Windsor Humanist Society

October 13, 2008

Faith-based AA Groups Cheaper & More Effective Than Conventional Cognitive Behavioural Therapy

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Problem drinkers attending the faith-based Alcoholics Anonymous groups are 30% more likely than others to remain sober for at least two years, according to research published this month.

The study, published in Alcoholism: Clinical and Experimental Research, found their treatment also costs 30% less than conventional cognitive behavioural therapy.

According to lead researcher Dr Keith Humphreys, based at Stanford University, this is because it requires fewer hospital visits and admissions.

Up to 80% of alcohol dependent patients start drinking again within six months of a hospital detox.

So why do AA members have a better chance than average?

Dr Humphreys told the BBC’s Health Check programme that many AA members point to the spiritual component of their 12-step programme as crucial in fighting the urge to drink.

Its non-doctrinal approach means people of all faiths – or no faith – can benefit.

Dr Humphreys said: “It used to be accepted dogma that there would never be a 12-step group in an Islamic country.

“But today I would bet that it is Brazil and Iran where 12-step groups are growing the fastest.”

Last year a group of Iraqi clerics visited Britain, where Professor Sadar Sadiq, the country’s National Advisor on Mental Health works as a practicing psychiatrist, to study approaches to alcohol treatment at first hand.

“They attended AA meetings and would like to implement it in Iraq,” said Professor Sadiq.

“But with the conflict and lack of security our progress is very slow.”

Professor Alan Marlatt of the University of Washington’s Addictive Behaviours Centre, in Seattle, said other spiritual approaches must be developed to help alcoholics.

“Many people can’t buy into AA’s basic assumption that you’re powerless and have to turn your individual decision making over to a ‘higher power’.”

An experiment in the benefits of Vipassana – or mindfulness – meditation at the nearby King County North Rehabilitation Facility offered the chance for Professor Marlatt to measure its effects among alcoholics and drug addicts.

The ten day programme required the prisoners to meditate silently for up to eleven hours a day.

He said: “We have a technique called urge surfing – you imagine that when the urge comes it is like an ocean wave.

“Starts small, gets bigger. You feel like you’re going to be wiped out. But you use your breath as a surf board to ride the wave without giving in to it.”

Not only did the meditating prisoners drink and take drugs less after their release, they were also less likely to be depressed or to re-offended than others.

Mindfulness meditation is a spiritual approach that requires no religious faith, said Professor Marlatt.

So is it just as effective a drug as conventional belief?

A painful experiment at Bowling Green State University in Ohio answered that question for psychology professor Kenneth Pargament.

He gave two groups of people two competing sets of mantras, one spiritual (ie: “God is love“) and one secular (“grass is green“) and timed how long each could keep their hands in a bowl of iced water.

His findings were published, in 2005, in The Journal of Behavioural Medicine.

“We found that spiritual meditators were able to tolerate the pain of the iced water for twice as long as the secular meditators. ” he told BBC’s Health Check.

“And we’ve replicated the study among people with migraine headaches, and people chanting the spiritual mantra experienced a much sharper decline in the number and severity of their headaches.”

Similarly, ongoing research at The Oxford Centre for the Science of the Mind suggests religious people suffer less physical pain when focussing on religious images vs non-religious pictures.

So what is stopping clinicians taking note? Partly the unscientific lack of definition of “spirituality“.

A recent of 265 books and papers on the subject showed researchers can mean at least 15 different things by it.

And even if researchers did agree on what spirituality is, they don’t yet know how it mediates its therapeutic effects in the brain.

In the past, the idea of a science of spirituality was a contradiction in terms and few would risk their reputations to study it.

But that is now changing – thanks in part to the example of recovering alcoholics of AA.

At a time of constrained health finances – especially in developing countries where alcoholism is rising fastest – an effective treatment programme that costs 30% less than usual is generating plenty of interest.

Professor Pargament said: “I think there are a number of scientists who have been sceptical but, like good scientists, have been persuaded by the data.

“And the data suggests that there are some really important links between spirituality and health and wellbeing.”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
…this post forwarded by Windsor Humanist, Alexander Neil after an January 29, 2007 article by Tracey Logan over BBC News

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39 Comments »

  1. An interesting article, but one part bothered me. They use “God is love” and “Grass is green” as if they are somehow comparable. As a non-believer, why would I ever focus on “Grass is green” as a means to help me accomplish any task? They should have tested “God is invisible” against “My parents love me.”. Of course the message about love is going to produce a better result most of the time, because it tends to be a motivator, not just a boring descriptor. (I tried to view the actual study, but wasn’t able to). I think what would be more useful is determining what sort of non-religious higher powers can be made to work for the purposes of 12-step programs. I think it’s hard to find someone who literally doesn’t believe in anything human or natural. Whether it’s a country, a group, a family member, a goal, an institution, humanity itself, the planet, quarks, randomness — all of these could be higher powers depending on the person. I lost someone to the AA cult, and they drifted amongst various religious AA groups, and have now separated themselves from my family, not for AA reasons, but for religious reasons. It’s now no longer possible to have even the shortest conversation with this person, without religion being a part of it. As I see it, the religious addiction has replaced the alcoholic addiction, with results that are not physically damaging, but have destroyed several significant and positive relationships in this person’s life. It should be possible for a person to go through a 12-step program and come out the other end a non-believer, particularly if that’s how they went in.

    Comment by Randy — November 8, 2008 @ 5:20 am | Reply

  2. oh yeah, AA is growing like wildfire the world over. just check AAWS’s own group & membership estimate survey numbers since the late 90’s through today (2 words: flatline & decline).

    this blog post is the pseudo-scientific equivalent of throwing mutltitudes of cherry-picked crap at a wall just to see what sticks. i could spend days picking it apart line by line & offering tons of counter sources, figures, & statements by prominent figures in the scientific & medical field. but it’s not worth the bother.

    if you think AA (or any 12-step program) is seamlessly conducive to a humanist mindset, perhaps you should actually read the ‘conferenced approved’ literature & make a point of sitting in on continuous meetings (at least a years’ worth — meetings of all stripes, especially ‘Big Book’ meetings). i did — for 6 years. i’m happier, more productive, & more fulfilled now having spent a full year away from its quasi-religious (even if non-denominational) literature, rhetoric, & (sometimes) outright bullying than i’ve been in at least a decade.

    what part of:

    ” … asking each morning in meditation that our Creator show us the way of patience, tolerance, kindliness and love.

    The spiritual life is not a theory. We have to live it.” (Alcoholics Anonymous, “Into Action” pg. 83)

    is seamlessly conducive to a decidedly non-theist, secular humanist personal philosophy? nothing against the ideals of “patience, tolerance, kindliness and love”, but AA ‘suggests’ — with a decidedly heavy hand — that those ideals must be granted one by an externalized, singular, personal (though somehow still universal) ‘all powerful’ source. the ‘alcoholic’ (i.e., inherently sinful human being) is incapable of generating those feelings & actions via his or her own volition.

    bullshit on that!

    (btw, i just opened my copy of the ‘Big Book’ to any random page & got the above quote; try it yourself — 7 out of 10 tries will get you a page or multiple passages mentioning the glorifying of ‘God/He/Him/Creator/Father/Higher Power’).

    in a 2004 report the World Health Organization estimated “76.3 million with diagnosable alcohol use disorders” and attributed “1.8 million deaths (3.2% of total) and a loss of 58.3 million (4% of total) of Disability-Adjusted Life Years (DALY) (WHO, 2002)” (link: http://whqlibdoc.who.int/publications/2004/9241562722_(425KB).pdf). AA’s global membership has remained steadily at or around the 2 million mark since 1990 (AAWS’s 2007 survey puts the estimate at 1.989 million worldwide).

    you do the math — use whatever [reasonable] percentage you want to develop a ratio between those who died from ‘alcoholism’ in a given year to the number of AA members & the number of alcoholics who continued drinking after walking away from 12-step therapy (often described as “the last house on the block” to deperate alcoholics). a purely superficial reading of those numbers looks like it’s a wash to me (i.e., doesn’t make a dent in preventing or treating alcoholism, never mind helping alcoholics return to productive, happy lives).

    i suspect that isn’t because AA is such the wonderful ‘big tent’ that it publicly presents to the world (AA’s preamble: “… a fellowship of men & women who share their experience, strength, & hope so that they might solve their common problem & help others recover from alcoholism.”). i suspect it’s because AA’s refusal to coutenance scientific & medical research, to rely iatrogenic principles for defining & ‘working’ with one another, & an absurd death grip on dogma that is firmly rooted in protestant christian principles (however vaguely it may be framed).

    and, jeez louise! — of course AA is more cost-effective than CBT-based treatments. you usually actually pay a psychotherapeutic professional to mediate a CBT group session, while you can hear any big book-addled crackpot prattle on about the necessity of god & prayer & humility in keeping you sober at a ‘free’ AA meeting.

    call my response ‘AA-bashing’ or ‘anti-AA’ or ‘close-minded’ all you want. but facts are facts. cherry-pick all the studies & quotes you want to bulk up your case for a ‘solution’ that has hardly scientifically proven itself as such — never mind, shown itself to openly embrace humanist, atheist, or agnostic ideals. AA ‘works’ for a very select few, & like the commenter above, i won’t ignore the program’s multiple flaws, negative effects, & utterly unsubstantiated ‘effectiveness’.

    new age hooey dressing itself up as humanist-compatible rational thought. get a clue.

    Comment by speedy0314 — May 15, 2009 @ 12:28 pm | Reply

  3. […] Dave and Bill Posted on May 15, 2009 by friendthegirl I just followed a blog link that AnnaZed provided, which reprints a BBC article about a study by Dr. Keith Humphreys from Stanford, which says that, […]

    Pingback by Dr. Dave and Bill « Stinkin Thinkin — May 15, 2009 @ 3:59 pm | Reply

  4. Quoting from the article: “In the past, the idea of a science of spirituality was a contradiction in terms and few would risk their reputations to study it. But that is now changing – thanks in part to the example of recovering alcoholics of AA.”

    This seems to fit right in to A.A.’s claim that A.A. is “spiritual, but not religious”. It may be spiritual, but it is also blatantly religious. The Steps and Big Book certainly pushes a prayer-answering favor-dispensing deity called “God” that removes our shortcomings, restores us to sanity, manages our lives, cares for us, loves us, listens to our prayers, gives us power and guides our groups (12 Steps and Tradition 2).

    And the Big Book (p. 63) says He is also our all powerful Employer who provides us what we need if we keep close to Him and perform His work well. And God is described as Creator and Maker throughout the Big Book.

    The part where they say you can choose your own higher power is just twaddle — yes they say that to newbies. But then they pressure you to work the 12 steps, which are blatantly religious, involving a prayer-answering favor-dispensing deity. Take Step 11:

    Step 11 “Sought through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of his will for us and the power to carry it out.”

    Now what concept of “God” fits in the above other than a prayer-answering deity? Do you pray to the group, a light bulb, a tree?

    Or take Step 3 – “Made a decision to turn our will and our lives over to the care of God as we understood him”

    What besides a deity would a person turn their will and lives over to? I sure wouldn’t turn my will and life over 100% to any human institution or group of humans. Not when they (many groups though not all) tell people to quit taking prescribed medications and quit seeing therapists.

    They also push people to read the Big Book — which is full of insults to non-believers, particularly the “We Agnostics” chapter where they call non-believers “vain”, “fooling ourselves”, “perverse”, prejudiced”, “obstinant” and on and on. How is this slamming of non-believers not religious?

    And many groups say the Lord’s Prayer — a prayer with explicitely Christian themes taken straight out of the bible (Matthew 6:9, Luke 11:1). Kind of hypocritical when they make such a big deal of saying they are “spiritual but not religious” and that they are a program based on “rigorous honesty” (and then lie about not being religious).

    Even groups that don’t put a lot of pressure on people to believe a certain way or to work the steps subject you to religious proselytization — unless you believe that proselytizing about a prayer-answering favor-dispensing deity isn’t religious.

    More on the spiritual – religious bait-and-switch – see http://www.orange-papers.org

    Three Federal Courts of Appeals (Second, Seventh, and Ninth circuits) and Two State Supreme Courts (New York and Tennessee) have ruled that Alcoholics Anonymous and Narcotics Anonymous are religious and that nobody can be coerced by government authority into attending these organizations (as that would violate the First Amendment’s prohibition against the state establishment of religion). No Federal Court of Appeals and no State Supreme Court has ruled otherwise. To date, the United States Supreme Court has declined to consider any of these rulings, thus letting these ruling stand. For more on these court rulings:

    Court rulings other than the 9th Circuit
    http://www.angelfire.com/journal/forcedaa/courtopinions.html

    9th Circuit Court Of Appeals Ruling (Inouye v. Kemna)
    http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/09/08/BA99S1AKQ.DTL

    Here is a Duke Law Journal article that discusses the religious aspects of A.A. and the definition of religion for constitutional purposes (first amendment establishment clause).

    Cited: 47 Duke L. J. 785
    [*pg 785]
    RELIGION AND REHABILITATION: THE REQUISITION OF GOD BY THE STATE
    DEREK P. APANOVITCH

    http://www.law.duke.edu/shell/cite.pl?47+Duke+L.+J.+785

    Comment by progree — May 16, 2009 @ 3:18 pm | Reply

  5. “Its non-doctrinal approach means people of all faiths – or no faith – can benefit.”

    That sounds like it came out of an AA press release. In fact, the whole article does. Alcoholics Anonymous has been judged to be “religious in nature” in 16 states so far. A person might try to make a case for non-denominational, but non-doctrinal is a bad joke. AA is designed for lapsed Christians. If you believe that people of all faiths or no faith can use the program of Alcoholics Anonymous, read the Big Book chapter “We Agnostics”:
    http://home.earthlink.net/~briggsmorebeach/Library/Alcoholics%20Anonymous.htm#CH04

    As a secular humanist, I was appalled.

    Back to Humphries:
    http://news.stanford.edu/news/2001/may23/12step.html

    This Humphries & Moos study was not a randomized longitudinal controlled study. It had no control group, the two groups he looked at were a 12step group and a CBT plus 12step group. How does one combine rational thinking and 12step dogma? Then he hand picked who went into the groups. Humphries & Moos have done several studies that place a positive spin on AA, all with methodological problems. Humphries and Moos are true believers, they begin with their outcome, then create the studies to prove it. Going to AA does not keep people from drinking, however, people who who start drinking again quit going to AA. Looking around the rooms and seeing sober people is no proof of anything at all.

    A major point in this study was that AA was cost-effective.

    The Walsh study, which was a randomized longitudinal controlled study, had different findings:
    “When we compared the costs of treatment for the A.A. and hospital groups, we found that the costs for the A.A. group averaged $1,200 less per person, a savings of just 10 percent. Even though the initial referral to AA was free, the AA group had much higher rates of additional treatment; 63 percent of subjects randomly assigned to AA eventually required hospitalization.”
    “A RANDOMIZED TRIAL OF TREATMENT OPTIONS FOR ALCOHOL-ABUSING WORKERS”,
    The New England Journal of Medicine, Volume 325, pages 775-782, September 12, 1991

    There have been no randomized longitudinal controlled studies that prove that AA works, the ones that have been done do not put AA in a good light:
    – The Brandsma study found that A.A. increased the rate of binge drinking
    – The Ditman study showed that A.A. increased the rate of rearrests for public drunkenness
    – As mentioned, the Walsh study found that “free A.A.” made later hospitalization more expensive
    – Doctors Orford and Edwards found that having a doctor talk to the patient for just one hour was just as effective as a whole year of A.A.-based treatment.

    Comment by raysny — May 17, 2009 @ 12:59 am | Reply

    • Of course it sounds like an AA press release. The study on which this article is based was published by NCADD, which is essentially an AA front group, founded by Marty Mann, who is touted as the “first female AA”.

      http://en.wikipedia.org/wiki/National_Council_on_Alcoholism_and_Drug_Dependence

      She wasn’t the first female AA, actually, since the real first female AA relapsed and drank herself to death, but she did form this group, which now publishes articles that have a remarkably pro-AA slant. This is typical of groups whose true purpose is to promote an ideology, but it’s too bad that their publications get confused with real science.

      Comment by Claire — June 13, 2009 @ 1:14 pm | Reply

  6. SMART Recovery offers FREE meetings and web based program information which includes CBT adapted for use in self-help/peer-support meetings, hence I’m very disappointed to see that professionals on SMART Recovery’s International Council of Advisors failed to mention the need for secular science-based options like SMART Recovery, as a useful and effective alternative or supplement to the faith-based 12-Step program support for which comes from anecdotal testimonials. They didn’t even comment on AA’s low retention rate which suggests that the great results apply to the 7% of AA attendees who remain with AA (and might have maintained abstinence anyway).

    They also overlooked the recent study “Spiritual direction in addiction treatment: Two clinical trials” by William R. Miller Ph.D. et. al. at the University of New Mexico Center on Alcoholism, Substance Abuse and Addictions (CASAA), Albuquerque, New Mexico, noted in Time/CNN online: “Battling Addiction: Are 12 Steps Too Many?” by John Cloud, which demonstrated, contrary to the researcher’s expectations, that the spiritual approach compared to a secular approach not only led to a significant delay in achieving abstinence, but also led subjects in the spiritual group to experience side-effects like anxiety and depression.

    The meta-analysis done by William Miller, et. al., which can be found at http://www.behaviortherapy.com/whatworks.htm. The most effective approaches of the 48, which were compared through their research, include Motivational Interviewing which led SMART Recovery to adopt its non-confrontational approach which our volunteer facilitators support during our discussion based meetings. Other tools shared in SMART Recovery were adopted from Cognitive Behavioral Therapy and the behavioral techniques found in the Community Reinforcement Approach, hence SMART Recovery’s program is culled from the best of what works in treatment, adapted for use in FREE self-help peer-support meetings. Further, the use of the anti-addiction medications which made the top of this rank ordered list is endorsed by SMART Recovery when prescribed by an appropriate health professional and used as prescribed. Looking over the bottom of the list, those treatments less likely to work and not supported by the research, makes it clear that confrontation and passivity characterize the least effective of the 48 rank ordered treatments, and that includes AA and Twelve-step Facilitated Therapy (a one on one “treatment” teaching the first 5 steps and pushing attendance at AA meetings).

    For those curious enough to follow up on the research that Raysny noted, look up: Religiosity and Participation in Mutual-Aid Support Groups for Addiction by Randolph G. Atkins, Jr., Ph.D. and James E. Hawdon, Ph.D. Journal Substance Abuse Treatment 2007 October; 33(3): 321–331. It makes clear the need for secular approaches, especially because the faith-based approaches worked only for those who continued to attend and participate which we know from AA’s own triennial survey, most people do not do. This bit of research reveals why they don’t stay and reading it one can conclude that there is a strong need for secular alternatives which attract those “low in religiosity”.

    So in conclusion, I’d say:

    1. That comparing free AA to professional treatment with CBT is not a fair comparison. It’s like comparing Mom’s chicken soup to seeing a doctor – obviously the doctor is more expensive, but I’d pay the money if I thought I had a serious disease;

    2. There is no controlled research that finds AA or 12-Steps to be effective.

    3. The illusion of its 12-step effectiveness is due to:
    a) The natural selection of those who stay with that program,
    b) Their incorporation of “spreading the good news” in evangelical fashion within the program,
    c) Their use of testimonials and anecdotes (which we psychologists have demonstrated in research to be very salient and persuasive, but scientists would agree that they are not really scientific evidence)
    d) The media’s on-going proliferation of these stories, anecdotes, and narratives, in their news coverage, and especailly in their entertainment because testimonials and confrontation make better movies and TV than cold statistics and talking heads; and
    e) Even the US government until this year gave support to AA and the 12-Steps. In the 1950’s the US Dept of the Navy produced the “Father Martin Chalk Talks” which were required viewing for all government employees engaged in addiction treatment and are a mandatory mainstay of current AODA treatments. And while denying to “endorse” any particular group, the government web sites and publications always included AA and other 12-Step spin office organizations along with listing for government agencies, but never listed any secular alternative citing the lack of proof that they worked while ignoring the forgoing problems with the 12-Steps.

    So here, even the talking heads are sadly bobbling to that tune (or perhaps the interview was edited to support the premise in the title?). I hope readers will check out SMART Recovery and other programs which the BBC and American media fail to cover (or edit out).

    I look forward to feedback on this position, (though not the usual irrate hate and accusations that I am consigning people to death by my speaking out on the 12-Steps). And for those who doubt that AA threatens death to those who will not accept their 12 “merely suggested” steps, check out page 174 of Bill Wilson’s 12 Steps and 12 Traditions. If more people read the Big Book and this addendum, I think there would be less general nonsense in the above article about AA like the assertion that: “Its non-doctrinal approach means people of all faiths – or no faith – can benefit” which is clearly at odds with any standard of truth

    Comment by doctorhenrysteinberger — May 20, 2009 @ 2:29 pm | Reply

  7. Cheaper & more effective?
    I would not bet my life on that if I were you.

    Comment by H — May 30, 2009 @ 8:37 pm | Reply

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    Comment by Casual Male Promo Code — April 28, 2013 @ 1:21 pm | Reply

    • This is old news and misses the point that those people who self-select to attend AA have a different level of motivation than those who don’t. It also misses the point that MORE people would likely stay sober if they had know of the choice and been offered SMART Recovery as well as AA. It’s sad that SR was not included in this research (a problem that continues to afflict the AODA research community). Sadder still, SMART Recovery is the only evidence-based mutual support group (according to Dr. Linda Sanchez of the U. of Texas – Arlington), and still it is not mentioned or included for research. One would think that there is a lot of stealth support for AA that deliberately ignores any other options.

      Comment by Henry Steinberger, PhD — April 30, 2013 @ 12:13 pm | Reply

    • Why is this old article still posted on a “Humanist Society” site? It has been shown to be AA propaganda in all the meaningful comments – save those from AA supporters who still come to worship at this alter.

      Henry

      Henry Steinberger, SMART Recovery Advisor

      Comment by Doc Henry Steinberger — April 30, 2013 @ 12:31 pm | Reply

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    • Sad that the Humanists are putting this out as gospel considering that any group participation, including SMART Recovery, a science-based and secular support and self-help group, has been shown to help. But you are not comparing groups – secular vs faith-based – you are comparing something verses nothing. Bad form!

      As Humanists I hope you will look into secular approaches and maybe check out some better research starting with:

      Atkins, Jr., Randolph G. & Hawdon, James E., Ph.D. Journal of Substance Abuse Treatment, Religiosity and participation in mutual-aid support groups for addiction. Volume 33, Issue 3, October 2007, Pages 321-331.

      This study proves my point. Mutual-aid groups help, but the group that one chooses or stays with reflects their worldview or level of religiosity. Don’t be fooled – religion can be addictive and dangerous, and we Humanists had better wake up to that fact and the fundamentalists get ever more violent and undermine education.

      Henry

      Henry Steinberger, SMART Recovery® Advisor

      Discover the Power of Choice!

      1994-2014 20th Anniversary of SMART Recovery®

      Comment by Doc Henry Steinberger — August 21, 2014 @ 3:30 pm | Reply

  34. Sad that the Humanists are putting this out as gospel considering that any group participation, including SMART Recovery, a science-based and secular support and self-help group, has been shown to help. But you are not comparing groups – secular vs faith-based – you are comparing something verses nothing. Bad form!

    As Humanists I hope you will look into secular approaches and maybe check out some better research starting with:
    Atkins, Jr., Randolph G. & Hawdon, James E., Ph.D. Journal of Substance Abuse Treatment, Religiosity and participation in mutual-aid support groups for addiction. Volume 33, Issue 3, October 2007, Pages 321-331.

    This study proves my point. Mutual-aid groups help, but the group that one chooses or stays with reflects their worldview or level of religiosity. Don’t be fooled – religion can be addictive and dangerous, and we Humanists had better wake up to that fact and the fundamentalists get ever more violent and undermine education.

    Comment by Henry Steinberger, PhD — August 21, 2014 @ 3:33 pm | Reply

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    Comment by aa — August 28, 2014 @ 3:19 pm | Reply


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