Alcoholics Anonymous more effective than established treatments for alcohol use disorder
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Alcoholics Anonymous appeared to be the most effective route for treating alcohol use disorder, according to study results published in Cochrane Database of Systematic Reviews.
“When treating alcohol use disorder, facilitating a well-articulated Twelve-Step Facilitation intervention, such as those included in the randomized controlled trials in this review, is likely to produce higher rates of continuous abstinence and remission,” John Kelly, PhD, ABPP, Elizabeth R. Spallin professor of psychiatry at Harvard Medical School, told Healio Psychiatry. “These interventions can save lives as well as money (eg, ED/hospital readmissions, mental health visits). Every clinician should be aware of this, as the evidence is of sufficiently high quality to include Alcoholics Anonymous/Twelve-Step Facilitation (AA/TSF) as an effective and cost-effective part of the clinical armamentarium.”
According to Kelly and colleagues, although AA has remained popular and influential for decades, research regarding its effectiveness is lacking. The researchers sought to determine whether peer-led AA and professionally delivered TSF, which is meant to stimulate AA involvement, achieved outcomes including abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity and health care cost offsets. To do so, they conducted a systematic review and meta-analysis using the Cochrane review system. They included randomized-controlled trials, quasi-randomized controlled trials and non-randomized studies that compared AA/TSF with other interventions, such as cognitive behavioral therapy, motivational enhancement therapy, TSF treatment variants or no treatment.
Results showed that among 27 relevant studies with 10,565 participants, manualized AA/TSF interventions typically produced higher rates of continuous abstinence compared with the other established treatments evaluated. Further, nonmanualized AA/TSF performed as well as other established treatments. Specifically, the researchers found that 42% of AA/TSF participants were likely to remain abstinent at 12 months (RR = 1.21; 95% CI, 1.03-1.42) compared with 35% of participants receiving other treatments. The intervention also likely performed as well as other treatments for alcohol-related consequences and addiction severity. In addition, four of five economics studies investigated showed AA/TSF provided substantial cost savings.
“Most addiction cases in middle- and high-income countries globally are from alcohol, so greater implementation of these interventions could have a big public health impact,” Kelly told Healio Psychiatry. “Given that AA is widespread and available for free at the point of service, AA may be one of the closest things in public health we have to a free lunch.” – by Joe Gramigna
Disclosures: Kelly reports funding from the NIH and the U.S. Veterans Health Administration to conduct research into alcohol use disorders, comorbidities, treatment response and mechanisms of behavior change in AA and Self-Management Recovery and Training. Please see the study for all other authors’ relevant financial disclosures.