Alcoholics Anonymous (A.A.) - Detailed Report

• At "open meetings," speakers tell how they drank, how they discovered A.A., and how its program has helped them. Members may bring relatives or friends, and usually anyone interested in A.A. is also welcome to attend "open meetings."
• "Closed meetings" are for alcoholics only. These are group discussions, and any members who want to may speak up, ask questions, and share their thoughts with fellow members. At "closed meetings," A.A. members can get help with personal problems in staying sober and in everyday living. Some other A.A. members can explain how they have already handled the same problems - often by using one or more of the Twelve Steps.

THE TWELVE STEPS OF ALCOHOLICS ANONYMOUS

1. We admitted we were powerless over alcohol-that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
    

Alcohols Anonymous (A.A.) is rated a "3 – Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. For more information on the rating of a “3 – Promising Research Evidence,” please see the Scientific Rating Scale.

Gossop, M., Harris, J., Best, D., Man, L., Manning, V., Marshall, J., et al. (2003). Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Alcohol & Alcoholism, 38(5), 421-426.

Type of Study: Pretest/Posttest
Number of participants: 150
Population:

Age Range: Not given
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Patients admitted to an inpatient alcohol detoxification and treatment unit.

Location/Institution: London, U.K.
Summary: (To include comparison groups, outcomes, measures, notable limitations) This study examined the relationship between post-treatment A.A. attendance and drinking outcomes. Results showed a positive correlation between number of meetings attended during the inpatient period and number of meetings attended during follow-up. Those attending A.A. during follow-up reported drinking less. There was also a trend for A.A.-attenders to drink less frequently and in lower daily amounts, but this did not reach statistical significance. More frequent attendance (weekly or more) was associated with less drinking than less frequent attendance.
Length of post-intervention follow-up: 6 months

McKellar, J., Stewart, E., & Humphreys, K. (2003). Alcoholics Anonymous involvement and positive alcohol-related outcomes: Cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men. Journal of Consulting and Clinical Psychology, 71(2), 302-308.

Type of Study: Prospective study
Number of participants: 2,319 men
Population:

Age Range: 18 – 65+
Race/Ethnicity: 52% Caucasian, 42.3% African American, 2.9% Hispanic/Latino, 2.2% Native American, and 0.1% Asian
Status (e.g., foster care, CW): Male veterans seeking treatment for alcoholism at VA inpatient programs.

Location/Institution: National
Summary: (To include comparison groups, outcomes, measures, notable limitations) This study uses structural equation modeling, a technique which allows researchers to statistically determine likely causal and mediating relationships between study variables. Participants completed and inventory at baseline and 1 and 2 years after discharge. Specific measures included the Health and Daily Living Form, assessing hazardous alcohol use, and the Problems from Substance Use Scale, assessing negative consequences of alcohol and drug use. A.A. involvement (number of meetings in the previous month, frequency of reading A.A. material, frequency of talking to a sponsor, number of A.A. friends) was measured. Prior to treatment motivation to change was assessed with the Stages of Change Readiness and Treatment Eagerness Scale, and psychopathology was assessed by doctoral level program staff using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Analysis showed that A.A. affiliation predicted lower alcohol-related problems at 2 years.
Length of post-intervention follow-up: 2 years

Moos, R. H., & Moos, B. S. (2005). Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders. Drug and Alcohol Dependence, 80, 337-347.

Type of Study: Non-randomized comparison group
Number of participants: 461
Population:

Age Range: No help: 32.6, A.A. only: 33.3, Treatment: 33.9 years on average
Race/Ethnicity: No help: 78.8% Caucasian, A.A. only: 85.4% Caucasian, Treatment: 78.8 % Caucasian
Status (e.g., foster care, CW): Previously untreated individuals with alcohol-use disorder seeking treatment via and information and referral center or detox program.

Location/Institution: Not given
Summary: (To include comparison groups, outcomes, measures, notable limitations) Participants were divided into three groups for analysis: Those who did not enter treatment, those who attended A.A. only, and those who sought professional treatment. Note that the majority of those in the professional treatment group (65.9%) also participated in A.A. Measures included frequency of alcohol consumption, dependence symptoms, and life problems (i.e., health, job, money, family) related to drinking. Psychological and social functioning and coping were also assessed using the Situational Confidence Questionnaire, and items from the Life Stressors and Social Resources Inventory and the Coping Inventory, developed by the authors. Significantly more individuals in the A.A. and Treatment group exhibited stable remission than in the untreated group (42.3% versus 24.2%). However, those who entered A.A. or treatment 1 year after initial referral or detox (delayed treatment group) did not show better remission rates than untreated individuals. The authors suggest that the delayed treatment group had a poorer prognosis.
Length of post-intervention follow-up: 16 years.

Moos, R. H., & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology, 62(6), 735-750.

Type of Study: Non-randomized comparison groups
Number of participants: 461
Population:

Age Range: No help: 32.6, A.A. only: 33.3, Treatment: 33.9 years on average
Race/Ethnicity: No help: 78.8% Caucasian, A.A. only: 85.4% Caucasian, Treatment: 78.8 % Caucasian
Status (e.g., foster care, CW): Previously untreated individuals with alcohol-use disorder seeking treatment via and information and referral center or detox program.

Location/Institution: Not given
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study uses the same sample, measures, and study procedure as Moos & Moos, 2005. Analysis showed that for both the treatment and A.A. only groups, participating in 27 weeks or more of treatment or A.A. involvement resulted in significantly better outcomes at 16 years in relation to those who remained untreated. Statistical analysis also showed that for the treatment group, additional participation in A.A. resulted in improved outcomes, over and above treatment alone.
Length of post-intervention follow-up: 16 years

The following studies were not included in rating A.A. on the Scientific Rating Scale:

Tonigan, J. S., Toscova, R., & Miller, W. R. (1996). Meta-analysis of the Alcoholics Anonymous literature: Sample and study characteristics moderate findings. Journal of Studies on Alcohol, 57, 65-72.

Reviews of research on Alcoholics Anonymous (A.A.) have speculated how findings may differ when grouped by client and study characteristics. In this review, meta-analytic procedures were used to summarize the findings of 74 studies that examined A.A. affiliation and outcome. Results were divided by whether samples were drawn from outpatient or inpatient settings. The results were also divided by a global rating of study quality that jointly considered use of subject selection and assignment, reliability of measurement, and corroboration of self-report. Efficacy of dividing study results was examined by changes in magnitude of correlations and unexplained variance. RESULTS: A.A. participation and drinking outcomes were more strongly related in outpatient samples. Better-designed studies were more likely to report positive psychosocial outcomes related to A.A. attendance. In general, A.A. studies lacked sufficient statistical power to detect relationships of interest. CONCLUSIONS: A.A. experiences and outcomes are heterogeneous, and it makes little sense to seek omnibus profiles of A.A. affiliates or outcomes. Well-designed studies with large outpatient samples may afford the best opportunity to detect predictors and effects of A.A. involvement.

Kownacki, R. J., & Shadish, W. R. (1999). Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments. Substance Use and Misuse, 34(13), 1897-1916.

This article reviews the outcome (usually abstinence at 12 months) of 21 controlled studies of A.A., with emphasis on methodological quality. Severe selection biases compromised all quasi-experiments. Randomized studies yielded worse results for A.A. than nonrandomized studies, but were biased by selection of coerced subjects. Attending conventional A.A. meetings was worse than no treatment or alternative treatment; residential A.A.-modeled treatments performed no better or worse than alternatives; and several components of A.A. seemed supported (recovering alcoholics as therapists, peer-led self-help therapy groups, teaching the Twelve-Step process, and doing an honest inventory).

Humphreys, K. (2003). Alcoholics Anonymous and 12-step alcoholism treatment programs. Recent Developments in Alcoholism, 16, 149-64.

Alcoholics Anonymous (A.A.) self-help groups are the most commonly accessed component of the de facto system of care for alcohol problems in the United States. Further, A.A.'s concepts and approach have strongly influenced a significant number of professional treatment programs. Nevertheless, only a modest number of longitudinal, comparative outcome studies on A.A. and on professional 12-step treatment programs have been conducted, which has limited both the certainty and scope of conclusions that can be drawn about these interventions. Research indicates that participation in A.A. and in 12-step treatment are associated with significant reductions in substance abuse and psychiatric problems. Further it has been found that such interventions reduce health care costs over time in naturalistic, quasi-experimental, and experimental studies. Evaluation studies have also begun to illuminate the processes through which self-help groups and 12-step treatment programs exert their effects. To build on this knowledge base, future research should (1) be methodologically flexible and well-matched to its phenomenon of interest, (2) include evaluation of the unique features of self-help organizations, (3) increase representation of African-Americans and women in research samples, and (4) increase statistical power through larger sample sizes and more reliable measurement. Key content areas for future enquiry include further longitudinal evaluation of the outcomes of participation in A.A. and 12-step treatment (particularly in outpatient samples); better specification of the aspects of A.A. that influence outcome; and individual, community, and health organization-level controlled studies of the health care cost consequences of 12-step interventions.

Alcoholics Anonymous World Services, Inc. (1972). A brief guide to Alcoholics Anonymous. Retrieved August 10, 2006, from http://www.aa.org/en_pdfs/p-42_abriefguidetoaa.pdf

Krentzman, A. (2007). The evidence base for the effectiveness of Alcoholics Anonymous: Implications for social work practice, Journal of Social Work Practice in Addictions, 7(4), 27-48.