Comment by mullingitover | Hacker News Reader

Comment by mullingitover | Hacker News Reader

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Trying to find sources to confirm this, but I've repeatedly heard that cognitive behavioral therapy dominated AA in effectiveness. I would take this more as an indictment of psychotherapy than an endorsement of AA.

Edit: I found a review of Project MATCH[1].

> Background

> Project MATCH was the largest and most expensive alcoholism treatment trial ever conducted. The results were disappointing. There were essentially no patient-treatment matches, and three very different treatments produced nearly identical outcomes. These results were interpreted post hoc as evidence that all three treatments were quite effective. We re-analyzed the data in order to estimate effectiveness in relation to quantity of treatment.

>Results

> The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.

[1] https://bmcpublichealth.biomedcentral.com/articles/10.1186/1...

As someone who is been in psychotherapy and an arm-chair psychology enthusiast, not every kind of therapy will be effective for everyone. This also goes for psychiatric medications.

CBT is often oversold as a cure for every kind of mental health issues. New meta-research has found that the effectiveness of CBT has been decreasing for quite some time and long-term effectiveness of CBT is arguable.

Regarding effectiveness of AA, I think it makes sense. Lot of people with addiction suffer from childhood trauma, emtional neglect, and abandonment. In psychological term it is called attachment injury. A community where you are not shamed, validated, understood, and accepted would give corrective emotional experience, which would in turn heal your attachment trauma. I've heard this phrase somewhere: "what cures people in therapy is love". So it's not surprising that finding a community where you are accepted would help you treat your addiction.

> not every kind of therapy will be effective for everyone

That's pretty problematic though, isn't it? At some point, you're dropping below placebos, not everything works for everyone, but should we still put weight on it? Homeopathy and intense praying works for some as well, but we don't say "I guess it's not effective for everyone". Psychotherapy (not the behavior therapy kind) gets a pass for some reason.

It makes sense to take a lot of these numbers with a healthy amount of skepticism.

That second 'A' means something. AA has no membership, no census, no graduation. Additionally, I doubt the people who stay involved are a random sample, so identifiable 12-steppers are going to be a skewed distribution.

I'm sure at least some of that can be controlled, but claims about their efficacy have been all over the map, I think, because of this.

I'm positive you can find many therapies and other methods that end up working better than AA.

I went through some of those methods and they are very effective. It also cost me around $10k, and that's after very good insurance.

Many (most?) alcoholics are not in a position where they can spend 10k on treatment. So it's really a moot comparison. Further confounding many of the studies is that AA is filled with people who are there by court order or other reasons. It's not at all a fair comparison. In most of these studies, someone who slips up and has a single drink after 2 years of sobriety is bucketed in with someone who only has a week of sobriety total.

I've actually talked to my addictions therapist about this, and is his opinion, every single study done surrounding AA has been absolute garbage.

Cognitive behavioral therapy is a form of psychotherapy obviously, so if the article is representing the Cochrane analysis accurately, it contradicts what you've repeatedly heard.

Edit: https://eu.usatoday.com/story/news/health/2020/03/11/alcohol... specifically mentions CBT as one of the psychotherapies found to be less effective by this new meta-study. and the NYT article now linked at the top goes into this.

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