Alcoholics Anonymous began in 1935 when Bill Wilson, a stockbroker, and Robert Smith, a surgeon, met in Akron and agreed that they were powerless over their drinking. Drawing on their own experiences, they founded Alcoholics Anonymous, the nation’s first self-help program, dedicated to the proposition that problem drinkers can achieve sobriety only through the support of other alcoholics.
For decades Alcoholics Anonymous has been synonymous, in the public mind, with alcoholic treatment. Even Hollywood, in movies such as “Come Back, Little Sheba” (1952) and “The Days of Wine and Roses” (1962), promoted AA as the sole solution.
Those who entered medical facilities for treatment invariably were expected to attend AA meetings and follow the program’s 12 steps, which include turning over one’s life to a higher power, taking a moral inventory of shortcomings, making restitution to those one has harmed through the addiction and helping others with similar problems.
People arrested for drunken driving or some other transgression involving alcohol generally were ordered by the courts to join AA as a condition of a sentence or probation.
Although AA is still pervasive in America, cracks are appearing in the facade as critics challenge AA’s reputation as the universal cure for alcoholism.
Prominent among them is Jack Trimpey, a clinical social worker and “former drunk.” Trimpey became so disillusioned with AA that in 1986 he started Rational Recovery, a self-help program headquartered in Lotus, Calif., that rebuts the concept of alcoholism as a disease and offers a method of achieving sobriety based on self-reliance and responsibility.
“We raise the serious question of whether recovery groups of any kind are healthy places to be,” Trimpey says. “Even though we have meetings, we tell people at the first meeting that if you have a problem with drinking it’s not good to hang out with former drunks. It’s better to make relationships based on common interests and passions rather than a common problem.
“All we do is teach people to abstain (from drinking or drugs) for the rest of their lives. It’s an abrupt program and very effective. The majority of people who get better from their addictions, by the way, are doing it on their own, outside the recovery group movement.”
Wrestling `the Beast’
Rational Recovery’s method, called Addictive Voice Recognition Technique, or AVRT, involves teaching people to recognize their addictive voice, or “the Beast” and how to ignore it or defeat it.
“Our approach offers people planned abstinence, where you make a plan to abstain, then you make a commitment to that plan and then you learn how to stick to it,” says Trimpey, who is the author of “Rational Recovery” (Pocket Books) and “The Small Book” (Dell).
“AA never made sense to me. It demands complete devotion from its members. You must literally turn your life over to the movement and attend meetings for the rest of your life.”
Hollow explanations
Scott D. Miller, a Chicago therapist, says he began questioning the AA approach while working with problem drinkers in a public agency. “People who had problems with alchohol were coming back week after week and were not experiencing the changes they hoped for,” Miller says. “I was interpreting that as either their not having `hit bottom’ or as (Alcoholics Anonymous’) `Big Book’ says, being `fundamentally incapable of being honest with themselves.’ But those explanations began to ring a bit hollow.”
Miller, co-author with Insoo Kim Berg of “The Miracle Method: A Radically New Approach to Problem Drinking” (Norton), says he doesn’t buy the concept of alcoholism as a disease either. “There is absolutely zero evidence that it is a single unitary disease,” he says.
“I’m a heretic, because I see this disease model as a metaphor and Jack Trimpey’s notion of an addictive voice as a metaphor. There is no scientific evidence to support (either one).”
Miller says that the alcoholism/addiction field has “been focused on studying those people who actually make it to treatment. An argument could be made that most of the people who have alcohol problems never make it into treatment. Therefore, they must solve their problems on their own, but we’ve never studied those people.
“There are multiple ways to solve this particular problem. Rather than giving (problem drinkers) a bunch of ideas, things to do about solving their problem, we need to help them think through their problem and find strategies that make sense to them. And then let them think about the strategies rather than forcing them by confrontation and heavy-handed techniques, which has been the tendency in the field. The work we’re doing is trying to tailor the level of intervention to the client’s readiness for change.”
Alternative views
Jerry Dorsman, a therapist in the Cecil County Health Deparment’s Division of Mental Health in Maryland and author of “How To Quit Drinking Without AA” (Primus Publishing), agrees that “individuality is important.
“For some people the (first AA step of admitting) that they’re powerless over alcohol becomes a key message, and they make the leap that because of that they can’t drink. For other people it’s a bad message because they can use that powerlessness as an excuse, saying `Well, I don’t have any control.’
“The other idea in AA which is a corollary is `once an alcoholic, always an alcoholic.’ Maybe that’s one of the reasons studies show that people in AA tend to relapse often. It’s like you’re never shedding the skin. You call yourself an alcoholic even years into recovery. Your life may be becoming a success in many ways, yet you’re still identifying with that negative side. That can be a problem. On the other hand, for some people it continues to remind them in the long run not to touch, not to use.”
Dorsman, whose self-help book includes worksheets and checklists, often uses a cognitive-behavioral approach with clients. “I start with reasons for drinking,” he says. “Usually people have a number of reasons. It helps solve some kind of a problem. There’s a set of reasons but there is also a set of problems. I help people evaluate those problems and then finally ask the question `Are the benefits worth the problems?’
“Then I go on to all kinds of techniques that have been proven in various settings to have a positive impact on people in recovery. There is tremendous individual variation, but it’s my belief that everyone is capable of recovery.”
Little controlled research
Stanton Peele, whose 1989 book “Diseasing of America” (Lexington Books) fired the first salvos against the addiction-as-disease model promoted by AA, decries “the mind-set of people running addiction units who think that AA was wisdom delivered by God on those tablets given to Moses. They are completely incapable of considering alternatives. So AA’s negative impact is not only on individuals who are forced into it and don’t belong there, but also on creating a mind block (against) coming up with more constructive ways of dealing with the problem.”
Despite the claims of some AA proponents, there has been “very little controlled research” on the efficacy of AA, according to Dr. John Allen, chief of the treatment research branch of the National Institute on Alcohol Abuse and Alcoholism.
“Those few studies that have been done on AA itself have been criticized as being somewhat artificial–that is, these are situations where people were mandated to get treatment and were randomly assigned to AA versus an alternative treatment,” Allen says. “People who are supportive of AA would say a big part of treatment is the desire to go. And so they would believe that studies in situations where people were constrained to get treatment would not be a fair reflection of AA.
“On the positive side, if you look at treatment outcome, participation in Alcholics Anonymous does tend to be positively correlated with a good treatment outcome.”
Working on sobriety
Says Dr.John Franklin, associate professor of psychiatry and director of addiction psychiatry at Northwestern University: “AA is thought to be very effective in treating alcoholics for those who can stick with it. Not everyone does. The majority of people drop out in three months. The people who stay with AA will tend to do better than the people who don’t.
“It’s probably not any more effective than some of the other professional treatment programs. Certain people are just not going to take to the whole concept of being powerless and having a higher power, so it doesn’t make much sense to refer them that.”
Ron Harders, a self-employed computer repairman and “recovered alcoholic” who lives in Harvard, Ill., is someone who could not accept AA. After two drunken driving arrests and the subsequent loss of his driver’s license, he quit drinking on his own in 1991. To get his driver’s license reinstated, he was required to participate in an alcohol treatment program and forced to attend AA meetings.
“The spiritual, religious part of AA got to me,” Harders says. “I’m not an unreligious person, but this was almost cult-like, like brainwashing. You’re supposed to agree that you’re not responsible for what you’re doing, that you need a higher power to get over this thing. I knew that wasn’t true, because I had been sober for three years.”
Harders heard about Rational Recovery, read some books and attended some meetings and now coordinates weekly RR meetings in Harvard. With RR’s method, he says, “I’m able to recognize the addictive voice whenever it arises and say no to it. AA doesn’t teach you how to live. It guarantees failure, because all it says is that you’re a terrible person.”
For some, it works
However, a 25-year member of AA who asked to be identified as “Joe” credits AA for helping him “to have a full, rich and pretty rewarding life. I go to at least three meetings a week. I enjoy the fellowship of men and women sharing their experiences, strengths and hopes with one another that they may solve their common problem and help others to recover from alcoholism.
“I lost the compulsion to drink some time ago, but sobriety is more than just not drinking. Like life, sobriety is a process.”
FINDING HELP
There are any number of books that offer aid for those in trouble with alcohol. Here are some of the best:
“How to Stop Drinking Without AA:” By Jerry Dorsman(Prima Publishing)
Rational Recovery by Jack Trimpey (Pocket Books)
“The Small Book” by Jack Trimpey (Dell)
“The Miracle Method” by Scott D. Miller and Insoo Kim Berg (Norton)
“Moderate Drinking” by Audrey Kishline (Crown)
For information on group meetings in Greater Chicagoland:
Rational Recovery: 847-328-0100
Alcoholics Anonymous: 800-371-1475 or 312-346-1475
