The Facts are In: AA Works

Critics may have their own opinions, but not their own facts.

Posted Apr 30, 2020

As many readers may already know, Alcoholics Anonymous has been the object of intense criticism and outrageous claims for some time. These generally take the form of personal anecdotal accounts by people who say that AA either disappointed them or believed it failed them. Others make unsubstantiated claims about how AA harms most of the men and women who try it.

The latter is interesting in light of the 115,000 registered AA groups worldwide (a statistic that does not include the many unregistered groups that exist). The claim implies that these individuals are either badly mistaken or somehow the victims of a worldwide fraud. These critics are often marketing their own favored alternatives, which typically are not supported by rigorous research so much as testimonials or case studies that praise the alternatives’ supposed success.

Meanwhile, as for disappointed or critical individuals, it is surely possible that some may have had bad experiences. Since AA is a decentralized fellowship, it is possible for such experiences to happen. Then again, some people report disappointing experiences in psychotherapy. That said, a closer reading of these criticisms usually reveals that they are criticisms by men and women who either gave AA a halfhearted try, or who expected more from AA that it can offer. After all, AA is a fellowship that advocates a 12 step program of recovery, but which clearly states that it is the responsibility of its members to commit to following that program.

In Pursuit of the Facts

AA has traditionally adhered to its commitment to being a “program of attraction.” As such it does not advertise; nor does it respond in any official way to criticism. It does not conduct or fund academic research, limiting itself to triennial voluntary membership surveys which it publishes and which offer largely demographic and utilization data such as membership, length of sobriety, occupational background, and reasons for seeking AA. Aside from its 12 step program as described in two publications—Alcoholics Anonymous and Twelve Steps and Twelve Traditions—it does not exert control over membership or meetings. This lack of central control has allowed AA to proliferate and diversify.

Although AA itself does not conduct research, over the past two decades or more it has been the subject of academic researchers who, recognizing its ubiquity, sought and obtained funding to conduct carefully designed studies intended to ascertain just how effective it is at promoting and sustaining sobriety. These studies have included randomized clinical trials comparing Twelve Step Facilitation (TSF), a therapeutic intervention aimed at helping substance abusers understand and utilize AA as a means to pursue sobriety. Many such clinical trials effectively compared AA to alternative approaches, such as cognitive-behavioral therapy (CBT). Other studies looked at factors such as AA attendance and AA “involvement” (getting a sponsor, making AA friends, etc.) and its relation to sobriety.

Because academic researchers do not generally see their role as defenders of a particular approach to recovery, the vast amount of research on AA and its effectiveness has remained ensconced in academic journals, which are not particularly accessible to the general public. Critics of AA have notably ignored the findings of this research. Fortunately, that has recently changed and the door to looking at the facts about AA has opened.

The Facts Speak: The 2020 Cochrane Report

Cochrane Reports constitute a prestigious and influential source of objective information about the viability of treatments for a wide range of medical and psychiatric disorders. These reviews require a thorough review of rigorous research (as opposed to opinions or anecdotal accounts) which are then published in a form that is accessible to the general public. The research must include randomized clinical trials (RCTs) which are considered the gold standard for determining the effectiveness of medical and psychological treatments.

In March 2020 Cochrane published a review of research on AA. The review included 27 studies and 10,565 participants. Many of these were clinical trials. The authors of the review summarized their findings as follows:

There is high-quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence.

This simple sentence speaks volumes. It says, in effect, that AA works, and that all those men and women in the 100,000+ AA meetings are not deluded. Of course, the skeptics may continue to embrace their denial. As the saying goes, “Don’t try to confuse me with facts.” These include people who promote their favored alternatives, notwithstanding the absence of objective research regarding their effectiveness. Their appeal is often based on a simple but appealing premise: “No matter how severe your substance abuse problem, and no matter how severe its consequences may be, you really don’t need to quit.”

The significance of the Cochrane Report extends beyond the academic research community. It suggests that those who, having thought about their own substance abuse and whether the best (and honest) alternative is to pursue abstinence, would do well to give a fellowship like AA a try. Incidentally, there are other fellowships—SMART Recovery, Women for Sobriety—which are very compatible with AA in their shared commitment to abstinence and their embrace of fellowship as a means to get there, and which can offer another route to the same goal. (Note: In these times of pandemic, these fellowships offer on-line meetings. www.sober24 is one example, though each fellowship offers meetings via its own web site).

The bottom line is that those men and women who are honest enough to acknowledge that their substance abuse has done harm to themselves, their loved ones, their careers, and/or their lifestyles would be wise to be open to trying a fellowship that advocates abstinence and offers fellowship as a pathway to achieving it.