Can we choose between evidence- and faith-based programs to treat alcohol dependency?

EVERY week in Australia, about 2000 Alcoholics Anonymous (AA) meetings take place – or a number like that. In their efforts to protect anonymity, AA doesn’t keep precise records.

You don’t have to sign up to become a member; a spokesperson for AA describes the membership as “fluid” and the programs are not evaluated. Therefore, they’re also not evidence based. 

That has led to criticism, such as a recent article in the national publication Of Substance that asked whether 12-step programs are ‘in step’ with modern treatment approaches.

AA, Narcotics Anonymous and similar programs do not receive Government funding, so they are not under the same pressure as other programs, such as the cognitive behavioural therapy (CBT)-based Self Management and Recovery Training (SMART Recovery), to justify their success.

But does that mean they don’t work? A spokesperson for AA said the fact that the program has been in existence for 75 years in the US, and 65 years in Australia, must count for something. The funding source also provides evidence of that, he said.

“It’s self-funded by the members themselves, and that wouldn’t be happening if they weren’t benefitting from it.”

Associate Professor Anthony Shakeshaft of UNSW’s National Drug and Alcohol Research Centre agrees 12-step programs should not be dismissed merely because they haven’t been rigorously evaluated. “We don’t know very well who it works best for, but there does seem to be evidence that it does have some effect.”

Project MATCH, a US study completed in 1996, compared three separate approaches – 12-step therapy, CBT and motivational enhancement therapy – and found results were virtually the same for all three, he says.

One of the biggest differences between AA’s approach and that of SMART Recovery is that AA encourages abstinence, while SMART Recovery promotes harm minimisation. 

“Typically the recommendation is that people who are heavily dependent on alcohol really ought to be abstinent for at least a significant period of time, if not forever,” Professor Shakeshaft says. 

“My suspicion is AA is likely to be more effective for that group who are heavily dependent, mainly because it does give them that support. We should have a range of treatments available and let patients choose the one they feel most comfortable with.”

But before it gets to that stage, he believes GPs can play a significant role, using the first few questions of the AUDIT questionnaire for an initial screening, and then offering some relevant advice. If that brief intervention doesn’t work, then refer them on.

“There’s lots of evidence that GPs doing that makes a difference; it reduces patients’ drinking by 25–30%,” he says. 

Reference and websites 

Of Substance, vol. 9 no. 1 2011 24

http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/?tool=pubmed