Talk:Alcoholics Anonymous

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Some recent edits[edit]

Yet another editor tried adding WP:MEDPOP-violating references to the article: [1]. Somewhat interestingly, it looks like not only is Lance Dodes' book unreliable because of WP:MEDPOP, but he doesn't agree with his own numbers. In this edit, the number was 5%-8%, but Dodes elsewhere claims 26%, as I once pointed out: [2]

I also removed a paragraph based on a 37-year-old article, because of WP:MEDDATE. Defendingaa (talk) 01:40, 3 March 2016 (UTC)

Since it was brought up (again), we allow AA's own literature in this article because WP:SELFPUB allows an organization's own literature to be used as a reference when describing said organization. WP:MEDPOP and WP:MEDDATE are for the medical claims made in this article: Claims about AA's effectiveness, the disease theory of alcoholism, etc. Defendingaa (talk) 04:48, 4 March 2016 (UTC)
"The number of people who continue to show up" is not exactly "biomedical information", which is a key phrase you will find throughout MEDRS.
MEDRS does not respect SELFPUB sources or advocacy websites for biomedical claims. It does, however, permit the use of books such as Dodes'; see Wikipedia:Identifying reliable sources (medicine)#Books. Look right underneath MEDPOP to see what MEDRS thinks of the AA website as a source for biomedical information.
Also, Dodes never says that "the number" is anything, because there are multiple numbers in question. He says that AA says that "the number of people who continue to show up for more than 12 months" is 26 percent, but "the number of people who maintain sobriety for more than 12 months" is 5 to 8 percent. AA, by the way, appears to have never contradicted this latter number, even though they don't happen to promote it. WhatamIdoing (talk) 05:32, 4 March 2016 (UTC)
Since Alcoholics Anonymous is the most commonly used treatment for alcoholism, it is a medical treatment. The published literature treats AA as a medical treatment -- including, yes, having Cochrane reviews which discuss AA -- so we Wikipedia editors need to do the same. Defendingaa (talk) 06:16, 4 March 2016 (UTC)
Does the medical literature treat the number of people attending a meeting as WP:Biomedical information? MEDRS doesn't cover just anything health-related. It's specifically about biomedical information. "Biomedical", as in "you must have some biology there". Non-biomedical information (e.g., sociomedical information) isn't covered.
But... even if MEDRS fully applied, MEDRS directly says that a pop sci or pop medicine book from an expert, published by a reputable press, is actually MEDRS-compliant. It also says the opposite about the websites of advocacy groups. WhatamIdoing (talk) 06:32, 4 March 2016 (UTC)
Statistics about prevalence of recreational drugs is considered biomedical information, so information about alcoholism treatment is also biomedical information as per Wikipedia policy standards. Defendingaa (talk) 06:39, 4 March 2016 (UTC)

WP:MEDPOP allows direct lay summaries of peer-reviewed articles[edit]

While WP:MEDPOP does not allow us to link to popular press articles and books which either do not use peer-reviewed source, or use a combination of multiple peer-reviewed sources to come up with their own conclusions, is does allow us to link to articles which are lay summaries of peer-reviewed literature, as long as we also include the peer-reviewed article in question. This in mind, I am adding the New York times summary of Humphreys, K., Blodgett, J. C. y Wagner, T. H. (2014) as a separate reference, since Humphreys himself wrote a lay summary of his article which is in the reference, and we can not have multiple lay summaries in a reference because of limitations with the template. Defendingaa (talk) 14:18, 3 March 2016 (UTC)

I invite you to read the section in MEDRS about books, and to tell me if you can find any requirement for peer review anywhere in it. Please do also tell me when you get to the sentence that begins "Additionally, popular science and medicine books are useful sources". You'll find it at the beginning of the second paragraph in that section. WhatamIdoing (talk) 05:04, 4 March 2016 (UTC)
"The Sober Truth" is hardly a "medical textbook" (it certainly is quite biased) and its publisher is not known for making medical texts. Accepting this book's claims without looking at peer-reviewed literature on the subject which contradicts Dodes' conclusions violates WP:UNDUE. Defendingaa (talk) 06:34, 4 March 2016 (UTC)
concur w/ WAID opinion as to MEDRS (as it pertains to this particular article)--Ozzie10aaaa (talk) 11:18, 4 March 2016 (UTC)
I appreciate your input. The reason for the really high bar for sources in this article is based on consensus we hammered out last year. I do know that consensus can change -- and, if it does, then there are a number of sources I would like to see included in the article:

[outdent]

There may be some value including the Dodes book and the 2015 Glaser article in this article, but including both without including the reliably sourced information from other experts just as or more qualified than Dodes and Glaser would be a flagrant violation of a fundamental pillar of Wikipedia policy.

We will end up with "Dodes says this, but the New York Times considers his book deeply flawed, and John F. Kelly with Gene Beresin wrote an article saying the science contradicts Dodes' findings." Is this what editors want? Is this the new consensus for the article? Defendingaa (talk) 15:33, 4 March 2016 (UTC)

For the record, I agree that Dodes' book isn't a medical textbook. It is, however, a "popular medicine" book ("popular medicine" means medicine explained for non-professionals, not a best seller  ;-), which is what the second paragraph in that section discusses.
I always like 'compare and contrast' for opinions. However, the NYT book review may have some problems. For example, the same 1990 comments from AA on their survey that Dodes cites (approvingly) as the source of the 26% statistic is the same one that disavows, in the appendices, the 75% efficacy statistic that the NYT book review asserts as their current position: 'Individuals may rebel against this result as contradicting our time-honored statement that "half get sober right away, another 25% eventually make it," etc. That statement applies to observations made at an earlier time, and there is no reason to doubt that changes in society and in A.A. since that time could create a different circumstance today.' And book review's actual complaint with the Dodes book – the flaws he perceives – isn't about Dodes' disparagement of AA; it's with what Dodes recommends as an alternative. The nicest thing that the book reviewer says about AA is a half-hearted statement that it "may be better than nothing" for some small fraction of people. The book reviewer wants people on prescription drugs, and Dodes wants people in psychodynamic therapy; neither of them seem to actually support AA.
The Cochrane review should wait until it's progressed beyond the science by press release stage. It's likely that we won't have to wait very long for it.
The WBUR piece is interesting for highlighting bias. Dodes reads a Cochrane review that says "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems" and concludes "no evidence that they work". The WBUR authors read the exact same sentence and conclude "AA and 12-step treatment were shown to be as effective as anything else to which they were compared".
Both of these statements are true: it works just as poorly as the treatments it was compared to. Homeopathy has been shown to be "as effective as" the placebo that it's compared to in clinical trials – but it does nothing. Multiple different chemotherapy regimens have been shown to be "as effective as" each other for late-stage lymphoma – but you will probably die, no matter which one you choose (CHOP-R is standard because it has slightly fewer side effects than the alternatives). "As effective as" doesn't mean "actually effective" in an absolute sense. It also misrepresents the recent research. PMID 19207347 doesn't say that AA works; it says that if you tell people to go to AA, and they actually go, then they do better than the people that you told to go to AA but didn't go (that's what "Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement" means in plain English). PMID 19309183 says that if you tell people to change their social networks, then AA attendance is one of the results. PMID 19581057, which begins with the words "Drop-out from 12-step groups is notoriously high" (that's approximately what Dodes' numbers say, right?), seems to be about AA facilitation (and is more of the psych stuff that the NYT book review disparages).
So the bottom line for me is that none of these actually seem to disagree with Dodes' claim that very few people who show up (i.e., for at least one meeting) are actually successful at achieving and maintaining sobriety as a result. WhatamIdoing (talk) 16:52, 4 March 2016 (UTC)
As you point out, there isn't anything out there with a track record better than the 12 steps. This is not what Dodes tries to imply in his book. He tries to imply that he has found something that works better -- but he hasn't. There is a strong correlation between regular meeting attendance and continuous sobriety; in The Natural History of Alcoholism Revisited, there is a table showing that 48% of the people who experienced stable remission had attended 300 or more AA meetings, while only 2% of the people who were chronic alcoholics had attended 300 or more AA meetings. Because of the universality of Alcoholics Anonymous, it's hard to tell if this is a correlation or causation (Dodes tries to argue, unsuccessfully, that it's 100% correlation -- the old "AA is no better than spontaneous remission" chestnut which the majority of modern peer-reviewed science on addiction disagrees with), but PMC4285560 makes a strong case that it's the program itself (and not self-selection bias) that is helping people.
It noteworthy that you mention cancer treatments. We routinely give patients expensive treatments for cancer even when we know it will almost certainly not work. But, when we suggest that people with alcoholism problems attend Alcoholics Anonymous meetings, people get upset at suggesting this treatment, even though AA is free (Though, yes, I always put $2 in the basket). The New York Times review of Dodes' book is not saying AA doesn't work -- it's saying that it's foolish to not recommend AA when it's free and sometimes works.
When I first joined AA, I knew the numbers. I knew the chances of achieving long term sobriety were statistically low. But, that didn't stop me from regularly going to meetings. I found a mentor -- sponsor -- who got me to read the Big Book and work the program as described there. Just as the Big Book promised me, I had a spiritual awakening -- that was about three decades ago and I haven't had a drink since then.
I would like to see a peer-reviewed study where they see the success rate of people who do the things we suggest people in meetings do: Get a sponsor. Work the 12 steps as written in the first 164 pages of the Big Book. Some studies get close to that (PMC2220012, etc.), and they show that engaged members can and do get sober.
The failure rates that biased authors like Dodes like to quote are based on statistics involving people who attend meetings because of a "nudge from the judge" or other outside coercion. People who do not work the program usually do not get better. But to imply that these low success rates exist because the Alcoholics Anonymous program does not work is downright dishonest. The program works -- the peer-reviewed research shows that it works -- but most people who are attending AA on a court slip will not work the program we suggest newcomers work to achieve long term sobriety. Defendingaa (talk) 17:38, 4 March 2016 (UTC)
One final point before I go for the day: The discussion in that New York Magazine article about what the next Cochrare review on Alcoholism treatment might say is not science by press release; it was the journalist who sought the scientists, not the other way around. Defendingaa (talk) 17:46, 4 March 2016 (UTC)
Actually, there seem to be more effective treatments – just probably not Dodes' favorite one. (You may have noticed that we aren't mentioning Dodes' favorite treatment, as that's irrelevant to the topic at hand.)
What is relevant is the fact that, in your words, "the chances of achieving long term sobriety were statistically low". Every source agrees on that point, especially if you're depending upon AA alone to get you there. So why doesn't this article say exactly that, in plain English?
By the way, it's not mathematically possible for court-ordered attendance to cause these low success rates, even if we assume that the prospect of jail and probably losing your kids isn't extraordinarily motivating. According to AA, 88% of members aren't under court orders. Excluding all court-ordered attendees from Dodes' calculation would raise the rate of one-year "survival rate" (abstinence plus continued attendance) from his estimate of 5–8% only up to 6–9%. That's still ineffective (by AA's own chosen standard of success) for more than 90% of people who ever attend an AA meeting, and it's still a third of the number that the FDA says are significantly helped by Vivitrol (to give one example of a more effective [on average] treatment).
I agree that the NYT book review doesn't say that AA never works. Can you agree that it also never says that it actually does work, or that Dodes' estimate of overall success is wrong?
Even Dodes agrees that the people who are most likely to be successful in AA are the people who put the most into it. That view is common in the literature, but strangely underplayed in these articles. I think it's reasonable to include all of this information:
  • If you count all the people who ever attended an AA meeting, then the long-term success of AA is quite rare – maybe one in 20 people.
  • Most people drop out within weeks or months. Many don't "really try", to use AA's phrase, even if they continue attending.
  • But success rates are higher (unknown, but higher) for the people who continue to work hard at it.
Maybe providing this complete picture of reality would help readers the most. It might help set realistic expectations for courts and family members about the limited benefit of forcing someone to attend. It might encourage members to "work the program" instead of hoping that showing up is enough. It might help general readers remember that addiction is complicated, that "better than nothing" isn't necessarily "good", and that it's a hard journey. WhatamIdoing (talk) 06:41, 5 March 2016 (UTC)

How do we achieve WP:NPOV?[edit]

There are two trains of thought when looking at Alcoholics Anonymous (AA):

  • There is the train of thought that AA does not work because only x% (usually 5%) of people who ever go to even one AA meeting stay sober. This line of thinking does not appear in recent peer-reviewed literature about AA's effectiveness, but it's a popular figure to quote in anti-AA polemics such as Dodes' "The Sober Truth" (it's not me calling "The Sober Truth" a Polemic -- it's the New York Times which called it that). I think this article has spent too much effort engaging in original research about what this percentage is -- the only sources which give out a percentage are anti-AA polemics.
  • Then there is the train of thinking that AA helps because x% of people who engage in AA/twelve step facilitation/12-step treatment get sober, where x can be as high as 75% (e.g. on page 197 of The Natural History of Alcoholism Revisited there is a chart showing that, of the chronic alcoholics who went to 300 or more AA meetings, 48% of people who had stable remission went to 300 or more meetings, while only 2% of the alcoholics still chronically drinking went to 300 or more meetings; it's easy but probably original research to run the math and find that, on this chart, 74% of the people who went to 300+ meetings had stable remission, 21% of the 300+ meetings attenders had intermittent alcoholism, and only 5% of people who went to 300 or more meetings were still chronic alcoholics -- numbers, that, interestingly enough, agree with the figures in the preface to the second edition of AA's own Big Book [50% got sober right away, 25% got sober after relapsing, and the rest showed improvement])

This article has had, over the years, numerous attempts to make this "The AA article which the Orange Papers wrote", which is not a neutral point of view. For us to be neutral, we need to represent both points of view in this article. For example, as I pointed out above, it may be OK to include Dodes' "The Sober Truth", but, if we do, we will also have to include the articles from reliable sources which disagree with Dodes' conclusions. Ditto with the Glaser article from last year.

Defendingaa (talk) 03:47, 8 March 2016 (UTC)

Removing 1990 Triennial survery; Adding Lande Dodes[edit]

I have removed the following:

Internal AA surveys suggest that about 40% of the members sober for less than a year will remain another year. About 80% of those sober more than one year, but less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year. Those who remained sober outside the fellowship could not be calculated using the survey results.

This paragraph used the following reference: "Comments On A.A. Triennial Surveys". Alcoholics Anonymous World Services. December 1990.  But I can not find the "40%", "80%" and "90%" numbers claimed in the paragraph; this appears to be original research.

I have replaced it with a paragraph about The Sober Truth by Lance Dodes; it describes both Dodes' figures and the counterarguments to those figures, as well as mentioning Glaser's 2015 article about AA. Since the Dodes book and the Glaser article got so much attention, it's probably a good idea to mention them in this article, as long as, in the interest of WP:NPOV, we have other reliable sources with different points of view. Defendingaa (talk) 12:49, 15 April 2016 (UTC)