New Study Measures Step Completion for Alcoholics Anonymous

Alcoholics Anonymous (AA) is synonymous with abstinence and recovery. It is a worldwide program that strives to help individuals struggling with alcohol dependency achieve lives that are free from the physical and psychological damage that alcohol addiction can cause. AA is founded on 12 steps that are designed to address the mental, physical, and spiritual aspects of alcoholism. Many people view the steps as both spiritual and behavioral because they require spiritual surrender to a higher power and they require action, such as completing a personal inventory of one’s life and performing service work within and outside of AA. Many formal in-patient treatment centers require that their clients attend AA meetings when they leave and encourage the program, the idea of sponsorship, and regular meeting attendance to maintain abstinence.

One of the challenges for researchers seeking to gauge the success of the 12-step program of AA is the fact that completion of the steps is self-reported and does not result in anything tangible. For instance, completing an inventory of one’s life can be done exhaustively, leaving no stone unturned, or it can be done half-heartedly. But regardless, an inventory has been taken. Brenna L. Greenfield of the Department of Psychology at the University of New Mexico decided to compare two existing tools for self-reports to see what method provided the most accurate prediction of alcohol abstinence for individuals in AA. Greenfield used the Alcoholics Anonymous Inventory (AAI) and the General Alcoholics Anonymous Tools of Recovery (GAATOR) to rate step completion over a period of 9 months in a sample of 130 individuals new to AA.

Greenfield found that the participants experienced decreases in daily alcohol consumption and decreased daily drug use as a result of entering AA. However, they did not increase their adherence to the steps during the 9 months. In fact, at the 3-, 6-, and 9-month follow-ups, the rates of step-meeting attendance declined when compared to their attendance upon entering the program. This led to high rates of self-reported step completion but low rates of practical application of the principles taught in the steps, as measured by the AAI and GAATOR.  Greenfield believes that this study underscores the importance of accurately assessing the implementation of the behavioral and spiritual principles of the 12 steps to better identify those at risk for alcohol or drug relapse. Greenfield added, “Our findings suggest that indirect measures of step work such as the GAATOR produce fewer false negatives than direct measures.”

Greenfield, B. L., Tonigan, J. S. (2012). The General Alcoholics Anonymous Tools of Recovery: The adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029268

Related articles:
No Pain, No Gain: Psychotherapy and Mental Health Recovery Take Time
Identifying and Treating Addiction and Substance Abuse Problems
What Is Recovery?

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  • Gwen

    August 14th, 2012 at 6:25 PM

    Well noone can abstain and contain his addiction unless he really wants to himself.he may have the best designed program but as long as a person does not put in his efforts and work over it,its not going to happen.that is what dictates the practical use of the steps in the AA program.

  • Diane E

    August 15th, 2012 at 4:18 AM

    I have never been much of a proponenet of AA simply because it leave sthe completion of the steps up to the addict, and we all know most of the time how that goes. Most addicts are in no way equipped to handle this kind of responsibility and completion alone, and yet that’s what AA does. Yes you have a sponsor and this is supposed to be someone you can reach at all hours of the day, but how many times do you know a full blown alcoholic to pick up a phone instead of picking up a bottle? Some are successful, but mostly this will not happen. Let’s look at this for what it is- AA is the answer for some, but for most it continues to set them up for continual failure and most of them will have to look elsewhere for the real answer to their addiction issues.

  • Ron

    August 15th, 2012 at 4:57 AM

    The whole point of AA is to not only get you to stop drinking but to help you learn to take responsibility for your own actions and walk you through these steps which can ultimately give you the strength to do the program on your own. While I don’t think that it intentionally sets people up for failure, I do believe that in the beginning it is far easier to fail on the program over succeed, that’s why it’s always good to let friends and familiy know when you are going to AA and tell them the ways that they can help to hold you accountable and hopefully sober and clean.

  • Milton

    August 15th, 2012 at 10:03 AM

    AA is a great idea.But what we should understand is that at the end of the day it is the individual conviction and will power that will help quit alcohol(or whatever it is that you are trying to quit).

    Having such a program as a guide while you are doing the homework required is a great combination that is bound to deliver positive results.

  • gillian

    August 15th, 2012 at 11:34 AM

    I just always thought that AA was this great program who could help anyone who truly had made the promise to stop drinking until I found myself there after a bad divorce.
    It’s so easy to say, yeah I can walk these steps, I can do this with just these meetings and getting into this AA lifestyle. But God it is so much harder than that. You don’t know how it feels to be so consumed by that desire to drink that it literally hurts when you can’t have it.
    maybe I just haven’t found the right way to stop for good, maybe that’s not in the cards for me. But I know that if I do it will have to be with something or someone stronger for me than that pull of AA because I am not sure that I can do all that.

  • Collins T

    August 16th, 2012 at 4:36 AM

    What if you are trying AA with some other treatment, like maybe individual therapy? Think that addicts would be more likely to complete the program then?

  • AntiDenial

    August 16th, 2012 at 5:18 AM

    Doing the steps in the first place is a dangerous practice. Doing a personal inventory with non professionals, that most likely still have emotional problems is a terrible idea. It is really comes down to confession of sins, that if one so chooses they should do with a minister. Not strangers!

  • Jack

    August 17th, 2012 at 10:47 AM

    I really don’t know how I feel about AA or any of the other “name” treatment programs that are out there.

    What I do know is this, and it’s simple. If you are a drinker who can’t control it, then you need to stop. That’s it. You have to be willing to admit that you do have a problem, and then you have to come up with a way to fix it. Not rocket science there. I think that the things that you have to do are very individual, what works for one person may not work for someone else. So that’s one thing to keep in mind. But there has to be some support there. B it a sponsor, a spouse, a sibling, friend, whatever. There has to be someone there to walk with you through this emotional whirlwind and give you support when you need it. But ultimately it all comes down to the fact that you and you alone are the only one who can change this for good.

  • Bill Wilson

    August 24th, 2012 at 4:35 PM

    I’m reading a lot of rationalization and judgement in the responses here. Ron’s answer begins to approach how AA works. The first misconception that I want to address is that people work the steps on their own. Not so. An AA sponsor works through the steps with the person working the steps by sharing experience, strength and hope. No one in AA claims to be a professional…in fact it is clearly stated in the Big Book that we are not professionals, but that we have found (in our experience) one alcoholic relating to another alcoholic is the best way to open the door of recovery. Many people in AA get outside help, being an ADHD with a life of disaster and wreckage, and self medication through alcohol and drugs, I have found that the outside help by itself did not cure me of all my problems, and that I had to admit powerlessness over alcohol, drugs and people, places and things (including the ignorant responses in here to the blog post regarding working the steps). Self-knowledge is key to long term sobriety, and yes, sadly only about 10% of those who enter a twelve step program remain in the program long term. AA is a program of attraction, and to think that an Alcoholic ought to be “forced” to work the steps in some sort of regimented manner and the implication that this process can in some manner be graded is absurd. The primary character attribute of any alcoholic (and addict) is that they have an issue with authority and are rebellious. That’s why the rehabs send people to AA, they get people that are desperate or forced to be there, and know that once the addict is over being desperate, that the only hope for that person to maintain sobriety and grow is through the 12 steps. Nothing better has come along.

  • Cara

    February 15th, 2018 at 12:21 PM

    I enjoyed reading this blog and website. I never in a million bazillion years thought I could achieve sobriety. And it was only by the grace of God I can say that I have over a year clean and sober. I have a husband who is also in recovery and am always willing an anxious to learn more on how to obtain sanity and knowledge. The cravings are gone, but the sanity part is coming slowly. AA was my saving grace. Finding a strong sponsor who I could relate to and she took me through the steps. Little by slow, as she would say I developed a strong sense of self and self worth. I wanted more out of life. I wanted a job, a husband, to be a good Mom. None of these are possible when I decide to pick up a drink or drug. As far as people using their rules when it comes to these groups, I think Bill W said it perfectly! We are addicts, we do NOT like to be told what to do and when or how to do. So if you are saying this person is not allowed to say such in such in a blog or a group that makes no sense to me as an addict because we ALL have issues and we ALL are just trying to recover. So the judging needs to stop for us recovering addicts to live in harmony!
    Thanks for letting me share. :)

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