Alcoholic Anonymous
Collipal Cabello
To keep sobriety as its primary purpose, AA in 1950 instituted the twelve traditions to ensure membership for anyone wishing to stop drinking, and to exhort that all memberships be kept anonymous, especially in public media, but when anonymity is broken, no repercussions are prescribed. The traditions also have AA avoiding hierarchies, dogma, public controversies and other outside entanglements as well as not acquiring property. Along with urging members to not use AA for material gain or public prestige, the traditions insist that no dues or fees are required, and to be self-supporting, no AA entity should accept outside financial aid.[14][15]
Following his hospital discharge, Wilson joined the Oxford Group and tried to recruit other alcoholics to the group. These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober. Dr. Silkworth suggested that Wilson place less stress on religion (as required by The Oxford Group) and more on the science of treating alcoholism.
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,[36] 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.[37]
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.[38] By 1946, as the growing fellowship quarreled over structure, purpose, authority, 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.[14] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[39] as AA had grown to millions of members internationally.[40]
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.[40]
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 working with alcoholics in need (the "12th Step").[48] (AA's 12th step is: "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.")[49] 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.[50]
AA's program extends beyond abstaining from alcohol.[51] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[52] through "an entire psychic change," or spiritual awakening.[53] A spiritual awakening is meant to be achieved by taking the Twelve Steps,[54] and sobriety is furthered by volunteering for AA[55] and regular AA meeting attendance[56] or contact with AA members.[54] 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 experienced all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person.[55] 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.[57]
AA meetings are gatherings where recovery from alcoholism is discussed. One perspective sees them as "quasi-ritualized therapeutic sessions run by and for, alcoholics".[59] There are a variety of meeting types some of which are listed below. At some point during the meeting a basket is passed around for voluntary donations. AA's 7th tradition requires that groups be self-supporting, "declining outside contributions".[14] Weekly meetings are listed in local AA directories in print, online and in apps.
AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age,[63] sexual orientation,[64][65] or culture.[66][67] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[68][65]
Some critics have criticized 12-step programs as "a cult that relies on God as the mechanism of action"[74] and as "overly theistic and outdated".[75] Others have cited the necessity of a "higher power" in formal AA as creating dependence on outside factors rather than internal efficacy.[75] A 2010 study found increased attendance at AA meetings was associated with increased spirituality and decreased frequency and intensity of alcohol use.[76][77] Since the mid-1970s, several 'agnostic' or 'no-prayer' AA groups have begun across the US, Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo the use of opening or closing prayers.[78][79]
Since then medical and scientific communities have defined alcoholism as an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild).[86] The ten criteria are: alcoholism is a Primary Illness not caused by other illnesses nor by personality or character defects; second, an addiction gene is part of its etiology; third, alcoholism has predictable symptoms; fourth, it is progressive, becoming more severe even after long periods of abstinence; fifth, it is chronic and incurable; sixth, alcoholic drinking or other drug use persists in spite of negative consequences and efforts to quit; seventh, brain chemistry and neural functions change so alcohol is perceived as necessary for survival; eighth, it produces physical dependence and life-threatening withdrawal; ninth, it is a terminal illness; tenth, alcoholism can be treated and can be kept in remission.[87]
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 in working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did.[89][90][91] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[92] 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.[93]
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.[94] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[95] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[96]
In 1939, High Watch Recovery Center 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.[101] 32% of AA's membership was introduced to it through a treatment facility.[88]
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