Effectiveness of Alcoholics Anonymous

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The effectiveness of Alcoholics Anonymous in treating alcoholism has been extensively studied. Many papers have been published studying the degree to which Alcoholics Anonymous (AA) helps alcoholics keep sober. The subject is controversial with some studies showing AA helping alcoholics, while other studies do not show AA efficacy. The U.S. Surgeon General stated in a 2016 report on addiction that "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions." The program appears to be helpful for a subset of alcoholics; Alcoholics Anonymous appears to be about as effective as other support groups recommending abstinence from alcohol and other drugs of abuse. The 2020 Cochrane meta-analysis of Alcoholics Anonymous says that, based on randomized controlled trials, AA-oriented therapies have a 42% abstinent rate one year after treatment, compared to the 35% abstinence rate with other therapies. [1] [2]

Contents

Overview

There are a number of ways one can determine whether AA works and numerous ways of measuring if AA is successful. The 2020 Cochrane review of Alcoholics Anonymous determines success as "abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets." [1]

Because of the anonymous and voluntary nature of Alcoholics Anonymous ("AA") meetings, it is difficult to perform random trials with them; the research suggests that AA can help alcoholics make positive changes. [3] The Surgeon General of the United States 2016 Report on Alcohol, Drugs, and Health states "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions." [4] [5]

The research is quite complex and is still developing; [3] some studies have suggested an association between AA and increased abstinence or other positive outcomes, [6] [7] [8] [9] [10] but other studies have not. [11] [12] Likewise, some articles in the popular press state that Alcoholics Anonymous helps some alcoholics get sober, [13] [14] [15] [16] but others claim AA is not effective. [17] [18]

While older studies did not show a correlation between being assigned to AA and better treatment outcomes, [19] newer studies show that Alcoholics Anonymous significantly increases abstinence after treatment. [1] [20] [21] The 2020 Cochrane review saw, at the 12-month follow up, a 42% abstinent rate for AA and twelve-step facilitation treatments which encourage patients to regularly attend AA meetings, compared to 35% abstinent using non-AA interventions. [1] [2]

Alcoholics Anonymous appears to be about as effective as other abstinence-based support groups. [22]

Systematic reviews, meta-analyses and large clinical studies

Cochrane Reviews

The 2020 Cochrane review of Alcoholics Anonymous shows that AA results in more alcoholics being abstinent and for longer periods of time than some other treatments, but only as well in drinks-per-day and other measures. [1] [23] When comparing Alcoholics Anonymous and/or Twelve Step Facilitation to other alcohol use disorder interventions, at the 12-month follow up, randomized controlled trials show a 42% abstinent rate for AA/TSF treatments, compared to 35% abstinent using non-AA interventions. [2] [24]

The study concludes that "Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non-manualized AA/TSF performed as well as other established treatments [...] clinically-delivered TSF interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence." [1] Here, a "manualized" treatment is one where a standard procedure was used. [25] A TSF treatment is a "twelve-step facilitation" treatment: A treatment which encourages a patient to attend Alcoholics Anonymous. [26]

While Nick Heather speculated that subjects receiving Alcoholics Anonymous-centered interventions who were not abstinent did worse than other subjects, [27] John Kelley and Alexandra Abry clarified that not only did the subjects undergoing AA-based interventions have a higher abstinent rate, those who did not achieve abstinence did not have worse drinking outcomes. [28]

An older 2006 Cochrane review stated that the "available experimental studies did not demonstrate the effectiveness of AA or other twelve-step approaches in reducing alcohol use and achieving abstinence compared with other treatments", [19] but the newer review has more than three times the number of studies and participants, and uses studies with better methodologies. [29]

Kelly 2017

In 2017, Kelly and others from the Massachusetts General Hospital released a randomized experimental study where they looked at how twelve step facilitation (TSF) affected recovery among teenagers. The study concluded there was no significant difference in percent days abstinent between the control group and the group undergoing TSF, and that the TSF group had better 12-step meeting attendance, as well as fewer negative addiction consequences: less guilt about their substance abuse, being more responsible, having more money, etc. [30]

The group who randomly underwent TSF had a higher percentage of days abstinent (58% vs. 49% at the nine-month follow-up, overall p=0.33) and a larger number of subjects either completely or "mostly" abstinent (33% vs. 21% at the nine-month followup, overall p=0.30); this data, while not considered statistically significant in the study, was combined with data from other studies and made part of the 2020 Cochrane review of Alcoholics Anonymous. [1]

Humphreys, Blodgett, and Wagner 2014

A 2014 meta-analysis of the data from five studies by Keith Humphreys, Janet Blodgett and Todd Wagner concluded that "increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection." [7] [14]

Kaskutas 2009

In 2009, Lee Ann Kaskutas performed a meta-analysis of other studies looking at how effective Alcoholics Anonymous is. The article notes that "rates of abstinence are about twice as high among those who attend AA" but concluded that whether Alcoholics Anonymous has a specific effect is unclear (a specific effect, in this context, is whether it's the actual Alcoholics Anonymous program which helps keep people sober, instead of other factors, including the fact that people more motivated to stay sober will go to more meetings, or that the group support helps alcoholics regardless of the actual program, etc.), stating that there were "2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect." [31]

Moos and Moos 2006

A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment: Of subjects highly involved with AA in their first year of alcohol treatment, 67% were sober 16 years later. The study looked at the outcome of a group of alcoholics seeking treatment over a 16-year period. The subjects decided on their own whether to use AA, and how much AA treatment they got. The study stated that "individuals who participated in AA for 27 weeks or more had better 16-year outcomes", showing that "only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more." [6]

The study's results may be skewed by self-selection bias. [31] [32]

Project MATCH (1998)

Project MATCH was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The study concluded that twelve-step facilitation was as effective as the other psychotherapies studied. [33]

Brandsma 1980

The 1980 book Outpatient Treatment of Alcoholism describes a mid-1970s study. Participants were assigned randomly within five treatments, including an Alcoholics Anonymous-like meeting. [34] Later analysis says that there are "concerns with the Brandsma trial which call its experimental results into question". [31]

Membership retention

In 2001–2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. Respondents were asked if they had ever attended a twelve-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105). [35] In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270). [35]

The Sober Truth

Lance Dodes, in The Sober Truth, says that most people who have experienced AA have not achieved long-term sobriety, stating that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety for longer than one year. [17] Gabrielle Glaser used Dodes' figures to state that AA has a low success rate in a 2015 article for The Atlantic , which says that better alternatives than Alcoholics Anonymous for alcohol treatment are available. [18]

The 5–8% figure put forward by Dodes is controversial; [16] Thomas Beresford, M.D., says that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure." [36] [37] The New York Times calls The Sober Truth a "polemical and deeply flawed book". [38] John Kelly and Gene Beresin state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong (Dodes responded by pointing out that "I have never said that AA is harmful in general"), noting that "studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge [...] produce about one third higher continuous abstinence rates." [15] [39] Jeffrey D. Roth and Edward J. Khantzian, in their review of The Sober Truth, called Dodes' reasoning against AA success a "pseudostatistical polemic." [40]

Lance Dodes has not, as of March 2020, read the 2020 Cochrane Review which shows AA efficacy, but in response to it says that he does not feel creating a social support network helps with addiction. [41]

See also

Related Research Articles

Alcoholics Anonymous Sobriety-focused mutual aid fellowship

Alcoholics Anonymous (AA) is an international fellowship requiring no membership dues or fees dedicated to helping alcoholics peer to peer in sobriety through its spiritually inclined Twelve Steps program. Non-professional, non-denominational, self-supporting and apolitical, an avowed desire to stop drinking is its sole requirement for membership. Despite not endorsing the disease model of alcoholism, to which its program is nonetheless sympathetic, its wider acceptance is due in part to many AA members promulgating it. As of 2020, having spread to diverse cultures and geopolitical areas normally resistant to grassroots movements, AA has had an estimated worldwide membership of over two million with 75% of those in the U.S. and Canada.

Twelve-step programs are mutual aid organizations for the purpose of recovery from substance addictions, behavioral addictions and compulsions. Developed in the 1930s, the first twelve-step program, Alcoholics Anonymous (AA), aided its membership to overcome alcoholism. Since that time dozens of other organizations have been derived from AA's approach to address problems as varied as drug addiction, compulsive gambling and overeating. All twelve-step programs utilize a version of AA's suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.

Rational Recovery was a commercial vendor of material related to counseling, guidance, and direct instruction for addiction designed as a direct counterpoint to Alcoholics Anonymous (AA) and twelve-step programs. Rational Recovery was founded in 1986 by Jack Trimpey, a California-licensed clinical social worker. Trimpey is a recovered alcoholic who works in the field of treatment of alcoholism and other drug addictions. Rational Recovery is a commercial trademark, along with the Addictive Voice Recognition Technique (AVRT). The organization published a periodical, the Journal of Rational Recovery, from at latest 1993 until at least June 2001. The former "Rational Recovery" website ("rational.org") is no longer active.

Narcotics Anonymous Mutual help 12-Step organization

Narcotics Anonymous (NA), founded in 1953, describes itself as a "nonprofit fellowship or society of men and women for whom drugs had become a major problem". Narcotics Anonymous uses a 12-step model developed for people with varied substance use disorders and is the second-largest 12-step organization.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function.

Al-Anon Family Groups, founded in 1951, is a "worldwide fellowship that offers a program of recovery for the families and friends of alcoholics, whether or not the alcoholic recognizes the existence of a drinking problem or seeks help." Alateen "is part of the Al-Anon fellowship designed for the younger relatives and friends of alcoholics through the teen years".

Crystal Meth Anonymous (CMA) is a California-based non-profit, public-benefit corporation founded in 1994. The members of the fellowship of Crystal Meth Anonymous work a twelve-step program of recovery with recovering crystal meth addicts. Participants in local groups meet in order to help others recover from methamphetamine addiction. CMA advocates complete abstinence from methamphetamine, alcohol, inhalants, and all other psychoactive drugs not taken as prescribed.

Nicotine Anonymous (NicA) is a twelve-step program founded in 1982 for people desiring to quit smoking and live free of nicotine. As of July 2017, there are over 700 face-to-face meetings in 32 countries worldwide with the majority of these meetings occurring in the United States, Iran, India, Canada, Brazil, the United Kingdom, Australia, Russia and in various online community and social media platforms.. NicA maintains that total abstinence from nicotine is necessary for recovery. NicA defines abstinence as “a state that begins when all use of nicotine ceases.

Drug addiction recovery groups

Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction. Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programs may advocate a reduction in the use of illegal drugs rather than outright abstention, although this is for other programs typically not a sustainable treatment plan in the long term. One survey of members who found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. The survey found group participation increased when the individual members' beliefs matched those of their primary support group. Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs and to a lesser level in non religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for the twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organizations for Sobriety.

SMART Recovery is an international non-profit organization that provides assistance to individuals seeking abstinence from addiction. SMART stands for Self-Management and Recovery Training. The SMART approach is secular and research-based, using cognitive behavioral therapy (CBT) and non-confrontational motivational methods.

Project MATCH began in 1989 in the United States and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). MATCH is an initialism for Matching Alcoholism Treatments to Client Heterogeneity. The project was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The programs were administered by psychotherapists and, although twelve-step methods were incorporated into the therapy, actual Alcoholics Anonymous meetings were not included. Three types of treatment were investigated:

LifeRing Secular Recovery Addiction and recovery organization

LifeRing Secular Recovery is a secular, non-profit organization providing peer-run addiction recovery groups. The organization provides support and assistance to people seeking to recover from alcohol and drug addiction, and also assists partners, family members and friends of addicts or alcoholics. It is an abstinence-based recovery program with three fundamental principles: sobriety, secularity and self-empowerment. The motto of LifeRing is "empower your sober self."

Moderation Management (MM) is a secular non-profit organization providing peer-run support groups for anyone who would like to reduce their alcohol consumption. MM was founded in 1994 to create an alternative to Alcoholics Anonymous and similar addiction recovery groups for non-dependent problem drinkers who do not necessarily want to stop drinking, but moderate their amount of alcohol consumed to reduce its detrimental consequences.

Secular Organizations for Sobriety (SOS), also known as Save Our Selves, is a non-profit network of autonomous addiction recovery groups. The program stresses the need to place the highest priority on sobriety and uses mutual support to assist members in achieving this goal. The Suggested Guidelines for Sobriety emphasize rational decision-making and are not religious or spiritual in nature. SOS represents an alternative to the spiritually based addiction recovery programs such as Alcoholics Anonymous (AA). SOS members may also attend AA meetings, but SOS does not view spirituality or surrendering to a Higher Power as being necessary to maintain abstinence.

The Big Book (Alcoholics Anonymous) Bestselling book on how to recover from addictions

Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism is a 1939 basic text, describing how to recover from alcoholism. Written by William G. "Bill W." Wilson, one of the founders of Alcoholics Anonymous (AA) and many of the first 100 members of the group, the composition process was collaborative, with drafts of the book sent back and forth between Bill W's group in New York and Dr. Bob, the other founder of A.A., in Akron, OH. It is the predecessor of the seminal "twelve-step method" widely used to treat many addictions, from alcoholism, heroin addiction and marijuana addiction to overeating, sex addiction and gambling addiction, with a strong spiritual and social emphasis.

Community reinforcement approach and family training (CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to help people learn to reduce the power of their addictions and enjoy healthy living. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.

Lance M. Dodes is an American psychiatrist and psychoanalyst best known for his theory that all addictions are psychological compulsions.

<i>Outpatient Treatment of Alcoholism</i> 1980 book

Outpatient Treatment of Alcoholism is a book by Jeffery Brandsma, Maxie C. Maultsby Jr., and Richard J. Welsh, published in 1980. It describes a study of 260 individuals, 184 referred by the courts and 76 self-referred or referred by other agencies for 210 days. Participants were assigned randomly within five groups: AA-like meetings, RBT therapy administered by a non-professional, RBT therapy administered by degreed professionals, Insight Therapy administered by professionals, and a control group which received no treatment.

References

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  3. 1 2 "Frequently Asked Questions: Searching for Alcohol Treatment". NIAAA. 2018-11-29. the free and flexible support provided by mutual help groups can help people make and sustain beneficial changes and thus promote recovery
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  13. ↑ Lopez, German (2 January 2018). "Why some people swear by Alcoholics Anonymous — and others despise it". Vox . About a third of people maintain recovery from alcohol addiction due to 12-step treatment, another third get something out of the treatment but not enough for full recovery, and another third get nothing at all.
  14. 1 2 Frakt, Austin (2015-04-06). "Alcoholics Anonymous and the Challenge of Evidence-Based Medicine". The New York Times. Retrieved 2015-06-21.
  15. 1 2 Kelly, John F.; Beresin, Gene (7 April 2014). "In Defense of 12 Steps: What Science Really Tells Us about Addiction". WBUR's Common Health: Reform and Reality. Archived from the original on 2014-04-11. Retrieved 2018-01-05.
  16. 1 2 Singal, Jesse. "Why Alcoholics Anonymous Works". The Cut. Retrieved 2017-12-25. [Lance Dodes] has estimated, as Glaser puts it, that "AA's actual success rate [is] somewhere between 5 and 8 percent," but this is a very controversial figure among addiction researchers.
  17. 1 2 Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN   978-0-8070-3315-9. University of California professor Herbert Fingarette cited two [...] statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. [Reference: H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988)] Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members.
  18. 1 2 Glaser, Gabrielle. "The Irrationality of Alcoholics Anonymous". The Atlantic . Retrieved 2016-04-15.
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  20. ↑ Litt, Mark; Kadden, Ronald; Kabela-Cormier, Elise; Petry, Nancy (2009). "Changing Network Support for Drinking: Network Support Project Two-Year Follow-up". J Consult Clin Psychol. 77 (2): 229–242. doi:10.1037/a0015252. PMC   2661035 . PMID   19309183.
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  22. ↑ Zemore, Sarah E; Lui, Camillia; Mericle, Amy; Hemberg, Jordana; Kaskutas, Lee Ann (2018). "A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD". Journal of Substance Abuse Treatment. 88: 18–26. doi:10.1016/j.jsat.2018.02.004. PMC   5884451 . PMID   29606223. Lay summary.
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  24. ↑ Lopez, German (11 March 2020). "A new, big review of the evidence found that Alcoholics Anonymous works — for some". Vox .
  25. ↑ "manualized therapy". American Psychological Association.
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  27. ↑ Heather, Nick (2020). "Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers"". Alcohol and Alcoholism. doi:10.1093/alcalc/agaa137. PMID   33316028. those more strongly committed to total abstinence after receiving AA/TSF were likely to experience more protracted 'slips' if they did for any reason drink
  28. ↑ Kelly, John F.; Abry, Alexandra W. (2021). "Leave the Past Behind by Recognizing the Effectiveness and Cost-Effectiveness of 12-Step Facilitation and Alcoholics Anonymous". Alcohol and Alcoholism. doi:10.1093/alcalc/agab010. PMID   33616171. while more individuals in AA/TSF achieved continuous abstinence, those who were not completely abstinent did not drink more heavily, drink more frequently or experience more alcohol-related consequences
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  30. ↑ Kelly, John F; Kaminer, Yifrah; Kahler, Christopher W; Hoeppner, Bettina; Yeterian, Julie; Cristello, Julie V; Timko, Christine (2017). "A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder". Addiction. 112 (12): 2155. doi:10.1111/add.13920. PMC   5673563 . PMID   28742932. Lay summary.
  31. 1 2 3 Kaskutas, Lee Ann (2009). "Alcoholics Anonymous Effectiveness: Faith Meets Science". Journal of Addictive Diseases. 28 (2): 145–157. doi:10.1080/10550880902772464. PMC   2746426 . PMID   19340677.
  32. ↑ Szalavitz, Maia (2016). Unbroken Brain: A Revolutionary New Way of Understanding Addiction. the research that does show AA to be effective is overwhelmingly flawed by what is known as selection bias.
  33. ↑ Keith Humphreys. "Here's proof that Alcoholics Anonymous is just as effective as professional psychotherapies". The Washington Post . Archived from the original on 2016-05-31. Retrieved 2018-05-29. AA skeptics were confident that by putting AA up against the best professional psychotherapies in a highly rigorous study, Project MATCH would prove beyond doubt that the 12-steps were mumbo jumbo. The skeptics were humbled: Twelve-step facilitation was as effective as the best psychotherapies professionals had developed.
  34. ↑ Brandsma, Jeffery M; Maultsby, Maxie C; Welsh, Richard J (1980). Outpatient Treatment of Alcoholism: a review and comparative study . Baltimore, MD: University Park Press. ISBN   978-0-8391-1393-5. OCLC   5219646.
  35. 1 2 Kaskutas, Lee Ann; Ye, Yu; Greenfield, Thomas K.; Witbrodt, Jane; Bond, Jason (30 June 2008). Epidemiology or Alcoholics Anonymous Participation. Recent Developments in Alcoholism. 18. pp. 261–282. doi:10.1007/978-0-387-77725-2_15. ISBN   978-0-387-77724-5. PMID   19115774.
  36. ↑ Beresford, Thomas (2016), Alcoholics Anonymous and The Atlantic: A Call For Better Science, National Council on Alcoholism and Drug Dependence, archived from the original on 2019-07-15, retrieved 2019-07-16, [Herbert Fingarette used] two publications from the Rand Corporation [...] At 4-year follow-up the Rand group identified patients with at least one year abstinence who had been regular members of AA 18 months after the start of treatment: 42% of the regular AA members were abstinent, not the "calculated" 5.5% figure.
  37. ↑ Emrick, Chad; Beresford, Thomas (2016). "Contemporary Negative Assessments of Alcoholics Anonymous: A Response". Alcoholism Treatment Quarterly. 34 (4): 463–471. doi:10.1080/07347324.2016.1217713. S2CID   151393200.
  38. ↑ Friedman, Richard A. (2014-05-05). "Taking Aim at 12-Step Programs". The New York Times.
  39. ↑ Humphreys, Keith; Moos, Rudolf (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. PMID   11371720. 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB [cognitive-behavioral] programs, p < 0.001)
  40. ↑ Roth, Jeffrey D; Khantzian, Edward J (2015). "Book Review: The Sober Truth: Debunking the Bad Science behind 12-step Programs and the Rehab Industry". Journal of the American Psychoanalytic Association. 63: 197–202. doi:10.1177/0003065114565235. S2CID   145764030.
  41. ↑ Becker, Deborah. "AA Keeps People From Drinking Alcohol Longer Than Other Tools, Cochrane Review Finds". WBUR-FM.

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