AA merits the extensive attention we pay to it here because of its unique position in the recovery field. This is particularly true in the United States.
AA began by the meeting of two alcoholics named Bill Wilson ("Bill W") and Bob Smith ("Bob S"). During the late 1930's, alcoholism and drug addiction were unsuccessfully treated by the emerging field of psychiatry. Physicians and society did not understand addiction very well at that time. People were considered "crazy" and sent to institutions, or given substitute medications that did not offer a "cure." Into this vacuum emerged AA. AA took a spiritual approach to addiction, rather than a medical one. Ironically, 12-step culture, even today, seems to adhere to a medical, disease model of addiction.
During that period in history, the medical approach to addiction was a rather dismal failure. Therefore, the success of the spiritual approach rapidly caught on. This is because these two people (Bill W and Bob S) managed to achieve sobriety when all their other efforts had failed. We provided a more detailed history of AA in the section called Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective section.
Like other support groups (such as self-empowering support groups) AA is a non-professional approach to recovery. Attendance is free of charge but uses a "pass-the-hat" method for receiving member contributions. AA literature makes it clear "the only requirement for membership is a desire to stop drinking." Although popular media often cites the now familiar, "Hello, my name is --- and I'm an alcoholic" technically speaking, no one needs to identify themselves as such. They may decide they are a member simply because they have the desire to stop drinking. Thus, some people attend AA for quite a while before ever attempting or establishing any period of sobriety. They simply have a "desire to stop drinking." However, they may not have acted upon that desire yet.
At a typical meeting, a volunteer chairperson leads the meeting and discussion. It usually begins with a standard preamble read from the AA "big book" (Alcoholics Anonymous, 1955). The chairperson typically chooses a topic from AA literature. The chairperson may share his or her own personal experience with that topic. Many meetings include a statement that encourages confidentiality. However, like all non-professional support groups, it simply isn't possible to enforce confidentiality. In contrast, confidentiality is a legal requirement for most professional counselors and therapists.
Members take turns sharing their thoughts and experiences on the chosen topic for the meeting. The culture is one of self-disclosure and vulnerability. Unlike most self-empowering support groups, so-called "cross talk" is discouraged. This means members may speak of their own experience but are discouraged from commenting upon another person's statements or disclosures. Therefore, meetings resemble disclosures by members, rather than discussion between members. A significant component of AA's success for many individuals is likely the social support they experience through AA.
AA considers complete abstinence the recovery goal. However, relapse is accepted as a part of that process. AA is a fellowship that calls for the belief in a higher power. Although the majority of members interpret this as "God," some members call their AA group their "higher power." This is based on the premise that the wisdom of a group is greater than the wisdom of a single individual. Nonetheless, 12-step groups most certainly have a culture that stresses spirituality.
AA aims to strengthen a person's relationship with self, others, and a higher power. Many people liken AA to a developmental process that helps people balance self-centered concerns (like those of infants) to other-centered concerns (like those of mature adults). In fact, some groups liken their sobriety date to a date of birth (or re-birth). For instance, members with 6 years of sobriety consider themselves developmentally similar to literal 6-year-old children. Members encourage each other with messages of change that is available through hope and redemption. They seek to help newcomers correct immature, grandiose, self-absorbed tendencies referred to as "character defects."
At the core of the AA program are the following 12 steps (Alcoholics Anonymous, 2012):
1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. 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.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to other alcoholics, and to practice these principles in all our affairs.
The completion of these 12 steps is a continuous process. It often takes a year or longer to complete one cycle. Members learn and complete the steps with the aid of a "sponsor." Sponsors are experienced members. Sponsors are familiar with the program, and have "worked" the steps. Because the 12th step emphasizes helping others, members consider sponsorship an important part of the program. Sponsors help newcomers proceed through the 12-steps. In addition, sponsors provide additional one-on-one support that is not available at group meetings. Most sponsors typically ask newcomers to call them if they feel the urge to drink. This level of commitment is often above and beyond what any addictions professional could offer.