Tuesday, May 21, 2019

Good to see the word is getting out

Reddit posted yet another repost of that old 2015 article from The Atlantic about how AA supposedly has a 5% success rate. However, this time someone actually researched the number and posted the following:
From Dodes' book " research indicates that only 5 to 8 percent of the people who go to one or more AA meetings achieve sobriety for longer than one year."
https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous#The_Sober_Truth
But that number is controversial (and the above wikipedia article gives a good overview of the conflicting views).
Point being, all of the effort I have gone to over the years to find accurate information about AA’s success and making the Wikipedia article on the topic reflect what science actually knows is paying off; people can no longer claim “AA has only a 5% success rate” without the claim being questioned.

The mid-2010s situation where a single doctor, without quoting any actual study, makes up a 5% success rate figure for AA by multiplying numbers from different studies together and not being questioned are behind us. Now, anyone interested in facts can and does find out that Dodes’s numbers were garbage.

AA has a 67-75% success rate among people who regularly go to meetings.  This is the number that science shows us; this number has been replicated across multiple studies and has been consistent since the mid-1950s.

Tuesday, May 14, 2019

Review: “US of AA” by Joe Miller

I will review “US of AA: How the Twelve Steps Hijacked the Science of Alcoholism” by Joe Miller. Since this blog focuses on the efficacy of AA (67-75%), I will look at how this book looks at AA’s success. To quote the book:
Perhaps the most widely known statistic showing AA's ineffectiveness relative to other treatment methods is the 5 percent success rate -- that served as a centerpiece statistic in The Sober Truth, a 2014 expose by former Harvard psychiatry professor Lance Dodes of the bad science behind AA. In fact, he gathered the statistic from AA’s own surveys. Every three years since 1968 AA has randomly queried several thousands of its members for basic info -- age, career, gender, how they came to AA, and length of sobriety. One of the questions AA asks is the month and year when they first came into AA. In 1990, the AA member who analyzed the results used the data to "show the probability that a member will remain in the Fellowship a given number of months." He calculated that out of every hundred people who came into AA, eighty leave within a month. At the three-month mark, only ten remain. At one year, that number has dwindled to five.
Seems straightforward: AA fails ninety-five percent of the people who come in the door.
In other words, the author has completely disregarded any real research on AA’s success done in the last decade. Indeed, Miller did not correctly read The Sober Truth, since Dodes does concede that that old 1990 AA survey shows a 26% retention rate. Dodes’s book uses another trick to make up the 5% success rate figure, which is also inaccurate (he multiplies numbers from unrelated studies to cook up that artificial 5% figure).

If Miller can not get basic facts about AA’s success rate correct, I see no need to waste my time reading any more of this poorly researched book.

Fortunately, this book did not get the level of press that Dodes’s poorly argued 2014 polemic got.

Wednesday, February 13, 2019

Another article with a reasonable look at AA

Here is an article, written by a medical student, which looks at Alcoholics Anonymous (AA) from the viewpoint of a doctor who needs to understand the program better. Not only does it have a favorable viewpoint about AA, it links to and summarizes scientific studies showing the AA works for most people who make a regular habit of going to meetings:

http://in-training.org/sitting-in-the-circle-what-a-third-year-medical-student-learned-from-alcoholics-anonymous-16951

Well worth a read.

Sunday, February 10, 2019

As one Reddit user put it

Here is a Reddit post which nicely summarizes the “AA does not work” nonsense out there:
Partial truth & twisting of facts is however representative of those with a bias and agenda against 12 Step recovery modalities. They expect the gullible to just accept their reporting as the entire truth and not take the time to check out the actual facts. Those with a predilection against 12 step or have a perceived resentment of course will jump on the partial truths and outright lies of those with a similar bias.
How else can you describe a mindset where people believe AA has a 5% success rate even though no peer reviewed study has ever concluded this. Instead, the studies show a 67%-75% success rate among alcoholics who get serious about the program; people in denial, however, don’t let facts gets in the way of their flawed world view.

Friday, January 4, 2019

AA has a 67-75% success rate

Critics of the 12-step programs attempt to discredit the longitudinal studies, which show a 67-75% success rate for AA:
  • They don’t like the fact that those high success rate numbers only come from people who actively go to AA meetings.  However, this is consistent with AA’s own claim that “Rarely have we seen a person fail who has thoroughly followed our path” (emphasis mine)
  • They claim the numbers are invalid because of “self selection bias”; in other words, they believe the people who are clean and sober because of AA would have gotten clean and sober anyway in an alternate universe where AA doesn’t exist. A 2014 paper demonstrates this actually isn’t the case.
  • They complain that the studies do not include dropouts.  However, the drop out rate is small enough to not significantly skew the numbers, especially since, most of the time, the dropouts undoubtedly 1) Didn’t work the AA program and 2) Didn’t get sober. 
  • They make other complaints about the methodology of the studies. However, this ignores the fact that these numbers have been pretty consistent across multiple longitudinal studies. Fiorentine 1999: 74.8% success rate. Moos and Moos 2006: 67% success rate 16 years later. The Natural History of Alcoholism Revisited by George E. Vaillant has a table on page 197 showing that 19 out of 100 alcoholics attended 300 or more meetings over a 10-year period, of those 19, 14 were sober: 74% success rate. Witbrodt 2012 saw similar numbers: “high 12-step attendance (abstinence rates averaging 75%)”. AA’s own Big Book has the same abstinence rate using 1955 numbers: “Of alcoholics who came to A.A. and really tried, 50% got sober at once and remained that way; 25% sobered up after some relapses”
The fact is this: We have multiple studies showing the same number: 75% success rate among people who keep coming back to AA. The science is undeniable: Meeting makers make it.
 

Wednesday, January 2, 2019

Brandsma 1980: The AA treatment

The 1980 book Outpatient Treatment of Alcoholism (Brandsma 1980) has been quoted by anti-AA critics as showing AA as being ineffective.  In this post, I will look at the “AA” treatment which the subjects of the book underwent. Here is how the book describes it (“SHARP” here is an office the Brandsma research team set up for conducting their research; they tried to get people in the community to attend, but it ended up that most people got treatment there because the court mandated them to go):
An AA treatment group was started at SHARP by contacting the local AA organization. They sent two volunteers, a man (with a B.S.) and a woman (with a high school education), to begin our new group. They had 14 and 10 years experience in AA, respectively. The AA group was open to all who would attend and was conducted by one or the other of these people for approximately 1 year until January, 1973. By that time (the beginning of the research in terms of assigning patients), a member of the group (not included in the research project) had become very adept at running meetings. This minority group member, who had a 9th grade education, had had no AA experience before modeling himself after the two initial leaders of this group. This person remained the leader for the rest of the time of the research project (with a 3-week hiatus when an experienced AA counselor filled in), and continues to be involved in AA today. He received no remuneration for this, but was very cooperative in providing attendance reports for the project.
The “AA” treatment is described in more detail in another section of the book:
Our group met once per week and tended to focus on persons present for the first time, but not to the exclusion of other members. The 12 steps of AA were used as the content focus for discussions. The men were made aware of the availability of “sponsor-friends” and were encouraged to ally themselves with one or more of their own choosing. Generally our patients seems to neglect availing themselves of this opportunity, and the assignment of sponsors was not followed up on in this group. Beyond this description we are unable to be more specific. [...]

The nature of scientific investigation did force some small changes in the usual AA norms. First, most of our clients came coerced from the court system and all were then randomly assigned to treatments. Thus they were not “free to choose” whether to have treatment or the type of treatment. However, a person’s first visit to AA usually results from some form of “coercion,” e.g. a wife or boss. Second, participation was not anonymous because we kept attendance records, although this was an unobtrusive procedure. If a man’s attendance was poor or nonexistent, he would be contacted at least once by a project social worker, reminded of the conditions of his parole, and encouraged to return. This type of “coercion” (in contrast to the “buddy system”) is different than usual AA procedures. Our group did not develop a high degree of cohesiveness or a formalized buddy system as some do, nor did we offer other “services,” as does Al-Anon. However, given our population, situation, and purposes, we believe this was a representative treatment effort within the AA framework.
So, as we can see, almost no one in the Brandsma treatment got a sponsor, everyone in the group was a “court card” attender, and, even worse, they would get a threatening phone call if they didn’t show up at the meeting.

The Brandsma 1980 “AA” treatment (and, yes, Kaskutas 2009 is slightly inaccurate in her description of the “AA” treatment offered in the Brandsma study; the meetings were open to the public, but it’s unknown whether the meetings were listed in a local AA directory) does not sound like a meeting where people were effectively working the AA program. Kaskutas’s concern that “a potentially important therapeutic ingredient of AA—the experience of longer-term members—would not have been present in the AA condition” is spot on: The leader of the meeting had barely a year sober and the other attendees were “court slip” members.

Based on the description of the “AA” treatment, any conclusions Brandsma 1980 makes about AA efficacy are suspect.

Monday, December 31, 2018

Some history behind Pendery 1982

Let me finish off 2018 by taking about how the seminal work refuting the notion that alcoholics can moderate their drinking again, Pendery 1982, came to be published.

Pendery 1982 (i.e. M.L. Pendery, I.M. Maltzman, and L.J. West. "Controlled Drinking by Alcoholics? New Findings and a Reevaluation of a Major Affirmative Study" Science 217) is a very key paper in the history of alcoholism studies; the release of the paper was the last nail in the coffin that alcoholics can engage in sustained controlled drinking again. It humiliated the controlled drinking for alcoholics proponents; the study undeniably shows that alcoholics who try moderate drinking end up either dead, drinking like an alcoholic, or abstaining from alcohol.

The paper has a very interesting history which can be seen in two articles from 1982, when this very important paper was published:
  • Alcoholism study under new attack. This article shows how the 1970s Sobell studies resulted in alcoholism experts from that era believing that alcoholics could learn to drink in a responsible manner, and how Pendery 1982 refuted that notion.
  • Showdown nears in feud over alcohol studies. This article shows how hard Pendery and Maltzman had to work to make their paper a reality: “At every step of the way the Sobells have tried to block the investigation by Dr. Pendery and Dr. Maltzman. [...] The Sobells refused to hand over their list of the participants [...] Undaunted by the Sobells' resistance, the Pendery group tracked down a list of the patients' names at a county alcoholism center [...] The Sobells retaliated with a suit to block the use of the names, but a Federal District court dismissed their action in April 1977 [...] It took Dr. Pendery, using thousands of dollars of her own money and whatever time she could squeeze in among her other obligations, several more years to track down patients”
However, despite all this resistance, the paper was published and the notion that alcoholics could control their drinking again was no longer mainstream addiction research. 60 Minutes broadcast a segment describing the Pendery paper; Al Gore, long before he became vice president, wanted to investigate the Sobells for fraud.

Ultimately, the addiction experts who supported Sobell’s point of view would appear to have never let go of Pendery 1982. As recently as 2015, in a poorly researched anti-AA polemic, Glaser inaccurately describes the Sobell study. The Sobell study was not accurate; while an initial 1982 panel felt the Sobells were reasonably accurate in their research, a later 1984 Federal investigation (you know, with subpoena powers) pointed out that the Sobells were “careless in preparing their manuscripts for publication”. Indeed, some of the “controlled drinking” subjects in the study sued the Sobells.

Since people who think alcoholics can drink moderately again bring this up: How the alcoholics given abstinence treatment fared is a red herring. The Sobell study was done in the early 70s, some four decades before we starting finding twelve step facilitation treatments which effectively got more people going to 12-step meetings and abstaining from alcohol.

The fact of the matter is this: With one exception, Pendery 1982 shows us that the supposedly moderately drinking alcoholics in the Sobell study were either dead, engaging in out of control drinking, or were abstaining from alcohol 10 years later.