Alcoholics Anonymous: membership characteristics and effectiveness as treatment.

Reports published since 1976 were reviewed with respect to the characteristics of alcohol-dependent individuals who affiliate with Alcoholics Anonymous (AA). No "AA personality" was identified inasmuch as systematic differences have not been observed between affiliates and nonaffiliates. Evaluation studies were reviewed with regard to data on AA's effectiveness as treatment, leading to several observations. When "alcoholics" participate in AA in addition to professional treatment, their outcome on drinking and other indices is no worse, and may be better, than that of patients who do not involve themselves in AA. AA involvement tends to be associated with relatively high abstinence rates but with only fairly typical total improvement rates. The effectiveness of AA as compared to other treatments for "alcoholism" has yet to be demonstrated. Reliable guidelines have not been established for predicting who among AA members will be successful. An alcohol-involved person's chances of participating in AA are related to the type of drinking outcome achieved. Caution was raised against rigidly referring every alcohol-troubled person to AA.

Alcoholics Anonymous: affiliation processes and effectiveness as treatment.

Recent findings from the empirical literature on Alcoholics Anonymous (AA) suggest that no clear exclusionary criteria for this organization exist, except that alcohol-dependent individuals who become nonproblem drinkers appear to be less likely to affiliate with or maintain involvement in AA. Of those alcoholics who become long term, active AA members, about 40 to 50% enjoy several years of total abstinence, with about 60 to 68% improving to some extent, drinking less or not at all during their participation. Those who combine AA with other forms of treatment seem to do as well as or better than those who go to AA alone. More active AA participants do as well as or better than those who participate less actively. Compared to professionally treated alcoholics, AA members seem to achieve abstinence at a higher rate. Consideration is given to the apparent unsuitability of AA for problem drinkers who choose the goal of nonproblem drinking.

Disulfiram treatment of alcoholism. A Veterans Administration cooperative study.

We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 +/- 8.4) than those in the 1-mg (75.4 +/- 11.9) or the no-disulfiram (86.5 +/- 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking.

A review of psychologically oriented treatment of alcoholism. II. The relative effectiveness of different treatment approaches and the effectiveness of treatment versus no treatment.

A review of 384 studies of psychologically oriented alcoholism treatment showed that differences in treatment methods did not significantly affect long-term outcome. Mean abstinence rates did not differ between treated and untreated alcoholics, but more treated than nontreated alcoholics improved, suggesting that formal treatment at least increases an alcoholic's chances of reducing his drinking problem.