http://www.orange-papers.org/orange-eff ... ant_deathsProfessor (and Doctor) George E. Vaillant of Harvard University is an enthusiastic advocate of Twelve-Step treatment, and is currently a Non-alcoholic -- Class A -- member of the Alcoholics Anonymous World Services, Inc. (AAWS) Board of Trustees. In 1983, he published his book The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, where he described the natural healing process associated with individuals addicted to alcohol -- "spontaneous remission" -- where some of the people who are addicted to alcohol will simply quit, and choose to stay abstinent of their own volition, without any Alcoholics Anonymous meetings, or any therapy program, or any other outside intervention at all.
Dr. Vaillant's question was: does the A.A. program improve on the percentage of alcoholics who undergo spontaneous remission?
Following the passage of the Hughes Act, the U.S. government -- the NIAAA to be specific -- funded studies of alcoholism treatment. Dr. Vaillant participated in the Cambridge-Sommerville [Massachusetts] Program for Alcohol Rehabilitation (CASPAR). It featured 24-hour walk-in services with medical treatment for detoxing. It treated 1000 new patients per year, did 2500 detoxifications per year, and had 20,000 outpatient visits per year.
To study the effectiveness of various methods of treating alcoholism ("treatment modalities"), Vaillant compiled forty years of clinical studies. Vaillant and the director William Clark also conducted an eight-year longitudinal study of their own where Vaillant reported having followed 100 patients who had undergone Twelve-Step treatment. (That was an unusually large and long-term study.) Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. Fully 95% of the treated patients relapsed sometime during the eight-year period that Vaillant followed them. Professor Vaillant candidly reported:
When I joined the staff at Cambridge Hospital, I learned about the disease of alcoholism for the first time. My prior training had been at a famous teaching hospital that from past despair had posted an unwritten sign over the door that read "alcoholic patients need not apply." ... At Cambridge Hospital I learned for the first time how to diagnose alcoholism as an illness and to think of abstinence in terms of "one day at a time." ... To me, alcoholism became a fascinating disease. It seemed perfectly clear that by meeting the immediate individual needs of the alcoholic, by using multimodality therapy, by disregarding "motivation," by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.
But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. Our clinic followed up our first 100 detoxification patients, the Clinic sample described in Chapter 3, every year for the next 8 years. ...
Table 8.1 shows our treatment results. After initial discharge, only five patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. In table 8.1, the outcomes for the Clinic sample patients are contrasted with two-year follow-ups of four treatment programs that analyzed their data in a comparable way and admitted patients similar to ours. The Clinic sample results are also contrasted with three studies of equal duration that purported to offer no formal treatment. Although the treatment populations differ, the studies are roughly comparable; in hopes of averaging out major sampling differences, the studies are pooled. Costello (1975), Emrick (1975), and Hill and Blane (1967) have reviewed many more disparate two-year outcome studies and have noted roughly similar proportions of significantly improved and unimproved alcoholics. Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.[/b]
