Dirk Hanson M.A.

Does A.A. Work?

Despite recent progress in the medical understanding of addictive
disease, the amateur self-help group known as Alcoholics Anonymous, and
its affiliate, Narcotics Anonymous, are still regarded by many as the
most effective mode of treatment for the ex-addict who is serious about
keeping his or her disease in remission. A.A. and N.A. now accept
anyone who is chemically dependent on any addictive drug—those battles
are history. In today’s A.A. and N.A., an addict is an addict. A
pragmatic recognition of pan-addiction makes a hash of strict
categories, anyway.

Nonetheless, under the biochemical paradigm of addiction, we have to
ask whether the common A.A.-style of group rehabilitation, and its
broader expression in the institutionalized form of the Minnesota
Model, are nothing more than brainwashing combined with a covert pitch
for some of that old-time religion. As Dr. Arnold Ludwig has phrased
it, “Why should alcoholism, unlike any other ‘disease,’ be regarded as
relatively immune to medical or psychiatric intervention and require,
as AA principles insist, a personal relationship with a Higher Power as
an essential element for recovery?” The notion is reminiscent of
earlier moralistic approaches to the problem, often couched in strictly
religious terms. It conjures up the approach sometimes taken by
fundamentalist Christians, in which a conversion experience in the name
of Jesus is considered the only possible route to rehabilitation.

But if all this is so, why do so many of the hardest of hard scientists
in the field continue to recommend A.A. meetings as part of treatment?
Desperation? Even researchers and therapists who don’t particularly
like anything about the A.A. program often reluctantly recommend it, in
the absence of any cheap alternatives.

In 1939, Bill Wilson and the fellowship of non-drinkers that had
coalesced around him published the basic textbook of the movement,
Alcoholics Anonymous. The book retailed for $3.50, a bit steep for the
times, so Bill W. compensated by having it printed on the thickest
paper available—hence its nickname, the “Big Book.” The foreword to the
first printing stated: “We are not an organization in the conventional
sense of the word. There are no fees or dues whatsoever. The only
requirement for membership is an honest desire to stop drinking. We are
not allied with any particular faith, sect or denomination, nor do we
oppose anyone. We simply wish to be helpful to those who are afflicted.”

In short, it sounded like a recipe for complete disaster: naïve,
hopeful, objective, beyond politics, burdened with an anarchical
structure, no official record keeping, and a membership composed of
anonymous, first-name-only alcoholics.

Amid dozens of case histories of alcoholics, the Big Book contained the
original Twelve Steps toward physical and spiritual recovery. There are
also Twelve Traditions, the fourth one being, “Each group should be
autonomous except in matters affecting other groups or A.A. as a
whole.” As elaborated upon in Twelve Steps and Twelve Traditions,
“There would be real danger should we commence to call some groups
‘wet’ or ‘dry,’ still others ‘Republican’ or ‘Communist’…. Sobriety had
to be its sole objective. In all other respects there was perfect
freedom of will and action. Every group had the right to be wrong. The
unofficial Rule #62 was: “Don’t take yourself too damn seriously!”

As a well-known celebrity in A.A. put it: “In Bill W.’s last talk, he
was asked what the most important aspect of the program was, and he
said it was the principle of anonymity. It’s the spiritual foundation.”
Co-founder Dr. Bob, for his part, believed the essence of the Twelve
Steps could be distilled into two words—“love” and “service.” This
clearly links the central thrust of A.A. to religious and mystical
practices, although it is easily viewed in strictly secular terms, too.
Alcoholics Anonymous recounts a conversation “our friend” had with Dr.
C.G. Jung. Once in a while, Jung wrote, “…alcoholics have had what are
called vital spiritual experiences…. They appear to be in the nature of
huge emotional displacements and rearrangements.” As stated in Twelve
Steps and Twelve Traditions, “Nearly every serious emotional problem
can be seen as a case of misdirected instinct. When that happens, our
great natural assets, the instincts, have turned into physical and
mental liabilities.”

Alcoholics Anonymous asserts that there are times when the addict “has no effective mental defense” against that first drink.

Bill Wilson wrote:
Some strongly object to the A.A. position that alcoholism is an
illness. This concept, they feel, removes moral responsibility from
alcoholics. As any A.A. knows, this is far from true. We do not use the
concept of sickness to absolve our members from responsibility. On the
contrary, we use the fact of fatal illness to clamp the heaviest kind
of moral obligation onto the sufferer, the obligation to use A.A.’s
Twelve Steps to get well.

This excruciating state of moral and physical sickness—this
“incomprehensible demoralization”—is known in A.A. as hitting bottom.
“Why is it,” asks Dr. Arnold Ludwig, “that reasonably intelligent men
and women remain relatively immune to reason and good advice and only
choose to quit drinking when they absolutely must, after so much damage
has been wrought? What is there about alcoholism, unlike any other
‘disease’ in medicine except certain drug addictions, that makes being
in extremis represent a potentially favorable sign for cure?”

Hitting bottom may come in the form of a wrecked car, a wrecked
marriage, a jail term, or simple the inexorable buildup of the solo
burden of drug-seeking behavior. While the intrinsically spiritual
component of the A.A. program would seem to be inconsistent with the
emerging biochemical models of addiction, recall that A.A.’s basic
premise has always been that alcoholism and drug addiction are diseases
of the body and obsessions of the mind.

When the shocking moment arrives, and the addict hits bottom, he or she
enters a “sweetly reasonable” and “softened up” state of mind, as A.A.
founder Bill Wilson expressed it. Arnold Ludwig calls this the state of
“therapeutic surrender.” It is crucial to everything that follows. It
is the stage in their lives when addicts are prepared to consider, if
only as a highly disturbing hypothesis, that they have become powerless
over their use of addictive drugs. In that sense, their lives have
become unmanageable. They have lost control.

It isn’t necessary to take a strictly spiritual view in order to
recognize the existence of some kind of power higher than the self. The
higher power referred to in A.A. may simply turn out to be the complex
dynamics of directed group interaction, i.e., the group as a whole. It
is a recognition of holistic processes beyond a single individual—the
power of the many over and against the power of one. Sometimes that
form of submission can be healthy.

Dirk Hanson
Addiction Inbox
http://addiction-dirkh.blogspot.com

Author's Bio
Dirk Hanson is a freelance science reporter and novelist who lives in
Minnesota. His book, "The Chemical Carousel: What Science Tells Us
About Addiction," is available from Amazon.

info@dirkhanson.org