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.
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.)
Repeats the 50 - 75% figure often cited.
Analysis from a hostile source (More Revealed: A Critical Analysis of Alcoholics Anonymous and the Twelve Steps):
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):
Describes the problems of defining remission, and gives extensive data on remission rates.
Briefly, the rate of spontaneous (self) remission for alcohol:
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.