AA Effectiveness

Research limitations

AA tends to polarize observers into believers and non-believers, and discussion of AA often creates controversy rather than objective reflection. Moreover, a randomized study of AA is difficult: AA members are not randomly selected from the population of chronic alcoholics, with the possible exception of those who are mandated by courts to attend AA meetings; they are instead self-selected. There are two opposing types of self-selection bias: (1) drinkers may be motivated to stop drinking before they participate in AA (2) AA may attract the more severe and difficult cases. Controlled experiments with AA versus non-AA subjects are also difficult because AA is so easily accessible. Twelve-step groups, like AA, are not conducive to probability sampling of members. Research on AA is therefore susceptible to sampling bias.

Studies

Studies of AA's efficacy have produced inconsistent results. While some studies have suggested an association between AA attendance and increased abstinence or other positive outcomes, other studies have not. A Cochrane Review of eight studies, published between 1967 and 2005, measuring the effectiveness of AA, found "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism, based on a meta-analysis of the results of eight trials involving a total of 3,417 individuals. To determine further the effectiveness of AA, the authors suggested that more studies comparing treatment outcomes with control groups were necessary.

Retention

Every third year since 1968, AA has issued a pamphlet summarizing its latest triennial survey of meeting attendants. Additional published comments and analysis for academics and professionals have supplemented the survey results from 1970 through 1990. The 1990 commentary evaluated data of triennial surveys from 1977 through 1989 and found that the distribution of those with one year or less indicated that one quarter (26%) of those who first attend an AA meeting are still attending after one year. Furthermore, nearly one third (31.5%) leave the program after one month, and by the end of the third month, almost half (47.4%) leave. Of those who stay for three months, half (50.0%) will attain one year. After the first year, the rate of attrition slows. Only those in the first year were recorded by month.

Two landmark surveys that sampled the general population produced independent results on AA continuance rates. The 1990 National Longitudinal Alcohol Epidemiologic Survey (NLAES) found that Alcoholics Anonymous has a 31% continuance rate. The 2001-2002 National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) indicates a slightly higher rate, at 35.2%.

Sobriety of members

Internal AA surveys suggest that about 40% of the members sober for less than a year will remain another year. About 80% of those sober more than one year, but less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year. Those who remained sober outside the fellowship could not be calculated using the survey results.

Health-care costs

As a volunteer-supported program, AA is free of charge. This contrasts with treatments for alcoholism such as inpatient treatment, drug therapy, psychotherapy and cognitive-based therapy. One study found that the institutional use of TSF to encourage participation in AA reduced health-care expenditures by 45% when compared to another group that was not encouraged to participate in AA.