AA was the first twelve-step program and has been the model for similar recovery groups like Narcotics Anonymous and Gamblers Anonymous. Al-Anon/Alateen are 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.
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 Dr. Bob Smith. Wilson and Smith co-founded AA with a word of mouth program to help alcoholics. Smith's last drink on June 10, 1935 is considered by members to be the founding date of AA. By 1937, Wilson and Smith 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, informally referred to by members as "The Big 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 led 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. In this era AA also began its international expansion, and by 2001 the number of members worldwide was estimated at two million.
In 2006 there were a reported 1,867,212 AA 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, typically $1 collected per meeting in America, 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 constitute 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.
The AA suggested program of recovery for alcoholics includes abstaining from alcohol one day at a time and having a spiritual awakening through following Twelve Steps, helping with duties and service work in AA, and regular AA meeting attendance or contact with AA members. Members are encouraged find 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. The program of action has the goal of producing a "personality change sufficient to recover from alcoholism" . AA promotes the idea that recovery from alcoholism entails more than not drinking.
It is important to distinguish between the AA "program" and the "fellowship" of AA. The fellowship includes meetings and friendships with other AA members, whereas 'the program', refers to the course of action outlined in the first 164 pages of the book Alcoholics Anonymous.
In a typical 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, usually the beginning of Chapter Five, entitled "How It Works". Announcements from the chairperson 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. There is no requirement on anyone to make a donation. Most members contribute a small amount, often just some loose change. The making of large donations is actively discouraged in AA 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" suggestion, where responding to another member's comments is discouraged. In many meetings, in order to encourage identification, members confine their comments to their alcoholic drinking and recovery, following the guidelines of "what it was like, what happened and what it's like now". This format is intended to avoid wide ranging debate of other topics from distracting the group from its primary purpose. After the discussion period, the meeting is typically ended with a prayer, usually the Serenity Prayer or often in the US, the Lord's Prayer. These ending prayers are sometimes undertaken by the entire group forming a circle and holding hands. More socializing typically follows the close of 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.
AA's 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. Before coming to AA, 64% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 65% received outside treatment or counseling, and 84% of those members said that that outside help played an important part in their recovery. A survey conducted in 2004 showed that AA received 11% of its membership from court ordered attendance. http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdfAA2004Membership Survey
Many studies have demonstrated an association between AA attendance and increased abstinence or other positive outcomes. Other studies have concluded that AA attendance can lead to poorer outcomes than other therapies.
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.
In a survey of treatment providers from the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and Society of Psychologists in Addictive Behaviors the scores of the treatment provider's responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics AA identified by Ernest Kurtz) were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or free-will model addiction).
Critics argue that some AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics, and believe that more options should be available to problem drinkers who can manage their drinking with the right treatment.
A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency. A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was "Abstinence represents the most stable form of remission for most recovering alcoholics". A long-term (60 year) follow-up of two groups of alcoholic men concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence.
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