Effectiveness of Alcoholics Anonymous
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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.
Analytical definitions of effectiveness, efficacy and success vary according to the particular field of reference investigating the practices, methods and prognoses of treating alcoholics, and in what terms these concepts are framed in individual studies. 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 organisation itself, or from similar twelve-step recovery programmes based on the twelve-step approach run externally from the AA organisation; 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.
A 2006 Cochrane systematic review that reviewed studies published between 1966 and 2005 that investigated the efficacy of AA and twelve step facilitation (TSF), concluded that "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism. 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.
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). A calculation based on these numbers results in a 35.2% continuance rate. In addition, the continued engagement and newcomers attendance over the past year allows a basic calculation of the percentage of those attending that were newcomers over the past year (23.2%)
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 analysis found that from 1977 to 1989 around one quarter (26%) of those who first attend an AA meeting are still attending after one year. Nearly one third (31.5%) leave the program after one month, and by the end of the third month, just over half (52.6%) have left. 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.
Lance Dodes, former director of substance abuse treatment at Harvard’s McLean Hospital and assistant clinical professor of psychiatry at Harvard Medical School, says Alcoholics Anonymous helps between 5 percent and 10 percent of its participants. Dodes also believes A.A. harms 90 percent of participants because of the perception that "If you fail in A.A., it's you that's failed" and not A.A. In response to these claims John F. Kelly and Gene Beresin, both Harvard Medical School professors argue that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment. They further point out that Dr. Dodes psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness
- Addiction recovery groups
- Alcoholics Anonymous
- Recovery model
- Self-help groups for mental health
- Substance abuse
- Intervention Counseling
- Community Reinforcement Approach and Family Training (CRAFT)
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