Alcoholics Anonymous

Alcoholics Anonymous (AA) is a global, peer-led mutual-aid fellowship focused on abstinence-based recovery from alcoholism through its spiritually inclined Twelve Steps. AA's Twelve Traditions, besides emphasizing anonymity and being free to all with no governing hierarchy, position AA as non-promotional, non-professional, as well as unaffiliated while having no politics or a creed members must swear to. In 2021 AA estimated it was active in 180 countries with nearly two million members—73% located in the United States and Canada.

AA dates its origin to a 1935 Ohio meeting between Bill Wilson (Bill W) and Bob Smith (Dr. Bob). (Other members commonly go by first names and last name initials.) Meeting through the Christian revivalist Oxford Group, they continued under its aegis to fellowship with other alcoholics until forming what became AA. In 1939 the fellowship introduced its Twelve Steps with the publication of Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism; usually known as "the Big Book". Later editions amended the subtitle with "Thousands of Men and Women".

The Twelve Steps are a suggested, ongoing self-improvement program to abstain from alcohol through the aid of personally defined, but not required, "God as we understood Him". The steps begin with an acknowledgment of powerlessness over alcohol and the unmanageability of life due to alcoholism. Subsequent steps emphasize rigorous honesty, including the completion of a "searching and fearless moral inventory", acknowledgment of "character defects", sharing the inventory with a trusted person, making amends to individuals harmed, and engaging in regular prayer or meditation to seek "conscious contact with God" and guidance in following divine will. The final step, the 12th, focuses on maintaining the principles of recovery, sharing the message with other alcoholics, and participating in "12th Step work," such as peer sponsorship, organizing meetings, and outreach to institutions like hospitals and prisons.

AA meetings differ in format, with variations including personal storytelling, readings from the Big Book, and open discussions. While certain meetings may cater to specific demographic groups, attendance is generally open to anyone with a desire to stop drinking alcohol. The organization is self-supporting through member donations and literature sales. Its operations follow an "inverted pyramid" structure, allowing local groups significant autonomy. AA does not accept external funding or contributions.

Empirical evidence supports AA's efficacy. A 2020 Cochrane review found that manualized AA and Twelve-Step Facilitation (TSF) therapy demonstrated higher rates of continuous abstinence compared to alternative treatments, including cognitive-behavioral therapy, and resulted in healthcare cost savings over time.

Criticism of AA has addressed various aspects of its program and operations. Concerns have been raised about its overall success rate, the perceived religious nature of its approach, and allegations of cult-like elements. Additional critiques include reports of "thirteenth-stepping", where senior members engage romantically with newer members, and legal challenges related to safety and the religious content of court-mandated participation in AA programs.

Rowland Hazard's journey from Carl Jung's psychiatric treatment to spiritual conversion through the Oxford Group played a pivotal role in shaping the foundations of Alcoholics Anonymous, influencing its principles of recovery. In 1926, Hazard went to Zurich, Switzerland, to seek treatment for alcoholism with psychiatrist Carl Jung. When Hazard ended treatment with Jung after about a year, and came back to the US, he soon resumed drinking, and returned to Jung in Zurich for further treatment. Jung told Hazard that his case was nearly hopeless (as with other alcoholics) and that his only hope might be a "spiritual conversion" with a "religious group".

Back in America, Hazard went to the Oxford Group, whose teachings were eventually the source of such AA concepts as "meetings" and "sharing" (public confession), making "restitution", "rigorous honesty" and "surrendering one's will and life to God's care". He became converted to a lifetime of sobriety while on a train ride from New York to Detroit after reading For Sinners Only, by Oxford Group member AJ Russell. Hazard underwent a "spiritual conversion" with the help of the Group and began to experience the liberation from drink that he was seeking. Members of the group introduced Hazard to Ebby Thacher, whom Hazard brought to the Calvary Rescue Mission, directed by Oxford Group leader Sam Shoemaker.