Treatment Journal Reviews Empowering Your Sober Self

The current issue of Alcoholism Treatment Quarterly contains a review of my book Empowering Your Sober Self.  The reviewer, who is none other than the distinguished scholar William L. White (Slaying the Dragon and other works), writes, in conclusion:

Nicolaus offers us a clear window into the basic approach of LifeRing Secular Recovery, one of the major secular alternatives to AA. LifeRing was founded in the San Francisco Bay Area in 1999 and became a national organization at a founding conference in Florida in 2001. LifeRing hosts face-to-face recovery support meetings, a range of e-mail lists for member- to-member communication, online (www.unhooked.com, www.lifering.org) chat rooms and Internet forum (bulletin board), an online social network (lifering.ning.com), LifeRing social events, and the annual LifeRing Congress.

In Empower Your Sober Self, Nicolaus has created an engaging text for individuals seeking recovery and for service professionals wanting a greater understanding of LifeRing’s core ideas and recovery support strategies. Empower Your Sober Self also includes the voices of many LifeRing members whose personal stories illustrate key points in the book.

 The discussions in this book include some of the more controversial issues in the addictions field. Nicolaus outlines positions on these issues clearly and forcefully and in ways that help distinguish LifeRing Secular Recovery from 12-step programs and from other 12-step alternatives. This book is intended to inform rather than convert. Not everyone will agree with the ideas and approaches set forth here, but for the past decade, individuals and families have used LifeRing Secular Recovery as an effective framework to initiate and maintain long-term recovery from life-impairing addictions. Those recoveries are cause for celebration, and this book details how they did it. Those seeking a solution to alcohol and other drug problems and professionals assisting people with such problems will find great value in Empower Your Sober Self.

This strikes me as a fair and even-handed assessment and I'm grateful to the writer.  It's also a good sign that the journal, which goes to the more research-minded echelons of the treatment profession and to academics, has taken note of this book.  Hopefully, the review -- and the book, for those who will read it -- will persuade a larger number of treatment professionals to include LifeRing meetings in their referral pool.

For a PDF copy of the complete review, click here.

Confrontation Therapy, R.I.P.

Two of my favorite scholars have combined to write a powerhouse of an article that everyone interested in addiction treatment will want to read. William R. Miller, co-author of the Handbook of Alcoholism Treatment Approaches (reviewed here), and William L. White, author of the monumental history Slaying the Dragon (reviewed here), have written what hopefully will be an obituary for an era, entitled "Confrontation in Addiction Treatment." It's in Counselor Magazine.

I've posted excerpts and a short comment in the New Recovery Blog; go there.

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).