Proof that Alcoholics Anonymous works

[John Rutledge]

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Edited October 28, 2009 by John Rutledge

[Guest ASchwartz]

Ray Smith, JR and others,

Ray, for some very odd reason you have cast Phoenix Multisport as the same old twelve step stuff painted over to hide the rot. Perhaps it is the way I wrote the article but that is so far from the truth that it defies logic. OK, so you report that you want facts. The facts are that Phoenix is not some painted over rot to hide the same old, same old. The is no requirement that anyone has to have ever been to any program. They just have to want to stop and they do not have to take any oath or make any promises. It is not an "all day program" and many of those recovering are working to support themselves.

Ray, JR and others, there is another program that is not 12 step at all and it is called Smart Recovery. It can be found at http://wwwsmartrecovery.com

Ray, what I find so frustrating in attempting to reason with you is that anything positive that is presented is immediately cast in the most negative light possible. That includes your insistent and persistent statement that we (Mark and I) are attempting to promote AA. It may seem that way to you but it is not what you refer to as "fact." The problem is that it is not enough to be critical alone without offering positive alternatives. You said something vague about "motivational interviewing." If there is something to offer there why not state what it is and where people can go to get it.

At the risk of sounding too pro AA again, if you do a search of outcome studies for addiction treatments, even alcohol alone, on GoogleScholar

you will find many controlled studies that focus on treatment and outcome. The results do not damn AA. They do not praise AA or praise anything. You can read the abstracts if you do not wish to purchase the articles but the controlled studies really give a balanced view. As to percentages of people helped by any programs of any type, the results are mixed at best.

What seems to be factual is that some programs help some people some times. That incudes treatment with medications. That also includes psychotherapy diagnoses.

By the way, Ray, I agree with you that diagnosis and treatment of the emotional disorders is overlooked and is probably a good reason why so few get better regardless of where they go.

How about that, I actually agree with you about something.

Allan

[John Rutledge]

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Edited October 28, 2009 by John Rutledge

[Guest ASchwartz]

JR,

Thanks for that posting. It is very helpful and you are correct.

Allan

[Ray Smith]

Ray Smith, JR and others,

Ray, for some very odd reason you have cast Phoenix Multisport as the same old twelve step stuff painted over to hide the rot. Perhaps it is the way I wrote the article but that is so far from the truth that it defies logic. OK, so you report that you want facts. The facts are that Phoenix is not some painted over rot to hide the same old, same old.

It wasn't your article, I googled Phoenix Multisport. Read about it on several sites, watched a Newsweek video, the people in the video were all AA/NA members speaking in AA language:

( http://www.newsweek.com/id/40211#?l=1785302026&t=27481154001 ) Phoenix holds 12step in high regard. Affiliated with West Pines, a 12step treatment center. It is not a 12step group, it is an outside activity for 12step members. It is not a recovery method and in my opinion, not germane to recovery discussions.

Yes, I'm familiar with SMART, and also with RR, LifeRing, WFS, but mostly with SOS. I believe that these alternatives to AA have a place (primarily for those who have been exposed to AA and have been lead to believe that a face to face group is necessary for recovery), but I do not believe they are necessary for people to quit drinking. In a way, these groups re-enforce the concept that one needs a group to quit. Stanton Peele examines this in Diseasing of America . The vast majority of people who quit alcohol and drug problems do so on their own, attending a group that tells them they cannot do it alone is counterproductive. Convince someone they can't do something and they most likely will be unable to do it.

I don't believe in any one size fits all program, especially when it comes to dually diagnosed people. I believe most people will benefit from CBT or DBT classes, or by working with a therapist who employs Motivational Interviewing or Motivation Enhancement. ACTT programs around the world use MI, the main problem being that most of the professionals working on ACT teams today were trained with 12step in mind and some have not kept up. The substance abuse counselor I work with is a Hazeldon graduate who would be pushing 12step if she could. I was hired because I understand the objections to 12step recovery, and because I have stayed sober without it.

MI boils down to getting the client to decide what it is THEY want, and then helping them explore what they are willing to do to get there. I was in an ACT program that was starting up in New York and had the opportunity to attend workshops given by Minkoff and Scaicca. (My Human Services professors were jealous.)

As far as studies go, I've been making a serious study of AA the past 7 years. There have only been a few randomized longitudinal controlled studies, Brandsma, Ditman, Walsh, Orford & Edwards, and in each of these, AA was found to be lacking. About the only studies that show AA in a positive light are the studies by Humphries and Moos, who cherry pick the subjects of their studies and confuse correlation and causation. The work of George Vaillant, Harvard professor, researcher, and former member of AA's Board of Trustees is a real eye-opener. He set out to prove that AA worked (bad start for a serious study), instead, he proved that AA did not change the rate of spontaneous remission and raised the mortality rate of those involved in the program as explained in his book The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery

You claim I'm trying to portray AA in a bad light, I say you're spotlighting the few people who stay in AA and maintain their sobriety while ignoring the 95% of new members who drop out in their first year and the objections to AA that caused them to drop out.

[Guest ASchwartz]

Ray,

First:

This debate continues:

For example, you statement about Phoenix Multi Sport:

It is not a 12step group, it is an outside activity for 12step members.

You seem to have a talent for distorting and that results from your logic. For example, you watched some sort of Newsweek video about Phoenix and it evidently included members who came from twelve step programs. So, you grant that Phoenix is not a twelve step program, instead, you state that "it is for twelve step members.

I believe (but someone else may need to check this) that you are using converse reasoning. The fact that the people you saw in the video were twelve steppers does not mean that Phoenix is for twelve steppers.

Why am I stressing this? In and of itself this is a minor point. Phoenix is a small program and makes little difference to what we are discussing. However, I believe it points up your tendency towards faulty reasoning. And, for that reason, I am saying that, in this case, the major facts are less important than the reasoning.

Phoenix is not for twelve step members. Phoenix is for anyone who wants to stop abusing drugs, regardless of whether they were in a program or not. As I have said before, there are members who have been to twelve step programs and there are members who have not.

Second:

I do insist that you are portraying AA in a bad light. But, the reason for my making this assertion about you is that you entire argument (in my view) is negative.

Here is what I mean. Much of your anti AA and anti 12 step argument is more about the nature of addiction and not about any programs of any kind or type. The addictions have built into them this tragedy of relapse, suicide and destruction of life.

How do we help people. You seem to be someone who is deeply involved in the field, has done lots of research and reading, and who leads your own groups. You more than anyone should be moving towards alternatives that might help.

Your anti AA and anti 12 step attitude would not rankle if it was balanced with positives in the direction of what works or what might work. Phoenix Multi Sport, thus far, and with the people involved (admittedly a small sample and it is a very young organization) may be on to something. The real and living people out here who I met are very enthusiastic. What are you enthusiastic about? What do you point to as possibilities for people who are trapped by an addiction?

In my mind, the problem is not AA or 12 steps but Addiction and why people need to be addicted. And, it in my opinion, so many are addicted because they find no meaning in their lives. They feel empty inside, unfulfilled because they see no purpose to their lives.

Allan

[Ray Smith]

In my mind, the problem is not AA or 12 steps but Addiction and why people need to be addicted. And, it in my opinion, so many are addicted because they find no meaning in their lives. They feel empty inside, unfulfilled because they see no purpose to their lives.

Allan

Allan,

You're quick to dismiss Narconon, what is the difference? Their members, like AA members are convinced that they have the inside track to dealing with addictions. Could it be that Narconon (Scientology) is a thinly disguised quasi-religious program that fails to demonstrate any validity to its claims?

For the select few, there is no harm and some even seem to thrive in those groups, so should we look the other way when it comes to all the people it doesn't work for?

[Guest ASchwartz]

Ray,

You're quick to dismiss Narconon, what is the difference? Their members, like AA members are convinced that they have the inside track to dealing with addictions. Could it be that Narconon (Scientology) is a thinly disguised quasi-religious program that fails to demonstrate any validity to its claims?

Once again, you have missed the point and given another example of your negativity. Yes, Narconon is scientology and that is extremely suspicious. But, what do you have to offer in a Positive direction?

Allan

[John Rutledge]

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Edited October 28, 2009 by John Rutledge

[Ray Smith]

Ray,

Once again, you have missed the point and given another example of your negativity. Yes, Narconon is scientology and that is extremely suspicious. But, what do you have to offer in a Positive direction?

Allan

Because of the huge overlap people in who have coexisting mental health and substance abuse disorders, first thing I'd suggest is a mental health assessment. This assessment can be a guide as to what may be the best treatment method for the person. The program I work for uses Motivational Interviewing with MH clients with or without substance abuse issues.

Brief interventions performed by health care providers, statistically, have the best outcomes, followed by Motivational Enhancement.

If you have a supportive family, Community Reinforcement Approach and CRAFT for the family.

Antabuse or craving reduction drugs in combination with individual therapy. CBT or DBT classes.

If the person is a reader, there are now hundreds of books available on the subject; one of the best known of these is Rational Recovery by Jack Trimpey.

If the person is computer savvy, there is plenty of online support and information:

SOS:

http://www.sossobriety.org/

http://health.groups.yahoo.com/group/sossaveourselves/

SMART:

http://www.smartrecovery.org/

http://smartrecovery.org/SMARTBoard/

LifeRing:

http://www.unhooked.com/index.htm

http://forums.delphiforums.com/lifering/start

WFS:

http://www.womenfor sobriety.org/

RR:

http://www.rational.org/

And with all those options, the majority of people, 80%, quit on their

own. The idea that a person NEEDS a face to face group in order to be able to stop is one of the most successful pieces of misinformation that has come out of AA. People quit drinking or drugging on their own every day and have been doing so for thousands of years. Teaching people they cannot quit on their own keeps people from making a serious effort and makes it more difficult to succeed. Imagine if everyone believed they must join a 12step program in order to quit smoking.

I haven't missed the point, I've been trying to make a different point, and that's why I brought up Narconon. Almost any objection you can raise against Narconon can also be leveled against AA. Don't get me wrong, I'm not suggesting Narconon as a recovery program, but you'll find people in that program who will swear by it and give glowing testimonials who cannot see the downside of that program. I see a major flaw in mixing recovery and religion of any kind; dealing with both a relapse and a crisis of faith is traumatic. When you start telling people they have a 'spiritual disease', you're getting into a very murky area, I think professionals should stick to evidence based practices. Peele's Diseasing of America: How we allowed recovery zealots and the treatment industry to convince us we are out of control does an excellent job of shedding light on this problem.

And if something doesn't work, you try something else. Relapses do not make a person a "poor unfortunate" who cannot get clean. People who fail at 12step treatment are told they aren't trying hard enough and sent back for more of the same until they finally get sick of the cycle and quit, while AA grabs the credit.

Until AA outperforms spontaneous remission, it cannot be considered a valid form of recovery. It is a false path, one that keeps people away from other methods that have better outcomes.

[John Rutledge]

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Edited October 28, 2009 by John Rutledge

[Ray Smith]

I have not made the kind of study into Narconon/Scientology that I have into 12step treatment, but from what I have found it that there exists a layer of deniability between Narconon and Scientology that reminds me of AA and 12step rehabs. "No, no, no, it the other one that takes all your money and we're not really them."

Narconon is the hook, if people do well in it, it gets them curious about Scientology.

Both are quasi-religious treatment methods that deny they are religious, the people involved claim they have the true way and both claim inflated success rates. Members are encouraged to cut out people who are not members, claiming outsiders cannot understand, I believe it is more of an attempt to keep members from being exposed to outside views.

I really don't see any difference in the more extreme cases. Granted, the anti-medication faction of AA is only about 20% as compared to Scientology's 80%+,but people die no matter who is preaching it.

I tried Antabuse once in rehab after two weeks of not drinking. Made me feel slightly nauseous all the time, so I ignored it for years. It may have helped me a later date had I not had a negative first opinion. Several people I talk to tell me that it works for them. That taking it in front of a spouse helped restore a level of trust that would have been difficult or impossible to achieve without it.

[Guest ASchwartz]

Ray,

The difference between AA and Narconon is that Narconon is part of what is truly a cult. Scientology is a very real cult. They are extremely secretive, have been accused of following and threatening members who want to leave it and keep its leaders in the shadows. AA is not quasi religious, even though you think so. Rather, they are attempting to replace lack of meaning with something meaningful. Its fine that you do not approve and I understand but the Christian religions are not cults: they are not secret, they do not hide in the shadows, etc. But, yes, Christianity is religious and AA does believe that religion helps.

You continue to point out the high drop out rate and the failure of AA. But, it is not the failure of AA but the frustrating nature of the addictions.

Antabuse was itself a failure from the start because, if someone wanted to drink, they just did not take it and that way did not feel nauseated. The new medications claim to take the craving for alcohol away. However, even there, the results have been mixed and there, too, if people stop taking the medication, the cravings return. In addition, if the person wants to drink, they stop the medicine. It seems that there is this "wanting to drink" that is separate from "craving."

I happen to agree with you, as do many others, that psychogical problems cannot and should not be separated from the treatment of the addicted person. They need to be treated together and to be seen as part of the same "syndrome."

Allan

[Ray Smith]

Well Allen, I haven't called AA a cult, but it is at least cult-like. Former member of AA's Board of Directors, George Vaillant and AA historian, Dick B. both call AA a cult, but I find it to be a conversation stopper. I do find that AA does fit almost all the 100 signs of being a cult on "The Cult Test" at:

http://www.orange-papers.org/orange-cult_q0.html

Narconon is not as obvious as Scientology, it's more of a way to entice people into the real cult. I would agree that Scientology is an obvious cult, but I don't think the difference between Narconon and AA on the spectrum is vast.

Antabuse? That's all you got out of all I wrote? I believe it's justified to say it works for some people.

"Researchers analyzed data gathered from 1993 to 2002, when 180 chronic alcoholics admitted to a two-year comprehensive integrated treatment program called the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA), in which supervised intake of disulfiram or calcium carbimide is a major component of the program.

"We found an abstinence rate of more than 50 percent among the patients studied," said Ehrenreich. "Long-term use of alcohol deterrents appeared to be well-tolerated. Abstinence rates were better in patients who stayed on alcohol deterrents for more than 20 months as compared to patients who terminated intake at 13 to 20 months." "

http://alcoholism.about.com/od/meds/a/blacer060108.htm

The Handbook of alcoholism treatment approaches: Effective alternatives lists Disulfiram 22nd in effectiveness of the 48 alcohol treatment methods they studied.

http://www.behaviortherapy.com/whatworks.htm

My biggest problem with the promotion of 12step treatment on these boards is that we're not talking about the general public, these boards are for folks with mental illnesses. The rule of thumb in the treatment of coexisting disorders is that half of all people with mental illness have substance abuse issues and half of people with substance abuse issues have a mental illness. So why are all people with substance abuse issues directed to treatment where mental health is largely ignored?

In 12step treatment, mental health is given lip service and little else; the abstinence rate for those with coexisting disorders in traditional 12step treatment is "too small to be accurately measured." [Kathleen Sciacca]

"(12step) Addiction professionals may believe that mental illness is a symptom or manifestation of substance abuse; mental health professionals may believe that substance abuse is a symptom of mental illness. Neither group is therefore likely to provide effective treatment for multiple diagnosed patients in their usual treatment setting." [Kenneth Minkoff]

Interagency Program development was implemented in Michigan in 1985. It proved that continuity of care across systems, with professionals of varied disciplines, is attainable and resulted in improved, less costly services for the dually diagnosed clients. So why, almost twenty five years later, has so little changed?

I think the question of whether AA is religious or not deserves its own thread and it is way too late for that tonight.

[Guest ASchwartz]

Ray, I am impressed with your knowledge and am beginning to enjoy our conversation. Have a good evening.

Allan

[John Rutledge]

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Edited October 28, 2009 by John Rutledge

[Ray Smith]

Ray, I am impressed with your knowledge and am beginning to enjoy our conversation. Have a good evening.

Allan

Thanks, Allan.

My objections to AA started with the religious nature of the program, but the more I examined the program I found statistically, it doesn't work very well, and for the population I work with, those with moderate to severe mental illness, it rarely works at all. Beyond the statistics, I have ethical problems with those who would send folks with anxiety, depression, or self esteem problems to a group that believes that every substance abuser needs ego deflation or that delusional people need instruction in magical thinking.

Working with people who have mental illnesses, helping them with simple things that allow them to stay out of group homes or institutions is my job and my passion. I primarily work with those who have coexisting substance abuse issues.

After being treated unsuccessfully for depression, I discovered amphetamines not only afforded me the energy to work my two jobs, but relieved my depression. This led to drinking in order to sleep at night.

After a couple of years, I was noticing the side effects and amphetamines were becoming more difficult to obtain, so I quit, but I had developed a sizable addiction to alcohol.

I experienced more problems with depression. No one would treat the depression until I had several months clean from alcohol, I was told that AA was the only way to quit. Thus began my two decade journey into ineffective, inappropriate treatment.

I've experienced some of the worst and come through. I want to use what I learned in those years and in the eight years that I've been sober to help people avoid going through the same things.

[Ray Smith]

I now believe that the most harmful aspect of the program as written is the idea that one is powerless over alcoholism (or their addiction).

I joined AA in order to do something about my addiction. Yes, I was conned into it, but I wasn't forced. If I had been powerless, I wouldn't have done anything, I shouldn't be able to comprehend doing anything about it. None of this "powerless over the first drink" nonsense, that is not how it is written in the literature, that is a rationalization, an afterthought attempting to make sense of the absurd.

Bill Wilson describes alcoholics as having out of control egos. While that may have been the case for Bill Wilson, it simply is not the case for many, if not most. Foisting powerlessness on a person with a negative self image is digging the hole deeper. Alcoholics have been marginalized by society, they do not need to further internalize powerlessness. Empowerment, gaining control of self, realizing potential, tapping internal strengths to make positive changes, rather than relying on outside forces to "fix" them, this should be at the center of any substance abuse treatment, but especially for those who experience coexisting mental illness.