Does AA Actually Work?

In a 2014 survey by the National Survey on Drug Use and Health, about 27.9 million people in the United States had Alcohol Use Disorder (AUD) [1]. AUD is defined as an addictive disorder where people depend on alcohol for everyday functioning, despite negative consequences that affect their physical and mental wellbeing [2]. According to the DSM-5, some of the diagnostic criteria for AUD include “recurrent alcohol use resulting in a failure to fulfill rote obligations”, “recurrent alcohol use in situations in which it is physically hazardous”, and “a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects” [3]. In addition to its burden on mental health and hindrance of life obligations, AUD can cause a variety of chronic health complications such as alcohol-induced cardiomyopathy, cirrhosis of the liver, and delirium tremens [2]. 

Alcoholics Anonymous (AA) has become one of the most popular forms of treatment for patients with AUD. AA serves as a low-cost way for people suffering from AUD to get support in their recovery. AA programs can be found all across the United States and have no membership requirements other than someone who wants to get help for their unhealthy relationship with alcohol. AA runs on a “twelve steps and twelve traditions” process where people in the program will work through steps built on honesty, courage, and humility. This functions to build a community for individuals with AUD in recovery through sponsorship programs with others who had previously suffered with AUD and share wisdom from their road to recovery [4].

Despite its ability to foster this community, is AA actually effective in initiating and sustaining cessation of alcohol use? Although it is often difficult to get accurate data about the efficacy of AA because of the program’s anonymity policy, there have been a multitude of studies completed to attempt to understand how well AA works. Throughout many studies, a positive correlation has been found between continued abstinence and attendance of AA. Additionally, there has been a lot of support for the increase in people staying sober and the number of AA meetings that they consistently attend [5]. While retention rates remain low at nearly 40%, the AA reported that only about 27% of consistent members stayed sober for less than a year, with over 22% being sober for more than 20 years [6]. However, the efficacy of each individual step within AA has been contested, indicating that the effectiveness of AA does not lay in the actual groundwork of the program, but instead from the stability and community the program builds for participants [5]. For many AA participants, being able to develop a sense of identity with people who have similar struggles in AA helps them stay sober [7].

In a 2020 review study by Stanford spanning over 10,000 participants, AA was found to be at least equally effective as psychotherapy in helping patients achieve sobriety [8]. The professor who ran the study at Stanford, Dr. Keith Humphreys, attributes the success of AA to the social interaction that it emphasizes, with many participants highlighting the importance of the sponsorship program [4, 8]. This is promising for patients struggling with AUD because of AA’s easy access, especially in comparison to psychotherapy which includes cost and access barriers. For instance, “X” study showed that treatment costs were reduced by approximately $10,000 per person when choosing AA over traditional therapy [8]. 

While  AA may not work for everyone, it is clear that, for many people, it has become the right program they need to get and stay sober from alcohol. AA’s effectiveness appears to lay within the community building the program allows and the low barrier to entry. With this in mind, other programs focused on helping people with different forms of addiction could help improve their effectiveness by attempting to imitate AA’s emphasis on interconnectivity and availability. 

Reviewed By: Clare Williams

Designed By: Devin Mulcrone

References

[1] National Institute on Alcohol Abuse and Alcoholism. (2025). Prevalence of Past-Year Alcohol Use Disorder (AUD) https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics

[2] Cleveland Clinic. (2025). Alcohol Use Disorder https://my.clevelandclinic.org/health/diseases/3909-alcoholism

[3] RAND Corporation. (2021). Diagnostic Criteria Checklist https://www.rand.org/content/dam/rand/pubs/tools/TLA900/TLA928-1/resources/step-2/AUD/RAND_TLA928-1.diagnostic-checklist_AUD.pdf

[4] Alcoholics Anonymous. (2026). What is A.A.? https://www.aa.org/what-is-aa

[5] Kaskutas, Lee Ann. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of Addictive Diseases Vol 28, Issue 2. Doi: 10.1080/10550880902772464

[6] Wagener, Dan. (2025), Alcoholics Anonymous: The 12 Steps of AA & Success Rates American Addiction Centers https://americanaddictioncenters.org/rehab-guide/12-step/whats-the-success-rate-of-aa

[7] Bulumac, Adriana Lavinia. (2024). Affiliation to the Alcoholics Anonymous (AA) community: A qualitative study on differences between highly affiliated and low/non-affiliated individuals. Nordic Studies on Alcohol and Drugs. Vol 41, Issue 6. Doi: 10.1177/14550725241278089

[8] Erickson, Mandy. (2020). Alcoholics Anonymous most effective path to alcohol abstinence. Stanford Medicine Psychiatry & Mental Health https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html

Afrin Addiction: When Breathing Easy Becomes a Compulsion

Afrin is unassuming: it’s an over the counter decongestant nasal spray that doesn’t require an ID to purchase. There are no viral news stories of people cooking up street drugs with it (unlike certain cough medicines) and it does not require a prescription to purchase. However, hiding behind its subtle packaging lurks one of the most habit-forming medications on the market. Afrin uses the active ingredient oxymetazoline to constrict the blood vessels in the nose to allow air to pass more easily through the nostrils and is intended for short-term use, as in before a flight or during a brief illness [1]. When someone uses Afrin for more than 2-3 days in a row or uses it many times per day, the structures in the nose whose job it is to filter and warm up the air we breathe become blocked by the medication, leading to chronic sinus infections and worsened breathing [1]. In addition, constant constriction of the blood vessels with Afrin use can cause them to swell more easily in the absence of Afrin, leading to inflammation and the feeling of a “stuffy nose” whenever Afrin is stopped [2]. This makes it nearly impossible for the person dependent on Afrin to experience the same level of decongestion without Afrin and creates a negative feedback loop where the “solution” to the congestion appears to be more Afrin, which temporarily relieves the symptoms but has diminished results over time.

What makes this addiction so dangerous is that it isn’t as obvious as dependence on opioids or cigarettes, but can still have lasting health consequences. For example, long-term use can cause permanent damage to the nasal mucosa which can lead to frequent nosebleeds and more frequent viral infections due to the chronic dryness and lack of filtration from the medication [3]. The solution to this hidden addiction is awareness. Someone who is advised by a physician or other provider to use Afrin for a short-term illness may assume that no harm could come from using it for more time than prescribed. Already, some ENT providers are warning their patients about how “habit forming certain over the counter nasal sprays can be” and are emphasizing the importance of sticking to the prescribed dosage and timing [4]. The Afrin addiction crisis is stealthy and often flies under the radar, but improved communication and education about the dangers of certain nasal sprays can help people breathe easier in the long term.

Reviewed By: Benji Forman References

[1] “Breaking the Habit: Understanding Afrin Addiction.” Sinus and Allergy Wellness Center of North Scottsdale. https://www.sinusandallergywellnesscenter.com/breaking-the-habit-understanding-afrin-addiction/

[2] Larsen, D. “Can you get addicted to certain nasal sprays?” Southwest Ohio ENT Specialists. https://soents.com/can-you-get-addicted-to-certain-nasal-sprays/

[3] Elangovan, S (2024). “The Hidden Risks of Chronic Nasal Decongestant Use.” Resolve ENT. https://www.resolveent.com/blog/1215240-the-hidden-risks-of-chronic-nasal-decongestant-use/

[4] Correspondence with Dr. Michael Gaslin, ENT

Portugal’s Approach to Drug Use

In 2001, the Portuguese government took up a new mode of managing drug use; they decriminalized it. By doing so, public and private drug use of all illegal drugs, if the amount possessed is not above the average consumed in ten days, is no longer a crime [1]. Instead, drug use is treated as an illness and a public health issue.

While the United States has drug courts, Portugal has the Commissions for the Dissuasion of Drug Addiction, which focuses on the psychosocial aspect of drug use and provides drug users with referrals to healthcare institutions [1]. When police send a user to the commission, the drug user is required to present themselves to the commission physically. There, a group of social workers assesses their drug use on a scale from casual to addiction and encourages them to seek necessary treatment [1]. The commission rarely fines offenders and instead chooses to intervene with counseling to prevent them from becoming addicted [2]. During the first year of its implementation, of the 6,000 users who were sent to the commission, 1,600 underwent treatment at the Prevention and Treatment of Drug Addiction Service, a public rehabilitation center in Portugal [3].

Portugal’s Commissions for the Dissuasion of Drug Addiction is a public health approach that treats drug addiction as the chronic illness it is [2]. The commission, more like a doctor than a court of law, is concerned with the health and well-being of the person, not isolating them from society [2]. While the decriminalization of drugs was initially marked with an increase in drug use in Portugal, the harm associated with the use of drugs has been reduced [2]. Programs for free distribution of clean needles, testing of drugs for purity and potency, and methadone treatment allow drug use to be less harmful [2]. Since decriminalization in 2001, the percentage of teenagers who reported using illicit drugs in Portugal decreased by half, indicating that decriminalization may be a successful method for drug use prevention [2].

Portugal’s drug policy has changed the way other nations approach drug use. In 2016, the Global Commission on Drug Policy encouraged nations to decriminalize the possession of drugs and opt for alternative consequences, such as counselling or community service [4]. Portugal’s approach to drug use is promoting much-needed conversations as to what the goals of drug policy are and how these goals can realistically be achieved.

Reviewed By: Gage Gruett

Designed By: Jennifer Liu

References

[1] Rêgo, X., Oliveira, M. J., Lameira, C., & Cruz, O. S. (2021). 20 years of Portuguese drug policy - developments, challenges and the quest for human rights. Substance abuse treatment, prevention, and policy, 16(1), 59. https://doi.org/10.1186/s13011-021-00394-7

[2] Kristof, N. (2017). War on Drugs: Portugal may be winning the battle against drug abuse through decriminalisation. Independent Digital News & Media.

[3] Miller, S. B. (2002, Aug 08). Portugal assesses its softer approach to drug users; A year ago Lisbon decriminalized drug use. Views differ on whether the policy is effective. The Christian Science Monitor. https://login.proxy.lib.duke.edu/login?url=https://www.proquest.com/newspapers/portugal-assesses-softer-approach-drug-users-year/docview/405679443/se-2

[4] Dreifuss, R., & Bém, P. (2016). Non-violent drug users should face no penalty—a call from the Global Commission on Drug Policy. BMJ, i5921. https://doi.org/10.1136/bmj.i5921