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Gauging the Effectiveness of One Component of Alcoholics Anonymous

Allan Schwartz, LCSW, Ph.D. Updated: May 5th 2010

Gauging the Effectiveness of One Component of Alcoholic's AnonymousGauging the Effectiveness of One Component of Alcoholics Anonymous

Maria Pagano, PhD, assistant professor of psychiatry at Case Western Reserve University School of Medicine, established an empirical model to quantify and gauge an alcohol abuser's level of engagement in Alcoholics Anonymous(AA), and in their related helping activities(AAH) at AA. The study, "Running Ahead: Service to Others in Sobriety(SOS)," was published in the spring 2010 issue of Alcoholism Treatment Quarterly.

This research is an extension of Dr.Pagano's 2004 study, "Helping others in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH," published in the Journal of Studies on Alcoholism (65, 766-773).The study involved 1,726 treatment seeking alcohol abusers in Project MATCH. In this study, Dr. Pagano demonstrated that AAH(Alcoholics Anonymous Related Helping) cut the risk of relapse in half in the year following discharge.

According to Dr. Pagano, "Service activities measured by the SOS are free, accessible, available to all patients regardless of education, gender, or racial background, and can be encouraged right from the start." Such activities can begin with preparing the coffee pot and making coffee for each meeting.

While I am aware that there are those who are opposed to AA, it is important to pause and consider the ramifications of the findings. The fact is that addiction is extremely complex and, as a result, not available to simple solutions. In no way do I believe that service activities are a panacea for addiction. What are the complexities of addiction?

There are multiple varieties of addictions, as there are reasons for becoming and remaining addicted.

Causes of addiction:

1. Personality disorders.
2. History of childhood sexual or physical abuse and neglect.
3. Severe mental illness.
4. Depression and low self esteem.
5. Extreme trauma and Post Traumatic Stress Disorder.
6. Genetic or inherited pre disposition to addiction.
7. Growing up in the midst of domestic violence.
8. Teenage ADHD and seeking solace and self medication through drugs.

This is not a complete list.

Just as there are complex reasons for addiction,  there are equal complexities for why some people recover, while others remain addicted or quickly relapse. Of course, brain damage due to drugs will mitigate against recovery. This is also true of some cases of severe mental illness or diminished intellectual capacity.

The research cited above indicates that some people are helped to recovery and abstinence because of the kind of psychological support provided by the opportunity to give service to others. This does not mean that it will work for everyone. Whatever the combination factors such as personality, family support, genetics and environmental factors are, it is important to know and utilize the fact that at least some are being helped by this aspect of AA and other support programs. One does not have to buy in to all of AA in order to find help there and elsewhere.

It should be kept in mind that psychotherapy in conjunction with AA or other support groups also helps people towards recovery and maintenance. In criticizing AA, it's important not to "throw out the baby with the bath water."

Your comments are encouraged and appreciated.

Allan N. Schwartz, PhD


Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

Service is Service - Kathleen - May 17th 2010

AA encourages Any service work (service being defined as an act of giving without expectation of any personal gain).Most AA members start rendering service within AA, however Step twelve distinctly says that we are to "Practice these principles in All our affairs."   That includes out in the real world, helping your neighbor carry groceries, picking up the trash on your block, or speaking at an AA meeting; offering help where help is needed.I also know that AA is not for everybody--there are many other fine programs available. But, any time you want to check us out, I'm sure that one meeting is worth a million words.

no such thing as ALL of AA --Sober for 25 years - Kathleen - May 16th 2010

Sometimes I believe that AA is both the most mis-understood AND the most sucessful Alcoholic Treatment therapy there is--Why?

Because there ARE No rules, no fees, no assessments, no therapies.

no Titles, No one is turned away, NO-one keeps records, we seldom know one anothers' last names'And no one is ever paid one penny for the life saving power of Truth. 

There is  only demand made of us: "Rigourous Honesty"

Every thing else is a suggestion, including the twelve steps, including service.  No one is required to do anything.  It is all voluntary and comes from the graditude of Individuals who have discovered the freedom and healing that comes from practicing Rigourous Honesty--So, you see,  It's not the service work that promotes success--it is the rigourous honesty that inspires both the service work and the recovery rate.  And also the total respect, welcome, and genuine understanding.  I suggest that you read the brief texts called "How it Works" and "The Promises''. They are both easily available on line.

I also live with Mental illness, and have used AA's Principles --particularly "Rigorous Honesty" as a guide to my treatment decisions--I also take several Psychotropic Medications.  Yes, AA has it's Purists--who are against any MOOD-Altering substances.  But most of us realize that some MOODS require altering before recovery can begin.   I have been sober for over 25 years.  I have never recieved treatment for alcoholism except for AA.  I have never relapsed; and I still strive to live by these principles.  I am also a Church-going Christian,  and there is no conflict between AA membership and my religion.    AND.....IT Works!

From what I've seen of Addiction & Mental Health Centers &  Treatments  they lack the desire for open-mindedness, transparency and peer empowerment.   The missing ingredient is not service: it is Trust.  Thank you for your time.

Service works - Kathy Berman - May 8th 2010

Nov. 24, 1976 is my AA birthday. I have been writing about my spiritual journey that I call recovery since Nov. 2004. The AA triangle is recovery, unity and service.

I believe that service works for several reasons. It gives confidence to those who often come to sobriety without any good feelings about self. It also gives the giver and the receiver a feeling of being needed.

I think the balance for public and private service needs to exist. To me it is the balance between the ego and the soul.

Service to others - Mona Lisa - May 6th 2010

One of the many things that I think helps anyone to move away from addictive behaviors is doing things other than drinking.  It's all part of building a life that doesn't include alcohol.  Service to others is absolutely one of the "things other than drinking" that can help, and the connection with others that such service can create is invaluable.  So I'm not surprised by the results of this study.  They make sense to me.

But why do we need to assume that "service to others" can only occur within the context of a recovery support group?  Or, if it's helpful that the service be within a recovery support group, why must that group be AA?

We spend so much time staring at AA that we don't see anything else.  And I think that's a shame.


OK - Gabby - May 6th 2010

Thinking of going back to AA,,, but not for the "steps" or anything else ,,, but just to be around people that understand...... does that make sense? Won't never buy into the Bullshit... but it is nice to have someone who has been there to talk to... JT ( aka GAbby)

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