How effective is Alcoholics Anonymous?

Brendan Koerner explores Alcoholics Anonymous in a fantastic Wired article.

AA has been around since 1935. Created amid the doom and gloom of the Great Depression by a failed stockbroker and reformed lush named Bill Wilson. Lacking any formal training, Wilson created a 12-step process by cribbing ideas from religion and philosophy with a structure inspired by the Bible. Although he didn't know it at the time, this 200-word instruction set would become the cornerstone of addiction treatment in America and around the world.

More facinating, Koerner notes, is that “despite all we've learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better.” That's quite an achievement for a onetime deadbeat. Further complicating the issues is that AA is notoriously difficult to study and requires one to surrender to a higher power. No one is quite sure how, or how well, AA works.


The problem is it's incredibly difficult to measure the success of AA:

As a result of these complications, AA research tends to come to wildly divergent conclusions, often depending on an investigator's biases. The group's “cure rate” has been estimated at anywhere from 75 percent to 5 percent, extremes that seem far-fetched. Even the most widely cited (and carefully conducted) studies are often marred by obvious flaws. A 1999 meta-analysis of 21 existing studies, for example, concluded that AA members actually fared worse than drinkers who received no treatment at all. The authors acknowledged, however, that many of the subjects were coerced into attending AA by court order. Such forced attendees have little shot at benefiting from any sort of therapy—it's widely agreed that a sincere desire to stop drinking is a mandatory prerequisite for getting sober.

Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico's Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).

For the first time, research in behavior change and neurology is starting to offer some insight into what's happening in the AA meetings.

To begin with, there is evidence that a big part of AA's effectiveness may have nothing to do with the actual steps. It may derive from something more fundamental: the power of the group.

Psychologists have long known that one of the best ways to change human behavior is to gather people with similar problems into groups, rather than treat them individually.

AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one's deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone.

But how effective is AA? The answer is that no one knows. Koerner points out the reasons why we don't know “AA's strict anonymity policy, which makes it difficult for researchers to track members over months and years” and we're not sure “how to account for the selection effect.” Koerner continues “As a result of these complications, AA research tends to come to wildly divergent conclusions, often depending on an investigator's biases.”