Alcoholics Anonymous (A.A.)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Alcoholics Anonymous (A.A.) has been rated by the CEBC in the area of: Substance Abuse Treatment (Adult).

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

Brief Description

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

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

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital

Homework

This program does not include a homework component.

Languages

Alcoholics Anonymous (A.A.) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Confidential meeting room

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

Since Alcoholics Anonymous (A.A.) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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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

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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.
  • 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.

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.

Type of Study: Pretest/Posttest
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 examined the relationship between post-treatment Alcoholics Anonymous (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 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.

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

Population:

  • Age — 18–65+
  • 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)
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. Alcoholics Anonymous (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 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.

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)
Participants were divided into three groups for analysis: Those who did not enter treatment, those who attended Alcoholic Anonymous (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 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.

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)
Note: This study uses the same sample, measures, and study procedure as Moos & Moos (2005). Analysis showed that for both the treatment and Alcoholics Anonymous (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 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.

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. Participants were assigned to a low A.A. group (averaging fewer than 5 meetings at most follow-ups), a medium A.A. group (about 50 meetings a year at each follow-up), a descending A.A. group (about 150 meetings year 1, then decreasing steeply), and a high A.A. group (about 200 meetings at 1 year, then decreasing gradually by year 7). Participants completed telephone interviews at years 1, 3, 5, and 7. Measures used included 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. Major study limitations included lack of randomization or a no-treatment control group.

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.

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 post-treatment abstinence (abstinence from alcohol, abstinence from drugs). Participants were assessed at intake and at 3 and 6-month follow-ups using 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. Major study limitations included 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.

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. Participants were assessed at intake using the Alcohol Use Disorders Identification Test (AUDIT), and at 3 and 6-month follow-ups using 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. Major study limitations included 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.

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.

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

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

This article was not included in the CEBC scientific rating process because it is not a study on the effectiveness of Alcoholic Anonymous (A.A.). This article provides a summary of evaluation research on A.A. and suggests future directions for scientific work in this area.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.

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

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

Date Research Evidence Last Reviewed by CEBC: January 2015

Date Program Content Last Reviewed by Program Staff: August 2006

Date Program Originally Loaded onto CEBC: August 2006