Some things you can’t measure

Columbia University conducted a 573-page report entitled Addiction Medicine: Closing the Gap between Science and Practice. This in-depth study’s major takeaway is that, for the extreme severity of the affliction and the prevalence of it in our society, addiction is grossly under-treated. On page 133 of said study, under the section “Most People in Need of Treatment Do Not Receive It,” the scientists write:

In 2010, 15.9 percent of the U.S. population ages 12 and older–40.3 million people–met diagnostic criteria for addiction… CASA Columbia’s analysis indicates that only one in 10 (10.9 percent, 2.5 million) of those in need of addiction treatment (excluding nicotine) receive it, leaving a treatment gap of 20.7 million individuals. The proportion of individuals in need of addiction treatment who actually receive it has changed little since 2002, when 9.8 percent of those in need received it.

In a nutshell, the study finds that; despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.

This is and should be the focal point. As a society, we desperately need the research community’s brilliance, expertise and contributions to solve this crisis: a dire lack of resources to help addicts. Yet despite this, there are still efforts made to measure the success of Alcoholics Anonymous in order to ‘debunk’ it.

*           *            *

Alcoholics Anonymous is anonymous. Anonymity is the core of this program. It defines the fundamental essence of what it is. It is the very fiber of the fellowship. I can write this letter to you with a free conscience because I am not a member of this community. Publicly identifying oneself as a member of AA is against the spirit of the program (although recovering alcoholics may, under certain circumstances, be encouraged to discuss their program privately with personal contacts). I might not even know if I am close to someone in this program. You don’t know, either. Because it’s anonymous.

My excessive emphasis on the anonymity of this program is because it is directly related to data collection and the ability to conduct evidence-based research on this program. If one does not understand the importance of anonymity in this program, than he or she is not qualified to exert a scientific opinion. He or she is not properly taking into consideration how this skews his or her data and/or the research and studies he or she is reading.

How does this, then, relate to data collection and evidence-based research? Many activities are ‘anonymous,’ but are still measurable (such as voting, for instance). But here I highlight several key reasons why the nature of Alcoholics Anonymous makes any type of ‘data’ dubious in nature:

  1.  This is a volunteer, decentralized organization that is nonprofessional. If a group does take attendance, it may be only periodically measured and is dependant upon the meeting. Some meetings never take any attendance at all.
  2. No one AA community is the same. The AA community is comprised of its members and the culture those members foster within their immediate fellowship. The effectiveness of one AA ‘group’ is not reflective by any means of the ‘whole.’ One group could be significantly more, or less, successful in supporting its members than others.
  3. Members of AA don’t always attend the same meetings. They may go to one meeting on Avenue A and the next week go to another meeting on Avenue Z. It’s possible they go to ten different meetings all over their city or community. You cannot track them accurately by tracking their attendance at one particular meeting ‘location.’
  4. Success is notoriously difficult to measure with addictions. An addict may call him or herself successful because he or she managed not to drink for 5 days in a row. An addict may label him or herself unsuccessful because he or she has been sober for 29 years and they still occasionally feel the urge to drink. Success may be showing up to a meeting and not drinking for 60 minutes straight. Success may be making it to the grave without another drop of liquor touching his or her lips.

Gabrielle Glaser, author and journalist, wrote the article The Irrationality of Alcoholics Anonymous in The Altlantic. I can summarize the long, winding article with one single quote: “The problem is that nothing about the 12-step approach draws on modern science.” Basically, her premise is that AA is ‘irrational’ because it isn’t evidence-based according to modern standards and science. It did not escape my notice that Glaser herself is neither scientist nor academic researcher, and this feels like quite the bold denouncement from someone with a master’s in history.*

Glaser claims that the success rate of AA is between 5 and 8 percent. These numbers are frequently cited when criticizing the program. They are taken from the book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, by Lance Dodes, a retired psychiatry professor from Harvard Medical School. He draws this conclusion based on AA ‘retention rates.’ This is the percentage of people who attend a meeting at a given point (when the study is initiated) and those who are present in the meeting at a given point in the future. I listed my reservations about this above. And in addition to all this, you can be at an AA meeting every single day and not experience ‘success.’ Your rate of attendance at AA meetings does not mean you are actively participating in the program.

I don’t know the success rate of AA. It could be far higher than, let’s say, 6 percent. Alternatively, it could even be lower. The bottom line is that no one knows, even if they pretend to, and if they pretend to they are disingenuous. You are not going to be able to find out due to the nature of the program. Therefore I caution anyone who may be tempted to judge the program to be wary of drawing conclusions based on the ‘data reports’ of success. We simply don’t know, and publicly criticizing an organization that might be the only possible avenue for help, based on suspicious data and conjectures, may be providing an addict (already usually highly paranoid and irrational) just the excuse they need not to seek help.

This begets a question worthy of consideration. The success rate of AA, in and of itself… does it even matter to the huge, untreated swath of addicts in the United States? It doesn’t, because for most addicts there is no alternative. Even if it is only very minimally successful, let’s say (hypothetically) it hits a success rate of 5%, at least it’s there. The alternative is, for the average addict, nothing at all.

I would be remiss if I did not address the higher power, or God element, in the AA literature. This is particularly unnerving to many scientists and researchers, and many potential participants in the program itself. Yes, belief in a higher power is an integral component to the Alcoholics Anonymous. No, you cannot effectively participate in the program without acknowledging and accepting this. Yet the ‘higher power’ component, or the God element, is not as simple as many people assume it to be. AA does not ascribe a higher power to its participants. Every single addict identifies a higher power as he or she sees it or understands it. This can range from a higher power that is; your better self, the collective goodness of humanity, the Christian Jesus, the Muslim God, the unity of your fellowship, love, Mother Earth, the Holy Squirrel of Kalamazoo. The relevance of the higher power in AA is that an addict cedes control and acknowledges that he or she is powerless of his or her addiction, and that they need help from a higher power, be that his or her better self, an angel wreathed in billowing robes or the glory of the Fibonacci numbers. So no, it is not a cult. But yes, it is a spiritual program.

We must tread very, very carefully around the subject of addiction. Addicts are desperate, vulnerable and irrational. They are controlled by their addiction, which is a progressive disease. They need help. There are extremely limited resources for an addict to get help, and as we have seen, the vast majority of them never get treatment. An addict, in a moment of despair, can go online and chances are they can find, within a twenty-mile radius, an Alcoholics Anonymous meeting that is about to happen. They can go sit with fellow addicts who understand and accept them and who do not judge them, no matter what egregious and horrific acts they have committed. And neither you, nor me, nor anyone, is ever going to be able to figure out just how ‘successful’ the program is.

The fact of the matter is that this is not an organization that lends itself to accurate scientific assessment. And if one insists on publicly tearing down existing structures based on unreliable data, I would recommend making very certain there is another option in its place. And as it currently stands, there aren’t.

 

 

*We can all draw our own conclusions, as I do myself on this very blog. I question Glaser’s wisdom and judgment, yet it is her right to exert her opinion. I do, however, judge The Atlantic for publishing an article publicly denouncing an organization because it isn’t evidence-based according to the modern standards of science, yet is written by someone who is not qualified to draw those conclusion and has a book to sell.

3 Comments

  1. Jessica, This blog is so well written and so right on. I too don’t know how many lives have been saved because of AA but I personally know of several. If it only would be one it would be worth it but I know it has to be many over the years. Thanks so much for posting on a topic that still has a stigma attached to it many circles. I worry about the people in their 20’s, 30’s, and 40’s who feel that the only way they can be part of a social group is to drink. I know that I am not alone in that concern. Perhaps your blog post will lead some of them to think about going to a meeting. As you commented so well, there are many meetings all the time in every location. You only have to check social media.

    Like

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