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Alcoholics Anonymous: “The Big Book”

BMJ 2009; 339 doi: (Published 28 October 2009) Cite this as: BMJ 2009;339:b4387
  1. Elizabeth Loder, clinical editor, BMJ
  1. eloder{at}

    Breathes there a doctor who has not heard of or referred a patient to Alcoholics Anonymous (AA)? Alcohol abuse is a medical problem in its own right and complicates many others, yet arguably its most successful treatment remains the lay-led self management system outlined in the multi-authored book Alcoholics Anonymous, often referred to simply as “the big book.”

    It remains a bestseller that is periodically updated but retains substantial original content. Along with personal stories and testimonials from recovered alcoholics, the book laid out the now famous 12 steps to recovery, which began with the confession: “We admitted that we were powerless over alcohol—that our lives had become unmanageable.”

    The structure of AA groups is the same the world over. They emphasise camaraderie, insist on the need for abstinence, and encourage reliance on a “higher …

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