Alcoholics Anonymous

Alcoholics Anonymous logo
AA meeting sign (German)
Sobriety token or "chip", given for specified lengths of sobriety, on the back is 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] founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio. AA's stated "primary purpose" is to help alcoholics "stay sober and help other alcoholics achieve sobriety".[2][3][4] 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 and groups remain anonymous in public media, altruistically help other alcoholics and 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.[5][6]

According to AA's 2014 membership survey, 27% of members have been sober less than one year, 24% have 1–5 years sober, 13% have 5–10 years, 14% have 10–20 years, and 22% have more than 20 years sober.[7]

The first female member, Florence Rankin, joined AA in March 1937,[8][9] and the first non-Protestant member, a Roman Catholic, joined in 1939.[10] AA membership has since spread "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements.[11] In the fourth edition of Alcoholics Anonymous (November 2001), it states "Since the third edition was published in 1976, worldwide membership of AA has just about doubled, to an estimated two million or more..."[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

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 Dr. 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 Dr. 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 Dr. 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 June 10, 1935, the date marked by AA for its anniversaries.[17][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".[18] 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

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.

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.[22] 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.[5] At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference,[23] as AA grew to millions of members internationally.[24]

Organization and finances

Main article: Twelve Traditions
A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense",[24] and Bill Wilson called it a "benign anarchy".[25] 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."[26]

In 2006, AA counted 1,867,212 members and 106,202 AA groups worldwide.[24] The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.[27]

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.[24]

AA groups are self-supporting, relying on voluntary donations from members to cover expenses.[24] The AA General Service Office (GSO) limits contributions to US$3,000 a year.[28] Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.[5]

AA receives proceeds from books and literature that constitute more than 50% of the income for its General Service Office.[29] Unlike individual groups, the GSO is not self-supporting and maintains a small salaried staff. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and are responsible to the AA groups they represent. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.[30]

Program

AA's program extends beyond abstaining alcohol.[31] Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism"[32] through a spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps,[33] and sobriety is furthered by volunteering for AA[34] and regular AA meeting attendance[35] or contact with AA members.[33] 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.[36] 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.[37]

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.[31] 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.[38]

Meetings

AA meetings are "quasi-ritualized therapeutic sessions run by and for, alcoholics".[39] 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 "a desire to stop drinking" that cannot be challenged by another member on any grounds.[5] "Open" meetings are available to anyone (nonalcoholics can attend as observers).[40] 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.

Except for men's and women's meetings, and meetings targeting specific demographics (including newcomers, gay people, and young people), AA meetings do not exclude other alcoholics. While AA has pamphlets that suggest meeting formats,[41][42] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[5] 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".[43]

Confidentiality

US courts have not extended the status of privileged communication, such as that enjoyed by clergy and lawyers, to AA related communications between members.[44][45]

Spirituality

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.[46] 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 forgo use of opening or closing prayers.[47][48] There are online resources listing AA meetings for atheists and agnostics.[49]

Disease concept of alcoholism

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.[50] Though AA initially avoided the term "disease", in 1973 conference-approved literature categorically stated that "we had the disease of alcoholism."[51] Regardless of official positions, from AA's inception most members have believed alcoholism to be a disease.[52]

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."[52] In his introduction to The Big Book, non-member Dr. 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."[53] AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us."[54] 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. [55]

Canadian and United States demographics

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.[7]

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.[7] 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.[7]

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.[7]

Effectiveness

Research limitations

AA tends to polarize observers into believers and non-believers,[56] and discussion of AA often creates controversy rather than objective reflection.[57] Moreover, a randomized study of AA is difficult: AA members are not randomly selected from the population of chronic alcoholics; they are instead self-selected or mandated by courts to attend AA meetings.[58] There are two opposing types of self-selection bias: (1) drinkers may be motivated to stop drinking before they participate in AA; (2) AA may attract the more severe and difficult cases.[59]

Studies

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,[60][61][62][63][64] other studies have not.[65][66]

The 2006 Cochrane Review of eight studies (the studies reviewed were done between 1967 and 2005) measuring the effectiveness of AA found no significant difference between the results of AA and twelve-step participation compared to other treatments, stating that "experimental studies have on the whole failed to demonstrate their effectiveness in reducing alcohol dependence or drinking problems when compared to other interventions."[67]

A 2014 study by Keith Humphreys, Janet Blodgett and Todd Wagner concluded that "increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection."[60] Austin Frakt, writing for The New York Times, discusses how the study's methodology minimizes outside factors, such as how motivated the people who succeed at becoming abstinent are.[68]

A study published in 2016 shows that prayer helps people who have achieved sobriety in Alcoholics Anonymous reduce cravings for alcohol.[69] The study used a MRI machine to scan how subjects reacted to images of people drinking. The study randomly assigned the subjects, so that some subjects saw the images after saying prayers in the Big Book of Alcoholics Anonymous; others after reading newspaper articles. The people who had just seen the prayers reported feeling fewer cravings for alcohol; the MRI scans of their brains confirmed that there was a different reaction.

The Sober Truth

Dodes, in "The Sober Truth", argues that most people who have experienced AA have not achieved long-term sobriety, making the controversial argument that research indicates that only 5 to 8 percent of the people who go to one or more AA meetings achieve sobriety for longer than one year.[70] Gabrielle Glaser used Dodes' figures to argue that AA has a low success rate in a 2015 article for The Atlantic.[71]

The 5 to 8 percent figure put forward by Dodes is controversial; Thomas Beresford, MD., writing for the National Council on Alcoholism and Drug Dependence, says that the book uses "three separate, questionable, calculations that arrive at the 5-8% figure."[72] This is not the only criticism the book has received; The New York Times calls The Sober Truth a "polemical and deeply flawed book" [73] and John F. Kelly, an associate professor at Harvard, as well as Gene Beresin, a professor at Harvard, feel that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong (Dodes responded by pointing out that "I have never said that AA is harmful in general"), noting that "studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge [...] produce about one third higher continuous abstinence rates" [74][75]

Health-care costs

As a volunteer-supported program, AA is free of charge. This contrasts with treatments for alcoholism such as inpatient treatment, drug therapy, psychotherapy, and cognitive-based therapy. One study found that the institutional use of twelve-step-facilitation therapy to encourage participation in AA reduced healthcare expenditures by 45% when compared to another group that was not encouraged to participate in AA.[75]

Relationship with institutions

Hospitals

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.[76][77][78] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[79] 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.[80]

Prisons

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.[81] In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic.[82] Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.[83]

United States Court rulings

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.[84][85] 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.[86][87]

American treatment industry

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.[88] 32% of AA's membership was introduced to it through a treatment facility.[7]

United Kingdom treatment industry

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.[89]

Criticism

Thirteenth Stepping

"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates or sex. The Journal of Addiction Nursing reported that 50% of the women that participated in a survey (55 in all) experienced 13-stepping behavior from others.[90] AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.[91]

Moderation or abstinence

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics.[92] 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.[93] 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."[94]

Cultural identity

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.[95] A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial.[96] 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.[97] 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.[98]

Other criticisms

Literature

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine.[101] 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.

AA in music

Psychedelic folk musician Red Label Catharsis refers to AA in the song We, Agnostics

AA in film

Films about Alcoholic Anonymous

Films where primary plot line includes AA

See also

Notes

  1. ↑ http://www.aa.org/assets/en_US/smf-92_en.pdf
  2. ↑ Michael Gross (2010). American Journal of Public Health (December 1, 2010).
  3. ↑ AA.org
  4. ↑ Mäkelä 1996, p. 3
  5. 1 2 3 4 5 "The Twelve Traditions". The AA Grapevine. Alcoholics Anonymous. 6 (6). November 1949. ISSN 0362-2584. OCLC 50379271.
  6. ↑ 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.
  7. 1 2 3 4 5 6 "Alcoholics Anonymous 2014 Membership Survey" (PDF). A.A. World Services. 2014.
  8. ↑ Anonymous (1939). Alcoholics Anonymous. New York: Works Publishing Company. p. Original Manuscript p. 217.
  9. ↑ 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.
  10. ↑ Kurtz 1991. pp. 52"
  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 (2001). Alcoholics Anonymous (4th ed.). Alcoholics Anonymous World Services, Inc. Retrieved June 8, 2013.
  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, p 117.
  15. ↑ Kurtz, Ernest (1980). Not-God: a history of Alcoholics Anonymous. Center City, Minn: Hazelden Educational Services. ISBN 0-89486-065-8.
  16. ↑ Pittman, Bill "AA the Way it Began" 1988, Glenn Abbey Books
  17. 1 2 Kurtz 1991. pp. 18–20
  18. 1 2 Kurtz 1991. pp. 16–17
  19. ↑ Kurtz 1991. pp. 45–46
  20. ↑ Kurtz 1991. pp. 46–8
  21. ↑ GSOwatch.aamo.info
  22. ↑ 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 (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  23. ↑ Pass It On 1984, p. 359
  24. 1 2 3 4 5 "AA Fact File" (PDF). General Service Office of Alcoholics Anonymous. 2007.
  25. ↑ AA Comes Of Age, p. 225
  26. ↑ Carroll, Steven (2010-03-03). "Group avoids politics of alcohol – author". http://www.irishtimes.com/. Retrieved 2010-03-30. External link in |publisher= (help)
  27. ↑ Wilson, Bill. "The A.A. Service Manual Combined with Twelve Concepts for World Services" (PDF). Alcoholics Anonymous World Services, Inc. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  28. ↑ "A.A. GSO Guidelines: Finances" (PDF). Alcoholics Anonymous General Service Office. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  29. ↑ "GSO 2007 Operating Results". Alcoholics Anonymous General Services Office. Archived from the original on 2009-12-12. Retrieved 2009-12-12. Gross Profit from Literature ~8,6M (57%), Contributions ~$6.5M (43%)
  30. ↑ "Alcoholics Anonymous : International General Service Offices". Alcoholics Anonymous website. Archived from the original on 2009-12-12. Retrieved 2009-10-08.
  31. 1 2 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.
  32. ↑ Bill W. 2002, Appendix II
  33. 1 2 "This is AA" (PDF). Alcoholics Anonymous Work Services, Inc. 1984. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  34. ↑ AA.org
  35. ↑ "A Newcomer Asks.." (PDF). Alcoholics Anonymous World Services, Inc. 1980. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  36. ↑ Questions and Answers on Sponsorship 2005 http://aa.org/pdf/products/p-15_Q&AonSpon.pdf
  37. ↑ 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.
  38. ↑ 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.
  39. ↑ 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.
  40. ↑ The A.A. Group (PDF). Alcoholics Anonymous World Services, Inc. 1990. p. 13.
  41. ↑ "The A.A. Group" (PDF). Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  42. ↑ "Suggestions For Leading Beginners Meetings" (PDF). Alcoholics Anonymous World Services, Inc. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  43. ↑ Mäkelä 1996, p. 149–150
  44. ↑ 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.
  45. ↑ Hoffman, Jan (15 June 1994). "Faith in Confidentiality of Therapy Is Shaken". New York Times. Retrieved 2008-10-23.
  46. ↑ 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
  47. ↑ C., Roger (Nov 2011). "A History of Agnsotic Groups in Alcoholics Anonymous: Part 1". Humanist Network News. Retrieved 2014-02-12.
  48. ↑ Freedman, Samuel (Feb 21, 2014). "Alcoholics Anonymous, Without the Religion". The New York Times. Retrieved 2014-02-26.
  49. ↑ http://www.agnosticaanyc.org/worldwide.html for example is a directory of agnostic AA meetings
  50. ↑ Rush, Benjamin (1805). Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind. Philadelphia: Bartam.
  51. ↑ AA.org
  52. 1 2 BHRM.org
  53. ↑ Alcoholics Anonymous page xxx
  54. ↑ Living Sober p 68
  55. ↑ Gately, Iain (2008). Drink: A Cultural History of Alcohol. Penguin Group. p. 417. ISBN 9781592403035.
  56. ↑ Vaillant, 1995, p 255.
  57. ↑ Vaillant, 1995, p 265.
  58. ↑ Griffith 2002, p. 103–117
  59. ↑ Humphreys, Keith (2002). Galanter, Marc; Begleiter, Henri; Deitrich, Richard; Gallant, Donald, eds. "Alcoholics Anonymous and 12-Step Alcoholism Treatment Programs". Recent Developments in Alcoholism. Recent Developments in Alcoholism. Springer US. 16: 149–164. doi:10.1007/b100495. ISBN 978-0-306-47258-9. PMID 12638636.
  60. 1 2 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: 2688–94. doi:10.1111/acer.12557. PMC 4285560Freely accessible. PMID 25421504. Lay summary.
  61. ↑ Walitzer, Dermen, Barrick (2009). "Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial.". Addiction. 104: 391–401. doi:10.1111/j.1360-0443.2008.02467.x. PMC 2802221Freely accessible. PMID 19207347.
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  66. ↑ Terra, Mauro Barbosa; Barros, Helena Maria Tannhauser; Stein, Airton Tetelbom; Figueira, Ivan; Palermo, Luiz Henrique; Athayde, Luciana Dias; Gonçalves, Marcelo de Souza; Da Silveira, Dartiu Xavier (2008). "Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents". American Journal on Addictions. 17 (1): 48–53. doi:10.1080/10550490701756393. PMID 18214722.
  67. ↑ Ferri, MMF; Amato, Laura; Davoli, Marina; Ferri, Marica (2006). Ferri, Marica, ed. "Alcoholics Anonymous and other 12-step programmes for alcohol dependence". Cochrane Database of Systematic Reviews. 2006 (3): CD005032. doi:10.1002/14651858.CD005032.pub2. PMID 16856072.
  68. ↑ Frakt, Austin (2015-04-06). "Alcoholics Anonymous and the Challenge of Evidence-Based Medicine". The New York Times. Retrieved 2015-06-21.
  69. ↑ Marc Galanter, Zoran Josipovic, Helen Dermatis, Jochen Weber, and Mary Alice Millard (2016-03-25). "An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous". The American Journal of Drug and Alcohol Abuse: 1–11. doi:10.3109/00952990.2016.1141912. Lay summary.
  70. ↑ Lance Dodes, M.D.; Zachary Dodes (2014). The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. ISBN 978-0807033159. Even though AA does not conduct scientific studies on its success rates, a number of clinicians have tried to audit the figures. The National Longitudinal Alcohol Epidemiologic Survey, a 1992 review by the US Census Bureau and National Institute on Alcohol Abuse and Alcoholism (NIAAA), included a survey of AA members. It found that only 31 percent of them were still attending after one year. AA itself has published a comparable figure in a set of comments on its own thirteen-year internal survey, stating that only 26 percent of people who attend AA stay for longer than one year.33 A third study found that after eighteen months, between 14 and 18 percent of people still attended AA. So let us assume that between 14 percent and 31 percent of people stay with AA for more than one year. Now we must ask: out of this remaining population, how many stay sober? .... These totals all fall within a close range. Together, they support the fact that roughly 5 to 8 percent of the total population of people who enter AA are able to achieve and maintain sobriety for longer than one year.
  71. ↑ Glaser, Gabrielle. "The Irrationality of Alcoholics Anonymous". The Atlantic. Retrieved 2016-04-15.
  72. ↑ Beresford, Thomas (2016), Alcoholics Anonymous and The Atlantic: A Call For Better Science, National Council on Alcoholism and Drug Dependence, retrieved 2016-04-15
  73. ↑ http://www.nytimes.com/2014/05/06/health/the-sober-truth-seeing-bad-science-in-rehab.html?_r=3
  74. ↑ In Defense Of 12 Steps: What Science Really Tells Us About Addiction | CommonHealth
  75. 1 2 Humphreys, Keith; Moos, R (May 2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. ISSN 1530-0277. PMID 11371720.
  76. ↑ Cheever, Susan (June 14, 1999). "Bill W.: The Healer". Time Magazine. p. 201. Retrieved 12 June 2013. by helping another alcoholic, he could save himself
  77. ↑ B., Dick (1997). "Turning point". Turning Point: A History of Early A.A.'s Spiritual Roots and Successes (Volume 10 ed.). Good Book Publishing Company. p. 110. ISBN 9781885803078. Retrieved 12 June 2013. Bill went back to Towns constantly to work on alcoholics there, simply trying to help others had kept him from even thinking of drinking
  78. ↑ Lois (1979). Lois remembers: memoirs of the co-founder of Al-Anon and wife of the co-founder of Alcoholics Anonymous (illustrated, reprint ed.). Al-Anon Family Group Headquarters. p. 95. ISBN 9780910034234. Retrieved 12 June 2013. simply trying to help other had kept him from even thinking of drinking
  79. ↑ Alcoholics Anonymous (3rd ed.). Alcoholics Anonymous World Services, Inc. 1976. p. 89.
  80. ↑ "Treatment Committee". http://area62.org/. Area 62. Retrieved 9 June 2013. External link in |work= (help)
  81. ↑ "Corrections Workbook" (PDF). New York, NY: Alcoholics Anonymous Word Services, Inc. 1995. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  82. ↑ "Corrections Catalog". Archived from the original on 2009-12-12. Retrieved 2009-12-12. The titles include: Carrying the Message into Correctional Facilities, Where Do I Go From Here?, A.A. in Prison: Inmate to Inmate, A.A. in Correctional Facilities, It Sure Beats Sitting in a Cell, Memo to an Inmate Who May be an Alcoholic, A Message to Corrections Administrators
  83. ↑ "AA Guidelines from GSO: Cooperating with Court, DWI and Similar Programs" (PDF). Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  84. ↑ LII Editorial Board (June 11, 1996). "IN THE MATTER OF DAVID GRIFFIN, APPELLANT, v. THOMAS A. COUGHLIN III, AS COMMISSIONER OF THE NEW YORK STATE DEPARTMENT OF CORRECTIONAL SERVICES, ET AL., RESPONDENTS.". http://www.law.cornell.edu. Retrieved 8 June 2013. External link in |work= (help)
  85. ↑ Honeymar (1997). "Alcoholics Anonymous As a Condition of Drunk Driving Probation: When Does It Amount to Establishment of Religion". Columbia Law Review. 97 (2): 437–472. doi:10.2307/1123367. JSTOR 1123367.
  86. ↑ Egelko, Bob (8 September 2007). "Appeals court says requirement to attend AA unconstitutional". San Francisco Chronicle. Archived from the original on 2009-12-12. Retrieved 2007-10-08.
  87. ↑ Inouye v. Kemna, 504 F.3d 705, 714 n.9 (9th Cir. 2007) (“[T]he AA/NA program involved here has such substantial religious components that governmentally compelled participation in it violated the Establishment Clause.”).
  88. ↑ Robertson, Nan (1988). Getting Better: Inside Alcoholics Anonymous. New York: Morrow. p. 220. ISBN 978-0-688-06869-1. LCCN 87031153. OCLC 17260252. OL 4127115W.
  89. ↑ Day, E; Gaston, RL; Furlong, E; Murali, V; Copello, A (December 2005). "United Kingdom substance misuse treatment workers' attitudes toward 12-step self-help groups". Journal of Substance Abuse Treatment. 29 (4): 321–327. doi:10.1016/j.jsat.2005.08.009. PMID 16311185.
  90. ↑ Bogart, Cathy J.; Bogart, Cathy J. (2003). "'13th-Stepping:' Why Alcoholics Anonymous Is Not Always a Safe Place for Women". Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions. 14 (1): 43–47. doi:10.1080/10884600305373. ISSN 1548-7148. OCLC 34618968.
  91. ↑ Questions and Answers on Sponsorship, page 10. 2005.
  92. ↑ Peele 1989
  93. ↑ Shute, Nancy (September 1997). "The drinking dilemma: by calling abstinence the only cure, we ensure that the nation's $100 billion alcohol problem won't be solved". U.S. News & World Report. 123 (9): 54–64.
  94. ↑ Alcoholics Anonymous page 20-1,24
  95. ↑ Alexander, Francesa; Rollins, Michele (1985). "Alcoholics Anonymous: the unseen cult" (PDF). California Sociologist. Los Angeles: California State University. 17 (1): 33–48. ISSN 0162-8712. OCLC 4025459. Archived (PDF) from the original on 2009-12-12. Retrieved 2009-12-12.
  96. ↑ Right, Kevin B. W (1997). "Shared Ideology in Alcoholics Anonymous: A Grounded Theory Approach". Journal of Health Communication. 2 (2): 83–99. doi:10.1080/108107397127806. PMID 10977242.
  97. ↑ Levinson, D. (1983). Galanter, Marc, ed. "Current status of the field: An anthropological perspective on the behavior modification treatment of alcoholism". Recent Developments in Alcoholism. New York: Plenum Press. 1: 255–261. doi:10.1007/978-1-4613-3617-4_14. ISSN 0738-422X. PMID 6680227.
  98. ↑ Wilcox 1998, p. 109–124
  99. ↑ Harpers.org
  100. ↑ Cainwork=harpers.org, Arthur H. (2014). "Alcoholics Anonymous | Harper's Magazine". Retrieved May 4, 2014.
  101. ↑ A Worldcat search for materials authored by Alcoholics Anonymous and more specific divisions of the organization (AA Grapevine, World Services, General Service Conference, World Service Meeting) yields well over 500 results.
  102. ↑ Urycki, Mark (27 March 2012). "Bill W. documentary at CIFF". Kent, Ohio: WKSU. Retrieved 21 May 2012.
  103. ↑ Linden, Sheri (18 May 2012). "'Bill W.' cuts through the anonymity". Los Angeles Times. Los Angeles: Los Angeles Times. Retrieved 22 May 2012. Laudatory but never simplistic, "Bill W." is a thoroughly engrossing portrait of Wilson, his times and the visionary fellowship that is his legacy.

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