By porkchoptze
The Alcohol Harm Reduction Blog

Although many people find that 12 step groups such as AA or NA are helpful for their drug or alcohol problems, a growing body of evidence suggests that just as many people may be harmed by 12 step programs as are helped by them.

Anecdotal evidence from many ex-AA and ex-NA members tells us that participation in 12 step groups led them to increased alcohol or drug use, depression, and sometimes thoughts of suicide or suicide attempts.

Long term studies of the effectiveness of AA such as Brandsma et al (1980) and Vaillant (1995) found that people were just as likely to quit on their own as with the help of AA or a 12 step treatment program.

The real explanation for this seems to be not that AA has no effect at all-but rather that just as many people are HARMED by AA as are helped by it.

The number that are harmed cancel out the number that are helped and the net result is zero effect for the group as a whole.

How much or how little a person drinks appears to be entirely irrelevant to whether the person will find AA helpful or harmful.

The determining factor in whether a person is helped or harmed by a 12 step group appears to be personality type. People who are black-and-white thinkers, who are conformists, who like to be told what to do, and who like simple and clear-cut rules to follow appear to do very well with AA. 

People who think in shades of gray, who want to be masters of their own destiny, who are non-conformists and contrarians appear to be harmed by AA. These are the people who find that AA meetings make them want to drink.

What is the evidence?

Research by Wilson (1994) found that conformists were more successful in AA others.

Research by Poldrugo and Forti (1988) suggests that AA is a better fit for people with dependent personality type than for others.

Karno MP, Longabaugh's 2005 study of data from Project MATCH showed that docile clients did far better with highly structured and directive approaches whereas reactive or angry clients did far better with motivational interviewing approaches.

In other words AA is a much better match for sheep than for wolves.

People who are motivated by peer-pressure to do drugs are probably the same ones who can be motivated by peer-pressure in a 12 step group to stay off of drugs.

People like who were drinking or drugging in reaction to a fundamentalist Christian upbringing are likely to drink or drug themselves to death in the similarly religious atmosphere of AA.


If AA meetings help you to stay off the booze-then great!!! Keep going back!

But if AA meetings make you want to drink, then run-do not walk-the other direction!

It isn't like there aren't plenty of secular alternatives to AA around these days. There are SMART Recovery, SOS, LifeRing, WFS, and HAMS just to name a few. Lots of people do not even need a support group to quit drinking.

Drinking alcohol is not like cancer which is a disease. Drinking alcohol is a choice and people choose to stop doing it all the time. You can't just choose to stop having cancer.

Some people try to say that those who quit on their own are not "true alcoholics". (I do not know what the hell a false alcoholic would be). But the studies have shown over and over again that regardless of what definition of the word "alcoholic" you use-people are still just as likely to quit on their own as when they are sent to a 12 step treatment program or when they are coerced to attend AA.

What about 12 step treatment programs?

Study after study has shown that 12 step treatment programs are no more effective than no treatment at all. These same studies (eg. Brandsma 1980)  have shown that alternative approaches such as Cognitive Behavioral Therapy-CBT-have far superior outcomes over 12 step treatments or a no-treatment control group.

Project MATCH did demonstrate that 12 Step Facilitation Therapy was as effective as CBT, however, the one problem with 12 Step Facilitation Therapy is that it is not available anywhere.

By definition 12 Step Facilitation Therapy has to be done one-on-one with a trained counselor and this is expensive. Instead, 12 step treatment centers run 12 step groups on the cheap-and this 12 step group therapy has been repeatedly shown to be no more effective than no treatment at all. You might as well flush your money down the toilet as pay for this sort of treatment.

On the other hand, effective approaches such as CBT are available for free at SMART meetings and HAMS also offers effective harm reduction and CBT-based approaches for free.

The conclusion is that we need to get the 12 step religion out of the hospitals and treatment centers and courtrooms and employee assistance programs and back into the rooms where it belongs!

And if you tell your doctor that AA meetings make you want to drink and s/he STILL tries to send you to AA in spite of it-then you had better sue him/her for malpractice!


Brandsma JM, Maultsby MC, Welsh RJ. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.

Karno MP, Longabaugh R. (2005). An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use. J Stud Alcohol. 66(6), 825-32.

PubMed Abstract:

Poldrugo F, Forti B. (1988). Personality disorders and alcoholism treatment outcome. Drug Alcohol Depend. 21(3), 171-6.

PubMed Info:

Vaillant GE. (1995).The natural history of alcoholism revisited Cambridge, Mass. Harvard University Press.

Wilson E. (1994). A Clinician's Guide to Cognitive Developmental Assessment and Intervention with Alcohol and Other Drug Abuse Clients. Dissertation, Greenwich University.

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