Alcoholics Anonymous: who benefits?

Alcoholics Anonymous (AA) is the most popular self-help organization for individuals with alcohol-related problems. This includes both alcohol-dependent and, to a lesser extent, alcohol-abusing drinkers. For many people, self-help through AA is the only alcoholism treatment they receive. Other members join the fellowship before entering professional treatment or are introduced to AA as a component of their professional treatment. Attendance at AA also commonly is recommended as aftercare following professional treatment. Yet experience shows that not all clients benefit from AA to the same extent. Therefore, two questions arise: Who does well in AA, and why do these people succeed?

These questions do not have simple answers, however, because outcome (i.e., reduction of drinking or improvement of psychological and social characteristics) associated with AA, as with any kind of alcoholism treatment, is influenced by many characteristics of the clients and the AA groups. For example, the success of AA participation depends not only on an individual's initial decision to attend AA but also on the degree of his or her involvement in AA (e.g., frequency of attendance at meetings, "sharing" at meetings, or serving as or having an AA sponsor). Even similar levels of AA involvement may result in different outcomes for different people, depending on the individual's characteristics and experiences with professional treatment.

Despite four decades of AA research, no clear picture has emerged as to which patient characteristics can predict a positive outcome with AA and, therefore, can be used as criteria for matching patients to AA. This is due in part to the limitations and variability of methodological approaches used in the studies. Most investigators recruit their samples from patients in inpatient or outpatient treatment settings. Some studies retrospectively analyze patients with previous AA experience to identify personal characteristics that predicted AA involvement. In other studies, patients are monitored after professional treatment to determine which characteristics may motivate them to …