It's pretty similar in the UK to your description of USA [I assume you mean USA when you say Americans and not any of the other 41 American countries? Bugbear, sorry].
In the UK in many areas we say "[Are you] Alright?" and the response is "[Yes,] [Are you] Alright?". You are not supposed to say whether you are "alright", just answer "Good" or an equivalent. It's analogous to the traditional [middle/upper class] "How do you do?" to which the response expected was "How do you do?". The follow up is usually what the weather is like or something about traffic ...
In the UK in many areas we say "[Are you] Alright?" and the response is "[Yes,] [Are you] Alright?". You are not supposed to say whether you are "alright", just answer "Good" or an equivalent. It's analogous to the traditional [middle/upper class] "How do you do?" to which the response expected was "How do you do?". The follow up is usually what the weather is like or something about traffic ...