(October 27, 2014 at 10:12 am)alpha male Wrote: IMO you're downplaying the importance of AA. The study said:

Consistent with prior studies (Fiorentine, 1999; Fiorentine & Hillhouse, 2000; Moos et al., 2001; Ritsher, McKellar, et al., 2002; Ritsher, Moos, & Finney, 2002), longer participation in AA made a positive contribution to alcohol-related, self-efficacy, and social functioning outcomes, over and above the contribution of treatment. An initial episode of professional treatment may have a beneficial influence on alcohol-related functioning; however, continued participation in a community-based self-help program, such as AA, appears to be a more important determinant of long-term outcomes.

No it didn't, it didn't say anything of the sort. This is what it said (this is the paper's abstract):

• This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcomes, but this was not true of subsequent treatment. Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA. - Moos & Moos, 2006.

In the paper they noted that success at the 16-year mark was mostly attributed to people who stayed with the program for 27 weeks or longer in the first year (whether treatment or AA). They found that participants who attended both treatment and AA for 27 weeks or longer were less likely to be problem drinkers 16 years later than those who only did one or the other.

So, staying in either treatment or AA for 27 weeks in the first year was the most important determinant.

Again though, this compared AA to whatever professional treatment was available in that place at that time in c. 1990 (the paper in fact doesn't even bother to mention the year, and as far as I could tell from skimming it doesn't tell you very much about what the professional treatment plan entailed, so I suppose it could have been 1989, 1988 etc we don't know just from the paper). Treatments for addiction and mental illness have improved a lot in the last 24 years.

(October 27, 2014 at 11:20 am)alpha male Wrote: Er, I'm gonna go out on a limb here and suggest that most everyone who makes it to AA, rehab or therapy tried willpower and self control multiple times without success. That's why they end up in those places.

If you can control your drinking through willpower and self control, then you're not an alcoholic. My brother is a heavy drinker, but he can stop whenever he needs to. He's not an alcoholic.

I spent years in AA, and almost a year in an intensive Christian rehab, and 2 other secular rehabs before that. I’ve been hospitalized 9 times for alcohol overdose, spent dozens of weeks cumulatively in detox, spent and lost over $200,000 in booze and losses inflicted thereof. Had 3 DUIs, lost all my friends and my family due to my drinking, and have been told by several doctors that my next drink could kill me. I’ve lived on the streets, slept in alleys, under bridges, AND went out and drank a half gallon a day for years after being told I would die. I’m 43 years old.

Uh, yeah I think I MIGHT be an alcoholic.

I used to say “prayer is the last resort of the truly damned.” Since I am still alive, and basically left with no “help,” I guess my new slogan is “I am the last resort of the truly damned.”

What I mean to say, is that I believe that the old and much maligned concepts of willpower and self control may become the only thing you can rely on when addicts like me find that AA, church, and rehabs (as we know them today) don’t work very well. Advances in neuroscience have proven such concepts as “ego depletion” and “decision fatigue” that addicts in particular suffer from. Diet also plays an enormous part in decision making and clear thinking. It’s no surprise that willpower and self control alone do not work for addicts given the mountain of stress, bodily damage and poor diets that they inflict on themselves. BUT, once these things are normalized, self control, which has been fatigued by overuse, can be strengthened like a muscle. There is too much on the topic to go into here, but I honestly believe it best for all addicts to not discount themselves as a major element in sobriety. I used to say AA is a good start – it can get you in a place where people understand and some shoulders to cry on, but when you go home at night (if you have one) you are always alone with your thoughts.

I’m going on a year soon, and I won’t get a chip, go to church, or celebrate in any way, except do some mindfulness exercise, make sure I’ve got plenty of glucose in my system at all times, and get plenty of rest.

Yikes Dorian, I'm glad you're doing so much better now, that's some scary shit.

I would argue that regardless of whether or not someone attends AA meetings, we cannot know exactly WHAT IT IS that is 'keeping someone sober.' One could argue that willpower and a decision to simply stop ruining one's own life and that attending AA is simply a byproduct of that decision.

I would have to favor CBT over AA personally because it is based on real science and is updated as new information is discovered. And SMART Recovery provides CBT based techniques and practices to help people stay sober and it is completely free, so that point is moot.

If one really cares to do some research, you will find that most claim that AA is just as effective as any other method of staying sober. And in these studies I would argue that willpower and a decision to stop destroying one's own life is more of a factor than anything, hence the consistency of 'success' in individuals despite the method used to obtain sobriety. At least that's what makes sense to me.

I do believe AA is great for those who can make it work for them. And while some people I know who are atheist have found success in AA, others I know have also claimed that there are many logical loopholes to jump through in order for them to make sense of AA. I suppose it's up to the individual.

Just looked back over Moos & Moos 2006 again.

I disagree with their conclusions.

Their findings were that:

1. Outpatient treatment was effective.
2. AA was effective.
3. They were roughly equally effective if used for 27 weeks in the first year.
4. From 28 weeks treatment showed no further improvement, but AA showed further improvement.

To me what this indicates is that a. treatment involves a lengthy process, b. the process is finite - i.e. it does have a point at which treatment can be considered "complete" and can no longer be improved upon, and this was 27 weeks. That's HALF A YEAR! If someone remained in treatment for half a year they had the best chance for long-term success compared to those who didn't enter treatment or used treatment or left their treatment plan earlier.

AA was similar, except that it showed "some improvement" beyond 27 weeks. This means, clearly, that AA is not as effective at delivering its therapy than the professional treatment. If AA was more effective then it should reach its peak and maintain it.

Statistically speaking, more people who entered both treatment and AA were not problem drinkers after 16 years than those who only did one or the other.

My main criticism would be that the paper does not mention the improvements that have been made in professional intervention therapy, including but not limited to CBT which can provide a tailored plan individualised to a person or a cohort or demographic of people with specific needs. If it was a 5-year study, instead of a 16-year study, started in 2009 and compared AA to CBT I'd be very surprised if AA was equal; and the evidence may also show (I don't know because I haven't looked, I'm just speculating) that CBT is more efficient and doesn't require the same length (27 weeks) as in the past - noting of course that individual results may vary. I base this on the fact that I hear therapists talking about 3-to-6 month plans indicating that they expect their clients to require treatment that lasts between 13 to 26 weeks, and that would be quite an improvement over the 27 weeks that was required in 1990 (or whatever year the study was actually commenced in).

(October 27, 2014 at 6:30 pm)Aractus Wrote: No it didn't, it didn't say anything of the sort. This is what it said (this is the paper's abstract):

Yes, it did. Here's the paper itself:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/

Scroll down to Independent Contribution of Treatment and Alcoholics Anonymous and you'll see the part I quoted.

---

(October 28, 2014 at 1:40 am)Aractus Wrote: Just looked back over Moos & Moos 2006 again.

I disagree with their conclusions.

Yes, I'm sure most of you do, as you're against AA on philosophical grounds, and no amount of evidence is going to sway you.

No, that quoted section - you're right I was wrong that it wasn't in the paper - clearly contradicts the rest of the paper. The most important determinant for success was completing 27 weeks either in outpatient-treatment or in AA in the first year. This is made very clear elsewhere in the paper. Continued involvement in AA lead to further long-term improvements, but it wasn't at all "the most important determinant for success".

And that's just going on their data, and their own claims elsewhere in the paper.

The fact is that treatment is effective and doesn't lose its effectiveness the way that AA appears to. Even the program they used in 1990 for 27 weeks produced results that could not be improved upon at that time (i.e., a patient receiving 28 or more weeks of professional treatment saw no further benefit). This is good, this is what we want from treatment, we want it to be finite - if it's 27 weeks or whatever the length, there should be a cut off time that the benefit has been delivered by.

With AA this was not the case. Thus you could argue that AA has more to offer but is unable to offer it within the same time period. And that's compared to 1990's treatment.

Compared to today's CBT outpatient programs it would probably not do anywhere near as well as it did in 1990 against a more primitive form of treatment. Today we have treatment programs that as I said seem to be expected to last between 3 to 6 months, which is a lot faster than 27 weeks to deliver that long-term benefit. You also have to remember treatment is generally once a week, whereas AA can be up to three meetings per week, so although they both delivered the same long-term benefit after 27 weeks, it takes more relative effort for those attending AA than for those attending treatment.

Most importantly of all, as I said before, patients who received both professional treatment and attended AA had the best chance of success. So again, AA does not replace therapy, but it can work in parallel to deliver further benefit and further chance of success. My advice to any alcoholic would be to try both CBT (outpatient care) by a qualified therapist, and AA, and based on the study to attend AA for at least 27 weeks, and to attend the CBT treatment plan for the duration requested by the therapist.

(October 25, 2014 at 2:08 am)Aractus Wrote: Drich, where did your figures come from?

Did you pull them out of ur fat red-neck ass?

I referenced leading-edge treatment that suggests that peer-support is not the best model for anorexic treatment, you referenced nothing - nada - and claim that peer support is important?

Where is your evidence?

Life. My experience with loved one who drank and used heavy drugs.

(October 28, 2014 at 10:07 pm)Aractus Wrote: No, that quoted section - you're right I was wrong that it wasn't in the paper - clearly contradicts the rest of the paper. The most important determinant for success was completing 27 weeks either in outpatient-treatment or in AA in the first year. This is made very clear elsewhere in the paper. Continued involvement in AA lead to further long-term improvements, but it wasn't at all "the most important determinant for success".

Ah, so you're a better interpreter of the data than the authors of the published paper. Got it!

The authors of the published paper contradicted themselves there, this is clear.

Compared to individuals who did not enter treatment in the first year after they sought help, individuals who obtained treatment for 27 weeks or more experienced better 16-year alcohol-related outcomes. Individuals who participated in AA for 27 weeks or more in the first year, and in years 2 and 3, had better 16-year outcomes than did individuals who did not participate in AA. Some of the contribution of treatment reflected participation in AA, whereas the contribution of AA was essentially independent of the contribution of treatment.