How Effective is Alcoholics Anonymous?

For decades, scientists were unsure how well Alcoholics Anonymous worked. An extensive review of AA studies found that it outperforms other common treatments like cognitive behavioral therapy.

For those struggling with alcohol use disorder, Alcoholics Anonymous (AA) is often touted as the go-to option for support. With more than 123,000 groups across 180 countries worldwide, the AA model — free and open to the public — has guided people through addiction since it began in 1935. And in recent decades, a growing body of research has shown that it can be incredibly effective.

“I think it is the power of peers,” says John Kelly, a professor of psychiatry at Harvard Medical School. Kelly led a 2020 analysis that reviewed the scientific evidence of AA’s effectiveness across 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants.

The Science of Alcoholics Anonymous

AA has been around for more than 85 years, but scientific evidence didn’t start to build about its effectiveness until around the 1990s, Kelly says.

“Anecdotally, we knew that AA was very large, influential and attended by millions of people,” he adds. “But we had no idea from a scientific public health standpoint about its real clinical utility.”

Kelly and his team examined studies published in the past couple of decades in which people were randomly assigned to AA or other 12-step programs by health professionals. They found that such programs had outcomes similar to other treatments, but were “dramatically better when you’re talking about remission, sustained remission, and complete abstinence over many years,” says Kelly. In short, AA often outperforms other types of therapies or interventions, such as cognitive behavioral therapy.

“Organizations like AA are a good match for the long-term undulating course of addiction recovery,” Kelly adds. “In terms of AA’s ability to sustain remission over time, that’s what really stood out: 20 to 60% higher rates of remission.”

Other Benefits of Alcoholics Anonymous

Researchers are also learning more about how the AA approach benefits those suffering from alcohol addiction. Kelly explains that it can boost cognitive and behavioral coping abilities, which are key to remaining abstinent.

“It can also reduce craving, reduce impulsivity, and massively changes social networks,” he says. “It can also increase spirituality, which can help people reframe stress and find meaning and purpose.”

While the evidence shows AA is broadly effective, it’s admittedly not for everyone. Some who are referred may never attend, while others may drop out after trying it.

“We know that no one treatment works for everybody,” Kelly says. That’s why it’s important to investigate a variety of different options to find what works for those going through addiction. “The question is how can we identify the exact, precision fit for patients in different kinds of treatments, who are going to benefit from a particular approach.”

Combatting Alchohol Addiction

Alcohol use disorder is a leading driver of death throughout the world. According to the World Health Organization, “harmful use of alcohol” is responsible for around 3 million deaths per year, equating to about 5.3% of all deaths. This is particularly acute in people in their 20s and 30s. In the U.S. alone, an estimated 95,000 people die annually due to “alcohol-related causes.”

In the face of such a widespread public health problem, Kelly says, “in AA we have a free resource in the community which can save lives, sustain remission and reduce healthcare costs for individuals and the healthcare system. That’s good news from a public health perspective, as it’s able to help people achieve long-term remission and reduce the burden on the healthcare system.”

By Sean Mowbray, Discover Magazine