John F. Kelly, Ph.D., ABPP. Recovery Research Institute Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine Harvard Medical School 

Success of Alcoholics Anonymous and Twelve Step Programs Documented Interview with:

John F. Kelly, Ph.D., ABPP. Recovery Research Institute Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine Harvard Medical School 

Dr. Kelly

John F. KellyPh.D., ABPP.
Recovery Research Institute
Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine
Harvard Medical School What is the background for this study?

Response: Alcohol use disorder is one of the leading causes of disease, disability, and preventable death worldwide. Alcoholics Anonymous (AA) is a widespread international recovery support organization designed to address it. While it has remained popular and influential for many decades, until recently the quantity and quality of the research on AA and clinical treatments designed to stimulate AA involvement – Twelve-Step Facilitation (TSF) treatments – had not been evaluated adequately.

This systematic review and meta-analysis used the rigor of the Cochrane review system to subject AA/TSF to the same scientific standards as other clinical interventions. What are the main findings?

Response: With 27 included trials, 4 economic studies, and more than 10,000 patients  we found that, compared to other well-established treatments for alcohol use disorder such as cognitive-behavioral therapy (CBT), AA/TSF interventions produced significantly higher rates of continuous abstinence and remission up to three years post treatment. AA/TSF also substantially reduced health care costs when compared to established treatments. On other outcomes, like intensity of alcohol use, alcohol-related consequences, and addiction severity, AA/Twelve-Step Facilitation performed as well or slightly better. What should readers take away from your report?

Response: When treating alcohol use disorder, facilitating some kind of well-articulated Twelve-Step Facilitation intervention such as those included in the randomized controlled trials in this review is likely to produce higher rates of continuous abstinence and remission. These interventions can save lives as well money (e.g., ED/hospital readmissions; mental health visits). Every clinician should be aware of this as the evidence is of sufficiently high quality to include AA/Twelve-Step Facilitation as an effective and cost-effective part of the clinical armamentarium. Most addiction cases in middle- and high-income countries globally are from alcohol, so greater implementation of these interventions could have a big public health impact. Given that AA is widespread and available for free at the point of service, AA may be one of the closest things in public health we have to a free lunch. What recommendations do you have for future research as a result of this work?

Response: We’ve known for a while that some kind of long-term engaging recovery support service that can help sustain remission over time is often needed for individuals with moderate to severe alcohol use disorder. While we now know with some confidence that AA can do this, we need more research on mutual-help organization effects for other drugs as well as the effects of other kinds of long-term recovery support services that can attract and engage individuals who are not interested in attending AA, but that may also help prevent recurrence of alcohol use disorder and help build resilience. 

Disclosures: Dr. Kelly’s work on alcohol use disorder, other drug addiction, treatment and recovery support services, has been supported by the NIAAA, NIMH, SAMHSA, the State of Massachusetts Dept. of Public Health and by the Massachusetts General Hospital (MGH) Recovery Research Institute and the Elizabeth R. Spallin Professorship in the Field of Addiction Medicine at Harvard Medical school.


Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880.


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Last Updated on March 11, 2020 by Marie Benz MD FAAD