Founded in 1935, Alcoholics Anonymous (AA) is a mutual-help organization for alcoholics, with about 2 million members and 99,000 groups in more than 140 countries. Among individuals who seek help for an alcohol problem in the United States, more than half go to AA—substantially more than those who choose formal treatment.
The structure and function of AA are guided by the Twelve Steps (structuring the therapeutic process) and the Twelve Traditions (governing AA’s operation as an organization). Members are encouraged to attend meetings and “work” the steps, often with support from a senior “sponsor.” Working the steps requires that members (1) admit powerlessness over their drinking, (2) accept that only a power greater than themselves can relieve them of alcohol dependence, (3) surrender to a higher power, (4) admit to their defects and ask for their removal, (5) acknowledge how they have hurt others and make amends where possible, and (6) help others become acquainted with AA and carry out God’s will generally. AA has a spiritual emphasis, but it is noncreedal. AA draws from many traditions, encouraging individuals to interpret “God” as they deem fit.
The Twelve Traditions were developed to preserve AA as an organization dedicated to helping individuals live life free of alcohol. In accordance with these traditions, groups are self-starting and self-governing. No franchise system allots territories or populations to groups, and groups are autonomous and financially independent. Meetings are led by temporary leaders instructed to “serve but never govern.” Except for the copyrights on its publications, AA owns no property and AA forbids external affiliations and endorsements. AA does not solicit members through promotional activity and receives income only from voluntary contributions.
Ample research suggests that AA is effective in helping individuals remain abstinent from alcohol. Studies of Veterans’ Administration (VA) inpatients have reported abstinence rates twice as high among men reporting AA (vs. no AA) attendance. Likewise, Project MATCH, a rigorous clinical trial of individuals seeking treatment for alcohol problems, found that AA attendance predicted higher rates of abstinence during treatment and through the 1-year follow-up. These and similar studies of AA’s effectiveness have been challenged on grounds that individuals who choose to attend AA have higher motivation than those who decline involvement, or differ in other ways that could account for the relationship between AA and outcomes. Those concerns have been somewhat mitigated by consistent findings that AA affiliates display higher initial problem severity than non-affiliates. Some evidence suggests that AA is ineffective when involvement is coerced, although naturalistic studies have also found good outcomes under coercion.
AA’s approach differs substantially from usual psychotherapeutic practice. There is no professional therapist in attendance at AA meetings. Members are of equal status and help each other, in part by listening, telling their stories, doing service (e.g., setting up chairs and making coffee), and sponsoring others. Further, AA’s claim to authority is not based on scientific knowledge, but on tradition, experience, and spiritual beliefs. Nevertheless, many treatment programs now incorporate clinicians with experience in 12-step groups, and some are explicitly modeled on 12-step principles (e.g., the “Minnesota model” approach). Further, most treatment centers now encourage or mandate 12-step attendance.
AA has helped spawn countless 12-step groups for the addictions and other lifestyle problems (e.g., Narcotics Anonymous, Cocaine Anonymous, Overeaters Anonymous, and Obsessive Compulsive Anonymous) and contributed to the formation of various secular alternatives, such as Rational Recovery Systems (founded in 1986), Secular Organizations for Sobriety (founded in 1986), and Women for Sobriety (founded in 1976). Associated groups include Al-Anon (for family members of alcoholics), Alateen (for their teenage children), and Adult Children of Alcoholics.
References:
- Alcoholics Anonymous, http://www.alcoholics-anonorg/ Alcoholics Anonymous World Services. (1939). Alcoholics Anonymous: The story of how many thousands of men and women have recovered. New York: Works.
- McIntire, (2000). How well does A.A. work? An analysis of published A.A. surveys (1968–1996) and related analyses/ comments. Alcoholism Treatment Quarterly, 18, 1–18.
- Tonigan, J. , Connors, G. J., & Miller, W. R. (2003). Participation and involvement in Alcoholics Anonymous. In T. Babor & F. K. Del Boca (Eds.), Matching alcoholism treatments to client heterogeneity: The results of Project MATCH (pp. 184–204). New York: Cambridge University Press.