How Effective is Alcoholics Anonymous?

Alcoholism and other substance abuse disorders are unfortunately very common in today’s society. It is likely that you know or love someone who is suffering with them, or who has suffered from them in the past. As the child of an alcoholic parent, I am sadly no exception. When you think about alcoholism and other substance abuse disorders, something that may come to mind is Alcoholics Anonymous (AA) or other similar 12-step social intervention programs designed to help individuals overcome their addiction and maintain a life of abstinence and improved health.

Bot how effective, really, is AA? And how can this be objectively measured? After all, most studies on this very subject are in danger of suffering from self-section bias: the only people whose success is being measured are those who chose to attend AA or who consented to be part of these studies. These individuals might skew the effectiveness results because how can you really control for other factors that might contribute to a person’s success with treatment? Such factors could include a person’s self-efficacy (their innate belief in whether they can achieve their goals), whether they even think that they have a substance abuse problem, or whether they are attending meetings voluntarily or as part of a court order which could obviously impact an individual’s willingness and desire to put effort into the program.

So what does the research say? There is a wide range of results. A fair number of published studies about the efficacy of AA do not take into account this self-selection bias so their reported success rates may be skewed. And then there are studies that show being forced into an intervention program like AA actually has worse outcomes than no intervention at all. But then it seems to be common sense that if you willingly seek help (for any condition), you’re likely to do better and have more favorable results because of this internal motivation rather than if you are forced into it.

A study done by Humphreys, Blodgett & Wagner (2014) suggests that for people seeking help for their alcohol problems, attending AA meetings more frequently can lead to both short and long term decreases in the consumption of alcohol. This study is unique in that it is a sort of meta-analysis of other randomized clinical trials with the goal of controlling for self-selection bias when determining the overall efficacy of AA. It used a fairly complex statistical model to control for this self-selection bias with the hope of getting to the bottom of how effective AA is overall as an intervention. It did show that AA has the potential to be a very effective intervention, but it also went on to note that “for populations with high pre-existing AA involvement, further increases in AA attendance may have little impact” (Humphreys, Blodgett, & Wagner, 2014). I take this to mean that if an individual who has maybe not had as much success with AA in the past, increasing the frequency with which they attend meetings isn’t likely to make very much of a difference. This could also potentially mean that If you attend meetings frequently, attending even more frequently may not show much more improvement.

Another study by Kownacki and Shadish (1999) has a similar goal but focuses more on the outcomes of those who voluntarily attend AA and those who are coerced into it as in the case of court-ordered punishment. The authors conclude that coercion “yields significantly worse results than treatment alternatives, and nonsignificantly worse than doing nothing at all” (Kownacki & Shadish, 1999). They also say that instead of forcing these individuals into intervention programs like AA, they would be better served by being referred to inpatient or other psychotherapy treatments (Knownacki & Shadish, 1999). It comes as no surprise then that they also conclude that those who voluntarily attend AA and make an active effort to work the program have better outcomes, but that these individuals might also have done equally well in other types of intervention programs thanks to their self-efficacy (Kownacki & Shadish, 1999).

So what does this all mean? Is AA an effective intervention program for those dealing with alcohol abuse and dependence issues? It seems the answer is complicated. Yes… but also, maybe not. The biggest predictor of success seems to stem not from the actual program itself, but the patient’s self-efficacy and whether they were coerced or forced into that particular intervention. Like most things in life, it appears to be that you will tend to get out of it what you put in.

References

Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials. Alcoholism: Clinical and Experimental Research,38(11), 2688-2694. DOI: 10.1111/acer.12557

Richard J. Kownacki & William R. Shadish (1999) Does Alcoholics Anonymous Work? The Results from a Meta-Analysis of Controlled Experiments, Substance Use & Misuse, 34:13, 1897-1916, DOI: 10.3109/10826089909039431

1 comment

  1. Thank you for sharing this post on AA and the effectiveness of this type of intervention. I would definitely have to agree that it is difficult to evaluate the effectiveness of such a program due to many of the variables that you have cited. I think that it may be important to not underestimate the soft, or unstated impact that may result by those who are mandated to such programs. Even though they do not choose to be there, it might be that being forced into the repetition of something that can clearly demonstrate a life that is more manageable, offers a glimpse of something that would be available to them at a future date. I can appreciate that this complicates the evaluation even more because you can’t measure something that has not happened. But let’s suppose an AA meeting, even when forced to be there has, by some measure a psychological intervention that helps attendees reformat their experiences in a positive way. This can be done by hearing the success stories of others attending AA and being able to relate to their experience. Frequently, those who are mandated to AA often would have the support of a drug and alcohol counsellor. These two circumstances allow for an alcoholic to experience and be present to an enhancing attributional style where they can see things from a more positive perspective.

    Addiction is a slippery slope. I know this because I work in recovery and have, over the years, had several repeat customers. The first time they come in, mandated, angry and closed off, but because of their required abstinence and program expectations of counselling supports, each time they take away another piece of the puzzle. The repetition, persuasion and social influence of AA may assist them in building new tools and offer them a new perspective, belief or value. It may not take hold right away, but, like the seed that has been planted, eventually, with water, it may grow and the alcoholic comes to want the benefits of AA and abstinence for themselves.

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