The thing is, there aren’t and never will be any solid numbers on the effectiveness of 12-step programs because of the nature of the programs themselves. That second A stands for “Anonymous,” so nobody takes attendance at AA meeting or tracks whether and how long people get sober, because that would defeat the purpose of anonymity, which is to draw people in. Alcoholics, as you know, engage in a lot of shameful behavior, and the promise that their identities will never be revealed publicly (at least when it works as it ought) is a powerful inducement to come and keep coming back. It’s entirely on the individual to enforce the program on him/herself. Yes, it’s very frustrating to anyone who’s looking for scientific proof of the efficacy of this form of treatment, but them’s the breaks.
I’ll second Phlosphr’s suggestion to go to some 12-step meetings to actually see the program in action, and talk to some people there, particularly people who have been in there for a number of years. They can tell you, and more importantly, show you, how the program works. It’s not something that works for everyone, but it works better than anything anyone’s come up with before or since.
Since AA doesn’t demand adherence to any of the Steps (“take what you want and leave what you don’t”), sobriety cannot be attributed to the “Program” because there really isn’t a program. You can go to meetings and embrace none of the steps, but if you don’t drink, you’re sober. Likewise, you can embrace all of the steps, but if you’re still drinking, your adherence to the steps is meaningless in terms of sobriety.
I don’t see how anyone could credit AA for something that is so free-style as to be virtually meaningless.
The “turning it over” is because the vast majority of alcoholics–those who end up coming to AA, at any rate–have tried and tried to overcome the disease on their own and have failed miserably. Willpower just isn’t enough to overcome addiction for most people. It’s a paradoxical “surrender to win” concept, and it actually does work for a lot of people–it’s kind of like getting caught in a rip current; once you stop trying to swin against the current, then you can start to work your way back to shore. The key is that Step Three is only a quarter of the way through. You turn it over, but then there’s stuff for YOU to do after that. It gets you to stop focusing on the big, HUGE problem of the alcoholism and start working on the things you can change, your thinking and behavior, in a methodical way.
Well, I can’t speak for anyone else, but I really don’t think it’s sheer coincidence that the date I had my last drink is the day before I started going to AA. Yeah, every last bit of the program is voluntary, as is any other form of therapy, but the success of the treatment is directly proportional to the effort and honesty that the “patient” puts into it. It’s exactly as they say at the end of a lot of meetings: “It works if you work it.”
I’m sure for your life and the people whose lives you have touched, it’s not dismissable at all. That’s your personal truth and I’m not attacking it or questioning it.
But try to imagine, for one moment, that we are talking about something else, that does not personally affect you, and which you are extremely skeptical of. Say, for the sake of argument, you are skeptical that radiation therapy cures cancer, which is a commonly accepted belief despite the fact that it has, at times, been a contested issue. Say for the sake of argument you have ten studies sitting in front of you that say overwhelmingly there is no evidence radiation therapy cures cancer. And someone with cancer says, “I’ve been cancer-free for 20 years because of radiation therapy! It saved my life!” Do you assume the person is lying? No. But does it prove anything, really, about macro trends in radiation therapy? No.
Great idea. Let’s all pretend my first post didn’t happen.
New OP:
**Hi guys! I hope you’re all having a fabulous day! So I’ve been thinking about the past lately, and my painful experience having been the child of an alcoholic father. I’ve often heard the expression that Alcoholism is a disease, and since I don’t know a lot about it I was wondering if anybody could point me toward information that supports this theory? I’m also wondering about the effectiveness of 12-Step Programs – can anybody provide evidence that they work, because all the investigating I have done has indicated they have an abysmal failure rate. Furthermore, how do people feel about the issue of personal responsibility when it comes to alcoholism? Are alcoholics completely responsible for their drinking behavior and the way it affects others, or to a certain degree are they at the mercy of this ailment?
It actually doesn’t work for “a lot” of people; “it” appears to work for a few people. Long-term sobriety eludes most people who try AA. None of the “steps” are exclusive to AA, nor do they have anything to do with sobriety in and of itself. Moral deficiencies are not what causes alcoholism, nor can morality “fix” it. Not drinking fixes it.
I’m glad you’ve been able to beat the problem so far. But you quit drinking *before * you started going to AA; if you stopped going to meetings tomorrow, do you believe you would begin drinking again? If so, why?
Most long term AA-ers don’t believe if they stopped going to meetings they would immediately start up again the next day…But they do believe it would happen eventually,and through habit of association they choose to continue their meetings to aid in staying away from the drink.
I left Narcotics Anonymous because all it did was remind me of my addiction every time I walked through the door. It wasn’t until I stopped going and started healing on my own without the constant reminder of drugs, that I was able to beat it.
For some, it helps to be reminded, but it made me crave my drug of choice when we sat around and talked about drugs for an hour.
I’m clean almost 2 years now.
I still fight it sometimes, especially when I’m in physical pain, which is a trigger for me (painkillers were my DoC).
It doesn’t make sense to use “success rate of treatment” as a barometer for whether a condition can be called a “disease.” Pancreatic cancer is most certainly a disease (though not a communicable pathogenic disease) and its survival rate is low.
I suppose before you can argue whether alcoholism is a disease, you should try to define what you believe a disease is.
Is shell shock (post-traumatic stress disorder) a disease? It has recognizable symptoms, it has treatments available, and there are common factors of causation among patients who suffer from it. It can be caused by voluntary actions on the patient’s part, broadly defining “voluntary” to mean the patient chose to be on the battlefield instead of going AWOL and being locked up.
Is a broken arm a disease? It’s certainly a limited type of disease; some aspects of it can often be identified with clinical tests like X-ray. It can be treated, with varying degrees of success in various patients, although those patients shouldn’t be advised to treat their arm “as good as new” and put similar stresses on that arm again.
Is scurvy a disease? It’s caused by a dietary insufficiency of vitamin C and has a definite treatment regimen. It might not be a contagious condition. Should we re-categorize scurvy as “vitamin C withdrawal” and classify vitamin C as an addictive substance?
What about radiation poisoning? You put a foreign agent in or near a body, in sufficient quantity, and it causes the body to react and exhibit certain traits. Is this not similar to alcoholism, where alcohol is a toxin the body attempts to eliminate?
What about sleepwalking, or epileptic seizures, or photic sneeze response, or autism? These and many other conditions elicit certain behaviors from the patient that they may or may not be able to control.
There are definitely arguments for and against. Some still reject the idea of alcoholism as a disease because it cannot easily be diagnosed with identical or similar symptoms from patient to patient. You may find a summary here on Wiki.
I know a lot of people who NEED those meetings. Like with any illness/disease/whatever, not all treatments work for all people. I’m saying it didn’t work for me. If it helps 5% of people, then why knock it? That’s 5% less addicts/alcoholics in the world.
What would these studies consist of? Who would be your control group? What do you mean by “the scientific method”?
Re: AA vs. the Steps – there’s the organization, and there are the teachings. I haven’t been to a meeting in, damn, I don’t even know – 17 years or so? But I do live by the Steps, and that seems to work pretty well for me. (A friend and I were talking, a month or so ago, and I referred to something that had happened back in my using days – he looked at me and said “Yanno, I can’t even imagine you as a drunk.”) (Oh wait, that’s an anecdote. My bad.)
That argument concerns me, because it suggests that 5% is good enough. I’m really concerned that there might be a better treatment out there, that’s not AA, that doesn’t get as much mainstream acceptance, and yet which has a much higher success rate. I would rather alcoholics have treatment options that are proven to work–and if none are proven to work, then I would hope that people continue to work on the issue and investigate until a method can be found that does work.
Not drinking “fixes” the problem of the physical addiction to alcohol, but does absolutely nothing for the mental illness. As I’ve said several times already, AA is therapy, it’s not a cure; it’s intended to address the mental and behavioral aspects of the addiction. There are those people who can simply stop drinking and never have any more problems, but for those for whom that isn’t the case, they need something more than just quitting cold turkey.
I quit drinking WHEN I started going to AA; phrasing it the way you did makes it sound as though I quit on my own, and at some later point started going to meetings, that is definitely not the case, so please don’t try to spin it that way. I would have continued drinking had I not gone to AA when I did; I had no intention of getting sober. I was sent to treatment, and got hit upside the head with my own behavior and had to admit to myself that I am an alcoholic. Being in the treatment center gave my body some time to detox, which was definitely helpful, but if I hadn’t started to work the steps and integrate the AA program into my life, I would have gone right back to drinking, I’m sure of it, because I didn’t just drink too much, I was crazy, I was fucked up in the head.
I’ve gotten better over time, and I don’t crave a drink the same way I used to, but I don’t believe I am cured of alcoholism. There is a possibility I might be able to drink safely again, but it’s not a chance I’m willing to take. I’ve seen people with long-term sobriety start to drink again, and it’s never been pretty. I don’t lose anything by continuing to go to AA. I get a great deal of benefit from going to meetings–it helps me a hell of a lot just to go into a meeting and share some crazy thought that came into my head and see other people nodding in recognition. I learn that I’m not alone in my problems, and that there are people I can talk to about it who will understand what’s going on and help me through it. I’ve also been very lucky to have had some great sponsors who never coddled me, never let me get away with blaming anyone else for my shit, and forced me to be honest with myself. That’s how the program works when it works.
Why doesn’t it work for everybody? Beats the hell out of me.
I have no dog in this fight, but it seems to me that those who criticize AA for a poor success rate are not taking into consideration the obvious corollary, which is what is the success rate without AA, or for programs other than AA? IOW, if we posit some drug that is so perniciously addictive that only 5% of the people who fall down that rabbit hole will ever successfully climb back out, and we posit a program wherein 6% are shown to climb back out, then that program is a success.
I’m not advocating for AA, but you can hardly call the program an abysmal failure if people are able to do as well or better than they would have done on another program, or without a program.
It also seems obvious to me that people’s mechanisms for coping and recovering differ by the individual. Some people
No god, no steps, no meetings. Quite appealing for millions of people. I don’t believe either of these groups offer up success stats, and that’s fine. They offer alternate opinions on the subject.
If you follow the link I gave in the OP, you will find information on a vast number of observational studies and experiments that were done scientifically. I mean studies like that.
Observational studies aren’t experiments, they are just taking in information that already exists, therefore they don’t involve control groups. An example of an observational study might be collecting data on how often kids watch TV and collecting other data they want to measure it against, such as how well those kids do in school. It involves offering precise definitions for words like “success” and “failure” (for example, success might consist of having been alcohol free for 3 years, failure might consist in having had a relapse within the last 3 years, something of that nature.) It involves quantifying data and defining all terms and using consistent methods. In this case, I’d be happy with self-reporting (even though it’s generally not very reliable)-- say taking a sample of people who had been members of AA for a quantified length of time and asking them whether they’d relapsed in the last 3 years. Hell, you could even ask them whether they attributed their success to AA. Then you could take another sample of alcoholics not in AA and do a similar survey…and compare the numbers. Then maybe you could do some longitudinal studies over time, follow those folks and see if the numbers change.
I just described to you one of the loosest, least precise measures of testing whether a treatment works, and yet I’d be satisfied with that, because I haven’t even seen something so basic as a self-report observational study that indicates AA works.
So for the last 17 years you haven’t been in treatment for AA, but you find the ideas to be helpful. Since the crux of my argument against group therapy is that it keeps people focused on the problem instead of other things going on in their lives, I feel like you’re making my point for me.
Basically you’re mad at me for questioning what worked for you, when really I’m on your side, because if AA truly is a piece of shit I’d rather call it out and find treatments that do work. Don’t you think sufferers of alcoholics and their families deserve treatments that have evidence that they work? What does that say to the thousands who have tried AA unsuccessfully? How would they feel if they’ve been blaming themselves all this time for their failure and later it turned out they just didn’t have the tools that have been proven to work?
I’m sorry it’s so offensive to you that I want people to have treatment options that work.
