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Comment by throwaway999777 | Hacker News Reader

> The reason this is so important is that should this woman have a "slip" - which LOTS of alcoholics do - now the world, and needy alcoholics, have one more reason to dismiss AA.

> Try it before you judge it.

An organization that tries to inflate its own public success rate, and then asks people to keep an open mind towards it rather than dismiss it. Ok.

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I haven't dug up the stats in the while, but last I checked, their success rate was exactly the same as cold-turkey going it alone.

We've had this discussion ad nauseam on other addiction threads here. The TL;DR of the literature is that in the short term, most methods have the same "success rate", where success here is defined as successfully achieving abstinence from the problem substance.

Participation in AA or other support groups (eg. SMART/Rational Recovery) is associated with substantially increased rates of continuous abstinence at the 1, 3 and 5 year marks after quitting, although there may be some self-selection bias going on there (participation rates being higher among the more motivated and so on).

> Participation in AA is associated with substantially increased rates of continuous abstinence at the 1, 3 and 5 year marks after quitting

It's been shown, as much as is possible, that that's all selection bias. People rarely fall off the wagon and then keep going to meetings.

AA's rules around anonymity and consent make it conveniently impossible to run good studies, so they are able to (rightly, for the most part) write off any study that runs against them, but are also unable to show any positive findings that don't fall prey to very obvious problems.

I'm not sure why you are so vehement in attacking AA. Members (such as myself) who have access to other forms of treatment (medication, therapy, and sober housing) use them. What AA gives me is a powerful source of support. Let me offer a recent example:

A couple of days ago, I stepped off my back porch wrong and broke my ankle pretty badly. I was in a lot of pain, and I definitely needed to go to the hospital. A part of me was actually quite excited at the possibility of obtaining a "legitimate" supply of opiate painkillers. Luckily, I called a friend from AA and took his much more reasonable advice not to take the chance. Once I'd made that decision I realized that I'd been greatly exaggerating the pain to myself, and that it was nothing OTC painkillers couldn't handle.

Scary stuff, right? I had come up with a way to convince myself that it'd be ok to take score some drugs, which could very easily have sent me off into a relapse. It's when things like that happen that you need to listen to a "higher power": someone who isn't having your crazy addict thoughts and can assess your behavior rationally and objectively.

Since I'm laid up, AA people have been helping me get groceries, rides to meetings, and just stopping by to say hi. I can't really see a recovery professional doing that.

Your "quote" is not what I wrote, I include other support groups in my statement. I have no interest in arguing with obvious axe-grinding.

> People rarely fall off the wagon and then keep going to meetings.

I have a significant number of acquaintances who did exactly that, myself included, but I am not going to make the claim that my personal experience means anything statistically.

> It's been shown, as much as is possible, that that's all selection bias.

If that is the case, feel free to provide some sort of citation to back up your claim.

I have no axe to grind, other than a disdain for supporting emotional ties with poor statistics. I've never brushed with AA or alcoholism in any capacity. That said:

In Project MATCH [1] we learn that "twelve-step" (AA), cognitive behavioral therapy, and motivational enhancement therapy all have very similar results across a large number of measures.

We also find that CBT performs equivalently to "brief opportunistic intervention" (which goes under a variety of names, but takes a single 5-minute meeting), which is the minimum amount of treatment that we're ethically allowed to give alcoholics.

So it may work better than nothing (can't really study that), but there are much lower-touch methods that give equivalent results.

[1] https://en.wikipedia.org/wiki/Project_MATCH

[2] http://robinsteed.pbworks.com/w/file/fetch/52176344/Treatmen..., study by "Chick et al. (1988)"

So which is it - is it a treatment with no benefits other than that which is attributable to selection bias, as you first claimed, or is it a high-touch treatment that performs similarly to CBT or other forms of therapy? You're moving the goalposts. The latter statement is perfectly valid, as AA is really just CBT dressed up with additional social support and a charitable aspect.

Why the focus on high-touch/low-touch? It doesn't cost anyone anything except for those who attend, and even those who do aren't obligated to spend anything. It does take up some time, but it is time that I enjoy spending.

I have undergone both CBT and yes, have attended AA. The former did not do much for me, the latter did. AA as practiced in my area is strongly remniscent of CBT, only with additional social support, which is helpful for recovering alcoholics who have likely either alienated most people or who have built social networks focused around substance abuse.

If you were to say that addiction is complicated and the right course of treatment is difficult to determine and efficacy is hard to measure, I certainly would agree.

> So which is it - is it a treatment with no benefits other than that which is attributable to selection bias, as you first claimed, or is it a high-touch treatment that performs similarly to CBT or other forms of therapy?

It is a high-touch treatment that performs as well as a 5 minute intervention, despite constant claims that it is better. In the post I originally replied to, you implied that you were comparing it to other methods rather than nothing, although it wasn't terribly clear.

> It doesn't cost anyone anything except for those who attend

The oft-claimed improvement of AA over other methods messes up our views on addiction, as well as the justice system for addicts. Our refusal to use drugs to fight addiction even though the science is quite clear stems from full-abstinence organizations, largely led by AA.

His understanding of the reasoning behind Tradition 11 is flawed. It has nothing to do with protecting the image AA from member relapses.

It has to do with encouraging humility among its members, who are alcoholics and who generally tend to have issues with being self-centered. This is true of a lot of the traditions - "leaders are trusted servants, they don't govern" and so on. Basically trying to keep addicts from getting an inflated sense of their own importance.

Yea, better to do nothing, I'm sure it'll sort itself out.

Yes. You can either do AA or do nothing with your problem. That's the only two options in the world.

Jeez these AA PR snippets are just stellar.

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