Research

Is Alcoholics Anonymous Religious, Spiritual, or Neither? Review Finds AA Effective, But Not In the Way You Think

Alcoholics Anonymous (AA) is a ubiquitous recovery mutual-help organization that continues to arouse controversy, in part because of the programs spiritual orientation.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Alcoholics Anonymous (AA) is a world-wide recovery mutual-help organization. While at one time high-quality research on AA was scant, the 1990s saw an explosion of AA research after the United States’ Institute of Medicine called for more studies on AA’s effectiveness and its mechanisms of behavior change. This paper reviews the religious/spiritual origins of AA and explores findings from the past 25 years of AA research on its effectiveness and mechanisms of behavior change.

HOW WAS THIS STUDY CONDUCTED?

The author conducted a literature review, summary and synthesis of studies examining the effectiveness of AA, and AA’s mechanisms of behavior change.

WHAT DID THIS STUDY FIND?

Does AA really confer causal benefits?

What are the mechanisms through which AA is thought to support recovery?

 

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The author notes that the quasi-religious overtones of AA continue to raise skepticism and concern in the popular media and scientific arena. Evidence now exists, however, demonstrating that AA is an effective clinical and public health ally that aids addiction recovery through its ability to mobilize therapeutic mechanisms similar to those mobilized in formal treatment, but is able to do this for free over the long term in the communities in which people live. To dismiss AA superficially as a potentially effective addiction recovery support option on the grounds that it is religious or spiritual and therefore unscientific is inconsistent with the body of rigorous research accumulated during the past 25 years.

LIMITATIONS
  1. While many scientifically rigorous studies now exist helping to clarify the mechanisms through which AA confers recovery benefits, there is still much to learn about these mechanisms.
  2. Even the most sophisticated studies reviewed in this paper were only able to explain 50% of the direct effects of AA on alcohol outcomes, leaving the other half unexplained; even less was explained in young adult samples. This means there likely other mechanisms through which AA confers benefit which are not currently explained. Further research is needed to understand these other mechanisms as well as how the importance of these mechanisms may differ across different individuals.
  3. There is limited data on the dynamic nature of the mechanisms of behavior change in AA. That is, the ways in which individuals benefit from participation in AA over time are likely to shift in nature and magnitude as individuals progress in recovery and mature. This also needs further study.

BOTTOM LINE

  • For individuals & families seeking recovery: Evidence for AA’s effectiveness is strong. Although AA is a spirituality-based program, it works through a number pathways. As such, individuals may benefit from AA participation regardless of their spiritual leanings.
  • For scientists: The models explaining AA’s mechanisms of behavior change require further specification. Work is needed that more deeply explores the underlying mediators influencing AA’s effectiveness, as well as for whom, and under what conditions AA works best. Greater knowledge in this regard could inform the nature of recovery processes more broadly and enhance recovery management interventions.
  • For policy makers: AA offers effective, free and widely available recovery support for individuals with alcohol and other substance use disorders. In the context of soaring healthcare costs, AA offers closest thing we have to a free lunch. Moreover, in spite of it being free and non-professional, AA appears to confer its benefits through similar mechanisms to clinical interventions. Supporting the dissemination of resources that link people to AA is likely to have public health benefit. Additionally, funding is needed for more research, particularly on the application of 12-step interventions for drugs other than alcohol.
  • For treatment professionals and treatment systems: A large base of evidence now supports AA’s effectiveness. Evidence also suggests AA can complement and extend the benefits of clinical care while simultaneously reducing health care costs. Patients may benefit from AA participation even if they do not identify with the spiritual aspects of the program.

CITATIONS

Kelly, J. F. (2017). Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research. Addiction112(6), 929-936.

 

 

**Note: One or more authors of this study were Recovery Research Institute Staff, including the director and/or other research scientists. As with all summaries, staff made the greatest possible effort to recognize and account for any potential biases in the review of this article.

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