LifeRing Secular Recovery is an organization that hosts the U.S. UU. And in-person and online international support meetings. Choosing recovery close to home means your support system is only a few miles away.
Alcoholics Anonymous (AA) is a faith-based program that has helped many people overcome their binge drinking habits since the 1930s. The goal of AA has been to help people who suffer from alcohol addiction through a set of spiritual principles called the “Twelve Steps”. However, modern approaches to addiction treatment and peer recovery support have helped develop and influence new alternatives to AA as society changes. Many people continue to use 12-step programs, such as AA, to support their long-term recovery after they have completed residential treatment or while undergoing an intensive outpatient program (IOP).
There are also others that use less religious communities that use a combination of online support groups for sober people, recovery counseling, and medical tools. Whether you choose a more traditional support group, such as AA, or take another path to help you achieve your long-term recovery goals, research supports the effectiveness of finding a community of like-minded people. Tempest is an online program where members can take an admissions survey, take clinically proven courses, and establish connections in community groups. Also known as TLC, The Luckiest Club is an online recovery community where members have access to daily sobriety meetings, a members-only forum, monthly workshops, and group training with trained leaders.
Loosid is a full-service, sober application for people in recovery to find a like-minded community of more than 140,000 people. The app has recovery tools, including a dating app and daily tips on sobriety. Founded in 1975, Women for Sobriety (WFS) is a national organization that helps all women find their path to recovery through “self-discovery.”. The WFS achieves this goal through its self-help program called the “New Life Program”.
There are a variety of formats for A, A. Meetings and every meeting takes on the feel of its local area. At most meetings, you'll hear members talk about what drinking did to them and to those around them. Most also share what steps they took to stop drinking and how they live their lives today.
The purpose of all meetings is for A, A. Members should “share their experience, strength, and hope with each other so that they can solve their common problem and help others recover from alcoholism”. Meetings are usually listed as open or closed meetings. In both types of meetings, participants may be asked to limit their discussion to issues related to recovering from alcoholism.
Group meetings are led by A, A. Members who determine the format of their meetings. Meetings are held in person, online, or by phone. The members of each meeting decide when, where, and how often they will meet.
You can even find meetings at beaches, parks, or other outdoor settings. Online and telephone meetings are also available. Various platforms are used depending on what the group members prefer. Some of them are video conferences where you see each other's faces.
In other online meetings, everyone's video is turned off. Other meetings use a dial-up teleconference number. Whether closed or open, an A, A. The member who acts as a “leader” or “president” opens the meeting in the format of that group and selects a topic for discussion.
The backgrounds of many thematic meetings derive from A, A. Literature, such as Alcoholics Anonymous (Big Book), Twelve Steps and Twelve Traditions, As Bill Sees It, Daily Reflections and by AA Grapevine. These are usually sessions led by a group member who has been sober for a while, to help newcomers. Meetings for beginners can also follow a discussion format or focus on steps one, two, and three.
A guide to the main beginner meetings is available in G, S, O. Because the Twelve Steps are the foundation of personal recovery in A, A. These same formats can be applied to group meetings on the Big Book or the Twelve Traditions. Many groups are in the habit of reading aloud the relevant material from the Big Book or the Twelve Steps and the Twelve Traditions at the beginning of the meeting.
People get together and talk, and there's a social environment in the room once the meeting is over. Some may come before you and offer their help or share their experiences being sober. While many members find this time after the meeting valuable, it's up to you if you want to stay and socialize. Meetings welcome attendees from court programs and treatment centers.
The strength of our program lies in the voluntary nature of membership in A, A. It educated us about the true nature of illness. Who made the referral to A, A. What concerns us is the problem drinker.
We cannot predict who will recover, nor do we have the authority to decide how any other alcoholic should seek recovery. Sometimes, a referral source requests proof of attendance from A, A. The nature and extent of any group's participation in this process depends entirely on the individual group. Some groups, with the consent of the potential member, have an A, A.
This can be provided in a voucher provided by the reference source or by a digital method if the group is online. The referred person is responsible for returning proof of attendance. Proof of attendance at meetings is not part of A, A. Each group is autonomous and has the right to choose whether or not to credit its attendance at its meeting.
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thousand. Before sharing sensitive information, make sure you're on a federal government site. Alcohol use disorder (AUD) carries a prodigious burden of illness, disability, premature mortality, and high economic costs due to lost productivity, accidents, violence, incarceration, and increased health care utilization. For more than 80 years, Alcoholics Anonymous (AA) has been a widespread organization for the recovery of AUD, with millions of members and free treatments at access points, but only recently has rigorous research been carried out on its effectiveness.
Alcoholics Anonymous (AA) and other 12-step programs for alcohol use disorder Alcohol use disorder (i.e. Alcoholism (alcoholism) is a public and individual health problem of concern around the world. AA is a free, generalized mutual help community that helps people recover from alcoholism and improve their quality of life. The included studies were funded by one or more grants from the United States National Institutes of Health (18 studies), the United States Department of Veterans Affairs (8 studies), and other organizations (p.
Ex. Private foundations or academic institutions; 8 studies). Two studies did not report their source of funding. The certainty of the tests ranged from very low to high for the different outcomes.
Most of the high-certainty evidence was based on the results of studies with reliable study designs (randomized controlled trials) and good measurement methods. Some tests were considered to have low certainty, in part because of inadequate methods for deciding what treatment each person in the study should receive, which may allow factors other than treatments to affect the results. There was some inconsistency in the evidence between the studies, which could be due to variation in the clinical characteristics of the participants, the times of follow-up, the error in the participants' memory of certain outcomes, and differences in the duration of interventions or the effects of the therapist. Some studies had small sample sizes, leading to less accurate estimates of longer periods of abstinence and to high variability around the estimates of beverages per day of consumption.
TSF interventions are likely to have quite similar mechanisms of change, since they have been directly adapted from AA interventions, but, since they are short-lived and AUD is often chronic, any long-term impact of TSF would be due less to the intervention itself than to its ability to connect a person to long-term participation in AA. We included studies that compared AA or TSF with other interventions, such as motivational improvement therapy (MET) or cognitive behavioral therapy (CBT), 12-step program variants, or no treatment. We included adult men and women (18 years of age or older) with alcohol use disorder (AUD), alcohol abuse, or alcohol dependence, as defined by standardized criteria (i.e.,. The Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions (APA 1994; APA 201; the ninth and tenth revisions of the International Statistical Classification of Diseases and Related Health Problems (WHO 20; and validated screening or diagnostic tools).
Studies involving participants who had been forced to attend AA meetings were excluded (p. In this review, the participation of AA and TSFs were compared to at least one of the following interventions:. These results were measured using a self-report and, when available and appropriate, confirmed by a bioassay. We did not impose restrictions on language, year of publication, or status of publication.
We identified published, unpublished, and ongoing studies by searching the following databases since their inception. We model the thematic strategies for databases based on the search strategy designed for CENTRAL (Appendix). The following test records were searched:. Using a standardized data extraction form, two review authors (JK and KH) independently summarized the relevant elements of the study, including the study design, sample characteristics, description of experimental and control interventions, results, study funding, and conflicts of interest.
Any disagreement regarding these details was resolved between all authors of the review through discussion. The authors of the studies were contacted for clarification when necessary. We addressed the domains of sequence generation and assignment concealment (avoiding selection bias) using a single input for each study. It was not possible to blind participants and staff (performance bias) since this review focused on psychosocial interventions.
In fact, knowledge of participation in a psychosocial intervention is part of the therapeutic effect; therefore, we believe that the lack of blinding of participants and staff does not introduce biases. For this reason, all studies were considered to have a low risk of performance bias. Initially, it was planned to evaluate the blinding of the outcome evaluator separately to determine objective and subjective outcomes, but all the results reported in the included studies were subjective (self-reported data), although many of them were supported by an objective biological test (p. Outcome data were considered incomplete (although any observed attrition bias was also noted) for all outcomes.
We implemented the “risk of bias” tables for use in the evaluation of RCTs, quasi-RCTs, and prospective observational studies that included a comparison intervention, in accordance with the criteria recommended by Cochrane Drugs and Alcohol (see Appendix 2 for more information). We calculated the standardized mean difference (SMD) for the continuous variables (p. The percentage of days of abstinence (PDA)) or the relative risk (i.e. Risk coefficients (RR)) for dichotomous variables (p.
Proportion of participants (total abstinence), with the uncertainty of the estimate expressed by 95% confidence intervals (CIs). Whenever possible, we pooled and analyzed the effects of studies using meta-analyses. Random effect estimates were used to account for possible heterogeneity between the interventions studied in the included studies. The remaining studies were described in tabular format and the results were described in the narrative.
Then, in the Results section, they are called Analysis 1.1, Analysis 2.3, and Analysis 6.3, and they appear in the tables in the “Data and Analysis” section as “Other Data”. We evaluated the presence and impact of missing data on the study findings. We detail this in the narrative as appropriate. We also detail in a table how the included studies handled the missing data.
When necessary, the original authors of the study were contacted to try to obtain the missing data and information on their possible impact. Given the potential high level of heterogeneity between experimental treatments and comparison treatments, we performed a quantitative aggregation (meta-analysis) that included a statistical estimate of the degree of heterogeneity calculated using the Q value and the statistical I2. It was planned to use visual inspection of funnel graphs (graphs of the estimate of the effect of each study compared to the sample size or the standard error of the effect) to indicate possible publication bias if there were at least 10 studies included in the meta-analysis. The funnel graphs were not inspected because there were always fewer than 10 studies in a given meta-analysis (Sterne, 201).
Whenever possible, we performed a pooled analysis and aggregated the data using a random effects model, because we expected a certain degree of heterogeneity between the trials). This was possible for the proportion of completely abstinent participants, PDA, DDD, and PDHD. We analyzed the five observational, prospective, and non-randomized studies that we included separately (see Analysis 5.1, Analysis 5.2, Analysis 5.3, Analysis 5.4, Analysis 5.5, Analysis 6.1, Analysis 6.2, Analysis 6.3, and Analysis 6,. We describe subgroup analyses according to the severity of AUD, when appropriate (p.
According to DSM IV criteria, “abuse” versus “dependence”; APA 199. The GRADE system uses the following criteria to assign test scores. The grade may be reduced for any of the following reasons:. Electronic searches returned 12,733 articles from the databases specified in Electronic Searches. Five additional studies were identified through author correspondence and three through clinical trial histories, making a total of 12,741 articles.
After eliminating duplicates, 5808 records were left. We deleted 5758 of them after analyzing the titles and abstracts, as they were irrelevant to the current study. This left a total of 50 full-text reports, which we examined in detail. 13 of these studies were excluded because they did not meet the inclusion criteria (documented in Figure 1; see also Characteristics of Excluded Studies).
This left a total of 37 published study reports related to the 27 main studies that met our inclusion criteria. Most of the studies were conducted in the U.S. USA, with a study from the United Kingdom (Manning (201) and another from Norway (Vederhus) (201). The details of the characteristics and bias indices of each study are included in the Characteristics of the included studies.
When there were two or more articles that described different follow-up time points for a given study, we combined the articles that described the results of the different time points of that study. The tables of characteristics of the included studies also include two additional ratings for each study, as follows:. The total number of participants in the 27 included studies was 10,565, including 2,456 participants who contributed to economic analyses. Manualized (%3D), the treatment covers the standardized content in a linear or modular way to ensure that the same treatment is administered over time and in different places where the intervention can be implemented.
This ensures that the treatment can be replicated, a key factor in confirming findings in different studies using the same treatment. N %3D number of participants in the cell subcategory Taking into account these dimensions, the following are the findings of the studies included in five categories summarized with the following subcategories:. The duration of follow-up ranged from the end of treatment to five years (table). For economic studies, the duration of follow-up ranged from one year to seven years.
Thirteen studies included a bioassay (breathalyzer, blood test, urine test, saliva test, or a combination of both), while 13 did not report on the use of one; the final study was only an economic analysis, for which the use of a bioassay was not appropriate. The included studies were conducted before the introduction of biological assays such as ethyl glucuronide (EtG) and phosphatidyleethanol (PEth), which can detect alcohol for much longer than the assays used in the studies. Since, at that time, there was a limited window for detecting alcohol consumption using breathalyzers and urine bioanalysis, the use of bioassays to corroborate self-reporting was less common than it is now. In any case, systematic bias in comparison treatment interventions is unlikely to occur because all participants underwent the same procedures and protocols.
Of the 27 studies included, 12 did not report how they managed the missing data; 5 used intention-to-treat analysis (with the worst case scenario); and the remaining 10 studies used various procedures to impute or compensate for any missing data (see table). A The score was lowered due to the limitations of the study (high risk of selection bias) B It was lowered by two levels due to inconsistency (I2 %3D 91%) C It was lowered due to imprecision (the IQ does not exclude significant benefit or significant harm) D It was lowered due to imprecision (moderate sample size (n %3D) E It was reduced due to the limitations of the study (possible wear bias and possible blinding of the outcome bias) F Degraded due to imprecision (small sample size (n %3D) e (wide confidence interval) G Se The score was lowered since the narrative synthesis was carried out, therefore, the estimates are not accurate. due to imprecision (moderate sample size (n %3D 30). b) Rating was reduced due to imprecision (small sample size (n %3D).
C: Rating was reduced due to imprecision (small sample size (n %3D)). Rated lower due to study limitations (risk of random sequence generation, concealment of assignment, and dropout bias). A reduced score due to the limitations of the study (the lack of control of the sample selection and the non-random nature). b Degraded due to indirectionality (comparability of cohorts in terms of baseline characteristics and outcome measures, and protection against pollution).
C: Degraded due to imprecision (being a single study with a moderate sample size (N %3D %3D 20%). Rated lower due to study limitations (risk of dropout bias). b) The score was reduced due to imprecision (a single study with a moderate sample size (N %3D)). The score was reduced as the narrative synthesis was carried out, therefore, the estimates are not accurate.
A Downgraded due to random sequence generation bias and problems with the comparability of the cohorts at the start of the study; protection against contamination among study interventions. Formal evidence of heterogeneity between studies indicated a low probability of potential heterogeneity, which ranged from Tau 2% 3D 0.00, P %3D 0.98; I2 %3D 0% at six months of follow-up, to Tau 2% 3D 0.01, P %3D 0.16; I2 %3D 37% at 12 months of follow-up, suggesting consistency between the reported findings. The GRADE certainty score for this evidence was high. One study (Davis 200) and another study report that examined the results at the end of treatment (McCrady (199)) were excluded from the meta-analysis, because they reported on the proportion of days of alcohol consumption and it was not possible to calculate the standard deviation.
However, we were able to include McCrady's two six-month and 18-month follow-up reports from 1996 (Analysis 1,. The GRADE certainty score for this evidence was very low; it was reduced due to the limitations, inconsistency, and imprecision of the studies. The GRADE certainty score for this evidence was low; the score was reduced due to study limitations and imprecision. The GRADE certainty score for this evidence was moderate; it was reduced due to the imprecision of the study.
The GRADE certainty score of the tests after 12 months of follow-up was low; two levels were reduced due to imprecision and the wide confidence interval. The GRADE certainty score for this evidence was low; we degraded it due to the limitations of the studies and because a narrative synthesis was carried out and, therefore, the estimates are not accurate. None of the studies in this category reported this result. The GRADE certainty score for this evidence was low; two levels were reduced due to the small sample size.
The GRADE certainty score for this evidence was low; the score was reduced due to imprecision (moderate sample size) and due to study limitations (no information was reported to assess four different types of bias). The GRADE certainty score for this evidence was moderate; it was reduced due to imprecision (moderate to small sample). The GRADE certainty score for this evidence was moderate; it was reduced due to imprecision (small sample). Kahler 2004 found no difference between drinking per day (DDD) interventions (MD −4.10, 95% CI −10.44 to 2.24; P %3D 0.21; 1 study, 42 participants; analysis 3,.
The GRADE certainty score for this evidence was moderate; it was reduced due to study limitations (risk of random sequence generation, concealment of assignment, and attrition bias). No studies were included in this category. We include four studies, published in six articles, in this category (Blondell 2001; Humphreys 1996; Ouimette 1997; Zemore 201. See Table 5 for a summary of the results of our main results and the certainty of the tests for each outcome). The GRADE certainty score for this evidence was very low; the score was reduced due to the limitations of the studies (lack of control over sample selection and the non-randomized nature of the study).
The GRADE certainty score for this evidence was very low; it was reduced due to imprecision (moderate sample size) and indirect nature (comparability of cohorts for basal characteristics and outcome measures, and protection against contamination). The GRADE certainty score for this evidence was very low; we degraded it due to the limitations of the study (lack of control over sample selection and the non-randomized nature of the study) and the indirect nature (comparability of the cohorts in terms of baseline characteristics and outcome measures, and protection against contamination). Only one study reported the severity of alcohol addiction in this category; Humphreys from 1996 used the Alcohol Dependence Scale and found no difference between interventions (MD −0.30, 95% CI −2.20 to 1.60; P %3D 0.76; 1 study, 201 participants; Analysis 5,. The GRADE certainty score for this evidence was very low; the score was reduced due to study limitations (risk of dropout bias).
The GRADE certainty score for this evidence was very low; the score was reduced due to study limitations (risk of dropout bias) and imprecision (moderate sample size). We carry out a narrative synthesis and, therefore, the estimates are not accurate. The GRADE certainty score for this evidence was moderate; it was reduced due to random sequence generation bias, problems with the comparability of the cohorts at the start of the study, and protection against contamination among the study interventions. The follow-up after the intervention ranged from three to 60 months, with a modal duration of 12 months (see table).
Overall, the study samples were quite large and had adequate power to detect the effects. However, sample sizes were highly variable and biased between studies, ranging from a minimum of 48 participants in Kahler (2004) to a maximum of 3018 in Ouimette (1997), with an average of 400 participants per study (mean: 406.4; SD 616.2; median of 20). The measurement in the included studies included psychometrically validated assessment tools. The lack of information on any outcome related to quality of life, functioning, or psychological well-being was notable.
If people with AUD are opposed to attending AA, despite strong evidence of their potential to aid recovery, doctors might consider linking to alternative mutual aid organizations, as they may confer benefits with similar levels of participation. Alternatives can also be considered when a patient has made a sustained effort to participate in AA, but has not gained sufficient benefit from it. Most of this research was carried out in the U.S. In the U.S., more research is needed to determine the extent to which the results observed here differ in other countries.
None of the studies included in this review reported any outcomes related to quality of life, functioning, or psychological well-being. Increasing interest and importance is attached to these important indices, in addition to substance-related outcomes (Kelly, 201), and new studies should collect data on these results. Some research has examined the usefulness of AA for people with other common substance use disorders (e.g. Disorders related to cocaine, cannabis, opioid use, etc.
More research is needed to understand the extent to which these people could benefit from other mutual aid organizations, such as Narcotics Anonymous or Cocaine Anonymous (Bøg 201). Studies also suggest that AA's participation in reducing health care costs may have immense clinical and public health value and economic benefit.). These analyses could be expanded to include potential gains in economic revenues derived from increased employment or productivity, or both, and also reductions in criminal justice costs related to the decline in criminal activity that could result from increased AA participation. CINAHL EBSCO (Cumulative Index of Literature on Nursing and Related Health) edited (no change in conclusions).
AA is present in more than 180 countries. The book Alcoholics Anonymous, the basic text of AA, has been translated into more than 70 languages. There are more than 1,000 AA meetings a week in the western counties of Alameda and Contra Costa. Virtual meetings are available around the world.
There are AA meetings that start every hour. With a lively online community and local meetings across the United States, LifeRing Secular Recovery is an alternative to traditional, spiritually based 12-step programs, such as AA. These studies show that TSF can increase participation in AA and, in doing so, AA leads to better outcomes in alcohol consumption. .
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