Without a doubt, the general consensus in this country is that Alcoholics Anonymous is an effective remedy for alcoholism and is the treatment of choice. Virtually all treatment centers in the United States funnel their clientele into Alcoholics Anonymous or sister groups such as Cocaine Anonymous.
Rarely, if ever, does the mass media carry anything except the highest praise for AA and the treatment facilities. In newspaper articles, television news features and radio interviews, politicians, movie stars, famous athletes and even an ex-first lady carry the message that they had faced alcoholic ruin but “being in recovery”*1 saved their lives.
The multi-billion dollar treatment industry advertises the need for “treatment,” costs of which can run into the tens of thousands of dollars for a standard 28-day stay.
Each business sells its own treatment as the best for those suffering from what they claim is an incurable, progressive disease. Success rates of as high as 90 percent are reported.
While not all advertisements explicitly state “medical treatment,” it is usually implied. While often set in hospitals, rarely is much about the treatment “medical.” A small number of alcoholics, perhaps ten or fifteen percent, do need medical assistance for a few days of detoxification. However, any medical attention generally stops there. The stress is on AA indoctrination.
early reports of AA‘s success
AA members in the early 1940s, according to Jack Alexander in Life magazine, claimed 100 percent success with “non-psychotic drinkers who sincerely want to quit”.59
While the 100 percent claim was questioned, a 75 percent claim was accepted without question and often repeated in the scientific literature and praised as a “remarkable” rate of recovery. The Big Book claims 50 percent at once, 25 percent after some relapses and improvement in the others. They do, however, have a qualifier. These are the rates for those who “really tried.”
It seems almost no one subjected these numbers to rigorous examination. The first report of anyone actually doing so apparently appeared on the other side of the world in an Australian medical journal in 1948.
The author, while extolling the virtues of AA, reported that, from his observation, “Only about 10 percent of patients give up drinking at once. The majority of the others may remain sober for weeks or months and then relapse.”60
Many people have such faith they see no need to actually keep count and perhaps even see the idea of tracking results, of questioning the effectiveness of their “spiritual principles,” as offensive. It would be putting science over personal experience (the Fifth Gospel from the Oxford Group).
In medicine, however, the normal course for determining the effectiveness of a treatment is to compare it against other treatment and/or no treatment at all.
There have been two controlled studies of the effectiveness of Alcoholics Anonymous independent of any other type of treatment. Since they deal with persons required by the court to attend AA, they demonstrate the relative effectiveness of AA in a coercive context. Since a significant number of AAs are first indoctrinated in this way, both studies are relevant.
Dittman et al, the San Diego study of court referral
The first was an experiment done in San Diego, California. Chronic offenders, averaging twelve prior drunk arrests each, were given a thirty-day suspended sentence and a one-year probation. A requirement of probation was that they remain abstinent for one year.
A court judge randomly assigned 301 people to one of three categories: no treatment, a psychiatrically oriented community alcoholism clinic and Alcoholics Anonymous. Complete data for a minimum of one year was available on 241 cases. In the no-treatment group, 56 percent were rearrested. The AA group fared the worst. In what was almost a tie with the clinic group, 69 percent of the group sent to AA was rearrested. An interesting question, one that was not answered in the research paper, is whether the clinic, as is customary, also sent their clients to AA.
In the first month, all groups did equally as well (or poorly, depending on how one chooses to look at it). After the first month, presumably when AA or clinic attendance should begin showing its effect, is precisely when both groups lost ground against no treatment. Also, while only eleven of the 241 persons credited AA with their longest period of abstinence, nine of these eleven, or a full 80 percent, were rearrested. Those who credited AA the most were rearrested the most. The authors of the report stated,
“Some of the present writers [3 of 5] were quite optimistic about the possibilities of enforced referral to treatment, but the early encouraging anecdotal reports are not borne out by present data.”61
Brandesma et al, a study of treatment of court referrals in Kentucky
In another study of court referral for treatment done in Lexington, Kentucky, 197 alcoholic patients began treatment.62 They were randomly divided into five groups; professional “insight” therapy, professional behavior therapy, lay-led behavior therapy, AA, and a no-treatment control group. Of the 197 patients who began therapy, 104 were still available for the one-year final outcome study.
Of the subjective measures, perhaps the most telling is the number of respondents who reported improvement for the last three months. AA tied with the no-treatment control group for the smallest percentage of those who could report improvement. One of the professional groups and the lay group fared remarkably better. All groups had some members who attended AA but the lay-led group, which reported the best results on this measure, had the least intense AA involvement.
Compounding this pathetic outcome for AA is that the twelve who stuck with AA for the year scored progressively worse on two important MMPI*2 scales. One of these, the Finney Addiction Scale, is used to identify people who have trouble with narcotics by measuring the qualities such people tend to have. The AA members became more like the kind of people who have narcotics problems.
The other measure, called the Hysteria Scale, is related to people who have somatic complaints and to the denial of difficulties. The AA group, the group that reported the least success, was also the one most inclined to hide its difficulties.
The main criticism of these two studies is that they deal only or predominately with people coerced into treatment by the legal system. This, of course, is true. It is also true, however, that they make an excellent case against court-mandated AA attendance.
There apparently have been no controlled studies done of AA against other treatment in a non-coercive environment. So unquestioned has been the effectiveness of AA that most studies comparing treatments compare different versions of AA-based treatment. “Successful outcomes” are often defined, not in moderation or abstinence, but in rates of AA attendance. However, some revealing studies have been done.
Harvard psychiatrist George Vaillant's study
A most revealing study of the over-all success of AA was done by Harvard psychiatrist and prominent authority on the disease of alcoholism, George Vaillant. In one of the longest studies of its size and type, Vaillant followed 100 men for eight years. The men selected were the first 100 consecutive admissions for detoxification at an alcoholism clinic. They were followed up annually. Praised for his candidness, Vaillant wrote of his project in his book, “The Natural History of Alcoholism,”
“It seemed perfectly clear…by turning to recovering alcoholics [AA members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients…into the treatment system of AA, I was working for the most exciting alcohol program in the world.
But then came the rub. [We] tried to prove our efficacy. …
After initial discharge, only 5 patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. …Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.”63
Stanton Peele, an investigator independent of Vaillant's study, after examining some of Vaillant's unpublished data found,
“Of those who quit drinking on their own, none of the twenty-one men followed up since the end of the study were abusing alcohol. …Relapse was more common for the AA group: 81 percent of those who quit on their own either had abstained for ten or more years or drank infrequently, compared with the 32 percent of those who relied on AA who fall in these categories.”64
Despite the fact his own data shows people do worse with AA than without it, in the same book where he presents the failure of “inexorably moving patients… into the treatment system of AA,” Vaillant goes into detail telling how AA works. Perhaps even odder, he stated,
“…if we have not cured all the alcoholics who were first detoxified over 8 years ago, the likelihood of members of the Clinic sample attending AA has been significantly increased.”65
Odd indeed, for a doctor to discount not having cured or ameliorated the symptoms of an illness, but to instead boast of getting the patients to join AA. How can this be?
One possibility is that George Vaillant is “God-controlled.” He gives indications that this may be so. In attempting to explain the division between those (like himself) who believe that AA works and those who don't, he offers, “[F]or AA to work, one must be a believer.”66
Perhaps the problem with his alcoholic patients dying at an “appalling” rate wasn't because of a failure of AA but because of a failure on the part of his patients to believe in AA. This is in spite of the fact that those who didn't believe, and wouldn't go, did better.
Also indicative of his being a present-day grouper is that he advises,
“Clinicians and relatives alike need to take the first ‘step’ of Al-Anon seriously: they must admit their own ‘powerlessness over alcohol.’”67*3
It seems he himself takes the first step seriously and has admitted his powerlessness. Did he take the second? The third? Whether he did or not, he certainly seems to be “working the twelfth.” The Twelfth Step is “to carry the message,” meaning to work to bring new people into “the program.” To this end, George Vaillant, as a medical expert on alcoholism, advised in the prestigious Harvard Medical School Health Letter,
“Sooner or later, and preferably sooner, the alcoholic should be induced to attend meetings of Alcoholics Anonymous.”68
a study of how AA works in hospitalized patients
One study of many which indicate how AA works in hospitalized patients brings to mind “Oxfordizing” and the five Cs. In a Texas hospital69 35 men of various lengths of hospitalization in an AA-based program underwent psychological testing. It was found that the longer a patient was in the program the higher he scored on responses indicating defeat, guilt and fear. Perhaps most important, as the patients became more indoctrinated in AA, their self-concept became progressively more negative than when they first sought help for their drinking problems. As the Oxford Group before them, Alcoholics Anonymous uses guilt to bring about conversion to membership. Alcoholics Anonymous has the added benefit of manipulation through fear. With these tools at its disposal, indoctrination proceeds. This is all to get a person with a drinking problem to join what has been called, and AAs own statistics70 back up, “a society of slippers.”
The “medical” justification for AA indoctrination used by treatment enterprises and AA itself is the disease theory. Careful examination of disease theory, which many of us have accepted for humanitarian reasons, will show its effects have been far from humanitarian.