Trouble in the Temple of Twelve Steps

The twelve steps of Alcoholics Anonymous represent a foundational approach to treating alcoholism that’s lately been attracting rational scrutiny and criticism. In the latest issue of the Atlantic, Gabrielle Glaser says that “researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective.”

Sounds a bit harsh, doesn’t it? The twelve steps of AA not only dominate alcoholism treatment. They have been applied to other addictions, including food addiction and overeating. So naturally, these sensational headlines attract considerable attention.

A key piece of evidence in Glaser’s argument is the conclusion of a systematic review by the Cochrane Collaboration that said in 2006:

No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.

John Kelly, a professor of psychiatry and addiction medicine at Harvard, begs to differ with Glaser. He says, “There’s quite a bit of evidence now, actually, that’s shown that AA works.”

As Glaser herself notes, “Alcoholics Anonymous is famously difficult to study.” But studies completed after the 2006 Cochrane review may have addressed some of the issues that compromised prior studies. Kelly and his colleague at Harvard, Gene Beresin, wrote last year:

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior.

A new Cochrane review is expected later this year and it will incorporate newer evidence than the last one.

It’s tempting to say you’ve debunked something so widely used as AA’s twelve steps. It certainly grabs headlines if you do. And demanding evidence for interventions that people rely upon is certainly the right thing to do. Some aspects of AA surely do need more study.

But there’s a difference between a myth and a presumption. One has been disproved, while the other lacks definitive proof. By suggesting that AA has been “debunked,” Glaser is overstating her case and perhaps putting her own credibility at risk.

Click here to read Glaser’s story in the Atlantic, here to read a different view in New York Magazine. Click here for the 2006 Cochrane Review and here for a 2014 study of AA’s effectiveness.

Inner Temple, photograph © JH Images.co.uk / flickr

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