In a Veterans Affairs study tracking 362 men and women fighting alcohol addictions, those who had sought professional help and joined Alcoholics Anonymous (AA) within a year of starting treatment were the most likely to be free of problem drinking 16 years later. Others, including those who received professional help but never got involved with AA, or joined only later on, did not fare as well. The findings appear in the October 2005 issue of Alcoholism: Clinical and Experimental Research.

Early involvement in AA was linked with better continuity in the program over time, and it appears this may have been the crucial factor in promoting long-term remission, said lead author Rudolf H. Moos, PhD, an alcoholism expert at the Palo Alto, CA VA Healthcare System, and Stanford University.

"The findings suggest that counselors in information and referral centers, as well as clinicians in substance-abuse treatment settings, should make every reasonable effort to enable people with alcohol-related problems to enter and continue to take part in self-help groups such as AA," said Moos.

The researchers tracked patients initially enrolled at non-VA, community-based detoxification or information and referral centers, and had them complete extensive surveys four times over 16 years. Overall, 65% of those who initially took part in both treatment and AA were free of alcohol problems at 16 years, compared to 57% of those who took part only in AA, and 50% of those who received treatment alone. The data also showed that:

• People who entered AA soon after they first sought professional help were more likely to stay involved with AA than those who delayed joining the group until after their first year of treatment. Those who stayed more involved had a better chance of being free of alcohol problems at 1-, 3-, 8- and 16-year follow-ups than those who attended fewer meetings or were involved for less time.
• Those who received professional help but delayed participation in AA until after their first year of treatment appeared to derive no additional benefit from joining the group.
• Those who beat their addiction but dropped out from AA were more likely to resume drinking than those who stayed involved with the group.

One limitation of the study, said the authors, is that people who join and participate faithfully in AA may be a more motivated group of individuals to begin with, and it could be this trait and not AA, per se, that is responsible for their better outcomes. The authors wrote that nonetheless, they "believe the findings reflect the real-world effectiveness of participation in AA."

According to Moos, a big part of the challenge in treating alcohol addiction is keeping patients in 12-step self-help programs such as AA. A 2003 study by his team, involving 2,778 men with substance-abuse disorders, found that while more than 90% got involved with AA or other 12-step programs before or during the first year of treatment, 40% of these patients dropped out within a year. Moos said those who were actively following the program were less likely to drop out, and that more support from clinicians and counselors at treatment programs would likely have bolstered their clients' involvement in AA.

Substance abuse, including alcoholism, is among the top three diagnoses in VA's healthcare system. VA treats some 215,000 patients each year for substance abuse disorders, and in fiscal year 2004 funded nearly 100 studies in this area. VA counselors typically recommend that patients become involved in community-based self-help groups, though such participation is not mandated.