In Shuggie Bain, Agnes Bain hopes to quit drinking by joining a support group called Alcoholics Anonymous (AA). Later in the novel, Shuggie learns of Alateen, an offshoot of AA for children of alcoholics. Both are recovery programs that exist in real life.
Prior to the founding of Alcoholics Anonymous in 1935, the prevailing opinion in the Western world was that alcoholism resulted from a moral failing that could not be cured. When seeking treatment for his chronic alcohol abuse, Bill Wilson (anonymized as Bill W.), a New York stockbroker, sought treatment in 1933 and 1934 from William Silkworth. The doctor theorized that alcoholism was not a moral failing but more akin to a disease that required total abstinence in treatment. Wilson valued Silkworth's opinion, but began drinking again after a month.
Wilson soon after joined The Oxford Group, a religious organization that conceived of alcoholism as a sin one could overcome. Not religious himself, he was intrigued by the group's spiritual approach to overcoming addiction. Wilson then returned to treatment and Silkworth administered a concoction of drugs that provoked hallucinations. Wilson experienced what he understood as a spiritual conversion and felt a new serenity in accepting his powerlessness over his alcoholism and giving himself over to God.
During a business trip to Akron, Ohio in 1935, Wilson met Robert Smith (Dr. Bob), having sought out another Oxford Group member to speak with while trying to maintain sobriety. Together they developed AA using a combination of Silkworth's idea of alcoholism as a disease and the Oxford Group's emphasis on spirituality; they believed this would translate into an approach that empathized with alcoholics while trying to convince them away from hopelessness. Breaking with the Oxford Group, Wilson and Smith said that alcoholism was a state of insanity, not a state of sin.
In 1938, Wilson wrote a twelve-step program to aid other alcoholics. The steps involved admitting powerlessness over alcohol, believing a higher power could restore one to sanity, making a moral inventory of oneself, admitting to one's wrongs, making amends to people one has harmed, seeking a spiritual connection through prayer, and carrying the message to other alcoholics. By 1939, there were three groups that met regularly to discuss their disease and provide mutual encouragement and support. One hundred people had achieved sobriety through AA. In the same year, Wilson wrote "The Big Book," which touched on members' experiences of recovery while laying out AA's philosophy and the twelve-step program at its core.
Over the following decades, AA spread to become a not-for-profit worldwide recovery program, with daily meetings hosted in churches, community centers, universities, and other spaces. Many other support group fellowships in AA's mold emerged, such as Gamblers Anonymous and Nicotine Anonymous among dozens of others. Each new group adapted the twelve-step method to address other types of substance abuse, compulsive behavior, and dependency issues. Family and friends also founded auxiliary groups such as Co-Dependents Anonymous and Adult Children of Alcoholics to address their own symptoms of dysfunction that arose from relationships with people with compulsive personalities.
Although AA has faced skepticism since its founding, in 2020, a Stanford medical review of AA studies found that abstinence from substance abuse was sixty percent higher among AA members than alcoholics who sought other recovery methods. The research also estimated that free 12-step programs reduced mental health counseling costs by $10,000 per person.
