Does Alcoholics Anonymous Work? (2023)

Introduction

The largest, most rigorous independent study on Alcoholics Anonymous to date shows that AA can help people get sober, stay sober, drink less, and suffer fewer negative consequences of drinking, all while keeping health care costs down. Watch scientists John Kelly (Harvard/MGH) and Keith Humphreys (Stanford/VA) discuss their findings (published 3/11/20 by the Cochrane Collaborative), with commentary from psychologist Gabrielle Jones.

Video

Alcoholics Anonymous is an international fellowship of people who struggled with alcohol addiction since its founding in America.

In 1935, tens of millions of people worldwide have joined local AAA meetings for help getting.

And staying sober AAA is non professional peer led and self-funded participation is anonymous and open to anyone looking for help with a drinking problem.

Aaa's foundation is abstinence.

It offers treatment not a cure for alcohol.

Addiction.

Aaa's approach is based on the 12 steps, which start with admitting to being powerless over alcohol.

Other steps, help members recover from addiction through social and spiritual support and aim to improve their relationships with others by making amends for past wrongs.

Go to any AAA meeting and you'll probably meet people who tell you that AAA is the only reason they're alive and sober today.

But there are plenty of critics too who claim that AAA is poorly, studied ineffective overhyped and more spiritual than scientific.

So is Alcoholics Anonymous actually effective in helping people recover from alcohol addiction, or is it more like a fad diet with mass popularity, but little in the way of real results, researchers at Stanford Harvard and the European Monitoring Centre for drugs and drug addiction set out to answer this question in a new landmark study, they systematically reviewed the most rigorous research on Alcoholics Anonymous to date.

And they found strong scientific support that AAA is effective in helping with recovery from alcohol addiction, here's, John, Kelly, one of the study's authors.

Well we did this study because alcohol is the world's favorite drug.

It is also the world's most lethal drug in terms of a psychoactive drug that can confer harms in terms of premature mortality disease and disability as well as a huge economic burden in terms of lost productivity criminal.

Justice costs and health care costs.

I was interested in a a from the very beginning of my career and I have to say at first I, didn't have a particularly respectful take on it.

It seemed to me that you had to have a degree.

You should be trained in medicine or psychology or social work, and you should understand things about neuroscience and and medications if you wanted to help people had problems, but my snobbishness was not well-founded more.

And more studies have sort of cropped up and it's written.

Why is it important to do those studies it's, the most common place people seek help for alcohol? Problems fact that something is popular doesn't mean that it works.

So your job as a scientist is to say, okay, you know, he's popular.

And so it that makes it of interest, but I'm still going to subject it to tests because these are vulnerable people.

And if it didn't work, you would have an obligation to let people know that.

So what we did in this particular study review was what we call a systematic review.

What that means is that it is a comprehensive review of all the available published science in a certain area.

The advantage of this review is that we reviewed randomized control trials.

So these were true experimental studies.

This integration of evidence is done under something called the Cochrane Collaboration, which is the gold standard in medicine internationally for assessing effects in any area for any type of medicine or any type of intervention and it's extremely structured and rigorous and how you have to go through the evidence, the author's searched, the world's largest databases for all the research ever done in any language on the effectiveness of a a relative to other addiction treatments.

They used predetermined standards for research design to identify the most rigorous and relevant studies.

Then they reviewed the top 36 reports for any evidence of bias and graded, the quality of the evidence.

Their final meta analysis included 36 reports on 25 different studies on the clinical outcomes and cost savings of Alcoholics Anonymous.

These reports involved, almost 150 scientists at 67 different institutions around the world and included more than 10,000 research subjects.

The most important conclusion of the review is that even though Alcoholics Anonymous was invented by peers and not by professionals and was not created by people like me whose do science for a living nonetheless, the science supports what they did.

And in fact, people who go to Alcoholics Anonymous are depending on the study and the sample about 20 to 60% more likely to end up abstinent than people who do not.

And that is a really big treatment effect.

I mean, if you think how many people die from alcohol problems, you know if you could increase survival rates for cancer, twenty to sixty percent, you would be, you know, overjoyed as it has as a hospital or as a researcher.

And so you know, we should be overjoyed that this peer grassroots organization is able to deliver this.

You know, shockingly large and reliable benefit to people who are struggling with serious alcohol problems in every study reviewed scientists compared participation in AAA, or in counseling that encouraged AAA participation to one or more other treatments, including professionally, delivered therapies outpatient treatment by a doctor psychologist or social worker, mindfulness meditation and education programs when they looked at complete abstinence from alcohol.

In every study AAA was as good as and most often better than other addiction treatments in a third of the studies AAA was better by large margins over other treatments.

For example, in one study 60% more people stayed abstinent through AAA than through cognitive behavioral therapy.

They also helped people stay abstinent over the long run.

It was more effective than other treatments at every time point over three years in the most rigorous set of studies at the same time.

There are people who go to a, and they don't end up for the abstinent, but they also cut their drinking a lot.

And this was a bit of a surprise for a pure abstinence organization.

But when we looked at outcomes beyond abstinence, like how many days of heavy drinking did you have or how much did you drink on the days when you were drinking, they also came out very well there when studies looked at AA's effects on partial sobriety measured by the number of days, people stayed sober AAA was better than other treatments in a third of the studies and equally good in the rest AAA was also equally good at reducing the number of drinks people consumed on the days.

They chose to drink in terms of alcohol-related consequences like health problems, miss days of work, duis and relationship problems.

Aaa was also as good or better than other treatments.

Another major finding I think a very important one from a societal perspective from a healthcare system perspective is the ability not just to produce higher remission rates.

But to do that at a much reduced healthcare cost people are going to the emergency room, not ending up in the hospital.

Bed they're, not using mental health or addiction, formal clinical services as much a a produce significant cost savings in four out of the five studies that analyzed costs.

And the savings could be dramatic.

For example, in one study a a participation reduced healthcare costs by more than ten thousand dollars per patient over two years, relative to cognitive behavioral therapy AAA was also better at helping these people.

Stay sober.

The takeaways are clear the most rigorous data available on Alcoholics Anonymous shows that it can help people get sober.

Stay sober, drink less and suffer fewer negative consequences of drinking all while keeping healthcare costs down.

But how does AAA actually work? How does AAA work? I mean, it's, it's, a real enduring mystery to scientists and there's been a lot of research done on this question.

And probably one important thing to say outright is it works differently for different people for most people, the major way that AAA works is via psychosocial factors.

So it helps people shift their social network by dropping heavy drinkers out of the network and adopting abstainers and people in recovery.

It has a lot of different.

You could say hands out to people in the river who are all drowning.

And each one grabs a different hand.

So for some people it's I need a fellowship of people who don't drink, they will not have to worry when I'm around them.

Then they will pull out a bottle or offer me a drink.

And they will specifically support me in that goal of mine second role, modeling and hope you can walk into a meeting feeling very, you know, just down on yourself and destitute.

And then you see somebody who who is like you now, but they're doing great.

And and and they they may tell their story of, you know, I was, you know, drinking and I lost my marriage and and my job and you're the guy, oh, my gosh, that sounds like me and said and now I'm doing great and I'm in recovery and I pull things back together with my wife and I've got a good job and I'm close to my kids again, that feels really good that that inspires hope there is another kind of very key component to AAA.

And that is the idea of sponsorship or mentorship.

And that really occurs through more experienced member taking on board, a new member under their wing as it were to really act as a kind of a recovery coach in these early days weeks and months is so critical.

When people are trying to change addictive behavior.

Another way that it works is it boosts cognitive and behavioral coping skills, much like calming, behavioral therapy would accept that it does that through the peer network support of meetings.

And so in other words, people learn skills in the meetings about how to stay sober and how to think differently about themselves and about the adaptation to recovery.

The other ways that we found that AAA works confers benefit again through proper mechanistic research is through reducing craving, reducing impulsivity maintaining motivation for abstinence over time at a high level.

So this constant vigilance that occurs through the reappraisal.

When people go to meetings they're reminded of what their addiction used to be like counselors, who treat addiction have seen how a a can adapt to serve different communities, here's, dr.

Gabrielle Jones, a clinical psychologist and addiction expert who was not involved in the Cochran review, I have a lot of people who come to me and say, how does a a actually work and that's also a very difficult question because everybody is different how AAA might work for a person of color who is generally used to being in community with others that's.

The direction I would take I would talk about how being in community gives you a support system.

It gives you a network.

It gives you people to lean on.

They understand that from from a cultural perspective, people also seem to benefit in AAA from the experience of helping others, which is to AA's philosophy.

What that means is, this is not a service it's, not like going into a restaurant where you're the customer.

And you just take things you're also supposed to give things.

And one of the interesting findings about the social support literature is that giving support seems to be as good for our health as getting it.

And it really structures itself in ways.

You can do that for some people it's, you know, maybe the simplest thing of like I set up the chairs before the meeting or I make the coffee, but it's a role.

And it gives a sense of Worth and a sense of service.

So we talk often in psychology about harm reduction and I believe that community based meetings are a source of harm reduction, because that allows people to have somewhere to go when they have nowhere to go.

And it allows people to get things off of their chest when they don't have anywhere else to do that and it's a place where they know, they'll be encouraged to be sober, it's, not a bar it's, not a restaurant.

It is a safe haven where other people are sober and are accomplishing what people want to accomplish.

And in underserved communities that can't have or don't have access to mental health or physical health as easily a a being right down.

The street really makes a difference in terms of recovery.

The underserved in our communities can really benefit from AAA and community-based meetings because they are free, and they are often easily accessible.

So you can generally find an AAA meeting at a nearby church or community center, because of the wide stretch of AAA, you could go almost to any country in the world and find an AAA meeting in your language.

And that is really what makes it beneficial, because we don't have that privilege in the health care system.

So what do the results of this new review mean for professionals, who counsel people with alcohol addiction, I think first and foremost is that this should be on the radar screen of every clinician who treats alcohol use disorder for several reasons.

One is that you're more likely on average to increase somebody's chances of remission that can help them.

It can help their family, and it can reduce the burden on the healthcare system.

I would hope that physicians and pastors and social workers would see this study and understand how valuable AAA and 12-step meetings and community meetings can be for people that they are interacting with for their family members for their friends and I would hope that they would advocate or encourage their clients to at least try some of these meetings just because sometimes you know given our healthcare system, the people that we see who have addiction problems or struggle with addiction, don't, necessarily have the resources to go to a rehabilitation facility for 30 or 60 days.

And in the mean time they can go to an a a meeting or a meeting of sorts just to get them started.

What does the study mean for you? If you have an alcohol problem? What it means is that Alcoholics Anonymous, in fact, has a good evidence base and a good chance of improving your life it's, not a guarantee you can't make guarantees about addiction.

But the evidence is there that it is a perfectly rational thing to do to give it a try and see.

So you can take some hope from this.

If you've been wondering, you know, should I seek help for my drinking in Alcoholics Anonymous.

It is a perfectly.

Wise course to pursue.