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.
