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Concepts of Alcoholics Anonymous
JOURNAL OF MEDICINE Vol. 44, Aug.,1944.
By Bill W.
Anonymous is an informal fellowship of about 12,000 formerly
alcoholic men and women who are to be found banded together
as groups in about three hundred and twenty-five American
and Canadian communities, these groups ranging in size
from half a dozen to many hundreds of individuals. Our
oldest members have been sober for from eight to nearly
ten years. Of those sincerely willing to stop drinking
about 50 per cent have done so at once, 25 per cent after
a few relapses, and most of the remainder have improved.
It is probable that half of our members, had they not
been drinkers, would have appeared in ordinary life to
be normal people. The other half would have appeared as
more or less pronounced neurotic.
Anonymous, or "AA," popularly so-called, has
but one purpose - one objective only -"To help other
alcoholics to recover from their illness."
is asked of the alcoholic approaching us save a desire
on his part to get well. He subscribes to no membership
requirements, no fees or dues, nor is belief in any particular
view, medical or religious, demanded of him. As a group
we take no position on any controversial question. Emphatically,
we are not evangelists or reformers. Being alcoholics
who have recovered, we aim to help only those who want
to get well. We do this because we have found that working
with other alcoholics plays such a vital part in keeping
us all sober.
may inquire "Just how does AA work?" I cannot
fully answer that question. Many AA techniques have been
adopted after a ten-year process of trial and error which
has led to some interesting results. But, as laymen, we
doubt our own ability to explain them. We can only tell
you what we do, and what seems, from our point of view,
to happen to us.
the very outset we should like it made ever so clear that
AA is a synthetic concept - a synthetic gadget, as it
were, drawing upon the resources of medicine, psychiatry,
religion, and our own experience of drinking and recovery.
You will search in vain for a single new fundamental.
We have merely streamlined old and proved principles of
psychiatry and religion into such forms that the alcoholic
will accept them. And then we have created a society of
his own kind where he can enthusiastically put these very
principles to work on himself and other sufferers.
too, we have tried hard to capitalize on our one great
natural advantage. That advantage is, of course, our personal
experience as drinkers who have recovered. How often the
doctors and clergymen throw up their hands when, after
exhaustive treatment or exhortation, the alcoholic still
insists, "But you dont understand me. You never
did any serious drinking yourself, so how can you? Neither
can you show me many who have recovered."
when one alcoholic who has got well talks to another who
hasnt, such objections seldom arise, for the new
man sees in a few minutes that he is talking to a kindred
spirit, one who understands. Neither can the recovered
AA member be deceived, for he knows every trick, every
rationalization of the drinking game. So the usual barriers
go down with a crash. Mutual confidence, that indispensable
of all therapy, follows as surely as day does night. And
if this absolutely necessary rapport is not forthcoming
at once it is almost certain to develop when the new man
has met other AAs. Someone will, as we say, "click
soon as that happens we have a good chance of selling
our prospect those very essentials which you doctors have
so long advocated, and the problem drinker finds our society
a congenial place to work them out for himself and his
fellow alcoholic. For the first time in years he thinks
himself understood and he feels useful; uniquely useful,
indeed, as he takes his own turn promoting the recovery
of others. No matter what the outer world thinks of him,
he now knows he can get well, for he stands in the midst
of scores of cases worse than his own who have attained
the goal. And there are other cases precisely like his
own - a pressure of testimony which usually overwhelms
him. If he doesnt succumb at once, he will almost
surely do so later when Barleycorn builds a still hotter
fire under him, thus blocking off all his other carefully
planned exits from dilemma. The speaker recalls seventy-five
failures during the first three years of AA - people we
utterly gave up. During the past seven years sixtytwo
of these people have returned to us, most of them now
making good. They tell us they returned because they knew
they would die or go mad if they didnt. Having tried
everything else within their means and having exhausted
their pet rationalizations, they came back and took their
medicine. That is why we never need to evangelize alcoholics.
If still in their right minds they come back, once they
have been well exposed to A.A.
to recapitulate. Alcoholics Anonymous has made two major
contributions to the program of psychiatry and religion.
These are, it seems to us, the longmissing links
in the chain of recovery:
Our ability, as ex-drinkers, to secure the confidence
of the new man - to "build a transmission line into
The provision of an understanding society of ex-drinkers
in which the newcomer can successfully apply the principles
of medicine and religion to himself and others.
far as we AAs are concerned, these principles, now
used by us every day, seem to be in surprising agreement.
Lets compare briefly what in a general way medicine
and religion tell the alcoholic:
The alcoholic needs a personality change.2.
The patient ought to be analyzed and should make a full
and honest mental catharsis.3.
Serious personality defects must be cured through accurate
self-knowledge and realistic adjustment to life.4.
The alcoholic neurotic retreats from life, is a picture
of anxiety and abnormal self concern; he withdraws from
The alcoholic must find, "a new compelling interest
in life," must "get back into the herd."
He should find an interesting occupation, should join
clubs, social activities, political parties, or discover
hobbies to take the place of alcohol.
The alcoholic needs a change of heart, a spiritual awakening.2.
The alcoholic should make an examination of the "conscience"
or a moral inventory and a frank discussion.3.
Character defects (sins) can be eliminated by acquiring
more honesty, humility, unselfishness, tolerance, generosity,
The alcoholics basic trouble is self- centeredness.
Filled with fear and self seeking he has forgotten the
brotherhood of man.5.
The alcoholic should learn the expulsive power of
a new affection," love of serving man, of serving
God. He must "lose his life to find it;" he
should join the church and there find self forgetfulness
in service. For "faith without works is dead."
far religion and medicine are seen in hearty accord. But
in one respect they do differ. When the doctor has shown
the alcoholic his underlying difficulties and has prescribed
a program of readjustment, he says to him, "Now that
you understand what is required for recovery, you should
no longer depend on me. You must depend on yourself. You
go do it."
then, the object of the doctor is to make the patient self-sufficient
and largely, if not wholly, dependent upon himself.
does not attempt this. It says that faith in self is not
enough, even for a nonalcoholic. The clergyman says that
we shall have to find and depend upon a higher power - God.
He advises prayer and frankly recommends an attitude of
unwavering reliance upon Him who presides over all. By this
means we discover a strength much beyond our own resources.
the main difference seems to add up to this: Medicine says,
know yourself, be strong and you will be able to face life.
Religion says, know thyself, ask God for power, and you
become truly free.
Alcoholics Anonymous the new man may try either method.
He sometimes eliminates "the spiritual angle"
from the Twelve Steps to Recovery and wholly relies upon
honesty, tolerance and working with others. But it is interesting
to note that faith always comes to those who try this simple
approach with an open mind - and in the meantime they stay
however, the spiritual content of the Twelve Steps is actively
denied, they can seldom remain dry. That is our AA experience
everywhere. We stress the spiritual simply because thousands
of us have found we cant do without it.
this point I should like to state the Twelve Steps of the
Alcoholics Anonymous Program of Recovery so that you physicians
may accurately compare your methods with ours.
We admitted we were powerless over alcohol that
our lives had become unmanageable.2.
Came to believe that a power greater than ourselves could
restore us to sanity.3.
Made a decision to turn our will and our lives over to
the care of God as we understood him.4.
Made a searching and fearless moral inventory of ourselves.5.
Admitted to God, to ourselves, and to another human being
the exact nature of our wrongs.6.
Were entirely ready to have God remove all these defects
Humbly asked Him to remove our shortcomings.8.
Made a list of all persons we had harmed, and became willing
to make amends to them all.9.
Made direct amends to such people wherever possible, except
when to do so would injure them or others.10.
Continued to take personal inventory and when we were
wrong promptly admitted it.11.
Sought through prayer and meditation to improve our conscious
contact with God as we understood Him, praying only for
knowledge of His will for us and the power to carry that
Having had a spiritual experience as the result of these
steps, we tried to carry this message to alcoholics, and
to practice these principles in all our affairs.
down, these steps mean, simply (1) admission of alcoholism;
(2) personality analysis and catharsis; (3) adjustment of
personal relations; (4) dependence upon some higher power;
and (5) working with other alcoholics.
strongly we point out that adherence to these principles
is not a condition of AA membership. Any alcoholic who admits
he has a problem is an A.A. member regardless of how much
he disagrees with the program. Based upon our experience,
the whole program is a suggestion only. The alcoholic, objecting
at first to the spiritual factor, is urged to keep an open
mind, meanwhile treating his own AA group as a "power
greater than himself." Under these conditions the newcomer
commences to undergo a personality change at such a rate
and of such dimensions that he cannot fully account for
it on the basis of self-realization and self-discipline.
Not only does his alcoholic obsession disappear, but he
finds himself progressively free of fear, resentment, and
inferiority. These changes seem to have come about automatically.
Hence he concludes that "A power greater than himself"
must of indeed have been at work. Having come to this point,
he begins to form his own concept of God. He then develops
confidence in that concept, which grows as he gets proof
in everyday life that his new faith actually works, really
is what AAs are trying to say when they talk about
a spiritual experience. They mean a certain quality of personality
change which, in their belief, could not have occurred without
the help and presence of the creative spirit of the universe.
the average AA, many months, may lapse before he is aware
of faith in the spiritual sense. Yet I know scarcely an
AA member of more than a years standing who still
thinks his transformation wholly a psychologic phenomenon
based entirely upon his own normal resources. Almost everyone
of our members will tell you that, while he may not go along
with a clergymans concept of God, he has developed
one of his own on which he can positively depend, one which
works for him.
AAs are quite indifferent to what people may call
this spiritual experience of ours. But to us it looks very
much like conversion, the very thing most alcoholics have
sworn they never would have. In fact I am beginning to believe
that we shall have to call it just that, for I know our
good friend, Dr. Harry Tiebout, is sitting in this room.
As you may know, he is the psychiatrist who recently told
his own professional Society, The American Psychiatric Association,
that what we AAs get is conversion - sure enough and
no fooling! And if the spirit of that great psychologist,
William James, could be consulted, hed doubtless refer
us to his famous book, varieties of Religious Experience,
in which personality change through the "educational
variety of spiritual experience, or conversion is so ably
explored. Whatever this mysterious process is, it certainly
seems to work, and with us who are on the way to the asylum
or the undertaker anything that works looks very, very good
Im very happy to say that many other distinguished
members of your profession have pronounced our Twelve Steps
good medicine. Clergymen of all denominations say they are
good religion, and of course we AAs like them because
they do work. Most ardently we hope that every physician
here today will find himself able to share this happy agreement.
In the early years of AA, it seemed to us alcoholics that
we wandered in a sort of no-mans-land, which appeared
to divide science and religion. But all that has changed
since AA has now become a common meeting ground for both
Alcoholics Anonymous is a cooperative venture. All cases
requiring physical treatment are referred to you physicians.
We frequently work with the psychiatrist and often find
that he can do and say things to a patient, which we cannot.
He, in turn, avails himself of the fact that as ex-alcoholics
we can sometimes walk in where he fears to tread. Throughout
the country we are in daily touch with hospitals and sanitariums,
both public and private. The enthusiastic support given
us by so many of your noted institutions is something for
which we are deeply grateful. The opportunity to work with
alcoholics means everything; to most of us it means life
itself. Without the chance to forget our own troubles by
helping others out of theirs, we would certainly perish.
That is the heart of AA - it is our lifeblood.
have torn still other pages from the Book of Medicine, putting
them to practical use. It is from you gentlemen we learn
that alcoholism is a complex malady; that abnormal drinking
is but a symptom of personal maladjustment to life; that,
as a class, we, alcoholics are apt to be sensitive, emotionally
immature, grandiose in our demands upon ourselves and others;
that we have usually "gone broke" on some dream
ideal of perfection; that, failing to realize the dream,
we sensitive folk escape cold reality by taking to the bottle;
that this habit of escape finally turns into an obsession,
or, as you gentlemen put it, a compulsion to drink so subtly
powerful that no disaster, however great, even near death
or insanity, can, in most cases, seem to break it; that
we are the victims of the age-old alcoholic dilemma; our
obsession guarantees that we shall go on drinking, but our
increasing physical sensitivity guarantees that we shall
go insane or die if we do.
these facts, coming from the mouths of you gentlemen of
science, are poured by an AA member into the person of another
alcoholic they strike deep - the effect is shattering. That
inflated ego, those elaborate rationalizations by which
our neurotic friend has been trying to erect selfsufficiency
on a foundation of inferiority, begin to ooze out of him.
Sometimes his deflation is like the collapse of a toy balloon
at the approach of a hot poker. But deflation is just what
we AAs are looking for. It is our universal experience
that unless we can start deflation, as so self-realization,
we get nowhere at all. The more utterly we can smash the
delusion that the alcoholic can get over alcoholism "on
his own," or that someday he may be able to drink like
a gentleman, the more successful we are bound to be.
fact, we aim to produce a crisis, to cause him to "hit
bottom," as AAs say. Of course you will understand
that this is all done by indirection. We never pronounce
sentences, nor do we tell any alcoholic what he must do.
We dont even tell him he is an alcoholic. Relating
the seriousness of our own cases, we leave him to draw his
own conclusions. But once he has accepted the fact that
he is an alcoholic and the further fact that he is powerless
to recover unaided, the battle is half won. As the AAs
have it, "he is hooked." He is caught as if in
a psychologic vise.
the jaws of it do not grip him tightly enough at first,
more drinking will almost invariably turn up the screw to
the point where he will cry "Enough!" Then, as
we say, he is softened up. This reduces him to a state of
complete dependence on whatever or whoever can stop his
drinking. He is in exactly the same mental fix as the cancer
patient who becomes dependent, abjectly dependent, if you
will, on what you men of science can do for cancer. Better
still, he becomes "sweetly reasonable," truly
open-minded, as only the dying can.
these conditions, accepting the spiritual implications of
the AA program presents no difficulty even to the sophisticate.
About half of the AA members were once agnostics or atheists.
This dispels the notion that we are only effective with
the religiously susceptible. You remember now the famous
remark, "There are no atheists in the foxholes."
So it is with most alcoholics. Bring them within range of
the AA and "blockbusters" will soon land near
enough to start radical changes in outlook, attitude, and
are some of the basic factors which perhaps partly account
for such success as we have had. I wish time permitted me
to give you an intimate glimpse of our life together, of
our meetings, of our social side, of those fast friendships
unlike any we had known before, of our participation by
thousands in the war effort and the armed services, where
so many AAs are discovering that they can face up
to reality - no longer institutionalized, even within an
AA Group. We have all found that God can be relied upon
both in Alaska and India, that strength can come out of
weakness, that perhaps only those who have tasted the fruits
of reliance upon a higher power can fully understand the
true meaning of personal liberty, freedom of the human spirit.
you who are here this morning must realize how much we A.A.s
are beholden to you, how much we have borrowed from you,
how much we still depend on you. For you have supplied us
with ammunition which we have used as your lay assistants
- gun pointers for your artillery. I have put out for inspection
our version of the factors which bring about personality
change, our method of analysis, catharsis, and adjustment.
I have tried to show you a little of our great new compelling
interest in life -this society where men and women understand
each other, where the clamors of self are lost in our great
common objective, where we can learn enough of patience,
tolerance, honesty, humility, and service to subdue our
former masters - insecurity, resentment, and unsatisfied
dreams of power.
I must not close without paying tribute to our partner,
Religion. Like Medicine, it is indispensable. At this temple
of science I hope none will take it amiss if I give Religion
the last word:
grant us the serenity to accept the things we cannot change,
courage to change the things we can, and wisdom to know
address inquiries and requests for AA literature to The
Alcoholic Foundation, Box 459, Grand Central Annex, New
York17, New York.
C. Kirby Collier, Rochester. - Realizing how ineffectual
our efforts in the treatment of the chronic alcoholic through
the usually accepted psychiatric procedures were was my
reason for investigating Alcoholics Anonymous. With one
of their members I was privileged to attend a meeting in
New York and had the opportunity to discuss their philosophy
with Mr. Wilson. First, I was impressed with the honesty
and sincerity of those members I met, and second, with the
broad socio-religious background and its psychiatric implications
- chiefly mans recognition of self, his abilities
as well as his inefficiencies, and that intangible power
which all mankind recognizes, whether he acknowledges it
or not. Upon my return home, I asked three chronic alcoholics,
all of twenty to twentyfive years duration, to organize
a group, after going over the situation with them as I understood
it. These three contacted others and held their first meeting
in the small apartment of one. Growing, they approached
me as to a place for meeting. We eliminated the Y.M.C.A.,
Public Library, church halls, or parish homes for obvious
reasons, and at last advised a room in one of our large
centrally located hotels. This has worked out nicely and
meetings are held each Sunday afternoon and Wednesday evening.
From the original group of three, contacts have been made
with over 500, of whom 60 per cent are active members, having
been free from indulgence in alcohol for one to two years.
our city we have had a Council on Alcohol for about three
years. The group consists of psychiatrists, social workers,
and others, who meet each month for discussion. At two of
these meetings members of AA have spoken, and, as a result,
two members of AA are now members of this Council. Members
of AA are frequently called upon to address various groups,
and it is most interesting to hear of men who have never
spoken in public before being willing to get up and talk
before any group. In Rochester they have become especially
interested in meeting with youth groups. I might say that
I have attended but few meetings of the Rochester group
and these only at their invitation. I have felt that AA
is a group unto themselves and their best results can be
had under their own guidance, as a result of their philosophy.
Any therapeutic or philosophic procedure which can prove
a recovery rate of 50 to 60 per cent must merit our consideration.
As stated by Tiebout in a paper read at Detroit, Michigan,
before the American Psychiatric Association in May, 1943,
"It is highly imperative for us, as presumably openminded
scientists, to view wisely and long the efforts of others
in our field of work. We may be wearing bigger blinders
than we know.
Foster Kennedy, New York City, - We have heard a truly moving
and eloquent address, moving in its form and in its facts.
have no doubt that a man who has cured himself of the lust
for alcohol has a far greater power for curing alcoholism
than a doctor who has never been afflicted by the same curse.
No matter how sympathetic and patient the doctor may be
in the approach to his patient, the patient is sure either
to feel, or to imagine, condescension to himself, or to
the notion that he is being hectored by one of the minor
organization of Alcoholics Anonymous calls on two of the
greatest reservoirs of power known to man religion
and that instinct for association with ones fellows
which Trotter has called the "herd instinct."
Religious faith has been described by Matthew Arnold as
a convinced belief in a power greater than ourselves that
makes for righteousness, and a sense of helpfulness from
this can be acquired through a kind of spiritual conversion
which might well be called a variety of religious experience.
sick mans association with those who, having been
sick, have become or are becoming well, is a therapeutic
suggestion of cure and an obliteration of his feelings of
being, in society, a pariah; and this tapping of deep internal
forces is shown by the great growth of this sturdy and beneficent
movement. Furthermore this movement furnishes an objective
of high emotional driving power in making every cured drunkard
a missionary to the sick.
physicians, I think, have always had difficulty in finding
an occupation for our convalescent patients of sufficient
emotional driving power to replace the psychic results of
the alcohol that has been withdrawn. These men grow filled
with a holy zeal, and the very zealousness keeps the missionary
steady while the next man is being cured.
think our profession must take appreciative cognizance of
this great therapeutic weapon. If we do not do so, we shall
stand convicted of emotional sterility and of having lost
the faith that moves mountains, without which medicine can
Harry M. Tiebout, Greenwich, Connecticut My first
contact with AA began five years ago when a patient with
whom I had been working for well over a year came under
the influence of AA and within a relatively short time dried
up and for at least four years has remained completely dry.
At that time I was puzzled and a little indignant that my
best efforts had failed but AA had worked; but I kept sending
patients, and now the situation has reversed. I get puzzled
and a little indignant when AA doesnt work.
a psychiatrist, I have to think about the relationship of
my specialty to AA and I have come to the conclusion that
our particular function can very often lie in preparing
the way for the patient to accept any sort of treatment
or outside help. I now conceive the psychiatrists
job to be the task of breaking down the inner resistance
so that which is inside will flower, as under the activity
of the AA program.
this respect I should like to point out that the same flowering
can take place with patients who are not alcoholics, and
I should like at this time to record my indebtedness to
Mr. Wilson and AA for the understanding which has made my
own therapeutic practice a more intelligent and meaningful
process in so far as my own attitudes is concerned. I now
have more faith in the patients own inner resources.