I write this with great respect and genuine appreciation for the Alcoholics Anonymous (AA) community. I don’t know of any other global organization that makes it so easy to connect with others who share your struggle, virtually anywhere and anytime.
This list is intended to help people who want a professional perspective, so you can be fully informed and educated about AA. It’s based on studies and the experiences of thousands of patients.
Before I dive into the 10 points, here’s a brief introduction to the AA program.
What Is Alcoholics Anonymous (AA)?
Alcoholics Anonymous (AA) is a global support network made up of people helping each other recover from alcohol addiction. Established in 1935, AA offers a path to sobriety through regular group meetings and peer support.
According to the Substance Abuse and Mental Health Services Administration (SAMSHA), 12-Step models are used by approximately 74% of treatment facilities. Central to AA’s approach is a spiritual foundation – not tied to any specific religion – which encourages members to lean on a “higher power” of their own understanding and find strength through shared experiences and community.
Exploring the 12 Steps of the AA Program
The 12-Step model is the foundation of Alcoholics Anonymous (AA), and consists of a series of guiding principles designed to help people overcome addiction through personal growth, spiritual development, and mutual support. They are written in the “Big Book.”
Here’s a brief list of the 12 steps of Alcoholics Anonymous:
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 alcoholics and to practice these principles in all our affairs.
The Top 10 Things You Need to Know About AA
AA paved the way for alcohol treatment, almost single-handedly, at a time when the medical community had no clear solutions. While it remains the most used approach, it is also a self-perpetuating system, as its alumni often go on to establish or staff other facilities.
The following list is based on data, as well as the experiences of patients I treat. Here are 10 things you should know about:
1. Common Fears Before Attending Your First AA Meeting
Any new group can be intimidating – but especially this one – because it’s a new type of meeting and group where most people have no idea what they’re walking into. You don’t know if members will be your age, have similar severities or types of addiction, have relatable life experiences, or maybe even be someone you know. This uncertainty often creates anxiety about whether you’ll end up in the right spot.
Indeed, these problems do exist in AA. Many of my patients are turned off by the know-it-alls, proselytising, politics, and boasting. And although privacy is meant to be respected, people are still people. There’s gossip and names that escape the room.
There’s also a common fear that you’ll be expected to adopt certain beliefs about God as part of your recovery. Even though some groups loosen their definitions of God, it’s hard to explain that away when it is clearly central to the steps. For people who want a secular approach or enjoy their own personal beliefs about a higher power, this can be a significant barrier.
2. The Origins of AA: Insightful or Too Subjective?
The founders of AA recognized that addiction involved deeper underlying issues, but many of their ideas were developed through personal experiences, including hallucinations and subjective opinions — not through research or science.
Today, we understand that willpower is not a reliable concept in addiction recovery. We also know the psychological value of taking full personal responsibility for choices, rather than turning that over to a higher power. While some ideas from AA remain meaningful, others do not hold up under modern scrutiny.
3. The Pitfall of Viewing Sobriety as the Only Goal
Many programs treat sobriety as an absolute rule, considering anything else a failure. While that might sound reasonable at first, evidence shows that although sobriety is important for health, focusing solely on sobriety is not the most effective approach.
The reality is that many of my patients have been shamed for a brief lapse, where the highest goal is on the number of days sober. The natural and expected course of progress will usually include relapses that get shorter and less severe. That’s what clinicians expect, and why we can offer grace to patients going through appropriate phases of recovery. AA’s rigidity on sobriety is not only misinformed, but can become a primary source of new and unnecessary shame.
Studies indicate that emphasizing emotional health and overall wellness leads to better long-term outcomes. This makes sense when you consider the self-defeating guilt a person might feel if they relapse, especially when sobriety is their sole measure of success. The focus should be on the process of growth, with lapses being reason for question but not shame.
4. The Impact of Self-Labeling in Recovery
AA encourages members to introduce themselves by saying,
“Hi, I’m ________, and I’m an alcoholic.”
While admitting to one’s struggles can feel useful, research suggests that defining yourself primarily by your addiction can be harmful. I don’t encourage my patients who have dealt with anger or depression to forever introduce themselves that way, and I wouldn’t recommend it with addiction either.
It’s much healthier and forward looking to see yourself as more than your addiction – for example, as a parent, a hard worker, or any other identity that brings you pride and purpose. And if a conversation calls for it and it’s appropriate to share, it’s just fine to explain that you’ve been heavily addicted to something before.
5. Rethinking Addiction: Beyond the Disease Model
AA is based on the disease model of addiction, which is far from being an established or universally accepted model. The program upholds the notion that once you are an alcoholic, you are always an alcoholic, citing brain imaging that points to certain pathways as proof.
However, more modern understandings show that the so-called addiction pathway is simply tapping into a neural circuit we all have – one that drives us to pursue natural rewards like food, sex, and security. In this understanding, addiction is what we call a learned behavior that results from our development out of certain kinds of experiences.
For example, we experience larger dopamine surges in anticipation of food and sex than we do with cocaine or heroin. Current research gives us good reason to be much more optimistic and to view ourselves as capable of reversing unhealthy learned behaviors – not destined to a lifetime of addiction disease.
I see how calling it a disease can help people blame their mistakes on how they were born. The problem is the data doesn’t support that, and – more importantly – it cuts off the difficult but necessary process of accepting our own responsibility to improve ourselves.
6. The Risks of Untrained Leadership in Peer Support
Since AA is peer-based, anyone who has been in the program long enough can become your “sponsor.” It’s not uncommon to encounter sponsors who struggle with their own health issues. Some may become overly involved or even invasive in your personal life.
So while you may be fortunate enough to get a patient, wise, well trained sponsor, a lot of the time you might get a sponsor who has no business leading anyone through such a complicated and important life issue. Unfortunately, experiences of inappropriate relationships, “big brothers” micromanaging or invading privacy, and even sexual harassment all occur in spaces that are supposed to be safe. It’s an easy way for someone with no credentials to gain a position of authority.
To be fair, this can happen in any unregulated space. And there is always a risk of the self proclaimed leaders of a group to take advantage of the vulnerabilities of new entrants. But these problems are far more sensitive and serious when dealing with the topic of addiction. They become especially critical in moments when participants are lost, desperate, and at their most vulnerable.
7. The Risks of Triggering and Negative Influences in AA Groups
Talking about past or recent drinking can be very triggering for many people. In fact, I have seen numerous patients who relapse after attending AA meetings, sometimes because they are pressured into sharing emotional stories without the proper guidance and psychological space to do so.
I’ve also had a large number of patients who were excited to meet a new friend in groups, only to later realize that new friend was a bad influence. Sometimes that can be a case where the friend’s relapse brings them down too, or often dealing drugs to other members.
It can also be very hard to hear people share about their addiction during meetings in ways that are nostalgic and romanticized. This often leads to even more difficulty with cravings.
8. Camaraderie Doesn’t Have to Revolve Around Alcohol
While camaraderie is indeed helpful, it doesn’t have to be centered around alcohol use. You can find supportive and nonjudgmental friends anywhere. Identifying with others around interests that represent healthy parts of us is a great way to draw us towards the person we want to become.
A lot of my patients find it exhausting to relate to their group around a topic that they are so eager to move past. It’s one thing to have occasional humble reminders of where we have been in life, but to continually define our tribe and belonging around our worst behavior (and on a daily basis) is not typically what we would encourage in psychiatry.
9. Mixed Messages on Medication in AA
One significant criticism of AA by clinicians is its general discouragement of medication to treat underlying mental health issues, such as depression or anxiety. Despite the Big Book explicitly endorsing the use of medication when necessary, in practice many AA groups and members hold a different view. They often advise against or even shame medication as a sign of weak faith or insufficient commitment to sobriety. The line goes: “you’re replacing one drug with another.”
This mixed message can create confusion and misplaced doubt for people who may benefit from safe and appropriate medications. Modern addiction treatment recognizes that co-occurring mental health disorders are common and that medication can be a critical part of a comprehensive addiction recovery plan.
10. Is AA Actually Effective? What the Research Says
The largest peer-reviewed analysis, conducted by Cochrane Reviews, concluded:
“No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.”
Keep in mind that when facilities claim 90+% success rates, those numbers typically come from their own internal studies. That means the data isn’t independently verified, there’s no control group for comparison, and the results rely only on responses from people who return follow-up calls – among many other flaws common in non–peer-reviewed studies.
Now if you take tens of millions of people, even small success rates will produce millions of changed people who share their success stories. That doesn’t mean nothing good comes from AA, but it’s to say it doesn’t need to be considered the gold standard approach. At the very least, you shouldn’t be shunned for asking questions or looking at the range of options.
Alternatives to the AA 12-Step Model
We all know there’s no one way forward, yet AA usually presents itself as the only golden solution. Questions and challenges can be met with rigidity and resistance. Relapses or failures are met with: “then you’re not working the program right.”
It should be obvious that an approach needs to be broad and adaptive enough to meet people at their particular point of struggle. A high achiever who pressures themselves might need different ideas than someone abused as a child. And someone who lost a loved one might need different ideas than someone who people pleases.
Here are just a few of the many options available:
SMART Recovery
One of the most well-known alternatives to the 12-Step approach is SMART Recovery. Like AA, it offers group support, but it’s grounded in evidence-based therapy — specifically, Cognitive Behavioral Therapy and Rational Emotive Behavioral Therapy.
SMART provides structured materials to guide each meeting, focusing on logic and behavior change rather than spiritual beliefs.
Refuge Recovery
Another recognized option is Refuge Recovery, which draws from Buddhist philosophy. Its foundation is quite different – focusing on mindfulness, meditation, and understanding the root of cravings.
However, the challenge with Refuge Recovery is accessibility – active groups can be hard to find in many areas.
Self Recovery
Self Recovery is a complete therapeutic system – not just peer support or a collection of steps. The program includes group meetings as one part of a more comprehensive structure. It uses evidence-based tools to address deeper issues such as childhood experiences, longstanding insecurities, patterns in relationships, and emotional regulation.
In other programs, when you share serious personal struggles, you might receive vague or unqualified feedback from peers – or hear that you should seek professional help elsewhere. In contrast, Self Recovery integrates that guidance directly into the program.
The group support is led by licensed peer facilitators, not self proclaimed experts. Meetings are optional, can be fully anonymous, and introduce well-established topics that highlight common themes in addiction. This helps groups stay productive.
Key Benefits of Self Recovery
The Self Recovery program offers a comprehensive and scientific approach to addiction, featuring:
Bite-sized video lessons by a psychiatrist that take you through the entire process of psychological, emotional, and behavioral change, paired with reflection exercises to help turn knowledge into real change. Lessons encompass the full range of how humans suffer. It’s our suffering that drives us to use external things for comfort.
An Audio Mindfulness Series designed specifically for addictive behaviors, helping you understand and manage the sensations of cravings through meditation.
Weekly live support groups providing direct access to meetings with licensed facilitators where you can ask questions and get support.
Daily self-check-ins after most lessons, allowing you to privately reflect and plan your next steps in recovery.
Music for your journey. It will connect you emotionally with the material and encourage deeper exploration of your thoughts and feelings.
Together, these features create a strategic, engaging, and empathetic path to lasting change. Discover Self Recovery here!
