AA: What The Science Says

AA is the opposite of evidence-based treatment.

Here are the Twelve Steps of Alcoholics Anonymous:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Surrendering power (becoming powerless) is irrational. Psychology and Psychiatry are areas of science from which we have empowered ourselves to cure our illnesses. To dismiss all these resources and instead state that we are powerless is plain stupid. To place that power in God, an imaginary being for whose existence there is zero evidence, and our motives in believing (fear of death, our reason for existence, etc...) are completely suspect and self-serving, is irresponsible.  AA is the opposite of evidence-based treatment.

AA:  What the Science Says.

The low success rate of AA's religiously-based "treatment" reflects this stupidity. There have been only two scientifically valid studies done on the efficacy of AA.

The Ditman Study

The first study, the Ditman Study, was done in San Diego in 1964. The subjects were 301 "chronic drunk offenders" who where defined as having had two DUIs in the last three months or three DUIs in the last year. The subjects were randomly divided into three groups: an untreated group, an AA treatment group, and a clinical treatment (type not specified) group. After a year, there was no statistical differences between the three groups in terms of recidivism rate, rearrests, or in time elapsed prior to arrest. AA was no more effective than no treatment at all.

Ditman, K.S., Crawford, G.C., Forgy, E.W., Moskowitz, H., & MacAndrew, C. (1967).  A controlled experiment on the use of court probation for drunk arrests.  American Journal of Psychiatry, 124(2), 64-67.

The Brandsma Study

The second study, the NIAAA-funded "Outpatient Treatment of Alcoholism," randomly assigned subjects to five groups: untreated, A.A., lay-led Rational Emotive Behavioral Therapy (REBT), professionally-led one-on-one REBT, and one-on-one Freudian-based insight therapy. In terms of retention rate, AA was the worst with a 68% drop out rate. All the other groups had 40-46% drop out rates.

In terms of drinking behavior all treatments worked: professional REBT 80%; lay REBT 100%; insight, 92%; A.A. 67%; untreated, 50%; reported decreased drinking. Significantly, A.A. treated subjects were over four times more likely to binge drink compared with the control group, and nine times more likely than the lay-REBT group.

The authors of the study concluded:

AA seems to have definite limitations of social class, ideology, flexibility of adopting new techniques, and the type of personality it appeals to. Our study suggests further conformation of this in our severe dropout rate from this form of treatment. It is probably, as Ditman et al.'s (1967) work suggests and ours confirms, that AA is just not effective as a coerced treatment with municipal court offenders.

(Brandsma et al., 1980, p. 84, emphasis added)

Brandsma, J.M., Maultsby, M.C., & Welsh, R.J. (1980).  Outpatient treatment of alcoholism:  A review and comparative study.  Baltimore:  University Park Press.

AA's Triennial Surveys

The AA monograph, Comments on AA's Triennial Surveys, while not a controlled survey, is worthy of attention. The Triennial surveys are large surveys of several thousand AA members.

The Comments document indicates only a 5% retention rate after one year. This "5% success rate" often mentioned, therefore, is only a measurement of continued attendance. Anyone who has gone to AA meetings can attest to the fact that not all members remain abstinent. The success rate, therefore is less than 5%. Given that the spontaneous remission rate is between 3.7% to 7.4%, AA recovery rate may be even lower than doing nothing at all. AA could very well be preventing remission.

Alcoholics Anonymous. (n.d., presumably 1990).  Comments on AA.s triennial surveys. New York:  Alcoholics Anonymous World Services.

  

So Why Have States Chosen AA as a Mandatory Rehabilitative Treatment Program?

The science clearly shows A.A. is ineffective, while REBT/insight therapies have been shown to be effective.  So why is the State mandating AA when other, more effective, alternatives are available?  (I was told here in NH that only AA would be accepted--SMART Recovery, a from of REBT, would not.)

The answer should be obvious after examining AA's Twelve Steps (above) and noting the main difference between AA "therapy" and REBT/insight therapies.  It all comes down to God and religion.  Look at how many times the word "God" or "Him" appears in the twelve steps!  AA members always argue, "it's not religious, it's spiritual"--which is complete nonsense.  The Lord's Prayer is said, while holding hands, at the end of every single meeting I've been to.  That is religious.  It is not spiritual.  In fact, it's cultish.

Christian fundamentalists, whose mission it is is to proselytize and convert the "unfortunates," are using influential lobbying groups to convince State Legislatures that AA is an effective and nonreligious treatment for alcoholism.   It's a stealthy way of powerfully imposing their religious beliefs on a demonized segment of society, all with the State's blessings.

The Founding Fathers, particularly Adams and Jefferson, would be disgusted.  As am I.