ALCOHOLICS ANONYMOUS, celebrating its 76th anniversary this year, counts two million members who participate in some 115,000 groups worldwide, about half of them in the U.S. How well does it work? Anthropologist William Madsen, then at the University of California, Santa Barbara, claimed in a 1974 book that it has a nearly miraculous success rate, whereas others are far more skeptical. After reviewing the literature, we found that AA may help some people overcome alcoholism, especially if they also get some professional assistance, but the evidence is far from overwhelming, in part because of the nature of the program.
Alcoholics Anonymous got its start at a meeting in 1935 in Akron, Ohio, between a businessman named Bill Wilson and a physician, Bob Smith. Bill W and Dr. Bob, as they are now known, were alcoholics. Wilson had attained sobriety largely through his affiliation with a Christian movement. Smith stopped drinking after he met Wilson, whose success inspired him. Determined to help other problem drinkers, the men soon published what has become known as The Big Book, which spelled out their philosophy, principles and methods, including the now famous 12-step method. Alcoholics Anonymous was the books official title and also became the name of the organization that grew from it.
In AA, members meet in groups to help one another achieve and maintain abstinence from alcohol. The meetings, which are free and open to anyone serious about stopping drinking, may include reading from the Big Book, sharing stories, celebrating members sobriety, as well as discussing the 12 steps and themes related to problem drinking. Participants are encouraged to work the 12-step program, fully integrating each step into their lives before proceeding to the next. AA targets more than problem drinking; members are supposed to correct all defects of character and adopt a new way of life. They are to accomplish these difficult goals without professional help. No therapists, psychologists or physicians can attend AA meetings unless they, too, have drinking problems.
A for Abstinence?
Most studies evaluating the efficacy of AA are not definitive; for the most part, they associate the duration of participation with success in quitting drinking but do not show that the program caused that outcome. Some of the problems stem from the nature of AAfor example, the fact that what occurs during AA meetings can vary considerably. Further, about 40 percent of AA members drop out during the first year (although some may return), raising the possibility that the people who remain may be the ones who are most motivated to improve.
Nevertheless, the results of one well-designed investigation called Project Match, published in 1997, suggest that AA can facilitate the transition to sobriety for many alcoholics. In this study, a group of prominent alcoholism researchers randomly assigned more than 900 problem drinkers to receive one of three treatments over 12 weeks. One was an AA-based treatment called 12-step facilitation therapy that includes contact with a professional who helps patients work the first few of the 12 steps and encourages them to attend AA meetings. The other treatments were cognitive-behavioral therapy, which teaches skills for coping better with situations that commonly trigger relapse, and motivational enhancement therapy, which is designed to boost motivation to cease problem drinking.
The AA-based approach seemed to work and compared favorably with the other therapies. In all three groups, participants were abstinent on roughly 20 percent of days, on average, before treatment began, and the fraction of alcohol-free days rose to about 80 percent a year after treatment ended. What is more, 19 percent of these subjects were teetotalers during the entire 12-month follow-up. Because the study lacked a group of people who received no treatment, however, it does not reveal whether any of the methods are superior to leaving people to try to stop drinking on their own.
Other research suggests that AA is quite a bit better than receiving no help. In 2006 psychologist Rudolf H. Moos of the Department of Veterans Affairs and Stanford University and Bernice S. Moos published results from a 16-year study of problem drinkers who had tried to quit on their own or who had sought help from AA, professional therapists or, in some cases, both. Of those who attended at least 27 weeks of AA meetings during the first year, 67 percent were abstinent at the 16-year follow-up, compared with 34 percent of those who did not participate in AA. Of the subjects who got therapy for the same time period, 56 percent were abstinent versus 39 percent of those who did not see a therapistan indication that seeing a professional is also beneficial.
These findings might not apply to all problem drinkers or AA programs, however. Because this study was naturalistic, that is, an investigation of people who chose their path on their own (rather than as part of the study), the researchers could not control the precise makeup of the meetings or treatments. Furthermore, the abstinence rates reported might apply only to those with less severe alcohol problems, because the scientists chose people who sought help for the first time, excluding others who had done so in the past. Various studies have found that a combination of professional treatment and AA yields better outcomes than either approach alone.
Taken as a whole, the data suggest that AA may be helpful, especially in conjunction with professional treatment, for many people who are addicted to alcohol. We do not know, however, whether AA might occasionally be harmful. When a group is highly confrontational, for example, alcoholics may become resistant to change [see The Advice Trap, by Hal Arkowitz and Scott O. Lilienfeld; Scientific American Mind, September/October 2010]. Nevertheless, in light of the evidence supporting the program, the wide availability of meetings and the lack of expense, AA is worth considering for many problem drinkers.