NCSB Journal Summer 2026

LAWYER ASSISTANCE PROGRAM

The Evidence is In B Y R O B Y N N M O R A I T E S

spinoff 12-step fellowship 2 follows the same Twelve Traditions to govern themselves. These requests for evidence and proof of efficacy are considered outside issues that will draw the 12 step fellowships into public controversy. It stands to reason that in following tradition ten, no 12-step fellowship will ever defend its exis tence. Moreover, they do not need to. If they did not work, they would vanish because people would stop going. Since AA’s beginning in 1935, the only “evidence” of AA’s (and even tually other 12-step fellowships’) efficacy was their grassroots expansion around the world with increasing numbers of people getting clean and sober and carrying a message of hope and recovery to others. Enter John Kelly, PhD, 3 a Harvard re searcher and founder of Massachusetts General Hospital’s Recovery Research Institute. He came to Charlotte to speak in the fall of 2025, and I had the pleasure of attending his presen tation. The audience was a veritable Who’s Who in the addiction/treatment/recovery world. Why? Dr. Kelly has spent the last 30 years conducting treatment and recovery re search in the addiction field. As a part of his efforts, he has focused on collecting, analyzing, and documenting empirical evidence not only showing that 12-step fellowships work, but also how they work. I hope to highlight some key takeaways from his presentation in this ar ticle. For those interested in the unabridged version, feel free to visit the published synopsis on the research page of our website. 4 To begin, it was fascinating to see the recovery journey measured and quantified. 5 For example, we know from experience that it takes multiple serious conversations with concerned family members, friends, coworkers, and doctors (and often serious consequences like a DWI, divorce, unemployment, etc.) for a person with severe alcohol and other substance use disorder to finally acknowledge the problems and seek help. Alcohol and other substance use disorders are often progressive

The lawyer assistance movement got its start in the mid-1970s when lawyers started getting sober in Alcoholics Anonymous (AA). As they got sober, they realized that their drinking bud dies—typically other lawyers—could also ben efit from getting sober. In its earliest days, the lawyer assistance movement (both nationally and in North Carolina) was basically AA meet ings for lawyers. In the mid to late 1990s, the movement expanded to include mental health issues. Following the national trend, North Carolina’s program evolved from a purely vol unteer run organization of sober lawyers to an organization with clinical staff equipped to ad dress a range of mental health issues, including substance use disorder, while incorporating and maintaining the organized energy and enthu siasm of those early pioneer volunteers. Our peer support groups, whether substance use disorder related or mental health related, are largely modeled on AA’s peer support structure. The strength of our volunteer network is squarely rooted in our AA origins. So, LAP began out of AA and AA is the program of re covery that most of our participants recovering from substance use disorder use today to not only get sober, but to stay sober. Every few years someone emails me an ar ticle critical of AA and other 12-step fellowships as non-evidence-based. The authors inevitably promote their own book or treatment approach as a superior option (without evidence). Some times the authors go so far as to say that AA’s General Service Office (GSO) never responded to their requests for evidence proving that AA works. To begin with, AA GSO does not col lect this data. AA GSO does not even have a membership list. But there is another more important reason AA GSO does not respond to these requests. The Twelve Traditions are the set of rules that govern how AA operates. 1 Tradition ten states, “Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.” Every

diseases, so over time, if left untreated, symptoms continue to worsen (as do the attendant consequences). We also know it takes several years of continued recovery before the risk of relapse drastically drops. The research bears this out. At five years of continuous remission/sobriety, the risk for meeting criteria for an alcohol or other drug use disorder in the following year drops to 15%, which mirrors the risk of the annual general population risk for developing one of these disorders. The public health costs associated with ad diction are high. Alcohol use disorder alone imposes an estimated economic and public health burden reaching hundreds of billions of dollars annually (latest inflation-adjusted figure of approximately $349 billion, a figure which continues to rise). The direct healthcare costs associated with treating alcohol-related illnesses and injuries are estimated at $28-$35 billion annually. This includes emergency room visits, hospitalizations, treatment of liver diseases, and other alcohol-related medical conditions. The largest portion of the total burden, however, comes from lost workplace productivity, ac counting for more than 70% of the total eco nomic cost. As reported in 2022 for years 2015 2019, alcohol use disorder is responsible for

SUMMER 2026

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