Alcoholics Anonymous

Alcoholics Anonymous (AA) offers emotional support and advocates abstinence to recovering alcoholics. The international organization, developed in 1935 by Bill Wilson and Bob Smith, depends on self-help groups and a 12-step model. AA regards alcoholism as both a medical and spiritual disease. AA purports to carry its message to alcoholics in an anonymous setting while not promoting itself or endorsing outside enterprises. AA relies on nonprofessionals who are recovering alcoholics. As such, privacy concerns may be an issue. This entry describes the AA 12-step program, discusses privacy concerns associated with the program, and presents criticisms of AA.

12-Step Program

The 12-step program espoused by AA emphasizes spiritual, character, and social development and growth. To get to an individual’s goal of sobriety, AA members work their steps with the help of a sponsor who is an alcoholic in recovery. The steps must be worked sequentially, thus building on the previous step, and are completed only when the step is accepted and internalized. Half of the steps involve the necessity of the participant to appeal to a higher power to eliminate character defects. Prayer, meditation, or continued spiritual growth are essential throughout the recovery process of AA to progress through the steps. It is important to note that higher power can mean different things to different people, so it can refer to God, nature, the group, or any power that is greater than the individual. AA advises that once an alcoholic, always an alcoholic. As such, the program requires lifelong abstinence and attendance at AA meetings to strengthen moral character.

Regardless of the treatment modality, such as insight-oriented therapy, detoxification, or medication, the rate of treatment success for alcoholism is not encouraging. Relapse is a significant problem for alcoholics because the addiction itself resides deep within the brain, and the necessity to prevent relapse rests ultimately with the individual. Thus, effective relapse prevention is purported to require some kind of supervision beyond the individual, an enduring behavior that competes with alcohol, strong interpersonal relationships, and a heightened sense of spirituality, thereby achieving a sustained pattern of relapse prevention.

Privacy Concerns

The state of privacy for AA seems to be evolving. Washington state enacted legislation in 2016 to protect the confidentiality of sponsors in AA in order to prevent sponsors from testifying in civil matters against the individual in recovery. Criminal courts have ruled that statements made during the course of an AA recovery program are not admissible in court, given that the spiritual nature of AA places it under a constitutionally protected activity.

Criticisms

Critics maintain that the 12-step AA programs do not necessarily benefit the individual. On the one hand, there seems to be a lack of substantive research supporting the effectiveness of AA, especially as a stand-alone treatment approach. On the other hand, there is also a lack of scientific data disproving the value of AA.

There appear to be several reasons for the lack of data on AA. The organization does not seem to value research. Because AA does not incorporate professionals, researchers may have to overcome their own biases when evaluating the program. Alcoholism tends to extend over many years and across numerous interventions, so methodical challenges exist in isolating and studying the effect of AA as a stand-alone treatment strategy.

Critics note the challenges inherent in conducting research on an organization that is anonymous and self-selected. Questions can be raised about success rates due to selection bias, since the data come from those participating in AA who are already motivated to stop drinking. Furthermore, program participants may have improved on their own since the natural recovery rate for alcoholism is 24%, according to Deborah A. Dawson and colleagues. In 2009, the Cochrane Collaboration conducted a meta-analysis of studies conducted between 1966 and 2005 and found a dearth of experimental studies that decisively demonstrated the efficacy of AA in the treatment of alcoholism as well as methodological issues with many studies of AA. However, other studies have shown the effectiveness of AA in treating alcoholism.

In addition, detractors note the requirement of a lifetime commitment to AA meetings. Individuals are advised that they will relapse if they fail to attend meetings and work the program.

Critics report that AA is a spiritual program with a reliance on a higher power that may be difficult to achieve for nonbelievers. Furthermore, there is concern that placing oneself in the hands of a higher power may disempower the individual, resulting in a lack of confidence in one’s own power and ability to abstain from alcohol.

Current evidence-based therapies, such as cognitive behavioral therapy, attribute success in treating alcoholism to empowering individuals to manage their lives and improve their self-confidence. These therapies promote self-efficacy, which demonstrates that the individual has what it takes to manage his or her own life. These particular therapies are short term in nature and typically result in improvement in approximately 6 months. Professionals tend to hold that AA can be a component of treatment, but AA is not sufficient as the total treatment approach.

Despite the criticisms, AA groups continue to flourish, 12-step programs are part of treatment protocols, and professionals refer patients to these programs. Individuals attest to the importance of the acceptance and support that AA provides throughout their recovery process.

Marcia Baruch and Nancy Zarse

See also Privacy ; Privacy, Medical ; Psychological Assessment ; Religion ; Stigma

Further Readings

Alcoholics Anonymous.Twelve Steps and Twelve Traditions. New York, NY: AA Grapevine and Alcoholics Anonymous, 2004.

Dawson, D. A., et al. “Recovery From Alcohol Dependence: Response to Commentaries.” Addiction, v.100/3 (2005).

Diaconis, A. “The religion of Alcoholics Anonymous (AA): Applying the Clergy Privilege to Certain AA Communications.” Cornell Law Library Prize for Exemplary Student Papers (2014). http://scholarship.law.cornell.edu/cllsrp/7 (Accessed October 2017).

Ferri, M., et al. “Alcoholics Anonymous and Other 12-Step Programmes for Alcohol Dependence” (Review). Cochrane Database of Systematic Reviews, v.3:CD005032 (2006). doi:10.1002/14651858.

Jonas, D. E., et al. “Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings.” JAMA, v.311/18 (2014). doi:10.1001/jama.2014.3628

Kessler, R. C. “The Epidemiology of Dual Diagnosis.” Biological Psychiatry, v.56 (2004).

McGovern, Mark (with Scott Edelstein). Living With Co-Occurring Addiction and Mental Health Disorders: A Handbook for Recovery. Center City, MN: Hazelden, 2009.

Orey, B. “Alcoholics Anonymous as a Vital Tool in the Treatment of Addicts.” UC Merced Undergraduate Research Journal, v.8/1 (2015). http://escholarship.org/uc/item/88b2w26x (Accessed October 2017).

Powers, T. “Washington State Senate Bill Provides 12-Step Sponsors Freedom From Civil Court Testimony.” Sober Nation (2016). https://sobernation.com/washington-state-senate-bill-provides-12-step-sponsors-freedom-from-civil-court-testimony/ (Accessed October 2017).

Ruppe, D. “AA Confession Can’t Be Used in Court.” ABC News (2017). http://abcnews.go.com/US/story?id=92654 (Accessed October 2017).

Vaillant, G. “Alcoholics Anonymous: Cult or Cure?” Australian and New Zealand Journal of Psychiatry, v.39 (2005).