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An interview with George E. Vaillant, M.D.
E. Vaillant, M.D., joined AA's General Service Board
as a Class A (nonalcoholic) trustee in 1998. He
is professor of psychiatry, Harvard Medical School,
director of the Study of Adult Development, Harvard
University Health Services, and director of research
in the Division of Psychiatry, Brigham and Women's
Hospital. The author of The Natural History of Alcoholism
Revisited, a comprehensive study of alcoholism,
George lectures widely on alcoholism and addiction
and is one of the foremost researchers in the field.
© The A.A.
Grapevine, Inc., May 2001
In an article about alcoholism in Harvard Magazine, you
were quoted as saying that 50 percent of the people brought
into emergency rooms with fractures are there as a result
of alcohol, but that blood-alcohol levels are never checked.
It made me curious about the way medical professionals view
alcoholism today. Can you tell us something about that?
Vaillant: What happens in emergency rooms is actually much
more dramatic than that. Probably 50 percent of all the
people brought into emergency rooms had blood-alcohol levels
over .25 - which is enough to make any nondependent person
comatose, not just prone to accidents. And even though this
is a clear biochemical fact staring doctors in the face,
no referral is made - nothing is done about it - because
when it comes to treating alcoholism, the medical profession
feels so helpless, so without hope. And for a doctor, feeling
powerless is reason enough to put his head in the sand.
Why do you think that feeling persists?
Vaillant: You have to remember that very few doctors have
ever seen a recovered alcoholic. If you're recovered, you
don't have any reason to tell your doctor you're an alcoholic.
And if you're not recovered, you go back to see him a hundred
times, so you're forever etched in his memory. Consequently,
doctors overcount the failures and have no knowledge of
the successes. They don't understand that 40 percent of
all recovery has probably occurred through Alcoholics Anonymous.
What could be done to change that?
Vaillant: The two simplest ways that I know are both within
the power of the Fellowship. One is to take your doctor
to open meetings so he or she can see for themselves these
well-dressed people in nice suits who look like anybody
else and have been in recovery for years. It was terribly
important for me to get inside of open meetings and see
sober alcoholics for myself because they're terribly inspiring.
second is to twelfth-step your doctor - not to teach him
about alcohol or Alcoholics Anonymous, but to give him a
list of names that motivated patients could call. Doctors
aren't experienced enough in their practices to find recovering
alcoholics, so recovering alcoholics must either say "I
will talk with patients," or give doctors referrals.
What medical professionals need is a list of referral sources,
clearly typed, and some success using those referrals, so
they have hope rather than hopelessness.
How did you, a nonalcoholic, get to know AA?
Vaillant: I was working for an alcohol clinic where it was
a condition of employment. I had to go to a meeting a month.
In addition, half the staff were recovering alcoholics,
and they were the first people whom I'd met at Harvard in
ten years who knew anything about the disease.
Is there any movement afoot to establish that kind of requirement
for medical students today?
Vaillant: For the last ten years, medical students in many
medical schools have been required to go to one or two AA
meetings, due in large part to the activity of AA's CPC
(Cooperation with the Professional Community) committee.
But the problem is that in your first two meetings, there's
so much going on that you don't always get the feeling of,
"My God, these people are recovering." It's more
about learning what a terrible disease alcoholism is and
not about realizing that the people in the meeting are the
same people you see in your emergency room with the fractures.
people are only slowly learning is that you can teach medical
students anything that's noble and good about people and
they get it right on the exam. But where medical students
learn how to be doctors is on the hospital wards and in
the emergency rooms, where they're working with residents.
And interns, for very good reasons, hate active alcoholics
with a passion. Therefore, the educational program has to
begin again after residency. And that really is something
patients can do for their doctors - not by teaching them
about AA, but by telling their stories and offering whatever
suits them of the Twelve Steps. And, as I said, by giving
them a number to call when the roof is falling in.
You said about 40 percent of the people who remain abstinent
do it through AA. What about the other 60 percent? Could
we in AA be more open, more supportive of these?
Vaillant: Yes. You know, if you're batting 400, it's all
right to miss a few. I think the fact that AA knows the
answer to an extremely complicated problem is probably all
it doesn't hurt at the level of GSO for AA to have humility
and understand that 60 percent do it without AA. It's also
true that most of those 60 percent do it with the AA toolbox:
their spirituality doesn't come from AA; their support group
doesn't come from AA; and what I call "substitute dependency"
doesn't come from AA. But they still use the same ingredients
that AA uses.
I don't think there's anything that the other 60 percent
are doing that AA needs to learn from, except: "If
it ain't broke, don't fix it." If you meet someone
who has stayed sober for more than three years and they're
pleased and boasting that they did it without AA, thank
your Higher Power for another recovery. You know, there's
"little" sobriety, being dry, and there's sobriety
with a big S, which includes humility and not thinking that
you're the center of the earth. So if someone is doing something
without your help, good enough.
What have you discovered about AA since becoming a trustee?
Or as you put it, what if anything has made you say, "Aha!"
Vaillant: I'd never seen the General Service Manual before,
and to me as a nonalcoholic, it is a great piece of world
literature, like the American Constitution. It is a great
contribution to human thought.
also learned something about spirituality. Every time there
is a board weekend, I arrive thinking, "Oh my God,
this is another weekend I'm not with my family." Then
I spend the next two days bathed in love and acceptance
that is not from my being anyone special. So I've learned
another definition of spirituality: we are each like the
beautiful wave that's about to crash on the beach, saying,
"This is it. This is forever." Then a voice from
behind says, "Don't worry, son. You're not a wave;
you're part of the ocean."
There is still a great deal of debate about the role of
addicts in AA. What are your views on that?
Vaillant:This is a terribly important question. AAs should
focus on alcoholism. They're right. They've got enough to
do, and there are enough alcoholics to go around in the
world that they should never fear for their primary purpose.
because there are a lot of people with mixed addictions,
it's important for individual groups that can tolerate them
to be tolerant and inclusive. There are some groups that
welcome white, middle-aged Protestant males. And that's
okay; they should be there, even though the rest of AA may
regard them as hopeless dinosaurs and politically incorrect.
And there are other groups that tolerate people who spend
a little bit too much time talking about their $5-million
cocaine habit and not enough time talking about alcoholism.
And that's the wave of the future. There are increasingly
fewer alcoholics. So some groups are going to have to change.
What are some of the other challenges that AA faces?
Vaillant: I think there are two, really. One is to come
to some meaningful terms with the individuals who are frightened
that AA is a religion. This will involve some work and growth
in AA to incorporate its diversity without losing its traditions.
This is in keeping with the question of keeping the first
164 pages that Bill W. wrote in the Big Book and at the
same time including contemporary stories about things some
groups might be horrified by.
second challenge (and this may be more important to me as
a class A trustee) is to convey to the world what an extraordinary
organization Alcoholics Anonymous is - not only in its ability
to cure alcoholism but in its ability to conceptualize the
fact that we're all one planet.
as an example, groups that are supposed to know about human
beings and to be peaceful - the Christian church, the psychoanalytic
movement, and the peace movement - are constantly splintering
and fighting with each other. And somehow for sixty years,
AA has kept two million very diverse individuals, who in
their past lives were often a lot less peaceful than the
Christians, the psychoanalysts, and the advocates of peace,
working together for a common good.
not sure that's a challenge to the Fellowship, or necessary
to keep people sober. It's simply to me a challenge that
people appreciate the depth of this message, which is expressed
more in the Twelve Traditions and Twelve Concepts that in
the Twelve Steps.
When you spoke of religious skeptics or of those fearful
that AA might have a religious agenda, were you thinking
of professionals in the field of alcoholism, or alcoholics
Vaillant: Oh, both. Alcoholics, because of the shame, are
enormously sensitive to exclusion. So to say, "If you
want what we have, you have to believe in a Higher Power;
you have to be spiritual, or you have to fake it till you
make it" is enormously threatening to some people.
They're still at a point of self-absorption; the idea of
depending on a power greater than themselves is something
they're going to have to learn. Think of it this way: there
are a lot of things parents believe, like the value of working
hard and completing an education, that make no sense to
an eighteen-year-old. And for some alcoholics, spirituality
is like one of those things that you learn when you get
older. AA has to constantly remind itself that it needs
to meet people where they are and that it can only make
W. spells out very clearly that Alcoholics Anonymous is
not a religion. And he makes it clear that there should
be nothing about AA that excludes anyone who's a suffering
alcoholic. But how you get people who've grown up in one
tradition to understand how the world looks to people who've
grown up in another takes ongoing discussion. Universality
is very hard to achieve. And AA, in its effort of world
unity, is constantly having to evolve. It's not a question
of changing. It's a process of growth.
© The A.A.
Grapevine, Inc., May 2001
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