Introducing the Cochrane review of Twelve Step facilitated recovery

Cochrane is an unaffiliated, international network of researchers that perform systematic reviews of medical evidence to improve health outcomes and healthcare practices around the world.

A newly released Cochrane Review into Twelve Step Facilitated recovery (TSF), found “high certainty evidence” that TSF programs that were designed to increase participation in Alcoholics Anonymous (AA) can lead to higher rates of continuous abstinence over months and years compared to other treatments including cognitive behaviour therapy.

What does Cochrane say about Twelve Step facilitated recovery?

This 2020 study included 27 separate studies of 10,565 people who were involved in a variety of programs with different approaches, duration and intensity. The 2020 study was a far more extensive study than another carried out in 2006, which, while still conclusive in its support for TSF, only included a few thousand participants.

The study found that compared to other alcohol rehab centres where people go to detox from a binge on alcohol and drugs or commit to a residency program in an effort to stop drinking alcohol, TSF programs have higher rates of abstinence over months and years.

The 2020 review also confirmed that TSF programs significantly reduce the healthcare costs associated with problem drinking: “In terms of healthcare costs, policy makers will be interested that four of the five economics studies we identified showed considerable cost-saving benefits for AA and related 12 step clinical programs designed to increase AA participation, indicating these programs could reduce healthcare costs substantially.”

The lead author of the Cochrane review, Dr John Kelly, said that a high degree of confidence can be placed in these new findings. He went on to say that TSF programs and AA should be a frontline treatment option to be implemented in countries where AA is available.

“Implementing TSF interventions along the lines of those tested in this review is very likely to result in improved alcohol use disorder treatment outcomes and substantially lowered use of health care resources that saves money,” Dr Kelly said.

Who benefits most from Twelve Step Facilitated recovery (TSF)? 

A TSF is best suited to a person who has tried other methods to stop drinking alcohol and found they couldn’t remain abstinent. This is a particular group who require ongoing support and treatment for alcoholism and or substance abuse. It could also be helpful to people who are at different stages of their drinking and can’t see how their drinking is either causing harm or has the potential to cause harm. A TSF includes lots of interactions with other problem drinkers who are living a sober life. These associations and relationships can help somebody on the brink of alcoholism to break through their denial.

A TSF is applying the 12 step recovery program as pioneered by Alcoholics Anonymous (AA) into the life of a person who is experiencing significant problems with alcohol. According to Cochrane, the reasons that TSF programs outperform other well established treatments is because they are grounded in the AA recovery community: “It successfully links people to a free, ubiquitous, long term recovery, peer support organisation.” 

The Cochrane review listed the following benefits of a TSF/AA program compared to other types of programs: Multiple therapeutic factors including improved physical, emotional and spiritual wellbeing; improved social networks; improved coping skills; recovery motivation; decreased impulsivity and craving; abstinence self efficacy (self belief); psychological well being.

In a separate interview on the Cochrane website, Dr John Kelly said that TSF programs do quite a bit better than other forms of treatment when measuring sustained abstinence and remission.

“The review also found that AA/TSF reduced health care costs substantially while simultaneously improving patient’s abstinence relative to other treatments,” he added.

Is a TSF for everybody who experiences a problem with alcohol?

Interestingly, and of importance to anybody who has a drinking problem, The Cochrane review found that a TSF program can be effective in reducing “drinking intensity, negative alcohol-related consequences and addiction severity.”

So while Cochrane identified the benefits of a TSF for anybody who is wanting to reduce the frequency and intensity of their drinking, people who are less affected may find other forms of intervention sufficient. A controlled drinking program or some intensive education into the harmful effects of alcohol may be suitable to that type of drinker. And there are those drinkers who experience problems with alcohol and are able to respond to the warning signs or pleas from loved ones and stop or moderate before their situation becomes too serious. This person may be unhappy, seek intervention and change their habits without too much trouble. Of course, if they try to stop or moderate and find they are not able to, then intervention using a TSF program could be most beneficial.

Why is a Cochrane review so important? 

The fact that Cochrane is unaffiliated makes its advocacy significant and authoritative. In the internet age where the dissemination of information is widespread on multiple platforms and often unregulated, credible, reliable information is essential for the right health outcomes.

The necessity for reviews like those conducted by Cochrane has been highlighted in a recent article in The Conversation, the world’s leading publisher of research news and analysis. The Conversation identified that most global medical research is poorly designed and compromised by financial or political bias. It even claims that 85% of research is wasted, often because a study’s findings aren’t compatible with the subject matter’s marketability.

A Cochrane Review is published without the bias of a financial or political motive and its analysis includes the veracity of the theory, protocols and findings behind the research.

Who was Cochrane named after?

Cochrane is named in honour of the British Medical Researcher Archie Cochrane who died in 1988 soon after he’d endorsed some trials that made significant changes to the way women are cared for during pregnancy and childbirth. Cochrane was dedicated to ensuring that the information and care that health professionals and consumers received was completely accurate and proven.

Archie Cochrane is recognised as one of the fathers of evidence based medicine.

He believed that because resources for healthcare would always be limited, they should be used to provide equitable forms of health care which had been shown in properly designed evaluations to be effective.

The Sydney Retreat is a TSF program

The Sydney Retreat uses a TSF program as pioneered by Alcoholics Anonymous to help people to recover from alcoholism and or drug addiction.

The Retreat is a peer led recovery approach that benefits from the lived experience of people in recovery. It introduces residents to the recovery community and most importantly, it provides the education and support for people so that they know that they are not alone.

The TSF program used by The Retreat provides residents with a design for long term sober living. Not only will you be provided with the tools to stop drinking and using drugs, you will become a part of a community who help one another to get sober and stay sober.

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