AA’s Effectiveness Still a Mystery

Alcoholics Anonymous is the most effective addiction intervention in history — in fact, it may well be the most successful self-help program ever. It doesn’t work for everyone, though, and even after more than seven decades and countless studies, researchers still don’t know why the 12 Steps are Gospel for some and nonsense for others.

This conundrum is extensively explored in a new article in Wired magazine, with author Brendan I. Koerner noting that research into addiction, the brain, behavior, and group relationships — social networks, in the current vernacular — is starting to provide more clues about how programs like AA work.

“The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit,” writes Koerner. “Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life — the scent of stale beer, the clink of toasting glasses — is enough to knock them off the wagon.

“AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape,” he continues. “Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism — something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission.”

New York Times columnist David Brooks cites the Wired story in a June 28 op-ed in which he says the lessons from AA research include the fact that most people will fail at recovery, that no one program will fit the needs of all, and that people are far too complex to reliably predict their behavior — or design social programs to change it.

That’s not a call to fatalism, Brooks is quick to add: “It is possible to design programs that will help some people some of the time. AA embodies some shrewd insights into human psychology … In a culture that thinks of itself as individualistic, AA relies on fellowship. The general idea is that people aren’t really captains of their own ship. Successful members become deeply intertwined with one another — learning, sharing, suffering and mentoring one another. Individual repair is a social effort.”