Is AA Effective?
Some researchers criticize Alcoholics Anonymous because it is not “evidence-based medicine.” AA’s manual, known as the Big Book, was originally published in 1939, so it pre-dates modern research methods. So, they say, it must be old-fashioned. Aren’t there newer and better modalities for treating alcoholism?
There are new methods for treating alcoholism, but not better methods. A newly released study shows that AA is a highly effective treatment, and in most cases, it is more effective than other methods.
The study was done by Cochrane, a UK non-profit that develops “systematic reviews of the strongest evidence available about healthcare interventions.” This worldwide organization of researchers has been helping to develop best practices in medicine for a number of years. This particular study was overseen by Stanford University and Harvard University doctors, under the direction of Dr. John Kelly of Harvard.
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The researchers examined 27 studies containing 10,565 participants, winnowing away many other studies which didn’t meet their strict criteria. They studied both programs utilizing Alcoholics Anonymous (AA) and programs using Twelve Step Facilitation treatment (TSF). The results may have been surprising to other researchers, but the results confirmed what front-line clinicians have always known: AA works.
The statements by the researchers were unambiguous. “Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated.” For families struggling with addiction, “continuous abstinence” is the goal. Some researchers have other goals, like fewer relapses or fewer drinks per day. But families aren’t looking for slight statistical improvements. They want their beloved alcoholic to achieve full recovery, which means being clean and sober.
The other treatments investigated included cognitive behavioral therapy (CBT), motivational enhancement therapy (MET) and others. Many academics have been loath to place Alcoholics Anonymous in the pantheon of modern treatment. AA was not developed under the auspices of careful research but was instead the product of experience. Its development was not guided by physicians, but by alcoholics who had managed to achieve sobriety. For some, AA was merely anecdotal and little better than hearsay.
This view was belied by the fact that more modern support groups have grown very slowly, while AA has meetings around the world. For example, a popular and effective support group which uses CBT is called SMART Recovery. Its members are quite satisfied with it and are happy to pay the small fee for each meeting. After 20 years of promotion, SMART has approximately 20 meetings per week in the Metro Detroit area, including Ann Arbor. AA on the other hand has well over 1,000 meetings per week in the Metro Detroit Area, though some estimates run as high as 1,500 meetings per week, because not all meetings are published. This number does not include Ann Arbor.
So, while AA is often given short shrift in the ivory tower, it is very popular among people who are getting sober and staying sober.
The new study from the Cochrane Review goes on to state: “There is high-quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence.”
A New York Times article reporting on the study included a memorable quote from John F. Kelly, a professor of psychiatry at Harvard Medical School and director of the Recovery Research Institute at Massachusetts General Hospital: “These results demonstrate AA’s effectiveness in helping people not only initiate but sustain abstinence and remission over the long term.” … “It’s the closest thing in public health we have to a free lunch.”
As you might expect, combining AA with other treatments is even more effective. When we work with families, we recommend: 1) a thorough detox and stabilization in a medical facility, 2) a residential treatment long enough to address co-occurring issues and establish a person in sobriety, and 3) daily participation in AA. In our experience, if a person practices the AA program with the guidance of a sponsor, they will achieve long-term and contented sobriety.
And you can’t beat the price.