Talk:Effectiveness of Alcoholics Anonymous/Archive 1

Archive 1

Archive 2

Notablility

Does wikipedia have notablility guidlines for studies? most of these studies are referanced by 80+ other studies while some are significanly less than that...one only having 11 refereances and another only 20. I feel that we should consentrate on notable studies, otherwise this becomes an indiscriminate repository of unequaly valued reserch.Coffeepusher (talk) 13:37, 16 March 2008 (UTC)

There is a bit about preferring the original studies over literature reviews, but in general if it's peer-reviewed it's considered worthy of inclusion. We also wouldn't want to exclude new studies that haven't been cited by subsequent ones.

We should work on making this article less of a study by study summary of the information out there and more about condensing it in to commonalities that impact effectiveness (e.g. attrition, abstinence violation, court-ordered vs. voluntary) -- Scarpy (talk) 18:25, 16 March 2008 (UTC)

Yes, please be careful about ranking scientific journal articles. Many articles are referenced because the citing authors think that the cited paper is crap and so sometimes bad articles have lots of cites. Also, the age of the article is important. Obviously an older paper will have had more chance to be cited than a new paper. The decision as to which papers are good and which are bad has to be left to the experts. Also a word of caution about review articles. Such articles are often used to push the authors viewpoint. In many cases, the conclusions of a research article are misreported by a review author, either on purpose or by accident. The original research paper is always to be preferred, even if it is hard to get a hold of.Desoto10 (talk) 05:37, 17 March 2008 (UTC)

Entry Structure

I wonder how this entry should be structured. Clearly US-based vs. ROW is not the way to go. Some ideas for headings would be "Spirituality", "Abstinence", "Patient Matching", "Cost of Care", "Regional Differences", ... Just throwing these out here. Suggestions welcome.Desoto10 (talk) 05:40, 17 March 2008 (UTC)

I guess that first we have to decide what is "effectiveness"? Is AA's concept of effectiveness different from APA's concept? Is abstinence a goal, harm-reduction, going to meetings, not going to jail? We need a definition of effectiveness first before we can relate studies to it.Desoto10 (talk) 05:47, 17 March 2008 (UTC)

Defining effectiveness would be WP:OR. We'll have to use the definitions and metrics in the research, and be clear about how it was defined. I like the ideas for far for the headings/topics. -- Scarpy (talk) 15:59, 17 March 2008 (UTC)

I believe Country of Origin for the Study is important and be stated. Studies could be grouped under different headings but keeping the intergrity of the study intact , not to put a differenct spin on the study to match with the sub category/heading to fit with the heading it is to be filed under. --207.232.97.13 (talk) 21:35, 17 March 2008 (UTC)--207.232.97.13 (talk) 21:36, 17 March 2008 (UTC)Fred

No question that location of the study is important, and I would include a heading for regional differences. There is no reason why studies cannot be in more than one place. I would like to get consensus on this, but I think that just listing the studies and their conclusions is not worth much.Desoto10 (talk) 06:49, 22 March 2008 (UTC)

Ståhlbrandt, Johnsson, Berglund

A 12-step-influenced alcohol intervention program. The 12-step program provided lectures by therapists trained in the 12-step approach.

It seems to me that this study program would be quite different from AA, lacking many characteristics, such as:

• Group support
• Daily contact with other alcoholics
• Meeting's sharing and identification
• Commitments
• Opportunity for the subject to sponsor others

In short, not AA. That was my reason for removing it from an article on the effectiveness of AA.

Mr Miles (talk) 21:08, 29 April 2008 (UTC)

You can add language to the article to clarify that it's a kind of TSF and not specifically AA groups. -- Scarpy (talk) 21:43, 29 April 2008 (UTC)

Done. Mr Miles (talk) 22:51, 29 April 2008 (UTC)

Does anyone else look at this article and shake their head?

Like you could work on it, but someone would just throw more crap in to it? -- Scarpy (talk) 16:51, 9 May 2008 (UTC)

Yep. The medical community can't agree on the effectiveness of AA. Even if they could, no Wiki editor is ever going to have enough knowledge to be able to judge which studies best represent the scientific opinion at the current time. Even if a Wiki editor was able to do that, their work would still be undermined by some POV-pusher with a grudge who would bombard the article with any old stuff they can paste in from Google. It's a lose-lose situation, but what is the alternative, delete the article? Mr Miles (talk) 22:47, 9 May 2008 (UTC)

As the article is now, it would be more appropriately titled "List of studies on the effectiveness of Alcoholics Anonymous." Writing a real article would mean distilling all of the information in the articles to relevant topics on AA's effectiveness. -- Scarpy (talk) 00:44, 10 May 2008 (UTC)

I agree, how do we change the title? Mr Miles (talk) 01:04, 10 May 2008 (UTC)

This Article Came up for deletion and was Approved by a number of editiors as a keeper

When this article was originally submitted it was put up for deletion and a number of editors made the decision to keep it.

The article was origianlly titled Effectiveness of Twelve Steps and was changed to Effectivness of Alcoholics Anonymous by Scarpy who by the way voted to keep it. Interesting is it not how opinions vacilate?

--MelvilleSitter (talk) 00:11, 16 May 2008 (UTC) --MelvilleSitter (talk) 00:11, 16 May 2008 (UTC)

I'm not questioning it's notability, I'm just dismayed by the horrible way it's written and the massive amount of work it would take to make to make it a reasonable article. -- Scarpy (talk) 00:43, 16 May 2008 (UTC)

Interesting

• Mutual-help Helps -- Scarpy (talk) 22:05, 28 May 2008 (UTC)

• This too. -- Scarpy (talk) 22:27, 28 May 2008 (UTC)

• McKellar, John (2007). "Predictors of changes in alcohol-related self-efficacy over 16 years". Journal of Substance Abuse Treatment. 35 (2): 148–55. doi:10.1016/j.jsat.2007.09.003. PMID 18037604. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: extra punctuation (link) -- Scarpy (talk) 00:11, 23 July 2008 (UTC)

Valliant

is the following sentence:

"Although AA is not a magic bullet for every alcoholic, in that there were a few men who attended AA for scores of meetings without improvement, good clinical outcomes correlated with frequency of AA attendance, having a sponsor, engaging in a Twelve-Step work, and leading meetings. "

a direct quote of Valliant or just paraphrasing? Thanks,Desoto10 (talk) 04:33, 11 August 2008 (UTC)

Summaries

We could use a similar outline as this review: [1] -- Scarpy (talk) 04:33, 31 August 2008 (UTC)

Please quit reverting Vaillant

The information sourced is more current and from his later book 1996 on the same subject, not the earlier 1983. --207.232.97.13 (talk) 01:29, 9 September 2008 (UTC)Fred

With as much disorganized plagiarism and non-sense as there is in this article, including both doesn't really change the overall entropy. -- Scarpy (talk) 06:09, 9 September 2008 (UTC)

As we can't agree on this, I've included both versions. Okay. Mr Miles (talk) 20:49, 9 September 2008 (UTC)

Ståhlbrandt, Johnsson, Berglund

There is a mistake in the abstract of this piece of research:

Students showed significant differences in AUDIT score reduction in favor of the BSTP compared with controls, and had a tendency to show better results than the TSI intervention. The TSI did not differ significantly from the control group.

Can you spot it? It's probably just a mistake in the abstract, so if we really want to include this research, someone needs to read the actual article, not the abstract. Or we can just remove it, as I have.

Incidentally, why are we including this research which doesn't study AA (TSI by therapists) on alcoholics (just high risk levels of consumption of alcohol)?

Mr Miles (talk) 20:49, 9 September 2008 (UTC)

The study examined Alcoholics Anonymous and Brief Skills training as an method of intervention for high risk students , students who engaged in high risk alcohol consumption. —Preceding unsigned comment added by 139.173.54.11 (talk) 06:04, 9 October 2008 (UTC)

No, the study examined TSI administered by therapists, not Alcoholics Anonymous. Additionally, the abstract used in the article has a mistake in it, the actual article may not have a mistake and might be included (if you disagree with my first point that it doesn't test the effectiveness of AA). You will need to obtain and read the actual article. Mr Miles (talk) 19:08, 9 October 2008 (UTC)

The introductory paragraph outlines that TSI being delivered by therapist is being used in lieu of AA. See Project Match. This page is a study on the Effectiveness of Alcoholics Anonymous, a person with a drinking problem or engaged in high risk drinking, may or may not be an alcoholic , because alcoholic is an ambigious term at best and there are many types of alcoholics. However they all engage in substance abuse, that much can be said.

The Swedish study examined the effects of a Twelve step appraoch and Brief Skills in dealing with dealing with Students engaged in high risk drinking behavior. It is a based on the twelve step approach and like Project Match was delivered by therapists.

Mr. Miles I find your attitudes & arguments disingenuous to say the least. It is absurb that you tell others to read the study when it is apparrent you have not read it yourself. This leaves you with the inabilty to accurately fact check on the Swedish study and in no position to delete bonafide contributions by other editors.

Mr. Mile I have check the discussion page on your talk page and it is quite clear you have gone to great efforts in the past to delete entire studies from this section that are not favorable to Alcoholics Anonymous thus presenting the reader of the wiki with a very skewered view of the AA approach in dealing with drinking/addiction.

I guote from your talk page.

"Entire sections on the studies section of Alcoholics Anonymous being removed, leaving only those favouring AA, resulting in an edit war and editors banned from posting: http://en.wikipedia.org/w/index.php?title=Alcoholics+Anonymous&diff=197618867&oldid=197618528 Administrator Seicer this July 2008, commented on the housecleaning tactics to remove anything negative concerning Alcoholics Anonymous was unacceptable."

Maybe it is time for you to read the study Mr. Miles. —Preceding unsigned comment added by 199.60.112.30 (talk) 22:08, 13 October 2008 (UTC)

Have you read the study? You have inserted a link to the abstract with the logic fallacy. I don't have to have read it as I'm not proposing its insertion.

Also if you don't sign in, regular editors might think you are actually MisterAlbert/Fred who writes with a very similar style to you but is blocked from using Wikipedia for edit warring. Mr Miles (talk) 23:16, 13 October 2008 (UTC)

NO SIGN IN RULES BUDDY....I HAVE READ THE STUDY, BUDDY FAXDED IT. A LITTLE LENGTHY, READ THE PRESS REVIEWS AND EXCERPT AND GOOD ENOUGH FOR ME. YOURS TRULY : FUTUREBOY END OF STORY. YOUR PARANOIA CONCERNING OTHER USERS IS VERY VERY FUNNY. —Preceding unsigned comment added by 199.60.112.30 (talk) 22:03, 14 October 2008 (UTC)

Effectiveness of AA vs. Effectiveness of all twelve-steps

Editing my first comments on the discussion page.

I had planned overtime to include research on other twelve step programs as it becomes available. --MelvilleSitter (talk) 21:31, 15 March 2008 (UTC)

You should, but I think it would be better in the articles on those particular groups. -- Scarpy (talk) 18:26, 16 March 2008 (UTC)

I agree. Effectiveness of AA is a pretty big subject. The other 12-step programs would likely get lost in it. I think that the inclusion of studies that examine "generic" 12-step program philosophy are welcome here, but something along the lines of the effectiveness of Overeaters Anonymous would not.Desoto10 (talk) 05:44, 17 March 2008 (UTC)

Twelve Step Program(s) are or should be substantially identical -- there's one 12-step Program of Recovery

Investigation will show that when Bill Wilson, one of AA's co-founders, drafted Chapter 5 "How It Works," he created the twelve-step program; its origins came from the Oxford Group.

How to Listen to God: Overcoming Addiction Through Practice of Two-Way Prayer by Wally Paton ISBN 978-0-9657720-4-4 & published by Faith With Works Publishing Co. of Tucson, AZ (www.faithwithworks.com)provides detailed and credible insight into Bill Wilson's experience between November, 1934 and April, 1939 when he and the First One Hundred published the 1st edition of Alcoholics Anonymous: The Story of How One Hundred Men Have Recovered From Alcoholism.

In AA's "basic text" is everything between the title page and page 164 of The current version of AA's "Big Book" Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered From Alcoholism 4th ed. Other than about 200 fairly insubstantial word changes (i.e., hundred became thousands), the main change involved moving the Doctor's Opinion from Chapter 1 to the front material preceding page 1 (now Bill's Story, formerly Chapter 2).

Wilson introduced the language for the twelve steps to make the Oxford Group's absolute Standards and Steps palatable to alcoholics willing to go to any length to recover from alcoholism. These men had repeatedly tried and failed to stop drinking altogether. The Christian-oriented Standards are: Honesty, Purity, Unselfishnes and Love. The Four Steps are Surrender, Sharing, Restitution and Guidance. Bill W learned wordsmithing in law school; there is evidence showing he had disdain for Christian and other religions, even after he initially recovered from alcoholism in 1934. He said he wrote the twelve steps in 1938-39 so that newcomers to AA would find no loopholes in AA's "program of action."

AA's Big Book is like a cookbook; newcomers were told to read it to understand AA's view of the problem, the solution (a vital spiritual experience or psychic change), and the course of ACTION required to produce the results. The published text reads "Half measures availed us nothing" while Bill's manuscript said "Half measures will avail you nothing." In either case the message is clear; a cookbook recipe does little until the cook gathers the ingredients, follows the instructions, and cooks the dish. Many who attend contemporary AA meetings do not get the message precisely presented in AA's basic text because they cannot or will not read the book; they listen to hearsay which has become garbled over the years.

The foundation of all other Anonymous fellowships or Twelve-Step fellowships is AA's Twelve Steps. Only step One contains the word "alcohol" and step Twelve speaks of helping other "alcoholics". Those words are easily deleted, substituted, or adapted to meet the needs of non-alcoholics seeking to achieve the desired results.

I have sponsored a physician, a member of Alcoholics Anonymous and Pills Anonymous; he once served on an editorial committee responsible for writing the contemporary literature used by Narcotics Anonymous. He and I agree there should be absolutely no material difference between the program of recovery used by each fellowship if they are truly using the twelve-step program.

On the other hand, I'm told AA in Africa and Australia is so different from what AA's First One Hundred learned and passed on to their protege's that the variations can get pretty wierd. Doesn't that sound like the evolutionary changes found in some of the world's major religions? There are those who believe contemporary AA in the U.S. has drifted away from the early program of recovery that worked exceedingly well, producing a 75% recovery rate or better (see the Foreword to the 2nd edition, AA Comes of Age, Pass It On, and Doctor Bob and The Good OldTimers and As Bill Sees it -- all publications of AA World Services' General Service Office in New York. You can get them from by calling AA in your locale or by going to your local bookseller's store--where you can get the literature by paying a much higher price). //Don K. (talk) 07:40, 24 October 2008 (UTC)

The effectiveness of AA and other twelve-step programs is purely an experimental and scientific question, and should be supported buy peer-reviewed studies. Anecdotes and a single physician's opinion are not relevant.

The majority of twelve-step fellowships do not deal with substance abuse problems and there's no reason to assume a program originally designed for treating alcoholism would be as effective for treating, say, schizophrenia; at least no more than one would assume anti-biotics would be effective for treating broken limbs. More than that many of the other fellowships have added other guiding principles to their programs, while they are very similar they are not "the same." -- Scarpy (talk) 18:20, 24 October 2008 (UTC)

Begging the question?

Only one study mentions that AA doesn't cost very much. Leaving that out of the other studies is like saying that "when the dealer maintains my car it is 10% more reliable than when I maintain it." And "forgetting" to mention that it is also 1000% more expensive! Student7 (talk) 23:12, 22 April 2009 (UTC)

Acronyms

What is meant here by RBT? I did a bit of looking around and concluded that it is most likely "Reinforcement-based therapy", though it could also be "Rational behavior therapy", neither of which have pages on Wikipedia, but probably should. Since both are used in treating addictions, I am puzzled as to which is meant here. I hate finding undefined acronyms.Susan Chambless (talk) 14:06, 25 May 2009 (UTC)

If you're talking about the RBT from Outpatient Treatment of Alcoholism (Jeffrey Brandsma) [2] consider it the same as REBT -- it's Albert Ellis stuff. In 1980 it looks like they had not settled on the acronym yet. -- Scarpy (talk) 16:07, 25 May 2009 (UTC)

The Challenge of Assessing the Effectiveness of Alcholics Anonymous

Research and personal experience will show that even defining "alcoholics anonymous" is difficult because it is the name of a fellowship (a group of people with a common interest and common experience) which has independent, fully autonomous groups responsible to no authority (See the AA Service Manual).

In practice, AA varies about as widely as "education" or "religion" or "manufacturing". An AA member attended AA meetings on seven continents then said, "it varies widely and gets pretty weird in some places."

The common link is the Alcoholics Anonymous Program of Recovery as laid out in A.A.'s "Big Book" which has the proper title "Alcoholics Anonymous: the story of how many millions of men and women have recovered from alcoholism" the differences between the four editions are relatively minor. The book is best described as "AA's Basic Text." Recovery requires what Silkworth, in the Doctor's Opinion, described as an "entire psychic change"; on p. 27, Dr. Carl Jung used the term "vital spiritual experience" which he then described in some detail. Appendix II of AA's basic text clarifies the difference between a sudden spiritual experience and a slower, educational-variety spiritual awakening; both produce a personality change sufficient to recover from alcoholism.

With the advent of multi-modal "treatment centers" in the U.S. circa 1970, the AA program was adapted, revised, reshaped, and changed in countless ways. There is no central authority governing AA groups or meetings called "AA". Treatment Center clients experienced in group therapy came to dominate AA "discussion meetings" which became popular since 1970. Big Book Study meetings and other study sessions fell out of fashion; in some areas practically all AA meetings are discussion meetings and fewer than 10% are study meetings or literature-based meetings. As a result, a newcomer to AA may reasonably conclude AA is is no more than confessional group therapy without a professional counselor facilitating the session--if the newcomer does not learn about the program of recovery contained in the basic text and discussed carefully in big book study and step study meetings.

Dr. George Vaillant, M.D., has expertise in psychology, psychiatry, treatment of alcoholism and alcoholics, and Alcoholics Anonymous. In his 2008 book "Spiritual Evolution: a scientific defense of faith", the last chapter provides good insight into the AA program of recovery and it explains why it is extraordinarily difficult (or practically impossible) to objectively assess the efficacy of AA even though the program is known to be extremely effective if properly put into action.

Students of the AA Big Book are well-advised to read each sentence carefully,(beginning at the title page) identify any instruction contained in that sentence, perform as indicated, then proceed through to page 164. The results of performing the tasks as instructed produced the international acclaim AA deserved in its early years. The dilution of the program and the evolution of the fellowship has clouded the issue and adversely affected the efficacy of AA.

I wish to collaborate with other Wikipedians to improve the quality of the articles on Alcoholics Anonymous and the Twelve-step Program of Recovery. How can I be of service? The current articles can be objectively improved, thereby reducing misunderstanding and inappropriate clamor. //Don K. (talk) 07:49, 23 November 2009 (UTC)

Copyright issues in this article - text removed

Partly copied from my reply at User_talk:VernoWhitney

Those watching this article since I began the task of rewriting it will note that I reformatted the list of studies into a nicer series of sections. Disappointingly, it seems that the vast majority of the descriptions of the studies are in fact culled either from the journal article abstracts or else from secondary sources that mention the articles (and curiously, a few of these latter are listed in Further reading but are not cited as references). This explains why it has the "laundry list" style it does, since it has been an effective copy-and-paste job with some superficial rewording. The bizarrest side of how this has been done in this case is that in some cases material from other AA-related paper abstracts has been culled to discuss another unrelated study.

For example the article contains under "Project MATCH":

"Published in 1998, Project Match began in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). High-risk alcohol consumption among university students is well documented. Several types of intervention have proved to be effective in reducing alcohol consumption...."

Now take a look at this study abstract; PMID 17295731 from a paper in Alcohol Clin Exp Res which was not related to Project MATCH, published in 2007 by Ståhlbrandt et al:

"High-risk alcohol consumption among university students is well documented. Several types of intervention have proved to be effective in reducing alcohol consumption..."

Project MATCH ran from 1987-1998, and yet this text is from a 2007 study not at all related to it. In other cases, the abstracts have been copied directly for the papers they mention. I have to wonder what the author/authors who did this were trying to do. It seems the entire set of paragraphs are culled in this manner. Therefore, I have deleted the copyright violating text. --NicholasTurnbull | (talk) 07:21, 13 June 2010 (UTC)

Salvaged section references from deleted copyvio text

Each individual section was a copyvio (though sometimes not from the referenced paper itself, but from another paper or external source), but the composition of the studies together weren't a copyright violation themselves -- that is, the actual listing of studies was original. Therefore, below is a list of the references I salvaged for each paper, to assist with rebuilding a new article to cover all of the studies.

• 1967: Ditman et al

• August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". American Journal of Psychiatry 124 (2): Abstract.

• 1979: Brandsma, Maltsby and Welsh

• Brandsma, Jeffrey, Phd. , Maultsby , Maxie, Welsh, M.D. Richard, M.S.W. The Out Patient Treatment of Alcoholism A Review and comparative study, University Park Press, Baltimore, 1980.

• 1991: Walsh et al

• DC Walsh, RW Hingson, DM Merrigan, SM Levenson, LA Cupples, T Heeren, GA Coffman, CA Becker, TA Barker, SK Hamilton, and et al."A randomized trial of treatment options for alcohol-abusing workers" Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115. http://content.nejm.org/cgi/content/abstract/325/11/775

• 1995: George Vaillant

• Vaillant, George Eman (May 1995). The Natural History of Alcoholism Revisited (2nd ed.). Harvard University Press. pp. vii - xi. ISBN 0674603788. OCLC 31605790.

• 1998: Project MATCH

• Main article: Project MATCH
• NIAAA Reports Project MATCH Main Findings, Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.
• Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." Journal of Studies on Alcohol, 58(1), 7-29.
• Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2

• 1999: Arimer, Plamer and Marlatt

• Larimer, Mary E; Palmer, Rebekka S; Marlatt, G. Alan (1999). "Relapse prevention. An overview of Marlatt's cognitive-behavioral model". Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism 23 (2): 151–160. ISSN 1535-7414. OCLC 42453373. PMID 10890810. http://findarticles.com/p/articles/mi_m0CXH/is_2_23/ai_59246580/pg_1

• 2001: Crape, Latkin, Laris and Knowlton

• Crape L, Latkin, Carl A, Laris Alexander and Knowlton, Amy - - John Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA - - Received 9 August 1999; revised 1 June 2001; accepted 2 June 2001. Available online 5 February 2002

• 2001: Humphries & Moos

• Humphreys, Keith; Moos, Rudolf (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. ISSN 1530-0277. PMID 11371720.

• 2006: Moos & Moos

• Moos, Rudolf H.; Moos, Bernice S. (June 2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology 62 (6): 735–750. doi:10.1002/jclp.20259. PMID 16538654.

• 2008: Terra et al

• Terra, Barros, Stein, Figueifa, Palermo,Atayde, Goncalves, Silveira "Do Alcoholics Anonymous Groups Really Work?" Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents " American Journal on Addictions, Volume 17, Issue 1 January 2008 , pages 48 - 53 http://www.informaworld.com/smpp/content?content=10.1080/10550490701756393

The details from the Cochrane review were preserved, as they had already been rewritten (by me). --NicholasTurnbull | (talk) 07:43, 13 June 2010 (UTC)

Recovery Outcome Rates: Contemporary Myth and Misinterpretation

I don't see the issue with this article being that it is or is not a reliable source, but rather than information from it is not used as it is not a reliable source. Stating that a self-published article was written and citing that article is not violating WP:RS, WP:V or WP:NOR in any way that I'm aware of since I last read them. -- Scarpy (talk) 23:26, 7 December 2010 (UTC)

Please stop the edit warring. This is getting really, really, really old. -- Scarpy (talk) 01:50, 10 December 2010 (UTC)

Unsourced claim of comparison between AA and other therapies

I removed the following:

an adherence rate that would be comparable to, or better than, those found in studies of other addiction therapy treatments.

McIntire does not make this claim that I could see in the article. I could have missed it, but I don't think he compares AA with other therapies at all and just concentrates on his interpretation of the survey statistics.Desoto10 (talk) 03:11, 23 December 2010 (UTC)

The use of non reliable sources for this article and information taken out of context in other source material

Don McIntyre looked at the AA survey and his book showed that there 81 percent left in the first month by month three is was close to 91 percent, what Mcintyre did for reasons of his own was to exclude these people from the sample and come up with new percentages. This should be noted for the wiki reader, It is not up to the reader to have to research and correct misleading accounts by ommission.

Using a source from three unnamed authors, from a unpublished paper, which is POV does not meet wiki standards for reliable sources and it should be deleted from this page. Jayseer (talk) 01:25, 26 January 2011 (UTC)

Scope of study

Firstly thanks for adding this article. It is interesting and one I want to know more about. The problem I can see in general (apart from finding accurate data) is what data would the author like to test. I agree in general with the AA definition of a 90 day cut off. This is crude but better than nothing. If research is done into antidepressants then the study would most probably not include those who went to the doctor, got some SSRIs and then didn't take them. This is directly analogous of going to AA and not doing the programme of recovery (which happens extremely frequently. The article would perhaps be better to break down the research as it does. Loss of initial interest followed by statistics as to who stayed after taking the medicine. The natural concluding research would be to quantify how many people relapsed while still taking the medicine- again anti-psychotic drugs keep many schizophrenic people stable while they are taking them, when the stop taking them the drug may be blamed for not working during a relapse. The problem with this research is the complete lack of data so all in all I Think the author has produced at least a great starting point and at best a worthy article in its own right. ¬¬¬¬08/11/11 — Preceding unsigned comment added by 178.106.182.86 (talk) 17:06, 8 November 2011 (UTC)

Actually, drop-outs, as they are called in clinical research are handled in very precise ways such that the statistical power of the study remains intact. If too many subjects drop out of the test group then there can be real trouble when it comes time to analyze the data. In addition, if too many people drop out of the test group because of side-effects then this greatly weakens the case for accepting the new treatment/drug/etc. So, no, you cannot just toss out all of the people who leave AA during the first 90 days. However, in the end, these surveys are just that--surveys, and non-independent internal surveys at that. They say little or nothing about the effectiveness of AA and relate only to retention which, as AA concedes, is dismal. Desoto10 (talk) 17:28, 8 April 2013 (UTC)

Results from Triennial Surveys

I wonder why the results concerning the retention rates of AA are included in this article as they have no real bearing on the effectiveness of the program, but rather on the numbers that stay in the fellowship. Nowhere do the triennial surveys measure alcohol use, which must be the outcome variable in an effectiveness study. The material, in my opinion, should be moved to augment the information in the AA article.Desoto10 (talk) 03:12, 8 April 2013 (UTC)

I have removed all of the surveys listed here

This article has had, for far too long, a laundry list of surveys. WP:MEDDATE states that "Look for reviews published in the last five years or so." All of the reviews in the laundry list are over five years old, and there is a good deal of newer surveys about how effective Alcoholics Anonymous is. I have also added appropriate footnotes and a long list of surveys to the references, both the ones that demonstrate that AA is effective, as well the ones that demonstrate that AA is not effective.

I am sure some of the surveys have good information in them; I hope any editor that restores any of the deleted articles includes a brief note describing the survey and its conclusions.

If anyone wants to look at the list, I have preserved a copy in my sandbox.

Defendingaa (talk) 03:46, 23 June 2015 (UTC)

Getting rid of older references

For a while now, we have had a WP:CITEKILL list of references for the "some studies show AA works, but other do not" bit. WP:MEDDATE in mind, I think it's time to get rid of any of the references which came out before the last Cochrane review of the effectiveness of AA, which came out in 2006.

That in mind, I have gotten rid of the following references showing that AA is effective:

• Moos, Rudolf H.; Moos, BS (February 2004). "Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders". Journal of Consulting and Clinical Psychology. 72 (1): 81–90. doi:10.1037/0022-006X.72.1.81. PMID 14756617.
• Humphreys, Keith; Moos, R (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. ISSN 1530-0277. PMID 11371720.
• Morgenstern, Jon; Laboview, Erich; McCrady, Barbara S; Kahler, Christopher W; Frey, Ronni M (October 1997). "Affiliation with Alcoholics Anonymous after treatment: a student of its therapeutic effects and mechanisms of action". Journal of Consulting and Clinical Psychology. 65 (5): 768–888. doi:10.1037/0022-006X.65.5.768. PMID 9337496.
• Tonigan, J. Scott (2001). "Benefits of Alcoholics Anonymous Attendance – Replication of Findings Between Clinical Research Sites in Project MATCH". Alcoholism Treatment Quarterly. 19 (1): 67–77. doi:10.1300/J020v19n01_05.

And the following really old reference showing that AA is not effective:

• Ditman, Keith S; Crawford, George G; Forgy, Edward W; Moskowitz, Herbert; MacAndrew, Craig (August 1967). "A controlled experiment on the use of court probation for drunk arrests". American Journal of Psychiatry. 124 (2): 160–163. PMID 4951569.

Defendingaa (talk) 07:33, 26 August 2015 (UTC)

Why is a well-executed study become less meaningful over time? I question the justification for deleting studies when they could lead a researcher to meaningful data. Without more substantial reasoning, I recommend reinstating the citations.

//Don K. (talk) 23:40, 27 August 2015 (UTC)

Wikipedia considers studies to become less meaningful over time as a matter of Wikipedia policy WP:MEDDATE. The problem with this particular article is that it has, for too long, been a laundry list of studies without any commentary or discussion of what the studies say. See, for example, an older revision of this page. I don't mind more studies being here, but they really ought to be given at least a one-sentence summary (and ideally, a short paragraph summary), so we're not just listing the Google Scholar results for a search for "Effectiveness of Alcoholics Anonymous." Defendingaa (talk) 15:03, 28 August 2015 (UTC)

I have added one of the studies I removed earlier: Brandsma 1980. Intead of it being a bare reference, I summarize the study and use two other more recent studies which explain why the study was flawed. Defendingaa (talk) 14:57, 8 September 2015 (UTC)

As AA and other Twelve Step programs are by Tradition programs of attraction, meaning that members come to the program freely and without external influence or coercion, a study of court-monitored or court-ordered attendance at meetings can have very little meaning on the effectiveness of these programs because they violate the methodologies of the programs from the outset. I have not read the Dittman article, so I do not know for sure if that is what the article describes, but I think the title suggests that it does. I think anyone who has been at a meeting where there are significant numbers of court-ordered attendees can attest to the different nature of those attendees. (I'm not implying that personal experience trumps evidence here, just re-framing the issue into something more directly understandable.) Of course this brings up the issue of self-selection bias, but that just supports the fact that these programs cannot be studied without interfering with their normal operation, and thus their efficacy. Dcs002 (talk) 23:03, 27 September 2015 (UTC)

Dodes quote

Dodes' book was being misrepresented in this article. I've clarified. Here's the relevant passage (easily accessible online, e.g., long excerpt):

Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures. The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members. It found that only 31 percent of them were still attending after one year. AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year. A third study found that after eighteen months, between 14 and 18 percent of people still attended AA. So let us assume that between 14 percent and 31 percent of people stay with AA for more than one year. Now we must ask: out of this remaining population, how many stay sober?

As we have seen, research has shown that only a small subset of people stay sober in AA for any appreciable length of time, and this subset grows smaller with each passing year. When people do attend AA often or regularly, especially when they become emotionally invested in the system ("AA involvement" as opposed to "AA attendance", as the literature describes), they do well. As noted above, attending a self-help program per se is not helpful, but the active involvement seems to make a difference.

So, what percentage of AA attendees become actively involved? In 2003, a group in London headed by J. Harris looked at patients in residential treatment and concluded that while 75 percent of alcoholics entering residential treatment had attended AA previously, the number of those working the program (being involved versus merely attending) was 16/75, or 21 percent.

Within this group, how many not only improved, but consistently maintained sobriety? University of California professor Herbert Fingarette cited two other statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members. Similarly, taking the 21 percent involved from the Harris study and multiplying that by the 25 percent who remain in AA yields an overall efficacy of 5.25 percent. Or, we could use the more positive results of the Fiorentine study, in which approximately 40 percent of individuals categorized as having continued active participation in AA maintained high rates of abstinence. Combining this with the Harris data giving the percentage of people who are actively involved, overall effectiveness of AA becomes 21 percent times 40 percent, or 8.4 percent.

These totals all fall within a close range. Together, they support the fact that roughly 5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than one year.

– Dodes, Lance; Dodes, Zachary (2014-03-25). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. Beacon Press. p. 71–72. ISBN 9780807033166.

The first problem is that the article was saying that Dodes claims a 12-month retention rate of 26 percent, when Dodes explicitly attributes that number to AA itself – and further bolsters the likely accuracy of AA's claim by saying that it is comparable to the results from some independent studies.

The second problem is that Dodes only goes into this as a means of explaining that "26 percent retention" after one year is very importantly different from "26 percent sobriety" after one year. Dodes looks at multiple studies and determines that the latter number – the percent sober for a year, as opposed to the percent showing up for a year – is in the range of 5 to 8 percent. Dodes is far more interested in AA's efficacy in producing sober people rather than its efficacy in producing warm bodies in a meeting.

The third problem is still unaddressed: One of the factors that seems to be agreed upon by AA and multiple independent experts is that "working" or "really trying" makes a difference. Warm bodies at meetings don't get sober at the same rate as people who go all in for recovery. So why isn't that factor properly described in this article? I think it should be. WhatamIdoing (talk) 06:28, 4 March 2016 (UTC)

As you can see, the high WP:MEDRS bar doesn't exist in this sub-article -- that was part of the compromise when we hammered out consensus about what sources we can and can not include in Alcoholics Anonymous. The problem with including Dodes' book is that it is, according to the New York Times, a "polemical and deeply flawed book about the nature and treatment of addiction." Its findings are disputed by experts in the field, who stated that "Dr. Dodes doesn’t acknowledge the more recent randomized controlled trials of addiction treatment [...] These studies show that 12-step treatment improves outcomes by up to 20% for as long as two years post-treatment via its ability to engage patients, and also tends to produce much higher rates of continuous abstinence than other forms of treatment." This contradicts Dodes' own claims that "12-step treatment for substance use disorder is no better than doing nothing."

I see you've added the Dodes' reference to this article. I am going to have to revise that section of the article, since Dodes' findings are, at best, contentious. Defendingaa (talk) 16:17, 4 March 2016 (UTC)

Thomas P. Beresford

I just found a refutation from Thomas Beresford refuting the supposed 5-8% figure for AA's success that Dodes/Glaser quoted in 2014/2015 which got so much popular press. This guy knows his stuff; a simple Google Scholar search shows him publishing a large number of highly cited articles in the medical field, including a number on alcoholism, some of which have been cited over 100 times. The website where his criticism of Dodes' numbers was published, the NCADD is also quote notable. Defendingaa (talk) 07:08, 2 April 2016 (UTC)

Using a personal blog for a lay summary

I have finally found a good lay summary for that old anti-AA chestnut, Brandsma 1980: [3] The problem: It's a personal blog. However, considering how old Brandsma 1980 is, the only people who are really interested in it tend to be anonymous internet commenters (as well as editors of RationalWiki not to mention Wikipedia editors about eight years ago before the anti-AA brigade was chased out of here) who like to say "Brandsma 1980 shows that AA is worse than nothing because it increases binge drinking !!!!!11!!!!!" It's not the kind of publication the mainstream press is going to pay any attention to, since it's old enough to be a museum piece, but since it still is quoted by some (This shows a recent version of Rational Wiki article on AA, happily devoting an entire section to Brandsma 1980), and since one needs to go to a good library (or buy it for $25-$125) to read a copy of it, and since I haven't found a summary of it from a bona fide reliable source that effectively summarizes it, it's better for the Wikipedia readership to have a blog source summarizing this than to have no lay summary at all.

Brandsma 1980, of course, doesn't belong on the main Alcoholics Anonymous article; the study is just too old as per WP:MEDDATE. But, it belongs here, simply because it's still brought out by people with an anti-AA agenda. Defendingaa (talk) 14:50, 16 April 2016 (UTC)

@Defendingaa: I went to the library, checked out the book and read it a few years back when I was doing more editing on this article. I know this sounds like an arrogant thing to say (and it's been several years since I read it) but my hunch is that if I took the time to do that, my description of it is probably accurate. The Brandsma study was a contentious topic back then, and I think we had similar problems with people relying on second-hand summaries of it. I appreciate what you're doing here, but we really should stick to using the actual research and not blog summarizing the research. If needs be, I can try to get ahold of the book again (and scan it this time). - Scarpy (talk) 18:00, 17 April 2016 (UTC)

@Scarpy: I have two different summaries of Brandsma 1980 which both say that it was only at the six-month follow up (and not at the just after treatment, 3-month, 9-month, and one year followups) that the AA-like group had increased binge drinking: http://www.hamsnetwork.org/effective.pdf (this is a group which includes Stanton Peele, no fan of AA) and, that blog entry http://slatestarcodex.com/2014/10/26/alcoholics-anonymous-much-more-than-you-wanted-to-know/. Since you do not like having a blog entry used as a lay summary, I will remove it -- but I think the blog gave a reasonable summary of Brandsma 1980, and I think this page was better off with a blog entry summary than only having a summary here. Defendingaa (talk) 22:42, 17 April 2016 (UTC)

@Defendingaa: I also disagree with your point regarding WP:MEDDATE. If this were more of a medical article on a strictly medical topic with advancing and change technology, yes. AA's basic literature hasn't changed much in the last few decades. - Scarpy (talk) 18:06, 17 April 2016 (UTC)

@Scarpy: Consensus seems to be leaning towards not having WP:MEDRS and WP:MEDDATE apply at all, so let me word that differently: The results in Brandsma 1980 -- notably the claim from someone who probably didn't read the study that AA results in increased binge drinking -- are from over a generation ago, and they have not been reproduced in more recent studies. Defendingaa (talk) 22:42, 17 April 2016 (UTC)

Another place where the "Brandsma 1980 shows that AA increases binge drinking" claim (which I hope we can agree has been effectively refuted) has been parroted: [4] This, however, is a blog, not a WP:RS so I can't use it as an example of how Brandsma 1980 has been misinterpreted. Defendingaa (talk) 05:07, 18 April 2016 (UTC)

@Scarpy: You may have to scan Brandsma 1980 in after all. PMC2746426 says it was at the three month followup, not six month, followup when the people who went to the AA-like meetings had increased binge drinking in Brandsma 1980. I'm going to change the article because this is a WP:RS summary which I trust more than a blog or HAMS network. Defendingaa (talk) 05:26, 18 April 2016 (UTC)

Talking to myself: There's a few libraries in my area with that book. I'll see if I can get my hands on it. Defendingaa (talk) 05:37, 18 April 2016 (UTC)

Also, Google Books lets me search the book, but only lets me see tiny snippets of it. The snippets on binge drinking I was able eek out are as follows:

...The 3-month follow-up indicated that AA members had increased their binges and more often drank in order to feel superior. Perhaps the philosophy...

...the AA group (2.37 in past 3 months) in contrast to both the control (0.56) and lay-RBT group (0.26). In this analysis AA was five times more likely to binge than the control and nine times more more likely than the lay-RBT. The AA group average was 2.4 binges in the last three months since outcome. It was more important 3-month follow-up for the control group to relax and least important for the lay-RBT group (p = ...

So, not only was that blog summary not a reliable source, it was down right wrong. The increased binge drinking was at three, not six months, after the treatment. (Personally, I think the three-month binge drinking they saw with the AA members was a statistical fluke, nothing more. That study was from decades ago and I know of no other study which has reported AA members binge drinking more). Defendingaa (talk) 06:00, 18 April 2016 (UTC)

Thanks for looking in to this, sorry I ghosted on this discussion. 2016! We've been doing this for too long! :) - Scarpy (talk) 22:35, 22 May 2018 (UTC)

SSC

@Defendingaa: - thanks for the link to SSC. I've read Scott Alexander before but didn't know he had read this topic. Was also nice to see his nods to Wikipedia. I wish he would have covered some of the ground I mentioned here regarding more fundamental questions of effectiveness. - Scarpy (talk) 22:32, 22 May 2018 (UTC)

The reason I included the link is because it's a good introduction (both informative and entertaining to read) to the studies trying to measure how well AA works. No other single article that I have read has taught me more about how to look at and understand studies about AA. I disagree with its conclusion (e.g. he passes over purely experimental studies showing AA effectiveness like Walitzer 2009), but it's very good for people just starting to look at AA effectiveness. Defendingaa (talk) 12:49, 23 May 2018 (UTC)

Altered Dodes quote

I have altered the quote used in Dodes' "pseudostatistical polemic" (as Jeffrey D. Roth and Edward J. Khantzian put it) to, instead of having ellipsis hiding the second half of his argument that AA has only a 5% success rate, to instead fully quote what is, according to Emrick and Beresford 2016, Dodes' best argument for a 5% success rate. Here is the old Dodes quote:

Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures. The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members. It found that only 31 percent of them were still attending after one year. AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year.33 A third study found that after eighteen months, between 14 and 18 percent of people still attended AA. So let us assume that between 14 percent and 31 percent of people stay with AA for more than one year. Now we must ask: out of this remaining population, how many stay sober? .... These totals all fall within a close range. Together, they support the fact that roughly 5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than one year.

I have replaced it with this quote:

University of California professor Herbert Fingarette cited two [...] statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. [Reference: H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988)] Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members.

Defendingaa (talk) 15:00, 24 May 2018 (UTC)

The Natural History of Alcoholism Revisited does not claim a 5% success rate

Since editors have, over the years, have tried to use The Natural History of Alcoholism Revisited to show a 5% success rate for AA, I need to point out that this claim has never been echoed in peer-reviewed literature, and has been shown to be wrong.

For an edit to add content that The Natural History of Alcoholism Revisited claims that AA has a 5% success rate, they will need to add a citation from a reliable source that this is what the book states.

Defendingaa (talk) 19:39, 23 June 2018 (UTC)

The 1990 AA Triennial survey

I observe that someone removed the link to "Alcoholic Anonymous Recovery Outcome Rates" a few years ago. It is true that this particular paper is not peer-reviewed, however, the contents of this paper have affected how peer-reviewed and other books written by professionals view AA retention. Here are a number of books and papers which claimed the 1990 Triennial survey showed a 5% retention rate before "Alcoholic Anonymous Recovery Outcome Rates" was published:

• McIntire, Don (2000). "How Well Does A.A. Work?". Alcoholism Treatment Quarterly. 18 (4): 1. doi:10.1300/J020v18n04_01. at 12 months the figures are 5% remaining and 95% departed.
• Carl G. Lukefield, "Behavioral Therapy for Rural Substance Abusers", 2000 has this quote: "By 12 months, 90 percent have dropped out (McCrady & Miller, 1993)"
• Charles Bufe, AA: Cult or Cure 1997 has this quote Quote: "AA produced a large monograph, “Comments on A.A.’s Triennial Surveys,” that analyzed the results of all five surveys done to that point. [...] AA has a 95% new-member dropout rate during the first year of attendance."

However, after "Alcoholic Anonymous Recovery Outcome Rates" was published, a number of sources all of a sudden decided that the 1990 Membership retention survey showed a 26% one-year retention rate, which just happens to be the number in that paper. Even anti-AA polemics like Dodes' poorly-argued The Sober Truth now use the 26% figure. For example:

• Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN 978-0807033159. AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year
• Adrian, Manuella (2012). "Can Failure Carefully Observed Become a Springboard to Success?". Substance Use & Misuse. 47 (13–14): 1384. doi:10.3109/10826084.2012.706178. the Alcoholics Anonymous triennial surveys from 1977 through 1989 found that one quarter (26%) of those who first attend an AA meeting are still attending after 1 year

Point being, while "Alcoholic Anonymous Recovery Outcome Rates" was not peer-reviewed, at least one peer-reviewed article and one anti-AA polemic trust its figures, so the paper's conclusions of a 26% one-year retention rate are considered reliable among treatment experts.

That in mind, I have restored this reference to Effectiveness of Alcoholics Anonymous alongside a note that the 1990 Triennial Surveys show a 26% and not 5% retention rate. As Slate Star Codex puts it: "Almost everyone’s belief about AA’s retention rate is off by a factor of five because one person long ago misread a really confusing graph and everyone else copied them without double-checking."

(I have added this same note to the user who removed this reference five years ago).

Defendingaa (talk) 23:11, 27 May 2018 (UTC)

@Defendingaa: McIntire may be cited incorrectly here, I think he was one of the few to get the very confusing chart in the AA-publised results of AA Triennial survey right. I would need to re-read it, but my memory from years ago is that he (1) defined "tried aa" as anyone who had been to "90 meetings in 90 days" or something to that effect. (2) correctly clarified the meaning of the graph as not when people dropped out, but at a given snapshot in time how many people in each been had started AA within a year.... Suppose I should probably re-read it, but flagging it now. - Scarpy (talk) 19:32, 26 October 2018 (UTC)

Here is the entire paragraph (bottom of page 7 of the 2000 McIntire paper) where he argues that the 1990 Triennial survey numbers show a 5% retention rate:

Figure C-1, (see Appendix A) which starts with the beginning of the second month, shows that 19% "of those who come to A.A." remain at the end of 30 days. This says, in effect, that during the first 30 days, 81% of those who came to their first A.A. meeting dropped out or ceased to attend meetings. Similarly, at the end of 90 days, only 10% of newcomers are still present; 90% have dropped out. And at 12 months the figures are 5% remaining and 95% departed.

While it was popular at the time to argue that the Triennial survey showed a 5% first year retention rate (or "success rate"), that argument is no longer used by peer-reviewed literature describing 12-step effectiveness; instead we see a more accurate 26% one-year retention rate. The original 1990 triennial survey is available online, and the original survey plainly states the following:

This has been the case for each of the five surveys we are reporting on, and the remarkable similarity of results for the surveys is shown in Figure C-1, where all five are plotted on a single scale by taking into account the size of each survey. That figure also tabulates the average over the five surveys, and that average strongly suggests that about half those who come to A.A. are gone within three months. Unfortunately there seems to be no way in which the reasons for departure can be determined. (Emphasis mine)

So, while McIntire argued that AA had only a 10% retention rate after three months, the actual survey says the rate is around 50%. The reason is because that old survey is a Frequency distribution graph showing the number of people in their first year of sobriety who are sober a given number of months, not the number of people who stay sober after n months. If AA had a 100% one-year retention rate ("success rate", as it's frequently and inaccurately called), the graph would have shown an 8.3% count for each month; instead we see 5% of the people in their first year of sobriety happen to be in their 12th month, while 19% are in their first month--which shows a 26% retention rate for AA over the first year sober. Likewise, the graph shows 10% of the people in their first year are in their third month -- which is about a 50% three-month retention rate.

Furthermore, there is nothing in the original 1990 triennial survey discussing a 81% one-month dropout rate; the number comes from people who didn't understand the graph and decided that's what it showed without any discussion of how AA was supposed to measure the people who dropped out in their first month (since AA doesn't keep membership records nor meeting attendance records). Indeed, the 26% rate that a correct reading of the graph shows is seen in other studies, such as Moos and Moos 2006, which shows 24.9% of the subjects heavily engaged with AA in their first year of alcohol treatment.

Most importantly, from the point of view of the Wikipedia, reliable sources published after the paper correcting misconceptions about this widely misread graph concede that that old triennial survey shows a 26%, not 5%, one year retention rate; when older papers argue one number but newer papers argue another number, we should be inclined to better trust the newer numbers. Defendingaa (talk) 01:20, 28 October 2018 (UTC)

I know, have been saying all of that for years. Will re-read his whole paper again, as I remember him being the first to correct this misconception, but don't see it in the bits I noted in 2009. - Scarpy (talk) 05:25, 28 October 2018 (UTC)

Looking over his paper, McIntire does point out that 1) An 81% first-month dropout rate does not coincide with the experience of people in the AA fellowships (for the simple reason, as we found out later, that number was a fiction) 2) That if one only looks at people with 90 or more days in 12-step fellowships, you get a 55% success rate (the 2008 paper makes a similar calculation and makes a similar conclusion). His paper was one of the first to question the then prevalent wisdom that the 1990 survey only showed a 5% AA retention rate. (The actual figure is that high AA attendance roughly doubles one’s chances of getting sober; in Moos and Moos 2006, sobriety went up from 33% to 67%; in the EpiLab Longitudinal Treatment Surveys, about 27% of low/non AA was sober, and 50-56% of people with high exposure to AA were sober) Defendingaa (talk) 15:33, 28 October 2018 (UTC)

Brandsma 1980 redux

Since there are a couple more recent papers criticizing Brandsma 1980, when I restored that study to this article, I added this paragraph (with cited footnotes) summarizing the criticism of this paper:

This study had poor methodology. There was no effort to stop the people in the control group from attending Alcoholics Anonymous meetings, and the "Alcoholics Anonymous" treatment patients underwent in the Brandsma study did not use actual Alcoholics Anonymous meetings. "The control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting)"

That might not have been neutral, so Krb19 tried to make that paragraph more balanced:

Notably, there was no effort to stop the people in the control group from attending Alcoholics Anonymous meetings, and the "Alcoholics Anonymous" treatment patients underwent in the Brandsma study did not use community Alcoholics Anonymous meetings. A later critical analysis noted: "the control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting)"

I feel this wording undermines the significant criticism Kaskutas 2009 has about Brandsma 1980, so I reworded it again, hopefully more neutral:

There was no effort to stop the people in the control group from attending Alcoholics Anonymous meetings. The "Alcoholics Anonymous" treatment patients underwent in the Brandsma study did not use community Alcoholics Anonymous meetings; a later analysis says that there are "concerns with the Brandsma trial which call its experimental results into question" because "the control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting)"

I think this is pretty neutral, especially in light of just how problematic Brandsma 1980 is, especially when quoted out of context in anti-AA polemics. As just one example of this, here is how Dodes’s The Sober Truth describes Brandsma 1980:

The investigators found “significantly more binge drinking at the 3-month follow-up” among the people assigned to the AA-oriented meetings. As the year mark approached, the researchers noted, “All of the lay-RBT clients reported drinking less during the last 3 months. This was significantly better than the AA or the control groups at the 0.005 level [meaning the finding was highly statistically significant].” The final data led the researchers to conclude: “In this analysis the AA group was five times more likely to binge than the control group and nine times more likely than the lay-RBT group. The AA group average was 2.4 binges in the last 3 months.”

Brandsma, who passed away in 2008, is probably rolling in his grave that his legacy is this particular study that he did in 1979-1980 being misrepresented. Scott Alexander, in his blog, does not view how this study has been abused very kindly:

Brandsma (1980) is the study beloved of the AA hate groups, since it purports to show that people in Alcoholics Anonymous not only don’t get better, but are nine times more likely to binge drink than people who don’t go into AA at all.

There are a number of problems with this conclusion. First of all, if you actually look at the study, this is one of about fifty different findings. [...]

Second of all, the increased binge drinking was significant at the 6 [this is an error; it was at three months we saw the increased binge drinking] month followup period. It was not significant at the end of treatment, the 3 month [Scott probably means 6-month] followup period, the 9 month followup period, or the 12 month followup period. Remember, taking a single followup result out of the context of the other followup results is a classic piece of Dark Side Statistics and will send you to Science Hell.

Scott also has the same issues with this study Kaskutas 2009 had:

Brandsma didn’t use a real AA group, because the real AA groups make people be anonymous which makes it inconvenient to research stuff. He just sort of started his own non-anonymous group, let’s call it A, with no help from the rest of the fellowship, and had it do Alcoholics Anonymous-like stuff. On the other hand, many members of his control group went out into the community and…attended a real Alcoholics Anonymous, because Brandsma can’t exactly ethically tell them not to. So technically, there were more people in AA in the no-AA group than in the AA group.

Point being, it’s a little hard to be neutral w.r.t. Brandsma 1980, so I am opening up a discussion to make sure we do our best here on the Wikipedia. Defendingaa (talk) 08:45, 4 December 2018 (UTC)

Thank you Defendingaa, I think it looks better now. My main concern was the sentence "This study had poor methodology." I think the current version is reasonable, incorporating quotations of other researchers regarding their analysis. This is a useful article, thanks for your work on it. Krb19 (talk) 15:17, 9 December 2018 (UTC)

I hope you (or any other competent editor) continue to review this article and the Alcoholics Anonymous one. With me being the only significant editor of this article, I am concerned that my pro-AA stance will make the article not neutral, so we need other contributions to keep the article balanced, while keeping the article up-to-date. Defendingaa (talk) 20:10, 15 December 2018 (UTC)

I have updated the Brandsma 1980 section to note that the AA treatment was a really poor AA meeting (its leader during the research trial was relatively new to AA; almost no one got a sponsor; and it was not a very cohesive fellowship). I don’t think this is undue weight, since this article is about AA effectiveness, and since Kaskutas 2009 had the same issue with Brandsma 1980 (“a potentially important therapeutic ingredient of AA—the experience of longer-term members—would not have been present in the AA condition” is how Kaskutas worded it). Defendingaa (talk) 03:05, 3 January 2019 (UTC)

Do we not have a specific article on Brandsma 1980? Similar to Project MATCH? Could make an article Outpatient Treatment of Alcoholism covering the book and its reception since it was published. - Scarpy (talk) 01:04, 1 February 2019 (UTC)

I have created an Outpatient Treatment of Alcoholism article, and have made this article’s section on Brandsma 1980 shorter. Defendingaa (talk) 03:11, 18 February 2019 (UTC)

Updating article

Hi Defendingaa (and all interested parties). I like this article and in particular its format/layout of a central topic/question and sections for individual studies on that topic, with abstracts/context in a readable format, somewhat from usual journal abstracts. I'm planning to browse the literature and see if there's any notable recent work on the subject or any older studies that were overlooked, although at present it looks fairly comprehensive. One thought I had when looking through pubmed is all the research done on other 12-step programs, in particular narcotics anonymous and to a lesser extent the other drug-related 12 step groups, and whether we might want to put some of that work here, or whether it should go on its own page.

Another question is what format of studies are best suited to this page, because I see a lot of mediational/ANOVA/mixed-effects type studies where various they investigate various attributes (age, gender, use history, location, etc, etc) that might mediate the effectiveness. Many of them are probably too technical/small/obscure to treat in depth here, but I may try to create a section covering some of the meta-analyses of mediational/mixed-effects studies - along the lines of "X and Y study found AA 20% more effective in people of Z race, and study A found that older, more extroverted people benefited the most from sponsorship, and that people with B disease did not benefit" or some such.

Also, there are some relatively recent bestseller books that treat this topic in depth, I'm thinking in particular about Unbroken Brain by Szalavitz, maybe i'll go find a copy and see what her summary of the research looks like, not sure if it deserves a section of its own since its not 100% focused on effectiveness of AA. Anyway, good page and I would love to see more of these, say, "Comparative Effectiveness of different Hypertension Medications" with a section for each big study or topic. Krb19 (talk) 20:13, 31 January 2019 (UTC)

@Krb19: you'll find an "Effectiveness" section in a lot of the other articles on twelve-step groups and support groups that function like them (where I could find sources when I was doing similar research a few years back). If it's not specific to a particular fellowship. it might be good material for a section in addiction recovery groups, or twelve-step program.

Be careful not to run afoul of WP:OR when commenting on research methods.

One question that really hasn't been tackled here is what effectiveness really means in this context. There are multiple answers to this question, primarily we've focused on people stopping drinking, but that's only one facet of AA (see for example Dry drunk). It could be that people who stop drinking using one method are better off or worse off in other ways that aren't often talked about, and those would speak to the overall "effectiveness" of those methods. - Scarpy (talk) 00:53, 1 February 2019 (UTC)

[outdent]

I appreciate Krb19’s questions and concerns, and here is my response:

• Other 12-step programs. I do sometimes come across a study about another fellowship; when I do, I edit the appropriate article for that fellowship. See, for example Narcotics_Anonymous#Effectiveness, LifeRing_Secular_Recovery#Effectiveness, and SMART_Recovery#Effectiveness
• Yes, most of the studies I have read do include extensive demographic data, but the parts of the studies where they ask the “Does AA work?” question usually doesn’t include demographic data in the answer.
• As a general rule, we avoid bestsellers because of WP:MEDPOP (and are even leery of medical textbooks as per WP:MEDBOOK), but I can address this particular book. Maia Szalavitz has a pretty strong anti-AA bias, and it shows in Unbroken Brain. The part where she directly addresses AA’s effectiveness can be summarized like this: Cochrane 2006 (but she ignores the post-Cochrane experimental studies showing AA/TSF is more effective), followed by Walsh 1991 (but she ignores the fact that the hospitalization treatment included a lot of AA meetings, and, oh it was 227, *not* 200 subjects), followed by claiming that Moos and Moos 2006 is caused by self selection (which is probably partially true, but she ignores studies and meta-studies showing AA effectiveness which can not be attributed to self-selection, e.g. Humphreys 2014). This is followed by a quote that “70% of those referred to AA drop out within six months, according to Scott Tonigan” (which, yes, is consistent with the figures I have seen—this is the first really accurate quote in the book about AA effectiveness). Now if multiple reliable sources start using Szalavitz’s book to argue about AA’s efficacy, we should add a section about the book (we did that with The Sober Truth), but, in my opinion, not until then, since the book doesn’t (in regards to this subject: Does AA work?) really cover anything we don’t already cover here.

(I, for the record, define AA success as “AA helps people get and stay sober”, since that’s something which can be objectively measured)

Defendingaa (talk) 06:04, 8 February 2019 (UTC)

@Defendingaa: Your last point is a very good one, but I want to push back on it a bit because we're missing an opportunity if that's all we look at. In other twelve-step related research you'll see things like worldview transformation or self-transformation. I've long suspected, having researched this for years now, there are three reasons why outside of AA/NA many twelve-step fellowships fail to thrive. One, to your point, is that they don't have objective measurements of success. One outcome of effectiveness research on AA that could be a real benefit to not just to AA but to the efforts of all mutual-aid groups is to document correlates of sobriety that can be measured using psychometrics or other tools and applied to fellowships not dealing with substance abuse. In this way, those could be used in struggling fellowships to identify members that are doing things right. For example, they would be a good indicator of who would or wouldn't be a good sponsor in those groups. Neurotics Anonymous created a test of mental and emotional health which I believe is the only attempt I'm aware of to quantify this qualitative part of recovery (and it's notable for being a good start, but is far from what is needed).

FWIW if you're curious, the second reason is that they're defined too broadly and because of it when people show up there's not enough in common among members to have real group cohesion through a significant amount of shared experiences unique to people like them. For example, most American adults have unsecured debt and almost certainly have a desire to have less of it, but that's so common it's not enough for group cohesion in a fellowship like Debtors Anonymous, hence why it's so small. Similar reasoning would apply to groups like Emotions Anonymous and Neurotics Anonymous. My guess is that versions of these fellowships defining a more narrow demographic of people who are likely to have more in common would grow much larger much faster. The third reason is that fellowships that do have objective measures of success like Sexual Compulsives Anonymous and Gamblers Anonymous are dealing with behaviors that are likely comorbid with other addictions (e.g. there are very few people who just have problems with sex or gambling that haven't had issues with alcohol or other drugs). So most people go to the larger fellowships and only end up in places like SCA or GA if they really need the common experience of those specific addictions and aren't a good fit in the larger fellowships... anyway, these last two points are unrelated, but didn't want anyone to feel like I was holding out on them. :) - Scarpy (talk) 21:31, 11 February 2019 (UTC)

I tend to agree with you, but Alcoholics Anonymous itself defines success as people who “got sober” (as per the Foreword to the Second Edition of AA’s Big Book), and anti-AA critic Dodes defines success as “A treatment for alcoholism may be called successful if an individual no longer drinks in a way that is harmful in his or her life.” Defendingaa (talk) 03:02, 12 February 2019 (UTC)

@Defendingaa: that's an AA answer (or a critic of AA answer). It's not a Wikipedia "we are building encyclopedic knowledge about AA and related topics" answer. I didn't want to repeat too much of what I said here but it's all still relevant. The other things we're missing if we just focus on "does AA get people sober?" are "what things could AA do to be more effective at getting people sober?" Which is really the more important question. We also miss the chance to distinguish AA from other organizations. Are their salient differences among members? Maybe dry drunks are more common in other organizations? Maybe they're more common in AA? I'll say again, after doing this for more than a decade, it's clear that researchers read Wikipedia and it's a starting point for many of them. What we put in this articles are the seeds of ideas that will likely be researched in academia. We should take that seriously. I can say, almost for certain, if it wasn't for pages like addiction recovery groups in 2007, there probably wouldn't be studies like the excellent one you've added in 2019. It's like we're the player that does a set in volleyball, and we give researchers the ability to spike the ball. It takes several years, but happens often. - Scarpy (talk) 17:50, 12 February 2019 (UTC)

I think it’s a good topic of study to look at how the 12 steps improve one’s psychological well being. I also think it’s important to emphasize that the meetings work for people who actually go to the meetings, since there’s still a lot of the old “5% success rate” misinformation still being spread online. This is why I’m giving more honest success rate numbers (67% from Moos and Moos 2006, for example) in the lead, so that people looking up AA’s success rate can get good honest numbers about how well it works for people who get serious about it. Defendingaa (talk) 17:14, 17 February 2019 (UTC)

@Defendingaa: There's good evidence for that when it comes to AA. But again I think to the extent that we can summarize research that exists that digs deeper, it's worth doing. I suspect you know as well as I do that not all meetings are created equal. Meetings create kind of "micro-cultures" and some of them are really awful while some of them are really beneficial and there's plenty of them in between. "13th stepping" for example is probably more common in some meetings than others (and for sure, I know it occurs outside of AA in other support groups, but still). At the meeting level, providing research (where it exists) on the factors that make them better or worse is related in aggregate to AA's overall effectiveness. - Scarpy (talk) 01:28, 19 February 2019 (UTC)

Making this article more neutral

Let’s look at some of the discussion started by Scott Alexander’s 2014 article on AA efficacy over at Reddit:

https://www.reddit.com/r/psychology/comments/2kdy7p/alcoholics_anonymous_much_more_than_you_wanted_to/clkp7wn/

Scott Alexander there makes an interesting observation about the Kelly & Beresin article we reference, stating the following:

I did see the Kelly & Beresin article you linked, but I wasn't too happy with it because it seemed to push AA too strongly - eg cite a study saying it worked better than CBT-based treatments without mentioning the other studies saying CBT works better than AA; it also seems to misquote the researcher it's talking about at a couple of points, which isn't a flaw in its research per se but makes me worried.

Point being, someone who has read the same literature has less of a pro-AA stance than this article currently has (since, as far as we know, we don’t link to or describe those “other studies saying CBT works better than AA”).

That in mind, I hope other people familiar with the literature chime in and link to or describe which other studies we should add to this article to make it more balanced. Defendingaa (talk) 02:50, 27 December 2018 (UTC)

There is too much emphasis on "flaws" in studies that conclude a lower efficacy rate. There is also a repeated emphasis on the frequency of attendance correlating to successful outcomes, without noting self-selection as a factor except to say that these outcomes can't possibly all be due to self-selection. This is disingenuous at best, though I wouldnt Milehisailor (talk) 07:18, 11 April 2019 (UTC)

These assertions, from a user who has only made a single edit, have a number of flaws.

The first being the old myth that the old (and false) low efficacy rates for AA come from peer reviewed research. There actually aren’t any published peer-reviewed “studies that conclude a lower efficacy rate” (i.e. the 5% number anti-AA critics come up with never came from a study, but from some flawed reasoning, as the article details).

The second flaw is that this writer contends that the article ignores self-selection (“without noting self-selection as a factor”). We do not; self-selection is discussed in the lead after we quote longitudinal studies which show a high (67-75%) success rate for AA meeting attenders.

This comment then implies that we’re making up the notion that AA success does not come from self selection (“these outcomes can't possibly all be due to self-selection”). We are not: The conclusion that there is evidence of AA efficacy that does not come from self-selection has been shown in peer-reviewed research.

(There were older studies which show AA is about as effective as other treatments/as effective as no treatment, but there are also peer-reviewed articles which criticizes those studies. The main issue being that the control is contaminated: If someone went to AA and got sober, even if the doctor/judge did not tell them to go to AA, old studies did not consider that a success for AA; and, likewise, if someone was told by a doctor/judge to go to AA but the subject never went to a meeting, old studies considered that a failure for AA. Newer studies with treatment methodologies which actually get people in the rooms of AA show that people who go to AA more drink less.)

I welcome criticism, but the criticism should be based on peer-reviewed research, and based on what the article actually says, not just be false assertions from a user who has only ever made one edit to the Wikipedia. Defendingaa (talk) 13:35, 11 May 2019 (UTC)

More thoughts on perceived neutrality

I have been thinking about why it may be that the article is perceived as not being neutral, despite being reasonably neutral. The main issues are as follows:

• The good science (i.e. experimental studies) showing AA efficacy for a subset of alcoholics is fairly new, having only come from studies published in the last ten years or so. As recently as 13 years ago, one could (and did) make a strong case that no experimental studies showing AA efficacy were out there, but a lot has changed since then. In 2016, the US Surgeon General stated that "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions." -- that’s something they probably would not had said in 2006.

• Over the years, a number of anti-AA polemics have been published, with some of their arguments becoming well known, despite not being particularly scientific. Someone who has read the anti-AA polemics may see this article as being biased because it doesn’t accept those polemics as as gospel truth. The fact is that there is a lot of controversy among actual scientists in the addiction field about the polemic talking points (e.g. Lance Dodes’s The Sober Truth, which we devote a whole section to).

• A number of books published, even this decade, and a lot of blogs and articles posted on B-grade websites, still ignore the recent science showing that AA helps some alcoholics.

Back in 2009, one could say with a straight face that there wasn’t any hard science showing AA efficacy. Here in 2019, a lot has changed, but I can see why someone who isn’t familiar with the new science might see this article as being horribly biased, when the article actually is just quoting a lot of science that wasn’t around until recently.

Thoughts?

Defendingaa (talk) 22:46, 27 May 2019 (UTC)

Here’s what I consider to be a neutral article about the efficacy of AA recently published (within the last two years) by the popular press: https://www.vox.com/policy-and-politics/2018/1/2/16181734/12-steps-aa-na-studies Here’s a key quote: “Years of evidence show that the 12 steps, on average, really can help treat alcohol addiction. But that comes with some major caveats.” Defendingaa (talk) 15:56, 28 May 2019 (UTC)

At the risk, I suppose, of really beating a dead horse -- our definition of "effectiveness" comes in the play here. We're thinking about effectiveness is very remedial ways (e.g. overall, is this effective?), and my hunch is that people reading this article are asking questions like "why should I expect AA to help me if I'm ordered to go by the court and I'm an atheist?" That's totally a fair question. - Scarpy (talk) 17:13, 28 May 2019 (UTC)

I think we should hunt for reliable sources which ask this question. I know that Dianne Bently’s dissertation states that “identifying as atheist or belonging to another faith could cause an individual to stop attending AA” (Dianne Bently, “Quantitative Assessment of Psycho-Social Factors Associated with Alcoholics Anonymous Involvement” 2018, Walden University dissertation). Defendingaa (talk) 10:42, 31 May 2019 (UTC)

Another question might be "what is the mechanism of effectiveness is AA?" Is it making connections with other people? Is it spirituality? Is it having a "daily program?" What evidence shows that's the case? Some good thoughts on that spirituality point in this recent blog post https://aaagnostica.org/2019/05/26/spiritual-not-religious-the-hollow-claim-of-alcoholics-anonymous/. - Scarpy (talk) 00:08, 29 May 2019 (UTC)

This might be a good study to include: “Psychosocial and Clinical Predictors of Retention in Outpatient Alcoholism Treatment” by Filho and Baltieri, from 2012. “Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates.” Defendingaa (talk) 10:46, 31 May 2019 (UTC)

And the most important question, in my opinion, "how can AA be more effective?" That's the real question that's also really taboo in AA. In fact, you ask that question in virtually any fellowship and people walk out the door. It's also completely fair and very important. Are there gaps or blindspots in AA? Are there people that really would be better served in other groups or with other treatments? Could AA address any of this? That's an overton window - Scarpy (talk) 17:13, 28 May 2019 (UTC)

I think we should look for reliable sources which ask that question. AA is not evidence-based, but the evidence is that it works for some alcoholics. Defendingaa (talk) 10:48, 31 May 2019 (UTC)

I think there actually are some neutrality problems, some things that read like they're putting the thumb on the scale for the pro-effectiveness side... even if they are subtle and come more from writing from a point of view than from dishonest intent. A quick example:: "While the group who randomly underwent TSF had a higher percentage of days abstinent (58% vs. 49% at the nine-month follow-up, overall p=0.33) and a larger number of subjects either completely or "mostly" abstinent (33% vs. 21% at the nine-month followup, overall p=0.30), these numbers were not considered statistically significant." The main point is that the study showed no statistically significant difference... but instead of just getting that, we're not only giving but leading with the information that TSF "won". That is not vital summary data, the vital data is that no statistically significant difference was found, and giving that data at all may be misleading to those who don't understand statistics. --Nat Gertler (talk) 18:04, 28 May 2019 (UTC)

I have removed the sentence in question. I added that information because it’s a good idea to include information from a study which is not in the abstract; there have been studies deleted from this page because the summary here only included information in the abstract. I welcome editors reviewing this article and finding other specific POV issues with it. Defendingaa (talk) 01:30, 29 May 2019 (UTC)

That's a valid point. If the results were not statistically significant, then they cannot be used to state the effectiveness of the treatment. — The Hand That Feeds You:^Bite 20:12, 28 May 2019 (UTC)

I hate to keep pointing this out, and if someone wants to tell me why I'm crazy, go ahead. If I were to take issue with the paragraph that Nat Gertler quotes from, I should first say there's a significant apriori assumption of what "effectiveness" means and a bit of bait and switch or conflation when it comes to describing what is being measured. To spell it out:

(1) any claim to the effectiveness of twelve-step facilitation for alcoholism is not the same as the effectiveness of Alcoholics Anonymous. That's sort of like conflating doing exercising with a physical therapist in a hospital with going to a gym on your own. Perhaps exercise is common to both but the conditions are very different and conflating them is WP:OR, to put it bluntly (even if it's a common conflation). - Scarpy (talk) 00:08, 29 May 2019 (UTC)

The thing about 12-step facilitation (TSF) is that it’s easier to perform experimental studies around. Just telling someone “Go to AA” is not going to increase their chances of going to a meeting and working the program (because any alcoholics told to do that has probably already been told to do so by others), so a lot of experiments where we tell group 1 to go to AA but tell group 2 to do something else end up just having the group “assigned” to AA not going to meetings or meaningfully working the program (e.g. Brandsma 1980 had an entire “AA” meeting run by newcomers without the oldtimers to properly mentor them). TSF gets people in the meeting rooms of good AA meetings without the “well, they were self-selected to go to AA” issue. If there was a question about whether exercise helps people be healthier, then it would make sense to see if people who engage in physical rehabilitation do end up getting better if they perform more physical exercise because of the rehabilitation. Indeed, Humphreys 2014 was able to separate out the “increased AA attendance” but from the TSF stuff to determine effectiveness for Alcoholics Anonymous itself which doesn’t come from self selection. Defendingaa (talk) 10:59, 31 May 2019 (UTC)

(2) AA's primary purpose is for members to "stay sober and help other alcoholics to achieve sobriety." Should this be our measure for effectiveness when including content in this article? Because if so it's woefully inadequate on measuring AA's efforts to help other alcoholics achieve sobriety. We should be clear about this and there should be editor consensus about what we mean when we say "effectiveness" in the context of this article.

(3) The primary purpose is not the only thing to judge AA's effectiveness on, there's also the Responsibility Declaration: I am Responsible. When anyone, anywhere, reaches out for help, I want the hand of A.A. always to be there. And for that: I am responsible. How well does AA as an organization and members of AA do this? I feel like we're giving AA a pass here with a wink and a nod like "we know you're not really that good but we don't mind if you pretend." But it's official and if there's WP:RS on how well AA does at helping everyone--not just alcoholics--that should be included. - Scarpy (talk) 00:08, 29 May 2019 (UTC)

To address points 2 and 3, the Betty Ford Center in Palm Springs, California, performed a survey where 62% of patients defined recovery from addiction as no longer using the substance one is addicted to, so I think it’s fair this is the general definition of recovery in this article. Defendingaa (talk) 11:03, 31 May 2019 (UTC)

I think using some definition that is neither provided by academics nor is grounded in AA's stated goals is hard to support. It is also a weak definition (not using for how long?) and weighs the scale heavily on AA's philosophy of addiction (i.e., if out of a sample set of AAers 30% ended up being folks who were getting drunk daily, while out of the control group 10% were daily drunks while 40% ended up being one-beer-a-week drinkers, under this definition AA is "effective".) --Nat Gertler (talk) 13:00, 31 May 2019 (UTC)

In terms of “is the drinking OK”, Moos and Moos 2006, as one data point, shows that the more alcoholics are abstinent, the less subjects have drinking problems -- moderation does not appear to be a sustainable long term solution. See also Pendery 1982, where alcoholics who became “moderate” drinkers were not moderately drinking a decade later -- they were either in out of control drinking, abstinent, or dead. There are short term studies based on self-reported information which conclude moderation may work for alcoholics, but I haven’t seen a 10-year followup showing the moderation still working. Note that there are Sinclair Method advocates out there who claim medications can successfully get alcoholics to moderate their drinking, but their thinking is based on looking only at the short-term studies with the best results, while using dubious information which doesn’t even come from studies (the 1990 Triennial graph, or Lance Dodes’s 2014 book) to claim AA has a 5% success rate; overall, the medications that usually advocate overall have a slight but significant effect. Defendingaa (talk) 14:41, 2 June 2019 (UTC)

What Pendery found (he says, looking it up) is that a sizable portion (7 out of 20) of those who chose a moderate drinking path were not problem drinking ten years later, either because they were still moderating (1) or because they had since chosen not to drink (6). So simply labeling those who are on a moderation path failures is problematic. And that study was only on those labeled "physically dependent". And even that 1, that 5 percent, would be enough to put a weight on the question of what effectiveness is to be measured. --Nat Gertler (talk) 15:53, 2 June 2019 (UTC)

What Pendery found was that, of the 20 people assigned to moderation therapy by the Sobells, 7 out of 20 of them were no longer engaging in problem drinking, by completely abstaining from alcohol. The Sobells claimed that alcoholics could moderately drink again, but that approach had a (with the Sobell study, at the 10-year follow-up point) a 5% success rate. Indeed, “some of the patients in the study filed a lawsuit seeking $96 million in damages stemming from the controlled drinking treatment.” It would appear moderation may not be a long-term solution for many alcoholics. Moos and Moos 2006 shows a higher success rate for moderate drinking (i.e. they were not abstinent from alcohol and did not have self-reported “Drinking problems”) 16 years after treatment: 21% for people who didn’t participate in AA at all, as well as 18% for people who had a lot of non-AA therapy; only about 8% of people who went to a lot of AA meetings were moderately drinking. In all cases, there were more people abstinent than were moderately drinking; in addition, there were more people with drinking problems than were moderately drinking. Again, moderation looks risky. Defendingaa (talk) 05:15, 6 June 2019 (UTC)

While moderation is risky, not drinking is also risky, as a large portion of those who choose that path will fall off the wagon at some point. But that doesn't go to the question of whether those who do succeed in avoiding problem drinking should be counted in effectiveness. The question of being effective at what, compared to what, seems vital, and there are problems with the suggested measurements. --Nat Gertler (talk) 05:49, 6 June 2019 (UTC)

The number of people who a. Try to not drink and b. Go to one at least one AA meeting a week c. End up drinking anyway is about 25-33%, and I can see why that is a large portion of alcoholics AA seems to not work for (there’s also the entire harm reduction angle: A lot of people with drinking problems are plain simply not ready or willing to abstain, so if we can reduce their drinking to manageable levels, even if only temporarily, we may be doing some good). Anyway, WP:NOTAFORUM. We need to define success the way reliable sources define success. PMC2746426 goes to a lot of effort to make graphs showing AA attendance vs. Sobriety as seen in Moos and Moos 2006, so that seems to be a perfectly reasonable way of viewing success and efficacy. Defendingaa (talk) 14:58, 6 June 2019 (UTC)

(4) As is spelled out in Not God: A History of Alcoholics Anonymous by Ernest Kurtz and other materials (some of which appear in the article on Dry drunks), in AA alcoholism is often considered to be more of a symptom of an underlying disease of self-centeredness "the core perception of the problem is selfishness" as Kurtz put it. This suggests that we should be focusing on a range of outcomes and not just sobriety.

(5) if this article was re-titled something like "The Effectiveness of Alcoholics Anonymous and derived clinical practices in helping people become sober and maintain sobriety" or if that was spelled out somewhere in the article, I would have less of a gripe (I've never looked, but I'd imagine there's a title character limit set somewhere that likely runs afoul of). Either way, an Effectiveness of twelve-step facilitation for treating alcoholism would be completely appropriate none-the-less, as would articles on AA's effectiveness in other areas--building social bonds, reducing narcissism, and other things that are largely undiscussed here but that are as important if not more important than sobriety.

(6) is cost-effectiveness at all considered here and availability/accessibility relative to other things? This is a minor point but also overlooked.

As it stands, we have a list of mostly lame attempts at comparing AA (or things like AA) to CBT and other treatments. I don't blame people reading it for disliking the dichotomy between Secular CBT vs. Spiritual AA, because it's a false dichotomy and one that's been forced on us by ideologues rather than a meaningful distinction. There's many more interesting things to research here that are unrelated to that tried and boring decades-old feud. - Scarpy (talk) 00:08, 29 May 2019 (UTC)

@Scarpy You bring up a lot of interesting points, and I don’t have time to address all of them right now. I personally see the feud as being one against those who advocated controlled drinking (who would look for any and all evidence that AA was bunk and not working) and those who advocate abstinence and 12-step approaches (who traditionally felt people who weren’t making it in AA were not working the program hard enough; this hard line approach, fortunately, has lost a lot of traction in the last 15 years or so). Defendingaa (talk) 01:39, 29 May 2019 (UTC)

Should we include the 2012 report by the National Center on Addiction and Substance Abuse at Columbia University?

I reverted this addition in the Alcoholics Anonymous article (because the general rule of thumb there is that we don’t change the section on AA efficacy in the main AA article without first hammering out consensus on the talk page), but will include it here:

However a 2012 report by the National Center on Addiction and Substance Abuse at Columbia University stated that most people who are in need of addiction treatment "...do not receive anything that approximates evidence-based care.” (Reference: Gabrielle Glaser’s rather biased 2015 article about AA).

I went to the bother of getting the actual report, and here it what it has to say, in context:

This five-year national study revealed that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposed the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services, including pharmaceutical and psychosocial therapies and other medical care.

Note the following: That report is criticizing treatment centers; no where in the report are the words "Alcoholics Anonymous" or "12-step" or "12 step" used. I agree that treatment centers should use more evidence based treatments, and consider treatment methodologies besides the AA Big Book (If you’re going to charge $50,000 for treatment, I would like more than just a $6.25 study edition Big Book), but I think this conversation would belong in the since-deleted treatment centers page and not on this page, which is about the efficacy of Alcoholics Anonymous. Defendingaa (talk) 06:44, 12 June 2019 (UTC)

An interesting article I found

I found the following interesting article which looks at the “Does AA work” controversy from the point of view that the mainstream media (mostly) gets it wrong:

• https://thewinnower.com/papers/860-alcoholics-anonymous-and-other-addiction-treatment-a-scientific-perspective

Originally a Medium story (except that the author deleted it, but since it has an open license, it can still be legally mirrored), the article argues that addiction is a difficult to handle, and that all of the solutions out there (Alcoholics Anonymous, Medication, CBT, other therapy types) are not that effective, but that Contingency Management may be the most effective method to treat addiction.

While on the topic of Naltrexone, Cochrane (which may be long in the tooth when they discuss AA efficacy), back in 2010 said that Naltrexone has about a 17% success rate (Success: Not returning to heavy drinking) (17% is slightly less than the overall abstinence success rate of AA if we include dropouts); the article also says that Naltrexone decreased the number of drinking days by 4% (the reason this number is so low is because Naltrexone has a small but significant effect when getting alcoholics to moderate their drinking, but is ineffective for abstinent-based treatments)

Just some interesting stuff to think about when thinking about how to improve this article. Defendingaa (talk) 05:37, 14 June 2019 (UTC)

Is the article neutral?

Article does not comply with Wikipedia's NPOV policy, which states the article should be "presenting fairly, proportionately, and as far as possible without bias all significant views that have been published by reliable sources." One user with an admittedly strong pro-AA bias is selectively citing studies that show high efficacy of AA when in fact the body of the research on the subject is much more mixed. People deserve a serious and balanced look at the published literature on this subject. They don't need a sober alcoholic disingenuously editing an article to promote AA. — Preceding unsigned comment added by 71.82.198.122‎ (talk) 13:06, 22 May 2019 (UTC)

Please let us know which studies are missing. I welcome more informed research on this very controversial topic. But I want to see real research, not just polemical assertions without evidence to back them up and personal attacks against other editors. Please use reliable sources and summarize studies (put more emphasis on recent studies, as per WP:MEDDATE) which you feel are more neutral. Defendingaa (talk) 17:02, 22 May 2019 (UTC)

Re-adding the NPOV tag. Given that I'm as LLMSW & M.Psych who treats people with Substance Misuse Disorders, among other challenges, I have plenty of access to "informed research" on the subject. As you noted above, it's a controversial issue in the field, but this article is heavily slanted towards one side of that controversy. The fact is that your editing of this article has made the article non-compliant with NPOV. It also looks like you've added original content of your own which is also prohibited. — Preceding unsigned comment added by 71.82.198.122 (talk) 23:24, 22 May 2019 (UTC)

Thank you, again, for your contributions, and I want you to know you are welcome to make positive contributions to the Wikipedia. Please be aware that professional credentials do not matter here and that it’s important to talk about the content, not about fellow editors. I encourage you to discuss specific issues with the content of the article. Are there studies were are overlooking? Are we misrepresenting any studies out there? If there is original content in the article, where is it, so we can address it? But, the fact of the matter is this: “For the past several years, the addiction research field has moved beyond asking whether AA and 12-step treatment works, to investigating how and why they work”. This in mind, I am removing the NPOV tag again; please, if you wish to put it back, please discuss exactly which specific content of the article is not neutral, instead of talking about the editors editing the article. Principles before personalities. Defendingaa (talk) 17:55, 25 May 2019 (UTC)

NPOV again. None of the original issues with this article have been resolved. Still in violation of NPOV. It's hard to avoid personalities when one dishonest and unethical editor is the source of the NPOV issue. That editor is perfectly capable of changing this article to be more balanced and bring it into compliance with NPOV. Please do not use wikipedia for advocacy. — Preceding unsigned comment added by 71.82.198.122 (talk) 15:37, 27 May 2019 (UTC)

At this point, this IP appears to be more interested in attacking other editors instead of addressing content. I have put a Template:Uw-disruptive1 on their talk page and will report them if they continue their disruptive behavior. Defendingaa (talk) 16:41, 27 May 2019 (UTC)

Since the editor continues to revert without meaningful discussion, I have reported the user’s disruptive editing. I will leave the issue to the admins now. Defendingaa (talk) 17:16, 27 May 2019 (UTC)

The discussion an AN/I is now archivedDefendingaa (talk) 13:48, 14 June 2019 (UTC)

Why Humphreys 2014 is notable

I should go in to more detail why Humphreys 2014 (which shows AA efficacy which can not be attributed to self selection) is notable. I will simply list URLs which cite this study, as well as the quotes around the footnotes:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385165/ “State of the art analyses have shown that AA confers a causal impact on improving outcomes”
• https://addiction.surgeongeneral.gov/sites/default/files/chapter-5-recovery.pdf “A substantial body of research indicates AA is an effective recovery resource”
• https://www.nytimes.com/2015/04/07/upshot/alcoholics-anonymous-and-the-challenge-of-evidence-based-medicine.html “A.A. helps alcoholics, apart from the fact that it may attract a more motivated group of individuals. With that established, the next step is to encourage even more to take advantage of its benefits.”
• http://applications.emro.who.int/emhj/v23/03/EMHJ_2017_23_03_150_160.pdf “Promoting self-help group involvement can improve outcomes while reducing the costs of long-term care”
• https://ncadd.org/index.php/blogs/research-update/alcoholics-anonymous-science-vs-sensationalism “With this revolutionary study we can now be more confident that ever that we are standing on scientifically supported ground when asserting that AA is not only effective but is actually more effective than some alternative interventions in treating the disease of alcoholism.”

As one can see, Humphreys 2014 has been used as evidence that AA helps some alcoholics by publications from very reliable sources on the matter of public health, such as the Surgeon General of the United States and the World Health Organization. It has also been used as the subject of an article in The New York Times, highly praised in a publication by the National Council on Alcoholism and Drug Dependence, as well as being cited in other peer reviewed articles.

Humphreys 2014 is a very significant landmark in the science of alcoholism, and has been cited and quoted in a number of very reliable sources. Defendingaa (talk) 07:27, 16 June 2019 (UTC)

Why I have restored Kownacki and Shadish 1999 (as well as Ditman 1967)

Back in 2017 an IP tried to add Kownacki and Shadish 1999 to the article (for example: this diff); we ended up getting in an edit war and blocking the user for a day. As a compromise with this user, I added information about Kownacki and Shadish 1999 here instead, and going as far as reading the actual article to better summarize it here.

This particular study seems to be fairly widely used; it’s on the first page of Google search results for “Does Alcoholics Anonymous work?”, and in the last month or so, it was brought up in a Reddit thread about Alcoholics Anonymous efficacy (not to mention an article posted this year about AA efficacy). So, I consider it notable, and unless we come with consensus to not have it here, we need to have it to best preserve neutrality (since there is at least one user who really wants it here).

In addition, if we are going to have Kownacki and Shadish 1999 here, we also need to have Ditman 1967 since K&S 1999 refers to that 1967 study. Defendingaa (talk) 13:27, 14 July 2019 (UTC)