Effectiveness of Alcoholics Anonymous

The effectiveness of Alcoholics Anonymous in treating alcoholism is a subject of ongoing interdisciplinary research and debate in a multitude of academic and non-academic contexts. While newer studies have suggested an association between AA attendance and increased abstinence or other positive outcomes, older studies and studies done outside of the United States have not.

Experimental studies into the effectiveness of Alcoholics Anonymous (AA) have been based either on results obtained from individuals attending meetings run under the umbrella of the AA organization itself, or from similar twelve-step recovery programs based on the twelve-step approach run externally from the AA organization; generically termed, in this latter case, as twelve-step facilitation (TSF).

Studies of both implementations of the therapeutic model have not yielded conclusive evidence of effectiveness when assessed in terms of long-term prevention of problem drinking as compared with other treatments, although limitations are widely acknowledged in obtaining acceptable data due to the difficulty in applying experimental controls to clinical analyses of AA, such as adequate placebo control and uniformity of the delivered therapy.

Clinical studies

Cochrane Review

A 2006 Cochrane systematic review that reviewed studies published between 1966 and 2005 that investigated the efficacy of AA and twelve step facilitation (TSF) found no significant difference between the results of AA and twelve-step participation compared to other treatments, stating that "experimental studies have on the whole failed to demonstrate their effectiveness in reducing alcohol dependence or drinking problems when compared to other interventions." This conclusion was based on a meta-analysis of the results of eight trials involving a total of 3,417 individuals; the authors note that further efficacy studies are needed, and mention the presence of flaws in one included study regarding the definition of success of interventions.

John Kelly, who is working on the updated version of the Cochrane review concerning Alcoholics Anonymous, says that there are "positive results in favor of Twelve-Step Facilitation treatments that have emerged from the numerous NIH-sponsored randomized clinical trials completed since the original review published in 2006."

Humpreys, Blodgett, and Wagner 2014

A 2014 study by Keith Humphreys, Janet Blodgett and Todd Wagner concluded that "increasing AA attendance only leads to short-term decreases in alcohol consumption that cannot be attributed to self-selection." Austin Frakt, writing for The New York Times, discusses how the study's methodology minimizes outside factors, such as how motivated the people who succeed at becoming abstinent are.

Kaskutas 2009

In 2009, Lee Ann Kaskutas performed a meta-analysis of other studies looking at how effective Alcoholics Anonymous is. The article notes that "rates of abstinence are about twice as high among those who attend AA" but that whether Alcoholics Anonymous has a specific effect is unclear (a specific effect, in this context, is whether it's the actual Alcoholics Anonymous program which helps keep people sober, instead of other factors, including the fact that people more motivated to stay sober will go to more meetings, or that the group support helps alcoholics regardless of the actual program, etc.), stating that there were "2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect."

Moos and Moos 2006

A 2006 study by Rudolf H. Moos and Bernice S. Moos looked at the outcome of a group of alcoholics seeking treatment over a 16-year period. The study stated that "individuals who participated in AA for 27 weeks or more had better 16-year outcomes", showing that "only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more."

Brandsma 1980

In 1980, the book Outpatient treatment of alcoholism was published. It describes a study where patients were randomly placed in one of three treatment options, including Alcoholics Anonymous, or in a control group. The study concluded that Alcoholics Anonymous was less effective than even the control group.

This study had poor methodology. There was no effort to stop the people in the control group from attending Alcoholics Anonymous meetings, and the "Alcoholics Anonymous" treatment patients underwent in the Brandsma study did not use actual Alcoholics Anonymous meetings."The control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study (that was not an actual AA meeting)"

Membership Retention

Results from National Longitudinal Alcohol Epidemiological Survey (NLAES)

In 1992, the United States Census Bureau and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Longitudinal Alcohol Epidemiologic Survey (NLAES). Direct face-to-face interviews were conducted with one randomly selected respondent, 18 years of age or older, in each of 42,862 households within the contiguous United States and the District of Columbia. NLAES respondents were asked whether they ever attended an Alcoholics Anonymous meeting for any reason related to their drinking. 1106 respondents stated they had attended an Alcoholics Anonymous meeting for their drinking prior-to-the past year. 348 respondents stated they attended an Alcoholics Anonymous meeting prior-to-the past year and continued to attend Alcoholics Anonymous during the past year, a 31% continuance rate.

Results from NIAAA’s National Epidemiological Survey on Alcoholism and Related Conditions (NESARC)

In 2001-2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. This time, respondents were asked if they had ever attended a 12-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105). In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270).

Results from Triennial Surveys

To measure the retention of members, the 1968 AA General Service Conference voted to begin surveying those participating in AA. A survey was conducted beginning that year and subsequent surveys have been conducted about every three years (triennially), the latest of which was in conducted in 2011 and published in 2012. The basic results of the surveys are made available in pamphlet form to AA members. Additional comments and analysis intended for academic and professional audiences were written to supplement the survey results from 1970 to 1990. Non-alcoholic Board of Trustee Member, Dr. John [Jack] Norris wrote the second and third analyses. The second was presented at the North American Congress on Alcohol and Drug Problems, the third was presented at the International Congress on Alcoholism and Drug Dependence.

The 1990 commentary evaluated data of triennial surveys from 1977 through 1989 and found that after the first year, the rate of attrition slows. Only those in the first year were recorded by month. The survey states that the data "strongly suggests that about half those who come to A.A. are gone within three months." While the survey itself does not have an actual one-year retention figure in it, The Sober Truth by Lance and Zachery Dodes says that it shows that 26% of people who attend AA meetings stay for over a year. In the previous surveys, this group (those remaining active for ninety days) would be the only ones considered to have "tried AA." After the first year, the rate of attrition slows. The nature of the survey questions asked did not allow a direct comparison between the twelfth month of the first year and the first month of the second year. Only those in the first year were recorded by month. The necessity of an introductory period was not considered in the 1990 analysis, and the concept was not present in its analysis.

Sobriety of AA members

According to AA World Services, about 40% of AA members sober for less than a year will remain another year. About 80% of those sober less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year; however, the survey states that this information does not predict the number that will remain sober, and those who remain sober but not in the fellowship cannot be calculated. These figures have been repeated within a few percentage points using the same calculations since 1974. While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990.

See also

• Addiction recovery groups
• Alcoholics Anonymous
• Alcoholism
• Recovery model
• Self-help groups for mental health
• Substance abuse
• Intervention Counseling
• Community Reinforcement Approach and Family Training (CRAFT)

Further reading

Books

• Marlatt, Alan., Harm Reduction Pragamatic Strategies for Managing High Risk Behavior, New York Guildford Press 1998, ISBN 1-57230-397-2
• Daley Dennis C. and Marlatt, Alan, Overcoming Your Alcohol or Drug Problem: Effective Recovery Strategies Therapist Guide (Treatments the Work) Oxford ; New York : Oxford University Press, 2006,
• Marlatt, Alan G. Vandenbos, Gary R., Addictive behaviors : readings on etiology, prevention, and treatment, Washington, DC : American Psychological Association, c1997. ISBN 1-55798-468-9
• Witkiewitz, Katie A. and Marlatt, Alan G. Therapist's Guide to Evidence-Based Relapse Prevention (Practical Resources for the Mental Health Professional)
• Dimeff, Linda A., Baer, John S. Kivahaln, Daniel R., Marlatt, Alan G., Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach, 2007,
• Donovan Dennis M., Marlatt, Alan G. Assessment of Addictive Behaviors, 1988
• Donovan, Dennis M, Marlatt, Alan G., Relapse prevention: maintenance strategies in the treatment of addictive behaviors, New York : Guilford Press, c2005. ISBN 978-1-59385-176-7