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“Analyzing the available data about AA requires that we begin with a clear definition of success. Success, after all, can mean any number of things. Should one measure it in days of sobriety? Weeks without a binge episode? What if people who are making substantive progress slip and have one drink during an otherwise successful period of time: Should they “go back to zero,” as is the practice in many AA chapters? What if they stop drinking but acquire a gambling problem instead?”

Quote by Lance Dodes

Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

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Lance Dodes

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“Disease is usually a binary system: either you’ve got it or you don’t. Pneumonia: got it or you don’t. HIV: got it or you don’t. Multiple sclerosis, polio, emphysema—all of these are yes-or-no propositions. But alcoholism is not, in fact, a disease: it is a behavior, or perhaps a collection of behaviors. And because nobody can say for sure whether a behavior has ever been eliminated for good without a crystal ball, we must first establish a baseline definition of what success looks like in the treatment of addiction. I’ll propose this simple definition: A treatment for alcoholism may be called successful if an individual no longer drinks in a way that is harmful in his or her life.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“A review of all such reports between 1976 and 1989 was performed by C. D. Emrick (of the School of Medicine of the University of Colorado) and colleagues. The researchers concluded: "The effectiveness of AA as compared to other treatments for “alcoholism” has yet to be demonstrated. Reliable guidelines have not been established for predicting who among AA members will be successful. . . . Caution was raised against rigidly referring every alcohol-troubled person to AA.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“In a paper published in the New England Journal of Medicine, the oldest continuously published medical journal in the world and widely considered the world’s most prestigious, D. C. Walsh and his co-researchers “randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at AA meetings, and a choice of options. The findings were notable: On seven measures of drinking and drug use . . . we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often . . . by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). These results led the researchers to issue a warning in their final recommendations: “An initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“In 2006, the Cochrane Collaboration undertook a characteristically careful and detailed look at studies of AA and 12-step recovery. First, the researchers recapped what had been determined to date: "[A] meta-analysis [historic analysis of previous studies] by Kownacki (1999) identified severe selection bias in the available studies, with the randomised studies yielding worse results [for AA] than non-randomised studies. This meta-analysis is weakened by the heterogeneity of patients and interventions that are pooled together. Emrick 1989 performed a narrative review of studies about characteristics of alcohol-dependent individuals who affiliate with AA and concluded that the effectiveness of AA as compared to other treatments for alcoholism was not clear and therefore needed to be demonstrated." The Collaboration then identified eight high-quality, controlled, randomized studies, with 3,417 subjects in all. Their conclusion was unambiguous: “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“What troubles many good scientists about research like the Fiorentine paper is that studying the people who choose to attend AA is an almost perfect recipe for generating the compliance effect error. AA members who frequently attend meetings may be demonstrating the same sort of self-care qualities that the placebo takers do. They may be, in effect, the Boy Scouts, or “eager patients,” of the addict population. Nobody who has looked at this data would dispute that people who attend AA most often and stay the longest are more likely to improve than the dropouts. The question is whether AA is driving this outcome or benefiting from a correlation instead. Is it possible that the kind of people who stay in 12-step programs are already more likely to improve? Would they be equally likely to do so in any treatment, or even no treatment at all? At heart, the dilemma facing AA research is whether people stay in AA because they’re the type of people who will stick with a program no matter what it is and who would have stuck with it even if it were of no help to them at all.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Visit a therapist and AA together, the data suggests, and you are likely to do better than you would with therapy alone. But visit a therapist for one year and then try AA, and you won’t do any better than if you had just stayed in therapy.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Unsurprisingly, they found that the people who stuck with either treatment—AA or professional treatment—did significantly better than those who did not. These were the compliers.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“People who stayed in AA for fewer than six months had worse outcomes than people who never entered AA at all. This finding seems to mirror the Brandsma data: AA attendees seem to get worse before they get better. One theory is that the finding is nothing but noise—the standard statistical turbulence that can foul any short-term study. But if the data are real and repeatable, then they suggest something the Moos researchers perhaps did not consider: that AA might do more harm than good for the people who choose to attend but do not buy into the program.”

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Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“Why do large observational studies such as that of Fiorentine and Moos seem to suggest that AA is effective, while smaller controlled studies like those of the Brandsma, Walsh, and others included in the Cochrane Review do not? The likely explanation is simple: people stay in AA if they’re getting better and leave if they aren’t. This is understandable. If you are able to stop drinking, then continuing to attend AA is a comfortable and affirming choice. If you struggle with drinking and can’t make use of the AA approach, then you are less likely to keep attending. Over the long term, the people who remain in AA are, by definition, the success stories. But they represent a very small slice of the people who start there; as we will see shortly, the dropout rate from AA is extremely high. These facts—that AA works for the diehards and fails for the dropouts—are perennially misunderstood by the press and even by some researchers. Proponents of the program proudly point to the fact that people who stay in AA tend to be sober, ignoring the tautological nature of this claim. Reviewing this logic, Harvard biostatistics professor Richard Gelber said, “The main problem is the self-fulfilling prophesy: the longer people stick with AA the better they are, hence AA must be working. It is like saying the longer you live, the older you will be when you die.” As we will soon see, this fundamental error in logic undergirds nearly every claim of AA’s efficacy.”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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“In 2008, J. McKellar (writing as lead author, with Ilgen, Moos, and Moos as coauthors) concluded that “clinicians should focus on keeping patients engaged in AA.” This recommendation is even more dogmatic than Moos and Moos suggested in their original paper. In fact, this paper itself notes that pressuring people to attend AA is usually unhelpful: “a significant number of substance abuse patients never attend self-help groups after discharge,” that is, when no longer mandated to attend.”

AddictionRecoverySobrietyRehabGamblers AnonymousGam AnonAlcoholics Anonymous12 Step ProgramAaAl Anon
Book:The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry
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