What little we know about the efficacy of the 12 Steps, the system at the heart of Alcoholics Anonymous, comes from a lengthy study called Project MATCH. As I mention in my Wired piece, Project MATCH confirmed that the Steps perform as well as other therapies when applied in a clinical setting—though, as critics like to point out, no alcoholism treatment produces especially laudable results.
One of the most provocative papers to make use of Project MATCH’s data is “Are Alcoholism Treatments Effective?”, which argues that clinical approaches may actually be no better than leaving heavy drinkers to their own devices. The authors’ two most striking assertions are depicted in the chart above. First, they contend that subjects who had a single therapy session actually fared worse than those who had no treatment at all. And more importantly, they ask whether treatment need be any longer than a few days, an argument I summarized in an early draft of the Wired article:
The Project MATCH data also gave credence to an increasingly popular concept in addiction medicine: the usefulness of brief treatment. According to an analysis of the study conducted at the University of Miami School of Medicine, subjects derived virtually all of a therapy’s benefits during their first week of counseling. “There is not a lot of evidence in the alcohol field that longer is better,” says William R. Miller, an emeritus professor at the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addiction (CASAA). A simple statement of concern by a doctor, followed by a handful of therapy sessions, may actually be as effective as a lifetime’s worth of AA meetings.
Re-reading this discard a few months after the fact, I now realize that the last line needs a disclaimer appended to the end—”…for some people.” And that was the big challenge in tackling this piece: Just as there are many paths to becoming hooked on booze, there are many paths to recovery. What we need to figure out is a better way of determining who will benefit from what kind of treatment—and, by extension, who doesn’t need treatment at all. I don’t think we’re particularly close to making that happen, alas.
Update As a commenter on an early post just pointed out, the Wired piece got picked up by The New York Times‘ David Brooks. Here’s his take.