Does AA work? That’s (in part) up to you
Clinician support improves Alcoholics Anonymous’ success rate.
Similarly, Project MATCH participants involved in AA during the first 6 months after treatment had more-frequent abstinent days in the 7 to 12 months after treatment. AA “involvement” included identifying oneself as an AA member, working the steps, having an AA sponsor, and celebrating sobriety milestones.12
The National Drug Abuse Collaborative Cocaine Treatment Study is the most detailed analysis of self-help use. This multi-site RCT by Weiss and colleagues enrolled 487 individuals for behavioral treatment of cocaine dependence.23
Twelve-step attendance did not predict substance use outcomes, but active participation (such as making coffee for a meeting or reading AA literature) in a given month predicted decreased substance use in the following month. Subjects whose participation increased over the first 3 months showed reduced drug use in the following 3 months. Interestingly, those who participated without attending meetings regularly (such as by reading AA literature or calling a sponsor) benefited as much as those who attended meetings more regularly.
Summary. Actively engaging in 12-step treatment—as measured by identifying with the fellowship and following the steps—appears more important to success than simply attending meetings.
EFFECTIVE AA REFERRALS
To encourage engagement when referring, try to match patients to AA groups attended by persons with whom they feel comfortable (Table 2).24 Adolescents, for example, tend to have more difficulty engaging and remaining in AA than do adults.25 One remedy may be to recommend a Young Person’s AA group composed primarily of adolescents and young adults.
Although AA embraces a spiritual approach to recovery, a person can benefit from participating without having a specific religious affiliation or spiritual beliefs.12,26 The emphasis on spirituality and a “higher power” varies from one AA group to another as well as from region to region. For patients who are uncomfortable with AA’s religiosity, other self-help options for alcohol dependence include SMART Recovery (a CBT-based treatment) and Secular Organization for Sobriety (see Related resources).
Table 2
Matching patients to AA groups:
6 variables to consider
| Variable | Suggestion |
|---|---|
| Socioeconomic status | Match by group location |
| Gender | Women-only groups |
| Age | Young people’s AA |
| Religious content | Beginners’ groups and speaker or topic discussion groups have less-spiritual focus, whereas Step groups and Sunday meetings have more spiritual focus |
| Smoking status | Most groups are smoke-free |
| Drug of choice | Consider AA, Narcotics Anonymous, or a combination of both |
| Source: Reference 29. | |
Some studies20,21—but not all27—suggest that individuals with co-occurring psychiatric disorders have more difficulty participating fully in AA than those without such comorbidity.
Kelly et al20 examined the influence of major depressive disorder (MDD) on AA participation and treatment outcomes in 2,161 men with substance use disorders. During the first year after discharge from inpatient substance-abuse treatment, MDD appeared to have no effect on AA attendance rates or substance abuse outcomes. However, the 110 men with co-occurring MDD showed significantly less social participation in AA—with fewer friends, contacts/calls, and sponsors—and they continued to suffer substantial depression.
This suggests that clinicians could help patients with MDD engage in AA by addressing social anxiety symptoms (how to ask for a sponsor, the importance of establishing and using the AA social network). Carefully monitoring and treating acute depressive symptoms also may enhance AA social participation, especially for patients new to AA.
Impaired social relating is common to many psychiatric disorders—such as psychotic disorders, anxiety disorders, trauma and personality disorders—and social skills training may help other dual-diagnosis patients entering AA. Those with impaired self-control—as with mania or overt psychosis—or inability to maintain interpersonal boundaries are best referred to AA after you stabilize symptoms that would disrupt the group setting.
- Alcoholics Anonymous. General Services Office, PO Box 459, Grand Central Station, New York, NY 10163. Phone (212) 870-3400. www.aa.org
- AA Grapevine: International Journal of Alcoholics Anonymous. https://www.aagrapevine.org.
- National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov
- National Institute on Drug Abuse. https://www.nida.nih.gov/NIDAHome.html
- Cocaine Anonymous. https://www.ca.org
- Narcotics Anonymous. https://www.na.org
- Secular Organizations for Sobriety. https://www.sossobriety.org
- SMART Recovery. https://www.smartrecovery.org
