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Alcoholics Anonymous

From Wikipedia, the free encyclopedia

Alcoholics Anonymous
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book.
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book.
NicknameAA
Formation1935; 86 years ago (1935)
Founded atAkron, Ohio
TypeMutual-help addiction recovery twelve-step program
HeadquartersNew York, New York
Membership (2020)
2,100,000
Key people
Bill Wilson, Bob Smith
Websiteaa.org

Alcoholics Anonymous (AA) is an international fellowship requiring no membership dues or fees, dedicated to helping alcoholics peer to peer in sobriety through its spiritually inclined Twelve Steps program.[1][2][3] Structurally guided by its Twelve Traditions, AA is set up as non-professional, non-denominational, as well as self-supporting and apolitical, with an avowed desire to stop drinking being its sole requirement for membership.[1][2][4] AA has not endorsed the disease model of alcoholism, to which its program is nonetheless sympathetic, but its wider acceptance is partly due to many members independently promulgating it.[5] As of 2020, having spread to diverse cultures, including geopolitical areas normally resistant to grassroots movements, AA has had an estimated worldwide membership of over two million with 75% of those in the U.S. and Canada.[6][7]

AA marks 1935 as its starting year when a 6 months sober Wall Street securities analysist Bill Wilson (Bill W.), reeling from a failed proxy deal, sought to maintain his new sobriety by meeting another alcoholic, surgeon Bob Smith (Dr. Bob), then detoxing in an Akron, Ohio hospital. Wilson put to Smith that alcoholism was not a failure of will or morals, but a malady from which he had recovered as a member of the Christian revivalist Oxford Group.[8] Having exiting the Oxford Group to form a fellowship of alcoholics only, Wilson and Smith, along with other early members, wrote Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism, from which AA acquired its name. Published in 1939 and commonly called "the Big Book", it contains AA's Twelve Step recovery program.[9] Later editions added the Twelve Traditions, first adopted in 1946, to formalize and unify the fellowship as a “benign anarchy”.[9]

The Twelve Steps are presented as a suggested self-improvement program of initially admitting powerlessness over alcohol and acknowledging its damage, the listing of and striving to correct personal failings, the making of amends for past misdeeds, and, in order to stay recovered, the pursuit of continued spiritual development while helping other alcoholics towards sobriety through the Steps. The Steps also suggest the healing aid of an unspecified God—"as we understood Him"—but are accommodating to agnostic, atheist, and non-theist members.[4]

Besides requiring a member to only have at minimum a desire to stop drinking, the Twelve Traditions hold that helping others recover from alcoholism is AA's primary purpose. That AA should have no opinions on other causes is to avoid public controversy. That members or groups should not use AA to gain wealth, prestige, or property. That dogma and hierarchies are to be avoided. That AA groups are autonomous and self-supporting—declining outside contributions—but they are barred from lending the AA name to other entities. And, without threat of retribution or means of enforcement, that members should remain anonymous in public media.[10][11][12]

With AA's permission, subsequent fellowships such as Narcotics Anonymous and Gamblers Anonymous have adapted the Twelve Steps and the Twelve Traditions to their addiction recovery programs.[13]

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.
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.[14] Some members founded the group to help in maintaining sobriety. "Grouper" Ebby Thacher was Bill 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".[15][16]

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.[17] At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.[18] 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.[19]

The first female member Florence Rankin joined AA in March 1937,[20][21] and the first non-Protestant member, a Roman Catholic, joined in 1939.[22] The first Black AA group was established in 1945 in Washington, D.C. by Jim S., an African-American physician from Virginia.[23][24]

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,[25] 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.[26]

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.[27] 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.[10] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[28] as AA grew to millions of members internationally.[29]

Organization and finances

A regional service center for Alcoholics Anonymous
A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense",[29] and Bill Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy".[30] 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."[31]

In 2018, AA counted 2,087,840 members and 120,300 AA groups worldwide.[29] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.[32]

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.[29]

AA groups are self-supporting, relying on voluntary donations from members to cover expenses.[29] The AA General Service Office (GSO) limits contributions to US$3,000 a year.[33] Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.[10]

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.[34] 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.[35] 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.[36]

Program

AA's program extends beyond abstaining from alcohol.[37] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[38] through "an entire psychic change," or spiritual awakening.[39] A spiritual awakening is meant to be achieved by taking the Twelve Steps,[40] and sobriety is furthered by volunteering for AA[41] and regular AA meeting attendance[42] or contact with AA members.[40] 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.[41] 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.[43]

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.[37] 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.[44]

Meetings

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics".[45] 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).[10] 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.[10] "Open" meetings are available to anyone (nonalcoholics can attend as observers).[46] At speaker meetings (also known as gratitude meetings)[citation needed], 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.[citation needed] In addition to those three most common types of meetings,[citation needed] there are also other kinds of discussion meetings that tend to allocate the most time for general discussion.[47]

Building for Spanish-speaking AA group in Westlake neighborhood, Los Angeles
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,[48][49] or culture.[50][51] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[52][49] While AA has pamphlets that suggest meeting formats,[53][54] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[10] 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".[55]

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.[56][57]

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.[58] 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.[59][60] There are online resources listing AA meetings for atheists and agnostics.[61]

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.[62] Though AA usually avoids the term "disease", 1973 conference-approved literature said "we had the disease of alcoholism."[63] Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.[64]

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."[64] 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."[65] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."[66] 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.[67]

Since then medical and scientific communities have defined alcoholism as an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild).[68] 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.[69]

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.[70] The survey found that 89% of AA members were white.[70]

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.[70] 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.[70]

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.[70]

Effectiveness

The effectiveness of Alcoholics Anonymous in treating alcoholism has been extensively studied. Many papers have been published studying the degree to which Alcoholics Anonymous (AA) helps alcoholics keep sober. The subject is controversial with some studies showing AA helping alcoholics, while other studies do not show AA efficacy. The U.S. Surgeon General stated in a 2016 report on addiction that "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions." The program appears to be helpful for a subset of alcoholics; Alcoholics Anonymous appears to be about as effective as other support groups recommending abstinence from alcohol and other drugs of abuse. The 2020 Cochrane meta-analysis of Alcoholics Anonymous says that, based on randomized controlled trials, AA-oriented therapies have a 42% abstinent rate one year after treatment, compared to the 35% abstinence rate with other therapies.[71][72]

Overview

There are a number of ways one can determine whether AA works and numerous ways of measuring if AA is successful. The 2020 Cochrane review of Alcoholics Anonymous determines success as "abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets."[71]

Because of the anonymous and voluntary nature of Alcoholics Anonymous ("AA") meetings, it is difficult to perform random trials with them; the research suggests that AA can help alcoholics make positive changes.[73] 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."[74][75]

The research is quite complex and is still developing;[73] some studies have suggested an association between AA and increased abstinence or other positive outcomes,[76][77][78][79][80] but other studies have not.[81][82] Likewise, some articles in the popular press state that Alcoholics Anonymous helps some alcoholics get sober,[83][84][85][86] but others claim AA is not effective.[87][88]

While older studies did not show a correlation between being assigned to AA and better treatment outcomes,[89] newer studies show that Alcoholics Anonymous significantly increases abstinence after treatment.[71][90][91] The 2020 Cochrane review saw, at the 12-month follow up, a 42% abstinent rate for AA and twelve-step facilitation treatments which encourage patients to regularly attend AA meetings, compared to 35% abstinent using non-AA interventions.[71][72]

Alcoholics Anonymous appears to be about as effective as other abstinence-based support groups.[92]

Systematic reviews, meta-analyses and large clinical studies

Cochrane Reviews

The 2020 Cochrane review of Alcoholics Anonymous shows that AA results in more alcoholics being abstinent and for longer periods of time than some other treatments, but only as well in drinks-per-day and other measures.[71][93] When comparing Alcoholics Anonymous and/or Twelve Step Facilitation to other alcohol use disorder interventions, at the 12-month follow up, randomized controlled trials show a 42% abstinent rate for AA/TSF treatments, compared to 35% abstinent using non-AA interventions.[72][94]

The study concludes that "Manualized AA/TSF interventions usually produced higher rates of continuous abstinence than the other established treatments investigated. Non-manualized AA/TSF performed as well as other established treatments [...] clinically-delivered TSF interventions designed to increase AA participation usually lead to better outcomes over the subsequent months to years in terms of producing higher rates of continuous abstinence."[71] Here, a "manualized" treatment is one where a standard procedure was used.[95] A TSF treatment is a "twelve-step facilitation" treatment: A treatment which encourages a patient to attend Alcoholics Anonymous.[96]

While Nick Heather speculated that subjects receiving Alcoholics Anonymous-centered interventions who were not abstinent did worse than other subjects,[97] John Kelley and Alexandra Abry clarified that not only did the subjects undergoing AA-based interventions have a higher abstinent rate, those who did not achieve abstinence did not have worse drinking outcomes.[98]

An older 2006 Cochrane review stated that the "available experimental studies did not demonstrate the effectiveness of AA or other twelve-step approaches in reducing alcohol use and achieving abstinence compared with other treatments",[89] but the newer review has more than three times the number of studies and participants, and uses studies with better methodologies.[99]

Kelly 2017

In 2017, Kelly and others from the Massachusetts General Hospital released a randomized experimental study where they looked at how twelve step facilitation (TSF) affected recovery among teenagers. The study concluded there was no significant difference in percent days abstinent between the control group and the group undergoing TSF, and that the TSF group had better 12-step meeting attendance, as well as fewer negative addiction consequences: less guilt about their substance abuse, being more responsible, having more money, etc.[100]

The group who randomly underwent TSF had a higher percentage of days abstinent (58% vs. 49% at the nine-month follow-up, overall p=0.33) and a larger number of subjects either completely or "mostly" abstinent (33% vs. 21% at the nine-month followup, overall p=0.30); this data, while not considered statistically significant in the study, was combined with data from other studies and made part of the 2020 Cochrane review of Alcoholics Anonymous.[71]

Humphreys, Blodgett, and Wagner 2014

A 2014 meta-analysis of the data from five studies 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."[77][84]

Kaskutas 2009

In 2009, Lee Ann Kaskutas performed a meta-analysis of other studies looking at how effective Alcoholics Anonymous is. The article notes that "rates of abstinence are about twice as high among those who attend AA" but concluded that whether Alcoholics Anonymous has a specific effect is unclear (a specific effect, in this context, is whether it's the actual Alcoholics Anonymous program which helps keep people sober, instead of other factors, including the fact that people more motivated to stay sober will go to more meetings, or that the group support helps alcoholics regardless of the actual program, etc.), stating that there were "2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect."[101]

Moos and Moos 2006

A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment: Of subjects highly involved with AA in their first year of alcohol treatment, 67% were sober 16 years later. The study looked at the outcome of a group of alcoholics seeking treatment over a 16-year period. The subjects decided on their own whether to use AA, and how much AA treatment they got. The study stated that "individuals who participated in AA for 27 weeks or more had better 16-year outcomes", showing that "only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more."[76]

The study's results may be skewed by self-selection bias.[101][102]

Project MATCH (1998)

Project MATCH was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The study concluded that twelve-step facilitation was as effective as the other psychotherapies studied.[103]

Brandsma 1980

The 1980 book Outpatient Treatment of Alcoholism describes a mid-1970s study. Participants were assigned randomly within five treatments, including an Alcoholics Anonymous-like meeting.[104] Later analysis says that there are "concerns with the Brandsma trial which call its experimental results into question".[101]

Membership retention

Results from NIAAA's National Epidemiological Survey on Alcoholism and Related Conditions

In 2001–2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. Respondents were asked if they had ever attended a twelve-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105).[105] In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270).[105]

Effectiveness: The popular press

The Sober Truth

American psychiatrist Lance Dodes, in The Sober Truth, says that most people who have experienced AA have not achieved long-term sobriety, stating that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety for longer than one year.[87] Gabrielle Glaser used Dodes' figures to state that AA has a low success rate in a 2015 article for The Atlantic, which says that better alternatives than Alcoholics Anonymous for alcohol treatment are available.[88]

The 5–8% figure put forward by Dodes is controversial;[86] Thomas Beresford, M.D., says that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure."[106][107] The New York Times calls The Sober Truth a "polemical and deeply flawed book".[108] John Kelly and Gene Beresin state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong (Dodes responded by pointing out that "I have never said that AA is harmful in general"), 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."[85][109] Jeffrey D. Roth and Edward J. Khantzian, in their review of The Sober Truth, called Dodes' reasoning against AA success a "pseudostatistical polemic."[110]

Lance Dodes has not, as of March 2020, read the 2020 Cochrane Review which shows AA efficacy, but in response to it says that he does not feel creating a social support network helps with addiction.[111]

Effectiveness: See also

Effectiveness: Further reading

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.[112][113][114] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[115] 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.[116]

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.[117] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[118] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[119]

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.[120][121] 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.[122][123]

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.[124] 32% of AA's membership was introduced to it through a treatment facility.[70]

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.[125]

Criticism

Sexual harassment ("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.[126] Women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women.[127] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.[128]

Criticism of Culture

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics.[129] 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.[130] 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."[131]

In 1983, a review stated 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.[132] A study based on observations of AA meetings warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults.[133] A later review disagreed, stating that AA's program bore little resemblance to religious cult practices.[134]

Literature

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[135] 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.

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, 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 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 Charlotte King (KaDee Strickland) and 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.[155]

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

Notes

  1. ^ a b AA Grapevine (15 May 2013), A.A. Preamble (PDF), AA General Service Office, retrieved 13 May 2017
  2. ^ a b Michael Gross (1 December 2010). "Alcoholics Anonymous: Still Sober After 75 Years". American Journal of Public Health. 100 (12): 2361–2363. doi:10.2105/ajph.2010.199349. PMC 2978172. PMID 21068418.
  3. ^ Mäkelä 1996, p. 3
  4. ^ a b "Information on AA". aa.org. Retrieved 18 April 2019.
  5. ^ https://www.williamwhitepapers.com/pr/Dr.%20Ernie%20Kurtz%20on%20AA%20%26%20the%20Disease%20Concept%2C%202002.pdf
  6. ^ Tonigan, Scott J; Connors, Gerard J; Miller, William R (December 2000). "Special Populations in Alcoholics Anonymous" (PDF). Alcohol Health and Research World. 22 (4): 281–285. PMC 6761892. PMID 15706756.
  7. ^ Alcoholics Anonymous (April 2016). "Estimates of A.A. Groups and Members As of December 31, 2020" (PDF). Retrieved 17 December 2016. cf. Alcoholics Anonymous (2001). Alcoholics Anonymous (PDF) (4th ed.). Alcoholics Anonymous World Services. p. xxiii. Retrieved 17 December 2016.
  8. ^ John, Stevens. "Bill W. of Alcoholics Anonymous Dies". New York Times. Archived from the original on 2 November 2021. Retrieved 19 November 2012.
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  11. ^ Chappel, JN; Dupont, RL (1999). "Twelve-Step and Mutual-Help Programs for Addictive Disorders". Psychiatric Clinics of North America. 22 (2): 425–46. doi:10.1016/S0193-953X(05)70085-X. PMID 10385942.
  12. ^ https://www.aa.org/assets/en_US/m-24_aafactfile.pdf
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  14. ^ Cheever, Susan (2004). My name is Bill: Bill Wilson: his life and the creation of Alcoholics Anonymous. New York: Simon & Schuster. p. 129. ISBN 978-0-7432-0154-4.
  15. ^ Pass It On, 1984, p 117.
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  17. ^ Pittman, Bill "AA the Way it Began" 1988, Glenn Abbey Books
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References

External links

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