How Do 12 Step Fellowships Define Addiction and Alcoholism?

There are many different definitions for “addiction” and “alcoholism” as defined by different organizations. There is the definition from the Merriam Webster dictionary, the definition from the American Society of Addiction Medicine (ASAM), the definition published by the Journal of American Medical Association and of course there is the personal definition used by any addict or alcoholic confronted with their problem, who use everything possible to explain how they don’t fit the definition of an alcoholic or addict and don’t need help for their drinking or drug use (those self-described definitions are always so fun.)

Finally, there is the definition of alcoholism and addiction as defined by 12 Step communities Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Although the language can change a bit from fellowship to fellowship and although the initial 12 Step fellowship of AA details its birthday all the way back on June 10, 1935, the 12 Step fellowships may actually have the most comprehensive definition of alcoholism and addiction of any organization. In its most generalized understanding, the 12 Step fellowships define addiction and alcoholism as a threefold illness: a physical allergy, a mental obsession and a spiritual malady.

So what do these three parts of the illness of alcoholism and addiction mean? Here is a simple breakdown to help understand the definition as defined by AA and NA.

Physical Allergy:
The first part of the illness or disease is the physical aspect, what the 12 Step fellowships call an allergy to alcohol and drugs. And what is an allergy? An allergy is a response by the body to a substance to which it has become hypersensitive. It is a medical condition that causes someone to become sick after ingesting something that typically is harmless to most people. So a person with alcoholism or addiction is allergic to alcohol and drugs and the physical response from the body when an addict or alcoholic ingests alcohol or drugs is what the 12 Step fellowships call the physical phenomenon of craving. This bodily reaction is one that makes the person crave more drugs and alcohol. It is the idea that when an addict or alcoholic drinks or gets high, after a certain point, they have little or no control over the amount of drugs and alcohol that they take. They are often literally unable to stop for extended periods of time. In “The Doctor’s Opinion” in the Big Book of Alcoholics Anonymous it says “We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker.” The allergy of alcohol and drugs on an addict or alcoholic means that when drugs or alcohol is used, it sets off the phenomenon of craving and because of the way their bodies process the alcohol and drugs, it sets off cravings for more. It is why addicts and alcoholics can never truly predict how much of a substance they will use.

Mental Obsession:
The second part of the illness or disease of addiction and alcoholism as defined by AA, NA and other 12 Step fellowships is what is known as the mental obsession or the obsession of the mind. This is the second part of the illness and what some literature in the 12 Step fellowships call “the greater aspect of the disease.” The mental obsession is explained as the overriding obsession that an alcoholic or addict has regarding drugs and alcohol. It is the part of the illness that causes issues with perception, where the addict and alcoholic cannot see what drugs and alcohol will negatively do to them but rather what drugs and alcohol will do FOR them (meaning the feeling it gives them, including ease, comfort, confidence and dissipation of fear and anxiety.) In one excerpt from the Big Book of Alcoholics Anonymous, the mental obsession is described as being when alcoholic “at certain times has no effective mental defense against the first drink,” meaning that will-power, consequences, emotional appeals of loved ones and any other hundreds of reasons that make sense not to drink or use will not keep the alcoholic or addict from drinking or using. The obsession of the mind is too powerful and blocks out all reasoning. It is the reason that the addict and alcoholic, after having been detoxed and physically separated from substances for a period of time, will then begin to drink and use again. This is the thinking that loved ones hear that makes no sense in the light of years of evidence demonstrating drugs and alcohol to be a problem, such as “it will be different this time.”

Spiritual Malady:
Underlying both the physical allergy and mental obsession as defined by 12 Steps fellowships is the core of addiction and alcoholism: the spiritual malady. Although many people mistake or misunderstand “spirituality” as it relates to 12 Step fellowships, in terms of the spiritual malady of the illness we are talking about connectivity, underlying feelings, emotions, reactions to life and typically issues for addicts and alcoholics that are SOLVED by drugs and alcohol. A malady is considered a disease or ailment, so quite frankly AA and NA explain the underlying issues for addiction and alcoholism as a disease or ailment of the spirit. “Spirit” is often defined as the nonphysical part of a person that is the seat of emotions and character. Sometimes it’s referred to as the soul. So this part of the disease of addiction and alcoholism really can be considered a sickness of the soul. It is often explained as a “feeling of difference”, “feeling apart from the world”, “feeling separated from others”, “not fitting into my own skin” and manifests itself in loneliness, depression, anxiety and fear. The Big Book talks about feeling “restless, irritable and discontent.” So Alcoholics Anonymous and Narcotics Anonymous typically explain the spiritual malady as what an addict and alcoholic feel while sober, before ever using drugs or alcohol. Because of this discomfort of the spirit, drugs and alcohol actually become the solution to that ailment; they AWAKEN the spirit. For addicts and alcoholics, LIFE is the problem and drugs and alcohol are their SOLTUION. However, due to the previous other two parts of the illness (the physical allergy and mental obsession), this solution that the addict and alcoholic finds through drugs and alcohol eventually becomes a problem and a detriment. However, due to the obsession of the mind and the allergy of the body, the addict and alcoholic will be unable to stop even when they want to.

Due to the way 12 Step fellowships define addiction and alcoholism, they also seek out a spiritual solution to the illness. It is believe through the spiritual answer achieved through the 12 Steps that addiction and alcoholism can be overcome because the spiritual malady can be overcome through unselfish, consistent daily actions of helping others, service, transparency of thought, honesty and a number of other spiritual principles. The Big Book of Alcoholics Anonymous says “once the spiritual malady is overcome, we straighten out mentally and physically.”

Although there are clearly issues that the 12 Steps do not address clinically, there is also something to be said to looking towards to spirituality in recovery as a necessary piece of the puzzle of recovery. This does not necessarily meaning God, a Higher Power, religion or any other traditional aspect of spirituality but instead looking at spirituality as connectivity, relationships, love and purpose.

If you or someone you know is in need of help because of drug and/or alcohol abuse or addiction, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis substance abuse treatment in the Baltimore, Maryland, Washington, DC and Virginia area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at Contact us today. For more information on all of our drug addiction and alcohol addiction services and recovery resources, please visit our web site at

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