Journal of Psychology and Theology, Vol. 15 (2), 124-131, 1987
The Success of Alcoholics Anonymous:
Locus of Control and God's General Revelation
by Laird P. Bridgman and William M. McQueen, Jr.
Alcoholism may be the oldest and most cross-culturally persistent problem man has had to face. It can be found in every culture that knows alcohol, and it is no respector of age, race, social status, income, or sex. Certainly every generation has felt that the problem of alcoholism is worse in their decade than in previous generations. The present generation is no exception. Mayer (1983) reports that alcohol-related accidents are the leading cause of death in the 15-24 age group in our nation, and that 5%, or approximately 10 million Americans are at risk for serious health and social consequences. Efforts directed toward treating the problem of alcoholism have been varied and wide-ranging with little success in reforming the alcoholic individual. Alcoholics Anonymous, however, is one exception to this poor success rate.
Alcoholics Anonymous (A.A.) is a fellowship of "alcoholic men and women who have banded together to solve their common problems" (Alcoholics Anonymous, 1984a, p.15). World wide membership in 1976 was estimated at more than one million members from only 28,000 groups meeting at that time. In 1984, more than 58,000 groups were meeting in 114 countries (Alcoholics Anonymous, 1984c). A.A. literature reports recovery rates up to 75% of members who really use their methods. For example, Geary (1980) found continued sobriety among 50% of 56 alcoholics from an A.A. inpatient program at a 24 month follow-up. As the research shows, Alcoholics Anonymous can be a very effective program.
Origins of the A.A. Program
The origins of Alcoholics Anonymous are of special importance to our topic, as most people are unaware of the evangelical foundations of the A.A. program. The story began with the struggle for sobriety of a man named Bill Wilson, a one-time Wall Street success story whose career was ruined by his alcoholism. While Bill was searching for ways to stay sober he met Ebby T., another struggling alcoholic, and through him was introduced to the Oxford Group, a "non-denominational evangelical movement streamlined for the modern world." It was the principles of the Oxford Group, originally called the First Century Christian Fellowship, which were to have a profound influence in the latter formation of the A.A. program. Bill Wilson describes the Oxford Group's philosophy best:
"Little was heard of theology, but we heard plenty of absolute honesty, absolute purity, absolute unselfishness, and absolute love. Confession, restitution, and direct guidance of God underlined every conversation. We were talking about morality and spirituality, about God-centeredness versus self-centeredness."
The A.A. members stayed with the Oxford Group for several years until it became obvious that the alcoholic members had a different focus from the non-alcoholic members. According to Bill, "From our point of view, we felt very sure we couldn't do much about helping the Oxford Group to save the whole world. But, we were becoming more certain every day that we might be able to sober up many alcoholics." So, in 1937 the alcoholic members left the Oxford Group and, feeling "like a nameless bunch of alcoholics," soon adopted the name "Alcoholics Anonymous."
In May of 1938, Bill began attempting to set down the principles of A.A. He soon realized that although the suffering alcoholic needed a "spiritual awakening" to reach sobriety, the religious terminology of the day and especially the authoritarian method with which it was often presented tended to hinder many alcoholics from receiving it. Eventually three factors emerged within A.A. The atheists and agnostics did not want the word "God" to appear in any of the writings. The liberals (the largest group) had no objections to the use of "God, " but they objected to any other theological propositions. The conservatives felt that A.A. was a Christian group from the beginning and ought to say so up front. After much compromise and heated debate the principles were slowly and painstakingly formed. In April, 1939, the "Big Book" was published. It, and the 12 Steps it contained, was expressed "in terms that anybody - anybody at all - could accept and try. Countless A.A. members have since testified that without this great evidence of liberality they could never have set foot on the path of spiritual progress or even approached A.A. in the first place."
Principles of the A.A. Program
The A.A. program of treatment for the alcoholic individual is based on the philosophies found in the Twelve Steps. They are as follows:
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 Him.
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 our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
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 awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
The core of the A.A. program is based on the first two steps. Unless alcoholics are willing to admit powerlessness over alcoholism, and that only a Power greater than the individual can restore them to "sanity," they cannot reach recovery. Because of the progressive and lethal nature of their problem, alcoholics believe that acceptance of these two facts leads to life and that denial eventually leads to death.
A.A. members refer specifically to a "Higher Power" to whom they must turn over their lives if they are to continue to live (Step 3). The terminology they use and the spiritual base itself are constructed to purposefully avoid any "religious" terminology which might alienate some individuals. Atheists and agnostics are encouraged to "keep an open mind" regarding the concept of a Higher Power, and, if nothing else, to consider the group itself as the "Higher Power." The concept of "God" or "Higher Power" is defined only by the group or individual's understanding of him, and not as someone else or some church might describe him. A.A. members credit their Higher Power with the successful maintenance of their sobriety. As they turn their lives and wills over to his care, he gives members the power not to drink.
Social Learning Theory and Locus of Control
According to Rotter's (1954) social learning theory, reinforcement strengthens the expectancy that similar behavior will take place in the future. The potential for a given behavior to occur is a function of the reinforcing value of the behavior's results and the individual's expectancy that the behavior will result in such reinforcement. The latter concept, the individuals expectancy of the outcome of behaviors, is referred to as locus of control (LOC). Lefcourt (1976) described it as a "generalized expectancy, operating across a large number of situations, which relates to whether or not the individual possesses or lacks power over what happens to him"
Traditionally, LOC has been defined as a bipolar construct, with internal LOC and internal LOC being the opposite poles. Individuals with an internal LOC are those who feel that they are masters of their own fate. They have control over what happens to them in life. Individuals with an external LOC have the opposite perspective. They feel at the mercy of the situation or circumstances around them.
More recently, researchers have suggested that LOC is a multidimensional rather than a unidimensional construct. Lefcourt (1972) suggested that external control could be separated into two dimensions: the influence of powerful others and the effects of chance and luck. Levenson (1974) constructed and validated a multidimensional LOC scale to measure expectations influenced by internal mastery, control by powerful others, and chance.
Rotter (1975) suggested that expectations in a specific situation are a function of the expectancy peculiar to that situation, as well as being a function of generalized expectations. The balance between these specific expectancies and generalized expectancies is determined mostly by the novelty of the situation - and the generalized expectation increases in importance as the situation becomes more ambiguous or novel. Rotter therefore suggested that responses in familiar situations can most easily be estimated by using a measure that relates directly to the expectancy in that situation.
Worell and Tumility (1981) argue that an alcoholic's internality is engendered by the use of the drug itself and may, therefore, have little of its origins in the individual's social reinforcement history. They suggest that what is needed is a measure directly relevant to the sense of control experienced by alcoholics over their drinking. The data from the research (e.g., Donovan & O'Leary, 1978), as well as arguments such as Worell and Tumilty's have led to the development of LOC measures specifically designed to evaluate the individuals' perceived LOC regarding their drinking behaviors.
Alcoholism and Locus of Control
The use of drinking-specific LOC measures has not adequately accounted for, or resolved, the confusion that exists in the research. Part of the problem may be a reluctance on the part of science to change old ways of thinking in spite of conflicting evidence. Traditionally, and logically it seems, alcoholics have been viewed as having an external locus of control. All too often alcoholics have been heard to insist that they need a drink because....Maybe they had a hard day at work, or maybe their spouse nags them all the time. Whatever the "reason," alcoholics always appear to be drinking because of something that someone else did. One A.A. author aptly summarizes: "looking back at this kind of thinking and our resultant behavior, we see now that we were really letting circumstances outside ourselves control much of our lives." This is what is thought of as an external locus of control. Researchers have proceeded to search their data to find statistics supporting their stated or implied hypothesis that alcoholics have an external locus of control prior to treatment will result in the alcoholic's developing an internal locus of control. Much to the consternation of these researchers, they have continued to find that their pretreatment alcoholics have a significant internal locus of control orientation. Not satisfied with these results, they have continued to explain away the problem data by attributing it to confounding variables such as age, socio-economic factors, and variability on cut-off scores on the Internal-External scales (Butts & Chotlos, 1973; Costello & Manders, 1974: Naditch, 1975; Oziel, Obitz, & Keyson, 1972; Robsenow & O'Leary, 1978).
However, members of A.A. will insist that it is an internal locus of control regarding their drinking which causes them the problems. Alcoholics persist in maintaining their drinking behavior in the face of strong social, financial, and personal health pressures to change - a trait of the internally oriented individual. As A.A. notes, "He, the alcoholic, is and must be the master of his destiny. He will fight to the end to preserve 'that position.
Even if one accepts the A.A. model that an alcoholic has an internal LOC, that still does not account for the conflicting research data. The problem is that the general measures of LOC often yield different information than specific measures of LOC in the same study (Pyle, 1984). However, the variance in the data may be accounted for if, as Pyle suggests, one allows for the possibility that the individual is able to substain two distinct loci of control; one for life events in general and the other for drinking behaviors. This would account for much of the conflicting research regarding alcoholism and LOC.
Prior to treatment, alcoholics LOC tends to be internal (Distefano, Pryer, & Garrison, 1972; Gols & Morosko, 1970; Gozali & Sloan, 1971; Pyle, 1984; Worell & Tumility, 1981). They view themselves as having the ability to control their own drinking. They drink because they "want to." However, alcoholics are unable to control their drinking by their own willpower or resources. As A.A. points out, "It is now well established that willpower all by itself is about as effective a cure for alcohol addiction as it is for cancer." To reach and maintain sobriety, alcoholics must surrender to the fact that they cannot control their drinking. Tiebout, according to Brown (1985), defines surrender as "the moment of accepting reality on the unconscious level," and sees a difference between "surrender" and "compliance" in that compliance is a temporary submission to abstinence with an unconscious intention to return to drinking." Brown states that "the individual who has accepted the reality of loss of control can proceed to live with that reality, beginning the process of recovery...Rather than an abnegation of responsibility, the admission of powerlessness is the first step in the assumption of responsibility." This surrender represents a shift in locus of control orientation from internal to external.
An example of this shift in locus of control is found in Pyle's (1984) study with a male Veterans Administration inpatient population. His hypotheses were, for the most part, in keeping with those of previous researchers. For example, he predicted that successful treatment would result in an increase in internality, and the pretreatment internality would be positively correlated with successful treatment. However, his results did not support his hypotheses. His data illustrated a significant shift across treatment from an internal to an external LOC. Also, success at follow-up was significantly correlated to externality at post treatment. This development of an external LOC by surrendering the will to a Higher Power is the principle mechanism behind most of the success of A.A. That is, there are positive psychological effects of surrendering to a Higher Power regardless of the actual power of the particular god. Brown (1985) quotes one A.A. member's description of the key to his recovery: "I could not have maintained a comfortable sobriety without having had a spiritual awakening and the resultant radical shift in my beliefs and my entire being in the world." There are obviously other factors, such as social support (Donovan, 1984; Lefcourt, Martin, & Saleh, 1984), which play into the successful treatment of an alcoholic in the A.A. program, but the principle mechanism is A.A.'s central theme of a Higher Power.
If the Twelve Steps are carefully examined it will become apparent that A.A. teaches its members two distinct attitudes. The first, as discussed above, is that they must accept the fact that they are "utterly helpless" to control their drinking. The second, which is drawn from Steps 3-12, is that they must become responsible human beings. Note particularly Steps 8 and 9, which instruct individuals to make a list of everyone they have wronged and to make direct amends wherever possible. A.A. teaches that members must take charge of their own lives; no one is going to do it for them. These attitudes coincide with the hypothesis stated earlier by Pyle (1984) that it is possible for the individual to sustain two distinct loci of control, one for life events in general and the other for drinking behaviors. O'Leary, Donovan, Hague, and Shea (1975) argued that increased internality is associated with accountability for actions, responsibility for decision-making , and acceptance of consequences. Obviously it is more desirable for individuals to be and act responsible for themselves than to be irresponsible, and researchers have persistently asserted that the alcoholic needs to develop more internality and to be a more responsible person. The problem is that the researchers have tried to generalize that principle to the alcoholic's behaviors, and as discussed above, that is not the cure, but the problem. However, helping alcoholics to develop an external LOC regarding their drinking behaviors and an internal LOC regarding life in general seems to be the optimal solution.
Christianity and A.A.
Christians who examine the principles of the A.A. program are most commonly struck by the absence of any reference to Jesus Christ. They will notice a considerable amount of energy being spent on the concept of God or a Higher Power. In fact, Royce (1985) suggests that if one were to remove the concept of God, A.A. would no longer be an effective program. How are Christians to reconcile the obvious success of many A.A. members with their lack of a relationship with Jesus Christ? How can an individual who does not profess Jesus Christ as Lord have a personal relationship with God? This is a particularly important question where it appears that God is indeed providing some sort of help to that person.
The Apostle Paul, in his letter to the Christians in Rome, writes, "All have sinned and fallen short of the glory of God" (Romans 3:23). His point is that all humans are sinners and therefore lack the ability to have a personal relationship with God. In spite of humanity's condition, God loved them enough to reach out and provide the means whereby humankind and God could once again enjoy a personal relationship. That means was the sacrifice of God's only son, Jesus Christ, so that "whoever believes in Him (Christ) should not perish, but have eternal life" (John 3:16). In the Gospel According to John, Jesus says, "I am the way, and the truth, and the life; no one comes to the Father, but through me" (John 14:6). Therefore, no one can have a personal relationship with God unless they come to God through Christ Jesus.
However, our point is not to deny that God is at work in the recovery process, but that he is working more in a general revelatory sense rather than a special revelatory sense (Narramore, 1985). When general principles are discovered through science or nature which apply to all people, then that is a demonstration of God working through naturalistic laws, which are a part of his general revelation to man. For example, Narramore uses the example of the healing of a broken leg to illustrate this concept. If the doctor sets the leg in a cast and three months later the leg is mended, then that is an example of God working through the natural healing processes he created in the human body. This natural process is a part of God's general revelation. If God performs a miracle and supernaturally heals the leg, then that would be an example of God working through special revelation. With respect to the A.A. program, it is through God's general revelation (the A.A. principles) that the alcoholic achieves sobriety through the development of an external locus of control. Also, much of the success of secular psychotherapy could be explained for Christians in terms of God's general revelation.
Issues for Future Research
The research and issues just discussed raise many important questions for future research. First, research should pursue the hypothesis that it is possible for an individual to sustain two distinct loci of control, one for a specific behavior such as drinking and the other for life in general. Secondly, research is needed with which begins with the hypothesis that alcoholics are more internal with respect to drinking at the start of treatment, shift to an external locus of control across treatment, and that success at follow-up is correlated to externality at posttreatment. Long-term research is needed to investigate the relationship between continued sobriety and locus of control, as well as the relationship between relapses and changes in locus of control.
A.A. members maintain that individuals must reach their own "bottom" - or point at which they are willing to admit that they cannot control their drinking before they can ever maintain sobriety. What are the factors involved in this process? For instance, not all alcoholics had to lose their job, wife, family, and freedom (jail) before they reached "bottom." A big part of the A.A. program is the tradition of older A.A. members sharing their "stories" at meetings. Part of the rationale behind this tradition is the idea that "newcomers" (individuals new to the A.A. program) might identify with the speaker's story, and thereby see where they are headed if something does not change. Once these factors have been identified, what interventions can be developed to effectively help individuals find bottom?
Pyle (1984) raises the question of what role the locus of control construct plays in a patient's decision to leave treatment against medical advice. The answer to this question would prove useful in predicting the likelihood that an individual will complete treatment.
Finally, further research clarifying the relationship between denial and social desirability is needed. Denial is a defense mechanism obviously used by alcoholics, and social desirability is considered a key factor by many researchers. However, as Pyle (1984) points out, previous research has been unable to determine the relationship between these two constructs.
In summary, the success of the A.A. program for non-Christian members is a source of cognitive dissonance for Christians. Where does the power to change come from for these individuals since A.A. does not emphasize a personal relationship with Christ? Even though these individuals may not benefit from God's special revelation through Jesus Christ, they can benefit from God's general revelation through science and nature. This article has proposed that this happens through a change from an internal to an external LOC regarding alcoholics' drinking behaviors. That is, they must come to accept the fact that they cannot control their own drinking. Research on alcohol treatment programs shows that successful maintenance of sobriety is related to an acceptance of the inability to control drinking. The results indicate that abstinence is the only effective method of maintaining sobriety (Abbot, 1984; Alcoholics Anonymous, 1975; Fry, 1985; Rozensky & Honor, 1984). The solution, as found in the principles of A.A. is to help alcoholics develop an external LOC regarding their drinking behavior and an internal LOC regarding their life in general. It is this development of an extenal LOC regarding drinking behaviors which is seen as the principle mechanism for the success of the A.A. program. Additionally, some issues for future research were presented.