Is Alcoholics Anonymous Evidenced-Based? Or Tradition-Based?
“Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to individuals as well as traditional practices.”
In other words, a failure to truly apprehend the myriad nuances of the object of study results in bad science or at least a truncated science.
It’s important to view the infographic above and understand that evidenced-based practice isn’t without its critics and controversies. Wrestle with these concepts a bit before moving forward. Arrive at your own conclusions.
Alcoholics Anonymous
Alcoholics Anonymous (AA) has long been a popular choice for those seeking support in their journey to sobriety.
As a self-help group founded on the principle of mutual support and the belief in a higher power, it has helped countless individuals struggling with alcohol addiction.
However, questions have arisen surrounding the efficacy of AA’s approach and whether its methods are evidence-based.
To determine if Alcoholics Anonymous is indeed an evidence-based program, it is essential to evaluate the scientific literature and research that has been conducted on the subject.
Various studies have attempted to quantify the success rates of AA participants and understand the organization’s methods compared to alternative treatment options.
Critics and proponents of AA’s approach often clash on the program’s efficacy, with some arguing that the spiritual nature of the program detracts from its scientific basis.
This article aims to explore the available data and analyze whether Alcoholics Anonymous can be considered an evidence-based treatment for alcohol addiction, enabling readers to draw conclusions based on the presented research and analysis.
Alcoholics Anonymous and Effectiveness
Research and Outcome
Various studies have been conducted to evaluate the effectiveness of Alcoholics Anonymous (AA) as an evidence-based approach to treating alcohol addiction.
Some research suggests that AA can be effective in helping individuals achieve and maintain sobriety. For instance, a meta-analysis by Kelly et al. (2020) found that AA was more effective than other therapies in certain aspects such as increasing abstinence rates and reducing alcohol-related consequences.
However, the literature on AA’s effectiveness is not without inconsistencies. Some studies report no significant difference between AA and other treatment modalities, whereas others show mixed results.
Due to these discrepancies, it is important to consider the available evidence carefully when assessing AA’s overall effectiveness.
Again, revisit the inforgraphic illustrating the differences between tradition-based practice and evidenced-based practice. On what side do you suppose Alcoholics Anonymous falls?
Alcohol Abstinence and Sobriety
A key component of AA’s program is the promotion of abstinence from alcohol as a primary goal.
Research findings indicate that AA can be effective in helping its members achieve sobriety and maintain abstinence over time.
For example, in a study by Moos and Moos (2006), participants who attended AA meetings were more likely to be abstinent at 1, 3, and 5-year follow-ups compared to individuals who did not attend meetings.
Despite these positive findings, it is worth noting that AA’s abstinence-focused approach may not be suitable for everyone, and alternative evidence-based treatments such as Cognitive Behavioral Therapy and Motivational Enhancement Therapy may better serve some individuals’ needs (see Smart Recovery or Rational Recovery)
AA Membership and Engagement
The degree of engagement in AA often appears to play a role in its effectiveness in promoting abstinence and sobriety.
Active participation in meetings, serving in a group service role, securing a sponsor, and involvement in activities beyond meetings are associated with more favorable outcomes for AA members.
A study by Kaskutas et al. (2009) found that increased engagement in AA activities was correlated with a higher likelihood of abstinence.
This suggests that not only membership in AA but also active participation in various aspects of the program may contribute to its effectiveness.
Reduction of Alcohol-Related Consequences
Another essential outcome to consider when evaluating AA’s effectiveness is the reduction of alcohol-related consequences.
Participation in AA has been found to reduce the negative consequences often experienced by individuals with alcohol use disorders.
For example, a study by Witbrodt et al. (2012) showed that AA attendance led to reduced alcohol-related consequences, such as legal and employment issues and improved mental and physical health.
These findings support the idea that AA can be effective not only in promoting abstinence but also in mitigating some of the detrimental effects of alcohol use.
In summary, Alcoholics Anonymous can be effective in helping individuals achieve and maintain sobriety and reduce alcohol-related consequences.
However, the evidence is somewhat inconsistent, and AA may not be the most suitable treatment option for everyone.
Consequently, it is vital to consider a range of evidence-based treatments (such as Acceptance and Commitment Therapy) to ensure individuals receive the most appropriate support for their needs.
The 12-Step Program
History and Foundations
The 12-step program, most commonly known as Alcoholics Anonymous (AA), was founded in 1935 by Bill Wilson and Dr. Bob Smith.
They developed this program, as composed in AA’s basic text, as a way to help individuals overcome their addiction to alcohol and maintain lifelong sobriety.
The guiding principle of AA is the belief that recovery from addiction can only be achieved through the fellowship of others who share the same struggles.
AA meetings typically follow a formula that includes the reading and sharing of personal experiences related to the program’s 12 steps.
These steps represent a guiding path to recovery and are based on spiritual principles grounded in humility, surrender, and introspection.
Twelve-Step Facilitation
Twelve-Step Facilitation (TSF) is a treatment approach designed to help individuals engage and actively participate in 12-step programs. TSF involves sessions with professional therapists or counselors, who provide education about 12-step programs and guide the individual through each step.
Key components of TSF include:
- Encouraging individuals to attend and participate in meetings.
- Providing information on AA literature such as the Big Book, 12 Steps, and 12 Traditions.
- Discussing the principles of the program and helping individuals apply them to their lives.
TSF has shown to be an effective component of addiction treatment, and many treatment centers incorporate it into their programs.
Sponsorship and Higher Power
A distinctive aspect of 12-step programs is the concept of sponsorship.
A sponsor is someone who has experienced success in the program and guides newer members through the steps.
The sponsor provides guidance, encouragement, and a sense of accountability.
The idea of a higher power is essential in the 12-step program. The program emphasizes surrendering one’s will and addiction-related problems to a higher power, which can be a personal representation of God, nature, or even the group itself.
This concept is not intended to be religious; rather, it is an essential element of the spiritual basis of the program, encouraging individuals to seek external help and strength in overcoming their addiction.
In conclusion, the 12-step program has helped millions of people worldwide to achieve and maintain sobriety.
It is an evidence-based approach to addiction recovery that uses the power of group fellowship and spiritual principles to help individuals overcome their destructive behaviors.
Comparing AA to Other Treatments
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a well-established form of therapy that has been shown to be effective in treating addiction and alcohol use disorder.
It focuses on identifying and challenging maladaptive thought patterns, as well as developing healthy coping skills to manage triggers and cravings.
According to a Cochrane review, CBT has the potential to yield similar or better outcomes compared to Alcoholics Anonymous, while also being more cost-effective. Additionally, CBT can be easily integrated with other treatment approaches.
Below is an example of CBT in action:
Motivational Enhancement Therapy
Motivational Enhancement Therapy (MET) is a short-term, goal-oriented intervention that seeks to enhance a person’s motivation for change.
It has demonstrated positive effects in several studies, particularly when combined with other treatments.
Compared to AA, MET can provide quicker results in a more structured environment.
However, both approaches emphasize the importance of maintaining motivation for recovery, and they can be complementary in addressing alcohol use disorder.
Pharmacological Interventions
Pharmacological interventions have been helpful in treating addiction, supplementing therapy and other treatments.
Medications such as naltrexone, acamprosate, and disulfiram can reduce cravings and relapse rates.
Comparatively, Alcoholics Anonymous does not promote the use of psychiatric medications, but it does not discourage their use if prescribed by a healthcare professional.
The efficacy of combining pharmacological interventions with AA remains an area of ongoing research.
Alternative Support Groups
Alongside AA, other support groups like Narcotics Anonymous (NA) and SMART Recovery provide assistance for those in recovery.
These alternatives have different approaches and belief systems, which may resonate with individuals who do not connect with AA’s 12-step philosophy.
For example, SMART Recovery focuses on self-empowerment, whereas NA addresses addiction more broadly rather than just alcohol use disorder.
These support groups can also coexist with therapy, pharmacological interventions, and other treatment options, depending on the individual’s needs and preferences.
Scientific Debates and Criticisms
Cult-like Accusations
Some critics argue that Alcoholics Anonymous (AA) exhibits cult-like characteristics, given its emphasis on spirituality and its reliance on a “higher power” to overcome alcoholism. While AA does not specifically mandate a belief in a supernatural deity, it does promote the idea of surrendering to a higher power as one of its 12 steps to recovery.
This concept, combined with the close-knit nature of the group, has raised concerns regarding the potential for manipulation and undue influence over vulnerable members.
To read a solid refutation of this critique, click here.
Self-Selection Bias
Another issue in evaluating the efficacy of AA is the presence of self-selection bias.
AA is a voluntary program; therefore, individuals who choose to participate may have certain characteristics that predispose them to both be more likely to join AA and to experience better outcomes (this seems like a stretch, but it’s a common attack on AA).
This makes it difficult to draw causal conclusions about the program’s effectiveness.
For instance, self-selection bias could result in a situation where individuals who are more highly motivated to recover from alcohol-use disorder may disproportionately seek out and attend AA meetings.
If these individuals are more likely to succeed in their recovery due to their higher motivation, it may appear that AA is effective when, in reality, it is more attributable to the pre-existing motivation.
Lack of Randomized Control Trials
Research on Alcoholics Anonymous has been primarily observational in nature, often relying on surveys, questionnaires, and retrospective studies.
Such studies have limitations, particularly when it comes to establishing cause-and-effect relationships.
A key problem in this area is the lack of randomized controlled trials (RCTs), which are considered the gold standard of scientific research for determining the effectiveness of interventions.
One reason for the scarcity of RCTs is the difficulty in conducting them within AA settings.
Ethical and practical concerns often preclude researchers from randomizing participants to AA or control conditions, as individuals seeking help for alcohol-use disorder are typically in need of immediate treatment and cannot be delayed for the sake of research.
Additionally, it might be challenging to maintain the anonymity and confidentiality of AA participants in an RCT.
Despite these criticisms, there is some evidence supporting the effectiveness of AA.
Research by the Recovery Research Institute has pointed to mechanisms of behavior change within AA that lead to improved outcomes for many participants.
Further research involving randomized trials may help to provide a more definitive answer to whether AA is, in fact, an evidence-based treatment for alcoholism.
Impact on Public Health and Society
Social Context and Support
Alcoholics Anonymous (AA) has a significant impact on public health and society by addressing addiction severity through a supportive social context.
AA provides a sense of belonging to its members, helping them overcome addiction and lead healthier lives.
The program emphasizes on group meetings and sharing of personal experiences, which creates a supportive environment for individuals in recovery.
The long-term benefits of such social support are well-documented and can lead to reduced relapse rates and improved mental health.
Health Care Costs
In addition to its positive impact on addiction severity and social context, AA also plays a role in reducing health care costs related to alcoholism.
The organization provides a cost-effective alternative to traditional treatment methods, such as outpatient or residential rehabilitation programs.
By encouraging self-help and peer support, AA can alleviate some of the financial burden on public health systems.
Moreover, as individuals in recovery maintain long-term sobriety, they are less likely to require expensive medical interventions for alcohol-related health issues.
Effectiveness for Specific Populations
Drinking Intensity and Severity
The effectiveness of Alcoholics Anonymous (AA) can vary depending on the drinking intensity and severity of the individual.
Research has shown that individuals with more severe alcohol addiction tend to benefit more from participation in AA, as it offers them the support and accountability necessary to reduce alcohol-related consequences (yet, this same population is associated with the least amount of motivation)
Some observational studies have reported a stronger association between AA attendance and improved outcomes for those with higher levels of problem drinking.
In contrast, individuals with less severe drinking problems might not gain as much from AA participation, as they might already possess sufficient motivation and resources to manage their alcohol consumption (contradicts the above critique).
Nevertheless, many still find the mutual help and shared experiences offered by AA beneficial in their recovery journey.
Alcohol Addiction and Cocaine Use
For individuals struggling with both alcohol addiction and cocaine use, the effectiveness of AA might be influenced by their dual diagnosis.
There is limited research in this area, but some studies suggest that AA could be beneficial for those dealing with both addictions.
Participation in mutual help groups, such as AA, can provide a sense of belonging and support that is crucial for those facing multiple substance use disorders.
However, it’s important to note that AA specifically focuses on alcohol addiction and might not directly address other substance abuse issues.
In such cases, individuals with dual diagnoses might require additional treatment interventions, such as medications or therapy, tailored to their unique needs.
Religious and Spiritual Beliefs
The role of religious and spiritual beliefs in the effectiveness of AA has been a subject of discussion.
AA’s 12-step program incorporates the concept of a higher power, which can be interpreted differently by each participant.
For individuals with strong religious or spiritual beliefs, embracing this tenet might facilitate their recovery process.
They might draw strength from their faith and find solace in the belief that they are not alone in their struggle.
On the other hand, those with no or different religious beliefs might find it challenging to fully engage with the 12-step program (see Big Book Myths).
Despite this potential barrier, many still benefit from the mutual support and camaraderie offered within AA meetings, as these aspects of the program transcend the bounds of specific belief systems.
Conclusion
Alcoholics Anonymous (AA) is a widely recognized and utilized support group for individuals struggling with alcohol addiction.
Its core principles and 12-step program have been the foundation for many recovery programs worldwide.
However, the question of whether AA is evidence-based remains a topic of debate.
Several studies have found positive outcomes associated with participation in AA, such as increased abstinence and improved mental health status.
Some research also supports that AA participation may lead to reduced health care costs.
Nevertheless, the self-reporting nature of these studies and the varying degrees of participant adherence to the program may influence the outcomes.
Other research points to the importance of individual factors in determining the efficacy of AA.
Factors such as the severity of the addiction, the presence of co-occurring mental health disorders, and personal motivation may play critical roles in the success of an individual within the AA program.
While AA may not be a one-size-fits-all solution, it has undoubtedly helped many people achieve sobriety and maintain it over time.
Ultimately, further research is needed to explore the aspects of AA that contribute to its effectiveness and determine in which contexts and for which individuals it is most beneficial.
In the meantime, it is essential to consider each person’s unique circumstances and needs when determining the appropriate treatment pathway.
For some, AA may be an invaluable support system, while others may require additional or alternative evidence-based treatments to achieve lasting recovery.
Frequently Asked Questions
How effective is the Alcoholics Anonymous program?
The effectiveness of Alcoholics Anonymous (AA) varies from individual to individual. Some studies suggest that AA can lead to long-term sobriety, whereas others show mixed results.
However, it is widely accepted that AA can be beneficial for some people, providing them with a supportive community and a structured approach to recovery.
What factors contribute to the success rate of AA?
Several factors contribute to the success rate of AA, including the level of peer support, commitment to the program, and individual motivation for change.
Furthermore, the length of time an individual spends in the program and their willingness to practice the 12-steps play significant roles in their recovery progress.
Are there any scientific studies supporting AA’s methods?
Yes, there are scientific studies that support the effectiveness of AA’s methods. However, the research is not without limitations, such as self-reporting biases, selection biases, and lack of control groups.
More rigorous research is needed to conclusively determine the overall effectiveness of AA’s approach.
How does AA compare to other addiction treatment options?
AA is one of many addiction treatment options available. Other treatment options include cognitive-behavioral therapy, motivational enhancement therapy, and pharmacological interventions.
Some people find success in combining AA with other treatments, while others may find more benefit from alternative approaches. It is essential to find the treatment method that works best for the individual.
What are some criticisms of the Alcoholics Anonymous program?
Critics of AA argue that the program’s focus on spirituality and higher power can discourage those who do not share these beliefs.
Additionally, the 12-step approach’s one-size-fits-all nature may not be suitable for all individuals, and the program’s insistence on personal powerlessness can clash with the belief in self-efficacy for recovery.
Why might AA not be suitable for all individuals seeking help?
AA might not be suitable for all individuals due to various factors, such as personal beliefs, preferences in recovery methods, or a lack of connection with the group.
It’s essential for each person seeking help to explore different treatment options and find the approach that works best for them.