Alcohol use disorders are a problem of millions nationwide. It represents a major public health problem in the United States. Approximately 7.4% of the U.S. population meet the diagnostic criteria for alcohol abuse or dependence, a proportion that results in substantial costs to the individual and society, among them elevated morbidity and mortality rates, traffic accidents, injuries, crime, broken families, domestic violence and fetal alcohol syndrome (2004).
It is also already considered a disease. The disease model of alcoholism has a history dating back more than two hundred years, and is considered by many to be the dominant paradigm guiding scientific inquiry and treatment approaches for much of the 20th century ( 2002). The concept gained popularity through its promotion by Alcoholics Anonymous.
The disease model of alcohol dependence, or “alcoholism”, remains the dominant conceptual model or paradigm of both alcohol and drug treatment, especially in the USA. However, this situation is changing in response to empirical evidence, managed care cost containment policies and greater pressures to demonstrate treatment efficacy and effectiveness (2004).
Today, a treatment industry based on the disease theory generates more than billion a year in revenues, and both supports and serves hundreds of thousands of individuals who have an emotional commitment (in the case of alcoholics) or an economic commitment (on the part of treatment providers) to the medical model of alcoholism (1995).
Alcoholics Anonymous was developed by and , both late-stage alcoholics and desperate for an alternative, in the late 1930s. According to various literatures and also what is written on their website, Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for Alcoholics Anonymous membership; the group is self-supporting through their own contributions. Alcoholics Anonymous is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. The primary purpose of Alcoholics Anonymous and its members is to stay sober and help other alcoholics to achieve sobriety (1986).
This description also appears in most other literature published by Alcoholics Anonymous and is read at the start of nearly every Alcoholics Anonymous meeting. Accordingly, it depicts the essentials of the Alcoholics Anonymous program that its members wish to convey to outsiders as well as to newcomers. The essentials of the Alcoholics Anonymous program are also represented by the twelve suggested steps Alcoholics Anonymous. All Alcoholics Anonymous members are strongly encouraged to use the “Twelve Steps” in dealing with their alcoholism and with life in general (1986).
Members of Alcoholics Anonymous believe alcoholism to be a progressive and eventually fatal disease that follows a progressive series of stages that lead to institutionalization in a mental hospital, jail, or death. While cultural variations (as well as the assumption that “alcoholism” is a social construction that emerged during a specific historical period) should be acknowledged, it should also be pointed out that the “disease” model of Alcoholics Anonymous has been applied cross-culturally. One might argue that the “disease” model must have some material validity for so many members in so many different cultures to find it descriptive of their own experiences ( 2000).
An important activity that Alcoholics Anonymous promotes is alcoholics helping other alcoholics to stay sober through involvement in service work. Although the benefits of having a sponsor are apparent to the recipient, the Alcoholics Anonymous literature encourages alcoholics to help other alcoholics primarily as a method of strengthening their own sobriety. A continuing theme throughout Alcoholics Anonymous principles is the critical importance of recovering alcoholics shifting their focus from self to others. Through sponsorship and twelfth-step work, service involvement comprises a broad range of activities that involve directly helping other struggling alcoholics (2004).
Although there is no formal definition of sponsorship, sponsors typically have some regular contact with their sponsees to provide guidance and encouragement, to discuss what challenges sponsees may be facing and to reinforce the Alcoholics Anonymous teachings and principles. Twelfth-step work also involves helping alcoholics more generally, although the manner of help is not concretely defined. It is described as taking on “the unspectacular but important tasks that make good twelfth-step work possible, perhaps arranging for the coffee and cake after the meeting, where so many skeptical, suspicious newcomers have found confidence and comfort in the laugher and talk. This is twelfth-step work in the best sense of the word (2004).”
Alcoholics Anonymous is often criticized for being just another substitute addiction, emphasizing “powerlessness” to already disenfranchised groups, being a religion or cult, adhering to a medical model of disease instead of a strengths perspective, and other such areas of concern to social workers. Many of these interpretations are based on viewing Alcoholics Anonymous as an alternative treatment model or a rational service delivery model ( 1998).
In spite of methodological problems aggravated by the anonymous, voluntary, self-selection of Alcoholics Anonymous membership, there is evidence to indicate that Alcoholics Anonymous is a very useful approach for alcoholics who are trying to stop drinking. Previously published studies found that greater involvement with Alcoholics Anonymous could modestly predict reduced alcohol consumption. Involvement or active participation in Alcoholics Anonymous processes (such as “working the 12 Steps”), rather than just attendance at their meetings, was related to positive outcomes in these findings and supported in other studies (1998).
The utilization of Alcoholics Anonymous services varies from individual to individual but research suggests that certain patterns occur in racial and ethnic perspectives. Racial differences in Alcoholics Anonymous affiliation may be influenced by many variables such as type and severity of alcohol problems.
Research indicates that Hispanic clients are less likely than non-Hispanic white clients to attend Alcoholics Anonymous after treatment. Hispanic and non-Hispanic clients responded differently to encouragement to attend AA. Contrary to what many believed, differential rates of attendance in Alcoholics Anonymous by ethnicity were not related to ethnic differences in the practicing of prescribed Alcoholics Anonymous-related behaviors. As the principles of the group become internalized, Hispanics become less reliant upon continued attendance, much as one can learn to learn, through education, and thereby continue to grow in knowledge without continued attendance at formal classes ( 2002).
Black Americans are also found to be overrepresented in the public alcohol treatment system, but may be less likely to use Alcoholics Anonymous and other informal services. Ethnographic, clinical and epidemiological research has documented that at least some blacks participate in Alcoholics Anonymous ( 1999).
Alcoholics Anonymous has grown to become the largest and most popular mutual-help program in the U.S. for individuals with alcohol problems (2004). The frequency at which AA meetings occur on any given day in the majority of American cities and the absence of membership fees contribute to the popularity of this community-based resource.