Alcoholics Anonymous

Alcoholics Anonymous (AA) is an international fellowship of alcoholics dedicated to sobriety and recovery through its spiritually inclined Twelve Steps program.Membership and participation are free, though all expenses of the fellowship are covered by member donations (the fellowship's "7th tradition"). 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.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. 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 results in higher abstinence rates and lower medical costs compared to either no treatment or treatments led by medical professionals.

AA dates its founding to 1935 when Bill Wilson, an alcoholic but sober stock speculator, sought to maintain his new sobriety by helping another alcoholic, surgeon Bob Smith (Dr. Bob), find sobriety. 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.[11] Having exited 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. Later editions added the Twelve Traditions, first adopted in 1946, to formalize and unify the fellowship as a "benign anarchy".

AA's program extends beyond abstaining from alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"through "an entire psychic change," or spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps,and sobriety is furthered by volunteering for AA[44] and regular AA meeting attendance or contact with AA members.Members are encouraged to find an experienced fellow alcoholic, called a sponsor, to help them understand and follow the AA program. The sponsor should preferably have experience of all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person. Following the helper therapy principle, sponsors in AA may benefit from their relationship with their charges, as "helping behaviors" correlate with increased abstinence and lower probabilities of binge drinking.

AA's 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."[67] 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."[68] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us." Wilson explained in 1960 why AA had refrained from using the term "disease":

Alcoholics Anonymous (AA) is an international fellowship of alcoholics dedicated to sobriety and recovery through its spiritually inclined Twelve Steps program.Membership and participation are free, though all expenses of the fellowship are covered by member donations (the fellowship's "7th tradition"). 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.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. 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 results in higher abstinence rates and lower medical costs compared to either no treatment or treatments led by medical professionals.

AA dates its founding to 1935 when Bill Wilson, an alcoholic but sober stock speculator, sought to maintain his new sobriety by helping another alcoholic, surgeon Bob Smith (Dr. Bob), find sobriety. 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.[11] Having exited 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. Later editions added the Twelve Traditions, first adopted in 1946, to formalize and unify the fellowship as a "benign anarchy".

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.

The Twelve Traditions provide guidelines for relationships between members, other groups, the global fellowship, and society at large. The Twelve Traditions stipulate that: AA, by having no opinions on other causes, avoids public controversy; members or groups should not use AA to gain wealth, prestige, or property; dogma and hierarchies are to be avoided; 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, members should remain anonymous in public media.

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.

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.

AA sprang from the Oxford Group, a non-denominational, altruistic movement modeled after first-century Christianity. 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".

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.At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself. Following his hospital discharge, Wilson joined the Oxford Group and recruited other alcoholics to the group. Wilson's early efforts to help others become sober were ineffective, prompting 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.

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

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, from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a Higher Power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal, and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches.

In 1941, interviews on American radio and favorable articles in US magazines, including a piece by Jack Alexander in The Saturday Evening Post, led to increased book sales and membership. By 1946, as the growing fellowship quarreled over structure, purpose, and authority, as well as finances and publicity, Wilson began to form and promote what became known as AA's "Twelve Traditions," which are guidelines for an altruistic, unaffiliated, non-coercive, and non-hierarchical structure that limited AA's purpose to only helping alcoholics on a non-professional level while shunning publicity. Eventually, he gained formal adoption and inclusion of the Twelve Traditions in all future editions of the Big Book. At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference, as AA grew to millions of members internationally

Organization and finances

Main article: Twelve Traditions

A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense", and Bill Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy". In Ireland, Shane Butler said that AA "looks like it couldn't survive as there's no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust". Butler explained that "AA's 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."

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

A member who accepts a service position or an organizing role is a "trusted servant" with terms rotating and limited, typically lasting three months to two years and determined by group vote and the nature of the position. Each group is a self-governing entity with AA World Services acting only in an advisory capacity. AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" of the 21-member AA Board of Trustees.

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

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. 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.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.

Program

See also: Twelve-step program § Twelve Steps

AA's program extends beyond abstaining from alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"through "an entire psychic change," or spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps,and sobriety is furthered by volunteering for AA[44] and regular AA meeting attendance or contact with AA members.Members are encouraged to find an experienced fellow alcoholic, called a sponsor, to help them understand and follow the AA program. The sponsor should preferably have experience of all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person. Following the helper therapy principle, sponsors in AA may benefit from their relationship with their charges, as "helping behaviors" correlate with increased abstinence and lower probabilities of binge drinking.

AA's program is an inheritor of Counter-Enlightenment philosophy. AA shares the view that acceptance of one's inherent limitations is critical to finding one's proper place among other humans and God. Such ideas are described as "Counter-Enlightenment" because they are contrary to the Enlightenment's ideal that humans have the capacity to make their lives and societies a heaven on Earth using their own power and reason.After evaluating AA's literature and observing AA meetings for sixteen months, sociologists David R. Rudy and Arthur L. Greil found that for an AA member to remain sober a high level of commitment is necessary. This commitment is facilitated by a change in the member's worldview. To help members stay sober AA must, they argue, provide an all-encompassing worldview while creating and sustaining an atmosphere of transcendence in the organization. To be all-encompassing AA's ideology 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.

Meetings

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics". 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). 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. "Open" meetings are available to anyone (nonalcoholics can attend as observers). 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.

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, or culture. Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish. While AA has pamphlets that suggest meeting formats, groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole". Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".

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.

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. 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.There are online resources listing AA meetings for atheists and agnostics.

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

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."[67] 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."[68] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us." Wilson explained in 1960 why AA had refrained from using the term "disease":

We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead, there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady—a far safer term for us to use.

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