What Is Alcoholics Anonymous and How Does It Work?

In the realm of recovery from addiction, Alcoholics Anonymous (AA) stands as a pivotal and widely recognized support system. It has offered a beacon of hope to those struggling with alcohol use disorder. 

This article explores the origins, principles, and effectiveness of AA, shedding light on how its peer-support model and emphasis on anonymity provide a unique and impactful approach to overcoming alcoholism. Examine AA’s success rates and find out why it remains a cornerstone in the journey to recovery for many.

For those struggling with alcohol use disorder, AA is often touted as the go-to option for support. With more than 123,000 groups across 180 countries worldwide, the AA model is free and open to the public.

AA was founded in 1935 and has guided people through addiction ever since. And in recent decades, a growing body of research has shown that it can be incredibly effective.    

“I think it is the power of peers,” says John Kelly, a professor of psychiatry at Harvard Medical School. Kelly led a 2020 analysis that reviewed the scientific evidence of AA’s effectiveness across 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants.

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Alcoholics Anonymous operates on a peer-support model to help individuals overcome alcoholism. A key principle of AA is anonymity, ensuring a safe and confidential environment where members can openly share their struggles without fear of external judgment. Here's a brief overview of how it works:

AA meetings are gatherings where individuals share their experiences and support each other in their journey to sobriety. These meetings are often characterized by sharing personal stories, discussing challenges, and offering mutual support.

A sponsor in AA is a member who has made significant progress in their own recovery and offers personal guidance and support to newer members, often referred to as sponsees. The role of a sponsor is crucial in the AA framework, as they mentor and assist sponsees in understanding and working through the 12 Steps of the AA program.

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A 12-step program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems. The 12-step approach has been adapted by numerous groups to address various types of dependencies and challenges, but started at AA.

1. Admitting powerlessness

2. Belief in a higher power

3. Decision to turn over will

4. Moral inventory

5. Admitting wrongs

6. Readiness for God to remove flaws

7. Humbly asking God to remove shortcomings

8. List of persons harmed

9. Making amends

10. Continued personal inventory

11. Seeking through prayer and meditation

12. Spiritual awakening and message-carrying

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In 2014, Alcoholics Anonymous conducted a study regarding its success rate with over 6,000 members. Of the members surveyed, 22 percent had been sober for 20 years or more. The findings also revealed that 27 percent of participants had achieved sobriety for less than a year. 

Furthermore, about 24 percent had maintained sobriety for a period ranging from one to five years. Those who had stayed sober for five to 10 years accounted for 13 percent of the participants. A slightly higher percentage, 14 percent, had been sober for 10 to 20 years. 

AA has been around for more than 85 years, but scientific evidence didn’t start to build about its effectiveness until around the 1990s, Kelly says.

“Anecdotally, we knew that AA was very large, influential and attended by millions of people," he adds. "But we had no idea from a scientific public health standpoint about its real clinical utility.” 

Kelly and his team examined studies published in the past couple of decades in which people were randomly assigned to AA or other 12-step programs by health professionals.

They found that such programs had outcomes similar to other treatments, but were “dramatically better when you’re talking about remission, sustained remission, and complete abstinence over many years,” says Kelly. 

AA often outperforms other types of therapies or interventions. “Organizations like AA are a good match for the long-term undulating course of addiction recovery,” Kelly adds. “In terms of AA's ability to sustain remission over time, that's what really stood out: 20 to 60% higher rates of remission.”  

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Alcohol use disorder is a leading driver of death throughout the world. According to the World Health Organization, “harmful use of alcohol” is responsible for around 3 million deaths per year, equating to about 5.3% of all deaths.

This is particularly acute in people in their 20s and 30s. In the U.S. alone, an estimated 95,000 people die annually due to “alcohol-related causes.” 

In the face of such a widespread public health problem, Kelly says, “in AA we have a free resource in the community which can save lives, sustain remission and reduce healthcare costs for individuals and the healthcare system. That’s good news from a public health perspective, as it's able to help people achieve long-term remission and reduce the burden on the healthcare system.” 

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Researchers are still learning how the AA approach benefits those suffering from alcohol addiction. Kelly explains that it can boost cognitive and behavioral coping abilities, which are key to remaining abstinent.

“It can also reduce craving, reduce impulsivity, and massively changes social networks,” he says. “It can also increase spirituality, which can help people reframe stress and find meaning and purpose.” 

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While the evidence shows AA is broadly effective, it’s admittedly not for everyone. Some who are referred may never attend, while others may drop out after trying it.  

“We know that no one treatment works for everybody,” Kelly says. That’s why it’s important to investigate a variety of different options to find what works for those going through addiction. “The question is how can we identify the exact, precision fit for patients in different kinds of treatments, who are going to benefit from a particular approach.” 

Alcoholics Anonymous is a worldwide fellowship where individuals come together to share experiences, strength, and hope to recover from alcoholism. 

AA assists individuals struggling with alcoholism through mutual support, regular meetings, and adherence to the 12-step program. This program emphasizes acknowledging alcoholism, making amends, and aiding others in their recovery journey.

The anonymity statement of AA underscores the importance of confidentiality, stating that anonymity forms the spiritual foundation of their traditions, reminding members to prioritize principles over personalities.

Bill Wilson, often known as Bill W., and Dr. Bob Smith founded AA in Akron, Ohio, in 1935.

The exact number of AA members varies and is difficult to determine due to the organization's confidential nature, but it is estimated to have millions of members across the globe.

AA is not a religious organization but has spiritual elements. It encourages belief in a higher power as understood by each individual, accommodating people of various faiths and beliefs.

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This article was originally published on Feb. 21, 2023 and has since been updated by the Discover staff.