Alcoholics Anonymous (AA) is an informal society for recovering alcoholics. 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 two million recovering alcoholics.
The stated purpose is "to stay sober and help other alcoholics to achieve sobriety." AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis. In turn, AA offers a community of recovering people who support each other by "sharing experience, strength and hope" and by working the suggested Twelve Steps together. These involve putting your life in the hands of a higher power.
Alcoholics Anonymous 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. Although the AA has its critics, it has helped numerous people to overcome their dependence on alcohol and in the process it has saved marriages and prevented the subsequent breaking up of families. Based on self-help, its success is testimony to the deep capacities of the human mind to find ways of restoring mental as well as physical health. The A.A. pattern is now used for many addiction programs. Recognition of a "higher power," however differently individuals understand this is widely recognized as a vital element in personal and social transformation. Alcoholics Anonymous shows that putting God, or a higher power, first in your life can help overcome an addiction.
Group treatment of alcoholism in the early twentieth century can be traced to New Thought, a religious and philosophical movement in the second half of the nineteenth century which focused on mind and spirit, and the Emmanuel Movement, a Protestant church sponsored, pre-Freudian psychotherapeutic system established in 1906 by Reverend Elwood Worcester. Relaxation therapy and autosuggestion were used to reach the unconscious. New Thought taught that sickness was the result of failure to recognize the Christian God as sole reality and that 'right thinking' had a healing effect. The Emmanuel Movement claimed that all diseases including alcoholism had physical, mental and spiritual components and that prayer, group support and self-help were important to recovery.
Reverend Worcester's Emmanuel Movement first focused on treatment of tuberculosis in Boston's slums. Later, treatment included a variety of 'mental disorders', including alcoholism. Treatment redirected the attention of patients away from their problems to a life of service and spirituality. Courtenay Baylor, a patient of the Emmanuel Movement, eventually became influential in the group treatment of alcoholism. Richard R. Peabody, author of "The Common Sense of Drinking," was a patient of Baylor who further refined the treatment method emphasizing control of the patient's feelings. Patients were prescribed detailed schedules. Worcester, Baylor and Peabody were not physicians. Success of their treatment methods is unclear. The Emmanuel Movement and other integrations of spirituality and psychotherapy influenced the eventual development of the spirituality-based principles of the 12-steps approach to addiction recovery by Alcoholics Anonymous (AA).
In the 1930s public opinion saw alcoholism as a moral failing. Those without financial resources could find help only through state hospitals, the Salvation Army, and other charitable and religious groups. Those who could afford psychiatrists or hospitals were often treated with barbiturates and belladonna known as "purge and puke." A little known book by Richard Peabody titled The Common Sense of Drinking first proffered the alcoholic could "train his mind" so that he would no longer want to drink. (It was this book where the phrase "halfway measures are of no avail" originally appeared. Bill Wilson borrowed from it heavily in composing Alcoholics Anonymous.)
One contemporary doctor who had great influence on AA was William Duncan Silkworth, M.D., a specialist in treating alcoholics. He contended that alcoholism was a disease that consisted of an obsession and an allergy. The "obsession" was the desire to start drinking, and the "allergy" (in the general sense, an adverse reaction, not an immunoglobularly mediated acute hypersensitivity) was the compulsion to continue once the first drink had been taken. In Silkworth's view, alcoholics were caught by the delusion that despite often severe consequences of the last drinking episode, no harm will be done by the next drink. Silkworth believed that the two primary protectors of health; reason and will, were of no use against this disease.
AA was founded by Bill Wilson, a Wall Street stock speculator, and Dr. Bob Smith, a proctologist from Akron, Ohio, both alcoholics. The chain of events that led to the meeting of these men began in Europe, where American business executive Rowland Hazard sought treatment for alcoholism with the famous Swiss psychiatrist Carl Jung. After a prolonged and unsuccessful period of therapy, Jung told Hazard that his case, like that of most alcoholics, was nearly hopeless. The only possibility for a cure was through spiritual conversion.
Back in America, Rowland Hazard joined the Oxford Group, a Christian Evangelical association. The group advocated finding God through a spiritual surrender, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. (Bill Wilson later gave credit for the concepts behind Steps Three through Twelve to the teachings of Rev. Samuel Moor Shoemaker of the Oxford Group. Through the Oxford group, Hazard underwent a spiritual conversion and achieved his long hoped for sobriety.
Rowland Hazard introduced his acquaintance Ebby Thacher to Jung's conversion cure and the Oxford Group's spiritual principles. Thacher too attained sobriety, for a time. Thacher visited an old school friend, Bill Wilson. Wilson was an alcoholic whose promising career on Wall Street was ruined by his drinking. He failed to graduate from law school because he was too drunk to pick up his diploma. He had blown partnerships and business deals, all but destroyed his marriage, been hospitalized for alcoholism under the care of Dr. William Silkworth, and still continued to drink. Wilson was astonished to find that his old drinking companion had become sober through spiritual means, but he struggled with the existence of God. Then "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."
Wilson excitedly told his wife Lois about his spiritual discovery. Yet the very next day he drank again. Eventually, he found himself back in hospital under Silkworth's care. According to Wilson, while lying in bed, depressed and despairing he cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!". He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Bill Wilson described his experience to Dr. Silkworth, who told him not to discount it. Ebby Thacher visited Bill Wilson at Townes Hospital and introduced him to the basic tenets of the Oxford Group and the book Varieties of Religious Experience by American psychologist and philosopher William James, which described experiences similar to Wilson's. Wilson never drank again for the remainder of his life.
Wilson found that his own sobriety grew stronger when he shared his personal alcoholic experience with other alcoholics. At one point Wilson was on a business trip in Akron, OH, and was tempted to relapse. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. He eventually reached Oxford Group member Henrietta Seiberling, whose group had been trying to help alcoholic Dr. Bob Smith. Wilson met with Smith for what was planned as 15 minutes, and the two men talked late into the night. They became friends, and for three months they studied the Bible, held long discussions, and reviewed Oxford Group ideas, eventually fashioning a pioneer recovery program. Smith's last drink is said to have been on June 10, 1935 and that is considered within AA to be the date AA was founded.
Wilson returned to New York and established a second group. Later, he revisited Smith in Akron. They reviewed progress of the movement. Between the two groups in New York and Akron numbered forty recovered alcoholics with continuous sobriety. They had a recovery program worth spreading. Impassioned discussions led to agreement that the essential communications tool would be a book. After great difficulties raising funds for printing, a publishing company, Works Publishing Inc, was incorporated. Capital was raised by selling shares to the groups’ members and friends. Wilson began work writing the book summarizing their treatment methods for alcoholism in this Word of Mouth program.
The basic program had developed from the works of William James, Dr Silkworth and the Oxford Group (from which the AA groups separated in 1937). Several of the Oxford Group's ideas were deliberately rejected, particularly those that would involve AA in theological controversy. The program involved an alcoholic admitting that they were beaten by alcohol, making a moral inventory of their defects, confessing their shortcomings with another person, making restitution to those harmed by their drinking, trying to help other alcoholics and praying to whatever God they believed in for the power to practice these precepts. Wilson expanded these principles, with contributions from others in the groups including several atheists who restrained the religious content. The final version of the Twelve Steps was completed by the fall of 1938.
The book, Alcoholics Anonymous, was published in 1939 and has been a perennial best-seller ever since. 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 took its name from the book. The first edition had a "circus cover" of red and yellow. It was printed in heavy paper and made a large size, thought to make it more saleable. This spawned the nickname, "The Big Book," a name that sticks today. Sales of the book and the popularity of AA increased rapidly after positive articles in Liberty magazine in 1939 and the Saturday Evening Post in 1941. 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. Stories of original members from the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were reprinted in the book Experience, Strength, and Hope.
AA provide support for members attending meetings regularly. Dr. W.W. Bauer, speaking before the American Medical Association in 1946, described the fellowship, "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."
The 12 Steps are sometimes summarized as "Trust God, clean house, and help others." AA members are encouraged to "work the Steps," usually under the guidance of a voluntary sponsor—a member who has experience working the program. The Steps are designed to help the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Although the steps are based on seeking help from a higher power, atheists and agnostics have achieved long term sobriety in AA, since AA offers freedom to follow one's own path. Bill Wilson wrote a chapter in the "Big Book" entitled We Agnostics for alcoholics like him who were struggling with the idea of a Higher Power.
"Working the program" might involve the following activities:
Alcoholics Anonymous has an informal control structure. There is no hierarchy of leaders. Guidelines for group conduct are outlined in the Twelve Traditions below. A member who accepts a service position (an organizing role in a group) is referred to as a trusted servant, a reference to Tradition 2. A member's commitment to service is held for a limited period, typically three months to one year, after which another member volunteers or is chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities. Each meeting, small or large, is considered a self-governing entity.
At the local and national level, AA groups are self-supporting. The society has no membership fees and does not charge to attend meetings, but relies on 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 to $2 per meeting.
Alcoholics Anonymous does receive proceeds from the sale of its book Alcoholics Anonymous, along with other published books and literature. Revenues from literature sales constitute more than 50 percent of the income for the General Service Office (GSO), 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 such as printing literature, responding to public inquiries, and organizing state or national conferences. The centers are funded by local members and 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 nonalcoholics..
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). These traditions were developed from the first 13 years of experiences of the early groups with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"
Although AA lacks an official, singular definition of alcoholism, Dr. Silkworth contributed the chapter in the AA basic text of Alcoholics Anonymous entitled "The Doctor's Opinion." That chapter has 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." 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…" Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and 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'." 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.
In his book The Natural History of Alcoholism Revisited, Harvard psychiatric professor George E. Vaillant, who is a member of the Board of Trustees of Alcoholics Anonymous World Services, posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?" 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. Aware of the difficulties of obtaining direct evidence by statistical methods, he nevertheless 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."
He also writes that AA was formed by people deeply distrustful of organized 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.
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," 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." Despite his own statistics, Vaillant continued to argue that AA shows an 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 concludes that "AA is the most effective means of long-term relapse prevention in the physicians armamentarium." His 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."
In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA. 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."
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. 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 percent of the men in 12-step programs were abstinent one year after discharge, compared to 36 percent of those treated by cognitive-behavioral therapy. 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.
A study from 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 they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy. Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness. Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.
Tonigan's study found the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. "The magnitude of these benefits did not differ between sites." A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.
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