Anonymous Struggle for 25 Years
The growth of Alcoholics Anonymous, founded a quarter-century ago this
month, has spurred new efforts to control a major national health problem.
By H. Jack Geiger
On the evening of June 10, 1935, a New York stockbroker visited a surgeon
in a suburb of Akron, Ohio. Both men were confirmed and "hopeless"
drunks. In despair and loneliness, they almost inadvertently made a major
medical and social discovery. This month, nearly a quarter of a million
people in sixty nations - their lives deeply touched by that event will
mark its twenty-fifth anniversary.
The stockbroker and the surgeon began to realize, that evening, that they
could stay sober, and be helped, by helping other alcoholics to stay
sober. In the past quarter-century, their realization has been repeated a
hundred thousand times over, in strikingly varied settings and involving
the whole roster of human types. For from it grew Alcoholics Anonymous,
the remarkable fellowship of compulsive drinkers who don't drink.
There is a great natural drama in the story of A.A. But by now perhaps
the drama is less important than the attempt to read its meaning. Beyond
the questions - What is A.A., does it work, how often, how well, for
whom? - there is an important issue: what has it taught us about
alcoholism?
A.A. is not, as some suspect, a herky-jerk parade of stumble-bums
shambling up the road from skid row to salvation; it lacks the
psalm-singing self-righteousness of the usual crusade. Neither is it a
"scientific" or medical organization. Nor is it, finally, "the answer" to
alcoholism.
But it is - and this is the crucial fact - the top of the iceberg, one of
the view visible aspects of a major national health problem. To
understand A.A. it is necessary to know something about the underlying
structure of alcoholism - the parts of the iceberg that we usually keep
below the surface of national awareness and concern.
It is a big iceberg. A recent estimate (and it is probably a serious
under-estimate) counts more than 4,700,000 alcoholics in the United
States - one man in every fifteen over the age of 20, six men for every
woman. Only about 8 per cent are on skid row, and only about 750,000 have
obvious signs of illness. There are one to two million problem drinkers
in industry, hundreds of thousands in the wards of mental hospitals. Five
to six million wives, husbands, parents and children are living in the
same household with alcoholism and are the victims of its erratic
behavior.
The count could be more accurate if researchers had an exact idea of what
they were counting.
Alcoholism is not simply synonymous with drinking, heavy drinking or
drunkenness, and no one is certain whether it is a symptom, a disease in
its own right, or several diseases. Most of the rule- of-thumb
definitions (the man who drinks alone, the man who drinks the first thing
in the morning, the man who has "lost his will power") are either wrong
or inadequate. Most of the scientific classifications (one of the
researchers recently counted thirty-four) are not much better.
One theme, however, keeps recurring. The alcoholic is a man who is either
unable to abstain from liquor or unable to stop once he has started; the
first drink "pulls a trigger" and his controls disintegrate.
Within this broad definition, some researchers feel, there are at least
two distinct types: "addictive" drinkers, driven usually by internal
stresses, who seek the biggest, quickest alcoholic jolt they can find,
and "habitual excessive symptomatic" drinkers, men in search of a gentle,
anxiety-obliterating alcoholic plateau with the longest - not the
quickest or most intense - effect.
Theories about the cause of alcoholism are equally vague. One group holds
that a genetic - or combined genetic and nutritional diet effect causes a
craving for alcohol, but the evidence is skimpy.
Psychiatrists contend that alcoholism is the expression of
self-destructive urges - "chronic suicide," in one man's graphic phrase -
or of homosexual impulses, or of a fixation on oral pleasures. A recent
Stanford University study explicitly tested these hypotheses, and found
no good evidence for any of them.
Still another theory rests on the startling difference in alcoholism
rates among ethnic and social-class groups in the United States. The
relative number of alcoholics, for example, among Irish-Americans and
"native-stock" Americans is much greater than among Italian-Americans and
Jews. The figures are consistent with the idea that cultures with
contradictory values and customs - for example, associating alcohol with
pleasure and sin, escape and drunkenness - are likelier to produce
alcoholism than cultures in which drinking is consistently seen as an
unremarkable supplement to meals, or a part of ritual religion.
A dwindling but highly vocal group finally, still insist that the cause
of alcoholism is alcohol itself, despite the fact that some 94 percent of
all the Americans who drink never experience uncontrollable cravings for
alcohol, blackouts, "the shakes" or similar symptoms.
Alcoholics Anonymous agrees that the alcoholic is forever "One drink away
from a drunk" - but there the theorizing stops. In the belief that
alcoholism comes in people, not bottles, it takes no stand on
prohibition, temperance or liquor laws.
A.A. is a vast network of local organizations, but it has almost no
organizational structure. Its growth has been meteoric, but it has never
asked anyone to join. Its one goal is sobriety, yet no member ever "takes
a pledge." Its tone and orientation are religious, but its membership
includes several thousand agnostics who happily rub shoulders with
Protestants, Jews, Catholics and Mormons.
Though it keeps no records, conducts no research and is, if anything,
faintly hostile to too much probing (We're just a bunch of ex-drunks,"
says one member, "and we don't care how or why it works, so long as it
does"). A.A. has been at least indirectly responsible for major strides
in the scientific understanding of alcoholism.
It detracts not at all from A.A.'s accomplishments that this new
scientific effort suggests that A.A. is not the whole answer to
alcoholism and that, in fact, its methods and results are not much better
or worse than any others.
What are the methods? The interested observer can find out on almost any
night in any American city. Atypical meeting begins with from thirty to
100 men and women gossiping on rows of wooden chairs in a church meeting
house or a rented hall. There is a busy traffic to and from a stand with
coffee, soft drinks and doughnuts.
In one corner, someone is idly playing a piano. The air is heavy with
cigarette smoke, and the talk is loud and cheerful. On the wall are a few
signs with messages like "Easy does it" and "First things first." One
bears the A.A. motto:
"God grant us the serenity to accept the things we cannot change, courage
to change the things we can, and wisdom to know the difference."
The visitor who plays guessing games about those present soon discovers
he is wasting his time: the seedy looking young man in the front row is a
casual guest who has never been drunk in his life; the white haired,
grandmotherly lady next to him has a record of twenty arrests and six
hospitalizations.
Here and there, however, he may be able to spot a newcomer - someone
drawn and tense and perhaps tremulous - and he may note that each one is
sticking close to a "sponsor," an established A.A. member who is giving
him special attention, introducing him to friends, pouring his coffee.
Finally, the chairman calls for order. "My name is Joe and I'm an
alcoholic," he begins. He announces that this is the regular weekly
"open" meeting of the group (there is a closed meeting for alcoholics
only, later in the week). He calls for a moment of silence "to be used as
each person sees fit." He announces plans for a dance, a bowling contest,
and a party to be sponsored by the local "Al-Anon an auxiliary group in
which relatives of A.A. members meet to talk over some of the problems of
having an alcoholic in the family.
Then he introduces the first of three speakers from a neighboring A.A.
group who have come to "tell their stories." The first speaker begins
with the standard line: "My name is and I'm an alcoholic." ("If he can
make it anyone can," someone whispers gleefully. "He was the worst wet
brain in history.")
What follows is, perhaps, the last thing the visitor expects: it is at
once tragic and uproariously funny, and the hall rocks again and again
with laughter.
A steelworker describes his weekly, wobbly odyssey from home to jail to
hospital to home again - where his despairing wife, he adds, always
covered him with the help- wanted pages from the newspaper while he slept
it off.
A business executive recounts his early career as a bootlegger's
assistant, hauling home-made gin in a baby carriage until "some drunk
stole the wheels." Later, a confirmed alcoholic, his job and family gone,
he decided to drink himself to death - only to discover, painfully, that
"you don't die that easy."
A suburban housewife wryly displays the sole trophy of her drinking days,
a citation as a faithful Cub Scout den mother. "The kids must of had a
great time, with me drunk at every meeting," she says, but adds quietly,
"except for two of them - my kids."
The laughter that comes is the laughter of recognition. The alcoholic
newcomer discovers that the troubles, horrors and tragedies he thought
were unique have, in fact, been shared by most of the people in the hall
- people who now are not only sober but (to his even greater
astonishment) happy.
A number of themes run through the talks, "Easy does it" turns out to be
a warning against the grandiose ambitions and unrealistic drives that
affect alcoholics. "First things first" is a reminder of the need for
priorities in the long job of rehabilitation.
Another slogan, "Live and let live," is shorthand for the observation
that resentment and self-pity push the drinker back toward the bottle.
The "24-hour plan" expresses the knowledge that the alcoholic's only hope
at present is total abstinence - and that it is easier to quit one day at
a time than to face a lifetime without alcohol's solace.
In all the talks there are reference to the "Twelve Steps, "which are the
core of A.A. belief. Here the compulsive drinker admits that he has
become powerless over alcohol, that his life has become unmanageable. He
decides that his fate is in the hands of a "Power greater than" himself,
and turns his life over to "the care of God as I understand Him."
He undertakes a searching self-inventory, admits his wrongs, tries to
make amends, prays for removal of his shortcomings. Finally - the
all-important Twelfth Step - he tries to carry the message of this
"spiritual experience" to other alcoholics if and when they seek help.
This is, in essence, what began in Akron in 1935, spread slowly to New
York, then to Cleveland and Chicago. In 1938 there were sixty members; by
1940, one man recalls, "there were two's and three's and five's of us in
half a dozen cities."
Today after a period of explosive growth beginning in 1941, there are
more than 7,000 groups. Each is autonomous and self- supporting (by
voluntary and unrecorded contributions, not dues) and has no permanent
chairman or officers.
The individual groups support an over-all "General Service Board" seven
alcoholics, eight nonalcoholic's - in New York, and this, together with
an annual convention of elected delegates and a national newspaper wryly
called "The Grapevine," is all that holds the loose federation together.
A.A. works, its students believe, by overcoming the drinker's biggest
barrier - the lack of real, vital emotional contact with any single human
or group, the feeling that nobody really understands or cares. In A.A. he
finds people essentially like himself, who cannot reject him and whom he
finds hard to reject or deceive. The concept of alcoholism as an illness
eases his guilt; his identification with a group dilutes it. Gradually,
the group itself provides a satisfying alternative to drinking.
How well does A.A. work? A.A. usually claims that of those who really
try, 50 per cent sober up at once and stay that way, another 25 per cent
remain sober after a few relapses. Unfortunately, the best evidence
suggests that these figures are probably wrong. A few careful studies by
outside observers report much lower figures in the 30-to-40 per cent
range.
The most important source of error, of course, is the statistical catch
in "those who really try." This means, in effect, counting only those
alcoholics who find the program attractive enough to join, and dismissing
the failures as persons who don't count.
Clearly, the alcoholics who join A.A. are a self-selected group and may
not be representative of all alcoholics. A recent study by Cornell
University's Dr. Harrison Trice - one of eight nonalcoholic members of
A.A.'s General Service Board - found striking differences in personality
and past experience between A.A. members and uncontrolled alcoholics who
had come to meetings but failed to join.
But results like these may represent a major step forward, for they
suggest that there is no single type of "alcoholic" and no single "cure."
The important question then becomes, not "What works?" but "What works
best - for whom?"
Twenty-five years ago when A.A. began, alcoholism made physicians uneasy,
frustrated psychiatrists, hardened social workers, wearied judges and
jailers, inflamed "wets" and "drys" and, all too frequently, killed the
alcoholic.
It still does - but the picture is changing. Tranquilizing drugs can be
used to help control alcoholic cravings and ease the pangs of withdrawal
- and they give the physician, at last, the knowledge that there is
something he can really do for such patients.
Psychiatrists, in recent years, have soft-pedaled their emphasis on
alcoholism as a mere symptom of some deeper emotional disorder and
focused on the drinking itself. Perhaps more important, they are
beginning to abandon the widely held feeling that alcoholism is an
incurable personality defect and are trying new, less orthodox therapies.
"The psychiatrist and his techniques have to be less rigid," notes Dr.
Morris Chafetz of Massachusetts General Hospital's alcoholism clinic in
Boston, "and he has to be a pioneer in his approach to each case."
"The passive, non-directive therapist of alcoholics who follows his usual
therapeutic approach usually has no patients to treat after a while."
At this and other clinics, psychiatrists now work in teams with social
workers and psychologists. Wherever possible, if the patient has a
family, an attempt is made to bring the wife into treatment, too, in
individual or group counseling sessions. Almost invariably, such efforts
increase the success rate to 30 per cent or better.
In the past decade, finally, a therapy has began to appear for the
skid-row drinkers, the derelicts, the homeless men of the bottle gang who
rotate between rented rooms and jail. Observers noted that these men did
well while they were jailed - and protected - but always drank when they
were tossed out, jobless and unskilled in the simplest tasks of living.
A dozen states now have "half-way houses," small residential units which
offer food and shelter, group identification, support from physicians and
social workers, and a firm but gentle push toward employment and
self-sufficiency. The improvement rate - and these are the "hopeless" men
- is better than 30 per cent.
For all these advances, including many in which it has had no direct
part, A.A. can claim some real credit - they may, in fact, represent its
greatest contribution. Raymond G. McCarthy of Yale's Center for Alcohol
Studies, explains:
"The real effect of A.A. extended far beyond its members. A.A. changed
the social climate, dramatized alcoholism as an illness, substituted
'alcoholic' for 'drunkard' in public thinking, and demonstrated that
something could be done."
In this 1960 view, AA's 200,000 members are still, statistically, only a
drop in the bucket. And, as is the case with all other workers in the
field of alcoholism, they clearly have a long way yet to go.
But already they have added a strange social prescription to medicine's
stock of remedies. The idea is, after all, very old. "I am my brothers
keeper," says one member, and he is mine and that's the heart of it."
Source: The New York Times Magazine, June 5, 1960.
Contact:
The Legacy Group of Alcoholics Anonymous © 2005