The inspired plan to help alcoholics by enabling them to help other alcoholics was devised by a stockbroker, Bill W., and a medical practitioner, Dr Bob, at Akron, Ohio, in 1935. The movement was based on concepts and techniques derived from a number of sources. Both founders were active Oxford Group members and used as a basis for Alcoholics Anonymous the principles of open self-scrutiny, admission of defects, aid to others, and making reparations for harm done in the past. The religious component is epitomized by their adoption of an eighteenth-century prayer of Friedrich Otinger: God give me the detachment to accept those things I cannot alter; the courage to alter those things which I can alter; and the wisdom to distinguish the ones from the others ‘; an A A member, in a phrase of William James, is asked in Step Two to believe that a Power greater than ourselves ‘ can restore him to sanity. The
physician, W. D. Silkworth, proposed to the founders of the movement the idea that alcoholism was an illness; his belief that the basis of the condition was an allergy to alcohol was enthusiastically adopted and widely publicized.1 This, as we have seen, is no longer a tenable hypothesis, but it permitted an approach to be formulated which identifies the drinking itself as the disease process. Stopping drinking and remaining abstinent are the goals of AA members. In their theoretical statement of the causes of alcoholism they do not adopt the broader approach of the medical profession, which holds that there are underlying psychological factors to which attention must be paid.
Their programme is based on the famous Twelve Steps:
1. 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.
j. 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 a personal inventory and when we were wrong promptly admitted it.
11. Sought through power of 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.
I. Silkworth, W. D. (1937). Alcoholism as a manifestation of allergy’. Medical Record, 14 J, 249.
12. Having had a spiritual experience as a result of these steps, tried to carry this message to alcoholics and to practise these principles in all our affairs.
These steps are buttressed by twelve Traditions which are concerned with the cohesion and management of local groups. The first tradition is: Our common welfare should come first; personal recovery depends on AA unity’. The fifth tradition runs: Each group has but one primary purpose – to carry its message to the alcoholic who still suffers ‘. The ninth takes us firmly into the organizational sphere: Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy’.
To join, all one has to do is to get in touch with any AA member or to look them up in the telephone directory. It is not necessary to have stopped drinking. The alcoholic who joins an AA group is provided with a new sub-culture, made up of companions engaged upon a common task.1 A new, all-embracing outlook on life is offered him. He learns a special, memorable, technical language in which to talk about and reflect on the symptoms occurring in the course of alcoholism and he absorbs a system of ideas devised by alcoholics themselves to provide practical ways of becoming abstinent. Anybody who wants to stop drinking and is prepared to admit that he is powerless over alcohol’ can join AA. There are groups in most cities. At the meetings members describe their successes and failures since the last meeting and discuss difficulties common to all. A new member may be introduced and absent members may be inquired about. One or more members usually will relate the story of former drinking days and successful recovery. Only alcoholics play a part in the movement, which does not rely on doctors or ministers or other professional personnel. Wives are admitted to special meetings.
As the designation of Alcoholics Anonymous emphasizes, first names only are used, so that members can shed some of the customary social caution (in English AA groups more stress than in North America is placed on the anonymity principle).1
Each newcomer is assigned a sponsor, an AA member who has successfully stopped drinking. The function of the sponsor is to come to the sufferer’s aid whenever necessary and to stay with him for as long as necessary. The care and selflessness shown by some sponsors is one of the twin pillars of the movement, the other being the group meetings, which may occur as often as every night.
The success of different AA groups in providing active sponsorship for new members and in dealing with rivalries, open hostilities and other quarrelsome behaviour varies from group to group.2
The alcoholic who succeeds with AA’s help in becoming abstinent has found a constant body of people who share his enduring interest to stay sober regardless of difficulties which crop up. The discovery of so many pleasant men and women in the group helps him considerably in ridding himself of the idea that alcoholics, himself in particular, are despicable. His own self-esteem grows with this realization. He finds friends, an active social life, the satisfaction of helping others and, in time, the chance to take a leading part in the affairs of his local group. His guilt over the harm he did to others is reduced both by the relief of confession and by the opportunities for reparation which he is afforded when called upon to sponsor new members. Many AA members find that the movement becomes their overriding life concern.
The AA approach can be a life-changing experience for alcoholics who are sociable, who derive satisfaction from helping fellow sufferers and from their company, who are responsive to concentrated attention upon drinking and who do not seek psychological exploration and treatment of underlying problems. Nowadays AA groups will even receive alcoholics who are simultaneously undergoing psychiatric treatment; they are progressively willing to accept that some of their members are helped by medical measures such as antabuse; many groups have active links with physicians in their area, who provide hospital facilities for treating alcoholics during withdrawal symptoms. In some psychiatric hospitals AA members are invited in to sponsor patients being treated for alcoholism. One such hospital,1 Warlingham Park Hospital near London, arranged for an AA group to function in the hospital itself. The physician can learn much from Alcoholics Anonymous and medical men interested in alcoholism do well to seek the cooperation of the local AA group.
AA achieves least success with those alcoholics who are not gregarious and cannot tolerate the pressures towards continuous and intimate relationships with others. Such alcoholics mention this as one of their chief reasons for not having been helped by the movement. Another is the distaste that may be engendered not only by having to confess publicly about their drinking history but also by the apparent relish with which, one after another, hardened abstainers recount their past and rehearse their former drinking habits.
These activities together with the religious emphasis, which varies considerably from group to group, put off some newcomers who feel themselves not part of the group. They are undoubtedly features which may strike an outsider attending an open meeting as unacceptable; however, the movement is not intended for outsiders but for insiders. It has forged techniques which it has found effective for many alcoholics. AA realizes for instance that public declarations of former drinking are a necessary group defence against relapse by serving as a constant reminder of what might happen again.
Two other forms of treatment which we do not personally use should be discussed.