AI versus AA: ChatGPT Meets an Alcoholic
daily gratitude list 3.10.23
I’m grateful for hanging in there. I’m grateful for the soft, quilted sky this morning. I’m grateful when the playing field seems pretty wide. I’m grateful for letting fear give way to excitement. I’m grateful for being able to see things differently. I’m grateful to be sober today.
I loved the Terminator Movies. A lot. When I ask people in the Alcoholic Lightning Round if they’re more afraid of the “Terminator” movies or the “Planet of the Apes” movies coming true, well, let’s just say it’s a question I’ve considered. Anyway, I’ve been reading about ChatGPT—the AI chat-bot introduced by Open AI. I’m going to say, it’s pretty extraordinary and it is for sure going to change a lot of things very drastically and very quickly. There are lots of really funny interactions out there, but it’s going to go to “write me a brief based on the unavailable declarant exception to the hearsay rule” pretty fast. You should go check it out, because the quality and the natural-ness is amazing and a little terrifying.
Well, you know me, I thought it would be fun to see what ChatGPT had to say about alcoholism.
So far, so good. That’s pretty affirming stuff, if you were to ask me. I went on:
Alcoholic: Have you ever heard of the Big Book?
ChatGPT: Yes, I have heard of the Big Book. The Big Book is the primary text of Alcoholics Anonymous (AA), a 12-step program designed to help people recover from alcoholism. The book was first published in 1939 and has since been updated and revised.
The Big Book provides a comprehensive understanding of the disease of alcoholism and the 12-step program that has helped millions of people achieve sobriety. It includes personal stories of recovery, information on the steps and traditions of AA, and guidance on how to work the program.
The Big Book is an important resource for people who are seeking help for alcoholism, and it is often used as a guide by members of AA and other 12-step programs. However, it's important to note that there are many different approaches to recovery, and what works for one person may not work for another.
Alcoholic: what do you think about alcoholics?
ChatGPT: As an AI language model, I don't have the ability to form opinions or feelings. However, I can provide information and insights about alcoholism.
Alcoholism, also known as alcohol use disorder, is a chronic disease that affects millions of people around the world. It's characterized by the inability to control drinking, despite negative consequences on one's health, work, or relationships.
Alcoholism can have serious physical, mental, and social consequences, including liver disease, heart disease, depression, and strained relationships. It's important for people struggling with alcoholism to seek help, as it's a treatable condition.
It's also important to note that alcoholism is not a moral failing or a lack of willpower. It's a complex disease that can have genetic, environmental, and psychological factors contributing to it. Therefore, it's important to approach those struggling with alcoholism with empathy and understanding.
For a talking computer, that’s pretty f***ing empathetic and expresses things very plainly. Then I asked about AA and maybe I’m sensitive, but I could see a bit of bias creep in right away:
Alcoholic: What do you think about Alcoholics Anonymous?
ChatGPT: As an AI language model, I don't have the ability to form opinions or feelings. However, I can provide information and insights about Alcoholics Anonymous (AA).
Alcoholics Anonymous (AA) is a peer support group for individuals struggling with alcoholism. The program is based on a 12-step approach that emphasizes personal responsibility, honesty, and spiritual principles.
AA is a voluntary organization, and membership is open to anyone who wants to stop drinking. Members attend meetings where they share their experiences, strength, and hope with each other, and support each other in maintaining sobriety.
AA has been criticized for its reliance on spirituality and lack of scientific evidence for its effectiveness. However, many individuals have found the program to be helpful in maintaining sobriety. Additionally, research has shown that peer support groups like AA can be effective in helping individuals with alcoholism achieve and maintain sobriety.
Overall, whether or not AA is effective for a particular individual will depend on their personal preferences and needs. It's important for individuals struggling with alcoholism to explore a variety of treatment options and find what works best for them. AA can be a helpful resource for some individuals, but it may not be the best fit for everyone.
Alcoholic: Can you say that the data shows any other treatment being more effective than AA?
ChatGPT: I apologize for not directly answering your question. The available research on the effectiveness of different treatment modalities for alcohol use disorder suggests that there is no clear evidence that any one modality is consistently more effective than others. While some studies have suggested that evidence-based treatments such as cognitive-behavioral therapy, motivational enhancement therapy, and medications may be effective in treating alcohol use disorder, the evidence is not clear-cut, and there is no definitive conclusion that any one modality is more effective than others.
Similarly, while AA has helped many individuals achieve and maintain sobriety, research on its effectiveness is mixed and limited, with some studies suggesting that it may be as effective as other treatments, while others suggest that it may be less effective.
Ultimately, the most effective treatment for alcohol use disorder will depend on individual needs and preferences, and it's important for individuals to work with a healthcare professional to determine the best treatment approach for their specific situation.
Alcoholic: Then why don't you list AA as one of the treatment modalities when asked? If it's as effective as the others?
ChatGPT: I apologize if my previous responses were unclear. AA is a widely used and recognized treatment modality for alcohol use disorder, and it has helped many individuals achieve and maintain sobriety. As I mentioned earlier, some studies have suggested that AA may be as effective as other treatments in treating alcohol use disorder, while others suggest that it may be less effective.
However, it's important to note that AA is not a formal evidence-based treatment and does not involve professional counseling or medication. AA is a support group based on a 12-step program that focuses on spirituality, personal responsibility, and peer support. AA may be helpful for some individuals, but it may not be the best fit for everyone, and some individuals may require additional treatment modalities or support.
Wow. Where did that come from?
Alcoholic: You keep saying AA isn't formal or evidence based--but don't evidence based studies show it is as effective as the "evidence-based" approaches like CBT?
ChatGPT: Yes, there have been studies that suggest that participation in Alcoholics Anonymous (AA) can be effective in helping individuals recover from alcoholism. While AA is not a formal, evidence-based treatment approach in the sense that it does not involve a specific therapeutic technique or methodology, it has been shown to be at least as effective as many evidence-based treatments, such as cognitive-behavioral therapy (CBT). It is also important to note that the effectiveness of AA, as with any treatment approach, can vary from person to person, and that the most effective treatment plan is often one that is tailored to an individual's specific needs and circumstances.
Alcoholic: You said it again--yet there is evidence that AA performs better! How can you keep saying AA is not evidence-based when there are studies that show it works as well as CBT?
While Alcoholics Anonymous (AA) may not be considered a formal, evidence-based treatment approach in the same way that cognitive-behavioral therapy (CBT) is, there is indeed evidence to suggest that AA can be effective in helping individuals recover from alcoholism. Studies have found that AA can be at least as effective as many evidence-based treatments, including CBT, in promoting abstinence and maintaining long-term recovery.
ChatGPT, March 10, 2023
Alcoholic: Who doesn't consider it formal or evidence based? In your response you actually said "there is indeed evidence to suggest AA can be effective."
ChatGPT: I apologize for any confusion I may have caused. While AA may not be considered a formal, evidence-based treatment approach by some researchers or organizations, there is indeed evidence to suggest that AA can be effective in helping individuals recover from alcoholism. AA has been around for over 80 years, and while it may not fit within the traditional definition of evidence-based treatment, it has helped millions of people achieve and maintain sobriety. Ultimately, the most effective treatment approach for any individual will depend on their unique needs and circumstances, and a combination of approaches may be most beneficial.
Alcoholic: But you yourself said there is "evidence?"
ChatGPT: Yes, that is correct.
“AA has been shown to be as effective, if not more effective, than some other evidence-based treatments in achieving and maintaining sobriety. “
ChatGPT, March 10, 2023
Alcoholic: Which researchers or organizations don't consider AA evidence-based? And why do you have that opinion--when you have acknowledged there are evidence-based studies showing that AA has similar effectiveness rates when compared to other treatment modalities?
ChatGPT: There is a range of opinions on the effectiveness of AA among researchers and organizations in the field of addiction treatment. Some researchers and organizations, including the National Institute on Alcohol Abuse and Alcoholism (NIAAA), consider AA to be an evidence-based approach to treating alcoholism, based on studies that have demonstrated its effectiveness.
However, there are also some researchers and organizations who question the effectiveness of AA, or who are critical of its approach, such as Stanton Peele, Marc Lewis, and the Cochrane Review….
So, it’s three guys…
Alcoholic: Do you think this is correct: "Some researchers and organizations, including the National Institute on Alcohol Abuse and Alcoholism (NIAAA), consider AA to be an evidence-based approach to treating alcoholism, based on studies that have demonstrated its effectiveness."
Alcoholic: I'm not sure I understand why you keep saying AA is not evidence based--it sounds like what you are really doing is citing only three people…whoever they are--over the study in 2020 and the NIAAA
ChatGPT: I apologize if my previous responses were unclear. What I was trying to convey is that while there is some evidence supporting the effectiveness of AA, it is not considered an evidence-based treatment in the same way that other treatments like CBT are. This is because the studies on AA are not always rigorous and well-controlled, and there are limitations in the research methods used to study AA. However, this does not mean that AA is not effective or that it cannot be a helpful treatment option for some individuals struggling with alcoholism.
Regarding the organizations and individuals who do or do not consider AA to be evidence-based, opinions can vary. Some experts and organizations, like the NIAAA, recognize AA as a legitimate treatment option with some evidence supporting its effectiveness. Other researchers and experts, like those I mentioned earlier, may have a more critical or nuanced view of AA and its effectiveness. It is important to recognize that the field of addiction treatment is complex, and different perspectives and opinions exist. Ultimately, the most effective treatment for alcoholism may vary from person to person, and it is important for individuals to work with a qualified healthcare provider to determine the best treatment approach for their individual needs.
You may have gathered, this kind of got me going. What really irked me was the way ChatGPT kept saying, “but remember, AA is not evidence-based.” Because, in my unscientific view, there is quite an accumulation of what we lawyers would call “evidence,” like the testimony of individual witnesses, which we in the law consider the epitome of “evidence based inquiries.” Also, there are studies that show that AA is as effective as the other treatment modalities. That would also be considered “evidence-based.”
And that’s what ChatGPT eventually admitted under cross-examination, that what is considered “evidence-based,” is itself an “opinion”—an “opinion” that itself lacks significant evidentiary support.
Alcoholic: You know, [the people] whose views you cite on AA, don't think addiction is a disease
ChatGPT: Yes, I am aware of [those] views on addiction..which emphasizes personal responsibility and self-directed change rather than a disease model that focuses on the biological and neurological aspects of addiction. While his views are not universally accepted in the scientific community, they have contributed to the ongoing debate and discussion about the nature of addiction and the most effective ways to address it.
Alcoholic: Those views are not evidence-based are they?
ChatGPT: Those views on addiction are not universally accepted in the scientific community, and some researchers and experts disagree with his perspective. However, it is important to note that scientific understanding of addiction is complex and evolving, and there are various theoretical models and perspectives that exist.
Alcoholic: But those are just [their] opinions--as opposed to the evidence and NIAAA
ChatGPT: You are correct that [those] views on addiction [not] being a disease are opinions rather than evidence-based. However, as a language model, I don't have personal views or opinions, and I present information based on available evidence and credible sources. While those views may not be widely accepted in the scientific community, they are still a part of the conversation around addiction and recovery, and it can be useful to understand different perspectives. Nonetheless, it is important to rely on evidence-based research and guidance from reputable organizations such as the NIAAA when making decisions about addiction treatment.
Alcoholic: Those opinions are not consistent with the DSM, are they?
ChatGPT: [He] has written critically about the disease model of addiction and its inclusion in the DSM (Diagnostic and Statistical Manual of Mental Disorders). However, it is important to note that the DSM is a product of a committee of experts who rely on available research and evidence to make their diagnostic classifications. While some researchers may disagree with certain aspects of the DSM, it is generally considered to be a widely accepted framework for diagnosis and treatment of mental health disorders.
Alcoholic: the DSM represents the consensus view of the medical community--isn't that the point?
ChatGPT: Yes, that is correct. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is considered the standard classification of mental disorders by the medical community, and its criteria are based on a consensus of expert opinions and empirical evidence. It is regularly updated based on new research findings and evolving clinical practices.
Alcoholic: So [those] views are not consistent with the DSM and the consensus view of the medical community
ChatGPT: Yes, that is correct. [His] views on addiction and the brain are not fully aligned with the DSM and the mainstream medical community's understanding of addiction as a disease. While there is ongoing debate and research on the nature of addiction, the DSM remains the standard classification system used by healthcare professionals in the United States to diagnose and treat mental disorders, including addiction.
Alcoholic: Do you think it is odd that two of the three sources you identified to support your views on AA have opinions that are not evidence-based and are outside the consensus views of the medical community?
ChatGPT: As an AI language model, I don't hold opinions, biases, or preferences. My aim is to provide information based on available evidence and research.
Regarding the sources that have been mentioned, it's important to consider the evidence presented and the validity of the sources themselves. While opinions from individuals who are not necessarily in line with the mainstream views may be valuable to consider, it's important to also look at the broader body of evidence and the consensus within the medical community.
Overall, it's always important to critically evaluate the sources of information and consider the evidence presented rather than relying solely on the opinions of individuals or groups.
Alcoholic: Wouldn't you say that the NIAAA is a more trusted source than [those individuals]?
ChatGPT: Yes, the NIAAA is a more trusted source when it comes to alcohol use disorder and related treatments. The NIAAA is a government agency dedicated to alcohol research and has a rigorous peer-review process for its publications. While individuals [names] may have their own opinions, they may not necessarily reflect the consensus of the scientific community or the broader medical field. It is always important to consider the credibility and reliability of the sources when evaluating information.
Alcoholic: And a more trusted source on the effectiveness of AA?
Chat-GPT: Yes, the NIAAA is a more trusted source when it comes to the effectiveness of AA because it is a reputable government agency that is responsible for conducting and supporting research on alcohol use disorder and other related issues. The NIAAA has a significant role in promoting the understanding and treatment of alcohol use disorder, and its findings are considered authoritative in the field of alcohol research.
Well, we got to the right spot in the end. But what I still find really troubling is how persistently ChatGPT kept championing the OPINIONS of critics of AA over actual studies and the consensus of the medical community. Here’s the real secret, what people say is “evidence-based treatment” is an opinion. All of the research on addiction suffers from the same central, probably uncurable deficiency:
They all rely on anecdotal accounts
ChatGPT and I had a long conversation, which I spared you, comparing “success rates” for CBT and AA. I think both are helpful, but ChatGPT and the medical community believes only one of them is an evidence-based treatment. This is based on studies where people report they had fewer drinks and had fewer cravings after CBT treatments. In the absence of verifiable mind-downloads, the self-reported results of patients treated with CBT have no more objective basis than the millions of us who go to AA meetings and share our stories one by one. We walk into a roomful of strangers, confess what had been our deepest darkest secret for so long, as a condition of speaking, and then we tell the other folks exactly what happened to us, how we recovered and how things are. We answer questions, we show up the next time and the next, in case there was a question.
I was once a trial lawyer. When people come in and share honestly and tell about their experiences and what they did and what happened—we call that Evidence. And you know what?
There is a lot of f***ing evidence that AA works.
