Alcoholics Anonymous and other 12-step programmes for alcohol dependence

Evidence Summaries

Level of Evidence = B
Alcoholics Anonymous and other 12-step programmes appear to have similar effect as other interventions for alcohol dependence.

A Cochrane review 2 included 27 trials involving a total of 10,565 participants. RCTs comparing manualized Alcoholics Anonymous (AA)/Twelve-Step Facilitation (TSF) to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (RR 1.21, 95% CI 1.03 to 1.42; 2 studies, n=1936 participants). For percentage days abstinent (PDA), AA/TSF appeared to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI -4.36 to 10.43; 4 studies, n=1999). There was no significant difference when comparing non-manualized AA/TSF with other clinical interventions.

A Cochrane review 1 included 8 trials involving a total of 3417 participants. Alcoholics Anonymous (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. Other studies reported similar retention rates regardless of treatment group (including Cognitive Behavioral Therapy and Motivational Enhancement Therapy). 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 12-step facilitation (TSF) approach vs 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 12-step approach in promoting complete abstinence.

Comment: The quality of evidence is downgraded by study quality (several limitations), by inconsistency (heterogeneity in interventions and outcomes).

References

1. Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev 2006 Jul 19;3:CD005032.  [PMID:16856072]

2. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev 2020;(3):CD012880.  [PMID:32159228]


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