Tuesday, October 27, 2015

A good discussion of the 2006 Cochrane review

Here is a post from late last year discussing the problems with the last (2006) Cochrane review of how effective Alcoholics Anonymous is:


Sunday, August 23, 2015

Brandsma 1980: Not peer reviewed

While researching which studies to discuss in the Effectiveness of Alcoholics Anonymous Wikipedia article, I went over to the Rational Wiki Alcoholics Anonymous article to see if I could add some peer reviewed information showing that AA is not effective from the other side.

Unfortunately, the Rational Wiki did not have any good science in it. The study they refer to with allegations that AA actually increases binge drinking has the ambiguous name "Brandsma et al. 1980" Research revealed that this supposedly scientific, albeit dated, survey showing how AA is worse than no treatment would have a DOI or PMCID, the way peer-reviewed studies do. It doesn't. 

A Google search of the study showed the primary people referring it were unreliable anti-steppers (including, yes, people on the fringe of academia like Stanton Peele). Apparently, this study got put on the Orange Papers site, where the usual cadre of anti-steppers mirrored it from.

Finally, I got some solid information about this article in, of all places, an Amazon review. To summarize: This study was not peer reviewed, was published by one University Park Press, which mainly prints university textbooks -- read: not published in a journal, and its methodology is, at best, suspect.

It is referred to in journal papers, but usually negatively. For example, PMC2746426 mentions "concerns with the Brandsma trial which call its experimental results into question", and PMC3602358 says that studies like this are "significantly limited in their methods or interpretability," PMC3549307 (by the same authors) says the same thing.

Why is it that anti-steppers need to use a 35-year old non-peer reviewed study to find "science" to back up their anti-AA talking points? Because the real science shows that AA actually works.

Let me rephrase that: The objective science shows the people who go to more AA meetings are more likely to stay sober. The science has not yet concluded that it's AA's 12 step program that results in the statistically undeniable positive outcomes for AA members, but research is going in that direction.

Sunday, June 21, 2015

June 2015 round-up

OK, I'm back, but just to summarize a couple of articles and comments I have found.

First of all,  a recent study concluded that "increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection." (PMC4285560). Austin Frakt wrote a New York Times piece about it: http://www.nytimes.com/2015/04/07/upshot/alcoholics-anonymous-and-the-challenge-of-evidence-based-medicine.html 

This study is pretty key: It's been well-established by the science that, as we say in AA, "meeting makers make it"; the question now being asked is "do meeting makers make it because those that go to meetings are more motivated to get sober, or because AA helps keep alcoholics sober?" This study concludes it's the actual program which keeps people sober.

* * *

Here's another good refutation of Lance Dodes's book: http://www.amazon.com/gp/cdp/member-reviews/A3HLE5G8L7A4OQ For example, here's an excerpt from one study (PMC2746426; I have taken the liberty to remove references to other parts of the study placed in parenthesis in the original):
Rates of abstinence are about twice as high among those who attend AA; higher levels of attendance are related to higher rates of abstinence; these relationships are found for different samples and follow-up periods; prior AA attendance is predictive of subsequent abstinence; and mechanisms of action predicted by theories of behavior change are present in AA. However, rigorous experimental evidence establishing the specificity of an effect for AA or Twelve Step Facilitation/TSF is mixed, with 2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and to that reported significant effects for AA after adjusting for potential confounders such as motivation to change.
This is how Dodes quotes that in his book:
Rigorous experimental evidence establishing the specificity of an effect for AA or 12 Step Facilitation is mixed, with two trials finding a positive effect for AA, one trial finding a negative effect for AA, and one trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and to that reported significant effects for AA after adjusting for potential confounders such as motivation to change.
Only someone with a strong anti-12-step bias would take a study that states that "rates of abstinence are about twice as high among those who attend AA" and conclude that the study is saying that "the strong evidence that one would expect if AA were clearly effective is simply not present."

What Dodes is doing here is a dishonest: He is not arguing that meeting makers make it, although he tries to imply that using unrelated data. The evidence that "meeting makers make it" is so well-established in the addiction science academic community that Dodes does not even try to directly argue that adage. What he is instead arguing is that perhaps meeting makers make it because they were more motivated to get sober at the start, or because of AA's social network. 

It's a strictly academic question, and does not affect the fact that AA is the only alcohol support group in the world with thousands upon thousands of free meetings. Even here, the studies are at worst inconclusive, only because AA is so successful and universal that anyone seeking treatment for alcoholism has been exposed to AA. To go from "it's really hard to decide whether someone going to AA is successful because of the program itself or because of other factors" to "AA doesn't help alcoholics" is a really large, and downright intellectually dishonest, leap.

Anyway, studies like PMC4285560 have tried really hard to eliminate other factors, and conclude that there's something about the AA program itself that is helping keep people sober. While not directly looked at in this study, I say it is the 12 steps as written in the first 164 pages of the Big Book that are keeping people sober.

As we were talking about at a meeting yesterday, the problem with the press is that the only news that attracts the press is bad news. The numerous studies giving us more and more evidence that AA works are ignored by the press; it was Lance Dodes's very biased, inaccurate, and negative book which got so much mainstream press attention last year.

Friday, March 27, 2015

I am leaving this blog for a while

It's important to not completely ignore the anti-steppers. While the AA program and the 12 steps are a very effective way that keep countless alcoholics and drug addicts clean and sober one day at a time, they are not perfect. A good member of AA is open to criticism and complaint.

Yes, there is a lot of anger and hostility among a lot of anti-steppers, and, yes, it is toxic for an alcoholic in recovery to associate too much with people with the hateful world view many anti-steppers have (this is one of the big reasons I don't allow comments here: I'm not about to let the bitter resentful anti-steppers choose when they can try to poison my mind with their hatred), but there are nuggets of legitimate criticism which AA members should heed.

This is going to probably be my last blog post for a while; I have also decided to no longer post in that far too long flamewar which the comments section of Glaser's hit piece has become. I will conclude my discussion of Glaser's latest click bait piece with a couple of articles which discuss it:

https://www.thenationalcouncil.org/lindas-corner-office/2015/03/alcoholics-anonymous-irrational/  There are good comments in the comment section here; infinitely better signal to noise ratio than the mire that is the comments for Glaser's latest hit piece.

http://www.huffingtonpost.com/tommy-rosen/spirituality-versus-scien_b_6909290.html  Not as good of a rebuttal to Glaser's hit piece as the New York Magazine piece, but raises some interesting points. Also: http://highfunctioningalcoholics.com/content/critique-of-gabrielle-glasers-atlantic-article-irrationality-of-aa/

The science against AA is at best murky; it's not scientifically an open and shut case like evolution, vaccinations, or climate change.

One last thing: The opinions expressed in this blog are my own and do not represent the opinions of Alcoholics Anonymous as a whole. In fact, Alcoholics Anonymous has no opinion on outside issues.

Thursday, March 26, 2015

Some anti-stepper talking points have value

Some anti-stepper talking points have value. 
  • I agree with Monica Richardson in principle: It's a really bad thing for men to chase newcomer women in the program. But, yes, AA does have protections for women (a culture of men staying with men, women with women, and a large number of women-only meetings), but it can't protect a woman hell-bent on getting in to a relationship.
  • I agree members should not play doctor and should not tell members what medications to take or not take. 
  • There's an anti-intellectual streak in many meetings which rubs me wrong (and contradicts the Big Book). 
  • People who say the steps are the only way to stay sober are as bad as Christian fundamentalists who say all non-Christians are damned.
I don't agree with the notion that the steps do not work, or that the Steps are just religious claptrap, and arguments along that line, and my decades of sobriety (caused by a spiritual awakening which I had while working the steps) are a testament that they worked very well with me. The only reason they don't work more is because most alcoholics don't want to work them.

But, yes, if someone can get sober without the steps (like one friend of mine who didn't need anything at all), I think that's great. AA has no monopoly on sobriety.

Wednesday, March 25, 2015

Glaser got the Sobell story wrong

I am not about to read, much less point by point refute, all of Gabrielle Glaser's over 8000 word anti-AA screed published in The Atlantic this month.  However, the 300 or so words she writes about the Sobell study and its aftermath are inaccurate.  For me to properly comment on it, I need to give readers here the entire content of what Glaser wrote on that Sobell study:
To many, though, the idea of non-abstinent recovery is anathema.

No one knows that better than Mark and Linda Sobell, who are both psychologists. In the 1970s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence. Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely. (Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications.) The Sobells published their findings in peer-reviewed journals.

In 1980, the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation. “We didn’t set out to challenge tradition,” Mark Sobell told me. “We just set out to do good research.” Not everyone saw it that way. In 1982, abstinence-only proponents attacked the Sobells in the journal Science; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes.

Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations. Their studies were accurate. But the exonerations had scant impact, Mark Sobell said: “Maybe a paragraph on page 14” of the newspaper.
(Emphasis mine) 

I watched that 60 Minutes segment when it came out. It helped save my life. It is very telling that Glaser does not describe what that segment said. Glaser gives the false impression that the critics merely had issues with the Sobells’s honesty. What Glaser is not telling her readers is what happened to those 20 people who the Sobells tried controlled drinking with: Four died drunk. Eight – make that nine – were engaging in out of control drinking. Six were abstaining from alcohol altogether. Only one of those 20 people in the Sobell study was able to achieve long-term controlled drinking.

The panel who investigated the Sobells merely found that the Sobells did not commit fraud; the contemporary New York Times story describing the report points out that “The Federal panel found that the Sobells overstated their success in one passage of a 1978 book” and that
“The panel also found that the Sobells made incorrect statements about the number of times they contacted patients.”

That is a far cry from Glaser’s assertion that “[The Sobells’s] studies were accurate.” The panel made so such conclusion, and Glaser should not be implying that they did. There’s a world of difference between not deliberately lying and making an accurate survey.

This is not the first time I’ve seen Glaser give the wrong impression. In a previous hit piece attacking the 12-step programs, she implied that Joanne Fry was the sponsor for Karla Brada, who, like many alcoholics, died drunk. Joanne Fry has since flat out denied ever being Karla’s sponsor, and Glaser never directly stated that Joanne was her sponsor, but tried to imply it.

Tuesday, March 24, 2015

The press has been very hostile to AA this month

The press has been very hostile to AA and other 12-step programs this month.

First of all, numerous articles about that Moderation Management group have been hitting the mainstream press this week. Never mind that MM's founder died drinking, and killed two innocent people because of her drinking. There are undoubtedly heavy drinkers out there who can moderate their drinking, but I don't care. There are also active alcoholics who think they are merely heavy drinkers who can somehow moderate their drinking, and who will go to great lengths to believe that lie. Countless alcoholics have died thinking they could moderate their drinking; I pointed out a few examples in my posting yesterday.

Here is a post from over a year ago refuting the claims that serious alcoholics can moderate their drinking: https://elplatt.com/return-moderate-drinking-still-lie

Not only has Moderation Management been getting a lot of press this month, but also anti-stepper Gabrielle Glaser just got a long article with the same tired old anti-stepper talking points published in The Atlantic. The best refutation to her talking points published so far is the article "Why Alcoholics Anonymous Works" by Jesse Singal: http://nymag.com/scienceofus/2015/03/why-alcoholics-anonymous-works.html 

Back in the time before I started drinking and during my active drinking, the mainstream press was not this hostile towards Alcoholics Anonymous. Indeed, in my day, 60 Minutes aired a segment about how one controlled drinking program was a failure that killed no less than four alcoholics. The fact the press was so friendly to the 12-step program is one of the reasons I got clean and sober as quickly as I did.

I am worried about the bullshit active alcoholics are reading these days. Moderation Management's bullshit that a heavy alcoholic can drink normally again already killed its founder and two innocent people; I wonder how many other people MM and the positive press it is getting this month will kill. I wonder how many active alcoholics will read Glaser's article in The Atlantic and take the drink that kills them instead of getting to a meeting and getting better.

Alcoholics need help, not people cosigning their bullshit.

My resentment

I am resentful against anti-steppers. I am resentful against people like Stanton Peele, Monica Richardson, Ken Ragge, Gabrielle Glaser, and the countless anonymous anti-steppers (“Mr. Orange”, etc.) who parrot the same tired old anti-12-step slogans and who claim that the program never works, which for me is completely preposterous because they have been working really well for me for the last few decades, for family members, and for my friends who I have met in the 12-step rooms.

I am resentful, not because they are wrong, not because they are bitter, but because they cosign an active alcoholic's bullshit. There are people out there who, unless they stop drinking and somehow treat their alcoholism, will die a miserable death drinking. As long as those active alcoholics are listening to the lies of anti-steppers instead of going to a meeting or calling their sponsor, they will get worst, not better, and many of them are dying.

I wonder how many people have died because they went to an anti-stepper website on the Internet and believed its lies instead of going to a meeting or something else to actually treat their alcoholism. I know I have seen too many people not get the program or anything else that would have helped the active alcoholic improve and instead die from the disease of alcoholism.

The funny thing is this: I actually agree with the objections of many of the anti-steppers. As just one example, I agree with Monica Richardson that there are men who treat 12-step meetings like a singles club, trying to get in the pants of pretty newcomer women. But, not only does the AA culture encourage men to stick with men and women stick with women, but also there are countless women's meetings which men are not allowed to step foot in. 

But I draw the line when it comes to cosigning bullshit. Anti-steppers have a right to free speech. But, for the active alcoholic, listening to or paying attention to the wrong people kills.

Monday, March 23, 2015

The failure of the Sobell study

In the early 1970s, there was a study done by Sobell and Sobell that indicated that alcoholics could control their drinking. Of the 70 subjects they studied, they attempted to teach 20 of them how to control their drinking.  The study concluded that these 20 alcoholics successfully learned how to drink like gentlemen again.

Some other researchers followed up on those same 20 alcoholics who supposedly learned controlled drinking, publishing a paper about a decade after the Sobell and Sobell paper. They found that:
  • 1 was able to still moderate their drinking.
  • 8 were engaging in out of control drinking.
  • 6 realized they had to stop drinking altogether.
  • 4 died because of their drinking.
  • 1 was kicked out of the original controlled drinking study because they could not control their drinking
The point being: The alcoholics actually could not control their drinking, even though the Sobells's research paper indicated that they could.

Note that most accounts from the anti-stepper crowd about this criticism of the Sobell/Sobell study concentrate on the accusations of fraud; these accusations are a distraction. What matters is what happened to the people who tried controlled drinking: They didn't succeed. 

See also: Return to Moderate Drinking is Still a Lie.