Alcoholics Anonymous (AA)

No conversation about alcoholism or substance abuse recovery is complete without mentioning Alcoholics Anonymous. The group has become synonymous with the concept of addiction rehabilitation in general, and it was instrumental in changing the conversation in how people with drinking problems came to be understood and regarded. As the science and psychology of addiction evolves, the role of Alcoholics Anonymous is also changing, but it remains a cornerstone of the aftercare experience.

Alcoholics Anonymous and the 12 Steps

Alcoholics Anonymous (AA) is a global organization that was created, and is designed, to help former alcoholics through the process of learning to live their lives without the crutch of alcohol abuse. People who attend AA groups have made the decision to stop drinking and stay sober. Some of them join voluntarily; some attend as a continuation of their therapy; some are required to be there because of a court order. Whatever brings them there, the other members of the group act as a support network, explains the American Journal of Public Health; they share success stories and honest accounts of setbacks, and use this emotional connectedness to inspire and encourage each other to keep going.

Alcoholics Anonymous is based on the 12 Steps, devised by its co-founder, Bill W., and based on the Christian beliefs he adopted as part of his sobriety. The 12 Steps are presented as a set of principles to guide former alcoholics on how to tackle the problems caused by their addiction, how to make amends, and how to continue in their new lives as recovering drinkers. The 12 Steps have proven iconic enough to be adapted by other self-help and addiction recovery groups, such as Gamblers Anonymous, Narcotics Anonymous, and Food Addicts in Recovery Anonymous, with the precise terms adapted to represent the focus of the particular group. Additionally, many groups have changed the explicitly Christian overtones of the original 12 Steps to reflect secular or agnostic philosophies.

The 12 Steps are as follows:

  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.

 

From the Oxford Group to AA

The story behind the steps starts in Switzerland, specifically with Carl Jung, the famous psychiatrist and psychologist who is considered the father of analytical psychology. Renowned as he is for his pioneering work in the understanding of the psyche and the self, Jung was also a pantheist; his study of world religions and mythologies was instrumental in his belief that spiritual health was vital to an individual’s wellbeing. This came into play when Jung was confronted with an alcoholic patient, Rowland Hazard III, whose problem was so severe that contemporary methods of treatment proved ineffective. Jung counseled the patient that the last remaining measure to overcome the demon of addiction was to experience a spiritual rebirth.

Hazard duly joined a Christian evangelical movement, known as the Oxford Group. In addition to the basic tenets of the Christian faith (such as honesty and personal change), “personal evangelism” was stressed, or one member of the group sharing his story with someone outside of the group, especially if the other person was undergoing a personal crisis.

The Oxford Group’s creed was based on four principles: all people are sinners, all sinners can be changed, confession is required for that change, and the change must also change others. One of the people Hazard spread his word to was Bill Wilson, an old friend and former drinking partner. Through Hazard, Wilson (who was struggling with his alcoholism) learned of Carl Jung’s pantheistic musings on the importance of healthy spirituality; for Wilson, that healthy spirituality manifested in the form of a desperate conversion to Christianity in an attempt to quit drinking. When this happened in 1934, Wilson attributed the victory to his faith, and specifically Hazard’s intervention. He spoke to Dr. Bob Smith, a fellow Oxford Group member and recovering alcoholic who applied the same principles to his own battle with addiction. Smith had his last drink on June 10, 1935, one month after he and Wilson started working together; today, that date is celebrated as the birth of Alcoholics Anonymous, and its founders are remembered as “Bill W.” and “Dr. Bob.”

 

The Mystery of Alcoholics Anonymous

Smith and Wilson left the Oxford Group in 1937 to focus on developing Alcoholics Anonymous, and by 1938, they had successfully brought the message to almost a hundred alcoholics in the Ohio and New York areas. Looking to capitalize on their momentum, they decided to document the group in a book. Wilson took the lead on the project, naming the resulting publication, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. He included 12 guidelines that, if followed, would grow the individual’s spirit to the point of overcoming the temptation to drink, and help the person make reparations for all the damage done during the days of drinking. These became known as the 12 Steps, and the book’s popularity led to Wilson’s group adopting the name of the book itself.

Alcoholics Anonymous became so well-known that Wilson and other early members of the group were invited to a dinner hosted by John D. Rockefeller, Jr., the patriarch of one of the most powerful families in American history. Despite Wilson’s requests, Rockefeller refused to finance AA, believing that the money would only corrupt the noble ambitions of the group. Instead, Rockefeller felt that the organization’s own characteristics – the personal testimonies, the word-of-mouth, and the anonymity – were key to its success and longevity.

Wilson took this to heart, coming up with additional points to safeguard the integrity and future of his group. To that effect, he wrote that every individual AA group should decline outside contributions and ought to be able to fully support itself. Alcoholics Anonymous was never to be a professional organization; “the only requirement for AA membership,” he wrote, “is a desire to stop drinking.” Above all, groups had to prize anonymity; Wilson wrote that it is “the spiritual foundation of all our traditions,” and that the sacrifice of identity would help members “place principles before personalities.”

In some ways, the championing of anonymity has been AA’s blessing and curse. It not only protects the privacy of the people it seeks to help (and those who seek it for help), it also protects the organization at large from public relations and morale damage if a high-profile member were to relapse. In the more than 75 years since Alcoholics Anonymous formed, NPR notes that “no one knows how exactly it works.”

Contemporary Criticisms

While this provides a blanket of comfort and security to the many thousands of people it helps, the secrecy has not gone over well with the more scientifically minded in the treatment community. The success and acceptance of the program has clashed with the desire for evidence and statistics, leading to Pacific Standard saying that AA is not a form of professional treatment, and it offers mixed results; but as a “mutual aid organization,” the 12-Step method comes into its own. Similarly, The Atlantic goes so far as to call Alcoholics Anonymous a pseudoscientific organization, one that dictated the treatment conversation for generations (to the point where its claimed success rate of 75 percent went unquestioned for decades), but has overstayed its privileged place in American culture.

The term is also used by outlets like Salon and New York Magazine, which suggest that the time has come for Alcoholics Anonymous to be decoupled from mainstream alcoholism recovery. The point is made by Mia Szalavitz, a recovering addict and now an addiction researcher and author, who wrote a book about how developments in neuroscience and psychology might render AA obsolete. Szalavitz takes issue with the AA concept of “hitting rock bottom,” the moment when a person experiences a personal loss (e.g., a DUI, eviction, divorce, firing, etc.) as a sign that the addiction has become too damaging to ignore. This expectation, writes Szalavitz, is “harsh and humiliating,” in the sense that help is withheld until the person crosses a tragic Rubicon. But so deeply does it run in the DNA of Alcoholics Anonymous that it has influenced how any 12-Step methodology treats addiction therapy. This, says Szalavitz, has made the treatment community on the whole “embrace a totally false, harmful view of what addiction is.”

The point is echoed by a clinical professor of anesthesiology at the University of California, Irvine who goes even further, telling Wired magazine that the 12-Step model itself “is an outdated 20th century concept”; addiction goes too deep for patients to simply be talked out of it, he argues.

Scientific Support and Success Rates

But not everyone in the treatment community is as skeptical toward Alcoholics Anonymous. Scientific American grants that it’s not a perfect solution, but claims that criticisms of the group are often unfair or based on false assumptions. For many alcoholics, AA’s wide availability of meetings and lack of expense make it a worthy consideration. The Recent Developments in Alcoholism journal said 12-Step programs are “an ideal recovery recourse,” and the Alcoholic Research & Health journal notes that the rise of other treatment methods have not displaced the model of mutual health groups, which are still the most widely sought-after source of help for alcoholism and other substance abuse problems.

While admitting that the oft-cited success rate of 5 percent “isn’t great,” Dr. Drew Pinsky, a celebrity doctor and addiction medicine specialist argued that “the fact it, [Alcoholics Anonymous] does work when people do it,” saying the real success rate is as high as 12 percent. The American Society of Addiction Medicine speculated that approximately 10 percent of the people who become part of a 12-Step program enjoy long-term success in their recovery. In 2014, AA self-reported that 27 percent of the 6,000 members who participated in an internal study were sober for less than a year; 24 percent retained their sobriety for up to five years, and 13 percent lasted for as long as a decade. Fourteen percent of the study’s participants stayed sober between 10 and 20 years, and 22 percent reported remaining sober for more than two decades.

A long-term study conducted by the National Institute on Alcohol Abuse and Alcoholism found that, after eight years, people with alcoholism who were part of both inpatient treatment and an AA group had a better chance of staying sober for the first three years of study. By the end of the eight years, those who received both had a much higher rate of abstinence. The researchers at NIAAA concluded that regular attendance at AA meetings had a notable impact on the viability and longevity of recovery.

Despite the criticisms and controversies, Alcoholics Anonymous remains a cultural force for treatment, rehabilitation, personal growth, and sobriety. The programs claims it has more than 2 million members globally, and reports that 33 percent of the 8,000 members in North America retained their sobriety for at least 10 years. It’s not for everyone, agrees Psych Central, but for many, it has made a life-changing difference.

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