Author Topic: Does Alcoholics Anonymous Work?  (Read 645 times)

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Offline Enkidu

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Does Alcoholics Anonymous Work?
« on: March 06, 2017, 02:21:12 AM »
Nothing on the subject here since 2011 and I didn't want to necro post. I've been under the impression for many years that AA is essentially a cult that, statistically, doesn't actually help people with alcoholism (emotionally intense personal anecdotes notwithstanding).

This article is a few years old (2015) but I just came across it. Is it missing anything? Seems about right to me.

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/?utm_source=atlfb

Quote

The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods.


edit: added quote from article
« Last Edit: March 06, 2017, 02:28:09 AM by Enkidu »

Offline Harry Black

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Re: Does Alcoholics Anonymous Work?
« Reply #1 on: March 06, 2017, 03:05:09 AM »
We had a pre crash thread about it. I think its certainly worth discussing again.
The only defence of it that I ever see is "Well it worked for my friend!"

Offline Johnny Slick

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Re: Does Alcoholics Anonymous Work?
« Reply #2 on: March 06, 2017, 03:58:15 AM »
AAers say that it works but with the caveat that you have to keep with the program. That's nice but the ability to stay with a program is in fact one criterion for effectiveness.
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Offline Ah.hell

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Re: Does Alcoholics Anonymous Work?
« Reply #3 on: March 06, 2017, 09:53:38 AM »
I have my doubts and when I've looked at in the past the data was mixed and generally poor quality.  Pretty much every story about AA ends with, "Works for some people, so....."

Offline moj

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Re: Does Alcoholics Anonymous Work?
« Reply #4 on: March 06, 2017, 10:17:52 AM »
When I was younger I was forced into due to being under age and arrested for booze and pot. Its mostly BS that happens upon a few things that may help some people. I think having a new social sober network is nice and can help some people, but the hole being powerless, higher power and chronic disease I think is BS. To go anecdotally though my twin brother used it to get off heroin 20 years ago and is still in it and clean today. I think it helped introduce a lot of ideas about magical thinking that is still fairly prevalent with him. His wife is a natruopathic doctor and they buy into every crunchy fad you can think of.

Offline Ah.hell

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Re: Does Alcoholics Anonymous Work?
« Reply #5 on: March 06, 2017, 10:59:43 AM »
There's definitely something to be said for the sober social network. 

Anecdotally, my old man has been sober for....30 years, he went through the DTs when he quit, he quit AA after a few weeks because it "made him want to drink".  The constant litany of shitty stories can't be good for your mental state.   Also, it wasn't exactly anonymous in a town of 1500.   I also knew a guy who'd been in AA for around 20 years who had quit drinking before his 18th birthday.  That's just a cult at that point. 

Offline Johnny Slick

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Re: Does Alcoholics Anonymous Work?
« Reply #6 on: March 06, 2017, 04:07:13 PM »
So, I do feel like there are some aspects of AA that got slammed a bit here that actually I think do work in terms of providing yourself with a personal framework. I am not an alcoholic and have no frame of reference as to how this would help actual alcoholics but I have taken to heart a couple of the precepts of AA in my own life (granted that I agree that the spiritual stuff is meh).

First up, the deal with the "being powerless" and the "higher power" thing actually does have its uses and those things are facets that I as a person working with ADHD use to help come to grips with things. First up, don't think of it as being completely powerless in the sense of "I can't move the needle of change even a little tiny bit". The bits that we have an issue with are the first 3 and I think it's possible to re-interpret them:

Quote
1. We admitted we were powerless over alcohol - that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
For a lot of us, we have our struggles in which we *are* personally "powerless" against these things, again, not in the sense that there's no use touching anything because it won't make a difference, in the sense that we've lived with these things alone for years and years and years and have tried to fix them ourselves and have failed. Step 1 is basically saying "I did not fail to fix myself because I lack character, I failed to fix myself because this issue is bigger than myself". This was simply beyond my ability to fix and there just plain can't be any shame in admitting this because once you let shame come through, the self-doubt comes along with it and you lead yourself back down the path to self-destruction. Just... sit back and accept that you need help, that's the point of #1.

Which leads to point #2... that "power greater than ourselves" need not be God; in fact, I think it works better when it's *not* God because even if you believe in God, your relationship with God is still a one-to-one thing and the whole point of steps 1 and 2 is that you need to reach out to actual other *people*. Yes, sure, spirituality or what have you can sometimes allow you to summon willpower or at least divert it from other places to make you achieve things you might not otherwise have achieved. But here's the thing to me: chances are, you've probably already gone through the negotiating with your higher power thing if you are religious, or working on harnessing your own mental capacity (by means of meditation, for example) if you are not. Step 2 reads a little bit like "come to Jesus" but what I think it really is supposed to mean is two-fold: one, that you are not permanently broken, and two, that you can fix yourself by turning to the community at large for help. For my own self, I am not even close to conquering ADHD by myself and I am incredibly grateful that there things beyond me that can fix this: medication, for one. My therapist, for another. A close circle of friends who care about me, for three.

Point 3 might take the most legerdemain to interpret in a secular way but I think it can be done as well. The point here is not *necessarily* that you have to give yourself to God specifically, although AA is first and foremost a Christian organization and they're going to expect that. The idea behind it, though, is that you're building on step 1, where you admit that you can't do this alone, and step 2, where you allow other people to come in and help you, and continue on to step 3, which is to be humble and accept that you don't have all of the answers. Step 3 is about accepting that step 2 has to be non-conditional to work. For me, it's accepting that whatever I might feel in the moment about my condition, doctors have studied ADHD on millions of people and I am not particularly special in that regard and so I don't get to do things like stop taking my meds when I feel "better" or something. It also means understanding that medication + therapy has been shown to work much better than medication alone in many cases and so, even when I feel very uncomfortable in a session, remaining open to the possibility that that uncomfortability means we are moving in important directions (and, at the same time, accepting that my therapist knows much more about how the mind works and about how we put up roadblocks to success, etc. than I do, no matter how smart I might think that I am). And finally, it means that I have to accept my friendships for what they are, which in turn means that I have to accept that they might know more about some aspect of life than I do and to at least consider what they have to say when they say things to me (I feel like it also means that I have to be reciprocal but that may be a lesson to take home from one of the later steps).

Again, I do not want to argue that this means that AA is good or bullshit or whatever. What I'm talking about here is essentially a personal philosophy and I don't think that you can scientifically quantify philosophy. If it "works" it does so because it provides you a framework for how to move through life. Whether that exact framework is effective for others is almost besides the point (I say "almost" because I'm not sure that a framework built around the notion that everybody is secretly a 7 foot tall lizard is necessarily going to help you much unless paranoia is something you want in your life). I think the best thing is to choose a framework, try hanging your life on it, and a few months down the line re-evaluate it to see which bits work and which ones do not.
Speak what you think now in hard words, and to-morrow speak what to-morrow thinks in hard words again, though it contradict every thing you said to-day.

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Offline moj

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Re: Does Alcoholics Anonymous Work?
« Reply #7 on: March 08, 2017, 09:15:16 AM »
Yes I've heard those arguments from proponents of the system but seems like a very convoluted way to go about it. I don't think asking for help is the same as admitting to being powerless. Furthermore think it has a very negative effect on some people who get to wrapped up in the idea of being powerless and and life long condition that they double down on being drunks, "fuck it, why fight it"... The article on the OP claims AA only has a single digit success rate. Here's anther good section from the article about AA being a one size fits all why that is wrong

Quote
Part of the problem is our one-size-fits-all approach. Alcoholics Anonymous was originally intended for chronic, severe drinkers—those who may, indeed, be powerless over alcohol—but its program has since been applied much more broadly. Today, for instance, judges routinely require people to attend meetings after a DUI arrest; fully 12 percent of AA members are there by court order.

Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. And a recent survey of nearly 140,000 adults by the Centers for Disease Control and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.

We once thought about drinking problems in binary terms—you either had control or you didn’t; you were an alcoholic or you weren’t—but experts now describe a spectrum. An estimated 18 million Americans suffer from alcohol-use disorder, as the DSM-5, the latest edition of the American Psychiatric Association’s diagnostic manual, calls it. (The new term replaces the older alcohol abuse and the much more dated alcoholism, which has been out of favor with researchers for decades.) Only about 15 percent of those with alcohol-use disorder are at the severe end of the spectrum. The rest fall somewhere in the mild-to-moderate range, but they have been largely ignored by researchers and clinicians. Both groups—the hard-core abusers and the more moderate overdrinkers—need more-individualized treatment options.

Offline Johnny Slick

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Re: Does Alcoholics Anonymous Work?
« Reply #8 on: March 08, 2017, 09:24:20 AM »
I absolutely agree that one size does not fit all, not by a longshot. That being said, to your other point I do think that there is a need to admit that, if you're not precisely powerless, that by asking for help you have to admit that you don't have *enough* power to overcome whatever that thing is that you're dealing with. I think that, sure, some people may double down on being drunks. Others, without that outlet to be in a group of similar people who have also admitted to powerlessness, will never get to that point themselves where they admit to being weak enough to need help. That's not just about arrogance or whatever; a lot of people just plain don't feel that they can ever show signs of weakness to others for a variety of reasons. Having that central plank that says "before we move on, you have to admit that all that crap you tried in the past didn't work and won't work because this issue is bigger than you can handle" is kind of fundamental for these folks.

Again, the stuff I'm talking about are the personal philosophy aspects. Sure, the program itself may well be not terribly effective. We're a skeptical community; I think we all pretty well accept that by the stats, AA is not a program that actually curbs alcoholism all that well. That being said, there doesn't seem to be a lot of evidence that the mind is shaped the way Freud envisioned it either but that doesn't mean that his writing can't provide an interesting and sometimes useful framework to talk about how it works.
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Offline Mr. Beagle

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Re: Does Alcoholics Anonymous Work?
« Reply #9 on: March 08, 2017, 09:38:23 AM »
I do not believe there is any one "cure" for alcoholism. It is true, however, that a drink deferred for a day is one less day without the negative effects of alcohol, so in this sense, the program works for many as well as any.

As for the "higher power" language, I now graciously assume that, when someone evokes "God" or similar language, what they mean is "I really wish," or "I really hope," or "I really fear." God language has been a placeholder for these sentiments since the dawn of human language. At least AA keeps it fairly generic.
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Offline superdave

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Re: Does Alcoholics Anonymous Work?
« Reply #10 on: March 08, 2017, 10:46:08 AM »
For any other illness, a doctor will prescribe for your he treatment that has the best chance of working, and only if that fails will he prescribe other options. 
If AA does work for some people but there are better options, AA should not be the first line of therapy and should only be used if some other therapy more likely to work  has failed.
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Offline Ah.hell

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Re: Does Alcoholics Anonymous Work?
« Reply #11 on: March 08, 2017, 10:51:44 AM »
AA benefits from the lack of effective competition or at least evidence of effective competition.  When I've look at this in the past, there just isn't a lot of good evidence for any programs.  AA has just been around and has a lot of anecdotal evidence.

Offline Swagomatic

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Re: Does Alcoholics Anonymous Work?
« Reply #12 on: March 08, 2017, 01:34:18 PM »
I think there are a couple of overarching reasons that AA is so widely used in spite of its dismal success rate - it is free or very low cost, and it is widely available.  I grew up with an alcoholic father and, consequently, we were usually on the edge of poverty. There is no way that our family could have afforded any kind of rehab therapy.  We were stuck with AA. 

The only peaceful, happy times I can remember growing up, were the times when my dad was "working the program." The truth is, though, he always ended up falling off the wagon.  It still pisses me off to think about it.

Rehab is out of reach for poor people.  As long as that is the case, AA is going to exist.
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Offline Ah.hell

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Re: Does Alcoholics Anonymous Work?
« Reply #13 on: March 08, 2017, 02:02:22 PM »
From what I gather, most of the expensive rehab facilities don't have a particularly good record either and some are just in patient AA. 

Offline arthwollipot

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Re: Does Alcoholics Anonymous Work?
« Reply #14 on: March 09, 2017, 02:27:35 AM »
I have my doubts and when I've looked at in the past the data was mixed and generally poor quality.  Pretty much every story about AA ends with, "Works for some people, so....."

This is pretty much it. As far as I am aware, yes, it does indeed work for some people. If you're the type of person for whom it is likely to work, it'll probably work for you. If you're not, it probably won't. If you don't know whether you're that type of person or not, you should do some research on its methods and, if necessary, try it.

If it doesn't work for you, don't get discouraged, because there are other methods out there that might work better.

 

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