Associate Professor University of California San Diego, California
Background & Introduction: Alcoholics Anonymous (AA) is a widely used and effective mutual help program for alcohol use disorder (AUD).1,2 Little is known about the geographic distribution of AA meetings or their association with community demographics. Prior studies suggest lower AA utilization among racial/ethnic minorities and individuals with lower socioeconomic status, but the role of access remains unclear.3,4 This study evaluates how AA meeting availability varies by ZIP code demographics in major U.S. cities.
Methods: Throughout May of 2025, we identified ZIP codes from the 20 most populous U.S. cities using SimpleMaps data, and recorded the weekly count of AA meetings via local intergroup directories.5 Demographic variables for each ZIP code included population, median income, education level, unemployment rate, and racial/ethnic composition. Independent variables were categorized based on established thresholds, professional judgment, and spline-informed inflection points. Negative binomial regression was used to assess associations in our bivariate and multivariable modeling, accounting for overdispersion and excess zeros in the outcome.
Results: We identified 8554 AA meetings in total in 854 zip codes in our sample dataset during the study period. The median number of weekly AA meetings per ZIP code was 3.00 [IQR: 0.00–14.00]. In our multivariable model, ZIP codes with >30% Black residents had significantly fewer meetings than those with < 10% (adjusted incidence rate ratio (aIRR) = 0.44; 95% CI: 0.30–0.65; p < .001). ZIP codes with >20% Asian residents had significantly fewer meetings than those with < 5% (aIRR = 0.57; p = .008). ZIP codes with >5% Native American residents had significantly fewer meetings than those with < 2% (aIRR = 0.39; p = .037). In contrast, higher education and income were strongly associated with greater meeting availability. ZIP codes with >40% college-educated residents had nearly twice as many meetings as those with < 20% college-educated residents (aIRR = 1.84; p < .005). Zip codes in both the high (>$75,000 median household income) and mid-low ($35,000-$75,000 median household income) income categories had dramatically higher meeting counts, with IRRs of 13.61 (95% CI: 5.68–34.93; p < .001) and 18.46 (95% CI: 7.85–46.68; p < .001), respectively, compared to low-income areas ( <$35,000 median household income).
Conclusion & Discussion: AA meeting availability varies significantly by ZIP code demographics. Communities with higher proportions of racial minorities, lower educational status, and lower socioeconomic status have reduced access to meetings, which may exacerbate disparities in AUD treatment. Expanding AA availability in underserved areas is a potential strategy to improve equity in recovery resources. Additionally, given the observed disparities in access to AA meetings among individuals residing in lower-income ZIP codes and communities of color, it is essential that medical providers proactively offer and discuss evidence-based pharmacologic treatments for AUD as part of a comprehensive and equitable care approach.
References: 1. Alcoholics Anonymous. Estimated Membership (SMF 132). New York, NY: Alcoholics Anonymous World Services; 2021. https://www.aa.org/sites/default/files/literature/smf-132_Estimated_Membership_EN_1221.pdf 2. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020;3(3):CD012880. doi:10.1002/14651858.CD012880.pub2 3. Zemore, S. E., Mericle, A. A., Martinez, P., Bergman, B. G., Karriker-Jaffe, K. J., Patterson, D., & Timko, C. (2024). Disparities in Alcoholics Anonymous participation from 2000 to 2020 among U.S. residents with an alcohol use disorder in the National Alcohol Survey. Journal of Studies on Alcohol and Drugs, 85(1), 32–40. https://doi.org/10.15288/jsad.23-00086 4. Mulia N, Tam TW, Schmidt LA. Disparities in the use and quality of alcohol treatment services and some proposed solutions to narrow the gap. Psychiatric Services. 2014;65(5):626 633. doi:10.1176/appi.ps.201300188 5. SimpleMaps. City level data and interactive map tools. Pareto Software, LLC. Available at: https://simplemaps.com. Accessed October 16, 2025.
Disclosure(s):
Ciaran Murphy, MD, MPH: No financial relationships to disclose
Wayne Kepner, PhD: No financial relationships to disclose
Benjamin H. Han, MD: No financial relationships to disclose
Learning Objectives:
Describe how socioeconomic status, race, and educational status impact access to AA meetings.
Understand existing gaps in knowledge regarding access to AA meetings and underlying causes of disparities.
Describe utility in creating novel datasets to address unmet research needs.
