The Case for 12-Step Facilitation: A New Review of the Evidence

In 2006, the Cochrane Collaboration published a review of eight studies it determined were of high enough quality to gauge the effectiveness of the use of 12-Step Facilitation (TSF) and Alcoholics Anonymous (AA) in treating the symptoms of alcohol use disorder (AUD).

At the time, the review cited that while there were many studies offering statistics on employing TSF and AA in managing outcomes, very few of these studies met their threshold for use in forming an accurate appraisal of the evidence.

While the 2006 review found the studies that did meet their criteria demonstrated effectiveness in reducing alcohol consumption and improving abstinence, the lack of quality studies called for further review of evidence in the future.  

Last month, a new review was published by Cochrane evaluating newer studies in addition to those previously reviewed. This review uses 27 studies with over 10,000 participants determined to meet criteria sufficient to demonstrate the effectiveness of AA and TSF in comparison to other forms of treatment or no treatment at all.

The review concludes that there is good evidence to support TSF/AA is as or more effective than the compared modalities. The review also concludes that TSF/AA likely reduces the economic burden of treating those with AUD, both for clients and the healthcare system as a whole.


What is TSF and What Alternatives Exist?

12-step facilitation is a treatment modality utilized by a majority of professional treatment centers that encourages involvement in AA and other 12-step programs to improve outcomes in addiction treatment.

This introduction to 12-step concepts is designed to provide a foundation for long-term recovery for those who intend to continue abstinent recovery from addiction after completing treatment. AA and other 12-Step programs are designed as free, peer-led support groups to maintain recovery.

There are other forms of treatment that the studies reviewed also utilized to help reduce the negative effects of AUD. These include motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and therapies combining a variety of modalities.

There are types of treatment that also display effectiveness in treating symptoms and are often used in combination with 12-step facilitation and AA. These studies included data for those who did not obtain any formal treatment.


Measuring Success in Recovery

In particular, the studies focused on evaluating outcomes following the various types of treatment. There is some difficulty in quantifying success in recovery, but the review uses the following metrics in measuring effectiveness; rates of continuous abstinence at 12 months, percentage of days abstinent, longest periods of abstinence, drinking intensity, alcohol-related consequences, and alcohol addiction severity.

While 12-step programs are themselves abstinence-based, there is evidence that participation still improves outcomes for participants who do not stay continually sober. This is an important factor for those considering 12-step participation or who have previously been a part of a 12-step program.

There is a demonstrable benefit to using 12-step facilitation in the long-term, even if permanent abstinence isn’t attained on the first attempt.

Another important factor that those entering treatment must consider is healthcare costs. The study found that those participating in TSF or AA incurred lower costs in seeking treatment as compared to other treatment modalities.

The last study found that those with less severe prognoses actually incurred less cost in treating their condition. When worse cases were compared, TSF again led to savings on healthcare costs in treatment for these individuals.


What the Review Determined: Does TSF/AA Work?

The review concludes that for each diagnostic criterion, TSF/AA was as effective in treating Alcohol Use Disorder as other modes of treatment were. When it comes to increasing abstinence, the evidence suggests that TSF/AA exceeded the effectiveness of other established treatments.

This is in line with the abstinence-only based program of AA and other 12-step groups and provides support for the wide-scale use of this model throughout the treatment community. In comparison to other models, the TSF/AA treatments reviewed also led to a lower financial burden on participants and on the healthcare system.

The 2006 review was the first of its kind to systematically consider the available research into Alcoholics Anonymous and 12-step facilitation.

The authors of that review were optimistic that further studies would confirm what their limited review found: that these methods led to better outcomes for those with addiction and that this was supported by the best data available.

A decade and a half later, the studies conducted in the interim have further supported the original conclusion that TSF/AA is an effective treatment method for those looking to recover.

Most encouraging, 12-step facilitation is widely employed within the treatment industry because its effectiveness is proven to work for clients who are looking for a solution to their struggles with addiction by remaining abstinent.

Access to care is essential in early recovery and the widespread availability of treatment utilizing evidence-supported modalities like 12-step facilitation ensures those seeking help get the best care possible.


Burning Tree serves people who struggle with addiction, co-occurring disorders, and find themselves ready to accept help. Our specialists focus on meditation and holistic practices to help build a better recovery for you. We include your family and meet you where you are emotionally and spiritually to support your journey of healing. We hope you will find the strength to get you on your way and call us now at 855-381-6224.


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