To evaluate the literature on AA effectiveness according to this criterion which usually is studied by considering biological plausibility , theoretical plausibility will be discussed; that is, does AA work in a way that is consistent with major theoretical perspectives on health behavior and behavior change?
The theory argues that despite low self esteem, many alcoholics have a narcissistic personality [ 28 ] and a sense of omnipotence. They drink to self-medicate, as a way of addressing unmet needs and uncomfortable psychological states. AA solutions consistent with this characterization of the problem are evident at meetings, in the AA steps, and through people in the AA fellowship.
The antidote includes changing environmental cues such as staying away from bars , role modeling seeing others succeed at not drinking , and self-efficacy believing you can abstain. Seeing yourself able to abstain for one day begins to build self-efficacy, which accumulates with the passage of every sober day.
Spending time at AA meetings and with people in AA also leads to relapse prevention mechanisms put forward by standard behavioral modification techniques. These include learning how to say no to a drink when offered, having a plan of action when confronted with likely drinking conditions, and choosing alternative behaviors to take the place of drinking.
Several studies offer empirical support for these mechanisms. The positive relationship between AA involvement and abstinence has been shown to be partially mediated explained by a psychological and spiritual mechanisms including finding meaning in life [ 30 ], greater motivation for abstinence [ 31 ], and changes in religious beliefs and spiritual experiences [ 32 ]; b social influences such as fewer pro-drinking influences [ 33 ], more friends in general [ 34 ], having AA friends supportive of abstinence [ 35 ], and enhanced friendship networks [ 36 ]; and c social learning and behavioral mechanisms including improved self-efficacy [ 31 , 37 ] and effective coping and relapse prevention skills [ 34 , 36 ] to abstain.
These mechanisms and theories are inter-related. For example, AA friends represent a particularly effective source of social support, because they provide expertise in preventing relapse.
This is not a thorough review of the literature on AA effectiveness. For example, we did not keep track of the number of relevant studies located, nor of the relative numbers of studies with positive versus negative findings for AA or TSF effectiveness. However, we did take care to present any study where the effect of AA was negative.
The goal was not to provide an exhaustive review of the evidence, but rather to present representative studies that address AA effectiveness according to six accepted criterion for establishing scientific causation. This framework may be especially appropriate for considering AA effectiveness, because it acknowledges the value and limitations of experimental evidence in the context of other criterion for determining treatment effectiveness.
Another limitation is the choice of theoretical frameworks for consideration. Biological theories were not considered here, because their solution is not behavioral but pharmacological: genetic theory one is predisposed to develop alcoholism and neurobiological theories the brain becomes addicted to alcohol. The breadth of theoretical frameworks through which AA mechanisms can be understood is encouraging. As stated at the outset, the experimental evidence for AA effectiveness addressing specificity is the weakest among the six criteria considered crucial for establishing causation.
It is noteworthy that neither of these studies attempted to randomize patients to AA per se; instead, they focused on interventions intended to facilitate AA involvement. In fact, CBT and MET aftercare patients attended more meetings than the TSF outpatients, and the aftercare patients overall attended twice the number of meetings at every follow-up compared to the outpatients [ 22 , see pp.
There are other concerns with the Brandsma trial [ 25 ] which call its experimental results into question. The control condition allowed for participation in actual AA meetings, while those in the AA condition attended a weekly AA-like meeting administered by the study that was not an actual AA meeting. The description of the AA condition states that the steps were used for discussion content, the group focused on newcomers, and they told patients about sponsors [ 25 , p.
The meetings may not have been open to other AA members in the community, and not been listed in the AA meeting directory, which would mean that a potentially important therapeutic ingredient of AA--the experience of longer-term members--would not have been present in the AA condition. This is of special concern because the control condition did allow for attendance at such meetings. Given these challenges in conducting rigorous randomized trials of AA effectiveness, researchers have turned to statistical methods to address the selection bias associated with AA attendance in observational studies.
These efforts are intended to address criteria 5, specificity of the AA effect. A third study [ 41 ] adjusted for baseline motivation and psychopathology as potential confounders, and found that those with more AA involvement at 1 year had fewer alcohol problems at the 2-year follow-up interview.
The method allowed investigators to study whether the selection bias operationalized by the Propensity Scores varied based on whether an individual had a low versus a high propensity to attend AA.
What, then, is the scorecard for AA effectiveness in terms of specificity? Among the rigorous experimental studies, there were two positive findings for AA effectiveness, one null finding, and one negative finding. Among those that statistically addressed selection bias, there were two contradictory findings, and two studies that reported significant effects for AA after adjusting for potential confounders such as motivation to change.
Readers must judge for themselves whether their interpretation of these results, on balance, supports a recommendation that there is no experimental evidence of AA effectiveness as put forward by the Cochrane review. As for the scorecard for the other criteria, the evidence for AA effectiveness is quite strong: Rates of abstinence are about twice as high among those who attend AA criteria 1, magnitude ; higher levels of attendance are related to higher rates of abstinence criteria 2, dose-response ; these relationships are found for different samples and follow-up periods criteria 3, consistency ; prior AA attendance is predictive of subsequent abstinence criteria 4, temporal ; and mechanisms of action predicted by theories of behavior change are evident at AA meetings and through the AA steps and fellowship criteria 6, plausibility.
This paper was presented as the plenary address to the American Society of Addiction Medicine [ 43 ] by the recipient of the R. Brinkley Smithers Distinguished Scientist Award.
The author would like to acknowledge the helpful feedback received from colleagues, including Drs. National Center for Biotechnology Information , U. J Addict Dis. Author manuscript; available in PMC Sep Lee Ann Kaskutas , Dr.
Author information Copyright and License information Disclaimer. Copyright notice. See other articles in PMC that cite the published article. Abstract Research on the effectiveness of Alcoholics Anonymous AA is controversial and is subject to widely divergent interpretations. Introduction Research on the effectiveness of Alcoholics Anonymous AA is controversial and is subject to widely divergent interpretations. These are the criterion: The relationship between an exposure here, exposure to AA and the outcome abstinence, as AA does not recommend any drinking for alcoholics must be strong.
Methods Articles involving Alcoholics Anonymous. Results Criterion 1, strength of association How large is the relationship between AA exposure and abstinence? Open in a separate window. Figure 1. Criterion 2, dose response relationship Do higher levels of AA attendance or involvement relate to higher levels of abstinence? Figure 2. Figure 2a. Figure 3. The following items can be downloaded from the website: A newly revised and restyled pamphlet explaining to the employer how AA can help the problem drinker in the workplace.
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Anyone with a desire to stop drinking is welcome, regardless of race, gender, sexual orientation, religion, income or profession. You can just sit and listen and learn more about recovery, or you can share about your situation. Search x. Common Searches. Have a problem with alcohol? There is a solution. Learn More. Find A. State or Province, Town or Zip Code. Looking for help with a drinking problem An A. While men tend to drink to feel more powerful and to decrease inhibition, women are more likely to drink from a place of numbing or pain reduction.
They do not report feeling more powerful while drinking. As a result, women tend to see improved outcomes with cognitive behavioral therapy over the step program, as well as programs like the trauma recovery empowerment model TREM , which seeks to empower women toward skill-building and coping with past sexual and physical trauma. While this higher power is sometimes interpreted as the program itself, this reliance on outside power to guide the process may not be a comfortable notion for everyone.
Other drawbacks of the step program involve the lack of emphasis on physical recovery. Addiction comes with adverse health effects and withdrawal symptoms that are not addressed by the step model. Some are also uncomfortable with the very public nature of step programs in asking participants to acknowledge their addiction in a group setting. For someone with a co-occurring mental disorder, the experience of talking about their drug or alcohol use in a group setting can increase symptoms of the disorder.
Every year brings forth additional awareness of the complexity of addiction and improvements in recovery programs to increase long-term success rates.
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