Alcohol Anonymous

Alcohol Anonymous (AA) is an informal meeting society for recovering and recovered alcoholics. Alcoholic’s Anonymous members state their primary purpose as, "to stay sober and help other alcoholics to achieve sobriety." Alcohol Anonymous suggests that alcoholics follow its program and abstain from alcohol in order to recover from alcoholism, and share their experience, strength, and hope with each other that they may solve their common problem. Alcohol Anonymous was the first twelve-step program and has been the model for similar recovery groups like Narcotics Anonymous. Al-Anon/Alateen is programs designed to provide support for relatives and friends of alcoholics. Although AA is not for everyone and attrition rates are high, there is evidence supporting the effectiveness of AA as a treatment for alcoholism.

Organization

In 2006 there were a reported 1,867,212 Alcohol Anonymous members in 106,202 AA groups worldwide. The Twelve Traditions informally guide how AA groups function and the Twelve Concepts for World Service guide how AA is structured globally.

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. 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" out of twenty-one members of the AA Board of Trustees.

AA groups are self-supporting and not charities and they have no dues or membership fees. Groups rely on member donations, to collect per meeting, to pay for expenses like room rental, refreshments, and literature. No one is turned away for lack of funds.

AA receives proceeds from books and literature which constitutes more than 50% of the income for the General Service Office (GSO), which unlike individual groups is not self-supporting and maintains a small salaried staff. It also maintains service centers which coordinate activities like printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and responsible to the AA groups they represent.

12 Step Program

The suggested AA recovery program for alcoholics includes abstaining from alcohol one day at a time, following Twelve Steps, helping with duties and service work in AA, and regular AA meeting attendance or contact with AA members. Members are encouraged to ask their group for help in finding an experienced fellow alcoholic called a sponsor to help them follow the AA program, ideally one that has enjoyed sobriety for at least a year and is of the same sex as the sponsee, and who does not impose personal views on sponsees but only teaches the suggested AA program.

AA Meetings

Anyone is allowed to attend "open" AA meetings, while "closed" meetings are reserved to those who have a desire to stop drinking.  There are groups restricted to men or women, groups angled at gay people, and groups for speakers of minority languages. Most AA meetings begin with socializing. Formats vary between meetings, for example, a beginner's meeting might include a talk by a long-time sober member about his or her personal experience of drinking, coming to AA and what was learned there of sobriety. A group discussion on topics related to alcoholism and the AA program might follow.

In a standard meeting, the chairperson starts by calling the meeting to order and offering a short prayer, meditation, and/or period of silence. Then, a section from "The Big Book" may be read aloud, typically the beginning of Chapter Five, entitled "How It Works". Announcements from the leader and/or group members follow. Many groups celebrate newcomers, visitors, and sobriety anniversaries with rounds of applause. Following the announcements, donations are collected, usually by passing a basket around the room. Depending on the type of meeting, there follows either a talk by a speaker relating their personal experience with alcoholism and AA or a discussion session with topics chosen by the chairperson, the speaker, and/or the attendees. A hallmark of these types of AA meeting is the "no crosstalk" rule, whereby responding to another member's comments is discouraged. After the discussion period, appreciation may be expressed to the speaker and the meeting is ended with a prayer, usually the Serenity Prayer or often in the US, the Lord's Prayer. These ending prayers are often undertaken by the entire group forming a circle and holding hands. More socializing typically follows the formal meeting, and it is common for members to gather at nearby coffee shops. Other meeting formats also exist where specific AA related topics are discussed in more detail. A common example is a Step Study meeting where one or more of the 12 steps are discussed at length.

Disease of alcoholism

AA regards alcoholism as a disease (though Bill Wilson once stated that it was more comparable to an illness or malady), and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone. Dr William Silkworth introduced to Wilson and AA the idea that alcoholism is a disease consisting of an obsession to drink alcohol, and an allergy, which was the compulsion to continue drinking once the first drink had been taken. Alcoholics, he argued, can never safely use alcohol in any form at all, since once forming the habit, they cannot break it.

Limitations on research

The study of AA tends to polarize observers into believers and non-believers, and discussion of AA often creates argument rather than objective reflection. Many researchers take a skeptical view of AA because some of AA's methods are spiritual, not scientific. A randomized trial of AA is very difficult because members are self-selected, not randomly selected with the exception of court mandated AA attendance. Two opposing types of self-selection bias are that drinkers may be motivated to stop drinking before they attend AA, and AA may attract the more severe and difficult cases. Control groups with AA versus non-AA subjects are also difficult because AA is so easily accessible.

Studies

Many studies have demonstrated an association between AA attendance and increase abstinence or other positive outcomes. Other studies have concluded that AA attendance can lead to poorer outcomes than other therapies.

Attrition

In a 1989 internal AA report based on an average of five surveys, it was estimated that of those who attended AA for the first time, 81% leave the program after one month and 95% were gone after twelve months. After the first year, the rate of attrition slows.

About 40% of the members sober for less than a year will remain another year, About 80% of those sober less than five years will remain sober and active in the fellowship another year. About 90% of the members sober five years or more will remain sober and active in the fellowship another year, however the survey states that this information does not predict the number that will remain sober, and those who remain sober but not in the fellowship cannot be calculated. These figures have been repeated within a few percentage points using the same calculations since 1974.

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