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Anonymous Struggle for 25 Years
The
growth of Alcoholics Anonymous, founded a quarter-century
ago this month, has spurred new efforts to control a major
national health problem.
by
H. Jack Geiger
On
the evening of June 10, 1935, a New York stockbroker visited
a surgeon in a suburb of Akron, Ohio. Both men were confirmed
and "hopeless" drunks. In despair and loneliness,
they almost inadvertently made a major medical and social
discovery. This month, nearly a quarter of a million people
in sixty nations - their lives deeply touched by that event
will mark its twenty-fifth anniversary.
The
stockbroker and the surgeon began to realize, that evening,
that they could stay sober, and be helped, by helping other
alcoholics to stay sober. In the past quarter-century, their
realization has been repeated a hundred thousand times over,
in strikingly varied settings and involving the whole roster
of human types. For from it grew Alcoholics Anonymous, the
remarkable fellowship of compulsive drinkers who don't drink.
There
is a great natural drama in the story of A.A. But by now
perhaps the drama is less important than the attempt to
read its meaning. Beyond the questions - What is A.A., does
it work, how often, how well, for whom? - there is an important
issue: what has it taught us about alcoholism?
A.A. is not, as some suspect, a herky-jerk parade of stumble-bums
shambling up the road from skid row to salvation; it lacks
the psalm-singing self-righteousness of the usual crusade.
Neither is it a "scientific" or medical organization.
Nor is it, finally, "the answer" to alcoholism.
But it is - and this is the crucial fact - the top of the
iceberg, one of the view visible aspects of a major national
health problem. To understand A.A. it is necessary to know
something about the underlying structure of alcoholism -
the parts of the iceberg that we usually keep below the
surface of national awareness and concern.
It is a big iceberg. A recent estimate (and it is probably
a serious under-estimate) counts more than 4,700,000 alcoholics
in the United States - one man in every fifteen over the
age of 20, six men for every woman. Only about 8 per cent
are on skid row, and only about 750,000 have obvious signs
of illness. There are one to two million problem drinkers
in industry, hundreds of thousands in the wards of mental
hospitals. Five to six million wives, husbands, parents
and children are living in the same household with alcoholism
and are the victims of its erratic behavior.
The
count could be more accurate if researchers had an exact
idea of what they were counting.
Alcoholism is not simply synonymous with drinking, heavy
drinking or drunkenness, and no one is certain whether it
is a symptom, a disease in its own right, or several diseases.
Most of the rule- of-thumb definitions (the man who drinks
alone, the man who drinks the first thing in the morning,
the man who has "lost his will power") are either
wrong or inadequate. Most of the scientific classifications
(one of the researchers recently counted thirty-four) are
not much better.
One theme, however, keeps recurring. The alcoholic is a
man who is either unable to abstain from liquor or unable
to stop once he has started; the first drink "pulls
a trigger" and his controls disintegrate.
Within
this broad definition, some researchers feel, there are
at least two distinct types: "addictive" drinkers,
driven usually by internal stresses, who seek the biggest,
quickest alcoholic jolt they can find, and "habitual
excessive symptomatic" drinkers, men in search of a
gentle, anxiety-obliterating alcoholic plateau with the
longest - not the quickest or most intense - effect.
Theories
about the cause of alcoholism are equally vague. One group
holds that a genetic - or combined genetic and nutritional
–diet effect causes a craving for alcohol, but the
evidence is skimpy.
Psychiatrists contend that alcoholism is the expression
of self-destructive urges - "chronic suicide,"
in one man's graphic phrase - or of homosexual impulses,
or of a fixation on oral pleasures. A recent Stanford University
study explicitly tested these hypotheses, and found no good
evidence for any of them.
Still another theory rests on the startling difference in
alcoholism rates among ethnic and social-class groups in
the United States. The relative number of alcoholics, for
example, among Irish-Americans and "native-stock"
Americans is much greater than among Italian-Americans and
Jews. The figures are consistent with the idea that cultures
with contradictory values and customs - for example, associating
alcohol with pleasure and sin, escape and drunkenness -
are likelier to produce alcoholism than cultures in which
drinking is consistently seen as an unremarkable supplement
to meals, or a part of ritual religion.
A dwindling but highly vocal group finally, still insist
that the cause of alcoholism is alcohol itself, despite
the fact that some 94 percent of all the Americans who drink
never experience uncontrollable cravings for alcohol, blackouts,
"the shakes" or similar symptoms.
Alcoholics
Anonymous agrees that the alcoholic is forever "One
drink away from a drunk" - but there the theorizing
stops. In the belief that alcoholism comes in people, not
bottles, it takes no stand on prohibition, temperance or
liquor laws.
A.A. is a vast network of local organizations, but it has
almost no organizational structure. Its growth has been
meteoric, but it has never asked anyone to join. Its one
goal is sobriety, yet no member ever "takes a pledge."
Its tone and orientation are religious, but its membership
includes several thousand agnostics who happily rub shoulders
with Protestants, Jews, Catholics and Mormons.
Though
it keeps no records, conducts no research and is, if anything,
faintly hostile to too much probing (We're just a bunch
of ex-drunks," says one member, "and we don't
care how or why it works, so long as it does"). A.A.
has been at least indirectly responsible for major strides
in the scientific understanding of alcoholism.
It detracts not at all from A.A.'s accomplishments that
this new scientific effort suggests that A.A. is not the
whole answer to alcoholism and that, in fact, its methods
and results are not much better or worse than any others.
What
are the methods? The interested observer can find out on
almost any night in any American city. Atypical meeting
begins with from thirty to 100 men and women gossiping on
rows of wooden chairs in a church meeting house or a rented
hall. There is a busy traffic to and from a stand with coffee,
soft drinks and doughnuts.
In one corner, someone is idly playing a piano. The air
is heavy with cigarette smoke, and the talk is loud and
cheerful. On the wall are a few signs with messages like
"Easy does it" and "First things first."
One bears the A.A. motto:
"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."
The visitor who plays guessing games about those present
soon discovers he is wasting his time: the seedy looking
young man in the front row is a casual guest who has never
been drunk in his life; the white haired, grandmotherly
lady next to him has a record of twenty arrests and six
hospitalizations.
Here
and there, however, he may be able to spot a newcomer -
someone drawn and tense and perhaps tremulous - and he may
note that each one is sticking close to a "sponsor,"
an established A.A. member who is giving him special attention,
introducing him to friends, pouring his coffee.
Finally, the chairman calls for order. "My name is
Joe and I'm an alcoholic," he begins. He announces
that this is the regular weekly "open" meeting
of the group (there is a closed meeting for alcoholics only,
later in the week). He calls for a moment of silence "to
be used as each person sees fit." He announces plans
for a dance, a bowling contest, and a party to be sponsored
by the local "Al-Anon an auxiliary group in which relatives
of A.A. members meet to talk over some of the problems of
having an alcoholic in the family.
Then
he introduces the first of three speakers from a neighbouring
A.A. group who have come to "tell their stories."
The first speaker begins with the standard line: "My
name is and I'm an alcoholic." ("If he can make
it anyone can," someone whispers gleefully. "He
was the worst wet brain in history.")
What follows is, perhaps, the last thing the visitor expects:
it is at once tragic and uproariously funny, and the hall
rocks again and again with laughter.
A
steelworker describes his weekly, wobbly odyssey from home
to jail to hospital to home again - where his despairing
wife, he adds, always covered him with the help- wanted
pages from the newspaper while he slept it off.
A business executive recounts his early career as a bootlegger's
assistant, hauling home-made gin in a baby carriage until
"some drunk stole the wheels." Later, a confirmed
alcoholic, his job and family gone, he decided to drink
himself to death - only to discover, painfully, that "you
don't die that easy."
A suburban housewife wryly displays the sole trophy of her
drinking days, a citation as a faithful Cub Scout den mother.
"The kids must of had a great time, with me drunk at
every meeting," she says, but adds quietly, "except
for two of them - my kids."
The
laughter that comes is the laughter of recognition. The
alcoholic newcomer discovers that the troubles, horrors
and tragedies he thought were unique have, in fact, been
shared by most of the people in the hall - people who now
are not only sober but (to his even greater astonishment)
happy.
A number of themes run through the talks, "Easy does
it" turns out to be a warning against the grandiose
ambitions and unrealistic drives that affect alcoholics.
"First things first" is a reminder of the need
for priorities in the long job of rehabilitation.
Another
slogan, "Live and let live," is shorthand for
the observation that resentment and self-pity push the drinker
back toward the bottle. The "24-hour plan" expresses
the knowledge that the alcoholic's only hope at present
is total abstinence - and that it is easier to quit one
day at a time than to face a lifetime without alcohol's
solace.
In all the talks there are reference to the "Twelve
Steps, "which are the core of A.A. belief. Here the
compulsive drinker admits that he has become powerless over
alcohol, that his life has become unmanageable. He decides
that his fate is in the hands of a "Power greater than"
himself, and turns his life over to "the care of God
as I understand Him."
He
undertakes a searching self-inventory, admits his wrongs,
tries to make amends, prays for removal of his shortcomings.
Finally - the all-important Twelfth Step - he tries to carry
the message of this "spiritual experience" to
other alcoholics if and when they seek help.
This
is, in essence, what began in Akron in 1935, spread slowly
to New York, then to Cleveland and Chicago. In 1938 there
were sixty members; by 1940, one man recalls, "there
were two's and three's and five's of us in half a dozen
cities."
Today
after a period of explosive growth beginning in 1941, there
are more than 7,000 groups. Each is autonomous and self-
supporting (by voluntary and unrecorded contributions, not
dues) and has no permanent chairman or officers.
The
individual groups support an over-all "General Service
Board" seven alcoholics, eight nonalcoholics - in New
York, and this, together with an annual convention of elected
delegates and a national newspaper wryly called "The
Grapevine," is all that holds the loose federation
together.
A.A. works, its students believe, by overcoming the drinker's
biggest barrier - the lack of real, vital emotional contact
with any single human or group, the feeling that nobody
really understands or cares. In A.A. he finds people essentially
like himself, who cannot reject him and whom he finds hard
to reject or deceive. The concept of alcoholism as an illness
eases his guilt; his identification with a group dilutes
it. Gradually, the group itself provides a satisfying alternative
to drinking.
How
well does A.A. work? A.A. usually claims that of those who
really try, 50 per cent sober up at once and stay that way,
another 25 per cent remain sober after a few relapses. Unfortunately,
the best evidence suggests that these figures are probably
wrong. A few careful studies by outside observers report
much lower figures in the 30-to-40 per cent range.
The
most important source of error, of course, is the statistical
catch in "those who really try." This means, in
effect, counting only those alcoholics who find the program
attractive enough to join, and dismissing the failures as
persons who don't count.
Clearly,
the alcoholics who join A.A. are a self-selected group and
may not be representative of all alcoholics. A recent study
by Cornell University's Dr. Harrison Trice - one of eight
nonalcoholic members of A.A.'s General Service Board - found
striking differences in personality and past experience
between A.A. members and uncontrolled alcoholics who had
come to meetings but failed to join.
But results like these may represent a major step forward,
for they suggest that there is no single type of "alcoholic"
and no single "cure." The important question then
becomes, not "What works?" but "What works
best - for whom?"
Twenty-five
years ago when A.A. began, alcoholism made physicians uneasy,
frustrated psychiatrists, hardened social workers, wearied
judges and jailers, inflamed "wets" and "drys"
and, all too frequently, killed the alcoholic.
It still does - but the picture is changing. Tranquilizing
drugs can be used to help control alcoholic cravings and
ease the pangs of withdrawal - and they give the physician,
at last, the knowledge that there is something he can really
do for such patients.
Psychiatrists,
in recent years, have soft-pedaled their emphasis on alcoholism
as a mere symptom of some deeper emotional disorder and
focused on the drinking itself. Perhaps more important,
they are beginning to abandon the widely held feeling that
alcoholism is an incurable personality defect and are trying
new, less orthodox therapies.
"The
psychiatrist and his techniques have to be less rigid,"
notes Dr. Morris Chafetz of Massachusetts General Hospital's
alcoholism clinic in Boston, "and he has to be a pioneer
in his approach to each case."
"The
passive, non-directive therapist of alcoholics who follows
his usual therapeutic approach usually has no patients to
treat after a while."
At this and other clinics, psychiatrists now work in teams
with social workers and psychologists. Wherever possible,
if the patient has a family, an attempt is made to bring
the wife into treatment, too, in individual or group counseling
sessions. Almost invariably, such efforts increase the success
rate to 30 per cent or better.
In the past decade, finally, a therapy has began to appear
for the skid-row drinkers, the derelicts, the homeless men
of the bottle gang who rotate between rented rooms and jail.
Observers noted that these men did well while they were
jailed - and protected - but always drank when they were
tossed out, jobless and unskilled in the simplest tasks
of living.
A
dozen states now have "half-way houses," small
residential units which offer food and shelter, group identification,
support from physicians and social workers, and a firm but
gentle push toward employment and self-sufficiency. The
improvement rate - and these are the "hopeless"
men - is better than 30 per cent.
For
all these advances, including many in which it has had no
direct part, A.A. can claim some real credit - they may,
in fact, represent its greatest contribution. Raymond G.
McCarthy of Yale's Center for Alcohol Studies, explains:
"The
real effect of A.A. extended far beyond its members. A.A.
changed the social climate, dramatized alcoholism as an
illness, substituted 'alcoholic' for 'drunkard' in public
thinking, and demonstrated that something could be done."
In
this 1960 view, AA’s 200,000 members are still, statistically,
only a drop in the bucket. And, as is the case with all
other workers in the field of alcoholism, they clearly have
a long way yet to go.
But
already they have added a strange social prescription to
medicine’s stock of remedies. The idea is, after all,
very old. “I am my brothers keeper,” says one
member, and he is mine and that’s the heart of it.”
(Source:
The New York Times Magazine, June 5, 1960)
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