Special Pleading for Alchoholics Anonymous

[Dymanic]

So maybe all the religious dogma is a placebo and the real help is the fact that it puts alcoholics in an environment that both supports them and discourages them from relapsing, but their program does indeed 'work.'

That's pretty much my take on things. I've come to see alcoholism as an attitude, at least in part -- a certain way of looking at the world and one's place in it. I can't say whether this is symptom or cause, and at some point, it may not even matter, but one thing I have noticed is that when some people quit drinking, instead of an improvement in their attitude, what happens is it gets worse, at least for a while. There doesn't seem to be much more to it than simply toughing it out. It's not merely the insight that can be provided by a person who has been through that; it's that some things are just harder to do on your own.

Think of all the people who go to a gym to lose weight. I mean, sure, the equipment is nice and all, but lots of those folks have equipment at home that would serve just as well if they'd use it. Thing is, they don't. When it comes right down to it then, the main thing is that most people find it easier to push themselves to a greater level of effort when they're in a room full of people who are all committed to doing the same.

I do, however, have to question your use of the phrase "religious dogma", taking that to refer to "a body of doctrines formally or authoritatively confirmed". The AA approach is, to my way of thinking, just about the opposite of that. Phraseology such as "higher power" and "God as we understand Him" were chosen explicitly in order to abdicate to the individual the authority to make those determinations, and the book declares itself to be "suggestive only" and goes on to say "we realize we know only a little". That doesn't mean there aren't plenty of people in AA who take a dogmatic approach to such things; there are. But AA itself does not take a dogmatic approach to religious beliefs; its stance is: you're on your own there.

 

[fls]

I don't know about placebo (nor do I know what would constitute a placebo treatment for alcoholism - taking sugar pills?)

Somewhat OT, but your choice of placebo simply depends upon what aspect of the program you wish to investigate. If it's the 12-steps (i.e. religious dogma), then your placebo is involvement in a program without that dogma.

but AA has a documented history of working better than no treatment:

http://www3.interscience.wiley.com/journal/112481055/abstract?CRETRY=1&SRETRY=0
http://psycnet.apa.org/?fa=main.doiLanding&doi=10.1037/0022-006X.72.1.81

Other research suggests that those who seek help are less likely to relapse in general.
http://www3.interscience.wiley.com/journal/118730605/abstract

So maybe all the religious dogma is a placebo and the real help is the fact that it puts alcoholics in an environment that both supports them and discourages them from relapsing, but their program does indeed 'work.'

Does it mean that its the most effective program? No. I doubt even AA would claim that they've stumbled upon the magical uber-quitting program. However, it's totally inaccurate to say it doesn't work.

Or it may be that those people who are most likely to quit and to avoid relapse are also more likely to show up at a program - making 'attendance at meetings' a marker for success, but not contributing to the cause of success. I'm not saying that that is necessarily the case, but observational research does not differentiate between the two. And from the list of research I linked to earlier, the RCT's (which would be able to differentiate between the two) did not show AA performing better than no treatment or other treatments.

Linda

 

[portlandatheist]

I do, however, have to question your use of the phrase "religious dogma", taking that to refer to "a body of doctrines formally or authoritatively confirmed". The AA approach is, to my way of thinking, just about the opposite of that. Phraseology such as "higher power" and "God as we understand Him" were chosen explicitly in order to abdicate to the individual the authority to make those determinations, and the book declares itself to be "suggestive only" and goes on to say "we realize we know only a little". That doesn't mean there aren't plenty of people in AA who take a dogmatic approach to such things; there are. But AA itself does not take a dogmatic approach to religious beliefs; its stance is: you're on your own there.

I understand your point. AA is much less dogmatic than many religious traditions out there with their "god as you understand him/her" approach. A lot of good points have been made, I guess AA really rubs me the wrong way because for me, I see it basically as Christianity in disguise: Accept God/Christ/a rock/a door knob, confess, and repent(12 steps). Rinse and repeat. So, its not as dogmatic as the worst offenders, but it is still dogma and woo. Addiction treatment is just plain ripe territory for woo and everybody wants a piece: religious institutions of all stripes, homeopaths, acupuncturists, etc. It would be nice if this complex problem was dealt with in a more rational manner. It seems like a lot of people are pointing out the assumed benefits of the group environment as well as the notion that motivated quitters may mecca to AA which should be taken into consideration.

 

[GreyICE]

I understand your point. AA is much less dogmatic than many religious traditions out there with their "god as you understand him/her" approach. A lot of good points have been made, I guess AA really rubs me the wrong way because for me, I see it basically as Christianity in disguise: Accept God/Christ/a rock/a door knob, confess, and repent(12 steps). Rinse and repeat. So, its not as dogmatic as the worst offenders, but it is still dogma and woo. Addiction treatment is just plain ripe territory for woo and everybody wants a piece: religious institutions of all stripes, homeopaths, acupuncturists, etc. It would be nice if this complex problem was dealt with in a more rational manner. It seems like a lot of people are pointing out the assumed Scientifically documented benefits of the group environment as well as the notion that motivated quitters may mecca to AA which should be taken into consideration.

Where did your bias slip into this post?

Nothing 'assumed' about it.

 

[Dymanic]

I guess AA really rubs me the wrong way because for me, I see it basically as Christianity in disguise: Accept God/Christ/a rock/a door knob, confess, and repent(12 steps).

My take on that is that Christianity does not have exclusive rights to some of the things it claims as its own, and that in fact its success lies in its ability to exploit some very basic aspects of human nature; aspects which AA also expoits. Probably the most obvious of these is the need to seek acceptance within a group. That's a powerful drive for herd animals like us humans, and it can work for you or it can work against you. The "confession" thing is part of that. Being accepted is of limited value if you're simply a successful phony (that is, it may have cash value, or status value, but perhaps not so much emotional value). Letting them see who you really are is risky (at least, it seems to be for most alcoholics) -- but if you do that, and then they accept you, that acceptance is something of a different nature entirely.

The "let go and let God" thing seems to me to be about learning to turn off another powerful drive: the need to seek solutions, even if they're forced solutions. When confronted with a problem, it is very natural for most of us to want to do something -- anything ("even if it's wrong"). This is sometimes referred to as "action bias", and I first heard about it in the context of studies done with goalkeeping in soccer; it seems that goalies attempting to block penalty kicks usually jump either left or right even though it turns out that the statistically optimal strategy is to just stand in the middle. In other words, the benefit (as I see it) resides entirely with the "let go" part; the "let God" part is unnecessary, and if it's detrimental, it may still be an acceptable tradeoff against the crazy kind of forced decision-making you so often see in wet or recently dry alcoholics. If you don't drink from the poisoned water hole, it doesn't matter so much that the reason you don't is because you believe it to be haunted by evil spirits.

As for "repentance", that word has been heavily loaded by those who would have us believe that it is not possible to have morals without supernatural beings; a notion I reject. It's another of the things Christians think they invented, but it seems pretty basic to me. If you realize that you've done something wrong, you try to set it right, and you resolve not to do that sort of thing anymore. There can be lots of good reasons to do that whether you believe in spirits or not. If you're an alcoholic, and one of the reasons you get drunk is to assuage guilt, well, there's an extra reason.

I think the "motivated quitters" idea has merit. A lot of people in AA do talk about repeated unsuccessful attempts to stay sober through solitary effort, but that they were willing to try again in AA could be taken as evidence of motivation, so, yeah.

Addiction treatment is just plain ripe territory for woo and everybody wants a piece: religious institutions of all stripes, homeopaths, acupuncturists, etc. It would be nice if this complex problem was dealt with in a more rational manner.

I agree with all of that. It may be that the very thing that makes it such a tempting target is that the science of addiction is so incomplete and rational approaches correspondingly so unproven.

 

[Miss_Kitt]

Weighing in from the sidelines...

Hi, I'm Miss Kitt, and I'm not an alcoholic...

I do come from an alcoholic family. I have seen AA be successful for a family member, worse than nothing for a family member, and meaningless for a family member.

I agree with the OP, though, that AA tends to claim a lot more than it can actually prove. For example, AA folks tend to talk about how they're "much better than" no treatment--but they refuse to gather any kind of statistics, claiming that would get rid of their anonymity. To which I reply, medical research often uses anonymous but consistant labels for study subjects, there are protocols for such studies to be safely run.

In my experience, parts of the AA program are incompatible with reason, objectivity, and skepticism. However, most people are not being reasonable, objective, or skeptical in their approach to living when they contemplate joining AA, so that isn't a short-term barrier.

There is an overall fatalist perspective--that only a "Higher Power" that you must "trust" to take you in the right way; that you are helpless and hopeless; and that the only two choices are AA or drunkeness--that seems to me to be a bad guideline for a functional adult life. Again, there may be a place in the spectrum between unthinking drinking and denial and fully functioning human, where that's a minor point. There may also be people to whom that kind of blind faith in whatever is as independent as they can be, and clinging to AA meetings instead of a bottle is healthier and certainly safer on the roads.

But I would certainly recommend secular alternatives, if available.

As the wonderful Dr Linda pointed out with her link, AA hasn't done all that well in what few studies have been done. It has certainly worked for some people; but so has acupuncture, Zen Buddhism, and becoming a bull-rider. So has deciding not to drink. It may well be that simply deciding you're done with denying the problem is the most important component, regardless of what form that acknowledgment takes.

The issue of what alcoholism is, has not even been fully defined. If someone comes home every day and has two highballs after dinner, 350 days a year, are they an alcoholic? They will certainly be physically addicted, but if they never are adversely impacted in career or relationships, and it doesn't bother them, I believe the DSM-IV R wouldn't find them to be alcoholic. On the other hand, a binge-drinker who gets hammered once a month and can't remember half the weekend would certainly be considered an alcoholic by most definitions, but clearly is not physically addicted (or couldn't go a month between events).

I'm not going to say I know what "the answer" is, but I can say from observation that for some people, AA is visibly just a different form of Church, with a congregation and clergy of present and former drunks. (Note that AA says you are NEVER a 'former alcoholic'; also, that your disease is "progressing even when you are sober". I consider both of those statements to be highly dubious assertions in the absense of compelling data to support them.)

I commend the OP for bringing up this important topic!

 

[Dancing David]

I understand your point. AA is much less dogmatic than many religious traditions out there with their "god as you understand him/her" approach. A lot of good points have been made, I guess AA really rubs me the wrong way because for me, I see it basically as Christianity in disguise: Accept God/Christ/a rock/a door knob, confess, and repent(12 steps). Rinse and repeat. So, its not as dogmatic as the worst offenders, but it is still dogma and woo. Addiction treatment is just plain ripe territory for woo and everybody wants a piece: religious institutions of all stripes, homeopaths, acupuncturists, etc. It would be nice if this complex problem was dealt with in a more rational manner. It seems like a lot of people are pointing out the assumed benefits of the group environment as well as the notion that motivated quitters may mecca to AA which should be taken into consideration.

I can understand that but there is more to the twelve steps that the religious gloss, a lot of DFD groups focus on the DFD but here is another possible interpretation.

1. Admitted to ourselves that our lives had become unmanageable: (This is a crucial step for some people, they are in denial that drinking is an issue) that we are "powerless' over substance x/behavior x. (Many people will say, well so and so can drink, so I can too)

2. Came to belief that a power other than ourselves. (You will notice that I don't use god, in fact I have recovery books where the word god is blacked out.) This is to say: I must do something different" But it is the oookiest part of the program. Many groups allow you to interpret Higher Power as you wish. Some don't.

3. Made a decision to turn our lives over to god...

This is the crucial part and it is in stupid religious phraseology. When you don't use you have to face the motivation to use, panic, boredom, and trauma, whatever. This is the phase where people decide to pray, exercise, do whatever it takes other than using.

Now I admit I have reacted violently (internally) to much of the god talk ay meetings, it is important that these meeting exist, but you have to have very good boundaries when you go to them, in more ways than just the ones about religion. I can't abide the smarmy dork wads that sit there and say things like "I am listening to others and I am sooo glad I am not there anymore" (They are sort of rubbing your face in it.)


But as far as there being a selection effect in AA, I have never seen it. You see all sorts, those who make it, and hordes of those who don't. I have seen groups where they have had to ask disruptive drunks to leave.


Now on the other hand, I fully support the development of groups that are solely rationally based and don't involve the use of the word god,

However any one who thinks that AA says 'accept god and he will solve all your problems' has never been to a meeting.

There are those who object to the god things and it is a huge barrier for them, I searched for a while to find home groups that weren’t as godly as others. For many, especially women, it is the word powerless. They have started a different model ….

 

[Dancing David]

Personally I think the idea that "You must reach bottom" is a very damaging idea, I found that you can "walk on the bottom" and that "you can always go lower", it would be ebtter to refer to it as the point where " I decided to change", there are times where the bottopm language is like throwing someone under the bus.

I believe that it is better to just say "Well, you can start to make different choices now".

 

[fls]

But as far as there being a selection effect in AA, I have never seen it. You see all sorts, those who make it, and hordes of those who don't. I have seen groups where they have had to ask disruptive drunks to leave.

You don't see what you just described as a selection effect?

Linda

 

[Gravy]

From a 2006 Cochrane Review (abstract):

Alcoholics Anonymous and other 12-step programmes for alcohol dependence.

MAIN RESULTS: Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF [Twelve-Step Facilitated] versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.

AUTHORS' CONCLUSIONS: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

 

[Dymanic]

Hi, I'm Miss Kitt, and I'm not an alcoholic...

Hi Miss Kitt! I hope you won't mind if I find myself inclined to attribute to your viewpoint from the perspective of a non-alcoholic approximately the same weight I would to that of a non-parent in matters related to child rearing.

For example, AA folks tend to talk about how they're "much better than" no treatment--but they refuse to gather any kind of statistics, claiming that would get rid of their anonymity.

As I mentioned above, I think it's a poorly defined problem to begin with, as it presupposes that recovery and relapse can be measured in a consistent and meaningful way. AA folks often tend to talk about the difference between genuine recovery (that which comes as a benefit of working the steps and all that) and the phenomenon known as the "dry drunk" -- a person who, despite not drinking, continues to practice old thinking and behavior. They speak of this as if it were something that can be evaluated crisply and objectively, and that bothers me; but I find myself able to easily forgive them for it; after all, they do not claim to be scientists. It bothers me more when the approach taken by those who do claim to be scientists does not appear to be much better.

In my experience, parts of the AA program are incompatible with reason, objectivity, and skepticism.

In my experience, parts of simply being a human being are incompatible with reason, objectivity, and skepticism.

There is an overall fatalist perspective--that only a "Higher Power" that you must "trust" to take you in the right way; that you are helpless and hopeless; and that the only two choices are AA or drunkeness.

Yes, you do get that. I think it's partly a legacy feature. In the early days of AA, the membership was limited pretty much exclusively to what are now referred to as "low bottom" drunks; those whose drinking had completely devastated them emotionally, financially, and physically -- and at that time, the smorgasbord of treatment options did not exist. One important underlying assumption is that for individuals like that, total abstinence is the only alternative. To a man, these guys were seasoned veterans of every possible approach to moderate drinking, and every single one of them had failed at that. That may not qualify as "data", but I do find it fairly compelling.

I'm not going to say I know what "the answer" is, but I can say from observation that for some people, AA is visibly just a different form of Church, with a congregation and clergy of present and former drunks.

I think you said that just right: AA is that for some people. I'd allow more than that: if the membership of a particular group includes a large enough number of such people, the meeting itself can become barely distinguishable from church. Again, we're talking about two different things; what AA is, and what people make of it.

 

[fls]

As I mentioned above, I think it's a poorly defined problem to begin with, as it presupposes that recovery and relapse can be measured in a consistent and meaningful way. AA folks often tend to talk about the difference between genuine recovery (that which comes as a benefit of working the steps and all that) and the phenomenon known as the "dry drunk" -- a person who, despite not drinking, continues to practice old thinking and behavior. They speak of this as if it were something that can be evaluated crisply and objectively, and that bothers me; but I find myself able to easily forgive them for it; after all, they do not claim to be scientists. It bothers me more when the approach taken by those who do claim to be scientists does not appear to be much better.

Can you be more specific? In particular, if abstinence is not the desired outcome, what sorts of outcomes do you see as desirable?

Linda

 

[Dymanic]

Can you be more specific?

Not really. That's the whole problem. How do we measure "recovery"? Are there degrees of that? Can we rely on individuals to accurately and honestly report how they're doing with respect to alcohol use, much less on their own level of "emotional maturity" or anything like that? If not, then what do we do, count the number of times they've been arrested? How many cars they've wrecked? The number of relationships or jobs they've been in and out of? If we decide that total abstinence IS the only reasonable measure, can we even rely on them to honestly report on that?

I see the whole business as hopelessly fuzzy; far too much to easily lend itself to a scientific approach. Hence, I take a skeptical approach toward any attempt to do that

 

[fls]

Not really. That's the whole problem. How do we measure "recovery"?

What I'm asking is what you would consider meaningful recovery. Are things in your list, like emotional maturity, abstinence, avoidance of criminal and negligent behaviours, maintenance of social relationships and employment, meaningful to you? You started going to meetings and you continue to go. Do you have any sense of why you do so?

And even if you are unable to conceptualize whatever it is that is relevant to you, does this invalidate the possibility that others can identify behaviours they wish to avoid?

Are there degrees of that? Can we rely on individuals to accurately and honestly report how they're doing with respect to alcohol use, much less on their own level of "emotional maturity" or anything like that? If not, then what do we do, count the number of times they've been arrested? How many cars they've wrecked? The number of relationships or jobs they've been in and out of? If we decide that total abstinence IS the only reasonable measure, can we even rely on them to honestly report on that?

I see the whole business as hopelessly fuzzy; far too much to easily lend itself to a scientific approach. Hence, I take a skeptical approach toward any attempt to do that

Science has tackled far more difficult problems than alcoholism, which has the advantage, after all, of involving a specific substance with specific quantifiable effects. I'm not sure why you think that the scientific approach is confined to easier subjects. Are you suggesting that a reasonable alternative is to ignore those questions that are difficult to answer?

Linda

 

[Soapy Sam]

Measuring blood alcohol is easy.
If someone is willing to carry a breathalyser and submit to testing by friends and employers, the question of measurement ceases to be subjective.
The question is - who is serious enough about quitting to submit to that ?

 

[Dancing David]

You don't see what you just described as a selection effect?

Linda

I understand what you are saying, they can come back the next day as long as they aren't disruptive.

I think that people who quit on their own are likely to not go to AA, given the number of people forced into AA against thier will, I think the selection effect is mixed.

It would take some really large control groups, as fay as I know the success rate is about the same for all forms of treatment. And it probably relects the remission rate without treatment. I know that people swear by long term residential treatment but I will have to look at samples in controls and demographic matching before I could say that it is.

I like a relapse prevention/life skills approach myself.

 

[Dancing David]

Not really. That's the whole problem. How do we measure "recovery"? Are there degrees of that? Can we rely on individuals to accurately and honestly report how they're doing with respect to alcohol use, much less on their own level of "emotional maturity" or anything like that? If not, then what do we do, count the number of times they've been arrested? How many cars they've wrecked? The number of relationships or jobs they've been in and out of? If we decide that total abstinence IS the only reasonable measure, can we even rely on them to honestly report on that?

I see the whole business as hopelessly fuzzy; far too much to easily lend itself to a scientific approach. Hence, I take a skeptical approach toward any attempt to do that

There are a number of ways you could measure recovery, wether abstinence or reduction is the goal. Personaly I think addicts have to quit.

Quality of life scales, measures of spending, relationship development, those could all be used.

And certainly the behavioral markers you meantion would be good ones.

 

[Dymanic]

What I'm asking is what you would consider meaningful recovery. Are things in your list, like emotional maturity, abstinence, avoidance of criminal and negligent behaviours, maintenance of social relationships and employment, meaningful to you?

Yes they are, and that's why I see several problems with trying to quantify this. One is that it's a very individualized thing. One person might be satisfied with improved relationships even while remaining permanently unemployed. Another might settle for simply holding down a job, or staying out of jail. Abstinence alone doesn't seem like an adequate criterion; I've known several people who committed suicide while active in the program and (presumably) sober. Most of the people I've known who stayed sober for a significant period of time report improvement in those areas they consider most important, but those aren't statistics; they're anecdotes. They don't become statistics until you can decide on some objective criteria that can be broadly applied.

Returning to the list then, it appears to represent a mixture of things that can, at least in principle, be measured objectively (abstinence, criminal behavior, employment) with things that, in my opinion, cannot (emotional maturity, healthy relationships). Who gets to decide what constitutes "emotional maturity" or what a "healthy relationship" is? Is there any hope of such an undertaking not degenerating into a psychobabble marathon? Ultimately, it seems to me that you'd have to settle for measuring that which can be measured -- the "specific quantifiable effects" -- and hoping that the results can be meaningfully extrapolated to the rest. I don't see it as a difficult problem so much as a poorly defined problem.

During my time in the program, I've seen a lot of people come and go, and while I was once among the many in AA whose default assumption is that these individuals relapsed, I've learned not to be so hasty about that. It seems like those studies suffer from essentially the same flaw. Lacking data, they must rely heavily on assumption. I'm not saying they're flawed necessarily; just that I have trouble regarding them as very powerful. Maybe I just haven't looked at them closely enough.

You started going to meetings and you continue to go. Do you have any sense of why you do so?

The simple answer is that I do so partly because I've come to enjoy going, and partly because I see it as an opportunity to contribute something. I was going to say "as a duty", and there is some truth to that -- but I changed it because the greater truth is that contributing in a positive way to the lives of others isn't something I feel obligated to do; it's something I want to do. When I was an active alcoholic (as was the case when I was a kid, interestingly enough), it was all about "them" making me do stuff...

Ok wait. I think we're starting to get into the complicated answer, and for the sake of brevity, I was going to omit that for now.

 

[fls]

Yes they are, and that's why I see several problems with trying to quantify this. One is that it's a very individualized thing. One person might be satisfied with improved relationships even while remaining permanently unemployed. Another might settle for simply holding down a job, or staying out of jail. Abstinence alone doesn't seem like an adequate criterion; I've known several people who committed suicide while active in the program and (presumably) sober. Most of the people I've known who stayed sober for a significant period of time report improvement in those areas they consider most important, but those aren't statistics; they're anecdotes. They don't become statistics until you can decide on some objective criteria that can be broadly applied.

Yes, any particular study starts with identifying/choosing a relevant/significant outcome. You seem to agree that there are several outcomes that are of interest, but think abstinence is over-used?

Returning to the list then, it appears to represent a mixture of things that can, at least in principle, be measured objectively (abstinence, criminal behavior, employment) with things that, in my opinion, cannot (emotional maturity, healthy relationships). Who gets to decide what constitutes "emotional maturity" or what a "healthy relationship" is? Is there any hope of such an undertaking not degenerating into a psychobabble marathon?

This is a familiar trade-off. There seems to be a fairly consistent inverse relationship between how easy it is to measure something and how useful that measurement is. If you think it's difficult for alcoholism, you should try it for Quality Assurance.

What tends to happen is that different studies tackle the question at different levels, so that information that is reliable and can reasonably be generalized (e.g. surveys, census data) is supplemented by information that has better validity (e.g. clinical or personal interviews).

Ultimately, it seems to me that you'd have to settle for measuring that which can be measured -- the "specific quantifiable effects" -- and hoping that the results can be meaningfully extrapolated to the rest. I don't see it as a difficult problem so much as a poorly defined problem.

I agree - for these kinds of issues, more care must be taken in defining the problem and outcomes than for something like testing a new drug for hypertension.

During my time in the program, I've seen a lot of people come and go, and while I was once among the many in AA whose default assumption is that these individuals relapsed, I've learned not to be so hasty about that. It seems like those studies suffer from essentially the same flaw. Lacking data, they must rely heavily on assumption. I'm not saying they're flawed necessarily; just that I have trouble regarding them as very powerful. Maybe I just haven't looked at them closely enough.

The point of study is to collect data rather than relying on assumption. I'm not saying that the available research is strong already. I just wanted to challenge the idea that special pleading is justified because this area of study presents unique difficulties. The difficulties are those we encounter frequently in medical research - try measuring something like 'health', for example.

Linda

 

[Dymanic]

You seem to agree that there are several outcomes that are of interest, but think abstinence is over-used?

Well, I guess I really don't know how much it's used as an endpoint in studies, but in AA, it's regarded more as a starting point than an endpoint. The underlying assumption is that there was a reason that you developed a problem with alcohol to begin with, and the introspective work is designed to address that. That's what the "dry drunk" business is all about. It's a way of saying that just being sober probably won't cut it unless you attack the root of the problem. I think that's valid in principle, but of course it becomes a bit tautological if you turn around and use abstinence as the ultimate test for how well you've accomplished that.

I just wanted to challenge the idea that special pleading is justified because this area of study presents unique difficulties.

I certainly can't disagree with that, and nor can I present myself as an unbiased observer. My biased observation is that AA works for some people and not for others, and that the latter probably represent a much larger group than the former. As for why that is, I haven't the first clue, except that wanting it to work seems to be an important factor. It seems perfectly within the realm of possibility that when it does "work" (whatever that means), it's due to a placebo effect upon self-selected individuals predisposed to benefiting from a placebo.