Editing Alcoholics Anonymous (section)

=== Reviews and studies ===

==== Long-term recovery effectiveness ====
There have been numerous studies on the effectiveness of AA. A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate 16 years later for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment.<ref name="PMC2220012">{{cite journal |last1=Moos |first1=Rudolf H. |last2=Moos |first2=BS |date=June 2006 |title=Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals |journal=Journal of Clinical Psychology |volume=62 |issue=6 |pages=735–750 |doi=10.1002/jclp.20259 |pmc=2220012 |pmid=16538654}}</ref><ref name="PMC4285560">{{cite journal |author=Humphreys |author2=Blodgett |author3=Wagner |year=2014 |title=Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials |journal=Alcoholism: Clinical and Experimental Research |volume=38 |issue=11 |pages=2688–94 |doi=10.1111/acer.12557 |pmc=4285560 |pmid=25421504}}</ref>  However, this may be influenced by [[self-selection bias]].<ref name="PMC2746426">{{cite journal |last1=Kaskutas |first1=Lee Ann |year=2009 |title=Alcoholics Anonymous Effectiveness: Faith Meets Science |journal=Journal of Addictive Diseases |volume=28 |issue=2 |pages=145–157 |doi=10.1080/10550880902772464 |pmc=2746426 |pmid=19340677}}</ref><ref name="UnbrokenBrain">{{cite book |last=Szalavitz |first=Maia |title=Unbroken Brain: A Revolutionary New Way of Understanding Addiction |date=2016 |quote=the research that does show AA to be effective is overwhelmingly flawed by what is known as selection bias.}}</ref> [[Project MATCH]], a 1990s multi-site study, found AA to be more effective than no treatment.<ref>{{cite news |author=Keith Humphreys |title=Here's proof that Alcoholics Anonymous is just as effective as professional psychotherapies |url=https://www.washingtonpost.com/news/wonk/wp/2014/06/09/heres-proof-that-alcoholics-anonymous-is-just-as-effective-as-professional-psychotherapies/ |url-status=live |archive-url=https://archive.today/20160531201422/https://www.washingtonpost.com/news/wonk/wp/2014/06/09/heres-proof-that-alcoholics-anonymous-is-just-as-effective-as-professional-psychotherapies/ |archive-date=2016-05-31 |access-date=2018-05-29 |newspaper=[[The Washington Post]] |quote=AA skeptics were confident that by putting AA up against the best professional psychotherapies in a highly rigorous study, Project MATCH would prove beyond doubt that the 12-steps were mumbo jumbo.  The skeptics were humbled: Twelve-step facilitation was as effective as the best psychotherapies professionals had developed.}}</ref> Other studies link increased AA attendance with higher spirituality and reduced alcohol consumption.<ref name="KellyEddie2020">{{cite journal |last1=Kelly |first1=John F. |last2=Eddie |first2=David |date=February 2020 |title=The role of spirituality and religiousness in aiding recovery from alcohol and other drug problems: An investigation in a national U.S. sample. |url= |journal=Psychology of Religion and Spirituality |volume=12 |issue=1 |pages=116–123 |doi=10.1037/rel0000295 |issn=1941-1022 |eissn=1943-1562 |pmc=7989793 |pmid=33767804}}</ref><ref name="Sánchez-IglesiasSaizMolina2022">{{cite journal |last1=Sánchez-Iglesias |first1=Iván |last2=Saiz |first2=Jesús |last3=Molina |first3=Antonio J. |last4=Goldsby |first4=Tamara L. |date=31 December 2022 |title=Reporting and Interpreting Effect Sizes in Applied Health-Related Settings: The Case of Spirituality and Substance Abuse |url= |journal=Healthcare |volume=11 |issue=1 |page=133 |doi=10.3390/healthcare11010133 |eissn=2227-9032 |pmc=9818974 |pmid=36611592 |doi-access=free}}</ref><ref name="Brandsma1980">{{cite book |last1=Brandsma |first1=Jeffery M |url=https://archive.org/details/outpatienttreatm00bran |title=Outpatient Treatment of Alcoholism: a review and comparative study |last2=Maultsby |first2=Maxie C |last3=Welsh |first3=Richard J |publisher=University Park Press |year=1980 |isbn=978-0-8391-1393-5 |location=Baltimore, MD |oclc=5219646 |url-access=registration}} Brandsma 1980 is paywalled, but [[Outpatient Treatment of Alcoholism|is summarized in the Wikipedia]]</ref>

A 2020 Cochrane review concluded that AA is more effective than other treatments, such as MET and CBT, in terms of abstinence rates. It also noted similar success in reducing drinking and alcohol-related problems, though this conclusion was based on moderate-certainty evidence.<ref name="Cochrane2020distilled">{{cite journal |last1=Kelly |first1=John F. |last2=Abry |first2=Alexandra |last3=Ferri |first3=Marica |last4=Humphreys |first4=Keith |year=2020 |title=Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers |journal=Alcohol and Alcoholism |volume=55 |issue=6 |pages=641–651 |doi=10.1093/alcalc/agaa050 |pmc=8060988 |pmid=32628263}}</ref><ref name="NYTCochrane2020">{{cite news |last1=Frakt |first1=Austin |last2=Carroll |first2=Aaron |date=11 March 2020 |title=Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In |url=https://www.nytimes.com/2020/03/11/upshot/alcoholics-anonymous-new-evidence.html |newspaper=[[The New York Times]]}}</ref> The review found that AA participation via AA twelve step facilitation (AA/TSF) had sustained remission rates 20-60% above other well-established treatments. Additionally, 4 of the 5 economic studies in the review found that AA/TSF lowered healthcare costs considerably.{{efn|"Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."<ref>{{cite journal |doi=10.1002/14651858.CD012880.pub2 |pmid=32159228 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |year=2020 |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=CD012880 |page=15 |pmc=7065341}}</ref>}}<ref name="Cochrane2020" /><ref>{{Cite web |title=How Effective is Alcoholics Anonymous? |url=https://www.discovermagazine.com/health/how-effective-is-alcoholics-anonymous}}</ref> [[Nick Heather]], an addiction researcher, critiqued the review, arguing it may have a sample bias and that it failed to measure outcomes like quality of life or alcohol dependence, which are important for evaluating recovery.<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/16856072/">{{cite journal |author=Ferri M, Amato L, Davoli M |year=2006 |title=Alcoholics Anonymous and other 12-step programmes for alcohol dependence. |url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16856072 |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD005032 |doi=10.1002/14651858.CD005032.pub2 |pmc= |pmid=16856072}}</ref><ref name="HEATHER2020">{{cite journal |last1=Heather |first1=Nick |year=2020 |title=Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers" |url=https://www.researchgate.net/publication/347836811 |journal=Alcohol and Alcoholism |volume=56 |issue=4 |pages=377–379 |doi=10.1093/alcalc/agaa137 |pmid=33316028}}</ref> The authors responded, stating their review showed AA is at least as effective as other treatments and more cost-effective.<ref name="HEATHER2020" /><ref name="Cochrane2020_p35">Kelly, John F.; Humphreys, Keith; Ferri, Marica (2020). "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". Cochrane Database of Systematic Reviews. 3 (CD012880): 35. doi:10.1002/14651858.CD012880.pub2. PMC 7065341. PMID 32159228.</ref> The authors also noted the lack of quality-of-life measures was due to the limitations of the reviewed studies.<ref name="HEATHER2020" />

==== Comparative effectiveness and cost effectiveness ====
A 2020 systematic review indicated that manualized AA and Twelve-Step Facilitation (TSF) therapy yields more healthcare cost savings and leads to higher continuous abstinence rates.{{efn|name=manualized}}<ref name="Cochrane2020" /><ref name="NPRCochrane2020">{{cite news |last=Becker |first=Deborah |title=New Review Finds Alcoholics Anonymous Is Effective, But Not For Everyone |url=https://www.npr.org/2020/03/12/815097806/new-review-finds-alcoholics-anonymous-is-effective-but-not-for-everyone |publisher=[[NPR]]}}</ref> A longitudinal study suggests that LifeRing and SMART Recovery fared worse than AA across several outcomes, however, the effects are insignificant when controlling for the baseline alcohol goal of total abstinence.<ref name="Zemore2018">{{cite journal |last1=Zemore |first1=Sarah E |last2=Lui |first2=Camillia |last3=Mericle |first3=Amy |last4=Hemberg |first4=Jordana |last5=Kaskutas |first5=Lee Ann |year=2018 |title=A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD |journal=Journal of Substance Abuse Treatment |volume=88 |pages=18–26 |doi=10.1016/j.jsat.2018.02.004 |pmc=5884451 |pmid=29606223}}

* {{lay source|template=cite news|author=German Lopez|date=5 Mar 2018|title=Alcoholics Anonymous works for some people. A new study suggests the alternatives do too|url=https://www.vox.com/science-and-health/2018/3/5/17071690/alcoholics-anonymous-aa-smart-lifering-study|work=Vox}}</ref> More recent studies employing randomized and blinded trials have shown 12-step programs provide similar benefit compared to motivational enhancement therapy (MET) and [[cognitive behavioral therapy]] (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.<ref name="Kelly2020">{{cite journal |last1=Kelly |first1=John F |last2=Abry |first2=Alexandra |last3=Ferri |first3=Marica |last4=Humphreys |first4=Keith |date=6 July 2020 |title=Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers |url= |journal=Alcohol and Alcoholism |volume=55 |issue=6 |pages=641–651 |doi=10.1093/alcalc/agaa050 |issn=0735-0414 |eissn=1464-3502 |pmc=8060988 |pmid=32628263}}</ref>

==== Patterns of engagement and disengagement ====
The 2001–2002 National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) found that 3.4% of respondents had attended a 12-step meeting. Of those, 988 had ceased attending, 348 continued attending, and 105 were newcomers. These figures help to understand engagement and disengagement patterns within AA.<ref name="A. Kaskutas, Y 2008">{{cite book |last1=Kaskutas |first1=Lee Ann |title=Recent Developments in Alcoholism |last2=Ye |first2=Yu |last3=Greenfield |first3=Thomas K. |last4=Witbrodt |first4=Jane |last5=Bond |first5=Jason |date=30 June 2008 |journal=<!-- Citation bot:  series, not journal--> |isbn=978-0-387-77724-5 |volume=18 |pages=261–282 |chapter=Epidemiology of Alcoholics Anonymous Participation |doi=10.1007/978-0-387-77725-2_15 |pmid=19115774}}</ref>

==== Mechanisms of recovery ====
Although AA claims that spirituality is the primary mechanism for achieving change and recovery, there is growing evidence that suggests this is only true for a minority of AA attendees with a high addiction severity.<ref name="SeminarsInAddiction">{{cite encyclopedia|editor-first=Ed|editor-last=Day|first1=John|last1=F Kelly|first2=Alexandra|last2=Abry|first3=Brandon|last3=G Bergman|pages=270|url=https://books.google.com/books?id=LfJLEAAAQBAJ&dq=2021%3A+Addiction+Recovery+Mutual-Aid+Organisations&pg=PA266 |encyclopedia=Seminars in Addiction|title=Addiction Recovery Mutual-Aid Organisations|date=4 November 2021 |publisher=[[Cambridge University Press]]|isbn=978-1-911-62318-2}}</ref><ref name="pmid12380849">{{cite journal| author=Tonigan JS, Miller WR, Schermer C| title=Atheists, agnostics and Alcoholics Anonymous. | journal=J Stud Alcohol | year= 2002 | volume= 63 | issue= 5 | pages= 534–41 | pmid=12380849 | doi=10.15288/jsa.2002.63.534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12380849  }}</ref> Instead, AA's beneficial effects are carried predominantly by social, cognitive and affective mechanisms.<ref name="pmid27718303">{{cite journal| author=Kelly JF| title=Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. | journal=Addiction | year= 2017 | volume= 112 | issue= 6 | pages= 929–936 | pmid=27718303 | doi=10.1111/add.13590 | pmc=5385165 }}</ref> However, atheist and agnostic people are less likely to initiate and sustain AA attendance in comparison to spiritual and religious people.<ref name="pmid12380849" />