Alcoholics Anonymous vs. other approaches: the evidence is now in - <AUTHOR> https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-new-evidence.html <comment><USER3> So far the comments have been about people's prior experiences with the topic (which is great), or prior opinions about the topic (which is ok). But the more interesting story is being overlooked: this is heavy-duty new research that overturns previous conclusions, including the prior expectations of at least one of the lead authors. It would be good to discuss the specifics of the article and the new study.

<comment><USER4> Do you think you could elaborate why you believe this is "heavy-duty" new research (or even new research at all, rather than a new meta-analytic synthesis of old research)?

My quick read of the study suggests that they examined several outcomes, got null or low powered results on most of them, and chose to highlight the single result which did show a significantly positive effect on recovery; that result was based on a meta-analytic estimate of the pooled sample of just two studies. In particular, my understanding is that this study found a null on "percentage days abstinent", a null on "longest period of abstinence", a null on "drinks per drinking day", a null on "alcohol-related consequences". For alcohol addiction severity they report the results of one study without doing any original analysis. And for "rates of continuous abstinence" they found a positive effect. In most cases these are graded as "low certainty evidence". The positive effect is claimed to be "high certainty evidence", but the CI / p-value for the positive effect is not adjusted for multiple comparisons -- I don't think that's fatal, but it does speak to the fragility of the outcome.

The other concern I have is that they separate "manualized" treatments (e.g. AA treatments administered according to a protocol) from "non-manualized" (e.g. ad hoc administration of the AA treatment) treatments. This is fine -- we would expect to see that if something about the protocol was useful, the non-manualized treatments would display an attenuated version of the same effect. Instead we get a null on the original positive effect, and a positive effect on one of the original nulls

Finally, the authors seem a little loose with what the comparison groups are. They claim they recruited studies which compared AA to no treatment, but the results are all motivated as being AA versus CBT. What happened to the no treatment studies? Perhaps these are buried in the full text. The rate of spontaneous remission of addiction is believed to be fairly high and most of the past criticism of the efficacy of AA has been motivated by comparison to spontaneous remission.

It strikes me that there is significant distortion of the study findings from the Cochrane write-up to the Stanford press release, and from the Stanford press release to the NYT piece, and that in both cases the distortion is in favour of claiming the study has found affirmative evidence that AA works better, rather than just no evidence to claim it works worse. For instance, one of the thrusts of the NYT piece is that the past Cochrane review was based on a limited number of studies... but the operative finding in this review is based on an even more limited number of studies, even if the pool of studies from which they drew has become larger over the last 15 years.

All of this is from a quick read of the review -- I am off campus right now and don't feel like VPNing or pirating the full text to deep dive the analysis.

<comment><USER5> > And for "rates of continuous abstinence" they found a positive effect.

It's been a while since I reviewed the literature for substance abuse disorder, but if I remember correctly it was highly disputed whether complete abstinence was necessary (or even beneficial) for treatment. Has this changed?

The argument was that by focusing on abstinence you are setting a significant part of your patience up for failure with all the psychological harm involved in knowing that they've failed, which might result in severe and frequent relapses.

EDIT: To conclude. I find it hard to draw conclusions if success is measured in "days of abstinence". That means that a patient that has recovered from cognitive behavior therapy (CBT) that uses occasionally and non-detrimentally is not considered a success! Further AA or other 12-step programs do often stress abstinence while CBT does not, this creates a counting bias in favor of 12-step programs.

<comment><USER6> I'm a recovering information addict, food addict, sex addict, and love addict.

Doing the same behaviors in a mindful way instead of out of a desire to mask/numb/avoid matters.

Also, I stopped counting my various abstinence stretches because it's not actionable information. I don't assess my recovery that way. I take a look at my needs and identify how I'm doing meeting them.

<comment><USER7> Love addict? Care to elaborate?

<comment><USER8> Addicted to relationships/falling in love.

It's a thing.

That initial honeymoon period? It's like it fixes _everything_. I'm a whole different person.

Then the honeymoon period ends and I get bored and irritated and nasty. I need to find another one to fix me. Because the current relationship is clearly where the problem lies.

Repeat ad infinitum.

That's my experience of it. Others may have a different experience.

</comment></comment></comment></comment></comment></comment><comment><USER9> Little known fact:

Bill Wilson[1], co-founder of Alcoholics Anonymous, believed LSD could help alcoholics achieve a "spiritual experience" that was crucial to them attaining sobriety[2] (incidentally, that a spiritual experience could help alcoholics was an idea he got from Carl Jung[3]). Wilson's own experiences with LSD are discussed in detail here: [4]

In the 50's and 60's there was research in to using LSD to treat alcoholism, with promising results:

 _" Osmond treated more than 700 chronically alcoholic patients with LSD and ended up with around a 50 percent overall success rate. One of Osmond's most compelling studies took place in the late 1950s with a cohort of subjects from the group Alcoholics Anonymous. This cohort was comprised of individuals that had failed the famous 12-step program, and again Osmond hit his 50 percent success rate, this time with a 12-month follow-up period."_[5]

In 2012 a meta-analysis of studies with a total of 536 participants found _" evidence for a beneficial effect of LSD on alcohol misuse"_.[6]

[1] - [https://en.wikipedia.org/wiki/Bill_W](https://en.wikipedia.org/wiki/Bill_W).

[2] - [https://www.theguardian.com/science/2012/aug/23/lsd-help- alc...](https://www.theguardian.com/science/2012/aug/23/lsd-help-alcoholics- theory)

[3] - [http://barefootsworld.org/wilsonletter.html](http://barefootsworld.org/wilsonletter.html)

[4] - [https://aaagnostica.org/2015/05/10/bill-wilsons- experience-w...](https://aaagnostica.org/2015/05/10/bill-wilsons-experience- with-lsd/)

[5] - [6] - [https://www.ncbi.nlm.nih.gov/pubmed/22406913](https://www.ncbi.nlm.nih.gov/pubmed/22406913)

<comment><USER10> Not even to speak about Ayahuasca (DMT) and Ibogaine. They seem to have even more of these therapeutic properties.

<comment><USER11> Ibogaine is amazing at dealing with addiction, considering that it can blow away a serious Heroin addiction after one good trip.

<comment><USER12> Isn't ibogaine that one drug where you have to go to West Africa to find it due to its being illegal and inaccessible everywhere else and trips last for literal days?

<comment><USER13> tis indeed.

as distinguished from iocaine, which is merely inconceivable.

<comment><USER14> But which cup is it in?

<comment><USER15> it occupies both cups until observed

<comment><USER14> surprise! it also occupies both cups after consumed!

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER16> The AA way was described in The Power of Habit as one of the examples of successful habit change. Basically: keep the habit's cue(e.g. feeling depressesed) and the reward(social interaction) but replace the bad habit(drinking) with a better one(meeting with the sponsor).

<comment><USER17> My alcoholism (if it can be called that - it is a spectrum) is driven in part by the social interaction of fellow drinkers. The predictability of seeing each other at the bar, of hanging out and not worrying about the day.

I've talked to one or two of them about doing tea on Tuesdays, or some other thing that could get us from drinking 3-7 stouts a night.

That book may be worth a read.

</comment></comment><comment><USER18> recovering addict here. some words for those who may be struggling.

i tried a number of things over many years (life coach, therapy, meditation retreats, ayahuasca, ibogaine, etc).

i reached a bottom, and nothing i had tried really worked or stuck. kept relapsing after a few months of sobriety at most.

ultimately it was going to AA that i largely credit to my successful transformation into a happy life of sobriety.

if you're not sure if it's right for you and struggling with addiction, i highly recommend having an open mind, and trying 90 meetings and 90 days. see how you feel after. it's the daily practice that is transformative.

there is something powerful about being focused on a purpose with a group of similarly motivated people.

the people in the rooms of AA understand the challenge you're facing in a way that friends and family often don't.

you quickly realize that the 'higher power' thing is a pretty easy to move beyond, regardless of your religious orientation. a 'higher power' can even be a conceptual device - e.g. the wisdom of the people in your meeting who have achieved a life of sobriety.

it's also not to say that AA in itself is a savior. it's a healthy component to integrate as part of a balanced recovery of body, mind, and spirit.

eating well, exercising often, and finding ways to be helpful are other important pillars to incorporate along your journey.

good luck, be well.

<comment><USER19> I had other experiences. The friendships I had in AA were superficial. Once, when I was struggling and needed help and people to talk to, I was completely ignored by the people around me. They didn't want to help the struggling - just to have this toxic positivity that nothing is wrong.

I later moved out of state. I came back to visit family, and went back to a meeting to find out that there were rumors that I had relapsed after I moved and continued using until I was homeless. It was a drama fest. Absolutely ridiculous.

When I moved, the meetings I encountered were extremely hostile to atheists.

<comment><USER20> > When I moved, the meetings I encountered were extremely hostile to atheists.

In my experience there are two types of atheists who go to AA: those for whom religion "isn't their thing" and those who are actively hostile to religion.

I think the latter group should find an alternative to AA.

<comment><USER19> Nice. Blaming the victim and implying I was the hostile one.

I'm respectful of others' religions. It's a private matter. I made friends, ostensibly, until they found out I was an atheist.

So fuck right off with your pseudo-righteous bullshit, okay?

<comment><USER20> Judging from how hostile your response is you are probably in the later category.

I'm an atheist and I've been going to AA meetings for years in a very religious area and I've had no problems at all.

If you are in the former category you are welcome and should try a different AA group.

<comment><USER21> Consider that you _did_ suggest it was their own fault because they did something bad and you have all the reason you need for their "hostile" response. You've been fairly unpleasant about something that was obviously a big thing in their life and that yields you responses like this. Turning that around and (again) blaming _them_ and suggesting their negative response is _entirely_ their fault goes beyond that into the fairly toxic. That's not a healthy way to communicate with other people.

<comment><USER20> > Consider that you did suggest it was their own fault

No I didn't. My original post was for anyone seeking help with substance abuse - that AA is a good option for atheists who are friendly to religion and a bad option for those who are hostile.

If I had wanted to put the parent into the hostile to religion group then I would have said so.

Edit: I also never said anything about being hostile to religious people which is the way the parent decided to interpret it so they could take a swing at me.

</comment></comment></comment></comment></comment></comment></comment><comment><USER22> I didn't do AA but did AlAnon for children of alcoholics recovering from trauma. Despite what people think, the 12 step program is super light on the spirituality stuff and very atheist friendly. As a recovery group AlAnon was super useful for getting some closure on the hell my parents dragged me through and just leaving that stuff behind.

Edit:I guess I should have qualified that I've only done support groups in SF that have been great and usually hosted by churches.

<comment><USER23> My understanding is that they don't even need you to acknowledge a God, just that "there is cosmically something bigger than you and you have no power to govern it"

Is that about what you experienced?

<comment><USER24> even that is just silly. it is true only when the idea devolves into that kind of tautology.

I would obviously let it slide if I needed this kind of thing, but it is clearly cruft.

<comment><USER23> I won't pretend I understand how it works but I think it has to do with accepting that you aren't in control of things, especially your addiction.

</comment></comment></comment></comment><comment><USER25> > Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences, and > his fellow investigators determined that AA was nearly always found to be > more effective than psychotherapy in achieving abstinence.

This does not appear to include other programs like pharmacological extinction or the Sinclair method.

> We included randomized controlled trials (RCTs), quasi‐RCTs and > non‐randomized studies that compared AA or TSF (AA/TSF) with other > interventions, such as motivational enhancement therapy (MET) or cognitive > behavioral therapy (CBT), TSF treatment variants, or no treatment.

<comment><USER3> Ok, I've edited the title to mention psychotherapy, since that's the alternative that the submitted article (at least) focuses on. Which is still an interesting finding.

Edit: we've since changed the URL and therefore also the title (see [https://news.ycombinator.com/item?id=22550789](https://news.ycombinator.com/item?id=22550789))

<comment><USER26> Had to scroll pretty far. The new link is paywalled for me (mobile).

</comment></comment></comment><comment><USER27> Outsider's uninformed opinion: if you attend AA then regardless of any official narrative or agenda this means you're spending important time with people who (a) used to drink, and (b) don't drink any more. Their example plus hearing what they've got to say seems like an excellent approach.

<comment><USER28> One wise ex drunk I know summed up his steps: 1) Action. 2) Group.

The "brand name" of the group is not so relevant.

</comment></comment><comment><USER29> If you're one of those for whom AA didn't work I would encourage you to look at the The Sinclair Method. It has changed many lives for the better (including mine).

[https://www.reddit.com/r/Alcoholism_Medication/](https://www.reddit.com/r/Alcoholism_Medication/) [https://cthreefoundation.org/](https://cthreefoundation.org/)

<comment><USER30> I googled it, seems to be you're supposed to take some drug that makes you stop drinking.

<comment><USER31> "Some drug that blocks the euphoric effects of drinking" would be more accurate.

<comment><USER32> What worked for me is developing an esophagus condition that makes drinking alcohol or coffee result in instant burning pain. It was so easy to stop drinking, multiple times, when that surfaced.

</comment></comment></comment></comment><comment><USER33> It's the community. Half the members of AA can't even name all the steps, but in AA they find kinship with other people with similar experiences and similar struggles.

Humans are hyper-social. We live better, grow better, heal better, and confront difficulties better when we have others. This is true for introverts too. Introverts are not anti-social, they just have a more muted less intense social style.

<comment><USER34> the old saying is... you are who you hang with.

hang around with good, positive people and good, positive things will happen.

</comment></comment><comment><USER35> I'm unsure about this meta analysis because it's presumably based on AA publications.

The thing is That numerous prior AA publications have treated "falling off the wagon" or missing one of the steps to mean that you weren't doing AA properly, and so they _dont report it as a failure_.

Essentially they end up getting close to just filtering out all the treatment failures, which inflates their success rate.

<comment><USER36> Based on the OP and two other articles (see below), I believe your presumption is mistaken. It's hard to say for sure, because the list of studies included in the meta-analysis hasn't been published yet (that I can find). (Edit: it looks like the study is available at [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full)) But the articles make it clear that this was a rigorous meta-analysis done by qualified researchers. Surely they didn't just toss in AA publications uncritically. What they're saying is that, after careful review, the studies that have been popularized in the past as showing that AA was less effective are the ones that turn out to be wrong. From the NYT link:

 _The 2006 Cochrane Collaboration review was based on just eight studies, and ended with a call for more research to assess the program's efficacy. In the intervening years, researchers answered the call. The newer review also applied standards that weeded out some weaker studies that drove earlier findings._

 _In the last decade or so, researchers have published a number of very high- quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion._

[https://www.nytimes.com/2020/03/11/upshot/alcoholics- anonymo...](https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous- new-evidence.html)

[https://eu.usatoday.com/story/news/health/2020/03/11/alcohol...](https://eu.usatoday.com/story/news/health/2020/03/11/alcoholics- anonymous-aa-helps-people-stay-sober-longer-study-finds/5008835002/)

<comment><USER35> Ok, this article itself measures in terms of continuing to attend meetings, etc

Some basic googling found [https://www.theatlantic.com/magazine/archive/2015/04/the- irr...](https://www.theatlantic.com/magazine/archive/2015/04/the- irrationality-of-alcoholics-anonymous/386255/) from 2015, which covers most of my understanding of AA.

The measure of success should be _relapse after treatment_ , but AA doesn't have the concept of stopping, and more importantly does not consider relapse after ceasing attendance to be a failure of their 12 step program.

This ignores the moral corruptness of praying on, and essentially mandating indoctrination, of people in need of help.

<comment><USER36> The debunking you're quoting has presumably been superseded by the much higher-quality randomized studies reported on in the article. At least, if that's not the case, then the researchers who've published the new meta- analysis lack even basic competence, which seems unlikely.

</comment></comment></comment></comment><comment><USER37> So I got sober in AA just as pagers were becoming a thing. I was lucky and found a young people's group in Pasadena.

If you have problems with Meetings, that's cool. Find another one. Nothing is going to be handed to u cause you want to get sober. It took a little while before I found the right meetings. Or you can find a sponsor, no where in the big book does it say that u have to go to meetings.

But if anybody is telling what you can and can't do then, start talking to Someone else... that's just nonsense.

I'm always suspect of people with a grudge against AA. I'm here to help and if it's not for you that's cool to. I'm not Christian but if works for some and doesn't hurt other then who am I to judge.

</comment><comment><USER38> I am 7 years sober via the AA path after trying just about everything else.

I really, really didn't want to go into an AA room the first time and even when I mustered the courage to try it I almost drove out of the parking lot :).

The decision to walk into the room changed my life.

There are many paths to recovery but if you are at a point or have questions you would like to ask privately please reach out to me anonymously.

I set up an email firstname.lastname@example.com to go with this anon account.

<comment><USER39> Did you ever read Roger Ebert's homage to AA? If not, you might enjoy it.

[https://www.rogerebert.com/rogers-journal/my-name-is- roger-a...](https://www.rogerebert.com/rogers-journal/my-name-is-roger-and-im- an-alcoholic)

<comment><USER38> Thank you for passing this along!

</comment></comment></comment><comment><USER40> There's a lesser known study in which someone who is optimistic about their behavior performs worse. The people who think they have the most willpower are likely to give in. The more people lose will, the more they view that failure as an anomaly, work harder at it, and spiral worse.

When smokers were asked to smoke the same number of cigarettes every day, and explicitly told not to smoke less, they gradually smoke less.

The people who are pessimistic about their odds often do well. It's likely that AA's approach of making people to feel powerless is what ironically gives them more willpower.

Sources: Howard Rachlin, The Science of Self-Control; Kelly McGonigal, Maximum Willpower.

</comment><comment><USER36> [https://archive.md/emYOt](https://archive.md/emYOt)

</comment><comment><USER41> Interesting. I was never a fan of AA and I was very critical in the lack of science and rigor in addiction treatment, and actually for mental health in general. I always felt there were better treatments, but CBT-based group therapy / 12-step alternatives are pretty rare. All you really need to start a chapter of AA is to not have one nearby and a place to host it. It's comforting that AA at least doesn't make things worse, on average, even if its not amazing. I'm still not comfortable with the fact that the government will require people to attend what is essentially a religious service as criminal punishment, and there are certain aspects of AA that they should probably at least de-emphasize.

<comment><USER42> "I'm still not comfortable with the fact that the government will require people to attend what is essentially a religious service as criminal punishment"

Maybe there's some kind of slippery slope there, where they eventually start sending you to church for a parking ticket. But we don't seem to be sliding to that conclusion very quickly; so if it works, just go with it.

If you want to make a big federal case out of it, you could probably win it. But I honestly don't see how anyone wins with that outcome.

<comment><USER43> > But I honestly don't see how anyone wins with that outcome.

Then you presumably aren't aware of how abusive religious people can be towards atheists, and that includes in AA groups.

<comment><USER42> It's one thing to criticize religious impositions on a secular activity (like addiction recovery). What you have just done is criticize religious _people_ as a group, and claim that they are abusive.

Criticize ideas and policies; not groups of people.

<comment><USER43> > What you have just done is criticize religious people as a group, and claim > that they are abusive.

No, I have obviously not.

> Criticize ideas and policies; not groups of people.

Why? What, in your mind, is the problem with criticizing abusive religious people as a group?

</comment></comment></comment></comment></comment><comment><USER44> Those interested in A.A.'s official position on atheism and agnosticism should check out the pamphlet[0] _Many Paths to Spirituality_ published recently by AA World Services, the legal entity responsible to North American A.A.. The link is to a product page - click on the picture of the pamphlet to download a pdf. There are sober atheists in AA. To anyone who gets a bad reaction to professed atheism in an AA meeting, remind the offenders of AA's Tradiion 3: "THE ONLY REQUIREMENT FOR AA MEMBERSHIP IS A DESIRE TO STOP DRINKING". If they persist, find or start another meeting.

[0][https://www.aa.org/assets/en_US/aa-literature/p-84-many- path...](https://www.aa.org/assets/en_US/aa-literature/p-84-many-paths-to- spirituality)

</comment><comment><USER45> I completely agree with the message that people-helping people is super effective.

But I'd like to point out that one of the core tenants of AA is to surrender to a higher power.

I'm not advocating in favor of religion. But rather highlighting that maybe people who accept 'surrender' of their own will are more likely to get better. There's something to the concept that seems powerful.

Anecdotally, I've known someone who used to be stressed out and controlling. Last time I saw him he was not so stressed. He said his life changed once he surrendered and accepted his destiny. He didn't go religious or anything, just 'accepted' his fate.

It reminds me of the old saying: The reasonable man adapts himself to the world, the unreasonable man adapts the world to himself, therefore all progress is due to the unreasonable man.

<comment><USER46> I think there's a major understanding of this part of AA. This DOES NOT mean acknowledging that you believe there is a god. The concept of a "higher power" can mean anything you want it to mean. You can imagine your higher power is Gandalf, Sauron, elves at the bottom of the garden, or even some aspect of your "best self." You could imagine it to be the spirits of your ancestors or even something like the energy of the universe.

The point is surrendering to something "bigger" than yourself. Don't get tied up in militant atheist perspectives.

<comment><USER47> > You can imagine your higher power is Gandalf, Sauron, elves at the bottom of > the garden

That's quite cheeky.

Telling people to believe in a "higher power" simply translates into the gods in the mainstream religion in the society they live in.

<comment><USER48> I'm with you - whenever a non-demoninational event goes down, or when someone says "take the higher power of your choice, could be Gandalf, it doesn't matter!" I can't help roll my eyes. It's an ignorant thing to say. Assuming a religion is "invalid" or not a "religion" if it doesn't have a godhead at all. Many don't, named or otherwise. "Higher Power." And lord forbid your chosen godhead is someone else's religion fallman. When I was growing up in SC and we'd do these school classroom prayers (public school, unconstitutional, but who's keeping score?), me being a cringy little 13 year old atheist would say shit like "hail satan" and raise ire of pretty much the entire school. So no, they don't really mean "your higher power of choice," they mean "your given godhead that I can convince myself is actually mine just under a different name."

</comment></comment></comment></comment><comment><USER49> Does anyone else feel like this study is a bit tautological in that it's measuring attributes that are valued by the AA method? Many other methods don't preach abstinence so of course they're going to get less total abstinence duration. But I wonder if there are better ways to measure overall effectiveness and well-being. Some people learn to manage their drink and would fare poorly on that metric.

</comment><comment><USER50> Anecdotally, self-help is an effective approach not mentioned in the article.

<comment><USER51> It works for a lot of people. For many people, particularly the worst cases, it does not. Most people who end up in AA have tried self-help already.

</comment></comment><comment><USER52> The studies in this space are notoriously bad(AA has a lot of true believers, which can lead to publication bias, and psychotherapy research in general is pretty poor). And one the best and largest studies(MATCH) on the topic show that pretty much every non-pharmacological treatment is the same.

For a different take on the literature look at [https://slatestarcodex.com/2014/10/26/alcoholics- anonymous-m...](https://slatestarcodex.com/2014/10/26/alcoholics-anonymous- much-more-than-you-wanted-to-know/)

<comment><USER36> But Cochrane reviews are notoriously good. They're always spoken of as the standard in meta-analysis. What's interesting here is that new research is contradicting previous findings.

According to [https://www.nytimes.com/2020/03/11/upshot/alcoholics- anonymo...](https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous- new-evidence.html), the weak studies they weeded out were ones that had found against AA, not in favor of it.

<comment><USER52> It is, but even if the review is done really well garbage in/garbage out.

<comment><USER36> _The 2006 Cochrane Collaboration review was based on just eight studies, and ended with a call for more research to assess the program's efficacy. In the intervening years, researchers answered the call. The newer review also applied standards that weeded out some weaker studies that drove earlier findings.

In the last decade or so, researchers have published a number of very high- quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion._

(from that NYT link)

<comment><USER52> Thanks, you're right I didn't look into this enough.

</comment></comment></comment></comment></comment><comment><USER53> Its possible cultivating those beliefs, even if false, is a powerful tool in overcoming addiction. It may actually be the case that cultivating some belief in a higher reason / order to the universe is beneficial in recovery. There are dedicated circuits in the brain for religious / spiritual thinking and feeling, and when activated may play a role.

As a counter-point, its possible to imagine a scientific discovery that while true, would cause mass suicide and depression upon discovery (e.g. an asteroid will hit the planet in 10 days). While implausible, suppose that we "found scientific proof" the god exists and is the christian god, and eternal life / punishment awaits us after death. This knowledge / belief would probably radically alter the behaviors of society (lower crime, suicide, depression, etc).

Another good example is a healthy self confidence. For most people, this is incredibly beneficial (stave off depression, get a stable life, eat right, avoid addiction), but could be seen as a false belief. Most people's contributions don't "matter" in any real cosmic sense, their lives won't be remarkable, and they aren't more talented / qualified than most people. The insignificant experience we gain in a few years on this tiny dust speck isn't enough to make confident opinions on life or the universe. Most people are cogs in the machine, generating waste heat, and their death would hardly be noticed, and soon forgotten. But embracing those facts as "true" would have a markedly negative effect for most people, so perhaps its better to falsely believe the opposites of these (and we have dedicated circuitry to help us do just that, ignore all evidence to the contrary).

My basic takeaway is that this entire AA thing is an experiment to ask that very question: does cultivating this set of thought patterns prove effective? Is it more effective than the thought patterns of other approaches? Even if the beliefs are "forced" or "false", are they effective?

EDIT: wording.

<comment><USER54> > Its possible cultivating those beliefs, even if false, is a powerful tool in > overcoming addiction. It may actually be the case that cultivating some > belief in a higher reason / order to the universe is beneficial in recovery.

Also - these beliefs may be soothing, which decreases stress level and helps with depression and addiction.

<comment><USER53> Great point. I think we evolved these types of thinkings because it helped with tribal cohesion, self-soothing, and the ability to deal with adversity. The thought "everything happens for a reason" comes to mind.

</comment></comment></comment><comment><USER3> We changed the URL from [https://medicalxpress.com/news/2020-03-alcoholics- anonymous-...](https://medicalxpress.com/news/2020-03-alcoholics-anonymous- effective-path-alcohol.html) to one that gives more information about what's going on here.

<comment><USER55> I couldn't read the NY article due to paywall. I could read the Medicalxpress link.

<comment><USER3> Users post workarounds in the threads. There's one in this thread. I realize finding it is a chore when there are a ton of comments, but that's a small price to pay for a significantly better article.

</comment></comment></comment><comment><USER56> How is it even possible to study AA meetings when they can vary so much everywhere in the world? Some have been horrible with horrible people while others were fine...some were good. I just never saw actual consistency even in the same meetings.

</comment><comment><USER5> Direct link to study:

[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full)

</comment><comment><USER57> I find it frustrating that the subheading says "less expensive." No, it's FREE. Absolutely free. Donations optional.

To me, it sounded like the editor of the piece didn't want it to sound promotional, which made it less true.

<comment><USER58> No-cost-to-member, and overall cost, are two different notions. bAs are financial and nonfinancial costs, e.g., time, travel or transport, facilitator, meeting space, training or. materials.

</comment></comment><comment><USER59> I lost one of my best friends to alcoholism about a month ago. My friend was 54 years old.

AA is good. It does help, but it's not an absolute cure. It does seem better than most (all?) of the other methods.

The very best way forward is simply to not take the first drink, ever. (This is what I am hypocritically telling my children. I drank to excess in my younger days, but I've been dry for about 20 years.) I hope they listen. Booze works for many people, but it's absolutely disastrous for some.

<comment><USER60> The best way to avoid dying in a car crash is to never get into a car, ever, but we're not advocating that, are we? Car crashes kill more people in the US than alcohol abuse.

I get that you're afraid that your kids will end up abusing alcohol, but I think you do them a disservice by painting the world so black-and-white. Avoiding alcohol can have many good effects, but it can also leave people out of many valuable social (and in some industries) business experiences, as much as it's a shame that that's still the case. Better to let them make their own decisions when the time comes without unduly influencing them with an absolute. (And many prohibitions that you lay on kids end up backfiring greatly with opposite effect, so there are no guarantees.)

Meanwhile, there are lots of more likely ways that they could screw up their life. Alcohol is just an easy bogeyman to shake a stick at.

<comment><USER61> Cars get you places.

Alcohol qua alcohol is a pretty terrible drug, toxic in reasonable doses, very addictive, affects judgement, and so on and so forth. I happen to think in a culture with a sane attitude towards drugs in general, alcohol wouldn't be a favorite.

Mormons, Muslims, straight-edgers, teetotalers, and alcoholics, all manage to socialize and conduct business just fine while never touching alcohol. Literally all you have to do is order soda water. Anyone who gives you crap for not drinking is going to turn out to have other bad habits, bet money on this.

GP is right: the absolute best way to avoid problems with alcohol is to not drink it. Considering GP was a problem drinker, and that has a genetic basis, you are being arrogant as hell telling him how to raise his children.

</comment></comment></comment><comment><USER62> "for each additional A.A. meeting attended, health care costs fell by almost 5%"

Wow. It's really quite stark to see it in such austere terms.

The cost nature of this is quite exceptional if you think about this.

Without even unpacking anything to any degree, it would seem that dragging oneself to a meeting, socializing with others in the same plight, re-affirming one's commitment to 'getting better' probably really goes a long way to changing behavior.

</comment><comment><USER63> AA is great. It saved my Dad's life. For a while, I was going too. Ultimately I began drinking again and things are much better now. I also know that if things ever get rough for me I can rely on AA. Really great group of non- judgmental people in there. As an agnostic, the "God" stuff wasn't a problem for me, it's pretty light and on your own terms.

</comment><comment><USER64> Someone else mentioned this and I agree wholeheartedly. I think unless you have a physical addiction to something, you just need to discard it and "forget" about it.

For drinking, I think the new Heineken 0.0 is a game changer. You can go out to a bar and hold one and drink, get the placebo effect.

</comment><comment><USER65> A fantastic book and complete alternative to the AA approach is Allen Carr's Easy Way to Control Alcohol. It focuses on the reasons TO drink which is unusual. And it does a good job of dismantling them.

</comment><comment><USER34> just remember everyone that there are other 12 step and recovery focused programs and out there. so adventure out, explore, meet people, find where you fit and heal :)

[https://aa.org/pages/en_US/meeting-guide](https://aa.org/pages/en_US/meeting- guide) Alcoholics Anonymous - for those who have a desire to stop drinking alcohol.

[https://www.na.org/meetingsearch/](https://www.na.org/meetingsearch/) Narcotics Anonymous - for those who have a desire to stop using drugs.

[https://secularaa.org/meetings/](https://secularaa.org/meetings/) Secular AA - same thing as AA except they don't pray nor require a belief in a higher power (no God stuff)

[https://whitebison.org/WellBriety.aspx](https://whitebison.org/WellBriety.aspx) Wellbriety - Wellbriety means to be sober and well. Wellbriety teaches that we must find sobriety from addictions to alcohol and other drugs and recover from the harmful effects of drugs and alcohol on individuals, families and whole communities. The 'Well' part of Wellbriety is the inspiration to go on beyond sobriety and recovery, committing to a life of wellness and healing everyday.

[https://heroinanonymous.org/meetings/](https://heroinanonymous.org/meetings/) Heroin Anonymous - for those who have a desire to stop using herion (basically like NA only herion focused.)

[https://crystalmeth.org/cma-meetings/cma-meetings- directory....](https://crystalmeth.org/cma-meetings/cma-meetings- directory.html) Crystal Meth - for those who have a desire to stop using crystal meth (basically like NA only crystal meth focused. the meetings are off the charts)

[https://www.smartrecoverytest.org/local/](https://www.smartrecoverytest.org/local/) SMART Recovery - Self-Management And Recovery Training (SMART) is a global community of mutual-support groups. At meetings, participants help one another resolve problems with any addiction (to drugs or alcohol or to activities such as gambling or over-eating). Participants find and develop the power within themselves to change and lead fulfilling and balanced lives guided by our science-based and sensible 4-Point Program®.

If you know or attend other group, please list :)

<comment><USER34> one other thing... just because you might have had a bad experience at one aa or recovery meeting doesn't mean that recovery in general sucks. i always say, there is a reason why most 5:30 pm meetings are called Happy Hour. most trade the room for the bar and although they aren't drinking or using they are still jerks and aren't doing the same stuff they use to do. the old saying is a sober horse thief is still a horse thief. i find that people who are serious about getting sober usually go to morning meetings or smaller meetings (like church meetings). also... men with men, women with women seems to work for most.

</comment></comment><comment><USER66> I realize this might not be a popular approach, but I figured I would share my experience here in case anyone else is helped by it:

I was an alcoholic for over 10 years. I would drink multiple liters of vodka weekly. It was not uncommon for me to drink an entire 375 ml bottle of vodka in an evening.

I never really considered myself to be an "alcoholic" in the traditional sense though, because I didn't let it affect my day-to-day life as a programmer. I was young and healthy, and I didn't usually have much of a hangover because I only drank high end vodka, and I always drank a lot of fluids. Whenever I got a hangover, I would just pop an ibuprofen and the hangover would disappear after about an hour. I would literally set my alarm an hour before I wanted to wake up, and when that alarm went off I would wake up, pop an ibuprofen, drink half a glass of water, then go back to sleep. By the time my second alarm went off an hour later, I was as good as new.

I literally did this for years, while often working 12 hour days as a programmer. Nobody could tell, and it didn't seem to affect me too negatively, so I didn't see a reason not to. It helped me relax at the end of a long day, and it made movies and television more fun and enjoyable to watch. It was also fun to go out to bars and hang out with friends.

Eventually, though, it caught up to me, and I started to get reports from doctors about abnormal liver test results. They were still just borderline, but it was enough to scare some sense into me. I had just recently had a son, and I realized I wanted to be alive for when he grew up.

So I tried to stop drinking. I didn't want to go to alcoholics anonymous (I didn't consider myself to be an alcoholic after all, and I'm an atheist and didn't want to deal with all of their religion/higher power 12-step stuff).

Quitting cold turkey worked for about 3 months, but as I'm sure you know, the alcohol drinking culture in the programming startup world is extremely prevalent.

It was only a matter of time until I ended up in a social scene where I felt pressured to drink, and I had a beer along with everyone else. It was all right, I told myself. It was just a beer! No big deal! I had quit drinking before and I have it under control now, so it's ok! Nope. Once I got a taste and a reminder of the stress relief offered by alcohol, I started right back into it. Next thing I knew, I was drinking vodka every night again.

After a couple of more false attempts to stop (with each one being thwarted by my having a beer and getting sucked back in), I finally came to terms with the fact that I simply can't drink. I can't touch the stuff or I will get sucked back in. I realized I was an actual alcoholic.

So I stopped. I carefully tapered off my heavy alcohol consumption over the course of a week, and that was it. I've now been sober for a year and a half. Whenever I'm in social situations where other people are drinking beer, I simply order a diet coke or something and I sit and enjoy their company. I might even shoot the breeze and chat about all my favorite types of scotch or whatever. But I absolutely do not allow myself to have even one sip of alcohol, because I've learned the hard way what it leads to.

As a side note, during that year and a half, I also managed to get completely out of $50,000 worth of debt, pay off my car, and diet my way from 245 lbs all the way to 180 lbs (still have another 20 lbs to go before I reach my goal of 160).

And I did it all without alcoholics anonymous or medication or therapy or anything. I simply accepted ownership of the problem, made a decision, and stuck with it.

With that said, however, there _was_ a catalyst and a "higher power" that lead to the change and kept me on track:

I had a kid, and I realized that I wanted to stay alive long enough to see him grow up and have kids of his own.

I realize this might not be a magic bullet for anyone (and I hope you get help if you need it), but my point is simply that sometimes it is in fact possible to do on your own (given the right circumstances and motivation), although this fact is something that is not very popular to mention.

</comment><comment><USER37> FYI: the best meetings are the speaker meetings. Less drama, higher quality of people who want to get sober. Also most of the groups goes out to coffee or dinner after the meeting.

</comment><comment><USER67> I wonder if there are any studies about how religion in general works for alcoholism? It would be interesting to study how much of AA's function comes from religion.

</comment><comment><USER68> For what it may be worth, our church also has a very good (edit: free) 12-step program for any addiction (like porn or substances): [https://addictionrecovery.churchofjesuschrist.org/steps?lang...](https://addictionrecovery.churchofjesuschrist.org/steps?lang=eng)

I think even just reading it, watching some videos, is worthwhile, but the complete program can be effective.

</comment><comment><USER69> Trying to find sources to confirm this, but I've repeatedly heard that cognitive behavioral therapy dominated AA in effectiveness. I would take this more as an indictment of psychotherapy than an endorsement of AA.

Edit: I found a review of Project MATCH[1].

> Background

> Project MATCH was the largest and most expensive alcoholism treatment trial > ever conducted. The results were disappointing. There were essentially no > patient-treatment matches, and three very different treatments produced > nearly identical outcomes. These results were interpreted post hoc as > evidence that all three treatments were quite effective. We re-analyzed the > data in order to estimate effectiveness in relation to quantity of > treatment.

>Results

> The results suggest that current psychosocial treatments for alcoholism are > not particularly effective. Untreated alcoholics in clinical trials show > significant improvement. Most of the improvement which is interpreted as > treatment effect is not due to treatment. Part of the remainder appears to > be due to selection effects.

[1] [https://bmcpublichealth.biomedcentral.com/articles/10.1186/1...](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-5-75)

<comment><USER70> As someone who is been in psychotherapy and an arm-chair psychology enthusiast, not every kind of therapy will be effective for everyone. This also goes for psychiatric medications.

CBT is often oversold as a cure for every kind of mental health issues. New meta-research has found that the effectiveness of CBT has been decreasing for quite some time and long-term effectiveness of CBT is arguable.

Regarding effectiveness of AA, I think it makes sense. Lot of people with addiction suffer from childhood trauma, emtional neglect, and abandonment. In psychological term it is called attachment injury. A community where you are not shamed, validated, understood, and accepted would give corrective emotional experience, which would in turn heal your attachment trauma. I've heard this phrase somewhere: "what cures people in therapy is love". So it's not surprising that finding a community where you are accepted would help you treat your addiction.

<comment><USER71> > not every kind of therapy will be effective for everyone

That's pretty problematic though, isn't it? At some point, you're dropping below placebos, not everything works for everyone, but should we still put weight on it? Homeopathy and intense praying works for some as well, but we don't say "I guess it's not effective for everyone". Psychotherapy (not the behavior therapy kind) gets a pass for some reason.

</comment></comment></comment><comment><USER72> It's noteworthy that all but one of the studies quoted in that meta-review were conducted in the United States. The usual criticism levied against AA is that it takes a religious approach, but that's not even true, it it built on evangelicalism. If you are in the US, you are either evangelical or you at least understand evangelicalism because that's what your friends and colleagues profess. You wonder how AA would fare in other countries, where their approach would meet with bafflement or hostility because the background is not understood.

<comment><USER73> Even in the US, it heavily depends on where you live. If you are in one of the big west coast cities, I would imagine you can observe a situation similar to Europe.

I felt like that joke from one of the more recent seasons of Silicon Valley, where the episode revolved around one of the characters "being outed" as a christian, was very on point, from what I have personally observed both in SF and Seattle. A bit of background on the episode: one of the CEOs of partnered companies owned a gay dating site. No one had any concerns or issues with that, but as soon as some people found out that the CEO was christian, all hell broke lose and the following quote was dropped "You can put micro doses of LSD in your cereal and people will call you a pioneer. But the one thing you cannot be is a Christian."

P.S. The show is obviously pretty tongue-in-cheek, no one seriously claims you cannot be Christian in those areas or that you would face hostility due to it. But people will definitely be questioning it a bit.

</comment></comment><comment><USER74> This is probably not going to be a popular thing to say but total abstinence isn't necessarily the goal that everyone who has a drinking problem is aiming for.

Just as those who over eat want to control their appetite for food rather than simply stop eating so do some who have a drink or drugs problem. In many cases the drink is a symptom not a cause. Remove the cause and for some people at least the drink problem will subside.

I worry also that the AA members are also a subset of those who have a drinking problem, are we sure that they are a comparable subset to those who took other paths? How do the studies account for people who drop out of either AA or some other program and did the studies follow up years later to find out if people had fallen back into addiction?

The article was a bit light on details.

And lastly the article mentions relative efficacy but doesn't say anything about how efficacious any of the programs were leaving me wondering if any of them are worthwhile.

<comment><USER75> Great comment, except the first line is only true of some recovering alcoholics.

It is not at all true for a great many of them, and for them that is downright dangerous advice.

<comment><USER76> Just because it isn't true for all doesn't mean we should eshew it. Yes, some folks find out they can't drink at all, ever. Others will do just fine being without for a bit, then learning how to drink moderately. It isn't dangerous advice, merely truthful and we can be honest about it not being right for everyone.

</comment></comment></comment><comment><USER77> throwaway account obviously. this got long but here's my (five) cents.

I'm an addict in recovery. In the past alcohol and then switched to opiates (sadly all to common story of getting pills from MD unnecessarily). I haven't faced many consequences and have been still successful in tech. still not 'out' about opiates to work or friends, just my peers in recovery.

I have found the underlying hypothesis of this - group support - has been a really big help for me. I found a group for those in recovery that participate in sports (the Phoenix) which has a double punch of great community and also physical activity which is super beneficial.

For me, I think this has been the second biggest contributor to success.

But my #1 - with opiates in particular - is medicine replacement therapy. I tried so many times to get off myself. I finally got on buprenorphine which has been a lifesaver and successful to date on first try [one year!]. There are also some drugs now for alcoholism but unfortunately stimulants seem to not have great options.

It seems a shockingly low amount of rehabs use replacement therapy [1] [2] or even know about it (or even as a short term withdrawal taper tool). There are also a scary amount of overdoses from relapse post rehab.

I think the science is pretty convincing - there are studies showing even if relapse after maintenance therapy the period of abstinence before relapse is longer [3] - and also just seems like MUCH higher success rate [4].

BUT this is still an opiate! My doctor has patients who have been on for years. A lot struggle to get off. I personally don't have a problem with very long term use - personally I see parallels with SSRIs/SNRIs where many users report problems getting off and withdrawal, but obviously who would say you should get off something like prozac - a mind altering drug that has clear benefit?

The most FU part of this for me - it still takes a special license to dispense buprenorphine replacement therapy, patient numbers are capped per MD, and there is a ton of stigma all around even at pharmacies who dont blink twice doling out opiates. Pisses me off when looking at how most MDs can dole out opiates with far less training/license requirements. also pharma definitely profits - though there are now generics. i've found at least for the strips it's basically the same price. The pills without naloxone are cheaper - <USER2> for addicts struggling that gets rid of the back stop and overdose preventer.

Plus having only a few Drs in many states (or none) that charge cash or medicare only makes it in-accesible for many of the downest and out addicts. It should be free (or covered by the worst pharma co s) and FAR more MDs should be able to write script.

[1] [https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rp...](https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/sr107-NSSATS- Buprenorph.htm)

[2] [https://www.rehabs.com/pro-talk/opioid-addiction- treatment-w...](https://www.rehabs.com/pro-talk/opioid-addiction-treatment- why-dont-more-rehabs-use-suboxone/)

[3] [https://www.ncbi.nlm.nih.gov/pubmed/30094695](https://www.ncbi.nlm.nih.gov/pubmed/30094695)

[4] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/)

<comment><USER78> I've heard that part of the motivation for the escalation of opiate strength (fentanyl and carfentanil) is because so many people have begun seeing success with these new therapies. The illegal marketplace has probably been losing profits.

Maybe replacement therapy isn't perfect, but I've seen it help a lot of people who are in a bad place. I wish there was more motivation for finding exit strategies, but there doesn't seem to be any profit in that.

<comment><USER77> my dr mentioned that he's had success with the sub cutaneous thing. it lasts a month and it seems like it's a good way to slowly taper down. and he said the bupe stays in your body for a LONG time when doing that - longer than a month after the 30 day period

it's really hard to taper down! it takes a lot of willpower not to just take more since you have it sitting around. i wonder if would be more successful with like a 1 month taper for in patient program.

<comment><USER79> I tapered off of my Suboxone prescription gradually over a long period of time. By the end of it, I was taking very tiny pieces of the film. They were small enough that at some point, it was probably more mental than anything.

I wish you all the best! After getting off of it, the hardest part for me was still maintaining a clean lifestyle while avoiding the types of people and behaviors that lead to scoring or abusing other drugs (alcohol included) as well.

<comment><USER77> How long of a taper did you do? im not on a very high dose but was still thinking about like 3 months. but I also am 50/50 like I'm worried about the after effects you have - this is working so well now I see very little downside to long term use and the upside is really big imho - except probably harder to eventually taper off the longer I'm on.

<comment><USER79> By not high, do you mean around 2-4 mgs? If so, 3 months is probably a good timeline for taking a 25%-50% reduction every 1-2 weeks or so. I might have even taken longer for the last few doses. I think the big thing is not to rush it and take a pace you're comfortable with. Like you say, taking buprenorphine is much preferable to turning to alternatives.

My first experience with a taper was at rehab as they were pushing me out the door. They rushed it, and I was dopesick as I left. You can imagine that didn't turn out well.

Another thing I credit my recovery to is having strong support along the process. Also, building new lifestyle habits like going to the gym helped me improve my self-image. I don't know how much making that sort of change would apply to you but thought I'd mention it.

<comment><USER77> great advice - thank you. it's helpful hearing success, and triple from those who have successful business lives especially tech/engineering/etc

yup on on 4mg.

i go to the phoenix snd got into my preferred sport again! something i gave up while using that was a huge part of my life. and it's been so good to get it back both community, new friends, and just getting back into shape.

</comment></comment></comment></comment></comment></comment></comment><comment><USER80> RIP Herbert Fingarette

Love Stanton Peele

Jeffrey Schaler is a Choice

</comment><comment><USER81> Belief in a higher power a serious side effect of this treatment regime, though.

</comment><comment><USER82> Finally, scientific evidence of the vast healing power of God. /s

</comment><comment><USER83> What's more interesting is since "The Irrationality of Alcoholics Anonymous" (2015)[1] HN thinks they are experts in how AA doesn't work.

These meme bugs that infect people are the on ongoing issue you see a lot here.

They make no sense, but that's why the meme works. AA is free and you talk to people about your issues, it's hard to see why it's wrong, which is why people love the meme.

Throw in some other regulars -

Inefficiencies mean people actually use more because of "Jenkins paradox" so don't make things efficient!

You are supposed to wake up every night in the middle because some researcher in the arts read it in 300 year old documents.

People are more afraid of losses than gains.

Dumb people think they are smart.

People rise to their level of incompetence... Actually this ones true. But it does mean Impostor Syndrome is more complex than people say.

[https://www.theatlantic.com/magazine/archive/2015/04/the- irr...](https://www.theatlantic.com/magazine/archive/2015/04/the- irrationality-of-alcoholics-anonymous/386255/)

<comment><USER84> > They make no sense, but that's why the meme works. AA is free and you talk > to people about your issues, it's hard to see why it's wrong, which is why > people love the meme.

this isn't a very charitable take. there are a lot of legitimate reasons to be skeptical about AA. to an outsider, the tone and content of the twelve steps can seem pretty weird. why abstinence only, and why don't coffee and cigarettes count? why are people prohibited from identifying themselves as a drug addict in some AA meetings (as if alcohol is not itself a drug)? why does AA itself collect essentially no data that could be used to determine the efficacy of the program? why do courts mandate attending AA but not other similar support groups?

the old adage "it's hard to beat free" certainly applies here, but I wouldn't casually discount all the negative stories in this thread from addicts that tried AA.

</comment></comment><comment><USER85> Dear Dang, what does your admin toolset look like? Have you written about that anywhere? I'm curious, is this post of yours at the top because it has the most upvotes, or because you are pinning it here?

<comment><USER86> I've always assumed that some top level posts are elevated based on the quality/upvotes of their best replies.

<comment><USER85> Yeah I think it works like that too.

Yet at the same time I think dang has the ability to move any post up or down/re-prioritizing or re-ranking based on his intellect, instead of a natural, organic ranking. It becomes a forced therapy session by dang. We also cannot know if this happens, since those moves would be invisible to everyone else on the site (except to other admins/moderators). I do not think it's far fetched to think he has this power, seeing as karma scores are conveniently hidden for all posts (except for the author of each individual post).

I'm a little disturbed that dang seems to 'steer' conversations based on his own interests. There's a bunch of smart people here and I don't understand why he goes past his role as administrator to interject into certain threads. It's 'bad hosting' in my eyes.

With my questions I'm trying to understand what the rules of the game are, to see whether I like them or not and whether I want to keep playing (engaging on HN).

<comment><USER3> We're not in every thread moving things up and down, but HN is curated and that involves judgment and interpretation. For example, if there's an offtopic comment, especially a generic one [1] sitting at the top of a thread collecting upvotes as they tend to do, it's a standard moderation move to downweight it.

The idea of HN is intellectual curiosity. Sadly, upvotes alone don't optimize for that; the voting system optimizes for indignation and repetition. Countervailing mechanisms, such as software and moderation, are needed. We use software to do what we know how to automate and humans to do what we don't know how to automate—though I wish we did, because most of the human intervention at this level is tedious.

Today is a good moment to illustrate this, actually. If humans weren't curating HN, we wouldn't have had [https://news.ycombinator.com/item?id=22545878](https://news.ycombinator.com/item?id=22545878) or [https://news.ycombinator.com/item?id=22548217](https://news.ycombinator.com/item?id=22548217), and probably not even the current thread about AA. It would have been all coronavirus stories, or almost all.

[1] [https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...](https://hn.algolia.com/?dateRange=all&page=0&prefix=false&query=by%3Adang%20generic%20discussion&sort=byDate&type=comment)

</comment></comment></comment></comment><comment><USER87> That doesn't make sense: AA is not very effective at all.

"Based on these data, he put AA's actual success rate somewhere between 5 and 8 percent."

[https://www.theatlantic.com/magazine/archive/2015/04/the- irr...](https://www.theatlantic.com/magazine/archive/2015/04/the- irrationality-of-alcoholics-anonymous/386255/)

<comment><USER36> The Cochrane meta-analysis has arrived at opposite results to that debunking, based on 21 recent randomized studies. It's interesting how many comments in this thread are pointing to the older results as if they debunk the newer ones.

</comment></comment><comment><USER88> It's refreshing to see people helping people in programs like AA.

I'm curious to see if the success of these programs change in the coming decades, as younger generations seem to be moving away from social interaction in favor of social MEDIA interaction. Will this have an impact on the success of programs like AA? I hope not.

<comment><USER89> You could always have an AA meeting in VR Chat. In fact, I'd be surprised if there isn't one.

<comment><USER90> Doing it virtually makes it hard to retain the "anonymous" part of AA.

<comment><USER91> Anonymous is at the level of press, radio and films...

<comment><USER92> ^^ Tradition 11. Tradition 12 states:

"Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities."

While it is easy to take the word anonymity at face value, in my opinion as an alcoholic active in AA, anonymity as it is mentioned here in tradition 12 deals more with ego and pride. When you walk into a meeting, you leave "what you are" at the door and walk in as "who you are." This translates into practices of not using honorifics. A judge isn't "Your Honor" at a meeting. A priest isn't "Father." All are equal, and all are just one drink away from being drunk. Thus, placing AA's principals before our own personalities.

</comment></comment></comment></comment></comment><comment><USER93> Last I google-researched, AA-style treatment was really the ONLY effective treatment against long term dependence/addiction. Psychotherapy and others almost always failed.

It probably is related to the social network effect that was described with Vietnam vets dumping heroin addiction when they returned home to their old social groups that didn't accomodate the behavior. AA et al provide a new social group that actively tries to stop the addiction.

<comment><USER94> For those who AA doesn't work for, I would recommend psychotherapy, joining a meditation group (for the social benefit, not for counseling), and practicing regular meditation, particularly loving-kindness meditation, which you can google and is easy to practice. A good psychotherapist can help you learn how to talk to yourself in a more supportive way. Meditation can help you to break out of your mental ruts and pause before taking habitual action.

<comment><USER50> Yin Yoga is pretty good, too.

</comment></comment></comment><comment><USER13> is there an HN flagbot randomly flagging posts for opaque reasons?

will smearing blood on this post keep it from getting flagged or is this comment already suspect and targeted by the Reaper XNPQ3 due to it being a reply to a previously flagged post?

does it cost you any points in heaven to flag a post?

May I simply feel free to flag posts containing adjectives in lieu of adverbs?

I've noticed that all of the 50 states I'd visited featured grammatically incorrect street signs advising one to "drive slow"... must be related to sign painters being grown up "slow children playing" also from grammatical butchery sign infamy...</comment>


Announcing .NET Core 3 Preview 2 - <AUTHOR> https://blogs.msdn.microsoft.com/dotnet/2019/01/29/announcing-net-core-3-preview-2/ <comment><USER2> C# pattern matching capabilities are starting to remind me of OCaml tutorials in the university. Sweet.

</comment><comment><USER3> _using var options = Parse(args);_

That's going to tidy up a ton of my code, flatter is definitely better.</comment>


JSBuild ensures that CommonJS modules can be used in browser-based applications  - <AUTHOR> http://github.com/azer/jsbuild JSBuild ensures that CommonJS modules can be used in browser-based applications (on the web) without any need of source code modification. It's a new Python library and a command-line utility that builds specified CommonJS modules and packages by generating unobtrusive Javascript code. <comment><USER2> This is the worst thing about CommonJS. By default, it can not work in browsers - the most common environment for javascript.

You either need a special loader, or you need to package the code into a wrapper.

The other bad part about it is that it is not async. Which means your code blocks whilst it loads. Loading code off a slow hard disk, or off the network? Blocked.

I'm not sure why they have made these design decisions.

CommonJS seems a step backwards to me.

<comment><USER3> There are a lot of misconceptions about CommonJS modules in the browser. You've touched on most of them.

 _Of course_ you need a loader or packaging script, any module system that wants to handle dependencies will. Script tags are inadequate for anything except the simplest cases.

You _can_ load your modules asynchronously, even though the main "require()" API is synchronous. Simply load the modules and their dependencies up front before executing them. This is what we've been doing for years in the Objective-J loader, and several CommonJS browser loaders already do it.

Also, I believe "require.async(id, callback)" is part of the spec now too, and they're working on an "async module definition" spec, which allows loading in script tags with minimal boilerplate ("require.def(id, function() { / _module_ / })")

</comment></comment><comment><USER4> Can anyone comment on how this compares to something like RequireJS? (<http://requirejs.org/docs/why.html>)

<comment><USER3> I can't really tell how JSBuild works because the docs aren't very helpful and I don't feel like diving into the code right now, but I can tell you RequireJS only supports modules in one of the wrapped "transport" / "async module definition" formats, NOT all CommonJS modules. The author is very opinionated about this so I wouldn't expect that to change any time soon.

Yabble does support unwrapped modules, so you might want to take a look at that: <http://github.com/jbrantly/yabble>

<comment><USER4> Thanks, I'll check out Yabble too.

</comment></comment></comment><comment><USER5> If you are using CoffeeScript, I wrote a little tool which essentially does the same, but is _much_ less complex (IMHO): <http://github.com/chrislloyd/roast>

When compiling all it does it does is inline the files you have requir'd.</comment>


Spy General Unloads on Obama's ISIS War Plan - <AUTHOR> http://www.thedailybeast.com/articles/2015/01/27/ex-pentagon-spy-chief-blasts-white-house-paralyzed-by-radical-islam.html

<comment><USER2> Big deal. A retired _General_ , who was head of the DIA, rants and raves in front of "the crowd at the annual National Defense Industry Association's special-operations meeting."

I'm cynical enough about the US defense establishment to see this as someone telling pigs at the trough that they need more swill from the government. General Flynn is a product of the "deep state", he's definitely going to advocate it's continued existence.

What really tickles me is the recycled anti-communist rhetoric: "fueled by a vision for worldwide domination", "committed to the destruction of freedom and the American way of life". Ha ha! I remember those phrases! You're just trying to scare me again! Fool me once, shame on me and all that. "Al Queda" replaced "Russkies" as the bogey man, now we're working towards replacing "Al Queda" with "ISIS". Just more pork for the defense companies and "IC" TLAs, is what I say it is.

</comment><comment><AUTHOR> General's remarks in full are here (paywall if you're not a first-time visitor): [http://foreignpolicy.com/2015/01/27/the-text-of-general- flyn...](http://foreignpolicy.com/2015/01/27/the-text-of-general-flynns- speech/)</comment>


Bad Times in Tech? Not If You're a Startup Serving Other Startups - <AUTHOR> https://www.nytimes.com/2019/08/02/technology/brex-start-up.html <comment><USER2> I will say, for what it's worth, that the customer experience of using Brex is really quite outstanding (my current startup is a customer.)

They've figured out things that in hindsight just seem so obvious to a good UX, and yet we've all been so trained to have low expectations from the mediocre service traditional banks/corporate card providers offer that it seems outstanding.

From limited experience - the fact that virtual cards are first-party citizens, the helpful text messages you get (which include a warning the first time you use a card physically, instant text records when you use a card physically, the ability to photograph receipts and send them back to that same text phone #, and and and.)

American Express (my only other corporate card comparison) of course _could_ offer this stuff, but it's just not in their DNA because, well, they haven't had to innovate because they had what amounts to a monopoly on corporate spending cards. And I should note - Amex ties the credit on those cards to the founder (requiring a personal guarantee until the company reaches a certain - large - size.)

Anyway, this is all to say I'm a fan and it doesn't surprise me they've having the success they are so far. Let's hope they can do it profitably and keep it up!

<comment><USER3> I have a visa card. They introduced a verification check for online use a few years ago. This involved giving the answer to a question or typing in a passphrase or something (can't remember, I almost never use it).

When setting it up on the web I had to type in the answer/passphrase/whatever. It was rejected. I read the form again, looked at the error msg, no indication why, typed it in again, again rejected.

I called the bank, "oh, it's got to have a digit in it". It did not say on the form a digit was needed, nor did the error message.

They could not even manage to tell the users the most trivial requirements either directly or in the error message. It's beyond pathetic. It's literally incomprehensibly incompetent to fail at such a low level.

<comment><USER4> I remember "Verified By Visa" which would send you to a site that looked like it was drawn by a crayon. It shocks me how financial institutions often make web sites that look like a parody of a phishing site. For instance, my credit union had an online banking service which used the name "myvaultsentry.com" which just seemed liked something a high school hacker would think up.

It is strange because operationally Visa is good at what they do, and they put a huge amount of effort and expense into developing a brand, but for legacy organizations (academia too) the web seems to be made of kryptonite.

<comment><USER5> MBNA, a credit card provider in the U.K., used to provide online services under a completely different website than their main one, with a domain like "bank card services dot co dot uk"* and a barely-styled website

I thought I was being phished until I confirmed it was real on the phone with them.

(it may not have been that domain so don't try in case that's a sketchy site)

</comment></comment></comment></comment><comment><USER6> I ran a bootstrapped company with $150k/mo of well-documented, above-board recurring revenue and Chase wouldn't give it a credit limit above $5k.

Entrusting my finances to another startup like Brex is scary, but damn is the pitch compelling compared to mainstream banks.

<comment><USER7> I think you could easily buy an hq (or any other relatively liquid asset that would also help the business in other ways) outright with that kind of money and use that to collateralize a much larger credit limit

<comment><USER8> What's an hq?

<comment><USER9> Headquarters (real estate)

<comment><USER10> uh that's not liquid

<comment><USER7> Real estate (especially smaller, less customized office space) is usually liquid enough to use as collateral for a loan

</comment></comment></comment></comment></comment></comment><comment><USER11> This Pedro Franceschi is the same kid that created iUsers to allow multi-users in iPad and hacked Siri to understand portuguese years before Apple. I'm really happy that their startup has a big potential and I hope it succeeds, I'm a real fan

</comment><comment><USER12> As this is Hacker News, Paul Graham's comments on Yahoo during the .com bubble are particularly relevant:

By 1998, Yahoo was the beneficiary of a de facto Ponzi scheme. Investors were excited about the Internet. One reason they were excited was Yahoo's revenue growth. So they invested in new Internet startups. The startups then used the money to buy ads on Yahoo to get traffic. Which caused yet more revenue growth for Yahoo, and further convinced investors the Internet was worth investing in. When I realized this one day, sitting in my cubicle, I jumped up like Archimedes in his bathtub, except instead of "Eureka!" I was shouting "Sell!"

[http://www.paulgraham.com/yahoo.html](http://www.paulgraham.com/yahoo.html)

<comment><USER13> > except instead of "Eureka!" I was shouting "Sell!"

and then missing 2 more sustained years of jaw dropping prices

don't act clairvoyant.

<comment><USER12> You do realize that was a quote from the pg blog post I linked, correct?

<comment><USER13> Yes, I even read it to make sure he didn't call it closer to the crashes

</comment></comment></comment></comment><comment><USER14> Brex's PR firm certainly seems to be earning their keep. This is the third or fourth article about Brex that 'wasn't about Brex' I've seen on HN in the last couple of months.

</comment><comment><USER15> Isn't this just a reformation of the idea there's only two business models?

Either you mine for gold yourself or you sell shovels to others who want to mine for gold.

<comment><USER16> Btw Google for the word "Bre-X" and you will read about a gold mining scandal from the dotcom era.

</comment></comment><comment><USER17> Brex sounds like it's headed for bankruptcy based on the article. They're unprofitable now, and have incredibly risky clients sitting in front of what feels like a looming recession.

</comment><comment><USER18> It seems like it's doing well because things are bad in silicon valley, not in spite of. It sounds like there are a lot of desperate startups getting loans to 'simulate' growth by having negative profit margins (since they can't get real growth otherwise), then they use that fake growth to get investors' money which they use to service debt, then they keep raising money until they exit or IPO. It doesn't seem sustainable. All these debts end up the hands of corporate shareholders. There's a point where companies and the public will stop buying useless startups (if that point hasn't already passed).

<comment><USER19> > things are bad in silicon valley

Really?

> there are a lot of desperate startups getting loans to 'simulate' growth by > having negative profit margins (since they can't get real growth otherwise)

You're conflating a few things, here. The Amazon strategy of reinvestment works as long as it's genuine growth and not overdone. Uber's more of an open question: they've increased demand through subsidies, the question is what will demand look like when prices reflect the true cost. Postmates is in the same situation as Uber, but much worse because they offer a service people can trivially do themselves.

> All these debts end up the hands of corporate shareholders.

Not usually. And startups don't usually use debt (except in ~2015/2016), they sell equity. VC funds tend to have more pensions and sovereign wealth.

</comment></comment><comment><USER20> There's always a PG article -- [http://www.paulgraham.com/submarine.html](http://www.paulgraham.com/submarine.html) [April 2005]

</comment><comment><USER21> > for his Bernese mountain dog, Ruby, who is named after the coding language > Ruby on Rails

/facepalm

<comment><USER11> I remember Pedro giving talks on Rubyconf in Brazil with only 15 years old, this kid grew with the help of Ruby community, so it makes sense he gives so much importance to it

<comment><USER22> I think the facepalm was meant to be "OMG this finance journalist doesn't know the difference between a framework and a language, what an idiot".

(Fwiw, the difference between the two is super nuanced and irrelevant to most journalism about tech. They're both "tools to make software". If I were a journalist, I'd also call Rails a programming language, because that's a term much of the general public understands is "a thing people use to build software with")

(so who knows, maybe the author actually knows, but decided to write for the NYT audience and not pedants on HN)

<comment><USER23> > I think the facepalm was meant to be

Reading it again, I'm sure you're right, but I totally missed that. Actually the lines between language and library and framework are not so easy to pin down. Maybe the finance journalists are on to something.

</comment></comment></comment></comment><comment><USER24> It's nothing more than the same Ponzi scheme we saw in 1999. If venture funding dries up, for their customers, they are also toast. I hate that the modern idea of a "successful" company is how much money they can raise and at what evaluation.

<comment><USER19> It's very different. Look at how the public market is treating Uber. Its pre- IPO valuation was rosy, but not out-of-line, and its price has been pretty consistent since the first few weeks. It's not like every tech IPO is up 200%-500% on the first day, then keeps climbing by 1% per day.

> I hate that the modern idea of a "successful" company is how much money they > can raise and at what evaluation.

So the value of the company? I agree that it doesn't capture value to society, but it's better than "community-adjusted EBITDA."

<comment><USER24> It's always "different this time". Uber still hasn't proven it has a sustainable business model. It's marginal profit is still negative with no signs of bring cash flow positive. During the dot com boom the first time, you also had companies going public with no profitability and crazy valuations.

</comment></comment></comment><comment><USER25> The scariest thing about this article is it didn't contain the word "bubble"

</comment><comment><USER26> I think this is a good example of a "Submarine"[0] article

      [0] http://www.paulgraham.com/submarine.html

</comment><comment><USER27> For those that are familiar with the service are they really mostly/only focused on companies that have outside investment?

From glancing at their literature it seemed like their gig was lending money to companies that actually already had the money in the bank, like providing company spending cards to a startup with a few million in VC money sitting somewhere.

Is that correct or do they lend to companies with more traditional economics, like a bootstrapped company with a million or two in annual revenue but without major cash reserves or investment?

<comment><USER28> They told me they basically only serve companies with VC investment. We were declined despite meeting the stated balance requirements because we were self- funded.

<comment><USER27> That seems like a pretty lame business model. Like why bother?

Though I guess that question answers itself, it seems logical to the predictably solipsistic VC community, who then throw money at it.

<comment><USER29> Less risky, because a VC does due diligence.

</comment></comment></comment></comment><comment><USER30> Startups serving other startups sounds exactly like the dot com boom/bust. When the bust started, it spread across the entire Valley because exactly this.

</comment><comment><USER31> I.e., when people are mining for gold, sell pick axes!

</comment><comment><USER32> I don't understand the economics of Brex. I used to work for a large, analytics-savvy credit card company, and people would freak out if the percentage of customers going bad (not paying their debt) exceeded something like 3-5%. Given that VC-funded startups fail at a rate of 11/12, isn't Brex effectively throwing money down a massive black hole, assuming they're extending credit? And this is at the top of credit cycle, probably within a few years of a recession, where a higher than normal percentage of good debt will go bad too.

</comment><comment><USER33> Bad times? Only lazy bums like me and poor H1s are still sitting at our old BigCo (life work balance is amazing, plus there are too few of us left who is doing the stuff so we are treated pretty soft and accurately :) . Anybody who left during the last year and a half got minimum 300 (junior and/or really incapable engineers) with the normal engineers getting 400-500K and that isn't in a red hot AI and the likes. The money is just sloshing around. Granted everything comes to an end, and we're definitely due for the one, yet it definitely didn't happen yet.

<comment><USER34> Who's paying 400-500K for normal engineers? Even FAANGs don't pay that much for for Senior Software Engineers.

</comment></comment><comment><USER35> The Brex interview handed out real customer bank balance and transaction history and suggested that that data was all they they used to build their underwriting model.

</comment><comment><USER36> How is it different than say, stripe issuing?

[https://stripe.com/nz/issuing](https://stripe.com/nz/issuing)

<comment><USER37> Brex is identical to what Stripe is offering, but Brex's cards offer credit. From what I can see and correct me if I'm wrong, Stripe doesn't offer credit lines

<comment><USER38> [https://stripe.com/partners/fundingcircle](https://stripe.com/partners/fundingcircle)

I've used it for my bootstrapped company, works great.

<comment><USER39> I haven't touched base with these lenders in a while but I thought p2p lenders like fundingcircle only offer term loans?...

Do they offer credit lines and revolvers now too? Curious how that works out in the p2p space.

</comment></comment></comment></comment><comment><USER40> Is it official? The Startup Industrial Complex?

</comment><comment><USER41> During a gold rush the best way to make money is to sell shovels.

<comment><USER42> > During a gold rush the best way to make money is to sell shovels.

That's never actually true, it's just a nice saying. The most money is always made in owning a super structure business - in tech, a platform - that has very wide appeal, rather than concerning yourself with trying to compete to sell shovels to a temporary gold rush.

Selling shovels is an opportunistic business, only good for a short-term run. The real money is always made by focusing instead on larger, longer term opportunities that are sustainable.

Some things persistently ignored about the shovel selling business during gold rushes: most of the shovel sellers lose their hats in the bust, because they don't see it coming and they carry inventory and speculate on demand constantly. The history of gold rushes is that the shovel sellers frequently miscalculate the duration of the rushes. They get hammered when it ends, most of them go bankrupt (see: every oil boom in US history).

It's better to be Exxon or Chevron and own large reserves in the ground, not the primary company selling little pieces of gear to Exxon. It's better to be the majors in the Permian (gold rush) making money long-term off the reserves, not the little shovel sellers that constantly boom and bust with each big blip in the oil market.

It was far better to own refining and pipelines - chokepoint super structures - during the oil boom in Standard Oil's time, than to be a shovel seller to the oil industry or oil wildcatters.

It's better to be Rio Tinto, Newmont or BHP and own the mines & supply than to be selling mining equipment. BHP is a $137b company, Rio Tinto is a $91b company. The shovel sellers are comically tiny by comparison, borderline irrelevant in size versus these juggernauts.

For the last century it has been better to be De Beers than to be selling diamond industry equipment.

During the car boom in Henry Ford's time, it was better to be one of the surviving majors than to be a shovel seller. This fundamental is always true.

During the mobile gold rush it's better to be Apple and Google than ARM, Foxconn or Qualcomm (Samsung for their part covers all the bases). The super structures - Apple & Google platforms in this case - usually by far make the most money, the shovel sellers are typically much smaller and less profitable.

<comment><USER43> IBM is over 100 years old. I don't think most people in tech understand how profound that is, between the obvious changes in leadership but more astonishingly business-sinking technology shifts, industry tanking economic phenomenon, etc.

There will not be another IBM coming out of San Francisco culture.

I only skimmed the article so I couldn't tell if it was loathsome or self- paraody of what is going on in SF right now. But I hope they and readers realize it is simply ouroboros.

<comment><USER44> I don't know. Apple has something like 250 billion in their war chest. They could stop selling stuff for a hundred years and still pay 20000 people $100k a year.

<comment><USER43> Sure but neither a startup nor raised in the current SF startup culture. Apple definitely has potential to transcend tech and leadership although we need to see 1-2 more changes in leadership to know for sure.

</comment></comment></comment></comment></comment><comment><USER45> How do they monitor the bank account and balances?

</comment><comment><USER46> In a gold rush the miners go broke but the hardware store makes boatloads of cash.

<comment><USER47> In a tech boom the startups go broke but the property owners make boatloads in rent.

<comment><USER48> Who are property owner if not executives at big companies and also people who are contributor of VC funds?

</comment></comment></comment><comment><USER49> I offer small services other startups too [https://launchpropeller.com/#/](https://launchpropeller.com/#/)</comment>


Ask HN: Clojure vs Go - <AUTHOR>

I'm really wanting to get proficient in one of these languages.
I'm a fan of python. Go is really attractive to me for this reason. I feel like it is a language that I could really love.
Clojure is still a bit alien to me. I've gone through tutorials and have built small dummy programs. I feel like this language can make me improve more as an overall programmer. However, I am still skeptical if it will benefit me as much as go.
I'm attracted to both languages because I'm trying to improve on my knowledge of concurrent/parallel programming.
Any reasons to choose one over the other as my next language? For reference I feel like I'm proficient in Python/Java/JavaScript/C++. <comment><USER2> In my mind Clojure is an easy win unless you're writing short running things that need to boot fast (though you could consider clojurescript + node for that).

Both languages have good support for concurrency, but for me Clojure has much more going for it:

\- It's fast, and has all the tooling and libraries from the JVM \- it has immutable datastructures with literals for all of them) by default, this is huge, they're probably the thing I miss most when I have to use other languages. \- It encourages functional programming very strongly, but has excellent support for managing mutable state when you need it. \- It's very simple (it's a lisp) and has a very small number of primitives, with much of the standard library coming from macros rather than actually being baked into the language. \- The community is amazing, #clojure on freenode is incredibly helpful and friendly towards noobs.

I probably don't sell it well, but I'd highly recommend watching some of Rich Hickey's talks to sort of understand the philosphy that goes into Clojure:

[http://www.infoq.com/presentations/Simple-Made- Easy](http://www.infoq.com/presentations/Simple-Made-Easy) [http://www.infoq.com/presentations/Are-We-There-Yet-Rich- Hic...](http://www.infoq.com/presentations/Are-We-There-Yet-Rich-Hickey)

Don't go for Go just because it's familiar ;)

</comment><comment><USER3> If you are attempting to learn about concurrent programming I think using python is you're best bet (initially) because it provides a "low signal to noise" which best demonstrates some of the common pitfalls concurrent programming promotes as well as some of the solutions. (such as those found in the python wiki) [[http://wiki.python.org/moin/Concurrency/Patterns](http://wiki.python.org/moin/Concurrency/Patterns)].

Understanding the problems then allows you to make a better choice and understand some of the choices made for you by the language designers, such as why does Clojure use STM and promote immutability? Are actors/goroutines/coroutines the same thing? What is so good about this reducers library? etc. etc. Linking the dots and the "ah ha!" moments will help you make your choice and understand more about why the tool might be a greater asset than the other.

In short: Understand the problem before solving it. (or use the hammer for nails and screwdriver for screws)

</comment><comment><USER4> If you are proficient in Python/Java already. There is no reason for you not to choose a Lisp language. Clojure is a good choice.</comment>