“As the whisky rose to my head I told myself I would manage better next time, but I might as well get good and drunk then. And I did. The remorse, horror and hopelessness of the next morning are unforgettable.” – Excerpt from Alcoholics Anonymous’ the Big Book
Some call it bad science. Some say it changed their lives, saved their lives, even. Alcoholics Anonymous seems to be as polarizing as it is anonymous. There are statistics that say AA has about a 75 percent retention rate. Others say that number stands somewhere between 5 and 8 percent.
The debate has been brewing for some time over the efficacy of faith-based 12-step programs and America’s apparent dependency on them. It’s clear, though, that alcohol consumption has become and will remain an American pastime.
One would be hard pressed to walk down any given street and not find an advertisement for some kind of liquor or beer or both. Alcoholics sometimes call those triggers. The companies that make up America’s $400 billion alcohol industry might call that advertising money well spent.
It doesn’t come as a surprise that the inevitable downside of American’s booming appetite for booze is the roughly 88,000 annual alcohol-related deaths in the United States alone; worldwide there are roughly 2.5 million deaths. A recent Gallup poll found that the average American consumes about four drinks a week, with 54 percent of respondents consuming between one and seven drinks a week; 12 percent said they drink eight or more.
Of those respondents, 22 percent say that sometimes they drink too much. According to data with the National Council on Alcoholism and Drug Dependence, roughly 17.6 million Americans suffer from alcohol abuse or dependency with another 2.5 million who regularly engage in risky drinking patterns.
For those who want to climb out of the bottle, one of the most common (and cost effective) options for treatment is to attend AA meetings. Often, as a result of legal consequences, a judge will order people to attend AA as well.
According to the doctrine of AA, the Big Book, a person who has become dependent on alcohol must have “admitted we were powerless over alcohol — that our lives had become unmanageable.” For those who follow the rest of AA’s steps, admitting this is one of the most important moments in their lives.
Skeptics, however, believe AA’s approach to be a dangerous fallacy, due largely in part to the fact that an individual must admit they are powerless over alcohol. Several books have been published criticizing the abstinence only approach used by AA.
In his book Alcoholics Anonymous: Cult or Cure, Charles Bufe explores the reasons why the doctrine of AA excludes those who may not want to participate in a “spiritual awakening.”
“I should point out that those who blindly, and vocally, embrace the 12 steps are fully welcome at most meetings,” Bufe wrote. “Those who have doubts and those who have disagreements with the AA dogma are normally ostracized if they express their opinions; and those who remain silent and sit on their doubts will normally be the objects of proselytization and dire warnings, and, if they continue to refuse to mouth accepted AA wisdom, will win, at best, grudging acceptance — if they are strong enough to stand up to the ridicule and condescension they are sure to encounter.”
Alcoholrehab.com, an online resource for people seeking treatment for alcohol addiction, addresses some of the criticism surrounding AA. “Despite its success rate, there is growing acceptance that Alcoholics Anonymous is not a good treatment option for everyone. There are also a number of criticisms that further bring into question its favored position as a treatment for alcoholism,” the website reads.
It also addresses the argument that AA is cult-like, categorizing theses accusations as “hard to stick” because unlike a cult, AA does not pursue membership and does not prevent members from leaving.
However, there is one figure in the AA canon that has achieved a cult-like following, the founder of the organization, Bill Wilson. Members revere Wilson as the modern patron saint of sobriety.
A Brief History
Born in East Dorset, Vermont in 1895, Wilson would grow up to be a prominent figure of sobriety and spiritual awakening. Some who are fond of AA refer to it as the greatest spiritual movement of the 20th century, although there are many who view it as simply a way to get sober.
Wilson grew to be a prosperous Wall Street broker and even found some success after the market crashed in 1929 plunging the nation into the Great Depression. The stock market collapse, however, did feed Wilson’s need to drink heavily. He wrote that he would consume quarts of gin in one sitting and days would pass without him leaving the comfort of his drunkenness.
In 1935, after years of uncontrollable drinking habits, Wilson had a spiritual awakening. He began attending meetings with the Oxford Group, an anti-alcoholic fellowship from which he would later derive the idea for AA. The general concept was for a person to help other alcoholics with their addiction and to build a support system. Groups began to form in Akron, Ohio; New York City; and Cleveland.
As a way to ensure continuity with the group’s message and philosophy, Wilson wrote the Big Book in 1939, thereby creating what would be the AA bible. It remains the main pillar of the group.
The Big Book is centered on Wilson’s own beliefs. “My friend promised me that when these things were done, I would enter upon a new relationship with my Creator; that I would have the elements of a way of living which answered all my problems,” Wilson wrote. “Belief in the power of God, plus enough willingness, honesty and humility to establish and maintain the new order of things were the essential requirements.”
Still AA is non-denominational and contends that an individual’s “higher power” can be anything other than one’s self. In any case, Wilson’s AA philosophy quickly caught on and membership numbers ballooned.
As of January 2015, there are an estimated 60,143 AA groups in the United States with 1,283,704 members. Each group operates largely autonomously from the others and each is self-sufficient in terms of funding, which is one of the main “traditions” of AA.
Robert and Louise
Robert began drinking when he was 14. As a member of AA, he asked that his identity be withheld so that he could speak freely about his experiences with the group. Also, Robert said his work colleagues have no idea he struggles with alcoholism. Sometimes he even attends meetings on his lunch break.
“From the second I took my first sip I could just tell that I really liked it…too much probably,” Robert said. Originally from Montgomery, Robert said that he ended up in AA by way of a treatment facility, though he did not want to mention which one.
Throughout college, Robert said that his drinking had progressed to the point where he couldn’t go to class and eventually he dropped out. “I couldn’t stop. Consequences started to catch up with me. I was depressed. But I couldn’t see any of this when it was happening,” he said. “I ended up in rehab due to these consequences from my drinking habits.”
Robert went through treatment for four months before graduating to a halfway house, where he stayed for another five months. What really hit home for Robert, after all of the treatment and “working the steps” was the selflessness that comes with helping others who were suffering from similar addictions.
“The addict is very selfish. It’s always take, take, take. What AA does is it takes you out of that mentality,” Robert explained. “I had a lot of bad ideas about what spirituality meant. I had been drinking and drugging for a long time, and I wasn’t about to have anyone tell me about God when I came in there. But I came to see spirituality as being more than just that.”
The first three steps in AA are all about surrendering, Robert explained. “I couldn’t stand the way I felt, so I drank,” he said. Once he realized that he had been trying to fix the emotion, rather than the cause of his problem, Robert said his eyes were opened to the root of his discontent.
Through the AA support system, Robert — who has been sober for over 5 years now — also found his current girlfriend, Louise, who also asked to remain anonymous because she too has tried to keep her bout with alcoholism between close family and friends.
Louise grew up in a house with an alcoholic parent in Texas. Even before she started drinking when she was 16, Louise was introduced to AA through family members who attended meetings. “But I started drinking anyway,” she said. “I just drank on the weekends, same old stuff as everyone else.” She smiled. “Well, I guess I was pretty rowdy, actually.”
Louise said that even though she had seen the ugliness of alcoholism first hand, she justified her drinking because of her friends were doing it too. In college, Louise said she continued to “chase the party” as her drinking habits became more serious. “It wasn’t as fun as it once was,” she said. “When I took my first drink I felt like everything was okay, but as it progressed I started to feel the sickness. It was something that I had inherited.”
Though studies have shown that alcoholism has no single cause and is not directly passed down through family members, it can result from childhood environment, genetics and psychological factors, among other things.
It was in college that Louise became aware of her problem. “Whereas most people in college can go out and drink and get crazy, I couldn’t do that. People can still manage to get good grades and be okay, but with me, I flunked out and was just not okay,” she said, adding that her personal relationships had also deteriorated as a result. “Alcohol had become my master.”
Not long after her family put her in a treatment facility. The first stint in rehab didn’t take for Louise any more than it did for Robert. At 21 years old, Louise fought back, saying she didn’t need to be there and that surely there was another way. She checked herself out of rehab.
Two years later Louise found herself in a dark place. And maybe that’s what she needed, she said. “I knew at this point I had to make a change. I’d be dead now if I stayed where I was.”
That’s something that many alcoholics point to, the moment they decided for themselves, rather than being told by the court or family members, that it was time to make a change.
When she decided it was time to get serious with her sobriety, Louise began to attend meetings at the same place Robert had been going. During her “Come-to-Jesus meeting,” as she described it, she met with her sponsor and several others at a café. Louise said she had been awake for six days and was strung out on pills.
“My sponsor kept asking if I was high, and finally I just kind of sat back and said, ‘Yeah, I am,’ and I just felt this huge weight lifted off of me,” Louise said. Robert, who was sitting on the other side of the table, muttered to himself “Thank God,” as she recalled. “He was just relieved that I wasn’t insane.”
Now sober for 18 months, Louise said the support system she was able to form in AA is something she will carry with her for life even as she will always carry the burden of alcoholism.
“I like to think of it like this,” Robert said. “Once I was a cucumber, but after I started drinking I became a pickle. You can’t turn a pickle back into a cucumber. That is to say, once you’re an alcoholic, there isn’t any way to go back.”
Luckily, they both said, they found each other and a community in AA that keeps them grounded. “What it taught me is just to live life less selfishly,” Louise said. “Now I get to help other people out of the same darkness I went through. … That’s reason enough to stay sober.”
God (“As we understood Him”)
Of the 12 steps in AA, three mention God (“as we understood Him”) specifically. Those who have been through the program are quick to point out that this does not mean any particular deity. “It could be whatever you want it to be,” John said.
John, a recovering alcoholic (who asked to remain anonymous for reasons similar to those given by Robert and Louise), said that after going through the program, he became more open to the idea of spirituality. “I’ve never been very comfortable with the idea of organized religion,” John said. “I just have never been one to say I am right and you are wrong.”
Still, he had been raised in a family that went to church regularly, and John said he was acquainted with Christianity. But he said AA opened his mind to the possibility of people being able to believe what they want without their beliefs infringing upon his. Everyone comes as they are, he said, and no one is more right than anyone else on the road to recovery.
John also said that the 12-step program worked for him, but that it may not be for everyone. “I’ll always be an alcoholic,” he said. “Recovery doesn’t change that. It’s up to me now to stay sober.” By next week, if he succeeds, John will have been sober for 8 months.
“The most important thing to me — and I think to most people who stick with the steps — is finally finding a community that accepts you and who is there to support you no matter what and with no expectations of anything in return,” John said.
Having recently completed a stay at Bradford Health Services, John said that the true test of his resolve came after he got out and was staying in the Fellowship House, a sober living facility, on Birmingham’s Southside. “I will say this of the Fellowship House, they give you plenty of room to hang yourself if you want. They let you keep your phone and you can go where you want as long as it doesn’t interfere with the classes you have to attend. It let me understand myself and the reasons why I had ended up there. But that’s when the test begins. And that made me stronger I think,” John said.
“As for the 12-step program, I can’t sit here and say it’s going to work for everyone, because it’s not. But I can say it worked for me. It’s what got me here today, and that is all I know. I’m sure other programs work, but this is the route I took,” John said, echoing one of the 12 main “traditions” of AA. “ Our public relations policy is based on attraction rather than promotion.”
As the corporate director of alumni services with Origins Recovery, part of Kacy Ritter’s job is to keep track of the people who come through the recovery program. She’s been in charge of helping people after they complete the 12 steps at Origins-, a national behavioral healthcare center that focuses on drug and alcohol addiction, for a little over three years.
Ritter said that she deals with skepticism towards the spiritual aspect of the 12-step program. As an alumnus herself, Ritter said that when she checked into a facility, she was a dyed-in-the-wool atheist.
“I was one of those people that would argue with facts that there is no soul and there is no God, all that kind of stuff. What is interesting, though, is that alcohol is a great persuader,” Ritter said. “And when you get to the end of your rope and you start to realize it’s ineffective to do it on your own, you start to open yourself up to spirituality. The interesting thing is that it doesn’t have to be anything specific. A lot of people think that spirituality means religion. But in reality it has nothing to do with religion.”
Ritter believes that “working the steps” helps to treat the internal condition that may be driving a person to drink in the first place. “It’s the happiness that comes along with helping other people,” Ritter explained. “Any spiritual path or text you look at points to the complications of selfishness. When you can get out of your self and start helping others, you are going to find greater fulfillment. That’s the whole basis of it.”
Not without skepticism
Lance Dodes, a retired professor of psychiatry at Harvard Medical School and author of the book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, said that the methods used by AA are not based in science and the retention rates of those who come through the program are not as high as AA would have people believe.
One of Dodes’ main arguments is that people should not have to admit they are powerless over a substance — the first step of AA. “That is certainly backwards,” Dodes said over the phone. “The whole idea is that you need to find a way to be empowered, not being powerless over a substance.
“By saying that you’re powerless, that suggests that the urge to drink isn’t something to do with you, rather something that is being done to you. The best way to deal with an urge to drink is to figure out what it is you are trying to do. There is something inside of you and if you can figure that out, you can master it.”
Dodes is not completely against AA — by his own account, it does work for some people — but he rejects the notion that everyone needs to go through the 12 steps. He believes success starts with the way people look at alcoholism, which, in his view is not a disease, but a symptom of some psychological distress.
Dodes gives an analogy of someone who is trapped in a cave. “You’re in the darkness, trapped and you’re helpless. At that moment, you’ll do anything to get out. You’ll scratch at the rocks, you’ll hit it, you may even break your arm trying to get out. It doesn’t matter. There is a theory that says if you’re not enraged and you’re not hitting the rocks there is something wrong with you,” Dodes said.
This rage is the root of what drives people to drink, Dodes explained. People will turn to alcoholism to quell the rage they may be experiencing from feeling trapped or helpless, he said. “If you have a bottle of whiskey with you in that cave, instead of hitting the rocks and trying to get out, a person might say, ‘I can’t stand being so overwhelmed, I’m going to do something that gives me a feeling of power,’ and they sit down and have a drink. The difference is that all of these symptoms that we call addictions are what we in psychology call displacements.”
What Dodes has focused on over the years, and written three books about, is why people return to these behaviors. Very little has been determined about why some people become more psychologically dependent on alcohol than others.
“Why are some people trapped by something that other people don’t feel trapped by?” Dodes asked. “People with addictions can feel trapped by all types of things in their lives. Sometimes it’s something we can understand like a death or some humiliation or disappointment. When they can figure that out, what’s causing it, then they can do something direct.”
Whereas Dodes stopped short of offering prescription alternatives, some believe taking pills to be a viable way to wean someone off alcohol.
Some doctors will prescribe Naltrexone, an opioid antagonist that helps stem cravings for alcohol. It should be noted this is typically prescribed to the heavy drinkers who have a physical alcohol dependency, not someone suffering from a psychological addiction. However, some believe Naltrexone and similar drugs can be effectively used by anyone who craves alcohol.
In a story recently published in The Atlantic, “The Irrationality of Alcoholics Anonymous,” author Gabrielle Glaser addressed the use of the drug Naltrexone.
“In the United States, doctors generally prescribe naltrexone for daily use and tell patients to avoid alcohol, instead of instructing them to take the drug anytime they plan to drink,” Glaser wrote.
“There is disagreement among experts about which approach is better — Sinclair is adamant that American doctors are missing the drug’s full potential — but both seem to work: naltrexone has been found to reduce drinking in more than a dozen clinical trials, including a large-scale one funded by the National Institute on Alcohol Abuse and Alcoholism that was published in JAMA in 2006. The results have been largely overlooked. Less than 1 percent of people treated for alcohol problems in the United States are prescribed naltrexone or any other drug shown to help control drinking,” Glaser continued.
In her article, Glaser offers recovery options other than the 12-step method. “Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work,” Glaser wrote.
Because Dodes also believes AA to be based in something other than hard science, he thinks that one-on-one therapy is a better solution than the “one size fits all” mentality exhibited by AA.
“Some people may not be as afflicted as someone else,” Dodes said. “You can’t just paint everyone with a broad brush. There needs to be more focus put on the individual and get to what it is that makes that specific person want to participate in this behavior.”
Besides questioning the AA approach, Dodes said that his Harvard research leads him to believe the success rate of the 12-step method is closer to 8 percent, rather than the 75 percent success rate AA says it has.
According to Dodes, who analyzed the various surveys conducted by AA, the numbers are “dishonest” and don’t fully account for everyone who has been through the program.
“The studies typically start out with about 100 people and they follow them through their recovery,” Dodes said. “About 50 percent of these people drop out during the studies. The people who stay are typically the ones who are doing well and the authors of the studies will draw their conclusions from the people who stayed. Basically it’s like them saying, ‘If you look at the people who stayed with the program, they do really well.’”
Ritter admits that the success rate has dropped since the early years of AA, where it was about 75 percent, but she does not think its nearly as low as Dodes believes it to be.
“There is definitely a need to collect more outcome data,” Ritter said. “Whereas the success rate has dropped a little from 75 percent, I think the people who actually complete the 12 steps and are sponsoring others, those people are more successful than someone who attends because they might have to. Some people just go through the motions. But those who follow through are setting themselves up for success.”
The 13th step
Perhaps the most important step in AA is the one that an individual must take after they complete the program and they are on their own in a world full of booze.
There is no timeline for how long it takes someone to complete all 12 steps, although Robert said it typically takes a few months. “I came in really gung-ho, and wanted to knock it out as quickly as I could. But once I started it, I realized it wasn’t something that needed to be rushed. It’s really a time to take some moral inventory,” Robert explained.
One of the main reasons AA has seen such success is because they operate autonomously and don’t take outside donations like other recovery programs, Robert said. “It’s not a racket,” he said. They are just there to help anyone who needs assistance. “We don’t try and tell people this is where they need to be.”
Judges do sometimes tell people AA is where they must be, and it is not uncommon for those mandated by the court to come to meetings with skepticism, Robert said. But they are welcomed anyway.
Dodes said this explains AA’s success. “The reason AA works is not because of the steps. It’s because it’s supportive,” he said. “There are other support groups around and they are also free.”
John recently moved into his own apartment after staying in a sober living facility for several months after he got out of rehab. “The real challenge comes,” he said, “when you are on your own.”
As a waiter, John said that recently he was carrying a martini to a table and some of it spilled on his hand. “Before I went through the steps I might have wanted to just lick it off my hand, but now — and I can’t tell you exactly why — the thought of drinking is just not appealing to me anymore,” John said.
“What it taught me — and maybe this is why — is I have more to live for than just myself. I have kids. I want to do right by them and not live selfishly. That’s really what I took away from the 12 steps. There is more to life than just me. I don’t think I could have realized that any other way.”
For “Selling Sobriety,” last month’s cover story about other drug rehabilitation options in Alabama, click here.