I initially ignored this article, since it was published by one FilterMag, not a particularly mainstream magazine, and one which a fellow Wikipedia editor calls “an openly biased source advocating harm-reduction.” However, since I’m starting to see this article being used as an attempt to “refute” the Cochrane 2020 review of AA, it is time to address this.
Stanton Peele has a long-standing opposition to AA and rejection of any science showing AA efficacy, posting anti-AA screeds more than 30 years ago and claiming that chronic alcoholics can drink moderately again despite the scientific evidence showing that to be a fool’s errand. Hardly an objective dispassionate source.
Compare this to the peer-reviewed prestigious Cochrane 2020 report on AA. The Cochrane Library is considered by the Wikipedia community to be “generally of high quality” and their 2020 report on AA is an exemplary example of their excellent scientific rigor.
This attempt to refute Cochrane 2020’s report on AA is really really bad.
Peele claimed that AA overall doesn’t help alcoholics, since, while
AA does increase abstinence, Peele alleged that it does not decrease
overall percentage of drinking days and other measures of what I would call alcoholism severity. Nick Heather echoed this claim,
attributing it to Peele, when writing a letter criticizing the Cochrane
Review. Here is the response to Heather from one of the Cochrane writers:
It should be remembered also, that DDD [Drinks per drinking day] and alcohol-related consequences are averages based solely on those individuals who actually drank at all [...] 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 consequence
Peele mentions that it’s only at the one year mark we see an increase in abstinence large enough to be very statistically significant (i.e. have a low P value). The reason for this is because the only study with enough subjects to decrease the standard deviation and resulting P value was the 1990s Match study at the one-year followup. Studies, including the Match one, show similar increases in abstinence at other time points, but with fewer subjects. There’s no reason to believe the results would be different if we had as many subjects as we do at the one-year mark, but we cannot get a low enough P with the number of subjects we have to consider the data except at the one-year mark, by Cochrane standards, “high certainty” evidence. [1]
Peele also claims there were not any “reliable”
studies showing AA effectiveness in the mid-2000s. Never mind that we had Moos and Moos 2006 and Fiorentine 1999 which showed a strong correlation between
abstinence and regular AA attendance, not to mention Project MATCH which
should AA was just as effective as psychotherapy (and whose raw data shows greater abstinence among people directed to go to AA meetings).
He then claims it was a “self selecting”
population, but all of the studies used randomization of subjects. He
then continues to build up a straw man about Cochrane 2020: He claims
they only used two studies to show manualized AA-based TSF treatment has
better abstinent outcomes, but pages 88 and 89 of the actual Cochrane
review show six different studies, all showing better results for
therapies which get people in the rooms of AA. Then he claims the
Cochrane review shows higher drinking intensity, but page 92 shows that
it’s only a single study (McCrady 1996) which saw a higher percentage of
days heavy drinking, while two other studies show either the same
number of days of heavy drinking, or a slight improvement for AA-based
treatments. The idea that there is an “abstinence violation effect”, that since drinks per day and what not are the same between AA-assigned and non-AA-assigned subjects, and the false allegation this indicates AA attenders who still drink have worse drinking consequences has been addressed above.
He then links to studies which did not pass the muster to be part of Cochrane 2020. I can do that too: Moos and Moos 2006, which shows a 67% 16-year success rate for Alcoholics Anonymous. He then complains that the studies only pick good subjects, which isn’t true: The studies pick subjects who only have alcoholism because, you know, AA is not a program for treating mental illness; it’s a program for treating alcoholism.
One Brandon Bergman who helped with the research for the 2020 Cochrane review of AA also has posted a rebuttal to Peele’s article.
Alcoholics Anonymous works for some alcoholics. The fact that there has been, in the last two years, no serious science refuting the Cochrane 2020 review shows just how solid that review is.
[1] See the graph on page 89 of the Cochrane review.
