, Yale Medical School: “Poignantly written and personal, yet presents the current science of addiction in a clear and engaging way…His book brings to life the countless devastating effects of addiction that affect individuals across all strata of society while attacking the stigma of addiction and shows the importance of neuroscience in understanding and treating it.”

New York Journal of Books: “…(T)his is an eye-opening book enriched by facts, figures, and heartbreaking stories, the addiction parallel of Professor Mukherjee’s The Emperor of All Maladies. It is well-balanced, thorough, and challenging, inducing empathy in members of the public and those working in the field alike.”

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