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opinion piece claims that only 25% of alcoholics will achieve abstinence, but the study it links to supporting that outdated 25% figure doesn’t actually conclude this; it claims a 25% success rate for abstinence, and links to an old article from 2005 using results that are nearly two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.