While there hasn’t been any mainstream press criticizing AA’s efficacy recently, I think, while Dodes’s figures are now outdated and discredited in light of Cochrane 2020, it would serve the reader to know the exact source data Dodes used to synthesize his bogus 5% “success rate” figure for Alcoholics Anonymous (AA).
A few years ago, Dr. Thomas Beresford had this to say about Lance Dodes’s alleged 5% success rate for Alcoholics Anonymous:
The Atlantic article’s source [i.e. Lance Dodes’s book] multiplies a 25% AA attendance figure by a 22% abstinence figure to arrive at a 5.5% estimate of AA’s effectiveness. Where do these figures come from? Another second-hand source [Note: This blog post will detail that second-hand source below] that also cites the work of others: two publications from the Rand Corporation that examined, among other things, attempts at controlled drinking and offered little focus on AA’s effectiveness. At 4-year follow-up the Rand group identified patients with at least one year abstinence who had been regular members of AA 18 months after the start of treatment: 42% of the regular AA members were abstinent, not the “calculated” 5.5% figure.
It may benefit the reader to dive in to this more deeply. Here is how Lance Dodes describes AA as supposedly having a 5% success rate:
University of California professor Herbert Fingarette cited two [...] statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. [Reference: H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988)] Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members.
And here is how the late Herbert Fingarette, back in 1988, described A.A.’s success rate (as cited by Dodes above):
[...] one large-scale study of alcoholics in treatment centers in the U.S. found that 71 percent of their subjects had attended A.A. at some point; but at eighteen-month and subsequent followups only 14 percent to 18 percent were attending. Moreover, the rate of problems was higher for irregular A.A. attenders than for either regular attenders or non-attenders. Among those who were regular A.A. attenders at the time of the initial interview, only 22 percent consistently maintained abstention up through the thirty-month followup interview, and over 33 percent had not only returned to drinking but also showed alcohol-related physical symptoms and life problems.
This paragraph has a single footnote, the 1980 Rand report on alcoholism. The 1980 Rand Report can be readily downloaded. Let’s start of with a summary of a graph on page 154 of that report.
Never attended AA: 23 out of 129 (18%) sober over 6 months.
Some AA attendance: 85 out of 315 (27%) sober over 6 months
Lots of AA attendance: 42 out of 74 (57%)
The Rand report, as skeptical as it is of AA (remember, they were trying to determine if alcoholics could moderately drink again, something we know today is a fool’s errand), admits that the abstinence rate for regular AA attenders is higher than any other group, with a p score of under .05.
The 22% and 18% figures Beresford then Dodes used for the bogus 5.5% figure, are based on table 6.15 at the bottom of page 129 of that 1980 Rand report. This is a four year follow up, with four columns based on 18-month followup AA attendance (never, only in the past, only occasionally, and regular attendance). They also looked at the number of people with over 6 months sober, over one year sober, and with 2.5 years sober.As expected, the more people went to AA, the more likely they would be sober. In more detail:
| AA attendance | 6 months+ sober | 1 year+ sober | 2.5+ years |
| Never | 24% | 16% | 11% |
| Only in past | 25% | 19% | 12% |
| Occasionally | 29% | 19% | 12% |
| Regularly | 45% | 42% | 22% |
Now, as we can see, overall, not that many people managed to get 2.5 years sober, but those that went to AA were more likely to stay sober. As it turns out, only 18% of the people were regular AA attenders (Dodes, mysteriously, claims the number is 25%); of those, only 22% got sober.
So, Dodes’s 5.5% number is based on this Rand report, and it is both:
- The people who regularly went to AA meetings. People who did not regularly attend AA meetings were not considered an “AA success” in Dodes’s book, regardless of whether they actually got sober.
- Of those people, only the people who did not have one drink for over 2.5 years were considered a success. If someone had a single drink two years ago, but was sober for over a year, regularly attending AA meetings, they were still considered to be not an “AA success”.
By doing everything to minimize the number of people that are an “AA success”, he was able to come up with a really low number for AA success. Indeed, if we make the bar more reasonable, such as one year or more sober, we get an 8% (instead of 4%) success rate, again not counting the people who didn’t regularly attend AA but got sober anyway.
Why did Dodes use a 1980 study based on 1970s numbers in a 2014 book? The numbers in the 1980 study were remarkably low. If we play the same game with the numbers in Moos and Moos 2006, we get a 17% success rate for AA, again not counting everyone who got sober who didn’t regularly go to AA meetings.
Even if we use this old 1980 study, if we use the numbers on page 128 (not page 129) of the 1980 Rand report, we get a 8% success rate (if only regular attenders count), or a 24% success rate if anyone who has set foot in AA counts. Actually, we get a 57% success rate if we only use the number of people regularly going to AA as our denominator (instead of all the people in the study).
Point blank: The math Dodes used to come up with a 5.5% AA success rate are based on a study that was 34 years old when he wrote the book, even though another similar 8-year-old study was available, and use a kind of math whose goal appears to be to make AA look as bad as possible.
Dodes’s numbers were disingenuous, plain and simple.
As an aside, since that old 1980 Rand report claimed that some AA attendance resulted in worse drinking consequences than no AA attendance, something Fingarette observed, I will address that. Those numbers were based on self-reporting answers. Based on the fact that the studies used in the 2020 Cochrane report on AA do not see worse drinking consequences for people randomly assigned to AA-centered therapies, the most likely reason that old Rand report saw worse consequences is because people who never have gone to AA are more likely to be dishonest about the extent of negative consequences from their drinking. As I have heard countless people say in AA meetings, doctors could not properly treat us because we were so dishonest about our drinking before going to AA.