Does AA Really Work?

drinkingIt can’t be easy to learn that your much-younger ex-husband is hot-tubbing it with a bevy of Brazilian babes. So perhaps it’s not all that surprising that an anguished Demi Moore turned to substances to relieve her pain.

After suffering a seizure and spending a night in the hospital, the actress—who was famously sober for over a decade—is the latest in a long line of celebrities to publicly embrace Alcoholics Anonymous (AA). But how effective are the 12-steps anyway? Is the program more successful than one-on-one psychiatric counseling? Is it more effective than no treatment at all?

The truth is, nobody really knows. Accurate reports about the success rates of 12-step programs like AA and NA are notoriously difficult to obtain. The few studies that have attempted to measure the effectiveness of the program have often been contradictory. Fiercely protective of their anonymity, AA forbids researchers from conducting clinical studies of its millions of members. But the organization does conduct its own random surveys every three years. The result of AA’s most recent study in 2007 were promising. According to AA, 33 percent of the 8,000 North American members it surveyed had remained sober for over 10 years. Twelve percent were sober for 5 to 10 years; 24 percent were sober 1 to 5 years; and 31 percent were sober for less than a year.

the fixThe study didn’t disclose how long each person interviewed had been working the rooms to achieve sobriety. It also revealed little about the percentage of people who attended AA, relapsed, and left the program. A 1990 summary of five different membership surveys (from 1977 through 1989) reported that 81 percent of alcoholics who engaged in the program stopped attending within a year. And only 5% of the AA attendees surveyed had been attending meetings for more than a a year.

One report found AA and cognitive behavioral therapy to be equally effective, statistically speaking. “It was the initial decision to get better that determined a person’s chances of succeeding,” an expert says. “What followed made little difference. Although AA doubtless helps some people, it is not magic.”

“When you look at people just taking themselves to a meeting, long-term abstinence is pretty low,” admits Dr. David Sack, an addiction psychiatrist and the chief executive of Promises Treatment Centers. “But the fact is it works well for the people who work it.”

But how does AA stack up against other treatments, like cognitive behavioral therapy? A 2007 study by the National Council on Alcoholism’s medical journal reported that people attending 12-step treatment programs had a 49.5% abstinence rate after a single year. Those who were in CBT programs were less successful, maintaining a 37%  abstinence rate. It almost seems too close to call. And it doesn’t take into account people who try and try again. The difficulty with measuring AA’s effectiveness is that it’s not really a treatment program. It is a support network of non-professionals that offers a model for abstinence.

“Health care professionals want to study treatment and that’s understandable,” says Sack. “But it’s not like studying the effectiveness of a drug. AA’s view is ‘that’s not our problem if you think it works or not because we are here to help and support each other.’”

demi moore

Demi Moore

Twelve-step literature routinely stresses the importance of service, encouraging its members to give of themselves to others through sponsoring of fellow alcoholics or even making coffee. Independent studies have affirmed that concept. In a 2004 survey published in the Journal of Drug and Alcohol Abuse, alcohol addiction researcher Sarah Zenmore reported that giving support helped recovering alcoholics and addicts to maintain their sobriety. “Studies have shown that AA involvement is a strong predictor of sustained recovery,” she reported. That included “meeting attendance as well as helping activities such as doing service in the AA fellowship and being a sponsor.”

How alcoholics come to arrive at AA is another strong predictor of their future sobriety. Call it the Big Boss effect. One study found that people who were directed to attend the program by a counselor or physician boasted abstinence rates of 60 percent. “Adding a little pressure on the front end,” says Sack, “may make a huge benefit from what people get out of it. Even if it’s done by telephone.”

When you consider the gears and levers of AA, it’s not all that different than Cognitive Behavioral Therapy, which attempts to treat alcoholism from a psychological perspective that stresses rewards and punishment. Twelve-step programs serve up the same pragmatic tips and tools: the idea of ‘stinking thinking’ for negative thoughts; learning what people, places and events will trigger your drinking or drugging; planning activities rather than running around helter skelter. And likewise CBT doctors encourage you to seek out support groups—like AA.

In 2006, a study in the Journal of Clinical Psychology found that out of 628 people, the ones who went to AA for 27 weeks or more had better 16-year outcomes for such factors as good social functioning and abstinence than those had no treatment at all. So at least it seems that AA is better than nothing, right? Not so fast, says Deborah A. Dawson, a respected epidemiologist at the National Institute on Alcohol Abuse and Alcoholism. In her 2005 article in the journal Addiction, Dawson pointed out that many health problems often improve on their own through what’s known as “spontaneous remission.” Everyone gets over a flu or a headache, sometimes even without Nyquil or common aspirin. She calculated that the natural rate of recovery for alcoholism was 24.4 percent. In other words, over the course of one year, a quarter of alcoholics got tired and just gave up. No meetings. No treatment. No nothing. They just woke up one day and said, “Enough.”

Of course, it’s probable that many people die off before they “mature out.” . The toughest barrier to measuring the effectiveness of AA is a difference in value systems. AA places the highest value on abstinence. But a growing number of clinical researchers are willing to consider other, less ideal outcomes, like the occasional backslider or binger. Indeed, ‘harm-reduction’ has become an increasingly used buzzword among many treatment professionals. “Many people go through treatment and then they use drugs less and that is unhealthy,” says Sack.  “It doesn’t mean they’re doing as well as they could. But their behaviors have moderated as a result of those treatments. And that’s not a bad thing.”

A number of experts have criticized AA’s all-or-nothing mentality, not because it’s an unworthy goal, but because it puts unbearable pressure on people who can’t live up to so high a standard. Their philosophy is that once you start to backslide you’re powerless to stop it.

It may be that none of these things really matter. One of the most illuminating reports on the topic appeared in 2005 in the online journal BMC Public Health. It analyzed data of an 8-year study that found AA, CBT and motivational enhancement therapy were all equally effective, and reported that nearly all the effect of the treatment was achieved, much like waterboarding, after attending a single session. “It was the initial decision to get better that determined a person’s chances of success,” said Dr. Bankole Johnson, chairman of psychiatry and neurobehavioral sciences at the University of Virginia, and author of The Rehab Myth: New Medications That Conquer Alcoholism. “What followed made little difference. Although AA doubtless helps some people, it is not magic.”

No one who has spent time in AA would disagree. And if Demi Moore finds herself in the rooms trying dig out of out the dark hole she’s been cast in, she’ll no doubt find out, too. And we’ll all also know the results one way or another.

Kevin Gray
The Fix 

Comments

  1. says

    There’s also the aspect that the average AA meeting with a *voluntary* donation of $1 is arguably WAY more successful than other spa-treatment recovery houses that charge thousands of dollars for what I would argue are, at best identical results.

    PS…there are AA meetings for agnostics and atheists; the reason AA has held together for so long is that one of the early group ideas was a “God of my understanding”; I have friends in AA who are Atheistic Buddhists, pagans and generic non-affiliated believers in HP like me.

    There are other ways to get sober, and good luck with yours, Craig.

  2. says

    This article reflects a very confused, and confusing, approach to the statistics on addiction recovery. What it seems to “prove,” if anything, is that support groups increase the chances of overcoming alcoholism and other addictions. Duh. There really is no reason to think that it’s the 12-steps, or the Higher Power, or any of the other magical aspects of AA that does the trick — it’s the fellowship and sense of shared purpose, and that’s common to many or all forms of group support. What’s key is that new members feel welcome and that they bond with others present. LifeRing Secular Recovery offers group support free of religious doctrine, or any one-size-fits-all “program.” Instead, it tries to support individuals as they develop their own approach to finding recovery. We seek to empower the sober-self inside every addict. We’re young and relatively small and haven’t yet been the subject of studies, but I’m confident we’re at least as successful as AA .

  3. Jim Fuller says

    Can’t begin to guess how many such pieces, written by people with no real experience or knowledge of alcoholism or addiction, I’ve read over the years. What I can relate is the fact that I, personally, know at least two hundred people who have attained long-term sobriety through AA. Yes, really, at least two hundred, and that’s a very conservative number. I am, of course, one of their number. And, no, I am not a religious fanatic nor a true believer of any type. Not religious at all, in fact. One of the great many things the people who write these things miss in their eight or ten hour “study” of AA is the wide variety of meanings of “higher power” that work for various members of AA.

  4. George says

    The Council for Secular Humanism has a similar program without the “higher power” nonsense, and statistics indicating better outcomes than AA. Most likely any sort of support group would help so long as the person feels motivated to continue attending. But of course those may be the people more likely recover anyway.

  5. Robert Illes says

    What is really left out of this article is that in fact the main premium of AA is NOT really abstinence, but the rest of the 11 steps. Quitting drink or drug is just the first step. Then the real work begins,
    These 12 steps are deliberately simple, developed nearly 80 years ago, so that they are approachable to people to aid in self awareness (why am I doing this destructive behavior?) and how to be happy NOT doing it, by getleading a spiritual (NOT religious), selfless lifestyle. Of course there would be no statistics of success per se because that is the very nature of AA – no rules, no records. And every single AA member works their own “program”; none are precisely the same (i.e., some members don’t have a sponsor, some go to 20 meetings a week, some go to 20 meetings a year, some sponsor others, some don’t. Some may well have learned how to drink “normally” etc.) But ask any member of AA who has made it through, say, 5 years or 1 year or 21 days, and they will assure anyone, on an anecdotal basis, of course, how incredibly successful it is for themselves or others they have observed, and the relief they feel. AND it’s absolutely FREE but for voluntary donations.
    Of course there are those who don’t “get it”, those who are around for many years and then “go out”. Invariably, those cases can be accredited to, as Dr. Sack says in the artcile, not “working it” – which means not mere abstinence; that’s just the first step. There are 11 more steps of absolutely equal importance for the program to work. And the principles can be applied (and have been) to many many addictions (overeating, smoking, living with an alcoholic, being a child of an alcoholic, hell even screaming in traffic).
    There may well be other forms to relieve the destruction of drugs and alcohol – whether psychiatry, group therapy or just plain old “white knuckling it” because one is sick and tired of being sick and tired. But, whichever one it is, few human endeavors work better than when one has a support system, and reliable tools. And just about every alternative therapy gets right back to those same tools that AA has refined.
    And all of this I just “heard from a friend.”.

Leave a Reply

Your email address will not be published. Required fields are marked *