Does Alcoholics Anonymous (AA) Work?
ALCOHOLICS ANONYMOUS (AA), celebrating its 76th anniversary this year, counts two million members who participate in some 115,000 groups worldwide, about half of them in the U.S. How well does it work? William Madsen was an anthropologist who worked at University of California Santa Barbara in 1974. He claimed it had a "nearly miracle" success rate. Others, however, are skeptical. After reviewing the literature, we found that AA may help some people overcome alcoholism, especially if they also get some professional assistance, but the evidence is far from overwhelming, in part because of the nature of the program.
Alcoholics Anonymous began in Akron in Ohio in 1935 when a doctor and businessman called Bill Wilson met. Bill W., and Dr. Bob, as they're now called, were both alcoholics. Wilson's affiliation with the Christian Movement was one of the main reasons he had achieved sobriety. Smith stopped drinking after he met Wilson, whose success inspired him. The men quickly published "The Big Book," which is now a well-known reference for their principles, methods and philosophy. Alcoholics Anonymous became the official name for the book and the foundation of the organization.
Members of AA meet together in small groups to support one another's efforts to abstain from alcohol. The meetings, which are free and open to anyone serious about stopping drinking, may include reading from the Big Book, sharing stories, celebrating members' sobriety, as well as discussing the 12 steps and themes related to problem drinking. Each step is to be fully integrated into the participants' lives, and then move on to the next. Participants are encouraged "work" with the 12-steps program. AA targets more than problem drinking; members are supposed to correct all defects of character and adopt a new way of life. The members can achieve these challenging goals on their own without the need for professional assistance. No therapists, psychologists or physicians can attend AA meetings unless they, too, have drinking problems.
Most studies evaluating the efficacy of AA are not definitive; for the most part, they associate the duration of participation with success in quitting drinking but do not show that the program caused that outcome. The nature of AA is problematic. For example, what happens at AA meetings may vary greatly. Another problem is that around 40% of members leave AA within the first year. However, some might return. This raises the possibility that those who stay may be most driven to make improvements.
Project Match's 1997 findings, which were published by a well-designed research group, show that AA is able to facilitate many alcoholics' transition to sobriety. In this study, a group of prominent alcoholism researchers randomly assigned more than 900 problem drinkers to receive one of three treatments over 12 weeks. A 12-step facilitation therapy, an AA-based treatment that focuses on helping patients to work through the 12 steps. Patients are encouraged to go to AA meetings and also get help with the initial few steps. The other treatments were cognitive-behavioral therapy, which teaches skills for coping better with situations that commonly trigger relapse, and motivational enhancement therapy, which is designed to boost motivation to cease problem drinking.
The AA-based treatment seemed to be effective and compared well with other treatments. Participants in all three groups were abstinent for approximately 20 percent on an average day before starting treatment. The percentage of alcohol-free days increased to around 80 percent one year later. Additionally, 19% of subjects in the 12-month-long follow up were teetotalers. Because the study lacked a group of people who received no treatment, however, it does not reveal whether any of the methods are superior to leaving people to try to stop drinking on their own.
Another study suggests that AA may be better than no help. Rudolf H. Moos of Stanford University, the Department of Veterans Affairs, and Bernice Moos released results of a 16-year survey of problem drinkers. They had either tried to stop drinking on their own or sought professional help. Among the subjects who participated in at least 27 weeks worth of AA meetings over the course of their first year, 67% were abstinent by the end of the 16-year following-up. That compares to 34 percent for those who did no AA. 56% of subjects who had therapy over the same time frame were absent compared to 39% who saw a therapist. It is clear that seeking professional assistance can be beneficial.
However, these findings may not be applicable to everyone who drinks or uses AA. The study was not controlled by the researchers because it involved people choosing their paths independently. Because the researchers chose only those people seeking treatment for alcoholism, they could not have determined if the reported abstinence rates were applicable to others with more serious problems. Multiple studies show that AA and professional treatment yield better results than any one of the two.
Taken as a whole, the data suggest that AA may be helpful, especially in conjunction with professional treatment, for many people who are addicted to alcohol. The possibility that AA may sometimes prove to be detrimental is something we do not yet know. For example, alcoholism can be exacerbated by a confrontational group [see Hal Arkowitz, Scott O. Lilienfeld, "The Advice Trap"; Scientific American Mind September/October 2010.] Nevertheless, AA should be considered for those with problem drinking, due to the strong evidence, easy access and low expense.