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In my research I've found statistics for spontaneous remission from addiction: http://www.ncbi.nlm.nih.gov/pubmed/10976668. The statistics for A.A. seem to be a little more difficult to find/interpret. For example: http://www.12step.com/statistics.html seems to indicate several different 12-step recovery statistics - but indicates a lack of scientific support for any of them. This seems to be the case with most 12-step statistics sites - with the most obvious offense that they are written from a biased viewpoint (the disgruntled ex-A.A.)

So to my question: Are there any good statistical studies that show A.A. to have a better rate than spontaneous remission?

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    What makes me highly skeptical about it is that it has this strong religious component. I'd love to see some statistics. – Lagerbaer Apr 6 '11 at 21:56
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    @Lagerbaer Though an A.A. would argue with you about that and instead insist on "spiritual" - I agree, if the healing comes from a "higher power" we are just back to an existence of God question. In that case, with my current beliefs, I'd posit that we should see no difference between spontaneous remission and recovery in A.A. rates. And what I've seen so far seems to point to this- but I'm having problems finding truly objective and complete (see my comment above to Zenon) statistics that support this. – user776 Apr 6 '11 at 22:52
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    @Lagerbaer: Whether the religion involved is factual or entirely made up is irrelevant here: what is relevant is its effect on the participants. Most people in the US are religious to some extent. There is no a priori reason to believe that a religious or spiritual approach would be more or less effective than any other. – David Thornley Apr 7 '11 at 1:50
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    @jaskey13: Abstinence is a terrible metric for a definition of remission. Consider a different addiction: would you consider a sex addict to be in remission because they have vowed to never again have sex? A healthy person does not abstain from the substance they were addicted to, they partake of it at the same level that a non-addict does. Which is why you'll not find good evidence for this; there is no good definition for the concept of addiction in the first place. – DampeS8N Apr 7 '11 at 11:56
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    @Rick N it is always interesting to me how the more hardline proponents of the AA program insist that any examination is detrimental to it's proper functioning. In the current age- the one we live in- this indicates weakness or willful ignorance. – user776 Jun 16 '12 at 0:55
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Wired magazine printed an excellent overview of Alcoholics Anonymous last year. Here is what it had to say regarding the statistics of AA's effectiveness:

But how effective is AA? That seemingly simple question has proven maddeningly hard to answer. Ask an addiction researcher a straightforward question about AA’s success rate and you’ll invariably get a distressingly vague answer. Despite thousands of studies conducted over the decades, no one has yet satisfactorily explained why some succeed in AA while others don’t, or even what percentage of alcoholics who try the steps will eventually become sober as a result.

As a result of these complications [listed in the article but snipped], AA research tends to come to wildly divergent conclusions, often depending on an investigator’s biases. The group’s “cure rate” has been estimated at anywhere from 75 percent to 5 percent, extremes that seem far-fetched. Even the most widely cited (and carefully conducted) studies are often marred by obvious flaws. A 1999 meta-analysis of 21 existing studies, for example, concluded that AA members actually fared worse than drinkers who received no treatment at all. The authors acknowledged, however, that many of the subjects were coerced into attending AA by court order. Such forced attendees have little shot at benefiting from any sort of therapy—it’s widely agreed that a sincere desire to stop drinking is a mandatory prerequisite for getting sober.

Yet a growing body of evidence suggests that while AA is certainly no miracle cure, people who become deeply involved in the program usually do well over the long haul. In a 2006 study, for example, two Stanford psychiatrists chronicled the fates of 628 alcoholics they managed to track over a 16-year period. They concluded that subjects who attended AA meetings frequently were more likely to be sober than those who merely dabbled in the organization. The University of New Mexico’s Tonigan says the relationship between first-year attendance and long-term sobriety is small but valid: In the language of statistics, the correlation is around 0.3, which is right on the borderline between weak and modest (0 meaning no relationship, and 1.0 being a perfect one-to-one relationship).

“I’ve been involved in a couple of meta-analyses of AA, which collapse the findings across many studies,” Tonigan says. “They generally all come to the same conclusion, which is that AA is beneficial for many but not all individuals, and that the benefit is modest but significant … I think that is, scientifically speaking, a very valid statement.”

That statement is also supported by the results of a landmark study that examined how the steps perform when taught in clinical settings as opposed to church basements. Between 1989 and 1997, a multisite study called Project Match randomly assigned more than 1,700 alcoholics to one of three popular therapies used at professional treatment centers. The first was called 12-step facilitation, in which a licensed therapist guides patients through Bill Wilson’s method. The second was cognitive behavioral therapy, which trains alcoholics to identify the situations that spur them to drink, so they can avoid tempting circumstances. And the last was motivational enhancement therapy, a one-on-one interviewing process designed to sharpen a person’s reasons for getting sober.

Project Match ultimately concluded that all three of these therapies were more or less equally effective at reducing alcohol intake among subjects. But 12-step facilitation clearly beat the competition in two important respects: It was more effective for alcoholics without other psychiatric problems, and it did a better job of inspiring total abstinence as opposed to a mere reduction in drinking. The steps, in other words, actually worked slightly better than therapies of more recent vintage, which were devised by medical professionals rather than an alcoholic stockbroker.

AA is still far from ideal. The sad fact remains that the program’s failures vastly outnumber its success stories. According to Tonigan, upwards of 70 percent of people who pass through AA will never make it to their one-year anniversary, and relapse is common even among regular attendees.

[I retained the emphasis from the original but added links to the studies mentioned for convenience.]

The article has a lot of information on the history and details of the program, including some theories as to why it works for some people. It also addresses some of the issues raised in the question's comments, particularly regarding exactly how the spiritual component assists in treating addiction.

While I could spend years looking into the subject, I suspect that hundreds of studies later, I would end up drawing a similar conclusion to the article's author. Studies on AA are all over the map and it's impossible to draw a sound conclusion at this point in time. AA is not a panacea by any stretch of the imagination, but there is clearly some benefit to the program. More research is needed to pick out the most helpful segments of the program and combine them with other techniques, so many more people can receive successful treatment.

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    Thank you for this. I read the article-I was particularly struck by "AA doesn’t work for everybody. In fact, it doesn't work for the vast majority of people who try it." and then the paragraph outlining the difficulties of doing a real analysis of A.A. It seems though the author has enough evidence to make the first claim. In which case I'd like to know if it is merely an anecdotal generalization or if there is an actual # signifying "a vast majority." I'm going to look into it- but I'm inclined to accept this answer if no one else anything to say and I can't find that #. Thank you – user776 Apr 9 '11 at 17:52
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    It amuses me how "total abstinence" is listed as being more desirable than "a mere reduction in drinking". I would think the most desirable outcome would be that one could drink socially without suffering ill effects (much like the desired outcome when treating binge eating and/or food addiction), with never drinking again being more realistic but less desirable. – Yamikuronue Feb 16 '12 at 16:53
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    Yeesh, I hate all of those studies - it doesn't look like there's even any evidence for AA being better than going untreated, much less for it being more effective than any other modality. I mean yeah going to AA meetings has a "small but valid" effect, but if you're the sort of person who would really commit to going to AA meetings maybe you're the sort of person who would figure out some other way to pull yourself out even without AA. – Tacroy Mar 28 '12 at 18:13
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    A person who is likely to commit to AA attendance may already be predisposed to quit drinking alcohol. There is a possibility for a hidden variable in assessing the correlation between AA and alcoholism recovery. – Joel Cornett Jun 16 '12 at 16:12
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    Playing devil's advocate here: I wonder how many AAers keep drinking and additionally become religious. – Housemeister Apr 1 '15 at 17:21
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It's time to give an answer that is updated for 2018 (make that 2020):

  • The 2020 Cochrane Review of Alcoholics Anonymous shows a small but significant increase in full abstinence from alcohol using well-run (“manualized”) treatments which get patients in the rooms of AA compared to other treatments: 42% success rate for go-to-AA treatment, compared to a 35% success rate for non-AA treatment. Cochrane Reviews are considered the gold standard of meta-reviews.
  • We now have “good studies” (read: Experimental studies, i.e. studies with randomization) which show that Alcoholics Anonymous (actually, 12-step-facilitation, which is a type of paid therapy where the patient is given advice on how to go to 12-step meetings and be a part of the 12-step culture) is more effective than a control condition where subjects were not (or not significantly, depending on the study) encouraged to go to 12-step meetings. Walitzer 2009 and Litt et al. 2009 come to mind.
  • Humphreys 2014 (PMC 4285560 and it’s free to read) uses a sophisticated statistical technique called “instrumental modeling” to show that being randomly selected such that one goes to more 12-step meetings results in increased sobriety. In particular, about every 3% increase in AA attendance (caused by randomization) resulted in about 1% increase in percentage of days abstinent.
  • The studies which conclude that AA is no more effective than spontaneous remission (actually, the experimental studies where AA participation did not result in increased abstinence) are older studies with methodological problems. For example, Brandsma 1980’s study, frequently brought up by critics, had a serious methodological problem: The “AA” treatment was not an actual AA meeting (i.e. the meetings did not have the fellowship aspect real AA meetings have). See Kaskutas 2009 (PMC 2746426, which is again free to read) for discussion.

The current consensus among the addiction treatment community is that 12-step programs are effective for a significant subset of alcoholics and addicts. As the 2016 surgeon general report (PDF file) put it, “Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups.”

Edit Based on the studies and scientific evidence we have, it appears that it is mainly the fellowship of AA (and not the spiritual aspect of AA) that is keeping alcoholics sober. In particular, while a fairly preliminary study Zemore 2018 shows that other fellowships (LifeRing, Women in recovery, and SMART recovery) are roughly as effective as AA as long as the goal for the participant is complete abstinence from alcohol. With Litt 2009, in the AA treatment (which, yes, did reduce drinking), “the emphasis was shifted to using AA as a means of changing one's overall social support network, including avoiding drinking friends and acquiring non-drinking friends. AA-specific philosophy and focus on a higher power were downplayed”. In Stahlbrandt 2007, the “AA” treatment “was a 3-hour formal lecture, given by therapists trained in the 12-step method”—it did not have the fellowship aspect of actual AA meetings; the study did not see any difference between the control group and the “AA” experimental group.

The only study I can think of offhand which shows the spiritual aspect of AA helping people stay sober is Galanter 2016, which showed prayer helping alcoholics not think about drinking again among a small group (20) of sober members in AA.

There have been claims that Alcoholics Anonymous has only a 5% success rate, or that Alcoholics Anonymous is less effective than spontaneous remission, but those claims are not supported by modern peer-reviewed science.

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    Based on your summaries here, the studies you mention only appear to have compared 12-step vs. no (formalized) treatment. Do you know of research comparing 12-step vs. other treatment programs? It's entirely plausible that the difference could be caused purely/primarily by having external support and not by anything specific to the 12-step model. – Dave Sherohman Nov 5 '18 at 8:51
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    You claim there are studies; please see if you can link to the results. – Shadur Nov 5 '18 at 13:46
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    @DaveSherohman In Walitzer 2009 compared three treatments: “169 alcoholic outpatients (57 women) randomly assigned to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA, or treatment as usual with no special emphasis on AA.” People exposed to the “12-step directive condition” had “a higher percent days abstinent relative to participants in the treatment-as-usual comparison group”. In Litt 2009, again there were three treatments randomly assigned, and the treatment where subjects went to AA more were more sober. – samiam Nov 5 '18 at 14:19
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    Please don't feel shackled to only link to free articles. Links to paywalled articles will be read by fewer of our users, but there are plenty of us with access to journal articles. – Oddthinking Nov 5 '18 at 14:58
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    Done. I have added references to two more studies making the argument that it’s mainly the fellowship aspect of AA keeping alcoholics sober (e.g. if we give people an AA program without the fellowship part, it doesn’t help), while linking to one small study showing the spirituality helps some alcoholics stay sober. – samiam Nov 6 '18 at 0:52

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