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A new scientific review released Wednesday wades into the long-running debate about Alcoholics Anonymous. The review found AA can sometimes be more effective than many other forms of professional addiction treatment.
But that likely won't change the debate.
The Study Review's Findings
Published in the Cochrane Library, the review suggests that Alcoholics Anonymous -- a decades-old program that uses group meetings and other tools to help people with substance use -- can help people refrain from drinking longer than some other treatments. Among the ones AA was compared against was cognitive behavioral therapy [CBT], which is often used to address a person's addiction.
The study found patients involved with AA — or programs based on AA principles — had longer periods of complete abstinence from alcohol. The best patient outcomes were for AA — or treatments that encouraged AA — that followed a manual or used a more structured clinical approach. The review found 42% of AA participants were completely abstinent one year later, compared with 35% of participants who underwent other treatments like CBT.
A Cochrane Review is a systematic examination of the available medical research on a health care topic. It's a tool often used by insurers and policy makers when making decisions about health care. This review looked at more than two dozen studies of AA involving more than 10,000 people.
"This review — considered in the gold standard in academic medicine — suggests that AA and clinical treatments designed to stimulate AA involvement among patients with alcohol use disorder produce higher rates of continuous remission over time and substantially reduce health care costs," said the review's co-author Dr. John Kelly with Massachusetts General Hospital's Recovery Research Institute. "Basically, it works. And from a clinical standpoint, it seems to work better than anything else — from a psychosocial standpoint — at producing continuous remission."
Kelly's review also suggested AA and other programs based on its "12 steps" were as effective as traditional treatments in reducing the intensity of drinking and negative alcohol-related consequences.
"The reason why AA works is because it actually mobilizes the same kinds of therapeutic mechanisms that are mobilized by formal treatment," Kelly said. "It helps people shift their social network away from people who are heavy drinkers and drug users toward individuals who are in recovery. And it boosts cognitive behavioral coping skills, self-efficacy and reduces craving and impulsivity. These are the kinds of things that we try and target in formal treatment."
In most cases, AA is based on what are known as the 12 steps. They're specific actions AA adherents take to help recover from substance use. Participants follow the steps in an attempt to guide them into recovery.
Not surprisingly, the strongest 12-step adherents are those who've been helped by it.
People 'Recover In Community'
At a recent AA meeting in Worcester, 67-year-old Jim Direda explained he's been going to meetings almost daily for about half his life. At this meeting, group members offered suggestions to help a man who recently relapsed. Direda said the daily meetings provide social support without judgment.
"This is how we do it, is coming together and sharing some of the stuff we talk about," he said. "Sometimes it doesn't matter what the hell we talk about, it's just being around other people that understand what it's like to be on the planet without alcohol or drugs or whatever your choice was."
In fact, Direda said he doubts recovery can happen without AA.
"People don't recover in isolation; they recover in community," he said. "If you haven't built a recovering community into your life, then I think the odds are you're going to relapse. Because whatever got you to the place where you started to fill up with drugs and alcohol, that stuff hasn't gone away," Direda said.
"Sometimes it doesn't matter what the hell we talk about, it's just being around other people that understand what it's like to be on the planet without alcohol or drugs, or whatever your choice was."Jim Direda
The review's conclusions were vastly different from the last Cochrane Review on AA, done in 2006. The main conclusion of the 2006 review was that the medical research did not "unequivocally demonstrate the effectiveness of AA or 12-step facilitated approaches."
Debate Over AA Likely Remains
Dr. Richard Saitz, with Boston Medical Center, questions the new review. Saitz said although these reviews were conducted 14 years apart, they relied on many of the same studies and focused on AA used along with professional treatment — not on AA alone. The rates were higher for AA used along with professional treatments, compared to patients only turning to peer-led AA.
"Mostly it [the new review] looks like studies of either sending people to AA or frequent counseling, and that yields similar results to other kinds of alcohol use disorder psychotherapies. That's what their main finding is," Saitz said. "And I, unfortunately, I don't think that tells us so much about AA effectiveness."
But Kelly argued this review is different in that it looked at more — and better — research on AA. The 2006 review involved eight studies of a few thousand participants. The Cochrane Library also said the latest look was more extensive.
"The studies included in this update examined a range of programs that differed in their approach and intensity," stated a Cochrane Library press release, "and these were compared against other programs and different treatments for alcohol use disorder. "
The review won't likely change the minds of 12-step opponents, like Dr. Lance Dodes, a retired assistant psychiatry professor at Harvard. Dodes hadn't yet read the new Cochrane Review, but said in an interview that he is opposed to the fundamental idea of AA — that fellowship and social connections are needed to deal with substance use disorders. Dodes has written books arguing against AA as the primary treatment for addiction.
"What does spirituality or morality or a good feeling toward others have to do with addiction? Zero. It has nothing to do with it. Addiction isn't about that. It's a psychological symptom to help you get through feelings of being overwhelmed," Dodes said. "The problem is that 90% or more of all the people who are referred to AA do not do well, and many of them are harmed."
But that won't sway people like Jim Direda, who said that decades of meetings continue to comfort him.
"It's nice to walk into a place and feel welcome. I walk in the door of this place and I don't feel like, "Jeeze, I don't know anybody,' or 'I don't belong here,' " Direda said. "I don't struggle with any of those things. I know I'm with people who get me and are just like me."
Direda said — as the AA slogans suggest — that he'll keep coming back, and he'll take it one day at a time.
This segment aired on March 10, 2020.
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