Our certainty in the evidence ranged from very low to high for the different outcomes. Most of the high-certainty evidence was based on the results from studies with reliable study designs randomized controlled trials and good measurement methods. We considered some evidence to be of low certainty, partly because of inadequate methods for deciding which treatment each person in the study was to receive, which can allow factors other than the treatments to affect the results.
There was some inconsistency in the evidence across studies that could be due to variation in the clinical characteristics of the participants, times of follow-up, error in participant recall of certain outcomes, and differences in intervention durations, or therapist effects.
Some studies had small sample sizes, which led to less precise estimates of the longest periods of abstinence, and high variability around estimates of drinks per drinking day. Alcohol use disorder AUD confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization.
For over 80 years, Alcoholics Anonymous AA has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted. To evaluate whether peer-led AA and professionally-delivered treatments that facilitate AA involvement Twelve-Step Facilitation TSF interventions achieve important outcomes, specifically: abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets.
We searched for ongoing and unpublished studies via ClinicalTrials. We also included healthcare cost offset studies. For analyses, we followed Cochrane methodology calculating the standard mean difference SMD for continuous variables e.
The average age of participants within studies ranged from We rated selection bias as being at high risk in 11 of the 27 included studies, unclear in three, and as low risk in Risk of bias due to inadequate researcher blinding was high in one study, unclear in 22, and low in four.
This Cochrane review looks at the effects of these programs on reducing alcohol consumption and the effects of heavy drinking such as physical health, family, or employment problems , and enhancing long-term abstinence.
The authors of the review also examined whether AA and TSF programs reduce healthcare costs compared to other treatments. The previous Cochrane review published in was based on the eight available studies including a few thousand participants.
The quantity and quality of the research has increased substantially since then. Twenty-seven studies are now included in this updated Cochrane review, comprising 10, people. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported.
Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.
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