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Alcoholics Anonymous (AA) is a worldwide mutual aid society[1] self-decribed as a fellowship of men and women with a desire to stop drinking alcohol while helping others to do so through a program of character development by following its invention, the Twelve Steps.[2][3] AA was started by two Americans, Bill Wilson and Dr. Bob Smith (commonly known as Bill W. and Dr. Bob), but its intentionally broad philosophy has aided AA in spreading "across diverse cultures holding different beliefs and values." AA's independence and removal from other organizations and avoidance of "outside issues" has helped its spread to geopolitical areas otherwise resistant to grassroots movements.[4] Although approximately two-fifths of people who participate in AA drop out within the first three months[5] its program can help alcoholics maintain sobriety.[6] Noting that brief treatment is ineffective for patients who can't maintain sobriety, the American Psychiatric Association recommends sustained treatment in conjunction with community resources such as AA.[7]

AA is named after it self-published book, "Alcoholics Anonymous", first published in 1939, which describes its program of recovery and is informally known as The Big Book.



In 1934 Bill Wilson's drunkenness had ruined a promising career in finance. Ebby Thacher, a former drinking friend, introduced Wilson to a six step spiritual solution for alcoholism that he picked up as a member of the Oxford Group, a Christian society that promoted sobriety. Wilson subsequently stopped drinking for good, but during a 1935 business trip to Akron, Ohio, Wilson's obsession for alcohol returned. In an effort to stay sober, he met with another alcoholic, Dr. Bob Smith, with whom he related how he stayed sober with the help of a power greater than himself. Wilson and Smith continued to meet and became convinced that working with another alcoholic helped them to stay sober. For the benefit of other alcoholics, they co-founded AA. The last day Smith drank alcohol—June 10, 1935—is the anniversary date of AA.[8]

By 1937, Wilson and Smith counted 40 alcoholics they helped to get sober, and two years later, they counted 100 members (including one woman). To promote the fellowship, Wilson and other members wrote Alcoholics Anonymous, the book for which the fellowship is named. Informally referred to by members as "The Big Book", it suggests a twelve-step program in which members admit powerlessness over alcohol, acceptance of a Higher Power, taking of a moral inventory, making amends to those harmed, and seeking direction, guidance, and power from a God "of one's own understanding". In 1941 interviews on American radio and favorable articles in US magazines, particularly by Jack Alexander in The Saturday Evening Post, were followed by increased book sales and membership.[9] By 1946, the growing fellowship was confused and quarreling over practices, finances, and publicity. Wilson's corrective was to write the guidelines for non-coercive group management, Twelve Points to Assure our Future, that eventually became known as the Twelve Traditions.[2] At the 1955 St. Louis convention, in Missouri, Wilson relinquished stewardship of AA to the General Service Conference.[10] In this era, AA started to expand internationally and grew to an estimated two million by 2001.[11]


A regional service center for Alcoholics Anonymous.

In 2006 AA reported 1,867,212 members and 106,202 AA groups worldwide.[11] The Twelve Traditions informally guide how AA groups function, and the Twelve Concepts for World Service guide how AA is structured globally.[12]

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/or 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" out of twenty-one members of the AA Board of Trustees.[11]

AA groups are self-supporting and not charities. There are no dues or membership fees. Groups rely on voluntary member donations to pay for expenses like room rental, refreshments, and literature. Typically, a basket is passed during the meeting. The Twelve Traditions of AA are read (including the Seventh Tradition, which states: "Every A.A. group ought to be fully self-supporting, declining outside contributions"). In the United States, for example, people often put a dollar or two in the basket. Any contribution is voluntary and not required of anyone.[11] AA GSO discourages individuals from making large donations by limiting contributions to US$3,000 per annum, and it returns contributions mailed from sources outside of AA.[13] Beyond the group level, AA may hire outside professionals for services that either require specialized expertise and/or are full time responsibilities.[2]

AA receives proceeds from books and literature which constitute more than 50% of the income for the General Service Office (GSO).[14] Unlike individual groups the GSO is not self-supporting and maintains a small salaried staff. It also 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. Other International General Service Offices (i.e., Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.[15]


The scope of AA's program is much broader than just changing drinking behavior.[16] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[17] while abstaining from alcohol, one day at a time. A spiritual awakening is achieved from following the Twelve Steps,[18] and sobriety is furthered by volunteering for AA[19] and regular AA meeting attendance[20] or contact with AA members.[18] 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 gender as the sponsored person, and refrain from imposing personal views on the sponsored person.[21] Following the helper therapy principle, sponsors in AA benefit as much, if not more, from their relationship than do those they sponsor. Helping behaviors correlate with increased abstinence and lower probabilities of binge drinking.[22]

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 at variance with 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.[16]

Sociologists David Rudy and Arthur Greil evaluated AA's literature and observed AA meetings for sixteen months. They note that although AA's ideology denies AA is religious in nature, 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 world view. To help members stay sober AA must, they argue, provide an all-encompassing world view while creating and sustaining an atmosphere of transcendence in the organization. To be all-encompassing AA's ideology places an emphasis on tolerance rather than on a narrow religious world view 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.[23]


AA meetings are "quasi-ritualized therapeutic sessions run by and for any alcoholics".[24] They are usually informal and often feature discussions. Local AA directories list a variety of weekly meetings. Those listed as "closed" are only for those with "a desire to stop drinking",[2] while "open" meetings are available to anyone. Speaker meetings have one or two members tell their stories, while discussion meetings allocate the most time for general discussion. Some meetings are devoted to studying and discussing the AA literature. Except for men's and women's meetings, most meetings for specific demographics (including newcomers, gays, and young people) do not exclude other alcoholics. While AA has pamphlets suggesting meeting formats,[25][26] AA groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or A.A. as a whole".[2] Different cultures affect ritual aspects of meetings, nonetheless around the world "many particularities of the AA meeting format can be observed at almost any A.A. gathering".[27]

Young person's meetings

In an attempt to appeal to younger alcoholics, particularly to those under the age of 30, many localities are offering groups for a younger crowd.[28] These groups often go over the hardship of staying sober around certain peer groups and how to manage emotions without drinking or drugging. The purpose of these groups, as in other AA groups, is to provide assistance to the suffering alcoholic with advice and stories. Providing young alcoholics with these things will let them know that they are not alone in their suffering and that they can get help from those around them. In these groups, younger alcoholics can find people that share the same disease, around the same age, and hopefully can make new friends with new social activities that can promote the idea of having fun without using alcohol or drugs. There is an annual event, the International Conference of Young People in Alcoholics Anonymous, which allows young members of Alcoholics Anonymous to celebrate their sobriety.


Although a statement is read during meetings saying that what is said there should remain confidential, AA members, unlike lawyers or clergy, are not legally bound to maintain confidentiality.[29][30]

Disease of alcoholism

Although AA lacks an official, singular definition of alcoholism, Dr. William Silkworth contributed the chapter in the basic text of Alcoholics Anonymous entitled "The Doctor's Opinion." This chapter has become one of the more influential pieces in AA literature. In it, he wrote they "have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity."[31] The allergy takes the form of a craving, which is explained earlier in the chapter, "the phenomenon of craving is limited to this class [alcoholics] and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit ... they cannot break it..."[32]

Contrary to Silkworth's original opinion, alcoholism does not actually constitute an allergy in the medical sense of the word, a fact acknowledged in later AA literature. "Technically, in strictly scientific terms, alcoholism is not a true allergy, the experts now inform us."[33] This explains why a spiritual experience (as opposed to a specific medical treatment, such as the use of antihistamines to combat an actual allergic reaction) is advocated in AA for achieving and maintaining sobriety. "When the spiritual malady is overcome, we straighten out mentally and physically." [34] Alcoholics Anonymous claims to provide a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.[35]

In the article 'Alcoholics Anonymous and the Disease Concept of Alcoholism,' AA historian Ernest Kurtz wrote, "The closest the book Alcoholics Anonymous comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the 'We Agnostics' chapter, where we are told that alcoholism 'is an illness which only a spiritual experience will conquer'." [36] This definition is the statement, "If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic."[37]

In 1960, Bill Wilson gave a speech to the National Catholic Clergy Conference on Alcoholism. During the ensuing question and answer discussion, Wilson was asked why he did not use the term "disease" when he spoke of alcoholism. He replied, "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."[38]

Canadian and US demographics

AA's New York General Service Office regularly surveys AA members in North America. Its 2004 survey of over 7,500 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 65% male and 35% female. Average member sobriety is eight years with 36% sober more than ten years, 14% sober from five to ten years, 24% sober from one to five years, and 26% sober less than one year. Before coming to AA, 64% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 65% received outside treatment or counseling, and 84% of those members said that that outside help played an important part in their recovery. The same survey showed that AA received 11% of its membership from court ordered attendance.[39]


Limitations on research

The study of AA tends to polarize observers into believers and non-believers,[40] and discussion of AA often creates controversy rather than objective reflection.[41] A randomized trial of AA is very difficult because members are self-selected, not randomly selected from the population of chronic alcoholics,[42] with the possible exception of those who participate in AA to comply with a court mandate. Two opposing types of self-selection bias are that drinkers may be motivated to stop drinking before they participate in AA, and AA may attract the more severe and difficult cases.[43] Control groups with AA versus non-AA subjects are also difficult because AA is so easily accessible.


Research into AA's efficacy has led to inconsistent results between studies. While some studies have suggested an association between AA attendance and increased abstinence or other positive outcomes,[44][45][46][47][48][49] other studies have not.[50][51][52][53][54] A Cochrane Review of eight studies, published between 1967 and 2005, measuring the effectiveness of AA, found no significant difference between the results of AA and twelve-step facilitation approaches compared to other treatments. To determine further the effectiveness of AA, the authors suggested that more studies comparing treatment outcomes with control groups were necessary.[55]


According to AA, most who start attending AA meetings drop out.[56] Every third year since 1968 AA issues a pamphlet summarizing its latest triennial survey of meeting attendants. Additional published comments and analysis for academics and professionals have supplemented the survey results from 1970 through 1990.[5] The 1990 commentary evaluated data of triennial surveys from 1977 through 1989 and found that one quarter (26%) of those who first attend an AA meeting are still attending after one year. Furthermore, nearly one third (31.5%) leave the program after one month, and by the end of the third month, over half (52.6%) have left.[56] After the first year, the rate of attrition slows. Only those in the first year were recorded by month.[56] About 40% of the members sober for less than a year will remain another year. About 80% of those sober less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year. Those who remained sober outside the fellowship could not be calculated using the survey results.[56]

Health care costs

As a volunteer-supported program, AA is a free service. This stands in contrast to treatments for alcoholism such as inpatient treatment, drug therapy, psychotherapy and Cognitive Based Therapy. Research has noted that institutional use of AA in certain circumstances has reduced health care expenditures by 45%.[47]

Relationship with institutions


In the United Kingdom and New Zealand, Alcoholics Anonymous holds meetings in prisons. AA prison and probation liaisons cooperate with staff and AA volunteers give talks to staff in the legal profession.[57] In the United States AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods to approach correctional facility officials with the intent of developing an in-prison AA program.[58] In addition, a variety of pamphlets are published by AA specifically for the incarcerated alcoholic.[59] Additionally, the AA General Service Office also provides a pamphlet with guidelines for members working with incarcerated alcoholics.[60]

Court rulings

United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed to be a religion, it was ruled that it contained enough religious components to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution.[61] In September 2007, United States Court of Appeals for the Ninth Circuit stated that a parole office can be sued for ordering a parolee to attend AA.[62][63]

American treatment industry

Although Alcoholics Anonymous does not endorse and is not allied with any outside facility, since 1949 when Hazelden treatment center was founded by some AA members, alcoholic rehabilitation clinics have frequently incorporated precepts of the AA program into their own treatment programs.[64] A reverse influence has also occurred with AA receiving 31% of its membership from treatment center referrals.[39]

United Kingdom treatment industry

A cross-sectional survey of substance misuse treatment providers in the West Midlands found fewer than ten percent integrated twelve-step methods in their practice and only a third felt their consumers were suited for Alcoholics Anonymous or Narcotics Anonymous membership. Less than half were likely to recommend self-help groups to their clients. Providers with nursing qualification were more likely to make such referrals than those without. A statistically significant correlation was found between providers self-reported level of spirituality and their likelihood of recommending AA or NA.[65]


Moderation or abstinence

For more details on this topic, see Alcoholism: Management

AA acknowledges that not all drinkers are alcoholics, but advocates total abstinence for those who are.[66] Critics such as Stanton Peele and Nancy Shute argue, however, that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics,[67] and believe that more options should be available to problem drinkers who can manage their drinking with the right treatment.[68]

Cultural identity

One review of AA warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults.[69] A subsequent study concluded, however, that AA's program bore little semblance to religious cults because the techniques used appeared beneficial.[70] Another difference is that, unlike what happens in cults, AA does not seek to prevent a member leaving or renouncing the movement. In this regard there is complete freedom. Another study found that the AA program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity replacing it with the deviant identity.[71] A survey of group members, however, found they had a bicultural identity and saw AA's program as a complement to their other national, ethnic, and religious cultures.[72] There is no absolutely uniform experience in AA with members adopting a wide variety of religion beliefs, political opinions and life-styles. Despite the emphasis on a "Higher Power" and the use of the word "God" in AA literature such as the 12 Steps and the Big Book, there is no common way of understanding this phrase and some AA members even claim to be atheist or agnostic.

Other notable criticism

  • "Thirteenth-stepping" is a disparaging euphemism referring to AA members who seek to seduce new members.[73] To avoid this type of behavior, AA typically suggests that men be sponsored by men, and women be sponsored by women.[74] In some cases, however, men may be sponsored by women and vice versa; particularly with members who are homosexual.[citation needed]
  • Arthur H. Cain argued that AA members rely too heavily on dogmatic slogans and become overly dependent on the group.[75]


Alcoholics Anonymous publishes several books, reports, pamphlets and other media including a periodical known as the AA Grapevine.[76] 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.

See also


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  2. ^ a b c d e "The Twelve Traditions". The A.A. Grapevine (Alcoholics Anonymous) 6 (6). November 1949. ISSN 0362-2584. OCLC 50379271. 
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  70. ^ Right, Kevin B. W (1997). "Shared Ideology in Alcoholics Anonymous: A Grounded Theory Approach". Journal of Health Communication 2 (2): 83. doi:10.1080/108107397127806. PMID 10977242. 
  71. ^ Levinson, D. (1983). Galanter, Marc. ed. "Current status of the field: An anthropological perspective on the behavior modification treatment of alcoholism". Recent Developments in Alcoholism (New York: Plenum Press) 1: 255–261. ISSN 0738-422X. PMID 6680227. 
  72. ^ Wilcox 1998, p. 109-124
  73. ^ Bogart, Cathy J.; Bogart, Cathy J. (2003). "'13th-Stepping:' Why Alcoholics Anonymous Is Not Always a Safe Place for Women". Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions 14 (1): 43–47. doi:10.1080/10884600305373. ISSN 1548-7148. OCLC 34618968. 
  74. ^ Questions and Answers on Sponsorship, p. 10
  75. ^ Cain, Arthur H. (February 1963). Alcoholics Anonymous: Cult or Cure?. Harper's Magazine. ISSN 0017-789X. Archived from the original on 2003-09-01. 
  76. ^ A Worldcat search for materials authored by Alcoholics Anonymous and more specific divisions of the organization (AA Grapevine, World Services, General Service Conference, World Service Meeting) yields well over 500 results.


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Up to date as of January 15, 2010

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Proper noun

Alcoholics Anonymous


Alcoholics Anonymous

  1. An organization which aims to help alcoholics to remain sober


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