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Just one example: Their information about Alcoholics Anonymous’s effectiveness can charitably be described as a dumpster fire: https://rationalwiki.org/wiki/Alcoholics_Anonymous (For example, they cite Brandsma 1980, which is a very outdated chestnut anti-AA polemics always bring out; the study is really old and its methodology was pretty bad: https://en.wikipedia.org/wiki/Brandsma_1980 )
In particular, Rational Wiki’s article on AA completely ignores Cochrane 2020, which shows that Alcoholics Anonymous has a 42% success rate: https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_An...
Cochrane reviews are considered the gold standard for meta-reviews. If the data, which does show AA [1] helps some alcoholics become abstinent, wasn’t scientifically sound, it wouldn’t had become part of the review.
Saitz either thinks a 7% improvement is a “similar result”, or he wasn’t familiar with the study when interviewed.
Obviously, people are free to think the science doesn’t “conclusively support” a given theory. Using this line of thinking, some people think radiocarbon dating doesn’t “conclusively support” the idea of the earth being older than 6,000 years -- but that’s hardly an evidence-based scientific line of reasoning.
[1] Since it’s not practical to use randomization to compare AA per se to non-AA recovery because of “contaminated control” issues, modern studies compare twelve-step facilitation (TSF) treatment with non-TSF treatment.
Some references:
- https://www.thecut.com/2015/03/why-alcoholics-anonymous-work...
- https://www.wbur.org/commonhealth/2020/03/11/medical-science...
Compare this to Reddit, where some high-traffic sub-Reddits (/r/atheism cough cough) delete links to scientific evidence showing AA efficacy: https://archive.is/gEXfA Why let facts get in the way of a good social networking rage fest?
Not this again. We know for a fact that treatments which encourage people to be a part of AA fellowships result in a significantly higher rate of abstinence from alcohol. [1]
See Ycombinator discussion here: https://news.ycombinator.com/item?id=22545557
This doesn’t mean AA is for everyone, but it does show that Alcoholics Anonymous is quite helpful for a significant subset of alcoholics.
[1] John Kelly, et. al. “Alcoholics Anonymous and other 12‐step programs for alcohol use disorder” Cochrane 2020 PMC7065341 (open access, no paywall: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065341/ )
I’m not sure how a reasonable conversation can continue. We’ve moved to a Twilight Zone alternate reality at this point. The only way we can go further in to la la land is to make a completely invalid comparison to Nazism so that Godwin’s Law can be invoked.
Another thing: Discarding what a judge says about a what is legal matter is not a particularly compelling argument. It’s the kind of thinking done by people who believe in conspiracy theories. As a contemporary example, people who are convinced that the 2020 United States presidential election was rigged, when pointed out that judges have concluded there is no reasonable evidence supporting that assertion, will say something like “I couldn't really care less what the judge concluded”.
“Judge Hauk concluded that on balance it was more important to determine how the patients were faring following treatment than any possible breach of confidentiality and invasion of privacy which were protected by their right to refuse to participate in the study”
Source: Alcoholism: A Review of its Characteristics, Etiology, Treatments, and Controversies by Irvine Maltzman
(Keep in mind this was the mid-to-late 1970s in California)
One patient’s “attorney had complained to the Hospital about the treatment that he had received.” As I describe elsewhere in this thread, some of the patients ended up trying to sue the Sobells. So, no, the patients were not happy with the treatment they received.
The subjects had no problem being contacted for follow-up: “the patients contacted prior to the court injunction all expressed a willingness to cooperate and to be interviewed”
Indeed, a judge familiar with the medical privacy laws of that era (we’re talking the mid-to-late 1970s here) made a court decision that contacting the patients for follow-up was perfectly OK: “Judge Hauk concluded that on balance it was more important to determine how the patients were faring following treatment than any possible breach of confidentiality and invasion of privacy which were protected by their right to refuse to participate in the study.”
The “delighted” bit comes from Alcoholism: A Review of its Characteristics, Etiology, Treatments, and Controversies by Irvine Maltzman, which goes in to the Sobell controversy in great detail.
Edit: Going back to the book, here’s the most relevant quote from the late Maltzman: “the patients contacted prior to the court injunction all expressed a willingness to cooperate and to be interviewed” Maybe “delighted” was too strong of a word.
It will become non-paywalled (or should I say, non-semi-paywalled) come March over at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065341/
Looking over at that Nice website, it looks like the Nice reports haven’t taken the information the 2020 Cochrane review on AA used in to account yet.
Reference: https://www.nytimes.com/1984/09/11/science/panel-finds-no-fr...
The current science shows that Alcoholics Anonymous is an incredibly effective treatment for many alcoholics. Indeed, the 2020 Cochrane Review on AA shows that Alcoholics Anonymous is more effective then other treatments in getting alcoholics abstinent. See https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymo... or https://www.wbur.org/commonhealth/2020/03/11/medical-science...
Keep in mind that Cochrane reviews are the golden standard for high quality meta analysis of science, as pointed out at https://en.wikipedia.org/wiki/Wikipedia:MEDDATE
Here’s what happened: The paper Sobell 1973 made the bold claim that alcoholics could moderately drink again if given the right kind of therapy. So, other researchers asked: What was the long-term outcome with those patients supposedly engaging on “controlled drinking”?
So this research team including one Pendery asked Sobell for the list of patients so they could perform a proper follow-up. The Sobell researchers refused to provide the list. The Pendery team managed to get the list anyway. The Sobells then sued Pendary and their team to stop them from using the list.
After some litigation, the Pendary team got the Sobell lawsuit dismissed and then followed up with those supposedly moderate drinking patients.
Out of the 20 patients the Sobell study claimed were moderately drinking, only one arguably was still moderately drinking a decade later. Four of those “moderate drinkers” died from drinking too much. Eight were engaging in out of control drinking. Six were completely abstinent from alcohol. And one could not be found, but appeared to be “gravely disabled”.
No wonder the Sobells tried to block the follow up study with lawsuits: Because it showed that those “moderate drinkers” were no longer moderately drinking.
After a lot of effort, the Sobell lawsuit(s) were dismissed and the truth won.
References: https://www.nytimes.com/1982/11/02/science/showdown-nears-in...
https://www.nytimes.com/1982/06/28/us/alcholism-study-under-...
If we’re not telling alcoholics that abstinence is the goal, we’re telling them they can “moderately drink”. “moderate drinking”, simply put, is what we call non-abstinence for alcoholics.
This is very different from saying that a one-day relapse is a complete failure, and, yes, I agree that Alcoholics Anonymous is too focused on raw sobriety time.
Brandsma 1980 is the only study I can think of off of the top of my head comparing AA (and a few other therapies) to no treatment; AA (and everything else) did significantly better than getting no help.
What this new Cochrane study demonstrates is that AA is more effective at giving alcoholics long-term abstinence than traditional psychotherapy treatments.
Active alcoholics are downright dishonest about how bad their alcoholic drinking is; they will claim it is moderate drinking to anyone who asks them (including scientists making a study) and lie about the amount of alcohol they actually consume.
The most famous study refuting the claims that alcoholics can moderately drink again is probably Pendery 1982, which showed that people who were reported as successfully moderately drinking in an early 1970s study were, a decade later, either not drinking at all, engaging in out of control drinking, or dead from alcohol-related complications.
Some more discussion about it is here:
There are about 10 findings, and the only “high” quality finding is that there appears to be a significant increase in abstinence, especially long term abstinence from people who get treatments which get them in the rooms of AA (“TSF” treatments).
We can dive down in to the details about this finding (percent abstinent) on pages 88 and 89 of the report. They actually use six different studies, but only two of them provide information at the one-year follow-up, so only those two get listed in the summary on page 4 of the report.
Considering that they compared a number of things, and only percentage of subjects abstinent showed, with high confidence, a difference between AA/TSF and other treatments, I’m a little worried we may be seeing a multiple comparison fallacy. Then again, this is unlikely: They are seeing P values of 0.02 and 0.03 (1-in-30 to 1-in-50) for the abstinent numbers, but only look at about 10 factors.
Humphreys 2014, another meta-analysis of multiple studies, showed AA effectiveness which can not be attributed to self-selection, but it saw something different: A fairly small but significant increase in the percentage of days abstinent. While they did see in the 2020 Cochrane review, they did not see it with a high level of confidence (see pages 89-90).
Percentage days heavy drinking — I don’t have a copy of Brandsma 1980 handy, but I think that’s what the “Brandsma 1980 shows that AA results in increased binge drinking!!!111!!!!!” claim parroted by the usual anti-AA crowd talks about — might be increased in the short term after starting AA treatment, based on the one study which has 6-month follow-up figures for this; Brandsma 1980 only saw it at the 3-month follow-up and not later. Then again, the Cochrane study of those numbers show a pretty high P value (0.79, just glancing at those figures), which means we still don’t really know if Brandsma 1980 actually saw something. Scott Alexander dismisses it as an example of a multiple comparison fallacy, and the P values for it in Cochrane 2020 means we probably didn’t actually see something, but this may merit additional investigation.
Cochrane 2020, of course, didn’t look at the longitudinal studies showing really high abstinence rates for people who self-select to go to a lot of AA meetings, but even using only randomized studies, we are seeing a significant increase in number of subjects who get and stay sober when they engage in treatment which encourages AA attendance.
Another thing: There are no recent high-quality studies comparing AA to no treatment (“spontaneous remission”, an expression I see used mainly by people with a pretty strong anti-AA bias) because it’s been established for a long time that AA (or any other treatment you can think of) is better than no treatment. Even Brandsma 1980 saw that going to their AA-like meetings was significantly better than getting no treatment at all.
In summary, with some caveats, we are seeing solid scientific evidence that AA really helps alcoholics get sober and stay sober. Ten years ago, someone could still say “AA does not have a higher success rate than no treatment” with a straight face; today, to claim something like that requires ignoring a lot of scientific evidence.
Knee-length dresses (i.e. “short dresses”) seem to reasonably fall under the definition of “cocktail casual”. For example: https://www.clbxg.com/Cocktail-Casual/
>the dress code for the daytime sessions is business casual. For the Awards Dinner on Tuesday evening, we're trying to step it up a bit and ask that you dress cocktail casual (Men: blazer/sport coat, stacks, suit, Women: short but somewhat formal dress and heels)
(emphasis in original)
Point being, the original quote is asking both men and women to dress up, but the article implies, with its clickbait headline, that it’s only asking women how to dress.
And, yes, I'm still very frustrated at how, in the mid-2010s, the outrage press strongly implied that the scientific consensus states that Alcoholics Anonymous has a 5% success rate. Actually, that was just the opinion of one medical doctor and that 5% figure does not come from a peer reviewed study; the mainstream consensus is that Alcoholics Anonymous works great for the 25% or so of alcoholics who actually go to meetings regularly.
AA has, according to one study, a 67% success rate. The study saw that, of people who regularly went to AA, 67% were sober 16 years later:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/
Another study shows a 75% success rate, but it's behind a paywall:
https://www.vox.com/science-and-health/2018/3/5/17071690/alc...
https://www.tandfonline.com/doi/abs/10.1080/108107397127806
(Note that this is a paywall link. Here is a quote to give readers here a gist of that article: "acceptance of the tenets of AA may be associated with positive behavioral change"; the paper describes how working the AA program results in people having a more positive world view)
12-step meetings are not a short-term fix; I have already linked to a paper which shows that two out of three people who regularly go to AA meetings in their first year of alcohol treatment are still sober 16 years later. Here's the original paper with those figures:
That article shows that people who regularly go to AA meetings are more likely to be sober (e.g. 67% people who went to one or more meeting a week were sober 16 years later).
Because of the universal nature of AA, it is hard to randomize for it (if you just randomly tell an alcoholic to go to AA, they have already been told that by others, so that's not a very good randomization; the control is contaminated); that said, there are studies where people randomly selected to go to AA are more likely to be sober. A 2014 meta study shows that greater AA attendance results in greater sobriety, which can not be attributed to self-selection (in other words, we have finally scientifically demonstrated that the people doing well are being helped by AA):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285560/
Now, that Gabrielle Glaser article you link to which claims AA is a cult uses some very dubious figures for AA's success. They come from Lance Dodes; since Dodes could not find any studies that AA has a 5% success rate, he instead multiplied multiple numbers from unrelated studies to synthesize the 5% figure. His numbers have been questioned by a number of treatment experts, including Thomas Beresford, John Kelly, Gene Beresin, and Jeffrey D. Roth (who called Dodes's figures a "pseudostatistical polemic").