Effectiveness of Alcoholics Anonymous

The effectiveness of Alcoholics Anonymous, the success of the Alcoholics Anonymous (AA) twelve step program in treating alcoholism, is a subject of ongoing interdisciplinary research and debate in a multitude of academic and non-academic contexts.

Analytical definitions of effectiveness, efficacy and success vary according to the particular field of reference investigating the practices, methods and prognoses of treating alcoholics, and in what terms these concepts are framed in individual studies. Experimental studies into the effectiveness of AA have been based either on results obtained from individuals attending meetings run under the umbrella of the AA organisation itself, or from similar twelve-step recovery programmes based on the twelve-step approach run externally from the AA organisation; generically termed, in this latter case, as twelve-step facilitation (TSF).

Studies of both implementations of the therapeutic model have in general not yielded definitive evidence of efficacy when assessed in terms of long-term prevention of problem drinking as compared to other treatments, although limitations are widely acknowledged in obtaining acceptable data due to the difficulty in applying experimental controls to clinical analyses of AA, such as adequate placebo control and uniformity of the delivered therapy. Despite this lack of experimental confirmation in clinical studies, Alcoholics Anonymous itself claims an approximate membership retention of 26% after twelve months from initial attendance.

Meta-analyses
A 2006 Cochrane systematic review by  Ferri et al on  studies of alcohol treatment conducted between 1966 and 2005  that  investigated the efficacy of both AA and non-AA twelve-step program attendance, concluded that "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism. This conclusion was based on a meta-analysis of the results of eight trials involving a total of 3,417 individuals ; the authors, however, note that further efficacy studies are needed, and mention the presence of flaws in one included study regarding the definition of success of interventions.

Results from National Longitudinal Alcohol Epidemiological Surevey (NLAES)

In 1992 United States Census Bureau and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Longitudinal Alcohol Epidemiologic Survey (NLAES). Direct face- to-face interviews were conducted with one randomly selected respondent,18 years of age or older, in each of 42 862 households within the contiguous United States and the District of Columbia. NLAES respondents were asked whether they ever attended an Alcoholics Anonymous meeting for any reason related to their drinking. 758 respondents stated they had attended an Alcoholics Anonymous meeting for their drinking prior-to-the past year (SC7015-2). 348 respondents stated they continued to attend Alcoholics Anonymous during the past year (sc7015-3), a 46% continuance rate.

Results from Triennial Surveys
To help answer questions about AA's effectiveness, the 1968 AA General Service Conference unanimously voted to begin surveying those participating in AA. A survey was conducted beginning that year and subsequent surveys have been conducted about every three years (triennially), the latest of which was in conducted in 2007 and published in 2008. The basic results of the surveys are made available in pamphlet form to AA members. Additional comments and analysis intended for academic and professional audiences were written to supplement the survey results from 1970 to 1990. Non-alcoholic Board of Trustee Member, Dr. John [Jack] Norris wrote the second and third analyses. The second was presented at the North American Congress on Alcohol and Drug Problems, the third was presented at the International Congress on Alcoholism and Drug Dependence.

The 1990 analysis found that from 1977 to 1989 around one quarter (26%) of those who first attend an AA meeting are still attending after one year. Nearly one third (31.5%) leave the program after one month, and by the end of the third month, just over half (52.6%) have left. In the previous surveys this group (those remaining active for ninety days) would be the only ones considered to have "tried AA." After the first year, the rate of attrition slows. The nature of the survey questions asked did not allow a direct comparison between the twelfth month of the first year and the first month of the second year. Only those in the first year were recorded by month. The necessity of an introductory period was not considered in the 1990 analysis, and the concept was not present in its analysis.

Don McIntire conducted an analyses of the survey results from  1970 to 1987 and found that 81 percent of attendees leave in the first month and by the third month 90 percent have left, he suggested for various reasons  a period after ninety days was necessary before before a person can be considered to have "tried AA." If a participant with a desire to stop drinking voluntarily sought assistance in AA for that length of time but ultimately found AA to be unhelpful and dropped out, that would be considered a sign of failure. His analysis showed for those who remained past the ninty day period, the results of the Triennial Surveys approximately fit the rule of thumb suggested in the second edition of Alcoholics Anonymous; of alcoholics who "really tried" to follow the AA program "50% got sober at once and remained that way; 25% sobered up after some relapses, and among the remainder, those who stayed with Alcoholics Anonymous showed improvement."

People may participate in AA for less than ninety days for several reasons. For instance, they may do so under the coercion of a recovery/treatment program, employee assistance program, or as mandated by a court. Similarly, they may do so in response to an ultimatum of a family member or friend and chose to attend meetings rather than deal with the consequence. Some may also attend AA because they have an alcoholic family member or friend and are curious about the organization, they are students seeking information about alcoholism, or they are participating in multiple twelve-step programs but not primarily in AA. Others attend and then determine other methods such as harm reduction are more appropriate for them.

About 40% of the members sober for less than a year will remain another year. About 80% of those sober less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year, however the survey states that this information does not predict the number that will remain sober, and those who remain sober but not in the fellowship cannot be calculated. These figures have been repeated within a few percentage points using the same calculations since 1974.

The most recent survey of AA members, conducted in 2007, found that 33% had been continuously sober for more than 10 years, 12% had between 5 and 10 years of sobriety, 24% between 1 and 5 years, and 31% less than 1 year. Comprehensively, the average length of sobriety for all members was more than 8 years, with 52% of the membership being between 41 and 60 years of age (http://www.aa.org/pdf/products/p-48_07survey.pdf).

While AA has continued to publish member surveys, they have not published any parallel commentary or analysis of the surveys since 1990. A paper, however, was self-published in 2008 by three independent authors (not endorsed by AA) clarifying the 1990 commentary.