Alcoholics Anonymous, or AA, is a mutual aid recovery support group that has been helping people around the world quit using alcohol and other substances for 87 years. AA is abstinence based, meaning it is encouraged that participants not use any mind-altering substances in order to maintain sobriety.
AA’s success rate has been historically difficult to measure, largely because the program is anonymous. But thanks to rigorous research done by John F. Kelly, Keith Humphreys, and Marica Ferri, we now know that Alcoholics Anonymous and clinically-related Twelve-Step Facilitation programs can be just as, or more effective than treatment modalities like Cognitive Behavioral Therapy (CBT) to maintain long-term sobriety for people with alcohol use disorder.
What Does the Research Suggest?
In March 2020, the Cochrane Library published the paper “Alcoholics Anonymous and other 12‐step programs for alcohol use disorder”. This extensive systematic review evaluated whether AA and professionally-delivered treatments that facilitate AA involvement achieved outcomes such as abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets.
Twenty-seven studies consisting of a total of 10,565 participants were included in the review. This included studies published in English and non-English journals. The evidence reviewed suggests that 42% of participants engaging in AA were still completely abstinent from drugs and alcohol after a year. This is compared to 35% of participants who did not engage with AA in any way but received treatments like CBT. This difference is quite a significant one and shows that AA is indeed effective for people looking to abstain from alcohol use.
You can learn more about the landmark review and see interviews with the study’s authors, who discuss detailed research methods, in this Youtube video produced by Stanford University:
What This Means for Recovery
It’s important to note that AA itself is not a treatment modality. However, the review focuses primarily on twelve-step facilitation programs (TSF) which encourage continued AA participation beyond the completion of the treatment program. AA has often been critiqued as being non-scientific and some have questioned whether or not its tenets should be promoted in treatment settings.
While it’s true that the spirituality piece of AA may not be for everyone, the findings of the Cochrane Review prove that the criticism of AA being scientifically ineffective does not hold water. AA is an effective recovery support program for those who wish to remain abstinent from alcohol and other substances and are willing to engage with the principles of the twelve-step program. It would be a disservice to people with substance use disorder if treatment programs did not present AA as an option for a pathway to recovery.
That being said, the idea that “AA is the only way” is also harmful. Ensuring that people with substance use disorders know they have options when it comes to long-term recovery will help them think about what they want for themselves and make their own decisions based on their goals. Having AA as one of those options will likely lead to positive outcomes.
Unfortunately, for some, AA may be a more attractive option for reasons of accessibility. AA carries the added benefit of being free. A study that was part of the review found that participation in AA cut healthcare costs by over $10,000 per individual.
In today’s society of expensive health care services, finding anything that improves the health of an individual at no-cost is extremely rare. The authors of the Cochrane review noted that policymakers may even be interested in related 12-step clinical programs because they are much more likely to reduce healthcare costs.
Community is Key
Part of the reason AA is so effective is because of community. Role-modeling and mentorship helps give people who are newly sober hope for the future. They are able to learn coping skills through peer support by attending meetings.
AA may be the largest peer recovery support group in the world, but it is not the only one. There are many other peer recovery support groups that follow the 12-step model (Narcotics Anonymous, Cocaine Anonymous, etc.) but there are others as well. If a person is not certain that 12-step is right for them, they may get many of the same benefits from another support program. These include SMART Recovery, Recovery Dharma, and even online communities.
This research pointing to the effectiveness of AA is wonderful news for the recovery community. But it’s important for proponents of 12-step recovery to remain open and willing to support individuals in the pathways to recovery that they choose for themselves.