Free The Sober Truth by Lance Dodes Page B

abstinence (even though more
attendance
was not). The Weiss and Majer studies together suggest that the helpful factor in AA treatment may be the level of engagement or sense of group membership, rather than the therapeutic value of the meetings themselves. Of course this interpretation, too, might just be backward: it is entirely possible that the people who do well in AA become more involved as a result—that is, sobriety drives participation.
    By now, the danger of looking at such correlations and concluding that people with alcoholism should go to AA should be evident. It would be akin to recommending that therapists try to get people into religion if they believe religious people are more contented. People who are devout have self-selected into religious organizations because this is meaningful to them. But that devotion cannot be imposed on others. People who do well in AA might very well self-select because they find it meaningful for some reasons I will describe later in this book. But given the results of all the studies on 12-step treatment, trying to push others into AA, who are less likely to find it meaningful, is a mistake.
    The practice of recommending AA to all problem drinkers may also be harmful, as suggested by evidence that AA dropouts do worse than those who seek no treatment at all. The Moos study, for example, found that people who attended but did not stick with AA had worse outcomes than people who never entered the program. This makes sense, since failing to benefit from the approach that others claim to be the best (or only) effective treatment is depressing indeed. Often this depression is exacerbated when the person is blamed for not adequately “working” the program.
ACTUAL NUMBERS
    Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures. The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members. It found that only 31 percent of them were still attending after one year. 32 AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year. 33 A third study found that after eighteen months, between 14 and 18 percent of people still attended AA. 34 So let us assume that between 14 percent and 31 percent of people stay with AA for more than one year. Now we must ask: out of this remaining population, how many stay sober?
    As we have seen, research has shown that only a small subset of people stay sober in AA for any appreciable length of time, and this subset grows smaller with each passing year. When people do attend AA often or regularly, especially when they become emotionally invested in the system (“AA involvement” as opposed to “AA attendance,” as the literature describes), they do well. As noted above, attending a self-help program per se is not helpful, but the
active
involvement seems to make a difference.
    So, what percentage of AA attendees become actively involved? In 2003, a group in London headed by J. Harris looked at patients in residential treatment and concluded that while 75 percent of alcoholics entering residential treatment had attended AA previously, the number of those “working” the program (being “involved” versus merely attending) was 16/75, or 21 percent. 35
    Within this group, how many not only improved, but consistently maintained sobriety? University of California professor Herbert Fingarette cited two other statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. 36 Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members. Similarly, taking the 21 percent “involved” from the Harris