Two Drunks in Akron: The Story of AA, What the Evidence Says, and the Secular Roads That Grew From It

Alcoholics Anonymous began as one person with alcohol problems trying to help another. Ninety-one years later, it is both a global fellowship and a subject of unusually tangled debate. The evidence is stronger than many critics assume, narrower than many slogans suggest, and only one part of a much wider recovery landscape.

Akron, Ohio, 1935: Bill W., a stockbroker visiting from New York, met Dr. Bob S., a surgeon whose drinking had resisted repeated efforts to stop.1 Their first conversation was not AA’s official birthday. The fellowship traditionally dates its founding to June 10, 1935, the date Dr. Bob gave for his last drink.2 Some AA historians place the actual last drink a week or two later; the traditional date was fixed in hindsight.3

That detail matters. AA did not appear as a finished program. It grew from two people discovering that talking honestly with someone who recognized the problem could help both of them stay sober.

What matters most

• AA is a free, peer-led fellowship. Twelve-step facilitation, or TSF, is professional treatment designed to increase participation in AA or similar groups.
• A 2020 Cochrane review included 27 studies and 10,565 participants. Manualized AA/TSF improved continuous abstinence in a key comparison, while many other drinking outcomes were similar to established treatments.4
• AA has no single honest “success rate.” Studies use different people, denominators, interventions, outcomes, and follow-up periods.
• AA’s official literature does not tell members to reject prescribed medication. A sponsor or member should never direct someone to stop medical treatment.5
• SMART, LifeRing, SOS, Women for Sobriety, Recovery Dharma, Refuge Recovery, Moderation Management, and secular AA offer meaningfully different cultures and goals. Evidence outside AA is promising but thinner.

Zoom

Before AA had a name

AA inherited ideas rather than inventing them all. The Oxford Group, a Christian revival movement, emphasized personal inventory, confession, restitution, prayer, and helping others. Bill W. had contact with the group through Ebby Thacher, a friend who had stopped drinking and spoke about spiritual change.

William James’s The Varieties of Religious Experience gave Bill a language for sudden and gradual transformation. The well-known Carl Jung story is more indirect. In AA tradition, Jung told a patient often identified as Rowland Hazard that a profound spiritual experience might offer hope where medical treatment had failed. The surviving Jung-Bill correspondence dates from 1961, decades after the reported clinical encounter, and some chronology and identity details are disputed by historians.67 It is fair to describe the story as influential AA tradition, not a contemporaneous medical record proving a chain of events.

This mixed inheritance helps explain both AA’s durability and some people’s discomfort. The program speaks of spiritual awakening and a higher power, yet local groups vary widely in theology, language, and practice.

The history is often retold as a clean chain from Jung to Rowland, Rowland to the Oxford Group, Ebby to Bill, and Bill to Dr. Bob. Surviving records do not support treating every link as equally documented. The broad influences are clear; exact conversations and chronology are less so. A respectful history can preserve AA’s tradition while telling readers where historians have questions.

Medicine was also present. Bill had repeated hospital treatment, and physician William Silkworth’s description of alcoholism as involving an allergy-like physical response and a mental obsession shaped early AA language. Those historical concepts should not be imported unchanged into modern diagnostic science. Their importance is what they helped early members understand: repeated drinking was not simply a failure to know better.

From two people to a fellowship

Bill W. and Dr. Bob helped other people, first in Akron and then through emerging groups. In April 1939, the first edition of Alcoholics Anonymous, later called the Big Book, set out the Twelve Steps and personal accounts. The fellowship eventually took the book’s name.1

The Twelve Traditions developed later to address group survival, autonomy, money, public relations, leadership, and anonymity. They were formally adopted at AA’s first International Convention in 1950. Sponsorship, where one member helps another work through the program, became customary rather than a professionally licensed role. Service can range from making coffee to leading meetings or helping a newcomer.

Milestone chips are common but not universal. So are prayers, readings, and the phrase “90 meetings in 90 days.” Local custom should not be confused with binding clinical instruction.

Anonymity served more than privacy. It limited public celebrity and placed principles above personalities. Group autonomy allowed AA to spread without a central authority directing every meeting. Those same features create variation. A welcoming group and a shaming group can both use the AA name, which is why fit must be judged locally.

Sponsorship is similarly decentralized. A sponsor may help someone read literature, work Steps, make calls before drinking, and learn meeting culture. A sponsor is not automatically a therapist, physician, pharmacist, lawyer, or emergency service. Healthy boundaries preserve what peer experience does well.

What a meeting is actually like

An open meeting welcomes observers, family members, and professionals. A closed meeting is generally for people who identify as having a drinking problem or a desire to stop. Listings may describe speaker, discussion, Step, Big Book, beginner, secular, women’s, LGBTQ+, young-person, or online formats.

Someone may arrive early, sit quietly, and decline to share. A chairperson usually opens with readings, members speak from personal experience, and the group may close with a prayer or other statement. People may offer phone numbers or introduce themselves afterward. There is no enrollment fee. Groups may pass a basket for optional contributions.

A speaker meeting may devote most of the hour to one recovery story. A discussion meeting offers a topic and shorter member shares. Step and Big Book meetings read and discuss a text. Beginner meetings explain language and customs. Identity-focused meetings can reduce the burden of being the only young, queer, women, or culturally isolated person in a room. Online meetings trade travel access for new privacy and attention challenges.

No one has to disclose a diagnosis or detailed history on a first visit. A person can listen, compare several formats, and ask what happens if they need medical help. Court slips and attendance verification are local administrative practices, not AA treatment outcomes.

AA’s anonymity tradition asks members not to identify other attendees publicly. That is a community norm, not the same as clinician-patient privilege or a legal guarantee. Online platforms, screenshots, shared rooms, and court involvement create additional privacy concerns. A reader can ask the group how it handles privacy before sharing details.

For online meetings, use a display name and camera choice that match your privacy needs, check who can enter, and notice whether sessions are recorded. Headphones can protect other attendees from being overheard. The platform still collects data under its own terms, and a group promise not to record cannot control every participant’s device.

Court-required attendance introduces another layer. A group may verify presence without endorsing the mandate or sharing clinical information. Ask what identifying information is placed on a slip or digital record. A meeting secretary is not a probation officer or therapist.

What the strongest review found

The 2020 Cochrane review by Kelly, Humphreys, Ferri, and colleagues examined 27 studies with 10,565 participants, including 21 randomized or quasi-randomized studies, five nonrandomized studies, and one purely economic study. Participants were non-coerced adults with AUD. Comparators included motivational enhancement, CBT, and other twelve-step approaches. Certainty ranged from very low to high.4

The crucial distinction is between AA and TSF:

• AA is the peer-led fellowship and its meetings.
• Twelve-step facilitation is a structured treatment delivered by a professional to help a patient engage with AA or another twelve-step community.

For manualized AA/TSF versus treatments with a different theoretical orientation, two randomized or quasi-randomized trials with 1,936 participants found better continuous abstinence at 12 months: risk ratio 1.21, 95% confidence interval 1.03 to 1.42, rated high certainty. The finding remained consistent at 24 and 36 months.4

That does not mean “AA beats CBT” in every way. At 12 months, percent days abstinent was similar in four studies with 1,999 participants and very low-certainty evidence. AA/TSF probably performed similarly for drinks per drinking day and alcohol-related consequences at 12 months. Evidence for percentage of heavy-drinking days was low certainty. Four of five economic studies found substantial healthcare cost savings, probably because a free community resource can replace some continuing professional care.4

Adverse outcomes were not reported consistently enough to support a sweeping safety comparison. Follow-up, manualization, comparator, and population differed across studies. The responsible conclusion is specific: professionally delivered TSF that increases AA participation can improve continuous abstinence and may reduce healthcare costs, while many non-abstinence outcomes are similar to other established treatments.

The review also found that nonmanualized AA/TSF generally performed as well as other established treatments for several outcomes, with lower certainty. At 12 months, manualized approaches did not show a clear percent-days-abstinent advantage, while at 24 and 36 months AA/TSF was favored on that measure with low-certainty evidence. Drinking intensity and alcohol-related consequences were often similar. The pattern is more useful than a victory slogan: AA-oriented care can be at least competitive and particularly helpful for continuous abstinence.

The economic findings deserve careful interpretation. Four of five studies found meaningful cost savings, often when professional linkage increased use of free community support and reduced later healthcare use. Cost savings do not prove that every meeting is clinically appropriate, and they should not become an excuse to deny therapy or medication.

How AA may help

AA can change a person’s social network. It supplies sober role models, repeated rehearsal of coping stories, a place to be accountable, opportunities for service, and a structure for making amends and responding to craving. Studies of mediation suggest that shifts toward recovery-supportive relationships, coping, and self-efficacy may explain part of the benefit. A plausible mechanism is not proof that every Step is necessary or that spirituality works the same way for everyone.

Older observational studies were especially vulnerable to self-selection. People who attend more may begin more motivated, have fewer barriers, or be more able to sustain abstinence. People who improve may keep attending, while those who struggle may disappear from follow-up. Randomization to TSF reduces some bias, but no trial can assign lifelong AA involvement in the way it assigns a pill.

Social-network change may be especially important because alcohol is social for many people. If every friend, weekend, and celebration centers on drinking, a new behavior has to compete with an entire environment. Meetings can supply phone contacts, sober activities, and visible examples of ordinary life after alcohol. A group can also become unhealthy if it pressures, exploits, isolates, or shames members. Mechanism is not a guarantee of culture.

Why AA Has No Single Success Rate

A meeting survey may count current members, excluding everyone who left. A treatment trial may count every randomized participant, including those lost to follow-up. One study may ask about continuous abstinence; another counts fewer drinking days; another measures a year, while another measures a month. Retention is not the same as abstinence, and relapse is not the same as permanent failure.

This is why both “AA works for only 5 percent” and a universal high success claim are misleading. The honest questions are: Which AA or TSF exposure? Compared with what? For whom? What outcome? At what time?

Dropping out may reflect schedule, transportation, childcare, trauma, language, identity, theology, a harmful interaction, or a group that simply did not fit. Nonattendance is not a diagnosis of unwillingness.

Medication is not disloyalty

AA does not prescribe, endorse, or oppose a particular medicine. Its Conference-approved pamphlet states that “Some A.A. members must take prescribed medication for serious medical problems” and that “No A.A. member should ‘play doctor’; all medical advice and treatment should come from a qualified physician.”5 Other Conference-approved literature states that AA does not make medical or psychological diagnoses and does not provide drugs or any medical or psychiatric treatment.8

Individual experiences can diverge from policy. Some people report being shamed by a sponsor or member for taking naltrexone, antidepressants, stimulant medication, or medication for opioid use disorder. That behavior is not universal AA policy, but its impact can be serious.

Never stop naltrexone, a psychiatric medicine, or any prescribed treatment because a sponsor or meeting participant tells you to. Contact the prescriber. A peer can share experience. They cannot safely manage withdrawal, interactions, bipolar disorder, psychosis, seizures, or opioid blockade.

The same boundary works in the other direction. A clinician should not dismiss a patient’s AA community merely because it is spiritual. Ask whether it supports safety, prescribed treatment, and sustained change. Collaborative care can include a sponsor and a prescriber without pretending they have the same role.

Who may fit AA, and who may not

Some people value AA’s availability, frequent meetings, shared language, sponsor model, abstinence goal, service, and spiritual framework. A person can often find a meeting today without insurance or an appointment.

Others may be uncomfortable with higher-power language, public identification, an abstinence-only culture, pressure from a particular member, past religious trauma, uneven group dynamics, or a mismatch with a local meeting. A secular meeting can still be AA. Group autonomy allows adapted readings and agnostic or atheist language while retaining the Steps and Traditions.

A person may also value some parts and reject others. They may attend meetings for community without choosing a sponsor, use secular interpretations of the Steps, or combine AA with SMART tools. Conversely, someone may appreciate the sponsor relationship but need trauma therapy elsewhere. Fit is not measured by total agreement.

Warning signs include demands for money beyond transparent voluntary contributions, romantic or sexual pressure, instructions to stop medicine, threats about leaving, promises that the group can cure every illness, or pressure to disclose trauma publicly. Seek another group and professional help when boundaries are violated.

Leaving one group does not mean mutual help failed. Trying another format can be a better test than forcing loyalty to a room that feels unsafe.

Secular and alternative roads

SMART Recovery was incorporated in 1994 by the nonprofit board that had ended its affiliation with Rational Recovery, and it adopted the SMART name that October. Its 4-Point Program draws on CBT, rational emotive behavior therapy, and motivational methods: build and maintain motivation, cope with urges, manage thoughts and behavior, and live a balanced life. It describes itself as having “a scientific foundation, not a spiritual one,” and it says it “supports the scientifically informed use of psychological treatment and legally prescribed psychiatric and addiction medication.”9

LifeRing Secular Recovery adopted its name on May 23, 1999 and became a national organization at its constitutional Congress in February 2001. It emphasizes its “3-S philosophy” of Sobriety, Secularity, and Self-Empowerment, and the idea of strengthening the “sober self.” Meetings are run by peers in recovery, and members build individualized recovery plans.10

Secular Organizations for Sobriety, or SOS, began as a concept and network around 1985, with early meetings following soon after. It is secular, peer-led, and abstinence-oriented. Historical dates vary by whether a publication, organization, or first meeting is counted.

Women for Sobriety was founded in 1975 by Jean Kirkpatrick, who established the nonprofit and published its 13 Acceptance Statements that year. Its New Life Program uses those statements, positive self-definition, and peer support. It is abstinence-based, and its current stated policy is that attendees “must identify as female, be at least 18 years old, not under the influence of any substance, and trying to achieve sobriety.”11

Recovery Dharma was organized in 2019, when the former Refuge Recovery board formed the Recovery Dharma Collective as a “peer-led and democratically run” movement. It uses Buddhist-inspired practices such as meditation, inquiry, compassion, and sangha. It is generally non-theistic, but it has a spiritual and philosophical vocabulary. Buddhism itself should not be presented as a clinical treatment.12

Refuge Recovery developed around 2014 and remains distinct from Recovery Dharma. Its abstinence-oriented program includes meetings, meditation, inventory, mentorship, retreat, and service within a Buddhist-inspired framework.13

Moderation Management began in 1994. It offers peer support, tracking, goal setting, and structured behavior change for people seeking moderation, breaks, or abstinence. MM states it “is not treatment or therapy” and cannot advise beyond peer support.14 Moderation is not appropriate for everyone: anyone with physical dependence or withdrawal symptoms needs clinical assessment before attempting a moderation goal.

Online communities include official virtual meetings from the groups above. They expand access but vary in moderation, privacy, commercial incentives, identity verification, and evidence. A large follower count is not a clinical credential.

Comparing the paths

What alternatives research can and cannot say

A 2018 naturalistic longitudinal study followed current attendees of Women for Sobriety, LifeRing, SMART, and twelve-step groups. Initial group differences were reduced after accounting for baseline recovery goal, suggesting that fit and engagement may matter more than a simple brand ranking. Recruitment from existing attendees and self-selection prevent a causal equivalence claim.15

A pooled U.S. PAL analysis of the 2015 and 2021 cohorts included 1,152 adults with lifetime AUD who had attended one of those groups in the prior 30 days. Surveys at baseline, six months, and 12 months had 81% to 88% response. Greater involvement predicted abstinence, fewer drinking days, and fewer alcohol problems. Group choice was not related to outcomes after adjustment, but participants chose their groups, and SMART practice varied by time and place.16

These studies did not test SOS, Recovery Dharma, Refuge Recovery, Moderation Management, secular AA as its own intervention, or generic online communities. “No adequate trials found” is more honest than declaring equal effectiveness.

Engagement is not merely attendance. In the pooled PAL study it included elements such as having a regular or home group, volunteering, and service. Greater involvement predicted better later outcomes, but the direction may run both ways. People doing better may become more involved, and involvement may help them do better. Adjustment reduces confounding but cannot randomize belonging.

Program descriptions also change. SMART meetings in one era or city may differ from another. Recovery Dharma and Refuge Recovery have organizational histories that readers sometimes merge. Online communities can appear and disappear quickly. An article can compare official models without turning brand identity into a fixed treatment ingredient.

How to choose

Try approximately six varied meetings as a practical experiment, not a validated prescription. Compare whether you feel physically and emotionally safe, whether the goal matches yours, whether prescribed treatment is respected, whether leadership boundaries are clear, and whether you can realistically return.

You can attend AA and take medication. You can use SMART while seeing a therapist. You can move from moderation to abstinence. You can leave a harmful group without leaving recovery.

The best group is not the one with the strongest slogan. It is one you can return to, that respects safety and prescribed care, and that helps change behavior outside the meeting.

Frequently asked questions

Is AA religious?

AA calls itself spiritual rather than religious, but its language and practices can feel religious. Local groups vary, and secular AA meetings adapt language within AA’s group-autonomy tradition.

Does AA really work better than therapy?

Manualized AA/TSF improved continuous abstinence in a key Cochrane comparison, while many drinking-intensity and consequence outcomes were similar to established therapies. The answer depends on outcome and intervention.

Is an AA meeting confidential?

AA has a strong anonymity norm, but a meeting is not protected like a clinical relationship in every circumstance. Ask about privacy, especially online or in court-connected settings.

Can I take medication and still attend AA?

Yes. AA does not give medical advice, and its approved literature recognizes prescribed treatment. Never stop medication on a member’s advice; contact your prescriber.

What if abstinence is not my goal?

SMART meetings may be flexible, and Moderation Management explicitly supports moderation for appropriate participants. Physical dependence or withdrawal signs require medical assessment, and abstinence is safer in some situations.

Choose what you can return to

The goal is not loyalty to a brand of recovery. It is safer, sustained change with support that fits. If withdrawal or medication decisions are part of the picture, return to No Rock Bottom Required. Then choose a room, screen, clinician, or combination you can honestly come back to.

This article provides education about peer support. Mutual-help groups do not replace emergency care, withdrawal management, diagnosis, or individualized medical treatment.

Related reading on NP FADY

• The Loan Shark in the Bottle: How Alcohol Borrows Pleasure From Your Brain and Charges Interest
• No Rock Bottom Required: Every Proven Way Out of Alcohol Use Disorder, and How to Pick Yours

References

1. Alcoholics Anonymous. The Start and Growth of A.A. https://www.aa.org/the-start-and-growth-of-aa ; Alcoholics Anonymous. A Brief History of the Big Book (F-166), which dates first publication to April 10, 1939. https://www.aa.org/sites/default/files/literature/F-166_1224_0.pdf

2. AA Grapevine. Founders’ Day. https://www.aagrapevine.org/Free-Access-2021

3. Rebellion Dogs Publishing. Founder’s Day and Other AA Myths, Busted. https://rebelliondogspublishing.com/blogs/rebellion-dogs-blog/posts/4740926/founder-s-day-and-other-aa-myths-busted

4. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020;3:CD012880. doi:10.1002/14651858.CD012880.pub2. https://pmc.ncbi.nlm.nih.gov/articles/PMC7065341/

5. Alcoholics Anonymous. The A.A. Member: Medications and Other Drugs (P-11). https://www.aa.org/aa-member-medications-and-other-drugs and https://www.aa.org/sites/default/files/literature/P-11_0925.pdf

6. Kurtz E. Not-God: A History of Alcoholics Anonymous. Hazelden; 1979.

7. Bluhm AC. Verification of C. G. Jung’s analysis of Rowland Hazard and the history of Alcoholics Anonymous. Hist Psychol. 2006;9(4):313-324. https://pubmed.ncbi.nlm.nih.gov/17333633/

8. Alcoholics Anonymous. A.A. at a Glance (F-1). https://www.aa.org/sites/default/files/literature/assets/f-1_AAataGlance.pdf

9. SMART Recovery. Frequently Asked Questions (https://smartrecovery.org/about-us/frequently-asked-questions); About Us (https://smartrecovery.org/about-us); Allwood S, White W. A Chronology of SMART Recovery (https://deriu82xba14l.cloudfront.net/file/2120/Chronology-percent-20of-percent-20SMART-percent-20Recovery.pdf)

10. LifeRing Secular Recovery. Governance and History (https://lifering.org/governance-menu/); About Us (https://lifering.org/about-us/)

11. Women for Sobriety. About the New Life Program (https://www.womenforsobriety.org/about); Founder (https://www.womenforsobriety.org/founder); FAQ (https://www.womenforsobriety.org/faq)

12. Recovery Dharma Global. About (https://recoverydharma.org/about/); Joint Statement of the Board of Directors of Refuge Recovery and Noah Levine et al., July 6, 2019 (https://recoverydharma.org/joint-statement-july-2019/)

13. Refuge Recovery World Services. Program description. https://www.refugerecovery.org/

14. Moderation Management. About and common questions. https://moderation.org/about/

15. Zemore SE, Lui C, Mericle A, Hemberg J, Kaskutas LA. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. J Subst Abuse Treat. 2018;88:18-26. https://pubmed.ncbi.nlm.nih.gov/29606223/

16. Zemore SE, Lui CK, Mericle AA, Li L, Martinez P, Timko C. Second-wave mutual-help groups: examining effectiveness for individuals with alcohol use disorders in the longitudinal, U.S. national PAL Study cohorts. Int J Drug Policy. 2026;147:104921. doi:10.1016/j.drugpo.2025.104921. https://pubmed.ncbi.nlm.nih.gov/40750480/

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.