Harvard Mental Health Letter

How Alcoholics Anonymous works

Everyone knows what the initials AA stand for. Founded in 1935, Alcoholics Anonymous is the oldest, best known, and most successful mutual help organization on earth. Its millions of members make it the most widely used treatment for alcoholism, and it has inspired many imitators, including Narcotics Anonymous (NA). By some estimates, as many as 1 in 10 Americans, including two-thirds of those ever treated for alcoholism, have attended at least one AA meeting.

Since 1935 new treatments, including drugs and behavioral therapies, have been introduced for alcoholism. But it often still resists conquest, and Alcoholics Anonymous — ubiquitous and nearly cost-free — still offers the best hope to many. Researchers have begun to consider systematically how and why the AA approach to addiction succeeds or fails, and their discoveries may improve the prospects for treating all substance abusers.

Aims and means

The guiding principles of AA are the 12 steps, promulgated in a volume called the "Big Book" as well as other literature. These guidelines call for a spiritual transformation. Members are supposed to take responsibility for changing themselves and helping others. They are expected to admit that they have lost power over alcohol or other drugs and that their lives have become unmanageable. They seek a spiritual awakening by appealing to a higher power, praying and meditating, admitting sins and errors, making amends to people they have hurt, and finally, carrying the message to others. For Bill W., as the founder of Alcoholics Anonymous was known, the transformation was instantaneous and overwhelming, with mystical overtones. But more often it is gradual, with repeated advances and retreats, in a pattern typical of recovery from addiction.

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