Kaskutas,whose 2009 paper "Alcoholics Anonymous Effectiveness: Faith Meets Science" I frequently cite when pointing out that AA works for people who work it, or why early randomized controlled trials did not show an accurate picture of 12-step effectiveness, recently co-published a paper comparing 12-step groups to other mutual help groups entitled "Comparison of 12-Step Groups to Mutual Help Alternatives for AUD in a Large, National Study: Differences in Membership Characteristics and Group Participation, Cohesion, and Satisfaction."
One of the groups they looked at is a no-drinking, no-God fellowship called "LifeRing Secular Recovery." Like AA, they are very adamant about complete abstinence on their webpage: in one article they talk about the "low success rate of Moderation Management, and of individuals trying to moderate on their own," and one of their fundamental philosophies is sobriety, which they make clear means complete abstinence.
Despite this, Kaskutas' paper mentions that "LifeRing [...] members were less likely to endorse the most stringent abstinence goal," which is interesting because stringent abstinence is a fundamental part of the LifeRing program. My take on it, having not read the paper (I am not about to spend 36 dollars getting a paper which will be free in six months), is that LifeRing, and other non-AA mutual aid fellowships, mainly attract people who are not satisfied with AA. My experience working with newcomers is that the biggest stumbling block is the fact that AA strongly suggests complete abstinence for alcoholics; we frequently read a part of the Big Book describing how an alcoholic can never drink moderately again.
Indeed, the majority of people online who are opposed to AA online are people who claim alcoholics can drink moderately; it is not surprising that even an AA alternative which also advocates for abstinence attracts the kinds of people who still think they can control their drinking again.
In terms of the study itself, while showing promising results, it has the same issue that studies which claim alcoholics can drink moderately again have: It is a short-term study using self reported data.
Monday, December 12, 2016
Tuesday, May 17, 2016
A FAQ
A brief FAQ
For the 20%[1][2][3] or so of alcoholics who become highly engaged with the program, Alcoholics Anonymous has about a 75%[4][5] effectiveness rate.[6]
For people who do not take AA as seriously, the number of alcoholics who achieve long-term sobriety is about 20%[7], with the amount of people achieving sobriety directly correlated to AA participation[8].
While some of the positive effects of the AA program keeping people sober can be attributed to self-selection bias, one 2014 study makes the case that AA's effectiveness shown in these studies does not come from self-selection[9]; a 2016 study demonstrates that some of the specific effect is the prayers AA members say.[10]
Other data that is inaccurate
Randomized controlled trials
Early randomized controlled trials were ineffective because the control group was not really a control group (people who wanted to stay sober went to AA anyway, even if they were not assigned to AA, and people assigned to AA did not necessarily take the program seriously), so their numbers can not be trusted.[11]
Brandsma 1980
Anti-AA advocates claim that Brandsma 1980[12] shows increased binge drinking among AA members. 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[13] even though 3) The study is 36 years old.[14]
AA is actually not rated #37 (sometimes #38) compared to other treatments
Another common talking point popular with the anti-AA crowd is a table from Handbook of Alcoholism Treatment Approaches which ranks AA fairly lowly compared to other treatments. That table is, shall we say, weird: It rates acupuncture as one of the top 20 treatments of alcoholism, and gives motivational enhancement (#2 in the table), cognitive therapy (#13), and AA (#37) very different ratings, when the 2006 Cochrane study rate those as being about equal[15]; other studies rate AA and/or TSF (Twelve Step Facilitation: teaching patients how to go to meetings and be a part of the AA culture) as being superior.[16] No other reliably published meta-analysis comparing AA to other treatments has rated AA as being inferior.[17]
5% success rate myth #1: The Sober Truth
Lance Dodes' The Sober Truth is a recent attempt to cook numbers to claim AA has a 5% success rate (for some reason, anti-AAs have a real obsession with coming up with a 5% success rate figure, facts be ignored). While this book was widely reported in the press in 2014, its claimed 5-8% success rate for AA does not come from any peer-reviewed studies, but is instead derived by multiplying numbers from different studies together. Beresford looks at the math Dodes performed to come up with these bogus figures, and explains why the math is invalid at https://www.ncadd.org/blogs/research-update/alcoholics-anonymous-call-for-better-science.
5% success rate myth #2: AA triennial survey
There is a chart in the 1990 AA triennial survey showing that 5% of the members in their first year happened to be in their 12th month, instead of the 8.3% we would expect if AA had a 100% success rate. This has frequently been misread to indicate that only 5% of members of AA stay sober one year. An actual analysis of the graph shows a 26% retention rate.[3]
5% success rate myth #3: Reading Vaillant poorly
Some claim that Vaillant's book The Natural History of Alcoholism showed a 5% success rate, but that is a myth. The old green-papers site refuted it quite nicely: http://web.archive.org/web/20150329052802/http://green-papers.org/ "95% of patients had relapsed at some time during the study, even though many of these eventually attained sobriety. [...] It's well known that most severe alcoholics only get sober after many relapses, to the extent that relapses can be considered part of the recovery process. So don't pretend that's a failure. [...] And anyway, this was a study of a health network, not AA."
How the moderation myth tainted studies about AA
A couple of surveys from the 1970s and early 1980s erroneously reported that AA makes people who drink again have worse relapses. The reason why these surveys were inaccurate is probably because they were based on self-reported data. Since people in AA are less likely to be dishonest about their drinking, they will self-report any drinking they engage in as being more chronic, while people not in AA are more likely to dishonestly report their drinking as being "moderate" or "under control" (e.g. lying about the number of drinks they have when filling out the survey).
References
- 1 Effectiveness of Alcoholics Anonymous
- 2 Other data that is inaccurate
- 3 Alcoholics can not moderate their drinking
- 4 References
For the 20%[1][2][3] or so of alcoholics who become highly engaged with the program, Alcoholics Anonymous has about a 75%[4][5] effectiveness rate.[6]
For people who do not take AA as seriously, the number of alcoholics who achieve long-term sobriety is about 20%[7], with the amount of people achieving sobriety directly correlated to AA participation[8].
While some of the positive effects of the AA program keeping people sober can be attributed to self-selection bias, one 2014 study makes the case that AA's effectiveness shown in these studies does not come from self-selection[9]; a 2016 study demonstrates that some of the specific effect is the prayers AA members say.[10]
Other data that is inaccurate
Randomized controlled trials
Early randomized controlled trials were ineffective because the control group was not really a control group (people who wanted to stay sober went to AA anyway, even if they were not assigned to AA, and people assigned to AA did not necessarily take the program seriously), so their numbers can not be trusted.[11]
Brandsma 1980
Anti-AA advocates claim that Brandsma 1980[12] shows increased binge drinking among AA members. 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[13] even though 3) The study is 36 years old.[14]
AA is actually not rated #37 (sometimes #38) compared to other treatments
Another common talking point popular with the anti-AA crowd is a table from Handbook of Alcoholism Treatment Approaches which ranks AA fairly lowly compared to other treatments. That table is, shall we say, weird: It rates acupuncture as one of the top 20 treatments of alcoholism, and gives motivational enhancement (#2 in the table), cognitive therapy (#13), and AA (#37) very different ratings, when the 2006 Cochrane study rate those as being about equal[15]; other studies rate AA and/or TSF (Twelve Step Facilitation: teaching patients how to go to meetings and be a part of the AA culture) as being superior.[16] No other reliably published meta-analysis comparing AA to other treatments has rated AA as being inferior.[17]
5% success rate myth #1: The Sober Truth
Lance Dodes' The Sober Truth is a recent attempt to cook numbers to claim AA has a 5% success rate (for some reason, anti-AAs have a real obsession with coming up with a 5% success rate figure, facts be ignored). While this book was widely reported in the press in 2014, its claimed 5-8% success rate for AA does not come from any peer-reviewed studies, but is instead derived by multiplying numbers from different studies together. Beresford looks at the math Dodes performed to come up with these bogus figures, and explains why the math is invalid at https://www.ncadd.org/blogs/research-update/alcoholics-anonymous-call-for-better-science.
5% success rate myth #2: AA triennial survey
There is a chart in the 1990 AA triennial survey showing that 5% of the members in their first year happened to be in their 12th month, instead of the 8.3% we would expect if AA had a 100% success rate. This has frequently been misread to indicate that only 5% of members of AA stay sober one year. An actual analysis of the graph shows a 26% retention rate.[3]
5% success rate myth #3: Reading Vaillant poorly
Some claim that Vaillant's book The Natural History of Alcoholism showed a 5% success rate, but that is a myth. The old green-papers site refuted it quite nicely: http://web.archive.org/web/20150329052802/http://green-papers.org/ "95% of patients had relapsed at some time during the study, even though many of these eventually attained sobriety. [...] It's well known that most severe alcoholics only get sober after many relapses, to the extent that relapses can be considered part of the recovery process. So don't pretend that's a failure. [...] And anyway, this was a study of a health network, not AA."
Alcoholics can not moderate their drinking
While not directly about AA's effectiveness, there is no reliable scientific evidence that alcoholics can drink moderately again. The studies that claim alcoholics can do so are based on self-reported information from alcoholics over period of a couple years or less. What is happening is that alcoholics have a pattern of being dishonest about their drinking, to the point that surveys using self-reported data from alcoholics are inaccurate. This has been seen time and time again: The Sobell Study from the early 1970s was shown to be a sham in 1982; the Rand report from 1976 was shown to be wrong in the 1980 follow-up; the NESARC study from 2001-2002 was a two-year study which never had a follow-up; and while Moderation Management's effectiveness has never been scientifically analyzed, its founder realized she could not control her drinking, but it was too late: Her runaway drinking resulted in her killing two people while driving drunk; she eventually killed herself.[18]How the moderation myth tainted studies about AA
A couple of surveys from the 1970s and early 1980s erroneously reported that AA makes people who drink again have worse relapses. The reason why these surveys were inaccurate is probably because they were based on self-reported data. Since people in AA are less likely to be dishonest about their drinking, they will self-report any drinking they engage in as being more chronic, while people not in AA are more likely to dishonestly report their drinking as being "moderate" or "under control" (e.g. lying about the number of drinks they have when filling out the survey).
References
- The Natural History of Alcoholism Revisited by George E. Vaillant has a table showing that 19 out of 100 alcoholics attended 300 or more meetings over a 10-year period. The table is on page 197, and can be downloaded from http://web.archive.org/web/20150329052802/http://www.green-papers.org/Vaillant-Nat_hist_of_alcoholism_revisited-excerpts.pdf
- This article shows a roughly 80% drop out rate in Brazil: Terra, Mauro Barbosa; Barros, Helena Maria Tannhauser; Stein, Airton Tetelbom; Figueira, Ivan; Palermo, Luiz Henrique; Athayde, Luciana Dias; Gonçalves, Marcelo de Souza; Da Silveira, Dartiu Xavier (2008). "Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents". American Journal on Addictions 17 (1): 48–53. doi:10.1080/10550490701756393. PMID 18214722. "AA adherence was below 20%"
- http://hindsfoot.org/recout01.pdf, while independently published and not peer-reviewed, performs statistical analysis of the unpublished 1990 triennial survey which anti-AA advocates frequently quote (since unsophisticated people reading it have incorrectly concluded it shows a 5% retention rate among AA members), showing that 26% of members surveyed make it from their first month to their twelfth month. If you insist on these figures in a more mainstream source, Dodes parrots that 26% figure in The Sober Truth.
- That table in The Natural History of Alcoholism Revisited has, of those 19 alcoholics who took AA seriously, 14 who achieved long-term sobriety. While the actual 14 people figure is not on this table, 29 people * 48% is 14.
- Beresford, Thomas (2016), Alcoholics Anonymous and The Atlantic: A Call For Better Science, National Council on Alcoholism and Drug Dependence, retrieved 2016-04-15 This page refers to Fiorentine 1999, pointing out that "the data Fiorentine presents is as follows: 77.7% of individuals who attended AA 12-step meetings at least weekly reported being free of drug use for 6 months prior to a 24-month follow-up, a finding corroborated by urinalysis at the time of the interview, and 74.8 % reported being free of alcohol use during the same time period"
- Another study, which measures something slightly different, has similar high success figures for people who were highly engaged with Alcoholics Anonymous: Moos, Rudolf H.; Moos, BS (June 2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology 62 (6): 735–750. doi:10.1002/jclp.20259. PMC 2220012. PMID 16538654.
- Of the 81 alcoholic subjects in The Natural History of Alcoholism Revisited who did not attend 300 AA meetings over a 10-year period, 15 achieved long-term sobriety
- See the graphs in Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases 28 (2): 145–157. doi:10.1080/10550880902772464. PMC 2746426. PMID 19340677.
- Humphreys, Blodgett, Wagner (2014). "Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials". Alcoholism: Clinical and Experimental Research 38 (11): 2688–94. doi:10.1111/acer.12557. PMC 4285560. PMID 25421504.
- Marc Galanter, Zoran Josipovic, Helen Dermatis, Jochen Weber, and Mary Alice Millard (2016-03-25). "An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous". The American Journal of Drug and Alcohol Abuse. doi:10.3109/00952990.2016.1141912. Lay summary.
- There is some discussion of this in Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases 28 (2): 145–157. doi:10.1080/10550880902772464. PMC 2746426. PMID 19340677.
- Here's the proper citation for Brandsma 1980 Brandsma, Jeffery M; Maultsby, Maxie C; Welsh, Richard J (1980). Outpatient treatment of alcoholism: a review and comparative study. Baltimore, MD: University Park Press. ISBN 0-8391-1393-5. OCLC 5219646.
- While I haven't seen this cited by an anti-stepper in the wild, I should note this: Ogborne AC, Bornet A (1982). "Abstinence and abusive drinking among affiliates of Alcoholics Anonymous: are these the only alternatives?". Addict Behav. PMID 7102452. This study, like Brandsma 1980, is a museum piece; the study uses data from the "Rand report", which is available for download and a table showing AA effectiveness there is on top of page 98 (page 114 in the PDF), showing fewer AA members who engage in "normal drinking." The notion that the Rand report showed alcoholics drinking normally again has since been discredited, see the blog entry at https://elplatt.com/return-moderate-drinking-still-lie for discussion; what that 1982 paper probably saw was that AA members are less likely to report their drinking as "normal drinking" and more likely to be honest about the negative consequences of their drinking
- While not a reliable source, the best discussion I have found about Brandsma 1980 is at http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/, in the beginning of section III. Note that this blog dismisses longitudinal studies too easily, but, then again, it was published before Humphreys, Blodgett, Wagner 2014 demonstrated a specific effect for AA, and before Galanter 2016 showed that prayer is part of that specific effect.
- Ferri, Marcia; Amato, Laura; Davoli, Marina (19 July 2006). "Alcoholics Anonymous and other 12-step programmes for alcohol dependence". Cochrane Database of Systematic Reviews (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID 16856072.
- Humphreys, Keith; Moos, Rudolf (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research 1 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. PMID 11371720.
12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB [cognitive-behavioral] programs, p < 0.001
- While not published by a mainstream press nor peer-reviewed, the blog entry at http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/ devotes an entire section to this table and why it is inaccurate. Scroll down to section VI.
- While, yes, a blog, a good discussion with references of how alcoholics can not moderate their drinking and why any study claiming otherwise is wrong is at the blog entry https://elplatt.com/return-moderate-drinking-still-lie
Tuesday, May 10, 2016
Prayer helps keep alcoholics sober
For a long time we have known that people who choose to go to meetings are much more likely to stay sober. Recently, PMC4285560 gave evidence that AA has a “specific effect”; in other words, there is something about the AA program itself that is keeping people sober. And now, we have a new study (mirror) which tells us one aspect of AA’s specific effect: Prayer.
The actual study can be read online (mirror). To summarize, they got some people with long term sobriety, put them in MRI machines, then saw if prayers from the Big Book would affect their reactions to seeing people drinking alcohol. It did. Their level of craving of alcohol was diminished by saying 12-step prayers.
What does this tell us? It tells us that the AA program and the prayers in the Big Book can really help keep people sober.
The actual study can be read online (mirror). To summarize, they got some people with long term sobriety, put them in MRI machines, then saw if prayers from the Big Book would affect their reactions to seeing people drinking alcohol. It did. Their level of craving of alcohol was diminished by saying 12-step prayers.
What does this tell us? It tells us that the AA program and the prayers in the Big Book can really help keep people sober.
Friday, April 29, 2016
The table in Handbook of Alcoholism Treatment Approaches
There is a table in the book Handbook of Alcoholism Treatment Approaches comparing various treatments of Alcoholism; it ranks AA as being one more the most ineffective treatments.
This table is, shall we say, weird. It rates acupuncture as one of the top 20 treatments of alcoholism, and gives motivational enhancement (#2 in the table), cognitive therapy (#13), and AA (#37) very different ratings, when the 2006 Cochrane study rate those as being about equal; other studies rate AA and/or TSF (Twelve Step Facilitation: teaching patients how to go to meetings and be a part of the AA culture) as being superior.
I also note that they only looked at seven different studies when rating AA, which leads me to believe they have only looked at old randomized controlled trials which do a terrible job of measuring AA's effectiveness.
I mean, if there was something besides this book out there arguing that acupuncture was a good deal more effective than AA, than maybe this table would convince me. But the results seem to be randomly placed on the table and I do not know of any other meta-study ranking AA as being inferior to other treatment methods. On the other hand, Cochrane 2006 said that AA is about as effective as other treatments, and Project MATCH shows that TSF is somewhat more effective than other therapies (See PMC2746426 for discussion). Fiorentine 1999, Vaillant 1995, and, yes AA's own big book give a success rate for AA around 75% for people who choose to attend one or more meeting a week; Moos & Moos 2006, which measures something slightly different, has similar figures.
Slate Star Codex discusses this table in depth in section VI (scroll down).
This table is, shall we say, weird. It rates acupuncture as one of the top 20 treatments of alcoholism, and gives motivational enhancement (#2 in the table), cognitive therapy (#13), and AA (#37) very different ratings, when the 2006 Cochrane study rate those as being about equal; other studies rate AA and/or TSF (Twelve Step Facilitation: teaching patients how to go to meetings and be a part of the AA culture) as being superior.
I also note that they only looked at seven different studies when rating AA, which leads me to believe they have only looked at old randomized controlled trials which do a terrible job of measuring AA's effectiveness.
I mean, if there was something besides this book out there arguing that acupuncture was a good deal more effective than AA, than maybe this table would convince me. But the results seem to be randomly placed on the table and I do not know of any other meta-study ranking AA as being inferior to other treatment methods. On the other hand, Cochrane 2006 said that AA is about as effective as other treatments, and Project MATCH shows that TSF is somewhat more effective than other therapies (See PMC2746426 for discussion). Fiorentine 1999, Vaillant 1995, and, yes AA's own big book give a success rate for AA around 75% for people who choose to attend one or more meeting a week; Moos & Moos 2006, which measures something slightly different, has similar figures.
Slate Star Codex discusses this table in depth in section VI (scroll down).
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:
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.
- 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?
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.
Saturday, April 16, 2016
A reasonable overview of the AA research out there
Here is a reasonable, if not great overview of the various studies about Alcoholics Anonymous' effectiveness:
http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/
The biggest defect this essay has is that it too easily dismisses longitudinal studies, claiming they are completely ineffective because of selection bias. Unfortunately, because of the peculiar nature of AA, a proper randomized controlled trial is not feasible (the people who get sober in the control group and/or non-AA-treatment group will, as likely as not, end up going to AA meetings), so longitudinal studies are a reasonable research mechanism, albeit with the thorny self selection bias issue.
PMC4285560, which was published around the same time that blog entry was made, uses sophisticated statistical methods to minimize self selection bias; once that is done, we see that there is a specific effect from the AA program that keeps people sober.
This blog entry's strength is that it has good summaries of studies which are only available in books or behind paywalls. For example, reading its summary of Brandsma 1980, a long-time chestnut anti-steppers love to bring out, shows that the study does not actually reveal a pattern of increased binge drinking among AA members (a claim which is frequently parroted by anti-steppers, such as in the "Rational" wiki).
http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/
The biggest defect this essay has is that it too easily dismisses longitudinal studies, claiming they are completely ineffective because of selection bias. Unfortunately, because of the peculiar nature of AA, a proper randomized controlled trial is not feasible (the people who get sober in the control group and/or non-AA-treatment group will, as likely as not, end up going to AA meetings), so longitudinal studies are a reasonable research mechanism, albeit with the thorny self selection bias issue.
PMC4285560, which was published around the same time that blog entry was made, uses sophisticated statistical methods to minimize self selection bias; once that is done, we see that there is a specific effect from the AA program that keeps people sober.
This blog entry's strength is that it has good summaries of studies which are only available in books or behind paywalls. For example, reading its summary of Brandsma 1980, a long-time chestnut anti-steppers love to bring out, shows that the study does not actually reveal a pattern of increased binge drinking among AA members (a claim which is frequently parroted by anti-steppers, such as in the "Rational" wiki).
Friday, April 15, 2016
Salon's posts on AA
As I mentioned in my previous blog entry, with one exception, all of Salon's articles about AA have been negative. Let's look at Salon's list of AA articles:
- Pseudo-science and Bible-thumping, the worst of both worlds: The problem with rehab, AA and calling addiction a disease Negative, obviously
- Addiction is not a disease: How AA and 12-step programs erect barriers while attempting to relieve suffering Another negative one
- The drunkard’s loop: How one writer fought her way back from blackout alcoholism While this article mentions AA, it is not an article about AA
- AA is not a fraud: Why haters are afraid to listen Salon's one and only positive article about AA
- Debunking Alcoholics Anonymous: Behind the myths of recovery Here is one of the articles from Lance Dodes Salon published
- The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction Salon likes Lance Dodes' bovine excrement about AA so much, they published two articles from him
- Is my friend suicidal? This article mentions AA but is not about AA
- My sober conversion to atheism While not as negative as, say, anything Lance Dodes ever wrote, this article is pretty negative about the AA program
- “Inside Rehab”: How it could work better, and why it doesn’t Surprisingly neutral when mentioning AA, but this is not an article about AA per se
- “Workaholism” is real This article only mentions AA in passing
- I was a sober college student Not directly about AA, but describes AA positively
- I didn’t even want these kids! Not directly about AA, but describes the 12-step program positively
Wednesday, April 13, 2016
Salon is cutting staff
With one exception, every single article that Salon has posted about Alcoholics Anonymous (mirror) has been negative. As it turns out, Salon is having financial difficulties and laid off a number of workers (mirror).
I make this prediction: Salon will not be around too much longer. It will have the same fate as Substance, a magazine which was devoted to having an anti-12-step view of alcohol and drug abuse, closing its doors. On the day Substance magazine said good bye to the world, there were thousands of thousands of Alcoholics Anonymous meetings throughout the world, with countless oldtimers telling newcomers how they stayed sober by working the program using the first 164 pages of the Big Book. On the day when Salon closes their doors, there will be countless AA meetings all over the world and countless oldtimers telling newcomers how the 164 keeps them sober. The numerous anti-AA polemics that Salon has published will be relegated to the dustbin of history, and Alcoholics Anonymous will continue to thrive.
My prayers are with the people who have been laid off from Salon, that they find productive work again, perhaps for media outlets more receptive to AA's message, such as NY Mag (mirror).
I make this prediction: Salon will not be around too much longer. It will have the same fate as Substance, a magazine which was devoted to having an anti-12-step view of alcohol and drug abuse, closing its doors. On the day Substance magazine said good bye to the world, there were thousands of thousands of Alcoholics Anonymous meetings throughout the world, with countless oldtimers telling newcomers how they stayed sober by working the program using the first 164 pages of the Big Book. On the day when Salon closes their doors, there will be countless AA meetings all over the world and countless oldtimers telling newcomers how the 164 keeps them sober. The numerous anti-AA polemics that Salon has published will be relegated to the dustbin of history, and Alcoholics Anonymous will continue to thrive.
My prayers are with the people who have been laid off from Salon, that they find productive work again, perhaps for media outlets more receptive to AA's message, such as NY Mag (mirror).
Monday, April 11, 2016
"The Insane Idea"
Here is a very long -- probably too long -- article which goes in to, among other things, the fact that the science shows, as we say after the serenity prayer, "it works if you work it."
http://thepointmag.com/2016/examined-life/the-insane-idea Mirror: https://archive.is/u2ttt
One point this article makes is that it is an objective scientific fact that "the longer people attend twelve-step meetings, the more likely they are to achieve long-term sobriety."
The article, however, while acknowledging the countless studies showing a correlation between AA attendance and long-term sobriety, and correctly points out that "It is [a] gerrymandered set of data that leads Dodes to the conclusion that just “5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than a year”," simply quotes Dodes' assertion that AA's success rate may be because of self selection, without looking at PMC4285560 which indicates that it's not just self-selection which causes people who regularly go to meetings to stay sober.
A somewhat disappointing article; while it engages Glaser and Dodes for their inaccurate polemics, the author did not look at the recent research showing that AA is effective before writing this extended rambling piece.
http://thepointmag.com/2016/examined-life/the-insane-idea Mirror: https://archive.is/u2ttt
One point this article makes is that it is an objective scientific fact that "the longer people attend twelve-step meetings, the more likely they are to achieve long-term sobriety."
The article, however, while acknowledging the countless studies showing a correlation between AA attendance and long-term sobriety, and correctly points out that "It is [a] gerrymandered set of data that leads Dodes to the conclusion that just “5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than a year”," simply quotes Dodes' assertion that AA's success rate may be because of self selection, without looking at PMC4285560 which indicates that it's not just self-selection which causes people who regularly go to meetings to stay sober.
A somewhat disappointing article; while it engages Glaser and Dodes for their inaccurate polemics, the author did not look at the recent research showing that AA is effective before writing this extended rambling piece.
the
longer people attend twelve-step meetings, the more likely they are to
achieve long-term sobriety - See more at:
http://thepointmag.com/2016/examined-life/the-insane-idea#sthash.v6jBN2HS.dpuf
the
longer people attend twelve-step meetings, the more likely they are to
achieve long-term sobriety - See more at:
http://thepointmag.com/2016/examined-life/the-insane-idea#sthash.v6jBN2HS.dpuf
the
longer people attend twelve-step meetings, the more likely they are to
achieve long-term sobriety - See more at:
http://thepointmag.com/2016/examined-life/the-insane-idea#sthash.v6jBN2HS.dpuf
the
longer people attend twelve-step meetings, the more likely they are to
achieve long-term sobriety - See more at:
http://thepointmag.com/2016/examined-life/the-insane-idea#sthash.v6jBN2HS.dpuf
the
longer people attend twelve-step meetings, the more likely they are to
achieve long-term sobriety - See more at:
http://thepointmag.com/2016/examined-life/the-insane-idea#sthash.v6jBN2HS.dpuf
Sunday, April 10, 2016
More Revealed by Ken Ragge
Before I begin, let me make something crystal clear: While I have strong disagreements with Mr. Ken Ragge about how effective Alcoholics Anonymous is, I keep him in my prayers and give him the utmost dignity, because all human beings deserve to be treated with dignity. This entry is in no way a criticism of Mr. Ken Ragge as a person; it is a criticism of his book More Revealed.
There have been multiple attempts to add More Revealed to the Alcoholics Anonymous Wikipedia page. Each attempt has failed. The reason is because the book is not notable enough to be added to a prominent Wikipedia article. To quote one Wikipedia editor:
There have been multiple attempts to add More Revealed to the Alcoholics Anonymous Wikipedia page. Each attempt has failed. The reason is because the book is not notable enough to be added to a prominent Wikipedia article. To quote one Wikipedia editor:
- It has no new research; it merely regurgitates other research.
- It is not a research book; it is a polemic. It was written with a conclusion in mind; any evidence that contradicts that conclusion is ignored.
- The book claims that "There apparently have been no controlled studies done of AA against other treatment in a non-coercive environment." (p 30) This is completely wrong.
- "There are also many exclusive meetings in private homes where an invitation is necessary and “undesirables” ... are not invited." (p 98) This is a very extraordinary claim (since any such meeting can not be an Alcoholics Anonymous meeting because it violates the third tradition), and Ragge presents no evidence to back this claim up.
- Alan Ogborne in a 1993 review of More Revealed said that "This reviewer found nothing particularly new in the book but was concerned that the author found nothing positive to say about AA. This is difficult to reconcile with the obvious fact that very large numbers of people have found AA helpful and live productive and fulfilling lives within the movement. Certainly some AA groups become cultist and some members are convinced that AA is the only way to recover from alcoholism. However, this is clearly not universal."
- See Sharp Press, who published this book, has only published a few books in small numbers, and tends to only publish fringe content.
Saturday, April 2, 2016
AA has a higher success rate than 5%
There is a frequently quoted 5% success rate figure for AA's success. This is a popular figure which anti-steppers love to bring up in the comments sections of articles about AA, almost always without citation. This number comes from no less than three different sources, all of which use incorrect methods to derive the 5% number:
- The 1990 Triennial Survey which the anti-steppers love to bring out had, of the population of people in their first year, 5% in their 12th month. To say this shows a 5% success rate shows a profound ignorance of statistics, as a HindsFoot article clearly shows.
- Agent Orange started a rumor that Vallant in The Natural History of Alcoholism Revisited showed a 5% success rate. The old green-papers site refuted it quite nicely; I summarize those findings in the Wikipedia talk page for Valliant's book. The actual AA success figures in that book, for people who attended 300 or more meetings over a ten-year period, is on page 197. The "this many people who attended 300 or more meetings" numbers are not in that table, but easily enough determined with some simple math: 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book (50% got sober right away, 25% got sober after relapsing, and the rest showed improvement).
- Lance Dodes used some questionable math in The Sober Truth to come up with this same figure; Gabrielle Glaser, in her 2015 hit piece, parroted Dodes' figures. Thomas Beresford, writing for the National Council on Alcoholism and Drug Dependence, directly refutes Dodes' bogus 5% figure in one article and shows some actual success figures for AA in another article.
Thursday, March 31, 2016
Frivolous lawsuit against AAWS dismissed
I have discussed in three previous blog entries Karla Brada's tragic death and the frivolous lawsuit Karla's family brought against AA World Services (AAWS). Anyone who was not a fanatic anti-stepper could see that the lawsuit has no merit -- how can AAWS be responsible for a relationship that did not even start in an AA meeting, much less a domestic violence incident that happened in a private residence?
The courts agreed: The lawsuit against AAWS has been dismissed (mirror). While the murderer is still a party to the lawsuit, the judge decided that AA could not possibly be held responsible for something that had nothing to do with AA.
My prayers are with the Brada family that they can find peace and happiness. Hopefully, by having AAWS dismissed as a defendant, they can move on beyond what has been a misplaced resentment.
The courts agreed: The lawsuit against AAWS has been dismissed (mirror). While the murderer is still a party to the lawsuit, the judge decided that AA could not possibly be held responsible for something that had nothing to do with AA.
My prayers are with the Brada family that they can find peace and happiness. Hopefully, by having AAWS dismissed as a defendant, they can move on beyond what has been a misplaced resentment.
Wednesday, March 30, 2016
Let’s look at one of the 25%
The numbers I have seen, for long term sobriety of people who really try the AA program, is about 75%, with most of the remaining 25% showing improvement. I haven't found any numbers more recent than the 1970s where a study says "We looked at this number of alcoholics. This number of people were really serious of the program; of those people, this percent got sober." The 1970s numbers I have seen, from The Natural History of Alcoholism Revisited, are that roughly 75% of those serious about working the program stay sober.
The figures which claim a 5% or 8% or 10% success rate are numbers which include any alcoholic who has been to even one AA meeting and decided not to return; those numbers are not valid, for the same reason we do not judge the success of fitness programs by looking at people who do not exercise, or judge the success of chemotherapy by looking at the people who do not take chemotherapy. Working the AA program is defined as attending meetings once a week or more, getting a sponsor, and working the steps as written in the first 164 pages of the Big Book -- to say AA is a failure because a large percentage of alcoholics refuse to do that (because -- this is based on my own personal experience talking to newcomers after meetings and then calling them up when I don't see them at meetings -- most people who are exposed to AA still want to drink) is downright intellectually dishonest.
So, even with this 75% success rate, what about the other 25%? I think I have found on the web a an example of someone who just does not have a positive reaction to the 12-step program. Now, I could be a circa 1990 AA fanatic and assert that someone like this deserves to drink again because they're too stubborn to accept the God thing. But, since I actually work the program as written in the 164, "love and tolerance of others is [my] code."
What do I suggest for someone like this? First of all, I would like to commend Dick for trying really hard to work the program, and I think there are people out there who just can not have a spiritual experience as described in the Big Book, not even the gradual kind as described in the "Spiritual Experience" appendix. Do I think these people are doomed to an alcoholic death? Not necessarily.
Dick is saying he's trying SMART recovery. He hasn't said, in the comments, whether it is giving him continuous sobriety, but it seems more appealing to him than the traditional AA program. Another option for Dick is to go to AA, but only to agnostic meetings, such as the ones listed here:
http://www.agnosticaanyc.org/worldwide.html
Since I have worked the program as written in the 164, I have learned the principle of "Live and let live." I appreciate Dick's honesty and wish him the utmost in getting and staying sober.
The figures which claim a 5% or 8% or 10% success rate are numbers which include any alcoholic who has been to even one AA meeting and decided not to return; those numbers are not valid, for the same reason we do not judge the success of fitness programs by looking at people who do not exercise, or judge the success of chemotherapy by looking at the people who do not take chemotherapy. Working the AA program is defined as attending meetings once a week or more, getting a sponsor, and working the steps as written in the first 164 pages of the Big Book -- to say AA is a failure because a large percentage of alcoholics refuse to do that (because -- this is based on my own personal experience talking to newcomers after meetings and then calling them up when I don't see them at meetings -- most people who are exposed to AA still want to drink) is downright intellectually dishonest.
So, even with this 75% success rate, what about the other 25%? I think I have found on the web a an example of someone who just does not have a positive reaction to the 12-step program. Now, I could be a circa 1990 AA fanatic and assert that someone like this deserves to drink again because they're too stubborn to accept the God thing. But, since I actually work the program as written in the 164, "love and tolerance of others is [my] code."
What do I suggest for someone like this? First of all, I would like to commend Dick for trying really hard to work the program, and I think there are people out there who just can not have a spiritual experience as described in the Big Book, not even the gradual kind as described in the "Spiritual Experience" appendix. Do I think these people are doomed to an alcoholic death? Not necessarily.
Dick is saying he's trying SMART recovery. He hasn't said, in the comments, whether it is giving him continuous sobriety, but it seems more appealing to him than the traditional AA program. Another option for Dick is to go to AA, but only to agnostic meetings, such as the ones listed here:
http://www.agnosticaanyc.org/worldwide.html
Since I have worked the program as written in the 164, I have learned the principle of "Live and let live." I appreciate Dick's honesty and wish him the utmost in getting and staying sober.
Tuesday, March 29, 2016
Some quick bookmarks
Some quick bookmarks:
https://www.drugabuse.gov/.../behavioral-4
"the efficacy of 12-step programs (and 12-step facilitation) in treating alcohol dependence has been established"
http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/
"the results of one well-designed investigation called Project Match, published in 1997, suggest that AA can facilitate the transition to sobriety for many alcoholics"
"research suggests that AA is quite a bit better than receiving no help [...] Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA"
http://alcalc.oxfordjournals.org/.../421.long
"Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders."
https://www.drugabuse.gov/.../behavioral-4
"the efficacy of 12-step programs (and 12-step facilitation) in treating alcohol dependence has been established"
http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/
"the results of one well-designed investigation called Project Match, published in 1997, suggest that AA can facilitate the transition to sobriety for many alcoholics"
"research suggests that AA is quite a bit better than receiving no help [...] Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA"
http://alcalc.oxfordjournals.org/.../421.long
"Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders."
Monday, March 14, 2016
AA is like antibiotics
Your doctor told you to never to take only one antibiotic. Unless you take a pill twice a day until the bottle is empty, the antibiotic will not be effective.
Likewise, Alcoholics Anonymous is not going to be effective unless you do what is suggested: Regular attendance at meetings and working the 12 steps as written in the first 164 pages of the Big Book.
Lance Dodes, in his anti-Alcoholics Anonymous polemic (When calling this book a "polemic", I am quoting The New York Times, which called the book a "polemical and deeply flawed book"), argues that AA doesn't work because only some small percentage of people who attend even one meeting get sober and stay sober.
This is a meaningless number; the majority of alcoholics out there do not want to get better. AA is a program for people who want it, not for people who need it. In fact, there has never been developed an alternate treatment which is more effective than AA -- AA, or any other treatment, is only going to be as effective as the percentage of alcoholics who want to get sober.
Valliant, in his classic The Natural History of Alcoholism Revisited, has a table on page 197. I ran the math on this table: 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book, which states that 50% got sober right away, 25% got sober after relapsing, and the rest showed improvement.
So, yes, Alcoholics Anonymous works. As long as you take all of the pills in the bottle: Making a habit of going to meetings and working the steps with a sponsor. Claiming the AA doesn't work because most alcoholics do not work it is dishonest.
Likewise, Alcoholics Anonymous is not going to be effective unless you do what is suggested: Regular attendance at meetings and working the 12 steps as written in the first 164 pages of the Big Book.
Lance Dodes, in his anti-Alcoholics Anonymous polemic (When calling this book a "polemic", I am quoting The New York Times, which called the book a "polemical and deeply flawed book"), argues that AA doesn't work because only some small percentage of people who attend even one meeting get sober and stay sober.
This is a meaningless number; the majority of alcoholics out there do not want to get better. AA is a program for people who want it, not for people who need it. In fact, there has never been developed an alternate treatment which is more effective than AA -- AA, or any other treatment, is only going to be as effective as the percentage of alcoholics who want to get sober.
Valliant, in his classic The Natural History of Alcoholism Revisited, has a table on page 197. I ran the math on this table: 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book, which states that 50% got sober right away, 25% got sober after relapsing, and the rest showed improvement.
So, yes, Alcoholics Anonymous works. As long as you take all of the pills in the bottle: Making a habit of going to meetings and working the steps with a sponsor. Claiming the AA doesn't work because most alcoholics do not work it is dishonest.
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