charismatic organizations: the case of alcoholics anonymous
The media covered a new book by Lance Dodes called The Sober Truth. In the book, Dodes surveys the evidence on rehab and finds that there is literally no evidence that rehab, AA or other popular methods for kicking drugs are effective. From a recent Alternet article:
Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism. This group reached the same conclusion about professional AA-oriented treatment (12-step facilitation therapy, or TSF), which is the core of virtually every alcoholism-rehabilitation program in the country.
What I find interesting is that I was told this before by physicians and social workers. These programs work for very few people and this is common knowledge. But why didn’t I draw the logical conclusion? If it’s expensive ($200,000 for a stint in a fancy rehab center) and it doesn’t work, why not just stop doing it?
Two answers: The Robin Hanson answer is that it’s a signal of morality. We do it to show that we care, even if the evidence is dodgy. Another (not unrelated) answer is that charismatic orgs get less scrutiny. AA is trying to be nice to people and help them overcome serious problems, so I am less inclined to search for evidence that assesses their effectiveness. This is different than, say, a think tank that is pushing a policy that I don’t like. Then, I’ll search high and low for all the evidence I can find to fight them.
Bottom line: We should probably get tougher on organizations that claim to do good. We’re probably giving out too many free passes.