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Vox thoroughly covers study on treatment alternatives to Alcoholics Anonymous


5 Star


Alcoholics Anonymous works for some people. A new study suggests the alternatives do too.

Our Review Summary

This is excellent coverage of a study suggesting that Alcoholics Anonymous (AA) and similar 12-step programs aren’t the only worthwhile support groups for those recovering from alcohol use disorders. Alternative programs that (unlike AA) aren’t based on a spiritual philosophy may be just as effective, the results show.

The story earns high marks for thoroughly describing the evidence that forms the basis for the coverage and explaining its key limitations. It also features perspective from an independent expert and notes the big gap in availability between AA and its less established counterparts.

But do these programs have any downsides and what do they cost? Readers would have benefited from hearing those specifics, but the omissions are relatively minor considering the broad scope of the coverage.


Why This Matters

The story does an admirable job of explaining the scope of the addiction problem in the U.S. and why it’s important to have alternatives to traditional 12-step programs. Here’s the key text:

Based on federal data, more than 20 million people in the US have a substance use disorder, and within that group, more than 15 million have an alcohol use disorder. Excessive drinking alone is linked to 88,000 deaths each year. So finding the right solutions for this problem is literally a matter of life or death.



Does the story adequately discuss the costs of the intervention?

Not Applicable

The story does not discuss costs associated with either AA or the alternative addiction treatment groups. That would be useful information for people who may not understand how these groups work. However, since these groups generally don’t charge members for participation (although they may solicit donations or require the purchase of recovery literature), we’ll rate this Not Applicable.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


The story reports the researchers’ conclusion that “[Women for Sobriety], LifeRing, and SMART are as effective as 12-step groups for those with AUDs.”

The story also quantifies that level of effectiveness when it says that studies broadly find that “about a third of people maintain recovery from alcohol addiction due to 12-step treatment, another third get something out of the treatment but not enough for full recovery, and another third get nothing at all.”

The story acknowledges that there were some differences in the data — for example that those who reported SMART as their primary group “seemed to have worse substance use outcomes,” and that “there were lower odds of total abstinence among LifeRing members.” It explains that those differences might be explained by the differing goals of the programs, as LifeRing doesn’t emphasize complete abstinence as intensely as the 12-step programs. While it would be interesting to know just how much worse the outcomes were with these alternate groups, we don’t think the omission is enough to merit a not satisfactory grade.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

While there is no well-established quantification of harms of mutual-help groups, we feel this potential should be borne in mind, just as we would expect reports of negative side effects and adverse events in a medication study. The story doesn’t mention potential downsides to any of these programs.

For example, as a ProPublica investigation pointed out in 2014, some who participate in AA meetings are forced to do so by the criminal justice system. This group of mandatory members may include violent felons who are trading attendance for a lighter sentence. ProPublica noted that in some cases, this can create “a combustible mix of violent ex-felons and newcomers who assume that others ‘in the rooms’ are there voluntarily.”  These conditions may increase the potential for sexual and financial abuse of AA members.

Does the story seem to grasp the quality of the evidence?


This is a strong point of the story. It notes multiple times that the study is not the last word on this subject and calls attention to specific limitations of this type of study via an independent expert source who tells readers:

It’s based on an online survey, not the kind of randomized trial that’s typically the gold standard in research. That may have led to some potentially biased results — perhaps participants in specific groups were less likely to report bad outcomes, for instance.

And since it’s only one study, it’s possible that the results were biased in some other way. So it’s up to future research to verify the findings.

Does the story commit disease-mongering?


The story references reliable sources regarding the massive impact of alcohol use disorders and doesn’t overstate their toll.

Does the story use independent sources and identify conflicts of interest?


The story quotes an expert source who was not affiliated with the research and who provides useful context about key limitations of this study. It doesn’t appear that there are any undisclosed conflicts of interest.

Does the story compare the new approach with existing alternatives?


The story’s main focus is to compare popular 12-step programs with their alternatives. And it explains why alternatives are necessary, since many people object to the spiritual component of AA. It would have been useful to also include outcomes associated with medication for alcohol use disorder, as well as outcomes when there is no formal treatment.

Does the story establish the availability of the treatment/test/product/procedure?


The story thoroughly addresses the gulf in availability between 12-step programs and alternative approaches.

Most treatment facilities in America are, according to the survey data and research, at least partly based on the 12 steps — making it the only option for many people. While alternatives like SMART or LifeRing do exist, they’re not nearly as available as AA — and they certainly aren’t built into professional treatment programs in the same way as the 12 steps.

Does the story establish the true novelty of the approach?


The story explains that about two-thirds of AA participants don’t derive much or any benefit from the program, and that’s why this study documenting the effectiveness of alternatives is important news.

Does the story appear to rely solely or largely on a news release?


The story clearly goes beyond any news release.

Total Score: 8 of 9 Satisfactory


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