Alcoholics Anonymous AA: Meetings, How to Join, & the 12 Steps

Although, such dually‐diagnosed samples are sometimes reviewed separately (e.g. Tonigan 2018), we included these studies here because they otherwise met our inclusion criteria. When we performed sensitivity analyses, we did not find differences in the overall pattern of findings when we included or excluded these studies. We were not able to perform an analysis of publication bias, but consider it unlikely that we missed any high quality studies.

AA is not controlled or standardized by professionals, so historically it has been harder to study than professionally‐designed and delivered treatments for which manuals are written, doses can be randomly assigned, and length of contact can be standardized and predetermined (Humphreys 2004; Kelly 2013a). However, AA researchers have become increasingly sophisticated at finding methods to rigorously evaluate AA, including in randomized clinical trials. Reviews of this research have been conducted, including a prior Cochrane Review (Ferri 2006a; Ferri 2006b; Kaskutas 2009a; Kelly 2009b), but a flurry of additional empirical investigations since these reviews were conducted signifies a need for a major update. Consequently, an additional rigorous, high‐quality systematic review is needed that includes more recent studies to provide information about the clinical and public health utility, effectiveness, and cost‐effectiveness of AA and TSF. This review updates and supercedes the previously conducted Cochrane Review (Ferri 2006b). In three studies, AA/TSF had higher healthcare cost savings than outpatient treatment, CBT, and no AA/TSF treatment.

Big Book ASL – Chapter 11 – A Vision For You

Following his hospital discharge, Wilson joined the Oxford Group and tried to recruit other alcoholics to the group. These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober. Dr. Silkworth suggested that Wilson place less stress on religion (as required by The Oxford Group) and more on the science of treating alcoholism.

For alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). For longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). We included two studies, reported in four papers, in this category (Grant 2018; Ouimette 1997). See Table 6 for a summary of the results for our main outcomes and certainty of evidence for each result. We included four studies, reported in six papers, in this category (Blondell 2001; Humphreys 1996; Ouimette 1997; Zemore 2018).

A Message to Young People

Several studies, including two comparative clinical trials that were included in the current review, have examined this. In these, use of appropriate temporally‐lagged mediational analyses supported a causal chain in which TSF led to higher AA participation, which subsequently led to better alcohol use outcomes (Litt 2007; Walitzer 2009). Specifically, the Litt 2007 study found post‐treatment AA attendance partially mediated the effect of the TSF Network Support treatment on PDA (particularly post‐treatment PDA), and Walitzer 2009 found that AA involvement during treatment and at six‐month follow‐up increased subsequent PDA.

Follow‐up length ranged from the end of treatment through to five years (Table 8). For the economic studies, follow‐up length ranged from one year to seven years. As recommended by Cochrane (Shemilt 2011a), we utilized the Evers checklist for rating the certainty of economic studies in the current review (Evers 2005; Appendix 3). We considered incomplete outcome data (while also taking due note of any observed attrition bias) for all outcomes.

Big Book ASL – Foreword to First Edition

The fourth study found that total medical care costs decreased for participants attending CBT, MET, and AA/TSF treatment, but that among participants with worse prognostic characteristics AA/TSF had higher potential cost savings than MET (moderate‐certainty evidence). None of the RCTs comparing non‐manualized AA/TSF to other clinical interventions assessed https://ecosoberhouse.com/ LPA, alcohol‐related consequences, or alcohol addiction severity. A 2020 review looked at 27 studies involving a total of 10,565 participants and noted that A.A. And other twelve-step programs are effective for increasing abstinence. The authors also reported that these programs appear to be as effective as other alcohol treatment methods.

We planned to use visual inspection of funnel plots (plots of the effect estimate from each study against the sample size or effect standard error) to indicate possible publication bias if there were at least 10 studies included in the meta‐analysis. We did not inspect funnel plots because there were always less than 10 studies in any given meta‐analysis (Sterne 2011). We appraised the presence and impact alcoholics anonymous of missing data on study findings. We also detailed in a table how the included studies handled missing data. When necessary, we contacted the original study authors to attempt to obtain missing data and information of their potential impact. We attempted to identify other potentially eligible studies by searching the reference lists of retrieved included studies, systematic reviews, and meta‐analyses.

The GRADE certainty rating for this evidence was very low; we downgraded because of study limitations (lack of control of sample selection and non‐randomized nature of the study). ADowngraded due to random sequence generation bias, and problems with comparability of cohorts at baseline; protection against contamination between study interventions. ADowngraded due to study limitations (risk of random sequence generation, allocation concealment, and attrition bias). Keeping these dimensions in mind, below we have reported the findings from the included studies in five summary categories with subcategories as follows. The Characteristics of included studies tables also include two additional ratings for each study as follows.

• Follow‐up length ranged from the end of treatment through to five years (Table 8).
• This means making time for eating, sleeping, and having fun, as well as behaving kind enough toward yourself that you permit yourself these necessities.
• This is according to a new generation of kinda-sorta temporary temperance crusaders, whose attitudes toward the hooch is somewhere between Carrie Nation’s and Carrie Bradshaw’s.
• Although we observed heterogeneity in the magnitude of the effects for AA/TSF in comparison to other treatments or TSF variants, the direction of the findings in almost every case was in the same direction, with AA/TSF doing as well as, or better than, comparison interventions.
• However, Alcoholics Anonymous is an organization specifically for people struggling with alcohol use.

This review summarized research comparing the Alcoholics Anonymous (AA) and similarTwelve‐Step Facilitation (TSF) programs (AA/TSF) to other treatments to see if they help people with drinking problems to stay sober, or reduce alcohol consumption and drinking‐related consequences. We also examined whether AA/TSF reduces healthcare costs relative to other treatments. Follow‐up after intervention ranged from three to 60 months, with a modal length of 12 months (see Table 8). On the whole, study samples were quite large and adequately powered to detect effects. However, sample sizes were highly variable and skewed across studies, ranging from a low of 48 participants in Kahler 2004 to a high of 3018 in Ouimette 1997, with an average of 400 participants per study (mean 406.4; SD 616.2; median 201).