Well, I dunno actually

Support is vital: from families and friends, health professionals and organisations. Drug and alcohol support groups are proved to help people stay sober and clean. And yet these preventive healthcare schemes are being slashed because of council budget cuts. In Warwickshire, for instance, the public health budget has been cut by £40 a head since 2014.

Do we actually have any proof that drug and alcohol support groups do this? And if so, are they a cost effective manner of doing so?

Genuine question.

24 comments on “Well, I dunno actually

  1. Demanding accountability in public services? That’s just madness…

    (see also education, health, defence, …)

  2. Although considered by some to be the most rigorous scientific test of effectiveness, there are only three randomized controlled trials of community-based self-help groups. All were conducted on AA and all used coerced samples. The first, conducted in the late 1960s, showed that, compared with individuals assigned to a treatment program or no treatment, a court order to attend five AA meetings did not reduce number of arrests for chronic drunkenness (Ditman, Crawford, Forgy, Moskowitz, & Macandrew, 1967). Unfortunately, this study gathered no information on alcohol use per se. The other two trials studied a range of outcomes, and compared AA alone to professional treatments combined with AA attendance Brandsma et al., 1980, Walsh et al., 1991. Both suggested worse clinical outcomes for AA alone, one in terms of more individuals dropping out and the other in terms of number of relapses over time. At the same time, individuals assigned to AA alone in both of these trials improved in absolute terms from baseline, and had significantly lower health care costs over time than did those individuals assigned to treatment plus AA.

    one research team studied 887 substance dependent patients treated in inpatient programs that strongly emphasized the importance of 12-step self-help group involvement with those of 887 individuals treated in inpatient programs that had no such emphasis (Humphreys & Moos, 2001). At treatment intake, the two groups of patients were comparable on treatment history, alcohol and drug problems, psychiatric problems, demographic variables, and motivation. At one-year followup, those who were encouraged to join self-help groups were significantly more likely to be abstaining from drugs and alcohol. Further, these patients also relied more on self-help groups and less on further treatment services for support after discharge, reducing their health care costs by almost $5000 a year.

    https://www.sciencedirect.com/science/article/pii/S0740547203002125

  3. I’m biased, but I reckon 12 step plans and support groups are bollocks.

    You just need a 1 step plan:

    STEP 1 – STOP IT

    And why would I want to hang around a bunch of alcoholics who constantly talk about booze, anyway? Sounds like that would drive me to drink.

  4. Why does this need a scheme? Why does this need men at the ministry?

    I know some people who do counselling and they all do pro bono work for poor people. And they’re far more effective because they aren’t right-on PC types.

  5. My late mother was an alcoholic, drinking two bottles of whisky a day plus chasers. I pressed her into going to AA, but it did her no good because she didn’t want to change. Also, the other members were not only abusing alcohol but also various drugs, so she had little in common with them. Some years later she died with alcoholic dementia.

    So, I conclude that if you want to give up, a support group could well help. If you are coerced or merely unsure, a support group will be useless.

  6. Theo – yarp.

    Alcoholics only get better when they want to stop being alcoholics.

    This is why I’m skeptical about support groups, because you either want to conquer your vices or you don’t.

    People do need support, but the best form, IMO, is for the recovering alcoholic is to set a date and tell his loved ones that he’s stopping the drink from that date. That way, there’s a sense of accountability to people who are important to you.

    Giving up alcohol is the easy bit, even with the DT’s, sleepless nights, pain, boredom, etc.

    Admitting that you have a problem and deciding that you love your life and the people in it more than you love being sloshed – that’s the hard part. The human brain is an amazing rationalisation machine, and there’s always a “reason” to drink.

  7. Public Health could take the money they are currently wasting on telling us absurd lies about sugar and spend it on these groups instead. Problem solved.

    I suspect the money is going the other way though – from these programs to the nutter prohibitionists. The zealots always win these battles.

  8. £40 per head is probably about what they are spending on lying about second hand smoke being dangerous.

    What I find fascinating about AA is its clear growth from the Oxford Movement and Evangelicalism generally. Like facing the devil, we are powerless against alcohol. Like the battle against sin, either we drink and sin or we don’t. There is no middle ground. There is little room for what seems a sensible position – drink less.

    It probably doesn’t work all that well either.

  9. “Alcoholics go to meetings, drunks go to parties” – Anon

    I mostly quit my bottle of wine a day habit last year, not because I was an alcoholic, nor even concerned about it, just because it was not a healthy habit to have and continue.

    I didn’t need to go to any meetings, I just stopped ordering boxes of wine from Aldi’s online wine service (delivered to my door by Royal Mail) and decided not to have wine in the house.

    If I want a bottle (as I occasionally do), I have to walk the mile or so to and from the local Aldi and I only buy one bottle at a time. This regime has cut my consumption down from 1 bottle a day to a couple of bottles (2 – 4) a month.

    There may be an argument about not having and “addictive personality” (whatever that means), but certainly things like gambling (even in a French casino with clients) I find boring more than anything else and drugs were never my thing either.

    One year on and I feel much better for it and I struggle to understand this whole “If you don’t go to a meeting, your sobriety won’t last” schtick I find hard to understand.

    Maybe it’s an American thing, but the whole approach of having “Court Ordered attendance at AA meetings” sounds horrifically puritanical, so I’m not surprised that these have no statistically significant impact on alcoholism.

    If people want to change they will change of their own accord (even if they are beset by bumps on the road), if they don’t want to change (even if it is killing them), then they won’t.

  10. John Galt – “I mostly quit my bottle of wine a day habit last year, not because I was an alcoholic, nor even concerned about it, just because it was not a healthy habit to have and continue.”

    A bottle is seven standard drinks? It is likely to be healthier than none. Half a bottle a day would be about the ideal level from a health perspective. If I took a wild guess at your sex and age, I would say even more so if it was red.

  11. “And why would I want to hang around a bunch of alcoholics who constantly talk about booze, anyway? ” Steve says.
    Lot of sense there. You want to give up booze, first thing to do is not put yourself in a position you might be tempted to have drink. And the last thing you need is to be with people desperately want a drink. Odds on, one of them’ll slip & take you with them.
    Mr Galt has the right idea. Make getting that first drink something you have to expend considerable energy on. Gives time to change your mind, if nothing else.

  12. “set a date and tell his loved ones that he’s stopping”

    This works for lots of things. Anything that you know might be difficult, just tell the right people you are going to do it. It makes it so much more difficult to back track.

    “and decided not to have wine in the house.”

    This also works for lots of things.. including all sorts of snacks or other tempting stuff. Having to go to the effort of buying things individually can work brilliantly for “all things in moderation”.

  13. Funnily enough, there was a long segment on this very issue on US National Public Radio this last weekend.

    Highlights I remember – the success rate for AA in proper studies is about 8% – that’s people who get sober and stay sober.

    Many judges order people convicted of alcohol-related offences to attend AA because their treatment options are seriously limited, the cost to the state is low-to-zero, AA has a good reputation for helping people (whether or not it is true), and it does impose some real burden in time and effort on the offender.

    Many described how AA has social aspects, both good and bad – the Hollywood types who go to AA, not because they have a problem, but because they will meet and mingle with powerful Hollywood types who do, and they will have the social advantage of a shared problem – or – the problem mentioned above, that AA gathers alcoholics together and this often results in more drinking – not less.

    Riffing on a point that Theodore Dalrymple often makes – compared to alcohol, quitting most narcotics is easy – it’s uncomfortable, but generally nothing like the horror story that ‘cold turkey’ is suggested to be, usually by addicts who play up its horrors in order to justify their continuing to use. He likens it to a bad case of the flu, no more. By contrast, an alcoholic quitting alcohol is at serious health risks, the DTs are real and the severest result really is death Same for some other classes of drugs, like the benzodiazepams.

    But a whole industry, both commercially- and morally-driven, has grown up around the idea of addition as a ‘disease’ that requires a ‘cure’, and that a ‘cure’ is possible. Which is mostly nonsense – what’s called addiction should more-properly be considered as a freely-chosen vice which a person chooses to adopt and which they will continue to indulge until they freely choose to stop. Unfortunately, a lot of people are either a) making money or b) gaining moral or spiritual benefit form the model of addiction-as-disease, and so we should not expect it to change anytime soon.

    llater,

    llamas

  14. Weight Watchers has a significant success rate, as do jogging clubs helping middle-aged office workers re-discover the concept of a waistline.
    Disputes about the success rate for AA but if the US data is contaminated by drunks ordered to attend AA when they don’t want to the true success rate for volunteers must be higher
    So the answer to (i) is “Yes” and to (ii) No-one knows because the only data is contaminated

  15. @llamas:

    That’s really interesting, never having been addicted to anything I could never really understand either the motivation or experience of addicts.

    The only genuine alcoholic I’ve know (and it killed him last year) was my downstairs neighbor and he wasn’t so much addicted as just enjoyed drinking, even though it was clearly killing him.

    Then again, over the years I have developed quite a tolerance to alcohol. In my 20’s drinking a bottle of wine would have had me paralytic, whereas nowadays it just gives me a mild intoxication and even two bottles only results in a headache and dog breath mouth the following morning.

    Not sure how you define addiction, but doing something of your own choice which is killing you sounds pretty stupid at the very least.

  16. “but doing something of your own choice which is killing you sounds pretty stupid at the very least.”

    This could very largely be another side to the wider social problem of poor impulse control that is so detrimental in all other aspects of life.

  17. It’s Dawn Foster, so Corbynista warnings apply in addition to the Guardian ones.

    To me the support groups seem to be treatment not prevention, so she is cart before horse anyway.

    OTOH the only genuinely forever reformed alcoholic (and wife beater) I knew personally was ‘solved’ by conversion at a Pentecostal Prayer Meeting.

  18. Meanwhile, more people are giving up cigarette smoking…just 15% of the adult UK population now smokes. I’ve never understood what anyone gets out of it, particularly given the health risks. At least with booze, there’s the taste as well as the intoxication. I tried cigarettes in my youth, but they made me feel sick and dizzy. And smokers treat the world as their ashtray.

  19. In my 20s, I’d already had at least three years of expensive training in HM Forces, and drinking a bottle of wine merely made me unfit to drive.

    Now, bottles of port, that was serious dehydration – mostly a mouth full of dry rags.

    I had my first proper hangover in my early 40s. I thought I was dying …

  20. ‘Do we actually have any proof that drug and alcohol support groups do this?’

    Just ask them.

  21. John Galt,

    “Then again, over the years I have developed quite a tolerance to alcohol. In my 20’s drinking a bottle of wine would have had me paralytic, whereas nowadays it just gives me a mild intoxication and even two bottles only results in a headache and dog breath mouth the following morning.”

    And nowadays wine is a good 3% stronger than it was 30 years ago.

  22. If you really want to stop drinking, support groups can help get you sober and keep you sober. And you don’t sit around talking about booze all the time; that would be idiotic. The social aspect is crucial, since having people to talk to who are not going to stigmatise you is liberating, and people who have long-term sobriety act as an existence proof that it’s doable. Addictions almost by definition are refractory to willpower, which is why there is a difference between an alcoholic and a heavy drinker.

    No-one, least of all people in the groups, is under any illusion that they are a panacea. Stick around long enough and you will see people relapse and die. But when they work they work pretty well.

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