12-Step treatment and recovery support likely will never be able to shed all criticisms directed its way. But one clinical psychologist and retired college instructor believes no one should be able to argue successfully that Alcoholics Anonymous (AA) and its principles have not undergone rigorous research.
That certainly had been true in the late 1980s when the Institute of Medicine (IOM) pointed out the lack of an evidence base for 12-Step approaches, but Joseph Nowinski, PhD, says that analysis from IOM would end up fueling substantial research inquiry that now forms the content of his new book, If You Work It, It Works! The Science Behind 12-Step Recovery.
The Hazelden Publishing book, officially out Feb. 1, is targeted largely to a general-interest readership, but Nowinski believes its straightforward accounting of major studies will prove useful to addiction professionals as well.
“It can help them to understand why they are sending someone to AA,” says Nowinski, who operates a private practice near Hartford, Conn., and formerly taught at the University of Connecticut and the University of California-San Francisco. “I don't like to go to a doctor who wants to give me a particular treatment and can't explain why he thinks it's going to work.”
Nowinski himself played an integral role in one of the most prominent studies that compared 12-Step and other approaches in the treatment of addiction.
Yale University researchers in 1990 asked Nowinski to design an alcohol treatment program based on the 12-Step model. His “12-Step facilitation” intervention would be used in one of the three treatment arms in Project MATCH, a highly cited study in which nearly 2,000 individuals with an alcohol use disorder received either 12-Step facilitation, cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET).
The Project MATCH researchers found that all three treatments succeeded in promoting abstinence and reducing overall drinking at periods from 3 to 12 months post-treatment. In addition, 12-Step facilitation was reported to be as helpful to persons with an alcohol abuse problem as it was for those with more severe alcohol dependence. “In other words, the Twelve Step model seemed not to be limited in its effectiveness to those who had bottomed out,” Nowinski writes in the new book.
12-Step facilitation is included on the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Registry of Evidence-Based Programs and Practices.
The first section of Nowinski's book plainly states the highlights of numerous research studies in support of 12-Step approaches. He focuses a great deal on crucial elements that enhance the success of 12-Step treatment and/or support once an individual decides to pursue that route. He considers these factors particularly critical to success:
Consistent attendance at some 12-Step meetings. Research has shown that attending two to three meetings a week will yield a 70% probability of maintaining long-term sobriety five years post-treatment, Nowinski says.
Having a 12-Step sponsor, with particular importance on securing one in the first few months of recovery.
One's perception of one's place in the 12-Step group. Research has indicated that the most actively engaged group members who truly identify as being part of the group tend to have the best outcomes, Nowinski said.
Research also has demonstrated that 12-Step support and formal treatment together tend to produce better results than either of the two alone, he said.
Nowinski, who also pens a blog for Psychology Today, says he becomes the target of criticism on many occasions when he writes about the 12 Steps. He sees several reasons why this remains such an incendiary topic.
“One is that AA has grown and grown—it is ubiquitous,” he says. “Anybody who feels they have a different approach sees it as competition.”
Another reason involves AA's practice never to respond directly to criticism, based on its traditions that reinforce anonymity. “AA does not have a public relations office,” Nowinski says. “It is an easy target.” In addition, the spiritual underpinnings of AA often become the subject of attack, he says.
Nowinski points out that combining 12-Step approaches with cognitive or other modalities often has merit. He adds that just as not all treatment facilities are created equal, 12-Step support meetings have different characteristics and should be examined closely by clinicians so that they can make thought-out recommendations to their patients.
Also, other support group models such as SMART Recovery and Women in Sobriety should be considered, he says. “I'm certainly in favor of any support group where the goal is abstinence,” Nowinski says.
He concludes about his book, “I'm hoping it can be a counterbalance to a lot of the baseless criticism that's out there, so that people can make an informed decision.”