[[Image:Figure alcoholicsanonymous ingolstadt.JPG|thumb|right|AA meeting sign]]
{{TOCright}}'''Alcoholics Anonymous''' ('''AA''') is an informal meeting society for recovering [[Alcoholism|alcoholics]] whose primary purpose is to stay sober and help other alcoholics achieve sobriety.<ref>{{cite web | title = What is AA? Defining "Alcoholics Anonymous" | publisher = The General Service Board of Alcoholics Anonymous (Great Britain) | url =http://www.alcoholics-anonymous.org.uk/geninfo/02whatis.shtml | accessdate = 2006-11-27 }}</ref> AA 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.<ref>''AA Preamble''</ref><ref>[http://www.alcoholics-anonymous.org/en_pdfs/m-24_aafactfile.pdf AA Fact File], 'The Recovery Program'</ref><ref name = "bigbook">''Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism.'' 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at [http://www.aa.org/bigbookonline/ www.AA.org]</ref> AA was the first [[twelve-step program]] and has been the model for similar recovery groups like [[Narcotics Anonymous]]. [[Al-Anon/Alateen]] are programs designed to provide support for relatives and friends of alcoholics. The organization was named after its primary guidebook ''Alcoholics Anonymous'', also known as ''The Big Book''. Although AA is not for everyone, there is growing evidence supporting the effectiveness of AA as a treatment for alcoholism.<ref>''Practice Guideline for the Treatment of Patients With Substance Use Disorders'', 2nd ed. American Psychiatric Association, August 2006. ([http://www.psych.org/psych_pract/treatg/pg/SUD2ePG_04-28-06.pdf PDF] 2.2 MB.} P 98.</ref>

==History==
{{ See main|History of Alcoholics Anonymous}}
By 1934 alcoholic [[Bill W.|Bill Wilson]] had ruined a promising Wall Street career with his constant drunkenness. He was introduced to the idea of a spiritual cure by old drinking buddy [[Ebby Thacher]] who had become a member of a Christian movement called the [[Oxford Group]]. Wilson was treated by [[William Duncan Silkworth|Dr. William Silkworth]] who promoted a [[Disease theory of alcoholism|disease concept of alcoholism]]. While in the hospital, Wilson underwent a spiritual experience which convinced him of the existence of a healing higher power and he was able to stop drinking. On a 1935 business trip to Akron, Ohio, Wilson felt the urge to drink again and in an effort to stay sober, he sought another alcoholic to help. Wilson was introduced to [[Bob Smith (doctor)|Dr. Bob Smith]], and Smith also found sobriety through spiritual means.

Wilson and Smith co-founded AA with a word of mouth program to help alcoholics. By 1937 they determined that they had helped 40 alcoholics get sober, and two years later, with the first 100 members, Wilson expanded the program by writing a book entitled ''Alcoholics Anonymous'' which the organization also adopted as its name. The book described a twelve-step program involving admission of powerlessness, moral inventory, and asking for help from a higher power. In 1941 book sales and membership increased after radio interviews and favourable articles in national magazines, particularly by Jack Alexander in The Saturday Evening Post. By 1946, as membership grew, confusion and disputes within groups over practices, finances, and publicity lead Wilson to write the guidelines for noncoercive group management that eventually became known as the [[Twelve Traditions]]. AA came of age at the 1955 St. Louis convention when Wilson turned over the stewardship of AA to the General Service Board.<ref>''Pass It On'' p 359</ref> In this era AA also began its international expansion, and by 2001 the number of members worldwide was estimated at two million.

==Organization==
{{see also|Twelve-step program#The Twelve Traditions|l1=Twelve-step program: The Twelve Traditions}}

In 2006 there were a reported 1,867,212 AA members in 106,202 AA groups worldwide.<ref name="AAFACTFILE">[http://www.aa.org/en_information_aa.cfm?PageID=2 AA Fact File]</ref> The [[Twelve Traditions]] informally guide how AA groups function, and the Twelve Concepts for World Service guide how AA is structured globally.<ref>The AA Service Manual/Twelve Concepts for World Service (BM-31).</ref>

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 one year 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.<ref>The [http://www.alcoholics-anonymous.org/en_pdfs/m-24_aafactfile.pdf AA Fact File], 'The Structure of AA'</ref>

AA groups are self-supporting and not charities, and they have no dues or membership fees. Groups rely on member donations, typically $1 collected per meeting in America, to pay for expenses like room rental, refreshments, and literature.<ref>[http://alcoholism.about.com/library/weekly/aa980408.htm Once Upon A Time...] Mitchel K. 04/08/98</ref> Visitors and new members are asked not to donate, and no one is turned away for lack of funds.<ref>[http://www.alcoholics-anonymous.org/en_pdfs/m-24_aafactfile.pdf]AA Fact File p 17</ref>

AA receives proceeds from books and literature which constitute more than 50% of the income for the General Service Office (GSO),<ref>[http://www.aa.org/en_gso05_operresults.cfm GSO 2005 Operating Results], 'Gross Profit from Literature ~$6.7M (55%), Contributions ~$5.4M (45%)'</ref> 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.

==Program==
{{see also|Twelve-step program#The Twelve Steps|l1=Twelve-step program: The Twelve Steps}}

The suggested AA recovery program for alcoholics includes not drinking alcohol one day at a time, following [[Twelve Steps]],<ref name="THISISAA">http://www.alcoholics-anonymous.org/en_pdfs/p-1_thisisAA.pdf This is AA pamphlet</ref> helping with duties and service work in AA,<ref>http://www.alcoholics-anonymous.org/en_services_for_members.cfm?PageID=98&SubPage=119 Sponsorship-A Vital Stepping Stone to Service & Sobriety</ref> and regular AA meeting attendance<ref>http://www.alcoholics-anonymous.org/en_is_aa_for_you.cfm?PageID=14 A Newcomer Asks pamphlet</ref> or contact with AA members.<ref name="THISISAA"/> 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.<ref name="SPONSORPAMPHLET">http://www.alcoholics-anonymous.org/en_pdfs/p-15_Q&AonSpon.pdf Questions and Answers on Sponsorship pamphlet</ref>

Anyone is allowed to attend "open" AA meetings while "closed" meetings are for alcoholics, or those who feel they might be alcoholics, only.<ref>http://www.alcoholics-anonymous.org/en_information_aa.cfm?PageID=10 AA at a Glance pamphlet</ref> There are groups for men only, groups for women only, groups angled at gay people, and groups for speakers of minority languages. Meeting formats vary between groups, and beginner meetings include a speech by the leader about how he or she came to AA and what was learned, then a group discussion on topics related to alcoholism and the AA program.<ref>[http://www.alcoholics-anonymous.org/en_pdfs/mu-1_begmeetings.pdf] Suggestions for Leading Beginners Meetings pamphlet</ref>

In the [[United States of America]], Courts have ruled since [[1996]] that inmates or parolees cannot be ordered to attend AA or other recovery programs that have a substantial religious component since such coercion is in violation of the [[Establishment Clause]] of the [[First Amendment]] of the Constitution.<ref>name="EGELKO2007">{{cite news | last = Egelko | first = Bob | title = Appeals court says requirement to attend AA unconstitutional | date = 2007-09-08 | accessdate = 2007-10-08 | publisher = [[San Francisco Chronicle]] | url = http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/09/08/BA99S1AKQ.DTL}}</ref><ref>[http://www.ca9.uscourts.gov/ca9/newopinions.nsf/6FA63303852632AC8825734F0059D078/$file/0615474.pdf?openelement Inouye vs. Kemna page 11889]</ref> AA receives 11% of its membership from court ordered attendance.<ref>http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey</ref>

===Influences on the Treatment Industry===

Since 1949 when [[Hazelden]] treatment center was founded by members of alcoholics anonymous, some alcoholic rehabilitation clinics have frequently incorporated precepts of the AA program into their own treatment programs.<ref>N. Roberson, ''Getting Better:Inside Alcoholics Anonymous'' (London: Macmillan, 1988), p 220</ref> A reverse influence has also occurred with AA receiving 31% of its membership from treatment center referrals.<ref>http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey</ref>

==Effectiveness==
===Limitations on research===
The study of AA, like politics, tends to polarize observers into believers and non-believers,<ref>Vaillant, 1995, p 255.</ref> and discussion of AA often creates argument rather than objective reflection.<ref>Vaillant, 1995, p 265.</ref> Many researchers take a skeptical view of AA because some of AA's methods are spiritual, not scientific.<ref name="VAILLANT1995CHAPTER4">{{cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Chapter 4: Paths into Abstinence | pages = 231 - 277 | isbn = 0674603788 | oclc = 31605790}}</ref> Membership is voluntary and determined by the individual, not by the group, with no requirements, dues or fees, or membership lists.<ref>Maria Gabrielle Swora. "The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous." ''Mental Health, Religion & Culture'', Sep2004, Vol. 7 Issue 3, p187-209.</ref> A randomized trial of AA is very difficult because members are self-selected, not randomly selected.<ref name="EDWARDSCHAPTER8">{{cite book | last = Edwards | first = Griffith | authorlink = Griffith Edwards | title = Alcohol: The World's Favorite Drug | publisher = Thomas Dunne Books | edition = 1st edition | month = April | year = 2002 | chapter = Chapter 8: Alcoholics Anonymous | pages = 103 - 117 | isbn = 0312283873 | oclc = 48176740}}</ref> 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.<ref name="HUMPHREYS2003">{{cite book | last = Humphreys | first = Keith | title = Recent Developments in Alcoholism | chapter = Alcoholics Anonymous and 12-Step Alcoholism Treatment Programs | volume = 16 | publisher = Springer US | doi = 10.1007/b100495 | year = 2002 | pages = 149 - 164 | id = PMID 12638636 | isbn = 978-0-306-47258-9}}</ref> Control groups with AA versus non-AA subjects are also difficult because AA is so easily accessible.<ref name="HUMPHREYS2003"/> AA can work, but how well and for whom has not yet been adequately researched.<ref>Nace, Edgar P. "Alcoholics Anonymous" in ''Substance abuse: a comprehensive textbook''. Ed. Joyce H. Lowinson et al. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005, p 597 & 598.</ref>

===AA surveys===
AA's own 2004 survey of over 7500 members in Canada and the United States concluded that AA is composed of 89.1% white, 65% male, and 35% female members. Average member sobriety is eight years with 36% sober more than ten years, 14% sober from five to ten years, 24% sober from one to five years, and 26% sober less than one year. Factors that may influence AA success rates involve 64% of members receiving medical, counseling, or spiritual help before attending AA, and 65% receiving help after attending AA, with such help playing an important role in recovery for 84% of them.<ref>http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey</ref>

Other data on attrition and retention is given in a 1989 internal AA report based on an average of five surveys. It estimated that of those who attended AA for the first time, 19% remained in AA after one month and 5% remained after twelve months. As length of sobriety increased, chances of remaining in AA for at least another year increased, from 41% with less than a year of sobriety to 91% with five years or more. There is no accurate way to determine why people leave, but the high attrition rate was significant in revealing that more needed to be done to help newcomers remain in AA.<ref>[http://thearidsite.tripod.com/AACOMMPR.PDF "Comments On A.A. Triennial Surveys" (PDF, 2 MB)], Dec. 1990, Alcoholics Anonymous World Services.</ref>

=== Project MATCH ===
Project MATCH began in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The project was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The programs were administered by psychotherapists and studied twelve-step methods, not necessarily AA.<ref name = "match">[http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm NIAAA Reports Project MATCH Main Findings], Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.</ref><ref>Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." ''Journal of Studies on Alcohol'', 58(1), 7-29.</ref>

Three types of treatment were investigated:
*Cognitive Behavioral Coping Skills Therapy, focusing on correcting poor self-esteem and distorted, negative, and self-defeating thinking.<ref>Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2p</ref><ref>Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "[http://www.msnbc.msn.com/id/17083397/site/newsweek/page/0/ Rehab Reality Check]" ''Newsweek'', 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c</ref>
*Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.<ref>Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. ''Science News'' v151.n4 (Jan 25, 1997): pp62(2).</ref>
*Twelve-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation.<ref name="match" />

The study concluded that patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. NIAAA Director Enoch Gordis, M.D. said that treatment providers and patients can have confidence that, if well-delivered, they represent state of the art in behavioral treatments.<ref name="match" />

[[Stanton Peele|Dr. Stanton Peele]] criticized MATCH on the basis that there was no untreated study group to determine whether the treatments were more effective than the natural recovery process. Therapists in MATCH were more highly trained and monitored than addiction counselors usually available to the public. Effectiveness for all treatments was measured by reduction in frequency and intensity of drinking, whereas twelve-step and abstention-based programs, he argued, should claim no improvement without full abstention.<ref>Peele, Stanton. [http://www.peele.net/lib/niaaa.html "Ten Radical Things NIAAA Research Shows About Alcoholism."] ''The Addictions Newsletter'' (The American Psychological Association, Division 50), Spring, 1998 (Vol 5, No. 2), pp. 6; 17-19.</ref> Other researchers stated that "AA has rarely been investigated with the kind of rigorous methological attention it received in Project MATCH." <ref>J. Scott Tonigan, Gerard J. Connors, and William R. Miller. "Participation and involvement in Alcoholics Anonymous", in Thomas Babor, Frances K. Del Boca, eds, ''Treatment Matching in Alcoholism'', Cambridge University Press: 2003, p 184.</ref>

=== George Vaillant ===
In ''[[The Natural History of Alcoholism Revisited]]''<ref name="VAILLANT1995ACKNOWLEDGEMENTS">{{cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Acknowledgments | pages = vii - xi | isbn = 0674603788 | oclc = 31605790}}</ref> Harvard professor of psychiatry [[George Eman Vaillant|George E. Vaillant]], a member of the Board of Trustees of Alcoholics Anonymous World Services, described his investigations into the effectiveness of AA.<ref name="VAILLANT1995THEPROBLEM">{{cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Introduction: The Problem | pages = 1 - 11 | isbn = 0674603788 | oclc = 31605790}}</ref> In the sample of 100 severe alcoholics from his clinic, 48% of the 29 alcoholics who eventually achieved sobriety attended 300 or more AA meetings,<ref>Vaillant 1995, p 196, 257.</ref> and AA attendance was associated with good outcomes in patients who otherwise would have been predicted not to remit.<ref>Vaillant 1995, p 268.</ref> In the sample of 465 men who grew up in Boston's inner city, the more severe alcoholics attended AA, possibly because all other avenues had failed<ref>Vaillant 1996, p 262-263.</ref> Vaillant's research and literature surveys revealed growing indirect evidence that AA is an effective treatment for alcohol abuse,<ref name="VAILLANT1995CHAPTER4"/> partly because it is a cheap, community-based fellowship with easy access.<ref name="VAILLANT2005">{{cite journal | last = Vaillant | first = George E. | title = Alcoholics Anonymous: cult or cure? | journal = Australian and New Zealand Journal of Psychiatry | volume = 39 | issue = 6 | month = June | year = 2005 | pages = 431-436 | doi = 10.1111/j.1440-1614.2005.01600.x | id = PMID 15943643}}</ref> 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, good clinical outcomes correlated with frequency of AA attendance, having a sponsor, engaging in a Twelve-Step work, and leading meetings. Vaillant concluded that AA appears equal or superior to conventional treatments for alcoholism and that skepticism of some professionals regarding AA as an effective treatment for alcoholism is unwarranted.<ref name="VAILLANT2005"/>

===Other studies===
*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. Associations between treatment and long-term alcohol-related outcomes appeared to be due to participation in AA.<ref name="MOOS2006A">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals | journal = Journal of Clinical Psychology | month = June | year = 2006 | pages = 735 - 750 | doi = 10.1002/jclp.20259 | id = PMID 16538654}}</ref><ref name="MOOS2006B">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Rates and predictors of relapse after natural and treated remission from alcohol use disorders | journal = Addiction | volume = 101 | issue = 2 | pages = 212 – 222 | year = 2006 | month = February | doi = 10.1111/j.1360-0443.2006.01310.x | id = PMID 16445550}}</ref><ref name="MOOS2004">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders | journal = Journal of Consulting and Clinical Psychology | year = 2004 | month = February | volume = 72 | issue = 1 | pages = 81 - 90 | doi = 10.1037/0022-006X.72.1.81 | id = PMID 16445550}}</ref>

*In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the United States, five of the programs were twelve-step based and five used [[cognitive-behavioral therapy]]. Over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy.<ref>Krista Conger. [http://news-service.stanford.edu/news/2001/may23/12step.html "Study points out value of 12-step groups in treating substance abuse."] Stanford Report, May 23, 2001. Retrieved 2007-05-05.</ref>

*A 1997 study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.<ref>J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)</ref>

*The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. 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.<ref>J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77</ref>

*For a 1967 study a court judge randomly assigned offenders to either clinical treatment, AA treatment, or no treatment, and after one year 68% in the clinic group were rearrested, 69% in the AA group were rearrested, and 56% were rearrested in the group receiving no treatment. No statistically significant differences between the three groups were discovered in [[recidivism]] rate, in number of subsequent rearrests or in time elapsed prior to rearrest.<ref>(August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". ''American Journal of Psychiatry'' 124 (2): Abstract.</ref>

*Belief in the disease theory of alcoholism and high commitment to total abstinence were found to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).<ref name="LARIMER1999">{{cite journal | last = Larimer | first = Mary E | coauthors = Palmer, Rebekka S; Marlatt, G. Alan | title = Relapse prevention. An overview of Marlatt's cognitive-behavioral model | year = 1999 | volume = 23 | issue = 2 | pages = 151-160 | pmid = 10890810 | journal = Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism | issn = 1535-7414 | oclc = 42453373}}</ref>

==Criticism and controversy==
{{see also|Twelve-step program#Criticism|l1=Twelve-step program: Criticism}}

===Moderation vs. abstinence===
The debate about moderation versus total abstinence is one of the most hotly contested issues in alcohol treatment.<ref name="SHUTE1997">{{cite journal | last = Shute | first = Nancy | title = The drinking dilemma: by calling abstinence the only cure, we ensure that the nation's $100 billion alcohol problem won't be solved | journal = [[U.S. News & World Report]] | volume = 123 | issue = 9 | month = September | year = 1997 | pages = 54 - 64}}[http://silkworth.net/magazine_newspaper/us_news_world_report_sep_8_1997.html]</ref> AA acknowledges that not all drinkers are alcoholics, but advocates total abstinence for those who are.<ref>{{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | year = 2001 | month = June | edition = 4th edition | location = [[New York, New York]] | isbn = 1893007162 | oclc = 32014950 | url = http://www.aa.org/bigbookonline/en_BigBook_chapt2.pdf | format = PDF}}</ref> Critics believe more options should be available to problem drinkers who can manage their drinking with the right treatment.<ref name="SHUTE1997"/>

===Disease of alcoholism===
{{main|Disease theory of alcoholism}}
The concept of alcoholism and addiction as a disease is controversial.<ref>Alan I. Leshner. [http://www.apa.org/about/contact.html "What does it mean that addiction is a brain disease?"] ''Monitor on Psychology'' (American Psychological Association) Volume 32, No. 5 June 2001.</ref> [[William Duncan Silkworth|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.<ref name="littledoctor">Dale Mitchel, ''Silkworth: The Little Doctor Who Loved Drunks''. Hazelden, 2002.</ref> Alcoholics, he argued, can never safely use alcohol in any form at all, since once forming the habit, they cannot break it.<ref>''Alcoholics Anonymous'' ''The Doctor's Opinion'' page xxviii.</ref>

AA regards alcoholism as a disease<ref>''[http://www.aa.org/en_is_aa_for_you.cfm?PageID=14 ''A Newcomer Asks]'' (AA pamphlet)</ref><ref>''[http://www.aa.org/en_information_aa.cfm?PageID=17&SubPage=63 The Alcoholic Can Recover]'' (AA pamphlet)</ref> (though Bill Wilson once stated that it was not and more comparable to an illness or malady)<ref> {{cite web | last = | first = | authorlink = | coauthors = | title = A Conversation with Bill W. | work = | publisher = | date = 2003 | url = http://www.nccatoday.org/conversation.htm | format = | doi = | accessdate = 2006-10-20 }}
</ref> and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone.<ref name="BIGBOOKCHAPTER3">{{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | year = 2001 | month = June | edition = 4th edition | chapter = Chapter 3: More About Alcoholism | pages = 30 - 43 | location = [[New York, New York]] | isbn = 1893007162 | oclc = 32014950 | url = http://www.aa.org/bigbookonline/en_BigBook_chapt3.pdf | format = PDF}}</ref> AA has been criticized by opponents of the disease model, especially those who argue that AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.<ref>[[Stanton Peele]]. ''The Diseasing of America''. Lexington, MA: Lexington Books, 1989.</ref>

===Thirteenth-stepping===

Mutual support and abuse have both been observed in AA groups.<ref name="VAILLANT2005"/> AA undertakes no external restriction, screening, or vetting of its members, and the long-form version of Tradition Three states that any two or three alcoholics gathered together for sobriety may call themselves an AA group.<ref>http://www.aa.org/bigbookonline/en_appendiceI.cfm</ref>

"Thirteenth-stepping" is a euphemistic term describing the practice of targeting new and vulnerable AA members for dates or sex. Fifty-five female AA members, selected through [[Sampling (statistics)#Convenience sampling|convenience]] and [[snowball sampling]], were surveyed on the thirteenth-stepping behavior they witnessed or experienced in AA, such as: feeling seduced, or feeling intimidated and uncomfortable with sexual comments; receiving unwanted hugs and flirting; observing men flirting with, pressuring, and seducing of other women; and observing men who seemed more interested in sex than in recovery. At least 50% of the survey participants experienced seven or more of these behaviors, two volunteered that they were raped by men they met in AA. Chemical dependency treatment providers should be aware of this trend, and vulnerable women like those with histories of sexual abuse should be referred to female-only groups or be trained to avoid sexual exploitation in coed meetings.<ref name="BOGART2003">{{cite journal |journal=Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions |title='13th-Stepping:' Why Alcoholics Anonymous Is Not Always a Safe Place for Women |last=Bogart |first=Cathy J. |coauthors=Pearce, Carol E. |year=2003 |volume=14 |issue=1 |pages=43-47 |doi=10.1080/10884600305373 |issn=1548-7148 |oclc=34618968}}</ref>

A leaked internal AA memorandum stated that the UK AA service board was considering how to deal with a small minority of members being investigated by police for taking advantage of vulnerable new AA members.<ref>Gerard Seenan. "[http://www.guardian.co.uk/uk_news/story/0,,339726,00.html Drink advice service confronts sex abuse.]" ''The Guardian'', July 5, 2000.</ref> Former members of a Washington DC Midtown AA group alleged that females were manipulated into sexual relationships with older male group members, older male sponsors were assigned to young women, members were told to cut off ties with family and friends, and others told to stop taking their medications. Several churches banned the group from meeting in their facilities and members complaining to AA New York office, found that AA has no firm hierarchy and exercises no oversight of individual groups.<ref>Fisher, Marc. [http://www.washingtonpost.com/wp-dyn/content/article/2007/07/21/AR2007072101356.html "Seeking Recovery, Finding Confusion]." Washington Post. Sunday, July 22, 2007, p A01.</ref><ref>Summers, Nick. "[http://www.newsweek.com/id/35018" A Struggle Inside AA]." ''Newsweek'' May 7, 2007.</ref><ref>http://www.nbc4.com/news/13306389/detail.html</ref>

===Cult-like behavior===
The rhetoric and emotional language of AA leads some journalists and social scientists to fear AA is a religion or cult: that the term "sobriety" has taken on a religious flavor and AA members over-rely on dogmatic slogans and are slaves to the group;<ref>Arthur H. Cain, "[http://www.legacyaa.com/articles/cult_or-cure.htm Alcoholics Anonymous: Cult or Cure?]." ''Harper's Magazine'', February 1963</ref> that AA's need for submission to a higher power leaves potential for abuse, and submission can become the basis for cult-like cohesion.<ref>Mark Dombeck, "[http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=9527 Alcoholics Anonymous is a Cult?]." MentalHelp.net, Jun 1st 2006. Retrieved 2007-07-23</ref> Individual alcoholics attending incompatible AA groups or allying themselves with unfortunate sponsors sometimes tell horror stories about AA. Common to cults, AA members are not encouraged to take a dispassionate or scientific view of their organization, and as with any partisan group, members can be extremely and erroneously opinionated, convinced for example, that AA is the only way to recover from alcoholism.<ref>Alan Ogborne. Book Review of ''More Revealed''. ''Addiction'' Aug 93, Vol. 88 Issue 8, p1150-1152.</ref>

AA is unlike cults in that its program is based on suggestion only, religious conviction does not prevent AA membership since it has no doctrine of any one specific type of God or obedience to charismatic leaders, and it operates on the principle of leadership rotation. AA's encouragement of dependence is healthy in the way that dependence on exercise is healthy,<ref name="VAILLANT2005"/><ref>Vaillant 1995, p 266. Summarizing Nace, E.P. 1992. "Alcoholics Anonymous" in J.H.Lowinson, P.Ruiz, and R.B.Millman, eds. ''Substance Abuse: A Comprehensive Text Book''. Baltimore: Williams and Wilkins. Pp 486-495.</ref> and it does not try to isolate its members from society and take over their lives by creating an unusual and total dependence on the organization for basic human needs like friends, food, and shelter, as is typical with other cult practices.<ref name="contentment">Matthew Berry. Contentment, Depression & Substance-Use. (2007) Australiasian Professional Society on Alcohol and Other Drugs Annual Conference, Auckland, New Zealand.</ref>

===Confidentiality===
Twelve-step program members are not legally bound to keep confidentiality agreements like [[therapist]]s or [[clergyman|clergy]] so care should be taken before revealing sensitive information to a meeting or sponsor.<ref name="COLEMAN2005">{{cite journal | last = Coleman | first = Phyllis | title = Privilege and Confidentiality in 12-Step Self-Help Programs: Believing The Promises Could Be Hazardous to an Addict's Freedom | journal = The Journal of Legal Medicine | volume = 26 | issue = 4 | month = December | year = 2005 | pages = 435-474 | doi = 10.1080/01947640500364713 | issn = 0194-7648 | oclc = 4997813}}</ref>

== Literature ==
* {{cite book | last = Alcoholics Anonymous | title = Alcoholics Anonymous | publisher = Alcoholics Anonymous World Services | date = 1976-06-01 | isbn = 0916856593 | oclc = 32014950 | url = http://www.aa.org/bigbookonline}}
* {{cite book | last = Alcoholics Anonymous | title = Twelve Steps and Twelve Traditions | publisher = Alcoholics Anonymous World Services | date = 2002-02-10 | isbn = 0916856011 | oclc = 13572433}}
* {{cite book | last = Alcoholics Anonymous | title = Pass It On | publisher = Alcoholics Anonymous World Services | date = 1984 | isbn = 0916856011}}

==See also==
{{Col-begin}}
{{Col-2}}
* [[History of AA]]
* [[Addiction recovery groups]]
* [[Al-Anon/Alateen]]
* [[Drunkenness]]
* [[Alcoholism]]
{{Col-2}}
* [[Self-help groups for mental health]]
* [[List of twelve-step groups]]
* [[Twelve-step program]]
* [[Substance abuse]]
* [[Recovery model]]
{{Col-end}}

==References==
{{reflist|2}}

==External links==
* [http://www.aa.org/ AA official website]
*[http://aagrapevine.org/ AA Grapevine] – the international journal of AA.
* [http://web.archive.org/web/20070426152814/http://religiousmovements.lib.virginia.edu/nrms/aa.html Alcoholics Anonymous] formerly on the Religious Movements Homepage Project, [[University of Virginia]]

[[Category:Alcohol abuse]]
[[Category:Addiction and substance abuse organizations]]
[[Category:Twelve-step programs]]
[[Category:Organizations established in 1935]]
[[Category:Non-profit organizations]]

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