Understanding and Counseling the Alcoholic by Howard J. Clinebell, Jr.
Howard J. Clinebell, Jr. Is Professor of Pastoral Counseling at the School of Theology at Claremont, California (1977). He is a member of the American Association of Marriage and Family Counselors, and the American Association of Pastoral Counselors. He is a licensed marriage, child and family counselor in the State of California. His personal website is http://members.aol.com/clinebellh/index.htm, and his email address is clinebellH@aol.com. This book is the Revised and Enlarged Edition published by Abingdon Press, Nashville, 10th Printing, 1990. Used by permission. This material ws prepared for Religion Online by Richard V. Kendall.
Chapter 5: Alcoholics Anonymous -- Our Greatest Resource
If I were asked to give my strongest impression resulting from the study which underlies this book, it would be this: In all the dark history of the handling of the problem of alcoholism, the brightest ray of hope and help is Alcoholics Anonymous! There are two corollaries to this: (1) AA is the most effective referral resource available today. (2) It behooves everyone concerned with helping alcoholics to be thoroughly familiar with AA.
The fact is that, because of AA, some 375,000 alcoholics,1. a high proportion of whom had been labeled "hopeless" by their families, friends, doctors, and clergymen, are today living constructive, happy lives without alcohol. The existence of 375,000 success stories is evidence enough that here is something of momentous significance. AA is not the complete answer to the problem of alcoholism. Nor does it claim to be. Like any approach to any human problem, it has its inadequacies. Everything considered however, AA offers the best referral resource for these reasons: (1) It is available in almost every community in our country. (2) It is free. (3) It has a higher percentage of success in achieving sobriety than any other approach, religious or non-religious.
How AA Began and Grew
A minister of my acquaintance calls AA "a modern chapter in the book of the Acts." He has been as close to AA as almost any clergyman in the country and, therefore, has a wide experience on which to base his judgment. ‘Whether or not one accepts his description as entirely accurate, it is impossible to gainsay that AA -- past and present -- provides a thrilling spiritual story. It is the story of how a group of men and women who had been consigned by society to its scrap heap, banded themselves together and conquered the "unconquerable" craving, becoming an inspiration to their fellow men. Two names dominate the early chapters of this story -- Bill W. and Dr. Bob -- founder and co-founder of AA. Bill W. is a lanky, homespun Vermonter. He was born in East Dorset, Vermont, in 1895. His father was owner-operator of a marble quarry. 2. When Bill was ten, his parents were divorced, and he went to live with his grandparents in the same town. His schooling, which had started in "a one-room schoolhouse with a chunk stove" was continued at a boarding school in Manchester and then at Burr and Burton Seminary and Military College in Norwich. The First World War interrupted his college career in the third year. He was married just before he went overseas.
While in the army Bill began to drink. In mentioning the reason for his previous abstinence he says, "I had been warned. . . too many people had died of it." Coming out of the army, he faced a difficult adjustment. As he puts it, "I had been an officer and thought I was pretty good. I came out and all I could get was a clerk’s job with the New York Central. I was such a damn poor clerk that I got fired at the end of a year." After a while he got a job as an investigator for a security company on Wall Street. He completed a night-school course at Brooklyn Law College but never received the diploma because he was intoxicated and did not attend the graduation. In retrospect he comments whimsically, "Wasn’t that just like a drunk?"
By the late twenties Bill and Lois, his wife, had saved some money. Bill began to dabble in stocks with considerable success. Meanwhile his drinking was mounting steadily. ‘When the crash came in ‘29, Bill found himself $60,000 in debt. He drank himself out of an opportunity for a comeback. By 1932 Bill was in bad shape physically, and his wife had to go to work to support them. From 1932 to 1934 he went downhill at an "awful rate." At the end of a series of hospitalizations, a medical specialist in alcoholism, William Silkworth, confided to Lois that her husband was "hopeless." He explained that Bill’s attempt to adjust his neurosis by means of alcohol had lead to an obsession which condemned him to go on drinking and, further, he had a physical sensitivity -- an "allergy" -- to alcohol which guaranteed that he would go insane or die, perhaps within a year. Bill points out that this concept of the fatal power of the disease, provided by Silkworth, became in AA a powerful deflationary tool, shattering the ego at depth and laying the subject open for conversion.
Meanwhile an alcoholic named Roland H., the director of a large chemical company, had been seeking help from the famous Swiss psychoanalyst, Carl Gustav Jung. Jung had told him that nothing but a religious conversion could help his alcoholism. Seeking desperately for this he returned to America, came under the influence of the Oxford Group Movement, 3. and was "changed." Roland and another Oxford Grouper went to see an alcoholic named Ebby T., to whom they were able to pass on the Oxford philosophy and experience.
Bill W., having received what amounted to a death sentence from the doctor, maintained three months of fear-inspired sobriety. As is true of almost all such sobriety, it was limited in duration. One day as Bill sat half-drunk in the kitchen of his Brooklyn home, Ebby T., whom he had known for a long time, paid him a visit. Ten years later Bill could say, "It was perhaps right there on that very day that the Alcoholics Anonymous commenced to take shape." 4.
Bill noticed immediately that there was something different about his friend, so he asked, "Ebby, what’s got into you?" Ebby replied, "Well, I’ve got religion." This came as a shock to Bill since he had thought Ebby, like himself, to be a confirmed agnostic. Knowing Bill’s prejudices, Ebby went on to say, "Well, Bill, I don’t know that I’d call it religion exactly, but call it what you may, it works." This aroused Bill’s curiosity. He insisted that Ebby explain. So Ebby told of his encounter with the Oxford Groupers:
Some people came and got hold of me. They said, "Ebby, you’ve tried medicine, you’ve tried religion, you’ve tried change of environment . . . and none of these things has been able to cure you of your liquor. Now here is an idea for you. . Why don’t you make a thorough appraisal of yourself? Stop finding fault with other people. . . . When have you been selfish, dishonest . . . intolerant? Perhaps those are the things that underlie this alcoholism. And after you have made such an appraisal of yourself, why don’t you sit down and talk it out with someone in full and quit this accursed business of living alone? . . . Why don’t you take stock of all the people . . . you have hurt -- all of the people who annoy you, who disturb you. Why don’t you go to them and make amends; set things right and talk things out, and get down these strains that exist between you and them? . . . Why don’t you try the kind of giving that demands no reward? . . . Seek out someone in need and forget your own troubles by becoming interested in his." 5.
Then Ebby told Bill how he asked the Groupers where religion came into the picture; they had replied: "Ebby, it is our experience that no one can carry out such a program . . . on pure self-sufficiency. One must have help. Now we are willing to help you . . . but we think you ought to call upon a power greater than yourself, for your dilemma is well-nigh insurmountable. So, call on God as you understand God." 6. Those who are acquainted with AA will see many of the principles which later became central in that group inherent in the Oxford Groupers’ approach to Ebby.
Ebby was careful not to force any of his views on Bill. He merely said that he was leaving the ideas that had helped him with the hope that they might help his friend. In spite of Ebby’s permissive approach, Bill was irritated by this blow to his pet philosophy of self-sufficiency. So he continued to drink. But he couldn’t help turning Ebby’s words over in his mind. At last, in his desperation, the question hit him: "Well, how much better off am I than a cancer patient? But a small percentage of those people recover and the same is true of alcoholics." So Bill W. became willing to do anything that might help him get rid of the obsession that had condemned him to death. He was at his "bottom" -- open to help.
In order to get the alcohol out of his system so that he could think the whole thing through, Bill had himself admitted to Towne Hospital in New York City. \Vhen Ebby came to visit him, Bill’s first thought was, "I guess this is the day he is going to try to save me. Look out." (Incidentally, this is the way many alcoholics feel when approached by those with religious ideas.) But Ebby skillfully evaded Bill’s defenses, talking only in general terms until Bill himself asked him to review his story.
After Ebby left the hospital that day, there occurred what is known semi-facetiously in AA as Bill’s "hot flash." Here is his description of what occurred:
When he was gone, I fell into a black depression. This crushed the last of my obstinacy. I resolved to try my friend’s formula, for I saw that the dying could be open-minded. Immediately on this decision, I was hit by a psychic event of great magnitude. I suppose theologians would call it a conversion experience. First came an ecstasy, then a deep peace of mind, and then an indescribable sense of freedom and release. My problem had been taken from me. The sense of a Power greater than myself at work was overwhelming, and I was instantly consumed with a desire to bring a like release to other alcoholics. It had all seemed so simple -- and yet so deeply mysterious. The spark that was to become Alcoholics Anonymous had been struck. 7..
Bill called William Silkworth to his bed and tried to tell him what had happened. The doctor said he had heard of such experiences but had never seen one. Bill asked, "Have I gone crazy?" to which he responded, "No, boy, you’re not crazy. Whatever it is, you’d better hold on to it. It’s much better than what you had just a few hours ago."
When Bill came out of the hospital, he felt very grateful to the Oxford Group. So he attended Group meetings and worked with alcoholics at the Calvary Mission, telling about his religious experiences and trying to induce it in them. The Calvary Mission, a result of the Oxford Group impetus in the Calvary Episcopal Church of New York, was a rescue mission. It represents a significant exception to the dominant Oxford Group interest in the upper classes. Bill and his wife worked tirelessly, day and night. Often their Brooklyn home was filled with alcoholics in various stages of sobriety. 8. Silkworth continued to encourage Bill in his efforts and to provide him with numerous opportunities to work with alcoholics. In spite of everything, at the end of six months, Bill had sobered only one person -- himself. But a key AA principle was growing from his failures, for he had learned, as he put it, "that working with other alcoholics was a powerful factor in sustaining my own recovery." 9..
Six months after his conversion Bill accepted a job opportunity in Akron. Just when the venture seemed certain to succeed, the whole thing collapsed. Overwhelmed by the failure, Bill had one "comforting" thought: "With a fifth of gin, I could be a millionaire -- at least for a while." 10. He wondered how God could be so mean to him, after all the good he had done for Him. Suddenly he realized that he might get drunk again, unless he found another alcoholic to talk to.
From the church directory in the hotel lobby, Bill chose the name of a clergyman at random. Over the phone he told him of his urgent need to work with another alcoholic. The clergyman gave him a list of ten Oxford Groupers and suggested that surely one of them would know an alcoholic. The first nine calls proved to be of no avail, but on the tenth he was greeted by a warm southern voice, a nonalcoholic Oxford Grouper who insisted that she understood how he felt and that he should come to her home at once. This lady, Henrietta S., arranged for Bill to meet Dr. Bob S. at her home the next day. The next day -- the day after Mother’s Day in 1935 -- the fellowship of AA was born.
Dr. Bob had had a long series of terrifying bouts with alcohol. He had been hospitalized repeatedly and was losing his medical practice. In 1933 he had begun attending Oxford Group meetings, seeking help. He sought the counsel of two prominent ministers who were active in the movement. For two years he did everything they and the other Groupers suggested. He read the Bible daily, prayed intensely, and attended church regularly. In spite of everything, his drinking increased.
The meeting of Bill and Dr. Bob illustrates another cardinal principle of AA -- the fact that an alcoholic has a natural advantage in establishing rapport with another alcoholic. When Dr. Bob appeared at Henrietta’s door, she discreetly whisked him and Bill off to the library. Bob’s first words were, "Mighty glad to meet you, Bill. But it happens I can’t stay long; five or ten minutes at the outside." Bill laughed and observed, "Guess you’re pretty thirsty, aren’t you?" Bob replied, "Well, maybe you do understand this drinking business after all." Their first talk lasted for hours.
Out of Bill’s desperation the AA principle of enlightened self-interest was taking shape. He explained to Dr. Bob how much he needed him if he was to stay sober. Bill showed Dr. Bob the missing ingredient in his solution -- that "faith without works is dead." And so the two men sought another alcoholic to help. The first case, supplied by a neighboring minister, was unsuccessful. (Fifteen years later this "unsuccessful" prospect appeared at the funeral of Dr. Bob, a successful member of AA.) Then they tried a prominent Akron lawyer who had lost nearly everything through alcoholism. They found him in a city hospital, chained to a bed. They explained the medical nature of his sickness, and of their own drinking and recoveries. The man on the bed shook his head, "Guess you’ve been through the mills, boys, but you never were half as bad off as I am. For me it’s too late. I don’t dare to go out of here. Alcohol has me, it’s no use." This feeling of being worse than anyone else is common among alcoholics. Bill and Dr. Bob made no attempt to argue away the man’s hopelessness.
They returned to the hospital the next day. When they entered the man’s room, he cried to his wife who was visiting him:
Here they are. They understand. After they left yesterday I couldn’t get what they told me out of my mind. I laid awake all night. Then hope came. If they could find release, so might I. I became willing to get honest with myself, to square my wrongdoings, to help other alcoholics. The minute I did this I began to feel different. I knew I was going to get well. 11.
This man rose from his bed never to drink again. He became AA number three. And so AA began to grow.
After a few months of working with Dr. Bob in Akron, Bill returned to New York and began to apply the principles there. There followed the years of trial and error from which AA proper emerged. For a time the, as yet, nameless movement was connected with its parent, the Oxford Group. Gradually in both New York and Akron, it became an independent entity. AA had learned much from the Oxford Group Movement. Most important had been a demonstration of the power of a nonprofessional, religiously oriented group to help people with their problems. AA had also learned some things about what not to do in trying to help alcoholics. The aggressive evangelism and clamor for public figures characteristic of the Oxford groups had to be eliminated from any program which would work with alcoholics. The modifications and changes of the Oxford technique were made on a trial-and-error basis by the early members of what came to be called AA. The modifications probably became more important, so far as the success of AA is concerned, than the original Oxford techniques and ideas with which they started. These modifications allowed AA to be adapted to the special psycho logical needs of alcoholics.
In the fall of 1937 Bill visited Dr. Bob, and the two began counting noses. They were amazed to be able to count forty alcoholics who had been dry for a significant time. Suddenly the awareness dawned on them that something new, perhaps something great, had been started. They saw that, as someone has put it, "God had lighted a torch and shown alcoholics how to pass it from one to another." From that moment plans for spreading the good news to the thousands of alcoholics who could be helped began to take shape.
The growth of the movement was slow at first. By the end of the fourth year there were one hundred members. Progress was the most rapid in Ohio. The first amoeba-like branching-off from the original Akron group took place in May, 1939, when enough men were coming to that group from Cleveland to make it advisable to start a separate group there. Disagreement among members of this new Cleveland group resulted in two other groups there in 1939. During the winter of 1938 a modest gift from John D. Rockefeller kept the work from floundering. In the spring it was decided to publish a book which would record the collective experiences of the early members to help other alcoholics. The completion of the Big Book -- as it is affectionately known in AA -- in April, 1939, marked a milestone in the growth of the movement. "The Way Out," which was the first choice for a title, turned out to be the title of twelve other books; so they decided to call their new book Alcoholics Anonymous. Thus the little fellowship of about one hundred re covered alcoholics acquired a name.
Sales were so slow at first that a deputy sheriff appeared one day at the Newark office of AA to dispossess them because they could not pay the printing debt. A grateful member saved the situation by mortgaging his business to raise the needed money. The group’s fortunes improved rapidly in the fall of 1939 when Liberty magazine and the Cleveland Plain Dealer each published an article about AA. Inquiries poured in from distant places. The movement was spreading like a chain letter. During 1940 it reached such places as Chicago, Detroit, Little Rock, Houston, Los Angeles, and San Francisco, via the book and by members moving to new homes. In 1941 an article by Jack Alexander appeared in the Saturday Evening Post, entitled "Alcoholics Anonymous, Freed Slaves of Drink, Now They Free Others." The "handful of drunks" watched with mingled joy and amazement as thousands flocked in seeking help. Since then AA has grown by geometric progression. In April, 1954, the AA Directory gave the active membership as 128,196. By January, 1967, the estimated worldwide membership stood between 350,000 and 400,000. AA’s General Service Office in New York was in direct communication with an expanding network of some 12,000 groups, including 7,821 in the U.S., 1,241 in Canada, and 2,136 groups outside the U.S. and Canada. In addition there were some 700 prison groups and 600 hospital and rehabilitation center groups. 12. The growing international impact of AA was reflected in these 1965 membership estimates: 13,803 members in Mexico, Central and South America; 3,966 in the United Kingdom; 7,313 in Europe; 2,816 in Africa; 3,228 in Australia; 749 in Asia; 1,543 in New Zealand; and 61 in Oceania. Many of the groups abroad were established by AA seamen and traveling businessmen. The jet age has accelerated this growth, producing what might become an international "sobriety explosion." In one Asian country, AA’s development was cultivated mainly by a U.S. Army sergeant and a native clergyman. AA literature is now available in a dozen languages. In many countries there are AA groups meeting in hospitals and prisons, as well as in the usual community settings. (In the U.S., the 400 hospital groups have over 11,000 members and the 500 prison groups have some 25,000 members. 13 How effective AA will be in non-Western cultures (with different attitudes toward guilt, pleasure, and the goals of life, for example) and what modifications will eventually occur in the AA program in such cultures has yet to be determined.
A significant milestone in AA history was the First International Conference held in Cleveland in July, 1950, the fifteenth anniversary year of its founding. Seven thousand AA delegates met in an atmosphere of gratitude and victory and, with humility, rededicated themselves "to the single purpose of carrying the good news of AA to those millions who still don’t know." 14. A Twentieth Anniversary International Convention was held in St. Louis in July, 1955. More than 10,000 AA members and spouses attended the Thirtieth Anniversary International Convention in Toronto, Canada, in July, 1965. AA’s from numerous countries spoke with deep gratitude for what the fellowship and recovery program had meant in their homelands. Amid general rejoicing for AA’s startling effectiveness with "lost cause" alcoholics, there was a persistent note of determination that this success would not lead to complacency. When Bill W. and his wife Lois were introduced at the mass meetings, there was thunderous applause and repeated standing ovations. In one talk, Bill re minded the convention: "When we remember that in the thirty years of AA’s existence we have reached less than 10 percent of those who might have been willing to approach us, we begin to get an idea of the immensity of our task and the responsibilities with which we will always be confronted." 15. He also stressed the need for cooperation with all who work on the alcoholism problem, including the more than one hundred agencies (in the U.S. and Canada) now engaged in rehabilitation, research, and alcohol education.
Administratively each local AA group is autonomous. In 1938 an Alcoholic Foundation, composed of five non-alcoholics and four alcoholics, was formed to handle the publishing of the book. In 1942 the Foundation was incorporated -- to assure continuity. It was made the custodian of AA "tradition and policy," as well as repository of funds, collected from literature sales and a strictly voluntary contribution of one dollar per member by local groups. The Foundation maintains a General Service Office in New York City, which acts as a clearing house for all AA groups. It distributes literature, answers letters of inquiry from all over the world, and advises members about group problems. In 1950, The AA Grapevine, the official periodical of AA, published a proposal by Bill and Dr. Bob that a General Service Conference of AA be formed. This proposal, which was subsequently adopted and is now in operation, provided for a small body of state and provincial delegates meeting yearly to assume direct responsibility for the General Service Headquarters. The plan aims at providing a representative group to "take the place of Dr. Bob and Bill," to keep the Foundation (renamed the General Service Board) firmly anchored to the movement it serves, and to insure the continuity of the services of AA. A significant event in the growth of AA occurred in 1955 with the publication of a new edition of the Big Book. It has 612 pages, as compared with 400 in the original edition, and contains 29 new "stories" of recoveries, representing a wider geographical and vocational range; included were more stories by younger alcoholics and "higher-bottom" cases.
On November 19, 1950, Dr. Bob died after a prolonged illness. Bill W. is now devoting most of his time to writing material which will be helpful to members of AA. His major literary productions are Twelve Steps and Twelve Traditions and The AA Way of Life, A Reader by Bill,16 These have become companion volumes to the Big Book in AA circles. Bill is now having what he calls "a season of reflection," during which he is trying to get some light on the question: What does it all mean? 17. Meanwhile the movement which Bill W. and Dr. Bob started continues to grow and flourish. One reason for this is the robust sense of responsibility on the part of many AA’s for reaching the unreached alcoholics. This was reflected in the "responsibility" theme of the Thirtieth Anniversary Convention; at that inspiring meeting, AA members were invited to rededicate themselves to the unfinished task, in these words:
"I am responsible. When anyone, anywhere, reaches out for help, I want the hand of AA always to be there. And for that: I am responsible." 18. It was evident that this sense of responsibility is globe-encircling, including all of the world’s twenty-five million still-suffering alcoholics. 19.
How and Why AA Works
The seventy-seven interviews which I had with AA members gave me convincing proof that there is no such thing as a blanket answer to the question of how and why AA works. For AA is a permissive organization, and each person who comes to it works out his own program. The best that one can hope to do is to describe certain common principles and experiences drawn from the interviews which are typical of many in AA. We shall do so by de scribing a hypothetical alcoholic whom we shall call "Joe." Joe is actually a composite of the experience of many different alcoholics.
Joe might have come in contact with AA in one of many ways. For example, a friend or business associate with the same problem might have suggested he try AA, or his doctor or minister might have recommended it to him. But let us say that his wife is the person who made the initial contact. She has had about all she can take of Joe’s drinking. For several years it has been making life almost unbearable. Now he is in the middle of another bender. All his promises and good intentions have come to naught. In her desperation she remembers a magazine article about AA. She looks in the telephone directory to see if it is listed. She dials the number, and an AA group secretary answers. The harassed wife asks if they will "try to do something with Joe?" The secretary, herself an alcoholic, inquires whether Joe is interested in stopping, or at least in talking to someone who might be able to help him. If the reply is, "No, but the Lord knows he needs it!" the secretary will explain that the AA approach works only in cases where the alcoholic has some desire for help, and that to talk to Joe now would probably only antagonize him. The secretary may suggest a chat with his wife instead. In such a talk the secretary will try to help her understand the true nature of Joe’s problem and perhaps suggest certain things which she can do as his wife in helping him get to AA eventually.
If Joe is willing to talk to someone, the secretary will suggest that he come to the office or AA clubhouse from which she is talking. Here -- in the emphasis on Joe’s willingness for help and to come to the AA headquarters -- is evident one of the primary reasons for AA’s effectiveness, viz., the initiative is kept with the alcoholic. This principle is followed in all AA procedures. When one recalls the hypersensitivity of the alcoholic to authority, the importance of this principle is self-evident.
If Joe is too sick to navigate, however, the secretary sends a pair of AA volunteers -- "Twelfth-steppers" -- to his home. They find Joe retching and shaking in bed. They introduce themselves, and one of them mentions that he had the "shakes" himself less than a year ago. If Joe needs a drink desperately, one of them may go out to buy a bottle. The other begins to talk, not about Joe -- which would raise Joe’s defenses -- but about himself. He tells about his own grim experiences with alcohol. The first AA returns with the whiskey which soon quiets Joe’s pounding nerves. Then this AA tells about his drinking -- the jobs he lost, the trouble he caused, the desperation, hopelessness, and loneliness he felt.
Joe senses that these fellows know what they’re talking about. The bridge of communication which one alcoholic is able to establish with another is being constructed. Herein lies another key to AA’s effectiveness. The candid accounts of their drinking experiences by the AA’s may cause Joe to open up a bit. He is still suspicious, but he advances a cautious question about "the program" which they have mentioned. "How much does it cost?" "Do I have to sign a pledge?" The men explain that there are no dues or fees and that most of the work is done by volunteers like themselves who do it to keep sober. "Sobriety insurance" they call it. This sounds slightly insane to Joe, but as he gradually grasps what they are saying, he realizes that he is helping them by allowing them to help him. Thus he does not feel the extreme burden, which would eventually become unbearable to his alcoholic ego, of being entirely the recipient in the helper-helped relation. This is another reason for AA’s effectiveness. From the beginning it allows him to feel useful and not entirely dependent.
The men go on to explain that there are no pledges and no "musts" in the AA program and that even long-time members only agree with themselves to stay sober a day at a time. This, they explain, is the "Twenty-four Hour Plan." In plain English this means, "Tomorrow I may go on the damnedest bender you ever heard of but I’m not going to have a drink today." 20. They explain that anybody can stay sober for twenty-four hours if that person really wants to. The twenty-four hour plan is one of several tools which AA will provide Joe to help him over the first hard days and weeks. These tools help in breaking the addictive cycle -- drinking to anesthetize the effects of previous drinking -- and are another reason for AA’s remarkable effectiveness.
As to joining, the AA’s assure Joe that anyone who admits that alcohol has him licked and wants help is a member. They go on to tell how they discovered, after years of trying to handle alcohol, that alcohol was handling them. Their lives had become unmanageable because their bodies didn’t react to alcohol like the body of a normal drinker. Because they had a physical allergy to alcohol, their schemes to "drink like a gentleman" were foredoomed to failure. Further, it was the first drink that set them off on a binge. By presenting alcoholism to Joe as a problem which is at least in part a physical sickness for which there is no known cure, they achieve several things which contribute to AA’s effectiveness. They help reduce Joe’s staggering guilt-fear load which has paralyzed his psychic energies. They reduce his guilt by showing him that since it is a sickness, his alcoholism is not primarily a matter of willpower. They reduce his fear that he is insane by providing him with the first rational explanation for his bizarre behavior. The psychic energies thus released are made available for therapeutic use. By pointing out that his sickness is in large measure physical, they avoid the moralism and guilt that still tend to cling to mental or emotional illnesses in our culture. By emphasizing the fact that there is no cure for the illness, they stress its seriousness. But they also point out that the AA program has allowed them to live happily with their illness -- like insulin does with the diabetic.
The presence of two well-dressed men who "talk his language" and seem to understand the horror of his alcoholic world begins to penetrate Joe’s isolation and to awaken in him this spark of hope: "If they did it, perhaps I can too." Because they are there to help themselves by helping him, and because they do not lecture or try to sell him anything, Joe relaxes his defenses. Since they have been through the same dark valley, the AA’s can anticipate his fears and suspicions, his alibis and defenses. Joe senses that here are two men he cannot fool. He begins to feel a little less alone.
Throughout all their contacts with Joe, the Alt’s are careful not to say to Joe that he is an alcoholic. They know that there is only one person whose decision about that can make the slightest difference -- Joe himself. By telling him what they think about him they might prevent him from coming to his own admission that alcohol has him licked. But, if Joe shows even the mildest interest, the men will invite him to an AA meeting. If he has reacted negatively or shows that he obviously has not "had enough" in his struggle with alcohol, the men will leave with the hope that they have planted some seed which will stimulate his desire for help at some later date. (In the cases of those interviewed by the writer, there was often a time gap ranging from one month to five years between the first contact with AA and the beginning of real participation.) In any case the Twelfth-steppers will leave their names and phone numbers with the suggestion that Joe call them any time he feels like taking a drink. In pre-inflation days this was known as "nickel therapy." This is another of the tools which AA provides Joe in order to help him over the periods of temptation. But Joe must use the tools himself if they are to be effective. Thus the initiative is kept with him. If he eventually succeeds in the AA program, he will know that it is his success. Before the AA’s go, they may leave a copy of the AA book or other AA literature.
If Joe is obviously in serious physical condition, the AA’s may suggest that he be hospitalized so that he can receive detoxification treatment, vitamin therapy, and a sound diet. AA itself does not own any therapeutic facility, nor is it affiliated with any; but it gladly cooperates with hospitals and treatment centers in many places. This is done through the Institutional Committees, composed of AA’s who commit themselves to regular availability for Twelfth Step work in institutions, including general hospitals, mental hospitals, and correctional facilities. Two patterns of alcoholic hospitalization have emerged. Some hospitals have separate alcoholic wards; more assign alcoholics to general medical wards and rooms just as they would any other sick person. Research has shown that, with modern tranquilizers and detoxification methods, alcoholics cause no greater disturbance than any other group of seriously ill patients. In both patterns, the volunteer services of AA members are invaluable parts of the treatment program. With the doctor’s encouragement and the patient’s agreement, the AA’s make frequent visits, surrounding the hospitalized alcoholic with acceptance and offering him the AA recovery program. Equally important, they continue to offer him fellowship and help during the shaky days after he leaves the hospital. Several of the interviewees attributed their successful beginnings in AA to the fact that they had had such hospitalization. The advantage of the all-alcoholic ward is that the entire atmosphere can become saturated with AA’s spirit of hope, particularly if the nurses and attendants are Alt members. In a number of hospitals (mainly mental hospitals), recovered alcoholics are working very effectively as lay therapists.
The term "sponsor" came into use as a result of certain hospital programs which admitted alcoholics only if they were sponsored by an AA member. It was soon discovered that the principle of having a person designated to guide a new man during his early days in AA had great merit. So the idea was applied to new members in general. Let us say that one of the men -- we’ll call him "Harry" -- who called on Joe has "hit it off" with him and has become his sponsor. Harry calls on Joe almost every evening. He may phone him each morning, just to say hello. Often he brings other AA friends along to meet Joe.
As soon as Joe is feeling a little better, Harry takes him and his wife to an open meeting of the local AA group. Closed meetings are for alcoholics only; open meetings welcome nonalcoholic relatives, friends, and anyone else who is interested, as well as the alcoholics themselves. Here is something of what takes place. Before proceeding, it is important to make several points clear. This description is based on an actual meeting that took place in the New York City area -- with the exception of the third talk which happens to have been given in a Chicago AA meeting. Names and places have been altered to protect anonymity. In spite of this basis, it is impossible to convey the real feeling of an AA meeting on paper. Neither the talks -- of which portions are given -- nor the meeting should be taken as being typical, for there is no such thing as a typical meeting or talk. Each talk is a unique entity, reflecting the experiences and personality of the speaker. Then too, meeting practices vary greatly from one section of the country to another.
The meeting is held in the parish house of a church, rented by the AA group at a nominal rate. Camaraderie pervades the hall. There is spirited conversation and laughter as those present mix informally. It is obvious that these people enjoy being together. Harry enters with Joe and his wife. They are soon surrounded by AA’s, some of whom have already been to see Joe. Joe is still somewhat foggy, but he is impressed with their interest in him and by their general appearance. These people look successful and happy. Joe wonders, "Can these folks be alcoholics? Maybe they’ll bring the drunks in later." He feels relieved that none of his new friends seem to notice that his hand still trembles when he reaches out to shake theirs or that he can’t carry on much of a conversation. The folks he meets seem to represent a cross section of occupations -- a plumber, a dentist, a stevedore, an artist, a corporation lawyer. As has been said, "AA’s membership is as diverse and exclusive as a classified telephone directory." 21.
A little after 8:30 P.M. the chairman of the group raps a gavel, calling the meeting to order. Conversation gradually subsides as the members move to take seats. Joe looks around. There are about 125 present, one third of whom are women. Ages range from the white-haired grandfatherly man to several young people in their late twenties. On the walls of the room are several placards: "Easy Does It," "First Things First," "Live and Let Live," and "But for the Grace of God." Joe, who feels down on life in general, including God, winces internally at the last one.
The chairman begins to speak:
This is the regular Friday night open meeting of the East Brooklyn group of Alcoholics Anonymous. I would like to welcome all of you, especially the new comers. Our AA magazine says on its masthead: "Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is an honest desire to stop drinking. Alt has no dues or fees. It is not allied with any sect, denomination, politics, organization, or institution; does not wish to engage in any controversy, neither endorses nor opposes any cause. Our primary purpose is to stay sober and help other alcoholics achieve sobriety." That pretty well says it for my money. We’re fortunate in having a group of speakers from the Uptown Group No. 2 with us. It’s a pleasure to welcome them and to present Bob Green, who will lead tonight’s meeting. (Applause as the leader comes forward from the audience.)
Bob Green takes the speaker’s stand:
My name is Bob Green, and I’m an alcoholic. It’s good to be here tonight. As the chairman said, this is a fellowship. We’re all here because this is the best way we know of helping ourselves stay sober.
The leader for the evening continues for a few minutes, telling a little about AA and about his own experiences with alcohol. He concludes his opening remarks in this way:
I want to say a word to the newcomers. Only as we strive to help you, can A.A. continue or any of us stay sober. The only thing we ask is that you keep an open mind. We’re going to hear from three speakers tonight. If you don’t hear some thing tonight that rings a bell with your experience, keep coming to meetings. And I must add that anything that I or any speaker says represents our own opinions, and is not necessarily the opinion of A.A. in general. With this I’ll give you my first speaker, Jake White. (Applause.)
My name is Jake ‘White, and I am an alcoholic. After twenty-two years of drinking, I actually quit. I got so bad I had to sneak liquor into my house. My wife kept calling my drinking to my attention, so I had to get the liquor in without her knowledge. I would put a couple of bottles in my coat and stalk past her -- when you’re half loaded nobody sees anything -- (laughter) and hide them in the hamper. Usually when I tried to get the bottles out of the hamper quietly, I got the bottles but the hamper came with them. (Laughter.) One time after a particularly bad bout, my wife said to me, "Why don’t you make me the happiest woman alive?" I said, "How?" She replied, "Drop dead!" (Laughter.) Finally my wife kicked me out. I had said to her, "This house is half mine, let’s divide it." We did. She took the inside and I took the outside. (Laughter.)
So I took a furnished room and got a job in a hospital -- admissions desk on the maternity ward. (Laughter.) I soon discovered that in a Jewish hospital the fathers of new baby boys throw a party when the kid is a week old. So I could freeload quite regularly. Finally it got bad, so I quit just before they fired me.
My family had given me up long before. I was getting so bad I was scared of myself. Lying in a cheap furnished room, drinking, dreading the time when the liquor would give out, or I wouldn’t be able to keep it on my stomach. I finally called up the only brother who would still speak to me and asked him to come down. He protested but finally came and got me in the county hospital for eleven days. While I was there a social service worker asked me if I’d heard about AA. I said, "What’s that?" He gave me an A.A. pamphlet to read. On Sunday the boys came to visit me, and I saw the light for the first time. I went to AA; it was the thing I had been looking for. At that time there were only about twenty-five members in Brooklyn. I listened to their stories -- they had been on the Bowery, been in all sorts of places I had never been. I began to feel I was not as bad as them -- forgetting to take the inventory and check my own record. After four months I said to myself, "Maybe with all my knowledge of AA, I could take a couple of beers."
The first night I had six, but woke up the next morning feeling fine. I was scared to death of what would happen if I got drunk. The third night of my experiment I got drunk, papa threw me the hell out, and I was back in the furnished room. (Laughter.) For the next five years I was on the bum. I would sit in a cheap gin-mill telling drunks they should go to AA -- just the thing for them. (Laughter.) I lost job after job. One year it took two envelopes to send in my income tax slips, I had so many of them. (Laughter.)
I lost all hope and resigned myself to an alcoholic death. Then two men came to see me. I knew before they spoke that they were from AA. I was never so glad to see anyone in my life. That was May 23, 1948. No drinks since then. I poured the liquor I had tied to the bed springs down the drain when those men left. I was really through.
AA doesn’t fail -- we fail it. It works, if we will work it. To the newcomer I want to say two things. First, the most important thing in AA is to get active in the work and get to know people in AA. The more people you know, the better time you’ll have and the easier to stay sober. Second, it’s easier to stay sober than to get sober. I owe everything to AA. If it wasn’t for AA, I’d probably be dead by this time. Instead, I’ve got my home together again and I’m holding down a job and enjoying life -- without booze. ‘When I talk to the "Man upstairs," I say "thank you" for AA. (Applause.)
Following Jake’s speech, the leader interjects some of his own experiences, confirming something Jake has said. After mentioning that alcoholism is no respecter of age, color, or sex, he introduces his second speaker, an attractive woman of about forty. She begins by telling about how she helped her brother get into Alt but resisted it herself, even after she was in serious trouble, because she couldn’t imagine that anything could help her. She relates: "I got so bad I couldn’t comb my hair. .. . I drank by myself behind closed doors. I never could tell where sleep ended and blackouts began." Finally, as a last resort before suicide, she decided to try AA. With the exception of one brief slip at three months, she had been sober for two years and ten months. The speaker then turns to a discussion of the fourth step, describing at some length how it helped her. Finally, she concludes her talk with these words:
To the newcomers I’d like to say, don’t be discouraged if you don’t get it right away. You can do it, if you put a little of the effort into the program which you formerly put into getting and hiding liquor. I have a lot to be thankful for -- to AA, my sponsor, and the Higher Power. One is the fact that before AA when I woke up, I used to say, "Good God, morning!" Now I can say, "Good morning, God." (Applause.)
After the second speaker, the leader from the visiting group turns the rostrum over to the secretary of the local group who makes announcements concerning future meetings and says: "There are no dues or fees in AA, but we do have expenses, so we’ll now pass the hat." During the collection there is a buzz of conversation. Some stand and stretch. Since most AA’s smoke, by now the air in the room is a blue haze.
After a few minutes the leader introduces the third speaker who is one of the old timers of the visiting group. He mentions his own drinking experiences only briefly and spends most of his time telling how the various steps have helped him.
We are like a man who has bought a farm with the sole thought of raising wheat. And raise wheat the farm does -- the finest of wheat. But as the farmer goes about the task of raising wheat, he finds the most beautiful of flowers springing up in odd corners; he notices for the first time a grove of stately trees. And as time goes on, he strikes oil in this acre and gold in that; here he finds coal, and there he finds silver, and now he comes upon a curative spring. And the end is not yet. Each day he comes upon new comforts, new beauty, new riches; each day he rises to new adventures; each day’s discovery sets him atingle for the next.
Does my allegory sound far-fetched -- just some words strung together to make a speech? Let’s take inventory -- an old AA custom. Everything in Alt stems from the twelve steps of the Recovery Program. . . . Let’s look at the twelve steps, not to discuss them and what they mean, but solely to see what they give us over and above sobriety.
In the first step, we admitted that alcohol had made our lives unmanageable. With that admission comes the first peace we have known in years. Why? Because for years a battle had been raging inside us -- our mind and our conscience on one side, this strange and savage appetite on the other. And now the battle is over.
In the second and third steps we came to believe that a Higher Power could help us and we placed our will and our lives in his hands. And what do we get? A resurgence of faith and of hope. A great gift, indeed, to us who have lived in despair. The fourth and fifth steps led us to take inventory of our lives and to tell the exact nature of our wrongs. The devil of remorse that had long plagued us has gone. The burden of evil that bent our shoulders and weighted our limbs has gone.
And so we break with the past. So we become new men. That’s not a figure of speech. The seven remaining steps make that just as real as the platform I stand upon. In the sixth and seventh steps, we make restitution to ourselves by casting off the shoddy, sodden garments of the drunkard; by clothing ourselves in tolerance, in humility, in honesty and charity. In the eighth and ninth steps, we made restitution to others. Those four steps help us get rid of those alcoholic lenses that were before our eyes -- the ones that caused us to see not the decent, kindly folk about us but grotesque and distorted figures -- demons in a land of nightmare.
Perhaps the greatest gift of all the steps, next only to sobriety, is contained in the next two -- the steps of the daily inventory, the daily seeking of closer union with God. And so to the twelfth step. It told us that we’d have a spiritual experience. Some of us were a little doubtful about that. We realize now that it’s impossible to make a real effort to fulfill the other steps without having a spiritual experience. The twelfth step told us, too, to carry this message to other alcoholics. No man in this audience, I don’t care what his life has been, has ever savored a satisfaction so complete, so unalloyed, as that which comes to one who is the instrument by which an alcoholic enters into and is redeemed by AA.
Yes, there are reasons -- a hundred times the number of those I have cited -- for joining AA, over and above and beyond achieving just plain sobriety. 22.
When the third speaker finishes, the leader thanks the local group for the privilege of "carrying the message," and says, "Now let’s stand and close the meeting in the usual way." The group then repeats the Lord’s Prayer in staccato phrases. This comes as a jolt to Joe who has been pleasantly surprised up to this point by the lack of "religious" practices in the meeting. The smoking, the laughter, the occasional "damn" during the talks had made him feel comfortable and somewhat relaxed.
Feeling socially awkward, Joe starts to make an excuse to leave, but before he can get it out, he is ushered by several AA’s to a table where coffee and doughnuts are waiting. Harry makes sure that his "baby" gets comfortably acquainted with some group stalwarts who drift over to the table. Among others, Joe meets a fellow who works at his trade. They begin to "talk shop" and before long have exchanged telephone numbers. Joe’s AA circle is beginning to grow. Conversation, mostly about AA activities and alcoholism, fills the room in waves. Twelfth Step work is going on over coffee cups. After about a half hour members begin to leave. Many stay for as long as an hour.
Let us pause for a moment and analyze what has happened to Joe. He has begun to become a part of an emotionally meaningful group which can provide him with a supportive web of relationships within which he can apply the principles of AA. It is an attractive group. The alcoholic has always associated "cures" with the unpleasant. In contrast, here is a group which is enjoying sobriety. It gives Joe’s ego a lift by making him as a newcomer feel important. He is no longer an outcast. Someone actually wants him in his group! During the course of Joe's drinking he has become generally desocialized. Here is a group that can reverse the process and serve as a doorway to the land of the living. It can do this because it is, sociologically speaking, an in-group whose close ties of fellowship provide the environment for resocialization. The intensity of the fellowship has been compared by one AA speaker to that shared by those who have peen through a battlefield experience together. This attractive ingroup is open only to alcoholics. Joe’s reluctance to admit that alcohol has him licked is counterbalanced by the fact that this admission is his ticket of entrance to the group. His chief liability has thus become an asset. Equally important is the fact that here is a group of people who speak with complete candor and lack of guilt about their common "sickness." Joe feels a great relief. He thinks, "Since they don’t blame themselves for their alcoholism, they won’t blame me for mine." It is by reversing the usual moralistic, punitive attitude toward alcoholism in our culture that AA is able to provide a solution to the problem.
Already Joe’s isolation is beginning to break down. He realizes that he is not alone and is not uniquely cursed. He has seen a room full of examples of those who don't even regard it as a curse. He has seen a hundred examples of the fact that the AA program works. Joe has begun to identify with some of the speakers as they described their experiences.
The AA group can help Joe because it is anonymous and non-exploitative. Anonymity quiets his early fears that someone will find out he’s an alcoholic. (Actually everyone who knows Joe has long been acquainted with the fact.) Anonymity also casts an atmosphere of clandestineness around the movement which gives it ~ certain added appeal, especially for those alcoholics who are in the "gang" stage of psychosocial development. The fact that AA is free and is based on the principle of alcoholics helping other alcoholics in order to help themselves means that Joe need not fear either financial or emotional exploitation. All this helps him identify with the group. As he begins to feel a sense of belonging, i.e., to derive emotional satisfactions from the group, the group is able to influence his attitude and behavior along group-approved lines. This is an unconscious process by which normal social controls, which have had little meaning to Joe in the advanced stages of his alcoholism, are reestablished. The AA group provides an interpersonal environment where successful abstinence is rewarded’ by group approval and acceptance. This is very important in keeping Joe sober during the early months in AA.
When they reach Joe’s house after the AA meeting, Harry is invited in for another cup of coffee. While his wife fixes it, Joe queries Harry about the signs at the front of the meeting hall. Harry explains:
Those are the AA mottoes, Joe. They’re more of the tools that Alt gives us to use, if we want to, in staying sober. Take "Easy Does It," for example. It means different things to different AA’s, but it’s good advice for most of us. For most it means taking life in our stride rather than letting everything upset us. Before AA when we’d get mad or hurt, we’d go get drunk. The motto helps remind us of the cost of getting upset and, when we do, the cost of getting drunk. For a new comer, "Easy Does It" suggests that our problems have been piling up over the years and we can’t expect them to be solved magically overnight. This is where "First Things First" comes in. When we come into Alt, we have all kinds of problems. We discover that it pays not to forget that staying sober is always our first problem; other problems can be solved gradually, but only if we maintain our sobriety. "Live and Let Live" reminds us to keep our damn noses out of other people’s business. If they want to get drunk, that’s their business. If they want to believe an elephant is their higher power, that’s up to them too. We alkies are short on tolerance before we hit AA. We get mixed up in other people’s business, get hurt and mad, and then drunk. This motto helps keep us from judging the other guy. "But for the Grace of God" simply reminds us that we’re not different or better than the next drunk -- just luckier. It helps in Twelfth Step work to remember this and to remember that you’re just one drink from a drunk yourself.
Joe points out to Harry that he’s afraid he can’t go for the "God business." Harry reassures him, "That’s O.K. A lot of us felt that way when we came in. Take what you can use from the AA program and forget the rest for the time being. Your ‘higher power’ can be whatever suits you -- nature, science, the AA group -- why I have one friend in AA whose first higher power was a Fifth Avenue bus that almost knocked him down. He stayed sober, and gradually his ideas began to change." By its general permissiveness concerning theology, AA is able to help countless alcoholics whose prejudices against overt religion would keep them from identifying with a more orthodox approach.
Joe’s wife brings in the coffee, and the conversation continues. The question of the "Twelve Steps" comes up. Harry takes the worn copy of the Big Book he has loaned to Joe and opens it to page 59, where the steps are listed and their workings explained. He points out that the "we" refers to the early members who pooled their experience and wrote the steps. Joe takes the book and glances over the steps:
Here are the steps we took, which are suggested as a Program of Recovery:
1. We admitted we were powerless over alcohol -- that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of his will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps we tried to carry this message to alcoholics, and practice these principles in all our affairs.
Joe gulps and says, "It’s a big order for a guy like me." Harry responds, "Yes, it’s a big order for all of us, and nobody is ever able to follow the Program fully. Just remember that the steps are only suggested. Take them cafeteria style. Use what you can. Don’t worry about the others. When you have taken the first step and admitted your problem, you are a part of AA." Thus Harry again demonstrates the permissive atmosphere of AA. In subsequent conversations and AA experiences Joe will gradually absorb the AA philosophy implied in the steps.
Before Harry says goodnight, he learns that Joe and his wife used to play bridge before Joe’s drinking interfered with their social life. So he invites them to play with a group of AA’s who meet once a week in various homes. Here is another expression of the AA fellowship. Harry also arranges to take Joe to the "beginner’s meeting," at which a member with several years’ sobriety will lead a study of the Twelve Steps, as well as discuss problems raised by the new comers. In addition, he makes a date with Joe to attend the closed meeting of the local group two nights later. Harry knows that he must keep Joe immersed in AA if he is to maintain his sobriety during the first difficult days and weeks.
There are no passwords, esoteric practices, or secret cures involved in a closed meeting. The fact that one is there means that the person admits he has an alcoholic problem. The closed meeting is usually smaller in size than the open. It almost always involves extensive opportunity for what might be called "audience participation." There may be a panel consisting of AA’s who answer questions from the floor; or there may simply be an individual chair man who steers a general discussion concerning one of the steps or of problems raised by anyone present. Here are some of the questions raised at one closed meeting:
Will someone give me some help on the eighth and ninth steps?
How can I achieve tolerance?
Is it necessary for a person living in a suburb to attend meetings in his own home town?
Is it possible to achieve the power of sobriety without the spiritual side of AA? Can a person have such an aversion to alcohol that he will not be tolerant in Twelfth Step work?
How can I expect AA to help me when other groups have failed?
Each of these questions is discussed roundly by those present. Near the close of the meeting a man asks for and receives help on a specific Twelfth Step case which is giving him trouble.
Attending a closed meeting has the following values so far as newcomer Joe is concerned. Because it is all-alcoholic, he feels more protected than in open meetings. It gives him a chance to talk in a smaller group where everyone has the same problem. He feels much freer to talk because he knows he is "among those who understand." The closed meeting provides opportunity to make new friends within the AA circle. It gives him a feeling of being a part of some thing from which the world in general is excluded. This gives his very battered ego a boost.
There are other expressions of the AA fellowship in which Joe can participate. For example, there are the AA clubs. There are at least two kinds. Those like the "24-Hour Club" in New York City are devoted purely to AA sociability. Unlike AA proper, there are membership dues. One must be an AA to join. The other type of club serves both as an "open house" for AA sociability and as a center for Twelfth Step work. Every year about 5,000 "flying squadrons" of Twelfth-steppers go out from one such club in New York. There are no dues, support being derived from voluntary contributions. All AA’s are welcome. Until Joe finds a job, he will probably spend a substantial share of each day at such a club, drinking coffee and chatting with Alt friends who drop in. This, like AA fellowship in general, serves as a substitute for the fellowship of the tavern and is an important factor in keeping Joe sober. Although established by AA members, the clubs are not a part of AA proper.
For Joe’s wife there is the "Al-Anon Family Group." Here she will find understanding and help in a group of wives who are attempting to deal with their own personality problems by applying AA principles.
During the first few weeks, Joe is "as conscious of alcohol as a toothache." He thinks about it all the time. But he holds on desperately to his newborn sobriety. Sometimes he wonders if it is worth it; then he remembers the horror of the last binge. He breaks the twenty-four hour plan into sixty-minute pe riods, saying, "I’ll not take a drink for this hour!" This and the desire not to let Harry down are all that keep him from the first drink. Gradually the craving subsides.
After Joe has had a few weeks of sobriety, Harry invites him to go along on a Twelfth Step call. To please Harry he agrees, in spite of butterflies in his stomach. To his surprise Joe discovers that telling his story to the alcoholic gives him a real lift. He feels useful and important. He begins to realize that his alcoholism has prepared him in a unique way to help other alcoholics. As Harry put it before they arrived at the prospect’s house, "Your story will probably do this guy more good than the advice of a fancy psychiatrist at twenty bucks an hour." Joe also discovers that seeing someone else in the throes of a hangover refreshes his memory of his own recent condition. All this helps Joe keep sober.
Joe is in the "honeymoon" or "pink cloud" stage. The first long hours have lengthened into days, the days into weeks. He is beginning to recuperate physically, and he revels in his newfound sobriety and friendships. His higher power is the AA group. He hasn’t paid much attention to the Twelve Steps. Every thing looks rosy to Joe.
After about three months of sobriety, the elation may begin to diminish. He may begin to think of good reasons why he can’t attend meetings so often. Then one day, when he steps into a bar "to make a phone call," the idea hits him that surely one drink wouldn’t hurt him. So he tries an "experiment." Sure enough, nothing happens -- at first. He continues to "nibble," avoiding meetings and AA friends. After a few days the compulsion hits him, and he "goes off the deep end." Joe’s binge lasts for several days during which he experiences worse remorse than he has ever known before. He feels that he has betrayed his AA friends.
For a while after his slip Joe continues to avoid Harry. Finally he screws up his courage and goes to a meeting, expecting the worst. To his surprise nobody looks askance at him or treats him with condescension. When he tells Harry about his slip, his sponsor smiles and dismisses it with, "Could have happened to anybody, and often does, Joe." The attitude of the group toward Joe is simply, "Glad to see you back."
Joe’s slip causes him to take stock. With the aid of Harry’s counsel, he sees that prior to the slip he had admitted intellectually but not accepted emotion ally the fact that he, Joe Blank, is an alcoholic. The slip has been a great persuader in his case, enabling him to accept the truth about himself. He has now really taken the first step. In so doing he has surrendered some of his alcoholic grandiosity about himself. He is less defensive because he is less vulnerable. His ego-image has been a burden. The burden is now reduced, and Joe is really open to help from the AA program. It should not be inferred from this description that an alcoholic must have a slip in order to "get" the AA program. Thirty-seven percent of the interviewees had not had any slips.
Joe realizes that up to now he has almost ignored the Twelve Steps. So he begins to read the AA book and work on the "fearless and searching moral inventory" described in steps four through ten. These steps, Harry tells him, are really a unit and are important "to keep you sober, not to get you that way." They do this by getting at the roots of the alcoholic’s problem. The theory is as follows. Because of the alcoholic’s "allergy" to alcohol, one drink sets off a physiological chain reaction, leading eventually to intoxication. Since this allergy is incurable, the problem is to help the alcoholic keep from taking the first drink. This is the central purpose of the AA program. It accomplishes this in a variety of ways, many of which have already been discussed. It indoctrinates him with the idea behind the AA slogan "It’s the First Drink That Does It" until it becomes almost a conditioned reflex. This helps counteract the rationalization process which leads to the first drink. AA helps the person call on the help of some higher Power (God, as the individual understands him) to help withstand temptation. It teaches him to keep busy helping other alcoholics. And, very important, it helps him to reduce the interpersonal friction that drives the alcoholic to take the first drink. This is the purpose of steps four through ten. The word "moral" is a stumbling-block for him at first until Harry explains that it simply means those feelings and actions, past and present, which tend to make an alcoholic drink.
And so Joe makes a list of the various people he has hurt by his drinking. He talks the whole picture over with his trusted friend, Harry, discussing feelings and events he hasn’t dared verbalize before. This of course brings catharsis to his spirit, and he feels as though a load has been lifted. This gives him courage to make some direct amends where they are obviously in order. When this process is completed, he feels that he can really look the world in the eye. By straightening out some of his past messes, he reduces both his guilt about the past and anxiety about the future. All this helps him maintain happy sobriety. Harry reminds him that the personal inventory habit is a continuing part of the AA program.
Here we see the AA handling of the problem of responsibility. It has reduced the alcoholic’s guilt by recognizing the physical element in the problem. Yet, it prevents him from using this as an alibi by adding that the factor which keeps the disease from being controlled is "alcoholic thinking" -- selfishness, fear, resentment, lack of humility -- matters for which the alcoholic is responsible. Thus, though Joe is not responsible for having an alcoholic bio chemistry, he is responsible for doing something about his personality.
When Joe has achieved a full three months of sobriety without a slip, he is asked to speak at an AA meeting. He finds that telling his story has a remarkable effect. He is pleased when the audience laughs at some of his drinking escapades. He finishes on a note of gratitude to his sponsor and his other AA friends who have "saved my life." After the meeting, members of the group gather round to congratulate him. Somehow he feels that he now really belongs to this fellowship. He has declared publicly that he is an alcoholic. He has told his story before a hundred people -- the story he could not even admit to himself a few months before. There is a sense of release in this, as there is a sense of satisfaction in the thought that his talk may have helped some new comer, perhaps several, to find the AA solution.
As a result of his moral inventory and his other experiences in AA, Joe’s attitude toward the "spiritual angle" gradually changes. Like the majority of AA’s his "spiritual awakening" is of the type which William James called the "educational variety," rather than the "hot flash" type such as was experienced by Bill W. He begins to join with the others in saying the Lord’s Prayer in closing the meetings. He observes that "the folks who seem to get the most out of the program are those who develop the spiritual angle." Then one day he suddenly realizes that he is sober and enjoying it! This impresses him as being nothing short of miraculous. There must be some higher Power to effect such a miracle. He finds that he has been getting an increasing "kick" out of Twelfth Step work. That he has become less self-centered also seems a miracle to Joe. So he begins to do some praying on his own. Although he still doesn’t use the word "God," Joe begins to mention the "Man upstairs" in his talks and conversations. Gradually he begins to feel a "conscious contact" with his higher Power and to gain help therefrom.
What has happened to Joe? As he has cleaned up the debris of his past and has become accepted in vital fellowship, he gradually relinquishes his bitter ness and hostility toward life in general. This naturally affects his religious life. Then too, he has come to depend on the AA group for many of his inter personal satisfactions, and will therefore be influenced by group values. The man who has achieved success in the "spiritual angle" is likely to have prestige in the group. In spite of the theological permissiveness of AA (which is real and important) there is, implied in the literature, a rather orthodox theology -- viz., a personal God, with whom one can communicate, who is interested in individuals and will help those who are obedient to his will. This point of view exerts an ideological gravitation on those who remain a part of the group. Another way to put this is that religious growth tends to take place within a group dedicated to certain religious ideals.
In terms of the psychology of alcoholism, this development is most significant. Joe has made three important "acceptances," (or "surrenders") -- each is a step away from grandiose isolation of alcoholism. Each represents the relaxing of the perfectionistic ego-image or self-concept which is the alcoholic’s defense and his curse. First, he accepted the fact that he is an alcoholic. Second, he accepted the help of the group, and the group was his higher Power for a time. Now he has accepted a higher Power who is in but beyond the group. This may mean dynamically that he has outgrown the utter dependency on the group which characterized his early days in AA. It most certainly means that he has stopped fighting authority and authority symbols as such. Corroborating this is the fact that there is apparently a definite correlation between length of sobriety and relative orthodoxy of the theology among AA’s. For example, the author divided his interviewees in terms of their God-concepts, ranging from atheist-agnostic to orthodox. Those in the atheist-agnostic category, though several had been associated with AA for considerable periods of time, had -- with one exception -- relatively unstable and brief periods of sobriety. As one AA said in commenting on this fact, "They’re still fighting."
It would seem clear that a more mature and satisfying relationship with the higher Power serves several very important functions with regard to staying happily sober. For one thing it gives one a sense of "at homeness" in the universe which helps satisfy the "longing to belong" that is a deep human need. For another, it puts the power and resources of faith at the disposal of the individual for use in meeting the problems of living. What is more, such a relationship helps allay the ultimate anxiety which is an important part of every problem, and is especially prominent in alcoholism.
As Joe’s sobriety becomes more stable, some of his AA behavior patterns will gradually change. Chances are that he will no longer feel the necessity of attending so many meetings and engaging in so much Twelfth Step work as in the first year or two. He will attend a meeting or two a week because he enjoys the fellowship. After a year or so he will begin to venture outside the social circle of AA. This is an indication of his increased self-esteem and the consequent diminishing of his need for the psychological protection of an all-alcoholic group. The majority of his friends will still be in AA, however. He may join in church activities -- the Big Book encourages this. His participation indicates both his expanding interpersonal circle and his growing interest in spiritual values. If he does join the church, he will very likely be a great asset to it. After the first year or two Joe will begin to put greater emphasis on the psychological and spiritual aspects of the Alt program and less on his drinking history. It may be that, as his alcohol-caused problems decrease, his under lying personality problems will reassert themselves and he will seek psycho therapeutic help. In any case his personality problems are no longer complicated by alcohol, and he is better able to cope with them, with or without professional assistance.
Let us leave our friend Joe now, with the reminder that there is no such individual as a "typical AA." Just as each person’s alcoholism develops differently, so each person’s AA experience is a unique entity. In conclusion, it might be well to mention that a long-time member of AA who read this chapter expressed the feeling that "Joe" is perhaps a somewhat more advanced case than is the average newcomer to AA today.
How Effective Is AA?
Just how effective is the AA approach? The answer will be divided into three categories: (1) AA’s effectiveness in breaking the addictive cycle and producing initial sobriety; (2) its effectiveness in producing long-term sobriety; (3) the extent to which the approach is successful in changing underlying personality-structure, rather than simply controlling symptoms. (In fairness to AA, it should be pointed out that AA itself does not aim at changing personality-structure. Sobriety alone is its basic goal.)
The fact that AA has grown from one person to over 375,000 in thirty years would seem to be ipso facto evidence that it is very effective in producing initial as well as long-term sobriety. Based on his observation of the first fifteen years of AA’s existence, Bill W. gives some estimates:
Of those alcoholics who wish to get well and are emotionally capable of trying our method, 50 percent recover immediately, 25 percent after a few backslides. The remainder are improved if they continue active in AA. Of the total who approach us, it is probable that only 25 percent become AA members on the first contact. Carrying a certain amount of indoctrination, the remainder depart for the time being. Eventually two out of three will return to make good. . . . A list of 75 of our early failures today discloses that 70 returned to AA after one to ten years. We did not bring them back. They came of their own accord. 23.
These estimates reflect the situation in the early years of AA when mainly "last gasp," highly motivated alcoholics were seeking help. Since that time many younger alcoholics and those in earlier stages of the illness have approached AA, often tentatively and halfheartedly. Consequently, the proportion of estimated recoveries has tended to decline. No one really knows how much it has declined or what percentage of all those who now make some gesture toward AA eventually become affiliated with the fellowship and recover.
But even if one makes generous deductions for possible inaccuracies in membership estimates, a possibility that is readily admitted by AA leaders, the overall picture is one of remarkable effectiveness in helping thousands achieve both initial and long-term sobriety. If AA is currently effective with 50 percent (or even 40 percent) of those who make a determined effort to "work the program," it is still two or three times as successful as any other widely available treatment. It may be that AA’s success rate is still above 50 percent for such persons.
There is no gainsaying the fact that AA sobriety is often of long duration. One study of an AA Group in a mental hospital showed that slightly over 50 percent achieved stable sobriety, the majority with no slips. 24. I personally know several AA’s who have been without a drink for more than twenty years. The combined uninterrupted sobriety of 75 of my interviewees was 205 years, or an average of 2.7 years. Even more significant, from the standpoint of human values, than the record of uninterrupted sobriety is the fact that even those who had had frequent slips during their AA experience had been sober the bulk of the time. This would not have been true without AA, an organization to which they return quickly for help after a slip.
AA has demonstrated such amazing effectiveness, first on the level of producing initial sobriety because:
1. It waits until the individual is at least somewhat receptive to help. This means that the alcoholic has suffered enough through his drinking so that the pain outweighs the pleasure (or anesthetic satisfaction) of alcoholism. AA rightly recognizes that an alcoholic’s own desire for sobriety is an indispensable ingredient in any plan of help. AA is successful because it relies on attraction as its means of bringing new members. The fact that it is an attractive fellow ship enhances its effectiveness. The essential ingredients in this attractiveness are AA’s lack of moralism, lack of unction, and its group acceptance.
2. AA immediately relieves the stresses of the advanced stages of alcoholism. A psychotherapist may seek to go directly to the underlying causes of the addiction; the evangelistic approach is immediately concerned about the general condition of the soul; AA on the other hand concentrates on the secondary level of the problem -- helping the alcoholic to stop drinking by helping to diminish the pain and problems resulting from the excessive drinking itself.
3. It does this by providing the alcoholic with certain tools such as the twenty-four hour plan which it teaches him to use to control the craving. This is in contrast with the evangelistic approaches which sought to produce initial sobriety by means of a torrid religious experience. Because many alcoholics have strong prejudices against anything religious, the AA method appeals to many who cannot respond to the other.
4. AA immediately reduces many of the stresses of guilt and fear by allowing the alcoholic a new way of thinking about his problem. The AA conception of alcoholism -- recognizing a physical factor in the sickness -- renders the alcoholic’s behavior intelligible to himself and greatly reduces the fear and guilt which were supplying him with added desire for the "blessed oblivion" of alcohol.
5. Alt immediately surrounds him with an accepting fellowship of individuals who have been through his experience and can therefore establish rapport when professional counselors have failed. It is this supportive fellowship which carries him through the first trying days of recovery. The fact that the fellow ship is frequently focused through an individual sponsor who can become a parent-figure for the new AA "baby" is important. (Of course, many AA’s have no sponsor.) The dependent relationship in Alt allows the course of social regression which the alcoholic has followed to be reversed. The AA ingroup can serve as a substitute family. Again, AA uses supportive group therapy rather than religious therapy to promote initial sobriety.
6. AA’s fine relationship with hospitals, doctors, and alcoholic clinics allows the newcomer to have the medical adjuncts to therapy which are often so important in establishing initial sobriety. This is in contrast with what might be called the "all religious" approach.
Beyond this success in inducing initial sobriety, AA is most effective in helping alcoholics achieve prolonged sobriety because:
1. In contrast with the rescue mission and Salvation Army, AA deals with a smaller proportion of those whose alcoholism is complicated by the added problem of homelessness.
2. The fact that AA depends neither on religious thrill (as evidenced, for example, by the lack of group singing), nor on a "hot flash" type of religious experience, makes for a more stable sobriety. Religious ecstasy is apt to produce an emotional hangover, which is destructive to sobriety. In AA, religious resources are made available on a more temperate basis and are utilized more for maintaining than producing sobriety. Because of its permissive attitude toward theological ideas, it accepts the alcoholic at the point he has reached in his religious life and allows his religious formulations to grow as his experiences change. Because the "spiritual angle" of the Alt program is so subtle, it can "slip up on a fellow," as one Alt put it.
3. AA provides substitute satisfactions to replace those of alcohol. Enjoy able and continuing fellowship in a group overcomes loneliness, a great enemy of prolonged sobriety. In addition there is an abundance of oral satisfactions -- smoking, talking, and oceans of coffee -- to replace the orality of alcoholism.
4. It sustains sobriety by keeping the alcoholic busy helping "those who do not know." It gives him a sense of mission and of unique usefulness. Be coming a sponsor imposes a responsibility on a person to set a good example for his "baby." This motivates the sponsor in the direction of continued sobriety. It also helps him feel important, boosting his self-esteem.
5. By providing a suggested series of steps, AA provides a continuing pro gram of spiritual growth which is important, especially after the first enthusiasm of belonging has dimmed. It is significant that half of these steps are devoted to altering the attitudes and interpersonal frictions which, in alcoholics, tend to produce a binge.
6. AA is successful in sustaining sobriety because it brings the pressure of responsibility to bear on the alcoholic when he is able to handle it. In the early phases the person finds help in the "allergy" conception. As he acquires more stable sobriety, he is confronted by the necessity of taking responsibility for the changing of those attitudes which lead him to drink. Then he is motivated to use the Twelve Steps.
7. AA is more successful in maintaining sobriety because it is successful in strengthening the person’s real self-esteem, as distinguished from his grandiosity. It does this by keeping the initiative with him throughout the process, by making him feel accepted in a group, by respecting his rights as an adult to think and do what he himself wants to (including getting drunk), and by giving him a sense of unique usefulness in helping other alcoholics. As Alt increases his self-acceptance, it diminishes his need for defensive grandiosity, which, like medieval armor, was a terrible weight as well as a protection.
8. Alt tends to produce long-term sobriety because it is non-authoritarian in organization and constituency. Each group is autonomous in all matters which affect only that group. Central agencies are considered as coordinating and service groups for AA as a whole. This decentralized democracy distributes the sense of responsibility to each member and reduces the inherent frustrations of authoritarian or hierarchical organizations. This makes for healthy group life and thus enhances the prospects for individual sobriety. The fact that AA is a self-help program in which there are no outside "authorities" is very significant in the light of the alcoholic’s tendency to be rebellious toward authority.
9. The fact that AA can provide continuing group support makes for long-term sobriety. AA is so well distributed that wherever a member goes he is likely to find a group.
Closely related is the question as to whether AA will continue to exist, or will meet the fate of movements such as the Washingtonians, the first organized attempt by alcoholics to help alcoholics on a large scale. This movement began in the 1840’s in Baltimore. At the beginning the Washingtonians focused attention on helping alcoholics. By means of mass meetings, testimonials, pledges, and material help, they succeeded in aiding hundreds. Unfortunately they did not follow the AA practice of admitting only alcoholics. The movement rose meteorically, spreading to city after city. Soon it was inextricably mixed with the temperance movement, attracting thousands of non-alcoholics. This sealed its doom. It was thoroughly absorbed into the temperance movement and, having lost its distinctive task of helping alcoholics, declined and died within a few years. It is the author’s opinion that AA has an excellent chance of survival and continued growth because it has avoided the mistakes of the Washingtonian movement and has protected itself against the perils of institutionalism and the dangers of becoming side tracked into other causes. It has done this by the formulation of "traditions" based on the trial-and-error experience of many groups. These traditions are officially recognized within the movement and are generally observed -- so much so that AA, for example, has refused to accept several sizable bequests left by grateful members. The complete statement of the traditions, along with a discussion of them, is found in the book by Bill W., Twelve Steps and Twelve Traditions. 25. They are given here in the brief form printed in The Grapevine each month:
THE TWELVE TRADITIONS
1. Our common welfare should come first; personal recovery depends upon Alt unity.
2. For our Group purpose there is but one ultimate authority . . . a loving God as he may express himself in our Group Conscience. Our leaders are but trusted servants . . . they do not govern.
3. The only requirement for AA membership is a desire to stop drinking.
4. Each Group should be autonomous, except in matters affecting other groups or Alt as a whole.
5. Each Group has but one primary purpose . . . to carry its message to the alcoholic who still suffers.
6. An AA Group ought never endorse, finance or lend the AA name to any related facility or outside enterprise lest problems of money, property and prestige divert us from our primary spiritual aim.
7. Every AA Group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
9. AA as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10.Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
11.Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.
12.Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles above personalities.
There is still the third criterion of AA’s effectiveness. To what extent does the AA approach alter underlying personality structure rather than simply controlling symptoms? Is AA’s effectiveness in producing long-term sobriety the result of the resolving of psychological conflicts which lie at the roots of alcoholism, or is it the result of an effective means of keeping the conflicts repressed or under control? As far as AA itself is concerned, this question is of little interest. The sole object of AA is sobriety. But the student of human personality and religion must ask the question. To him the "how" of the production of sobriety goes to the heart of an understanding of the dynamics of AA. Is the sober member of AA really a new person, or has he achieved a more effective way of controlling his unresolved inner conflicts?
Data from the author’s interview files suggest that sweeping generalizations in answer to this question are not possible. In some cases, the alcoholic’s AA solutions seemed rigid and repressive, as if the persons involved were having to hold themselves very hard to keep from slipping. On the other hand, some of the alcoholics seemed relatively relaxed and un-compulsive about their AA solutions. For instance when the interviewees were asked how they now handle their hostile feelings, twenty-nine gave answers showing repressive handling, such as: "I feel all bound up -- all under control. I want to say, ‘to hell with it all’ "; or "Anger is something I must absolutely avoid." On the other hand, there were fifteen cases in which anger was being handled quite constructively. For example, "I don’t keep resentment inside me. I go talk it over with the person"; or "Before, if my wife and I had a fight, I’d go out and slam the door and get drunk. Now I just go out and slam the door." The manner in which a religious approach to problems deals with the so-called "negative feelings" such as anger constitutes a reliable barometer for measuring the degree of repressiveness involved.
One reason why AA has certain repressive tendencies is its inadequate conception of human personality. The AA point of view, as set forth in the recognized literature of the movement, does not take full cognizance of the fact that personality factors such as selfishness, resentment, and hostility, which are controlled through the AA program, are actually symptoms of deeper problems of inadequacy, insecurity, and inner conflict. For example, anger, as AA says, does produce slips in alcoholics. It does so, however, not because anger in itself is a destructive feeling, but because it is considered "bad" by the person’s conscience. This is why angry feelings have a destructive effect. Because of early conditioning, anger is unacceptable to the self-concept and therefore threatening to the person, producing anxiety. It is this anxiety that causes the alcoholic to drink. Since it does not recognize this, AA therapy tends to control symptoms rather than influence underlying causes in some cases. As we have said, many individual AA’s do recognize the symptomatic nature of selfishness and negative feelings. Nevertheless, these individuals tend to feel that AA cannot and should not emphasize such a recognition in its general approach, for to do so would be to make it seem too much like psychiatry. This psychologizing, they feel, would frighten away many alcoholics who can come and accept it in its present form.
However, in those cases in which AA results in a basically repressive solution -- "sitting on the lid harder" -- sobriety is always precarious. Even if such a person stays sober, other symptoms are likely to appear. In most cases these symptoms are relatively harmless and considerably less objectionable than active alcoholism. The substitute compulsions seen in AA are examples of this -- frantic Twelfth Step work and endless oral activity. In some cases the substitute symptoms are not so harmless -- e.g., "nervous breakdowns" following long periods of sobriety in AA. The common assumption regarding wives of AA’s is that they have unmixed joy over their husband’s affiliation. Although this is true, by and large, the writer has known of cases in which the alcoholics have become so irritable and unpleasant that the wives almost wished they were drinking again. While the "almost" should be emphasized, this unpleasantness is still indicative of unsolved inner conflicts.
There are several things that must be said on the other side of the picture. If one compares AA with a psychoanalytically oriented therapy, it is probably valid to label it "repressive inspirational," as one writer on the subject has done. 26. But if one compares it to the evangelistic approach to alcoholism, it is relatively unrepressive. Then too, AA is accurate in regarding sobriety as a value in itself. As long as an alcoholic is drinking, his "motor" is racing, but his personality resources are out of gear. Keeping the individual sober is a prerequisite to the solution of any personality problem. By keeping him sober and by its social therapy the AA approach does actually "solve" many of his personality problems. This is especially true of those alcoholics whose under lying psychopathology is relatively minor. When they stop drinking and become accepted in the AA group, they often make very adequate adjustments.
All therapies contain positive and negative controls on behavior. Compared to most religious approaches to alcoholism, AA has less negative and more positive controls. Being non-authoritarian, AA does not use irrational fear as a motivation. Fear of losing status in the group by having a slip and fear of what alcohol can actually do are both realistic fears. Major motivations are positive -- e.g., the desire to achieve the psychological rewards of full participation in the group. It is because AA satisfies so many of the alcoholic’s needs that it is able to control his attitudes and behavior in the direction of sobriety.
AA recognizes that there must be a reorientation of the personality if the person is to stay sober. Personality change and sobriety are mutually inter dependent. As one interviewee put the matter: "I don’t know if I’m sober because I’m happy or happy because I’m sober."
AA emphasizes the importance of self-understanding (steps four and ten). Several interviewees showed that they had gained considerable dynamic in sight through this phase of AA. Within the supportive relationship of AA, these individuals had been able to do in a limited way what one is able to do in a psychotherapeutic relationship -- viz., feel secure enough to relax one’s usual defenses and take an honest look at painful aspects of the self.
It is my conviction that individual psychotherapy is sometimes needed in addition to AA in order to produce permanent, non-compulsive sobriety. This is not to suggest that most AA’s need psychiatric treatment. Rather it is to indicate that in those cases where underlying psychopathology is severe, psychotherapy is a necessary supplement to AA therapy. This is fully in accord with much AA thinking. Bill W. suggested to me, for example, that the fourth or inventory step provides a natural bridge for the AA who needs it to receive psychiatric help. 27.
Alcoholism is like a building of several stories. AA is admirably equipped to take care of the upper levels -- the runaway symptom levels. It can halt the addictive cycle and repair the personality damage resulting from the addiction. Once a person has been sober for a considerable time, the underlying psycho pathology may need to be treated. This is where psychotherapy can be a valuable supplement to the AA program. The two can actually be complementary -- the social therapy of AA giving indispensable group support and resocialization during the psychotherapy, and the psychotherapy aiding the person in forming more satisfying relationships in AA and beyond by resolving some of his inner conflicts. In order for this to happen the psychotherapist must have some appreciation and understanding of AA in particular and of religious dynamics in general.
If AA could combine its amazing program of social therapy with psycho therapeutic insights and techniques, particularly group therapy, an approach to alcoholism with maximum effectiveness might be produced. AA might then bring new life to many who cannot find fully satisfying sobriety in the present program. What is more, if such a development should take place, AA might set a pattern for a more fundamental cooperation between religion and psychology in dealing with human problems in general.
It should be reemphasized that AA, by itself and in its present form, is a tremendously hopeful and helpful program. One of those interviewed ex pressed a sentiment that is echoed by thousands of alcoholics today: "AA was for me the birth of hope!" The fundamental reason why it has been so is that AA has developed a means of conveying the experience of acceptance to the alcoholic. Through its accepting fellowship it has been more successful than any previous approach in helping the alcoholic to feel accepted by life and, therefore, to accept himself. As we have said before, this is what has been described in religious terms as "salvation by grace through faith." Thus AA has found an answer to the alcoholic’s deep feeling of isolation, loneliness, and rejection. In this sense, AA is a religious therapy par excellence for alcoholism.
There are many aspects of AA’s program and philosophy which can be applied to other problems of living. It is a tribute to AA that this has actually been tried by several groups, e.g., "Narcotics Anonymous" and "Divorcees Anonymous." The church, too, can learn much from AA, both about alcoholism and the healing power of creative religion. One of the incidental rewards that most people who become interested in AA derive from their contact is a little gem known as the "AA Prayer." After having been attributed to nearly every saint and seer in history, it finally was traced to Reinhold Niebuhr. 28. It is good philosophy not only for alcoholics but for those who wish to help them:
God grant me the serenity
Ruth Fox, a New York psychiatrist, has said that if her patients acquire the ability, through several years of psychotherapy, to live by the principles of this brief prayer, she would regard their therapy as successful.
1. Estimated world Alt membership, January, 1967: between 350,000 and 400,000 (Communication from AA’s General Service Office).
2. Biographical data on Bill’s early life are from personal interviews.
3. The Oxford Group Movement, or Buchmanism, was a movement inspired by a Lutheran minister, Frank Buchman. It first flourished on college campuses (including Oxford) and then spread to other areas. It was an attempt to bring vital Christianity into the lives of people, changing them to live by certain ethical absolutes and motivating them to change others. It stressed the importance of groups in this change and appealed mainly to the "up and outers."
4. W. W. (Bill W.), "The Fellowship of Alcoholics Anonymous," Alcohol, Science and Society, p. 462. A comprehensive history of AA by a co-founder is contained in Alcoholics Anonymous Comes of Age (New York: Harper & Bros., 1957).
5. Ibid., p. 463.
7. W. G. W., "Alcoholics Anonymous" (panel discussion, "Chronic Alcoholism as a Medical Problem"), New York State Journal of Medicine, L (July 15, 1950), 1709.
8. Lois W., The AA Grapevine, February, 1950, p. 12.
9. W. G. W., "Alcoholics Anonymous" (panel discussion).
10. Oscar W. Ritchie, "A Sociohistorical Survey of AA," QJSA, IX (June, 1948), 122.
11. The AA Grapevine, January, 1951, p. 7.
12. Communication with AA’s General Service Office, January 20, 1967.
13. Figures from AA 30 (AA World Services 1965), p. 19.
14. "We Come of Age," The AA Grapevine, September, 1950, p. 3.
15. The AA Grapevine, October, 1965, p. 21. It was the author’s privilege to participate in the Toronto Convention.
16. The first of these was published by Harper & Brothers, 1953; the second by Alcoholics Anonymous World Services, 1967.
17. Interview, February 10, 1953. Additional biographical data on Bill W. are to be found in the Big Book, pp. 10-26.
18. AA 30, p. 45.
19. This is the AA estimate; see AA 30, P. 19.
20. The Editors of Fortune, in collaboration with Russell W. Davenport, U.S.A., The Permanent Revolution (New York: Prentice-Hall, 1951).
21. Ibid., p. 149.
22. This AA talk is condensed from one given by a member of the Chicago Group on the fifth anniversary of his sobriety, May 22, 1945.
23. W. C. W., "Alcoholics Anonymous" (panel discussion), p. 1708.
24. P. L. Smith, "Alcoholics Anonymous," Psychiatric Quarterly, XV (1941), 554-62. The fact that half of a group of alcoholics who were in a mental hospital recovered is significant.
25. Used by permission of AA General Service Headquarters.
26. Thomas W. Giles, "Group Psychotherapy," Psychosomatic Medicine, April, 1943.
27. Personal interview.
28. Niebuhr says: "Of course it may have been spooking around for years, even centuries, but I don’t think so. I honestly believe that I wrote it myself." (The AA Grapevine, January, 1950, p. 6.)
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