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Alcoholics Anonymous (AA) is an informal meeting society for people who identify themselves as alcoholic. AA suggests that alcoholics abstain from alcohol and follow its spiritual program of action and share their experience, strength, and hope with each other that they may solve their common problem.

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.

History
By 1934 alcoholic Bill Wilson had ruined a promising Wall Street career with his constant drunkenness. He was introduced to the idea of a spiritual cure by an old drinking buddy Ebby Thacher who had become a member of a "first century Christian movement" called the Oxford Group. Wilson was treated at Charles B. Towns hospital by Dr. William Silkworth, who promoted a disease concept of alcoholism. While in the hospital, Wilson underwent what he believed to be a spiritual experience and, convinced of the existence of a healing higher power, 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 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 favorable 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.

Organization


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.

At above the group level AA may hire outside professionals for services that either require specialized expertise and/or are full time responsibilities, as of 2007 GSO in New York employees 40 or so such workers.

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.

Program
AA promotes the idea that beating alcoholism entails more than not drinking, and, to this end, suggests a program of action which has the goal of producing a "personality change sufficient to recover from alcoholism". While abstaining from alcohol, one day at a time, the personality change is believed to be brought about by means of a spiritual awakening achieved from following the 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 understand and follow the AA program. Some members suggest the sponsor is preferably 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. Following the helper therapy principle, sponsors in AA benefit as much, if not more, from their relationship than do the sponsees. Helping behaviors correlate with increased abstinence and lower probabilities of binge drinking. The AA program is distinct from 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.

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

In a typical meeting, the chairperson starts by calling the meeting to order and offering a short prayer, meditation, and/or period of silence (actual practice varies by region). Then, a section from the book Alcoholics Anonymous 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.

In-Group Language
A guide for hearing-impaired alcoholics and their interpreters, describes AA meetings as containing “their own language, set of rules and values, and much ‘in-group’ language” and that members uses freely idiomatic and metaphorical phrases such as “Keep it simple”, “Let go and let God”, and “If you turn it over, but don’t let go, you end up upside-down”.

Disease of alcoholism
AA regards alcoholism as an illness. and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone. Dr William Silkworth introduced to Wilson and AA the idea that alcoholism is an illness consisting of an obsession to drink alcohol, and an allergy, which was the compulsion to continue drinking once the first drink had been taken. (Silkworth's understanding of an allergy in the 1930s differs from that used in modern medicine today.) Alcoholics, he argued, can never safely use alcohol in any form at all, since once forming the habit, they cannot break it.

Demographics
AA's New York General Service Office regularly surveys AA members in North America. Its 2004 survey of over 7,500 members in Canada and the United States concluded that, in North America, AA members who responded to the survey have these attributes: 89.1% white, 65% male/35% female. 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. The same survey showed that AA received 11% of its membership from court ordered attendance. Since only a small fraction of AA's North American members know about and choose to submit the survey questionnaire, this self-selecting sample is not likely to produce the same results as a more correct and accurate random-sample survey.

Other International General Service Offices (i.e., Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.

Limitations on research
The study of AA tends to polarize observers into believers and non-believers, and discussion of AA often creates controversy rather than objective reflection. Many researchers take a skeptical view of AA because AA's solution (Jung's spiritual experience on p 26 & the spiritual awakening described in Appendix II of AA's basic text) is spiritual, that is not tangible or material (i.e., not scientific). A randomized trial of AA is very difficult because members are self-selected, not randomly selected from the population of chronic alcoholics, with the possible exception of those who participate in AA to comply with a court mandate. Two opposing types of self-selection bias are that drinkers may be motivated to stop drinking before they participate in AA, and AA may attract the more severe and difficult cases. Control groups with AA versus non-AA subjects are also difficult because AA is so easily accessible.

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

Attrition
In a 1989 internal AA report based on an average of five surveys, it was estimated that of those who attended AA meetings for the first time, nearly one third (31.5%) leave the program after one month. By the end of the third month, just over half (52.6%) have left. Of those who remain after three months, about half (55.6%) will remain until the twelfth month. After the first year, the rate of attrition slows.

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

Prisons
In the United Kingdom, Alcoholics Anonymous, holds meetings in prisons. AA prison and probation liaisons cooperate with staff and AA volunteers give talks to staff in the legal profession. In the United States AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods to approach correctional facility officials with the intent of developing an in-prison AA program. In addition, a variety of pamphlets are published by AA specifically for the incarcerated alcoholic The AA General Service Office also provides a pamphlet with guidelines for members involved in doing the twelfth step work, that is "carrying the message to those who still suffer." The pamphlet instructs members how to work within correctional facilties.

Court rulings
Since 1996, courts across the United States, in a number of different cases, have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed to be a religion, it was found to contain enough religious components (spirituality, god, prayer and proselytism) to make such coercion a violation of the Establishment Clause of the First Amendment of the constitution. In September 2007, United States Court of Appeals for the Ninth Circuit stated that a parole office can be sued for ordering a parolee to attend Alcoholics Anonymous.

American 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. A reverse influence has also occurred with AA receiving 31% of its membership from treatment center referrals. Alcoholics Anonymous, however, does not endorse and is not allied with any rehabilitation center or outside facility.

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).

United Kingdom treatment industry
A cross-sectional survey of substance misuse treatment providers in the English West Midlands found fewer than ten percent 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 have were likely to recommend self-help groups to their clients. Providers with nursing qualification were more likely to make such referrals than those without. A statistically significant correlation was found between providers self-reported level spirituality and their likelihood of recommending AA or NA.

Moderation or abstinence
AA acknowledges that not all drinkers are alcoholics, but advocates total abstinence for those who are. However, some 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."

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. However, a further study concluded that AA's program bore little semblance to a religious cult's because the techniques used appeared beneficial. Another study found that an AA program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity replacing it with the deviant identity. 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.

Other notable criticism

 * AA undertakes no external restriction, screening, or vetting of its members.
 * "Thirteenth-stepping" is a disparaging euphemism used by some AA members to refer to the romantic or sexual involvement of an existing male or female member with a newcomer. To avoid this type of behavior, AA typically suggests that men be sponsored by men, and women be sponsored by women (though in some cases, particularly with members who are homosexual, men may be sponsored by women and vice versa).
 * Critics have noted that some AA members rely too heavily on dogmatic slogans and become overly dependent on the group.
 * AA has been described as having substantial religious components. AA members typically make a strong distinction between Religion and Spirituality that has become quite atypical among the general public; regardless of religious identification.
 * Although a statement is read during meetings that what is said there should remain confidential, AA members, unlike lawyers or clergy, are not legally bound to maintain confidentiality.