Critics of Alcoholics Anonymous often say there’s no proof that AA works. But then, “proof” is a term that scientists don’t use. The outcome of research is evidence, not proof. The strongest “laws” in science, such as gravity and evolution, are theories.
Basically, the criticism is that AA hasn’t undergone rigorous randomized controlled trials (RCT). RCTs are what we use to show efficacy and safety of medicine: One group gets a placebo while the other group gets the real medicine, each without knowing it, and we see whether the real medicine works better than the placebo. That would be almost impossible with AA. Permission to attend AA cannot be denied to create a control group. But just because successful RCTs haven’t been done doesn’t mean there’s been no effective research on AA. A search in Google Scholar of research since 1980 with “Alcoholics Anonymous” in the title shows more than 1,000 hits and another 1,000 hits for “12 Steps” and “Twelve Steps.”
Let me cite a couple in particular:
- Research just published in Drug and Alcohol Dependence culled control and experimental groups for testing AA from the data of Project MATCH, an RCT of alcoholism treatments. Researcher Stephen Magura at Western Michigan University compared outcomes for people who attended AA only because it was part of their treatment program against people who did not attend AA because it wasn’t part of their treatment. This second group would have gone to AA if it had been part of their treatment, but it wasn’t. The results were that the group that went to AA as part of treatment had greater abstinence and less problem drinking.
- Researcher Lee Ann Kaskutas from the Alcohol Research Group has published many studies on AA; along with Marc Galanter, she edited a book on research about AA that contained many dozens of studies. In her 2009 paper entitled “Alcoholics Anonymous Effectiveness: Faith Meets Science,” a review of several dozen published research reports on the effectiveness of AA, Kaskutas notes that because randomized trials are so difficult with AA, many researchers instead use statistical methods to assess its effectiveness. She looked at six criteria for success and found that AA nailed five of them and showed middling success in the sixth.
- Rates of abstinence are about twice as high for those who attend AA
- Higher levels of AA attendance are related to higher rates of abstinence
- The above two successes are found among different samples and follow-up periods
- Prior AA attendance is predictive of subsequent abstinence
- Mechanisms of behavior change are evident at AA meetings
But the sixth criteria – labeled “specificity” — showed mixed results. It’s somewhat difficult to specifically identify AA attendance as leading to abstinence. Because there are so many variables, it’s hard to show precise cause and effect. Nonetheless, of four studies that examined specificity, two were positive, one was negative and one was null.
Kaskutas put together an informative Power Point on this paper, which I found on the Internet and share with you here:
Of course, people who go to AA couldn’t care less about the research; they just know what works for them. True, AA doesn’t work for everybody. But then, many treatments for other chronic diseases work for some but not others.
We know alcoholism is a chronic disease. The research shows that AA is an effective treatment for it.