A.A. Statistics, Statistics, Enough Already

[dickburns]

:)Success Rates. Success Rates. A.A. Statistics

Enough Already?

Dick B.

© 2008 by Anonymous. All rights reserved

The hills are alive with the sound of statistics. Statistics on A.A. success rates. Statistics on A.A. relapses. Statistics on recovery rates. Statistics on early A.A. cures. And surveys of A.A. and 12-Step populations, and other groups.

Have we had enough? The search engines and the web sites might suggest a continued interest, but they don’t prove the value or need. The subject matter is clouded with prejudices against A.A., prejudices in favor of A.A., religious contentions, atheist contentions, “scientific” methods and approaches, antagonism to “anecdotal” evidence, favor of treatment over fellowship, erroneous statements of A.A. roots, history, and principles, and misunderstanding of illusory ideas like a “higher power,” “spiritual, but not religious,” “powerless,” and “recovered.” And out of this pot full of mixed ingredients, some think you can take today’s diverse alcoholic/addict populations, varied interpretations, and subjective views of anonymous programs and conduct a reliable survey. Again, have we had enough?

Are we considering A.A.’s stated primary purpose of carrying a “message” to the still suffering alcoholic? And are today’s statistics founded on an understanding of what the “message’ is?

As one who has written his share on successes, failures, and cures, I’m not prepared to discard the work already in place, whether mine or that of someone else. But I do think it’s appropriate to suggest some conditions for evaluation.

The conditions:

• Do the statistics come from eye witness statements, rosters, or records.

• Are sample studies based on sound statistical measures, random samples, etc.

• Is a survey conducted by someone who either uses eye-witness materials or follows sound statistical methods.

• Is the surveyed population sufficiently broad—covering visitors, rim-runnners, “be-backs,” the disenchanted, and those who went elsewhere and succeeded.

• Does the survey distinguish between alcoholics and addicts, dual-addicted and poly-addicted, religious and non-religious, atheists and believers, professionals and participants, attenders and observers, “approved” and non-approved literature sources.

• Are the same people questioned or surveyed more than once in alternative meetings, groups, and populations—thus counting the same person’s replies in several different arenas

• Is the surveyor promoting treatment, therapy, religious preferences, A.A. hostility.

• Is the measure of “participation” based on subjective value judgments such as “meetings attended,” “sponsorship,” “service,” “taking the steps,” “membership.”

• Has any effort been made to distinguish between those who subscribe to some “higher power” theory, those who believe in the Creator, those who believe that A.A. is “spiritual, but not religious.”

• Are the surveyors conversant with the history and sources and variations in A.A.

• Are the surveyors conversant with the religious practices that were intimately involved in early A.A. and are virtually non-existent in today’s A.A.

•

There many factors that could be sifted and explained, but the real question is why any survey is published at all. Does the survey help a newcomer to achieve permanent sobriety today. Does the survey help improve a fellowship. Is the survey used to justify treatment, rehabs, therapy, drug courts, research, grants, and new endeavors in the pharmaceutical, nutritional, psychological, science, and medical activity. Is it conducted by someone with a conflict of interest.

The Early Program

Over and over, I have published the following statement: “Early A.A. had a documented 75% to 93% success rate among seemingly hopeless, medically incurable, real alcoholics who went to any lengths to establish a relationship with God.” A.A. literature so states. The Big Book provides one of the 75% reports. DR. BOB and the Good Oldtimers provides the 93% report on Cleveland. Rosters naming names and dates of sobriety and terminal dates of the early pioneers so state. I have personally seen several and checked out one for accuracy with Dr. Bob’s daughter before she died. These rosters have been sent to the Griffith Library in East Dorset, Vermont, where they are available for inspection. Bill Wilson frequently reported on the “counting of noses” that he, Dr. Bob, and Anne Smith conducted in late 1937 in which they identified 40 men who had maintained continuing sobriety (20), those who had relapsed but returned (10), and those who had “shown improvement.” Examples of Bill’s statements can be found in the DR. BOB book and elsewhere. Wilson and his wife frankly conceded that Bill himself had achieved no success whatever with the drunks he tried to help in New York in his first six months, nor with those whom the Wilsons had taken into their homes in the early years. This information can be found in Alcoholics Anonymous Comes of Age and in Lois Remembers. Richard K. of Massachusetts has published four land-mark, detailed studies of the early pioneers and confirmed the foregoing facts. These were published by the Golden Text Publishing Company. There is a large scrap book of newspaper articles from across the nation in the first decade extending from 1935 to 1945 that contains the statements of early AAs that they had been cured by the power of God. A complete copy of the scrap book contents has now been lodged at the new Dr. Bob Core Library at North Congregational Church in St. Johnsbury, Vermont.

Though true, what is the value of such statistical material in helping newcomers today.

The answer I have given is that a newcomer: (1) has to want to hear the history and the statistics: (2) then needs to hear accurate historical information (including statistics), if he or she wants to hear it; (3) then needs to decide whether he or she wants to believe accurate historical information and statistics; (4) has to want to apply the early A.A. program ideas today; and (5) at the very least, has to be willing to abstain permanently, believe in the Creator, obey His will, grow in fellowship with Him, and provide love and service to others still suffering. My belief, based on my own experience and comparing it with the early program, is that this historical foundation can and does provide the basis for achieving a permanent cure, a new life, and a worthy future for those previously deemed hopeless failures and where willing to place their trust in the Creator.

Gloria Deo

dickb@dickb.com

[Mark]

Welcome to the community Dick. you're welcome to post written pieces as you have, but maybe also come in and introduce yourself in your own words, please, so we can get to know you.

Mark

[Gene S.]

Welcome to the community Dick. you're welcome to post written pieces as you have, but maybe also come in and introduce yourself in your own words, please, so we can get to know you.

Mark

Dick B. is an anthologist and a historian of AA movement.

Dick, I would like to inform you you about evidence based standards:

Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more.

Systems to stratify evidence by quality have been developed, such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:

Level I: Evidence obtained from at least one properly designed randomized controlled trial.

Level II-1: Evidence obtained from well-designed controlled trials without randomization.

Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

The UK National Health Service uses a similar system with categories labeled A, B, C, and D. The above Levels are only appropriate for treatment or interventions; different types of research are required for assessing diagnostic accuracy or natural history and prognosis, and hence different "levels" are required. For example, the Oxford Centre for Evidence-based Medicine suggests levels of evidence (LOE) according to the study designs and critical appraisal of prevention, diagnosis, prognosis, therapy, and harm studies:

Level A: consistent Randomised Controlled Clinical Trial, Cohort Study, All or None, Clinical Decision Rule validated in different populations.

Level B: consistent Retrospective Cohort, Exploratory Cohort, Ecological Study, Outcomes Research, Case-Control Study; or extrapolations from level A studies.

Level C: Case-series Study or extrapolations from level B studies

Level D: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles

A newer system is by the Grade Working Group and takes in account more dimensions that just the quality of medical evidence.[10] "Extrapolations" are where data is used in a situation which has potentially clinically important differences than the original study situation. Thus, the quality of evidence to support a clinical decision is a combination of the quality of research data and the clinical 'directness' of the data.

Despite the differences between systems, the purposes are the same: to guide users of clinical research information about which studies are likely to be most valid. However, the individual studies still require careful critical appraisal.

Categories of recommendations

In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit of the service and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses:

Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients.

Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.

Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations.

Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.

Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

This is a distinct and conscious improvement on older fashions in recommendation and the interpretation of recommendations where it was less clear which parts of a guideline were most firmly established.

[Ray Smith]

I'd like to thank Dick for making AA history accessible. Whenever someone tries to call AA "spiritual, not religious", I send them to Dick B's pages.

[Guest ASchwartz]

Hi Everyone,

Everyone has been so fixated on AA that it perhaps distracts from another kind of thinking. Why not talk about other alternatives. AA is not the only thing out there. Do any of you know of or have experience with other types of support groups and treatments for Alcohol and Drug addiction?

Allan

[xenophon]

My anecdotal evidence is: SMART Recovery

It is CEBT based. The ideal is to abstain. It has a good 'tool box'. The idea is empowerment. It is accepting of dual diagnosis as a fact of life. It is accepting and upbeat; but not to gloss over things. The message board is good. The chat room and on line meetings are good. The on line meetings tend to be a bit chaotic at times. Not all that many face to face meetings. No sponsors. It is inspired by Albert Ellis. Dr. Horvath is involved with it.

A down side to SMART may be that some may find it too 'rational'.

SOS and LifeRing seem OK to me.

I have no personal experience with them. Just observing their forum at Delphi. None of these three seem to have a need to control.

All three seem competent and worth a good look see.

[SuziQ]

Hi,

I've thought and thought and it seems that in many ways AA and NA are the only games in town. Xenophen named a couple of others, but they are not easily available. She mentioned Dr. Ellis---I took a year long course in Rational Emotive Therapy from the Univ of Maryland when I was a counselor in Pensylvania. I liked it and used for myself and in my counseling--back then. There has been aversion therapy. There was Daytop. There are church based rehab centers. The medical treatment centers today employ psychological approaches mixed with some AA. There was Synanon---what a trip that was--I was there for a month. I've done some EST seminars--another trip. I did some re-birthing sessions. I did a 3 mo stint in a state hospital and 3 mos in the very upscale Cedars-Sinai Psych ward. I spent a few days in jail now and then. And I have used psychiatrists, psychologists and counselors thru the years on an as needed basis. I took a course in the physiological effects of alcohol while a counselor. A good basic course in the what alcohol does to the body without emotional overtones might help many understand what is happening and prevent deaths from alcohol overdose in colleges.

I am truly sorry that AA and NA members, in general, are not so open to these additional support therapies. However, I truly doubt that I would have had all the oportunites to move forward with dealing with living problems if it were not for AA. And I was lucky enough to have money to pay for the additional therapy---many do not. Even getting sober enough in AA to rebel against what some members want you to believe is a step forward. It is the only place I know that is open 24/7 and free to anyone that realizes they are in trouble with drugs and alcohol. No papers to fill out, no waiting to get in, no checking to see if insurance will pay, no answering machine until someone returns to the office, no checking our email to see if someone has replied, and most of us want the same instant relief in sobriety that alcohol gave us---at least in the beginning of sobriety. That is what AA offers--someone who understands what it is like to be drunk and who believes that you will have a better life if you are sober. They smile, they say welcome, come on in, and at that moment that is what you need. Later, with sobriety, you may find out lots of things you don't like and move on--but that moment changes many lives for the better.

[Wade72]

Generally I get seriously flamed when I mention that I work for a CBT drug and alcohol rehab, since apparently I am "living off the backs of addicts". Anyways feel free to flame away if you like, I'm use to it and I will console myself with the many sober friends that use to be clients that I now have, it is the most affective programme I have seen. The science behind it works for many people and is totally non-religious, instead of saying you are powerless, we say you have all the power, you just need some better decision making tools. It is definitely a good fit for some people with a success rate as high or higher then anything else. I never put down AA, NA, or any other programme for that matter since I believe that whatever works for you is great. There is even a Temple here in Thailand that has an excellent FREE programme that I have referred many people over to, but doesn't fit everyone since it is based on Buddhism.

Anyways for my 2 cents toss CBT into the ring as an alternative to AA that fits for allot of people.

Wade

[SuziQ]

Thanks Wade,

I did take a course in RET in the 70's, but I got sober in 1966. Maybe that is why I am an advocate of AA and NA. Police still parked outside NA meetings and it was illegal to treat drug addicts. There were few if any treatment centers as such. It was into a general mental hospital. Life Magazine, a leading magazine of the time, had just published an article on methodone. I overdosed on alcohol during a long binge drinking episode and went to the hospital, only to be told that I belonged at the mission on skid row and that was where they would refer me. So, thank goodness, there are more treatment options.

SuziQ

[Guest ASchwartz]

Hi Wade and SuzieQ,

Wade, can you explain what CBT is? I am not sure if you are referring to cognitive behavioral therapy or something else, altough I sense it is something else.

Also, why should you be flamed. We need as many effective treatment modalities for the addictions as possible. Also, I believe that there is now wide acceptance of Buddhist teachings here in the United States. Some of it has been integrated into various types of psychotherapy.

Allan

[Wade72]

ASchwartz;

Sorry I should of explained that, yes I meant cognitive behavioural therapy is the modality we us at our clinic. It seems to be more popular in the UK then the USA. As for why I get flamed, a couple of boards that I use to frequent had several extreme A.A. advocates that seemed to believe anything other then A.A. is wrong, and I just got use to it I guess. Seems people here are more open minded to other possibilities.

The temple programme I mentioned here in Thailand is called Wat Tham Krabok, which runs a different yet seemingly affective programme for some people and it's free, they state you need about 5 dollars a day to buy food plus cigarettes if your a smoker. It is more then just a detox though it seems and once you have signed yourself in I am told you can't leave and they will restrain you if necessary. So for a detox I am sure it is very affective for anyone, as a treatment programme after the detox why I said it is not suitable for everyone is it is geared very much to Buddhism, where that is perfectly fine with me I wouldn't think it is going to be very affective for someone with strong beliefs in another religion. Just as one of the main arguments I hear about 12-step programmes is the religious side of it.

I am not trying to re-start the debate on is AA religious or not. My only point is if someone believes it is and thats an issue for them, then it is definitely a problem, for them. As will be the Buddhist program if you believe it will be a problem or a contradiction to your belief system.

[Mr Nut Man]

Hi Everyone,

Everyone has been so fixated on AA that it perhaps distracts from another kind of thinking. Why not talk about other alternatives. AA is not the only thing out there. Do any of you know of or have experience with other types of support groups and treatments for Alcohol and Drug addiction?

Allan

Hi Allan!

I do go to meetings of AA everyday pretty much. I go basically for the fellowship, I don't believe everything that they say, and as far as I am concerned they do try and push there own spiritual *religion* on others. At least that has been my experience. Even after I went to college to be a minister, I have changed in my own belief system and that is just the way it is.

As far as Dick is concerned I think that sometimes IMO people just come and post on new forums etc just once to get them into the system with there own name if they have built it up as of such. That is just my own opinion and I am not flaming anyone just wondering what others motives are when they join and only post once and never come back to the topic at hand. Getting there own material out on the Internet I suppose. Heck I could do that myself but I choose not too..And anyways I am only a junkie trying to recovery Just For Today.

I use many things for my recovery, and most of them are not based on anything that most would use I guess. Like I said I go to meetings, I am not sure about the God thing anymore and don't dwell on it as much now that SuziQ replied to my thread that I started here. Thanks BTW I try to do what I can to just stay clean and somewhat sane if there is such a thing. But the way that my mind is LOL that is only for a little while. I am sure that I have a lot of mental issues that could be treated with medications, however I don't want to take them. Even though I have taken some of them about a month ago I took myself off of them like my Doctor said I could if I started to break out which I did.

I go to see her next week, and so far I can see of course my mood swings and they are not pretty. But lately the main thing that I have done when I get real depressed is to just like avoid things until I can get my attitude back on a more positive side. Sometimes that takes a lot of effort on my part. I might have to get back on my Anti-D's but I am not going to take that other stuff that makes me emotionless. I hate not being able to feel feelings, and sometimes I think a lot of people are way to quick to jump into meds. Of course this is my own opinion

So I guess my recovery treatment or program is a do it yourself type of thing. I take what I need from others that I think might be valuable, I have a good friend in AA that I talk to quite a lot about issues and things. I sometimes get into the 12 step kick and other times I say it is a bunch of BS...so I do have other things and most pertain to the Internet that I do and keeps me focused on staying clean..so that is a huge part of my stuff that I do. It has been working for almost 26 months now the longest I have ever been clean. So I will continue the journey that I am on..

Thanks for allowing me to be here.

[Ray Smith]

Hi Everyone,

Everyone has been so fixated on AA that it perhaps distracts from another kind of thinking. Why not talk about other alternatives. AA is not the only thing out there. Do any of you know of or have experience with other types of support groups and treatments for Alcohol and Drug addiction?

Allan

People are shoved into AA first, it is only when they complain (and have picked up some bad information and habits) that anything else is tried. By that time, there is a degree of recovery from AA that needs to be dealt with.

In my brief flirtations with AA, I "came to believe" that people couldn't get sober without AA, and that in order to get sober with AA, I had to accept AA's version of God. Since I couldn't do this, I believed my only options were suicide or the slow suicide of drinking myself to death. Several AA members confirmed these beliefs, questioning why I didn't give in and start believing.

Statistically, brief intervention, Motivational Enhancement, and Motivational Interviewing are produce better success rates than AA. Problem is, things are set up one way now and people are making money with the way things are. They have no desire for change.

[xenophon]

It stands to reason that those modalities would have better results.

It is not unusual for people to go through a period of substance abuse. And, the reasons may, frequently, be quickly discerned.

I suspect, but cannot prove, that severity and duration of the problem are important. And, the root cause is often important. All three are part of the solution.

I am not surprised that those methods are better results. It is quite logical that those methods work better than AA ever will.

Very little is actually known about those who put an end to destructive drinking. That should not be a surprise.

[Ray Smith]

The reason that people fixate on AA is that over 90% of rehabs and treatment facilities are 12step-based. People in 34 states can still be mandated to take part in a program that has been deemed at least "religious in nature" and a violation of Constitutional rights in the rest.

After decades of forcing people into inappropriate treatment, many are speaking out.

Alcoholics Anonymous members routinely talk of AA as the only method that works. Study after study show that AA does not work, that AA the highest mortality rate of any treatment option, that expose to AA results in more binge drinking and more costly later hospitalizations, and more re-arrests. It has caused AA folks to dismiss all scientific studies.