Alcoholics Anonymous the best way to abstain

By Dr. Ananya Mandal, MDMar 11 2020

Researchers from the Stanford School of Medicine have found that utilizing the help of a support group like Alcoholics Anonymous could be the best possible way for those with alcohol dependence to abstain. This finding came from a review article titled "Alcoholics Anonymous and other 12‐step programs for alcohol use disorder," published in the Cochrane Database of Systematic Review.

For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted. Image Credit: SeventyFour / Shutterstock

Problem statement

The researchers said Alcohol use disorder (AUD) was described as a public health problem leading to 3.3 million deaths annually across the globe and they added that AUD led to a 10 fold greater risk of substance abuse and was 5.1 percent of all disease conditions across the world leading to an average reduction of 20 to 30 years in the life span.  United States of America spends 250 billion USD annually on alcohol and related conditions, they wrote. Treatment includes several approaches, and among these, one of the oldest is the support groups such as Alcoholics Anonymous (AA).

Background of AA

Alcoholics Anonymous or AA was started in 1935 by two men in Akron, Ohio, who started a support group to help each other stay sober and abstain from alcohol. A 12 step approach to abstinence was also developed by them with the first step being the acceptance of having AUD and the last step being becoming a sponsor to a new member to help him, or her stay sober. AA now has over 2 million members across 180 countries across the globe, and there are over 118,000 AA groups.

What was this review about?

This was a review that aimed at assessing the efficacy of Alcoholics Anonymous mutual help groups that are operated by peers or professionals. Some of the efficacy parameters examined included the effects of this group participation on drinking intensity, consequences of drinking, and abstinence. The study also aimed at assessment of healthcare costs on the use of AA group support. The AA interventions were compared with other clinical interventions such as motivational enhancement therapy (MET), cognitive‐behavioral therapies (CBT), and 12 step interventions or twelve-step facilitation (TSF). The effects of these interventions were compared to no treatment or "wait list control" in different studies.

What was done?

For this study, a total of 35 studies were reviewed. These were collaborative work from 145 researchers around the world published in various journals and involving over 10,080 participants. Lead researcher Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences, looked at the efficacy of AA compared to other measures on several variables including abstinence, frequency of drinking, consequences of drinking, and health care costs of alcohol. Onboard were researchers from Harvard Medical School and European Monitoring Center for Drugs and Drug Addiction as well.

Humphreys said, "Cochrane Reviews are the gold standard in medicine for the integration of all the research about a particular intervention. We wanted to do this work through Cochrane because of its rigor and reputation."

Results

AA was found to be more effective in fulfilling all the objectives in almost all the studies, the team of researchers noted. It was pitched against psychotherapy, where it emerged as more beneficial in abstinence.

Results showed that AA was 60 percent more effective compared to other measures to help those with AUD abstain. None of the 35 studies reviewed showed any other method significantly better than AA. AA and 12-step facilitation counseling was also found to be immensely cost-saving, found the researchers. One of the studies said that mental health costs could be reduced by $10,000 per person with AA. Humphreys said that the efficacy of AA remained for all irrespective of their age and gender or if they were veterans or civilians. He said that this was proven in five countries and added, "It absolutely does work."

Implications

According to the researchers, the social interactions in AA work in its favour and that provides the necessary emotional support to those with AUD to abstain from drinking. Humphreys said, "If you want to change your behavior, find some other people who are trying to make the same change."

According to Humphreys, several professionals are skeptical about the effectiveness of AA in helping those with AUD abstain. He explained that many psychologists and psychiatrists using CBT or MET believe that their approach was better and more effective than peer operated AA groups. For this study, they looked at both AA and 12 step counseling, and he agreed that AA was more effective.

Dr. John Kelly, Elizabeth R. Spallin Professor of Psychiatry at Harvard Medical School and Director of the Massachusetts General Hospital Recovery Research Institute, said, "Alcohol use disorder can be devastating for individuals and their families, and it presents a significant, worldwide, costly public health problem. Alcoholics Anonymous is a well-known, free, mutual-help fellowship that helps people recover and improve their quality of life.  One important finding from this review was that it does matter what type of TSF intervention people receive - better organized and well-articulated clinical treatments have the best result. In other words, clinical programs and clinicians need to use one of the proven manualized programs to maximize the benefits from AA participation." Kelly added, "In terms of healthcare costs, policymakers will be interested that four of the five economics studies we identified showed considerable cost-saving benefits for AA and related 12-step clinical programs designed to increase AA participation, indicating these programs could reduce healthcare costs substantially."

Humphreys said that this study does not include the efficacy of other support groups for addictions such as Narcotics Anonymous. He said however, that this study is "certainly suggestive that these methods work for people who use heroin or cocaine." He concluded that this study validates the advice given to those with AUD to try AA for their condition, saying, "That was really good advice, and that continues to be good advice."

This study was supported by Stanford's Department of Psychiatry and Behavioral Sciences and was not funded.