Diverse Groups Helped by AA

Study shows gender, religion and mental illness are not barriers

Alcoholics Anonymous and other mutual-help groups seem to help people recover from alcoholism no matter what their religious beliefs and gender, or whether or not they have mental disorders, according a new study released today.

The three-year study of 227 recovering alcoholics who went through treatment showed that greater attendance of AA or other meetings following treatment resulted in improved rates of abstinence or in less intensive alcohol consumption in the event of relapse. These beneficial effects were not influenced by gender, religious preferences, psychiatric disorders or whether the patient had prior attendance at AA or other groups.

The study is one of the few to examine the effectiveness of 12-step programs prospectively among different types of people with substance use disorder. The study assessed all types of addiction mutual-help groups that patients attended and found that patients mostly went to AA meetings, probably because they are more available.

“Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource – mutual-help groups such as AA,” said Robert Stout, Ph.D., a co-author of the study. “Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it.”

Stout, a mathematical psychologist who has been studying addiction treatment for nearly three decades, is director of Decision Sciences Institute of the Pacific Institute for Research and Evaluation.

The results of the study also support the belief in recovery circles that the more you put into it, the more you get out of it.

"There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes," said co-author John F. Kelly, associate director of the Massachusetts General Hospital/Harvard Addiction Research Program. "If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome."

While not everyone benefits from AA, this study suggests that even people who are not seen as a good fit for mutual-help groups can still derive benefit. For example, critics of 12-step programs say they aren’t suited for atheists or agnostics, or for people with fundamentalist religious beliefs, because the programs promote a belief in a higher power while allowing wide latitude in defining it. Some clinicians are uncomfortable referring clients to 12-step support groups because of their spiritual aspect.

Others say that the focus on “powerlessness” espoused in the first of the 12 steps can be detrimental to women because it reinforces low self-esteem and a diminished societal role.

And, some mental health practitioners believe that substance use disorders among psychiatric patients are the result of self-medicating, and therefore if the mental health disorder is successfully treated first, substance use will diminish, obviating any need for addiction-focused program. Another concern is that people with mental illnesses will have trouble becoming engaged in socially-oriented fellowships, or that the need to take psychotropic drugs will meet with disapproval from other AA members.

“There are a lot of unsubstantiated ideas about AA floating around out there,” Stout said. “Our study shows that mutual-self help groups will work for a wide range of people that some say wouldn’t be helped. We need more studies to get to the bottom of what really is and isn’t working.”

The study is published in the August edition of Alcoholism: Clinical and Experimental Research. It was funded by the National Institute on Alcohol Abuse and Alcoholism.

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