Gabrielle Glazier’s article in The Atlantic, “The Irrationality of Alcoholics Anonymous,” is an interesting read–thought provoking, despite the fact that it contains misrepresentations and misconceptions about AA and a good deal of irrational thought itself. I’ll come back to those points.
Let’s begin by noting the question, stated more than once, that if alcoholism is a disease, why don’t we treat it medically? The answer, obviously, is that medicine has little to offer the true alcoholic. As Glazier notes, alcoholism is a complex set of symptoms. Psychiatry has advanced a great deal since AA was founded in 1935, but it remains basically alchemy. What is known about the workings of the human brain is dwarfed by what is not known. And in practice, psychiatry itself ignores scientific method (and the well-being of the patient) in favor of generalized strategies untailored to the individual and unreliable in the hands of individual practitioners. Some time ago, over a three year period, four professionals diagnosed me with four different psychiatric conditions, each indicating a very different course of treatment. All four were wrong. We must remember that there is no test for chemical imbalance. There is no test for alcoholism.
It is also ironic that at a time when religious people and even scientists are rediscovering the power of prayer for healing, psychiatry is dismissing God as unscientific. Well, yes, it is. But science is beginning to admit that it does not have all the answers, and psychiatry in particular should be at the forefront of that admission.
Glazier notes that there is not a bright line division between alcoholic and nonalcoholic. That is true in a sense. Yet we know from scientific research that there are physical characteristics associated with alcoholism, including changes to liver cells that result in processing alcohol differently, resulting in physical addiction to alcohol. Part of the problem with the article is its fallacy of equating alcohol abuse with alcoholism. Our society has largely adopted this attitude: people who get in trouble because of alcohol are sent to AA by judges, by parents, and by treatment centers. Not all of them are alcoholic. Some may become so, and some are just going through a period of heavy drinking due to negative or positive conditions in their lives. (My brother had to “re-evaluate his drinking habits” while in college; he’s never had a problem since.)
But the main complexity in treating true alcoholics– those who have both the physical addiction and a mental compulsion to drink– is that alcohol is a treatment for an underlying condition. Despite Glazier’s assertion to the contrary, AA well recognizes this fact: “Our liquor was but a symptom. So we had to get down to causes and conditions” (Alcoholics Anonymous, 64). Of the twelve steps, only one of them even mentions alcohol. The others speak of finding a higher power, admitting fault, forgiving others, and setting things right.
The underlying condition of an alcoholic is difficult to identify. When I was drinking, I would have told you I was drinking to kill the pain. But it wasn’t physical pain. It was a deep, psychic pain. I might have told you it was the pain of living. Today, I would characterize it as a deep spiritual dissatisfaction with life that only alcohol (and various other drugs) could relieve. Until I found AA.
Therein lies the problem: Glazier relates that doctors in Finland are using a drug called naltrexone to block the components of alcohol from reaching the receptors in the brain. This would work for a person who drinks for the effect of getting drunk. Why drink if alcohol does nothing for you? But imagine for a moment that alcohol is the only thing you’ve found that makes life bearable. Take it away and life becomes unbearable. Naltrexone makes the alcohol not work. Will you live in agony, or stop taking the blocker? For an alcoholic, the answer is obvious. Absent some other way to ease the pain, we will return to alcohol again and again, regardless of the cost to our health, our families, and our careers.
Glazier, a self-described non-alcoholic, relates that she tried naltrexone and found that her desire to drink diminished. My wife (a recovering alcoholic thanks to AA) relates that to trying my prostate medication to see if it makes a difference. Absent the mental and physical addiction to alcohol, which non-alcoholics can’t grasp, an experiment like that is meaningless. Can Glazier imagine wanting a drink so badly that she would leave her baby alone in a crib while she went to a bar or liquor store, or drive drunk with her child in the car? So badly that she would drink the night before she was scheduled for a court-ordered urinalysis test to verify she was still sober? So badly that she’d drink even while taking antabuse, which would make her vomit violently and uncontrollably when she did so? So badly that, like my uncle, she would drink even if her liver had failed and the doctor told her that one drink would kill her? I seriously doubt it. I wonder of she can imagine the efficacy of naltrexone in those situations?
How can this underlying pain of an alcoholic be addressed? Carl Jung said a massive psychic change was required. AA suggests a spiritual experience. Buddhist practitioners have had success with intensive meditation. There’s been some success with Cognitive Behavioral Therapy (CBT). But in general, psychology and psychiatry have little to offer. Psychology too often fails because alcoholics themselves do not tell the truth. We fear giving up the only thing that makes life bearable, and we lie and obfuscate to ensure that doesn’t happen. Psychiatry fails because, well, it’s a science only when compared with astrology. They don’t know why an alcoholic is so maladjusted to life. How can you fix something when you don’t understand its cause?
AA offers a simple (but not easy) approach that creates a spiritual experience in the practitioner. Yes, it works. I’ve been sober 32 years. But does it work for everyone? Obviously not.
As an aside, I’ll be the first to admit that AA is difficult for atheists. I was an agnostic when I got sober, and that was a challenge. The difficulty for atheists is obvious if you go to a meeting in Buddhist countries like Sri Lanka or Thailand: there aren’t many sober Buddhists. Using AA as an atheist can be done. I’ve known atheists who have. (They often don’t remain atheists, though; the spiritual power of the process eventually causes them to acknowledge faith in God, though it may take years. I myself, formerly agnostic, am now a seminary student.) But I agree that AA is not necessarily for everyone.
Here we run into one of the first misconceptions about AA: the claim cited in the article, originally made in the 1955 version of the book Alcoholics Anonymous, that 75% of the people who came to AA stopped drinking. That number is now closer to 5-8%. But that’s not what the original claim says.
“Of alcoholics who came to A.A. and really tried, 50% got sober at once and remained that way, and 25% sobered up after some relapses…” (Alcoholics Anonymous, xx, emphasis added)
Two things are of note: first, they were dealing with alcoholics, not problem drinkers. Oldtimers who got sober in the 1950s told me that back then, hospitals wouldn’t take an alcoholic, and health insurance wouldn’t cover their treatment. People detoxing would often go into seizures in a meeting, and no one called an ambulance because it wouldn’t come. The social stigma against alcoholism was so strong at that time that you had to be pretty far gone to go to AA. You just didn’t see the casual DUI driver or tippling college student in meetings.
The second point is the phrase “really tried.” The Twelve Steps are not rocket science. AA wisdom says that no one is too dumb to work them but some of us are too smart. They demand a level of honesty and willingness that most people just can’t muster. They demand a level of commitment that comes from the certainty that there is no other possible way to survive. The dying alcoholic is a good candidate for this program. The DUI driver trying to stay out of jail or the binge-drinking college student trying to please his or her parents is not.
As more and more sources send drinkers to AA, the proportion of alcoholics who are willing to “really try” drops. Obviously, so does the success rate. What is AA’s success rate among “true” alcoholics? No one knows, because there’s no effective way to measure them. It’s an anonymous program, after all. Clearly it’s higher than 5-8%, but no one knows how many of the people being sent to AA are actually alcoholics.
It is also noteworthy that not all step-based recovery centers take the steps seriously. During my bout with mental illness, I attended one that had patients read the first three steps while undergoing therapies, CBT, and various other activities. We didn’t actually work the steps. Meetings were optional. Perhaps it was coincidental that many of my fellow patients were there for the second or third time.
Here’s one of the more frightening things I read in the article: the statistic that some 22% of those treated for alcohol dependency could return to moderate drinking. I’m not against drinking–for the nonalcoholic. But for the alcoholic, the risk is so great, why would I take a 4 out of 5 chance that I can’t drink moderately? I’ve been told by certain ministers that if I’ve accepted Christ into my life, I can drink socially. Maybe so. But if they’re wrong, I would lose my career, my family, and probably my life. Why would I even try? That’s irrational.
Herein lies another irrationality in the thinking behind the article: that drinking is normal, and that normal is good. That idea alone drives many who struggle with alcohol back to the bottle. We desperately want to be “normal.” The truth is, from the time I first got drunk at age 16, I never wanted to just “have a drink with dinner.” I wanted to get as drunk as I could as often as I could. Yes, I’d lie to you, both about how much I wanted and how much I’d had. But honestly, I wanted to be shitfaced drunk as much of the time as I could. Periods of sobriety were miserable. (They usually lasted about ten hours while I went to work.) Why would I think that even after 32 years sober, it would be any different? More to the point, why would I take the chance? That would be irrational.
This thinking also blurs the lines between those who struggle drinking responsibly for whatever reason, and those who are alcoholic. That line can indeed be blurred, as some of the former work their way along the spectrum into the letter category. But by failing to distinguish between those who truly have an addiction and those whose drinking habits we just don’t approve of, we do both a disservice.
Glazier highlights one fact that is undeniably true: abstinence alone will not work in the treatment of alcoholism. An untreated alcoholic will crave that which gives him or her relief until he or she eventually gives in and drinks again.
Let’s put this another way: unlike the problem drinker, alcohol is not the problem for an alcoholic, it’s the self-prescribed treatment of the problem. The problem is far deeper, and is as yet unidentified by science.
Something has to change if an alcoholic is to get sober. This article, while trumpeting the scientific method, highlights that science has so far failed in the treatment of alcoholism. In the absence of real answers (or even real understanding) from the psychiatric community, and with the increasing respect for the role of God in healing, why take aim at AA? It’s not the only answer, but it has gotten million of alcoholics like me sober.
Surely that’s a good thing.