Alcoholics Anonymous

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Contents 1 History 1.1 Alcoholism in the 1930s 1.2 Jung, Oxford, and Ebby 1.3 Bill Wilson gets sober 1.4 Dr. Bob gets sober 1.5 A new program 1.6 A new group 1.7 The Big Book 1.7.1 How It Works 1.7.2 Publication 1.8 Internal controversies 2 Organization 2.1 The Twelve Traditions 2.2 The Twelve Concepts 3 Working the program 3.1 The Twelve Steps 3.2 Meetings 3.2.1 Court ordered 4 Effectiveness 4.1 Research bias 4.2 Project MATCH 4.3 George Vaillant 4.4 Moos and Moos 4.5 Veterans Study 4.6 After treatment 4.7 Brandsma 4.8 Tonigan 5 Criticism 5.1 Moderation vs. abstinence 5.2 Disease of alcoholism 5.3 Abuse of trust 5.4 Is AA a cult? 5.5 Other 6 Literature 7 See also 8 References 9 External links

Alcoholics Anonymous (AA) is an informal society for recovering alcoholics whose primary purpose is to stay sober and help other alcoholics achieve sobriety.^[1] AA suggests that alcoholics follow its program and abstain from alcohol in order to recover from alcoholism, and share their experience, strength, and hope with each other that they may solve their common problem.^[2][3][4]

Meeting in local groups that vary in size from a handful to hundreds of members, AA estimated that as of 2001 there were 100,000 groups and 2,000,000 members worldwide.^[5]

AA was the first twelve-step program and has been the model for similar recovery groups like Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous, and Sexaholics Anonymous. Al-Anon/Alateen are companion programs designed to provide support for relatives and friends of alcoholics.

Alcoholics Anonymous is also the name of their primary guidebook, known as "The Big Book," from which the organization received its name.

History

Alcoholism in the 1930s

Public opinion in post-Prohibition 1930s America saw alcoholism as a moral failing, and the medical profession saw it as a condition that was incurable and lethal.^[6] Those without financial resources found help through state hospitals, the Salvation Army, and other charitable and religious groups. Those who could afford psychiatrists or hospitals were subjected to a treatment with barbiturate and belladonna known as "purge and puke"^[7] or were left in long-term asylum treatment.

The Emmanuel Movement was founded in 1906 by Dr. Elwood Worcester and Dr. Samuel McComb in Boston's Emmanuel Church, and in 1931 they published a book called Mind, Body, and Spirit addressing the nature of alcoholism.^[8] The movement worked closely with the medical field and produced lay therapists like Courtney Baylor and Richard Peabody. Peabody wrote The Common Sense of Drinking and his ideas became paralleled in The Big Book.^[9]

Jung, Oxford, and Ebby

In 1931 an American business executive Rowland Hazard sought treatment for alcoholism with psychiatrist Carl Jung in Switzerland.^[10] When Hazard ended treatment with Jung after about a year, he soon got drunk and returned for further treatment. Jung told Hazard that his case was nearly hopeless like other alcoholics and that his only hope might be a spiritual conversion with a religious group.^[11]

Back in America, Hazard joined the Oxford Group, a non-denominational Christian Evangelical association and the source of AA concepts like meetings and sharing for witness, finding a higher power, making restitution, and rigorous honesty. Hazard underwent a spiritual conversion with the help of Oxfords and finally achieved sobriety.^[12][13]

Members of the group introduced Hazard to Ebby Thacher. Hazard brought Thacher to the Calvary Rescue Mission, lead by Oxford leader Dr. Sam Shoemaker,^[14] which had helped over two-hundred thousand needy people.^[15] Thacher also attained periodic sobriety^[16] and in keeping with Oxford practices which taught that a new convert must win other converts in order to preserve his own conversion experience, he contacted his old friend Bill Wilson when he heard Wilson still had a drinking problem.^[17][18]

For more details on this topic, see Oxford Group and Ebby Thacher

Bill Wilson gets sober

Bill Wilson, also know as Bill W. was an alcoholic who had seen a promising career on Wall Street ruined by his drinking. He also failed to graduate from law school because he was too drunk to pick up his diploma, damaged his marriage, and was hospitalized for alcoholism under the care of Dr. William Silkworth, yet he still continued to drink.

When Thacher visited him at his New York apartment, Wilson was astonished to find that his old drinking companion had become sober through spiritual means. Until then, Wilson had struggled with the existence of God, but of his meeting with Thacher he wrote, "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last."^[5]

After attending his first meeting at the Calvary Mission, Wilson excitedly told his wife Lois about his spiritual progress, yet the next day he drank again and eventually found himself back in hospital under Silkworth's care. While lying in bed depressed and despairing Wilson cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!".^[19] He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Wilson described his experience to Dr. Silkworth who told him not to discount it.

Thacher visited Wilson at Townes hospital and introduced him to the basic tenets of the Oxford Group and the book Varieties of Religious Experience by American psychologist and philosopher William James, which described experiences similar to Wilson's. Upon his release from the hospital on December 18, 1934, Wilson moved from the Calvary Rescue Mission to the Oxford meetings at Calvary House. There he learned more about Oxford principals and made friends with Sam Shoemaker. Wilson socialized after the meetings with other ex-drinking Oxfords and he became interested in learning how to help other alcoholics achieve sobriety.^[20]

Dr. Bob gets sober

Armed with his new-found spiritual ideas, Wilson spent the first half of 1935 trying to help other alcoholics but failed to bring any to sobriety. Silkworth advised Wilson to stop preaching and talk more about alcoholism as a disease that condemns alcoholics to go mad or die. After a failed business venture in Akron, Ohio, Wilson was tempted to drink and realized that he needed to talk to another alcoholic to stay sober. He found a church directory in his hotel lobby where he phoned local ministers to ask if they knew any alcoholics he could talk to. Norman Sheppard directed him to fellow Oxford member Henrietta Seiberling whose group had been trying to help a desperate alcoholic named Dr. Bob Smith.

Smith started drinking while he was a student at Dartmouth College and almost failed to graduate from Rush Medical College in Chicago. He opened a medical practice and married in 1915 but his drinking caused his practice and family life to suffer. For seventeen years Smith's daily routine was to stay sober until the afternoon, get drunk, sleep, then take sedatives to calm his morning jitters.

Smith was an Oxford member but still drinking. Seiberling convinced Smith to meet with Wilson but Smith insisted that it last only fifteen minutes. Smith was impressed with Wilson's knowledge of alcoholism and ability to share from his experience and their discussion lasted for six hours. Smith became the first alcoholic Wilson success brought to sobriety, and Smith's last drink was a beer used to steady his hand for surgery, on June 10, 1935 which is considered by members to be the founding date of AA.^[21]

A new program

Wilson and Smith sought to develop a simple program to help even the worst of alcoholics, and a new and more successful approach that empathized with alcoholics yet convinced them of their hopelessness and powerlessness. Drinking alcoholics are in a state of insanity rather than a state of sin, an idea they learned apart from the Oxford Group.^[22][23]

To produce a spiritual conversion necessary for sobriety and sanity, alcoholics needed to realize that they couldn't conquer alcoholism by themselves, and that surrender to a higher power through confession and prayer was required. Sober alcoholics could show drinking alcoholics that it was possible to enjoy life without alcohol, thus inspiring a spiritual conversion that would help ensure the most important goal of sobriety.^[24][25][26]

A new group

After he and Smith worked with AA members three and four, Bill D. and Ernie G., and an initial Akron group was established, Wilson returned to New York and began hosting meetings in his home in the fall of 1935. He allowed alcoholics to live with him for long periods of time but stopped the practice in 1936 when he saw it did little to help them recover.

At the end of 1935, Oxford member Jack Smith publicly disapproved of Wilson's work with alcoholics and in 1937, Wilson left the Oxford Group (the Akron group separated from Oxford in 1939). Wilson stated that among other reasons, the Oxfords were too aggressive and public in their recruiting tactics, as well as exclusionary to non-Christians.

Wilson returned to Akron where he and Smith concluded that over forty alcoholics in Akron and New York had remained sober since they began their work. Wilson was overjoyed and made plans to implement his program on a mass scale, which included publishing a book, employing paid missionaries, and opening alcoholic treatment centers.

Initial fundraising efforts failed after the plan was approved by Smith and a majority of members, but in 1938 Wilson's brother-in-law Dr. Leonard Strong Jr. contacted Willard Richardson who arranged for a meeting with A. Leroy Chapman, an assistant for John D. Rockefeller Jr. Wilson envisioned receiving millions of dollars but Rockefeller offered fifty thousand dollars, stating that Wilson's project should be self-supporting. Wilson later gave Rockefeller credit for the idea of AA being non-professional.

Wilson was disappointed with Rockefeller's contribution which did not allow for the missionaries and treatment centers, but he and Smith proceeded to form a non-profit group called the Alcoholic Foundation and decided to publish a book which would share their personal experiences and what they did to stay sober.^[27]

The Big Book

Wilson began work on the book, dictating from notes as secretary Ruth Hock typed. As financial difficulties were encountered, the first two chapters "Bill's Story" and "There Is a Solution" were printed immediately to help raise money. After receiving an offer from Harper & Brothers to publish the book, early New York member Hank P., whose story The Unbeliever appears in the first edition of the Big Book, convinced Wilson to retain control over the book by publishing it themselves. Hank devised a plan to form Works Publishing Inc and raise capital by selling its shares to group members and friends.

Initially they had no success, but eventually Wilson and Hank obtained what they considered to be a promise from Reader's Digest to do a story about the book once it was completed. On the strength of that promise, AA members and friends were persuaded to buy shares, and Wilson received enough financing to continue writing the book.^[28] The editor of Reader's Digest claimed not to remember the promise and the article was never published.^[29]

How It Works

After the third and fourth chapters of the Big Book were completed, Wilson decided that a summary of methods for treating alcoholism was needed to describe the "word of mouth" program, which he included in Chapter Five of The Big Book called How It Works.^[30] The basic program developed from the works of William James, Dr. Silkworth, and the Oxford Group, and included six basic steps:

1. We admitted that we were licked, that we were powerless over alcohol.
2. We made a moral inventory of our defects or sins.
3. We confessed or shared our shortcomings with another person in confidence.
4. We made restitution to all those we had harmed by our drinking.
5. We tried to help other alcoholics, with no thought of reward in money or prestige.
6. We prayed to whatever God we thought there was for power to practice these precepts.

Wilson decided that the six steps needed to be broken down into smaller sections to make them easier to understand and accept.^[30] With contributions from other group members including several atheists who restrained religious content like Oxford material that would later result in controversy, by the fall of 1938 Wilson expanded the six steps into the final version of the Twelve Steps.^[31]

Publication

By January 6, 1939, One Hundred Men was the working title of the Wilson's book and more than one hundred titles were proposed, like The Empty Glass, The Dry Way, The Dry Life, Dry Frontiers, and Wilson's idea, The B.W. Movement. Members wanted to call it The Way Out but that name was already in use. They chose the name of an earlier fund-raising pamphlet which was devised by New Yorker writer and AA member Joe W. and the book Alcoholics Anonymous was published in April 1939.

Alcoholics Anonymous came to be known as The Big Book due to its bulkiness, and Clarence S. said that he was the first to use the name "Alcoholics Anonymous" as a fellowship title in May 1939 for the group he founded in Cleveland.

Initially The Big Book did not sell. Five thousand copies sat in the warehouse and Works Publishing was nearly bankrupt. Morgan R., recently released from an asylum, contacted his friend Gabriel Heatter, host of popular radio program We the People, to promote his newly-found recovery through AA. The interview was considered vital to the success of AA and its book sales, so to ensure Morgan stayed sober for the broadcast, members of AA kept him locked in a hotel room for several days under a twenty-four hour watch. The interview was a success and Hank P. had twenty thousand postcards mailed to doctors announcing the Heatter broadcast and encouraging them to buy a copy of Alcoholics Anonymous.^[32]

Sales of the book and the popularity of AA increased rapidly after positive articles in Liberty magazine in 1939^[33] and the Saturday Evening Post in 1941.^[34] The fourth edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each edition, personal stories represented the current membership of AA, and stories of original 1930s members were removed. In 2003, stories removed from the first three editions of The Big Book were gathered together in the book Experience, Strength, and Hope.^[35]

Internal controversies

By 1940, Hank P. had started drinking steadily after four years of sobriety when he was unable to account for Works Publishing finances. Hank blamed Wilson for the financial scandal, his divorce, and loss of his mistress Ruth Hock. He also accused Wilson of profiting from The Big Book royalties. Clarence S., who claimed to be the true founder of AA, also questioned New York AA headquarters about the book deal. Despite their actions, Wilson remained cordial with both men according to Oxford principles.^[36] By 1944 group numbers increased and more letters were sent to AA headquarters asking how to handle internal disputes,^[37] and in 1946 Wilson produced the Twelve Traditions as an initial way to better organize the AA fellowship.

Organization

The Twelve Traditions informally guide how AA functions, with its leadership rotating and of limited term. A member who accepts a service position or an organizing role is a "trusted servant." Terms typically last three months to one year and are determined by group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities since each meeting is considered a self-governing entity.

At the local and national level, AA groups are self-supporting and not a charity. AA has no membership fees and does not charge to attend meetings, but relies on member donations to pay for expenses like room rental and refreshments. Individual contributions are typically $1 per meeting^[38] and are limited to a maximum annual amount of $3000 per year.^[39]

AA receives proceeds from books and literature which are periodically revised. Literature sale revenues constitute more than 50% of the income for the General Service Office (GSO),^[40] which unlike individual groups is not self-supporting through contributions and maintains a small salaried staff.

AA maintains service centers which coordinate activities like printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and responsible to the AA groups they represent.

AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" out of twenty-one members of the AA Board of Trustees.^[41]

The Twelve Traditions

Main article: Twelve traditions

To avoid conflicts caused by questions of publicity, religion, and finances, the Twelve Traditions guide how members and groups interact with each other and AA as a whole. They were developed from early group experiences to answer the questions, "How can AA best function?" and "How can AA best stay whole and still survive?" They were first published in the April 1946 AA Grapevine as Twelve Points to Assure Our Future, formally adopted at AA's First International Convention in 1950, and published in book form as Twelve Steps and Twelve Traditions in 1953.^{[42][43][44][45]}

1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. For our group purpose there is but one ultimate authority – a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose to carry its message to the alcoholic who still suffers.
6. An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
9. A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

The Twelve Concepts

The Twelve Concepts for World Service were written by Wilson and adopted by the General Service Conference of Alcoholics Anonymous in 1962. Just as the Twelve Steps deal with the individual and the Twelve Traditions address the group, the Twelve Concepts interpret the world service structure as it emerged through early AA history and experience.^[46]

1. Final responsibility and ultimate authority for A.A. world services should always reside in the collective conscience of our whole Fellowship.
2. The General Service Conference of A.A. has become, for nearly every practical purpose, the active voice and the effective conscience of our whole society in its world affairs.
3. To insure effective leadership, we should endow each element of A.A.—the Conference, the General Service Board and its service corporations, staffs, committees, and executives—with a traditional “Right of Decision.”
4. At all responsible levels, we ought to maintain a traditional “Right of Participation,” allowing a voting representation in reasonable proportion to the responsibility that each must discharge.
5. Throughout our structure, a traditional “Right of Appeal” ought to prevail, so that minority opinion will be heard and personal grievances receive careful consideration.
6. The Conference recognizes that the chief initiative and active responsibility in most world service matters should be exercised by the trustee members of the Conference acting as the General Service Board.
7. The Charter and Bylaws of the General Service Board are legal instruments, empowering the trustees to manage and conduct world service affairs. The Conference Charter is not a legal document; it relies upon tradition and the A.A. purse for final effectiveness.
8. The trustees are the principal planners and administrators of over-all policy and finance. They have custodial oversight of the separately incorporated and constantly active services, exercising this through their ability to elect all the directors of these entities.
9. Good service leadership at all levels is indispensable for our future functioning and safety. Primary world service leadership, once exercised by the founders, must necessarily be assumed by the trustees.
10. Every service responsibility should be matched by an equal service authority, with the scope of such authority well defined.
11. The trustees should always have the best possible committees, corporate service directors, executives, staffs, and consultants. Composition, qualifications, induction procedures, and rights and duties will always be matters of serious concern.
12. The Conference shall observe the spirit of A.A. tradition, taking care that it never becomes the seat of perilous wealth or power; that sufficient operating funds and reserve be its prudent financial principle; that it place none of its members in a position of unqualified authority over others; that it reach all important decisions by discussion, vote, and whenever possible, substantial unanimity; that its actions never be personally punitive nor an incitement to public controversy; that it never perform acts of government; that, like the Society it serves, it will always remain democratic in thought and action.

Working the program

• Not drinking one day at a time.^[47]
• Regular AA meeting attendance.^[48]
• Regular contact with AA through phone, internet, and mail.^[47]
• Service work and helping with duties in AA.^[49]
• Working the Twelve Steps.^[47]

The Twelve Steps

Main article: Twelve steps

AA members take the Twelve Steps with the help of a sponsor.^[47] An AA sponsor is an alcoholic who has has been sober at least a year, is enjoying sobriety, has an understanding of the Twelve Steps, and is of the same sex.^[50] The Twelve Steps help alcoholics achieve a spiritual, emotional, and mental state of lasting sobriety through surrender to God or a higher power in order to remove character defects, resentment being chief among them. Atheists and agnostics are not excluded from sobriety in AA since they can choose their own non-religious concept of a higher power.^[51]

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. 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.

Meetings

Anyone is allowed to attend "open" AA meetings while "closed" meetings are for alcoholics only.^[52] Meeting formats vary between groups, a beginner meeting outline includes:^[53]

• Welcoming newcomers to AA.
• Assure that member anonymity is respected.
• Explaining that AA members only speak their own opinions and not for AA as a whole.
• Informing members about the group size and scope.
• Sharing by the leader for twenty or thirty minutes about how he or she came to AA and what was learned.
• Opening the meeting for discussion of topics like how to stay away from a drink or how to work the program.
• Giving information about other local meetings.
• Recommending that members obtain AA books, pamphlets, or the Grapevine magazine.

Court ordered

Judges and probation officers have required individuals to attend twelve-step programs as conditions of their parole and sentences resulting in a number of court cases starting in 1996. The Ninth Circuit Court of Appeals in San Francisco ruling on the case of Inouye vs. Kemna on September 7, 2007 stated, "the constitutional dividing line between church and state in such cases is so clear that a parole officer can be sued for damages for ordering a parolee to go through rehabilitation at Alcoholics Anonymous or an affiliated program for drug addicts." The Ninth Circuit pointed to cases decided before 2001 when eight state and federal courts that had ruled on the issue agreed that a parolee has a right to attend a secular treatment program. The conclusion was that coercion of a person into AA/NA or related treatment programs was unconstitutional.^[54] The Ninth Circuit said that although they had substantial religious components, it did not consider AA or NA themselves to be religions.^[55]

AA does not offer religious services.^[56] Anyone can attend open AA meetings and AA cannot discriminate against any member who attends under pressure from a court, an employer, or any other agency.^[57] Not all AA groups provide proof of attendance that may be required by a court or probation office.^[58]

Effectiveness

Research bias

AA is difficult to research due to its spiritual nature.^[59] Membership is voluntary and determined by the individual, not by the group, with no requirements, dues or fees, or membership lists.^[60] A randomized trial of AA is not possible because members are self-selected, not randomly selected.^[6] Two opposing types of self-selection bias are that drinkers may be motivated to stop drinking before they attend AA, and AA may attract the more severe and difficult cases.^[61] Control groups with AA versus non-AA subjects are impossible because AA will not prevent undesirable subjects from attending.^[61] AA works, but how well and for whom has not yet been adequately researched.^[62]

Project MATCH

Project MATCH began in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The project 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 programs were administered by psychotherapists and studied twelve-step method, not necessarily AA.^[63][64]

Three types of treatment were investigated:

• Cognitive Behavioral Coping Skills Therapy, focusing on correcting poor self esteem and distorted, negative, and self-defeating thinking.^[65][66]
• Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.^[67]
• Twelve-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation^[63]

Patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. NIAAA Director Enoch Gordis, M.D. said that treatment providers and patients can have confidence that, if well-delivered, they represent state of the art in behavioral treatments.^[63] Dr. Mark Willenbring of the NIAAA said that a year after completing a rehab program, about a third of alcoholics were sober, an additional 40 percent were improved but still drank heavily on occasion, and a quarter completely relapsed."^[68]

Dr. Stanton Peele criticized MATCH since there was no untreated study group to determine whether the treatments were more effective than the natural recovery process. Therapists in MATCH were more highly trained and monitored than addiction counselors usually available to the public. Effectiveness for all treatments was measured by reduction in frequency and intensity of drinking, whereas twelve-step and abstention-based programs should claim no improvement without full abstention.^[69]

George Vaillant

In The Natural History of Alcoholism Revisited which includes a 60-year study of 600 alcoholic men,^[70] Harvard psychiatric professor George E. Vaillant, a member of the Board of Trustees of Alcoholics Anonymous World Services, asked "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?"^[71] Despite difficulties of obtaining direct evidence by statistical methods, research revealed growing indirect evidence that AA is an effective treatment for alcohol abuse.^[59] AA shows an advantage over other treatments because it is a cheap, community-based fellowship people can easily return to.^[72]

Although AA is not a magic bullet for every alcoholic, in that there were a few men who attended AA for scores of meetings without improvement, good clinical outcomes correlated with frequency of AA attendance, having a sponsor, engaging in a Twelve-Step work, and leading meetings. Thus AA appears equal or superior to conventional treatments for alcoholism, and skepticism of professionals regarding AA as an effective treatment for alcoholism is unwarranted."^[72]

Moos and Moos

In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA.^[73][74][75] They reported that clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. A conclusion was that associations between treatment and long-term alcohol-related outcomes appeared to be due to participation in AA.^[73]

Veterans Study

Moos, Moos, and Humphreys studied 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the U.S. Five of the programs were twelve-step based and five used cognitive-behavioral therapy. The study concluded that over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy.^[76]

After treatment

A 1997 study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.^[77]

Brandsma

A 1979 Brandsma study found alcoholics in AA for several months were binge drinking five times as much as a control group that received no treatment at all, and nine times as much as a group that received Rational Emotive Behavior Therapy, arguing that teaching people they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy.^[78] A 1967 Ditman study found a correlation between participation in AA and an increase in the rate of multiple arrests for public drunkenness.^[79]

Tonigan

Tonigan's study found the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. "The magnitude of these benefits did not differ between sites." A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.^[80]

Criticism

Moderation vs. abstinence

The debate about moderation versus total abstinence is one of the most hotly contested issues in alcohol treatment.^[81] The Big Book acknowledges that not all drinkers are alcoholics, but advocates total abstinence for those who are.^[82] Critics believe more options should be available to problem drinkers who can manage their drinking with the right treatment.^[81]

Disease of alcoholism

Main article: Disease theory of alcoholism

The concept of alcoholism and addiction as a disease is controversial.^[83]

Dr. Silkworth said that alcoholism is a disease consisting of an obsession to drink alcohol, and an allergy or adverse reaction and compulsion to continue drinking once the first drink had been taken.^[84] Alcoholics can never safely use alcohol in any form at all, since once forming the habit, they cannot break it.^[85]

AA regards alcoholism as a disease^[86][87] (though Bill Wilson once stated that it was not and more comparable to an illness or malady)^[88] and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone.^[89]

AA has been criticized by opponents of the disease model, especially those who argue that AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.^[90]

Abuse of trust

Mutual support and abuse have both been observed in AA groups.^[72] AA undertakes no external restriction, screening, or vetting of its members, and the long-form version of Tradition Three (the basis of AA policy) states that any two or three alcoholics gathered together for sobriety may call themselves an AA group.^[91]

Thirteenth-stepping is a euphemistic term describing the practice of targeting new and vulnerable AA members for dates or sex. A survey of fifty-five female AA members, selected through convenience and snowball sampling, were rated on a thirteen question, four-level Likert scale instrument. Each question was associated with thirteenth-stepping experiences like feeling seduced, or intimidated and uncomfortable with sexual comments; receiving unwanted hugs and flirting; observing men flirting with, pressuring, and seducing other women; and observing men who seemed more interested in sex than in recovery. At least 50% of the survey participants experienced seven or more of these behaviors, and two were raped by men they met in AA. Chemical dependency treatment providers should be aware of this trend, and vulnerable women like those with histories of sexual abuse should be referred to female-only groups or be trained to avoid sexual exploitation in coed meetings.^[92]

A leaked internal AA memorandum stated that AA members are increasingly being investigated by police for sexual abuse. A small minority of members was taking advantage of vulnerable new members who were seeking help by phone or looking for a sponsor. The UK AA service board was considering how to deal with the issue on a national level.^[93]

Former members of a Washington DC Midtown AA group alleged that teenage girls and women were manipulated into sexual relationships with older male group members, older male sponsors were assigned to young women, members were told to cut off ties with family and friends, and others told to stop taking their medications. Members complained to AA New York office in an attempt to have them condemn Midtown practices, and found that AA has no firm hierarchy, no official regulations, and exercises no oversight of individual groups.^[94][95] Several local churches banned the group from meeting in their facilities.^[96][97]

Is AA a cult?

A "health cult" is a system for the cure of diseases based on dogma set forth by its promulgator.^[98] In 1963 Dr. Arthur H. Cain said that the term "sobriety" had taken on a religious flavor and AA members over-relied on dogmatic slogans and were slaves to the group.^[99] AA's need for submission to a higher power leaves potential for abuse, and submission can become the basis for cult-like cohesion.^[100] Some AA groups become cultist and some members are convinced that AA is the only way to recover from alcoholism.^[101]

Vaillant reports on Nance that rhetoric and emotional language of AA spirituality leads journalists and social scientists to fear AA is a religion or cult. Individual alcoholics attending incompatible AA groups or allying themselves with unfortunate sponsors tell horror stories about AA. Common to cults, AA members are not encouraged to take a dispassionate or scientific view of their organization, and as with any partisan group, members can be extremely and erroneously opinionated.

Helpful aspects of AA were also found like tolerance, a non-threatening personal style, and acceptance of self and others. Vaillant states that AA's encouragement of dependence is healthy like dependence on exercise is healthy, and that the rigidity of AA is like the discipline of post-coronary exercise programs. AA is unlike cults in that its program is based on suggestion only, religious conviction does not prevent AA membership and minority opinions are respected, it has no prescribed concept of "higher power" or charismatic leaders, and it operates on the principle of leadership rotation.^[72][102]

Other

For more details on this topic, see the related sections in the following article Twelve-step program: Criticism

Literature

• Alcoholics Anonymous (1976-06-01). Alcoholics Anonymous. Alcoholics Anonymous World Services. ISBN 0916856593. OCLC 32014950. 
• Alcoholics Anonymous (2002-02-10). Twelve Steps and Twelve Traditions. Alcoholics Anonymous World Services. ISBN 0916856011. OCLC 13572433. 
• Alcoholics Anonymous (1984). Pass It On. Alcoholics Anonymous World Services. ISBN 0916856011. 

See also

AA Grapevine Addiction recovery groups Alcoholism Al-Anon/Alateen Drunkenness

List of Twelve-Step groups Recovery model Self-help groups for mental health Substance abuse Twelve-step program

References

External links

• Wikipedia article
• AA official website

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