Alcoholics Anonymous The first face-to-face meeting I attended was an Alcoholics Anonymous (AA) meeting at the United Methodist Church in Greenville, SC on a Friday night. Smoking was allowed at the meeting, which was held in a wheelchair-accessible facility. Coffee and snacks were served. I arrived ten minutes early. Several others were also there early, including the person setting up a table full of literature. The person setting out the literature smiled and said hello to me when I browsed the books, all of which were related to the Twelve Step program. Most of the books were official Alcoholics Anonymous publications, and I recognized the "Big Book" immediately as well as some of the other publications that are listed on the AA website.

As the people filled into the space, I noticed that many knew each other. They talked casually in the moments before the meeting began formally. I took my seat in the back. No one asked who I was the entire time I was there, allowing me to make my observations undisturbed, and without me causing any disturbances to the regular attendees. I did not recognize anyone there.

The speaker began. A fifty-something year-old woman stood at the podium and introduced herself by her first name. "Hi, I'm Sandy and I'm an alcoholic." This was the way each member introduced himself or herself in front of the group. The pattern established a common identity and worldview shared by the members: that their addiction is an integral part of who they are, and inextricably linked with their identities. Only one person, obviously a newcomer, had trouble with the self-definition, as "I'm an alcoholic." When this individual stood up to speak, he said, "Hi I'm Andy and…" he hesitated. "I'm here because I drink too much." The other members responded in the same way they do to the veteran members, returning the greeting with "Hi, Andy!" No judgment was passed, and no one told him that he could not speak unless he identified himself as an alcoholic.

I noticed that the meeting combined formal and informal elements. For example, Sandy was the proctor of the meeting. She started the meeting with a five-minute talk that was basically an anecdote, and then she initiated a discussion of Step Two. Used copies of the Big Book were passed around to those of us, like me, who did not have our own copies. The Step study lasted about twenty minutes. Sandy the proctor led the discussion and moderated it. Several group members spoke in turn, as Sandy called on them when they raised their hands.

Sandy did look at the clock, indicating that the meeting did follow a schedule. However, there was a fifteen minute period during which is was an "open session." This was when Andy raised his hand to speak. Others like him, with varying times of sobriety, spoke during the open session. They each had a story to tell. Storytelling, I learned, was integral to the AA meeting. It was a way for members to share their experiences, hardships, and lessons. The idea is to create a safe community in which individuals can reflect upon what alcohol has done to them, their relationships, and their careers. Some common themes ran throughout the stories. Many mentioned an alcoholic parent or spouse. Quite a few discussed the ways alcohol affected their jobs or their health. Several members talked about God or their Higher Power.

Spiritual growth is an important aspect of the Twelve Step model. For many, spirituality is equated with religion. However, some members who spoke simply said "Higher Power," and not "God." After the storytelling session, Sandy asked if one of the members would like to lead the group in prayer. The use of prayer was not unexpected. What was strange was that the prayer chosen was the "Lord's Prayer," instead of the "Serenity Prayer" that I was expecting to hear.

Meeting Observation 2: Narcotics Anonymous

The second face-to-face meeting I attended was a Narcotics Anonymous (NA) meeting at the same church in Greenville on a Wednesday evening. I arrived a few minutes early. People were sitting around a round table, which was really four tables pushed together. There were seats for about twenty people. I felt uncomfortable in a circular seating arrangement because it meant that my identity as an outsider might be noticed, unlike my anonymity at the larger AA group. At the AA meeting, the chairs were in rows.

As with the Alcoholics Anonymous meeting, the NA meeting started with a person setting out literature on the back table. The books included the Big Book of Alcoholics Anonymous and also several NA-specific texts. One of these texts was being used...

It was called the "Little White Book." The leader of the meeting began suddenly, sitting from her place in the circle. She introduced herself. "Hi I'm Jan and I'm a recovering addict." Jan started with the Serenity Prayer, which all the people chanted while we held hands. Because of the format of the tables, the NA meeting here was intimate.
Then, Jan went on to explain that they would be using the Little White Book for study as the focal point of the meeting. Browsing through the book, I noticed that the same twelve steps, only slightly altered, were used. General ideas common to all Twelve Step meetings, ranging from anonymity to surrender to the higher power, were all addressed. The Twelve Traditions were the focal point of this meeting. These traditions are collective, and apply to the group, as opposed to the steps, which apply to the individual.

Before beginning the study, Jan said, "We have a new person here. Would you like to introduce yourself?" I gave my first name, and said that I was an observer. Everyone said hello and most smiled. The study session was about the fifth principle, which reads, "Each group has but one primary purpose -- to carry the message to the addict who still suffers."

Pondering the role of the Twelve Traditions, I realized that they are integral to the organizational culture of the group. These twelve traditions were the principles upon which meetings were held and organized. They prevented people from misunderstanding the core tenets of the Twelve Step meetings, and may be why the Twelve Step groups have endured for so long. The principles claim that outside donations are never accepted, among other things related to the ethics of the group. The principle being discussed in this meeting, about the "one primary purpose," was explained as being a reminder of why all the group members all here. "It is not just about helping ourselves, it's about helping others," one of the members stated.

The round table encouraged a lively discussion about this principle, which also led to the discussion of some of the other NA Twelve Principles. One of the principles states that the group "ought never be organized," which especially made sense in the context of this small and informal group. The leader concluded with the Serenity Prayer, which was also chanted in unison while holding hands as the meeting begun. Afterwards, tea and coffee were served. This was a nonsmoking meeting.

The Disease Concept and Etiology

The Twelve Step program promotes a disease model of addiction that has been widely supported in the literature. However, not all researchers agree that addiction is classifiable as a disease. The Twelve Step programs have been vocally criticized, largely on the basis of their quasi-religious nature. In Diseasing of America, author Stanton Peele lambastes the Twelve Step disease model of addiction and recovery. Peele (1999) claims that moderated drinking is preferable to abstinence. Although Peele's (1999) work has received some support, and it mirrors some cognitive-behavioral interventions in addiction, it has also been widely criticized for its lack of research integrity. For example, Wallace (2012) claims that Peele's work is "shown to be based largely on inadequate scholarship, misrepresentations of the literature, inappropriate comparisons, unwarranted generalizations, and straw-man arguments," (p. 261).

The Twelve Step model has influenced psychological practice and the development of treatment interventions for disease. Because of this, it is important to pace the Twelve Step model in context of alternative interventions in addiction. As Parssinen & Kerner (1980) point out, the disease model grew out of a "culture of medicine" that permeated early 20th century psychology (p. 275).

Subsequent cognitive-behavioral interventions sometimes substantiate claims made by Peele, for example. The cognitive-behavioral intervention does not work on a disease model, which presumes a predilection for addiction-based either on biological or on psychological factors. A core difference between the two models, disease and non-disease, is the method of treatment. Control over one's addiction is assumed to be possible for the cognitive-behavioral therapist, who uses techniques to change the way the client reacts to stress in order to cease cravings for drugs and alcohol. In the addiction model, control over the disease is not deemed any more likely than control over one's insulin levels.

In some ways, the disease model is based on observations of addicts and alcoholics who have…