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The most recent survey of AA members, conducted in 2007, found that 33% had been continuously sober for more than 10 years, 12% had between 5 and 10 years of sobriety, 24% between 1 and 5 years, and 31% less than 1 year. Comprehensively, the average length of sobriety for all members was more than 8 years, with 52% of the membership being between 41 and 60 years of age (http://www.aa.org/pdf/products/p-48_07survey.pdf).
The most recent survey of AA members, conducted in 2007, found that 33% had been continuously sober for more than 10 years, 12% had between 5 and 10 years of sobriety, 24% between 1 and 5 years, and 31% less than 1 year. Comprehensively, the average length of sobriety for all members was more than 8 years, with 52% of the membership being between 41 and 60 years of age (http://www.aa.org/pdf/products/p-48_07survey.pdf).


While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990.<ref name="MCINTIRE2000"/> A paper, however, was self-published in 2008 by three independent authors (not endorsed by AA) clarifying the 1990 commentary.<ref name="THREEAMIGOS">{{cite paper |title=Alcoholics Anonymous (AA) Recovery Outcome Rates: Contemporary Myth and Misinterpretation |date=11 October 2008 |author=Arthur S |coauthors=Tom E., Glenn C |url=http://hindsfoot.org/recout01.pdf |accessdate=2009-12-19 |archivedate=2009-12-19 |archiveurl=http://www.webcitation.org/5mA3r6hSn}}</ref>
While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990.<ref name="MCINTIRE2000"/>


== See also ==
== See also ==

Revision as of 03:08, 7 December 2010

The effectiveness of Alcoholics Anonymous, the success of the Alcoholics Anonymous (AA) twelve step program 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 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 in general not yielded definitive evidence of efficacy when assessed in terms of long-term prevention of problem drinking as compared to 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]. Despite this lack of experimental confirmation in clinical studies, Alcoholics Anonymous itself claims an approximate membership retention of 26% after twelve months from initial attendance — an adherence rate that would be comparable to, or better than, those found in studies of other addiction therapy treatments[4].

Clinical studies

Meta-analyses

A 2006 Cochrane systematic review by Ferri et al on studies of alcohol treatment conducted between 1966 and 2005 that investigated the efficacy of both AA and non-AA twelve-step program attendance, 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[5]; the authors, however, note that further efficacy studies are needed, and mention the presence of flaws in one included study regarding the definition of success of interventions[5].

Results from Triennial Surveys

To help answer questions about AA's effectiveness, the 1968 AA General Service Conference unanimously voted to begin surveying those participating in AA.[4] 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 2007 and published in 2008.[4][6][7][8][9] 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.[4] 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,[10] the third was presented at the International Congress on Alcoholism and Drug Dependence.[11]

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.[12] In the previous surveys this group (those remaining active for ninety days) would be the only ones considered to have "tried AA."[4] 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.[12] The necessity of an introductory period was not considered in the 1990 analysis, and the concept was not present in its analysis.[4]

The analyses published from 1970 to 1987 considered an introductory period of ninety days, during which time a "newcomer" regularly attended meetings, was necessary before a newcomer was considered to have "tried AA."[4] If a participant with a desire to stop drinking voluntarily sought assistance in AA for that length of time but ultimately found AA to be unhelpful and dropped out, that would be considered a sign of failure.[4] Of the alcoholics who stayed following the introductory period,[4] the results of the Triennial Surveys approximately fit the rule of thumb suggested in the second edition of Alcoholics Anonymous;[13] of alcoholics who "really tried" to follow the AA program "50% got sober at once and remained that way; 25% sobered up after some relapses, and among the remainder, those who stayed with Alcoholics Anonymous showed improvement."[4]

People may participate in AA for less than ninety days for several reasons. For instance, they may do so under the coercion of a recovery/treatment program, employee assistance program, or as mandated by a court. Similarly, they may do so in response to an ultimatum of a family member or friend and chose to attend meetings rather than deal with the consequence. Some may also attend AA because they have an alcoholic family member or friend and are curious about the organization, they are students seeking information about alcoholism, or they are participating in multiple twelve-step programs but not primarily in AA. Others attend and then determine other methods such as harm reduction are more appropriate for them.[4]

About 40% of the 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.[12]

The most recent survey of AA members, conducted in 2007, found that 33% had been continuously sober for more than 10 years, 12% had between 5 and 10 years of sobriety, 24% between 1 and 5 years, and 31% less than 1 year. Comprehensively, the average length of sobriety for all members was more than 8 years, with 52% of the membership being between 41 and 60 years of age (http://www.aa.org/pdf/products/p-48_07survey.pdf).

While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990.[4]

See also

References

  1. ^ Ferri M, Amato L, Davoli M, Alcoholics Anonymous and other 12-step programmes for alcohol dependence http://www.cochrane.org/reviews/en/ab005032.html
  2. ^ Emrick, C. (1989). Alcoholics Anonymous: Membership characteristics and effectiveness as treatment. In Galanter, M., ed. (1989). Recent developments in alcoholism, Vol. 7: Treatment research. New York, NY, US: Plenum Press, pp. 37-53.
  3. ^ Bebbington, P. (1976). The efficacy of Alcoholics Anonymous: the elusiveness of hard data. British Journal of Psychiatry 128:1, pp. 572-580. PMID 1084198.
  4. ^ a b c d e f g h i j k l McIntire, Don (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. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ a b Ferri et al 2006
  6. ^ "Alcoholics Anonymous 2004 Membership Survey". Alcoholics Anonymous World Services' General Service Office. 2005. Archived from the original (PDF) on 2009-12-12. Retrieved 2009-12-12. {{cite journal}}: Cite journal requires |journal= (help)
  7. ^ "Alcoholics Anonymous 1998 membership survey". New York: Alcoholics Anonymous World Services. 1999. {{cite journal}}: Cite journal requires |journal= (help)
  8. ^ "Alcoholics Anonymous 2001 membership survey". New York: Alcoholics Anonymous World Services. 2002. {{cite journal}}: Cite journal requires |journal= (help)
  9. ^ "Alcoholics Anonymous 2007 Membership Survey". Alcoholics Anonymous World Services. 2008. Archived from the original (PDF) on 2009-12-19. Retrieved 2009-12-19. {{cite journal}}: Cite journal requires |journal= (help)
  10. ^ 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.
  11. ^ 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.
  12. ^ a b c "Comments On A.A. Triennial Surveys". Alcoholics Anonymous World Services. 1990. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |month= ignored (help)
  13. ^ Bill W., 1955 p. xix-xx

Further reading

  • Marlatt, Alan., Harm Reduction Pragamatic Strategies for Managing High Rish Behavior, New York Guildford Press 1998, ISBN 1572303972
  • 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 1557984689
  • 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
  • Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. (2002). "Process and outcome changes with relapse prevention versus 12-Step aftercare programs for substance abusers". Addiction. 97 (6): 677–689. doi:10.1046/j.1360-0443.2002.00101.x. PMID 12084137. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Brown, A. E., Pavlik, V. N., Shegog, R., Whitney, S. N., Friedman, L. C., Romero, C.; et al. (2007). "Association of spirituality and sobriety during a behavioral spirituality intervention for twelve step (TS) recovery". American Journal of Drug and Alcohol Abuse. 33 (4): 611–617. doi:10.1080/00952990701407686. PMID 17668347. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  • Carrico, A. W., Gifford, E. V., & Moos, R. H. (2007). "Spirituality/religiosity promotes acceptance-based responding and 12-step involvement". Drug and Alcohol Dependence. 89 (1): 66–73. doi:10.1016/j.drugalcdep.2006.12.004. PMID 17229532. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Cisler, R., Holder, H. D., Longabaugh, R., Stout, R. L., & Zweben, A. (1998). "Actual and estimated replication costs for alcohol treatment modalities: Case study from Project MATCH". Journal of Studies on Alcohol. 59 (5): 503–512. PMID 9718102. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Craig, T. J., Krishna, G., & Poniarski, R. (1997). "Predictors of successful vs. unsuccessful outcome of a 12-step inpatient alcohol rehabilitation program". The American Journal on Addictions. 6 (3): 232–236. PMID 9256989. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Deskovitz, M., Key, D. E., Hill, E. M., & Franklin, J. T. (2004). "A Long-Term Family-Oriented Treatment for Adolescents with Substance-Related Disorders: An Outcome Study". Child & Adolescent Social Work Journal. 21 (3): 265–284. doi:10.1023/B:CASW.0000028455.18661.bd. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Fiorentine, R. (1999). "After drug treatment: Are 12-step programs effective in maintaining abstinence?". American Journal of Drug and Alcohol Abuse. 25 (1): 93–116. doi:10.1081/ADA-100101848. PMID 10078980.
  • Fiorentine, R., & Hillhouse, M. P. (2000). "Drug treatment and 12-step program participation: The additive effects of integrated recovery activities". Journal of Substance Abuse Treatment. 18 (1): 65–74. doi:10.1016/S0740-5472(99)00020-3. PMID 10636609. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Fiorentine, R., & Hillhouse, M. P. (2000). "Exploring the additive effects of drug misuse treatment and Twelve-Step involvement: Does Twelve-Step ideology matter?". Substance Use & Misuse. 35 (3): 367–397. doi:10.3109/10826080009147702. {{cite journal}}: Unknown parameter |unused_data= ignored (help)CS1 maint: multiple names: authors list (link)
  • Fiorentine, R., & Hillhouse, M. P. (2003). "Why extensive participation in treatment and twelve-step programs is associated with the cessation of addictive behaviors: An application of the Addicted-Self Model of recovery". Journal of Addictive Diseases. 22 (1): 35–55. doi:10.1300/J069v22n01_03. PMID 12661978.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • Finney, J. W., Moos, R. H., & Humphreys, K. (1999). "A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-step and cognitive-behavioral treatment to substance use outcomes". Alcoholism: Clinical and Experimental Research. 23 (3): 537–544. doi:10.1111/j.1530-0277.1999.tb04150.x. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Finney, J. W., Noyes, C. A., Coutts, A. I., & Moos, R. H. (1998). "Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment". Journal of Studies on Alcohol. 59 (4): 371–380. PMID 9647419. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Gossop, M., Stewart, D., & Marsden, J. (2008). "Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study". Addiction. 103 (1): 119–125. doi:10.1111/j.1360-0443.2007.02050.x. PMID 18028521. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Goubert, D., McKay, J. R., Burke, M., & McLellan, A. T. (1996). "Treatment program progress: Reliability and predictive validity of the Treatment Program Progress Rating Scale". The American Journal on Addictions. 5 (2): 174–180. doi:10.3109/10550499608995674. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Humphreys, K., & Moos, R. (2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • Humphreys, K., & Noke, J. M. (1997). "The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients". American Journal of Community Psychology. 25 (1): 1–16. doi:10.1023/A:1024613507082. PMID 9231993. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Johnson, J. E., Finney, J. W., & Moos, R. H. (2006). "End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: Do they differ and do they predict 1-year outcomes?". Journal of Substance Abuse Treatment. 31 (1): 41–50. doi:10.1016/j.jsat.2006.03.008. PMID 16814009. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Kahler, C. W., Kelly, J. F., Strong, D. R., Stuart, G. L., & Brown, R. A. (2006). "Development and Initial Validation of a 12-Step Participation Expectancies Questionnaire". Journal of Studies on Alcohol. 67 (4): 538–542. PMID 16736073. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Kahler, C. W., Read, J. P., Ramsey, S. E., Stuart, G. L., McCrady, B. S., & Brown, R. A. (2004). "Motivational Enhancement for 12-Step Involvement Among Patients Undergoing Alcohol Detoxification: Journal of Consulting and Clinical Psychology". 72 (4): 736–741. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Keene, J. (2000). "The limits of therapeutic models of substance misuse for policy and practice: A qualitative study of two agencies". International Journal of Drug Policy. 11 (5): 337–349. doi:10.1016/S0955-3959(00)00051-7. PMID 10967516. {{cite journal}}: Unknown parameter |month= ignored (help)
  • Kelly, J. F., & Moos, R. (2003). "Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences". Journal of Substance Abuse Treatment. 24 (3): 241–250. doi:10.1016/S0740-5472(03)00021-7. PMID 12810145. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Kingree, J. B. (2001). "Predictors of 12-step group preference among low-income treatment participants with alcohol problems". Alcoholism Treatment Quarterly. 19 (1): 57–66. doi:10.1300/J020v19n01_04.
  • 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. (1998). "A Russian-American approach to the treatment of alcoholism in Russia: Preliminary results". Journal of Psychoactive Drugs. 30 (1): 25–32. PMID 9565206. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Mengis, M., Maude-Griffin, P. M., Delucchi, K., & Hall, S. M. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Moos, R. H., & Moos, B. S. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Moos, R. H., Moos, B. S., & Andrassy, J. M. (1999). "Outcomes of four treatment approaches in community residential programs for patients with substance use disorders". Psychiatric Services. 50 (12): 1577–1583. PMID 10577876. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Morgenstern, J., & Bates, M. E. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Ouimette, P. C., Finney, J. W., & Moos, R. H. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Ouimette, P. C., Finney, J. W., Gima, K., & Moos, R. H. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Ouimette, P. C., Moos, R. H., & Finney, J. W. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Penn, P. E., & Brooks, A. J. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Polcin, D. L. (2000). "Professional counseling versus specialized programs for alcohol and drug abuse treatment". Journal of Addictions & Offender Counseling. 21 (1): 2–11. {{cite journal}}: Unknown parameter |month= ignored (help)
  • 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. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Stephenson, G. M., & Zygouris, N. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  • Swora, M. G. (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. {{cite journal}}: Unknown parameter |month= ignored (help)
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  • Thevos, A. K., Roberts, J. S., Thomas, S. E., & Randall, C. L. (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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