incarcerated alcoholic. Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics. United States court rulings United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed a religion, it was ruled that it contained enough religious components (variously described in Griffin v. Coughlin below as, inter alia, "religion", "religious activity", "religious exercise") to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution. In 2007, the Ninth Circuit of the U.S. Court of Appeals stated that a parolee who was ordered to attend AA had standing to sue his parole office. United States treatment industry In 1939, High Watch Recovery Center in Kent, Connecticut, was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12-step-based treatment center in the world still operating today. In 1949, the Hazelden treatment center was founded and staffed by AA members, and since then many alcoholic rehabilitation clinics have incorporated AA's precepts into their treatment programs. 32% of AA's membership was introduced to it through a treatment facility. Effectiveness There are several ways one can determine whether AA works and numerous ways of measuring if AA is successful, such as looking at abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost. The effectiveness of AA (compared to other methods and treatments) has been challenged throughout the years, but recent high quality clinical meta-studies using quasi-experiment studies show that AA costs less than other treatments and results in increased abstinence. In longitudinal studies, AA appears to be about as effective as other abstinence-based support groups. Because of the anonymous and voluntary nature of AA meetings, it has been difficult to perform random trials with them. Environmental and quasi-experiment studies suggest that AA can help alcoholics make positive changes. In the past, some medical professionals have criticized 12-step programs as pseudoscientific and "a cult that relies on God as