Well one could argue that it's worse than doing nothing if one considers the following extract from the Harvard Mental Health Letter, from The Harvard Medical School.



So if as many as 50% manage to cure themselves without treatment, and the "treatment" of AA secures a much lesser % of success, it can be argued that the afflicted would be better off not going to AA meetings.

What I mean is that there is both scientific and anecdotal evidence to support the effectiveness of AA. I've provided numerous links to the scientific literature. Here's one:
https://www.ncbi.nlm.nih.gov/pubmed/19340677

You are of course entitled to your beliefs. There are lots of folks who believe vaccinations are not beneficial or even harmful. I am wondering if you have any evidence to support your beliefs.

Here's what the Harvard Mental Health Letter has to say about AA:

Where are AA's studies of their effectiveness? They avoid it like the plague. It is like an alcoholic refusing to examine their drinking. Which is why we are stuck debating nonsensical anecdotes, and not actual studies on the people doing AA and the effectiveness of same.

Interesting that I post a letter from the Harvard and you post one directly contradicting mine. Maybe someone in that institution is on the bottle. :D


That to one side here is an article of interest from The Atlantic:

https://www.theatlantic.com/magazine...nymous/386255/

Excerpt 1:

A grand success rate claimed here and given there are no surveys quoted perhaps a little dubious.

Excerpt 2:

Well, given that a professor is the source of the data gives it some credibility I suppose. The contrast between 75% and 5 - 8% is rather stark.

AA is not going to withhold AA from people in order to create a control group.

AA is not going to ask its members if they're still drinking.

It's not going to look up people who stopped attending and find out why, and if they are still drinking. It does not ask for names and contact information.

It's not going to ask if you were court-ordered into AA.

However, third parties research these variable with some frequency. The studies of effectiveness of AA are mixed. See the Scientific American article and "Alcoholics Anonymous Effectiveness: Faith Meets Science." (It's not really about faith, if the title turns you off). These have been linked to, by name, in this thread.

Meanwhile, perhaps AA's best-known detractor, "Agent Orange," puts together some decent information, but he is so prone to hyperbole and sometimes venom that he's frankly unreliable. The studies themselves often have serious flaws - and this includes some that support the effectiveness of AA. For example, it's very difficult to tease out the variables that make it "work" or not work.

Quantitative studies IMO should be taken pretty universally with a grain of salt, which is why we're left with anecdotes. I disagree that they are "nonsensical" but I think I understand where you're coming from.

1) The Glaser article in The Atlantic was highly critical of AA. My understanding it was based, at least in part on the Dodes book. A good rebuttal to Glaser's article can be found here:
https://thepointmag.com/2016/examine...he-insane-idea

If it were up to me AA would never have made any statements about its success rate. That's my personal opinion. It's important to remember that to a large extent you are judging what AA wrote in 1935 - 1955 by today's medical standards. AA was developed in part as a response to the failure of medicine at that time to help alcoholics. The article I cite above gives discusses the state of medical treatment of alcoholism at that time.

The Dodes book has been criticized and rebutted. See the following:
from the journal "Alcoholism Treatment Quaterly"
https://www.tandfonline.com/doi/full...eedAccess=true

an extensive critique from "Psychology Today" written by two Harvard professors
https://www.psychologytoday.com/us/b...ment-addiction

from the NYT book review by a professor of clinical psychiatry at Weill Cornell Medical College

https://www.nytimes.com/2014/05/06/h...ehab.html?_r=3

from "Wikipedia"
Dodes views are hardly mainstream medicine/science.

And that is a valid argument. Bill Wilson wrote most of the Big Book's first section and he was prone to exaggeration. He went through dozens if not hundreds of his own failures (as he acknowledges) and initially based his success claims on fewer than 100 people, most of them low-bottom white Protestant men, all of them volunteers. At one point he envisioned a chain of for-profit treatment centers. He was not a naturally humble person, but he knew how to listen and took advice seriously.

However, IMO, people who attend open meetings with regular newcomers can probably see for themselves that it's not a magic formula. A lot of 24-hour chips are given out, often to people who have been in AA before. However, that's based strictly on my own experience in midsize to large cities, where disagreements within one group often spur the creation of new meetings.

IIRC "How It Works" ("Rarely have we seen a person fail who has thoroughly followed our path. ...)" has been read in all of them. Its message to me is hopeful, not scolding. Not everyone agrees. Nor should they, IMO.

Just a small disclaimer: Funding and staffing AA meetings is moot. All you need is an empty room.

You can counter this argument if you want, and you can probably find evidence against it. Perhaps the VA does spend money; I don't know.

AA's tradition discourage any active promotion of AA. AA makes no pretense of being a scientifically or medically based approach to alcoholism. AA has no one on staff to conduct such research and no mechanism for funding research. It's not what they do. I've posted numerous links to scientific/medical research on the effectiveness of AA. I'm happy to discuss that research with any one here.

That study that says
"However, rigorous experimental evidence establishing the specificity of an effect for AA or Twelve Step Facilitation/TSF (criteria 5) is mixed, with 2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect. "

If only addiction were so simple that being 'powerful enough' was what you needed to quit.

Try 'just not drinking booze' when you've got a full blown physical dependency on alcohol. For some people (like myself), quitting drinking without help simply is not possible (alcohol withdrawal is potentially fatal if you've got a bad enough dependency).

Having said that, I think AA is ********.

And the major problem is that apparently there are no standards that one can assume all AA meets follow. Therefore you can't compare different AA meets as they are all likely to be different to one another.

That is a small part of what the author writes. Arguably, AA and TSF are not the same thing. We'd have to dig deeper to look at exactly what those 4 studies were looking at. The author does discuss some of the problems with the negative/null studies in her conclusions.
My point is, of course, that it has not been scientifically established that AA is not effective or has a negative effect and that there is some evidence for the effectiveness of AA.

This thread is not simply an academic discussion for me - Thread I started in 2013:

http://www.internationalskeptics.com...d.php?t=267785

I've watched this women I love go from relapse to relapse and just about every negative consequence noted for alcoholic/addicted persons. AA did not help her...because...not religious...she wasn't like the other alcoholics...she made over 100K a year and had a custom house! you name the excuse, she had/has it. In-patient rehabs worked for just about as long as she'd be an in-patient. Last go-round with acute alcoholic pancreatitis got her two weeks in the hospital, and because she was discovered by her neighbors unconscious on her front steps they gave her an MRI as a precaution. It wasn't good, but she's unwilling to go along with medical advice.

I wouldn't gas if she became a nun if it worked to beat her alcoholism.

Discussion about what some other person in different circumstances did to kick/get sober has little effect and so does formal counseling. People either get clean and sober or they don't, and arguing about the methodology of their approach to getting there doesn't do anything to make the process better, easier, or more effective.

Sorry to keep beating this drum but according to the proponents for AA in this thread there isn't an AA, therefore each AA meet has to be assessed on its own success rate, therefore you can't extrapolate the results from one AA meet to a group of AA meets.

I thought the thread's purpose was to discuss the court mandating of programs with religious language and/or overtones. Everyone has different thoughts, opinions, and experiences regarding whether or not these programs work. They work differently for different people. But whether they work or not, my stance is that courts have no business mandating anything with even a whiff of religion. My mind can't be changed on that account because I am a severe stickler about separation of church and state.

I sort of feel bad about the direction the thread has taken, and I fear that my comments may have aided the derail. I think people should do whatever works for them. I simply object n the strongest possible terms to these programs being used in court-ordered settings, whether outpatient or ESPECIALLY inpatient.

I really hope that something ends up working for your girlfriend. It's terrible to watch these things happen to people you love. :(

True.

The whole is AA a religion debate focuses on the idea that in the 12 steps you can replace god / higher power with whatever you want. This, of course, is a red herring. The 12 steps are statement of faith. Alcoholism is a moral failure that requires a spiritual awakening. How is that NOT religion?

Not even AA cares if it's effective, though. Well, no more than any religion cares about how effective it's teachings are. Like any religion they have rules and make claims and the faithful will follow.

AA doesn't want studies. Why would it? It's not like the results of any study is going to actually change anything. We all know this a hallmark of religion, nothing changes. The dogma is the dogma, period.

If AA is helpful to anyone, that is a happy coincidence.

Actually that is the basis of sobriety, any thing else is just to help you DFD (Don't ******* Drink)

As a recovering addict I know how agonizing a choice it is but it really is the only choice, the rest is just to help cope

:)

It is real life for many in this thread
:)

I think he's referring to addicts who have a physical dependence. Alcohol withdrawal, if the dependence is serious enough, can be fatal. In those kinds of cases, ceasing drinking isn't enough. Medical intervention (usually including hospitalization) is needed.

Of course, once the detox is complete, everything comes down to coping mechanisms.

The courts are faced with a simple fact that unfortunately sets the stage for sentencing an addict/alcoholic to a program that features religious belief as one of the core principles.

There are no proven approaches to "curing" addictions and no court anywhere is going to surrender it's authority just because the program of choice isn't proven effective and invokes the name of god.

Even post-conviction in-custody therapy is usually 12 step based.

Yes of course they are, and when you try to replace the faith/God bits with something secular, it all becomes wishy washy and somewhat meaningless, as illustrated in my post #137.

But there are tons of secular alternatives. They're just not as well-known because they haven't been around as long.

Furthermore, there's no reason that the programs couldn't be tweaked to remove the most overt religiosity, especially in inpatient settings. It is so detrimental to recovery to force an atheist who is already at the end of their rope to recite the Lord's Prayer (for example) at the end of every group meeting like a child at religious boarding school. Not everyone will appreciate that because not everyone ******* hates religion with a passion, but many of the people committed to rehab DO.

They already lose so many of their rights by virtue of being in there, then it's just like an extra kick in the face. Especially when places lie about it. "Oh no, no religion here!" Then the people get there, and they're locked in, and they're not allowed to make phone calls for at least a week, and oh whaddaya know? Prayer time, every day, multiple times a day. Don't like it? We'll tell the judge you were being uncooperative.

Everyone has their berserk buttons, and this is one of mine. I see it as extremely shady and disrespectful, and it was the main reason I quit my old job (at that particular kind of center). That is where my objection comes from, and like I said, I'm completely intractable about it. Courts need to update their list of options.

This sounds like a gish-gallop or moving of the goalposts to me. "Well, the steps invoke God!"

When directed to a secular version, "That's too wishy-washy."

We could argue all day about whether support groups actually help, or whether addiction is really a disease, or what powerless really means. What AA calls spiritual growth could probably also be termed emotional growth or just growth. Why is there even a list of steps? Maybe just because people like lists.

If someone can do it with willpower that's perfectly OK. You don't need a checklist. Just stop. Or if moderation is your thing, just cut down. You don't need a group or anything. If that's not working for you, try something else. You can even go to AA and state that you don't believe in God and that you are planning to stop at a liquor store on the way home, or even that you're actually drunk. I don't think anyone would bat an eye, unless you were raising a ruckus. The might chip in for an Uber though.

You seem to be all over the place here, and you call what I posted gish-gallop. :confused:

Well we have argued "all day" about the help that support groups may give. The evidence for and against the effectiveness of AA is most contradictory it seems. Given there is some confusion about defining what is an authentic AA group, as pointed out by others, this is hardly surprising.

Re: the highlighted:

1. AA won't tell the judge squat.
2. Agreed. I thought they already had, at least in the U.S.

My boonta button is people conflating treatment centers with AA. AA won't lock you in, search your room or take away your phone. It doesn't report to judges or probation officers. When you say "it" and "this" I'm afraid people will think AA does these things. It's not coercive. And there are groups who use secular versions of the steps. These are available in Vancouver but I don't know if the BC Board of Nursing or whoever accepts this for rehabilitation. IMO it should. From what I've heard meetings in Canada are more secular than those in the U.S. as are meetings in the UK and Australia.

AA helps some but not others. Saying it helps no one actually harms those who would be helped.

Exactly. Whether you agree with AA methods/philosophy/spirituality or not, it has helped a lot of people recover from a miserable condition. To deny that strikes me as in some way cruel.

AA does not conform to your notion of what an organization should look like. AA's success - whatever it is - depends in large part on the very qualities which you find so perplexing.

Yes, there is a lot of variability between meetings and that is one factor that would make AA difficult to study scientifically. To add to the confusion, many of the studies that have been done are not studies of AA but of a Twelve-Step Facilitation approach. To a greater or lesser extent therapists will try to replicate AA in a clinical setting and may or may not encourage patients to attend actual AA meetings. The TSF group may be compared to control group which may be attending AA on their own. It's a mess.

If AA stands for anything, it is that alcoholism is not simply a "moral failure".
I'm going to quote from the Gabrielle Glaser article in The Atlantic that is critical of AA:
"As an organization, Alcoholics Anonymous has no real central authority—each AA meeting functions more or less autonomously—and it declines to take positions on issues beyond the scope of the 12 steps. (When I asked to speak with someone from the General Service Office, AA’s administrative headquarters, regarding AA’s stance on other treatment methods, I received an e-mail stating: “Alcoholics Anonymous neither endorses nor opposes other approaches, and we cooperate widely with the medical profession.” The office also declined to comment on whether AA’s efficacy has been proved.)"

Imagine if AA did conduct or fund studies of its effectiveness? Would you trust those studies. Couldn't it be argued that those studies were biased? To those who attend AA meetings, the proof of its success is their own sobriety and that of those around them.

Because the conversation keeps changing. Yes, I do perceive that if one objection is addressed another will rush in, but they're not all coming from you.

What I'd like to know is, why did you find the secular 12 steps "wishy-washy" and "meaningless"? Can you be more specific? Do you have suggestions for improvement? What if there was a group that had applied those steps to their own lives, and could help others do the same?

Not all in one day, fortunately.

Yes.

Speaking of that:

The Brandsma study purporting to show increased binge drinking in the "AA" cohort (at 90 days, but not at one year) wasn't actually referring people to AA. Instead, they were in a group set up specifically for that study to simulate an "AA condition." The thing is, a static group is going to be a different experience than a community meeting where people come and go. Trying to standardize AA changes its nature. For people who don't like AA that's a bug. For people who do, it's a feature.

If there is a common denominator in all this variability that enables recovery it would be in the interest of all AA members to conduct studies to determine what it is. Once known the meetings could concentrate on that aspect and significantly increase the recovery rate.

If there is no common denominator then the meetings and attendees are effectively stumbling around in the dark hoping to encounter the important aspect by accident. As you say, it’s a mess.

In fact it was a leader in proposing that alcoholism was a disease - and it's been attacked for that as well.

I can't even envision a realistic scenario where it could do anything resembling a head-to-head comparison with other methods - what's it going to do, forbid people to attend AA? Also I'm not sure there's any one superior method - perhaps a combination works best.

Medical and nursing boards usually require action on multiple fronts. They're not trying to be mean; they want their practitioners back.

And why is it the job of a drop-in social club for drunks to do that research? Fundamentally that's all AA is. It's not a research institution equipped to do longitudinal studies with placebos and control groups. How would that even work in an organization that doesn't collect personal information? It's not going to withhold AA from anybody, so that's out. It's not going to hound people who want nothing to do with AA.

AA's mission is not to save the world. It's to be there for people who want it. And unfortunately people who don't want it are sometimes forced to go there.

Within AA there is a common denominator: the steps. But even if you never work any of them, you're still learning new behavior - how to relate to people without drugs and alcohol. That's another common denominator.

Re: highlighted. I don't think there is a single important aspect. If someone finds something that works for everyone, they'll probably get rich.

I made the decision to quit drinking, but I definitely did not do what 8enotto suggested worked for him, which was that he was 'powerful enough' to 'simply not drink booze'.

For lots of alcoholics, to 'simply not drink booze' will end badly. No amount of willpower and being 'powerful enough' is going to prevent or get you through the DTs. I don't think it's helpful to imply that addiction just needs willpower to beat it. I wonder whether or not 8enotto had an actual addiction to alcohol or just drank too much.

Acupuncture helps some but not others. Saying it helps no one actually harms those who would be helped.

Being as generous as possible the best reading of the evidence at the moment seems to be that a particular meet of AA may have helped some people attending that meet with a slightly higher success rate than the spontaneous remission rate of some alcoholics. But we don't know which meet that was, what that meet does to help people. (According to the proponents of AA in this thread. )

I have no views of what an organisation that treats alcoholics "should look like". All I am pointing out is if your and others description of AA meets are accurate then you cannot extrapolate a success rate from one study of one AA meet to any other.

In other words there is no evidence that AA "works" any better than any other approach. In my opinion the state should not be mandating non evidence based treatment.

As I said above unfortunately AA is not being treated by the state as a drop-in social club for drunks, it is being treated by the state as if it was a treatment for alcoholism, which you and its other proponents in this thread also claim.

Problem is that such claims are not evidence based.

Well the following 3 mainly seem wishy washy to me - the coloured ones are the Godless ones. Don't know how to prove or measure wishy washiness, just a sense that the author is desperately trying to make something fit.


5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Admitted to ourselves without reservation, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
Were ready to accept help in letting go of all our defects of character.
7. Humbly asked Him to remove our shortcomings.
With humility and openness sought to eliminate our shortcomings.

If they are well designed and transparent, why not? But, as you say, AA is ethereal, each meeting is something different. It is a social club.

To people that attend church, the benefit they derive is proof of it's validity;
Ditto people that go to Chiropractors, homeopathy, etc.
One person's faith does not truth make.

AA's 12 steps were handed down like the 10 commandments. There is no reason or science involved. Debating the 12 steps is debating religion. It's all Hitchen's razor. The 12 steps where handed down without evidence and they can be dismissed without it.

Peer support has science behind it as helpful. The 12 steps add nothing of benefit to peer support.

You weren't reasoned into your faith, reason won't disabuse you of it.

ETA: Forgot to address "moral failure". Tell me what other disease requires a "spiritual awakening" to fix? Right, only moral failure requires spiritual awakening. Religion is not the solution to disease. And, again, AA is a religion with the Big Book as the Bible and Bill W as the prophet. Nothing has changed in 80 years, which again, is a hallmark of a religion.

Sad fact: The court goes through the motions. It has no true vested interest in "curing" anyone's addictions.

12 step programs for individuals convicted of alcohol or drug possession related convictions is nothing more than ticket punching.

The jurisdictions that have gone to the "drug court" model

https://www.nij.gov/topics/courts/dr...s/welcome.aspx

Do a somewhat better job of it, but everything related to successfully getting clean rides on the individual, not the program.

I make no argument that the state should be mandating AA and arguably, in the USA, there are 1st amendment issues when courts do so. I believe that courts and employers adopted the practice of mandating AA because there was no more effective or cost-effective alternative. As BStrong notes, there has been a move towards "drug courts" recently. I understand that "drug court" programs include AA as a option.

We're treating it like it's treatment? We shouldn't be. AA is not medical treatment. But peer support might be a legitimate part of an overall treatment plan, even if one can't standardize the peer-support experience.

Aside from the absence of a deity I see no real qualitative difference between any of these comparisons.

Is it the god-bothering that makes the religion based ones less wishy-washy to you?

Hmm, kind of clunky. It's not difficult to rewrite 6, but 7 is tricky. Still, I bet there's a way.

About 15 years after the Big Book was published Bill Wilson recreated this early version of the Six Steps:


Admitted hopeless
Got Honest with self
Got honest with another
Made Amends
Helped other without demand
Prayed to God as you understand Him

AA is not going to rewrite the steps anytime soon, but this does show the process can be expressed differently.

If that's a real question, here's something that addresses things that both you and Darat say:

To me the 12 steps are statements of commitment, not faith. The spiritual awakening could just as easily be called emotional growth. The process of self-examination and amends is designed to clear up toxic grudges and shame. You see how you've contributed to your own troubles, but you also see that a lot of stuff isn't your fault.

Darat is right that there isn't any way to standardize the steps; there isn't even a requirement that you do them. There haven't always been 12 of them. But they hit the same areas.

The steps don't really tell you how to stop, though. A few people may be struck sober; obviously most are not. A lot of effort has gone into creating some standardized formula that makes people ready to quit, and I'm not sure it's possible. Bill Wilson eventually felt that LSD might help people get there. For someone, somewhere, it probably did.

There is zero evidence that AA helps and lots that it doesn't. It seems that your chance of quitting alcohol with AA is the same as if you never went to a meeting.

What part of the program is good for an overall treatment program? The part where you sit in a room and listen to other alcoholics glorify their drinking days and refer to new people as "light weights" who don't know the meaning of "rock bottom?"

So the problem with alcoholics is that they aren't spiritually woke enough?

You are twisting the meaning of all things AA in an attempt to make it fit what is currently known about addiction. One of the big issues with AA is that they are stuck in the past, touting a system that doesn't work because it is in their best interest to do so. If they were truly interested in a cure their program would have evolved since its inception.

Early addiction therapy was based on a very flawed set of experiments on rats and we have been paying for it ever since. Rats were put in a cage and given a choice between water and water laced with drugs. They inevitably chose the drugs.

However, there was a serious flaw. The rats were in a cage. Nothing else. Take that same cage and put things in there for rats to do, other rats for them to socialise, and have sex, with and the rats inevitably ignored the drugs in favour of plain water.

Take from that what you will but it definitely shows that sitting around a barren room, smoking cigarettes and drinking coffee while talking about the glory days of drinking, isn't a good strategy for recovery.