Disordered use of alcohol is a significant problem for millions of people worldwide, and – because of adjacent factors such as costs to the healthcare system, job loss, violence, and drunk driving – it’s also a significant public health concern.
One of the best-known methods for treating alcohol use disorder is Alcoholics Anonymous (AA). Millions of people around the world use AA for support and guidance as they seek a path to sobriety.
Founded 80 years ago, AA – comprised of the familiar twelve steps, and characterized by the acknowledgment of powerlessness before alcohol – is now a worldwide presence. The organization has local chapters around the globe, and is depicted in popular culture so often that it’s probably the first treatment method that comes to mind for people who want to quit drinking.
But scientists and medical doctors didn’t create AA. The method itself, as well as its underlying philosophy, was developed by two men: Bill Wilson and Bob Smith. They created AA because of their own problems with drinking. Despite these humble origins, millions of people rely on AA year after year to get and stay sober.
Because of this, AA often faces skepticism within the medical and scientific community. How can a method devised by two non-scientists be so effective? Is AA really as effective as its reputation would suggest? Or is it merely a popular approach with unverified or exaggerated results? Is there, in fact, any hard science that indicates AA is a legitimate treatment for alcohol use disorder (AUD)?
The Stanford Study
Scientists at Stanford recently examined those questions in a study that compared AA with other methods of treatment, including motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT).
To conduct the study, Dr. Keith Humphreys – a professor of psychiatry and behavioral sciences – and his colleagues first determined how to evaluate the effectiveness of the methods in question. Alcohol use disorder (AUD) is a complex phenomenon. What outcomes constitute success? And how, for the purposes of the study, would they define the costs of AUD?
The most obvious desired outcome is a change in behavior of the participant seeking treatment. Did AA lead to abstinence more often than other methods? Was it more reliable than other methods? And were there other measurable outcomes to consider?
Increased Abstinence and Lowered Health Care Costs
For the purposes of their study, the scientists decided to focus on measurable data sets to define success. These included:
- The duration of time that subjects refrained from drinking alcohol
- The amount they reduced their drinking overall if they didn’t abstain completely
- Their health care costs
The investigators looked at data from over 27 different studies, with a total of over 10,000 participants, ranging in age from 34 to 51.
The data showed that AA is an effective intervention for promoting abstinence. They also found that the twelve-step method is likely a factor in reduced healthcare costs, reducing the incidence of alcohol-related violence, accidents, and other consequences of heavy or disordered alcohol use.
What Makes AA Effective?
We need more data for a conclusive analysis, but one aspect of twelve-step programs and the AA approach that appears to help people is the meeting-based structure. Dr. Humphreys and colleagues concluded this element of AA is a key to its success in changing behavior.
That sounds simple, but the group approach is based on behavioral science.
AA meetings reinforce social structures that allow members to support each other in all aspects of recovery. These include examining their behaviors, making changes, and creating and sticking to new habits. Humans are social creatures. Social interactions have a profound influence on behavior. Support from peers can range from practical advice, such as simple tips on how to have fun without drinking, to emotional support, to genuine fellowship.
Why does this simple support from ordinary people work so well?
According to the Stanford study, it’s about our development as a species. Humans evolved over millennia to communicate and learn from each other’s experiences. Hearing from someone who’s been there, knowing that they faced similar challenges and struggles – and succeeded in overcoming them – provides a dose of optimism. Often, it can make the difference between staying sober and relapsing.
A final note: the Standford study showed therapeutic methods such as motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) worked in treating AUD, too. That supports research that shows a multi-modal approach to addiction treatment – often called integrated treatment and/or holistic treatment – is the most effective path to long-term, sustained sobriety. In fact, most well-regarded treatment programs use the integrated approach. They combine individual therapies like CBT with group therapy, and lifestyle changes, which include diet, exercise, and mindfulness techniques. With the added benefit of community support programs like AA, these full-spectrum, holistic programs achieve the most favorable outcomes for people seeking long-term sobriety.