How Does Alcoholics Anonymous Work?

Alcoholics Anonymous (AA) stands as a symbol of hope for millions worldwide who are battling alcohol misuse. However, for those who may be unfamiliar with its principles, AA’s inner workings might be a bit of a mystery. Why do so many people attribute their journey to sobriety to AA and how does it remain one of the most common treatments for alcohol misuse?

Whether you’re considering attending a meeting or you’re just curious about how AA works, understanding its concepts and the program’s support can help you decide whether it's right for you.

The Beginnings of Alcoholics Anonymous (AA)

AA dates back to 1935 when a New York stockbroker (Bill W.) and an Akron, Ohio, surgeon (Dr. Bob) crossed paths. Both men had been in contact with the Oxford Group, a nonalcoholic fellowship that emphasized the spiritual values in daily living. It was only after the two met that they were able to achieve sobriety, sparking the founding of AA. 

The first AA group started in Akron’s City Hospital. The second group formed in New York and the third in Cleveland. After four years, the three groups had helped 100 people achieve sobriety. In 1939, the founders published what is known as “The Big Book,” the basic textbook titled Alcoholics Anonymous, which explains AA’s philosophy and methods. It also offers case histories. 

Over time, AA continued to expand, and its teachings became more popular and widespread. Significant events, including Dr. Bob’s work in hospital care for alcoholics and the AA General Service Conference, integrated AA’s teachings into medical care, introduced it to other agencies, and ensured the ongoing functioning of AA. Despite the passing of AA’s founders, its teachings and presence endure in some 180 nations around the world. Today, AA continues to promote the 12 Steps of recovery on which the group was founded. Let’s learn more about the 12 Steps and why they’ve helped many achieve sobriety.

AA’s 12-Step Program

The 12 Steps were created to establish a clear path to overcoming alcohol addiction. They were inspired by spiritual ideas centered around honesty, faith, humility, and repentance. Although the 12 Steps may vary slightly between groups, the core ideas remain intact.

• Admittance. “We admitted we were powerless over alcohol — that our lives had become unmanageable.” The first step to change is admitting that we may have an issue.
• Faith. “Came to believe that a Power greater than ourselves could restore us to sanity.“ The second step focuses on the belief that we can begin to change. 
• Trust. “Made a decision to turn our will and our lives over to the care of God as we understood Him.” In this step, we put our faith in a higher power while making a commitment to turn our life around. 
• Honesty. “Made a searching and fearless moral inventory of ourselves.” This step calls for us to be honest in our self-reflection — identifying habits and values we can improve.
• Courage. “Admitted to God, to ourselves, and another human being the exact nature of our wrongs.” By admitting that we have a problem, we develop the courage to move forward.
• Willingness. “We’re entirely ready to have God remove all these defects of character.” Now that we’ve identified aspects of our life we want to improve and developed the courage to make these changes, this step calls for a deeper commitment to change.
• Humility. “Humbly asked Him to remove our shortcomings.” This step is rooted in the idea that humility can help enact positive change. 
• Forgiveness. “Made a list of all persons we had harmed, and became willing to make amends to them all.” By making a list, we acknowledge those we may have hurt — urging us to forgive ourselves and to seek forgiveness from others.
• Reconciliation. “Made direct amends to such people wherever possible, except when to do so would injure them or others.” This action helps us mend relationships that may have been damaged due to our drinking habits. 
• Perseverance. “Continued to take personal inventory and when we were wrong promptly admitted it.“ This step encourages us to persevere despite the challenges and setbacks of recovery.
• Patience. “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.“ This step calls for us to be patient with ourselves and our spiritual healing.
• Love. “Having had a spiritual awakening as a result of these Steps, we tried to carry this message to alcoholics, and to practice these principles and all these affairs.” The last step is self-compassion and compassion toward others who may also have been in a similar situation as ourselves.

These steps are the basis of AA’s program to help members achieve sobriety. Also integral to AA are the 12 Traditions (not to be confused with the 12 Steps).

The 12 Traditions of AA

AA helps its members achieve recovery by fostering a sense of community and promoting personal growth and responsibility. The 12 Traditions differ from the 12 Steps in that the traditions are less about individual acts and more about the principles of AA overall. The traditions aim to unite AA members and ensure the organizations stays true to its founding values.

1. Unity. The first tradition states that the welfare of the group comes first, as personal recovery depends on the unity of AA.
2. Group Conscience. The second tradition notes that AA leaders do not govern the group, as God is the ultimate authority. 
3. Membership Requirements. The only requirement is the desire to stop drinking.
4. Autonomy. This tradition states that every group is autonomous, except in matters that affect other groups or AA as a whole.
5. Primary Purpose. The purpose of the group is to carry the message of AA to those who are struggling with alcohol misuse.
6. Non-Affiliation. AA pledges to not endorse external agencies, as doing so may distract from the main purpose of the group. 
7. Self-Support. AA groups are self-supporting and do not accept outside contributions. 
8. Non-Professionalism. AA is non-professional, but its service centers may employ professional workers. 
9. Service Structure. This tradition states that AA should not be organized but does allow a service committee to be responsible for those it serves. 
10. Non-Opinion. AA pledges to have no opinions on outside matters in order to stay out of public controversy. 
11. Attraction. AA aims to attract rather than promote — maintaining personal anonymity in the media.
12. Anonymity. The last tradition is a key aspect — reminding their members to place its principles ahead of personalities. 

A more thorough explanation and application can be found in a book written by one of AA’s founding members, Twelve Steps and Twelve Traditions. AA also has additional literature and resources that delve into other major concepts of the program and provide guidance on specific applications.

Key Literature and Resources of the Program

The practices of AA remain strong today, as many of its teachings are well-documented in key literature and resources of the program. Alcoholics Anonymous, also known as “The Big Book,” is one of the core components, as it provides background on AA, stories of how the first members got sober, and information on how to seek recovery. The basic text has helped many people recover from alcohol use disorder (AUD) since the first edition was published in 1939.  

Another helpful resource written by AA members for AA members is Daily Reflections, a collection of inspirational messages about living sober every day of the year. More specific resources such as AA and the Armed Services, AA as a Resource for the Healthcare Professional, and AA for Alcoholics with Mental Health Issues can be found as pamphlets on the AA website. 

Online resources can also be found on the AA Grapevine website and AA’s Meeting Guide App. The app not only identifies resources but also locates nearby meetings. So, If we decide to take the step to attend a meeting, what can we expect?

How It Works: AA Meetings

AA hosts two main types of meetings — open and closed. Open meetings are for anyone interested in AA’s program. Closed meetings are for members coping with alcohol misuse and seeking change and support. Both meetings are conducted by AA members who decide the format of the meetings. The common meeting formats include discussion meetings, speaker meetings, step meetings, and Big Book study meetings. 

Although each type of meeting may differ slightly, the meeting elements remain similar:

• Readings. The meeting usually opens with the AA Preamble, or purpose. Other elements such as a moment of silence, reciting the Serenity Prayer, and introductions may also occur before the readings. Then, readings from the Big Book begin. “How It Works” or “More About Alcoholism” are common chapters that are read during the meetings.
• Sharing sessions. After the readings, the “chairperson” will propose a topic to be discussed, such as a specific step or challenges members face. Sharing isn’t mandatory but can be beneficial. 
• Sponsorship announcements. A sponsor in AA offers guidance and support. Oftentimes, newer members looking for a sponsor may stay to explore sponsoring. There is no requirement, however, to have a sponsor.

After the meeting, some people may stay and chat. It’s a great opportunity to connect with others on a similar path. Despite the popularity of AA, however, its effectiveness remains in question. Let’s examine its success rate and challenges.

Effectiveness and Challenges of AA

Although AA is one of the most widely known options for addressing alcohol addiction, its effectiveness is less clear. Some sources claim that AA has a low success rate at 5% while addiction specialists report a slightly higher rate at 8%–12%. The Big Book claims a success rate of 50%, and a 2020 review found that none of the studies found AA to be less effective than other interventions or no intervention. While the review shows that AA is at least effective across the board, research shows that about 40% drop out of the program within the first year. Overall, the effectiveness of AA is not definitive. 

AA may be well known, but it does face skepticism. As we’ve learned, much of AA is based on the concept of a higher power, which everyone is not comfortable with. Additionally, AA is structured around meetings, and if we’re not able to attend regularly, we may not receive the full benefits of the program. An effective treatment program for alcohol misuse should meet an individual’s specific needs, which is why AA may not be a good fit for everyone.

Although AA may not work for everyone, the element of support during recovery can be beneficial. Let’s take a closer look at the positive aspects of support groups in general during the recovery process. 

Benefits of Support Groups in Recovery

Support groups don’t need to be rigidly structured and formatted. They can be as tight-knit as a group of friends who’ve had similar experiences or as noncommittal as a public forum where we can share and learn from each other. No matter which format we prefer, support groups can provide many benefits:

• Sense of community. A common aspect of alcohol misuse is social isolation. It can push us deeper into dependence as we don’t have outside support. Participating in a support group helps us realize that our personal struggles are often shared experiences. 
• Reduced rate of relapse. Support groups can serve as motivation and accountability. While relapse is a common experience in recovery, support from peer groups can help reduce the rate.
• Increased retention. Doing hard things with others can be easier than doing them alone. Hence our gym buddy or go-to coworker. The presence of peers in support groups can increase retention — bolstering success rates of recovery. 
• Improved relationships. The sense of community in support groups along with our commitment to change can have a positive impact on our personal relationships.

Support groups like AA can help us on our path to recovery, but if we don’t align with some of AA’s values or just want to try something else, what other options are there?

Treatment Options Aside From AA

Just as some of us may enjoy running while others prefer gentle movement like yoga for our daily exercise, some alcohol misuse treatment options may work better for us than others. Luckily, there are many options we can explore: 

• SMART Recovery. This is another major international community of peer support groups. Unlike AA, SMART highlights the importance of self-reliance and is based on six stages of change.
• LifeRing. LifeRing is another anonymous, peer-led recovery group that differs from AA in that it is secular. The three philosophies of LifeRing include sobriety, secularity, and self-help.
• Women for Sobriety (WFS). WFS is the first peer support program tailored specifically for women. Their New Life Program focuses on positive reinforcement, cognitive strategies, overall well-being, and group involvement. 
• Moderation Management (MM). MM is another secular, peer-run support group. It focuses on supporting those who are looking to improve their relationship with alcohol and make other positive lifestyle changes. 
• Secular Organizations for Sobriety (SOS). Also known as Save Our Selves, SOS focuses on abstinence by breaking the cycles of sobriety. The three main elements of SOS are acknowledgment, acceptance, and prioritization of sobriety. 
• Alcohol reduction apps. Apps like Reframe feature support groups to help us connect with others who may have similar experiences. We can be a part of a supportive community right from the convenience of our phones. 

AA can be beneficial for some of us, but it does have its shortcomings. Fortunately, other options like those above can help us in our recovery by meeting our specific needs.

Moving Forward

AA is a bit like Cinderella’s glass slipper — the shoe doesn’t fit everyone. Its philosophy and support program have paved the way for other treatment models and can be beneficial for some seeking sobriety. Its spiritual basis and prescriptive structure, however, can prevent some of us from reaping AA’s peer-support benefits.

Happily, there are many ways we can stay on the path to recovery!