It seems that whenever I read an article which claims that AA is not effective in treating alcoholism, particularly one written by someone who is a journalist rather than the nitwits from sites like The Orange Papers, I nearly always see the “success rate” for AA pegged at about five percent. Those numbers are usually accompanied by the comment that this is about the same rate as people who quit on their own. And my response to that statistic is always the same: “Really? Where the fuck are the researchers getting those numbers?”
While I don’t blame the journalists for citing peer-reviewed scientific studies that draw the conclusion that AA is no more effective than both other programs or the addict just doing nothing, the problem I have is with the studies themselves—specifically the population of alcoholics that they draw on when quantifying what constitutes AA “treatment” or even AA membership.
One of the most commonly cited resources is the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, a collection of eight various trials from 1967 to 1982 that examined 3,417 subjects with an alcohol dependence. Like nearly all scientific studies on AA effectiveness, this one doesn’t define what constitutes AA (or 12-step facilitation) participation, so we don’t know if the subjects in the study went to a treatment center that subscribed to a 12-step program or to a couple of meetings and hated the Higher Power stuff or was someone who was pressured by a spouse.
I’m willing to bet that it’s not a very representative cross section of people in AA recovery. The subjects from these studies were “attending AA on a voluntary or coerced basis” according to the selection criteria—which to me is two completely different populations that should never have been combined.
As my brother who drank himself to death roughly five years ago said to my other (sober) brother and me when we attempted to 12-step him, “I hear it doesn’t work if you don’t want it to.” No shit. So how can you include people who may not want to get sober in a study measuring AA effectiveness?
There are also studies that present “evidence that consistent AA attendance improves drinking outcomes” and “confirm the robustness of AA effectiveness overall.” Still, while these studies point to AA attendance as a criteria and draw a strong correlation between showing up there and staying sober, anybody that goes to AA on a consistent basis understands that attending meetings may be the most important thing, but it’s really only the tip of the recovery iceberg.
Going to an AA meeting to have a court slipped signed (which, btw, is how I got re-introduced to AA when I got a DUI) isn’t, of course, the same as being fully involved and actually working a program of recovery. Because if you were to ask me if I wanted to stay sober the first time I came into AA (when I didn’t), I would have told you I did. But the truth of the matter was that I wasn’t willing to do anything to accomplish that goal, and was mostly interested in having my trouble go away, rather than not drinking or taking drugs. And total abstinence was never really part of my plan, never mind taking suggestions.
Another commonly cited reference by journalists trying to make the point that AA is not effective is AA’s own internal surveys, published by Alcoholism Treatment Quarterly in 2000. The surveys were taken between 1968 through 1996 and they determined that 81 percent of newcomers to AA stopped attending meetings within the first month, and that after 90 days only 10 percent of those people were still around.
This reinforces my point: If the subjects aren’t at the meetings, how is that AA’s fault? AA and other treatments “work if you work it,” but if you’re not there, how can you be considered an AA participant?
Countless people try diets or get gym memberships to try to lose weight—particularly at this time of year—and if they do what they’re supposed to, all of them work, at least to some degree. But if they don’t go to the gym and work out or follow the diet plan, is that the gym or the diet plan’s fault? No. If you diet and exercise, you are most probably going to lose weight, but if you stop doing those things, you probably won’t. The same thing is true with AA. People who show up and participate get results.
AA, of course, really does not lend itself to the scientific model. For starters, any program that involves having a belief in a Higher Power as one of its building blocks can’t possibly be quantified, even though multiple studies indicate that prayer is an effective tool in increasing positive health outcomes. You also can’t measure desire, willingness or the role that honesty plays in getting and staying sober, even though those in both 12-step programs and other treatment modalities will tell you that they are critical for recovery.
There’s a guy in my group that sums it up this way when he speaks to patients in a detox: “AA works spectacularly well for people who really want to be sober and are willing to do a little work, but it works really shitty for people who don’t.”
In this case, it’s safe to say that common sense trumps flawed science.
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