Disordered use of alcohol is a concern for millions of individuals worldwide, and – because of adjacent factors such as costs to the healthcare system, job loss, violence, and drunk driving – is also a pressing public health concern.
For decades, one of the best-known methods for treating alcoholism has been Alcoholics Anonymous (AA). Millions of people around the world turn to 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 over alcohol – has gained worldwide acceptance. The organization has local chapters around the globe, and has been depicted in popular culture so often that it’s probably the first treatment method that comes to mind for most people who consider seeking treatment to reduce their alcohol intake or want to embark on a sober lifestyle.
But AA wasn’t devised by scientists or medical doctors. Rather, the method itself, as well as its underlying philosophy, was developed by two men – Bill Wilson and Bob Smith – as a result of their own enduring struggles with drinking. Yet 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 whose results are uncertain or exaggerated? Is there, in fact, any hard science to support the effectiveness of AA as a legitimate treatment for the disease that behavioral health professionals call alcohol use disorder?
The New Stanford Study
Scientists at Stanford recently undertook to examine those questions, in a study that compared AA and twelve-step facilitation with other methods of treatment, such as motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT).
In order to embark on this study, Dr. Keith Humphreys – a professor of psychiatry and behavioral sciences – and his colleagues first had to determine how to evaluate the effectiveness of the methods they intended to compare. Alcohol abuse is a complex phenomenon. What outcomes would constitute success? And how, for the purposes of the study, would the costs of alcoholism be defined?
The most obvious desired outcome is a change in behavior of the participant seeking treatment. Did AA lead to abstinence more often, and more reliably, than other methods? And were there other measurable outcomes that could be evaluated?
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.
Overwhelmingly, the data showed that AA is the most effective intervention for promoting abstinence. They also found that the twelve-step-method is likely a factor in reduced healthcare costs, and that it lowers the incidence of alcohol-related violence, accidents, and other consequences of heavy or disordered alcohol use.
What Makes AA So Effective?
Further study is needed for a conclusive analysis. But one widely-known aspect of twelve-step intervention and the AA approach is its meeting-based structure. Dr. Humphreys and his colleagues concluded that this aspect of AA was key to its success in changing behavior.
That sounds simple, but the findings have sound basis in behavioral science.
AA meetings reinforce social structures that allow members to support each other in examining their behaviors, making changes, and sticking to new habits. Humans are social animals, and social interactions have a profound influence on their behavior. Support from peers can range from practical advice, such as simple tips and life hacks, to emotional support and a shoulder to cry on.
Why would this simple support from ordinary people work as well as, and in many cases better than, therapeutic intervention from a trained professional?
Simply put, humans have evolved over centuries to communicate with each other and learn from each other’s experiences. Hearing from someone who has been there, knowing that they faced similar challenges and struggles – and succeeded in overcoming them – may provide a dose of optimism that makes the difference between sticking to a sober path and relapse.
A final note: the support of therapeutic methods such as MET and CBT was also found to be effective, and there is no evidence to suggest that combining AA with therapeutic intervention would decrease its effectiveness. Indeed, though further study is needed, a combined approach may prove to be the most effective intervention of all.