Alcoholics Anonymous

Alcoholics Anonymous
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book and is written by AA members.
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book and is written by AA members.
Nickname AA
Formation 1935; 86 years ago (1935)
Founded at Akron, Ohio
Type Mutual-help addiction recovery twelve-step program
Headquarters New York, New York
Membership (2020)
2 100 000
Key people
Bill W., Bob Smith
Website aa.org

Alcoholics Anonymous (AA) is an international mutual aid fellowship[1] with the stated "primary purpose" of enabling its members to "stay sober and help other alcoholics achieve sobriety “ through its spiritually inclined Twelve Steps program."[1][2][3] It is non-professional, non-denominational, self-supporting, and apolitical while asking for no dues or fees; the only requirement for membership is an avowed desire to stop drinking.[1][2][4] Though AA has neither originated nor promulgated the disease model of alcoholism — viewing it as an outside issue on which it has no opinion, its members have done much for its popularization.[5] AA has spread "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements, and as of 2020 its estimated worldwide membership is more than two million. [6][7]

AA was founded in 1935 in Akron, Ohio when the alcoholic Bill Wilson first met and discussed alcoholism with the detoxing alcoholic Bob Smith as not a failure of will or morals, but as an illness from which he had recovered as a member of the 1st century Christian revivalist Oxford Group. Having departed the Oxford Group, Wilson and Smith, with other members, wrote and in 1939 published Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism. The book, from which AA draws its name, is commonly called "the Big Book" and contains its program of recovery the Twelve Steps.[8] Later editions of "the Big Book" added the Twelve Traditions - first adopted 1946 - to formalize and keep the fellowship stable, focused and unified.[8]

The Twelve Steps are intended as a non-coercive self-improvement program through acknowledgment of ones lack of power over alcohol, ones personal failings, and the making of amends for past misdeeds, along with the helping of other alcoholics, and continuous spiritual development. The Steps suggest the healing aid of an unspecified "God - as we understood him" but are nonetheless accommodating to agnostics, atheists, and non-theistic members.[4]

The Traditions hold that recovery from alcoholism is its only purpose, making plain that AA has no opinion on any “outside issues” as it seeks to avoid controversy, that members or groups should not use AA to gain wealth, prestige and property, and that Dogma and hierarchies are to be avoided. They also declare that AA groups are autonomous, self-supporting and should not lend the AA name to any other organizations. Without any threat or means of retribution or enforcement, they advise members to remain anonymous in public media.[9][10]

Subsequent addiction recovery fellowships such as Narcotics Anonymous and Gamblers Anonymous have adopted the Twelve Steps and Traditions.[11]

History

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 sprang from the Oxford Group, a non-denominational, altruistic movement modeled after first-century Christianity.[12] Some members founded the group to help in maintaining sobriety. "Grouper" Ebby Thacher was Wilson's former drinking buddy who approached Wilson saying that he had "got religion", was sober, and that Wilson could do the same if he set aside objections to religion and instead formed a personal idea of God, "another power" or "higher power".[13][14]

Feeling a "kinship of common suffering" and, though drunk, Wilson attended his first group gathering. 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 William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna.[15] At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.[16] Following his hospital discharge, Wilson joined the Oxford Group and recruited other alcoholics to the group. Wilson's early efforts to help others become sober were ineffective, prompting Silkworth to suggest that Wilson place less stress on religion 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.[17]

The first female member Florence Rankin joined AA in March 1937,[18][19] and the first non-Protestant member, a Roman Catholic, joined in 1939.[20] The first Black AA group was established in 1945 in Washington, D.C. by Jim S., an African-American physician from Virginia.[21][22]

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,[23] 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.[24]

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.[25] By 1946, as the growing fellowship quarreled over structure, purpose, and authority, as well as 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.[9] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[26] as AA grew to millions of members internationally.[27]

Organization and finances

A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense",[27] and Bill Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy".[28] 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."[29]

In 2018, AA counted 2,087,840 members and 120,300 AA groups worldwide.[27] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.[30]

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.[27]

AA groups are self-supporting, relying on voluntary donations from members to cover expenses.[27] The AA General Service Office (GSO) limits contributions to US$3,000 a year.[31] Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.[9]

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 General Service Office.[32] 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 donations 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 traditional "12th Step" work of working with alcoholics in need.[33] 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.[34]

Program

AA's program extends beyond abstaining from alcohol.[35] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[36] through "an entire psychic change," or spiritual awakening.[37] A spiritual awakening is meant to be achieved by taking the Twelve Steps,[38] and sobriety is furthered by volunteering for AA[39] and regular AA meeting attendance[40] or contact with AA members.[38] 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 experience of all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person.[39] 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.[41]

AA's program is an inheritor of Counter-Enlightenment philosophy. 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.[35] 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. To help members stay sober AA must, they argue, 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 could 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.[42]

Meetings

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics".[43] They are usually informal and often feature discussions with voluntary donations collected during meetings. (AA's 7th tradition encourages groups to be self-supporting, declining outside contributions).[9] Local AA directories list weekly meetings. Those listed as "closed" are available to those with a self-professed "desire to stop drinking," which cannot be challenged by another member on any grounds.[9] "Open" meetings are available to anyone (nonalcoholics can attend as observers).[44] At speaker meetings (also known as gratitude meetings), one or more members who typically come in from a neighboring town's meeting tell their stories. At Big Book meetings, the group in attendance will take turns reading a passage from the AA Big Book and then discuss how they relate to it after. At twelve-step meetings, the group will typically break out into subgroups depending on where they are in their program and start working on the twelve steps outlined in the program. In addition to those three most common types of meetings, there are also other kinds of discussion meetings that tend to allocate the most time for general discussion.[45]

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, sexual orientation,[46][47] or culture.[48][49] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[50][47] While AA has pamphlets that suggest meeting formats,[51][52] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[9] 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".[53]

Confidentiality

US courts have not extended the status of privileged communication, such as that enjoyed by clergy and lawyers, to AA related communications between members.[54][55]

Spirituality

A study found an association between an increase in attendance at AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use. The research also found that AA was effective at helping agnostics and atheists become sober. The authors concluded that though spirituality was an important mechanism of behavioral change for some alcoholics, it was not the only effective mechanism.[56] Since the mid-1970s, several 'agnostic' or 'no-prayer' AA groups have begun across the U.S., 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.[57][58] There are online resources listing AA meetings for atheists and agnostics.[59]

Disease concept of alcoholism

More informally than not, AA's membership has helped popularize the disease concept of alcoholism which had appeared in the eighteenth century.[60] Though AA usually avoids the term "disease", 1973 conference-approved literature said "we had the disease of alcoholism."[61] Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.[62]

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."[62] 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."[63] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."[64] 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.[65]

Since then medical and scientific communities have generally concluded that alcoholism is an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild).[66] 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.[67]

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.[68]

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.[68] 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.[68]

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.[68]

Effectiveness

Studies of AA's efficacy have produced inconsistent results. While some studies have suggested an association between AA attendance and increased abstinence or other positive outcomes,[69][70][71][72][73] other studies have not.[74][75][76]

The Surgeon General of the United States 2016 Report on Alcohol, Drugs, and Health states "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions."[77]

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.[78][79][80] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[81] 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.[82]

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.[83] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[84] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[85]

United States court rulings

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.[86][87] 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.[88][89]

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.[90] 32% of AA's membership was introduced to it through a treatment facility.[68]

United Kingdom treatment industry

A cross-sectional survey of substance-misuse treatment providers in the West Midlands found fewer than 10% integrated twelve-step methods in their practice and only a third felt their consumers were suited for Alcoholics Anonymous or Narcotics Anonymous membership. Less than half were likely to recommend self-help groups to their clients. Providers with nursing qualifications were more likely to make such referrals than those without them. A statistically significant correlation was found between providers' self-reported level of spirituality and their likelihood of recommending AA or NA.[91]

Criticism

Thirteenth-stepping

"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, in pursuit of sexual company. The authors suggest that both men and women need to be prepared for this behavior or find male-only or female-only groups.[92] Women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women.[93] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.[94]

Moderation or abstinence

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics.[95] 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.[96] 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."[97]

Cultural identity

One review of AA warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults.[98] A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial.[99] Another study found 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.[100] A survey of group members, however, found they had a bicultural identity and saw AA's program as a complement to their other national, ethnic, and religious cultures.[101]

Literature

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[102] 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.

  • Anonymous (2011). Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism (multiple PDFs) (4th ed.). ISBN 978-1-893007-16-1. 575 pages. Also available in libraries. Free to read
  • Anonymous (2002). Twelve Steps and Twelve Traditions (multiple PDFs). ISBN 978-0-916856-01-4. 192 pages. Also available in libraries. Free to read
  • "Home Page". AA Grapevine. Alcoholics Anonymous. ISSN 0362-2584. OCLC 319167052. Also available in libraries.

AA in media

Film

In television

Chuck Lorre's Mom follows dysfunctional daughter/mother duo Christy and Bonnie Plunkett, who are estranged for years while simultaneously struggling with addiction. They attempt to pull their lives and relationships together by trying to stay sober and visiting Alcoholics Anonymous. The show also explores themes of alcoholism, drug addiction and relapse.

In Hill Street Blues, Captain Furillo (Daniel J. Travanti) is a regular member of AA and is shown several times in AA meetings.

In Grey's Anatomy, AA plays a large role in the storylines of multiple characters. In season 6, Dr. Richard Webber (James Pickens Jr.) begins struggling with alcoholism and it is revealed that he has a history of alcohol addiction. AA and maintaining sobriety become an important part of Dr. Webber's life throughout the rest of the series. Alcoholism, but more so drug addiction, is also heavily featured in the spin-off series Private Practice. In season 4, it is revealed that both Dr. Charlotte King (KaDee Strickland) and Dr. Amelia Shepherd (Caterina Scorsone) have a history of problem drinking and narcotics addiction. This becomes the main theme in season 5 when Amelia relapses and begins using again following her friend's suicide. The season follows her relapse and recovery. When Amelia joins Grey's in season 11, overcoming addiction remains an important part of her storyline. Both series commonly discuss AA meetings, sponsors, and the "serenity prayer".

In Aaron Sorkin's political drama, The West Wing, the character Leo McGarry is an admitted alcoholic and drug addict. He is reluctant to attend regular AA meetings, feeling the high-profile nature of his position as Chief of Staff of the White House would encourage a media frenzy. The vice president (Tim Matheson) invites him to a "weekly poker game", which turns out to be a secret AA meeting known only to those invited.

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.[122]

This is Us is a family drama where two of the main characters are members of AA. Generational patterns of addiction are covered. Some episodes feature characters reading AA literature and attending meetings.

How to Get Away with Murder also features a main character with substance use disorder issues, as a recurring theme. In later seasons, Annalise Keating is seen attending AA meetings.

See also

Dr. Bob's House Akron, Ohio

Ignatius Hall at St. Thomas Hospital Akron, Ohio

Mayflower Manor Akron, Ohio

Copyright