IMPORTANT:This page has used Creative Commons Licensed content from Wikipedia in either a refactored, modified, abridged, expanded, built on or 'straight from' text content! (view authors)


Template:Citation style 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[1][2], 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[3]. 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.

Clinical studies

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[4]; 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[4].


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. [5]

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.[6] 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.[6][7][8][9][10] 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.[6] 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,[11] the third was presented at the International Congress on Alcoholism and Drug Dependence.[12]

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.[13] In the previous surveys this group (those remaining active for ninety days) would be the only ones considered to have "tried AA."[6] 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.[13] The necessity of an introductory period was not considered in the 1990 analysis, and the concept was not present in its analysis.[6]

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."[6] 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.[6] His analysis showed for those who remained past the ninty day period ,[6] the results of the Triennial Surveys approximately fit the rule of thumb suggested in the second edition of Alcoholics Anonymous;[14] 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."[6]

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.[6]

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.[13]

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.[6] A paper, however, was self-published in 2008 by three independent authors (not endorsed by AA) clarifying the 1990 commentary.[15]

See also

References

  1. Ferri M, Amato L, Davoli M, Alcoholics Anonymous and other 12-step programmes for alcohol dependence http://www.cochrane.org/reviews/en/ab005032.html
  2. Emrick, C. (1989). Alcoholics Anonymous: Membership characteristics and effectiveness as treatment. In Galanter, M., ed. (1989). Recent developments in alcoholism, Vol. 7: Treatment research. New York, NY, US: Plenum Press, pp. 37-53.
  3. Bebbington, P. (1976). The efficacy of Alcoholics Anonymous: the elusiveness of hard data. British Journal of Psychiatry 128:1, pp. 572-580. Template:PMID.
  4. 4.0 4.1 Ferri et al 2006
  5. SOURCE: National Longitudinal Alcohol Epidemiologic Survey Data, Manual 1 July 11 1994, National Institute on Alcohol Abuse and Alcoholism.
  6. 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 McIntire, Don (December 2000). "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968–1996) and Related Analyses/Comments". Alcoholism Treatment Quarterly 18 (4): 1–18. doi:10.1300/J020v18n04_01.
  7. Template:Cite paper
  8. Template:Cite paper
  9. Template:Cite paper
  10. Template:Cite paper
  11. Norris, John (18 December 1974). "Analysis of the 1974 Survey of the Membership of A.A.". North American Congress on Alcohol and Drug Problems. San Francisco, CA.
  12. Norris, John (3 September 1978). "Analysis of the 1977 Survey of the Membership of A.A.". 32nd International Congress on Alcoholism and Drug Dependence. Warsaw, Poland.
  13. 13.0 13.1 13.2 Template:Cite paper
  14. Bill W., 1955 p. xix-xx
  15. Template:Cite paper

Further reading

  • Marlatt, Alan., Harm Reduction Pragamatic Strategies for Managing High Rish Behavior, New York Guildford Press 1998, ISBN 1572303972
  • Daley Dennis C. and Marlatt, Alan,, Overcoming Your Alcohol or Drug Problem: Effective Recovery Strategies Therapist Guide (Treatments the Work)Oxford ; New York : Oxford University Press, 2006,
  • Marlatt, Alan G. Vandenbos, Gary R., Addictive behaviors : readings on etiology, prevention, and treatment, Washington, DC : American Psychological Association, c1997. ISBN 1557984689
  • Witkiewitz, Katie A. and Marlatt, Alan G. Therapist's Guide to Evidence-Based Relapse Prevention (Practical Resources for the Mental Health Professional)
  • Dimeff, Linda A., Baer, John S. Kivahaln, Daniel R. , Marlatt, Alan G. , Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach, 2007,
  • Donovan Dennis M., Marlatt , Alan G. Assessment of Addictive Behaviors, 1988
  • Donovan , Dennis M, Marlatt, Alan G. , Relapse apse prevention : maintenance strategies in the treatment of addictive behaviors, New York : Guilford Press, c2005. ISBN 159385176
  • Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. (June 2002). "Process and outcome changes with relapse prevention versus 12-Step aftercare programs for substance abusers". Addiction 97 (6): 677–689. doi:10.1046/j.1360-0443.2002.00101.x. PMID 12084137.
  • Brown, A. E., Pavlik, V. N., Shegog, R., Whitney, S. N., Friedman, L. C., Romero, C., et al. (2007). "Association of spirituality and sobriety during a behavioral spirituality intervention for twelve step (TS) recovery". American Journal of Drug and Alcohol Abuse 33 (4): 611–617. doi:10.1080/00952990701407686. PMID 17668347.
  • Carrico, A. W., Gifford, E. V., & Moos, R. H. (June 2007). "Spirituality/religiosity promotes acceptance-based responding and 12-step involvement". Drug and Alcohol Dependence 89 (1): 66–73. doi:10.1016/j.drugalcdep.2006.12.004. PMID 17229532.
  • Cisler, R., Holder, H. D., Longabaugh, R., Stout, R. L., & Zweben, A. (September 1998). "Actual and estimated replication costs for alcohol treatment modalities: Case study from Project MATCH". Journal of Studies on Alcohol 59 (5): 503–512. PMID 9718102.
  • Craig, T. J., Krishna, G., & Poniarski, R. (Summer 1997). "Predictors of successful vs. unsuccessful outcome of a 12-step inpatient alcohol rehabilitation program". The American Journal on Addictions 6 (3): 232–236. PMID 9256989.
  • Deskovitz, M., Key, D. E., Hill, E. M., & Franklin, J. T. (June 2004). "A Long-Term Family-Oriented Treatment for Adolescents with Substance-Related Disorders: An Outcome Study". Child & Adolescent Social Work Journal 21 (3): 265–284. doi:10.1023/B:CASW.0000028455.18661.bd.
  • Fiorentine, R. (1999). "After drug treatment: Are 12-step programs effective in maintaining abstinence?". American Journal of Drug and Alcohol Abuse 25 (1): 93–116. doi:10.1081/ADA-100101848. PMID 10078980.
  • Fiorentine, R., & Hillhouse, M. P. (January 2000). "Drug treatment and 12-step program participation: The additive effects of integrated recovery activities". Journal of Substance Abuse Treatment 18 (1): 65–74. doi:10.1016/S0740-5472(99)00020-3. PMID 10636609.
  • Fiorentine, R., & Hillhouse, M. P. (2000). "Exploring the additive effects of drug misuse treatment and Twelve-Step involvement: Does Twelve-Step ideology matter?". Substance Use & Misuse 35 (3): 367–397. doi:10.3109/10826080009147702.
  • Fiorentine, R., & Hillhouse, M. P. (2003). "Why extensive participation in treatment and twelve-step programs is associated with the cessation of addictive behaviors: An application of the Addicted-Self Model of recovery". Journal of Addictive Diseases 22 (1): 35–55. doi:10.1300/J069v22n01_03. PMID 12661978.
  • Finney, J. W., Moos, R. H., & Humphreys, K. (March 1999). "A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-step and cognitive-behavioral treatment to substance use outcomes". Alcoholism: Clinical and Experimental Research 23 (3): 537–544. doi:10.1111/j.1530-0277.1999.tb04150.x.
  • Finney, J. W., Noyes, C. A., Coutts, A. I., & Moos, R. H. (July 1998). "Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment". Journal of Studies on Alcohol 59 (4): 371–380. PMID 9647419.
  • Gossop, M., Stewart, D., & Marsden, J. (January 2008). "Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study". Addiction 103 (1): 119–125. doi:10.1111/j.1360-0443.2007.02050.x. PMID 18028521.
  • Goubert, D., McKay, J. R., Burke, M., & McLellan, A. T. (Spring 1996). "Treatment program progress: Reliability and predictive validity of the Treatment Program Progress Rating Scale". The American Journal on Addictions 5 (2): 174–180. doi:10.3109/10550499608995674.
  • Humphreys, K., & Moos, R. (2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x.
  • Humphreys, K., & Noke, J. M. (February 1997). "The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients". American Journal of Community Psychology 25 (1): 1–16. doi:10.1023/A:1024613507082. PMID 9231993.
  • Johnson, J. E., Finney, J. W., & Moos, R. H. (July 2006). "End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: Do they differ and do they predict 1-year outcomes?". Journal of Substance Abuse Treatment 31 (1): 41–50. doi:10.1016/j.jsat.2006.03.008. PMID 16814009.
  • Kahler, C. W., Kelly, J. F., Strong, D. R., Stuart, G. L., & Brown, R. A. (July 2006). "Development and Initial Validation of a 12-Step Participation Expectancies Questionnaire". Journal of Studies on Alcohol 67 (4): 538–542. PMID 16736073.
  • Kahler, C. W., Read, J. P., Ramsey, S. E., Stuart, G. L., McCrady, B. S., & Brown, R. A. (August 2004). Motivational Enhancement for 12-Step Involvement Among Patients Undergoing Alcohol Detoxification: Journal of Consulting and Clinical Psychology. 72. pp. 736–741.
  • Keene, J. (September 2000). "The limits of therapeutic models of substance misuse for policy and practice: A qualitative study of two agencies". International Journal of Drug Policy 11 (5): 337–349. doi:10.1016/S0955-3959(00)00051-7. PMID 10967516.
  • Kelly, J. F., & Moos, R. (April 2003). "Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences". Journal of Substance Abuse Treatment 24 (3): 241–250. doi:10.1016/S0740-5472(03)00021-7. PMID 12810145.
  • Kelly, J. F., Myers, M. G., & Brown, S. A. (December 2000). "A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment". Psychology of Addictive Behaviors 14 (4): 376–389. doi:10.1037/0893-164X.14.4.376. PMC 1945122. PMID 11130156.
  • Kelly, J. F., Myers, M. G., & Brown, S. A. (May 2002). "Do adolescents affiliate with 12-step groups?: A multivariate process model of effects". Journal of Studies on Alcohol 63 (3): 293–304. PMC 1978185. PMID 12086130.
  • Kelly, J. F., Myers, M. G., & Brown, S. A. (2005). "The effects of age composition of 12-step groups on adolescent 12-step participation and substance use outcome". Journal of Child & Adolescent Substance Abuse 15 (1): 63–72. doi:10.1300/J029v15n01_05. PMC 2136436. PMID 18080000.
  • Kingree, J. B. (2001). "Predictors of 12-step group preference among low-income treatment participants with alcohol problems". Alcoholism Treatment Quarterly 19 (1): 57–66. doi:10.1300/J020v19n01_04.
  • Kingree, J. B. (2005). "Twelve-Step Subculture and Cultural Competency Among Clinicians: A Response to Holleran and MacMaster". Alcoholism Treatment Quarterly 23 (4): 121–125. doi:10.1300/J020v23n04_09.
  • Levine, B. G., & Nebelkopf, E. (Jan-March 1998). "A Russian-American approach to the treatment of alcoholism in Russia: Preliminary results". Journal of Psychoactive Drugs 30 (1): 25–32. PMID 9565206.
  • Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. (September 1998). "Network support for drinking, Alcoholics Anonymous and long-term matching effects". Addiction 93 (9): 1313–1333. doi:10.1046/j.1360-0443.1998.93913133.x. PMID 9926538.
  • Mengis, M., Maude-Griffin, P. M., Delucchi, K., & Hall, S. M. (Summer 2002). "Alcohol use affects the outcome of treatment for cocaine abuse". The American Journal on Addictions 11 (3): 219–227. doi:10.1080/10550490290087992. PMID 12202014.
  • Moos, R. H., & Moos, B. S. (April 2004). "Help-seeking careers: Connections between participation in professional treatment and Alcoholics Anonymous". Journal of Substance Abuse Treatment 26 (3): 167–173. doi:10.1016/S0740-5472(03)00190-9. PMID 15063909.
  • Moos, R. H., Moos, B. S., & Andrassy, J. M. (December 1999). "Outcomes of four treatment approaches in community residential programs for patients with substance use disorders". Psychiatric Services 50 (12): 1577–1583. PMID 10577876.
  • Morgenstern, J., & Bates, M. E. (November 1999). "Effects of executive function impairment on change processes and substance use outcomes in 12-step treatment". Journal of Studies on Alcohol 60 (6): 846–855. PMID 10606498.
  • Ouimette, P. C., Finney, J. W., & Moos, R. H. (April 1997). "Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness". Journal of Consulting and Clinical Psychology 65 (2): 230–240. doi:10.1037/0022-006X.65.2.230. PMID 9086686.
  • Ouimette, P. C., Finney, J. W., Gima, K., & Moos, R. H. (March 1999). "A comparative evaluation of substance abuse treatment III. Examining mechanisms underlying patient-treatment matching hypotheses for 12-step and cognitive-behavioral treatments for substance abuse: Alcoholism". Clinical and Experimental Research 23 (3): 545–551.
  • Ouimette, P. C., Moos, R. H., & Finney, J. W. (September 1998). "Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes". Journal of Studies on Alcohol 59 (5): 513–522. PMID 9718103.
  • Penn, P. E., & Brooks, A. J. (Win 2000). "Five years, twelve steps, and REBT in the treatment of dual diagnosis". Journal of Rational-Emotive & Cognitive Behavior Therapy 18 (4): 197–208. doi:10.1023/A:1007883021936.
  • Polcin, D. L. (October 2000). "Professional counseling versus specialized programs for alcohol and drug abuse treatment". Journal of Addictions & Offender Counseling 21 (1): 2–11.
  • Sandoz, C. J. (1999). "The spiritual experience in recovery: A closer look". Journal of Ministry in Addiction & Recovery 6 (2): 53–59. doi:10.1300/J048v06n02_05.
  • Saarnio, P., & Knuuttila, V. (April 2003). "A study of risk factors in dropping out from inpatient treatment of substance abuse". Journal of Substance Use 8 (1): 33–38. doi:10.1080/1465989031000067227.
  • Stephenson, G. M., & Zygouris, N. (February 2007). "Effects of self reflection on engagement in a 12-step addiction treatment programme: A linguistic analysis of diary entries". Addictive Behaviors 32 (2): 416–424. doi:10.1016/j.addbeh.2006.05.011. PMID 16822620.
  • Swora, M. G. (September 2004). "The rhetoric of transformation in the healing of alcoholism: The twelve steps of Alcoholics Anonymous". Mental Health, Religion & Culture 7 (3): 187–209. doi:10.1080/13674670310001602445.
  • Tavares Rodrigues, J., & Pinto de Almeida, L. (2002). "Freedom and compulsion: An analysis of twelve steps programming of Alcoholics Anonymous". Psicologia em Estudo 7 (1): 113–120.
  • Thevos, A. K., Roberts, J. S., Thomas, S. E., & Randall, C. L. (May-June 2000). "Cognitive behavioral therapy delays relapse in female socially phobic alcoholics". Addictive Behaviors 25 (3): 333–345. doi:10.1016/S0306-4603(99)00067-2. PMID 10890288.
  • Thevos, A. K., Thomas, S. E., & Randall, C. L. (July 2001). "Social support in alcohol dependence and social phobia: Treatment comparisons". Research on Social Work Practice 11 (4): 458–472. doi:10.1177/104973150101100403.
  • Timko, C., Billow, R., & DeBenedetti, A. (August 2006). "Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship". Drug and Alcohol Dependence 83 (2): 111–121. doi:10.1016/j.drugalcdep.2005.11.005. PMID 16338102.
  • Timko, C., & Debenedetti, A. (October 2007). "A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes". Drug and Alcohol Dependence 90 (2-3): 270–279. doi:10.1016/j.drugalcdep.2007.04.007. PMID 17524574.
  • Timko, C., DeBenedetti, A., & Billow, R. (May 2006). "Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes". Addiction 101 (5): 678–688. doi:10.1111/j.1360-0443.2006.01391.x. PMID 16669901.
  • Tonigan, J. S., Bogenschutz, M. P., & Miller, W. R. (June 2006). "Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment?". Journal of Substance Abuse Treatment 30 (4): 323–330. doi:10.1016/j.jsat.2006.02.008. PMID 16716847.
  • Villanueva, M., Tonigan, J. S., & Miller, W. R. (2007). "Response of Native American clients to three treatment methods for alcohol dependence". Journal of Ethnicity in Substance Abuse 6 (2): 41–48. doi:10.1300/J233v06n02_04. PMID 18192203.
  • Weegmann, M. (June 2004). Alcoholics Anonymous: A Group-Analytic View of Fellowship Organizations: Group Analysis. 37. pp. 243–258.
  • Wilson, K. G., Hayes, S. C., & Byrd, M. R. (Winter 2000). "Exploring compatibilities between Acceptance and Commitment Therapy and 12-step treatment for substance abuse". Journal of Rational-Emotive & Cognitive Behavior Therapy 18 (4): 209–234. doi:10.1023/A:1007835106007.
  • Winters, K. C., Stinchfield, R. D., Opland, E., Weller, C., & Latimer, W. W. (April 2000). "The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers". Addiction 95 (4): 601–612. doi:10.1046/j.1360-0443.2000.95460111.x. PMID 10829335.
  • Witbrodt, J., & Kaskutas, L. A. (2005). "Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence". American Journal of Drug and Alcohol Abuse 31 (4): 685–707. doi:10.1081/ADA-68486. PMID 16320441.
  • Zemore, S. E. (October 2007). "A role for spiritual change in the benefits of 12-step involvement:". Alcoholism: Clinical and Experimental Research 31 (Suppl 3): 76S–79S. doi:10.1111/j.1530-0277.2007.00499.x. PMID 17880352.
Community content is available under CC-BY-SA unless otherwise noted.