William Cohen

AA Reflection

In today’s reflection I want to discuss the efficacy of 12 step programs. 12 step programs have
historically been controversial due to their emphasis on spirituality and surrender to a higher
power. This has been known to alienate some participants and prevent others from being
comfortable within this group space. The 12 steps in their basic form is as follows:
Step 1: admit powerless over alcohol
Step 2: accept that a higher power, in whatever form, will restore your sanity
Step 3: make a decision to turn your will and life over to a higher power
Step 4: take a moral inventory of yourself
Step 5: admit to a higher power, another human, and yourself the nature of your
wrongdoings
Step 6: accept that a higher power will remove your character defects
Step 7: humbly request the higher power remove your shortcomings
Step 8: list people you hurt during your addiction and be willing to make amends
Step 9: make amends to those people unless it would harm them
Step 10: continue to take a personal inventory, and when you’re wrong, admit it
Step 11: use prayer and meditation to connect with the higher power
Step 12: carry the message of AA to other alcoholics and continue to practice the principles of
the 12 steps in your daily life

6 of the 12 steps involve some form of higher power or spirituality. While the Big Book
encourages participants to think of whatever higher power they subscribe to it is a nebulous
description that leaves atheist and agnostic participants with some trepidations attending AA.

Pinning down the actual efficacy of AA and 12 step programs is a bit difficult because all studies
involve some kind of self report, and there is a tremendous amount of attrition among AA
chapters. A 2011 study suggests approximately %40 of people drop AA within their first year of
attendance. Another barrier to analysis is that some people may not be willing to report relapse
due to social and status ramifications the admission of their replace may have among their
newly found social circle.

An internal study performed by AA indicates that %27 of participants were sober for less than
one year, %24 were sober for 1-5 years, %13 remained sober 5-10 years, %14 were sober 10-
20 years, and %22 percent were sober for greater than 20 years. Additional studies show
significant benefit and prolonged abstinence within those that attend AA vs those that took on
no form of therapy. Unfortunately, the data also suggest that active participation is necessary
within the program in order to receive long term benefit. There are additional individual step 12
engagement programs offered by clinicians to help patients learn what full engagement is and
how to get the most of their community support.

While there is a plethora of studies showing that AA is effective, the best recommendation to
those suffering from addiction is to find a form of treatment that they can actually stick to. One
Meta analysis showed that regardless of religiosity patients who attended AA meetings were
significantly more likely to remain abstinent from alcohol. On the contrary, the same analysis
offered that atheists and agnostics were significantly less likely to attend meetings after their
follow up period in the study. The most interesting finding, however, was that atheists and
agnostics were equally likely to remain sober as their religious counterparts in the study as long
as they continued to attend meetings. It was those that were unsure of their religious beliefs that
were the most likely to relapse and reported the highest drinking frequency during the study.

There is extensive data backing up AA and its ease of access around the country make it the
most accessible form of treatment for addiction. It is unfortunate that there are those that will
feel unwelcome and unable to commit to participation in such meetings. It is therefore
impossible to make a blanket recommendation to those seeking treatment that this will be an
appropriate measure. It is up to each individual and their providers to discuss options and figure
out what works in order to decide on a treatment regimen that will work long term.

Atheists, agnostics and Alcoholics Anonymous. Journal of Studies on Alcohol, 63(5), 534–541
(2002).

Lilienfeld, S. and Arkowitz, H. (2011). Does Alcoholics Anonymous Work? Scientific American.

Kaskutas, L.A. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of
Addictive Diseases, 28(2), 145–157.

Alcoholics Anonymous. 2014 Membership Survey.

Alcoholics Anonymous. (2017). This is A.A. An introduction to the A.A. Recovery Program.