The 1990 triennial survey: 26%, not 5% one year retention rate

There is an old myth that a 1990 AA Triennial survey shows a 5% one-year retention rate for Alcoholics Anonymous. This is a false belief: That graph, frequently brought up by anti-steppers with little interest in objective truth, actually shows a 26% retention rate, as pointed out in the article "Alcoholics Anonymous (AA) Recovery Outcome Rates".

The graph is not a membership retention graph; it is a simple count of, among the members in their first year, how many were around a given number of months.  If AA had a 100% retention rate, the graph would have shown 8.3% (i.e. 100% divided by 12) of members (instead of the 5% it shows) in their 12th month of sobriety.

The wording in the survey itself says it is a graph of "the number of members that have been around a given number of months"; it was not a graph of per-month membership retention.

This graph does not show an 80% first month drop out rate and it does not show a 5% one-year retention rate.  It shows a 70% first-month retention rate and a 26% one-year retention rate.

Here are a number of books and papers which claimed the 1990 Triennial survey showed a 5% retention rate before "Alcoholic Anonymous Recovery Outcome Rates" was published:

• McIntire, Don (2000). "How Well Does A.A. Work?". Alcoholism Treatment Quarterly. 18 (4): 1. doi:10.1300/J020v18n04_01. "at 12 months the figures are 5% remaining and 95% departed."
• Carl G. Lukefield, "Behavioral Therapy for Rural Substance Abusers", 2000 has this quote: "By 12 months, 90 percent have dropped out (McCrady & Miller, 1993)"
• Charles Bufe, AA: Cult or Cure 1997 has this quote Quote: "AA produced a large monograph, “Comments on A.A.’s Triennial Surveys,” that analyzed the results of all five surveys done to that point. [...] AA has a 95% new-member dropout rate during the first year of attendance."

However, after "Alcoholic Anonymous Recovery Outcome Rates" was published, a number of sources all of a sudden decided that the 1990 Membership retention survey showed a 26% one-year retention rate, which just happens to be the number in that paper. Even anti-AA polemics like Dodes' (poorly-argued) The Sober Truth now use the 26% figure. For example:

• Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN 978-0807033159. "AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year"
• Adrian, Manuella (2012). "Can Failure Carefully Observed Become a Springboard to Success?". Substance Use & Misuse. 47 (13–14): 1384. doi:10.3109/10826084.2012.706178. "the Alcoholics Anonymous triennial surveys from 1977 through 1989 found that one quarter (26%) of those who first attend an AA meeting are still attending after 1 year"

Point being, the conclusion in "Alcoholic Anonymous Recovery Outcome Rates" that those old surveys showed a 26% one-year retention rate are considered reliable among treatment experts.

As Slate Star Codex puts it: "Almost everyone’s belief about AA’s retention rate is off by a factor of five because one person long ago misread a really confusing graph and everyone else copied them without double-checking."

Moderation for alcoholics: Maybe not

Let’s take a look at this article (original link); this article is an opinion from 2016 on what the science says about Alcoholics Anonymous. First of all, it accurately shows that the 2006 Cochrare review on AA effectiveness is out of date:

Ferri, Amato, and Davoli’s conclusion in a 2006 meta-analysis published in the Cochrane Review [13] has been widely quoted (see e.g., [14]): “No experimental studies unequivocally demonstrated the effectiveness of AA or [Twelve-Step Facilitation] TSF approaches for reducing alcohol dependence or problems” [13].
[...]
Several studies do support some efficacy of TS programs of recovery [15-19]. AA participation is associated with fewer drinks and more abstinent days [15-17], and recent studies show that AA attendance improves sobriety even while controlling for self-selection bias [18]. While these studies do not show unequivocal evidence of success—and are not evidence of sufficient effectiveness to recommend AA/TS programs for everyone—they do support inclusion of TS in the set of appropriate interventions.
[...]
13. Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev. 2006;(3):CD005032.
14. Frakt A. What is known about the effectiveness of AA? Incidental Economist. December 20
15. Walitzer KS, Dermen KH, Barrick C. Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial. Addiction. 2009;104(3):391-401.
16. Witbrodt J, Ye Y, Bond J, Chi F, Weisner C, Mertens J. Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan. J Subst Abuse Treat. 2014;46(4):412-419.
17. Moos RH, Moos BS. Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. J Clin Psychol. 2006;62(6):735-750.
18. Humphreys K, Blodgett JC, Wagner TH. Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials. Alcohol Clin Exp Res. 2014;38(11):2688-2694.
19. Kaskutas LA. Alcoholics Anonymous effectiveness: faith meets science. J Addict Dis. 2009;28(2):145-157.

So far so good; this shows that AA effectiveness for a subset of alcoholics is pretty much undeniable at this point, and it even links to an experimentatal study (Walitzer 2009) showing this. At this point, the article jumps the shark by giving us this inaccurate whopper without footnotes:

Additionally, TS [Twelve Step] programs promote the goal of abstinence, but moderation is a better goal for some people.

This is a really bold claim, so we would expect about seven footnotes showing research supporting this claim, like we had with the claim that AA helps some alcoholics. But, no, this claim is made without a single footnote.

I will link to two articles which make a strong case this claim is downright false:

• Return to Moderate Drinking is Still a Lie (original article)
• Here’s What Happened When I Tried Moderation Management (original article)

After the disaster that was Sobell 1973, where the moderate drinkers who supposedly did well were either drunk, dead, or abstinent 10 years later, I will not believe any study showing alcoholics moderately drinking again without a 10-year followup. The reason why we need a 10-year followup is because alcoholics are really good at being dishonest about their alcoholic drinking being “moderate”, and it takes up to a decade for the drinking to get so bad the alcoholic can no longer deny their drinking is out of control.