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+ | [[Image:Aa-logo.jpg|thumb|right|200px|Logo for AA]] |
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− | '''Alcoholics Anonymous''' is a world-wide fellowship of [[alcoholism|alcoholic]]s whose primary purpose is to stay sober and to carry the message of recovery to other alcoholics through the practice of the Twelve Steps. A.A. is the original [[twelve-step program]] and has been the source and model for all subsequent recovery groups such as [[Gamblers Anonymous]], [[Narcotics Anonymous]], [[Sexaholics Anonymous]], [[Overeaters Anonymous]], and [[Al-Anon/Alateen]]. The adaptability of the AA Twelve Step Program to these other addictive behaviors seems to suggest that recovery under this model almost always begins after the addicted person admits that they themselves are powerless to effect their own "cure." This acknowledgement is stated in the 1st Step: "We admitted we were powerless over alcohol——that our lives had become unmanageable." |
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+ | '''Alcoholics Anonymous''' ('''AA''') is an informal society for recovering [[Alcoholism|alcoholics]].<ref>{{cite web |
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+ | | title = What is AA? Defining "Alcoholics Anonymous" |
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+ | | publisher = The General Service Board of Alcoholics Anonymous (Great Britain) |
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+ | | url =http://www.alcoholics-anonymous.org.uk/geninfo/02whatis.shtml |
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+ | | accessdate = 2006-11-27 }}</ref> Members meet in local groups that vary in size from a handful to many hundreds of individuals. In 2001 there were 100,000 groups worldwide, making a global community of more than two million recovering alcoholics<ref>''Alcoholics Anonymous'' p 16</ref>. |
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+ | The stated primary purpose of the society is "to stay sober and help other [[alcoholism|alcoholics]] to achieve sobriety."<ref>{{cite web |
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− | The prior history of recovery from alcoholism is most closely associated with the salvation model in which the alcoholic is implored to undergo a spiritual renewal in order to overcome his drinking. Before the 1930s, alcoholism was primarily seen as a moral failure and hence recovery was to be found in a commitment to religious principles. Emotional appeals were made by preachers, pledges were signed, and the alcoholic was swept away on a tide of optimism, hopeful that some integral change had indeed occurred. |
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+ | | title = What is AA? Defining "Alcoholics Anonymous" |
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+ | | publisher = The General Service Board of Alcoholics Anonymous (Great Britain) |
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+ | | url =http://www.alcoholics-anonymous.org.uk/geninfo/02whatis.shtml |
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+ | | accessdate = 2006-11-27 }}</ref> AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis;<ref>The [http://www.alcoholics-anonymous.org/en_pdfs/m-24_aafactfile.pdf AA Fact File], 'The Recovery Program'</ref><ref name = "bigbook">''Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism.'' 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at [http://www.aa.org/bigbookonline/ www.AA.org]</ref> the society in turn offers a community of recovering people who support each other by "sharing experience, strength and hope"<ref>''AA Preamble''</ref> and often by working the suggested Twelve Steps together. |
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+ | Alcoholics Anonymous was the first [[12-step program]] and has been the model for similar recovery groups such as [[Al-Anon/Alateen]], [[Gamblers Anonymous]], [[Narcotics Anonymous]], [[Sexaholics Anonymous]], and [[Overeaters Anonymous]]. Al-Anon and Alateen are companion programs designed to provide support for relatives and friends of alcoholics. |
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− | The general futility of this single minded approach was soon demonstrated when the great majority of alcoholics fell back into their "evil ways" and resumed drinking. The failure to remain sober reinforced the drunkard's belief, not to mention society's, that he was indeed morally defective. The institution of Prohibition in the 1920s and early 1930s, in which alcohol was to be denied to all US citizens, demonstrates the frustration of the Temperance Movement to stop the alcoholics from inflicting their harm upon society; moral appeals had failed to cure the problem and so now the law itself was to be employed to deny "the occasion of sin." |
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+ | ==AA History== |
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− | The belief underlying the moral approach is that every person has the power to choose; a bad choice is reflective of a bad person and so the person must be made good in order to choose well. The concept of a genetic, psychological, physical predisposition to alcoholism was not conceived of at that time and so a solution that took those ideas into consideration was not available. |
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+ | ===Pre-AA understanding of alcoholism=== |
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+ | In the 1930s public opinion saw alcoholism as a moral failing, and the medical profession saw it as a condition that in many cases was incurable and lethal.{{Fact|date=July 2007}} Those without financial resources could find help only through state hospitals, the Salvation Army, and other charitable and religious groups. Those who could afford psychiatrists or hospitals were often subjected to a treatment with barbiturate and belladonna known as "purge and puke."<ref>"Bill W." —''Time'''s "Most Important People of the 20th Century". Susan Cheever. ''[[Time]]'' 153.23 (June 14, 1999): p201+.</ref> |
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− | One revolutionary aspect of Alcoholics Anonymous was to remove the problem of alcoholism from the moral sphere and put it into the perspective of an illness from which the alcoholic is suffering. Recovery ceased to mean that we had a bad person becoming good, but rather, we had a sick person becoming well. By defining alcoholism in this manner, the alcoholic could be free to analyse his behavior and its causes in a more clinical fashion and not be distracted by the anxiety of damnation that had previously dogged his heels. "I drink because I am an alcoholic, and if I stop drinking, I will not suffer the pains of my dis-ease." |
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+ | One contemporary doctor who would have a great influence on AA was [[William Duncan Silkworth|William Duncan Silkworth, M.D]], who specialised in the treatment of alcoholics. He contended that alcoholism was by nature a disease that consisted of an obsession and an allergy. The "obsession" was the desire to start drinking, and the "allergy" (in the sense of an abnormal reaction) was the compulsion to continue once the first drink had been taken. In Silkworth's view, alcoholics were caught by the delusion that, despite the often severe consequences of the last drinking episode, no harm will be done by the next drink. Silkworth believed that the two primary protectors of health—reason and will—were of no use against this disease.<ref name="littledoctor">Dale Mitchel, ''Silkworth: The Little Doctor Who Loved Drunks''. Hazelden, 2002.</ref> |
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+ | ===A search for a spiritual cure=== |
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− | Another vital aspect of Alcoholics Anonymous is that it is exclusively run by and peopled by other alcoholics. It is difficult for some non-alcoholics to understand the loneliness of an alcoholic or the despair he feels as he continues to ruin his life, seemingly of his own will, and an all-alcoholic group provides solace for some recovering from alcohol addiction. |
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+ | AA was founded by [[Bill W.|Bill Wilson]], a Wall Street stock speculator, and [[Bob Smith (doctor)|Dr. Bob Smith]], a proctologist from [[Akron, Ohio]], both alcoholics. The chain of events that led to the meeting of these men began in Europe, where American business executive Rowland Hazard sought treatment for alcoholism with the famous Swiss psychiatrist [[Carl Jung]]. After a prolonged and unsuccessful period of therapy, Jung told Hazard that his case, like that of most alcoholics, was nearly hopeless—the only possibility for a cure was through spiritual conversion.<ref>Dale Mitchel. ''Pass It On: The Story of Bill Wilson and How the A. A. Message Reached the World'' Hazelden. 1984, p 381-385.</ref><ref> |
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+ | {{cite journal |
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+ | | last = Finlay |
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+ | | first = Steven W |
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+ | | title = Influence of Carl Jung and William James on the Origin of Alcoholics Anonymous |
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+ | | journal = Review of General Psychology |
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+ | | volume = V4 |
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+ | | issue = |
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+ | | pages = 3-12 |
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+ | | publisher = |
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+ | | date = 2006-3-11 |
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+ | | url = http://content.apa.org/journals/gpr/4/1 |
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+ | | doi = |
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+ | | id = |
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+ | | accessdate = 2006-10-20 }} |
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+ | </ref> |
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+ | Back in America, Rowland Hazard joined the [[Oxford Group]], a Christian Evangelical association.<ref>{{cite book |
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+ | | title = The Oxford Group and Alcoholics Anonymous, 2nd ed. |
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+ | | author = Dick B. |
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+ | | publisher = Paradise Research Publications, Inc. |
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+ | | location = Kihei, Maui, Hawaii |
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+ | | date = 1998 |
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+ | }}</ref> The group advocated finding God through a spiritual surrender, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. (Bill Wilson later gave credit for the concepts behind Steps Three through Twelve to the teachings of Rev. [[Samuel Moor Shoemaker]] of the Oxford Group.<ref>{{cite book |
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+ | | title = Alcoholics Anonymous comes of age |
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+ | | author = Bill W. |
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+ | | authorlink = Bill W. |
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+ | | publisher = Alcoholics Anonymous |
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+ | | location = New York |
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+ | | date = 1957 |
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+ | | id = ISBN 0-916856-02-X |
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+ | }}</ref><ref>{{cite book |
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+ | | title = New Light on Alcoholism: God, Sam Shoemaker, and AA, 2nd. ed. |
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+ | | author = Dick B. |
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+ | | publisher = Paradise Research Publications, Inc. |
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+ | | location = Kihei, Maui, Hawaii |
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+ | | date = 1998 |
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+ | }}</ref>) Through the Oxford group, Hazard underwent a spiritual conversion and achieved his long hoped for sobriety. |
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+ | ===The conversions of Thacher and Wilson=== |
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− | Many have claimed A.A. to be the most successful treatment for alcoholism ever devised. Though some take issue with this claim - and A.A. itself makes no such formal claim - the opinion is widely accepted because no other program has attained the same level of prominence. Dissenters have argued that there are no controlled double blind scientific studies to back the claims and that reputable scientific research casts doubts on the effectiveness of [[12 step treatment | such programs]][http://www.unhooked.com/booktalk/hester_miller_handbook.html]. One factor that complicates research into AA effectiveness is the difficulty of gathering statistical information on a membership that stresses anonymity as an essential characteristic of the fellowship. |
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+ | Rowland Hazard introduced his acquaintance [[Ebby Thacher]] to Jung's conversion cure and the Oxford Group's spiritual principles, and Thacher, too, attained sobriety (although, in his case, it would not last his whole life<ref>''Alcoholics Anonymous Comes of Age ''(New York: Alcoholics Anonymous Publishing, 2004), p. 179''</ref>). Thacher visited an old school friend by the name of Bill Wilson. Wilson was an alcoholic who had seen a promising career on Wall Street ruined by his drinking. He had failed to graduate from law school because he was too drunk to pick up his diploma. He had blown partnerships and business deals, all but destroyed his marriage, been hospitalized for alcoholism under the care of Dr. William Silkworth, and still continued to drink. Wilson was astonished to find that his old drinking companion had become sober through spiritual means, but he struggled with the existence of God. Then "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last."<ref>''Alcoholics Anonymous'' p 12</ref> |
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+ | Wilson excitedly told his wife Lois about his spiritual discovery, yet the very next day he drank again, and eventually found himself back in hospital under Silkworth's care. According to Wilson, while lying in bed depressed and despairing he cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!".<ref>''Pass it on'' p 121.</ref> He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Bill Wilson described his experience to Dr. Silkworth, who told him not to discount it and that he had noticed a differnce in his demeanor. Eby Thacher visited Bill Wilson at Townes hospital, introduced him to the basic tenets of the Oxford Group, and gave him a copy of ''[[Varieties of Religious Experience]]'' by American psychologist and philosopher [[William James]], which described experiences similar to Wilson's. (Bill never could recall if it was Eby or Rowland who had given him the book) Upon his release from the hospital, Wilson admitted he was licked, got honest with himself, got honest with another, made amends, helped other alcoholics and prayed to whatever God he thought there was. (speech 1952 convention) William G Wilson never drank again for the remainder of his life. |
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− | A.A. literature describes a difference between an "alcoholic" and a "hard drinker," claiming that unlike a hard drinker, who may drink enough alcohol to cause gradual physical and mental impairment but nevertheless retains the ability to stop or moderate his or her drinking, given sufficiently strong reasons (Alcoholics Anonymous, p. 20-21)), an alcoholic has a disease which renders him/her bodily and mentally different from others. A.A. literature suggests that for effective recovery the diagnosis of ones own alcoholism must be made by oneself, and has no opinion on abstinence for others. |
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− | There also exist a number of purely secular non-12 step programs which promote abstinence as a recovery goal, as well as programs which promote a goal of moderation for "problem drinkers" as opposed to "alcoholics." A listing can be found in the external links section of this article. None has achieved the same wide-spread use and recognition as AA, and none is without its own controversies. |
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+ | ===A new program for recovery=== |
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− | Some people object to [[teetotalism|abstinence]] as a goal, preferring other programs which aim for moderation. [http://www.habitsmart.com/cntrldnk.html] Others advocate [[harm reduction]] as the most effective step towards addressing the immediate social problems caused by abuse of alcohol and other drugs. Many who have had some contact with A.A. have strong opinions, supportive and non-supportive, about A.A. Thus there is controversy about A.A. |
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+ | In keeping with the practices of the Oxford Group, Wilson found that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. At one point Wilson was on a business trip in Akron, OH, and was tempted to relapse. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. He eventually reached Oxford Group member Henrietta Seiberling, whose group had been trying to help alcoholic Dr. Bob Smith. Wilson met with Smith for what was planned as 15 minutes, and the two men talked late into the night. They became friends, and for three months they studied the Bible, held long discussions, and reviewed Oxford Group ideas, eventually fashioning a pioneer recovery program. Smith's last drink is said to have been on [[June 10]], [[1935]]—a beer to steady his hand for surgery—and that is considered within AA to be the date of the founding of AA. |
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+ | Wilson returned to New York, establishing a second group, he later revisited Akron and reviewed the movement with Smith. They estimated that by [[1937]], the two groups numbered forty recovered alcoholics with continuous sobriety<ref>''Alcoholics Anonymous Comes of Age ''(New York: Alcoholics Anonymous Publishing, 2004), p. 144''</ref>, and decided with this success in mind, that they had a recovery program worth spreading. Impassioned discussions led to agreement that the essential communications tool would be in the form of a book. After great difficulties in raising the required funds for printing, a publishing company, ''Works Publishing Inc''., was incorporated, and capital raised by selling shares to the groups’ members and friends. Wilson set to work writing the book. When he reached chapter five, he decided that a summary of their methods for treating alcoholism was needed to describe the ''Word of Mouth'' program. In these early days, the basic program had developed from the works of William James, Dr Silkworth and the Oxford Group (from which the AA groups separated in 1937<ref>''Alcoholics Anonymous Comes of Age ''(New York: Alcoholics Anonymous Publishing, 2004), p. 160''</ref>), although several of the Oxford Group's ideas and attitudes were deliberately rejected, particularly any which would involve AA in theological controversy. The program involved an alcoholic: admitting that they were beaten by alcohol, making a moral inventory of their defects or sins, confessing their shortcomings with another person, making restitution to those harmed by the alcoholic's drinking, trying to help other alcoholics and praying to whatever God they believed in for the power to practice these precepts. Wilson, with contributions from others in the groups including several atheists who restrained the religious content, expanded these principles and the final version of the [[Twelve Steps]] was completed by the fall of [[1938]]<ref>''Alcoholics Anonymous Comes of Age ''(New York: Alcoholics Anonymous Publishing, 2004), p. 163''</ref>. |
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− | ==History and development== |
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− | A.A. was started by two alcoholics who first met on [[May 12]], [[1935]]. One was [[William Griffith Wilson|Bill Wilson]] (William Griffith Wilson), a New York stockbroker; the other was Dr. [[Bob Smith (doctor)|Bob Smith]] (Robert Holbrook Smith), a medical doctor and surgeon from [[Akron, Ohio]]. In A.A. circles, the former is known as "Bill W." and the latter, "Dr. Bob." |
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+ | ===The "Big Book"=== |
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− | [[Image:BILLNBOB.JPG|thumb|none|left|Dr Bob Smith (left) and Bill Wilson (right), the co-founders of A.A.]] |
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+ | [[Image:Bigbook.jpg|thumb|right|200px|First Edition of The Big Book]] |
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+ | The book, ''Alcoholics Anonymous'',<ref name = "bigbook" /> was published in 1939 and has been a perennial best-seller ever since. While several titles for the book were proposed (including "The Way Out", which was already in use), Bill Wilson and Dr. Bob finally settled on "Alcoholics Anonymous", and the fellowship itself took its name from the book. The first edition had a "circus cover" of red and yellow, and it was printed in heavy paper and had the margins brought in an additional inch making it fuller, which was thought to make it more attractive for the price—hence the nickname "Big Book", a name that sticks today with the same indented margins. Sales of the book—and the popularity of AA—increased rapidly after positive articles in ''[[Liberty (1924-1950)|Liberty]]'' magazine in 1939<ref> Fulton Oursler. "[http://www.barefootsworld.net/aalibertymag1939.html Alcoholics and God]." ''Liberty''. September 30, 1939.</ref> and the ''[[Saturday Evening Post]]'' in 1941.<ref>Jack Alexander. "[http://www.barefootsworld.net/aajalexpost1941.html Alcoholics Anonymous]." ''Saturday Evening Post''. March 1, 1941.</ref> The 4th edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter called "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each successive edition, the personal stories have been reviewed to represent the current population of AA, with the result that the stories of the original members of the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were gathered together in the book "Experience, Strength, and Hope." |
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+ | ==The AA program== |
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− | Wilson had been sober since December 11th, 1934 (six months) when he met Smith, although he had struggled with sobriety for years. In that time he had made several important discoveries about his own alcoholism. |
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+ | AA provides support for members attending regular meetings. One description of meetings comes from Dr. W.W. Bauer, who spoke for the American Medical Association in 1946 when he stated "Alcoholics Anonymous are no crusaders: not a temperance society. They know that they must never drink. They help others with similar problems...In this atmosphere the alcoholic often overcomes his excessive concentration upon himself. Learning to depend upon a [[higher power]] and absorb himself in his work with other alcoholics, he remains sober day by day. The days add up into weeks, the weeks into months and years."<ref>''Alcoholics Anonymous'', Appendix III, p 570.</ref> |
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+ | The 12 Steps are sometimes summarized as "Trust God, clean house, and help others." AA members are encouraged to "work the Steps", usually under the guidance of a voluntary sponsor—a member who has experience working the program. The Steps are designed to help the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Although the steps are based on seeking help from a higher power, atheists and agnostics have achieved long-term sobriety in AA, since AA offers freedom to follow one's own path.<ref>http://www.agnosticaanyc.org/faq.html</ref> Bill Wilson wrote a chapter in the "Big Book" entitled ''We Agnostics'' for alcoholics like him who were struggling with the idea of a Higher Power. |
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− | Firstly he had learned from a New York alcoholism specialist, Dr. [[William Duncan Silkworth]], that alcoholism was not simply a moral weakness. Silkworth told Wilson, during one of Wilson's admissions to his drying-out clinic, that alcoholism had a pathological disease-like character. He told Wilson that, in his view, alcoholism was akin to an allergy, in the sense that it produced abnormal reactions to alcohol that were not observed in non-alcoholic drinkers; he called these reactions a "phenomenon of craving" -- once started drinking, the alcoholic finds it very difficult to stop. In addition, Dr. Silkworth told Wilson that alcoholics had a mental obsession that gave them reasons to return to alcohol after periods of sobriety, even knowing that they would then develop overwhelming cravings. This "double whammy" (as he called it) meant that the alcoholic could not stop once started, and could not stop from starting again. This explained the enormous recidivism rate of alcoholics. |
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+ | "Working the program" might involve the following activities: |
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− | Wilson also discovered that some alcoholics were able to recover on a [[Spirituality|spiritual]] basis. This approach had been used by one of Wilson's old drinking buddies, Ebby Thacher, to get sober. Thacher had learned about the spiritual approach from Rowland H., an American business executive and alcoholic who had undergone treatment with the famous Swiss analytical psychologist Dr. [[Carl Jung]]. After a prolonged and unsuccessful period of therapy, Jung told Rowland that his case, like that of most alcoholics, was nigh on hopeless. Rowland was horrified and begged Jung to tell him anything that might help. Jung replied there was only one hope: a genuine spiritual conversion experience. History, he said, had recorded isolated examples of recovery from alcoholism that appeared solely attributable to the spiritual conversion of the alcoholic. He told Rowland to seek out a conversion experience. |
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+ | * Above all, avoiding the first drink. "One is too many and a thousand never enough." |
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+ | * Regular attendance at meetings, and participation by talking or listening. Meetings are usually easy to find in large cities, and there are also AA meetings by phone, internet, and mail. For newcomers, 90 meetings in 90 days are often recommended to break the drinking habit and immerse them in a culture of sobriety. |
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+ | * Regular contact with a sponsor for support in staying and living sober and in working the program. |
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+ | * Service work, which can range from making coffee at meetings to attending national AA conferences. |
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+ | *Working the Twelve Steps. For new members the Steps are seen as a path of personal growth towards sobriety. Experienced members often rework all the steps at intervals of a few years, but they at a minimum usually carry out the following activities: |
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+ | ** Regular attention to personal inventory and admission of wrongs (Step Ten). |
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+ | ** Daily prayer and meditation (Step Eleven) |
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+ | ** Carrying the message to other alcoholics (Step Twelve). |
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+ | ===The 12 Steps of Alcoholics Anonymous=== |
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− | Rowland H. returned to America and found a means to a [[spiritual awakening]] through the [[Oxford Group]], a self-styled first-Century Christian movement founded by [[Frank Buchman]] that advocated finding god through moral inventory, confession of defects, restitution, reliance upon god, and helping others. It appeared that a spiritual awakening would relieve alcoholics of the mental obsession that kept sending them back to alcoholism after periods of sobriety. Note that Wilson later (''Alcoholics Anonymous comes of age'', New York: Harper; 1957, p. 39) credited A.A.'s ideas of self examination, acknowledgement of character defects, restitution for harm done, and working with others, to the religious influence of Rev. Samuel Moor Shoemaker and the Oxford Group Movement. |
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+ | # We admitted we were powerless over alcohol – that our lives had become unmanageable. |
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+ | # Came to believe that a Power greater than ourselves could restore us to sanity. |
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+ | # Made a decision to turn our will and our lives over to the care of God ''as we understood Him''. |
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+ | # Made a searching and fearless moral inventory of ourselves. |
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+ | # Admitted to God, to ourselves and to another human being the exact nature of our wrongs. |
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+ | # Were entirely ready to have God remove all these defects of character. |
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+ | # Humbly asked Him to remove our shortcomings. |
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+ | # Made a list of all persons we had harmed, and became willing to make amends to them all. |
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+ | # Made direct amends to such people wherever possible, except when to do so would injure them or others. |
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+ | # Continued to take personal inventory and when we were wrong promptly admitted it. |
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+ | # Sought through prayer and meditation to improve our conscious contact with God ''as we understood Him'', praying only for knowledge of His will for us and the power to carry that out. |
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+ | # Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. |
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+ | ==The organization of the society== |
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− | Following one of Wilson's relapses, he returned to the hospital where he was sedated and detoxified. He prayed in bed during his recovery: "If there be a God, will He show himself! The result was instant, electric, beyond description. The place seemed to light up, blinding white. I knew only ecstasy and seemed on a mountain. A great wind blew, enveloping and penetrating me. To me, it was not of air, but of Spirit. Blazing, there came the tremendous thought. 'You are a free man.' Then the ecstasy subsided. I now found myself in a new world of consciousness which was suffused by a Presence. One with the universe, a great peace stole over me" (Three talks to medical societies by Bill W., co-founder of Alcoholics Anonymous. New York; Alcoholics Anonymous World Services; 1973, p.10). |
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+ | Alcoholics Anonymous has an informal control structure: there is no hierarchy of leaders. Guidelines for group conduct are outlined in the Twelve Traditions (below). A member who accepts a service position (an organizing role in a group) within the society is referred to as a ''trusted servant'', a reference to Tradition 2. A member's commitment to service is held for a limited period, typically three months to one year, after which another member is chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities as each meeting, small or large, is considered a self-governing entity. |
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− | Wilson questioned whether he had a genuine [[religious experience]] (see also [[peak experiences]])or was on the verge of madness. Dr. Silkworth advised him that "hopeless alcoholics" sometimes report conversion experiences before being "turned around" toward recovery. He referred Wilson to [[William James]]' ''[http://www.gutenberg.org/etext/621 Varieties of Religious Experience]'' and directed him to Lectures IX and X, dealing with conversion. James states in the first paragraph of Lecture IX, "To be converted, to be regenerated, to receive grace, to experience religion, to gain an assurance, are so many phrases which denote the process, gradual or sudden, by which a self hitherto divided, and consciously wrong, inferior and unhappy, becomes unified and consciously right, superior and happy, in consequence of its firmer hold upon religious realities. This at least is what conversion signifies in general terms, whether or not we believe that a direct divine operation is needed to bring such a moral change about." Lecture VIII, "The Divided Self" also refers to the condition before conversion. In ''When A.A. Came of Age'', Wilson states that Dr. Silkworth "reminded me of Professor William James's observation that truly transforming spiritual experiences are nearly always founded on calamity and collapse." |
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+ | At the local and national level, AA groups are self-supporting and not a charity. The society has no membership fees and does not charge to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs such as room rental and refreshments. Contributions from members are limited to a maximum annual amount of $2000 per year, though most only donate $1 to $2 per meeting. |
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− | James' Lectures IX and X discussed the conversion of "Mr. S. H. Hadley, who after his conversion became an active and useful rescuer of |
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− | drunkards in New York." His footnote 104 states "I have abridged Mr. Hadley's account. For other conversions of drunkards, see his pamphlet, Rescue Mission Work, published at the Old Jerry McAuley Water Street Mission, New York City. A striking collection of cases also appears in the appendix to Professor Leuba's article." |
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+ | Alcoholics Anonymous does receive proceeds from the sale of its book ''Alcoholics Anonymous'', along with other published books and literature, which are periodically revised. Revenues from literature sales constitute more than 50% of the income for the General Service Office (GSO)<ref>[http://www.aa.org/en_gso05_operresults.cfm GSO 2005 Operating Results], 'Gross Profit from Literature ~$6.7M (55%), Contributions ~$5.4M (45%)'</ref>, which unlike individual groups is not self-supporting through contributions and does have a small number of salaried staff. |
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− | William James cited the works of James H. Leuba and Edwin D. Starbuck frequently. Leuba quoted sections of ''Autobiography'' by John B. Gough, who describes his depression as an alcoholic. Leuba also points out that self-surrender is necessary for conversion. He quotes S. H. Hadley and comments "In this record the approach towards complete surrender can be followed step by step. He has laid aside pride enough to respond to the invitation and thereby confess publicly his inability to cease drinking. Old crimes, and that which the settlement of them will require of him, pass before his mind; for a moment he hesitates to accept the attitude towards them which submission to God would demand. His humble prayer for succour, and its effect, indicate that all the resistance of which he is conscious had given away, and that, as he called upon Christ, he threw himself unreservedly at his feet." |
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+ | Additional to the GSO, Alcoholics Anonymous also maintains a few service centers, which have the task of coordinating activities such as printing literature, responding to public inquiries, and organizing state or national conferences. Funded by local members, the centers are directly responsible to the AA groups in the region or country they represent. |
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− | Starbuck describes conversion following what A.A. came to refer to as "hitting rock bottom." When "the divine urging has become imperative and irresistible. Here is the critical point, the tragic moment. The subject resorts to evasion of good influences, pointing out the perfection of the present self, the imperfection of others, and anything to preserve the old self intact. It is more often a distress, a deep undefinable feeling of reluctance, which is perhaps a complex of all surface considerations which a thorough break in habits and associations would involve. He continues until complete exhaustion takes away the power of striving; he becomes nothing; his will is broken; he surrenders himself to the higher forces that are trying to claim him; he accepts the higher life as his own." |
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+ | Alcoholics Anonymous is exclusively served by people who identify themselves as alcoholics with the exception that seven of the 21 members of the AA Board of trustees are listed as “nonalcoholic friends of the fellowship”<ref>The [http://www.alcoholics-anonymous.org/en_pdfs/m-24_aafactfile.pdf AA Fact File], 'The Structure of AA'</ref>. |
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− | Most importantly, Wilson found that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. Wilson was on the verge of a relapse on a business trip to Akron. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. Thus he was introduced to Smith. Had it not been for Wilson's decision to reach out to a fellow sufferer, AA would not exist today. |
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+ | ===The 12 Traditions of Alcoholics Anonymous=== |
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− | These were the ideas that he presented to Smith, who had been struggling with his own chronic drinking addiction. The two struck up a solid friendship and together they put Wilson's discoveries into practice. Smith's last drink is said to have been [[June 10]], [[1935]], and that is considered within A.A. to be the date of the founding of A.A. Their first publication in 1939, ''Alcoholics Anonymous'', the first 164 pages of which have remained virtually unchanged since then, has been a perennial best-seller. The fellowship began to be called "Alcoholics Anonymous" after the publication of this book. Given this start, it is no surprise that A.A. groups and members are frequently called "Friends of Bill W." |
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+ | {{ main|Twelve traditions }} |
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+ | The affairs of Alcoholics Anonymous are governed broadly by AA's Twelve Traditions, suggested rules for organizing how the members and groups of the society interact with each other and with AA as a whole (see the book ''Twelve Steps and Twelve Traditions'' for more information<ref>''Twelve Steps and Twelve Traditions'', New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2. </ref>). These traditions were developed from experiences of the early groups during their first 13 years with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"<ref>''Alcoholics Anonymous'' p 561</ref> |
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− | The [[AA Grapevine]] is the international journal of Alcoholics Anonymous. It is written, edited, illustrated, and read by A.A. members and others interested in the A.A. program of recovery from the disease of alcoholism. |
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+ | # Our common welfare should come first; personal recovery depends upon A.A. unity. |
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− | The growth of A.A., especially in its early years, was striking. In 2002, the General Service Office of Alcoholics Anonymous reported more than 100,000 A.A. groups in 150 countries, with a total membership of approximately two million alcoholics. |
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+ | # For our group purpose there is but one ultimate authority – a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern. |
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+ | # The only requirement for A.A. membership is a desire to stop drinking. |
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+ | # Each group should be autonomous except in matters affecting other groups or A.A. as a whole. |
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+ | # Each group has but one primary purpose to carry its message to the alcoholic who still suffers. |
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+ | # An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose. |
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+ | # Every A.A. group ought to be fully self-supporting, declining outside contributions. |
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+ | # Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers. |
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+ | # A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve. |
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+ | # Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy. |
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+ | # Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films. |
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+ | # Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities. |
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+ | ==AA's definition of alcoholism== |
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− | ==How the A.A. program works== |
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− | Although some believe that A.A's success lies in the sense of support its members gain from attending regular meetings, many members, as well as A.A's literature, hold that the essence of the program is the Twelve Steps. The Steps incorporate Dr. Silkworth's description of the two-fold problem of physical allergy and mental obsession in Step One, Dr. Jung's description of the spiritual solution in Step Two, the Oxford Groups' method of reaching a spiritual awakening in Steps Three through Eleven, and Wilson's experience in helping others in Step Twelve. The process of working the Steps is sometimes summed up as "Trust god, clean house, and help others." (See [[twelve-step program]] for a list of the steps themselves.) |
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+ | Although AA lacks an official, singular definition of alcoholism, Dr Silkworth contributed the chapter in the AA basic text of Alcoholics Anonymous entitled "The Doctor's Opinion". That chapter would become one of the more influential pieces in AA thought. He wrote they "have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an [[allergy]] which differentiates these people, and sets them apart as a distinct entity."<ref>''Alcoholics Anonymous'' page xxx.</ref> That allergy takes the form of a craving which is explained earlier in the chapter when he states "the phenomenon of craving is limited to this class [alcoholics] and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit ... they cannot break it..."<ref>''Alcoholics Anonymous'' page xxviii.</ref> Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.<ref>''Alcoholics Anonymous'' p 567</ref> |
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− | A.A. members are encouraged to "work the Steps", usually with the guidance of a voluntary sponsor. (A sponsor is a more experienced member who has worked the Steps before, usually of the same sex as the sponsee, and freely chosen - and just as freely "fired"- by the sponsee.) The Steps are designed to help the alcoholic achieve a spiritual, emotional and mental state conducive to lasting sobriety. There are many long-term A.A. members who claim that working the Steps has freed them entirely from the urge to drink alcohol. Whereas staying sober was once difficult and uncertain, these members report that sobriety is now much easier, provided they keep working the A.A. program. |
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+ | In the article ''Alcoholics Anonymous and the Disease Concept of Alcoholism'', AA historian Ernest Kurtz wrote, "The closest the book ''Alcoholics Anonymous'' comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the 'We Agnostics' chapter, where we are told that alcoholism 'is an illness which only a spiritual experience will conquer'."<ref>{{cite journal |
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− | Most members regard attendance at A.A. meetings as important to their sobriety (although there are groups in A.A. made up of loners and members living in remote locations who communicate by mail and internet). Even members with decades of continuous sobriety still go to meetings regularly. There is no compulsion or requirement to attend. Members may attend as few or as many meetings as they wish, as frequently or infrequently as they like. However, new members are encouraged to go to 90 meetings in 90 days, and a sponsor may set his or her own expectations for a sponsee's attendance. No official membership or attendance records are kept at any level in A.A. However there are annually published estimates which are available through AAs headquarters in New York City, known as "GSO" (General Service Office). |
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+ | | last = Kurtz |
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+ | | first = Ernest |
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+ | | coauthors = |
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+ | | title = Alcoholics Anonymous and the Disease Concept of Alcoholism |
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+ | | journal = Alcoholism Treatment Quarterly |
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+ | | volume = |
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+ | | issue = |
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+ | | pages = |
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+ | | publisher = |
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+ | | date = |
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+ | | url = http://www.bhrm.org/papers/AAand%20DiseaseConcept.pdf |
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+ | | doi = |
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+ | | id = |
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+ | | accessdate = 2006-10-20 }} |
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+ | </ref> In 1960, Bill Wilson gave a speech to the National Catholic Clergy Conference on Alcoholism. During the ensuing question and answer discussion, Wilson was asked why he did not use the term ''disease'' when he spoke of ''alcoholism'' in that speech. He replied, <blockquote>"We AA's 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 do not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always call it an illness, or a malady, -- a far safer term for us to use."<ref> {{cite web |
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+ | | last = |
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+ | | first = |
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+ | | authorlink = |
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+ | | coauthors = |
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+ | | title = A Conversation with Bill W. |
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+ | | work = |
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+ | | publisher = |
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+ | | date = 2003 |
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+ | | url = http://www.nccatoday.org/conversation.htm |
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+ | | format = |
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+ | | doi = |
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+ | | accessdate = 2006-10-20 }} |
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+ | </ref></blockquote> |
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+ | == Research on AA == |
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− | With the above in mind, a typical individual program of recovery for a newcomer may include: |
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− | * Above all, avoiding the first drink. |
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− | * Attendance at one or more meetings daily for 90 days or longer. Some people coming into A.A. have attended meetings daily for the first year. (Note: nowhere in A.A. literature is there a reference to frequent attendance at A.A. meetings. Many A.A.s believe this notion started in the treatment centre industry; graduating patients were advised to attend many A.A. meetings, presumably in an effort to acquire a new peer group of abstinent friends to reinforce the effects of treatment. Regardless of source, this recommendation is consistent with a suggestion commonly heard in A.A. that one in recovery should "change playgrounds and playmates.") |
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− | * Contact with one's sponsor daily in order to work the steps and to discuss whatever problems one may be having in one's life, problems which may, if not addressed, lead the alcoholic to take the first drink: "One [drink] is too many and one thousand [drinks] never enough." |
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− | * Daily prayer and/or meditation, as suggested by Step 11: "Sought through prayer and meditation to improve our conscious contact with god ''as we understood him,'' praying only for knowledge of his will for us and the power to carry that out." |
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− | * Daily attention to Step 10: "Continued to take personal inventory and when we were wrong, promptly admitted it." |
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− | * Service work, which, for the newcomer, can be as uncomplicated as making coffee at meetings, helping to set up and break down tables and chairs, etc. |
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+ | One reason that many researchers take a skeptical view of AA is that AA is so unscientific because of its spiritual basis.<ref>Vaillant, 1995, p 254.</ref> "Membership is voluntary and is determined by the individual, not by the group. There are no membership requirements except for the desire to stop drinking, no dues or fees, no membership lists. AA is notoriously difficult to pin down as an organization," writes Maria Gabrielle Swora.<ref>Maria Gabrielle Swora. "The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous." ''Mental Health, Religion & Culture'', Sep2004, Vol. 7 Issue 3, p187-209.</ref> In his book ''Alcohol: The World's Favourite Drug'', addiction specialist Griffith Edwards argues that a randomised trial of AA is not possible because members are self-selected, not randomly selected.<ref>Griffith Edwards. ''Alcohol: The World's Favourite Drug''. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. pp 116 – 117.</ref> In other words, was AA the cause of their sobriety, or did they simply go to AA when they were ready to stop drinking? In spite of the obstacles to obtaining direct evidence, many researchers have tackled the problem of whether AA is effective at creating sobriety. |
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− | It will be noted that the program is to be worked ''daily'' and done so ''one day at a time.'' Frequently heard at meetings: "I'm a winner today, no matter what happens, as long as I don't pick up that first drink." |
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+ | ==== Project MATCH ==== |
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− | A common feature of A.A. meetings is that members are asked to speak to the group about their experience with alcoholism and recovery. However, there is no requirement to speak. Some members speak every time they are asked; others simply sit and listen in meetings for years before they say anything; some may choose never to speak. |
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+ | Project MATCH was initiated in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).<ref name = "match">[http://www.niaaa.nih.gov/NewsEvents/NewsReleases/match.htm NIAAA Reports Project MATCH Main Findings], Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.</ref> The project was an 8-year, multisite, $27-million investigation that asked whether certain types of alcoholics respond best to specific forms of treatment.<ref>Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." ''Journal of Studies on Alcohol'', 58(1), 7-29.</ref> MATCH notes "No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients." Three types of treatment were investigated: |
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− | A.A. does not charge membership fees to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs like room rental, coffee, etc. Contributions from members are limited to a maximum annual amount. A.A. is self-supporting and is not a charity. It accepts no subsidies from any non-A.A. source and donations of money or other items of value from such sources are not accepted. |
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+ | *Cognitive Behavioral Coping Skills Therapy, which focuses on correcting poor self esteem and distorted, negative, and self-defeating thinking.<ref>Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2p</ref><ref>Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "[http://www.msnbc.msn.com/id/17083397/site/newsweek/page/0/ Rehab Reality Check]" ''Newsweek'', 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c</ref> |
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+ | *Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.<ref>Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. ''Science News'' v151.n4 (Jan 25, 1997): pp62(2).</ref> |
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+ | *12-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation<ref name="match" /> |
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+ | All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied. |
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− | A.A. receives proceeds from sale of its book ''Alcoholics Anonymous'' along with other A.A. published books and literature, which are periodically reviewed from a cost standpoint so that printed materials can be priced to be self-sustaining while not actually being a source of profit for the organization. |
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+ | The conclusion of the research was that patient-treatment matching is not necessary in alcoholism treatment, because the three techniques were approximately equal in effectiveness. In a December 1996 press release<ref name="match" />, NIAAA Director Enoch Gordis, M.D. said "These findings are good news for treatment providers and for patients who can have confidence that any one of these treatments, if well-delivered, represents the state of the art in behavioral treatments." |
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− | Many A.A. groups use the famous [[Serenity Prayer]] and many AA groups in the Southern United States often close their meeting with [[The Lord's Prayer]]. |
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+ | However overall success rates for all treatments were, and continue to be, less than spectacular. Based on information from Dr. Mark Willenbring of the NIAAA, ''Newsweek'' reported in their February 2007 issue that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."<ref>Adler et al. 2007</ref> |
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− | ==Beliefs about alcoholism== |
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− | There is no official creed of A.A. belief about alcoholism, since individual members are free to believe whatever they wish based on their own experiences. Even the core twelve step program is presented to members as suggested rather than mandatory. While AA literature states that "our twelve steps are only suggestions", many more traditionally-minded members claim that today's decreased emphasis on "Step Work" has resulted in a drastic decline in AA's success rate. In the early days of AA, say critics of today's meeting-centred brand of Alcoholics Anonymous, the 12 Steps were mandatory and attendance at meetings were optional. They claim that during this time, AA experienced 75-90% success rates of recovery{{fact}}. In recent years however, the Fellowship has shifted its views greatly and now many veteran AA members advise newcomers that meetings are mandatory while placing less emphasis on "working the steps". Some blame this lessened emphasis on The Twelve Steps for a first-time sobriety success rate of approximately 5%, according to an internal study conducted by AA Intergroup in 1988. Other estimates put overall success rates however somewhere between 5 and 10%. Given that AA's membership is by definition, anonymous, and its administrative body -- the General Service Office, General Service Board and annual General Service Conference -- acknowledges the importance of anonymity, no records are kept on AA members, so non-anecdotal data about success rates cannot be obtained from official AA sources. |
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+ | The study has been criticised by addiction expert Dr [[Stanton Peele]] as unscientific and politically motivated. Dr Peele stated that the outcomes of the study where at odds with abstinence based programs, as Project MATCH defined a "successful outcome" as a reduction (as opposed to cesation) of alcohol use.<ref name = "Bait and Switch in Project MATCH">[http://www.peele.net/lib/projmach.html], Stanton Peele article on Project MATCH floors, PsychNews International, Vol. 2, May-June 1997.</ref> |
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− | Many A.A. members share similar views on alcoholism and most would agree with the following statements: |
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+ | ==== George Vaillant ==== |
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− | * '''Alcoholism has no cure.''' Once an alcoholic, always an alcoholic. There is no way to make a "normal" drinker out of an alcoholic. Nor is there any way to make a non-alcoholic into an alcoholic. Alcoholics who do not drink can recover and function in normal society, but should they drink again, their active alcoholism will re-emerge quickly and be as debilitating as before. This is true even in cases where alcoholics have remained sober for many years before relapsing. The concept that "alcoholism has no cure" is one at variance with the remarks of A.A.'s two founders--each of whom specifically stated he had been "cured." So too A.A. Number Three (Bill D.) who stated he had been cured by the Lord. See Big Book, p. 191. In fact, for almost a decade after A.A.'s founding, all members from the mid-west and newspapers across U.S. trumpeted the fact that they had been cured and that the cure was reliance on the Creator. See Dick B. Cured; When Early AAs Were Cured and Why. |
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+ | [[George Eman Vaillant|Dr. George Vaillant]] is a board member of Alcoholics Anonymous World Service who in 1983 undertook a study to research the effectiveness of AA treatment. He compiled 40 years of clinical studies. He also conducted an eight-year longitudinal study of his own where Vaillant reported having followed 100 patients who had undergone Twelve-Step treatment. Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. His studied showed that 95% of alcoholics who reach AA fail to stay sober.{{Fact|date=July 2007}} |
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− | * '''Alcoholism is a progressive illness.''' Over time, alcoholics who continue to drink will get worse. Those who keep drinking will often die from alcohol-related causes or be institutionalized (prison, hospital or asylum). |
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+ | In his book ''The Natural History of Alcoholism Revisited'', Harvard psychiatric professor George E. Vaillant posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?"<ref>Vaillant, 1995, p 3</ref> Vaillant's book was partly based on his experience with "a vast collaborative effort" that had started with two studies in the late 1930s and was still running after 60 years.<ref>Vaillant, 1995, pp vii and ix.</ref> Aware of the difficulties of obtaining direct evidence by statistical methods, he nevetheless states in his summary of literature and personal experience that "... research during the last 15 years has revealed growing indirect evidence that AA is an effective treatment for alcohol abuse." <ref>Vaillant, 1995, p 265</ref> |
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− | * '''The first drink does the damage.''' Once an alcoholic takes a drink, a powerful craving for more alcohol sets in. This makes moderation or controlled drinking nearly impossible. Thus the A.A. approach of abstinence. Without the first drink, the craving cannot occur. Much of the A.A. program is intended to help the alcoholic stay stopped, thereby preventing the compulsive drinking cycle from starting. |
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+ | Despite his own statistics Vaillant continued to argue that AA shows an advantage over other treatments in the long term because, as a cheap, community-based fellowship it is easy for people to keep coming back. He argues that "AA is the most effective means of long-term relapse prevention in the physician’s armamentarium."<ref>Vaillant, 2005.</ref> |
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− | * '''The desire to stop drinking needs to come from the alcoholic.''' This often happens as a result of the alcoholic realizing that his or her life has become unmanageable and that excessive drinking is the cause. A.A. members call this "hitting bottom" - a potentially life-changing moment when the alcoholic perceives an urgent need for major personal change. |
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+ | He also writes that AA was formed by people deeply distrustful of organised religion, and that AA continues to pass the test of universalism by accepting members regardless of religious conviction. "Would that all 'religions' and fraternal organizations were as benign," he stated.<ref>Vaillant, 1995, p. 267.</ref> |
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− | * '''An Alcoholic cannot recover on his or her own.''' An alcoholic needs (or will benefit from) the fellowship of the AA program. Contact with other alcoholics provides an essential ingredient to the process of recovery. AA meetings may be important, along with reading AA materials and working the steps -- but it is working with other alcoholics, helping and being helped, talking and interacting, that allow an alcoholic to do what he or she cannot do alone -- stay sober. |
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+ | In 2005, Vaillant produced an extensive study of the efficacy and safety of AA in the treatment of alcoholism, reviewing the published works from 1940 until the present day. In this paper he acknowledges that, although AA is not a magic bullet for every alcoholic in that "there were a few men who attended AA for scores of meetings without improvement."<ref>George E. Vaillant. "Alcoholics Anonymous: cult or cure?" ''Australian & New Zealand Journal of Psychiatry'', Jun2005, Vol. 39 Issue 6, p431-436.</ref>, his overall observation is that "multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings." Despite a 95% failure rate Vaillant's overall conclusion is that "Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted."<ref>Vaillant, 2005</ref> |
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− | ==Structure== |
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− | The affairs of A.A. are governed broadly by A.A.'s [[Twelve Traditions]]. A.A. has a minimal amount of organized structure. There is no hierarchy of leaders and no formal control structure. People who accept service positions within the Fellowship are known only as "trusted servants." Individual A.A. members and groups cannot be compelled to do anything by "higher" A.A. authorities. Each A.A. group, small or large, is considered a self-supporting and self-governing entity. A.A. does maintain offices and service centres which have the task of co-ordinating activities like printing literature, responding to public enquiries and organizing state or national conferences. These offices are funded by local A.A. members and are directly responsible to the A.A. groups in the region or country they represent. (For more information, see A.A.'s [[Twelve Traditions]] as set out in the A.A. "Big Book" [http://www.aa.org/bigbookonline/ Alcoholics Anonymous] and discussed in detail in the A.A. book ''Twelve Steps and Twelve Traditions''.) |
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− | == |
+ | ==== Moos and Moos ==== |
− | U.S. judges continue to require attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendents convicted of a crime. A federal appeals court ruled in 1999 that doing so compromises the [[Establishment Clause]] of the [[First Amendment]] right not to have religion dictated to them by government - because A.A. practices and doctrine are (in the words of the district court judge who wrote [[Griffin v. Coughlin]][http://www.law.cornell.edu/nyctap/comments/i96_0137.htm]) "unequivocally religious". In that ruling it was also noted "adherence to the A.A. fellowship entails engagement in religious activity and religious [[proselytization]]. Followers are urged to accept the existence of God as a Supreme Being, Creator, Father of Light and Spirit of the Universe. In "working" the 12 steps, participants become actively involved in seeking such a God through prayer, confessing wrongs and asking for removal of shortcomings." The United States Supreme Court denied certiori and let this decision stand. |
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+ | In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA.<ref>"Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals." By: Moos, Rudolf H.; Moos, Bernice S. ''Journal of Clinical Psychology'', Jun2006, Vol. 62 Issue 6, p735-750.</ref><ref> See also Moos and Moos. "Rates and predictors of relapse after natural and treated remission from alcohol use disorders." ''Addiction'', 101, 212–222. And Moos and Moos, "Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders." ''Journal of Consulting and Clinical Pyschology'', 2004 Feb;72(1):81-90. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14756617 (abstract, retrieved 2007-05-04)]</ref> They reported that clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. A conclusion was that "Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."<ref>Moos and Moos, 2006</ref> |
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− | [[Grandberg V. Ashland County]] is another example concerning judicially-mandated A.A. attendance and the Establishment Clause. In that case the Federal 7th Circuit Court ruled, "Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue." In [[Warner v Orange County Department of Probation]], where a man convicted of drunk driving was sentenced to A.A. the court found that the county was guilty of “coercing the plaintiff into participating in religious exercises, an act which tends toward the establishment of a state religious faith.” Similar court cases where mandated AA attendance was ruled unconstitutional due to A.A.'s religiosity include [[Kerr v Lind]] and [[O’Connor v State of California]]. |
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+ | ==== The Veterans Study ==== |
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− | While A.A. World Services Inc. [the legal entity of the program as a whole] and A.A.'s General Service Office [the legal entity of A.A. in the U.S. and Canada] do not favour coercion regarding meeting attendance, their failure to unequivocally condemn the practice (and promulgate their condemnation at the cell level) is interpreted by some as tacit approval. A.A. experience long suggests that the program works best for people who seek sobriety of their own free will. The Third Tradition of A.A. states "The only requirement for A.A. membership is a desire to stop drinking." Those forced to attend meetings may not have any desire to stop drinking. Nevertheless, it is true that some members claim to owe their recovery to the fact they were ordered to go to A.A. by a judge or doctor. A.A. welcomes everyone at its meetings, including those who are there only because a court or other external authority compelled them. |
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+ | Moos, Mood, and Humphreys carried out a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the U.S.<ref>Krista Conger. [http://news-service.stanford.edu/news/2001/may23/12step.html "Study points out value of 12-step groups in treating substance abuse."] Stanford Report, May 23, 2001. Retrieved 2007-05-05.</ref>Five of the programs were 12-step based, and five used cognitive-behavioral therapy. The 12-step programs were found to be effective in terms of cost and recovery: over 45% of the men in 12-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. In answer to the often-posed question as to which comes first, AA participation or reduced drinking, the study concluded that the answer is AA.<ref>"How effective is Alcoholics Anonymous?" ''Harvard Mental Health Letter'', Dec 2003, Vol. 20 Issue 6, p7-7.</ref>Moos said, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals: "It is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems.<ref>http://www.news-medical.net/?id=18958,</ref> |
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− | The A.A. program contains spiritual ideas, but it does not promote any particular [[religion]] over others, and it has worked for adherents of many faiths, including Christians, Buddhists, Jews and Muslims as well as for many who identify with no religion. Nevertheless, since it suggests that the recovering alcoholic seeks help from a "Higher Power," some [[atheism|atheists]] and those not looking for a "spiritual" solution find themselves unable to accept A.A.'s Twelve Steps and instead seek out secular alternatives. Many others have been able to adapt the concept of a "Higher Power" in a manner that works for them, and there is a chapter of the book ''Alcoholics Anonymous'' called "We Agnostics" that speaks directly to agnostics and agnosticism. It counsels that even those members who "thought we were atheists or agnostics" were able to "lay aside prejudice and express even a willingness to believe in a Power greater than ourselves ... even though it was impossible for any of us to fully define or comprehend that Power, which is god" and "had to stop doubting the power of god" because "deep down in every man, woman, and child, is the fundamental idea of god." (quotes from ''Alcoholics Anonymous'', 4th Edition, p. 44, 46, 52, 55) Many alcoholics arrive at A.A. with a strong disbelief towards spiritual ideas. A.A. members usually counsel attendees with such beliefs to keep attending despite their perceived conflicting beliefs. The attitude towards these cases is usually the same as in the ''Alcoholics Anonymous'' book, they believe that eventually atheists and agnostics will "come around" to believing in a "higher power." Many agnostics and atheists find this attitude offensive and condescending, because they interpret such statements as being tantamount to saying that atheist and agnostics have simply not thought about the implications enough to come to see what A.A. adherents see as a basic "truth." It should also be noted that many believers reject AA's spiritualism as well. |
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+ | ==== Brandsma et al ==== |
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− | Many alcoholics who arrive at A.A. without belief in a god use the group itself as their "Higher Power." One such alcoholic defined "GOD" as "Group Of Drunks" until he was able to discover a spiritual concept of god which worked for him. Other A.A. members point out that there are many powers greater than one's self to choose from. The idea that this power must be God is not necessarily true for everyone. Some A.A. members choose some principle, such as the truth, or compassion, or the law of impermanence and constant change and surrender to that principle as their "higher power". Others may focus on the program itself, defining "GOD" as "Good Orderly Direction." On the other hand, newcomers are cautioned that it is unwise to use any one person, such as a sponsor, as their higher power in that all individual human beings are fallible and, in the case of another recovering alcoholic, no matter how long his or her sobriety, capable of relapse. The basic idea is that, in order to recover, the alcoholic must "surrender," meaning that he or she must admit his or her powerlessness over alcohol and unmanageability of life and must stop depending only on self, while beginning to rely on help from a "power greater than [one's self]," whatever the precise nature of that power. Many recovering alcoholics would agree with the statement: "I had done things my way long enough, and all it got me was drunk. I decided it was time to start following directions." |
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+ | A study from 1979 found a correlation between AA and an increased rate of binge drinking. After several months of participating in AA, the alcoholics in AA were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got [[Rational emotive behavior therapy|Rational Emotive Behavior Therapy]]. Brandsma argues that teaching people that they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy.<ref>Brandsma, Jeffrey, Maxie Maultsby, and Richard J. Welsh. ''Outpatient Treatment of Alcoholism''. Baltimore, MD.: University Park Press, 1979. p 105.</ref> Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness.<ref> Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D. (August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". ''American Journal of Psychiatry'' 124 (2): pp. 160-163.</ref> Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.<ref>Bower, Bruce. "AA's motivational benefits." ''Science News'' 152.n19 (Nov 8, 1997): 297(1).</ref> |
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+ | ==== J. Scott Tonigan ==== |
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− | Ironically, it has been the experience of some A.A. "old timers" (recovering alcoholics with many years of uninterrupted sobriety) that active alcoholics who seek recovery in A.A. without having a prior religious concept of god may have a better chance of lasting recovery than their more religious counterparts. This seems to be true because the former may find it easier to focus on working the program itself, instead of using previously-held religious beliefs as a rationalization for seeking an "easier softer way." However, as stated elsewhere, many people who come to A.A. with all sorts of religious beliefs, or the lack thereof, have found long-lasting recovery from alcoholism in A.A. "one day at a time." |
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+ | Tonigan's study found the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. "The magnitude of these benefits did not differ between sites." A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.<ref>J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77</ref> |
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− | Finally, many AA members would agree with the idea that most members *begin* AA involvement as a result of some form of coercion, whether from family, a spouse, a boss or supervisor, or the courts. Even those who are not pressured by others are nonetheless pressured by circumstances -- they have "hit rock bottom" and decided that the pain of drinking and the consequences of drinking are too severe to be tolerated. Regardless of initial pressures, many AA members come to value their involvement with the AA program and embrace sobriety for the benefits it brings them. |
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+ | ==Criticism and controversy== |
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− | ==Discussion of the Merits of A.A.== |
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− | Though there is little doubt that A.A. is the number one treatment for |
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− | alcoholism in the world today, it has its detractors. |
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+ | ===Moderation vs. abstinence=== |
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− | (Note: in this section, BB refers to ''The Big Book'', aka ''Alcoholics Anonymous'', 3rd Edition, by the first 100 members of Alcoholics Anonymous, and 12x12 refers to ''Twelve Steps and Twelve Traditions'', by William G. Wilson) Note: in 2001 the 4th edition of Alcoholics Anonymous, was released. The first 164 pages (including the doctors opinion), of the BB have been left intact and unchanged since the book's initial publication in 1939. The only change in each edition, aside from some minor updating of the basic text from the first to the second edition, has been the addition and/or deletion of some of the stories in the back of the book. |
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+ | The AA program is often challenged in the debate on cutting back versus total abstinence, "one of the most hotly contested issues in alcohol treatment".<ref name="shute">Nancy Shute. "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'' v123 n9, Sept 8, 1997:pp54(10). Page 57.</ref> Treatment available in America, particularly, tends to lean towards total abstinence,<ref>Shute, 1997, p 57 & 60</ref> even though not all problem drinkers are actually alcohol dependent.<ref>See ''alcohol abuse'' (a drinking pattern that causes problems) and ''alcohol dependence'' (i.e. alcoholism—an addiction and obsession) in the [[DSM-IV]] and the ''APA Dictionary of Psychology'', 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007.</ref> AA has been criticized for recommending total abstinence as the only solution,<ref>Shute, 1997, p 61</ref> however the AA "Big Book" does make it clear that the program is for alcoholics and that not all drinkers are alcoholics: "Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone. ...[This type of person] can also stop or moderate, although [they] may find it difficult and troublesome and may even need medical attention."<ref>''Alcoholics Anonymous'' p 20-21.</ref> Nevertheless, it is likely that some AA members are over-zealous in recommending abstinence to all people with drinking problems. |
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+ | ===Disease concept of alcoholism=== |
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− | ===AA's Supporters=== |
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− | On one hand, supporters claim that AA is an indispensable support group for people seeking to free themselves of an addiction to alcohol. Some things they cite include: |
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+ | The concept of alcoholism (and addiction) as a disease is controversial.<ref>Alan I. Leshner. [http://www.apa.org/about/contact.html "What does it mean that addiction is a brain disease?"] ''Monitor on Psychology'' (American Psychological Association) Volume 32, No. 5 June 2001.</ref> AA regards alcoholism as a disease,<ref>''[http://www.aa.org/en_is_aa_for_you.cfm?PageID=14 ''A Newcomer Asks]'' (AA pamphlet)</ref><ref>''[http://www.aa.org/en_information_aa.cfm?PageID=17&SubPage=63 The Alcoholic Can Recover]'' (AA pamphlet)</ref> and in practical terms AA often uses the concept to challenge the belief of some chronic, compulsive drinkers that they can stay sober by willpower alone.<ref>''Alcoholics Anonymous'' p 30-31</ref> AA has been criticized by opponents of the disease model, especially those who argue that some AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.<ref>[[Stanton Peele]]. ''The Diseasing of America''. Lexington, MA: Lexington Books, 1989.</ref> |
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− | * The [[American Medical Association]] supports the disease model of alcoholism that was developed in the early part of the 20th century and embraced by AA. |
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− | * A large amount of [[anecdotal evidence]] in which people assert that joining AA saved their lives [http://www.aa-uk.org.uk/alcoholics-anonymous-reviews/2005/05/lot-of-bottle.html] [http://www.aa-uk.org.uk/alcoholics-anonymous-reviews/2005/05/i-was-taught-to-take-my-life-one-day.html] [http://www.aa.org/default/en_about_aa_sub.cfm?subpageid=68&pageid=12] [http://www.aamolly.org.uk/alexg.htm] |
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− | * Long-term sobriety lengths of 20, 30, or 40 or more years are not uncommon in AA.{{citation needed}} |
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− | * Many members find that AA is [[fun]]. While meetings can be serious, they can also be filled with [[laughter]]. Social activities such as dances, picnics, and conventions are enjoyed by great numbers of AAs. Many members discover that their fears of never again having fun after quitting drinking have proven false. Many AA's believe that engaging in therapeutic [[recreation]] that does not include alcohol helps them to stay away from drinking. |
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− | * Because of the large number of AA groups (over 100,000 worldwide as of 2001), AA members are free to try different groups until they find groups that they enjoy. Because AA members come from all walks of life and every segment of [[society]], there is a tremendous amount of variety within the [[fellowship]]. Not only do these facts make it difficult to [[generalize]] about AA groups, but these circumstances allow for a level of flexibility that accommodates the sobriety needs of a large spectrum of recovering alcoholics. |
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− | * The fact that AA does not require a belief in any specific higher power means that AA is not a [[religion]]. Since members are free to choose any higher power they like--including higher powers that are not spiritually based--and since members are allowed to change higher powers whenever they like, this agility facilitates a kind of [[transference]] that aids in recovery from alcoholism. By this definition, an alcoholic is a person who has turned alcohol into a higher power. By selecting an alternate higher power of his or her own choice and/or design, the alcoholic is able to achieve the psychological transference that topples alcohol as a higher power. As the alcoholic progresses in [[recovery]] over months and years, this same flexibility allows the recovering alcoholic to switch to higher powers that are more individually appropriate to that AA member at that given time. |
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− | * "Doing the footwork and turning over the results." Contrary to occasional criticism, the AA program encourages members to act as individuals and to think for themselves. Not only must they design the pace of their own programs and choose their own higher powers with which to supplant alcohol, but they must do their own "footwork" in all areas of their lives. The [[individual]] in AA is fully empowered to do his or her own footwork. When the AA program speaks of "powerlessness," this applies to the ''results'' of the footwork. This distinction is expressed in the words, "Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." In life, footwork is always changeable by the individual, while results are often uncertain, unpredictable, and/or out of the individual's control. |
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− | * The "Toolbox Principle." Many AA's see the program as a large "toolbox." Not everyone feels comfortable with all of the tools all of the time. Many AA's find that they can stay sober while using some tools and not others, or using different tools at different times. This flexibility allows members to reach for the specific help they need at specific times, then use a different kind of help as circumstances fluctuate. |
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− | * [[Enlightened self-interest]]: Many AA's believe that in order for an alcoholic to stay sober, he or she must be in the program for him- or herself. According to this perspective, an AA member does not work the program for the sake of his family, his job, his community, or for the sake of any AA group or AA as a whole. An alcoholic works the program for himself, and helps others primarily because it helps oneself. |
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− | * Every AA member is free to have a sponsor of his or her own choice or not to have a sponsor at all. Some AA's have more than one sponsor at one time. Some AA's have a sponsor or sponsors at the beginning of sobriety, then choose not to have sponsors later on. A member may "fire" a sponsor at any time, and vice versa. Because AA members are learning to become individually empowered, it is their [[responsibility]] to select appropriate sponsors and change sponsors when necessary. The great variety of available sponsors is another aspect of the program's flexibility in terms of the shifting needs of individual members. |
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− | * Many members and groups acknowledge that AA isn't the right program for everyone, and that there are effective alternatives for other individuals. |
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− | * The 12 steps are suggestions rather than requirements (though "they are 'suggested' in the same way that, if you jump out of an airplane with a parachute, it is 'suggested' that you pull the ripcord" (''Daily Reflections; A Book of Reflections by A.A. members for A.A. members'', Alcoholics Anonymous World Services, Inc., pg. 344)) |
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− | * There are no official membership records, allowing members to come and go as they choose (see [[Alcoholics Anonymous#A.A..2C religion and the law|above]] for the exception to this, which AA itself does not sanction) |
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− | * Despite Bill W.'s claim that members are "impersonally and severely disciplined from without" in a letter to Dr. Harry Tiebout (quoted in ''Not-God: A History of Alcoholics Anonymous'', Ernest Kurtz, page 129, a book put out by a publisher which publishes much addiction literature), AA lacks any sort of formal disciplinary measures against members who fail to adhere strictly to the program |
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− | * The claim that AA is spiritual, not religious, and that the requisite Higher Power can be anything including god (as the individual understands Him, according to the [[12 steps#The twelve steps|3rd Step]]), the group itself (one [http://www.wtv-zone.com/Liandre/Liandres/400_AA_Slogans.html slogan]: "G.O.D.='''G'''ood '''O'''rderly '''D'''irection), a philosophical system, a dead person, the universe, nature, a principle or anything the individual member chooses to invent. AA philosophy acknowledges that all rational people admit the existence of powers greater than themselves, and that this is in fact one of the definitions of a [[rational]] person. |
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− | * The [http://www.wtv-zone.com/Liandre/Liandres/400_AA_Slogans.html slogan] that says to "Take what you can use and leave the rest." Members are also reminded that AA will work for them only if they work the program. |
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− | * The lack of a guru-like figure rising to fill the late Bill Wilson's shoes, lending credibility to the [http://www.wtv-zone.com/Liandre/Liandres/400_AA_Slogans.html slogan] that says "principles before personalities" |
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− | * According to the BB, "Our primary purpose is to stay sober and to help others to achieve sobriety." Thus, AA is not a social movement and is not involved in trying to reshape society or to affect communities or their values. AA prefers to appeal to potential members through "attraction rather than promotion." |
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+ | === Occasions of abuse at meetings === |
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− | ===AA's Critics=== |
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+ | AA groups have the benefits and risks of any community, and it is important to acknowledge that mutual support and abuse are both possible. There is no external restriction or vetting of AA members, and in fact the long-form version of Tradition 3 states that "Any two or three alcoholics gathered together for sobriety may call themselves an AA group..."<ref>http://www.aa.org/bigbookonline/en_appendiceI.cfm</ref> ''Newsweek'' reported on alleged cult-like and abusive behaviour in one controversial Washington DC AA group.<ref>Nick Summers. "[http://www.msnbc.msn.com/id/18368218/site/newsweek/page/0/ A Struggle Inside AA]." ''Newsweek''. May 7, 2007.</ref> One of the women interviewed allegedly experienced pressure to have sex with senior members, and was told to cut off ties with anyone outside the group and to stop taking her antidepressant medication. However this woman reportedly moved to another AA group and was "relieved" to find these practices were not widespread and were contrary to AA philosophy. In the UK in 2000, ''the Guardian'' newspaper reported that a leaked internal AA memorandum stated that "volunteer members are increasingly being investigated by police forces examining allegations of sexual abuse."<ref>Gerard Seenan. "[http://www.guardian.co.uk/uk_news/story/0,,339726,00.html Drink advice service confronts sex abuse.]" ''The Guardian'', July 5, 2000.</ref> According to the memo, a small minority of members were taking advantage of vulnerable new members who were seeking help by phone or by looking for a sponsor. At that time the AA service board was considering how to deal with the issue on a national level in the UK. |
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− | Specific criticisms sometimes put forth by AA's critics (some of whom go so far as to call AA a [[cult]]) include: |
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− | * There have been at least three randomized clinical trials that studied the effectiveness of AA. Specifically: Ditman et al. 1967; Brandsma et al. 1980; Walsh et al. 1991. |
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− | **Dr. Ditman found that participation in A.A. increased the alcoholics' rate of rearrest for public drunkenness.[1] |
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− | **Dr. Brandsma found that A.A. increased the rate of binge drinking. After several months of indoctrination with A.A. 12-Step dogma, the alcoholics in A.A. were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Behavior Therapy. Brandsma alleges that teaching people that they are alcoholics who are powerless over alcohol yields very bad results and that it becomes a self-fulfilling prediction -- they relapse and binge drink as if they really were powerless over alcohol.[2] |
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− | **And Dr. Walsh found that the so-called "free" A.A. program was actually very expensive -- it messed up patients so that they required longer periods of costly hospitalization later on.[3] |
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− | * While AA acknowledged in the foreword to the second edition of the Big Book that "we surely have no monopoly", one of the stories following the main text of the book still claims that AA is "the ''only'' remedy" to alcohol abuse (BB, pg. 259. Emphasis added.), despite some current research which shows that high percentages of alcohol abusers recover without medical treatment (''Treatment of Drug Abuse and Addiction -- Part III'', The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.). Another study suggests that AA may be "no better than the natural history of the disease" in keeping people alive and sober (''The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery'', George E. Vaillant, pgs. 283-286.) |
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− | * The claim that people who refuse to work the program thoroughly, or do but are not helped by it, are "constitutionally incapable of being honest with themselves" (BB, pg. 58.), implies that, by definition, the AA program itself is incapable of failure, provided that the alcoholic is properly motivated. This seems to deny the existence of honest, motivated individuals for whom the program doesn't work. ("consitutionally incapable of being honest with themselves" has nothing to do with motivation and everything to do with being thorough through the steps and when the truth gets to be too much, backing down and not trudging through the rough spots.) |
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− | * A lack of official checks and balances designed to keep sponsors from abusing their position (though sponsors can be fired at any time) |
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− | * Claims that alcoholics are "doomed to an alcoholic death" unless they decide to "live on a spiritual basis" (each AA member being allowed to decide for himself what "spiritual basis" means) (BB, pg 44) and "Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant." (12x12, pg. 174). |
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− | * In the discussion of self-centeredness, statements such as "Sometimes they [other people] hurt us, seemingly without provocation, but we ''invariably'' find that at some point in the past we have made decisions based on self which later placed us in a position to be hurt." (BB, pg. 62. Emphasis added.) may be generalized so as to leave no room for instances where the victim was blameless, such as [[child sexual abuse|childhood sexual abuse]] or another form of mistreatment of either children or innocent adults unable to protect themselves. Many AA members interpret this to mean that blameless victims are at fault for continuing to be hurt by a past event, and not at fault for the past event itself. Some critics assert that this interpretation is incompatible with the text, saying that it clearly refers to the actual acts of others, not the victims' attitudes towards those acts, and suggests the problems of victims are that they have made "decisions based on self", that, ''later'' place them in a position to be hurt, not that they have chosen to remain affected by earlier hurts. On the other hand, supporters assert that the "decisions based on self" could have been, and in the case of blameless victims, clearly were, made ''after'' the event itself that occurred. An unofficial slogan sometimes heard in AA is "There are no victims, only volunteers." This clearly indicates the belief that nobody is ever victimised in any way that they could not have avoided. (Some AA members believe that these types of statements are only intended to warn against a habitual victim mentality. Some AA members understand that people can experience either innocent bad luck or be seriously victimized through no fault of their own.) In any case, the interpretation suggests that whether one continues to be hurt by previous abuse is something one can have full choice over, whereas physical and mental trauma resulting from victimisation might be chronic and something the victim is ''truly'' powerless over. |
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− | * The claim that "If we were to live, we had to be free of anger." (BB, pg. 66) when psychologists say that while anger must be [[Anger management|managed]], it is not possible or healthy to do away with it entirely. (Some AA members interpret "free of anger" to mean that one should not be enslaved by their anger, be a "rageaholic," or engage in habitual toxic anger, not to mean that they should have no anger at all.) |
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− | * The "To Wives" chapter of the Big Book being written as advice from one wife of an alcoholic to another, when it was in fact written by Bill W. himself despite his wife Lois' desire to write it (''Getting Better: Inside Alcoholics Anonymous'', Nan Robertson, page 70-71; ''Pass It On'', a publication of AA, page 200.) |
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− | * Bill W.'s frequent use of first-person plural giving the implication that all alcohol abusers have similar defects of character ([[12 steps#The twelve steps|6th Step]]) and past experiences (examples: "...something had to be done about ''our'' vengeful resentments, self-pity, and unwarranted pride." 12x12, pg. 47. and "''We'' never thought of making honesty, tolerance, and true love of man and [[god]] the daily basis of living." 12x12, pg. 72. Emphasis added.) |
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− | * The contradiction between the BB's claim that "We will seldom be interested in liquor. "If tempted, we recoil from it as from a hot flame" We will see that our new attitude toward liquor has been given to us without any thought or effort on our part. It just comes! That is the [[miracle]] of it." (BB, pgs. 84-85) and Bill W.'s own statement that even co-founder Dr. Bob "was bothered very badly by the temptation to drink." "Unlike most of our crowd, I did not get over my craving for liquor much during the first two and one half years of abstinence." ["Dr. Bob's Nightmare"] (BB page 181) On the other hand, Dr. Bob's use of the word "craving" is consistent with the physical cravings described by Dr. Silkworth, not with the lack of the mental obsession to ''return'' to liquor that is described. |
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− | * AA's heavy reliance on [http://www.wtv-zone.com/Liandre/Liandres/400_AA_Slogans.html numerous slogans] [http://www.recoveryresources.org/aphorisms.html] [http://www.geocities.com/HotSprings/Spa/2973/index11.html], including ones used to defer criticisms brought up during meetings, such as "Take the cotton out of your ears and put it in your mouth!" |
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+ | ===Court mandated AA attendance=== |
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− | ====Criticisms specific to religious themes==== |
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− | Critics see the following points as evidence of religious themes in AA: |
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+ | Judges in the [[United States]] sometimes require attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. "Open" AA meetings are open to anyone who wishes to attend, including those mandated by a court. Court ordered attendees have to answer to the judge, not to anyone in AA. Such forced attendance may not satisfy AA's [[Twelve traditions|Tradition]] 3, which says that "The only requirement for A.A. membership is a desire to stop drinking." |
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− | * Many of the steps being adapted and altered from tenets that "came straight from Dr. Bob's and (Bill W.'s) own earlier association with the [[Oxford Group]]s" (''The Language of the Heart'', William G. Wilson, pg. 298), a Christian spiritual movement with which friends of theirs had been involved and which places a large emphasis on taking individual responsibility for the harm one has done to others and confession to god and another person. |
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− | * Because "most alcoholics just wanted to find sobriety, nothing else", "The [[Oxford Group]]s' absolute concepts ... had to be fed with teaspoons rather than by buckets." (''Alcoholics Anonymous Comes Of Age'', William G. Wilson, pgs. 74-75.) |
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− | * The statement that "At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to [[god]]" ("god" or "higher power" being defined by the AA member himself, including non-spiritual, agnostic, or atheist beliefs) (BB, pg. 77) |
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− | * "Being entirely ready to have god remove these defects of character" ([[12 steps#The twelve steps|sixth step]]), "or, if you wish, our [[sin]]s" (12x12, pg. 48), and "[[pray]]ing only for knowledge of His will for us and the power to carry that out" ([[12 steps#The twelve steps|eleventh step]]) |
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+ | Court decisions can be cited to support the argument that AA is based on religious activities. The [[New York Court of Appeals]] ruled in 1999 that mandating attendance at AA meetings compromises the [[Establishment Clause]] of the [[First Amendment]] right of those sentenced not to have religion dictated to them by government - because AA practices and doctrine are (in the words of the judge who wrote Griffin v. Coughlin<ref>{{cite web |
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− | ====Criticism of religious themes from religious groups==== |
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+ | | title = Griffin v. Coughlin |
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− | Several [[Traditionalist Catholics]] have expressed misgivings about what they term "the abominably liberal and indifferentist," nature of AA while at the same time acknowledging it should be cautiously tolerated to avoid the greater evil of alcoholism.[http://www.sspx.ca/Angelus/2002_September/Traditional_Catholic.htm] A small number of ultra-conservative Protestants have expressed discomfort about what they believe to be [[New Thought]], [[Society of Jesus|Jesuitic]], or even [[occult]] aspects to [[Bill W]]'s personal philosophy. |
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+ | | work = |
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+ | | publisher = |
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+ | | date = 1996-6-11 |
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+ | | url = http://www.law.cornell.edu/nyctap/comments/i96_0137.htm |
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+ | | format = |
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+ | | doi = |
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+ | | accessdate = 2006-10-20 }}</ref>) "unequivocally religious". In that ruling it was also noted "adherence to the AA fellowship entails engagement in religious activity and religious [[proselytization]]." In "working" the Twelve Steps, participants become actively involved in seeking God through prayer, confessing wrongs and asking for "removal of shortcomings." The United States Supreme Court denied [[certiorari]] and let this decision stand. |
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+ | |||
+ | ''Grandberg v. Ashland County'' is another example concerning judicially-mandated AA attendance and the Establishment Clause. In that case the [[United States Court of Appeals for the Seventh Circuit]] ruled, "Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue." In ''Warner v. Orange County Department of Probation'' a man convicted of drunk driving was sentenced to AA. The court found that the county was guilty of “coercing the plaintiff into participating in religious exercises, an act which tends toward the establishment of a state religious faith.” |
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+ | === Accusations of cult practice === |
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− | ==Literature== |
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− | *''Alcoholics Anonymous Comes of Age. A Brief History of A.A.'', New York: Alcoholics Anonymous, 1990, ISBN 091685602X. |
||
− | For more literature, see [[Bill W.#Literature|Bill W.]], Literature; [[Bob Smith (doctor)#Literature|Dr. Bob]], Literature; [[Twelve-step program#Literature|Twelve-step program]], Literature. |
||
− | *[http://www.barefootsworld.net/aajalexpost1941.html "Alcoholics Anonymous" by Jack Alexander, Saturday Evening Post, March 1, 1941] |
||
− | *[http://www.eskimo.com/%7Eburked/post1950/post1950.html The Drunkard's Best Friend by Jack Alexander, Saturday Evening Post, April 1, 1950] |
||
+ | Merriam-Webster defines a cult as "a system for the cure of disease based on dogma set forth by its promulgator". <ref>"[http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=cult& Cult]" in Merriam-Webster's Online Dictionary, M-W.com.</ref> As early as 1963, Alcoholics Anonymous has come under scrutiny as a possible [[cult]]. Dr Arthur H. Cain talked of the "religious flavour" the word sobriety had taken in AA, the "slavery" to the group and an over reliance on dogmatic slogans. <ref>Arthur H. Cain, "[http://www.legacyaa.com/articles/cult_or-cure.htm Alcoholics Anonymous: Cult or Cure?]." ''Harper's Magazine'', February 1963</ref> It is said that AA's need for submission to a higher power leaves potential for abuse, and that that submission can become the basis for cult like cohesion <ref>Mark Dombeck, "[http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=9527 Alcoholics Anonymous is a Cult?]." MentalHelp.net, Jun 1st 2006. Retrieved 2007-07-23] |
||
− | ==Dramatic Portrayals== |
||
+ | </ref>. Various authors have stated that AA "uses all the methods of brain washing, which are also the methods employed by cults", "is able to suppress attitudes that could undermine its traditions" and "provides the prospective affiliate not merely with a solution to problems related to drinking, but also with an overarching world view with which the convert can and must reinterpret his or her past experience". <ref>Jeffrey A. Schaler. [http://www.schaler.net/fifth/cultbusting.html "Cult Busting"] ''The InterPsych Newsletter'' Vol 2, Issue 5, June, 1995.</ref> Alcoholics Anonymous, in line with its own traditions, does not comment on accusations of cult behaviour in its groups. |
||
− | *''My Name is Bill W.''[http://www.imdb.com/title/tt0097939/] Story of the founders of AA |
||
− | *''Days of Wine and Roses''[http://www.imdb.com/title/tt0055895/] An early portrayal of AA (1962) |
||
− | *''[[South Park]]'' [http://www.imdb.com/title/tt0121955/] Parodied AA in the December 7, 2005 episode ("[[Bloody Mary (South Park)|Bloody Mary]]") |
||
− | *''[[The Simpsons]]'' [[Homer Simpson]] is sentenced to attend AA meetings in the episode [[Duffless]]. In the episode [['Round Springfield]], [[Barney Gumble]] is trying AA, but quickly falls back to drinking. |
||
− | ==External links== |
||
− | ====Official A.A. links==== |
||
− | * [http://www.aa.org/ A.A. home page] |
||
− | * [http://www.aagrapevine.org/ The A.A. Grapevine] |
||
− | ====Unofficial A.A. sites on the internet==== |
||
− | * [http://www.alcoholicsanonymous.org/ The Unofficial Website for AA Related Information] |
||
− | * [http://www.ballina.net/aa Example of Regional Unofficial Site] |
||
− | * [http://stayingcyber.org/ Staying Cyber: An AA Meeting for the WWW] |
||
− | * [http://www.recovery.org/aa/bigbook/ww/ AA Big Book] |
||
− | * [http://www.geocities.com/Heartland/Estates/7372/brainwashed.html The Washing Machine] |
||
− | * [http://www.aahistory.com/ AA History and Trivia] |
||
− | * [http://www.aa-intergroup.org/index.html Online Intergroup of AA] |
||
− | * [http://www.xanga.com/GlennS GlennS's AA blog & Friends of Bill W blogring] |
||
+ | ==See also== |
||
− | ====Testimonials (Stories of Recovery via AA)==== |
||
− | * [http://www.memorywiki.org/en/Category:Alcoholism Recovery Stories]--from MemoryWiki |
||
− | * [http://www.peele.net/lib/twelve.html Horror Stories] |
||
− | ====Critical links==== |
||
− | * [http://www.angelfire.com/blog/aaacomix Triple A Comix--AA In Satire] |
||
− | * [http://www.morerevealed.com/ More Revealed: A Critical Analysis of Alcoholics Anonymous] |
||
− | * [http://www.orange-papers.org/ The Orange Papers] |
||
− | * [http://www.geocities.com/drugsandalcoholinfo/webpagesandpapers/mindcontroltactics.htm Allegations of "Mind Control" in A.A.] |
||
− | * [http://oldweb.uwp.edu/academic/criminal.justice/aacult01.htm Is A.A. a Cult?] |
||
− | * [http://www.morerevealed.com/books/coc/ AA Cult Or Cure?] |
||
− | * [http://www.peele.net/ Stanton Peele PhD, national AA and 12-Step treatment critic] |
||
+ | * [[Alcoholism]] |
||
− | ====Links to AA alternatives==== |
||
+ | **for alternate treatments to AA, see section [[Alcoholism#Politics and public health|Alcoholism:Politics and public health]] |
||
− | Abstinence based programs |
||
+ | * [[Al-Anon/Alateen]] |
||
− | * [http://rational.org/ Rational Recovery] |
||
+ | * [[Twelve-step program]] |
||
− | * [http://www.smartrecovery.org SMART Recovery] |
||
+ | * [[AA Grapevine]], the international journal of Alcoholics Anonymous. |
||
− | * [http://www.secularsobriety.org/ SOS - Secular Organizations for Sobriety] |
||
+ | * [[Drunkenness]] |
||
− | * [http://www.unhooked.com/index.htm Lifering] |
||
+ | * [[Substance abuse]] |
||
− | * [http://www.womenforsobriety.org/ WFS - Women For Sobriety] |
||
+ | * [[Narcotics Anonymous]] |
||
+ | * [[Cocaine Anonymous]] |
||
+ | * [[Overeaters Anonymous]] |
||
+ | * [[Alateen]] |
||
+ | ==Further reading== |
||
− | Moderation/[[harm reduction]] based programs |
||
+ | ===Books=== |
||
− | * [http://www.moderation.org MM - Moderation Management] |
||
+ | *''Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism.'' 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at [http://www.aa.org/bigbookonline/ www.AA.org] and [http://www.thebigbook.org/ www.BigBook.org]. |
||
− | * [http://www.mywayout.org My Way Out] |
||
+ | *''Alcoholics Anonymous Comes of Age. A Brief History of AA'', New York: Alcoholics Anonymous, 1990, ISBN 0-916856-02-X. |
||
+ | *''Living Sober: Some methods A.A. members have used for not drinking'', New York: Alcoholics Anonymous, 1975, 1998, ISBN 0-916856-04-6. |
||
+ | *''Twelve Steps and Twelve Traditions'', New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2. |
||
− | == |
+ | ===Articles=== |
+ | <div class="references-small"> |
||
− | # {{cite journal |
||
+ | * {{cite journal |
||
− | | title = A Controlled Experiment on the Use of Court Probation for Drunk Arrests |
||
− | | author = Keith S. Ditman, M.D. |
||
− | | coauthors = George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D. |
||
− | | journal = American Journal of Psychiatry |
||
− | | volume = 124 |
||
− | | issue = 2 |
||
− | | date = August 1967 |
||
− | | pages = pp. 160-163 |
||
− | }} |
||
− | # {{cite book |
||
− | | title = Outpatient Treatment of Alcoholism |
||
− | | first = Jeffrey |
||
− | | last = Brandsma |
||
− | | coauthors = Maxie Maultsby, and Richard J. Welsh |
||
− | | publisher = University Park Press |
||
− | | location = Baltimore, MD. |
||
− | | pages = page 105 |
||
− | }} |
||
− | # {{cite journal |
||
| title = A Randomized Trial of Treatment Options for Alcohol-abusing Workers |
| title = A Randomized Trial of Treatment Options for Alcohol-abusing Workers |
||
| journal = The New England Journal of Medicine |
| journal = The New England Journal of Medicine |
||
| volume = 325 |
| volume = 325 |
||
| pages = 775–782 |
| pages = 775–782 |
||
− | | date = September 12, 1991 |
||
}} |
}} |
||
− | + | * {{cite journal |
|
| title = The Ideology of a Therapeutic Social Movement: Alcoholics Anonymous |
| title = The Ideology of a Therapeutic Social Movement: Alcoholics Anonymous |
||
| first = Leonard |
| first = Leonard |
||
Line 253: | Line 305: | ||
| location = New Brunswick, NJ |
| location = New Brunswick, NJ |
||
}} |
}} |
||
− | + | * {{cite journal |
|
− | | title = Alcoholics Anonymous comes of age |
||
− | | author = Bill W. |
||
− | | authorlink = Bill W. |
||
− | | publisher = Alcoholics Anonymous |
||
− | | location = New York |
||
− | | date = 1957 |
||
− | | id = ISBN 091685602X |
||
− | }} |
||
− | # {{cite book |
||
− | | title = The Varieties of Religious Experience |
||
− | | first = William |
||
− | | last = James |
||
− | | publisher = Longman's Green |
||
− | | location = New York |
||
− | | date = 1928 |
||
− | }} |
||
− | # ''Three Talks to Medical Societies by Bill W., co-founder of Alcoholics Anonymous'' World Service, 1973. |
||
− | # {{cite journal |
||
| title = A Study in the Psychology of Religious Phenomenon |
| title = A Study in the Psychology of Religious Phenomenon |
||
| first = J.H. |
| first = J.H. |
||
Line 278: | Line 312: | ||
| volume = 7 |
| volume = 7 |
||
| pages = 309-385 |
| pages = 309-385 |
||
− | | date = 1896 |
+ | | date = 1896 }} |
+ | * {{cite book |
||
− | }} |
||
− | # {{cite book |
||
| title = The Psychology of Religion |
| title = The Psychology of Religion |
||
| first = E.D. |
| first = E.D. |
||
Line 288: | Line 321: | ||
| date = 1899 |
| date = 1899 |
||
}} |
}} |
||
− | + | * {{cite journal |
|
| title = A Study of Conversion |
| title = A Study of Conversion |
||
| first = E.D. |
| first = E.D. |
||
Line 297: | Line 330: | ||
| date = 1897 |
| date = 1897 |
||
}} |
}} |
||
+ | </div> |
||
+ | ==External links== |
||
+ | * [http://www.aa.org/ Alcoholics Anonymous official website] |
||
+ | |||
+ | ==References== |
||
+ | {{reflist|2}} |
||
[[Category:Alcohol abuse]] |
[[Category:Alcohol abuse]] |
||
[[Category:Addiction]] |
[[Category:Addiction]] |
||
[[Category:Drug rehabilitation]] |
[[Category:Drug rehabilitation]] |
||
− | [[Category:Twelve-step |
+ | [[Category:Twelve-step programs]] |
+ | [[Category:Alcohol rehabilitation]] |
||
− | |||
+ | [[Category:Self-care]] |
||
− | [[ca:Alcohòlics anònims]] |
||
+ | [[Category:Community services]] |
||
+ | <!-- |
||
+ | [[bg:Анонимни алкохолици]] |
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+ | [[ca:Alcohòlics Anònims]] |
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[[da:Anonyme Alkoholikere]] |
[[da:Anonyme Alkoholikere]] |
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[[de:Anonyme Alkoholiker]] |
[[de:Anonyme Alkoholiker]] |
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+ | [[et:Anonüümsed Alkohoolikud]] |
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[[es:Alcohólicos Anónimos]] |
[[es:Alcohólicos Anónimos]] |
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[[eo:Alkoholuloj Anonimaj]] |
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[[gl:Alcólicos Anónimos]] |
[[gl:Alcólicos Anónimos]] |
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[[hr:Anonimni Alkoholičari]] |
[[hr:Anonimni Alkoholičari]] |
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+ | [[is:AA-samtökin]] |
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[[it:Alcolisti Anonimi]] |
[[it:Alcolisti Anonimi]] |
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[[nl:Anonieme Alcoholisten]] |
[[nl:Anonieme Alcoholisten]] |
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+ | [[ja:アルコホーリクス・アノニマス]] |
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[[no:Anonyme alkoholikere]] |
[[no:Anonyme alkoholikere]] |
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[[pl:Anonimowi Alkoholicy]] |
[[pl:Anonimowi Alkoholicy]] |
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− | [[pt:Alcoólicos |
+ | [[pt:Alcoólicos Anónimos]] |
+ | [[ru:Анонимные алкоголики]] |
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[[fi:AA-liike]] |
[[fi:AA-liike]] |
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[[sv:Anonyma Alkoholister]] |
[[sv:Anonyma Alkoholister]] |
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+ | [[tr:Anonim Alkolikler]] |
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+ | [[uk:Спільнота анонімних алкоголіків]] |
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+ | [[zh:戒酒無名會]] |
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+ | --> |
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{{enWP|Alcoholics Anonymous}} |
{{enWP|Alcoholics Anonymous}} |
Revision as of 09:47, 19 August 2007
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Alcoholics Anonymous (AA) is an informal society for recovering alcoholics.[1] Members meet in local groups that vary in size from a handful to many hundreds of individuals. In 2001 there were 100,000 groups worldwide, making a global community of more than two million recovering alcoholics[2].
The stated primary purpose of the society is "to stay sober and help other alcoholics to achieve sobriety."[3] AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis;[4][5] the society in turn offers a community of recovering people who support each other by "sharing experience, strength and hope"[6] and often by working the suggested Twelve Steps together.
Alcoholics Anonymous was the first 12-step program and has been the model for similar recovery groups such as Al-Anon/Alateen, Gamblers Anonymous, Narcotics Anonymous, Sexaholics Anonymous, and Overeaters Anonymous. Al-Anon and Alateen are companion programs designed to provide support for relatives and friends of alcoholics.
AA History
Pre-AA understanding of alcoholism
In the 1930s public opinion saw alcoholism as a moral failing, and the medical profession saw it as a condition that in many cases was incurable and lethal.[How to reference and link to summary or text] Those without financial resources could find help only through state hospitals, the Salvation Army, and other charitable and religious groups. Those who could afford psychiatrists or hospitals were often subjected to a treatment with barbiturate and belladonna known as "purge and puke."[7] One contemporary doctor who would have a great influence on AA was William Duncan Silkworth, M.D, who specialised in the treatment of alcoholics. He contended that alcoholism was by nature a disease that consisted of an obsession and an allergy. The "obsession" was the desire to start drinking, and the "allergy" (in the sense of an abnormal reaction) was the compulsion to continue once the first drink had been taken. In Silkworth's view, alcoholics were caught by the delusion that, despite the often severe consequences of the last drinking episode, no harm will be done by the next drink. Silkworth believed that the two primary protectors of health—reason and will—were of no use against this disease.[8]
A search for a spiritual cure
AA was founded by Bill Wilson, a Wall Street stock speculator, and Dr. Bob Smith, a proctologist from Akron, Ohio, both alcoholics. The chain of events that led to the meeting of these men began in Europe, where American business executive Rowland Hazard sought treatment for alcoholism with the famous Swiss psychiatrist Carl Jung. After a prolonged and unsuccessful period of therapy, Jung told Hazard that his case, like that of most alcoholics, was nearly hopeless—the only possibility for a cure was through spiritual conversion.[9][10] Back in America, Rowland Hazard joined the Oxford Group, a Christian Evangelical association.[11] The group advocated finding God through a spiritual surrender, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. (Bill Wilson later gave credit for the concepts behind Steps Three through Twelve to the teachings of Rev. Samuel Moor Shoemaker of the Oxford Group.[12][13]) Through the Oxford group, Hazard underwent a spiritual conversion and achieved his long hoped for sobriety.
The conversions of Thacher and Wilson
Rowland Hazard introduced his acquaintance Ebby Thacher to Jung's conversion cure and the Oxford Group's spiritual principles, and Thacher, too, attained sobriety (although, in his case, it would not last his whole life[14]). Thacher visited an old school friend by the name of Bill Wilson. Wilson was an alcoholic who had seen a promising career on Wall Street ruined by his drinking. He had failed to graduate from law school because he was too drunk to pick up his diploma. He had blown partnerships and business deals, all but destroyed his marriage, been hospitalized for alcoholism under the care of Dr. William Silkworth, and still continued to drink. Wilson was astonished to find that his old drinking companion had become sober through spiritual means, but he struggled with the existence of God. Then "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last."[15]
Wilson excitedly told his wife Lois about his spiritual discovery, yet the very next day he drank again, and eventually found himself back in hospital under Silkworth's care. According to Wilson, while lying in bed depressed and despairing he cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!".[16] He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Bill Wilson described his experience to Dr. Silkworth, who told him not to discount it and that he had noticed a differnce in his demeanor. Eby Thacher visited Bill Wilson at Townes hospital, introduced him to the basic tenets of the Oxford Group, and gave him a copy of Varieties of Religious Experience by American psychologist and philosopher William James, which described experiences similar to Wilson's. (Bill never could recall if it was Eby or Rowland who had given him the book) Upon his release from the hospital, Wilson admitted he was licked, got honest with himself, got honest with another, made amends, helped other alcoholics and prayed to whatever God he thought there was. (speech 1952 convention) William G Wilson never drank again for the remainder of his life.
A new program for recovery
In keeping with the practices of the Oxford Group, Wilson found that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. At one point Wilson was on a business trip in Akron, OH, and was tempted to relapse. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. He eventually reached Oxford Group member Henrietta Seiberling, whose group had been trying to help alcoholic Dr. Bob Smith. Wilson met with Smith for what was planned as 15 minutes, and the two men talked late into the night. They became friends, and for three months they studied the Bible, held long discussions, and reviewed Oxford Group ideas, eventually fashioning a pioneer recovery program. Smith's last drink is said to have been on June 10, 1935—a beer to steady his hand for surgery—and that is considered within AA to be the date of the founding of AA.
Wilson returned to New York, establishing a second group, he later revisited Akron and reviewed the movement with Smith. They estimated that by 1937, the two groups numbered forty recovered alcoholics with continuous sobriety[17], and decided with this success in mind, that they had a recovery program worth spreading. Impassioned discussions led to agreement that the essential communications tool would be in the form of a book. After great difficulties in raising the required funds for printing, a publishing company, Works Publishing Inc., was incorporated, and capital raised by selling shares to the groups’ members and friends. Wilson set to work writing the book. When he reached chapter five, he decided that a summary of their methods for treating alcoholism was needed to describe the Word of Mouth program. In these early days, the basic program had developed from the works of William James, Dr Silkworth and the Oxford Group (from which the AA groups separated in 1937[18]), although several of the Oxford Group's ideas and attitudes were deliberately rejected, particularly any which would involve AA in theological controversy. The program involved an alcoholic: admitting that they were beaten by alcohol, making a moral inventory of their defects or sins, confessing their shortcomings with another person, making restitution to those harmed by the alcoholic's drinking, trying to help other alcoholics and praying to whatever God they believed in for the power to practice these precepts. Wilson, with contributions from others in the groups including several atheists who restrained the religious content, expanded these principles and the final version of the Twelve Steps was completed by the fall of 1938[19].
The "Big Book"
The book, Alcoholics Anonymous,[5] was published in 1939 and has been a perennial best-seller ever since. While several titles for the book were proposed (including "The Way Out", which was already in use), Bill Wilson and Dr. Bob finally settled on "Alcoholics Anonymous", and the fellowship itself took its name from the book. The first edition had a "circus cover" of red and yellow, and it was printed in heavy paper and had the margins brought in an additional inch making it fuller, which was thought to make it more attractive for the price—hence the nickname "Big Book", a name that sticks today with the same indented margins. Sales of the book—and the popularity of AA—increased rapidly after positive articles in Liberty magazine in 1939[20] and the Saturday Evening Post in 1941.[21] The 4th edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter called "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each successive edition, the personal stories have been reviewed to represent the current population of AA, with the result that the stories of the original members of the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were gathered together in the book "Experience, Strength, and Hope."
The AA program
AA provides support for members attending regular meetings. One description of meetings comes from Dr. W.W. Bauer, who spoke for the American Medical Association in 1946 when he stated "Alcoholics Anonymous are no crusaders: not a temperance society. They know that they must never drink. They help others with similar problems...In this atmosphere the alcoholic often overcomes his excessive concentration upon himself. Learning to depend upon a higher power and absorb himself in his work with other alcoholics, he remains sober day by day. The days add up into weeks, the weeks into months and years."[22]
The 12 Steps are sometimes summarized as "Trust God, clean house, and help others." AA members are encouraged to "work the Steps", usually under the guidance of a voluntary sponsor—a member who has experience working the program. The Steps are designed to help the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Although the steps are based on seeking help from a higher power, atheists and agnostics have achieved long-term sobriety in AA, since AA offers freedom to follow one's own path.[23] Bill Wilson wrote a chapter in the "Big Book" entitled We Agnostics for alcoholics like him who were struggling with the idea of a Higher Power.
"Working the program" might involve the following activities:
- Above all, avoiding the first drink. "One is too many and a thousand never enough."
- Regular attendance at meetings, and participation by talking or listening. Meetings are usually easy to find in large cities, and there are also AA meetings by phone, internet, and mail. For newcomers, 90 meetings in 90 days are often recommended to break the drinking habit and immerse them in a culture of sobriety.
- Regular contact with a sponsor for support in staying and living sober and in working the program.
- Service work, which can range from making coffee at meetings to attending national AA conferences.
- Working the Twelve Steps. For new members the Steps are seen as a path of personal growth towards sobriety. Experienced members often rework all the steps at intervals of a few years, but they at a minimum usually carry out the following activities:
- Regular attention to personal inventory and admission of wrongs (Step Ten).
- Daily prayer and meditation (Step Eleven)
- Carrying the message to other alcoholics (Step Twelve).
The 12 Steps of Alcoholics Anonymous
- We admitted we were powerless over alcohol – that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
The organization of the society
Alcoholics Anonymous has an informal control structure: there is no hierarchy of leaders. Guidelines for group conduct are outlined in the Twelve Traditions (below). A member who accepts a service position (an organizing role in a group) within the society is referred to as a trusted servant, a reference to Tradition 2. A member's commitment to service is held for a limited period, typically three months to one year, after which another member is chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities as each meeting, small or large, is considered a self-governing entity.
At the local and national level, AA groups are self-supporting and not a charity. The society has no membership fees and does not charge to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs such as room rental and refreshments. Contributions from members are limited to a maximum annual amount of $2000 per year, though most only donate $1 to $2 per meeting.
Alcoholics Anonymous does receive proceeds from the sale of its book Alcoholics Anonymous, along with other published books and literature, which are periodically revised. Revenues from literature sales constitute more than 50% of the income for the General Service Office (GSO)[24], which unlike individual groups is not self-supporting through contributions and does have a small number of salaried staff.
Additional to the GSO, Alcoholics Anonymous also maintains a few service centers, which have the task of coordinating activities such as printing literature, responding to public inquiries, and organizing state or national conferences. Funded by local members, the centers are directly responsible to the AA groups in the region or country they represent.
Alcoholics Anonymous is exclusively served by people who identify themselves as alcoholics with the exception that seven of the 21 members of the AA Board of trustees are listed as “nonalcoholic friends of the fellowship”[25].
The 12 Traditions of Alcoholics Anonymous
- Main article: Twelve traditions
The affairs of Alcoholics Anonymous are governed broadly by AA's Twelve Traditions, suggested rules for organizing how the members and groups of the society interact with each other and with AA as a whole (see the book Twelve Steps and Twelve Traditions for more information[26]). These traditions were developed from experiences of the early groups during their first 13 years with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"[27]
- Our common welfare should come first; personal recovery depends upon A.A. unity.
- For our group purpose there is but one ultimate authority – a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
- The only requirement for A.A. membership is a desire to stop drinking.
- Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
- Each group has but one primary purpose to carry its message to the alcoholic who still suffers.
- An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
- Every A.A. group ought to be fully self-supporting, declining outside contributions.
- Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
- A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
- Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
- Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.
- Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.
AA's definition of alcoholism
Although AA lacks an official, singular definition of alcoholism, Dr Silkworth contributed the chapter in the AA basic text of Alcoholics Anonymous entitled "The Doctor's Opinion". That chapter would become one of the more influential pieces in AA thought. He wrote they "have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity."[28] That allergy takes the form of a craving which is explained earlier in the chapter when he states "the phenomenon of craving is limited to this class [alcoholics] and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit ... they cannot break it..."[29] Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.[30]
In the article Alcoholics Anonymous and the Disease Concept of Alcoholism, AA historian Ernest Kurtz wrote, "The closest the book Alcoholics Anonymous comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the 'We Agnostics' chapter, where we are told that alcoholism 'is an illness which only a spiritual experience will conquer'."[31] In 1960, Bill Wilson gave a speech to the National Catholic Clergy Conference on Alcoholism. During the ensuing question and answer discussion, Wilson was asked why he did not use the term disease when he spoke of alcoholism in that speech. He replied,
"We AA's 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 do not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always call it an illness, or a malady, -- a far safer term for us to use."[32]
Research on AA
One reason that many researchers take a skeptical view of AA is that AA is so unscientific because of its spiritual basis.[33] "Membership is voluntary and is determined by the individual, not by the group. There are no membership requirements except for the desire to stop drinking, no dues or fees, no membership lists. AA is notoriously difficult to pin down as an organization," writes Maria Gabrielle Swora.[34] In his book Alcohol: The World's Favourite Drug, addiction specialist Griffith Edwards argues that a randomised trial of AA is not possible because members are self-selected, not randomly selected.[35] In other words, was AA the cause of their sobriety, or did they simply go to AA when they were ready to stop drinking? In spite of the obstacles to obtaining direct evidence, many researchers have tackled the problem of whether AA is effective at creating sobriety.
Project MATCH
Project MATCH was initiated in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).[36] The project was an 8-year, multisite, $27-million investigation that asked whether certain types of alcoholics respond best to specific forms of treatment.[37] MATCH notes "No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients." Three types of treatment were investigated:
- Cognitive Behavioral Coping Skills Therapy, which focuses on correcting poor self esteem and distorted, negative, and self-defeating thinking.[38][39]
- Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.[40]
- 12-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation[36]
All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied.
The conclusion of the research was that patient-treatment matching is not necessary in alcoholism treatment, because the three techniques were approximately equal in effectiveness. In a December 1996 press release[36], NIAAA Director Enoch Gordis, M.D. said "These findings are good news for treatment providers and for patients who can have confidence that any one of these treatments, if well-delivered, represents the state of the art in behavioral treatments."
However overall success rates for all treatments were, and continue to be, less than spectacular. Based on information from Dr. Mark Willenbring of the NIAAA, Newsweek reported in their February 2007 issue that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."[41]
The study has been criticised by addiction expert Dr Stanton Peele as unscientific and politically motivated. Dr Peele stated that the outcomes of the study where at odds with abstinence based programs, as Project MATCH defined a "successful outcome" as a reduction (as opposed to cesation) of alcohol use.[42]
George Vaillant
Dr. George Vaillant is a board member of Alcoholics Anonymous World Service who in 1983 undertook a study to research the effectiveness of AA treatment. He compiled 40 years of clinical studies. He also conducted an eight-year longitudinal study of his own where Vaillant reported having followed 100 patients who had undergone Twelve-Step treatment. Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. His studied showed that 95% of alcoholics who reach AA fail to stay sober.[How to reference and link to summary or text]
In his book The Natural History of Alcoholism Revisited, Harvard psychiatric professor George E. Vaillant posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?"[43] Vaillant's book was partly based on his experience with "a vast collaborative effort" that had started with two studies in the late 1930s and was still running after 60 years.[44] Aware of the difficulties of obtaining direct evidence by statistical methods, he nevetheless states in his summary of literature and personal experience that "... research during the last 15 years has revealed growing indirect evidence that AA is an effective treatment for alcohol abuse." [45]
Despite his own statistics Vaillant continued to argue that AA shows an advantage over other treatments in the long term because, as a cheap, community-based fellowship it is easy for people to keep coming back. He argues that "AA is the most effective means of long-term relapse prevention in the physician’s armamentarium."[46]
He also writes that AA was formed by people deeply distrustful of organised religion, and that AA continues to pass the test of universalism by accepting members regardless of religious conviction. "Would that all 'religions' and fraternal organizations were as benign," he stated.[47]
In 2005, Vaillant produced an extensive study of the efficacy and safety of AA in the treatment of alcoholism, reviewing the published works from 1940 until the present day. In this paper he acknowledges that, although AA is not a magic bullet for every alcoholic in that "there were a few men who attended AA for scores of meetings without improvement."[48], his overall observation is that "multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings." Despite a 95% failure rate Vaillant's overall conclusion is that "Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted."[49]
Moos and Moos
In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA.[50][51] They reported that clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. A conclusion was that "Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."[52]
The Veterans Study
Moos, Mood, and Humphreys carried out a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the U.S.[53]Five of the programs were 12-step based, and five used cognitive-behavioral therapy. The 12-step programs were found to be effective in terms of cost and recovery: over 45% of the men in 12-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. In answer to the often-posed question as to which comes first, AA participation or reduced drinking, the study concluded that the answer is AA.[54]Moos said, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals: "It is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems.[55]
Brandsma et al
A study from 1979 found a correlation between AA and an increased rate of binge drinking. After several months of participating in AA, the alcoholics in AA were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Emotive Behavior Therapy. Brandsma argues that teaching people that they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy.[56] Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness.[57] Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.[58]
J. Scott Tonigan
Tonigan's study found the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. "The magnitude of these benefits did not differ between sites." A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.[59]
Criticism and controversy
Moderation vs. abstinence
The AA program is often challenged in the debate on cutting back versus total abstinence, "one of the most hotly contested issues in alcohol treatment".[60] Treatment available in America, particularly, tends to lean towards total abstinence,[61] even though not all problem drinkers are actually alcohol dependent.[62] AA has been criticized for recommending total abstinence as the only solution,[63] however the AA "Big Book" does make it clear that the program is for alcoholics and that not all drinkers are alcoholics: "Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone. ...[This type of person] can also stop or moderate, although [they] may find it difficult and troublesome and may even need medical attention."[64] Nevertheless, it is likely that some AA members are over-zealous in recommending abstinence to all people with drinking problems.
Disease concept of alcoholism
The concept of alcoholism (and addiction) as a disease is controversial.[65] AA regards alcoholism as a disease,[66][67] and in practical terms AA often uses the concept to challenge the belief of some chronic, compulsive drinkers that they can stay sober by willpower alone.[68] AA has been criticized by opponents of the disease model, especially those who argue that some AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.[69]
Occasions of abuse at meetings
AA groups have the benefits and risks of any community, and it is important to acknowledge that mutual support and abuse are both possible. There is no external restriction or vetting of AA members, and in fact the long-form version of Tradition 3 states that "Any two or three alcoholics gathered together for sobriety may call themselves an AA group..."[70] Newsweek reported on alleged cult-like and abusive behaviour in one controversial Washington DC AA group.[71] One of the women interviewed allegedly experienced pressure to have sex with senior members, and was told to cut off ties with anyone outside the group and to stop taking her antidepressant medication. However this woman reportedly moved to another AA group and was "relieved" to find these practices were not widespread and were contrary to AA philosophy. In the UK in 2000, the Guardian newspaper reported that a leaked internal AA memorandum stated that "volunteer members are increasingly being investigated by police forces examining allegations of sexual abuse."[72] According to the memo, a small minority of members were taking advantage of vulnerable new members who were seeking help by phone or by looking for a sponsor. At that time the AA service board was considering how to deal with the issue on a national level in the UK.
Court mandated AA attendance
Judges in the United States sometimes require attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. "Open" AA meetings are open to anyone who wishes to attend, including those mandated by a court. Court ordered attendees have to answer to the judge, not to anyone in AA. Such forced attendance may not satisfy AA's Tradition 3, which says that "The only requirement for A.A. membership is a desire to stop drinking."
Court decisions can be cited to support the argument that AA is based on religious activities. The New York Court of Appeals ruled in 1999 that mandating attendance at AA meetings compromises the Establishment Clause of the First Amendment right of those sentenced not to have religion dictated to them by government - because AA practices and doctrine are (in the words of the judge who wrote Griffin v. Coughlin[73]) "unequivocally religious". In that ruling it was also noted "adherence to the AA fellowship entails engagement in religious activity and religious proselytization." In "working" the Twelve Steps, participants become actively involved in seeking God through prayer, confessing wrongs and asking for "removal of shortcomings." The United States Supreme Court denied certiorari and let this decision stand.
Grandberg v. Ashland County is another example concerning judicially-mandated AA attendance and the Establishment Clause. In that case the United States Court of Appeals for the Seventh Circuit ruled, "Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue." In Warner v. Orange County Department of Probation a man convicted of drunk driving was sentenced to AA. The court found that the county was guilty of “coercing the plaintiff into participating in religious exercises, an act which tends toward the establishment of a state religious faith.”
Accusations of cult practice
Merriam-Webster defines a cult as "a system for the cure of disease based on dogma set forth by its promulgator". [74] As early as 1963, Alcoholics Anonymous has come under scrutiny as a possible cult. Dr Arthur H. Cain talked of the "religious flavour" the word sobriety had taken in AA, the "slavery" to the group and an over reliance on dogmatic slogans. [75] It is said that AA's need for submission to a higher power leaves potential for abuse, and that that submission can become the basis for cult like cohesion [76]. Various authors have stated that AA "uses all the methods of brain washing, which are also the methods employed by cults", "is able to suppress attitudes that could undermine its traditions" and "provides the prospective affiliate not merely with a solution to problems related to drinking, but also with an overarching world view with which the convert can and must reinterpret his or her past experience". [77] Alcoholics Anonymous, in line with its own traditions, does not comment on accusations of cult behaviour in its groups.
See also
- Alcoholism
- for alternate treatments to AA, see section Alcoholism:Politics and public health
- Al-Anon/Alateen
- Twelve-step program
- AA Grapevine, the international journal of Alcoholics Anonymous.
- Drunkenness
- Substance abuse
- Narcotics Anonymous
- Cocaine Anonymous
- Overeaters Anonymous
- Alateen
Further reading
Books
- Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org and www.BigBook.org.
- Alcoholics Anonymous Comes of Age. A Brief History of AA, New York: Alcoholics Anonymous, 1990, ISBN 0-916856-02-X.
- Living Sober: Some methods A.A. members have used for not drinking, New York: Alcoholics Anonymous, 1975, 1998, ISBN 0-916856-04-6.
- Twelve Steps and Twelve Traditions, New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2.
Articles
- A Randomized Trial of Treatment Options for Alcohol-abusing Workers. The New England Journal of Medicine 325: 775–782.
- Blumberg, Leonard. The Ideology of a Therapeutic Social Movement: Alcoholics Anonymous. Journal of Studies on Alcohol 38: pp. 2122–42.
- Leuba, J.H. (1896). A Study in the Psychology of Religious Phenomenon. American Journal of Psychology 7: 309-385.
- Starbuck, E.D. (1899). The Psychology of Religion, New York: Scribner's.
- Starbuck, E.D. (1897). A Study of Conversion. American Journal of Psychology 8: 268-308.
External links
References
- ↑ What is AA? Defining "Alcoholics Anonymous". The General Service Board of Alcoholics Anonymous (Great Britain). URL accessed on 2006-11-27.
- ↑ Alcoholics Anonymous p 16
- ↑ What is AA? Defining "Alcoholics Anonymous". The General Service Board of Alcoholics Anonymous (Great Britain). URL accessed on 2006-11-27.
- ↑ The AA Fact File, 'The Recovery Program'
- ↑ 5.0 5.1 Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org
- ↑ AA Preamble
- ↑ "Bill W." —Time's "Most Important People of the 20th Century". Susan Cheever. Time 153.23 (June 14, 1999): p201+.
- ↑ Dale Mitchel, Silkworth: The Little Doctor Who Loved Drunks. Hazelden, 2002.
- ↑ Dale Mitchel. Pass It On: The Story of Bill Wilson and How the A. A. Message Reached the World Hazelden. 1984, p 381-385.
- ↑ Finlay, Steven W (2006-3-11). Influence of Carl Jung and William James on the Origin of Alcoholics Anonymous. Review of General Psychology V4: 3-12.
- ↑ Dick B. (1998). The Oxford Group and Alcoholics Anonymous, 2nd ed., Kihei, Maui, Hawaii: Paradise Research Publications, Inc..
- ↑ Bill W. (1957). Alcoholics Anonymous comes of age, New York: Alcoholics Anonymous. ISBN 0-916856-02-X.
- ↑ Dick B. (1998). New Light on Alcoholism: God, Sam Shoemaker, and AA, 2nd. ed., Kihei, Maui, Hawaii: Paradise Research Publications, Inc..
- ↑ Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 179
- ↑ Alcoholics Anonymous p 12
- ↑ Pass it on p 121.
- ↑ Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 144
- ↑ Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 160
- ↑ Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 163
- ↑ Fulton Oursler. "Alcoholics and God." Liberty. September 30, 1939.
- ↑ Jack Alexander. "Alcoholics Anonymous." Saturday Evening Post. March 1, 1941.
- ↑ Alcoholics Anonymous, Appendix III, p 570.
- ↑ http://www.agnosticaanyc.org/faq.html
- ↑ GSO 2005 Operating Results, 'Gross Profit from Literature ~$6.7M (55%), Contributions ~$5.4M (45%)'
- ↑ The AA Fact File, 'The Structure of AA'
- ↑ Twelve Steps and Twelve Traditions, New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2.
- ↑ Alcoholics Anonymous p 561
- ↑ Alcoholics Anonymous page xxx.
- ↑ Alcoholics Anonymous page xxviii.
- ↑ Alcoholics Anonymous p 567
- ↑ Kurtz, Ernest. Alcoholics Anonymous and the Disease Concept of Alcoholism. Alcoholism Treatment Quarterly.
- ↑ A Conversation with Bill W.. URL accessed on 2006-10-20.
- ↑ Vaillant, 1995, p 254.
- ↑ Maria Gabrielle Swora. "The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous." Mental Health, Religion & Culture, Sep2004, Vol. 7 Issue 3, p187-209.
- ↑ Griffith Edwards. Alcohol: The World's Favourite Drug. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. pp 116 – 117.
- ↑ 36.0 36.1 36.2 NIAAA Reports Project MATCH Main Findings, Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.
- ↑ Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." Journal of Studies on Alcohol, 58(1), 7-29.
- ↑ Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2p
- ↑ Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "Rehab Reality Check" Newsweek, 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c
- ↑ Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. Science News v151.n4 (Jan 25, 1997): pp62(2).
- ↑ Adler et al. 2007
- ↑ [1], Stanton Peele article on Project MATCH floors, PsychNews International, Vol. 2, May-June 1997.
- ↑ Vaillant, 1995, p 3
- ↑ Vaillant, 1995, pp vii and ix.
- ↑ Vaillant, 1995, p 265
- ↑ Vaillant, 2005.
- ↑ Vaillant, 1995, p. 267.
- ↑ George E. Vaillant. "Alcoholics Anonymous: cult or cure?" Australian & New Zealand Journal of Psychiatry, Jun2005, Vol. 39 Issue 6, p431-436.
- ↑ Vaillant, 2005
- ↑ "Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals." By: Moos, Rudolf H.; Moos, Bernice S. Journal of Clinical Psychology, Jun2006, Vol. 62 Issue 6, p735-750.
- ↑ See also Moos and Moos. "Rates and predictors of relapse after natural and treated remission from alcohol use disorders." Addiction, 101, 212–222. And Moos and Moos, "Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders." Journal of Consulting and Clinical Pyschology, 2004 Feb;72(1):81-90. (abstract, retrieved 2007-05-04)
- ↑ Moos and Moos, 2006
- ↑ Krista Conger. "Study points out value of 12-step groups in treating substance abuse." Stanford Report, May 23, 2001. Retrieved 2007-05-05.
- ↑ "How effective is Alcoholics Anonymous?" Harvard Mental Health Letter, Dec 2003, Vol. 20 Issue 6, p7-7.
- ↑ http://www.news-medical.net/?id=18958,
- ↑ Brandsma, Jeffrey, Maxie Maultsby, and Richard J. Welsh. Outpatient Treatment of Alcoholism. Baltimore, MD.: University Park Press, 1979. p 105.
- ↑ Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D. (August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". American Journal of Psychiatry 124 (2): pp. 160-163.
- ↑ Bower, Bruce. "AA's motivational benefits." Science News 152.n19 (Nov 8, 1997): 297(1).
- ↑ J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77
- ↑ Nancy Shute. "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 v123 n9, Sept 8, 1997:pp54(10). Page 57.
- ↑ Shute, 1997, p 57 & 60
- ↑ See alcohol abuse (a drinking pattern that causes problems) and alcohol dependence (i.e. alcoholism—an addiction and obsession) in the DSM-IV and the APA Dictionary of Psychology, 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007.
- ↑ Shute, 1997, p 61
- ↑ Alcoholics Anonymous p 20-21.
- ↑ Alan I. Leshner. "What does it mean that addiction is a brain disease?" Monitor on Psychology (American Psychological Association) Volume 32, No. 5 June 2001.
- ↑ A Newcomer Asks (AA pamphlet)
- ↑ The Alcoholic Can Recover (AA pamphlet)
- ↑ Alcoholics Anonymous p 30-31
- ↑ Stanton Peele. The Diseasing of America. Lexington, MA: Lexington Books, 1989.
- ↑ http://www.aa.org/bigbookonline/en_appendiceI.cfm
- ↑ Nick Summers. "A Struggle Inside AA." Newsweek. May 7, 2007.
- ↑ Gerard Seenan. "Drink advice service confronts sex abuse." The Guardian, July 5, 2000.
- ↑ Griffin v. Coughlin. URL accessed on 2006-10-20.
- ↑ "Cult" in Merriam-Webster's Online Dictionary, M-W.com.
- ↑ Arthur H. Cain, "Alcoholics Anonymous: Cult or Cure?." Harper's Magazine, February 1963
- ↑ Mark Dombeck, "Alcoholics Anonymous is a Cult?." MentalHelp.net, Jun 1st 2006. Retrieved 2007-07-23]
- ↑ Jeffrey A. Schaler. "Cult Busting" The InterPsych Newsletter Vol 2, Issue 5, June, 1995.
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