Non‐manualized AA/TSF may also perform slightly better than other clinical interventions for PDA (MD 3.00, 95% CI 0.31 to 5.69; 1 study, 93 participants; low‐certainty evidence). None of the studies included in this review reported on any outcomes regarding quality of life, functioning, or psychological well‐being. There is increasing interest and importance being placed on these important indices in addition to substance‐related outcomes (Kelly 2018), and new studies should gather data for these outcomes. Since the publication of the National Institutes of Health‐sponsored AA research monograph summarizing the research on AA up until the early 1990s (McCrady 1993), numerous RCTs/quasi‐RCTs and well‐controlled comparative non‐randomized studies have been conducted using professionally‐delivered TSF interventions. In addition, research into sophisticated mechanisms of behavior change has been conducted to delineate the precise ways that AA participation confers recovery benefit (see Kelly 2009a; Kelly 2017a).
- Increased more after a 1941 article in the Saturday Evening Post about the group.
- To have the most positive experience possible with the program, it’s important to look for a positive group that can help lift you up and give you the right kind of support and advice.
As noted in Assessment of risk of bias in included studies, we rated all reports across seven risk of bias dimensions using the standard Cochrane ‘Risk of bias’ ratings criteria (see Appendix 2; Figure 4; Figure 5). These criteria apply to risk of bias ratings for randomized as well as for observational, prospective, studies. In the latter case, random sequence generation and allocation concealment are automatically rated as ‘high risk’; we awarded such ratings in this review (i.e. for the 5 included observational, prospective studies). In future updates of this review, if we include a larger number of observational, prospective studies, then it may also be prudent to conduct a separate ‘Risk of bias’ rating specifically designed for evaluating risks in such studies, for example ROBINS‐I (Sterne 2016).
Sobriety in AA: Since getting sober, I have hope
Meetings typically close with a prayer, moment of silence, recitation of the Responsibility Statement, or by reading a section of another A.A. Group consisted of only Bill, Dr. Bob, and a patient at an Akron hospital. In 1939, the program expanded, largely due to the publication of the book, https://ecosoberhouse.com/, which is known as the “Big Book.” The growth of people’s interest in A.A. Increased more after a 1941 article in the Saturday Evening Post about the group.
Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. Another immediate need you should fulfill following a relapse is a safe living environment. If your living arrangements are neither safe nor conducive to recovery, please consider alternative arrangements. If you have relapsed, stop using the substance as quickly as possible.
The Big Book
Published in 1939, the AA Big Book contains 11 chapters that include personal stories and spiritual insights. A.A.’s primary purpose is to help alcoholics to achieve sobriety. Recovery works through one alcoholic sharing their experience with another. Many times, when you relapse, several factors are at play—thoughts, feelings, or situations that impacted you before picking up the substance again, leading to the relapse.3 For your recovery to be successful, you should identify what these factors are for your specific situation. A critical step in overcoming this stage of relapse is to practice self-care in its physical, psychological, and emotional aspects.
See Table 1 for a summary of the results for our main outcomes and certainty of evidence for each result. The original AA intervention is purported to work via its social fellowship and 12‐step program (Alcoholics Anonymous 2001). The social components operate through peer support and role modeling of successful AUD recovery, and through providing close mentoring and recovery management oversight through ‘sponsorship’.
About the Big Book
There are thousands of AA meetings run all across the country, and each goes at its own pace, with its own types of discussions. To have the most positive experience possible with the program, it’s important to look for a positive group that can help lift you up and give you the right kind of support and advice. Try not to be dismayed–every meeting attended is still a step in the right direction, whether or not you feel particularly connected to the group.
- Such analyses could be expanded to include the potential gains in economic revenue from increased employment or productivity, or both, and also reductions in criminal justice costs related to lowered criminal activity that might result from increased AA participation.
- Alcohol use disorder (i.e. alcoholism) is a concerning individual and public health problem worldwide.
- In conclusion, clinically‐delivered TSF interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence.
- These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober.
John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute alcoholics anonymous on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses.
Warning Signs of Alcoholic Relapse
Such studies demonstrate that TSF is able to increase AA participation and by doing so, AA leads to better alcohol use outcomes. Economic analyses suggest probable substantial healthcare cost savings can be obtained when treatment programs proactively and systematically link people with AUD to AA using TSF strategies, such as those used in the studies included in this review. The analyses indicate that the reason for this benefit is due to the ability of the AA/TSF to increase AA participation, and thereby increase abstinence rates. Thus, a relatively brief clinical intervention (AA/TSF) can help people with AUD to become engaged in a long‐term, freely available, community‐based, recovery support resource that can help them sustain ongoing remission. In addition to peer‐led AA mutual‐help groups, researchers have also evaluated clinical interventions that have adapted the methodology and concepts of AA.
The studies varied in design; and whether treatments were delivered according to standardized procedures (i.e. manualized); and whether AA/TSF was compared to a treatment that had a different theoretical basis (e.g. cognitive behavioral therapy (CBT)), or to a different type of TSF (i.e. one that varied in style or intensity from the AA TSF). Alcoholics Anonymous, also known as the “Big Book,” presents the A.A. First published in 1939, its purpose was to show other alcoholics how the first 100 people of A.A. Now translated into over 70 languages, it is still considered A.A.’s basic text. The GRADE certainty rating for this evidence was very low; we downgraded due to study limitations (risk of attrition bias).
Methods
These Twelve‐Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups (Humphreys 1999). These interventions vary in session length, format, and duration of treatment. For example, TSF interventions can consist of a single session lasting a few minutes to multiple, hour‐long sessions delivered over several months (see Table 8). TSF interventions can also be delivered clinically in individual or group sessions. The goal of TSF interventions is to engage people with AUD with AA during and, importantly, post treatment, to sustain remission over time. TSF interventions have been studied to determine whether they succeed at linking individuals with AA, and whether this, in turn, results in better alcohol‐related and other outcomes (Ducharme 2006; Kelly 2013a; Kelly 2017a; Knudsen 2016; Longabaugh 1998; Litt 2007; Mann 2006a; Mann 2006b; Walitzer 2009; Walitzer 2015).
The GRADE system uses the following criteria for assigning grades of evidence. These outcomes were measured through self‐report and, when available and appropriate, confirmed via bioassay. 12-Step AA meetings are often held in public, accessible buildings with lots of parking, such as churches, schools, coffee shops, and restaurants. Zoom Meetings can be joined by clicking the meeting’s “Zoom” button. Please read the meeting’s description to find the meeting password, if one is required.
