In Praise of Tuesday’s 6pm Meeting, Free Coffee* and Knowing Smiles

By Robert Castan 06/01/21

Research shows that full and active participation in AA performs better over time than first-line clinical treatments to keep recovering alcoholics alcohol-free and in recovery.

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Group therapy or AA meeting: several people sit in folding chairs in a circle

Even before they get into recovery (and, hopefully, they do get there one day), alcoholics already know all about the idea of a “Higher Power” - the concept that there is an unseen, spiritual force above all of us in the great scheme of things, more powerful than our humble selves, and far more in control of everything than we are.

In fact, you could say alcoholics, when they’re actively drinking, have been regularly worshipping one specific “higher power,” albeit straight from the neck of the bottle, on a daily basis for years and years, and sometimes even 24/7, on a particularly inspired day.

As an AA acquaintance, after an especially freezing winter’s night meeting in Seattle, once said to me: “Let’s face it - they don’t call it spirituality for nothing, you know. S-p-i-r-i-t-uality. That’s so stupid, even old drunks like me can understand it.” Yes, she really did s-p-e-l-l it out like that.
 

“F.E.A.R. = Face Everything And Recover”
- Old Alcoholics Anonymous (AA) Proverb


So, here’s the thing.

Regardless of what you may believe to be true of Alcoholics Anonymous, whether you think it’s just old and bearded, God-fearing guys getting together every week, and telling each other drinking war stories, or simply an exceptionally good example of how we can find real healing for ourselves and for each other within a supportive community network, there has always been one specific point that has always been vehemently debated.

Everyone from the addiction experts, the medical clinicians, and the mainstream media, right down to a couple of die-hard drinkers arguing in a bar, the question remains the same, and so do the arguments for and against.

The question is this: Does AA actually work?

You may have missed it, as the following results came out during 2020 when the majority of our minds were rightly firmly focused elsewhere, but now there is proof - and clear, 100% proof, at that (and yes, pun intended). It’s official - well, as official as these things can be.

Yes, AA really does work.

AA Provides Powerful, Cost-Effective Addiction Treatment

Hold the front page. What? Let’s repeat that… Alcoholics Anonymous really does work. Tuesday’s 6pm meeting, “free” coffee (pop your coins in the jar, please, newcomers), friendly faces, knowing smiles, even the old war stories that say, “It’s okay, brother, sisters, I’ve been in that hell you now find yourself in. I got out, and you can, too. You’re not alone,” and everything else - put it all together, it works.

AA works. Now we know. Got that? OK, if that isn’t enough, now here’s the real bombshell - the “hold-the-front-page” headline:

Active involvement in the AA’s 12-Step program is as good as any other form of addiction treatment.

Based upon the clinical results of 27 peer-reviewed studies, representing over 10,000 participants, and in the very first analysis of its kind, supported by the U.S. National Institute of Alcohol Abuse and Alcoholism (NIAAA), active involvement in the AA’s 12-Step program performed as well as first-line clinical interventions at the end of treatment for keeping people abstinent from alcohol - and, therefore, sober.

Clear-headed, 100% sober.

Furthermore, in the majority of these 27 studies, which had to go through rigorous criteria to be included, full participation in AA even performed better over timed follow-ups - specifically at 6, 12, 24, and 36 monthly intervals - after the end of first-line clinical treatment for ensuring sobriety.

That’s definitely worth repeating: Full and active participation in AA even performed better over time than first-line clinical treatments in keeping recovering alcoholics alcohol-free and in recovery.

The proof comes from an ongoing review study, “Alcoholics Anonymous and Other 12-Step Programs for Alcohol Use Disorder,” which is being conducted through the esteemed Cochrane Library’s program of systematic clinical reviews, considered the gold standard in scientific rigor for medical research.

This particular report, produced by the Recovery Research Institute, a leading nonprofit research institute of Massachusetts General Hospital (and an affiliate of Harvard Medical School), represents the most comprehensive and up-to-date review and analysis of the medical research community’s current and historical scientific literature on the effectiveness of Alcoholics Anonymous.

More on the report, its evidential findings, and what it all means for the field of addiction treatment and recovery later in this article.

Lockdowns, Locked Doors and Lost Recoveries

Let’s just remind ourselves of what the COVID-19 pandemic did to the absolutely huge number of AA meetings, here in the U.S.: When the stay-at-home orders came and the quarantine lockdowns began, every one of these meetings either had to move online or come to a temporary end.

The once open doors of church halls, community centers, town halls and the like were now firmly closed, and the tough-looking padlock locking you out told you everything you needed to know about the fate of your usual 6pm Tuesday evening meeting.
 

“F.E.A.R. = F*** Everything And Run”
- Alternative AA version

 

Knowing what we know now about exactly how effective these AA meetings are in keeping their regular attendees safely on the recovery wagon, it stands to reason that, when the lockdowns came, countless alcohol addiction recoveries simply fell by the wayside, lost to those who had previously relied on the camaraderie, the warm friendship, and the sense of real fellowship their local meetings provided to keep them focused, alcohol-free, and firmly in recovery.

Fortunately, things are changing. According to the latest government figures, around 62% of U.S. adults have had at least one vaccination shot, and over 135 million are now fully vaccinated.

Last month, the White House proudly declared the country was finally getting to grips with a virus that has taken over half a million lives across the nation to date, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recently stated, "We do need to start being more liberal, as we get more people vaccinated."

Importantly for the usual participants of AA meetings, no doubt extremely fed up staring into a computer screen, very soon they will once again be meeting in-person - together again, with the free coffee* and the knowing smiles.

Always on the Edge of Accepted Addiction Treatment

Alcoholics Anonymous, one of many 12-Step programs and similar mutual-aid programs around today, is easily the world’s most widely available and most used support group for recovering substance addicts. During its 85-year history, it has supported countless millions of alcoholics, spread all over the globe, to find a manageable and sustained recovery from their own personal version of this chronic disease.

However, as we said earlier, AA’s efficacy has always had the clinical doubters and expert naysayers, and so, as viable addiction treatment, it has always been right out there on the edge of accepted treatment.

Regardless, it does have its rightful place in the “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition),” published by the National Institute on Drug Abuse (NIDA), which states, “Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.”

Hopefully, the editors at NIDA will now edit the sentence to read does help maintain abstinence.” Who knows? On the basis of this article, they may even publish a Fourth Edition...

Back to the doubters. The late 20th century saw clinical scientists and addiction experts begin (once again) to question and debate its actual effectiveness, often citing a lack of cohesive and reliable data for analysis. Fortunately, we now have that data - an additional 30 years' worth, both cohesive and reliable, to draw on for analysis.

Not only that, the researchers have now:

  • Developed highly sophisticated methods for evaluating AA
  • Thoroughly tested its clinical interventions, and
  • Developed a rigid methodology to compare these interventions to other treatments, such as Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET).

Twelve-Step Facilitation (TSF)

In addition, their analysis included another recognised treatment strategy, directly allied to AA, and known as “Twelve-Step Facilitation” (or TSF, for short). TSF is an active engagement strategy included as standard in many professional treatment programs which directly links current program participants to 12-step mutual-aid organizations like AA, and encourages the active engagement and involvement of those people.

Effectiveness and Cost Study of Alcoholics Anonymous (2020)

So, sadly without a suitable fanfare, let’s provide a more detailed summary of the study’s findings, in terms of both the effectiveness and cost benefits of AA and TSF compared to other first-line clinical interventions, namely the standard therapies of CBT and MET:

Effectiveness

  • Alcoholics Anonymous and Twelve-Step Facilitation (AA/TSF) produced rates of alcohol abstinence, and subsequent alcohol use, comparable to first-line clinical interventions, and outperforms them over follow-up; for example:
    • a 21% lower risk of a return to alcohol use among AA participants compared to those receiving other clinical interventions at 12-month follow-up.
    • a 66% lower risk of a return to alcohol use among AA participants compared to those receiving other clinical interventions at 6-month follow-up.
  • Specifically, AA/TSF was found to be better than other standard treatments (eg. CBT and MET) in achieving:
    • Continuous abstinence, and
  • Specifically, AA/TSF was as effective as other standard treatments in reducing:
    • The intensity of drinking
    • Alcohol-related consequences, and
    • The severity of AUD.
  • Lastly, AA/TSF showed a higher percentage of days abstinent from alcohol use; for example:
    • at the 24-month stage, an average improvement of 12.1% days, and
    • at the 36-month stage, an average improvement of 6.6% days.

Cost

In addition to the overall effectiveness of AA/TSF as an addiction treatment in its own right, the Recovery Research Institute researchers took the opportunity to assess cost comparisons between the 12-Step program and the traditionally recognized therapies.

In a 3-year follow up study of individuals with severe AUD, the researchers found that AA participants had alcohol-related outcomes comparable to outpatients receiving clinical addiction treatment, yet their alcohol-related health care costs associated with AA participation were considerably lower - 45% lower, in fact, representing a cost-saving of $2,856 per participant.

What Does AA’s Proven Effectiveness Mean for Addiction Treatment?

The report’s implications are undeniably extensive, affecting current and future recovering alcoholics, their families and loved ones, the field of addiction treatment and recovery, including both the medical researchers and addiction treatment businesses, and, particularly when you consider the cost-saving aspects, even right up to the policy makers in federal government.

For example, if a recovering alcoholic is opposed to AA in some way, they really should consider alternative mutual-aid organizations, such as Self-Management and Recovery Training (SMART), LifeRing, Refuge Recovery, and Women for Sobriety, and then actively participate in the group of their choice.

Certainly, far more research is needed around AA and other mutual-aid programs to discover what it is about the concepts and practicalities of each that drives these levels of engagement. With the additional benefit of significant cost-savings, hopefully, in the future, it will result in professional addiction treatment being far more accessible to more people who need it.

Increased access to alcohol addiction treatment is certainly something that desperately needs to happen, and happen soon, especially when you consider the following recent statistics:

  • Only 7.2% of people, aged 12 and older, who had AUD in 2019 received any treatment, and
  • Furthermore, only 6.4% of adolescents, ages 12 to 17, who had AUD in 2019 received any treatment.


*(Pop your coins in the jar - thanks)

 

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Robert Castan.jpg

Robert Castan is the CEO of SpringBoard Recovery in Scottsdale, Arizona. Robert started his professional career as a house manager and has become an industry leader and trusted voice in the treatment world. He brings extensive knowledge of organizational growth, industry-leading outcomes, and comprehensive marketing to SpringBoard Recovery.
 
Robert has been walking his own path of recovery for over 10 years.  This path has truly driven his ambition to help make treatment available to others who are struggling with addiction.  Robert finds great joy in traveling and keeping physically active, with an emphasis on biking. Robert resides in Arizona with his husband and two four-legged children.