Without a doubt, the general consensus in this country is that Alcoholics Anonymous is an effective remedy for alcoholism and is the treatment of choice. Virtually all treatment centers in the United States funnel their clientele into Alcoholics Anonymous or sister groups such as Cocaine Anonymous.
Rarely, if ever, does the mass media carry anything except the highest praise for AA and the treatment facilities. In newspaper articles, television news features and radio interviews, politicians, movie stars, famous athletes and even an ex-first lady carry the message that they had faced alcoholic ruin but “being in recovery”*1 saved their lives.
The multi-billion dollar treatment industry advertises the need for “treatment,” costs of which can run into the tens of thousands of dollars for a standard 28-day stay.
Each business sells its own treatment as the best for those suffering from what they claim is an incurable, progressive disease. Success rates of as high as 90 percent are reported.
While not all advertisements explicitly state “medical treatment,” it is usually implied. While often set in hospitals, rarely is much about the treatment “medical.” A small number of alcoholics, perhaps ten or fifteen percent, do need medical assistance for a few days of detoxification. However, any medical attention generally stops there. The stress is on AA indoctrination.
It seems almost no one subjected these numbers to rigorous examination. The first report of anyone actually doing so apparently appeared on the other side of the world in an Australian medical journal in 1948.
Many people have such faith they see no need to actually keep count and perhaps even see the idea of tracking results, of questioning the effectiveness of their “spiritual principles,” as offensive. It would be putting science over personal experience (the Fifth Gospel from the Oxford Group).
In medicine, however, the normal course for determining the effectiveness of a treatment is to compare it against other treatment and/or no treatment at all.
There have been two controlled studies of the effectiveness of Alcoholics Anonymous independent of any other type of treatment. Since they deal with persons required by the court to attend AA, they demonstrate the relative effectiveness of AA in a coercive context. Since a significant number of AAs are first indoctrinated in this way, both studies are relevant.
The first was an experiment done in San Diego, California. Chronic offenders, averaging twelve prior drunk arrests each, were given a thirty-day suspended sentence and a one-year probation. A requirement of probation was that they remain abstinent for one year.
A court judge randomly assigned 301 people to one of three categories: no treatment, a psychiatrically oriented community alcoholism clinic and Alcoholics Anonymous. Complete data for a minimum of one year was available on 241 cases. In the no-treatment group, 56 percent were rearrested. The AA group fared the worst. In what was almost a tie with the clinic group, 69 percent of the group sent to AA was rearrested. An interesting question, one that was not answered in the research paper, is whether the clinic, as is customary, also sent their clients to AA.
In another study of court referral for treatment done in Lexington, Kentucky, 197 alcoholic patients began treatment.62 They were randomly divided into five groups; professional “insight” therapy, professional behavior therapy, lay-led behavior therapy, AA, and a no-treatment control group. Of the 197 patients who began therapy, 104 were still available for the one-year final outcome study.
Of the subjective measures, perhaps the most telling is the number of respondents who reported improvement for the last three months. AA tied with the no-treatment control group for the smallest percentage of those who could report improvement. One of the professional groups and the lay group fared remarkably better. All groups had some members who attended AA but the lay-led group, which reported the best results on this measure, had the least intense AA involvement.
Compounding this pathetic outcome for AA is that the twelve who stuck with AA for the year scored progressively worse on two important MMPI*2 scales. One of these, the Finney Addiction Scale, is used to identify people who have trouble with narcotics by measuring the qualities such people tend to have. The AA members became more like the kind of people who have narcotics problems.
The other measure, called the Hysteria Scale, is related to people who have somatic complaints and to the denial of difficulties. The AA group, the group that reported the least success, was also the one most inclined to hide its difficulties.
The main criticism of these two studies is that they deal only or predominately with people coerced into treatment by the legal system. This, of course, is true. It is also true, however, that they make an excellent case against court-mandated AA attendance.
There apparently have been no controlled studies done of AA against other treatment in a non-coercive environment. So unquestioned has been the effectiveness of AA that most studies comparing treatments compare different versions of AA-based treatment. “Successful outcomes” are often defined, not in moderation or abstinence, but in rates of AA attendance. However, some revealing studies have been done.
“It seemed perfectly clear…by turning to recovering alcoholics [AA members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients…into the treatment system of AA, I was working for the most exciting alcohol program in the world.
Odd indeed, for a doctor to discount not having cured or ameliorated the symptoms of an illness, but to instead boast of getting the patients to join AA. How can this be?
Perhaps the problem with his alcoholic patients dying at an “appalling” rate wasn't because of a failure of AA but because of a failure on the part of his patients to believe in AA. This is in spite of the fact that those who didn't believe, and wouldn't go, did better.
The “medical” justification for AA indoctrination used by treatment enterprises and AA itself is the disease theory. Careful examination of disease theory, which many of us have accepted for humanitarian reasons, will show its effects have been far from humanitarian.
*1 Use of the phrase "in recovery" is an excellent indication of 12-Step membership.
*3 This is the same as AA's first step. Al-Anon was originally formed to give the wives of the early AA's an opportunity to "work a spiritual program." It is now available to those who work with, and friends of, alcoholics.