Alcoholics Anonymous is an international, spiritually oriented community of alcoholics who meet in groups. The primary purpose of A.A. members is to stay sober and help other alcoholics do the same. A.A. formed the original twelve-step program and has been the source and model for all similar recovery groups such as Gamblers Anonymous, Emotional Anonymous, Narcotics Anonymous, Sexaholics Anonymous, Overeaters Anonymous, and Al-Anon/Alateen, among others.
Until the mid-1930s, alcoholics who did not have the financial means to hire a psychiatrist or admit themselves to a private sanitarium could find help only at state hospitals, in jails, or through street ministries. The founding of Alcoholics Anonymous marked the first approach to supporting the sustained recovery of the alcoholic, regardless of their financial standing.
Alcoholics Anonymous was surely the first organization of its kind to define alcoholism as a progressive disease. A.A. teaches that to recover an alcoholic should abstain completely from alcohol.
Another aspect of Alcoholics Anonymous is that it is exclusively run by alcoholics (aside from 7 out of 21 members of the A.A. Board of trustees who are listed as “nonalcoholic friends of the fellowship”). A.A. believes that the relative success of their program is owed to their opinion that a recovering alcoholic has a special ability to bond and provide insight into the necessity of sobriety to the alcoholic.
A.A. literature describes a difference between an "alcoholic" and a "problem drinker", claiming that unlike a ‘problem drinker’ who may drink alcohol but retains the ability to stop or moderate his or her drinking, an alcoholic has an incurable disease rendering them unable to moderate their consumption of alcohol. A.A. states that only the individual him- or herself can determine whether he or she is an alcoholic
History and development
A.A. was started by two alcoholics who first met on May 12, 1935. One was Bill Wilson (William Griffith Wilson), a New York speculator; the other was Dr. Bob Smith (Robert Holbrook Smith), a medical doctor and surgeon from Akron, Ohio. In A.A. circles, the former is known as "Bill W." and the latter, "Dr. Bob."
How the A.A. program works?
Some AAs believe that A.A's success lies in the sense of support its members gain from attending regular meetings. Far more members, as well as A.A's literature, hold that the essence of the program is having a "spiritual awakening" [originally called a spiritual experience] through the application of the Twelve Steps. The process of working the Steps is sometimes summed up as "Trust God, clean house, and help others."
A.A. members are encouraged to "work the Steps", usually with the guidance of a voluntary sponsor. (A sponsor is a more experienced member who has worked the Steps before) The Steps are designed to help the alcoholic achieve a spiritual, emotional and mental state conducive to lasting sobriety. Many A.A. members believe finding God through the application of the Steps has freed them entirely from the urge to drink alcohol. Whereas staying sober was once difficult and uncertain, these members report that sobriety is now much easier, provided they keep enlarging their spiritual life.
The Steps incorporate Dr. Silkworth's description of the two-fold problem of physical allergy and mental obsession in Step One, Dr. Jung's description of the conversion solution in Step Two, the Oxford Groups' method of reaching a spiritual experience through Steps Three through Eleven, and universal witnessing experience of helping others as did the Salvation Army, the Missions, and early Akron A.A.,in Step Twelve. It would be grossly negligent to leave out of this summary and the previous part the history of Akron A.A., the fact that it preceded the 12 Steps, the fact that its ideas derived from United Christian Endeavor, the fact that its simple program was investigated and described by Frank Amos in terms of five musts--that had nothing to do with Jung, Silkworth,the Oxford Group, or Wilson's experience. The five were: (1) Abstinence and resisting temptation--from the Salvation Army and Rescue Missions. (2) Reliance on the Creator and coming to Him through His Son - same sources plus Christian Endeavor. (3) Obedience to His will through eliminating sin (Oxford Group and Bible) and living love and service (Christian Endeavor) (4) Growth in fellowship through prayer, Bible study, Quiet Time, and reading (Christian Endeavor). (5) Intensive work in helping others get straightened out (Salvation Army). Also, it would be grossly negligent not to mention that the Book of James, Jesus' Sermon on the Mount, and 1 Corinthians 13 were considered absolutely essential to the early program of recovery.
Some members regard attendance at A.A. meetings as important to their sobriety (although there are groups in A.A. made up of loners and members living in remote locations who communicate by mail and internet). Many members who achieved initial sobriety through AA have completed their return to life and no longer participate in meetings, although some members with 20 years or more of sobriety continue to participate.
With the above in mind, a typical individual program of recovery for a newcomer may include:
· Above all, avoiding the first drink.
· Attendance at one or more meetings daily for 90 days or longer. Some people coming into A.A. have attended meetings daily for the first year. (Note: nowhere in A.A. literature is there a reference to frequent attendance at A.A. meetings. This notion may started in the treatment centre industry; graduating patients were advised to attend many A.A. meetings, presumably in an effort to acquire a new peer group of abstinent friends to reinforce the effects of treatment. Within A.A., this is referred to as "staying away from slippery people and slippery places."
· Contact with one's sponsor daily in order to work the steps and to discuss whatever problems one may be having in one's life, problems which may, if not addressed, lead the alcoholic to take the first drink: "One [drink] is too many and a thousand [drinks] never enough."
· Daily prayer and/or meditation, as suggested by Step 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."
· Daily attention to Step 10: "Continued to take personal inventory and when we were wrong, promptly admitted it."
· Service work, which, for the newcomer, can be as uncomplicated as making coffee at meetings, helping to set up and break down tables and chairs, etc.
It will be noted that the program is to be worked daily Dr. Bob cited the Sermon on the Mount for the phrases "Easy does it" and 'one day at a time.' His wife Anne often spoke of the "one day at a time" idea. See Matthew 6:34. Frequently heard at meetings: "I'm a winner today, no matter what happens, as long as I don't pick up that first drink."
A common feature of A.A. meetings is that members are asked to speak to the group about their experience with alcoholism and recovery. However, there is no requirement to speak. Some members speak every time they are asked; others simply sit and listen in meetings for years before they say anything; some may choose never to speak.
A.A. does not charge membership fees to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs like room rental, coffee, etc. Contributions from members are limited to a maximum annual amount. At the local level, A.A. groups are self-supporting and not a charity. At the national level, A.A. is not self-supporting. About half of its sustenance comes from sales of the literature, mostly written by Wilson, and for which he received royalties. Local groups contribute to the national level. It accepts subsidies, as well, from two non-A.A. sources: literature sales to non-AA entities as well as cash from AA convention sites.
A.A. receives proceeds from sale of its book Alcoholics Anonymous along with other A.A. published books and literature, which are periodically reviewed from a cost standpoint. Revenues from literature sales constitute more than 50% of the income for the General Service Office.
Many A.A. groups use the famous Serenity Prayer and many AA groups in the United States often close their meeting with a prayer from the Bible, The Lord's Prayer.
Structure
The affairs of A.A. are governed broadly by A.A.'s Twelve Traditions. A.A. has a minimal amount of organized structure. There is no hierarchy of leaders and no formal control structure. People who accept service positions within the Fellowship are known only as "trusted servants." Individual A.A. members and groups cannot be compelled to do anything by "higher" A.A. authorities. Each A.A. group, small or large, is considered a self-supporting and self-governing entity. A.A. does maintain offices and service centres which have the task of co-ordinating activities like printing literature, responding to public enquiries and organizing state or national conferences. These offices are funded by local A.A. members and are directly responsible to the A.A. groups in the region or country they represent. (For more information, see A.A.'s Twelve Traditions as set out in the A.A. "Big Book" Alcoholics Anonymous and discussed in detail in the A.A. book Twelve Steps and Twelve Traditions.)
AA's Supporters
Supporters claim that AA is an indispensable support group for people seeking to free themselves of an addiction to alcohol. Some of their arguments include:
· The American Medical Association supports the disease model of alcoholism that was developed in the early part of the 20th century and embraced by AA.
· A large amount of anecdotal evidence in which people assert that joining AA saved their lives.
· Long-term sobriety lengths of 20, 30, or 40 or more years are growing more and more uncommon in AA
· Many members find that AA is fun. While meetings can be serious, they can also be filled with laughter. Social activities such as dances, picnics, and conventions are enjoyed by great numbers of AAs. Many members discover that their fears of never again having fun after quitting drinking have proven false. Many AA's believe that engaging in therapeutic recreation that does not include alcohol helps them to stay away from drinking.
· Because of the large number of AA groups (over 100,000 worldwide as of 2001), AA members are free to try different groups until they find groups that they enjoy. Because AA members come from all walks of life and every segment of society, there is a tremendous amount of variety within the fellowship. Not only do these facts make it difficult to generalize about AA groups, but these circumstances allow for a level of flexibility that accommodates the sobriety needs of a large spectrum of recovering alcoholics.
· The fact that AA no longer requires belief in the Creator has caused some to argue (unsuccessfully in the courts) that AA is not a religion. An alcoholic is a person who has turned alcohol into a higher power. * "Doing the footwork and turning over the results." Contrary to occasional criticism, the AA program encourages members to act as individuals and to think for themselves. Not only must they design the pace of their own programs and choose their own higher powers with which to supplant alcohol, but they must do their own "footwork" in all areas of their lives. The individual in AA is fully empowered to do his or her own footwork. When the AA program speaks of "powerlessness," this applies to the results of the footwork. This distinction is expressed in the words, "Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." In life, footwork is always changeable by the individual, while results are often uncertain, unpredictable, and/or out of the individual's control.
· AA believes that members cannot control *outcomes*. It is possible to manage one's life, but one cannot force a desired outcome. One *can* work toward an outcome, set goals, make plans, pursue desired ends, and so forth. The results of those efforts, however, are not determinable except through God's guidance. An AA member learns to change the things that can be changed, as has been noted.
· The "Toolbox Principle." Many AA's see the program as a large "toolbox." Not everyone feels comfortable with all of the tools all of the time. Many AA's find that they can stay sober while using some tools and not others, or using different tools at different times. This flexibility allows members to reach for the specific help they need at specific times, then use a different kind of help as circumstances fluctuate.
· Enlightened self-interest: Many AA's believe that in order for an alcoholic to stay sober, he or she must be in the program for him- or herself. According to this perspective, an AA member does not work the program for the sake of his family, his job, his community, or for the sake of any AA group or AA as a whole. An alcoholic works the program for himself, and helps others primarily because it helps oneself.
· Every AA member is free to have a sponsor of his or her own choice or not to have a sponsor at all. Some AA's have more than one sponsor at one time. Some AA's have a sponsor or sponsors at the beginning of sobriety, then choose not to have sponsors later on. A member may "fire" a sponsor at any time, and vice versa. Because AA members are learning to become individually empowered, it is their responsibility to select appropriate sponsors and change sponsors when necessary. The great variety of available sponsors is another aspect of the program's flexibility in terms of the shifting needs of individual members.
· Many members and groups acknowledge that AA isn't the right program for everyone, and that there are effective alternatives for other individuals.
· The 12 steps are suggestions rather than requirements (though "they are 'suggested' in the same way that, if you jump out of an airplane with a parachute, it is 'suggested' that you pull the ripcord" (Daily Reflections; A Book of Reflections by A.A. members for A.A. members, Alcoholics Anonymous World Services, Inc., pg. 344))
· There are no official membership records, allowing members to come and go as they choose (see above for the exception to this, which AA itself does not sanction)
· Despite Bill W.'s claim that members are "impersonally and severely disciplined from without" AA lacks any sort of formal disciplinary measures against members who fail to adhere strictly to the program
· The claim that AA is spiritual, not religious, and that the requisite Higher Power can be anything that all rational people admit the existence of powers greater than themselves, and that this is in fact one of the definitions of a rational person.
· The slogan that says to "Take what you can use and leave the rest." Members are also reminded that AA will work for them only if they work the program.
· The lack of a guru-like figure rising to fill the late Bill Wilson's shoes, lending credibility to the slogan that says "principles before personalities"
· According to the BB, "Our primary purpose is to stay sober and to help others to achieve sobriety." Thus, AA is not a social movement and is not involved in trying to reshape society or to affect communities or their values. AA prefers to appeal to potential members through "attraction rather than promotion."
AA's Critics
Specific criticisms of AA (some of whom go so far as to call AA a cult) include:
· There have been atleast three randomized clinical trials that studied the effectiveness of AA. Specifically: Ditman et al. 1967; Brandsma et al. 1980; Walsh et al. 1991.
· Dr. Ditman found that participation in A.A. increased the alcoholics' rate of rearrest for public drunkenness.[1]
· Dr. Brandsma found that A.A. increased the rate of binge drinking. After several months of indoctrination with A.A. 12-Step dogma, the alcoholics in A.A. 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 Behavior Therapy. Brandsma alleges that teaching people that they are alcoholics who are powerless over alcohol yields very bad results and that it becomes a self-fulfilling prediction -- they relapse and binge drink as if they really were powerless over alcohol.[2]
· And Dr. Walsh found that the so-called "free" A.A. program was actually very expensive -- it affected patients so that they required longer periods of costly hospitalization later on.
· While AA acknowledged in the foreword to the second edition of the Big Book that "we surely have no monopoly", one of the stories following the main text of the book still claims that AA is "the only remedy" to alcohol abuse (BB, pg. 259. Emphasis added.), despite some current research which shows that high percentages of alcohol abusers recover without medical treatment (Treatment of Drug Abuse and Addiction -- Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.). Another study suggests that AA may be "no better than the natural history of the disease" in keeping people alive and sober (The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, pgs. 283-286.)
· The claim that people who refuse to work the program thoroughly, or do but are not helped by it, are "constitutionally incapable of being honest with themselves" (BB, pg. 58.), implies that, by definition, the AA program itself is incapable of failure, provided that the alcoholic is properly motivated. This seems to deny the existence of honest, motivated individuals for whom the program doesn't work. ("Constitutionally incapable of being honest with themselves", in this view, would have nothing to do with motivation and everything to do with being thorough through the steps, and when the truth gets to be too much, backing down and not trudging through the rough spots. On the other hand, it might also refer to individuals who suffer from severe mental illnesses/imbalances that are completely separate from alcoholism, but which prevent the person from being able to even distinguish what reality may be.)
· A lack of official checks and balances designed to keep sponsors from abusing their position (though sponsors can be fired at any time)
· Claims that alcoholics are "doomed to an alcoholic death" unless they decide to "live on a spiritual basis" (each AA member being allowed to decide for himself what "spiritual basis" means) (BB, pg 44) and "Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant." (12x12, pg. 174).
· In the discussion of self-centeredness, statements such as "Sometimes they [other people] hurt us, seemingly without provocation, but we invariably find that at some point in the past we have made decisions based on self which later placed us in a position to be hurt." (BB, pg. 62. Emphasis added.) may be generalized so as to leave no room for instances where the victim was blameless, such as childhood sexual abuse or another form of mistreatment of either children or innocent adults unable to protect themselves. Many AA members interpret this to mean that blameless victims are at fault for continuing to be hurt by a past event, and not at fault for the past event itself. Some critics assert that this interpretation is incompatible with the text, saying that it clearly refers to the actual acts of others, not the victims' attitudes towards those acts, and suggests the problems of victims are that they have made "decisions based on self", that, later place them in a position to be hurt, not that they have chosen to remain affected by earlier hurts. On the other hand, supporters assert that the "decisions based on self" could have been, and in the case of blameless victims, clearly were, made after the event itself that occurred. An unofficial slogan sometimes heard in AA is "There are no victims, only volunteers." This clearly indicates the belief that nobody is ever victimized in any way that they could not have avoided. (Some AA members believe that these types of statements are only intended to warn against a habitual victim mentality. Some AA members understand that people can experience either innocent bad luck or be seriously victimized through no fault of their own.) In any case, the interpretation suggests that whether one continues to be hurt by previous abuse is something one can have full choice over, whereas physical and mental trauma resulting from victimization might be chronic and something the victim is truly powerless over.
· The claim that "If we were to live, we had to be free of anger." (BB, pg. 66) when psychologists say that while anger must be managed, it is not possible or healthy to do away with it entirely. (Some AA members interpret "free of anger" to mean that one should not be enslaved by their anger, be a "rageaholic," or engage in habitual toxic anger, not to mean that they should have no anger at all.)
· The "To Wives" chapter of the Big Book being written as advice from one wife of an alcoholic to another, when it was in fact written by Bill W. himself despite his wife Lois' desire to write it (Getting Better: Inside Alcoholics Anonymous, Nan Robertson, page 70-71; Pass It On, a publication of AA, page 200.)
· Bill W.'s frequent use of first-person plural giving the implication that all alcohol abusers have similar defects of character (6th Step) and past experiences (examples: "...something had to be done about our vengeful resentments, self-pity, and unwarranted pride." 12x12, pg. 47. and "We never thought of making honesty, tolerance, and true love of man and god the daily basis of living." 12x12, pg. 72. Emphasis added.)
· The contradiction between the BB's claim that "We will seldom be interested in liquor. "If tempted, we recoil from it as from a hot flame" We will see that our new attitude toward liquor has been given to us without any thought or effort on our part. It just comes! That is the miracle of it." (BB, pgs. 84-85) and Bill W.'s own statement that even co-founder Dr. Bob "was bothered very badly by the temptation to drink." "Unlike most of our crowd, I did not get over my craving for liquor much during the first two and one half years of abstinence." ["Dr. Bob's Nightmare"] (BB page 181) On the other hand, Dr. Bob's use of the word "craving" is consistent with the physical cravings described by Dr. Silkworth, not with the lack of the mental obsession to return to liquor that is described.
· AA's heavy reliance on numerous slogans. including ones used to defer criticisms brought up during meetings, such as "Take the cotton out of your ears and put it in your mouth!"