Does AA Work and How Effective Are 12-step Programs?

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Does AA Work Effectiveness of 12-step Programs

By:  Rick Fannin

Twelve-step self-help groups, like Alcoholics Anonymous, are an important component of the system of care for individuals recovering from drug or alcohol addiction and substance use disorders.  As many as 9% of adults in the United States have attended an Alcoholics Anonymous (A.A.) meeting at some point in their life, and more than 3% have attended a 12 step meeting in the last year.  Worldwide, A.A. host more than 160,000 meetings with more than 2,000,000 people attending at least meeting in any given year [5].  But does AA work, and how effective are 12-step programs?

12-Step programs like Alcoholics Anonymous and Narcotics Anonymous have remained one of the go-to methods of recovery for millions upon millions of individuals. Whereas the programming at most alcohol and drug rehabs is heavily dependent on counseling and psychotherapeutic methods, the 12 Step method is more about one’s emotional, social, and spiritual recovery from alcoholism or drug addiction. In fact, while 12-Step groups are often recommended as a means of sustaining one’s sobriety after completing a treatment program, it’s not uncommon for professionals to devalue the 12 Step method 1 as a primary recovery tool.

12-Step literature acknowledges the disease model of addiction, but it seems to incorporate a scientific paradigm into its spiritual recovery modality. With a closer look at the 12 Step method, it becomes increasingly clear that there are numerous scientifically-based processes underlying much of the 12-Step recovery method.

The disease of addiction can be described as a primary, progressive, chronic, and relapsing disorder.  Twelve step programs, like A.A., or Narcotics Anonymous (N.A.), and other 12 step support groups can provide additional support during and after formalized treatment that allows for success in achieving long-term sobriety from addiction.

Drug Addiction Relapse Rates

The relapse rates for drug addiction and alcoholism are comparable to those for other chronic relapsing diseases. According to a 2014 studyRelapse Rate

Relapse Rate from the Journal of the American Medical Association (JAMA), relapse rates for drug addiction range from 40 to 60 percent.

This 40-60% relapse rate for drugs or alcohol is similar to the relapse rates of other diseases.  For example:

  • Type 1 Diabetes: 30-50%
  • Hypertension: 50-70%
  • Breast Cancer: 40-50%
  • Colon Cancer: 50%
  • Asthma: 50-70%

Different Types of 12-Step Program with a Common Formula

Many different 12-Step programs exist to help individuals work toward their goals.  12 Step groups are a model for self-help that originated with Alcoholics Anonymous in 1939.  The goal of these groups is to provide the social support needed to remain abstinent from drugs and alcohol.  The foundation of these groups is that it is a fellowship of men and women who are willing to share their experience, strength, and message of hope so that others may recover from addiction.

People dependent on drugs, alcohol, or gambling, or other behaviors have found that others who have had similar struggles can provide enormous support and help to one another.  For this reason, these groups are called fellowships, where participants show concern and support for one another through sharing and understanding.

Different Types of 12-Step Programs

From A to Z and everything in between, there are more than fifty types of 12 step programs. Many of these programs are strictly based on the same 12 steps developed by Alcoholics Anonymous. Others are loosely based on these steps. There is a type of 12 step program for most anything’ from A.A. (Alcoholics Anonymous) to W.A. (Workaholics Anonymous). The myriad of problems covered range from social issues (like gambling) to drugs (alcohol, cocaine, heroin), eating (overeaters and eating disorders) and support for family members and friends who are in the 12 step programs (i.e. Al-Anon and Alateen).

Some of the more popular 12-step programs include:

  • AA – Alcoholics Anonymous
  • Al-Anon - Codependency
  • CA – Cocaine Anonymous
  • CMA – Crystal Meth Anonymous
  • CR – Celebrate Recovery
  • FAA. – Food Addicts in Recovery Anonymous
  • GA – Gamblers Anonymous
  • HA. – Heroin Anonymous
  • MA – Marijuana Anonymous
  • NA – Narcotics Anonymous
  • OA – Overeaters Anonymous
  • OLGA – Online Gamers Anonymous
  • SA. – Sexaholics Anonymous
  • SAA – Sex Addicts Anonymous
  • SLAA – Sex and Love Addicts Anonymous

The Common 12-Step Formula

While the methodology of each program differs, the purpose of a 12-step program is always the same –to help people struggling with addiction. The process includes different steps and goals that each member adheres to and accomplishes. According to the American Psychological Association, some common steps and principles of the twelve-step process include:

  1. Honesty: After many years of denial, recovery can begin with one simple admission of being powerless over alcohol or any other drug a person is addicted to. Their friends and family may also use this step to admit their loved one has an addiction.
  2. Faith and Hope: Before a higher power can begin to operate, you must first believe that it can. Someone with an addiction accepts that there is a higher power to help them heal.
  3. Surrender: You can change your self-destructive decisions by recognizing that you alone cannot recover; with help from your higher power, you can.
  4. Soul searching: The person in recovery must identify their problems and get a clear picture of how their behavior affected themselves and others around them.
  5. Integrity: Step 5 provides a great opportunity for growth. The person in recovery must admit their wrongs in front of their higher power and another person.
  6. Acceptance: The key to Step 6 is acceptance—accepting character defects exactly as they are and becoming entirely willing to let them go.
  7. Humility: The spiritual focus of Step 7 is humility or asking a higher power to do something that cannot be done by self-will or mere determination.
  8. Willingness: This step involves making a list of those you harmed before coming into recovery.
  9. Forgiveness: Making amends may seem challenging, but it can be a great way to start healing your relationships for those serious about recovery.
  10. Maintenance: Nobody likes to admit to being wrong. But it is a necessary step to maintain spiritual progress in recovery.
  11. Spiritual Connection: The purpose of Step 11 is to discover the plan your higher power has for your life.
  12. Service: The person in recovery must carry the message to others and put the principles of the program into practice in every area of their life.

What are the Benefits of 12 Step Programs Like Alcoholics Anonymous?

The major strength of A.A., then, is that it’s everywhere, with thousands of meetings a day and millions of members.  The other benefit of 12-step programs is that they are free, unlike formalized counseling and addiction treatment.  This can provide continuity of support following formalized addiction treatment.

 

The power of A.A. and the 12 steps instead lies in shifting social networks, bringing people who struggle with alcohol addiction together. That gives people an essential outlet for discussing challenges and coping mechanisms related to addiction with others who can credibly relate to the struggle of getting into recovery while also providing a social check on unwanted behaviors.

The Study of 12-Step Programs

Alcohol addiction is by far the most prominent kind of drug addiction in the U.S. Based on federal data, more than 20 million Americans 12 or older had a substance use disorder in 2018, and nearly 15 million of those had an alcohol use disorder. Excessive drinking alone is linked to 88,000 deaths each year, with that death toll rising in recent years. So, A.A. and 12-step treatment’s potential effectiveness for some people with alcohol addiction is a big deal.  For many, A.A. has saved their life.

A.A. was the first of the 12 step programs, and given the prominence of alcohol abuse, A.A. has been the primary focus of research regarding the effectiveness of 12-step programs.  Additionally, given that there are over 50 types of 12-step “anonymous” programs, independently researching the effectiveness of each one would be an expensive and daunting task.

What Is the Success Rate of Alcoholics Anonymous?

Success is a vague term to describe the prognosis of recovery from addiction.  Some people never relapse, while others relapse and never relapse again after that initial bump in the road.  Others may discontinue the use of drugs or alcohol but never fully recovered because of untreated mental health issues, poor relationships, shame, long-held resentments, and other barriers to wellbeing.

There isn’t an exact success rate available since many of the results are published by A.A. and vary based on several factors.   Because A.A. is anonymous, some group members don’t participate in studies since it could breach the anonymity of the group.  Many want their participation in A.A. to remain unidentified, in line with the group’s original intention.  Additionally, participants might not want to admit relapsing.

Moreover, the people who attend meetings change constantly since people often drop out.   In fact, 40% of people drop out of A.A. during the first year.[6]

Although some sources have criticized A.A. for having a low success rate, the rate likely isn’t 5% like some say it is.[7]

  • Addiction specialists cite success rates slightly higher, between 8% and 12%.[7]
  • Alcoholics Anonymous Big Book touts about a 50% success rate, stating that another 25% remain sober after some relapses.[9]
  • A New York Times article stated that A.A. claims that up to 75% of its members stay abstinent.[8]
  • A study conducted by A.A. in 2014 showed that 27% of the more than 6,000 members who participated in the study were sober for less than a year. In addition, 24% of the participants were sober 1-5 years while 13% were sober 5-10 years. Fourteen percent of the participants were sober 10-20 years, and 22% were sober for 20 or more years.[5]

The National Institute on Alcohol Abuse and Alcoholism featured results on a long-term study on A.A. members. The study consisted of formally treated, informally treated (A.A.), and untreated individuals who suffered from an alcohol problem.[10]

  • The one-year and three-year follow-up points indicated that half of the participants who entered A.A. on their own were abstinent. In contrast, only a quarter of those who entered into formal treatment was abstinent at the follow-up time.
  • The eight-year follow-up showed that 46% of those who chose formal treatment were abstinent, while 49% of individuals who attended A.A. were abstinent.
  • Results revealed that those with alcohol issues who participated in both formal treatment and A.A. were more likely to be abstinent than those in formal treatment between years one and three but did not show much difference in abstinence rates after eight years. This group did not show much difference from the AA-only group across the follow-up period in terms of abstinence rates.
  • The results concluded that for some, A.A. attendance could be a source of recovery.

A study conducted on males from the U.S. Department of Veterans Affairs showed abstinence rates of those recovering from alcohol abuse at one year and 18 months. Approximately 20-25% of those who didn’t attend a 12-step program, such as A.A., or another aftercare program were abstinent from alcohol and drugs after one year.

On the other hand, the abstinence rate was nearly twice as high for those who attended A.A. or another similar 12-step program without any aftercare. The results showed that the more meetings people attended and the longer they were in the program, the greater the chances of alcohol and drug abstinence.[11]

Another study mentioned in the same publication observed a smaller outpatient sample. The results concluded that over 70% of those who attended a 12-step program weekly for six months before the two-year follow-up point were abstinent from alcohol.

Another study conducted on those with an untreated drinking problem showed 70% of those with 27 weeks or more in A.A. were abstinent from alcohol at the 16-year follow-up mark. Moreover, the study revealed those with a shorter duration of time in A.A. had lower abstinence rates.[11]

Outpatient Addiction Treatment and Twelve-Step Support Groups

While certainly, millions worldwide have been successful at overcoming addiction by fully utilizing the 12-step approach.  However, for many, formalized treatment, professional counseling, and medically assisted treatment are necessary to stop illicit substance use.

Possibly the solution that offers the greatest odds of success in recovery is to hedge your bets and do both outpatient addiction treatment and incorporate 12 step support groups.  Many treatment centers still utilize or encourage patients to attend 12 step groups as part of their recovery. Working the 12 steps and attending meetings are considered evidence-based solutions in the recovery field [11].

Research shows that 46% that complete formal treatment remains abstinent [10].  However, the abstinence rate is nearly doubled for those who complete formal treatment and include attendance and participate in 12-step programs as part of their daily recovery plan [11].

Those looking for a recovery support group after they’ve already sought out addiction treatment may benefit greatly from a 12-step approach. However, people should research their options and determine which type of self-help support group would best fit their needs.

Sources

  1. Alcoholics Anonymous. Historical Data: The Birth of A.A. and Its Growth in the U.S./Canada.
  2. Alcoholics Anonymous. (2017). This is A.A. An introduction to the A.A. Recovery Program.
  3. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
  4. Substance Abuse and Mental Health Services Administration. (2017). Behavioral Health Barometer, United States, Volume 4.
  5. Alcoholics Anonymous. 2014 Membership Survey.
  6. Lilienfeld, S. and Arkowitz, H. (2011). Does Alcoholics Anonymous Work? Scientific American.
  7. Stein, J. and Forgione, M. (2011). Charlie Sheen claims A.A. has a 5% success rate – is he right? Los Angeles Times.
  8. Friedman, R. (2014). Taking Aim at 12-Step Programs. The New York Times.
  9. Alcoholics Anonymous World Services, Inc. (2001).Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered From Alcoholism.
  10. Kelly, J. and Yeterian, J. The Role of Mutual-Help Groups in Extending the Framework of Treatment. National Institute on Alcohol Abuse and Alcoholism.
  11. Kaskutas, L.A. (2009). Alcoholics Anonymous Effectiveness: Faith Meets ScienceJournal of Addictive Diseases, 28(2), 145–157.

 

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