Chapter 15
A.A. In Hospitals and Treatment Centers
In A.A.’s earliest days, all newcomers were hospitalized!
It was providential that one of the co-founders, Dr. Bob S., was a physician associated with a hospital in Akron. So not only did he and Bill W. seek and find A.A. #3 in Akron City Hospital, but as other alcoholic prospects came along, they were routinely required to put themselves in private rooms at the hospital for five to eight days of detoxification and orientation by A.A. visitors. (See Chap. 3)
This was so much a part of the treatment that Warren C., who came to A.A. in Cleveland in July 1939, recalled that there was considerable debate about whether he should be admitted to the Fellowship, since he had not been hospitalized.
Dr. Bob was also associated with St.Thomas Hospital, where he became acquainted with Sister Ignatia. She later recalled that they often discussed the tragedies caused by excessive drinking and the fact that alcoholics were sick and needed help. “Then one day, to my great surprise, Dr. Bob told me about his own drinking problem” and about his meeting with Bill and what had resulted. Meanwhile, City Hospital balked at admitting Dr. Bob’s “jittering patients” and told him to seek refuge for them elsewhere. So he explained his problem to Sister Ignatia. “I was fearful to admit an alcoholic,” she admitted. “But he assured me he would see that the patient didn’t cause any trouble, so I consented to try it.”
Thus began an arrangement to admit alcoholic prospects to St.Thomas that became legendary. Between that day and the time Dr. Bob died, 4,800 alcoholics were treated there under his care. They were assigned to two- to four-bed rooms; because “group therapy helps one forget himself in helping others.” A.A. visitors kept a continuous discussion of A.A. going from noon until 10 p.m. There were no repeaters allowed among the patients. (For a complete description read Chap. XIV, “A.A. and St.Thomas Hospital” in Dr. Bob and the Good Oldtimers.)
So, when the Clevelanders broke away from the Akron meetings, one of the first things they did (with Dr. Bob’s help) was arrange for hospitalization of prospective members at Deaconess Hospital. And when the Cleveland Plain-Dealer articles brought in hundreds, other hospitals were pressed into service. St.Vincent’s Charity Hospital followed Deaconess in admitting alcoholics as a matter of policy in a ward under the care of Sister Victorine. Eventually, when A.A.’s who had found their sobriety in Akron/Cleveland spread out to found the Fellowship in other towns and cities throughout the Midwest and beyond, initial hospitalization was part of the program. (See below)
In New York, Bill W. turned first to Towns Hospital, where he himself had recovered, to find other alcoholics to help. And as other newcomers joined, they were routinely hospitalized there first. Towns Hospital treated both drug addicts and alcoholics, detoxifying them, helping them medically through their withdrawal, getting them back on their feet with the help of rest and vitamins and discharging them. Dr. Silkworth’s typical treatment began with a thorough admission examination to make sure there were no other complications of the heart, blood pressure, lungs, liver, kidneys, etc. The patient was then sedated and put to bed. He was also given Dilantin to avoid convulsions. Over the next two days, he was tapered off with chloral hydrate or phenobarbital, cleaned out with epsom salts, and started on vitamins. The aim was to have the patient sedative-free at the end of three days. He was usually discharged after five days, unless there were other complications. After the advent of Alcoholics Anonymous, its patients were separated on their own floor. A.A. sponsors were not only responsible for admitting them and picking them up on release, but also were expected to spend much time as possible with the alcoholic in the hospital. Other A.A. visitors were welcomed. When the New York Intergroup began operating in 1946, one of its prime functions was to arrange hospitalization for prospects who needed it—and a hospital desk has been maintained for that purpose ever since.
However, Towns Hospital was small and specialized, so in 1945 a group of A.A.’s approached the Board of Knickerbocker Hospital, a general hospital with a good reputation, and persuaded them to set aside a pavilion for the treatment of alcoholics. Dr. Silkworth was in charge and A.A. filled the same role it did at Towns.
The patients at Knickerbocker began their five-day stay in private or semi-private rooms, but by the third day the men were moved into a six-bed ward, nick-named “Duffy’s Tavern”, which also served as a men’s club during visiting hours. Here, together with sponsors and A.A. members, they discussed their common problem, shared their hopes and fears, and began to absorb the principles of Alcoholics Anonymous. Female patients continued to occupy private rooms. The five days cost $85.00.
The nursing department in particular was very skeptical in the beginning about accepting alcoholics in a general hospital. However, the Director of Nursing reported in 1947 to the administrator, “I anticipated great difficulty in obtaining nurses willing to care for alcoholic patients.. . To my surprise, I found that although nurses dislike caring for alcoholics, they seem much interested in alcoholics affiliated with Alcoholics Anonymous because they have a sincere desire to be helped.. .I also anticipated difficulty in handling alcoholic patients with a skeleton staff because of the disturbances caused by unmanageable patients. It has proved quite the contrary. The A.A. sponsors and visitors have been most helpful in their volunteer work…”
In 1956, the hospital administrator reported, “I continue to be amazed at the changes that can be wrought by scientific medical care and psychological direction in a short period of time. Men and women who came into the hospital defeated, hopeless and, in many cases, helpless, go forth to face the world with renewed hope and confidence. As of 1956 we have hospitalized approximately 11,000 alcoholic patients at Knickerbocker.”
Rockland State Hospital, a New York mental institution, bears the honor of being the first of its kind to establish an A.A. group. The year was 1939, when Bill and Lois were staying temporarily with friends, Mag and Bob V., in Monsey, New York, after the foreclosure of their Brooklyn home. Bob V. spoke with Dr. Russell Blaisdell, head of the nearby Rockland institution, about A.A. Dr. Blaisdell “gave us the run of a ward and let us start a meeting within the walls,” Bill relates. “The grimmest imaginable cases began to get well and stay that way when released.” The Rockland meeting continues to the present time.
Of course, facilities of a sort to care for drunks had existed in almost every part of the country long before A.A. existed. Mental institutions and sanitariums provided longer-term treatment and attempted “cures” by psychiatry, aversion-treatment or other methods, with minimum success. Then there were the “drunk-farms” which typically did not so much treat alcoholics as provide them with a reasonably wholesome, alcohol-free environment with some medication where they were detoxified for a few days and then returned to drinking. Most of these facilities of whatever kind (including Towns Hospital) were “revolving doors.”
But a drunk farm which was to make history as the great-granddaddy of all freestanding, intensely A.A.-oriented facilities was High Watch Farm in Kent, Connecticut. Bill W relates in, A.A. Comes of Age “Up in the hills of Connecticut.. a group of farms belonged to a dear lady known affectionately to countless A.A.’s as Sister Francis (Mrs. Francis Helling]. This wonderfully good soul, out of her own pocket, had operated these farms for charity—for the aged, for children and for any wayfarer who passed by.” Sister Francis called it the Ministry of the High Watch, and she apparently had special compassion for the plight of the alcoholics who sought her help. “In the summer of 1939,” Bill continues, “Marty M. . . conducted a party of us to Connecticut to meet Sister Francis” and to see the farm. Marty M. recalled later that after she and Bill had admired the serene beauty of the setting in the Berkshires and found themselves in a room that served as a chapel in the pre-Revolutionary Colonial farmhouse, they were overwhelmed with the spiritual presence around them. Bill turned and murmured softly, “God, Marty, you can cut it with a knife!”
According to Bill, “Sister Francis seemed to be as delighted with us as we were with her. She offered us use of the place if some of us would create a board of trustees to look after it.” This came about, and High Watch Farm has operated ever since. It has none of the aspects of an institution. There are no physicians or nurses in residence, and no counselors. But every person on the board and on the staff is a member of Alcoholics Anonymous, and the “treatment” consists of the A.A. recovery program.
One cannot mention treatment of alcoholics—and the influence of Alcoholics Anonymous in treatment—without describing the Minnesota experience. In 1985, Minnesota had a total of 3,800 residential beds for the treatment of alcoholics, plus outpatient programs with an enrollment of another 1,000. As early as 1912, Wilimar State Hospital treated drunks (among whom it was called “the jag farm”) along with mental patients. With the advent of A. A., the hospital became “heavily influenced by the thinking of a relatively small group of recovered alcoholics, all members of Alcoholics Anonymous,” according to Dan Anderson, Ph.D., a Willmar staff member at the time (and later a recognized national authority as director of Hazelden). As a result, in 1950, it made “a radical departure from psychiatric tradition and from the conventional understanding of alcoholism.” This change required acceptance of hypotheses which are taken for granted now but entirely new and extremely controversial in those days. Among these new assumptions, as outlined by Dr. Anderson, were the following:
(1) Alcoholism exists. Although it was recognized that skid row inhabitants drank too much, the condition was not otherwise acknowledged by professionals, alcoholics themselves, or their families. Partly through A.A. members, the Willmar staff came to realize that alcoholics all shared certain signs and symptoms in common. “Alcoholism did exist.”
(2) Alcoholism is an illness. Continued pathological drinking in the face of disastrous consequences and loss of control persuaded the professionals that this behavior was not voluntary but was indeed an illness.
(3) Alcoholism is a multi—phase illness—i.e., it is complex, including physical, mental, social and spiritual aspects, all of which had to be treated if the alcoholic was to recover.
(4) Alcoholism is a chronic, primary illness. It is not just a symptom of an underlying disorder, but must be treated directly as an illness in its own right.
“It was no accident,” says Dr. Anderson, “that our basic program philosophy came very close to…the Twelve Steps of Alcoholics Anonymous. In fact, the A.A. movement was the only viable new approach. . . worth exploring. . . On the negative side, it was a voluntary program and the practicing alcoholic had to be motivated to want it…it also appeared to be quite dogmatic, and it was not really well-known or understood by the general public.
“Yet, on the positive side were its remarkable results. A.A. could sober up alcoholics and sustain them for extended periods of what appeared to be happy sobriety. These sober alcoholics were then able to describe their condition—the power of the addictive need and the personality changes that took place not only while drinking but in recovery as well. A.A. members were also willing to work with practicing alcoholics and alcoholics in treatment…”
In devising a program structure and strategy, Willmar departed radically from existing psychiatric practices. “To properly utilize the philosophy of Alcoholics Anonymous,” Dr. Anderson continues, “we needed on staff one or more recovered alcoholics who were practicing members of A.A.—”counselors” [the first use of that term] to work directly with the patients. Not only were these recovering alcoholics needed to communicate the philosophy of A.A., it was also hoped that they would act as role models for the patients. . . The A.A. way of life, through the influence of the new counselors, gradually became more and more a part of treatment program. . . The influence of Alcoholics Anonymous on our program cannot be overestimated.”
This, then, was the origin of the so-called “Minnesota model” of treatment for alcoholics, as practiced first at Willmar and later exemplified at Hazelden after Dr. Anderson became its director in 1961. Hazelden had been started in 1949 by several A.A. members at a lakeside setting near Center City, not far from Minneapolis-St.Paul. It was named after the daughter of the family from whom the property was purchased. Lynn C. was its first director. After some financially rocky years, Pat B., the recovered-alcoholic scion of a prominent family, became interested in Hazelden, and three generations of the B. family were to be the principal benefactors and leaders of the facility.
Pat B., with the concurrence of the other Hazelden Foundation trustees, was also responsible for starting a treatment center for women alcoholics in 1956 on another lakeside estate near Dellwood. It was called Dia Linn, a Gaelic name meaning “God be with us.” Ten years later, Dia Linn was incorporated into Hazelden at Center City, making it coeducational.
In 1985, with a 194-patient capacity, Hazelden draws from all 50 states and scores of foreign countries. It has a staff of 793 full- and part- time persons, including 20 interns and 42 trainees. For, since 1966, has also trained other treatment professionals, and so has become the model for other facilities through the u.s. and in. other countries as well.
Among other famous, A.A.-oriented treatment centers in Minnesota was Pioneer House in Minneapolis. It was started by Pat C., founder of Minnesota A.A. (See Chap. 4), and John McD. It maintained ties with Hennepin County Hospital and the Veteran’s Hospital for medical treatment, but it was also America’s first treatment center to require the Fifth Step of its patients before release. A 21-day program, it served approximately 400 men per year. Pioneer House was purchased by Hazelden in 1981.
St.Mary’s Hospital in Minneapolis opened its alcoholism treatment unit in 1968. It became known for its aggressive and confrontive approach. It acquired such an impressive record of success that it has attracted patients from all over the country and usually has a waiting list. Abbott-Northwestern Hospital followed in 1970 and St.John’s in St.Paul in 1971. In the early ’70 ‘s, in the wake of the Hughes Bill (see below), the Twin City saw the opening of Metropolitan Medical Center, Golden Valley, Deaconess, Mercy, Unity, Mounds Park and St.Joseph’s. In other Minnesota locations, Rochester’s Methodist Hospital set up a unit in ’72 in cooperation with the Mayo Clinic. In Pine City in the northeastern part of the state, Pine Manor I began in ’69, followed by Pine Manor II in Nevis in ’72. Among other outstate facilities were NAEVE in Albert Lea; St.Cloud Community Hospital; Miiler-Dwan in Duluth; and St.John’s in Morehead. The list is only fragmentary, but indicative of the breadth of treatment offered—almost invariably heavily A.A.-oriented.
Wherever A.A. groups spread, hospitalization for the drunk was a prime concern—and, in the early days, a critical problem. Any listing here is necessarily very incomplete, but among the hospitals and other facilities mentioned in archival records are these. In Cincinnati, Good Samaritan Hospital agreed in 1941 to work with drunks sponsored by A.A. In Milwaukee, St.Michael’s Hospital and Meta House were cooperating in the ’40’s. Philadelphia A.A.’s Jim B. and Bob M. made arrangements in April 1945 with Dr. Wilson, superintendent of Episcopal Hospital to open the city’s first detox unit; and the next year, Serenity Farms near Hickory, Pennsylvania, was opened. In Pittsburgh, at about the same time, four hospitals opened their doors to alcoholics. St.Margaret’s, Presbyterian, Pittsburgh, and Western Psychiatric. Perhaps the most famous rehab facility in Pennsylvania was—and is-Chit-Chat Farms, near Reading, opened in 1959 under the direction of the legendary Dick C.
There was the County Hospital in Rochester, Benedictine in Kingston, St.Peter’s in Albany, and Samaritan in Troy, New York. The first facility in Kansas was The Shrine on the Hill in Kansas City, started in 1942 by Dr. Miles N. and still operating. Near Arkansas City, hundreds of alcoholics found their sobriety at Jim J. ‘s ranch. Valley Hope was the name of a center started by (WHO) in (WHEN) at (WHERE), and now embraces units at (NAME THEM)—all A.A. oriented. Although not an alcoholic rehab as such, the noted Menninger Clinic in Topeka has an historic understanding of alcoholism and of Alcoholics Anonymous. (Dr. Carl Menninger is credited with the insightful statement that “to an alcoholic, a drink is a desperate attempt at self-medication.”)
King County Hospital in Seattle, Washington, began admitting drunks under A.A. sponsorship in 1948. California A.A. had an early history of being generally anti-treatment-centers. However, in Los Angeles, County Hospital played a key role in the birth of A.A. there (See Chap. 4) and in northern California, thousands of A.A.’s got sober at Duffy’s (GET CORRECT NAME AND MORE INPORMATION) (ALSO JOE PURSCH AT LONG BEACH AND OI~ANGE COUNTY, BETTY FORD’ S PLACE AT PALM SPRINGS, ETC.)
By 1953, the Trustees had an Institutions Committee (including A.A. work in both correctional facilities and hospitals) and the Headquarters office had created a separate desk to coordinate activity by the groups and to correspond with the institutions. It was reported to the Conference that there were 101 hospital groups with 2,253 members. Two years later, out of 200 hospital groups, 11 were in Australia and six in Great Britain, with plans to start groups in Germany, South Africa and Japan. And by 1955 represented 40 states, four Canadian provinces and eight foreign countries represented among 211 groups with 4,952 members. And the office distributed an “Exchange Bulletin” to institutions groups even before the new “A.A. Exchange Bulletin” for regular A.A. groups began that May.
A separate Institutions Directory was developed the following year, “since it is impractical to list them in the large A.A. Directory.” Feeling the need for more A.A. experience in this field, the Trustees’ Committee conducted two surveys: one of hospital groups, the other of hospital administrators where groups existed, in order to strengthen service to them. The surveys revealed, “growing acceptance of A.A. by institutional administrators.” The Conference sought ways to encourage hospital group sponsorship as a basic Twelfth Step activity. The same survey was repeated in 1964 and revealed the same encouraging acceptance by administrators and the same problems obtaining sufficient participation by outside groups and members.
The number of hospital groups continued to burgeon. In 1960, there were 302 hospital groups (including three new ones in Norway) with 6,509 members; in 1965, 547 groups and 12,913 members; in 1970, 767 groups and 18,604 members. As exciting as this growth was, it was only a prelude to the explosion that took place during the decade that followed. With the passage of the so-called Hughes Bill, huge sums of Federal money were poured into the field of alcoholism, stimulating the opening of literally thousands of treatment centers, both in hospitals and free¬standing. This resulted in the number of hospital/treatment center A.A. groups doubling again in ten years, reaching (HOW MANY) groups with (NUMBER) members in. 1980; and by 1985, (HOW MANY) groups and (NUMBER) members.
The accompanying increase in work load for the Conference Institutions Committee was one factor in its being dissolved by the 1977 Conference and replaced with two committees: one for correctional facilities and one for treatment facilities. The Trustees’ Institutions Committee followed suit. A new pamphlet, “A.A. in Treatment Facilities,” appeared in 1979, replacing “A.A. in Hospitals.” And the following year, Dr. Norris made a talk, also published as a paper, on “Bridging the Gap.” It stressed the critical role of A.A. groups and members in the community in helping the alcoholic patient make the transition from the treatment center to the outside world. Concern over reaching the older alcoholic in treatment centers surfaced in the Trustees’ Committee in 1981, and an article on the subject appeared in the “Treatment Center Bulletin” that year.
Long before there was a Trustees’ Institutions Committee or a General Service Conference, there was institutions work going on at the grass-roots level. Local A.A. members—either acting as individuals or working through their Intergroups/Central Offices or through their District and Area Committees—have always borne the responsibility for dealing with the administrators of hospitals and treatment centers and for carrying the A.A. message to alcoholics within those institutions. Institutions Committees existed before anyone tried to coordinate their efforts. Until the late ’70’s, these committees usually served both correctional facilities and treatment facilities. After the Conference Institutions Committee was split into two separate committees in 1977, a ripple effect spread to many—but not all—Institutions Committees out in the field. The result is that in 1985, there were, in the U.S./Canada, 221 Treatment Facilities Committees, 243 Correctional Facilities Committees, and 240 Institutions Committees probably serving both.
In California, which has a reputation for doing things differently, the Hospital & Institutions Committees (better known as H&I Committees) grew up as a separate service entity—separate, that is, from Central Offices and from the General Service Structure. (MORE ON THE HISTORY AND SCOPE AND ACTIVITY OF H&I COMM’S)
Because of this diversity of experience and of methods used among the committees on the firing line, the Conference felt the need to coordinate their activity and lay down guidelines. One result, in 1978, was a Conference recommendation which read, “A.A. members who meet with the administration of a treatment facility concerning the formation of an A.A. group on its premises should explain group autonomy as well as what A.A. can and cannot do (Traditions), and also should have a good understanding of the facility’s rules and regulations. After mutual agreements are reached, it is important that this information be shared with the A.A.’s who will be attending the group’ s meetings. It was suggested that groups meeting in treatment facilities try to abide by the self-support Tradition. If money for rent is not accepted by a facility, groups should contribute in some other way. It was also felt that A.A.’s employed by the facility should not run the groups at the facility.” This general policy recommendation was affirmed by the 1984 Conference.
A giant step forward in. helping local committees was taken in 1985 with the preparation of the Treatment Facilities Workbook. It was the product largely of the efforts of staff member Eileen G. and Class A Trustee Joan K. Jackson, Chairperson of the Treatment Facilities Committee.
The place of Alcoholics Anonymous in the treatment center was summed up in. a professional paper written in 1976 by Or. Frank Herzlin, Medical Director of Freeport (L.I.) Hospital one of the better known treatment centers. (Dr. Herzlin also served as a non-trustee member of A.A.’s Treatment Facilities Committee.) He said, in part: “As a general rule, I take the view that a person who does not become involved in Alcoholics Anonymous will not be successful. This is communicated to the patient in no uncertain terms. A.A. should be explained to the person whether he or she has had exposure to (it] or not. A program of involvement in A.A. is outlined including frequency and types of meetings, the Twelve Steps, and what the participant can expect to derive from the program. Sponsorship should be arranged and explained…
“The A.A. program is, and must be, the foundation of any successful treatment program. Those professionals who avoid its inclusion will fail most of the time. I cannot emphasize this point too much.”