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Alcoholics Anonymous: A Primer

by Will Long

August 28, 2022

Does Alcoholics Anonymous Really Work? 

Millions of people have walked through the doors of a meeting location in the 87 years since Alcoholics Anonymous (AA) was founded by Bill Wilson. It’s the most successful addiction treatment program in history, turning ever-more alcoholics into successful recovery stories. There’s a very good chance that you’ve seen a copy of Alcoholics Anonymous on a bookshelf. Also known as the “Big Book,” this addiction recovery guide was written and published by Wilson in 1939 and features the contributions of over a hundred of those who participated in the early years of AA. It’s one of the bestselling self-help books in the history of modern publishing, selling over 30 million copies in the time since it’s shown up on the sales floors of bookshops, therapy offices, and church libraries.

So, what exactly is AA? Does it work for those who go to meetings? We examined the history, founding principles, critical reviews and spoke with some folks who went through the program.

A Brief History of Alcoholics Anonymous

Bill Wilson was a World War I veteran who began to drink heavily and carried that habit over with him when he started working on Wall Street as a stock market analyst. Once the Great Depression hit, he was out of work but continued drinking heavily in ways that he felt could be hidden from his wife. Through a transformative religious experience in the early 1930s, Wilson came to understand he was an alcoholic and could only be free from the disease through a combination of resolve and self-realization.

AA started in a fascinatingly unique way through the facilitation of Wilson and Dr. Robert Smith in 1935. Formed in the wake of the Oxford Group’s evolution, it began as a collection of acquaintances that met in each other’s homes and spread their message by word of mouth. The organizing, materials, and management done by the early members helped AA build a solid foundation on which it’s continued to spread. Wilson’s wife Lois founded the Al-Anon Family Groups in 1951, which is a support organization for the families of those in AA.

AA is now the world’s most popular addiction treatment program. While there are people who claim AA doesn’t work, there are countless people who will defend the organization and its principles tooth-and-nail. AA advocates have good reason to defend the organization from detractors who make all sorts of anti-AA claims, considering it’s one of the most effective advocates for recovery through the sheer number of people it draws in its orbit.

The Twelve Steps and Twelve Traditions

AA not only treats those suffering from alcoholism, but it also serves as a key model for organizations that use a 12-step method to treat practically any addiction. Those who participate in 12-step programs generally agree that a major part of their success is “working the steps.”. The 12-step setup gives a moralistic framework by which those who actively achieve recovery can find success. The Twelve Steps are as follows:

AA also abides by the Twelve Traditions, published in 1946. The Twelve Traditions are a way of self-regulating the image and goals of AA so that it can remain a positive neutral force in the lives of its members. One curious aspect of AA is that the organization shuns all endorsements and alignments and instead has only focused on the one goal they have through the 12 steps—recovery for attendees. This explicit anti-endorsement policy has potentially been a big part of why the group has grown and been so successful over its 87-year life. The Twelve Traditions are as follows:

A Critical View of Alcoholics Anonymous

The research on AA is kind of sketchy, per se, due to various issues in how the studies were set up, but what can be gleaned from critical reviews is that AA is neither specifically effective nor ineffective, according to Astral Codex Ten author and psychiatrist Dr. Scott Siskind. Practically any kind of basic intervention is a valid way of treating the disease, and the literature in AA reinforces this point. Dr. Siskind states towards the end of his article discussing all available studies on AA, “If we take all this seriously, then it looks like every psychosocial treatment (including brief opportunistic intervention) is the same, and all are better than no treatment.”

One reason AA works is that AA may offer something similar to what religious activity offers society—a place to share the burden and find support through community. The theory that providing fellowship is a key reason why programs like AA work is a legitimately compelling argument. Many of those who either attend or have attended AA actively choose to embrace the pseudoreligious aspect of the organization as a way of actualizing self-overcoming or as an extension of their faith. As a pluralistic, yet higher-power-embracing organization, AA is a natural fit for those who lean toward a post-rationalist mindset.

In 2020, a vast-in-scope Stanford University metanalysis determined that AA works, with socialization being a key component of why it’s so effective. Dr. Keith Humphreys (professor of psychiatry and behavioral sciences at Stanford) argued, “AA works because it’s based on social interaction.” The press release for Stanford’s study on AA also stated that AA is not less effective than other interventions and has the potential to cut down the cost of medical care per person by up to $10,000.

The Atlantic published an article that argued AA is a severely outdated and archaic way of treating alcoholism. Met with fierce criticism by many, the article exhibited many incorrect assumptions that AA critics make, along with unfortunate mis-readings of scientific literature. Pushing back on the AA criticism, here’s what journalist and podcast host Jesse Singal wrote for The Cut in response to the extraordinary claims put forth by The Atlantic:

Simply put, “People who self-select to attend AA, or people who are randomized to a 12-step facilitation intervention, end up having people in their social network who are supportive of their abstinence,” [Dr. Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group] said. Reams of research show that social networks, and the norms contained therein, are powerful drivers of behavior, so to Kaskutas—who noted that she is an atheist—the focus on AA’s quirks and spiritual undertones misses the point. “When you think about a mechanism like supportive social networks, or the psychological benefit of helping others, well, they have nothing to do with faith, or God—they have to do with the reality of what goes on in AA, with people meeting others in the same boat as they are in, and with helping other people (for but two examples of these mechanisms of action),” she said. So it can be the case both that AA rests on overly judgmental moral language, takes the unlikely view that God himself (or “a higher power”) is what cures people’s alcoholism, and has various other flaws—and that it still works for a lot of people, simply by connecting them to others going through the same struggles.

Religion for the Secular?

As the world’s most popular addiction treatment program, it draws many near to the heart of what they accomplish. However, some are quick to point out that AA was founded by religious people. For example, many meetings close out with the Lord’s Prayer. Some non-religious members actively choose to stand aside during meetings, some groups choose to recite something more secular or general (the Serenity Prayer is one example of this), and some groups simply shy away from the use of more overtly religious material despite the close association the group has with Christian values and beliefs. For some who try AA, the religious slant of the material and meeting style is a turn-off, but the organization understands this and is incredibly tolerant towards those of other belief systems or lack thereof.

The Final Verdict

You’re probably expecting us to give you an actual answer on whether AA works or doesn’t. But here’s the thing: it doesn’t actually matter if AA works or not. It doesn’t matter to attendees well-versed in the Big Book, anyways, and, as the basic text of AA, the Big Book has the final say. Maintaining a spirit of openness and neutrality is very important to how AA operates since the ultimate goal is helping people recover from a disease. Anything that hinders the mission is considered negative.

I spoke with an AA attendee who offered some thoughts on AA versus other treatment programs and received answers that showed different levels of appreciation towards the program and revealed that the public’s perception of AA can often be wrong.

John W. (name changed to protect anonymity) reminded me of how AA approaches other treatment methods in the Big Book. “The official stance of AA is that if another method helps people solve their problem, then it’s a good thing. ‘Upon therapy for the alcoholic himself, we surely have no monopoly,’ right? It’s an open-minded organization. Whatever works for you is best.” No other organization has achieved the outcomes that AA has due to the sheer size.

Another AA attendee I spoke with, an anonymous meme-maker and satirist that posts on a variety of social media platforms as “Bill_Wilson_Tho” (BWT), said that for him he couldn’t make the change he needed to make in recovery without the self-recognition of addiction and accountability that AA provided.

“I initially scoffed at the 12 steps and said I’ll never do that. Lo-and-behold, I couldn’t keep a needle out of my arm for too long,” he said. “I’ve tried literally every way I could think of but that’s what makes a true addict an addict. Once I stopped, I couldn’t stay stopped. I needed something bigger than myself to help me stay stopped.”

Many of those in AA abide by the rule that real “sobriety” is when you’re completely substance-free. This can be a hang-up for some folks, but for others, it’s a powerful motivator. For BWT, what helped him was the end goal of being completely free of any substance that held his attention.

“While on maintenance drugs, I was still physically dependent on [those maintenance drugs] to help me feel normal. Once I had the window of willingness to actually get involved in AA, it completely changed the way I operated in society. I’m accountable, my family wants me in their life, and I can do anything and go anywhere I want.”

What Does Alcoholics Anonymous Really Offer?

It’s obvious that there are many for-profit rehabs that completely fail to do what they claim they do. One advantage AA has over these kinds of places for many people is that it’s a free program that doesn’t claim to do anything but offer a social support framework through which attendees can work through their addiction in an often-effective way. Lots of attendees prefer AA over an unguided approach to recovery that doesn’t give someone a moral or social framework to work within.

It’s hard not to be impressed with what Bill Wilson and his colleagues did for almost a century of those suffering from addiction. The sheer number of those who have achieved what was once thought impossible or a moral failure is truly legendary. Next time you spot the triangle (unity, service, recovery) in a circle or see the double-As, know that there are anonymous people who are doing something special for themselves and each other. If you’re curious about the group, give them a visit during an open meeting and don’t be afraid to ask questions. For some who think they might be an alcoholic, the first AA meeting you set foot in could be a life-changing experience.

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To learn more about what Landmark Recovery offers our patients, call our dedicated admissions team today at 888-448-0302. We offer a variety of treatment paths for those suffering from a substance use disorder. Our mission is to save a million lives in the next century.

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About the Author

Will Long

Will Long

A graduate of Middle Tennessee State University, Long has been a writer for Landmark Recovery since 2021. He specializes in research and writing about substance abuse from a scientific and social perspective. Unearthing information from underexplored, far-flung corners of the Internet, Long’s passion is finding emerging trends in substance use and treatment that the public should know about.