Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults (>18 years) with alcohol-use disorder, alcohol abuse, or alcohol dependence
Intervention: Alcoholics Anonymous (AA)/Twelve-Step Facilitation (TSF) (manualised) ᵃ
Comparison: Alternative clinical intervention ᵇ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Proportion completely abstinent: 12-month follow-up | Favours intervention | High |
Proportion completely abstinent: 24-month follow-up | Favours intervention | High |
Proportion completely abstinent: 36-month follow-up | Favours intervention | High |
Percentage days abstinent: 12-month follow-up | No statistically significant difference | Very Low |
Percentage days abstinent: 24-month and 36 month follow-up | Favours intervention | Very Low |
Longest period of abstinence: 6‐month follow‐up | No statistically significant difference | Low |
Drinks per drinking day: 12-month and 24-month follow-up | No statistically significant difference | Low |
Drinks per drinking day: 36-month follow-up | Favours intervention | Moderate |
Percentage days heavy drinking: 12-month and 24-month follow-up | No statistically significant difference | Low |
Alcohol‐related consequences: 12-month and 24-month follow-up | No statistically significant difference | Moderate |
Addiction Severity Index (ASI): 6-month follow-up | Favours intervention | Low |
ASI: 12-month follow-up | See note ᶜ | Low |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) notes that most of the reviewed studies were carried out in the United States and additional research is needed to determine how results might differ in other countries. It also noted that the low certainty for some outcomes came from studies using inadequate randomisation methods and variability across studies, possibly due to small sample sizes, variation in the clinical characteristics of the participants, times of follow‐up, outcomes reliant on participant recall, and differences in intervention durations, or therapist effects. ᵃ Manualised treatment intended to increase AA participation is linear or modular to ensure it is replicable across time and different sites, which is key to confirming the results of different studies which evaluate the same treatment. ᵇ Self‐Management and Recovery Training (SMART); case management (work with a therapist establishing goals to overcome problems related with abstinence); cognitive behavioural therapy; or treatment as usual. ᶜ Results reported narratively (one quasi-RCT with 112 people found better ASI scores with AA/TSF compared with alternative clinical intervention [SMART]).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
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