It should be noted that although AA attempts to appeal to all
religious and non-religious denominations, the spiritual content,
including the Lord’s Prayer at the end of every session at some
community settings and submitting to a “Higher Power”, may
prevent certain individuals from participating in this program
[65,66]. Additionally, there is evidence linking premorbid religiosity
and positive connection to God with higher probability of AA
membership [67]. This may become a deterrent to treatment for
individuals who require the structure and intensity of inpatient care
or supplementary support to outpatient programs but are reluctant to
attend AA sessions frequently. Additionally, concomitant psychiatric
conditions, such as attachment avoidance and anxiety, may make
social engagement difficult for certain individuals and create
ambivalence toward 12-step approaches to recovery [28].