“What troubles many good scientists about research like the Fiorentine paper is that studying the people who choose to attend AA is an almost perfect recipe for generating the compliance effect error. AA members who frequently attend meetings may be demonstrating the same sort of self-care qualities that the placebo takers do. They may be, in effect, the Boy Scouts, or “eager patients,” of the addict population. Nobody who has looked at this data would dispute that people who attend AA most often and stay the longest are more likely to improve than the dropouts. The question is whether AA is driving this outcome or benefiting from a correlation instead. Is it possible that the kind of people who stay in 12-step programs are already more likely to improve? Would they be equally likely to do so in any treatment, or even no treatment at all? At heart, the dilemma facing AA research is whether people stay in AA because they’re the type of people who will stick with a program no matter what it is and who would have stuck with it even if it were of no help to them at all.”