Alcoholics Anonymous founder Bill Wilson was quite fond of threatening atheists and people who didn't go to AA with death. In Chapter 4 of the AA Big Book, he says on page 44 that drinkers are "doomed to an alcoholic death or to live on a spiritual basis." On page 53 of this same chapter he says, "When we became alcoholics...we had to fearlessly face the proposition that either God is everything or else He is nothing." In Chapter 9 the Twelve Steps and Twelve Traditions on page 174 Bill says, "Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant."
All of these statements gave rise to the popular 12-step slogan: "The only alternative to AA is jails, institutions, or death." But do these statements have any basis in scientific fact, or are they merely rhetoric by means of which a charismatic leader held the reins of his flock?
Let's see what the scientific evidence has to say.
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted 2001 to 2002, surveyed a total of 43,093 adults, and was the largest and most comprehensive study of alcohol problems ever conducted in the Unites States. NESARC found the past year prevalence of Alcohol Dependence in the U.S. is 3.8 percent. The population of the U.S. at this time was about 285 million people, with about 210 million adults over the age of 18. That means there were about 8 million active alcoholics in the U.S. in 2001. Since the size of the U.S. population has increased only slightly from 2001 to today, there are about the same number of active alcoholics today.
...although alcohol is responsible for about 88,000 deaths per year in the U.S., only about 3,700 of these deaths are due to Alcohol Dependence...-Kenneth Anderson
The CDC tells us that although alcohol is responsible for about 88,000 deaths per year in the U.S., only about 3,700 of these deaths are due to Alcohol Dependence, aka alcoholism. Moreover, an analysis of the NESARC data by Dr. Gene Heyman showed that approximately 5 percent of people with Alcohol Dependence recover each year – about 400,000 Americans. What this tells us is that for every one person who dies of Alcohol Dependence each year there are roughly 100 who recover, as is illustrated in Figure 1.
According to a study of the NESARC data by Cohen, et al., only about 11 percent of people with an Alcohol Use Disorder ever attend AA in spite of the fact that NESARC shows that the lifetime remission rate for Alcohol Dependence is over 90 percent. Even when we include those people who seek other forms of help – such as rehab, seeing a therapist, talking to a clergyman, etc. – together with those who go to AA, only 14.6 percent ever seek any form of help; the other 85.6 percent go it alone without AA, rehab, or anything.
...about 90 percent of people who recover from Alcohol Dependence do so without AA and only about 10 percent who recover utilize AA to do so.-Kenneth Anderson
Other studies also suggest that about 90 percent of people who recover from Alcohol Dependence do so without AA and only about 10 percent who recover utilize AA to do so. For example, a joint study by OASAS and Drugfree.org found that 23.5 million Americans are in recovery from drug or alcohol addiction, whereas AA's membership in the U.S. is only 1.3 million; even if we add in other 12-step groups such as NA, CA, MA, etc. we are unlikely to get a total of 2 million: less than 10 percent of those in recovery. Moreover, NESARC tells us that roughly half of all people who recover from Alcohol Dependence do so by cutting back on alcohol and half by abstaining. We will make the generous assumption that 11 percent of those in recovery are in AA and will further assume that those in AA are abstaining. NESARC also tells us that the lifetime remission rate for Alcohol Dependence is roughly 90 percent; when we put this together we get the results in Figure 2.
The final question which remains is what would happen to those 11 percent who currently recover via AA if AA had never existed.
People considering attending AA or TSF programmes should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes.-Cochrane Review
Would they all have drunk themselves to death as AA dogma suggests? Or would they all have recovered on their own as the fans of spontaneous remission would like to believe? A meta-analysis of studies of 12-step programs conducted by the prestigious Cochrane Review found that extremely few properly controlled studies of 12-step programs had ever been conducted and that given the dearth of adequate studies it was impossible to conclude whether 12-step programs were superior to any other form of treatment; in fact there was not sufficient evidence to conclude that 12-step programs were superior to no treatment at all. In the words of the study, "People considering attending AA or TSF programmes should be made aware that there is a lack of experimental evidence on the effectiveness of such programmes."
Maybe now that 80 years have passed since the founding of AA and untold billions have been poured into the promotion of the 12 steps, someone will finally conduct a properly controlled experiment to show whether the 12 steps are effective or not.
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