Highlights from the conference "How AA and NA Work"

Presentations (hopefully video too) will be up next week. I’ll post a link when they’re up.

Sarah Zemore gave a great presentation on the evidence for the effectiveness of 12 step groups. It was powerful and well organized. I found a link to an identical presentation here.

She very effectively rebutted the Cochrane Review from a few years ago by making the following points. (These are based on notes I took and are incomplete. Hopefully they post video so that you can see her complete rebuttal for yourself.)

  • It was limited only to randomized trials and ignored the overwhelming observational evidence.
  • It included one of Zemore’s studies which was NOT a randomized study of AA.
  • She acknowledged that the randomized evidence is ambiguous.
  • Randomized trials of AA are hard to do because some subjects in other groups end up participating in AA. This happened in Project MATCH.
  • The Cochrane Review did not find Twelve-step Facilitation ineffective. It found it no more effective that CBT and MET.
  • Finally, she cited 4 randomized studies of Twelve-step Facilitation: The outpatient arm of Project MATCH, a study by her colleague Kaskutas, and two others that I missed.

It was important for me because supporters of Twelve-step Facilitation are too often painted as the equivalent of intelligent design advocates. It’s just not so and the evidence in this presentation made this unequivocally clear. Twelve-step Facilitation is not the only approach that works, but it’s an evidence based practice.

Laudet made one self-evident point that jarred me because it is almost never made in professional circles. She pointed out that the subjects of one of her studies were infected with HIV at a rate of 22% and Hep C at a rate of 33%. She then said something to the effect of, “As a public health matter, we need to focus on keeping these people in recovery. If they relapse they are likely to spread these illnesses.”

When’s the last time you read anything about recovery as a strategy to reduce communicable disease?

Laudet (as did Zemore) attempted to deconstruct AA, so that it’s mechanisms for change could be identified and still be offered to clients who prefer not to participate in AA or NA.

Bill White gave a rousing historical perspective of AA and NA’s histories and pointed out the looming challenges that face twelve-step recovery groups. These challenges included matters like methadone maintenance patients as full NA members and the limitations of the 3rd tradition and singleness of purpose in AA. He noted that fewer that 18% of people entering treatment in the U.S. were primarily identified as alcohol dependent.