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Addiction & Treatment
Research

1989 BALDWIN RESEARCH FOUNDED

ADHERING TO AA'S BIG BOOK

BRI has been conducting longitudinal outcome studies since 1990. In that the research has gone on uninterrupted for nearly 27 years, it is likely that the researchers at BRI have logged more actual time and effort studying substance use programs than any other drug and alcohol research organization. During that time, BRI has developed all of its own techniques for making sense out of what would appear to be corrupt data. Let's take a few moments to understand where and what these decades of research have brought us.

At the start, the founders of BRI set about conducting research through observational studies to discover evidence that 12-step programs, specifically Alcoholics Anonymous, worked. Much to the researchers' surprise, their research revealed irrefutable evidence that the program of Alcoholics Anonymous and drug and alcohol treatment programs were not effective in helping people overcome drug and alcohol problems. Once it was understood that that paradigm was a failure, the question became: Is there anything that could be done to assist those who sought help to stop their drug and/or alcohol use? Literally hundreds of approaches were looked at and some were studied in-depth. Only two methods emerged as promising: social programs, i.e. programs that provided social development skills and programs that provided life skills information, both of the instructional type and the experiential type. Over time this led to the codification of a "social/educational" program (which later transformed into a social/learning program), which has been studied and refined for more than 26 years. But given the fact that all social self-reporting studies are flawed, how were these studies designed so as to produce meaningful results?

In the early days, perhaps for the first 2 years, the research was exclusively observational. That is, the researchers were not known to be researchers, but were just part of the whole group. No one in the informal group of subjects knew that they were being observed or studied. The group of subjects was loosely held together by self-selected social bonds. No one was encouraged to belong or to socialize with those within the self-selected social circle. The expansion of the study pool was based entirely on natural self-selection. It was a natural process of people coming to know each other and deciding to spend time together.

The researchers observed the study subjects nearly every day for more than a year, not on the basis of being in some sort of group or study, but simply on the basis of being friends. And, even though many became subjects of the study as a matter of being coerced by legal requirements or family influences to refrain from alcohol and drug use, the group of subjects, for the most part, avoided making moral judgments as to each other's behaviors. At that time (1989 through 2000) much of the information talked about was from the book Alcoholics Anonymous and of particular interest was from the title page of that same book which announced that this book is "The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism."

This idea that people actually "recovered" from substance use was antithetical to the, then, Alcoholics Anonymous dogma. Consequently, this disorganized group of self-labeled "recovered" people were marginalized, and even maligned by contemporary Alcoholic Anonymous members. The affect of this vicious conduct from contemporary Alcoholic Anonymous members was interesting and may have had some influence as to the outcome of the study. The abusive behavior by contemporary Alcoholic Anonymous members toward these "recovered" people brought the study group closer together, gave them an identity outside Alcoholics Anonymous and strengthened their resolve in their assertion that they were, indeed, recovered.

Keep in mind that this was an actual observational study to determine the efficacy of the Alcoholics Anonymous Program. Thus, as researchers, the researchers had to introduce information to the study subjects that was antithetical to the prevailing Alcoholics Anonymous dogma so as to compare the study group to the control group, Alcoholics Anonymous. Initially, the information that the study subjects received was from the book entitled Alcoholics Anonymous. The researchers challenged one central tenet of Alcoholics Anonymous: no one ever recovers from the condition Alcoholics Anonymous called "alcoholism." Alcoholics Anonymous contended: "Once an alcoholic, always an alcoholic." Contrary to that tenet the researchers told the study subjects that they could recover and just live normal lives.

The reaction by local Alcoholics Anonymous members to the concept of being "recovered" was mind-boggling. On the one hand the book entitled Alcoholics Anonymous claims that it is "The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism." [Emphasis added] On the other hand, members of Alcoholics Anonymous, at the time, steadfastly asserted that no one ever "recovers" from what they referred to as "alcoholism." These Alcoholics Anonymous members further opined that everyone who is an alcoholic, a real alcoholic, can never recover, i.e. they will always be an alcoholic, no matter whether they drank alcohol or not. This contention by these Alcoholics Anonymous members and, indeed, the contemporary Alcoholics Anonymous members of today, claim their orthodoxy from page 85 of Alcoholics Anonymous which allegesWe are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition..."

The dichotomy brought about by these two diametrically opposed orthodoxies was, and is, irreconcilable. Here's the problem. Being "recovered" is to "To get back; regain or to restore (oneself) to a normal state" or "To regain a normal or usual condition, as of health." Being "not cured" is "to relieved or rid of something detrimental, as an illness or a bad habit." Obviously, both conditions cannot be experienced at the same time; they are, in fact, mutually exclusive. Paradoxically, this conflict prodded the researchers in a new direction; a direction that would not come to fruition until many years later: happiness motivation (aka The Positive Drive Principal), free will, autonomy, neuroplasticity and Cognitive Behavioral Learning.

The researchers were confronted with the question as to how one knows if or when he/she is "recovered." The simple answer was "when you are, you'll know it." Such an answer was way too spooky, very Alcoholics Anonymous-like and woefully inadequate. The researchers offered two explanations that were a foreshadowing of the real science that would follow later, much later. The researchers explained to the subjects that if they believed that they were recovered, then, indeed, they were.Years later this would become the real science of "you are what you think." The second explanation was "If you know that you can drink safely and choose not to, then you are recovered."This set the researchers on the path that drinking and/or drugging was, in the final analysis, merely a choice. [Note: Over time this second explanation could not withstand the researchers' scrutiny, i.e. it should have stated, "If you know that you can drink safely and choose to drink safely or choose to abstain altogether, then you are recovered."] Eventually, this idea of drinking and drugging being a choice would evolve to understanding the human attribute of free will.

In any case, through-out the incessant "recovered controversy" many of the study subjects continued to attend Alcoholics Anonymous meetings; some didn't, but remained with their newly adopted social group. Subsequent to the migration away from Alcoholics Anonymous' tenet that recovery is impossible, the researchers anticipated a dramatic fall in the study group's abstinence rate, which at the time was well above 80%. It didn't happen. The study subjects accepted the concept that they were recovered and 75% remained sober and drug free for the entire year of the study.

Significantly, none of the results depended upon self-reporting. The researchers lived among the subjects observing them nearly every day. Moreover, none of the subjects ever suspected that they were being studied.

For the record, the control group for this study was studied the year prior to the Baldwin Research Project of 1990. The original researcher studied the efficacy of 10 Alcoholics Anonymous meetings in the Capital District of New York State. This researcher attended these 10 meetings faithfully for one year keeping a record of each new attendee. The study was simplistic so as not to introduce complicated statistics into the analysis. The data was normalized for time by each individual having a weight of 1, regardless of the event of joining a meeting or vacating a meeting, i.e. if a person showed up for the first time at the last meeting of the study he/she was counted as being there for the entire year and if a person missed the last meeting and missed the two previous meetings then he/she was counted as left within the first year. If after missing three consecutive meetings or more and then returned to the meeting sometime later he/she was counted as a new attendee.

The results were disappointing, at best. Less than 10% of those who showed up at these ten meetings during the one year study were still there on the last day of the study. At that time, the researchers, along with drug and alcohol treatment programs, considered the Alcoholics Anonymous Program the "gold standard of treatment." Again, keep in mind, this was an observational study; no one knew that they were being studied. Most, certainly some, of those who came and left within the year, left to continue their drinking and/or drugging. Others may have left to continue drinking and sometime later joined the ranks of the multitude that spontaneously stopped using substances on their own. Still others may have left the meeting and spontaneously stopped using substances on their own, never to use again. All three of these scenarios did not detract from the study results inasmuch as Alcoholics Anonymous asserts that everyone who stops attending meetings uses again. So to remain consistent with the tenets of Alcoholics Anonymous, the researchers accepted this tenet.

There were, however, other possible explanations for a new attendee to Alcoholics Anonymous to exit from one or more of the meetings being observed in the study. It was thought that some who left the observed meetings may have decided to attend other meetings in the community that were outside the scope of the study. To address this possibility the researcher periodically dropped in on other meetings looking for study dropouts. Then there may have been some who simply relocated out of the study area and continued to go to meetings at their new location or stopped attending meeting. Either way it is speculated that the number of attendees who fell into these categories was not significant to the study outcome.

Furthermore, this research was corroborated in a study conducted by Alcoholics Anonymous World Services, Inc. That organization reported: of those who came to Alcoholics Anonymous, only 5% remain for a period of one year or more. That said; there is no effort here to make any claims with respect to the accuracy of Alcoholics Anonymous' study. Still there are two very compelling arguments that cannot be ignored. First, Alcoholics Anonymous World Services, Inc. most certainly does not benefit from reporting such poor results. And second, Alcoholics Anonymous World Services, Inc.'s findings are within reasonable statistical limits of Baldwin Research Institute's documented results (< 10%). The fact that these two studies statistically agreed is significant given that the studies conducted by Baldwin Research Institute, Inc. and its predecessor were observational studies, i.e. not dependent upon the validity of self-reporting and the Alcoholics Anonymous study relied on self-reporting. Of great interest at the time was the fact that these two different study methods produced similar results.

The Baldwin Research Alcoholics Anonymous meeting study was an undercover firsthand observational study (9.6%) and the Alcoholics Anonymous World Services, Inc.'s study was a self-reporting questionnaire response study yielding a similar finding that AA was effective for 5% of the people who attended meetings. The fact that these two studies independently arrived at results that were so similar created a real conundrum. Could it be, that firsthand observational studies are no more reliable than self-reporting questionnaire response studies? Or could it be that self-reporting questionnaire response studies are just as reliable as firsthand observational studies? Or perhaps the similar results were merely a coincidence. While these questions may titillate the intellect, it is safe to conclude that clandestine firsthand observation by a trained researcher is probably as good as it gets for behavioral studies, i.e. what is, is.

Moreover, the significance of these early observational studies is that no other researchers have done what was done here in the Baldwin Research Project of 1990. No other research project, so far as is known, ever conducted an observational study of drug and alcohol users' cessation attempts where the researchers were, themselves, merely members of the study subjects' social community. And, so far as is known, no other published research observed the behavior of their study subjects without the study subjects knowing that they were being studied. The importance of these two facts cannot be overstated. The two studied groups, the control group and the test group, were free to behave any way they chose, unfettered by the inevitable external influence of knowing they were being observed. The only difference between the control group (10 meetings of Alcoholics Anonymous) and the test group (38 subjects of the Baldwin Research Project of 1990) was the information they received and the self-determined social environment.

The control group was exposed exclusively to the standard fare of Alcoholics Anonymous, i.e. "once an alcoholic, always an alcoholic," vis-a-vis the test group that rejected the aforementioned tenet of Alcoholics Anonymous and instead embraced the concept that they could and did change, and therefore, "recovered." The results were nothing short of astounding: the control group achieved less than a 10% abstinence rate, while the test group achieved a 75% abstinence rate, for the same length of time. Inasmuch as neither of these studies relied on self-reporting, but relied solely on clandestine firsthand observation, the results are thought to be far more reliable than any other study ever conducted.

This would have been a great story but for the lack of understanding by the researchers as to what they had discovered. The researchers concluded that the positive message that one could recover from the fraudulent condition known as "alcoholism" was true. At the time, what had really happened lingered in obscurity and would remain there for many years. Simply put, unbeknownst to the researchers at the time, these subjects were beginning to understand their wants and desires, their free will and autonomy, (the three inherent human attributes described in Cognitive Behavioral Learning) resulting in a new way of thinking about themselves and their environment. Fortuitously, these first two studies set the researchers on a course that led to real solutions for problems with substance use, along with solutions for most other unwanted habitual behaviors (including most "mental illnesses"). But this path to Cognitive Behavioral Learning, which would eventually be understood fully in 2015, was a long and circuitous one fraught with dead ends, misunderstandings and utter frustration. Nonetheless, the researchers ventured forward bolstered by the possibility that they may have successfully broken through into a whole new paradigm.

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