Conflict between 12-Step Anonymous Groups and Science Continued
Meanwhile, the fields of psychology and psychiatry were still in their infancy during the 1930s. By the 1950s, psychology had established itself as a legitimate science in the United States. However, scientific addiction research was delayed until the early 1970s. During this time, the federal government established the National Institute on Alcohol Abuse and Alcoholism in 1970. In 1974, the National Institute on Drug Abuse came on the scene.
It was not until the 1960s that professional alcohol treatment became widely available. At this time, health insurance began to reimburse for alcohol treatment. These developments during the 1960s and 1970s placed addiction research and professional treatment well behind the growth of Alcoholics Anonymous and other 12-step groups. In the public's mind, the 12-step approach was THE approach of choice addiction (White, 1998).
AA's success as an organization has not been matched by a research record. After 75 years of existence, scientific study had been unable to confirm AA's effectiveness. There certainly is a correlation between attendance at AA meetings and success in recovery. However, what remains unknown is whether these successes would have occurred anyway (Hester & Miller, 2003). Although the idea that "success would have occurred anyway" may seem unlikely, recent research would suggest otherwise. Research indicates that most individuals who recover from alcohol dependence do so independently; i.e., without attending treatment or a support group. The National Epidemiological Survey on Alcohol Related Disorders (National Institute on Alcohol Abuse and Alcoholism, 2012) found that:
"Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptom of alcohol dependence. About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment."
Many individuals who attend 12-step programs, such as AA, naturally attribute their success to their participation in the 12-step program. Stated differently, they attribute their recovery to membership in their 12-step group and usually to a higher power. Note, in these groups the only requirement for membership is a desire to stop the unwanted behavior (drinking, drugging, masturbating, and gambling).
However, successful recovery may have occurred for other more generic, non-specific reasons (besides attendance and 12 steps). We still don't know what causes members' recovery. Scientists call this the "mechanism of action." The mechanism of action might include the social support they receive at meetings. It might be the availability of a personal coach (called a sponsor). It might be due to an increased sense of hope caused by observing other recovering people. It could be due to the distraction from addiction that meeting attendance provides. It might be due to the motivation that hope inspires. Or, it might be due to an unseen benevolent force. As scientists, we cannot responsibly ignore the "mechanism of action." To clinicians, the sheer fact that people get well is great. To researchers, we need to know why- the mechanism of action.
Unfortunately, we do not yet know which of these ingredients, if any, are responsible for recovery. Moreover, these ingredients are not unique to 12-step groups. Research has demonstrated that each of these ingredients (social support, hope, motivation, and religious/spiritual practice) can contribute to people's ability to change. Someone's personal recovery experience may lead to the conclusion that AA membership "caused" their recovery. That's great. However, scientists know any of these other variables associated with change could have caused it. If so, these other variables would account for the positive correlations between AA and recovery. Why do we care? Because we want to know what these ingredients are, so that everyone can have a successful recovery!
Although AA itself is of unknown effectiveness, research has scientifically validated the effectiveness of "12-step facilitation." This is approach supports and encourages AA attendance and the principles of the 12-steps. This research suggests 12-step facilitation is comparable in effectiveness to other well-established and effective psychotherapies for addictions treatment. Project MATCH published the first evidence of the effectiveness of 12-step facilitation in 1997 (Project MATCH Research Group, 1997).
Thus, history provides us a better understanding of the polarization that emerged between devotees of 12-step programs, and devotees of science. What it does not explain is why this polarization continues. At one time, 12-step programs were the only option available for someone struggling with addiction. We appreciate anything that helps someone to recover. At the time of the historical emergence of these AA, science at that time had nothing to offer. Such is not the case today. Nonetheless, because people were successful using 12-step programs, while other methods had failed, these programs became the primary means of recovery in the absence of any scientific support. Twenty to thirty years later, science has begun to catch up and has much to offer. Yet, the contributions of addictions research have had little impact upon the addictions treatment field.
The failure to rely on scientific research is rather unique to the addictions field. Most people with a serious disease or disorder would be outraged if their doctor recommended a treatment that had no scientific evidence for its effectiveness. Insurance companies will not pay for treatments that are unproven or experimental. Similarly, most people with a serious disease or disorder do not rely solely on God for help, regardless of their beliefs. They seem able to integrate their personal beliefs about God with scientific information. We see no reason this integration should not be standard within the addictions treatment.