How effective is Alcoholics Anonymous?

The Guidelines for the Treatment of Alcohol Problems, commissioned by the Australian government and created by Sydney University has a section on Peer Support and AA that starts on page 174. It is definitely worth a read.

See: Guidelines for the treatment of alcohol problems.pdf

There is also a Good Summation of the Guidelines by Medical Journal of Australia 4 October 2021 Volume 215 No 7. Extracts from Chapter 3 page S17 below highlight the most recent positive reviews of Peer Support Programs like Alcoholics Anonymous.

Here is a quick summary via video of AA in the context of the Cochrane Report and one that could be shared with your colleagues, clients and/or patients and their families.

Watch this 15 minute Youtube Video: Does AA Work?
By Stanford University

My observation is that there has been a change in the understanding of the actual nature of AA as a grass-roots peer-support lived experience fellowship. I remember one researcher in the early 1980s being very angry that AA itself was not open to research, as if the fellowship was being purposefully devious and unwilling to be open to scrutiny. From my perspective, I considered this researcher lacked basic knowledge about this fellowship, its purpose and functioning, and respect for its aims and limits as a grass-roots support network.

This video explores a little of the issues that researchers and clinicians have had that may have biased their approach to Alcoholics Anonymous.

Likewise it’s my opinion that Smart Recovery was developed from a naive understanding of the way AA uses the concept of powerlessness and the God concept. “Powerlessness” is not meant to mean a person can do nothing to improve their functioning and their lives. Rather that by accepting abstaining from alcohol, one gains more clarity and improves one’s ability to deal with a range of problems. Why?Because being sober allows one to think and function better than when affected by the drug alcohol. Simply put for many people with alcohol use disorder or alcohol addiction, it is far easier to abstain in the long run, then to try to moderate. As noted elsewhere on this website, there is also a prejudice against abstaining from alcohol in our society, whereas abstaining from a legal drug like nicotine is well accepted and not questioned.

Alcoholics Anonymous.has a number advantages over similar programs - the main ones being its singleness of purpose; that it is a community (fellowship) where help is freely given and received — 24 x 7; it has a recovery program called the Steps; and aims to operate within a set of ethical principles called Traditions and Concepts of Service.

Any questions? Feel free to contact me

Ro Goold

Extracts from Chapter 3 page S17

Social context of alcohol problems

Notwithstanding the importance of restoring neurobiological imbalances that can maintain addictive behaviours, it is important to highlight that alcohol-related problems rarely occur in isolation, so the wider social context should be appreciated.47

Provision of additional support regarding potential interpersonal and financial problems in addition to referral for any social problems such as housing and child welfare-related issues may be required. Re-establishment of social functioning — including relationships, healthy behaviour (such as exercise and nutrition) and employment — might thus be a significant component of longer term goals.47

Addressing these factors, in conjunction with pharmacological assistance, is likely to be key for treatment gains that are sustainable.

Peer support programs

In the context of addiction, peer support entails the sharing of social, emotional and practical assistance among people with a lived experience of problems with alcohol or other drugs. Peer support programs encourage discussion of experiences, provide guidance, and offer a free, accessible and widely available form of care alongside, after or outside of professional treatment for alcohol use.

Engaging in peer support groups like Alcoholics Anonymous (AA) and SMART Recovery (Self-Management and Recovery Training) has consistently been shown to enhance the gains people make in professional treatment. In Patient Pathways, one of Australia’s largest treatment outcome studies, those who attended peer support groups in the year after initiating a treatment episode were significantly more likely to have reliably reduced the frequency of their drinking or to report abstinence 1 year later. 48

Alcoholics Anonymous

AA, the first 12-step model for alcohol problems, was established 85 years ago. It is the world’s best known and most widely accessed form of peer support for alcohol problems and is now available in over 150 countries. Its core program (based around 12 steps) promotes increased self-awareness and heightens a sense of meaning in life. In Australia, there are an estimated 20,000 members of AA and about 1800 AA groups.49 

Despite the fact that AA has been subjected to the most rigorous research of peer support groups to date, there remains much scepticism about AA’s effectiveness and philosophical approach (eg, its focus on higher power and being powerless around alcohol), with low referral rates reported among clinicians. 50

Findings of a recent Cochrane review on the effectiveness of peer-led AA and professionally delivered or manualised treatments designed to facilitate AA involvement (12-step facilitation interventions) on the outcomes of people with alcohol use disorder showed that these approaches lead to higher rates of continuous abstinence at 1 year, when compared with conventional psychological treatments such as CBT, and are equally effective at helping people reduce alcohol-related consequences and severity of addiction. 51 

Adapting social networks (eg, increasing the number or proportion of non-drinking or pro-recovery peers in one’s network) is one of the key mechanisms through which people benefit. 52 Participation in AA (especially when facilitated by a peer or clinician) is an effective strategy for increasing the uptake of peer support during and after treatment, and improving or sustaining treatment outcomes. 51

As such, assertive referral practices are encouraged.

SMART Recovery

SMART Recovery and other secular forms of peer support have grown considerably in the past two decades. SMART Recovery was established 25 years ago and operates in 25 countries; it is free and, in Australia, offers about 250 weekly in-person or on-line meetings. It adopts an MI and CBT framework and is run by trained facilitators (clinicians or peers, and often both). It embraces harm reduction and recognises that greater success is achieved when individuals set realistic and achievable goals. 53

While based on an empirically supported theoretical framework, few randomised control trials have been conducted to assess its efficacy. 54 

However, evidence for SMART Recovery is beginning to emerge, with studies suggesting that many people benefit in terms of reduced drinking, improved mental health and well-being, and the strengthening of connections with others. 55

Online support groups

Online peer support communities — like Counselling Online, Hello Sunday Morning, Sober in the Country and other peer support groups for people with alcohol problems — have also grown in popularity. However, evaluation of their effectiveness to date has been limited to qualitative analysis of blog posts and forum content, with preliminary evidence suggesting that engagement in Hello Sunday Morning’s blog platform is associated with reductions in alcohol consumption, particularly among heavier drinkers.56