Alcoholics Anonymous (AA) is an international mutual aid fellowship founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio. AA's stated "primary purpose" is to help alcoholics "stay sober and help other alcoholics achieve sobriety". With other early members, Bill Wilson and Bob Smith developed AA's Twelve Step program of spiritual and character development. AA's initial Twelve Traditions were introduced in 1946 to help the fellowship be stable and unified while disengaged from "outside issues" and influences.
The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organizations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adopted and adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.
According to AA's 2014 membership survey, 27% of members have been sober less than one year, 24% have 1-5 years sober, 13% have 5-10 years, 14% have 10-20 years, and 22% have more than 20 years sober. 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, other studies have not. A 2006 Cochrane Review both states that "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF (Twelve step Facilitation) approaches for reducing alcohol dependence or problems" and that "Severity of addiction and drinking consequence did not seem to be differentially influenced by [twelve-step programs] versus comparison treatment interventions, [...] and no conclusive differences in treatment drop out rates were reported."
The first female member, Florence Rankin, joined AA in March 1937, and the first non-Protestant member, a Roman Catholic, joined in 1939. The first Black AA group was established in 1945 in Washington DC by Jim S., an African American physician from Virginia. AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements. Close to 2 million people worldwide are members of AA as of 2016.
AA's name is derived from its first book, informally called "The Big Book", originally titled Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism.
Maps, Directions, and Place Reviews
Oxford Group origins
AA sprang from The Oxford Group, a non-denominational movement modeled after first-century Christianity. 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".
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 Dr. William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna. At the hospital a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself. 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 Dr. 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 Dr. 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.
While Wilson and Smith credited their sobriety to working with alcoholics under the auspices of the Oxford Group, a Group associate pastor sermonized against Wilson and his alcoholic Groupers for forming a "secret, ashamed sub-group" engaged in "divergent works". By 1937, Wilson separated from the Oxford Group. AA Historian Ernest Kurtz described the split:
...more and more, Bill discovered that new adherents could get sober by believing in each other and in the strength of this group. Men [no women were members yet] who had proven over and over again, by extremely painful experience, that they could not get sober on their own had somehow become more powerful when two or three of them worked on their common problem. This, then--whatever it was that occurred among them--was what they could accept as a power greater than themselves. They did not need the Oxford Group.
In 1955, Wilson acknowledged AA's debt, saying "The Oxford Groupers had clearly shown us what to do. And just as importantly, we learned from them what not to do." Among the Oxford Group practices that AA retained were informal gatherings, a "changed-life" developed through "stages", and working with others for no material gain, AA's analogs for these are meetings, "the steps", and sponsorship. AA's tradition of anonymity was a reaction to the publicity-seeking practices of the Oxford Group, as well as AA's wish to not promote, Wilson said, "erratic public characters who through broken anonymity might get drunk and destroy confidence in us."
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, 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.
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. 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. At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference, as AA grew to millions of members internationally.
Organization and finances
AA says it is "not organized in the formal or political sense", and Bill Wilson called it a "benign anarchy". 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."
In 2006, AA counted 1,867,212 members and 106,202 AA groups worldwide. The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.
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.
AA groups are self-supporting, relying on voluntary donations from members to cover expenses. The AA General Service Office (GSO) limits contributions to US$3,000 a year. Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.
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. In keeping with A.A.'s Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and through the voluntary donations of A.A. members and groups. It does not accept donations from people or organizations outside of A.A.
In keeping with A.A.'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. All 12th Step calls that come to the Central Office are handed to sober A.A. 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.
Program
AA's program extends beyond abstaining alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism" through "an entire psychic change," or spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps, and sobriety is furthered by volunteering for AA and regular AA meeting attendance or contact with AA members. 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. 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.
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. 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 places an emphasis on tolerance rather than on 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.
Meetings
AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics". They are usually informal and often feature discussions. Local AA directories list a variety of 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. "Open" meetings are available to anyone (nonalcoholics can attend as observers). At speaker meetings, one or two members tell their stories, while discussion meetings allocate the most time for general discussion. Some meetings are devoted to studying and discussing the AA literature.
AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation, or culture. Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish. While AA has pamphlets that suggest meeting formats, groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole". 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".
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.
Spirituality
A study found an association between an increase in attendance to 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. Since the mid-1970s, a number of '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 forgo use of opening or closing prayers. There are online resources listing AA meetings for atheists and agnostics.
Disease concept of alcoholism
More informally than not, AA's membership has helped popularize the disease concept of alcoholism, though AA officially has had no part in the development of such postulates which had appeared as early as the late eighteenth century. Though AA initially avoided the term "disease", in 1973 conference-approved literature categorically stated that "we had the disease of alcoholism." Regardless of official positions, from AA's inception most members have believed alcoholism to be a disease.
Though cautious regarding the medical nature of alcoholism, AA has let others voice opinions. The Big Book states that alcoholism "is 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." In his introduction to The Big Book, non-member Dr. William Silkworth said those unable to moderate their drinking have an allergy. Addressing the allergy concept, 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." AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us." 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.
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.
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. 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.
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.
Effectiveness
Research limitations
AA tends to polarize observers into believers and non-believers, and discussion of AA often creates controversy rather than objective reflection. Moreover, a randomized study of AA is difficult: AA members are not randomly selected from the population of chronic alcoholics; they are instead self-selected or mandated by courts to attend AA meetings. There are two opposing types of self-selection bias: (1) drinkers may be motivated to stop drinking before they participate in AA; (2) AA may attract the more severe and difficult cases.
Studies
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, other studies have not. Even meta-analyses and literature reviews have resulted in widely divergent conclusions.
The 2006 Cochrane Review of eight studies (the studies reviewed were done between 1967 and 2005) measuring the effectiveness of AA found no significant difference between the results of AA and twelve-step participation compared to other treatments, stating that "experimental studies have on the whole failed to demonstrate their effectiveness in reducing alcohol dependence or drinking problems when compared to other interventions."
A 2014 study by Keith Humphreys, Janet Blodgett and Todd Wagner concluded that "increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection." Austin Frakt, writing for The New York Times, discusses how the study's methodology minimizes outside factors, such as how motivated the people who succeed at becoming abstinent are.
A meta-analysis by Dr. Lee Ann Kaskutas in 2009 reported that while the evidence base for twelve step groups from experimental studies was weak, "other categories of evidence... are overwhelmingly convincing". Specifically, the correlation between exposure to AA and outcome, the dose-response relationship, and the consistency of the association were found to be very strong. In other words, the frequency by which individuals attend meetings appears to have a statistically significant correlation with maintaining abstinence. Kaskutas noted two studies which both found that 70% of those who attended twelve-step groups at least weekly were abstaining from alcohol consumption at follow ups two and sixteen years later. Those who attended less than once per week showed about the same success rate as those who didn't attend meetings. Kaskutas also found AA to function consistently with known behavioral change theories and substantial empirical support for specific mechanisms through which AA facilitates change.
A preliminary study suggested that "AA prayers" help long-term AA members reduce cravings for alcohol. The study used a MRI machine to scan how subjects reacted to images of people drinking. The study randomly assigned the subjects, so that some subjects saw the images after saying prayers in the Big Book of Alcoholics Anonymous; others after reading newspaper articles. The people who had just seen the prayers reported feeling fewer cravings for alcohol; the MRI scans of their brains confirmed that there was a different reaction.
The Sober Truth
Dr. Lance Dodes, in his 2014 book The Sober Truth, argues that most people who have experienced AA have not achieved long-term sobriety, making the controversial argument that research indicates that only 5 to 8 percent of the people who go to one or more AA meetings achieve sobriety for longer than one year. Gabrielle Glaser used Dodes' figures to argue that AA has a low success rate in a 2015 article for The Atlantic.
The 5 to 8 percent figure put forward by Dodes is controversial; Thomas Beresford, MD, writing for the National Council on Alcoholism and Drug Dependence, says that the book uses "three separate, questionable, calculations that arrive at the 5-8% figure." This is not the only criticism the book has received. Cornell University clinical psychiatry professor Richard A. Friedman, in his review for the New York Times, called The Sober Truth a "polemical and deeply flawed book", noting that it was designed to promote psychodynamic therapy for addiction, which itself lacks a strong evidence base. John F. Kelly, an associate professor at Harvard, as well as Gene Beresin, a professor at Harvard, feel that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong, noting that "studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge [...] produce about one third higher continuous abstinence rates"
Health-care costs
As a volunteer-supported program, AA is free of charge. This contrasts with treatments for alcoholism such as inpatient treatment, drug therapy, psychotherapy, and cognitive-based therapy. One study found that the institutional use of twelve-step-facilitation therapy to encourage participation in AA reduced healthcare expenditures by 45% when compared to another group that was not encouraged to participate in AA.
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 of working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did. Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics". 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.
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. In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic. Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.
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. 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.
American treatment industry
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. 32% of AA's membership was introduced to it through a treatment facility.
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.
Criticism
Thirteenth Stepping
"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates or sex. The Journal of Addiction Nursing reported that 50% of the women that participated in a survey (55 in all) experienced 13-stepping behavior from others. AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.
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. Along with Nancy Shute, Peele has advocated that besides AA, other options should be readily available to those problem drinkers who are able to manage their drinking with the right treatment. The Big Book says "moderate drinkers" and "a certain type of hard drinker" are able to 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."
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. A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial. 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. 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.
Literature
Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine. 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.
- Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism (multiple PDFs) (4th ed.). 2011. ISBN 1-893007-16-2. 575 pages. Also available in libraries.
- Twelve Steps and Twelve Traditions (multiple PDFs). 2002. ISBN 0-916856-01-1. 192 pages. Also available in libraries.
- "Home Page". The AA Grapevine. Alcoholics Anonymous. ISSN 0362-2584. Archived from the original on 3 April 2009. Also available in libraries.
AA in film
Films about Alcoholic Anonymous
- My Name Is Bill W. - dramatized biography of co-founder Bill Wilson.
- When Love Is Not Enough: The Lois Wilson Story - a 2010 film about the wife of founder Bill Wilson, and the beginnings of Alcoholics Anonymous and Al-Anon.
- Bill W. - a 2011 biographical documentary film that tells the story of Bill Wilson using interviews, recreations, and rare archival material.
- The 13th Step - A 2016 documentary film about sexual predators in Alcoholics Anonymous.
Films where primary plot line includes AA
- A Walk Among the Tombstones (2015), a mystery/suspense film based on Lawrence Block's books featuring Matthew Scudder, a recovering alcoholic detective whose AA membership is a central element of the plot.
- When a Man Loves a Woman - an airline pilot's wife attends AA meetings in a residential treatment facility.
- Clean and Sober - an addict (alcohol, cocaine) visits an AA meeting to get a sponsor.
- Days of Wine and Roses - a 1962 film about a married couple struggling with alcoholism. Jack Lemmon's character attends an AA meeting in the film.
- 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 attendants.
- 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 2 members of the local AA chapter. A 1977 TV drama was also based on the play.
- I'll Cry Tomorrow - A 1955 film about singer Lillian Roth played by Susan Hayward who goes to AA to help her stop drinking. The film was based on Roth's autobiography of the same name detailing her alcoholism and sobriety through AA.
- 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.
- 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.
Source of the article : Wikipedia
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