SANTA BARBARA, CALIF. — A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.
Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.
One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.
Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer. “It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.
Study's 10-Year Follow-Up
Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”
In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.
“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster. Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns. There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity.
“In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported. Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.
AA Viewed as Valuable Resource
A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.
Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”
Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA.
Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.
Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study.
Recent AA attendance was reported by 39%. This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, for example, reading core AA literature. “It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.
A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.