Alcoholics Anonymous
Alcoholics Anonymous (AA) is a global peer-led mutual aid fellowship begun in the United States dedicated to abstinence-based recovery from alcoholism through its spiritually inclined twelve-step program.[1][2][3][4][5][6][7] AA's twelve traditions, besides stressing anonymity, establish it as free to all, non-professional, unaffiliated, and non-denominational as well as apolitical with a public relations policy of attraction rather than promotion.[2][3][8] In 2020 AA estimated a worldwide membership of over two million, with 75% of those in the US and Canada.[9][10]
Nickname
AA dates its founding to 1935 with Bill Wilson's (Bill W.) and Bob Smith's (Dr. Bob) first commiseration alcoholic-to-alcoholic. Meeting through AA's immediate precursor the Christian revivalist Oxford Group, they and other alcoholics there helped each other until forming in 1937 what became AA. At first only white and male, though neither intentionally or for long, in 1939 they published Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism. Known as “the Big Book", it is the origin of AA's name.[11][12][13]
The Big Book debuted AA's suggested—but not required—twelve steps as a continuing sobriety program of prayer, reflection, admission, better conduct and atonement, all to produce a "spiritual awakening" followed by taking others—usually sponsees—through the steps. Integral to the steps is divining and following the will of an undefined God—"as we understood Him" or a “ higher power"—but differing practices and beliefs, including those of atheists, are accommodated.[8]
To keep sobriety as its primary purpose, and to remain what Wilson called a “benign anarchy”, AA instituted its twelve traditions in 1950 to ensure membership to all wishing to stop drinking with no dues or fees required. Members are advised not to use AA for material gain or to increase public prestige. All memberships are to be kept anonymous, especially in public media, but for broken anonymity, no consequences are prescribed. The traditions have AA steering clear of hierarchies, dogma, public controversies, while other outside entanglements or acquisition of property are to be avoided. To stay independent and self-supporting, the traditions would have AA groups accepting outside contributions from no one.[14][15]
For all demographics, a 2020 scientific review found clinical treatments increasing AA participation via AA twelve step facilitation (AA/TSF) had sustained remission rates 20-60% above well-established treatments. Additionally, 4 of the 5 economic studies in the review found that AA/TSF lowered healthcare costs considerably.[a][17][18][19] Regarding the disease model of alcoholism, despite scattered allusions in AA literature an otherwise receptive AA has not endorsed it. Its association with AA, as well as a good deal of its broader acceptance, stems from many members propagating it.[20]
With AA's permission other recovery fellowships such as Narcotics Anonymous and Al-Anon have adopted and adapted the twelve steps and traditions.[21]
The Big Book, the Twelve Steps, and the Twelve Traditions[edit]
To share their method, Wilson and other members wrote the book initially titled Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism,[36] from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a higher power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal, and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches.[37]
In 1941, interviews on American radio and favorable articles in US magazines, including a piece by Jack Alexander in The Saturday Evening Post, led to increased book sales and membership.[38] By 1946, as the growing fellowship quarreled over structure, purpose, authority, finances and publicity, Wilson began to form and promote what became known as AA's "Twelve Traditions", which are guidelines for an altruistic, unaffiliated, non-coercive, and non-hierarchical structure that limited AA's purpose to only helping alcoholics on a non-professional level while shunning publicity. Eventually, he gained formal adoption and inclusion of the Twelve Traditions in all future editions of the Big Book.[14] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[39] as AA had grown to millions of members internationally.[40]
In May 2017, Alcoholics Anonymous World Services Inc. filed a lawsuit in the Supreme Court of the State of New York seeking the return of the original manuscript of the Big Book from its then-owner. AAWS claimed that the manuscript had been given to them as a gift in 1979.[41] This action was criticized by many members of Alcoholics Anonymous since they didn't want their parent organization engaged in lawsuits.[42] Alcoholics Anonymous World Services Inc. asked the court to voluntarily discontinue the action in November 2017.[43]
Spirituality[edit]
Some have criticized 12-step programs as "a cult that relies on God as the mechanism of action"[74] and as "overly theistic and outdated".[75] Others have cited the necessity of a "higher power" in formal AA as creating dependence on outside factors rather than internal efficacy.[75] A 2010 study found increased attendance at AA meetings was associated with increased spirituality and decreased frequency and intensity of alcohol use.[76][77] Since the mid-1970s, several 'agnostic' or 'no-prayer' AA groups have begun across the US, Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo the use of opening or closing prayers.[78][79]
Canadian and United States demographics[edit]
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. The survey found that 89% of AA members were white.[88]
Average member sobriety is slightly under 10 years with 36% sober more than ten years, 13% sober from five to ten years, 24% sober from one to five years, and 27% sober less than one year.[88] Before coming to AA, 63% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 59% received outside treatment or counseling. Of those members, 84% said that outside help played an important part in their recovery.[88]
The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court-ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.[88]
Relationship with institutions[edit]
Hospitals[edit]
Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value in working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did.[89][90][91] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[92] Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.[93]
Prisons[edit]
In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program.[94] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[95] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[96]
Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[151] 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.