Is AA Effective?: Wall Street Journal vs Cochrane Collaboration

STATS.org weighs in on the Wall Street Journal's criticism of the Cochrane Collaboration's recent review of research on 12 step facilitation (TSF). In my opinion, the STATS author has a bias against 12 step recovery and specialty addiction treatment. (I'll acknowledge a bias in favor of both.) Some examples:

• Her statement about 12 step "baggage".
• Her lame attempt at fair criticism. ("Yet it is important not to dismiss 12-step programs entirely.") Why is it necessary to "dismiss" 12-step recovery at all? Can't one affirm the value of other paths to recovery without dismissing 12-step programs?
• Her tendency to link TSF and specialty treatment to Synanon.

She's also a disease model skeptic and has written (here and here) about her negative personal experiences with 12 step recovery (dismissing her depression, pushing religion, etc.) and determination that her addiction was self-medication.

Unfortunately, she's the only journalist I'm aware of that specializes in analyzing addiction treatment and drug policy. Her point of view is valuable, but it's not unbiased.

The Cochrane review is accurate in that studies looking at relatively short term outcomes of various treatment approaches find little or no advantage for one over another. This is important but doesn't paint a complete picture. These studies (as do all treatment studies) focus only on recovery initiation. We know relatively little about recovery maintenance. Study after study finds that 12-step attendance is related to higher rates of abstinence. This could simply be an artifact of motivation, but it's probably much more complicated than that. There's a lot of diversity in treatment quality, intensity, duration, combinations of approaches, etc. There's a shift toward disease management models that will emphasize long term outcomes and recovery maintenance, not just recovery initiation.

We've got a lot to learn, but here's some of what we know:

• Is 12-step effective at initiating recovery? - YES
• Are other approaches effective at initiating recovery? - YES
• Is 12-step involvement associated with maintaining abstinence? - YES
• Are other approaches associated with maintaining abstinence? - I haven't seen the evidence.
• Do 12-step programs work for everyone? - NO
• Does anything work for everyone? - NO
• Are there other paths to recovery? - YES
• Do some people initiate recovery with one approach and maintain recovery by other means? - YES

We should continue to research 12-step recovery and other approaches. Learning more about the factors that contribute to the benefits of 12-step involvement might help in developing recovery maintenance strategies to help people who won't attend 12-step groups or don't benefit from 12-step groups -- and of course, approaches without the "baggage" that troubles the writer.