Some other recent criticism of AA in the press

I have found other criticism of AA in the mainstream press over the last year which I should address here in this blog.

Naltrexone redux

A recent New York Times opinion piece (archive link) brought out the same old tired “AA (or abstinence) doesn’t work but Naltrexone allows alcoholics to drink like gentlemen” chestnut.

While cherry picked studies show remarkably high success rates for Naltrexone, this is offset by other studies which do not replicate those results. Naltrexone, like AA, appears to be effective for a subset of alcoholics, but, as per Cochrane, it only helps about 11% of alcoholics. 

The most disturbing thing about studies showing Naltrexone showing controlled drinking among alcoholics is that they consistently do not have long term follow-up periods. For example, that New York Times opinion piece links to two different studies which supposedly show alcoholics successfully drinking moderately again. In both cases, the final follow-up is one year after treatment.

As someone who remembers Pendery 1982 all too well, positive results for moderate drinking without long term follow-ups are not very encouraging. Sure, anything someone throws a dead cat, they will hit a study of alcoholism showing alcoholics successfully engaging in “moderate drinking” over the short term, but the few long-term follow-ups I have seen show that moderate drinking is not a long-term solution to chronic alcoholism.

As a point of comparison, the 1990s Project MATCH randomized study showed increased abstinence for people who engaged in AA-centered therapies three years after treatment (as per its data as presented in Cochrane 2020), and Moos and Moos 2006 is a longitudinal study showing that Alcoholics Anonymous keeps alcoholics sober 16 years later.

Another thing: That New York Times opinion piece claims that only 25% of alcoholics will achieve abstinence, but the study it links to supporting that outdated 25% figure doesn’t actually conclude this; it claims a 25% success rate for abstinence, and links to an old article from 2005 using results that are nearly two decades old. More recent figures from Cochrane show a 42% success rate.

Abstinence violation effect

There have been two (open access) different letters (paywall) recently published which make the same criticism of Cochrane 2020: They claim that there is an “abstinence violation effect” where the subjects undergoing AA-based treatment who are not abstinent somehow do worse when they drink again than subjects not undergoing AA-based treatment. In other words, the accusation is that AA may increase abstinence, but overall AA doesn’t improve things for alcoholics, because the alcoholics not abstinent supposedly drink more heavily.

This “abstinence violation effect” is actually a myth, as one of the authors of the 2020 Cochrane review on AA explains. Since this letter is paywalled, I will quote the most important part of that letter here:

while more individuals in AA/TSF achieved continuous abstinence, those who were not completely abstinent did not drink more heavily, drink more frequently or experience more alcohol-related consequences

Point being, AA overall improves things for alcoholics. 42% are straight up abstinent from alcohol a year later, and those who do not achieve abstinence do not, repeat not have worse consequences from their drinking.

I will only respond to articles published by the mainstream media

Moving forward, I will only respond to new articles published by the mainstream media which falsely state Alcoholics Anonymous does not work, or link to sources that falsely state that Alcoholics Anonymous is not effective. For example, the Vice article I criticized yesterday was published by a mainstream publisher, and while it did acknowledge Cochrane 2020, it also linked directly to sources which falsely claim AA doesn’t help alcoholics. 

My criteria is: “Is this a source notable enough to have its article linked to by mainstream news aggregators?” In other words, stuff published by mainstream newspapers and magazines. Sources which do not meet that bar will be ignored: social media postings, self-published blogs, postings in comment sections (here in the 2020s, comment sections are not as popular as they were a decade ago; good riddance to bad rubbish), and so on will be cheerfully ignored. 

If a new peer reviewed study making very negative claims about AA’s efficacy were to be published, I would address it here. Remember: Metastudies from top-notch publisher like the Cochrane 2020 review on AA’s effectiveness trump a single study, even if it’s peer-reviewed.

I am aware and acknowledge AA is not for everyone, and that other treatments appear to be just as effective as AA, but, for most alcoholics, AA is the first place they will go seeking treatment and trying to get better, and the goal of this blog is to make sure that alcoholic still suffering from the disease is properly informed that AA can very well help them get sober and better.

I now have a Twitter account, which I will primarily use to engage with authors of pieces which unfairly criticize AA. 

Goodbye for now. This account will only be made active again the when and if I see a new anti-AA article from a reliable and mainstream source.

Vice posted an anti-AA screed

Over a year ago, I retired this blog. When I retired the blog, I noted “I would restart this blog again if inaccurate claims about AA efficacy made it back to the mainstream press”.

Well, wouldn’t you know it, Vice has posted an anti-AA screed (archive link) in the UK edition of their magazine.

First of all, Vice is considered, as I type this, a source of questionable reliability in the Wikipedia. Concerning the quality of the article they posted about AA, I can see why their reliability is not top notch.

Near the beginning of the article, they link to two anti-AA Facebook groups; one has, as I type this, about 1,600 members; the other has around 1,300 members. Compare that to the one AA support group with about 41,500 members and another unofficial group simply called Alcoholics Anonymous with about 39,300 members, we see that the there are 24-30 people getting better in AA for each person who wastes their time complaining about the program and not improving. Considering how much more popular the AA-positive support groups are, it’s undue weight to focus only on the anti-AA groups.

They then look at the AA documentary The 13th Step without any critical evaluation of its contents. This “documentary” (which was a complete flop without little to no notability) makes the accusation that women will be forced to endure sexual harassment if they wish to get sober in AA. That may be true of a few isolated fellowships (such as the infamous Midtown fellowship well over a decade ago), but the general rule is this:

• Alcoholics Anonymous has safe spaces for women: A number of meetings are meetings which only women can attend.
• There is a strong cultural rule that men stick with men and women stick with women in the AA fellowship, in order to minimize women getting unwanted sexual advances.
• Many sponsors and people in the rooms of AA suggest people stay out of relationships (i.e. have sex) in their first year of sobriety; this again is for the protection of newcomer women.
• The fellowships I have been to will confront men who make inappropriate advances towards women.
  

Women have plenty of options to avoid men and harassment in the fellowships I have been to.

Next, the article goes on to mentions a book written by one Steven Slate, who makes a number of dubious claims about AA’s effectiveness. For example, he quotes a study published over 40 years ago to make negative claims about AA’s efficacy, without acknowledging that the study has been discredited, something I have extensively discussed on this blog. As another example, Mr. Slate has not even acknowledged the existence of the Cochrane 2020 study which shows that Alcoholics Anonymous is more effective at achieving abstinence for alcoholics than other treatments.

Indeed, the Vice article does acknowledge that “AA definitely works” for a significant subset of alcoholics, but only in the final paragraph.

The fact of the matter is this: AA works most of the time for people who work it. However, alcoholics are a stubborn lot, and many of them will find excuses for not going to meetings, not working the steps, and not getting better: Complaining about sexual harassment (so why not only go to women’s AA meetings) or falsely claiming that AA does not help alcoholics.

It’s unfortunate that Vice media has chosen to publish an article which encourages alcoholics to come up with more excuses to not go to AA and more excuses to not get better.

Update: The author the this Vice article has responded on Twitter: “Hi! Thanks for responding. This article isn’t meant to downplay AAs significance in helping millions get sober. It’s just an alternative perspective that explains why some people left during the pandemic. It’s good to offer alternative solutions so such complex problems!”