Posts tagged statistics

Measuring Success

Steven Slate put up a really good post a couple of days ago over at his Clean Slate blog. I thought that I’d highlight it here for those who may have missed it. Read it, take notes, study it. There will be a test later:

Fake Success Rates: Retention and Completion

Suicide

Recently the subject of suicide came up in the comments. It’s a subject that we touch on, but haven’t focused on. It’s an important one, and so I wanted to open a thread to discuss the topic, to cull information, anecdotes, research and resources. I would really like to understand this subject better than I do.

So far, I am aware of the Vaillant’s results: Alcoholics Anonymous 3% suicide mortality rate [I corrected this, based on raysny’s clarification in this comment. Sorry for botching that. It’s an important distinction.]. And also aware of a great deal of personal testimony. But not much more.  Has anyone followed up on Vaillant’s results? Is it even possible?  I’m also aware that the subject is controversial, even among the muckrakers.

A couple of very close friends of mine died from their addictions in such a way that couldn’t be classified as suicide, but which I believe were deliberate, or perhaps suicidally reckless. For example, one friend, who didn’t die, told me that one night he decided to kill himself by doing all the cocaine he had in his possession at once (he had been a dealer, so he had a lot), but that if he survived the night, he would give it up for good. He survived, and gave it up just as he promised himself. But if he had died, would that have been a suicide? It would have been classified as an OD or an accident. I’m sure that we all can think of similar tragedies. And I wonder, when we consider suicide, do we count these, too?

I think that some people might find that the connection isn’t between AA and suicide, but between alcoholism and suicide, and that highlighting the correlation is specious. What is your take on that?

Clearly, I have a lot of questions, which is why I never tackled the subject. I just don’t trust myself to address it responsibly or thoroughly. Perhaps, together, we begin to trace an outline.

feh

I found this letter to the editor posted on The Durango Herald, and was going to give it the old “Balls!” treatment, but after reading it over a few times, I found that I couldn’t. It appears to have been written by someone who has experienced a lifetime of incredible despair, and who ultimately found some peace by attending a 12-step program. Further, his problems seem to stem from a bleak and relentless depression (among other psychiatric complications?), and addiction as well. 

While I consider individual members of AA and other 12-Step advocates to be fair game — because, even though they insist that they don’t speak for AA, they do. They are the only ones who do. They’re the face of AA. As I’ve said, they’re the front line. These are the 12-steppers, the sponsors, the ones telling each other how it’s done. And Alcoholics Anonymous doesn’t exist as an accountable entity; it has deliberately placed that onus on the shoulders of its members. So they’re the ones I address. As far as I’m concerned, they don’t get to hide under GSO’s or AAWS’s skirts, because GSO and AAWS have hiked their skirts up and run away screaming toward the horizon with their asses on fire. Continue reading feh

Unofficial, Unoffical AA Slogans

[This goes under my new category: Gratuitous AA Bashing. Alternately: kiss my ass.]

pollution sunset

pollution sunset

After having participated in many discussions with AAs, I have noticed that, while they often disown and dismiss their slogans, they also tend to be Carbon-Based Random Slogan Generators in their own right, responding to any given argument by stringing several slogans together in response to any criticism of their program.

A good case in point is the AA’s response I received in the comments to my Stinking Thinking post, in which the commenter politely handed me my ass for assuming that AAs treat these slogans as gospel, when, in fact, they are just guideposts — even while he unconsciously uses nonsense slogans to make his point, specifically: a variation on “None are too dumb for AA, but some are too smart,” and “One might accuse groups of ‘brainwashing,’ but the fact is, lots of brains NEED a good washing…” Using only two slogans in five paragraphs shows uncommon restraint, and I commend that. But I’m gonna address these.

Being smart isn’t anything to apologize for, as I’ve mentioned before. Neither is there such a thing as “too smart.” Smart is just a thing you are, like blonde or funny. Imagine telling a toddler he’s “too smart.” Not that I don’t get what they’re trying to say: AA works, but not if you sit around trying to analyze it until you suck all the God out of it, like taking the magic out of awe-inspiring sunset, by explaining that all the brilliant colors are generated by pollution.

And clever as it sounds, the brainwashing slogan is just bullshittery on so many levels, no matter how you interpret it, which could be a few different ways: First, “I’d rather be brainwashed than drunk, in jail, institutionalized, or dead.” (That’s a false dichotomy.) Second, “The antidote to my brainwashing is more brainwashing.” (Another false dichotomy.) Third, “Ha ha! So what if I’m brainwashed? I like it!” (“I know you are, but what am I?” To which there is no response, except “Honey? Hide the kids now.”) Fourth, they are making some kind of distinction between brainwashing (which is real) and washing one’s brain (which is not), which sounds kind of Yodaesque, but doesn’t make any sense at all if you’re smart. My gut feeling is that this slogan is simply damage control – a way of offering up just enough of the truth, in a light-hearted way, to diffuse further inquiry. Continue reading Unofficial, Unoffical AA Slogans

Anti-addiction pill blunts craving

Anti-addiction pill blunts craving

Seems to block release of certain brain chemicals

I don’t think naltrexone is a news to most of the people who read here… Here’s the article. 

And this is an enormous surprise:

Despite studies showing effectiveness, established rehab programs have been slow to adopt the use of medication. At Hazelden in Minneapolis, Minnesota, a small proportion of patients receive anti-addiction drugs, but medical director Dr. Kevin Clark says the traditional model — based on intensive therapy and the 12 steps popularized by Alcoholics Anonymous — is still best. “It is a disease of the brain, but it’s a multifaceted disease. It has a spiritual component, a behavioral component to it,” says Clark. “Our experience tells us that having the network of support and recovery is what really makes the difference.”

John Schwarzlose, executive director of the Betty Ford Center, echoes that but takes a more stringent approach. No patients at Betty Ford receive anti-addiction drugs as part of treatment, although a handful of long-time addicts may be referred to a prescribing physician once their stay is over. “Where we battle with [the National Institute on Alcoholism and Alcohol Abuse] is when they say we have trials of a new drug, and then proclaim this is a treatment for alcoholism,” says Schwarzlose. “They’re smart people, but they’re missing how complex this disease is.” Schwarzlose argues that Willenbring and Johnson are using the wrong measure of success. He says abstinence is the only true measuring stick — that an alcoholic who is drinking less is just at a way station on the road to relapse. “Naltrexone has reduced drinking, but once you’re addicted, there is no such thing as ‘OK’ drinking. This is one of those cases where there’s a real schism between the research and actual practice.”

This attitude frustrates Willenbring, who estimates that in the United States only one addict in 10 has even heard about medication options. “In most cases, the treatment is entirely nonmedical. Most people are not even told about the medications that are available for treating alcohol dependence, and I think that’s a crime.”

Now, I’m not a big cheerleader for pharma — companies that invent maladies that you never hear about, didn’t even know you had, until you hear about the brand new pill that will change your life.  But I find the unwillingness to explore, examine, and re-think approaches to addiction that have not been working, by self-righteous, 12-stepping know-it-alls, who utterly dismiss other options, discourage innovation, and withhold information from their clients, to be motivated by exactly the same kind of greed.

How Alcoholics Anonymous lies with statistics

The AA faithful are great at taking what they want and leaving the rest when it comes to demonstrating the effectiveness of the program. Every member of AA who successfully quit drinking is held up as an affirmation of the program, while those 95% plus who fail are disregarded as though they don’t exist. Or, if challenged, they will say that those who fail do not fully “give in to the program.” Of course, by this logic, AA is 100% effective.

Most often, their rationalization of why AA works is anecdotal. They will use their own experience as an example, and they will use the examples of the dozens of other people in their home group to show that the program does indeed work for some people. The problem with this logic is that it disregards the five percent of alcoholics who would have quit on their own without AA by taking full credit for their quit. Because AA meetings are where people motivated to quit drinking tend to congregate, it gives the illusion of a successful program to those making anecdotal observations. Let me draw a comparison:

Let’s assume a type of cancer that has a 5% percent remission rate, and a company produces an herbal remedy that offers a cure for a percentage of people. If we were to take ten thousand people with this cancer, and follow their progress over five years, and along the way replace those who either died or dropped out of the study, we would have 2,500 people whose cancer went into remission while taking the herbal remedy. It looks impressive, but it is the same number of people who would fall into remission from a control group who took a placebo. The herbal remedy would be proved ineffective, and if that herbal company took these figures and offered up an infomercial showing testimonials of cancer patients who were cured while using the remedy, it would be beyond unethical. It would be criminal. Continue reading How Alcoholics Anonymous lies with statistics

How Alcoholics Anonymous Lies with the Truth

“To see what is in front of one’s nose requires a constant struggle.”

George Orwell wrote the above words. So much of the insular world of Alcoholics Anonymous is analogous to entering an Orwellian state, and how AA manipulates public perception is a prime example of this. Many are familiar with the 1989 summary of five previous Triennial surveys released by Alcoholics Anonymous, that shows it to have 95% percent dropout rate within the first year. (source:aa_triennial_survey ) For obvious reasons, AA will not release any further summaries. They don’t really need to, because nothing has changed about the organization to make a positive change to their zero percent effectiveness rate. I say zero percent effective, because the natural course of the disease shows that 5% of alcoholics will quit on their own anyway. Sure, 5% of AAers successfully quit for their first year, but if we were to pluck out a sample of 100 alcoholics who started playing golf, or began knitting, or converted to Catholicism – they, too, would have a 5% quit rate after a year. That does not mean that participating in golf or knitting or Catholicism helps a person recover from alcoholism.

I have often heard a true AA believer say something akin to “I know it works, because I have seen too many success stories to doubt it; and every AA meeting I attend if filled with people who have quit for three or five or fifteen years”. I have seen the same thing, and to a newly indoctrinated AAer who just happens to be stepping into a room for the first time, this all looks impressive. It seems even more impressive after hearing the drunkalogs and stories from other members after any given meeting, telling the newbie how bad their drinking problem was, and how they quit because of Alcoholics Anonymous.

There is a reason the room is filled with successful former drinkers, and that is because AA happens to be a place where people motivated to quit drinking congregate. Giving AA credit for their quits is like blaming hospitals for making people sick, because there are so many sick people at hospitals. Still, this does not prevent AA from using this perception to their advantage. Even though AA does not release any more survey summaries, they still take cherry picked data from their surveys and release it to the public in an effort to give the appearance of its effectiveness. Basically, they lie. Let’s take a look at an example of AA does this. I will use their 2004-survey-brochure, which is given to the public, as an example.

Here is a press release of their 2004 survey. It isn’t raw data – it is their manipulation and interpretation of the raw data. Like all good propaganda, it contains elements of the truth, as in this quote, which is taken from this press release:

Length of Sobriety – 36% of respondents say they have been sober more than 10 years; and 14%, 5-10 years. In response to prior queries, 24% say they have been sober from 1-5 years and 26%, less than one year. These totals indicate that more alcoholics in A.A. are staying sober longer.”

This is an example of lying with the truth, particularly with the inclusion of the last line – “These totals indicate that more alcoholics in A.A. are staying sober longer”. They also say that the average length of sobriety is 8 years. This is patently false, and all one has to do is take this data, and plug in the variables from their 1989 survey summary to see that there is no change in the rate of effectiveness:

Assume a new chapter is started with exactly 100 members with a new person filling in the void left when a member leaves. At the end of year one, there will be 5 one year members and 95 who have been there for less than a year. Go forward another year. You will now have close 10 successful quitters of one and two years (actually, 9.5 if you assume the average, but since you can’t split an actual person, I’m rounding up). Fast forward ten years, and that chapter will have a good many permanent quitters. It looks impressive to anyone attending their first meeting. You’ll have close to 70 people (70%) of the room who have quit for 6 months or more. Of those, close to half are at 5 years or longer. Each of them attributing their success to AA. All of them telling you to work the steps and you can do as they did. Now fast forward 20 years, keep the same success rates of 5%, 30% and 95%, the room looks even more impressive. And if you took a survey of only those who are active members, plot them on that bell curve, you will come up with numbers almost identical to the numbers in brochure and press release:

35% have been sober for over 10 years.

16% have been sober between 5-10 years.

28% have been sober between 1-5 years.

22% have been sober less that 1 year.

The average quit time in this example is 8 years, just like the 2004 survey shows. As impressive as these numbers seem to a person looking around the room, they only prove a 5% quit rate.

Recently on Youtube, I watched a video an AAer had made questioning why a group of people would criticize a “benign and benevolent benefactor”. To him, I would point to the above as an example why AA, like any cult, is not benign. What the numbers do not show, and what is most important, are the consequences of AA’s duplicity. The few successful quitters in that room are impacted little beyond their ability for rational thought, but the hundreds of others who went through the turnstiles with unrealistic expectations of success have been manipulated and harmed. Most go back to drinking, many with the idea that they failed the only thing that could help them recover from their addictions – and they are led to believe it to be their own fault, because they were not “honest with themselves” or they were “selfish” or they “didn’t work it”. The state of being for an X-Stepper who leaves the group is not dissimilar to someone leaving the Moonies or the Church of Scientology, although they are most likely more compromised, because their addiction has been left untreated.

MA