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Alcoholics Anonymous and other 12-step programmes for alcohol dependence
Open accessAbstract
BACKGROUND: Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)). OBJECTIVES: To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems. SEARCH STRATEGY: We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies. SELECTION CRITERIA: Studies involving adults (<18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants. DATA COLLECTION AND ANALYSIS: One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers. MAIN RESULTS: Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. AUTHORS' CONCLUSIONS: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.
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“The protective function of 12-Step attendance has been well documented”
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“Among the addiction treatments to date, the success of the Alcoholic Anonymous (AA) program has not been duplicated.[9] AA being a spirituality-based program is congruent with the Gita.”
ResultHouston, R. J., & Schlienz, N. J. (2017) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2017.09.006 · Cited by 56
“Evidence-based behavioral and psychosocial interventions for SUDs (34, 35) include, but are not limited to, cognitive behavioral therapy (CBT) (36, 37), motivational interviewing (MI) and motivational enhancement therapy (MET) (38–40), contingency management (CM) (41–43), and twelvestep facilitation (TSF) (44).”
BackgroundReflections on the Teaching of Evidence-Based Practice
Shlonsky, A., & Stern, S. (2007) · doi:10.1177/1049731507301527 · Cited by 54
Systematic review of control groups in nutrition education intervention research
Byrd-Bredbenner, C., Wu, F.-F., Spaccarotella, K., Quick, V., Martin-Biggers, J., & Zhang, Y.-T. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0546-3 · Cited by 51
“In this and other studies [76], usual treatment was considered an active control whereas some researchers categorize usual treatment as inactive (or passive) because it typically is not structurally equivalent on non-specific factors to the experimental condition [6, 7, 24, 32, 76].”
BackgroundEnabling or Engaging? The Role of Recovery Support Services in Addiction Recovery
Davidson, L., White, W. L., Sells, D., Schmutte, T. J., O’Connell, M. J., Bellamy, C. D., & Rowe, M. (2010) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2010.511057 · Cited by 63
Global alcohol policy and the alcohol industry
Anderson, P. (2009) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328329ed75 · Cited by 48
Palitsky, R., & Kaplan, D. M. (2021) · Mindfulness · doi:10.1007/s12671-019-01253-0 · Cited by 46
“Similarly, AA has performed disappointingly in metaanalytic reviews (Ferri et al. 2006; Kownacki and Shadish 1999).”
BackgroundVederhus, J., Timko, C., Kristensen, Ø., Hjemdahl, B., & Clausen, T. (2014) · Addiction · doi:10.1111/add.12471 · Cited by 46
“A recent systematic review reported that studies after Project MATCH have not been entirely consistent, and a formal meta-analysis was not possible due to the heterogeneity of TSF studies [11].”
BackgroundContinuing care for patients with alcohol use disorders: a systematic review.
Lenaerts, E., Matheï, C., Matthys, F., Zeeuws, D., Pas, L., Anderson, P., & Aertgeerts, B. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.10.030 · Cited by 45
“…successful interventions in our analysis, were also found to e effective in meta-analyses (Irvin et al., 1999; Powers et al., 2008). n the contrary, no convincing evidence exists for the effectiveness f twelve step facilitation in reducing alcohol dependence or probems (Ferri et al., 2006).”
Combining medically assisted treatment and Twelve-Step programming: a perspective and review
Galanter, M. (2018) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2017.1306747 · Cited by 44
Mendola, A., & Gibson, R. L. (2016) · AMA journal of ethics · doi:10.1001/journalofethics.2016.18.6.sect1-1606 · Cited by 44
“org 648 conclusive evidence to show that it cannot” [13].”
BackgroundInfluentialThe Prevention and Treatment of Gambling Disorders: Some Art, Some Science
Derevensky, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.024 · Cited by 45
Neurobiological Foundations of Behavioral Addictions
Vaccaro, A. G., & Potenza, M. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.016 · Cited by 45
Tsai, J., & Gu, X. Z. (2019) · Addiction Science & Clinical Practice · doi:10.1186/s13722-019-0138-4 · Cited by 44
“A Cochrane Review of Twelve-Step programs like Alcoholics Anonymous concluded there was lack of experimental studies demonstrating the effectiveness of these programs [26], but a more recent systematic review found that there is substantial causal evidence of their effectiveness in reducing SUDs and SUD-related outcom…”
BackgroundBroadening the Base of Addiction Mutual-Help Organizations
Kelly, J., & White, W. (2012) · Journal of Groups in Addiction & Recovery · doi:10.1080/1556035x.2012.705646 · Cited by 43
Mindfulness-Based Interventions Applied to Addiction Treatments
Kechter, A., & Black, D. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.040 · Cited by 43
Agrawal, A., Freedman, N., Cheng, Y.-C., Lin, P., Shaffer, J., Sun, Q., Taylor, K. C., Yaspan, B., Cole, J., Cornelis, M. C., et al. (2012) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.015545 · Cited by 42
“Lifetime drinkers may also report recent abstention due to a host of environmental factors (eg, life events and pregnancy) (54), due to health factors (eg, gastrointestinal disease) (55), or due to enrollment in a treatment program for alcohol dependence (eg, Alcoholics Anonymous) (56).”
BackgroundEmerging drugs to treat alcoholism
Soyka, M., & Rösner, S. (2010) · Expert Opinion on Emerging Drugs · doi:10.1517/14728214.2010.500811 · Cited by 42
“A number of psychosocial and psychotherapeutic approaches are used in alcoholism including cognitive--behavioral therapies, motivational enhancement, 12 step therapies or family therapy [2-4], but relapse to alcoholism is still more common than abstinence.”
BackgroundAcupuncture for alcohol dependence: a systematic review.
Cho, S.-H., & Whang, W. (2009) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2009.00959.x · Cited by 42
Feedback Models for Gambling Control: The Use and Efficacy of Online Responsible Gambling Tools
Griffiths, M. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.034 · Cited by 42
Human Neurobiological Approaches to Hedonically Motivated Behaviors
Burger, K. S., Shearrer, G. E., & Sadler, J. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.009 · Cited by 42
Pornnoppadol, C., Ratta-apha, W., Chanpen, S., Wattananond, S., Dumrongrungruang, N., Thongchoi, K., Panchasilawut, S., Wongyuen, B., Chotivichit, A., Laothavorn, J., et al. (2018) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-018-9995-4 · Cited by 41
“Booster sessions similar to those of other well-established programs, such as 12-step programs might help maintain remission and prevent relapse at 6 months or earlier (Brown et al. 2002; Ferri et al. 2006).”
Multidimensional evaluation of a mental health court: Adherence to the risk-need-responsivity model.
Campbell, M. A., Canales, D., Ran, W., Totten, A. E., Macaulay, W. A. C., & Wershler, J. (2015) · Law and Human Behavior · doi:10.1037/lhb0000135 · Cited by 41
Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence
van Amsterdam, J., & van den Brink, W. (2013) · Journal of Psychopharmacology · doi:10.1177/0269881113495320 · Cited by 109
Prevention and Treatment of “Food Addiction”
Davis, C., & Mason, A. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.023 · Cited by 42
Kelly, J. F., & Greene, M. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.08.006 · Cited by 40
Alcohol use while on the liver transplant waiting list: A single‐center experience
Carbonneau, M., Jensen, L. A., Bain, V., Kelly, K., Meeberg, G. A., & Tandon, P. (2010) · Liver transplantation · doi:10.1002/lt.21957 · Cited by 40
“Although we found no studies assessing the impact of BAL screening on alcohol use by patients while on the transplant waiting list, a recent Cochrane review assessing the effectiveness of Alcoholics Anonymous and other counseling methods in the general population found that any intervention at all was found to be of a…”
Kelly, J. F., & Yeterian, J. D. (2012) · Substance Abuse · doi:10.1080/08897077.2011.634965 · Cited by 38
“There have been hundreds of empirical studies on AA that have been summarized in several meta-analyses (10–12) and one Cochrane review (13).”
BackgroundSchulte, E. M., Schiestl, E. T., & Gearhardt, A. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.035 · Cited by 43
Reed, D. D., Naudé, G. P., Gelino, B. W., & Amlung, M. T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.011 · Cited by 48
Participatory Design of Technologies to Support Recovery from Substance Use Disorders
Schmitt, Z., & Yarosh, S. (2018) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3274425 · Cited by 41
“Additionally, research findings concerning the effectiveness of 12-step fellowships have been divergent [48], with evidence of their effectiveness in treating SUDs [46,89] appearing as frequently as evidence citing their ineffectiveness [30,56].”
BackgroundFuture directions in examining the self in psychological disorders
Kyrios, M., Moulding, R., Bhar, S., Doron, G., Nedeljkovic, M., & Mikulincer, M. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781139941297 · Cited by 36
Dale, E., Kelly, P. J., Lee, K. S. K., Conigrave, J. H., Ivers, R., & Clapham, K. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2019.106038 · Cited by 35
Sensitization of Incentive Salience and the Transition to Addiction
Warlow, S. M., Baumgartner, H. M., Freeland, C. M., Naffziger, E. E., Olney, J. J., Berridge, K. C., & Robinson, M. J. F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.006 · Cited by 46
Neurobiology of Substance Addictions
Christie, N. C., & Bechara, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.015 · Cited by 44
Multiple Memory Systems, Addiction, and Health Habits: New Routes for Translational Science
Stacy, A. W., Pike, J. R., & Lee, A. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.017 · Cited by 43
Tanning as an Addiction: The State of the Research and Implications for Intervention
Miller, K. A., & Mays, D. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.037 · Cited by 43
Prevention and Treatment of Compulsive Buying Disorder
Galimov, A., & Black, D. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.027 · Cited by 42
Blum, K., Roy, A. K., Podesta, A., Modestino, E. J., Steinberg, B., Gondré-Lewis, M. C., Baron, D. A., Thanos, P. K., Lott, L., Badgaiyan, S., et al. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.031 · Cited by 42
Considering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
Blum, A. W., & Grant, J. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.038 · Cited by 44
Cavicchioli, M., Movalli, M., Ramella, P., Vassena, G., Prudenziati, F., & Maffei, C. (2019) · Addiction Research & Theory · doi:10.1080/16066359.2019.1590558 · Cited by 38
“The current DBT-ST program should be compared with other evidence-based interventions for SUDs focused on acceptance mechanisms (e.g., 12-steps programs, motivational interviewing; Burke et al. 2003; Ferri et al. 2006), which do not include mindfulness teaching and practice.”
MethodCollins, S. E., Duncan, M. H., Smart, B. F., Saxon, A. J., Malone, D. K., Jackson, T. R., & Ries, R. K. (2014) · Substance Abuse · doi:10.1080/08897077.2014.904838 · Cited by 33
van Dam, D., Vedel, E., Ehring, T. W., & Emmelkamp, P. M. G. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.01.004 · Cited by 169
Psychosocial interventions for stimulant use disorder
Minozzi, S., Saulle, R., Amato, L., Traccis, F., & Agabio, R. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011866.pub3 · Cited by 32
Self-citationBehavioral Economics and Addictive Disorders
Jarmolowicz, D. P., & Schneider, T. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.005 · Cited by 42
Treatment of alcohol use disorder and co-occurring PTSD
Taylor, M., Petrakis, I. L., & Ralevski, E. (2016) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2016.1263641 · Cited by 39
Bergman, B. G., Kelly, J. F., D, M. F. M., & Evins, A. E. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106661 · Cited by 43
An approach to the patient with substance use and abuse.
Maldonado, J. (2010) · The Medical clinics of North America · doi:10.1016/j.mcna.2010.08.010 · Cited by 31
Mueller, S., Petitjean, S., Boening, J., & Wiesbeck, G. (2006) · Alcohol and Alcoholism · doi:10.1093/alcalc/agl122 · Cited by 30
Kelly, J., Fallah-Sohy, N., Cristello, J. V., Stout, R., Jason, L., & Hoeppner, B. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108287 · Cited by 29
“…poor visibility and/or variable provision of quality smoking cessation services or whether these services are unappealing at this stage of recovery in which individuals are focusing more on the more acutely lethal risks of relapse to other drugs is unclear (Kelly et al., 2019; Kelly et al., 2020).”
BackgroundOpioid Therapy in Patients with Chronic Noncancer Pain: Diagnostic and Clinical Challenges
Cheatle, M. D., & O’Brien, C. P. (2011) · Advances in psychosomatic medicine · doi:10.1159/000324067 · Cited by 30
Farren, C., & McElroy, S. (2010) · Alcohol and Alcoholism · doi:10.1093/alcalc/agq060 · Cited by 29
“A Cochrane review recommended that people considering attending AA or a 12-step treatment programme should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes (Ferri et al., 2006).”
BackgroundBujarski, S., & Ray, L. A. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.05.008 · Cited by 37
“…AUD including cognitive behavioral therapy, 12-step facilitation, and motivational interviewing, though the efficacy of existing behavioral treatments is only modest, particularly at more severe stages of alcoholism (Anton et al., 2006; Ferri et al., 2006; Magill & Ray, 2009; Rubak et al., 2005).”
Kelly, J. F., & Greene, M. C. (2014) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2014.907015 · Cited by 21
Metadata
- Authors
- Ferri, M., Amato, L., & Davoli, M.
- Affiliations
- Agency of Public Health; Project Unit: EBM and Models of Health Assistance; Via di Santa Costanza 53 Rome Italy 00198
- Azienda Sanitaria Locale Roma 3 (IT)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2006-07-19
- Volume
- 2010
- Issue
- 1
- Pages
- CD005032-CD005032
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC12167657
- OpenAlex
- W1541598409
- Cited by
- 347
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 9 · 2021: 7 · 2020: 63 · 2019: 27 · 2018: 18 · 2017: 24 · 2016: 21 · 2015: 32 · 2014: 21 · 2013: 18 · 2012: 26
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Sociology and Political Science › Homelessness and Social Issues
- Keywords
- Alcoholics Anonymous, twelve-step facilitation, 12-step programs, alcoholism, self-help groups, abstinence, treatment retention, treatment discontinuation, alcohol consumption, psychosocial interventions, family quality of life, alcohol-related accidents
- MeSH terms
- Adult, Alcoholics Anonymous, Alcoholism, Humans, Self-Help Groups, Program Evaluation, Randomized Controlled Trials as Topic
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