Alcoholics Anonymous

Nickname	AA
Formation	1935; 89 years ago (1935)
Founders	Bill Wilson Bob Smith
Founded at	Akron, Ohio
Type	Mutual aid addiction recovery twelve-step program
Headquarters	New York, New York
Membership (2020)	2,100,000
Website	aa.org

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 non-professional, unafiliated, non-denominational and 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]

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. The new fellowship—at first only white and male, though this was neither intentional or for long—published in 1939 Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism. Known as “the Big Book", it is also 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. For taking the steps, divining and following the will of an undefined God "as we understood Him" or as “a higher power" is integral, but differing practices and beliefs, including those of atheists, are accommodated.^[8]

To keep sobriety as its primary purpose, AA instituted its twelve traditions in 1950 to ensure membership to all wishing to stop drinking with no dues or fees required. They urge all memberships 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. Additionally, members are advised not to use AA for material gain or to increase public prestige. To stay independent and self-supporting, the traditions would have no AA entity accepting outside contributions.^[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 other 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, an otherwise receptive AA has not endorsed it though many AA members have promoted it towards wider acceptance.^[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]

History

AA was founded on 10 June 1935 but AA's origins are said to have begun when the renowned psychotherapist Carl Jung inspired Rowland H., an otherwise hopeless drunk, to seek a spiritual solution by sending him to the Oxford Group— a non-denominational, altruistic Christian movement modeled after first-century Christianity. Ebby Thacher got sober in that same Oxford Group and reached out to help his drinking buddy Bill Wilson.^[22] Thacher approached Wilson saying that he had "got religion", was sober, and that Wilson could do the same if he set aside objections and instead formed a personal idea of God, "another power" or "higher power".^[23][24] Feeling a "kinship of common suffering", Wilson attended his first group gathering, although he was drunk. Within days, Wilson admitted himself to the Charles B. Towns Hospital after drinking four beers on the way—the last alcohol he ever drank. Under the care of Dr. William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna.^[25] At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.^[26] This "spiritual awakening" may have been brought on by belladonna hallucinations and delirium tremens.^[27]

Following his hospital discharge, Wilson joined the Oxford Group and tried to recruit other alcoholics to the group. These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober. Dr. Silkworth suggested that Wilson place less stress on religion (as required by The Oxford Group) 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.^[28]

The first female member, Florence Rankin, joined AA in March 1937,^[29][30] and the first non-Protestant member, a Roman Catholic, joined in 1939.^[31] The first black AA group commenced in 1945 in Washington D.C., and was founded by Jim S., an African-American physician from Virginia.^[32][33]

While writing the Big Book in the several years after 1935, Wilson developed the Twelve Steps, which were influenced by the Oxford Group's 6 steps and various readings, including William James's The Varieties of Religious Experience.^[34][35]

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,^[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]

Organization and finances

AA says it is "not organized in the formal or political sense",^[40] and Wilson, borrowing the phrase from anarchy theorist Peter Kropotkin, called it a "benign anarchy".^[13] 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."^[44]

In 2018, AA had 2,087,840 members and 120,300 AA groups worldwide.^[40] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.^[45]

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.^[40]

AA groups are self-supporting, relying on voluntary contributions from members to cover expenses.^[40] The AA General Service Office (GSO) limits contributions to US$5,000 a year.^[46] "Below" the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.^[14]

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 GSO.^[47] 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 contributions 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 working with alcoholics in need (the "12th Step").^[48] (AA's 12th step is: "Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.")^[49] 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.^[50]

Program

AA's program extends beyond abstaining from alcohol.^[51] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"^[52] through "an entire psychic change," or spiritual awakening.^[53] A spiritual awakening is meant to be achieved by taking the Twelve Steps,^[54] and sobriety is furthered by volunteering for AA^[55] and regular AA meeting attendance^[56] or contact with AA members.^[54] 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 experienced all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person.^[55] 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.^[57]

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.^[51] 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. They argue that to help members stay sober, AA must 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 may 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.^[58]

Meetings

AA meetings are gatherings where recovery from alcoholism is discussed. One perspective sees them as "quasi-ritualized therapeutic sessions run by and for, alcoholics".^[59] There are a variety of meeting types some of which are listed below. At some point during the meeting a basket is passed around for voluntary donations. AA's 7th tradition requires that groups be self-supporting, "declining outside contributions".^[14] Weekly meetings are listed in local AA directories in print, online and in apps.

Open vs Closed meetings

"Open" meetings welcome anyone—nonalcoholics can attend as observers.^[60] Meetings listed as "closed" welcome those with a self-professed "desire to stop drinking," which cannot be challenged by another member on any grounds.^[14]

Speaker meetings

At speaker meetings one or more members come to tell their stories.^[61]

Big Book meetings

At Big Book meetings, attendees read from the AA Big Book and discuss it.^[61]

Discussion meetings

There are also meetings with or without a topic that allow participants to speak up or "share".^[62]

Online vs. offline meetings

Online meetings are digital meetings held on platforms such as Zoom. Offline meetings, also called "face to face", "brick and mortar", or "in-person" meetings, are held in a shared physical real-world location. Some meetings are hybrid meetings, where people can meet in a specified physical location, but people can also join the meeting virtually.

Specialized meetings

AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age,^[63] sexual orientation,^[64][65] or culture.^[66][67] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.^[68][65]

Meeting formats

While AA has pamphlets that suggest meeting formats,^[69][70] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".^[14] 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".^[71]

Confidentiality

In the Fifth Step, AA members typically reveal their own past misconduct to their sponsors. US courts have not extended the status of privileged communication, such as physician-patient privilege or clergy–penitent privilege, to communications between an AA member and their sponsor.^[72][73]

Spirituality

Some critics 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]

Disease concept of alcoholism

More informally than not, AA's membership has helped popularize the disease concept of alcoholism^{[citation needed]} which had appeared in the eighteenth century.^[80] Though AA usually avoids the term disease, 1973 conference-approved literature said "we had the disease of alcoholism."^[81] Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.^[82]

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."^[82] 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."^[83] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."^[84] 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.^[85]

Since then medical and scientific communities have defined alcoholism as an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild).^[86] 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.^[87]

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. 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

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.^[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

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]

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.^[97][98] 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.^[99][100]

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.^[101] 32% of AA's membership was introduced to it through a treatment facility.^[88]

Effectiveness

There are several ways one can determine whether AA works and numerous ways of measuring if AA is successful, such as looking at abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost.^[17]

The effectiveness of AA (compared to other methods and treatments) has been challenged throughout the years,^[102] but recent high quality clinical meta-studies using quasi-experiment studies show that AA costs less than other treatments and results in increased abstinence.^[17][103] In longitudinal studies, AA appears to be about as effective as other abstinence-based support groups.^[104]

Because of the anonymous and voluntary nature of AA meetings, it has been difficult to perform random trials with them. Environmental and quasi-experiment studies suggest that AA can help alcoholics make positive changes.^{[105][106][107]}

In the past, some critics have criticized 12-step programs as pseudoscientific^[75][108] and "a cult that relies on God as the mechanism of action".^{[74][75][109]} Until recently, ethical and operational issues had prevented robust randomized controlled trials from being conducted comparing 12-step programs directly to other approaches.^[75] More recent studies employing randomized and blinded trials have shown 12-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.^[110]

Cochrane 2020 review

A 2020 Cochrane review concluded that "compared to other well-established treatments, clinical linkage using well-articulated Twelve-Step Facilitation (TSF) manualized interventions intended to increase Alcoholics Anonymous (AA) participation" are more effective than other established treatments, such as motivational enhancement therapy (MET) and cognitive-behavioral therapy (CBT), as measured by abstinence rates.^[111][112] Manualized TSF probably achieves additional desirable outcomes—such as fewer drinks per drinking day and less severe alcohol-related problems—at equivalent rates as other treatments, although evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".^[111]

In the same year, Nick Heather, an addiction researcher, expressed concerns about the review. He argued that as it did not measure outcomes such as quality of life or reduction in alcohol dependence it could not replace the findings of an earlier review, which were largely inconclusive.^[113][114] He also claimed that only measuring abstinence as an outcome may not reflect the reality of recovery for many people, and noted a possible sample bias in the review: much of the data considered high-quality included participants receiving individualized treatment. Heather claimed this biased the sample towards individuals who were more socially stable and likely to receive such treatment, and stated that these conditions would not be replicated in "typical AA groups".^[114]

The authors of the review responded to this critique, reiterating the findings of their review, that AA "proved at least as effective and in some cases more effective than comparison conditions on all reported outcomes and was also substantially more cost-effective".^[115][111] They stated that the lack of quality-of-life measures was due to the studies they reviewed lacking such measures and was not a choice on their part, but clarified that their study did take into account more outcomes than just abstinence. In response to the concern expressed by Heather that "those more strongly committed to total abstinence after receiving AA/TSF were likely to experience more protracted 'slips' if they did for any reason drink",^[114] the Cochrane review authors stated that subjects who did not achieve abstinence did not have worse drinking outcomes overall.^[116] Finally, they stated that their study was clearly an advance compared to the 2006 review^[113] as it considered data from "more than triple the number of research participants and trials". They also noted that their review considered high-quality data than the 2006 one.^[115]

Older studies

A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate 16 years later for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment.^[117][118] The study's results may be skewed by self-selection bias.^[119][120]

Project MATCH was a 1990s 8-year, multi-site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment.^[121]

Brandsma 1980 showed that Alcoholics Anonymous is more effective than no treatment whatsoever.^[122]

Membership retention

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).^[123] 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).^[123]

The popular press

The Sober Truth

American psychiatrist Lance Dodes, in The Sober Truth, says that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety.^[124]

The 5–8% figure put forward by Dodes is controversial;^[125] other doctors say that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure."^[126][127] Addiction specialists state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong.^[128][129] One review by Dr. Jeffrey Roth Khantzian called Dodes' reasoning against AA success a "pseudostatistical polemic"; he further noted that two of Dodes' colleagues, Dr. John F Kelly and Dr. Gene Beresin, wrote in their own review for NPR Boston's website, that the book was "so far off the track of scientific research that he doesn’t realize that for the past several years, the addiction research field has moved beyond asking whether AA and 12-step treatment works, to investigating how and why they work.” ^[130]

Dodes has not, as of March 2020, read the 2020 Cochrane review showing AA efficacy, but opposes the idea that a social network is needed to overcome substance abuse.^[131]

The Irrationality of Alcoholics Anonymous

In a 2015 article for The Atlantic, Gabrielle Glaser criticized the dominance of AA in the treatment of addiction in the United States.^[132] Her article uses Lance Dodes's figures and a 2006 Cochrane report to state AA had a low success rate, but those figures were subsequently criticized by experts as outdated.^{[125][126][127]} The Glaser article incorrectly conflates the efficacy of treatment centers with the efficacy of Alcoholics Anonymous.^[133] The Glaser article says that "nothing about the 12-step approach draws on modern science", but a large amount of scientific research has been done with AA, showing that AA increases abstinence rates.^[127] The Glaser article criticizes 12-step programs for being "faith-based", but 12-step programs allow for a very wide diversity of spiritual beliefs, and there are a growing number of secular 12-step meetings.^[134][135]

Criticism

Sexual advances ("thirteenth-stepping")

"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates. In 2003, 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 pursuing sexual company. The authors suggest that both men and women must be prepared for this behavior or find male or female-only groups.^[136] As of 2010, women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women.^[137] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.^[138] AA also has a safety flier which states that "Unwanted sexual advances and predatory behaviors are in conflict with carrying the A.A. message of recovery."^[139]

The family of Karla Mendez, who was murdered in 2011 by a man she met at an AA meeting, filed a civil lawsuit in 2012 against AA asserting AA had a "reckless disregard for, and deliberate indifference…to the safety and security of victims attending AA meetings who are repeatedly preyed upon at those meetings by financial, violent, and sexual predators...".^[140][141] The lawsuit against AA was dismissed in 2016.^[142][143]

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.^[144] 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.^[145] 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."^[146]

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.^[147] A 1985 study based on observations of AA meetings warned of detrimental iatrogenic effects of the twelve-step philosophy and concluded that AA uses many methods that are also used by cults.^[148] A later review disagreed, stating that AA's program bore little resemblance to religious cult practices.^[149] In 2014, Vaillant published a paper making the case that Alcoholics Anonymous is not a cult.^[150]

Literature

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.

• Anonymous (2011). Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism (multiple PDFs) (4th ed.). ISBN 978-1-893007-16-1. OCLC 49743393. 575 pages.
• Anonymous (2002). Twelve Steps and Twelve Traditions (multiple PDFs). Hazelden. ISBN 978-0-916856-01-4. OCLC 13572433. 192 pages.
• "Home Page". AA Grapevine. Alcoholics Anonymous. ISSN 0362-2584. OCLC 319167052.

AA in media

Film and television

• Bloody Mary - A 2005 episode of the animated TV series South Park where Randy Marsh must attend AA meetings after getting a DUI.
• My Name Is Bill W. – dramatized biography of co-founder Bill Wilson.^[152][153]
• When Love Is Not Enough: The Lois Wilson Story – a 2010 film about the wife of founder Bill Wilson, and the beginnings of Alcoholics Anonymous and Al-Anon.^[154][155]
• Bill W. – a 2011 biographical documentary film that tells the story of Bill Wilson using interviews, recreations, and rare archival material.^[156][157]
• A Walk Among the Tombstones (2015), a mystery/suspense film based on Lawrence Block's books featuring Matthew Scudder, a recovering alcoholic detective whose AA membership is a central element of the plot.^[158]
• When a Man Loves a Woman – a school counselor attends AA meetings in a residential treatment facility.^[159]
• Clean and Sober – an addict (alcohol, cocaine) visits an AA meeting to get a sponsor.^[160]
• Days of Wine and Roses – a 1962 film about a married couple struggling with alcoholism. Jack Lemmon's character attends an AA meeting in the film.^[161]
• Drunks – a 1995 film starring Richard Lewis as an alcoholic who leaves an AA meeting and relapses. The film cuts back and forth between his eventual relapse and the other meeting attendees.^[162]
• Come Back, Little Sheba – A 1952 film based on a play of the same title about a loveless marriage where the husband played by Burt Lancaster is an alcoholic who gets help from two members of the local AA chapter.^[163] A 1977 TV drama was also based on the play.
• I'll Cry Tomorrow – A 1955 film about singer Lillian Roth played by Susan Hayward who goes to AA to help her stop drinking. The film was based on Roth's autobiography of the same name detailing her alcoholism and sobriety through AA.^[164][165]
• You Kill Me – a 2007 crime-comedy film starring Ben Kingsley as a mob hit man with a drinking problem who is forced to accept a job at a mortuary and go to AA meetings.^[166][167]
• Smashed – a 2012 drama film starring Mary Elizabeth Winstead. An elementary school teacher's drinking begins to interfere with her job, so she attempts to get sober in AA.^[168]
• Don't Worry, He Won't Get Far on Foot – a 2018 biography/comedy/drama by Gus Van Sant, based on the life of cartoonist John Callahan.^[169]
• Flight — a 2012 film starring Denzel Washington as an alcoholic airline pilot. The movie includes a dramatic representation of a prison AA meeting.^[170]
• 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.^[171]
• Doctor Sleep – Released in 2019, Doctor Sleep is a sequel to The Shining, directed by Mike Flanagan and based on Stephen King's work. Ewan McGregor stars as a man who, after overcoming his own demons through AA, helps others do the same.^[172]