One thing that article does is point to a study which “proves” that alcoholics can control and moderate their drinking. One thing to keep in mind is that while it’s pretty easy to find a study which shows that out-of-control alcoholics claim they are controlling their drinking, those studies are generally short term and based on self-reported data. The last time we had a real long-term study was the 10-year follow-up in Pendery 1982, a famous (if old) study showing that alcoholics do not successfully control and moderate their drinking over a long time period.
But, interested, I looked at this meta-study supposedly showing controlled drinking among alcoholics. This meta-study included studies going back to the 1970s. Most of the studies had only short-term follow-ups; there were only two studies with follow-ups longer than two years.
Diving deeper, I looked at the two studies with a final follow-up longer than two years used to support the idea that an alcoholic can control and enjoy his drinking:
One study with a 3.5 year follow up is Graber et. al. 1988 [1]. N=24 (which is a much lower N than the studies used to support Cochrane 2020) Looking at the study, I observed that while the supposed “controlled drinkers” claimed to be drinking less than the group told to abstain from alcohol, the collaterals (usually, the drinker’s loved ones) reported that the “controlled drinkers” were actually drinking a lot more than the abstinent group: Self-reported data among the abstinent group was 21 drinks a week (collaterals reported less); collaterals reported nearly 41 drinks a week for the controlled drinking group (self-reporting was a good deal lower).
The other study they used was from back in the 1970s: Caddy et. al. 1978 [2]. I started reading this study before metaphorically throwing it across the room. It looks at alcoholics in the infamous Sobell 1973 study. The very same alcoholics they looked at in Pendery 1982! (To be pedantic, Pendery 1982 only looked at the 20 alcoholics in the controlled drinking experimental group, while Caddy 1978 looked at all 70 subjects across four groups, but still) At this point, I stopped bothering to read the meta-study.
We know exactly what happened to that very same CD-E (experimental controlled drinking) group of 20 alcoholics 10 years later: They weren’t controlling and enjoying their drinking! (4 dead, 8 out-of-control drinking, 6 abstinent, 1 moderately drinking, 1 not located) Despite this, the meta-study, without even mentioning the existence of Pendery 1982, claimed this study showed the controlled drinking group did better than the abstinent group. I can not take seriously a meta-study which uses data based on those 20 people in Pendery 1982 to argue an alcoholic can control and enjoy his drinking.
If we throw out the data based on the subjects in Pendery 1982, we are left either with studies whose final follow-up is at most two years after treatment, or with the all of 24 subjects in Graber et. al. 1988 where the “moderate drinking” (“controlled drinking” as they called it back then) group was apparently drinking a good deal more than the abstinent group, and were, based on their collaterals, being more dishonest about their drinking.
In terms of the N used for long term follow-ups, as a point of comparison, the Match study used by the Cochrane group in their 2020 AA report had, at the three year follow-up, 952 subjects.
To address the rest of that article, to use Dodes’ questionable figures to conclude AA has a low success rate, and then compare that to a figure that, as it turns out, considers 12-step fellowships a part of mainstream treatment to imply AA isn’t “mainstream treatment” is straight up bad science. [3] The article tries really hard to downplay the results of Cochrane’s 2020 report on Alcoholics Anonymous: After claiming TSF (which, yes, gets people in the rooms of AA where the real recovery starts) isn’t more effective than other treatments, the article finally contradicts itself in the next sentence by conceding that 12-step oriented therapies increase abstinence, but hedges this by stating “the goal of 12-step facilitation therapy is always abstinence, while other therapies may support a goal of controlled drinking or harm reduction for some heavy and dependent drinkers”; never mind that the article wasn’t able to provide a compelling case that controlled drinking is a workable long-term solution for alcoholics (it isn’t, as I already detailed earlier in this post). Did I mention that this article doesn’t even try to address the multiple observational studies showing that regular AA meeting attenders are twice as likely to get and stay sober?
(I originally posted this on Reddit)
[1] “Abstinence or controlled drinking goals for problem drinkers: A randomized clinical trial” 1988
[2] “Individualized behavior therapy for alcoholics: a third year independent double-blind follow-up” 1978
[3] The science in that article gets worse. The article links to AA’s 2014 membership survey pamphlet stating that, since 27% of people in the survey are in their first year, this shows a 73% relapse rate. Actually, what the pamphlet shows is that 27% of members are in their first year, and 73% have one year or more sober—quite the opposite of a 73% relapse rate. Like I said, bad science.