Is There Evidence That AA Is Not Effective? | Ask Stanton

Question

Dr. Peele,

I’m currently working on the LPP program. I’m also seeing a life coach who specializes in addiction and attends and supports 12 step programs. She argues that randomized controlled trials show AA is superior to other programs and sent me this link to support her position. https://www.recoveryanswers.org/research-post/update-evidence-alcoholics-anonymous-participation/

Can you present a counter to this position that argues that several RCT’s have found that AA is a superior treatment, and provide links to research support for your position? I am struggling to find good research to back up my position, much of it from your writings, that AA is poorly effective and often counterproductive.

Thanks so much!

Erik

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Dr. Peele’s Answer

Dear Erik,

Thanks for your attention to this regressive movement.

It is puzzling in the extreme. Given the still/dominant position of the 12 steps in American alcoholism and addiction treatment, who could possibly believe that things are going well? As has been widely publicized, America experienced a new all-time record of 93,000 drug deaths in 2020, a number that has been growing since the beginning of the century. The Global Burden of Disease study completed by WHO found that, among 196 nations worldwide, the U.S. had the worst, or near worst, level of quality life years list for all three major drug killers—cocaine, opioids, and methamphetamines.

In my memoir, A Scientific Life on the Edge: My Lonely Quest to Change How We see Addiction, I provide the details for this cultural prevarication about the 12 steps.

I begin:

Are Alcoholism Treatment/12 Steps Really Working?

“In 2020, Keith Humphreys and John Kelly made news by conducting a systematic review in the prestigious Cochrane Report asserting, contrary to an earlier review, that AA works. It has been widely noted. But their analysis is simply a sleight-of-hand, a shuffling of the deck.No research over many decades contests a clear picture of the results of 12-step treatment and AA.”

I then review the major studies involving AA (including the Cochrane Report), resulting in this conclusion:

“AA and 12-step treatment, which totally dominate the American alcoholism landscape, have never, over repeated research assessments, demonstrated an ability to reduce alcoholism or improve overall life functioning for alcoholics. While increasing abstinence rates, these approaches to alcoholism can actually lead to more, and more intense, relapses over time (due, as I have already explained in regards to relapse prevention, to its all-or-nothing view of and approach to alcoholism and treatment). The 12 steps thus produce no better, and what can often be worse, long-term life functioning.”

Reviewing the Global Burden results, I note:

“I reviewed the Global Burden of Disease Study finding that, among 196 nations, deprived and advantaged, the US was second in disability life years lost to drugs, and thirty-ninth in DALYs lost to alcohol. As I reacted to the Cochrane AA review in Filter: ‘The presence of 12-step programs in every US community is not succeeding by measures of life satisfaction, survival rates, or mortality due to drugs and alcohol.’ Does anyone disagree with that?”

Finally, I ask,

“In attempting to corroborate AA’s beneficial impact on society, do Humphreys and Kelly mean to say that our bottom-of-the-tank rankings for death and disability attributable to substance use, the last twenty years
of rising drug deaths, and our painful societal guilt and unhappiness over drugs and alcohol are the best we can hope for? They do. They are pushing as a scientific assessment what actually comprises a reversion to the drug war and temperance. The bottom line to their work is that we should push AA and the 12 steps more than we have been doing for the past half-century, while accepting that substance use is beyond control for many people—moreover, a number that is increasing. Why is this happening now?”

Of course, there is now a national awareness of our failure to stem exploding drug and alcohol deaths and negative outcomes, which has led to a revolution in the acceptance of harm reduction, which is essentially the antithesis of AA.

Ironically, just as my book was going to press, Kelly (working with Sally Satel) published this result of research showing that the disease theory makes it less likely that people will recover: “Alex [hypothetical sufferer of the brain disease addiction] was seen as least blame-worthy when the opioid addiction was described using the biomedically loaded term (‘chronically relapsing brain disease’). . . . The problem is that the use of medical terminology led to a lower perceived likelihood that Alex could recover.” This pessimism included not only observers, but people themselves regarding their own drinking/addiction issues.

But, finally, let me turn this question back to you, Erik. You are experiencing both LPP and 12-step assistance. Can you answer these questions for us? How do AA and LPP differ? Why did you find it inadequate to simply rely on the 12 steps? What makes you so seemingly skeptical of the mantra you are being fed by your 12-step counselor?

At this point, I believe that you should be as good as—better than—I am at pointing out the the discrepancies, inadequacies, and ultimate failure and counterproductiveness of AA’s disease model.

Have at it!

Yours,
Stanton


 

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