Researchers found that 12-step programs were particularly effective when used alongside and after professional treatment.
In the past few weeks, the pace of news has been unrelenting, so it would be understandable if you missed a flutter of headlines last month claiming that Alcoholics Anonymous and other 12-step programs are more effective and cheaper than other treatments for addiction.
While the work is important — and validating for the millions of people who have used AA to get and stay sober — there are caveats to the research. Here’s what you should know about the latest study about the effectiveness of AA.
What the study found
On March 11, a team of researchers with the Cochrane Collaboration published a scientific review looking at the effectiveness of AA and other 12-step programs. The review looked at the conclusions of 27 different scientific studies, which overall included 10,565 participants.
After examining the results from these studies, the authors concluded, “There is high quality evidence that [AA and 12-step programs] are more effective than other established treatments, such as [cognitive behavioral therapy], for increasing abstinence.”
It’s important to note that the studies in the review specifically looked at alcohol use disorder, not any other types of addiction. Still, the results were striking. People in 12-step programs were more likely than those getting other therapies to be continuously sober at 12 months, and two studies found this benefit continued up to 36 months. People in 12-step programs had a higher percentage of days abstinent at 24 and 36 months. And, unsurprisingly, the cost associated with 12-step treatment was lower than the cost associated with other therapies.
The study was a followup to a 2006 review by the Cochrane Collaboration that found inconclusive evidence to support that AA was more effective than other treatments. Since then, additional studies have provided evidence for the superior effectiveness of 12-step programs.
“High-certainty clinical research evidence now clarifies that AA is a viable recovery option,” study author John Kelly told Medscape Medical News. Kelly is the director of the Recovery Research Institute, Massachusetts General Hospital and a professor of psychiatry in addiction medicine at Harvard Medical School.
The study’s limitations
It may be tempting to look at the headlines surrounding this study and conclude that anyone struggling with addiction just needs to get themselves to a meeting. However, that’s not the case. The study only looked at alcohol use disorder. Plus, it only compared AA to other behavioral interventions, not medication-assisted treatment (MAT).
“Our concern is that people will misinterpret the study, to assume that nothing else is needed other than 12 steps,” says William C. Moyers, vice-president of public affairs and community relations at the Hazelden Betty Ford Foundation.
This could be particularly harmful for people with opioid use disorder, for which MAT is the standard of care. It could also be dangerous for more than 9 million Americans who have substance use disorder and a co-occurring mental illness.
“The 12 steps themselves are not going to help with depression, bipolar disorder or trauma,” Moyers says. “Whether it’s medication, CBT or talk therapy, there are many tools that are vital to how people struggling with substance abuse are treated.”
The 12 steps as an adjunct to treatment
Moyers says that while the 12 steps are “a proven pathway to recovery” for millions of people — himself included — they should not be classified as a treatment. This became especially clear to the providers at Hazelden Betty Ford when the opioid epidemic began.
“When it came to treatment of opioid patients, the 12 steps by themselves are not enough to keep patients on the course of recovery, particularly after they left treatment,” he says. “The physical cravings are too powerful for the 12 steps to keep at bay.”
That’s why Hazelden Betty Ford began using MAT in addition to 12-step programs to treat people with opioid use disorder.
“Now, we’re truly treating the mind, body and spirits of our patients,” Moyers says. “It’s working.”
Laurence M. Westreich, MD, a professor of psychiatry at New York University School of Medicine, shared a similar message with Medscape when he commented on the recent study.
“AA can be a powerful adjunct for those trying to stop addictive behaviors,” he said.
He added that those “who are most successful in addressing an addiction choose the most productive idea from professional therapies and peer-led support groups like AA in bolstering their recovery.”
The study supports this. Researchers found that 12-step programs were particularly effective when used alongside and after professional treatment. In short: when you’re trying to get and stay sober, use all the tools that are available.
The 12 steps can increase access to treatment
One of the biggest issues in the treatment of substance use disorder nationally is the “treatment gap.” The National Institutes of Health has estimated that as few as 10% of people who need addiction treatment get it. Cost and time to dedicate to residential treatment are huge factors that keep people from accessing care.
AA and other 12-step modalities are free and readily available, both in person and online. Because of that, they can be a powerful tool for people who might not have other means to get treatment.
“It’s universally available any time of day, any day of the week, and it’s free,” Carol J. Weiss, MD, a professor of psychiatry at Weill Cornell Medical College, told Medscape.
While ideally everyone who needs treatment would have access to MAT, high-quality therapy, and 12-step programs, that’s simply not the case. For people facing a frustrating and expensive healthcare system, free 12-step programs can provide benefits at a very low cost, Kelly told The New York Times.
“It’s the closest thing in public health we have to a free lunch,” he said.