Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In

I should have put this up sooner.  I’ve been totally vegging out, bingeing on Netflix and learning to bake bread.

AA works.  As of Dec 31 this year I will have been sober for 20 full years.

From The New York Times:

An updated review shows it performs better than some other common treatments and is less expensive.

By Austin Frakt and Aaron E. Carroll
March 11, 2020

For a long time, medical researchers were unsure whether Alcoholics Anonymous worked better than other approaches to treating people with alcohol use disorder. In 2006, a review of the evidence concluded we didn’t have enough evidence to judge.

That has changed.

An updated systematic review published Wednesday by the Cochrane Collaboration found that A.A. leads to increased rates and lengths of abstinence compared with other common treatments. On other measures, like drinks per day, it performs as well as approaches provided by individual therapists or doctors who don’t rely on A.A.’s peer connections.

What changed? In short, the latest review incorporates more and better evidence. The research is based on an analysis of 27 studies involving 10,565 participants.

The 2006 Cochrane Collaboration review was based on just eight studies, and ended with a call for more research to assess the program’s efficacy. In the intervening years, researchers answered the call. The newer review also applied standards that weeded out some weaker studies that drove earlier findings.

In the last decade or so, researchers have published a number of very high-quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion.

“These results demonstrate A.A.’s effectiveness in helping people not only initiate but sustain abstinence and remission over the long term,” said the review’s lead author, John F. Kelly, a professor of psychiatry at Harvard Medical School and director of the Recovery Research Institute at Massachusetts General Hospital. “The fact that A.A. is free and so widely available is also good news.

“It’s the closest thing in public health we have to a free lunch.”

Studies generally show that other treatments might result in about 15 percent to 25 percent of people who remain abstinent. With A.A., it’s somewhere between 22 percent and 37 percent (specific findings vary by study). Although A.A. may be better for many people, other approaches can work, too. And, as with any treatment, it doesn’t work perfectly all the time.

Rigorous study of programs like Alcoholics Anonymous is challenging because people self-select into them. Those who do so may be more motivated to abstain from drinking than those who don’t.

Unless a study is carefully designed, its results can be driven by who participates, not by what the program does. Even randomized trials can succumb to bias from self-selection if people assigned to A.A. don’t attend, and if people assigned to the control group do. (It may go without saying, but we’ll say it: It would be unethical to prevent people in a control group from attending Alcoholics Anonymous if they wanted to.)

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3 Responses to “Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In”

  1. Charlie Says:

    My only problem with AA is its requirement to believe in a higher being. Luckily I found through an RD article years ago that there are groups where religion need not be a part of the recovery.

    • Suzan Says:

      I was agnostic/atheist when I got sober. Found myself praying during the process. Slid back to atheist/agnostic but I am in the process of converting to Reform Judaism as much of my agnosticism was based on not believing in the divinity of Jesus. But there is an AA saying regarding a higher power. The most important part is realizing you aren’t it.

  2. Tina Says:

    The entire concept of “powerlessness” is simply that YOU/I are(am) powerless over people, places, and things. It does not imply “weakness”, but is am embrace of reality. In a good AA group there is no requirement to believe in God, or “any sect, denomination, etc., etc,”. It’s about letting go of ego. It’s about stopping behavior that led us to the very brink of disaster.


    “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

    The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are selfsupporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.”

    Copyright © The AA Grapevine, Inc. Reprinted with permission

    When a group endorses Jesus, or any other deity they go against the principles of AA and often have problems helping folks achieve sobriety. No matter what they say, some folks have trouble accepting ANY “power” that’s not THEM. As the saying goes: “All folks get sober — some just have to die first.”

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