Is AA effective?
As simple as this question appears, the abundance of misinformation surrounding AA demanded books and even more studies to solve the riddle of AA efficacy, yet the answer remains seemingly undiscovered. With all the research performed, citing article after article forms a derivative practice calling herein for a different approach to determining AA effectiveness based on contextualizing the program for individual scrutiny.
The research measuring AA efficacy complicates with factors that bias most studies in favor of Twelve Step facilitation, beginning with the research methods: mostly self-reported surveys, questionnaires, and treatment follow-ups. This research subjectivity further confounds when measuring sobriety. Some tests measure days, weeks, months, years, and rarely decades. A difficulty arises using these data collection methods due to the reliance on participants’ honesty, continued subject involvement, and significance of sobriety lengths.
Consider sobriety’s definition, and you readily see the problems defining this ambiguous idea. AA defines sobriety as total abstinence (among other more spiritual elements). In AA, you can be considered to lack sobriety depending on how you act and talk, which clouds the term in nuanced meaning. AA members lose their sobriety with one drink, meaning a person twenty years abstinent must start over as though they failed.
To people outside the program, including many researchers, sobriety is abstinence, and one drink in twenty years does not appear significant since most normal drinkers don’t maintain lengths nearing this time. If anything, you could argue anyone taking a single drink after years of sobriety is above average. As such, no length of abstinence meaningfully attaches to sobriety, meaning the measure is at the researcher's discretion which inspires various studies of AA effectiveness measured in days, weeks, months, years, etc.
Further complicating these methods, AA is not forthcoming with data on membership, and meetings don’t require formal registration, so quitters are not updated, meaning a member might belong to multiple AA groups or join once and never return. Even meta-analyses of decades of research often fail because researcher or data bias misrepresents AA effectiveness. For example, coerced AA participation and voluntary participation differ because those forced by courts to attend AA may not share the same motivation to follow the program as voluntary participants, and this can skew results.
Clarifying many of these research issues, a recent AA study performed by the Cochrane Review claims AA programs are more effective than other treatments for alcohol use disorder (AUD). Answering this claim, addiction expert Stanton Peele wrote a critical analysis of the Cochrane review in Filter Magazine, showing bias and flaws. Peele argued the review problems based on numerous points:
The review ignored the evidence for alternative approaches that are more flexible, patient-centered, and evidence-based.
Peele also described several methodological problems with the Cochrane review:
The inclusion of studies with low quality and high risk of bias
The exclusion of studies that compared AA/TSF (Twelve Step Facilitation) with other active treatments
The failure to account for confounding factors such as self-selection and dropout rates
The reliance on surrogate outcomes such as abstinence and remission rather than quality of life and harm reduction
The lack of consideration for the heterogeneity and diversity of AUD patients and their preferences
The disregard for the potential harms and ethical issues of AA/TSF, such as coercion, stigma, and religiosity.
Peele’s critique of the Cochrane Review reveals the bias often built into the research. It would seem obvious, from a research standpoint, that data collection methods issues combined with decades of social and treatment industry bias would call for more stringent testing, yet reports like the Cochrane review continue to overlook vital data.
Another factor, evidenced by AA’s total domination of the treatment industry, is the bias inherent in society and culture that assumes AA works. Courts, mental health professionals, parents, spouses, and government agencies would not suggest or force AA participation if they believed it did not work. This level of social bias condemns much opposition to being ignored.
Why would you entertain criticism of AA if you believe it already works? People don’t.
Convincing members and nonmembers of AA’s danger likens in frustration to converting an evangelist to atheism. The task’s difficulty stems from AA’s claim that death, insanity, or jail form the only alternatives, making any criticism weighted with a life and death struggle. (This says nothing of the faith factor involved.) Awareness of this resistance calls for a more rational, risk-associated, harm-avoidance approach used herein.
AA Is Ineffective Because It Doesn’t Treat The Problem
AA claims to treat any number of uncontrolled drinking causes, including a spiritual malady, character defects, an allergy, selfishness, self-will run riot, etc. This claim holds much interest since AA appears to remedy everything except the actual alcohol consumption problem using God, prayer, confession of character defects, providing help to another alcoholic, and other spiritual actions. The only thing AA tells you to do about drinking is “don’t drink, pray, work the steps, and go to meetings.”
None of the twelve steps tell you how to quit drinking.
None of the twelve steps have anything to do with drinking except promising you won’t drink as a byproduct of their performance.
You decided to quit drinking on your own before walking into the meeting, during the meeting, or after, but AA did nothing to make you quit.
Perhaps your compulsive drinking’s only cause resulted from the overindulgence of alcohol or circumstance, which means, like many people, you could remain sober or moderately drink. However, instead of resolving your drinking, on your own, by realizing your overindulgence and circumstance’s weight, you now belong to the AA fellowship, which blinds you to the real cause of your drinking. By being a diligent member of AA, you believe drinking results from anything but too much alcohol or a bad life experience. Now, instead of acquiring resilience to overindulgence and negative circumstances, you identify as weak, diseased by alcohol, and prone to uncontrollable drinking, whether ten years or two years sober.
You’re an accident waiting to happen when life takes a nosedive.
If you quit drinking via AA’s spiritual osmosis and have impulse control, depression, OCD, or some other underlying cognitive disorder, you risk serious harm because AA is, again, not treating your drinking’s causes. If you self-medicate with alcohol or drugs, you might start uncontrolled drinking by not treating your disorder. If you pegged sobriety to the AA group, the risk heightens in the eventual problem or dispute that makes you lose faith in AA members or the organization, even temporarily. Even if that doesn’t occur, life circumstances may change, and having not learned triggers and cues recognition particular to your real issue, you may likely sink back into uncontrolled drinking.
AA provides no resilience to the true causes of your drinking.
AA Is Ineffective Because It Is A Spiritual Program
AA’s strange definition of spirituality includes what appears to be religious rights cemented into their Twelve Steps, but AA disclaims the program with steps as suggestions. While suggesting their steps might exclude, at least on paper, the program from being a religion, by claiming the steps are suggestions, AA drains any credibility from its treatment method. Cures do not work when the patient picks and chooses; you either take chemo weekly as prescribed to treat your cancer or don’t and likely die. AA says everything (steps and meetings) are suggestions, meaning pick and choose which parts of the treatment you wish to perform.
Any other disease receives a treatment, not a treatment you pick and choose from.
Beyond the à la carte treatment and considerations of AA as a sect or cult, adhering strictly to the program’s self-declared identity as a spiritual program, the ineffectiveness of the program elucidates:
There are no known spiritual cures scientifically proven to work.
Spiritual cures fall into the realm of faith healing, psychic healing, and witchcraft. Even if AA claimed not to be a spiritual program, it is still a faith-based cure because AA claims God removes the compulsion to drink. To date, no supernatural or faith-based cures have proven scientifically effective, especially in place of modern medicine, and most of these treatments rely exclusively on anecdotal evidence, which often proves erroneous, placebo effect, coincidence, or fraud. Why do common sense, legal-inspired warnings of substituting alternative or spiritual remedies for medical treatment disappear when alcoholism is the problem?
Spiritual cures run the risk of not treating the problem and ultimately risking your life.
AA is Ineffective Because it is an Illusion
Members sometimes attend AA multiple times over days, weeks, or months before getting a sponsor and working the program: all while not drinking. If you are still drinking when you arrive at AA, many members will tell you to keep coming back but won’t help you with the steps until you stop drinking. AA, evidenced by the literature, does nothing to stop someone from drinking before working the steps; therefore, the program does nothing.
It is possible, even likely, you sat in a meeting, felt a moment of clarity or had a moment of inspiration, and resolved to quit drinking. You didn’t experience that moment because of AA or God. You had that moment because of a growing resilience or a strong motivation to quit obsessive drinking, perhaps both.
Almost no one comes to AA and gets sober on the first visit.
When you hear AA members discussing years of sobriety and spiritual experiences, either spontaneously felt or grown over time (AAs claim both), know they experienced the same resilience or motivation. (If you were not experiencing these forces, then why were you going to AA in the first place?) Members giving all credit to AA overlook AA inaction, and as a result, they reinforce the illusion of AA effectiveness.
Some AAs argue attendance, working the steps, praying to God, and making amends remove guilt and other negative feelings that cause drinking. These acts have nothing to do with abstinence since AAs don’t even work the steps until they stop drinking. Furthermore, if removing negative feelings, apologizing, and making other amends curbed the urge to drink obsessively, most drunks and addicts would achieve sobriety without attending meetings since so many repeatedly tried so hard and so many times to fix wrongdoings.
Disregarding everything just said, even if you go to AA and feel some spiritual awakening or motivation to quit drinking, you are ultimately the one who will raise the glass of booze to drink. According to AA, if you drink, you didn’t work the program correctly, and this forms a paradox of thought most AAs never consider: if I didn’t need the Twelve Steps to get sober enough to work the Twelve Steps, then how can improper step work cause me to relapse after starting the Twelve Steps?
Logically, you would be better off not working the steps.
If you treat yourself with an illusion, you might as well not receive any treatment.
Examples of AA’s ineffectiveness and danger abound, but ultimately, you must judge the program because of the great wall of bias surrounding the fellowship. Bing’s AI-driven search reveals this built-in bias when asking whether AA is effective.
According to several scholarly sources, Alcoholics Anonymous (AA) and other 12-step facilitation programs are effective treatments for alcohol use disorder (AUD). A meta-analysis of 27 studies found that AA and related interventions were more effective than other therapies in increasing abstinence, reducing drinking, and lowering health care costs²⁴⁵. AA is also the most commonly sought source of help for AUD in North America¹ and attracts a diverse membership¹.
(1) Meta-analysis supports AA as treatment for AUD. https://www.niaaa.nih.gov/research/niaaa-research-highlights/meta-analysis-supports-aa-treatment-aud Accessed 3/13/2023.
(2) Alcoholics Anonymous most effective path to alcohol abstinence. https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html Accessed 3/13/2023.
(3) Alcoholics Anonymous and other 12-step programs for alcohol use .... https://pubmed.ncbi.nlm.nih.gov/32159228/ Accessed 3/13/2023.
(4) Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol .... https://academic.oup.com/alcalc/article/55/6/641/5867689 Accessed 3/13/2023.
(5) New study shows how effective Alcoholics Anonymous really is - USA TODAY. https://www.usatoday.com/story/news/health/2020/03/11/alcoholics-anonymous-aa-helps-people-stay-sober-longer-study-finds/5008835002/ Accessed 3/13/2023.
Notice how the search engine returned only the latest findings by the Cochrane Review discussed by various sources and ignored Peele’s article along with many other articles countering that finding. AA’s favoritism stretches across every area of society and information systems, making alternative treatment nearly impossible to find.
It will be up to you to determine AA’s credibility