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Alcoholics Anonymous (AA) is an international mutual aid fellowship founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio. AA states that its primary purpose is to help alcoholics "to 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 and groups remain anonymous in public media, altruistically helping other alcoholics and avoiding affiliations with any other organization. The Traditions also recommend that those representing AA avoid 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.
AA's data show that 26% are still attending AA a year after their first meetings. However—due to problems in methodology—by 2006, no experimental studies had unequivocally demonstrated the effectiveness of AA for reducing alcohol dependence or problems. The first female member, Florence Rankin, joined AA in March 1937, and the first non-Protestant member, a Roman Catholic, joined in 1939. AA membership has since spread "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements. In the Fourth Edition of Alcoholics Anonymous (November 2001), it states "Since the third edition was published in 1976, worldwide membership of AA has just about doubled, to an estimated two million or more..."
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.
AA sprang from The Oxford Group, a non-denominational movement modeled after first-century Christianity. Some members found the Group to help in maintaining sobriety. One such "Grouper", as they were called, was Ebby Thacher, Wilson's former drinking buddy and his acknowledged sponsor. Following the evangelical bent of the Group, Thacher told Wilson that he had "got religion" and 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".
Wilson felt with Thacher a "kinship of common suffering" and—while drunk—attended his first Group gathering. Within days, Wilson admitted himself to the Charles B. Towns Hospital, but not before drinking four beers on the way—the last time Wilson drank alcohol. Under the care of Dr. William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna. At the hospital in a state of despair, 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 June 10, 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."
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.
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.
AA receives proceeds from books and literature that constitute more than 50% of the income for its General Service Office. Unlike individual groups, the GSO is not self-supporting and maintains a small salaried staff. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and are responsible to the AA groups they represent. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.
The scope of AA's program is much broader than just abstinence from drinking alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism" through a 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 gender 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.
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 only for those with "a desire to stop drinking", while "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. Except for men's and women's meetings, meetings targeting specific demographics (including newcomers, gay people, and young people), AA meetings do not exclude other alcoholics. 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".
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 closing prayers.
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." 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. 
AA's New York General Service Office regularly surveys AA members in North America. Its 2011 survey of over 8,000 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 65% male and 35% female. Average member sobriety is slightly under 10 years with 36% sober more than ten years, 12% 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, 62% received outside treatment or counseling. Of those members, 82% said that outside help played an important part in their recovery. The same survey showed that AA received 12% of its membership from court ordered attendance.
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, with the possible exception of those who are mandated by courts to attend AA meetings; they are instead self-selected. 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. Controlled experiments with AA versus non-AA subjects are also difficult because AA is so easily accessible. Twelve-step groups like AA are not conducive to probability sampling of members. Research on AA is therefore susceptible to sampling bias.
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 Cochrane Review of eight studies, published between 1967 and 2005, measuring the effectiveness of AA, found "no experimental studies unequivocally demonstrated the effectiveness of AA" in treating alcoholism, based on a meta-analysis of the results of eight trials involving 3,417 individuals. To determine further the effectiveness of AA, the authors suggested that more studies comparing treatment outcomes with control groups were necessary.
Every third year since 1968, AA has issued a pamphlet summarizing its latest triennial survey of meeting attendants. Additional published comments and analysis for academics and professionals have supplemented the survey results from 1970 through 1990. The 1990 commentary evaluated data of triennial surveys from 1977 through 1989 and found that the distribution of those with one year or less indicated that one quarter (26%) of those who first attend an AA meeting are still attending after one year. Furthermore, nearly one third (31.5%) leave the program after one month, and by the end of the third month, almost half (47.4%) leave. Of those who stay for three months, half (50.0%) will attain one year. After the first year, the rate of attrition slows. Only those in the first year were recorded by month.
Two landmark surveys that sampled the general population produced independent results on AA continuance rates. The 1990 National Longitudinal Alcohol Epidemiologic Survey (NLAES) found that Alcoholics Anonymous has a 31% continuance rate. The 2001-2002 National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) indicates a slightly higher rate, at 35.2%.
Internal AA surveys suggest that about 40% of the members sober for less than a year will remain another year. About 80% of those sober more than one year, but less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year. Those who remained sober outside the fellowship could not be calculated using the survey results.
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.
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.
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 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.
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. 31% of AA's membership results from treatment centers referrals.
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.
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 available to problem drinkers who can manage their drinking with the right treatment. The Big Book, however, acknowledges "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."
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.
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.
Gross Profit from Literature ~8,6M (57%), Contributions ~$6.5M (43%)
by helping another alcoholic, he could save himself
Bill went back to Towns constantly to work on alcoholics there, simply trying to help others had kept him from even thinking of drinking
simply trying to help other had kept him from even thinking of drinking
The titles include: Carrying the Message into Correctional Facilities, Where Do I Go From Here?, A.A. in Prison: Inmate to Inmate, A.A. in Correctional Facilities, It Sure Beats Sitting in a Cell, Memo to an Inmate Who May be an Alcoholic, A Message to Corrections Administrators
Laudatory but never simplistic, "Bill W." is a thoroughly engrossing portrait of Wilson, his times and the visionary fellowship that is his legacy.
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