Does Alcoholics Anonymous Work?

Many people turn to Alcoholics Anonymous (AA) for sobriety. Because it values anonymity, it can be difficult to determine the success rate of AA.

Alcohol is one of the most addictive substances in the world. The lifetime rate for alcohol abuse or dependence is more than 30%, about three times higher than for drugs. Because it’s legal, it’s also more available.

Since 1935, Alcoholics Anonymous (AA) has been building a reputation as the solution to alcoholism, but not even its founders considered it a medicine or even therapy. It isn’t scientific—its roots are in faith-based practices—but it is often one of the first steps toward recovery, and its template is incorporated in many evidence-based treatments.

The question remains: does AA work? And if it does, how and why?

What Is Alcoholics Anonymous?

Alcoholics Anonymous is not formal addiction treatment and doesn’t pretend to be, though it has been mistaken as such by judges and politicians. AA is an informal organization with no leaders or officers. It’s something like a support group or group therapy, but it’s not treatment.

According to its website, Alcoholics Anonymous is:

•  “An international fellowship of men and women who have had a drinking problem.” That word fellowship is carefully chosen. No one is in charge, no one is above anyone else. Some people have been members and sober for longer periods, but all are equal.
•  “It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere.”

Nonprofessional means no medical doctors or psychologists—unless they have alcohol use disorder—and it does not schedule therapy sessions or offer detoxification services.

Attendance is free. There are no membership dues, though they may pass around a collection plate to pay for the use of the space.

Most large cities have several AA meetings every day in different locations. Anyone can attend as many or as few meetings as they wish.

• “There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.” Membership is also informal. There are no membership cards or initiation rituals. You don’t even have to attend meetings to be a member. All it takes to be a member is to want it.
• There is no age limit to attend AA either. AA estimates that 10% of its members are younger than 30. Some people do grow out of alcohol abuse, but it can cause irreparable damage. The sooner one stops drinking abusively, the better. To make AA seem relevant to young people, AA has produced a video Young & Sober in AA: From Drinking to Recovery.

How AA Works

AA is a fellowship, a group of people whose lives have been damaged by their inability to drink safely and moderately that gets together to not drink. It’s a replacement social activity. Hanging around bars and friends who drink may not be helpful, especially early in sobriety.

At the meetings, members say their first names and acknowledge that they are alcoholics. This admission in public and to themselves is considered the first step to recovery. Members share stories of how alcohol use has hurt them—their families and friends, their job prospects, their health—and how they have overcome it.

Members learn from each other and help each other. Those who have long periods of sobriety behind them act as sponsors—AA’s equivalent of a mentor—to newly sober members, offering their experience, advice, and a sympathetic ear.

However, Alcoholics Anonymous and other similar groups are not treatments for alcohol or drug addiction per se. The closest thing to therapy in AA is the twelve steps, a sequence of acts that AA believes will help you to become and stay sober if you perform them to completion and in order. People in AA refer to this process as working the steps.

Does Alcoholics Anonymous Work?

Alcoholics Anonymous clearly works for many people, but how well it works depends on how you define success.

AA has built-in a big loophole for itself: it works if you work the steps and stick with the program and if you want to stop drinking. The Big Book states, if it doesn’t work, you didn’t try or there was something wrong with you.

For an organization with such a long history and a plan that so many professionals have embraced, you would think that there must be lots of evidence that AA succeeds in keeping people sober. There are several reasons why there isn’t.

For one thing, it’s anonymous. AA’s anonymity was intended to make people feel more comfortable attending, but it also makes it difficult to confirm if they are remaining sober. They can’t even confirm if the people attending their meetings are sober and don’t try.

No one conducts a breathalyzer, cheek swab, or urine test at AA meetings. The atmosphere is nonconfrontational, friendly, and accepting.

At the same time, AA doesn’t discourage or forbid additional treatments; it just doesn’t provide them. The Big Book acknowledges that a medical detoxification (detox) might be a necessary first step.

What Is the Success Rate of AA?

In the foreword to the Big Book, 2nd edition, it claims: “Of alcoholics who came to A.A. and really tried, 50% got sober at once and remained that way; 25% sobered up after some relapses, and among the remainder, those who stayed on with A.A. showed improvement.”

It doesn’t say where they got those figures or how they knew they “really tried,” but AA occasionally surveys its members, including in 2014. According to that survey of 6,000 then-current members who responded (though in 2010 AA estimated their worldwide membership was more than 2 million):

• 27% stay sober for less than one year (down from 31% in 2007).
• 24% one-to-five years (no change).
• 3% five-to-10 years (down from 12%).
• 14% 10-to-20 years.
• 22% more than 20 years.

In 2007, the survey only asked about sobriety for more than 10 years, which was 33%. That suggests that the 2014 numbers represent a higher dropoff rate.

On March 11, 2020, the Cochrane Library released a new review of AA’s effectiveness that concluded that adding AA after another treatment has begun has better results than treatment without AA. One writer interpreted the data to indicate AA members had a 42% abstinence rate at one year compared to 35% for cognitive behavioral therapy.

On the other hand, success rates may depend on when you start or stop counting. Not everyone who attends their first AA meeting continues to attend. Many do not complete the 12 steps before stopping. How long must one attend before you consider their success or failure as a relevant statistic?

One AA critic claims that by AA’s figures, 95% who start attending quit within a year and that half of the remaining 5% achieve “long-term sobriety.” Other researchers say 40% drop out in the first year, and that some of those may return later.

Whatever the number, the question is how it compares to other or no treatment. Not everybody who abstains from alcohol does so through AA.

One attempt at a comprehensive cross-treatment survey, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), found that working the twelve steps had about the same success rate as other treatments such as cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET).

While other studies have produced similar results, some observers felt that Project MATCH had significant scientific failings, primarily that there was no control group so there was no way to determine how many might have gotten better on their own.

Some people do experience natural recovery, that is, they recover without using AA or any formal or active treatment.

According to the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey of U.S. adults, ages 18 and older:

• One in four (24.4%) individuals with prior-to-past year alcohol dependence achieved abstinence without help.
• One in five (20.6%) remained in stable natural recovery more than five years later.

Those are slightly lower success rates than AA reports.

Does Alcoholics Anonymous Cause Harm?

Apart from whether AA helps, we need to consider whether it harms. While even a harsh AA critic found 17 good things to say about the program—including that it provides moral support, gives structure for individuals in recovery from alcohol use disorder, and “is everywhere, almost all of the time,” and is free—others argue there are aspects of AA as practiced that can cause psychological or physical harm. It fosters helplessness instead of self-motivation. Work the steps without question. Keep going to meetings forever. You can’t trust your instincts or stop on your own. <

One former AA member from Britain—who acknowledges the program saved his life and still considers himself “pro-choice” on AA—says that over time, AA nurtured his anxieties and encouraged obsessive thinking, perhaps causing or worsening his obsessive compulsive disorder (OCD).It frequently references God. This creates the impression that you must accept God for AA to work. This is difficult for atheists or those who have had a troubled religious upbringing. They might feel they are not welcome or cannot benefit from AA.

This is also counter to AA cofounder Bill W.’s intent. He based AA in part on the Oxford Group, an organization that helped him. He later broke away from the Oxford Group because it was more interested in promoting faith than recovery.

However, aside from reciting the Lord’s Prayer and the Serenity Prayer, most meetings aren’t overly religious. As one atheist said, even though she “couldn’t adopt the higher power vagueness of AA,” she still “worked the steps.”

It may discourage other treatments. Although there’s nothing in AA that says you can’t use other methods in addition to AA, it doesn’t encourage them, either. AA, perhaps inadvertently, has by its ubiquity discouraged the study of alternatives to AA. Its marketing success means many judges order drunk drivers to AA in the belief that it’s the only way for them to get and stay sober.

Professional rehab usually includes 12-step principles or twelve-step facilitation (TSF)—encouraging clients to attend AA or NA meetings—in addition to scientific treatment, as a free, widely available part of aftercare. AA can and should be as accommodating.

It includes sexual predators. Some people call the practice of older male AA members seducing young, newly sober female members—sometimes under the guise of sponsorship—the 13th step (there’s a 2015 documentary by that title) or 13th stepping. Because AA is open to all, there is no screening or vetting process.

Defenders of AA say that there’s no way to know that someone is a sexual predator and nothing they can do to prevent them from attending meetings. All they can do is advise new members not to date during their first year of recovery. Any new relationship can be a distraction and new members are most vulnerable.

That is oft-repeated advice but it is found nowhere in AA’s Big Book (maybe because Bill W. was alleged to have been a 13th stepper), so members may feel as if they can disregard it.

Alternatives to Alcoholics Anonymous

Alcoholics Anonymous and its 12 steps are not the only treatments available. They are not even the best, at least for all individuals with AUD. A notorious ranking in The Handbook of Alcoholism Treatment Approaches ranked AA’s effectiveness 38th out of 48, below the 12 steps alone (37th).

Among those alternatives are programs based on science or evidence, including:

• Behavioral therapies. Based on basic psychotherapy or talk therapy, these are therapies a psychologist uses to change the way individuals think, to seek other solutions than numbing their senses with alcohol or drugs. They include cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), rational emotive behavioral therapy (REBT), and dialectical behavior therapy (DBT).
• Non 12-step alternatives. Groups that incorporate one or more behavioral therapies include SMART Recovery (Self-Management and Recovery Training), Women for Sobriety (WFS), and LifeRing Secular Recovery.
• Medication-assisted treatment (MAT). Abruptly stopping alcohol use—going “cold turkey”—can sometimes be life-threatening. It also may gradually intensify the desire to resume drinking after leaving rehab. That’s why gradual detoxification under medical monitoring is advised, sometimes with the addition of medications such as naltrexone, acamprosate, or disulfiram. Also known as the Sinclair Method, using drugs such as naltrexone can help control cravings and ease withdrawal pains from alcohol.
• Contingency management (CM). This is an add-on method to encourage continued abstinence by giving out vouchers for prizes (or chances for prizes) based on clean urine tests. Community reinforcement approach (CRA) is a similar program. Both programs increase retention rates and abstinence duration.

Rehabilitation and Alcoholics Anonymous Statistics

In Project MATCH, abstinent days increased from 20% to 80% for individuals using 12-step facilitation (TSF), cognitive behavioral therapy (CBT), and motivational enhancement therapy (MET).

A six-month follow-up study found that AA attendance after rehab treatment resulted in longer periods of abstinence and a larger reduction in the amount of alcohol consumed. The more frequent the attendance, the greater the effect.

If the religious language is off-putting, another form of support group, fellowship, or mutual aid organization might have similar benefits. They are comparatively fewer and harder to find than AA. In addition, similar benefits can be achieved with a therapist during one-on-one or group therapy.

The use of drugs (MAT) to aid recovery is dismissed and discouraged by AA and many judges and politicians as exchanging one addiction for another. But these drugs are not addictive, do not cause euphoria, and are usually only for short-term use.

One-third of US adults will have an alcohol use disorder at some point in their lives.

Alcoholics Anonymous has helped and will continue to help many overcome their alcohol use disorder, but it’s not the only method that works and it may not be enough on its own.

AA has value, and evidence-based medical and psychological treatments have value, but they don’t work for everybody, every time. The solution is to use them together.

Sources

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