Alcoholics ?anonymous (A.A.) is a science-based intervention with proven effectiveness. A.A. is more effective than non-treated control groups and equally effective to Cognitive Behavioral Therapy (CBT) and Motivational Interviewing. This issue is settled in the scientific literature. I have a bibliography of over 200 published articles that support the effectiveness of 12-Step Programs.
Nothing works for everyone. 12-step programs are no exception. People who had a bad experience with 12-Step programs are not reliable reporters. Neither are A.A. advocates who see 12-Step Programs doing all things for all people.
Twelve Step Programs are well-known and utilized in the United States. Of the US adult population:
- 9% have been to an AA meeting at some time,
- 3.6% in the prior year, only about one-third of these for problems of their own.
- About one-half these percentages, mostly women, have attended Al-Anon.
- Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year.
- During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counseling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking. (Room and Greenfield 1993)
Research into 12-Step effectiveness shows clearly that Twelve Step Programs are effective in helping many people recover from alcoholism and drug dependence. Twelve-step programs get many of their members as a result of referrals from professional counselors, therapist, and doctors.
Many people who achieve long-term recovery use other forms of counseling and therapy at various points in their recovery. They use what I call a “12-Step Plus” Approach. Most people use professional counseling and therapy in addiction to working the 12-Step Program. Some people, however, have found recovery through professional therapy and support groups, like SMART Recovery, that are not based on the 12-Steps.
Many people in long-term recovery use 12-Step Programs very heavily in the first one to three years although the frequency of meetings goes down after that. Many people who start in 12-Step programs and achieve a stable recovery significantly reduce or stop attending meetings and do well. Most in this category start attending meetings again or increase the frequency of meeting during highly stressful periods of life.
Twelve Step programs are the single most effective, least expensive, and most readily available recovery program world-wide. As such, it is being supported by managed care companies in order to reduce the price of healthcare. The tendency to refer to A.A. is expected to increase as the Affordable Health Act (ACA) imposed greater demands for cost containment.
Twelve step programs work better when used in conjunction with other forms of counseling, therapy, and treatment.
Relapse rates in 12-Step Programs, and all forms of addiction treatment, are highest in the first 90 days. This is the period of recovery where people are most toxic from the effects of long-term alcohol and drug poisoning to the brain. It is a time of change and crisis. It is the period of time when recovery supports have not yet been firmly established. Detoxification and residential or day treatment are valuable to get people stabilized in this critical first 12 weeks of recovery.
After five years of continuous sobriety relapse in a group of alcoholics is less likely than having addiction develop in a similar group who has never had an addiction.
The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at the US Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step–C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistency over several treatment subgroups: Patients attending the “purest” 12-step and C-B treatment programs, and patients who had received the “full dose” of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment. (Ouimette 1997)
Ouimette, Paige Crosby; Finney, John W.; Moos, Rudolf H., Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, Vol 65(2), Apr 1997, 230-240.
ROOM, R. and GREENFIELD, T. (1993), Alcoholics anonymous, other 12-step movements and psychotherapy in the US population, 1990. Addiction, 88: 555–562.
You can find other studies with a simple search on Google scholar searching on Twelve Steps Outcomes and Twelve Step Facilitation (TSF).
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