Alcoholics Anonymous most effective path to alcohol abstinence (2024)

Alcoholics Anonymous, the worldwide fellowship of sobriety seekers, is the most effective path to abstinence, according to a comprehensive analysis conducted by a Stanford School of Medicine researcher and his collaborators.

After evaluating 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants — Keith Humphreys, PhD, professor of psychiatry and behavioral sciences, and his fellow investigators determined that AA was nearly always found to be more effective than psychotherapy in achieving abstinence. In addition, most studies showed that AA participation lowered health care costs.

AA works because it’s based on social interaction, Humphreys said, noting that members give one another emotional support as well as practical tips to refrain from drinking. “If you want to change your behavior, find some other people who are trying to make the same change,” he said.

The review was published March 11 in Cochrane Database of Systematic Review. Cochrane requires its authors to undertake a rigorous process that ensures the studies represented in its summaries are high-quality and the review of evidence is unbiased.

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

The other co-authors are a researcher from Harvard Medical School and a researcher from the European Monitoring Center for Drugs and Drug Addiction.

Though well-known, AA faces skepticism

Although AA is well-known and used by millions around the world, mental health professionals are sometimes skeptical of its effectiveness, Humphreys said. Psychologists and psychiatrists, trained to provide cognitive behavioral therapy and motivational enhancement therapy to treat patients with alcohol-use disorder, can have a hard time admitting that the lay people who run AA groups do a better job of keeping people on the wagon.

Early in his career, Humphreys said, he dismissed AA, thinking, “How dare these people do things that I have all these degrees to do?”

Humphreys noted that counseling can be designed to facilitate engagement with AA — what he described as “an extended, warm handoff into the fellowship.” For the review article, Humphreys and his colleagues evaluated both AA and 12-step facilitation counseling.

AA began in 1935 when two men in Akron, Ohio, were searching for a way to stay sober; they found it by forming a support group. They later developed the 12 steps, the first being accepting one’s inability to control drinking; the last, helping others sustain sobriety by becoming a sponsor of a new member. The AA model — open to all and free — has spread around the globe, and AA now boasts over 2 million members in 180 nations and more than 118,000 groups.

Though the fellowship has been around for more than eight decades, researchers have only recently developed good methods to measure its effectiveness, Humphreys said.

For the Cochrane review, the researchers found 57 studies on AA; of those, 35 passed their rigorous criteria for quality. The studies used various methods to measure AA’s effectiveness on alcohol use disorder: the length of time participants abstained from alcohol; the amount they reduced their drinking, if they continued drinking; the consequences of their drinking; and health care costs.

AA shines

Most of the studies that measured abstinence found AA was significantly better than other interventions or no intervention. In one study, it was found to be 60% more effective. None of the studies found AA to be less effective.

In the studies that measured outcomes other than complete abstinence, AA was found to be at least as effective. For the studies that considered costs, most showed significant savings associated with AA participation: One found that AA and 12-step facilitation counseling reduced mental health costs by $10,000 per person.

The researchers looked only at studies of AA; they excluded Narcotics Anonymous and organizations focused on addiction to other substances. While it was beyond the scope of their study, Humphreys said the AA review is “certainly suggestive that these methods work for people who use heroin or cocaine.”

Humphreys noted that the findings were consistent whether the study participants were young, elderly, male, female, veterans or civilians; the studies in the review were also conducted in five different countries. “It absolutely does work,” he said of AA’s method.

He added that he feels validated in giving advice to so many patients to try AA: “That was really good advice, and that continues to be good advice,” he said.

Humphreys is a member of the Wu Tsai Neurosciences Institute at Stanford.

The research was not funded.

Stanford’s Department of Psychiatry and Behavioral Sciences supported the work.

Hear Humphreys discuss the research in a 1:2:1 podcast hosted by Paul Costello, senior communications strategist and adviser for Stanford Health Care and the School of Medicine.

Alcoholics Anonymous most effective path to alcohol abstinence (2024)

FAQs

What does the AA Big Book say about abstinence? ›

The Big Book of Alcoholics Anonymous explains that “our liquor was but a symptom” of our spiritual malady, and “the only relief we have to suggest is entire abstinence.” If we do not embrace complete abstinence from drugs and alcohol, our lives will continue to be unmanageable and we will continue to face consequences, ...

What is the success rate of the 12-step program? ›

Although AA has been criticized by some sources for having a low success rate, the rate likely isn't 5% like some say it is. Addiction specialists cite success rates slightly higher, between 8% and 12%.

What is the 12-step model? ›

12-step programs are powerful peer support groups that help people recover from substance use disorders, behavioral addictions, and sometimes other co-occurring mental health conditions. 12-step programs also help people achieve and maintain abstinence from substances.

What are the two sins in the AA Big Book? ›

there are only two sins; the first is to interfere with the growth of another human being, and the second is to interfere with one's own growth. Happiness is such an elusive state.

What is the nightly prayer in Alcoholics Anonymous? ›

It offers the following nighttime prayer:

“God, forgive me where I have been resentful, selfish, dishonest, or afraid today. Help me to not keep anything to myself but to discuss it all openly with another person — show me where I owe an apology and help me make it. Help me to be kind and loving to all people.

What is the oldest and most successful 12-step program? ›

Developed in the 1930s, the first twelve-step program, Alcoholics Anonymous (AA), founded by Bill Wilson and Bob Smith, aided its membership to overcome alcoholism.

What does STEP 7 mean in AA? ›

Step 7 of Alcoholics Anonymous involves humbly asking a higher power to remove our character defects. The direct text of Step 7 reads; “Humbly ask Him (God, inspiration, etc.) to remove our shortcomings.” The pivotal part of this Step is often humility.

What is the 12th step prayer? ›

Twelfth Step Prayer

Dear God, My spiritual awakening continues to unfold. The help I have received I shall pass on & give to others, Both in & out of the Fellowship.

What are the principles behind the 12 steps of Alcoholics Anonymous? ›

The 12 spiritual principles of recovery are as follows: acceptance, hope, faith, courage, honesty, patience, humility, willingness, brotherly love, integrity, self-discipline, and service. Below are the spiritual principles of recovery, listed in order with the corresponding step: Step 1: Acceptance. The 2nd Step: Hope.

Is the 12-step program spiritual? ›

Spiritual – While the AA 12-step program is spiritually grounded, the program refers to a “higher power”, and members can interpret that for themselves. However, the foundation of the program is to surrender the self, or ego, to that higher power.

What are the three pillars of Alcoholics Anonymous? ›

The triangle symbol represents the three AA legacies: recovery, service, and unity. The Alcoholics Anonymous program seeks to achieve balance in these three areas to assist alcoholics in remaining sober.

Why does AA not work? ›

While AA is a well-known & respected program, the stigma surrounding addiction can be a barrier to success for some individuals. The shame and guilt associated with addiction can make it difficult for individuals to feel comfortable attending AA meetings and seeking help.

Does AA believe in abstinence? ›

A Program Based on Alcohol Abstinence

Although AA does not require complete alcohol abstinence, it does encourage it. A general belief exists throughout the AA community that drinking and AA don't mix.

Is emotional sobriety mentioned in the big book? ›

The Big Book mentions emotional sobriety in Step Twelve as an outcome of practicing all steps of the program and applying them to our daily lives: “Here we begin to practice all Twelve Steps of the program in our daily lives so that we and those about us may find emotional sobriety.”

What is Chapter 6 about in the Big Book of Alcoholics Anonymous? ›

Chapter 6, titled “Into Action”, is in my experience a guide for the steps 5 through 11 in the program we call Alcoholics Anonymous. This chapter, as its title suggests, is all about the recovering alcoholic physically reviewing his wrongdoings and setting them right. In other words, getting into action.

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