Let’s not turn back the clock: Comments on Kelly et al., “Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers”

John Kelly and colleagues have published a summary for clinicians and policy makers (Kelly et al., 2020a) of their recent Cochrane review of the effectiveness of Alcoholics Anonymous (AA) and 12-step facilitation treatment (TSF) for alcohol use disorder (AUD) (Kelly et al., 2020b). As would be expected of a Cochrane review and of these authors, they summarize a thorough, well-conducted and well-described meta-analysis. The main findings were that AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission1, where AA/TSF was superior, and also that AA/TSF reduces healthcare costs. From this, it is concluded that ‘Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits’ (Kelly et al., 2020a, p.641). While there are some issues to do with the internal validity of the findings, there are also serious concerns about their external validity and, in particular, their implications for treatment delivery.