The Cochrane Collaboration is the gold standard in medicine if you want to know whether a particular intervention works. Its methods are rigorous and its reputation unquestioned. It works by meta-analysis where the combined outcomes of multiple published trials are evaluated. People involved in the addiction treatment and recovery world might be interested to know that a Cochrane review, published in March this year has shown that Alcoholics Anonymous is significantly more effective than psychotherapy and other interventions, including no intervention, in achieving abstinence in people with alcohol use disorders. In studies where the outcome other than complete abstinence was measured, AA was found to be as effective and when costs were considered, AA showed significant savings, which is not surprising because AA is free to anyone who chooses the intervention. It should be noted that the outcomes of the measured studies were consistent, irrespective of age, gender, occupation or location as the studies reviewed covered five different countries.
What is the secret behind AA’s success in helping alcoholics achieve a sustainable sobriety? There are a number of elements that give AA a headstart over the competition.
Firstly, no other agency addresses the shame associated with alcoholism as effectively as AA. Membership of AA amounts to an anonymous but public disclosure that one is alcoholic and not just a heavy drinker or party animal. AA defines an alcohol use disorder in an unstigmatised way, which allows the alcoholic to accept the condition more readily. This is hugely important because unless you accept the problem, you won’t be able to start with a solution. AA makes it ok to be an alcoholic. It is the only club in the world where the entrance requirement is that you have to be an alcoholic. Everyone else tries to exclude alcoholics from their midst.
Secondly, it is not by chance that AA is described as a fellowship. It is not an organization, association or society. Fellowship creates an egalitarian sense of community, everyone is important, everyone belongs and there is no discrimination based on past exploits or behaviours. While everyone is accountable for their choices and behaviours, AA understands that alcoholics do anti social things as part and parcel of their illness. The shared commonality of negative experiences helps ameliorate the guilt arising from the behaviours that haunt the alcoholic and allows for a new found personal freedom.
The mainstay of AA is the actual 12 Step programme. This attracts most of the criticism but is AA’s secret weapon. Irrespective of how you might interpret the theology behind the programme, embedded in the steps is a pathway to a transcendent experience. The 12th step calls it “a spiritual awakening” but the preamble is gratitude, humility and an unconditional surrender. If these are the values that 12 step recovery embraces, then these are surely values that account for AA’s superior outcomes.
Finally, the real power behind AA’s success, despite it being a non professional group without an organizational hierarchy or formal structures (2 million members in 180 nations with 118 000 active groups), is its empirical but accurate explanation of the actual problem of alcoholism for every alcoholic – an inability to safely or accurately predict the outcome of alcohol use, once consumption commences despite external control measures, constraints or accountabilities. This resonates with everyone who has the problem and strongly informs abstinence as the most sensible route out of the mess.
So this Cochrane Review, the world’s most independent and reputable scientific review mechanism only confirms what every member of AA has already known for a long time– “it works if you work it”.[Cochrane reference: https://doi.org/10.1002/14651858.CD012880.pub2]