The Effectiveness of the Twelve

Report
THE EFFECTIVENESS OF THE TWELVESTEP 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.
JUST HOW EFFECTIVE IS
AA?
THE AA “PROMISES”
• 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.
REALITY
• 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.
ON THEIR OWN
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).)
WITH HELP
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."
AA Spontaneous Remission Rate
Year
AA vs Treatment Remission Rates
Alcoholics recovered Alcoholics remaining
Group
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
0
500
475
451
429
407
387
368
349
332
315
299
284
270
257
244
231
220
209
199
189
179
10000
9500
9025
8574
8145
7738
7351
6983
6634
6302
5987
5688
5404
5133
4877
4633
4401
4181
3972
3774
3585
3405
N at intake
N at outcome
38
42
12
25
AA
Lay-RBT
•
•
Mean number Mean number
of sessions of days treated
20.9
27.6
203
243
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.
Treatment Group
NO Re-arrests
Re-arrested Once
No treatment
Professional clinic
Alcoholics Anonymous
32 (44%)
26 (32%)
27 (31%)
14 (19%)
23 (28%)
19 (22%)
Re-arrested 2
or more times
27 (37%)
33 (40%)
40 (47%)
Total
73
82
86
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…
Study
Clinic sample [A.A.]
Three pooled "no
treatment" studies
Four treatment
studies
n in original
sample
106
n followed up
100
Duration of follow-up Abstinent or
Improved Abusing alcohol
(years)
social drinking
2
20%
13%
67%
245
214
2 to 3
17
15
68
963
685
2
21
16
63

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