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Wednesday, April 26, 2023

Alcoholics Anonymous

From Wikipedia, the free encyclopedia
 
NicknameAA
Formation1935; 88 years ago
Founded atAkron, Ohio
TypeMutual aid addiction recovery Twelve-step program
HeadquartersNew York, New York
Membership (2020)
2,100,000
Key people
Bill Wilson, Bob Smith
Websiteaa.org

Alcoholics Anonymous (AA) is an international peer-led mutual aid fellowship which meets online and in person and is dedicated to abstinence-based recovery from alcoholism through its spiritually-inclined Twelve Step program. Following its Twelve Traditions, AA is non-professional and non-denominational as well as apolitical and unaffiliated. In 2020 AA estimated its worldwide membership to be over two million, with 75% of those in the U.S. and Canada.

Although AA holds no opinion on the disease model of alcoholism—or on any medical issue, many AA members took a large role in making it popular. Regarding its effectiveness against alcohol use disorder, a 2020 scientific review saw clinical interventions encouraging increased AA participation resulted in higher abstinence rates over other clinical interventions, while most studies in the review found that AA led to lower health costs.

AA dates its start to 1935 with Bill Wilson (Bill W) first commiserating alcoholic to alcoholic with Bob Smith (Dr. Bob) who, along with Wilson, was active in AA's immediate precursor, the Christian revivalist Oxford Group. Within the Oxford Group, Wilson and Smith joined other alcoholics in supported each other in meetings and one on one until breaking off to form a fellowship of alcoholics only. In 1939 they published Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism. Known as the "Big Book" and as the source of AA’s name, it contains AA's Twelve Step recovery program. Subsequent editions included the Twelve Traditions adopted in 1950 to formalize and unify the fellowship, which Wilson called “a benign anarchy”. 

The Twelve Steps are presented as a suggested and continuing self-improvement program to effect a spiritual awakening once an alcoholic has conceded powerlessness over alcohol and acknowledged its damage, as well as having listed and strived to correct personal failings and by making amends for misdeeds. After completing the Steps they suggest members take other alcoholics through them; though not explicitly prescribed, often by sponsoring other alcoholics. Divining and following the will of God "as we understood Him" is also urged by the Steps, but differing spiritual practices and persuasions, as well as non-theist members, are accepted and accommodated.

The Twelve Traditions are AA's advisory guidelines for members, groups and the rest of its organization. Besides making a desire to stop drinking the only membership requirement, the Traditions advise against dogma, hierarchies and involvement in public controversies to preserve recovery from alcoholism as AA’s primary purpose. Without threat of retribution or means of enforcement, the Traditions urge members to remain anonymous in public media. They also wish members or groups to not use AA to gain wealth, property or prestige. The Traditions establish AA groups as autonomous and self-supporting through members’ voluntary contributions while rejecting outside donations, and, as with all of AA, should not represent AA as affiliated with or in support of other organizations or causes.

With AA's permission, other fellowships such as Narcotics Anonymous and Al-Anon have adopted and adapted the Twelve Steps and the Twelve Traditions to their addiction recovery programs.

History

Sobriety token or "chip", given for specified lengths of sobriety, on the back is the Serenity Prayer. Here green is for six months of sobriety; purple is for nine months.

AA was founded on 10 June 1935; but AA's origins are said to have begun when the renowned psychotherapist Carl Jung inspired Rowland H., an otherwise hopeless drunk, to seek a spiritual solution by sending him to the Oxford Group—a non-denominational, altruistic Christian movement modeled after first-century Christianity. Ebby Thacher, a drinking buddy of Wilson's, got sober in that same Oxford Group and reached out to help his friend. Thacher approached Wilson saying that he had "got religion", was sober, and that Wilson could do the same if he set aside objections and instead formed a personal idea of God, "another power" or "higher power". Feeling a "kinship of common suffering", Wilson attended his first group gathering, although he was drunk. Within days, Wilson admitted himself to the Charles B. Towns Hospital after drinking four beers on the way—the last alcohol he ever drank. Under the care of William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna. At the hospital, a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.

Following his hospital discharge, Wilson joined the Oxford Group and tried to recruit other alcoholics to the group. These early efforts to help others kept him sober, but were ineffective in getting anyone else to join the group and get sober. Dr. Silkworth suggested that Wilson place less stress on religion (as required by The Oxford Group) and more on the science of treating alcoholism.

Wilson's first success came during a business trip to Akron, Ohio, where he was introduced to Robert Smith, a surgeon and Oxford Group member who was unable to stay sober. After thirty days of working with Wilson, Smith drank his last drink on 10 June 1935, the date marked by AA for its anniversaries.

The first female member, Florence Rankin, joined AA in March 1937, and the first non-Protestant member, a Roman Catholic, joined in 1939. The first Black AA group was established in 1945 in Washington, D.C. by Jim S., an African-American physician from Virginia.

Several years after 1935, in writing the Big Book, Bill W. developed the twelve steps, influenced by the Oxford Group's 6 steps, and readings including William James's The Varieties of Religious Experience

The Big Book, the Twelve Steps, and the Twelve Traditions

To share their method, Wilson and other members wrote the initially-titled book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism, from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a Higher Power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal, and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches.

In 1941, interviews on American radio and favorable articles in US magazines, including a piece by Jack Alexander in The Saturday Evening Post, led to increased book sales and membership. By 1946, as the growing fellowship quarreled over structure, purpose, and authority, as well as finances and publicity, Wilson began to form and promote what became known as AA's "Twelve Traditions," which are guidelines for an altruistic, unaffiliated, non-coercive, and non-hierarchical structure that limited AA's purpose to only helping alcoholics on a non-professional level while shunning publicity. Eventually, he gained formal adoption and inclusion of the Twelve Traditions in all future editions of the Big Book. At the 1955 conference in St. Louis, Missouri, Wilson relinquished stewardship of AA to the General Service Conference, as AA grew to millions of members internationally.

Organization and finances

A regional service center for Alcoholics Anonymous

AA says it is "not organized in the formal or political sense", and Bill Wilson, borrowing the phrase from anarchist theorist Peter Kropotkin, called it a "benign anarchy". In Ireland, Shane Butler said that AA "looks like it couldn't survive as there's no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust". Butler explained that "AA's 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."

In 2018, AA counted 2,087,840 members and 120,300 AA groups worldwide. The Twelve Traditions informally guide how individual AA groups function, and the Twelve Concepts for World Service guide how the organization is structured globally.

A member who accepts a service position or an organizing role is a "trusted servant" with terms rotating and limited, typically lasting three months to two years and determined by group vote and the nature of the position. Each group is a self-governing entity with AA World Services acting only in an advisory capacity. AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" of the 21-member AA Board of Trustees.

AA groups are self-supporting, relying on voluntary donations from members to cover expenses. The AA General Service Office (GSO) limits contributions to US$3,000 a year. Above the group level, AA may hire outside professionals for services that require specialized expertise or full-time responsibilities.

Like individual groups, the GSO is self-supporting. AA receives proceeds from books and literature that constitute more than 50% of the income for its General Service Office. In keeping with AA's Seventh Tradition, the Central Office is fully self-supporting through the sale of literature and related products, and the voluntary donations of AA members and groups. It does not accept donations from people or organizations outside of AA.

In keeping with AA's Eighth Tradition, the Central Office employs special workers who are compensated financially for their services, but their services do not include traditional "12th Step" work of working with alcoholics in need. All 12th Step calls that come to the Central Office are handed to sober AA members who have volunteered to handle these calls. It also maintains service centers, which coordinate activities such as printing literature, responding to public inquiries, and organizing conferences. Other International General Service Offices (Australia, Costa Rica, Russia, etc.) are independent of AA World Services in New York.

Program

AA's program extends beyond abstaining from alcohol. Its goal is to effect enough change in the alcoholic's thinking "to bring about recovery from alcoholism" through "an entire psychic change," or spiritual awakening. A spiritual awakening is meant to be achieved by taking the Twelve Steps, and sobriety is furthered by volunteering for AA and regular AA meeting attendance or contact with AA members. Members are encouraged to find an experienced fellow alcoholic, called a sponsor, to help them understand and follow the AA program. The sponsor should preferably have experience of all twelve of the steps, be the same sex as the sponsored person, and refrain from imposing personal views on the sponsored person. Following the helper therapy principle, sponsors in AA may benefit from their relationship with their charges, as "helping behaviors" correlate with increased abstinence and lower probabilities of binge drinking.

AA's program is an inheritor of Counter-Enlightenment philosophy. AA shares the view that acceptance of one's inherent limitations is critical to finding one's proper place among other humans and God. Such ideas are described as "Counter-Enlightenment" because they are contrary to the Enlightenment's ideal that humans have the capacity to make their lives and societies a heaven on Earth using their own power and reason. After evaluating AA's literature and observing AA meetings for sixteen months, sociologists David R. Rudy and Arthur L. Greil found that for an AA member to remain sober a high level of commitment is necessary. This commitment is facilitated by a change in the member's worldview. To help members stay sober AA must, they argue, provide an all-encompassing worldview while creating and sustaining an atmosphere of transcendence in the organization. To be all-encompassing AA's ideology emphasizes tolerance rather than a narrow religious worldview that could make the organization unpalatable to potential members and thereby limit its effectiveness. AA's emphasis on the spiritual nature of its program, however, is necessary to institutionalize a feeling of transcendence. A tension results from the risk that the necessity of transcendence if taken too literally, would compromise AA's efforts to maintain a broad appeal. As this tension is an integral part of AA, Rudy and Greil argue that AA is best described as a quasi-religious organization.

Meetings

Headquarters of Alcohólicos Anónimos in Montevideo, Uruguay

AA meetings are gatherings where recovery from alcoholism is discussed. One perspective sees them as "quasi-ritualized therapeutic sessions run by and for, alcoholics". There are a variety of meeting types some of which are listed below. At some point during the meeting a basket is passed around for voluntary donations. AA's 7th tradition requires that groups be self-supporting, "declining outside contributions". Weekly meetings are listed in local AA directories in print, online and in apps.

Open vs Closed Meetings

"Open" meetings welcome anyone—nonalcoholics can attend as observers. Meetings listed as "closed" welcome those with a self-professed "desire to stop drinking," which cannot be challenged by another member on any grounds.

Speaker Meetings

At speaker meetings one or more members come to tell their stories.

Big Book Meetings

At Big Book meetings, attendees read from the AA Big Book and discuss it.

Discussion Meetings

There are also meetings with or without a topic that allow participants to speak up or "share".

Online vs. Offline Meetings

Online meetings are digital meetings held on platforms such as Zoom. Offline meetings, also called "face to face," "brick and mortar," or "in-person" meetings, are held in a shared physical real-world location. Some meetings are hybrid meetings, where people can meet in a specified physical location, but people can also join the meeting virtually.

Specialized Meetings

Building for Spanish-speaking AA group in Westlake neighborhood, Los Angeles

AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation, or culture. Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.

Meeting formats

While AA has pamphlets that suggest meeting formats, groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole". Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".

Confidentiality

In the Fifth Step, AA members typically reveal their own past misconduct to their sponsors. US courts have not extended the status of privileged communication, such as physician-patient privilege or clergy–penitent privilege, to communications between an AA member and their sponsor.

Spirituality

Some medical professionals have criticized 12-step programs as "a cult that relies on God as the mechanism of action" and as "overly theistic and outdated". Others have cited the necessity of a "higher power" in formal AA as creating dependence on outside factors rather than internal efficacy. A 2010 study found increased attendance at AA meetings was associated with increased spirituality and decreased frequency and intensity of alcohol use. Since the mid-1970s, several 'agnostic' or 'no-prayer' AA groups have begun across the US, Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo the use of opening or closing prayers.

Disease concept of alcoholism

More informally than not, AA's membership has helped popularize the disease concept of alcoholism which had appeared in the eighteenth century. Though AA usually avoids the term disease, 1973 conference-approved literature said "we had the disease of alcoholism." Regardless of official positions, since AA's inception, most members have believed alcoholism to be a disease.

AA's Big Book calls alcoholism "an illness which only a spiritual experience will conquer." Ernest Kurtz says this is "The closest the book Alcoholics Anonymous comes to a definition of alcoholism." Somewhat divergently in his introduction to The Big Book, non-member and early benefactor William Silkworth said those unable to moderate their drinking suffer from an allergy. In presenting the doctor's postulate, AA said "The doctor's theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account." AA later acknowledged that "alcoholism is not a true allergy, the experts now inform us." Wilson explained in 1960 why AA had refrained from using the term disease:

We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead, there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady—a far safer term for us to use.

Since then medical and scientific communities have defined alcoholism as an "addictive disease" (aka Alcohol Use Disorder, Severe, Moderate, or Mild). The ten criteria are: alcoholism is a Primary Illness not caused by other illnesses nor by personality or character defects; second, an addiction gene is part of its etiology; third, alcoholism has predictable symptoms; fourth, it is progressive, becoming more severe even after long periods of abstinence; fifth, it is chronic and incurable; sixth, alcoholic drinking or other drug use persists in spite of negative consequences and efforts to quit; seventh, brain chemistry and neural functions change so alcohol is perceived as necessary for survival; eighth, it produces physical dependence and life-threatening withdrawal; ninth, it is a terminal illness; tenth, alcoholism can be treated and can be kept in remission.

Canadian and United States demographics

AA's New York General Service Office regularly surveys AA members in North America. Its 2014 survey of over 6,000 members in Canada and the United States concluded that, in North America, AA members who responded to the survey were 62% male and 38% female. The survey found that 89% of AA members were white.

Average member sobriety is slightly under 10 years with 36% sober more than ten years, 13% sober from five to ten years, 24% sober from one to five years, and 27% sober less than one year. Before coming to AA, 63% of members received some type of treatment or counseling, such as medical, psychological, or spiritual. After coming to AA, 59% received outside treatment or counseling. Of those members, 84% said that outside help played an important part in their recovery.

The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court-ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.

Relationship with institutions

Hospitals

Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value in working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did. Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics". Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.

Prisons

In the United States and Canada, AA meetings are held in hundreds of correctional facilities. The AA General Service Office has published a workbook with detailed recommendations for methods of approaching correctional-facility officials with the intent of developing an in-prison AA program. In addition, AA publishes a variety of pamphlets specifically for the incarcerated alcoholic. Additionally, the AA General Service Office provides a pamphlet with guidelines for members working with incarcerated alcoholics.

United States court rulings

United States courts have ruled that inmates, parolees, and probationers cannot be ordered to attend AA. Though AA itself was not deemed a religion, it was ruled that it contained enough religious components (variously described in Griffin v. Coughlin below as, inter alia, "religion", "religious activity", "religious exercise") to make coerced attendance at AA meetings a violation of the Establishment Clause of the First Amendment of the constitution. In 2007, the Ninth Circuit of the U.S. Court of Appeals stated that a parolee who was ordered to attend AA had standing to sue his parole office.

United States treatment industry

In 1939, High Watch Recovery Center in Kent, Connecticut, was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12-step-based treatment center in the world still operating today.

In 1949, the Hazelden treatment center was founded and staffed by AA members, and since then many alcoholic rehabilitation clinics have incorporated AA's precepts into their treatment programs. 32% of AA's membership was introduced to it through a treatment facility.

Effectiveness

There are several ways one can determine whether AA works and numerous ways of measuring if AA is successful, such as looking at abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost.

The effectiveness of AA (compared to other methods and treatments) has been challenged throughout the years, but recent high quality clinical meta-studies using quasi-experiment studies show that AA costs less than other treatments and results in increased abstinence. In longitudinal studies, AA appears to be about as effective as other abstinence-based support groups.

Because of the anonymous and voluntary nature of AA meetings, it has been difficult to perform random trials with them. Environmental and quasi-experiment studies suggest that AA can help alcoholics make positive changes.

In the past, some medical professionals have criticized 12-step programs as pseudoscientific and "a cult that relies on God as the mechanism of action". Until recently, ethical and operational issues had prevented robust randomized controlled trials from being conducted comparing 12-step programs directly to other approaches. Others, including addiction researcher Nicole Lee, have expressed concerns about the nature of many published AA studies, given that many are conducted by the "fellowship" itself. More recent studies employing randomized and blinded trials have shown 12-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.

Cochrane 2020 review

A 2020 Cochrane review concluded that "compared to other well-established treatments, clinical linkage using well-articulated Twelve-Step Facilitation (TSF) manualized interventions intended to increase Alcoholics Anonymous (AA) participation" are more effective than other established treatments, such as motivational enhancement therapy (MET) and cognitive-behavioral therapy (CBT), as measured by abstinence rates. Manualized TSF probably achieves additional desirable outcomes—such as fewer drinks per drinking day and less severe alcohol-related problems—at equivalent rates as other treatments, although evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".

In response to a concern expressed by another addiction researcher that "those more strongly committed to total abstinence after receiving AA/TSF were likely to experience more protracted 'slips' if they did for any reason drink", the Cochrane review authors stated that subjects who did not achieve abstinence did not have worse drinking outcomes overall.

Older studies

A 2006 study by Rudolf H. Moos and Bernice S. Moos saw a 67% success rate 16 years later for the 24.9% of alcoholics who ended up, on their own, undergoing a lot of AA treatment. The study's results may be skewed by self-selection bias.

Project MATCH was a 1990s 8-year, multi-site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment.

Brandsma 1980 showed that Alcoholics Anonymous is more effective than no treatment whatsoever.

Membership retention

In 2001–2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). Similarly structured to the NLAES, the survey conducted in-person interviews with 43,093 individuals. Respondents were asked if they had ever attended a twelve-step meeting for an alcohol problem in their lifetime (the question was not AA-specific). 1441 (3.4%) of respondents answered the question affirmatively. Answers were further broken down into three categories: disengaged, those who started attending at some point in the past but had ceased attending at some point in the past year (988); continued engagement, those who started attending at some point in the past and continued to attend during the past year (348); and newcomers, those who started attending during the past year (105). In their discussion of the findings, Kaskautas et al. (2008) state that to study disengagement, only the disengaged and continued engagement should be utilized (pg. 270).

The popular press

The Sober Truth

American psychiatrist Lance Dodes, in The Sober Truth, says that research indicates that only five to eight percent of the people who go to one or more AA meetings achieve sobriety.

The 5–8% figure put forward by Dodes is controversial; other doctors say that the book uses "three separate, questionable, calculations that arrive at the 5–8% figure." Addiction specialists state that the book's conclusion that "[12-step] approaches are almost completely ineffective and even harmful in treating substance use disorders" is wrong. One review called Dodes' reasoning against AA success a "pseudostatistical polemic."

Dodes has not, as of March 2020, read the 2020 Cochrane review showing AA efficacy, but opposes the idea that a social network is needed to overcome substance abuse.

The Irrationality of Alcoholics Anonymous

In a 2015 article for The Atlantic, Gabrielle Glaser criticized the dominance of AA in the treatment of addiction in the United States. Her article uses Lance Dodes's figures and a 2006 Cochrane report to state AA had a low success rate, but those figures were subsequently criticized by experts as outdated. The Glaser article incorrectly conflates the efficacy of treatment centers with the efficacy of Alcoholics Anonymous. The Glaser article says that "nothing about the 12-step approach draws on modern science", but a large amount of scientific research has been done with AA, showing that AA increases abstinence rates. The Glaser article criticizes 12-step programs for being "faith-based", but 12-step programs allow for a very wide diversity of spiritual beliefs, and there are a growing number of secular 12-step meetings.

Criticism

Sexual advances ("thirteenth-stepping")

"Thirteenth-stepping" is a pejorative term for AA members approaching new members for dates. A study in the Journal of Addiction Nursing sampled 55 women in AA and found that 35% of these women had experienced a "pass" and 29% had felt seduced at least once in AA settings. This has also happened with new male members who received guidance from older female AA members pursuing sexual company. The authors suggest that both men and women must be prepared for this behavior or find male or female-only groups. Women-only meetings are a very prevalent part of AA culture, and AA has become more welcoming for women. AA's pamphlet on sponsorship suggests that men be sponsored by men and women be sponsored by women.

Alcoholics Anonymous World Services has a safety flier which states that "Unwanted sexual advances and predatory behaviors are in conflict with carrying the A.A. message of recovery."

Criticism of culture

Stanton Peele argued that some AA groups apply the disease model to all problem drinkers, whether or not they are "full-blown" alcoholics. Along with Nancy Shute, Peele has advocated that besides AA, other options should be readily available to those problem drinkers who can manage their drinking with the right treatment. The Big Book says "moderate drinkers" and "a certain type of hard drinker" can stop or moderate their drinking. The Big Book suggests no program for these drinkers, but instead seeks to help drinkers without "power of choice in drink."

In 1983, a review stated that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. A 1985 study based on observations of AA meetings warned of detrimental iatrogenic effects of the twelve-step philosophy and concluded that AA uses many methods that are also used by cults. A later review disagreed, stating that AA's program bore little resemblance to religious cult practices. In 2014, Vaillant published a paper making the case that Alcoholics Anonymous is not a cult.

Literature

Alcoholics Anonymous publishes several books, reports, pamphlets, and other media, including a periodical known as the AA Grapevine. Two books are used primarily: Alcoholics Anonymous (the "Big Book") and Twelve Steps and Twelve Traditions, the latter explaining AA's fundamental principles in depth. The full text of each of these two books is available on the AA website at no charge.

Disease theory of alcoholism

From Wikipedia, the free encyclopedia
Alcohol dependence
1904 Claim of Alcoholism Being Disease4.jpg
A 1904 advertisement labeling alcoholism a "disease"
SpecialtyPsychiatry

The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function.

The largest association of physicians – the American Medical Association (AMA) – declared that alcoholism was an illness in 1956. In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Theory

Alcoholism is a chronic problem. However, if managed properly, damage to the brain can be stopped and to some extent reversed.  In addition to problem drinking, the disease is characterized by symptoms including an impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking. Alcoholism can also lead indirectly, through excess consumption, to physical dependence on alcohol, and diseases such as cirrhosis of the liver.

The risk of developing alcoholism depends on many factors, such as environment. Those with a family history of alcoholism are more likely to develop it themselves (Enoch & Goldman, 2001); however, many individuals have developed alcoholism without a family history of the disease. Since the consumption of alcohol is necessary to develop alcoholism, the availability of and attitudes towards alcohol in an individual's environment affect their likelihood of developing the disease. Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40-50% for environmental influences.

In a review in 2001, McLellan et al. compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. They found that genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders, providing evidence that drug (including alcohol) dependence is a chronic medical illness.

Genetics and environment

According to the theory, genes play a strong role in the development of alcoholism.

Twin studies, adoption studies, and artificial selection studies have shown that a person's genes can predispose them to developing alcoholism. Evidence from twin studies show that concordance rates for alcoholism are higher for monozygotic twins than dizygotic twins—76% for monozygotic twins and 61% for dizygotic twins. However, female twin studies demonstrate that females have much lower concordance rates than males. Reasons for gender differences may be due to environmental factors, such as negative public attitudes towards female drinkers.

Adoption studies also suggest a strong genetic tendency towards alcoholism. Studies on children separated from their biological parents demonstrates that sons of alcoholic biological fathers were more likely to become alcoholic, even though they have been separated and raised by non alcoholic parents.

In artificial selection studies, specific strains of rats were bred to prefer alcohol. These rats preferred drinking alcohol over other liquids, resulting in a tolerance for alcohol and exhibited a physical dependency on alcohol. Rats that were not bred for this preference did not have these traits. Upon analyzing the brains of these two strains of rats, it was discovered that there were differences in chemical composition of certain areas of the brain. This study suggests that certain brain mechanisms are more genetically prone to alcoholism.

The convergent evidence from these studies present a strong case for the genetic basis of alcoholism.

History

Historians debate who has primacy in arguing that habitual drinking carried the characteristics of a disease. Some note that Scottish physician Thomas Trotter was the first to characterize excessive drinking as a mental disease, or medical defect.

Others point to American physician Benjamin Rush (1745–1813), a signatory to the United States Declaration of Independence—who understood drunkenness to be what we would now call a "loss of control"—as possibly the first to use the term addiction in this sort of meaning.

My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.

— Levine, H.G., The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America

Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease", describing it as "a palsy of the will". Rush expounded his views in a book published in 1808. His views are described by Valverde, Levine and Spode. Already in 1802 the prominent German physician Christoph Wilhelm Hufeland had published a book on the “brandy plague” stating that the “infection” with spirits makes it “inevitably necessary to drink ever more.” Later he wrote an enthusiastic preface to the book On the addiction to drink and a rational cure of it by German-Russian physician C. von Brühl-Cramer. As Spode points out, this study marked the birth of a consistent "paradigm" of addiction as a mental illness, although it took many decades until this view was accepted.

In 1849 Swedish physician Magnus Huss coined the term alcoholism in his book Alcoholismus chronicus. Some argue he was the first to systematically describe the physical characteristics of habitual drinking and claim that it was a mental disease. However, Huss regarded heavy drinking still as a vice (that causes a destruction of the nervous system). Moreover, this came decades after Trotter, Rush, Hufeland and Brühl-Cramer wrote their works, and some historians argue that the idea that habitual drinking was a mental disease emerged even earlier.

Given this controversy, the best one can say is that the idea that habitual alcohol drinking was a disease had become more acceptable by the second half of the nineteenth century, although many writers still argued it was a vice, a sin, and not the purview of medicine but of religion.

Between 1980 and 1991, medical organizations, including the AMA, worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part:

"The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice."

In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Controlled drinking

The disease theory is often interpreted as implying that problem drinkers are incapable of returning to 'normal' problem free drinking, and therefore that treatment should focus on total abstinence. Some critics have used evidence of controlled drinking in formerly dependent drinkers to dispute the disease theory of alcoholism.

The first major empirical challenge to this interpretation of the disease theory followed a 1962 study by Dr. D. L. Davies. Davies' follow-up of ninety-three problem drinkers found that seven of them were able to return to "controlled drinking" (less than seven drinks per day for at least seven years). Davies concluded that "the accepted view that no alcohol addict can ever again drink normally should be modified, although all patients should be advised to aim at total abstinence"; After the Davies study, several other researchers reported cases of problem drinkers returning to controlled drinking.

In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers learning to consume alcohol in moderation. The publication of the study renewed controversy over how people with a disease which reputedly leads to uncontrollable drinking could manage to drink controllably. Subsequent studies also reported evidence of return to controlled drinking. Similarly, according to a 2002 National Institute on Alcohol Abuse and Alcoholism (NIAAA) study, about one of every six (18%) of alcohol dependent adults in the U.S. whose dependence began over one year previously had become "low-risk drinkers" (less than fourteen drinks per week and five drinks per day for men, or less than seven per week and four per day for women). This modern longitudinal study surveyed more than 43,000 individuals representative of the U.S. adult population, rather than focusing solely on those seeking or receiving treatment for alcohol dependence. "Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence."

However, many researchers have debated the results of the smaller studies. A 1994 followup of the original seven cases studied by Davies suggested that he "had been substantially misled, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data." The most recent study, a long-term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."

The second RAND study, in 1980, found that alcohol dependence represents a factor of central importance in the process of relapse. Among people with low dependence levels at admission, the risk of relapse appears relatively low for those who later drank without problems. But the greater the initial level of dependence, the higher the likelihood of relapse for nonproblem drinkers. The second RAND study findings have been strengthened by subsequent research by Dawson et al. in 2005 which found that severity was associated positively with the likelihood of abstinent recovery and associated negatively with the likelihood of non-abstinent recovery or controlled drinking. Other factors such as a significant period of abstinence or changes in life circumstances were also identified as strong influences for success in a book on Controlled Drinking published in 1981.

Managed drinking

As part of a harm reduction strategy, provision of small amounts of alcoholic beverages to homeless alcoholics at homeless shelters in Toronto and Ottawa reduced government costs and improved health outcomes.

Legal considerations

In 1988, the US Supreme Court upheld a regulation whereby the Veterans' Administration was able to avoid paying benefits by presuming that primary alcoholism is always the result of the veteran's "own willful misconduct." The majority opinion written by Justice Byron R. White echoed the District of Columbia Circuit's finding that there exists "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility". He also wrote: "Indeed, even among many who consider alcoholism a 'disease' to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary." However, the majority opinion stated in conclusion that "this litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue on which the authorities remain sharply divided." The dissenting opinion noted that "despite much comment in the popular press, these cases are not concerned with whether alcoholism, simplistically, is or is not a 'disease.'"

The American Bar Association "affirms the principle that dependence on alcohol or other drugs is a disease."

Current acceptance

Alcoholism is a disease with a known pathology and an established biomolecular signal transduction pathway which culminates in ΔFosB overexpression within the D1-type medium spiny neurons of the nucleus accumbens; when this overexpression occurs, ΔFosB induces the addictive state.

In 2004, the World Health Organization published a detailed report on alcohol and other psychoactive substances entitled "Neuroscience of psychoactive substance use and dependence". It stated that this was the "first attempt by WHO to provide a comprehensive overview of the biological factors related to substance use and dependence by summarizing the vast amount of knowledge gained in the last 20-30 years. The report highlights the current state of knowledge of the mechanisms of action of different types of psychoactive substances, and explains how the use of these substances can lead to the development of dependence syndrome." The report states that "dependence has not previously been recognized as a disorder of the brain, in the same way that psychiatric and mental illnesses were not previously viewed as being a result of a disorder of the brain. However, with recent advances in neuroscience, it is clear that dependence is as much a disorder of the brain as any other neurological or psychiatric illness."

The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism. The American Psychiatric Association recognizes the existence of alcoholism as the equivalent of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify alcoholism as a disease.

In the US, the National Institutes of Health has a specific institute, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), concerned with the support and conduct of biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. It funds approximately 90 percent of all such research in the United States. The official NIAAA position is that "alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle."

Certain medications including opioid antagonists such as naltrexone have been shown to be effective in the treatment of alcoholism.

Criticism

Some physicians, scientists and others have rejected the disease theory of alcoholism on logical, empirical and other grounds. Indeed, some addiction experts such as Stanton Peele are outspoken in their rejection of the disease model, and other prominent alcohol researchers such as Nick Heather have authored books intending to disprove the disease model.

These critics hold that by removing some of the stigma and personal responsibility the disease concept actually increases alcoholism and drug abuse and thus the need for treatment. This is somewhat supported by a study which found that a greater belief in the disease theory of alcoholism and higher commitment to total abstinence to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use). However, the authors noted that "the direction of causality cannot be determined from these data. It is possible that belief in alcoholism as a loss-of-control disease predisposes clients to relapse, or that repeated relapses reinforce clients' beliefs in the disease model."

One study published in 1996 found that only 25 percent of physicians believed that alcoholism is a disease. The majority believed alcoholism to be a social or psychological problem instead of a disease.

Thomas R. Hobbs says that "Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health care professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease."

The sociologist Lynn M. Appleton noted that "Despite all public pronouncements about alcoholism as a disease, medical practice rejects treating it as such. Not only does alcoholism not follow the model of a 'disease,' it is not amenable to standard medical treatment." She says that "Medical doctors' rejection of the disease theory of alcoholism has a strong basis in the biomedical model underpinning most of their training" and that "medical research on alcoholism does not support the disease model" . "Many doctors have been loath to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease," according to Dr. Bankole Johnson, Chairman of the Department of Psychiatry at the University of Virginia. Dr Johnson's own pioneering work has made important contributions to the understanding of alcoholism as a disease.

Frequency and quantity of alcohol use are not related to the presence of the condition; that is, people can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally or infrequently.

Historicist interpretations of the Book of Revelation

Historicism is a method of interpretation in Christian eschatology which associates biblical prophecies with actual historical events and identifies symbolic beings with historical persons or societies; it has been applied to the Book of Revelation by many writers. The Historicist view follows a straight line of continuous fulfillment of prophecy which starts in Daniel's time and goes through John of Patmos' writing of the Book of Revelation all the way to the Second Coming of Jesus Christ.

One of the most influential aspects of the early Protestant historicist paradigm was the assertion that scriptural identifiers of the Antichrist were matched only by the institution of the Papacy. Particular significance and concern were the Papal claims of authority over the Church through Apostolic Succession, and the State through the Divine Right of Kings. When the Papacy aspires to exercise authority beyond its religious realm into civil affairs, on account of the Papal claim to be the Vicar of Christ, then the institution was fulfilling the more perilous biblical indicators of the Antichrist. Martin Luther wrote this view into the Smalcald Articles of 1537; this view was not novel and had been leveled at various popes throughout the centuries, even by Roman Catholic saints. It was then widely popularized in the 16th century, via sermons, drama, books, and broadside publication. The alternate methods of prophetic interpretation, Futurism and Preterism were derived from Jesuit writings, whose counter-reformation efforts were aimed at opposing this interpretation that the Antichrist was the Papacy or the power of the Roman Catholic Church.

Origins in Judaism and Early Church

The interpreters using the historicist approach for the Book of Revelation had their origins in the Jewish apocalyptic writings, such as those in the Book of Daniel, which predicted the future time between their writing and the end of the world. Throughout most of history since the predictions of the book of Daniel, historicism has been widely used. This approach can be found in the works of Josephus, who interpreted the fourth kingdom of Daniel 2 as the Roman empire with a future power as the stone "not cut by human hands", that would overthrow the Romans. It is also found in the early church in the works of Irenaeus and Tertullian, who interpreted the fourth kingdom of Daniel as the Roman empire and believed that in the future it was going to be broken up into smaller kingdoms, as the iron mixed with clay, and in the writings of Clement of Alexandria and Jerome, as well as other well-known church historians and scholars of the early church. But it has been associated particularly with Protestantism and the Reformation. It was the standard interpretation of the Lollard movement, which was regarded as the precursor to the Protestant Reformation, and it was known as the Protestant interpretation until modern times.

Antichrist

From a series of woodcuts (1545) usually referred to as the Papstspotbilder or Papstspottbilder, by Lucas Cranach, commissioned by Martin Luther. "Kissing the Pope's feet"; German peasants respond to a papal bull of Pope Paul III. Caption reads: "Don't frighten us Pope, with your ban, and don't be such a furious man. Otherwise we shall turn around and show you our rears".
 
Passional Christi und Antichristi, by Lucas Cranach the Elder, from Luther's 1521 Passionary of the Christ and Antichrist. The Pope as the Antichrist, signing and selling indulgences.

Church Fathers

The Church Fathers who interpreted the Biblical prophecy historistically were: Justin Martyr, who wrote about the Antichrist: "He whom Daniel foretells would have dominion for a time and times and an half, is even now at the door"; Irenaeus, who wrote in Against Heresies about the coming of the Antichrist: "This Antichrist shall ... devastate all things ... But then, the Lord will come from Heaven on the clouds ... for the righteous"; Tertullian, looking to the Antichrist, wrote: "He is to sit in the temple of God, and boast himself as being god. In our view, he is Antichrist as taught us in both the ancient and the new prophecies; and especially by the Apostle John, who says that 'already many false-prophets are gone out into the world' as the fore-runners of Antichrist"; Hippolytus of Rome, in his Treatise on Christ and Antichrist, wrote: "As Daniel also says (in the words) 'I considered the Beast, and look! There were ten horns behind it – among which shall rise another (horn), an offshoot, and shall pluck up by the roots the three (that were) before it.' And under this, was signified none other than Antichrist"; Athanasius of Alexandria clearly held to the historical view in his many writings, writing in The Deposition of Arius: "I addressed the letter to Arius and his fellows, exhorting them to renounce his impiety.... There have gone forth in this diocese at this time certain lawless men – enemies of Christ – teaching an apostasy which one may justly suspect and designate as a forerunner of Antichrist"; Jerome wrote: "Says the apostle [Paul in the Second Epistle to the Thessalonians], 'Unless the Roman Empire should first be desolated, and antichrist proceed, Christ will not come.'" Jerome claimed that the time of the break-up of Rome, as predicted in Daniel 2, had begun even in his time. He also identifies the Little horn of Daniel 7:8 and 7:24–25 which "shall speak words against the Most High, and shall wear out the saints of the Most High, and shall think to change the times and the law" as the Papacy.

Protestant view of the Papacy as the Antichrist

Protestant Reformers, including John Wycliffe, Martin Luther, John Calvin, Thomas Cranmer, John Thomas, John Knox, Roger Williams, Cotton Mather, Jonathan Edwards, and John Wesley, as well as most Protestants of the 16th–18th centuries, felt that the Early Church had been led into the Great Apostasy by the Papacy and identified the Pope with the Antichrist. The Centuriators of Magdeburg, a group of Lutheran scholars in Magdeburg headed by Matthias Flacius, wrote the 12-volume Magdeburg Centuries to discredit the Catholic Church and lead other Christians to recognize the Pope as the Antichrist. So, rather than expecting a single Antichrist to rule the earth during a future Tribulation period, Martin Luther, John Calvin, and other Protestant Reformers saw the Antichrist as a present feature in the world of their time, fulfilled in the Papacy. Like most Protestant theologians of his time, Isaac Newton believed that the Papal Office (and not any one particular Pope) was the fulfillment of the Biblical predictions about Antichrist, whose rule is prophesied to last for 1,260 years.

The Protestant Reformers tended to believe that the Antichrist power would be revealed so that everyone would comprehend and recognize that the Pope is the real, true Antichrist and not the vicar of Christ. Doctrinal works of literature published by the Lutherans, the Reformed Churches, the Presbyterians, the Baptists, the Anabaptists, and the Methodists contain references to the Pope as the Antichrist, including the Smalcald Articles, Article 4 (1537), the Treatise on the Power and Primacy of the Pope written by Philip Melanchthon (1537), the Westminster Confession, Article 25.6 (1646), and the 1689 Baptist Confession of Faith, Article 26.4. In 1754, John Wesley published his Explanatory Notes Upon the New Testament, which is currently an official Doctrinal Standard of the United Methodist Church. In his notes on the Book of Revelation (chapter 13), Wesley commented: "The whole succession of Popes from Gregory VII are undoubtedly Antichrists. Yet this hinders not, but that the last Pope in this succession will be more eminently the Antichrist, the Man of Sin, adding to that of his predecessors a peculiar degree of wickedness from the bottomless pit."

In calling the pope the "Antichrist", the early Lutherans stood in a tradition that reached back into the eleventh century. Not only dissidents and heretics but even saints had called the bishop of Rome the "Antichrist" when they wished to castigate his abuse of power. What Lutherans understood as a papal claim to unlimited authority over everything and everyone reminded them of the apocalyptic imagery of Daniel 11, a passage that even prior to the Reformation had been applied to the pope as the Antichrist of the last days.

The identification of the Pope with the Antichrist was so ingrained in the Reformation Era, that Luther himself stated it repeatedly:

"This teaching [of the supremacy of the pope] shows forcefully that the Pope is the very Antichrist, who has exalted himself above, and opposed himself against Christ, because he will not permit Christians to be saved without his power, which, nevertheless, is nothing, and is neither ordained nor commanded by God".

and,

"nothing else than the kingdom of Babylon and of the very Antichrist. For who is the man of sin and the son of perdition, but he who by his teaching and his ordinances increases the sin and perdition of souls in the church; while he yet sits in the church as if he were God? All these conditions have now for many ages been fulfilled by the papal tyranny."

John Calvin similarly wrote:

"Though it be admitted that Rome was once the mother of all Churches, yet from the time when it began to be the seat of Antichrist it has ceased to be what it was before. Some persons think us too severe and censorious when we call the Roman Pontiff Antichrist. But those who are of this opinion do not consider that they bring the same charge of presumption against Paul himself, after whom we speak and whose language we adopt .. I shall briefly show that (Paul's words in II Thess. 2) are not capable of any other interpretation than that which applies them to the Papacy."

John Knox wrote on the Pope:

"Yea, to speak it in plain words; lest that we submit ourselves to Satan, thinking that we submit ourselves to Jesus Christ, for, as for your Roman kirk, as it is now corrupted, and the authority thereof, whereon stands the hope of your victory, I no more doubt but that it is the synagogue of Satan, and the head thereof, called the pope, to be that man of sin, of whom the apostle speaks."

Thomas Cranmer on the Antichrist wrote:

"Whereof it followeth Rome to be the seat of Antichrist, and the pope to be very antichrist himself. I could prove the same by many other scriptures, old writers, and strong reasons."

John Wesley, speaking of the identity given in the Bible of the Antichrist, wrote:

"In many respects, the Pope has an indisputable claim to those titles. He is, in an emphatical sense, the man of sin, as he increases all manner of sin above measure. And he is, too, properly styled, the son of perdition, as he has caused the death of numberless multitudes, both of his opposers and followers, destroyed innumerable souls, and will himself perish everlastingly. He it is that opposeth himself to the emperor, once his rightful sovereign; and that exalteth himself above all that is called God, or that is worshipped – Commanding angels, and putting kings under his feet, both of whom are called gods in scripture; claiming the highest power, the highest honour; suffering himself, not once only, to be styled God or vice-God. Indeed no less is implied in his ordinary title, "Most Holy Lord," or, "Most Holy Father." So that he sitteth – Enthroned. In the temple of God – Mentioned Rev. xi, 1. Declaring himself that he is God – Claiming the prerogatives which belong to God alone."

Roger Williams wrote about the Pope:

"the pretended Vicar of Christ on earth, who sits as God over the Temple of God, exalting himself not only above all that is called God, but over the souls and consciences of all his vassals, yea over the Spirit of Christ, over the Holy Spirit, yea, and God himself ... speaking against the God of heaven, thinking to change times and laws; but he is the Son of Perdition."

The identification of the Roman Catholic Church as the apostate power written of in the Bible as the Antichrist became evident to many as the Reformation began, including John Wycliffe, who was well-known throughout Europe for his opposition to the doctrine and practices of the Catholic Church, which he believed had clearly deviated from the original teachings of the early Church and to be contrary to the Bible. Wycliffe himself tells (Sermones, III. 199) how he concluded that there was a great contrast between what the Church was and what it ought to be, and saw the necessity for reform. Along with John Hus, they had started the inclination toward ecclesiastical reforms of the Catholic Church.

When the Swiss Reformer Huldrych Zwingli became the pastor of the Grossmünster in Zurich in 1518, he began to preach ideas on reforming the Catholic Church. Zwingli, who was a Catholic priest before he became a Reformer, often referred to the Pope as the Antichrist. He wrote: "I know that in it works the might and power of the Devil, that is, of the Antichrist".

The English Reformer William Tyndale held that while the Roman Catholic realms of that age were the empire of Antichrist, any religious organization that distorted the doctrine of the Old and New Testaments also showed the work of Antichrist. In his treatise The Parable of the Wicked Mammon, he expressly rejected the established Church teaching that looked to the future for an Antichrist to rise up, and he taught that Antichrist is a present spiritual force that will be with us until the end of the age under different religious disguises from time to time. Tyndale's translation of 2 Thessalonians, chapter 2, concerning the "Man of Lawlessness" reflected his understanding, but was significantly amended by later revisers, including the King James Bible committee, which followed the Vulgate more closely.

In 1870, the newly formed Kingdom of Italy annexed the remaining Papal States, depriving the Pope of his temporal power. However, the Papal rule over Italy was later restored by the Italian Fascist regime (albeit on a greatly diminished scale) in 1929 as head of the Vatican City state; under Mussolini's dictatorship, Roman Catholicism became the State religion of Fascist Italy (see also Clerical fascism), and the Racial Laws were enforced to outlaw and persecute both Italian Jews and Protestant Christians, especially Evangelicals and Pentecostals. Thousands of Italian Jews and a small number of Protestants died in the Nazi concentration camps.

Today, many Protestant and Restorationist denominations still officially maintain that the Papacy is the Antichrist, such as the conservative Lutheran Churches and the Seventh-day Adventists. In 1988, Ian Paisley, Evangelical minister and founder of the Free Presbyterian Church of Ulster, made headlines with such a statement about Pope John Paul II. The Wisconsin Evangelical Lutheran Synod states about the Pope and the Catholic Church:

There are two principles that mark the papacy as the Antichrist. One is that the pope takes to himself the right to rule the church that belongs only to Christ. He can make laws forbidding the marriage of priests, eating or not eating meat on Friday, birth control, divorce and remarriage, even where there are not such laws in the Bible. The second is that he teaches that salvation is not by faith alone but by faith and works. The present pope upholds and practices these principles. This marks his rule as antichristian rule in the church. All popes hold the same office over the church and promote the same antichristian belief so they all are part of the reign of the Antichrist. The Bible does not present the Antichrist as one man for one short time, but as an office held by a man through successive generations. It is a title like King of England.

Other views

Some Franciscans had considered the Emperor Frederick II a positive Antichrist who would purify the Catholic Church from opulence, riches, and clergy.

Some of the debated features of the Reformation's Historicist interpretations reached beyond the Book of Revelation. They included the identification of:

Seven churches

The non-separatist Puritan, Thomas Brightman, was the first to propose a historicist interpretation of the Seven Churches of Revelation 2–3. He outlined how the seven Churches represent the seven ages of the Church of Christ. A typical historicist view of the Church of Christ spans several periods of church history, each similar to the original church, as follows:

  1. The age of Ephesus is the apostolic age.
  2. The age of Smyrna is the persecution of the Church through AD 313.
  3. The age of Pergamus is the compromised Church lasting until AD 500.
  4. The age of Thyatira is the rise of the papacy to the Reformation.
  5. The age of Sardis is the age of the Reformation.
  6. The age of Philadelphia is the age of evangelism.
  7. The age of Laodicea is liberal churches in a "present day" context.

The age of Laodicea is typically identified as occurring in the same time period as the expositor. Brightman viewed the age of Laodicea as the England of his day. In the Millerite movement, each church represented a dateable period of ecclesiastical history. Thus, William Miller dated the age of Laodicea from 1798–1843, followed by the End of days in 1844.

The Roman Catholic priest Fr. E. Berry in his commentary writes: "The seven candlesticks represent the seven churches of Asia. As noted above, seven is the perfect number which denotes universality. Hence by extension the seven candlesticks represent all churches throughout the world for all time. Gold signifies the charity of Christ which pervades and vivifies the Church."

Seven seals

The traditional historicist view of the Seven Seals spanned the time period from John of Patmos to Early Christendom. Protestant scholars such as Campegius Vitringa, Alexander Keith, and Christopher Wordsworth did not limit the timeframe to the 4th century. Some have even viewed the opening of the Seals right into the early modern period.

Seventh-day Adventists view the first six seals as representing events that took place during the Christian era up until 1844. Contemporary-historicists view all of Revelation as it relates to John's own time, with the allowance of making some guesses about the future.

Seven trumpets

The classical historicist identifies the first four trumpets with the pagan invasions of Western Christendom in the 5th century AD (by the Visigoths, Vandals, Huns, and Heruli), while the fifth and sixth trumpets have been identified with the assault on Eastern Christendom by the Saracen armies and Turks during the Middle Ages. The symbolism of Revelation 6:12–13 is said by Adventists to have been fulfilled in the 1755 Lisbon earthquake, the dark day of 19 May 1780, and the Leonids meteor shower of 13 November 1833.

Vision of Chapter 10

The classical historicist view of the vision of the angel with the little book, in Revelation 10, represents the Protestant Reformation and the printing of Bibles in the common languages. The Adventists take a unique view applying it to the Millerite movement; the "bitterness" of the book (Rev 10:10) represents the Great Disappointment.

Two witnesses

The classical historicist view takes a number of different perspectives, including that the two witnesses are symbolic of two insular Christian movements, such as the Waldenses, or that the Reformers are meant, or the Old Testament and the New Testament. It is usually taught that Revelation 11 corresponds to the events of the French Revolution.

Beasts of Revelation

The historicist views of Revelation 12–13 concern prophecies about the forces of evil viewed to have occurred in the middle ages. The first beast of Revelation 13 (from the sea) is considered to be the pagan Rome and the Papacy, or more exclusively the latter.

In 1798, the French General Louis Alexandre Berthier exiled the Pope and took away all his authority, which was restored in 1813, destroyed again in 1870, and later restored in 1929. Adventists have taken this as fulfillment of the prophecy that the Beast of Revelation would receive a deadly wound but that the wound would be healed. They have attributed the wounding and resurgence in Revelation 13:3 to the papacy, referring to General Louis Berthier's capture of Pope Pius VI in 1798 and the pope's subsequent death in 1799.

Adventists believe that the second beast (from the earth) symbolizes the United States of America. The "image of the beast" represents Protestant churches who form an alliance with the Papacy, and the "mark of the beast" refers to a future universal Sunday law. Both Adventists and classical historicists view the Great whore of Babylon, in Revelation 17–18, as Roman Catholicism.

Number of the Beast

Passional Christi und Antichristi, by Lucas Cranach the Elder, from Luther's 1521 Passionary of the Christ and Antichrist. The Pope is signing and selling indulgences.
 

Adventists have interpreted the number of the beast, 666, as corresponding to the title Vicarius Filii Dei of the Pope. In 1866, Uriah Smith was the first to propose the interpretation to the Seventh-day Adventist Church. In The United States in the Light of Prophecy, he wrote:

The pope wears upon his pontifical crown in jeweled letters, this title: "Vicarius Filii Dei," "Viceregent of the Son of God;" [sic] the numerical value of which title is just six hundred and sixty-six. The most plausible supposition we have ever seen on this point is that here we find the number in question. It is the number of the beast, the papacy; it is the number of his name, for he adopts it as his distinctive title; it is the number of a man, for he who bears it is the "man of sin."

Prominent Adventist scholar J. N. Andrews also adopted this view. Uriah Smith maintained his interpretation in the various editions of Thoughts on Daniel and the Revelation, which was influential in the church.

Various documents from the Vatican contain wording such as "Adorandi Dei Filii Vicarius, et Procurator quibus numen aeternum summam Ecclesiae sanctae dedit", which translates to "As the worshipful Son of God's Vicar and Caretaker, to whom the eternal divine will has given the highest rank of the holy Church".

The New Testament was written in Koine Greek, and Adventists used Roman numerals to calculate the value of "Vicarius Filii Dei" whose word is in Latin language. "Vicarius Filii Dei" is Latin, and it does not exist in the New Testament, which was written in Koine Greek.

Samuele Bacchiocchi, an Adventist scholar, and the only Adventist to be awarded a gold medal by Pope Paul VI for the distinction of summa cum laude (Latin for "with highest praise"), has documented the pope using such a title:

We noted that contrary to some Catholic sources who deny the use of Vicarius Filii Dei as a papal title, we have found this title to have been used in official Catholic documents to support the ecclesiastical authority and temporal sovereignty of the pope. Thus the charge that Adventists fabricated the title to support their prophetic interpretation of 666, is unfair and untrue.

However, Bacchiocchi's general conclusion regarding the interpretation of Vicarius Filii Dei is that he, together with many current Adventist scholars, refrains from using only the calculation of papal names for the number 666:

The meaning of 666 is to be found not in the name or titles of influential people, but in its symbolic meaning of rebellion against God manifested in false worship. ... the true meaning of 666 is to be found not in external markings or on a pope's title, but in the allegiance to false worship promoted by satanic agencies represented by the dragon, the sea-beast, and the land beast.

Commentaries

Notable and influential commentaries by Protestant scholars having historicist views of the Book of Revelation were:

Distance education

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