An AA treatment group was started at SHARP by contacting the local AA organization. They sent two volunteers, a man (with a B.S.) and a woman (with a high school education), to begin our new group. They had 14 and 10 years experience in AA, respectively. The AA group was open to all who would attend and was conducted by one or the other of these people for approximately 1 year until January, 1973. By that time (the beginning of the research in terms of assigning patients), a member of the group (not included in the research project) had become very adept at running meetings. This minority group member, who had a 9th grade education, had had no AA experience before modeling himself after the two initial leaders of this group. This person remained the leader for the rest of the time of the research project (with a 3-week hiatus when an experienced AA counselor filled in), and continues to be involved in AA today. He received no remuneration for this, but was very cooperative in providing attendance reports for the project.The “AA” treatment is described in more detail in another section of the book:
Our group met once per week and tended to focus on persons present for the first time, but not to the exclusion of other members. The 12 steps of AA were used as the content focus for discussions. The men were made aware of the availability of “sponsor-friends” and were encouraged to ally themselves with one or more of their own choosing. Generally our patients seems to neglect availing themselves of this opportunity, and the assignment of sponsors was not followed up on in this group. Beyond this description we are unable to be more specific. [...]So, as we can see, almost no one in the Brandsma treatment got a sponsor, everyone in the group was a “court card” attender, and, even worse, they would get a threatening phone call if they didn’t show up at the meeting.
The nature of scientific investigation did force some small changes in the usual AA norms. First, most of our clients came coerced from the court system and all were then randomly assigned to treatments. Thus they were not “free to choose” whether to have treatment or the type of treatment. However, a person’s first visit to AA usually results from some form of “coercion,” e.g. a wife or boss. Second, participation was not anonymous because we kept attendance records, although this was an unobtrusive procedure. If a man’s attendance was poor or nonexistent, he would be contacted at least once by a project social worker, reminded of the conditions of his parole, and encouraged to return. This type of “coercion” (in contrast to the “buddy system”) is different than usual AA procedures. Our group did not develop a high degree of cohesiveness or a formalized buddy system as some do, nor did we offer other “services,” as does Al-Anon. However, given our population, situation, and purposes, we believe this was a representative treatment effort within the AA framework.
The Brandsma 1980 “AA” treatment (and, yes, Kaskutas 2009 is slightly inaccurate in her description of the “AA” treatment offered in the Brandsma study; the meetings were open to the public, but it’s unknown whether the meetings were listed in a local AA directory) does not sound like a meeting where people were effectively working the AA program. Kaskutas’s concern that “a potentially important therapeutic ingredient of AA—the experience of longer-term members—would not have been present in the AA condition” is spot on: The leader of the meeting had barely a year sober and the other attendees were “court slip” members.
Based on the description of the “AA” treatment, any conclusions Brandsma 1980 makes about AA efficacy are suspect.
