Talk:Effectiveness of Alcoholics Anonymous/Archive 2

Moderate drinking
While Alcoholics Anonymous does not endorse moderate drinking for its own members (it has no opinion on whether anyone else can or can not moderately drink), since editors have brought up the subject here, I would like to point out that we have a section in the alcoholism article on moderate drinking. Defendingaa (talk) 23:33, 23 July 2019 (UTC)

A more reader friendly article?
I can't recall the last time I've seen an article set up like this. Not so friendly to the lay reader imho.

Also, I think more should be said of alternatives to AA, such as naltrexone treatment. Treatment "effectiveness" is often relative to alternatives when referring to treating diseases.

The article below (popular press) highlights some of this

www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

 Dig deeper talk 00:29, 12 June 2019 (UTC)


 * We already include a reference to the Glaser article in this article (I have expanded it, as per your edits). The problem with including just the Glaser article in the lead is that it puts undue weight on one side of the AA controversy.  For us to be more balanced, if this article was to violate the guidelines which say popular press articles are not as reliable as peer-reviewed science, we will have to include that article from NY Mag which shows the other side of the complicated controversy w.r.t. Alcoholics Anonymous effectiveness (and, indeed, is a response to Glaser’s article), as well as more recent stuff, such as this excellent article from Vox (summary: AA works great for about 1/3 of alcoholics.  I personally think the number is about 1 in 5 of alcoholics, since three out of four alcoholics can not/will not make a habit of going to AA meetings, and AA just does not work for about 1 in 20 alcoholics, no matter how hard they work the program).


 * The topic of this article is the efficacy of Alcoholics Anonymous. It is not an article about the Sinclair Method (yes, I know, you said Naltrexone, not “Sinclair Method”, but considering the number of people I have seen online, including here, who argue a. Alcoholics Anonymous does not work, using some questionable reasoning and b. Naltrexone -- usually called “Sinclair Method” -- works, by cherry picking studies, I have become a bit jaded whenever someone brings up one of the most critical articles about AA efficacy and then brings up medication assisted treatment, since I have seen that very particular bias before many times), a topic which, last time it was put to a vote, was not considered notable enough to have its own Wikipedia article.


 * Perhaps this article should be rewritten to not dig so deeply in to the actual peer-reviewed science on the matter, but we will have to come up with consensus to do that. Again, Wikipedia guidelines are that peer reviewed science is more reliable than the popular press. 06:06, 12 June 2019 (UTC)


 * Update: In response to this editor’s concerns, I have added some references to popular press articles in the lead, both ones that are for and against AA efficacy. The wording is this: “Likewise, some articles in the popular press state that Alcoholics Anonymous helps some alcoholics get sober, but others claim AA is not effective.”. Defendingaa (talk) 00:15, 13 June 2019 (UTC)


 * A significant overhaul of the article may be worth considering. Digging deeper is fine for editors, not so ideal for lay readers ;)
 * Below are some Cochrane reviews. Systematic Reviews and meta-analyses usually have more credibility than single studies. Listing off individual studies is uncommon on wikipedia, may difficult for the lay reader to understand, and could be perceived as original research. Good examples of comparable wikipedia articles (or sections) might be Chiropractic_controversy_and_criticism, Acupuncture, Vision therapy.
 * | Naltrexone and nalmefene for alcohol dependent patients
 * | Acamprosate for alcohol dependent patients
 * | Which talking therapies work for people who use drugs and also have alcohol problems?

 Dig deeper talk 21:33, 15 June 2019 (UTC)


 * A 2013 version of that 2018 Cochrane article is available to read. Going over it, it only uses one study, from 1998, to look at AA efficacy, and it ignores studies which look only at alcohol abuse. It ignores the recent studies showing AA Efficacy, since they are recent and look only at how AA reduces alcohol drinking.  Point being, there hasn’t been a Cochrane review which looks at how well AA reduces drinking since 2006, but there have been multiple experimental studies showing that AA (or TSF which gets people in the AA rooms) reducing alcohol abuse published since then.  Defendingaa (talk) 17:26, 16 June 2019 (UTC)


 * Also, I think the comparison to Acupuncture and Chiropracty is not a reasonable one: Unlike those treatments, there is hard scientific evidence that AA meeting attendance does help some alcoholics stay sober. Defendingaa (talk) 12:34, 17 June 2019 (UTC)


 * The question then comes: Which studies should we include? The Wikipedia rule is that we should include studies discussed in third party reliable sources.  So, that in mind, should we include only meta-analysis?  Should we only include Cochrane studies?  Or should we include other studies mentioned in mainstream press articles?  In terms of widely discussed, I think Humphreys 2014, Kaskukas 2009, and the 2006 Cochrane study should be included (all three are meta-analysis, and this balances both sides of the debate among treatment experts on the matter).  Multiple treatment experts have said that the 2006 Cochrane analysis is out of date, so it would make the article non-neutral to include only the 13-year-old Cochrane analysis while ignoring all of the research done in the last 13 years.  Defendingaa (talk) 00:22, 16 June 2019 (UTC)


 * I have removed a number of studies. The ones I have retained are referenced in other sections of the article; the reason to include Litt et al. 2009 and Walitzer 2009 is because these were linked to in https://www.wbur.org/commonhealth/2014/04/07/defense-12-step-addiction which is a pro-AA article from the popular press.  The reason for Humphreys 2014 is because 1) It’s a meta-analysis 2) The New York Times did an article about it.  Moos and Moos 2006 is widely cited; people pro-AA say it shows AA meeting makers make it; anti-AA polemics almost always cite it, arguing that the high level of success it shows for AA meeting attenders comes entirely from self-selection; point being, for or against AA, Moos and Moos 2006 is frequently discussed.  Walsh 1991 is frequently brought up; anti-AA polemics say it shows AA doesn’t work; pro-AA people say that it shows more AA works better than less AA (Cochrane 2006 uses it too).  Brandsma 1980 is frequently used in anti-AA polemics to argue that this early study shows that AA increases binge drinking.  Since that particular book now has its own Wikipedia article, it makes sense to link to that here.  Project Match was a big expensive 1990s study, was used as part of Cochrane 2006, is frequently cited, and it has its own Wikipedia article.  Fiorentine 1999 is cited (incorrectly, as it turns out) by Lance Dodes in his anti-AA polemic The Sober Truth Defendingaa (talk) 00:40, 16 June 2019 (UTC)

I have removed the sub-sections on Litt et al. 2009 and Walitzer 2009. However, I will still reference these studies. When the 2006 Cochrane report concludes that "The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments", it violates neutrality to completely ignore studies published after 2006 which, in fact, are experimental studies that demonstrate the effectiveness of AA (actually the effectiveness of TSF methods which get people in more AA meetings) compared with other treatments. Defendingaa (talk) 14:26, 16 June 2019 (UTC)
 * I should also point out that Humphreys 2014 states that “a series of scientific teams conducted randomized clinical trials in which professionally-provided AA-involvement facilitation interventions were shown to improve patient outcomes (e.g., Walitzer et al., 2009)” Defendingaa (talk) 15:35, 16 June 2019 (UTC)


 * OK. I still feel categories / subcategories should be based on criteria, not the publications. The article needs to be reorganized. Not necessarily delete content, just reorganize it so the lay reader can more easily make sense of the research.  Dig deeper talk 22:44, 9 August 2019 (UTC)


 * My main concern about doing those edits myself is that I’m concerned my edits will be considered biased. My take, after reading a bunch of literature on the subject, is that most informed treatment experts feel AA works really well for some (about 1/3 to 1/5) but not all alcoholics.  There, however, is a small number of experts (Stanton Peele and Lance Dodes) who feel AA is not effective and might even be harmful.  In this day and age of outrage culture, it’s the controversial minority opinion which gets all of the attention, even though it does not reflect current consensus among treatment experts (as seen in the 2016 Surgeon General report as well as the current opinion expressed over at the NIAAA web site).  The disorganized structure of this page is how it was long before I started editing it, since there was some pretty intense edit warring going on making this page. Defendingaa (talk) 11:36, 12 August 2019 (UTC)

Wording in the lede
First of all, I do appreciate Nat Gertler coming by and making some revisions to the article.

I think we can add a sentence saying that AA appears helpful to the lede of the article, so I have added this sentence:


 * The research suggests that AA can help alcoholics make positive changes.

This is based on what the NIAAA says over at https://alcoholtreatment.niaaa.nih.gov/FAQs-searching-alcohol-treatment#topic-how-can-mutual-help-groups-help where they state “Many individuals find that participation in mutual help groups helps to reinforce and extend the benefits of professional alcohol treatment services. These groups—including Alcoholics Anonymous (AA) [...] the evidence suggests that the free and flexible support provided by mutual help groups can help people make and sustain beneficial changes and thus promote recovery.” I think “The research suggests that AA can help alcoholics make positive changes.” is a reasonable summary of what that page is saying, with the actual references in the section below the lede.

Another reference which supports this assertion is from the Surgeon General’s 2016 report on addiction, where they state that “Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions.”

These are both reliable sources saying something on Alcoholics Anonymous this decade when summarizing various alcoholism treatment approaches.

The only other big meta-summary of alcoholism and drug treatment I can think of from this decade is the recent AAAS paper on the matter, where they state “empirical studies have provided support for both mutual support [A.A. and other support groups, such as SMART (Self-Management and Recovery Training)] and medical models of treatment for alcohol use disorder [...] Mutual support group (e.g., A.A. and SMART) attendance and engagement have been shown to be associated with recovery from alcohol use disorder, even in the absence of formal treatment. However, selection biases (e.g., people selecting to attend these groups) raise difficulties in assessing whether other factors that are associated with treatment effectiveness may be the active ingredients for improving outcomes among those who attend mutual support groups. For example, individuals who are highly motivated to change might be more likely to attend mutual support groups. Likewise, mutual support groups often provide individuals with increased social network support for abstinence. Motivation to change and having a social network that supports abstinence (or reductions in drinking) are both factors that are associated with greater treatment effectiveness.” While not quite as positive as the two other meta-articles about addiction from this decade when discussing AA (and they have completely ignored Humphreys 2014 which demonstrates AA’s efficacy is not entirely self-selection), they tend to lean towards saying that AA is helping alcoholics.

The 2006 Cochrane report on Alcoholics Anonymous efficacy is outdated as per reliable sources on the subject; it’s mentioned here but shouldn’t be part of the lede, unless we make the lede a lot longer.

Thoughts? Defendingaa (talk) 18:58, 8 November 2019 (UTC)


 * The concerns I have with "The research suggests that AA can help alcoholics make positive changes." are:
 * It is horribly vague. "Can help"? "Positive changes"?? That says very close to nothing. A monkey trained to slap the beer can out of one's hand can help to make a positive change. Heck, a monkey trained to pick up one's empties and put them in the recycling helps make a positive change; you're not drinking any less, but you're recycling more, and that's a good thing.
 * It's synthesizing a statement made about the general category into a statement about a specific example. If an article says "The L.A. Lakers score a lot of points" and "Nat Gertler is an L.A. Laker", we cannot use that to say "Nat Gertler scores a lot of points." (Really, I'm the guy on the bench saying "Put me in, coach! Sure, I'm a chubby mid-sized dude in my fifties with no skills, but think of the element of surprise!")
 * I will forego expressing concern that seeing reduction in drinking as a "positive change" is POV (although Dr. Jack Daniels may disagree.) --Nat Gertler (talk) 15:09, 9 November 2019 (UTC)
 * I do not think going from NIAAA’s statement on the matter, which, again is “the free and flexible support provided by mutual help groups can help people make and sustain beneficial changes and thus promote recovery” to “The research suggests that AA can help alcoholics make positive changes.” is advocating any POV nor original research; it simply restates what recent reliable sources have to say on the matter. The original wording is quite wordy, but it explicitly states AA as being helpful, as can be clearly seen when looking at the full context of the quote:


 * Most research on mutual help groups has been on AA and similar 12-step groups. Both the anonymous and voluntary nature of participation in these groups makes it difficult to conduct randomized controlled trials (the gold standard of scientific research) to directly study their effectiveness.


 * However, numerous studies have looked at the outcomes of participants over time, often comparing them to people who did or did not also receive some form of professional treatment. While this body of literature is complex and still growing, the evidence suggests that the free and flexible support provided by mutual help groups can help people make and sustain beneficial changes and thus promote recovery.


 * (Emphasis mine) To go back to the Nat Gertler and Lakers metaphor, let us suppose a reliable original source on the L.A. Lakers said “Most research on the L.A. Lakers has been done on the number of points Kobe Bryant has scored. [...] The evidence suggests that the L.A. Lakers are a high scoring team”, it would not violate WP:SYNTH to conclude that Kobe Bryant is a high scoring player, especially when we can directly point to the peer-reviewed research showing Bryant scoring a lot of points.


 * On the question of whether or not being sober a beneficial change; that’s a philosophical question, and not one I am qualified to answer in my role as a Wikipedia editor. However, I can ask if reliable sources describe “AA and similar 12-step groups” bringing about a “beneficial change”? They do, as shown in the quote above.


 * That said, I feel it actually would be more neutral to have the lede go back to directly quoting what the Surgeon General has to say on the topic: “Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions”.


 * Defendingaa (talk) 19:10, 9 November 2019 (UTC)


 * In response to Nat Gertler’s concerns, I have updated the lede to just directly quote the Surgeon General again, so that there is no possibility that a quote summarizing the consensus on AA efficacy can be accused of violating WP:OR or WP:SYNTH. In addition, when we hammered out consensus about what to say about AA efficacy in the main Alcoholics Anonymous article, we all agreed that including the Surgeon General’s quote in a short two-paragraph summary of AA effectiveness was neutral and unbiased.  Defendingaa (talk) 19:34, 9 November 2019 (UTC)
 * It doesn't look like you all agreed. It looks like a conversation between three people: you, one who agreed with you, and one who did not. --Nat Gertler (talk) 00:37, 10 November 2019 (UTC)
 * I can not speak for @Scarpy but we addressed their objection: The initial version of the Surgeon General’s report we linked to did not have any footnotes. I found a version of the report with footnotes pointing to the peer reviewed science supporting their assertion, resolving the objection. Defendingaa (talk) 04:56, 10 November 2019 (UTC)

First proposal
Thinking about this all weekend long, I have updated the wording of the lede to make two things clear:


 * AA is not for every alcoholic
 * AA is no more (and no less) effective than other peer support groups.

Here is the sentence I have added, the notes in brackets [like this] are the references for these assertions which are visible when looking at the page source.


 * The program appears to be helpful for a subset of alcoholics; [As per https://www.vox.com/policy-and-politics/2018/1/2/16181734/12-steps-aa-na-studies which is a good lay summary of the peer reviewed science as of 2018] Alcoholics Anonymous appears to be about as effective as other abstinent-based support groups. [Ref: PMC5884451 and the NIAAA page at https://alcoholtreatment.niaaa.nih.gov/FAQs-searching-alcohol-treatment#topic-how-can-mutual-help-groups-help where it's clear AA is about as effective as any other peer support group when treating alcoholism

The point being, my best understanding after reading a lot of research on the topic is that AA works really great, but only for some alcoholics, and it’s no better (but no worse) than other peer support groups. The popular “folk” understandings, both for and against AA (i.e. either AA is the only way to get sober, as stated in countless dogmatic AA meetings, or AA has only a 5% success rate, as per Peele/Dodes/Glaser/etc.) are inaccurate. Defendingaa (talk) 11:04, 11 November 2019 (UTC)


 * It appears there is not consensus about what to put in the lead yet, even though there has not been any discussion for over two months (My archiving of this discussion was contested). Do you have anything to add to how we should word the lead?  Do you feel putting the 2016 Surgeon Quote about AA/12-step efficacy is a reasonably summary of the current opinion of treatment experts?  Thank you for your time.  Defendingaa (talk) 17:50, 13 January 2020 (UTC)


 * We still don't have a consensus definition of what we mean by "effectiveness" in the context of the "effectiveness of AA." If we're going to say sobriety, NIAAA seems to be speaking more generally ("make and sustain beneficial changes and thus promote recovery" -- this doesn't really say sobriety). Where as AAAS says "attendance and engagement have been shown to be associated with recovery from alcohol use disorder" and the Surgeon General is some what vague, but seems to be referring to abstaining from alcohol... I think maybe this is an opportunity to be more explicit. So if effectiveness means sobriety here, we should really only quote what the sources are saying about abstinence and sobriety. If we're going to talk about others things (e.g. community and helper theory and those kinds of things in terms of effectiveness), we should also discuss those explicitly.... that being said, I like the lede now. I made a few small changes. It occurs to me, there's not a good term for the subset of addictive drugs AA and NA discourage (e.g. nicotine and caffeine are addictive but not the kind of thing you'd set a sobriety date back for). The term narcotic is ambiguous. Could say something like drugs of abuse which lists "alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, hallucinogens, methaqualone, and opioids" in the lede, and seems about right. - Scarpy (talk) 19:39, 13 January 2020 (UTC)

I have changed my username
This is just a heads up that I have changed my username from "Defendingaa" to "SkylabField"; the reason I did this change is because the old username resulted in some other editors accusing me of editing in bad faith. SkylabField (talk) 11:44, 16 January 2020 (UTC)