Some other recent criticism of AA in the press

I have found other criticism of AA in the mainstream press over the last year which I should address here in this blog.

Naltrexone redux

A recent New York Times opinion piece (archive link) brought out the same old tired “AA (or abstinence) doesn’t work but Naltrexone allows alcoholics to drink like gentlemen” chestnut.

While cherry picked studies show remarkably high success rates for Naltrexone, this is offset by other studies which do not replicate those results. Naltrexone, like AA, appears to be effective for a subset of alcoholics, but, as per Cochrane, it only helps about 11% of alcoholics. 

The most disturbing thing about studies showing Naltrexone showing controlled drinking among alcoholics is that they consistently do not have long term follow-up periods. For example, that New York Times opinion piece links to two different studies which supposedly show alcoholics successfully drinking moderately again. In both cases, the final follow-up is one year after treatment.

As someone who remembers Pendery 1982 all too well, positive results for moderate drinking without long term follow-ups are not very encouraging. Sure, anything someone throws a dead cat, they will hit a study of alcoholism showing alcoholics successfully engaging in “moderate drinking” over the short term, but the few long-term follow-ups I have seen show that moderate drinking is not a long-term solution to chronic alcoholism.

As a point of comparison, the 1990s Project MATCH randomized study showed increased abstinence for people who engaged in AA-centered therapies three years after treatment (as per its data as presented in Cochrane 2020), and Moos and Moos 2006 is a longitudinal study showing that Alcoholics Anonymous keeps alcoholics sober 16 years later.

Another thing: That New York Times opinion piece claims that only 25% of alcoholics will achieve abstinence, but the study it links to supporting that outdated 25% figure doesn’t actually conclude this; it claims a 25% success rate for abstinence, and links to an old article from 2005 using results that are nearly two decades old. More recent figures from Cochrane show a 42% success rate.

Abstinence violation effect

There have been two (open access) different letters (paywall) recently published which make the same criticism of Cochrane 2020: They claim that there is an “abstinence violation effect” where the subjects undergoing AA-based treatment who are not abstinent somehow do worse when they drink again than subjects not undergoing AA-based treatment. In other words, the accusation is that AA may increase abstinence, but overall AA doesn’t improve things for alcoholics, because the alcoholics not abstinent supposedly drink more heavily.

This “abstinence violation effect” is actually a myth, as one of the authors of the 2020 Cochrane review on AA explains. Since this letter is paywalled, I will quote the most important part of that letter here:

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 consequences

Point being, AA overall improves things for alcoholics. 42% are straight up abstinent from alcohol a year later, and those who do not achieve abstinence do not, repeat not have worse consequences from their drinking.

I will only respond to articles published by the mainstream media

Moving forward, I will only respond to new articles published by the mainstream media which falsely state Alcoholics Anonymous does not work, or link to sources that falsely state that Alcoholics Anonymous is not effective. For example, the Vice article I criticized yesterday was published by a mainstream publisher, and while it did acknowledge Cochrane 2020, it also linked directly to sources which falsely claim AA doesn’t help alcoholics. 

My criteria is: “Is this a source notable enough to have its article linked to by mainstream news aggregators?” In other words, stuff published by mainstream newspapers and magazines. Sources which do not meet that bar will be ignored: social media postings, self-published blogs, postings in comment sections (here in the 2020s, comment sections are not as popular as they were a decade ago; good riddance to bad rubbish), and so on will be cheerfully ignored. 

If a new peer reviewed study making very negative claims about AA’s efficacy were to be published, I would address it here. Remember: Metastudies from top-notch publisher like the Cochrane 2020 review on AA’s effectiveness trump a single study, even if it’s peer-reviewed.

I am aware and acknowledge AA is not for everyone, and that other treatments appear to be just as effective as AA, but, for most alcoholics, AA is the first place they will go seeking treatment and trying to get better, and the goal of this blog is to make sure that alcoholic still suffering from the disease is properly informed that AA can very well help them get sober and better.

I now have a Twitter account, which I will primarily use to engage with authors of pieces which unfairly criticize AA. 

Goodbye for now. This account will only be made active again the when and if I see a new anti-AA article from a reliable and mainstream source.

Vice posted an anti-AA screed

Over a year ago, I retired this blog. When I retired the blog, I noted “I would restart this blog again if inaccurate claims about AA efficacy made it back to the mainstream press”.

Well, wouldn’t you know it, Vice has posted an anti-AA screed (archive link) in the UK edition of their magazine.

First of all, Vice is considered, as I type this, a source of questionable reliability in the Wikipedia. Concerning the quality of the article they posted about AA, I can see why their reliability is not top notch.

Near the beginning of the article, they link to two anti-AA Facebook groups; one has, as I type this, about 1,600 members; the other has around 1,300 members. Compare that to the one AA support group with about 41,500 members and another unofficial group simply called Alcoholics Anonymous with about 39,300 members, we see that the there are 24-30 people getting better in AA for each person who wastes their time complaining about the program and not improving. Considering how much more popular the AA-positive support groups are, it’s undue weight to focus only on the anti-AA groups.

They then look at the AA documentary The 13th Step without any critical evaluation of its contents. This “documentary” (which was a complete flop without little to no notability) makes the accusation that women will be forced to endure sexual harassment if they wish to get sober in AA. That may be true of a few isolated fellowships (such as the infamous Midtown fellowship well over a decade ago), but the general rule is this:

• Alcoholics Anonymous has safe spaces for women: A number of meetings are meetings which only women can attend.
• There is a strong cultural rule that men stick with men and women stick with women in the AA fellowship, in order to minimize women getting unwanted sexual advances.
• Many sponsors and people in the rooms of AA suggest people stay out of relationships (i.e. have sex) in their first year of sobriety; this again is for the protection of newcomer women.
• The fellowships I have been to will confront men who make inappropriate advances towards women.
  

Women have plenty of options to avoid men and harassment in the fellowships I have been to.

Next, the article goes on to mentions a book written by one Steven Slate, who makes a number of dubious claims about AA’s effectiveness. For example, he quotes a study published over 40 years ago to make negative claims about AA’s efficacy, without acknowledging that the study has been discredited, something I have extensively discussed on this blog. As another example, Mr. Slate has not even acknowledged the existence of the Cochrane 2020 study which shows that Alcoholics Anonymous is more effective at achieving abstinence for alcoholics than other treatments.

Indeed, the Vice article does acknowledge that “AA definitely works” for a significant subset of alcoholics, but only in the final paragraph.

The fact of the matter is this: AA works most of the time for people who work it. However, alcoholics are a stubborn lot, and many of them will find excuses for not going to meetings, not working the steps, and not getting better: Complaining about sexual harassment (so why not only go to women’s AA meetings) or falsely claiming that AA does not help alcoholics.

It’s unfortunate that Vice media has chosen to publish an article which encourages alcoholics to come up with more excuses to not go to AA and more excuses to not get better.

Update: The author the this Vice article has responded on Twitter: “Hi! Thanks for responding. This article isn’t meant to downplay AAs significance in helping millions get sober. It’s just an alternative perspective that explains why some people left during the pandemic. It’s good to offer alternative solutions so such complex problems!”

A farewell to this blog

Back in 2014, one Lance Dodes posted a book claiming a 5% success rate for Alcoholics Anonymous. The numbers in this book were widely criticized by treatment experts at the time, but because of the outrage effect of social media, where something which generates anger and outrage is more widely shared and remembered than accurate information, it was Dodes’s 5% figure which got a lot of traction back then.

These numbers were never considered accurate by treatment experts, but it took six years for the numbers to be definitely discredited with the 2020 Cochrane Review of Alcoholics Anonymous, which saw a 42% success rate for AA (number of alcoholics still sober one year after treatment).

Since Cochrane reviews are considered the gold standard of medical studies, this review got widely praised in the mainstream press. The mainstream thinking now is that Alcoholics Anonymous is quite effective for some alcoholics.

This blog existed to counter the destructive thinking that AA has a low success rate, a thought which was in mainstream consciousness in the mid-2010s. Now that the 2020 Cochrane study is out, there is no longer a need for me to take a deep dive in to medical studies to demonstrate why Alcoholics Anonymous is effective for some alcoholics.

One of the better articles to help people understand what the medical reviews are saying is from 2014 at Slate Star Codex; its information is dated, of course, now that we have rock solid evidence of AA efficacy, but it is a good read and introduction to the medical science and why it was so hard to find solid evidence for AA efficacy.

I would restart this blog again if inaccurate claims about AA efficacy made it back to the mainstream press, but I find that unlikely in light of the latest Cochrane review on the matter.

As I type these words, we are in the middle of the COVID-19 pandemic. It is a challenging time for everyone, and I am glad that AA has been able to adapt to online meetings so alcoholics can still experience fellowship and recovery.

My final words are this: For people who do not like AA, other treatments, such as SMART recovery, appear to be just as effective. Just get better, whether or not it’s in the rooms or outside the rooms of AA.

Disqus is going out of style

In the mid-2010s, back when “AA has a 5% success rate” was all over the press, the commenting platform everyone was using was Disqus, a platform which thrived on outrage culture. Naturally, the kinds of people who claim Alcoholics Anonymous does not work were more interested in spreading outrage than in spreading objective truth, so this was a hotbed of “AA does not work” nonsense.

Here, in 2020, most platforms have moved beyond using Disqus. To note:

• The Fix no longer uses Disqus, and, indeed, no longer has comment sections for their articles.
• The Atlantic no longer uses Disqus. Like The Fix, they simply no longer have a comments section.
• A number of regional newspapers no longer have Disqus comments.

The only place with significant discussion of Alcoholics Anonymous who still uses Disqus is Patheos, and, not surprisingly, there are still articles, mostly in the Atheist section of that site, which have comments that parrot the same outdated, inaccurate nonsense about AA’s efficacy.

The only other place besides Disqus comments where I have seen people still parrot claims that AA has a low success rate is on Reddit, which is a well known hotbed of outrage-inducing inaccurate information.

The 2020 Cochrane review of AA has been released

The 2020 Cochrane review of AA efficacy has finally been released. Unlike the old 2006 review, which stated that “available experimental studies did not demonstrate the effectiveness of AA or other twelve-step approaches in reducing alcohol use and achieving abstinence compared with other treatments”, the new 2020 Cochrane review has this to say:

clinically-delivered TSF [twelve-step facilitation] interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence

Looking at the study, the strongest data shows that Alcoholics Anonymous significantly increases abstinent rates: When comparing Alcoholics Anonymous and/or Twelve Step Facilitation to other alcohol use disorder interventions, at the 12-month follow up, studies show a 41.8% abstinent rate for AA/TSF treatments, compared to 34.5% abstinent using non-AA interventions.

The New York Times, in an article about this review, has this to say:

A.A. leads to increased rates and lengths of abstinence compared with other common treatments

While the full review is behind a paywall, its summary is freely available for anyone to read.

This is the final nail in the coffin for the “AA has a 5% success rate” nonsense the media was spreading around in the mid-2010s.

More on Pendery 1982

Pendery 1982 is a study which saw that, over the long term, alcoholics who try moderate drinking only have a 5% success rate. People who want to moderately drink again, of course, want to invalidate the results of this study. One attempt at doing this is to complain that Pendery 1982 only looked at the 20 alcoholics who tried moderate drinking in the 1970s Sobell study, and did not look at the alcoholics in the abstinence only control group. For example, “Pendery reinterviewed the controlled drinking group to dispute a previous study but didn't make contact with the abstinence group at all [...] If you are inspecting purported results of a study why not investigate all study participants. Why is it OK to investigate only one side” (note that I normally no longer link directly to self-published rants made by an anti-AA pro-drinking proponent, but since they have subsequently deleted their account, I can do so without making the discussion personal).

This is a red herring. If there was a real methodological problem with Pendery 1982, why did Science (one of the most prestigious journals out there) publish it? The abstinent “control” group was not studied because they were not relevant; if a follow-up study can invalidate the experimental condition (as Pendery 1982 did), there is no need to see what happened with the control condition.

Philip Abelson, the editor of Science when Pendery 1982 was studied, had this to say about the process of making that report:

The report that we published in our 9 July issue [Pendery et aI., 1982] was very carefully edited. It was extensively reviewed, including evaluation by an expert statistician. [...] We required that assertions made about patients' histories be documented by court records, police records, hospital records, or affidavits. The final draft was checked repeatedly, sentence by sentence, to ensure that supporting evidence was available. In crucial instances, two or more independent documents corroborated statements made.

Now, let me describe Philip Abelson in more detail: He helped in the research which won the 1951 Nobel Prize in Chemistry. He won the National Medal of Science in 1987. He was part of the Manhattan Project. He was a key researcher in the design of the nuclear submarine. He did a lot of important paleobiology research. He had over 40 years of experience in the scientific technique when he allowed Pendery 1982 to be published. If there was a real problem with the science behind Pendery 1982, he would had found it.