Evidence That Alcoholics Anonymous Works

Free and open to all, Alcoholics Anonymous support groups beat professional therapy, if you give it your full attention and do whatever it takes to stay sober.

When you look for treatment for a drinking problem, you might need detox — time with doctors on hand to treat severe withdrawal symptoms like hallucinations and convulsions. The next step if possible is often a residential in-patient program. Afterwards, you’ll probably be urged to join a local Alcoholics Anonymous (AA) group, if not ordered by a court to attend one if you’ve been arrested for a violation involving alcohol. There, alongside other people with a history of alcohol use disorder and with the help of a mentor, called a sponsor, you’ll practice a 12-step program that rigorous honesty, along with careful attention to reading the AA Big Book and following the 12 AA Traditions. It’s a program of action, particularly one of addressing character flaws that are interwoven with a person’s drinking habits.

While Alcoholics Anonymous isn’t a sure bet, the worldwide program is the best therapy available, according to a review for the prestigious Cochrane Library. The review concluded that 42 percent of AA participants who follow the program’s recommendations are completely abstinent a year after they join, compared to 35 percent of people who receive a different kind of addiction therapy. AA had better results across groups — veterans, young and old, male or female.

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Even if you never attend an Alcoholics Anonymous meeting, it’s hard to avoid the 12 steps in alcohol treatment. “Twelve-step thinking has influenced most addiction treatment programs,” wrote Keith Humphreys, PhD, a professor of psychiatry at Stanford who was part of the Cochrane team evaluating AA, in an email. It’s also true that peer support is built into professional addiction treatment: About half of registered or licensed addiction counsellors are people who are in recovery themselves. However, they’ll have training as well in either (or some combination of) motivational enhancement therapy — designed to make you want to change your life — or cognitive behavioral therapy, which helps you see and change the thinking that triggers unwanted behavior.

There’s no rule you can’t participate in AA (AA is not a program of “rules” but one of suggestions based on nearly 80s years of member experience) and seek out professional or other help as well: more than half of its members do, according to a 2014 AA survey. But Humphreys believes that AA alone may be fine. In the 2020 Cochrane review, he and two other researchers identified 27 rigorous randomized studies, covering more than 10,500 participants in all, which compared the AA model to a different kind of therapy. They concluded that AA is your best bet for continuous abstinence over a year, two years, and three. In one study, researchers concluded that AA was 60 percent more effective than any other intervention or no intervention. None of the studies found AA to be less effective.

You’ll have plenty of company in AA. Open to all and free, AA now estimates that it has more than 2 million members around the world.

The history of AA

In 1934, Bill Wilson (or Bill W., as he’s sometimes called because members typically do not use their last name in the program to maintain anonymity), a stockbroker known to drink two quarts of a whiskey a day, checked into a hospital in New York City. He received a hallucinogen, belladonna, an experimental treatment, and, the story goes, after calling out to God he saw a flash of light and felt an unfamiliar serenity.

He had been sober for five months when he traveled to Akron, Ohio, in 1935 for a shareholders' meeting and proxy fight. He lost.

Alone and unhappy, he struggled to stay away from the hotel bar. His immediate reaction was that he needed to find another drinker and help him get sober. The man he found, Robert Smith, called "Dr. Bob," had also been in contact with a Christian organization called the Oxford Group. Together, they decided that their best chance lay in helping each other and people with the same problem. They soon developed the famous 12 steps and the AA Big Book (along with the original 100 members), and their model spread around the globe.

Inspired by the Oxford Group, the founders included the term “God” or “higher power” in six of the 12 steps. In most meetings you’ll hear the “Serenity Prayer,” which has been credited to the Protestant theologian Reinhold Niebuhr: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Spread by AA, this may be the only prayer ever to rival the Lord’s Prayer in popularity, notes the author of the “Yale Book of Quotations.” Niebuhr may have been thinking of a famous maxim of the Greek philosopher Epictetus, who didn’t mention God. Although some people approaching AA balk at praying to God, you can interpret “higher power” as any power greater than the individual (the universe, the AA group, or whatever you please).

One of the most famous early members was Charles Jackson, the writer-hero of “Lost Weekend,” the story of a four-day drinking bout that quickly inspired a Billy Wilder movie. In 1953, newly clean, he became a tireless speaker about alcoholism, crediting AA for saving him. In his most famous speech, in 1959, he scolds himself as “too self-absorbed, too self-infatuated,” blaming arrogance for his lapses and seeking humility and altruism as a cure. But Jackson is a sad example of losing the battle against addiction. He traded alcohol for Seconal, and died from the drug while writing a sequel to “Lost Weekend.”

The American Medical Association named alcoholism a disease in 1956, but doctors at the time could offer only detox. AA members — pledging to help others with their disease as a way of staying sober) — began to visit hospital detox wards and invite patients to meetings.

Why don’t more people get better?

Although AA has a better track record than other form of therapy, the data suggests that most members are drinking again within their first year.

Some argue that AA works only for people who are highly motivated. The Cochrane study included solely randomized trials: the participants didn’t get to choose which type of treatment they received. The people you encounter in a group will be more self-selected than those assembled by a randomized study, but not entirely: more than 10 percent of AA members have been ordered to attend by a judge.

Fighting alcohol use disorder isn’t easy for at least three major reasons:

• Because alcohol is a legal drug, you can’t avoid it completely. Every time you go to a nice restaurant, a waiter will try to hand you a wine list. Liquor advertising is a constant reminder, too. Bars and liquor stores are everywhere.
• Your biology may be working against you. Brain imaging studies suggest that people who develop addictions have fewer receptors for dopamine, a chemical that gives us pleasure. If it’s simply harder for some people to feel ordinary pleasure, it makes sense that they might rely more on a chemical boost. There is no clear pattern of inheritance, but children of people with alcohol use disorder are two to six times more likely than the general public to develop alcohol problems. Having a strong “head for liquor” is actually a bad sign: If you need more alcohol to feel the effects, you’re more likely to eventually develop problems.
• Life can be rough. Some people learned to drink to manage stress, and they relapse when life presents new difficulties. Others use alcohol to manage depression, though it may eventually deepen the depression.

Why AA may not be for you

Some people do better taking medication for cravings, and AA does not consider the practice part of the program. AA does not view drinking moderately to be a successful recover practice, either. Finally, you may not need it. There’s evidence that plenty of people recover on their own, although AA believes they are not necessarily “recovered” but often clinging to sobriety by their fingernails, as they saying goes. But don’t kid yourself: if you’ve quit five times in five years, you aren’t one of them.

Who will you find in a meeting? If it’s typical of AA’s membership, according to its own 2014 survey, the participants will fall into four roughly equal groups: newbies sober a year or less, another group sober one to five years, another sober between five and 20 years, and 22 percent sober 20 years or more. If you’re new to AA, it might be inspiring to see so many who have made it work for decades. Remember that the dropouts aren’t in the room. Over time, it’s important not to let that arrogance Jackson spoke of get the better of you. Be humble and follow suggestions from other members, rather than trying to lead the group or thinking you’re cured, one member explained. In short, trust the group and your higher power.

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