Effectiveness of Alcoholics Anonymous

Research into the effectiveness of Alcoholics Anonymous and in particular of their twelve-step program has generated a number of studies within the United States as well as within other countries. Several of these studies researched Twelve Step Facilitationcite book |last=Nowinski |first=Joseph |coauthors=Baker, Stuart |title=The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Substance Dependence |isbn=1592850960 |year=2003 |publisher=Hazelden PES |oclc=55877880 |location=Center City, MN] with alcoholic clients and not Alcoholics Anonymous (AA) direction.

Research conducted in the United States

Ditman et Al

In 1967 a study: a court judge randomly assigned offenders to either clinical treatment, AA treatment, or to a no treatment group {control group}, and after one year 68% in the clinic group were rearrested, 69% in the AA group were rearrested, and 56% were rearrested in the group receiving no treatment. No statistically significant differences between the three groups were discovered in recidivism rate, in number of subsequent rearrests or in time elapsed prior to rearrest. [(August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". "American Journal of Psychiatry" 124 (2): Abstract.]

Brandsma, Maltsby and Welsh

In a 1979 study of 260 individuals referred by the courts, other agencies or self-referred, subjects were treated for 210 days. Participants were assigned randomly to one of five groups: AA meetings run by experienced non-professionals, RBT therapy administered by a non-professional, RBT therapy administered by degreed professionals, Insight Therapy administered by professionals, and a control group who received no treatment.

After treatment was completed a three month follow up showed that the AA group treatment was associated with five times more binge drinking than the control group and nine times the binge drinking of the Non Professional RBT group. Nonprofessional RBT was deemed the superior treatment in a comparison between the two. The study concluded coerced AA attendance did not work well.

Another finding showed AA had the largest drop out rate. Insight and the Professional RBT group ranked the highest in drinking indexes for the most non-drinking days over the 3 and 9 month follow up. [Brandsma, Jeffrey, Phd. , Maultsby , Maxie, Welsh, M.D. Richard, M.S.W. "The Out Patient Treatment of Alcoholism " A Review and comparative study, University Park Press, Baltimore, 1980.]

DC Walsh, RW Hingson, DM Merrigan, SM Levenson, LA Cupples, T Heeren, GA Coffman, CA Becker, TA Barker, SK Hamilton, and et al.

A 1991 study: 227 workers identified as abusing alcohol were randomly assigned to one of three groups. 1: Compulsory AA meetings 2: Compulsory Inpatient Treatment or 3: to a Choice of Options. All three groups improved and no significant differences was found when measured against the criteria of the job performance variables over a two year follow up period. There was a significant difference between the three groups in the measure of alcohol and drug use over the two year period follow up. Those assigned to the in patient hospital did the best and those assigned to AA did the least well. Additional inpatient treatment was required by 63% of AA group, by 38% of the Choice group, and 23% by the subjects originally assigned to the inpatient hospital group. The conclusion drawn from the trial was assigning people to AA alone or to a Choice of Options though less costly involved a higher risk than Inpatient Treatment. [DC Walsh, RW Hingson, DM Merrigan, SM Levenson, LA Cupples, T Heeren, GA Coffman, CA Becker, TA Barker, SK Hamilton, and et al."A randomized trial of treatment options for alcohol-abusing workers" Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115. http://content.nejm.org/cgi/content/abstract/325/11/775]

George Vaillant

In "The Natural History of Alcoholism Revisited"cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Acknowledgments | pages = vii - xi | isbn = 0674603788 | oclc = 31605790] Harvard professor of psychiatry George E. Vaillant, a member of the Board of Trustees of Alcoholics Anonymous World Services, described his investigations into the effectiveness of AA.cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Introduction: The Problem | pages = 1 - 11 | isbn = 0674603788 | oclc = 31605790] In the sample of 100 severe alcoholics from his clinic, 48% of the 29 alcoholics who eventually achieved sobriety attended 300 or more AA meetings, [Vaillant 1995, p 196, 257.] and AA attendance was associated with good outcomes in patients who otherwise would have been predicted not to remit. [Vaillant 1995, p 268.] In the sample of 465 men who grew up in Boston's inner city, the more severe alcoholics attended AA, possibly because all other avenues had failed [Vaillant 1996, p 262-263.] Vaillant's research and literature surveys revealed growing indirect evidence that AA is an effective treatment for alcohol abuse, partly because it is a cheap, community-based fellowship with easy access.cite journal | last = Vaillant | first = George E. | title = Alcoholics Anonymous: cult or cure? | journal = Australian and New Zealand Journal of Psychiatry | volume = 39 | issue = 6 | month = June | year = 2005 | pages = 431–436 | doi = 10.1111/j.1440-1614.2005.01600.x | pmid = 15943643] Although AA is not a magic bullet for every alcoholic, in that there were a few men who attended AA for scores of meetings without improvement, good clinical outcomes correlated with frequency of AA attendance, having a sponsor, engaging in a Twelve-Step work, and leading meetings. Vaillant concluded that AA appears equal or superior to conventional treatments for alcoholism and that skepticism of some professionals regarding AA as an effective treatment for alcoholism is unwarranted. [The Natural History of Alcoholism 1983, p. 194-199 Harvard University Press , 1983] However, he also notes that the “effectiveness of AA has not been adequately assessed” [Vaillant 1995, p 255.] and that “direct evidence for the efficacy of AA... remains as elusive as ever. [Vaillant 1995, p 265.] For example, if an alcoholic achieves sobriety during AA attendance, who is to say if AA helped or if he merely went to AA when he was ready to heal? [Vaillant 1995, p 253. Vaillant 1996, p 158.] Note that in this article alcoholics will be referred to as male to reflect the bias of the samples.]

Morgenstern et al

In 1997, A study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills. [J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)]

Project MATCH

In 1998, a study that began in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The programs were administered by psychotherapists and, although twelve-step methods were incorporated into the therapy, actual AA meetings were not included. [http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm NIAAA Reports Project MATCH Main Findings] , Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.] [Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." "Journal of Studies on Alcohol", 58(1), 7-29.] Three types of treatment were investigated:1.Cognitive Behavioral Coping Skills Therapy, focusing on correcting poor self-esteem and distorted, negative, and self-defeating thinking. [Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2] [Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. " [http://www.msnbc.msn.com/id/17083397/site/newsweek/page/0/ Rehab Reality Check] " "Newsweek", 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c] 2.Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit. [Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. "Science News" v151.n4 (Jan 25, 1997): pp62(2).] 3.Twelve-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation.The study concluded that patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. Although it is acknowledged that the TSF treatment group used in the Match study was not a true implementation of Alcoholics Anonymous some investigators believe that it represents the most rigorous investigation of this group to date. [J. Scott Tonigan, Gerard J. Connors, and William R. Miller. "Participation and involvement in Alcoholics Anonymous", in Thomas Babor, Frances K. Del Boca, eds, "Treatment Matching in Alcoholism", Cambridge University Press: 2003, p 184.] Project Match generated criticism for flaws in the study , cited in peer reviews, for the methods they used in the selection of subjects and the fact they did not use a control group.. [Bower, Bruce , Science News "Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies http://findarticles.com/p/articles/mi_m1200/is_n4_v151/ai_19084159/pg_] [Peele,Stanton "Recovering from an All-or-Nothing Approach to Alcohol" http://www.peele.net/lib/allornothing.html] [Culter, R. and Fishbain, D.: "Are alcoholism treatments effective?" The Project MATCH data. BMC Public Health 2005, 5:75doi:10.1186/1471-2458-5-75 http://www.biomedcentral.com/1471-2458/5/75 ]

Arimer, Plamer, Marlatt

In 1999 it was found that Belief in the disease theory of alcoholism and high commitment to total abstinence were found to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).cite journal | last = Larimer | first = Mary E | coauthors = Palmer, Rebekka S; Marlatt, G. Alan | title = Relapse prevention. An overview of Marlatt's cognitive-behavioral model | year = 1999 | volume = 23 | issue = 2 | pages = 151–160 | pmid = 10890810 | journal = Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism | issn = 1535-7414 | oclc = 42453373 http://findarticles.com/p/articles/mi_m0CXH/is_2_23/ai_59246580/pg_1]

Crape, Latkin, Laris and Knowlton

2001 A study was undertaken to evaluate the relationship of Sponsorship and sustained abstinence in NA/AA. The 500 participants were injection drug users that came from the inner city of Baltimore , from the community at large and were independent of treatment center affiliation. The study found that over the 1 year period that there was little difference in the abstinent rate for those people who had a sponsor in NA/AA and those who did not have a sponsor. The study concluded that those people who sponsored others by giving guidance and direction to other addicts had improved abstinent rates however it did little to improve the short term success rates of those being sponsored. [Crape L, Latkin, Carl A, Laris Alexander and Knowlton, Amy - - John Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA - - Received 9 August 1999; revised 1 June 2001; accepted 2 June 2001. Available online 5 February 2002]

Humphreys and Moos

In a 2001 study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the United States, five of the programs were based on twelve-step principles, but run by professional therapists, and five used cognitive-behavioral therapy. Over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. The study concluded that AA participation preceded reduced drinking. ["How effective is Alcoholics Anonymous?" "Harvard Mental Health Letter", Dec 2003, Vol. 20 Issue 6, p7-7.] Moos stated, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals and it is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems. cite journal | last = Humphreys | first = Keith | coauthors = Moos, Rudolf | month = May | year = 2001 | title = Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study | journal = Alcoholism: Clinical and Experimental Research | volume = 25 | issue = 5 | pages = 711–716 | doi = 10.1111/j.1530-0277.2001.tb02271.x | pmid = 11371720 | issn = 1530-0277]

Tonigan

A study that compared the findings of eleven of Project Match's clinical sites in regards to AA attendance. With AA attendance was increased abstinence and reductions in alcohol-related consequences along with psychosocial improvement. [J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77: http://www.haworthpress.com/store/ArticleAbstract.asp?sid=QLEMCGS5ENAK9LQJAVM8K6F95UL40E10&ID=10329]

Moos and Moos

Individuals with Alcohol problems who obtained 27 weeks or more of clinical treatment in the first year had better 16-year outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better outcomes 16 years later. Some of the association between clinical treatment and better long-term outcomes appears to be due to participation in AA. Subsequent AA involvement was also associated with better 16-year outcomes, but this was not true of subsequent clinical treatment.cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals | journal = Journal of Clinical Psychology | month = June | year = 2006 | pages = 735–750 | doi = 10.1002/jclp.20259 | pmid = 16538654 | volume = 62] cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Rates and predictors of relapse after natural and treated remission from alcohol use disorders | journal = Addiction | volume = 101 | issue = 2 | pages = 212 – 222 | year = 2006 | month = February | doi = 10.1111/j.1360-0443.2006.01310.x | pmid = 16445550] cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders | journal = Journal of Consulting and Clinical Psychology | year = 2004 | month = February | volume = 72 | issue = 1 | pages = 81–90 | doi = 10.1037/0022-006X.72.1.81 | pmid = 16445550]

Akins and Hawdon

In 2007, a national survey was undertaken to identify the main differences between participants in mutual support groups. The data indicated active involvement in mutual support groups aids the individual's ability to remain sober and clean regardless of the type of support group. There was more involvement with the support group where the respondent's beliefs matched that of the support group. Non-religious people were less likely to participate in 12 step groups than people who were religious. [Aikens, Randolf & Hawdon , James "Religiosity and participation in mutual-aid support groups for addiction" Volume 33, Issue 3, Pages 321-331 http://www.journalofsubstanceabusetreatment.com/article/PIIS0740547207001870/abstract]

Research conducted in other countries

Ferri, Davoli, Amato

*Italy 2006- No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed. [Ferri M, Amato L, Davoli M, "Alcoholics Anonymous and other 12-step programmes for alcohol dependence" http://www.cochrane.org/reviews/en/ab005032.html]

Terra, Barros, Stein, Figueifa, Palermo, Atayde, Goncalves, Silveira

*Brazil 2008 -A study was undertaken to determine factors affecting adherence to Alcoholics Anonymous (AA) groups. It involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed in their homes six months later, a questionnaire focusing on patient relationship with AA groups were used and the responses were evaluated by two independent researchers. AA adherence was below 20%. Factors that contributed for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA. [Terra, Barros, Stein, Figueifa, Palermo,Atayde, Goncalves, Silveira "Do Alcoholics Anonymous Groups Really Work?" Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents " American Journal on Addictions, Volume 17, Issue 1 January 2008 , pages 48 - 53 http://www.informaworld.com/smpp/content?content=10.1080/10550490701756393]

References