Scientific studies to evaluate the effectiveness of Alcoholics Anonymous (AA) have increased significantly in number and methodological sophistication [1]. Early AA studies focused narrowly on drinking outcomes, but more recent studies reflect growing interest in the effects of AA participation on the larger arenas of emotional/behavioral health and quality of life [2–4].
Current efforts to define recovery for research and clinical purposes similarly include the elements of global health and citizenship in addition to the resolution of alcohol and other drug problems [5]. These trends are congruent with AA’s view of itself.
A central tenet of AA is that recovery from alcoholism involves far more than the removal of alcohol from an otherwise unchanged life. AA’s 12 Steps and core concepts within the culture of AA (e.g. dry drunk, emotional sobriety, spiritual awakening) convey a vision of recovery as a radical transformation in character, identity and interpersonal relationships. AA’s ‘promises’ speak not of an escape from drunkenness but from fear, selfishness, self-pity and regret and the acquisition of freedom, happiness, serenity, peace, confidence and authentic connection to others [6].
Kelly et al. [7] have added to the literature of the effects of AA on global health through their study of changes in depression as a mediator of the influence of AA participation on drinking outcomes. The authors begin with two foundational points: (1) depression can predate the onset of alcohol use disorders (AUD), be exacerbated by AUD or emerge as a consequence of AUD; and (2) depression constitutes an obstacle to recovery and a risk factor for relapse following recovery initiation.
Kelly and colleagues’ finding that AA participation alters drinking patterns (via increased abstinence and lowered intensity and duration of relapse episodes), in part, by decreasing negative affect and depression adds an important new contribution to the existing literature on mechanisms of change in AA. They also add nuance to the question of whether factors such as decreased depression are peripheral outcomes of changes in drinking behavior or the driving force behind changes in drinking behavior. The lagged design of this study allows a clearer suggestion of causation related to the latter influence. Hopefully, future studies of mechanisms of change in AA will similarly distinguish mediators of change from outcomes of change. . . . . . .
Read Full Commentary (PDF)
_______________________________________________________
