I am almost a year sober. Close enough that I am starting to think about what the next year looks like, and far enough that I have opinions about how I got here. Two opinions in particular. Alcoholics Anonymous works for a lot of people, and the data backs that up. And it is not the only way to get better, and a lot of what makes it work has nothing to do with the steps.
Both can be true. They have to be true, because the people I know who have stayed sober have done it differently from each other, and most of them have done it without a strict twelve step program at all.
Start with what AA actually does
The strongest piece of evidence we have is the 2020 Cochrane review by John Kelly, Keith Humphreys, and Marica Ferri. They pulled together 27 studies covering more than 10,500 people and asked the boring, important question: does AA work compared to other treatments. The answer, simplified: yes. 42 percent of AA participants were continuously abstinent at one year, compared to 35 percent of people receiving other treatments including cognitive behavioral therapy. The same review found AA-based programs were associated with substantially lower healthcare costs over time.
That is a real result. AA outperforms several first-line clinical treatments on the specific outcome of continuous abstinence, and it is free, and it is everywhere. If you are reading this and you are deciding whether to walk into a meeting, the answer is walk in.
I will go further. I think AA gets unfairly trashed in a lot of secular spaces. People hear "higher power" and check out. That is a mistake. The mechanism that makes AA work is not the theology. It is something I have written about in another context, and it is what the rest of this post is really about.
What AA is actually doing
The epilogue of The Accents of Faith is built around a simple argument. The great traditions converged on a small set of practices that work on the human nervous system whether you believe in the framework that produced them or not. Slow breathing. Gratitude. Honest self-disclosure. Synchronized movement. Awe. Showing up in person. Sustained contact with people who are different from you.
Look at AA through that lens and most of what is happening makes sense without a single appeal to the divine.
- Showing up. Robert Putnam's research at Harvard found that the variable doing the work in religious communities was not the theology or the prayer. It was regular, face-to-face contact with the same group of people over time. AA replicates this exactly. Same room, same time, same people, every week. The Holt-Lunstad meta-analysis of 148 studies covering more than 300,000 people found that social isolation is associated with a 50 percent increase in mortality risk, roughly equivalent to smoking fifteen cigarettes a day. The meeting is the medicine.
- Honest self-disclosure. Step four (a moral inventory) and step five (admitting the inventory to another person) are confession. James Pennebaker at the University of Texas spent his career documenting that writing or speaking honestly about painful experiences for fifteen to twenty minutes a day reduces anxiety, strengthens immune function, and improves mood. The mechanism does not require a sponsor. The discipline of doing it does.
- Service and gratitude. Steps eight and nine (making amends) and step twelve (helping the next person) are gratitude and prosocial action wrapped together. Both correlate with reduced depression and improved mood across multiple studies. The slogan "you keep what you have by giving it away" is not metaphysics. It is reasonably good behavioral science.
- Awe and the small self. "Higher power" is the part most people choke on. But Jennifer Stellar's 2015 Berkeley research found that awe was the single emotion most consistently associated with reduced inflammation. The experience of being temporarily small in the face of something larger than you does something specific to the body. AA's higher power language is one route to that experience. It is not the only one.
None of this is an argument against AA. It is an argument for understanding what AA is doing so you can recognize the same machinery in other places.
Where AA falls short
Three honest critiques.
The first is that the spiritual heart of AA is only as good as your sponsor and the room you walk into. AA does not have central quality control. Some sponsors are brilliant, patient, sober for decades, and have done their own work. Others are five months in, working out their own stuff in your face, and giving advice they read on a coffee mug. Same program, completely different experiences. The rooms vary the same way. A meeting in one neighborhood will save your life. A meeting six blocks away will make you never want to go back.
This is not a knock on AA. It is the cost of being a free, decentralized, peer-led organization. But it means the advice "just go to AA" is incomplete. The real advice is "find the right room, find the right sponsor, and protect both."
The second is that AA defaults to abstinence. That is the right goal for some people. It is not the right goal for everyone. The 2018 Peer Alternatives in Addiction study found that SMART Recovery, LifeRing, and Women for Sobriety produced outcomes comparable to AA once the researchers controlled for participants' starting goals. There is also a real evidence base behind the Sinclair Method, which uses naltrexone to extinguish the reward signal that drinking produces. Some people stop. Some people moderate. Both can be valid. AA does not have a great answer for the second group.
The third is that the steps make assumptions that not everyone shares. A "moral inventory" framing works if you grew up with that vocabulary. For people raised outside religion, it can land as guilt-coded language for what is really cognitive behavioral therapy. The work is good. The packaging is not universal.
The book's framework, applied
Here is where the epilogue of Accents stops being a tidy summary and starts running into reality. The argument of the book is that you can extract the practices from the traditions and use them on their own. That is true. But the book undersells how much work it takes.
Reading "show up regularly with the same group of people" and actually doing it for a year are two completely different things. The traditions had a structure that did most of the work for you. They put a building in your neighborhood. They scheduled the gathering. They built guilt and habit and community pressure on top of attendance. If you do not show up, three people will text you. The secular version requires you to build all of that yourself, in a culture that has gotten very good at making solitude feel productive.
So if you are using the framework of Accents as a substitute for AA, here is the harder version of what it asks of you. This is what I learned in a year of sobriety, not what the book lays out cleanly.
- Pick the structure first, then the people. The most important thing is not what you call your recovery. It is whether you have a regular, in-person, recurring container for it. AA gives you that container for free. If you walk away from AA, you have to build the container yourself. SMART Recovery, LifeRing, a therapist with a standing weekly slot, a recovery-friendly running club, or some combination. Pick the container before you pick the philosophy.
- Find a sponsor figure even if you are not in AA. The single highest-leverage relationship in recovery is the person you can call at 11 p.m. on a Tuesday. AA calls them sponsors. Outside AA, you have to assemble that role yourself. Often it is one part therapist, one part friend with longer sobriety, one part partner. The point is to have someone whose job in your life is to know the truth about your drinking, not just the polished version.
- Audit who you are around. Spiritual sobriety, whatever you want to call it, depends on your sponsor and the people you surround yourself with. Some friendships do not survive sobriety, and pretending they will is how people relapse. This is not pessimism. It is just honest. The people who supported your drinking are not the people who will support your not-drinking, and you cannot will them to.
- Replace the bar, not just the drink. Bars and drinking dinners are infrastructure for socializing. If you take them away and put nothing in their place, the loneliness is what gets you. Build the replacement before you need it. Run clubs, climbing gyms, choirs, regular game nights, Sunday cooking with the same people. The synchronized movement and same-people-every-week parts of the book are not optional. They are the whole point.
- Use medicine if it helps. Naltrexone, acamprosate, disulfiram, and gabapentin all have evidence behind them. AA traditionally has been quiet or hostile about medication-assisted treatment. The more honest current consensus is that medicine and meetings are not in opposition. If your doctor thinks naltrexone will help, take it. The book's framework does not address medication at all, which is a gap.
- Confess in writing or in person, but confess. Whatever framework you are using, find a way to do step four and five. Pennebaker's data is clear. Write about the things you have been carrying about your drinking. Tell someone you trust the version that does not flatter you. The mechanism is not religious. The discipline is.
- Build something that takes the place of the buzz. Drinking is, partly, a low-effort awe substitute. Replace it with something higher quality. Twenty minutes a week in nature, a long walk in a cathedral or a museum, an actually challenging book, a hard physical practice. The brain wants the small-self experience. Give it a better version.
What sobriety has actually taught me
A year in, three things stand out.
The first is that the part of sobriety I expected to be hard, the not-drinking, has been the easy part. The hard part is rebuilding the social and emotional architecture that drinking quietly held up for most of my adult life. AA gets that, even if its solution is not the only one.
The second is that the program you choose matters less than the consistency you bring to whatever you choose. AA, SMART, the Sinclair Method, therapy plus a running club, sober Substack plus a sponsor figure who is technically your old roommate. They all work if you actually do them. They all fail if you do them halfway.
The third is that the people you surround yourself with are the program. Whatever room you walk into every week is where your sobriety lives. That is true in AA and it is true outside AA. It is the only sentence in this post I am completely sure of.
So
If you are deciding whether to start with AA, start with AA. The data is on its side, the cost is zero, and most of what makes it work is not the part of it that scares you. If AA is not for you, the framework is portable. The breath, the honesty, the community, the awe, the showing up, the moving with other bodies. They work whether you call them steps or not.
Just know that the secular version is not easier. It is harder, because you have to build the container yourself. The container is the program. Build it. Then show up.