You are saying that any one meeting may have 50% attendance by people who have stopped drinking. But in total there are still less than 10% of all people who try AA that are successful. Maybe 10% is too low depending on the methodology used to collect the information, but I doubt it would be high enough to make a difference.
There is an important question not asked here, why doesn’t AA collect some numbers? Do they at all monitor their success rate? If they are monopolizing treatment for alcohol problems then we need that information from them to produce a scientific evaluation of the efficacy of the program, and to find ways to provide other treatments for the cases they don’t even claim to have success with.
Look, you’re correct. I can get really stubborn and I dislike it when people don’t believe me or disagree with me. It’s actually quite frustrating for me to have people tell me things that I actually experienced didn’t happen, that it is a logical fallacy or confirmation bias. I know what happened!!! I also know that I am biased and reluctant to accept the statistic 90%. It very well could be 90%. It is definitely the overwhelming majority of people who go, do not get sober. Is it really that important if it is 75% or 80% or 90%. I mean, for the sake of discussion, is the exact precise percentage that important or is it more important to agree that the majority of the people who go do not get sober?
Politics. They claim it is due to anonymity issues or logistical issues but you already know the answer to this, it is implicit in your question. They know the program is largely ineffective. To put it another way, if they did a best guess estimate that 75% of the people who attended got sober, don’t you think they would want to document it?
Yes. If someone has an alternate method that works for 30% of people, where AA only works for 10% of people, then knowing that and transitioning everyone over to the new method is helping tens or hundreds of thousands of people that wouldn’t have otherwise been helped. Obviously a success rate of 90% or 99% would be even better, but no one will ever know unless that statistics are carefully maintained and publicized.
And, of course, if non-intervention has a better success rate than 10%, then that’s also worth knowing. One could only wish that doctors of the 18th century had say back and let their patients’ bodies heal themselves, rather than blowing smoke up their anus and bleeding them. In those cases where the doctor got lucky and saved you or you healed in spite of his efforts, you still really shouldn’t be thanking his intervention.
Are you under the impression that I am defending AA vs other treatment methods? I have 0% disagreement with you that other methods are better. And your point that a 10% or 20% difference is significant when thousands of people are involved is accurate as well.
What I am advocating is that AA provides a sense of camaraderie for those who like the meetings and enjoy going to them. A bond with people that is like very few other groups you will be able to find. Similar to the bond police officers have or people in battle. Not to be too melodramatic and not to be all drama queen but unless you have been to the meetings and formed those bonds, well, you have to experience it to understand it. (I’m not saying you can’t conceptualize or understand such a situation. Please don’t think I am speaking too strongly against you.)
12 steps are highly “religious” in their format
12 step is a process of group think, the sayings, attitudes and personalities are incredibly uniform and conformist
12 steps teach a victim mentality*
(*powerlessness, the constant focus on all the wrongs you did and the need for amends, repeated self inventory and self criticism)
Are you familiar enough with how the steps function to comment? Maybe, if it fails 90% of the time it’s faults aren’t so important, what is important is that it doesn’t work. I’m interested nonetheless in your opinion.
And what I am saying is that article is guilty of the same crime it accuses AA of. On what basis does it say that? Is there any evidence of that being true? Or is she just repeating what has been said. The article impressed me on first read but as I try to fact check I find that it is very superficial coverage of the evidence.
I get that that JAMA article is a hard slog full of jargon and abbreviations but the bottom line is that Dr. Dode’s estimate of AA’s lack efficacy may not be the true bottom line and naltrexone may not be “all that” after all.
The gold standard for comparing approaches is the randomized controlled trial (RCT). Matched populations randomized into different treatment arms.
The JAMA article reports a large RCT called the COMBINE study comparing several approaches to the treatment of alcohol dependence as defined by DSM-IV. No exclusion for too much alcohol intake but they did need to meet “more than 14 drinks (women) or 21 drinks (men) per week, with at least 2 heavy drinking days (defined as ≥4 drinks/d for women and ≥5 drinks/d for men) during a consecutive 30-day period within the 90 days prior to baseline evaluation.”
There were several treatment options that were done in various combinations:
Medical management: "a 9-session intervention focused on enhancing medication adherence and abstinence using a model that could be adapted by primary care settings’
Combined behavioral intervention (CBI) which “integrated aspects of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and support system involvement external to the study.” AA attendance was emphasized. Not quite just AA but it was emphasized.
Medications: active/placebo naltrexone or active/placebo acamprosate or both and a no med or placebo condition.
They measured days of abstinence, days until first heavy drinking day, and a combined measure that they labelled “good clinical outcome”: “a good clinical outcome was categorized as abstinence or moderate drinking without problems. Moderate drinking was defined as a maximum of 11 (women) or 14 (men) drinks per week, with no more than 2 days on which more than 3 drinks (women) or 4 drinks (men) were consumed. Problems were defined as endorsing 3 or more items on a standardized questionnaire52 assessing physical, social, and psychological consequences of drinking.”
The findings? The combination of nine primary care sessions (focusing on abstinence and medication adherence) with either the AA heavy CBI or the naltrexone or both were all pretty much tied at giving the highest rates of “good clinical response” (all 71 to 74%) and the small differences that there were faded with time. Those primary care sessions by themselves not as effective and acamprosate was not found effective in this study. There was a slight trend for the CBI group to have more days abstinent.
Subsequent work has apparently identified genetic markers that predict a good response to naltrexone. If you don’t have those markers those 9 brief primary care sessions along with an AA heavy combined behavioral intervention may actually in fact be the best game in town.
Good heavens, it’s not like AA is the Catholic Church. It’s almost completely decentralized. There’s no leadership structure and relatively little official policy. And it’s 12 steps and 12 traditions, not 12 questions. The traditions are what has kept AA going for so long in pretty much the same form. They limit what any AA group can do in the name of AA which is pretty much everything except to hold meetings.
AA doesn’t have or claim any power to influence government spending, etc. I do agree that court mandated attendance is inappropriate and I wish that AA groups would not sign court slips. I do know many long term members who first visits were court mandated, but the practice comes at a cost.
AA doesn’t have data because AA is not in the research business. It doesn’t count people or track them or study them. The only thing AA members do is try to stay sober and to help other alcoholics stay sober. Again, this is why is has lasted, with virtually no structure, for so long and in so many places. There’s no lobbying, no advertising, no affiliations of any sort. Treatment facilities may adopt a 12 step approach, but that ain’t AA.
AA is most certainly built upon Protestant Christianity. No doubt about it. I just read that “any 2-3 people who gather together” can call themselves an AA group if they have no other affiliation. Straight from the gospels. But at least in my part of the country, meetings are full of atheists, agnostics, pagans, Buddhists, and, for all I know, entire Wiccan covens. Nobody cares. Meetings are often held in churches, but churches don’t run groups. They just rent out meeting space.
AA doesn’t insist it’s the only way to go for all problem drinkers. Just that it’s a way that has worked for a lot of alcoholics. Not problem drinkers, but people who truly can’t control their drinking. People who have tried, without success, to control their drinking for months, years, decades. Many of these people have learned, often the hard way, that they really can’t pick up that first drink.
I find the concept of Atheists in AA or making a rock your Higher Power to largely be a myth. In my whole 10 years of going to meetings I don’t think I ever met a person who said a rock was their Higher Power. That is just a phrase that gets repeated a lot with no substantiation. I never heard anyone say “I don’t believe in a Higher Power” or “WTF is God doing in these steps”. I honestly never recall that happening. Maybe it did but I just don’t remember. If it did happen it was rare, that’s my point. And towards the end of my attending meetings, after I became an Atheist, the few times I said “You know people… You really ought to quit depending on a God that doesn’t exist and rely on yourself instead” you wouldn’t believe how much hostility I received for saying that. Of course I was being confrontational but the point is you can’t be in the 12 steps and be an open and vocal Atheist. You are welcome to attend as long as you keep your views to yourself of course… but who wants to be in an environment where yo can’t express yourself.
Sounds like you got a bit preachy yourself! It may vary depending on where one lives. I’m from New England where people are not likely to ask you about your religious views in any context. Issues with the god stuff are discussed on a regular basis in at least one of my meetings. But I agree it isn’t for everyone. Hearing other people talk about God is definitely going to happen.
Would you have called me preachy if I had talked about the value of relying on a higher power??? Why is it only preachy if I say you don’t need one?
So, apologies for being rude, but you’ve never actually heard anyone say in a meeting that they don’t believe in God, or that they were an Atheist, or that their Higher Power was a rock? Even though you claim Atheists attend your meeting?
Thankfully, I do not have much personal experience with substance abuse treatment programs. I am, however, willing to posit a theory that at least a portion of what keeps AA as essentially the default treatment option, and what will also help keep it on the top of that particular heap is the fact that AA is, to my understanding, free of mandatory costs.
I could go to an AA meeting without a dime in my pocket and receive precisely the same level of assistance as anyone else. I do not believe medically-based treatment options or other rehab options offer default free treatments. I also suspect that at least a portion of the reason that Courts tend to order AA as opposed to other treatment options is because AA is free. You don’t need health insurance (which many, many adults do not possess) or health insurance that covers other treatment options (which not all health insurance does), or even cash.
In addition it doesn’t matter who or what you are. Gay or Straight. Democrat or Republican. Black, White, any other race. The 12 steps are a real melting pot.
Why do courts mandate a particular form of treatment at all? Why not just tell those concerned that they must not drink, and let them figure out how to achieve that? That leaves them free to attend AA if they wish, seek other treatment if that’s their preference and they have access, or just stop drinking on their own, as very many people do.
About half of my extended family are alcoholics, and I’ve gone to a one meeting with one of them, so I’m probably slightly more knowledgeable than your average person, but far less than an expert. I’ve probably learned more about it via the SDMB than through direct contact.
> 12 steps are highly “religious” in their format
I have no particular opinion of this. I note that religious people are horrible at following the rules of their religion, so it doesn’t encourage me to think that the methodology is liable to work. Whereas it does make me worry that there’s the potential for cultish antics or people taking advantage of their position (e.g., the 13th step), since that’s another tendency of religious organizations.
> 12 step is a process of group think, the sayings, attitudes and personalities are incredibly uniform and conformist
I’m anti-conformist, so if I was an alcoholic, I would probably not be well-suited to AA. Likewise, I never viewed myself as a good fit for the military. Assuming that I’m not alone in the world, again this doesn’t make it seem like AA is a particular good one-stop solution.
(Though, because I’m anti-conformist, I never felt any peer pressure to drink, so it’s not a particular concern.)
> 12 steps teach a victim mentality
I don’t think I know enough to say anything on that. The thought I’ve generally had is a concern that their methodology is liable to heap a bunch of stress on people by telling them that, “There’s danger around every corner! You’re never going to be safe ever again!” Granted, that sort of approach might be a solution for some number of people, whose personalities it ties into well, but for most it just seems like something which is liable to make someone who is already feeling bad about themselves and their lives (and hence who turn to drinking) feel even more discouraged about their position in world. And if that person is someone who is, for example, an undiagnosed depressive, then not only are you adding stress, you’re presenting this as a solution to his problem when you should be getting him diagnosed, so that his doctor can start trying out anti-depressives on him.
Some of the people I met outside the rooms when I was still going to meetings, people who had went to meetings but it didn’t take for them, some of them described AA almost exactly the way you did.
We are, as usual, caught in a loop here. Since this is MPSIMS and not GD or the Pit, let’s try to agree on some things:
AA is incorrigibly, irredeemably religious, even cultish, in nature, specifically Christian, and has made only half-hearted attempts to figleaf over that. Many people, including Christians, find that off-putting; some leave immediately while others ignore it. Others don’t mind it, and still others find it to be a feature, not a bug.
AA was created 80 years ago by rank amateurs making it up as they went along. Through the efforts of co-founder Bill Wilson, an egotistical twat who lived and remained influential far too long, the AA treatment model became ossified, and it continues to be operated not by trained professionals but by rank amateurs, working from Wilson’s catechisms and otherwise making it up as they go along, using AA as a hammer when not everything is a nail, which wouldn’t be a problem except…
AA is widespread and free, making suggesting or ordering people to join an easy copout for judges, bosses, medical doctors, and others whose budgets of time and money do not permit other more expensive and less available systems. Note that this is not the fault of AA, but that of external groups tossing problems over the wall. Such lazy and cheap court systems are why some DUIs are out among us, sleeping through AA meetings while not working toward their sobriety.
At the same time, AA members are not officers of the court and lack any power over those people to force them into sobriety. The most they can do is not sign the court’s form, and the only judgement they can make before doing that is whether the person physically attended, not that he got anything out of it.
Alcohol addiction, like it says on the sign, is an exceedingly hard habit to break. What studies there are (see 6 below) show is that the great majority of addicts of all sorts fail the first time they try. There is a Twain or Simpsons quote for every occasion, and I will go with Twain, “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” The important number would be the people who break out of the cycle of addiction long-term, but we don’t know that because…
The studies are few and they suck. I haven’t read the Finland study, but all that I have read were poorly constructed, with no controls, small study groups, and, their greatest sin, time periods too short to learn anything, having been put together by grad students and doctoral candidates whose horizons are a semester or year away. Typically, if a person leaves the study for any reason he is assumed to be a failure and back on Skid Row. They share this fallacious belief with many people in AA, who make no allowance for people who choose another path to sobriety, finding AA to be bullshit for them. Or for even people who move to another town. But flexibility is not a strong suit in addicts in recovery or grad students with a deadline, and with anonymity subjects like Joe who was usually in the 5:30 meeting are hard to track. And with study groups as small as twelve, a single dropout drastically skews the results.
That’s a lot to respond too. It seems you don’t see much good about the group at all. I will concede that most of your points are correct. What I disagree with is the rank ameture part. The 12 steps have some people who are really really good at working the 12 steps and they work as a group and in sponsorship (one on one interaction) to lead others. Most, not all, but most of them are even living pretty happy and productive lives, above and beyond being sober, and it’s a result of the 12 step program that they have these benefits. it’s my personal opinion that it doesn’t really matter if it’s 7 steps or 12 or 17, the important thing is there is a group process to follow based off of some type spiritual/philosophical practices. The 12 steps work great for those who like and adopt the program and work horribly for everyone else, with everyone else being the vast majority of people who try the program.
You said you told *other people *to quit believing in God. That’s the preachy part. It doesn’t bother me when people talk about their own experiences, with or without a higher power. It would bother me if someone stood up and announced that they knew what was right for others, God or no God. One of the AA basics is you only talk about you and what works for you.
I must not have been clear. I have most certainly heard many people in meetings say they don’t believe in God, or that their higher power is the fellowship, or that they are Buddhist, or that their higher is best experienced in a sailboat. I myself talk about not believing in the kind of personal God that most people speak of when they speak of God. But I’m not here to argue with you. You had your own experiences with AA, just as I’ve had mine. There’s nothing to win here.