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.
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.
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.
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.
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.
A brief FAQ
Effectiveness of Alcoholics Anonymous
For the 20%[1][2] or so of alcoholics who become highly engaged with the program, Alcoholics Anonymous has about a 75%[4][5] effectiveness rate.[6]
For people who do not take AA as seriously, the number of alcoholics who achieve long-term sobriety is about 20%[7], with the amount of people achieving sobriety directly correlated to AA participation[8].
While some of the positive effects of the AA program keeping people sober can be attributed to self-selection bias, one 2014 study makes the case that AA's effectiveness shown in these studies does not come from self-selection[9]; a 2016 study demonstrates that some of the specific effect is the prayers AA members say.[10]
Other data that is inaccurate
Randomized controlled trials
Early randomized controlled trials were ineffective because the control group was not really a control group (people who wanted to stay sober went to AA anyway, even if they were not assigned to AA, and people assigned to AA did not necessarily take the program seriously), so their numbers can not be trusted.[11]
Brandsma 1980
Anti-AA advocates claim that Brandsma 1980[12] shows increased binge drinking among AA members. However 1) The study looked at about three dozen different findings at multiple follow-up periods, but this result was only seen in this one finding at one follow-up period 2) This result has not been replicated in recent studies[13] even though 3) The study is 36 years old.[14]
AA is actually not rated #37 (sometimes #38) compared to other treatments
Another common talking point popular with the anti-AA crowd is a table from Handbook of Alcoholism Treatment Approaches which ranks AA fairly lowly compared to other treatments. That table is, shall we say, weird: It rates acupuncture as one of the top 20 treatments of alcoholism, and gives motivational enhancement (#2 in the table), cognitive therapy (#13), and AA (#37) very different ratings, when the 2006 Cochrane study rate those as being about equal[15]; other studies rate AA and/or TSF (Twelve Step Facilitation: teaching patients how to go to meetings and be a part of the AA culture) as being superior.[16] No other reliably published meta-analysis comparing AA to other treatments has rated AA as being inferior.[17]
5% success rate myth #1: The Sober Truth
Lance Dodes' The Sober Truth is a recent attempt to cook numbers to claim AA has a 5% success rate (for some reason, anti-AAs have a real obsession with coming up with a 5% success rate figure, facts be ignored). While this book was widely reported in the press in 2014, its claimed 5-8% success rate for AA does not come from any peer-reviewed studies, but is instead derived by multiplying numbers from different studies together. Beresford looks at the math Dodes performed to come up with these bogus figures, and explains why the math is invalid at https://www.ncadd.org/blogs/research-update/alcoholics-anonymous-call-for-better-science.
5% success rate myth #2: AA triennial survey
There is a chart in the 1990 AA triennial survey showing that 5% of the members in their first year happened to be in their 12th month, instead of the 8.3% we would expect if AA had a 100% success rate. This has frequently been misread to indicate that only 5% of members of AA stay sober one year. An actual analysis of the graph shows a 26% retention rate.
5% success rate myth #3: Reading Vaillant poorly
Some claim that Vaillant's book The Natural History of Alcoholism showed a 5% success rate, but that is a myth. The old green-papers site refuted it quite nicely: http://web.archive.org/web/20150329052802/http://green-papers.org/ "95% of patients had relapsed at some time during the study, even though many of these eventually attained sobriety. [...] It's well known that most severe alcoholics only get sober after many relapses, to the extent that relapses can be considered part of the recovery process. So don't pretend that's a failure. [...] And anyway, this was a study of a health network, not AA."
Alcoholics can not moderate their drinking
While not directly about AA's effectiveness, there is no reliable scientific evidence that alcoholics can drink moderately again. The studies that claim alcoholics can do so are based on self-reported information from alcoholics over period of a couple years or less. What is happening is that alcoholics have a pattern of being dishonest about their drinking, to the point that surveys using self-reported data from alcoholics are inaccurate. This has been seen time and time again: The Sobell Study from the early 1970s was shown to be a sham in 1982; the Rand report from 1976 was shown to be wrong in the 1980 follow-up; the NESARC study from 2001-2002 was a two-year study which never had a follow-up; and while Moderation Management's effectiveness has never been scientifically analyzed, its founder realized she could not control her drinking, but it was too late: Her runaway drinking resulted in her killing two people while driving drunk; she eventually killed herself.[18]
How the moderation myth tainted studies about AA
A couple of surveys from the 1970s and early 1980s erroneously reported that AA makes people who drink again have worse relapses. The reason why these surveys were inaccurate is probably because they were based on self-reported data. Since people in AA are less likely to be dishonest about their drinking, they will self-report any drinking they engage in as being more chronic, while people not in AA are more likely to dishonestly report their drinking as being "moderate" or "under control" (e.g. lying about the number of drinks they have when filling out the survey).
References
- The Natural History of Alcoholism Revisited by George E. Vaillant has a table showing that 19 out of 100 alcoholics attended 300 or more meetings over a 10-year period. The table is on page 197, and can be downloaded from http://web.archive.org/web/20150329052802/http://www.green-papers.org/Vaillant-Nat_hist_of_alcoholism_revisited-excerpts.pdf
- This article shows a roughly 80% drop out rate in Brazil: Terra, Mauro Barbosa; Barros, Helena Maria Tannhauser; Stein, Airton Tetelbom; Figueira, Ivan; Palermo, Luiz Henrique; Athayde, Luciana Dias; Gonçalves, Marcelo de Souza; Da Silveira, Dartiu Xavier (2008). "Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents". American Journal on Addictions 17 (1): 48–53. doi:10.1080/10550490701756393. PMID 18214722. "AA adherence was below 20%"
- That table in The Natural History of Alcoholism Revisited has, of those 19 alcoholics who took AA seriously, 14 who achieved long-term sobriety. While the actual 14 people figure is not on this table, 29 people * 48% is 14.
- Beresford, Thomas (2016), Alcoholics Anonymous and The Atlantic: A Call For Better Science, National Council on Alcoholism and Drug Dependence, retrieved 2016-04-15 This page refers to Fiorentine 1999, pointing out that "the data Fiorentine presents is as follows: 77.7% of individuals who attended AA 12-step meetings at least weekly reported being free of drug use for 6 months prior to a 24-month follow-up, a finding corroborated by urinalysis at the time of the interview, and 74.8 % reported being free of alcohol use during the same time period"
- Another study, which measures something slightly different, has similar high success figures for people who were highly engaged with Alcoholics Anonymous: Moos, Rudolf H.; Moos, BS (June 2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology 62 (6): 735–750. doi:10.1002/jclp.20259. PMC 2220012. PMID 16538654.
- Of the 81 alcoholic subjects in The Natural History of Alcoholism Revisited who did not attend 300 AA meetings over a 10-year period, 15 achieved long-term sobriety
- See the graphs in Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases 28 (2): 145–157. doi:10.1080/10550880902772464. PMC 2746426. PMID 19340677.
- Humphreys, Blodgett, Wagner (2014). "Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials". Alcoholism: Clinical and Experimental Research 38 (11): 2688–94. doi:10.1111/acer.12557. PMC 4285560. PMID 25421504.
- Marc Galanter, Zoran Josipovic, Helen Dermatis, Jochen Weber, and Mary Alice Millard (2016-03-25). "An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous". The American Journal of Drug and Alcohol Abuse. doi:10.3109/00952990.2016.1141912. Lay summary.
- There is some discussion of this in Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases 28 (2): 145–157. doi:10.1080/10550880902772464. PMC 2746426. PMID 19340677.
- Here's the proper citation for Brandsma 1980 Brandsma, Jeffery M; Maultsby, Maxie C; Welsh, Richard J (1980). Outpatient treatment of alcoholism: a review and comparative study. Baltimore, MD: University Park Press. ISBN 0-8391-1393-5. OCLC 5219646.
- While I haven't seen this cited by an anti-stepper in the wild, I should note this: Ogborne AC, Bornet A (1982). "Abstinence and abusive drinking among affiliates of Alcoholics Anonymous: are these the only alternatives?". Addict Behav. PMID 7102452. This study, like Brandsma 1980, is a museum piece; the study uses data from the "Rand report", which is available for download and a table showing AA effectiveness there is on top of page 98 (page 114 in the PDF), showing fewer AA members who engage in "normal drinking." The notion that the Rand report showed alcoholics drinking normally again has since been discredited, see the blog entry at https://elplatt.com/return-moderate-drinking-still-lie for discussion; what that 1982 paper probably saw was that AA members are less likely to report their drinking as "normal drinking" and more likely to be honest about the negative consequences of their drinking
- While not a reliable source, the best discussion I have found about Brandsma 1980 is at http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/, in the beginning of section III. Note that this blog dismisses longitudinal studies too easily, but, then again, it was published before Humphreys, Blodgett, Wagner 2014 demonstrated a specific effect for AA, and before Galanter 2016 showed that prayer is part of that specific effect.
- Ferri, Marcia; Amato, Laura; Davoli, Marina (19 July 2006). "Alcoholics Anonymous and other 12-step programmes for alcohol dependence". Cochrane Database of Systematic Reviews (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID 16856072.
- Humphreys, Keith; Moos, Rudolf (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research 1 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. PMID 11371720.
12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB [cognitive-behavioral] programs, p < 0.001
- While not published by a mainstream press nor peer-reviewed, the blog entry at http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/ devotes an entire section to this table and why it is inaccurate. Scroll down to section VI.
- While, yes, a blog, a good discussion with references of how alcoholics can not moderate their drinking and why any study claiming otherwise is wrong is at the blog entry https://elplatt.com/return-moderate-drinking-still-lie
For a long time we have known that people who choose to go to meetings are much more likely to stay sober. Recently, PMC4285560 gave evidence that AA has a “specific effect”; in other words, there is something about the AA program itself that is keeping people sober. And now, we have a new study (mirror) which tells us one aspect of AA’s specific effect: Prayer.
The actual study can be read online (mirror). To summarize, they got some people with long term sobriety, put them in MRI machines, then saw if prayers from the Big Book would affect their reactions to seeing people drinking alcohol. It did. Their level of craving of alcohol was diminished by saying 12-step prayers.
What does this tell us? It tells us that the AA program and the prayers in the Big Book can really help keep people sober.
