The Effectiveness of the Twelve-Step Treatment

'After all, facts are facts, and although we may quote one to another with a chuckle the words of the Wise Statesman, "Lies — damn lies — and statistics," still there are some easy figures the simplest must understand, and the astutest cannot wriggle out of.'

Leonard Henry Courtney, the British economist and politician (1832-1918), later Lord Courtney, speaking at New York, August 1895.

Everybody is entitled to their own opinions, but not their own facts.

Senator Patrick Moynahan

      Said a clever quack to an educated physician: "How many of the passing multitude, do you suppose, appreciate the value of science, or understand the impositions of quackery?"
      "Not more than one in ten," was the answer.
      "Well," said the quack, "you may have that one, and I'll have the other nine."

author unknown

At the beginning of every Alcoholics Anonymous meeting, someone reads out loud a plastic-laminated document that says, among other things, that this Twelve-Step program has rarely been known to fail, except for a few unfortunate people who are "constitutionally incapable of being honest with themselves":

RARELY HAVE we seen a person fail who has thoroughly followed our path. Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.
A.A. Big Book, 3rd & 4th Editions, William G. Wilson, page 58.

Nothing could be further from the truth. Even the most ardent true believers who will be honest about it recognize that A.A. and N.A. have at least 90% failure rates. And the real numbers are more like 95% or 98% or 100% failure rates. It depends on who is doing the counting, how they are counting, and what they are counting or measuring.

A 5% success rate is nothing more than the rate of spontaneous remission in alcoholics and drug addicts. That is, out of any given group of alcoholics or drug addicts, approximately 5% per year will just wise up, and quit killing themselves.6 They just get sick and tired of being sick and tired, and of watching their friends die. (And something between 1% and 3% of their friends do die annually, so that is a big incentive.) They often quit with little or no official treatment or help. Some actually detox themselves on their own couches, or in their own beds, or locked in their own closets. Often, they don't go to a lot of meetings. They just quit, all on their own, or with the help of a couple of good friends who keep them locked up for a few days while they go through withdrawal. A.A. and N.A. true believers insist that addicts can't successfully quit that way, but they do, every day.

Every disease has a spontaneous remission rate. The rate for the common cold is basically 100 percent — almost nobody ever dies just from a cold. People routinely just "get over it", naturally. Likewise, ordinary influenza — "the flu" — has a very high spontaneous remission rate, greater than 99%. Yes, some old people do die from the flu every year, but not very many. Most people just get over it.

On the other hand, diseases like cancer and Ebola have very low spontaneous remission rates — left untreated, they are very deadly and few people recover from them.

Alcoholism is in the middle. The Harvard Medical School reported that in the long run, the rate of spontaneous remission in alcoholics is slightly over 50 percent. That means that the annual rate of spontaneous remission is around 5 percent.

Thus, an alcoholism treatment program that seems to have a 5% success rate probably really has a zero percent success rate — it is just taking credit for the spontaneous remission that is happening anyway. It is taking the credit for the people who were going to quit anyway. And a program that has less than a five percent success rate, like four or three, may really have a negative success rate — it is actually keeping some people from succeeding in getting clean and sober. Any success rate that is less than the usual rate of spontaneous remission indicates a program that is a real disaster and is hurting the patients.

It's like this:

Imagine that there is a nasty disease that kills 50% of the people who get it. A pharmaceutical company has a new medicine that they want to test. So they give the drug to a bunch of the people who have the disease, and 50% of them get better.

The drug manufacturer cheers and brags, "Look at how great our new medicine is! We saved half of the patients!"

Wrong. The new drug saved nobody. The half who survived were the ones who were going to survive anyway. The drug had an effective zero percent cure rate, above and beyond normal spontaneous remission.

To compute the success rate of any medicine or treatment program, you have to subtract the normal rate of spontaneous remission from the apparent success rate. In this example, fifty percent minus fifty percent yields a zero percent success rate for the new medicine. The new medicine didn't make anybody recover.

(And if the survival rate of the patients who were taking the new medicine was less than half, then the new medicine was actually poisoning people and keeping them from recovering.)

When one of those people who is going to quit drinking anyway, or who did already just quit, walks into an A.A. meeting, A.A. is happy to take all of the credit for that success story, while disavowing any responsibility for all of those other people who walk in, are disgusted by what they see, and walk right back out, and relapse. That is grossly dishonest.

A.A. is also more than happy to convince the person who just quit that it is all due to A.A. and the Twelve Steps. And many of them will believe it. At meetings, you will sometimes hear testimonials like "I tried everything, the V.A. program, the Christian Brotherhood, and finally, A.A. is what worked."

The speaker is forgetting one of the famous corollaries to Murphy's Law:

"The thing you seek always seems to be in the last place that you look."

Many people who are in recovery require one or more relapses to convince themselves that they really can't drink or dope any more, not even just a little bit, now and then. They will think that they can just nibble, or "just have one", and that it will be okay. They will go through a lot of programs while they experiment and fail. It's a learning process. In the end, when some of them finally quit, really totally quit and stay quit, rather than die, they often give the credit to whichever program they just happen to be in when they finally quit. (All of them tend to overlook the fact that they stopped examining other programs after they successfully quit drinking. They just stuck with the program that they were in.)

Thus the Christian sects have a bunch of totally convinced true believers who say that Jesus saved them, and the Veteran's Administration has some veterans who believe that the V.A. program is the best, and Alcoholics Anonymous has a bunch of people who insist that A.A. and the Twelve Steps are the only answer.

In 1964, Dr. Milton A. Maxwell (who eventually became a member of the Board of Trustees of Alcoholics Anonymous World Services, Inc.) did a study of the relations between doctors and other treatment professionals and Alcoholics Anonymous. He wrote:

      Another root of Professional-AA strains consists of the very human tendency to be loyal to the therapy which has been successful in one's own case — and rather uncritically to adopt the ideological framework within which the help has come. We see this phenomenon in other areas. For example, the benefits of religious faith and personal integration can come through many different theological frames of reference — Roman Catholic, Pentacostal, Christian Science, Theosophy, Zen Buddhism, you name it. And, so often, the help found is taken as absolute proof of the truth of the accompanying theological framework. Or, witness what happens when a patient has shopped around from doctor to doctor, and finally finds one that helps: he becomes very loyal to the successful therapist — and to the successful therapeutic program. Why should the behavior of alcoholics be so different? I've been in alcoholism clinic and hospital settings where I've heard: "I tried the 'cure' over there. I tried AA. None of it worked. But this place has got the answers." And I've heard alcoholics talk who had boxed the professional compass and finally made it in AA. In either case, the reason for the success of the particular treatment may have been due more to the patient's by-now greater pain and desperation than to the nature of the treatment or the context of beliefs. But few patients can see this at the time and they become loyal to the "successful therapy" — and, unfortunately, sometimes antagonistic or unfavorable in their attitude toward other therapeutic programs. Now, I submit that this is quite standard human behavior. But it is one of the roots of misunderstanding, distrust, and strain in AA-professional relations.
PROFESSIONAL and ALCOHOLICS ANONYMOUS RELATIONS IN OREGON; An Exploratory Study Report, Milton A. Maxwell, Ph.D., 1965, page 10.

Yes: "they become loyal to the 'successful therapy' — and, unfortunately, sometimes antagonistic or unfavorable in their attitude toward other therapeutic programs." That is the mind-set of A.A. members in a nutshell.

The Harvard Medical School says that the vast majority of the people who successfully quit drinking for a year or more — eighty percent of them — do it alone, all by themselves, without any treatment program or "support group". Naturally, those do-it-yourselfers will also insist that they have the sure-fire solution that really works:
"Just don't drink any more alcohol, not ever, no matter what."

When you are at an A.A. meeting, you are in a self-selecting group. You won't hear from the Jesus-freak Christians, or the gung-ho V.A. guys, or the do-it-yourself guys, because they aren't there. You will only hear from the A.A. true believers, who will be happily reassuring each other that they are doing the only thing that really works.

  • A bunch of people went to a Baptist church for years.
  • During those years, many of the women got pregnant and had babies.
  • That proves it: Going to Baptist churches causes women to get pregnant and have babies.

That goofy logic is the same logic as A.A. uses to insist that it's a proven fact that going to A.A. meetings and doing the Twelve Steps causes people to quit drinking.

Many A.A. members are confusing causation with correlation, or causation with coincidence. They fail to see that they go to A.A. meetings because they want to quit drinking, not that they want to quit drinking because they go to A.A. meetings. And the reason that they finally quit drinking is because they really want to quit — want it so strongly that they finally really do it. And the commonest reason for quitting is because people just get sick and tired of being sick and tired, and wish to avoid death.

The Harvard Mental Health Letter, from The Harvard Medical School, stated quite plainly:

On their own
There is a high rate of recovery among alcoholics and addicts, treated and untreated. According to one estimate, heroin addicts break the habit in an average of 11 years. Another estimate is that at least 50% of alcoholics eventually free themselves although only 10% are ever treated. One recent study found that 80% of all alcoholics who recover for a year or more do so on their own, some after being unsuccessfully treated. When a group of these self-treated alcoholics was interviewed, 57% said they simply decided that alcohol was bad for them. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit. Others used such phrases as "Things were building up" or "I was sick and tired of it." Support from a husband or wife was important in sustaining the resolution.
Treatment of Drug Abuse and Addiction — Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.
(See Aug. (Part I), Sept. (Part II), Oct. 1995 (Part III).)

So much for the sayings that "Everybody needs a support group" and "Nobody can do it alone". Most successful people do.

And note that the Harvard Medical School says that the support of a good spouse is more important than that of a 12-step group. But A.A. says just the opposite: "Dump your spouse and marry the A.A. group, because A.A. is The Only Way."

"I decided I must place this program above everything else, even my family, because if I did not maintain my sobriety I would lose my family anyway."
The Big Book, 3rd Edition — Chapter B10, He Sold Himself Short, page 293.

Helping others is the foundation stone of your recovery. A kindly act once in a while isn't enough. You have to act the Good Samaritan every day, if need be.   ...   Your wife may sometimes say she is neglected.
The Big Book, 3rd Edition, William G. Wilson, Chapter 7, Working With Others, page 97.

And a rehash of the Big Book that is targeted at youths tells this story of an allegedly-successful recovery:

Even after she remarries, she doesn't lose sight of her priorities. She places God first and A.A. second. Her husband is never more than the third most important aspect of her life.
Big Book Unplugged; A Young Person's Guide to Alcoholics Anonymous, John R., page 107.

The husband is less important than A.A.? He rates third in importance? That is good for destroying a lot of marriages.

And it does. Psychology Today magazine reported that the divorce rate of couples where one partner joined A.A. was 25% in just the first year alone, which is sky-high.

The National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, performed the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. For it, they interviewed over 43,000 people. Using the criteria for alcohol dependence found in the DSM-IV, they found:
"About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment."

Likewise, American Health Magazine reported:

...people are about ten times as likely to change on their own as with the help of doctors, therapists, or self-help groups.
J. Gurion, American Health Magazine, March 1990.

In his book on the treatment of alcoholism, Dr. Sheldon Zimberg surveyed the literature for reports of spontaneous remission of alcoholism:

Spontaneous Remission in Alcoholism

      A number of studies have found that a small percentage of alcoholics improve to the point of remission of problems associated with alcohol consumption. Bailey and Stewart (235) interviewed alcoholics after three years without treatment and found that about 27 percent of the former patients denied alcoholism. Cahalan (268) in a national drinking practices study noted that drinking problems decrease in men after age 50 and the amount of alcohol consumed also decreases. Cahalan, Cisin, and Crossley (11) in another national survey of drinking practices found that about one-third more individuals had problem drinking in a period before their three-year study period than during the study period itself, suggesting a tendency toward spontaneous remission of drinking problems. Goodwin, Crane, and Guze (269) found that on an eight-year follow-up with no treatment about 18 percent of the alcoholic felons had been abstinent for at least two years. Lemere (238) reported long-term abstinence in 11 percent of untreated alcoholics over an unspecified interval. Kendall and Staton (236) reported 15 percent abstinence in untreated alcoholics after a seven-year follow-up. Kissin, Platz, and Su (203) reported a 4 percent one-year improvement rate in untreated lower class alcoholics. Imber et al. (10) described a follow-up of 58 alcoholics who received no treatment for their alcoholism. It was noted that the rate of abstinence was 15 percent at one year and 11 percent after three years.
      In sum, the preponderance of these studies suggests that a spontaneous remission rate for alcoholism of at least one-year duration is about 4-18 percent. Successful treatment would, therefore, have to produce rates of improvement significantly above this probable range of spontaneous remission.

10. Imber, S., Schultz, E., Funderburk, F., Allen, R. and Flamer, R. The Fate of the Untreated Alcoholic. J. Nerv and Ment. Dis., 1976, 162:238-247.
11. Cahalan, D., Cisin, I. H. and Crossley, H. M. American Drinking Practices: A National Survey of Drinking Behavior and Attitudes. New Brunswick, Rutgers Center for Alcohol Studies, 1974.
203. Kissin, B., Platz, A. and Su, W. H. Social and Psychological Factors in the Treatment of Chronic Alcoholics. J. Psychiat. Res., 1970, 8:13-27.
235. Bailey, M. B. and Stewart, S. Normal Drinking by Persons Reporting Previous Problem Drinking. Quart. J. Stud. Alc., 1967, 28:305-315.
236. Kendall, R. E. and Staton, M. C. The Fate of Untreated Alcoholics. Quart. J. Stud. Alc., 1966, 27:30-41.
238. Lemere, F. What Happens to Alcoholics. Amer. J. Psychiat., 1953, 109:674-675.
268. Cahalan, D. Problem Drinkers: A National Survey, San Francisco, Jossey-Bass, 1970.
269. Goodwin, W. W., Crane, J. B., and Guze, S. B. Felons Who Drink: An Eight-Year Follow-up. Quart. J. Stud. Alc., 1971, 32:136-147.

The Clinical Management of Alcoholism, Sheldon Zimberg, M.D., page 179, footnotes on pages 223 to 234.

The key sentence is the last one — for a treatment program to claim success, it would have to produce recovery rates greater than the usual rate of spontaneous remission. Alcoholics Anonymous comes nowhere near exceeding a 4 to 18 percent per year recovery rate.

Personally, I find the 18 percent number to be far too high to believe. (At that rate, 85% of all of the alcoholics in the country should have recovered in just the last 10 years. Obviously, that has not happened.) I agree with R. G. Smart, who calculated a spontaneous remission rate for alcoholism of between 3.7 and 7.4 percent per year. As a simple rule of thumb, the middle value of 5 or 5.5 percent per year is quite believable. Still, the claimed success rate of Alcoholics Anonymous does not even exceed that much lower rate of spontaneous remission.

Some people are confused by the spontaneous remission rate and how it works. They imagine that if 5% of the alcoholics are recovering each year, then after 20 years there should not be any more drunk alcoholics left. Unfortunately, it doesn't work that way. The 5% number is five percent of the alcoholics in the original starting group who are still sick, so the actual number of people recovering each year declines as the size of the group shrinks. (It's a logarithmic curve, like a radioactive half-life.)

Imagine that we have 10,000 alcoholics, and they are spontaneously recovering at a rate of five percent per year. The math works out like this:

Year Alcoholics recovered
this year
Alcoholics remaining
0 0 10000
1 500 9500
2 475 9025
3 451 8574
4 429 8145
5 407 7738
6 387 7351
7 368 6983
8 349 6634
9 332 6302
10 315 5987
11 299 5688
12 284 5404
13 270 5133
14 257 4877
15 244 4633
16 231 4401
17 220 4181
18 209 3972
19 199 3774
20 189 3585
21 179 3405

Even after 21 years, one third of the alcoholics are still drinking. In addition, in those 21 years, another whole new younger generation of alcoholics has matured and started drinking (so, theoretically, we have at least another 10,000 new alcoholics added to the mix). So no way does the problem spontaneously disappear, even though almost two-thirds of the original group of alcoholics are no longer drinking.

Many, many alcoholics do just recover spontaneously, and yet, the problem still never goes away.

Actually, we haven't computed the deaths from alcoholism and subtracted them out. That will make the number of remaining alcoholics decline much faster. (And we haven't even considered the deaths from tobacco. Most alcoholics are also heavy smokers, and more than half of the time, tobacco kills them before the alcohol does.) The real numbers are more complex than this chart indicates, but it is accurate enough for you to see the principle at work.

Likewise, the younger generation of alcoholics does not all start drinking at 21 years of age. They may start at any age from 12 to 35, or even later. So, in the real world, we have many successive waves of alcoholics starting and quitting simultaneously, producing very complex patterns of numbers. But the one simple, undeniable fact is that generation after generation, while all of the individual alcoholics do either quit drinking or die, the problem doesn't go away.

"...there is a paucity of scientific studies supporting the superior effectiveness of AA."
Reid K. Hester and William R. Miller (eds.)
Handbook of Alcoholism Treatment Approaches: Effective Alternatives. New York: Pergamon (1989), page 165.

...AA research has been mostly pre-experimental in design, has failed to use instrumentation of established reliability, has usually not attempted to check for the validity of the self report data obtained, has inadequately assessed the nature of subjects' alcohol problems, has been deficient in describing demographic characteristics of the sample and has sampled an unrepresentatively large number of middle-aged people and an unrepresentatively small number of women...
Emrick, Tonigan, Montgomery, Little (1993)

"It has often been alleged, but the allegations never substantiated experimentally, that behavior and conditioning therapies represent purely symptomatic treatment and that such treatment is usually ineffective in the long run."
Cyril M. Franks, Ph.D.
in Alcoholism: Its Scope, Cause, and Treatment, Dr. Ruth Fox, ed. (1955), page 189.

A recent review by the Cochrane Library, a health-care research group, of studies on alcohol treatment conducted between 1966 and 2005 states its results plainly:
"No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [12-step facilitation] approaches for reducing alcohol dependence or problems."
We're addicted to rehab. It doesn't even work., By Bankole A. Johnson, The Washington Post, Sunday, August 8, 2010

Dr. and Prof. Bankole A. Johnson currently serves as Alumni Professor and Chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia. Look here.

In spite of the scarcity of good, properly run randomized longitudinal controlled studies of the effectiveness of Alcoholics Anonymous, there are still several good tests and studies which were done properly, and give us a good idea of what is happening.

There is experimental evidence that the A.A. doctrine of powerlessness leads to binge drinking. In a sophisticated controlled study of A.A.'s effectiveness (Brandsma et. al.), court-mandated offenders who had been sent to Alcoholics Anonymous for several months were engaging in FIVE TIMES as much binge drinking as another group of alcoholics who got no treatment at all, and the A.A. group was doing NINE TIMES as much binge drinking as another group of alcoholics who got rational behavior therapy.

Those results are almost unbelievable, but are easy to understand — when you are drunk, it's easy to rationalize drinking some more by saying,

"Oh well, A.A. says that I'm powerless over alcohol. I can't control it, so there is no sense in trying. I'm doomed, because I already took a drink. One drink, one drunk. I'm screwed, because I already lost all of my sober time, and I have to give back all of my sobriety coins. Might as well just relax and enjoy it now. Pass that bottle over here, buddy."

It's also easy to rationalize taking the first drink with,

"I'm powerless. I can't help it. The Big Book says that I have no defense against those strange mental blank spots when I'll drink again. Bottoms up!"

Dr. Jeffrey Brandsma and his associates Dr. Maxie Maultsby (co-inventor of Rational Behavior Therapy) and Dr. Richard J. Welsh did a study where they took some alcoholics who had been arrested for public drunkenness, and randomly divided them into three groups, which got one of:

  1. A.A. treatment
  2. Lay RBT (non-professional Rational Behavior Therapy, something invented by Dr. Maxie Maultsby and Dr. Albert Ellis, something very similar to SMART)
  3. No treatment at all. This was the control group.

And the results were:

The variables that showed significant differences at outcome could be organized into three categories: treatment holding power, legal difficulties, and drinking behavior. Treatment holding power was indicated by the percentage of dropouts between intake and outcome (p = 0.05), the mean number of treatment sessions attended (p = 0.05), and the mean number of days in treatment. Less than one-third (31.6%) of the clients assigned to the AA group qualified for outcome measures in contrast to almost 60% for the lay-RBT group, and this occurred with equivalent attempts by our social work staff to keep the men in treatment, whatever type it was. Table 32 highlights these differences.

Table 32. Mean number of treatment sessions and days in treatment
Group N at intake N at outcome Mean number of sessions Mean number of days treated
AA 38 12 20.9 203
Lay-RBT 42 25 27.6 243

There were two measures of legal difficulties, both self-reported during the last 3 months. The means for the number of arrests (p = 0.04) are: lay-RBT, 1.24; AA, 1.67; and control, 1.79. The results for convictions (p = 0.02) are very similar.

The lay-RBT group had significantly fewer arrests and convictions than did the control group.   ...

All of the lay-RBT clients reported drinking less during the last 3 months. This was significantly better than the AA or the control groups at the 0.005 level. The lay-RBT group also reported on two variables (one a direct question, the other a summated series of questions) that it was less important to drink now to be sociable. In this regard the lay-RBT group was significantly different from the control group, whereas the AA group was not differentiated from either of the other two groups.

Three months after terminating treatment the only variables that revealed differences concerned drinking behavior.   ...   In this analysis AA was five times more likely to binge than the control and nine times more likely than the lay-RBT. The AA group average was 2.4 binges in the last 3 months since outcome.
Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105.

That is a clear description of a real disaster. Alcoholics Anonymous greatly increased the amount of binge drinking that the alcoholics were doing. Their bingeing didn't just increase a little bit — it was FIVE TIMES higher than the alcoholics who got nothing, no help or treatment at all. On the other hand, Rational Behavior Therapy, as taught by laymen (amateurs, non-professional counselors), really did help the alcoholics to cut down on their drinking. They were doing less binge drinking than the control group.

Notice the statement about "holding power".

Less than one-third (31.6%) of the clients assigned to the AA group qualified for outcome measures in contrast to almost 60% for the lay-RBT group, and this occurred with equivalent attempts by our social work staff to keep the men in treatment, whatever type it was.

A.A. couldn't "keep them coming back." A.A. seems to have been so repulsive to the alcoholics that more than two-thirds of them just walked out and didn't come back. Obviously, A.A. can't do much good if it just drives the alcoholics away.

And at the 12-month follow-up:

There were no significant results to report at 12-month follow-up. In certain cases where the data were inspected, part of the reason for this seemed to be the improvement of the control group.
Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105.

Over the long haul, the no-treatment control group did just as well as the others. That was spontaneous remission at work, again. A lot of people, even hard-core alcoholics, really do just quit drinking when they get sick and tired of being sick and tired.

Dr. Brandsma and co-authors concluded:


In general, it seems again that treatment has beneficial, if short-term, effects in contrast to no treatment. The superior holding power of the lay-RBT method with this population is a definite advantage for it. As Armor et al. (1978) have noted, "the single most important factor that consistently determines improvement is the amount of treatment. The greater the amount of treatment, the greater the improvement rate." In this sense lay-RBT was definitely superior to the AA group in our study and goes along with the suggestion from the Ditman et al. (1967) study that compulsory AA does not work well with municipal court offenders. At the very least it would seem to be a reasonable alternative for those alcoholics who refuse AA or do not seem to benefit by it.

The 3-month follow-up indicated that AA members had increased their binges and more often drank in order to feel superior. Perhaps the philosophy of total abstinence did not work well for these men — perhaps it led to depression and a tendency to go from one extreme to the other. This is admittedly speculative, but it adds a qualification to Emrick et al.'s (1977) suggestion that AA is more effective than professionals with regard to abstinence.
Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105.

In other words, Emrick was wrong when he suggested that the untrained lay therapists of A.A. — "sponsors" — were better recovery counselors than the trained professionals.

Again, RBT was far superior to A.A. because RBT was able to keep the majority of the its alcoholics — almost 60% of them — in the treatment program, while A.A. lost more than two-thirds of its people. And RBT reduced binge drinking, while A.A. increased it.

And note how Doctor Brandsma reported that "The 3-month follow-up indicated that AA members had increased their binges and more often drank in order to feel superior." Bill Wilson repeatedly declared that all alcoholics must have their egos crushed. "Getting rid of ego and self" by humiliating people with constant self-criticism and confession sessions is a big part of the A.A. program. But what Dr. Brandsma saw was that people responded to such treatment by drinking to get their egos back.

But of course. The urge to heal oneself, to fix whatever is broken, is one of the most deep-seated basic drives in life. Attack people's egos and selves, and they will respond by trying to repair their egos and sense of self. Many will drink so that they can feel good about themselves again. People will fight oppression however they can.

For another description of the Brandsma study, see the "More Revealed" web site:

A controlled study of the effectiveness of Alcoholics Anonymous was conducted in San Diego in the mid-nineteen-sixties. It is described in "A Controlled Experiment on the Use of Court Probation for Drunk Arrests", by Keith S. Ditman, M.D., George C. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D., in the American Journal of Psychiatry.1

In the study, 301 public drunkenness offenders were sentenced by the court to one of three "treatment programs". The offenders were randomly divided into three groups:

  • a control group that got no treatment at all,
  • a second group that was sent to a professional alcoholism treatment clinic,
  • and a third group that was sent to Alcoholics Anonymous.

All of the subjects were followed for at least a full year following conviction. Surprisingly, the no-treatment group did the best, and Alcoholics Anonymous did the worst, far worse than simply receiving no treatment at all. When the rates of re-arrest for public drunkenness were calculated, the following results were obtained:

Number of Rearrests Among 241 Offenders in Three Treatment Groups
Treatment Group NO
Re-arrested 2
or more times
No treatment 32 (44%) 14 (19%) 27 (37%) 73
Professional clinic 26 (32%) 23 (28%) 33 (40%) 82
Alcoholics Anonymous 27 (31%) 19 (22%) 40 (47%) 86

In every category, the people who got no treatment at all fared better than the people who got A.A. "treatment". Based on the records of re-arrests, only 31% of the A.A.-treated clients were deemed successful, while 44% of the "untreated" clients were successful. Clearly, Alcoholics Anonymous "treatment" had a detrimental effect. That means that A.A. had a success rate of less than zero. Not only was A.A.-based treatment a waste of time and money; A.A. was actually making it harder for people to get sober and stay sober.

And the A.A. people got rearrested more often after many months of A.A. training — not in the beginning. The rate of rearrests was the same for the no-treatment and A.A. groups during the first month of treatment (22%), but the A.A. group's rearrest rate increased later, after months of A.A. indoctrination.

And, strangely enough, the professional treatment program had the same problem. Their patients' rate of rearrests also increased with time, by the same amount. The more 'treatment' the patients got, the more they got rearrested.
Let me guess: The professional treatment program also included lots and lots of A.A. meetings. (They almost always do.)

Time Before Rearrest in Three Treatment Groups
Treatment Group No re-arrests After First Month Of Treatment Within First Month Of Treatment Total
No treatment 32 (44%) 25 (34%) 16 (22%) 73
Professional clinic 26 (32%) 39 (47%) 17 (21%) 82
Alcoholics Anonymous 27 (31%) 40 (47%) 19 (22%) 86

The authors concluded:

The failure of both Alcoholics Anonymous and the alcoholism clinic to produce fewer recidivists than did no treatment at all ought to be of great concern. Some of the present writers were quite optimistic about the possibilities of enforced referral to treatment, but the early encouraging anecdotal reports are not borne out by present data.
... the present data offer no support for a general policy of forced referrals to brief treatment.
Forced referrals to Alcoholics Anonymous and to an alcoholism clinic treatment program failed to reduce the likelihood of recidivism among a population of convicted chronic drunk offenders.
"A Controlled Experiment on the Use of Court Probation for Drunk Arrests", Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D., American Journal of Psychiatry, 124:2, August 1967, Page 163.

For another description of the Ditman study, see the "More Revealed" web site:

Similarly, Stanton Peele wrote:

A 1999 study of Texas' correctional substance abuse treatment programs found that those who participated in an in-prison [Twelve-Step] program had the same recidivism rates as non-participants. Although those who completed the program did better than untreated offenders, those who entered but did not complete the program did worse. Moreover, probationers enrolled in treatment in Texas had an overall higher recidivism rate than non-participants.

Two explanations could account for such findings. One possibility is that, while treatment and non-treatment groups are equally likely to be recidivist, those who quit treatment are those who were more likely to relapse anyway. Thus, counting only those who remain in treatment and aftercare is cherry-picking those most likely to succeed in the first place. The other possibility, which would scandalize A.A. zealots like [Oklahoma Governor Frank] Keating, is that those who have a negative reaction to A.A. and its 12-step approach are actually driven to relapse by the experience.
"Drunk with Power", Stanton Peele, Reason, May 2001, Vol. 33, Issue 1, p34, 5pp.

Peele also wrote:

The two randomized studies in which AA treatment was assigned found AA to yield worse outcomes than other forms of treatment — or no treatment at all.

(See Brandsma et al., The Outpatient Treatment of Alcoholism: A Review and Comparative Study, Baltimore: University Park Press, 1980;
Ditman et al., "A controlled study on the use of court probation for drunk arrests," American Journal of Psychiatry, 124:160-163, 1967.)

But Walsh et al. ("A randomized trial of treatment options for alcohol-abusing workers", The New England Journal of Medicine, 325:775-782, 1991) allowed alcoholics limited choices, and those who chose AA still did worst (about as bad as those assigned to AA).
AA's role in society — more negative than positive?

There, the success rate of A.A. was again negative — worse than zero. A.A. was hurting people by making it harder for them to quit and stay sober. Those patients who got no A.A. "treatment" at all were better off.

In addition, Stanton Peele has argued, in an article in The Sciences, that the most widely used alcoholism treatments (Twelve-Step) are the least effective. "This is seen in Deborah Dawson's (1996) analysis of data from the 1992 National Longitudinal Alcohol Epidemiologic Survey." Peele suggests that the "brief intervention" and "motivational enhancement" treatments are more successful alternatives.
(Peele, Stanton. The Sciences, 1998, vol. 38, no. 2, Mar-Apr, pp. 17-21.)

This is the study by Dr. Walsh and associates that Stanton Peele referred to:



Background. Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options.

Methods. We randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous (AA) meetings, and a choice of options. Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period.

Results. All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often (P<0.0001) by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment.

Conclusions. Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.

Diana Chapman Walsh, Ph.D.,
Ralph W. Hingson, SC.D.,
Daniel M. Merrigan, S.J., Ed.D., M.P.H.,
Suzette Morelock Levenson, M.P.H.,
L. Adrienne Cupples, Ph.D.,
Timothy Heeren, Ph.D.,
Gerald A. Coffman, M.S.,
Charles A. Becker, M.S.,
Thomas A. Barker, M.P.H.,
Susan K. Hamilton,
Thomas G. McGuire, Ph.D.,
and Cecil A. Kelly, C.A.C.
The New England Journal of Medicine, Volume 325, pages 775-782, September 12, 1991

The reported results included:

Drinking Outcomes
  ...   On four of the measures of drinking (mean number of daily drinks, number of drinking days per month, binges, and serious symptoms), we found no significant differences among the three groups at any follow-up point.
      On the remaining eight measures of drinking and drug use (any drinking, intoxication, blackouts, Iowa stage, Rand impairment score, definite alcoholism, cocaine use, and time to additional treatment), however, there were statistically significant differences among the three groups at one to four follow-up points. In terms of all but two of these measures, the hospital group had the fewest problems...   ...   On most, the compulsory A.A. group did the least well.   ...   The hospital group was significantly more likely to include continuous abstainers (37 percent vs. 17 percent for the choice group and 16 percent for AA only).

Other Drugs and Group Outcomes
      The compulsory AA group fared the least well overall. In addition, patients who were abusing cocaine, together with alcohol, did especially poorly in the AA group...   ...   The 30 cocaine users who were assigned to the AA group had the most evidence of problems on these measures of drinking, and they were the most likely, at every follow-up assessment, to report continued use of cocaine...
(Page 778.)

Note that most of the people who were sent to A.A. (63%) ended up requiring hospitalization anyway. In addition, they actually got worse while they were in A.A., so that they ended up requiring higher rates of expensive follow-up treatment in the hospital. The total cost savings from sending people to the "free" A.A. treatment, instead of hospitalizing them right away, was only 10%. This contradicts the often-repeated A.A. declaration that A.A. is "the most cost-effective treatment program", because it is free. It isn't cost-effective or "free" when all it does is make the patients worse, and make it more expensive for some hospital to clean up the mess later on. Walsh et. al. wrote:

When we compared the costs of treatment for the A.A. and hospital groups, we found that the costs for the A.A. group averaged $1,200 less per person, a savings of just 10 percent. Even though the initial referral to AA was free, the AA group had much higher rates of additional treatment; 63 percent of subjects randomly assigned to AA eventually required hospitalization.
(Page 780.)

And using A.A. to treat patients who were abusing both alcohol and cocaine was a total disaster:

Outcome Measures at 24 Months for Cocaine Users, According to Treatment Group
Any drinking
(In the previous 6 months.)
41 80 62 0.020
Any intoxication 32 77 54 0.005
Additional treatment
(Hospitalization for additional treatment because of uncontrolled drinking in the previous 24 months.)
18 63 27 0.001

In the period of 18 to 24 months after treatment, 80% of the A.A. group were still drinking. Once again, A.A. treatment had the worst outcome of any treatment method tested, and again, we see that the A.A. group required the most additional treatment in a hospital for uncontrolled drinking — far more than the other groups.

Dr. Walsh and associates concluded:

To a company or union counselor or a clinician advising patients, our findings argue for hospitalizing problem drinkers who are also using cocaine or other drugs. For other problem drinkers with reasonable job stability and no serious medical needs, an initial referral to AA (or the offer of a choice of treatment) is somewhat less costly (about 10 percent), but it entails extra risk. Employees sent only to AA, and those offered choices, are more likely to have their drinking problems resurface. The less costly intervention may be more efficient in the longer term if the money saved is spent to identify and refer more substance-abusing employees or if nonhospital options encourage seeking help. But if AA alone is mandated, or if choice is offered, our study shows that close monitoring is essential, because many employees have serious relapses in the first six months.
(Page 781.)

In other words, you have to watch them like a hawk because A.A. does not keep them sober.

Unfortunately, this otherwise excellent study did not have a control group, so we cannot determine what the overall success rate of any kind of treatment was, compared to the normal rate of spontaneous remission.

And there was also no group that got only threats of firing. That is, take one group of employees aside and tell them in no uncertain terms that if they don't immediately cut way down on their drinking that they will lose their jobs. The people in that study were undoubtedly made to understand that (because 31 of the employees were fired during the 2-year follow-up period), but the study did not test for what percentage of the employees would cut down or quit drinking of their own accord, rather than get fired, without any "treatment". That number has to be greater than zero, and may, in fact, account for a significant percentage of the successes in all three groups, all of which "improved during treatment". The authors recognized the effect of threats of firing, and found it in all three groups, but lacking a control group, were unable to measure it:

We found no differences among the three groups in any job outcome, including being fired. All three groups evidently brought their drinking problems under sufficient control at work for group differences in job performance to be rendered statistically insignificant.
(Page 780.)

A team of British researchers, lead by Doctors Jim Orford and Griffith Edwards, also tested the effectiveness of Alcoholics Anonymous treatment of alcoholics, and they also found it to be completely useless. Herbert Fingarette summarized their experiment in his landmark book Heavy Drinking:

      In the mid-1970s a team of reaserchers in Great Britain conducted a rigorously designed large-scale experiment to test the effectiveness of a treatment program that represented "the sort of care which might today be provided by most specialized alcoholism clinics in the Western world."11

      The subjects were one hundred men who had been referred for alcohol problems to a leading British outpatient program, the Alcoholism Family Clinic of Maudsley Hospital in London. The receiving psychiatrist confirmed that each of the subjects met the following criteria: he was properly referred for alcohol problems, was aged 20 to 65 and married, did not have any progressive or painful physical disease or brain damage or psychotic illness, and lived within a reasonable distance of the clinic (to allow for clinic visits and follow-up home visits by social workers). A statistical randomization procedure was used to divide the subjects into two groups comparable in the severity of their drinking and their occupational status.

      For subjects in one group (the "advice" group), the only formal therapeutic activity was one session between the drinker, his wife, and a psychiatrist. The psychiatrist told the couple that the husband was suffering from alcoholism and advised him to abstain from all drink. The psychiatrist also advised the husband to stay on his job (or return to it) and encouraged the couple to attempt to keep their marriage together. There was free-ranging discussion and advice about the personalities and particularities of the situation, but the couple was told that this one session was the only treatment the clinic would provide. They were told in sympathetic and constructive language that the "attainment of the stated goals lay in their own hands and could not be taken over by others."

      Subjects in the second group (the "treatment group") were offered a year-long program that began with a counselling session, an introduction to Alcoholics Anonymous, and prescriptions for drugs that would make alcohol unpalatable and drugs that would alleviate withdrawal suffering. Each drinker then met with a psychiatrist to work out a continuing outpatient treatment program, while a social worker made a similar plan with the drinker's wife. The ongoing counselling was focused on practical problems in areas of alcohol abuse, marital relations, and other social or personal difficulties. Drinkers who did not respond well were offered inpatient admission, with full access to the hospital's wide range of services.

      Twelve months after the experiment began, both groups were assessed. No significant differences were found between the two groups. Furthermore, drinkers in the treatment group who stayed with it for the full period did not fare any better than those who dropped out. At the twelve-month point, only eleven of the one hundred drinkers had become abstainers. Another dozen or so still drank but in sufficient moderation to be considered "acceptable" by both husband and wife. Such rates of improvement are not significantly better than those shown in studies of the spontaneous or natural improvement of chronic drinkers not in treatment. Or, as Vaillant once ironically remarked: "The best that can be said for our exciting treatment is that we are certainly not interfering with the normal recovery process."12

      Though the sophistication and elaborateness of the design and resources of this British experiment have made it a land-mark project, a similar experiment with sixty alcoholics had been reported in 1969. There results were of the same kind: After one year there was no evident difference between drinkers who had received intensive treatment and those who had received minimal treatment and had been told that the patient, not the program, had to deal with the problem.

Such experiments suggest that anything more than an hour or two of commonsense advice from an authoritative person may be a waste of time, money, and resources.13

11. Orford and Edwards (1977), 11. For the researchers' description of the experimental protocol summarized here, see pages 39-42; for their statement of their key findings, see pages 54-57.
12. Vaillant, "The Doctor's Dilemma" (1980), 18.
13. WHO Expert Committee on Problems Related to Alcohol Consumption, Problems Related to Alcohol Consumption (1980), 46.

Herbert Fingarette, Heavy Drinking, pages 78-80 and footnotes on page 94.
Also see:
Jim Orford and Griffith Edwards, 1977, Alcoholism : a comparison of treatment and advice, with a study of the influence of marriage, Oxford [England] and New York : Oxford University Press, ISBN: 0-19-712148-9

Jim Ordford was, in 1977,

  • M.A., DIP., PSYCH., PH.D.
  • Senior Lecturer in Clinical Psychology, University of Exeter
  • Principal Clinical Psychologist, Exe Vale Hospital, Exeter
  • previously Senior Lecturer and Research Worker, Institute of Psychiatry

And Griffith Edwards was, in 1977,

  • M.A., D.M., F.R.C.P., F.R.C., PSYCH., D.P.M.
  • Reader in Drug Dependence, University of London, Institute of Psychiatry
  • Honorary Consultant, Bethlem Royal Hospital and the Maudsley Hospital
  • Honorary Director, Addiction Research Unit, Institute of Psychiatry

You might notice that eleven out of one hundred is a rather high rate of success, when so many other tests and studies reported something closer to a five percent success rate — the usual rate of spontaneous remission in alcoholics. The two most obvious differences here are:

  1. That all of these patients were married, while a random selection of alcoholics will include many singles. In test after test, an intact marriage has been shown to be a valuable asset. Married alcoholics recover at twice the rate of singles. As the Harvard Medical School pointed out, the support of a good spouse was more helpful than a treatment program or a support group.
    In addition, patients who are still married still have something left to lose. Another study found that the people who do the best in recovery are not those who have "hit bottom" and lost everything; it's those people who still have something left to lose, and who will work to save it.

  2. That patients who were suffering from other serious mental or physical illnesses were filtered out and did not take part in this test. Some people who are terminally ill really are drinking to die, and there is little that can be done for them except give them better pain-killers. And many people who drink too much are actually suffering from other underlying disorders, either physical diseases or mental illnesses like depression or a bipolar disorder.

Prof. George E. Vaillant
(at Harvard, old photograph)
Professor (and Doctor) George E. Vaillant
of Harvard University is an enthusiastic advocate of Twelve-Step treatment, and was a Non-alcoholic — Class A — member of the Alcoholics Anonymous World Services, Inc. (AAWS) Board of Trustees for many years, until he rotated off. In 1983, he published his book The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, where he described the natural healing process associated with individuals addicted to alcohol — "spontaneous remission" — where some of the people who are addicted to alcohol will simply quit, and choose to stay abstinent of their own volition, without any Alcoholics Anonymous meetings, or any therapy program, or any other outside intervention at all.

Dr. Vaillant's question was: does the A.A. program improve on the percentage of alcoholics who undergo spontaneous remission?

Following the passage of the Hughes Act, the U.S. government — the NIAAA to be specific — funded studies of alcoholism treatment. Dr. Vaillant participated in the Cambridge-Sommerville [Massachusetts] Program for Alcohol Rehabilitation (CASPAR). It featured 24-hour walk-in services with medical treatment for detoxing. It treated 1000 new patients per year, did 2500 detoxifications per year, and had 20,000 outpatient visits per year.

To study the effectiveness of various methods of treating alcoholism ("treatment modalities"), Vaillant compiled forty years of clinical studies. Vaillant and the director William Clark also conducted an eight-year longitudinal study of their own where Vaillant reported having followed 100 patients who had undergone Twelve-Step treatment. (That was an unusually large and long-term study.) Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. Fully 95% of the treated patients relapsed sometime during the eight-year period that Vaillant followed them. Professor Vaillant candidly reported:

When I joined the staff at Cambridge Hospital, I learned about the disease of alcoholism for the first time. My prior training had been at a famous teaching hospital that from past despair had posted an unwritten sign over the door that read "alcoholic patients need not apply."   ...   At Cambridge Hospital I learned for the first time how to diagnose alcoholism as an illness and to think of abstinence in terms of "one day at a time."   ...   To me, alcoholism became a fascinating disease. It seemed perfectly clear that by meeting the immediate individual needs of the alcoholic, by using multimodality therapy, by disregarding "motivation," by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.

But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. Our clinic followed up our first 100 detoxification patients, the Clinic sample described in Chapter 3, every year for the next 8 years.   ...

Table 8.1 shows our treatment results. After initial discharge, only five patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. In table 8.1, the outcomes for the Clinic sample patients are contrasted with two-year follow-ups of four treatment programs that analyzed their data in a comparable way and admitted patients similar to ours. The Clinic sample results are also contrasted with three studies of equal duration that purported to offer no formal treatment. Although the treatment populations differ, the studies are roughly comparable; in hopes of averaging out major sampling differences, the studies are pooled. Costello (1975), Emrick (1975), and Hill and Blane (1967) have reviewed many more disparate two-year outcome studies and have noted roughly similar proportions of significantly improved and unimproved alcoholics. Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.

TABLE 8.1 Comparison of selected two-year follow-up studies.
Study n in original sample n followed up Duration of follow-up (years) Abstinent or social drinking Improved Abusing alcohol
Clinic sample [A.A.] 106 100 2 20% 13% 67%
Three pooled "no treatment" studiesa 245 214 2-3 17 15 68
Four treatment studiesb 963 685 2 21 16 63

a. These are studies by Orford and Edwards (1977), Kendall and Staton (1966), and Imber et al. (1976). Because at 1 year there was no difference between Orford and Edwards's treated and control populations and because at 2 years their report did not clearly separate the two populations, all 85 of their subjects on whom they had a 2-year follow-up are included.

b. These are the studies by Belasco (1971), Bruun (1963), Robson, Paulus, and Clarke (1965), and van Dijk and van Dijk-Koffeman (1973).

In table 8.2, the results of the Clinic sample at eight years are compared with five rather disparate follow-up studies in the literature which are of similar duration but which looked at very different patient populations. Once again, our results were no better than the natural history of the disorder.

TABLE 8.2 Long-term follow-up of treated and untreated alcoholics.
Study n in original sample n followed up Duration of follow-up (years) Abstinent or social drinking Improved Abusing alcohol or dead Dead Gamma alcoholics
Clinic sample [A.A.] 106 100 8 38% 7% 55% 29% 95%
Myerson and Mayer 1966 101 100 10 22 24 54 20 100
Bratfos 1974 1179 478 10 12 25 63 14 87
Goodwin, Crane, and Guze 1971 123 93 8 26 15 59 5 c.75
Voetglin and Broz 1949 ? 104 7 22 13 65 ? ?
Lundquist 1973 200 200 9 27 20 53 22.5 c.75

The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-286.
The same text was reprinted in Vaillant's later book, The Natural History of Alcoholism Revisited, George E. Vaillant, Harvard University Press, Cambridge, MA, 1995, pages 349-352.
[See the Bibliography at the end of this file for the references that Vaillant cited above.]

What Professor Vaillant, a Trustee of Alcoholics Anonymous World Services, Inc. — in other words, one of the highest-ranking A.A. leaders — is candidly, clearly describing is a zero-percent success rate for his A.A.-based treatment program.

The A.A. meetings and the Twelve Steps and all of the rest of A.A. program did not help the alcoholics at all. Zero improvement. Zilch. And it was even worse than no help:

  • Look at the "Abstinent or social drinking" and "Improved" columns of Table 8.1. You have to add the numbers together to get the over-all improvement rate for that item. So, for "A.A.", "no treatment", and "other treatment", we get 33%, 32%, and 37% over-all improvement rates, respectively. Those numbers are basically the same. There is no statistically significant difference between 33 and 32 percent, and hardly any between 33 and 37 percent. So A.A. treatment was no better than either "other treatment" or no treatment at all, and conversely, "other treatment" wasn't a whole lot better than either A.A. or "no treatment", either. After two years of A.A. treatment, "other treatment", or "no treatment", roughly two-thirds of the patients in all of those groups were still abusing alcohol. That's a dismal result.

  • Look at the "Abstinent or social drinking" and "Improved" columns of Table 8.2. Again, you have to add the numbers together to get the over-all improvement rate for that item. The A.A. "Clinic sample" scored 45 percent improved over-all, while the other programs ranged from 35 to 47 percent. Two of the programs, those in the Bratfos and Voetglin-Broz studies, seem to have been much worse than average, but all of the rest of the programs, including A.A., show approximately the same results. (The Voetglin-Broz study used something called "Conditioned Reflex Treatment". What caused the poor results in the Norwegian Bratfos study is unknown.)

  • Look at the "Dead" column of Table 8.2. The A.A.-treated group, the "Clinic sample", with the death rate of 29%, had the highest death rate of any kind of program, significantly higher than all of the other programs.

  • And those five people out of the hundred in the A.A.-treated "Clinic sample" who successfully stayed sober for 8 years are just the result of that same old five percent spontaneous remission rate at work, again.

  • As Professor Vaillant reported, the A.A. treatment program did not alter the natural history (the usual course) of alcoholism, except for yielding a higher death rate than doing nothing. A.A. did not save the alcoholics; it didn't even help them; it just killed them.

Remember that these terrible numbers were reported by a Trustee of Alcoholics Anonymous World Services, Inc., by a real true believer in A.A., by one of the highest-ranking A.A. insiders, by someone who loves A.A. and was trying hard to make it look good, not by some harsh critic of A.A. who might be suspected of bias, or of fudging the numbers to make A.A. look bad...

Remember this the next time you hear somebody say "Keep coming back! It works! (If you make it work...)"

So why does Professor Vaillant so enthusiastically recommend A.A. for everyone who has a drinking problem, when the A.A. program obviously doesn't work? The answer seems to be that Vaillant is a member of the Buchmanite / Alcoholics Anonymous religion. He is "under God-control", and he's trying to get everyone else under God-control too. Even if A.A. won't save people from alcoholism, it will make Buchmanites out of them, and make them "Seek and Do the Will of God."

Prof. Vaillant's own words on the subject were:

Recently the Annals of Internal Medicine editorialized that "the treatment of alcoholism has not improved in any important way in twenty-five years" (Gordis 1976). Alas, I am forced to agree. Perhaps the best that can be said for our exciting treatment effort at Cambridge Hospital is that we were certainly not interfering with the normal recovery process. How can I, a clinician, reconcile my enthusiasm for treatment with such melancholy data?

The answer derives from addressing the second horn of the dilemma. The problem of alcoholism is too immense and the pain it causes too severe to suggest that hospitals once again hang out signs that read "alcoholics need not apply." The demands alcoholism places on the health-care system are too pervasive to tell government bodies that it is useless to fund large-scale treatment programs. It is not a step forward to say that alcoholism is the sole responsibility of families, of the church, and of the police. Therefore, if treatment as we currently understand it does not seem more effective than natural healing processes, then we need to understand those natural healing processes. We need also to study the special role that health-care professionals play in facilitating those processes.

Consider tuberculosis as an analogy. In 1940 a well-known textbook of medicine advised, "Since there is no known specific cure for tuberculosis, treatment rests entirely on recognition of the factors contributing to the resistance of the patient." (Cecil 1940). In saying this the textbook did not recommend that the government and doctors get out of the business of treating tuberculosis; nor did it suggest that because genes and socioeconomic factors were etiologically just as important as contagion tuberculosis was really just a social problem and not a medical disorder. Rather, the text suggested that doctors learn more about natural healing processes.
Throughout history, physicians faced with disease that they can neither comprehend nor cure have played invaluable roles in capturing these natural forces. In his classic monograph, Persuasion and Healing, Jerome Frank, professor of Psychiatry at Johns Hopkins University, offered a transcultural model for healing that is nonspecific for disease or patient; but Frank's model maximizes both the relief of suffering and — of special importance in alcoholism — attitude change. Frank acknowledges the paradox that demand for therapy may seem increasingly insatiable at the very time of mounting complaint that such therapy may represent expensive fraud. What feeds such demand is not the patient's need for cure as much as his need to elevate his morale.

First, alcoholics feel defeated, helpless, and without ability to change. If their lives are to change, they need hope as much as relief of symptoms. Second, alcoholics often have an ingrained habit that is intractable to reason, threat, or willpower. To change a maladaptive habit, be it smoking or getting too little exercise or drinking too much alcohol, we cannot "treat" or compel or reason with the person. Rather, we must change the person's belief system and then maintain that change. Time and time again, both evangelists and behavior therapists have demonstrated that if you can but win their hearts and minds, their habits will follow. In other words, if we can but combine the best placebo effects of acupuncture, Lourdes, or Christian Science with the best attitude change inherent in the evangelical conversion experience, we may be on our way to an effective alcoholism program. I shall describe Frank's view in general terms and then illustrate his points with four relatively successful programs.

Frank's prescription for an effective "placebo" therapy (that is, for a modern-day Lourdes) has as its goal to raise the patient's expectation of cure and to reintegrate him with the group.
The sanctioned healer should have status and power and be equipped with an unambiguous conceptual model of the problem which he is willing to explain to the patient.
The common ingredients of such a program include group acceptance, an emotionally-charged but communally shared ritual, and a shared belief system. Such a ritual should be accompanied by a cognitive learning process that "explains" the phenomenon of the illness. The point is that if one cannot cure an illness, one wants to make the patient less afraid and overwhelmed by it.

Frank's prescription for attitude change is initially interrogation by and confession of sins to a high-status healer.
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 286-288.
The same text was reprinted in Vaillant's later book, The Natural History of Alcoholism Revisited, George E. Vaillant, Harvard University Press, Cambridge, MA, 1995, on pages 352-354.
[See the Bibliography at the end of this file for the references that Vaillant cited above.]

Essentially, Vaillant is saying that we can't just give up and do nothing. We should keep on trying something. I totally agree. And he wants the government to keep on funding his programs. That's understandable. (I don't necessarily agree, but it's understandable.)

Then Vaillant wrote,
"Perhaps the best that can be said for our exciting treatment effort at Cambridge Hospital is that we were certainly not interfering with the normal recovery process."
I disagree. Vaillant clearly demonstrated that that was exactly what they were doing: interfering with spontaneous remission, causing his group, his "Clinic Sample", to have a much higher death rate than anybody else was getting.

Then Vaillant asked the key question:
"How can I, a clinician, reconcile my enthusiasm for treatment with such melancholy data?"
Yes indeed, why send anybody else to A.A., when the results are so bad?

Notice how Vaillant slickly equated A.A. with "treatment", without quite saying so. That is a deceptive word game. "Treatment" and "mandatory Alcoholics Anonymous meetings" are not necessarily the same thing. (That is an example of the propaganda stunt "False Equality" — imply that two different things are equivalent, when they are not.) If you want "treatment", why not send the alcoholics to any of the other treatment programs that had the same dismal failure rate as Alcoholics Anonymous, but much lower death rates?

In trying to answer that question, Vaillant went, by some lengthy, tortured logic, from admitting that A.A. doesn't work, to recommending that we send more alcoholics to a program that is exactly like A.A. anyway,
    — because it might start to have a beneficial effect, maybe later after we learn more;
    — because we might get lucky and accidentally learn how to harness some "natural healing processes".
(Yes, and I might get lucky and win the lottery tonight, too, but I'm not holding my breath.)
Vaillant wants us to send more people to the program that had the highest death rate of any of the programs that he examined. Where is the sense in that?

I smell a rat. And I think that the rat is the reason why Vaillant was on the Board of Trustees of AAWS (Alcoholics Anonymous World Services, Inc.). Vaillant has cards he isn't showing, beliefs he isn't revealing to us, like religious beliefs that A.A. is good for something besides treating alcoholism...

Vaillant is a true believer in Alcoholics Anonymous. All through the rest of his book, Vaillant described how he used A.A. teachings, practices, and philosophy on his patients, and he told how wonderful he considered A.A. to be. The eight-year study described here is just a summation of that on-going program. Vaillant's enthusiasm for A.A. was hardly dampened by his discovery that it didn't work.

How can that be? The answer is,
"Easy. You don't have to be an alcoholic to join a cult religion. Just look at the Moonies, or Scientology, or the Hari Krishnas... They aren't alcoholics or drug addicts, but they are still irrational true-believer cult members, as crazy as a loon, as buggy as a flop-house blanket. And, occasionally, they even have members who are doctors. The People's Temple had a doctor and a nurse who mixed up and dispensed the cyanide drinks at Jonestown. And Synanon had a doctor who performed vasectomies on all of the men."

In A.A., before Prof. George Vaillant, there was Dr. Harry Tiebout, who was also not an alcoholic — he was a real, certified, psychiatrist — and he also abandoned his training and became a true believer in using Alcoholics Anonymous "treatment" to force his patients to "surrender".

And then there is Dr. G. Douglas Talbott, the previous President of ASAM (the American Society for Addiction Medicine, another A.A. front), who drove other doctors to suicide with his A.A.-based "therapy".

So there is no shortage of insane doctors, mad scientists, and other sick "therapists" who love to torture their patient-prisoners with fascist medicine. (See Straight, Inc. for more.)

Notice that Vaillant used the same old stereotype of "The Alcoholic" as A.A. does:
"They are all crazy and you can't reason with them, so you have to fool them and brainwash them into doing The Right Thing."
"Change their belief systems to change their behavior."
"If you can win their hearts and minds, then their habits will follow."

It's just another example of standard cult behavior — the arrogant belief that "Newcomers can't think right, so we will have to do their thinking for them."
"Newcomers can't think right,
— so it doesn't matter what they think — it's irrelevant anyway,
— so it's okay if we deceive them in order to help them."

Deliberately changing someone's belief system, possibly without his knowledge or permission, smacks of brainwashing and mind control, but that's what cults do. Deceptive recruiting is also what cults do.

Deliberately giving people a treatment program that is a proven failure (Vaillant himself proved it), while calling that failed program a "placebo", and then telling the patients that they are in the greatest, most exciting, alcoholism treatment program in the world, sounds like a good way to bring on a host of malpractice lawsuits. I don't know how anyone can call that ethical behavior, especially considering that people's lives are at stake.

Just recently, some Scandinavian researchers had this to say about placebos:

Placebo And Opioid Treatment Activate Same Neuronal Network

NEW YORK (Reuters Health) Feb 08 [2002] — Placebo treatment appears to activate the same part of the brain that is activated by opioids, Scandinavian investigators report.

Dr. Martin Ingvar, of the Cognitive Neurophysiology Research Group in Stockholm, and colleagues compared regional cerebral blood flow measured by positron emission tomography while inducing pain or a control stimulation in nine subjects. Their findings appear in the February 7th issue of Sciencexpress, the online edition of the journal Science.
"The experience of pain is always subjective," Dr. Ingvar told Reuters Health.

The placebo effect is influenced by several factors, including a person's expectations of the treatment and their desire to feel better, the investigators point out. By showing that placebo and an opioid agonist activate the same brain regions, the findings suggest that some of these same factors may be involved in triggering the pain relief.

Despite the evidence that placebo can affect the brain, Dr. Ingvar said that the report "does not support the use of placebo alone in treatment."

The Swedish doctors did not recommend trying to treat the patients' pain with only a placebo, but that is just what Vaillant recommended as a cure for alcoholism — essentially, "Don't give them anything real; just fake them out."

Also note that the Swedish researchers found that placebos work on the brain like opiates, to reduce the perceived intensity of pain. The Swedish doctors didn't say anything about placebos being useful for curing alcoholism or any other deadly illness or disease.

Note that Vaillant didn't give us even a vague hint of treating alcoholics like adults who are responsible for their own lives or deaths, which they really are, in the final analysis — they will live or die by their own hands. Vaillant just displays an arrogant, condescending attitude of "We'll fool those alcoholics into being good by playing mind games on them."

And then Vaillant actually recommends using a hocus-pocus witches' brew mixture of "the placebo effects of acupuncture, Lourdes, or Christian Science" combined with "the attitude change of an evangelical conversion experience" to manipulate people's minds. Unbelievable.

Also note that you are supposed to get a religious "evangelical" conversion experience from this A.A. organization that says that it isn't a religion and it doesn't do religious conversions.

Vaillant chose Jerome Frank's "transcultural model for healing that is nonspecific for disease or patient". What that means in plain English is that it is a generic cure-all. It's a cure-all that was designed with no particular disease or patients in mind; it's just supposed to be a general-purpose cure-all that is good for curing whatever ails you, just like good old-fashioned snake oil. It's just like the Twelve Steps, which are supposedly able to cure anything and everything from alcoholism to compulsive shopping to schizophrenia. And it's almost comical how Prof. Frank admits that such "therapy" suffers from "mounting complaints that such therapy may represent expensive fraud."

One wonders whether Jerome Frank's cure-all model was deliberately patterned after the A.A. program. It sure resembles A.A.. The similarity is far too much of a coincidence to assume that Prof. Frank did not write up his "model" in order to recommend the A.A. program.
(What was it I said, "There is no shortage of insane doctors, mad scientists, and other sick 'therapists' who love to torture their patient-prisoners with fascist medicine"?)

Vaillant describes Prof. Frank's ideal therapy program as: There should be a "sanctioned healer ... with an unambiguous conceptual model of the problem which he is willing to explain to the patient." In other words, there should be a leader with some simplistic dogmatic explanations that he is happy to shove on the newcomers. The explanations don't have to be true, just "unambiguous". The program should offer "group acceptance, an emotionally-charged but communally-shared ritual, a shared belief system", and some phony dogma that "explains" the phenomenon of the illness. In other words, the program should be Alcoholics Anonymous, with its groups, ritualistic meetings, shared beliefs, and dogma.

Note how Vaillant put quotes around the word "explains" when he wrote:

Such a ritual should be accompanied by a cognitive learning process that "explains" the phenomenon of the illness.

The dogma isn't supposed to really explain "the phenomenon of the illness"; it is just supposed to mollify the stupid patient with some unambiguous simplistic fairy tales. (Cult true believers really like black-and-white thinking and simple, "absolutely-true" statements.) Vaillant clearly states that the goal is to use emotionally-charged rituals and "unambiguous" misinformation to play games with the patient's mind, and he rationalizes it this way:

The point is that if one cannot cure an illness, one wants to make the patient less afraid and overwhelmed by it.

So that he can die comfortably, I guess — die comfortably as a "less afraid and overwhelmed" member of Vaillant's religion. Likewise, Prof. Frank said that the goal was not to cure the patient, but rather it was just to "elevate his morale." So that he can die with a smiley face on his head?
Apparently so, because that is what the real results are.

Personally, I'd rather really fix the problem, and I'd call quitting drinking, and staying quit, a workable cure. So some kind of a "cure" is possible, so there is no need to yammer about how we can't cure the illness, so let's play mind games on the patients.

Speaking of mind games, did you notice how Professor Vaillant's mind jumped from:
"A.A. and the other treatment programs that I examined all failed to cure or noticeably help the alcoholics",
"Therefore no cure is possible, so let's play mind games on the patients and give them hocus-pocus pseudo-religious faith-healing placebos, like the A.A. program. That program might capture some 'natural healing process'."
(Now I can see why they say that "Ph.D." means that the B.S. is "Piled High and Deep".)

Vaillant's plan for a treatment program is another example of The Enlightened Counselor's Deception, where "enlightened" counselors will tell public officials, "Of course we know that this nutty religious or spiritual or superstitious stuff that is at the heart of the A.A. and N.A. programs doesn't really work, but it offers a wonderful placebo effect, and if the patients think that it works, and it helps to keep the patients off of drugs and alcohol, then the illusion is a good thing. It might save their lives. So let's encourage it."

That is how the counselors who are true believers in the A.A./N.A. 12-step religion succeed in getting the government to financially support and promote their cult religion with public tax dollars and health insurance money, and that is how they talk judges into sentencing people to 12-step-based "treatment programs".

And finally, Frank and Vaillant want to get the patient to confess his sins to a "high-status healer" to get an "attitude change".
Just who or what on Earth is a "high-status healer"?
A sponsor who reputedly has a lot of status?
A lot of status, according to whom?

Since Vaillant already showed that Alcoholics Anonymous doesn't work, and doesn't heal anybody, an A.A. sponsor doesn't qualify as a "healer".

And why should the patient confess his sins to that "healer"?
Because it will make him quit drinking?

No. Of course not. Vaillant knows full well that that doesn't really work. Vaillant has already candidly reported that the A.A. 12-step program, with all of its guilt-inducing listing of sins, and confessing of sins, and "admitting the exact nature of your wrongs", doesn't work at all. Eight years of thorough testing showed A.A. treatment to be completely ineffective and utterly useless, and even downright harmful — it raises the death rate. And yet Vaillant wants to send all of the alcoholics to A.A. to confess their sins anyway, obviously for some other reason than the effective treatment of alcoholism.

The real reason for such confessions is because Vaillant is a thinly-veiled Buchmanite, or an A.A. true believer (same thing, really), who can't wait to get people on their knees, confessing their sins, because his cult religion tells him that people must confess their sins to each other in order to be holy. So, in order to better serve God, Vaillant has given himself the task of trying to get as many people as possible to confess their sins to each other, as well as to convert to his religion.

What does any of this have to do with curing alcohol abuse?!
Nothing. This is cult religion, not the treatment of alcoholism.

What Vaillant has done is pick out a "treatment model" — Jerome Frank's model — that matches his own Buchmanite religious beliefs, so that he can then recommend a religious program, specifically the Alcoholics Anonymous program, while pretending to be recommending a psychologically-oriented alcoholism treatment program.

Vaillant wants to send more people to A.A. in spite of the simple fact that when he tested the A.A. program, it didn't work. It was a disaster. The best thing that Vaillant could say for A.A. was that it did nothing. But, the truth is, A.A. was far worse than nothing. Over-all, A.A. had the highest death rate of any treatment or "non-treatment" program tested. Look at the "Dead" column in Table 8.2 again. Vaillant clearly demonstrated that A.A. kills: Over an 8-year period, the A.A.-treated "Clinic sample" had a 29% death rate. That really is appalling. That is nearly one out of every three patients, dead. That's the Bataan Death March. Compared to the other programs, the A.A. death rate was anything from 128% to 580% of the other programs' death rates.

So there is absolutely no sane reason to be sending more patients to Alcoholics Anonymous, or any program based on Alcoholics Anonymous, or any program that is even like Alcoholics Anonymous, when all of the other treatment programs killed fewer patients.

But there is a dishonest, ulterior religious motive for doing so, if you are a Buchmanite or a member of Moral Re-Armament, or perhaps a hidden member of the Alcoholics Anonymous religion. Then, you would want to send people to A.A. to make them do the Twelve Steps, and confess their sins, and Seek and Do the Will of God, because you believe it will please God...

The A.A. saying is,
"If you keep on doing what you've always been doing,
You will keep on getting what you've always been getting.
To expect anything different is insane."

Yes. And if you keep on sending patients to A.A. and N.A., you will keep on getting the same failure rate, and the same death rate.
To expect anything different is insane.

For a final laugh, you might be curious to know where Vaillant was going with his argument. We stopped quoting him at the point where Prof. Frank was advocating sending all alcoholics to some program where they would confess their sins to "a high-status healer." Well, after that, Vaillant declared that dogmatic cult religion is the best cure for alcoholism. Now, he never used those exact words, "dogmatic cult religion"; he just said:

Frank's prescription for attitude change is initially interrogation by and confession of sins to a high-status healer. This process involves four components: indoctrination, repetition, removal of ambiguity, and opportunity for identification. It has been demonstrated that the patient's active participation in such a process "increases a person's susceptibility especially if the situation requires him to assume some initiative" for his own attitude change (p. 112). In the Stanford Heart Disease Prevention Program, internist John Farquhar (1978) and his colleagues (Farquhar et al. 1977) have examined different models of reducing smoking, altering diet, and increasing exercise. In their efforts to reduce coronary risk in large populations of patients, they found that explanation of risk and rational advice by physicians are less useful than systematic indoctrination and repetition using mass media and opportunity for identification through peer support groups.

Frank writes: "the greatest potential drawback of therapy groups is their tendency not to supply sufficient support, especially in early meetings, to enable members to cope with the stresses they generate" (p. 190). One of the functions, then, of the medical-care system is to facilitate the transition of the isolated patient to group membership. Finally, if attitude change is to be maintained, repetition of group rituals and the group support that they engender must be sustained after clinic discharge.

Table 8.3 presents four alcohol treatment programs that fortuitously followed Frank's prescription and significantly facilitated remission from alcoholism. The table reflects the early treatment results reported by the Shadel clinic using emetine (Shadel 1944; Voetglin and Broz 1949), by the Menninger Clinic using disulfiram (Antabuse) and group therapy (Wallerstein 1956), by Beaubrun (1967) using an imaginative combination of indigenous paraprofessionals and medically sanctioned Alcoholics Anonymous, and by Sobell and Sobell using behavior modification (1973, 1976). Because they were adequately controlled, the Wallerstein and Sobell studies are especially convincing. Each program employed the newest method of its decade, was led by competent investigators, and found results that were clearly superior to those usually reported.

TABLE 8.3 Two-year follow-up results of "special" treatment programs compared with results from "routine" treatment programs.
Treatment program n in original sample n followed up Duration of follow-up (years) Abstinent or social drinking Improved Continued trouble
Four pooled treatment studiesa 963 685 2 21% 16% 63%
Emetine aversion (Shadel 1944) ? 300 2 60% 5% 35%
Antabuse (Wallerstein 1956) 47 40 2 53% 47%
AA (Beaubrun 1967) 57 57 7 37% 16% 47%
Behavior modification (Sobell and Sobell 1976) 20 20 2 35% 50% 15%
a. These are the studies cited in Table 8.1.

But what could emetine aversion conditioning in the 1940s, disulfiram coupled with group therapy in a world-famous clinic in the 1950s, the use of AA coupled with indigenous Calypso singing ex-alcoholics in the 1960s, and behavior therapy to return to controlled drinking in the 1970s have in common? First, they all maximized the placebo effect of medical treatment and effected significant attitude change.
Second, consistent with Frank's suggestions, in each of the programs the illness of alcoholism was carefully explained to each patient.
Third, consistent with altering ingrained behavior, all four treatments maximized attitude change in an emotionally charged setting.
Fourth, rather than trying to alter attitude by threat or by rational advice, each program altered attitudes by affecting self-esteem. The Sobells' patients were shown videotapes of themselves drinking in control and out of control; they highly valued the mastery involved in their return to controlled drinking.
The success of Alcoholics Anonymous — and its reasonable facsimiles which are continuously being rediscovered — probably results from the fact that it conforms so well to the natural healing principles that Frank outlines and with Frank's general prescription for therapeutic group processes.
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 288-291.
The same text was reprinted in Vaillant's later book, The Natural History of Alcoholism Revisited, George E. Vaillant, Harvard University Press, Cambridge, MA, 1995, pages 354-357.
[See the Bibliography at the end of this file for the references that Vaillant cited above.]

Outrageous. First off, note that Vaillant and Frank openly advocate brainwashing the patients:
Do not use "explanation of risk and rational advice by physicians."
Rather, use: "systematic indoctrination and repetition" to "effect significant attitude change".
Notice how they actually say that they want to "increase a person's susceptibility" to their mind-bending procedures, and then they want to use irrational "emotionally-charged group-ritual placebo" treatment to reinforce the effects. They don't even blush as they advocate using brainwashing and mind-control techniques on their patients.

By the way, Vaillant and Frank really should know enough about medical terminology to know that if a treatment works, and yields a real, measurable, strongly positive effect, then it isn't a placebo. By definition, a placebo is a do-nothing medicine. Vaillant claims real cures from Prof. Frank's "placebo" "natural healing principles". That's a contradiction in terms. So is this nonsensical oxymoronic double-talk:
"they all maximized the placebo effect of medical treatment..."
— Which would supposedly mean that medical treatment does not work and has no effect other than fooling the patients into healing themselves psychosomatically.

Now I know full well that there is such a thing as a placebo effect. Sometimes, patients will show improvement or relief from symptoms even if they are only given do-nothing sugar pills, because they believe that the pills will work. But you sure can't count on that effect, and you can't base a treatment program on hoping that you will get enough of a placebo effect to heal the patients.
Vaillant got no such helpful placebo effect in his own 8-year-long study of A.A. treatment, remember?
And plenty of people are not at all fooled by any placebo effect — junkies and other dopers being at the top of the list. When unscrupulous dope dealers cheat their customers by giving them powdered sugar instead of smack or other drugs, the junkies and dopers know it immediately. They don't get high on any "placebo effect". So to imagine that a "placebo effect" is going to magically cure all of the alcoholics is pathetically deluded wishful thinking. (Either that, or else it is deliberate deception. Either he's crazy, or he's lying. It has to be one or the other, because he sure isn't telling us the truth. You decide which it is.)

Next, Vaillant cited a study of the Stanford Heart Disease Prevention Program, which found that patients had been helped by a program that included "opportunity for identification through peer support groups."
So Vaillant suddenly assumed that peer groups were essential for the treatment of alcoholism, and began gleefully discussing the mechanics of how we can shove people into groups: "One of the functions, then, of the medical-care system is to facilitate the transition of the isolated patient to group membership."
Yes, force them all into Alcoholics Anonymous meetings, is what Vaillant really means. And then you have to Keep Them Coming Back for more and more "group ritual" medicine:
"Finally, if attitude change is to be maintained, repetition of group rituals and the group support that they engender must be sustained after clinic discharge."

Charles Manson
You know, that sounds like something a crazy cult would do to the newcomers:
"Attitude change" is achieved through "systematic indoctrination and repetition", and maintained through "group rituals."
That is a surprisingly accurate description of how Charles Manson brainwashed his followers and programmed them to go murder Sharon Tate, Rosemary and Leno La Bianca, and four of their friends in a grisly "helter-skelter" ceremony. The kids who committed those murders were not murderers to start with, but they were after Charles Manson gave them enough "attitude changes" and "systematic indoctrination" and "group rituals":7

      Listening to Leslie [van Houten], we began to see clearly how Manson had manipulated his followers during their frequent LSD trips together by leading intense role-playing sessions and fantasy games for up to eight hours at a time which, as Leslie said, "took root" in their minds. Under Charlie's direction, they played pirates and maidens, cowboys and Indians, devils and witches, in scenes replete with violent and sadistic imagery. When it came time to play Helter Skelter, life in the Family had become a game with no borders on fantasy and reality, an extended "trip" that kept up long after any chemical effects had worn off. Moreover, using the same kinds of techniques employed in many cults, Manson guided and badgered his followers into lasting states of confusion and not thinking that laid them open to every suggestion and command he gave. At all times, and especially during the Family's psychedelic episodes, Charlie's adept wordplay hammered home the final spikes of snapping.
      "Being around Charlie during that time was like playing a game of Scrabble," Leslie told us, aptly characterizing Manson's method of inducing madness. "He never labeled anything exactly like it was. He'd say, 'The question is in the answer,' and 'No sense makes sense' — things that would make your mind stop functioning. Then it wasn't a matter of questioning when things began to get bad. We'd stopped questioning months before."
Snapping: America's Epidemic of Sudden Personality Change, Flo Conway and Jim Siegelman, page 203.

(Incidentally, did you know that Charles Manson was trained in Scientology techniques? One of the times that he was in prison, his cellmate was a Scientologist, and the two of them whiled away the years by practicing Scientology procedures on each other. That's where Charles Manson learned how to manipulate other people's minds. What a small cult world it really is, after all.)

Charlie's girls shaved their heads after the jury found him guilty

Then Prof. Vaillant cited four studies that he hand-picked out of 40 years of the literature, one per decade, that supposedly demonstrated the successful application of Prof. Frank's "natural healing principles". Vaillant described them as: "four alcohol treatment programs that fortuitously followed Frank's prescription and significantly facilitated remission from alcoholism."

Ridiculous. They did not "fortuitously follow Frank's prescription". They didn't even accidentally or coincidentally do the same things.

Vaillant cherry-picked four studies that he thought looked sort of like Prof. Frank's ideas, but there is really not much similarity there at all. In fact, two of the four studies were done before Prof. Frank came up with his "non-specific natural healing program" in 1961, and they used drugs, not natural healing.

Then Vaillant used just one of those four studies — an obscure report from Trinidad (Beaubrun 1967) — to try to show the effectiveness of Alcoholics Anonymous treatment.

Apparently, the only study of anything like A.A. treatment that Vaillant could find that showed better than average results (the only study that he cited) was some people in the boondocks of Trinidad and Tobago in the 1960s, who used "indigenous calypso singing", combined with some A.A. rituals, for group therapy. (Vaillant didn't say whether they also used some voodoo rituals in their program.)

Notice how Vaillant quietly discarded his own eight years of carefully-documented research which showed that A.A. didn't work at all, and Vaillant just grabbed at one study of calypso sing-alongs in the Caribbean as evidence that Alcoholics Anonymous and Jerome Frank's screwy mind-altering "placebo group therapy" really do work after all.

Spontaneous Calypso Singing
Vaillant hasn't bothered to explain just what the calypso music get-togethers in Trinidad and Tobago have to do with American A.A. meetings. I've never seen an American A.A. meeting break out in spontaneous calypso singing, like the people in the comic movie Beetlejuice did. The fact that some natives in Trinidad and Tobago get a kick out of singing calypso songs at non-alcoholic parties is great — it sounds like a whole lot of fun and I'd like to go — but it doesn't prove that A.A. works in the USA. And the success of calypso singing hardly proves anything about Prof. Frank's so-called "placebo" treatment.

Remember that two of the four "successful" therapy programs that Vaillant cited as "proof" of Frank's "natural healing principles" actually used drugs — specifically emetine and disulfiram — to get their results, not Jerome Frank's psycho-babble nonsense about the wonderful benefits of placebos, brainwashing, and emotionally-charged group rituals.

And it's very strange that Vaillant cited the work of the Sobell and Sobell husband-and-wife team as "proof" that Frank's ideas work. The Sobells were so hated and vilified by the A.A. hierarchy (including hidden members and front groups) for advocating the teaching of controlled drinking that they were driven out of the USA, and had to move to Canada to continue their practice, because the A.A. faithful decided that teaching controlled drinking was against the A.A. dogma, and they accused the Sobells of killing alcoholics. (Talk about the pot calling the kettle black. Talk about psychological projection...) Vaillant's use of them as an example of successful treatment is also funny because their work had basically nothing to do with the irrational mind-altering emotionally-charged group rituals that Jerome Frank advocated. The Sobells used an approach more like, "Look at this videotape of yourself last night. This is how stupid you look and act when you get smashed. Wouldn't you like to just have a few instead, and keep your wits about you, and not look like such a jerk?"

(Ouch! That's really a rough treatment program, isn't it? Can you imagine waking up all hung over and sick and jittery, and having someone shove such a videotape in your face first thing in the morning? Talk about aversion therapy...)

And lastly, note how Vaillant summed up his argument by declaring that Alcoholics Anonymous was a big success because had it followed Prof. Frank's "natural healing principles":

The success of Alcoholics Anonymous — and its reasonable facsimiles which are continuously being rediscovered — probably results from the fact that it conforms so well to the natural healing principles that Frank outlines and with Frank's general prescription for therapeutic group processes.

Vaillant had shown no such success for A.A. at all — he had in fact, with his eight years of research, clearly demonstrated just the opposite, the total failure of A.A. treatment — yet he suddenly claimed success as a given, and stated that Frank's "natural healing principles" were "probably" the reason why. That is an example of the propaganda technique called "Assume the major premise" — just talk like something is true when you only wish it were true, and wish to fool other people into believing that it is true, and then quickly divert attention from that bogus assumption by arguing about something else, like whether Frank's principles were the reason why...

Likewise, Vaillant also failed to show that Jerome Frank's "natural healing principles" were anything but a formula for brainwashing patients into joining a cult religion, and yet he claimed that they had produced great results, which they clearly had not done. The four examples that Vaillant cited didn't even come close to showing any efficacy for Frank's so-called "principles", or even much relevance. That is such a lame attempt to deceive the reader that it is pathetic.

And there are no "reasonable facsimiles which are continuously being rediscovered". That is a complete fabrication, just some more wishful thinking, just another propaganda stunt — assume facts not in evidence, assume facts which are yet to be proved, "petitio principii". And it isn't even good English: "continuously being rediscovered"? Like copies of Alcoholics Anonymous get discovered, and then get lost, and then get rediscovered, over and over again, continuously? What nonsense.

Obviously, Professor Vaillant suffers from something far more serious than just a little confusion, or a misunderstanding, or a slight error in the analysis of the facts. It appears to be willful gross dishonesty and deceit. And that's one of the leaders of Alcoholics Anonymous at work, telling us how to treat the deadly problem of alcoholism.

It wouldn't be so bad if those professional A.A. bozos were just writing bizarre science fiction for the late-night cable TV horror movies. But what they are doing is far more serious than that.

  • They are lying to us about matters of life and death.
  • They are deceiving and misleading sick and vulnerable people about how to survive and recover from alcoholism.
  • They are taking people who are supposed to be receiving medical treatment and giving them cult religion instead.
  • They are bilking health insurance programs out of billions of dollars, leaving less money for giving real, working, medical treatment to other sick people.
  • Their lies are killing people.
  • Their quack medicine is killing people.
  • Their cult religion is killing people.
It seems to me that it takes really immoral monsters to commit such heartless crimes.

Michael Lemanski reported that the death rate in Vaillant's study was in line with other studies, and so was the inefficacy of 12-step treatment:

Treatment and Mortality Rates

      The high mortality rate of treated alcoholics within the Vaillant studies is supported by the results of a five-year mortality study of alcoholics conducted in conjunction with the DuPont Corporation. Of 76,687 employees of the corporation included in the survey, 922 were identified by physicians as alcoholic. The study included control groups in which each alcoholic employee was matched to another employee, known not to be alcoholic, by age, sex, payroll class (salary or hourly), and geographic location. The sample was segmented into three classifications: 1) known alcoholics; 2) suspected alcoholics; and 3) recovered/abstinent alcoholics. The average yearly mortality rate for the known alcoholics was 3.2% (versus .74% for the matched comparison group); for the suspected alcoholics it was 1.8% (versus, again, .74% for the matched comparison group); and for the recovered alcoholics it was 2.5% (versus .86% for the matched comparison group).21
      But a more recent survey of 12 long-term longitudinal studies of mortality rates of (for the most part) treated alcoholics found an average mortality rate of a still very high 2.15% per annum for the treated alcoholics, while the mortality rate in the single study of untreated alcoholics included in the survey was only 1.7% per annum, a lower figure than for all but one of the studies of treated alcoholics.22

Confirmation of Vaillant's Findings

      A one-year study published in 1985 confirms Vaillant's 1983 findings concerning the ineffectiveness of 12-step treatment. In a controlled clinical study, alcoholics were segregated into three treatment groups: 1) those who received medication only (disulfiram [antabuse] or chlordiazepoxide — drugs that produce physical discomfort when taken with alcohol); 2) those who received a complete addictions treatment program; and 3) those who received no treatment beyond a physical exam and a clinical interview once a month. The results were that the medication-only group had an 80% relapse rate; the treatment group had an 80% relapse rate; and the minimal-treatment group had a 74% relapse rate.
      The study's authors concluded:
Patients provided with a minimum of services showed as much improvement as those provided with extensive treatment over the same period of time. The ineffectiveness of the interventions could not be explained by differences in pretreatment alcoholism severity.23

21. "A Five-Year Mortality Study of Alcoholics," by Sidney Pell and C.A. D'Alonzo. Journal of Occupational Medicine, Volume 15 Number 2, February 1973, pp. 120-125.
22. "The Long-Term Course of Treated Alcoholism: I. Mortality, Relapse, and Remission Rates and Comparisons with Community Controls," by Finney, John, and Moos, Rudolf. Journal of Studies on Alcohol, Volume 52, 1991, pp. 44-54.
23. "Comparison of Three Outpatient Interventions: A Twelve-Month Follow-Up of Male Alcoholics," by Barbara Powell, et al. Journal of Studies on Alcohol, Volume 46, 1985, pp. 309-312.

A History of Addiction & Recovery in the United States, Michael Lemanski, pages 102-103 and 106.

So the death rates in the test at the DuPont Corporation were:

Known alcoholics 3.2% per year
Recovered alcoholics 2.5% per year
Suspected alcoholics 1.8% per year
Non-alcoholics 0.74 to 0.86% per year

That 3.2% per year death rate is very close to the 3% per year death rate that Prof. Vaillant reported in his A.A.-based treatment program. And Vaillant called that death rate "appalling".

Then, while the study by Finney and Moos reported lower death rates over-all, the untreated alcoholics still had a noticeably lower death rate than those who got treatment — 1.7% per year dead in the untreated alcoholics' group versus 2.15% per year dead in the treated alcoholics.

And the study by Dr. Powell showed once again that the group that got no 12-Step treatment or "help" at all had a lower relapse rate than the people that got the expensive treatment program:

Medications only 80% relapsed
Complete treatment program 80% relapsed
No treatment 74% relapsed

That means that the so-called "treatment" was actually harming the patients and making matters worse, and keeping people from getting sober, and occasionally even causing them to die. The alcoholics who never went near that 12-Step treatment center were actually better off.

In 1996, The National Longitudinal Alcoholism Epidemiological Survey was designed by the NIAAA and conducted by the US Bureau of the Census. The survey was large, both in terms of people, tens of thousands, and in terms of time, 20 years. Deborah A. Dawson, of the NIAAA, filtered out 4585 subjects who had displayed standard DSM-IV Alcohol Abuse and Dependency symptoms, and analyzed those people. There were populations of people who had not received any treatment, and those who had. The commonest treatment modality by far was the A.A. Twelve-Step "spiritual therapy." The treatments were a cross section of all of the standard treatments used in the USA, which means that at least 85% — probably 93%11 — of the treatment programs were based on the A.A. Twelve-Step program. The results were: 20 years after the onset of alcoholism symptoms, 80% of those who had undergone treatment were either abstinent, or "drinking without abuse or dependence." But, of those who had never received any treatment, 90% were either abstinent or drinking non-problematically.

When we flip those numbers around, expressing them as failure rates rather than as success rates, we get: After 20 years, 10% of the untreated people still had drinking problems, while 20% of the treated people still had drinking problems. It would appear that the treatment programs actually had a negative effect, with twice as many treated people as untreated people still having drinking problems after 20 years.

But there is one critical mitigating factor: the people who got treatment were in worse condition than the others, to start with. That's why they got treated. And after treatment, they were still in worse condition. So we cannot, just from this analysis, assume that the treatment had a negative effect. The most reasonable analysis of the effectiveness of the treatment of alcoholism with Twelve-Step programs is to say that the treatment had no effect. It didn't work, it didn't fix the alcoholics.

Both groups — the treated and the untreated people — were slowly but steadily improving as time passed. That was the spontaneous remission at work, again.
(See "Correlates of Past-Year Status Among Treated and Untreated Persons with Former Alcohol Dependence: United States, 1992," by Deborah A. Dawson, Alcoholism: Clinical and Experimental Research, Vol. 20, No. 4, June 1996, p. 773.)

Remember this the next time you hear someone say, "Nobody can do it alone." The truth is, more people do it alone than do it in any group therapy treatment program, or any treatment program of any kind. The acting President of the United States, G. W. Bush, is one of them. He says he just quit doping and drinking — quit cocaine and whiskey — when it got to be too much and became a big liability. He says he did no A.A., no meetings, no Twelve Steps, no sponsor, no Big Book. Bush says that he just said a prayer, asking for the Lord's help, then he quit, and that was the end of that...

One of the most interesting pieces of new "recovery" research has shown that newcomers do not benefit at all from getting sponsors. In a recent controlled study, a group of new Narcotics Anonymous and Alcoholics Anonymous members who got sponsors did no better than another group who didn't get sponsors. But strangely enough, the elder members who chose to become sponsors did better than the other members who did not choose to act as sponsors. (The sponsors were a self-selected group; not randomly chosen.) It seems that getting their egos stroked by acting as puffed-up, all-wise, all-knowing sponsors, ordering the wimpy newcomers around, helped some sponsors to stay clean and sober, even though it didn't help the newcomers any.

Examined the relationship between sponsorship and abstinence in 12-step treatment of injection drug users. 500 former and current injection drug users (median age 39 yrs) reported sponsorship in Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) at baseline and at 6-mo and 1-yr follow-ups. Results show that having a sponsor in NA/AA was not associated with any improvement in 1-yr sustained abstinence rates compared to non-sponsored controls. However, being a sponsor over the same time period was strongly associated with substantial improvements in sustained abstinence rates, even after controlling for involvement with community organizations, NA/AA meeting attendance, marital status, employment, participation in drug and alcohol treatment centers, and HIV status.
See: "The effects of sponsorship in 12-step treatment of injection drug users", Byron L. Crape, Carl A. Latkin, Alexandra S. Laris, Amy R. Knowlton (all of the Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD, USA), [Journal of] Drug & Alcohol Dependence, Vol 65(3), Feb 2002, pp. 291-301.

Traditionally, the sponsor is supposed to say that he isn't doing it for the newcomer; that he's doing it for his own sobriety. The Big Book actually instructs recruiters to tell new prospects:

Outline the program of action, explaining how you made a self-appraisal, how you straightened out your past and why you are now endeavoring to be helpful to him. It is important for him to realize that your attempt to pass this on to him plays a vital part in your recovery. Actually, he may be helping you more than you are helping him.
The Big Book, 3rd Edition, William G. Wilson, chapter 7, "Working With Others", page 94.

But who would have imagined that it was literally true that the recruiters were not doing it for the benefit of the newcomers, and that the newcomers would not benefit from the sponsors' so-called "help"?

Many, perhaps most, A.A. groups have a custom of giving out sobriety "medallions", or "coins", or "tokens" — choose whichever name you prefer. Beginners with no sober time get an aluminum "Just For Today" coin. Then the members collect coins for 30 days sober, 60 days, 90 days, 6 months, a year, and then multiple years. The count of how many of those coins are given away reveals that Alcoholics Anonymous has a horrendous dropout rate. Barely one percent of the newcomers get a 10-year coin, and only one in a thousand gets the 20-year coin.

Here is a table of the percentages of the new members who successfully earn any particular coin. The description of how the numbers were computed, is here.

All Numbers Scaled To 1000 Newcomers
Time Number per
1000 newcomers
Today 1000 100.0%
1 year 50 5%
2 years 29.54 2.95%
3 years 21.97 2.2%
4 years 17.8 1.78%
5 years 16.29 1.63%
6 years 13.26 1.33%
7 years 11.74 1.17%
8 years 10.6 1.06%
9 years 9.85 0.986%
10 years 11.74 1.17%
11 years 7.58 0.76%
12 years 7.58 0.76%
13 years 6.44 0.64%
14 years 6.06 0.61%
15 years 4.92 0.49%
16 years 3.41 0.34%
17 years 2.65 0.27%
18 years 2.27 0.23%
19 years 1.89 0.19%
20 years 1.52 0.15%
21 years 0.76 0.076%
22 years 0.76 0.076%
23 years 0.38 0.038%
24 years 0.38 0.038%
25 years 0.38 0.038%
26 years 0.24 0.024%
27 years 0.20 0.020%
28 years 0.16 0.016%
29 years 0.16 0.016%
30 years 0.16 0.016%
31 years 0.045 0.0045%
32 years 0.033 0.0033%
33 years 0.034 0.0034%
34 years 0.016 0.0016%
35 years 0.015 0.0015%
36 years 0.0045 0.00045%
37 years 0.0015 0.00015%

Now there are still a few problems with these numbers, like inventorying.

Look at the strange breaks in the chart at 10 years, 20 years, and 30 years. It appears that they lose one third of their members between 10 and 11 years, and half of their members between 20 and 21 years, and they lose more than two-thirds of their members — almost 3/4 — between 30 and 31 years.

No, not really.

What is really happening there is that the various clubs, groups, and intergroups stockpile and keep in inventory the coins for the lower numbers of years, so that they have them immediately on hand to give out to celebrants. But the numbers of people actually picking up the higher-numbered years' coins are so few that the groups do not inventory coins for the very high years. They special-order those coins one at a time when one of their oldtimer members has an upcoming birthday.

Where a given group will stop inventorying coins is a function of the size of the group. Small groups may stop inventorying the coins at 10 years. Larger groups, at 20 years. Very large groups, or intergroups, stop inventorying the coins at 30 years. It's pretty much human nature that they would pick round numbers like 10, 20 or 30. Hence the big non-linearities and apparent huge drop-out rates at 11, 21 and 31 years. We are just looking at sales of coins here, not actual membership numbers.

So the sales of a lot of the higher-years' coins do not represent success stories at all. Those coins have been purchased by clubs and groups, but not earned by anybody. They are just coins that were sold to the groups, and which are sitting in a box at the clubhouse, waiting for somebody to earn them. It appears that almost half of the 10-year coins, and fully half of the 20-year coins, and almost 3/4 of the 30-year coins fall into that category — just sitting in inventory, not yet earned by anybody.

Inventorying has a non-linear effect in distorting the numbers. Inventorying a moderate surplus of the coins for the first few years does not warp the numbers a lot, because so many of them are given out. But having just one spare 20- or 25- or 30-year coin sitting in the coin boxes of clubs and intergroups all over the USA may double the purchases of that particular denomination of coins. That is apparent from the huge discontinuities at 11, 21 and 31 years, where various groups cease inventorying.

Also notice the strange non-linearity between 7 and 10 years. They actually have 31 per thousand people getting 7-year coins, and then the numbers decline from there. But then they jump back up again at 10 years. I can only guess that maybe some people don't bother to pick up 8 or 9-year coins, but feel like 10 is a milestone that they want. But that would mean that they would have a zero-percent drop-out rate from 7 to 10 years, and only for those few years. Strange. I have no explanation for that anomaly.

[Later: one correspondent suggested that the answer is people picking up multiple coins at the 10-year point. Some people getting 10-year coins are so proud of themselves that they go to meetings all over town, picking up another coin at another meeting and enjoying the crowd applauding and cheering for them, again and again. And of course the same thing can happen with the other higher-year coins, especially the 20- and 30-year coins.]

I didn't bother to continue the last chart beyond 37 years because the following numbers are unreliable. That is, the sample size is too small. We are down into the noise level of the signal, where we can easily count all of the individual people in the state who have that many years, because such oldtimers are so rare. And the number of oldtimers jumps around randomly: 1, 2, 4, 8, 1, 8, 7... We need sales figures for the whole USA to see a smooth trend for those years.

Again, this is a very good indication of the A.A. attrition rate, but it is non-scientific and not 100% reliable. A.A. boosters who don't like these numbers are more than welcome to send in their state's total sales figures — preferably xeroxes or computer scans of the invoices for all of the purchases of coins from the manufacturers.

It would be especially nice to get the sales figures for the monthly coins during the first year, to fill out that part of the chart.

Reid K. Hester and William R. Miller (UNM, Albuquerque — Center for Alcohol, Substance Abuse and Addictions, Dept. of Psychology, University of New Mexico) rated the various alcoholism treatments in their book Handbook of Alcoholism Treatment Approaches: Effective Alternatives. A.A. 12-Step treatment went so far down the list that it almost disappeared. The best treatment was Brief Interventions, and it got a positive score of 390. A.A. got a negative score, MINUS 82, way below zero.


Brief intervention is number one, and A.A. is number 38.

Also see: == The same statistics in a different format.

"Brief Intervention" consists of a real doctor talking to the patient for usually less than one hour, questioning him about all of the ugly details of his drinking and telling him that he will die if he doesn't quit drinking. One time. That's it. No long counseling sessions, no great guidance, no on-going advice, no shoulder to cry on. And no 28-day treatment program. Just one "Dutch Uncle" session and it's over. And that's the most effective thing going.

That kind of puts the whole expensive "drug-and-alcohol treatment industry" to shame, doesn't it?

Brief Intervention is what I got. Less than an hour of the doctor asking pointed questions about all of the bad aspects of my drinking, and summing it all up by saying, "Quit drinking or die. Choose one." And it seems to have worked. I have almost 10 years sober now. Also almost 10 years off of cigarettes and any other drugs too.

But please understand that they just shove all of the work back on you. You have to choose to quit drinking and live, and then you have to do it. They never said that their "Brief Intervention treatment" would make you quit drinking.

The entire back two thirds of the Big Book, the collection of autobiographical stories, is just one long demonstration of the propaganda technique called "Proof by Anecdote." That's the stunt where you tell one or more individual stories that appear to support your grand generalization, and then you triumphantly conclude that your point is proven.

For example: President Ronald Reagan gave a speech on TV where he told of Sandinista soldiers tying a priest to a tree and beating him. Reagan concluded that this story was proof enough of the evils of the Sandinistas to justify the USA waging an undeclared, illegal, war against Nicaragua for several years, the war that ended with the treasonous Iran-Contra Arms-for-Hostages and the Oliver-North-Contra Cocaine-for-Guns fiascoes. (President Reagan didn't bother to give any TV speeches complaining about how many Nicaraguan civilians were killed by the Contras, or how many American inner-city black kids were killed by the Contras' cocaine. Just a few stories of Sandinista soldiers' misbehavior was all of the anecdotal evidence that Reagan needed or wanted...)

Likewise, Bill Wilson pointed to some people who had quit drinking while attending A.A. meetings, and printed a bunch of their testimonial stories in the Big Book, "Alcoholics Anonymous", and then said that they proved that the Twelve Steps work. He gave no evidence that those people would not have just quit anyway without A.A.; that they weren't cases of spontaneous remission — people who quit drinking because they just got sick and tired of being sick and tired. Wilson claimed that the "spiritual" A.A. program had made them quit, and then tried to use Proof By Anectode to "prove" it. And then Bill said absolutely nothing when most of those Big Book authors later relapsed.

Barry L. Beyerstein, Ph.D., wrote an article, Why Bogus Therapies Often Seem to Work, where he explained how informal testimonials are erroneously accepted as proof of the success of bogus therapies:

Many dubious methods remain on the market primarily because satisfied customers offer testimonials to their worth. Essentially, these people say: "I tried it, and I got better, so it must be effective." The electronic and print media typically portray testimonials as valid evidence. But without proper testing, it is difficult or impossible to determine whether this is so.
Many diseases are self-limiting. If the condition is not chronic or fatal, the body's own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients listed as improved exceeds the number expected to recover without any treatment at all (or that they recover reliably faster than if left untreated). Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the published norms for unaided recovery.
Buyer Beware!
The job of distinguishing real from spurious causal relationships requires well designed studies and logical abstractions from large bodies of data. Many sources of error can mislead people who rely on intuition or informal reasoning to analyze complex events.

Before agreeing to any kind of treatment, you should feel confident that it makes sense and has been scientifically validated through studies that control for placebo responses, compliance effects, and judgmental errors. You should be very wary if the "evidence" consists merely of testimonials, self-published pamphlets or books, or items from the popular media.

Dr. David Duncan has an interesting story about anecdotal evidence and testimonials:

That some of the people who receive ineffective or even harmful treatment will recover anyway and will in most cases credit the treatment for their recovery is the rule rather than the exception in all areas of treatment.

We have known for several decades now that having single coronary bypass surgery lowers a patient's life expectancy rather than making them less likely to have another heart attack, but it continues to be one of the most common surgical procedures in America and you will find many thousands of patients who believe it saved their life. (It does provide pain relief for heart patients who suffer from angina pectoris, but most who have the surgery don't suffer from angina.)

Quite a few years ago a friend of mine was involved in closing down a group of "kidney specialists" who were impostors with no medical training at all. They ran a clinic, infirmary and pharmacy for end state renal disease cases, where they sold their patients placeboes and performed surgery that consisted only in cutting the patient's skin and then suturing the wound. When they were shut down after several years, my friend surveyed their surviving patients and the families of those (the majority) who had died. A majority of both groups rated the care provided as excellent ("best possible" was the median rating), and only a few families felt that their deceased relative had received less than adequate care. Of those who were still alive, most were still sick but some had recovered and many credited the phoney doctors and their fake treatment with having saved their lives.

That is why researchers like myself are totally unimpressed by patient testimonials. Effective treatments and ineffective treatments are equally likely to produce ample numbers of satisfied patients, some of whom really have recovered, whether because of or despite the treatment they received. Of course, a smaller percentage of the patients who undergo the ineffective treatment will recover, but if that is a common form of treatment then the numbers of those recovered patients who endorse it will be large. If it is the most common type of treatment, then the ineffective treatment may be credited with more cures than the effective. Such has often been the case.

David F. Duncan, DrPH, CAS, FAAHB
Duncan & Associates
Clinical Associate Professor
Brown University Medical School
Council on Illicit Drugs
Nat'l. Ass'n. for Public Health Policy

When I wrote to Dr. Duncan, asking for details of the story, and the name of his friend who shut down the quacks, he replied:

His name was Mike Deckler and I believe it was in the late '50s or early '60s — he told me the story in 1973. He was working in the South at the time of the event and it was in North or South Carolina I think.

Accounts of patients who are very pleased with completely phoney treatments are commonplace. In blind controlled trials the patients receiving a placebo treatment are typically as satisfied as those who get a real treatment and those who recover spontaneously in the control group usually credit the sugar pills with curing them. When the trial is double-blind the clinicians are typically as unable as the patients to tell whether the treatment was real or not.

David F. Duncan, DrPH, CAS, FAAHB

We do not have nearly enough properly-done scientific tests of the various popular alcoholism treatment programs. Alcoholics Anonymous has a reputation for not liking scientists poking too deeply into its affairs. The very nature of the A.A. organization makes measurement of success very difficult. Everyone is anonymous; people are members if they say they are, and aren't if they say they aren't. Also, when someone relapses and disappears, he is then assumed to not be a member. Thus any casual glance at A.A. will be biased by cherry-picking: only the success stories are around to be counted. So we must be very careful about statistics and surveys, and ask who is doing the counting, and what they are counting, and how they are counting, and how they are defining success.

Le, Ingvarson, and Page put it well:

Research is less clear as to whether working the AA program is helpful in achieving sobriety. Outcome studies have attempted to assess AA's effectiveness by investigating the relationship between AA attendance and length of abstinence. Several studies have found that AA members report greater abstinence than nonmembers (Cross, Morgan, Mooney, Martin, & Rafter, 1990; Hoffman, Harrison, & Belille, 1983; Thurstin, Alfano, & Nerviano, 1987), and that the longer the membership in AA the greater the length of sobriety (McBride, 1991). Unfortunately, these studies are methodologically flawed due to the voluntary nature of AA membership. With the only criterion for membership being "a desire to stop drinking" (AAWS, 1984, p. 2), it is likely that those attending AA recognize their drinking problem and are motivated to change. Because of this self-selection it becomes impossible to know whether it is AA efficacy or member motivation that is being measured (Bebbington, 1976). Additional problems involved in the scientific research of AA include member anonymity, lack of control groups, and the confounding effects of other treatment programs. These difficulties have led researchers to conclude that the effectiveness of AA has yet to be proven (Bebbington, 1976; Bufe, 1991; Glaser & Ogbome, 1982; Vaillant, 1983) and that the study of AA may need "unprecedented standards of measurement not appropriate to other treatment programs" (Leach, 1973, p. 277).
Alcoholics Anonymous and the Counseling Profession: Philosophies in conflict by Christine Le, Erik P. Ingvarson, and Richard C. Page, Journal of Counseling & Development, 07-01-1995, page 603.
[See the bibliography at the end of this file for the list of references cited here.]

As Christine Le said, those people who wish to quit drinking go to A.A. meetings, while those who do not desire to quit drinking go someplace else, like to the bar. So of course the people in an A.A. meeting will report (somewhat) greater abstinence from alcohol than the other alcoholics. But that does not prove or even hint that Alcoholics Anonymous has somehow caused the alcoholics to drink less. Their own desire to quit drinking has caused them to drink less.

Something else to watch for is improper or biased testing. In a study of the use of LSD in therapy for alcoholism, the authors also studied the methods that other studies had used. Their observations were disconcerting — it seems that people have an unfortunate tendency to see whatever they wish to see whenever tests are not rigidly controlled:

Unfortunately, the absence of control groups in research on new psychiatric treatments seems to be the rule rather than the exception. To illustrate, Foulds (1958) found that 72 per cent of the research studies of new treatments reported in psychiatric journals (1951-1956) lacked controls. Moreover, he found that 83 per cent of the uncontrolled studies, but only 25 per cent of the controlled studies, reported that the treatments were successful. In addition, Glick and Margolis (1962), after reviewing the literature on chlorpromazine, found significantly lower clinical improvement rates in double-blind controlled studies than in non-blind uncontrolled studies, such as those discussed here, to yield a considerably higher number of positive results. The larger proportion of positive results in uncontrolled studies exists despite the lack of the very elements of design which would allow any firm conclusion.
Lysergic Acid Diethylamide (LSD) In The Treatment Of Alcoholism; An Investigation of its Effects on Drinking Behavior, Personality Structure, and Social Functioning, by Reginald G. Smart, Ph.D., Thomas Storm, Ph.D., Earle F. W. Baker, M.D., F.R.C.P.(C), Lionel Solursh, M.D., F.R.C.P.(C), 1967, page 48.
References cited:
Foulds, G.: Clinical research in psychiatry, J. Ment. Sc., 104, 259-65, 1958.
Glick, B., & Margolis, R.: A study of the influence of experimental design on clinical outcome in drug research, Am. J. Psychiat., 118, 1087-96, 1962.

So, the various treatments being tested were successful in 83 percent of the uncontrolled studies, but only in 25 percent of the controlled studies? How curious. It would seem that looking too closely, and measuring too carefully, makes the medicines or treatments suddenly stop working.

That's a good example of researcher bias. The researchers just really wanted their experiments to be successes, so that's what they tended to see. But when their studies were rigorously controlled, the researchers were forced to be more objective, and the "observed" success rate dropped sharply.

That Reginald Smart, et. al. study was done in 1967, but the situation does not seem to have changed much since then, if at all. Project MATCH was a $27 million study of alcoholism treatment programs funded by the U.S. Government (actually, the NIAAA) which also had no control groups, and at the end of it, the researchers happily announced that "treatment works", without having anything with which to compare the treated group to determine whether the treatment had actually had any effect at all. The whole project was just a huge waste of money. Such flawed testing of drug addiction and alcoholism treatment programs is all too typical. All too often, they simply measure the spontaneous remission rate once again, and then erroneously claim that the observed cases of recovery were caused by the treatment.
(For the report on Project MATCH see: Matching Alcoholism Treatments to Client Heterogeneity; Project MATCH Posttreatment Drinking Outcomes, by Project MATCH Research Group, Journal of Studies on Alcohol, January 1997, pp. 7-29.)

ScienceNOW magazine analyzed the results of Project MATCH, and concluded:

You can toss out the window any convictions about the best form of psychotherapy to get alcoholics to quit drinking. Contrary to a leading theory, it doesn't seem to matter which kind of technique you use. That's the bottom line of a 6-year, $27 million study whose findings were announced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at a press conference here today.

In recent years, a number of clinical studies have suggested that "matching" particular types of alcoholics with particular treatments — for example, teaching someone with poor impulse control how to think through actions before taking them — would help them quit drinking. Indeed, that was the premise behind NIAAA's Project MATCH, the most rigorous and extensive clinical trial ever of therapies for alcoholics.

The study involved 25 research institutions and 1726 alcoholics who were randomly assigned to 12 weekly sessions of one of three types of individual psychotherapy: cognitive-behavioral therapy (which seeks to teach new ways of thinking), motivational therapy (in which the patient is encouraged to take responsibility for his own recovery), and a spiritually oriented therapy derived from the philosophy of Alcoholics Anonymous (AA). The researchers' hypothesis was that people with "high cognitive impairment" would benefit from the first therapy, unmotivated people from the second, and "meaning-seeking" people from the third.

All therapies, however, appeared to be equally effective — a year later, the average number of drinking days per month among all participants had declined from 25 to six. "Outcomes were not substantially improved by patient matching," says Gerard J. Connors of the New York State Research Institute on Addictions. The main exception was that patients with few psychiatric problems and "meaning-seekers" did better with the AA-based therapy. They also went to more AA meetings.

The results show that "we're not yet at the core of what the pathophysiological changes are in alcoholism," says NIAAA director Enoch Gordis. Nonetheless, he says, the findings also suggest that "competently run programs" work.
Rewriting the Book on How to Treat Alcoholics, the editorial staff, ScienceNOW magazine, 12-17-1996.

Note that many doctors and researchers strongly disagree with Mr. Gordis' optimistic statement that treatment works. Project MATCH lavished so much money and attention on the patients that what they received was anything but a usual treatment program. The subjects were even paid money to come to treatment sessions. That's sure to make them "Keep Coming Back!", even if it doesn't work at all.
("I'll go to 'treatment' and get paid, then we can buy a big jug of wine and go sit under the bridge and get smashed...")

Also, there was a lot of cherry-picking and bias in the selection of the patients. Basically, the unmotivated losers were filtered out because the doctors wanted people who would complete the programs, so that they could get some test results. So of course the hand-picked, highly motivated patients showed a lot of improvement — much more than is "normal" or usual.

And again, there was no control group, so we cannot do a side-by-side comparison to see just how well the treatment really worked. And obviously, the very first thing we would have to do is subtract out the usual spontaneous remission rate from the successes, to see what else, if anything, was going on there. We have to ask the big important question:
"What percentage of those hand-picked, pampered, paid, and highly motivated patients would have quit drinking on their own anyway — especially if they were just paid and pampered, but got no 'treatment'?"

(For that matter, why didn't they test just paying the patients not to drink? Other researchers have found that to work. See Herbert Fingarette, Heavy Drinking.)

But without a control group, we can't calculate the rate of spontaneous remission among that particular set of patients, so most of the measurements are rendered meaningless. There is no standard against which to compare them.

In any case, the results show that the A.A. claim of having the only working program is false. Project MATCH showed that all treatments were basically the same. It's like that goofy fried chicken commercial on TV: "Parts is parts." Well, "Treatment is treatment."

Obviously, if all treatment programs score about the same, and none of them score any better than the rate of spontaneous remission in the long run, then "treatment" of alcoholism doesn't really work at all, and is just a big waste of time and money.

Even though there was no control group in Project MATCH, a couple of doctors managed to get a close equivalent to a control group, and the results showed that treatment didn't really work:

Cutler and Fishbain reanalyzed data from a clinical trial known as Project MATCH, which included 1,726 alcohol-dependent volunteers who each received one of three alcoholism approaches.

Treatment included cognitive behavioral therapy, which focused on things like dealing with thoughts about alcohol and urges to drink or motivational enhancement therapy, which aimed to strengthen patients' commitment to change and feelings of personal responsibility. The third approach was a program that introduced the first few "steps" of the Alcoholics Anonymous 12-step approach.

At the time the original study results were reported in the late 1990s, they were hailed as demonstrating the success of all three strategies, because there were no clear differences in patients' outcomes regardless of which therapy they received.

But Culter and Fishbain looked at the data in a different way, comparing the outcomes of participants who immediately dropped out of treatment with those of men and women who completed treatment.

They found that in the months following treatment, study participants who attended no therapy sessions did nearly as well as those who went to all sessions. On average, those who received no treatment were abstinent for 72 percent of the days the original investigators followed them.

Cutler and Fishbain found that patients who stuck with treatment made most of their improvement in the first week, before they had received the bulk of their therapy.

All of this, according to the researchers, suggests that motivated people entered the trial and that's why all the treatment approaches were successful.

Enrolling in a study, they write, "suggests that the alcoholic has crystallized a decision to reduce or abstain from drinking."
Alexander DeLuca, M.D., Study Questions Effectiveness of Alcoholism Therapy,

That study brings up a very interesting question:

If treatment is necessary or even somehow helpful for quitting drinking, then how can treatment centers and treatment programs demand that the patients stop drinking at Day One of the program, before the patients have gotten any treatment?

How can the so-called therapists and counselors demand that the patients act like they have gotten the full course of treatment — in other words, keep themselves sober — when the patients haven't actually gotten any "treatment" yet?

I can't think of another medical treatment where the doctor demands that the patients recover before they get the medicine.

And if the patients really can quit drinking before getting the treatment, then the treatment is unnecessary, and is probably just a waste of time and money.

The original idea behind Project MATCH was that some patients would do better in free A.A. meetings, while others needed professional treatment. It was also an attempt to explain why A.A. failed every test of the effectiveness of A.A. treatment. The logic was, "Well I know that some people recover in A.A.; I've seen it. So there must be some other people who respond to A.A. very poorly, and they are pulling down the averages. Their failures are masking the other peoples' sucesses. If we can match the patients to the treatment, we will get better results."

The first mistake was in assuming that because some people recover in A.A. rooms, that they recover because of Alcoholics Anonymous. That is assuming a cause-and-effect relationship where none may exist. We can, with equal validity, say, "I know that people recover in hospital rooms that are painted green — I've seen it with my own eyes. So the healing effects of green rooms are an established fact."

And we could also continue with that flawed logic like this, "So if we separate the patients who will respond well to green rooms from those who will do poorly, and just put the first group in the green rooms, then we can improve the healing rate of our patients."

Unfortunately, such a strategy is just as flawed as saying, "If we can separate out the times that the roulette wheel will hit on red from the times that it will hit on black, and then only bet red when red is coming up, then we can make a whole lot of money."
Alas, no one has ever been able to do it.

One person has come up with what looks like an interesting approach. For her Doctoral thesis, Barbara Ann Wilmes explored the concept of locus of control and its applicability to choosing an A.A-based recovery program or a Rational Recovery (or SMART) program. The idea behind locus of control is that some people see their lives as being controlled by external forces; they feel like they are just leaves getting blown around in the wind. They see the center of control of their lives as being outside of themselves. They have an external locus of control.

Other people feel that they are very much in control of their own lives; they see what happens to them as being caused by their own actions. They have an internal locus of control.

Wilmes found that people who felt that external forces controlled their lives, and that they were "powerless over alcohol", preferred A.A., where they felt that an external "Higher Power" or "Power Greater Than Themselves" would make them quit drinking.

On the other hand, the internal-locus people preferred Rational Recovery or SMART where they were taught to control their own behavior themselves. And in fact, many of the A.A. dropouts left because they strongly disagreed with the A.A. philosophy of powerlessness. They went and joined R.R. or SMART:

"Twenty-two of the 24 RR/RSN subjects who left Alcoholics Anonymous reported doing so because they explicitly disagreed with the philosophy of the Alcoholics Anonymous program and were strongly dissatisfied with their experience there."
Submitted in partial fulfillment of the Requirements for the degree of Doctor of Social Welfare in the Adelphi University School of Social Work, Spring 1988.
Printed by UMI Dissertation Services, 300 North Zeeb Road, P.O. Box 1346, Ann Arbor, Michigan 48106-1346.
1-800-521-0600 734-761-4700
This book is available through an interlibrary loan from Adelphi University Libraries, Garden City, New York.

Note that Wilmes did not find that matching people with recovery groups by their locus of control produced greater abstinence or sobriety. (She didn't test for that; she didn't have the resources for such a long-term test.) She just found that they liked their groups better.

For many years in the 1970s and 1980s, the AA GSO (Alcoholics Anonymous General Service Organization) conducted triennial surveys where they counted their members and asked questions like how long members had been sober. Around 1990, they published a commentary on the surveys: Comments on A.A.'s Triennial Surveys [no author listed, published by Alcoholics Anonymous World Services, Inc., New York, no date (probably 1990)]. The document has an A.A. identification number of "5M/12-90/TC". (There is a copy here.) The document was produced for A.A. internal use only. It has a graph on page 12 (Diagram C-1) that shows that newcomers drop out, relapse, leave, or disappear at a staggeringly high rate.8

Figure C-1 from page 12 of the Commentary on the Triennial Surveys (from 1977 to 1989), A.A. internal document number 5M/12-90/TC
Also see: Addiction, Change & Choice; The New View of Alcoholism, Vince Fox, M.Ed. CRREd., page 66

The first analysis of the graph that I got was the statement that the percentages that are shown in the graph are the percentages of newcomers remaining after the indicated number of months. But after a few years of thinking about it, I came to the conclusion that it isn't so. That would require a "longitudinal study", which means that you have to track people through time, and keep track of how they were doing, and see if they were still going to A.A.

Several critics have pointed out that the graph merely indicates how many months the people had been in A.A. when the triennial survey was done.

So what really happened was, some group secretary announced, "Your attention please! All of you people with a year or less in A.A., listen up, because these questions are for you. Now, how many of you are in your first month in A.A.? Let's see a show of hands."
And some hands go up.

"Now, how many of you are in your second month in A.A.? Let's see a show of hands."
And fewer hands go up.

"Now, how many of you are in your third month in A.A.? Let's see a show of hands."
And fewer hands go up.

And so on, until, "Now, how many of you are in your twelfth month in A.A.? Let's see a show of hands."
And far fewer hands go up.

Then they graphed the results as percentages of the total number of people counted. So the graph simply shows what percentage of the counted newcomers were in their first or second month, or seventh or twelfth month, or whatever.

Now some A.A. defenders have claimed that this chart shows really good results for A.A., like that 56% of the people who stayed for three months stayed for a full year. That appears to be true, but that is nothing to brag about, because the survey does not show a good retention rate for A.A., far from it.

As a way of measuring the A.A. retention rate, the way that they did the survey is fatally flawed. Here is the big gotcha: The survey did not count the huge number of people who dropped out before the survey was done. They never asked, "Will all of the people who are not here please raise your hand?"

They counted almost none of the people who came to A.A., and didn't like what they saw, and walked out after a few meetings, and didn't come back. Those people were not around to be counted in the survey. So the numbers are worthless for determining the A.A. retention rate.

For instance, the graph does not show what percentage of the newcomers actually stayed for three months. All we know is that a large number of people came to A.A. and then dropped out, and some small fraction of them were left still attending meetings three months later.

The numbers do have some limited usefulness for determining the dropout rate though. It's one of those funny mathematical things that isn't reversible. We can use those numbers to determine that the A.A. dropout rate is at least as bad as some number, or worse, but we cannot determine that the A.A. retention rate is any better than some number, just because of all of those uncounted people.

Oh, and reinterpreting the results does not improve the case for A.A., just the opposite. The results may be even worse for A.A.

Note that we are not told exactly how the GSO decides who is a member. The most likely criterion is the one used by Bill C. in 1965. Charles Bufe pointed out that in a 1965 article in the Quarterly Journal of Studies on Alcohol, Bill C. considered anyone who had attended 10 or more meetings to be a member.5 But that eliminates from the statistics all of those people who came looking for help, and attended a few or several meetings, but who were so put off by the religiosity and cultishness and faith-healing atmosphere that they stopped coming back, so such a selective process biases the numbers. It's cherry-picking.

Please note that my opinion of the following document has changed over the years. The original interpreters of this document felt that it was a longitudinal study that tracked new members over time, to see how long they stayed in. A.A. defenders have been insisting that it was merely a one-day snap-shot of the composition of the population of new members with less than a year of membership. I have come to the conclusion that the second opinion is the correct one.

Note that it doesn't matter which way you look at the study; the numbers still show a very high drop-out rate. In fact, interpreting the chart as a one-day chart actually makes the numbers worse, not better, because a one-day snapshot fails to count all of the dropouts who just came to a few meetings, disliked what they saw, and walked away, and did not come back to get counted in a survey.

In response to the first interpretation, someone at the New York A.A. office responded to the publication of that chart:

From: ny-aa@...
Date: Mon Oct 11, 2004
Subject: Success Rate in The First Year

Following the 1989 Triennial Survey of Alcoholics Anonymous, a paper was written for A.A. providing some analysis of the of the 1977, 1980, 1983, 1986 and 1989 Surveys. One graph has been misiniterpreted by some A.A. critics as showing a low 5% recovery rate. That is NOT what it shows at all. Actually, 56% of those who stay for three months stay for a full year.

C-1 "Percent of Those Coming to AA Within the First Year Who Have Remained the Indicated Number of Months."

Month .. %
1 ... 19
2 ... 13
3 ... 10
4 ... 9
5 ... 8
6 ... 7
7 ... 7
8 ... 6
9 ... 6
10 .. 6
11 .. 6
12 .. 5

The second (percent) column is the distribution of the people who were present at the randomly selected groups on the day of the survey. The first column is what month "number" they were in. For example Line "3" says that 10% of the people in the sample (attending A.A. for less than a year) had been coming for two months but less than three months.

You can see the attrition here but the second column is not the percent those staying that length of time. If nobody dropped out, every number of months would have 1/12th or 8.3% of the people. Since we often tell newcomers to take three months to decide if they are alcoholics, I multiply by 11.1 to create a third column with 100 in the 4th month.

Month . % . Adjusted
1 ... 19 .. 210
2 ... 13 .. 144
3 ... 10 .. 111
4 ... 9 ... 100 <---
5 ... 8 ... 89
6 ... 7 ... 78
7 ... 7 ... 77
8 ... 6 ... 67
9 ... 6 ... 67
10 .. 6 ... 66
11 .. 6 ... 66
12 .. 5 ... 56

Of those who were in their first month, about half decided they were not alcoholics or that A.A. was not for them and didn't stay for three months. It is reasonable to say that those who stay three months are interested in our program of recovery. Of these, over half stay active in A.A. at least a year.

Visiting an A.A. meeting does not mean someone is an alcoholic.
Leaving A.A. does not mean someone has returned to drinking.
Tom E

Tom claims that we completely misunderstand the chart, and that "Actually, 56% of those who stay for three months stay for a full year."

By our previous interpretation of the chart, exactly half of those present at the three-month point (10%) are still around at the end of a year. We say 50%, and he says 56%. That hardly amounts to a major revision of the numbers, no matter how you look at them.

The kicker is this line:
"Since we often tell newcomers to take three months to decide if they are alcoholics, I multiply by 11.1 to create a third column with 100 in the 4th month."

There is no logic to that. He might as well say, "Since we tell beginners to eat lots of ice cream and candy bars to overcome cravings, I multiply all of the numbers by 17."

Making the numbers look bigger does not change reality.

Nevertheless, even after he finishes with his mathematical gyrations, all he is saying is that a hair over one half of those few people who stay for three months will end up staying for a whole year.

That's almost exactly what we all said earlier.

Furthermore, even if the numbers are what Tom describes — just asking the people present how many months they have been coming back — then the numbers still show a huge attrition rate. The fact that so many people are in their first months of sobriety, and so few at 10, 11, and 12 months, shows a large dropout rate.

Look at the numbers grouped into quarters:

First 3 months 19 + 13 + 10 43
Second 3 months 9 + 8 + 7 24
Third 3 months 7 + 6 + 6 19
Fourth 3 months 6 + 6 + 5 17

Almost half of all of the new people present are in their first three months of sobriety. (And 52% of the newcomers are in their first third of a year.) That isn't right. If people were staying in, then the numbers in the third column should all be the same — 25.

And the greatest part of the attrition is hidden and not shown by those numbers. Such a survey won't tell you anything about all of the people who dropped out in their first few weeks and were not around to answer the questionnaire.

We know from personal experience that plenty of people drop out in their first month. Many, many people go to just a few A.A. meetings, and don't like what they see, and don't come back. The number of "one-timers" or "two-timers" is immense. If you go to A.A. meetings for just a few months you will see a zillion beginners who just show up once, and you will never see them again. They were not counted. All of those A.A. numbers that are obtained by only questioning those people who "keep coming back" are skewed and biased.

That problem actually immensely biases the numbers.

Do a simple thought experiment. Imagine that you have one first-time newcomer who comes to a meeting each day. He only comes once, and is disgusted by what he sees, and leaves, and the next day, it's somebody else who does the same thing. There are 365 days in a year, and 1095 days in 3 years. (Those A.A. surveys are triennial surveys.) So, in 3 years, there are 1095 one-day visitors who don't like what they see, and leave.

Assume that there are also a whole bunch of people who only come two times, and a bunch who only come three times, and some only four times, and so on.

There will be only 1 of those "one-timers" present on the day that the survey is done, so only one of them will be counted. In a triennial survey that is done on just one day every three years, which essentially just takes a snap-shot picture of the people in attendance on that day, the odds of a one-timer getting counted are actually count less than one in a thousand.

Likewise, the odds of a "two-timer" getting counted in the survey are only 1 in 547.
And only 1 in 365 for the "three-timers",
and only 1 in 273 for the "four-timers",
and so on.

There are an immense number of A.A. drop-outs who don't get counted in such a triennial survey.

So there is a row of numbers missing from the table. The chart should really look something more like this:

First days 100 (a rough guess) 100
First 3 months 19 + 13 + 10 43
Second 3 months 9 + 8 + 7 24
Third 3 months 7 + 6 + 6 19
Fourth 3 months 6 + 6 + 5 17

In the yahoo group "AAhistorylovers", ny-aa wrote:

One hand-drawn graph in a paper summarizing the 1977 through 1989 Trennial Surveys has been misread by many people. The myth of a 95% drop-out in the first year comes because it reported the membership length of people who were in their first ever year of Alcoholics Anonymous. The x-axis scale of the graph was the percentage who had been coming for any given number of months, it was not the retention percentage.

My AAHistoryLovers Post 2379 (with added comments by moderator Glenn C) presents the proper reading of the graph. The retention from any month to any other is the ratio of the number of members found. For every 100 people who were in their first year, 19 were in their first month and 5 were in their twelfth.
5 / 19 = 0.26 So 26% remain at the end of their first year. Newcomers often are told, "Try A.A. for three months and decide if you are an alcoholic." About half leave during that "test drive." The Survey found 9 in their fourth month. 5 / 9 = 0.56 So 56% of those staying beyond three months finish the year of their first ever A.A. experience.

Sorry, "aany", but that math is broken.

What you are missing is the vast majority of the newcomers. You have not counted any of the newcomers who drop out in the first month, which is most of them.

It's like this:

[Please note: these numbers are from the previous way of interpreting the graph. If we use the second way of interpreting the graph, the dropout rate will be at least as bad.]

You have a large group where 100 new people come each month. Some come out of curiosity, wondering if A.A. can help them to quit drinking. Others are court-ordered, or are sent by a treatment program. Whatever.

In the first month, 81% of them stop coming back. On the day that the triennial survey is done, there are 19 people remaining out of that 100, and they have 1 month of membership.

There are also present 13 who have been coming for 2 months, who are left over from the previous month's 100 newcomers.

Then there are 10 left from the 100 newcomers the month before that.

Then 9 are left from the month before that. And so on, down to the 5 who are left from the 100 newcomers who came 12 months ago.

Month remaining
0 100
1 19
2 13
3 10
4 9
5 8
6 7
7 7
8 6
9 6
10 6
11 6
12 5

Now it is true that there are 10 remaining at the three-month point, and 5 at the end of a year, so 50% of those who stay for 3 months do end up staying for a whole year. That statistic does not conflict with the fact that there is still only a 5% retention rate for 1 year.

Now are there any holes in this logic? Yes. Just one, but it's a big one:

It is that we do not know for sure how many newcomers come each month. If it is 200, then that group only has a 2.5% annual retention rate. On the other hand, if it is 50, then the group has a 10% annual retention rate.

Has anyone else studied this problem? Can we learn anything from them?

Yes. The Australian A.A. organization has. They found that A.A. in Australia also had only a 5% annual retention rate:

Australian General Service Conference 1994
Chairman's Opening Address

"Our 1992 Survey showed that only 5% of newcomers to AA are still attending meetings after 12 months. This is a truly terrible statistic. Again we must ask 'Where does the fault lie?'"

Dr. Ron Whitington — Chairman, General Service Board.

AA Around Australia, Spring Edition, No 90., October 1994, page 2.

... The survey was a well conducted professional study involving 1,425 members from 123 of the country's AA groups... (page 19)

And then other people, like Nell Wing, Bill Wilson's secretary, and Francis Hartigan, Lois Wilson's secretary, also reported that A.A. only had a 5% success rate. Read on.

Also see Scott S.'s analysis of the AA-NY statements.

When the A.A. founder Bill Wilson wrote his history of Alcoholics Anonymous in 1957, he admitted that the early A.A. program had been a disaster:

At first nearly every alcoholic we approached began to slip, if indeed he sobered up at all. Others would stay dry six months or maybe a year and then take a skid. This was always a genuine catastrophe. We would all look at each other and say, "Who's next?"
Alcoholics Anonymous Comes Of Age, William G. Wilson, (1957), page 97.
As Bill Sees It: The A.A. Way of Life, William G. Wilson, (1967), page 154.

Nell Wing

And Nell Wing, who was a secretary of Alcoholics Anonymous for 35 years, and Bill Wilson's personal secretary for many of those years, as well as A.A.'s first archivist, reported:

"There were alcoholics in the hospitals of whom A.A. could touch and help only about five percent. The doctors started giving them a dose of LSD, so that the resistance would be broken down. And they had about fifteen percent recoveries. This was all a scientific thing."
Alcoholics Anonymous Comes Of Age, William G. Wilson, (1957), page 370.

It would appear that LSD was three times as effective as Alcoholics Anonymous for treating alcoholism. Unfortunately, that doesn't work either, in the long run.
(Also see ASAM founder Dr. Ruth Fox's use of LSD on her alcoholic patients, to make them more compliant. ASAM == the American Society for Addiction Medicine, the A.A. front group founded by Dr. Ruth Fox to promote the 12-Step quack cure among doctors.)

Nan Robertson reported:

[Bill Wilson] had only scattered luck with those he tried to sober up personally...
Getting Better Inside Alcoholics Anonymous, Nan Robertson, pages 67-68.

In a letter of encouragement to a founding member of the Chicago A.A. group, Earl T., Bill Wilson wrote:

      Above all, don't get discouraged if the going is slow at first — that seems to be part of our education along this line. The summer I worked in Akron with Doc Smith, we tore about frantically and only bagged two who made the grade, Ernie G_____ [Galbraith] and Bill D_____ [Dotson].10
      Here in New York, it was the same story. I went along six months talking to a lot of them before any permanent results were obtained...
PASS IT ON, The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Services, Inc., pages 225-226.

[NOTE: Ernie Galbraith did not "make the grade". He seduced Dr. Bob's daughter Susan and relapsed constantly, and then quit A.A., and drank on and off for the rest of his life.

And in New York, Bill's first recruit was Henry Parkhurst, who helped to co-author the Big Book, but who relapsed and quit A.A. after Bill Wilson cheated Henry out of any share of the credit or royalties for the Big Book. Funny that Bill Wilson didn't mention any of that, while talking about how hard it was to "bag" some "permanent results".]

At a memorial service for Dr. Bob, Bill Wilson actually bragged about the pathetically low success rate of the whole A.A. program. (Bill was making himself out to be a long-suffering hero, working tirelessly to promote Alcoholics Anonymous.) Bill described the early days of A.A. this way:

You have no conception these days of how much failure we had. You had to cull over hundreds of these drunks to get a handful to take the bait.
Bill Wilson, at the memorial service for Dr. Bob, Nov. 15, 1952; file available here.

If you have to cull hundreds of drunks to get a few success stories, then that sounds like a one or two percent success rate. But wait! That was only the ones who were gullible enough to "take the bait", as Bill called it. That was just the recruiting success rate. How many of those new recruits stayed sober for a good long time, like several years? Even less, for sure. But that was far less than the usual five percent rate of spontaneous remission that we get with a bunch of alcoholics if we just do nothing with them. How could the numbers be so far off?

Simple: even among those alcoholics who would soon quit drinking all on their own, there were plenty of people who were not receptive to the A.A. message, people who didn't want to become religiomaniacs. Quitting drinking and joining Bill Wilson's Alcoholics Anonymous version of Frank Buchman's cult religion were two very different things.

That gives the lie to Bill's claims of great success in sobering up drunks that he wrote in the Big Book. Bill actually wrote this in the original manuscript of the A.A. "Big Book", Alcoholics Anonymous, before it was ever published:

We, of ALCOHOLICS ANONYMOUS, know one hundred men who were once just as hopeless as Bill. All have recovered. They have solved the drink problem.
The A.A. "Big Book"Alcoholics Anonymous, William G. Wilson, first edition multilith page 8 and the 1st edition hardback on page 27.

But there were only about 40 sober members of Alcoholics Anonymous altogether — whom Bill Wilson grandly called the "First 100" — including all of the members of the groups in New York, Akron, and Cleveland, when Bill started writing the Big Book in late 1938; and there were only 70 sober members of A.A. worldwide when Bill Wilson finished writing his chapters in early 1939. (And most of them eventually relapsed and returned to a life of drinking.) The "hundred" number is a shameless self-promoting barefaced lie.12

An alcoholic who was a doctor ["Doctor Bob", Dr. Robert Holbrook Smith] came to see me. He didn't talk like a preacher at all.
This doctor had imparted his knowledge to just a few other men at that time — not more than four or five — and now they number more than 70 persons*

* Written in 1939

The A.A. "Big Book"Alcoholics Anonymous, Joe Doppler, "The European Drinker", page 235 of the 3rd Edition.

And even before that, in 1938, when the fledgeling group of nameless alcoholics created "The One Hundred Men Corporation" to finance, write and publish the 'Big Book', Bill Wilson made similar grossly exaggerated claims of success in the prospectus for shares of that corporation (which made it a case of felony securities fraud):

In all, about two hundred cases of hopeless alcoholism have been dealt with. As will be seen, about fifty percent of these have recovered. This, of course, is unprecedented — never has such a thing happened before.

When Bill Wilson claimed that "never has such a thing happened before", he was pointedly ignoring all of the popular and successful sobriety movements and temperance unions which had come before, like the Women's Christian Temperance Union (WCTU), the Washingtonian Society, Keswick, the Keeley League, the Emmanuel Clinic, and the Salvation Army.

Likewise, in 1955, in the Foreword to the Second Edition of the Big Book, page XX, Bill Wilson wrote:

Of alcoholics who came to A.A. and really tried, 50% got sober at once and remained that way; 25% sobered up after some relapses, and among the remainder, those who stayed on with A.A. showed improvement. Other thousands came to a few A.A. meetings and at first decided they didn't want the program. But great numbers of these — about two out of three — began to return as time passed.

We will discuss the "really tried" qualifier below, but first I want to point out that Bill Wilson claimed that he was somehow able to keep track of thousands of people who came to only a few A.A. meetings, and disliked what they saw, and left. Bill declared that "great numbers of these — about two out of three — began to return." How could Bill know that? How could he possibly know that?

Robert Thomsen wrote a biography of Bill Wilson that was based on a set of autobiographical tapes that Bill recorded before his death. Thomsen parroted Wilson's claim:

In the year 1941, membership jumped from fifteen hundred to eight thousand, which meant that they probably dealt with another ten or fifteen thousand who looked in the door, turned around, and went out. In time Bill was to learn that two-thirds of these would one day return.
Bill W., Robert Thomsen, footnote on page 315.

  • How could Bill Wilson keep track of all of those thousands of visitors when they were all anonymous?
  • How could he remember ten or fifteen thousand people who came to the A.A. meeting rooms just once or twice, and didn't like what they saw, and left?
  • But that 10 or 15 thousand number is just the number of visitors who came to A.A. during the year 1941. Bill Wilson wrote his grand "75% sobered up" claim in 1955, in the Foreword to the Second Edition. By then, Bill would have had to have tracked literally hundreds of thousands of visitors, to see that two thirds of them eventually "began to return".
  • And what's with that slick word game? — "But great numbers of these — about two out of three — began to return as time passed"?
    Began to return? Either they returned or they didn't. How do great numbers of people "begin to return"?
    Did two-thirds of them really return, or did they only "begin to return"?

    One can imagine, "Well, they began to return. They put on their shoes and socks and coats, and headed for the New York City A.A. clubhouse, and got as far as 42nd Street before they turned around and went back home..."

    Or was it like, "There was this immense tsunami wave of people beginning to return to A.A. — It was flowing towards the A.A. clubhouse. Three people actually made it inside the clubhouse door before the wave reversed itself and flowed back out to sea..."

    Bill's phrasing indicates that only a few people actually returned, and Bill tried to imply that they were the leading edge of a big wave of returnees. That makes the "two-thirds" number meaningless.

    That is just such a typical Wilson Weasle — so much of what he wrote was such deceptive and misleading nonsense.

  • How could Bill determine that two thirds of them eventually returned? (If they actually returned, rather than just "began to return"...)
  • Did somebody keep attendance records?
  • Who kept the records, and how could he keep accurate records without any last names, when everybody was "anonymous"?
  • Or was Bill Wilson just fabricating tall tales again?

    Of course he was.

  • And will the Alcoholics Anonymous World Services, Inc. headquarters or the General Service Organization open up the locked and sealed archives of historical documents and let us see those original attendance records, to see how many people really returned?


In the quote above, where Bill wrote, "Of alcoholics who came to A.A. and really tried, 50% got sober at once, and remained that way; 25% sobered up after some relapses", we get the impression that at A.A. worked on at least 25% of the alcoholics right away (50% of the claimed half who joined A.A.), and 37.5% later (75% of the claimed half who joined A.A.).

But the quote from Dr. Bob's memorial service reveals that Bill Wilson was cherry-picking. Bill culled hundreds of alcoholics to get just a few of the best prospects to join Alcoholics Anonymous — to "take the bait". That sounds like a one or two percent recruiting rate. If two percent of the alcoholics joined Bill's "spiritual fellowship", and half of them really kept coming back to A.A. for a long time, and 75% of those committed members eventually recovered and achieved long-term sobriety, then that would yield an over-all success rate for Alcoholics Anonymous of only 3/4 of one percent — less than one out of a hundred. That really is appalling. That is not what we would call a good alcoholism treatment program. That is a total failure. That "success rate" is far less than the normal rate of spontaneous remission from alcoholism (five percent per year). We will get better results with the alcoholics if we do nothing.

Then Bill used that qualifier to filter out the failures: "Of alcoholics who came to A.A. and really tried..."
If they didn't join A.A., or they didn't "really try", then they didn't count.
But who decided whether they had really tried?
Well, Bill Wilson, of course.
Oh heck, with that qualifier, Bill Wilson could make the numbers into anything he wanted them to be.

Presumably, if someone just relapsed repeatedly, and showed no improvement, then he wasn't really trying, so don't count him. So Bill didn't.

The way Bill that counted those success stories, there was not one person who didn't show improvement, if they just really tried. There was not one total failure in Bill's program.

But we know full well that there were plenty of early members — members of the so-called "First One Hundred" — who totally relapsed, and just went out and died drunk:

  • Henry Parkhurst, the co-author of the Big Book, author of chapter 10, To Employers, and author of his own autobiographical story in the first edition, The Unbeliever. Hank had 4 years of sobriety in A.A. when Bill Wilson cheated Henry out of the Big Book money and drove him out of Alcoholics Anonymous. Died drunk and broke.

  • Florence Rankin, the second woman in A.A. and the author of the Big Book first edition story A Feminine Victory, died drunk, a suicide in Washington, D.C.
    (The first woman in A.A. was Jane Sturdevant and she is listed by Dr. Bob with 12 months of sobriety, dating her entrance into AA in February of 1937. You can read about her in Doctor Bob and the Good Oldtimers. (Thanks, L.D., for that one.) Which leaves the question, "What happened to her? Why is there no further mention of her in the A.A. history books? Why isn't she a legend in the A.A. history? I can only guess that the reason that "A.A. History Lovers" do not wish to talk about her is that she relapsed and returned to drinking, too.)

  • Jackie, an enthusiastic but constantly-relapsing recruiter, died drunk.

  • Paddy, another enthusiastic but constantly-relapsing recruiter, who was the founder of A.A. in Boston, died drunk.

  • Doctor Bob's son-in-law Ernie Galbraith — "A.A. Number Four" — the constantly-relapsing older alcoholic philanderer whom the autocratic Doctor Robert Smith forced on his teenage daughter Sue Smith, relapsed all of his life.

  • Pat C. of Los Angeles, the subject of the first-edition story "The Lone Endeavor", whose story was removed from the Big Book after he showed up in New York City more than a little intoxicated.

  • And then there was Bill Wilson's own recruiter Ebby Thacher, who sucked Bill into the Oxford Group cult religion and turned Bill into a religious fanatic, only to later relapse and leave the cult himself.

  • The early A.A. members managed to keep Morgan Ryan sober just long enough for him to appear on Gabriel Heatter's "We The People" radio program and tell all of America how a wonderful new organization called "Alcoholics Anonymous" had saved him from alcoholism, and then Morgan promptly relapsed afterwards.9

  • And Lois Wilson's private secretary, Francis Hartigan, reported that fully 50% of the authors of the stories in the first edition of the Big Book relapsed and did not maintain long-term sobriety.

  • In fact, Dick B. reports that the whole New York group, run by Bill Wilson, had a very high rate of relapse. (Dr. Bob's group in Akron did better.)

Aha! I just got it! Another qualifier: "those who stayed on with A.A.." Those who relapsed and didn't "Keep Coming Back" didn't count either.

So, in the end, Bill Wilson only counted the success stories. That is how he managed to get a much, much higher success rate than anyone else in the whole world has ever gotten, before or since.

Bill Wilson was just doing some Enron-style accounting. Enron created the illusion of big profits by transferring all of its expenses, liabilities and losses "off of the books" and hiding them somewhere else, leaving nothing but immense profits in sight, thus creating the appearance of a very successful, highly profitable, company. Bill Wilson created the illusion of a very successful alcoholism treatment program by transferring all of his failures off of the books (and out of the Big Book) and ignoring them, leaving only success stories for everyone to see. So Bill turned a mere five percent success rate into a fifty percent success rate (or 75%, or more).

Destructive narcissists categorized as "Manipulative" are particularly prone to use misleading statements and lies. Do they know they are lying? Yes. But, they feel they have the right to use any means available to achieve their ends. Further, some will have an assumption, much like that of "Suspicious" narcissists, that everyone is lying, and thus lying is fair play.
Loving the Self-Absorbed, Nina W. Brown, Ed.D., LPC, NCC, page 67.

Such a rationalization traps us in circular logic: It is okay to lie and exaggerate how many lives Alcoholics Anonymous really saves, in order to promote Alcoholics Anonymous — the end justifies the means — because Alcoholics Anonymous is such a wonderful organization that saves so many lives and it should be promoted...

Bill Wilson also said of alcoholics that...

Some of them may sink and perhaps never get up, but if our experience is a criterion, more than half of those approached will become fellows of Alcoholics Anonymous.
The A.A. Big Book Alcoholics Anonymous, William G. Wilson, page 163.

More than half join?
Hmmm... Bill Wilson seems to have been "mathematically challenged", to say it in a politically correct way. Bill wrote in the Big Book, in late 1938 or early 1939, that more than half of those approached became "fellows of Alcoholics Anonymous." But later, in 1952, he admitted that they had to cull hundreds of drunks to get just a few to "take the bait" and join. And then in 1957 he stated that most of those new members relapsed — "At first nearly every alcoholic we approached began to slip, if indeed he sobered up at all. Others would stay dry six months or maybe a year and then take a skid."

And Bill made more grand claims of success further on in the Big Book (written in December 1938):

RARELY HAVE we seen a person fail who has thoroughly followed our path. Those who do not recover are those who cannot or will not give themselves completely to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.
A.A. Big Book, 3rd Edition, William G. Wilson, page 58.

Bill's claim that "RARELY HAVE we seen a person fail who has thoroughly followed our path" is simply ridiculous, and is not supported by any facts or evidence, or even by Bill Wilson's other writings, so you can ignore that. In fact, the situation was so bad that Bill Wilson should have written,
"RARELY HAVE we seen a person succeed by thoroughly following our path."

Many people saw what Bill was doing with the numbers and corrected Bill's distortions. Nell Wing, Bill Wilson's personal secretary for many years (right up to his death), wrote:

      Many members recall Bill's tendency to exaggerate. Ruth Hock, Bill's secretary and office manager, remembers that when talking before a meeting he was prone to be overgenerous in quoting the latest membership count or convention attendance. He might say, for example, "Well, folks, I'm glad to say there are now 150 members." Ruth, who like me could be quite literal-minded, would lean over and whisper, "No, Bill, it's only 95" or whatever the figure was. Afterward, Bill would complain good-naturedly, "Oh, Ruth, you're spoiling my fun." Bill always claimed the attendance at the 1955 International Convention was 5,000. Dennis, who handled the registrations, told me the true number was about 3,100, plus possibly a few hundred walk-ins. I recall myself that the crowd nowhere near filled Kiel Auditorium.
Grateful To Have Been There, Nell Wing, page 61.

Lying and fudging the numbers in the critical life-or-death matter of recovery from alcohol addiction is fun?
Bill Wilson was really something else.

Like Dr. Alexander Lowen said,
      The tendency to lie, without compunction, is typical of narcissists.
(Narcissism, Denial of the True Self, Alexander Lowen, M.D., page 54.)

Francis Hartigan was Lois Wilson's (Bill's wife's) private secretary. He wrote a biography of Bill Wilson where he described the difficulties that Bill Wilson and Doctor Bob experienced in the very early days of A.A., in 1935 in Akron, Ohio:

We have to wonder why both the Wilsons and the Smiths did not simply give up. Today the nation's best alcoholism treatment centers report success rates ranging from 25 percent to 50 percent. During Bill's stay in Akron, he and Bob calculated their success rate to be about 5 percent, and among the few who seemed to catch on, not all of them were able to maintain consistent sobriety. The first edition of AA's Big Book, published in 1939, contains the personal recovery stories of many of AA's earliest members. Some years later, Bill made notations in the first copy of the book to come off the press, indicating which individuals portrayed therein had stayed sober. A good 50 percent of them had not.
Bill W. A Biography of Alcoholics Anonymous Cofounder Bill Wilson, Francis Hartigan, pages 91-92.

So 50 percent of the first-edition Big Book authors relapsed and returned to drinking? That has to be another reason why Bill Wilson almost completely replaced the original set of autobiographical stories when he published the second edition.

But Bill didn't bother to tell us about all of those relapses. He just floated a story about how the new biographies would be "more suitable for the times", while continuing his grossly dishonest "A.A. works great" song and dance.
And the policy of anonymity makes it impossible for us to check whether the more recent authors have relapsed. Who knows what the real success stories of those authors are, or whether the stories are in fact just fabrications, like the Indian "Tall Man" in the story Join The Tribe.

Note that the treatment centers who report a 25 to 50 percent success rate — or more, sometimes even 80% — are basically lying. They discount and ignore their dropouts, quitters, and relapsers, and only reveal what percentage of their program graduates stay sober (for a short while after graduation). They are also doing Enron-style accounting. Furthermore, most treatment centers demand that people be sober in order to "graduate", so that creates a circular definition of success: Only the sober people qualify as "graduates", so the treatment program must work great, because so many of its graduates are sober.

Also note that Bill and Dr. Bob ostensibly got that same old 5 percent success rate, at least in initial recruiting. But that is just the normal rate of spontaneous remission of alcoholism, once again. The A.A. program still did not show any improvement over the usual rate of spontaneous remission. A.A. did not increase the number of sober people over the number who would have quit anyway, without A.A.'s "help". In fact, A.A. appears to have actually reduced the usual success rate from 5 percent down to 2.5 or 3.5 percent or so, when all of those Big Book authors eventually relapsed.

In writing words of encouragement to Jennie B., the founding mother of A.A. in Boston, Bill Wilson described his own experiences in sobering up alcoholics like this:

      What you say about your discouragement in working with alcoholics surely brings the past before me. I guess I told you the story of 182 Clinton Street, Brooklyn, where we took in alcoholics for two years without any result whatever. In those days, Lois and I used to blame ourselves, thinking that somehow we failed. Only the other night, she and I looked over a list of the people we worked with in those days, both at 182 Clinton Street and elsewhere. The number of them who have since dried up was truly astonishing. This made us realize that in God's economy, nothing is wasted. At the time of our failure, we learned a little lesson in humility which was probably needed, painful though it was.
      We now see so clearly that the immediate results are not so important. Some people start out working with others and have immediate success. They are likely to get cocky. Those of us who are not so successful at first get depressed. As a matter of fact, the successful worker differs from the unsuccessful one only in being lucky about his prospects. He simply hits cases who are ready and able to stop at once. Given the same prospects, the seemingly unsuccessful person would have produced almost the same results. In other words, you have to work on a lot of cases before the law of averages commences to assert itself.
      So cheerio, Jennie — it ain't your fault.
'PASS IT ON', The story of Bill Wilson and how the A.A. message reached the world, Alcoholics Anonymous World Services, Inc. staff, 1984, pages 251-252.

What Bill Wilson was describing is normal spontaneous remission in alcoholics. A few alcoholics, like 5% of them, will be ready and able to quit now, or some time this year, because they are sick and tired of the drinking and being sick routine. Then 5% more will quit next year, and that many more the following year, and then the following... After a lot of years, you will see that half of the alcoholics have quit drinking. As Bill Wilson described it, "the law of averages commences to assert itself." The lucky A.A. recruiter "simply hits cases who are ready and able to stop at once." That recovery process has nothing to do with the efforts of any Alcoholics Anonymous missionaries, and it isn't caused by any Alcoholics Anonymous activities — not by the meetings, not by the 12 Steps, and not by the talk about God.

Bill Wilson was, in spite of his sanctimonious talk about humility, just presumptuously taking the credit for other peoples' hard work to quit drinking and save their own lives. There was zero evidence that anything Bill did at 182 Clinton Street made his house guests quit drinking several years later, but Bill still claimed the credit for their sobriety anyway, and implied that they were his success stories — that he had somehow caused them to quit drinking — that their sobriety was ultimately the fruit of his labors — "that in God's economy, nothing is wasted."

Bill Wilson did that again in the speech he gave at the memorial service for Doctor Bob. Bill described a manic depressive alcoholic in Akron named Eddie, to whom Bill and Dr. Bob gave a pep talk about quitting drinking. Eddie didn't go for it. He continued drinking and ended up confined to the State mental asylum for a dozen or more years. Finally, Eddie decided to quit drinking, and he showed up at Doctor Bob's funeral sober. So Bill promptly took the credit for Eddie's sobriety:

      Thereafter, Eddie was in the State Asylum for a period of a dozen or more years but believe it or not he showed up at the funeral of Dr. Bob in the fall of 1950 as sober as a judge and he had been that way for three years.
      So even that obscure little talk about Eddie made the grade.
Bill Wilson, at the memorial service for Dr. Bob, Nov. 15, 1952; file available here.

The current Alcoholics Anonymous organization still uses that same faulty logic when it claims that it has sobered up millions of people. A few newcomers quit drinking in order to save their own lives and their health, and then the A.A. organization takes the credit for their sobriety, and claims that it somehow made them quit drinking — "The program works," they say.

And of course A.A. disavows any responsibility for all of those millions of other people who don't quit drinking — the relapsers and the dropouts and the deaths. A.A. proselytizers never admit that the relapsers and dropouts prove that the 12-Step program does not work. A.A. boosters never recognize that the program is no help to the vast majority of alcoholics.

Thus that routine is just another example of cherry-picking — just claim the credit for the few successes while ignoring the many more failures.

The Sagan rule: "Extraordinary claims require extraordinary evidence."

The far-fetched claims of Bill Wilson that Frank Buchman's cult religion could cure alcoholism have not been backed up by even a little ordinary evidence, never mind some extraordinary evidence.

While we are talking about people cooking the books and faking the numbers, we shouldn't overlook Nan Robertson's statements in her popular book, Getting Better Inside Alcoholics Anonymous:

About 60 percent of all newcomers — some still drinking at first, most not — who go to A.A. meetings for up to a year remain in A.A. Usually, they stay sober for good. That means, of course, that 40 percent are lost to A.A. after trying out its program. These statistics refute the widely held notion of outsiders that Alcoholics Anonymous is successful with everyone.
Getting Better Inside Alcoholics Anonymous, Nan Robertson, 1988, page 94.

Nan Robertson actually reported that most of the newcomers to Alcoholics Anonymous had already quit drinking, but A.A. was happy to take the credit for their sobriety anyway, and claim that it had somehow made them quit drinking or "kept them sober".

Then Nan Robertson tried to imply that only 40 percent of the newcomers were "lost to A.A.", but she was just lying with qualifiers. She actually stated that only 60 percent of those few who stay in A.A. for a whole year continue to go to A.A. after that.

We know from the preceding information that at least 95 percent of the newcomers drop out by the one-year point, so she was really saying that only six tenths (60%) of the five percent who were still in A.A. at the one-year point would remain in A.A. after 1 year. That is a mere three percent who stay longer than one year. So the truth is that at least 97 percent of the newcomers were "lost to A.A.", not 40 percent.

And then the real truth is even worse than that — the attrition continues. Only one person per thousand newcomers to A.A. becomes a sober 20-year old-timer in Alcoholics Anonymous. So something like 99.9% of the newcomers are eventually "lost to A.A.".

Also notice Nan Robertson's use of the propaganda trick False Equality:

  1. "Remaining in A.A. equals staying sober for good."
  2. "Leaving A.A. equals staying drunk forever."
Nan Robertson just assumed that those who left A.A. did not ever get sober or stay sober on their own (which many do), and she also assumed that staying in A.A. means staying sober, rather than just relapsing repeatedly and doing a lot of binge drinking, which is what actually happens more often.

Did Nan Robertson do any kind of survey or follow-up to find out how many A.A. dropouts sobered up later? Or how many A.A. members stayed in A.A. long-term, and also stayed sober? Ms. Robertson never reported any such survey or study.

Further on in her book, Nan Robertson gave us some completely unverifiable declarations of A.A. successes, trying to imply that A.A. works. She described the work of Dr. Ruth Fox as:

She sent all her alcoholics into A.A. Those who stayed, she noted, often got sober for good; those who dropped out did not.
Getting Better Inside Alcoholics Anonymous, Nan Robertson, page 184.

Robertson implied that staying in A.A. makes people "get sober for good", and that dropping out of A.A. makes people drink. But she gave us no numbers at all — there is no indication whatsoever of what Dr. Fox's actual success rate might have been. Likewise, she didn't even give us a hint about how many people actually stayed in A.A. indefinitely. It's all vague hoopla. And there are no footnotes in Nan Robertson's book, nor any bibliography, nor any citations. None of her statements can be checked for accuracy, or verified, or traced back to their sources. She does not say anything about where she gets her statistics or other information.

And then Nan Robertson deceptively wrote that "Those who stayed often got sober for good." "Often". So sometimes the long-time A.A. members stayed sober, and sometimes they didn't. That is a meaningless statement, when you come right down to it. You can say the same thing about baseball — "Those people who kept coming back to more baseball games often stayed sober. (And, then again, often they didn't.)"

Nan Robertson tries to make us believe that staying in A.A. leads to prolonged sobriety. But how many successes did Dr. Ruth Fox really get from sending everybody to A.A.? Probably less than the usual five percent per year spontaneous remission rate.

And note how Robertson implied a cause and effect relationship between going to A.A. and getting sober, while actually giving us no evidence of that. We could just as easily say that prolonged sobriety caused a few people to stay in A.A., while those who continued to drink alcohol didn't feel inclined to waste their time on A.A. meetings.

And, more realistically, there is the distinct possibility that a few successful quitters got fooled into believing that A.A. was necessary for their sobriety, so they continued to attend meetings for many years. The drinkers, on the other hand, knew full well that A.A. wasn't necessary for drinking, so they didn't bother with A.A. meetings.

Oh, last but not least, how could Dr. Ruth Fox be so sure that those people who dropped out of A.A. didn't eventually get sober by their own efforts, or through some other program? Did Dr. Fox track all of them for the rest of their lives to see what really happened with them? No, of course not. So she cannot possibly truthfully make a blanket declaration that the A.A. dropouts didn't get and stay sober later on.

When we consider the facts that the overwhelming majority — more than 95% — of the newcomers dislike A.A. and drop out, and that nevertheless, more than 50% of all alcoholics eventually successfully quit drinking anyway, it is obvious that approximately half of the A.A. dropouts do achieve sobriety on their own.

Heck, for that matter, how long did Dr. Fox track the sober A.A. members? Five years? Ten years? Twenty years? If she didn't track them for a lot of years, then she couldn't really know whether they stayed sober or not, either.

Nan Robertson did not say anything about Dr. Fox having done a big, expensive, lengthy longitudinal controlled study to see who really stayed sober and who really stayed drunk, to see whether A.A. actually made more people get and stay sober. And there is no record or report of any such study in the professional literature, and Dr. Ruth Fox's own book failed to report any such test of the effectiveness of Alcoholics Anonymous treatment. So in the final analysis, Dr. Ruth Fox could not have known either whether the A.A. members stayed sober, or whether the A.A. dropouts stayed drunk.

Speaking of which, Dr. Ruth Fox also felt that LSD was very helpful in changing alcoholics' thinking and behavior:

LSD does seem to make the patient more willing to undertake the total program necessary for his recovery. After LSD most of the patients who formerly refused to cooperate were willing to take disulfiram, attend group therapy and to affiliate with A.A.
Ruth Fox, Alcoholism, Behavioral Research, Therapeutic Approaches, 1967, page 775,
quoted in Slaying the Dragon, William L. White, page 229.

So Dr. Ruth Fox felt that LSD was good because it helped to brainwash the patients and make them more obedient and cooperative? Heck, we have little A.A. brain police popping up all over the place.

By the way, that Dr. Ruth Fox was the founder of ASAM — The American Society for Addiction Medicine — another A.A. front group that exists to promote A.A. and the 12-Step cult religion treatment of alcoholism, this one by pretending to give doctors helpful advice about what works to treat or cure alcoholism.
And Dr. Ruth Fox was such a monster of a mad scientist that she gave her patients disulfiram and then alcohol, to deliberately make them very sick, in an attempt to build up an aversion to alcohol. Even after she discovered that the aversion therapy didn't work, and even after one patient nearly died from an almost fatal reaction to a single ounce of alcohol, she still insisted on giving each patient at least one session of being sick from the disulfiram/alcohol combination, before she released them from the hospital. (See: Disulfiram (Antabuse) as an Adjunct in the Treatment of Alcoholism, Dr. Ruth Fox, in Alcoholism: Behavioral Research, Therapeutic Approaches, edited by Ruth Fox, M.D., foreword by 'Mrs.' Marty Mann, Springer Publishing Company, Inc., New York, 1967.)

Speaking of fraudulent statistics from the early days of A.A., the Philadelphia A.A. group provided the following documents:

Special Report On AA Work At The Philadelphia General Hospital
December 13, 1940

The following is the complete experience of the Philadelphia A.A. Group with patients of the Philadelphia General Hospital since March 15. On this list are included only those men who have attended at least two or three A.A. meetings and have signified their intention of following the A.A. program.

Brief notes on the various individuals follow:

Joseph A. - Dry seven months, no trouble.
Frank B. - Dry five months, one slip after he left group one month ago.
Herbert C. B. - Dry four months, no trouble.
Joshua D. B. - Probably psychopathic; continuous slips.
Charles J. C. - Dry nine months, no trouble.
John D. - Dry four months through Philadelphia General Hospital and Byberry.
Joseph D. - Dry four months, no trouble.
George G. - Dry one month, no trouble.
John H. H. - Continuous slips before and after hospitalization.
William K. - Dry four months, no trouble.
Alfred K. - Dry four months, no trouble.
Arthur T. McM. - Dry eight months, no trouble.
William P. - Continuous after two hospitalizations, only attended five meetings, no work.
Harry McC. - Dry eleven months, one slip two months ago, hospitalization then.
James S. - Continuous slips before and after hospitalization.
George K. - Continuous trouble up to two months ago, first hospital May.
C. M. M. - Dry nine months, no trouble.
Hugh O'H. - Dry two months, no trouble.
Edmonds P. - Dry nine months, hospitalization recent, trouble since.
William J. P. - Dry three months, no trouble.
James R. - Dry five months, no trouble.
William R. - Dry six weeks, no trouble.
Carl R. - Dry eight weeks.
Biddle S. - Dry four months, hospital trouble now dry one month.
Thomas S. - Dry four months, one slip.
David W. - Dry seven months, no trouble.
William W. - Dry nine months, no trouble.
Margery W. - Dry three months, no trouble.

Nineteen out of twenty-eight who have come through the Philadelphia General Hospital have had no trouble. Of the nine who have had trouble, five have been with the group and had trouble previous to hospitalization.

This list was made at the request of Jack Alexander, writer for the Saturday Evening Post.

(Signed) A. W. Hammer M. D. - Surgeon
(Signed) C. D. Saul, M. D. - Chief resident, Saint Luke's Hospital
(Signed) Philadelphia General Hospital, By: John F. Stouffer M. D. - Chief Psychiatrist

This is merely anecdotal evidence, and not even convincing anecdotal evidence. Twenty-eight alcoholic men were detoxed and treated in Philadelphia General Hospital, and then they stayed sober for one or more months afterwards. Apparently, the doctors gave those alcoholics hell and told them that they would die if they didn't quit drinking, so most of them (68%) stayed sober for a few months after their hospitalization.

Oh, and they also attended at least two or three A.A. meetings.

So what?

Strange that the doctors didn't give any credit for the patients' sobriety to the hospital or to medical treatment. They tried to give all of the credit for successes to Alcoholics Anonymous, even when some of the patients had only gone to 2 or 3 A.A. meetings. (Well actually, it isn't that strange. The doctors were apparently A.A. members, and on a holy mission to spread Alcoholics Anonymous everywhere...)

Notice the funny fumbling word game where the authors tried to explain away (minimize and deny) the failures: "Of the nine who have had trouble, five have been with the group and had trouble previous to hospitalization."
Excuse me, but by definition, ALL alcoholics have had trouble with alcohol "previous to hospitalization".

Philadelphia Group
Post Office Box 332
William Penn Annex

Alcoholic Foundation
30 Vesey Street
New York, N. Y.

December 14, 1940


We believe that the time has arrived when we can give you a preliminary statement of the results of the work of Alcoholics Anonymous in Philadelphia since its inception in this city on February 20, 1940. This in effect is a ten months' report but for all practical purposes it can be considered only nine months because about a month was occupied in working out methods of prosecuting the activities.

According to the records of the Group, which have been kept with reasonable accuracy, ninety-nine men and women have during this period attended at least two meetings of the A. A. Group. In other words, they have had a fair opportunity to familiarize themselves with the A. A. program of recovery as given at the Thursday night meetings held at Saint Luke's and Children's Hospital.

Of the ninety-nine, seventy have remained dry without any slip at all; thirteen others are recovering from one or more slips, and sixteen have slipped without recovery up to the present time. It is not impossible that some of these sixteen may yet return to the Group.

Of the seventy, who have been dry without slips, thirty-nine have been dry from one to three months; seventeen from three to six months; twenty-five from six months to a year, and five from one to three years.

Obviously these five were not dried up through the activities of the Philadelphia A. A. Group but have recovered from alcoholism in other localities and through other means.

You can see that the Philadelphia A. A. Group has a core of thirty men who, we have every reason to believe, will never drink again. Seventeen more have gotten by the three months' critical period. It has been our observation that the first three months are the most difficult and that the man who gets by that period has every reason to believe that he is on the road to complete recovery.

We are even more sanguine of results which shall be achieved since we succeeded in opening our clubhouse about one month ago. It is being used extensively, especially by the unmarried men and is proving helpful not only as a social center but as a base for the spreading of the A. A. message.

We can testify as physicians to the increasing interest in A. A. work among members of the medical fraternity and are grateful for the opportunity that the A. A. has given us of assisting in the recovery of the unfortunate victims of alcoholism.

(Signed) A. W. Hammer M. D. - Surgeon
(Signed) C. Dudley Saul, Chief Resident Saint Luke's Hospital

Geez Louise. Somebody attends two lousy A.A. meetings, and A.A. is taking the credit for their sobriety? What a hoax.

If we take a closer look at the numbers, we get, of the 99 members:

  • 16 total failures
  • 13 slipping
  • 39 dry 1 to 3 months
  • 17 dry 3 to 6 months
  • 25 dry 6 to 12 months
  • 5 dry 1 to 3 years

Anything less than a year of sobriety is merely a short pause in someone's drinking career. There were only 5 men out of the 99 who had a year or more of sobriety. That means that the Philadelphia group actually had a five percent success rate.

Not coincidentally, five percent is also the usual rate of spontaneous remission in untreated alcoholics. So the real success rate of the Philadelphia A.A. group, above and beyond normal spontaneous remission, was zero.

But then the real kicker is this line talking about the 5 people with more than a year of sobriety:
"Obviously these five were not dried up through the activities of the Philadelphia A. A. Group but have recovered from alcoholism in other localities and through other means."

Hammer and Saul admitted that the five success stories were not actually sobered up by Alcoholics Anonymous — the successes got themselves sober long before they ever came to A.A. — but Hammer and Saul included them in the statistics anyway, as part of the 70 who were staying sober. I can only conclude that they did that to improve the appearance of the so-called "A.A. results" — so that the authors could be "even more sanguine of results".

Oh, by the way, these two numbers-fudging doctors appear to have actually been A.A. members — they authored those letters as the Philadelphia A.A. group, and included this line:
"we succeeded in opening our clubhouse about one month ago..." OUR clubhouse?

Now in fairness to those authors and the Philadelphia group, we must consider the fact that the group was new, and had not been together for enough years to have accumulated a bunch of old-timers with many years of sobriety. So those reported results were at best premature... So let's see what happened later...

The next letter is undated, but must have been written at least a year later, because the membership of the Philadelphia group had increased to over 200.

Statistical Record of Philadelphia Alcoholics Anonymous Group

The Philadelphia A. A. Group was formed February 27, 1940, with seven men as a nucleus. Six of these are definitely recovered cases.

We consider a man or woman an active member of A. A. when they have been dry in the group two months and have attended at least six general meetings.

We now have an ACTIVE MEMBERSHIP of one hundred and thirteen alcoholics, eighty-three of whom have not had a drink since their first A. A. meeting. Five of these have been dry from two to four years, twenty-seven dry from one to two years, forty-one dry from six to twelve months and twenty-six dry three to six months.

Twenty-three of these active members came directly from the Philadelphia General Hospital, thirteen from other hospitals and institutions.

There have been only twenty-three active members who do not appear to be recovering. These are not included in the above figures. Neither are the fifty other men and women who are now in the process of becoming members.

This gives us a total general membership of Two Hundred men and women.

To the best of our knowledge, the foregoing is correct.

(Signed) Dr. A. Weise Hammer
(Signed) Dr. C. Dudley Saul
Medical directors

The authors were cherry-picking. By using the qualifier that they considered someone a member of A.A. when he has been dry in the group for two months, they quickly discounted most of the A.A. failures and dropouts. None of the chronic relapsers or dropouts were counted as members. Only the more successful people were counted. That, of course, created the illusion that the A.A. program was much more successful than it really was.

It also creates invalid circular logic:
  1. Someone will be counted as an A.A. member only if he quits drinking and stays sober.
  2. A.A. obviously works great, because so many of its members are sober.

Then the authors raised the bar a little — six meetings were required to qualify as a member. It was still pretty presumptuous to imagine that a mere six meetings could make someone get and stay sober — that A.A. deserved the credit for someone's sobriety just because of six meetings.

Then the authors admitted that they had 23 other active members who were not staying sober, but that the authors did not include them in the provided numbers. They were cherry-picking again.

And notice the quibbling over "active members" versus "general members":

  • "We now have an ACTIVE MEMBERSHIP of one hundred and thirteen alcoholics"...
  • "This gives us a total general membership of Two Hundred men and women."
But they only wanted to talk about the 113 "active" members while computing the success rate of Alcoholics Anonymous. That's cherry-picking, again.

And it's also mixing apples and oranges:
  • Is the goal to produce active A.A. members who will "Keep Coming Back" to more A.A. meetings,
  • or is the goal to get people to quit drinking themselves to death?
If it's the later, then you have to count all of the alcoholics in computing the success rate.

So what else did the authors say? They stated that out of the 113 members about whom they would speak, 83 had stayed continuously sober. So 30 did not. So we know that they had 53 members (23 + 30) who were not staying sober.

Then they restated the numbers in another way, giving us a bunch of numbers which do not add up to either 83 or 113 or 200:

  • 5 sober 2 to 4 years
  • 27 sober 1 to 2 years
  • 41 sober 6 to 12 months
  • 26 sober 3 to 6 months
  • ---------------
  • 99 total

That leaves 14 out of the 113 "active" members who had less than 3 months sober. And we know that there were also 23 more failing members whom the authors just did not feel like including in the statistics. And we know that the authors simply did not count any of the unmentioned failing people who just never got two months of continuous sobriety in the group — "They weren't members because they didn't have two months of sobriety in A.A."
It seems that they really had 111 out of the 200 "general" members who weren't sober.

So what was the apparent success rate of the Philadelphia group, based on this report?
They had 32 members (5 + 27) who had a year or more of sobriety, out of the 136 (113 + 23) total "fully qualified" members on whom they reported. That yielded a 24 percent success rate.

And the 5 oldtimers with multiple years must be the same 5 people who got sober on their own before A.A. came along. If we ignore them, we get 27 successes out of 131 members, which yields an apparent 21 percent success rate.

Or, if we remember that they actually had 200 "general members", then they had an apparent success rate of only 13.8%. (27 divided by 195. That is, the 27 A.A. successes divided by the 200 general members minus the 5 oldtimers who quit on their own before A.A. was started.)

But we know that even that lower success rate is grossly inflated — that the real A.A. success rate with alcoholics was a lot lower than that because of all of the dropouts and chronic relapsers who were not counted as "members".

If they only had a 75 percent dropout rate after one year (which is much, much better than today's 95 percent dropout rate), then their real success rate would have been a mere five percent. (Or worse, if we take the 13.8% number and divide it by 4. That yields a mere 3.46% success rate.) Again, five percent per year is just the normal rate of spontaneous remission in untreated alcoholics. (And five percent is what Dr. Bob Smith and Bill Wilson calculated their success rate to be in Akron, Ohio.) So the real success rate of Alcoholics Anonymous in Philadelphia, above and beyond the normal rate of spontaneous remission, appears to have been zero, or even less than zero.

Also note how the authors, Hammer and Saul, began that letter by saying,
"The Philadelphia A. A. Group was formed February 27, 1940, with seven men as a nucleus. Six of these are definitely recovered cases."
But we know that five of those six "definitely recovered cases" were the oldtimers with multiple years of sobriety who got sober on their own before A.A. was started in Philadelphia.

So it looks like the A.A. promoters were taking credit for someone else's sobriety, yet again.

On the basis of the fraudulent statistics in the last two letters, one A.A. enthusiast's web site triumphantly declares:

The above letters bear out the statistics of early A.A., that 3 out of 4 alcoholics that attend meetings and apply the Steps of the A.A. Program and the Ideals contained in the BigBook to their lives, recover from the scourge of alcoholism and a seemingly hopeless state of mind and body.

What a load of bull.

An A.A. enthusiast exclaimed, "AA keeps millions sober and saved my life!!!"

Michael ([email protected]) came up with this excellent answer:

I can accept that having some people around you in AA who also had former drinking problems may have been helpful in some way, but YOU saved your life. Now let's review some numbers pertaining to those sober millions.

Alcoholics Anonymous surveys show that about 5% of newcomers stay for their first year. This figure includes those newcomers who remain sober and those who do not. This figure indicates an approximate 95% attrition rate among newcomers in a one year period.

"The membership figures listed below are based on reports to the General Service Office as of January 1, 2001, plus an average allowance for groups that have not reported their membership":

AA Members in U.S. 1,162,112
Total worldwide AA membership 2,160,013

AA was founded in 1935. After 66 years of Alcoholics Anonymous, the most accurate current worldwide membership figure we have is approximately 2.2 million. AA does not provide data on their web page to show how many of these 2.2 million are currently sober or have enjoyed permanent abstinence.

But a 1998 AA membership survey conducted by GSO shows that 47% were sober more than 5 years, 26% were sober between 1 and 5 years, and 27% were sober less than 1 year. So the most accurate figures we have show that 53% of AA membership have been sober less than 5 years. So just how many people is AA keeping sober? Evidently during the period from 1993 to 1998 AA was not keeping many people sober for long. It is safe to assume that the figures from 1998 haven't changed much because AA hasn't changed much. And this turns your "millions" into something closer to 1 million, maybe.

Let's look at something else from the 1998 survey:

Ages of Members
Under age 21 2%
Age 21 through 30 9%
Age 31 through 40 28%
Age 41 through 50 30%
Age 51 through 60 18%
Age 61 through 70 9%
Over 70 4%

The average age of an A.A. member is 45 years. We see a huge drop (12%) in membership from the rage 41-50 to 51-60. And fewer and fewer members in the later ranges. This suggests a large attrition factor for people who have been around AA for a while and left. You can observe this at meetings. Just look around and ask where all the old timers are. Where are all the people with 10, 20, 30 years or more sobriety? There should be a hell of a lot more than you are seeing if AA is keeping them sober.

So, Dave. Let's be careful in our claims about just how many people AA keeps sober. Of those 2.2 million who claim membership, we just don't know how many have actually stayed sober, the numbers suggest less than half. And how many struggle, how many will drink again, how many will leave AA? There is much in the statistics to suggest that AA is not exactly what you want it to be. Though I am not a statistician and there others on this list who I would rather trust to crunch numbers, your statement about AA keeping millions sober is demonstrably untrue and very misleading.

The larger problem with your view of AA's success is that it is shared by so many people. But the numbers don't lie. And when the courts and hospitals and religions and doctors and you and me have this notion that AA is the best game in town, we create a sadly misinformed culture where many people who need help and cannot benefit from AA are sent to AA. And when these people don't fare well, they are forced to take the blame upon themselves.

— Michael

Once again, we see that the A.A. failure rate is at least 95%, because 95% of all newcomers are gone at the end of the first year. Those who remain do not all stay sober, so the real success rate has to be even less. We definitely have an upper ceiling of 5% for the maximum possible success rate. But 5% is the normal rate of spontaneous remission in alcoholics. Five percent of them will quit if we send them all to A.A., and five percent of them will quit if we do nothing. That makes the real effective A.A. cure rate zero. It just does not improve on the rate of spontaneous remission. Alcoholics Anonymous does not increase the rate of sobriety in alcoholics.

An interesting note on that survey: Someone asked, "By what formula did they select the respondents? How did the GSO get their data? For all we know, they might have just grabbed the first couple of hundred people who were handy."

That is a great question. I must confess that the results were so bad that at first glance I accepted the numbers at face value. It didn't occur to me that the survey may have been biased, and that the truth might be even worse than the GSO was reporting.

(F.Y.I.:     GSO = General Service Organization, the headquarters of the non-profit service half of the A.A. organization.
AAWS = Alcoholics Anonymous World Services, Inc., the headquarters of the money-making, book publishing half.)

But that is actually highly likely. The survey is going to be contaminated with Observational Selection, a.k.a. "cherry-picking". Who will fill out a questionnaire? The people who are present at a meeting — the people who keep coming back. Who won't answer the questions? Someone who isn't there. (Like the people who are attending the meeting at the local bar.)

The Alcoholism Report said:

The analysis, distributed by the AA General Service Office (GSO), explained that the 1989 survey was done through a random sampling process that produced a sample of 9,394 completed questionnaires from AA members of the population of groups registered at GSO.
The Alcoholism Report, Feb 1991 v19 n7 p8(2).

That is not a random sampling of members. It is fake random. The original group of answered questionaires was biased — answered only by those members who Keep Coming Back — so any subgroup of questionaires randomly selected from that group will also be biased. Randomly selecting a set of items out of a biased sample just yields another (smaller) biased sample.

So those numbers that show that 47% of the members have more than five years of sobriety, while 53% have less, are highly suspect. The truth may well be that 75% or 85% or 95% of the members have less than five years, and that a lot of the short-timers are just missing meetings (relapsing, out getting drunk) and not filling out questionaires for the surveys.

Then there is the issue of honesty in reporting. Someone who just lost five or more years of sober Time by going on a binge may not be at all eager to report it to the gossips in his home group. (I keep hearing stories of A.A. old-timers who aren't really "old-timers" at all — they secretly drink — but they won't admit it because they don't want to lose all of their old-timer status in A.A..)

And one more complication in that GSO survey of members is the question of just who is a member. We were not told by exactly what criteria people were declared to qualify as "members who should fill out a survey". As mentioned earlier, Charles Bufe pointed out that, in a 1965 article in the Quarterly Journal of Studies on Alcohol, Bill C. considered anyone who had attended 10 or more meetings to be a member.5 But, as Bufe pointed out, that limits the "membership" to those people who show a high degree of motivation to "keep coming back". It conveniently eliminates all of those people who came to a few meetings looking for help, but who were so put off by the fundamentalist religiosity, guilt induction, or superstitious faith-healing atmosphere that they didn't come back. If all of those "revolving door" people were included in the surveys, the success rate of A.A. would be revealed as truly minuscule.

The "millions of members" claim is probably exaggerated for another reason, too: Since everyone is anonymous, and there is no official membership list, there is no way to eliminate duplicates. If someone goes to two or three different meetings around town each week, which a lot of people do, then they will almost certainly get counted as two or three people when the group secretaries at the various meetings count their members. It is possible for someone who is doing 90 meetings in 90 days to get counted as seven different people, one for every day of the week, if that person is going to seven different meetings per week. And then consider that some obsessed people do two or three meetings per day... There are plenty of opportunities for duplication and overlap.

(Theoretically, A.A. members are supposed to have just one "home group", even if they regularly attend several different meetings, and they are only supposed to be counted in, and vote in, that one home group. But lots of people have two or three "home groups.")

And for that matter, just counting everyone at the meetings and calling them all members is a bit presumptuous. The A.A. rules say that someone is a member when he says he is a member, not when the group secretary counts him, but I have been counted as a member often. The group secretary obviously counts the membership, pointing at the people present at the meeting one by one, and silently mouthing the numbers, while someone else "shares" his story. It happens at lots of meetings. But, as you might have guessed, I do not declare myself to be a member of Alcoholics Anonymous. But I'm counted as one in their inflated membership statistics.

And what about all of the people who are just visiting, or just checking it out, or just doing the minimum number of meetings that the judge sentenced them to? What about the people who only show up once a year to collect another coin? It's a bit much to claim that A.A. is keeping all of them sober.

When you consider all of those complicating factors, it is apparent that the real number of unique members that A.A. is "keeping sober" must be just a fraction of the advertised number. It's very hard — basically impossible — to say what the real number is when A.A. is an anonymous organization with no actual membership list.

When A.A. members try to convince me that A.A. really works, they almost invariably point to a large A.A. meeting and say something like, "Just look at all of those sober A.A. members. We have thousands of years of sobriety in this room."

But what those people in that meeting room actually prove is merely that A.A. has managed to get a bunch of people to meet in a room. (We do not even know for sure how long they have been sober, or if they really are continuously sober.)

  • There is no evidence that meeting in a room and telling stories made those people quit drinking.

  • There is no evidence that doing the Twelve Steps caused people to quit drinking.

  • And there isn't even any evidence that all of the sober people have actually done the 12 Steps. Lots of sober A.A. members have never bothered with the 12 Steps. After all, the Big Book says that the 12 Steps are only "suggested".

  • There is no evidence that those people who successfully quit drinking didn't really quit for some other reason that has nothing to do with Alcoholics Anonymous, like that
    • They were sick and tired of being sick and tired, and finally really decided that they didn't want to die that way.
    • They decided that they wanted to be healthy and happy.
    • They finally just decided that they really couldn't and wouldn't drink any more.
    • They wanted to save their marriage.
    • They wanted to keep or regain custody of their children.
    • They wanted to save their job and career.
    • They wanted their self-respect back.
    • They wanted to accomplish something in their lives besides suicide by bottle.
    • They wanted to stop hurting their loves ones.
    • They decided that alcoholism was too expensive, in too many ways.

  • The A.A. boosters merely assume a cause-and-effect relationship between going to A.A. meetings and quitting drinking, when there isn't really any evidence to support such a belief.

It is false logic to say that a few sober people in a room prove that A.A. works. It is just Observational Selection, i.e., "Cherry Picking". What the A.A. promoters never do is look at the A.A. failures. They never get together all of the A.A. failures and dropouts in another, much, much larger, room, and point at them and say, "Look at all of those drunk people. They prove that A.A. does not work very well at all."

No, the A.A. true believers just ignore the failures and continue to incant, at the start of every A.A. meeting,
"RARELY have we seen a person fail, who has thoroughly followed our path..."

(And if you point out the failures, the true believers just weasle out of it with that qualifier, and blame the victims: "Well, they don't count. They didn't thoroughly follow our path... They drank alcohol.")

One person asked, "When AA/NA or a particular rehab center claims an X% 'success rate' what exactly does that mean? I have seen some places boast 85-90%."

There are at least a couple of answers:

  1. Basically, what they do is: Just ignore everybody who fails or drops out or is kicked out of their program early. "They don't count because they didn't complete the program," the counselors say. That conveniently eliminates all of the failures, relapsers, and dropouts from the statistics. That produces numbers that are as biased as can be, of course. It isn't the successful abstainers who drop out of the programs; it's the people for whom the program was no help and are relapsing. The treatment centers are just engaging in some more Enron-style accounting. They create the illusion of great success by hiding all of their failures "off of the books".

    So if 100 people start the program, and at the end there are 10 left who actually graduate, and 8 of them are still clean and sober a month later, then the treatment center claims an 80% success rate.

    The treatment centers also almost never do longer-term follow-ups, like checking to see how many of their clients are still sober and drug-free a year after graduation. If the treatment centers ever did that, they would discover that their real success rate was nothing more than the usual rate of spontaneous remission.

    It seems to me that all of those treatment centers are guilty of criminal fraud and false advertising. Why doesn't someone sue and sic the Fair Trade Commission on them?

  2. Cora Finch ([email protected]) gave this answer:

    It comes down to two things, baseline and outcome. Both can be defined in a variety of ways, or left undefined.

    The "best" numbers come from studies with the highest baseline. Take highly-paid professionals who have had a DIU and get a lot of hangovers. In 1940 they would have been considered ordinary people. But now we can count them as alcoholics and put them in a diversion program with the threat of losing their jobs and — Wow, what a success rate!

We find the same deceptive claims of success in many reports. For instance, the Addiction Letter, May 1994, gives us an article by Scott McMillin, "THE UNFORTUNATE HISTORY OF ADDICTIONS TREATMENT ALSO MAY BE THE UNFORTUNATE FUTURE OF ADDICTIONS TREATMENT". In spite of the title, the author brags about having established an A.A.-based treatment program in the psychiatric unit of a hospital:

When I started as a counselor, almost 25 years ago, every psych unit had its ration of alcoholics and drug addicts. They seemed a little crazy on admission, but within a few days it was clear they were different from the rest of our patients. For one thing, they got better fast. A few days after admission, we were using them to round up the other patients for art therapy.

But the bloom wore off quickly. The issue was recidivism. Alcoholics and addicts were so clearly not mentally ill that the staff couldn't understand why they kept going back to alcohol and drugs.

For alcoholics, the psychiatric unit became a sort of failure machine. Once, in the mid-1970s, I did an informal phone survey of forty alcoholics and addicts treated during the preceding year at the psych unit where I worked. These were mostly employed persons. Of the thirty I managed to locate, twenty-five had returned to alcohol or drugs. Two died. Another was committed to the state asylum. Two found their way to Alcoholics Anonymous and seemed to be doing okay. Which left us with a recovery rate of 7 percent.

I brought this to the attention of several of our psychiatrists. They reacted in a way I've seen a great deal of, over the years: first with excuses, then with medication. "We're just not getting a good class of patients," complained one, as if our hospital wasn't located in one of the nation's richest counties. Then, since they assumed alcoholism was a symptom of some underlying mental illness (anxiety, depression, etc.), they passed out a lot of tranquilizers and antidepressants. An impressive effort, but a year later, repeating the phone survey on twenty-odd additional patients, I found our success rate had reached... 4 percent.

Eventually, the physicians (both medical and psychiatric) complained so much that the hospital decided to appease them by giving those irritating addicts a unit of their own. They hired a recovering alcoholic as head nurse, and she in turn hired a bunch of other recovering people as counselors. Of course, none had ever worked in a treatment center. But they were smart enough to concentrate on two things. First, wherever they could, they harassed the psychiatrists into taking the patients off tranquilizers. Second, they made sure everybody went to AA, and if possible, got a sponsor. By modern standards, this was a bad treatment program. Yet one year later, when I did my survey, 45 percent of our graduates were sober.
Full text available on EBSCO here.

This counselor who implies that he knows so much more than the doctors (25 years of experience) is playing numbers games with us, and he is lying with qualifiers. The first two numbers, the 7% and 4% success rates, described the success rate that the hospital got with all of the alcoholic patients — the good, the bad, and the ugly — but then the author only tells us what percentage of those who graduated from his program were still sober a year later — 45%. (It's just like Bill Wilson's claims of great success with those who really tried.) This author does not tell us what percentage of his clients actually graduated from his program. Why not? Would it reveal a completely ineffective treatment program? How many of his patients didn't "graduate"?

  • Oh, and precisely what were the requirements for "graduation"?
  • How long did someone have to be in the author's program in order to "graduate"?
  • Was complete and uninterrupted sobriety a requirement for "graduation"? That would really be cherry-picking just the success stories.
  • Certainly, a fair amount of sobriety must have been required for "graduation". Nevertheless, more than half of the author's very best pupils relapsed anyway.

If the author's A.A-based treatment program got the same nominal 10% graduation rate that most such A.A.-based treatment centers get, and a year later 45% of the program graduates were still sober, then that would yield an over-all long-term success rate of only 4.5%. But the normal rate of spontaneous remission in untreated alcoholics is 5% per year. It would appear that the author's program didn't improve on nature at all.

Also notice how the author disavows all responsiblity for the hospital's declining success rate. He nagged the doctors until they put the alcoholic patients on tranquilizers, but it was all the stupid doctors' fault, the author implies. The hospital originally had a 7% success rate with alcoholics, but due to this Stepper's determined meddling, the success rate dropped to 4%.

Then he and his fellow Steppers "harrassed" the psychiatrists to get the patients off of medications.
Notice the typical Steppers' prejudice against medications, as well as the arrogant attitude that Steppers know more than real doctors and psychiatrists.

Then the Steppers set up an A.A. program and forced all of the alcoholic patients into it. And what was the result? The hospital originally had a 7% success rate, but due to the Steppers' determined work, the final success rate was what?   4.5%?

What's wrong with this picture?

Besides the obvious facts that...

  • It is illegal to force hospital patients into a cult religion...
  • It is illegal to foist quack medicine and cult religion on patients, and then charge their health insurance for "treatment"...
  • This Stepper was practicing medicine without a license, arrogantly interfering with the work of real doctors... which is also illegal...
  • The author just assumed that old alcoholics who are "recovering" (which is code language for being 12-Step group members), like the head nurse and the other counselors, were more qualified than anybody else when it comes to treating alcoholism. There is no evidence to support that assumption.
  • This Stepper never told us what his program's graduation rate was, so he never revealed what his program's success rate was...
  • The author just tried to foist on us the groundless assumption that A.A. worked great, and was effective in treating alcoholism — an assumption that has never been demonstrated in any fair, valid, clinical test or controlled experiment or medical study. Quite the contrary. The valid medical tests all show that A.A. is a complete failure.

Reports of the inefficacy of treatment programs are everywhere (and so is the denial about the failure rate). This report showed up in a newsgroup on the Internet just recently:

From the newsgroup alt.recovery.from-12-steps, August 8, 2005:

"peacefulstar" said:

When i was in treatment we were told that only one of us would stay sober. I didnt believe it until 3 yrs ago.
We started with 39 people that was in 1985. we kept in contact and this is the way they are today:

     1 — 20 yrs sober
     1 — with 4 yrs after having 15 (my Self)
     7 — 1 yr or little more
     2 — with 5 mon
     1 — with 3 mon
     12 — in jail
     7 — unknown
     8 — died (including my husband)

Its sad when we look at it now but it helps me to remember.
I Thank God every day that I made it back. I also pray for those who are still out there. I go to meetings in jail, if i only reach one I feel blessed.
I am glad they told me what they did when i went in to treatment. I know today without AA and the tools they gave us i wouldnt be here.

That woman claims that her life was saved by "the AA tools", but she could not have given us any better evidence that the program didn't work at all. She talks about AA as if it did something good, but the statistics reveal a completely ineffective program. (And if the tools were so great, why did she relapse after 15 years of using them?)

Out of 39 people, after 20 years, only 2 people have multiple years of sobriety — even just two years. That is a success rate of only five percent, which is once again just the normal rate of spontaneous remission in alcoholics, nothing more.

Actually, it's far worse than the normal rate of spontaneous remission, because a five percent per year remission rate would have produced 2 who have 20 years sober, and 1 with 19, and one with 18, and one with 17, and so on. Almost two-thirds of the still-living alcoholics should have quit drinking after 20 years.
But they haven't.
The reported numbers are nowhere near that. She was actually describing a real disaster.

Perhaps the people going into that treatment program were especially sick people. If not, then the treatment program did something terrible to them.

At one university, a bunch of doctors and professors were puzzling over the fact that all alcohol and drug rehabilitation programs seemed to have about the same rates of success and failure, no matter what the treatment was. All of the programs that they were studying had about a 93% failure rate (by their counting methods), which left about a 7% success rate. Those professors and doctors were trying to find what treatment methods worked best, and what would save the most lives, but with all of the treatment programs getting the same low scores, it didn't seem to matter what the treatment was.

So, for a scientific experiment with a wacky sense of humor, the doctors and professors designed a new treatment program for drugs and alcohol, and put it to the test. The treatment program consisted of getting a bunch of alcoholics and drug addicts together for a weekly meeting, which started with playing patty cake with each other. You know, the children's nursery rhyme where you pat your hands together:

Patty cake, patty cake, baker man,
Bake a cake as fast as you can...

Then the participants spent the rest of the hour talking about whatever they felt like talking about: sports, television, and news, or drugs, sex, and rock and roll, or wine, women, and song, or whatever. There was no counselor to make them talk about the "right" stuff, or to say the "right" things, or to come to the "right" conclusions. Nevertheless, at the end of the year, the patty-cake treatment program had the same success rate as all of the other treatment programs, including Alcoholics Anonymous.

Now, to be fair, all of the treatment programs did score a percentage point or two better than the control group which got no treatment at all, which seems to indicate that just getting the alcoholics and drug addicts together in a room and letting them talk helped a little. The groups provided a sense of community and gave members some moral support, and encouragement to "make it", and succeed in abstaining. And sometimes they may have even shared their stories and given each other some helpful advice, now and then. But the inescapable conclusion was that all of the treatment programs were basically just taking the credit for the spontaneous remissions that were occurring anyway. The treatment programs were just taking the credit for the people's own hard work to save themselves.

People who believe in A.A. will often object to these statistics, and say something like, "I have seen the program help people. I've seen it save lives. It saved my life."

There are always A.A. defenders who will swear that A.A. saved their lives, but all objective, fair tests of A.A. that have been performed show no better success rate than no treatment at all. The only possible mathematical explanation is that A.A. kills one patient for each one that it saves, thus making the success rate balance out at zero.

That is a very strong damnation, but the numbers back it up. That accusation is, in fact, highly believable, given just how bad the "treatment program" really is. Just look at the death rate in Dr. Vaillant's A.A.-based treatment program. After 8 years of giving A.A. treatment to 100 alcoholics, Vaillant's score was 5 success stories, 29 deaths, and 66 people still drinking.

One of the biggest problems with the Twelve-Step program is the learned helplessness caused by the First Step, where people are taught to confess that they are "powerless over alcohol." This leads people to believe that they can't help but relapse, or, that once they have a drink, a full-blown relapse and total loss of self-control is inevitable and unavoidable:

"One drink, One drunk."

Dennis Daley summarized his work with alcoholics by writing:

The author discusses the problem of relapse with alcoholics and other drug abusers from three perspectives: client-related variables, common erroneous beliefs and myths held by professionals regarding relapse, and treatment system problems that may contribute to relapse...
This article integrates clinical experience, relapse literature, and data collected on 150 patients who completed treatment...
3. The person has not "hit bottom" yet. Believing a substance abuser must "hit bottom" is probably the most commonly held myth and is a major factor in failure to intervene with substance abusers.   ...   There is no empirical data to support the necessity to "hit bottom."
5. One substance use episode will lead to "loss of control" over all substance use. Teaching clients to expect one episode of use to lead to total loss of control may set the expectation that initial use cannot be curtailed before a full-blown relapse occurs. Many relapsers report periods of limited, controlled substance use prior to full-blown relapses and many report brief, short-term relapses. Marlatt has identified an "Abstinence Violation Effect," which refers to a person's perception of the initial drink or drug use following a period of abstinence.18 If one experiences the Abstinence Violation Effect as a highly negative, permanent, and painful transgression and evaluates oneself as a "failure," an initial lapse can result in a full-blown relapse. In the course of treating hundreds of relapsed substance abusers, my colleagues and I found that our clients reported that they thought total loss of control was inevitable or that the initial substance use behavior meant that they could not recover.

18. G. Marlatt, Relapse Prevention: A Self-Control Program for the Treatment of Addictive Behaviors, (Seattle: University of Washington, 1980)

Relapse Prevention with Substance Abusers: Clinical Issues and Myths, by Dennis Daley. Social Work, March-April 1987, pages 139-140.

Some A.A. members even believe that relapse is inevitable whenever cravings come along, because "We are powerless over alcohol." So if God doesn't remove your desire for drink, and stop the cravings, then you are doomed. Bill Wilson even wrote that alcoholics were powerless, once the desire to drink alcohol struck, and that "will power and self-knowledge would not help in those strange mental blank spots."

Then we have to consider the issue of suicides in Alcoholics Anonymous. There are no good studies or surveys that reveal what the suicide rate in A.A. really is, but there is quite a lot of anecdotal evidence that A.A. drives some people to suicide. A program that tells people that they are powerless over alcohol and hopeless and defective and sinful and full of moral shortcomings and cannot ever recover is just depressing enough to push some people over the edge into suicide.

And then the crazy, dogmatic, true-believer sponsors telling people with mental problems to stop taking their doctor-prescribed medications has caused a lot of deaths.

Many people will insist that A.A. caused them to quit drinking, that they could not have done it without A.A.. I always have to ask, "Which A.A.?"

A.A. is different things to different people:

  • For some people, it's "group support" where people encourage each other to get and stay sober — it is a circle of friends who hold your hand and give you moral support, and cheer you on, and give you little coins at each milestone of sobriety, like 3 months, 6, 9, a year... That is good stuff, I heartily recommend it. (At least, it isn't likely to hurt.)

  • For some people, A.A. is a meeting where people tell stories about alcoholism and recovery, and share their experiences.

  • For other people, A.A. is a system of pop psychology, transmitted in slogans:
    • Easy does it.
    • Live and Let Live.
    • Resign from the debating society.
    • Just don't take that first drink.
    • Just don't drink, no matter what.
    That isn't too bad, as long as you stay away from the vicious negative slogans, and it can be very helpful to some people.
    That "Just Don't Take That First Drink" rule is so good that if you just follow that one rule, you won't need any others, and you won't need the Twelve Steps or the Wilsonism religion.

  • For some people, A.A. is a collection of helpful home-spun simple wisdom, like "Well, bad as it is, you still don't have to drink over it."

  • For others, it's a non-drinking social club.

  • And for others, A.A. is a package of old superstitions and misinformation about alcoholism.

  • And for other people, A.A. is an intense one-on-one relationship with a sponsor (for better or worse).

  • And for some other people, A.A. is a mind-controlling religious cult with some very strange theology and lots of misinformation. It features intense indoctrination bordering on brainwashing, misinformation and deceit, deep immersion (90 meetings in 90 days), ego-destruction through self-criticism and confession sessions, thought-stopping clichés and slogans, guilt induction, wallowing in guilt, shame and self-contempt, suppression of your feelings ("Stuff Your Feelings"), pretending to get positive results ("Fake It Until You Make It"), and confessions of powerlessness, insanity, sinfulness, selfishness, resentments, and many other things. That can be very harmful. It has even driven people to suicide.

  • And for other people, A.A. is a very evil organization whose primary goal is the sexual exploitation of newcomers, particularly very young women and under-age girls.

So when people say that A.A. helped them, I always want to ask, "Which A.A.?", and "Precisely How?"

Another problem with such testimonials is the cult-like behavior of many A.A. members. Many other cults, like Scientology, the Moonies, and the Hari Krishnas, will, for publicity purposes, show off a chorus line of "poster children" who will all swear that their cult is just the greatest thing in the world and the best thing that ever happened to them, and it just totally changed their lives for the better, and their leader is just the greatest genius in the world with the very best teachings. Why, the leader is so good that he was sent here by God Himself. Or, he is God Himself.

Obviously, you can't believe everything you hear. In fact, such testimonials are totally worthless for really getting to the truth of the matter, no matter how sincere the believers may be in praising their group.

Nevertheless, testimonials can sound very convincing. Imagine that you are talking to an A.A. member, and she says, "A.A. is just the greatest organization in the world. I wouldn't have made it without A.A."

Well, that sounds good. You have to ask some more questions to get at the truth:

You: How much sober time do you have now?
Her: A year.
You: Congratulations. Is this the first time you've quit?
Her: No, I quit several times before, but always relapsed.
You: Did you go to A.A. all of those other times you quit, too?
Her: Yes.
You: So what was different the last time you quit?
Her: Well, I just got sick and tired of failing, and waking up sick and hung-over. I decided that I'd just had it with failing and being sick, and didn't want to do it any more.
You: So let's see, A.A. failed before, several times, but worked the last time.
Her: Oh, no, it wasn't A.A. that was failing, it was me. I didn't do it right before. I kept screwing up...

This person's insistence that the program always worked is actually also good evidence that the program always failed. She didn't stay sober until she quit "screwing up" and got her act together and kept herself sober. She kept herself sober. A.A. seems to have been irrelevant.

Often, people do not successfully quit drinking until they convince themselves that they really can't drink any more, not any at all — that they can't even just have a few now and then, without their drinking quickly spinning out of control. Once they learn that, they quit and stay quit. Until they learn that, they relapse. The Twelve Steps are irrelevant.

It's amazing how many of the true believers manage to reverse the cause-and-effect relationship between doing the Twelve Steps and quitting drinking, without seeing what they are doing.

The usual sequence of events for a lot of people is like this:

  • People drink until they crash and burn. They often end up sick and in the detoxification ward of a hospital or clinic.
  • People quit drinking there.
  • People are then introduced to Alcoholics Anonymous or Narcotics Anonymous, and required to go to a bunch of meetings as part of their "treatment program".
  • After a while, people do the Twelve Steps. Sometimes it takes months or a year for them to do all twelve.
  • People then claim that Alcoholics Anonymous and the Twelve Steps caused them to quit drinking.

Those people seem to be unable to see that they quit drinking first, and that caused them to go to meetings and do the Twelve Steps. They have reversed the cause-and-effect relationship in their minds. Well, their blindness is helped a lot by the true-believer cult members who surround them, telling them that the Twelve Steps are causing them to stay clean and sober.

Those believers are assuming a lot. Even if there were some apparent success, what proves that any observed success was caused by the Twelve Steps? How do you know it wasn't caused by the coffee and cigarettes at the meetings? Or the hard chairs? Or the social group? Or the horror stories?

It is ridiculous to suggest that the hard chairs may have had some effect in making people quit drinking, but it is no more ridiculous than suggesting that the Twelve Steps did it, when the Twelve Steps are a program for creating a cult religion, not a formula for quitting drinking.

When I was a child, I was never able to ride a bicycle. I just couldn't do it. I fell down every time I tried. I was powerless over bicycles.

Then one day, Jimmy loaned me his lucky rabbit's foot, and I succeeded. I didn't fall down.

That proves it: the rabbit's foot helped me to stay up on the bicycle. And now I can ride bicycles because I have a lucky rabbit's foot.

Walt Disney did the same routine with Dumbo and the Magic Flying Feather. Dumbo just could not fly until he got that magic feather; and then he could. The "magic feather" that the crow gave to Dumbo "made" Dumbo able to fly. Dumbo just "knew" that the feather was the cause of his success.

When people tell me that the Twelve Steps "made" them quit drinking, or "helped" them to quit, I always think about Dumbo's Magic Flying Feather.

Many A.A. members are convinced that their sobriety was caused by the 12 steps, or by going to meetings, or by some other part of the A.A. program, rather than by the fact that they are sober because they are not swallowing alcoholic drinks any more, and that was their own choice and their own accomplishment. They ignore obvious factors like that they quit drinking because they got tired of the down side, the horrible negative consequences of drinking. They got sick and tired of being sick and tired. They decided that they wanted to live. (And they also chose to start going to A.A. meetings for the same reasons.) They did all of the hard work and A.A. took all of the credit.

And when people insist that they will die if they don't Keep Coming Back for more meetings, I think about the time when Dumbo lost that magic flying feather and went into a panic and started falling. It was everything that the crow could do to get Dumbo to fly anyway, without the "magic" feather...

A question: "Where is the benefit to society?"

A.A. and its sister organization, N.A. (Narcotics Anonymous) have grown exponentially over the last 70 years, and they now claim to have a million or two members. And at least twenty times that many people have gone through the program, either voluntarily or by coerced attendance. Basically, almost everyone who qualifies as an alcoholic or drug addict has been to at least a few A.A. or N.A. meetings. If we were to believe those organizations' claimed success rates ("rarely fails" or "never fails"), they should have solved all of our drug and alcohol problems by now. Instead, the problems are far worse.

Back in the 1940s, Bill Wilson and Marty Mann went and testified before Congress, and declared that there might be 100,000 alcoholics in the USA, and that Bill and A.A. held the answer to that problem. Now A.A. says that there are many millions of alcoholics.

I can see the robot in the movie Lost in Space saying, "Danger, Will Robinson, Danger! Does not compute!"

For another detailed look at the effectiveness of Twelve-Step treatment, read the chapter on it in Charles Bufe's book, Alcoholics Anonymous, Cult or Cure? He also comes to the conclusion that the A.A. success rate is microscopic.

The enthusiastic supporters of twelve-step programs do not want to consider the idea that Twelve-Step treatment can be really harmful to people. But I seem, in my subjective opinion, to be seeing that.

One of the really disturbing things that I see is relative beginners, people with 6 months or less of clean and sober living, lecturing the newcomers about how alcoholism (or drug addiction) is a spiritual disease that requires a spiritual cure, and how the twelve-step programs are that kind of a spiritual cure. As if they could really know, from their few months of sobriety. But hey! Isn't 6 months of clean and sober living and going to meetings enough to make anybody a competent drug and alcohol rehabilitation counselor? Don't you know everything by then? Aren't you ready to start indoctrinating the newcomers, "the babies" and "the pigeons"?

And then there are those resident true believers, like the guy with 3 years of Time, who announces that the program gave him a new life — heck, going to meetings and being the resident old-timer IS his new life — and he declares that the answer to all beginners' problems — the answer to everything — is
"Do the Twelve Steps, Get a Sponsor, and Read the Big Book."
And that is all of the advice and help that you are going to get out of him. He's actually that simple-minded. And it's really a drag to see the beginners relapse and disappear when that program doesn't work for them.

I also see people expecting the Steps to really work, to take away their cravings. And they don't understand why it won't work for them, why they relapse. They cry that they don't seem to be able to completely give themselves to the program. They think they have something unusual wrong with them, because the Steps seem to be working for everybody else. (The other people are doing the "Fake It Until You Make It" and "Act As If" routines. It's just another reenactment of the "Emperor's New Clothes" story.)

One problematic element of the A.A. and N.A. dogma is the idea that relapse is a normal part of the recovery process. Somehow, it is taught so much that people relapse and then talk about their relapses with a disturbing detachment, almost as if it happened to someone else, and as if it were to be expected anyway. "Some cravings just suddenly came along, and a relapse just happened." (God didn't take away their cravings, and "the drink problem," or "the drug problem" didn't just magically disappear.)

Then they shrug and sadly say, "I hear that relapse is just a normal part of recovery." Or, "Oh well, I guess I'll quit when I'm ready..."

Unfortunately, some of the people in recovery here have not survived their relapses. When the drug of choice was heroin, some of the people here did not survive one night of relapse. Others were dead in two weeks. In their cases, relapse was definitely not part of the recovery process; it was part of the death process.

The stupid ideas that you are powerless over alcohol or drugs, that God will make the drink or drug problem just suddenly disappear, and that Bill Wilson's "spiritual principles" will solve all of your problems should be discarded. But that is what William Wilson wrote (about alcohol) in the Big Book (pages 59, 75 and 42, respectively,) so it must be true, and A.A. cannot discard that dogma. Bill Wilson's program is perfect, they maintain. (Some true believers even claim that Bill wrote the Big Book while being Guided by God, so everything that he wrote is the undeniable Word of God, and always correct.) They will not add or take away one single word from the sacred first 164 pages of the Big Book.

I cannot help but wonder, what if those people who died had been taught some real survival techniques, instead of wasting their time with twelve-step busy-work like admitting powerlessness, self-criticism, and confessions...

  • What if we had used all of those hours spent at meetings to instead teach them to recognize the addictive voice as it tempted them to relapse, and to fight it (AVRT)?

  • Or to recognize and resist cravings?

  • Or to use Rational Emotive Behavior Therapy (REBT) to rationally think their way through the acts that they were about to commit?

How about a little more science and modern medicine, and a whole lot less cult religion and quack medicine?

This is unfortunately typical of the Big Book's lessons on how to not die from drinking:

      ...we think we can render an even greater service to alcoholic sufferers and perhaps to the medical fraternity. So we shall describe some of the mental states that precede a relapse into drinking, for obviously this is the crux of the problem.   ...
      "Suddenly the thought crossed my mind that if I were to put an ounce of whiskey in my milk it couldn't hurt me on a full stomach. ...
The experiment went so well that I ordered another whiskey and poured it into more milk. That didn't seem to bother me so I tried another."   ...
      ...all reasons for not drinking were easily pushed aside in favor of the foolish idea that he could take whiskey if only he mixed it with milk!   ...
      Whatever the precise definition of the word may be, we call this plain insanity. How can such a lack of proportion, of the ability to think straight, be called anything else?
The Big Book, 3rd and 4th Editions, William G. Wilson, Chapter 3, More About Alcoholism, pages 36-37.

And a second drunkalogue:

      As I crossed the threshold of the dining room, the thought came to mind that it would be nice to have a couple of cocktails with dinner. That was all. Nothing more.
The Big Book, 3rd and 4th Editions, William G. Wilson, Chapter 3, More About Alcoholism, page 41.

That's it. That's all of the psychoanalysis of relapse that we get from the Big Book. Two lousy little stories that teach us almost nothing.
So much for describing "some of the mental states that precede a relapse into drinking."
So much for rendering "an even greater service to alcoholic sufferers and perhaps to the medical fraternity."
So much for preparing us to handle difficult situations.
How are those stories supposed to help us maintain sobriety?

Well they aren't. Bill Wilson gave us those stories as evidence to support his Buchmanite religious belief that we are powerless over alcohol.

More brain-damaged wisdom:

Job or no job — wife or no wife — we simply do not stop drinking so long as we place dependence upon other people ahead of dependence on God.
Big Book, 3rd Edition, William G. Wilson, Chapter 7, Working With Others, page 98.

Sorry, Bill, but you forgot "Depend On Yourself!"

Bill Wilson always teaches people NOT to depend on themselves, not to take care of themselves, not to heal themselves. Mr. Wilson's answer is always "His defense must come from a Higher Power." (The "locus of control" is always outside of oneself.)

He made a beginning, we have seen, when he commenced to rely upon A.A. for the solution to his alcohol problem. By now, though... he has become convinced that he has more problems than alcohol... His lone courage and unaided will cannot do it. Surely he must now depend upon Somebody or Something else.
Twelve Steps and Twelve Traditions, page 39.

We had approached A.A. expecting to be taught self-confidence. Then we had been told that so far as alcohol is concerned, it was a total liability. Our sponsors declared that we were the victims of a mental obsession so subtly powerful that no amount of human willpower could break it.
Twelve Steps and Twelve Traditions, William G. Wilson, page 22.

Remember that we deal with alcohol — cunning, baffling, powerful! Without help it is too much for us. But there is One who has all power — that One is God. May you find Him now!
The Big Book, 3rd Edition, William G. Wilson, pages 58-59.

Then it gets worse. The milk-and-whiskey drinker continued:

As soon as I regained my ability to think, I went carefully over that evening in Washington.   ...   I now remembered what my alcoholic friends had told me, how they had prophesied that if I had an alcoholic mind, the time and place would come — I would drink again. They had said that though I did raise a defense, it would one day give way before some trivial reason for having a drink. Well, just that did happen and more, for what I had learned of alcoholism did not occur to me at all. I knew from that moment that I had an alcoholic mind. I saw that will power and self-knowledge would not help in those strange mental blank spots. I had never been able to understand people who said that a problem had them hopelessly defeated. I knew then. It was a crushing blow.
The Big Book, 3rd and 4th Editions, William G. Wilson, Chapter 3, More About Alcoholism, pages 41-42.

What pathetic, self-defeating drivel. And it's all untrue.

Wilson wrote that "will power and self-knowledge would not help". That is totally untrue and completely backwards. Will power and self-knowledge are two of the best tools that you can have in your toolbox for staying sober.

Bill Wilson wrote that those alcoholic friends (meaning himself and Doctor Bob) prophesied things, like Biblical prophets of old. They didn't just predict things, like ordinary seers and telephone psychics. A funny choice of words, yes?

Those friends "prophesied" that alcoholics would suffer from "strange mental blank spots", where the alcoholism would seize control of their minds and "will power and self-knowledge would not help," and they would be drunk before they even realized what was happening. That is a great excuse for relapsing whenever someone craves a drink, but it is totally untrue. It is ridiculous pseudo-science.


People may

but there is no blank spot where the alcoholic is unable to see that he is deliberately lifting a drink to his mouth, choosing to drink, and that he is voluntarily swallowing it. There is no blank spot where he doesn't have a choice, and can't control his hands or his mouth.

But Bill Wilson insisted that there was, and that he just couldn't help but take a drink whenever he got some cravings.

Bill Wilson taught that he was "powerless" over every urge or craving he ever had, no matter whether it was a thirst for alcohol, cravings for cigarettes, greed for money, or the urge to cheat on his wife Lois by having sex with all of the pretty young women who came to the A.A. meetings looking for help for a drinking problem.

Bill Wilson just didn't want to be bothered with the hard work of resisting temptation. Like so many other phony gurus, he lived a life of hypocritical irresolute self-indulgence, preaching "spirituality" and self-sacrifice to others while indulging in all of the pleasures of the flesh himself — with the sole exception that he does appear to have finally quit drinking alcohol after it nearly killed him.
(Although some people even dispute that. Some claim that Bill Wilson never got more than a year of sobriety. And Bill Wilson died screaming for whiskey.)

In addition, Bill was just echoing the religious doctrine of Frank Buchman, who preached that everyone in the world had been defeated by sin, and was powerless over it, and could only be saved by surrendering his will and life to God and coming under "God-control" (which really meant, under "Frank-control"). Bill Wilson just substituted the word "alcohol" for "sin". Bill wanted all of the alcoholics to believe that they were powerless over alcohol — completely defeated by alcohol — so that they would despair and surrender their wills and their lives to Bill's group.

Bill continued:

Once more: The alcoholic at certain times has no effective mental defense against the first drink. Except in a few rare cases, neither he nor any other human being can provide such a defense. His defense must come from a Higher Power.
The Big Book, 3rd Edition, William G. Wilson, Chapter 3, More About Alcoholism, page 43.

No effective mental defense? You have to just hope that some Spirit or Holy Ghost or Higher Power will keep you from drinking?

And this is the program whose members claim is the best alcoholism recovery program in the world?

Bill Wilson was sure of it:

We think this account of our experiences will help everyone to better understand the alcoholic. Many do not comprehend that the alcoholic is a very sick person. And besides, we are sure that our way of living has its advantages for all.
The Big Book, William G. Wilson, the Foreword to the First Edition, page xiii of the 3rd edition.

Aha! There it is: And besides, the real goal of our program is to get everyone in the world living according to the Buchman-and-Bill religion, "our way of living."

At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God and the people about us.
The Big Book, 3rd and 4th Editions, page 77.

We have developed a new alcohol treatment program: the Cheech'n'Chong Treatment Program. It works like this: whenever you get cravings for alcohol, you put on a ballerina's tutu and slippers, and Mickey Mouse ears, just like Cheech and Chong in the movie "Up in Smoke." Then you jump up and down on one foot, while juggling five tennis balls, and reciting Shakespeare sonnets. Continue this procedure for as long as the cravings last.

This simple program has rarely been known to fail, except for a few unfortunates who are constitutionally incapable of being honest with themselves while wearing a tutu.

It works, if you work it.

And so does my magical ice cream cure that I just invented: Every time you get cravings for alcohol, you just go to Baskin Robbins and eat ice cream instead of drinking alcohol.

I particularly recommend the French Vanilla. Definitely avoid the Rum Raisin.

This simple program does not and can not ever fail, if you completely give yourself to this simple program. RARELY HAVE we seen somebody fail this simple program, except for a few people who are constitutionally incapable of being honest with their ice cream. There are such unfortunates among us. They seem to have been born that way.

So Keep Coming Back! to Baskin Robbins. It Works If You Work It! You Die If You Don't! So Work It, You're Worth It!

"It's a wonderful organization because it has helped so many people..."

Whenever I talk about the effectiveness of the Twelve-Step program, or of the propriety of coercively sending people to A.A., it seems like someone always answers with something like, "Well, it's okay for some people. It has really helped some people."

  • That is like saying that Scientology is okay for some people — that it is really a good organization because it got a few poster children off of drugs. It doesn't matter if it is a sleazy, lying, thieving con — it's okay for some people. Those poor, pathetic "pre-clears" just didn't know what to do with their lives until Scientology came along and told them to work day and night to get money to give to Scientology.

  • That is like saying that The Seed, or Straight, Inc., or any of the newer children's gulags which have been killing children lately, are really okay for some people — they are really good drug and alcohol rehabilitation programs because they got some kids off of drugs or alcohol for a while.

  • That is like saying that Reverend Jim Jones' People's Temple was okay for some people; that it was a good drug and alcohol rehab program because it really helped some people.

A little-publicized fact is that the People's Temple actually did get a bunch of people off of drugs and alcohol, for a while. It really did have a successful drug and alcohol rehab program going, for a while. In fact, Jim Jones ran such a popular and successful rehab program that he was named one of "The 100 Outstanding Clergymen in America" by the Foundation for Religion in American Life in 1975, and, in 1976, he was named "Humanitarian of the Year" by the Los Angeles Herald-Examiner. At the same time, San Francisco Mayor George Moscone appointed Jim Jones Chairman of the San Francisco Housing Authority. For a long while, the people in power in San Francisco thought that Reverend Jim Jones was just the greatest religious leader, a real crusader for "clean and sober living."

Jim Jones with Mayor Moscone

Jim Jones with Councilman Lindsay

Jim Jones with Bob Wallach, head of the SF Bar Association.
The People's Temple kept a small army of San Francisco attorneys busy as they successfully fought parents for custody of their own children and engaged in a wide variety of fraudulent activities. The legal fees were money well spent as local courts found in Jones' favor in every case.

In the end, 267 children died at Jonestown, including the son of Timothy Stoen, a former member and former Temple lawyer, who couldn't even get his own son back from Jim Jones.2

Mutual admiration society: Preacher-entrepreneur Cecil Williams, Police Chief Charles Gain, and Jim Jones
While building his "church" in San Francisco, Jones was engaged in extensive financial fraud and the torture and sexual abuse of children. Local politicians like Williams and Gain "saw no evil."

Mayor George Moscone and Jim Jones meet Walter Mondale at SFO
Willie Brown attributed Moscone's electoral victory to Jones.

Jones delivered votes for Jerry Brown's campaign for governor.
As governor, Brown ordered the Temple's records removed from San Francisco to Sacramento just weeks after the Jonestown mass murder.

Many people felt that they owed their lives to Jim Jones, because he had saved them from death by drugs and alcohol. Unfortunately, in the end, Rev. Jones collected on that debt by demanding that all of his followers commit suicide for him. And they were so brainwashed and indoctrinated and crazy that 914 of them actually did it. (Actually, not all of them did it voluntarily; those who refused were forcibly injected with cyanide or shot by the goon squad of true believers, "The Angels".)

Jonestown AP photo


And Jim Jones was such a monster that...

Mama died [of cancer] in Jonestown ten days before the massacre, with Larry never leaving her bedside. She died without pain medication because Jim [Jones] had consumed it himself. For two months Larry watched our mother drift away from life without any relief from her agony until she finally succumbed to her lung cancer.
Seductive Poison, Deborah Layton, 1998, page 297.

You mean Jim Jones took a dying woman's pain-killers so he could get high on them himself? In a word, yes. Now that is cold, really cold. (But so is making 914 people, including their children and babies, commit suicide for you.)

Jim Jones passed the People's Temple off as the most successful drug and alcohol rehabilitation program in California for a while, but in the end, Jim Jones was whacked out on stolen drugs all of the time.3 His autopsy revealed that he had so much pentobarbital in his system that he would have died of an overdose if he had not built up such a huge tolerance to the stuff.4

That's quite some Humanitarian of the Year.
That's quite some Holy Man.
That's quite some Director of a drug and alcohol rehabilitation program.

Obviously, some of the pundits didn't check the facts very closely before handing out the accolades. With drug and alcohol rehab programs, it seems like they rarely do. They seem to believe that if you are working with alcoholics and drug addicts, then you must be a saint, because nobody else wants that stinking job.

But hey, I guess we can cheerfully, mindlessly yammer the platitudes about how it was really a great organization because it really helped some people to get off of drugs and alcohol...

"I made you sane,
and ... I ... can ... make ... you ... insane."

— Chuck Dederich

Synanon was another one of those wonderful organizations that was "really good for some people", because it got them off of drugs and alcohol.

It started off as a utopian commune dedicated to saving the lives of drug addicts and alcoholics. The name "Synanon" was derived from the Alcoholics Anonymous name "Al-Anon" (Synanon = 'Sinners Anonymous'). Charles "Chuck" Dederich was a former member of Alcoholics Anonymous who claimed to have taken the best parts of A.A. and adapted them for use by drug addicts. In the beginning, Synanon really was a remarkable organization that got hundreds of people off of drugs and alcohol.

Dederich developed what he called "the Synanon Game", a confrontational style of group therapy where group members attack each other, ostensibly to expose all of their faults, "for their own good", of course.

To this day, Synanon and its methods are still used as a model for most of the "tough love" residential drug and alcohol rehabilitation facilities. The Seed, Straight, Inc., Delancy Street, Daytop, Phoenix House, and literally dozens more all claimed or claim to have taken the best features of Synanon for the design for their own programs.

"Tough Love: Abuse of a type particularly gratifying to the abuser, in that it combines the pleasures of sadism with those of self-righteousness. Commonly employed and widely admired in 12-step groups and treatment."
— Charles Bufe

Unfortunately, the cult leader Chuck Dederich went crazy, really crazy, and took over control of all of the members' sex lives and marriages, and all of the men except the leader Chuck Dederich had to get vasectomies and the pregnant women had to get abortions, so that they wouldn't have any bothersome children around the place. Then everyone in Synanon had to get divorced, and marry someone else in Synanon. Then, The Game was used to persuade men to exchange even their new wives in evening auctions called Changing Partners.

Charles "Chuck" Dederich
"Don't mess with us — you can get killed dead, physically dead."
"Yes, I do want an ear in a glass of alcohol, I really do."
"Nonviolence was just a position we took. We change positions all of the time."
(Photo by Charlie Downs)
Children were separated from their parents, and sometimes wouldn't see their parents for months on end, while they were beaten and abused, and those who tried to run away were beaten even more. And the courts would even return run-away children to Synanon, because their parents were there, even though the children hadn't seen their parents in months, and the parents presumably did not know how much their children were being beaten and abused...

For internal security, the Synanon "Church" had an armed militia — a goon squad — called The Imperial Marines. In the mid 1970s, the "church" of Synanon purchased a total of 152 pistols, rifles, and shotguns and more than 660,000 rounds of ammunition, reportedly including armor piercing projectiles.

The goon squad thugs brutally attacked and beat up Synanon members, splittees, critics, and even the occasional accidental trespasser, like people who had parked in their parking lot, or whose vehicle had skidded off of the road and onto Synanon property. The goon squad tracked down and ambushed one splittee, Phil Ritter, by attacking him from behind in the dark of night and smashing his skull with baseball bats. Ritter's skull was broken, brain fluid leaked into his spinal column, and he developed spinal meningitis, which put Ritter in a coma. Somehow he recovered.

After Synanon's former president, Jack Hurst, left Synanon, he says he received so many death threats that he bought an attack dog. One night, he came home to find his door open, all of his lights on, and his dog dead, hanging by a rope from a tree in his front yard.

Then the goon squad tried to kill Paul Morantz, a lawyer who was suing them, by putting a huge old rattlesnake in his mailbox, minus the rattle, so that there would be no warning buzz before the snake struck. The rattlesnake bit Morantz, and he nearly died. It took eleven vials of anti-toxin to save his life, and he suffered permanent damage to his arm.

Then, it was alleged on July 11, 1983, in U.S. District Court, by three former Synanon Foundation members, including Rodney Mullen, that Synanon officials had attempted to hire a professional hit man with "orders to have attorney Paul Morantz assassinated."

Charles Dederich was extremely drunk when the police finally came and arrested him — so drunk that he had to be carried out on a stretcher. He couldn't even walk. One witness reported that, at the end, Charles Dederich was drinking up to 2 quarts of Chivas Regal per day.13

Dederich pleaded no contest to charges of conspiracy to commit murder, and part of his sentence was to no longer run or have any contact with Synanon, at which point Synanon basically collapsed and disbanded. When the I.R.S. withdrew Synanon's charitable tax-exempt status, Synanon declared bankruptcy, and auctioned off the land to pay the taxes due. And that was the end of that.

One more thing: before we leave Synanon behind, it is worth asking,
"What was the success rate of Synanon? Really, just how effective was Chuck Dederich's 'confrontational attack therapy' program?"

That question is important because there are so many "tough love" rehab programs for children and adults, like Delancy Street, Daytop, Phoenix House, "The Seed", and Melvin and Betty Sembler's "Straight, Inc." and "Drug-Free America" rackets, that are based on Charles Dederich's Synanon methods. Well, the experts say:

In 1964 a New Jersey Drug Study Commission opted not to give Synanon any funding after reviewing rehabilitation statistics supplied by Synanon Foundation. Out of 1,180 addicts who had entered Synanon in its first five years of operation, only 26 had graduated! World renowned Berkeley sociologist and "thought reform" expert Dr. Richard Ofshe used Synanon's own data to compute a cure rate for heroin addicts at Synanon of only 10%. This is the only available scientific study ever done on the effectiveness of Synanon.9,10

9. Mitchell, Dave, Mitchell, Cathy, Ofshe, Richard, The Light on Synanon, pp.143 — 145.
Gerstel, David, Synanon, Paradise, Inc., p. 37.
10. Dr. Richard Ofshe and noted Berkeley psychologist and "cult expert" Dr. Margaret Thayer Singer were called in as expert witnesses in Ohio state's successful court action to close down Straight-Cincinnati.

— from the web page

Also note that the trio Cathy Mitchell, Dave Mitchell, and Dr. Richard Ofshe won the Pulitzer Prize for their journalistic work in exposing the evils of Synanon. See The Light on Synanon; it's good reading.

In addition, note that the only people whom Synanon kept off of drugs and alcohol were the people who stayed at Synanon (and then not all of them). Just like all of the other cults, you couldn't ever leave Synanon, and return to normal life, or else...

But hey, I guess we can cheerfully, mindlessly yammer the platitudes about how it was really a great organization because it really helped some people to get off of drugs and alcohol...

Or can we? If organizations like The People's Temple, Synanon, The Seed, or Straight, Inc. were really good organizations just because they got a few people off of drugs and alcohol, then we have horrendously low standards for just what constitutes "good".

Before we call Alcoholics Anonymous a "good" organization, because it is "good for some people", shouldn't we count both the harm done to the many, as well as the benefits for a few?

  • Shouldn't we count the harm done to people who were promised some kind of medical treatment for alcoholism but who were given cult religion and voodoo medicine instead?
  • Shouldn't we count the years of mental anguish and torment caused by bad counselling?
  • Shouldn't we count the suicides caused by bad counselling and guilt induction?
  • Shouldn't we count the "thirteenth stepping" — the sexual exploitation and the rapes — of the newcomers by the sponsors?
  • Shouldn't we count the lives and the years wasted while people "Expect A Miracle" and wait for some delusional faith-healing steps to really work?
  • Shouldn't we count the suicides, deaths, and other harm caused by sponsors telling their sponsees to quit taking the pills that the doctor gave them, and just trust the Twelve Steps to heal them?
  • Shouldn't we count the harm done to the people who get turned into angry, frustrated religious fanatics or hateful true believers?
  • Shouldn't we count the harm done to people who are badly misinformed and miseducated about alcoholism because all they ever got was the grossly unrealistic Alcoholics Anonymous religious dogma, and the grandiose delusions of Bill Wilson, instead of the true facts about alcoholism?
  • Shouldn't we count the harm done to the people who get turned into irrational slogan-slinging dogma-yammering true-believer cult members?
  • Shouldn't we count the harm done to the people who just give up on recovery because they have been fooled into thinking that Alcoholics Anonymous is all there is, and they clearly see that Alcoholics Anonymous is just an insane faith-healing religious cult, and they want no part of it?
  • Shouldn't we count the dropout rate and the relapse rate and the suicide rate and the death rate from continued drinking?
  • Shouldn't we count the divorce rate and the marriages wrecked and ruined by the A.A. practices of 13th-Stepping and encouraging members to dump their spouses and only associate with other A.A. members?

Go read Rebecca Fransway's book, AA Horror Stories, for a good look at some people who were harmed by A.A. and Twelve-Step "therapy."

Also see the list of horror stories that I have received at this web site.

Then go visit some more web sites.

And don't miss these exposés of the "tough-love" children's rehabilitation programs:
Children's Gulags

So how do monsters and madmen like Jim Jones and Chuck Dederich get away with it? How did Bill Wilson get away with it? How does Alcoholics Anonymous get away with selling cult religion and voodoo medicine for 70 years? The answer is, "Very easily." Far too many people just consider the drug and alcohol rehabilitation field to be a dirty business, and they don't want to look at it, or have any dealings with it.
"If someone says that they are taking care of the problem, then fine, let them have it. They are welcome to it."
And while they are doing it,
"There is no sense in looking too closely, or in giving them a hard time about how they are doing their jobs. What are we going to do, fire them? Nobody else wants the job."
It should then come as no surprise to find that there have been many scoundrels caught with their hands in the proverbial cookie jar, taking public tax money, ostensibly to rehabilitate addicts and alcoholics, while really pursuing some other agenda or having some ulterior motive, like theft, sexual exploitation, ego aggrandizement, or promoting cult religion, or any combination thereof.

What's that old saying, "Power Corrupts, and Absolute Power Corrupts Absolutely"? Therapists and sponsors have a lot of power over the newly-detoxed patients. And those newcomers are often sick, physically and mentally wrecked, confused, and cloudy-headed, so it's an easy set-up. Abuse of the system is to be expected, as long as mere mortals run the system.

And when some leader starts to claim that he is a prophet of God, or has a wonderful new system of sobriety from God, then don't expect the abuse to decrease.

As long as you believe in the A.A. Step Seven, that God must remove all of your defects of character and shortcomings, you are in great danger of relapse. What if you find that God hasn't bothered to fix you? Then you are dead meat. You are helpless, because you already confessed in Step One that you are powerless over your problem. And in Step Two, you confessed that you are insane, and in Step Three you turned your will over to God. You have left yourself no escape route, no way to save yourself. And sure enough, sooner or later, you will find that you are still just you, and you have the same cravings and temptations as before, and you still want to feel good, just like before.

The only way I can see to save myself is to assume that I will have to do all of the heavy lifting myself. Pardon me if I offend someone's religious beliefs, but I don't believe that God will take away all of my problems, and neither will Santa Claus, the Easter Bunny, or the Tooth Fairy. And Cinderella's Fairy Godmother has been AWOL lately, too. And I can't find Aladdin's lamp. So forget about Steps 1, 2, and 3, and forget about Step 7. Forget about all twelve of them, in fact.

Make up some new steps, like:

  • 1. I admit that drinking and smoking has gotten to be a real drag, and I am suffering so much that it isn't any fun any more.

  • 2. I quit, and I'm staying quit forever.

  • 3. Some of my friends may help me occasionally, but I'm mainly going to count on myself.

  • 4. Whenever I am tempted to relapse, I will think about step one again, and remember why I quit in the first place. I will also remember what happened the last time I relapsed.

I think that might do it for starters. Maybe we will make up some more steps later, but those four will certainly be a good start. They work for me.

I have my own 12-step program, and the first 11 steps don't mean (CENSORED BY NETWORK) and the 12th is "don't do it."

James Frey, Author of A Million Little Pieces, speaking on the ABC News 20/20 TV program, "Help Me, I Can't Help Myself", April 21, 2003.

Also see:


(Click on the number of the footnote to return to the citation.)

1) "A Controlled Experiment on the Use of Court Probation for Drunk Arrests"     Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D., American Journal of Psychiatry, 124:2, August 1967, pp. 160-163.

2) The Children of Jonestown, Kenneth Wooden, pages 6 and 191.

3) Hearing the Voices of Jonestown, Mary McCormick Maaga, pages 91 to 96.

4) Hearing the Voices of Jonestown, Mary McCormick Maaga, page 91.

5) Alcoholics Anonymous, Cult or Cure?, Charles Bufe, chapter 7.

6) R. G. Smart calculated that the spontaneous remission rate for alcoholism was between 3.7 and 7.4 percent per year.
For studies of spontaneous remission in alcoholics, see: (From Bufe)

  • Spontaneous Recovery in Alcoholics: A Review and Analysis of the Available Research, by R. G. Smart
    Drug and Alcohol Dependence, Vol. 1, 1975-1976, p. 284.
  • Recovery Without Treatment, by Thomas Prugh
    Alcohol Health and Research World, Fall 1986, pp. 24, 71 and 72.
  • Alcoholism as a Self-Limiting Disease, by Leslie R. H. Drew
    Quarterly Journal of Studies on Alcohol, Vol. 29, 1968, pp. 956-967.
  • Spontaneous Remission in Alcoholics: Empirical Observations and Theoretical Implications, by Barry S. Tuchfeld
    Journal of Studies on Alcohol, Vol. 42, No. 7, 1981, pp. 626-641.

7) See the Manson story and the interview with Leslie Van Houten in Snapping: America's Epidemic of Sudden Personality Change by Flo Conway and Jim Siegelman, pages 193-206.

8) See Alcoholics Anonymous, Cult or Cure? by Charles Bufe, chapter 7, "How Effective Is AA?":

AA's own statistics provide perhaps the most persuasive evidence that AA's success rate is minuscule. Since 1977, AA has conducted an extensive survey of its members every three years (though the survey scheduled for 1995 was conducted in 1996). These surveys measure such things as length of membership, age distribution, male-female ratio, employment categories, and length of sobriety. Following the 1989 survey, AA produced a large monograph, "Comments on A.A.'s Triennial Surveys,"11 that analyzed the results of all five surveys done to that point. In terms of new-member dropout rate, all five surveys were in close agreement. According to the "Comments" document, the "% of those coming to AA within the first year that have remained the indicated number of months" is 19% after one month; 10% after three months; and 5% after 12 months.12 In other words, AA has a 95% new-member dropout rate during the first year of attendance.

11. "Comments on A.A.'s Triennial Surveys," no author listed. New York: Alcoholics Anonymous World Services, n.d. (probably 1990).
12. Ibid., p. 12, Figure C-1.

Alcoholics Anonymous, Cult or Cure? by Charles Bufe, 2nd edition, 1998, chapter 7, "How Effective Is AA?", pages 91 and 102.

9) Bill Wilson speaking in Fort Worth, Texas, 1954. See the web page on 'How the book "Alcoholics Anonymous" came about' on
Also see the official A.A. history books PASS IT ON, pages 207-210, and Alcoholics Anonymous Comes Of Age, pages 174-175.

10) They were Ernie Galbraith the relapsing womanizer, and Bill Dotson the lawyer. Ernie Galbraith was another disaster in the long run, so he doesn't count as any kind of an A.A. victory either. Ernie ended up seducing Doctor Bob's daughter Susan, and relapsing constantly. In the end, Doctor Bob wished he had never recruited Ernie.
      Ernie G. wrote the story "The Seven-Month Slip" for the first edition of the Big Book. That "slip" was a full-blown seven-month-long relapse, not some little slip at the end of seven months of sobriety. Ernie never achieved anything like lasting sobriety, in or out of A.A.. See the Cult Test item, Disturbed Guru, for more about Ernie, Susan, and Doctor Bob.

11) The National Treatment Center Study conducted by the University of Georgia found that 93 percent of the more than 400 representative alcohol treatment programs surveyed were based on the twelve steps of A.A.. See:
Alcohol Treatment: When Faith-based Options Aren't Enough, By: Fletcher, Anne M., Humanist, 00187399, Nov/Dec2001, Vol. 61, Issue 6.
Also see: National Treatment Center Study Report by Paul Roman and Terry Blum, Institute for Behavioral Research, Athens, Georgia, 1997.
Michael Lemanski, in his book History of Addiction and Recovery in the United States, gives us a few more details on page 121 — that 96% of the inpatient facilities use 12-step treatment, but that over 90% of the facilities in the USA (both inpatient and outpatient, but mostly outpatient) are 12-step. The 93% number would appear to be an average of the inpatient and outpatient facilities' numbers.

UPDATE: 2012.08.28: For many years now, I have been quoting the National Treatment Center in Atlanta, Georgia, which found in 1996 that 93% of the treatment centers in the country used the 12-Step model. Well, it turns out that they did another study in 2005, and found that only 75% of the treatment centers are now using the 12-Step model. That is a big drop.

1996 Study:

2005 Study:

12) See Dick B.'s email about the "First 100" here. He said, "The first '100' is a figment of Bill's imagination."

13) Rod Janzen, The Rise and Fall of Synanon, page 182.


: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Essentially, the Bible of the American Psychiatric Association. This book describes all of the various mental illnesses that the Association recognizes. If you want to decide what kinds of crazy people your friends are, read this book. The last three editions are:

DSM-III-R == Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised.
Published by the American Psychiatric Association, Washington, DC. 1987.
ISBN: 0-521-34509-X (casebound); ISBN: 0-521-36755-6 (soft cover).

DSM-IV == Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Published by the American Psychiatric Association, Washington, DC. 1994, 1995, 1998.
ISBN: 0-89042-061-0 (casebound); ISBN: 0-89042-062-9 (soft cover).
Dewey: 616.89 D536 1994 or 616.89'075--dc20

DSM-IV-TR == Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Published by the American Psychiatric Association, Washington, DC. 2000.
ISBN: 0-89042-024-6 (casebound); ISBN: 0-89042-025-4 (soft cover).
LC: RC455.2.C4 D536 2000
Dewey: 616.89 D536 2000 or 616.89'075--dc21
See page 323 for delusional disorders, and page 658 for narcissistic personality disorder.

PROFESSIONAL and ALCOHOLICS ANONYMOUS RELATIONS IN OREGON; An Exploratory Study Report, No. 1, 1965, Milton A. Maxwell, Ph.D.
Mental Health Division, Oregon State Board of Control, Alcohol Studies and Rehabilitation Section
LC: HV5278.A78M3
A very small (20 page) report on Alcoholics Anonymous in Oregon in 1965, and its relations with alcoholism treatment professionals. He observed many of the failings of A.A. that are commonplace today, like resistance to taking medications even when needed, territorial jealousy, stubbornly clinging to outmoded and dogmatic ideas of alcoholism, and refusal to study treatment failures and revise the A.A. program. Dr. Maxwell hoped that those things would be changed and that A.A. would grow into a valuable ally for the professionals. Alas, none of that came to be.
(Note: Dr. Milton A. Maxwell eventually became a member of the Board of Trustees of Alcoholics Anonymous World Services, Inc..)
Quotes: here.

Correlates of Past-Year Status Among Treated and Untreated Persons with Former Alcohol Dependence: United States, 1992, by Deborah A. Dawson.
Alcoholism: Clinical and Experimental Research, Vol. 20, No. 4, June 1996, p. 773.

The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery     George E. Vaillant
Harvard University Press, Cambridge, MA, and London, England, 1983.
ISBN: 0-674-60375-3
LC: number RC565.V33 1983
Dewey: 616.86'1

The Natural History of Alcoholism Revisited     George Vaillant
Harvard University Press, Cambridge, MA, and London, England, 1995.
ISBN: 0-674-60377-X (cloth); ISBN: 0-674-60378-8 (paperback).
Dewey: 616.861 V131n 1995
This book also contains most of the text of the previous one.

Heavy Drinking: The Myth of Alcoholism as a Disease     Herbert Fingarette
University of California Press, Berkeley, CA, 1988.
ISBN: 0-520-06290-6
LC: number HV5292.F56 1988

Alcoholics Anonymous: Cult or Cure?     Charles Bufe, 1998.
See Sharp Press, PO Box 1731, Tucson AZ 85702-1731
ISBN: 1-884365-12-4
Dewey: 362.29286 B929a 1998
(This is the second edition; it has noticeably more information than the first edition. The first edition is: ISBN: 0-9613289-3-2, printed in 1991.)

A History of Addiction & Recovery in the United States, Michael Lemanski
See Sharp Press, PO Box 1731, Tucson AZ 85702-1731, 2001.
ISBN: 1-884365-26-4
Dewey: 362.29180973 or 362.2918 L547h
Also from See Sharp Press, another excellent critical analysis of the whole recovery industry, including A.A., treatment centers, and "codependency therapy".
Quotes: Mental health in A.A.

Peele, Stanton, The Sciences, 1998, vol. 38, no. 2, Mar-Apr, pp. 17-21.

Drunk with Power, Stanton Peele
Reason, May 2001, Vol. 33, Issue 1, p34, 5pp.
This article is available online, either through your public library's EBSCO periodicals database, or at Stanton Peele's web site:

AA's role in society — more negative than positive? Stanton Peele

"The Big Book", really:
Alcoholics Anonymous, Third Edition.
Alcoholics Anonymous World Services, Inc. New York, NY.
ISBN: 0-916856-00-3
Dewey: 362.29 A347 1976

Bill Wilson speech at the memorial service for Dr. Bob, Nov. 15, 1952.
Local copy here.

Comments on A.A.'s Triennial Surveys,     no author listed.
Alcoholics Anonymous World Services, New York, no date (probably 1990).
The document has an A.A.W.S. identification number of "5M/12-90/TC", and was produced for A.A. internal use only.
It reveals the information that five successive triennial surverys, from 1977 to 1989, showed that newcomers to A.A. dropped out at a staggering rate: 81% are gone after 1 month; 90% are gone after 3 months, and 95% are gone at the end of one year. (Page 12, diagram C-1.) That gives A.A. a maximum possible success rate of only 5%, even if you define "success" as staying sober for only one year.
But not all of those five percent who keep coming back are continuously sober. Many of them relapse repeatedly. And then the attrition continues.
A.A. old-timers with 20 years sober are as rare as hen's teeth, and are treated like visiting royalty when they show up to speak at meetings.

Grateful To Have Been There     Nell Wing
Parkside Publishing Corporation, Park Ridge, Ill, 1992.
ISBN: 0-942421-44-2
Dewey: 362.2928 WING
This is an interesting book, even if it is a complete whitewash and gloss-over. Nell Wing was Bill Wilson's secretary for about 35 years, so it is understandable. And we can see the obvious fingerprints of the other true believers, helping Nell to tell the standard stories in exactly the same way as others have, like Bill's conversations with the ghosts of Nantucket. (Page 56.)
Quotes: here and here and here.

Bill W. A Biography of Alcoholics Anonymous Cofounder Bill Wilson     Francis Hartigan
Thomas Dunne Books, An imprint of St. Martin's Press, 175 Fifth Avenue, New York, NY 10010, 2000.
ISBN: 0-312-20056-0
Dewey: B W11h 2000
Francis Hartigan was the secretary of and confidant to Bill Wilson's wife Lois. This book is pretty much a white-wash and tells the whole story from Bill's point of view. But it does contain a few surprises, like the chapter "The Other Woman" which details Bill's love affair with Helen Wynn, and hints at all of his other affairs where he cheated on Lois, both before and after sobriety, all of his married life.
      Note the interesting fact that Lois Wilson had her own private secretary. That doesn't quite jibe with the published image of Bill and Lois as a couple of desperately poor people who were always struggling just to survive. The A.A. propagandists fail to tell you that Bill Wilson managed to arrange A.A. finances so that he and Lois lived like royalty in their A.A.-supplied house in the country, while driving an A.A.-supplied Cadillac car and being supported in comfort for the rest of their lives by the Alcoholics Anonymous organization, with private secretaries and mistresses even. (And Bill never worked a straight job again.) So much for the much ballyhooed "unselfish, constructive action" and "abandoning self-seeking" and "giving up selfishness" and "having no thought of the profit motive" that Wilson always promoted (for the other A.A. members).

AA Horror Stories,     Rebecca Fransway, 2000.
See Sharp Press, Tucson, AZ.
ISBN: 1-884365-24-8
Dewey: 362.2918 T971 2000
This book will curl your hair. One fair-minded 12-Stepper suggested that every new A.A. member should be issued copies of both the Big Book and this book when he or she walks in the door, to tell the newcomers about both the good and the bad things that could happen to them in "the rooms." One of the most disturbing repeated themes is women who were the victims of rape or thirteenth-stepping being told to just shut up and find their part in it and go make some coffee, and to not harbor any resentments against their attackers.

Snapping: America's Epidemic of Sudden Personality Change     Flo Conway and Jim Siegelman
J. B. Lippencott Company, Philadelphia and New York, 1978.
ISBN: 0-397-01258-6
LC: 698.2.C66
LCCN: 78-6627
Dewey: 155.25 C767s
Interesting, and makes some good points. The authors concentrate on the psychological phenomenon of "snapping" — sudden, dramatic personality changes accompanied by hallucinatory or unreal or otherworldly experiences and feelings, which are often called "religious experiences" (like Bill Wilson called his). The authors build up a theoretical foundation for the phenomenon, and then they do a good job of exploring how a variety of cults induce and use snapping experiences to convert people into true believer cult members.
See the longer review in the Bibliography for more.

Alcoholics Anonymous and the Counseling Profession: Philosophies in conflict     Christine Le, Erik P. Ingvarson, and Richard C. Page, Journal of Counseling & Development, 07-01-1995

Narcissism, Denial of the True Self     Alexander Lowen, M.D.
Macmillan Publishing Comany, New York, 1983, and
Collier Macmillan Publishers, London, 1983.
ISBN: 0-02-575890-X
LC: RC553.N36L38 1983
LCCN: 83-18794
This is a great book, a real classic. Dr. Lowen advances the idea that narcissism is not falling in love with one's self, but rather with a false image of one's self. That small subtle difference actually makes a very large difference. In the original Greek mythology, Narcissus died — starved to death — because he was obsessed with his own image and stared at it endlessly. But as Narcissus approached death, his real emaciated appearance could not have been very attractive. Narcissus was seeing an illusion, not his true appearance.
      Dr. Lowen advances the idea that narcissism is often caused by child abuse and prolonged humiliation and pain in childhood. The child adopts a persona where he feels no pain and is powerful and invulnerable. The child thinks, "When I grow up, I'll be so powerful and strong that no one can hurt me or humiliate me ever again." Then the child, who grows into adulthood, spends the rest of his life pursuing and defending an illusion. Narcissists are obsessed with defending and preserving their image — they can't stand it if somebody "makes them look bad" — they can't stand criticism. They deny their true feelings and put on a mask of unfeeling, because they imagine that it will keep them from being hurt again. Likewise, they completely disregard other people's feelings. They are obsessed with power and control, so that they can control the world around them and prevent anyone from humiliating them again. Narcissists are often extremely seductive and manipulative people, often charismatic charmers, and occasionally high achievers as well. They lie habitually, without giving it a second thought. They fear insanity.
      In other words, Dr. Lowen was describing Bill Wilson, the abused son of an alcoholic father and a neurotic mother.

Loving the Self-Absorbed: How to Create a More Satisfying Relationship with a Narcissistic Partner     Nina W. Brown, Ed.D., LPC, NCC
New Harbinger Publications, Inc., Oakland, CA, 2003.
ISBN: 1-57224-354-6
Dewey: 158.2 B879L
This book tells you how to cope with being married to an obnoxious narcissist. The one thing I couldn't see was, "Why bother?" Nina Brown makes narcissists sound so bad that you really don't want to be married to one. But if you are some kind of long-suffering masochist who really wants to go through it all, read this book.
Quotes: here and here and here.

The efficacy of alcoholics anonymous: The elusiveness of hard data.     Bebbington, P. E. (1976).
British Journal of Psychiatry, 128, 572- 580.

Alcoholism treatment: A ten-year follow-up study.     Cross, G. M., Morgan, C. W., Mooney, A. J., Martin, C. A., & Rafter, J. A. (1990).
Alcoholism: Clinical and Experimental Research, 14(2), 169-173.

Does AA really work?     Glaser, E B., & Ogborne, A. C. (1982).
British Journal of Addiction, 77, 123-129

Alcoholics Anonymous after treatment: Attendance and abstinence.     Hoffman, N. G., Harrison, P. A., & Belille, C. A. (1983).
International Journal of the Addictions, 18(3), 311-318.

Abstinence among members of Alcoholics Anonymous.     McBride, J. L. (1991).
Alcoholism Treatment Quarterly, 8(1), 113-121.

The efficacy of AA attendance for aftercare of inpatient alcoholics: Some follow-up data.     Thurstin, A. H., Alfano, A. M., & Nerviano, V. J. (1987).
International Journal of the Addictions, 22, 1083-1090.

Correlates of Past-Year Status Among Treated and Untreated Persons with Former Alcohol Dependence: United States, 1992,     Deborah A. Dawson.
Alcoholism: Clinical and Experimental Research, Vol. 20, No. 4, June 1996, page 773.
See: quotes from Dawson's study.

Relapse Prevention with Substance Abusers: Clinical Issues and Myths,     Dennis Daley.
Social Work, March-April 1987, page 140.
See: quotes from Daley's study.

Outpatient Treatment of Alcoholism; A Review and Comparative Study,     Jeffrey Brandsma, Ph.D., Maxie Maultsby, Jr., M.D., and Richard J. Welsh, M.S.W.
University Park Press, Baltimore, MD., 1980.
ISBN: 0-8391-1393-5
LCCN: 79-9541
LC: RC565.B69 Dewey: 616.86106
One of the most important studies of the treatment of alcoholism, by highly qualified people. This book is must reading for the serious student of recovery programs.

A controlled study on the use of court probation for drunk arrests,     Ditman et al.
American Journal of Psychiatry, 124:160-163, 1967.

A randomized trial of treatment options for alcohol-abusing workers,     Walsh et al.
The New England Journal of Medicine, 325:775-782, 1991.

Lysergic Acid Diethylamide (LSD) In The Treatment Of Alcoholism; An Investigation of its Effects on Drinking Behavior, Personality Structure, and Social Functioning,     Reginald G. Smart, Ph.D., Thomas Storm, Ph.D., Earle F. W. Baker, M.D., F.R.C.P.(C), Lionel Solursh, M.D., F.R.C.P.(C)
Brookside Monograph of the Addiction Research Foundation No. 6, Published for the Addiction Research Foundation by University of Toronto Press, Toronto, Canada, 1967.
This study seems very fair and unbiased. The fact that it was done in Canada, rather than the politically-charged atmosphere of the USA probably had a lot to do with it.
After reviewing all of the available studies and literature, the authors come to this conclusion (on page 89):

2. The results as a whole fail to indicate that the LSD experience as described here is an effective adjunct to the clinical treatment of alcoholism. Over-all improvements in drinking behaviors were found as a result of treatment, but these could not be attributed to the use of LSD.

The following four items describe spontaneous remission in alcoholics (from Bufe):

Recovery Without Treatment, by Thomas Prugh
Alcohol Health and Research World, Fall 1986, pp. 24, 71 and 72.

Alcoholism as a Self-Limiting Disease, by Leslie R. H. Drew
Quarterly Journal of Studies on Alcohol, Vol. 29, 1968, pp. 956-967.

Spontaneous Remission in Alcoholics: Empirical Observations and Theoretical Implications, by Barry S. Tuchfeld
Journal of Studies on Alcohol, Vol. 42, No. 7, 1981, pp. 626-641.

Spontaneous Recovery in Alcoholics: A Review and Analysis of the Available Research, by R. G. Smart
Drug and Alcohol Dependence, Vol. 1, 1975-1976, p. 284.

References cited by Christine Le, Erik P. Ingvarson, and Richard C. Page,
in the excerpt from: Alcoholics Anonymous and the Counseling Profession: Philosophies in Conflict, in Journal of Counseling & Development, 07-01-1995, page 603.

  • Bebbington, P. E. (1976). The efficacy of alcoholics anonymous: The elusiveness of hard data. British Journal of Psychiatry, 128, 572- 580.

  • Bufe, C. Q. (1991). Alcoholics Anonymous: Cult or cure? San Francisco, CA: See Sharp.

  • Cross, G. M., Morgan, C. W., Mooney, A. J., Martin, C. A., & Rafter, J. A. (1990). Alcoholism treatment: A ten-year follow-up study. Alcoholism: Clinical and Experimental Research, 14(2), 169-173.

  • Glaser, E B., & Ogborne, A. C. (1982). Does AA really work? British Journal of Addiction, 77, 123-129

  • Hoffman, N. G., Harrison, P. A., &amp; Belille, C. A. (1983). Alcoholics Anonymous after treatment: Attendance and abstinence. International Journal of the Addictions, 18(3), 311-318.

  • McBride, J. L. (1991). Abstinence among members of Alcoholics Anonymous. Alcoholism Treatment Quarterly, 8(1), 113-121.

  • Thurstin, A. H., Alfano, A. M., &amp; Nerviano, V. J. (1987). The efficacy of AA attendance for aftercare of inpatient alcoholics: Some follow-up data. International Journal of the Addictions, 22, 1083-1090.

  • Vaillant, G. (1983). The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery. Cambridge, MA: Harvard University.

References cited by Prof. George Vaillant
in the quotes from The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery:

  • Baekeland, F., L. Lundwall, and B. Kissin. 1975. "Methods for the Treatment of Chronic Alcoholism: A Critical Appraisal." In Research Advances in Alcohol and Drug Problems, Vol. 2, ed. R. J. Gibbons, Y. Israel, H. Kalant, R. E. Popham, W. Schmidt, and R. G. Smart. New York: Wiley.

  • Beaubrun, M. H. 1967. "Treatment of Alcoholism in Trinidad and Tobago, 1956-65." British Journal of Psychiatry 113:643-658.

  • Belasco, J. A. 1971. "The Criterion Question Revisited." British Journal of Addiction 66:39-44.

  • Bratfos, O. 1974. The Course of Alcoholism: Drinking, Social Adjustment and Health. Oslo: Universitet Forlaget.

  • Bruun, K. 1963. "Outcome of Different Types of Treatment of Alcoholics." Quarterly Journal of Studies on Alcohol 24:280-288.

  • Cecil, R. 1940. Textbook of Medicine. New York: Saunders

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The Synanon and People's Temple CULTS:


Escape from Utopia: My Ten Years in Synanon William F. Olin
Unity Press, Santa Clara, CA 1980.
ISBN: 0-913-30053-5
Dewey: 362.293 O46e
--This is the story of Synanon, as it degenerated from a utopian social organization and also a successful drug and alcohol rehabilitation program, into a nightmarish cult, ending with the arrest of the cult's leader Charles "Chuck" Dederich on charges of conspiracy to commit murder. This story is especially good because it is told by a man who was an idealist, a successful architect seeking a utopia, one of the "life-stylers" who joined Synanon purely out of choice, rather than one of the addicts fleeing from death by drugs. It gives his story a certain credibility, and it also means that it is the story of a life gradually going down-hill over a ten-year period, as the organization gradually turned into a cult. Where some ex-addicts might see even some of the worst parts of Synanon as improvements in their lives, Olin didn't.

The Tunnel Back, Synanon     Lewis Yablonsky
The Macmillan Company, New York, 1965.
LCC 65-10664
Dewey: 362.29 Y12t
This is an earlier book about Synanon, from a very positive viewpoint. It is interesting to read this book second, and the one above first, and note the contrasts.
Details here.

The Light on Synanon: How a Country Weekly Exposed a Corporate Cult — And Won the Pulitzer Prize     Dave Mitchell, Cathy Mitchell, and Richard Ofshe
Seaview Books, New York, 1980.
ISBN: 0-87223-613-7
Dewey: 071.947 M681L
Fascinating, easy reading. This is the story of how a little weekly rural newspaper, run by the Mitchell husband-and-wife team, and the Berkeley University professor Richard Ofshe, managed to bring down the Synanon cult and win the Pulitzer prize in the process. What is really disturbing is how reluctant the California officials were to actually enforce the laws. For years, their attitude was, "Well okay, we'll file a report. But we can't press charges, or get a conviction, because it's just your word against theirs, and they have a thousand people, and 40 lawyers..." The authorities didn't raid Synanon, or make any arrests, until after Jim Jones' cult (also from northern California) committed mass suicide in Guyana. Only then did the authorities get scared and do something. [Dead Link] — Information on Straight, and its precursors, the Seed and Synanon.
Try: — More information on Straight, the Seed, and Synanon.

Jim Jones and Jonestown:

Awake In A Nightmare     Ethan Feinsod
W.W. Norton & Company, New York, NY, 1981.
ISBN: 0-393-01431-2
Dewey: 289.9 F299a
This is a fascinating story that starts with people's lives in VietNam, Detroit, and San Francisco, and continues through their lives in Jim Jones' People's Temple commune in Guyana, down to the bitter end.

Journey to Nowhere, A New World Tragedy     Shiva Naipaul
Simon and Schuster, New York, 1980.
ISBN: 0-671-42471-8
Dewey: 289.9 N157j
A rather depressing, but very accurate and colorful view of Guyana and The People's Temple of Jim Jones.

Seductive Poison, A Jonestown Survivor's Story of Life and Death in the People's Temple Deborah Layton
Anchor Books, Doubleday, New York, 1998.
ISBN: 0-385-48983-8
Dewey: B La 4547s 1998
The Layton family really got clobbered by Jim Jones' cult. The mother of the family, Mrs. Layton, died of lung cancer in Jonestown in spite of Jones' insistence that his faith healing was curing her. She also died without any pain pills because Jim Jones was gobbling them all up. Deborah's brother Larry was a true believer who helped to kill Congressman Ryan, and he's now doing life in a federal penitentiary. Only Deborah got out in time to live to tell the story.

In My Father's House, The Story of The Layton Family and the Reverend Jim Jones     Min S. Yee & Thomas N. Layton
Holt, Rinehart and Winston, New York, 1981
ISBN: 0-03-053396-1
Dewey: B La455y
This is the story of the Layton family, told from the viewpoint of the father of the family. He refused to join the People's Temple and go to Guyana, but he couldn't stop the rest of his family from going.

Snake Dance, Unraveling the Mysteries of Jonestown     Laurie Efrein Kahalas
Red Robin Press, New York, 1998.
ISBN: 1-55212-207-7
Dewey: 289.9 K12s
This book is very pro-Jim-Jones. It is a disorganized mess of scraps of information mixed with conspiracy theories. It is a frightening example of the mind of a true believer, someone who believes in the Big Lie so intensely that not even the deaths of 914 innocent people will make the author see that Jones was evil. The author still maintains that Jones was a saint. The author chooses to believe that it was all a big plot by the CIA, and Jonestown was a paradise, and "a peaceful community was targeted for destruction" because the U.S. Government didn't like Jim Jones' radical left-wing politics. The author just will not face one simple fact: It was Jim Jones, and not the CIA or the U.S. Government, who ordered 914 men, women, children and babies to drink cyanide Flavor-Aid®.

Our Father Who Art in Hell, The Life and Death of Jim Jones     James Reston, Jr.
Times Books, New York, 1981.
ISBN: 0-8129-0963-1
Dewey: 289.9 R439o

Six Years with God     Jeanne Mills
A & W Publishers, New York, 1979.
ISBN: 0-894-79046-3
This book is sickening. It is very good, but it is still sickening. This book borders on the unbelievable — the depths of Jim Jones' depravity and evil are almost unimagineable. The continuous lies, vicious hatred, terrorism, physical and mental torture that Jones inflicted on his followers was so sickening that I didn't actually finish reading the whole book. I had to stop. And it is mind-boggling how many followers stayed for more abuse.
      Jeanne Mills, her husband, and their young daughter were all murdered in their home in Berkeley, California, in March of 1980, by People's Temple cult members, just months after she published this book exposing the inner workings of the cult. That happened shortly after the mass suicide in Guyana, and the murders were apparently committed by a few surviving members of the Temple goon squad, "The Angels", who then committed suicide.

Hearing the Voices of Jonestown     Mary McCormick Maaga
Syracuse University Press, Syracuse, New York, 1998
ISBN: 0-8156-0515-3
Dewey: 289.9 M111h 1998

The Children of Jonestown     Kenneth Wooden
McGraw-Hill, New York, 1981.
ISBN: 0-07-071641-2
Dewey: 362.7044 W886c
Pays particular attention to the 267 children whom the Temple collected and killed. The Temple went into the foster parents business in California, taking care of wards of the court, and got a lot of kids off of drugs, permanently.

White Night, The Untold Story of What Happened Before — And Beyond — Jonestown     John Peer Nugent
Rawson, Wade Publishers, Inc., New York, 1979.
ISBN: 0-89256-116-5
Dewey: B Jo7178n

Gone From the Promised Land, Jonestown in American Cultural History     John R. Hall
Transaction Books, New Brunswick USA and Oxford UK, 1987
ISBN: 0-88738-124-3
Dewey: 289.9 H177g

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