Effectiveness of Alcoholics Anonymous

The 2020 Cochrane review of Alcoholics Anonymous shows that AA results in more alcoholics being abstinent and for longer periods of time than some other treatments, but only as well in drinks-per-day and other measures.[19][24] When comparing Alcoholics Anonymous and/or Twelve Step Facilitation to other alcohol use disorder interventions, at the 12-month follow up, studies show a 42% abstinent rate for AA/TSF treatments, compared to 35% abstinent using non-AA interventions.[22][25]

The study concludes that "Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non-manualized AA/TSF performed as well as other established treatments [...] clinically-delivered TSF interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence."[1] Here, a "manualized" treatment is one where a standard procedure was used.[26] A TSF treatment is a "twelve-step facilitation" treatment: A treatment which encourages a patient to attend Alcoholics Anonymous.[27]

An older 2006 Cochrane review stated that the "available experimental studies did not demonstrate the effectiveness of AA or other twelve-step approaches in reducing alcohol use and achieving abstinence compared with other treatments".[18]

A 2014 meta-analysis of the data from five studies by Keith Humphreys, Janet Blodgett and Todd Wagner concluded that "increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection."[6][13]

In 2009, Lee Ann Kaskutas performed a meta-analysis of other studies looking at how effective Alcoholics Anonymous is. The article notes that "rates of abstinence are about twice as high among those who attend AA" but concluded that whether Alcoholics Anonymous has a specific effect is unclear (a specific effect, in this context, is whether it's the actual Alcoholics Anonymous program which helps keep people sober, instead of other factors, including the fact that people more motivated to stay sober will go to more meetings, or that the group support helps alcoholics regardless of the actual program, etc.), stating that there were "2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect."[28]

A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment: Of subjects highly involved with AA in their first year of alcohol treatment, 67% were sober 16 years later. The study looked at the outcome of a group of alcoholics seeking treatment over a 16-year period. The subjects decided on their own whether to use AA, and how much AA treatment they got. The study stated that "individuals who participated in AA for 27 weeks or more had better 16-year outcomes", showing that "only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more."[5]

The study's results may be skewed by self-selection bias.[28][29]

Project MATCH was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The study concluded that twelve-step facilitation was as effective as the other psychotherapies studied.[30]

The 1980 book Outpatient Treatment of Alcoholism describes a mid-1970s study. Participants were assigned randomly within five treatments, including an Alcoholics Anonymous-like meeting.[31] Later analysis says that there are "concerns with the Brandsma trial which call its experimental results into question".[28]

In 2001–2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. Respondents were asked if they had ever attended a twelve-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105).[32] In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270).[32]

Lance Dodes, in The Sober Truth, says that most people who have experienced AA have not achieved long-term sobriety, stating that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety for longer than one year.[16] Gabrielle Glaser used Dodes' figures to state that AA has a low success rate in a 2015 article for The Atlantic, which says that better alternatives than Alcoholics Anonymous for alcohol treatment are available.[17]

The 5–8% figure put forward by Dodes is controversial;[15] Thomas Beresford, M.D., says that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure."[33][34] The New York Times calls The Sober Truth a "polemical and deeply flawed book".[35] John Kelly and Gene Beresin state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong (Dodes responded by pointing out that "I have never said that AA is harmful in general"), noting that "studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge [...] produce about one third higher continuous abstinence rates."[14][36] Jeffrey D. Roth and Edward J. Khantzian, in their review of The Sober Truth, called Dodes' reasoning against AA success a "pseudostatistical polemic."[37]

Lance Dodes has not, as of March 2020, read the 2020 Cochrane Review which shows AA efficacy, but in response to it says that he does not feel creating a social support network helps with addiction.[38]