Here is some information,
analysis, and links about the common question: Òhow effective is AA?.Ó
Some information about AA's
success rate comes from its own membership surveys. In particular, the rather
famous 'Comments on AA's Triennial Surveys' document cited by Charles Bufe in
Alcoholics Anonymous: Cult or Cure is AA's ID # 5M/12-90/TC, which was produced
for internal purposes. It is also summarized in Vince Fox's Addiction, Change,
and Choice (1993). The document is not listed in AA's 'Conference Approved Literature'
but Fox was able to obtain a copy from AA.
AA's own analysis was that 50%
of all those who try AA leave within 90 days, which they describe as cause for
'concern'. Their own data shows that is actually optimistic. In the 12-year
period shown, 19% remain after 30 days, 10% remain after 90 days, and 5% remain
after a year.
The retention rate of AA is 5%
after one year.
So do we define the success
rate as the retention rate? You'd have to tell me if you believe that success
in AA is measured by whether people are still attending meetings.
Other observations:
60% of those surveyed were
getting outside professional help. This means that any success (or failure)
rate, however it is defined, can't be attributed entirely to AA.
One way to measure the success
of AA would be by comparing 12-step based treatment with other treatments. A
1997 study found that 93% of American drug and alcohol treatment programs
follow the 12-step model. So it would be pretty easy to tell, at least, whether
12-step programs work.
An extensive study (Hester and
Miller, Handbook of alcoholism treatment approaches) shows that peer-based
12-step alcohol treatment programs do NOT have a higher success rate than no
treatment at all. Facilitated 12-step treatment (trained facilitators guiding
subjects through the twelve-step process) were marginally better. "The two
tests of AA found it inferior to other treatments or even no treatment but were
not sufficient to rank AA reliably."
Brief, non-confrontational
interventions and motivational interviewing were found most effective.
If you define success as
reduced drinking, absence of alcohol dependence, or a reduction in problem
drinking, then you see different results. Success in AA is presumed to be total
abstinence. But followup to many treatment programs finds people have done some
drinking, or drink moderately (defined by the researcher, not the patient!).
They would be considered failures in AA--but the behavior has changed. So if
one wants to improve the statistical success rates of 12-step treatment, just
broaden the definition of 'success' to include moderate drinking!
Here's psychiatrist George
Vaillant, an advocate of the standard hospital and AA treatment program,
reviewing his own studies of his own program in The Natural History of
Alcoholism:
"It seemed perfectly clear
that . . . by inexorably moving patients from dependence upon the general
hospital into the treatment system of AA, I was working for the most exciting
alcohol program in the world. But then came the rub. Fueled by our enthusiasm,
I and the director . . . tried to prove our efficacy. Our clinic followed up
our first 100 detoxification patients. . . . [and found] compelling evidence
that the results of our treatment were no better than the natural history of the
disease."
One interesting observation: a
long-term study of over 4,500 subjects found that more treated alcoholics than
untreated alcoholics had been abusing or dependent on alcohol within the
previous year! It is really difficult to draw any conclusions from that bit of
information!
So, is AA or 12-step treatment
useful, or is it harmful?
First of all, to any individual
who has succeeded at getting sober by means of AA it is successful. You are not
a statistic. Your advice can be useful to someone who is thinking about
quitting drinking, and nothing in any study diminishes the value of that
experience.
But to generalize from your
experience, and make predictions about what will happen to another person?
Alcohol abuse is so variable in its nature and effect that it just isn't
reasonable to do that.
And some believe that there are
other ways AA can be harmful.
Coerced treatment is often
harmful, resulting in depression, mental illness, and increased substance
abuse. Most coerced treatment in the US is into 12-step programs, and is often
simply mandatory attendance at AA meetings. Failure to accept the coerced
treatment results in loss of employment or prison, so the outcome is
undesirable either way.
If in fact AA was as effective
as no treatment at all, then AA attendance would not be harmful. But if it
delays those for whom it is inappropriate from seeking alternatives which may
be more effective for them, then it is harmful. If it is, in fact, less
effective than other treatments or than no treatment at all, it could be harmful.
In that regard, the simple
phrase 'Keep Coming Back' is harmful to someone who is not finding AA helpful.
To tell them that they are
somehow responsible for the program not working is harmful.
If someone who questions the
tenets of AA is told to 'take the cotton out of your ears and put it in your
mouth' or to 'stop thinking, stop talking, and start listening' -- they are
being harmed.
They should simply be urged to
look elsewhere, not blamed because AA didn't work for them. It doesn't diminish
the effectiveness of AA for you that it didn't work for someone else.
Recommending the program for
someone who may have abused alcohol but is not alcohol-dependent, and who may
have depression or other mental illness, is potentially very harmful. I would
consider sending a depressed teenager to AA for an episode of substance abuse
to be very irresponsible. A trained professional is appropriate, not a
peer-based program for what may simply be an ancillary problem. Don't think it
hasn't happened. Coercing teenagers into 12-step programs for simple
experimentation with drugs or alcohol is not uncommon.
-------------------------------------
For more information about the
success rates of AA vs. spontaneous remission:
General discussion of success
rate from AA source (Lets Ask Bill W.)
http://www.silkworth.net/ask_billw/Q&A33.html
Repeats the 50 - 75% figure
often cited.
Analysis from a hostile source
(More Revealed: A Critical Analysis of Alcoholics Anonymous and the Twelve
Steps):
http://www.morerevealed.com/books/mr/chap2.htm
Reviews two studies of referred
users, Vaillant's study, and Peele's review.
An extensive scientific review
from a neutral source (American Journal of Drug and Alcohol Abuse):
http://www.findarticles.com/p/articl...26/ai_65803046
Describes the problems of
defining remission, and gives extensive data on remission rates.
Briefly, the rate of
spontaneous (self) remission for alcohol:
Defined broadly--31.4%
Defined narrowly--24.2%
This study does have a useful
description of the abstinence process from this last source:
"Stall and Biernacki
proposed a three-stage model of spontaneous remission ...
The initial stage of the model
involves finding the resolve or motivation [from] a handful of initiating
factors--medical problems, pressure from family and friends to stop using,
extraordinary events, financial problems--that account for over half the
reasons cited by self-remitting alcohol, tobacco, and other drug abusers ...
The second stage ‰Û¦
consists of a public pronouncement to quit. ‰Û¦ Finding substitute
activities, replacing old associations with new ones, developing nondrug
recreational/leisure interests, and changing one's place of residence ...
The third or maintenance stage
É [is] ongoing social support, a growing sense of self-confidence and
willpower, and the discovery of life meaning through religion, education,
physical exercise, and identity."
I think all of us can find
something to relate to in that outline.
----
The only statistic that matters
to you is your own personal success rate! I agree that there is no right and
surefast way--that's my point, really. The main objection people from other
recovery groups have to AA is when people imply that it's the only way, and
make sweeping generalizations about the likelihood of success of it or any
other approach. And sloganeering just irritates me.
Many people take principles
from more than one recovery program, and there are areas of agreement among
them. People who come to SOS, LifeRing, or SMART Recovery often attend AA
meetings for the group support, and I'm sure that's true of most of the other
programs as well.