Abstract: A critical component of "sustainability" is the capacity to manage chronic social problems like addiction. Sociologists, anthropologists, historians, and other social scientists are invested in debates over substance abuse treatment. This study weds those engagements through an overview of past and current critiques of the twelve-step model, primarily Alcoholics Anonymous (AA), and evaluation of the efficacy of AA vis-à-vis other addiction therapies, including inpatient rehab centers and individual "sobriety coaches," among others. Though attacked by varying interests, from for-profit recovery services to even religious skeptics, AA remains among the most successful voluntary addiction treatment programs. This paper also questions why certain groups enjoy higher rates of lasting sobriety than others, with particular attention to gender, race, religion, and compulsory-versus-voluntary participation.