Some 1.2 million people belong to one of AA’s 55,000 meeting groups in the US.
The church will be closed tomorrow, and the drunks are freaking out. An elderly lady in a prim white blouse has just delivered the bad news, with deep apologies: A major blizzard is scheduled to wallop Manhattan tonight, and up to a foot of snow will cover the ground by dawn. The church, located on the Upper West Side, can’t ask its staff to risk a dangerous commute. Unfortunately, that means it must cancel the Alcoholics Anonymous meeting held daily in the basement.
A worried murmur ripples through the room. “Wha… what are we supposed to do?” asks a woman in her mid-twenties with smudged black eyeliner. She’s in rough shape, having emerged from a multiday alcohol-and-cocaine bender that morning. “The snow, it’s going to close everything,” she says, her cigarette-addled voice tinged with panic. “Everything!” She’s on the verge of tears.
A mustachioed man in skintight jeans stands and reads off the number for a hotline that provides up-to-the-minute meeting schedules. He assures his fellow alcoholics that some groups will still convene tomorrow despite the weather. Anyone who needs an AA fix will be able to get one, though it may require an icy trek across the city.
That won’t be a problem for a thickset man in a baggy beige sweat suit. “Doesn’t matter how much snow we get—a foot, 10 feet piled up in front of the door,” he says. “I will leave my apartment tomorrow and go find a meeting.”
He clasps his hands together and draws them to his heart: “You understand me? I need this.” Daily meetings, the man says, are all that prevent him from winding up dead in the gutter, shoes gone because he sold them for booze or crack. And he hasn’t had a drink in more than a decade.
The resolve is striking, though not entirely surprising. AA has been inspiring this sort of ardent devotion for 75 years. It was in June 1935, amid the gloom of the Great Depression, that a failed stockbroker and reformed lush named Bill Wilson founded the organization after meeting God in a hospital room. He codified his method in the 12 steps, the rules at the heart of AA. Entirely lacking in medical training, Wilson created the steps by cribbing ideas from religion and philosophy, then massaging them into a pithy list with a structure inspired by the Bible.
The 200-word instruction set has since become the cornerstone of addiction treatment in this country, where an estimated 23 million people grapple with severe alcohol or drug abuse—more than twice the number of Americans afflicted with cancer. Some 1.2 million people belong to one of AA’s 55,000 meeting groups in the US, while countless others embark on the steps at one of the nation’s 11,000 professional treatment centers. Anyone who seeks help in curbing a drug or alcohol problem is bound to encounter Wilson’s system on the road to recovery.
It’s all quite an achievement for a onetime broken-down drunk. And Wilson’s success is even more impressive when you consider that AA and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.
What we do know, however, is that despite all we’ve learned over the past few decades about psychology, neurology, and human behavior, contemporary medicine has yet to devise anything that works markedly better. “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps,” says Drew Pinsky, the addiction-medicine specialist who hosts VH1’s Celebrity Rehab. “In my world, if someone says they don’t want to do the 12 steps, I know they aren’t going to get better.”
Wilson may have operated on intuition, but somehow he managed to tap into mechanisms that counter the complex psychological and neurological processes through which addiction wreaks havoc. And while AA’s ability to accomplish this remarkable feat is not yet understood, modern research into behavior dynamics and neuroscience is beginning to provide some tantalizing clues.
One thing is certain, though: AA doesn’t work for everybody. In fact, it doesn’t work for the vast majority of people who try it. And understanding more about who it does help, and why, is likely our best shot at finally developing a system that improves on Wilson’s amateur scheme for living without the bottle.
AA doesn’t work for everybody, but when it does, it can be transformative. Members receive tokens to mark periods of sobriety, from 24 hours to one month to 55 years.
AA originated on the worst night of Bill Wilson’s life. It was December 14, 1934, and Wilson was drying out at Towns Hospital, a ritzy Manhattan detox center. He’d been there three times before, but he’d always returned to drinking soon after he was released. The 39-year-old had spent his entire adult life chasing the ecstasy he had felt upon tasting his first cocktail some 17 years earlier. That quest destroyed his career, landed him deeply in debt, and convinced doctors that he was destined for institutionalization.
Wilson had been quite a mess when he checked in the day before, so the attending physician, William Silkworth, subjected him to a detox regimen known as the Belladonna Cure—hourly infusions of a hallucinogenic drug made from a poisonous plant. The drug was coursing through Wilson’s system when he received a visit from an old drinking buddy, Ebby Thacher, who had recently found religion and given up alcohol. Thacher pleaded with Wilson to do likewise. “Realize you are licked, admit it, and get willing to turn your life over to God,” Thacher counseled his desperate friend. Wilson, a confirmed agnostic, gagged at the thought of asking a supernatural being for help.
But later, as he writhed in his hospital bed, still heavily under the influence of belladonna, Wilson decided to give God a try. “If there is a God, let Him show Himself!” he cried out. “I am ready to do anything. Anything!”
What happened next is an essential piece of AA lore: A white light filled Wilson’s hospital room, and God revealed himself to the shattered stockbroker. “It seemed to me, in the mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing,” he later said. “And then it burst upon me that I was a free man.” Wilson would never drink again.
At that time, the conventional wisdom was that alcoholics simply lacked moral fortitude. The best science could offer was detoxification with an array of purgatives, followed by earnest pleas for the drinker to think of his loved ones. When this approach failed, alcoholics were often consigned to bleak state hospitals. But having come back from the edge himself, Wilson refused to believe his fellow inebriates were hopeless. He resolved to save them by teaching them to surrender to God, exactly as Thacher had taught him.
Following Thacher’s lead, Wilson joined the Oxford Group, a Christian movement that was in vogue among wealthy mainstream Protestants. Headed by a an ex-YMCA missionary named Frank Buchman, who stirred controversy with his lavish lifestyle and attempts to convert Adolf Hitler, the Oxford Group combined religion with pop psychology, stressing that all people can achieve happiness through moral improvement. To help reach this goal, the organization’s members were encouraged to meet in private homes so they could study devotional literature together and share their inmost thoughts.
In May 1935, while on an extended business trip to Akron, Ohio, Wilson began attending Oxford Group meetings at the home of a local industrialist. It was through the group that he met a surgeon and closet alcoholic named Robert Smith. For weeks, Wilson urged the oft-soused doctor to admit that only God could eliminate his compulsion to drink. Finally, on June 10, 1935, Smith (known to millions today as Dr. Bob) gave in. The date of Dr. Bob’s surrender became the official founding date of Alcoholics Anonymous.
In its earliest days, AA existed within the confines of the Oxford Group, offering special meetings for members who wished to end their dependence on alcohol. But Wilson and his followers quickly broke away, in large part because Wilson dreamed of creating a truly mass movement, not one confined to the elites Buchman targeted. To spread his message of salvation, Wilson started writing what would become AA’s sacred text: Alcoholics Anonymous, now better known as the Big Book.
The core of AA is found in chapter five, entitled “How It Works.” It is here that Wilson lists the 12 steps, which he first scrawled out in pencil in 1939. Wilson settled on the number 12 because there were 12 apostles.
In writing the steps, Wilson drew on the Oxford Group’s precepts and borrowed heavily from William James’ classic The Varieties of Religious Experience, which Wilson read shortly after his belladonna-fueled revelation at Towns Hospital. He was deeply affected by an observation that James made regarding alcoholism: that the only cure for the affliction is “religiomania.” The steps were thus designed to induce an intense commitment, because Wilson wanted his system to be every bit as habit-forming as booze.
The first steps famously ask members to admit their powerlessness over alcohol and to appeal to a higher power for help. Members are then required to enumerate their faults, share them with their meeting group, apologize to those they’ve wronged, and engage in regular prayer or meditation. Finally, the last step makes AA a lifelong duty: “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.” This requirement guarantees not only that current members will find new recruits but that they can never truly “graduate” from the program.
Aside from the steps, AA has one other cardinal rule: anonymity. Wilson was adamant that the anonymous component of AA be taken seriously, not because of the social stigma associated with alcoholism, but rather to protect the nascent organization from ridicule. He explained the logic in a letter to a friend:
[In the past], alcoholics who talked too much on public platforms were likely to become inflated and get drunk again. Our principle of anonymity, so far as the general public is concerned, partly corrects this difficulty by preventing any individual receiving a lot of newspaper or magazine publicity, then collapsing and discrediting AA.