Are 12-Step Programs Like AA/NA Effective in Treating Substance Use Disorders?

Check out this answer from Consensus:

Twelve-step programs like AA and NA are effective in treating substance use disorders, particularly when participants are actively involved and supported by healthcare professionals. These programs are comparable to, and sometimes more effective than, other established treatments like CBT, especially in promoting long-term abstinence and reducing healthcare costs. They are beneficial for a wide range of individuals, including those with dual diagnoses and severe addiction. However, successful integration with other treatment modalities and professional support is crucial for maximizing their effectiveness.

Twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are widely used for treating substance use disorders (SUDs). These programs emphasize abstinence and provide peer support through structured group meetings. The effectiveness of these programs in treating SUDs has been the subject of extensive research.

Key Insights

• Effectiveness in Reducing Substance Use and Improving Mental Health:
  • Participation in dual-focus 12-step groups (e.g., Double Trouble in Recovery) has been associated with reduced substance use and improved mental health outcomes compared to control groups1.
  • Greater early participation in AA/NA is linked to better long-term outcomes for adolescents, even though attendance may decline over time2.
• Comparison with Other Treatments:
  • Manualized AA/TSF (Twelve-Step Facilitation) interventions are more effective than other established treatments like Cognitive Behavioral Therapy (CBT) for increasing abstinence and reducing drinking intensity over the long term9.
  • Non-manualized AA/TSF interventions may perform as well as other clinical interventions for various alcohol-related outcomes9.
• Long-term Benefits and Cost-Effectiveness:
  • AA/TSF interventions produce substantial healthcare cost savings compared to other treatments, particularly for individuals with severe alcohol use disorder9.
  • Long-term studies indicate that AA/NA attendance is associated with better mental health, longer life, and improved social outcomes4.
• Suitability for Different Populations:
  • Young adults with dual diagnoses (both SUD and mental health disorders) benefit as much from 12-step programs as those with only SUD, particularly when they are actively involved and have a sponsor7.
  • Stimulant users also benefit from 12-step programs, with prior attendance and perceived benefits predicting future involvement and positive outcomes6.
• Professional and Cultural Considerations:
  • Clinicians are encouraged to be familiar with 12-step activities and to support patient referrals to these programs, as they are a valuable resource for achieving long-term abstinence4 5.
  • There is a need for flexibility in integrating 12-step philosophy with other evidence-based practices like CBT to accommodate patients’ beliefs and preferences3.

Are 12-step programs like AA/NA effective in treating substance use disorders?

Sarah Zemore has answered Near Certain

An expert from Alcohol Research Group in Alcohol Use

Yes, there is good evidence that 12-step groups like AA/NA are effective in treating substance use disorders. A very large number of studies have found, and found reliably, that greater participation in 12-step groups is related—in a fairly linear fashion—to better outcomes for people attending treatment for an alcohol or drug problem [1-7]. In these studies, researchers have assessed 12-step involvement as meeting attendance and other core aspects of involvement, such as having a home group, having a sponsor, and doing volunteer or “service” work for the group, and they have found that greater involvement is related to better outcomes in a range of domains including substance use, social functioning, and mental health. These studies include rigorously conducted studies that adjusted comprehensively for possible pre-existing differences among those participating at higher compared to lower levels. Even more convincing, studies have found that interventions facilitating involvement in 12-step groups can produce better outcomes than standard treatment or even gold-standard, manualized treatments [8-13]. For example, an 8-year, $27-million study funded by NIAAA found that, among those in outpatient alcohol treatment, those participating in 12-step facilitation had higher rates of alcohol abstinence at follow-ups than those participating in both cognitive behavioral therapy and motivational enhancement therapy [9, 12]. So, even though many popular publications claim that AA is not scientifically based or substantiated, that is an incorrect claim. There is a good deal of rigorous evidence supporting the effectiveness of 12-step groups: These groups ARE effective IF people choose to participate in them. Moreover, contrary to popular belief, 12-step groups have been found to be effective for women, young people, and those who are not religious. Still, there is some evidence that they are less effective for individuals with severe mental health problems, such as psychosis [5, 14, 15].

There are a few caveats to these conclusions, however. Perhaps the biggest caveat is that most people, including severe populations who have attended formal treatment, do not attend 12-step groups as long as needed to obtain lasting benefits. While 12-step groups remain the most commonly sought resource for substance use problems (more common even than formal treatment) [16-19], help-seeking is rare, and those who do try 12-step groups often drop out [20, 21]. This suggests the need for other community resources for alcohol and drug problems. Notably, there are several secular mutual help groups, such as SMART Recovery, LifeRing, and Women for Sobriety, which are gaining recognition and research attention [22-24].  Also, the research base is limited in that studies have been conducted mainly on substance use treatment populations, so less is known about other populations (e.g., those who do not attend treatment, less severe individuals). Finally, the scientific literature on 12-step groups has devoted relatively little focus to drug-dependent populations, so less is known about whether 12-step groups are effective for those with drug use disorders specifically (e.g., those with opiate use disorders).

References

1.         Kaskutas, L.A., Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Diseases, 2009. 28(2): p. 145-157.
2.         Kelly, J.F., M. Magill, and R.L. Stout, How do people recover from alcohol dependence? A systematic review of the research on mechanisms of behavior change in Alcoholics Anonymous. Addiction Research and Theory, 2009. 17(3): p. 236-259.
3.         Tonigan, J.S., R. Toscova, and W.R. Miller, Meta-analysis of the literature on Alcoholics Anonymous: Sample and study characteristics moderate findings. Journal of Studies on Alcohol, 1996. 57(1): p. 65-72.
4.         Timko, C., Outcomes of AA for special populations, in Recent Developments in Alcoholism, Volume 18: Research on Alcoholics Anonymous and spirituality in addiction recovery, M. Galanter, et al., Editors. 2008, Springer: New York. p. 373-392.
5.         Kelly, J.F., Self-help for substance-use disorders: History, effectiveness, knowledge gaps, and research opportunities. Clinical Psychology Review, 2003. 23(5): p. 639-663.
6.         Moos, R.H., How and why twelve-step self-help groups are effective, in Recent Developments in Alcoholism, Volume 18: Research on Alcoholics Anonymous and spirituality in addiction recovery, M. Galanter, et al., Editors. 2008, Springer: New York. p. 393-412.
7.         Moos, R.H., Active ingredients of substance use-focused self-help groups. Addiction, 2008. 103(3): p. 387-396.
8.         Kaskutas, L.A., et al., Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach. Journal of Substance Abuse Treatment, 2009. 37(3): p. 228-239.
9.         Project MATCH Research Group, Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 1997. 58(1): p. 7-29.
10.       Timko, C., A. DeBenedetti, and R. Billow, Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 2006. 101: p. 678-688.
11.       Timko, C. and A. Debenedetti, A randomized controlled trial of intensive referral to12-step self-help groups: One-year outcomes. Drug and Alcohol Dependence, 2007. 90(2-3): p. 270-279.
12.       Project MATCH Research Group, Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research, 1998. 22(6): p. 1300-1311.
13.       Walitzer, K.S., K.H. Dermen, and C. Barrick, Facilitating involvement in Alcoholics Anonymous during out-patient treatment: A randomized clinical trial. Addiction, 2009. 104(3): p. 391–401.
14.       Timko, C., R. Billow, and A. DeBenedetti, Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship. Drug and Alcohol Dependence, 2006. 83(2): p. 111-121.
15.       Kelly, J.F., B.G. Bergman, and N. Fallah-Sohy, Mechanisms of behavior change in 12-step approaches to recovery in young adults. Current Addiction Reports, 2018. 5(2): p. 134-145.
16.       Zemore, S.E., et al., A moderating role for gender in racial/ethnic disparities in alcohol services utilization: Results from the 2000 to 2010 National Alcohol Surveys. Alcoholism: Clinical and Experimental Research, 2014. 38(8): p. 2286-2296.
17.       Cohen, E., et al., Alcohol treatment utilization: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 2007. 86(2-3): p. 214-221.
18.       Ilgen, M.A., et al., Longitudinal predictors of addictions treatment utilization in treatment-naïve adults with alcohol use disorders. Drug and Alcohol Dependence, 2011. 113(2-3): p. 215-221.
19.       Perron, B.E., et al., Differences in service utilization and barriers among blacks, Hispanics, and whites with drug use disorders. Substance Abuse Treatment, Prevention, and Policy, 2009. 4: p. 3.
20.       Cloud, R.N. and J.B. Kingree, Concerns about dose and underutilization of twelve-step programs: Models, scales, and theory that inform treatment planning, in Recent Developments in Alcoholism, Volume 18: Research on Alcoholics Anonymous and Spirituality in Addiction Recovery, M. Galanter, et al., Editors. 2008, Springer: New York. p. 283-301.
21.       Kelly, J.F. and R. Moos, Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences. Journal of Substance Abuse Treatment, 2003. 24(3): p. 241-250.
22.       Zemore, S.E., et al., Comparison of 12-Step groups to mutual help alternatives for AUD in a large, national study: Differences in membership characteristics and group participation, cohesion, and satisfaction. Journal of Substance Abuse Treatment, 2017. 73: p. 16-26.
23.       Zemore, S.E., et al., A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of Substance Abuse Treatment, 2018. 88: p. 18-26.
24.       Atkins, R.G. and J.E. Hawdon, Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, 2007. 33(3): p. 321-331.