It should be noted that although AA attempts to appeal to all religious and non-religious denominations, the spiritual content, including the Lord’s Prayer at the end of every session at some community settings and submitting to a “Higher Power”, may prevent certain individuals from participating in this program [65,66]. Additionally, there is evidence linking premorbid religiosity and positive connection to God with higher probability of AA membership [67]. This may become a deterrent to treatment for individuals who require the structure and intensity of inpatient care or supplementary support to outpatient programs but are reluctant to attend AA sessions frequently. Additionally, concomitant psychiatric conditions, such as attachment avoidance and anxiety, may make social engagement difficult for certain individuals and create ambivalence toward 12-step approaches to recovery [28].
Overall, the evidence seems to support involvement in an AA program, or something similar, in terms of successful outcomes. However, there appears no consistent evidence to suggest that involvement during an inpatient program is better than during an outpatient program.