So then, you agree that it should never be mandated by courts as a treatment, and should quit being presented and supported as a treatment/solution to alcohol or drug dependency.

Perfect! argument done.

There are, of course, issues with trying to rebut published scientific results with a link to an article in the popular press.

Glaser's article is largely based on the book "The Sober Truth" by Lance Dodes. I've posted multiple links criticizing this book above. Dodes was a psychoanalyst who had his own theory of alcoholism and addiction. The statistics that Dodes comes up with are not from his own work, they are reinterpretations of the work of others. Dodes himself has done little, actually I believe no, scientific work on the effectiveness of AA. Here is the abstract from a recent article by him in Clinical Social Work Journal. Make of it what you will.
"The case study method has been essential in psychoanalysis and psychodynamic therapy, since it is the only way to describe and explore the deepest levels of the human psyche. Addiction is no more and no less than a particular psychological mechanism, identical at its core to other psychological compulsions, and is therefore best understood and reported by this method that explores the mind in depth. We will discuss the value of the case report method in general and in specific with regard to psychoanalysis and addiction, criticisms raised about this method, and comparisons of it with nomothetic research."

A great rebuttal to the Glaser article can be found here:
https://thepointmag.com/2016/examine...he-insane-idea

General question for those that object to AA
 

If a friend or loved one is an addict/alcoholic and expresses a desire to attend AA, do you inform them of the programs' limitations and the reliance on a higher power or do you give them a ride to the meeting?

There are fundamental differences between the issue of whether a homeopathic remedy helps the sufferer from a common cold and whether AA helps someone suffering from alcoholism.

Certainly there might be issues with diagnosing oneself with a cold. Is it a rhinovirus, allergy, the flu? If someone comes to the conclusion that they are an alcoholic, there is, in my opinion, a very good chance they are correct.

There are issues with determining what the benefit from a homeopathic cold remedy might be and how to quantify them. Is the length of the cold lessened? Are the symptoms lessened? These are all subjective judgments about a magnitude of an effect. Abstinence from alcohol is a binary endpoint.

There is no plausible mechanism by which an overly dilute solution of some substance could have a physiological effect on a cold. There are a number of plausible mechanisms by which participation in AA could have a significant psychological effect.
1) If one is trying to get sober and stay sober, it may be helpful to observe others who have done so before you.
2) It may be helpful to get advice and encouragement from those others.
3) AA meetings may serve to replace the fellowship and camaraderie one use to associate with drinking.
4) An alcoholic may have become very isolated due to their drinking. AA can help an alcoholic break out of that isolated state.
5) An alcoholic may have other issues that played a direct role in their drinking such as depression, trauma, family of origin issues, etc. Spending time with others who share those same issues and have addressed them can be helpful.
6) Along the same lines, AA meetings can serve as a kind of informal, cost-effective group therapy.

I have no statistics, but I suspect a survey of AA members would hit upon these and other benefits/mechanisms.

So we have a correlation between AA attendance and well-defined binary endpoint (abstinence) (vide supra) and a number of plausible mechanisms for how that relation could be causal. Ideally, there would be a gold standard randomized trial. The difficulties with doing so have been discussed above.

Even if I would have run away from AA meetings to go watch tv or something I can agree with the above six points. I was never that social in person nor tried to be.

But to people that cannot do alone, need that healthier social interaction it provides well. It saved my uncle. He lead groups as his mission in life to share the good he found.

All of these are elements describing a peer support group, which have definite and demonstrated effect, are not in contention. They can and do help.

It is the 12 steps that are the issue. Do they add or subtract benefits to peer support?

If someone claims that AA works, then it's reasonable to ask them for evidence that it works. If they then go out of their way to explain why you can't expect evidence that AA works, then's it's reasonable to ignore their claims that it works.

I think it's valid to point out that you probably can't expect to find reliable statistics about AA (for a variety of reasons), but it's also valid to point out that if the evidence isn't out there, then there's no reason to believe the claims that it works.

I don't get the objection of some people in this thread to being asked for evidence that AA works, while simultaneously making positive claims about it working. Ok, you don't have the evidence because it isn't available. But then I don't have a reason to believe you when you say it works.

:)

I believe a lot of evidence has been provided.

Absolutely the former, without hesitation. What is this question even supposed to accomplish? Yes, some people get sober with the help of AA (of course I wouldn't deny someone's lived experience like that), but as has been pointed out numerous times, that doesn't mean it's the only or most effective way to get addiction treatment (as some of its defenders keep saying, it's not even a treatment). To clarify, I'm of the opinion that evidence doesn't show AA to be particularly effective, and I really don't like the religious elements and tenancies of cult-like behavior seen among some people who use AA (irrational defenses of the program, denying that people can be sober without it, etc. - there are plenty of good explanations of this out there). It helps some people, but I don't think it's the best method out there, and shouldn't be mandated through courts. If someone has gone through the steps, succeeded, and credits that success to AA, that's great; I'm glad it worked for them and their experience was positive, but that doesn't mean it's devoid of the problems expressed ad nauseum in this thread.

So if a person I cared about had an addiction problem and was asking for my thoughts about AA, I would probably say something like, "Well, a lot of people say it helps them, but studies tend to show success rates are pretty low; it's also religious at a fundamental level, the steps were adapted from an evangelical group's outline for 'saving' people, and some of the culture that surrounds it looks kind of culty to me. It's the first thing a lot of people turn to, because it's so well-known, but there are other systems that work better and are probably more consistent. As a kid, I was around a lot of people that were court-ordered into AA and it didn't help any of them. If you want to give AA a try, I'll give you a ride and support you, but if you want, I can also help you look for an option that might work better." And I'd feel pretty good about that advice, too, because in this scenario, I care about the person and want them to get successful help. I haven't had to do this with AA, but I've done something similar several times with friends that have come to me for advice about self-help books, diets, and alternative medicines.

That being said, I have a tendency towards what most of my friends consider sometimes insensitive levels of honesty, so maybe not everyone else that doesn't believe AA would do something similar. I'd rather be honest and maybe help someone make a more informed decision than just agree with whatever whim they have.

Not the least of which is that 99.9 percent (that's a guess) of common cold sufferers will enjoy spontaneous remission within a week or two at most.

From my perspective, the originals were the "god-bothering" ones. The guiding hand of God is essential to the whole theme. Man is just not up to it, so he hands over control to God. If you take God out of it, it becomes a meaningless babble in parts.

In my experience the steps help with emotional self-regulation. Not really to get sober but to deal with life. I'm not talking of the God stuff especially, but self-examination.

I can't help but ponder that there are ways to address such self-examination in an evidence based approach. Evidence and improvement should be the driving force. With AA, it's the cart before the horse.

Congratulations on your sobriety.

The Atlantic is not your friend.

Nor is it a serious rebuttal to peer reviewed research.

You're begging the question that lay reporters have a better grasp of the science than actual scientists reporting the actual science they did.

And you're begging the question that lay editors have a better grasp of the science than the actual scientists who reviewed the scientific claims.

Thank you for that. I don't consider myself clean and sober at the moment, though.

Both.

Dave

I'm stuck for what to say to be supportive which is hard considering I am a nobody on an internet forum who has been attacking something apparently important to you, something beneficial to you.

I'll leave it with impotent positive thoughts. :o

I wish you the best Minoosh. I've valued your contributions to this thread.

Agreed on both counts. I don't agree with some things Minoosh has posted but his(?) comments have been useful none-the-less.

Ok, so how about you address the answer, now?

Of course it can.

But you'd rather it couldn't, because whenever it is, it fails. So you prefer to focus on individual reports of success, as if that means anything.

A rather detailed discussion of studies can be found in the thread 'Are vaccines as safe as can be?'

It's interesting to see the opposite wrong arguments being made here on why AA can't be studied, as the wrong arguments there on why vaccines should have better studies.

In the vaccine thread, there is a call for studies that would force people not to be vaccinated, just like here saying a study would force people out of AA to be a control.

It's fascinating set of bookends. Very educational.

Have you noticed that I'm the one person on this thread who is quoting from and posting links to thet peer-reviewed medical literature?

That show the benefit of peer support, which is the only consistent element of different 12 step groups and non 12 step groups included in the peer-reviewed medical literatue.

The study I cited above, Moos and Moos. J Clin Psychol. 2006 June ; 62(6): 735–750, is clearly focused on participation in AA, not "peer support" in general.

Hey, Vancouverite here, associated with BC Humanists. (previously a director of BC Skeptics). My perspective is as follows:

I think the challenge specifically for this claimant is that he offered to go to a secular support group and also offered to continue the pharmaceutical treatments that had helped him up to now, but was told by his employer that no, only demonstrated AA attendance will qualify him to return to work because that's policy. Since he has buy-in with the secular one and no buy-in with AA's "higher power" mandatory capitulation, he feels the employer's policy is arbitrary and/or prejudicial against Atheists and a human rights violation. He did not refuse attendance - he refused to agree to the step in question during a meeting and this was reported to the employer as a refusal to participate, so he can't go back to work.

Personally, I think he has a good point. I agree that the benefits of group support carry a plausible mechanism for success despite unclear/jumbled study results, and that participant buy-in is critical. The barrier to his return to work is not necessarily his refusal to participate in a group process, but rather, specifically AA because of its Higher Power mandate.

AA is peer support. When I read the moos & moos, it talked about groups and AA after in/out patient treatment. Then they seemed to shorten it to simply AA, probably because AA is the gorilla in the room. But sure, let's say it's ONLY AA...

As you say, every AA meeting is different. Which AA did Moos & Moos study? Where does it show whichever AA they studied is more or less successful than peer support generally?

Of course he has a good point. AA is a religion, no two ways about it. The 12 steps are faith statements, with or without god. The 12 steps are pulled from forms of Christianity that were floating around at the time. The 12 steps don't even mention alcohol, and aim for spiritual awakening.

We got into the current thread because of AA folks claiming AA is not religion.

Thanks. I don't mind arguing though ;)

I know I'll find support when (not if) I get there. Have been dabbling.

I'm a her.

Do you have a link to those details? The OP article just said he refused to go.

I've never heard of a meeting where they make you do the steps and report to your employer if you don't :eye-poppi !!!

There is secular AA in Vancouver; I wonder if that was an option.

And did they provide a control group with a peer support system that was not AA, no they did not.
So it could be peer support and not AA that is effective, that is the point that was raised.

"Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes."

A little more background:

Is It Fair to Be Fired for Not Attending AA Meetings?

I wonder what his own proposal would have been, for treating his addiction and returning to work.

I thought I might have been wrong. Thanks for the correction.

The articles say he gave secular options for treatment but that any non-12 Step options were denied. None of the articles identify the options.

If a friend or loved one is suffering from depression and expresses a desire to use homeopathic medicine for treatment, do you inform them that homeopathy is ******** or do you buy them sugar pills?

The answer to both, of course, is to take them to a professional for professional help, e.g., medical help with withdrawal symptoms, psychiatric help with therapy, medications proven to be effective in helping people with depression, etc.

As others have said, if AA works for someone that's great, but at best it's a support group and at worst it's a social club where you hang out with people who won't stop talking about alcohol. Support groups have their place, but if someone is physically addicted to a substance they need more, and a friend/loved one deserves more.

I have never attended any rehab or AA in my life. But I have been in "serious" situations where demonstrated catholic faith was a requirement. I have none. Never bothered even faking it.

I got married in a Catholic church and had to look like I was praying. I said your if the prayer said my when referring to a belief. I was encouraged to say in english as the priest thought it might help. More than he knew.
I faked it, made my goal and got on with life. Other situations came up with my mil, she hated atheist, and just barely playing along made her happy.

This nurse in the thread could possibly have just played along, said the right words and not ruffled so many feathers. He took a higher road and seems like he is out of work. Honorable and all trying to point out something is wrong, but it really helps to hold a position of power going in. He didn't.
Now he is uncooperative and they don't want to change the system.



I don't fix all that is wrong I see other folks do. Results will be their problem and not mine. They take the losses. I don't point out poor thinking, even when a guy was here saying the sun will burn out so maybe he should be buying lots of candles. He forgot about it or seen the light, either way he didn't buy any candles.
I watch paranormal shows with the kids and point out obvious tricks and psych games these fools use. After a year the kids propose their ideas on how it was faked, sometimes they are dead on. But I am invested in those kids being able to think.

You are moving the goalposts.

That's a conundrum. One could take a stand against lying (playing along) but is it worth it if it will make your spouse unhappy? Probably not.

Thanks for the good wishes.

No, source is local, skeptics in the pub. The lawyer is Humanist-friendly and attends.




He offered to go, but was told no, only AA qualifies. This is partly why BCHA is involved, as they host the secular alternative.

He offered to continue to use the pharmaceutical prescriptions and/or attend a secular addiction group therapy that was designed to be an alternative to AA called Secular AA, since these had been working for him.

ETA: the other local secular alternative that was rejected was attending Secular Sobriety, which uses what's called "SMART Program" instead of the AA styled 12 step model.

Attends your pub group, or attends AA? If the latter, I'm surprised he would talk about what a specific person said or did in a meeting.

I can't imagine someone in a community AA meeting reporting to this guy's employer about what an attendee says/does in meetings. I know that's an argument from incredulity, but it runs very counter to AA tradition.

Another oddity is that he filed this complaint in 2015 and a hearing was supposed to be held that year.

A story I read from 2016 said,

I wonder why this has dragged on for so long.

If it's not inconvenient, do you have a source for the rejected programs above?

Every article I can find is basically the same story told in different sequence, with no details of the rejected programs. The reason I am interested is I wanted to look at the programs to see if perhaps they were rejected for valid reasons other than not being 12 step.

Alcohol and/or drug addiction is a completely different animal than depresion. There are many individuals suffering with addictions that may also be suffering from clinical depression, but that disease is treatable fairly easily, and in fact if we're talking about alcoholism, stopping the drinking sometimes has a positive effect on depression.

I look at the question the same way that you'd approach an individual with catastrophic physical injury.

You don't tell the victim how serious their wound(s) are or that they're dying, you stay calm, keep the victim conscious if possible and keep telling them to stay with you and help is on the way.

Bad thing - sometime it's a flat out lie. Good thing - the individual may survive.

I'll take the lie over the truth.

As an aside, anyone that believes that individuals out of control w/ drug or alcohol use are susceptible to logical argument and an appeal to self care hasn't lived with the consequences of addiction.

The best example that I can cite is from the autobiography of Greg Boyington, WWII Marine ace, Medal of Honor recipient.

He was a full blown alcoholic even before he flew with the Flying Tigers in China. While in captivity after being shot down by the Japanese, he was put in charge of warming sake for the camp guards and he found himself alone with the sauce.

He believed that if he drank, the best possible outcome would be a quick death via decapitation. He had witnessed the brutality of his captors and knew they were capable of the worst.

He drank anyway, to the point he blacked out. The guards woke him with a good beating, and Boyington was surprised that he hadn't been killed.

More modern examples of addiction under extreme circumstances:

https://www.nbcmiami.com/news/local/...511200292.html

A Florida man told officers he ingested crack cocaine while police chased him from Miami to the Upper Keys, sheriff's deputies said.

Mark Edward Welch, 50, of Lake Worth, was arrested Tuesday night and faces charges of DUI, fleeing and eluding, and possession of cocaine and drug paraphernalia, according to the Monroe County Sheriff's Office.

Florida City police started pursuing a black Jeep Liberty involved in hit-and-run crashes on the mainland. Welch drove from Miami to the Upper Keys and kept driving even after running over tire spikes, officials said.


http://www.fox2detroit.com/news/loca...-before-arrest

"In this job, you can never say you've seen it all," said Macomb County Sheriff Anthony Wickersham.

The suspect, 36-year-old Kristi Rettig of Eastpointe, now faces several charges including fleeing and eluding, assault with a dangerous weapon, and possession of a controlled substance.

"I think she truly believed she was going back to prison and figured she'd get one more hit of crack cocaine before she does her time," Wickersham said.

The passenger, 28-year-old Alexandra Weed of Melvindale, was also charged with possession.

The Macomb County sheriff wants to use this case as an example that it's never too late to join the "Hope Not Handcuffs" program which helps people get sober -- without fear of getting arrested.

The well intentioned folks here that believe an addict/alcoholic is basing their decisions about their addiction based on facts and statistics doesn't understand the subject matter.

To that demographic, anything that may give that person a leg up on beating their addiction - even snake oil or magic - is worth a hell of a lot more than statistics or discussions of higher-power this or that. None of these people ended up where they are be making good informed decisions. Expecting that these people will somehow begin making good decisions because that what's what you'd do under the same circumstances completely misses the point.

well said

Wrong.

As you say, people in crisis grab for anything. This is why we as a society try to ensure that what people in crisis grab for actually has a chance of helping and not causing additional harm. This is why we rational folks are constantly working to outlaw quackery, snake oil, homeopathy, magic, etc. so that people in crisis don't grab for them, and grab for something that can actually help.

Different, yes, but both diseases. One of the problems with AA is that it has marketed itself as "The Solution" to addiction. There is no other path to a better life but AA, and only an addict in denial would say otherwise.

I think this has hampered efforts to find other treatments. I can't point to any evidence for that, but I have seen anecdotal evidence referring to people who have addiction problems just need to get back to AA. A bit like Weight Watchers in their heyday.

I hope further study of the disease of addiction can get us to better solutions than AA or other current treatments. I think recognizing the limitations of AA and other current treatments is a big part of that.

AA isn't an addict/alcoholic version of quack cancer cures or "psychic surgery," it's a bunch of folks in the same boat making an effort towards solving their addictions. I see no harm in it. Whether it works or not can be debated forever but making the perfect (self realization and positive action in abstaining from the DOC) the enemy of the good (12 step and similar programs) doesn't save anybody's life.

Argument from Ignorance.
Which is why we study. And, unlike AA, improve.

It is not about the perfect being the enemy of the good, because we don't even know if AA is 'good'. AA has little evidence of success. Is it better or worse than simple peer support? We don't know. We do know it is a faith based approach, and we know that is a sword that cuts both ways.

I am advocating for evidence based approaches that change as more information is learned. By definition, this is not AA.

Being faith based, courts nor employers should be mandating AA. Courts and employers need better options.