Surprise! An article in a stoner magazine doesn't like Alcoholics Anonymous

Surprise! An article in a stoner magazine doesn't like Alcoholics Anonymous.

This article uses the following two anti-AA tropes to claim that AA does not work:

• Lance Dodes' claim that AA has a 5-8% success rate, which I have have dealt with four years ago in this blog, and which has been fully refuted in the article "Alcoholics Anonymous and The Atlantic: A Call For Better Science"
• That table in Handbook of Alcoholism Treatment Approaches which anti-steppers (such as stoners lying to themselves) love to bring out, which is also quite inaccurate (yes, I have already blogged about this table). Did I mention that its author, William R. Miller, has recently written a book telling alcoholics how to moderate their drinking which is, quite bluntly, a fool's errand.

The article also claims the AA Big Book is inaccurate when it claims a 75% success rate. Actually, I have seen multiple studies with this figure or similar figures; e.g. Moos and Moos 2006 shows, among alcoholics who took AA seriously, 67% of them were still sober 16 years later.

2018 is starting off as a great year

2018 is starting off as a great year.

The Vox published today a well-researched story about Alcoholics Anonymous with information which actually reflects what treatment experts know about AA today, called Why some people swear by Alcoholics Anonymous — and others despise it.

Unlike the anti-AA polemics posted by NPR, The Atlantic, and Salon over the past few years, they did not waste their time interviewing known anti-AA critics Lance Dodes or Stanton Peele. Instead, they talked to people with a more balanced view, such as Keith Humphreys.

There’s no nonsense about AA having a 5% success rate; they say about a third of alcoholics are successful using AA. This is actually higher than the numbers I have seen; for example, Moos and Moos 2006 shows that AA  has a 67% success rate among the 25% or so of alcoholics who choose to be highly involved in the program their first year sober.

I am glad to see the mainstream press is starting to publish articles showing the real success rate for AA, instead of publishing articles with deceptive success rate figures (there is no peer-reviewed study which concludes AA has a 5% success rate!) which discourage people from going to a program which can save their life.

There is no evidence Audrey Kishline was an active member of AA in 2000

Audrey Kishline was the founder of the group "Moderation Management", which pretended that chronic alcoholics could drink moderately again. Audrey Kishline was never able to drink moderately; in 2000, she got behind the wheel of her truck, and killed two innocent people while driving drunk. 

Soon afterwards, Kishline admitted that "moderation management is nothing but alcoholics covering up their problem."

Audrey Kishline ended up killing herself in late 2014. This was the end result and ultimate consequence of denying she had a drinking problem and deceiving herself and others that she could drink moderately again: Death. Not only her own death, but the death of two innocent bystanders.

One refrain anti-steppers attempt to make when people point out the consequences of Audrey Kishline lying to herself about her moderate drinking, is that she was in AA when she had her fatal drunken driving episode.

There is no evidence that Audrey ever actively worked an AA program before this tragic incident.

The evidence anti steppers bring up is this: http://archive.is/yDrVt where Audrey finally admits she can not drink moderately to the Moderation Management mailing list; she wrote that "I am now following a different path, and to strengthen my sobriety I am attending Alcoholics Anonymous, but will also attend Women for Sobriety and SMART Recovery. I am sure I can learn much from all of these fine programs."

Did Audrey get a sponsor? How often did Audrey go to meetings? Did she work the program as described in the first 164 pages of the Big Book? Was she serious about the program, or was she just trying to look good to others?

The fact that she was considering other programs when she wrote this sentence indicates that she was not serious about AA. I suspect she was just trying to look good to others.

In fact, let's look at an obituary posted after she killed herself to get more details of her life when she drove drunk like that: http://archive.is/SyhFU

When she wrote the email saying that moderation was not working any more, her drinking was so bad, she was forced by law enforcement to go to a detox program. Not a peep in her email about the fact her drinking was so bad, it was giving her legal problems, The email she sent to the listserv was dishonest, so its claim that Audrey was actively going to AA meetings is, at best, suspect.

The only evidence that Audrey went to even a single AA meeting between the time she wrote the email claiming she was going to AA and the time she killed two people driving drunk is an email which we now know was dishonest. 

(Update: The Dateline piece on Audrey's drunk driving has a tiny bit more detail about Audrey's supposed membership in AA between the time she left Moderation Management and that her fateful accident: "The creator of MM was admitting defeat. She checked herself into a detox facility followed up by AA meetings, but she couldn’t play by those rules either.  It did not go unnoticed by her 10-year-old daughter. [Kishline said that] 'I would keep falling off the abstinence wagon.' " Again, no details about the number of AA meetings Audrey went to or whether she actually got serious about working the program)

Update #2: Here is how Audrey Kishline described her year-2000 Alcoholics Anonymous supposed attendance in her autobiography Face to Face:

In the two months that followed [after she wrote the email to the Moderation Management list saying she could not moderate her drinking and before her tragic drunk driving accident] I was supposed to be attending AA meetings, abstaining from drinking, and "working the program." I had huge remorse about having become so drunk and calling the police [This refers to the event where she was forcibly put in detox]. Remorse was my motivation this time to get my act together and quit drinking. But the same old cycle I lived for years began to repeat. I'd abstain for a few days and immediately fall off. Each fall was getting worse and worse. It became increasingly harder for me to remain anonymous too. I was easily recognizable when I attended AA, which only added to my discomfort. I never identified myself as anyone other than "Audrey," but lots of people knew exactly who I was. 

(emphasis in bold like this mine; notes in italics and brackets [like this] added by me to give context)

This is a description of someone who almost never went to AA because they found excuses and justifications not to go, not the story of someone who took AA seriously and worked the 12 steps to the best of their ability. Supposed-to-be-going-to-AA but finding excuses not to go (such as thinking people will recognize and judge them) is not good enough for someone to get sober using the AA program.

Asking people to take responsibility for their life is not "victim blaming"

A common thread I have notice among people who are very critical about 12-step programs is a tendency to not want people be held accountable for their choices and actions. When someone points out that the 12-step program is successful for people who make a decision to work it, AA critics dismiss the evidence, claiming that this is victim blaming.  It is not.

A victim is defined as being someone "who is harmed by another". How is an addict, going to an Alcoholics Anonymous meeting, who decides on their own to no longer go to meetings a victim? They are not. They made a decision to stop going to AA meetings; they made a decision to drink again; they made decisions which they knew had negative consequences. They are not a victim; they are someone suffering the consequences of their own bad decisions.

AA works for people who choose to work it; it does not work for people who choose to not work it. This is a fact supported by science. Pointing out this fact is not victim blaming.

Orange Papers is gone from the Internet

The notorious "Orange Papers" site, which in its heyday falsely claimed that Alcoholics Anonymous is not helpful, is gone from the internet; it has been down for about half a year. According to its present whois information, it is down because the owner of the site has not been paying his bills.

There are unconfirmed reports that the owner of the site is homeless. While these reports are unconfirmed (I believe them to be true because their source is from people who have no reason to report this, except for concern of "Mr. Orange"'s well-being), we can confirm that the owner of this site is no longer able to pay basic bills such as hosting and registration for his web site. For anyone with a living wage, for anyone who is successful in life, the cost of these kinds of bills -- in the order of a couple hundred a year, if even that -- is trivial. Someone needs to have serious problems managing his life to not be able to pay this kind of bill.

My sponsor has always said that "Look at the life someone is living and decide if you want what they have."  I do not want to be unable to pay my bills, and I do not want to probably be homeless, so I have no reason to emulate Mr. Orange's behavior. 

My prayers, of course, are with Mr. Orange. I hope he gets out of the problems he is having in his life. Then again, life does have consequences, and I can not see any good coming from having a resentment against AA.

Alcoholics Anonymous almost always works if you work it. For the record, I am not homeless, I am able to pay my bills, and I am able to celebrate another day clean and sober.

Another bogus 5% success rate claim found in the wild

I have found another bogus 5% success rate claim in the wild, in the comments for this post:

http://www.patheos.com/blogs/secularoutpost/2016/11/04/pseudo-random-thoughts-on-aa-and-free-will/

The claim comes from a misreading of this passage in "Alcoholics Anonymous Effectiveness: Faith Meets Science":

As stated at the outset, the experimental evidence for AA effectiveness(addressing specificity) is the weakest among the six criteria considered crucial for establishing causation. Only two studies provided strong proof of a specific AA or TSF effect: the outpatient arm of Project MATCH (with effects at 1 and 3 years), and the intensive referral condition in Timko’s trial (with effects for abstinence at 6 months and 1 year).

The effect sizes were similar, with the TSF/Intensive referral
conditions having a 5-10% advantage in abstinence rates.

(Emphasis mine)

This passage uses a lot of specialized terminology and I can see why someone would misread it to mean that AA only has a 5-10% success rate. I would render the above paragraphs like this:

As we mentioned before, the evidence for the AA program helping alcoholics (and not other factors, such as the fact that people who take AA's program seriously simply being the people who want to get sober the most) is weak. Only two studies (Note: This was written before Humphreys 2014) provided strong proof that the AA program itself, or doctors trying to get alcoholics engaged in the AA program via TSF, is helping alcoholics.

The amount of effect we saw the program helping people was similar; when doctors tried really hard to get their patients to work the AA program (TSF), the patients were 5-10% more likely to stay sober.

In other words, whether or not an alcoholic works the AA program is a decision only the alcoholic can make. If a doctor tries really hard to get someone to work the program, the alcoholic is 5-10% more likely to get sober. This figure is not an overall success rate for AA. We know that, if the alcoholic himself decides to work the program, they have, depending on the study, between a 75% (Vaillant 1995; Fiorentine 1999) and 67% (Moos and Moos 2006) chance of staying sober.

Comparison of 12-step groups to mutual help alternatives

Kaskutas,whose 2009 paper "Alcoholics Anonymous Effectiveness: Faith Meets Science" I frequently cite when pointing out that AA works for people who work it, or why early randomized controlled trials did not show an accurate picture of 12-step effectiveness, recently co-published a paper comparing 12-step groups to other mutual help groups entitled "Comparison of 12-Step Groups to Mutual Help Alternatives for AUD in a Large, National Study: Differences in Membership Characteristics and Group Participation, Cohesion, and Satisfaction."

One of the groups they looked at is a no-drinking, no-God fellowship called "LifeRing Secular Recovery." Like AA, they are very adamant about complete abstinence on their webpage: in one article they talk about the "low success rate of Moderation Management, and of individuals trying to moderate on their own," and one of their fundamental philosophies is sobriety, which they make clear means complete abstinence.

Despite this, Kaskutas' paper mentions that "LifeRing [...] members were less likely to endorse the most stringent abstinence goal," which is interesting because stringent abstinence is a fundamental part of the LifeRing program. My take on it, having not read the paper (I am not about to spend 36 dollars getting a paper which will be free in six months), is that LifeRing, and other non-AA mutual aid fellowships, mainly attract people who are not satisfied with AA. My experience working with newcomers is that the biggest stumbling block is the fact that AA strongly suggests complete abstinence for alcoholics; we frequently read a part of the Big Book describing how an alcoholic can never drink moderately again.

Indeed, the majority of people online who are opposed to AA online are people who claim alcoholics can drink moderately; it is not surprising that even an AA alternative which also advocates for abstinence attracts the kinds of people who still think they can control their drinking again.

In terms of the study itself, while showing promising results, it has the same issue that studies which claim alcoholics can drink moderately again have: It is a short-term study using self reported data.