New Evidence for the Efficacy of 12-Step Programs

Alcoholics Anonymous (AA) and similar 12-Step programs have been criticized for many years as too overtly religious. One of the most frequent complaints about the system is its use of appeals to a “higher power.” Some people with alcohol use disorder (AUD) try AA meetings but feel they can’t get past “the God part.” By that they typically mean the references to “God, as we understood Him” in steps three and eleven, for example.  

For agnostics, atheists, or humanists, this terminology can feel awkward and distract from the recovery work they need to undertake in order to deal with what they view primarily as a medical condition. Other addicted people regard the traditional 12-Step approach as outdated and unscientific.

Addiction author Gabrielle Glaser assured us in 2015 that using 12-Step facilitation (TSF) as the default method in addiction treatment was a mistake: “The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work.”

There are, however, scientific studies that point in a different direction. New research published just this month concluded that “there is high-quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence.”

After evaluating 35 studies—involving the work of 145 scientists and the outcomes of 10,080 participants—Stanford psychiatry professor Keith Humphreys, Harvard psychiatry professor and addiction expert John Kelly, and fellow investigator Marica Ferri determined that AA was nearly always found to be more effective than psychotherapy in achieving abstinence. In addition, most studies showed that AA participation lowered healthcare costs.

Dr. Kelly 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 organized and well-articulated clinical treatments have the best result. In other words, it is important for clinical programs and clinicians to use one of the proven manualized programs to maximize the benefits from AA participation.”

Addiction expert Marc Galanter, M.D. also looked at the medical efficacy of the AA method in his 2016 book “What is Alcoholics Anonymous?” and concluded that “professionals and treatment programs that maintain a Twelve Step orientation are increasingly finding that this approach is compatible with the variety of psychotherapeutic and pharmacologic approaches now available.”

AA works because it's based on social interaction, Humphreys explained, noting that members give one another emotional support as well as practical tips to refrain from drinking. "If you want to change your behavior, find some other people who are trying to make the same change.”

The review was published in March in the Cochrane Database of Systematic Review. Cochrane requires its authors to undertake a rigorous process that ensures the studies represented in its summaries are high-quality and the review of evidence is unbiased.