Monday, August 13, 2018

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 First of all, it accurately shows that the 2006 Cochrare review on AA effectiveness is out of date: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:
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.