Friday, December 21, 2007

Once again on the AA dropout rate

Many people are now aware of the statistic that 95 per cent of newcomers in AA drop out during the first year. Out of one hundred who start, at the end of one year, only five are left.

I first learned this statistic from the Bufe volume, reviewed here. Bufe attributed it to AA's own Membership Surveys. However, I drew a blank -- and some hostile looks -- when I visited the AA library up on Riverside Drive in 2005 and asked to see the original survey reports. Since Bufe might be accused of anti-AA bias, I wanted a less impeachable source. Thanks to a very knowledgeable psychology Ph.D., I now have it, and it's very interesting.

Don McIntire of Burbank CA was given access to the AA membership surveys from 1968 through 1996. He is a staunch defender of AA and cannot be accused of negative bias. His article "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968-1996) and Related Analyses/Comments" in the Alcoholism Treatment Quarterly (Vol 18, No. 4, 2000) centers on the 5 per cent one-year retention rate and attempts to explain it.

The 95 per cent dropout rate is anything but a statistical fluke. AA's own membership surveys demonstrated the identical pattern, give or take trivial variations, in five successive triennial data collections spanning twelve years. McIntire depicted the trends in a graph (inset) showing a fairly tight braid whose strands are the data sets from different years. The five per cent figure is the average of the five studies.

Most of the attrition, McIntire's analysis shows, comes during the first 30 days. This is not obvious from the graph. The graph begins at 30 days. If you can read the tiny numbers on the x axis, you will see that the bundle of line graphs begins at around the 20 per cent mark. If the graph began at Day One and 100 per cent, the lines would drop almost like a rock.
  • McIntire found that an average of 81 per cent of AA first-time attendees dropped out during the first 30 days.
  • At the end of 90 days, 90 per cent of newcomers have dropped out; only ten per cent are left. (This gives a new dimension altogether to the "90 in 90" slogan, doesn't it?)
  • The attrition curve from 90 days to a full year is, by comparison, rather gentle: from ten per cent to five percent, a relative loss of "only" fifty per cent.
McIntire, who (as I said) is a staunch defender of AA, argues that the attrition during the first 90 days should just be ignored, and that AA should claim a 50 per cent success rate based on the trend from 91 days to one year.

The author's apologetic argument is that the FTA's (first time attendees) who drop out quickly aren't really alcoholics, or aren't really trying to get sober, and so they shouldn't count. Although that has a ring of plausibility for some cases, the author presents no data as to percentages.

AA co-founder Bill W., looking at numbers of this type, asked "What happened to the 600,000 who approached AA and left?" (Reported in White, Slaying the Dragon, p. 139) Despite Wilson's concern, apparently nobody in AA has ever, yet, bothered to try to contact any of the 95 per cent to try to find out their reasons for leaving.

We know from other data that alcoholics who don't do AA can nevertheless succeed in achieving long-term sobriety. In fact, the AA Grapevine has conceded that the majority of alcoholics who achieve the milestone five-year mark do it without using AA. (Vaillant., 1996, 2001)

Consequently, it's extremely unlikely that lack of motivation to get sober accounts for the 95 per cent AA dropout rate. Lack of desire to get sober is undoubtedly a part of the picture, but there has to also be a healthy percentage of the 95 per cent dropouts -- perhaps a majority -- who want to get sober but drop out of AA for other reasons.

McIntire's article never looks at this bigger picture. To do so would be to confront the reality that AA is driving people away who have a sincere desire to get sober (and many of whom will achieve that aim).


Craig T said...

Most self-help/mutual-aid groups have similar attrition rates (has LifeRing done a similar study?). It's always a good idea to question what causes the lack of appeal, and even to direct people to other groups that might fit them better.

There's really at least three things to consider (1) the effect of stigma on newcomers, (2) the fit of the newcomers personality to those all ready in the group, and (3) they willingness to do the work.

There is a good rebuttal to the 5% drop-out rate here:

David said...

AA certainly did not live up to Bill W.'s dream of a universal cure for alcoholism, and AA is not the only way out for problem drinkers. However, your 'revelation' that most drinkers don't get sober through AA is no put-down. Research over the last couple of decades indicates that AA is not for everybody, but is as good as any other treatment out there. Remember, there is no medical cure for alcoholism.

Anonymous said...

CraigTalbert and DavidMack: this is desoto10 from wiki.

The odd "rebuttal" to which Craig refers, above, in rebutting one AA 95% failure rate, claims "And anyway, this was a study of a clinic, not AA." How is that a rebuttal? For the second case of 95% attrition, which is actually what the article here was about, this "rebuttal" offers absolutely nothing except some nonsense about gym attendance. 95% of attendees at AA drop out after one year. This is not open to argument, and you both know it. You can try to explain it away, but you have to deal with reality. This issue for AA is how to keep some of these folks involved in AA, don't you think?

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Five Nineteen said...

Three words: Simple Frequency Distribution. Not understanding that concept leads to misreading of the graphs and the completely wrong 5% retention figure. The actual retention rate per the chart is 26%.

Martin Nicolaus said...

In response to 519: That's certainly higher math. Do you want to explain how you got there?

The author of the article, McIntire, simple-mindedly imagined that if out of 100 people at the end of the year only 5 are left, the one-year retention rate was 5 per cent.

If you can turn 5 per cent into 26 per cent I'd like to have you as my investment advisor. LOL.

Milo said...

Martin, the graph is very simple. The researchers went into different AA meetings and asked the people there how long they had been attending, they plotted the results for those within their first year on this graph by monthy averages. So it shows, 19% of people were in their first month, 13% their second, 10% in their third and so on up to 5% in their twelfth month. (The other 95% in the survey was comprised of those sitting in the same room and with less than 11 months time attending meetings.)

So, the graph actually shows that 26% of people who try an AA meeting for the first time are still attending AA after the first year, the attrition is from 19% (those in their first month) to 5% (those in their twelfth), and therefore around 74%.

It's a frequency distribution graph.

Martin Nicolaus said...

Milo: That's creative math. I don't understand it, and I suggest you write to Don McIntire, the author of the article, to explain it to him. If only 5 per cent of the people in a room have been attending for a year, most statisticians would say that the attrition rate at 1 year is 95 per cent. That's exactly how McIntire saw it. What McIntire did to put a happier face on the numbers is to set the baseline at 90 days, so that the attrition rate from 90 days to 12 months is 50 per cent (10 % to 5%), just discarding the numbers from the first three months. Needless to say, writing off the first 90 days doesn't sit well with what we think we know about the importance of the early days in recovery.

Anonymous said...

I believe from actually attending mtgs, the 5% a year figure. Your creative accounting is a contrivance. GSO too agrees with the 5%. Sorry...and agent green is anecdotal at best - let now let me outta this lifering stuff if were gonna do aa, please.

Anonymous said...

Just for some perspective on the 5% rate: Achieving behavioral change is EXTREMELY difficult across the board. As many as 90% of individuals do not achieve behavioral change on their first attempt (Polivy and Herman 2002). It isn't so much AA, then, as it is the difficulty of the task itself. And the best available evidence suggests AA has comparable levels of effectiveness to other treatment methods (Cognitive Behavioral Therapy and Motivational Enhancement Therapy) and is actually better for the more severely dependent and if total abstinence is the goal (Project MATCH Research Group 1997 & 1998). Is it far from perfect? Absolutely. But it is nonetheless (and sadly) one of the best options that we have for treatment. (And, in case you're wondering, I'm a researcher not a member.)

Martin Nicolaus said...

Re the latest "Anonymous" (why the secrecy?):

True, behavioral change is difficult. But blaming the 95% walkaway rate on the difficulty of change is a copout. The majority of alcoholics (60%) who achieve long-term sobriety do it outside of AA (Vaillant). So, it isn't the problems of change that deters them, it's the problems of AA.

I'm surprised you rely on the Project Match mess. PM did highly polished one-on-one counseling sessions, and really proved nothing either about AA as it works in real life, nor about the other methods.

KC said...

For Anonymous researcher and others:
I believe once you've attended a few AA/NA mtgs you'd begin to understand how disempowering faith-based healing as used in these 'fellowships" are and being science minded one can lose touch with reality of one's situation. By this i mean addiction is not a moral shortfall/character defect-it is a behavior/choice based...this is the key issue with AA/NA...their claim the individual has no choice.
In practice (emphasis) AA/NA goes against all science and claims one's only alternative is the power of prayer and turning one's will and life over to a higher power. So, really i believe this relieves the "fellowship" from any statistical does one quantify daily 'miracles." One can't because AA/NA is merely a placebo and NEVER EVER addresses depression or anxiety in a scientific manner.

KC said...

I would also challenge any AA/NA success rate as being invalid because it is self-reporting. If you don't have solid TESTING results, and that is impossible by the whole 'anonymous' thing, then really its just a heresay. I give you my experience: One my first experiences at a mtg was a speaker was to receive a 5 year coin; within minutes of taking the podium she passed out. Come to find out after the paramedics arrive she had BAC of over .08. So - we shall really never know the "attrition rate" nor the success rate of AA/NA. By my measurement (personal) any alternative to NA/AA is statistically better.