How Alcoholics Anonymous Lies With Front Groups: Project MATCH and Hazelden

Project MATCH, which stands for Matching Alcoholism Treatments to Client Heterogeneity, is the largest and most expensive ($27 million) multi-site clinical trial of different forms of rehab treatment to date. The idea of the study was to determine the effectiveness of matching specific forms of treatment to the individual characteristics of the patients. Three forms of treatment were studied: Twelve-Step Facilitation Therapy (TSF), Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET). The finding of the study showed a positive result for all three groups, including TSF. Here is the original press release from the NIH. So, the study validated the hypothesis, and all was right with the world for those advocates of AA and the 12-Step approach.

Hazelden is considered the gold standard in alcohol rehab treatment, and they base their model of treatment on the 12-Step approach. They created the Minnesota Model of addiction treatment, and they are far and away the largest publishers of AA based books, as well as the largest single purchaser of AA literature; they have board members that serve on the AA board. Hazelden has more than a  vested interest in the success (or perceived success) of the 12-Step approach to recovery. AA is their life blood, so when the initial findings of Project MATCH were announced, Hazelden was understandably pleased. Here is an article published by Hazelden in The Voice (2000) titled, “Recent research offers compelling support for the effectiveness of Twelve Step-based treatment”. Here is a quote from this article:

One of the largest and most widely quoted studies to support the ‘AA works’ philosophy is Project MATCH….”

It goes on to describe the type of 12-Step treatment used in Project MATCH:

Twelve Step Facilitation Therapy, grounded in AA’s concepts of alcoholism as a disease of the mind, body, and spirit and lifelong abstinence as the only sane response. This form of treatment guides clients through AA’s first five steps. It also actively encourages people to attend AA meetings, keep a journal of their experiences at meetings, read AA literature, and practice AA principles ‘in all our affairs.’”

It goes on:

Project MATCH found few differences in outcomes among the three treatments. This means that Twelve Step Facilitation held its own, working as well as Cognitive Behavioral Therapy and Motivational Enhancement Therapy. In fact, Twelve Step Facilitation offered a statistically significant advantage when total abstinence was the desired outcome.”

Finally, they offer a qualifier:

…treatments such as Twelve Step Facilitation (TSF) are technically not the same as AA. In Project MATCH and related studies, this treatment is based on individual counseling sessions with an ultimate purpose of guiding people to join AA. But in itself, AA is not a counseling or treatment program.”

This is an example of Hazelden wanting it both ways. On the one hand, this study proves that AA works. On the other hand, if it shows any component of the study was ineffective, it is “not really AA”. It is also absolute bullshit. Not only was TSF AA, it was spoon fed AA on steroids. This is taken directly from the TSF manual for the Project MATCH study:

“Twelve Step Facilitation Approach. This therapy is grounded in the concept of alcoholism as a spiritual and medical disease. The content of this intervention is consistent with the 12 Steps of Alcoholics Anonymous (AA), with primary emphasis given to Steps 1 through 5. In addition to abstinence from alcohol, a major goal of the treatment is to foster the patient’s commitment to participation in AA. During the course of the program’s 12 sessions, patients are actively encouraged to attend AA meetings and to maintain journals of their AA attendance and participation. Therapy sessions are highly structured, following a similar format each week that includes symptoms inquiry, review and reinforcement for AA participation, introduction and explication of the week’s theme, and setting goals for AA participation for the next week. Material introduced during treatment sessions is complemented by reading assignments from AA literature (p. x)….The therapeutic approach underlying this manual is grounded in the principles and 12 Steps of AA (p. xi)….The program described here is intended to be consistent with active involvement in Alcoholics Anonymous….It adheres to the concepts set forth in the “Twelve Steps and Twelve Traditions” of Alcoholics Anonymous….The overall goal of this program is to facilitate patients’ active participation in the fellowship of AA. It regards such active involvement as the primary factor responsible for sustained sobriety (“recovery”) and therefore as the desired outcome of participation in this program (p. 1)….This treatment program has two major goals which relate directly to the first three steps of Alcoholics Anonymous (p. 2)….The two major treatment goals are reflected in a series of specific objectives that are congruent with the AA view of alcoholism (p. 3)….Central to this approach is strong encouragement of the patient to attend several AA meetings per week of different kinds and to read the “Big Book” (“Alcoholics Anonymous”) as well as other AA publications throughout the course of treatment (p. 4)….The goal of the conjoint sessions is to educate the partner regarding alcoholism and the AA model, to introduce the concept of enabling, and to encourage partners to make a commitment to attend six Al-Anon meetings of their choice (p. 5)….[P]atients should be consistently encouraged to turn to the resources of AA as the basis for their recovery (p. 6)….Suggestions made by the 12-Step therapist should be consistent with what is found in AA-approved publications such as those that are recommended to patients (p. 8)….Encouraging patients to actively work the 12 Steps of Alcoholics Anonymous is the primary goal of treatment, as opposed to any skill that the therapist can teach (p. 10)….The therapist acts as a resource and advocate of the 12-Step approach to recovery (p. 11)….In this program, the fellowship of AA, and not the individual therapist, is seen as the major agent of change (p. 14)….The 12-Step therapist should not only be familiar with many AA slogans but should actively use them in therapy to promote involvement in AA and advise patients in how to handle difficult situations (p. 15)….In approaching alcoholic patients using this program…[t]here is…no cure for alcoholism; rather, there is only a method for arresting the process, which is active participation in the 12-Step program of Alcoholics Anonymous (p. 33). (Nowinski et al., 1995)” (Schaler, Jeffrey  “Addiction is a Choice”)

Of course it is AA. This is obvious, but even if it did not incorporate all of AA’s tenets (which it did), AA itself proclaims you can “take what you want and leave the rest”, which means that by their logic, any combination of any components of AA are fine. By their logic, a person can take only one step if that is all they need, and it would still be considered AA. This is just another example of AA, and in this case Hazelden, an AA front group, talking out of both sides of their mouth.

As it turns out, Project MATCH was fraught with problems, from selection criteria to participant selection. The initial conclusion was the victim of cherry picking the participants and misinterpreting the data. Upon peer review, it was shown that there was no difference between TSF (AA) and the two other forms of treatment. In this case, Hazelden was right. It also showed that none were more effective than no treatment at all. None of the treatments worked, and twelve stepping actually had more of a negative impact than no treatment at all. Here is a link to a peer review from the University of Miami: Are alcoholism treatments effective? The Project MATCH data. From the study:

Results

Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered. The zero treatment dropout group showed great improvement, achieving a mean of 72 percent days abstinent at follow-up. Effect size estimates showed that two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero treatment group. Outcomes for the one session treatment group were worse than for the zero treatment group, suggesting a patient self selection effect. Nearly all the improvement in all groups had occurred by week one. The full treatment group had improved in PDA by 62% at week one, and the additional 11 therapy sessions added only another 4% improvement.

Conclusion

The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.”

It also made this statement, which is applicable to not only inpatient rehab treatment, but for AA specifically:

Exaggerated claims of treatment effectiveness can have undesirable consequences for patients, for therapists, and for science. Patients who fail an “effective” treatment may feel even more hopeless. This increased despair may be extremely deleterious in people with such life-threatening habits. Therapists may feel inadequate or frustrated with repeated failures. For science, exaggerated claims tend to shift focus into unproductive directions, and to obscure the pertinent facts that are necessary in order to move the science forward.”

I cannot agree more, and I have seen the consequences of people failing while doing the AA program. The unrealistic expectations that come from reading the 12 promises and things such as “rarely have we seen a person fail…” exacerbates their already frail psychological state. Add to this the shame and other mind games, and you wind up with someone worse off than they were before entering AA.

One thing this report does not address, which is important, are the consequences to the family of the patient. Rehab treatment facilities are expensive, some costing tens of thousands of dollars per stay. Insurance does not always pay for these programs, and it is not unusual for families to drain their savings and mortgage their homes in order to receive treatment. This is understandable, as any person or family member of a person suffering from addiction will tell you. Most will do whatever is possible if they believe that it will properly treat their addictions. Family members of patients are encouraged to attend Ali-non meetings, where they are fed the same dogma that is given to the stepper. So, if an AAer is not yet convinced of their character flaws, their family will confirm them, and will attribute their addiction to those flaws, because they learned this from the good people in Ali-non. The financial and emotional harm tears relationships apart.

What has changed as a result of this study? Nothing, really, except Hazelden (and other AA based rehab facilities) no longer tout the results. It is business as usual. At this moment, someone is stepping into a treatment centre for the first time, and along with his or her family, they are expecting effective and proven treatment; integrity from their caregivers; and a way out of the hell of addiction in which they have found themselves. They won’t get any of that. Think about that next time some stepper tells you that we are picking on a benign and innocuous organization.

MA

  • Pingback: The Myth of ‘Anti-AA’ & ‘AA-Bashing’: Not Playing “The Mug’s Game” Any More « Stinkin Thinkin()

  • joedrywall

    Might as well put up a few more.
    http://thearidsite.tripod.com/12FRONTG.HTM

  • anonymous

    What a joke it is to go to a mental hospital, pay $25,000, and then get handed a big book. Hell, a person could decide to do that in Hawaii with their own personal nurse if they hadn't mind f***ed themself to death with booze and drugs.

    Why pay a mental hospital to solve a problem you brought on yourself with the implementation of a free program that sucks. I'll tell you, its because you are adicted to convenience, want to blame others for your troubles, and can't imagine geting up off your ass and fixing it yourself.

    I find that the loosers in AA have made a habit of failure.

    The other day a AA friend of mine said he was going to get drunk. I reminded him how badly this went the last time and told him that if he had a plan for drinking it might not end up so bad. This poor guy is so convinced that his only options are insanity, institutions, and death, that failure and debotchery have become a manifest destiny for him.

    It does not have to be that way. He has the money to quit his job, relocate near a liquor store, and drink for an extended period of time.

    Insted he fails to plan, has a stupid "AA slip" , looses everything, and then crawles back to dumb ass AA anonymous for some attention.

  • Pingback: “That Isn’t AA!” – Stinkin' Thinkin'()

  • RadI n Brooklyn

    It's Al-anon not Ali-non, as you talk like you know ali bout it:)

    Good stuff,  just lose a little credibility with poor spelling, i think.  But it's nice to hear the stuff I have been thinking for over 10 years and thousands of AA meetings.  Ha, What a joke.  Love the fellowship, but could do without the BullXXX.  Think I'l  join a sober knitting club or something

  • Radi, seriously, you certainly can find some awesome fellowship in groups that interest you, that lift your spirit. If you find that you've been subject to 10 years of bullshit, then find some fellowship at your local stitch'n'bitch — have coffee, create… You're in. Rock your sobriety Radi!

  • Ez

    I tried to link up with the 'not playing the mugs game' link above and got a "page not found" msg…bad link or archive gone?

  • Ez. That is Speedy's post, and it still exists, but I am having a hard time figuring out why it won't appear. I see it on the back-end, but I also get a "page not found" on the front page.

  • McGowdog

    The 12-Step therapist should not only be familiar with many AA slogans but should actively use them in therapy to promote involvement in AA and advise patients in how to handle difficult situations

    Can I be a 12-Step therapist?  CanI, CanI, CanI?  I'd be a good one.  I'd use my own slogans too;

     

    – Wait for the POP!  What's the POP?  The sound it makes when you pull your head outta your ass.

    – Praise the Lord, pass the basket.

    – First Things First… which we'd hand over the restroom doors of course.

    – I'd rather have a bottle in front of me than a Frontal Labotomy

    – There's a baby in every bottle

    – Wait for the miracle… in bed.

    Those are just a few I'd use.

    AA itself proclaims you can “take what you want and leave the rest”

    Nicely written btw, ftg.  I'm not so sure this one would make it into our group conscience.  If we can't claim, "But that's not A.A."… then can my group claim, "Well I guess we're not A.A."

    I think it's unnecesary.  Go try to pass that slogan on Danny Boy.  See if "Take what you want and leave the rest" comes up in his study group.  Is there virtue in the slogan?  Probably… in some context. 

    I have to look at "what is the truth" in this.  How was I shown?  "Get in or get out.  This is what we do.  Decide if this is what you're gonna do."  I didn't get the option to decide what "this" was.  I'll guarantee you Hazleden didn't write our autonomous Group Conscience.

     It also showed that none were more effective than no treatment at all. None of the treatments worked, and twelve stepping actually had more of a negative impact than no treatment at all.

    Where have I heard this before?  The guy who started our group which came from another big group in Denver was a guy named Frank McKibbon, RIP.  He said this, "There's a rumour in A.A. that you can come to A.A. to get and stay sober.  This simply is not true.  Most people who come into A.A. do not do the work, they go back out to drinking."  Would you argue him?

  • 12 step programs terrified me.  I had to go with SMART Recovery

  • Z

    I am studying all this anti AA material. It's really fascinating; I should have thought of doing it before; it has existed for longer than I realized. In this video Peele uses the term "cultural psychosis" to talk about the way in which Americans, due in part to the influence of AA, think of addiction and of the effects of drugs. http://www.youtube.com/watch?v=pQe9aedDH9I

  • Z

    Hm – if I put videos, the software seems to put the whole thing (I only mean to put the URL) and to cut out my comment explaining why I put it. So: this Peele one is of interest because he says the way we think, esp. in the US, about drugs and addiction, partly due to the influence of AA, isn't just wrong – it's a "cultural psychosis."

    Great term. I hadn't realized how much anti 12 step material there was out there now; people have figured out everything I had figured out and more; it is SO affirming to discover this.

  • Primrose

    It's a great feeling z.  I thought that I was alone in hating aa, and I was terrified of seeming anti-aa, because that made me 'in denial'.  Even now, I am loth to say, 'My name is Primrose and I am not only not alcoholic, but I have serious doubts whether that condition exists as aa portray it.'

    I wholeheartedly agree that 'it' is a cultural phychosis'.  I came to that conclusion myself when I was going through the denial mindfuck above.  It is unacceptable to say anything except the ridiculous platitudes.

  • Mona Lisa

    You might want to read this before posting further:

    http://stinkin-thinkin.com/faqrs/

  • Z

    Re "Are you saying that AA doesn’t work and makes things more difficult for problem drinkers?"

    See the title of the post: "How Alcoholics Anonymous Lies With Front Groups: Project MATCH and Hazelden." That's what it's about.

  • Patrick Dobson

    The essay above needs a central argument to make much sense. Are you saying that AA doesn’t work and makes things more difficult for problem drinkers? If so, that’s a great thesis. As with any thesis or argument, however, it needs solid information and evidence to back it up. Instead, this seems like a razor-sharp example of someone flailing away with very selective and often out-of-context information at something that makes them angry. There’s plenty of that going around these days.

    My argument is simple: If you have a problem and find a way around that problem or a way to get rid of it all together, do what works. All the arguments regarding the effectiveness or logic–or lack of either–of your method or ideas make no difference.

    Disease or not disease is an argument that can go on and on. God or no God. Spirit or no spirit. Jesus or no Jesus. (Personally, I’m not a believer. I’m what you might call la freethinker in the 19th century sense.) In the end, who cares? You’re in a pit. You have the option and choice to dig deeper or dig out. If AA turns your head and labor upward, good for you. If church, good for you. If moderating your consumption, good for you. In the end, we have to ask ourselves what’s so important about being able to drink, or, as Dr. Peele seems to argue, use cocaine, heroine, or crack recreationally? Does using AA as a tool in a wider body of life changes make you more apt to become insane, emotionally broken, or less of a productive citizen? Again, what difference does it make? If it does and you are miserable, and if the misery becomes too great, you will find a way to live that is less so. Or you’ll just remain insane, emotionally broken, or a slouch until you decide to do something different.

    The argument above also seems to take as a baseline that there is some central ideology to AA. But having been to meetings in 28 states and seven other countries, I have yet to find one AA meeting that looks like another. I have yet to meet an alcoholic who takes the AA program just like another. Groups, like people, tend to have neuroses, emotional problems, wider or narrower minds. Thus, some groups are better for some people than others.

    As far as I know, the program only suggests ways to keep from drinking, quit hurting, and screwing up life. They work for some, and fail for others. I’ve stayed sober for over 20 years, specifically with the AA program.

    Moreover, never seeing a person fail does not refer, nor can it, to success in life. It can only refer to, as you say, arresting the problem. No one in AA claims that alcoholism does goes away. As a matter of fact, it is accepted wisdom that it only gets worse. Only, by not drinking, people tend not to take part in or feel the consequences of drinking behavior.

    AA also does not claim to be the only way to stay sober or to arrest the problem. I personally know many people who stopped drinking, and don’t drink, without AA. Their lives are pretty good on some accounts. On others, well, maybe they should start drinking again because a life of abstinence is as miserable to them as a life of drinking.

    Personally, despite the arguments above and the opinions and statistical interpretations of Dr. Peele, a highly regarded professional, I can think of nothing more miserable than having a drink. Twenty or thirty is a whole lot less miserable, though the consequences may be devastating.

    Now, the more important question is whether AA or treatments or whatever holds out false hope to weak people. Maybe, and if so, it is wrong. But there are many things that hold out false hope for success in living: American materialism. Money. Sex. Religion. The idea of becoming like everyone else. The idea of being able to moderate substance abuse. Scientology. Astrology. Tarot.

    In other words, if nothing works, then why try?

    So, in the end, grind that ax, my brother, if it makes you feel better.

    Regardless that I gave up becoming a successful millionaire without AA, I certainly have a hell of a lot, and a hell of a lot more satisfying than if I would have listened to the arguments against AA’s effectiveness or basis in fact. Frankly, like most alcoholics, I would cling to these sorts of things as reasons not to stop drinking, probably to my demise.

    I’m not adverse to having a conversation over addiction, alleged addiction, the effectiveness of AA (which, as you point out, is just as ineffective as anything else, and I agree). But if we are to have such a discussion, we must away the emotional and cultural combativeness, which the above diatribe does not. The idea, I think, is to help people form better, more rewarding and fulfilling personal lives.

    By the way, if you’ve found a way that works for you outside of AA, good for you. I haven’t found that yet.

    • MA

      The essay above needs a central argument to make much sense. Are you saying that AA doesn’t work and makes things more difficult for problem drinkers? If so, that’s a great thesis. As with any thesis or argument, however, it needs solid information and evidence to back it up. Instead, this seems like a razor-sharp example of someone flailing away with very selective and often out-of-context information at something that makes them angry. There’s plenty of that going around these days.

      Hi, Patrick. Thanks for comment.

      I appreciate the lesson on constructing an argument, but it seems you yourself need a lesson in logic 101. The burden of proof that AA works is on AA, as it is impossible to prove a negative. I cannot prove AA doesn’t work, any more than I can prove that there is not an invisible elephant in the room. Your argument is fallacious, as any first year philosophy student would understand.

      Any study or survey that has actually tried to prove AA works, including the Project MATCH study referred to in this post, does not show it to be effective. No study will ever be produced showing it “does not work”, because that is not how science operates. Again, this is a simple concept to understand, as any first year biology student would tell you.

      As for the balance of your comment, most of what you wrote is addressed in the link Mona Lisa provided (do you AAs sit around and practice this script?).

  • MW

    AA is sick to the core. My sponsee got raped. Another sponsee was almost raped. By men of AA “in good standing,” men with sponsors and home groups. These are not the worst of the happenings I could tell.

    BTW just to be clear ( although I completely agree with every point made in this essay): I was also an Al-Anon member for almost 8 years. Al-Anons actually don’t sit around talking about the alcoholic’s defects of character.

    What they ACTUALLY do is sit around self-flagellating themselves with their own character defects. When one is new in Al-Anon, one is told to “stop focusing on the alcoholic” and to “focus on yourself.” Meetings are there primarily to teach each other how to stay with their abusive, narcissistic, unemployed partners until somebody dies.

    Al-Anon even has a handout that says “DON’T NAG, SCOLD, OR COMPLAIN.” Can you effin believe that? That handout, called” the do’s and don’ts,” was probably written by Bill to Lois.

    If anyone wants to hear more anti-feminist hilarity from Al-Anon literature, let me know, I have almost every book they publish. Might as well use it all for something good, other than kindling.

    Lest any AAer be self-righteously reading this, thinking to himself that we are all angry and resentful:

    Oh, man, nothing could be further from the truth. I haven’t felt this good in years! Probably not since I got sober. I got the 12-step monkey off of my back and I am actually happy now! The disparaging stuff I say about AA is not said in anger but due to the grave danger I see many women and children in who attend AA with criminals sent to those rooms by the state.

  • Interesting notion in Mr. Dobson’s comment, one I’ve heard before as well that seems as contradictory as much other 12 step twists of logic. I say this not to bash the commenter, but just in passing about this statement which I’ve heard before many times, paraphrased as :
    “They might as well go back to drinking or using, their lives are miserable” (the inference being that people outside of AA/NA/etc. are so miserable they should go back to what the stepper has already come to believe is an inevitably fatal disease–which is utterly illogical!).

    Please, if I have pegged you wrong here, feel free to tell me how so.

  • Debbiered

    Well, Hazelden and AA certainly didn’t help poor Robin Williams. Instead of finding “fellowship” at an AA meeting, a fellow member snapped his picture and sold their “story” to the tabloids. So much for Anonymous.

    • That was the least of Robins worries. AA failed him by telling him he was powerless and that he had a disease. I will miss him.