I think this gets to the crux of it. A lot of people have asked "If someone you knew wanted to go to AA, would you drive them to the meeting?" and similar questions. That's not really analogous to the OP situation, though.

The better question to ask is "If you knew someone with an alcohol problem, would you force them specifically to go to AA, regardless of what they wanted or other treatment options they might choose?"

While we're waiting for you to be satisfied with a proven treatment protocol for addiction, would you mind if the addicts/alcoholics in question attempt to work things out on their own?

Should it be debated or should it be studied as we study most other disease treatments?

We don't rely on debates to determine if a proposed drug is effective, we rely on studies. So far, AA has been rather resistant to studies.

Can you imagine a world where there was only one treatment for cancer and that treatment resisted most attempts to study whether it was effective or not? And yet the general consensus was that it probably was as good as you could get, so there's not much need to study cancer treatment anymore.

I'm OK with allowing the individual in question to decide if they want treatment or not.

Nope, tis you that did not understand
:)

What question did teh Greater Fool imply?

While I agree people should have options other than AA, I believe it does help some people.
Now what actually is the working factor is up to debate.

Working with MISA (Mentally Ill Substance Abuse) clients (funny I am one), our rules were solely one:

You can not express a desire fro active use while in group the caveat being you had to say you wanted to stop. But you were not allowed to attend if you sai 'Eff this I am getting drunk as soon as I get home"

The clinician who developed our program used a harm reduction model
1. Know why you don't want to use
2. Make plans to avoid use
3. Make an 'escape plan for when you were at risk of using or using
4. Make a plan to avoid use after a replase
4. Develop a life style on non-using behaviors, skills and support

The Greater Fool was attempting to move the goalposts also.

Yeah, let's be childish.

No, you are trying to have it both ways. You claim every AA is different so can't be studied, then site a study about AA. Again, which AA was studied?

You yourself say the only consistent aspect of AA is peer support, so how can it be claimed more than that is being measured by Moos & Moos? Nowhere does Moos & Moos, or any study, address 12 step vs peer support. So, Moos & Moos do not prove any point about AA other than peer support seems to work.

Moving goalposts: AA doesn't have to be religious, AA is not treatment, AA is a social club. AA can't be studied. Here is a study.

Probably the most helpful post in this thread.

Unless such meets prevents someone getting actual treatment. I do understand how some people say they'd go along with someone using woo or snake oil because they want more than anything else to support someone. However if someone is choosing to use homeopathy rather than chemo to treat their cancer, using something we know doesn't work I think it is morally wrong not to do everything in your power to try and get them to use a treatment we know is based on evidence of effectiveness.

This relates to AA because I am now very concerned that its structure could prevent people from seeking evidence based treatment.

Do you take such an approach to all medical treatments?

Problem is that we do not know if AA is a treatment. If it is being mandated by the state then it should be evidence based.

I believe you have it backwards. The prevalence of AA is largely a result of the failure of medical science to come up with a better approach.

AA's official stance on other treatments was mentioned here:
https://www.theatlantic.com/magazine...nymous/386255/
'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.”'

Because of the soft science peculiarities of addiction there isn't now and unlikely to be in the future a drug therapy that cures addiction.

Counseling does not cure addiction.

AA doesn't cure addiction.

Draconian criminal penalties don't stop individuals from using drugs or alcohol.

Individuals should not be forced into treatment.

If an individual enters into a plea agreement or a diversion program that keeps them out of custody and requires them to attend a step program or counseling that's on them - the government in the guise of the courts ought not to do so if it involves the invocation of religion, but they do.

Given the above, what is TGF's approach to helping addicts/alcoholics?

Today, many (most?) of those in AA are introduced to AA in a treatment center. Most of those treatment centers have some sort of medical basis/ doctors on staff/ etc. So, no, I don't think AA members are being prevented from seeking treatment.

AA's official stance on other approaches was mentioned here:
https://www.theatlantic.com/magazine...nymous/386255/
'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.”'

You can be concerned about anything you want including that AA's structure could prevent people from seeking medically-based treatments, but I can assure you that's not the case.

I'd be interested if you have in mind an effective evidence-based treatment for alcoholism that has been proven to be more effective than AA? Or do you simply believe that such treatment must exist?

NO!

Addiction is the disease with a thousand faces. It's the softest of soft science.

When a doctor can come up with a explanation of why one individual becomes
addicted to meth and avoids cocaine but the next addict in line won't touch meth but is addicted to coke maybe we can get somewhere with medication to turn the tide, but we are far from being there.

I don't believe that anyone on this thread has argued that the state should mandate AA.

I will however debate statements such as

AA forces people to do xyz
AA is a creepy cult
There is no evidence that AA is effective
There is a lot of evidence that AA does more harm than good.

If any of those are given as reasons why the state should not mandate AA attendance then I will debate the merit of the reason, not necessarily the conclusion.

It is important to note, however, that historically, both courts and employers, have not had a variety of cost-effective alternatives. Both courts and employers have taken advantage of AA because it is widely available and cheap.

In what way has AA been resistant to treatment? Can you give a specific example?

ETA: I meant resistant to study

Actually, BStrong's comment was spot on.

No, they are not "completely different animal(s)." Once past the physical withdrawal symptoms, in fact, they're pretty similar and one often springs from the other (e.g., treat the depression and someone might not feel the need to self-medicate with alcohol).
Then you're not doing it right. You should be looking at it as a disease. That means figuring out what caused it and what might be the best treatment for it.

Emotional nonsense and a far worse analogy than the one I made. Is this what AA teaches? That lying is the way to get through an alcohol problem? Fake it 'til you make it! <blech>

If somebody decides to go to an AA meeting, and it works to keep them from drinking, that's great. Pretty much everyone in this thread has signed off on that.

The problem, though, isn't with the idea of people doing what they choose to do. The issue under consideration is what we, as individuals and as a society of [hopefully] rational people, should be recommending to people in trouble. AA by its very structure cannot prove that it works. Asking skeptical/rational people to take AA on faith is more than a little foolish

Personally, I consider the idea of indefinitely attending a support group to be pure stupidity if only because it serves to keep alcohol (or whatever substance/behavior one is attempting to avoid) front and center in someone's mind. If they've stopped drinking for a month or two, it might be time to stop hanging out with people who regularly claim that alcoholism is an incurable disease. Maybe get into some therapy with a professional to reinforce good habits and look for and deal with root causes.
As an aside, I don't think anyone has suggested that an addict just needs a good talking-to, preferably with charts and graphs, to deal with their addiction.

What I (and I alone) am suggesting is that going to a support group isn't treatment, and going to one based on, and treated by its supporters as, religion might be particularly unhelpful for a lot of people.

2010 - 2013 I went through close to $500,000.00 on hospital bills and rehabs for my girl - I've looked into and paid the price to know about the subject matter and the question of what works and what doesn't.

Nothing, NOTHING outside of the individual addict themselves refraining from drinking/using solves the problem. All the counseling/AA/whatever available including medical intervention with medication is pretty much a sideshow compared to the individual will of the addict.

Out of all the folks that I've known that developed alcohol/drug addictions, including some very solid successful folks, I can count on one hand the number of folks that simply quit on their own volition w/o medical or behavioral intervention and stayed clean and sober.

Of the folks I know that went to various rehabs and went to AA, several dozen folks recovered - some still go to AA, other don't. Nobody is chasing them to come back - AA isn't scientology - and I've never heard someone claim that "AA is the only way."

The following is not meant in any fashion to refer to anyone posting in this thread, but the individuals I've encountered IRL that have serious negative opinions of AA are people who are in fact practicing addict/alcoholics - During the course of taking folks into custody for alcohol/drug related crimes I always made it a point to ask the person about their A/D use as a gauge of where they were at mentally at the time, and also because our county had a diversion program and if somebody could get help and wanted help I wanted them to get that help. If they were interested, I'd write my report accordingly and pass along my report to the probation department folks for sentencing recommendations.

Some folks that I had arrested got clean behind this program. Others used it to avoid jail/prison and just rode a revolving door into and out of jail.

One guy I knew that made the program work for him actually invited me to his CA (Cocaine Anonymous) meeting when he did his first "share." Interesting event. I was introduced as one of his arresting officers. I got a 50/50 Boo/clap breakdown.

There is no cure. Help provided by drug therapies have demonstrated (via research and studies) to aid in the problems of withdrawals and addiction.

There is no cure. Help is provided though proven (via research and studies) counselling processes.

There is no cure. If we broaden the idea to Faith Based programs, particularly those paired with evidence based programs, help is provided.

We know it doesn't work because we have ample evidence (via research and studies) demonstrating they don't work.

Evidence supports idea that forcing folks into most anything doesn't work.

A reasonable opinion.

Given that most of the 'givens' are questionable at best:

1. More work on drugs, some of which are already helping;
2. More work on the therapies that are already helping;
3. More work on paired Faith Based and evidence based therapies;
4. More education and reform removing addiction as a crime;
5. Courts moving addicts toward evidence based programs;
6. More study into the nature of addictions and more study into therapies that work;
7. Folding everything learned in the various areas into ever better treatment programs;

And thus you sign on to his childishness, great job.:thumbsup:

As I'm incapable of discussing this issue in a non-involved academic fashion I'll pass on further posting.

I hope you know how much good you have done. I have no doubt that most of the boo's were good natured. Like LE, alcoholics and addicts tend to have a dark sense of humor.

As you say, alcoholism/addiction is a very tough nut to crack. The alcoholic has a compulsion/obsession to drink in spite of the harm it is doing him. Anything that threatens that behavior can be met with an objection. Alcoholics can object to any form of intervention/treatment/AA no matter how benign. My favorite example of the futility of trying to reason with an alcoholic comes from, of all sources, the movie Blazing Saddles.

https://www.youtube.com/watch?v=39-natKpnkA

It's fiction, of course, but there is a great deal of truth in that short clip. The look on Sheriff Bart's face is priceless.

I said it is resistant to study. It does not collect data that can be used in any meaningful way to assess its effectiveness. It does not standardize its meetings or catalog them in any meaningful way so that they can be studied.

And despite its claims, it does discourage other treatment by its very nature.

The twelve steps are the only solution. If you lapse it is because you failed, not the twelve steps. You are powerless against your disease and must hand over all power to God.

Applying this thinking to any other disease would be called woo around here.

--------

Personal anecdote time:

I remember looking into AA when a good friend was sent to it by his doctor and parents. They had a little quiz to take to determine if you were an alcoholic. I aced that quiz. I met every major criteria. So did my friend. He was sober for a few months but then began drinking again. Later, we both just sort of hit bottom. We had our own stories, but we both had let our drinking get the better of us. So, did we go off to AA? No, we just dropped it back a notch and learned to not drink so much.

So, that makes us not "True Alcoholics" because we both stopped the cycle that was ruining our lives. But, we were also both "True Alcoholics" at one point because we met all of their criteria.

So, is he an AA success story or an AA failure? He has a nice career a great family and no real trouble with addiction. He also hasn't been to an AA meeting in over 20 years and drinks as much as he wants. I never went to a meeting and find myself in the same situation.

What type of data would you have it collect? There is a potential Uncertainty Principle in play here. Would the very act of measuring all this data change the nature of AA? I firmly believe that if AA did collect extensive data or conduct experiments on itself they would be met with a great deal of skepticism. Would you actually trust AA to study itself?

I don't know what you mean by the highlighted.

You both got better. Heavy drinking is a phase some people pass through. That's fine.

The old AA thread ran 174 pages. I don't know what finally killed it off. Arguing about AA was ultimately not very productive for me, personally. I doubt if any new arguments are being made in this thread.

If someone grows out of compulsive drinking I count that as a success and I don't care who gets the credit.

That's very nice but it's not very useful for improving treatment methodologies.

I think the fact that the data doesn't exist is much more germane than why the data doesn't exist or whether or not people would trust the data.

If there is no reliable data on the effectiveness of AA, then it matters not a whit why the data doesn't exist (I could think of several valid reasons why collecting reliable data on AA wouldn't be workable).

If someone asks for good data on the effectiveness of AA, then explaining to them why that good data doesn't exist, does not invalidate the request for the data. If the data does not exist to allow someone to make an evidence based judgment on something, then you can't make an evidence based judgment, even if there are very good reasons why the data isn't available.

Arguing why the data about AA is not available does not negate the fact that it is not available.

There are actually 3 separate questions:

1) Does AA collect research quality data on itself? - No, for reasons that have been discussed here and elsewhere.

2) Does data on the effectiveness of AA exist? - Yes. I've posted links to some of the studies here. Of course, anyone interested in looking for themselves can go to www.pubmed.gov and search for "Alcoholics Anonymous Efficacy".
see for example https://www.ncbi.nlm.nih.gov/pubmed/25421504

3) Is the data that does exist equivalent to a that obtained in a clinical drug trial? - No, for reasons that have been discussed here and elsewhere.

In the study sited in 2 above, in addition to encouragement to attend AA meetings, everyone received personalized non-AA therapies, for multi-weekly to weekly sessions. So, sure, peer support group is a great addition to personalized in & out patient services.

There are no studies that evidence 12 steps as being better or worse than peer support alone.

As indicated above, evidence based + faith based can be effective, but certainly shouldn't be the only game in town, and fortunately at least the evidence based therapies will improve over time.

Self-medicating with alcohol, opioids etc. may provide short-term relief but the flip side is that by covering up the symptoms it allows people to stay in bad situations, including living with treatable chronic depression or anxiety. Using I had only one problem: Getting more. Clean and sober I had to treat myself better.

I wish you luck with your friend. It sounds like she knows all the options and that you have done everything humanly possible to give her a shot at recovery. (Kidnapping is probably not an option.) Knowing you've done all you can sometimes makes it easier to accept the things you can't change. I've been in roughly your situation and the fear is corrosive, debilitating. It sucks.

Don't know if you're still reading this thread as you bowed out recently but I just wanted to put in a word of support. People do change if they want it but I don't know how to make them want it. Step Zero is wanting to live. It can happen but obviously there are no guarantees. Good luck.

A lot depends on a person's goals. Not everyone needs abstinence, but numerous programs other than AA stress abstinence for some people. Those who want to cut down might have success with naltrexone.

British Columbia has everything from abstinence-based treatment to facilities where people can inject heroin legally and more safely.

There's not really one methodology that works consistently. Addiction is a notoriously tough nut to crack. Some people seem to just grow out of it but others die prematurely despite having tried multiple treatment approaches.

Improving the methodologies isn't about a person's goals. It's about improving a person's useful options.

What's useful to a given individual may depend on their goals. For example, abstinence vs. moderation. The treatment plans would have some overlap but also contrasting features depending on the desired outcome.

This is the folks wanting evidence and improvement advocate. It is not the situation today with the AA Gorilla in the room (as shown in the OP), that hasn't change in 80 years, and won't change ever, so will never improve. Again, that is religion.

We need a TON more evidence based programs that provide the planning, evidence based options, and informed consent you describe. Which is not a whit like what happens with AA.

What's not being addressed in this thread is why AA became the only game in town of the 80 years since it's inception:

It's the only game in town because even though addiction is now medically in the disease category, society still in it's heart views addiction as a moral failing, weakness of character. This is why the popular fixes are still incarceration and the 12 steps of the AA to achieve a spiritual awakening.

We're moving away from god and punishment as a society, but it's an uphill battle.

How rational is rational recovery
 

Dancing David, you have long advocated Rational Recovery on ISF. I wonder if you are aware of this https://rational.org/index.php?id=58

I'm quoting from the website: "A central concept of AVRT is the Declaration of Personal Independence, which we recommend for recovery groupers getting started with AVRT-based recovery: I will never attend another recovery group meeting of any kind nor will I obtain professional services for the purposes of addiction recovery."

It goes on and I would like to quote more but I "copy" is disabled on the website. Hmm.

Let me contrast the above with the official AA position on "Seeking Professional Help" as found in the book "Living Sober"

"Probably every recovered alcoholic has needed and sought professional help of the sort AA does not provide."

"To take or not to take disulfiram (Antabuse), to go into psychotherapy, to go back to school or change jobs, to have an operation, to go on a diet, to quit smoking, to take or disregard your lawyer's advice about your taxes—these are all your own decisions.

To each his own, but I find the Rational Recovery position I've quoted above to be far more disturbing, cultish, and frankly dangerous than anything, including all the references to God, that I've ever read in AA.

BCHA's preferred program is Rational Recovery: [https://rational.org]

There was another local option, (not endorsed by BCHA but otherwise acceptable IMO) Secular Sobriety: [https://secular-sobriety.org]

In terms of their effectiveness... about the same amount of supporting evidence as AA, which is to say, probably no better than any random group support and possibly no better than nonattendance.


Worth mentioning: the pharmaceutical intervention was Naloxone, which IMO is not very effective. Specifically, it relies on patient compliance, and the history of its use among alcoholics is that the clever ones just plan ahead a few days for a weekend binge and stop taking the drug, resuming it on Monday. So, I'm with the employer on rejecting Noxalone as a condition of returning to work.

[quote=Minoosh;12752833]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.[/quote[

Attends Skeptics in the Pub. I was just explaining why some of the details are not 'googley' - reality is not entirely available on media links, unfortunately.



More than one 'hearing' and he didn't start out with good resources - he originally tried to handle it internally, and then he engaged a lawyer and it wound through the BC legal courts (the employer prevailed). So after losing those two strategies, he went to plan C and filed a human rights complaint with the support of BCHA, which goes before a unique Canadian/BC structure called a Human Rights Tribunal.

BCHA had a previous interest in government mandated AA and was already involved in a campaign to influence policy change. Then this guy comes up with a pretty good case involving an employer and union doing the same thing, so they kinda picked it up and ran with it.

ETA: link to BCHA's ongoing campaign about AA - [SECULAR ADDICTIONS RECOVERY]

I think there are two more meaningful questions related to the thread topic:

4) is there anything special about AA that is not included in other 12 step or secular recovery group programs that justifies its special status as approved while the others are rejected as acceptable treatments. if not, then what's the reason for the privilege?

5) is the 'higher power' step a mistake that, if removed/updated based on post market research, as we do with any science based treatment, would make the program more effective for more people? (this is the 'is this a religion' part - if no amount of new information will motivate an update of the technology, it's a religion IMO)

You mean Naltrexone not Naloxond. Naltrexone either oral or the monthly shot Vivitrol are to help decrease the amount and frequency you drink.
I work as Registered Nurse in an outpatient addictions facility. I administer dozens of Vivitrol shots a month. I note that patients are about 50 50 on its effectiveness
What I don't like is Suboxone. As one addict said is that is a coupon for heroin. People aren't tapered and.are still physically addicted to opiods. If there is any delay in their script they find heroin immediately.

Yes, Naltrexone, you're 100% correct.

Sorry, I'm used to discussing them in terms of their brand names (ReVia, Vivitrol), and did jumble them with a narcotic blocker Narcan / Naloxone.

I'm not sure what you mean by "the same amount of supporting evidence". I searched pubmed for "Rational Recovery" and found 5 papers only one of which from 1993 seemed to me to have actual data on the effectiveness of what it called "Rational Recovery".

I'm confused because the 1993 study referred to "63 established RR groups" while the rational.org website says "There are no Rational Recovery groups, anywhere!" Has Rational Recovery undergone some major change? If there are no groups, what type of participation was the nurse in question proposing???

The way to be sure is to read the entirety of his sentence. There is virtually no evidence for either.

Haven't we been around this merry-go-round before? Don't take my word for it. Do a pubmed search for "'Rational Recovery' efficacy" and "'Alcoholics Anonymous' efficacy" and see what you get.

And I guess I should qualify my vagueness... net evidence of effectiveness for both is about the same. ie weak.

There are different approaches to obtaining clinical proof of efficacy. Much of our FDA approval system is based on mechanism of action. IF the primary mechanism of action for AA is that it's a group support, then other group support approaches with similar frameworks share the same probability of success.

Which is the central point of Byron's complaint. He had a working support group. He was managing alcoholism just fine, but the employer said, "no, you can't use the one that works for you, you have to use the Theocratic one we listed in our bureaucratic system, every other Atheist sucks it up, why can't you, troublemaker."

Note: there's no reason he couldn't continue with the one that worked obviously. The issue is that he's being forced to use one he says doesn't work for him, on penalty of being fired.

I suspect they just don't keep their website up to date. Not everything on the Internet is updated reliably.

Incidentally, one of the career changes I'm considering when I take early retirement from my current employer at 55 (in 2023) is to move into journalism. It's become crystal clear over the last decade or so that Googling topics is less than useless - it's like a recipe for being misinformed. Local contacts are possibly the only real source of accurate information.

1) The paper I looked at from 1993 said they looked at "433 substance-abusing people attending 63 established RR groups".
https://www.ncbi.nlm.nih.gov/pubmed/8273770
The current website, copyrighted 2019, explicitly says there are no Rational Recovery groups.
https://rational.org/index.php?id=33
"Based on universal family values, AVRT is incompatible with the group format, ...." (italics as in original).
Are there 2 Rational Recoveries? Something strange is going on and it is not just a not up-to-date website.

2)That is why I've consistently cited www.pubmed.gov which I do not consider less than useless. There are many,many studies of AA that have been published in peer-reviewed medical literature. By my count there is 1 such paper on something called "Rational Recovery" that appears to be radically different than what exists now at rational.org. No matter how I look at it that is not "the same amount of evidence" (emphasis added).