The Effectiveness of the Twelve-Step Treatment
by A. Orange
'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.
Everybody is entitled to their own opinions, but not their own facts.
Senator Patrick Moynahan
At the beginning of every Alcoholics Anonymous meeting, someone reads out loud a plastic-laminated document that says, among other things, that this Twelve-Step program has rarely been known to fail, except for a few unfortunate people who are "constitutionally incapable of being honest with themselves":
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.
Nothing could be further from the truth. Even the most ardent true believers who will be honest about it recognize that A.A. and N.A. have at least 90% failure rates. And the real numbers are more like 95% or 98% or 100% failure rates. It depends on who is doing the counting, how they are counting, and what they are counting or measuring.
A 5% success rate is nothing more than the rate of spontaneous remission in alcoholics and drug addicts. That is, out of any given group of alcoholics or drug addicts, approximately 5% per year will just wise up, and quit killing themselves.6 They just get sick and tired of being sick and tired, and of watching their friends die. (And something between 1% and 3% of their friends do die annually, so that is a big incentive.) They often quit with little or no official treatment or help. Some actually detox themselves on their own couches, or in their own beds, or locked in their own closets. Often, they don't go to a lot of meetings. They just quit, all on their own, or with the help of a couple of good friends who keep them locked up for a few days while they go through withdrawal. A.A. and N.A. true believers insist that addicts can't successfully quit that way, but they do, every day.
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. On the other hand, diseases like cancer and Ebola have very low spontaneous remission rates -- left untreated, they are very deadly and few people recover from them. Alcoholism is in the middle. The Harvard Medical School reported that in the long run, the rate of spontaneous remission in alcoholics is slightly over 50 percent. That means that the annual rate of spontaneous remission is around 5 percent.
Thus, an alcoholism treatment program that seems to have a 5% success rate probably really has a zero percent success rate -- it is just taking credit for the spontaneous remission that is happening anyway. It is taking credit for the people who were going to quit anyway. And a program that has less than a five percent success rate, like four or three, may really have a negative success rate -- it is actually keeping some people from succeeding in getting clean and sober. Any success rate that is less than the usual rate of spontaneous remission indicates a program that is a real disaster and is hurting patients.
It's like this:
Imagine that there is a nasty disease that kills 50% of the people who get it. A pharmaceutical company has a new medicine that they want to test. So they give the drug to a bunch of the people who have the disease, and 50% of them get better.
The drug manufacturer cheers and brags, "Look at how great our new medicine is! We saved half of the patients!"
Wrong. The new drug saved nobody. The half who survived were the ones who were going to survive anyway. The drug had an effective zero percent cure rate, above and beyond normal spontaneous remission.
To compute the success rate of any medicine or treatment program, you have to subtract the normal rate of spontaneous remission from the apparent success rate. In this example, fifty percent minus fifty percent yields a zero percent success rate for the new medicine. The new medicine didn't make anybody recover.
(And if the survival rate of the patients who were taking the new medicine was less than half, then the new medicine was actually poisoning people and keeping them from recovering.)
When one of those people who is going to quit drinking anyway, or who did already just quit, walks into an A.A. meeting, A.A. is happy to take all of the credit for that success story, while disavowing any responsibility for all of those other people who walk in, are disgusted by what they see, and walk right back out, and relapse. That is grossly dishonest.
A.A. is also more than happy to convince the person who just quit that it is all due to A.A. and the Twelve Steps. And many of them will believe it. At meetings, you will sometimes hear testimonials like "I tried everything, the V.A. program, the Christian Brotherhood, and finally, A.A. is what worked."
The speaker is forgetting one of the famous corollaries to Murphy's Law:
"The thing you seek always seems to be in the last place that you look."
Many people who are in recovery require one or more relapses to convince themselves that they really can't drink or dope any more, not even just a little bit, now and then. They will think that they can just nibble, or "just have one", and that it will be okay. They will go through a lot of programs while they experiment and fail. It's a learning process. In the end, when some of them finally quit, really totally quit and stay quit, rather than die, they often give the credit to whichever program they just happen to be in when they finally quit. (All of them tend to overlook the fact that they stopped examining other programs after they successfully quit drinking. They just stuck with the program that they were in.)
Thus the Christian sects have a bunch of totally convinced true believers who say that Jesus saved them, and the Veteran's Administration has some veterans who believe that the V.A. program is the best, and Alcoholics Anonymous has a bunch of people who insist that A.A. and the Twelve Steps are the only answer.
In 1964, Dr. Milton A. Maxwell (who eventually became a member of the Board of Trustees of Alcoholics Anonymous World Services, Inc.) did a study of the relations between doctors and other treatment professionals and Alcoholics Anonymous. He wrote:
Another root of Professional-AA strains consists of the very human tendency to be loyal to the therapy which has been successful in one's own case -- and rather uncritically to adopt the ideological framework within which the help has come. We see this phenomenon in other areas. For example, the benefits of religious faith and personal integration can come through many different theological frames of reference -- Roman Catholic, Pentacostal, Christian Science, Theosophy, Zen Buddhism, you name it. And, so often, the help found is taken as absolute proof of the truth of the accompanying theological framework. Or, witness what happens when a patient has shopped around from doctor to doctor, and finally finds one that helps: he becomes very loyal to the successful therapist -- and to the successful therapeutic program. Why should the behavior of alcoholics be so different? I've been in alcoholism clinic and hospital settings where I've heard: "I tried the 'cure' over there. I tried AA. None of it worked. But this place has got the answers." And I've heard alcoholics talk who had boxed the professional compass and finally made it in AA. In either case, the reason for the success of the particular treatment may have been due more to the patient's by-now greater pain and desperation than to the nature of the treatment or the context of beliefs. But few patients can see this at the time and they become loyal to the "successful therapy" -- and, unfortunately, sometimes antagonistic or unfavorable in their attitude toward other therapeutic programs. Now, I submit that this is quite standard human behavior. But it is one of the roots of misunderstanding, distrust, and strain in AA-professional relations.
PROFESSIONAL and ALCOHOLICS ANONYMOUS RELATIONS IN OREGON; An Exploratory Study Report, Milton A. Maxwell, Ph.D., 1965, page 10.
The Harvard Medical School says that the vast majority of the people who successfully quit drinking for a year or more -- eighty percent of them -- do it alone, all by themselves, without any treatment program or "support group". Naturally, those do-it-yourselfers will also insist that they have the sure-fire solution that really works:
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