Alcoholics Anonymous

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Alcoholics Anonymous logo
Sobriety token or "chip", givean 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.

Alcoholics Anonymous (AA) is an international mutual aid fellowship[1] whose stated purpose is to enable its members to "stay sober and help other alcoholics achieve sobriety."[1][2][3] It was founded in 1935 by Bill Wilson and Bob Smith in Akron, Ohio. With other early members, Bill Wilson and Bob Smith developed AA's Twelve Step program of spiritual and character development. AA's initial Twelve Traditions were introduced in 1946 to help the fellowship be stable and unified while disengaged from "outside issues" and influences.

The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organizations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adopted and adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.[4][5]

The first female member, Florence Rankin, joined AA in March 1937,[6][7] and the first non-Protestant member, a Roman Catholic, joined in 1939.[8] The first Black AA group was established in 1945 in Washington DC by Jim S., an African-American physician from Virginia.[9][10] AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements.[11] Close to 2 million people worldwide are members of AA as of 2016.[12]

AA's name is derived from its first book, informally called "The Big Book", originally titled Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism.

Oxford Group origins[edit]

AA sprang from The Oxford Group, a non-denominational movement modeled after first-century Christianity.[13] Some members founded the Group to help in maintaining sobriety. "Grouper" Ebby Thacher was 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".[14][15]

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.[16] At the hospital a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.[17] 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.[18]

While Wilson and Smith credited their sobriety to working with alcoholics under the auspices of the Oxford Group, a Group associate pastor sermonized against Wilson and his alcoholic Groupers for forming a "secret, ashamed sub-group" engaged in "divergent works".[19] By 1937, Wilson separated from the Oxford Group. AA Historian Ernest Kurtz described the split:[19]

...more and more, Bill discovered that new adherents could get sober by believing in each other and in the strength of this group. Men [no women were members yet] who had proven over and over again, by extremely painful experience, that they could not get sober on their own had somehow become more powerful when two or three of them worked on their common problem. This, then—whatever it was that occurred among them—was what they could accept as a power greater than themselves. They did not need the Oxford Group.

In 1955, Wilson acknowledged AA's debt, saying "The Oxford Groupers had clearly shown us what to do. And just as importantly, we learned from them what not to do." Among the Oxford Group practices that AA retained were informal gatherings, a "changed-life" developed through "stages", and working with others for no material gain, AA's analogs for these are meetings, "the steps", and sponsorship. AA's tradition of anonymity was a reaction to the publicity-seeking practices of the Oxford Group, as well as AA's wish to not promote, Wilson said, "erratic public characters who through broken anonymity might get drunk and destroy confidence in us."[20]

The Big Book, the Twelve Steps and the Twelve Traditions[edit]

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,[21] 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. [22]

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.[23] 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.[4] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[24] as AA grew to millions of members internationally.[25]

Organization and finances[edit]

A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense",[25] and Bill Wilson called it a "benign anarchy".[26] 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."[27]

In 2006, AA counted 1,867,212 members and 106,202 AA groups worldwide.[25] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.[28]

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.[25]

AA groups are self-supporting, relying on voluntary donations from members to cover expenses.[25] The AA General Service Office (GSO) limits contributions to US$3,000 a year.[29] Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.[4]

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.[30] In keeping with AA's Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and through 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.[31] 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.[32]

Program[edit]

AA's program extends beyond abstaining alcohol.[33] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[34] through "an entire psychic change," or spiritual awakening.[35] A spiritual awakening is meant to be achieved by taking the Twelve Steps,[36] and sobriety is furthered by volunteering for AA[37] and regular AA meeting attendance[38] or contact with AA members.[36] 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.[37] 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.[39]

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.[33] 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 places an emphasis on tolerance rather than on 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.[40]

Meetings[edit]

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics".[41] They are usually informal and often feature discussions. Local AA directories list a variety of 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.[4] "Open" meetings are available to anyone (nonalcoholics can attend as observers).[42] At speaker meetings, 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.[43]

AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation,[44][45] or culture.[46][47] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[48][45] While AA has pamphlets that suggest meeting formats,[49][50] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[4] 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".[51]

Confidentiality[edit]

US courts have not extended the status of privileged communication, such as that enjoyed by clergy and lawyers, to AA related communications between members.[52][53]

Spirituality[edit]

A study found an association between an increase in attendance to 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.[54] Since the mid-1970s, a number of '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 use of opening or closing prayers.[55][56] There are online resources listing AA meetings for atheists and agnostics.[57]

Disease concept of alcoholism[edit]

More informally than not, AA's membership has helped popularize the disease concept of alcoholism, though AA officially has had no part in the development of such postulates which had appeared as early as the late eighteenth century.[58] Though AA initially avoided the term "disease", in 1973 conference-approved literature categorically stated that "we had the disease of alcoholism."[59][better source needed] Regardless of official positions, from AA's inception most members have believed alcoholism to be a disease.[60]

Though cautious regarding the medical nature of alcoholism, AA has let others voice opinions. The Big Book states that alcoholism "is 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."[60] In his introduction to The Big Book, non-member William Silkworth said those unable to moderate their drinking have an allergy. Addressing the allergy concept, 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."[61] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."[62] 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.[63]

Canadian and United States demographics[edit]

AA's New York General Service Office regularly surveys AA members in North America. Its 2014 survey of over 6,000 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 62% male and 38% female.[64]

Average member sobriety is slightly under 10 years with 36% sober more than ten years, 13% sober from five to ten years, 24% sober from one to five years, and 27% sober less than one year.[64] Before coming to AA, 63% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 59% received outside treatment or counseling. Of those members, 84% said that outside help played an important part in their recovery.[64]

The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court–ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.[64]

Effectiveness[edit]

Studies of AA's efficacy have produced inconsistent results. While some studies have suggested an association between AA attendance and increased abstinence or other positive outcomes,[65][66][67][68][69] other studies have not.[70][71][72]

The Surgeon General of the United States 2016 Report on Alcohol, Drugs, and Health states "Well-supported scientific evidence demonstrates the effectiveness of twelve-step mutual aid groups focused on alcohol and twelve-step facilitation interventions." [73]

Relationship with institutions[edit]

Hospitals[edit]

Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value of working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did.[74][75][76] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[77] Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.[78]

Prisons[edit]

In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program.[79] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[80] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[81]

United States court rulings[edit]

United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed a religion, it was ruled that it contained enough religious components (variously described in Griffin v. Coughlin below as, inter alia, "religion", "religious activity", "religious exercise") to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution.[82][83] In 2007, the Ninth Circuit of the U.S. Court of Appeals stated that a parolee who was ordered to attend AA had standing to sue his parole office.[84][85]

American treatment industry[edit]

In 1939, High Watch Farm in Kent, Connecticut was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12 step based treatment center in the world still operating today.

In 1949, the Hazelden treatment center was founded and staffed by AA members, and since then many alcoholic rehabilitation clinics have incorporated AA's precepts into their treatment programs.[86] 32% of AA's membership was introduced to it through a treatment facility.[64]

United Kingdom treatment industry[edit]

A cross-sectional survey of substance-misuse treatment providers in the West Midlands found fewer than 10% 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 qualifications were more likely to make such referrals than those without them. A statistically significant correlation was found between providers' self-reported level of spirituality and their likelihood of recommending AA or NA.[87]

Criticism[edit]

Thirteenth Stepping[edit]

"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates or sex. A study in the Journal of Addiction Nursing sampled 55 women in AA and found that 35% of these women had experienced a "pass" and 29% had felt seduced at least once in AA settings. The authors suggest that women need to be prepared for this behavior or find female-only groups.[88] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.[89]

Moderation or abstinence[edit]

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics.[90] Along with Nancy Shute, Peele has advocated that besides AA, other options should be readily available to those problem drinkers who are able to manage their drinking with the right treatment.[91] The Big Book says "moderate drinkers" and "a certain type of hard drinker" are able to stop or moderate their drinking. The Big Book suggests no program for these drinkers, but instead seeks to help drinkers without "power of choice in drink."[92]

Cultural identity[edit]

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.[93] A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial.[94] Another study found that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[95] 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.[96]

Literature [edit]

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[97] 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. The full text of each of these two books is available on the AA website at no charge.

AA in film[edit]

Films about Alcoholic Anonymous[edit]

Films where primary plot line includes AA[edit]

AA in Television[edit]

In the Seinfeld episode The Apology George Costanza becomes increasingly frustrated with what he perceives as James Spader 's character's failure to give him a proper apology, ultimately calling Spader's sponsor and accusing Spader of skipping Step 9. Spader sarcastically apologizes to George throughout the episode.

See also[edit]

Notes[edit]

  1. ^ a b AA Grapevine (15 May 2013), A.A. Preamble (PDF), AA General Service Office, retrieved 13 May 2017 
  2. ^ Michael Gross (1 December 2010). "Alcoholics Anonymous: Still Sober After 75 Years". American Journal of Public Health. 100: 2361–2363. doi:10.2105/ajph.2010.199349. PMC 2978172Freely accessible. PMID 21068418. 
  3. ^ Mäkelä 1996, p. 3
  4. ^ a b c d e "The Twelve Traditions". The AA Grapevine. Alcoholics Anonymous. 6 (6). November 1949. ISSN 0362-2584. OCLC 50379271. 
  5. ^ Chappel, JN; Dupont, RL (1999). "Twelve-Step and Mutual-Help Programs for Addictive Disorders". Psychiatric Clinics of North America. 22 (2): 425–46. doi:10.1016/S0193-953X(05)70085-X. PMID 10385942. 
  6. ^ Anonymous (1939). Alcoholics Anonymous. New York: Works Publishing Company. p. Original Manuscript p. 217. 
  7. ^ Bamuhigire, Oscar Bamwebaze (2009). Healing power of self love : enhance your chances of recovery from addiction through the. [S.l.]: Iuniverse Inc. p. x. ISBN 978-1-44010-137-3. 
  8. ^ Kurtz 1991, p. 47.
  9. ^ Alcoholics Anonymous. 3rd. ed., New York: AA World Services. 1976. p. 483. 
  10. ^ Mustikhan, Ahmar (13 April 2015). "First black AA group to celebrate 70th anniversary today in Washington DC". CNN iReport. 
  11. ^ Tonigan, Scott J; Connors, Gerard J; Miller, William R (December 2000). "Special Populations in Alcoholics Anonymous" (PDF). Alcohol Health and Research World. 22 (4): 281–285. PMID 15706756. 
  12. ^ Alcoholics Anonymous (April 2016). "ESTIMATES OF A.A. GROUPS AND MEMBERS AS OF JANUARY 1, 2016" (PDF). Retrieved 17 December 2016.  cf. Alcoholics Anonymous (2001). Alcoholics Anonymous (PDF) (4th ed.). Alcoholics Anonymous World Services. p. xxiii. Retrieved 17 December 2016. 
  13. ^ Cheever, Susan (2004). My name is Bill: Bill Wilson: his life and the creation of Alcoholics Anonymous. New York: Simon & Schuster. p. 129. ISBN 0-7432-0154-X. 
  14. ^ Pass It On, 1984, p 117.
  15. ^ Kurtz 1991, p. 17.
  16. ^ Pittman, Bill "AA the Way it Began" 1988, Glenn Abbey Books
  17. ^ Kurtz 1991, p. 19–20.
  18. ^ Kurtz 1991, p. 33.
  19. ^ a b Kurtz 1991, p. 45.
  20. ^ Kurtz 1991, p. 46-47.
  21. ^ GSOwatch.aamo.info
  22. ^ Anonymous, Alcoholics. "AA Big Book, preface" (PDF). Alcoholics Anonymous. Anonymous Press. Retrieved 25 December 2016. 
  23. ^ Jack Alexander (1 March 1941). "Alcoholics Anonymous" (PDF). Saturday Eventing Post (Reprinted in booklet form ed.). Alcoholics Anonymous World Services. ISBN 0-89638-199-4. Archived from the original (PDF) on 12 December 2009. Retrieved 12 December 2009. 
  24. ^ Pass It On, 1984, p. 359
  25. ^ a b c d e "AA Fact File" (PDF). General Service Office of Alcoholics Anonymous. 2007. 
  26. ^ Bill W. (1957). "benign+anarchy" Alcoholics Anonymous Comes of Age: A Brief History of A.A. Harper and Brothers. p. 224. 
  27. ^ Carroll, Steven (26 March 2010). "Group avoids politics of alcohol". The Irish Times. Retrieved 17 December 2016. 
  28. ^ Wilson, Bill. "The A.A. Service Manual Combined with Twelve Concepts for World Services" (PDF). Alcoholics Anonymous World Services, Inc. Archived from the original (PDF) on 12 December 2009. Retrieved 12 December 2009. 
  29. ^ "A.A. GSO Guidelines: Finances" (PDF). Alcoholics Anonymous General Service Office. Archived (PDF) from the original on 12 December 2009. Retrieved 12 December 2009. 
  30. ^ "GSO 2007 Operating Results". Alcoholics Anonymous General Services Office. Archived from the original on 12 December 2009. Retrieved 12 December 2009. Gross Profit from Literature ~8,6M (57%), Contributions ~$6.5M (43%) 
  31. ^ "Frequently Asked Financial Questions". Fort Worth central office of Alcoholics Anonymous. Retrieved 13 May 2017. 
  32. ^ "Alcoholics Anonymous : International General Service Offices". Alcoholics Anonymous website. Archived from the original on 12 December 2009. Retrieved 8 October 2009. 
  33. ^ a b Humphreys, Keith; Kaskutas, Lee Ann (1995). "World Views of Alcoholics Anonymous, Women for Sobriety, and Adult Children of Alcoholics/Al-Anon Mutual Help Groups". Addiction Research & Theory. 3 (3): 231–243. doi:10.3109/16066359509005240. 
  34. ^ Bill W. 2002, Appendix II, p. 567
  35. ^ Alcoholics Anonymous (4th ed.). New York: AA World Services. 2002. pp. xxix. ISBN 9781893007178. 
  36. ^ a b "This is AA" (PDF). Alcoholics Anonymous Work Services, Inc. 1984. Archived (PDF) from the original on 12 December 2009. Retrieved 12 December 2009. 
  37. ^ a b Questions & Answers on Sponsorship
  38. ^ "A Newcomer Asks." (PDF). Alcoholics Anonymous World Services, Inc. 1980. Archived (PDF) from the original on 12 December 2009. Retrieved 12 December 2009. 
  39. ^ Zemore, S. E.; Kaskutas, L. A. & Ammon, L. N. (August 2004). "In 12-step groups, helping helps the helper". Addiction. 99 (8): 1015–1023. doi:10.1111/j.1360-0443.2004.00782.x. PMID 15265098. 
  40. ^ Rudy, David R.; Greil, Arthur L. (1989). "Is Alcoholics Anonymous a Religious Organization?: Meditations on Marginality". Sociological Analysis. 50 (1): 41–51. doi:10.2307/3710917. JSTOR 3710917. 
  41. ^ Leach, Barry; Norris, John L.; Dancey, Travis; Bissell, Leclair (1969). "Dimensions of Alcoholics Anonymous: 1935–1965". Substance Use & Misuse. 4 (4): 509. doi:10.3109/10826086909062033. 
  42. ^ The A.A. Group 2016, p. 13.
  43. ^ Anonymous, Alcoholics. "SMF-177: Information on Alcoholics Anonymous" (PDF). Alcoholics Anonymous. AA World Services Inc. Retrieved 25 December 2016. 
  44. ^ The A.A. Group 2016, p. 12.
  45. ^ a b "Find a Meeting". Inter-Group Association of A.A. of New York. Retrieved 29 May 2017. 
  46. ^ "Native American Indian General Service Office of Alcoholics Anonymous (NAIGSO-AA)". Retrieved 29 May 2017. 
  47. ^ Cf. A.A. for the Native North American (PDF), New York: Alcoholics Anonymous World Services, 2009, retrieved 29 May 2017 
  48. ^ "Alcoholics Anonymous (A. A.) Meetings in Los Angeles County, California". Alcoholics Anonymous in Staten Island, N. Y. Retrieved 29 May 2017. 
  49. ^ The A.A. Group (PDF), New York: Alcoholics Anonymous World Services, 19 October 2016 [1990], retrieved 29 May 2017 
  50. ^ "Suggestions For Leading Beginners Meetings" (PDF). Alcoholics Anonymous World Services, Inc. Archived from the original (PDF) on 12 December 2009. Retrieved 12 December 2009. 
  51. ^ Mäkelä 1996, p. 149–150
  52. ^ Coleman, Phyllis (December 2005). "Privilege and Confidentiality in 12-Step Self-Help Programs: Believing The Promises Could Be Hazardous to an Addict's Freedom". The Journal of Legal Medicine. 26 (4): 435–474. doi:10.1080/01947640500364713. ISSN 0194-7648. OCLC 4997813. PMID 16303734. 
  53. ^ Hoffman, Jan (15 June 1994). "Faith in Confidentiality of Therapy Is Shaken". New York Times. Retrieved 23 October 2008. 
  54. ^ Kelly, John F. et al. Spirituality in Recovery: A Lagged Mediational Analysis of Alcoholics Anonymous’ Principal Theoretical Mechanism of Behavior Change Alcoholism: Clinical and Experimental Research Vol. 35, No. 3 March 2011 pp. 1–10
  55. ^ C., Roger (Nov 2011). "A History of Agnsotic Groups in Alcoholics Anonymous: Part 1". Humanist Network News. Archived from the original on 21 February 2014. Retrieved 12 February 2014. 
  56. ^ Freedman, Samuel (21 February 2014). "Alcoholics Anonymous, Without the Religion". The New York Times. Retrieved 26 February 2014. 
  57. ^ http://www.agnosticaanyc.org/worldwide.html for example is a directory of agnostic AA meetings
  58. ^ Rush, Benjamin (1805). Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind. Philadelphia: Bartam. 
  59. ^ Is A.A. for You? (PDF), New York: Alcoholics Anonymous World Services, 11 January 2017, retrieved 14 May 2017 
  60. ^ a b Kurtz, Ernest (2002). "Alcoholics Anonymous and the disease concept of alcoholism" (PDF). Alcoholism Treatment Quarterly. 20 (3–4): 5–39. doi:10.1300/j020v20n03_02. Retrieved 13 May 2017. 
  61. ^ Alcoholics Anonymous page xxx
  62. ^ Living Sober. p. 68. 
  63. ^ Gately, Iain (2008). Drink: A Cultural History of Alcohol. Penguin Group. p. 417. ISBN 9781592403035. 
  64. ^ a b c d e "Alcoholics Anonymous 2014 Membership Survey" (PDF). AA World Services. 2014. 
  65. ^ Humphreys, Blodgett, Wagner (2014). "Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials". Alcoholism: Clinical and Experimental Research. 38 (11): 2688–94. doi:10.1111/acer.12557. PMC 4285560Freely accessible. PMID 25421504. Lay summary. 
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