Ferri M, Amato L, Davoli M
Agency of Public Health, Project Unit: EBM and Models of Health Assistance, Via di Santa Costanza 53, Rome, Italy 00198.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD005032. doi: 10.1002/14651858.CD005032.pub2.
Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)).
To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems.
We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies.
Studies involving adults (<18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants.
One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers.
Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence.
AUTHORS' CONCLUSIONS: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.
戒酒互助会（AA）是一个国际性的组织，由戒酒成功的人士组成，通过自助小组提供情感支持，并为从酒精依赖中康复的人提供一种戒酒模式，采用12步戒酒法。虽然它是最常见的，但AA并不是唯一的12步干预措施，还有其他12步方法（称为十二步促进法（TSF））。
评估与其他心理社会干预措施相比，AA或TSF项目在减少酒精摄入量、实现戒酒、保持戒酒状态、改善受影响者及其家庭的生活质量以及减少与酒精相关的事故和健康问题方面的有效性。
我们检索了Cochrane药物与酒精研究小组的专业试验注册库、Cochrane对照试验中心注册库（CENTRAL）、自1966年起的MEDLINE、自1980年起的EMBASE、自1982年起的CINAHL、自1967年起的PsychINFO。检索于2005年2月更新。我们还查阅了相关研究的参考文献列表。
研究对象为年龄小于18岁、有酒精依赖的成年男女，他们自愿或被迫参加AA或TSF项目，并与不治疗、其他心理干预措施、12步变体进行比较。
一位审阅者（MF）评估研究是否纳入，并使用预定义的数据提取表提取数据。对研究的方法学质量进行评估，并由所有审阅者进行讨论。
纳入了八项涉及3417人的试验。与其他替代治疗相比，AA可能有助于患者接受治疗并使患者坚持治疗，不过这方面的证据来自一项将AA与其他干预措施相结合的小型研究，不应被视为定论。其他研究报告称，无论治疗组如何，保留率相似。三项研究将AA与其他干预措施相结合与其他治疗进行比较，发现饮酒量和饮酒天数百分比方面几乎没有差异。TSF与对照治疗干预措施相比，似乎对成瘾严重程度和饮酒后果没有差异影响，且未报告治疗退出率有确凿差异。纳入的研究无法对TSF在促进完全戒酒方面的效果进行确凿评估。
没有实验研究明确证明AA或TSF方法在减少酒精依赖或问题方面的有效性。一项大型研究关注的是与被认为成功的干预措施相关的预后因素，而不是干预措施本身的有效性，因此需要更多的疗效研究。
