"For the past several decades Alcoholics Anonymous and the  steps have dominated addiction treatment in America  boasting millions of adherents and turning into the standard option within most addiction treatment programs https_nssats_rpt.pdf in the US. A new study http has found however that AA the original step program and others like it dont have to be the only answer for people seeking out mutual help groups to deal with alcohol addiction. The study in short looked at how peoples selfreported outcomes with AA and step programs compare with the three biggest alternative mutual help groups  Women for Sobriety httpwomenforsobriety.orgbeta SMART Recovery http and LifeRing httplifering.org. It concluded that these other groups perform about as well as step programs. This study suggests that these alternatives really are viable options for people who are looking for recovery support and dont like AA for whatever reason Sarah Zemore lead author of the study told me.  The research is by no means the last word on this question  Zemore characterized the study as the beginning of a deeper evaluation into AA alternatives. But this is important. There has been a good amount of research https into AA and the  steps over the years broadly finding that about a third of people maintain recovery from alcohol addiction due to step treatment another third get something out of the treatment but not enough for full recovery and another third get nothing at all. Researchers have long suspected though that the benefits found in step treatment programs are not exclusive to the  steps. As Zemore told me The benefits of step groups are not driven by the  steps specific philosophy or adherence to the  steps. Its really more about general mechanisms like abstinence motivation and social support for abstinence. Presumably you could get those by participating in alternatives to AA. In other words these alternatives could help the onethird to twothirds of people who dont get anything or much out of AA. That would help deal with a big public health issue Based on federal data https more than  million people in the US have a substance use disorder and within that group more than  million have an alcohol use disorder. Excessive drinking alone is linked to  deaths each year https So finding the right solutions for this problem is literally a matter of life or death. What the study found The study http conducted by the Alcohol Research Group at the Public Health Institute in California and published last month in the Journal of Substance Abuse Treatment surveyed more than  people with alcohol use disorder AUD who were divided by which mutual help group they primarily participated in. Researchers followed up at six months then  months measuring involvement in the groups and various substance use outcomes including abstinence from drinking and alcoholrelated problems. After controlling for several factors the researchers concluded that Women for Sobriety LifeRing and SMART are as effective as step groups for those with AUDs. Essentially thats the story Zemore said. We were really interested in whether the effects of involvement on recovery outcomes depended on which group participants were in. And we found that they did not. There were some differences in the data. People who reported SMART as their primary group seemed to have worse substance use outcomes and there were lower odds of total abstinence among LifeRing members.  That might have something to do with differences in recovery goals. For example AA really emphasizes total abstinence from drinking as the solution to alcohol addiction. Groups like SMART and LifeRing meanwhile can be friendlier to the idea of members moderating their drinking but not quitting altogether. That could affect substance use outcomes  and especially abstinence outcomes. The studys survey data suggests this is in fact what was going on When researchers controlled for peoples recovery goals  meaning whether they wanted to commit to lifetime total abstinence or not  the differences between the step groups SMART and LifeRing went away. That suggests that people with less commitment to lifetime total abstinence are more likely to participate in SMART and LifeRing than they are to participate in step groups Zemore said. Thats why youre seeing these associations between SMART and LifeRing affiliation at baseline and worse recovery outcomes when you control for involvement. She added But I want to emphasize that these go away when you control for recovery goals. Again the study is not the final word. John Kelly an addiction researcher at Harvard Medical School who was not involved in the study told me that the study is good news in general but pointed out that its limited by its methodology Its based on an online survey not the kind of randomized trial thats typically the gold standard in research. That may have led to some potentially biased results  perhaps participants in specific groups were less likely to report bad outcomes for instance. And since its only one study its possible that the results were biased in some other way. So its up to future research to verify the findings. One tricky thing with this line of research is you cant really force people to participate in certain groups  so studies that randomly assign participants to AA SMART LifeRing or Women for Sobriety may not be easy to do. But there are ways that researchers could get around these problems such as only using participants who are willing to try different groups and actively following up with them to make sure they are actually participating. Another big research question figuring out why exactly these groups might work to help people stay alcohol or drugfree. Theres good research into how AA works but itd be good to figure out if SMART LifeRing and Women for Sobriety work in a similar way. That Zemore said will be one of her goals in future studies. Why we need alternatives In discussions about addiction treatment AA and the  steps tend to prompt polarizing reactions  some people swear by the programs others absolutely hate them.  Theres a good explanation for that While the research https shows that step treatment can be as effective as professional treatment modalities like cognitive behavioral therapy the research also shows that the  steps dont work for everyone.  As one example a prominent complaint about step programs is the spiritual aspect. This is a big part of the  steps with the final step even invoking a spiritual awakening. For people who arent religious or spiritual this can be a big turnoff thats one reason SMART and LifeRing exist to begin with  theyre meant to be secular alternatives to the  steps. The good news is that the research suggests the spiritual aspect doesnt fully explain why the  steps are effective for some people. Instead it seems other traits are just as if not more important  such as the social support that AA meetings provide and the lessons that participants can pick up at meetings. Thats long led researchers to suspect that alternative mutual help groups could work. If so that would let some people go to AA meetings if they prefer the  steps while others could find SMART LifeRing Women for Sobriety or something else that works for them. Basically everyone could find a workable solution. Providing these alternatives would essentially move addiction treatment closer to other kinds of medical problems. As Keith Humphreys a drug policy expert at Stanford University previously told me https We dont have anything that works for everybody. Theres very few places in medicine where you do. So there need to be as many alternatives as possible. The US is far from that at the moment. Most treatment facilities in America are according to the survey data and research https at least partly based on the  steps  making it the only option for many people. While alternatives like SMART or LifeRing do exist theyre not nearly as available as AA  and they certainly arent built into professional treatment programs in the same way as the  steps. As Albert a pseudonym for an AA member in Georgia previously told me https Theres just not a lot of widely advertised options available. AA and step treatment are the most wellknown and most recommended option so thats kind of where you tend to go. Zemores study begins to peel away at this problem. By showing that there really might be other effective options out there the research provides hope that there may be a better  or at least more complete  solution out there for alcohol addiction. For more on the research into AA and the  steps read Voxs explainer https"