ALCOHOLICS Anonymous is the most successful self-help group in the world and by far the most successful agency in helping alcoholic men and women stop drinking, and stay stopped.

Yet its critics (and there are many) argue that there is no reliable empirical evidence to support the efficacy of AA and its 12-step program. This is not true.

While it is the case that AA itself keeps no records and that its only membership requirement is a desire to stop drinking, recent American studies show how and why regular attendance at AA meetings is so successful.

A team of researchers from Massachusetts General Hospital recently conducted a large-scale study of alcoholic men and women. This demonstrates that participation in AA is so effective because regular attendance at meetings leads to individuals spending significant time with others who support their efforts to stay sober, and leads to increased confidence in their ability to remain abstinent in situations where others are drinking.

Led by John F. Kelly, associate director of the Massachusetts General Hospital Centre for Addiction Medicine, this study is the first to investigate exactly how AA helps individuals recover by examining the independent effects of several mechanisms simultaneously. Other researchers involved in this inquiry include Maria Pagano, who hails from my American alma mater, Case Western Reserve University in Cleveland, Ohio.

These researchers analysed data from Project MATCH, a federally funded trial of 1706 participants that compared three alcohol treatment approaches.

While participants in that study were randomly assigned to a specific treatment plan, all were able to attend AA meetings as well. The data gathered at several points during Project MATCH’s 15-month long study included recording participants’ alcohol consumption and their attendance at AA meetings.

These results demonstrated that, in comparison with cognitive behavioural therapy and motivational enhancement therapy, greater participation in AA was independently associated with more successful long-term recovery.

Study leader Kelly, an associate professor in the Harvard Medical School department of psychiatry, puts it thus: “Our findings are shedding light on how AA helps people recover from addiction over time. The results suggest that social context factors are key; the people who associate with individuals attempting to begin recovery can be crucial to their likelihood of success. AA appears adept at facilitating and supporting those social changes.”

The findings of the Massachusetts study reinforce those of George Vaillant, whose path-breaking book, The Natural History of Alcoholism Revisited, published by Harvard University Press, demonstrates the efficacy of attendance at AA leading to stable abstinence.

Moreover, Vaillant’s own large-scale longitudinal studies led him to realise that in the long term (that is, three to five years), trying to get alcoholics to control or moderate their usage was a mirage and that striving for abstinence was by far the safest therapeutic goal.

The team of researchers involved in the Massachusetts study found that those who frequently attended AA meetings had fewer symptoms of depression – along with less drinking – than did those with less AA participation.

“Our study is one of the first to examine the mechanisms underlying behavioural change with AA and to find that AA attendance alleviates depression symptoms,” Kelly says.

“Perhaps the social aspect of AA helps people feel better psychologically and emotionally, as well as to stop drinking.”

As Kelly explains, participation in the program’s 12 suggested steps and its social fellowship are designed to support a person’s sense of wellbeing. While an alcoholic becoming abstinent by whatever means often leads to a positive change in mood, that process seems to happen more quickly in AA participants.

At the beginning of the Massachusetts study, participants reported greater symptoms of depression than were observed in the general population. This is typical of alcohol-dependent individuals. Yet, as the study proceeded, those who attended more AA meetings had significantly greater reductions in their depression symptoms, along with much less frequent and less intensive drinking.

“Some critics of AA have claimed that the organisation’s emphasis on powerlessness against alcohol use and the need to work on character defects cultivates a pessimistic world view, but this suggests the opposite is true,” Kelly says. “AA is a complex social organisation with many mechanisms of action that probably differ for different people and change over time.

“Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood.

“Who wouldn’t want that?”

Emeritus professor of history and politics at Griffith University, Ross Fitzgerald is the author of 35 books, including My Name is Ross: An Alcoholic’s Journey.

The Weekend Australian November 26-27, 2011