Alcoholics Anonymous and clinically led 12-step programmes work

Author: Caroline White

Alcoholics Anonymous (AA) and clinically-led 12-step programmes (TSF) do help people recover their sobriety and are more effective than other approaches, such as cognitive behavioural therapy (CBT), finds a Cochrane Systematic Review* published today.

AA has been a popular treatment for alcohol use disorder for decades, but whether AA and related 12-step clinical treatments designed to increase AA participation are effective has been the subject of ongoing debate.

AA are peer-led mutual help groups. Twelve-step facilitation programmes adopt some of the principles and techniques of AA but are delivered by clinicians. They aim to engage people within AA during and after treatment for alcohol misuse.

Some of these programmes follow a manual, so that the same treatment can be delivered at different times and places.

This Cochrane review looked at the effect of these programmes on helping people cut down their alcohol consumption, and how good they are at enhancing long-term abstinence, as well as the impact of heavy drinking, including on physical health, family, or employment. 

The review authors also looked at whether AA and TSF programmes reduce healthcare costs compared to other approaches.

The previous Cochrane review on the topic, published in 2006, was based on the eight available studies involving a few thousand participants. The quantity and quality of the research has increased substantially since then.

Twenty-seven studies were included in this updated review, involving 10,565 people. The included studies looked at a range of programmes that differed in their approach and intensity, and compared them with other programmes and different treatments for alcohol misuse.

The authors found strong evidence that clinically delivered TSF programmes that follow a manual and are designed to increase AA participation can lead to higher rates of continuous abstinence over months and years, when compared to other active treatment approaches, such as CBT.

The evidence suggests that 42% of participants participating in AA would remain completely abstinent one year later, compared to 35% of participants in receipt of other treatments, including CBT. This effect is achieved largely by fostering increased AA participation beyond the end of the TSF programme.

When compared to the other approaches, AA-based programmes may perform just as well at reducing drinking intensity, the consequences of drinking, and addiction severity.

Lead author, Dr John Kelly, Elizabeth R Spallin Professor of Psychiatry at Harvard Medical School and director of the Massachusetts General Hospital Recovery Research Institute said, “Alcohol use disorder can be devastating for individuals and their families and it presents a significant, worldwide, costly public health problem. Alcoholics Anonymous is a well-known, free, mutual-help fellowship that helps people recover and improve their quality of life. 

“One important finding from this review was that it does matter what type of TSF intervention people receive - better organised and well-articulated clinical treatments have the best result. In other words, it is important for clinical programmes and clinicians to use one of the proven manualised programs to maximise the benefits from AA participation.”

He added: “In terms of healthcare costs, policy makers will be interested that four of the five economics studies we identified showed considerable cost-saving benefits for AA and related 12-step clinical programmes designed to increase AA participation, indicating these programmes could reduce healthcare costs substantially.”

*Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880.