Okay, let's have that "Does AA work?" thread. (Alcoholics Anonymous)

I was all set to post this in the other thread, then I saw twickster’s thread.

Look, AA may have its flaws, but I think “cult” is way off the mark. Especially when there are groups like Scientology, which I do believe to be a cult, and who are actively screwing people, ruining lives and making a hell of a profit. I realize I’m the one who brought up Scientology, so this may not be entirely fair, but I’ll post three comparisons.

  1. AA doesn’t cost dime one. (Okay, maybe a brief donation for coffee or use of the meeting area, but no fees to the organization itself. Scientology started as a freaking tax shelter and is now an empire.

  2. AA is, by definition, anonymous. Nothing brought up in a meeting is discussed elsewhere, or used against the member in later meetings. Scientology keeps a record of what you tell them, and threaten you with disclosure

  3. I walked away from AA. Easier done than said. Scientology does not let people simply walk away.

So perhaps my AA experience was not typical. That’s kind of what I’m saying, though: I don’t think there is one “typical” AA experience. But I don’t see where it’s actively ruined lives. Or what its agenda is supposed to be. Bill W. didn’t die rich.

Any research available as to A.A.'s success rate?
Any double-blind studies?

The research I offered in the other thread:

As I stated in that other thread, I know a great many people for whom AA has worked. Meaning that they tried many other ways to get sober and that it was only through AA that they were able to achieve sobriety.

It might help if we get a clear definition as to what “works” means? Do we get to say that because most people who try AA do not stay sober that AA does not work? Are there statistics for people that have actually worked the steps?

I hold that this issue is impossible to study in a meaningful way with statistics. For example, most people that wind up in AA started trying to get sober on their own. Where do they get counted? Which group failed? In other words you are not going to be able to do this one with a double blind or anything approaching sound methodology.

And in addition to that, at what point do I get to say that my personal experience is statistically valid? In other words, if I know, say, 100 alcoholics and I have observed that 100% of those alcoholics that have followed the program of Alcoholics Anonymous have achieved at least a year of continuous sobriety do I get to attach any significance to that?

The problem with AA is that it is anonymous. There will never be any scientific analysis of data to confirm their success. I just know too many people in the program, having been in the program, to know that it is a huge benefit.There are just too many people with long term recovery records and many short term people who fail now and then who credit AA with the degree of sobriety they have.

As one of our local DJs says, you’re not an alcoholic if you don’t go to the meetings… :smiley:

Maybe bigtime threadjack here, but just FYI: There is one drawback to AA, for those who might care about such things; for those of us who have security clearances, once you go to AA you are ‘announcing’ yourself as an alkie. This will greatly diminish the chances of getting a clearance (and perhaps of getting/keeping your job).

While there might not be any official roster or sign in sheet or whatever for DSS to check, make no mistake that the interview process is thorough, they check with friends, relatives, etc, and in some cases there’s a poly. And lying about it is a felony.

My understanding is there are multiple groups with different needs.

As in theres a large group that actually gets better by themselves, and can do worse with treatment.

That leaves the group that cant get better by themselves who are struggling more pretty much by definition.

In that group, the majority seem to do better with conventional treatment.

There is a very small remaining group that seem to find AA helpful, generally very long term chronic users. Mostly it wont cure them but it will stretch out the gaps between the really problematic periods a bit.

Cultwise, AA overall may not be one, but there is a risk for any individual place, ie small group, enforced norms, charismatic leader or leaders etc etc.


My issue with these stats is that it’s hard to make reliable conclusions from studies where the participants are self-selecting. For example, it’s possible that those who go to AA are mostly people who have already failed to stop drinking on their own.

Something that I would find helpful is the success rate of other programs. We can probably use those stats to conclude if AA is better or worse than other programs.

According to the 990 tax return form for 2008 (the last year this information is available), Alcoholics Anonymous General Service Board took in $10.2 million in contributions and grants. I know that’s nowhere near what Scientology takes in, but it’s not small potatoes. Many groups contribute to intergroups, but intergroups contribute to the General Service Board. (From guidestar.org; you need an account to see the 990.)

Not so. Confidentiality is not guaranteed, and it’s entirely possible, if not likely, for one’s personal problems and admissions to be the source of extra-meeting gossip. In fact, there is at least one case on record of someone being arrested and convicted of a crime based on an admission made at an AA meeting.
Also, the advice I got from a counselor about sharing at meetings is to keep it generic and restrict it to things you wouldn’t mind if your mother heard from a stranger, because that was the experience her clients shared with her. She also advised her clients to take their fifth step with a counselor or clergy member so that any potentially damaging or legally actionable admissions would be protected under legally-enforceable privilege. Finally, some meetings and groups are led by “gurus” who try to control their members with blackmail and other questionable, if not illegal, means. (Google “Midtown Group Washington, DC” for a particularly notorious example, but it happens elsewhere.)

It’s not always that simple. When I was going to meetings, people who left for whatever reason were assumed to have relapsed, which meant they were the center of some very vicious gossip. If most, if not all, of your social life revolves around meetings and AA-related activities, and you decide to leave, you have to replace that social life, which can be difficult.

Bill didn’t die rich, but he and Lois weren’t hurting, either. Their house was owned outright and the money AA brought in ensured that neither of them would have to work a traditional job; they could devote their lives to AA and Al-Anon, respectively.

This is an excellent point. There isn’t always a sign-in sheet, but people who are ordered to attend meetings do have to have a sheet signed by the chair to verify that they attended the meeting. There are also occasionally phone lists that someone may type up and distribute; once they’re distributed, there’s no control on where it ends up. And even though some groups deny this happens (NA, for example), people cruise church parking lots on meeting nights to see whose cars are parked there, and because some meetings are open to the public, there is no way to control who shows up; there were rumors in one town I lived in that one or two of the local law enforcement was checking out the parking lot to make sure the town drunks were at meetings. There have also been reporters who attend meetings if there are rumors of notable people in attendance, and in some groups, there is occasionally reason to believe that undercover police attend meetings to get leads on local dealers. What this all means is that if you have a good reason to keep your private business private, AA (or any 12-step group) may not be the best option for you.

Sorry for the back-to-back responses.

Part of the problem with alcoholism treatment research is that everyone involved is self-selected in some way or another.

The thread title asks about the effectiveness of AA while the OP seems to ask if it is a cult.

Last thing first…is AA a cult?

Pretty much yes. Comparing it to Scientology is not really relevant. We could make the argument any religion is a cult (albeit Scientology admittedly is its own special kind of freak show making most any other religion seem downright reasonable). There is a continuum in these things and saying Scientology is more cultish does not absolve AA of its cult-like features.

Seven of the twelve steps (PDF) are unabashedly resorting to God for the alcoholic’s recovery. Indeed the alcoholic’s recovery is, in AA, entirely dependent upon what amounts to an epiphany. To be sure some of the other steps are worthwhile exercises but recovery depends upon finding God.

Don’t believe me? How does this strike you? (Note this is from the Big Book posted on AA’s own website):

There is plenty more there but tellingly they disabled cut-and-paste functionality so I had to type all of that.
Is AA effective?

What is interesting is Bill Wilson, who founded AA, had his epiphany while he was tripping balls (and that is not hyperbole at all…if anything that puts it mildly…I have tripped balls and was nowhere near the following).

What is the Belladona Cure?

So, AA is founded on a guy who developed it based on his experiences with the above.

Now, consider AA was founded in 1935 based on the above. In 75 years it has not changed. Can you think of any medical procedure (that kind of overstates it but not sure how else to put it…it is a psychotherapy) that has not modified itself in 75 years? There has been no progress in the field since then?

You might say no one has proved it wrong since then, maybe he hit on the Holy Grail of therapy for alcoholics. Thing is no one really knows because the “anonymous” part enables them to be distinctly resistant to study. So, no one really knows.

What studies have been attempted have shown a distinct lack of effectiveness (already cited in an earlier post).

So, why does it persist? Everyone “knows” someone who was “saved” by AA. Thing is AA is a classic example of the “No True Scotsman” fallacy. Anyone who joins AA and fails failed because they did not do the program. Anyone who faithfully does the program and quits is a success.

And it is wrong to say there is no money in AA. It is a HUGE business.

True, your standard AA meeting requires no money from the participants (well, a request for a donation which is usually $1 so no great shakes there). That said there is a major industry that implements the 12-step program and does charge considerable sums. Hell, get busted for drunk driving and you may well find yourself in a state-mandated AA program and there is money moving there.

This has already gotten too long but there is more here to be sure.

I have no doubt AA has helped some people. Indeed I think some of the AA method is fantastic (where it makes people take personal responsibility for what they have done and seek to make amends). I also think the group therapy can (with caveats) be very useful.

But as a whole, for what it is, AA is a cult with no scientific evidence of success. Anecdotes of knowing people cured are all well and good but neither here nor there. At some point in human history everyone thought the earth was flat…didn’t make it so no matter how many people agreed with it.

Am I missing it, or is there anything to reflect the people who go to AA, relapse, return any number of times before finally staying sober…are they counted as hits or misses?

Ah, the Orange guy. Nothing like a guy with a chip on his shoulder for a cite.

Would you care for some unbiased research?

From here. Note, that is from the NIH site, not some guy who likes Orange.

From here. Also from the NIH.

And here is yet another published study.


Bolding mine.

Is A.A. for everyone? Nope. Are their nutjobs in A.A. Yep, just like there are nutjobs in every other area of life. Does it work for every one? Nope. Then again there is nothing in the world that works for everyone.

As to MsRobyn issues.

First, A.A. does take in money. In Vegas there are roughly 637 meetings a week. (Source, went to the Vegas A.A. page. Searched for meetings. Counted the number of meetings per search result page and multiplied by the number of pages (49*16) returned) 10 million bucks from the number of meetings in the country is not a lot. The GSB does have staff and also does work for A.A. If you check the cost per A.A. member is roughly $5.00 Yep, 5 bucks a head per year.

A.A. goes to prisons (been to a meeting at one once), distributes literature, provides hotlines and intergroup offices and other A.A. related services. Also, many of the meeting areas are rented. This requires money. Yet, if you have no cash no one cares. I have never been in a meeting, and have never heard of a situation, where anyone was pressured into giving cash. If it happened at any of the meetings I attend, the person doing so would get a very stern verbal thrashing.

Second, while anonymity is the goal, it will never be perfect. Hell, our government can’t keep secrets. In any system where people are involved there are going to be problems. This isn’t an A.A. issue. It is a some people suck issue. Should we stop seeing doctors because some of them violate doctor/patient confidentiality?

I believe in A.A. It saved my life and the lives of many people I know. I also know that it is not the only way. It doesn’t work for everyone. But it does work for many people. And trying to talk people out of trying A.A. when they are trying to get sober is insanely irresponsible.
:: On preview :: elucidator, in A.A. a relapse is considered starting fresh. A guy who relapses after 1 year is back at day 1. For the studies I would assume that they are looking for continuous sobriety.


Still, doesn’t quite answer the question. If I am to judge the efficacy of the treatment, I would want to know if the likelihood of success drops off drastically after initial failure, or not. I suppose it might be possible for one person to represent three different outcomes, two failures and a success. IF someone presents me with data about success and failure, I would want to know what happened, regardless of how AA chooses to define it. Their reasons may be perfectly valid internally, it may be that such an attitude is helpful, but I would not necessarily want my information bound by that.

It worked for my grampa my grandma my brother and my aunt. In fact no one in my family died while in the grip of the addiction or within 10 years of their last drink. My grandfather was able to get 15 more years out of life, make peace with the family he abused, remarry and start a new life. AA is batting 1000 in my family.

Unbiased research? How about George Vaillant, a Trustee of Alcoholics Anonymous. My second quoted post includes a quote from his book The Natural History of Alcoholism. But I’ll post it again:

We can trade cites back and forth. Ultimately I don’t find yours any more compelling than mine.

Doubt he has any except anecdotes.

I find it amazing how people swear by AA’s effectiveness yet empirical data over the course of 75 years is hard to come by.

There is a problem with this though (not that they defeated an addiction…that is good).

One of the complaints about AA’s “effectiveness” is it is self selecting. People who even go in the first place, barring a court order, are already of a mind to do something about their addiction.

ANY program that relied on people to walk in of their own accord would benefit from that self-selecting bias. Those folks, merely by virtue of having already identified a problem with themselves that they want fixed and chose on their own to seek help for it are more likely to be successful.

Someone needs to show that AA is better than anything else at helping that group.

The Orange Papers numbers that Melon keeps citing are somewhere between misleading and wrong. “5% of people at a meeting have been attending for a year” =/= “95% of those who start drop out in a year.” Simply put, those are different populations.

The two studies that Hester and Miller refer to have been criticized on various methodological grounds, so it’s not clear how useful their conclusions are.

Also, it may be worth noting that Vaillant counted any relapse, no matter how short, as a failure of the program. I can’t say that that’s necessarily wrong, but many people might disagree with that definition.

It’s really hard to develop reliable conclusions about AA. There are a lot of factors to control for, and that’s hard to do when the membership is largely anonymous. Many of the people in AA are simultaneously in other treatment programs, so the effects of AA can be hard to isolate. And so forth. In the end, AA supporters have a hard time pointing to hard data establishing its efficacy, and the data cited by opponents is generally flawed.

Finding the right treatment for a particular person may well be a matter of trial and error. If you’re able to stop or manage your drinking on your own, then problem solved. Some people may benefit from a therapist, especially if there’s some old trauma underlying the drinking. If other treatments are available and affordable, they may be worth exploring. But there’s also not a lot of downside to giving AA a try if you’re searching.

The fact that AA brings in money doesn’t seem very informative in itself. For people who aren’t successful in controlling their drinking on their own, any treatment is going to cost money.