Cochrane for Clinicians

Putting Evidence into Practice

Alcoholics Anonymous and Other 12-Step Facilitation Programs for Alcohol Use Disorder


Am Fam Physician. 2021 Mar 1;103(5):272-273.

Author disclosure: No relevant financial affiliations.

Related letter: Community Alcoholics Anonymous Programs Are Not a Replacement for Formal Treatment

Clinical Question

Are Alcoholics Anonymous (AA) and similar 12-step facilitation programs as effective as other established treatments for helping people with alcohol problems achieve abstinence and/or reduce drinking intensity, alcohol-related consequences, and alcohol addiction severity?

Evidence-Based Answer

Manualized (standardized and replicable) AA and similar 12-step facilitation programs produce higher rates of continuous abstinence than other established treatments. (Strength of Recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.) Nonmanualized (nonstandardized) 12-step programs perform as well as other established treatments investigated across a variety of alcohol-related outcomes. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Overall, 12-step programs may be superior to other treatments for increasing percentage of days of abstinence (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) and probably perform as well as other treatments at reducing drinking intensity.1 (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Excessive alcohol use continues to be a major cause of preventable morbidity and mortality.2 In the United States, it is the third leading preventable cause of death. Each year, 88,000 U.S. deaths are attributable to alcohol.3 Excessive alcohol use poses a substantial economic burden, costing the United States $249 billion in 2010.4 AA is a free, nonprofessional, peer-to-peer, community-based program focused on helping individuals with alcohol use disorder to achieve abstinence.5 Founded in the United States in 1935, AA has millions of members and is available in nearly every community worldwide.6 Twelve-step facilitated programs use the methodology and concepts of AA within the context of larger clinical/addiction tr

Author disclosure: No relevant financial affiliations.


show all references

1. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020;(3):CD012880....

2. Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000 [published correction appears in JAMA. 2005;293(3):298]. JAMA. 2004;291(10):1238–1245.

3. Gonzales K, Roeber J, Kanny D, et al.; Centers for Disease Control and Prevention. Alcohol-attributable deaths and years of potential life lost—11 states, 2006–2010. MMWR Morb Mortal Wkly Rep. 2014;63(10):213–216. Accessed July 24, 2020.

4. Sacks JJ, Gonzales KR, Bouchery EE, et al. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):e73–e79.

5. Alcoholics Anonymous. Historical data: the birth of A.A. and its growth in the U.S./Canada. Accessed July 24, 2020.

6. Alcoholics Anonymous. A.A. near you. Accessed July 24, 2020.

7. Humphreys K. Professional interventions that facilitate 12-step self-help group involvement. Alcohol Res Health. 1999;23(2):93–98.

8. U.S. Preventive Services Task Force. Unhealthy alcohol use in adolescents and adults: screening and behavioral counseling interventions. November 13, 2018. Accessed July 24, 2020.

9. Winslow BT, Onysko M, Hebert M. Medications for alcohol use disorder. Am Fam Physician. 2016;93(6):457–465. Accessed July 24, 2020.

10. Salisbury-Afshar E, Fleming M. Identification of and treatment for unhealthy alcohol use in primary care settings [editorial]. Am Fam Physician. 2019;99(12):733–734. Accessed July 24, 2020.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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