New research from Stanford School of Medicine and Harvard University found that the addiction support group Alcoholics Anonymous is the most effective way to achieve complete abstinence from drinking, and, at the very least, is as good as other popular interventions, like psychotherapy, when it comes to other important health outcomes, like limiting how much alcohol a person drinks and otherwise mitigating how severe their addiction is.
For decades, AA has been the main source of help for people struggling with alcohol use disorder (AUD). Still, critics have blasted the program’s faith-based approach, questioned the lack of clinical evidence behind the 12-step method, and argued for other, more medically-sound treatment options and solutions.
The report, which was published Wednesday in the Cochrane Database of Systematic Review, looked at 27 past studies evaluating the health outcomes of over 10,500 people. One of the studies included in the review, which is the largest study of alcohol treatment ever done, found that AA may be up to 60 percent more effective than cognitive behavioral therapy and 64 percent more effective than motivational enhancement therapy. These two types of psychotherapy are the most commonly used behavioral therapies for treating AUD.
The analysis, which was not funded by a private interest group or company, showed that AA helps cut health care costs for people with AUD by approximately $10,000 a person. (The more people adhere to AA, the less likely they’ll need to seek outpatient treatment or be admitted to a detox center, which can be very expensive.) “[AA members’] health care costs are dropping, but their health is just as good [as AUD patients who are treated through a traditional healthcare provider],” one of the study’s lead researchers, Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, told VICE.
According to the researchers, AA’s success can be linked back to its strong social component. The free sessions are held in local churches, hospitals, or other community centers and typically last about an hour or two, during which time members share their alcohol addiction experiences with one another. Members are also encouraged to get a sponsor—a recovered member who can help guide them on their path to recovery and provide daily advice and emotional support.
“Changing health behavior is easier when you’re around a bunch of supportive people who are trying to do it with you,” Humphreys said. AA provides the sense of "someone’s on the journey with me” and adds a level of accountability, he added.
AA has historically been nearly impossible to study. One big reason for this is that all of its members are anonymous—the organization keeps no records of who participates, nor do they track who recovers or relapses. AA’s success stories have, therefore, been largely anecdotal.
Other treatment agencies need to report who’s involved and what their health issues and outcomes are to the federal government. “AA is a free, independent resource, so they don’t need to say anything,” Humphreys said.
Without hard proof of AA's success rates, scientists were naturally skeptical of the program for years. Humphreys said when he first got into the field of psychiatry and heard about AA, he, too, thought it sounded ridiculous: How could a program with no doctors or medications actually work? he wondered. But in the 1990s, the National Institutes for Health started to take AA more seriously, given it’s steady growth, and research the hype behind AA. Since then, many experts’ outlooks have evolved, including Humphreys, who now says AA “absolutely does work” based on his research.
Through his research, Humphreys has determined that AA outperforms other well-established AUD treatments because it connects people to a “free, ubiquitous, long-term” recovery plan in which they’re deeply supported by peers. This, in turn, boosts member’s relapse coping skills and improves their motivation and self confidence in being able to achieve abstinence. Plus, it reduces cravings and impulsivity—two huge drivers behind AUD.
Many people have also been skeptical of AA’s massive membership (there are allegedly millions of members across 181 countries). “There’s sort of a natural suspicion of anything that gets big,” Humphreys said. AA’s faith-focused 12 steps can be off-putting, as well, and seem cult-like to some secular people. But according to Humphreys, how people interpret the spiritual aspect is quite malleable. In a Swedish study on AA, researchers asked members if they believed in God, and 80 percent said no. Humphreys’ past research has shown that a patient’s religion does not influence their likelihood of joining a 12-step group, and religious or not, people benefited from the program.
“There’s quite a few atheist, secular people there,” Humphreys said, noting that AA’s member base includes people with a wide range of beliefs—Buddhist, Catholic, Jewish, Rosicrucian, Unitarian, Islamic, and others—who find a way to make it make sense for them. “I think there’s more flexibility than people may realize,” he said.
If a person tries AA and it doesn’t feel like a fit, that’s okay, Humphreys says. There are other, less spiritual AUD-recovery mutual-help organizations out there that, like AA, help people work on recovering through peer support and self exploration. Though under-researched, these peer-led mutual help alternatives likely have the same benefits. A study from 2018 found that mutual help alternatives to AA—Self-Management and Recovery Training (SMART), LifeRing, Women for Sobriety—“are as effective as 12-step groups for those with AUDs.”
There is no one-size-fits-all treatment plan for alcohol use disorders, and what works for one person can greatly differ from what works for another. “Our view is there are a lot of pathways to recovery. [AA] is a good one, clearly—that’s what the study shows, but everyone’s gotta find the niche that they feel comfortable in,” Humphreys said. “If one doesn’t work, then please seek out another.”
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