
Alcoholics Anonymous vs. other approaches: the evidence is now in - pseudolus
https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-new-evidence.html
======
dang
So far the comments have been about people's prior experiences with the topic
(which is great), or prior opinions about the topic (which is ok). But the
more interesting story is being overlooked: this is heavy-duty new research
that overturns previous conclusions, including the prior expectations of at
least one of the lead authors. It would be good to discuss the specifics of
the article and the new study.

~~~
notafraudster
Do you think you could elaborate why you believe this is "heavy-duty" new
research (or even new research at all, rather than a new meta-analytic
synthesis of old research)?

My quick read of the study suggests that they examined several outcomes, got
null or low powered results on most of them, and chose to highlight the single
result which did show a significantly positive effect on recovery; that result
was based on a meta-analytic estimate of the pooled sample of just two
studies. In particular, my understanding is that this study found a null on
"percentage days abstinent", a null on "longest period of abstinence", a null
on "drinks per drinking day", a null on "alcohol-related consequences". For
alcohol addiction severity they report the results of one study without doing
any original analysis. And for "rates of continuous abstinence" they found a
positive effect. In most cases these are graded as "low certainty evidence".
The positive effect is claimed to be "high certainty evidence", but the CI /
p-value for the positive effect is not adjusted for multiple comparisons -- I
don't think that's fatal, but it does speak to the fragility of the outcome.

The other concern I have is that they separate "manualized" treatments (e.g.
AA treatments administered according to a protocol) from "non-manualized"
(e.g. ad hoc administration of the AA treatment) treatments. This is fine --
we would expect to see that if something about the protocol was useful, the
non-manualized treatments would display an attenuated version of the same
effect. Instead we get a null on the original positive effect, and a positive
effect on one of the original nulls

Finally, the authors seem a little loose with what the comparison groups are.
They claim they recruited studies which compared AA to no treatment, but the
results are all motivated as being AA versus CBT. What happened to the no
treatment studies? Perhaps these are buried in the full text. The rate of
spontaneous remission of addiction is believed to be fairly high and most of
the past criticism of the efficacy of AA has been motivated by comparison to
spontaneous remission.

It strikes me that there is significant distortion of the study findings from
the Cochrane write-up to the Stanford press release, and from the Stanford
press release to the NYT piece, and that in both cases the distortion is in
favour of claiming the study has found affirmative evidence that AA works
better, rather than just no evidence to claim it works worse. For instance,
one of the thrusts of the NYT piece is that the past Cochrane review was based
on a limited number of studies... but the operative finding in this review is
based on an even more limited number of studies, even if the pool of studies
from which they drew has become larger over the last 15 years.

All of this is from a quick read of the review -- I am off campus right now
and don't feel like VPNing or pirating the full text to deep dive the
analysis.

~~~
runarberg
> And for "rates of continuous abstinence" they found a positive effect.

It’s been a while since I reviewed the literature for substance abuse
disorder, but if I remember correctly it was highly disputed whether complete
abstinence was necessary (or even beneficial) for treatment. Has this changed?

The argument was that by focusing on abstinence you are setting a significant
part of your patience up for failure with all the psychological harm involved
in knowing that they’ve failed, which might result in severe and frequent
relapses.

EDIT: To conclude. I find it hard to draw conclusions if success is measured
in “days of abstinence”. That means that a patient that has recovered from
cognitive behavior therapy (CBT) that uses occasionally and non-detrimentally
is not considered a success! Further AA or other 12-step programs do often
stress abstinence while CBT does not, this creates a counting bias in favor of
12-step programs.

~~~
crawfordcomeaux
I'm a recovering information addict, food addict, sex addict, and love addict.

Doing the same behaviors in a mindful way instead of out of a desire to
mask/numb/avoid matters.

Also, I stopped counting my various abstinence stretches because it's not
actionable information. I don't assess my recovery that way. I take a look at
my needs and identify how I'm doing meeting them.

~~~
circlefavshape
Love addict? Care to elaborate?

~~~
NAaddict167
Addicted to relationships/falling in love.

It’s a thing.

That initial honeymoon period? It’s like it fixes _everything_. I’m a whole
different person.

Then the honeymoon period ends and I get bored and irritated and nasty. I need
to find another one to fix me. Because the current relationship is clearly
where the problem lies.

Repeat ad infinitum.

That’s my experience of it. Others may have a different experience.

------
pmoriarty
Little known fact:

Bill Wilson[1], co-founder of Alcoholics Anonymous, believed LSD could help
alcoholics achieve a "spiritual experience" that was crucial to them attaining
sobriety[2] (incidentally, that a spiritual experience could help alcoholics
was an idea he got from Carl Jung[3]). Wilson's own experiences with LSD are
discussed in detail here: [4]

In the 50's and 60's there was research in to using LSD to treat alcoholism,
with promising results:

 _" Osmond treated more than 700 chronically alcoholic patients with LSD and
ended up with around a 50 percent overall success rate. One of Osmond's most
compelling studies took place in the late 1950s with a cohort of subjects from
the group Alcoholics Anonymous. This cohort was comprised of individuals that
had failed the famous 12-step program, and again Osmond hit his 50 percent
success rate, this time with a 12-month follow-up period."_[5]

In 2012 a meta-analysis of studies with a total of 536 participants found _"
evidence for a beneficial effect of LSD on alcohol misuse"_.[6]

[1] -
[https://en.wikipedia.org/wiki/Bill_W](https://en.wikipedia.org/wiki/Bill_W).

[2] - [https://www.theguardian.com/science/2012/aug/23/lsd-help-
alc...](https://www.theguardian.com/science/2012/aug/23/lsd-help-alcoholics-
theory)

[3] -
[http://barefootsworld.org/wilsonletter.html](http://barefootsworld.org/wilsonletter.html)

[4] - [https://aaagnostica.org/2015/05/10/bill-wilsons-
experience-w...](https://aaagnostica.org/2015/05/10/bill-wilsons-experience-
with-lsd/)

[5] - [6] -
[https://www.ncbi.nlm.nih.gov/pubmed/22406913](https://www.ncbi.nlm.nih.gov/pubmed/22406913)

~~~
cies
Not even to speak about Ayahuasca (DMT) and Ibogaine. They seem to have even
more of these therapeutic properties.

~~~
Valmar
Ibogaine is amazing at dealing with addiction, considering that it can blow
away a serious Heroin addiction after one good trip.

~~~
throwaway5667
Isn't ibogaine that one drug where you have to go to West Africa to find it
due to its being illegal and inaccessible everywhere else and trips last for
literal days?

~~~
hootbootscoot
tis indeed.

as distinguished from iocaine, which is merely inconceivable.

~~~
jtms
But which cup is it in?

~~~
itronitron
it occupies both cups until observed

~~~
jtms
surprise! it also occupies both cups after consumed!

------
didymospl
The AA way was described in The Power of Habit as one of the examples of
successful habit change. Basically: keep the habit's cue(e.g. feeling
depressesed) and the reward(social interaction) but replace the bad
habit(drinking) with a better one(meeting with the sponsor).

~~~
unethical_ban
My alcoholism (if it can be called that - it is a spectrum) is driven in part
by the social interaction of fellow drinkers. The predictability of seeing
each other at the bar, of hanging out and not worrying about the day.

I've talked to one or two of them about doing tea on Tuesdays, or some other
thing that could get us from drinking 3-7 stouts a night.

That book may be worth a read.

------
elixanchor
recovering addict here. some words for those who may be struggling.

i tried a number of things over many years (life coach, therapy, meditation
retreats, ayahuasca, ibogaine, etc).

i reached a bottom, and nothing i had tried really worked or stuck. kept
relapsing after a few months of sobriety at most.

ultimately it was going to AA that i largely credit to my successful
transformation into a happy life of sobriety.

if you're not sure if it's right for you and struggling with addiction, i
highly recommend having an open mind, and trying 90 meetings and 90 days. see
how you feel after. it's the daily practice that is transformative.

there is something powerful about being focused on a purpose with a group of
similarly motivated people.

the people in the rooms of AA understand the challenge you're facing in a way
that friends and family often don't.

you quickly realize that the 'higher power' thing is a pretty easy to move
beyond, regardless of your religious orientation. a 'higher power' can even be
a conceptual device - e.g. the wisdom of the people in your meeting who have
achieved a life of sobriety.

it's also not to say that AA in itself is a savior. it's a healthy component
to integrate as part of a balanced recovery of body, mind, and spirit.

eating well, exercising often, and finding ways to be helpful are other
important pillars to incorporate along your journey.

good luck, be well.

~~~
athrowaway69
I had other experiences. The friendships I had in AA were superficial. Once,
when I was struggling and needed help and people to talk to, I was completely
ignored by the people around me. They didn't want to help the struggling -
just to have this toxic positivity that nothing is wrong.

I later moved out of state. I came back to visit family, and went back to a
meeting to find out that there were rumors that I had relapsed after I moved
and continued using until I was homeless. It was a drama fest. Absolutely
ridiculous.

When I moved, the meetings I encountered were extremely hostile to atheists.

~~~
iateanapple
> When I moved, the meetings I encountered were extremely hostile to atheists.

In my experience there are two types of atheists who go to AA: those for whom
religion “isn’t their thing” and those who are actively hostile to religion.

I think the latter group should find an alternative to AA.

~~~
athrowaway69
Nice. Blaming the victim and implying I was the hostile one.

I'm respectful of others' religions. It's a private matter. I made friends,
ostensibly, until they found out I was an atheist.

So fuck right off with your pseudo-righteous bullshit, okay?

~~~
iateanapple
Judging from how hostile your response is you are probably in the later
category.

I’m an atheist and I’ve been going to AA meetings for years in a very
religious area and I’ve had no problems at all.

If you are in the former category you are welcome and should try a different
AA group.

~~~
krageon
Consider that you _did_ suggest it was their own fault because they did
something bad and you have all the reason you need for their "hostile"
response. You've been fairly unpleasant about something that was obviously a
big thing in their life and that yields you responses like this. Turning that
around and (again) blaming _them_ and suggesting their negative response is
_entirely_ their fault goes beyond that into the fairly toxic. That's not a
healthy way to communicate with other people.

~~~
iateanapple
> Consider that you did suggest it was their own fault

No I didn’t. My original post was for anyone seeking help with substance abuse
- that AA is a good option for atheists who are friendly to religion and a bad
option for those who are hostile.

If I had wanted to put the parent into the hostile to religion group then I
would have said so.

Edit: I also never said anything about being hostile to religious people which
is the way the parent decided to interpret it so they could take a swing at
me.

------
sbilstein
I didn’t do AA but did AlAnon for children of alcoholics recovering from
trauma. Despite what people think, the 12 step program is super light on the
spirituality stuff and very atheist friendly. As a recovery group AlAnon was
super useful for getting some closure on the hell my parents dragged me
through and just leaving that stuff behind.

Edit:I guess I should have qualified that I’ve only done support groups in SF
that have been great and usually hosted by churches.

~~~
Waterluvian
My understanding is that they don't even need you to acknowledge a God, just
that "there is cosmically something bigger than you and you have no power to
govern it"

Is that about what you experienced?

~~~
gameswithgo
even that is just silly. it is true only when the idea devolves into that kind
of tautology.

I would obviously let it slide if I needed this kind of thing, but it is
clearly cruft.

~~~
Waterluvian
I won't pretend I understand how it works but I think it has to do with
accepting that you aren't in control of things, especially your addiction.

------
foxyv
> Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences, and
> his fellow investigators determined that AA was nearly always found to be
> more effective than psychotherapy in achieving abstinence.

This does not appear to include other programs like pharmacological extinction
or the Sinclair method.

> We included randomized controlled trials (RCTs), quasi‐RCTs and
> non‐randomized studies that compared AA or TSF (AA/TSF) with other
> interventions, such as motivational enhancement therapy (MET) or cognitive
> behavioral therapy (CBT), TSF treatment variants, or no treatment.

~~~
dang
Ok, I've edited the title to mention psychotherapy, since that's the
alternative that the submitted article (at least) focuses on. Which is still
an interesting finding.

Edit: we've since changed the URL and therefore also the title (see
[https://news.ycombinator.com/item?id=22550789](https://news.ycombinator.com/item?id=22550789))

~~~
andai
Had to scroll pretty far. The new link is paywalled for me (mobile).

------
grabbalacious
Outsider's uninformed opinion: if you attend AA then regardless of any
official narrative or agenda this means you're spending important time with
people who (a) used to drink, and (b) don't drink any more. Their example plus
hearing what they've got to say seems like an excellent approach.

~~~
frumiousirc
One wise ex drunk I know summed up his steps: 1) Action. 2) Group.

The "brand name" of the group is not so relevant.

------
towaway
If you're one of those for whom AA didn't work I would encourage you to look
at the The Sinclair Method. It has changed many lives for the better
(including mine).

[https://www.reddit.com/r/Alcoholism_Medication/](https://www.reddit.com/r/Alcoholism_Medication/)
[https://cthreefoundation.org/](https://cthreefoundation.org/)

~~~
openfuture
I googled it, seems to be you're supposed to take some drug that makes you
stop drinking.

~~~
sgentle
"Some drug that blocks the euphoric effects of drinking" would be more
accurate.

~~~
code_duck
What worked for me is developing an esophagus condition that makes drinking
alcohol or coffee result in instant burning pain. It was so easy to stop
drinking, multiple times, when that surfaced.

------
api
It's the community. Half the members of AA can't even name all the steps, but
in AA they find kinship with other people with similar experiences and similar
struggles.

Humans are hyper-social. We live better, grow better, heal better, and
confront difficulties better when we have others. This is true for introverts
too. Introverts are not anti-social, they just have a more muted less intense
social style.

~~~
thrownaway954
the old saying is... you are who you hang with.

hang around with good, positive people and good, positive things will happen.

------
olliej
I’m unsure about this meta analysis because it’s presumably based on AA
publications.

The thing is That numerous prior AA publications have treated “falling off the
wagon” or missing one of the steps to mean that you weren’t doing AA properly,
and so they _dont report it as a failure_.

Essentially they end up getting close to just filtering out all the treatment
failures, which inflates their success rate.

~~~
neonate
Based on the OP and two other articles (see below), I believe your presumption
is mistaken. It's hard to say for sure, because the list of studies included
in the meta-analysis hasn't been published yet (that I can find). (Edit: it
looks like the study is available at
[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full))
But the articles make it clear that this was a rigorous meta-analysis done by
qualified researchers. Surely they didn't just toss in AA publications
uncritically. What they're saying is that, after careful review, the studies
that have been popularized in the past as showing that AA was less effective
are the ones that turn out to be wrong. From the NYT link:

 _The 2006 Cochrane Collaboration review was based on just eight studies, and
ended with a call for more research to assess the program’s efficacy. In the
intervening years, researchers answered the call. The newer review also
applied standards that weeded out some weaker studies that drove earlier
findings._

 _In the last decade or so, researchers have published a number of very high-
quality randomized trials and quasi-experiments. Of the 27 studies in the new
review, 21 have randomized designs. Together, these flip the conclusion._

[https://www.nytimes.com/2020/03/11/upshot/alcoholics-
anonymo...](https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-
new-evidence.html)

[https://eu.usatoday.com/story/news/health/2020/03/11/alcohol...](https://eu.usatoday.com/story/news/health/2020/03/11/alcoholics-
anonymous-aa-helps-people-stay-sober-longer-study-finds/5008835002/)

~~~
olliej
Ok, this article itself measures in terms of continuing to attend meetings,
etc

Some basic googling found
[https://www.theatlantic.com/magazine/archive/2015/04/the-
irr...](https://www.theatlantic.com/magazine/archive/2015/04/the-
irrationality-of-alcoholics-anonymous/386255/) from 2015, which covers most of
my understanding of AA.

The measure of success should be _relapse after treatment_ , but AA doesn't
have the concept of stopping, and more importantly does not consider relapse
after ceasing attendance to be a failure of their 12 step program.

This ignores the moral corruptness of praying on, and essentially mandating
indoctrination, of people in need of help.

~~~
neonate
The debunking you're quoting has presumably been superseded by the much
higher-quality randomized studies reported on in the article. At least, if
that's not the case, then the researchers who've published the new meta-
analysis lack even basic competence, which seems unlikely.

------
chad_strategic
So I got sober in AA just as pagers were becoming a thing. I was lucky and
found a young people’s group in Pasadena.

If you have problems with Meetings, that’s cool. Find another one. Nothing is
going to be handed to u cause you want to get sober. It took a little while
before I found the right meetings. Or you can find a sponsor, no where in the
big book does it say that u have to go to meetings.

But if anybody is telling what you can and can’t do then, start talking to
Someone else... that’s just nonsense.

I’m always suspect of people with a grudge against AA. I’m here to help and if
it’s not for you that’s cool to. I’m not Christian but if works for some and
doesn’t hurt other then who am I to judge.

------
recoveredtoday
I am 7 years sober via the AA path after trying just about everything else.

I really, really didn't want to go into an AA room the first time and even
when I mustered the courage to try it I almost drove out of the parking lot
:).

The decision to walk into the room changed my life.

There are many paths to recovery but if you are at a point or have questions
you would like to ask privately please reach out to me anonymously.

I set up an email recoveredtoday@mail.com to go with this anon account.

~~~
blast
Did you ever read Roger Ebert's homage to AA? If not, you might enjoy it.

[https://www.rogerebert.com/rogers-journal/my-name-is-
roger-a...](https://www.rogerebert.com/rogers-journal/my-name-is-roger-and-im-
an-alcoholic)

~~~
recoveredtoday
Thank you for passing this along!

------
muzani
There's a lesser known study in which someone who is optimistic about their
behavior performs worse. The people who think they have the most willpower are
likely to give in. The more people lose will, the more they view that failure
as an anomaly, work harder at it, and spiral worse.

When smokers were asked to smoke the same number of cigarettes every day, and
explicitly told not to smoke less, they gradually smoke less.

The people who are pessimistic about their odds often do well. It's likely
that AA's approach of making people to feel powerless is what ironically gives
them more willpower.

Sources: Howard Rachlin, The Science of Self-Control; Kelly McGonigal, Maximum
Willpower.

------
neonate
[https://archive.md/emYOt](https://archive.md/emYOt)

------
c3534l
Interesting. I was never a fan of AA and I was very critical in the lack of
science and rigor in addiction treatment, and actually for mental health in
general. I always felt there were better treatments, but CBT-based group
therapy / 12-step alternatives are pretty rare. All you really need to start a
chapter of AA is to not have one nearby and a place to host it. It's
comforting that AA at least doesn't make things worse, on average, even if its
not amazing. I'm still not comfortable with the fact that the government will
require people to attend what is essentially a religious service as criminal
punishment, and there are certain aspects of AA that they should probably at
least de-emphasize.

~~~
jeffdavis
"I'm still not comfortable with the fact that the government will require
people to attend what is essentially a religious service as criminal
punishment"

Maybe there's some kind of slippery slope there, where they eventually start
sending you to church for a parking ticket. But we don't seem to be sliding to
that conclusion very quickly; so if it works, just go with it.

If you want to make a big federal case out of it, you could probably win it.
But I honestly don't see how anyone wins with that outcome.

~~~
zAy0LfpBZLC8mAC
> But I honestly don't see how anyone wins with that outcome.

Then you presumably aren't aware of how abusive religious people can be
towards atheists, and that includes in AA groups.

~~~
jeffdavis
It's one thing to criticize religious impositions on a secular activity (like
addiction recovery). What you have just done is criticize religious _people_
as a group, and claim that they are abusive.

Criticize ideas and policies; not groups of people.

~~~
zAy0LfpBZLC8mAC
> What you have just done is criticize religious people as a group, and claim
> that they are abusive.

No, I have obviously not.

> Criticize ideas and policies; not groups of people.

Why? What, in your mind, is the problem with criticizing abusive religious
people as a group?

------
MaysonL
Those interested in A.A.'s official position on atheism and agnosticism should
check out the pamphlet[0] _Many Paths to Spirituality_ published recently by
AA World Services, the legal entity responsible to North American A.A.. The
link is to a product page - click on the picture of the pamphlet to download a
pdf. There are sober atheists in AA. To anyone who gets a bad reaction to
professed atheism in an AA meeting, remind the offenders of AA's Tradiion 3:
"THE ONLY REQUIREMENT FOR AA MEMBERSHIP IS A DESIRE TO STOP DRINKING". If they
persist, find or start another meeting.

[0][https://www.aa.org/assets/en_US/aa-literature/p-84-many-
path...](https://www.aa.org/assets/en_US/aa-literature/p-84-many-paths-to-
spirituality)

------
NicolasGorden
I completely agree with the message that people-helping people is super
effective.

But I'd like to point out that one of the core tenants of AA is to surrender
to a higher power.

I'm not advocating in favor of religion. But rather highlighting that maybe
people who accept 'surrender' of their own will are more likely to get better.
There's something to the concept that seems powerful.

Anecdotally, I've known someone who used to be stressed out and controlling.
Last time I saw him he was not so stressed. He said his life changed once he
surrendered and accepted his destiny. He didn't go religious or anything, just
'accepted' his fate.

It reminds me of the old saying: The reasonable man adapts himself to the
world, the unreasonable man adapts the world to himself, therefore all
progress is due to the unreasonable man.

~~~
saberience
I think there's a major understanding of this part of AA. This DOES NOT mean
acknowledging that you believe there is a god. The concept of a "higher power"
can mean anything you want it to mean. You can imagine your higher power is
Gandalf, Sauron, elves at the bottom of the garden, or even some aspect of
your "best self." You could imagine it to be the spirits of your ancestors or
even something like the energy of the universe.

The point is surrendering to something "bigger" than yourself. Don't get tied
up in militant atheist perspectives.

~~~
eeZah7Ux
> You can imagine your higher power is Gandalf, Sauron, elves at the bottom of
> the garden

That's quite cheeky.

Telling people to believe in a "higher power" simply translates into the gods
in the mainstream religion in the society they live in.

~~~
komali2
I'm with you - whenever a non-demoninational event goes down, or when someone
says "take the higher power of your choice, could be Gandalf, it doesn't
matter!" I can't help roll my eyes. It's an ignorant thing to say. Assuming a
religion is "invalid" or not a "religion" if it doesn't have a godhead at all.
Many don't, named or otherwise. "Higher Power." And lord forbid your chosen
godhead is someone else's religion fallman. When I was growing up in SC and
we'd do these school classroom prayers (public school, unconstitutional, but
who's keeping score?), me being a cringy little 13 year old atheist would say
shit like "hail satan" and raise ire of pretty much the entire school. So no,
they don't really mean "your higher power of choice," they mean "your given
godhead that I can convince myself is actually mine just under a different
name."

------
manifestsilence
Does anyone else feel like this study is a bit tautological in that it's
measuring attributes that are valued by the AA method? Many other methods
don't preach abstinence so of course they're going to get less total
abstinence duration. But I wonder if there are better ways to measure overall
effectiveness and well-being. Some people learn to manage their drink and
would fare poorly on that metric.

------
snurfer
Anecdotally, self-help is an effective approach not mentioned in the article.

~~~
billjings
It works for a lot of people. For many people, particularly the worst cases,
it does not. Most people who end up in AA have tried self-help already.

------
JamesBarney
The studies in this space are notoriously bad(AA has a lot of true believers,
which can lead to publication bias, and psychotherapy research in general is
pretty poor). And one the best and largest studies(MATCH) on the topic show
that pretty much every non-pharmacological treatment is the same.

For a different take on the literature look at
[https://slatestarcodex.com/2014/10/26/alcoholics-
anonymous-m...](https://slatestarcodex.com/2014/10/26/alcoholics-anonymous-
much-more-than-you-wanted-to-know/)

~~~
neonate
But Cochrane reviews are notoriously good. They're always spoken of as the
standard in meta-analysis. What's interesting here is that new research is
contradicting previous findings.

According to [https://www.nytimes.com/2020/03/11/upshot/alcoholics-
anonymo...](https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-
new-evidence.html), the weak studies they weeded out were ones that had found
against AA, not in favor of it.

~~~
JamesBarney
It is, but even if the review is done really well garbage in/garbage out.

~~~
neonate
_The 2006 Cochrane Collaboration review was based on just eight studies, and
ended with a call for more research to assess the program’s efficacy. In the
intervening years, researchers answered the call. The newer review also
applied standards that weeded out some weaker studies that drove earlier
findings.

In the last decade or so, researchers have published a number of very high-
quality randomized trials and quasi-experiments. Of the 27 studies in the new
review, 21 have randomized designs. Together, these flip the conclusion._

(from that NYT link)

~~~
JamesBarney
Thanks, you're right I didn't look into this enough.

------
program_whiz
Its possible cultivating those beliefs, even if false, is a powerful tool in
overcoming addiction. It may actually be the case that cultivating some belief
in a higher reason / order to the universe is beneficial in recovery. There
are dedicated circuits in the brain for religious / spiritual thinking and
feeling, and when activated may play a role.

As a counter-point, its possible to imagine a scientific discovery that while
true, would cause mass suicide and depression upon discovery (e.g. an asteroid
will hit the planet in 10 days). While implausible, suppose that we "found
scientific proof" the god exists and is the christian god, and eternal life /
punishment awaits us after death. This knowledge / belief would probably
radically alter the behaviors of society (lower crime, suicide, depression,
etc).

Another good example is a healthy self confidence. For most people, this is
incredibly beneficial (stave off depression, get a stable life, eat right,
avoid addiction), but could be seen as a false belief. Most people's
contributions don't "matter" in any real cosmic sense, their lives won't be
remarkable, and they aren't more talented / qualified than most people. The
insignificant experience we gain in a few years on this tiny dust speck isn't
enough to make confident opinions on life or the universe. Most people are
cogs in the machine, generating waste heat, and their death would hardly be
noticed, and soon forgotten. But embracing those facts as "true" would have a
markedly negative effect for most people, so perhaps its better to falsely
believe the opposites of these (and we have dedicated circuitry to help us do
just that, ignore all evidence to the contrary).

My basic takeaway is that this entire AA thing is an experiment to ask that
very question: does cultivating this set of thought patterns prove effective?
Is it more effective than the thought patterns of other approaches? Even if
the beliefs are "forced" or "false", are they effective?

EDIT: wording.

~~~
badpun
> Its possible cultivating those beliefs, even if false, is a powerful tool in
> overcoming addiction. It may actually be the case that cultivating some
> belief in a higher reason / order to the universe is beneficial in recovery.

Also - these beliefs may be soothing, which decreases stress level and helps
with depression and addiction.

~~~
program_whiz
Great point. I think we evolved these types of thinkings because it helped
with tribal cohesion, self-soothing, and the ability to deal with adversity.
The thought "everything happens for a reason" comes to mind.

------
dang
We changed the URL from [https://medicalxpress.com/news/2020-03-alcoholics-
anonymous-...](https://medicalxpress.com/news/2020-03-alcoholics-anonymous-
effective-path-alcohol.html) to one that gives more information about what's
going on here.

~~~
lolc
I couldn't read the NY article due to paywall. I could read the Medicalxpress
link.

~~~
dang
Users post workarounds in the threads. There's one in this thread. I realize
finding it is a chore when there are a ton of comments, but that's a small
price to pay for a significantly better article.

------
jaybeeayyy
How is it even possible to study AA meetings when they can vary so much
everywhere in the world? Some have been horrible with horrible people while
others were fine...some were good. I just never saw actual consistency even in
the same meetings.

------
runarberg
Direct link to study:

[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full)

------
zackkatz
I find it frustrating that the subheading says “less expensive.” No, it’s
FREE. Absolutely free. Donations optional.

To me, it sounded like the editor of the piece didn’t want it to sound
promotional, which made it less true.

~~~
dredmorbius
No-cost-to-member, and overall cost, are two different notions. bAs are
financial and nonfinancial costs, e.g., time, travel or transport,
facilitator, meeting space, training or. materials.

------
RickJWagner
I lost one of my best friends to alcoholism about a month ago. My friend was
54 years old.

AA is good. It does help, but it's not an absolute cure. It does seem better
than most (all?) of the other methods.

The very best way forward is simply to not take the first drink, ever. (This
is what I am hypocritically telling my children. I drank to excess in my
younger days, but I've been dry for about 20 years.) I hope they listen. Booze
works for many people, but it's absolutely disastrous for some.

~~~
kelnos
The best way to avoid dying in a car crash is to never get into a car, ever,
but we're not advocating that, are we? Car crashes kill more people in the US
than alcohol abuse.

I get that you're afraid that your kids will end up abusing alcohol, but I
think you do them a disservice by painting the world so black-and-white.
Avoiding alcohol can have many good effects, but it can also leave people out
of many valuable social (and in some industries) business experiences, as much
as it's a shame that that's still the case. Better to let them make their own
decisions when the time comes without unduly influencing them with an
absolute. (And many prohibitions that you lay on kids end up backfiring
greatly with opposite effect, so there are no guarantees.)

Meanwhile, there are lots of more likely ways that they could screw up their
life. Alcohol is just an easy bogeyman to shake a stick at.

~~~
samatman
Cars get you places.

Alcohol qua alcohol is a pretty terrible drug, toxic in reasonable doses, very
addictive, affects judgement, and so on and so forth. I happen to think in a
culture with a sane attitude towards drugs in general, alcohol wouldn't be a
favorite.

Mormons, Muslims, straight-edgers, teetotalers, and alcoholics, all manage to
socialize and conduct business just fine while never touching alcohol.
Literally all you have to do is order soda water. Anyone who gives you crap
for not drinking is going to turn out to have other bad habits, bet money on
this.

GP is right: the absolute best way to avoid problems with alcohol is to not
drink it. Considering GP was a problem drinker, and that has a genetic basis,
you are being arrogant as hell telling him how to raise his children.

------
jariel
"for each additional A.A. meeting attended, health care costs fell by almost
5%"

Wow. It's really quite stark to see it in such austere terms.

The cost nature of this is quite exceptional if you think about this.

Without even unpacking anything to any degree, it would seem that dragging
oneself to a meeting, socializing with others in the same plight, re-affirming
one's commitment to 'getting better' probably really goes a long way to
changing behavior.

------
burnJS
AA is great. It saved my Dad's life. For a while, I was going too. Ultimately
I began drinking again and things are much better now. I also know that if
things ever get rough for me I can rely on AA. Really great group of non-
judgmental people in there. As an agnostic, the "God" stuff wasn't a problem
for me, it's pretty light and on your own terms.

------
throw51319
Someone else mentioned this and I agree wholeheartedly. I think unless you
have a physical addiction to something, you just need to discard it and
"forget" about it.

For drinking, I think the new Heineken 0.0 is a game changer. You can go out
to a bar and hold one and drink, get the placebo effect.

------
invisiblerobot
A fantastic book and complete alternative to the AA approach is Allen Carr's
Easy Way to Control Alcohol. It focuses on the reasons TO drink which is
unusual. And it does a good job of dismantling them.

------
thrownaway954
just remember everyone that there are other 12 step and recovery focused
programs and out there. so adventure out, explore, meet people, find where you
fit and heal :)

[https://aa.org/pages/en_US/meeting-guide](https://aa.org/pages/en_US/meeting-
guide) Alcoholics Anonymous - for those who have a desire to stop drinking
alcohol.

[https://www.na.org/meetingsearch/](https://www.na.org/meetingsearch/)
Narcotics Anonymous - for those who have a desire to stop using drugs.

[https://secularaa.org/meetings/](https://secularaa.org/meetings/) Secular AA
- same thing as AA except they don't pray nor require a belief in a higher
power (no God stuff)

[https://whitebison.org/WellBriety.aspx](https://whitebison.org/WellBriety.aspx)
Wellbriety - Wellbriety means to be sober and well. Wellbriety teaches that we
must find sobriety from addictions to alcohol and other drugs and recover from
the harmful effects of drugs and alcohol on individuals, families and whole
communities. The ‘Well’ part of Wellbriety is the inspiration to go on beyond
sobriety and recovery, committing to a life of wellness and healing everyday.

[https://heroinanonymous.org/meetings/](https://heroinanonymous.org/meetings/)
Heroin Anonymous - for those who have a desire to stop using herion (basically
like NA only herion focused.)

[https://crystalmeth.org/cma-meetings/cma-meetings-
directory....](https://crystalmeth.org/cma-meetings/cma-meetings-
directory.html) Crystal Meth - for those who have a desire to stop using
crystal meth (basically like NA only crystal meth focused. the meetings are
off the charts)

[https://www.smartrecoverytest.org/local/](https://www.smartrecoverytest.org/local/)
SMART Recovery - Self-Management And Recovery Training (SMART) is a global
community of mutual-support groups. At meetings, participants help one another
resolve problems with any addiction (to drugs or alcohol or to activities such
as gambling or over-eating). Participants find and develop the power within
themselves to change and lead fulfilling and balanced lives guided by our
science-based and sensible 4-Point Program®.

If you know or attend other group, please list :)

~~~
thrownaway954
one other thing... just because you might have had a bad experience at one aa
or recovery meeting doesn't mean that recovery in general sucks. i always say,
there is a reason why most 5:30 pm meetings are called Happy Hour. most trade
the room for the bar and although they aren't drinking or using they are still
jerks and aren't doing the same stuff they use to do. the old saying is a
sober horse thief is still a horse thief. i find that people who are serious
about getting sober usually go to morning meetings or smaller meetings (like
church meetings). also... men with men, women with women seems to work for
most.

------
remmargorp64
I realize this might not be a popular approach, but I figured I would share my
experience here in case anyone else is helped by it:

I was an alcoholic for over 10 years. I would drink multiple liters of vodka
weekly. It was not uncommon for me to drink an entire 375 ml bottle of vodka
in an evening.

I never really considered myself to be an "alcoholic" in the traditional sense
though, because I didn't let it affect my day-to-day life as a programmer. I
was young and healthy, and I didn't usually have much of a hangover because I
only drank high end vodka, and I always drank a lot of fluids. Whenever I got
a hangover, I would just pop an ibuprofen and the hangover would disappear
after about an hour. I would literally set my alarm an hour before I wanted to
wake up, and when that alarm went off I would wake up, pop an ibuprofen, drink
half a glass of water, then go back to sleep. By the time my second alarm went
off an hour later, I was as good as new.

I literally did this for years, while often working 12 hour days as a
programmer. Nobody could tell, and it didn't seem to affect me too negatively,
so I didn't see a reason not to. It helped me relax at the end of a long day,
and it made movies and television more fun and enjoyable to watch. It was also
fun to go out to bars and hang out with friends.

Eventually, though, it caught up to me, and I started to get reports from
doctors about abnormal liver test results. They were still just borderline,
but it was enough to scare some sense into me. I had just recently had a son,
and I realized I wanted to be alive for when he grew up.

So I tried to stop drinking. I didn't want to go to alcoholics anonymous (I
didn't consider myself to be an alcoholic after all, and I'm an atheist and
didn't want to deal with all of their religion/higher power 12-step stuff).

Quitting cold turkey worked for about 3 months, but as I'm sure you know, the
alcohol drinking culture in the programming startup world is extremely
prevalent.

It was only a matter of time until I ended up in a social scene where I felt
pressured to drink, and I had a beer along with everyone else. It was all
right, I told myself. It was just a beer! No big deal! I had quit drinking
before and I have it under control now, so it's ok! Nope. Once I got a taste
and a reminder of the stress relief offered by alcohol, I started right back
into it. Next thing I knew, I was drinking vodka every night again.

After a couple of more false attempts to stop (with each one being thwarted by
my having a beer and getting sucked back in), I finally came to terms with the
fact that I simply can't drink. I can't touch the stuff or I will get sucked
back in. I realized I was an actual alcoholic.

So I stopped. I carefully tapered off my heavy alcohol consumption over the
course of a week, and that was it. I've now been sober for a year and a half.
Whenever I'm in social situations where other people are drinking beer, I
simply order a diet coke or something and I sit and enjoy their company. I
might even shoot the breeze and chat about all my favorite types of scotch or
whatever. But I absolutely do not allow myself to have even one sip of
alcohol, because I've learned the hard way what it leads to.

As a side note, during that year and a half, I also managed to get completely
out of $50,000 worth of debt, pay off my car, and diet my way from 245 lbs all
the way to 180 lbs (still have another 20 lbs to go before I reach my goal of
160).

And I did it all without alcoholics anonymous or medication or therapy or
anything. I simply accepted ownership of the problem, made a decision, and
stuck with it.

With that said, however, there _was_ a catalyst and a "higher power" that lead
to the change and kept me on track:

I had a kid, and I realized that I wanted to stay alive long enough to see him
grow up and have kids of his own.

I realize this might not be a magic bullet for anyone (and I hope you get help
if you need it), but my point is simply that sometimes it is in fact possible
to do on your own (given the right circumstances and motivation), although
this fact is something that is not very popular to mention.

------
chad_strategic
FYI: the best meetings are the speaker meetings. Less drama, higher quality of
people who want to get sober. Also most of the groups goes out to coffee or
dinner after the meeting.

------
fulafel
I wonder if there are any studies about how religion in general works for
alcoholism? It would be interesting to study how much of AA's function comes
from religion.

------
lcall
For what it may be worth, our church also has a very good (edit: free) 12-step
program for any addiction (like porn or substances):
[https://addictionrecovery.churchofjesuschrist.org/steps?lang...](https://addictionrecovery.churchofjesuschrist.org/steps?lang=eng)

I think even just reading it, watching some videos, is worthwhile, but the
complete program can be effective.

------
mullingitover
Trying to find sources to confirm this, but I've repeatedly heard that
cognitive behavioral therapy dominated AA in effectiveness. I would take this
more as an indictment of psychotherapy than an endorsement of AA.

Edit: I found a review of Project MATCH[1].

> Background

> Project MATCH was the largest and most expensive alcoholism treatment trial
> ever conducted. The results were disappointing. There were essentially no
> patient-treatment matches, and three very different treatments produced
> nearly identical outcomes. These results were interpreted post hoc as
> evidence that all three treatments were quite effective. We re-analyzed the
> data in order to estimate effectiveness in relation to quantity of
> treatment.

>Results

> The results suggest that current psychosocial treatments for alcoholism are
> not particularly effective. Untreated alcoholics in clinical trials show
> significant improvement. Most of the improvement which is interpreted as
> treatment effect is not due to treatment. Part of the remainder appears to
> be due to selection effects.

[1]
[https://bmcpublichealth.biomedcentral.com/articles/10.1186/1...](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-5-75)

~~~
riyadparvez
As someone who is been in psychotherapy and an arm-chair psychology
enthusiast, not every kind of therapy will be effective for everyone. This
also goes for psychiatric medications.

CBT is often oversold as a cure for every kind of mental health issues. New
meta-research has found that the effectiveness of CBT has been decreasing for
quite some time and long-term effectiveness of CBT is arguable.

Regarding effectiveness of AA, I think it makes sense. Lot of people with
addiction suffer from childhood trauma, emtional neglect, and abandonment. In
psychological term it is called attachment injury. A community where you are
not shamed, validated, understood, and accepted would give corrective
emotional experience, which would in turn heal your attachment trauma. I've
heard this phrase somewhere: "what cures people in therapy is love". So it's
not surprising that finding a community where you are accepted would help you
treat your addiction.

~~~
luckylion
> not every kind of therapy will be effective for everyone

That's pretty problematic though, isn't it? At some point, you're dropping
below placebos, not everything works for everyone, but should we still put
weight on it? Homeopathy and intense praying works for some as well, but we
don't say "I guess it's not effective for everyone". Psychotherapy (not the
behavior therapy kind) gets a pass for some reason.

------
HarryHirsch
It's noteworthy that all but one of the studies quoted in that meta-review
were conducted in the United States. The usual criticism levied against AA is
that it takes a religious approach, but that's not even true, it it built on
evangelicalism. If you are in the US, you are either evangelical or you at
least understand evangelicalism because that's what your friends and
colleagues profess. You wonder how AA would fare in other countries, where
their approach would meet with bafflement or hostility because the background
is not understood.

~~~
filoleg
Even in the US, it heavily depends on where you live. If you are in one of the
big west coast cities, I would imagine you can observe a situation similar to
Europe.

I felt like that joke from one of the more recent seasons of Silicon Valley,
where the episode revolved around one of the characters "being outed" as a
christian, was very on point, from what I have personally observed both in SF
and Seattle. A bit of background on the episode: one of the CEOs of partnered
companies owned a gay dating site. No one had any concerns or issues with
that, but as soon as some people found out that the CEO was christian, all
hell broke lose and the following quote was dropped "You can put micro doses
of LSD in your cereal and people will call you a pioneer. But the one thing
you cannot be is a Christian."

P.S. The show is obviously pretty tongue-in-cheek, no one seriously claims you
cannot be Christian in those areas or that you would face hostility due to it.
But people will definitely be questioning it a bit.

------
kwhitefoot
This is probably not going to be a popular thing to say but total abstinence
isn't necessarily the goal that everyone who has a drinking problem is aiming
for.

Just as those who over eat want to control their appetite for food rather than
simply stop eating so do some who have a drink or drugs problem. In many cases
the drink is a symptom not a cause. Remove the cause and for some people at
least the drink problem will subside.

I worry also that the AA members are also a subset of those who have a
drinking problem, are we sure that they are a comparable subset to those who
took other paths? How do the studies account for people who drop out of either
AA or some other program and did the studies follow up years later to find out
if people had fallen back into addiction?

The article was a bit light on details.

And lastly the article mentions relative efficacy but doesn't say anything
about how efficacious any of the programs were leaving me wondering if any of
them are worthwhile.

~~~
handedness
Great comment, except the first line is only true of some recovering
alcoholics.

It is not at all true for a great many of them, and for them that is downright
dangerous advice.

~~~
Broken_Hippo
Just because it isn't true for all doesn't mean we should eshew it. Yes, some
folks find out they can't drink at all, ever. Others will do just fine being
without for a bit, then learning how to drink moderately. It isn't dangerous
advice, merely truthful and we can be honest about it not being right for
everyone.

------
addict_throwawa
throwaway account obviously. this got long but here's my (five) cents.

I'm an addict in recovery. In the past alcohol and then switched to opiates
(sadly all to common story of getting pills from MD unnecessarily). I haven't
faced many consequences and have been still successful in tech. still not
'out' about opiates to work or friends, just my peers in recovery.

I have found the underlying hypothesis of this - group support - has been a
really big help for me. I found a group for those in recovery that participate
in sports (the Phoenix) which has a double punch of great community and also
physical activity which is super beneficial.

For me, I think this has been the second biggest contributor to success.

But my #1 - with opiates in particular - is medicine replacement therapy. I
tried so many times to get off myself. I finally got on buprenorphine which
has been a lifesaver and successful to date on first try [one year!]. There
are also some drugs now for alcoholism but unfortunately stimulants seem to
not have great options.

It seems a shockingly low amount of rehabs use replacement therapy [1] [2] or
even know about it (or even as a short term withdrawal taper tool). There are
also a scary amount of overdoses from relapse post rehab.

I think the science is pretty convincing - there are studies showing even if
relapse after maintenance therapy the period of abstinence before relapse is
longer [3] - and also just seems like MUCH higher success rate [4].

BUT this is still an opiate! My doctor has patients who have been on for
years. A lot struggle to get off. I personally don't have a problem with very
long term use - personally I see parallels with SSRIs/SNRIs where many users
report problems getting off and withdrawal, but obviously who would say you
should get off something like prozac - a mind altering drug that has clear
benefit?

The most FU part of this for me - it still takes a special license to dispense
buprenorphine replacement therapy, patient numbers are capped per MD, and
there is a ton of stigma all around even at pharmacies who dont blink twice
doling out opiates. Pisses me off when looking at how most MDs can dole out
opiates with far less training/license requirements. also pharma definitely
profits - though there are now generics. i've found at least for the strips
it's basically the same price. The pills without naloxone are cheaper - but
for addicts struggling that gets rid of the back stop and overdose preventer.

Plus having only a few Drs in many states (or none) that charge cash or
medicare only makes it in-accesible for many of the downest and out addicts.
It should be free (or covered by the worst pharma co s) and FAR more MDs
should be able to write script.

[1]
[https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rp...](https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/sr107-NSSATS-
Buprenorph.htm)

[2] [https://www.rehabs.com/pro-talk/opioid-addiction-
treatment-w...](https://www.rehabs.com/pro-talk/opioid-addiction-treatment-
why-dont-more-rehabs-use-suboxone/)

[3]
[https://www.ncbi.nlm.nih.gov/pubmed/30094695](https://www.ncbi.nlm.nih.gov/pubmed/30094695)

[4]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/)

~~~
Pigo
I've heard that part of the motivation for the escalation of opiate strength
(fentanyl and carfentanil) is because so many people have begun seeing success
with these new therapies. The illegal marketplace has probably been losing
profits.

Maybe replacement therapy isn't perfect, but I've seen it help a lot of people
who are in a bad place. I wish there was more motivation for finding exit
strategies, but there doesn't seem to be any profit in that.

~~~
addict_throwawa
my dr mentioned that he's had success with the sub cutaneous thing. it lasts a
month and it seems like it's a good way to slowly taper down. and he said the
bupe stays in your body for a LONG time when doing that - longer than a month
after the 30 day period

it's really hard to taper down! it takes a lot of willpower not to just take
more since you have it sitting around. i wonder if would be more successful
with like a 1 month taper for in patient program.

~~~
formeruser
I tapered off of my Suboxone prescription gradually over a long period of
time. By the end of it, I was taking very tiny pieces of the film. They were
small enough that at some point, it was probably more mental than anything.

I wish you all the best! After getting off of it, the hardest part for me was
still maintaining a clean lifestyle while avoiding the types of people and
behaviors that lead to scoring or abusing other drugs (alcohol included) as
well.

~~~
addict_throwawa
How long of a taper did you do? im not on a very high dose but was still
thinking about like 3 months. but I also am 50/50 like I'm worried about the
after effects you have - this is working so well now I see very little
downside to long term use and the upside is really big imho - except probably
harder to eventually taper off the longer I'm on.

~~~
formeruser
By not high, do you mean around 2-4 mgs? If so, 3 months is probably a good
timeline for taking a 25%-50% reduction every 1-2 weeks or so. I might have
even taken longer for the last few doses. I think the big thing is not to rush
it and take a pace you're comfortable with. Like you say, taking buprenorphine
is much preferable to turning to alternatives.

My first experience with a taper was at rehab as they were pushing me out the
door. They rushed it, and I was dopesick as I left. You can imagine that
didn't turn out well.

Another thing I credit my recovery to is having strong support along the
process. Also, building new lifestyle habits like going to the gym helped me
improve my self-image. I don't know how much making that sort of change would
apply to you but thought I'd mention it.

~~~
addict_throwawa
great advice - thank you. it's helpful hearing success, and triple from those
who have successful business lives especially tech/engineering/etc

yup on on 4mg.

i go to the phoenix snd got into my preferred sport again! something i gave up
while using that was a huge part of my life. and it's been so good to get it
back both community, new friends, and just getting back into shape.

------
pcvarmint
RIP Herbert Fingarette

Love Stanton Peele

Jeffrey Schaler is a Choice

------
erokar
Belief in a higher power a serious side effect of this treatment regime,
though.

------
shrimpx
Finally, scientific evidence of the vast healing power of God. /s

------
aaron695
What's more interesting is since "The Irrationality of Alcoholics Anonymous"
(2015)[1] HN thinks they are experts in how AA doesn't work.

These meme bugs that infect people are the on ongoing issue you see a lot
here.

They make no sense, but that's why the meme works. AA is free and you talk to
people about your issues, it's hard to see why it's wrong, which is why people
love the meme.

Throw in some other regulars -

Inefficiencies mean people actually use more because of "Jenkins paradox" so
don't make things efficient!

You are supposed to wake up every night in the middle because some researcher
in the arts read it in 300 year old documents.

People are more afraid of losses than gains.

Dumb people think they are smart.

People rise to their level of incompetence... Actually this ones true. But it
does mean Impostor Syndrome is more complex than people say.

[https://www.theatlantic.com/magazine/archive/2015/04/the-
irr...](https://www.theatlantic.com/magazine/archive/2015/04/the-
irrationality-of-alcoholics-anonymous/386255/)

~~~
leetcrew
> They make no sense, but that's why the meme works. AA is free and you talk
> to people about your issues, it's hard to see why it's wrong, which is why
> people love the meme.

this isn't a very charitable take. there are a lot of legitimate reasons to be
skeptical about AA. to an outsider, the tone and content of the twelve steps
can seem pretty weird. why abstinence only, and why don't coffee and
cigarettes count? why are people prohibited from identifying themselves as a
drug addict in some AA meetings (as if alcohol is not itself a drug)? why does
AA itself collect essentially no data that could be used to determine the
efficacy of the program? why do courts mandate attending AA but not other
similar support groups?

the old adage "it's hard to beat free" certainly applies here, but I wouldn't
casually discount all the negative stories in this thread from addicts that
tried AA.

------
thulecitizen
Dear Dang, what does your admin toolset look like? Have you written about that
anywhere? I'm curious, is this post of yours at the top because it has the
most upvotes, or because you are pinning it here?

~~~
prawn
I've always assumed that some top level posts are elevated based on the
quality/upvotes of their best replies.

~~~
thulecitizen
Yeah I think it works like that too.

Yet at the same time I think dang has the ability to move any post up or
down/re-prioritizing or re-ranking based on his intellect, instead of a
natural, organic ranking. It becomes a forced therapy session by dang. We also
cannot know if this happens, since those moves would be invisible to everyone
else on the site (except to other admins/moderators). I do not think it’s far
fetched to think he has this power, seeing as karma scores are conveniently
hidden for all posts (except for the author of each individual post).

I’m a little disturbed that dang seems to ‘steer’ conversations based on his
own interests. There’s a bunch of smart people here and I don’t understand why
he goes past his role as administrator to interject into certain threads. It’s
‘bad hosting’ in my eyes.

With my questions I’m trying to understand what the rules of the game are, to
see whether I like them or not and whether I want to keep playing (engaging on
HN).

~~~
dang
We're not in every thread moving things up and down, but HN is curated and
that involves judgment and interpretation. For example, if there's an offtopic
comment, especially a generic one [1] sitting at the top of a thread
collecting upvotes as they tend to do, it's a standard moderation move to
downweight it.

The idea of HN is intellectual curiosity. Sadly, upvotes alone don't optimize
for that; the voting system optimizes for indignation and repetition.
Countervailing mechanisms, such as software and moderation, are needed. We use
software to do what we know how to automate and humans to do what we don't
know how to automate—though I wish we did, because most of the human
intervention at this level is tedious.

Today is a good moment to illustrate this, actually. If humans weren't
curating HN, we wouldn't have had
[https://news.ycombinator.com/item?id=22545878](https://news.ycombinator.com/item?id=22545878)
or
[https://news.ycombinator.com/item?id=22548217](https://news.ycombinator.com/item?id=22548217),
and probably not even the current thread about AA. It would have been all
coronavirus stories, or almost all.

[1]
[https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...](https://hn.algolia.com/?dateRange=all&page=0&prefix=false&query=by%3Adang%20generic%20discussion&sort=byDate&type=comment)

------
a_c_s
That doesn't make sense: AA is not very effective at all.

"Based on these data, he put AA’s actual success rate somewhere between 5 and
8 percent."

[https://www.theatlantic.com/magazine/archive/2015/04/the-
irr...](https://www.theatlantic.com/magazine/archive/2015/04/the-
irrationality-of-alcoholics-anonymous/386255/)

~~~
neonate
The Cochrane meta-analysis has arrived at opposite results to that debunking,
based on 21 recent randomized studies. It's interesting how many comments in
this thread are pointing to the older results as if they debunk the newer
ones.

------
zomg
It's refreshing to see people helping people in programs like AA.

I'm curious to see if the success of these programs change in the coming
decades, as younger generations seem to be moving away from social interaction
in favor of social MEDIA interaction. Will this have an impact on the success
of programs like AA? I hope not.

~~~
Agenttin
You could always have an AA meeting in VR Chat. In fact, I'd be surprised if
there isn't one.

~~~
xfitm3
Doing it virtually makes it hard to retain the "anonymous" part of AA.

~~~
bbunix
Anonymous is at the level of press, radio and films...

~~~
fat_cam
^^ Tradition 11. Tradition 12 states:

"Anonymity is the spiritual foundation of all our Traditions, ever reminding
us to place principles before personalities."

While it is easy to take the word anonymity at face value, in my opinion as an
alcoholic active in AA, anonymity as it is mentioned here in tradition 12
deals more with ego and pride. When you walk into a meeting, you leave "what
you are" at the door and walk in as "who you are." This translates into
practices of not using honorifics. A judge isn't "Your Honor" at a meeting. A
priest isn't "Father." All are equal, and all are just one drink away from
being drunk. Thus, placing AA's principals before our own personalities.

------
AtlasBarfed
Last I google-researched, AA-style treatment was really the ONLY effective
treatment against long term dependence/addiction. Psychotherapy and others
almost always failed.

It probably is related to the social network effect that was described with
Vietnam vets dumping heroin addiction when they returned home to their old
social groups that didn't accomodate the behavior. AA et al provide a new
social group that actively tries to stop the addiction.

~~~
metabagel
For those who AA doesn’t work for, I would recommend psychotherapy, joining a
meditation group (for the social benefit, not for counseling), and practicing
regular meditation, particularly loving-kindness meditation, which you can
google and is easy to practice. A good psychotherapist can help you learn how
to talk to yourself in a more supportive way. Meditation can help you to break
out of your mental ruts and pause before taking habitual action.

~~~
snurfer
Yin Yoga is pretty good, too.

------
hootbootscoot
is there an HN flagbot randomly flagging posts for opaque reasons?

will smearing blood on this post keep it from getting flagged or is this
comment already suspect and targeted by the Reaper XNPQ3 due to it being a
reply to a previously flagged post?

does it cost you any points in heaven to flag a post?

May I simply feel free to flag posts containing adjectives in lieu of adverbs?

I've noticed that all of the 50 states I'd visited featured grammatically
incorrect street signs advising one to "drive slow"... must be related to sign
painters being grown up "slow children playing" also from grammatical butchery
sign infamy...

