I have discussed in three previous blog entries Karla Brada's tragic death and the frivolous lawsuit Karla's family brought against AA World Services (AAWS). Anyone who was not a fanatic anti-stepper could see that the lawsuit has no merit -- how can AAWS be responsible for a relationship that did not even start in an AA meeting, much less a domestic violence incident that happened in a private residence?
The courts agreed: The lawsuit against AAWS has been dismissed (mirror). While the murderer is still a party to the lawsuit, the judge decided that AA could not possibly be held responsible for something that had nothing to do with AA.
My prayers are with the Brada family that they can find peace and happiness. Hopefully, by having AAWS dismissed as a defendant, they can move on beyond what has been a misplaced resentment.
Thursday, March 31, 2016
Wednesday, March 30, 2016
Let’s look at one of the 25%
The numbers I have seen, for long term sobriety of people who really try the AA program, is about 75%, with most of the remaining 25% showing improvement. I haven't found any numbers more recent than the 1970s where a study says "We looked at this number of alcoholics. This number of people were really serious of the program; of those people, this percent got sober." The 1970s numbers I have seen, from The Natural History of Alcoholism Revisited, are that roughly 75% of those serious about working the program stay sober.
The figures which claim a 5% or 8% or 10% success rate are numbers which include any alcoholic who has been to even one AA meeting and decided not to return; those numbers are not valid, for the same reason we do not judge the success of fitness programs by looking at people who do not exercise, or judge the success of chemotherapy by looking at the people who do not take chemotherapy. Working the AA program is defined as attending meetings once a week or more, getting a sponsor, and working the steps as written in the first 164 pages of the Big Book -- to say AA is a failure because a large percentage of alcoholics refuse to do that (because -- this is based on my own personal experience talking to newcomers after meetings and then calling them up when I don't see them at meetings -- most people who are exposed to AA still want to drink) is downright intellectually dishonest.
So, even with this 75% success rate, what about the other 25%? I think I have found on the web a an example of someone who just does not have a positive reaction to the 12-step program. Now, I could be a circa 1990 AA fanatic and assert that someone like this deserves to drink again because they're too stubborn to accept the God thing. But, since I actually work the program as written in the 164, "love and tolerance of others is [my] code."
What do I suggest for someone like this? First of all, I would like to commend Dick for trying really hard to work the program, and I think there are people out there who just can not have a spiritual experience as described in the Big Book, not even the gradual kind as described in the "Spiritual Experience" appendix. Do I think these people are doomed to an alcoholic death? Not necessarily.
Dick is saying he's trying SMART recovery. He hasn't said, in the comments, whether it is giving him continuous sobriety, but it seems more appealing to him than the traditional AA program. Another option for Dick is to go to AA, but only to agnostic meetings, such as the ones listed here:
http://www.agnosticaanyc.org/worldwide.html
Since I have worked the program as written in the 164, I have learned the principle of "Live and let live." I appreciate Dick's honesty and wish him the utmost in getting and staying sober.
The figures which claim a 5% or 8% or 10% success rate are numbers which include any alcoholic who has been to even one AA meeting and decided not to return; those numbers are not valid, for the same reason we do not judge the success of fitness programs by looking at people who do not exercise, or judge the success of chemotherapy by looking at the people who do not take chemotherapy. Working the AA program is defined as attending meetings once a week or more, getting a sponsor, and working the steps as written in the first 164 pages of the Big Book -- to say AA is a failure because a large percentage of alcoholics refuse to do that (because -- this is based on my own personal experience talking to newcomers after meetings and then calling them up when I don't see them at meetings -- most people who are exposed to AA still want to drink) is downright intellectually dishonest.
So, even with this 75% success rate, what about the other 25%? I think I have found on the web a an example of someone who just does not have a positive reaction to the 12-step program. Now, I could be a circa 1990 AA fanatic and assert that someone like this deserves to drink again because they're too stubborn to accept the God thing. But, since I actually work the program as written in the 164, "love and tolerance of others is [my] code."
What do I suggest for someone like this? First of all, I would like to commend Dick for trying really hard to work the program, and I think there are people out there who just can not have a spiritual experience as described in the Big Book, not even the gradual kind as described in the "Spiritual Experience" appendix. Do I think these people are doomed to an alcoholic death? Not necessarily.
Dick is saying he's trying SMART recovery. He hasn't said, in the comments, whether it is giving him continuous sobriety, but it seems more appealing to him than the traditional AA program. Another option for Dick is to go to AA, but only to agnostic meetings, such as the ones listed here:
http://www.agnosticaanyc.org/worldwide.html
Since I have worked the program as written in the 164, I have learned the principle of "Live and let live." I appreciate Dick's honesty and wish him the utmost in getting and staying sober.
Tuesday, March 29, 2016
Some quick bookmarks
Some quick bookmarks:
https://www.drugabuse.gov/.../behavioral-4
"the efficacy of 12-step programs (and 12-step facilitation) in treating alcohol dependence has been established"
http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/
"the results of one well-designed investigation called Project Match, published in 1997, suggest that AA can facilitate the transition to sobriety for many alcoholics"
"research suggests that AA is quite a bit better than receiving no help [...] Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA"
http://alcalc.oxfordjournals.org/.../421.long
"Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders."
https://www.drugabuse.gov/.../behavioral-4
"the efficacy of 12-step programs (and 12-step facilitation) in treating alcohol dependence has been established"
http://www.scientificamerican.com/article/does-alcoholics-anonymous-work/
"the results of one well-designed investigation called Project Match, published in 1997, suggest that AA can facilitate the transition to sobriety for many alcoholics"
"research suggests that AA is quite a bit better than receiving no help [...] Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA"
http://alcalc.oxfordjournals.org/.../421.long
"Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders."
Monday, March 14, 2016
AA is like antibiotics
Your doctor told you to never to take only one antibiotic. Unless you take a pill twice a day until the bottle is empty, the antibiotic will not be effective.
Likewise, Alcoholics Anonymous is not going to be effective unless you do what is suggested: Regular attendance at meetings and working the 12 steps as written in the first 164 pages of the Big Book.
Lance Dodes, in his anti-Alcoholics Anonymous polemic (When calling this book a "polemic", I am quoting The New York Times, which called the book a "polemical and deeply flawed book"), argues that AA doesn't work because only some small percentage of people who attend even one meeting get sober and stay sober.
This is a meaningless number; the majority of alcoholics out there do not want to get better. AA is a program for people who want it, not for people who need it. In fact, there has never been developed an alternate treatment which is more effective than AA -- AA, or any other treatment, is only going to be as effective as the percentage of alcoholics who want to get sober.
Valliant, in his classic The Natural History of Alcoholism Revisited, has a table on page 197. I ran the math on this table: 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book, which states that 50% got sober right away, 25% got sober after relapsing, and the rest showed improvement.
So, yes, Alcoholics Anonymous works. As long as you take all of the pills in the bottle: Making a habit of going to meetings and working the steps with a sponsor. Claiming the AA doesn't work because most alcoholics do not work it is dishonest.
Likewise, Alcoholics Anonymous is not going to be effective unless you do what is suggested: Regular attendance at meetings and working the 12 steps as written in the first 164 pages of the Big Book.
Lance Dodes, in his anti-Alcoholics Anonymous polemic (When calling this book a "polemic", I am quoting The New York Times, which called the book a "polemical and deeply flawed book"), argues that AA doesn't work because only some small percentage of people who attend even one meeting get sober and stay sober.
This is a meaningless number; the majority of alcoholics out there do not want to get better. AA is a program for people who want it, not for people who need it. In fact, there has never been developed an alternate treatment which is more effective than AA -- AA, or any other treatment, is only going to be as effective as the percentage of alcoholics who want to get sober.
Valliant, in his classic The Natural History of Alcoholism Revisited, has a table on page 197. I ran the math on this table: 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book, which states that 50% got sober right away, 25% got sober after relapsing, and the rest showed improvement.
So, yes, Alcoholics Anonymous works. As long as you take all of the pills in the bottle: Making a habit of going to meetings and working the steps with a sponsor. Claiming the AA doesn't work because most alcoholics do not work it is dishonest.
Tuesday, October 27, 2015
A good discussion of the 2006 Cochrane review
Here is a post from late last year discussing the problems with the last (2006) Cochrane review of how effective Alcoholics Anonymous is:
https://addictionandrecoverynews.wordpress.com/2014/12/27/2014s-top-posts-7/
https://addictionandrecoverynews.wordpress.com/2014/12/27/2014s-top-posts-7/
Sunday, August 23, 2015
Brandsma 1980: Not peer reviewed
While researching which studies to discuss in the Effectiveness of Alcoholics Anonymous Wikipedia article, I went over to the Rational Wiki Alcoholics Anonymous article to see if I could add some peer reviewed information showing that AA is not effective from the other side.
Unfortunately, the Rational Wiki did not have any good science in it. The study they refer to with allegations that AA actually increases binge drinking has the ambiguous name "Brandsma et al. 1980" Research revealed that this supposedly scientific, albeit dated, survey showing how AA is worse than no treatment would have a DOI or PMCID, the way peer-reviewed studies do. It doesn't.
A Google search of the study showed the primary people referring it were unreliable anti-steppers (including, yes, people on the fringe of academia like Stanton Peele). Apparently, this study got put on the Orange Papers site, where the usual cadre of anti-steppers mirrored it from.
Finally, I got some solid information about this article in, of all places, an Amazon review. To summarize: This study was not peer reviewed, was published by one University Park Press, which mainly prints university textbooks -- read: not published in a journal, and its methodology is, at best, suspect.
It is referred to in journal papers, but usually negatively. For example, PMC2746426 mentions "concerns with the Brandsma trial which call its experimental results into question", and PMC3602358 says that studies like this are "significantly limited in their methods or interpretability," PMC3549307 (by the same authors) says the same thing.
Why is it that anti-steppers need to use a 35-year old non-peer reviewed study to find "science" to back up their anti-AA talking points? Because the real science shows that AA actually works.
Let me rephrase that: The objective science shows the people who go to more AA meetings are more likely to stay sober. The science has not yet concluded that it's AA's 12 step program that results in the statistically undeniable positive outcomes for AA members, but research is going in that direction.
Unfortunately, the Rational Wiki did not have any good science in it. The study they refer to with allegations that AA actually increases binge drinking has the ambiguous name "Brandsma et al. 1980" Research revealed that this supposedly scientific, albeit dated, survey showing how AA is worse than no treatment would have a DOI or PMCID, the way peer-reviewed studies do. It doesn't.
A Google search of the study showed the primary people referring it were unreliable anti-steppers (including, yes, people on the fringe of academia like Stanton Peele). Apparently, this study got put on the Orange Papers site, where the usual cadre of anti-steppers mirrored it from.
Finally, I got some solid information about this article in, of all places, an Amazon review. To summarize: This study was not peer reviewed, was published by one University Park Press, which mainly prints university textbooks -- read: not published in a journal, and its methodology is, at best, suspect.
It is referred to in journal papers, but usually negatively. For example, PMC2746426 mentions "concerns with the Brandsma trial which call its experimental results into question", and PMC3602358 says that studies like this are "significantly limited in their methods or interpretability," PMC3549307 (by the same authors) says the same thing.
Why is it that anti-steppers need to use a 35-year old non-peer reviewed study to find "science" to back up their anti-AA talking points? Because the real science shows that AA actually works.
Let me rephrase that: The objective science shows the people who go to more AA meetings are more likely to stay sober. The science has not yet concluded that it's AA's 12 step program that results in the statistically undeniable positive outcomes for AA members, but research is going in that direction.
Sunday, June 21, 2015
June 2015 round-up
OK, I'm back, but just to summarize a couple of articles and comments I have found.
First of all, a recent study concluded that "increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection." (PMC4285560). Austin Frakt wrote a New York Times piece about it: http://www.nytimes.com/2015/04/07/upshot/alcoholics-anonymous-and-the-challenge-of-evidence-based-medicine.html
This study is pretty key: It's been well-established by the science that, as we say in AA, "meeting makers make it"; the question now being asked is "do meeting makers make it because those that go to meetings are more motivated to get sober, or because AA helps keep alcoholics sober?" This study concludes it's the actual program which keeps people sober.
Here's another good refutation of Lance Dodes's book: http://www.amazon.com/gp/cdp/member-reviews/A3HLE5G8L7A4OQ For example, here's an excerpt from one study (PMC2746426; I have taken the liberty to remove references to other parts of the study placed in parenthesis in the original):
What Dodes is doing here is a dishonest: He is not arguing that meeting makers make it, although he tries to imply that using unrelated data. The evidence that "meeting makers make it" is so well-established in the addiction science academic community that Dodes does not even try to directly argue that adage. What he is instead arguing is that perhaps meeting makers make it because they were more motivated to get sober at the start, or because of AA's social network.
It's a strictly academic question, and does not affect the fact that AA is the only alcohol support group in the world with thousands upon thousands of free meetings. Even here, the studies are at worst inconclusive, only because AA is so successful and universal that anyone seeking treatment for alcoholism has been exposed to AA. To go from "it's really hard to decide whether someone going to AA is successful because of the program itself or because of other factors" to "AA doesn't help alcoholics" is a really large, and downright intellectually dishonest, leap.
Anyway, studies like PMC4285560 have tried really hard to eliminate other factors, and conclude that there's something about the AA program itself that is helping keep people sober. While not directly looked at in this study, I say it is the 12 steps as written in the first 164 pages of the Big Book that are keeping people sober.
As we were talking about at a meeting yesterday, the problem with the press is that the only news that attracts the press is bad news. The numerous studies giving us more and more evidence that AA works are ignored by the press; it was Lance Dodes's very biased, inaccurate, and negative book which got so much mainstream press attention last year.
First of all, a recent study concluded that "increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection." (PMC4285560). Austin Frakt wrote a New York Times piece about it: http://www.nytimes.com/2015/04/07/upshot/alcoholics-anonymous-and-the-challenge-of-evidence-based-medicine.html
This study is pretty key: It's been well-established by the science that, as we say in AA, "meeting makers make it"; the question now being asked is "do meeting makers make it because those that go to meetings are more motivated to get sober, or because AA helps keep alcoholics sober?" This study concludes it's the actual program which keeps people sober.
* * *
Here's another good refutation of Lance Dodes's book: http://www.amazon.com/gp/cdp/member-reviews/A3HLE5G8L7A4OQ For example, here's an excerpt from one study (PMC2746426; I have taken the liberty to remove references to other parts of the study placed in parenthesis in the original):
Rates of abstinence are about twice as high among those who attend AA; higher levels of attendance are related to higher rates of abstinence; these relationships are found for different samples and follow-up periods; prior AA attendance is predictive of subsequent abstinence; and mechanisms of action predicted by theories of behavior change are present in AA. However, rigorous experimental evidence establishing the specificity of an effect for AA or Twelve Step Facilitation/TSF is mixed, with 2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and to that reported significant effects for AA after adjusting for potential confounders such as motivation to change.This is how Dodes quotes that in his book:
Rigorous experimental evidence establishing the specificity of an effect for AA or 12 Step Facilitation is mixed, with two trials finding a positive effect for AA, one trial finding a negative effect for AA, and one trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and to that reported significant effects for AA after adjusting for potential confounders such as motivation to change.Only someone with a strong anti-12-step bias would take a study that states that "rates of abstinence are about twice as high among those who attend AA" and conclude that the study is saying that "the strong evidence that one would expect if AA were clearly effective is simply not present."
What Dodes is doing here is a dishonest: He is not arguing that meeting makers make it, although he tries to imply that using unrelated data. The evidence that "meeting makers make it" is so well-established in the addiction science academic community that Dodes does not even try to directly argue that adage. What he is instead arguing is that perhaps meeting makers make it because they were more motivated to get sober at the start, or because of AA's social network.
It's a strictly academic question, and does not affect the fact that AA is the only alcohol support group in the world with thousands upon thousands of free meetings. Even here, the studies are at worst inconclusive, only because AA is so successful and universal that anyone seeking treatment for alcoholism has been exposed to AA. To go from "it's really hard to decide whether someone going to AA is successful because of the program itself or because of other factors" to "AA doesn't help alcoholics" is a really large, and downright intellectually dishonest, leap.
Anyway, studies like PMC4285560 have tried really hard to eliminate other factors, and conclude that there's something about the AA program itself that is helping keep people sober. While not directly looked at in this study, I say it is the 12 steps as written in the first 164 pages of the Big Book that are keeping people sober.
As we were talking about at a meeting yesterday, the problem with the press is that the only news that attracts the press is bad news. The numerous studies giving us more and more evidence that AA works are ignored by the press; it was Lance Dodes's very biased, inaccurate, and negative book which got so much mainstream press attention last year.
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