Letters XC

• He has stayed clean and sober for 6 years.
• He has done a huge amount of reading and compiled a website of literally thousands of pages.
• He helps remind us that AA is not the only way and provides alternatives.

• He distorts facts and figures. He ignores research he doesn't like. He'll read a whole book and quote only the one sentence that supports his views.
• Though millions of people have attended AA, Orange will not admit that AA has helped a single one of them.
  AND (the main reason I made this website):
• By his obsessive anti-AA stance, Orange may be turning away desperate people whom AA might be able to help.

About the respect, the only one to comment on is the years of sobriety. You are displaying a typical A.A. attitude where people are worth more if they have more years of sobriety. I reject that idea, even though I now rate as one of the "holy old-timers". The virtue of a person is not determined by how many years he has abstained from drinking alcohol. Heck, even Jesus Christ turned water into wine and drank it.

By the way, I just had another anniversary, so it's seven years now. So that makes me even holier and wiser, doesn't it?

About your criticisms:

• He distorts facts and figures. He ignores research he doesn't like. He'll read a whole book and quote only the one sentence that supports his views.

  No, I don't. I am very careful to not distort numbers or statements when I quote things. And I often quote entire pages of A.A. booster's diatribes, just to make sure that the entire argument is clear.

  Further down in this letter you complained about how I quoted and analyzed Prof. Dr. George Vaillant's book "The Natural History of Alcoholism". There, I quoted two or three entire pages, and two tables of numbers where he clearly described how his A.A.-based treatment program failed to cure alcoholics, and just yielded an "appalling" death rate. I didn't just quote one or two sentences.

  I do not quote entire books because that's a violation of copyright law, and it's also just too bulky. So of course I pick out the quotes I want to talk about.

• Though millions of people have attended AA, Orange will not admit that AA has helped a single one of them.
  

  No, that is not accurate. I have said several times that it is impossible to prove individual cases from statistics. Four years ago, I wrote this in a response to a letter.

  It is not possible to prove or disprove that one individual person was helped or not helped by A.A.; it is only possible to show that A.A. did or did not help A GROUP of people become more sober than another group who didn't get any A.A. treatment.
  

  It is possible that A.A. helped one guy "Joe" to quit drinking, while pushing 5 or 6 other guys towards their deaths by indoctrinating them with horrible cult dogma like that they are powerless over alcohol, and can't quit on their own, and can't ever get cured, and are disgusting sinners who need to do a Fifth Step and confess everything to their Sponsor... "Oh, and you need to stop taking those pills that the psychiatrist gave you. Meds quiet the still small voice of God."

  So it is theoretically possible that A.A. helped one guy in some way, while simultaneously killing five or six others. I don't consider that "helping people".

  Oh, and the other part of your statement, "Though millions of people have attended AA..." is irrelevant. It doesn't matter how many people have attended A.A. meetings, or Scientology or Moonies meetings, either. What matters is whether they were helped or hurt.

  A.A. often uses the propaganda trick of Appeal to Numbers to try to fool people's minds, like bragging that A.A. is a success because they have lots of members or get lots of people to attend their meetings. (They learned that trick from Frank Buchman, the monster who created all of the roots of Alcoholics Anonymous. Buchman habitually bragged about how many people came to his meetings, and implied that it meant that his religious cult was a success.)

  AND (the main reason I made this website):

• By his obsessive anti-AA stance, Orange may be turning away desperate people whom AA might be able to help.

  Thank you. I sincerely do hope that I turn some people away from getting sucked into Alcoholics Anonymous, because A.A. kills more alcoholics than it helps.

  Your standard A.A. phrase, "desperate people whom AA might be able to help" is unrealistic. The net results are that A.A. doesn't help them. A.A. makes them drink more, and A.A. makes them die more.

For the record, here is my own "Q&A; on AA":

Q: Are all AA members abusive cult extremists, like Agent Orange says?
A: No.

Does AA's low retention rate really indicate 95% failure?

Now the question is, "Should we call Dr. Tom a success or a failure?"

After all, Tom can argue that the patients quit before receiving his full course of treatment. They might have gotten better under his care. (In fact, a few people did, and Tom never stops bragging about them.)

On the other hand, we can argue that the patients should not have remained under Tom's care any longer. He was selling ineffective quack medicine and cult religion. That does not fix people's coronary problems. It often kills them. And since "Dr. Tom" failed to cure his patients, for whatever reasons, we can only call his treatment a failure.

And the few people who did recover under Tom's care are cases of normal spontaneous remission. No matter what the disease is, a few people will just get over it and get better. Their bodies just heal themselves. Or those people change their unhealthy sedentary lifestyles and bad diets, and heal themselves. Dr. Tom cannot claim those people as proof that his treatment works.

Well, I would call Dr. Tom and his so-called "treatment program" utter failures.

What would you call them?

Research by Vaillant

• 29 patients achieved stable remission;
• 24 were intermittent drinkers; and
• 47 were still chronic alcoholics.

Excuse me, but these numbers are obviously wrong. Blatantly, screamingly wrong. Can't you see that something is very funny about those numbers? You don't see it? Okay, I'll tell you:

WHERE DID ALL OF THE DEAD PEOPLE GO?

Previously, Vaillant declared that the score with his first 100 patients was: 5 continuously sober, 29 dead, and 66 still drinking. Now the dead people have been magically resurrected, and now we have 29 who are in "stable remission". Wow. It must be a miracle. Apparently George Vaillant is better at raising people from the dead than even Jesus Christ.

And right there on page 191 of the book that you cited, "The Natural History of Alcoholism Revisited", Dr. Vaillant clearly stated that he counted dead people as "sober" in order to come up with those improved numbers. And people who were called "in stable remission" only had to be sober for 51 weeks of each year to qualify as "sober for 3 years". That's what you call "massaging the data" and "cooking the books". Also, "Moving the Goalposts".

You know what else is wrong with those numbers? You are assuming that all improvement in the alcoholics is somehow due to Alcoholics Anonymous. But that isn't how reality works. With a normal 5% per year rate of spontaneous remission, after 8 years you will have 34 people out of a hundred alcoholics who have recovered all on their own, just self-healed, with no credit due to Alcoholics Anonymous. When Dr. Vaillant wrote that the results with A.A. were no better than the natural history of the disorder, that's what he meant. The recovery rate with A.A. "help" was no better than the natural spontaneous recovery rate.

In the numbers that you quoted above, 29 patients achieved stable remission, 24 were intermittent drinkers, and 47 were still "chronic alcoholics". We don't know whether "intermittent drinkers" means just healthy moderate drinking, or whether they occasionally drank too much, and still had a problem. But still, it looks like whatever improvement occurred can be explained by normal spontaneous remission — especially when many of the supposedly healthy successful sober people were actually dead.

By the way, Dr. Vaillant isn't just a psychiatrist at Harvard University. He is also a member of the Board of Trustees of Alcoholics Anonymous World Services, Incorporated, and he's one of the biggest promoters of Alcoholics Anonymous on the planet.

Fully 95% of the subjects had one or more relapses during the 8-year study, and twenty-nine had died — roughly three times the death rate expected for non-alcoholics of the same age. Seeing these results, it is hard to deny that severe alcoholism is difficult to cure. But contrary to Orange's summary, AA actually helped reduce the death rate. Here is where I see Orange falsifying the results:

1. Where the results showed that clinical treatment didn't work, Orange claims that AA didn't work.

   Again, Dr. Vaillant was testing the treatment of alcoholism with Alcoholics Anonymous. Dr. Vaillant was trying to prove that A.A. treatment works. The "clinical group" WAS the A.A. group.

2. Orange claims that every relapse counts as a failure for AA, even for patients who recovered at the end, and even though not all patients attended AA.

   Yes. You can't cherry-pick and just claim the success stories for A.A. while ignoring those whom A.A. did not help at all, or even hurt, like drove to relapse or drove to suicide.

   And your phrase, "even for patients who recovered at the end" implies that you expect me to give credit to A.A. for people who got a grip and quit drinking after they quit Alcoholics Anonymous. No way Jose'. That's just like the "Dr. Tom" described above trying to claim the credit for people who recovered from their coronary disease after they quit his treatment. He isn't due any credit for his ex-patients' recovery, and neither is Alcoholics Anonymous.

3. Orange ignores results that showed positive effects of AA.

   What positive results? You haven't shown any, and neither did Dr. Vaillant.

By all means, let's discuss facts. Uninformed opinions and propaganda tricks have no place in a discussion of what might save the lives of our friends.

(1) Was the study really about AA?

Wrong. The "clinic sample" was A.A.-treated patients. That's what Vaillant's program was doing — treating alcoholics with A.A. and testing how well it worked, while trying to prove that A.A. works.

Dr. Vaillant clearly declared that he and his co-worker William Clark were very excited about the "new" A.A. treatment, and set out to prove that it worked. Vaillant wrote:

  ...   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.
...
Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.
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.

When Vaillant wrote, "and there is compelling evidence that the results of our treatment were no better than the natural history of the disease", he was declaring that A.A. did not improve on what normally happens with untreated alcoholics — the "natural" course of the disease. (You know, "Jails, Institutions, or Death". But also many spontaneous remissions.) "Compelling evidence" is scientific jargon that means, "The evidence is overwhelming and cannot be interpreted any other way. The truth is self-evident."

(2) Did AA really fail 95% of the time?

95% of patients had relapsed at some time during the study, even though many of these eventually attained sobriety. Orange counted this as a 95% failure rate for AA.

Nope, A.A. failed 100% of the time. Even giving A.A. credit for the 5% spontaneous remission rate is being too generous. Just because some people were in or near an A.A. meeting when they quit drinking or cut down does not mean that A.A. deserves the credit for their sobriety. (A.A. is very good at stealing the credit for other peoples' hard work.)

Dr. Vaillant actually agreed there. On the next page of his book (p352 of Revisited), he wrote:

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.

And when you talk about those people who "eventually attained sobriety", you must remember that normal spontaneous remission goes on indefinitely, too. Just because somebody quits drinking later, after rejecting A.A., doesn't mean that he suddenly changes from an A.A. failure to A.A. success story. Approximately 5% of the alcoholics quit drinking each year, every year, to save their own lives. A.A. is not due any credit for their work to save themselves.

(3) Were the results negative for AA?

That phrase "was associated with" is a buzz-word for "now we are giving you unproveable assertions..." — "Now we are going to try to fool you by using the standard propaganda trick called 'Confusing Correlation With Causation'."

You can find all kinds of "associations" that don't prove anything:

• Increased attendance at Scientology centers was associated with reduced drug and alcohol use.
• Increased participation in the Moonies' cult religion was associated with reduced drug and alcohol use.
• Increased involvement in Rev. Jim Jones's cult religion — "The People's Temple" — was associated with reduced drug and alcohol use. (Not to mention the fact that it was also associated with an increased death rate.)
• Increased attendance at the local Baskin Robbins ice cream parlor was associated with reduced drug and alcohol use.

Again, you are 'Confusing Correlation With Causation'. Only those people who quit drinking and became committed members of the cult went to 300 A.A. meetings. The drinkers went to 300 meetings at the bar instead. So what else is new? That doesn't prove anything about what makes alcoholics quit drinking.

Antiquated and Irrelevant References

I have spent the last seven years searching for every and any valid Randomized Longitudinal Controlled Study of A.A. effectiveness that I could find, and that's all there is. After the first half-dozen clinical studies all showed A.A. to be a total failure, A.A. showed no interest in helping with any more studies. In fact, A.A. has been positively hostile to valid controlled studies, and arrogantly claims that they know more about alcoholism than the doctors do.

Please note that "research" is something more than just propaganda articles in magazines. Real research means Controlled Studies. "Research" is not just some fool jabbering about how he thinks A.A. works, or how he noticed that people who go to A.A. meetings drink less than the people who go to bars. Follow that link for a description of how you do a valid Randomized Longitudinal Controlled Study.

I have also had a challenge out there for seven years now, asking A.A. boosters to send in reports of ANY valid clinical test of A.A. that showed that A.A. worked or helped the alcoholics in any way. The only thing I have ever received was some links to the pathetic Moos and Humphries propaganda where they "discover" "associations", where people who go to A.A. meetings drink less than people who go to bars.

You claim that there is "plenty of newer research." What newer research? Please don't hold out on me. Tell me very specifically what you are talking about. Send me the authors' names, titles of articles, periodical where the work was reported, date, volume, and page number. Then I'll go to the local medical university library and get copies of the research.

But please don't send me any more links to articles that are just deceptive propaganda that "finds associations". I have enough of those already.

Another problem: these studies were not on regular, voluntary AA members, so it's no wonder AA showed limited success with them. Orange quotes as follows:

• "AA does not work well with municipal court offenders." (Brandsma)
• "Offenders were sentenced by the court to one of three 'treatment programs'". (Ditsman)

That's right. A.A. does not work well with court-ordered victims. And yet, the courts keep on doing it because the "counselors" and "advisors" who are hidden A.A. members keep on recommending it.

And The A.A. Grapevine has reported that the results of the last two triennial surveys show that about two-thirds of all A.A. members were coerced, forced, blackmailed, pressured, or otherwise shoved into A.A. by courts, prisons, parole officers, rehab facilities, bosses, co-workers, families, or whatever. So when we say that A.A. doesn't work well on coerced members, we are talking about fully two-thirds of the A.A. membership. No wonder A.A. doesn't work.

So the "regular, voluntary AA members" that you wrote about are mostly people who were once coerced into A.A. (and then some got brainwashed enough to stay in the cult after the coercion stopped).

How could anybody expect coerced cult religion to cure alcoholism? You would have to be crazy to believe that.

So what's the word on the street?

Let's sum up what some experts say for a balanced view, both pros and cons, of AA.

Vaillant

"Certainly, AA is not a magic bullet for every alcoholic. In my own follow-up studies, there were a few men who attended AA for scores of meetings without improvement." (2005, p 434).

"The implication from [my studies] is that a great many severely alcohol-dependent Americans, regardless of their social or psychological makeup, find help for their alcoholism through Alcoholics Anonymous." (1995, p 388)

"Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted." (2005, p 431).

Those two references to Vaillant's 2005 magazine article are classic propaganda. That article was a declaration that A.A. is "good spirituality", as opposed to "bad religion". Didn't you notice that Vaillant had to go all of the way to New Zealand to find a journal that would publish his cult religion diatribe? Apparently, no reputable American medical journal would touch it. No wonder. I have written about that obnoxious piece of untruth before, here.

Vaillant's other remark, about the "implication of his studies", is just some more of Vaillant contradicting himself, and promoting his favorite cult religion, in spite of the evidence.

In his Natural History of Alcoholism books, which you are quoting there with the 1995 quote, Vaillant did things like first report that A.A. was a total failure with an "appalling" death rate. Eight years of carefully documented study and testing proved it. But then, because that was such a bitter pill for Vaillant to swallow, he "discovered" that some natives in Trinidad and Tobago mixed some A.A. rituals with alcohol-free calypso sing-alongs and reduced the drinking at their parties. On the basis of that "research", Vaillant happily declared that Alcoholics Anonymous was a success after all.

You have to read Vaillant very carefully, and separate the wheat from the chaff.

Edwards

Edwards conjectures, on the basis of available research, that "AA probably works, in some way or other, for not less than 50% of the troubled drinkers that make contact with it." (2002, p 117.)

This is great. I must thank you for this one. There is nothing that you could have said that more clearly shows what a bunch of bull this pro-A.A. propaganda is.

The bibliography at the end of your web page shows that the author of this quote founded an "addiction center" in London:

Edwards, Griffith (April 2002). Alcohol: The World's Favorite Drug, 1st ed. Thomas Dunne Books. ISBN 0312283873. [Griffith Edwards founded the National Addiction Center in London and has served as editor-in-chief of the journal Addiction.]

UPDATE: Griffith Edwards passed away. His obituary is described and discussed here:
http://www.orange-papers.info/orange-letters327.html#William_N

Nace

"AA, like all other therapies for alcoholism, is limited. ... [Criticisms include] AA's being rigid, superficial, regressive, inspirational, fanatical, stigmatizing, and focusing only on alcohol. The rigidity is more likely to lie in individual members than the AA program itself." (p 597)

"Many efforts have been made to assess the effectiveness of AA attendance... In studies of AA from the 1940s to the early 1970s, sampling difficulties and other methodological problems were immense. Nevertheless, the findings indicated that thousands of AA members had achieved sobriety through AA." (p 597)

"AA involvement correlates favorably with a variety of outcome measures. Those patients who attend AA before, during, or after a treatment experience have a more favorable outcome in regard to drinking. In the few studies available that assess the outcome on other variables, AA involvement is associated with a more stable social adjustment, more active religious life, internal locus of control, and better employment adjustment. Increased ethical concern for others, an increased sense of well-being, and increasing dependence on a Higher Power with less dependence on others also have been described. Finally, there is a positive relationship between outcome and extent of AA participation. Outcome is more favorable for those who attend more than one meeting per week and for those who have a sponsor, sponsor others, lead meetings, and work Steps Six through Twelve after completing a treatment program." (p 592)

Once again, there is no evidence that A.A. works or helps anyone. It's all the "AA involvement is associated with..." propaganda trick. It's all a mess of statements that A.A. "correlates", or "is associated with", or has "a positive relationship", which is suggestive, but proves nothing.

You can just as easily say,

• "Suicide is strongly associated with reduced drinking."
  
• "Suicide positively correlates with a more spiritual way of life."
  
• "People who commit suicide will have greatly reduced dependence on alcohol."
  
• "People who commit suicide have greatly improved chances of remaining sober."
  
• "People who commit suicide have much lower rates of re-arrest and imprisonment."

No, that is the exact opposite of the truth. That is a complete reversal of reality. A.A. teaches alcoholics that they are Powerless Over Alcohol, and that their lives are unmanageable, and that they can't control their own lives and just quit drinking by an act of intelligent will power, and that they need a Higher Power to control them and keep them from drinking. A.A. theology teaches people to Turn It Over (to God), and rely on an external locus of control. Bill Wilson wrote that A.A. members must depend on Something Else, like "Higher Power", or the A.A. group, to keep them sober. They must not depend on themselves, or be self-reliant, or control their own lives, or think for themselves, Bill says. That is one of the big problems with the A.A. program.

American Psychiatric Association

"The effectiveness of AA, per se, has not been evaluated in randomized studies. However, other sources of information provide growing support for the utility of AA and 12-step-oriented treatments as well as the efficacy of professional therapies such as TSF [12-step facilitation] that are aimed at motivating patients to participate in AA. In addition, a large number of studies have documented that greater AA participation is associated with greater rates of abstinence from alcohol as well as with better drinking outcomes. Thus, most patients should be encouraged to attend at least several AA meetings to ascertain the appropriateness and utility of AA in helping them remain alcohol free."
== Practice Guideline for the Treatment of Patients With Substance Use Disorders, p 98-99. (PDF, 2.2 MB)

You could have stopped at the first sentence: "The effectiveness of AA, per se, has not been evaluated in randomized studies." Period. End of story. They present no valid evidence to show that A.A. works, or helps anyone.

And their statement is actually dead wrong. A.A. has been evaluated in randomized controlled studies. I have listed them, and you complained about the fact that I listed them: Brandsma, Ditman, Walsh, and Orford and Edwards.

The A.A. boosters just didn't like the results, so they keep on parrotting the line about "A.A. has not evaluated in randomized studies", or "A.A. has never been properly tested". Yes it has. And Alcoholics Anonymous failed the tests.

The rest of that rap is the usual "is associated with" nonsense. Like, "The rooster's crowing louder is associated with the sun rising. (Therefore the rooster must be causing the sun to rise.)"

Once again,

• The people who want to drink do so — they go to meetings at bars.
• The people who want to quit drinking do so. They don't go to bars. They may stay home, or they may go to A.A. meetings, or they may go to the movies, or they may go play bingo, or whatever.

You can always find "an association" between alcohol-free activities and increased sobriety.

Conclusion