Base one review3/6/2023 ![]() CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42 2 studies, 1936 participants high‐certainty evidence). RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT) (randomized/quasi‐randomized evidence) Risks of bias arising from the remaining domains were predominantly low or unclear.ĪA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. Risk of bias due to inadequate researcher blinding was high in one study, unclear in 22, and low in four. We rated risk of attrition bias as high risk in nine studies, unclear in 14, and low in four, due to moderate (> 20%) attrition rates in the study overall (8 studies), or in study treatment group (1 study). We rated selection bias as being at high risk in 11 of the 27 included studies, unclear in three, and as low risk in 13. AA/TSF was compared with psychological clinical interventions, such as MET and CBT, and other 12‐step program variants. ![]() The average age of participants within studies ranged from 34.2 to 51.0 years. We included 27 studies containing 10,565 participants (21 RCTs/quasi‐RCTs, 5 non‐randomized, and 1 purely economic study). We conducted random‐effects meta‐analyses to pool effects wherever possible. percent days abstinent (PDA)) or the relative risk (risk ratios (RRs)) for dichotomous variables. For analyses, we followed Cochrane methodology calculating the standard mean difference (SMD) for continuous variables (e.g. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). We categorized studies by: study design (RCT/quasi‐RCT non‐randomized economic) degree of standardized manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. Participants were non‐coerced adults with AUD. We also included healthcare cost offset studies. We included randomized controlled trials (RCTs), quasi‐RCTs and non‐randomized studies that compared AA or TSF (AA/TSF) with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants, or no treatment. We handsearched references of topic‐related systematic reviews and bibliographies of included studies. All searches included non‐English language literature. We searched for ongoing and unpublished studies via and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 15 November 2018. We searched the Cochrane Drugs and Alcohol Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, CINAHL and PsycINFO from inception to 2 August 2019. To evaluate whether peer‐led AA and professionally‐delivered treatments that facilitate AA involvement (Twelve‐Step Facilitation (TSF) interventions) achieve important outcomes, specifically: abstinence, reduced drinking intensity, reduced alcohol‐related consequences, alcohol addiction severity, and healthcare cost offsets. For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted. Alcohol use disorder (AUD) confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization.
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