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“Why do purely observational studies fail so often despite finding such clear associations? The diet soda example tells the tale. All of those alternative theories I mentioned can be boiled down to a single, devastating possibility: what if diet soda drinkers are just fundamentally different from regular soda drinkers, in any of the ways I mentioned, and this difference colors everything about the way they live and behave? Scientists call this the selection effect, or selection bias. When human beings are free to behave as they always have—free to willfully choose their behavior—there is no meaningful way to find a control group of comparable subjects.”

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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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“A growing body of evidence strongly suggests that people who do things faithfully and regularly for their own well-being, such as taking a multivitamin, exercising daily, or eating a certain diet, are, in fact, fundamentally different from people who don’t. People who adhere to, or comply with, medical advice are more likely to take care of themselves in numerous other ways as well: "Quite simply, people who comply with their doctors’ orders when given a prescription are different and healthier than people who don’t. This difference may be ultimately unquantifiable.”

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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“The compliance effect can lead researchers and reporters who study interventions to falsely credit a pill or diet with improving our health—“Look, people who take fish oil pills live longer than the rest of us!”—when the truth may be far more subtle: the kind of people who take supplements in a disciplined way are already healthier to begin with, with a better prognosis for every disease.”

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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“The compliance effect has led to some famously strange epidemiological results. One long-term study showed that people who took a placebo were half as likely to die as those who did not. Was the placebo protecting them in some way the researchers had failed to anticipate? Hardly. It turned out that simply taking the placebo regularly was a signpost for a wholly different lifestyle. The pill takers were simply more actively engaged in their health across the board.”

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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“A poor understanding of these issues—the need for randomization, the difference between correlation and causation, and the power of the compliance effect—has colored much of the research that has been conducted to date about the effectiveness of 12-step membership and attendance.”

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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“Deborah Dawson of the National Institute on Alcohol Abuse and Alcoholism, Division of Biometry and Epidemiology, once lamented the lack of credible data in the study of addiction treatment: “Few, if any, studies have assessed the impact of different types of treatment on both the probability and rapidity of recovery, i.e. on person-years of dependence averted.”5 Her principal complaint: the lack of controls in most AA studies.”

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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“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?”

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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“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.”

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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“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.”

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 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.”

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 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.”

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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