Problems Of Cooperation Between AA And Other Treatment Programs

Alcoholics Anonymous

4 years ago

Problems of Cooperation Between AA and Other
Treatment Programs
by Charles H. Aharan, Ph.D.

Regional Director, Alcoholism and Drug Addiction Research Foundation, Lake Erie Region, London, Ontario, Canada

January 1971 will mark the twentieth anniversary of my first contact with Alcoholics Anonymous. Looking back, I now realize it was one of the most significant events in my life. Like so many other people, I can say sincerely that this experience changed, or shaped, the direction of my life. Not only did I become familiar with this remarkable organization, but it was also the starting point of my life’s work. At the time of my initial contact, I was doing postgraduate work at the university. Because of the interest stimulated by this experience, I became fascinated with the problems of alcoholism in our society and with the therapeutic power of Alcoholics Anonymous. The result was that I did research in this area and then was fortunate enough, about two and a half years later, to be asked to establish the first treatment center for alcoholics in London, Ontario. What I am trying to convey is that AA shaped my ideas about recovery programs, and that my friends in AA, who shared with me their experiences with alcohol and their opinions about alcoholism, shaped my ideas about alcoholic and alcoholism.

In preparation for this occasion, I developed a number of ideas about what I wanted to say, and I nourished the fantasy that some of them would be worthwhile and original. However, I thought I should browse through the AA Grapevine, just to bring myself up to date. I looked up all twelve issues for 1969 and decided to set aside those issues that contained anything relevant to my topic. Perhaps you can imagine my consternation on discovering that eight of the twelve issues contained, not only appropriate references, but also every one of my “original” ideas, plus a number of others that had never even occurred to me. So much for my fantasies of presenting anything original.

I have taken some comfort, however, in the realization that most discoveries or new ideas in the area of human relationships are, in fact, rediscoveries and that there is a value in having different individuals expound the same ideas in their own unique ways. I have even heard it argued that AA itself is a restatement of an old idea – an ancient message of love, spoken in a new language more relevant to our times and to a particular group.

It is a more familiar role for me to be speaking to professionals about AA. On these occasions, I speak at length on certain of my professional colleagues’ attitudes which, I believe, prevent them from working effectively with Alcoholics Anonymous. Today, I am going to risk sharing with you observations of some AA members’ attitudes and practices which, I believe, defeat attempts at useful cooperation. Before launching out on thin ice and as a way of protecting myself, let me emphasize that I believe the AA philosophy is unassailable. What I intend to deal with are individual attitudes and practices which occur with enough frequency to be misidentified by the uninformed as an expression of the AA philosophy or policy.

The first requirement for successful cooperation between AA and non-AA treatment services is a spirit of goodwill generated out of the common goal of being helpful to those still suffering. The most effective working relationship is achieved when each tries to complement the other, rather than trying to compete. For this spirit of cooperation to exist, the welfare of the still-suffering alcoholic must take priority over all other considerations. The starting point, then, is in the quality of our concern. Too often, it seems to me, cooperative attempts degenerate into a battlefield, where each group ends up trying to demonstrate the superiority of its own technique and philosophy. When this happens, the suffering alcoholic gets lost in the struggle.

There are many personal characteristics that contribute to a cooperative endeavor, but I believe a fundamental characteristic of all parties to such an endeavor must be humility. For cooperation to take place, there must be on the part of all concerned awareness of their own limitations and of the possibility that the others with whom they are endeavoring to work are sincere people and, maybe, even individuals from whom it is possible to learn.

The first point I would like to make is that I do not believe the recovered alcoholic is necessarily an expert on alcoholism, although he may be. The recovered alcoholic in AA is, in my opinion, an expert on his own experience and on his method of working the program. When he ventures beyond his experience and starts to declaim on the nature of alcoholism and the role of alcohol in society, when he becomes involved in preventative educational programs, etc., I believe that he is risking credibility as a valuable partner in the eyes of many professionals in rehabilitation services.

I am much more inclined to think of the alcoholic in AA as an expert on a recovery program. He is knowledgeable and skilled in helping, and it is in the area of helping that the cooperative endeavor should be taking place. Having opinions about the nature of alcoholism is quite appropriate for the AA, but these opinions are often quite unimportant in terms of developing effective helping relationships. Cooperative undertakings quite often fall apart because of disputes as to the nature of alcoholism. All of us, in trying to work together, need to remember the AA principle of keeping an open mind.

Another attitude common enough to comment on, I believe, is the tendency of many AA members to claim that alcoholics are a very special breed, entitled to special consideration and recognition. It sometimes seems to me they claim to have the world’s market on suffering all sewn up. An extension of this view is the commonly expressed opinion that only an alcoholic can understand or help an alcoholic. I agree that an alcoholic has a tremendous advantage in communication, but I do not agree that only an alcoholic can relate meaningfully to another alcoholic, or even that being an alcoholic is a guarantee of success.

I am sure that many of you here today can think of fellow alcoholics whom you have found impossible to understand and, perhaps, difficult to help. I have noted that, when some AA people encounter this kind of problem, they are inclined to explain it by saying, “He is not ready” or “He hasn’t reached bottom.” However, when a nonalcoholic helper does not get to first base, then the explanation is: “Well, what do you expect? He is not an alcoholic.”

When confronted with this argument, I often respond by saying, “It’s true that I do not know how it feels to be an alcoholic, but don’t tell me that I don’t know what fear, remorse, shame, guilt, uncertainty, and despair feel like. These are feelings shared by all human beings.” I go on to say that, in my opinion, we have more in common than you imagine. We are brothers in our human frailty. The superiority of AA is secure, and it really does not need to be reinforced by emphasizing the failures of others.

In the same vein, we need to ask ourselves why we are so ready to believe just about everything we hear of certain individuals or groups. What personal needs are we satisfying by our uncritical acceptance of unverified rumors? Alcoholics often refer to themselves as con artists; as con artists, they should realize that one of the best ways to con somebody is to find out what he would like to hear and then feed it to him. Frequently, the practicing alcoholic will try to gain special recognition and attention by telling his AA friends or sponsors what he thinks they might like to hear about his previous attempts to get help from treatment agencies. (He will also, of course, tell the same kind of story to treatment agencies about the failures and the lack of help that he received in AA.)

I believe that people in treatment services and in AA would be very well advised to try to verify the stories they hear about one another before passing judgment. Certainly, I have had people come into me and try to rationalize their personal failure away by blaming Alcoholics Anonymous. I know better, and I tell them that it is pure nonsense.

I would like to suggest that, when an opportunity comes to AA members to work in a cooperative way with treatment programs, wherever possible they try to find out the treatment policy and philosophy of the unit that seeks their assistance. It would be desirable if a meeting could be arranged with the relevant people in the treatment center, to discuss with them their viewpoint about what constitutes adequate treatment. In doing this, you would be giving yourself the opportunity of finding out whether they practice in a manner that is acceptable to you. If you discover that they do not, and that they won’t change, then I would recommend an approach which says, in effect, “When you have finished with the patient, I would be glad to help in any way that I can.” I think this is infinitely better than trying to work with patients from a treatment center when your conviction about what the patient should be doing, or should not be doing, differs markedly from the conviction of the staff of the center. A suffering alcoholic’s involvement in this kind of contradictory relationship only results in damage.

I have had the experience of being present at AA meetings where I have heard speakers say that Antabuse was of no earthly use, or that our treatment center was of no earthly use. I respect the speaker’s right to his opinion and probably his right to express it. However, I cannot help but feel somewhat saddened when sitting with me is an alcoholic who trusts me, who believes in my competence, especially when I have been persuading the alcoholic to go to AA and have taken him there myself. I know no way of overcoming this kind of problem, except, perhaps, through an emphasis on the individuality of the program and the importance of maintaining an open mind.

There are one or two additional points about working together I would like to mention briefly. The first relates to the problems unique to the recovered alcoholic in AA who is employed in a treatment center as a counselor. I believe that the AA member in this position has to reconcile a number of issues. Perhaps one of the most difficult problems he will have to deal with is the temptation to become the interpreter and spokesman for AA at the treatment center and for the treatment center at AA. I believe people in this position would be wise to avoid this problem by stating, when asked to comment, that they are attending the meeting to stay sober, not to be a spokesman for any other group. As a matter of fact, I can’t think of any other reason why an AA member should go to an AA meeting.

One final point directly related to cooperation: In my experience, there is a tendency on the part of many AA members to use the treatment service as an easy way of doing Twelfth Step work. During our early contacts, I found that many times we were being used as a dumping ground. I never objected to trying to help; but, when this happened, I often felt that the individual was not receiving the full advantage of AA sponsorship.

In conclusion, I would like to share a thought which may not be directly related to the topic. It is of interest to me, and I would like to get some feedback about it. I believe that the impact and implications of the social and technical changes that have taken place in the thirty-five-year lifetime of AA are beyond my ability to comprehend and perhaps beyond the grasp of many others.

The society that gave birth to AA is not, in many important ways, the society of today. AA’s continued relevance is a testimony to the fact that AA, when founded, was ahead of its time. But the need to stay relevant is complicated by the rapid changes that are taking place.

AA principles are constant over time and should not change. But practice can change; words can change. AA pioneered in the development of a new approach to troubled people, and future historians will record its impact on the theory and practice of the helping disciplines. I have been wondering lately whether there was some way that AA could use some of the procedures that have been developed in the social and behavioral sciences – even though these procedures have grown out of AA impact. I am thinking particularly of the developments in group process.

I believe one of the great strengths of AA is its ability to communicate in a compelling way basic principles to live by; but I do think it could strengthen its communication of method. AA communicates what must be done, but I personally think there could be more support in the how-to-do-it area. This is particularly the case in the management of troublesome feelings that interfere with satisfying interpersonal relationships and personal growth. I have often had the impression that, for many members, the quantity of sobriety sometimes becomes more important than the quality. Concern about quality means that the individual should not remain content, complacent because he is a sober man. He must be concerned with what kind of sober man he is. It is sometimes too easy for a person to believe the battle is won when he achieves abstinence. The program (the Twelve Steps), of course, emphasizes the quality of sobriety, which is just another way of saying the quality of life – but the practice of many individuals and the character of some meetings do not.

In any human group, there are certain ways of behaving that encourage identification. In AA, there is a language, a style, and in some groups there are unwritten and unspoken traditions. In some groups, if an AA wishes to be recognized as a member in good standing, he will not speak about his fear of people, his inability to work or understand all aspects of the program, the fact that he may frequently behave badly, or the fact that he is unhappy and depressed – even when all of these things may be true. Instead, he will feel that he must tell an unqualified success story or not speak at all.

I have had many people in AA, new and old members alike, approach me because they were concerned that there might be something wrong with them. They tell me they like and need AA, but there is something missing – it’s not working for them as it does for the others. They tell me that they are often unhappy, that they are nervous at meetings, frightened that the chairperson may ask them to read the Steps or thank the speaker, or that they are bored and fed up. They think they are failures and different, because they so rarely hear speakers or other members frankly admit to the same kind of feelings. If they don’t blame themselves, they sometimes react in a much more destructive manner and decide that all the talk about happiness and contentment is just so much hot air.

Troublesome fears and discouragement are common experiences of the new member; apathy, loss of enthusiasm, and periodic disillusionment are not uncommon experiences of the older member. These problems are not impossible or even too difficult to resolve if one can admit them and share them. The ability to do this is influenced by the degree of openness there is in the individual’s group. To me, success in AA is characterized, not by the elimination of troublesome personal conflicts, but instead by a member’s growing confidence that, with application of the program in his life, he will be able to cope with his problems. His success at working the program is demonstrated, not by the absence of pain, but by the feeling that he can cope with pain. There is usually tolerance in AA for continuing problems related to the use of alcohol, but there is not always tolerance to the many other problems of living. By openly sharing the kind of problems I have mentioned, the individual makes himself available to help and will also help others who feel the same.

In recent years, in the field of social science, a great deal of progress has been made in the area of group process. Methods have been developed which are easy to acquire and which are remarkably effective in helping people to be more open in their relationships. It might be beneficial for some AAs to go to a center which offers this sort of training and development in human relationships and group process. Members who attended such a center would not achieve any special status in AA; in no sense would they be professional. They would simply achieve a meaningful and valuable personal experience and would, as a result, be more helpful AA members. They would be less willing to accept words and slogans which have lost their meaning through familiarity. They would be inclined to acknowledge and share the problems I have mentioned; they would be more sensitive to these problems in other people. AAs who have had the kind of experience I am referring to could add a new dimension to their group. Finally, and most importantly, this activity could be a growth dimension that would help AA members to evolve to deeper levels of self-knowledge and appreciation of the AA program.

A final word about cooperation: The true basis for cooperation resides in the awareness that love and tolerance must be inclusive. They cannot be limited to the members of one’s group or to members of AA. They must embrace all mankind.