I can barely remember smoking meetings. Today they're probably illegal.

ETA:

"It seems"? That's some rigorous language right there.

Read the links.

I've read every link presented in this thread.

I've read how AA, when grouped in with peer support AFTER in or out patient treatment yields positive results.

I've read the 'orange papers' that 'seem' to make good points.

Bottom line, AA is a religion. Like any religion, if it works for you: Hallelujah! Praise the Lord! Spread the word (Step 12).

This is false.

They won't knock on your door and try give you pamphlets. AA will hook you up with someone to talk to if you ask for it. And plenty of its members do it fine without supernatural beliefs.

I don't know how big it is but there is an agnostic AA movement.

More from the rat park guy, Bruce Alexander.

There's that word "spirituality." I'm not totally sure you can reason yourself into good mental health. You can try. I think he's right about building community, and he does not seem to be setting himself in opposition to AA.

Not that your description of an AA meeting is correct, but that's quite a leap isn't it?

In terms of what you can say about AA it is true, because you can't extrapolate from one AA meet to another. So a particular meet may provide evidence that it helps better than no treatment but that is all. You have no way of knowing why that particular meet in that particular time frame had a better than no treatment success rate.

As defined by you and others in this thread there is no evidence that any particular AA meet is better than no treatment. In other words there is no evidence that AA meets (note the plural) have a better success rate than no treatment.

A VA studied a sample of 2,319 male alcoholics in 15 Veterans Administration inpatient programs. It wasn't just one meeting. But you could argue that relying only on inpatient programs for veterans does not extrapolate to a representative cross-section of community meetings.

Project MATCH, a different large study, had perhaps a bigger flaw: There was no control group.

You're right about about the potential pitfalls - AFAIK no one has studied meeting-by-meeting success rates. But for all their variability they do tend to rely on a fairly similar template. Steps, meetings, sharing stories: What it was like, what happened and what is it like now. So it's not a free-for-all, either.

Have you noticed that of several points that people raise, you pick one to address? Like the point that no treatment for any disease is spiritual awakening.

No, AA won't knock on your door. Most religions don't. Like AA, they remain religions no matter how circumspect they are about evangelism.

You know there are religions without god? They are still religions. Agnostic AA is still a religion.

When any aspect of AA is challenged, you twist and mold AA to explain how that aspect is not required:

- Step 12 in not 'in your face' evangelism, so it's not as bad as other religions;

- You can remove 'god' from the 12 steps.

- Every meeting is different, so there is no one AA. However, studies show peer support, including AA, can be beneficial so score 1 for AA.

- The list goes on and on;

There is nothing about AA that you aren't willing to explain away to make it palatable. Except that religion thing, that's one thing AA isn't.

You completely missed the 'Orange Papers', oops.

Not statistically, it hasn't.

I do understand you have found your AA meets useful but you can't have it both ways, either there are standards applied and enforced in all AA meets or there isn't. You seem pretty adament there aren't so the success you believe you have had via your AA meets can not be used as an indicator that AA meets help people.

And don't forget the reason for this thread, someone was/is being forced to attend a meet that has religious elements when they do not have such beliefs. I also introduced the concern I have in regards to a state forcing someone into treatments that are not evidence based.

From your and others statements about what AA is my concerns have been heightened, I had assumed there was *an* AA treatment/approach I didn't realise there are no standards, that there is no consistent approach that could even in principle be subjected to actual scientific review.

There seems to be no grounds by which anyone can recommend from actual evidence any AA meets as a way to reduce or stop alcohol consumption, or as a treatment for alcoholism or even a support group for alcoholics.

I'm now 100% of the view that no state should be forcing anyone to attend any AA meet.

Most certainly, I have known two people who died from alcohol withdrawl

just for contrast here is rational recovery (Trimpey himself is a jerk in many ways, but the program is reasonable)
https://rational.org/index.php?id=1

Is that the only valid criterion available to us?

Yes, actually.

I wouldn't call he God based steps wishy washy as they are firmly focused on the God theme. If you believe in God it all makes sense in a way. Even though I don't have that belief I can see that.

State mandated AA gives a wily drunk a way out in a year, without actually having to bother going sober full time.

Get your licence back, keep your job and all for testing clean and not being stupid for about a year. You can learn the structure of the program and have a few barley pops at key times, just not near : surprise ' urine tests. If you play well they even claim you as a success for the program.

I know because several friends had to do it.

Going in fighting when the law says you must attend rehab hurt one bad financially and he actually had to sober up for 3 years.

Or one could actually want to stop being a drunk and then most anything would work. That us what I wanted before stupidity caught up with me.

It's all in the motivation of the person.

AA is an addiction.

Yes, I'm trying to address things people say without posting some huge essay responding to everything.

If you think spirituality plays no role in healing, OK. The Rat Park guy does cite spirituality and suggests the "fix" is making connections and building community. That's what AA is, but there are other communities and more yet that can be built.

How? By being a community that agrees on shared values?

Because the only requirement for membership is a desire to stop drinking.

At this point I don't even know what you mean by "religion."

IMO, you can. Not everyone in AA agrees, but we disagree about a lot of things.

OK.

I can only speak for my experience.

What makes you think I missed it? I've quoted from it, in this thread:

He quit drinking after a doctor warned him once. That's cool. BTW he thinks peer support is BS, even detrimental. He suggests having the right spouse.

Trying to counter him point by point - is madness for me. Can't do it.

If people want to form a community around hating AA that's cool. I hope it works for them.

True. How to get motivated before your life blows up in your face - that's not an exact science.

Assuming for the moment your argument is valid, isn't it valid both ways? How can there be evidence that any particular AA meeting doesn't help? How then can qayak's statement, "There is zero evidence that AA helps and lots that it doesn't.", be true?

There is some variability in AA meetings across both time and space, as there is in just about any human endeavor. That random variability, fluctuations, noise, whatever you want to call it is precisely what statisticians deal with on a regular basis and in no way precludes asking the question "Does AA have a positive impact on some measure of success for admitted alcoholics?" Pollsters ask people who they are going to vote for in an upcoming election. They can't extrapolate from their data to determine how Edgar in Des Moines will vote, but they can analyze their data statistically to predict who will win an upcoming election. I've said it before, AA is notoriously difficult to study for a variety of different reasons. Some of them have been discussed above. Pollsters determine how many people they have to poll to get the desired margin of error . I suspect that there are techniques that would allow a statistician to determine the sample size necessary to determine the effectiveness of AA across a given city, country, or the world. There are other aspects of the experimental design and data collection that would present far bigger challenges.

I'm going to quote from the article by Kaskutas that both Minoosh and I have linked to above.
"Criterion 1, strength of association How large is the relationship between AA exposure and abstinence? As shown in Figure 1, which draws on a longitudinal study of male inpatients in Veterans Administration programs, rates of abstinence are about twice as high for those who attended a 12-step group such as AA following treatment. One-year follow-ups considered 12-step group attendance and abstinence from alcohol and drugs, while the 18-month results reported AA attendance and alcohol abstinence. Results are remarkably similar, at 1-year and 18 months, for these different exposure and abstinence measures. About 20%–25% of those who did not attend AA or another 12-step group (or receive any other form of aftercare after the inpatient stay) were abstinent from alcohol and drugs at 1 year [15], and from alcohol at 18 months (combined alcohol and drug abstinence were not reported at 18 months) [16]. The rates of abstinence were about twice as high among those who had attended AA or another 12-step group (but no other form of aftercare). In terms of effect sizes, this translates to a robust medium-size effect (h=.5) [17, pp. 181–p.185]. Other studies are available that report on other substance use measures (such as percent days abstinent/PDA) and samples. This study is selected to demonstrate the strength of the association because it comes from a large sample (n=3018 at 1 year), it reported simple dichotomous measures of AA or 12-step group exposure and abstinence, and it reported separately for those who attended AA/12-step groups during follow-up but were not exposed to subsequent formal treatment."

That's evidence, actually statistical evidence, of AA's effectiveness. You may find the evidence weak, you may debates the merits of the experimental design, etc., etc., but it is evidence. The quote does refer to "Veterans Administration programs". If I get a chance I'll look at the original work to see how many different locations the study included. By the way, people are allowed to go to as many different meetings as they choose to find ones that work for them. So one person's sobriety doesn't depend on the effectiveness of 1 meeting.

Not all questions require answers based on statistics. If you ask me do lots of people like chocolate ice cream I would say yes. Do I have statistical evidence to back that up, no, but I'm quite confident that a lot of people like chocolate ice cream. How can i say that, after all there are different brands of chocolate ice cream? Yes, there are variations amongst different brands of chocolate ice cream but in the end lots of people like something that they consider to be chocolate ice cream. If you ask me has AA helped a lot of people then I would respond yes. Statistics, we don't need no stinking statistics.

It is not my intention to argue that courts/employers should force anyone to go to AA. There are valid arguments to be made against such mandates. However, I firmly believe that arguments that it is established that AA is not helpful to anyone or even harmful are both incorrect and are themselves potentially harmful.

To individuals making life choices? No. To society making public policy choices? Yes.

There is no evidence to support this. AA used to claim that they had a 100% success rate. That was proven wrong. Then they claimed a lesser amount. That was proven wrong based on the numbers they quoted. A study of their claimed numbers showed they had no better success than not going to AA.

Since their claims were debunked AA has steadfastly refused to provide any statistics on the claim that it is an invasion of privacy and threatens people's anonymity. For an organization that has no statistics on success there are sure a lot of people here making claims like they have actual statistics.

The known success rate of AA is exactly that of people who do not attend AA. 5-10%. Alcoholism tends to run its course and AA has no impact on that. The issue with AA is that it harms the other 90-95%. They tout the success and blame the failure on the addict. iI you are one of the unsuccessful ones you have failed, the program didn't fail you. The program never fails. It is blasphemous to suggest that the programmed failed someone. They failed, not the program.

Every other treatment program sees relapse as a failure of the treatment but not AA. They see it as a failure of the patient.

The difference is that people can't fool themselves into thinking they like chocolate ice cream. Liking chocolate ice cream is not subject to the cognitive biases that can fool people into thinking a medical treatment has been effective when it hasn't. That's why we do need to use the scientific method when assessing medical treatments, even though we don't need to use it when finding out the most popular flavours of ice cream.

Every argument you have made a Catholic could equally make, but it doesn't make Catholicism not a religion.

I wonder if there is such a thing as culturally AA. Not unlike a cultural Christian or Jew. Dogma isn't important, it's about community. Not the worst way to live.

At any rate, enjoy your community. I actually am glad that you are happy and healthier.

You say every AA is different and thus studies can't capture anything meaningful, then quote a study that AA is benefical. You admit the conflict here, but then go on to extrapolate AA's benefits.

Let me extrapolate differently:

First, this is after an in/out patient treatment program, which should be noted. AA meetings are a support feature, not a central feature.

Second, if every AA is different, it seems to me that the study is measuring the aspect common to all AA meetings: Peer support.

Like you, Dogma isn't as important as peer support / community. It's not about the 12 steps, which you admit aren't important. Which, now that I think back, the 12 steps did not feature in any of the meeting I attended, just experiences.

So, peer support has demonstrated benefit. Occams razor and all that.

Do you think people can fool themselves into thinking they are sober?
AA is not a medical treatment.

Is that a serious question? Every drunk driver thinks s/he's sober enough to drive a car, and is fooling him/herself. And plenty of high functioning alcoholics are able to fool themselves into thinking they're not dependent on alcohol.

It doesn't seem like "AA" can be defined as anything, really; yet courts are mandating it. What do they think they're mandating?

Dave

I think people can fool themselves into thinking attending AA meetings is the reason they have managed to stay sober, just as they can fool themselves into thinking a homeopathic remedy they took is the reason they're feeling better.

Absolutely

Here's the definition of placebo from google:
pla·ce·bo
/pləˈsēbō/
Learn to pronounce
noun
a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect.

Since AA's effects, if any, are psychological and dare I say it spiritual and not physiological it's not clear what it would mean to say that someone "fools" themselves into thinking AA has helped.

Then, yes they can. One more won't hurt. I can take it or leave it. I'm fine to drive, I've only had a couple. I can hold my drink. Sound familiar?

Dave

By sober I meant 100 % abstinent from alcohol. Sorry for the confusion

People can and do fool themselves every day.

There is a reason for rule 4, and it's to stop fooling oneself. Not everyone can handle rule 4. Some people avoid it in certain aspects of their life because sometimes we need the fiction. Badly. So we don't look at that elephant in the room.

Does this explain why four out if seven AA meeting halls aa step 4 and 5 ?

It takes the longest to get into a better frame of thought.

OK, then. People probably can't fool themselves into thinking they are 100% abstinent*. They can fool themselves into thinking they are abstinent because they went to AA, just as they can fool themselves into thinking they got over that cold because of the 30C homeopathic remedies, and not because they would have got over it whatever happened. And the court ruling is in effect saying, "You must go to AA, because you will not recover from your addiction without it." That's something that evidence should be required to demonstrate before the ruling is accepted.

Dave

* Though I'm not even sure of that; people are terribly good at self-deception. "I only had a small sherry, that's not even a proper drink."

I agree that the perceived beneficial effects of homeopathic remedies are, if any, in the mind of those using them. They have no physiological effect. How would you distinguish someone who fooled themselves (in their mind) into thinking that AA helped from someone who was truly helped from AA if even the help occurs only "in their mind", i.e. a beneficial effect on their psychological state. This distinction seems rather vague and ill-defined to me.

Yes when it comes to something other than personal preference, it is the basis of medicine and lots of things.

Anecdotal evidence is subject to many biases.

Not really, but they can fool themselves as to what is effective and what is just window dressing

Smells a bit like a shifting the onus of truth here whoanellie.

As in the argument for God's existence, if you are arguing in favour of the effectiveness of AA, the onus should be on you to prove its effectiveness, and not on others to prove its ineffectiveness.

I think you missed the point.

Perhaps you are right, but I am having trouble deciphering that sentence:

"Assuming for the moment your argument is valid, isn't it valid both ways? How can there be evidence that any particular AA meeting doesn't help? How then can qayak's statement, "There is zero evidence that AA helps and lots that it doesn't.", be true?"

I clicked, and it actually sounds weirder to me than AA does - and also quasi-religious. "I" am not my body; there is an "I" that can override the beast within. What's he talking about then, if not a soul? An intellect, maybe? I can see why this would appeal to some people but it doesn't sound any more "rational" to me than AA does.

And he absolutely despises support groups.

A) qayak stated that "There is zero evidence that AA helps and lots that it doesn't."

B) I replied that qayak's statement was false.

C) Darat made an argument that because of the variability across AA meetings it was not possible to have evidence that AA in general was helpful. Therefore, Darat argued, qayak's statement was true and I was incorrect in B.

D) The point I was trying to make is that there were two parts to qayak's statement. If Darat's argument is true then it seems to me it should be true for both parts of qayak's statement. If, theoretically it was not possible to obtain evidence that AA in general was helpful, isn't it also ,not possible to obtain "lots" of evidence that it isn't helpful? If Darat's argument is correct then the first part of qayak's statement is true but the 2nd part is false and the statement is in its entirety false.

E) I do not think Darat's argument is valid for the reasons I stated above.

Minoosh and I have provided a fair amount of evidence, both statistical and anecdotal, that AA is helpful. To be sure there is also evidence, both statistical and anecdotal, that it is not helpful. In my opinion the weight of the evidence is that AA is helpful. A great many alcoholics have gotten sober and stayed sober in AA. That is a good thing. There is certainly support in the medical literature for the correlation between AA attendance and abstinence.

Yeah. Good thing I wasn't calling them that either, huh?

I was pointing out that the comparison seemed to suggest that it was the inclusion of all that god-bothering that kept those steps from being wishy-washy.

Why is god-bothering needed for that?

That's something I don't get when people get 5-10 percent success rates for a different course of action; saying the success rate of quitting on your own vs. quitting in AA is the same, therefore AA is proven useless. But I think the 5-10 percent who quit on their own are not the same 5-10 percent who benefit from AA. Most people in AA have already tried doing abstinence on their own with no success. They're different populations. It seems to me good to have other alternatives on a spectrum that collectively benefit more people than having only one option would.

Probably a good number of problem drinkers simply throttle back and are able to attain moderation. Again, these probably aren't the same people who has no success cutting down and instead embraced abstinence.

If 10 percent are able to just stop, that doesn't mean the other 90 percent should stop trying other approaches.

The same way as the efficacy of any other treatment is determined; conduct randomised and properly controlled trials in which a valid statistical comparison is made between the recovery rate of people who had the treatment and people who did not. That's a very difficult thing to do perfectly, but as I understand it the best data available suggests that there is no significant difference in recovery rates.

The distinction is about whether or not that someone would have done just as well without AA. On an individual basis that's impossible to determine, but on a statistical basis within a population it's possible to infer.

And, of course, the burden of proof should be on the claim that AA has a positive effect, particularly when assessing whether it's appropriate to infringe someone's freedom of choice and of association by legally mandating them to attend. Without evidence in support of it, the legal ruling rests only on a matter of personal opinion.

Also, if personal motivation is a part of the efficacy of AA, doesn't it seem rather futile to force people to attend? One might think that their inevitable reluctance and lack of motivation would negate any possibility of AA working for them.

Dave

It would mean that their improvement was attributed to their attendance of AA but not caused by it.

AA is not "treatment". You can't do a randomized and properly controlled trial where you force one group to attend AA and force one group to not attend AA. But we have this (already quoted above)
"About 20%–25% of those who did not attend AA or another 12-step group (or receive any other form of aftercare after the inpatient stay) were abstinent from alcohol and drugs at 1 year [15], and from alcohol at 18 months (combined alcohol and drug abstinence were not reported at 18 months) [16]. The rates of abstinence were about twice as high among those who had attended AA or another 12-step group (but no other form of aftercare)."
Kaskutas. J Addict Dis. 2009 ; 28(2): 145–157

and this
"Compared to individuals who did not enter AA in the first year, individuals who participated in AA for 9 weeks or more had better 16-year alcohol-related and self-efficacy outcomes (Table 3). Some of these differences were quite substantial; only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more."

"The findings extend earlier results on this sample (Moos & Moos, 2004a; 2005b) and those of prior studies (Connors et al., 2001; Fiorentine, 1999; Ouimette et al., 1998; Watson et al., 1997) by showing that more extended participation in AA is associated with better alcohol related and self-efficacy outcomes. The results support the benefit of extended engagement in AA, in that a longer duration of participation in the first year, and in the second and third years, was independently associated with better 16-year outcomes. In addition, our findings indicate that attendance for more than 52 weeks in a 5-year interval may be associated with a higher likelihood of abstinence than attendance of up to 52 weeks. Part of the association between AA attendance and better social functioning, which reflects the composition of the social network, likely is a direct function of participation in AA. In fact, for some individuals, involvement with a circle of abstinent friends may reflect a turning point that enables them to address their problems, build their coping skills, and establish more supportive social resources (Humphreys, 2004; Humphreys, Mankowski, Moos, & Finney, 1999). Participation in a mutual support group may enhance and amplify these changes in life context and coping to promote better long-term outcomes. More broadly, the finding that the length of time individuals receive help for alcohol-related disorders is closely related to outcome is consistent with the fact that the enduring aspects of individuals’ life contexts are associated with the recurrent course of remission and relapse (Moos, Finney, & Cronkite, 1990).

Moos and Moos. J Clin Psychol. 2006 June ; 62(6): 735–750.

A good review of the literature can be found here: https://www.health.harvard.edu/newsl...nonymous_works

I believe you are wrong about the best available data showing no significant difference in recovery rates between those attending AA and those not.

I don't agree that someone should be legally mandated to attend AA. It's not my intention to change the subject of this thread but simply to correct a number of unsubstantiated statements and gross misconceptions that have been posted here. The highlighted is a valid point that might apply equally well to someone forced into AA by a proposed randomized trial. Getting sober and attending AA is ultimately all a matter of personal preference. If someone says that they attend AA and it helps them why is anyone entitled to argue with them?

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