Alcohol Disorders: Treatment Approaches

[lannarebirth]

I have a question about the way statistics are used here

If a guy goes to AA to try and stop drinking but relapses 19 times before becoming sober permanently on his 20th attempt; is that a 5% success rate(as is so often quoted here)? To my way of thinking, he is an AA success story.

[Couthy]

You got it mate,

Lies,

Damned lies,

and statistics.

AA like their invisible friend - me I will continue to watch 'Harvey'.

And no doubt be castigated by the God squad for being flippant - however, the central character in Harvey is Jimmy Stewart who in the movie does have a serious drink problem.

(Given his war record in B-17's I suspect he had met and seen enough screwed up young men who took to drink.)

god doesn't stop you drinking - after all if you believe in god then god started you drinking in the first place.

Errmm......paradox anyone?.

Couthy.

I have a question about the way statistics are used here

If a guy goes to AA to try and stop drinking but relapses 19 times before becoming sober permanently on his 20th attempt; is that a 5% success rate(as is so often quoted here)? To my way of thinking, he is an AA success story.

[Neeranam]

I have a question about the way statistics are used here

If a guy goes to AA to try and stop drinking but relapses 19 times before becoming sober permanently on his 20th attempt; is that a 5% success rate(as is so often quoted here)? To my way of thinking, he is an AA success story.

I'd consider him a success too.

[robitusson]

I have a question about the way statistics are used here

If a guy goes to AA to try and stop drinking but relapses 19 times before becoming sober permanently on his 20th attempt; is that a 5% success rate(as is so often quoted here)? To my way of thinking, he is an AA success story.

Good question. There are two problems here: 1) what constitutes sobriety. 2) A lack of research and data on the effectiveness of AA and 12 Step programmes. Some opinions I found are;

But even this 5% success rate is questionable if AA's success in dealing with alcohol problems is defined as the very modest level of one-year's continuous abstinence, because, as anyone who has spent much time in AA can attest, far from all AA members are abstinent. AA's self-reported rate of recovery (as derived from membership retention) is far from impressive; in fact, it appears to be no better than the rate of spontaneous remission, which has been estimated at anywhere from 1% to 33% per year of those with alcohol problems (Prugh, 1986, p. 24). One survey of the spontaneous remission literature estimates its prevalence at 3.7% to 7.4% per year (Smart, 1975/76, p. 284). If this is true, AA's recovery rate of 5% or less could well be lower than the rate of spontaneous remission.

http://thearidsite.tripod.com/12COMMEN.HTM

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AA maintain "even with those who first wrote their stories in the original edition of "Alcoholics Anonymous." In fact, 75 per cent of these finally achieved sobriety. Only 25 per cent died or went mad. Most of those still alive have been sober for an average of twenty years." Although it does not say what constitutes sobriety or what "going mad" means.

http://a-1associates.com/aa/success%20rate.htm

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The 5% is defined here by an AA member as permanent sobriety. He also highights the lack of adequate data.

8. Professionals have conducted surveys among veterans, patients, and selected groups of AAs. The accuracy is not the subject of my knowledge. But the facts about present-day A.A. are these in their studies: (a) A definite 75% fail to maintain sobriety. ( b ) Probably no more than one to five percent maintain permanent sobriety. © As often as not, those who aligned with AA have a lower success rate than those who got sober without AA. (d) To date there has been no adequate survey of success or failure among those AAs who - like the pioneers - were born again Christians, reliant upon the Creator for help, and joined together in some Christian church or Bible fellowship, or prayer group.

http://www.mental-health-matters.com/artic...e.php?artID=601

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This article refers to 93% relapse of patients in treatment centres (most of which use the 12 Step model of treatment of course).

Whether people succeed in overcoming an addiction may not be determined primarily by the treatment they receive. Vaillant notes that "the most important single prognostic variable associated with remission among alcoholics who attend alcohol clinics is having something to lose if they continue to abuse alcohol." Among Vaillant's own patients at an urban municipal hospital, many of whom had little to lose, 95 percent relapsed at some point after treatment. Another study of an inner-city hospital alcoholism ward, by John Helzer and his colleagues, found that 93 percent of the patients were either dead or still abusing alcohol five to seven years after treatment. Private treatment centers ordinarily show better outcomes, partly because their clients are more likely to have families, jobs, and incomes.

http://www.peele.net/lib/harvmed.html

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The definition of sobriety is not offered here but bases the 5% claim on an internal AA study from 1988.

In early Cleveland A.A., the documented success rate was 93%. In recent years however, the Fellowship has shifted its views greatly and some veteran AA members advise newcomers that meetings are mandatory while placing less emphasis on "working the steps". Some blame this lessened emphasis on The Twelve Steps for a first-time sobriety success rate of approximately 5%, according to an internal study conducted by AA Intergroup in 1988. Other estimates put overall success rates however somewhere between 5 and 10%.Given that AA's membership is by definition, anonymous, and its administrative body -- the General Service Office, General Service Board and annual General Service Conference -- acknowledges the importance of anonymity, no records are kept on AA members, so non-anecdotal data about success rates cannot be obtained from official AA sources.

http://www.answers.com/topic/alcoholics-anonymous

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Here the definition is getting sober and staying sober and the 5% figure is arrived at again.

Even though A.A., with its 12-step approach, has helped millions of people over the last 60-plus years, there is no evidence that A.A. is better than other approaches. On the contrary, a major research study, funded by the U.S. government, concluded that A.A. does not help the majority of people who attend the meetings.

In the summer of 2004, A.A.& apos;s own shocking statistics were revealed on Showtime's irreverent show, BULL****. Hosts Penn & Teller devoted an entire show to "12-Step Myths" and revealed secret member surveys that consistently verified that only 5% of A.A. members get sober and stay sober. After just one year, 95% of members stop showing up for meetings. A.A.'s 5% success rate is no better than the success rate for people who decide to quit on their own.

http://65.109.14.13/habit/aaonly.htm

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5% again but no definition.

Finally, recovery centers and literature substantially pre-empted doctrinal literature publication and distribution. But, as all the foregoing developments occurred, the A.A. success rates became observably more and more dismal—dropping from its original rate of at least 75% to about 5%. And these changes—one and all—provide solid reasons for returning to, re-examining, and learning early ideas and history.

http://www.aabibliography.com/

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An AA Board of Trustee members opinion.

One of the most enthusiastic boosters of Alcoholics Anonymous, Professor George Vaillant of Harvard University, who is also a member of the Board of Trustees of Alcoholics Anonymous World Services, Inc. (AAWS), showed by his own 8 years of testing of A.A. that A.A. was worse than useless -- that it didn't help the alcoholics any more than no treatment at all, and it had the highest death rate of any treatment program tested -- a death rate that Professor Vaillant himself described as "appalling". While trying to prove that A.A. treatment works, Professor Vaillant actually proved that A.A. kills. After 8 years of A.A. treatment, the score with Dr. Vaillant's first 100 alcoholic patients was: 5 sober, 29 dead, and 66 still drinking.

http://www.orange-papers.org/orange-effect...s.html#Vaillant

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The highest figure I could find, outside of the Big Book's claim of 75% and AA members opinions.

Since the 1930's, the main, and often only known treatment has been AA, and the other 12-step programs. Since the '30s, an abundance of research has been going on to reveal even more statistics, mainly which AA has about a 5-20% success rate, and that there are many viable, evidence-based alternatives, which might better suit the complex and individualized needs of people afflicted with alcohol and drug problems. Yet as many as 97% of all US treatment centers are still based solely on a 12-step plan.

http://www.topix.net/content/prweb/3163350...588864265657181

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Similar story in drug treatment centres.

In 1982, for example, Joseph A. Califano Jr., former secretary of Health and Human Services, evaluated New York state's drug-abuse programs. Of those treated for heroin addiction, less than 10% broke the habit.

http://www.peele.net/lib/latimes031490.html

Also....

researchers at the Downstate (New York) Medical Center Department of Psychiatry:

The general applicability of AA as a treatment method is much more limited than has been supposed in the past. Available data do not support AA's claims of much higher success rates than clinic treatment. Indeed, when population differences are taken into account, the reverse seems to be true.

http://www.peele.net/lib/diseasing3.html

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From a speaker at the Second Nationwide A.A. History Conference, June 26 2003. Success rate

As a professional counselor working in the addiction field for over 11 years I have been deeply concerned to see our overall success rate-between treatment and AA/NA- dwindle down to between 20-25%.

(Incidentally he also admits The early spiritual roots of A.A. are clearly, emphatically Biblical.)

http://www.aabibliography.com/alcoholics_A...rence_2004.html

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Clear definition of what constitutes success here.

Using the figure of five years’ sobriety as the criterion of success, one arrives at an AA success rate of approximately 2.6% to 3.5% (in comparison with the total number of “alcoholics” in the U.S. and Canada). And the success rate is lower than that if one defines “success” as AA does—as lifelong abstinence.

http://www.morerevealed.com/books/coc/chapter7.htm

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The 5% rate is attributed to spontaneous remission in this article. A bit extreme perhaps.

Even the most ardent true believers who will be honest about it recognize that A.A. and N.A. have at least 90% failure rates. And the real numbers are more like 95% or 98% or 100% failure rates. It depends on who is doing the counting, how they are counting, and what they are counting or measuring.

A 5% success rate is nothing more than the rate of spontaneous remission in alcoholics and drug addicts. That is, out of any given group of alcoholics or drug addicts, approximately 5% per year will just wise up, and quit killing themselves. They just get sick and tired of being sick and tired, and of watching their friends die. (And something between 1% and 3% of their friends do die annually, so that is a big incentive.) They often quit with little or no official treatment or help. Some actually detox themselves on their own couches, or in their own beds, or locked in their own closets. Often, they don't go to a lot of meetings. They just quit, all on their own, or with the help of a couple of good friends who keep them locked up for a few days while they go through withdrawal. A.A. and N.A. true believers insist that addicts can't successfully quit that way, but they do, every day.

Every disease has a spontaneous remission rate. The rate for the common cold is basically 100 percent -- almost nobody ever dies just from a cold. On the other hand, diseases like cancer and Ebola have very low spontaneous remission rates -- left untreated, they are very deadly and few people recover from them. Alcoholism is in the middle. The Harvard Medical School reported that in the long run, the rate of spontaneous remission in alcoholics is slightly over 50 percent. That means that the annual rate of spontaneous remission is around 5 percent.

Thus, an alcoholism treatment program that seems to have a 5% success rate probably really has a zero percent success rate -- it is just taking credit for the spontaneous remission that is happening anyway. It is taking credit for the people who were going to quit anyway. And a program that has less than a five percent success rate, like four or three, may really have a negative success rate -- it is actually keeping some people from succeeding in getting clean and sober. Any success rate that is less than the usual rate of spontaneous remission indicates a program that is a real disaster and is hurting patients.

It's like this:

Imagine that there is a nasty disease that kills 50% of the people who get it. A pharmaceutical company has a new medicine that they want to test. So they give the drug to a bunch of the people who have the disease, and 50% of them get better.

The drug manufacturer cheers and brags, "Look at how great our new medicine is! We saved half of the patients!"

Wrong. The new drug saved nobody. The half who survived were the ones who were going to survive anyway. The drug had an effective zero percent cure rate, above and beyond normal spontaneous remission.

To compute the success rate of any medicine or treatment program, you have to subtract the normal rate of spontaneous remission from the apparent success rate. In this example, fifty percent minus fifty percent yields a zero percent success rate for the new medicine. The new medicine didn't make anybody recover.

http://www.orange-papers.org/orange-effectiveness.html

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There have been at least 25 million Big Books sold to date.

http://www.alcoholics-anonymous.org/en_press.cfm?PressID=1

"Rarely have we seen a person fail who has thoroughly followed our path." Hardly.

Edited September 17, 2006 by robitusson

[sbk]

Just curious robitusson, do you have all of this saved to some doc that you just copy and past every single time?

[Mobi]

All that effort to extoll the evils of AA is enough to drive a person to drink

[robitusson]

Eh....no. I looked on the internet actually. Did you read any of it? I've deliberately posted the opinions of AA members too. Any comments?

[sbk]

Eh....no. I looked on the internet actually. Did you read any of it? I've deliberately posted the opinions of AA members too. Any comments?

Sorry, I gave up reading your extremely long winded posts about 3 threads back. You tend to reiterate the same point over and over again, I just assume, that after the first two paragraphs that nearly mimic previous posts, that you are just posting the same post over and over again.

Bad thing for a mod to admit to, sorry

[robitusson]

Sorry, I gave up reading your extremely long winded posts about 3 threads back. You tend to reiterate the same point over and over again, I just assume, that after the first two paragraphs that nearly mimic previous posts, that you are just posting the same post over and over again.

Bad thing for a mod to admit to, sorry

No problem. Up to you. How you know that I "tend to reiterate the same point" without reading anything is beyond me but if you do find you have something worthwhile to add, let me know.

A poster asked where a statistic came from. It's a controversial subject so I gave a comprehensive reply. I could have tried to make a vacuous smart comment instead I suppose. I'll consider that the next time.

Edited September 17, 2006 by robitusson

[sbk]

Feel free to post all the vacuous smart comments you want Just trying to make a point, is all. I suspect your excessively long posting style and constant reiteration turns off more people than it converts is all. Up to you

[robitusson]

All that effort to extoll the evils of AA is enough to drive a person to drink

Sources of information about AA = extolling the evils of AA. I see.

[robitusson]

Feel free to post all the vacuous smart comments you want Just trying to make a point, is all. I suspect your excessively long posting style and constant reiteration turns off more people than it converts is all. Up to you

I'm not trying to convert anyone. If people want to join a religion or cult, then go ahead.

If they want help with problem drinking then the facts may be useful. Hearsay and rumour tend not to be as reliable in my opinion. Sorry if it makes for long winded posts.

I actively welcome alternative information to the sources I posted, if anyone can find something then go ahead. I for one am interested enough to read it. If someone isn't interested, then don't.

[Mobi]

All that effort to extoll the evils of AA is enough to drive a person to drink

Sources of information about AA = extolling the evils of AA. I see.

Couldn't resist it, could you?

You'd be good in the 'last word" thread in Bedlam.

What with your long, tedious ever repetitive multiple posts, you'd bore everyone else off the forum and win by a mile.

Cheers Robbo

[robitusson]

Cheers Robbo

Cheers to you too M D'A.

Spot Goes To The Farm isn't too long and doesn't have too many big words either.

[sabaijai]

If you have a problem with the information another member presents, I humbly suggest that you either ignore it or respond in kind (rather than posting ad hominem barbs). Hard to say which are more tedious, vacuous ad hominems or long posts ...

[sabaijai]

Data on changes in brain chemistry pursuant to alcohol abuse and alcohol dependence beg the question, once someone with either of these disorders is sober for a significant period of time, does the brain chemistry go back to baseline? Or is the brain forever changed?

If one's brain chemistry returns to baseline after X period of sobriety, than I think we can safely conclude that behavioral treament approaches will be the most effective. If on the other hand the brain chemistry is forever altered, then it seems that pharmaceutical approaches would be the most effective treatment (combined with behaviour modification as needed).

[VanZam]

Brain chemistry can go back to a baseline after a period of time directly related to the amount consumed and for how long.

Severe alcoholics can develop brain damge, and permanant damage is common.

Memory loss is the most common symptom.

[ding]

Data on changes in brain chemistry pursuant to alcohol abuse and alcohol dependence beg the question, once someone with either of these disorders is sober for a significant period of time, does the brain chemistry go back to baseline? Or is the brain forever changed?

If one's brain chemistry returns to baseline after X period of sobriety, than I think we can safely conclude that behavioral treament approaches will be the most effective. If on the other hand the brain chemistry is forever altered, then it seems that pharmaceutical approaches would be the most effective treatment (combined with behaviour modification as needed).

No info on the brain. The research I've done is specifically confined to the ass. Mine is not in jail. Therfore it works.

[Neeranam]

No info on the brain. The research I've done is specifically confined to the ass. Mine is not in jail. Therfore it works.

Very, very wise words.

These are the facts that concern me.

[robitusson]

the facts

Always welcome.

[ding]

the facts

Always welcome.

In my life I have been granted some grace. A couple decades -so far so good. I really don't worry about the details any more. I love AA. And the sick fooks that populate it.

It's not such a serious thing, life and death aside, for me anymore. I feel better and people tell me I don't act quite so badly. It really seems to be a simple program for people with complexes.

I drank more and more. Trouble kept increasing, yet I couldn't stop for any length of time and couldn't limit it. I had a problem and I was able to have it shown to me a thousand times -until I saw it.

So I went to AA and followed the instructions. It works. Even for me somehow.