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Estimates of AA's Effectiveness

Biasing factors, such as "motivation," are a serious problem, but it does seem possible to draw at least tentative conclusions about the effectiveness of Alcoholics Anonymous.

A good starting point is AA's most recently announced membership figures. As of January 1, 1996, AA claimed 1.251 million members in the U.S. and Canada,vi while there were approximately 218 million individuals 18 years of age and over in the two countries at that time.

Taking the ARF estimates of the percentages of alcohol abusers and alcohol-dependent persons and multiplying them by total population figures yields a total of roughly 22 million individuals with alcohol problems in 1996; doing the same calculations using the NIAAA percentages yields a total of roughly 16.13 million persons.

Taking these as high and low estimates of the number of alcohol abusers, as of the date of the last avail-able AA membership figures, somewhere between 5.7% and 7.7% of U.S. and Canadian "alcoholics" belonged to AA.

And the percentage of those who will reach the AA goal of lifelong abstinence is much lower than that.

A noticeable feature of AA is that a large number of its members have been in the organization for a relatively short time. Based on my attendance at AA meetings in San Francisco in the late 1980s, I would estimate that over 50% of those attending meetings in that city at that time were members for less than one year and, in fact, that a majority were members for only a few months.

The situation appears to have change little in recent years. (The discrepancy between my observations and AA's claim that only 27% of its members have less than one-year's abstinence is probably accounted for by AA's astoundingly high dropout rate; because of it, one constantly sees new faces showing up at AA meetings, with many of them sticking around for relatively few meetings.)

My estimate, however, isn't too far out of line with the figures given by Bill C. in a 1965 article in the Quarterly Journal of Studies on Alcohol.vii In it, he reports that of 393 AA members surveyed, 31% had been sober for more than one year; 12% had been sober for more than one year but had had at least one relapse after joining AA; 9% had achieved a year's sobriety; 6% had died; 3% had gone to prison; 1% had gone to mental institutions; and 38% had stopped attending AA.

What makes these numbers even more dismal than they appear is the fact that Bill C. defined a member as someone who attended 10 or more AA meetings in a year's time.

When you take into account the "revolving door effect," it becomes apparent that far more persons attended AA meetings than the 393 "members" Bill C. lists.

It seems quite probable that he picked the figure of 10 meetings in a year as a membership criterion because AA's success rate would have been revealed as microscopic if he had used a smaller number of attendances as his membership-defining device.

(It should also be mentioned that attendance at 10 meetings in itself seems to imply a fairly high degree of motivation.)

The success rate calculated through analysis of the 1996 AA membership survey is hardly more impressive. The survey brochure indicates that 45% of members have at least five years' sobriety.

Using the figure of five years' sobriety as the criterion of success, one arrives at an AA success rate of approximately 2.6% to 3.5% (in comparison with the total number of "alcoholics" in the U.S. and Canada). And the success rate is lower than that if one defines "success" as AA does-as lifelong abstinence.

It could be argued that this is an unfair way of evaluating the effec­tiveness of AA, and that only "alcoholics" who have investigated AA should be considered.

That's a reasonable argument, but there's evidence that a very high proportion of "alcoholics" have at one time or another checked into AA.

Anyone who has attended many AA meetings can testify that droves of newcomers show up, attend one, or a few, meeting(s), and then are never seen again-the "revolving door effect."

As well, roughly 270,000 individuals accused or convicted of drunk driving and other alcohol-related crimes are coerced into 12-step treatment every year in the United States.viii Based on the sheer numbers of such persons, it seems probable that well over 50%, perhaps as many as 90%, of American and Canadian problem drinkers investigate AA at some time during their drinking careers.

There's statistical evidence to indicate that this is so. Well known re­searcher Robin Room, of the addiction Research Foundation, reports that a 1990 survey of 2058 Americans aged 18 and over revealed that 9% of American adults have attended an AA meeting at some time in their lives, and that an astounding 3.4% claimed to have done so in the previous year.ix

(The latter percentage is almost certainly incorrect.x)

If Room's 9% figure is even close to being correct, it's good evidence that a very high percentage of U.S. and Canadian alcohol abusers have attended AA at least once.

In 1996, 9% of American and Canadian adults corresponded to roughly 19.6 million individuals. This figure, when compared with the previously men­tioned estimates of alcohol abusers and alcohol-dependent persons (16.13 to 22 million individuals), provides persuasive evidence that the percentage of "alcoholics" who have tried AA is high indeed-and that AA's success rate is very low.

AA's Triennial Surveys

AA's own statistics provide perhaps the most persuasive evidence that AA's success rate is minuscule. Since 1977, AA has conducted an extensive survey of its members every three years (though the survey scheduled for 1995 was conducted in 1996).

These surveys measure such things as length of membership, age distribution, male-female ratio, employment categories, and length of sobriety.

Following the 1989 survey, AA produced a large monograph, "Comments on A.A.'s Triennial Surveys,"xi that analyzed the results of all five surveys done to that point.

In terms of new-member dropout rate, all five surveys were in close agreement. According to the "Comments" document, the "% of those coming to AA within the first year that have remained the indicated number of months" is 19% after one month; 10% after three months; and 5% after 12 months.xii In other words, AA has a 95% new-member dropout rate during the first year of attendance.

If success is defined as one-year's sobriety, on the face of it this 95% dropout rate gives AA a maximum success rate of only 5%; and a great many new members do not remain continuously sober during their first year in AA, which causes the apparent AA success rate to fall even lower.

Of course, many of the 95% who drop out within the first year are probably "repeaters" who have previously investigated AA, and this would increase the apparent AA success rate; but at least for the present there is no way to know what percentage of the dropouts are repeaters.

Additionally, at least some of the 95% who drop out of AA during their first year do manage to sober up; but to date there's no way to know what their numbers are.

As well, it seems quite probable that most of those who drop out early in the program do so because they dislike and disagree with AA, so it could be argued that most of them who overcome their drinking problems do so in spite of, not because of, AA.

Finally, at least some curiosity seekers and relatives of alcohol abusers show up at meetings, and this would further increase the apparent AA success rate.

But to date, there are no reliable figures on what percentage of those who "walk through the door" fit those categories-though my personal estimate, and that of researcher/author Vince Fox, is that no more than 10% of new faces at AA meetings belong to relatives or curiosity seekers.xiii

One thing, however, is certain: An extremely high percentage of American drinkers who have been hospitalized for alcoholism or who have participated in other institutional alcoholism programs have participated in Alcoholics Anonymous.

The number of patients treated for alcoholism is now approximately 950,000 annually,xiv which (because 12-step treatment is used in well over 90% of institutional programs) is a good indication that the proportion of alcohol abusers who have been exposed to AA is very high.

It should also be kept in mind that in most parts of the country convicted drunk drivers are still routinely forced to attend AA as a condition of probation, which pushes the percentage of alcohol abusers exposed to AA even higher.

Further, in most areas AA is the only widely available-and widely media-promoted-alcoholism self-help group, so AA has a very high volume of "walk in" traffic.

But let's give AA the benefit of the doubt and estimate that only 50% of U.S. and Canadian alcohol abusers have tried AA. That would double the success rate calculated earlier (based on the total number of U.S. and Canadian alcohol abusers), and it would increase to 5.2% to 7.0% if the criterion of success is defined as five years' sobriety.

In a worst case scenario, where 90% of U.S. and Canadian alcohol abusers have tried AA, where success is defined as five or more years of sobriety, where 45% of AA members have been sober for five or more years (as AA indicates), and where there are 22 million alcohol abusers in the two countries, the AA success rate would be about 2.9% (and even lower than that if the criterion of success is lifelong sobriety rather than five years' sobriety).xv

The true success rate of AA is very probably somewhere between these two extremes, depending, of course, on how one defines "success"; that is, AA's success rate is probably somewhere between 2.9% and 7% (of those who have attended AA).


Excerpt from book: Alcoholics Anonymous: Cult or Cure? by Charles Bufe - Chapter 7: How Effective Is AA?