Is Alcoholics Anonymous Effective?

Transcription

1 EDITORIAL Is Alcoholics Anonymous Effective? Alcoholics Anonymous (AA) is a world wide organization that is a social support group for people with a desire to quit alcohol. The primary purpose of the organization is to help its members stay sober and to help other alcoholics achieve sobriety (Alcoholics Anonymous, 2010). It is not affiliated with or allied with any religion, sect, denomination, political viewpoint, any other organization or institution. It does not support or oppose any cause. It does not have any membership dues or charges any money for its services. It is supported primarily by voluntary contributions of its members. The origins of AA can be traced back to another organization called Oxford Group in the early 20* century in the United States and Europe which was a religious movement emphasizing self improvement. In the early 193O's Alcoholics Anonymous was formed. June 10, 1935 is celebrated as the founding date of Alcoholics Anonymous. The hallmarks of AA are the Twelve Steps and the Twelve Traditions (Butler, 2010). Practicing the Twelve Steps helps one quit alcohol and remain sober. AA is not the only Twelve-Step program for recovering alcoholics, but it is the most widely known and available program of its type. Recently the Cochrane Database conducted a systematic review of randomized controlled trials evaluating the effectiveness of AA and other Twelve-Step programs (labeled Twelve Step Facilitation or TSF). Eight studies were included in the review, and, of these, three evaluated AA programs. The conclusions of this review were that "no experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problem" (Ferri, Amato, & Davoli, 2006).

2 While the Cochrane Review was surprising, given the popularity and wide dissemination of AA, Kaskutas (2008) noted in a letter to the editor in the Journal Addiction that the experimental evidence reviewed was just one of the six criteria for establishing causation that AA was effective. In another article Kaskutas (2009) has done a systematic review of these evaluations, and he notes that, with regard to causal evidence of effectiveness of AA, five out of six criteria are met. With regard to magnitude of effect, rates of abstinence in those who attend AA are about twice as high compared to those who do not. With regard to dose-response relationship, higher levels of attendance are related to higher rates of abstinence. With regard to the criterion of consistency, there is evidence for different samples and follow-up periods. Likewise the criteria of temporality and plausibility are also substantiated. The only criterion which has mixed evidence is the criterion of specificity. So, according to Kaskutas (2009), AA can be considered an effective approach. There are noted advantages and disadvantages to AA. A major advantage of the program is that it is widely popular and available. There are A A programs in every state, including Washington D.C., and abroad. AA is also fi-ee to its members, which means it does not prohibit individuals from attending based on financial resources. Meetings also are usually given during convenient times such as the evenings. Social support is an advantage to AA, as members are encouraged to find a "sponsor" during the program. Sponsors are typically recovering alcoholics who can share their personal stories of sobriety and assist the AA member through the process. AA also has an online community, whereby one can keep connected to others in the program in the comfort of one's home or work and have contact with others on nonsession days. There are some disadvantages to the actual programming of AA. One potential disadvantage lies in spiritual messages that are weaved into the program. These religious undertones could turn some people off, especially individuals that self-describe themselves as 'atheists' or do not believe in a higher power. Many noted disadvantages to AA center on the difficulty of conducting robust experiments to evaluate the effectiveness of the program. While the Cochrane review and others suggest that AA is either not effective or mildly effective, Kownacki and Shadish (1999) point out that few good studies evaluating the effects of

3 AA exist. One problem with many studies is the selection bias for AA participants. AA has the potential to attract two different types of members which may heavily impact the success of the program. For example in some cases AA might attract volunteers who chose whether or not to attend. These types of volunteers are likely more intrinsically motivated to succeed than volunteers who decide to never come or discontinue attendance. AA studies also suffer from the problem of high drop-out rates. It is unclear whether these drop-outs are successful alcohol abstainers and no longer need AA treatment, or they have relapsed. AA members could also be coerced into attending as through a court-ordered mandate. This has been noted as a bad idea; as research suggests those who are coerced do worse than those who volunteer (Kownacki, & Shadish, 1999). While randomized controlled trials (RCT) are typically considered the gold standard in program evaluation research, it is difficult to administer them with AA. For example, when randomizing participants into a treatment and comparison condition, it may be looked upon as unethical to withhold treatment from individuals who need treatment. To conclude, it can be said that while AA has many potential benefits, it is difficult to say whether it is truly effective. Given its 'naturalistic' setting, conducting effectiveness research is a difficult task, and we are going to have many quasi-experimental studies rather than RCT's. Also, given the anonymity of the program, tracking why people drop-out is not feasible. Further, recording long term effectiveness can be a very difficult task. Future research should add to the evidence of AA's effectiveness. ManojSharma, MBBS, CHES, Ph.D. Editor, Journal of Alcohol & Drug Education & Paul Branscum, MS, RD, LD University of Cincinnati 527C Teachers College PO Box Cincinnati, OH

4 REFERENCES Alcoholics Anonymous. (2010). Information on Alcoholic Anonymous. Retrieved from Butler, S. (2010). Benign anarchy. Alcoholics Anonymous in Ireland. Dublin: Irish Academic Press. Ferri, M., Amato, L., & Davoli, M. (2006). Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews, 3, DOI: / CD pub2 Kaskutas, L. A. (2008). Comments on the Cochrane Review on Alcoholics Anonymous effectiveness.[letter to the editor]. Addiction, 103, Kaskutas, L.A. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Diseases, 25(2), Kownacki, R. J., & Shadish, W R. (1999). Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments. Substance Use & Misuse, 34(13),

5 Copyright of Journal of Alcohol & Drug Education is the property of American Alcohol & Drug Information Foundation and its content may not be copied or ed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or articles for individual use.