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Why AA is Bad Science…and What It Means for Treatment

Alcoholics Anonymous is famously difficult to study.

Marcel De Grijs/Dreamstime
Source: Marcel De Grijs/Dreamstime

In an excellent piece in the Atlantic, writer Gabrielle Glaser gives an exposé on the lack of scientific evidence on the efficacy of Alcoholics Anonymous (AA) and the preponderance of evidence which shows that not only does the lauded program fail to work for most people who try it, but also that there are many other more effective treatments for alcoholism that are available in the United States and in other countries.

Though there is no question that AA has helped millions of people worldwide recover from alcoholism over the past nearly 80 years of its existence, tens of millions more are left wanting by the program. This may be in part because AA was designed to help bottom-of-the-barrel alcoholics, the worst of the worst, but has become a one-size-fits-all program for anyone with any kind of substance abuse problem. And while researchers know that the results of AA on its own as a treatment for addiction are poor, there is little research on the subject.

As the Atlantic article states:

"Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that 'no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.'”

Retired Harvard Medical School psychiatry professor Lance Dodes concurs with the assessment that AA on its own has a low success rate. In his book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, he estimates that AA’s success rate is between 5 and 8 percent. The addiction treatment industry is slightly more generous, generally estimating a success rate of as high as 10 percent. Still, at the end of one year, at least 9 out of 10 people who have tried AA as a treatment for addiction have left and are either not in recovery or used other treatment methods to deal with their addiction problem.

Why, then, is AA’s 12-step model the “go-to” treatment choice for most Americans? The answer is simple—for most of its history, AA really was the only treatment available for addicts and alcoholics. It is only in the last 20ish years or so that other, highly effective treatment models and therapies have been developed.

But in the period of AA’s existence, the group’s truisms have seeped into the fabric of American society. Take, for example, the widespread belief that a person must “hit bottom” before seeking help. Glaser wrote, “Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma.”

The author continued, poignantly quoting St. Paul psychiatrist and former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Mark Willenbring:

“You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack.' Absurd.”

What can be done? First, it is important not to vilify AA. It has helped millions of people to recover from alcoholism, more than any other program in the world. It also offers an important support opportunity that is available anywhere in the world, any time of the day or night, and is free.

An alcoholic in need can pick up the phone or log onto the internet and find instant support and assistance. No other recovery program offers this. That said, if used at all, AA should be used in conjunction with evidence-based therapies—therapies proven to provide successful treatment outcomes to those in need.

In The Big Book of Alcoholics Anonymous, the AA program’s main text, it is written: “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.”

That may still be true, but a lot of progress has been made in the field of addiction treatment. AA is no longer the best or only treatment possibility available.