'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

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. 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 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 patients.

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:

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.

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.

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.

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:

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.

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

There is also 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. I'm screwed, because I already lost all of my sober time. Might as well just relax and enjoy it. 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.

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:

DISCUSSION:

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.

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 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. People will fight oppression however they can.)

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:

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.)

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.

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?
http://www.peele.net/faq/aarole.html

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:

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:

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:

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 is currently a Non-alcoholic -- Class A -- member of the Alcoholics Anonymous World Services, Inc. (AAWS) Board of Trustees. 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.

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.

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 is 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."
Also:
"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.

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",
to:
"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."
And 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".
What?!
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 longitudinal 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.

Spo