Is Alcoholics Anonymous Effective?
By John David Balla
According to the National Institute on Alcohol Abuse and Alcoholism, December 2000 report,the vast personal, social, and economic problem of alcoholism will cost the U.S. economy $289 Billion by 2010. And the situation is getting worse, not better.
And while it is undeniably true that people do get sober in AA, according to its own 1990 Triennial Survey report, only 5 percent of AA members continue with the program longer than a year. That’s a 95 percent failure rate.
Natural recovery, or what many researchers call spontaneous remission, an admittedly clinical term for “getting sober on your own,” claims a success rate of between 3.7 and 7.4 percent (See Spontaneous Recovery in Alcoholics: A Review and Analysis of the Available Research, by R. G. Smart. Drug and Alcohol Dependence, Vol. 1, 1975-1976, p. 284.) To simplify matters, this number has been rounded out to 5.5 percent.
As you will soon see, both numbers contain several nuances that make a pure, apples-to-apples comparison problematic, including:
AA recovery may simply be a manifestation of spontaneous remission (with assistance) and thus explain the similarity in the percentages between AA findings and the finding of spontaneous remission.
We do know that about 2 million self-declared alcoholics try to quit drinking through AA each year.[2]
It is not known how many self-declared alcoholics try to quit drinking by means other than AA, but the number is likely at least at par with those who use AA.[3]
A year of attending AA meetings is not necessarily indicative of abstinence from alcohol. People in AA do relapse, but AA refuses any blame for these occurrences. They are the result of the member not following the program correctly, or being “constitutionally incapable of being honest with themselves .”(Big Book, page 58).
A year of abstinence of alcohol does not necessarily translate into long-term sobriety.
Spontaneous remission takes into account both abstinence and those individuals who return to moderate drinking. AA is of the position that moderate drinking for the alcoholic is impossible.
The plot thickens. In 1941 Saturday Even Post article cited AA cofounder Bill Wilson who stated that AA had a 50% success rate. If this number is to be trusted, than something had seriously gone astray with AA in subsequent decades. Either that or Mr. Wilson had fallen victim to wild exaggeration.
According to the A.A Fact File, published by AA (circa 2007 or soon thereafter), from its founding in 1935, AA membership hit 1 million in 1975. Thirty-two years later, membership almost doubled again, hitting nearly 2 million members in 2007. Using a compound growth rate of 5 percent per annum (based on AA’s Triennial Survey), beginning in 1975, membership would have reached over 4.7 million by 2007. But as AA reports, the number is less than half that – 2 million – which means something is askew. A second calculation is necessary to determine the true growth rate of AA compounded annually. This difference is attributable to AA’s successful accounting for first year growth while not doing the same for subsequent years of attrition. But when both growth and attrition are combined, a 2.2 percent actual growth rate is reached, which jives perfectly with AA’s own historical growth numbers.
It’s also important to keep in mind that this finding is based only on a single year of AA membership, not necessarily abstinence during that timeframe. In other words, AA statistically defines success as attending AA meetings for a period of one year, which is a subtle yet important distinction from abstinence, and moreover, is no guarantee of long-term sobriety. Indeed, active AA members do relapse.
Now if we use a 50 percent success rate proclaimed by Mr. Wilson, and assume this number to still hold true, the number of people in AA would be over 431 billion, actually 431,439,883,274, by 2007. The problem of course, is that there are 6.8 billion people occupying the planet at the time of this writing. Clearly, Mr. Wilson’s claim had no basis in reality.[4]
The likely deviation of the 5 percent per year retention rate of newcomers to AA, and the 2.2 annual growth rate from 1975 to 2007, is attributable to AA members who leave the program subsequent to their first year, as just touched upon. Basic arithmetic indicates the annual dropout rate after year one to be 2.8 percent, though there is no data to crunch these numbers to more precise groupings, i.e., 2-5; 6-10; 11-20 years. In other words, the 5 percent growth rate must be offset by 2.8 percent to account for the true growth of AA as promulgated by AA itself.
While there’s no reliable data on the number of sober alcoholics within the spontaneous remission category, it stands to reason that the same arithmetic holds true. If the same 5 percent success rate were compounded annually for spontaneous remission, in a short amount of time, maybe a decade or two, alcoholism, at least theoretically, would be eradicated from the planet. Or in the very least, those who either sought to help themselves or to get outside help, would all get it and be sober. The reality, of course, is much different. The presence of alcoholism and its many negative impacts on society, is growing, not contracting; growing at an average annual rate of 4.16 percent, according to the National Institute on Alcohol Abuse and Alcoholism, December 2000 report.[5] What this means is that the collective efforts to help alcoholics get sober is still producing more alcoholics, not less.
Therefore, the spontaneous remission number is also suspect. And for simplicity sake, we will downgrade it at par with the success rate of AA, that is, 2.2 percent, though clearly the number in actuality may be somewhat higher or lower.
Now using the standard rule of thumb, that 1 out of 10 people have a propensity for alcoholism, there are then approximately 30 million alcoholics in the United States (out of the total population of approximately 300 million), of which 1,213,269 are active in AA.[6] This is most telling for a few reasons:
- It shows that AA membership in the United States represents only 4 percent of all alcoholics, both sober and not sober.
- It shows that AA has fertile ground for growth, that is, there is no shortage of alcoholics out there to help.
- It shows that if AA maintains a 2.2 success rate, all alcoholics who seek out AA to be sober would do so in 150 to 170 years, even when we take into account population growth.
- Statistically speaking, there is no tangible benefit of AA over spontaneous remission. This is quite a remarkable finding. In other words, there appears to be no benefit in attending AA whatsoever; its successes are merely the result of spontaneous remission (with assistance), or so it can be argued.
The U.S. population growth rate is currently about 1 percent per year, according to the U.S. Census Bureau, and is expected to shrink by 50 percent within the next four to five decades, which is good news for the statistics espoused above. It is good news because if these success rates are to be trusted, it is just a matter of time where AA along with spontaneous remission will begin to contract the growth of alcoholism.
Yet today, for every person who gets sober, whether through AA or not, another person – actually slightly more than one person – takes their place in the alcoholism supply cycle, usually men and women in their twenties and thirties.
But because AA measures membership, not sobriety, we are affronted with two countervailing characteristics, which by themselves, present a host of statistical challenges that may or may not cancel each other out, and cannot go without mention:
- That AA members stay sober, which results in potentially over-reporting AA successes. Anyone in AA has first-hand knowledge of AA members who do indeed relapse, but since AA does measure relapse within AA, there is no hard data from which to work from.
- That AA members who leave AA do not stay sober, which results in under-reporting personal triumphs over alcoholism for which AA is likely to play a critical role. Again, AA does not measure relapse within its membership or former members, though implicit within what AA does report, is that leaving AA equates to relapse. Still, there is no hard data to quantify this occurrence.
This is the reality about alcoholism today. Sadly, the industry at large has come to view these numbers as the way it is, which allows them to take on a flavor of acceptability, and in they eyes of AA, are propagandized into miraculous successes.
But there is a second reality, a reality that looks at the recovery rates of alcoholics over the course of their entire lives. According to the Harvard Medical Review study, 50 percent of all alcoholics eventually stop drinking. This translates on a per annum basis of about 5 percent per year. (There’s that number again.)
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When I was a kid, we used to have big family parties once or twice a year to celebrate a major anniversary, or birthday, or some other milestone that the family deemed worthy of making a big deal about. I remember these parties well. We’d have 30, 40, even 50 of our relatives come in from all over the place, and converge on our very modest 3 bedroom bungalow in Lyons, a suburb just a few miles from Chicago. It was a good thing we had a full basement or there literally wouldn’t have been enough room.
I would go to bed hearing my dad and his cousins and uncles (plus a few aunts) laughing and shouting around the poker game whose sounds carried well from the ductwork up to my bedroom upstairs. Debauchery was commonplace, even before I hit the sack. Indeed, getting drunk was part of the celebration. In fact, my dad always got drunk (and rather obnoxious). So too did the majority of aunts, uncles, cousins, even grandparents.
One uncle would later die of complications brought on by decades of heavy drinking and smoking, plus a terrible diet. As for the rest, they would still show up to parties, but either not drink at all, or drink nothing like they used to. Even my dad almost completely quit drinking in his fifties, only occasionally having a glass or two of wine with my mom, and once getting drunk at a work Christmas party, all over the course of a decade. Not bad for a guy I had to drag out of the corner tavern more times that I can remember so that we could sit down as a family to have supper.
So was my dad ultimately successful in his quest to quit drinking? No. But was he eventually able to no longer drink alcoholically? Yes, for the last ten years of his life, he did not drink alcoholically, and was a much better husband, father, neighbor and person for it.
Many addiction experts believe that the key to getting sober is not just willingness, but strong support from friends and families. As such, AA is especially helpful to individuals who lack support from friends or family (or otherwise), usually late stage alcoholics who have burned so many bridges that no one wants anything to do with them. It then comes as no surprise why such people who find AA, adopt AA as the family they never had, or through decades of drinking, lost. This is where AA has a real and tangible benefit over spontaneous remission, a qualitative difference that mere number crunching has failed to substantiate, or even account. Indeed, this is where quantitative analysis has likely undermined AA’s impact and value.
The evidence reveals that AA is helpful as an early recovery program, especially for those in their first year of abstinence, and who have little support. (This is further supported by the research paper, One Hundred Alcoholic Doctors: A 21-Year Follow-Up, by Gareth Lloyd, which concludes, among other things, that “…there was also a strong relationship between recovery and attending meetings of self-help groups [including AA. However,] this relationship is not sustained in the long term…”
But many addiction specialists make an important distinction between sobriety and recovery. After all, without the former, there is no possibility of the latter. That’s why treatment centers (or rehabs), by removing access to alcohol completely, are critical to the alcoholic’s journey into sobriety. In a recent CNN special investigation hosted by Dr. Sanjay Gupta, Addiction: Life on the Edge…
“When it comes to drinking, only about one in four people getting treatment is able to quit drinking completely for a full year afterward.[7]”
Though presented in the context of the glass being Âľ empty rather than ÂĽ full, what Gupta fails to point out is that these figures are extraordinarily positive compared to the paltry 5 percent success rate of AA, and spontaneous remission for the same time period. In fact 5 times greater, a point that cannot be overstated.
Regardless of treatment modality or philosophy, drinking is simply no longer an option in rehab. And while obviously not a long-term solution, rehabs give the gift of sobriety to a person who otherwise could not achieve it. What they do after being released, now becomes a matter of some conscious choice, instead of an overwhelming unconscious compulsion to feed their addiction regardless of the consequences.
Conversely, the long-term effects of AA directly assault free will and personal identity, which has a strong tendency to turn the membership codependent and dysfunctional. AA warns of leaving AA and the implications of doing so, and members heed these warnings. As such, long-time members of AA who leave are likely to act out by relapsing with a rather unconscious motivation to fulfill the AA prophecy (a notion is further elaborated in the subsequent chapters.) Whether this would happen as frequently if AA didn’t take such a hard line on AA dropouts is a most interesting hypothetical to ponder.
About John David Balla
John David Balla is a corporate dropout, freelance writer, marketer, web designer, business consultant, and volunteer committed to truth-based principles and practices. For more information, go to www.woowoochronicles.com and www.fp2marketing.com.
[1] The report estimated the 1998 cost of alcohol abuse to the economy to be $185 Billion, a 25 percent increase from 1992. The 25 percent increase was then applied to the 1998 number to reach the 2004 number, and repeated again for the 2004 number to arrive at the 2010 calculation of $289 Billion. The 25 percent number, broken down into yearly growth, is 4.16 percent.
[2] Using AA’s failure rate plus its success rate as gleaned from AA 1990 Triennial Survey report, 2 million existing members, plus a 5 percent increase attributed to new members who stay in AA for at least one year = 100,000 (are presumed to have successfully stopped drinking). Now we multiply 95 percent to denote AA’s failure rate, i.e., newcomers who leave AA within a year to reach the second number of 1,900,000. Then we simply add the two together to arrive at the current number of alcoholics who attempt to stop drinking in a given year using AA as a platform, which is… 100,000 + 1,900,000 = 2,000,000.
[3] That would bring the yearly figure to 4,000,000. This translates to roughly 17.6% of all active alcoholics try to quite drinking in any given year (using figures published by the U.S. Census Bureau, which concludes that 7.4 percent, or 22,644,000 people of the total U.S. population, are alcoholic.)
[4] Perhaps he was speaking to percentage growth of the program in the 1940s which would have been growing by at least 50 percent. But that’s another thing entirely.
[5] I extrapolated the 25 percent growth rate the report sites from 1992 thru 1998 and then divide that number by the number of years that has lapsed between reports, i.e., six, to arrive at an average growth rate of 4.16 percent.
[6] Number taken directly from A.A. Fact File published by AA.
[7] Source: http://transcripts.cnn.com/TRANSCRIPTS/0904/19/cp.01.html