Alcoholics Anonymous

1. Introduction

Version followed: AA as it describes itself in current A.A. World Services (US/Canada) and AA Great Britain service literature (P-15 Questions & Answers on Sponsorship 2025 print, P-16 The A.A. Group, F-177 for court professionals, MU-1 beginners-meeting guidance, GB leaflet The AA Member – Medications and Other Drugs); clinician procedures follow the Project MATCH Twelve Step Facilitation Therapy (TSF) manual (Nowinski, Baker & Carroll, NIAAA Project MATCH Monograph Vol. 1, 1992/1995) as the originating manualised clinician protocol, with a 2024 UW addiction-psychiatry teaching summary of Hazelden-derived TSF for gaps.

AA is not a therapy and is not delivered by a clinician. It is a self-supporting, non-professional mutual-aid fellowship of alcoholics whose stated aim is to stay sober and help other alcoholics achieve sobriety; the only membership requirement is a desire to stop drinking, membership is self-declared, and meetings are free [source: P-16; AA GB About-AA; F-177]. It began in 1935 in Akron, Ohio, when Bill W. (a New York stockbroker) met Dr. Bob S. (an Akron surgeon); its basic text Alcoholics Anonymous (the "Big Book") was published in 1939, the Twelve Traditions were in use by about 1950, and AA is now present in about 180 countries [source: aa.org The Start and Growth of A.A.]. AA describes itself as "forever nonprofessional": sponsors are not counsellors, doctors, lawyers or social workers [source: P-15].

How change is understood to happen (AA's account, paraphrased): a member who accepts that they have lost control over alcohol joins a fellowship of peers, attends meetings, works the Twelve Steps with a sponsor, and carries the message to other alcoholics; recovery is framed as an ongoing, one-day-at-a-time way of life rather than a cure [source: P-15; TSF manual]. TSF translates this into a clinician's job: help the client reach acceptance (that they have a chronic, progressive illness, have lost control, and that abstinence is the only viable option) and surrender (willingness to rely on help beyond their own willpower, via the fellowship and a Higher Power as the client understands it), with active AA involvement as the main outcome the therapist works toward [source: TSF manual].

This guide is therefore written for a clinician who (a) refers clients to AA, (b) runs a TSF-style course of sessions alongside AA, or (c) works with clients already in AA. Nothing here describes the clinician running AA meetings or acting as a sponsor; the TSF manual explicitly forbids the therapist from acting as sponsor [source: TSF manual; UW TSF 2024].

2. Framework

2a. The fellowship's own structure (what the client enters)

AA has no phases, sessions or discharge. The member's path, as AA literature describes it [source: P-15; P-16; MU-1]:

• Newcomer: first meetings; often beginners meetings (a series, commonly six sessions, typically a 20–30 minute talk then open discussion, sometimes focused on Steps 1–3); receives a pamphlet packet and meeting list; greeted by hospitality/greeters; may be offered a temporary sponsor.
• Getting a sponsor: as early as possible; an informal, continuing peer relationship, typically with someone using the programme successfully, often a year or more sober.
• Home group: one group the member treats as base, takes on service jobs (coffee, literature, set-up) and votes in group conscience.
• Working the Steps with the sponsor, at the member's pace.
• Service and Twelfth Step work: carrying the message (e.g. going on Twelfth Step calls with a sponsor), service sponsorship, group and district roles, rotation of positions.

2b. The clinician protocol: Project MATCH TSF (12 weeks)

Format: 12 individual weekly sessions within 12 consecutive weeks (session 1 up to 90 minutes, others about 60). Clients with a partner: 10 individual + 2 conjoint sessions. Up to 2 additional emergency sessions [source: TSF manual].

[source: TSF manual table of contents; UW TSF 2024]. Any core or elective topic may be repeated to fill 12 sessions [source: TSF manual].

Standard session format (sessions 2–11) [source: TSF manual]: Review (10–15 min) of meetings attended and reactions, slips, urges, sober days, readings, and (UW version) sponsor contact, phone use and contact with AA members outside meetings; New Material (~30 min); Recovery Tasks (~10 min); Summary (~5 min, client restates the gist and their commitment).

Criteria for moving on: the manual sequences topics rather than setting hard gates. Practical criteria [synthesis, derived from the manual's topic objectives]: move from Topic 2 to 3 when the client can describe, in their own words, specific failed attempts to control drinking and its consequences; from 3 to 4 when they express willingness to accept help and are attending at least some meetings; select electives by the client's main relapse risks (family enabling → Topic 6; high-risk settings/peers → 7; emotional triggers → 8; guilt/shame and a sponsor in place → 9). Do not begin Steps 4–5 work in therapy unless the client has some sobriety and support; in AA this work is normally done with a sponsor [synthesis; uncertain: the manual's Topic 9 text is not drawn on].

After TSF: continued AA involvement is the intended maintenance; there is no stepped follow-up protocol in the parts of the manual opened [uncertain].

3. Guiding principles

From AA's own literature (shape how you refer and talk about AA):

• Cooperation, not affiliation [source: F-177; P-16]: you can work with local AA (e.g. its Cooperation with the Professional Community committee) but AA will not join your programme, report to you or endorse you. Practical meaning: never promise a referrer or court that AA will monitor the client.
• Singleness of purpose [source: F-177; P-16]: AA addresses alcohol only. Practical meaning: refer drug-only clients to NA/CA or other groups, not AA; dually addicted people with a drinking problem are welcome [source: MU-1].
• Self-declared membership; desire to stop drinking is the only requirement [source: P-16]. Practical meaning: a client who is ambivalent can still attend; they do not need to accept a label first.
• Open vs closed meetings [source: P-16; F-177]. Practical meaning: send family, students or yourself only to open meetings.
• Anonymity as a promise of privacy [source: P-16]. Practical meaning: never ask a client to identify other members; respect that the client may use first names only.
• AA keeps no records, gives no references, case histories or progress reports, does not follow up or control members, and provides no welfare services [source: F-177; P-16]. Practical meaning: monitoring, housing, money and medical care remain your job or other services'.
• Spiritual, not religious; individual spiritual freedom [source: P-15]; AA is not allied with any sect or institution [source: AA GB]. Practical meaning: frame Higher Power as the client's own understanding; never impose belief.
• Members don't "play doctor"; medical decisions belong to physicians; it is wrong to deprive an alcoholic of needed medication [source: AA GB medications leaflet; P-15]. Practical meaning: prepare clients on prescribed medication for possible unofficial pressure and give them AA's own leaflet.
• No coercion is AA's own stance on referral source: AA does not care how someone came; many came under pressure [source: F-177]. Practical meaning: mandated clients can be welcomed, but you still work on their own motivation.

From TSF (shape the therapist's stance):

• Therapist as educator, advocate and facilitator of AA involvement, not a substitute for AA [source: TSF manual]. Practical meaning: every session ends with AA-consistent tasks; redirect crises to AA resources.
• Never be the sponsor [source: TSF manual; UW TSF 2024]. Practical meaning: decline sponsor-like requests and coach the client to ask a member.
• Active, forthcoming, nonjudgmentally confrontive [source: TSF manual]: frank, factual feedback about denial, without lecturing or chastising. Practical meaning: name discrepancies with the client's own facts.
• Separate the illness from the person [source: TSF manual]. Practical meaning: frame slips and denial as the illness talking, not character failure.
• No coercion; suggestions, not assignments [source: TSF manual]: coercion yields compliance, not commitment. Practical meaning: phrase tasks as AA-style suggestions and negotiate them.
• Behaviour before belief [source: TSF manual]: going to meetings matters more early on than adopting AA beliefs; do not debate whether alcoholism is an illness. Practical meaning: aim for attendance first, let meaning follow.
• Abstinence focus; keep sessions on sobriety [source: TSF manual]: defer other issues with a promise of referral later; substituting other drugs is treated as part of the addiction. Practical meaning: put unrelated problems on a parking list. Note: this narrow focus reflects a 1990s research protocol; in routine care address co-occurring conditions concurrently [synthesis].
• Authentic positive regard for twelve-step principles and personal links with the local fellowship [source: UW TSF 2024; TSF manual]. Practical meaning: non-recovering therapists attend at least 10 open AA and 10 Al-Anon (or Families Anonymous) meetings and build AA contacts willing to take clients to meetings [source: TSF manual].
• Boundaries [source: TSF manual]: out-of-session contact is discouraged; client directed to AA phone contacts in crises. Practical meaning: give clients a list of AA phone numbers and the local hotline, not your mobile.

4. Intervention inventory

Organised in three groups: A. clinician referral and liaison procedures (any therapist), B. TSF session procedures (the manualised clinician protocol), C. fellowship practices (done by the client inside AA; the clinician explains, encourages and debriefs, never runs them). All example language is illustrative unless quoted.

A. Referral and liaison procedures

A1. Assessing fit and choosing a group

• Purpose / when: before any referral; whenever alcohol is a current problem.
• Steps: (1) Confirm alcohol is part of the problem; AA addresses alcohol only, so a drug-only client goes to another fellowship (e.g. NA) [source: F-177]. (2) Check the client's goal: AA's only requirement is a desire to stop drinking; a client wanting moderation is not excluded from attending but the programme is abstinence-based [source: P-16; TSF manual]. (3) Ask about beliefs and past experiences of AA (TSF session 1 covers prior AA experience) [source: TSF manual]; name concerns about God or spirituality as a known barrier [source: UW TSF 2024]. (4) Screen medical and psychiatric needs AA does not cover: withdrawal risk and detox, severe depression, psychosis, suicidality, which need medical or psychiatric care alongside [source: TSF manual; P-15]. (5) Check medications (see A5). (6) Identify suitable meetings via online meeting lists and the local intergroup or hotline [source: UW TSF 2024]; consider specialised groups (women, men, young people, professionals, other language) which AA permits if they welcome all alcoholics [source: P-16]. (7) If AA is a poor fit, offer alternatives the UW teaching lists: SMART Recovery, Women for Sobriety, Recovery Dharma/Refuge Recovery, secular AA meetings, Dual Recovery Anonymous for co-occurring disorders, Al-Anon for family [source: UW TSF 2024].
• Example language (illustrative): "You don't have to call yourself anything to go. The only thing AA asks is that you want to stop drinking. What have you heard about it, and what worries you?"
• Watch for: a client agreeing to please you (ask what they would actually do this week); trauma histories that make large mixed-gender meetings unsafe (start with a smaller or gender-specific meeting) [synthesis].

A2. Orienting the client to what happens at a meeting

• Purpose / when: before the first meeting; reduces fear and drop-out.
• Steps: explain, from AA's own description [source: P-16]: (1) Open meetings are for anyone, closed meetings for those with a drinking problem or wanting to stop. (2) Types: discussion (chair picks a topic such as honesty or resentments), speaker (members tell what they were like, what happened, what they are like now), beginners (Q&A or talk for newcomers, sometimes on Steps 1–3), Step, Tradition or Big Book study. (3) Typical flow: chair opens with the Preamble and remarks, maybe a moment of silence or the Serenity Prayer and a reading; an anonymity reminder; members share; a voluntary basket collection (the Seventh Tradition: groups are self-supporting, no dues); a closing (silence, prayer or the Responsibility Declaration). (4) Nobody has to speak; newcomers shouldn't be pressured with questions [source: MU-1]. (5) Newcomers usually get pamphlets and a meeting list [source: MU-1]. (6) Each speaker gives only their own opinion, not AA's [source: MU-1].
• Example language (illustrative): "You can sit at the back and just listen. If they pass a basket, putting in nothing is fine. You can say 'I'm new and I'll just listen today.'"
• Watch for: misreading prayer as religious affiliation (prepare them: AA says it is spiritual, not religious, and not allied with any sect) [source: P-15; AA GB].

A3. Active (facilitated) linkage

• Purpose / when: at referral, especially for anxious, isolated or ambivalent clients.
• Steps: (1) Prefer active referral over handing over a list: the UW teaching summary cites active referral by twelve-step peers outperforming referral by doctors and treatment as usual [source: UW TSF 2024]. (2) Arrange, with consent, for an AA contact to meet the client or take them to a meeting; the TSF manual recommends therapists build a network of AA contacts and uses AA escorts when clients avoid meetings; the therapist does not drive the client [source: TSF manual]. (3) Use the local AA hotline or intergroup office, which connects callers with volunteers [source: P-16]. (4) Ask the local Cooperation with the Professional Community (CPC) committee for an information session for staff, or ask for a meeting to be held in your facility; AA treatment/corrections committees take meetings into facilities and run "Bridging the Gap" contact programmes for people leaving treatment or custody [source: F-177; P-16; UW TSF 2024]. (5) Provide free AA literature (e.g. Big Book orientation) [source: UW TSF 2024]. (6) Agree a specific first meeting (day, time, place, how they will get there) and review it next session.
• Example language (illustrative): "Would it help if someone from AA met you outside on Tuesday and walked in with you? I can ask the local office to arrange that."
• Watch for: confidentiality: get written consent before sharing anything with an AA volunteer; share only logistics, not clinical information [synthesis].

A4. Meeting plan ("90 in 90") and negotiation

• Purpose / when: TSF session 1 and every review.
• Steps: (1) Propose the AA suggestion of one meeting a day for 90 days as the starting goal [source: TSF manual]. (2) Negotiate downward if needed rather than abandon the plan [source: TSF manual]. (3) Write a concrete schedule of named meetings. (4) Progress from passive attendance toward Step and discussion meetings and toward participation [source: TSF manual]. (5) For stimulant-using clients, the UW summary suggests aiming for weekly or more attendance [source: UW TSF 2024].
• Example language (illustrative): "AA's suggestion is 90 meetings in 90 days. If that isn't realistic, what number could you actually commit to this week, and which meetings?"
• Watch for: all-or-nothing reactions; a smaller kept commitment beats a large broken one [synthesis].

A5. Preparing clients on prescribed medication

• Purpose / when: any client on psychiatric or other prescribed medication.
• Steps: (1) Tell the client AA's own literature says medical advice should come from a physician, members should not "play doctor", and it is wrong to deprive an alcoholic of medication for disabling conditions such as depression or bipolar disorder [source: AA GB medications leaflet]. (2) Warn that some members have told others to stop medication and that the leaflet reports relapse or worsened symptoms after such advice [source: AA GB medications leaflet]. (3) Suggest the client carry or give their doctor that leaflet, be fully honest with the prescriber about how they take medication and that they no longer drink, and report urges to take more [source: AA GB medications leaflet]. (4) Medications for alcohol or opioid use disorder are not addressed in that leaflet [source: AA GB medications leaflet]; the UW summary lists medication for opioid use disorder and psychiatric medication as engagement barriers to troubleshoot [source: UW TSF 2024]. Prepare the client to choose meetings and a sponsor who respect medical treatment [synthesis].
• Example language (illustrative): "AA's own leaflet says medical decisions belong with your doctor. If anyone at a meeting tells you to stop your tablets, bring it here and to your prescriber first."
• Watch for: secret discontinuation; ask directly at each review [synthesis].

A6. Court-mandated attendance and attendance slips

• Purpose / when: mandated clients or when a referrer wants proof of attendance.
• Steps: (1) Explain to referrers that AA keeps no attendance records and gives no progress reports or reference letters [source: F-177]. (2) Some groups will sign or initial a court-provided slip as a courtesy; others decline for anonymity reasons; each group decides; alternatives are a slip the attendee signs or a sealed envelope they post [source: F-177]. (3) Make clear that a signature only shows attendance, not sobriety or staying for the whole meeting [source: F-177]. (4) Keep outcome monitoring (e.g. your own clinical review, any testing ordered by the court) separate from AA [synthesis].
• Example language (illustrative): "AA doesn't report to anyone. The slip just shows you were there. What happens in the room stays yours."
• Watch for: clients using attendance as performance; work on their own reasons (see section 5).

A7. Ongoing liaison with the local fellowship

• Purpose / when: as a standing practice for services.
• Steps: (1) Non-recovering therapists attend at least 10 open AA meetings and 10 Al-Anon or Families Anonymous meetings [source: TSF manual]. (2) Build contacts through the CPC committee ("cooperation, not affiliation") [source: F-177; P-16]. (3) Keep a current local meeting list and hotline number in the service [source: UW TSF 2024]. (4) Do not attend closed meetings unless you have a drinking problem yourself [source: P-16].

B. TSF session procedures (Project MATCH TSF manual)

TSF is a manualised research protocol published free by NIAAA; the manual itself does not set a certification requirement. Hazelden publishes later commercial TSF manuals (including one for co-occurring disorders) [source: UW TSF 2024]; their training requirements were not checked [uncertain].

B1. Session 1: Program Introduction and assessment

• Purpose / when: first session (up to 90 min).
• Steps [source: TSF manual]: (1) Rapport and background: living situation, work, why they are here. (2) Treatment history, prior AA experience, self-directed attempts to control drinking. (3) Chronological alcohol history from first use, with life events and other drug use. (4) Consequences: physical, legal, social, sexual, psychological, financial. (5) Dependence signs: tolerance and loss of control. (6) Share a diagnosis using the client's own report (the manual optionally uses Jellinek progression charts in an appendix; describe progression in your own words). (7) Programme overview: goals, therapist and client responsibilities (attend sober, keep a journal, try the recovery tasks, be honest about slips, one day at a time [source: UW TSF 2024]). (8) Starting tasks: a meeting schedule (A4) and initial readings from the Big Book and Living Sober.
• Example language (illustrative): "Let's go through your drinking from the very first drink to now, and what it has cost you along the way. Then I'll tell you honestly what I see."
• Watch for: confrontation should be direct, factual and nonjudgmental; coercion produces compliance, not commitment [source: TSF manual].

B2. Recovery journal

• Purpose / when: from session 1 throughout.
• Steps [source: TSF manual]: client records meetings attended and reactions, readings, slips, urges and recovery tasks; therapist reviews it at the start of each session. In Topic 2 the journal also holds a chronological account of how life became unmanageable.
• Example language (illustrative): "Jot down each meeting and one thing that stuck with you, plus any urge: when, where, what you did."
• Watch for: blank journals usually signal avoidance; explore rather than scold (section 5).

B3. Structured review (opening 10–15 min of each session)

• Purpose / when: sessions 2–12.
• Steps [source: TSF manual; UW TSF 2024]: ask about (1) meetings attended and reactions; (2) slips: what, where, with whom, and what they could do differently; (3) urges: when, where, how handled; (4) sober days, acknowledged without fostering complacency; (5) readings, sponsor progress, phone calls, contacts with AA members between meetings.
• Example language (illustrative): "Which meetings did you get to? What did you hear that fitted your own story, and what put you off?"
• Watch for: reactions to meetings are material; criticism of AA is explored (section 5), not argued with.

B4. Reading suggestions

• Purpose / when: every session's recovery tasks.
• Steps [source: TSF manual]: suggest specific passages from AA Conference-approved books matched to the topic (Big Book chapters, Twelve Steps and Twelve Traditions, Living Sober); frame as suggestions; ask next session what the client took from them. AA groups and sponsors also point newcomers to the Big Book, the Steps and Traditions and As Bill Sees It [source: P-15].
• Example language (illustrative): "Read the chapter on how it works before next week and mark one line that described you, and one you disagreed with."
• Watch for: literacy or neurodivergence; AA's sponsorship pamphlet suggests audio resources and explicit explanation of AA language [source: P-15].

B5. Topic 2: Acceptance (Step 1)

• Purpose / when: core topic, early sessions.
• Steps [source: TSF manual]: (1) Describe three stages of acceptance: recognising there is a problem; recognising that drinking is causing the difficulties; recognising loss of control with abstinence as the only option. (2) Frame acceptance as grief: denial, anger and bargaining are normal. (3) Review forms of denial with the client's own examples: refusing facts, minimising, avoiding, pointing at others' drinking, blaming, bargaining, rationalising; AA's informal term is "stinking thinking". (4) Key concepts (UW version): "we", powerlessness, unmanageability [source: UW TSF 2024]. (5) Give a brief overview of AA: founding, no cure, abstinence one day at a time, the value of peers. (6) Tasks: Step 1 readings and a journal account of how life became unmanageable.
• Example language (illustrative): "You've tried switching to beer, only drinking at weekends, and stopping for Lent. Each time it came back. What does that tell you?"
• Watch for: shame rather than acceptance; keep the illness separate from the person [source: TSF manual].

B6. Topic 3: Surrender (Steps 2–3)

• Purpose / when: after Acceptance.
• Steps [source: TSF manual; UW TSF 2024]: (1) Link Steps: Step 1 admits the problem, Steps 2–3 accept the solution. (2) Explore "insanity" as repeating harmful behaviour despite clear evidence, and as poor judgment. (3) Ask the client to describe a past plan or commitment to avoid consequences that failed. (4) Contrast self-reliance with interdependence; explore defiance and arrogance as forms of denial. (5) Discuss Higher Power, "turning over", and "care of" as the client can understand them; the fellowship itself may serve as a starting point [synthesis on the last clause]. (6) Do not debate whether alcoholism is an illness; attendance matters more than belief at first. (7) Tasks: chosen meetings including Step and discussion meetings, Step 2–3 readings, tracking resistance as possible denial.
• Example language (illustrative): "You don't have to settle what you believe today. Is there anything, a group of people, a principle, that might be stronger than your willpower alone has been?"
• Watch for: atheist or agnostic clients: AA's sponsorship pamphlet stresses individual spiritual freedom; secular AA meetings exist [source: P-15; UW TSF 2024].

B7. Topic 4: Getting Active

• Purpose / when: core topic, after Surrender; revisit often.
• Steps [source: TSF manual; UW TSF 2024]: (1) Explain that recovery needs participation, not solitary willpower: volunteering, speaking at discussion meetings, finding a home group, sharing, reading, reaching out between meetings, a sponsor, service and social fellowship. (2) Telephone use: collect numbers and call when having urges, after slips, when lonely, angry or tired, overwhelmed, or overconfident; role-play the call if the client hesitates. (3) Sponsor (B8). (4) Emphasise "People, Places and Things", "Easy Does It", "First Things First". (5) Tasks: specific meetings, readings, get three names and numbers (at least two of the same sex), call one person this week, list three qualities wanted in a sponsor.
• Example language (illustrative): "Let's practise. I'm the person from Thursday's meeting. Call me and say you're having a rough evening."
• Watch for: social anxiety (more role-play, escorted attendance).

B8. Coaching the client to get a sponsor

• Purpose / when: from Topic 4 onward.
• Steps: (1) Explain what a sponsor is: an informal, continuing peer relationship with a member who has made progress in recovery, meeting as equals [source: P-15]. (2) What to look for: someone using the programme successfully, often a year or more sober, with empathy, patience and time; AA generally advises same-sex sponsorship (some gay men and lesbians prefer otherwise); avoid romantic involvement [source: P-15]. TSF's guideline: same sex, same age or older, at least a year sober [source: TSF manual]. (3) What a sponsor does: shares their experience, encourages varied meetings, introduces the newcomer to members, explains Steps and Traditions and anonymity, is available when personal matters threaten sobriety [source: P-15]. (4) What a sponsor does not do: impose beliefs, give professional services, lend money, take the sponsee's inventory unasked, pretend to have all the answers [source: P-15]. (5) Temporary sponsors are available in many groups; changing sponsors is allowed [source: P-15]. (6) Role-play asking. (7) Refuse to act as sponsor yourself [source: TSF manual].
• Example language (illustrative): "Who have you heard share whose recovery you'd like? Let's practise the sentence: 'Would you be willing to be my sponsor, even temporarily?'"
• Watch for: a sponsor giving medical, legal or psychological directives, romantic or financial entanglement, or harshness toward a trauma survivor; AA's own pamphlet cautions against all of these [source: P-15].

B9. Slip analysis and AA-consistent plan

• Purpose / when: any slip reported in review.
• Steps [source: TSF manual]: (1) Get the facts: what, where, with whom. (2) Frame the slip as the illness overpowering willpower. (3) Identify what the client could do differently. (4) Plan an AA-consistent response for next time: call an AA friend, the sponsor or the hotline, go to a meeting. AA's sponsorship literature similarly advises against harsh criticism or excess sympathy, and suggests returning to Step 1, one day at a time [source: P-15].
• Example language (illustrative): "Walk me through Saturday, from the moment you thought about a drink. Where could a phone call have fitted in?"
• Watch for: hiding slips; reinforce honesty about slips as a client responsibility [source: UW TSF 2024].

B10. Slogans

• Purpose / when: to anchor coping in AA's language.
• Steps [source: TSF manual]: use slogans sparingly and tie them to the client's experience: "First Things First", "One Day at a Time", "Easy Does It", "Turn It Over"; UW notes "one day at a time" framing (or "for now") helps young people [source: UW TSF 2024].
• Example language (illustrative): "When you start planning the whole year sober, try just today. What does today need?"
• Watch for: slogans used to shut down emotion; follow with real exploration [synthesis].

B11. Elective topics (Topics 5–10)

[uncertain: the manual's text for these topics is not drawn on; only titles and objectives from the table of contents are used. Steps below are this guide's synthesis built on those titles and on AA concepts named elsewhere in the sources; do not attribute them to the manual's authors.]

• Topic 5 Genogram: [synthesis] map alcohol and other drug problems, recovery and abstinence across three generations; use it to support acceptance and identify family members who might enable.
• Topic 6 Enabling: [synthesis] identify people who protect the client from consequences (covering, lending money, buying alcohol); plan how to ask them to stop; link with conjoint sessions.
• Topic 7 People, Places and Things (or routines): [synthesis, concept from TSF Topic 4 text] list high-risk people, places and routines ("slippery"); plan substitutions, especially AA meetings and AA contacts.
• Topic 8 HALT: [synthesis; the acronym Hungry, Angry, Lonely, Tired is from the manual's table of contents] teach the client to check these four states during urges and respond (eat, call, go to a meeting, rest); the Topic 4 text lists loneliness, anger and tiredness as reasons to phone.
• Topic 9 Moral Inventories (Steps 4–5): [synthesis] explain that in AA these steps are worked with a sponsor; the therapist's role is to explain them, prepare the client, and help with distress, not to take the inventory; UW lists co-occurring anxiety, depression and PTSD as barriers at this stage [source: UW TSF 2024].
• Topic 10 Sober Living: [synthesis] plan leisure, relationships, work and AA social fellowship that support sobriety.
• Emotions / Spirituality electives appear in the UW teaching of Hazelden TSF without content [source: UW TSF 2024].

B12. Conjoint sessions (Enabling; Detaching)

• Purpose / when: clients with a partner; 2 of the 12 sessions [source: TSF manual].
• Steps: [source: UW TSF 2024 for supporter involvement limited to 2 sessions, enabling and caring detachment, and linking supporters to Al-Anon]; detailed procedures [uncertain]. Illustrative structure [synthesis]: session 1 identifies enabling behaviours and how to stop them; session 2 explains detaching with care (letting the drinker face consequences without anger or rescue) and refers the partner to Al-Anon open meetings. Sponsors and AA also point families to Al-Anon and Alateen and to open meetings [source: P-15].
• Example language (illustrative): "You've been the one ringing his work when he's hungover. What would happen if you stopped?"
• Watch for: domestic abuse; screen privately before any conjoint work and do not hold conjoint sessions where it is present [synthesis].

B13. Termination session

• Purpose / when: final session. Content [uncertain]. Illustrative [synthesis]: review journal and progress across acceptance, surrender and getting active; confirm home group, sponsor and weekly meeting plan; agree a slip plan; arrange referral for issues deferred during TSF (which the manual promises) [source for deferral: TSF manual].

B14. Emergency session

• Purpose / when: crises threatening sobriety (drunkenness, drink-driving arrest, family conflict, strong urges, depression, job trouble, detox need) [source: TSF manual].
• Steps [source: TSF manual]: assess the threat to sobriety; set priorities ("First Things First"); identify AA-consistent actions; resolve the crisis through AA as far as possible. Psychiatric emergencies (suicidal thinking, psychosis, violence, self-injury) require an emergency session or referral and review of whether TSF should continue. Uncomplicated medical detox does not end the programme.
• Example language (illustrative): "First things first: are you safe tonight, and who from AA can you be with this evening?"

B15. Client arrives intoxicated

• Steps [source: TSF manual]: do not hold the session; ask the client to call the AA hotline, an AA friend or the sponsor; if they refuse, arrange for a significant other to take them home; last resort local emergency services or police; reschedule. Assess medical safety and do not let them drive [synthesis].
• Example language (illustrative): "I can smell alcohol, so we won't do the session today. Let's call your sponsor now and get you home safely."

C. Fellowship practices (the client does these in AA; the clinician explains and debriefs)

C1. Meeting attendance and choosing meeting types

• Purpose: the main route into the fellowship.
• What AA describes: open, closed, discussion, speaker, beginners, Step/Tradition/Big Book study, plus business meetings, group inventories and Grapevine meetings [source: P-16]. Chairs may ask that discussion stay on recovery from alcoholism [source: P-16].
• Clinician's role (illustrative): "Try three different kinds this week, a speaker meeting, a beginners meeting and a discussion, and tell me which felt most like your people."
• Watch for: one bad meeting generalised to all of AA; groups vary widely [synthesis].

C2. Beginners meetings

• What AA describes [source: MU-1; P-16]: held separately from regular meetings; usually series of 4–12 meetings (six most common); a leader's talk of no more than 20–30 minutes, then discussion; newcomers' anonymity respected; nobody dominates; newcomers not pressed with questions; literature packet and meeting list provided.
• Clinician's role: make a beginners series the first referral for anxious or first-time clients [synthesis].

C3. Home group and service

• What AA describes [source: P-16; P-15]: one home group where the member takes on service, builds friendships, votes in group conscience, and often finds sponsorship. Service begins with tasks like coffee, literature or clean-up, and may progress to group officer (secretary, treasurer, general service representative) and district roles, with rotation and a service sponsor. Groups set their own sobriety minimums for service (six months to a year is common).
• Clinician's role (illustrative): "Which group could be home? Is there a small job there, like setting out chairs, that would give you a reason to turn up every week?"

C4. Sponsorship

• See B8 for the content AA publishes. Sponsors may bring newcomers on Twelfth Step calls and can explain AA to the family [source: P-15]. AA's 2025 sponsorship pamphlet adds suggestions for newcomers with learning differences or neurodivergence: text contact, co-working on Step 4, audio material, an emergency contact, explicit explanation of AA terms, flexible participation [source: P-15].

C5. Working the Twelve Steps

• What the sources describe: the Steps are the core of the 1939 Big Book [source: aa.org Start and Growth]; sponsors explain them [source: P-15]; Step 1 concerns admitting powerlessness and unmanageability, Steps 2–3 acceptance of a Higher Power and turning over will and life, Steps 4–5 moral inventory and admitting it [source: TSF manual; UW TSF 2024]; Step 12 involves carrying the message (Twelfth Step work) [source: P-16; P-15].
• [uncertain]: the aa.org page with the Steps is not drawn on, so Steps 6–11 are not paraphrased here. Read the Steps on aa.org before discussing them with clients; do not reproduce their text in handouts.
• Clinician's role: discuss the client's reactions to each Step as they meet it; help with emotional fallout (e.g. shame in Steps 4–5, amends that could create legal or safety risks) while leaving the Step work itself to client and sponsor [synthesis].

C6. Twelfth Step work (carrying the message)

• What AA describes [source: P-16; P-15]: groups keep the hand of AA available to any alcoholic who asks; secretaries or Twelfth Step chairs assign calls; members on lists visit struggling alcoholics; sponsors take newcomers along; corrections and treatment committees carry meetings into facilities.
• Clinician's role: encourage helping roles as the client stabilises; watch for overextension (AA itself warns sponsors not to take so many sponsees they risk their own sobriety) [source: P-15].

C7. Anonymity and the Traditions

• What AA describes [source: P-16]: members keep each other's identity and what is shared private; at public level no full names or faces in media; first name and last initial online; groups avoid filming talks; groups are self-supporting, take no outside money, and have no opinion on outside issues.
• Clinician's role: never ask clients to name other members; when a client discloses something heard in a meeting, focus on their own reaction [synthesis].

5. Handling problems

• Refuses to go to meetings [source: TSF manual]: interpret refusal as possible denial, explore fears (shyness, fear of failure), coach and role-play attendance, arrange an AA escort; the manual never terminates a client for refusing meetings. If refusal persists after real tries, offer an alternative mutual-help group (A1) rather than ending all support [synthesis].
• Criticises AA ("it's a cult", "too religious") [source: TSF manual; P-15]: TSF interprets criticism respectfully as possible denial and avoids debate. Add [synthesis]: separate valid concerns (a specific bad group, a pushy member) from global rejection; suggest a different meeting type, a secular meeting or a gender-specific group; give AA's own statement that it is not allied with any religion [source: AA GB].
• Higher Power objections [source: P-15; UW TSF 2024]: AA literature distinguishes spiritual from religious and stresses individual freedom; sponsors should not argue theology. In session [synthesis]: invite the client to define any "power greater than willpower" they can accept, including the group; never require belief.
• Late, cancelling or missed sessions [source: TSF manual]: explore the reason, listen for denial, interpret; if repeated, talk openly about motivation.
• Slips and relapse [source: TSF manual; P-15]: B9; no harshness, no excessive sympathy; return to Step 1 and one day at a time. Re-check withdrawal risk and medical need after any heavy relapse [synthesis].
• Substituting other drugs [source: TSF manual]: treated as part of the addiction and not accepted in TSF. In current care distinguish prescribed treatment from substitution [synthesis].
• Medication pressure from members [source: AA GB medications leaflet]: see A5; support the client to continue prescribed treatment and speak to the prescriber; a sponsor who insists on stopping medication contradicts AA's own literature.
• Depression, anxiety, PTSD, psychosis [source: TSF manual; UW TSF 2024]: mild depression may reflect withdrawal or the grief of acceptance; severe depression or other psychopathology needs referral; suicidality and psychosis need an emergency session or referral. Follow standard suicide risk assessment and safety planning; involve crisis services as needed [synthesis].
• Overwhelm at meetings or by the programme [synthesis]: reduce load (fewer, smaller or beginners meetings), "Easy Does It" and "First Things First" as cues [slogans from source: TSF manual]; online or phone meetings may help but are not described in the AA sources [uncertain].
• Overdependence on sponsor or therapist [source: P-15; TSF manual]: AA advises sponsors to reinforce reliance on the whole programme; TSF discourages out-of-session contact and redirects to AA contacts.
• Harmful sponsor or group behaviour [source: P-15; P-16]: AA's own literature cautions against romance between sponsor and sponsee, lending money, imposing beliefs, giving professional advice, overly harsh firmness (especially with trauma survivors), and unwanted romantic attention toward newcomers ("thirteenth-stepping" is the informal term; not in sources [uncertain]). Help the client change sponsors or groups (allowed) and point them to AA's safety literature (Safety and A.A.: Our Common Welfare, SMF-209, referenced in P-16 [uncertain]). If there is sexual exploitation, assault or threats, treat it as a safeguarding matter: help the client report to police or relevant authorities if they wish; AA groups cannot investigate or discipline in a formal sense [synthesis].
• Mandated or coerced clients [source: F-177; TSF manual]: AA welcomes people however referred; coercion yields compliance. Work on the client's own reasons; clarify what you will and will not report to the referrer and that AA reports nothing.
• Ruptures with the therapist [synthesis]: TSF's confrontive stance can feel like lecturing; if the client withdraws, acknowledge it, restate the illness-not-character framing, and ask for their view. If they reject the abstinence goal, consider switching to another approach (e.g. motivational or CBT-based treatment) rather than pushing TSF.
• Neurodivergent or learning-disabled clients [source: P-15]: use AA's own suggestions (text contact, audio literature, explicit explanation of jargon, flexible participation).
• Youth [source: UW TSF 2024]: autonomy needs, buffered consequences and peer importance make powerlessness and lifelong abstinence hard; show concrete benefits, find young people's meetings, use "for now" framing.
• Drug-only problems [source: F-177; P-16]: AA cannot help with drug addiction other than alcohol; refer to the relevant fellowship.
• Family members [source: P-15; TSF manual]: sponsors are not family counsellors; refer family to Al-Anon/Alateen and open AA meetings; use conjoint sessions (B12).
• Intoxicated in session; crises [source: TSF manual]: B14–B15.
• Confidentiality across systems [synthesis]: keep your clinical records separate from AA contacts; written consent before any contact with AA volunteers; never confirm to third parties that a client attends AA without consent.

Sources

Sources:

• Information on A.A. (F-2), aa.org landing page
• A.A. as a Resource for Drug and Alcohol Court Professionals (F-177/SMF-177)
• Questions & Answers on Sponsorship (P-15, 2025 print)
• Suggestions for leading beginners meetings (MU-1)
• The A.A. Group... Where It All Begins (P-16)
• The Start and Growth of A.A.
• The A.A. Member — Medications and Other Drugs (aa.org summary page)
• The AA Member – Medications and Other Drugs (AA Great Britain leaflet)
• What is AA? (AA Great Britain)
• Twelve Step Facilitation Therapy Manual, Project MATCH Monograph Vol. 1 (NIAAA) (opened through Topic 4; later topics seen only as table of contents)
• Twelve-Step Facilitation, UW PACC presentation, M. Murphy-Ryan, 29 Feb 2024

Books and manuals cited:

• Nowinski, J., Baker, S., & Carroll, K. (1992/1995). Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. Project MATCH Monograph Series, Vol. 1. NIAAA.
• Alcoholics Anonymous World Services (1939; current edition). Alcoholics Anonymous (the Big Book). Referenced through the sources above.

Further reading (not drawn on) [uncertain]: aa.org Twelve Steps page, P-11 US medications pamphlet PDF, Safety and A.A. (SMF-209), Hazelden TSF manuals, MAAEZ manual.