Why Does Alcoholics Anonymous Work?

Do Alcoholics Anonymous participants do better at abstinence than nonparticipants because they are more motivated? Or is it because of something inherent in the A.A. program?

How researchers answered these questions in a recent study offers insight into challenges of evidence-based medicine and evidence-informed policy. That's the topic of this week's Healthcare Triage.

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:

[underyourbreath]

Meh. The design of this study simply measures whether or not there is a treatment effect (getting help) and the researchers chose AA as the treatment. The results simply show AA is better than nothing; the study makes no attempt to compare the outcomes of AA to other treatment outcomes. Commenters should keep that in mind.

[cynthiaavila]

I have maintained alcohol abstinence for 3 months now and will continue this way for the rest of my life. I pay for and receive treatment from an addiction specialist once a week. I supplement my therapy with AA meetings because they don’t cost any money. Of course I always give a donation but i feel comfort i have AA as an back up because no money is required.

[jonathanhathaway]

I'd recommend the video, "Does Alcoholics Anonymous Work?", for comparisons to other treatments. I started going to AA this year, and I would recommend it to anyone with substance problems, but also for just about anyone. You walk into a room of people who have taken a hard look at themselves and look upon you without judgement, and welcome you back no matter how many times you may relapse. You listen to others and are listened to and find encouragement. The "higher power" thing is actually pretty flexible, and for those (like me) who aren't religious, the higher power could simply be the support of the group. In two months I have come a long way, mostly because I am drawn to the real happiness I see that others have achieved and have enjoyed for decades. I already know how miserable I was, beating myself up. Very few people realized I drank that much because I functioned so well, plus I'm a professional guitarist, so it didn't seem strange to most people to see me drink. I'm not an idiot, I can do the math and know that I was out of control and unhappy. I'm back in a big way, and AA has been a lifesaver.

[NotMeButAnother]

As a differentiation between having a support group and not having a support group I think it was important to study whether the group does have a positive impact and I'm glad that it does. This obviously doesn't change that AA itself is a very problematic program with its highly religious message, its content of denying the individual's ability to combat the addiction and a multitude of other attitudes that others have outlined better than I could here. AA is basically the Salvation Army of self-help groups, they're extremely prevalent and well known but also infamous for religious proselytising and sometimes outright bigotry as well as not actually being as good as other, less famous alternatives. So I think in terms of "is AA better than nothing" the answer being yes is a totally legitimate study, I just also believe it should be followed up with studies that compare its efficacy with other, hopefully less abusive alternatives.

[steve]

Once you get past physical dependence, "alcoholism" is all in your head. AA just redirects the obsession - instead of obsessing over drinking, members obsess over NOT drinking. Their entire lives still revolve around booze, which is why there's such a high relapse rate among AA members.

[SangoProductions]

I noticed the assumption that AA *did* work.

[camcat]

How about comparing AA to other treatment programs?

[tetsubo]

AA has at best a ten percent (10%) success rate. It *doesn't* work and never has. Go see a cognitive behavior therapist and gain the actual skills you need to solve your problems.

[AvailableUsernameTed]

So .. err .. Why Does Alcoholics Anonymous Work?

[davefogarty]

A.A. is only one of many options. It is too often treated as the only one.

[theoutlawpanterarulz]

I spent seven years in a bottle I went to psychiatric facilities rehab programs even jails and I’m just happy that I’m sober now thank God that I’m sober

[AdrenalineStew]

Are there studies that compare AA to other therapies like cognitive behavioral therapy or pharmacological therapies? The fact that it works a little better than doing literally nothing makes me wonder if there are more effective approaches to alcoholism recovery or treating addictions in general.

[maninspired]

Would prefer a video on AA vs secular alternatives.

[attepted-felicity]

I am disappointed that this video isn't actually really a true analysis of whether AA works. While I'm glad to hear that it is better than nothing, in the real world AA has a really low retention rate. Of course it is an excellent and life changing resource for some people committed to change and receptive to how the program works. But there are many other types of programs that may be more universally effective.

[pmyou]

Part of the problem with AA is that it is a religious approach. That brings in placebo effects of prayer and the appeal to the undefined higher power. That is something that needs to be addressed, too. Take note that there have been court requirements for non believers to participate in such programs, implicitly requiring atheists to espouse God. That is not an approach that is going to help people.

[Tarathiel]

wait 2 more meetings a month only produces 3 more days? That damn near sounds like margin of error. It seems like any treatment is better than no treatment, but that doesn't mean AA works...

[walterkathan]

either I am in denial or Alcoholics Anonymous did not work for me because I was supposed to talk about all the horrible things I did while I was under the effects of alcohol. the effects of alcohol did alter my judgement but it never made me do horrible things to anyone so I never got that part. What is Taught in AA is that one should just take away what applies to them and leave the rest, but how can one do that if everyone's saying that the reason why I didn't talk about the horrible things I did, was that I was in denial. Ever since I left AA, some ten years ago, I have never felt better I no longer have to feel like there is no hope for me without AA. However, if AA does work for anyone out there please continue to go take what I said with a grain of salt.

[Markd]

But what about AA vs secular treatment?

[LazyIRanch]

Courts need to stop sending felons to AA and NA. It doesn't help the felon stay sober, as they resent being forced to attend. What happens though, is some of those felons are predators who find a roomful of willing victims. I left AA for several reasons, but this was the main one. I saw so many vulnerable newcomers being taken advantage of by those "oldtimers" whom they were told to trust. It happened to me back in the 80's when I was a "newbie". "Newbie" is just another term for "fresh meat" in AA.

[beamfunk]

So going to AA now "works" because a subset of subjects reported a reduction in drinking, per month, of only 3 days for each 8 days of AA attendance? That is an incredibly low bar for a treatment to "work."