Treating Alcoholism

To take our minds off of viruses, if only for an instant, I report some recent findings on the best treatment for alcoholism. Surely, this matters. Yet, it is being overlooked in the current preoccupation with coronavirus.

Now, researchers have reported that the more effective treatment for alcoholism is… Alcoholics Anonymous. As it happens, AA is also the lowest cost treatment. It’s free.

The New York Times has the story:

For a long time, medical researchers were unsure whether Alcoholics Anonymous worked better than other approaches to treating people with alcohol use disorder. In 2006, a review of the evidence concluded we didn’t have enough evidence to judge.

That has changed.

An updated systematic review published Wednesday by the Cochrane Collaboration found that A.A. leads to increased rates and lengths of abstinence compared with other common treatments. On other measures, like drinks per day, it performs as well as approaches provided by individual therapists or doctors who don’t rely on A.A.’s peer connections.

In some way, this is not good news for individual therapists, but I will leave you to draw your own conclusions.

The report continues:

In the last decade or so, researchers have published a number of very high-quality randomized trials and quasi-experiments. Of the 27 studies in the new review, 21 have randomized designs. Together, these flip the conclusion.

“These results demonstrate A.A.’s effectiveness in helping people not only initiate but sustain abstinence and remission over the long term,” said the review’s lead author, John F. Kelly, a professor of psychiatry at Harvard Medical School and director of the Recovery Research Institute at Massachusetts General Hospital. “The fact that A.A. is free and so widely available is also good news.

“It’s the closest thing in public health we have to a free lunch.”

Statistically, AA performs better in ensuring abstinence. Sometimes other treatments can work well. And AA does not work all the time. So, with caveats:

Studies generally show that other treatments might result in about 15 percent to 25 percent of people who remain abstinent. With A.A., it’s somewhere between 22 percent and 37 percent (specific findings vary by study). Although A.A. may be better for many people, other approaches can work, too. And, as with any treatment, it doesn’t work perfectly all the time.

Rigorous study of programs like Alcoholics Anonymous is challenging because people self-select into them. Those who do so may be more motivated to abstain from drinking than those who don’t.

The last point is worth emphasizing. People self-select into AA programs, so perhaps they are more motivated to abstain than are those who simply visit their therapists once or twice a week. 

Also, AA is more comprehensive. It requires more, in terms of meetings, sponsor calls and also camaraderie. Let’s not overlook the fact that people who attend AA meetings regularly develop a circle of friends… and they do not want to let their friends down by dishonoring their commitment to the program.

To eliminate the issue of self-selection, researchers studied groups of people who had been assigned to AA randomly.

Despite these challenges, some high-quality randomized trials of Alcoholics Anonymous have been conducted in recent years. One, published in the journal Addiction, found that those who were randomly assigned to a 12-step-based directive A.A. approach, and were supported in their participation, attended more meetings and exhibited a greater degree of abstinence, compared with those in the other treatment groups. Likewise, other randomized studies found that greater Alcoholics Anonymous participation is associated with greater alcohol abstinence.

Researchers also measure the effectiveness of AA meetings by calculating the lower health care costs for those who regularly attend:

Another study found that for each additional A.A. meeting attended, health care costs fell by almost 5 percent, mostly a result of fewer days spent in the hospital and fewer psychiatric visits.

A.A. meetings are ubiquitous and frequent, with no appointment needed — you just show up. The bonds formed from the shared challenge of addiction — building trust and confidence in a group setting — may be a key ingredient to help people stay on the road to recovery.

Clearly, the final sentence seems to be the most crucial. Forming social bonds over addiction and being in it together as a group contributes mightily to recovery.

And, it doesn’t cost anything.