A Medley of Potpourri

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Wednesday, April 26, 2023

History of Alcoholics Anonymous

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymous 
 
AA Big Book, 2nd edition

Alcoholics Anonymous (AA) was founded in 1935 by Bill Wilson (known as Bill W.) and Robert Smith (known as Dr. Bob), and has since grown to be worldwide.

Alcoholism in the 1700s and 1800s

Nearly two centuries before the advent of Alcoholics Anonymous, John Wesley established Methodist penitent bands, which were organized on Saturday nights, the evening on which members of these small groups were most tempted to frequent alehouses. The hymns and teaching provided during the penitent band meetings addressed the issues that members faced, often alcoholism. As a result, penitent bands have often been compared to Alcoholics Anonymous in scholarly discourse.

Temperance Movement and Prohibition

Main article: Temperance movement

Alcoholism in the 1930s

In post-Prohibition 1930s America, it was common to perceive alcoholism as a moral failing, and the medical profession standards of the time treated it as a condition that was likely incurable and lethal. Those without financial resources found help through state hospitals, the Salvation Army, or other charitable societies and religious groups. Those who could afford psychiatrists or hospitals were subjected to a treatment with barbiturate and belladonna known as "purge and puke" or were left in long-term asylum treatment.

The Oxford Group

The Oxford Group was a Christian fellowship founded by American Christian missionary Frank Buchman. Buchman was a minister, originally Lutheran, then Evangelist, who had a conversion experience in 1908 in a chapel in Keswick, England, the revival center of the Higher Life movement. As a result of that experience, he founded a movement named A First Century Christian Fellowship in 1921. This came to be known as the Oxford Group by 1928.

Buchman summarized the Oxford Group philosophy in a few sentences: "All people are sinners"; "All sinners can be changed"; "Confession is a prerequisite to change"; "The changed person can access God directly"; "Miracles are again possible"; and "The changed person must change others."

The practices they utilized were called the five C's:

  • Confidence
  • Confession
  • Conviction
  • Conversion
  • Continuance

Their standard of morality was the Four Absolutes – a summary of the teachings of the Sermon on the Mount:

  • Absolute-Honesty
  • Absolute-Purity
  • Absolute-Unselfishness
  • Absolute-Love

In his search for relief from his alcoholism, Bill Wilson, one of the two co-founders of AA, joined The Oxford Group and learned its teachings. While Wilson later broke from The Oxford Group, he based the structure of Alcoholics Anonymous and many of the ideas that formed the foundation of AA's suggested 12-step program on the teachings of the Oxford Group. Later in life, Bill Wilson gave credit to the Oxford Group for saving his life.

An Oxford Group understanding of the human condition is evident in Wilson's formulation of the dilemma of the alcoholic; Oxford Group program of recovery and influences of Oxford Group evangelism still can be detected in key practices of Alcoholics Anonymous. The Oxford Group writers sometimes treated sin as a disease. They saw sin was "anything that stood between the individual and God". Sin frustrated "God's plan" for oneself, and selfishness and self-centeredness were considered the key problems. Therefore, if one could "surrender one's ego to God", sin would go with it. In early AA, Wilson spoke of sin and the need for a complete surrender to God. The Oxford Group also prided itself on being able to help troubled persons at any time. AA gained an early warrant from the Oxford Group for the concept that disease could be spiritual, but it broadened the diagnosis to include the physical and psychological.

In 1955, Wilson wrote: "The early AA got its ideas of self-examination, acknowledgment of character defects, restitution for harm done, and working with others straight from the Oxford Group and directly from Sam Shoemaker, their former leader in America, and from nowhere else." According to Mercadante, however, the AA concept of powerlessness over alcohol departs significantly from Oxford Group belief. In AA, the bondage of an addictive disease cannot be cured, and the Oxford Group stressed the possibility of complete victory over sin.

How Alcoholics Connected with the Oxford Group

Rowland Hazard

In 1931, Rowland Hazard, an American business executive, went to Zurich, Switzerland to seek treatment for alcoholism with psychiatrist Carl Jung. When Hazard ended treatment with Jung after about a year, and came back to the USA, he soon resumed drinking, and returned to Jung in Zurich for further treatment. Jung told Hazard that his case was nearly hopeless (as with other alcoholics) and that his only hope might be a "spiritual conversion" with a "religious group".

Back in America, Hazard went to the Oxford Group, whose teachings were eventually the source of such AA concepts as "meetings" and "sharing" (public confession), making "restitution", "rigorous honesty" and "surrendering one's will and life to God's care". Hazard underwent a spiritual conversion" with the help of the Group and began to experience the liberation from drink he was seeking. He became converted to a lifetime of sobriety while on a train ride from New York to Detroit after reading For Sinners Only by Oxford Group member AJ Russell.

Ebby Thacher

Members of the group introduced Hazard to Ebby Thacher. Hazard brought Thacher to the Calvary Rescue Mission, led by Oxford Group leader Sam Shoemaker. Over the years, the mission had helped over 200,000 needy people. Thacher also attained periodic sobriety in later years and died sober.

Bill Wilson

In keeping with the Oxford Group teaching that a new convert must win other converts to preserve his own conversion experience, Thacher contacted his old friend Bill Wilson, whom he knew had a drinking problem.

1934 Bill Wilson sober

Bill Wilson was an alcoholic who had ruined a promising career on Wall Street by his drinking. He had also failed to graduate from law school because he was too drunk to pick up his diploma. His drinking damaged his marriage, and he was hospitalized for alcoholism at Towns Hospital in New-York four times in 1933–1934 under the care of William Silkworth.

On Wilson's first stay at Towns Hospital, Silkworth explained to him his theory that alcoholism is an illness rather than a moral failure or failure of willpower. Silkworth believed that alcoholics were suffering from a mental obsession, combined with an allergy that made compulsive drinking inevitable, and to break the cycle one had to completely abstain from alcohol use. Wilson was elated to find that he suffered from an illness, and he managed to stay off alcohol for a month before he resumed drinking.

When Ebby Thacher visited Wilson at his New York apartment and told him "he had got religion," Wilson's heart sank. Until then, Wilson had struggled with the existence of God, but of his meeting with Thacher he wrote: "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last." When Thacher left, Wilson continued to drink. Thacher returned a few days later bringing with him Shep Cornell, another Oxford Group member who was aggressive in his tactics of promoting the Oxford Group Program, but despite their efforts Wilson continued to drink.

The next morning Wilson arrived at Calvary Rescue Mission in a drunken state looking for Thacher. Once there, he attended his first Oxford Group meeting, where he answered the call to come to the altar and, along with other penitents, "gave his life to Christ". Wilson excitedly told his wife Lois about his spiritual progress, yet the next day he drank again and a few days later readmitted himself to Towns Hospital for the fourth and last time.

At Towns Hospital under Silkworth's care, Wilson was administered a drug cure concocted by Charles B. Towns. Known as the Belladonna Cure, it contained belladonna (Atropa belladonna) and henbane (Hyoscyamus niger). These plants contain deliriants, such as atropine and scopolamine, that cause hallucinations.

It was while undergoing this treatment that Wilson experienced his "Hot Flash" spiritual conversion. While lying in bed depressed and despairing, Wilson cried out: "I'll do anything! Anything at all! If there be a God, let Him show Himself!" He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Wilson described his experience to Silkworth, who told him not to discount it.

Thacher visited Wilson at Towns Hospital and introduced him to the basic tenets of the Oxford Group and to the book Varieties of Religious Experience (1902), by American psychologist and philosopher William James. Upon reading the book, Wilson was later to state that the phrase "deflation at depth" leapt out at him from the page of William James's book; however, this phrase does not appear in the book. It was James's theory that spiritual transformations come from calamities, and their source lies in pain and hopelessness, and surrender. James's belief concerning alcoholism was that "the cure for dipsomania was religiomania".

Upon his release from the hospital on December 18, 1934, Wilson moved from the Calvary Rescue Mission to the Oxford Group meeting at Calvary House. There Wilson socialized after the meetings with other ex-drinking Oxford Group members and became interested in learning how to help other alcoholics achieve sobriety. It was during this time that Wilson went on a crusade to save alcoholics. Sources for his prospects were the Calvary Rescue Mission and Towns Hospital. Though not a single one of the alcoholics Wilson tried to help stayed sober, Wilson himself stayed sober.

1935 Dr. Bob sober

Henrietta Buckler Seiberling

Silkworth believed Wilson was making a mistake by telling new converts of his "Hot Flash" conversion and thus trying to apply the Oxford Group's principles. He advised Wilson of the need to "deflate" the alcoholic. He told Wilson to give them his medical understanding, and give it to them hard: tell them of the obsession that condemns them to drink and the physical sensitivity that condemns them to go mad and of the compulsion to drink that might kill them. He believed that if this message were told to them by another alcoholic, it would break down their ego. Only then could the alcoholic use the other "medicine" Wilson had to give – the ethical principles he had picked up from the Oxford Groups.

Subsequently, during a business trip in Akron, Ohio, Wilson was tempted to drink and realized he must talk to another alcoholic to stay sober. He phoned local ministers to ask if they knew any alcoholics. Norman Sheppard directed him to Oxford Group member Henrietta Seiberling, whose group had been trying to help a desperate alcoholic named Dr Bob Smith.

While he was a student at Dartmouth College, Smith started drinking heavily and later almost failed to graduate from medical school because of it. He opened a medical practice and married, but his drinking put his business and family life in jeopardy. For 17 years Smith's daily routine was to stay sober until the afternoon, get drunk, sleep, then take sedatives to calm his morning jitters. Seiberling convinced Smith to talk with Wilson, but Smith insisted the meeting be limited to 15 minutes. Smith was so impressed with Wilson's knowledge of alcoholism and ability to share from his own experience, however, that their discussion lasted six hours.

Wilson moved into Bob and Anne Smith's family home. There both men made plans to take their message of recovery on the road. During this period, however, Smith returned to drinking while attending a medical convention. During his stay at the Smith home, Wilson joined Smith and his wife in the Oxford Group's practice of "morning guidance" sessions with meditations and Bible readings. The Bible's Book of James became an important inspiration for Smith and the alcoholics of the Akron group. Wilson spent a month working with Smith, and Smith became the first alcoholic Wilson brought to sobriety. Smith's last drink was on June 10, 1935 (a beer to steady his hand for surgery), and this is considered by AA members to be the founding date of AA.

A new program

Robert Smith's House in Akron

Wilson and Smith sought to develop a simple program to help even the worst alcoholics, along with a more successful approach that empathized with alcoholics yet convinced them of their hopelessness and powerlessness. They believed active alcoholics were in a state of insanity rather than a state of sin, an idea they developed independently of the Oxford Group.

To produce a spiritual conversion necessary for sobriety and "restoration to sanity", alcoholics needed to realize that they couldn't conquer alcoholism by themselves – that "surrendering to a higher power" and "working" with other alcoholics were required. Sober alcoholics could show drinking alcoholics that it was possible to enjoy life without alcohol, thus inspiring a spiritual conversion that would help ensure sobriety.

The tactics employed by Smith and Wilson to bring about the conversion was first to determine if an individual had a drinking problem. To do this they would first approach the man's wife, and later they would approach the individual directly by going to his home or by inviting him to the Smiths' home. The objective was to get the man to "surrender", and the surrender involved a confession of "powerlessness" and a prayer that said the man believed in a "higher power" and that he could be "restored to sanity". This process would sometimes take place in the kitchen, or at other times it was at the man's bed with Wilson kneeling on one side of the bed and Smith on the other side. This way the man would be led to admit his "defeat". Wilson and Smith believed that until a man had "surrendered", he couldn't attend the Oxford Group meetings. No one was allowed to attend a meeting without being "sponsored". Thus a new prospect underwent many visits around the clock with members of the Akron team and undertook many prayer sessions, as well as listening to Smith cite the medical facts about alcoholism. A new prospect was also put on a special diet of sauerkraut, tomatoes and Karo syrup to reduce his alcoholic cravings. The Smith family home in Akron became a center for alcoholics.

Two realizations came from Wilson and Smith's work in Akron. The first was that to remain sober, an alcoholic needed another alcoholic to work with. The second was the concept of the "24 hours" – that if the alcoholic could resist the urge to drink by postponing it for one day, one hour, or even one minute, he could remain sober.

An Akron group and a New York group

After he and Smith worked with AA members three and four, Bill Dotson and Ernie G., and an initial Akron group was established, Wilson returned to New York and began hosting meetings in his home in the fall of 1935.

Wilson allowed alcoholics to live in his home for long periods without paying rent and board. This practice of providing a halfway house was started by Bob Smith and his wife Anne. Wilson's wife, Lois, not only worked at a department store and supported Wilson and his unpaying guests, but she also did all the cooking and cleaning. She also tried to help many of the alcoholics that came to live with them. She was attacked by one man with a kitchen knife after she refused his advances, and another man committed suicide by gassing himself on their premises. Later they found that he had stolen and sold off their best clothes. Wilson stopped the practice in 1936 when he saw that it did little to help alcoholics recover. The Wilsons did not become disillusioned with the Oxford Group until later; they attended the Oxford Group meetings at the Calvary Church on a regular basis and went to a number of the Oxford Group "house parties" up until 1937.

Separating from the Oxford Group

There were two programs operating at this time, one in Akron and the other in New York. The Akron Oxford Group and the New York Oxford Group had two very different attitudes toward the alcoholics in their midst. The Akron Oxford members welcomed alcoholics into their group and did not use them to attract new members, nor did they urge new members to quit smoking as everyone was in New-York's Group; and Akron's alcoholics did not meet separately from the Oxford Group.

The Wilsons' practice of hosting meetings solely for alcoholics, separate from the general Oxford Group meetings, generated criticism within the New-York Oxford Group. Oxford Group members believed the Wilsons' sole focus on alcoholics caused them to ignore what else they could be doing for the Oxford Group. While Sam Shoemaker was on vacation, members of the Oxford Group declared the Wilsons not "Maximum," and members were advised not to attend the Wilsons' meetings. In 1937 the Wilsons broke with the Oxford Group. According to the Oxford Group, Wilson quit; according to Lois Wilson, they "were kicked out." Wilson later wrote that he found the Oxford Group aggressive in their evangelism. He objected to the group's publicity-seeking and intolerance of nonbelievers, and those alcoholics who were practicing Catholics found their views to be in conflict with the Oxford Group teachings. On a personal level, while Wilson was in the Oxford Group he was constantly checked by its members for his smoking and womanizing. The alcoholics within the Akron group did not break away from the Oxford Group there until 1939. Their break was not from a need to be free of the Oxford Group; it was an action taken to show solidarity with their brethren in New York.

At the end of 1937, after the New York separation from the Oxford Group, Wilson returned to Akron, where he and Smith calculated their early success rate to be about five percent. Over 40 alcoholics in Akron and New York had remained sober since they began their work. Wilson then made plans to finance and implement his program on a mass scale, which included publishing a book, employing paid missionaries, and opening alcoholic treatment centers. The 18 alcoholic members of the Akron group saw little need for paid employees, missionaries, hospitals or literature other than Oxford Group's. Some of what Wilson proposed violated the spiritual principles they were practicing in the Oxford Group. By a one-vote margin, they agreed to Wilson's writing a book, but they refused any financial support of his venture.

1939 The Big Book

Main article: The Big Book (Alcoholics Anonymous)

The title of the book Wilson wrote is Alcoholics Anonymous: The Story Of How More Than One Hundred Men Have Recovered From Alcoholism but it is referred to by AA members as "the Big Book". Its main objective is to help the alcoholic find a power greater than himself" that will solve his problem, the "problem" being an inability to stay sober on his or her own.

Rockefeller

One of the main reasons the book was written was to provide an inexpensive way to get the AA program of recovery to suffering alcoholics.

In the early days of AA, after the new program ideas were agreed to by Bill Wilson, Bob Smith and the majority of AA members, they envisioned paid AA missionaries and free or inexpensive treatment centers. But initial fundraising efforts failed.

In 1938, Bill Wilson's brother-in-law Leonard Strong contacted Willard Richardson, who arranged for a meeting with A. Leroy Chapman, an assistant for John D. Rockefeller Jr. Wilson envisioned receiving millions of dollars to fund AA missionaries and treatment centers, but Rockefeller refused, saying money would spoil things. Instead, he agreed to contribute $5,000 in $30 weekly increments for Wilson and Smith to use for personal expenses.

Later, in 1940, Rockefeller also held a dinner for AA that was presided over by his son Nelson and was attended by wealthy New Yorkers as well as members of the newly founded AA. Wilson hoped the event would raise much money for the group, but upon conclusion of the dinner, Nelson stated that Alcoholics Anonymous should be financially self-supporting and that the power of AA should lie in one man carrying the message to the next, not with financial reward but only with the goodwill of its supporters.

Although Wilson would later give Rockefeller credit for the idea of AA being nonprofessional, he was initially disappointed with this consistent position; and after the first Rockefeller fundraising attempt fell short, he abandoned plans for paid missionaries and treatment centers. Instead, Wilson and Smith formed a nonprofit group called the Alcoholic Foundation and published a book that shared their personal experiences and what they did to stay sober. The book they wrote, Alcoholics Anonymous: The Story Of How More Than One Hundred Men Have Recovered From Alcoholism (the Big Book), is the "basic text" for AA members on how to stay sober, and it is from the title of this book that the group got its name.

Works Publishing

When Wilson had begun to work on the book, and as financial difficulties were encountered, the first two chapters, Bill's Story and There Is a Solution were printed to help raise money. After receiving an offer from Harper & Brothers to publish the book, early New-York member Hank P., whose story The Unbeliever appears in the first edition of the "Big Book", convinced Wilson they should retain control over the book by publishing it themselves.

Hank devised a plan to form "Works Publishing, Inc.", and raise capital by selling its shares to group members and friends. With Wilson's knowledge as a stockbroker, Hank issued stock certificates, although the company was never incorporated and had no assets.

At first there was no success in selling the shares, but eventually Wilson and Hank obtained what they considered to be a promise from Reader's Digest to do a story about the book once it was completed. On the strength of that promise, AA members and friends were persuaded to buy shares, and Wilson received enough financing to continue writing the book. Subsequently, the editor of Reader's Digest claimed not to remember the promise, and the article was never published.

Bill and Hank held two-thirds of 600 company shares, and Ruth Hock also received some for pay as secretary. Two hundred shares were sold for $5,000 ($79,000 in 2008 dollar value) at $25 each ($395 in 2008 value), and they received a loan from Charlie Towns for $2,500 ($40,000 in 2008 value). This only financed writing costs, and printing would be an additional 35 cents each for the original 5,000 books. Edward Blackwell at Cornwall Press agreed to print the book with an initial $500 payment, along with a promise from Bill and Hank to pay the rest later.

Hank P. returned to drinking after four years of sobriety and could not account for Works Publishing's assets. Hank blamed Wilson for this, along with his own personal problems. By 1940, Wilson and the Trustees of the Foundation decided that the Big Book should belong to AA, so they issued some preferred shares, and with a loan from the Rockefellers they were able to call in the original shares at par value of $25 each. Hank P. initially refused to sell his 200 shares, then later showed up at Wilson's office broke and shaky. Wilson offered Hank $200 for the office furniture that belonged to Hank, provided he sign over his shares. Hank agreed to the arrangement after some prodding from Wilson. Not long after this, Wilson was granted a royalty agreement on the book that was similar to what Smith had received at an earlier date. The transaction left Hank resentful, and later he accused Wilson of profiting from Big Book royalties, something that Cleveland AA group founder Clarence S. also seriously questioned. Using principles he had learned from the Oxford Group, Wilson tried to remain cordial and supportive to both men. Works Publishing became incorporated on June 30, 1940.

The Twelve Steps

After the third and fourth chapters of the Big Book were completed, Wilson decided that a summary of methods for treating alcoholism was needed to describe their "word of mouth" program. The basic program had developed from the works of William James, Silkworth, and the Oxford Group. It included six basic steps:

  1. We admitted that we were licked, that we were powerless over alcohol.
  2. We made a moral inventory of our defects or sins.
  3. We confessed or shared our shortcomings with another person in confidence.
  4. We made restitution to all those we had harmed.
  5. We tried to help other alcoholics, with no thought of reward in money or prestige.
  6. We prayed to whatever God we thought there was for power to practice these precepts.

Wilson decided that the six steps needed to be broken down into smaller sections to make them easier to understand and accept. He wrote the Twelve Steps one night while lying in bed, which he felt was the best place to think. He "prayed for guidance" prior to writing, and in reviewing what he had written and numbering the new steps, he found they added up to twelve. He then thought of the Twelve Apostles and became convinced that the program should have twelve steps. With contributions from other group members, including atheists who reined in religious content (such as Oxford Group material) that could later result in controversy, by fall 1938 Wilson expanded the six steps into the final version of the Twelve Steps, which are detailed in Chapter Five of the Big Book, called How It Works.

Many of the chapters in the Big Book were written by Wilson, including Chapter 8, To Wives. It was a chapter he had offered to Smith's wife, Anne Smith, to write, but she declined. His wife Lois had wanted to write the chapter, and his refusal to allow her left her angry and hurt. Some postulate the chapter appears to hold the wife responsible for her alcoholic husband's emotional stability once he has quit drinking.

Wilson kept track of the people whose personal stories were featured in the first edition of the Big Book. About 50 percent of them had not remained sober.

Promotion

Initially the Big Book did not sell. 5000 copies sat in the warehouse, and Works Publishing was nearly bankrupt. Morgan R., recently released from an asylum, contacted his friend Gabriel Heatter, host of popular radio program We the People, to promote his newly found recovery through AA. The interview was considered vital to the success of AA and its book sales, so to ensure that Morgan stayed sober for the broadcast, members of AA kept him locked in a hotel room for several days under a 24-hour watch. The interview was a success, and Hank P. arranged for 20,000 postcards to be mailed to doctors announcing the Heatter broadcast and encouraging them to buy a copy of Alcoholics Anonymous: The Story Of How More Than One Hundred Men Have Recovered From Alcoholism Book sales and AA popularity also increased after positive articles in Liberty magazine in 1939 and the Saturday Evening Post in 1941.

Revisions

The second edition of the Big Book was released in 1955, the third in 1976, and the fourth in 2001. The first part of the book, which details the program, has remained largely intact, with minor statistical updates and edits. The second part contains personal stories that are updated with every edition to reflect current AA membership, resulting in earlier stories being removed – these were published separately in 2003 in the book Experience, Strength, and Hope.

Anonymity

Originally, anonymity was practiced as a result of the experimental nature of the fellowship and to protect members from the stigma of being seen as alcoholics. The name "Alcoholics Anonymous" referred to the members, not to the message. If members made their membership in AA public, especially at the level of public media, and then went out and drank again, it would not only harm the reputation of AA but threaten the very survival of the fellowship. Later, as a result of "anonymity breaks" in the public media by celebrity members of AA, Wilson determined that the deeper purpose of anonymity was to prevent alcoholic egos from seeking fame and fortune at AA expense. Wilson also saw anonymity as a principle that would prevent members from indulging in ego desires that might actually lead them to drink again – hence Tradition Twelve, which made anonymity the spiritual core of all the AA traditions, ie the AA guidelines.

Into the 21st century

1989 movie about Bill W. and Bob Smith

As AA grew in size and popularity from over 100 members in 1939, other notable events in its history have included the following:

  • 1939 AA co-founder Bill Wilson and Marty Mann founded High Watch Farm in Kent, Connecticut. The world's first 12-Step-based rehab in the world.
  • 1941 2,000 members in 50 cities and towns. After the March 1941 Saturday Evening Post article on AA, membership tripled over the next year.
  • 1944 in June, AA Grapevine magazine was published containing first-person stories of AA members. Its slogan "an AA meeting in print" was adopted after receiving supportive letters from AA members in overseas military.
  • 1945 AA adopted the AA Grapevine as its national journal.
  • 1946 in April, AA Grapevine first published the Twelve Traditions (in the long/original form) as Twelve Points to Assure Our Future. They were derived by Wilson from group letters to AA headquarters asking how to handle disputes over such issues as finance, publicity, and outside affiliations, and were intended to be guidelines on group conduct and avoiding controversy.
  • 1949 AA Grapevine became the international journal of AA due to added readership in Canada and Europe.
  • 1949 A group of recovering alcoholics and AA members founded Hazelden Farm, a Minneapolis refuge and treatment center. Since then, 93 percent of alcohol rehabilitation clinics use AA concepts in their treatment, and a reverse influence has also occurred, with AA receiving 31 percent of its membership from treatment-center referrals.
  • 1950 The Twelve Traditions were unanimously adopted at AA's First International Convention.
  • 1950 On November 16, Bob Smith died. There were about 100,000 AA members.
  • 1953 The Twelve Traditions were published in the book Twelve Steps and Twelve Traditions.
  • 1953 Narcotics Anonymous received permission from AA to use the Twelve Steps and Twelve Traditions in its own program.
  • 1955 Second Edition of the Big Book released ; estimated 150,000 AA members.
  • 1957 Alcoholics Anonymous Comes of Age was published.
  • 1962 The Twelve Concepts for World Service were adopted by AA as a guideline for international issues.
  • 1962 The movie Days of Wine and Roses depicted an alcoholic in AA.
  • 1971 Bill Wilson died. His last words to AA members were, "God bless you and Alcoholics Anonymous forever."
  • 1976 Third Edition of the Big Book released ; estimated 1,000,000 AA members.
  • 1980 Dr. Bob and the Good Oldtimers gave an account of AA development in and around Akron and Cleveland, Ohio.
  • 1984 Pass It On detailed Wilson's life story.
  • 1988 The movie Clean and Sober depicted such aspects of AA culture as sponsorship.
  • 1989 The movie My Name Is Bill W. portrayed the AA story.
  • 2001 Fourth Edition of the Big Book released ; estimated 2,000,000 or more members in 100,800 groups meeting in approximately 150 countries around the world.
  • 2010 The TV movie When Love Is Not Enough: The Lois Wilson Story portrays the story of Lois and Bill Wilson, founders of Al-Anon and Alcoholics Anonymous.
  • 2012 Bill W., an American biographical documentary directed by Dan Carracino and Kevin Hanlon, about William Griffith Wilson.
at April 26, 2023
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Alcoholics Anonymous

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Alcoholics_Anonymous 
 
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book.
The book cover of Alcoholics Anonymous, 4th edition. AA derives its name from the title of this book.
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

Main article: History of Alcoholics Anonymous
 
For broader coverage of this topic, see Transpersonal psychology.
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

Main article: Twelve Traditions
 
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

See also: Twelve-step program § Twelve Steps

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

Main article: Disease theory 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

See also: Rational Recovery § Court-mandated twelve-step program attendance

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

See also: Twelve-step program

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

See also: Alcoholism § Management

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.

  • Anonymous (2011). Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism (multiple PDFs) (4th ed.). ISBN 978-1-893007-16-1. OCLC 49743393. 575 pages.
  • Anonymous (2002). Twelve Steps and Twelve Traditions (multiple PDFs). ISBN 978-0-916856-01-4. OCLC 13572433. 192 pages.
  • "Home Page". AA Grapevine. Alcoholics Anonymous. ISSN 0362-2584. OCLC 319167052.
at April 26, 2023
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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.

at April 26, 2023
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