Success rates in early A.A.
Richard K. wrote in and said: "Success Rate of Early AA: 75 - 93%. Success Rate of AA Today: 2.4 - 4.8%."
To get success rates as high as 50% first time through and 75% eventually (the normally cited figures for good early A.A.), you have to do either (a) prescreening and/or (b) exclude people from your sample who only came to a relatively few meetings and then dropped out because of lack of real internal motivation.
In early Akron A.A., Dr. Bob did very vigorous prescreening before he would begin working with people (see Dr. Bob & the Good Oldtimers). If you have a good eye, you can always increase your success rate by prescreening in this fashion.
Sgt. Bill S., in his book which just came out (On the Military Firing Line in the Alcoholism Treatment Program), explains how he obtained a similar success rate in the strongly A.A.-linked alcoholism treatment program which he set up at Lackland Air Force Base in San Antonio in the early 1950's: 50% got sober and stayed sober the first time around, and additional people, after being bumped from the program, eventually realized how they had missed the boat and came back to A.A. meetings on their own and got sober. Sgt. Bill S. (who got sober on Long Island in 1948, and now has 55 years of sobriety) also prescreened people before he would begin working with them: there had to be evidence of strong motivation (one of Dr. Bob's key criteria), and Sgt. Bill also excluded people who had serious mental problems. His criterion for the latter was that he refused to admit Air Force personnel into the program whose mental problems were so serious that they would have had to be released from the service anyway.
After Dr. Bob's death, Sister Ignatia continued to have high statistics at St. Thomas Hospital because she made the A.A. people do her prescreening for her, and insisted that an Akron A.A. member in good standing had to "sponsor" the newcomer, which meant agreeing to pay that newcomer's hospital expenses if he dropped out and didn't make it -- you can bet your boots that this made the prescreening rigorous indeed!
Also, Sister Ignatia normally allowed people only one chance to make it. On rare occasions, she would let a patient come back for a second try, but that patient would be completely isolated from the other incoming alcoholics, so as not to tear down morale. And no one at all got a third chance. That also increases your statistics on "successes," because when an alcoholism treatment center allows people to come back for treatment fourteen or fifteen times in a row, this greatly pulls down your observed success rate. See Mary Darrah's biography of Sister Ignatia, and the chapter in Sgt. Bill's book on the year he spent visiting Sister Ignatia at St. Thomas and seeing how she did it.
In Nancy Olson's recent book, With a Lot of Help from Our Friends, she has a couple of chapters on the successful treatment program which Dr. Joe Zuska set up for the Navy in the late 1960's. This was the one which Betty Ford and Billy Carter were later sent to in order to get sober. A whole book needs to be written on Dr. Joe, who is a marvelous man, and Dick J., who helped him start it. This program was a team effort, in which an A.A. member, a retired Navy Commander named Dick J., was given major input at all times, and in which Dr. Joe (a nonalcoholic himself) learned to listen to Dick J. and take him seriously. I am close friends with Submarine Bill, a retired submarine commander who went through the Navy program that Dr. Zuska originally devised, and they still did very careful prescreening, and also booted people out of, not only the treatment center, but the Navy, if they refused to work the program. So they too had those very impressive official success statistics.
Can A.A. still obtain similar success rates today? Submarine Bill and I have done a study of an excellent small A.A. meeting in Osceola, Indiana, which follows good old-time A.A. practices and procedures. Over the past twelve years plus, 90% of newcomers who attended every Tuesday evening without fail for a full year stayed sober for that whole year. And 90% of those who stayed sober that year, even if they later moved and started going to other A.A. meetings, are still sober today. That is around an 80% success rate, measured that way.
Obviously, we were using the other strategy for producing high measured success rates, one which was mentioned in a previous posting: we excluded those people who only attended a relatively few meetings and then dropped out because of lack of any real internal motivation.
Also, as Sgt. Bill explains in his book, there were both good A.A. groups and poor A.A. groups even in the old days, and even in the greater Akron area (he gives an account of a group not far from Akron in the mid 1940's which did an abysmally poor job of helping newcomers, and explains in detail why it failed to help nearly as many people as it could have).
There is a moral dilemma involved in doing prescreening or excluding certain groups from A.A. meetings (like court appointed attendees, most of whom have no real motivation, and therefore do not make it, and who lower the apparent success rate). If you set the standards too high, you will refuse to work with some alcoholics who could have made it, and condemn them to a miserable fate, perhaps even condemn them to the death penalty. If you set the standards too low, you tear down everybody's morale (as Sister Ignatia emphasized) and that too will mean that alcoholics who should have made it will end up failing and going to their doom. I am not sure there is an easy answer to this dilemma. I at least do not have one.
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