How Does AA Work? Just Fine
Despite passionate arguments pro and con, a recent study shows that the 12-step process continues to be effective treatment for alcoholism.
I have read in the comment sections on The Fix that AA is a sadistic cult. I have also read testimonials such as “AA saved me from myself and I would be dead without it.” I have read that AA is willy-nilly fear-based faith healing. I have read an experience written by a man who was sober for 26 years, who quit going to AA, drank, and lost everything. I have read that members of AA told other members to stop taking their medications, and as a result, committed suicide.
The above anecdota are probably all, to an extent, somehow, true. But I continue to find myself a stranger in a strange land when I enter comment sections. That’s not to say I don’t enjoy open forums of expression—I’d probably miss them if they disappeared, after all they’re quite amusing—but what I am sensitive to are people forming their opinions based on anecdotoids and ad hominem diatribes from ungrounded and unfounded sources.
Reading the anecdota, especially while you’re navigating the Internet for information to help yourself, can both infect and prime your experience while out in the world. For example, take self-diagnosis via WebMD. We all know it’s a bad idea but people continuously lose sleep over internet medical diagnoses. The same goes for all of the polarizing views on recovery, but even more so when AA is in question. The dichotomy alone will leave you baffled.
This article, however, will avoid polarizing sentiments and explain—in as plain of English as possible—a recent study published in the Journal of Substance Abuse and Treatment, and later adapted by Counselor Magazine as: Understanding twelve step involvement from a research perspective (Majer, Jason, & Ferrari, 2014).
Consider this an effort to show that rigorous scientific methodologies are being applied to twelve-step ideology. And it is the research that I am about to relay to you that people should place over the already mentioned anecdotoids when forming opinions about AA’s efficacy and the current systems of recovery in America.
And on that same note, cherry picking through comment sections—and actually using those comments made by someone who might be in AA—to support your arguments, while considering yourself an expert in the field, is part of the problem.
That it isn’t to say, though, that the current model doesn’t need improvement, and that we shouldn’t be critical of such a complex. We should be critical. But one must be informed in order to be critical properly, is all.
Conducted out of DePaul University’s Center for Community Research, the present study recruited 150 persons who were exiting an inpatient treatment center in northern Illinois.
Once recruited, participants were randomly assigned to two groups. Group 1 assigned participants to live in an Oxford House (SAMHSA approves of the Oxford House model). Group 2 assigned people to “usual after-care.” I asked the second author, Dr. Leonard Jason, director of the Center for Community Research at DePaul University, what was meant by “usual after-care.” He said, “It often involved going back to family or friends, or other places such as shelters or wherever they can find a place to live, even if temporarily.”
Once assigned to the two conditions (Oxford House or usual after-care), participants were interviewed every six months over a two-year period. What I found to be nothing short of amazing about this specific study was that the research team was able to keep track of over 85% of both their groups. Drug addicts and alcoholics are not the easiest population to keep track of.
The participants were interviewed every six months up until two years as to whether or not they were still abstinent from both drugs and alcohol. Participants were also scored, at each interview, as to whether or not they were categorically involved in AA. This means that those participants who met these four criteria: doing service work, having a sponsor, reading the literature, and calling other members for help were scored as being “categorically involved.” Participants who met 3 or less of these criteria were not categorically involved.
Another intelligent nuance of this study was that meeting attendance was not part of the criteria for categorical involvement. The study explained this by noting that meeting attendance is too inconsistent of a measure to really understand if one is actually involved in AA or not. For instance, someone who is new might go to 5 meetings a week whereas someone “with time” will go to 1 meeting every few weeks, and both would consider themselves members. There was also mention that meeting attendance has been linked to polarizing outcomes across studies. For these reasons, meeting attendance was left out of this study altogether.
Results and Implications
• Participants who were scored as being “categorically involved” (meeting all four of the aforementioned criteria) were 2.8 times more likely to maintain abstinence from both alcohol and illicit drugs at two years than those who were not categorically involved.
• Participants who were randomly assigned to Group 1 (Oxford House) were 5.6 times more likely to remain abstinent from drugs and alcohol at 2 years than those in Group 2 (usual after-care).
In sum, these results mean that those who remained involved (categorically: having a sponsor, reading the literature, doing service work, and calling other members for help) in AA, two years post-treatment, were more likely to be sober than those who were not.
This study also shows that those who live in an Oxford House (or possibly a recovery home) after treatment are far more likely to remain sober at the two-year mark than those who do not live in a communal residential setting.
There were other results of this study that were more specific to researching self-report instruments, and for the purposes of this post I left those results out.
A method of this study one may find problematic is that the population was clinical, meaning participants were recruited upon their exiting an inpatient treatment center. This is a valid concern because many treatment centers today are 12-step based. The research team of this study suggested that future research ought to make use of a community-based sample, meaning people randomly selected from the community, not those who found their way into a treatment center, would comprise the population of the study.
Many who read The Fix, who do not believe AA to be an effective support group, may scoff at these results—and that is OK. If people are truly dedicated to social change, as the researchers who conducted this study are, they will then amend the system from the inside out. Hijacking and trolling Internet comment sections will not cut it. The fact is, clinicians read studies like the one I just presented and in the discussion section of such studies the researchers can advise clinicians to,
“Encourage clients' active and concurrent involvement in a number of Twelve Step activities early in their recovery such as the ones used in the present study, and consider referrals to self-run, communal-living settings like Oxford Houses” (Majer, Jason, & Ferrari, 2014).
Please note, I am not saying AA is the end-all-be-all of solutions. That is nonsense. I’d like to see more options available for people. I am also not saying that AA gets and keeps people sober. All that I am saying is what a scientifically rigorous research design found, which is that AA increases your chances. Period.
I’m a realist when it comes to AA. I don’t believe in spiritual realms or any beyond-worlds. I don’t think spiritualism is required to beat any illness. But it also doesn’t matter what I believe because today in America doctors, clinicians, and other professionals look toward empirical results—positivism!—and such are the results that have just been presented to you. And so long as studies like the one I just presented are finding these results (there are many more where this came from), AA will still be recommended to people seeking help.
Alleged AA brainwashing conspiracy agendas, coupled with ad hominem circumstantial arguments, will not bring about a meaningful reevaluation of recovery in America. In order for there to be a dramatic overhaul of the current recovery-complex, it must be shown—proven rather—that it is broken.