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Thoughts on the “Geographical Cure”: Where would Alcoholics Anonymous be without it?

Updated: Aug 30, 2023

In Alcoholics Anonymous lore, twelve-steppers are taught to beware the “geographical cure.” The AA program imparts a common-sense lesson: when you move, your problems often come with you. The warning that changing locations doesn’t necessarily have the desired influence on habits runs contrary to the grand American ideal of re-invention. The maxim also harkens back to a historical tradition of vacation-like therapies—the sorts of escapist cures that it pithily dismisses.

Even so, AA’s own cure, in its early years, was geographic in other ways. Like any historical phenomenon, it was rooted in a time and place. And before the movement generated national press attention in the early 1940s, its spread relied on the mobility of members—mostly salesmen— who “carried the message” on their travels. The initial dissemination of AA’s solution to the problem of substance dependence reflected regional differences. As the first Detroit member claimed, “Psychiatry had not penetrated the Middle West.”

 Sigmund Freud, G. Stanley Hall, Carl Jung,  Abraham A. Brill, Ernest Jones, and Sandor Ferenczi at Clark U in 1909; Bill Wilson and fellow AA members in 1941

Sigmund Freud, G. Stanley Hall, Carl Jung, Abraham A. Brill, Ernest Jones, and Sandor Ferenczi at Clark U in Massachusetts 1909 (via; Bill Wilson and fellow AA members in 1941, in the Saturday Evening Post.

Jack Alexander, the author of the Saturday Evening Post article credited with making AA a household name, contrasted the recruitment strategies in the early chapters of Alcoholics Anonymous. While AA co-founder Bill Wilson trolled the halls of New York’s Towns Hospital in search of potential converts, “in the Middle West,” Alexander wrote, “the work [was] almost exclusively among persons who have not arrived at the institutional stage.” AA co-founder Bob Smith’s Akron home was hospitable to Protestant religious traditions and functioned as a halfway house for the hardest alcoholic cases. Recovering alcoholics from Akron eventually spread AA’s gospel westward to Cleveland, Indianapolis, Detroit, Chicago, St. Louis, and Los Angeles.

On the way, they shared AA’s central philosophy: the “disease” of alcoholism afflicted both body and soul, but could be arrested by following a simple series of spiritual practices that restored sufferers’ hope, faith, and sanity. Points co-founder Trysh Travis argued that Midwestern AA’s spiritual solution to the problem of substance dependence required members to sacrifice several supposedly manly qualities — such as autonomy, hubris, and one-upmanship — that went along with striving and drinking. Travis’s theory maps on to AA’s directive that newly recovering members ought to stay put and “take it easy.” That advice also has a medical history.

Literature scholar Anne Stiles contrasted two gendered forms of turn-of-the-twentieth century therapy, which she calls the “Rest Cure” and the “West Cure.” The Rest Cure, popularized by S. Weir Mitchell and famously depicted in Charlotte Perkins Gilman’s The Yellow Wall Paper, prescribed bed rest and dietary restriction to nervous women who supposedly suffered from over-stimulation. In contrast, Mitchell’s West Cure essentially articulated the frontier thesis as a viable medical treatment. Mitchell ordered neurasthenic men (among them: Teddy Roosevelt) to toughen up physically and psychologically by ranching, camping, and hunting in the vast American wilderness. Institutions like inebriate farms had long combined these general approaches to treatment, largely unsuccessfully; eventually, alcoholics had to leave the farms and cope with the world.

Charlotte Perkins Gilmans' diary (via National Library of Medicine); Roosevelt as a young man (via Britannica online)

Rest Cure and West Cure: Charlotte Perkins Gilman’s diary (via National Library of Medicine); Roosevelt (a childhood hero of AA co-founders Wilson and Smith) as a young man (via Britannica online).

AA members met bottomed-out initiates at the beside, not on the farm. There, Travis argues, they formed a kind of equalitarian tableau; iconic images of the “man on the bed” are still used highlight the shared experiences of AA recruits and their recovering proselytizers. But as early AA members recovered, some left, and set up camp in new cities where other alcoholics convalesced. When the first Illinois member left Bob Smith’s house for Chicago, he brought AA with him. “From a single member commuting to Akron, we now exceed six thousand,” wrote the salesman.

Man on the Bed stained glass window at the Akron intergroup office (via

“Man on the Bed” stained glass window at the Akron intergroup office (via

Initially, according to historian Ernest Kurtz, AA traveled along sales routes. The first Midwestern AA members may not have had trustworthy psychiatrists, but they were hardly on the frontier of civilization. This cartogram from the 1930s (below) was part of a broadcast network’s promotional campaign directed at potential advertisers; it displays the states in proportion to the percentage of business that they generate. By the beginning of 1940, almost all the existing AA groups had been founded in states with hefty “sales mileages,” namely New York, Ohio, Pennsylvania, Michigan, Illinois, and California (Washington DC was a lone outlier).

Sales Mileage vs Square Mileage (via Making Maps)

Sales Mileage vs Square Mileage (via Making Maps).

“The Depression was on and jobs were scarce,” wrote the first Detroit member. “My health was still uncertain. So I made a living for myself selling women’s hosiery and men’s made-to-order shirts. This gave me the freedom to do A.A. work and to rest for periods of two or three days when I became too exhausted to carry on.” Within a year, Detroit had an AA group; its first member had his own dry cleaning business. 

This itinerant method for founding new AA chapters changed after Jack Alexander’s article: “the Big Book rather than travelers became the main means of spreading the message,” wrote Kurtz. New groups ordered the Big Book directly from AA’s central office in New York. Orders came in so quickly that it was no longer possible for “some traveling ‘oldtimer’ from New York or Akron-Cleveland to look in on [group founders] in response to the initial request for literature.” Orders come less frequently today; AA membership has declined in recent years. But AA’s current area map still has traces of its pioneers’ tracks.

AA Areas, US and Canada (via

AA Areas, US and Canada (via

Close-up AA Areas; States founded earlier have more than one Area (indicated by dotted lines)

Close-up of AA Areas; states founded earlier have more than one Area (indicated by dotted lines).

States with dotted lines have too many groups to be governed by under a single AA “Area.”  All of the states with groups founded by 1940 support more than one Area group today. Taken in historical context, if AA’s “geographical” adage has a lesson, it’s not — as some twelve step critics charge — “Never move.” Early AA members who kept with the program did seem to benefit from a period of rest, reflection, and social support. But if some members had not made the decision to move, AA might have evolved altogether differently — or not at all. The new two-leg journey along seemingly different routes to health — taking “Rest” and moving “West” — may have enabled early AA members to build social networks that helped them reclaim the middle class status that eluded many during the Great Depression.



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