Twelve-step programs include the namesake organization, Alcoholics Anonymous (AA), and other mutual help programs that are modeled on the 12 steps of AA. Their unifying assumption is that the most effective and efficient path to recovery from alcoholism, addiction, and other problems is the dynamic of mutual help—one addict helping another. AA’s primacy and influence make detailed knowledge of its approach essential to understanding twelve-step programs in general.
Since the founding and development of Alcoholics Anonymous in the United States during the late 1930s, numerous programs representing a broad range of maladies have utilized the general principles of AA, the 12 steps. Initially concentrated in North America, AA and its spin-offs have progressively been adapted and implemented in significant areas of the world.
Alcoholics Anonymous History
On May 11, 1935, a failed, middle-aged New York City stockbroker, William Griffith Wilson, was in the lobby of the Mayflower Hotel in Akron, Ohio, facing a decision of whether to drink or maintain his 5 months of sobriety. Drawing upon knowledge of what would later be called “12 stepping,” the recovering alcoholic decided to reach out and try to remain sober by working with another alcoholic. Through a series of telephone contacts, ending with Henrietta Siberling, he was put in touch with Robert Holbrook Smith, an alcoholic and a practicing surgeon. Although not immediately successful, Dr. Smith did achieve sobriety a month later, thus laying the cornerstone upon which an association of alcoholics premised their recovery on the concept that one alcoholic working with another was an effective method of becoming sober and maintaining sobriety.
The moral tone and fundamental traditions from which Alcoholics Anonymous evolved were prevalent in American and European religious and philosophical thought in the 1800s in organizational forerunners, including the Washingtonian Society and the Oxford Groups. Bill Wilson, in particular, was strongly influenced by the philosophy and theology of William James and by currents of popular psychoanalytic thought that led AA to combine a spiritual, scientific, and medical approach to the treatment of alcoholism.
A brief description of AA is provided each month in the Grapevine, AA’s international journal. Typically, this description is read at the beginning of AA meetings:
Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.
The core of the AA program and the basic dynamics of recovery are best conveyed through the organization’s 12 steps:
- 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 12 steps provide a systematic and pragmatic regimen as well as a broad philosophy of life. Members of AA and other twelve-step programs use phrases like “working the steps” or “working the program.” Whatever the malady (alcoholism, drug addiction, gambling), the beginning of recovery starts with admission of the problem and the commitment to cease the behavior “one day at a time.” Group participants strive to “transcend” their problems and themselves by becoming other-centered rather than self-centered. Specifically, they come to trust and depend on others— whether it be God or a Higher Power, the group itself, a sponsor, or other addicts. In group jargon, “In order to keep it, you have to give it away.” Dependence on others and the belief that by helping others one helps oneself defines twelve-step programs as mutual-help rather than self-help groups.
The basic activity of twelve-step programs takes place in meetings at which participants share their experience, strength, and hope. In some meetings, participants provide personal testimonials; in other meetings participants discuss aspects of the program (e.g., one of the steps) or topics of interest or issue for specific members. In all meetings, the central dynamic is to highlight the value and the benefit of the new or sober life versus the old, addicted life and to attribute these changes to successfully working the program. In addition to meetings, working the program takes place in informal settings (open houses or club houses), in relationships between members and sponsors, and through helping others (twelve-step work).
Membership and Growth
AA initially grew slowly through personal contact and word of mouth in Akron/Cleveland, Ohio, and in New York City. With the publication in 1939 of the “Big Book” (Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have
Recovered from Alcoholism), an article in the Saturday Evening Post by Jack Alexander in 1941, and endorsement by influential people, membership reached 100,000 by 1950. Membership climbed to a million by the late 1970s and stands at more than 2 million today. These figures are estimates—probably conservative—since the organization maintains no official membership list or files.
Other Twelve-Step Programs
The AA program has spawned satellite, copycat, and spin-off organizations. Al-Anon and Alateen, both satellite organizations founded in the 1950s, focus their attention on family and friends. Copycat organizations include Narcotics Anonymous and Gamblers Anonymous, founded in the 1950s, and Co-Dependents Anonymous, founded in the late 1970s. More recently formed and less well-known groups include Debtors Anonymous, Spenders Anonymous, Emotions Anonymous, and Sexual Compulsives Anonymous. Spin-off organizations take selected aspects of AA ideology and practice and specifically reject others. For example, Rational Recovery and Secular Organization for Sobriety, founded in the 1980s, and the Society of Links in Sweden, founded in the 1940s, reject the spiritual and religious implications of AA while accepting repentance, restitution, and transcendence.
Popularity and Effectiveness
Anecdotal and popular data abound, but definitive empirical data remain limited. The 1990 U.S. National Alcohol Survey indicates that 13 percent of adults ages 18 and older, approximately 24 million, reported having attended a twelve-step meeting. While many of these were seeking help, some were likely supporting family members and others attending as part of an educational experience or requirement. The 2000 National Longitudinal Alcohol Epidemiologic Survey (NLAES) found that of individuals who had sought help because of drinking, nearly 76 percent also reported having attended a twelve-step meeting. Research generally shows that these programs are as effective as, and sometimes more so than, professional treatment. Twelve-step programs have other advantages. Among others, they are anonymous, usually free and voluntary, with the added benefit of 24-hour-a-day guidance and support as needed from group members and a personal sponsor.
From a humble beginning, two men, Bill Wilson and the aforementioned Robert Smith, became the founding fathers of the Fellowship of Alcoholics Anonymous and began a revolution in alcoholic recovery, which, in turn, has been applied to many walks of life. As a consequence, AA principles and philosophy have gained widespread, if not universal, acceptance, and their program of recovery has been adapted for usage in nearly every category within the world of addiction treatment.
- Alcoholics Anonymous. 2006. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. 5th ed. New York: Alcoholics Anonymous World Services.
- Humphreys, Keith. 2004. Circles of Recovery: Self-Help Organizations for Addictions. New York: Cambridge University Press.
- Room, Robin. 1993. “‘Healing Ourselves and Our Planet’: The Emergence and Nature of a Generalized Twelve-Step Consciousness.” Contemporary Drug Problems 19:717-40.
- Rudy, David R. 1986. Becoming Alcoholic: Alcoholics Anonymous and the Reality of Alcoholism. Carbondale, IL: Southern Illinois University Press.
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