A 2020 scientific review found that clinical interventions increasing AA participation via AA Twelve Step Facilitation (AA/TSF) had sustained remission rates 20-60% better than other well-established treatments regardless of demographics. Additionally, 4 of the 5 economic studies in the review found that AA/TSF lowered healthcare costs considerably.[lower-alpha 1][12][13][14] As for its association with the disease model of alcoholism, an otherwise receptive AA has not endorsed it, but many AA members have promoted it towards wider acceptance.[15]
In 1935, the recognized start of AA, Bill Wilson (Bill W.) first commiserated alcoholic-to-alcoholic with Bob Smith (Dr. Bob). Having met through AA's immediate precursor the Christian revivalistOxford Group, they fellowshipped there with other alcoholics until forming what became AA.[16] In 1939 the new fellowship, then mostly male and white, published Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism, also known as the Big Book and from which AA draws its name. All editions contain the twelve steps, and starting with the 1950 second edition, all subsequent editions have included the twelve traditions—fashioned so AA would stay as what Wilson called a "benign anarchy.[17][18][19]
AA's twelve steps are a suggested and continuing sobriety program of prayer, reflection, admission, better conduct and atonement, all to effect a “spiritual awakening”, after which members should take others through the steps, usually done by taking on sponsees. Divining and following the will of an undefined God—"as we understood Him", also designated as a “higher power”—is integral to the steps, but differing practices and beliefs, including those of atheists and other non-theists, are accommodated.[8]
The twelve traditions are guidelines to keep AA focused on altruistically helping others to recover from alcoholism. With AA's traditions membership goes to anyone professing a desire to stop drinking, and that all memberships should be kept anonymous, especially in public media, but no repercussions are prescribed for broken anonymity. Additionally the traditions have AA avoiding hierarchies, dogma, public controversies and other outside entanglements, or using AA for personal gain or public prestige. They also insist that no dues or fees are required, and to be self-supporting, no outside financial aid can be accepted.[20][21]
AA has allowed other recovery fellowships such as Narcotics Anonymous and Al-Anon to adopt and adapt the twelve steps and twelve traditions.[22]
Sobriety token or "chip", given for specified lengths of sobriety. On the back is the Serenity Prayer. Here green is for six months of sobriety; purple is for nine months.
AA was founded on 10 June 1935 but AA's origins are said to have begun when the renowned psychotherapist Carl Jung inspired Rowland H., an otherwise hopeless drunk, to seek a spiritual solution by sending him to the Oxford Group— a non-denominational, altruistic Christian movement modeled after first-century Christianity. Ebby Thacher got sober in that same Oxford Group and reached out to help his drinking buddy Bill Wilson.[23] Thacher approached Wilson saying that he had "got religion", was sober, and that Wilson could do the same if he set aside objections and instead formed a personal idea of God, "another power" or "higher power".[24][25] Feeling a "kinship of common suffering", Wilson attended his first group gathering, although he was drunk. Within days, Wilson admitted himself to the Charles B. Towns Hospital after drinking four beers on the way—the last alcohol he ever drank. Under the care of Dr. William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriantbelladonna.[26] At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.[27]
Following his hospital discharge, Wilson joined the Oxford Group and tried to recruit other alcoholics to the group. These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober. Dr. Silkworth suggested that Wilson place less stress on religion (as required by The Oxford Group) and more on the science of treating alcoholism.
Wilson's first success came during a business trip to Akron, Ohio, where he was introduced to Robert Smith, a surgeon and Oxford Group member who was unable to stay sober. After thirty days of working with Wilson, Smith drank his last drink on 10 June 1935, the date marked by AA for its anniversaries.[28]
The first female member, Florence Rankin, joined AA in March 1937,[29][30] and the first non-Protestant member, a Roman Catholic, joined in 1939.[31] The first Black AA group was established in 1945 in Washington, D.C. by Jim S., an African-American physician from Virginia.[32][33]
While writing the Big Book in the several years after 1935, Wilson developed the Twelve Steps, which were influenced by the Oxford Group's 6 steps and various readings, including William James's The Varieties of Religious Experience.[34][35]
The Big Book, the Twelve Steps, and the Twelve Traditions
To share their method, Wilson and other members wrote the initially-titled book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism,[36] from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a higher power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal, and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches.[37]
In 1941, interviews on American radio and favorable articles in US magazines, including a piece by Jack Alexander in The Saturday Evening Post, led to increased book sales and membership.[38] By 1946, as the growing fellowship quarreled over structure, purpose, authority, finances and publicity, Wilson began to form and promote what became known as AA's "Twelve Traditions", which are guidelines for an altruistic, unaffiliated, non-coercive, and non-hierarchical structure that limited AA's purpose to only helping alcoholics on a non-professional level while shunning publicity. Eventually, he gained formal adoption and inclusion of the Twelve Traditions in all future editions of the Big Book.[20] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[39] as AA had grown to millions of members internationally.[40]
In May of 2017, Alcoholics Anonymous World Services Inc. filed a lawsuit in the Supreme Court of the State of New York seeking to a return of the original manuscript of the Big Book from the then owner. AAWS claimed that the manuscript had been given to them as a gift in 1979.[41] This action was criticized by many members of Alcoholics Anonymous since they didn't want their parent organization engaged in lawsuits.[42] Alcoholics Anonymous World Services Inc. asked the court to voluntarily discontinue the action in November of 2017.[43]
A regional service center for Alcoholics Anonymous
AA says it is "not organized in the formal or political sense",[40] and Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy".[19] In Ireland, Shane Butler said that AA "looks like it couldn't survive as there's no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust". Butler explained that "AA's 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."[44]
In 2018, AA had 2,087,840 members and 120,300 AA groups worldwide.[40] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.[45]
A member who accepts a service position or an organizing role is a "trusted servant" with terms rotating and limited, typically lasting three months to two years and determined by group vote and the nature of the position. Each group is a self-governing entity, with AA World Services acting only in an advisory capacity. AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" of the 21-member AA Board of Trustees.[40]
AA groups are self-supporting, relying on voluntary contributions from members to cover expenses.[40] The AA General Service Office (GSO) limits contributions to US$5,000 a year.[46] "Below" the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.[20]
Like individual groups, the GSO is self-supporting. AA receives proceeds from books and literature that constitute more than 50% of the income for its GSO.[47] In keeping with AA's Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and the voluntary contributions of AA members and groups. It does not accept donations from people or organizations outside of AA.
In keeping with AA's Eighth Tradition, the Central Office employs special workers who are compensated financially for their services, but their services do not include working with alcoholics in need (the "12th Step").[48] (AA's 12th step is: "Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.")[49] All 12th Step calls that come to the Central Office are handed to sober AA members who have volunteered to handle these calls. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.[50]
AA's program extends beyond abstaining from alcohol.[51] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[52] through "an entire psychic change," or spiritual awakening.[53] A spiritual awakening is meant to be achieved by taking the Twelve Steps,[54] and sobriety is furthered by volunteering for AA[55] and regular AA meeting attendance[56] or contact with AA members.[54] Members are encouraged to find an experienced fellow alcoholic, called a sponsor, to help them understand and follow the AA program. The sponsor should preferably have experienced all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person.[55] Following the helper therapy principle, sponsors in AA may benefit from their relationship with their charges, as "helping behaviors" correlate with increased abstinence and lower probabilities of binge drinking.[57]
AA shares the view that acceptance of one's inherent limitations is critical to finding one's proper place among other humans and God. Such ideas are described as "Counter-Enlightenment" because they are contrary to the Enlightenment's ideal that humans have the capacity to make their lives and societies a heaven on Earth using their own power and reason.[51] After evaluating AA's literature and observing AA meetings for sixteen months, sociologists David R. Rudy and Arthur L. Greil found that for an AA member to remain sober, a high level of commitment is necessary. This commitment is facilitated by a change in the member's worldview. They argue that to help members stay sober, AA must provide an all-encompassing worldview while creating and sustaining an atmosphere of transcendence in the organization. To be all-encompassing, AA's ideology emphasizes tolerance rather than a narrow religious worldview that may make the organization unpalatable to potential members and thereby limit its effectiveness. AA's emphasis on the spiritual nature of its program, however, is necessary to institutionalize a feeling of transcendence. A tension results from the risk that the necessity of transcendence, if taken too literally, would compromise AA's efforts to maintain a broad appeal. As this tension is an integral part of AA, Rudy and Greil argue that AA is best described as a quasi-religious organization.[58]
AA meetings are gatherings where recovery from alcoholism is discussed. One perspective sees them as "quasi-ritualized therapeutic sessions run by and for, alcoholics".[59] There are a variety of meeting types some of which are listed below. At some point during the meeting a basket is passed around for voluntary donations. AA's 7th tradition requires that groups be self-supporting, "declining outside contributions".[20] Weekly meetings are listed in local AA directories in print, online and in apps.
Open vs Closed meetings
"Open" meetings welcome anyone—nonalcoholics can attend as observers.[60] Meetings listed as "closed" welcome those with a self-professed "desire to stop drinking," which cannot be challenged by another member on any grounds.[20]
Speaker meetings
At speaker meetings one or more members come to tell their stories.[61]
Big Book meetings
At Big Book meetings, attendees read from the AA Big Book and discuss it.[61]
Discussion meetings
There are also meetings with or without a topic that allow participants to speak up or "share".[62]
Online vs. offline meetings
Online meetings are digital meetings held on platforms such as Zoom. Offline meetings, also called "face to face", "brick and mortar", or "in-person" meetings, are held in a shared physical real-world location. Some meetings are hybrid meetings, where people can meet in a specified physical location, but people can also join the meeting virtually.
Specialized meetings
Building for Spanish-speaking AA group in Westlake neighborhood, Los Angeles
AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age,[63]sexual orientation,[64][65] or culture.[66][67] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[68][65]
Meeting formats
While AA has pamphlets that suggest meeting formats,[69][70] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[20] Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".[71]
Some medical professionals have criticized 12-step programs as "a cult that relies on God as the mechanism of action"[74] and as "overly theistic and outdated".[75] Others have cited the necessity of a "higher power" in formal AA as creating dependence on outside factors rather than internal efficacy.[75] A 2010 study found increased attendance at AA meetings was associated with increased spirituality and decreased frequency and intensity of alcohol use.[76][77] Since the mid-1970s, several 'agnostic' or 'no-prayer' AA groups have begun across the US, Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo the use of opening or closing prayers.[78][79]
More informally than not, AA's membership has helped popularize the disease concept of alcoholism which had appeared in the eighteenth century.[80] Though AA usually avoids the term disease, 1973 conference-approved literature said "we had the disease of alcoholism."[81] Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.[82]
AA's Big Book calls alcoholism "an illness which only a spiritual experience will conquer." Ernest Kurtz says this is "The closest the book Alcoholics Anonymous comes to a definition of alcoholism."[82] Somewhat divergently in his introduction to The Big Book, non-member and early benefactor William Silkworth said those unable to moderate their drinking suffer from an allergy. In presenting the doctor's postulate, AA said "The doctor's theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account."[83] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."[84] Wilson explained in 1960 why AA had refrained from using the term disease:
We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead, there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady—a far safer term for us to use.[85]
Since then medical and scientific communities have defined alcoholism as an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild).[86] The ten criteria are: alcoholism is a Primary Illness not caused by other illnesses nor by personality or character defects; second, an addiction gene is part of its etiology; third, alcoholism has predictable symptoms; fourth, it is progressive, becoming more severe even after long periods of abstinence; fifth, it is chronic and incurable; sixth, alcoholic drinking or other drug use persists in spite of negative consequences and efforts to quit; seventh, brain chemistry and neural functions change so alcohol is perceived as necessary for survival; eighth, it produces physical dependence and life-threatening withdrawal; ninth, it is a terminal illness; tenth, alcoholism can be treated and can be kept in remission.[87]
Canadian and United States demographics
AA's New York General Service Office regularly surveys AA members in North America. Its 2014 survey of over 6,000 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 62% male and 38% female.[88] The survey found that 89% of AA members were white.[88]
Average member sobriety is slightly under 10 years with 36% sober more than ten years, 13% sober from five to ten years, 24% sober from one to five years, and 27% sober less than one year.[88] Before coming to AA, 63% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 59% received outside treatment or counseling. Of those members, 84% said that outside help played an important part in their recovery.[88]
The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court-ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.[88]
Relationship with institutions
Hospitals
Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value in working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did.[89][90][91] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[92] Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.[93]
Prisons
In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program.[94] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[95] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[96]
United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed a religion, it was ruled that it contained enough religious components (variously described in Griffin v. Coughlin below as, inter alia, "religion", "religious activity", "religious exercise") to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution.[97][98] In 2007, the Ninth Circuit of the U.S. Court of Appeals stated that a parolee who was ordered to attend AA had standing to sue his parole office.[99][100]
United States treatment industry
In 1939, High Watch Recovery Center in Kent, Connecticut, was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12-step-based treatment center in the world still operating today.
In 1949, the Hazelden treatment center was founded and staffed by AA members, and since then many alcoholic rehabilitation clinics have incorporated AA's precepts into their treatment programs.[101] 32% of AA's membership was introduced to it through a treatment facility.[88]
Effectiveness
There are several ways one can determine whether AA works and numerous ways of measuring if AA is successful, such as looking at abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost.[12]
The effectiveness of AA (compared to other methods and treatments) has been challenged throughout the years,[102] but recent high quality clinical meta-studies using quasi-experiment studies show that AA costs less than other treatments and results in increased abstinence.[12][103] In longitudinal studies, AA appears to be about as effective as other abstinence-based support groups.[104]
Because of the anonymous and voluntary nature of AA meetings, it has been difficult to perform random trials with them. Environmental and quasi-experiment studies suggest that AA can help alcoholics make positive changes.[105][106][107]
In the past, some medical professionals have criticized 12-step programs as pseudoscientific[75][108] and "a cult that relies on God as the mechanism of action".[74][75][109] Until recently, ethical and operational issues had prevented robust randomized controlled trials from being conducted comparing 12-step programs directly to other approaches.[75] More recent studies employing randomized and blinded trials have shown 12-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.[110]
Cochrane 2020 review
A 2020 Cochrane review concluded that "compared to other well-established treatments, clinical linkage using well-articulated Twelve-Step Facilitation (TSF) manualized interventions intended to increase Alcoholics Anonymous (AA) participation" are more effective than other established treatments, such as motivational enhancement therapy (MET) and cognitive-behavioral therapy (CBT), as measured by abstinence rates.[111][112] Manualized TSF probably achieves additional desirable outcomes—such as fewer drinks per drinking day and less severe alcohol-related problems—at equivalent rates as other treatments, although evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".[111]
In response to a concern expressed by another addiction researcher that "those more strongly committed to total abstinence after receiving AA/TSF were likely to experience more protracted 'slips' if they did for any reason drink",[113] the Cochrane review authors stated that subjects who did not achieve abstinence did not have worse drinking outcomes overall.[114]
Older studies
A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate 16 years later for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment.[115][116] The study's results may be skewed by self-selection bias.[117][118]
Project MATCH was a 1990s 8-year, multi-site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment.[119]
Brandsma 1980 showed that Alcoholics Anonymous is more effective than no treatment whatsoever.[120]
Membership retention
In 2001–2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. Respondents were asked if they had ever attended a twelve-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105).[121] In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270).[121]
The popular press
The Sober Truth
American psychiatrist Lance Dodes, in The Sober Truth, says that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety.[122]
The 5–8% figure put forward by Dodes is controversial;[123] other doctors say that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure."[124][125] Addiction specialists state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong.[126][127] One review called Dodes' reasoning against AA success a "pseudostatistical polemic".[128]
Dodes has not, as of March 2020, read the 2020 Cochrane review showing AA efficacy, but opposes the idea that a social network is needed to overcome substance abuse.[129]
The Irrationality of Alcoholics Anonymous
In a 2015 article for The Atlantic, Gabrielle Glaser criticized the dominance of AA in the treatment of addiction in the United States.[130] Her article uses Lance Dodes's figures and a 2006 Cochrane report to state AA had a low success rate, but those figures were subsequently criticized by experts as outdated.[123][124][125] The Glaser article incorrectly conflates the efficacy of treatment centers with the efficacy of Alcoholics Anonymous.[131] The Glaser article says that "nothing about the 12-step approach draws on modern science", but a large amount of scientific research has been done with AA, showing that AA increases abstinence rates.[125] The Glaser article criticizes 12-step programs for being "faith-based", but 12-step programs allow for a very wide diversity of spiritual beliefs, and there are a growing number of secular 12-step meetings.[132][133]
"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates. A study in the Journal of Addiction Nursing sampled 55 women in AA and found that 35% of these women had experienced a "pass" and 29% had felt seduced at least once in AA settings. This has also happened with new male members who received guidance from older female AA members pursuing sexual company. The authors suggest that both men and women must be prepared for this behavior or find male or female-only groups.[134] Women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women.[135] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.[136]
Alcoholics Anonymous World Services has a safety flier which states that "Unwanted sexual advances and predatory behaviors are in conflict with carrying the A.A. message of recovery."[137]
Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics.[138] Along with Nancy Shute, Peele has advocated that besides AA, other options should be readily available to those problem drinkers who can manage their drinking with the right treatment.[139] The Big Book says "moderate drinkers" and "a certain type of hard drinker" can stop or moderate their drinking. The Big Book suggests no program for these drinkers, but instead seeks to help drinkers without "power of choice in drink."[140]
In 1983, a review stated that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[141] A 1985 study based on observations of AA meetings warned of detrimental iatrogenic effects of the twelve-step philosophy and concluded that AA uses many methods that are also used by cults.[142] A later review disagreed, stating that AA's program bore little resemblance to religious cult practices.[143] In 2014, Vaillant published a paper making the case that Alcoholics Anonymous is not a cult.[144]
Literature
Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[145] Two books are used primarily: Alcoholics Anonymous (the "Big Book") and Twelve Steps and Twelve Traditions, the latter explaining AA's fundamental principles in depth. The full text of each of these two books is available on the AA website at no charge.
Drunks – a 1995 film starring Richard Lewis as an alcoholic who leaves an AA meeting and relapses. The film cuts back and forth between his eventual relapse and the other meeting attendees.[156]
Come Back, Little Sheba – A 1952 film based on a play of the same title about a loveless marriage where the husband played by Burt Lancaster is an alcoholic who gets help from two members of the local AA chapter.[157] A 1977 TV drama was also based on the play.
You Kill Me – a 2007 crime-comedy film starring Ben Kingsley as a mob hit man with a drinking problem who is forced to accept a job at a mortuary and go to AA meetings.[160][161]
Smashed – a 2012 drama film starring Mary Elizabeth Winstead. An elementary school teacher's drinking begins to interfere with her job, so she attempts to get sober in AA.[162]
Flight — a 2012 film starring Denzel Washington as an alcoholic airline pilot. The movie includes a dramatic representation of a prison AA meeting.[164]
In CBS' Elementary, Jonny Lee Miller plays an adaptation of Sherlock Holmes who is a recovering drug addict. Several episodes are centered around AA meetings and the process of recovery.[165]
↑ "Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."[11]
Related Research Articles
Alcoholism is the drinking of alcohol to the point that causes problems, and continuing to drink even after problems arise. Problematic use of alcohol has been mentioned in the earliest historical records, such as in ancient Egypt and in the Bible, and remains widespread; the World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are stigmatizing and discourage seeking treatment, so clinical diagnostic terms such as alcohol use disorder or alcohol dependence are used instead.
Twelve-step programs are international mutual aid programs supporting recovery from substance addictions, behavioral addictions and compulsions. Developed in the 1930s, the first twelve-step program, Alcoholics Anonymous (AA), founded by Bill Wilson and Bob Smith, aided its membership to overcome alcoholism. Since that time dozens of other organizations have been derived from AA's approach to address problems as varied as drug addiction, compulsive gambling, sex, and overeating. All twelve-step programs utilize a version of AA's suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.
Rational Recovery was a commercial vendor of material related to counseling, guidance, and direct instruction for addiction designed as a direct counterpoint to Alcoholics Anonymous (AA) and twelve-step programs.
William Griffith Wilson, also known as Bill Wilson or Bill W., was the co-founder of Alcoholics Anonymous (AA).
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.
Dry drunk is an expression that describes an alcoholic who no longer drinks but otherwise maintains the same behavior patterns of an alcoholic. The objective of groups such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) is not just to help their members stop abusing drugs and alcohol. It is asserted in these programs that addiction is more systemic than a "bad habit" and is fundamentally caused by self-centeredness. Long term membership in Alcoholics Anonymous has been found to reform pathological narcissism, and those who are sober but retain characteristics associated with addiction are known in AA as dry drunks. The term is used by AA in relation to feelings of anger, depression and resentment.
Higher Power is a term used in Alcoholics Anonymous (AA) and other twelve-step programs. The same groups use the phrases "a power greater than ourselves" and "God of our understanding" synonymously. The term is intentionally vague because the program is not tied to a particular religion or spiritual tradition; members may use it to refer to any supreme being or deity, another conception of God, or even non-supernatural things such as the twelve-step program itself.
The term Oxford House refers to any house operating under the "Oxford House Model", a community-based approach to addiction recovery, which provides an independent, supportive, and sober living environment. Today there are nearly 3,000 Oxford Houses in the United States and other countries.
Al-Anon Family Groups, founded in 1951, is an international mutual aid organization for people who have been impacted by another person's alcoholism. In the organization's own words, Al-Anon is a "worldwide fellowship that offers a program of recovery for the families and friends of alcoholics, whether or not the alcoholic recognizes the existence of a drinking problem or seeks help." Alateen "is part of the Al-Anon fellowship designed for the younger relatives and friends of alcoholics through the teen years".
Crystal Meth Anonymous (CMA) is a California-based non-profit, public-benefit corporation founded in 1994. The members of the fellowship of Crystal Meth Anonymous work a twelve-step program of recovery with recovering crystal meth addicts. Participants in local groups meet in order to help others recover from methamphetamine addiction. CMA advocates complete abstinence from methamphetamine, alcohol, inhalants, and all other psychoactive drugs not taken as prescribed.
Nicotine Anonymous (NicA) is a twelve-step program founded in 1982 for people desiring to quit smoking and live free of nicotine. As of July 2017, there are over 700 face-to-face meetings in 32 countries worldwide with the majority of these meetings occurring in the United States, Iran, India, Canada, Brazil, the United Kingdom, Australia, Russia and in various online community and social media platforms.. NicA maintains that total abstinence from nicotine is necessary for recovery. NicA defines abstinence as “a state that begins when all use of nicotine ceases.
Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction. Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programs may advocate a reduction in the use of drugs rather than outright abstention. One survey of members who found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. Although there is not a difference in whether group or individual therapy is better for the patient, studies show that any therapy increases positive outcomes for patients with substance use disorder. The survey found group participation increased when the individual members' beliefs matched those of their primary support group. Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs and to a lesser level in non-religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for the twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organizations for Sobriety.
Alcoholics Anonymous (AA) is a global fellowship founded in 1935 by Bill Wilson and Robert Smith, and has since grown to be worldwide
SMART Recovery is an international community of peer support groups that help people recover from addictive and problematic behaviors, using a self-empowering and evidence-informed program. SMART stands for Self-Management and Recovery Training. The SMART approach is secular and research-based. SMART has a global reach, with a presence established in more than 30 countries. SMART Recovery is effective with a range of addictive and problematic behaviors
LifeRing Secular Recovery is a secular, non-profit organization providing peer-run addiction recovery groups. The organization provides support and assistance to people seeking to recover from alcohol and drug addiction, and also assists partners, family members and friends of addicts or alcoholics. It is an abstinence-based recovery program with three fundamental principles: sobriety, secularity and self-empowerment. The motto of LifeRing is "empower your sober self."
Secular Organizations for Sobriety (SOS), also known as Save Our Selves, is a non-profit network of autonomous addiction recovery groups. The program stresses the need to place the highest priority on sobriety and uses mutual support to assist members in achieving this goal. The Suggested Guidelines for Sobriety emphasize rational decision-making and are not religious or spiritual in nature. SOS represents an alternative to the spiritually based addiction recovery programs such as Alcoholics Anonymous (AA). SOS members may also attend AA meetings, but SOS does not view spirituality or surrendering to a Higher Power as being necessary to maintain abstinence.
Women for Sobriety (WFS) is a non-profit secular addiction recovery group for women with addiction problems. WFS was created by sociologist Jean Kirkpatrick in 1976 as an alternative to twelve-step addiction recovery groups like Alcoholics Anonymous (AA). As of 1998 there were more than 200 WFS groups worldwide. Only women are allowed to attend the organization's meetings as the groups focus specifically on women's issues. WFS is not a radical feminist, anti-male, or anti-AA organization.
Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism is a 1939 basic text, describing how to seek recovery from alcoholism. Written by William G. "Bill W." Wilson, one of the founders of Alcoholics Anonymous, and many of the first 100 members of the group, the composition process was collaborative, with drafts of the book being sent back and forth between Bill W.'s group in New York and Robert Holbrook Smith, the other AA founder, in Akron, Ohio. It is the predecessor of the seminal "twelve-step method" widely used to treat many addictions, from alcoholism, heroin addiction and marijuana addiction to overeating, sex addiction and gambling addiction, with a strong spiritual and social emphasis. It is one of the best-selling books of all time, having sold 30 million copies. In 2011, Time magazine placed the book on its list of the 100 best and most influential books written in English since 1923, the year in which the magazine was first published. In 2012, the Library of Congress designated it as one of 88 "Books that Shaped America."
Heroin Anonymous (HA) is a non-profit group founded in Phoenix, AZ in 2004 to help people addicted to heroin remain substance-free. Modeled after Alcoholics Anonymous, HA is a fellowship of people addicted to heroin who meet regularly to help each other practice complete abstinence from all drugs and alcohol. Heroin Anonymous does not provide drug counseling, medical or psychiatric treatment, or chemical dependency treatment.
Outpatient Treatment of Alcoholism is a book by Jeffery Brandsma, Maxie C. Maultsby Jr., and Richard J. Welsh, published in 1980. It describes a study of 260 individuals, 184 referred by the courts and 76 self-referred or referred by other agencies for 210 days. Participants were assigned randomly within five groups: AA-like meetings, RBT therapy administered by a non-professional, RBT therapy administered by degreed professionals, Insight Therapy administered by professionals, and a control group which received no treatment.
1 2 AA Grapevine (15 May 2013), A.A. Preamble(PDF), AA General Service Office, archived(PDF) from the original on 9 October 2022, retrieved 13 May 2017
↑ Chappel, JN; Dupont, RL (1999). "Twelve-Step and Mutual-Help Programs for Addictive Disorders". Psychiatric Clinics of North America. 22 (2): 425–46. doi:10.1016/S0193-953X(05)70085-X. PMID10385942.
↑ Schaberg, William H. (2019). Writing The big book: the creation of A.A. Las Vegas, NV. ISBN9781949481297.{{cite book}}: CS1 maint: location missing publisher (link)
↑ This first sentence has been revised to reflect conclusions drawn by William Schaberg's exhaustive research into 1930s AA documents. The results published in Writing the Big Book (2019) clarify many details, rewriting history. Many statements made online, and in earlier books, including Susan Cheever's book referenced next, need to be reconsidered.
↑ Anonymous, Alcoholics. "AA Big Book, preface"(PDF). Alcoholics Anonymous. Anonymous Press. Archived(PDF) from the original on 9 October 2022. Retrieved 25 December 2016.
↑ Jack Alexander (1 March 1941). "Alcoholics Anonymous"(PDF). Saturday Evening Post (Reprinted in booklet formed.). Alcoholics Anonymous World Services. ISBN978-0-89638-199-5. Archived from the original(PDF) on 2 December 2008. Retrieved 12 December 2009.
↑ "GSO 2007 Operating Results". Alcoholics Anonymous General Services Office. Archived from the original on 27 November 2008. Retrieved 12 December 2009. Gross Profit from Literature ≈8,6M (57%), Contributions ~$6.5M (43%)
1 2 Humphreys, Keith; Kaskutas, Lee Ann (1995). "World Views of Alcoholics Anonymous, Women for Sobriety, and Adult Children of Alcoholics/Al-Anon Mutual Help Groups". Addiction Research & Theory. 3 (3): 231–243. doi:10.3109/16066359509005240.
↑ "A Newcomer Asks."(PDF). Alcoholics Anonymous World Services, Inc. 1980. Archived(PDF) from the original on 15 March 2009. Retrieved 12 December 2009.
↑ Rudy, David R.; Greil, Arthur L. (1989). "Is Alcoholics Anonymous a Religious Organization?: Meditations on Marginality". Sociological Analysis. 50 (1): 41–51. doi:10.2307/3710917. JSTOR3710917.
↑ Leach, Barry; Norris, John L.; Dancey, Travis; Bissell, Leclair (1969). "Dimensions of Alcoholics Anonymous: 1935–1965". Substance Use & Misuse. 4 (4): 509. doi:10.3109/10826086909062033.
↑ The A.A. Group(PDF), New York: Alcoholics Anonymous World Services, 19 October 2016 [1990], archived(PDF) from the original on 9 October 2022, retrieved 29 May 2017
↑ Is A.A. for You?(PDF), New York: Alcoholics Anonymous World Services, 11 January 2017, archived(PDF) from the original on 9 October 2022, retrieved 14 May 2017[bettersourceneeded]
↑ Cheever, Susan (14 June 1999). "Bill W.: The Healer". Time. p.201. Archived from the original on 6 March 2008. Retrieved 12 June 2013. by helping another alcoholic, he could save himself
↑ "Corrections Workbook"(PDF). New York: Alcoholics Anonymous Word Services, Inc. 1995. Archived from the original(PDF) on 25 October 2010. Retrieved 12 December 2009.
↑ "Corrections Catalog". Archived from the original on 28 November 2008. Retrieved 12 December 2009. The titles include: Carrying the Message into Correctional Facilities, Where Do I Go From Here?, A.A. in Prison: Inmate to Inmate, A.A. in Correctional Facilities, It Sure Beats Sitting in a Cell, Memo to an Inmate Who May be an Alcoholic, A Message to Corrections Administrators
↑ Honeymar (1997). "Alcoholics Anonymous As a Condition of Drunk Driving Probation: When Does It Amount to Establishment of Religion". Columbia Law Review. 97 (2): 437–472. doi:10.2307/1123367. JSTOR1123367.
↑ Inouye v. Kemna,504F.3d705, 714 n.9(9th Cir.2007)("[T]he AA/NA program involved here has such substantial religious components that governmentally compelled participation in it violated the Establishment Clause.").
↑ Ferri, Marcia; Amato, Laura; Davoli, Marina (19 July 2006). "Alcoholics Anonymous and other twelve-step programmes for alcohol dependence". Cochrane Database of Systematic Reviews (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID16856072. no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems
↑ Szalavitz, Maia (2016). Unbroken Brain: A Revolutionary New Way of Understanding Addiction. the research that does show AA to be effective is overwhelmingly flawed by what is known as selection bias.
↑ Keith Humphreys. "Here's proof that Alcoholics Anonymous is just as effective as professional psychotherapies". The Washington Post. Archived from the original on 31 May 2016. Retrieved 29 May 2018. AA skeptics were confident that by putting AA up against the best professional psychotherapies in a highly rigorous study, Project MATCH would prove beyond doubt that the 12-steps were mumbo jumbo. The skeptics were humbled: Twelve-step facilitation was as effective as the best psychotherapies professionals had developed.
1 2 Kaskutas, Lee Ann; Ye, Yu; Greenfield, Thomas K.; Witbrodt, Jane; Bond, Jason (30 June 2008). "Epidemiology of Alcoholics Anonymous Participation". Recent Developments in Alcoholism. Vol.18. pp.261–282. doi:10.1007/978-0-387-77725-2_15. ISBN978-0-387-77724-5. PMID19115774.
↑ Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN978-0-8070-3315-9. University of California professor Herbert Fingarette cited two [...] statistics: at eighteen months, 25 percent of people still attended AA, and of those who did attend, 22 percent consistently maintained sobriety. [Reference: H. Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988)] Taken together, these numbers show that about 5.5 percent of all those who started with AA became sober members.
1 2 Singal, Jesse (17 March 2015). "Why Alcoholics Anonymous Works". The Cut. Retrieved 25 December 2017. [Lance Dodes] has estimated, as Glaser puts it, that "AA's actual success rate [is] somewhere between 5 and 8 percent," but this is a very controversial figure among addiction researchers.
1 2 Beresford, Thomas (2016), Alcoholics Anonymous and The Atlantic: A Call For Better Science, National Council on Alcoholism and Drug Dependence, archived from the original on 15 July 2019, retrieved 16 July 2019, [Herbert Fingarette used] two publications from the Rand Corporation [...] At 4-year follow-up the Rand group identified patients with at least one year abstinence who had been regular members of AA 18 months after the start of treatment: 42% of the regular AA members were abstinent, not the "calculated" 5.5% figure.
1 2 3 Emrick, Chad; Beresford, Thomas (2016). "Contemporary Negative Assessments of Alcoholics Anonymous: A Response". Alcoholism Treatment Quarterly. 34 (4): 463–471. doi:10.1080/07347324.2016.1217713. S2CID151393200.
↑ Humphreys, Keith; Moos, Rudolf (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. PMID11371720. 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB [cognitive-behavioral] programs, p < 0.001)
↑ Bogart, Cathy J.; Bogart, Cathy J. (2003). "'13th-Stepping:' Why Alcoholics Anonymous Is Not Always a Safe Place for Women". Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions. 14 (1): 43–47. doi:10.1080/10884600305373. ISSN1548-7148. OCLC34618968. S2CID144935254.
↑ Sanders, Jolene M. (2010). "Acknowledging Gender in Women-Only Meetings of Alcoholics Anonymous". Journal of Groups in Addiction & Recovery. 5: 17–33. doi:10.1080/15560350903543766. S2CID144776540. AA has evolved in a dialectical fashion to become more accommodating to women
↑ Questions and Answers on Sponsorship, page 10. 2005.
↑ Levinson, D (1983). "Current Status of the Field: An Anthropological Perspective on the Behavior Modification Treatment of Alcoholism". In Galanter, Marc (ed.). Genetics Behavioral Treatment Social Mediators and Prevention Current Concepts in Diagnosis. Recent Developments in Alcoholism. Vol.1. New York: Plenum Press. pp.55–261. doi:10.1007/978-1-4613-3617-4_14. ISBN978-1-4613-3619-8. ISSN0738-422X. PMID6680227.
↑ Right, KB (1997). "Shared Ideology in Alcoholics Anonymous: A Grounded Theory Approach". Journal of Health Communication. 2 (2): 83–99. doi:10.1080/108107397127806. PMID10977242.
↑ Vaillant, George (2014). "Positive Emotions and the Success of Alcoholics Anonymous". Alcoholism Treatment Quarterly. 32 (2–3): 214–224. doi:10.1080/07347324.2014.907032. S2CID144153785. What differentiates AA from universities, religions, and, of course, cults, is that AA, by experimentation during its first few years and perhaps guided by the outcomes of the alcoholics whom it was trying to heal, evolved along the lines of biological spirituality, not superstitious religion or institutional greed.
↑ Linden, Sheri (18 May 2012). "'Bill W.' cuts through the anonymity". Los Angeles Times. Los Angeles. Retrieved 22 May 2012. Laudatory but never simplistic, "Bill W." is a thoroughly engrossing portrait of Wilson, his times and the visionary fellowship that is his legacy.
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Peele, Stanton (1999). The Diseasing of America: how we allowed recovery zealots and the treatment industry to convince us we are out of control. San Francisco: Jossey-Bass. ISBN978-0-7879-4643-2. OCLC39605271.
Questions & Answers on Sponsorship(PDF), Alcoholics Anonymous World Services, Inc, 16 June 2016, archived(PDF) from the original on 25 March 2009, retrieved 13 May 2017
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