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.

Herbert Fingarette; Patheos again

Herbert Fingarette, who died last year, was someone who was always opposed to Alcoholics Anonymous and the disease theory of Alcoholism, and believed the lie that alcoholics can moderately drink again. Indeed, Lance Dodes did some creative math with Fingarette’s numbers when concluding Alcoholics Anonymous has a 5% success rate:

University of California professor Herbert Fingarette cited two [...] statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. [Reference: H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988)] Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members.

The New York Times points out that Fingarette never did any alcoholism science himself:

Professor Fingarette acknowledged that he had not conducted any experimental or clinical studies into alcoholism; he reached his conclusions by analyzing scientific literature

Point being, not only did not Dodes multiply unrelated numbers to synthesize an artificially low number for AA’s success, but he used figures from an author who himself never published an alcoholism study.

Patheos

Patheos is one of the few places on the Internet where the same old debunked myths about AA having a “5% success rate” keep coming up again and again (the other two big offenders are Reddit, which has little regard for the actual truth but prefers a good fictional story, and TheFix). I posted this refutation to those old discredited numbers in a recent article there:

AA has, among those who are heavily involved with it, a 75% success rate over the short term, and a 67% rate over the long term (16 years later). These numbers have been consistent among multiple longitudinal studies, and are the same numbers AA members observed in the mid-1950s. To name just one study showing a high success rate among regular AA members, please see PMC2220012 (Moos and Moos 2006)

Indeed, the Surgeon General, in 2016 (during the Obama administration), stated that “Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions.”

Lance Dodes’s numbers concluding that AA has a 5% success rate are very dubious. Quite frankly, Dodes pulled the numbers out of his rear end: He multiplied unrelated numbers from multiple studies together to synthesize an artificially low number for AA’s success. His figures were so bad, multiple highly regarded treatment experts have criticized him, with one calling his reasoning a “pseudostatistical polemic”

People are welcome to their opinions, but not to their facts. The fact is that AA works among a significant subset of alcoholics (and, yes, atheists, there are agnostic AA meetings, or just use SMART/LifeRing/whatever, which appear to be about as effective as long as abstinence is the goal). Denying facts is what we accuse the superstitious of doing; it would be best if we did not do the same thing.

The old anti-AA talking points are being posted less

There have been very few articles posted by a major media outlet parroting false figures for AA efficacy since 2015, with Gabrielle Glaser’s highly biased and inaccurate article The Irrationality of Alcoholics Anonymous.  That article, which has been refuted in the mainstream press (see “Why Alcoholics Anonymous Works” by Jesse Signal), is the last significant article criticizing AA’s efficacy. The only other articles more recent than that parroting the same inaccurate numbers are a 2018 Wired UK article by Stephen Armstrong (“The most popular treatment for alcoholism might be ineffective”) and a late 2018 article by a grade-B free newspaper called “The Stranger” entitled “This Drug Could Change Alcohol Addiction Treatment Forever” (there was also an opinion piece, not article, published in USA Today entitled “It took a village to kill my brother: How families, hospitals and government fail alcoholics” critical of AA’s success).

On the other hand, there have been a number of articles praising AA’s efficacy: Here’s a 2014 article; there is also a 2016 Forbes Article, a 2019 article published in a magazine for medical students praising AA’s success, and a 2018 Vox piece with a balanced view of AA’s real success.

The point being, mainstream media is more positive than negative towards AA as the 2010s end.

Cochrane 2018: Not relevant

There is a 2018 Cochrane report which claims that “We found that the talking therapies led to no differences, or only small differences, for the outcomes assessed.” This report, which is an update to a readily available 2013 report, only mentions 12-step programs in a single old study from 1998.

This Cochrane report ignores the recent studies showing AA efficacy, since they are recent and look only at how AA reduces alcohol drinking. Point being, there hasn’t been a Cochrane review which looks at how well AA reduces drinking since 2006, but there have been multiple experimental studies showing that AA (or TSF which gets people in the AA rooms) reducing alcohol abuse published since then.

I question the neutrality of the Cochrane committee with regards to effective spiritual treatments like the program; they are willing to update for 2018 a report which does not show efficacy for 12-step programs, but they are not updating their outdated 2006 report on Alcoholics Anonymous now that there are multiple experimental studies and a meta-study which scientifically demonstrate the efficacy of the steps.