Alcoholics Anonymous is notoriously difficult to evaluate scientifically. Several observational studies have been quite favorable to the program—finding, for instance, that the longer people attend twelve-step meetings, the more likely they are to achieve long-term sobriety, or that engagement in meetings, as opposed to mere attendance, can be correlated with sobriety. But for many such studies are innately compromised by the fact that their members self-select. In The Sober Truth, Lance Dodes dismisses the observational studies wholesale. The kinds of people who go to AA—moreover, the ones who stick around—are those who find it useful. What about everyone else? To really understand the effectiveness of AA, Dodes suggests, we must consider everyone who walks into the rooms, including those reluctant attendees who sulk into the back rows of speaker meetings, nod off during the Serenity Prayer and never return. AA’s literature claims that those who fail to fully participate in the twelve steps tend to relapse, but for Dodes such warnings are little more than community propaganda, a way of blaming the participant when the program fails them. “Imagine if similar claims were made in defense of an ineffective antibiotic,” he writes.
As the comparison makes clear, Dodes conceives of AA as a “treatment” for alcoholism, a term that assumes patient passivity and is at odds with how members often describe the program—as a spiritual discipline that requires its participants to engage in a series of actions and rituals. Yet it is the discussion of attendance versus participation that lays the groundwork for Dodes’s conclusion about AA’s inefficacy. Citing data from the NIAAA that claims up to 31 percent of people who go to AA stick around for a year or more, Dodes then modifies those numbers to reflect attendance rather than involvement.
more here.