The Research Recovery Institute has published another webinar that we consider good news. Its title is Mutual Help Groups as an Addiction Recovery Resource by Dr. Keith Humphries at Stanford University. (Links to the webinar are at the end.) In this blog piece we will summarize the presentation and discuss related data on the importance of social support networks that support sobriety as well as natural recovery.
Effectiveness of AA on Abstinence
Dr. Humphries presents compelling data that Alcoholics Anonymous (AA) has a positive impact on abstinence, both complete abstinence as well as percentage of days per week abstinent. Of the 27 studies though, only 8 studies examined the number of drinks a person drinks per day, and only 3 studies looked at the percentage of days per week a person engages in heavy drinking. In addition, only 8 studies looked at alcohol-related consequences. And in their conclusion, they note “Findings also indicate AA/TSF (TSF: Twelve Step Facilitation therapy) may perform as well as other clinical interventions for drinking intensity outcomes; however, these results are based largely on low certainty evidence and so should be regarded with caution.”
This is good news for those who choose to try and continue to affiliate with AA. Many people though either refuse to attend AA or stop going after some exposure to it.
AA is Not for Everyone
AA’s focus on sobriety and lack of attention to other issues that often occur with heavy drinking may limit its appeal (Ogborne). (Think co-occurring mental health conditions like depression, anxiety, and post-traumatic stress disorder.) AA’s triennial (every 3 years) surveys have reported 50% dropout rates within the first 3 months of starting AA (Chappel). Clearly AA is not for everyone.
The Issue of 13th Stepping
Then there is the issue of “13th stepping.” The link is to a podcase discussing a documentary film that “uncovers sex offenders, violent offenders and old timers who prey on innocent, vulnerable, AA members. Monica Richardson, the Director and a longtime AA member, left (AA) in 2011 to make the film after desperately trying to make things safer in AA.” While it is challenging to ascertain how often this occurs the possibility of it should be kept in mind for a therapist when making a recommendation to a client in early recovery.
Alternative Support Groups
Fortunately, there are alternatives to AA for mutual support groups for sobriety. There’s SMART Recovery, Moderation Management (MM), Life Ring, and Women for Sobriety. Full disclosure: We have collaborated with SMART Recovery for years because of its focus in providing science-based strategies to help people recover from alcohol or drug misuse. We also support both SMART Recovery and MM with funds from subscriptions to our web app.
There is evidence that social support for recovery improves outcomes. We’ve seen this in randomized clinical trials of modules in our CheckUpandChoices app; study participants who had the best outcomes combined our program with social support groups, either online or in-person. And social support groups can also mean church, synagogue, or other spiritual groups that support recovery by helping people develop healthy alternatives to heavy drinking.
The Bigger Picture of Alcohol Misuse and Recovery
In this discussion of AA and other mutual support groups it can be easy to forget that there are 4-5 times as many people with less severe alcohol problems than those at the severe end of the hazardous drinking spectrum who are more likely to attend AA.
SMART Recovery and MM can appeal to this larger group of heavy drinkers for several reasons. First, they avoid labeling people or telling them what to do with respect to goals of change. Second, SMART emphasizes increased self-efficacy and empowerment rather than being helpless to change one’s drinking. Third, its strategies focus on aspects of the person’s life other than just their drinking or drug use. This may be what keeps people involved with SMART Recovery. Fourth, and this is my personal experience in dealings with people in SMART Recovery: As a group they are the most positive and upbeat about their recovery as any group of people in recovery I’ve ever collaborated with.
It is helpful and hopeful to recognize that most people with alcohol and drug problems resolve them on their own without ever going to treatment or mutual support groups. We’ve written another “good news” blog piece about that, and you can read it here. The downside to “natural recovery” is that the average amount of time people experience problems before making changes is 10 years. The risk for a variety of negative consequences when drinking heavily can range from hangovers to more serious things like DWIs, depression, and anxiety. While social and interpersonal negative events tend to happen during and shortly after heavy drinking, health risks occur over a longer period of time. This means that the longer a person drinks heavily the greater his or her risk for developing a wide range of health consequences from their drinking. On the other hand, changing one’s drinking after a shorter period of heavy drinking reduces those health risks.
Finally, our research group has been developing effective programs for alcohol misuse since the dawn of the Internet (early 2000s), rigorously evaluating them in randomized clinical trials, and publishing the results in peer reviewed journals. Now, more than ever, there are many paths to changing one’s drinking and resolving alcohol related problems.
Here is the link to a Youtube recording of the hour long webinar by Dr. Keith Humphries at Stanford University and here is a link to the slides of the presentations (see Seminar 9 in the series). The discussion of alternative support groups starts at 37:13 in the video.