Alcoholics Anonymous & the 12 Steps to Recovery
What is Alcoholics Anonymous?
Alcoholics Anonymous (AA) is a self-help fellowship designed to provide mutual support to people in recovery from alcohol addiction. According to its website, members “share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.”
Groups are found almost everywhere across the globe; in fact, there are currently more than 115,000.1 AA meetings gather regularly to discuss their experiences with alcohol and its effects on their lives. They provide support to each other as they work through the 12 steps of recovery. Groups consist of men and women from different cultural, social, and economic backgrounds. They all have different experiences and histories with alcohol, so there’s no standard type of member.2
There are no requirements to attend an AA meeting other than having a desire to quit drinking. It is also not associated with any organization, sect, politics, denomination, or institution. Those attending AA make a commitment to join voluntarily, via court-mandated rehab, or as a continuation of therapy.
The 12 Steps of AA
AA is based on the 12 steps of recovery; it has a spiritual foundation that involves turning over your life to a “higher power.” According to AA, the 12 steps are as follows:3
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- We came to believe that a Power greater than ourselves could restore us to sanity.
- We made a decision to turn our will and our lives over to the care of God as we understood Him.
- We made a searching and fearless moral inventory of ourselves.
- We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- We were entirely ready to have God remove all these defects of character.
- We humbly asked Him to remove our shortcomings.
- We made a list of all persons we had harmed and became willing to make amends to them all.
- We made direct amends to such people wherever possible, except when to do so would injure them or others.
- We continued to take personal inventory and when we were wrong promptly admitted it.
- We 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.
These 12 steps were originally laid out in the textbook of AA, which is known as “The Big Book.” The idea behind AA is that people attain sobriety by working through each of these 12 steps in order, and with the assistance of a sponsor (someone who has had a longer time in recovery who can guide the person in recovery through times of crisis) and the fellowship of the group. The more a person can fully work through these steps, the more effective AA is believed to be.4
Facilitating Participation in 12 Step Groups
People who are interested in participating in a 12-step group like AA may have doubts or be unsure of whether they are ready (or willing) to become a member of a group. To help people increase their motivation to join, a highly-structured type of treatment known as 12-Step Facilitation Therapy was developed.
According to the National Institute on Drug Abuse (NIDA), this therapy focuses on promoting 3 main principles:5
- Acceptance, meaning helping the person understand that alcoholism is a progressive and incurable disease that cannot be resolved by willpower alone and that requires abstinence.
- Surrender, or admitting helplessness over alcohol and turning yourself over to a higher power.
- Encouraging active involvement in 12-step groups.
People who facilitate this type of therapy usually focus on helping someone with the first 5 steps of recovery. During treatment, participants are not only encouraged to join 12-step groups, but they are also advised to keep a journal of their experiences and attendance.
Therapy sessions generally follow the same format every week and involve “symptoms inquiry, review and reinforcement for AA participation, introduction and explication of the week’s theme, and setting goals for AA participation for the next week,” according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).6
Does AA Work?
Because AA is anonymous, it can be difficult to research its effectiveness, which is why a variety of clinical reviews offer mixed results. For example, one clinical review published in the Journal of Addictive Diseases found that only 2 studies out of the many examined had a positive finding for AA effectiveness.7 This does not mean that Alcoholics Anonymous is not effective, but that it is difficult for researchers to examine.7
One clinical review from the Alcoholism Treatment Quarterly reported the results of a survey that examined the perception of AA’s helpfulness among people involved in “abstinence-based treatment programs, a moderation-based program, and individuals not in treatment,” and found that 42.3% of participants found AA helpful, 18.2% had mixed comments, 19.2% found it unhelpful, and 20.3% did not mention AA.8
Yet another clinical review shared the results of a long-term study that found that, by the 8-year follow-up, 46% of people in formal treatment reached abstinence compared with 49% of the AA-only group.9
An article published in Scientific American shared the results of a 2006 study that examined problem drinkers who tried to quit on their own, participated in AA, or sought the help of a professional therapist.10 The results found that among those who attended at least 27 weeks of AA meetings during their first year in recovery, 67% remained abstinent at the 16-year follow-up, compared with 34% of those who did not participate in AA.10
Can AA Take the Place of Addiction Treatment?
AA alone is not typically sufficient enough for people to recover from alcohol dependence because they also generally need additional support to detox safely from alcohol, as well as learning how to manage alcoholism and avoid relapse in the future.
Because alcoholism is a lifelong disease similar to other chronic medical conditions (e.g., cancer, asthma, diabetes), there is no cure for it. However, with professional treatment and ongoing recovery efforts, it can be successfully managed.
Effective treatment for alcohol dependence usually begins with detox, followed by inpatient or outpatient rehab, depending on the extent of your addiction.11 Different therapies are provided and may include:12
- Behavioral treatments help you identify the reasons you developed an addiction and teach you the skills you’ll need to move forward in your life and prevent relapse.
- Medications, which can help you stop drinking and prevent relapse.
- Self-help groups, which are a way to obtain additional support.
Research shows that about one-third of people who receive treatment for alcoholism show no further symptoms one year later and have fewer alcohol-related issues.11 NIDA points out that self-help groups like AA can “complement and extend the effects of professional treatment,” and that most treatment programs encourage participating in these groups.13
FAQs About AA
Some of the most common questions about Alcoholics Anonymous include:14
- Does AA cost money? No, AA is free of charge.
- When should you go to AA? You can go to AA when you feel that alcohol has become a problem for you or even if you’re not yet sure. Anyone interested in AA is welcome at open meetings.
- Can you just walk into an AA meeting? Most people start by just attending a group in their area, which you can find on their website. Be aware that there are two options for meetings. Open meetings are group meetings that any member of the community may attend, and closed meetings are for members of AA only.
- Do you have to be religious? AA is not a religious society, though it is based on certain spiritual values. Individuals are free to interpret these values in the way that best suits their needs.
- Once I stop drinking, can I stop going to meetings? Though you are able to stop going to meetings at any time, it can be beneficial to continue to attend meetings in order to reduce the risk of relapse.
. Alcoholics Anonymous World Services. (2014). 2014 membership survey.
. Alcoholics Anonymous World Services. (2017). This is AA.
. Alcoholics Anonymous World Services. (2016). The twelve steps of Alcoholics Anonymous.
. Center for Substance Abuse Treatment. (1999). Treatment of adolescents with substance use disorders. (treatment improvement protocol (TIP) series, no. 32.) Chapter 4—Twelve-step-based programs. Rockville, MD: Substance Abuse and Mental Health Services Administration.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition) 12-step facilitation therapy (alcohol, stimulants, opiates).
. National Institute on Alcohol Abuse and Alcoholism. (1999). Twelve step facilitation therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence.
. Kaskutas, L. (2009). Alcoholics anonymous effectiveness: faith meets science. Journal of Addictive Diseases, 28(2), 145–157.
. Krentzman, A. R., Robinson, E. A., Moore, B. C., Kelly, J. F., Laudet, A. B…Strobbe, S. (2010). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcoholism Treatment Quarterly, 29(1), 75–84.
. Kelly, J. F., & Yeterian, J. D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33(4), 350–355.
. Lilienfeld, S. & Arkowitz, A. (2011). Does Alcoholics Anonymous work? The Scientific American.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for alcohol problems: Finding and getting help.
. Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health and Research World, 22(1), 5–12.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition): Where do 12-step or self-help programs fit into drug addiction treatment?
. Alcoholics Anonymous World Services. (2018). Frequently Asked Questions About A.A.