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The Science of 12-Step Programs

timothy posted about 8 months ago | from the your-brain-on-steps dept.

Science 330

Hugh Pickens DOT Com writes "Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts A.A. on "the fringe" in the minds of many scientists. But there is an interesting read at National Geographic where Jarret Liotta writes that new research shows that the success of the 12-step approach may ultimately be explained through medical science and psychology. According to Marvin Seppala, chief medical officer at Hazelden and sober 37 years, attending 12-step meetings does more than give an addict warm, fuzzy feelings. The unconscious neurological pull of addiction undermines healthy survival drives, causing individuals to make disastrous choices, he says. "People will regularly risk their lives—risk everything—to continue use of a substance." Addicts don't want to engage in these behaviors, but they can't control themselves. "The only way to truly treat it is with something more powerful," like the 12 steps, that can change patterns in the brain. Philip Flores, author of Addiction as an Attachment Disorder, says the human need for social interaction is a physiological one, linked to the well-being of the nervous system. When someone becomes addicted, Flores says, mechanisms for healthy attachment are "hijacked," resulting in dependence on addictive substances or behaviors. Some believe that addicts, even before their disease kicks in, struggle with knowing how to form emotional bonds that connect them to other people. Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. "We, as social mammals, cannot regulate our central nervous systems by ourselves," Flores says. "We need other people to do that.""

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330 comments

Gotta have a plan (5, Interesting)

maroberts (15852) | about 8 months ago | (#44534551)

I would suspect that programs such as these do work, because they provide a means of seeking help, support and resisting temptation, instead of having no direction to go but down.

Re:Gotta have a plan (-1, Troll)

Anonymous Coward | about 8 months ago | (#44534843)

Can somebody spot the naive idiot who doesn't know what they're talking about? I can, because before my account was banned after I had too much to drink and tried to choke Rob Malda at a bar before fucking Catherine...uh...Kathleen Fent without a condom, I had an epiphany -- That the folks in AA and other programs like it are not "warm and fuzzy" because they have a support system. In fact, if any of you bed-wetting momma's-boys actually been to an AA meeting, you'd know that the participants are not at all "warm and fuzzy." On the contrary, they are angry and bitter zealots. In short, the principle at work is addiction substitution.

That is why, when you go to an AA meeting, the folks have been sober for months or years and yet are chugging coffee and chain-smoking at 8 p.m. with angry and impatient scowls on their weathered faces. That is why born-again Christians are the most fanatical religiots, stalking you to shove their new-found love of Jesus up your ass while normal religiots would simply invite you to their church and then ta-ta.

We all do addiction substitution -- perhaps substituting morning coffee for a brunch soda, or replacing sex with porn when the wife is bitching for foreplay and all you want to do is spit on it and stick it in. Or, more to the point, Junkies getting "clean" by instead ingesting methadone. This "warm and fuzzy" picture being painted by the summary is complete bullshit.

I speak with authority in these matters because I am -- Ethanol-fueled , motherfuckers! And I got laid by a Filipina a couple hours ago. Made great food, and smelled interesting in a pungent-but-not-necessarily-bad way. Hooyah!

Re:Gotta have a plan (2, Insightful)

jones_supa (887896) | about 8 months ago | (#44534857)

That is why, when you go to an AA meeting, the folks have been sober for months or years and yet are chugging coffee and chain-smoking at 8 p.m. with angry and impatient scowls on their weathered faces.

Heh, it's so true. Someone may carry a medal how you are not drinking, but never tell that they have picked up some other vice. For example Penn Jillette has often mentioned how he has never touched drugs, but looking at the shape of him I bet he likes to guzzle down some junk food.

Re:Gotta have a plan (0)

Anonymous Coward | about 8 months ago | (#44535011)

It's a hard path I was stuck in NA after being busted for a ring of prescription forgeries and in the end I only needed one step.

Methadone clinic.

Beware (1)

justthinkit (954982) | about 8 months ago | (#44535343)

Beware methadone overdose [methadoneabusehelp.com]. Quoting from that page: "it stays in the body longer than other drugs". I've also heard that it stays in the body after it has stopped working, so you want more...leading, potentially, to overdoses. WA state pushes methadone (as it is cheaper) and has killed a bunch of people as a result.

Re:Gotta have a plan (0)

Anonymous Coward | about 8 months ago | (#44534907)

Fuck yeah. I'm putting back some cheap shitty strong booze in my own little corner of SE Asia ...... although around here the ladies smell regrettably clean.

Re:Gotta have a plan (1, Informative)

Anonymous Coward | about 8 months ago | (#44535235)

I understand that you're probably a young male troll who doesn't know anything much but...I've been in AA for 32 years, I've no doubt it saved my life and, indeed, have watched very young people die of the direct or indirect [car crash, suicide etc.] abuse of alcohol.

The meetings, in general, do not contain 'angry and bitter zealots', yes there are a few, we call them step-nazis, for example. There are also a few chain-smoking coffee drinkers, but we don't consider that to be the purpose of stopping drinking. Also, better that they do that for a while than kill themselves directly with drink.

It's not for everyone, and there are other approaches. But it's saved and improved a lot lives in the span of its existence.

So troll away, you've been fed, but somewhere else and about something else, why don't you or 'grow up' does that work for you?

Re:Gotta have a plan (-1)

Anonymous Coward | about 8 months ago | (#44535309)

Yessss, yesss. Feed me. What was your substitution? Was it Penn Jillette's fast-food? Chronically masturbating to porn? Three Ventis a day? Lifetime subscriptions to WoW, EvE, STEAM, or other regulary-occurring game downloads? Treating yourself to ever-better and faster rigs? Coin collection?
 
Tell me and reassure us, that you totally did not pick up or otherwise augment other habits in place of the drink. You're gonna prove me right, no matter how innocuous your new habits are. Pokemon playing? Beanie-Baby collecting? Knocking up a fat girl and accepting the result of that as your new distraction? One of the core tenets of the 12-step program is not to lie to yourself. So tell us the complete truth, if you dare.

You know what I'm feeling right now? The warm ingress of sweet ethanol on my tummy. Listening to tacky music under the influence, in the comfort of my own home. And you know what, shakey? It fuckin' rocks! Do you remember how nice the first drink felt on your tummy after a long, hard day at work? There's just no feeling in the world that can top that! Not even the first morning coffee. Yum!

-- Ethanol-fueled

Re:Gotta have a plan (2)

Joe Torres (939784) | about 8 months ago | (#44535257)

People suspect that many things work and sometimes they are wrong.

"'no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism." (https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous#Clinical_studies)

Well controlled scientific studies are great at answering these questions.

Re:Gotta have a plan (0)

Anonymous Coward | about 8 months ago | (#44535393)

>because they provide a means of seeking help, support and resisting temptation

And God was created for this purpose, along with some others.

So you need to get over your alcohol addiction... (3, Insightful)

Anonymous Coward | about 8 months ago | (#44534553)

in order to get back to the healthy, socially expected addiction to people. Makes sense.

Re:So you need to get over your alcohol addiction. (1)

smitty_one_each (243267) | about 8 months ago | (#44535001)

It cannot make sense until we have re-established purely materialistic explanations for every phenomenon.
This is a crucial aspect of achieving a fully deterministic, freewill-free model for human behavior.
Only then can humans become fungible with sheep in the eyes of SkyNet.
The eugenics applications alone of this effort are staggering.

Re:So you need to get over your alcohol addiction. (3, Insightful)

fustakrakich (1673220) | about 8 months ago | (#44535517)

...purely materialistic explanations for every phenomenon.

In my business, it's called troubleshooting. Find the problem and fix it.

The only faith required is the belief that you can do it. - Mark 10:52

quit drinking (4, Insightful)

gl4ss (559668) | about 8 months ago | (#44534567)

had to quit it due to pancreatitis. fuck twelve steps, fuck the AA, fuck the higher power, fuck the addiction treatment industry.

you see what's wrong with for example the AA 12 steps? 8 of the steps are "whee I'm a christian now and can't be judged for raping my cousin" and the rest are pretty much "It's not my fault I am/was an asshole". it's bullshit.

not fucking one of the steps is to ACTUALLY STOP DRINKING! and half of the steps are practically just setting up that it's not their fault if they drink!

here's my two step program.
1) stop drinking.
2) try to fill the time with something to make things feel as fun as when drinking.

step two is hard, because, hey, drinking is highly enjoyable.

(* due to having stopped drinking, I find myself unable to stop posting obnoxious poorly spelled comments to slashdot, but hey, it works. btw if you drink, don't be an asshole. AA is geared for people who are so big assholes they can't even go to the corner shop sober because they know they're such dicks when they drink, which makes for a sorry loop).

Re:quit drinking (5, Insightful)

Idimmu Xul (204345) | about 8 months ago | (#44534609)

You didn't just 'actually stop drinking' you got pancreatitis, which then motivated you to stop, your 2 step program is missing a couple.

Alcohol abuse is so socially acceptable most people don't even recognise it as abuse and it can take a massive upheaval of your social life to simply "stop drinking", as well as taking time to spot patterns of behaviour and triggers and then change them.

I do dislike the AA though, they say that if you stop drinking, you're just a dry drunk, so in their eyes even of 10 years sobriety you're still branded as an alcoholic, you still have to announce that you're an alcoholic, and that just reinforces the idea that you're weak, that you may slip up and that you need AA meetings to get by.

Re:quit drinking (5, Interesting)

Sycraft-fu (314770) | about 8 months ago | (#44534645)

Well their terminology may be a bit off but the idea is actually correct: You can't, at this point, be "cured" of alcoholism. You can stop drinking and that is what you need to do, but the addictive nature is still there. If you start again, you'll overdo it and spiral down the addict path. If your brain/body is such that it will get addicted to alcohol, then it will always be that way, and no amount of time will change that.

That's really what they are saying and it is correct. You don't cure an addiction, as in become such that you won't get addicted to the substance, you just stop taking the substance.

As an example take a look at nicotine. There actually are people who do not become addicted to it, my mother is one of them, they are just very rare. Most people, if you use it more than a little bit you WILL get addicted. We all understand that, so those of us that don't wish to get addicted avoid it. Also once you've quit smoking, you recognize that you can't start again, you can't do it "just a little bit," you'll get hooked again.

Well for alcoholics, that is how alcohol works. Most people, 90%ish, aren't like that. They do not get addicted. However for alcoholics it works like nicotine, they do get addicted. So the only answer is avoidance. There's no amount of time after which you are "cured" and can no safely drink, you just need to stay away.

Same thing goes for any addiction. You are never "cured" you just stop taking the substance. You can't ever go back to taking it, or you'll head down the path of addiction again.

Re:quit drinking (5, Insightful)

Trepidity (597) | about 8 months ago | (#44534895)

You can stop drinking and that is what you need to do, but the addictive nature is still there. If you start again, you'll overdo it and spiral down the addict path. If your brain/body is such that it will get addicted to alcohol, then it will always be that way, and no amount of time will change that.

That's commonly true, although alcohol is a strange drug because of how it figures in so many social situations. There's a segment of what you might call "problem drinkers" who do successfully change from drinking excessively to drinking moderately, mostly caused by a significant change in their social setting. For example they change cities and have a different group of friends with different activities.

This strongly depends on the person and the nature of their excessive alcohol use, though. It's "easier" in a sense to be cured if it has a large socially situated psychological component, such as people who drink too much basically because their social life revolves around spending 5-6 hours each evening at the pub, and drinking is what you do at the pub. In that case, a change in social setting can significantly cut down on the amount they drink. But you could argue that these people were not truly addicted; rather they were drinking more than they wanted to because of social/peer/environmental pressure to do so, and then stopped doing so when the external pressure disappeared.

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44534921)

As an example take a look at nicotine. There actually are people who do not become addicted to it, my mother is one of them, they are just very rare.

I suspect the idea that nicotine itself is addictive is flawed. Else everybody would simply slap on the patch and never smoke another cigarette.

Also once you've quit smoking, you recognize that you can't start again, you can't do it "just a little bit," you'll get hooked again.

...And having quit, I have no desire to smoke any further. I do not mind being around people smoking, to boot. Perhaps humanity is evolving. Suck it, homo sapiens sapiens; behold my salty homo sapiens superior balls.

Re:quit drinking (2)

alphatel (1450715) | about 8 months ago | (#44534927)

As an example take a look at nicotine. There actually are people who do not become addicted to it, my mother is one of them, they are just very rare. Most people, if you use it more than a little bit you WILL get addicted. We all understand that, so those of us that don't wish to get addicted avoid it. Also once you've quit smoking, you recognize that you can't start again, you can't do it "just a little bit," you'll get hooked again.

I was a smoker for 10 years and quit 10 years ago. I still smoke, but only when on vacation (which is so rare nowadays it might as well be retirement). I do not suffer any lingering after-effects. Even though in theory I shouldn't be able to kick the habit after smoking for a week or two in some summer retreat, it does not fail. Honestly by the time the vacation is over I am tired of the smoking ritual and its effects. The people I leave behind in those places, they don't stop smoking.

Non-sequitur break: Looks like I picked the wrong day to quit shooting heroin! - Lloyd Bridges, Airplane

Re:quit drinking (1)

Jah-Wren Ryel (80510) | about 8 months ago | (#44534939)

> If you start again, you'll overdo it and spiral down the addict path.

That's the problem with these programs - they teach people that they are helpless to their "addiction" which actually encourages addiction. If you are a permanent addict then if you have a drink well you are fucked so in for a penny in for a pound.

Re:problem with these programs (0)

TaoPhoenix (980487) | about 8 months ago | (#44535045)

Yep.

Most other activities, you can "give them up". But get involved for real with a program like AA? "Forever is a long time"!

"Sober 37 years"?! So let's say he started the program at 30, and now he's 67? Do some math people then re-apply the context!

"Oh yeah, I did some stuff back in 1973..." So? Didn't everyone? But a program like AA makes sure you can never forget it and move on!

And that's without even getting started on the Christian angle!

Re:problem with these programs (0)

Rob Y. (110975) | about 8 months ago | (#44535299)

Okay. First of all, there's no (official) 'Christian' angle in 12-step programs. The higher power is nothing more than a technique for letting go of trying to control things yourself. For lots of people, the 'higher power' is the group (no God required). And the purpose of it all is to give you enough breathing room to actually take a hard look at your behavior and learn that it (literally) won't kill you (or anybody else) to approach life honestly. The rest of it is all trappings to keep you occupied until that realization truly takes hold. Sure, there are plenty of people who go to AA because someone else 'makes them'. And it doesn't work for those people. There are also plenty of people for whom the program becomes a way of life (with good and bad aspects - not least is the desire of those who were genuinely helped to help others deal with their problem). And some people grow away from the day-to-day aspects and carry on with their lives, applying the lessons they learned in AA.

So why not shut the fuck up when you're ignorant about something instead of getting all superior and condescending.

Re:problem with these programs (0)

Anonymous Coward | about 8 months ago | (#44535383)

Bring up Jesus in an AA meeting and you are liable to be chastised. AA is a spiritual program, not a religious program. AA isn't about "stuff" one did, it's about not drinking, maybe so you don't do more "stuff".

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535189)

The word is "powerless". It means this: stop at the bar at 6 p.m. for a drink before going home, wake up in the morning somewhere other than home and not remember how you got there or what you did since 9 p.m. Imagine a food that made you hungrier with every couple bites. That is how an alcoholic brain responds to alcohol. Failed efforts to control drinking is part of the DSM-IV diagnostic criteria for alcohol dependence. Few people go off the wagon with "in for a penny, in for a pound" in mind. Generally, people decide that if they change their strategy, changing from liquor to beer, or beer to wine, or drinking with friends instead of alone, or whatever, then they can control their drinking. Such people return to their previous state quicker than it took to get there in the first place. I couldn't find the study that I once saw, but rats were implanted in a specific region of their brains with electrodes. After exposure to alcohol for a while a new and particular pattern of activity emerged. When denied alcohol for a time, the activity gradually went away. The rats were exposed to alcohol again and developed that pattern of activity in much less time than it took in the first place. It would seem that with heavy exposure to alcohol, a pathway is created, involved in the phenomenon of dependence, that can go dormant with abstinence, but which nevertheless remains and can be easily reactivated.

Re:quit drinking (-1)

Anonymous Coward | about 8 months ago | (#44535127)

Well their terminology may be a bit off but the idea is actually correct: You can't, at this point, be "cured" of alcoholism.

And that's smack on the money the one and single purpose of AA. To make people believe this. You can't be cured so you need jezus!

It's worth noting that countries where AA is non-existent or considered a club for weirdo jezus-freaks have just as many (or more) people who get off their alcohol addiction as countries that do have AA. Look up the numbers if you don't believe this, the measurable benefit of AA is exactly 0.0% It's a marketing ploy created to pull weak and vulnerable people into a church, and that's all there is to it.

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535481)

AA has nothing to do with Jesus, ignoramus.

Re:quit drinking (3, Interesting)

gl4ss (559668) | about 8 months ago | (#44534833)

3/4th of people don't quit drinking after getting alcohol induced pancreatitis locally here, probably a big part of it is the shitty education on the subject - they're one of the biggest money drains on public health care over here, every intensive care ward has someone dying from symptoms caused by reoccurances of it. the education for it given? a fucking brochure about dangers of drinking and then you're sent home with a weeks dose of opiates.

I'm not an advocate for all people to stop drinking totally, just for people for whom it will cause serious medical problems that are not offset by the benefits of drinking and for those who are just so big douches when they drink that it causes them massive problems, that they view as massive problems(thus, again, damages outweighing benefits of fun) - in which case the solution is the same two step. however those douches are actually a minority, but you notice them much easier.

Of course if you have no reason to stop drinking - why would you embark on even one step program to quit drinking?

AA system sucks, hard. and that for most substances the society has built artificial damages for "abuses" of many substances - so they become a serious hamper on your life much, much before they become an actual problem on your functionality as a person or a problem on your health and that's stupid - with alcohol it'll for most people become a hamper on the health long before it becomes a problem socially.

Re:quit drinking (3, Insightful)

AK Marc (707885) | about 8 months ago | (#44534613)

The difference is that an alcoholic would drink themselves to death despite pancreatitis. So you weren't an alcoholic. How do I know that an alcoholic would drink themselves to death, knowing the next drink would kill them, and doing it anyway? Because my uncle died that way.

Step 0.5 is to stop drinking. They won't let you in if you are actively drinking at the moment, so they assume you have quit, even if it's one day sober (while not sober).

You had a need to stop, you did stop. That proves you are not an alcoholic. So your views on it are irrelevant.

And they are all giving power to a higher power because the addicted can't stop themselves. So having an imaginary friend who's always there looking over your shoulder gives you some accountability when you'd otherwise have none. There's surprisingly little God in it, despite it being Christian God-based. It's psychological, giving help when needed.

Re:quit drinking (0, Troll)

burningcpu (1234256) | about 8 months ago | (#44534675)

No true Scotsman.

Re:quit drinking (1, Insightful)

Guppy06 (410832) | about 8 months ago | (#44534963)

"No True Scotsman" involves moving goalposts. Alcohol abuse is a well-documented, well-defined medical condition; the only "goalpost-moving" here is movement from the OP's self-diagnosis.

Or are you honestly trying to defend all the first-hand accounts of users of homeopathy, chiropractic, faith healing and the like?

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44534719)

> Step 0.5 is to stop drinking.

Sounds pretty straightforward this plan! I think I might be able to simplify it down to 3 steps, or 1 or maybe even zero steps if we're rounding down.

Re:quit drinking (4, Informative)

dcollins117 (1267462) | about 8 months ago | (#44534767)

Step 0.5 is to stop drinking. They won't let you in if you are actively drinking at the moment, so they assume you have quit, even if it's one day sober (while not sober).

The only requirement for A.A. membership is a desire to stop drinking. Anyone can go to meetings, sober or drunk, doesn't matter.

Re:quit drinking (0)

AK Marc (707885) | about 8 months ago | (#44534925)

I've been told that you will be refused entry if you are bringing alcohol in with you. Which AA were you at that allowed drinking alcohol in the meetings?

Re:quit drinking (1)

Anonymous Coward | about 8 months ago | (#44534959)

The Automobile Association in the UK was very happy to let me bring my whisky into their meetings.

Later we did burnouts and doughnuts in the car park.

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535185)

It is true that alcohol is not allowed in a meeting of recovering alcoholics, but the alcoholic is welcomed. The first step starts with the word "We". I can attest that after living many many days without having alcohol, I do know that if a bottle of gin was sitting next to me, my mind would be focused on the bottle for a fair amount of time in the meeting. For people who are early in their sobriety and are attending that meeting, the temptation may be too great. The meeting is a place where there is a "desire" to stop drinking, not a place where there is a desire to start drinking. I am sure that bringing alcohol into a high school basketball game is prohibited.

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535447)

What would be the point of drinking at meetings about not drinking? What dcollins117 refers to is the fact that if someone comes in drunk and is thinking about quitting, the person is welcome to join the meeting.

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535453)

I've been told that you will be refused entry if you are bringing alcohol in with you.

In 12 years of attending 3 or 4 AA meetings per week, I have never once seen anyone refused entry. People who are very clearly intoxicated show up all the time, they are welcomed. After all, they are the ones most in need of the help the program offers. And while drinking during a meeting is obviously not encouraged, I have seen people sit down with a travel mug full of some alcoholic beverage or another. Provided that they're not disruptive, nothing is said.

During this time I have seen exactly one occurrence of someone being pulled out into the hallway because he was being disruptive and obnoxious. Once he calmed down, he was again welcomed back into the meeting.

Re:quit drinking (5, Insightful)

cnaumann (466328) | about 8 months ago | (#44534873)

You are defining an alcoholic as someone that can only stop drinking if they use the 12 step program. Someone who is able to stop for any other reason is not a true alcoholic.Therefore, Only the 12 step program can keep a true alcoholic sober. And the views of anyone who was not a true alcoholic and was able to stop drinking without using the 12 step program views are irrelevant. I think data obtained with these criteria will be somewhat biased.

Surprisingly little God in them? Have you actually read them? (http://en.wikipedia.org/wiki/Twelve-step_program) The OP is essentially correct in his summery.

Re:quit drinking (1)

ebno-10db (1459097) | about 8 months ago | (#44535253)

You are defining an alcoholic as someone that can only stop drinking if they use the 12 step program.

No, he's defining an alcoholic as someone who cannot stop drinking without great difficulty, even if there are strong rational reasons for doing so. That's called addiction, and it's a well documented phenomenon. By contrast you offer no definition of alcoholism. Furthermore, all the OP said about AA is why it might help some of the people who have that problem.

Re:quit drinking (4, Insightful)

Hadlock (143607) | about 8 months ago | (#44534721)

Having watched a close friend spiral downwards and end up in a sober living home after a trip through the state mental hospital + inpatient rehab, the 12 step program is a system that is flexible and allows you to modify (although not fix, for a lot of people) some deep rooted behavioral problems so that when they go off the rails, it's a one or two day bender, not a two week "I haven't showered in 9 days and are these even my pants? where am i hey can i have some money i lost my wallet letsgogetsomebeermanthatsoundsgreat" binge that only stops because their liver has shut down and they end up detoxing in the hospital.
 
I'm glad for you it's not a big problem and you had something more pressing to get you off of alcohol, but for a lot of people a day job is a great excuse to drink. Go hang out at an AA or NA meeting center some time, listen to their stories about how alcohol has been a lifelong struggle. For a lot of those people, the 12 steps is the only thing they have going for them, and they're grateful for what they have. It's a very well designed program for a certain subsection of people, and if you aren't one of them, you shouldn't knock it, because it doesn't apply to you.

Re:quit drinking (4, Insightful)

m00sh (2538182) | about 8 months ago | (#44534723)

Gah, the point of the article is that what is in the 12 steps don't matter. The steps could be "impersonate an orangutan in heat". What works is that people hang out together and fulfill a social need.

Re:quit drinking (5, Interesting)

Anonymous Coward | about 8 months ago | (#44534879)

Why is this modded down?

If you type "is AA" into Google, Autocomplete will give "is AA a cult" as the first suggestion. Their success rates are abysmal.

"Trying to fill the time" is an enormously important part of quitting the booze. The physical alcohol dependency quickly disappears, but your brains desire to kill some time by getting drunk never goes away.

It's very annoying when the best posts on Slashdot get nuked, while somebody theorizing (poorly) about quitting alcohol can get modded up to +5. When I don't have an expert opinion on a topic, I let other people do the talking ...

Re:quit drinking (0)

Anonymous Coward | about 8 months ago | (#44535135)

The "its not my fault" and "Jesus will save me" are actually there for a reason. They are there to help you get rid of your anxiety and depression (the main reason to drink). It is easier if you don't want to kill yourself every second you are awake and feel that there is some meaning to it all... Of cause you probably should and there isn't, but self-delusion goes a long way towards a happy life.

Speak for yourself (0)

Anonymous Coward | about 8 months ago | (#44534575)

We, as social mammals, cannot regulate our central nervous systems by ourselves. We need other people to do that.

Maybe you can't.

Re:Speak for yourself (2)

jones_supa (887896) | about 8 months ago | (#44534899)

We, as social mammals, cannot regulate our central nervous systems by ourselves. We need other people to do that.

Maybe you can't.

Exactly. Other people can offer encouragement and support, and that can be valuable, but it's not that you cannot be motivated alone to quit. It's about life values, thinking, and taking care of health, which make you quit, not some social mammal central nervous system control stuff.

Re:Speak for yourself (1)

ebno-10db (1459097) | about 8 months ago | (#44535275)

It's about life values, thinking, and taking care of health, which make you quit, not some social mammal central nervous system control stuff.

What makes you think that "life values, thinking, and taking care of health" are necessarily disjoint from "social mammal central nervous system control stuff"?

It works? (2, Insightful)

Anonymous Coward | about 8 months ago | (#44534581)

It's been said in the comments on the NGS web site, but it's worth repeating here: The article starts from the presumption that 12 step programs are effective, based on the fact that they are popular. The actual science on twelve step programs says something else entirely.

http://www.nytimes.com/2006/07/25/health/25drin.html?_r=1&

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005032.pub2/abstract

Coming up with a "scientific explanation" for how AA "works" without any demonstration that it actually DOES work seems like a load of horseshit, not to put too fine a point on it.

Re:It works? (0)

Anonymous Coward | about 8 months ago | (#44534605)

You know what "why 12 step programs work" is? That's right: It's actually begging the question.

Re:It works? (2)

ebno-10db (1459097) | about 8 months ago | (#44535315)

The article starts from the presumption that 12 step programs are effective, based on the fact that they are popular. The actual science on twelve step programs says something else entirely.

Read your own fine article. From the NYT link:

no data showed that 12-step interventions were any more — or any less — successful in increasing the number of people who stayed in treatment or reducing the number who relapsed after being sober ... None of the studies compared A.A. with no treatment at all

It doesn't even pretend to address the point you're trying to make.

Re:It works? (2)

phantomfive (622387) | about 8 months ago | (#44535339)

The study you linked to says AA works as well as other types of treatments. It also quotes several researches who say AA is effective.

An AA Alternative: Naltrexone (2, Informative)

Anonymous Coward | about 8 months ago | (#44534587)

If there's anyone who wants to quit but doesn't like AA for whatever reason, I can recommend Naltrexone and the "Sinclair Method".

Re:An AA Alternative: Naltrexone (3, Interesting)

Anonymous Coward | about 8 months ago | (#44534781)

There's also another alternative. LSD. It makes the person who takes it think more clearly and see their problems in a whole new light and make them accept that they have a problem as well as give them the will to stop.

I'm not an alcoholic, but I stopped smoking cigarettes after taking acid once. It suddenly made smoking seem so stupid. I already knew that it was stupid, but somehow the acid made me really think about how cigarettes hurt me and that gave me the willpower to stop. And that wasn't even the reason I took the drug. It just sort of happened while I was smoking a cig. If someone took it with the sole purpose of getting to grips with their addiction with the help of a therapist it would probably be even more effective.

Unfortunately LSD is a schedule I drug. Probably because it makes you think too much about things you shouldn't think about.

Re:An AA Alternative: Naltrexone (0)

Anonymous Coward | about 8 months ago | (#44534919)

Unfortunately LSD is a schedule I drug.

And in Soviet Russia, the drug would schedule you...

Re:An AA Alternative: Naltrexone (1)

Anonymous Coward | about 8 months ago | (#44534937)

Acamprosate and a little willpower did it for me.

It's extremely useful for the first week or so. Make sure your drinking buddies know you've quit. You WILL lose a lot of friends.

Effective for some, not all (5, Informative)

ThatAblaze (1723456) | about 8 months ago | (#44534589)

The problem with 12 step programs isn't the people who they work for, the problem is that so often they are presented as the only option. Not everyone who has ever used any addictive substance has no control over themselves.Some people used them for different reasons, and those people are often forcefully pushed into these 12 step programs right along side the people who need them.

Most schools are trying to come to terms with the fact that people learn differently, when will treatment programs come to terms with the fact that people recover differently?

Re:Effective for some, not all (1, Troll)

silas_moeckel (234313) | about 8 months ago | (#44535083)

12 step programs success rate is the same as the spontaneous success rate. AKA it is not effective. It is a pseudo religious cult that the government forces people to got to. I'm sure addicts can use help dealing with there addiction but that costs real money not just free use of a church basement, coffee, and a doughnut spread.

Re:Effective for some, not all (1)

ebno-10db (1459097) | about 8 months ago | (#44535489)

The problem with 12 step programs isn't the people who they work for, the problem is that so often they are presented as the only option.

When? By whom? I've no doubt that some people say this, but I've never noticed it as a widespread problem.

Not everyone who has ever used any addictive substance has no control over themselves.

"No control over themselves" is getting seriously judgmental and/or philosophical. If they had no control over themselves then, absent permanent physical restraint, how did they stop? I'm a pragmatist. If it helps some people stop their destructive behavior, then it's a Good Thing (tm).

More nonsense (1, Interesting)

Anonymous Coward | about 8 months ago | (#44534599)

"Addicts don't want to engage in these behaviors, but they can't control themselves"

Nonsense. Read 'Addiction is a choice' and 'The myth of addiction'.
There is no such thing as 'addiction'. Every so-called 'addict' CHOOSES to engage in whatever behaviour they are doing, which is called an 'addiction'. Alcohol doesn't force you to pick up a bottle, doesn't move your arms for you, etc.

People take drugs because they are UNHAPPY, and if they stop taking those drugs, their real feelings come to the surface, which they have been trying to avoid all their lives, and they will do anything to continue avoiding them. That is all there is to it.

Re:More nonsense (5, Insightful)

Opportunist (166417) | about 8 months ago | (#44534667)

As a former heavy smoker I can tell you, I did want to smoke. Hell yeah. It felt good. It was relaxing, it was soothing, it was great. Don't give me that "I don't want to smoke but I can't stop" bull. You want to smoke. At least admit it. You may not like the coughing and the shitty taste in your mouth in the morning (no, really...), you may not like how people react to you, but you do like the cigarette (or in my case, cigar), the moment you light that fire you WANT it. Don't gimme any of that crap that you light it with remorse, you don't. You lean back, you put it in your mouth, you light it, you inhale, you enjoy it. Face it, that's the truth. Lie to yourself if you prefer, but that's simply how it is.

Was I an addict? I guess yeah. Did I like to stop? Yeah, I did. But mostly because for some odd reason from one day to the next the craving stopped. I lighted the cigar and it was not enjoyable. I did not like it. I simply didn't. I put it down and that was a few months ago now. The cigar is still lying where I put it, ready to be smoked at any time. I just don't want to.

Pretty much at the same time some important changes came to my life and I think it's pretty much how you described it. The drug was a substitute. Once it's no longer needed, it will cease to provide the enjoyment that it once did. That certainly doesn't work for everyone, but nobody should give me the bull that he doesn't like his drug. If he didn't, he'd simply drop it. Addiction is nothing but a craving that you want to fulfill. A quite heavy craving, I may add, but it's still you that decides whether or not you give in or whether you look for other ways to relax and enjoy.

Re:More nonsense (2, Insightful)

Anonymous Coward | about 8 months ago | (#44534799)

You guess you were an addict? That's a pretty good sign you weren't.

Though I've never been addicted to anything chemical, there was a point I started becoming OCD. I had to prewash my hands before I washed them (don't laugh, it seemed right at the time). Then I needed to post wash them. I had to unlock the doors to prove they were actually locked when I left the house. Which meant I had to lock them again, which brought the need to unlock them to prove it really was locked. I knew this was odd behavior, but it felt right. I was only about 12 years old then this started, and by 14 it was really annoying me, so I started forcing myself to not do those things. It was torture. Imagine putting your hand into water you know is very hot. Maybe you know it won't actually blister your skin, but you know it is hot, and it will hurt. But you override your instincts and force yourself to do it. Eventually you can break then bad instincts, but most people don't understand this because they've never gone through it. To this day I don't know why I developed those instincts. All I can say it it seemed like I should do them, and once I started, it seemed like I should more.

There were others as well, though I don't know if they are as common for other people with OCD. I felt the need to hide around corners and jump out at people. Even when I knew there was no chance I was going to scare them. I barely thought about it, I just felt myself doing it. It all went away when after I forced myself to stop the hand washing and lock resetting (I don't recall how long it took, but it felt like months because it sucked, but was probably more like one month (being over 20 years ago my memory of the situation isn't perfect).

Re:More nonsense (4, Insightful)

peragrin (659227) | about 8 months ago | (#44534809)

Addiction is a habit that has developed a chemical dependancy. Try taking a regular coffee drinker's coffee away from them for a couple of weeks. It is down right scary to watch the withdrawal.

Some have a hard time stopping others enjoy it so much they really don't want to stop. you can break the habit but because of the chemical dependency it is much much harder.

Also Habits are only a choice in the beginning. once they get going you have to choose to stop, to break the habit.

Re:More nonsense (2, Interesting)

Vintermann (400722) | about 8 months ago | (#44534883)

Some have a hard time stopping others enjoy it so much they really don't want to stop. you can break the habit but because of the chemical dependency it is much much harder.

But to some degree, the one IS the other. And to the degree it isn't: Hospital patients regularly get physically addicted to opiates. They get much purer stuff than on the streets, and they actually get more addicted - they need larger doses to have an effect, and so on. Yet after going through painful withdrawal, these people never want to try it again - they're no more likely to become opiate addicts than anyone else.

There was a big study on Vietnam veterans, probably they expected to find the opposite. But people who had been treated with opiates during the war did no better or worse than other veterans.

Another thing is that if you meet a really long-time addict, odds are he would have gone through withdrawals many, many times the last years. Odds are also that he would have spent many weeks or months sober in periods, without help. Many, perhaps most addicts can decide to stay sober for a while if the situation demands it (for instance for special events like visits or trips). Yet they go back on the drugs.

People use drugs because they want to. Why they want to, currently psychiatrists are doing a much better job actually explaining than neurobiologists. It's just more practical to look at in human terms. Maybe it will change one day, but that's how it is now.

Re:More nonsense (0)

Anonymous Coward | about 8 months ago | (#44534933)

> That is all there is to it.

Says random troller. Do you have any evidence at all? I think you have a problem sir.

Re:More nonsense (0)

Anonymous Coward | about 8 months ago | (#44535347)

If there is no such thing as addiction, then why is it possible for an extremely heavy drinker to hallucinate and even drop dead of a heart attack if he is suddenly without alcohol for a time? Why do alcohol wards sober people up under medical supervision? You would seem to have the understanding of "addiction" that pop culture has, assigning the term to every single thing that someone does with some frequency. How do you explain heroin withdrawal? Pop psychology is pop.

Or go with Narconon and become a Scientologist (0)

Anonymous Coward | about 8 months ago | (#44534629)

Given the choice between those two options, I'd pick the 12-step program every time.

12stepping is just a blameshifting game (0)

Opportunist (166417) | about 8 months ago | (#44534655)

Be honest, read those 12 steps. They basically consist of "I'm not guilty, I'm not to blame, I can't help it, I'm powerless, someone else should do it".

BULLSHIT!

That's just a justification. It helps people to quit something that helps them forget if they don't have to carry the weight of what "wrongs" they did, sure, but that doesn't take 12 steps. That just takes the simple step from being an asshole to others and feeling bad about it to generally being a self righteous asshole and feeling good about it. Sure, religion is a great way to take that step, but anything that gives you the "holier than thou" attitude will do.

Or you could simply accept that you did something wrong in the past, grow a pair and turn over a new page. Find something meaningful in your life to fill the void that alcohol took (and no, religion certainly isn't meaningful). Preferably it could be something that helps you manage the "wrongs" you did as your drinking self. Charity work works wonders here. Don't preach to others on the sins of alcohol, that only drags them down and actually keeps them from getting rid of (think back, what would you have done during your alcohol filled days when someone puts you down?).

On the surface, 12stepping does the same. In fact, though, it never acknowledges that YOU and YOU ALONE are responsible for whether or not you drink. Not some "higher power" and you certainly are not "powerless to stop". That's prime grade bullcrap. You and you alone are responsible for your life and what you do. And you and you alone can pull yourself out of the gutter. Friends can be a boon here, whether fellow sufferers are is debatable if you ask me. But in the end, it's your choice.

Re:12stepping is just a blameshifting game (2, Insightful)

Anonymous Coward | about 8 months ago | (#44534973)

You know, people don't wake up and say, "This is a good day to become a drunk/addict!"

If an addict read your post, they would think "Yeah, what's the point! Fuck it! I'm no good!" and then go out, get high and possibly die or kill someone.

What these 12-Step programs do is help deal with the shame and blame. The drunks feel all that guilt. They do ask themselves "WTF did I take that first shot?!"

They are numbing out feelings. Go to an open meeting sometime and you will hear story after story of childhood abuse and other horrible things that happened to those folks. Many were brought up to feel defective and worthless. So worthless that no one could possibly love them - many times they're isolated. Some started being a drunk because that were the only friends they thought they could have - the drunks they hooked up with just wanted a drinking buddy. Drugs and booze are the only thing that makes them feel good.

Many never developed proper coping skills and many had drunks for parents. When you grow up in an environment like that, you think that's normal.

The 12-Steps and other recovery groups like SOS allow these folks to connect and belong somewhere - and considering society's hangup and judgements - it's the only place where they can feel they belong. They also start to learn about the dysfunctional thinking and living. There's nowhere else to learn those things.

On the surface, 12stepping does the same. In fact, though, it never acknowledges that YOU and YOU ALONE are responsible for whether or not you drink. Not some "higher power" and you certainly are not "powerless to stop". That's prime grade bullcrap. You and you alone are responsible for your life and what you do. And you and you alone can pull yourself out of the gutter. Friends can be a boon here, whether fellow sufferers are is debatable if you ask me. But in the end, it's your choice.

Many folks need that "higher power" stuff to deal with their own hatred about themselves. "It's really not me - I have a "disease" and it's up to me deal with it." Get it? How many folks feel guilty about having colon cancer? Not many. But they take charge of their lives to get treated. Same idea here.

Granted it gets a bit tiresome -even condescending at times. (One poor guy had a tree for a higher power. The DOT took it down - snickers from all the Jesus/God believers in the room. Not a single expression of sorrow for the guy.).

But that's the thing, when you're an addict, you have no real friends - just other addicts who more than likely don't want to change. These programs give support for change and positive role models - mostly.

There are a LOT of problems with AA - some have accused it of being a cult which I sympathize with - but never the less, it does help folks from drinking and I'd rather have them being there than staying a drunk.

Redundant (1)

Livius (318358) | about 8 months ago | (#44534753)

"attending 12-step meetings does more than give an addict warm, fuzzy feelings."

"the human need for social interaction is a physiological one"

I'm sure there's some scientific value in quantifying the effect, but that's what people mean by "warm, fuzzy feelings" - it wasn't a mystery.

Social beings engage in social methods. (3, Insightful)

Bob_Who (926234) | about 8 months ago | (#44534771)

I am a strong advocate of whatever works.

It doesn't matter who is right or if its the best way or stupid or God or placebo effect. I think the issue is that human beings effect one another and that people with problems of any kind do have an affect on the people around them. These problems may be the result of their experience of the people around them. Whether or not addiction is a choice or a disease or a spiritual or a social disorder really does not matter. What matters is that those who may be afflicted with this dilemma attempt to engage with society in a way that will help to resolve behavior that is inevitably harmful to the self and to the people around them. I don't mean to judge others, each individual can make that determination for themselves. But if it seems that there is wreckage and damage to themselves and to others, and if it is difficult to ascertain how to get a handle on the situation, then its a pretty good bet that engaging with other human beings might be a good starting place.

While it is also true that 12 step programs derive from a spiritual, albeit even Christian flavored template, that in no way limits an individuals personal approach or beliefs. Its just a social venue in which to engage with fellow addicts. And yes there are all kinds of people out there, from the weird to the mundane. Some with "fight club" agendas and some working on a date for Saturday night. Many are addicted to 12 step groups and some are stoned and court mandated to attend. Whatever. It doesn't matter. Its like the rest of the world - there are all kinds. But if you try to do SOMETHING, try to engage with others in a way conducive to new behavior, or another perspective, then its a good place to start.

Why a 12 step? Because its all around, in pretty much every town in the western world. It is anonymous. It is inclusive of anyone who can just be present and listen. It costs nothing. You can leave at any time. If you don't like the kooks or freaks or holy rollers or drunks then just go and find a group that is normal like you. Or blow it off. Nobody will stand in your way. Just know that it is available to you, even if its not particularly useful or interesting to you, it remains an option. And the possibilities are as varied as the human beings that comprise our world. Some are even Scientologists lurking in narc-anon.

Like most things you get out of it what you put into it. If you spend more time drinking you'll spend more time dealing with those consequences, whatever they are. For some, it just means better wine, for others its a DUI or health concerns or anything else you can imagine. If you spend a lot of times doing something else instead, then you will get other results. It may not make you happy or solve your problems, but it will take time away from drinking or gambling or eating a gallon of ice cream or it doesn't matter what else.

My point is perhaps best stated by the immortal Tom Leher. He once said,

"Life is like a sewer.... What you get out of it depends on what you put into it"

And as with most things that goes for the 12 or 13 steps as well. Let the farce be with you.

It's a cult, plain and simple. But not all bad... (4, Interesting)

Anonymous Coward | about 8 months ago | (#44534775)

My father managed to get out of several decades of drug and alcohol abuse (and criminality) via the 12 step. He got an education in treating addicts and now work since a number of years treating others with the 12 step. It works (but that's not news).

Seeing this pretty close and talking to my father about many details, I can state this with absolute certainty that it is 100% exactly the same as any "mind-controlling" cult, but for a different purpose. It works the same, looks the same, everything - and it even has a lot of "god" in it, although many people choose to interpret that in other ways. Especially it is formed to teach you that you are powerless and must trust whatever higher power. It turns the addicts into addicts for meetings instead of drugs.

I have many many problems with the treatment as it is done today, especially since it forms a life-long dependency on something new (this is the trick!) instead of the drug, and the breaking down of the mind. But, on the other hand, it's better than the alternative. I just can't help thinking that there must be a better way than switch addiction for addiction. My father disagrees, of course, simply because for him, this is not how he views it, he sees himself as free from addiction, but he gets all jittery if he can't go to a meeting for a few days...

If we are gonna reprogram humans (it's similar to NLP?), I'm sure it would be possible to reprogram them in a better way than this.

Re:It's a cult, plain and simple. But not all bad. (5, Interesting)

JPLemme (106723) | about 8 months ago | (#44535005)

My AA story...

In college, I attended an AA meeting as a requirement for a Psychology class. I wan't an alcoholic or even on the path to alcoholism; I just needed to fulfill the requirement and "attend an AA meeting" was the easiest way to do that.

The first thing I noticed was that all the people in the meeeting (there were maybe 40 attendees) had replaced alcohol with coffee and cigarettes. The second thing was that all of these people seemed to care about each other. A lot. It wasn't anything explicit or obvious; it just seemed to radiate from everybody and it generated this vibe that was incredibly warm and fuzzy. I didn't announce why I was there, so unless they asked me the other attendees just treated me like another anonymous alcoholic. And they treated me like I was their son or their brother. It felt really, really comfortable and nice. At one point, I actually thought to myself "it's too bad I'm not an alcoholic, because it would be great to hang out with these people every week."

I left that meeting on an emotional high. The only way I can describe it is that it was like finding out you had a whole branch of your family that been searching for you for years, and now you've been reunited and your new family just accepts you with -- not just open arms -- but with a tangible joy that you've finally joined them. It was awesome! And then I got about 50 feet out the door and said to myself "You just got hooked by a cult!"

I was shocked because I had always assumed that I was 100% absolutely immune to cults. I had read stories about people who were brainwashed into joining them and thought that I -- with my intelligence and my skepticism and my stable family life -- could never fall for something like that. But I had only been there for two hours and they had hooked me. Had I been less intelligent or cynical or more lonely maybe I wouldn't ever have realized what was happening.

But more importantly (at least for the report I had to write for my Psychology class), I understood how AA works. It's a cult. A brain-washing, mind-controlling cult that uses the same psychological techniques as Jim Jones or Heaven's Gate to control people, and then uses that control to help them conquer their addiction demons. It's atomic fission harnessed to light up a city rather than to destroy it. And it works because we're social animals and our brains normally respond to social cues at a level far beneath our concious thought. Unless we're actively guarding against it, we can all be manipulated this way. Even you.

Please note, I'm not in any way claiming that AA is bad or that they use social power to do anything other than try to help people. People's need for social interaction is just a fact, and AA uses this knowledge as the starting point to help people stop drinking. Knowing that you have several dozen people who care about you, who would be disappointed if you had a relapse, who look to you as an example of success, or who would be happy to talk to you if you just need help resisting the urge; that knowledge might make the difference between you giving in to your addiction and you staying sober for another day. That's a good thing and if AA works for somebody then that's great.

So I completely agree with AC's suggestion that AA is a cult; but I disagree that this is in any way a bad thing.

Re:It's a cult, plain and simple. But not all bad. (1)

ebno-10db (1459097) | about 8 months ago | (#44535095)

I understood how AA works. It's a cult. A brain-washing, mind-controlling cult that uses the same psychological techniques as Jim Jones or Heaven's Gate to control people ... So I completely agree with AC's suggestion that AA is a cult; but I disagree that this is in any way a bad thing.

"Cult" is a very imprecise term. By your broad definition, your family is also a cult (you're the one who likened the meeting to a family reunion). For that matter, our entire society (and I suspect all societies) are cults by that definition. Families and societies are extremely strong means of controlling people.

Re:It's a cult, plain and simple. But not all bad. (1)

Anonymous Coward | about 8 months ago | (#44535055)

Doug Stanhope - AA Is A Poorly Constructed Cult and Doesn't Work
http://www.youtube.com/watch?v=4txNz25Ht9o

"Success" of AA? (2, Informative)

Anonymous Coward | about 8 months ago | (#44534827)

AA's own internal figures show that only 5% of people who start AA are not drinking one year later.
The spontaneous remission rate is also 5%.

So the ones who are stopping were going to stop anyway (and kudos to them).

But what about the 95% who don't stop? Other studies show that when groups of alcoholics were randomly assigned to court ordered AA, no treatment, or a therapy program, the AA group was FIVE TIMES as likely to engage in subsequent episodes of severe binge drinking as the no treatment group, and nine times more likely than the therapy group.

Here's a sampler:
http://www.thefix.com/content/the-real-statistics-of-aa7301
http://www.orange-papers.org/orange-effectiveness.html
http://www.youtube.com/watch?v=Z0DSEdLCAUg

Re:"Success" of AA? (1)

ebno-10db (1459097) | about 8 months ago | (#44535179)

AA's own internal figures show that only 5% of people who start AA are not drinking one year later ... So the ones who are stopping were going to stop anyway

Your logic doesn't follow - it's just a guess on your part.

Other studies show that when groups of alcoholics were randomly assigned to court ordered AA

How did the courts determine that these people were alcoholics? It's now common practice to order anyone who gets a DWI to go to AA, and I suspect that's a mistake. Doing a stupid thing like driving while drunk doesn't necessarily mean you're an alcoholic. People will also, on legal advice, start going to AA before a DWI court date. "Gosh your honor, I'm repentant, be lenient!".

Historically people went to AA because they chose to, not because they were ordered to by courts. That self-selection may be an important part of why it works for some and not others, and that's hardly surprising. That renders the entire idea of the conventional random control group nonsense. Random controls on treatments for psychological issues is a lot more difficult, and perhaps sometimes practically impossible, than for other problems. Giving group X a med for their arthritis and group Y a placebo (and don't forget to make it double blind!) is a much simpler issue to deal with.

Re: "Success" of AA? (0)

Anonymous Coward | about 8 months ago | (#44535317)

Same A/C here - you make good points, but I'm still confused as to how it could "work", and yet still only deliver remission rates in the same ballpark as no intervention?

What I find concerning too is that with a target rate of 100%, and an outcome of 5%, is that there has been no attempt to change the methodology or improve techniques IN OVER EIGHTY YEARS. Whats up with that? Doctors are always working on new treatments. Psychologists too. Heck, even plumbers and carpenters upgrade their methods from one decade to another - no disrespect to the trades, just pointing out that its a constant in all fields of human endeavor.

But you know who never upgrades their "technology"? Religions. Because they are not in the service of the outcome, they are in the service of the message, to perpetuate it whether it works or not.

And eighty years peddling the same techniques with a 5% hit rate sure seems fishy. And not lifting a finger to figure out what you are doing wrong by the other 95% seems pig-headed at best, and maliciously self serving at worst?

But like I said, I'm confused. If you have an insight that can reconcile that, I'm all ears...

Re:"Success" of AA? (1)

Dcnjoe60 (682885) | about 8 months ago | (#44535209)

AA's own internal figures show that only 5% of people who start AA are not drinking one year later.
The spontaneous remission rate is also 5%.

So the ones who are stopping were going to stop anyway (and kudos to them).

But what about the 95% who don't stop? Other studies show that when groups of alcoholics were randomly assigned to court ordered AA, no treatment, or a therapy program, the AA group was FIVE TIMES as likely to engage in subsequent episodes of severe binge drinking as the no treatment group, and nine times more likely than the therapy group.

Here's a sampler:
http://www.thefix.com/content/the-real-statistics-of-aa7301 [thefix.com]
http://www.orange-papers.org/orange-effectiveness.html [orange-papers.org]
http://www.youtube.com/watch?v=Z0DSEdLCAUg [youtube.com]

Why don't you sue the statistics from AA of those that complete the 12 step program? Many more start than finish, just like college. Success rates, independently verified for success rates for those who complete AA is 40%. That's not as high as going to a private therapist which is 55%, but then that number doesn't include all the people who start therapy and don't continue, either.

Your whole premise is based on the orange papers which even states that it is "One man's analysis." It is not a scientifically valid study. It is not accepted by those who work with substance abuse. It is what it is - one man's analysis, whether valid or not. But it sure gets a lot of traction on the internet. I know a handful of individuals who have succesfully went through AA and have been sober for as much as 20 years. does that mean I should put my analysis online and say it is 100% effectve? No, of course not. Because that isn't an analysis, but instead is ancedotal information.

The real studies that show the effectiveness of various treatments, have hundreds of particpants, if not more. They are statistically valid and peer reviewed. And those studies show very different results than the orange papers. People respond differently to different types of therapy, so it is easy to understand how a small, unscientific sample can lead to erroneous results. But valid samples show that the program when followed and completed is 80% as effective as dedicated counseling with a therapist. For those who can't afford a $200/hour therapist (and aren't an atheist), it could be a viable alternative.

Self selecting group - invalid. (0)

Anonymous Coward | about 8 months ago | (#44535511)

It sounds like those same people would have been just as successful at SOS or any other group that would support them in their goal of quitting drinking. Maybe, those same people would have quite without AA or any help because they were so motivated.

What needs to be done is take two groups of highly motivated people - one in AA and the other on their own - and see what happens.

Again, we're back to a self selection group.

The science that is really needed (1)

dirk (87083) | about 8 months ago | (#44534887)

I think before we start analyzing why 12 step programs work, maybe we should determine if they work. While everyone just assumes 12 step programs are the answers, there is very little scientific evidence and studies on whether they work better than anything else. It is a hard subject to study, but I think something that should be done since the state is sentencing people to 12 step programs. Before we force people to go into programs (especially one that force people to accept that there is a "higher power") I think there should be strong studies done to show that these programs work better than other programs or at least better than a person just deciding to stop.

Re:The science that is really needed (2)

Dcnjoe60 (682885) | about 8 months ago | (#44535163)

I think before we start analyzing why 12 step programs work, maybe we should determine if they work. While everyone just assumes 12 step programs are the answers, there is very little scientific evidence and studies on whether they work better than anything else. It is a hard subject to study, but I think something that should be done since the state is sentencing people to 12 step programs. Before we force people to go into programs (especially one that force people to accept that there is a "higher power") I think there should be strong studies done to show that these programs work better than other programs or at least better than a person just deciding to stop.

Actually, there are numerous studies on the effectiveness of 12 step programs and their success rate is around 40% versus 55% for dedicated therapy with a psychologist and less than 5% for self-treatment. I don't remember the issue, but in 2011 Scientific American had an article about it and listed several recent studies.

As for forcing people into accepting their is a higher power, nobody is forced into AA or other 12 step programs, it is totally voluntary and there are other options for therapy. As the SA article showed, they are not even the most effective programs, but they are effective. Like all forms of thereapy though, different programs/techniques work better for some than others and just becuase it works for one person does not mean it will for another. That is why courts will usually mandate therapy, but they will not mandate a specific therapy.

Re:The science that is really needed (1)

dirk (87083) | about 8 months ago | (#44535187)

Actually, often part of a person's court sentence is to attend AA. Yes, I guess they instead accept jail time, but that seems like a false comparison. And yes, it is often mandated that it be AA, not alcohol treatment in general. People have actually tried to attend other, non-AA, non-religious treatments and been told no, you must attend AA.

Re:The science that is really needed (1)

Dcnjoe60 (682885) | about 8 months ago | (#44535325)

Actually, often part of a person's court sentence is to attend AA. Yes, I guess they instead accept jail time, but that seems like a false comparison. And yes, it is often mandated that it be AA, not alcohol treatment in general. People have actually tried to attend other, non-AA, non-religious treatments and been told no, you must attend AA.

In the cities I have worked with substance abuse, the courts always give an option. However, AA is the one most often chosen because of costs. But maybe other communities mandate it. I thought the ACLU had a case they won against mandating AA, but maybe it didn't cover the entire country.

Re:The science that is really needed (1)

Swampash (1131503) | about 8 months ago | (#44535399)

Actually, often part of a person's court sentence is to attend AA. Yes, I guess they instead accept jail time, but that seems like a false comparison. And yes, it is often mandated that it be AA, not alcohol treatment in general. People have actually tried to attend other, non-AA, non-religious treatments and been told no, you must attend AA.

And that's illegal.

In April 1999 the U.S. Court of Appeals for the Second Circuit ruled that a court cannot require someone to attend Alcoholics Anonymous because doing so would violate that person's constitutional right to freedom of religion.

How it works (4, Insightful)

DaveV1.0 (203135) | about 8 months ago | (#44534957)

It trades one addiction for others: religion, caffeine, and nicotine. It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.

Re:How it works (4, Interesting)

rwyoder (759998) | about 8 months ago | (#44535123)

It trades one addiction for others: religion, caffeine, and nicotine.
It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.

There is an athiest/agnostic sub-group of AA, but judging by things found on their FB page, they are having an uphill battle with the powers-that-be in AA.

https://www.facebook.com/pages/Agnostics-and-Atheists-in-AA/168374259840358 [facebook.com]

http://www.aa-atheists.com/ [aa-atheists.com]

Re:How it works (1)

Dcnjoe60 (682885) | about 8 months ago | (#44535141)

It trades one addiction for others: religion, caffeine, and nicotine.
It trades personal responsibility for not drinking, and thus drinking, to an imaginary higher power.

Maybe, but I would rather a person who believes in a higher power get behind the wheel of a car than an alcoholic. Just saying.

Do 12-step programs even work? (4, Informative)

Jah-Wren Ryel (80510) | about 8 months ago | (#44534979)

There is a lot of evidence to suggest that 12-step programs are nothing more than window-dressing. That they take credit for spontaneous remission - the percentage of people who just quit on their own.

For example, alcoholics have a spontaneous remission rate of roughly 5% - so if an AA program has a 5% success rate (including the people who give up on the program - the AA people don't like to count them) then AA is just a no-op.

Here's one of many analyses making the argument that 12-steppers are just bad at math.

http://www.orange-papers.org/orange-effectiveness.html [orange-papers.org]

Re:Do 12-step programs even work? (3, Informative)

Dcnjoe60 (682885) | about 8 months ago | (#44535137)

There is a lot of evidence to suggest that 12-step programs are nothing more than window-dressing. That they take credit for spontaneous remission - the percentage of people who just quit on their own.

For example, alcoholics have a spontaneous remission rate of roughly 5% - so if an AA program has a 5% success rate (including the people who give up on the program - the AA people don't like to count them) then AA is just a no-op.

Here's one of many analyses making the argument that 12-steppers are just bad at math.

http://www.orange-papers.org/orange-effectiveness.html [orange-papers.org]

An article in Scientific American in 2011 (sorry I don't have the direct reference) showed AA had a 40% success rate. Dedicated therapy something like 55% and people going cold turkey or self-treating less than 5%.

I'm not sure why there is a discrepency between the link you quoted and the article in Scientific American. If I recall, the SA article quoted numeous statistically valid independant studies that corroborated their reported findings. Maybe the paper you referenced wasn't a statistically valid sample? I don't know, but given the plethora of studies that show otherwise, while not as successful as dedicated therapy, 12 step programs are universally recognized and accepted as being successful.

Re:Do 12-step programs even work? (2)

Jah-Wren Ryel (80510) | about 8 months ago | (#44535217)

Do you mean this one? [scientificamerican.com] Where they didn't count the people who dropped out early on?

Re:Do 12-step programs even work? (3, Informative)

Dcnjoe60 (682885) | about 8 months ago | (#44535401)

Do you mean this one? [scientificamerican.com] Where they didn't count the people who dropped out early on?

Yes, because in evaluating the efficacy of substance abuse programs the national standard when looking at recidivism is to look at those who have completed the program. Drop out rates are reported, but they don't impact the recidivism rate. That can only be measure once somebody completes the program. That is the same methodology used for private counselling related to substance abuse, too. So, when they say 40% for AA and 56% for private counselling, they are comparing apples with apples and only talking about those who completed therapy. The dropout rate for both is very high, which is why when court ordered, there is regular reporting back to the courts on attendance.

This isn't unique to substance abuse, most medical treatments follow this practice. If somebody starts chemo for cancer and drops out, it does not count against the effectiveness of that type of chemo for that type of cancer. It does get reported so that doctors are aware of what the dropout rate is so they can help the patient through it.

Put differently, when evaluating the effectiveness of any treatment, you need to look at patients who actually completed the treatment. It is important to know how many did not complete the treatment and why they didn't, but that doesn't change the effectiveness for those who do complete the treatment.

Re: Do 12-step programs even work? (0)

Anonymous Coward | about 8 months ago | (#44535351)

Different time frames. The 5% is after 1 year, the 40% is after several decades - the accumulation of 1 year outcomes, less relapses

Re:Do 12-step programs even work? (1)

Anonymous Coward | about 8 months ago | (#44535147)

For example, alcoholics have a spontaneous remission rate of roughly 5%

One of the episodes of Penn & Teller's "Bullshit!" was on 12-step programs. One thing they mentioned in the show was AA's internal studies on the program's success rate. I don't recall the exact number they came up with, but 5% doesn't sound far off.

This story reminds me of the time I was watching Mythbusters and they announced they were testing hypnosis, and my subsequent surprise that what they were testing wasn't whether or not hypnosis is real, but that they were assuming that it was and testing things about it. It's kind of the same thing here. They're skipping the question of whether 12 step programs work at all, and proceeding straight to figuring out what makes them so effective.

Clarification needed (1)

Dcnjoe60 (682885) | about 8 months ago | (#44535109)

"Since the inception of Alcoholics Anonymous — the progenitor of 12-step programs — science has sometimes been at odds with the notion that laypeople can cure themselves because the numerous spiritual references that go with the 12-step program puts A.A. on "the fringe" in the minds of many scientists.

12 step programs do not claim to cure anything. If an alcoholic enters AA, even if they refrain from alcohol for years, they are still an alcholic. Nothing is cured, they have only developed ways to deal with the alcoholism. Same is true for other addicitons treated through 12 step programs.

Maybe if scientists viewed 12 step programs as behavior modification programs, they wouldn't be so perplexed.

Since when is a 5 percent success rate "working"? (3, Informative)

HangingChad (677530) | about 8 months ago | (#44535155)

AAs success rate varies between 5 and 8 percent, about the same success rate you'd expect from no treatment.

If you can't beat the control group then it's junk science at best to try and derive meaningful conclusions from the few success stories and lends undeserved credibility to a program that is a massive statistical failure by almost any measure that means anything.

Incomplete Research is Incomplete. (5, Interesting)

VortexCortex (1117377) | about 8 months ago | (#44535293)

There was an AA meeting group in the civic center I volunteered at. A loved one and friend of mine also attended AA meetings.

Though I am an atheist without a drinking problem I helped set up and clean up, and became tangentially involved with 12 step programs over the years.

One major compulsion to attend AA and other 12 step addiction programs, especially for teen and young adult members, is the unwritten "13th Step": Sex and/or relapse into addiction with other members. Some have related to me that they were introduced to hard drugs or "milder" drugs like cigarettes and caffeine via AA... When I asked if trading one vice for another wasn't just as bad (smoking packs of cigarettes a day is very bad and severely addictive), "One addiction at a time," they would say. One need only look at the coffee expenses nearly all AA meetings have to realize the effectiveness at combating addictions are quite subjective... A cyberneticist might even say: They have changed from sating their tendency via physiological addiction into sociological addictions, either can be severely harmful; Please enjoy addictions responsibly; Everything flows, moderation is the key.

I can believe that addictive personalties may favor a certain substance or habitual activity above others (drug of choice), but I can also acknowledge that there is no such binary as "AA works" -- It's more like: AA has some success and a lot of failures: Success more likely only if you've "Hit Rock Bottom" first however, which I find quite ridiculous. Either it does or doesn't work, the belief in AA that a cathartic event that nearly destroys a person be practically a prerequisite for recovery is dangerous, reckless, and foolish -- Not based in empirical study, for certain; Only anecdote.

There was a teen 12 step program my friend was in, "Lifeway", and "PDAP", before that. These were largely modeled after AA's 12 steps, but Lifeway mushed the "you believe in a higher power" in with some other step so that it could squeeze in a step about abandoning your friends since they will cause you to fall back into addiction again... Even abandoning me because I wasn't "a winner" in life enough to help my friend "work a program". This is a common cult tactic.

The safety net gone, when my friend could not "work a program" due to being as atheist and thus incompatible with the "higher power" step, my friend's parents (upon advice from the parent meetings they attended) kicked my friend out of the house. They said the other families wouldn't let them stay with them, even though such was the apparent practice, and instead they were shown, "Tough Love". My friend became a 16 year old homeless person and flunked out of high school. My friend said they still attended the meetings, because they were too ashamed and afraid to contact an old friend like me -- they said that if the group, family, or "sponsor" found out about the contact it could mean prolonging the homelessness. Though they had been without drugs while failing to "work a program" for over a year, they started using drugs again once on the street... Of course! That was my friend's first encounter with harder drugs... This before the 3rd step of the program could even be attempted, they said.

AA and other 12 step programs do not provide the housing aspect a teenage kid requires to survive, so they were of no help, "Keep coming back, it works if you work it," is the literally ignorant motto. After months of homelessness and abject prostration before the parents of Lifeway my friend was allowed to stay with another family, but not their own family; It was more "Tough Love" they said. I saw my friend with the new family around town and was quite puzzled because they'd never hung out before, and I was given the cold shoulder when I tried to say Hi.

Later, my friend had said they had to earn back the right to live in their home, and couldn't take any chances... Meanwhile they were instructed to attend "outpatient" meetings, which my friend described as expensive pay-for AA meetings. My friend faked their way through the steps, lying when it came time to confess transgressions, all while staying sober On Their Own. Hey, a statistical anomaly, or WAY more common than you think? The study doesn't say... My friend firmly believed that coping with addiction did not require attend meetings and bearing every secret to strangers, or all the other ideological crap, just to stay sober, indeed it made his addiction far worse and more dangerous... Thus circling us back to the 13th step.

My friend said dating was prohibited (AA shares this rule, not forming new relationships until you're sober is how they put it), but there was an exception in Lifeway. Once my friend had made it far enough into the program they were allowed to date other members if they attended pay-for guy or girl only dating meetings where even the most personal of dating events became known to the group, and dating selection process was moderated by the group. If you ask me, requiring pay for access to dating and sex is borderline prostitution. Point being, the 13th step was applied heavily. The carrot of "Arranged Dating" was dangled effectively for many of the other members my friend said.

Additionally, my friend related a bit of a scandal when many of the "steering group" members -- Those long time respected active mentor-members of the program who became "sponsors" to other members and continued to go in for another tour of 12 steps; You never escape, see, you can't actually be cured according my friend, and literature their literature I've since read -- That's right: Humans don't change. "Once an addict, always an addict," by definition then, AA and its offspring can not work, eh? Self fulfilling prophesy? These programs can then only delay the inevitable "relapse" and restart of the program, not cure anyone... Hey, just look at the iterative self destructions that play out publicly despite repeated tours of 12 step programs. So, the scandal was that my friend got caught buying drugs from "Sponsor"! They called it, "Living the Dream". No big deal, that's bound to happen sometimes... Ah, well when my friend's "sponsor" was found out they didn't go down alone. It turned out that nearly all the "winners" and pillars of the community were secretly using drugs while simultaneously being the folks everyone looked up to.... and all the researcher statistics would have certainly marked these folks in the, "Look! It's Working", category. Yes?

After my friend was allowed to get a job they dumped the "12 step program" nonsense, and reunited with me, but only one other friend besides -- The social life destroyed by the group's cultist behavior. My friend fervently argues against 12 step programs and I have listened to every detail, time and again over the years since, and was made to swear NEVER to put my child in a 12 step program if given the choice. I don't have anything against AA, it worked OK for my other loved one... However, I think this more a testament to the family involvement and Scientology-like (e-meter-less) "auditing" to essentially control the individuals -- There is some rather sick crap in these 12 step ideologies. I can draw far too many similarities between the 12 step programs and the invasive emotional and mental abuse that many cults perform, including self-defeating affirmations that they are not strong enough to quit drugs and alcohol on their own...

Further statements like these are utterly wrong and ridiculous... They should be red flags to any with a rational mind:

"We, as social mammals, cannot regulate our central nervous systems by ourselves," Flores says. "We need other people to do that.""

This statement really is bullshit. I do regulate my central nervous systems by myself. Social interaction is not an all-encompassing regulation system, nor must other people be required to regulate nervous systems or reproductive cycles. Any human should agree... I have the most control over my nervous system than anyone I have met or read about.

Much like I learned how to wiggle my ears by controlling those muscles, my sleep paralysis [wikipedia.org] has allowed me a window of consciousness into the subconscious world of dreams. While falling to sleep, or waking I can stay in a mixed state of wake and dreaming and note the strange small hallucinations of everything a mind experiences: Seemingly random phrases in various voices, auditory hallucinations and even the pulsing "rushing" sound of sleep waves as my auditory pathways change from external to purely internal -- I have tinnitus which disappears during "sleep" while I'm still conscious -- small flashes of random visual hallucinations (a tree missing half its bark, a gecko leaping from a fern), a reoccurring yet fleeting medium sized black point that is also conceptually infinitely large and infinitesimally small that I somehow identify with, sensations of floating or falling or moving, odd disjointed concepts such as "recursive literary devices exist orthogonal to speech" spring to mind but not in words, rarely even flavors and scents, but as I go deeper into sleep I have more compulsions, angers, fears, even extreme embarrassment that flushes my ears and face, or sexual urges. It takes a lot of practice to notice them as hallucinations, especially since they started out very mild. I can distinguish them from ideas I can control, and the visual hallucinations are oddly placed in-front of things they should be behind if my subconscious understood Z-buffer depth culling...

And all of that I have slowly learned to control to various degrees. With much practice my conscious mind has began assuming direct control of my subconscious. I can reduce or increase the "strength" of hallucinations with a thought and control the moment I switch into sleep, and even learn to switch back out of it at will. I have even learned to control the paralysis itself to increase or weaken my immobility and free myself from the motionless state at will. This means I can indeed "regulate" parts of my "central nervous system" all by my lonesome. With this indirect learned control of the "depth" of my waking / sleep I don't just study what dreams are made of, but I also regulate my sleep systems to overcome jetlag far more quickly than by synchronizing to time zone's sleep cycle. Further, I can work out and solve programming problems as I lay there adjusting my sleep while I dream and remain conscious, so as not to waste time in so doing.

Now, To make such foolish statements such as a mind can not regulate itself would belie a fundamental lack of understanding in cybernetic systems (humans are cybernetic in nature). There is no hard separation between the body and brain. If you can stand without falling, you have a self regulating nervous system. If you can make yourself wake up earlier than you would like to sleep in on your day off, then you can indeed regulate your nervous system. Don't hold your breath waiting for me to agree a mind can gain no control over involuntary actions...... Studies have shown that even heart rate can be controlled by thought if you amplify the feedback via audible, visual or even touch. I would put forth say any amplified feedback such as heat or taste would even work to let a trained mind be conscious of and control such things.

Humans are really quite clueless when it comes to their own minds. When it comes to addictions and other such maladies they are brain butchers stabbing in the dark, and making wild assumptions. If it is purely social interaction that works, then the 12 step program is not required, thus the 12 step program DOES NOTHING IT'S A PLACEBO. The researchers do not deeply probe the issue enough or with enough knowledge to make any meaningful conclusions given the nature of the 12 step program itself. Humans have only barely begun to explore the mind from within it, and so they make uninformed statements about the societies and do studies with flawed premises while remaining in ignorance of simple universal cybernetic facts such as: Cybernetic systems that can control their inputs, can control their outputs, and thus the action in between.

It would be far better to say, "The Regular Accountability that 12 step programs provides its members via Sponsors, and bonding via shared secrets can be beneficial, but we have not studied the addictiveness of long term effects of the 12 step programs itself, thus we can make a broad generalization that as a general rule of thumb, are almost always wrong." That would be far better than spouting some unfounded social theory bullshit about how humans need social interaction to regulate physiological process (other than breeding), and that even though there is no laboratory evidence that supports the claim, human brains can't self regulate... That would be just dumb. I mean, really, if the human brain can not regulate itself, THEN WHAT DOES? It makes no sense. I could have summed up the whole article:

Peer Pressure Exists, and it can have good or bad effects, depending on which outcomes we subjectively label "good", and which behaviors researcher's confirmation bias selects as "better."

Actual Measurement of Effectiveness (1)

strack (1051390) | about 8 months ago | (#44535377)

this article cites a few studies on dopamine receptors and fucking brain waves, and tries to link those with 12 step programs, does a bad job of it, and does not cite any study of the actual success rate of AA vs quitting cold turkey. Probably because those studies show that AA has at best, no effect on relapse rates for addiction. and AA isnt grassroots. its sneaky religious indoctrination that judges can order alcoholics to attend in lieu of time in jail. and thats probably unconstitutional.

Psychology? Really? (-1)

Anonymous Coward | about 8 months ago | (#44535503)

Oh, psychology is science now?

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