Some basics about Alcoholics Anonymous

• AA was the first of what is now known as 12 Step Programs
  
  Since 1935, over 30 fellowships have evolved using the 12 steps, traditions and/or concepts of service for a variety of addictive substances and compulsive behaviours, like eating, shopping and working.
  
  The latter programs cannot be addressed by simply not eating, shopping or working and so definitions of “abstinence” are not as black and white as they can be for drugs such as alcohol, heroin, nicotine etc.
  
  Workalcoholics Anonymous, (WA,) as one of the newest fellowships, has addressed some of the ways in which our more modern societies understand a range of issues such as gender, spirituality, trans-generational trauma, brain chemistry etc.
  
  For example, WA proposes work addiction as being an adrenaline addiction, aided and abetted by other “feel good” brain chemicals, and does not ignore the broader social causes and/or influences.
  
  Check out Workalcoholics Anonymous here
  

• AA is an abstinence program.
  
  Abstinence programs for smoking, heroin use and other drugs are respected and supported by our society, so why not abstinence from alcohol?
  
  There are many factors influencing anti-abstinence attitudes - our culture's long history with alcohol use, its entrenched manufacture and distribution in our society, the peer group pressure for all to drink (because a sober person is more in control and thus could be a threat), the widespread lack of understanding of alcohol as a drug to name a few.
  
  

• Whilst many of people can get away with dangerous behaviours whilst drinking, the truth is that a person or other people can die in a single bout of drinking - a fall resulting in a brain bleed, a motor vehicle accident, a fight that becomes violent. However, higher chances exist for regular and heavy drinkers.
  
  Alcohol as a depressant drug affects the frontal lobe of the brain that controls inhibitions and decision making, A decision to only have two drinks can easily “dissolve” with that first or second drink.
  
  So - what is so important about those 1 or 2 standard drinks that the person risks continuing to use with possible fatal consequences?
  
  For an AA member, it is “insanity” to risk ongoing dependency and continued problems of the type that brought them to AA for the sake of only one or two drinks. 
  
  
  

• “Not having the first drink” i.e. Not drinking is easier to manage than trying to moderate.
  
  Alcohol as a drug, like other drugs can cause addiction, and for alcoholics, even after periods of abstinence, continued drinking can lead to craving, and re-addiction.   
  
  

• The only requirement for AA membership is a desire to stop drinking.
  
  This means younger people, people in earlier stages of their alcoholism can join AA - well before becoming chronic alcoholics.
  
  Only a small percentage of alcoholics become homeless.
  
  
  

• AA is an inclusive society.
  
  AA members come from all walks of  life, different ages, different cultural backgrounds, gender,  drinking styles, education, employment (professionals and trades) , politics, interests, etc.

  
  

• Be reassured that in AA a cross section of any Australian community Is present.
  
  In the early years of AA, it was mostly mid to late-stage alcoholics finding AA. Over time AA members realised that there were signs much earlier in their drinking that indicated that their drinking was more than simply a social past-time.
  
  
  

• AA is not a temperance society
  
  AA has no opinion on alcohol use in society,
  
  
  

• AA’s use of the word “Disease”
  
  In Australia, this word seems to be more associated with infectious disease, than with a medical condition.
  
  AA’s definition of the “disease” of alcoholism is not professional medical terminology,
  
  Alcoholics Anonymous as a non-professional support network describes alcoholism as a whole person health problem - 3 fold “disease” - physical, mental and spiritual - which makes sense given alcohol affects all aspects of a person’s functioning.
  
  
  

• Viewing “alcoholism” as an illness also makes it easier for the person to accept responsibility for the treatment of their condition.
  
  It is not a cop-out.
  
  Rather it helps separate blame from responsibility.

  
  And AA encourages its members to take responsibility for their behaviours that have harmed themselves and others by making amends (Steps 8 and 9 in the program).
  
  
  

• What happens if someone seems to refuse to take responsibility?

  Someone who refuses treatment for diabetes or another medically treatable condition would raise concerns about:
  
  1. their mental health (are they depressed, suffering from trauma or some other issue that means they do not value their own lives?) or
  
  2. their life circumstances (stressful work, domestic violence, poverty, isolation?) or
  
  3. their education and living skills (do they have the understanding/  skills to make change?).
  
  
  

• Alcoholics Anonymous success in the 1930’s resulted from the view 'alcoholism” was a “health” problem not a “moral” problem, given that Prohibition advocated by many religious people had given that impression.
  
  Yes drunken people can behave against moral standards on occasions, but this does not mean that they are “bad, sinful” people.”
  
  
  

• AA is not a cult. 
  
  People unfamiliar with AA can have this impression because there is a lot of repetition (alcohol effects brain functioning especially memory) and by AA’s very purpose, peer group pressure to stop drinking. In a society that promotes drinking at every turn, this is an important feature of AA’s effectiveness.
  
  But there are no rules, no membership fees, no musts – the whole program is suggested - regardless of what some individual members imply.
  

• Note: This peer pressure is tricky since some newcomers can interpret this as a black/white standard of “perfection”. So if they slip, they can feel they have failed and/or AA has failed them.
  
  Not so.
  
  Relapse is a common feature of people trying to make any major change to their behaviour eg. getting more exercise, eating differently - recovering from alcohol addiction likewise.
  
  
  As a professional, you can explain this and encourage your patient/ client to see this as part of their recovery journey. And besides, any time not drinking is helping them build more skills towards living a sober life, and helping them identifying “triggers” and ways to deal with those.
  
  
  

• AA is not a religious, but spiritual program.
  
  Initial impressions of AA can lead people to think that AA is a religion. It is not.

  
  This is understandable because AA grew out of, but separated from, a back-to-basic Christianity movement in the 1930’s in America.
  
  AA’s early literature was influenced by this Christian context and still influences some members today. This is changing.
  
  From its beginning in AA though, the idea of a “power greater” (as will power is no defense against alcoholism) was one of the individual's understanding.
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  There are a variety of views amongst AA members demonstrating AA’s inclusive use of the term GOD – “Group of Drunks”, Good Orderly Direction, Gift of Desperation, Great Out Doors” or GOD as defined by a specific tradition religion to name a few.
  
  Naturally people coming to AA can be put off by this question of AA appearing to be religious.
  
  No individual member can speak for all of AA.
  
  AA has literature, policies and guidelines that are the result of members coming together to find a majority view, These change over time outside culture changes and also as the collective wisdom grows.
  
  
  
  
  These AA free .pdf pamphlets may be useful for anyone with these concerns.
  
  Many paths to spirituality
  The God Word
  

  You can reassure your patients/ clients that AA itself is not religious, even though individual members may be.

  
  
  

• How effective is Alcoholics Anonymous?
  

The Cochrane Report 2022 on Alcoholics Anonymous and other 12‐step programs for alcohol use disorder concluded:

1. There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence.
   
   Non‐manualized AA/TSF may perform as well as these other established treatments.
   
   AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes.
   
   AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder.
   
   More about AA/TSF
   

2. Cost‐effectiveness studies.
   
   In three studies, AA/TSF had higher healthcare cost savings than outpatient treatment, CBT, and no AA/TSF treatment.
   
   The fourth study found that total medical care costs decreased for participants attending CBT, MET, and AA/TSF treatment, but that among participants with worse prognostic characteristics AA/TSF had higher potential cost savings than MET (moderate‐certainty evidence).
   
   Ref: cochranelibrary.com….pub2/full
   
   

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