Alcoholics Anonymous (AA) is an informal society for recovering alcoholics.^[1] AA members meet in local groups that vary in size from a handful to many hundreds of individuals. In 2001 there were 100,000 groups worldwide, making a global community of more than approximately two million recovering alcoholics^[2]. Although Alcoholics Anonymous has a central communication office, each group is essentially autonomous.

The stated primary purpose of the society is "to stay sober and help other alcoholics to achieve sobriety."^[3] AA was the first 12-step program and has been the model for similar recovery groups such as Al-Anon/Alateen, Gamblers Anonymous, Narcotics Anonymous, Sexaholics Anonymous, and Overeaters Anonymous. Al-Anon and Alateen are companion programs designed to provide support for relatives and friends of alcoholics.

AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis;^[4][5] the society in turn offers a community of recovering people who support each other by "sharing experience, strength and hope"^[6] and often by working the Twelve Suggested Steps together.

AA History

Pre-AA understanding of alcoholism

Until 1934, alcoholics without the financial means to hire a psychiatrist or admit themselves to a private sanitarium could find help only through state hospitals, jails, rescue missions, the Salvation Army, religious evangelists, or street ministries. The founding of Alcoholics Anonymous marked the first approach to supporting the sustained recovery of alcoholics, regardless of financial standing. ^{[citation needed]} Additionally, it was the first approach to combine the faith of religious people, the knowledge of medical people, and the experience-sharing capabilities of alcoholics who knew how to get well into a dedicated support group.^{[citation needed]}

AA was initiated by Bill Wilson, a Wall Street stock speculator, and Dr. Bob Smith, a surgeon from Akron, Ohio, both alcoholics. The two met on May 12, 1935. Wilson had been sober for five months when he met Smith, although he had struggled with sobriety for years. During his struggles, Wilson had made several important discoveries about his own alcoholism.

Wilson had been influenced by the opinions of Swiss psychiatrist Carl G. Jung, who believed that alcoholism could be cured by a genuine conversion, and William James, a Harvard philosophy and psychology professor who believed that recovery by conversion had been sporadically taking place for centuries in churches, rescue missions, and the Salvation Army.^[7] William Duncan Silkworth, a New York doctor, told Wilson that alcoholism was not a moral weakness. Silkworth told Wilson that alcoholics had a mental obsession that gave them reasons to return to alcohol after periods of sobriety, even when they knew that they would then develop overwhelming cravings. In addition, Silkworth theorized that alcoholism was akin to an allergy, in the sense that it produced abnormal reactions to alcohol that were not observed in nonalcoholic drinkers. He called it a "phenomenon of craving"; with the first drink, the alcoholic finds it virtually impossible to stop. The "obsession" was the desire to start drinking, and the "allergy" was the compulsion to continue. His theory explained the enormous recidivism rate of alcoholics. Silkworth was also familiar with the writings and theories of Jung and James.^[8]

Dr. William Silkworth, a pioneer in studying alcoholism, was one of the first physicians to deduce from his study of alcoholics that alcoholism was a disease two-fold in nature: that it was both a physical allergy and a mental obsession. As the craving, the physical allergy for alcohol -- be it a pattern of daily evening drinking, weekend binges, or episodic drunkenness -- becomes more and more ingrained, the mental obsession or delusion drives the person to believe that, despite the often severe consequences of the last drinking episode, no harm will be done by the next drink. Dr. Silkworth stated that the two primary protectors of health, reason and will, were of no use against this disease. He shared what he had learned with his patient Bill Wilson.

This approach was used by one of Wilson's old drinking buddies, Ebby Thacher, to help treat his addiction. Thacher had learned about the spiritual approach from Rowland Hazard, an American alcoholic and business executive who had undergone treatment with Jung. After a prolonged and unsuccessful period of therapy, Jung told Rowland that his case, like that of most alcoholics, was nearly hopeless. Rowland was horrified and begged Jung to tell him anything that might help. Jung replied there was only one hope: a genuine spiritual conversion.^[9] History, he said, had recorded examples of recovery from alcoholism that appeared solely attributable to the spiritual conversion of the alcoholic. He told Rowland to seek out a conversion in a religious atmosphere.^[10]

AA's origins: The Oxford Group

Upon returning to America, Rowland Hazard became a member of the Oxford Group^[11] and mastered their life-changing techniques to overcome alcoholism. The group was a self-styled first-century Christian movement founded by Frank Buchman, a Protestant evangelist, circa 1919. It advocated finding God through a surrender to Him, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. It appeared from the successes of several alcoholics in the Oxford Group that a conversion experience (which they chose to call a spiritual experience, and later a "change") would relieve alcoholics of the mental obsession that kept pulling them back to alcohol after periods of sobriety.

Wilson later credited AA's ideas of self-examination, acknowledgment of character defects, restitution for harm done, and working with others, to the teachings of Wilson's friend, Rev. Samuel Moor Shoemaker and the Oxford Group.^[12] Later, in an article published in AA's Grapevine, Wilson said that every idea in Steps Three through Twelve came directly from Shoemaker's teaching.^[13]

The conversions of Ebby and Bill

Rowland Hazard had passed along to Ebby Thacher (an old school friend and drinking companion of Wilson's) Jung's solution of conversion as well as the Oxford Group's life-changing principles. Rescuing Thacher from incarceration for inebriation, Rowland and a couple of Oxford Group friends lodged Thacher at Shoemaker's Calvary Rescue Mission. It was there that Ebby Thatcher obtained a copy of the book, The Varieties of Religious Experience. Philosopher-psychologist William James (1842-1910) was intrigued with mystical, existential experiences that people reported to him. He contended that such experiences were superior to any religious doctrine. He did not care about the religious persuasion of mystics as long as they achieved a personal experience.

Thacher visited his old friend Bill Wilson, who was still drinking heavily. Thacher told Wilson about his experience at the Rescue Mission. In Wilson's own words: "But my friend sat before me, and he made the point-blank declaration that God had done for him what he could not do for himself."^[14]

Wilson could see that his friend, who was once as hopelessly alcoholic as he was, had found something. Yet, as much as Wilson wanted to stop drinking, he still found it hard to accept his friend's attestation:

"Despite the living example of my friend there remained in me the vestiges of my old prejudice. The word God still aroused a certain antipathy. When the thought was expressed that there might be a God personal to me this feeling was intensified. I didn't like the idea. I could go for such conceptions as Creative Intelligence, Universal Mind, or Spirit of Nature, but I resisted the thought of a Czar of the Heavens, however loving His sway might be. I have since talked with scores of men who felt the same way.

"My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?'

"That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last."^[15]

Still drinking, and a few days after his conversion at the Mission, Wilson returned to the hospital, announced that he had "found something," and decided to call on the "Great Physician" Silkworth had told him about.Cite error: A <ref> tag is missing the closing </ref> (see the help page).

Wilson questioned whether he had a genuine conversion or was on the verge of madness. Silkworth advised him that "hopeless alcoholics" sometimes report conversion experiences before being "turned around" toward recovery. Thacher brought Wilson a copy of William James's Varieties of Religious Experience. Silkworth had also read this book, which contained many conversion accounts. Wilson spent the better part of the day poring over its contents and concluded that his experience was like those reported by James.^[8] Silkworth advised Wilson that he had undergone a genuine conversion. In AA Comes of Age, Wilson states that Silkworth "reminded me of Professor William James's observation that truly transforming spiritual experiences are nearly always founded on calamity and collapse."

Wilson could hardly have escaped reading the dramatic tales of other alcoholics' conversions at the altar of rescue missions that James's book contained. And, in fact, it was Thacher who had first gone to Calvary Rescue Mission and knelt at the altar, concluding: "I've got religion." Wilson in turn went to Calvary Rescue Mission, listened to the hymns, Bible reading, and testimonials, and then went to the altar himself. Wilson twice wrote in his autobiographical manuscripts, "For sure, I'd been born again;" and wrote a letter stating he too had "got religion." Wilson was no stranger to such conversion experiences since his grandfather Willie Wilson had gone through such an experience on Mount Aeolus in East Dorset, Vermont; had reported details almost identical to those Bill reported; had rushed to the altar of the local Congregational Church; had announced that he had been saved; and never drank again for the rest of his life.^[16]

A new program for recovery

In keeping with practices in the Salvation Army, the missions, and the Oxford Group, Bill Wilson bought into the slogan: "You have to give it away to keep it." Importantly, Wilson found that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. Wilson was on the verge of a relapse on a business trip to Akron. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. Bob Smith's little group of Oxford Group people and alcoholic families had been praying for him for healing from his alcoholism, and Smith was eventually converted.^[17] When Wilson called Henrietta Seiberling, she exclaimed, "You are manna from heaven," and introduced Wilson to Smith. Wilson presented his ideas on spiritual healing to Smith, and the two struck up a solid friendship. For three months, they studied the Bible, held long discussions, and reviewed Oxford Group ideas. Together they fashioned Akron's pioneer recovery program.^[18] Smith's last drink is said to have been on June 10, 1935, and that is considered within AA to be the date of the founding of AA.

The "Big Book"

The first AA book, Alcoholics Anonymous,^[5] was published in 1939 and has been a perennial best-seller ever since. When work began on the manuscript, there were about 40 alcoholics who had maintained sobriety; by the time it was published in the Spring of 1939, there were seventy-plus. While several titles for the book were proposed (including "The Way Out", which was already in use), Bill Wilson and Dr. Bob finally settled on "Alcoholics Anonymous". The fellowship itself eventually took its name from the book. The first edition had a "circus cover" of red and yellow, and it was printed in heavy paper and large size, which was thought to make it more saleable—hence the nickname "Big Book", a name that sticks today even though AA has published it in a more conventional size. Sales of the book—and the popularity of AA—increased rapidly after positive articles in Liberty magazine in 1939^[19] and the Saturday Evening Post in 1941.^[20] The 4th edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter called "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each successive edition, the personal stories have been reviewed to represent the current population of AA, with the result that the stories of the original members of the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were gathered together in the book "Experience, Strength, and Hope."

How the AA program works

AA provides a sense of support for members attending regular meetings. This is described in the GSO-approved AA pamphlet, "What is Alcoholics Anonymous?" "We are a Fellowship of men and women who have lost the ability to control our drinking and have found ourselves in various kinds of trouble as a result of drinking. We attempt—most of us successfully—to create a satisfying way of life without alcohol. For this we find we need the help and support of other alcoholics in A.A.[1] AA's literature holds that the essence of the program is having a "spiritual awakening" through working the Twelve Steps.

The Steps are sometimes summarized as "Trust God, Clean House, and Help Others." Each edition of AA's Big Book makes it clear that the end result of following the suggested Steps is finding God "as we understood Him" and establishing a relationship with Him. One description of meetings comes from Dr. W.W. Bauer, who spoke for the American Medical Association in 1946 when he stated "Alcoholics Anonymous are no crusaders: not a temperance society. They know that they must never drink. They help others with similar problems...In this atmosphere the alcoholic often overcomes his excessive concentration upon himself. Learning to depend upon a higher power and absorb himself in his work with other alcoholics, he remains sober day by day. The days add up into weeks, the weeks into months and years."^[21]

AA members are encouraged to "work the Steps", usually with the guidance of a voluntary sponsor (a sponsor is a more experienced member who has worked and is working the Steps). The Steps are designed to help the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Many AA members believe finding God through the application of the Steps has freed them entirely from the urge to drink alcohol. Both AA's founders Dr. Bob and Bill W. stated that they had recovered from alcoholism, as did "AA Number Three" Bill Dotson.^[22] Whereas staying sober was once difficult and uncertain, these members reported that sobriety was now much easier, provided they keep enlarging their spiritual life.

However, many atheists and agnostics have achieved long-term sobriety in the fellowship of Alcoholics Anonymous, without compromising their philosophical principles. AA offers much freedom, both to groups and to individuals; it has been described as "a fellowship of people working their individual programs". There are now AA groups for atheists and agnostics, with such names as "We Humanists" or "Village Agnostics". Some of AA's atheists and agnostics reject the Steps completely, whereas others modify them to eliminate religious references.^[23] For non-religious members, the AA program consists of the Fellowship (sharing experience, strength and hope) and the 24-Hour Program (staying away from the first drink, a day at a time).

Some members regard attendance at AA meetings as important to their sobriety (although there are groups in AA made up of lone members living in remote locations who communicate by phone, mail and internet). Many members who achieved initial sobriety through AA believe, after a time, that they have completed their recovery and no longer participate in meetings, however most studies done show that regular meeting attendance significantly improves the chances of continued sobriety. With the above in mind, a typical individual program of recovery for a newcomer may include:

• Above all, avoiding the first drink. "One [drink] is too many and a thousand [drinks] never enough."
• Attendance at one or more meetings per day for 90 days or longer. Some people coming into AA have attended meetings daily for the first year. While this recommendation is found nowhere in AA literature, it is often heard in meetings and many sponsors, having attended "90-in-90" themselves as newcomers, strongly advise sponsees to do the same. Some suggest that this recommendation may have originally come out of treatment centers; graduating patients were advised to attend many AA meetings, presumably in an effort to acquire a new peer group of abstinent friends to reinforce the effects of treatment. Within AA, this is referred to as "staying away from slippery people and slippery places" or "changing playgrounds and playmates".
• Asking a Power greater than themselves for strength and guidance.
• Contact with one's sponsor daily in order to work the Steps and to discuss life problems which may, if not addressed, lead the alcoholic to take the first drink.
• Daily prayer and meditation, as suggested by Step Eleven: "Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out."
• Daily attention to Step Ten: "Continued to take personal inventory and when we were wrong, promptly admitted it."
• Service work, which, for the newcomer, can be as simple as making coffee at meetings or helping to set up and break down tables and chairs. These are known as commitments.

It will be noted that the program is to be worked daily. Dr. Bob cited the Sermon on the Mount for the phrase 'One day at a time.' Members of AA frequently say, "I'm a winner today, no matter what happens, as long as I don't pick up that first drink."

A common feature of AA meetings is that members are asked to speak to the group about their experience with alcoholism and recovery. However, there is no requirement to speak. Some members speak at every meeting; others simply sit and listen in meetings for years before they say anything; some may choose never to speak.

The 12 Steps of Alcoholics Anonymous

1. We admitted we were powerless over alcohol--that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. 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.

The organization of the society

Alcoholics Anonymous has an informal control structure, for example there is no hierarchy of leaders. A member who accepts a service position (an organizing role in a group) within the society is known only as a "trusted servant." His commitment is held for a period of time (typically three months to one year), after which he relinquishes the duty to another member chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities as each meeting, small or large, is considered a self-supporting and self-governing entity.

At the local and national level, AA groups are self-supporting and not a charity. The society has no membership fees and does not charge to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs such as room rental and refreshments. Contributions from members are limited to a maximum annual amount of $2000 per year, though most only donate $1-$2 per meeting^{[citation needed]}.

Alcoholics Anonymous does receive proceeds from the sale of its book Alcoholics Anonymous, along with other published books and literature, which are periodically revised. Revenues from literature sales constitute more than 50% of the income for the General Service Office (GSO)^{[citation needed]}, which unlike individual groups is not self-supporting through contributions and does have a small number of salaried staff.

Additional to the GSO, Alcoholics Anonymous also maintains a few service centers, which have the task of coordinating activities like the printing of literature, responding to public inquiries and organizing state or national conferences. Funded by local members, the centers are directly responsible to the AA groups in the region or country they represent.

Alcoholics Anonymous is exclusively served by people who identify themselves as alcoholics with the exception that seven of the 21 members of the AA Board of trustees are listed as “nonalcoholic friends of the fellowship”^[24]).

AA's definition of alcoholism

In the article Alcoholics Anonymous and the Disease Concept of Alcoholism, AA historian Ernest Kurtz wrote, "The closest the book Alcoholics Anonymous comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the 'We Agnostics' chapter, where we are told that alcoholism 'is an illness which only a spiritual experience will conquer'."^[25] In 1960, Bill Wilson gave a speech to the National Catholic Clergy Conference on Alcoholism. During the ensuing question and answer discussion, Wilson was asked why he did not use the term disease when he spoke of alcoholism in that speech. He replied,

"We AA's 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 do not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always call it an illness, or a malady, -- a far safer term for us to use."^[26]

Although AA lacks an official, singular definition of alcoholism, William Duncan Silkworth, M.D. contributed the chapter in the AA basic text of Alcoholics Anonymous entitled "The Doctor's Opinion". That chapter would become one of the more influential pieces in AA thought. He wrote they "have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity."^[27] That allergy takes the form of a craving which is explained earlier in the chapter when he states "the phenomenon of craving is limited to this class [alcoholics] and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit ... they cannot break it..."^[28] Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.^[29]

Twelve Traditions

The affairs of Alcoholics Anonymous are governed broadly by AA's Twelve Traditions, suggested rules for organizing how the members and groups of the society interact with each other and with AA as a whole (see the book Twelve Steps and Twelve Traditions for more information^[30]). These traditions were developed from experiences of the early groups during their first 13 years with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"^[31]

The Twelve Traditions of Alcoholics Anonymous:

1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. For our group purpose there is but one ultimate authority- a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose to carry its message to the alcoholic who still suffers.
6. An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
9. A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

Research on AA

One reason that many researchers take a skeptical view of AA is that AA is so unscientific because of its spiritual basis.^[32] "Membership is voluntary and is determined by the individual, not by the group. There are no membership requirements, no dues or fees, no membership lists. AA is notoriously difficult to pin down as an organization," writes Maria Gabrielle Swora.^[33] In his book Alcohol: The World's Favourite Drug, addiction specialist Griffith Edwards argues that a randomised trial of AA is not possible because members are self-selected, not randomly selected.^[34] In other words, was AA the cause of their sobriety, or did they simply go to AA when they were ready to heal? In spite of the obstacles to obtaining direct evidence, many researchers have tackled the problem of whether AA is effective at creating sobriety.

Project MATCH

Project MATCH was initiated in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).^[35] The project was an 8-year, multisite, $27-million investigation that asked whether certain types of alcoholics respond best to specific forms of treatment.^[36] MATCH notes "No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients." Three types of treatment were investigated:

• Cognitive Behavioral Coping Skills Therapy, which focuses on correcting poor self esteem and distorted, negative, and self-defeating thinking.^[37][38]
• Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.^[39]
• 12-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation^[35]

All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied.

The conclusion of the research was that patient-treatment matching is not necessary in alcoholism treatment, because the three techniques were approximately equal in effectiveness. In a December 1996 press release^[35], NIAAA Director Enoch Gordis, M.D. said "These findings are good news for treatment providers and for patients who can have confidence that any one of these treatments, if well-delivered, represents the state of the art in behavioral treatments."

However overall success rates for all treatments were, and continue to be, less than spectacular. Based on information from Dr. Mark Willenbring of the NIAAA, Newsweek reported in their February 2007 issue that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."^[40]

George Vaillant

In his book The Natural History of Alcoholism Revisited, Harvard psychiatric professor George E. Vaillant posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?"^[41] Vaillant's book was partly based on his experience with "a vast collaborative effort" that had started with two studies in the late 1930s and was still running after 60 years.^[42] Aware of the difficulties of obtaining direct evidence by statistical methods, he nevetheless states in his summary of literature and personal experience that "... research during the last 15 years has revealed growing indirect evidence that AA is an effective treatment for alcohol abuse." ^[43]

Vaillant points out that AA shows its advantage over other treatments in the long term because, as a cheap, community-based fellowship it is easy for people to keep coming back. He argues that "AA is the most effective means of long-term relapse prevention in the physician’s armamentarium."^[44]

He also writes that AA was formed by people deeply distrustful of organised religion, and that AA continues to pass the test of universalism by accepting members regardless of religious conviction. "Would that all 'religions' and fraternal organizations were as benign," he stated.^[45]

In 2005, Vaillant produced an extensive study of the efficacy and safety of AA in the treatment of alcoholism, reviewing the published works from 1940 until the present day. In this paper he acknowledges that, although AA is not a magic bullet for every alcoholic in that "there were a few men who attended AA for scores of meetings without improvement."^[46], his overall observation is that "multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings." Vaillant's overall conclusion is that "Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted."^[47]

Moos and Moos

In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA.^[48][49] They reported that clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. A conclusion was that "Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."^[50]

The Veterans Study

Moos, Mood, and Humphreys carried out a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the U.S.^[51]Five of the programs were 12-step based, and five used cognitive-behavioral therapy. The 12-step programs were found to be effective in terms of cost and recovery: over 45% of the men in 12-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. In answer to the often-posed question as to which comes first, AA participation or reduced drinking, the study concluded that the answer is AA.^[52]Moos said, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals: "It is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems.^[53]

Research critical of AA

Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness.^[54] Brandsma et al. (1979) found a correlation between AA and an increased rate of binge drinking. After several months of participating in AA, the alcoholics in AA were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Emotive Behavior Therapy. Brandsma argues that teaching people that they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy^[55]

Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.^[56]

Occasions of abuse at meetings

AA groups have the benefits and risks of any community, and it is important to acknowledge that mutual support and abuse are both possible. There is no external restriction or vetting of AA members, and in fact the long-form version of Tradition 3 states that "Any two or three alcoholics gathered together for sobriety may call themselves an AA group..."^[57] Newsweek reported on alleged cult-like and abusive behaviour in one controversial Washington DC AA group.^[58] One of the women interviewed allegedly experienced pressure to have sex with senior members, and was told to cut off ties with anyone outside the group and to stop taking her antidepressant medication. However this woman reportedly moved to another AA group and was "relieved" to find these practices were not widespread and were contrary to AA philosophy. In the UK in 2000, the Guardian newspaper reported that a leaked internal AA memorandum stated that "volunteer members are increasingly being investigated by police forces examining allegations of sexual abuse."^[59] According to the memo, a small minority of members were taking advantage of vulnerable new members who were seeking help by phone or by looking for a sponsor. At that time the AA service board was considering how to deal with the issue on a national level in the UK.

Court Mandated AA Attendance

Judges in the United States sometimes require attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. "Open" AA meetings are open to anyone who wishes to attend, including those mandated by a court. Court ordered attendees have to answer to the judge, not to anyone in AA.

The New York Court of Appeals ruled in 1999 that mandating attendance at AA meetings compromises the Establishment Clause of the First Amendment right of those sentenced not to have religion dictated to them by government - because AA practices and doctrine are (in the words of the judge who wrote Griffin v. Coughlin^[60]) "unequivocally religious". In that ruling it was also noted "adherence to the AA fellowship entails engagement in religious activity and religious proselytization." In "working" the Twelve Steps, participants become actively involved in seeking God through prayer, confessing wrongs and asking for "removal of shortcomings." The United States Supreme Court denied certiorari and let this decision stand.

Grandberg v. Ashland County is another example concerning judicially-mandated AA attendance and the Establishment Clause. In that case the United States Court of Appeals for the Seventh Circuit ruled, "Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue." In Warner v. Orange County Department of Probation a man convicted of drunk driving was sentenced to AA. The court found that the county was guilty of “coercing the plaintiff into participating in religious exercises, an act which tends toward the establishment of a state religious faith.”

Popular culture

• My Name is Bill W. (movie) Story of the founders of AA (1989). Starring James Woods as Bill W, James Garner as Dr. Bob, JoBeth Williams as Bill's wife, Lois. Also released as Anonymous Hero
• Drunks (1995). (movie) Tells the story of an alcoholic named Jim (Richard Lewis), who is torn between AA and his addiction.
• Days of Wine and Roses An early portrayal of AA (1962)
• Courage To Change The Things We Can (New York: 1960) a novel by James Audain.
• Minus One: A Twelve-Step Journey (Haworth Press: 2004)-- a novel portraying a lesbian woman's first year of recovery in AA, by Bridget Bufford.

See also

• Alcoholism
• Al-Anon/Alateen
• Twelve-step program
• AA Grapevine, the international journal of Alcoholics Anonymous.
• Washingtonian movement, a 19th century fellowship of people trying to attain sobriety.
• Drunkenness
• Substance abuse

Further reading

Books

• Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org and www.BigBook.org.
• Alcoholics Anonymous Comes of Age. A Brief History of AA, New York: Alcoholics Anonymous, 1990, ISBN 0-916856-02-X.
• Living Sober: Some methods A.A. members have used for not drinking, New York: Alcoholics Anonymous, 1975, 1998, ISBN 0-916856-04-6.
• Twelve Steps and Twelve Traditions, New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2.

Articles

External links

• Alcoholics Anonymous official website
• More Revealed Online Library of Books critical of AA

References