Discussion on the merits of Alcholism Treatments

[David O]

This is a transfer of a few substantive posts from the the "front" of the site. The posts here are those looking solely at the issue of evidenced based treatments for Alcohol Dependence (if your post does not appear here, but should, let me know and I'll make sure it gets in):

David O wrote> One thing that's apparent is that the tone and content of this "debate," inclusive of the requests by Allan and Mark for civility, sounds almost identical to what was being posted 6 months ago and again even soon after the comment section for this article were opened. Essentially, we have nearly the same content being regurgitated with the same frequent caustic tone, only the names have changed.

The ego has a insatiable appetite, the more you feed it, the hungrier it gets, and the hungrier it gets, the closer it gets to one’s position. The problem is that once a position gets knocked down, the ego goes with it. Those with the most ego to lose (the ones with the more fragile egos) seem to be the ones who shout the loudest and wreak the most havoc.

A far more fruitful discussion would be that we provide a more reasoned and logical analysis of the various models- AA/12 step , Rational Recovery, SMART Recovery, Relapse Prevention, Harm Reduction, etc., which would require that folks be able to intelligently and respectfully discuss the merits and weaknesses of each program—this would be more helpful to anyone who was visiting the site and genuinely looking for answers. As it stands, much of the “debate” is egocentric, juvenile and unnecessarily disrespectful, while the real issue is being disregarded and those seeking answers are being left to decide not based on the merits of any program, but based on a “debate” muddied by personalities as opposed to real information.

Of course, I’m aware that such a discussion will likely not occur for obvious reasons.

David O.

Edited November 25, 2009 by David O

[David O]

Tony J wrote>> David O :"....which would require that folks be able to intelligently and respectfully discuss the merits and weaknesses of each program—this would be more helpful to anyone who was visiting the site and genuinely looking for answers. "

David, the article discusses the fact that some see AA as a cult. This has served as a rallying point for that vocal (though very small) minority.

I would be happy to discuss the merits and weaknesses of AA with a person who could discuss the merits and weaknesses of an alternative recovery method.

You see, there isn't anyone here who can speak intelligently and respectfully about other methods because the people that are here (the anti-aa's) were drawn by the title of the article. The only common bond they have is that they don't like AA. They aren't connected by 'recovery' or any positive type of bond. Only the negative 'hate' bond.

As an AA supporter I would be remiss if I let some of the lies and propaganda that is posted here go unchallgened.

Ego or not, the anti-AA who spends his time preaching the evils of AA and can only tell the suffering alcoholic to 'stop drinking' is very irresponsible, to say the least.

[David O]

Mona Lisa wrote>> Tony J writes: "I would be happy to discuss the merits and weaknesses of AA with a person who could discuss the merits and weaknesses of an alternative recovery method."

I'd be happy to discuss alternative recovery methods, Tony. Let’s start by looking at a recent meta-analysis that evaluated 48 different treatment modalities and ranked them by efficacy. Of the 48 treatments, AA and 12 step facilitation were ranked 36 and 37. Hester, R. K., & Miller, W. R. (Eds.). (2003). Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.). Boston: Allyn and Bacon. In case you don’t have the book handy, the ranking can be readily accessed here: http://www.addictioninfo.org/articles/53/1/What-works-A-summary-of-alcohol-treatment-research/Page1.html and a similar report is here: http://www.robertjmeyersphd.com/pdf/Evidence-based%20treatment.pdf

So, where do you want to start?

How about with the number 1 ranked treatment: Brief Interventions? Brief interventions typically consist of one to four short counseling sessions with a trained interventionist (e.g., physician, psychologist, social worker). They have been shown to be effective with both problem drinkers and alcohol-dependent individuals. http://pubs.niaaa.nih.gov/publications/aa43.htm. They've been shown to be especially effective in emergency room settings, where people often show up following alcohol-related incidents. http://www.niaaa.nih.gov/NewsEvents/NewsReleases/briefintervention.htm

Or how about the number 2 ranked treatment: motivational enhancement therapy. This is a method of assisting clients to improve their motivation to change by exploring and resolving ambivalence. Here's some interesting information on the method: http://casaa.unm.edu/mimet.html

Again, note that both of these approaches to alcoholism treatment have been found to be significantly more effective than AA. As the researchers who did the ranking put it: “[t]he negative correlation between scientific evidence and treatment-as-usual … could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy.” (p. 41).

[David O]

Tony J wrote>>> Mona : "Again, note that both of these approaches to alcoholism treatment have been found to be significantly more effective than AA. "

There are no numbers regarding AA one way or another. Talking about the recovery rates that can't be confirmed isn't the same as talking about the 'treatments'.

Your BIN treatment is merely a screening process. It's not a treatment at all. Success is measured by :

"Researchers contacted members of each group three months later to assess any changes in drinking habits. The intervention group reported drinking three fewer drinks per week than the controls, and more than one-third of individuals in the intervention group reported drinking at low-risk levels, compared with about one-fifth of those in the control group.

"

I don't know about anyone else, but 3 drinks per week more or less wouldn't have made much of a difference in my addictive behaviors. Assuming I (for some unknown reason) would tell the truth.

Statistics are not the treatment. Even if they were valid they wouldn't mean much in a discussion of treatment options.

Hyperlinks are also not a 'discussion'. They are merely pointing to what someone else has written. They are okay to back up an assertion but again, they don't constitute a 'discussion'.

[xenophon]

After I quit drinking, I investigated my options on line. I rread about: LifeRing, SOS, AA and SMART Recovery. I chose SMART as it seemed to suit me. If SMART did not work out, I would have gone to something else.

I had some unfinished business to work with my thoughts and emotions. Both remained fairly disordered. I did not go to live meetings , as live meetings are not my style. I did make good use of the 'tool box' The link to it:

http://www.smartrecovery.org/resources/toolchest.htm

The message board was fine; the people there were OK. The chat room and on line meetings were helpful.

I read the LifeRing and SOS websites. They both seemed good to me. I am not compatible with AA. People do make their own choices.

It was, of course, up to me to get my act together. No one else had any responsibility in that regard. Other people were good support and had good ideas. But, it was my job to get squared away.

It all came together and I live well nowadays I got what I wanted. And, I discovered that what I wanted is worth having.

Call no man happy until he is dead.

[Tony J]

Hey, this has the makings of a decent thread.

I hope it goes someplace.

[xenophon]

That is not impossible. There are some caveats:

One, none of these groups have a publicly presented success rate. There may be an internal number. But, nothing public.

There fore, what we are presented with are personal memorials. Those, perforce, must taken as what they are: personal memorials.

What 'works' is a personal judgement. What did I want this involvment with a group to accomplish? Did it, using my own personal criteria, accomplish those goals? With those in mind, something useful may result. There are no guarantees.

For myself, I would like to read something about: SOS, Life Ring, WFS, MM, Harm Reduction. And, DIY. Do it yourself is the the most commonly used option.

[Tony J]

Thread Deleted

Edited November 26, 2009 by Tony J

[David O]

Mona Lisa wrote>>: "Again, note that both of these approaches to alcoholism treatment have been found to be significantly more effective than AA. "

Tony J wrote>> There are no numbers regarding AA one way or another. Talking about the recovery rates that can't be confirmed isn't the same as talking about the 'treatments'.

David O wrote: The meta analysis summarizes numerous studies and gives recovery rates based on their collective findings: recovery rates are outcome measures for specific treatment modalities, which are seen as empirical to quasi-empirical findings with specific treatments. In this case, AA/12 step had fewer robust studies indicating efficacy while it has been the treatment model most available and with the longest track record, by >50 years, of any of the other models. To question this correlation, Tony, without more substantive information than what you’ve proposed weakens your argument. Essentially, your point is symbolic; however, not significant from a research perspective.

Tony>> Your BIN treatment is merely a screening process. It's not a treatment at all. Actually, it is one phase of the outcome study and not the entirety of the study. The screening phase is there to ensure that patients in the study qualify as alcohol dependent: this does not suggest outcome since it is a pre-treatment baseline measure."

Tony>> Statistics are not the treatment. Even if they were valid they wouldn't mean much in a discussion of treatment options. The study clearly delineates an outcome for brief treatment and while statistics is not treatment per se, it is an outcome measure of treatment; therefore, it reflects the findings of the specific modality. Whether or not people tell the truth is a valid point and can be asked of millions of behavioral science studies; however, it is considered a standard measure worldwide as a means for obtaining valid and reliable information (market research, clinical trials, and satisfaction and climate surveys all use this methodology). Once again, questioning the validity or reliability of the studies w/o providing a studied rationale cannot be the basis for determining treatment efficacy.

It might be constructive if you analyzed the reports from a construct or content validity perspective, or if you critiqued the face validity of each study and were able to provide findings of your own-- e.g., flawed research design, incorrect statistical analysis, incorrect findings based on the data, use of the wrong statistics (should have used chi-square as opposed to the analysis of variance) for the specific study.

My recommendation would be that when critiquing and finding fault with a research study that is grounded in statistics or numbers, one has to provide an empirically grounded basis or be able to find flaws that significantly undermine the outcome. I'm not sure you have done this, but only Mona Lisa can tell.

Tony>> Hyperlinks are also not a 'discussion'. They are merely pointing to what someone else has written. They are okay to back up an assertion but again, they don't constitute a 'discussion'. The hyperlinks provide readers with the basis for the poster’s (Mona Lisa) assertions, much like references do in a dissertation or paper in school. One cannot reasonably be expected to quote the entire paper for each reference as this would place an unduly high standard that even dissertation committees do not demand.

Tony, in lieu of attempting to critique Mona Lisa’s post, it is recommended that you present contradictory data. It would likely have to also be a meta-analysis so that everyone is comparing apples to apples. Thereby, the discussion would meet your standard:“there isn't anyone here who can speak intelligently and respectfully about other methods.” I think Mona Lisa has just done this; however, I’m it appears that your critique may not meet the standard already established by her—a standard that appears to meet your “intelligent and respectful” criteria.

Mona Lisa, it seems you’re not a member of the forum and cannot post a response. Please join ASAP so that you can better “defend” your assertions. My review is very cursory and I’m not an expert in treatment for addictions.

David O.

[David O]

Mona Lisa wrote>>>

Hi,

Apparently the discussion about evidence based alcohol treatment has been shifted over here, but I cannot participate in the thread because I'm new. I'll put my response here. I assume that is ok.

Tony, you say that "There are no numbers regarding AA one way or another. Talking about the recovery rates that can't be confirmed isn't the same as talking about the 'treatments'."

That's actually one of my points, Tony. AA can't be really be shown to have any recovery rate, because it's so difficult to study, being an anonymous program. That's basically the reason it ranked so low; too little evidence to support it. Interestingly, though, 12 step facilitation also didn't do well, and that's not an issue of anonymity.

Your BIN treatment is merely a screening process. It's not a treatment at all.

Well, it's both a screening process and a series of brief interactions with a clinician. Now, you're right, it isn't a treatment in the traditional sense, and yet, the data showed that it was more helpful than AA.

Statistics are not the treatment. Even if they were valid they wouldn't mean much in a discussion of treatment options.

I'm not sure what you mean here. Of course, statistics aren't treatment, but they provide evidence that the treatment works, and isn't that the point of our discussion?

Hyperlinks are also not a 'discussion'. They are merely pointing to what someone else has written. They are okay to back up an assertion but again, they don't constitute a 'discussion'.

That's an interesting comment, Tony. Actually, the reason I added the hyperlinks is because I wanted you to be able to refer to the materials I was writing about. That only seems fair, and it is certainly easier than reproducing all the material I was using in making my point.

In the end, I guess I'm not sure how to respond to you if you aren't interested in statistics or links. To me, those are the lifeblood of an intelligent discussion.

ML

[xenophon]

In all likelihood, I should not be here, as I am not 'in recovery'. I am not, and, was not, alcohol dependent. I did drink too much for a period of time owing to personal problems. The content of those problems is irrelevant, the relevance is that these matters led to alcohol abuse.

People such as myself are largely ignored: people who quit on their own. Having read about this matter, I was driven to conclude that people such as myself are considered to have never had a significant problem.

That is: if I am able to quit without help, I did not, in fact, ever have a serious problem. Forgive me if I find that amusing; my sense of humor runs to black.

I can, and do, accept that. But, it does seem to be the case that I am not unusual at all. Just want to point that out.

Second: mental ilness. There does seem to be a relationship between mental suffering/mentall illness and substance abuse. Just want to point that out.

[JulianP]

deleted.....

Edited February 11, 2010 by JulianP

[xenophon]

Julian, to be romantic about it, "fate knocked on the door".

Which is true, if a little dramatic. Actually, it was more prosaic: suicide by wine took too long. I decided that life was worth living. In retrospect, five years on, I made the right choice.

Having lived through what I lived through -- which I would not wish upon the devil or his horse - [ drinking was the smaller part of it] - I decided to make sense of it. I have not made sense of it. maybe I will not. So, I am looking. I will know what I am looking for after I have found it. I just hope that I see something that makes some sense.

The little sense that I have made of it comes to this: Life is contingent; and, deserve has nothing to do with it. That is, fate does knock on the door.

To discuss the content of the mental suffering seems to me a kind of inverse braggadocio; I suffered more than you suffered. That seems undignified to me. I am satisfied that I suffered the amount that fate called upon me to suffer. I believe that no man may be called happy until he is dead.

[Tony J]

Right. There are no statistics regarding AA. Therefore we can't compare AA to other programs using statistics. Sad but true.

So when you assert that 'the data' showed BIN was more effective than AA, you have actually asserted nothing. The BIN reports 53% but we have no number for AA. It is just plugged in at some point randomly.

Also, the criteria for effective treatment in the BIN program was 3 less drinks per week. For an alcoholic that would be a meaningless difference. (although that is a topic for the merits of that particular method)

The point of our discussion, I thought was to discuss different treatments and the pro's and con's of each. That has nothing to do with statistics which, as you can see don't add up to much. Statistics can prove anything.

Or, as in this case, nothing.

And hyperlinks are certainly a good thing, but if they aren't presented as part of a discussion of some sort, they're just ..... links. I just got the feeling you threw some studies my way and told me to read them. That isn't 'intelligent discussion' to me. It's intelligent enough, but the discussion part is lacking.

I guess I was thinking more along the lines of why BIN was better than AA in one area or another or SOS would appeal to this type of person.....you know a 'discussion' on the 'merits' of each.

The best you can get from statistics is how many people stopped drinking.

If you want to go strictly by statistics then death is the best treatment method. 100% success rate and it's free and available to everyone.

Obviously death has less merits than some of the other methods listed though.

Mona Lisa wrote>>>

Tony, you say that "There are no numbers regarding AA one way or another. Talking about the recovery rates that can't be confirmed isn't the same as talking about the 'treatments'."

That's actually one of my points, Tony. AA can't be really be shown to have any recovery rate, because it's so difficult to study, being an anonymous program. That's basically the reason it ranked so low; too little evidence to support it. Interestingly, though, 12 step facilitation also didn't do well, and that's not an issue of anonymity.

Your BIN treatment is merely a screening process. It's not a treatment at all.

Well, it's both a screening process and a series of brief interactions with a clinician. Now, you're right, it isn't a treatment in the traditional sense, and yet, the data showed that it was more helpful than AA.

Statistics are not the treatment. Even if they were valid they wouldn't mean much in a discussion of treatment options.

I'm not sure what you mean here. Of course, statistics aren't treatment, but they provide evidence that the treatment works, and isn't that the point of our discussion?

Hyperlinks are also not a 'discussion'. They are merely pointing to what someone else has written. They are okay to back up an assertion but again, they don't constitute a 'discussion'.

That's an interesting comment, Tony. Actually, the reason I added the hyperlinks is because I wanted you to be able to refer to the materials I was writing about. That only seems fair, and it is certainly easier than reproducing all the material I was using in making my point.

In the end, I guess I'm not sure how to respond to you if you aren't interested in statistics or links. To me, those are the lifeblood of an intelligent discussion.

ML

[Ray Smith]

Right. There are no statistics regarding AA. Therefore we can't compare AA to other programs using statistics. Sad but true.

Saying there are no statistics, then saying that you don't want links to statistics is disingenuous.

The largest study of its time was done by George Vaillant, Harvard professor and (former) member of AA's Board of Trustees. He compiled several earlier studies and ran his own. He had set out to prove that AA worked and found it worked no better than no treatment at all and had a higher mortality rate.

If we don't talk about stats & studies, facts & figures, we're merely giving opinions. AA has been given some great press since it began mostly testimonials. While testimonials have their place, if they were always true, I'd be spending my time making thousands of dollars a month in two hours a day on the internet rather than spending my time posting in forums such as this.

[xenophon]

All this is, I think, impressionistic. I do have an interested in learning something about SOS and LifeRing. I am satisfied that I have a pretty good reading on SMART Recovery, having been there and used the 'stuff' there.

So, what about SOS and LifeRing?

I think that all this may help someone take a decision on what to make use of.

[David O]

Xenophon,

I can't possibly do either justice, but for some pretty good info on SOS, you can go here:

http://www.secularhumanism.org/index.php?section=sos&page=index

http://cfiwest.org/sos/intro.htm

http://www.sossobriety.org/whatissos.htm

For Lifering, here is one site that might be of help:

http://liferingsc.info/Welcome.html

I'm sorry i don't have more. I think Lifering received some negative pres awhile back, but I'n ot sure what the bruhaha was about.

Hope this helps,

David

Edited November 27, 2009 by David O

[xenophon]

Thanks, I think that is helpful to many.

LifeRing and SOS were one organization at one time. There was a separation some years back.

Both seem to be quite self directed, a kind of design your own. Marty Nichols, the leader of LifeRing has good ideas, in my view.

[Mona Lisa]

Hope everyone had a nice Thanksgiving!

I'm back, but it looks like Tony has departed. The topic is still a good one though and I'm glad that others are chiming in.

Regarding recovery groups other than AA, to me, it seems as though taking the discussion in that direction feeds into the idea that support groups are necessary to recovery. I've been sober for a long time and I don't go to AA or any other support group (although I did go to AA for a few years at the beginning).

The reality of my life is that, despite quite a severe drinking history (I was psychologically and physically addicted to alcohol), I never have a desire to drink anymore. I don't struggle at all. I don't call myself an alcoholic. I don't say I'm in recovery. I simply consider myself a non-drinker, and I'm quite comfortable with that.

But AA's philosophy of powerlessness and the need for God's intervention has so permeated general thought, that I am still sometimes asked how I continue to stay sober. The truth is that I don't need to do anything. Drinking isn't an issue for me and hasn't been for years. Yet, when I answer honestly that I don't do anything, even laypeople give me a funny look...they've learned that alcoholism is a lifelong struggle requiring outside support forever.

It ain't so!

In my opinion, the single most critical factor in giving up an addiction is motivation. Heck, even in AA, they'll tell you that the program "isn't for those who need it, it's for those who want it". Motivated individuals quit. Social support can help, but it isn't the critical factor: motivation is. This might explain why Brief Interventions and Motivational Interviewing did so well in the meta-analysis I referred to previously.

ML

[xenophon]

I agree that drawing a line under alcohol abuse does not require life long support. A person may want some help during the rough early periods. Perhaps some good ideas on relacement of drink; or, moral support; or, good ideas on thinking more effectively; or, coping more effectively with turbulent emotions. That sort of thing.

Motivation and determination are very important.

[Guest ASchwartz]

Hi ML and Xenophon and Everyone,

I agree that a person does not necessarily need to continue in support groups forever in order to maintain sobriety. I am aware of the AA attitude towards this and I do not agree. It is an individual decision.

That is my point: There are things about AA that are useful and others that are not. Pick and choose what you need and what you reject.

What concerns me about this endless discussion of the pros and cons of AA is that, what in my opinion is more important gets ignored and that is the increasingly severe and dangerous problem of drug addiction in our society. It feeds into violent crime, gang activity the destruction of individuality and human dignity. Now, it not only is alcohol but an endless list of other drugs that pale in comparison to alcohol, not to imply that alcohol is harmless because it is not: it is dangerous. But people smoking battery acid in the form of Meth. Amphetamine, is even more dangerous and destructive.

Can we get to talking about those problems???

PLease???

Allan:confused:

[Mona Lisa]

Allan,

Actually, this thread is not about AA; it's intended to be a discussion on the merits of different treatments for alcoholism and as such it will inevitably touch upon some of the perceived problems with AA. The reason it will necessarily do this is because 12 step treatment is currently the one most commonly used and will therefore sometimes serve as a basis for comparison.

If you would like to begin a discussion regarding the overall drug problem in the US (I agree, it's an enormous problem) perhaps you could start a new thread.

ML

[xenophon]

I agree that alcolhol/substance abuse is a real problem. It is not just the gratification that comes from getting high that drives it. It is, also, [ I think] the 'self medicating' that drives it. Mental illness/mental suffering and substance abuse are connected.

Those root causes should be addressed mor effectively.

A lot of people do not seem to understand that 'getting high' does not solve anything. Ultimately, the 'friend' becomes an enemy.

[Mona Lisa]

Hi all,

Here's an interesting study:

http://www.u.arizona.edu/~penn/Brooks&Penn_2003.pdf

I'd suggest that people read the whole study, but here's a portion of the abstract:

The 12-step intervention was more effective [than SMART] in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention.

SMART was more effective in improving health and employment status,

but marijuana use was greater for SMART participants. Improvements in

alcohol use and life satisfaction occurred in both approaches.

Note that a significant limitation of this study is that there was no control group.

ML

[xenophon]

I do not quite know what to make of that study. It seems to me that it needs to be followed up.