The Science of 12-Step Programs 330
Hugh Pickens DOT Com writes "Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts A.A. on "the fringe" in the minds of many scientists. But there is an interesting read at National Geographic where Jarret Liotta writes that new research shows that the success of the 12-step approach may ultimately be explained through medical science and psychology. According to Marvin Seppala, chief medical officer at Hazelden and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings. The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he says. "People will regularly risk their lives—risk everything—to continue use of a substance." Addicts don't want to engage in these behaviors, but they can't control themselves. "The only way to truly treat it is with something more powerful," like the 12 steps, that can change patterns in the brain. Philip Flores, author of Addiction as an Attachment Disorder, says the human need for social interaction is a physiological one, linked to the well-being of the nervous system. When someone becomes addicted, Flores says, mechanisms for healthy attachment are "hijacked," resulting in dependence on addictive substances or behaviors. Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people. Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. "We, as social mammals, cannot regulate our central nervous systems by ourselves," Flores says. "We need other people to do that.""
An AA Alternative: Naltrexone (Score:2, Informative)
If there's anyone who wants to quit but doesn't like AA for whatever reason, I can recommend Naltrexone and the "Sinclair Method".
Effective for some, not all (Score:5, Informative)
Most schools are trying to come to terms with the fact that people learn differently, when will treatment programs come to terms with the fact that people recover differently?
Re:quit drinking (Score:5, Informative)
Step 0.5 is to stop drinking. They won't let you in if you are actively drinking at the moment, so they assume you have quit, even if it's one day sober (while not sober).
The only requirement for A.A. membership is a desire to stop drinking. Anyone can go to meetings, sober or drunk, doesn't matter.
"Success" of AA? (Score:2, Informative)
AA's own internal figures show that only 5% of people who start AA are not drinking one year later.
The spontaneous remission rate is also 5%.
So the ones who are stopping were going to stop anyway (and kudos to them).
But what about the 95% who don't stop? Other studies show that when groups of alcoholics were randomly assigned to court ordered AA, no treatment, or a therapy program, the AA group was FIVE TIMES as likely to engage in subsequent episodes of severe binge drinking as the no treatment group, and nine times more likely than the therapy group.
Here's a sampler:
http://www.thefix.com/content/the-real-statistics-of-aa7301
http://www.orange-papers.org/orange-effectiveness.html
http://www.youtube.com/watch?v=Z0DSEdLCAUg
Do 12-step programs even work? (Score:5, Informative)
There is a lot of evidence to suggest that 12-step programs are nothing more than window-dressing. That they take credit for spontaneous remission - the percentage of people who just quit on their own.
For example, alcoholics have a spontaneous remission rate of roughly 5% - so if an AA program has a 5% success rate (including the people who give up on the program - the AA people don't like to count them) then AA is just a no-op.
Here's one of many analyses making the argument that 12-steppers are just bad at math.
http://www.orange-papers.org/orange-effectiveness.html [orange-papers.org]
Re:Do 12-step programs even work? (Score:4, Informative)
There is a lot of evidence to suggest that 12-step programs are nothing more than window-dressing. That they take credit for spontaneous remission - the percentage of people who just quit on their own.
For example, alcoholics have a spontaneous remission rate of roughly 5% - so if an AA program has a 5% success rate (including the people who give up on the program - the AA people don't like to count them) then AA is just a no-op.
Here's one of many analyses making the argument that 12-steppers are just bad at math.
http://www.orange-papers.org/orange-effectiveness.html [orange-papers.org]
An article in Scientific American in 2011 (sorry I don't have the direct reference) showed AA had a 40% success rate. Dedicated therapy something like 55% and people going cold turkey or self-treating less than 5%.
I'm not sure why there is a discrepency between the link you quoted and the article in Scientific American. If I recall, the SA article quoted numeous statistically valid independant studies that corroborated their reported findings. Maybe the paper you referenced wasn't a statistically valid sample? I don't know, but given the plethora of studies that show otherwise, while not as successful as dedicated therapy, 12 step programs are universally recognized and accepted as being successful.
Since when is a 5 percent success rate "working"? (Score:4, Informative)
AAs success rate varies between 5 and 8 percent, about the same success rate you'd expect from no treatment.
If you can't beat the control group then it's junk science at best to try and derive meaningful conclusions from the few success stories and lends undeserved credibility to a program that is a massive statistical failure by almost any measure that means anything.
Re:Gotta have a plan (Score:1, Informative)
The meetings, in general, do not contain 'angry and bitter zealots', yes there are a few, we call them step-nazis, for example. There are also a few chain-smoking coffee drinkers, but we don't consider that to be the purpose of stopping drinking. Also, better that they do that for a while than kill themselves directly with drink.
It's not for everyone, and there are other approaches. But it's saved and improved a lot lives in the span of its existence.
So troll away, you've been fed, but somewhere else and about something else, why don't you or 'grow up' does that work for you?
Re:Do 12-step programs even work? (Score:4, Informative)
Do you mean this one? [scientificamerican.com] Where they didn't count the people who dropped out early on?
Yes, because in evaluating the efficacy of substance abuse programs the national standard when looking at recidivism is to look at those who have completed the program. Drop out rates are reported, but they don't impact the recidivism rate. That can only be measure once somebody completes the program. That is the same methodology used for private counselling related to substance abuse, too. So, when they say 40% for AA and 56% for private counselling, they are comparing apples with apples and only talking about those who completed therapy. The dropout rate for both is very high, which is why when court ordered, there is regular reporting back to the courts on attendance.
This isn't unique to substance abuse, most medical treatments follow this practice. If somebody starts chemo for cancer and drops out, it does not count against the effectiveness of that type of chemo for that type of cancer. It does get reported so that doctors are aware of what the dropout rate is so they can help the patient through it.
Put differently, when evaluating the effectiveness of any treatment, you need to look at patients who actually completed the treatment. It is important to know how many did not complete the treatment and why they didn't, but that doesn't change the effectiveness for those who do complete the treatment.
did someone get their feelings hurt? (Score:4, Informative)
At many AA groups, they'll not do the "everything's okay" bullshit. They'll tell you it's NOT okay to get drunk and punch your wife, then take your kids for a ride at 110 MPH. Did that hurt your feelings? That's okay. I care enough about you that I'd rather save your life than have you like me.
* there are tens of thousands of AA groups, who have held millions of meetings. Anything I say about AA in general may not apply to a particular meeting.
service to my fellows (Score:5, Informative)