DrSober

Now, let's be clear - I'm not arguing about the superiority of one recovery program over another here. Period. I don't personally think any recovery program or approach has some overall claim to superiority over another. I don't make that argument, and I don't want to participate in such an argument (and such an argument is inappropriate to the Newcomers forum anyways). So, with that in mind:

BMC Public Health | Full text | Are alcoholism treatments effective? The Project MATCH data

Project MATCH, to date, is one of the largest, most comprehensive studies of alcohol treatment ever conducted. It included several arms, including "12-step facilitation" (which most treatment programs are based on in the US).

They found that no treatment approach was more effective than any other. Different interpretations of this study abound. I take is as a call for individualizing treatment approaches (and for individuals individualizing their own approaches) as much as possible. Other people may say it just proves that "nothing science can offer (except my own personal program which worked for me) works."

I think the truth, as always, is complicated. Some people get sober and stay sober from AA. Some people get and stay sober using other approaches (religion, SMART recovery, Lifering). Some get sober by just deciding to stop using (and I don't assume that means these people weren't "alcoholics" or "addicts" - nor does that mean I assume they are). The world is full of nuance and diversity.

Finally, I think that moderation and controlled drinking approaches (which are included under the subset of "harm reduction approaches") can work for some people, let's call them "problem drinkers" (because amongst other things, by definition, moderation and controlled drinking approaches won't work for "alcoholics").

Behavioral self-control training for problem drinkers: A meta-analysis of randomized control studies

However, let's be clear: it's magical thinking to suggest that pointing this out and posting an article like this means I'm encouraging so-called alcoholics to try moderation.

Conversely, denying that moderation can work for some people won't make a so-called alcoholic choose to get sober quicker. That reminds me of the logic of the anti-drug propaganda of the 80s - they thought that suggesting to kids that cannabis use leads you to heroin addiction was a good idea. Of course, that's nonsense and probably makes the problem of drug abuse and addiction worse. They call that "prophylactic lies."

The thing that's a bit silly about this whole debate is that if you ask me my personal opinion, I think that when a person has a question in their mind as to whether they have a bona-fide addiction to alcohol or drugs or not, pursuing moderation as a goal is a bad idea. It just doesn't make sense, it's folly from a rational cost-benefit analysis, period.

I think we can spend a lot of time having ego-driven, chest-pounding debates as to what recovery methods are better than others. But those are really pointless debates. Talk about what worked for you - that's a far more convincing tale and can't be debated.

Jfanagle

Interesting study. The conclusion is not a particular eye opener.

"Alcoholics who decide to enter treatment are likely to reduce drinking. Those who decrease their drinking are more likely to remain in treatment. Widespread acceptance of these results would have a profound influence on alcoholism research and treatment because it would shift focus away from treatment components and toward patient characteristics and beliefs."

After almost 14 years sober there are some very basic facts about recovery from alcohol that I have seen and experienced.
1. There has to be a desire to stop.
2. One must recognize, accept and be willing to make certain changes in one's own behavior and habits as they relate to drinking.
3. The availability of a peer group who has experienced based knowledge of the process of abstinence, (I have no knowledge of controlled approaches) and when that peer group can counsel and advise based on their own successful methods to be used as a path to follow, the success on an individual is markedly improved.
4. An active role in other's efforts to abstain engenders an involvement and increasing knowledge of means to succeed by the individual who is providing the assistance. Much like a teacher in school continues to learn more every time they are called upon to teach the subject.
5. A continuing and ongoing involvement in some structured form and program of abstinence, even if it is minimal per week, but the fact that it is constant and requires a form of dedication recognized by the participant seems to keep the goal of abstinence at the ready when the alcoholic feels the importance of not drinking flagging.

Clinical studies abound by very learned and dedicated professionals in many fields of endeavor, but at the end of the day, and I suspect that the reason that the MATCH project reaches the conclusion that, "it would shift focus away from treatment components and toward patient characteristics and beliefs." is that willingness, effort and a determined regimented system followed over the long run seems to win the day.

Just my experience as a recovered alcoholic. Thanks for yet another measured study of the means of recovery.

Jon

ClearLight

The first link doesn't work so I have no way of evaluating it.

The second link is of a fellow associated with a correctional institute. That's not something to crow about. It's a meta study. That means he didn't conduct research himself. He correlated data from 17 other studies to reach his conclusion.

How were those other studies conducted? If they weren't conducted correctly their data is worthless.
Worse still they could have been conducted with the aim of reaching a certain preordained conclusion.
Who funded those other studies?
Who funded the correctional guy's study?
Even worse, none of those answers are available. You don't get to see ANYTHING which backs up his radical conclusion.
So I toss out the second study entirely.

If the first link ever works I'd be happy to check it out.

DrSober

Project MATCH - Wikipedia, the free encyclopedia

Re. meta-analysis - it's a valid way of conducting research, if conducted properly it's one of the most powerful ways of conducting research. Also, Behavior Therapy is a fairly prestigious behavioral sciences journal and their articles are peer reviewed prior to publication. If the meta was conducted poorly, it probably wouldn't have gotten published.

Either way, it doesn't really matter - I don't do controlled drinking or moderation. I do abstinence.

Fandy

why don't you and the other party who have disagreements, just debate this in private messages?

I think that this type of a thread will turn into yet another debate over conflicting programs or what is the best proven method to be sober.
it's been done so many times and you can't change people's minds, they believe what they believe, some people make a career out of this argument.

I thoroughly enjoy my sobriety and living too much to argue over it. I hope that you can get to this point too.

Soberpotamus

Internal validity of Project MATCH treatments: discriminability and integrity.

Internal validity of Project MATCH tr... [J Consult Clin Psychol. 1998] - PubMed - NCBI

https://www.google.com/url?sa=t&rct=...b7SZCkJINnPcug

ClearLight

Yeah, Meta-analysis can be powerful. It can also be wrong depending on a lot of variables. Particularly when evaluating behavior.

Either way, to simply accept a radical proposition with no access to the meta-study or the original studies methodology, because it's published in a particularly "well regarded" journal isn't acceptable. So the second link is still out.

As to Project Match - thanks for the Wikipedia link. Doesn't it raise a red flag for you concerning Project Match when the Wikipedia link itself contains this:
He goes on to reference there was no control group (!!!) among other things.

I haven't had time to review the link I found to Project Match in the Wikipedia article - I guess that's for tonight but it's sure not looking good.

But, even if Project Match looks alright - it's just one study. With under 2,000 subjects. In a limited time frame.

That's just not definitive to me.

Alraihani

I've known people who have gotten clean and sober through religion. I've met some people who have moderated their use after therapy and psychotropic meds. I think AA works for certain types of people and other methods are effective for other types of people. Even within AA people have different approaches to the program. Some are very rigid with the steps and the book, some aren't. Some people love the fellowship and want to resocialize within AA, some don't. Some people do tons of service, some don't. So it stand to reason that other methods can work. I personally would love more alternatives to AA.

visch1

My overall concern this topic has developed into was the miss guidance or saying things a newcomers AV or shite fairy might make them believe more bad things like drinking in moderation or I'll have an ounce of olive oil before each drink because I saw it on the internet etc. In my experience of chairing several hundred beginners and being very active in AA for almost 35 years I also feel that there are so many individual variables that a fix for one may only work for that one. I think that a program that adheres to the idea of the first drink gets you drunk AND a plan to repair/change the reasons we are uncomfortable and drink. I may be too sensitive as I've seen so many alcoholic miserable deaths, including my brother and my wifes descriptions as a Hospice nurse of some patients. I need reminding that we can't get anyone sober or drunk and sometimes I expect the sick to act well. Enough of this. BE WELL

Pete55

So they spent millions of dollars, hours of time in a clinical environment and as stated, results were disappointing, ofcourse, just to be reminded that it's simply the first drink that does the damage if you are a real alcoholic.
What they seem to miss is that the real alcoholic is a class all on it's own.
You either are or are not and the way to find out if you are is to talk with another recovered real alcoholic.
So what is a real alcoholic ?
There is a book written on this subject in 1939...written by real alcoholics who have recovered.
Problem is, it does not seem to me to a be a study book, it's an action book.
So in order the "get' the book, one needs to be suffering, become honest about their drinking and is willing to take certain steps.
So what does this book really contain ?
It contains the 12 steps and how to take those steps. Not study them, or read and criticize, or try to change what we already know what works from those who have worked it.
Oh but wait, there are those who have taken the steps and went back out and drank again.
So instantly those who are ready to criticise assume there is a better way, modern science. But wait, since when has alcohol the liquid "come of age into the 21st century" ?
It's the same substance in structure now as it was back for those with "big bang" theories since the beginning of time.

Oh but wait, "clinical experts" get hung up with words such as God, spiritual program of recovery and religion.
Well, I think every real alcoholic who has reached that rock bottom and reached out to, "who's out there" type of thing while isolating and curtains drawn during the day in a mood where I don't think can be "made to happen in a experimental clinical lab" environment only knows.
That's when the "spirit of the universe" becomes apparent because the only other option is death.
You cannot recreate that type of environment with open cheque book and millions of dollars to study the effects of alcoholism or with a Rhodes scholarship either.

So what is AA Recovery ? ( from top of page 40,book:"Stools and Bottles") it explains,
Finally, whatever works, none is superior than the other, it's simply not meant to be a challenge.

DoubleBarrel

Some of us care what works, what doesn't and are interested in the science of addiction too.

Many of us have been through multiple programs, and had conflicting information, and good and bad experiences within the same method.

With all due respect, if it bothers you, you don't have to follow the thread.

Soberpotamus

Valid and good points, imo!

Soberpotamus

Apparently not, as AA and 12-Step based programs are prevalent and dominant in the US. Even among those scientific clinical experts. AA is still pushed by the majority.



Agreed.

Jfanagle

I appreciate the tone and level headed contributions in this thread regarding a common problem and concern that I believe we all share, or I suspect we wouldn't be here.

What my simple mind has seen so far is that regardless of which approach one takes, there needs to be a recognition of the problem by the individual with the alcohol problem and a determined and continued willingness and dedication to finding a systematic approach to resolving the problem and not adopting a "someone fix me" attitude. At least that is the common thread, including the conclusions reached by the MATCH project.

Makes sense to my pea brain.

Jon

DoubleBarrel

I agree Jfanagle.

Thats why, whenever the debate about whether alcoholism is a disease comes up, Im conflicted.

The real answer probably is, its BOTH.

Clearly there is something in addicts that works like a disease might, and clearly active alcoholism has all the hallmarks of a progressive illness.

That being said, there is a very real psychosomatic and intellectual component to this addiction, and requires a willingness to change.

I understand why the 12 steppers, given the times it was originated, believed in a spiritual condition. I am less inclined to think so, but I am open to the general message regarding our own inability to stop ONCE WE START, and the fact that we become truly mental slaves when addicted.

Our willingness to change and adopt a mental attitude that results in a long period of abstinence is, however, contrary to the disease model, despite the eastern gurus and practitioners, who have tried to heal with the mind, science has not been able to find legitimacy in that theory, despite best efforts and mental states of those stricken with disease.

I, personally, have subscribed to a multi tiered recovery program, incorporating things that have made sense to me. And it is working. For the first time since the ripe old age of 13, I feel like I'm on the right track.

FWIW, my method(s) have been the following.

Rational recovery regarding my alcohol use/cravings. i.e. identifying the "beast"

Nutrition/Exercise as a fundamental basis for physical and mental healing.

Support/talk therapy to deal with the emotional problems, anxiety and coping, all of which were previously covered up with alcohol/drug use.

12 step meetings, very rarely, I have found useful, as a way of face to face contact with other known addicts. They are truly the only other people to understand the hell of addiction. And while I don't fully follow the steps/program, I have taken what makes sense to me, and incorporated it into a healthy way of interacting, whether that be taking responsibility for my past, or being grateful for my present. Its a good "gut check".

This site. Without which, I would have had a very rough go, especially early on. The immediacy of interaction, and reading all the different perspectives have been miraculous and incredibly helpful.

deeker

All I know is these numbers are pretty convincing to me about AA. Plus I have personal proof that it works if you are willing to follow their path without reservation.


Worldwide there are 114,642 AA groups

Members World-wide Total: 2,131,549

I have gone to State conventions with Thousands of people.

If it even works for just one then I have a chance.




The General Service Office does not keep membership records. The information shown here is based on
reports given by groups listed with G.S.O., and does not represent an actual count of those who consider
themselves A.A. members.
We are aware of A.A. presence in over 170 countries, including 63 other autonomous general service offices
in other lands. Annually we attempt to contact those G.S.O.s and groups that request to be listed in our
records. Where current data is lacking we use an earlier year’s figures.

nandm

Isn't the bottom line "finding a solution to unmaneagable drinking?" If that is the case then does it really matter what program one actually uses as long as it works for them? AA happens to be the program that worked for me but I know people who work other programs and even people who don't utilize an organize program who have found sobriety. To me that is what matters, finding a solution to ones problem.

The bottom line is if you are struggling with an alcohol problem, keep reaching out and trying programs until you find one that works for you because sobriety is well worth it and you are well worth it. That is what is key and important not fighting about who's program is the best on the block.

I do have to say that when I see a title like this that singles out AA it is frustrating to me as it is hard not to see it as an attack on the program that I know saved my life. I have to step back and realize it is just wording and probably not the intent of the OP and even if it was it does not change the fact that AA is the only program I found that worked for me.

Pete55

Disease does not sit well with me either. Somewhere I read that the World Health Organization, (WHO) had to come to some sort of official conclusion as to what terminology to use and decided the word "disease" rather than "condition".
To me the word disease sounds degrading when trying to describe alcoholism;
A condition of the body in the way it reacts to alcohol, ( physical "allergy" as it was described in the early days, that a small amount of alcohol for some causes a phenomenal craving for more of the same, coupled onto a mental obsession of the mind, arising from emotional compulsions.
To this day there is no known "cure" for the physical effects of alcohol, the obsession can be removed and the emotional issues get dealt with which takes time.

I don't come from any rehab networks of trying to deal with what happened to me when I drank alcohol for social occasions. My obsession was truly thinking that one day I'll drink normally and not blackout.
Well, I never discovered what "normal" drinking is. Socially the curtains became drawn till something happened I cannot described to this day and I am sure it was not a dream and I was sober 2 weeks at the time.
I admitted I was wrong about my drinking and sought to find out what it is that when I drink there is a noticeable change in my attitude and my inner experience in the perception of things changes to.
So my "reaching out" was not to try to stop, it was to seek information and then go drink again.
Well, the information I got and identified with was that I am in class that can never ever drink safely die to the physical condition of the my my body reacts to alcohol. I accepted it there and then, but was really peed off cos that information arrived in my life when everything everyone else was gone.
If one was to determine the use of the word "disease" as in something contagious, the only link I find is that the negative actions caused by a out of control drinker is what makes others around him/her judgmental and fear of their own safety. But by no way is this condition transmitted from one person to another in the physical sense of the word. Mentally, yes, negativity is "transmitted". If that is the case, then don't we all suffer some form of a "disease" in regards to alcohol and it's effects?

One more thing I need to say.
I don't blame entirely the problem drinker who keeps relapsing while trying to stop.
That person still has to go to a supermarket to buy groceries, but on the way out of the supermarket at the exit door is conveniently placed a liqueur store,
owned by the supermarket.
And this debate can spill out to another subject on that very issue.
How on earth can someone straight of a rehab or drying out place with very little or no mental defense try to begin to live normally when they need to go to a supermarket for food and groceries and the mind is focused back on booze on the way out of that store?
It's a big issue, difficult to solve.

tehmazzyland

for me as a non-AA recoverer, this:

...says it briliantly.

Personally I can't conceptualize my alcoholism as a disease because it takes away my personal responsibility, which remains key to my not drinking.

But this is personal. I've known people who considered it a disease because that was their way of dealing with it, and who am I to tell them their approach is wrong? It worked for them.

It's about whatever works for the individual.

Alraihani

I look at it more like a spiritual malady that causes the mental obsession, you know i can't remember off the word disease is used in pages 1 through 164