Wednesday, October 25, 2006

No Scientific Evidence that AA is Effective

A comprehensive meta-analysis of published effectiveness studies concerning Alcoholics Anonymous and twelve-step facilitation (TSF) treatment methods found no scientific basis for claims that these methods were effective. "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems." The study, by three Italian researchers, was published in August 2006 in the prestigious Cochrane Library journal in the UK. An abstract is available online here.


Barbaranne said...

Congratulations on your recovery and thank you for providing society with a venue for others to recover. With gratitude, I share that I have been given the gift of recovery from a hopeless state of mind and body for 18 continuous years through the support of the fellowship of Alcoholics Anonymous and the adoption of the 12-Steps as a way of life. Thank you for citing the study from which you concluded the ineffectiveness of 12-step programs: by refering to the study, I was able to more accurately know the results of the conclusions of the authors of the compiled research studies. It is noted in the "Plain Language Summary" that "...there were some limitations with these studies. Furthermore, many different interventions were often compared in the same study and too many hypotheses were tested at the same time to identify factors which determine treatment success." My initial assumption of your motive in misrepresenting the results of this research is that you are attempting to promote your product, your addiction treatment program. Am I wrong?

Marty N. said...

Dear Barbara Anne:

The real question I hear you asking, underneath your somewhat formulaic posture of injured loyalty, is: how is it possible that people get sober in AA if AA is "not effective" according to scientific studies?

The short answer is that YOU got YOURSELF sober, and you happened to do it in the environment that your local support groups provided. You clearly have adopted your group's negative attitude toward self-actualization, and you loyally assign all credit for your recovery to The Program. Understood, but chances are you could have and would have achieved the same success in another program, or perhaps without a program at all.

But how can you ever know whether peoples' success, as a group, is due to The Program, or due to their own inner energies to get clean and sober no matter what? The answer is to do double-blind studies with control groups, the same way that new pharmacological therapies are supposed to be tested. When you have several replicated studies of this kind, you can say with confidence that the medication is effective, meaning that the results you see are not due to a placebo effect and are not a chance blip.

There have been such studies on involuntary participants (e.g. Walsh), and with experimental participants (Project Match), but not with voluntary participants plus a control group. Take a look at Maia Szalavitz's comment, reported higher up in this blog. Why there are no direct randomized control group studies of voluntary AA members, is another question that would take us on a side track. The bottom line is that there is no credible scientific proof of AA's effectiveness. This is not only the conclusion of the current study, it is the conclusion of a string of previous studies, and is a point that knowledgeable partisans of AA, such as AA Trustee Dr. George Vaillant, expressly admit.

The above is, I think, your deeper question. As to your superficial point, claiming that I misrepresented the current study, you are simply wrong. You take one snippet out of context, arguing that the "limitations" of some of the studies point toward AA's efficacy; but actually, the "limitations" are in all the studies, including those that claim such efficacy. I quoted the principal conclusion of the study fair and square. You feel yourself drowning and so you are clutching at straws. This is quite unnecessary; the studies are not an attack on your sobriety, but on the contrary, they are a compliment to your own efforts and your own efficacy.

Here's the full text of the citation and abstract as retrieved from the source to which I linked:

Alcoholics Anonymous and other 12-step programmes for alcohol dependence

M Ferri, L Amato, M Davoli

Cochrane Database of Systematic Reviews 2006 Issue 4
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD005032.pub2 This version first published online: 19 July 2006 in Issue 3, 2006
Date of Most Recent Substantive Amendment: 20 March 2006

This record should be cited as: Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005032. DOI: 10.1002/14651858.CD005032.pub2.

Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)).

To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems.

Search strategy
We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies.

Selection criteria
Studies involving adults (<18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants.

Data collection and analysis
One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers.

Main results
Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.

Authors' conclusions
No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

Plain language summary
Alcoholics Anonymous (AA) is self-help group, organised through an international organization of recovering alcoholics, that offers emotional support and a model of abstinence for people recovering from alcohol dependence using a 12-step approach.

As well as AA, there are also alternative interventions based on 12-step type programmes, some self-help and some professionally-led. AA and other 12-step approaches are typically based on the assumption that substance dependence is a spiritual and a medical disease. The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments, but there were some limitations with these studies. Furthermore, many different interventions were often compared in the same study and too many hypotheses were tested at the same time to identify factors which determine treatment success.