PASTORAL PSYCHOLOGY, Vol. 2 (13), APRIL, 1951
THE PASTOR'S RESOURCES IN DEALING WITH ALCOHOLICS
Alcoholics Are Consumed With Guilt; They Do Not Need to Be Reminded of their Sins
by Marty Mann
It seems unlikely that there is any pastor anywhere who has not at some time in his ministry been confronted with the alcoholic problem. Alcoholism is far too prevalent among us not to have forced itself upon the attention of ministers of all denominations. Some of them may have known what to do, but the vast majority, by their own confession, have found themselves helpless. Their counseling, however effective on other problems, has all too usually failed in these instances. They have wondered why, for on many occasions they have made efforts way over and above what would normally be expected of them. They have given of their time, their energy, and of their great compassion for the suffering - to no avail. Others among them have given nothing and have turned from the problem as none of their concern, about which they knew nothing and could know nothing.
To those pastors who feel that they have been and can be helpful to alcoholics along already proven lines of their own, there is nothing to be said, save to wish them more and greater success. To those who feel that it is not their problem, it must be said that they are wrong, for frequently they are the first to whom the distraught family, or even the sufferers themselves, turn for comfort and advice. And although they may know nothing about alcoholisn now, they can learn enough to be of help. Enough is know, now, enough literature is available, so that no pastor need say he cannot understand alcoholism or the alcoholic. But he needs more than understanding of the problem and its human victims. He needs knowledge of the methods which have been able to help those victims, and then, through his understanding, he will be able to guide them toward the use of such methods.
This is where the majority, who have tried and tried in vain, can turn many of their failures into success. They have had understanding - at least enough to create sympathy and a great desire to help - but they have not had knowledge. Today they can remedy that lack. The National Committee on Alcoholism, 2 East 103rd Street, New York 29, is the distribution center for both general and specific information on alcoholism, and has prepared many pamphlets on various aspects of the problem. It also takes orders for my book, Primer on Alcoholism, recently published by Rinehart & Co.($2.00), which should be of enormous help in laying a foundation of basic knowledge.
Pastors, like everyone else, must start at the beginning. Their understanding has in most cases been intuitive, based on a love of humanity and an equal love for human beings as individuals, with all their faults and foibles, their tragic mistakes and their tremendous potentialities. Often that understanding has grown out of a real knowledge of the individual concerned, of their fundamental fitness of character, of their great potentiality for good. The pastor who kept on trying with that kind of understanding and its concomitant sympathy, kept going on the hope that his alcoholics would somehow, someday, "be themselves again." That is not enough. That intuitive understanding, fine as it is, must broaden itself and at the same time focus itself, with the aid of knowledge. It must learn to be a constructive understanding, able to teach the object of its sympathy what it knows.
It should be apparent to pastors with that much understanding that there is more to the problem of alcoholism than "moral weakness," and that therefore it will take more than moral strengthening or even the best spiritual guidance and bolstering to be of real help. Science tells us that alcoholism is a disease. Alcoholics Anonymous accepted that definition and uses it with effect on new "prospects" its members are trying to reach. A.A. defines the malady more specifically as "an obsession of the mind coupled with an 'allergy' of the body." The terms disease, malady, obsession, "allergy" - all are used to prove two points to the victim of alcoholism: 1. He is not alone, but is one of countless thousands suffering the identical illness. 2. He needs expert help to get well, just as he would if he had cancer, T.B., or diabetes. The pastor could well incorporate this knowledge into his understanding and sympathy with a great gain in its effectiveness on the alcoholic. The greatest gain, however, will come if he can instill hope.
Two things then, are necessary to constructive understanding, and they are expressed in the first two of the three points made by the National Committee on Alcoholism: 1. That Alcoholism is a disease and the alcoholic is a sick person. 2. The alcoholic can be helped and is worth helping. Next comes specific knowledge.
Psychiatric and psychological treatment have helped many alcoholics. The problem is to find an expert practitioner with a real interest in alcoholism (which usually means that he specializes in it) who can win the confidence and trust of the specific alcoholic who needs his help. It may be a psychiatrist, an analyst, a psychologist, or a lay therapist - the requirements remain the same: that they be expert in their treatment and that they be able to inspire faith in them and their method. In the case of lay therapists who specialize in alcoholism, this last requirement is almost invariably met, for those few who are in practice are themselves recovered alcoholics and the very fact is faith-inspiring to an alcoholic patient. A greater problem, however, is the time and expense involved in this type of treatment, if and when the right doctor or therapist can be found. Most alcoholics have little money to spare, and when sober they either have or need to have work, which means they have little time either. There are cases, however, in which time and money are available and where one or the other of these methods are strongly indicated.
The conditioned reflex method of treatment has also had a good measure of success. Unfortunately, it is not widely given in its most effective form, and the patient will usually have to travel some distance to one of the three or four really good places. While this treatment does not take so much time, it is expensive, so once again it is not the answer for the majority of alcoholics.
Alcoholics Anonymous, however, offers none of these problems. It has had a greater success with a greater number of alcoholics than all the other methods put together. It costs nothing. And it is very nearly everywhere. 100,000 members in 2500 A.A. groups scattered throughout the United States, Canada, and some twenty foreign countries, are ready and eager to help any alcoholic who wants help in recovering from that terrible malady known as alcoholism. In fact they need alcoholics to help, for it is in helping others that they help themselves to stay well. Knowledge about Alcoholics Anonymous, therefore, is probably the most useful knowledge that a pastor could have to implement his understanding. The day may come when pastors and all other groups who have struggled in vain with this hydra-headed problem: the courts, the social agencies, employers, bewildered families, even the doctors themselves, will have all of these methods available at no cost, to be used either singly or in conjunction with each other according to the needs of the individual alcoholic. That day will come when Alcoholic Information Centers and alcoholic clinics are established everywhere. Twenty-two such clinics now exist, located in different parts of the country, from Massachusetts to California. Thirty-five Alcoholic Information Centers are operating, each established by a local Committee for Education on Alcoholism. It is one of the major activities of the National Committee on Alcoholism to promote the establishment of such centers and clinics, and great headway is being made. When the National Committee's three points are finally and completely accepted by the public at large, every city and town will boast its information center and clinic, for the third point insists on action: 3. This is a public health problem and a public responsibility. Pastors can help gain acceptance for these concepts and can help to promote action on them. It is our hope that they will continue to take an active part in this work, as many of them have already done.
Meanwhile they are faced with the problem and must make do with the limited resources at hand. They already know what help they can expect from the Salvation Army, for instance, and how to obtain that help. For many years the Salvation Army was the only group who would extend a helping hand to the alcoholic, especially the down and out one. And they know of the Lutheran Inner Missions and that many of them have made a special effort to help alcoholics. Some social agencies, too, have tried to do more than they could do. It is a proud but pitiful record, the hopeless, ever-hopeful efforts of these groups, and their all too occasional successes. Organized religion in itself, through all denominations, has had occasional success, for a true religious conversion can heal alcoholism as well as other ailments.The difficulty lies in repeating the success with the next alcoholic in the long endless line waiting for help. That chain-reaction did not come until Alcoholics Anonymous came into being.
It is not the purpose of this article to explain the workings of Alcoholics Anonymous as a method of recovery. Such information can be had for the asking by writing them at Box 459, Grand Central Annex, New York 17. But there are many practical questions relating to the use of A.A. by other groups such as doctors, ministers, social workers, etc. which are not dealt with in the present A.A. literature. For instance, how can the pastor, in his professional capacity, work with A.A. and get help from it?
First, he will want to know if there is an A.A. group in his area. A letter to the Box 459 address will get him this information immediately, plus a local address to which he can again write for further details. Such a local address is usually just a P.O. Box number, but a letter there will reach the local group secretary who handles inquiries. The pastor should ask for a personal interview, either with the group secretary, or with some member who is willing to call on him and describe the set-up and workings of that local group. It is necessary to point out, especially to professional people used to working with organizations in the usual sense of the word, that A.A. groups are not organizations in that sense. They are rather loosely-knit fellowships, held together and operating on a purely voluntary and individual basis. No single member, including the secretary, can speak for the group as a whole. He or she can only offer his or her personal cooperation, and that of such other members as signify their interest and willingness to cooperate on that particular job. Therefore it is important that a pastor establish a working relationship with an individual or several individual members on who he can call for assistance. They will frankly tell him just how much he can count on, and describe their own limitations in that area.
Such limitations are obvious to those who are familiar with any A.A. group, but often seem to surprise people newly acquainted with A.A., particularly professional people. A.A. has no magic formula, for instance. Members cannot descend on an unwilling prospect and magic him or her into willingness and cooperation with the program of recovery. As in any other illness, the patient must want to get well - have the "will to live" as doctors phrase it for other maladies. Those who have accepted alcoholism as a disease will recognize this truth if they stop to think a moment. There are cases, however, in which the desire to get well is not evident to the family, friends, or pastor, but is nevertheless there. Sometimes, in such cases, if a meeting can be arranged between the "practicing" alcoholic and an A.A. member, the latter will be able to break through the wall of defiance which the alcoholic has built up against all efforts to help him (and which he calls "pushing him around" and "curtailing his right to live as he wishes"), and bring out the underlying wish to recover. It is my firm belief that very few alcoholics who have actually crossed the line from excessive drinking into true alcoholism, and therefore felt all the agonies and horrors of an exceedingly painful disease, actually wish to continue being like that. They want to get well, but unfortunately what they really want is to be as they used to be, able to drink normally without suffering. They do not know that they are victims of an incurable malady, and that, like diabetics who can never again touch sugar if they are to regain and maintain health, they can never again safely touch alcohol in any form. Once again, if they can be brought to accept alcoholism as a disease they, too, will eventually recognize this truth, and with that recognition, their cooperation in a program of recovery can usually be obtained.
A word of warning is in order here to pastors who are unfamiliar with alcoholism. A.A. cannot, and has no wish to help excessive drinkers back to moderation. It is a program designed specifically for true alcoholics, those who have lost the power of choice in the matter of where, when, and how much they drink, those who, when they drink at all, almost invariably end up in drunkenness. Many people mistakenly lump all drinkers who ever drink to excess under the heading of "alcoholics." Nothing could be further from the truth. Possibly many excessive drinkers, "spree drinkers," "Saturday night drunks," "party drunks," are indeed potential alcoholics in grave danger of crossing the line into true alcoholism, but the A.A. program rarely, if ever, appeals to such drinkers. Education in what alcoholism is, and how nearly they may be approaching it, might conceivably stop them in their tracks, (I have, in fact, seen that happen a few times) but an effort to push then into A.A. usually backfires. A.A. members know this, and through their vast experiences can recognize such drinkers as being outside their province. On the other hand, there are many alcoholics who have only recently crossed the line - or at least, only recently has it been apparent that their drinking has changed - and who have not yet lost anything - job, friends, or family, who can be reached by A.A. These are questions which can best be passed upon by A.A. members, and which the pastor would do well to discuss with them in the light of such knowledge as he has of the case, before either approaching the suspect himself or arranging any contact with A.A.
In short, the pastor's relationship with his local A.A. group should be one of reciprocity, of a free exchange of information and ideas on the particular case for which he desires help. Often the pastor will be able to get the patient interested in A.A. before he brings an A.A. member on the scene. It is assumed that he will have made every effort to learn about and thoroughly understand the workings of A.A. first; that he will have attended many meetings and talked with many members in addition to having read all the literature. In that case he should be able to vividly describe the set-up and the people in terms which will appeal to the alcoholic. He will be able to arouse his curiosity and at the same time to allay his fears, for he will have learned that there are no "musts" and no "dont's" in A.A., but only a great willingness to pass on the tricks of the trade" which have enabled the members to get sober and stay sober, and a great eagerness to accept newcomers as instant equals and as members in good standing from the moment of their entrance.
The pastor will also have discovered that he, himself, cannot do an A.A. job on the alcoholic. He will see with his own eyes at meetings and at interviews he may witness, that the man or woman who has actually been through the appalling experiences of alcoholism has an edge on him that no substitute knowledge can replace. For one thing, the sober A.A. member is the embodiment of hope. He is the living promise that it can be done. Hemakes faith in the possibility of recovery a thing that can be seen and touched and heard - himself. And, step by step, he can tell not how it can be done , but how he did it. The psychological value of such an object lesson for a helpless, hopeless sufferer cannot be matched. The nearest that the pastor can come to this is to relate a vivid and accurate story of the rehabilitation through A.A. of another alcoholic whom he personally knew. If he has that A.A. member's permission to give his name and to produce him as the first contact with A.A., the effect will be even better.
Of course it should be made clear that A.A. members are in no sense trained experts, nor do they make any such claim. They are strictly amateurs, but amateurs with a difference. In a field where all too few trained experts exist, the man with experience is in a unique position. And in this case the experience itself is unique: it is inside knowledge which gives its possessor an inside track to the heart of the problem involved. Nevertheless, in spite of all these advantages; a sound program which has thoroughly proven itself, and specially qualified exponents of that program, A.A. does not claim 100% success. There are alcoholics who cannot be reached by this method (a rough estimate is 75% success) and this fact must be recognized. Then, too, there are those who are primarily mental cases with alcoholism as one of their symptoms - they are not good A.A. material.
Another word of warning comes to mind. The pastor should never forget that all alcoholics are consumed with guilt. They do not need to be scolded and lectured, or reminded of their sins. They have suffered pangs of remorse over their own behavior and what it has done to those who love them as well as themselves, that are beyond the comprehension of normal people. In fact, their mental suffering, their guilt if you like, is abnormally acute, and therefore abnormally agonizing. These feelings of unbearable guilt are so much a part of the picture of alcoholism that many alcoholics drink because of them; in other words, they cannot bear to be sober, and remember clearly the things they have done. They endure torments inexpressible save by a Dante whenever they think clearly .... at least until time has dimmed the recollections. This state of affairs, incidentally, explains the alcoholic's reluctance, often downright refusal, to talk about his problem when he has been sober for a while. It is unbearable for him to look clearly at his memories. They hurt too much.
The pastor who understands this will not preach when an alcoholic comes to him for help. If he is a man of true compassion, he will be hard put to it not to overdo his proffered comfort. An attitude of objective sympathy and real comprehension - the opposites of condemnation and contempt - will prove the most helpful. Ministers perhaps do not realize that in the minds of the alcoholic whom they are anxious to help, they themselves offer the greatest obstacle. The reason is simple. The alcoholic considers himself a pretty low fellow when he looks squarely at his drinking problem and his behavior because of it. He may try to avoid such a conclusion, but in his heart he has admitted it. The minister, on the other hand, is a symbol of good. He stands for righteousness and upright behavior in the middle of his parishioners. He is a Godly man - in fact he stands for the voice of God in his Church. The alcoholic who goes to his pastor for help, in effect is bringing himself to judgement. If he has been persuaded or forced to go to his pastor by his family, he is being brought by them for judgment. And he does not want judgment by any man, even a man of God, for he has already judged himself and found himself wanting. What is more, judgment will not help him, as he has already discovered. What he needs is comfort, enlightenment, and hope. The pastor who can offer these can be really effective with alcoholics, can properly prepare them for the supreme effort they themselves must make in order to recover. In giving such comfort and hope, he can and should be pretty tough under the heading of enlightenment - he should never minimize the desperate seriousness of alcoholism, its progressive nature, its possible fatal end. He can stress the comparative hopelessness of any victim of such a terrifying disease attempting to cope with it unaided, even though his own intensive effort is essential if he is to use such aid.
Here, then, are some suggested techniques for getting an alcoholic interested in A.A.: a thorough familiarity with A.A.; an understanding of alcoholism and an acceptance of it as an illness (that it is a spiritual sickness as well as a mental and physical one, no A.A. member will deny); acceptance of the fact that he, the minister, can rarely ever do the whole job himself; the presentation of A.A. not as an abstract philosophy nor as a miracle-working mystical something, but in the form of a humanized personal story of what it did for someone real and live, who can be produced in the flesh; the offering of comfort, hope, and a straight-from-the-shoulder enlightenment. Now the pastor is ready to either produce an A.A. member for a private interview with his alcoholic, or to take the alcoholic to an A.A. meeeting and there introduce him to several members, in both cases turning him over for A.A. to finish the job.
Do the wrong methods still need to be enumerated? There are a few glaring ones that perhaps should be further pointed up. First and foremost, do not preach - or indicate to the alcoholic what a miserable sinner he is. He knows it. Do not attempt to take over the whole job of regenerating this poor devil - unless you want a large proportion of your time and energy taken up with small chance of success after all your pains. Once you have led him, (or her) into A.A., let go. In A.A. they say, "let go and let God." It's not impossible that A.A. may lead him more directly to God than you could. In which case, incidentally, he will return to you - eagerly, and full of gratitude for your guidance.
This brings us directly to the question of what does and does not work in speaking of religion to an alcoholic. A.A. of course has a spiritual basis: the words Higher Power or God are used in six of the twelve steps of the program. Of vital importance, however, is the fact that following the word God in Step 3 are the words, "As we understood Him" - in caps for greater emphasis. This takes into account the extreme individuality of the alcoholic, and the never-to-be-forgotten fact that each one must be treated as an individual case, according to his or her specific needs. There is no effort in A.A. to force the spiritual part of the program on a newcomer, and in many cases this is the last thing about A.A. to be accepted. Too many alcoholics have gone completely away from their religious connections, either drifted away or in some cases deliberately turned their backs upon all things religious. In such cases it is most unwise to stress religious or spiritual matters, it would merely serve to close the door on that person's chances for recovery. A.A. believes in leaving the door open, the wider the better, allowing the newcomer to make use of the purely psychological steps, the group therapy, and the social benefits of A.A. until such time as he or she is ready to progress a bit further. That time, incidentally, always comes.
In the case of the pastor, he will undoubtedly know the religious status and attitude of the alcoholic he is trying to help, and can be guided accordingly in speaking of spiritual matters. If he is not sure of the alcoholic's attitude he would be wise to understate the spiritual aspects, not only of A.A., but of his own interest in the case. One thing almost every alcoholic is terrified of is "being prayed over," as they put it. Some of them, who have read the A.A. literature and especially the twelve steps, stay away from meetings for some time for fear that will happen when they go there. Possibly they do not feel worthy of such efforts at the time they are asking for help! Certainly I have heard many of them say, "If I could not appeal to God when things weren't too bad, or thank Him when they were good, I have no right to ask Him for help when everything seems lost." Most of them, however, would probably put praying along with preaching - it only increases their sense of guilt at a time when they can't stand it.
The pastor who feels it is his bound duty to act as a spiritual mentor to an alcoholic who come to him, could perhaps succeed if he could recall out of his own experience some time of deep crisis or personal suffering in which he found comfort from his faith, and could tell that story simply and directly. In other words, if he could come down from his symbolic mountain above the battle and meet the tormented soul of the alcoholic on its own level of suffering, that soul could perhaps accept comfort from him and gain some of his faith.
Most of the foregoing has taken for granted the existence of an A.A. group within reach of the minister who wishes to make use of it. But there may be some towns where A.A. has not yet started. The pator who finds himself in such a situation need not give up hope. It takes two alcoholics trying to get well to make a group, but only one alcoholic trying to get well to start a group. If the pastor knows even one alcoholic whom he thinks really wants to stop drinking, he can very well help him to start an A.A. group. But he must always remember that it is the alcoholic who is starting the group, and not himself. In other words, he should remain in the background, ready to offer advice and assistance but not taking a prominent part in the activities of the one, two, or three alcoholics who are trying to get started. His greatest usefulness will always be in providing new prospects for the first ones to work on, in spreading the word around among his colleagues, and even in actually bringing the A.A. and the new prospect together. Possibly he will have trouble getting his first man - or woman. If he finds that talking it over and giving them all the literature and such suggestions as he may have derived from it are not enough to get that one started, he can take a further step. Correspondence with the A.A. central office or the nearest group, may bring a visit from a travelling A.A. who can call on the alcoholic, or he may be able to take his alcoholic on a visit to the nearest group. Ten years ago when there were not many groups, a Catholic priest in St. Louis shepherded several alcoholics whom he was trying to interest in A.A. up to Chicago where they could see it for themselves. The St. Louis group was started.
There is an important point here which needs re-emphasizing. A pastor may be vital to the starting of an A.A. group, but he will remain important to that group just so long as he does not try to take it over, just so long as he stays in the background. Non-alcoholics cannot successfully run A.A. groups. A.A. has been well called a "self-help" fellowship. This is particularly true of ministers, since if the group were too closely associated with a man of religion it might keep out agnostics, and a large portion of alcoholics think they are just that. They must get into the group to find out differently, and they will not come in if they think it is a religious outfit. Then, too, a close association with any one denomination might keep members of other faiths away, and A.A. has no particular creed, faith, or denomination - it numbers all of them within its ranks.
One more word, I think, needs to be said. Many ministers have asked me if A.A. drew people away from their church. Quite the contrary. Those who had a church, from which they had probably drifted away, almost invariably return to it. Some who had never had a church connection, make one after a while in A.A. A large proportion still had a connection, although most likely it was a tenuous one - such A.A. members can become very good church members. There is no conflict whatever between A.A. and the church - any church.