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 Specified
• Race/Ethnicity — Not Specified
• Gender — Not Specified
• Status — 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
• Gender — Not Specified
• Status — 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
• 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)
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
• 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 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.

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 range — 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 post-intervention 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 range — Mean age 34.1 years
• Race/Ethnicity — 72% Caucasian, 19% African American, 7% Hispanic, and 2% Native American
• Gender — Females
• 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 post-intervention follow-up: 6 months.

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: Non-randomized comparison groups
Number of Participants: 586

Population:

• Age range — Mean age 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 post-intervention follow-up: 7 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.