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Comment by mschuster91 | Hacker News Reader

> After a lot of effort, the Sobell lawsuit(s) were dismissed and the truth won.

The truth? Especially in anything related to alcohol/substance abuse, there most often is no objective "truth", as there are a lot of religious / moralizing standpoints involved. Alcoholics Anonymous, for example, has been shown to be more morals than science: https://www.theatlantic.com/magazine/archive/2015/04/the-irr...

What does help however is "housing first": https://www.samhsa.gov/homelessness-programs-resources/hpr-r...

Kinda makes sense, given that many people on the streets basically self-medicate either existing untreated mental health problems or the (enormous) stress that comes with living on the streets.

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> The truth? Especially in anything related to alcohol/substance abuse, there most often is no objective "truth"

I dunno, sounds pretty objective to me:

> Out of the 20 patients the Sobell study claimed were moderately drinking, only one arguably was still moderately drinking a decade later.

Of course, to conclude from a 20 person study that moderate drinking can never work is another thing. But simply ignoring the study can't be the solution either.

> What does help however is "housing first"

This is probably true, but you didn't give any empirical evidence for that either. Also, not all alcoholics are homeless.

That article from The Atlantic uses outdated information. The figures Glaser used for AA efficacy do not come from peer reviewed science and are inaccurate. See https://www.thecut.com/2015/03/why-alcoholics-anonymous-work... for a direct rebuttal of that 2015 article.

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

It's nice that the WBUR link includes a link to the review. Here it is for people who want it directly:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

The full 2020 Cochrane review on AA is paywalled until March, so I’m linking to media summaries of the review until it becomes open access.

What am I missing please?

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

When clicking on the link multiple times, Cochrane no longer gives access to the full report.

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/

AA works, but it likely works more because of the community than anything else. Drug addiction is often a symptom of isolation. Drugs often mimic the brain chemicals we get through positive social interaction, serving as a placebo.

You are kind of right. Being a part of a community all going through the same struggle definitely helps. Just not being around people getting wasted is a big help in itself. You can't just take a large chunk of your life away, it must be replaced with something.

The part about helping others is a big factor. It gives a reason other than self, which seems to be a big factor.

It's hard to say what makes it "work" for certain. The Oxford Group, the predecessor of AA, lacked the helping others aspect and did not see widespread success. This is what AA itself considers to be their unique magic.

Or maybe it's all the sayings! God, there are so many sayings.

Despite being very hostile initially, I got a lot of benefit from 12 step programs. It is not something I have stayed formally involved with, but I got a lot of helpful insight.

I don't think any one thing did it for me, it was a long and difficult process. The fact I'm alive and stable today is a small miracle. Most people in the state I was aren't so lucky.

I know what doesn't work though: Shame. I had to stop shaming myself before I could get well.

Maybe I'm misreading your comment, but I think you are mixing two different issues.

What about alcoholics who already have a home? "Housing first" won't help them, while AA arguably would.

Here's the English NICE advice about alcohol use disorders.

https://www.nice.org.uk/guidance/cg115

The evidence tab is useful to see what information they used to make the decision: https://www.nice.org.uk/guidance/cg115/evidence

Here’s the 2016 (i.e. done during the Obama administration) report from the US Surgeon General on some resources which help with recovery: https://www.ncbi.nlm.nih.gov/books/NBK424846/

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.

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