Alcoholics Anonymous (A.A.)

About This Program

Target Population: Adults who have identified themselves as alcoholics and are trying to maintain sobriety

Program Overview

A.A. is a voluntary, worldwide fellowship of men and women from all walks of life who meet together to attain and maintain sobriety. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership (Description obtained from: www.aa.org)

Program Goals

The program representative did not provide information about the program’s goals.

Essential Components

The essential components of Alcoholics Anonymous (A.A.) include:

  • 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.
  • There are 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.

    From A Brief Guide to Alcoholics Anonymous

Program Delivery

Adult Services

Alcoholics Anonymous (A.A.) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Substance abuse

Recommended Intensity:

Varies for each person

Recommended Duration:

No specific duration

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Confidential meeting room

Education and Training

Education and Training Resources

There is a manual that describes how to implement this program ; but there is not training available for this program.

Implementation Information

Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Alcoholics Anonymous (A.A.).

Fidelity Measures

The program representative did not provide information about fidelity measures of Alcoholics Anonymous (A.A.).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Alcoholics Anonymous (A.A.).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Alcoholics Anonymous (A.A.).

Relevant Published, Peer-Reviewed Research

This program 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 study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Two meta-analyses, see citations following, have also been conducted on Alcoholics Anonymous (A.A.) though these articles are not used for rating and therefore are not summarized:

  • 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. doi:10.15288/jsa.1996.57.65 
  • 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. doi:10.3109/10826089909039431 

Gossop, M., Harris, J., Best, D., Man, L. H., Manning, V., Marshall, J., & Strang, J. (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. doi:10.1093/alcalc/agg104 

Type of Study: One-group pretest-posttest design
Number of Participants: 150

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were 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 investigates the relationship between attendance at Alcoholics Anonymous (A.A.) meetings prior to, during, and after leaving treatment, and changes in clinical outcome following inpatient alcohol treatment. Measures utilized include the Alcohol Problems Questionnaire, the Severity of Alcohol Dependence Questionnaire, the Symptoms Checklist-53, and the Life Situation Survey. Results indicated significant improvements in drinking behaviours (frequency, quantity and reported problems), psychological problems, and quality of life were reported. Frequent A.A. attenders had superior drinking outcomes to non-A.A. attenders and infrequent attenders. Those who attended A.A. on a weekly or more frequent basis after treatment reported greater reductions in alcohol consumption and more abstinent days. This relationship was sustained after controlling for potential confounding variables. Frequent A.A. attendance related only to improved drinking outcomes. Despite the improved outcomes, many of the sample had alcohol and psychiatric problems at follow-up. Limitations include nonrandomization of participants, attrition rate, and selection bias

Length of postintervention 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. doi:10.1037/0022-006X.71.2.302 

Type of Study: Prospective study
Number of Participants: 2,319

Population:

  • Age — 18–65+ years
  • Race/Ethnicity — 52% Caucasian, 42.3% African American, 2.9% Hispanic/Latino, 2.2% Native American, and 0.1% Asian
  • Gender — 100% Male
  • Status — Participants were male veterans seeking treatment for alcoholism at VA inpatient programs.

Location/Institution: National

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study evaluated Alcoholics Anonymous (A.A.) positive alcohol-related outcomes. Measures utilized include the Health and Daily Living Form, the Problems from Substance Use Scale, the Stages of Change Readiness and Treatment Eagerness Scale, and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Results indicate that 1-year posttreatment levels of A.A. affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict A.A. affiliation at 2-year follow-up. Results also found that these effects were not attributable to motivation or psychopathology. Limitations include nonrandomization of participants, generalizability due to lack of female participants, and reliance on self-reported measures.

Length of postintervention follow-up: 2 years.

Moos, R. H., & Moos, B. S. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology, 72(1), 81-90.

Type of Study: Naturalistic longitudinal study
Number of Participants: 473

Population:

  • Age — Approximately 33-38 years
  • Race/Ethnicity — 82.4% Caucasian
  • Gender — 49.7% Women and 40.3% Men
  • Status — Participants were adults who were identified as having an alcohol use disorder and were recruited from three treatment programs for alcohol detoxification.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the influence of the duration and frequency of participation in Alcoholics Anonymous (A.A.) among individuals with alcohol use disorders, and the effect of additional participation and delayed participation on outcomes. Results indicate that compared with individuals who did not participate, individuals who affiliated with A.A.relatively quickly, and who participated longer, had better alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in A.A. had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence. Limitations include bias due to self-selection by subjects and a lack of information on use of other substances.

Length of postintervention follow-up: Varied by subject.

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. doi:10.1016/j.drugalcdep.2005.05.001 

Type of Study: Nonrandomized comparison group
Number of Participants: 461

Population:

  • Age — No help: Mean=32.6 years, A.A. only: Mean=33.3 years, Treatment: Mean=33.9 years
  • Race/Ethnicity — No help: 78.8% Caucasian, A.A. only: 85.4% Caucasian, Treatment: 78.8 % Caucasian
  • Gender — No help: 39.4% Female, A.A. only: 55.1% Female, Treatment: 52.7% Female
  • Status — Participants were previously untreated individuals with alcohol-use disorder seeking treatment via and information and referral center or detox program.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined changes over a 16-year interval and predictors of stable remission among previously untreated individuals with alcohol-use disorders who did not obtain help or who entered either Alcoholics Anonymous (A.A.) or professional treatment in the first year after initially seeking help. Participants were divided into three groups: Those who did not enter treatment, those who attended A.A. only, and those who sought professional treatment. Measures utilized include the Situational Confidence Questionnaire, the Life Stressors and Social Resources Inventory, and the Coping Inventory. Results indicate 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. Limitations include nonrandomization of participants, reliance on self-reported measures, and lack of data on the process and content of treatment.

Length of postintervention 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. doi:10.1002/jclp.20259 

Type of Study: Nonrandomized comparison groups
Number of Participants: 461

Population:

  • Age — No help: Mean=32.6 years, A.A. only: Mean=33.3 years, Treatment: Mean=33.9 years
  • Race/Ethnicity — No help: 78.8% Caucasian, A.A. only: 85.4% Caucasian, Treatment: 78.8 % Caucasian
  • Gender — Not specified
  • Status — Previously untreated individuals with alcohol-use disorder seeking treatment via and information and referral center or detox program.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses participants from Moos & Moos (2005). This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (A.A.) for previously untreated individuals with alcohol use disorders. Measures utilized include the Situational Confidence Questionnaire, the Life Stressors and Social Resources Inventory, and the Coping Inventory. Results indicate 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. Limitations include nonrandomization of participants, obtained information only on 6-month windows of alcohol-related outcomes at each follow-up, and lack of data on the content of treatment.

Length of postintervention follow-up: 16 years.

Kaskutas, L. A., Bond, J., & Avalos, L. A. (2009). 7-year trajectories of Alcoholics Anonymous attendance and associations with treatment. Addictive Behaviors, 34(12), 1029-1035. doi:10.1016/j.addbeh.2009.06.015 

Type of Study: Nonrandomized comparison groups
Number of Participants: 586

Population:

  • Age — Mean=34 years
  • Race/Ethnicity — 54% Caucasian, 31% African American, 9% Other, and 6% Hispanic
  • Gender — 67% Male and 33% Female
  • Status — Participants were adults in treatment for alcohol dependency who were recruited from ten public and private programs.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined follow-up data after participation in Alcoholics Anonymous (A.A.) to determine the relationship between treatment exposure and attendance. Measures utilized include the Diagnostic Interview Schedule for Psychoactive Substance Dependence-DSM-IV, Addiction Severity Index (ASI), AA Affiliation Scale, and the Religious Beliefs and Behaviors Scale. Results indicated that for all four groups, A.A. attendance increased from baseline to the year 1 follow-up, with the increase steepest for the high A.A. and descending A.A. groups. From there, it decreased, except for the medium A.A. group whose attendance levels remained stable. Treatment did not strongly correlate with A.A. meeting trajectories, although the low A.A. group tended to have the lowest treatment rates over time. Limitations include lack of randomization, lack of control group, and missing data on the following: treatment, A.A. attendance, and alcohol consumption during years 2, 4, 6, and 7.

Length of postintervention follow-up: 7 years.

Kingree, J. B., & Thompson, M. (2011). Participation in Alcoholics Anonymous and post-treatment abstinence from alcohol and other drugs. Addictive Behaviors, 36(8), 882-885. doi:10.1016/j.addbeh.2011.03.011 

Type of Study: One group pretest-posttest design
Number of Participants: 268

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — 53% Female and 47% Male
  • Status — Participants were adults who were recruited from three treatment programs for alcohol dependence and drug use.

Location/Institution: South Carolina

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined associations between two types of Alcoholics Anonymous (A.A.) participation (meeting attendance, having a sponsor) and two types of posttreatment abstinence (abstinence from alcohol, abstinence from drugs). Measures utilized include the Drug Use Frequency Questionnaire, Alcoholics Anonymous Affiliation Scale, Short Michigan Alcoholism Screening Test, Drug Abuse Screening Test, and the University of Rhode Island Change Assessment Questionnaire. Results indicated that having a sponsor, but not meeting attendance, was associated with subsequent abstinence from alcohol. Neither type of A.A. participation was associated prospectively with abstinence from other drugs, suggesting A.A. was more effective in reducing alcohol use. Limitations include lack of randomization and lack of a no-treatment control group.

Length of postintervention follow-up: 6 months.

Schonbrun, Y. C., Strong, D. R., Anderson, B. J., Caviness, C. M., Brown, R. A., & Stein, M. D. (2011). Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: Predictors of attendance and outcome. Alcoholism: Clinical and Experimental Research, 35(3), 532-539. doi:10.1111/j.1530-0277.2010.01370.x 

Type of Study: One group pretest-posttest design
Number of Participants: 245

Population:

  • Age — Mean=34.1 years
  • Race/Ethnicity — 72% Caucasian, 19% African American, 7% Hispanic, and 2% Native American
  • Gender — 100% Female
  • Status — Participants were women with alcohol dependency who attended A.A. prior to being incarcerated at the Rhode Island Department of Corrections Adult Correctional Institute.

Location/Institution: Rhode Island

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the effectiveness of Alcoholics Anonymous (A.A.) in a sample of incarcerated women with alcohol dependency. Measures utilized include the Alcohol Use Disorders Identification Test (AUDIT), the Timeline Followback (TLFB), and the Short Index of Alcohol Problems (SIP). Results indicated that A.A. attendance in the year prior to study entry and greater baseline consequences of alcohol use were associated with increased odds of higher frequency of A.A. attendance following incarceration. Weekly or greater A.A. attendance was associated with reductions in negative drinking consequences and frequency of drinking following incarceration. Limitations include lack of randomization and lack of a no-treatment control group.

Length of postintervention follow-up: 6 months.

Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of Alcoholics Anonymous without self‐selection Bias: An instrumental variables re‐analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688-2694. doi:10.1111/acer.12557 

Type of Study: Secondary data analyses from 5 existing randomized controlled trials
Number of Participants: 2,356

Population:

  • Age — 35-55 years
  • Race/Ethnicity — 79.5% Non-Hispanic White, 12.5% Black, 6% Hispanic, and 1.5% Other
  • Gender — Pooled sample: 72% Male. MATCH sample: 80% Male
  • Status — Participants who participated in the Alcoholics Anonymous program.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study utilized information from The National Institutes of Health RePORTER interface to employ an innovative statistical technique to derive a selection bias-free estimate of Alcoholics Anonymous (A.A.) impact. Six data sets from 5 randomized trials of A.A. facilitation interventions were analyzed using instrumental variables models. (1 with 2 independent parallel arms). Results indicate that for most individuals seeking help for alcohol problems, increasing A.A. attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high preexisting A.A. involvement, further increases in A.A. attendance may have little impact. Limitations include trials differed in sample size and inclusion/exclusion criteria

Length of postintervention follow-up: Varied by study.

Ermann, L. S., Lawson, G., & Burge, P. L. (2016). Unexpected social benefits of Alcoholics Anonymous for older women. Adultspan Journal, 15(1), 13-24. doi:10.1002/adsp.12016.

Type of Study: One group pretest-posttest design
Number of Participants: 14

Population:

  • Age — 52-81 years (Mean=61.0 years)
  • Race/Ethnicity — 100% White
  • Gender — 100% Female
  • Status — Participants who participated in the Alcoholics Anonymous program.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study examined the efficacy in Alcoholics Anonymous (A.A.) in regards to the participants’ most beneficial and meaningful experiences in the program. Results indicate that for most individuals (a) the value of forging new relationships with other women; (b) the sense of comfort and security derived from social interactions in A.A.; (c) the support instrumental in other areas, such as smoking cessation, health issues, and day-to-day ups and downs; and (d) the engagement in social activities with other members that exceeded the confines of the meetings, provided additional avenues for support. Limitations include small sample size, generalizability due to ethnicity, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Alcoholics Anonymous World Services, Inc. (1972). A brief guide to Alcoholics Anonymous. Retrieved from http://www.aa.org/pdf/products/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.

Contact Information

Alcoholics Anonymous
Agency/Affiliation: A. A. World Services, Inc.
Website: www.aa.org
Phone: (212) 870-3400

Date Research Evidence Last Reviewed by CEBC: September 2016

Date Program Content Last Reviewed by Program Staff: August 2006

Date Program Originally Loaded onto CEBC: August 2006