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,[1][2] 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.[3]

Clinical studies[edit]

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;[4] 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.[4]

Membership Retention[edit]

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.[5]

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).[6] 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).[6] 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[edit]

To measure the retention of members, the 1968 AA General Service Conference voted to begin surveying those participating in AA.[7] 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.[7][8][9][10][11] 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.[7] 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,[12] the third was presented at the International Congress on Alcoholism and Drug Dependence.[13]

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.[14] In the previous surveys this group (those remaining active for ninety days) would be the only ones considered to have "tried AA."[7] 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.[14] The necessity of an introductory period was not considered in the 1990 analysis, and the concept was not present in its analysis.[7]

Sobriety of AA members[edit]

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.[14] While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990.[7]

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.[15] 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[16]

See also[edit]

References[edit]

  1. ^ Ferri, Marica; Amato, Laura; Davoli, Marina (2006). "Alcoholics Anonymous and other 12-step programmes for alcohol dependence". Cochrane Database Syst Rev (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID 16856072. 
  2. ^ Emrick, C. (1989). "Alcoholics Anonymous: Membership characteristics and effectiveness as treatment" in Recent developments in alcoholism, Vol. 7: Treatment research M. Galanter, ed. (1989) New York: Plenum Press, pp. 37-53.
  3. ^ Bebbington, PE (1976). "The efficacy of Alcoholics Anonymous: The elusiveness of hard data". The British journal of psychiatry : the journal of mental science 128: 572–80. doi:10.1192/bjp.128.6.572. PMID 1084198. .
  4. ^ a b Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3
  5. ^ SOURCE: National Longitudinal Alcohol Epidemiologic Survey Data, Manual 1 July 11, 1994, National Institute on Alcohol Abuse and Alcoholism.
  6. ^ a b L. A. Kaskutas, Y. Ye, T. K. Greenfield, J. Witbrodt & J. Bond (2008). "Epidemiology or Alcoholics Anonymous Participation." Recent Developments in Alcoholism, Vol 18: Research on Alcoholics Anonymous and Spirituality in Addiction Recovery. 261-282
  7. ^ a b c d e f McIntire, Don (December 2000). "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968–1996) and Related Analyses/Comments". Alcoholism Treatment Quarterly 18 (4): 1–18. doi:10.1300/J020v18n04_01. 
  8. ^ "Alcoholics Anonymous 2004 Membership Survey". Alcoholics Anonymous World Services' General Service Office. 2005. Archived from the original on 2009-12-12. Retrieved 2013-03-19. 
  9. ^ "Alcoholics Anonymous 1998 membership survey". New York: Alcoholics Anonymous World Services. 1999. 
  10. ^ "Alcoholics Anonymous 2001 membership survey". New York: Alcoholics Anonymous World Services. 2002. 
  11. ^ "Alcoholics Anonymous 2007 Membership Survey". Alcoholics Anonymous World Services. 2008. Archived from the original on 2009-12-19. Retrieved 2009-12-19. 
  12. ^ Norris, John (18 December 1974). "Analysis of the 1974 Survey of the Membership of A.A.". North American Congress on Alcohol and Drug Problems. San Francisco, CA. 
  13. ^ Norris, John (3 September 1978). "Analysis of the 1977 Survey of the Membership of A.A.". 32nd International Congress on Alcoholism and Drug Dependence. Warsaw, Poland. 
  14. ^ a b c "Comments On A.A. Triennial Surveys". Alcoholics Anonymous World Services. December 1990. 
  15. ^ http://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-recovery
  16. ^ http://commonhealth.wbur.org/2014/04/defense-12-step-addiction

Further reading[edit]

  • 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 apse prevention : maintenance strategies in the treatment of addictive behaviors, New York : Guilford Press, c2005. ISBN 159385176
  • Kingree, J. B. (2005). "Twelve-Step Subculture and Cultural Competency Among Clinicians: A Response to Holleran and MacMaster". Alcoholism Treatment Quarterly 23 (4): 121–125. doi:10.1300/J020v23n04_09. 
  • Levine, B. G., & Nebelkopf, E. (Jan–March 1998). "A Russian-American approach to the treatment of alcoholism in Russia: Preliminary results". Journal of Psychoactive Drugs 30 (1): 25–32. doi:10.1080/02791072.1998.10399668. PMID 9565206. 
  • Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. (September 1998). "Network support for drinking, Alcoholics Anonymous and long-term matching effects". Addiction 93 (9): 1313–1333. doi:10.1046/j.1360-0443.1998.93913133.x. PMID 9926538. 
  • Mengis, M., Maude-Griffin, P. M., Delucchi, K., & Hall, S. M. (Summer 2002). "Alcohol use affects the outcome of treatment for cocaine abuse". The American Journal on Addictions 11 (3): 219–227. doi:10.1080/10550490290087992. PMID 12202014. 
  • Moos, R. H., & Moos, B. S. (April 2004). "Help-seeking careers: Connections between participation in professional treatment and Alcoholics Anonymous". Journal of Substance Abuse Treatment 26 (3): 167–173. doi:10.1016/S0740-5472(03)00190-9. PMID 15063909. 
  • Moos, R. H., Moos, B. S., & Andrassy, J. M. (December 1999). "Outcomes of four treatment approaches in community residential programs for patients with substance use disorders". Psychiatric Services 50 (12): 1577–1583. PMID 10577876. 
  • Morgenstern, J., & Bates, M. E. (November 1999). "Effects of executive function impairment on change processes and substance use outcomes in 12-step treatment". Journal of Studies on Alcohol 60 (6): 846–855. PMID 10606498. 
  • Ouimette, P. C., Finney, J. W., & Moos, R. H. (April 1997). "Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness". Journal of Consulting and Clinical Psychology 65 (2): 230–240. doi:10.1037/0022-006X.65.2.230. PMID 9086686. 
  • Ouimette, P. C., Finney, J. W., Gima, K., & Moos, R. H. (March 1999). "A comparative evaluation of substance abuse treatment III. Examining mechanisms underlying patient-treatment matching hypotheses for 12-step and cognitive-behavioral treatments for substance abuse: Alcoholism". Clinical and Experimental Research 23 (3): 545–551. doi:10.1111/j.1530-0277.1999.tb04151.x. 
  • Ouimette, P. C., Moos, R. H., & Finney, J. W. (September 1998). "Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes". Journal of Studies on Alcohol 59 (5): 513–522. PMID 9718103. 
  • Penn, P. E., & Brooks, A. J. (Win 2000). "Five years, twelve steps, and REBT in the treatment of dual diagnosis". Journal of Rational-Emotive & Cognitive Behavior Therapy 18 (4): 197–208. doi:10.1023/A:1007883021936.  Check date values in: |date= (help)
  • Polcin, D. L. (October 2000). "Professional counseling versus specialized programs for alcohol and drug abuse treatment". Journal of Addictions & Offender Counseling 21 (1): 2–11. doi:10.1002/j.2161-1874.2000.tb00147.x. 
  • Sandoz, C. J. (1999). "The spiritual experience in recovery: A closer look". Journal of Ministry in Addiction & Recovery 6 (2): 53–59. doi:10.1300/J048v06n02_05. 
  • Saarnio, P., & Knuuttila, V. (April 2003). "A study of risk factors in dropping out from inpatient treatment of substance abuse". Journal of Substance Use 8 (1): 33–38. doi:10.1080/1465989031000067227. 
  • Stephenson, G. M., & Zygouris, N. (February 2007). "Effects of self reflection on engagement in a 12-step addiction treatment programme: A linguistic analysis of diary entries". Addictive Behaviors 32 (2): 416–424. doi:10.1016/j.addbeh.2006.05.011. PMID 16822620. 
  • Swora, M. G. (September 2004). "The rhetoric of transformation in the healing of alcoholism: The twelve steps of Alcoholics Anonymous". Mental Health, Religion & Culture 7 (3): 187–209. doi:10.1080/13674670310001602445. 
  • Tavares Rodrigues, J., & Pinto de Almeida, L. (2002). "Freedom and compulsion: An analysis of twelve steps programming of Alcoholics Anonymous". Psicologia em Estudo 7 (1): 113–120. 
  • Thevos, A. K., Roberts, J. S., Thomas, S. E., & Randall, C. L. (May–June 2000). "Cognitive behavioral therapy delays relapse in female socially phobic alcoholics". Addictive Behaviors 25 (3): 333–345. doi:10.1016/S0306-4603(99)00067-2. PMID 10890288. 
  • Thevos, A. K., Thomas, S. E., & Randall, C. L. (July 2001). "Social support in alcohol dependence and social phobia: Treatment comparisons". Research on Social Work Practice 11 (4): 458–472. doi:10.1177/104973150101100403. 
  • Timko, C., Billow, R., & DeBenedetti, A. (August 2006). "Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship". Drug and Alcohol Dependence 83 (2): 111–121. doi:10.1016/j.drugalcdep.2005.11.005. PMID 16338102. 
  • Timko, C., & Debenedetti, A. (October 2007). "A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes". Drug and Alcohol Dependence 90 (2–3): 270–279. doi:10.1016/j.drugalcdep.2007.04.007. PMID 17524574. 
  • Timko, C., DeBenedetti, A., & Billow, R. (May 2006). "Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes". Addiction 101 (5): 678–688. doi:10.1111/j.1360-0443.2006.01391.x. PMID 16669901. 
  • Tonigan, J. S., Bogenschutz, M. P., & Miller, W. R. (June 2006). "Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment?". Journal of Substance Abuse Treatment 30 (4): 323–330. doi:10.1016/j.jsat.2006.02.008. PMID 16716847. 
  • Villanueva, M., Tonigan, J. S., & Miller, W. R. (2007). "Response of Native American clients to three treatment methods for alcohol dependence". Journal of Ethnicity in Substance Abuse 6 (2): 41–48. doi:10.1300/J233v06n02_04. PMID 18192203. 
  • Weegmann, M. (June 2004). "Alcoholics Anonymous: A Group-Analytic View of Fellowship Organizations: Group Analysis" 37 (2). pp. 243–258. 
  • Wilson, K. G., Hayes, S. C., & Byrd, M. R. (Winter 2000). "Exploring compatibilities between Acceptance and Commitment Therapy and 12-step treatment for substance abuse". Journal of Rational-Emotive & Cognitive Behavior Therapy 18 (4): 209–234. doi:10.1023/A:1007835106007. 
  • Winters, K. C., Stinchfield, R. D., Opland, E., Weller, C., & Latimer, W. W. (April 2000). "The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers". Addiction 95 (4): 601–612. doi:10.1046/j.1360-0443.2000.95460111.x. PMID 10829335. 
  • Witbrodt, J., & Kaskutas, L. A. (2005). "Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence". American Journal of Drug and Alcohol Abuse 31 (4): 685–707. doi:10.1081/ADA-68486. PMID 16320441. 
  • Zemore, S. E. (October 2007). "A role for spiritual change in the benefits of 12-step involvement:". Alcoholism: Clinical and Experimental Research 31 (Suppl 3): 76S–79S. doi:10.1111/j.1530-0277.2007.00499.x. PMID 17880352.