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Alcoholics Anonymous

Author: Julie Caulier Grice
Published Date: 10 April 2008

To help people with an alcohol addiction give up drinking through the support of an informal society.

After smoking, alcoholism kills more people in the UK than any other drug. According to government statistics, one in thirteen adults is dependent on alcohol. 33,000 people die each year due to alcohol-related incidents or associated health problems. Alcohol is involved in 15 percent of road accidents, 26 percent of drownings, and 36 percent of death in fires. A quarter of accidents at work are also drink-related. In 2004/05, there were around 35,600 admissions to the NHS with a primary diagnosis of mental and behavioural disorders due to alcohol.

Idea AA revolves around regular weekly meetings of men and women who come together to share their experiences of alcoholism and offer support and hope for others as they try and recover from alcoholism. There is an open membership policy and the only requirement is the desire to stop drinking. The attributes that normally distinguish people from each other are ignored while the one thing which members share: (alcoholism) is emphasised. AA was one of the first organisations to provide common sustained treatment for the recovery of alcoholics regardless of financial status, combining religious, psychological and medical support and insights. AA works on the basis of a very simple concept: recovering addicts provide support for other alcoholics to work through a prescribed twelve-step programme to recovery. Implementation AA was born in the summer of 1935 after a chance meeting in Akron, Ohio between Robert Holbrook Smith, a local doctor (‘Doctor Bob’), and William Wilson, a New York stockbroker. Wilson told Doctor Bob in very persuasive terms that alcoholism was a malady of the mind and body. He also told him how he managed to remain sober by attending the meetings organised by the Oxford Group Movement, (a mostly non-alcoholic fellowship that emphasized universal spiritual values in daily living), taking part in their small discussion groups and following their precepts: confession, honesty, talking out of emotional problems, unselfishness, making reparations and praying to God as personally conceived.

Doctor Bob was greatly moved by listening to the experience of a fellow sufferer, and was persuaded to stop drinking. Both men set out to work with alcoholics in Akron City Hospital, gathering them together to share experiences and their common struggle against alcoholism. By the end of 1935, a second group started to take shape in New York, and a third opened in Cleveland in 1939. In the same year the foundational book Alcoholics Anonymous was published, which explained AA’s philosophy and methods, including the famous Twelve Steps of Recovery. The Twelve Steps had been developed by trial and error over the preceding four years and contained some case studies of early members. Scaling up The organisation received initial support and funding from John Rockefeller, resulting in a series of sympathetic newspaper articles which gave AA a heightened profile and subsequent rise in membership. Membership jumped to 6,000 by 1941 and by 1950 had risen to 100,000. In 1950, AA held its first national conference in Cleveland, where its founding fathers stressed the importance of keeping the organisation as simple as possible. It was also here that the AA’s Twelve Steps to guide the alcoholic’s recovery and the twelve principles to guide the alcoholic’s relationships within the organisation and the outside world were consolidated.

In autumn of 1948, the first group was formed in London, others quickly following in Scotland and Wales. By 1959, the General Service Office in London was able to put out a list of over 100 AA groups. Twenty years later there were over a thousand groups operating in the UK. AA is successful because it spread not its organisation, but its basic idea. It operates with little formal structure and under conditions of anonymity. As an organisation it has two operating bodies: 1) AA World Service is based in New York and takes care of administrative tasks with a core staff of 79 who maintain links with local groups and prepare and distribute literature. 2) AA Grapevine Inc. publishes and distributes the AA magazine, the Grapevine. These two bodies are answerable to a General Service Body which is comprised of trustees who act to safeguard AA’s traditions. A general service conference is held annually involving delegates from AA local groups and the General Service Body, thus maintaining links between the centre and the periphery. Local groups are autonomous and self-funding with the hiring of halls and sundries financed through ‘passing around the hat’. AA manages to avoid many problems commonly affecting other organisations as they grow: lack of shared purpose between core and periphery, dilution of the original idea, lack of capacity to deliver – through its stripped down, basic organisational structure and emphasis on a core, straightforward, unalterable tradition, which is enshrined in The Big Book. Simplicity combined with the altruistic nature of the treatment which uses participants as ambassadors and mentors, helps spread the work of AA and increases membership.

AA now has 2 million members with over 60,000 groups in Canada and the USA. Groups operate in 180 countries around the world. AA also receives institutional support within the prison services of many countries and attendance of AA meetings often accompanies sentencing. Moreover, in societies where traditional support structures (church, family, neighbourhood) are in decline, AA and other mutual aid groups represent an important component of primary healthcare and provide an invaluable support structure for those in need. Challenges The early success of AA in North America was due in part to its strong resonance with the cultural ideas emerging at the time around the need to be self-reliant, individually driven to overcome hardship, and to take personal responsibility for success. AA operates in diverse religious settings, developed and developing countries, nations with private medical care and state health-care. However, development has been uneven. Outside of South Africa and Zimbabwe, there are few groups in the rest of Africa. Eastern Europe has also been slow on the uptake, while members in India and the Middle East tend to be employees of foreign firms. This can partly be explained by the tradition at AA meetings of members sharing their own life histories with others, regardless of class, gender, race, religion, or social status. Thus, cultures which put a high premium on privacy in emotional or social terms, or where people are ‘fixed’ within highly differentiated roles and relationships, have found it difficult to accommodate the core principles of mutual aid groups like AA.

AA’s early success lay in part upon its insistence that individuals, and groups of individuals collected in cohesive groups, should focus their ethical work on changing themselves and supporting others. In addition, AA did not engage in the public politics of alcohol consumption that was growing rapidly in 1940s and 1950s America. The ‘alcohol problem’ was viewed as the problem of the alcoholic, not the alcohol industry or wider culture. AA has never set itself against the alcohol industry, nor undertaken any lobbying or advocacy work to try and temper the rise of the drinking culture in modern societies. There are also questions over the effectiveness of AA. In reality, AA’s success rate is difficult to establish when compared to other treatments for alcohol abuse, (though it is usually argued to fare no better or worse). Assessment is made harder by the fact that it keeps no membership and is a loose affiliation. Randomised controlled trial research would also struggle to identify AA as a unique cause for success against alcoholism, because many people attending AA are also engaged with other therapeutic practice.