ADDICTION
March 26, 2020

Putting Alcoholics Anonymous to the Test

A huge study of AA's track record when it comes to helping alcoholics stay sober comes up with some impressive findings.

Alcoholics Anonymous (AA) has been around for about 85 years, and has several million members in 181 countries. The program is run by former alcoholics or people in recovery, who offer peer counseling in a group setting to help to those trying to remain sober. Because it doesn't use standardized treatment methods, researchers have had difficulty evaluating the program's effectiveness, but a recent study suggests better methods for doing so.

A team from the Harvard T.H. Chan School of Public Health, Stanford University and the European Monitoring Center for Drugs and Drug Addiction did a comprehensive review of the latest studies on the effectiveness of AA to treat alcohol use disorder (AUD). They found AA was, compared to psychotherapy, the more effective path to sobriety.

Mental health professionals are often skeptical about the effectiveness of AA, thinking, “How dare these people do things I have all these degrees to do?”

Clear evidence about the effectiveness of AA has been hard to come by. “There were pockets of evidence, but there was not a systematic summary like this,” John Kelly, lead author of the study, told TheDoctor.

When the researchers gathered data from 27 studies involving over 10,500 participants. AA was almost always more effective than other interventions, such as psychotherapy, they concluded. In one study, AA was found to be 60 percent more effective than cognitive behavioral therapy for helping people remain abstinent for one year.

It's not just about how well AA helps people quit drinking. One study found that AA and 12-step counseling reduced healthcare costs by as much as $10,000 per person.

“It was interesting to see the magnitude of the effect, both in terms of sustaining remission and reducing healthcare costs,” said Kelly, the Elizabeth R. Spallin Professor of Psychiatry at Harvard Medical School and director of the Massachusetts General Hospital Recovery Institute.

The reason AA is so effective has to do with its grounding in social interaction and peer support, Keith Humphreys, a co-author of the study, said in a statement. Members also share practical tips to keep from drinking. As he put it, “If you want to change your behavior, find some people who want to make the same change.”

“With a chronic illness like alcohol use disorder, which is susceptible to relapse over time, ongoing recovery support promotes long-term remission,” Kelly added. The fact that AA is widely available and free of charge is another reason behind its success.

Mental health professionals, such as therapists and licensed counselors, are often skeptical about the effectiveness of AA, Humphreys explained. Psychiatrists and psychologists may have a hard time admitting that the lay people who run AA meetings might do a better job of keeping people sober.

Early in his career, Humphreys, the Esther Ting Memorial Professor in the department of psychiatry, public mental health, and behavioral sciences at Stanford University, recounted he dismissed AA, thinking, “How dare these people do things I have all these degrees to do?” But counseling can coordinate with participation in AA. He described it as a “handoff into the fellowship.”

The researchers are also conducting a large ongoing trial looking at the ways participation in AA changes behavior in those with alcoholism, as well as the effectiveness of other 12-step groups, like Narcotics Anonymous.

The review is published in the Cochrane Database of Systematic Review.

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