I fully agree that there shouldn't be court mandates for attendance. I'd much prefer that a list of evidence-based treatments be given out and mandated, if mandating is appropriate.
I want to add that I am not anti-AA. I just think the country needs to view what it is more accurately.
Yup, although it has been several years now. I've also read the back of US currency. The phrase "separation of church and state" came from opinion pieces by Franklin and others at the intended purpose of the establishment clause. If that, a number of other things in the US, don't violate establishment, I'm not sure that a treatment that uses the phrase "god as you understand him" and openly welcomes others of different religions without attempts to convert them would be found to do so. This ambiguity particularly pronounced when AA openly declare no specific religious affiliation despite its clear historic originals.
I prefer those rulings, but I suspect it may be harder to land a win across the board on that. I'm a cynic; its one of my better qualities.
I find this statement offensive for any number of reasons.
Exactly.
I'm not sure why AA is immune to statements about its quality. An absence of evidence on efficacy does make it a poor intervention that isn't a good choice. If we don't know how a treatment works, if it works, or who it works for... then what would you call that? I don't object to the ideas or whatever else, but from an empiricist standpoint.. lacking those things does make it a crap treatment referral in my eyes.
Hey, we agree! The only thing here is that one is a treatment and one is not. Appreciating the nuances of that, regardless of how other treatment providers may have screwed with the model, is something I would expect all psychologists to be capable of.
, but I also think that as psychologists we should have a heightened awareness of the effects of language regarding marginalized groups such as people with addiction problems.
For what its worth, this is generally my "referral":
I'm fine with being offended
Until such a time as we know who it works for, when it works, and what components of it do work, I consider the program to not be well developed enough to spend a lot of time on vis-a-vis consideration as potentially useful. My focus is on the prevention of harm when it comes to service delivery (defined as broadly as you can go). If we, as a field, want to promote treatment of mental health issues, then lets do that. But that means we need to promote good, empirically based ones and not sit on the sidelines encouraging its using only to say "this works for some people because some people say it does so we should encourage its use". I've heard the same disclaimer quoted above, but I'm not sure why thats acceptable for a science to promote.
If you are referring to the Minnesota model, then that is a treatment. You keep conflating things and referencing a general misperception (which I don't think is as ubiquitous as you think), but really our job should be to correct these misperceptions.
I think that we have a similar attitude - I'm all for EBTs and good implementation and avoiding iatrogenic effects. However, I do have a practical question - what treatments have all of these things that you have referenced?
I felt that the line "it's a crap referral" was a bit sloppy and could be construed as demeaning to the members of AA. Also, what exactly is the critique of 12-step or other self-help type groups other than we don't have research to compare them to structured, professional treatment models?
I agree wholeheartedly that the state of EST science is subpar. However, there are large differences that are hard to ignore between the state of research on things like CBT and other treatments, such as alcoholics anonymous. It is not a matter of zero sum. We know far more about efficacy on many treatments than we do for AA. I would say, as always, more research is needed. Until there is a base of literature showing some level of efficacy I question the use of that treatment however.
It seems to me that the you have one standard of evidence for critiques and another standard of evidence for support.
Your point remains unclear. What do they do in these regions that you object to? Does everyone say that AA is treatment? Because I don't hear that.
No RCTs on AA because a) it is not a treatment and b) the nature of the group wouldn't lend itself to support it. There are meta-analyses (I think another big one is coming out soon too) that lend support to AA being beneficial.
And that resource use (time, money, etc) is problematic even if it would not translate to other treatments. Populations that are underserved don't have this to waste on an unsupported treatment we are supporting, in my eyes.
Call it a treatment one more time...
Treatment.
AA (and other 12 step groups) is a spiritual organization designed by alcoholics to support each other in recovery. Although these are different from religions in a lot of ways, it is probably closer in concept and design to religious organizations than it is to professional treatment. It would be almost as ridiculous to ask if there are any RCTs to show that religion is effective.
Call it a treatment one more time...
Thanks. I was about to reply to your other post. SA isn't my area and my reading has always emphasized a lack of outcome studies. I'll take a peruse.
Yay, agreement!
I disagree
I agree that a support system that is specific for recovery does make it harder to distinguish between professional treatment and just social support like T4Cs bowling league example (although those bowlers can drink a lot of beer so maybe not as good a social support for addiction as for depression
) . So I guess I won't blow your brains out.
I think this is precisely where we disagree. You seem to think there is a culture that supports this, when AA itself says exactly the opposite. You seem to think AA has forced itself into the court system when they just cooperate with said system. I'd say fix the court system instead of pointing the finger at AA. Moreover, using a term like "AA and its ilk" really generalizes a large, heterogeneous group of people around the world and comes off as very subjective.
