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CONCEPTS OF ALCOHOLICS ANONYMOUS
N.Y. STATE JOURNAL OF MEDICINE© Vol.
William G. Wilson
Alcoholics Anonymous is
an informal fellowship of about 12,000 formerly alcoholic
men and women who are to be found banded together as groups
in about three hundred and twenty-five American and Canadian
communities, these groups ranging in size from half a dozen
to many hundreds of individuals. Our oldest members have
been sober for from eight to nearly ten years. Of those
sincerely willing to stop drinking about 50 per cent have
done so at once, 25 per cent after a few relapses, and most
of the remainder have improved. It is probable that half
of our members, had they not been drinkers, would have appeared
in ordinary life to be normal people. The other half would
have appeared as more or less pronounced neurotic.
Alcoholics Anonymous, or "AA," popularly so-called,
has but one purpose - one objective only -"To help
other alcoholics to recover from their illness."
Nothing is asked of the
alcoholic approaching us save a desire on his part to get
well. He subscribes to no membership requirements, no fees
or dues, nor is belief in any particular view, medical or
religious, demanded of him. As a group we take no position
on any controversial question. Emphatically, we are not
evangelists or reformers. Being alcoholics who have recovered,
we aim to help only those who want to get well. We do this
because we have found that working with other alcoholics
plays such a vital part in keeping us all sober.
You may inquire "Just
how does AA work?" I cannot fully answer that question.
Many AA techniques have been adopted after a ten-year process
of trial and error which has led to some interesting results.
But, as laymen, we doubt our own ability to explain them.
We can only tell you what we do, and what seems, from our
point of view, to happen to us.
At the very outset we should
like it made ever so clear that AA is a synthetic concept
- a synthetic gadget, as it were, drawing upon the resources
of medicine, psychiatry, religion, and our own experience
of drinking and recovery. You will search in vain for a
single new fundamental. We have merely streamlined old and
proved principles of psychiatry and religion into such forms
that the alcoholic will accept them. And then we have created
a society of his own kind where he can enthusiastically
put these very principles to work on himself and other sufferers.
Then too, we have tried
hard to capitalize on our one great natural advantage. That
advantage is, of course, our personal experience as drinkers
who have recovered. How often the doctors and clergymen
throw up their hands when, after exhaustive treatment or
exhortation, the alcoholic still insists, "But you
don’t understand me. You never did any serious drinking
yourself, so how can you? Neither can you show me many who
Now, when one alcoholic
who has got well talks to another who hasn't, such objections
seldom arise, for the new man sees in a few minutes that
he is talking to a kindred spirit, one who understands.
Neither can the recovered AA member be deceived, for he
knows every trick, every rationalization of the drinking
game. So the usual barriers go down with a crash. Mutual
confidence, that indispensable of all therapy, follows as
surely as day does night. And if this absolutely necessary
rapport is not forthcoming at once it is almost certain
to develop when the new man has met other AA’s. Someone
will, as we say, "click with him."
As soon as that happens
we have a good chance of selling our prospect those very
essentials which you doctors have so long advocated, and
the problem drinker finds our society a congenial place
to work them out for himself and his fellow alcoholic. For
the first time in years he thinks himself understood and
he feels useful; uniquely useful, indeed, as he takes his
own turn promoting the recovery of others. No matter what
the outer world thinks of him, he now knows he can get well,
for he stands in the midst of scores of cases worse than
his own who have attained the goal. And there are other
cases precisely like his own - a pressure of testimony which
usually overwhelms him. If he doesn't succumb at once, he
will almost surely do so later when Barleycorn builds a
still hotter fire under him, thus blocking off all his other
carefully planned exits from dilemma. The speaker recalls
seventy-five failures during the first three years of AA
- people we utterly gave up. During the past seven years
sixty—two of these people have returned to us, most
of them now making good. They tell us they returned because
they knew they would die or go mad if they didn't. Having
tried everything else within their means and having exhausted
their pet rationalizations, they came back and took their
medicine. That is why we never need to evangelize alcoholics.
If still in their right minds they come back, once they
have been well exposed to AA
Now to recapitulate. Alcoholics
Anonymous has made two major contributions to the program
of psychiatry and religion. These are, it seems to us, the
long—missing links in the chain of recovery:
1. Our ability, as ex-drinkers,
to secure the confidence of the new man - to "build
a transmission line into him."
2. The provision of an understanding
society of ex-drinkers in which the newcomer can successfully
apply the principles of medicine and religion to himself
So far as we AA’s
are concerned, these principles, now used by us every day,
seem to be in surprising agreement. Let's compare briefly
what in a general way medicine and religion tell the alcoholic:
1. The alcoholic needs a
2. The patient ought to
be analyzed and should make a full and honest mental catharsis.
3. Serious personality defects
must be cured through accurate self-knowledge and realistic
adjustment to life.
4. The alcoholic neurotic
retreats from life, is a picture of anxiety and abnormal
self concern; he withdraws from the "herd."
5. The alcoholic must find,
"a new compelling interest in life," must "get
back into the herd," He should find an interesting
occupation, should join clubs, social activities, political
parties, or discover hobbies to take the
place of alcohol.
1. The alcoholic needs a
change of heart, a spiritual awakening.
2. The alcoholic should
make an examination of the "conscience" —
or a moral inventory and a frank discussion.
3. Character defects (sins)
can be eliminated by acquiring more honesty, humility, unselfishness,
tolerance, generosity, love, etc.
4. The alcoholic's basic
trouble is self-centeredness. Filled with fear and self
seeking he has forgotten the brotherhood of man.
5. The alcoholic should
learn the "expulsive power of a new affection,"
love of serving man, of serving God. He must "lose
his life to find it;" he should join the church and
there find self forgetfulness in service. For "faith
without works is dead."
Thus far religion and medicine
are seen in hearty accord. But in one respect they do differ.
When the doctor has shown the alcoholic his underlying difficulties
and has prescribed a program of readjustment, he says to
him, "Now that you understand what is required for
recovery, you should no longer depend on me. You must depend
on yourself. You go do it."
Clearly, then, the object
of the doctor is to make the patient self-sufficient and
largely, if not wholly, dependent upon himself.
Religion does not attempt
this. It says that faith in self is not enough, even for
a nonalcoholic. The clergyman says that we shall have to
find and depend upon a higher power - God. He advises prayer
and frankly recommends an attitude of unwavering reliance
upon Him who presides over all. By this means we discover
a strength much beyond our own resources.
So, the main difference
seems to add up to this: Medicine says, know yourself, be
strong and you will be able to face life. Religion says,
know thyself, ask God for power, and you become truly free.
In Alcoholics Anonymous
the new man may try either method. He sometimes eliminates
"the spiritual angle" from the Twelve Steps to
Recovery and wholly relies upon honesty, tolerance and working
with others. But it is interesting to note that faith always
comes to those who try this simple approach with an open
mind - and in the meantime they stay sober.
If, however, the spiritual
content of the Twelve Steps is actively denied, they can
seldom remain dry. That is our AA experience everywhere.
We stress the spiritual simply because thousands of us have
found we can't do without it.
At this point I should like
to state the Twelve Steps of the Alcoholics Anonymous Program
of Recovery so that you physicians may accurately compare
your methods with ours.
The Twelve Steps
1. We admitted we were powerless
over alcohol — that our lives had become unmanageable.
2. Came to believe that
a power greater than ourselves could restore us to sanity.
3. Made a decision to turn
our will and our lives over to the care of God as we understood
4. Made a searching and
fearless moral inventory of ourselves.
5. Admitted to God, to ourselves,
and to another human being the exact nature of our wrongs.
6. Were entirely ready to
have God remove all these defects of character.
7. Humbly asked Him to remove
8. Made a list of all persons
we had harmed, and became willing to make amends to them
9. Made direct amends to
such people wherever possible, except when to do so would
injure them or others.
10. Continued to take personal
inventory and when we were wrong promptly admitted it.
11. Sought through prayer
and meditation to improve our conscious contact with God
as we understood Him, praying only for knowledge of His
will for us and the power to carry that out.
12. Having had a spiritual
experience as the result of these steps, we tried to carry
this message to alcoholics, and to practice these principles
in all our affairs
Boiled down, these steps
mean, simply (1) admission of alcoholism; (2) personality
analysis and catharsis; (3) adjustment of personal relations;
(4) dependence upon some higher power; and (5) working with
Most strongly we point out
that adherence to these principles is not a condition of
AA membership. Any alcoholic who admits he has a problem
is an A.A. member regardless of how much he disagrees with
the program. Based upon our experience, the whole program
is a suggestion only. The alcoholic, objecting at first
to the spiritual factor, is urged to keep an open mind,
meanwhile treating his own AA group as a "power greater
than himself." Under these conditions the newcomer
commences to undergo a personality change at such a rate
and of such dimensions that he cannot fully account for
it on the basis of self-realization and self-discipline.
Not only does his alcoholic obsession disappear, but he
finds himself progressively free of fear, resentment, and
inferiority. These changes seem to have come about automatically.
Hence he concludes that "A power greater than himself"
must have indeed have been at work. Having come to this
point, he begins to form his own concept of God. He then
develops confidence in that concept, which grows as he gets
proof in everyday life that his new faith actually works,
really produces results.
This is what AA’s
are trying to say when they talk about a spiritual experience.
They mean a certain quality of personality change which,
in their belief, could not have occurred without the help
and presence of the creative spirit of the universe.
With the average AA, many
months, may lapse before he is aware of faith in the spiritual
sense. Yet I know scarcely an AA member of more than a year's
standing who still thinks his transformation wholly a psychologic
phenomenon based entirely upon his own normal resources.
Almost everyone of our members will tell you that, while
he may not go along with a clergyman's concept of God, he
has developed one of his own on which he can positively
depend, one which works for him.
We AA’s are quite
indifferent to what people may call this spiritual experience
of ours. But to us it looks very much like conversion, the
very thing most alcoholics have sworn they never would have.
In fact I am beginning to believe that we shall have to
call it just that, for I know our good friend, Dr. Harry
Tiebout, is sitting in this room. As you may know, he is
the psychiatrist who recently told his own professional
Society, The American Psychiatric Association, that what
we AA’s get is conversion - sure enough and no fooling!
And if the spirit of that great psychologist, William James,
could be consulted, he'd doubtless refer us to his famous
book, varieties of Religious Experience, in which personality
change through the "educational variety of spiritual
experience, or conversion is so ably explored. Whatever
this mysterious process is, it certainly seems to work,
and with us who are on the way to the asylum or the undertaker
anything that works looks very, very good indeed.
And I'm very happy to say
that many other distinguished members of your profession
have pronounced our Twelve Steps good medicine. Clergymen
of all denominations say they are good religion, and of
course we AA’s like them because they do work. Most
ardently we hope that every physician here today will find
himself able to share this happy agreement. In the early
years of AA, it seemed to us alcoholics that we wandered
in a sort of no-man's-land, which appeared to divide science
and religion. But all that has changed since AA has now
become a common meeting ground for both concepts.
Yes, Alcoholics Anonymous
is a cooperative venture. All cases requiring physical treatment
are referred to you physicians. We frequently work with
the psychiatrist and often find that he can do and say things
to a patient, which we cannot. He, in turn, avails himself
of the fact that as ex-alcoholics we can sometimes walk
in where he fears to tread. Throughout the country we are
in daily touch with hospitals and sanitariums, both public
and private. The enthusiastic support given us by so many
of your noted institutions is something for which we are
deeply grateful. The opportunity to work with alcoholics
means everything; to most of us it means life itself. Without
the chance to forget our own troubles by helping others
out of theirs, we would certainly perish. That is the heart
of AA - it is our lifeblood.
We have torn still other
pages from the Book of Medicine, putting them to practical
use. It is from you gentlemen we learn that alcoholism is
a complex malady; that abnormal drinking is but a symptom
of personal maladjustment to life; that, as a class, we,
alcoholics are apt to be sensitive, emotionally immature,
grandiose in our demands upon ourselves and others; that
we have usually "gone broke" on some dream ideal
of perfection; that, failing to realize the dream, we sensitive
folk escape cold reality by taking to the bottle; that this
habit of escape finally turns into an obsession, or, as
you gentlemen put it, a compulsion to drink so subtly powerful
that no disaster, however great, even near death or insanity,
can, in most cases, seem to break it; that we are the victims
of the age-old alcoholic dilemma; our obsession guarantees
that we shall go on drinking, but our increasing physical
sensitivity guarantees that we shall go insane or die if
When these facts, coming
from the mouths of you gentlemen of science, are poured
by an AA member into the person of another alcoholic they
strike deep - the effect is shattering. That inflated ego,
those elaborate rationalizations by which our neurotic friend
has been trying to erect self—sufficiency on a foundation
of inferiority, begin to ooze out of him. Sometimes his
deflation is like the collapse of a toy balloon at the approach
of a hot poker. But deflation is just what we AA’s
are looking for. It is our universal experience that unless
we can start deflation, as so self-realization, we get nowhere
at all. The more utterly we can smash the delusion that
the alcoholic can get over alcoholism "on his own,"
or that someday he may be able to drink like a gentleman,
the more successful we are bound to be.
In fact, we aim to produce
a crisis, to cause him to "hit bottom," as AA’s
say. Of course you will understand that this is all done
by indirection. We never pronounce sentences, nor do we
tell any alcoholic what he must do. We don’t even
tell him he is an alcoholic. Relating the seriousness of
our own cases, we leave him to draw his own conclusions.
But once he has accepted the fact that he is an alcoholic
and the further fact that he is powerless to recover unaided,
the battle is half won. As the AA’s have it, "he
is hooked." He is caught as if in a psychological vise.
If the jaws of it do not
grip him tightly enough at first, more drinking will almost
invariably turn up the screw to the point where he will
cry "Enough!" Then, as we say, he is softened
up. This reduces him to a state of complete dependence on
whatever or whoever can stop his drinking. He is in exactly
the same mental fix as the cancer patient who becomes dependent,
abjectly dependent, if you will, on what you men of science
can do for cancer. Better still, he becomes "sweetly
reasonable," truly open-minded, as only the dying can.
Under these conditions,
accepting the spiritual implications of the AA program presents
no difficulty even to the sophisticate. About half of the
AA members were once agnostics or atheists. This dispels
the notion that we are only effective with the religiously
susceptible. You remember now the famous remark, "There
are no atheists in the foxholes." So it is with most
alcoholics. Bring them within range of the AA and "blockbusters"
will soon land near enough to start radical changes in outlook,
attitude, and personality.
These are some of the basic
factors which perhaps partly account for such success as
we have had. I wish time permitted me to give you an intimate
glimpse of our life together, of our meetings, of our social
side, of those fast friendships unlike any we had known
before, of our participation by thousands in the war effort
and the armed services, where so many AA’s are discovering
that they can face up to reality - no longer institutionalized,
even within an AA Group. We have all found that God can
be relied upon both in Alaska and India, that strength can
come out of weakness, that perhaps only those who have tasted
the fruits of reliance upon a higher power can fully understand
the true meaning of personal liberty, freedom of the human
Surely, you who are here
this morning must realize how much we A.A.’s are beholden
to you, how much we have borrowed from you, how much we
still depend on you. For you have supplied us with ammunition
which we have used as your lay assistants - gun pointers
for your artillery. I have put out for inspection our version
of the factors which bring about personality change, our
method of analysis, catharsis, and adjustment. I have tried
to show you a little of our great new compelling interest
in life - this society where men and women understand each
other, where the clamors of self are lost in our great common
objective, where we can learn enough of patience, tolerance,
honesty, humility, and service to subdue our former masters
- insecurity, resentment, and unsatisfied dreams of power.
But I must not close without
paying tribute to our partner, Religion. Like Medicine,
it is indispensable. At this temple of science I hope none
will take it amiss if I give Religion the last word:
"God grant us the serenity
to accept the things we cannot change, courage to change
the things we can, and wisdom to know the difference."
Please address inquiries
and requests for AA literature to The Alcoholic Foundation,
Box 459, Grand Central Annex, New York 17, New York.
Dr. C. Kirby Collier, Rochester.
Realizing how ineffectual
our efforts in the treatment of the chronic alcoholic through
the usually accepted psychiatric procedures were was my
reason for investigating Alcoholics Anonymous. With one
of their members I was privileged to attend a meeting in
New York and had the opportunity to discuss their philosophy
with Mr. Wilson. First, I was impressed with the honesty
and sincerity of those members I met, and second, with the
broad socio-religious background and its psychiatric implications
- chiefly man's recognition of self, his abilities as well
as his inefficiencies, and that intangible power which all
mankind recognizes, whether he acknowledges it or not. Upon
my return home, I asked three chronic alcoholics, all of
twenty to twenty—five years duration, to organize
a group, after going over the situation with them as I understood
it. These three contacted others and held their first meeting
in the small apartment of one. Growing, they approached
me as to a place for meeting. We eliminated the YMCA, Public
Library, church halls, or parish homes for obvious reasons,
and at last advised a room in one of our large centrally
located hotels. This has worked out nicely and meetings
are held each Sunday afternoon and Wednesday evening. From
the original group of three, contacts have been made with
over 500, of whom 60 per cent are active members, having
been free from indulgence in alcohol for one to two years.
In our city we have had
a Council on Alcohol for about three years. The group consists
of psychiatrists, social workers, and others, who meet each
month for discussion. At two of these meetings members of
AA have spoken, and, as a result, two members of AA are
now members of this Council. Members of AA are frequently
called upon to address various groups, and it is most interesting
to hear of men who have never spoken in public before being
willing to get up and talk before any group. In Rochester
they have become especially interested in meeting with youth
groups. I might say that I have attended but few meetings
of the Rochester group and these only at their invitation.
I have felt that AA is a group unto themselves and their
best results can be had under their own guidance, as a result
of their philosophy. Any therapeutic or philosophic procedure
which can prove a recovery rate of 50 to 60 per cent must
merit our consideration. As stated by Tiebout in a paper
read at Detroit, Michigan, before the American Psychiatric
Association in May 1943, "It is highly imperative for
us, as presumably open—minded scientists, to view
wisely and long the efforts of others in our field of work.
We may be wearing bigger blinders than we know.
Dr. Foster Kennedy, New
We have heard a truly moving
and eloquent address, moving in its form and in its facts.
I have no doubt that a man
who has cured himself of the lust for alcohol has a far
greater power for curing alcoholism than a doctor who has
never been afflicted by the same curse. No matter how sympathetic
and patient the doctor may be in the approach to his patient,
the patient is sure either to feel, or to imagine, condescension
to himself, or to the notion that he is being hectored by
one of the minor prophets.
This organization of Alcoholics
Anonymous calls on two of the greatest reservoirs of power
known to man — religion and that instinct for association
with one's fellows which Trotter has called the "herd
instinct." Religious faith has been described by Matthew
Arnold as a convinced belief in a power greater than ourselves
that makes for righteousness, and a sense of helpfulness
from this can be acquired through a kind of spiritual conversion
which might well be called a variety of religious experience.
The sick man's association
with those who, having been sick, have become or are becoming
well, is a therapeutic suggestion of cure and an obliteration
of his feelings of being, in society, a pariah; and this
tapping of deep internal forces is shown by the great growth
of this sturdy and beneficent movement. Furthermore this
movement furnishes an objective of high emotional driving
power in making every cured drunkard a missionary to the
We physicians, I think,
have always had difficulty in finding an occupation for
our convalescent patients of sufficient emotional driving
power to replace the psychic results of the alcohol that
has been withdrawn. These men grow filled with a holy zeal,
and the very zealousness keeps the missionary steady while
the next man is being cured.
I think our profession must
take appreciative cognizance of this great therapeutic weapon.
If we do not do so, we shall stand convicted of emotional
sterility and of having lost the faith that moves mountains,
without which medicine can do little.
Dr. Harry M. Tiebout, Greenwich,
My first contact with AA
began five years ago when a patient with whom I had been
working for well over a year came under the influence of
AA and within a relatively short time dried up and for at
least four years has remained completely dry. At that time
I was puzzled and a little indignant that my best efforts
had failed but AA had worked; but I kept sending patients,
and now the situation has reversed. I get puzzled and a
little indignant when AA doesn't work.
As a psychiatrist, I have
to think about the relationship of my specialty to AA and
I have come to the conclusion that our particular function
can very often lie in preparing the way for the patient
to accept any sort of treatment or outside help. I now conceive
the psychiatrist's job to be the task of breaking down the
inner resistance so that which is inside will flower, as
under the activity of the AA program.
this respect I should like to point out that the same flowering
can take place with patients who are not alcoholics, and
I should like at this time to record my indebtedness to
Mr. Wilson and AA for the understanding which has made my
own therapeutic practice a more intelligent and meaningful
process in so far as my own attitudes is concerned. I now
have more faith in the patient's own inner resources.