Terra Sigillata

Brendan Koerner in Wired how, why, and if Alcoholics Anonymous works

Posted by Abel Pharmboy on July 1, 2010
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The last two days (here and here), you lovely commenters and I have been bantering about legacy media’s reluctance to use the original literature citation in print or online coverage of science, medicine, and health stories. The discussion has drawn input from working writers as well as scientists and bloggers and I also draw your attention to the comments at the impetus for these posts over at The White Coat Underground with PalMD.

But remember, my dear ink- and pixel-stained friends, I am also a graduate advisory board member and instructor in a science and medical journalism program at a major state university. So, I hope those new to the blog understand that my comments and objections arose from my concerns and love for journalism and journalists.

To further emphasize my admiration for superb sci/med/health writing, I wish today to add another writer to my growing blog category of “Journalists, Awesome.”

Via my drug abuse research colleague, DrugMonkey, my attention was drawn to a new Wired magazine article by Brendan I. Koerner entitled, Secret of AA: After 75 Years, We Don’t Know How It Works.

I strongly recommend this long-form article for anyone in the field of substance abuse and dependence research, psychology and general clinical research, students of excellent science writing, alcoholics and their family members, and anyone who thinks that good science writing no longer exists.

I don’t want to influence your views any further other than to say that since poured my first whiskey and water for my grandmother when I was around 7, I’ve had a longstanding interest in why Alcoholics Anonymous helps so many alcohol-dependent folks kick the disease for decades while others trying the approach continue to crash and burn or otherwise abhor its very tenets, especially the “Higher Power” focus. The reader comments there also reflect this bipolar view of the unorganized organization.

Regular readers will also recall that PharmDad died of alcoholism at age 58 after two rounds of inpatient rehab at a nationally-renowned facility – he despised AA even though we had been ardent churchgoers when I was a kid.

The only other thing I will say about the article is that I hypothesize, as a natural products pharmacologist, is that AA founder Bill Wilson’s hospital room encounter with God was more than likely a hallucination induced by the Belladonna alkaloids he had been given as part of the addiction treatment regimens of the 1930s.

I’m also now going through some of Brendan Koerner’s online writing and photos at his personal site, YouThrobber, and blog (Microkhan) and have just started following him on Twitter.

Some may know Koerner from his Wired piece earlier this year, How Twitter and Facebook Make Us More Productive, but he also cites other reader favorites such as Why Is Antifreeze So Delicious?, Where Do “Cakewalks” Come From?, and The Long, Slow, Tortuous Death of Zima. It seems that his most recent gig with Wired has given him even more latitude.

Koerner is also the author of the book, Now The Hell Will Start,

But, please, go read his long article on Alcoholics Anonymous. Yes, you may need to bookmark it to read later this evening, but please do.

He definitely sounds like someone I’d love to have a drink with.

Addendum: Koerner also notes in his Tuesday blogpost on Project MATCH that David Brooks editorialized about his Wired piece in The New York Times on Monday.

Addendum #2: I am just realized upon re-reading the article that while Koerner hyperlinks extensively to external sites for explanations of various terms and characters, he does not link to the primary literature when he cites it in the article. I’d really love to ask him why that is since we’ve been talking about this the last two days.

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Comments

  1. #1 friendthegirl
    July 1, 2010

    Hi.

    I’m not a scientist (I do co-author a blog that is critical of Alcoholics Anonymous and the whole 12-Step addictions industry — so… full disclosure), and I’m really curious about what in Koerner’s article recommends it to students of excellent science writing.

    You picked up on the fact that Koerner didn’t offer direct links to any studies. I found that frustrating, myself. People on our blog had a hard time tracking down the studies. And there was a lot in there that just didn’t make any plain sense. Like, for instance, I just couldn’t get my head around what “relapse” means in terms of rats. What on earth does that mean?

    And this: “A person’s openness to the concept of spiritual rebirth, as determined by their neural makeup, could indicate whether they’ll embrace the steps. Last September, researchers from the National Institutes of Health found that people who claimed to enjoy “an intimate relationship with God” possess bigger-than-average right middle temporal cortices. And a Swedish study from 2003 suggests that people with fewer serotonin receptors may be more open to spiritual experiences.”

    That can’t possibly mean anything to a lay person except that people who believe in God have bigger brains. If I believe in Creationism, do I have a bigger brain? How did he go from spiritual rebirth to an intimate relationship with God? Is there an explanation? And the Swedish study… well, someone in the comments pointed out that the study was talking about people with MORE serotonin receptors, not fewer. Which makes sense even to me.

    And, if were talking brains, I wonder what all this means in the context of an alcoholic — and all the differences between an alcoholic’s brain and all the spiritual stuff and serotonin receptors, etc.

    And then there’s the Project MATCH study, which was found to be problematic, upon peer review. It doesn’t seem that the Koerner knew about the follow up: http://www.biomedcentral.com/1471-2458/5/75

    When it comes to studies and statistics, I’m on shaky ground, and so I might be totally off in why I think this article doesn’t make much logical sense. So, I am curious about what recommends it as an example of fine science writing.

  2. #2 Abel Pharmboy
    July 2, 2010

    @friendthegirl – Let me first say that I *love* your blog, Stinkin’ Thinkin’: Muckracking the 12-Step Industry. (For our readers, here is the specific post refuting Koerner’s article.) To be honest, I’ve not seen much in the science and medicine blogosphere talking about abuses in the addiction treatment industry. Reading through some of your posts makes me think that scientists more focused in this area than I really need to address the pseudoscience side of this industry as you are (although I write about drug dependence from time-to-time, my professional experience derives solely from many natural products being drugs of abuse – I am a cancer pharmacologist by training – and my personal experience comes from being surrounded by alcoholism my entire life and especially that my Dad despised AA and ended up dying at 58)

    Why I think Koerner does a good job is that he broadly makes the topic engaging by discussing the controversies: he captures the high degree of uncertainty in whether AA “works” (note that the title of my post, “how, why, and if Alcoholics Anonymous works”). He does a good job defining the history and, yes, while he does rely on a few anecdotes he does cite literature. But you are correct that he did fail to cite the follow-up deconstruction of the Project MATCH study.

    Still, I think he did a good job of citing that no one treatment approach is better than the other, and all are pretty much poor, and that alcoholism is not a single disease – just as we face in cancer. For example, he cites that Project MATCH data only really showed that an AA or CBT approach provided benefit for those alcoholics with underlying psychiatric illness.

    One point that he didn’t really bring up is that “AA” is not truly standardized in the scientific sense. As you note in your blogpost, one may end up with the crazy cat lady as your sponsor. Here in the Research Triangle, though, you may end up with a scientist or physician as your sponsor. Even within a community, some groups can be a bunch of opportunistic men preying on scared young women (the Thirteenth Step) while others may be more open to CBT approaches (rare, but possible). I also think that Koerner does a good job pointing out that AA groups are opposed to the use of drugs like naltrexone and acamprosate, a stance that I think is just plain ignorant.

    He also points out how difficult it is to study AA because of the anonymity clause and how difficult it is to study addiction in animal models (yes, there is indeed a pretty good model of rat alcohol consumption and relapse – I’ll try to get one of my addictions researchers here to explain but it largely involves chronic feeding of alcohol to rats, depriving them for a period of time, then reintroducing alcohol and measuring how much they drink again relative to the amount prior to forced abstinence.)

    So, I largely think that Koerner captured that alcoholism is a heterogeneous disease but could’ve done better in noting that AA is also a heterogeneous approach despite its reliance on the 12 steps – depends where you live and which group you go to.

    But you’ve really raised my awareness of the challenges and abuses in addictions treatment and I’d really love to explore that more.

    Thanks so much for commenting and I look forward to reading more of your blog.

  3. #3 friendthegirl
    July 2, 2010

    Goodmorning! Thanks for the explanation, and also for the visit.

    One study that Koerner missed was AA’s own Valiant study, which was based on their own surveys. It ended up showing that not only is AA ineffective, but it has a significant suicide rate of 3%. They have never since made the results of these surveys public.

    I understand better why you appreciate the article, scientifically speaking, and thanks for teasing it all out for me. Definitely the piece is much broader than most. But it still seems to me to give a pass to the kooky stuff. Maybe someday someone in a major publication will write a piece that is actually critical of AA.

    Yeah, addictions treatment industry is rife with pseudoscience, because it’s founded solidly on the 12 Steps — I think that something like 90%+ of treatment facilities in this country are 12-Step. We have a whole field of medicine that seems to have been shunted off to faith healing.

    I would love to know how this happened!

    Hey, I am so glad you appreciate that Debbie Harry vid. Thank you again.

    ftg

  4. #4 Liz
    July 2, 2010

    Thanks for linking to the article – it’s a great read. And to answer the above question about why it’s an example of good science writing, I appreciated the descriptions of how alcohol and alcoholism affect the brain.

    A non-scientific piece about AA that I highly recommend is Roger Ebert’s “My Name is Roger, and I’m an Alcoholic.”

  5. #5 Abel Pharmboy
    July 2, 2010

    Liz, yes! I love Ebert’s article from last year celebrating his 30 years sober. I had never known any about his struggles. between that one and his recent Esquire interview by Chris Jones about him and his wife living with cancer and losing his voice, the man is THE MAN.

    ftg – great to see you back and, yes, I am truly inspired by Deborah Harry. I forgot to mention that I did take a substance abuse course run by one of my colleagues about 10 years ago and we talked about a book by Marianne Gilliam entitled, How Alcoholics Anonymous Failed Me (Amazon). She spoke specifically about why AA was problematic for her as a woman and also that the model looks outside of oneself rather than within. She turned to new agey, self-discovery stuff (“love-based” healing, I think she called it) and found that she was not an addict forever, being able to drink a glass or two of wine later on without falling into a bender. She also had a co-morbid eating disorder that fed into her alcoholism. I haven’t looked enough through your archives to see if you reviewed it but I just throw it out there.

    And yes, I would love to see a major writer (besides you, of course!) fully and critically address the ugly underbelly of AA.

  6. #6 friendthegirl
    July 2, 2010

    Abel, I haven’t read that book… and no review yet on Stinkin Thinkin. I’ll definitely give it a read.

    Oh, I remember when the Ebert article came out. It generated a real firestorm among “my people.” I guess the reason celebrity endorsements get us snarly is that these are people who are never, ever going to be subject to, or even witness, the abusive power dynamic that devastates so many people in AA.

    ftg

  7. #7 friendthegirl
    July 3, 2010

    Hi, I thought you might be interested in this response to the Wired article: http://www.huffingtonpost.com/stanton-peele/aa-isnt-the-best-solution_b_629004.html

    Have a fun weekend!

  8. #8 Joe
    July 6, 2010

    Wendy Kaminer wrote a book (I’m Dysfunctional, You’re Dysfunctional) which included a discussion of this. It is just her observations; but she is a critical thinker and quite witty.

  9. #9 walter rich
    July 22, 2010

    Excellent article. maybe someday science will solve this addiction problem but until then AA is a very viable option.

    The AA option offers some unique receovery elements:strong identification with the devesistating behavior patterns and hopelessness that are hallmarks of the addictive state of mind. Powerful personel examples of individuals who have changed and been released from this condition, instilling hope that recovery is possible. A path to change (the suggested 12 steps) and both individual (sponsorship) and group support during this extended process. Continuous awareness of the nature of the illness and the dangerous signposts that could lead to relapse (resentment, fear,self pity, selfcenteredness, etc.) The need and inherent stength of a felleowship—so immensley powerful in any human endeavor.It’s all free.

    There is no magic solution and the path to recovery, even within the fellowship, varies greatly. It works for many.