Alcoholics Anonymous seems to generate a storm of controversy. People are either adamantly for it or against it, and rightfully entitled to their opinions. But claims of whether it works or not should be based on empirical scientific research not on the hearsay of somebody’s uncle Willy her aunt Edna.
Here is proof positive it works.
The research I’m going to talk about compares two groups of people. Those who go through regular addiction treatment programs and do not engage in AA, versus people who attend regular addiction treatment programs and follow up by attending and participating in AA. That qualifier is important, as many studies have been done on the effectiveness of addiction treatment. But validly constructed scientific studies on AA by itself are very difficult and rare.
I was looking through some graduate school papers and ran across a bibliography folder I had put together concerning Alcoholics Anonymous. In it I found 2 different studies that both lead to the conclusion; that AA membership and participation added to formal addiction treatment positively impacts recovery. The primary measure of “positive impact” was abstinence rates.
The important thing about these 2 studies is these are meta-analysis studies. Meta-analysis simply means that they look at many, many studies and condense the different findings into summations and conclusions. One of these two meta-analysis studies looked it 107 different research studies (1) that had been conducted on AA, the other meta- study looked at 74 research studies(2).
The conclusion of the 2 meta-studies, (looking at a total of 181 research studies), led to the opinion that there was a much higher positive outcome rate for those attending formal treatment and participating in AA. People attending formal treatment but who did not participate in AA, did not do as well.
What is a positive outcome? And what are we comparing?
The studies compared abstinence rates one year after treatment and three years after treatment. The one-year abstinence rate for formal treatment alone was 20.6% versus 42.4% for formal treatment plus AA participation. The three-year abstinence rate was 25.9% for formal treatment alone versus 50.9% for treatment plus Alcoholics Anonymous participation.
In other words remaining absent by adding participation to AA as part of the recovery program has significant positive results. So, two different summations of large amounts of data in controlled, published studies led to the same conclusion. Alcoholics Anonymous as an adjunct to formal addiction treatment positively works.
Emrick, C. D., Tonigan, J. S., Montgomery, H., & Little, L. (1993).
Alcoholics Anonymous: What is currently known? (pp. 41-76). In B.
S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous:
Opportunities and alternatives. New Brunswick, NJ: Rutgers
Tonigan, J. S., Toscova, R., & Miller, W. R. (1996). Meta-analysis of the
literature on Alcoholics Anonymous: Sample and study characteristics
moderate findings. J of Studies on Alcohol, 57, 65-72.
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{ 9 comments… read them below or add one }
Hmmm…..these studies are measuring relapse rates based on whether or not people follow up with AA after they leave treatment….from a 12 step based facility.
Much more precise is to measure relapse rates from people who leave 12 step based treatment programs, and then also measure relapse rates from people who leave non-12 step based treatment centers.
This data is probably harder to come by because the majority of the industry is 12 step based, no? But I believe there was another big meta-study called Project Match (an 8 year, 27 million dollar study), and they concluded that there was no statistical difference between 3 treatment models, one of them being 12 step based and the others being cognitive behavioral and motivational enhancement therapy.
Point being, there is probably data out there to back up a variety of viewpoints in a field with this level of “anonymity” (it is hard to get reliable follow-up data on those in recovery). In other words, you can probably “prove” anything.
Project Match concludes that there is no point in matching people to different therapies, as the effectiveness is the same either way. But I still think that some level of customization is beneficial. I also think that the idea of customization might be found in AA, especially given the idea of sponsorship (finding someone to guide you through the steps).
Anyway, thanks for the topic Bill, it makes for interesting discussion, and I still think there is value in AA, even though my ideas sometimes lean more towards the search for a different solution…..
Very interesting results. It seems as if the additional support that can be gained by participating in an AA group can greatly benefit someone who is already receiving treatment elsewhere. Sounds like the key is support and positive reinforcement.
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Hi Patrick,
Project Match looks at 12 Step Facillitation which is actually a therapeutic model based on principles of the 12 steps; but it is not the same as 12 step group attendance. Project Match actually showed that in most categories all 3 therapies were equal, but a distinct edge went to 12 step facilliatation in keeping more people sober longer.
My graduate work was done in 12 step facillitation therapy.
Bill
Great, great research. I’ve been telling people AA works all my life, yet I’ve heard some people give diatribes against AA. Not all of them, mind you, but just a few that tried the program and failed. I’ll be getting them this link, to read and reconsider.
I know it works, my father’s been through it. Good thing that now there’s indisputable proof that the program works, maybe more people will get on it and save their lives.
I don’t know if the study is conclusive. For once, it only takes in consideration results from 12 step facilities, but it doesn’t talk about other types of programs, so it’s not universal. On the other hand, it’s pretty obvious that AA works, everyone that’s ever been there can tell you.
I’m glad you made the point about 12 Step Based not being the same as 12 Step long term participation. In my experience, whatever introduction treatment centers give to the 12 Steps is very limited and not so applicable to the way they’re treated outside of therapy, once a person is in the 12 Step community. That said, any introduction is likely helpful.
I wrote about a lot of the current research as well as ways to integrate 12 Step recovery with other methods in my book, the 12-Step Buddhist. An individual could use this to fully customize their treatment approach, with the help of a qualified “management team.” I hope you’ll find the book useful.
-d
Hi Bill, seems like this post already generated quite a bit of conversation. I’d like to point out that numerous studies have shown that follow-up care after leaving initial treatment is always better in terms of producing longer abstinence. Whether the after care is an outpatient program, private counseling, or social support groups (like AA but not only), it’s the follow-up that seems to matter.
Now, there’s little doubt that AA is some of the most available social support, and it’s free, but I just wanted to make the point that it’s not necessarily anything about the program itself that produced the improvement.
Best,
Adi
Adi,
I hear you….but there are over 2,000,000 people currently in AA. Many of them for years. Professional aftercare on that scale or timeframe just does not happen.
Annabelle,
The studies are from all types of facilities, not jusy 12 step facillitation treatment centers. Many centers regardless of treatment orientation recommend AA.
Bill