Empirical Awakening: The New Science on Mutual Help and Implications for Cost Containment Under Health Care Reform

ABSTRACT

Over the past 75 years, Alcoholics Anonymous (AA) has grown from 2 members to over 2 million members. AA and similar organizations (e.g., Narcotics Anonymous [NA]) are among the most commonly sought sources of help for substance-related problems in the United States. It is only relatively recently, however, that the scientific community has conducted rigorous studies on the clinical utility and health care cost-offset potential of mutual-help groups and developed and tested professional treatments to facilitate their use. As a result of this research, AA as an organization has experienced an “empirical awakening,” evolving from its peripheral status as a “nuisance variable” and perceived obstacle to progress to playing a more central role in a scientifically informed recovery oriented system of care. Also, professionally delivered interventions designed to facilitate the use of AA and NA (“Twelve-Step Facilitation” [TSF]) are now “empirically supported treatments” as defined by US federal agencies and the American Psychological Association. Under the auspices of health care reform, a rational societal response to the prodigious health and social burden posed by alcohol and other drug misuse should encompass the implementation of empirically based strategies (e.g., TSF) in order to maximize the use of ubiquitous mutual-help recovery resources.

KEYWORDS:

• Alcoholics Anonymous
• health care costs
• health care reform
• mutual help groups

Notes

Although RCTs are assumed to rule out the selection bias inherent in mutual-help participation and thus produce a more accurate cause and effect estimate of AA's impact, a recent review indicates RCTs may not in fact do this (28).