Monday, January 8, 2018

Naltrexone, acamprosate, and the Sinclair Method

Since I have been in an online debate with someone who claims AA doesn't work and advocates the Sinclair Method, I should go over the newer medication assisted therapies.

The Sinclair Method is simply suggesting to use the medication Naltrexone along with engaging in moderate drinking. There have been studies showing that people can more easily moderately drink when taking Naltrexone, but the effect has also been described as being modest

The Sinclair Method has the same problem all other moderation methods have: Yes, it shows some, albeit modest, level of short term success, but we do not have long term studies. Short-term studies advocating moderate drinking are unreliable; long term follow ups show the "moderate" drinkers drinking heavily again. Until we have a 10-year follow up study showing people still using Naltrexone to moderate their drinking, or being able to abstain from drinking altogether after using Naltrexone for a while, I am very skeptical. We have had too many people die deceiving themselves with "moderate drinking" approaches; I have not seen evidence that Naltrexone is a silver bullet that will change things.

Naltrexone is not an effective therapy for people who want to abstain; there are two studies showing this drug has little to no effect when the patient pursues abstinence. 

Acamprosate, on the other hand, seems to work better when the goal is abstinence. The effect is "small but significant", but it may help alcoholics achieve abstinence when used with other therapies.

I think, when used with the 12 steps and regular Alcoholics Anonymous, Acamprosate may be a helpful drug for achieving long-term sobriety. Bill Wilson had no objection to the use of medications to successfully work the AA program. That said, while the effect for both drugs is there, it's small.

Sunday, January 7, 2018

I also oppose dogmatism in AA

There is remarkable little I disagree on with the author of

The fact of the matter is this: A quarter of a century ago, when a home computer was an investment which cost as much as a good used car, and the internet was only something only occasionally mentioned in magazines, people were a lot more dogmatic in AA meetings. The steps, outlined in the first 164 pages of the Big Book were the only way to save sober, and if you didn't get serious about working the steps right now you would surely relapse again. People enjoyed beating the program over people's head and using the program as an excuse to bully newcomers. 

I found the dogmatism of those people repulsive, and managed to stay sober, even though I had to fire my sponsor just before working my fifth step. According to the AA fundamentalists, I was on the path to relapse since I didn't finish the steps. It took me a decade to finally finish up the steps (where step nine has been by and large living amends), a decade where I never relapsed.

The point being: I was not, for large parts of my recovery, a Big Book thumper. There was a brief period when I started thumping the Big Book pretty heavily at meetings, to the point someone with more time than me told me to stop beating the drum. The program, as written in the first 164 pages of the Big Book, is a very effective program, but I no longer pretend that it is the only, or even necessarily best, way to stay sober.  

And, the AA program has changed. It used to be standard fare to hear people proclaim "The program as written in the first 164 pages is the way to stay sober." Recently, I got in a heated discussion when I pointed out that a person can stay sober with just the 164; telling people they must work the program a certain way is just not how things are done at AA meetings any more.

Atheists, who used to hide in the corners, now openly proclaim their atheism in the rooms. Indeed, the Gravevine is looking for atheists and agnostics who are still sober to publish their stories in official AA literature. They may still be Big Book meetings, but there are also people with years clean and sober who openly admit that they do not like the Big Book in meetings.

That said, the fanaticism of people with an agenda is even worse. describes them well. When they were a loud spoken minority, that was one thing. Once Lance Dodes's book made their viewpoints get printed in mainstream journals, that was when a line was crossed. I knew, from my decades of experience with AA, that claims of AA not being helpful were simply not true. I started reading scientific papers, started to understand what was being discussed; the page is a good, reasonably balanced introduction to what the science has to say about AA effectiveness. 

AA works if you work it. The science shows that. The AA Big Book, in the preface to the second edition, claims a 75% success rate among "alcoholics who came to A.A. and really tried." Multiple observational studies support this figure, to name just three: Valliant 1995, Fiorentine 1999, and Moos and Moos 2006

No, AA is not for everyone. There are people who may be better off staying sober using SMART Recovery, Life Ring Fellowship, The Sinclair Method, whatever. Or the first 164 pages of the Big Book: I have well over 10,000 days clean and sober working the Big Book program. But making false claims that AA fails the majority of people who really try the program is downright dishonest. Making claims that AA has a 5% success rate is downright dishonest. Using 38-year-old or 50-year-old studies to claim AA doesn't work while ignoring studies from this century showing AA effectiveness is downright dishonest.

Hence, this blog. I correct the record when people with an agenda against AA use outdated or inaccurate information to downplay AA's huge success keeping people sober.

Saturday, January 6, 2018

Surprise! An article in a stoner magazine doesn't like Alcoholics Anonymous

Surprise! An article in a stoner magazine doesn't like Alcoholics Anonymous.

This article uses the following two anti-AA tropes to claim that AA does not work:
The article also claims the AA Big Book is inaccurate when it claims a 75% success rate. Actually, I have seen multiple studies with this figure or similar figures; e.g. Moos and Moos 2006 shows, among alcoholics who took AA seriously, 67% of them were still sober 16 years later.

Tuesday, January 2, 2018

2018 is starting off as a great year

2018 is starting off as a great year.

The Vox published today a well-researched story about Alcoholics Anonymous with information which actually reflects what treatment experts know about AA today, called Why some people swear by Alcoholics Anonymous — and others despise it.

Unlike the anti-AA polemics posted by NPR, The Atlantic, and Salon over the past few years, they did not waste their time interviewing known anti-AA critics Lance Dodes or Stanton Peele. Instead, they talked to people with a more balanced view, such as Keith Humphreys.

There’s no nonsense about AA having a 5% success rate; they say about a third of alcoholics are successful using AA. This is actually higher than the numbers I have seen; for example, Moos and Moos 2006 shows that AA  has a 67% success rate among the 25% or so of alcoholics who choose to be highly involved in the program their first year sober.

I am glad to see the mainstream press is starting to publish articles showing the real success rate for AA, instead of publishing articles with deceptive success rate figures (there is no peer-reviewed study which concludes AA has a 5% success rate!) which discourage people from going to a program which can save their life.

Thursday, December 28, 2017

There is no evidence Audrey Kishline was an active member of AA in 2000

Audrey Kishline was the founder of the group "Moderation Management", which pretended that chronic alcoholics could drink moderately again. Audrey Kishline was never able to drink moderately; in 2000, she got behind the wheel of her truck, and killed two innocent people while driving drunk. 

Soon afterwards, Kishline admitted that "moderation management is nothing but alcoholics covering up their problem."

Audrey Kishline ended up killing herself in late 2014. This was the end result and ultimate consequence of denying she had a drinking problem and deceiving herself and others that she could drink moderately again: Death. Not only her own death, but the death of two innocent bystanders.

One refrain anti-steppers attempt to make when people point out the consequences of Audrey Kishline lying to herself about her moderate drinking, is that she was in AA when she had her fatal drunken driving episode.

There is no evidence that Audrey ever actively worked an AA program before this tragic incident.

The evidence anti steppers bring up is this: where Audrey finally admits she can not drink moderately to the Moderation Management mailing list; she wrote that "I am now following a different path, and to strengthen my sobriety I am attending Alcoholics Anonymous, but will also attend Women for Sobriety and SMART Recovery. I am sure I can learn much from all of these fine programs."

Did Audrey get a sponsor? How often did Audrey go to meetings? Did she work the program as described in the first 164 pages of the Big Book? Was she serious about the program, or was she just trying to look good to others?

The fact that she was considering other programs when she wrote this sentence indicates that she was not serious about AA. I suspect she was just trying to look good to others.

In fact, let's look at an obituary posted after she killed herself to get more details of her life when she drove drunk like that:

When she wrote the email saying that moderation was not working any more, her drinking was so bad, she was forced by law enforcement to go to a detox program. Not a peep in her email about the fact her drinking was so bad, it was giving her legal problems, The email she sent to the listserv was dishonest, so its claim that Audrey was actively going to AA meetings is, at best, suspect.

The only evidence that Audrey went to even a single AA meeting between the time she wrote the email claiming she was going to AA and the time she killed two people driving drunk is an email which we now know was dishonest. 

(Update: The Dateline piece on Audrey's drunk driving has a tiny bit more detail about Audrey's supposed membership in AA between the time she left Moderation Management and that her fateful accident: "The creator of MM was admitting defeat. She checked herself into a detox facility followed up by AA meetings, but she couldn’t play by those rules either.  It did not go unnoticed by her 10-year-old daughter. [Kishline said that] 'I would keep falling off the abstinence wagon.' " Again, no details about the number of AA meetings Audrey went to or whether she actually got serious about working the program)

Update #2: Here is how Audrey Kishline described her year-2000 Alcoholics Anonymous supposed attendance in her autobiography Face to Face:
In the two months that followed [after she wrote the email to the Moderation Management list saying she could not moderate her drinking and before her tragic drunk driving accident] I was supposed to be attending AA meetings, abstaining from drinking, and "working the program." I had huge remorse about having become so drunk and calling the police [This refers to the event where she was forcibly put in detox]. Remorse was my motivation this time to get my act together and quit drinking. But the same old cycle I lived for years began to repeat. I'd abstain for a few days and immediately fall off. Each fall was getting worse and worse. It became increasingly harder for me to remain anonymous too. I was easily recognizable when I attended AA, which only added to my discomfort. I never identified myself as anyone other than "Audrey," but lots of people knew exactly who I was. 
(emphasis in bold like this mine; notes in italics and brackets [like this] added by me to give context)

This is a description of someone who almost never went to AA because they found excuses and justifications not to go, not the story of someone who took AA seriously and worked the 12 steps to the best of their ability. Supposed-to-be-going-to-AA but finding excuses not to go (such as thinking people will recognize and judge them) is not good enough for someone to get sober using the AA program.

Tuesday, December 19, 2017

Asking people to take responsibility for their life is not "victim blaming"

A common thread I have notice among people who are very critical about 12-step programs is a tendency to not want people be held accountable for their choices and actions. When someone points out that the 12-step program is successful for people who make a decision to work it, AA critics dismiss the evidence, claiming that this is victim blaming.  It is not.

A victim is defined as being someone "who is harmed by another". How is an addict, going to an Alcoholics Anonymous meeting, who decides on their own to no longer go to meetings a victim? They are not. They made a decision to stop going to AA meetings; they made a decision to drink again; they made decisions which they knew had negative consequences. They are not a victim; they are someone suffering the consequences of their own bad decisions.

AA works for people who choose to work it; it does not work for people who choose to not work it. This is a fact supported by science. Pointing out this fact is not victim blaming.

Friday, November 3, 2017

Orange Papers is gone from the Internet

The notorious "Orange Papers" site, which in its heyday falsely claimed that Alcoholics Anonymous is not helpful, is gone from the internet; it has been down for about half a year. According to its present whois information, it is down because the owner of the site has not been paying his bills.

There are unconfirmed reports that the owner of the site is homeless. While these reports are unconfirmed (I believe them to be true because their source is from people who have no reason to report this, except for concern of "Mr. Orange"'s well-being), we can confirm that the owner of this site is no longer able to pay basic bills such as hosting and registration for his web site. For anyone with a living wage, for anyone who is successful in life, the cost of these kinds of bills -- in the order of a couple hundred a year, if even that -- is trivial. Someone needs to have serious problems managing his life to not be able to pay this kind of bill.

My sponsor has always said that "Look at the life someone is living and decide if you want what they have."  I do not want to be unable to pay my bills, and I do not want to probably be homeless, so I have no reason to emulate Mr. Orange's behavior. 

My prayers, of course, are with Mr. Orange. I hope he gets out of the problems he is having in his life. Then again, life does have consequences, and I can not see any good coming from having a resentment against AA.

Alcoholics Anonymous almost always works if you work it. For the record, I am not homeless, I am able to pay my bills, and I am able to celebrate another day clean and sober.