Introduction

Alcoholics Anonymous (AA) is the world's largest and most recognisable recovery ‘programme’, and the Twelve Step Programme is central to its philosophy. AA is a global organisation of 2.2 million members (AAWS, 2001), with a reported 3,651 weekly group meetings in the United Kingdom (AAWS, 2015). AA has made many claims in its literature about the programme's effectiveness (AAWS, 2001), yet Groh (2008, 44), for example, states that: ‘Overall, the AA literature is characterized by inconsistent findings, with researchers continuing to debate the role of AA in promoting abstinence (Emrick et al, 1993; Humphreys, 2004; Kownacki and Shadish, 1999; McCrady and Miller,1993; Tonigan et al, 1996).’ Kelly et al (2009, 237) add to the debate, referring to almost the exact same studies, ‘Rigorously conducted empirical reviews of AA-focused research indicate that AA participation is helpful for many different types of individuals in their recovery from alcohol dependence.’ One author suggests that claims of AA effectiveness are ambiguous whereas the other suggests a consensus of positive opinion regarding effectiveness.

This chapter explains how AA members sustain long-term behavioural change, or in other words, how members of AA maintain their sobriety. To achieve this, I constructed a conceptual model of change from AA's core texts, Alcoholics Anonymous (2001) – colloquially known as the Big book – and The twelve steps and twelve traditions (1952), and a review of academic literature. The model was then empirically tested in interviews with 20 long-term abstinent members of AA who each narrated various dimensions of their recovery as it had unfolded over time.

The model has four components. First, motivation to engage (MtE) refers to the circumstances or pressures under which an individual seeks help from AA. Once a member has joined AA the transition to recovery takes time, often years, and is aided by AA's Twelve Steps, sponsorship and relationships formed among AA's wider social network. This forms the second component, structured social engagement (SSE). Third, the effects of joining and participation in AA are an increase in an individual's personal agency (PA). The concomitant effect on behavioural outcomes (BO) represents the fourth component.

A brief history of AA