Alcoholics Anonymous

Alcoholics Anonymous (AA) is an informal society for recovering alcoholics. Members meet in local groups that vary in size from a handful to many hundreds of individuals. In 2001 there were 100,000 groups worldwide, making a global community of more than two million members.

The stated primary purpose of the society is "to stay sober and help other alcoholics to achieve sobriety." AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis; the society in turn offers a community of recovering people who support each other by "sharing experience, strength and hope" and often by working the suggested Twelve Steps together.

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

History

Early understanding of alcoholism

In the 1930s public opinion saw alcoholism as a moral failing, and the medical profession saw it as a condition that in many cases was incurable and lethal. 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 often subjected to a treatment with barbiturate and belladonna known as "purge and puke." A little known book, however, by Richard Peabody titled "The Common Sense of Drinking" first proffered the alcoholic could "train his mind" so that he would no longer want to drink.

A search for a spiritual cure

AA was founded by Bill Wilson, a Wall Street stockbroker and stock analyst, and Dr. Bob Smith, a proctologist from Akron, Ohio, both alcoholics. The chain of events that led to the meeting of these men began in Europe, where American business executive Rowland Hazard sought treatment for alcoholism with the famous Swiss psychiatrist Carl Jung. After a prolonged and unsuccessful period of therapy, Jung told Hazard that his case, like that of most alcoholics, was nearly hopeless—-the only possibility for a cure was through spiritual conversion.

Back in America, Rowland Hazard joined the Oxford Group, a Christian Evangelical association. The group advocated finding God through a spiritual surrender, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. (Bill Wilson later gave credit for the concepts behind Steps Three through Twelve to the teachings of Rev. Samuel Moor Shoemaker of the Oxford Group.) Through the Oxford group, Hazard underwent a spiritual conversion and achieved his long hoped for sobriety.

The conversions of Thacher and Wilson

Rowland Hazard introduced his acquaintance Ebby Thacher to Jung's conversion cure and the Oxford Group's spiritual principles, and Thacher, too, attained sobriety (although, in his case, it would not last his whole life). Thacher visited an old school friend by the name of Bill Wilson. Wilson was an alcoholic who had seen a promising career on Wall Street ruined by his drinking. He had failed to graduate from law school because he was too drunk to pick up his diploma. He had blown partnerships and business deals, all but destroyed his marriage, been hospitalized for alcoholism under the care of Dr. William Silkworth, and still continued to drink. Wilson was astonished to find that his old drinking companion had become sober through spiritual means, but he struggled with the existence of God. Then "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."

Wilson excitedly told his wife Lois about his spiritual discovery, yet the very next day he drank again, and eventually found himself back in hospital under Silkworth's care. According to Wilson, while lying in bed depressed and despairing he cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!". He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Bill Wilson described his experience to Dr. Silkworth, who told him not to discount it. Eby Thacher visited Bill 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, Wilson, to paraphrase his own words, admitted he was licked, got honest with himself, got honest with another, made amends, helped other alcoholics and prayed to whatever God he thought there was. (speech, 1952 convention.) Wilson never drank again for the remainder of his life.

A new program for recovery

In keeping with the practices of the Oxford Group, Wilson believed that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. At one point Wilson was on a business trip in Akron, OH, and was tempted to relapse. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. He eventually reached Oxford Group member Henrietta Seiberling, whose group had been trying to help alcoholic Dr. Bob Smith. Wilson met with Smith for what was planned as 15 minutes, and the two men talked late into the night. They became friends, and for three months they studied the Bible, held long discussions, and reviewed Oxford Group ideas, eventually fashioning a pioneer recovery program. Smith's last drink is said to have been on June 10, 1935—a beer to steady his hand for surgery—and that is considered within AA to be the date of the founding of AA.

Wilson returned to New York, establishing a second group, he later revisited Akron and reviewed the movement with Smith. They estimated that by 1937, the two groups numbered forty recovered alcoholics with continuous sobriety, and decided with this success in mind, that they had a recovery program worth spreading. Discussion led to agreement that the essential communications tool would be in the form of a book. After great difficulties in raising the required funds for printing, a publishing company, Works Publishing Inc., was incorporated, and capital raised by selling shares to the groups’ members and friends. Wilson set to work writing the book. When he reached chapter five, he decided that a summary of their methods for treating alcoholism was needed to describe the Word of Mouth program. In these early days, the basic program had developed from the works of William James, Dr Silkworth and the Oxford Group (from which the AA groups separated in 1937), although several of the Oxford Group's ideas and attitudes were deliberately rejected, particularly any which would involve AA in theological controversy. The program involved an alcoholic: admitting that they were beaten by alcohol, making a moral inventory of their defects or sins, confessing their shortcomings with another person, making restitution to those harmed by the alcoholic's drinking, trying to help other alcoholics and praying to whatever God they believed in for the power to practice these precepts. Wilson, with contributions from others in the groups including several atheists who restrained the religious content, expanded these principles and the final version of the Twelve Steps was completed by the fall of 1938.

The "Big Book"

File:Bigbook.jpg

First Edition of The Big Book

The book, Alcoholics Anonymous, was published in 1939 and while several titles for the book were proposed (including "The Way Out", which was already in use), Bill Wilson and Dr. Bob finally settled on "Alcoholics Anonymous", and the fellowship itself took its name from the book. The first edition had a "circus cover" of red and yellow, and it was printed in heavy paper and large size, which was thought to make it more saleable —hence the nickname "Big Book", a name that sticks today even though AA has published it in a more conventional size. Some critics of A.A. have suggested that the nickname "The Big Book" was meant to evoke the phrase "The Good Book", which is a term of affection for The Bible, and they argue that the newer editions of the "Big Book" are meant to resemble small, portable Bibles. Sales of the book—and the popularity of AA—increased rapidly after positive articles in Liberty magazine in 1939 and the Saturday Evening Post in 1941. The 4th edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter called "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each successive edition, the personal stories have been reviewed to represent the current population of AA, with the result that the stories of the original members of the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were gathered together in the book "Experience, Strength, and Hope."

The program

AA states its objective "to carry its message to the alcoholics who still suffer". AA members are encouraged to "work the Steps", usually under the guidance of a voluntary sponsor—a member who has already completed the 12-step program. The Steps were designed with the intention of helping the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Although the steps are based on seeking help from a higher power, atheists and agnostics are not excluded from achieved long-term sobriety in AA, since AA does not discriminate against any religion or lack of religion. Bill Wilson wrote a chapter in the "Big Book" entitled We Agnostics for recovering drunks who were struggling with the idea of a Higher Power.

"Working the program" might involve the following activities:

• Above all, avoiding the first drink.
• Regular attendance at meetings, and participation by talking or listening. AA meetings are frequent in large cities. Phone, internet, and mail are also methods used by members to attend AA. The organization urges new attendees to attempt 90 meetings in 90 days, which it believes will help to break the drinking habit and immerse them in a culture of sobriety.
• Regular contact with a sponsor for support in staying and living sober and in working the program.
• Service work, activities such as making coffee at meetings.
• Working the Twelve Steps.

AA recommends that longer-term members should:

• Regularly attend to personal inventory (in accordance with Step Ten).
• Daily prayer and meditation (in accordance with Step Eleven)
• Communicating the AA method of recovery to other alcoholics (in accordance with Step Twelve).

The 12 Steps of Alcoholics Anonymous

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.

Organization

Alcoholics Anonymous has an informal control structure: there is no hierarchy of leaders. Guidelines for group conduct are outlined in the Twelve Traditions (below). A member who accepts a service position (an organizing role in a group) within the society is referred to as a trusted servant, a reference to Tradition 2. A member's commitment to service is held for a limited period, typically three months to one year, after which another member is chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities as each meeting, small or large, is considered a self-governing entity.

At the local and national level, AA groups are self-supporting and not a charity. The society has no membership fees and does not charge to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs such as room rental and refreshments. Contributions from members are limited to a maximum annual amount of $2000 per year, though most donate only $1 to $2 per meeting.

Alcoholics Anonymous does receive proceeds from the sale of its book Alcoholics Anonymous, along with other published books and literature, which are periodically revised. Revenues from literature sales constitute more than 50% of the income for the General Service Office (GSO), which unlike individual groups is not self-supporting through contributions and does have a small number of salaried staff.

Additional to the GSO, Alcoholics Anonymous also maintains a few service centers, which have the task of coordinating activities such as printing literature, responding to public inquiries, and organizing state or national conferences. Funded by local members, the centers are directly responsible to the AA groups in the region or country they represent.

Alcoholics Anonymous is exclusively served by people who identify themselves as alcoholics with the exception that seven of the 21 members of the AA Board of trustees are listed as “nonalcoholic friends of the fellowship”.

The Twelve Traditions

Main article: Twelve traditions

The affairs of Alcoholics Anonymous are governed broadly by AA's Twelve Traditions, suggested rules for organizing how the members and groups of the society interact with each other and with AA as a whole (see the book Twelve Steps and Twelve Traditions for more information). These traditions were developed from experiences of the early groups during their first 13 years with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"

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.

Definition of alcoholism

Although AA lacks an official, singular definition of alcoholism, Dr Silkworth contributed the chapter in the AA basic text of Alcoholics Anonymous entitled "The Doctor's Opinion". That chapter would become one of the more influential pieces in AA thought. 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." That allergy takes the form of a craving which is explained earlier in the chapter when he states "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..." Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.

On page 44 of the Big Book, it states, "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."

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'." 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 in that speech. He replied,

"We AA's 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 do not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always call it an illness, or a malady, -- a far safer term for us to use."

Research

One reason that many researchers take a skeptical view of AA is that AA is so unscientific because of its spiritual basis. "Membership is voluntary and is determined by the individual, not by the group. There are no membership requirements, no dues or fees, no membership lists. AA is notoriously difficult to pin down as an organization," writes Maria Gabrielle Swora. In his book Alcohol: The World's Favourite Drug, addiction specialist Griffith Edwards argues that a randomised trial of AA is not possible because members are self-selected, not randomly selected. In other words, it is difficult to determine in each case if AA was the cause of sobriety or if the alcoholic simply attended AA when they were ready to stop drinking. Edwards himself conjectures, on the basis of available research, that "AA probably works, in some way or other, for not less than 50% of the troubled drinkers that make contact with it." The studies below have attempted to examine the effectiveness of Alcoholics Anonymous.

Project MATCH

Project MATCH was initiated in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The project was an 8-year, multisite, $27-million investigation that asked whether certain types of alcoholics respond best to specific forms of treatment. MATCH notes "No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients." Three types of treatment were investigated:

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

All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied.

The conclusion of the research was that patient-treatment matching is not necessary in alcoholism treatment, because the three techniques were approximately equal in effectiveness. In a December 1996 press release, NIAAA Director Enoch Gordis, M.D. said "These findings are good news for treatment providers and for patients who can have confidence that any one of these treatments, if well-delivered, represents the state of the art in behavioral treatments."

However overall success rates for all treatments were, and continue to be, less than spectacular. Based on information from Dr. Mark Willenbring of the NIAAA, Newsweek reported in their February 2007 issue that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."

Project MATCH has been criticised by addiction expert Dr Stanton Peele on the grounds that there was no untreated study group to determine whether the treatments were more effective than the natural recovery process. Peele argued that the therapists in MATCH were much more highly trained and monitored than the addiction counselors usually available to the public. Peele also objected that effectiveness for all treatments was measured by reduction in frequency and intensity of drinking, whereas abstention-based programs such as 12-step should claim no improvement without full abstention.

George Vaillant

In his book The Natural History of Alcoholism Revisited, Harvard psychiatric professor George E. Vaillant, who is a member of the Board of Trustees of Alcoholics Anonymous World Services, posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?" Vaillant's book was partly based on his experience with a 60-year study of 600 alcoholic men. Aware of the difficulties of obtaining direct evidence by statistical methods, he nevertheless states in his summary of literature and personal experience that "... research during the last 15 years has revealed growing indirect evidence that AA is an effective treatment for alcohol abuse." Vaillant argued that AA shows an advantage over other treatments in the long term because, as a cheap, community-based fellowship it is easy for people to keep coming back. He argues that "AA is the most effective means of long-term relapse prevention in the physician’s armamentarium."

In 2005, Vaillant produced an extensive study of the efficacy and safety of AA in the treatment of alcoholism, reviewing the published works from 1940 until the present day. In this paper he acknowledges that, 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.", his overall observation is that "multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings." Dr. Vaillant's overall conclusion is that "Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted."

Moos and Moos

In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA. 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 "Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."

The Veterans Study

Moos, Mood, and Humphreys carried out a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the U.S.Five of the programs were 12-step based, and five used cognitive-behavioral therapy. The 12-step programs were found to be effective in terms of cost and recovery: over 45% of the men in 12-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. In answer to the often-posed question as to which comes first, AA participation or reduced drinking, the study concluded that the answer is AA.Moos said, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals: "It is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems.

Brandsma et al

A study from 1979 found a correlation between AA and an increased rate of binge drinking. After several months of participating in AA, the alcoholics in AA were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Emotive Behavior Therapy. Brandsma argues that teaching people that they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy. Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness. Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.

J. Scott 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.

Criticism and controversy

Moderation vs. abstinence

The AA program is often challenged in the debate on cutting back versus total abstinence, "one of the most hotly contested issues in alcohol treatment". Treatment available in America, particularly, tends to lean towards total abstinence, even though not all problem drinkers are actually alcohol dependent. AA has been criticized for recommending total abstinence as the only solution, however the AA "Big Book" does make it clear that the program is for alcoholics and that not all drinkers are alcoholics: "Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone. ...[This type of person] can also stop or moderate, although [they] may find it difficult and troublesome and may even need medical attention."

Disease concept of alcoholism

The concept of alcoholism (and addiction) as a disease is controversial. AA regards alcoholism as a disease, and in practical terms AA often uses the concept to challenge the belief of some chronic, compulsive drinkers that they can stay sober by willpower alone.

Court mandated attendance

Judges in the United States have in the past required attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. "Open" AA meetings are open to anyone who wishes to attend, including those mandated by a court. Court ordered attendees have to answer to the judge, not to anyone in AA. Such forced attendance may not satisfy AA's Tradition 3, which says, "The only requirement for A.A. membership is a desire to stop drinking."

AA takes the position that the organization cannot discriminate against any prospective member, even if he or she attends under pressure from a court, an employer, or any other agency. The distinction between coercion or pressure as represented by legal authorities, one's own conscience or pressure from friends and family is taken to be immaterial.

Occasions of abuse at meetings

AA groups have the benefits and risks of any community, and it is important to acknowledge that mutual support and abuse are both possible. Although no research has been undertaken to determine if Alcoholics Anonymous carries more or less risk of abuse than any other organization of similar size, AA undertakes no external restriction or vetting of its members, and the long-form version of Tradition 3 states that "Any two or three alcoholics gathered together for sobriety may call themselves an AA group..."

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.

See also

• Alcoholism
  • For a list of treatment programs see section Alcoholism:Politics and public health
• Al-Anon/Alateen
• AA Grapevine, the international journal of Alcoholics Anonymous.
• Drunkenness
• Substance abuse
• Twelve-step program
  • List of Twelve-Step groups

External link

• Alcoholics Anonymous official website