Although federal experts estimate that alcohol abuse leads to 88,000 Americans’ deaths annually and economic costs of almost $250 billion, one of the nation’s oldest and best-known programs to deal with this problematic behavior has long been surrounded by doubts.
Critics have questioned its effectiveness, criticized its “irrationality,” and focused on its stepped regimen, desperate and self-enrolling participants, and core tenets, including its spiritual appeals to higher and external powers.
But after a deep dig into the building and rigorous evidence about it — including scrutiny of 27 studies, (some of them randomized clinical trials) with more than 10,000 participants — researchers from Harvard, Stanford, and Europe have concluded in a published, research review for the respected Cochrane Collaboration that Alcoholics Anonymous, indeed, can be beneficial for many but not all excessive alcohol users.
“AA leads to increased rates and lengths of abstinence compared with other common treatments. On other measures, like drinks per day, it performs as well as approaches provided by individual therapists or doctors who don’t rely on AA’s peer connections.”
The researchers, in their “plain language” summary, observed of the 12-step core facilitation approach, that such “interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence. This effect is achieved largely by fostering increased AA participation beyond the end of the [12-step] intervention. AA … will probably produce substantial health care cost savings while simultaneously improving alcohol abstinence.”
As lead author John F. Kelley, a Harvard Medical School psychiatry professor, told the New York Times:
“These results demonstrate AA’s effectiveness in helping people not only initiate but sustain abstinence and remission over the long term. The fact that AA is free and so widely available is also good news. It’s the closest thing in public health we have to a free lunch.”
The researchers noted that alcohol treatment programs can be expensive and vary in results, with non-AA programs leading to abstinent behavior in 15% to 25% of their participants. That compares with 22% to 37% for those in AA, an organization whose members may make claims for higher rates.
Other approaches, including cognitive behavioral therapy — in which trained therapists help patients to understand themselves better and why they abuse alcohol and how that affects them, their lives, and those whom they love — may work better than AA for a given individual, the researchers said. Still, for convenience and cost’s sake alone, AA makes a powerful case for itself, particularly now that careful studies have detailed its outcomes.
That had been an issue before, including in 2006 when Cochrane last looked at AA, finding the evidence for it inconclusive and the studies of it unpersuasive or lacking. In medical science, the work of groups like AA can be difficult to evaluate, starting with the self-selecting nature of its participants. They already may be highly motivated and more likely to change behaviors with AA. Further, the group protects the anonymity of members, who also do not need to appear at one site nor make appointments to join groups that meet across the country.
Since 2006, however, researchers have conducted many more and tougher studies of the group and its work, reported Kelley and colleagues Keith Humphreys of Stanford and Marica Ferri of the European Monitoring Centre for Drugs and Drug Addiction.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs and other harmful substances like alcohol. Booze has been abused for centuries, and modern Americans may think that medical science knows all it needs to help problem drinkers.
The reality is different. Alcohol, long a significant health and mental health problem for men, has fast become a rising issue for women, too, particularly older women. Women, who typically weigh less than men, may put themselves at higher risk of harms because they may drink at the same levels but experience higher intoxication. Their excessive consumption also heightens the potential they will suffer from cardiovascular diseases, certain cancers, alcohol‐related liver disease, and acute liver failure.
Men, notably older men, face persistent problems with their alcohol consumption, which can prove even more detrimental to their health as they age. Alcohol abuse has become a big part of “deaths of despair,” in which older, less educated white men — believing their economic and social prospects are in sharp decline — engage in behaviors that damage their health and kill them.
Alcohol, of course, also takes a terrible toll on the nation’s roads, as the federal Centers for Disease Control and Prevention separately has reported:
“Every day, 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This is one death every 50 minutes. The annual cost of alcohol-related crashes totals more than $44 billion. In 2016, 10,497 people died in alcohol-impaired driving crashes, accounting for 28% of all traffic-related deaths in the United States. Of the 1,233 traffic deaths among children ages 0 to 14 years in 2016, 214 (17%) involved an alcohol-impaired driver.”
While the nation battles the opioid and overdose crisis, we also cannot ignore the mayhem that alcohol can cause. We’ve got a lot of work to do on excessive drinking, and it is good to know that AA can play an important role in helping those with alcohol problems.