12-step fellowships offer a way to reconcile shrunken resources with the desire to get more patients safely out of treatment. Accounting for the self-selection bias which has obscured AA’s impacts, this synthesis of US trials finds that attending more meetings after treatment boosts abstinence. Why then is research equivocal on whether promoting attendance improves drink-related outcomes?

Key points from summary and commentary
• This synthesis of US trials found that the more AA meetings problem drinkers attend after treatment, the fewer the days on which they drink, even after accounting for the possibility that more promising patients self-select into AA.
• However, research is equivocal on whether systematically and intensively encouraging attendance at 12-step groups significantly improves drink-related outcomes; heavy drinking and adverse consequences are usually unaffected even if abstinence is modestly boosted.
• A trial in England found no statistically significant improvements in abstinence after more active referral to 12-step groups, but was not a definitive test of these types of interventions.