# Finally! A critical article of AA in a mainstream publication! **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [March 25, 2015, 7:47pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964 "2015-03-25T19:47:48Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [March 27, 2015, 7:09pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/101 "2015-03-27T19:09:57Z")
> [@Robert163](#): > > Yeah, I have to agree that your points are pretty reasonable. But at the same time if there was a study which said 90% of the people who owned firearms didn’t know how to shoot well (I am just making up a crazy example ok) and you told me, no, I love guns and have been shooting them all of my life and in all the gun clubs and hunting trips I went on, let me tell you, people knew how to shoot. I’d probably believe you or at least hear you out, I’d try to figure out how your personal testimony matched up against the statistics. Well, that is if I were in the mood to learn about firearms and people who owned them. If I just wanted to win a debate I probably wouldn’t give any credit to anything you had to say. > > Also, I haven’t been to meetings in over a decade so my bias to want to belong and having a personal stake is not exactly valid. Furthermore, the 90% you were quoted was for AA, I went to NA, and from the few meetings I went to in AA (mainly in my first year) I seem to remember them having a lot more people mandated and a lot more new people in the rooms. Their meetings were a lot larger than ours. > > But lets just think about this logically for a moment. If your contention is that 90% of the people in a 12 step meeting are not working the program successfully, let me ask you, how is that meeting going to be run? _I_ haven’t contended anything of the sort-I’ve just said that your personal and admittedly partial recollections are not something I would consider as heavy evidence to use against the scientific studies referred to in this thread. Do you have any reason to distrust the studies? ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 7:18pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/102 "2015-03-27T19:18:44Z")
> [@Czarcasm](#): > > _I_haven’t contended anything of the sort-I’ve just said that your personal and admittedly partial recollections are not something I would consider as heavy evidence to use against the scientific studies referred to in this thread. Do you have any reason to distrust the studies? Well, we are talking at cross purposes here 1- Proposition 1, 90% of the people who come to AA do not get sober 2- Proposition 2, 50% of the people in the meeting are members who come on a regular basis, who are sober 50% of the meeting is from regular members, 50% are revolving door. So you have one group that is consistent and one group that has lots and lots of turnover and cumulatively adds up to 90%. And to answer your question I am suspicious of the 90% statistic. I’d say maybe 60% fail to get sober. Maybe more realistically 75% fail to get sober. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [March 27, 2015, 7:25pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/103 "2015-03-27T19:25:47Z")
> [@Robert163](#): > > Well, we are talking at cross purposes here > > 1- Proposition 1, 90% of the people who come to AA do not get sober > 2- Proposition 2, 50% of the people in the meeting are members who come on a regular basis, who are sober > > 50% of the meeting is from regular members, 50% are revolving door. So you have one group that is consistent and one group that has lots and lots of turnover and cumulatively adds up to 90%. > > And to answer your question I am suspicious of the 90% statistic. I’d say maybe 60% fail to get sober. Maybe more realistically 75% fail to get sober. It’s easy to find out where the studies get their numbers from. Where do you get _your_ numbers from? ---
**Author:** ![Claverhouse](https://avatars.discourse-cdn.com/v4/letter/c/13edae/32.png) [@Claverhouse](https://boards.straightdope.com/u/Claverhouse)\ **Post date:** [March 27, 2015, 7:26pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/104 "2015-03-27T19:26:09Z")
> [@jtgain](#): > > Except they aren’t asking or demanding anything. They aren’t asking for money, the deed to your house, or sex with your spouse. There is the door; you can come when you want and leave when you want. If you like steps 1 through 7, but can’t do step 8, then good luck and God bless. > > If these people aren’t sincere, then what are they gaining from all of this? Validation. Which is all any good commie or libertarian or religious ever wanted ( apart from the end-times, of course: when they would be exalted above all others, and watch their mockers fry ). ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [March 27, 2015, 7:27pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/105 "2015-03-27T19:27:55Z")
> [@Czarcasm](#): > > Do you have any reason to distrust the studies? Well . . . Is the data collected via self reporting? A friend’s son had to do AA after a DUI. When asked, he claimed to have not had so much as a sip of mouthwash. When ordered to give urine he was dirty. So, I’d wanna know the design of the study. ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 7:32pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/106 "2015-03-27T19:32:01Z")
> [@Czarcasm](#): > > It’s easy to find out where the studies get their numbers from. > Where do you get _your_ numbers from? 1- Are you even paying attention to the idea that both numbers could be correct and that we are talking at cross purposes? 2- If, you had been shooting guns all of your life and a study came out that said 90% of the people who owned firearms didn’t know how to use them, but the MAJORITY of the people you had known, friends, gun clubs, hunting trips, knew how to shoot guns, what would you do? Would you assume that you remembered wrong and that the statistics were correct or would you be suspicious of the statistics? ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [March 27, 2015, 7:35pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/107 "2015-03-27T19:35:12Z")
> [@Robert163](#): > > 1- Are you even paying attention to the idea that both numbers could be correct and that we are talking at cross purposes? > > 2- If, you had been shooting guns all of your life and a study came out that said 90% of the people who owned firearms didn’t know how to use them, but the MAJORITY of the people you had known, friends, gun clubs, hunting trips, knew how to shoot guns, what would you do? Would you assume that you remembered wrong and that the statistics were correct or would you be suspicious of the statistics? I would wonder if the people I knew might not be representative of the overall population. I’d also worry about confirmation bias, which has fooled me more than once. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 27, 2015, 7:35pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/108 "2015-03-27T19:35:22Z")
> [@jtgain](#): > > However, the article linked in the OP does state that there is a type of alcoholism for which moderation is not recommended: the hard core chronic alcoholic. And those type of people are the ONLY ones that AA pretends to have the answer for treatment. … And yet what is the actual _data_ for that recommendation? The naltrexone studies do not exclude the “hard core alcoholic” … criteria required meeting alcohol use disorder definitions and no exclusions for meeting it too well. In fact naltrexone works best for those who crave alcohol the most. Of course some studies are defining “heavy drinking” as five or more drinks a day … and still drinking 4 drinks a day is questionable as success. Here’s a big [randomized controlled trial](http://jama.jamanetwork.com/article.aspx?articleid=202789). (CBI = intensive behavioral counseling which “integrated aspects of cognitive behavioral therapy,43 12-step facilitation,44 motivational interviewing,45 and support system involvement external to the study”) > [@](#): > > … The percentages of good clinical outcomes were 58% for the placebo/medical management group, 74% for the naltrexone/medical management group, 71% for the placebo/CBI plus medical management group, and 74% for the naltrexone/CBI plus medical management group … comparable outcomes were produced by CBI alone, naltrexone alone, and the combination of CBI and naltrexone, if provided in the context of medical management. … while CBI in this study incorporated components of cognitive behavioral therapy, it differs in many ways41 from standard cognitive behavioral therapy, including a greater emphasis on Alcoholics Anonymous attendance … It should be noted that the differential treatment effects seen during treatment, while persisting to some degree, largely dissipated over the year posttreatment, consistent with previous reports.67,68 While those treated with naltrexone still had less relapse to a heavy drinking day over the year posttreatment, this was only marginally significant. … In conclusion, within the context of medical management, naltrexone yielded outcomes similar to those obtained from specialist behavioral treatment (ie, CBI). I don’t pretend that to have a comprehensive grasp of this stuff but that RCT does seem to argue against the complete lack of efficacy of an AA style approach (given that AA attendance was a keystone of their CBI arm which gave comparable results to the naltrexone arms). The more I read the more it seems like this is not as simple as the linked article makes it appear. ---
**Author:** ![Mithras](https://avatars.discourse-cdn.com/v4/letter/m/f04885/32.png) [@Mithras](https://boards.straightdope.com/u/Mithras)\ **Post date:** [March 27, 2015, 7:39pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/109 "2015-03-27T19:39:29Z")
> [@Robert163](#): > > Well, we are talking at cross purposes here > > 1- Proposition 1, 90% of the people who come to AA do not get sober > 2- Proposition 2, 50% of the people in the meeting are members who come on a regular basis, who are sober > > 50% of the meeting is from regular members, 50% are revolving door. So you have one group that is consistent and one group that has lots and lots of turnover and cumulatively adds up to 90%. > > And to answer your question I am suspicious of the 90% statistic. I’d say maybe 60% fail to get sober. Maybe more realistically 75% fail to get sober. Pretend you were talking about cancer treatment. A doctor tells you he’s got a drug you can take that could cure you as long as you take it for life. In fact, he says, it appears to be working for half the people on it right now. Then he tells you the bad news: you’ve only got a 10% chance of being in the group for which it works. Nine patients out of ten that he puts on this drug die. Would you ask him if there was a better treatment option? ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 7:46pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/110 "2015-03-27T19:46:46Z")
> [@kayaker](#): > > I would wonder if the people I knew might not be representative of the overall population. I’d also worry about confirmation bias, which has fooled me more than once. Right. I’ve OBVIOUSLY mistaken what happened over a 10 year period of my life. Here it was I am remembering meetings where there were lots of people sharing and relating and helping each other learn, one person to make coffee, one person to chair the meeting, one person to lead the discussion, _several_ people to join the discussion and talk about their experience, one person to make announcements, one person to hand out the sobriety chips, one person to lead the closing prayer. I must of most certainly misremembered all of that. In fact, now that I think about it, it was ONE PERSON filling all of those positions and I just misremembered it as a group of people because of confirmation bias. ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [March 27, 2015, 7:47pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/111 "2015-03-27T19:47:33Z")
> [@Robert163](#): > > 1- Are you even paying attention to the idea that both numbers could be correct and that we are talking at cross purposes? It doesn’t matter since your number isn’t a number. On this forum, your insight is just “shit you made up”, not anything of significant value. That’s not to say that anyone thinks that you’re just making stuff up, just that in the presence of science, and knowing of the existence of [these](http://en.wikipedia.org/wiki/List_of_fallacies), [these](http://en.wikipedia.org/wiki/List_of_cognitive_biases), and [these](http://en.wikipedia.org/wiki/List_of_memory_biases), ain’t no one gives a rat’s patootie what your subjective experience is up to the point in time where you can prove to us that you’re a robot, not a human. ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 7:51pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/112 "2015-03-27T19:51:00Z")
> [@Sage\_Rat](#): > > It doesn’t matter since your number isn’t a number. On this forum, your insight is just “shit you made up”, not anything of significant value. > > That’s not to say that anyone thinks that you’re just making stuff up, just that in the presence of science, and knowing of the existence of [these](http://en.wikipedia.org/wiki/List_of_fallacies), [these](http://en.wikipedia.org/wiki/List_of_cognitive_biases), and [these](http://en.wikipedia.org/wiki/List_of_memory_biases), ain’t no one gives a rat’s patootie what your subjective experience is up to the point in time where you can prove to us that you’re a robot, not a human. See my response above this one. ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 7:53pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/113 "2015-03-27T19:53:21Z")
> [@Mithras](#): > > Pretend you were talking about cancer treatment. A doctor tells you he’s got a drug you can take that could cure you as long as you take it for life. In fact, he says, it appears to be working for half the people on it right now. Then he tells you the bad news: you’ve only got a 10% chance of being in the group for which it works. Nine patients out of ten that he puts on this drug die. > > Would you ask him if there was a better treatment option? Yes, of course I would. But if he also told me here is a cancer support group where the majority of the people attend regularly find comfort from being part of a group, I’d go to that group… ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [March 27, 2015, 8:43pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/114 "2015-03-27T20:43:09Z")
> [@Amateur\_Barbarian](#): > > Utterly irrelevant question. Millions of people put their heart and soul into things that are of, at best, personal value and often just from inertia. > > The argument that “all these nice people have been doing this, for a long time” doesn’t change the basic problem of AA hogging the treatment spectrum without being intrinsically valuable enough to warrant that dominance. Assuming that to be true, how is it AA’s fault that it has a position of dominance? It’s not like they firebomb rival treatment groups that open in competition with it. If this drug works as well as hoped, then it will fall into irrelevancy. What is the entrenched power structure that keeps AA at the top of the heap? ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 8:55pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/115 "2015-03-27T20:55:52Z")
> [@jtgain](#): > > What is the entrenched power structure that keeps AA at the top of the heap? It doesn’t cost anybody anything. It doesn’t cost the government to mandate people. It’s an easy “solution” for your spouse or you boss to give as an ultimatum. It doesn’t cost any psychologist fee, no psychiatrist fee, no insurance, no copay. It doesn’t cost anything to get a meeting up and running. Two or three people with some clean time and a coffee pot can start a new meeting chapter. The training and organization is minimal. But the format is simple and uniform. What you learn and how the meetings function is the same in Boston as it is in St. Louis, San Francisco, London and Tokyo. It’s the ease of running the organization that makes it practical from a logistical and economic standpoint. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [March 27, 2015, 8:58pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/116 "2015-03-27T20:58:42Z")
> [@DSeid](#): > > And yet what is the actual _data_ for that recommendation? The naltrexone studies do not exclude the “hard core alcoholic” … criteria required meeting alcohol use disorder definitions and no exclusions for meeting it too well. In fact naltrexone works best for those who crave alcohol the most. > > Of course some studies are defining “heavy drinking” as five or more drinks a day … and still drinking 4 drinks a day is questionable as success. > > Here’s a big [randomized controlled trial](http://jama.jamanetwork.com/article.aspx?articleid=202789). (CBI = intensive behavioral counseling which “integrated aspects of cognitive behavioral therapy,43 12-step facilitation,44 motivational interviewing,45 and support system involvement external to the study”) > I don’t pretend that to have a comprehensive grasp of this stuff but that RCT does seem to argue against the complete lack of efficacy of an AA style approach (given that AA attendance was a keystone of their CBI arm which gave comparable results to the naltrexone arms). > > The more I read the more it seems like this is not as simple as the linked article makes it appear. I think we are talking past each other here. I don’t doubt that there is likely a better method of treating alcoholism that something invented by two amateurs in the 1930s. What I have a problem with is that many are saying that total abstinence is not required, contrary to AA teachings because of the linked article in the OP. It is just the opposite. The linked article states that for the worst alcoholics, moderation is likely not possible. However, the AA treatment was developed by and for ONLY the worst alcoholics, and the AA treatment insists on total abstinence. Therefore, what AA teaches (total abstinence for hard core alcoholics) and what the article suggests (total abstinence for hard core alcoholics) are absolutely in agreement. However, many posters are suggesting that the article somehow implies that AA is wrong because some alcoholics can learn to moderate their drinking. That may be true, but AA only discusses the worst form of alcoholic who cannot moderate his or her drinking. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [March 27, 2015, 9:02pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/117 "2015-03-27T21:02:33Z")
> [@Robert163](#): > > It doesn’t cost anybody anything. It doesn’t cost the government to mandate people. It’s an easy “solution” for your spouse or you boss to give as an ultimatum. It doesn’t cost any psychologist fee, no psychiatrist fee, no insurance, no copay. It doesn’t cost anything to get a meeting up and running. Two or three people with some clean time and a coffee pot can start a new meeting chapter. The training and organization is minimal. But the format is simple and uniform. What you learn and how the meetings function is the same in Boston as it is in St. Louis, San Francisco, London and Tokyo. It’s the ease of running the organization that makes it practical from a logistical and economic standpoint. But therein lies the problem. AA’s first step is an admission of powerlessness over alcohol. My wife, my boss, or the judge can certainly make me go to AA meetings, but they cannot demand that I believe in my heart of hearts a certain thing. So, their mandate fails at step one. I suppose if they want the superficial satisfaction of making me sit in a room and drink coffee that would work as far as that goes, but this, like all forms of mandatory treatment, will not work because my heart isn’t in it. I need to want to go before it will work. That’s a big reason why I hate courts forcing drug and alcohol treatment on people. ---
**Author:** ![No\_umlaut\_for\_U](https://avatars.discourse-cdn.com/v4/letter/n/ea5d25/32.png) [@No\_umlaut\_for\_U](https://boards.straightdope.com/u/No_umlaut_for_U)\ **Post date:** [March 27, 2015, 9:05pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/118 "2015-03-27T21:05:38Z")
Doesn’t the mandated AA series of meetings for DUIs play hell with anonymity? I can’t see how someone would be comfortable spilling his guts (or even being seen) in front of Mr. Smith from church’s wayward daughter, or his son’s grade school teacher just off a bender. ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 9:11pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/119 "2015-03-27T21:11:17Z")
> [@jtgain](#): > > But therein lies the problem. AA’s first step is an admission of powerlessness over alcohol. My wife, my boss, or the judge can certainly make me go to AA meetings, but they cannot demand that I believe in my heart of hearts a certain thing. So, their mandate fails at step one. > > I suppose if they want the superficial satisfaction of making me sit in a room and drink coffee that would work as far as that goes, but this, like all forms of mandatory treatment, will not work because my heart isn’t in it. I need to want to go before it will work. That’s a big reason why I hate courts forcing drug and alcohol treatment on people. You’re entirely correct!!! 100% correct. I know about AA because I lived in a halfway house my first year in recovery and had no car. We went to about half AA and half NA meetings. After that I mainly went to NA. But, back to the point, it even talks in the big book a couple of places that people were “turned away” from meetings in the early days because their drinking had not become bad enough. They seriously at that time did not think AA would work for a “moderate” drunk. You said the same thing in your post above. Mandating people and having them just fill a seat and get a form signed has one legitimate purpose only. It gives them exposure to something that may help them later. That is, of course, assuming you can get past the religious aspects of the meetings and some of the other problems attached to AA/NA. Like the group think and thinking with a victim mentality. ---
**Author:** ![Robert163](https://avatars.discourse-cdn.com/v4/letter/r/4af34b/32.png) [@Robert163](https://boards.straightdope.com/u/Robert163)\ **Post date:** [March 27, 2015, 9:12pm UTC](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964/120 "2015-03-27T21:12:27Z")
> [@No\_umlaut\_for\_U](#): > > Doesn’t the mandated AA series of meetings for DUIs play hell with anonymity? I can’t see how someone would be comfortable spilling his guts (or even being seen) in front of Mr. Smith from church’s wayward daughter, or his son’s grade school teacher just off a bender. You’re not required to participate. All you are required to do is to sit in a chair for an hour and listen. as far as not being recognized you can go to a meeting in the next town over or go to a meeting on the “wrong” side of town. But if you’re stuck in a little small town way away from any other town, your options are a bit more limited in that regard… [Previous page](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964.md?page=5) [Next page](https://boards.straightdope.com/t/finally-a-critical-article-of-aa-in-a-mainstream-publication/715964.md?page=7)