The Steps start from a basic acceptance that we can control and change only ourselves and our own reactions to people and events. Twelve Step participants take ongoing inventory of themselves and honestly acknowledge the ways they have hurt themselves and others. When they are ready, they attempt to make amends to all persons they have harmed. Trust, acceptance, love, goodwill and forgiveness are key elements in a Twelve Step program just as they are important elements of any healthy relationship.

The twelve steps of alcoholics anonymous do not come from the Oxford Groups because there were twelve apostles the  Oxford Groups practised six steps all of which AA adopted but also added six which had to do specifically with a non denominational or religious numinous power and the specific effects of alcohol addiction on the character on the afflicted.  As many addicts -- probably many more -- have been harmed by the ignorant prescription or pharmaceuticals to people in recovery for AA as have been harmed by a lay AA sponsor telling a member that all prescriptions are bad. .   
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The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study suggests the transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol, and cannabis users. [10] An increased risk of transition to dependence among minorities and those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.
Topiramate, a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however, as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.[177] A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.[178]
The NIAAA defines risky drinking of "standard drinks," with one standard drink equal to about 12 ounces of typical American beer, 5 ounces of wine, or 1.5 ounces of hard liquor. These figures are based on "typical" (mass market) forms of beer and wine; particularly for beer, many specialty beers may contain up to twice the amount of alcohol as a mass market beer does. For wine, the alcohol content is more constant, but wine coolers often contain less alcohol and some types of wine, such as zinfandels and port, may contain twice the average amount of alcohol. For men, 4 or more drinks a day or 14 or more a week within the last year is considered risky, while for women it is 3 or more a day or 7 or more a week.
For people in the first stage of alcohol use (having access but not having yet used alcohol), preventive measures are used. Therefore, limiting access to alcohol or other drugs, addressing any risk factors of the alcohol consumer or family, as well as optimal parental supervision for youth and expression regarding expectations are often recommended. The approach to those who have experimented with alcohol should not be minimized by mental health professionals, since infrequent use can progress to the more serious stages of alcohol use if not addressed. Therefore, professionals recommend that the alcohol-consuming individual be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user be referred for brief counseling, a self-help group, and/or family support group. People who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.
Women tend to be more sensitive to the effects of alcohol and may develop alcohol-related health problems sooner and after consuming less alcohol than men do. Alcohol use in pregnant women can lead to miscarriage, stillbirth, premature birth, low birth weight, and other problems in the baby, such as abnormal facial features, malformation of organs (such as the brain and heart), growth deficits, and hearing and vision problems. Brain damage due to a mother's alcohol use may result in behavioral problems, speech and language delays, and learning disabilities, according to the March of Dimes.
Friends and family members are interconnected—suspended in delicate balance. When a loved one begins the arduous journey of recovery, the balance shifts. With work and understanding, relationships can be reshaped into something better and a healthier balance can be achieved. Recovery and support for the recovering person are reciprocal gifts that keep on giving.

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Another variation comes from the fact that some people are uncomfortable with the specific, religious aspects of the 12-Step program. As stated above, and as evident by the steps themselves, the 12-Step model originated from a Christian point of view. Those who are not Christian have modified the steps to refer to their specific religious or spiritual practice as a way to connect more with the structure of the 12-Step program. In addition, a number of non-religious 12-Step groups have modified the steps to fit a secular model that can help those who are agnostic or atheist practice the program without feeling forced to adhere to a religion they don’t believe in.
In the case of expectant mothers who drink, future healthcare costs double, now including both the mother and child. For example, a child born with fetal alcohol syndrome could require special schooling. Not only is this a personal and unnecessary family tragedy but also it stands to impact the social system financially in the form of healthcare and education for years.
During Step 9, individuals will attempt to make amends for wrongdoings done to specific individuals. People are encouraged to reach out to these individuals and let them know that they would like to approach them to make amends. It can be very humbling to do so. In some cases, it is not possible to have these conversations directly, or doing so would be more harmful, so indirect methods may be ideal. Individuals can write a letter to the person (even if it will never actually be delivered), or they may choose to donate to a charity in their honor or help someone else in need.
Alcohol use is the fourth leading cause of preventable death in the United States (after smoking, high blood pressure, and obesity). According to a 2018 report from the WHO, in 2016 the harmful use of alcohol resulted in about 3 million deaths, or 5.3% of all deaths around the world, with most of these occurring among men. [1, 2] The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink. [3]
We take your privacy seriously and understand the magnitude of your current situation, as well as its impact on your career and family. While we are required to report monitoring information for mandated admissions, health care professionals entering IPRP on a voluntary basis have complete confidentiality. So, don't hesitate to pick up the phone and call us for more information. 
I'm sober since 1999, with AA and by the grace of my Higher Power. No religion for me. Meetings, sponsor, litterature and 12 steps every day if possible. I live a wonderful life, quiet and stable. My only enemy is my ego. He often try to bring me back to the "Old Me"... but AA, my sponsor, my sponsees and other members are always there to help me. And I'm there for them.
Alcoholics Anonymous (AA) : Alabama • Alaska • American Samoa • Arizona • Arkansas • California • Colorado • Connecticut • Delaware • Federated States of Micronesia • Florida • Georgia • Guam • Hawaii • Idaho • Illinois • Indiana • Iowa • Kansas • Kentucky • Louisiana • Maine • Marshall Islands • Maryland • Massachusetts • Michigan • Minnesota • Mississippi • Missouri • Montana • Nebraska • Nevada • New Hampshire • New Jersey • New Mexico • New York • North Carolina • North Dakota • Northern Mariana Islands • Ohio • Oklahoma • Oregon • Pennsylvania • Rhode Island • South Carolina • South Dakota • Tennessee • Texas • Tribal Areas • Utah • Vermont • Virgin Islands • Virginia • Washington • Washington DC • West Virginia • Wisconsin • Wyoming
WHO's ICD-10 "alcohol harmful use" and "alcohol dependence syndrome" Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism.[24] The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence.[100] The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.[103]
Some people don’t like or are not interested in the 12-Step model, even with the variations above or through organizations that facilitate the 12-Step model. Some people don’t like basing their recovery on the idea that they cannot control their addiction, when there is evidence that there are ways of practicing internal control over the recovery process.

"When I first told my family I was going into treatment, they were stunned," said Cathy, a recovering alcoholic. "I wanted to talk, needed to talk, but none of us had the right words yet. Now, five years later, I realize that it doesn't really matter how perfectly you say something. You have to risk saying the wrong thing and just start communicating.
Thank you for letting Los Angles Central Office serve and support you. LACO maintains this website and publishes both the online and print meeting directories, and it is the information hub for AA in the Los Angeles area. At Central Office volunteers are of service 365 days a year answering the phones and sharing experience, strength and hope. Let us know how we can help your group carry the message.
AA is the most widely available 12-Step program, and meeting times and locations are easily found on the Internet. Our Continuum of Care staff provides recommendations for solution-based meetings with a solid foundation of support. At Origins Behavioral HealthCare, we familiarize our patients with 12-Step meetings during their stay and connect them with 12-Step resources in their own communities.
Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.[29] Risk is greater in younger people due to binge drinking, which may result in violence or accidents.[29] About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.[11] Alcoholism reduces a person's life expectancy by around ten years[22] and alcohol use is the third leading cause of early death in the United States.[29] No professional medical association recommends that people who are nondrinkers should start drinking wine.[29][30] Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers[31] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.[32][33] A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting a propensity to bone fractures.[34]
Photodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It's used to treat actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.
Alcoholics Anonymous became so well-known that Wilson and other early members of the group were invited to a dinner hosted by John D. Rockefeller, Jr., the patriarch of one of the most powerful families in American history. Despite Wilson’s requests, Rockefeller refused to finance AA, believing that the money would only corrupt the noble ambitions of the group. Instead, Rockefeller felt that the organization’s own characteristics – the personal testimonies, the word-of-mouth, and the anonymity – were key to its success and longevity.
Programs like AA and other 12-Step groups provide a healthy community of support and solidarity filled with individuals who are all seeking to remain sober on a long-term basis. Individuals who regularly attend AA meetings are about twice as likely to remain abstinent over those who don’t, per the Journal of Addictive Disorders. The 12 Steps can go a long way in providing individuals in recovery with the support they need.
Meditation, prayer, and journaling make up Step 11 as individuals use these tools to form a spiritual connection with God or the higher power. Quiet time and solitude provide for self-reflection, and meditation can be helpful to increase the connection between the body, mind, and soul. When a person is in tune with themselves physically and emotionally, the spiritual aspect is also strengthened. Journaling during Step 11 can be a beneficial way to explore thoughts and emotions more fully as well.
Alcohol misuse and dependence are primarily diagnosed through the use of clinical screening surveys. Several hundred such surveys exist, and they vary in the number and nature of questions they ask. Some of the more common scientifically-validated questionnaires include the Michigan Alcohol Screening Test (MAST), a shorter version called the Brief MAST, the Alcohol Use Disorders Identification Test (AUDIT), and a commonly employed, quick survey called the CAGE questionnaire. These surveys ask a range of questions about frequency of drinking, problems that result, and ability to stop.

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There are no dues or fees for members of AA. Prohibitive cost can be a major hurdle when it comes to sticking with a treatment program. Even if it’s working, someone might drop out if it becomes too expensive for them to stay with it. While a group might do a collection to cover expenses like rent or refreshments, there is no mandatory cost required to join AA.
Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.[40] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.[41] Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers.[42] Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[43] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.[44] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.[45][46]
Many newcomers who attend 12-step meetings find personal validation in the stories of other addicts. Substance abusers who have been isolated by their disease have the opportunity to relieve their pain by sharing their experiences with others. Alcoholics who have lost their jobs, families, and dignity can recover their self-respect and restore broken relationships with the help of the fellowship and the 12 steps.
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Standing by your friend or family member’s progress during and after treatment is important, too. For example, alcohol is everywhere. Even after recovery, your person will be in situations they can’t predict. Ways you can help include avoiding alcohol when you’re together or opting out of drinking in social situations. Ask about new strategies that they learned in treatment or meetings. Stay invested in their long-term recovery.
In keeping with AA's Eighth Tradition, the Central Office employs special workers who are compensated financially for their services, but their services do not include traditional "12th Step" work of working with alcoholics in need.[31] All 12th Step calls that come to the Central Office are handed to sober AA members who have volunteered to handle these calls. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.[32]
Other options include inpatient and outpatient rehab centers, which offer professional addiction treatment and medical care. These programs can also offer a medically supervised detox, which is important in the early stages of alcohol withdrawal. People who have been drinking heavily for long periods of time and stop are at risk of symptoms such as insomnia, nausea, vomiting, tremors, fever, seizures, hallucinations, and severe confusion. Some of these symptoms can be dangerous or even fatal. A medical detox can reduce these symptoms and prevent complications.7
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Like individual groups, the GSO is self-supporting. AA receives proceeds from books and literature that constitute more than 50% of the income for its General Service Office.[30] In keeping with AA's Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and through the voluntary donations of AA members and groups. It does not accept donations from people or organizations outside of AA.
The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee. The Big Book (from Alcoholics Anonymous) states that once a person is an alcoholic, they are always an alcoholic, but does not define what is meant by the term alcoholic in this context. In 1960, Bill W., co-founder of Alcoholics Anonymous (AA), said:
Detoxification begins 4–6 hours after the last consumption of alcohol and lasts for 5–7 days. In this period, diazepam is administered every six hours to control the detoxification process and withdrawal symptoms. While detoxification often occurs in hospitals, some people undergo detoxification in their homes. However, patients should not consider undergoing detoxification at home if they have suicidal feelings, do not have friends and family to support them, or have experienced severe withdrawal symptoms before.
Once the person has safely detoxed from alcohol, a comprehensive rehabilitation program is the best step. These programs offer intensive therapy to help clients understand the root causes of their addiction and change their behaviors toward intoxicating substances. The National Institute on Drug Abuse (NIDA) recommends remaining in a rehabilitation program for 90 days, or three months.
The cause of alcoholism seems to be a blend of genetic, physical, psychological, environmental, and social factors that vary among individuals. A given person's risk of becoming an alcoholic is three to four times greater if a parent is alcoholic. Some children of alcohol abusers, however, overcome the hereditary pattern by not drinking any alcohol at all.

The twelve steps of the program are listed above and on the steps page in generic form. Other groups who have adopted the 12 steps to address their own particular addictive or dysfunctional behavior have similar ideas, usually with only minor variations. These steps are meant to be worked sequentially as a process of getting rid of addictive behaviors and should result in a growth in freedom and happiness, as outlined in the Promises. The general governing approach for A.A. groups was originally laid out in the Twelve Traditions, and they remain the guiding principles for most 12 step groups today.
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