Dan McGown wrote:

> Okay, I've read the whole article. You cite it for the table. The
> prelude to the table expressly says that "Forty-three treatments were
> ranked, although 13 of them had too few studies to be definitively
> rated." AA is expressly stated to be among the studies "with too few
> studies to be definitively rated."

Dan,

Dan,

How can it be that AA, around for 70 years and virtually the only
"treatment" used for the last few decades, had too few studies to be
definitively rated? Does that not say something to you?

AA members had a hand in the founding in the first school of alcoholism
studies. AA members founded the NCADD. AA members had a heavy hand in
the founding of the NIAAA. So how wasn't what is most promoted by the
three the most definitively studied?

> Moreover, what is shown is not actual data or even actual study
> results. It is a "meta study" massaging results from a bunch of
> somebody else's studies with no controls whatever over the sources of
> data.

Meta analyses do have their problems. However, a meta analysis of all
available studies is hardly without usefulness. It is when the studies
are carefully picked through that problems come up. Just as the study
says, there weren't enough studies available to definitively rate AA.
Remember, we are supposed to be talking science here, not advertising.

> Later in the same article, however, there is a report of an actual
> controlled comparison study. It showed that AA did as well as your
> other pet methods:

I'm glad you brought up Project MATCH.

> "The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
> created an elaborate $27 million research project, called Project
> MATCH, to test the notion that alcoholics will do better when they are
> assigned to a treatment appropriate to them and their drinking
> problem. Three treatments were tested: 12-step, cognitive-behavioral
> coping skills (this includes social skills training) and motivational
> enhancement. Each client was tested extensively and randomly assigned
> to one type of treatment. The hypothesis was that people's distinct
> profiles would predict the therapy that worked best for them. Results
> of the study are now in: no treatment did better than any other, no
> set of traits predicted which therapy worked best for a person."

As the first sentence above says, the purpose of the study wasn't to
show which treatment was best. It was to see if treatment authorities
could assign people to the varying treatments based on patient
characteristics and get better outcomes by doing so.

>
> 12 step programs not only did as well as your other chosen
> methods, they did so without the expense of treatments that most of us
> drunks can't afford.

The above statement is simply not true. When the study first came out,
the argument on an addiction discussion list at Kent State populated by
therapists and researchers, any mention that the one treatment arm that
you refer to as '12-step programs' brought a sounding "That wasn't AA.
It was 12 Step Facilitiation." Of course, that is what it was called,
but the poor showing of AA, they somehow believed, as AA members always
do, in contradiction to knowing that AA would be proven far and away the
most successful with their thousands of hours of testimonials at
meetings was because it was TSF, not AA.

Twelve Step Facilitation means an intricate program invoving "two
hatters" "facilitating" peoples' entry into 12 Step groups. It was not
only was not only far more expensive than the Motivational Interviewing
arm, it called for lifetime commitment to "the program." Motivation
Interviewing, I think it was just four sessions with a counselor, was
far and away the cheapest of the three.

There were serious problems with the study, not least of which that
there was no control group and the requirements to be in the study were
so strict as to rule out those who weren't extremely motivated. Because
of the requirements to be in the study were so strict, it guaranteed a
very high success rate. Because of no control group, the claims by the
treatment industry that Project MATCH proved "treatment works" were
simply ad copy having nothing to do with the reality of what was and
wasn't found in Project MATCH. Moreover, the attention that each
participant had and the careful watching of the therapists insured that
the study had, for all practical purposes, nothing to do with actual
treatment in the U.S.

In any case, the 12 Step Facilitation arm was extremely expensive.
Motivation Interviewing was cheap. Since they both had the same
results, according to this study, Motivational Interviewing was far
superior to the other methods under study. For any government agency,
if going solely by the Project MATCH results (of course, there is plenty
of other data and considerations), Motivational Interviewing was
superior because it delivered the _same_ results for far _less_ money..

>
> Finally, some of your other "preferred" methods are not even designed
> for actual alcohol addicts. For instance, your pet Brief Interventions:
> /"Brief interventions/ do not view patients as out of control. They
> avoid classifying people as alcoholics or problem drinkers.
> Controlling one's drinking is the person's responsibility. A primary
> care physician or other health care worker first assesses whether
> someone is drinking excessively. The care worker then provides
> feedback about normal levels of drinking and the likely health
> outcomes from excessive drinking."

Here you seem to be confounding someone being "in denial" and being an
"actual alcohol addict." If they are sent to 12 Step "treatment" one of
the first jobs of the treatment authorities is to break through their
"denial." If one is to compare 12-Step treatment to other methods, it
is not necessary (counterproductive even) to first convince them of a
fundamental AA tenet and then to help them to see things in an opposite way.

>
> Ken, in our advice in here to other people in other threads, we have
> repeatedly drawn a distinction between people who are addicted to
> alcohol and people who are simply, for other reasons, abusing
> alcohol. Techniques such as "Brief Interventions" and "Social Skills
> Training" may work well for people who are not addicts but who are
> abusing alcohol. That doesn't say, however that they have a prayer of
> working for someone who is addicted to alcohol.

But that distinction between being "addicted to alcohol" and merely
"more serious problem drinkers" is an AA construct having little to do
with the real world but much to do with peoples' maleability. Again,
one can't judge by whether they are "in denial" or not as to whether
they need treatment.

>
> Okay, I've read the whole article. It doesn't support your diatribes
> against 12 step programs. It also doesn't say that your preferred
> treatments are demonstrably better than 12 step programs in general,
> let alone when dealing with actual alcoholics. Is that all you've got?

It does indicate there are successful treatments. It does indicate that
the most "popular" and judicially enforced treatment is, for all
practical purposes, untested.

Ten billion dollars invested in untested treatment. Hmmm. Why should
that be?

I've got plenty more. That was just a quicky on the way to work. :-)

Ken Ragge
http://www.morerevealed.com


>
>
>
>
>
>
>
> "Ken" <nospam@nowhere.org <mailto:nospam@nowhere.org>> wrote in
> message news:ZNSdnXGaMokpfQTenZ2dnUVZ_s2dnZ2d@comcast.com. ..
> Dan McGown wrote:
>
>>>Using scientifically proven methods, there would be a higher success rate
>>>at moderating/stopping drinking and drug use but then that is not at all
>>>what the 12th Step is about, is it?
>>>
>>>Ken Ragge
>>>
>>>
>>
>>Fraud. You always attack AA but you never get around to actually
>>identifying what these scientifically proven methods might be.
>>
>>
> Dan,
>
> Copied from http://www.peele.net/lib/allornothing.html :
>
> Forty-three treatments were ranked, although 13 of them had too
> few studies to be definitively rated. Brief interventions had the
> highest score, followed by social skills training. At the bottom
> of the list in effectiveness were general alcoholism counseling
> and educational lectures and films about alcoholism. AA received
> the lowest score among the 13 treatments inadequately tested.
> Miller et al. were quick to note that the treatments with the
> worst clinical records are almost universally the ones used by
> American alcoholism programs.
>
>
>
> Table 3. Most and Least Effective Alcoholism Treatments
> Highest Rated
> Brief interventions +239
> Social skills training +128
> Motivation enhancement +87
> Community reinforcement +80
> Behavioral contracting +73
> Lowest Rated
> Metronidazole - 102
> Relaxation training - 109
> Confrontational counseling - 125
> Psychotherapy - 127
> General alcohol counseling - 214
> Alcoholism education programs - 239
> Methods with Too Few Tests to be Reliably Rated
> Sensory deprivation +40
> Developmental counseling +28
> Acupuncture +20
> ...... ...
> Calcium Carbamide - 32
> Antipsychotic medication - 36
> AA - 52
>
> Source: Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker, N.S.,
> Bien, T.H., Luckie, L.F., Montgomery, H.A., Hester, R.K., and
> Tonigan, J.S. (1995). What works?: A methodological analysis of
> the alcohol treatment outcome literature. In R.K. Hester and W.R.
> Miller (Eds.), /Handbook of alcoholism treatment approaches/ (2nd
> Ed., pp. 12-44).
>
>
>
> I'm sure, however, that you will totally discount this and
> continue pushing the Steps and disease "education."
>
> Ken Ragge
> http://www.morerevealed.com
>

Ken, I think that I see one more of the points where we have trouble
finding common ground. You keep talking about the ten billion dollar
treatment industry and the high cost of the step programs.
My "treatment" has cost me a dollar a meeting, voluntarily given, so
that we can buy coffee and pay nominal rent for the use of the building.
I have seen street drunks put in about 37 cents in change, which was
all they had, and lots of people just pass the basket because they didn't
have that.
The meetings that I see are self help projects that cost only the
pittance that the members put in themselves.


"Ken" <nospam@nowhere.org> wrote in message
news:FvOdnSPkPutViAbeRVn-iA@comcast.com...
> Dan McGown wrote:
>
>> Okay, I've read the whole article. You cite it for the table. The
>> prelude to the table expressly says that "Forty-three treatments were
>> ranked, although 13 of them had too few studies to be definitively
>> rated." AA is expressly stated to be among the studies "with too few
>> studies to be definitively rated."
>
> Dan,
>
> Dan,
>
> How can it be that AA, around for 70 years and virtually the only
> "treatment" used for the last few decades, had too few studies to be
> definitively rated? Does that not say something to you?
>
> AA members had a hand in the founding in the first school of alcoholism
> studies. AA members founded the NCADD. AA members had a heavy hand in
> the founding of the NIAAA. So how wasn't what is most promoted by the
> three the most definitively studied?
>
>> Moreover, what is shown is not actual data or even actual study results.
>> It is a "meta study" massaging results from a bunch of somebody else's
>> studies with no controls whatever over the sources of data.
>
> Meta analyses do have their problems. However, a meta analysis of all
> available studies is hardly without usefulness. It is when the studies
> are carefully picked through that problems come up. Just as the study
> says, there weren't enough studies available to definitively rate AA.
> Remember, we are supposed to be talking science here, not advertising.
>> Later in the same article, however, there is a report of an actual
>> controlled comparison study. It showed that AA did as well as your other
>> pet methods:
>
> I'm glad you brought up Project MATCH.
>> "The National Institute on Alcohol Abuse and Alcoholism (NIAAA) created
>> an elaborate $27 million research project, called Project MATCH, to test
>> the notion that alcoholics will do better when they are assigned to a
>> treatment appropriate to them and their drinking problem. Three
>> treatments were tested: 12-step, cognitive-behavioral coping skills (this
>> includes social skills training) and motivational enhancement. Each
>> client was tested extensively and randomly assigned to one type of
>> treatment. The hypothesis was that people's distinct profiles would
>> predict the therapy that worked best for them. Results of the study are
>> now in: no treatment did better than any other, no set of traits
>> predicted which therapy worked best for a person."
>
> As the first sentence above says, the purpose of the study wasn't to show
> which treatment was best. It was to see if treatment authorities could
> assign people to the varying treatments based on patient characteristics
> and get better outcomes by doing so.
>
>> 12 step programs not only did as well as your other chosen methods, they
>> did so without the expense of treatments that most of us drunks can't
>> afford.
>
> The above statement is simply not true. When the study first came out,
> the argument on an addiction discussion list at Kent State populated by
> therapists and researchers, any mention that the one treatment arm that
> you refer to as '12-step programs' brought a sounding "That wasn't AA. It
> was 12 Step Facilitiation." Of course, that is what it was called, but the
> poor showing of AA, they somehow believed, as AA members always do, in
> contradiction to knowing that AA would be proven far and away the most
> successful with their thousands of hours of testimonials at meetings was
> because it was TSF, not AA.
> Twelve Step Facilitation means an intricate program invoving "two hatters"
> "facilitating" peoples' entry into 12 Step groups. It was not only was not
> only far more expensive than the Motivational Interviewing arm, it called
> for lifetime commitment to "the program." Motivation Interviewing, I
> think it was just four sessions with a counselor, was far and away the
> cheapest of the three.
> There were serious problems with the study, not least of which that there
> was no control group and the requirements to be in the study were so
> strict as to rule out those who weren't extremely motivated. Because
> of the requirements to be in the study were so strict, it guaranteed a
> very high success rate. Because of no control group, the claims by the
> treatment industry that Project MATCH proved "treatment works" were simply
> ad copy having nothing to do with the reality of what was and wasn't found
> in Project MATCH. Moreover, the attention that each participant had and
> the careful watching of the therapists insured that the study had, for all
> practical purposes, nothing to do with actual treatment in the U.S.
>
> In any case, the 12 Step Facilitation arm was extremely expensive.
> Motivation Interviewing was cheap. Since they both had the same results,
> according to this study, Motivational Interviewing was far superior to the
> other methods under study. For any government agency, if going solely by
> the Project MATCH results (of course, there is plenty of other data and
> considerations), Motivational Interviewing was superior because it
> delivered the _same_ results for far _less_ money..
>
>> Finally, some of your other "preferred" methods are not even designed
>> for actual alcohol addicts. For instance, your pet Brief Interventions:
>> /"Brief interventions/ do not view patients as out of control. They avoid
>> classifying people as alcoholics or problem drinkers. Controlling one's
>> drinking is the person's responsibility. A primary care physician or
>> other health care worker first assesses whether someone is drinking
>> excessively. The care worker then provides feedback about normal levels
>> of drinking and the likely health outcomes from excessive drinking."
>
> Here you seem to be confounding someone being "in denial" and being an
> "actual alcohol addict." If they are sent to 12 Step "treatment" one of
> the first jobs of the treatment authorities is to break through their
> "denial." If one is to compare 12-Step treatment to other methods, it is
> not necessary (counterproductive even) to first convince them of a
> fundamental AA tenet and then to help them to see things in an opposite
> way.
>
>> Ken, in our advice in here to other people in other threads, we have
>> repeatedly drawn a distinction between people who are addicted to alcohol
>> and people who are simply, for other reasons, abusing alcohol.
>> Techniques such as "Brief Interventions" and "Social Skills Training" may
>> work well for people who are not addicts but who are abusing alcohol.
>> That doesn't say, however that they have a prayer of working for someone
>> who is addicted to alcohol.
>
> But that distinction between being "addicted to alcohol" and merely "more
> serious problem drinkers" is an AA construct having little to do with the
> real world but much to do with peoples' maleability. Again, one can't
> judge by whether they are "in denial" or not as to whether they need
> treatment.
>
>> Okay, I've read the whole article. It doesn't support your diatribes
>> against 12 step programs. It also doesn't say that your preferred
>> treatments are demonstrably better than 12 step programs in general, let
>> alone when dealing with actual alcoholics. Is that all you've got?
>
> It does indicate there are successful treatments. It does indicate that
> the most "popular" and judicially enforced treatment is, for all practical
> purposes, untested.
> Ten billion dollars invested in untested treatment. Hmmm. Why should that
> be?
>
> I've got plenty more. That was just a quicky on the way to work. :-)
>
> Ken Ragge
> http://www.morerevealed.com
>
>
>>
>> "Ken" <nospam@nowhere.org <mailto:nospam@nowhere.org>> wrote in
>> message news:ZNSdnXGaMokpfQTenZ2dnUVZ_s2dnZ2d@comcast.com. ..
>> Dan McGown wrote:
>>
>>>>Using scientifically proven methods, there would be a higher success
>>>>rate at moderating/stopping drinking and drug use but then that is not
>>>>at all what the 12th Step is about, is it?
>>>>
>>>>Ken Ragge
>>>>
>>>
>>>Fraud. You always attack AA but you never get around to actually
>>>identifying what these scientifically proven methods might be.
>> Dan,
>>
>> Copied from http://www.peele.net/lib/allornothing.html :
>>
>> Forty-three treatments were ranked, although 13 of them had too
>> few studies to be definitively rated. Brief interventions had the
>> highest score, followed by social skills training. At the bottom
>> of the list in effectiveness were general alcoholism counseling
>> and educational lectures and films about alcoholism. AA received
>> the lowest score among the 13 treatments inadequately tested.
>> Miller et al. were quick to note that the treatments with the
>> worst clinical records are almost universally the ones used by
>> American alcoholism programs.
>>
>>
>> Table 3. Most and Least Effective Alcoholism Treatments
>> Highest Rated
>> Brief interventions +239
>> Social skills training +128
>> Motivation enhancement +87
>> Community reinforcement +80
>> Behavioral contracting +73
>> Lowest Rated
>> Metronidazole - 102
>> Relaxation training - 109
>> Confrontational counseling - 125
>> Psychotherapy - 127
>> General alcohol counseling - 214
>> Alcoholism education programs - 239
>> Methods with Too Few Tests to be Reliably Rated
>> Sensory deprivation +40
>> Developmental counseling +28
>> Acupuncture +20
>> ...... ...
>> Calcium Carbamide - 32
>> Antipsychotic medication - 36
>> AA - 52
>>
>> Source: Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker, N.S.,
>> Bien, T.H., Luckie, L.F., Montgomery, H.A., Hester, R.K., and
>> Tonigan, J.S. (1995). What works?: A methodological analysis of
>> the alcohol treatment outcome literature. In R.K. Hester and W.R.
>> Miller (Eds.), /Handbook of alcoholism treatment approaches/ (2nd
>> Ed., pp. 12-44).
>>
>>
>>
>> I'm sure, however, that you will totally discount this and
>> continue pushing the Steps and disease "education."
>>
>> Ken Ragge
>> http://www.morerevealed.com
>>

dan mcgown wrote:

> Ken, I think that I see one more of the points where we have trouble
>finding common ground. You keep talking about the ten billion dollar
>treatment industry and the high cost of the step programs.
> My "treatment" has cost me a dollar a meeting, voluntarily given, so
>that we can buy coffee and pay nominal rent for the use of the building.
> I have seen street drunks put in about 37 cents in change, which was
>all they had, and lots of people just pass the basket because they didn't
>have that.
> The meetings that I see are self help projects that cost only the
>pittance that the members put in themselves.
>
Dan,

"Community AA," meaning AA entirely removed from the treatment
industry, is certainly a part of AA but only a very tiny part. I've
never doubted the good intentions of the majority of people at such
meetings. Remember, I used to be an AA myself. Now whether they are
(or I was) accurate in sincerely held positions of the efficacy of AA
is true, is an entirely different matter.

And when we are talking about the government spending big bucks to help
people, we should be making damn sure that what we are doing is really
helping them.

Ken Ragge
http://www.morerevealed.com