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Recently, I’ve been involved in an academic debate regarding the concept of alcoholism and addiction as diseases. During that debate, I discovered what I consider to be a major contradiction between the diagnosis of alcoholism (upon which I will focus in this post) and its “treatment.” That discovery led me to a second and even more startling revelation.

Without doubt, the advent of alcoholism as a disease accomplished some positives. E.Morton Jellinek was the major force behind the development of the disease model. Without going into Jellinek’s ideas and the conclusions he reached from his research, some of which are unquestionably wrong, it need only be stated for now that without Jellinek, alcoholism might still be considered the result of “character defects.”

Redefining alcoholism as a disease seemingly de-stigmatized alcoholism. However, that de-stigmatization occurred only in the definition of alcoholism, not its treatment. That contradiction is the subject of this essay.

While nearly every therapist, psychologist, psychiatrist, and physician in the United States accepts the disease model of alcoholism and other addictions, they almost-uniformly refer every one of their patients to AA as the one and only road to recovery. Remember that these professionals have, as part of their acceptance of the disease model, obviously concluded that diseases are not caused by “character defects.”

But at the same time, in its primary document (the Twelve Steps), AA members “must” (of course they can ignore it, but no reason to attend AA exists in that case) accept the 6th Step, i.e, being “entirely ready to have God remove all these defects of character” [bolding and italics mine].

This raises two points, the first being the most important.

  • (1) Because almost all therapists, psychologists, psychiatrists, and physicians accept the disease model of alcoholism, they also by default accept that a disease does not result from “character defects.” However, the only “treatment” they offer is referral to AA, which, while paying lip service to the disease model, clearly views alcoholism as the result of “character defects,” otherwise known as a “sinful nature.” Such “treatment” negates the very essence of the treatment community’s own diagnosis. That’s precisely parallel to a physician who knows the use of shark cartilage as a cancer treatment goes against everything he believes about the disease of cancer, but he still points every cancer patient to shark cartilage as the only treatment that “works.”
  • (2) Because AA accepts the disease theory of alcoholism, at least on the surface, its own 6th Step repudiates the definition of alcoholism as a disease and AA as a coherent “philosophy.” AA inculcates the idea of alcoholism as the result of “character defects,” the very idea Jellinek, the founder of the disease model, disputed. Thus, AA is entirely based upon a “sin and redemption” approach. While it may work for some, it is, without question, a faith-based organization, as both the Twelve Steps and the fact that, at least in my experience, every AA meeting ends with the specifically-Christian Lord’s Prayer and the Serenity Prayer (“God grant me the wisdom…”) attest.

Point (1) is far more important than a blatant contradiction. That the sole recovery model to which patients are referred denies the very diagnosis and understanding of alcoholism that the entire treatment community accepts is an almost unbelievable fact. Of even more concern is that no one has ever noticed this unbridgeable gap between the treatment community’s diagnosis and understanding of alcoholism and the sole model of recovery it suggests.

The point is not to engage in argument with AA or its members; rather, the point is a psychological, medical, economic, and political one: Why is AA never questioned as the sole road to recovery by those who so depend upon it when “treating” patients? Why has no one else ever noticed the black hole between diagnosis and “treatment”? How can the treatment community not notice that AA’s primary document stands in direct opposition to its own accepted definition of alcoholism?

The American Medical Association’s own diagnosis states: “Disease means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage” [again, bolding and italics mine].

The American Psychiatric Association never mentions AA in its Substance-Related Disorders Position Statement. Its Diagnostic and Statistical Manual of Mental Disorders describes only criteria; it no longer addresses etiology in regards to any disorder or, in the sole case of alcoholism/addiction, “disease.”

Despite this avoidance of the issue at hand, the American Psychological Association, the American Psychiatric Association, The American Medical Association, and The World Health Organization all consider alcoholism a disease. And to prove how the medical community and AA are becoming still more integrated, some medical schools are now including AA “education” as part of their academic requirements.

What does all of this mean for the patient? Isn’t the treatment of a disease the role of the treatment community? Or is the treatment community’s addiction to AA psychological, so that it refers patients to the most available “resource” as a stress reliever? Is it economic, since AA is free, much like church? Is it political, with “disease” more likely to gain legislative support that in turn provides funding for research, grants, etc.? Is it simple ignorance? Going back to the patient, left to a cold war of the self, the answer hardly matters. However, were the treatment community to recognize or admit the discrepancy between its diagnosis and treatment of alcoholism, it would make all the difference in the world.

In conclusion, given the treatment community’s ubiquitous acceptance of alcoholism as a disease and acceptance of AA as the sole recovery model for alcoholic patients despite AA’s insistence that alcohol is the result of “character defects,” the entire psychological, psychiatric and medical communities are not only complicit in the inevitable relapse of patients but engaging in nationwide malpractice.

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Paul A. Toth PAUL A. TOTH's Airplane Novel, already a Midwest Book Review Reviewer's Choice and the 9/11 novel, is available now. His other novels include Finale, Fishnet and Fizz. Click here to visit his sites.

95 Responses to “Alcoholism, AA and the Medical Industry: Nationwide Malpractice”

  1. Irene Zion says:

    Damn, Paul,

    You sure do sound different when you write something serious than when you are writing from your creative brain.
    Two different people!

  2. Jane says:

    It is this “character defect” labelling that creates a negative cycle. I had no idea this jargon was used at AA. I can’t say I understand the entire framework of AA or its members, but am not sure if “shaming” someone into changing has ever really had any lasting effect, except for creating a negative one.

  3. Paul A. Toth says:

    Yes, that was a major point I wanted to make. It’s one thing for laypeople like us not to be aware of the AA “character defect” terminology; it’s an entirely different thing for professionals to either be unaware of, or worse, ignore it. And I think this is a major issue. If all the organizations involved in the treatment of recovering alcoholics subscribe to a disease model, and they all do, then the treatments and support groups to which their members refer patients should obviously be in line with that disease model. However, the exact opposite is the case. Unfortunately, I am well aware that those who refer patients to AA will talk their way around any opposition to it, even if AA negates the very manner in which they define alcoholism. Why AA has become even more untouchable and unquestionable than religion is beyond my understanding. It’s all rather amazing and, for the recovering alcoholic and all those close to him or her, terribly sad.

  4. Sparrow says:

    Paul,
    You have got the wrong idea about ‘these defects of character’ in the 6th Step.
    There is one word which you have missed. That word is ‘these’. What this means is that as a ‘result’ of the alcoholics drinking he did certain things which he should now address. He makes a list of these things in Step 4. He talks about them in Step 5. And, in Step 6 he is ready to change his behaviour – get rid of ‘these’ defects and begin to be released from the guilt and shame he has built up during his drinking.
    Bill W. who wrote much of the AA texts once said that he was taught in school to try not to use the same word in close proximity to each other. Thus in Step 4 there is a ‘moral inventory; in Step 5 there are ‘wrongs’ to talk about; in Step 6 the description is ‘defects of character'; and in Step 7 they are described as ‘shortcomings’. To AA’s they all mean the same thing – “I stuffed up and I need to put it right.”
    So there is no conflict.
    Incidentally, Bill W. shied away from using the word ‘disease’. That was used only by professional people. He preferred to describe alcoholism as a ‘malady’.
    Regards
    Sparrow

    • Carl D'Agostino says:

      I’ve given some study to alternative alcoholism treatment protocols, about 30. Worked for specialists doing basic research providing rough draft for text for therapists using holistic and alternative medicine protocols in treatment. There’s a relatively new one. I think it’s ET(empowerment therapy). Denies alcoholism as disease because it gives alcoholic sense of victimhood. The theory is that this disables one from taking full responsibility enabling one to pass the buck as to the cause of one’s alcoholism. To deny being a participant in the destruction. If we are victims we are absolved of
      fault. Empowerment recognition means if we got ourselves into addiction we can get ourselves out of it. If it’s a disease like cancer we are not responsible for getting it. But if it’s not a disease but a character defect, we caused it and can change it by addressing defects and behavior modification. We are unaware of some character defects so they use inventory to give us insights. I am not sure I’ve given ET proper perspective here, but I am sure you get the drift. However, AA teaches that we are responsible for our actions too. Some AA’s deny disease concept. “I don’t have a disease. I choose to drink myself into manageability and I’m sick and tired of being sick and tired. I will not live this way any more.” They’ve “Made a decision…”

  5. Thomas Wood says:

    Hey Paul, First quick thing: please check out Gravatar.com to include a picture in your comment section.

    Now, questions/comments:
    I’m not sure I see a “contradiction” so absolutely as you do. You seem to be saying that the terms “disease” and “character defect” are necessarily incompatible, and that an institution which ascribes to the first cannot agree to the methods of a group which still uses the other. While I agree the term “character defect” is arcane at best and confusing at worst, I don’t see it as a reason for condemning the AA program as a viable treatment. I see what you’re saying linguistically, but I’m not sure I agree with your conclusion.

    If we call something a disease it is reclassifying something as a biological defect, yes? We don’t think of diseases as something we are really responsible for. They just happen. But that’s not entirely true. Death is inevitable, but good health is something we can affect. We can reduce the risk of heart disease, cancers, hepatitis, infection, etc. We can exercise and eat right. We have some controls. So, at best, calling something a disease means that we can reduce characteristics to a biological level and study it there.

    But what about this term, “character defect?” What is that? This feels like the “who we are.” The girls who sleep with everyone at 13 and yell at their mom’s on talk-shows, they have a character defect. Jeff Skilling, former CEO of Enron, he had a character defect. We think of a character defect as something we can control, something we are responsible for. But can we really control our characters? This is a huge question but the short answer is yes and no (note the similarities to the disease). Can’t you think of some real assholes who probably couldn’t or “wouldn’t” stop being assholes just because you demonstrated that it wasn’t leading to a good life? Is that a disease? Are they responsible?
    The trouble is that notions of responsibility, control and simple cause and effect are often blurred. Many things seem, under some light, to be something that we have control over, where all the results seem a matter of choice. On closer inspection, we can find evidence that the cause lies elsewhere. Through a reductive examination, we see nature’s influence, and how that nature was shaped. We appreciate that individuals are physically compelled to behave in such a way, but we cannot completely deny a person’s responsibility for the actions they take without risk of reducing all action to cause and effect. In short, we are left with a melding of perspectives. At the cellular level, a possible hereditary trait which manifests hyper activity of the nucleus accumbens; at the human level, an addict. Being an addict is certainly a part of their character, isn’t it? If not, then what is character?
    The medical community uses AA because it has some degree of success, and because it offers the most important aspect of overcoming addiction, immediate and regular support that is completely accessible; but it’s not the only program out there. There are alternatives to AA

    • Richard Cox says:

      I loved this essay, Paul, and to someone unfamiliar with AA it seems upon first inspection to be a no-brainer, and also causes me to wonder why questions like yours haven’t arisen sooner. Or perhaps they have, but the fact remains that AA is by far the most common treatment for alcoholism.

      And if it’s “correct” to call alcoholism a disease, then I assume there must be studies in place to address the biological causes and symptoms in order to provide medicine to combat it? For instance, you don’t use only behavioral therapy to combat heart disease.

      However, I also enjoyed Thomas’ comment, because truly, what does it mean that we define something as a “disease?” You both discuss the biological aspects, something out of our control, but Thomas also veers into the area of determinism. What is truly the cause and effect relationship? Can a fairly simple one be identified? Thomas points out how we typically think of character defects as behavior based, and then relates this to being healthy as a means to combat what we traditionally think of as disease. However, while better dietary and exercise habits reduce the likelihood of disease across the population, in an individual the relationship is not so clear-cut. Disease can strike (seemingly) randomly, and without regard to an individual’s behaviors. Think of someone who eats responsibly but their blood cholesterol levels are nevertheless uncontrollable, versus the fellow who eats like a pig and yet his arteries are perfectly clean. This seeming randomness of disease is part of why we think of it as out of our control. Whereas, many would say you can choose not to drink alcohol.

      In fact, when I’m suffering from a hangover, I often refer to the pain as self-inflicted. It’s hard to feel sympathy for someone who intentionally poisons himself at the bar all night in the interest of having a good time. Labeling alcoholism as a disease does have a de-stigmatizing effect, but still I think as a society we look at drinking as something you choose to do, and thus not completely on par with, say, a neuromuscular disease that no one understands very well. Which is probably part of why we choose behavioral therapy over drug therapy.

      I didn’t take your essay as condemning AA as a viable treatment. It obviously works for many people. What I would like to understand better, after reading this, is what the other alternatives are, and not just other behavioral therapies. Personally, if I were a candidate for AA, I wouldn’t go because of its relationship with Christian faith. But even if there are secular treatments, I’m still curious about what work might be in the works for attacking alcoholism (and other addictions) at the cellular level.

      Thanks for posting this. A nice, thought-provoking read.

      • Carl D'Agostino says:

        “Oh, if there was a medicine to cure alcoholism…” There is certainly a biological (physiological)component for alcoholism, as well as psychological elements. For AA this is a cop out. Through the 12 Steps one becomes a changed person and this new person with connection with higher power is relieved of the obsession. The new person an individual becomes no longer cares to drink following this spiritual path. If there was a medicine/cure the person may stay sober but have not been reborn and so AA rejects the notion.

  6. Paul A. Toth says:

    On its own website, AA states that alcoholism is a disease: http://www.aa.org/subpage.cfm?page=12

    Thus, AA has currently dismissed the statement you quote, which was offered by one of its founders, Bill W.

    Further, Step 6 couldn’t be clearer. It’s obvious that “these character defects” (I’ve added “these” to no discernible effect) are such a major part of AA’s thinking that they’re included as one of AA’s mere Twelve Steps. Now, if AA’s method of addressing what it sees as character defects works for some, I have no problem with that. I am not, nor will I, engage in an argument over the validity of AA because it’s akin to arguing religion: neither side will convince the other of anything. Finally, my mission is not to attack AA but rather the incompatibility between the disease concept and the Twelve Steps, the cornerstone of the AA recovery model.

    Step 6 could not more clearly be out of line with the disease model. From the Lakeside-Milam Recovery Centers’ come the following comments by Dr. James R. Milam: “This paper describes the polarity and the shift to the new model that is transforming our entire view of alcoholism (and other drug addictions). I have adapted the terms ‘psychogenic’ (of psychological origin) for the old paradigm and ‘biogenic’ (of biological origin) for the new.

    “The psychogenic model is based on the nearly universal belief that alcoholism is a symptom or consequence of an underlying character defect, a destructive response to psychological and social problems, a learned behavior. The biogenic model recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality. It will help at the outset to realize that compromise is not possible, that the two are not complimentary but mutually exclusive alternatives, like a perceptual figure-ground reversal.” [http://www.lakesidemilam.com/TheAlcoholismRevolution.htm]

    Now, I could offer a thousand links indicating that one of the primary motives behind the creation of the disease model was the de-stigmatization of the alcoholic, who would no longer be seen as having “character defects” but rather a disease. Thus, AA’s own site contradicts itself, and so do those treatment professionals who subscribe to both the disease and AA models. AA obviously has developed its approach over a long period of time, considers that approach correct, and is therefore unlikely to make major changes to its approach. Therefore, it’s up to the treatment community to decide whether it wishes to view alcoholism as a disease or the result of “character defects,” or offer an alternative to those choices.

    I will agree the issue is incredibly complex. That’s exactly why I find the nearly-universal adoption of AA as the sole path to recovery a bit puzzling and overly simple, especially when those adopting it subscribe to a theory — the disease model — that explicitly denies “character defects” as a cause of alcoholism.

    I’m arguing against two points here. One commentator sees no incompatibility between a disease model that rejects the idea of character defects and an organization that has embedded within its primary document the belief in character defects as a cause of alcoholism. The other commentator denies that the 6th step *really* means “character defects” based upon the word “these.”

    Both cases are rather simple to address. The “disease model” and “character defects” are absolutely incompatible, if not by AA’s definition, then by the disease model’s definition, or vice versa. One cannot have it both ways. Next, by including the word “these” in quoting the 6th Step, one only adds an unsupported specificity to the term “character defects,” i.e., “these character defects” meaning exactly which character defects? Step 5 does not clarify matters: “Admitted to God, to ourselves and to another human being the exact nature of our wrongs.” A “wrong” an alcoholic commits does not equate a character defect. A drunken alcoholic may commit all kinds of wrongs, but his or her thinking and behavior are rendered irrational by alcohol; that person’s true character has been deactivated. Thus, we are back to “these character effects,” and the language does not require a linguist to parse.

    I stand by my statements, though I know they will come under attack due to the fervor with which many AA members support their organization. If it has worked for them, that fervor is understandable. I’m glad it works for such recovering alcoholics. My article is not concerned with AA, per se, but rather the contradiction — which neither comment explained away — between one model that denies “character defects” and another that accepts “character defects” as one of alcoholism’s causal agents. One can “complexify” the issue to infinity, but the division between believing in the “disease model” or “character defects” remains something like believing in God: you do or you don’t, unless a person wants to be agnostic about it, an unlikely motivation for someone to become a substance abuse counselor.

    • Elijah Joshua says:

      I read quite a few of the articles and found great logical points by several writers, you being one of them. I get it. But in America, the treatment of alcoholism from colonial times through the alcohol epidemic of the 1800’s to prohibition and beyond hasn’t improve a hell of a lot. I think A.A is a trusty tool that you go to when you have a problem in this area. They don’t really have a non-expensive intervention to take it place that won’t cost the client money he does not have. Now the psychological treatment community piggybacking off of one of substance abuse bread and butter theories 12 steps, maybe they need to step their game up. As a substance abuse counselor, I believe more holistic approaches should be investigated for the treatment of addictions.
      Character defects on the other hand, well we all have them, 2 bricks short of a full load. As long as there is human nature there will be misdiagnoses, as long as there is people help people they will miss the mark, and as long as people have ideas people will disagree. Good luck. I think I will marinade the subject.

  7. Paul A. Toth says:

    Addendum: There indeed exist alternatives to AA. Of all the times I’ve been seen by therapists, psychologists and psychiatrists, I had to inform them about those alternatives. None seemed especially impressed by the alternatives. I’ve been seen by enough such professionals to extrapolate that this is the norm due to the much greater “fame” of AA.

  8. Tip Robin says:

    Great points made here Paul.

    I got a DUI in California and had to attend several AA-type meetings. They had three or four alternatives to AA, like Smart Recovery and Rational Recovery. I can’t remember which one I went to, but it was an alternative one, and it was fine, whatever. I tend to binge drink when I do, and that’s what got me the DUI in the first place. I have since lessened my own drinking to fewer and fewer situations, partly because my body simply can’t take it much anymore.

    While I think your point is definitely valid and perspicacious, I doubt anyone involved with AA or drinking heavily or even in the medical field even give a damn about the semantics of it. You might be the first to really care, hence the essay, which I found illuminating.

    On a side note, I’m not sure how much you read others’ works, but David Foster Wallace’s Infinite Jest goes into incredible exhaustive detail about addiction, specifically following Don Gately, a character who is consumed with going to AA meetings and running a Recovery house. I got so close to that world that I felt like I never really needed to see it firsthand, because I already had. He also delves deeply (somewhere in the book, can’t remember) into the essence of what addiction means, medically-speaking.

    Cheers on the essay. I hope it garners some attention by some people in the field who might care enough to consider it.

  9. Matt says:

    Paul–as the others have said, very interesting points here. This essay reminded me of something I haven’t thought of in a long time:

    Some years ago a work acquaintance was having some severe troubles with alcohol, and was finally told by HR that he needed to begin attending AA or he would be terminated. He flatly refused, on the grounds that, as an atheist, their mandate he attend a religious organization violated his Constitutionally-protected religious freedoms. When they fired him, he sued them for religious discrimination, and won. He told me afterwards he would have been perfectly happy to attend a secular-based treatment program (he was trying to sober up anyways), but none were offered, even after he asked.

    Also, have you ever heard Gary Busey wax poetic about the benefits of AA? It’s a lot like listening to Tom Cruise discuss Scientology.

  10. Paul A. Toth says:

    To All:

    I will respond at length to some of your posts tomorrow. I was unable to post lengthy comments I had written earlier due to a glitch on my end.

    To Matt:

    Very interesting. Also of note, the Supreme Court at least once ruled in favor of plaintiff who had been ordered by the court to attend AA. However, the ruling was non-binding and did not set a precedent. However, various courts have ruled that AA is a religious organization and that defendants cannot be forced to attend AA meetings. To me, it’s beyond question that AA is a religious, faith-based organization. However, some atheists find a way around that fact, learning to live with it in exchange for the group support. I understand this thinking when AA works for the atheist or agnostic; however, I’ve attended AA and have always eventually left simply because I could not convince myself of a higher power in any form, and that undercuts the entire program. Nevertheless, I can’t say I gained nothing from it, and I certainly met some intelligent and interesting people. On the other hand, I have also attended meetings in which a subtle pressure to believe or convert, or the suggestion that I would eventually do so if I remained in the program, was palpable.

    I don’t think the above negates the following statement: I’m not arguing against AA’s approach or existence. I may not agree with it, but that’s another matter. I’m only concerned with the treatment approach and the inconsistencies mentioned in the article.

    It did cross my mind that if AA wanted a still-broader membership, it should consider forming a separate and secular group that would consist of meetings in which alcoholism would be discussed and support shared, without the involvement of religion, higher powers, faith, etc. This could also simply be an addition to the already-varied types of meetings, e.g., speaker meetings, 12 step meetings, etc. Since AA is, as some have noted, by far the most and usually only available support group, why not spread its arms open to nonbelievers? While it claims to do so, AA actually only addresses agnostics in its Big Book (apparently, atheists are “lost souls”), and even though that chapter is often referenced by those trying to convince me that AA is accepting of nonbelievers, the chapter insists that one will, over time, develop belief. Therefore, except for the types of atheists I mentioned, there are few options.

    I will post information about AA alternatives and a few books tomorrow. A choice of support groups should be available to alcoholics, but that choice only exists in some towns and cities. For most people, it’s AA or a do-it-yourself project. However, I will provide some resources that may be of assistance to those doing it themselves. And I will also, again, address some of the comments to which I was earlier unable to respond.

    Thanks for all the comments, whether pro, con or somewhere in between.

  11. Paul A. Toth says:

    To Richard Cox:

    As to your question about AA alternatives, here is some information. I can’t provide links, as doing so seems to cause errors in my posting comment replies. Simply search for the organizations, and you should find them at or near the top of the results.

    Organizations:

    Rational Recovery: No meetings in the AA sense; see the site for the types of arrangements available. Primarily text-based, but the website includes a an online Crash Course, a link to which you’ll find upon scrolling down the home page.

    SMART Recovery: Online support with discussion forums, chat rooms, etc., plus meetings in some towns and cities.

    Books:

    Rational Recovery: The New Cure for Substance Addiction by Jack Trimpey: The “textbook” of Rational Recovery.

    When AA Doesn’t Work For You: Rational Steps to Quitting Alcohol by Albert Ellis: By the founder of Rational Emotive Behavior Therapy, a practical but well-supported psychological theory based on philosophers both ancient and modern. Easy to put into practice, but one must to keep putting it into practice. If taking the Rational Recovery approach, I would definitely use this book in conjunction with the former’s “textbook.” The reverse is not necessarily the case.

    How To Control Your Anxiety Before It Controls You by Albert Ellis: Many alcoholics have preexisting anxiety disorders that alcohol worsens. Once recovery occurs, anxiety may persist even for those who had no preexisting anxiety disorder. This book has remarkably reduced my anxiety within weeks and began to work after I had read the first chapter. Again, it must not only be put into practice but kept there. Ellis has other books that apply to almost every emotional issue with which a recovering or still-practicing alcoholic might struggle.

    As to the disease model, personally, I do not believe the evidence exists to prove its validity. I prefer the term “syndrome,” or “a group of signs and symptoms that occur together and characterize a particular abnormality or condition” (Mirriam-Webster). Whether or not research will one day support the disease model, I’ve no idea. For now, I am not that concerned with either the current definition or my suggested replacement term. I consider the debate a waste of time and resources that would be better spent on treatment and treatment research.

    An alcoholic experiences less choice than an occasional heavy drinker because the body and brain have become so acclimated and dependent upon alcohol that an insufficient quantity, or a quantity absorbed too long after “happy hour,” will cause severe anxiety and other torturous problems, not to mention the very real possibility of a seizure. The intensity of withdrawal cannot be described; it can only truly be understood by experiencing it. As one begins to withdraw, drinking almost becomes rational, except that drinking to relieve withdrawal backfires the next day, when symptoms intensify, and so on. Thus, continued drinking under such circumstances is simultaneously rational and irrational, accounting for the trap in which alcoholics find themselves and the reason why they continue creating the trap in which the alcoholic finds himself. It takes a tremendous amount of strength to stop drinking and undergo detoxification. That’s why treatment consistent with diagnosis and definition is crucial.

    Regarding treatment at the cellular level, I doubt it exists now, but I would guess that research is underway. Other new drug therapies are emerging, but I’m not familiar with them yet. When I become so, I will post my thoughts here or on my website, Violent Contradiction: The Paul A. Toth Blog.

  12. Paul A. Toth says:

    Excuse the typos and other errors; I’ve stayed up far too late!

  13. Egad – this started out complex and quickly snowballed into more complexity, and it’s fascinating to me. I think I’m going to have to go back and re-read this (and the comments that follow) to really come to grips with the concepts, and I’m really intrigued by Thomas’s reductionist arguments.

    Without having any experience with AA, and being luckily untouched by alcholism in the lives of myself, my friends, and my family, I have heard it said that one of the issues with AA is a certain absolution of responsibility – this post has made me re-consider a lot of my previously-held (and admittedly hazy) considerations.

  14. Marni Grossman says:

    I think there’s a sense of “fault” or even “character defect” in lots of maladies we define as “diseases.” Lung cancer is a disease, but if the patient was a smoker, society often considers him/her at least partly responsible. And, from experience, I know that anorectics are often accused of “doing it for attention,” in spite of the fact that anorexia is accepted as a disease.

    We always seem to want someone to blame.

  15. Paul A. Toth says:

    Blame is the national past-time. My theory proposes that m=sc2, i.e., “Moralizing equals skeletons in the closet squared.”

    For those interested in the effectiveness of AA, some statistics exist that may easily be found via web searching. Those statistics are not aplenty, as it’s difficult to study a group that understandably requires, as its name indicates, that everyone remain anonymous.

    I won’t go into those statistics or the conclusions I reached, as I don’t want to push aside the purpose of my writing the article and convert the discussion into one about the success or failure of AA as a recovery model. For now, I’ll only state the obvious: AA works for some number of members; others drop out and return or never return; and some never attend a single meeting. Each individual is different and will accept or reject the AA model for reasons of his or her own: one individual will find AA a lifesaver; the next will consider AA of moderate assistance; and a third will repeatedly relapse despite incessantly attending AA meetings. To make things more complex, all of those results have a multitude of possible explanations.

    The article’s “target” is not AA but the treatment community and those under its care, so at least the latter will become aware of the discrepancy between how and why they’ve been diagnosed as alcoholics and the contradiction in the recovery approach almost always suggested and often almost imposed upon them by that treatment community. Ultimately, of course, I hope to reach the treatment community. Still, even the strongest and best-supported argument usually fails to cut through long-held ideas and habitual behavior, whether that be the treatment community…or an the alcoholic.

    Ultimately, my point is not that the treatment community should never refer patients to AA. Instead, I’m arguing that the treatment community’s doing so is, according to its own definition of alcoholism, contradictory and irrational. And if their definition is correct, then its dangerous, as well.

    Finally, whatever its merits, society needs to take a long look at why AA has become so ubiquitous that for those in all but a few cities and towns, absolutely no alternative recovery groups exist. Thus, the alternatives I’ve mentioned, and to which a comment above includes a link, involve reading for most rather than group support, support I would thoroughly endorse if an as-easily-accessible secular alternative, as well as AA, were available. Since diseases often offer a variety of treatments from which a patient chooses, so too should alcoholism and addiction, if considered diseases, offer a variety of options from which to choose. In a response above, I explained one simple way in which this goal could be accomplished with zero federal, state or local government assistance and minimal effort.

  16. Dan Newland says:

    Well, Paul, you have obviously touched on a controversial point, judging from this barrage of comments. It is an extraordinary essay, by the way – thought-provoking from a singular point of view. And as such, it makes it clear that a great deal more thought SHOULD be given to the subject.
    I don’t want to take anything away from AA. It has clearly helped millions of people deal with their chemical dependencies since its inception and obviously works for a lot of people.
    This said, however, the point can be made that while other alternatives exist, they are forced to stand in the shadow of AA. This is not necessarily because they have been proven not to be just as effective as AA (if not more so). Rather, it is because AA has become a worldwide “bestseller”, sort of the Sydney Sheldon of self-help programs for alcoholics. Or perhaps a better metaphor, in terms of the perception of not only the public at large, but also of many in the medical and sociological professionals would be that it has reached the institutional status of the Boy/Girl Scouts in terms of the mass appeal of its profile and the ostensible “rightness” of its methods. What this means is that, in the belief that “you can’t argue with success” or that “certain institutions are of unquestionable repute”, AA has become the sacred benchmark for the prevention and curing of alcoholism.
    But seen objectively, while it may clearly be a “silver bullet” for a lot of people in trouble with drink, and maybe even for a majority of people in this situation in a largely “Puritan” America, it must be said that it is not for everyone – and you have said this in no uncertain terms, and terms that I, for one, have never seen elsewhere before.
    This is more problematic than it might appear at first glance, since it is not a question of “if you like it, fine, and if not, fine too.” The fact is that if the vast majority of mental health professionals and civil institutions are wont to recommend AA above any other program and are loath to equally recommend others that are just as effective if not more so, then we have to assume that significant numbers of people who voluntarily seek help in AA are driven away by its clearly non-secular peculiarities, as are those who are ordered or strongly urged by the courts or by professionals to seek help specifically with that organization. And since alcoholism (read, chemical dependency) is an illness in which the subjects seldom fully understand why they do what they do and in which it takes an absolutely monumental effort for them to come to terms with the fact that they have a serious problem and need to do something about it, we have to assume that many of those who try AA and fail to get past its “preachy” tone and its guilt-generating facets simply “fall through the cracks” and back into the depths of their illness, ultimately dying of their disease.
    The worst part of this is that it apparently hasn’t served to spark the emergence of vastly improved methods within AA itself or within more advanced programs for dealing with chemical dependency from a secular and critically objective stance. Rather, blame falls where it can least afford to be placed: on the addict, who is stigmatized for “failing to respond to AA treatment”.

  17. Paul A. Toth says:

    I’ve made two slight corrections to the article. First, apparently it has only been my experience that *every* AA meeting ends with the Lord’s Prayer. Additionally, I forgot to mention that the Lord’s Prayer was followed by the Serenity Prayer. I’ve been told that this is not the case in every AA meeting; perhaps it’s a Florida practice.

    Next, of course no AA member *must* believe the 6th Step, but not believing in the steps and attending AA meetings is akin to an atheist attending church services. Finally, treatment providers should obviously not — though they obviously do — ignore the primary document of the organization to which they refer all their alcoholic patients.

  18. Paul A. Toth says:

    To Dan Newland:

    Many thanks. I agree with all of your points. While I assail the treatment community, the alcoholics who do not respond to AA for whatever reasons are the ones to suffer…and they’re already suffering more than most people could bear.

    The “bestselling metaphor” is a good one. The absolute “victory” of AA is a phenomena as difficult or even impossible to understand as why one novel goes to the moon, while thousands upon thousands of others may hover over the earth or more likely crash to the ground.

    It’s that hyper-prevalence of AA as the sole treatment option (except in a relatively-few areas) that may partially drive the treatment community to rely upon it as the sole recovery method despite the gaping discrepancy between the AA model and the treatment community’s model of alcoholism.

    Thus, the development of a secular alternative to AA, without dogma either atheistic or religious, but simply a group that discusses alcoholism without the trappings of religion or any other institution — just simple dialogue — would go a long way in addressing the problems I explained in the article.

    Meanwhile, the treatment community needs, but will likely never, reconsider its understanding of AA…or perhaps they don’t understand the exact nature of AA in the first place but simply accept the usual work-around phrases such as, “You can always use the group as your higher power.” Wrong answer.

  19. Ah, AA and alcoholism. I don’t understand the whole situation anymore. I used to, when I was younger, when alcohol obviously = teh badd.

    Now? I see way more people addicted to caffeine than alcohol. I see way more people overweight, overworked, and on their ways to earlier graves. I’m certain more people require the eye-opening cup of coffee than the eye-opener drink, and I personally don’t think the effects of alcohol are any worse than the effects of high fructose corn syrup and caffeine.

    But then, that doesn’t even get into the legitimacy of the APA and psychiatric disorders. I used to edit The Journal of Psychosocial Nursing and Mental Health Services, a journal dedicated to the practice of psychological nurses usually in clinical settings, and which addressed a wide range of behaviors, mental illnesses, spectrum disorders, and the treatments thereof. We ensured we used person-first terminology (as in, for us, there is no such thing as an alcoholic. We would say people with alcoholism. No schizophrenics, only people with schizophrenia), which I always thought interesting in itself, but I remember one conversation my supervisor and I often had was concerning whether such things disorders existed, and what made some people more susceptible to certain disorders than others. A lot of times, it seemed like symptoms of disorders were a bit like characteristics of a horoscope. Meaning, if you didn’t know it was based on your birthday, one might read all the twelve signs of the Zodiac and think, “Huh, I’ve got characteristics of all these signs. Maybe I’m more than one.” Especially with something like depression; we all feel some of the symptoms of depression–whether acute or not-at-all–at some point.

    Try reading the symptoms of borderline personality disorder and actually attempting to make a diagnosis, or even come up with a set of criteria for one. It’s damn near impossible. And when you do come to a diagnosis, which is better: ameliorating symptoms of depression or bipolar disorder, or living life in the haze of antidepressant medication–which, by all accounts, doesn’t actually relieve symptoms of depression so much as equalize mood, which means, sure, you won’t be as sad, but maybe you won’t be able to get as happy, either?

    I’ve known people who have credited AA with saving their lives, but I’m rarely sure whether it was the tenets of AA or the support that AA provides. The group structure seems a supportive therapeutic system that allows people to talk openly about their struggles, while at the same time offering encouragement to cope with them; it doesn’t sound terribly far removed from something like cognitive-behavioral therapy.

  20. Paul A. Toth says:

    To Will:

    Thanks for your post. Your comments are interesting. I have to take issue, though, with the idea that caffeine is as bad as alcohol; no one ever had a seizure from going “cold turkey” off Diet Coke or coffee, and nobody ever ended up in detox after a caffeine binge.

    I do agree that the support element of AA being its strongest component. That’s why I suggest that AA itself simply offer an extra meeting for those who merely want to discuss their recovery and lives, without the rest of the AA philosophy — or any other philosophy or psychology — involved: just plain talk. It need be neither atheist, agnostic, religious, nor spiritual. People would be free to discuss those issues, but those issues wouldn’t be part of the organization’s agenda or proposed recovery method. There would be no agenda. Just talk.

    Finally, I can’t disagree more that AA isn’t “terribly removed from something like cognitive-behavioral therapy.” The latter is completely rational, though I don’t necessarily agree with it as a strong enough weapon against alcoholism; to me, it’s more suited to minor problems, but that’s just my opinion. AA, on the other hand, requires faith in something, anything, just one thing a person can call a higher power. Many, it’s true, don’t choose God but something else. In any event, a higher power and AA still require faith, which by self-definition is not a question of rationality; it’s a leap of faith, as the faithful themselves say. Something like Albert Ellis’ Rational Emotive Behavior Therapy, an offshoot of cognitive-behavioral therapy, and an improvement over it, is 100 percent rational. It does nothing more than teach people how to think, something most alcoholics either never learned or “unlearned” during their years of drinking. Ellis addresses many issues in his prolific writings, including alcoholism, as well as factors that contribute or result from alcoholism, such as anxiety, depression, etc. AA completely rejects the notion that the alcoholic can think his or her way out of alcoholism; Ellis disagrees. I leave it to the particular alcoholic to decide. I have my opinions, but I’m not going to post them here because, again, I’m doing everything I can to keep the focus on the specific issue my article addresses and to avoid this string of comments from devolving into a flame war about whether the AA approach is valid or not. That’s beside the point of my article, and such arguments do nothing but create friction, hostility and division, without solving problems or convincing anyone of anything.

    So, to repeat, the argument my article presents for consideration is that a glaring contradiction exists between how the treatment community defines alcoholism and its almost-universal treatment of recovering patients by referring them to AA. My problem is NOT with AA; it’s with the fact that the treatment community’s definition of alcoholism rejects the notion of character defects as a causal agent in the development of alcoholism, while the almost-sole recovery model upon which it depends embraces character defects as the essence of the alcoholic’s addiction. That’s not unlike diagnosing someone with cancer, telling them that of course it’s not their fault, then sending them to a new age therapist who believes all diseases are the result of a person’s metaphysical disconnection…a character defect. This contradiction needs to be addressed or, as I stated in the article, the treatment community is engaged in malpractice, as I see it.

  21. Becky says:

    I will preface this all by saying that I didn’t read all the comments, and much of this has likely already been said. Nevertheless, here’s my take:

    As a person who grew up in a home where AA was a fact of life (my father sobered up appx. 1 year before I was born), I feel at least a little qualified to say that I don’t think the 6th step is about character defects so much as it is about, well, God, yes. To a degree. But also, one very common thread among addicts and especially those who abuse alcohol is, ironically, near-pathological perfectionism and a need for control.

    Alcohol is something they find, or that finds them, that relieves them of these anxious feelings, not by giving them control or perfection, but by making them not care so much about it–making them forget this self-inflicted responsibility to make everything in their lives just so. Of course, eventually that person is going to sober up, at least in the early going, and find that the mistakes they’ve made while drunk are just more things to feel anxious about, out of control of, and the only way they can escape that feeling is to drink again.

    So, while alcoholism might not be a character flaw in and of itself, it can stem from character flaws. And their status as flaws would not have to rely on outsiders’ declaration of them as such so much as they would be evident in the alcoholic individual’s reaction to them. They are something to be escaped from, even at the expense of other valuable things in a person’s life. Like a lot of mental illnesses or “disorders,” one of the primary diagnostic questions is, “does this array of symptoms make the person’s life unmanageable?” That’s what makes it a flaw, or a problem, or maladaptive, or a no-good-thing. In the case of personality traits that foster alcoholism, there’s a consequence that makes a person’s life unmanageable.

    It is a psychological “flaw,” for all intents and purposes. After all, alcoholism is a disease, in many respects, but then again, it is not like the flu or cancer or typical diseases and it can’t be regarded in exactly the same way. It is involuntary to a point, but you don’t really contract it involuntary. You USE alcohol for something, and then at some point you can’t do without it. So the flaws are whatever you’re using it for. And they are flaws because they hurt the drinker. Not because they have offended anyone else. They are flaws because they have encouraged the drinker to become an alcoholic.

    So that step isn’t about alcoholism itself being a character flaw but finding another way to relieve oneself of the incredible burdens associated with feeling constantly self-critical, dealing poorly with failure, characterizing things as failures that are not failures, and so on. “Let go, let God,” is a way to let go and care a little less about and feel less responsible for every trifling little thing that happens in the world–without getting drunk.

    And AAers are quick to point out that “God,” in this day and age, is whatever you want him to be. A Christian God is easiest for most people in a predominantly Christian society, and the notion of having a greater power is so important to the “let go” aspect of alcohol recovery that a total secularization of the process would probably render it useless. I mean, you don’t like the idea of a higher power, don’t join AA. But I feel like the serenity prayer, especially (except for the technical use of the word “God”) strikes me as just plain old good advice, for the most part. You have to pretty nitpicky to object to its use strictly on the grounds that it contains the word “God.”

    All that said, I don’t think changing the wording of the sixth step would do much good in combating relapse.

    Alcoholics and drug addicts relapse because they are addicts. And AA remains, I believe, the most effective long-term strategy for long-term sobriety that exists. Some people don’t need it. Most people should probably try it if they want to stay sober in the long-term.

    • Carl D'Agostino says:

      “It is involuntary to a point, but you don’t really contract it involuntarily.” You’ve captured it. You have alcoholism because it’s a disease and drinking is a symptom with it’s accompanying levels of self destruction. You also have it because you were a participant it developing it.

  22. Paul A. Toth says:

    To Becky:

    Thanks for the comments. As mentioned in my replies to others’ comments that you understandably haven’t had time to read, I’ve stated that I’m not going to discuss, and will discourage debate about, whether AA “works” or not. Therefore, I cannot address many of your points without myself beginning the debate I want to avoid, one that’s beside the point of the article.

    Since I’m an alcoholic, I’m familiar with the ways in which one uses alcohol to medicate away anxiety, depression, etc., as well as to forget what one doesn’t want to remember. These and other factors you mention are either emotional disorders that preexisted alcoholism or emotional disorders that resulted from alcoholism.

    Why anyone becomes an alcoholic remains and may always remain a mystery, even though a genetic propensity to one’s becoming an alcoholic has been shown to exist. Despite that fact, I suspect a large proportion of alcoholics do not possess this genetic propensity. That’s another debate but one to which research currently provides no answer; therefore, it’s a useless debate.

    Without attacking AA, if Step 6 means what you state in your lengthy post explaining it, then Step 6 should be more-clearly stated. For instance, “God, remove the burdens from me that led to my drinking.” However, given that only twelve steps were written, it can only be assumed that those words were chosen very carefully, and that the words mean what they mean. Thus, God must remove a character defect, which could be interpreted to mean a “sinful nature.” Either way, those are the words, and the implication is clear: I, as an alcoholic, have character defects, according to AA. Now, one can accept or ignore this notion and still attend AA. However, the notion exists and runs throughout the AA philosophy.

    The point, again, is not to attack AA but rather to indicate that the treatment industry views alcoholism as a disease. So does AA, but its primary document rejects the disease model. AA is clearly a road to redemption model, Christian or not, and one followed by many people of every religion and no religion. I know some of these people find that AA helps them achieve lasting sobriety. I am not going to begin quoting statistics or anything else to prove one way or the other AA’s effectiveness. Rather, the treatment industry needs to reevaluate its own thinking regarding alcoholism. Either it’s a disease without character defects, or, as AA sees it, a disease that resulted from and/or created character defects. These two approaches are in direct conflict. That conflict is irresolvable.

    At the very least, the treatment community should inform those whom it refers to AA that AA does not adhere to the accepted psychological, psychiatric and medical definition or model of alcoholism.

    In a better world, alternatives would exist. As I’ve stated several times, AA itself could create a second group in which people simply discuss their recovery, lives, etc., with no theory, religion, philosophy, psychology, or anything else involved: just a room and just plain talk, without prayers, without structure, except some kind of time limit, of course.

    Currently, in most areas, AA is the only recovery group option. This is unfortunate. There should at least exist one alternative. Alcoholics should have choices, just as most patients who suffer from other diseases or syndromes (I prefer “syndrome” to “disease,” as I don’t think the criteria necessary regarding alcoholism being a disease by definition has yet been proven) almost always have choices.

    I’m glad AA works for many recovering alcoholics. I have heard of and read about many different ways of understanding AA; it seems a very individual process (and I have attended AA meetings). Still, even granting your argument that the 6th Step means something other than what its words indicate, AA’s approach clearly implies that the alcoholic requires help from God or a higher power to remove *something* in the mind or soul, call it what you will, that created and/or continues to create the presence of a disease: either one has character defects and becomes an alcoholic, or one develops character defects that maintain alcoholism. Either way, “defects in character” were the words carefully chosen for Step 6 and, by themselves and also considering much of AA’s overall philosophy, the AA model negates the treatment community’s very definition of alcoholism, or vice versa. That was the point of the article.

    Best of luck.

    • Becky says:

      I understand the point of the article.

      But I think your literal interpretation of the 6th step is not shared by many people in the program, and as such, presents no problem for them in their recovery or utilization of its strategies.

      That is, your article relies on an assumption that the notion of character flaws is inherently detrimental to individual recovery, and I don’t think that’s true. I don’t think you can show that’s true. A lot of drunks have very glaring and predictably similar types of character “flaws.” Not all. Many. Potentially most. I think those flaws can come from somewhere. Bad experiences, drinking itself, whatever. But failing to acknowledge the sorts of behavioral and cognitive aspects of why they started drinking and continue to drink seems to me like it would bode very badly for people’s recovery. Very few drunks are undamaged. No one drinks, abusively, for no reason at all.

      (Please forgive my use of “you” going forward. It is strictly for ease of typing and is not meant to mean YOU, necessarily.)

      And indeed, people develop traits and behavioral habits, habits of thought as a result of their drinking that persist long after they they sober up. Manipulation, emotional immaturity, blaming, etc. AA is as much about confronting those things as it is about confronting emotional or behavioral issues that preceded the alcoholism. My personal sense is that, unlike cancer, part of the “cure” (as part of the impetus) for alcoholism resides in personal responsibility. Part of that includes taking responsibility for the things you can change (like recognizing hurtful or maladaptive behaviors for what they are and doing your part to get rid of them), and part of that falls under the category of things you can’t change (like, for whatever reason, you are/were an alcoholic, and your body was physically dependent, and you can’t beat yourself up for that, but you can set about the business of discovering what made alcohol tempting and important to you and resolving those issues).

      I mean, yeah. Alcohol is a disease. It has predictable mental and physical symptoms and is deeply rooted in biology.

      But you catch it from drinking too much. It is predilection activated by a chosen behavior. It doesn’t spontaneously erupt from within your cells through no doing of your own. It’s NOT cancer. You can control whether or not it “flares up” again. It is dependent on your thinking, your behavior and whether or not you take a drink.

      There are things you can do about it and things you can’t. There are things you need to be responsible for and things you can do nothing about.

      But a drunk refusing to take any responsibility for the behaviors and thoughts personality difficulties that led to his drinking or persist on after it and still expecting to get well strikes me as unrealistic. Then again, I am potentially too indoctrinated to think differently. “No such thing as an alcoholism-related character defect” based on the notion that the word “disease” disallows it strikes me as a barter to the tune of “I’m not an alcoholic.” “There’s nothing wrong with me, I’m just an alcoholic.” Well, yeah. There is something wrong with you. You’re an alcoholic. And you got that way somehow when other people around you didn’t.

      (From here forward, “you” means YOU.)

      I know you don’t want to argue, and I don’t mean this to be a flame at all. I am a big fan of heated debate, and this should be taken as that and nothing more. This is pretty controversial stuff. You have to accept that people are going to openly disagree and have strong feelings about it.

      • Becky says:

        I should rephrase. “You must have known people would openly disagree and feel strongly.” I suppose you don’t have to accept anything.

      • Paul A. Toth says:

        Becky:

        You state, “Alcohol is a disease. It has predictable mental and physical symptoms and is deeply rooted in biology.” Then you state: “But you catch it from drinking too much. It is predilection activated by a chosen behavior. It doesn’t spontaneously erupt from within your cells through no doing of your own. It’s NOT cancer.” Your views are not for me to oppose, but they do seem in line with AA’s contradictory messages that alcoholism is a disease but, no, wait, it’s really character defects. In this most recent message, you basically accepted the character defect viewpoint. I understand that viewpoint; there are many possibilities and that’s why I’m suggesting calling alcoholism a “syndrome,” not a disease. But if it’s going to be called a disease, by the treatment community and/or AA, then the idea that character defects play a role is canceled, and vice versa. You can’t have it both ways; that’s why I avoid the either/or question of whether alcoholism is a disease. I believe it’s a syndrome because there are multiple causes, some based on personality type, psychological factors, etc., influenced by the environment, one’s friends, and one’s own choices, to an extent.

        I also have to dispute the idea an alcoholic has a choice in the precise meaning of the term “choice.” I myself will argue that a bottle cannot put itself in my hand; obviously, if I have a relapse, I made a stupid decision. But there are reasons for that stupid decision beyond my own fully-accepted stupidity. An alcoholic at the severe or chronic stages has typically spent a couple of decades, at least, in treating every event in life, happy or sad, by drinking. You drink to enhance the happiness, and you drink to dampen the sadness. Eventually, you forget that these feelings are even normal. I, as an alcoholic, began to believe that I should be immune to misery, and that each moment of happiness had to be magnified to make the most of it. This kind of thinking continues for most after they quit; that’s the primary reason why remaining abstinent is so difficult. Of course, choice in some manner always exists, but it’s a choice altered for the alcoholic by his/her own learned irrationality, which has occurred both as a result of alcohol and as a means of justifying continuing drinking when deciding to do so is completely absurd and verges a on suicide attempt. So why do they do it? Better put, why have I made the wrong choice? I believe a variety of factors converge or descend upon the alcoholic, often including an emotion — probably one the drinking was meant to block out — and the person begins to think of alcohol exactly the same way the person with a headache reaches for aspirin. It’s not automatic, but it’s too damn close.

        I’ve decided to put in place a variety of preventative measures. For one thing, I’m going to have my psychiatrist prescribe an on-hold script for Antabuse. Should temptation arise unexpectedly, I will go get that filled immediately. However, my major and life-threatening binges have almost all occurred beginning in November and continuing into the first weeks of January. Therefore, this October, I will start taking the Antabuse. Next, I have informed my girlfriend that if I seriously begin talking about drinking, she is to tell me she’s leaving, grab the bank card, and go…no matter what. Therefore, I would have no money with which to drink. And there are other less drastic measures in place.

        So, to a degree, I agree with you. My point is not to back the disease model, although I don’t agree with the character defect model either. To me, it’s all too complex for any kind of answer a person could give in less than three hours. No single word or even groups of phrases can explain why alcoholics behave the way they do.

        Finally, another major problem I have with the treatment community is that alcoholics are all virtually the same. I dispute that notion. Alcoholics become alcoholics for countless reasons. Of course, they become alcoholics the same way: they drink too much for too long. On the other hand, even that is not predictable. I know people who drink far more than I do who suffer hardly any consequences (though perhaps they will one day). Why? Too complex to answer. Is that a character anti-defect? Perhaps they’re stronger than me in will and temperament and emotional resilience.

        Obviously, our points won’t converge, but I think they cross over one another at certain points. And though I don’t think I’ve complained about negative posts (only noting my desire to avoid an AA vs. anti-AA debate), but, yes, I was well aware plenty of fire would come my way. Actually, I’m surprised at the number of positive responses.

        Best,

        Paul

        • Becky says:

          I guess I don’t see the issue then. Based on this, as far as I can see, we are closer to agreement than not.

          It’s a disease, but it’s not like other diseases, and people who contract it tend to have certain (and in many cases similar) shortcomings.

          My basic perception of the ideas happening here was that you were finding in the “character flaw + God” situation some kind of moral objection rooted in a secular aversion to something like original sin, if you want the truth. That your argument, in the end, was that people who didn’t like the idea of God or religion were being cheated by the recovery community, which was loyal to an organization whose primary worldview was based on Judeo-Christian notions on the origins of vice. I was trying to figure out what God and character flaws and AA and substance abuse relapse had to do with each other and based on some things you had said in comments, that was the only way I could make those ideas come together. I thought, to be perfectly honest, that part of the motivation here was a sort of tedious and run-of-the-mill discomfort with the word “God.”

          Maybe that’s not quite it.

          Yes, the degree to which a person must drink and how long they must be a drinker in order to “have problems” varies from individual to individual. And there are people with chronic alcoholism who must drink every day and there are those who are bing-drinkers. Your statement that the treatment community treats all alcoholics the same perplexes me a bit, mostly because, based on what I’ve seen, a great deal of difference is acknowledged. Granted, I’ve never been through the process myself. Of course people have all kinds of reasons for becoming alcoholics, all sorts of underlying motivators. But the disease progression is often the same, behaviors the same, even if it doesn’t occur at the same pace…I mean, there are individual drunks with their own issues and their own triggers and etc., but I don’t know that there is, like, a “special” alcoholic. Most mental illnesses, for example, require only a certain number of common symptoms for a diagnosis. You don’t have to have every symptom of schizophrenia to be diagnosed with schizophrenia and be a perfectly obvious and average schizophrenic. Many diseases, an not even just mental ones, manifest in all kinds of ways in different people.

          My feeling is that a pretty broad definition of “problems” is necessary. Of course lots of people are able to be drunks and not lose their jobs, not lose their spouses, whatever. Doesn’t mean they’re not alcohol dependent or that they don’t suffer problems as a result of it.

          Or, if they drink regularly (in a way that you would suspect is “too much”), but TRULY fail to suffer any detrimental effects, in their lives, in their heads, in their relationships, in their bodies, it is arguable they have no drinking problem at all. Can you have a drinking problem if drinking doesn’t give you any problems? Is that even possible?

          Virtually everyone I know who is currently in AA managed to remain gainfully employed and not end up homeless while they were drinking, for example. So were they problem-less? I’d guess they’d say they had plenty of problems. Most of which they hid successfully or happened in their own heads. If they didn’t have problems, they probably wouldn’t have sobered up. More willfull or having stronger emotional resilience to keep certain aspects at bay or to slow the progression of addiction? Maybe. My husband smokes casually on weekends, almost never during the week, and after being a non-smoker before marrying me 7 years ago, aside from picking up social smoking, shows no appreciable escalation in his smoking habits. It is incredibly frustrating.

          Something is different in his head than in mine, that’s for sure. Just thinking about quitting smoking makes me so nervous I need to go smoke. Character flaw in me? Superiority in him? To an extent, guess. Must be. For whatever reason, I struggle with having the courage to quit, and he can’t seem to find the obsessiveness to start.

          So, yeah. I think he’s the winner in that character war scenario. At least insofar as smoking is concerned. I’m sure I’ve got him beat on other accounts, but I don’t pretend that there’s nothing wrong with me that transcends the object of my obsession. Obviously there is. Seems like getting to understand what that issue is will be critical to me being able to quit.

      • Carl D'Agostino says:

        I think this discourse by Becky indicates she has a qualified tale on Step 6. I did not know I had certain defects until I took inventory. I was not dishonest or in denial. I just did not realize it. For example I was told I was selfish. I felt I was generous, but my selfishness was manifested that since I lived in addiction I denied others the benefit of the good thing I may have given or received.

  23. Thomas Wood says:

    Paul (let’s see if I can entice you…despite your disclaimer):

    I think I see what you’re saying. I read that article that you quoted from and given strict definitions of psychogenic and biogenic models, the two are certainly incompatible.

    My approach was, as it always is, from my layman’s perspective of the terms, and not from a historical or academic approach.

    “Character” is a tough thing to define, and I agree that it is inappropriate given its wide berth for interpretation, ranging from objective-moral implications. I see character as a loose mixture of desire, intention, and action. As such, I see alcoholism as a disease (biogenic) which affects one’s character. For me, then, a character defect, in the case of alcoholism, is the manifestation of the disease from the highest perspective.

    I don’t like the sound of the 6th step, either. But, under my definitions, it is valid, following this form:

    -Alcoholism is a disease, caused by biology.
    -Alcoholism affects the part of our character which makes decisions.
    -Since this disease has rendered us not powerful enough to control ourselves (make/follow-through-with decisions) something more Powerful than us (step 2) will be needed.
    -AA calls that power God
    – We are ready for that Power (god in AA’s words) to remove this defect of Character (our inability to make/follow-though-with decisions)

    So, under my reductionist understanding of the term “character defect,” I find it compatible with the disease model.

    Having said all of that, I totally agree that it’s an awful lot of interpretation to get to an understanding, and there is more room for falling into a psychogenic view of the problem than not, leading me to agree that the term is pretty obsolete. (Unless, of course, all AA members take a semester of Philosophy and Logic as part of their program.)

    • Paul A. Toth says:

      Good points. I realize different people interpret AA and its steps in a variety of ways, and it’s not for me to dispute that they do so or convince them that AA doesn’t work; I know it works for many people.

      It would be for AA to decide that Step 6 should be revised and phrased to more accurately reflect what most people here have stated that step means to them. Almost every post to date suggests that virtually no one truly believes in the character defect model; they’ve interpreted it to mean something beyond the statement in and of itself. That’s not my business. That’s why I addressed the treatment community, of which I will, I hope, one day be a part (all, of course, dependent upon my own successful elimination of yearly binges). Therefore, it’s really the disease model that’s the problem, and the unwillingness of the treatment community to learn alternatives to AA, which anyone in the profession should be ready to offer those who have reasons beyond denial for not attending AA.

      These two points are crucial to my meaning, so I’ll repeat them: (1) it’s the treatment community’s job to repair the contradiction I mentioned, though AA, if it wished to do so, could also rephrase Step 6 to better reflect the disease model and its members own understanding of the step and/or eliminate the disease model as part of its program…but that’s AA’s decision; (2) AA works for many but not for all, and I do not believe those who, for whatever reason besides a desire to continue drinking, disagree with AA and choose not to attend its meetings should be labeled “lost causes”…they should be offered the choices that exist and, hopefully one day, locally-available alternatives rather than the online support and books which offer the only current alternative for those living in all but a few locations.

      ~ Paul

      • Thomas Wood says:

        Can I just first say that I’m tickled you came back into the discussion.

        I think all I would say is how much I agree with your two main points there. For my friends who have, shall I say, “survived” their addictions, their success was based on being involved in some program. It is the regular support that seemed to do it for them.

  24. Thomas Wood says:

    Ps… Don’t forget to check out Gravatar.com The general theme seems to be a photo which personifies “writer-sexy,” a look which requires dark lighting and a subtle angle of the head measuring no greater than 13 degrees to the right or left.

    • I’m absolutely 100% guilty of going for the “moody author portrait” look. OK, it was a quick camphone self with no prep at all but I think my intentions are blindingly obvious. Looks like I went over thirteen degrees though.

  25. I wrestled with many of these issues when I quit drinking in 1988, I didn’t like AA, the group I went to was God heavy, I certainly did not believe in God and I thought, is this a better life than drinking all the time? After all the arguments, the fights and disgust, I finally made a few friends in recovery who knew what I was going through. I spent a lot of time worrying about the technicalities of AA when it boiled down to this, either I am going to keep drinking and die or stop and live. The thing is, only addicts understand other addicts. But one point that is seldom mentioned is that addicts in AA are sick, which is to say, I often saw people quit drinking to develop some other budding mental health problem. Alcoholism in my experience is a tight intertwining of the physical and mental and man, after years of drinking, the mental part is way screwed up. Conclusion? There ain’t no easy way out! AA did help me get back on track, much as I resisted. I took what I needed and left the rest behind. But that’s just me.

  26. Paul A. Toth says:

    I’ve some time added to my schedule, so I’ll try my best to reply when I can.

    David, what you describe makes sense to me. I know many like you who took what they “needed and left the rest behind.” And AA worked for most of them. Others, however, don’t find the approach so helpful, and their reasons to me don’t matter. Unless they’re willing to accept the AA process, much less some of what you left behind, they’ve no alternatives. That’s my main concern beyond what I mentioned in the article. Some may simply be adverse to groups. Some of those people might have anxiety issues that lead to their avoiding groups. The reasons for avoiding AA, and for attending AA, are endless and complex. In some cases, refusal to attend AA might indicate a denial of alcoholism, but this assumption is, in my experience, too often made in every single case by the treatment community, which largely and truly believes AA is the *only* way to stop drinking. That cannot possibly be true; otherwise, until the advent of AA in the early part of the 20th century, no one in history would have ever successfully stopped drinking. Obviously, many succeeded in doing so.

    Therefore, I’m not at all attacking AA; I’m simply making a strong case that it should not be the sole option. Options do exist in a very few localities, plus Internet groups and books, but those to me are not as effective as the support of a discussion group intended for those who prefer another approach than that of AA: simple discussion, without ritual, prayer, documents, steps, etc…in other words, pure dialogue and nothing that some must leave behind in order to benefit from the experience.

    It also crossed my mind that there would not be too much of a problem were the treatment community to suggest, “Why don’t you give an AA meeting or two a try. If you don’t care for its approach, we’ll discuss it next time, and I’ll offer some alternatives.” That would be more reasonable.

    Nevertheless, the contradiction the article addresses would still exist, and nothing above has done anything more than spend paragraph after paragraph redefining what the obviously-carefully phrased Step 6 states.

    Best wishes,

    Paul

    • Becky says:

      Well, depending on how one understands the wording of step six, there is potentially no contradiction at all. I think that’s why people keep bringing it up.

      That was what I was trying to illustrate by bringing it up.

      “Character flaws” is only oppositional to the disease model under one interpretation, and if few people are using that interpretation and if everything AA says tends to undermine that interpretation, I’m not sure you can insist it exists as an inherent, inescapable contradiction.

      “Redefinition” seems to suggest that you believe the understanding you’re offering is the native meaning of that wording, but I never took it that way. Never even looked at it that way until I read this article. Everything I’ve heard about it from people in the program in my 30+ years on the planet does not support your notion of the “native meaning” of that statement.

    • I know you were not putting down AA, I have the same frustrations as you. I did find a lot of good groups in NYC when I lived there and especially enjoyed a double trouble meeting on the lower east side I used to go to for bi-polar alkies. Wow, heard some stories there. But anyway, you should check out my site at my space, myspace.com/dbreithaupt and look thru my photo files, I have a letter Kurt Vonnegut wrote me when I was in rehab and it talks about AA and religion in AA etc. You might get a kick out of it. Thanks again for your posts, I enjoy them as always.

  27. Paul A. Toth says:

    Well, in the twelve short steps of AA, the wording was obviously chosen quite carefully, so if those who composed what they wrote in the 6th Step meant what its members prefer to believe they meant, they would have written it that way. By the way, Bill W. didn’t agree that alcoholism is a disease, even though AA now says it is a disease. So, in that way, I suppose a person has no idea what the hell AA means and doesn’t mean, so anything goes. It is a disease and it isn’t a disease; people have character defects, but they don’t have character defects. Whatever works for others is fine with me, but if they believe they’ve negated my argument, they’ve only negated what the 12 steps of their own program clearly state. Interpret Step 6 and the other eleven steps anyway you like; the fact remains that in doing so, one no longer is placing faith in the step’s original meaning, which is so short and clear that a mentally-impaired person could understand it: character defects exist which God must remove. Take away the God aspect, and you still have character defects. Now, if that’s arguable, it’s only arguable through an absolute lack of knowledge and/or an ability to read whatever one wants to believe into the clearly stated Step 6. I can only imagine, if a god existed, how that god would feel about the Ten Commandments (he forgot two) being twisted around until they meant anything a person or persons wanted them to mean. “Thou shalt not kill” is no less a clear statement beyond interpretation as Step 6, but a killer will talk his way around that, too, once he turns Christian on death row.

    • Becky says:

      Maybe Bill W. did believe that. Maybe that’s what it meant at one point.

      But plenty of people get by without having any trouble with it. People don’t read it that way anymore.

      And I don’t think one can “read whatever one wants to believe into” step 6.

      For example, it most certainly does not say, “go have a drink.”

      It does not say, “The sun is blue.”

      These are unreasonable interpretations. I haven’t seen a single unreasonable interpretation offered here yet. All of them remain essentially true to the function of the 6th step and its general spirit, which I believe to be as follows: That people need to work on their issues beyond drinking to stay sober, and that having some faith that the weight of the world does not rest on their shoulders alone can help a person to do that.

      If AA wants to stick with their wording as a matter of tradition, it doesn’t strike me as a problem, and I don’t think it is a problem for most people and certainly not in the universal, “nationwide malpractice” way you describe.

      It seems intuitive enough that people should have numerous options when approaching their recovery. I have no problem with that. Few would. I can’t imagine you being able to get anyone to argue with you on that account. And there are any number of reasons why people should have options, only one of hundreds, if not thousands, is that people may have problems with AA’s religious flavor.

      What I don’t understand is why’d you’d hang an argument to that effect on God and the 6th step so exclusively. It weakens the argument, in my opinion. Makes it seem a littler personal.

  28. Paul A. Toth says:

    I worded that sentence carefully, subtracting “God” so that only “character defects” remain; I don’t care about the God issue. I don’t care what AA’s members understand Step 6 to mean.

    The simplicity of Step 6, even if everyone in AA agrees it’s more or less complicated than I think, summarizes in plain English — for the assistance of the learning-impaired segment of the treatment community — one of many aspects of AA that place the onus of alcoholism on the alcoholic but then transfers that onus to “God” or a “higher power.”

    You see, I have no particular problem with that. I don’t even know why AA members or family of AA members feel the need to comment. I am not addressing AA members. I am not telling them what to think. I am not telling them their interpretations are incorrect. My argument is not addressing the philosophy of AA; it’s addressing the philosophy of the treatment community. That philosophy is self-contradictory. My article focuses on Step 6 because it clearly states a position of AA that runs throughout its “traditions.” It is not only Step 6 but almost all of AA that contradicts the treatment community’s understanding of alcoholism. That is not my interpretation; that is a fact. I focused on Step 6 because I do not currently have time to write a book (but thanks for the idea).

    Further, some have supported AA *and* the notion that alcoholics have absolute control over whether or not they drink, an equally-contradictory stance. AA itself states in its first three steps: “We admitted we were powerless over our addiction – that our lives had become unmanageable; came to believe that a Power greater than ourselves could restore us to sanity; made a decision to turn our will and our lives over to the care of God as we understood God.”

    Therefore, the alcoholic has shifted the burden onto “God” or a “higher power.” I understand this lifts the burden for some and allows for growth. It is not my point to argue against that understanding.

    I am addressing contradictory thinking, NOT amongst AA members and AA itself but the treatment community and the treatment community alone. My argument is not weakened by my focus because, as we have seen, Step 6, so brief and to the point, has on this page alone generated thousands of words explaining what it “really” means. If I ran an organization with tenets so open to question and interpretation, I would throw them in the trash. No human resources’ department would intentionally construct such a vague instruction.

    There’s no getting around it: The Twelve Steps clearly imply that the alcoholic has a “sinful” nature that can only be redeemed by God. Now that may be of tremendous help to some alcoholics, but it’s not medicine, it’s not psychology, and it in no way suggests a disease, which the main website of AA clearly states alcoholism to be.

    A disease, as defined by Mirriam-Webster, is a “CONDITION of the living animal or plant BODY or of ONE OF ITS PARTS that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” Therefore, if AA, AND the treatment community, consider alcoholism to be a disease, then evidence should be visible in the body and/or blood. Signs and symptoms do not indicate a disease. Anxiety can take the form of many APPARENT medical conditions, known as somatic conditions. We can all agree the signs and symptoms of alcoholism exist; however, signs and symptoms also exist for every psychological disorder so far identified.

    So far as I’m concerned, AA can do whatever it wants. But if the treatment community wants to choose an inaccurate definition, and then violate that definition by referring patients solely to AA, which obviously views alcoholism as a “sin” or some kind of “secular sin” that can be exorcised only through AA attendance, then, yes, that amounts to malpractice, though I would much prefer the treatment community to educate itself regarding alternatives to AA, the actual definition of the term “disease,” and what AA proscribes throughout its philosophy and literature, not just the 6th Step.

  29. Robert Clark Young says:

    You make a common error, Paul, conflating the disease of the alcoholic with the actions of the alcoholic. The alcoholic is not responsible for being an alcoholic, as alcoholism is a disease. However, he is responsible for his actions. It is this responsibility for his actions that the Sixth Step is addressing, not the alcoholism itself. Even after completing the Sixth Step–and all twelve of the steps–the alcoholic is still an alcoholic, after all, albeit with a stronger chance of remaining a sober one.

    In other words, the alcoholic is not responsible for having a disease. But he is responsible for everything that he does. The words “character defects” in the Sixth Step refer to his actions and his character, not to the underlying disease. There is therefore no contradiction in the AA program.

    I hope this helps!

  30. Robert Clark Young says:

    Let me expand on this by means of an example.

    Let’s say that a person contracts AIDS through no fault of his own, either being born with it or getting it through a blood transfusion. That person has an incurable disease.

    Now let’s say that this person, knowing he has AIDS, goes around being selfish and irresponsible, lying to his sexual partners about it, practicing unsafe sex, and infecting others.

    That person can never be cured of AIDS, but the principle of Step Six could change his behavior so that he is no longer a selfish, irresponsible liar, going around doing damage to society.

    The situation with alcoholism and AA is much the same.

    Alcoholism is an incurable disease, like AIDS. AA does not claim to cure alcoholism; thus AA is not, as you and others incorrectly assume, a treatment for alcoholism. AA says that an alcoholic is always an alcoholic–once you have the disease you’re stuck for it forever, even if you are 50 years sober.

    What AA tries to do instead, then, is modify behavior. NONE of the steps actually addresses the DISEASE of alcoholism; all of them attempt to modify BEHAVIOR in one way or another.

    This behavioral modification is a gradual process–a fact which, in itself, is one of many program features that begin to break down the black-and-white worldview of many alcoholics.

    I really think you are conflating two things–a disease which AA does not claim to cure, and behaviors which AA does claim can be modified. AA is about helping people change their behaviors, not about curing their underlying alcoholism.

    I have 24 years without a drink. I am STILL an uncured alcoholic. But my behavior has been modified tremendously, and continues to be modified one day at a time.

  31. Paul A. Toth says:

    No, I disagree. If a disease causes alcoholism, then a disease is causing the the irrational thinking and behavior of the alcoholic. To say the alcoholic is responsible for a disease that causes his actions is like saying a Tourette sufferer is responsible for shouting obscenities in public. There is of course some degree of choice, but that choice diminishes as alcoholism progresses. Can you agree with that fact? I do, because I’ve been there. And most alcoholics remain irrational in their thinking after they quit drinking; that’s why they relapse, not because of character defects. Their choices are hampered not by a disease, or a character defect, but irrational thinking that either developed as a result of drinking or which never existed in the first place. Correcting that irrational thinking is the solution. Then the alcoholic can be truly responsible. To conclude, I must again clarify that I’M not claiming alcoholism is a disease; the treatment community considers it a disease, but of a different order than you and AA describe. AA’s message interpretation, and its members interpretation of AA’s interpretation, is all well and good as far as I’m concerned, but the definition used by the treatment community simply denies character defects as causal agents in the development of AA.

    That, as I’ve repeated and repeated and repeated and repeated, is my point.

    I think the confusion lies with yourself and your many cohorts in the posts above, as all of you seem to think I’m pointing out contradictions in AA (which do exist, but that’s not my interest); I’m addressing contradictions in the treatment community’s approach to alcoholism.

    AA members, take a deep breath, or an inventory, and relax. AA is not going anywhere. There’s no need to be so defensive about it; AA already has a stranglehold on the treatment community to the point that the community rarely realizes alternatives do exist.

    Sometimes the overabundance of confidence in the faith approach of AA surpasses that of religious fundamentalism. I don’t know what causes this reaction, beyond the inability of many AA members’ failure to recognize the article attacks the treatment community and NOT AA. No matter how many times I state that I’m glad for anyone whom AA helps, I am repeatedly provided yet another interpretation of what AA and its 12 Steps “really” mean.

    And while AA helps many, I also understand the needs of those it doesn’t help. Whether you and your friends agree or not, such people do exist, and AA will never reach them, not because they’re all “in denial” but because, believe it or not, some actually don’t agree with the AA philosophy and abstain without any greater difficulty than any AA member experiences. But this is not good enough. It MUST be true that ONLY AA works and that everyone who fails to recognize this will DIE or go INSANE and is IN DENIAL. Only those who believe exactly that and nothing less will escape the wrath of an AA member on defensive…or is offensive? I can’t always tell.

    Whatever works, works, in my view, but that’s not good enough for AA, which has apparently reached the untouchable status of religion. It’s not the existence of AA, or that many agree with what it claims, or bend what it claims until it matches what they prefer it to mean, that irks me. It’s the idea that no one else can possibly be right, an absolute certainty, which are the hallmarks, I’m afraid, of cult members.

    As to your additional AIDS analogy, people with AIDS are not rendered irrational by their disease. And AIDS is, unlike alcoholism, an obviously-provable disease. Its presence can be detected in the blood. However, I would guarantee that most of those acting so irresponsibly are also substance abusers, and the reason they’re acting irrationally is the result of substance abuse…a symptom, not a disease. Their disease is AIDS. They also have an emotional disorder or syndrome otherwise known as alcoholism/addiction. Those who don’t have substance abuse issues, and are not suffering from dementia or some other AIDS-related illness, obviously bear absolute responsibility for their actions. On the other hand, spinoffs of AA would claim they’re sex addicts, so we’re right back where we started.

  32. Robert Clark Young says:

    Well, with all due respect, I don’t think you can say you’re not taking issue with AA, when you spend so much time taking issue with AA.

    A couple of things you’ve said have really got my interest, because they involve matters I’ve thought of for a long time.

    You said “I could not convince myself of a higher power in any form.” I wonder how you can really mean that, if you think about it. Because what a statement like that says–and I have no idea if, with your careful attention to language, you really mean this–is that you consider yourself to be the most powerful entity in the universe. This is, of course, “classic alcoholic thinking.”

    Obviously, things that are more powerful than you certainly exist. That is a rational observation, not a leap of faith.

    I live a couple of minutes from the beach. I go down there and look at the waves. They are clearly more powerful than I am. Any number of natural phenomena are more powerful than I am. Contrary to what you say, this is not a “leap of faith”–this is a completely reasonable conclusion.

    AA is based on reason and what is empirical, not on faith.

    It is just as rational to observe that a practicing alcoholic already has a higher power–alcohol. AA is not asking the alcoholic to FIND a higher power, but simply to CHANGE higher powers. This is a simple psychological transference that anybody who has willingness is capable of doing. Even a completely uneducated person can do it.

    Alcohol is no longer my higher power. This year its the waves at the beach. Next year it will be something else. I’ve had a couple of dozen higher powers, and guess what, all of them have kept me sober, and not a single one of them has been religious in nature.

    In my 24 years in AA, I have never had the “leap of faith” that you posit. Blind faith is an alien notion to me. My “faith,” if you will, is rational and empirical only, based only on the fact that working the AA program has worked for me in the past. I wouldn’t believe in it otherwise. I don’t think any alcoholic worth his salt would, as we are natural skeptics–as you are demonstrating here.

    You say that there are people for whom AA doesn’t work. Now I’m going to throw one of those hated slogans at you, lol–Did those people work for AA? Because AA isn’t for those who need it. It isn’t for those who want it. It isn’t for those who’ve been sent there against their wills. It isn’t for those who want to be there. It’s only for those who work it.

    But in the final analysis, it doesn’t really matter what the AA program contains. If we sat there for an hour playing tiddlywinks and were able to stay sober that way, then that is what we would do. If jumping jacks worked, we would do that. Why does the rest of the world care what we’re doing in there?

    The only thing the outside world owes us is gratitude, because we were sitting in our meetings doing something that you regard as irrational and stupid, instead of getting in our cars drunk and killing your loved ones.

    Thus, my practice of Step Six may have saved the life of your loved one, whom I haven’t killed with my car. I think that fact trumps any argument against it.

  33. Robert Clark Young says:

    One of the prime motivators for my posting here is that, after 24 years in AA, I don’t recognize the fellowship (not “organization”) as it is being described here. It strikes me as a straw man argument.

    I’m going to knock these inaccuracies down one by one.

    AA doesn’t claim, and has never claimed, to be the only route to sobriety. AA literature is clear on this.

    AA is not a religion. A religion has a set dogma about a higher power, whereas AA allows you to select a higher power of your own understanding. This can be a non-spiritual higher power if you choose.

    AA is not a cult, since it has no leader, no property, no organizational structure, etc.

    A person who has done nothing but go to meetings–even for extended periods of time–has not “tried” AA. Sobriety is like any other goal in life–you have to work for it. Those who do not work for it will be unable to sustain it. This is going to be true in ANY recovery program, not just AA. So when somebody tells you that AA did not work for him, ask him if he worked for AA. Did he drive people to meetings, did he buy birthday cakes and served them to street drunks at a meeting downtown, did he set up chairs, did he set out literature, did he do any of the many service jobs available in AA? Sobriety is an activity, not a condition. Some drunk who shows up at meetings, doesn’t like what he hears, and hasn’t done any work in the program, has not in fact tried AA. AA is a job, but one that takes up a fraction of the time of drinking and its consequences.

    More specifically, I feel that I have been mischaracterized personally. I am not a Christian, and I doubt that anyone could loathe religion, and Christianity specifically, as much as I do. I think people who are not familiar with what the concept of a “higher power” really means in recovery just insert into this term their views about Judeo-Christianity. Believe me, if that was what was required, I would have died drunk a long time ago.

    In AA, all ideas about a “higher power” are respected. Each person gets to figure out his own, no matter what anybody tells you. This is hardly “religious fundamentalism.” This is the exact opposite. This is tolerance and acceptance of all views.

    It is also false that AA compels anybody to become a “member.” In the first place, we are not an organization, but an informal fellowship, and “the only requirement for membership is a desire to stop drinking.” We have no power to compel anyone to “join” us. True, the courts often send people to us, but that is not by our design. Ours is designed as a program of “attraction, not promotion.”

    Thus, the argument that AA doesn’t “reach” everyone is immaterial, because it is not the job of AA to reach anybody. According to our traditions, people who hit bottom must find AA on their own.

    AA is not out to take over the world, to achieve the perfection of its “members,” to promote a religion, to solve the spiritual questions of the universe, to change society, or any of the other motivations that have been falsely ascribed here. The AA Traditions are clear: “Our primary purpose is to stay sober and to help other alcoholics achieve sobriety.” Period.

    At most meetings we say “We are not saints.” Our purpose isn’t to be perfect; our purpose is to stay sober and help others. It really is that simple. It’s not the huge Machiavellian conspiracy that’s being posited here.

    The way we are being portrayed here is prejudicial and false. We are being portrayed as a bunch of people who must all think the same way, a bunch of Judeo-Christian fundamentalists who do nothing but sit in folding chairs, yet are somehow plotting to take over this or that aspect of the world. These characterizations are untrue.

    I understand that the main target here is the treatment industry, but it is disingenuous to say that it is all right to mischaracterize AA in all of these ways just because the treatment industry is the target–and so therefore criticism of AA is allowed, but defense and explanation are somehow off-topic. One can’t have it both ways. If one is going to bash AA as one goes about bashing others, then of course it’s legitimate to point out how AA has been mischaracterized.

    This intolerance toward–and generalized mischaracterization of–a diverse group of people is, to my mind, akin to one of the chief “hallmarks of religious fundamentalism.”

    • Amar says:

      Actually as many, if not more, practising Christians find AA offensive as do atheists and agnostics. There was a truly venomous strain of invective against mainstream Christianity from many of the same zealots at meetings I attended who preached the strange nebulous anythying-you-like-can -be-God creed. I think this may belie the fact that really many of these 12 step adherents know deep down that there is no coherence to their silly belief system, so they lash out at organised religions that do at least have an internally consistent theology.
      I found getting roped into religious controversy and being put on the spot over my private religious beliefs when I had gone to AA on the understanding that it was a support group for stopping drinking insulting and intrusive.
      I soon became weary of listening to the preaching of a surrogate religion which was all pretext and no substance and the casual attacks on established religion from people holding forth about how much they hated it when I had no interest in discussing such things.

  34. Paul A. Toth says:

    In response to above two posts, I have only claimed that *some* AA members engage in the type of forceful and proselytizing manner described, and that is an empirical fact. Next, I have stated again and again that many within AA, including atheists, find a way to a higher power, that I could not, but that I am glad for those whom it works.

    In terms of a higher power, I hardly think I’m the most powerful person in the world; quite the opposite is true. But let’s say I took a natural power, one that could be proven to exist: for example, let’s make that higher power nature. Can nature really remove my “character defects”? Can any empirically-proven power remove my “character defects”? The answer is emphatically “no.” These are what might be called blind forces, the results of evolution, biology, physics, etc. By their very nature, they don’t “care” about my “character defects” or anything else. Still, if someone finds that such alternatives work for them, that’s fine with me.

    I did not claim that all AA members are religious fundamentalists; I stated that *some* AA members act worse than religious fundamentalists. There is no arguing with them. This case proves my point. I did not raise the issues that AA members continually raise; AA members did.

    To say that AA only works if one works the program *can* become circular logic. Even if a person finds the program helpful but continually relapses, they will be told they’re not “working hard enough.” That can be stated into the infinite future but will more likely result in the person leaving AA for good and returning to either a life of abstinence without AA or, more likely, drinking, since no alternative programs exist in most areas — not because AA and only AA works.

    AA itself may not claim to be the only way, but many of its members certainly do so. As mentioned, I have been threatened that I would die if I did not attend AA. No, I would have died had I not stopped drinking.

    “AA member” is just a shortcut. I realize it’s not a club. However, I don’t want to repeatedly use the phrase “those who attend AA meetings on a regular basis.”

    Finally the very history of AA reveals that it was developed through Judeo-Christian, and more specifically Christian, theology, and with the assistance of Christian theologists. Christian redemption themes run throughout AA’s literature. This cannot be denied; it is empirically true. A person may not realize this, or choose to ignore it, but the fact remains. If a person would like links to this issue, I will be happy to provide them. But even if all AA members were Christians, and AA only allowed Christians to attend, I wouldn’t care. It’s not the point.

    It’s *my* argument that’s being distorted and mischaracterized. That’s because everything in this post is unquestionably true, but it will again be misrepresented, attacked, etc., simply because those who attend AA meetings choose their own definitions and, by doing so, not only make AA into anything they want it to be but do the same to any article or discussion that mentions AA in all but ways in which a halo exists over the words “Alcoholics Anonymous.”

  35. Robert Clark Young says:

    Now you’re trying to have it both ways again. You say “those who attend AA meetings choose their own definitions and, by doing so . . . make AA into anything they want it to be.” That is true, to an extent–for instance, one gets to define “higher power” as one chooses. But even if you meant that statement as absolutely as it is written, it destroys your entire argument that AA is a religion, a cult, a monolith, or even any kind of an organization.

    In no religion or cult is one allowed to “choose their own definitions.” Your evidence for attacking AA as being inflexible is to cite how flexible it is! This is extremely sloppy thinking. If AA’s defenders, as you claim, are coming at you from every possible rhetorical direction, then that is all the evidence you need that you are not dealing with a dogmatic monolith.

    AA is not an organization, and does not have leaders of any kind, but is instead a very loose fellowship, an extremely big tent that allows a tremendous multiplicity of points of view. Your own reported experience with people from AA gives the lie to your central tenet that the fellowship is a dogmatic monolith.

    Another anomaly is that you define an AA member as a person “who attends AA meetings regularly.” This is an extremely shortsighted view of what AA is all about, and doesn’t differ much from the total knowledge of AA that a member of the general public might have. AA is a gigantic toolbox, and meeting attendance, while important, is only one of the many tools in that box.

    As I said before, simply attending meetings does not constitute working the AA program. Yet the few statistics that exist on the efficacy of AA are based on meeting attendance, not on working the program.

    In 24 years, I have never seen anybody who is working the program go out and drink. Somebody with a service position in the group, who is being sponsored and who is sponsoring somebody else, who communes with a higher power, who socializes with fellow AAs outside the meeting room, and who uses the many other tools is not, in my experience, going to go out and drink. A person who sees AA as you see it–simply passively attending meetings–doesn’t have much of a chance. Again, it’s like anything else in life–if you want The Promises to come true, you have to work for them. And I’m not talking about white-knuckle “sobriety”–I’m talking about The Promises, which are clearly outlined in our literature and which, incidentally, have nothing at all to do with Christianity.

    But as far as meetings go, there are many different ways to attend them, and in your reductive approach you fail to make any distinction even there. A person can sit in the meeting passively, even hostilely, and never speak. (But hey, even some of them eventually get sober!) Or a new person who shares can mistakenly believe that the only purpose of sharing is to sit there and bitch about his life. Or a more experienced member might recognize that the purpose of sharing is to ADD something to the meeting, specifically on that day’s topic. Again, AA is not the monolith you presume it to be, and even meeting attendance, which is only ONE of the tools, can mean vastly different things to different people.

    Having said all this, I’ll grant you that it is possible for an actively engaged member to go out and drink, although I have never seen it. (Typically what happens is that a person stops working the program and THEN goes out and drinks.) The AA program is paradoxical in many ways–it teaches control, for instance, through the route of admitting powerlessness. By admitting powerlessness, I become powerful. But that power extends only to the first drink. For the sober person, the first drink is a choice, and all bets are off for the subsequent ones. So it is theoretically possible for a person who is fully engaged in working the AA program to DECIDE to take that first drink. I’ve never seen it happen, but that doesn’t mean it doesn’t happen or couldn’t happen. All we have is a 24-hour respite, and any of us could decide to drink–tomorrow.

    This has been an extensive discussion, and this is the first time the 24-hour plan has been mentioned. Many thousands of words can be written about it. I’m not going to do that here, but will mention it only to point out that there are many features of the AA program which you have ignored in your critique. Your total definition of AA is that it is about going to some meetings and having to define everything the same way everybody else does, and you are wrong on both points, as your own evidence shows. If you really want to talk about AA you have to address all of it. A sideways bash like yours simply is not intellectually rigorous, even if your main interest is in bashing the treatment industry, which in fact is not run by AA–another error in your reporting.

    Finally, what you say about the Christian roots of AA is a red herring. As I’ve already demonstrated, AA does not operate like any religion in the world. True, there were Christians who were part of AA in the past, and Christians who are part of it today. But the message of Christ is nowhere to be found in AA or its literature, just as the message of Christ, in my opinion, is nowhere to be found in the Christian churches. In any case, your argument is like saying the United States is a monarchical nation because Britain founded the colonies. It is a specious argument.

    Instead of working on Christian principles, AA works on a system of enlightened SELF-interest. Why do I help others in the program? Because doing so helps ME. That is the only way you’ll ever get an alcoholic to do anything–show him how it benefits HIM.

    That is part of the brilliance of AA, and part of the secret of why it works (as distinct from how it works). AA takes all of the screwed-up, selfish thinking of the alcoholic and bends it around in ways that are designed to keep him sober. I could write a book about how AA does not, and perhaps I should.

    Thank you for the conversation.

  36. Paul A. Toth says:

    I had composed a lengthy response to your post, complete with links to reliable sources. However, for some reason, the post never appeared. Therefore, I am going to post a much briefer response, as I’m short on time.

    1) In terms of your claim that I labeled AA a “cult,” you took my statement out of context. In context, I stated the following: “It’s not the existence of AA, or that many agree with what its claims, or bend what it claims until it matches what they prefer it to mean, that irks me. It’s the idea that no one else can possibly be right, an absolute certainty, which are the hallmarks, I’m afraid, of cult members.” Therefore, I did not call AA a cult. I stated that some percentage of AA adherents act in a cult-like fashion.

    2) The argument that AA is not an organization is so facile that it hardly deserves a response. However, I will only note that the AA site address ends in .org, as in “organization,” that AA refers to itself as an organization in its literature, though preferring the term “fellowship,” and that AA is a non-profit organization. It also has a structure with board members. Therefore, it is an organization, though why that term should disturb AA adherents is beyond me.

    3) The claim that those who fail to continue participating or remain sober in AA because they are not “working the program” amounts to circular logic. Obviously, by that anti-reasoning, any statistics of any nature evaluating AA’s effectiveness would show it to be 100 percent effective in 100 percent of all cases, an absurd claim by any standard.

    4) You seem to presume I have never been to meetings or have only attended one or two. Actually, I attended many meetings and in more than one state. I simply decided to “purchase”
    a different toolbox.

    5) Regarding Christianity and AA, the latter is steeped in the former. The red herring is the terminology “God of one’s choosing.” I think we know the specific God to which the founders referred. They were willing to “accept” those of any religious background and even agnostics (the Big Book tellingly does not address atheists; it obviously considers them to be “lost souls”). Interesting, however, and contradictory, was a surprising discovery upon which I stumbled during my research for my original reply to you. I was going to provide a link to an example of the following, but you can easily find similar evidence on your own. Anyway, some Christian churches and groups reject AA, claiming that it’s not “really” Christian but a sort of “new age” approach, one that removes “personal responsibility” and “rejects” certain passages of the Bible. That’s as outlandish a claim as to state that AA works 100 percent of the time or 0 percent of the time. So, I will grant you that AA, to my surprise, is assailed from several angles, including, in some cases, the Christian angle.

    6) As to the supportive nature of the meetings, the shared reaching out, etc., I agree. Any alternative to AA should certainly include that vital element.

    That concludes my remarks regarding AA, as I am now about to note in my next comment.

    Thank you for your thoughts.

    ~ Paul A. Toth

  37. Paul A. Toth says:

    A Note to Those Engaged in the AA Debate

    Thank you for your comments; we must agree to disagree. I am no longer going to address comments that deal with the issue of AA, including what it means, whether or not it works, the supposed inaccuracy of my viewpoint, the false assumption that I oppose AA, the false assumption that I have not attended enough meetings to be fully aware of AA’s workings, the false assertion that I cannot read and understand what the simple words of Step 6 mean (words with which I have expressed no concern except in regards to the treatment community), etc. You are welcome to agree with each other amongst yourselves.

    I will continue responding to comments specifically addressing the subject of the article, that being the treatment community and not AA.

    Thank you for the discussion. I hope it continues, though I also hope it returns to the point of the article, which the expected Word War regarding AA seems to have destroyed.

    Best of luck to all of those in recovery, whether you take the AA approach, or a different path to rational thinking.

    Sincerely,

    Paul A. Toth

  38. Paul A. Toth says:

    I’d like to start a new line of discussion. This suggested discussion is not intended to create a debate about the need for support groups, whether AA or its existing alternatives. Obviously, psychological issues, or however one interprets the emotional/thinking aspects of alcoholism, need to be addressed.

    Question:If alcohol really is a disease, shouldn’t it primarily be treated by physicians?

  39. forbese says:

    I agree, the you tube videos are confusing of the all in the head linked to jenny mccarthy dystonia caused by vaccine cheerleader. What’s NOT confusing; however is the factual discoveries of her pyschogenic disorder. In short, she really thinks she has dystonia, thus presents as such. Similar cases are seen in the case of psychogenic autism (factitious disorders) where the persons either deliberately feign being autistic or they really believe they are autistic. Normally, you find this in people who have taken large amounts of LSD type drugs, combined with a severly abusive past, thus resulting in a very mixed presentation of whatever it is they feel will bring them the most attention and nurturing. Autism is popular today, so many mentally ill persons are adopting this persona. Mainly, because few, if any professionals or media will challenge such a diagnosis after even a less than competant professional duped by the complexity of the presentation—validates it. Ooops, than it becomes a save face issue, where neither the media or the professionals (not to forget publishers who publish stories that later turn out not to be autistic people) involved in the faulty diagnosis want to be embarrassed. This is unfortunate, as this does a great disservice to the autism community in general. Recall the Amanda Baggs controversy and the case of Ms. Donna Williams. You Tube has a recent video out discussing some of this I’ve mentioned. It is on you tube under the name, “autism spectrum seems out of control” and another video named, “autism epidemic out of control.” The video has most definately hit on something few outside psychoanalytical or psychiatric circles, have even noticed.

  40. Paul A. Toth says:

    To Forbese:

    I am not familiar enough with these issues to comment, though I have read a bit about them. But thanks much for the comments; I am sure some readers might have something more to add than I can.

    Best,

    Paul

  41. Paul A. Toth says:

    To Amar:

    Yes, I happened across the phenomenon while researching some of my responses. I was surprised to learn that, as you mention, some Christians don’t feel AA is “Christian enough.” Meanwhile, some, like me, consider it “too Christian.” The simple answer would be for AA to use its vast network to provide a secular version of AA, which would supply nothing more than meeting rooms in which people could discuss alcoholism with no preexisting structure whatsoever, no dogma, no steps, no anything but conversation. I am willing to bet that’s what helps AA attendees the most, anyway. To borrow an AA catch phrase, “Keep it simple, stupid!”

    It seems to me there’s one thing that can be stated about AA: nobody agrees what AA actually is. Reading the above posts reveals a stunning array of ideas about what it means and doesn’t mean. That tells me it means what a person makes of it. That may be considered a positive, but I could say the same for taking a bike ride.

  42. Amar says:

    A lot of people (myself included) just see no relevance in discussing their religious beliefs at all in the context of a support group for an alcohol addiction. I would not expect a concern that I should develop spiritual beliefs to be a component of any support group or treatment regimen for any other physical or mental health problem, so why should alcoholism be any different? I have actually attended a support group called the Manic Depressive Fellowship in the UK which was a normal non-religious, non-“spiritual” support group and found the approach much more helpful. I think having real underlying mental health problems such as mood disorders etc. mis-diagnosed as “spiritual” or moral maladjustments is a real danger for many with as yet unidentified problems of this nature. In my own case, my recovery hinged on my finding an accurate diagnosis and approriate medication for a treatable underlying condition that was a major cause of my past alcohol problem, rather than undergoing some kind of spiritual epiphany. I don’t think I’m unique or unusual in this respect.

  43. Amar says:

    I meant to say “medical treatment” rather than just medication.

  44. Paul A. Toth says:

    You’re absolutely not alone. A person doesn’t have to be an atheist or agnostic to see my point by any means. Whatever the official AA party line, religion does, just as you’ve noted, come up and come up frequently in AA meetings. Almost all of the meetings I’ve attended began and ended with a prayer, one of them a specifically Christian prayer. Were I a believer, I would not attend church to treat my alcoholism. I might find comfort there, but not a cure. Diseases either have cures or they’re terminal. Alcohol is either a medically-treatable disease or it’s an incurable terminal disease…unless we dismiss the term “disease.” And if it’s not a disease but a psychological disorder, then it should be treated by psychological and/or psychiatric means. If a person chooses at attend AA meetings along with such treatment, that’s their business. But for a therapist to consider AA some form of psychological, psychiatric or medical treatment of a disease is so unethical that anyone doing so should have his or her license revoked.

  45. Amar says:

    We all have our own private views or beliefs regarding such matters. I prefer that they should remain just that, private. I completely agree with you that professionals have no business recommending “spiritual” solutions for health or mental health problems. I think it raises serious questions about their competence and their impartiality should, for instance, a doctor or counsellor do so.

  46. Susan says:

    Thanks for the article and keeping up with the comments a months later! I stumbled upon this from a link from another blog that is critical of AA on many levels, but I hadn’t thought of the direct and rather obvious contradiction between step 6 and the concept of alcoholism as a disease. I have heard the theory that the classification of alcoholism as a disease might have something to do with the insurance industry in the States, and would not be surprised if that is the case.

    A year ago I would have probably answered differently, but now after spending a good chunk of the last year in AA, and then more recently firmly out of AA (and admittedly a bit pissed off about it for various reasons), I would say that alcoholism should be classified more along the lines of other mental disorders. A lot of disorders can be improved with medication, and you can learn coping mechanisms and new behaviours to help in your daily life. I think that addiction and alcoholism might be similar, and there are new medications that have shown promise in treating addictions, but of course behavioural modification is also necessary.

    Upon leaving AA, I have become increasingly frustrated and surprised that it is such a mainstay of addiction treatment, not questioned more or even studied for efficacy. I wonder why the skeptic community has not picked up on this as well, because it seems a ripe topic. The comments here, which I spent a good amount of time reading, had some excellent examples of Big Book talk, and the kind of mental gymnastics that are required to ‘make the steps work’ and hold contradictory opinions in your head. It is far too much for a person who is vulnerable and not thinking clearly. If that amount of twisting of words is required, than indeed it is not a ‘simple programme’.

  47. Paul A. Toth says:

    Thank you. It’s a rare occasion I am thanked for these comments. I believe AA is questioned within skeptical circles, and there are, you’ve probably noted, a number of anti-AA sites, though I don’t think any of them have made the points I’m trying to make. Secondly, the resolution of the conflict I discuss concerns me far more than the conflict itself.

    Let’s put aside those who claim AA has provided the means to continued abstinence, even though the statistics show that AA is no more effective than anything else or nothing at all. Instead, what is the problem? You’ve named it: a person is hard pressed to find a therapist who isn’t a glassy-eyed proponent of AA, as immune to reasoning as AA’s own adherents. But the latter may be spiritual or whatever they claim to be that supposedly helps; that’s their business. The therapist who has nothing upon which to base his unquestioning support of and indeed faith in AA in another matter, a danger to others and in my mind subject to litigation. Of course, the courts are as brainwashed by AA as therapists, so there goes that option.

    At this point, unless lucky enough to live in a very few locales, one is on his own with books, etc. Alternatives to AA exist but are difficult to find. Rational Recovery requires and really even has no groups; I’ve found it helpful but not enough to merit its being my sole mode of recovery.

    You can visit my blog and run down the list of links at http://violentcontradiction.blogspot.com/
    I’ve listed the major alternatives I’ve located. For now, this article was the best I could do in terms of attacking the discrepancy between how the treatment community views alcoholism and how it fails to actually treat it. It’s like defining a dog as a cat and then wondering why the dog refuses to act like a cat.

    Someone with organizational skills and the support of people like us might be able to build a nationwide network of secular meetings without AA’s spiritual model. However, therein lies the key to AA’s “success.” Though the lunatic fringe of Christians reject even AA, 99 percent of churches allow the group free space because of its “God talk.” The obstacle is now obvious: where to hold such meetings without being charged a fee? Obviously, the huge numbers of churches that allow AA to meet in their rooms are going to look at someone coming to them from a secular point of view and requesting free space will receive with same glassy-eyed stare of therapists.

    As mentioned above, I had this exact experience a week ago with a now-dismissed therapist. I felt as though I had walked into this essay, and there’s so far no escaping its pessimism.

    Still, if anyone is interested in attacking this problem, I would consider lending a hand, or two, if a workable strategy can be arranged.

    Thanks for your thoughts and for keeping this discussion going.

    Paul

    • Becky says:

      Sorry to interject, but are you sure you would be charged a fee just for not being AA, or is that just cynicism? I suspect it would depend, at least in part, on the type of church you approached. And not all AA meetings are held in churches. I mean, it’s not the only place to hold a meeting of any kind, which you must know.

      I find it curious that you would blame a mythical all-church with an imaginary monopoly on meeting space for fees it has not yet charged you to hold hypothetical meetings of your as-of-yet theoretical addiction support group.

      I mean, you’re finished before you even begin.

  48. Paul A. Toth says:

    Good point. I didn’t mean to imply that all AA meetings are held in churches, but I did mean to imply that I suspect they receive those rooms gratis. I’m not stating that an alternative group would be charged fees by churches, only that churches provide the most obvious and prevalent supply of free spaces. I highly doubt churches are going to offer such free spaces to an AA alternative that does not include “God talk” as part of its agenda.

    Thus, the problem becomes one of finding free spaces, enough to become a known alternative to AA, so obvious that even a therapist would notice its existence and be forced to offer it. But AA has masterfully used religion, while step dancing around it, to secure its status as the nearly-sole available recourse for alcoholics.

    True, a few meeting places could be secured. If you take a look at the sites linked on my blog (see blog link above), you’ll note that a couple do offer meetings, but they’re so difficult to find and indeed impossible to find in most locations. I would guess the reason for this is that they cannot find free spaces. This is a problem any group regarding any topic faces. Are hospitals, churches, clinics, etc., all of which have completely bought AA’s conception of itself as the “only thing that works,” going to be open to competing groups? I doubt it. More likely, therapists will consider non-AA forms of treatment as the equivalent of “denial.” But the true denial is that AA serves as a free form of pseudo-therapy offered by those who pronounce alcoholism a disease.

    Perhaps I will make this my mission. But I will need help. Anyone interested? Contact me at tothnews@aol.com.

    • Becky says:

      Again, I think the notion of the All-Church is problematic.

      Churches range widely from the very conservative to the very liberal, in some cases (though I’m not super familiar with them), even specializing in general spiritualism and catering to non-believers as well as avowed Christians (see Unitarian Universalism). Episcopalians and some Lutheran churches (in the Lutheran ELCA synod, it is important to emphasize, since Wisconsin and Missouri synod Lutherans tend to be much more conservative) are also more liberal and increasingly so, as are, I suspect, other various denominations.

      As I said, I think the type of church matters. Also, it probably matters how you characterize your group. If you say it’s a support group for recovering addicts for whom AA has not worked, or a support group for addicts looking for alternatives to 12-step programs, that’s different than marching in and demanding free space and free coffee for a group of atheist addicts who are primarily there because they don’t like Christianity and refuse to hear “God talk.” I mean, that’s hardly even a matter of faith or not faith. That’s just sort of hypocritical. I wouldn’t be friendly towards people who said “I don’t like your kind, but give me free stuff,” either. You can debate whether or not that’s a very Christian stance or not, but at the end of the day, it is certainly a perfectly human one.

      Beyond that, there are also Jewish temples, Buddhist community centers and meditation centers, public schools, public community centers, and any number of other institutions, both religious and secular, that routinely hold meetings for various groups. Some may charge, some may not. I mean, you’d have to at least look into it.

      My personal feeling is that there are not more and more easy-to-find, non-AA groups for any number of reasons, likely the very least of which is where to meet. If AA doesn’t work for people, many of those individuals are probably still addicts, and probably not excellent organizers. If they are no longer addicts, they probably got that way from a 12-step program (as you say, that’s where therapists send primarily send people) or at least are somehow already sober, so they probably don’t have too much reason to start such a group. On top of that, since therapists primarily direct to AA, there may simply not be much demand. Addicts are not famous for being particularly resourceful or–at least–persistent when it comes to seeking out help for themselves.

      I’m just saying there’s a whole concert of factors here. The notion that religiosity is the primary impediment to everything you want to do strikes me as more of a personal grudge posing as a rationalization for inaction than a real obstacle.

    • Becky says:

      Also, VFW, Elks clubs, Shriners, Masonic lodges, and those sorts of places. I’m not sure about all the particulars of these types of places when it comes to offering meeting spaces, but all tend to be involved in charitable work, and though they may charge for wedding receptions and such, attitudes may be different when it comes to something like addiction recovery, especially among Vets and especially if someone in your group or one of their family members is a member of the organization in question. I mean, just throwing out ideas here.

      At any rate, presentation of your idea and intentions is key.

      Good luck.

  49. Paul A. Toth says:

    Well. To both of the above posts, I mainly say, “Thanks.” It’s true: Unitarian Christians, for instance, would almost certainly be open to the idea. And I’d never thought of the other other venues suggested.

    Let me say in my defense that it wasn’t my intention to form a new group; first of all, I have no theory regarding the matter. I simply wanted to point out the contradictions between the therapeutic and psychiatric disease model of alcoholism and the “treatment” it suggests.

    However, this new line of thought has given me an idea. I will begin to pursue that idea and let you know the results. Recent comments have been helpful and optimistic. I tend toward pessimism; sometimes I need a slap.

    I don’t think it’s within my abilities to form an entirely new group, but — you’ll see.

    Best,

    Paul

    • Becky says:

      Last but not least, depending on the type of organization you’re dealing with, you might consider the possibility of bartering for a space. I mean, that could take any number of shapes and holds the potential for community-type connections not just within, but beyond the group you intend to create.

      You might barter something in the way of a professional area of expertise or just help the shriners clean their casino shuttlebus. I mean, I don’t know if shriners have casino shuttlebuses, but you get the point.

      In any event, I’m happy to be of encouragement.

  50. Paul A. Toth says:

    Excellent points! You’re a very creative thinker. I will certainly utilize these points in the plan I am developing.

    Many thanks.

    Paul

  51. Paul A. Toth says:

    Now that I have had time to consider all of the great advice I received over the latter portion of this discussion, I am moving towards action. I ask that you join me.

    First, take a look at SMART Recovery, a secular group located here: http://www.smartrecovery.org/

    Then, join the SMART Recovery Facebook page: http://www.facebook.com/pages/SMART-Recovery-USA/102376027397?ref=ts

    If you’re looking for an alternative to AA, this is the place to go, and I am going to help you and others like us get there.

    Best,

    Paul

  52. Carl D'Agostino says:

    Had a research job for rough draft text book alcoholism treatment protocols. Gave them 2 -5 pages on each of these:

    Body Cleansing
    Transpersonal Psychology
    Motivational Enhancement Therapy
    Nutritional Gene Therapy
    Biochemical Repair
    Orthomolecular Medicine
    Talk Therapy
    Exercise
    Religious/Spiritual Experience Models
    Neuro-Linguistic Programing
    Religion and 12 Steps(Christianity, Bhuddism,Hinduism,Islam,Taoism, Judaism,

  53. Carl D'Agostino says:

    Had a research job for rough draft textbook drugs/alcoholism treatment protocols. Gave them 2-5 pages on these:

    Body Cleansing
    Transpersonal Psychology
    Motivational Enhancement Therapy
    Nutritional Gene Therapy
    Biochemical Repair
    Orthomolecular Medicine
    Talk Therapy
    Exercise
    Religious/Spiritual Experience Models
    Neuro-Linguistic Programing
    World Religions as sources 12 Steps
    12 Steps Programs
    Mindfulness
    Ayurvedic Medicine
    16 Modalities Meditation
    Holistic Medicine
    Acupuncture
    Hypnotism
    Aroma Therapy
    Wilderness Therapy
    Dance Therapy
    Pet Therapy
    Environmental Awareness Therapy

    Have 500 entry bibliography, annotated, drugs, alcohol, addiction, treatment, history, toxicology,law enforcement, AA alternatives, etc. Mostly from most recent dozen years with inclusion of older classics.

    I retain authorship this stuff. Could rewrite you edit part of Smart. 150- 200 pages here. Need $$. Gotta be careful, on social security disability. Partners? Your last post says “join me.”

  54. Paul A. Toth says:

    I never said AA should bend over backwards for atheists, although, supposedly not being a Christian organization, it certainly bends over backwards for Christians, given that every AA meeting I’ve attended included the specifically Christian Lord’s Prayer. I wonder how Muslims feel about that?
    And it’s simply incredible the amount of arrogance multiplied by self-defensiveness some AA members, Christian and not, exhibit.

    My argument is clear: if alcohol is a disease, then it must have physical causes that should be treated by physicians, not asking God to remove character defects. Show me a physician who tells a cancer patient to ask that God remove character defects as a mode of treatment and I’ll show you a multimillion dollar malpractice suit.

    I really don’t care what AA labels alcoholism or how it claims to “treat” it, nor do I care if people continue to go despite AA’s inarguably abysmal statistical record. I’m interested in the TREATMENT industry. Got it? For all I care, you can go to Lourdes and see if that “cures” your “disease.” But if a supposed professional suggests the same, then I have a problem with it.

    Certain AA members obviosuly have deep self-doubts about AA. That’s why they can’t bear the slightest disagreement with AA. To disagree with AA is to threaten their very sense of identity and existence. To even disagree not with AA itself but the treatment industry somehow threatens them. Apparently, the entire planet must attend AA, or AA members will suffer paralyzing self-doubt expressed as know-it-all attacks and “interventions.” In such moments of projected self-doubt, I suggest you say a Serenity Prayer.

  55. Carlos says:

    I have tons of questions regarding the whole “treatment” for Alcohol and Drug Addiction. It took me quite some time to quite. And I say that a good part of it was from the misinformation. What we call treatment today; I came to understand that is not treatment at all.

    If you get an infection you can bet that the antibiotic that the doctor prescribe to you, has been studied at length before approved by FDA (besides FDA’s problems) you bet that most of it have been rigorously studied. Yet not such is so for the 12 Step Program, in fact although I have learned eventually that there is significant and substantial research on alcohol and drug addition, most of it is ignored by large percentage of treatment facilities (as high as 91%)who practice what I call to be religious indoctrination. Indoctrination itself has a lot of problem. You bet that what we are getting for treatment is not well research and has not be tested for risk and harms.

    I learn that AMA took on the name of diseace of Alcoholism, not because they have much evidence or research, but because they were attratcted to the term disease.

    I have been looking for a Mal-prctice attorney, as I have plenty of evidence that the treatment facility I went to, more than anything else sabotaged my treatment and they have not evidence that what they do works.

  56. Carlos says:

    There are a lot of holes. My eyes open up to how lax and sloppy substance abuse treatment is when I read Dr. Miller and Hester “Handbook of Alcoholism Treatment….” and the fact that they Substance Abuse Mental Health Service Administration had been publishing Treatment Improvement Protocols for the past few decades mostly ignored by. You can get all of this publications for free by calling their 1 800 number or thru the internet. It is fairly easy reading.

    http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip

    By the way there are about 7 federal cases that do state that AA NA is substantially religious in nature. The last case I know is Destefano vs. Emergency Group Housing in New York. Where in plain English says that no public funds can be used to promote AA NA etc. The other cases were from people in probation parole and in Correctional Institution. You can find most of them in the internet.

    I find AA treatment no only lax in science and sloppy. I think it is archaic, capricious and arbitrary most of what they do.

    god I lots of things to say, but I am at a library lab and I can not take too much time with you guys.

  57. Carlos says:

    I can tell you without any doubt that most 12Step Treatment facilities violates Tradion6, 8 and 11

    Six because someone is either borrowing or stealing the AA/NA name

    Eight because there exist a whole bunch of AA gurus running around now, and treatment therapist are the worse violators.

    And 11 because they force you to go to AA NA meeting when it is a program of promotion nor attraction.

    I can also tell you “like it who likes it and dislike it who wants to dislike it”, that AA has no real record of outcome; I think they are all coincidences. you might feel it save your life, but they are a dismal failure, when so many people are relapsing. And only 5% of the people stay in AA after a year <this last one is from the TriAnnuel Report of AA itself you can get it from National.).

    I consider it inductrination and not treatment.

  58. Carlos says:

    “And if it’s “correct” to call alcoholism a disease, then I assume there must be studies in place to address the biological causes and symptoms in order to provide medicine to combat it? For instance, you don’t use only behavioral therapy to combat heart disease.”

    My problem with calling it a disease, beside the fact that there is not much scientific research like in other diseases, it really does not meet the criteria for disease. It is not as progressive as it is claim to be, that seem to be more suggestive that accurate. , not that it does not happen to people but that it does not happen as much as it is claimed outside of AA. It is actually a fairly rear outside of AA. So it seems to be more of an act of self-fulfilling prophesy.

    But the big one is that after 100 of years of calling it a disease. A and Edmonton Jellies where not the first that called it a disease. It goes back to 1800s. There is not one blood test, x ray, geriatric test, allergy test or any other physical test that show the disease physically, nor it intensity etc. There is no thermometer to measure this disease. There are a lot of wholes in its science. Although there are a lot of true believers now that they are trying to prove all kinds of science and they are very doubtful intention. When it jumped from a fellowship and a society to treatment it became pseudoscience. I suggest we read about the characteristics of pseudoscience and you will see how much current treatment fits the characteristics of pseudoscience.

  59. Carlos says:

    “Oh, if there was a medicine to cure alcoholism…” There is certainly a biological (physiological) component for alcoholism, as well as psychological elements. For AA this is a cop out. Through the 12 Steps one becomes a changed person and this new person with connection with higher power is relieved of the obsession. The new person an individual becomes no longer cares to drink following this spiritual path. If there was a medicine/cure the person may stay sober but have not been reborn and so AA rejects the notion.”

    I do not know if you will ultimately call it a cure. Many people who have tried AA, swears by
    NALTREXON. I do not have much experience with it, but I suppose that a good number of people
    who take Naltrexon, after a while they may loose the taste for alcohol or may drink with a lot more
    moderation. I think there are a lot of treatment coming up and Miller and Hester who have been doing Review of the literatures since the 1970, before AA became infiltrated in the treatment facilities.

    In SAMHSA website
    TIP 28 Naltrexone And Alcoholism Treatment 28: Treatment Improvement Protocol (TIP) Series 28

    • kathleen gargan says:

      just to note that, inaddition to SMART recovery, there are 3 secular registered as 501 (c) (3) organiztions in the united states. LifeRIng Secular Recovery, Secular Organizations for SObriety and Women for SObriety.

  60. Paul A. Toth says:

    Kathleen:

    Thank you for adding that info; I should have mentioned it. Both SMART Recovery and I, a volunteer for SMART Recovery, support these specific organizations, as well as other legitimate AA alternatives for those whom AA does not work.

    Kindly,

    Paul

  61. What Is Physical Therapy…

    […]Paul A. Toth | Alcoholism, AA and the Medical Industry: Nationwide Malpractice | The Nervous Breakdown[…]…

  62. A First Century Christian Fellowship

    Major Sources for Observing Early A.A.’s Apostolic Principles, Practices, and Resemblance to First Century Christianity at Work

    By Dick B.
    © 2012 Anonymous. All rights reserved

    A Common Observation about “Old-School” Alcoholics Anonymous

    Alcoholics Anonymous History: A.A. cofounder Dr. Bob called the first A.A. group (known as “Akron Number One”)—founded on July 4, 1935—“a Christian fellowship.” [DR. BOB and the Good Oldtimers (New York, NY: Alcoholics Anonymous World Services, Inc., 1980), 118]

    Of the five Rockefeller people—including John D. Rockefeller, Jr—who met the early AAs, listened to Dr. William Silkworth, and read the report that Frank Amos had given to them in February 1938, all said something to the effect, “Why this is First Century Christianity at work. What can we do to help?” And they did help.

    But long before that, Christian evangelists were telling New Englanders and many in other parts of the world how the Apostles not only found salvation, but taught and lived Christianity—healing drunks, addicts, and derelicts along the way.

    And then there was the Oxford Group and that American sparkplug of its early period, Rev. Samuel M. Shoemaker, Jr. Bill Wilson called Shoemaker a “cofounder” of A.A. Bill discussed the proposed Big Book and Step contents with Shoemaker. He even asked Sam to write the 12 Steps, but Sam humbly declined. Yet the very language of the 12 Steps paralleled Sam’s teachings—teaching founded on basic ideas in the Bible that Dr. Bob said were the foundations for the Steps.

    Shoemaker and many other early Oxford Group people called their life-changing group and groups “A First Century Christian Fellowship” and defined what that phrase meant to them and their groups.

    “A First Century Christian Fellowship”

    At the times Bill W. (1934-1937) and Dr. Bob (1933 until at least 1939) were involved with the Oxford Group, it was actively using the name “A First Century Christian Fellowship.” And here are some of the ways people described the personal work with others of members of that important A.A. predecessor, the Oxford Group.

    In his popular book, Life Changers, Harold Begbie (who had written Twice Born Men and much more about General William Booth and the Salvation Army) described the Group this way:

    Above all, the Group was a Fellowship—a first-Century Christian Fellowship controlled by the Holy Spirit. [Dick B., The Oxford Group & Alcoholics Anonymous, p. 31]

    We discuss and cite precise sources for the following statements:

    . . . Frank Buchman’s formation of what he and his friends called “A First Century Christian Fellowship.” Buchman had said, “It is an attempt to get back to the beliefs and methods of the Apostles.” He said, “We not only accept their beliefs, but also decided to practice their methods” [Dick B., The Oxford Group & Alcoholics Anonymous, p. 286]

    In Life Changers, author Begbie also wrote:

    Since those words were written he has paid a visit to the United States in company with F. B, . . .

    —-

    In his last letter written from America he tells me that he is entering with others into “A First Century Christian Fellowship,” explaining that they wish to get back to the type of Christianity which was maintained by the apostles—“We not only accept their beliefs, but are also decided to practice their methods.”

    He announces in detail the elemental beliefs of a First Century Christianity. He believes in:

    The possibility of immediate and continued fellowship with the Holy Spirit—guidance.
    The proclamation of a redemptive gospel—personal, social, and national salvation.
    The possession of fullness of life—rebirth, and an ever-increasing power and wisdom.
    The propagation of their life by individuals to individuals—personal religion.

    Out of these beliefs proceeds the method of propagation:

    Love for the sinner.
    Hatred of the sin.
    Fearless dealing with sin.
    The presentation of Christ as the cure for sin.
    The sharing and giving of self, with and for others.

    “We are more concerned,” he writes, “with testifying to real experiences, explicable only on the hypothesis that God’s power has brought them to pass, through Christ, than with teaching an abstract ethical doctrine.”

    Rev. Samuel Shoemaker spoke of the Group as “A First Century Christian Fellowship” as follows:

    The Spirit can communicate His truth to a spiritual fellowship of believers in ways He cannot communicate to individuals: it is another phase of Christ’s meaning when He said that “where two or three are gathered together in my name, there am I in the midst of them. He is wherever a believer is; but He is present in heightened reality in the fellowship. [Dick B., The Oxford Group & Alcoholics Anonymous, 293]

    In his first significant book, Realizing Religion, Shoemaker had the following to say about the days “when the Church had martyrs in it.” Shoemaker wrote at page 67:

    I believe that originally this was the spiritual impulse, entirely apart from considerations of ecclesiastical order or the founding of a brotherhood by Jesus, which welded Christians together in the days when the Church had martyrs in it. The value of united prayer and worship, of inspiring and instructing a group bent on one object, the constant impact of the words and the interpretation of Jesus, has often been dwelt upon. . .

    The Acts of the Apostles

    In Acts chapters 1 to 6, there are a number of descriptions of what the First Century Christians did, what they had received, and how they fellowshipped together. Here we will just quote two segments.

    The first from Acts 2:38-43, 46-47:

    Then Peter said unto them, Repent, and be baptized every one of you in the name of Jesus Christ for the remission of sins, and ye shall receive the gift of the Holy Ghost.
    For the promise is unto you, and to your children, and to all that are afar off, even as many as the Lord our God shall call.
    And with many other words did he testify and exhort, saying, Save yourselves from this untoward generation.
    Then they that gladly received his word were baptized: and the same day there were added unto them about three thousand souls.
    And they continued stedfastly in the apostles’ doctrine and fellowship, and in breaking of bread, and in prayers.
    And fear came upon every soul: and many wonders and signs were done by the apostles. . . .

    And they, continuing daily with one accord in the temple, and breaking bread from house to house, did eat their meat with gladness and singleness of heart.
    Praising God, and having favour with all the people. And the Lord added to the church daily such as should be saved.

    The second segment from Acts 4:29-32:

    And now, Lord, behold their threatenings: and grant unto thy servants, that with all boldness they may speak thy word.
    By stretching forth thine hand to heal; and that signs and wonders may be done by the name of thy holy child Jesus.
    And when they had prayed, the place was shaken where they were assembled together; and they were all filled with the Holy Ghost, and they spake the word of God with boldness. And the multitude of them that believed were of one heart and of one soul. . . . And with great power gave the apostles witness of the resurrection of the Lord Jesus: and great grace was upon them all.

    The Keys to Applying First Century Christianity in Recovery Programs Today

    Our latest title is:

    How to Conduct “Old School” 12-Step Recovery Meetings Using Conference-Approved Literature: A Dick B. Guide for Christian Leaders and Workers in the Recovery Arena.

    In a small number of pages, this new book—very succinctly and very specifically—covers the ground above and then shows how the successful “Christian fellowship” practices of the First Century and of the early A.A. group in Akron can be applied today and fully supported by Conference-approved literature published by Alcoholics Anonymous World Services, Inc. And how those who join together in Christian fellowship can attain healing and a whole life in the same way the Apostles did and that the old school AAs did.

    Gloria Deo

  63. Rita Thompson says:

    I do not see the contridictions you mention in the article. In fact the disease model and the AA program explain the loss of control, and why will power is not effective. The brain imaging now shows how the judgement is bypassed when a substance is introduced .Brain imaging shows that even visual triggers high jack judgement. The defects are not said to cause the disease. Insight, and being accountable are condusive to good mental health. These concepts are not mutually exclusive. In addition I would think it is rare that mental health professionals would discourage additional resources for an individual in recoverey,and working to sustain remission

  64. Tucker says:

    The logic behind the points you are trying to make is flawed, and some of the statements you make are completely unfounded.

    Starting with your assertion that because step the 6th emphasizes the identification of character defects, that AA assumes character defects are the cause of alcoholism, is a faulty assumption. Read “The Doctor’s Opinion”. It is, intentionally, the introduction to the rest of the book, and it explains from a certain Doctor’s point of view the nature of alcoholism being mainly physical (an allergic like reaction), and mental (mental obsession to return to the first drink).

    You also claim that if someone wants to ignore the 6th step that they have no reason to go to meetings. This is also false. Many people benefit from attending AA without working the steps. There is a saying that “meeting makers make it”. Not everyone would agree with that statement, but the only requirement for membership is a “desire to stop drinking”, not a willingness to work all of the steps.

    AA is a program that aims to help its members “stay sober and to help other alcoholics achieve sobriety”. The reason there is a focus on character defects is because it’s important to avoid situations in which the person will be more likely to drink. If a person tends to be selfish and self-centered (which alcoholics have an inordinate tendency to be), they will be more likely to “step on the toes of their fellows” and develop resentments, and resentments according to the Big Book are “the number one offender”. People drink over resentments, so alcoholics need to be extra careful that they do not develop them.

    The funny thing is that you are criticizing medical professionals for referring people to AA without considering why they are referring people to AA. It may be because in their experience they’ve found that it works when other forms of treatment fail. While the success rate in AA may be low, even very low, it tends to have a better track record than other methods of treatment when in terms of long term sobriety.

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