March 11, 2020 / 9:33 PM / 3 months ago

AA, other 12-step programs more effective than talk therapies

(Reuters Health) - Alcoholics Anonymous and similar 12-step programs can lead to higher rates of continuous abstinence than other addiction treatment approaches like cognitive behavioral therapy, a large new study suggests.

In an analysis of pooled data from 27 earlier studies, researchers found a 20% higher rate of abstinence for one year among people who attended AA or a 12-step program that encourages participation in AA, according to the Cochrane Database of Systematic Reviews report.

“We now have good evidence that AA and 12-step-facilitation treatments produce high rates of remission and reduced healthcare costs,” said study coauthor John Kelly of Harvard Medical School, who directs the Massachusetts General Hospital Recovery Research Institute in Boston.

“AA creates a socially engaged fellowship,” Kelly said. “The social network can attract and engage people longer term, which reduces relapse risk. This tends to be a chronic relapsing condition.

Other approaches do fine over the short term, Kelly said. “But they are not sustaining remission over the long term,” he said. “AA provides accountability. You have someone to report to, your sponsor, who acts like a mentor. And it’s a resource that is often just around the corner.”

Another big benefit to AA is that it is free, Kelly said.

For the analysis, Kelly’s team looked for studies that compared 12-step programs to other addiction treatments. They ultimately settled on 27 studies that included 10,565 patients with an average age of 34.

The analysis found that AA and AA-connected 12-step programs had 20% improved abstinence rates over a period of 12 months compared to other therapies. That effect remained constant at both 24 and 36 months.

When the researchers looked at the data in terms of number of days of abstinence, they found AA and other 12-step programs worked as well as other interventions. The data also showed that AA and 12-step programs worked as well as others when it came to getting drinkers to cut back on the amount of alcohol they were consuming.

Recently AA has come under more scrutiny and there has been a suggestion that it’s not that effective, said Dr. Tim Brennan, director of the Addiction Institute at Mount Sinai West and St. Luke’s in New York City, who wasn’t involved in the review.

“This is a compelling study,” Brennan said, adding that AA can be very hard to study because of its anonymity.

“However, the important take home point is that while this may suggest that AA may be as effective or more effective as other options, it’s always important to speak with a clinician about alcohol use,” Brennan said. “For some people AA can be a godsend, but others find the opposite, that it is triggering and exacerbates things.”

Another piece of advice, Brennan said: if you don’t like a particular AA group, try some others.

AA can be a very important resource for people having trouble getting into a treatment program or without insurance, said Dr. Antoine Douaihy, a professor of psychiatry and medicine at UPMC Western Psychiatric Hospital in Pittsburgh, who also wasn’t involved in the review.

“You can continue attending for years and years and you don’t have to worry about insurance covering it,” Douaihy said. “And you can go any time. There are meetings happening evenings and weekends. And for people who are struggling and have to travel, they can find AA meetings.”

Moreover, Douaihy said, “there’s a huge scientific literature on mutual support groups, AA in particular, showing that they can be an important part of people’s recovery. Having a sponsor and working through at least four of the steps is really predictive of the benefits.”

SOURCE: bit.ly/2vMWKCd Cochrane Database of Systematic Reviews, online March 11, 2020.

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