Founded in 1935 in Akron, Ohio, Alcoholics Anonymous (AA) is the original and arguably most well-known of all the 12-step programs. AA was formed to help those with a dependence on alcohol get and stay sober and, in its own words, “Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.” With the significant costs of alcohol-related conditions and other resulting problems to society, AA makes a critical contribution to helping people regain control of their lives through its famous group-based formula or fellowship, which has been proven to work repeatedly. Its success across languages and cultures speaks to its accommodating and welcoming nature, and it accepts members irrespective of faith, race, gender or any other potentially “limiting” criteria. Crucially, membership is free, meaning that nobody need be excluded on the basis of finances. AA groups are self-supporting and rely solely on donations. Members just need to leave any unrelated issues at the door, respect confidentiality, and not court controversy, which seem like a pretty reasonable exchanges for a life changing process.
Alcohol Use Disorder in the US and Beyond
According to the National Institute on Alcohol Abuse and Alcoholism, 95,000 people die from alcohol-related causes annually (approximately 68,000 men and 27,000 women). This makes alcohol the third leading cause of preventable deaths in the US after tobacco, poor diet, and physical inactivity. In terms of how Alcohol Use Disorder (AUD) plays out on a wider societal level, close to 20% of Emergency Department admissions are attributable to alcohol. Chronic alcohol-associated conditions resulting in death include:
- Liver disease
- Heart disease
- Unspecified liver cirrhosis
- Upper aerodigestive tract cancers
- Liver cancer
- Supraventricular cardiac dysrhythmia
- Breast cancer, and
Additionally, over a quarter of driving fatalities are attributable to alcohol, so the case against alcohol misuse is pretty compelling. Of course, this problem is not unique to the US, with the World Health Organization (WHO) reporting in 2014 that alcohol misuse was the “first-leading” risk factor for disability and early death in 15-49-year-olds. One global consistency is that alcohol misuse in men is almost three times that of women.
Other Unintended Consequences of AUD
In 2017, approximately 7.5 million U.S. children aged 17 and under lived with a parent with AUD. This comes with its own set of consequences and related effects such as neglect and other forms of harm and mistreatment. As with other forms of substance misuse, along with mistreatment related to mental health issues, Alcohol Use Disorder can create a cycle of Substance Use Disorder and precipitate mental health issues in the families and partners of the sufferer. Alcohol use in pregnancy can have an impact on the unborn child which can carry through to infancy. One study of “more than 6,000 first-graders across four U.S. communities estimated that as many as 1–5 percent of first-grade children have fetal alcohol spectrum disorders (FASD).” Finally, there is an increased risk of drowning, motor vehicle-related injuries, and death along with contraindication of medications.
What Impact has the Global Pandemic had on Alcohol Use and Misuse?
Anecdotally, most of us are aware of the increased consumption of alcohol as a result of the global pandemic (“doom drinking”) and, specifically, local lockdowns which contribute to “social isolation, economic loss (and) psychological distress”. While many people have made light of this, the American Association for the Study of Liver Disease reports a “rising tide of Alcohol Use Disorder and Alcohol-Related Liver Disease,” which is nothing to laugh about. People with existing issues are also at greater risk from the disease due to compromised immune systems and reduced access to care as a result of pandemic restrictions. Lack of resources and social isolation are big factors in precipitating alcohol use relapse. Some fear that the easing of restrictions will bring about a period of extended celebration akin to the Roaring Twenties, with champagne corks popping worldwide and a general sense of wild abandon. This could also serve to tempt those who are struggling to limit their drinking or abstain and increase incidents of alcohol-related issues. This is only speculation at this point as many people are still reticent to leave their homes unless it is vital and to renounce adherence to social distancing practices.
Why Does AA Work?
AA meetings hold an air of ritual about them, which can act as a form of therapeutic substitute for the ritual of drinking. The fact that the organization is run by those who have lived through the issues experienced by attendees gives it credence and a sense of relatability. Regular attendance and the encouragement of a “Sponsor,” someone who has lived through the experience and come out the other side, is also a crucial component. The Sponsor is key to helping people achieve the awakening that is brought about by the Twelve Step process and to support and guide their mentee to stay on track. Another helpful element is that “open” meetings enable non-sufferers to attend and observe, which can be useful to friends and family members who want to understand the process and support their loved-ones through it. AA meetings also take place in both hospitals and correctional facilities where, especially in the latter, participation is completely voluntary so people can leave treatment or incarceration in a much better place than when they entered. The mutual aid aspect of the program seems to be key to its success, with the US Surgeon General reporting in 2016 that there is “well-supported scientific evidence [to] demonstrate the effectiveness” of the interventions. Perhaps the biggest testament to the success and efficacy of the fellowship is that it has spawned sister fellowships such as Narcotics Anonymous and Gamblers Anonymous that have adopted the Twelve Steps and other conventions developed and practiced by AA. Imitation is the sincerest form of flattery and, in this case, one that benefits us all. Happy 86th Anniversary, Alcoholics Anonymous. Keep up the great work!!!
 May, P., Chambers, C., Kalberg, W., Zellner, J., Feldman, H., Buckley, D., Kopald, D., Hasken, J., Xu, R., Honerkamp-Smith, G., Taras, H., Manning, M., Robinson, L., Adam, M., Abdul-Rahman, O., Vaux, K., Jewett, T., Elliott, A., Kable, J., Akshoomoff, N., Falk, D., Arroyo, J., Hereld, D., Riley, E., Charness, M., Coles, C., Warren, K., Jones, K. and Hoyme, H., 2018. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA, 319(5), p.474.
 Lange, S., Probst, C. and Rehm, J., 2020. Coronavirus disease 2019 crisis and intentional injuries: now is not the time to erode alcohol control policies. Canadian Journal of Public Health, 111(4), pp.466-468.
 Da, B., Im, G. and Schiano, T., 2020. Coronavirus Disease 2019 Hangover: A Rising Tide of Alcohol Use Disorder and Alcohol‐Associated Liver Disease. Hepatology, 72(3), pp.1102-1108.
 Substance Abuse and Mental Health Services Administration (US) and Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. US Department of Health and Human Services, November 2016.