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effectiveness of the _A model of recovery in comparison to other treatments

Old 12-06-2011, 07:56 PM
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effectiveness of the _A model of recovery in comparison to other treatments

Hi,

I have a question. I have been trying to ascertain the effectiveness of the _A model of recovery from statistics and hard evidence, in comparison to other treatment options and no treatment. I have found data which appears to run counterpoint to commonly held assumptions. I would like to start a thread and share this information with other members and open up the discussion on this topic. The problem is where do I do this? I would have thought the Secular Section here would be the place, but now I am having my doubts. Should I present this within the Twelve Step forums or would they be overly sensitive to the truth?

Thanks
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Old 12-28-2011, 08:59 AM
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Simian66, We do have a forum right below this one for Secular People who are in 12 step programs. You might find that more to what you are talking.

As you can see, I removed this post from the FYI Take a minute and read. Thanks.
and gave it its own thread.
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Old 12-31-2011, 05:00 AM
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It seems this is the place to post it.
I'd be interested in seeing the data.

I'm a non-believer, but think AA is a wonderful organization for those with a predisposition for religion. I still gained a lot from the fellowship, shared experiences and knowing I wasn't the only one going through this.

It took me a while to lose the animosity I had toward deity-based solutions that made absolutely no sense to me.
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Old 12-31-2011, 07:09 AM
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The "AA alternatives" don't fare much differently than AA. Read the project MATCH findings, minus the spin they later put on it to justify spending $25 million dollars.
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Old 12-31-2011, 07:21 AM
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simian: There actually IS no absolute empirical proof that any recovery pathway is superior to another. If you look closely, lots of studies are done but none of them have a control group (as TU correctly points out, the Big Kahuna of all studies, Project MATCH, showed that the three different recovery approaches tested had equal effectiveness compared with each other---but there was no control group, so we don't know if any of them was better than natural remission).

As a result I've become increasingly convinced that the best possible situation for those of us who desire to recover from addictions is to be able to choose what pathway works best for us. There is no "best" way and no superior "brand" of recovery. There is no gold standard Plan A and no also-ran Plan B.

I think what many of us grapple with is that for too long, there has existed in the US the entirely invalid and unjust idea that there is only one right way to recover. Those of us who haven't found that path useful have been told we're hopeless cases. We've been treated as outcasts or outliers, our failures used to "prove" that path's superiority (even as its own failures were ignored) and our successes diminished on the grounds that we were dry drunks or never "real" addicts/alcoholics in the first place.

I've been abstinent, though, for 13+ years now and I can report that the situation has changed since the time I quit drinking. For example, just this week, SAMHSA published a working definition of recovery (see http://blog.samhsa.gov/2011/12/22/sa...-for-feedback/--it does not say "recovery consists of being a member of Program A forever"; instead it defines recovery as:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

and includes the following as guiding principles:

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s).

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds, including trauma experiences, that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.


I think this statement reflects what is happening in general, as people are becoming more open minded about the variety of ways in which people recover from addictions.

A case in point is the discussions that are going on right now on SR, where people are openly sharing about the variety of paths that are working for them. Such discussions would not have happened even a year or two ago. Even that recently, those of us who posted anything other than blazing success with the "right" program were treated as pariahs; no matter how politely we phrased things, it was clear that we were not welcome here and what we were saying was viewed as dangerous.

This has clearly changed and the change is something for which I am truly grateful.
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Old 12-31-2011, 07:37 AM
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Very well said.
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Old 12-31-2011, 08:36 AM
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Originally Posted by onlythetruth View Post
If you look closely, lots of studies are done but none of them have a control group (as TU correctly points out, the Big Kahuna of all studies, Project MATCH, showed that the three different recovery approaches tested had equal effectiveness compared with each other---but there was no control group, so we don't know if any of them was better than natural remission).
I had originally mentioned that there was no control group in the project MATCH study for "no treatment," but I went back and edited it out of my post. It is a very valid and pertinent observation, and one has to wonder why they would do that, since even a 7th grade science student knows you need a control group in an experiment. Still, I thought it might make me come off as biased towards no treatment, which admittedly, I am.
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Old 12-31-2011, 08:50 AM
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Originally Posted by Terminally Unique View Post
I had originally mentioned that there was no control group in the project MATCH study for "no treatment," but I went back and edited it out of my post. It is a very valid and pertinent observation, and one has to wonder why they would do that, since even a 7th grade science student knows you need a control group in an experiment. Still, I thought it might make me come off as biased towards no treatment, which admittedly, I am.
They didn't do it because they CAN'T do it, TU. Research ethics these days do not allow researchers to "deny treatment" to people with mental health issues, thus making it difficult, if not impossible, to use control groups in such experiments.
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Old 12-31-2011, 08:59 AM
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Originally Posted by onlythetruth View Post
They didn't do it because they CAN'T do it, TU. Research ethics these days do not allow researchers to "deny treatment" to people with mental health issues, thus making it difficult, if not impossible, to use control groups in such experiments.
I'm sure they could have found plenty of addicted people who had no interest in treatment to serve as a control group. As long as they were informed that they were not going to receive treatment for their addiction, it would have been ethical. Those who chose to participate as a control group would just be doing what they usually do anyway.
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Old 12-31-2011, 09:34 AM
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I am not sure why if even matters to look at "evidence." Every type of treatment inflates its claims of success. No surprise there. And who cares anyway?

Statistics and proof do not help any of us as individuals find what will be effective for us. It is like anti-depressants--the statistics do nothing to tell any one or any doctor what will be effective in any specific case. You just have to to keep trying till you find the one that works.

Knowing that x number of people were helped by Prozac or SmartRecovery ultimately does not help us figure out what we need to do as individuals. Sure it is interesting intellectually, but it does not help in recovery to know that only x% of people recover through this or that program. Even if only 1% get helped by a particular program, then I want that 1% to find it.
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Old 12-31-2011, 09:58 AM
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Regarding studies and surveys we can take our pick from a variety of final results, studies that show an effectiveness range from 90% to sub 0 effectiveness for different approaches.

Because there is no uniformity, no duplication of results, or control group and no followup or methods to ensure the validity of what the subjects are self-reporting, and often little willingness on the part of people who should properly be participating for more realistic numbers.

I can't think of an area of study that is conducted more shabbily than recovery statistics.

Interesting that the Scientologists have concrete studies testifying to their 90% recovery success rates...shouldn't we be pushing newcomers to become Scientologists if statistical success is all that important to us?

If we are not willing to do that then why is this even a concern? Or is there more in the mix here than truly wanting no more than to send new people in the best scientifically studied and highest statistically proven direction?

If there's no other agenda let's hear some strong and ongoing Narconon promoting.
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Old 12-31-2011, 10:13 AM
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Originally Posted by langkah View Post
I can't think of an area of study that is conducted more shabbily than recovery statistics.
The world of addiction recovery is the ultimate huckster's paradise.
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Old 12-31-2011, 10:20 AM
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I was reading in the New York Times yesterday about what better dream could there be than the pharmaceutical industry's producing a drug for which there could be guaranteed endless patients who "needed" it, married with a medical industry (yes industry) with an endless stream of paying patients who would need their services on a twice monthly basis.

It was referring to the "new" drug about to come on the market next year -- "pure" hydrocodone, ZOHYDRO, "untainted" by that nasty acetaminophen which would have naturally curtailed the maximum safe daily dosage.

This, of course, means a whole new batch of patients who will "need" addiction recovery services!

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Old 12-31-2011, 10:29 AM
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There was one study done in 1975 at the Kansas City VA Medical Center that did have a control group of sorts. They were simply advised to quit drinking. If anyone has a link to the full article, I would be interested.

Abstract available here.

J Stud Alcohol. 1977 May;38(5):1004-31.

Alcoholism: a controlled trial of "treatment" and "advice".

Edwards G, Orford J, Egert S, Guthrie S, Hawker A, Hensman C, Mitcheson M,
Oppenheimer E, Taylor C.

Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups.
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Old 12-31-2011, 10:38 AM
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I have the whole article in pdf format, but I don't think I can attach it to a post here. I would need an email address, but SR email function doesn't permit pdf attachments unless I am missing something.
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Old 12-31-2011, 10:53 AM
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I'd love to see the entire article if you can figure out a way to upload it, failedtaper.

There were several studies done before the enactment of ethics rules preventing them. Those had mixed results. There were indeed some that showed quite bad outcomes including the famous Vaillant studies.
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Old 12-31-2011, 10:57 AM
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Originally Posted by Terminally Unique
The world of addiction recovery is the ultimate huckster's paradise.
True...I've also experienced it in the world of treatment for autism. There are valid approaches and there is pure quackery. The desperate person is usually not in a place to discriminate between the two and will often pay for useless treatments no matter the cost. Deplorable, really.
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Old 12-31-2011, 10:59 AM
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Originally Posted by onlythetruth View Post
I'd love to see the entire article if you can figure out a way to upload it, failedtaper.

There were several studies done before the enactment of ethics rules preventing them. Those had mixed results. There were indeed some that showed quite bad outcomes including the famous Vaillant studies.
It's something like 28 pages, and I can email it regular email. If you have an email address you want it sent to, PM me.

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Old 12-31-2011, 11:02 AM
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Originally Posted by Terminally Unique View Post
I'm sure they could have found plenty of addicted people who had no interest in treatment to serve as a control group. As long as they were informed that they were not going to receive treatment for their addiction, it would have been ethical. Those who chose to participate as a control group would just be doing what they usually do anyway.
So you'd think, TU, but I am assured by a dear friend of mine who does clinical research in the addictions area that it simply is not possible to get funding for a study that runs afoul of the "withholding treatment" rule. This is not just a 12 step thing, it's an issue for all sorts of mental health and substance abuse treatments. The ethics rules are meant to protect people from research abuse, but those same rules also make it difficult to do proper testing with control groups.
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Old 12-31-2011, 11:24 AM
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There's also something about a "self selected" population that skews study results to the place they cannot be extrapolated to the general population.
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