The British Journal of Psychiatry 128: 572-580 (1976)
© 1976 The Royal College of Psychiatrists
The efficacy of Alcoholics Anonymous: the elusiveness of hard data
PE Bebbington
The paper is concerned with methodological problems relating to the
scientific study of the effectiveness of Alcoholics Anonymous (AA). Studies
of the effectiveness of AA fall into two categories-- longitudinal and
cross-sectional, and may be criticized on the basis of over-simple criteria
of success. The particular problems of the requirement for control groups
in studies of effectiveness are pointed out. The problems arising out of
the whole process of affiliation and disaffiliation and their implications
for scientific study are discussed. The requirement for sound statistical
analysis is stressed, and inadequacies in the techniques of follow-up are
indicated. The studies which have some bearing on AA as a treatment
facility are reviewed. These include multivariate studies involving AA
attendance as one factor, studies in which AA was the main variable in a
hospital programme, and longitudinal studies of AA from within the
organization. Particular difficulties in using cross-sectional surveys for
the purpose of estimating efficacy are pointed out. The conclusion reached
is that because of the methodological difficulties the totality of these
studies dose not add significantly to the knowledge concerning AA which we
possess from clinical experience. Moreover, without a change in the unusual
characteristics of AA when considered as a treatment facility it seems
unlikely to be possible to assess its effectiveness in a scientific manner.
