This piece was written for Stinkin’ Thinkin’ by a regular reader — an ex-AA member with 29 years in the program. Thank you!!
Get out your slide rules, nerds! – ftg
[UPDATED by soberbychoice to factor in more current numbers, correct some typos, respond to apologists, and general bulletproofing. UPDATE 2: Further updated on January 11, to reflect more current numbers showing AA’s grip on the treatment industry in the US is eroding.]
AA had 2.1-million members worldwide in its 1993 group count records. 1.26-million in the US and 94,000 in Canada; the remainder in the rest of the world. (The Triennial Survey does not survey membership numbers, but does report the numbers in the group count database, which are the latest numbers for each individual group that GSO has on file for each group.) The AA group database in 2007 said the total membership shown by all the groups worldwide was 2-million. In other words, using the same database, membership had declined about 100,000 from the peak fourteen years previous. GSO for 2010 reports the membership number at exactly the 2.1-million number of 1993.
The membership count over the last couple of years has “grown” as GSO rolled out a new software system that allowed Area registrars to more easily update group membership numbers. Some of the “this can’t possibly be true because AA clearly has an awesome retention and success rate of at least 25%” crowd have panicked and suggested that the method of counting at GSO changed in 1993, thus showing a membership decline that year. That means the numbers prior to 1993 were inflated by 271,000, but it does nothing to change the conclusion that AA is running in place compared to the number of treatment center patients sent to AA and the court-assigned people. The 1994 count was 1.8-million. So, in sixteen years until 2010 AA gained 300,000 members back, roughly the 271,000 who were dropped in ’93, if one wants to buy the apologists story, and I don’t. That’s roughly 19,000 new members per year out of all the million or more who got a Big Book and an AA group introduction.
It’s a little hard to conceive of how 271,000 people can disappear in one year and it takes 16 years to get them back when you’ve got the courts and the treatment centers doing pushups for you, but the apologist’s answer is that GSO decided some groups were really just “meetings” and some groups were counting hanger-ons that didn’t really belong, so “poof” on over a quarter million alcoholics. The more likely explanation is that the HMO’s by the early 1990’s were drastically cutting back on 28-day treatment. That is reinforced by a fairly dramatic decline in Grapevine subscritions over the same period. No matter how you massage the numbers, apologize for the numbers, or sprinkle them with the ashes of the First 100, there ain’t a retention rate or success rate here worth all the chant’s in last year’s meetings.
From the treetop level, AA has a negative growth rate relative to all the “potential” members who walked in the door and then promptly walked back out. So the “success rate” is actually negative from that viewpoint. Let’s dig deeper. The number of people in the US each year who go through drug and alcohol treatment programs is estimated at about one million by the government’s NIAAA. 93% of those treatment programs are Twelve-Step based. So, several hundred thousand people each year are exposed to AA meetings for some period of time. There are 1.3-million AA members in North America by AA’s official group count. My conclusion is that there are a few hundred thousand core AA members with long-term sobriety and the rest of the “membership” is those treatment-center people and court-ordered people cycling through each year. Any long-term AA member can “see” this from their own experience in the rooms. One great churn of humanity pretending to be a gigantic world organization.
In what is clearly good news for AA critics and really bad news for AA and the approximately 90 staff members in New York City who depend on Big Book sales for much of their livelihood, it appears the 12-Step monopoly on treatment centers in the US has begun a steady decline. While NIAAA’s 93% number above applies to the majority of the period covererd in this article, the National Treatment Center’s update from 2005 shows that dominance has eroded to only 75.6% of the private treatment centers. Other data show AA’s dominance in the public treatment centers may be no higher than 60%, even though it does appear AA meeting attendance is required or encouraged even in those that are not based on 12-Step treatment. (See links in Mona Lisa’s comment in the discussion thread below.) The “feeder” system is clearly beginning to break down from the treatment venue, though the court-coerced feeder system appears as robust as ever. It’s a fair forecast to say staff reductions in NYC are on the near horizon and that those staffers, who currently enjoy a defined-benefit pension plan (an underfunded one) not enjoyed by most AA members, will increasingly seek career opportunites elsewhere.
It’s hard to know how many long-term AA members there are. The Grapevine, the official magazine, first reached a circulation of 100,000 subscribers in 1978. It peaked in ’93 at the same time the membership peaked, at 138,000. Today the GV circulation stands at 93,000 and is losing money at a rate—several hundred thousand dollars per year–that is alarming the General Service Office in NYC. Again, no growth. The GV surveys estimate that the magazine has a “passalong” rate of four times. So, we have possibly 400,000 members who are devoted enough to read the official magazine. Not much to hang your hat on, but just as good as all the other guessing that goes on in an anonymous organization that keeps virtually no records and does little or no research to speak of, and certainly allows no negative information to reach the membership.
AA World Services sells one-million Big Books each year and has each year for the last two decades. Yet, no membership growth. What gives? Clearly, the organization is not the “attraction” that it proclaims to be; most of its “churn” are coerced people cycling through, having gotten a Big Book worth $8 as part of their $25,000 “treatment” bill. Saying AA has a “retention rate” of even 5% is nonsense. If 5% of the newcomers were staying, AA membership would double every twelve years (Rule of 72; divide the percentage into 72 to find the time to double; into 115 to find the time to triple). So, if AA had a success rate of 5%, it would have doubled its membership between 1994 and 2006 to 3.6-million. The actual 2006 count was 1.98-million. The average drunk is apparently a lot smarter than he/she is thought to be: While “professionals” in courts, counseling and medicine still propound the AA solution, the drunks are voting with their feet and leaving in droves!
So, why hasn’t “rigorous honesty” propelled the AA leadership to recognize what is clearly in front of their face? Part of it is, of course, plain fear, which was supposed to have disappeared with working the Steps. But there is “money, property, and prestige” here too. AAWS and the Grapevine (the only sources of business income in NYC for the General Service Board, General Service Office, and the Conference) are a $16-million dollar a year enterprise, all but roughly $2-million of that being AAWS, which employs all the GSO staff. Most of the $14-million of AAWS revenue comes from literature sales, primarily the Big Book. About $6-million or so comes from “the hat” from the AA groups in the US/Canada. Only about 44% of the groups send anything. Unity is impressive, huh? If Big Book sales were to decline, the NYC operation would be in real trouble, just as Grapevine is already.
The intellectual property suits and copyright suits against AA members in Germany and Mexico that AAWS initiated or participated in were all about protecting that income stream. So, despite former AA Chair Michael Alexander’s (Bill and Lois W.’s attorney and also the attorney who did most of AA’s legal work as a member of the Bern Smith law firm from the 1950’s forward) insistence that when AA faces problems it “goes to prayer instead of law,” AAWS helped sue members in both countries by insisting that the copyright on the 1939 First Edition was still valid in those two countries. The income stream clearly matters more than all the claimed spiritual principles and the Traditions!
AAWS has now printed and sold about 30-million copies of the Big Book since 1939, most of those in the last two decades. Wise AA leaders know that the massive gap between the distribution of the book and the membership numbers spells trouble both for the NYC operations and the future of the movement. Thus, only the renegades within the leadership dare question the coercion that is driving the survival of the movement. The AA Trustees know that if the courts were to prohibit forced AA attendance, or the insurance companies were to cease funding anything but proven efficacious treatment, the movement would be in perilous shape indeed. Needless to say, you don’t get to be or get to remain an AA Trustee if you ask hard questions!
How does one account for the societal acceptance of AA as a solution to alcohol and other problems when AA’s own statistics show its not succeeding at anything beyond churning people through its rooms? American missionary zeal has to account for a lot of it, after all, AA has not taken off in any other region of the world like it has here. The Hughes Act, which Bill W. and Marty M. endorsed enthusiastically in congressional testimony, poured billions of federal dollars into creating the “treatment movement” in the US, something no other country has experienced. Interestingly, the AA stagnation started about the same time as the HMO’s quit funding massive 28-day treatment programs. And finally, the external milieu in the US has been very favorable to AA. Witness M. Scott Peck’s book, “The Road Less Traveled,” which sold ten-million copies (published 1978), arguing that if ordinary Americans were lucky, they would become alcoholics and qualify to join AA. The greater probability today is that one or more books will be on the market in the next five years saying AA is proven not to work.
I joined AA in 1981 when AA had one-million members. On my tenth anniversary, AA had more than doubled. That would be a growth rate of 7.2%. With the current count, AA has a growth rate since I joined of something like 2.5%. Given that more than 10-15 million people at least have been introduced to AA in that time by treatment centers and courts, etc., it’s hard for me to conceive of the merits of a debate about AA’s “retention rate” or its “success rate.” There is neither, very obviously, if you know the mega picture. (Here devoted AA’s could venture into the unknowable and say, well maybe a whole lot of those quit drinking because of what they learned in a few AA meetings. I don’t know many AA’s who would regard that as a “success rate,” however.)
On AA’s 30th anniversary in 1965 Bill W. asked “so where are the 600,000” that came and didn’t stay? We have the same question today, but the number is in the high millions as AA celebrated its 75th anniversary on June 10 last year.
AA’s Triennial Survey shows the membership to be an average age of 47, sober about 8 years. Approximately 85-90% of the members are white, and those numbers are not changing appreciably with the dramatic demographic changes in the US population. The US Census Bureau estimates our country will be minority white by 2042. AA is going to somehow have to miraculously either bring in the minorities that have not flocked to it over the decades, or else it is going to have to dramatically increase its penetration rate in the white population, if it is to remain anywhere near its current size in a decade or so.
Between the “demographic determinism” of the above, the increasing secularization of the US, the decline of residential treatment programs, the obvious beginning of the retreat from the disease model of alcoholism and the very predictable retreat of professionals from the AA “model” in favor of pharmaceutical and behavior treatment programs like the Sinclair Method, cognitive behavior therapy, SMART, etc., it’s very easy to surmise that AA will likely be a very small organization on its 100th anniversary. As well, we could add the information now available on the internet that makes two things very clear: AA is not the only way by any stretch to quit drinking, and there are plenty of downsides to AA groups almost everywhere.
I am not among those familiar with AA who wishes to pretend (in the face of the obvious evidence) that this is a movement that is thriving in its attractiveness to newcomers, is retaining some outlandish percentage of those who come to it for help, or that if AA would just get back to some model of “primitive AA,” all would be well. AA has a core group of a few hundred thousand members in the US–many of them the 55,000 or so who attended the San Antonio convention last July–and the rest are the folks cycling through from treatment centers and the courts. We should add, many of those being people who have “recycled” through treatment centers and AA multiple times.
I have several observations about what may have happened to AA. One of them is this: The first members who wrote the Big Book said, “We know only a little. More will be revealed.” Bill W. and many of the early leaders, whatever else their faults, were fascinated with what more could be learned about alcoholism, how it could be treated, etc., and, most importantly, how AA could be most responsive to the next alcoholic who walked into the rooms. Today AA is not a learning organization. It is not open to new ideas. It is not open-minded to listen to either its concerned friends or let alone its critics. AA is frozen into organizational rigidity at a time of incredible changes in the societal milieu in which it exists. Bill W. would have been passing out Prozac pills in the late eighties, just like he did niacin and LSD in the fifties and sixties; today he would be passing out naltrexone, Campral, Topamax, Baclofen and anything else that physicians think might help someone to quit drinking. To that extent, as wacko as Bill W. clearly was, he was far more of an open-minded cult leader than those who fervently believe they are following in his footsteps by prescribing nothing, not even aspirin, other than a 1939 book that members now believe revealed every truth that one needs to know.
AA members’ response to all this–there being none from the headquarters or General Service Conference–is to flail about trying to say “the numbers our critics use have got to be wrong…you don’t know how high the success rate is in my group…” or, alternatively, to retreat into primitive AA mode and say, “We’d get back to the 75% success rate if we made all the newcomers get on their knees and recite the Third Step Prayer just like Dr. Bob did.” For those desperate AA defenders who spend their time trying to decipher the Triennial Survey numbers and counter the claim that the “retention rate” is only five percent, there is really bad news: There is no retention rate to debate about. All we can debate is the “churn” rate.
It’s going to be incredibly fascinating to see if some leadership emerges in AA to change the organization’s future, if AA fractures into a myriad group of organizations (arguably that has already happened with all the Back to Basics and fundamentalist sects within AA and the groups that have basically unaffiliated themselves from AAWS by buying their BB’s cheaper through Anonymous Press), or if it gets replaced by a support organization that is more palatable to those who need help. The trigger for change could be more court decisions that stop the flow of newcomers from that source; it could be the growth of treatment centers that offer alternatives to Step-based recovery; it could be additional breakthroughs in medicine that go beyond the somewhat promising pharmaceutical tools physicians now have like naltroxene and soon, nalmefene; or, it could be a sound study of sufficient stature that says it’s medieval to think character defects are the cause of alcoholism and here are some things that do work and have proven efficacy based on sound research.
At the moment most of the leadership in AA is still very comfortable with the organization’s monopoly status and is not even in the mode of believing anything needs to change. At the grassroots level, many thinking AA’s are quite concerned about what has happened to the movement, but they are not organized and no consensus has developed on what reform steps need to be taken. My further guess would be that no reform movement in AA would have much of a chance of success unless there was incredible pressure from the professional organizations with which it is allied to demand that it change in many fundamental ways. No multi-billion-dollar industry like the “treatment movement” has ever surrendered voluntarily. And certainly no institution, short of the Church when it had the power of the Inquisition, has managed to survive when the core doctrines have proven not to provide a solution. And this much is as certain as the flowing of the rivers and the growing of the grasses: No “reform” or “renewal” of AA is possible so long as the 1939 Big Book remains the basic text and the 12X12, Bill W.’s awkward projection of his own psychoanalysis onto the whole class of alcoholics, is the manual for taking the Steps. Even minor changes to the BB like taking out “To Wives” or changing anything in the first 164 pages would result in a splintering of the movement that has typically done in all the previous alcoholic movements in the US.