Why Alcoholics Anonymous Works

A journalistic piece entitled,  “The Irrationality of Alcoholics Anonymous “, written by  Gabrielle Glaser, also harshly criticizes Alcoholics Anonymous. AA and similar 12-step programs.

I cite a blog on her criticisms here (1)

Why Alcoholics Anonymous Works

“Glaser’s central claim is that there’s no rigorous scientific evidence that AA and other 12-step programs work.

First, she writes that “Unlike Alcoholics Anonymous, [other methods for treating alcohol dependence] are based on modern science and have been proved, in randomized, controlled studies, to work.” In other words, “modern science” hasn’t shown AA to work.”

Glaser appears to lessen her argument by suggesting that AA is difficult to study (so how can she be so sure it is not effective then?).

” Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works.”

Equally there, in her world view, would also be no conclusive data to suggest if doesn’t work? So why make bold claims either way?

” In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

According to (1), Glaser is simply ignoring a decade’s worth of science, not only here but throughout the piece.

“No, that’s not true,” said Dr. John Kelly, a clinical psychologist and addiction specialist at Massachusetts General Hospital and Harvard Medical School. “There’s quite a bit of evidence now, actually, that’s shown that AA works.”

Kelly, alongside Dr. Marica Ferri and Dr. Keith Humphreys of Stanford, is currently at work updating the Cochrane Collaboration guidelines (he said they expect to publish their results in August).

” Kelly said that in recent years, researchers have begun ramping up rigorous research on what are known as “12-step facilitation” (TSF) programs, which are “clinical interventions designed to link people with AA.”

Dr. Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group who has conducted TSF studies, suggest that TSF outperforms many alternatives.

“They show about a 10 to 20 percent advantage over more standard treatment like cognitive behavioral therapy in terms of days abstinent, and typically also what we find is that when people are engaged in a 12-step-oriented treatment and go to AA, they have about 30 percent to 50 percent higher rates of continuous abstinence,” said Kelly.”

The original Cochrane paper that Glaser cites came out before the latest round of studies did, so that research wasn’t factored into the conclusion that there’s a lack of evidence for AA’s efficacy. In a followup email, Kelly said he expects the next round of recommendations to be significantly different:

Although we cannot as yet say definitively what the final results will bring in the updated Cochrane Review, as it is still in progress, we are seeing positive results in favor of Twelve-Step Facilitation treatments that have emerged from the numerous NIH-sponsored randomized clinical trials completed since the original review published in 2006. We can confirm that TSF is an empirically-supported treatment, showing clinical efficacy, and is likely to result also in lowered health care costs relative to alternative treatments that do not link patients with these freely available recovery peer support services. Another emerging finding is that a central reason why TSF shows benefit is because it helps patients become actively involved with groups like AA and NA, which in turn, have been shown to enhance addiction recovery coping skills, confidence, and motivation, similar to professional interventions, but AA and NA are able to do this in the communities in which people live for free, and over the long-term.

In other words, the most comprehensive piece of research Glaser is using to support her argument will, once it takes into account the latest findings, likely reverse itself.”

In other words, it will also help contradict Glaser’s arguments.

“In an email and phone call, Glaser said that TSF programs are not the same thing as AA and the two can’t be compared. But this argument doesn’t quite hold up: For one thing, the Cochrane report she herself cites in her piece relied in part on a review of TSF studies, so it doesn’t make sense for TSF studies to be acceptable to her when they support her argument and unacceptable when they don’t.

For another, Kelly, Katsukas, and Humphreys, while acknowledging that TSF programs and AA are not exactly the same thing, all said that the available evidence suggests that it’s the 12-step programs themselves that are likely the primary cause of the effects being observed (the National Institutes of Health, given the many studies into TSF programs it has sponsored, would appear to agree).”

“It’s worth pointing out that while critics of AA point it as a bit cultlike…to the researchers who believe in its efficacy, there’s actually very little mystery to the process. “We have been able to determine WHY these 12-step facilitation interventions work,” said Kaskutas in an email. “And we have also been able to determine WHY AA works.”

Simply put, “People who self-select to attend AA, or people who are randomized to a 12-step facilitation intervention, end up having people in their social network who are supportive of their abstinence,” she said.

Reams of research show that social networks…are powerful drivers of behavior, so to Kaskutas — who noted that she is an atheist — the focus on AA’s quirks and spiritual undertones misses the point.

“When you think about a mechanism like supportive social networks, or the psychological benefit of helping others… they have to do with the reality of what goes on in AA, with people meeting others in the same boat as they are in, and with helping other people (are but two examples of these mechanisms of action),” she said.”

At the heart of recovery via 12 step groups may be because it “works for a lot of people, simply by connecting them to others going through the same struggles.”

 

 

France - Alcoholic Anonymous celebrates its 75th year

 

 

 

Let’s be Friendly with our Friends?

Cross fertilisation among Recovery Fellowships

I have unfortunately heard sometimes not very complimentary remarks about different recovery groups and fellowships which I have never found particularly helpful or useful in attracting the alcoholic or addict who is still suffering. The simple reality is that people recover from alcoholism and addiction by a wide variety of means, and recovery regimes.

My father recovered via the Catholic Church and was probably not even aware of 12 step or other recovery groups?

People seem to recover in a myriad of ways – unassisted, via religious, spiritual and secular means.

The Big Book says we (AA) have no monopoly on God – I would add we have no monopoly on recovery or treatment either, however widely and prolifically used 12 step programs have become internationally.  We may benefit more from a position of love and tolerance and understanding of the reality we are in recovery from a potentially fatal malady and support each other however we can, no matter what our recovery affiliation is.

It may be that each and every group have many useful recovery knowledge and skills to learn from each other. Showing a united front as a greater recovery community may have a profound effect on attracting suffers of addictive behaviours to recovery.

In this video, William White explains how co-attendance between different fellowships is becoming much more common, as recovering individuals stray over to check out other recovery groups and fellowships. For example for woman for sobriety to attend woman’s groups in AA, perhaps brought to together by a general  “woman in recovery” generality.

It is not unusual for secular groups in recovery to also attend AA meetings especially atheist and agnostic groups with AA. Again a commonality in a more  non theist approach may be a commonality here, especially as there is  rise of agnostic and atheist  approaches within recovery, and especially 12 step groups, such as AA Agnostica. In fact, the Ernie Kurtz and William White have researched this rising trend in much detail.

 

In fact William White writes about this in his website – in the blog “Further reflection on Dual Citizenship” by himself and John Kelly, another leading researcher into recovery.

The Dual Citizenship Phenomenon

“Dr. Tom Horvath recently posted a blog on the “dual citizenship phenomenon”–individuals who concurrently participate in SMART Recovery and AA or other 12-step meetings.

Dr. Horvath’s interest in this phenomenon was sparked by recovering people simultaneously being involved in secular, spiritual and religious recovery support groups–groups whose core ideas and practices would on the surface seem to be incongruous.

The degree of dual citizenship in recovery is revealed in the membership survey of various recovery mutual aid groups.  In Gerard Connors and Kurt Dermen’s survey of Secular Organizations for Sobriety (SOS) members, 30% of (SOS) respondents reported concurrent AA attendance with an average of more than 50 A.A. meetings attended in the past year.

Lee Ann Kaskutas’ study of Women for Sobriety (WFS) revealed that about one-third of WFS members also concurrently attend AA meetings. 

In the LifeRing Secular Recovery Survey, 35% of LSR members surveyed reported co-attendance in another recovery support program–57% of those reporting attending AA. 

The most recent survey of SMART Recovery membersrevealed that 32.4% of SMART Recovery members also attend AA, NA or another 12-step program, 13.8% attend meetings of another secular recovery support program, and 10.5% participate in a faith/religious/spiritually-based program.

(Typically these dual citizens report that “I attend AA for the fellowship and community, and SMART Recovery for the tools.” These individuals, I suspect, would not attend AA if SMART Recovery were as large and had the same depth of community – certain individuals who seem equally committed to both organizations and both approaches –  these individuals are the true dual citizens.)

Such surveys reveal considerable eclecticism in recovery support participation across what are often portrayed as quite distinct frameworks of addiction recovery support.”

 

More recovering individuals are looking at themselves as members of a greater recovery community rather than simply identifying themselves within the confines of fellowship membership.

My own recovery has hugely enhanced by researching the neuropsychology of addiction and recovery over the last 5-6 years, in fact, on occasion this research has saved my life from probable relapse. My blogs seek to embrace aspects of DBT, CBT, psychological and psycho-analytic theories of addiction etc.

I have come to an understanding of my own addictive behaviours as being driven by an inherent emotional dysfunction mainly via academic research. For me the spiritual malady of AA can also be explained in terms of emotional dysregulation as can the processes of positive behavioural change prompted by working the 12 steps.  These views are not opposing but complementary, mutually supporting views.

I have a “critical” head which is not at odds with 12 step spirituality. I have not given up on self, but chosen to exercise self under the direction of my Higher Power, a HP that does not act via fear. My critical head has helped me explore my spirituality.  I do not leave my reasoning brain at the door when I enter the rooms of AA and I don’t suggest any one else does either.

In fact my initial understanding of myself as an alcoholic is primarily based on the perceived wisdom of AA members in their lived experiences  as recovering alcoholics –  I believe AA is as much about this shared recovery experience as it is the contents of the Big Book.

The “traditions” of AA are also borne out of the lived experience of recovery, compiled and organised by Bill Wilson from the lessons learnt in a multitude of recovery settings and recovery group experiences throughout the US and beyond over a number of years.

The Big Book described this illness in one way nearly 80 years ago and this way is still valid today but it should never preclude us from adding to this sum of knowledge, from explaining this illness given the understandings which have been developed in that 80-year time frame. We now know a huge amount about this condition and increasingly about recovery.

Bill Wilson himself commented that he feared the Big Book would become “frozen in time”. As someone who looked at different possible supplements to recovery, such as vitamin therapies, one can be sure that he were alive today he would be absolutely fascinated with  developments in our knowledge base about this condition and it’s recovery.

He may even have some pride that he helped in no small part, by  prompting such inquiry. Bill Wilson was fascinated and intrigued by alcoholism and his fellow alcoholics. For him anything that alleviated  the suffering of alcoholics would be considered helpful. He after all asked us to be “friendly with our friends”?

Isn’t that we are all trying to achieve, a greater understanding of the underlying mechanisms of this emotional disorder, this spiritual malady? A greater awareness of the recovery process and possible outcomes of recovery? For ourselves and our families and communities.

Isn’t this a wonderful journey that we can all share?