Talk:Alcoholics Anonymous

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This is an old revision of this page, as edited by Freddydog (talk | contribs) at 23:59, 9 February 2008 (→‎Brandsma Et Al=). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Other Studies

I changed the second study description to emphasize that the "12-step" groups were not actual AA meetings, but rather professional therapists who encouraged the participants to continue with AA after treatment. Also, the fact that this is a "quasi-experimental" study is a little bothersome. Desoto10 (talk) 04:26, 22 January 2008 (UTC)[reply]

After re-reading the study described in the second bulleted item in "Other Studies" I suggest that it should be removed from AA and placed in "12-step programs" or whatever it is called. This study is not about AA, but rather is about professional implementation of a 12-step program in order to facilitate the entry of patients into AA. As it is written, it gives the false impression that attendence at AA meetings gave a better outcome than attendance at CBT meetings. Most studies by these authors are designed to determine the most cost-effective ways to treat alcoholism and their opinion is that they should be funneling patients from the VA into AA, rather than treating them in-house. Desoto10 (talk) 05:32, 23 January 2008 (UTC)[reply]


I have ordered a copy of The Outpatient Treatment of alcoholism and will be adding its findings to this page . I tried to add it on this web page from this source, I have the physical copy of this book by Peele, but it was deleted as not having a valid publisher, even though Peeles work is accepted. http://www.morerevealed.com/library/resist/r_chap_2.htm My general thoughts on this are the Match Study with all its flaws should go to 12 step page and a reference of where to find it left on this page. --207.232.97.13 (talk) 22:31, 31 January 2008 (UTC)Fred[reply]

Brandsma et Al.

Cited by Both Health Canada and United Kingdom National Health Service{pdf file}


One thing both these government health pages have in common is they both the failings of the Project Match Study.

Health Canada may be a review , but it reviewed qualified controlled studies, there is no references to Vaillant.

What we have on this Wiki page is more emphasis placed on Project Match with all its failings and shortcomings, as well as the somewhat muddeled research of George Vaillant given considerable emphasis and the qualified research of Brandsma, Holder etc not even considered!!!

The idea that this is a scholarly page is somewhat of a laugh.

My wiki editing may be sadly lacking and I certainly do not have the skills of some on this page but my research is GOOD. If you look at the material I have dug up and brought to this page, it has been a improvement. When I first arrived it read like more like a piece of AA literature.

Step Thirteen I suggest we both get a copy of Brandsma and edit this page to bring to a higher scholastic standard. --207.232.97.13 (talk) 01:25, 23 January 2008 (UTC)Fred--207.232.97.13 (talk) 01:25, 23 January 2008 (UTC)[reply]

I have a copy of Brandsma's book, I've been meaning to scan parts of it for Step13. But, you have an excellent idea. It is great research with a very useful bibliography. There are nine used copies on amazon [1]. -- Craigtalbert (talk) 03:42, 23 January 2008 (UTC)[reply]
and we arn't opposed to you using the Holder, all we asked was you found the actuall article. you got so hung up on the health canada debate you missed my point that it has an excellent bibliography, and you can probably find those sources...or ask if you can't and you want one. I am in college, as well as craig and probably many other people we have access to databases because of this and can get you origional articles. I can get the Holder article for you, it will take a bit of time (I have to do an inner library loan) here is the abstract...let me know if you want it.
By Holder H, Journal Of Studies On Alcohol [J Stud Alcohol], 1991 Nov; Vol. 52 (6), pp. 517-40; PMID: This study undertakes an analysis of cost effectiveness of alcoholism treatment modalities based upon (1) findings from clinical trials, (2) costs for treatment in settings and/or by providers and (3) recommendations from treatment experts about appropriate settings, providers and treatment events. This analysis, which assumes a prototypic patient, suggests that modalities with the most evidence of effectiveness (based on three or more clinical trials) are not the most expensive. Within this study, total cost of care was negatively related to effectiveness. Modalities categorized as having insufficient evidence of effectiveness (i.e., lacking three or more clinical trials) are in the higher cost categories. The results of this first effort to establish initial cost/effectiveness considerations are intended to stimulate researchers to conduct the types of clinical studies where both cost and effectiveness are carefully measured to increase the scientific basis for future cost/effect policy considerations. The authors expect future clinical studies will revise the results of this initial effort."
based on his past studies, he is a specialist in elderly care and community efforts. I found another article by him that argued for a systems approch to alcoholism (looking at the problem as a whole rather than isolating it to "the alcoholic" "aa" "prevention") and argued that education+ an increse in sales price would curb alcohol abuse (gross simplification, but that really was one conclusion).Coffeepusher (talk) 07:05, 23 January 2008 (UTC)[reply]

Project MATCH

Well I could hardly believe project match, all treatments are equally effective! How to justify a 27 million dollar rip off of the tax payers money. Do treatment centers have a lobbying group? --207.194.108.93 (talk) 04:22, 24 January 2008 (UTC)The Library[reply]

The findings from MATCH, although undramatic, provided desperately needed information on the best ways to treat alcoholism. Academic sources frequently cite MATCH as a major landmark study. — DavidMack (talk) 18:29, 24 January 2008 (UTC)[reply]

That some sources cite MATCH as a major landmark study suggests that they didn't actually read the study or are biased. It is a horribly flawed piece of work. You really do need to have a control group in an experiment like this (that is if you want to make any claim about the effectiveness of the treatments). The problem is that the study directors were so sure that there would be a big effect of matching patients to treatment groups that they figured that a real control would not be required. Don't forget, MATCH can make no conclusions about the effectiveness of ANY treatment, only that assigning patients to different treatment modalities based on the criteria used for the study makes no difference in outcomes. Desoto10 (talk) 02:25, 25 January 2008 (UTC)[reply]

MATCH was a comparison study, so no control group was used. Also, it may help you to actually read the studies you discuss as well as some of the responses from other professionals in the field. Reading Peele alone puts you in a "yeah, whatever" frame of mind that makes it hard to participate in the debate at an objective level. — DavidMack (talk) 18:37, 25 January 2008 (UTC)[reply]

I don't understand your comments. I have read the main Match study and several follow-on studies that used Match data. Comments from professionals do not interest me unless they are providing evidence for their utterances. I don't think that I have ever mentiond Peels. If you cannot be objective, then don't contribute. I don't get why anybody wants the Match study in this article with anything other than a brief mention. It didn't support or denounce AA, it had precious little to do with AA at all. Desoto10 (talk) 00:54, 26 January 2008 (UTC)[reply]

There was the "zero treatment" group that dropped out right after the initial visit--scientifically speaking not a control group, but data is data-- as characterized in the article that Fred/.13 is so fond of [2].

There is a pretty blistering rebuttal to that article by one of the MATCH researchers, found here: http://www.biomedcentral.com/1471-2458/5/76 Desoto10 (talk) 06:32, 25 January 2008 (UTC)[reply]

Data may be data, but dropouts from a study do not a control group make. Don't forget that pretty good outcomes result from simply paying attention to an alcoholic, whether by the primary doc or allied health people. Dropouts would have no such attention.Desoto10 (talk) 05:03, 25 January 2008 (UTC)[reply]

Thank you for repeating nearly exactly what I said? :) -- Craigtalbert (talk) 16:40, 25 January 2008 (UTC)[reply]

I try to help where I can :)Desoto10 (talk) 00:54, 26 January 2008 (UTC)[reply]

At any rate, save the abstinence violation effect, Brandsma's study pretty much shows the same thing. His lay-RBT groups did just a little better (not significant) than an authentic AA group, both significantly better than the control group (his had one). -- Craigtalbert (talk) 04:45, 25 January 2008 (UTC)[reply]

I'll get the book, but do you know how "control group" was defined in the Brandsma study?Desoto10 (talk) 05:03, 25 January 2008 (UTC)[reply]

Here's how Brandsma's description of the control group for his study.
Forgot to sign. -- Craigtalbert (talk) 06:57, 26 January 2008 (UTC)[reply]

Thanks Craigtalbert. More evidence about how difficult it is to study AA and addictions in general. How do you come up with a valid control goup? I guess since I can't come up with an answer myself I shouldn't complain that others cannot either.Desoto10 (talk) 05:10, 29 January 2008 (UTC)[reply]

I have a copy at home, will give you the word for word when I get home from work. -- Craigtalbert (talk) 16:40, 25 January 2008 (UTC)[reply]

The truth is, there is no such thing as a perfect study; every sampling technique is flawed (read Sampling (statistics). The mature reader/researcher evaluates every study with an eye to what its strengths and weaknesses are and how the results can best be applied. MATCH is a very high-quality study that compared treatments; no control group was needed because it was a comparison — what's so hard to understand about that. Peele et al. are not interested in an objective view of the strengths and weaknesses, they just want to pick out and magnify the weaknesses. Why? Because Peele has his pet theories and he doesn't like objective research that challenges him. — DavidMack (talk) 18:29, 25 January 2008 (UTC)[reply]

I have yet to bring up anything about or from Peele. You are absolutley correct, Match was a comparison study and was not designed to provide measures of absolute effectiveness. Therefore, nobody can use it for that. You cannot say that it determined that AA works or that AA doesn't work. It is silent on that issue.Desoto10 (talk) 00:54, 26 January 2008 (UTC)[reply]

Match Edit

I changed one of the sentances in the description of the Match study section to emphasize that this was not a study of AA, per se, but of a professional implementation of 12-step methods. This is a critical distinction that is often overlooked by both supporters and detractors of this study. AA does not involve professional psychotherapists and so to compare an AA meeting to a session with one is invalid. It is probably arguable as to which is better :)Desoto10 (talk) 03:54, 25 January 2008 (UTC)[reply]

We discussed doing this before, I kind of though Step13/.215 would make the changes as it was his idea. But, at any rate, thank you for doing that. -- Craigtalbert (talk) 04:34, 25 January 2008 (UTC)[reply]

Sorry that I did not catch that this has been discussed before. There is such a ton of "discussion" for this topic that I just skimmed most of it.Desoto10 (talk) 04:57, 25 January 2008 (UTC)[reply]

Out of interest, I did some clicking to find out how this sentence changed and eroded over the months.

  • At 20:34, 5 May 2007 the MATCH section was added including the following sentence: "All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied."
  • At 13:56, 8 November 2007, it was amdended to "The programs were administered by psychotherapists and studied twelve-step method, not necessarily AA."
  • At 03:50, 25 January 2008, the sentence was amended to its current version, "The programs were administered by psychotherapists and, although twelve-step methods were incorporated into the therapy, actual AA meetings were not included."

I just want to check, is the current version correct? Did the references actually state that "actual AA meetings were not included"? — DavidMack (talk) 19:33, 25 January 2008 (UTC)[reply]

I would use the term "evolved" rather than "eroded". As it stands now, the sentence is correct and makes sense. Desoto10 (talk) 22:12, 25 January 2008 (UTC)[reply]

DavidMack, that is correct. In order to allow oversight of the therapy, professional counselers were used for all methods. However, one aspect of TSF is to encourage attendance at AA meetings and so one would expect that more subjects from the TSF group would have attended AA meetings. But such attendance was not part of the MATCH study. Desoto10 (talk) 21:54, 25 January 2008 (UTC)[reply]

AA is by nature a difficult topic to research. (Quote from before:) Because of the inherent limitations of research on AA (discussed in the article), you either get a direct study of AA that is vague with suggested results, or you get an indirect study of something similar to AA that may give high quality results. The MATCH study is the latter type. I believe the best option is the current version: to state the results and note that they apply to TSF, not strictly to AA. To make things more complicated, the press release states "Many patients in the three treatments also participated in community meetings of Alcoholics Anonymous..." — DavidMack (talk) 01:12, 26 January 2008 (UTC)[reply]

MATCH relevant?

Given that the Match study did not directly study the effects of AA attendance on alcoholism I think we need to move it out of this article and put it in "12-Step Program" article. For better or for worse, including it here leads people to believe that AA, itself was studied, which it was not. (running for cover) Desoto10 (talk) 22:22, 25 January 2008 (UTC)[reply]

If you can make a convincing argument that it some how applies to all twelve-step groups -- or even most of them -- then sure. But you haven't yet for the other information you ported, and I don't see how this is any different -- Craigtalbert (talk) 23:21, 25 January 2008 (UTC)[reply]

I am sorry, but I don't understand your logic. Project Match studied the effects of matching alcoholics to three treatment programs, none of which were AA. Alcoholics and 12-step facilitation therapy were studied, not AA. AA meetings never involve professional therapy. For sure the study relates to AA because AA is a 12-step program for alcoholics. It deserves a mention in the AA article, but is far more relevant to the Alcoholism and/or 12-step program articles. Where have I gone astray in this logic? —Preceding unsigned comment added by Desoto10 (talk • contribs) 00:42, 26 January 2008 (UTC)[reply]

Ok, I'll explain it for the third time. The twelve-step program article is about twelve step programs, of which there are more there are at least 50+ notable ones. Of those, maybe 1/5 are for addicts, and less than 1/50th are for straight up alcoholics. You're trying to turn the twelve-step program article in to a "well, this isn't exactly about AA so I guess it belongs here" article, and that's not what it is.
As far as the project match research goes, if it's twelve-step related and deals explicitly with alcoholism, then it seems relevant here. Just keep the language should be clear enough that readers know what the difference is. -- Craigtalbert (talk) 06:26, 26 January 2008 (UTC)[reply]
A "mention" is in fact all MATCH did get. The article gives a super-brief summary of MATCH; and most of that section is on the rather dubious criticisms of MATCH, such as the supposed lack of control group. — DavidMack (talk) 01:15, 26 January 2008 (UTC)[reply]

The comments on lack of a control group apply only when someone brings up an "expert opinion", such as that of Dr. Gordis where he makes claims about the study that are not supported by the study. Now that that is gone, the references to control group are not required and should be removed. What I am trying to say is let us take out the entire section on Project Match and replace it with two sentences, one saying what the study demonstrated, and one pointing out that there is controversy. The rest should be sent over to Alcoholism and/or 12-step. Why are you so hot to keep this study, which was not about AA here on the AA page?Desoto10 (talk) 02:26, 26 January 2008 (UTC)[reply]

See my sentence above starting "AA is by nature a difficult topic to research ..." — DavidMack (talk) 20:40, 27 January 2008 (UTC)[reply]


Other Studies should become Studies or Research. Then both Match and Vaillaint should be moved into the Study section.

Match should not be given its own section, A brief description of Match , what it accomplished and a brief citation of its flaws should be cited with references. If someone is interested they can opene the references.

Vaillant Should be moved into the Other Studies as well.

In fact other studies should be studies. It would be worth noting in the study section the difference between a control and non control group for example:

"Studies were excluded if they did not use a proper procedure to equate treatment, if they did not use control groups (randomization or case-control), or if they did not use at least one outcome measure of drinking or drinking problems. Studies without control or comparison groups were not considered because they cannot show how the study subjects in treatment might have fared without treatment or when treated in other ways. However, many of the studies that were reviewed had other shortcomings that limit their interpretation. These shortcomings will be noted at various points in what follows and at the end of Section 7."

Perhaps we could do an brief description of the importance of a control group and then define those studies cited on the page as lacking them. --207.232.97.13 (talk) 01:31, 3 February 2008 (UTC)Fred[reply]

APA Guidelines

I just waded through ref 5, the APA "Practice Guidelines" and I could not find where they claim "Although AA is not for everyone, there is growing evidence supporting the effectiveness of AA as a treatment for alcoholism.[5]" from the intro paragraph of this article. The APA guidelines certainly do encourage practitioners to utilize AA, and that is what we should say. In addition, ref 5 is every bit as much of a review article with a synthesis of new conclusions made by the authors and is definitely not a source for claims of "growing evidence". I would change the sentance in question to something like: "The Practice Guidelines for Treatment of Patients with Substance Use Disorders by the American Psychiatric Associations encourages practitioners to consider AA or other psychosocial support groups as part of their treatment paradigm".Desoto10 (talk) 22:05, 25 January 2008 (UTC)[reply]

Check again, p 98 - 99:
"The effectiveness of AA, per se, has not been evaluated in randomized studies. However, other sources of information provide growing support for the utility of AA and 12-step-oriented treatments. ... Thus, most patients should be encouraged to attend at least several AA meetings to ascertain the appropriateness and utility of AA in helping them remain alcohol free. Individual patient needs and concerns should, however, be taken into consideration when making this recommendation."
The wording as it is now looks like a pretty accurate paraphrase to me.
Yes, it is a review article, with references, and it represents expert opinion that there is "growing evidence". If a wiki editor just read the research on their own and concluded that "there is growing evidence," that would be original research. Also note that this professional review refers to MATCH as a "landmark". — DavidMack (talk) 00:59, 26 January 2008 (UTC)[reply]
OK, sorry I missed p 98. Now that we know the primary sources for that statement, should we not put those in rather than the APA review article?Desoto10 (talk) 01:45, 26 January 2008 (UTC) Well, I just looked up the appropriate references for that statement (259, 261, 956, 958, 959). They are either review articles themselves or "other", meaning book chapters, expert opinion, etc. I don't see that they are referencing studies at all.Desoto10 (talk) 01:52, 26 January 2008 (UTC)[reply]

Here are the references cited by our reference:

  • [259] primary source Humphreys K, Wing S, McCarty D, Chappel J, Gallant L, Haberle B, Horvath AT, Kaskutas LA, Kirk T, Kivlahan D, Laudet A, McCrady BS, McLellan AT, Morgenstern J, Townsend M, Weiss R: Self-help organizations for alcohol and drug problems: toward evidence-based practice and policy. J Subst Abuse Treat 2004; 26:151–158 [G]
  • [261] could be primary source or literature review McCrady BS: Recent research in twelve step programs, in Principles of Addiction Medicine. Edited by Graham AW, Schultz TK, Wilford BB. Chevy Chase, Md, American Society of Addiction Medicine, 1998, pp 707-718 [F]
  • [956] primary source Miller WR, Hester RK: Inpatient alcoholism treatment: who benefits? Am Psychol 1986; 41:794–805 [G]
  • [958] literature review McKay JR, Murphy R, Longabaugh R: The effectiveness of alcoholism treatment: evidence from outcome studies, in Psychiatric Treatment: Advances in Outcome Research. Edited by Mirin SM, Gossett JT, Grob MC. Washington, DC, American Psychiatric Press, 1991, pp 143–158 [F]
  • [959] primary source Moos RH, Finney JW, Cronkite RC: Alcoholism Treatment: Context, Process, and Outcome. New York, Oxford University Press, 1990 [F]

I think you're splitting hairs. If you want to help make a good article, recognize reliable sources like the APA study and use them. — DavidMack (talk) 02:08, 26 January 2008 (UTC)[reply]

Maybe you missed that the APA graded each of the references and placed them in this order:

The following coding system is used to indicate the nature of the supporting evidence in the summary recommendations and references:

[A] Double-blind, randomized clinical trial. A study of an intervention in which subjects are prospectively followed over time; there are treatment and control groups; subjects are randomly assigned to the two groups; both the subjects and the investigators are blind to the assignments.

[A–] Randomized clinical trial. Same as above but not double-blind.

[B] Clinical trial. A prospective study in which an intervention is made and the results of that intervention are tracked longitudinally; study does not meet standards for a randomized clinical trial.

[C] Cohort or longitudinal study. A study in which subjects are prospectively followed over time without any specific intervention.

[D] Case-control study. A study in which a group of patients is identified in the present and information about them is pursued retrospectively or backward in time.

[E] Review with secondary data analysis. A structured analytic review of existing data, e.g., a meta-analysis or a decision analysis.

[F] Review. A qualitative review and discussion of previously published literature without a quantitative synthesis of the data.

[G] Other. Textbooks, expert opinion, case reports, and other reports not included above.

All of the references that you listed were F or G (just look at the end of each of your references). Hardly the most convincing to the APA, apparantly.Desoto10 (talk) 02:32, 26 January 2008 (UTC)[reply]

F and G are a category, nothing to do with quality. — DavidMack (talk) 20:38, 27 January 2008 (UTC)[reply]

Actually, they are rated for quality and F and G are the lowest.Desoto10 (talk) 01:23, 30 January 2008 (UTC)[reply]

Does it give a reference for landmark status:)? I am now totally confused about review articles. You guys have been here for a while, what is the deal? In most scientific studies, review articles are often included as references for things that are generally accepted as true simply to keep the reference lists manageable. They are also often discussed in papers when the review author synthesizes new information from the references that he/she studied. When are references to peer-reviewed review articles acceptable on Wiki and when are they not? Thanks.Desoto10 (talk) 01:45, 26 January 2008 (UTC)[reply]

Who said there was a problem with peer-reviewed literature reviews? -- Craigtalbert (talk) 06:31, 26 January 2008 (UTC)[reply]
... to elaborate a little bit more. It would be best to work with the original studies than a review of them, unless the review compared the data and found some kind of result not obvious from the original studies. Wikipedia is not a paper encyclopedia. We can cite as many references as we'd like, and when/if articles get to big, we can split them up -- as was all ready done with the history section for this article.
That being said, and as is stated in WP:RS, I'm ok with people using peer-reviewed literature reviews from publications that have an established an established fact-checking record (e.g. academic journals). If someone uncovers something horribly wrong with one of these reviews, or something about it is disputed, then it can be discussed. But such reviews meet the criteria for a reliable source. -- Craigtalbert (talk) 06:44, 26 January 2008 (UTC)[reply]

Brandma et al , had a Control Group and evaluated the participants improvement based on actual attendance in an AA group . Project Match lacked a control group and provided 12 step treatment {not AA} through a highly trained therapist. Why has Brandsma been excluded from this web page?--MisterAlbert (talk) 22:05, 26 January 2008 (UTC)[reply]

Depression and Alcoholism, I always believed there was a connection, this is probably off topic but I thought I would pass this on. Research around the World. http://www.cmha.bc.ca/enews/enewsmar07.htm --MisterAlbert (talk) 22:32, 26 January 2008 (UTC)[reply]

Thought I would pass it on --MisterAlbert (talk) 22:32, 26 January 2008 (UTC)[reply]

Dry drunk

There is an entry in Wiki for "Dry drunk". I have just finished editing it and have explained my reasoning on the Dry Drunk discussion page. Maybe it used to be here and was removed? I don't know that it deserves its own entry, but I would not argue strongly to bring it back. It is AA-speak, is it not? If anyone has any scientifically valid references about it, maybe you should take a look.Desoto10 (talk) 05:51, 31 January 2008 (UTC)[reply]

Flaherty, J.A. (1955). "The Psychodynamics of The "Dry Drunk"". The American journal of psychiatry. 112 (6): 460–464. doi:10.1176/appi.ajp.112.6.460. ISSN 0002-953X. PMID 13275595. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
Such articles can be found using the research method I suggested previously. -- Craigtalbert (talk) 01:18, 2 February 2008 (UTC)[reply]

Which shows you the value of that particular technique! 1955? Oh come on.Desoto10 (talk) 22:05, 3 February 2008 (UTC)[reply]

The value of psychodynamics? I wonder what Freud would say about someone asking for scientifically valid references, who then responds sarcastically when somebody offers one? If you're looking for something newer than 1955, not only would be be a good idea to say so when you ask, but you'll also want to have a look at the other 247 Google Scholar results. -- Craigtalbert (talk) 08:25, 4 February 2008 (UTC)[reply]
I took a look at it, and it seems to have been writen based on this source [3] which is the first source referenced, and also the source they copied the entire article from at first. Personaly I wouldn't include it, since in my experience it is a phrase used to "other" (to use a cultrual studies phrase) people in recovery, and shame them into doing what you think they should be doing...and its definition varries depending on who is using it or it is beeing used to.Coffeepusher (talk) 06:12, 31 January 2008 (UTC)[reply]

Thanks for clearing that up. I had no idea where all of the Bush stuff was coming from.Desoto10 (talk) 06:22, 31 January 2008 (UTC)[reply]

It could follow under 13th stepping in the criticism section, it is used alot in 12 step meetings, I agree with Coffepusher assessment , but possibly it could be put in under criticism as it has no medical merit to back it up.-- What the article in counter punch is addressing is a personality disorder, {very hard to treat} that AA'ers believe their program will cure. 207.232.97.13 (talk) 22:22, 31 January 2008 (UTC)Fred[reply]

Vaillant did some research on personality change after sobriety. The 'alcoholic personality' can take months to fade. If you're interested I can dig it up. — DavidMack (talk) 18:01, 1 February 2008 (UTC)[reply]

Gordis comment

This comment by NIAAA Chief Gordis is troubling:

NIAAA Director Enoch Gordis, M.D. said that treatment providers and patients can have confidence that, if well-delivered, they represent state of the art in behavioral treatments.[34]

Yes, he said that, but no, the MATCH study did not address the absolute effectiveness of any one of the three treatments. Do we just leave it there because he said it, or what?Desoto10 (talk) 06:27, 31 January 2008 (UTC)[reply]

In re reading it...it really dosn't say anything that we would use (in this article). I would not oppose its deletion, In fact I will support it.Coffeepusher (talk) 06:37, 31 January 2008 (UTC)[reply]

DoneDesoto10 (talk) 07:18, 31 January 2008 (UTC)[reply]

Comment about Peele in Project Match Section

This comment seems odd: Other researchers stated that "AA has rarely been investigated with the kind of rigorous methological attention it received in Project MATCH." [41]

As has been mentioned before, Match did not evaluate "AA". So, just like Dr. Gordis' statement, I don't know what to do about it. The investigators apparently did say this in a peer-reviewed journal article (that I have not read), but it is wrong. If we need to say something positive about Match, then I don't think that should be too difficult.Desoto10 (talk) 08:33, 31 January 2008 (UTC)[reply]

In that case it should be deleted --207.232.97.13 (talk) 23:02, 31 January 2008 (UTC)Fred[reply]

I put it back in. It is a comment on MATCH from a reliable, academic source. — DavidMack (talk) 17:57, 1 February 2008 (UTC)[reply]

It still seems to be gone, as far as I can tell66.120.181.218 (talk) 03:39, 2 February 2008 (UTC)[reply]

MATCH evaluated AA indirectly. As stated in the article, direct, randomised trials are difficult or impossible with AA, so the best research available on AA is always indirect. — DavidMack (talk) 18:06, 1 February 2008 (UTC)[reply]

The article states that Cutler and Fishbain criticise MATCH based on results from zero-treatment group, and also that Peele accuses MATCH of not having a zero-treatment group. Can someone please explain this? Also, would the person who put in the Cutler and Fishbain critique be willing to add the MATCH rebuttal? Thanks. — DavidMack (talk) 18:18, 1 February 2008 (UTC)[reply]

Regardless , it is clearly stated Project Match did not evaluate AA. Your comment does not belong in Critics of Project Match.

Science for Dumb People . A control group is a control group, it is not people who sign up to take part in one of the three treatments then drop out.


There is no real data provided on AA attendance, regardless of Tonigans claim. In fact if you put Tonigan in , there was no real data in the study to back up Tonigans remarks. --MisterAlbert (talk) 19:47, 1 February 2008 (UTC) In fact The Project MATCH Research Group (1997) reported that only one hypothetical "match" was clearly supported by the data. This proposed that clients with low psychiatric severity would do best in the 12-step facilitation condition. The results showed that these clients had more abstinent days during six and twelve months of follow-up than those treated with cognitive behavioural therapy. However, the extent to which clients in either condition became involved in AA during the follow-up period has not been reported.[reply]

That is not rigouress investigation. --MisterAlbert (talk) 19:47, 1 February 2008 (UTC)[reply]


Here is the qualifier on research follow up: in the outpatient group only, less psychiatrically severe subjects had 4 more abstinent days per month on average in TSF than in CBT treatment. from Peeles article. —Preceding unsigned comment added by MisterAlbert (talk • contribs) 20:11, 1 February 2008 (UTC)[reply]


I think that we might be arguing about two distinct issues:

1. Did Project Match "study" AA?

2. How to handle the views of critics of Project Match.

As for 1, it is clear that TSF therapy is NOT AA, but, as DavidMack keeps saying, it is pretty much all we have to work with if we want studies that randomly assign subjects to different therapies.

The second point seems to me to be more difficult to deal with as much of the criticism of the Match study does not relate to the results of the study itself, but to the (sometimes incorrect) commmentary about the study. My take is that the Match study did what it set out to do: determine if outcomes were better for patients assigned to different treatments based on the patient's scores on psychological tests. By and large, and certainly for the initial reports, there was no such effect--subjects did pretty much the same no matter what treatment group they were assigned to. All fine and good so far. But then some individuals made claims about how the study showed how good current treatments are, resulting in a dogpile of criticism because the study was not designed for determining absolute treatment effects. Does this make any sense? I think that the Match study could be summarized in one or two sentances (maybe just the way it is now), with the caveat that some investigators made claims about the results of the study that are not backed by the study and that others critisize both the study and the claims. The rebuttle to C&F by the Match PI strongly implies that the statement by Gordis was either wrong or taken out of context.Desoto10 (talk) 00:49, 2 February 2008 (UTC)[reply]

Yes, in this article certain users tend to generate a flood of copy, and others have to pare it down to what is concise, reliable and relevant. — DavidMack (talk) 21:41, 4 February 2008 (UTC)[reply]

I need to repeat a question from above: The article states that Cutler and Fishbain criticise MATCH based on results from zero-treatment group, and also that Peele accuses MATCH of not having a zero-treatment group. Can someone please explain this? Also, would the person who put in the Cutler and Fishbain critique be willing to add the MATCH rebuttal? Thanks. (Again.) — DavidMack (talk) 21:46, 4 February 2008 (UTC)[reply]

Other Studies

This sounds like an interesting study, but it appears to reference a dissertation. Is there an actual peer-reviewed published full study on this?

The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.[54] Desoto10 (talk) 08:38, 31 January 2008 (UTC) Hmmm, more likely it is a book, eh? SorryDesoto10 (talk) 08:40, 31 January 2008 (UTC)[reply]

No offense taken, but since all my references have been so rigourlessly scourged from this web page for not having a peer reviewed source, I feel it is only right this one be deleted as well. --207.232.97.13 (talk) 22:26, 31 January 2008 (UTC)Fred[reply]

Which study are you discussing here? Maybe it got separated from the original thread. — DavidMack (talk) 18:20, 1 February 2008 (UTC)[reply]

David and '13, The reference in question was:

^ J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77 I initially thought that this might be a dissertation which are difficult to obtain sometimes and are not always peer-reviewed (at least mine wasn't). Looking closer, it appears to be a book which I guess is OK. Tonigan has many peer-reviewed publications in this space and is a strong proponent of 12-step community-based self-help groups. If necessary, it shouldn't be too hard to find backup refs for this book.Desoto10 (talk) 21:34, 1 February 2008 (UTC)[reply]

It was published in Alcoholism Treatment Quarterly: [4]. -- Craigtalbert (talk) 08:44, 4 February 2008 (UTC)[reply]

The Italian Study

Thought I would post this and open it up for discussion. http://www.nytimes.com/2006/07/25/health/25drin.html

--MisterAlbert (talk) 23:14, 2 February 2008 (UTC)[reply]

Interesting. We could quote the actual study for sure, although it is a review.Desoto10 (talk) 22:10, 3 February 2008 (UTC)[reply]

It looks to me that the conclusions are the same as MATCH: "researchers ... found little to suggest that 12-step programs reduced the severity of addiction any more than any other intervention," which sounds like a negative way of saying that AA is equally effective. Another MATCH-like statement is "None of the studies compared A.A. with no treatment at all, and the researchers said that made it more difficult to draw conclusions about effectiveness." It looks like this study may have covered Project MATCH, since it mentions "cognitive-behavioral therapy" and "motivational enhancement therapy", which both featured in MATCH. Anyway, those are just comments, it looks like relevant and reliable research. — DavidMack (talk) 21:57, 4 February 2008 (UTC)[reply]

Intro

I just cut out a chunk that Craig had worked hard at, concerning AA's effectiveness. That matter is dealt with later; the intro mostly has to say that AA is there. A sentence starting "The Big Book asserts" might work to close that graf. PhGustaf (talk) 18:10, 6 February 2008 (UTC)[reply]

It does read better that way. Thank you. -- Craigtalbert (talk) 21:47, 6 February 2008 (UTC)[reply]
Well, you cut out a clumsy last sentence I made to that entry some time ago, so thanks back. I think the passage is pretty good as it stands, and that an NPOV cloture to it is unneeded and impossible. PhGustaf (talk) 16:48, 7 February 2008 (UTC)[reply]

I'd like to put the following sentence in the opening "Although AA is not for everyone and the issue of AA effectiveness is controversial, there is growing evidence supporting the effectiveness of AA as a treatment for alcoholism". Wikipedia:Lead section says "The lead serves a dual role both as an introduction to the article below and as a short, independent summary of the important aspects of the article's topic." — DavidMack (talk) 19:00, 7 February 2008 (UTC)[reply]

The problem is that it's easy to find a one-liner cite, as well documented as yours, that can be quoted to suggest that AA is irrelevant or destructive. The Intro is, well, an Intro, and should strive to avoid any hint of a POV. I've said my piece here; other opinions heard with gratitude. PhGustaf (talk) 21:18, 7 February 2008 (UTC)[reply]
The one-liner cite is from a peer-reviewed professional journal whose mandate is to give evidence-based treatment guidelines to psychiatrists. The litigious U.S. environment gives even more incentive to provide objective rationale, otherwise patients could sue if they felt their referring doctor harmed them by referring them to AA. This is not POV (my own personal bias). This is an objective statement from an extremely reliable source. If there is another one-liner cite from an equally reliable source based on wide survey of the literature, then we will take that into account. Untill then, the intro should stand. — DavidMack (talk) 18:05, 8 February 2008 (UTC)[reply]
I added the following material, revised for more objectivity: "The issue of AA effectiveness is controversial. Although AA is not for everyone and attrition rates tend to be high,[5] there is growing evidence supporting the effectiveness of AA as a treatment for alcoholism.[6]" I hope this is acceptable to all editors. It summarises the most important and controversial discussion.
PhGustaf, when you deleted this material last time your edit summary said: "The issue is too complex to address with a one-liner of questionable context. The matter is already better addressed below." Wikipedia:Lead section says that the opening should be both an introduction and "independent summary of the important aspects of the article's topic." (See also Wikipedia:Writing better articles#Lead section.) If the topic is important, it should be in the opening. I don't see how the context is questionable; its relevant, reliable, and on-topic. — DavidMack (talk) 18:35, 8 February 2008 (UTC)[reply]
We should probably worry about WP:LEAD when the article is a bit more stable, until then keeping it as an accurate summary of the entire article is going to be kind of tough. -- Craigtalbert (talk) 23:04, 8 February 2008 (UTC)[reply]
I still see the line as, at best, cherry-picked. But I won't hack it out again. More opinions are solicited: A consensus would be nice. PhGustaf (talk) 23:55, 8 February 2008 (UTC)[reply]

Brazilian 2008 Study

Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents


Would provide more of an international world view. -- Craigtalbert (talk) 21:49, 6 February 2008 (UTC)[reply]

Looks interesting and relevant. Is it a reliable source? — DavidMack (talk) 18:51, 7 February 2008 (UTC)[reply]
Most definitely. -- Craigtalbert (talk) 23:15, 8 February 2008 (UTC)[reply]

Atkins 2007

Chins up fellows:

This was added to attrition, I moved it to studies, however I do have my doubts as it was a survey not a study. Input appreciated:

Randolph G. Atkins Jr Ph.D.a, and James E. Hawdon Ph.D.b aThe Walsh Group, Bethesda, MD 20817, USA bDepartment of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA Received 29 January 2007; revised 15 June 2007; accepted 1 July 2007. Available online 20 September 2007.


Abstract Mutual-aid support groups play a vital role in substance abuse treatment in the United States. A national survey of mutual-aid support groups for addiction was conducted to identify key differences between participants in recovery groups. Survey data indicate that active involvement in support groups significantly improves one's chances of remaining clean and sober, regardless of the group in which one participates. Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober. Religious respondents were more likely to participate in 12-step groups and Women for Sobriety. Nonreligious respondents were significantly less likely to participate in 12-step groups. Religiosity had little impact on SMART Recovery participation but actually decreased participation in Secular Organizations for Sobriety. These results have important implications for treatment planning and matching individuals to appropriate support groups. Freddydog (talk) 22:23, 7 February 2008 (UTC)[reply]

Here it is on CiteULike: http://www.citeulike.org/article/2002656
I recommended this article privately to Step13 awhile back, I think it's worth adding. -- Craigtalbert (talk) 23:15, 8 February 2008 (UTC)[reply]
This also seems to be the opinion of many steppers [5]. -- Craigtalbert (talk) 22:23, 9 February 2008 (UTC)[reply]

On making major changes

It's usually better, I think, to work out major changes to an article in a sandbox or in preview pages than to post a half dozen intermediate edits on the way there. At least this keeps such careless editors as myself from slashing in at the middle and leaving a worse mess than existed before. PhGustaf (talk) 23:21, 7 February 2008 (UTC)[reply]

And, someone should 'splain to me how I managed this too-small font. PhGustaf (talk) 23:33, 7 February 2008 (UTC)[reply]


Brandsma Et Al

Have just received my copy of the Oupatient Treatment of Alcoholism p. 115

Note 1/3 of the Book is comprised of Appendices.

Overall the results indicate coerced attendance to AA is not recommended. Chapter 9 conclusions:

1. AA had the most dropouts of all therapies 2. AA & RBT had the least number of sessions for those who didn't drop out 3. Treatment of any type was better than the control group 4. Insight and Pro RBT were the best in the number of days dry.


In 3 month after terminating treatment, the AA group had increased their binge drinking, some in the AA group said it made them feel superior. p. 106--Freddydog (talk) 23:59, 9 February 2008 (UTC)[reply]

There is no such thing as an alcoholic personality, there are some common traits.p. 25

1. strong tendency to regress under stress 2. Primitive defense mechanisms..acting out in aggressivley and sexually when drunk but acting different when sober 3. massive usuage of denial 4. Dependency on enviromental supports..he has learned to provoke the enviroment to act on his behalf 5. Naricissitc, ego centric and passive demanding behaviors other individuasl are objects to be manipulated into taking care of ones needs.

People with these structures in their personality get caught in cycles of frustration and pain,

--Freddydog (talk) 23:59, 9 February 2008 (UTC)[reply]

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