Saturday, April 23, 2016

The most common anti-AA talking points

There are three key studies anti-steppers like to bring out when claiming the steps do not work:
  • Ditman 1967. This is one of the earliest studies on AA, done before we knew how to properly study AA. It was a RCT -- a "randomized controlled trial." A RCT doesn't work with AA because 1) The people assigned to AA do not necessarily work the steps as suggested by oldtimers in AA meetings 2) The people not assigned to AA who are serious about getting sober end up going to the program anyway.
  • Brandsma 1980. Like Ditman 1967, this was a RCT, with the same problems. In addition, there is an opt-repeated claim that this study shows AA results in increased binge drinking. However 1) The study looked at about three dozen different findings at multiple follow-up periods, but this result was only seen in this one finding at one follow-up period 2) This result has not been replicated in recent studies [1] even though 3) The study is 36 years old.
  • The 1990 AA Triennial survey. This was not a scientific survey; this was an informal survey AA sent to members. Of the people in their first year of recovery, about 5% were in their 12th month of recovery, which is lower than the 8.3% rate we expect to see if AA had a 100% retention rate. Statistical extrapolations show that this survey shows a 29% retention rate; the question I ask is this: Is it AA's fault that 71% of newcomers decide to not come back to an AA meeting?
Note that the most recent information anti-steppers tend to bring out is over a quarter century old. What they don't like to talk about is the evidence that AA works: The more someone works AA, (That's from 2006 -- this century) the more likely they are to stay sober (That's from 2009). They dismiss this evidence with some hand-waving about "self selection", arguing that the people who stay sober by going to AA would have stayed sober anyway. While this is one possible explanation why people who go to AA stay sober, there is no evidence that this is the case. Indeed, there is a study from 2014 (under two years ago) showing that it's not just self-selection that keeps alcoholics in AA sober

Now, this study showing that it's not just self selection is just one study, and we need to have further studies to confirm that AA itself (and not just self-selection) helps keep alcoholics sober, but that's the direction the evidence points to right now. I would worry about these results being in just one study if the study was 36 years old, but this study is not even two years old.

Bottom line: If you have a drinking problem, and want to get and stay sober, AA is an effective way to do just that. 

[1] Edit: I need to point out Ogborne 1982, but this study is most likely just observing the fact that AA members are more likely to be honest about the negative consequences of their drinking.