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People in Recovery Blog
Does going to AA increase your odds of staying sober
January 2, 2015
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If You Work It, It Works: The Science Behind 12 Step Recovery

If You Work it, It Works

By Joseph Nowinski, Ph.D.

A Look at "Naturalistic" Studies

The first research method we will examine is used in studies that follow men and women who do (or don’t) choose to participate in AA. Rudolf and Bernice Moos conducted one such study. Rudolf Moos is a professor in the Department of Psychiatry and Behavioral Sciences at Stanford University and the recipient of the Hofheimer Prize Award from the Journal of Psychiatric Research. He and his wife and co-researcher, Bernice, are both affiliated with the Center for Health Care Evaluation, also in Palo Alto, California.

This study began by identifying a sample of 362 men and women who had experienced enough problems related to drinking that they were motivated to call an information and referral center to find help. They were diagnosed based on what they reported about themselves and their drinking via a questionnaire. The researchers then followed these volunteers for sixteen years—a remarkable length of time for any study—assessing them periodically.

The Moos sample was divided into three categories, depending on what individuals chose to do. No one was assigned to any of these groups; rather, they simply represent the different path-ways that the participants voluntarily chose in the first year of the study. That is what makes this a naturalistic study. Here are the pathways:

  • Group 1: People who decided to start going to AA but not to seek professional treatment of any kind
  • Group 2: People who decided to start going to AA and seek professional treatment at the same time
  • Group 3: People who decided to seek professional treatment but did not start going to AA

When examined “at the starting gate”—when they first entered this long-term study—the three groups did not differ demographically or in terms of their drinking patterns. For example, those with the worst drinking problems did not systematically choose one path over the others. This is important because it means that initially the three groups were essentially alike other than for the different pathways they chose.

All three groups were followed for sixteen years and assessed after years one, three, eight, and finally again at year sixteen. This is indeed a long time to follow a group of people and is a good example of what researchers call a longitudinal study. Another example of a naturalistic study would be to identify two comparable groups of people, one that then decided to diet and
exercise carefully, and a second that did not. Assuming that the two groups were equivalent at the outset, a longitudinal study could be used to compare the status of their health one year, three years, eight years, and sixteen years later.

Obviously, naturalistic longitudinal studies have the potential to tell us a lot about the consequences of pursuing different pathways. In the case of the Moos study, here is what they found:

  • People in group 2, who opted for treatment and AA at the same time, participated in AA longer and more frequently.
  • Moreover, people in this group were the most likely to stay sober throughout the course of the study.
  • People who began attending AA but then dropped out were more likely to start drinking again.

The longer people remained active in AA, the more likely they were to stay sober at all four follow-ups: one year, three years, eight years, and sixteen years.

One additional finding of interest in this study concerned those in group 3, who opted at the outset for treatment but decided against going to AA. Some of the men and women in this group later decided to try AA, but this delayed move did not seem to improve their chances of staying sober. We do know, however, that when they finally decided to attend AA meetings, they did so less often than those in the other groups. The authors conjecture the men and women in group 3 may have held more negative or skeptical attitudes about AA; for example, that it encourages dependency. Alternatively, they may not have believed (rightly or wrongly) that their alcohol use disorder was severe enough to warrant attending AA. Either way, these late-starters did not fare as well as their counterparts who opted either for AA alone or AA plus treatment from the beginning of their recovery efforts.

A companion naturalistic longitudinal study, also conducted by researchers at the Center for Health Care Evaluation, followed 135 individuals (half men, half women) who also reached out to an information and referral service in Northern California. Prior to initiating these contacts, none of the men and women had ever received treatment for an alcohol use disorder.

The researchers followed this group for three years, gathering information at different points in time. Here are some of the questions they sought to answer:

  • How severe was each individual’s drinking problem?
  • Had they sought treatment after making contact?
  • Had they tried AA?
  • Were they drinking heavily, moderately, or not at all at each point in time?
  • How much support did they feel they had for staying sober from a spouse, friends, or family?
  • What was their socioeconomic status?

One thing I found of interest in this particular study, which was published in a 1995 edition of the journal Addictive Behaviors, was a footnote that appeared on the first page. The footnote addresses whether recovery that is associated with attending AA should be considered “natural” or a “treatment.” I believe the authors correctly asserted that AA is not a treatment, for two reasons. First, they suggest that fellowships like AA are better viewed as natural community resources and ways of life, rather than treatments.

Second, self-help, peer recovery fellowships like AA require no professional guidance or intervention, but are run by their members. This is important, because critics of AA often refer to it as an “unproven treatment,” when in fact AA has always considered itself to be a recovery fellowship, not a treatment program. That’s not to say, however, that AA and the Twelve Step program is “unproven” as a way to stop drinking. That is the very issue we are examining here.

Out of this starting group of 135 men and women with alcohol use disorders, 28 eventually became abstinent—they did not drink at all, showed no objective signs of dependency, and had no drinking-related problems. Another 29 people in the study ended up being “moderate” drinkers—they drank significantly less, showed a few (but not a lot) objective signs of dependency, and reported few drinking-related problems. This finding, that some people became moderate drinkers, will be addressed in more detail in the next chapter. For now, let’s explore what the researchers discovered when they took a closer look at the people who abstained:

  • This group had more severe drinking problems at the outset.
  • They believed their drinking was a very serious problem.
  • They had little social support; instead they relied heavily on AA to maintain their recovery.

The second bullet may be the most significant. These individuals had decided on their own that they had a severe drinking problem that needed attention. In other words, they agreed with the diagnosis they received. Findings from this second naturalistic study echo those from the one previously discussed, but they also amplify them. These additional data point in a specific
direction: the men and women in this study who had more severe drinking problems, who believed their problem was severe, and who reported having little social support were inclined to choose AA as their solution. It became their path to recovery, and they became abstinent. Moreover, they did so without any outside intervention.

In contrast to the above, the group whose problems were less severe, and who reported having the added benefit of supportive relationships, eventually became moderate drinkers. Again, this does not mean that they experienced no drinking-related problems, but rather that they experienced relatively few of them.

These results raise the question of whether abstinence or moderate drinking should be the goal of treatment, and this will be addressed in chapter 4. As it stands, the two naturalistic studies we’ve looked at so far support the idea that AA works for those who choose to work it. In addition, and perhaps because AA has become so ubiquitous and accessible in society, it is often chosen as a solution, especially for those with more severe drinking problems who do not have other sources of social support.


Since the publication of Alcoholics Anonymous in 1939, the Twelve Steps have been central to staying sober for millions of people around the world. AA (Alcoholics Anonymous), NA (Narcotics Anonymous), Al-Anon, and countless other recovery organizations and treatment programs have adopted the Steps as their program for abstaining from substance use and compulsive behaviors. However, recently a growing chorus of critics of the Twelve Step model is claiming that the science behind this model is questionable.

In If You Work It, It Works!, Joseph Nowinski, Ph.D. calls upon the most up-to-date research, teamed with the critical work he did on Project Match, an eight-year multi-site research study proving the efficacy of Twelve Step Facilitation, to build a compelling case as to why working the Steps provides predictable and successful outcomes with:

  • Experienced, knowledgeable sponsors
  • Consistent attendance at peer support groups
  • Systematic application of the Steps
  • Treatment professionals effectively incorporating the Steps and peer support in their recovery management programs

Joseph Nowinski, Ph.D. is a clinical psychologist who has taught at the University of California San Francisco and the University of Connecticut, as well as serving as Supervising Psychologist, University of Connecticut Health Center. He is the author of Twelve Step Facilitation Therapy (TSF), listed in the National Registry of Evidence-based Programs and Practices and Almost Alcoholic: Is My (or My Loved One's) Drinking a Problem? with co-author Robert Doyle, and blogs regularly for the Huffington Post and Psychology Today.

Want to learn more?

Read more about the science behind the twelve-steps.

>> Order your copy of If You Work It, It Works!

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Gifts of Sobriety Gifts of Sobriety
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12 Smart Things to Do When the Booze and Drugs Are Gone 12 Smart Things to Do When the Booze and Drugs Are Gone
The author of the recovery mainstay 12 Stupid Things That Mess Up Recovery offers a fresh list of "smart" things to do to attain and sustain emotional sobriety.

A Woman's Guide to Recovery A Woman's Guide to Recovery
If you are a woman who has found the courage to start down the road of recovery, this book, written by the executive director of Hazelden in Naples (and former director of the Hazelden Women's Recovery Center), explains how you can live a life "beyond your wildest dreams." Its pages are filled with expert advice, caring support, and personal stories of women who have found their way of…

eBook A Womans Guide to Recovery eBook A Womans Guide to Recovery
Buy your Kindle eBook from Amazon Buy your kobo eBook Buy your eBook formats from Barnes and Noble Buy your iBook at iTunesIf you are a woman who has found the courage to start down the road of recovery, this book, written by the executive director of Hazelden in Naples (and former director of the Hazelden Women's Recovery Center), explains how you can live a life "beyond your wildest…

Stepping Stones to Recovery For Women Stepping Stones to Recovery For Women
Inspiring rticles, reflections, and affirmations written for women in recovery.

Six Essentials to Achieve Lasting Recovery Six Essentials to Achieve Lasting Recovery
This book offers six guiding principles that are key to lasting recovery from addiction to alcohol and other drugs. It will help you understand why they're important, how they relate to the Twelve Steps, and why they work.

Life Recovery Bible Workbook Life Recovery Bible Workbook
This companion workbook to The Life Recovery Bible will help you discover how the Scriptures reveal the pathway to wholeness: God's program of forgiveness, reconciliation, and healing.

Sex in Recovery Sex in Recovery
With this groundbreaking work, Sex in Recovery, Jennifer Matesa uncovers the challenges real people encounter when they start taking their clothes off--without drinking or using in order to do so. Providing readers "a meeting between the covers," Matesa blends first-person accounts bravely shared by diverse members of the recovery community, insights from experts, and her own…

eBook Stepping Stones To Recovery From Codependency eBook Stepping Stones To Recovery From Codependency
An inspiring collection of articles and personal stories about codependent behavior, this book focuses on self-sabotaging behavior patterns and good principles of self-care.

eBook Six Essentials to Achieve Lasting Recovery eBook Six Essentials to Achieve Lasting Recovery
This book offers six guiding principles that are key to lasting recovery from addiction to alcohol and other drugs. It will help you understand why they're important, how they relate to the Twelve Steps, and why they work.

eBook A Sober Mom's Guide to Recovery eBook A Sober Mom's Guide to Recovery
Recovering from an addiction is tough enough, but when you throw in the tremendous responsibilities of motherhood, resisting cravings and remaining abstinent - much less enjoying the rewards of sobriety - can seem like an impossible challenge.

Passages Through Recovery Passages Through Recovery
Based on the experiences of thousands of recovering men and women, Passages through Recovery presents an action plan for preventing relapse, one that can help us understand how recovery works and what is needed to move from active addiction to sobriety.

Easy Does It Mom Easy Does It Mom
A profoundly compassionate and useful title for moms in recovery, Easy Does It, Mom provides practical information and tools any mother can implement immediately.

eBook Passages Through Recovery eBook Passages Through Recovery
Based on the experiences of thousands of recovering men and women, Passages through Recovery presents an action plan for preventing relapse, one that can help us understand how recovery works and what is needed to move from active addiction to sobriety.

eBook Sex In Recovery eBook Sex In Recovery
With this groundbreaking work, Sex in Recovery, Jennifer Matesa uncovers the challenges real people encounter when they start taking their clothes off--without drinking or using in order to do so. Providing readers "a meeting between the covers," Matesa blends first-person accounts bravely shared by diverse members of the recovery community, insights from experts, and her own…

Recovery Now Recovery Now
Recovery Now combines the most current research with the timeless wisdom of Alcoholics Anonymous, Narcotics Anonymous, and other established Twelve-Step program guides to offer an accessible basic text written in today's language for anyone recovering from addiction to alcohol and other drugs.

eBook Recovery Now eBook Recovery Now
Recovery Now combines the most current research with the timeless wisdom of Alcoholics Anonymous, Narcotics Anonymous, and other established Twelve-Step program guides to offer an accessible basic text written in today's language for anyone recovering from addiction to alcohol and other drugs.

eBook Alcohol eBook Alcohol
In this definitive guide about alcohol, authors Mark Rose and Cheryl Cherpitel examine the nature and extent of alcohol use in the United States, current treatment models and demographics, and the biology of alcohol, addiction, and treatment.

African- Americans in Treatment African- Americans in Treatment
Written by African-Americans to help African-Americans who have fallen victim to addictive diseases.

When Your Teen Is In Treatment When Your Teen Is In Treatment
Written by chemical dependency counselors and parents, this pamphlet assures parents that recovery can help the whole family.

eBook Prescription Painkillers eBook Prescription Painkillers
The definitive book on the impact of prescription painkiller abuse on individuals, communities, and society by one of America's leading experts on addiction.

Prescription Painkillers Prescription Painkillers
The definitive book on the impact of prescription painkiller abuse on individuals, communities, and society by one of America's leading experts on addiction.

Recovering My Kid Recovering My Kid
National expert Dr. Joseph Lee explains the nature of youth addiction and treatment and how families can create a safe and supportive environment for their loved ones during treatment and throughout their recovery.

eBook Recovering My Kid eBook Recovering My Kid
National expert Dr. Joseph Lee explains the nature of youth addiction and treatment and how families can create a safe and supportive environment for their loved ones during treatment and throughout their recovery.

Methamphetamine Methamphetamine
Written for professionals and serious lay readers by nationally recognized experts, Methamphetamine is a thoroughly researched and highly readable book on the medical, social, and political issues concerning this impactful drug.

eBook Methamphetamine eBook Methamphetamine
Written for professionals and serious lay readers by nationally recognized experts, Methamphetamine is a thoroughly researched and highly readable book on the medical, social, and political issues concerning this impactful drug.

Getting Involved In AA Getting Involved In AA
Help clients overcome reservations about attending AA meetings.

Living with Co-occurring Addiction and Mental Health Disorders Living with Co-occurring Addiction and Mental Health Disorders
Drawing from an evidence-based program by internationally recognized pioneers in the integrated treatment of co-occurring disorders from the Dartmouth Medical School, Living with Co-occurring Addiction and Mental Health Disorders is a handbook designed to inform and empower those with a substance use problem and a mental health disorder.

Now What Now What
Addiction and recovery insider, expert, and best-selling author William Cope Moyers answers the question "Now What?" for addicts and their loved ones, every step of their journey from contemplation through intervention, treatment, and recovery.

eBook Now What eBook Now What
Addiction and recovery insider, expert, and best-selling author William Cope Moyers answers the question "Now What?" for addicts and their loved ones, every step of their journey from contemplation through intervention, treatment, and recovery.

Painkillers, Heroin, and the Road to Sanity Painkillers, Heroin, and the Road to Sanity
Recovery from prescription painkillers or heroin addiction can feel impossible. With new approaches to treatment and guidance from those in long-term recovery, a healthy, drug-free life is possible.

eBook Painkillers Heroin and the Road to Sanity eBook Painkillers Heroin and the Road to Sanity
Recovery from prescription painkillers or heroin addiction can feel impossible. With new approaches to treatment and guidance from those in long-term recovery, a healthy, drug-free life is possible.

eBook The Grandfamily Guidebook eBook The Grandfamily Guidebook
Ready or not, you're a parent again. If you're wondering how exactly you're going to raise your grandchildren, you're not alone. The Grandfamily Guidebook offers advice on everything from engaging with birth parents, to legal and financial issues, school and social life, and your own self-care.

The Grandfamily Guidebook The Grandfamily Guidebook
Ready or not, you're a parent again. If you're wondering how exactly you're going to raise your grandchildren, you're not alone. The Grandfamily Guidebook offers advice on everything from engaging with birth parents, to legal and financial issues, school and social life, and your own self-care.

eBook If You Work It, It Works! eBook If You Work It, It Works!
Joseph Nowinski, Ph.D. calls upon the most up-to-date research, teamed with the critical work he did on Project Match, an eight-year multi-site research study proving the efficacy of Twelve Step Facilitation, to build a compelling case as to why working the Steps provides predictable and successful outcomes.

If You Work It, It Works If You Work It, It Works
Joseph Nowinski, Ph.D. calls upon the most up-to-date research, teamed with the critical work he did on Project Match, an eight-year multi-site research study proving the efficacy of Twelve Step Facilitation, to build a compelling case as to why working the Steps provides predictable and successful outcomes

Taking Back Your Life Taking Back Your Life
Up-to-date, guided support to help women with a gambling problem achieve the rewards of a hopeful life, free of addiction.

eBook Help for The Hard Times eBook Help for The Hard Times
Buy your Kindle eBook from Amazon Buy your kobo eBook Buy your Barnes and Noble eBooks Buy your iBook at iTunesLearn how to provide students with the tools to grieve and ways to keep their losses from becoming too overwhelming with this compassionate book.

App Apple Field Guide to Life App Apple Field Guide to Life
This award-winning app teaches you the essential skills connected to core recovery principles, helping you evolve in your sobriety.

App Android Field Guide to Life App Android Field Guide to Life
This award-winning app teaches you the essential skills connected to core recovery principles, helping you evolve in your sobriety.

eBook Taking Back Your Life eBook Taking Back Your Life
Up-to-date, guided support to help women with a gambling problem achieve the rewards of a hopeful life, free of addiction.

An Elephant In the Living Room Leader's Guide An Elephant In the Living Room Leader's Guide
Professionals and other adult helpers will learn basic information in order to help children cope with an addicted parent or sibling.

Codependent's Guide to the Twelve Steps Codependent's Guide to the Twelve Steps
Melody Beattie, the best-selling author of Codependent No More, interprets the Twelve Steps for people involved in codependent, unsatisfying relationships.

Easy Does It Mom Easy Does It Mom
A profoundly compassionate and useful title for moms in recovery, Easy Does It, Mom provides practical information and tools any mother can implement immediately.

Recovering My Kid Recovering My Kid
National expert Dr. Joseph Lee explains the nature of youth addiction and treatment and how families can create a safe and supportive environment for their loved ones during treatment and throughout their recovery.

You Need Help! You Need Help!
Through a rich combination of user-friendly tools and real-life stories, Mark S. Komrad, M.D., offers you step-by-step guidance and support as you take the courageous step of helping a friend who might not even recognize that he or she is in need.

App Apple My Sober Life App Apple My Sober Life
My Sober Life teaches and reinforces the essential skills connected to core recovery principles, helping young people evolve in their sobriety.

Related Articles
A Sober Mom's Guide to Recovery: Taking Care of Yourself to Take Care of Your Kids, by Rosemary O'Connor Supermom in Recovery -- Frazzled and Emotionally Spent
Supermom--running around like a basket case with an endless to-do list trying to please everyone and ending up frazzled and exhausted. Before recovery, this was my life. I have witnessed many mothers (including myself) fly around in the Supermom cape at speeds faster than lightning so we don't have to stop and feel the feelings of not being enough. We often don't stop to realize the impact our Supermom role has on our children.
Addict in the Family by Beverly Conyers Eight Reasons Why Detaching with Love is Good for Your Addicted Loved One
Anyone who has ever attended a Twelve Step meeting knows that detachment looms large in the toolkit of suggestions for coping with an addicted loved one. "Detach with love", we are told,"if you want to preserve your sanity."Detachment is neither unloving nor unkind. It is simply accepting the fact that we can not live our loved ones' lives for them.
An excerpt from Navigating Grace by Jeff Jay. A moving illustration of the power of grace to elevate us during troubling times, Jeff Jay offers a soulful account of his solo sailing journey that turned into a battle for survival on the open sea. Something Marvelous from Navigating Grace
Sometimes the past can foreclose the future, with no option but to start again. So a quiet part of me cradled the dream and my broken self and carried us through the hours. I knew my life with God was safe, even if this mad adventure killed me. I had a growing allergy to everything commonplace, and I was determined to do something marvelous, something men only talk about and then regret not doing. What could go wrong? The short answer is: anything.
Addict in the Family: Revised and Updated by Beverly Conyers Relapse and Consequences
I knew on an intellectual level that relapse is part of the process of recovery. Yet the emotional punch of relapse always caused me heartache and pain.
High: Six Principles for Guilt-Free Pleasure and Escape by Jodie Gould Being of Service Finding Purpose
Countless religions teach us that helping others is not only a worthy pursuit but a moral obligation. But donating either your time (the best) or your money (also great, especially if given willingly and not just as a tax break) is like a boomerang of positivity.
Daybreak: Meditations for Women Survivors of Sexual Abuse Stress
No one can avoid stress, yet we can help ourselves out of it by not getting stuck going round and round inside it and feeling victimized by being stuck.
The Promise of A New Day, A Book of Daily Meditations by Karen Casey and Martha Vanceburg Life Lessons
It is not our smooth passages that reveal new understandings, but the strenuous, uphill battles that benefit us with the knowledge we need to grow.
Jodie Gould, author of High: Six Principles for Guilt-Free Pleasure and Escape Are You Connected
Studies have shown that feeling a part of a family, circle of friends, and community throughout our lifetime helps stave off depression and, of course, loneliness, while keeping our minds vibrant. There is also some evidence that spending time with others can even increase our longevity.
Lisa Woititz, author of Unwelcome Inheritance: Break Your Family's Cycle of Addictive Behavior 8 Things That ACOAs Can Do To Outwit Depression
Many of us who have alcoholism or other addictions in our families suffer from depression to some degree. We've gone to self-help groups and therapists for a number of years, hoping that if we can uncover hidden emotional issues that the feeling of hopelessness will disappear.
Unwelcome Inheritance by Lisa Woititz Codependency and Addictive Thinking
When we ACoAs look at the tapestry that is our family history, we discover that there's so much more than meets the eye. While we cannot change that history, the good news is that we can obtain skills and learn new ways of behaving and thinking that can change things for the better when it comes to ourselves and our children and their children.


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