The Effectiveness of the Twelve-Step Treatment

1. The Effectiveness of the Twelve-Step Treatment • 'After all, facts are facts, and although we may quote one to another with a chuckle the words of the Wise Statesman, "Lies — damn lies — and statistics," still there are some easy figures the simplest must understand, and the astutest cannot wriggle out of.' • Leonard Henry Courtney, the British economist and politician (1832-1918), later Lord Courtney, speaking at New York, August 1895.

2. Just how effective is AA? The AA “Promises” Reality • RARELY HAVE we seen a person fail who has thoroughly followed our path. Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.A.A. Big Book, 3rd & 4th Editions, William G. Wilson, page 58. • Every disease has a spontaneous remission rate. The rate for the common cold is basically 100 percent — almost nobody ever dies just from a cold. People routinely just "get over it", naturally. Likewise, ordinary influenza — "the flu" — has a very high spontaneous remission rate, greater than 99%. Yes, some old people do die from the flu every year, but not very many. Most people just get over it.

3. On Their Own With Help There is a high rate of recovery among alcoholics and addicts, treated and untreated. According to one estimate, heroin addicts break the habit in an average of 11 years. Another estimate is that at least 50% of alcoholics eventually free themselves although only 10% are ever treated. One recent study found that 80% of all alcoholics who recover for a year or more do so on their own, some after being unsuccessfully treated. When a group of these self-treated alcoholics was interviewed, 57% said they simply decided that alcohol was bad for them. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit. Others used such phrases as "Things were building up" or "I was sick and tired of it." Support from a husband or wife was important in sustaining the resolution.Treatment of Drug Abuse and Addiction — Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3. (See Aug. (Part I), Sept. (Part II), Oct. 1995 (Part III).) The National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, performed the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. For it, they interviewed over 43,000 people. Using the criteria for alcohol dependence found in the DSM-IV, they found: "About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment."

4. AA Spontaneous Remission Rate AA vs Treatment Remission Rates • All of the lay-RBT clients reported drinking less during the last 3 months. This was significantly better than the AA or the control groups at the 0.005 level. The lay-RBT group also reported on two variables (one a direct question, the other a summated series of questions) that it was less important to drink now to be sociable. In this regard the lay-RBT group was significantly different from the control group, whereas the AA group was not differentiated from either of the other two groups. • Three months after terminating treatment the only variables that revealed differences concerned drinking behavior.   ...   In this analysis AA was five times more likely to binge than the control and nine times more likely than the lay-RBT. The AA group average was 2.4 binges in the last 3 months since outcome.Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105.

5. Better Than Nothing… But Not Much. When I joined the staff at Cambridge Hospital, I learned about the disease of alcoholism for the first time. My prior training had been at a famous teaching hospital that from past despair had posted an unwritten sign over the door that read "alcoholic patients need not apply."   ...   At Cambridge Hospital I learned for the first time how to diagnose alcoholism as an illness and to think of abstinence in terms of "one day at a time."   ...   To me, alcoholism became a fascinating disease. It seemed perfectly clear that by meeting the immediate individual needs of the alcoholic, by using multimodality therapy, by disregarding "motivation," by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. Our clinic followed up our first 100 detoxification patients…