Outpatient Treatment of Alcoholism

Outpatient Treatment of Alcoholism is a book by Jeffery Brandsma, Maxie C. Maultsby Jr., and Richard J. Welsh, published in 1980. It describes a study of 260 individuals, 184 referred by the courts and 76 self-referred or referred by other agencies for 210 days. Participants were assigned randomly within five groups: AA-like meetings, RBT therapy administered by a non-professional, RBT therapy administered by degreed professionals, Insight Therapy administered by professionals, and a control group which received no treatment.

Outpatient Treatment of Alcoholism
AuthorJeffery Brandsma, Maxie C. Maultsby & Richard J. Welsh
CountryUnited States
LanguageEnglish
SubjectAlcoholism, alcoholism treatment
PublisherUniversity Park Press
Publication date
1980
ISBN0839113935

Methodology

The AA treatment meeting was created by the research team, and was held at a rented office building set up to run the overall study. The meeting was open to the public,[1] but it is unknown whether the meeting was listed in local AA directories.[2] While initially run by two AA members with over 10 years of experience before the trial started, the AA meeting was led by a member of the group (who was not in the study) with no previous AA experience during the research trial. Even though the AA patients were encouraged to get a sponsor, almost none of them got one. Attendance records were kept; people with poor or no AA attendance were reminded by a social worker about the conditions of their parole. Brandsma noted that the AA group "did not develop a high degree of cohesiveness".

Results

The study found that AA was more effective than no treatment, and about as effective as the three other alcoholism treatments. According to the study, both the AA-style and the lay-RBT group were able to stop drinking more often than the control group after one or two initial drinks, and when drinking, they both consumed three to four times less alcohol per day than the control group.[1]

Increased binge drinking

While some people who went to the AA-like meetings indulged in binge drinking at the three-month after treatment mark, there was no increase in binge drinking for the AA-style meeting members six months, nine months, or one year after treatment.[2] The fact that this study saw increased binge drinking has been noted in polemics[3] critical of Alcoholics Anonymous.[4]

Criticism

There was no effort to stop the people in the control group from attending Alcoholics Anonymous meetings.[5] The "Alcoholics Anonymous" treatment patients underwent in the Brandsma study did not use community Alcoholics Anonymous meetings; a later analysis says that there are "concerns with the Brandsma trial which call its experimental results into question" because "the control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting)".[2]

Jeffrey Brandsma

Jeffrey Brandsma, born on December 14, 1943, was the principal author of this study. He got a Ph.D. in clinical psychology, and was at the University of Kentucky Medical College as an Associate Professor when this study and book were published. He moved to Augusta, Georgia in 1981, after this book came out. He passed away on February 19, 2008.[6]

References
  1. Brandsma, Jeffery M; Maultsby, Maxie C; Welsh, Richard J (1980). Outpatient Treatment of Alcoholism: a review and comparative study. Baltimore, MD: University Park Press. ISBN 978-0-8391-1393-5. OCLC 5219646.
  2. Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases. 28 (2): 145–157. doi:10.1080/10550880902772464. PMC 2746426. PMID 19340677. One reason that several of the other trials may not have found positive effects for AA/TSF is because many individuals randomized to the non-AA/non-TSF conditions also attended AA; thus, the AA or TSF condition ended up being compared to a condition consisting of an alternative treatment plus AA [...] There are other concerns with the Brandsma trial which call its experimental results into question. The control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting). The description of the AA condition states that the steps were used for discussion content, the group focused on newcomers, and they told patients about sponsors, but it is not clear whether the meetings were led by AA members, whether crosstalk was allowed, whether the meeting leader shared their story as part of the meeting, or whether the meeting format was what one would encounter at an actual AA meeting. The meetings may not have been open to other AA members in the community, and not been listed in the AA meeting directory, which would mean that a potentially important therapeutic ingredient of AA--the experience of longer-term members--would not have been present in the AA condition. This is of special concern because the control condition did allow for attendance at such meetings.
  3. Friedman, Richard A. (2014-05-05). "Taking Aim at 12-Step Programs". The New York Times. [The Sober Truth is a] polemical and deeply flawed book
  4. Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN 978-0-8070-3315-9. The investigators found "significantly more binge drinking at the 3-month follow-up" among the people assigned to the AA-oriented meetings.
  5. Magura, Stephen; Cleland, Charles M.; Tonigan, J. Scott (2013). "Evaluating Alcoholics Anonymous's Effect on Drinking in Project MATCH Using Cross-Lagged Regression Panel Analysis". Journal of Studies on Alcohol and Drugs. 74 (3): 378–85. doi:10.15288/jsad.2013.74.378. PMC 3602358. PMID 23490566. "The few randomized controlled trials of AA that have been conducted are significantly limited in their methods or interpretability [...] some alcoholism study subjects always go to AA on their own, even if not specifically assigned to go".
  6. "Jeffrey Melvin Brandsma: Obituary". The Augusta Chronicle. Archived from the original on 2018-12-04. Retrieved 2019-06-17.
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