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In Hospitals and Treatment Centers
A.A.'s earliest days, all newcomers were hospitalized!
was providential that one of the co-founders, Dr. Bob S.,
was a physician associated with a hospital in Akron. So
not only did he and Bill W. seek and find A.A. #3 in Akron
City Hospital, but as other alcoholic prospects came along,
they were routinely required to put themselves in private
rooms at the hospital for five to eight days of detoxification
and orientation by A.A. visitors. (See Chap. 3)
This was so much a part of the treatment that Warren C.,
who came to A.A. in Cleveland in July 1939, recalled that
there was considerable debate about whether he should be
admitted to the Fellowship, since he had not been hospitalized.
Dr. Bob was also associated with St.Thomas Hospital, where
he became acquainted with Sister Ignatia. She later recalled
that they often discussed the tragedies caused by excessive
drinking and the fact that alcoholics were sick and needed
help. "Then one day, to my great surprise, Dr. Bob told
me about his own drinking problem" and about his meeting
with Bill and what had resulted. Meanwhile, City Hospital
balked at admitting Dr. Bob's "jittering patients"
and told him to seek refuge for them elsewhere. So he explained
his problem to Sister Ignatia. "I was fearful to admit an
alcoholic," she admitted. "But he assured me he would see
that the patient didn't cause any trouble, so I consented
to try it."
began an arrangement to admit alcoholic prospects to St.Thomas
that became legendary. Between that day and the time Dr.
Bob died, 4,800 alcoholics were treated there under his
care. They were assigned to two- to four-bed rooms; because
"group therapy helps one forget himself in helping others."
A.A. visitors kept a continuous discussion of A.A. going
from noon until 10 p.m. There were no repeaters allowed
among the patients. (For a complete description read Chap.
XIV, "A.A. and St.Thomas Hospital" in Dr. Bob and the Good
when the Clevelanders broke away from the Akron meetings,
one of the first things they did (with Dr. Bob's help)
was arrange for hospitalization of prospective members at
Deaconess Hospital. And when the Cleveland Plain-Dealer
articles brought in hundreds, other hospitals were pressed
into service. St.Vincent's Charity Hospital followed
Deaconess in admitting alcoholics as a matter of policy
in a ward under the care of Sister Victorine. Eventually,
when A.A.'s who had found their sobriety in Akron/Cleveland
spread out to found the Fellowship in other towns and cities
throughout the Midwest and beyond, initial hospitalization
was part of the program. (See below)
New York, Bill W. turned first to Towns Hospital, where
he himself had recovered, to find other alcoholics to help.
And as other newcomers joined, they were routinely hospitalized
there first. Towns Hospital treated both drug addicts and
alcoholics, detoxifying them, helping them medically through
their withdrawal, getting them back on their feet with the
help of rest and vitamins and discharging them. Dr. Silkworth's
typical treatment began with a thorough admission examination
to make sure there were no other complications of the heart,
blood pressure, lungs, liver, kidneys, etc. The patient
was then sedated and put to bed. He was also given Dilantin
to avoid convulsions. Over the next two days, he was tapered
off with chloral hydrate or phenobarbital, cleaned out with
epsom salts, and started on vitamins. The aim was to have
the patient sedative-free at the end of three days. He was
usually discharged after five days, unless there were other
complications. After the advent of Alcoholics Anonymous,
its patients were separated on their own floor. A.A. sponsors
were not only responsible for admitting them and picking
them up on release, but also were expected to spend much
time as possible with the alcoholic in the hospital. Other
A.A. visitors were welcomed. When the New York Intergroup
began operating in 1946, one of its prime functions was
to arrange hospitalization for prospects who needed it—and a hospital desk has been maintained for that purpose
However, Towns Hospital was small and specialized, so in
1945 a group of A.A.'s approached the Board of Knickerbocker
Hospital, a general hospital with a good reputation, and
persuaded them to set aside a pavilion for the treatment
of alcoholics. Dr. Silkworth was in charge and A.A. filled
the same role it did at Towns.
patients at Knickerbocker began their five-day stay in private
or semi-private rooms, but by the third day the men were
moved into a six-bed ward, nick-named "Duffy's Tavern",
which also served as a men's club during visiting
hours. Here, together with sponsors and A.A. members, they
discussed their common problem, shared their hopes and fears,
and began to absorb the principles of Alcoholics Anonymous.
Female patients continued to occupy private rooms. The five
days cost $85.00.
nursing department in particular was very skeptical in the
beginning about accepting alcoholics in a general hospital.
However, the Director of Nursing reported in 1947 to the
administrator, "I anticipated great difficulty in obtaining
nurses willing to care for alcoholic patients.. . To my
surprise, I found that although nurses dislike caring for
alcoholics, they seem much interested in alcoholics affiliated
with Alcoholics Anonymous because they have a sincere desire
to be helped.. .I also anticipated difficulty in handling
alcoholic patients with a skeleton staff because of the
disturbances caused by unmanageable patients. It has proved
quite the contrary. The A.A. sponsors and visitors have
been most helpful in their volunteer work..."
1956, the hospital administrator reported, "I continue to
be amazed at the changes that can be wrought by scientific
medical care and psychological direction in a short period
of time. Men and women who came into the hospital defeated,
hopeless and, in many cases, helpless, go forth to face
the world with renewed hope and confidence. As of 1956 we
have hospitalized approximately 11,000 alcoholic patients
State Hospital, a New York mental institution, bears the
honor of being the first of its kind to establish an A.A.
group. The year was 1939, when Bill and Lois were staying
temporarily with friends, Mag and Bob V., in Monsey, New
York, after the foreclosure of their Brooklyn home. Bob
V. spoke with Dr. Russell Blaisdell, head of the nearby
Rockland institution, about A.A. Dr. Blaisdell "gave us
the run of a ward and let us start a meeting within the
walls," Bill relates. "The grimmest imaginable cases began
to get well and stay that way when released." The Rockland
meeting continues to the present time.
course, facilities of a sort to care for drunks had existed
in almost every part of the country long before A.A. existed.
Mental institutions and sanitariums provided longer-term
treatment and attempted "cures" by psychiatry, aversion-treatment
or other methods, with minimum success. Then there were
the "drunk-farms" which typically did not so much treat
alcoholics as provide them with a reasonably wholesome,
alcohol-free environment with some medication where they
were detoxified for a few days and then returned to drinking.
Most of these facilities of whatever kind (including Towns
Hospital) were "revolving doors."
a drunk farm which was to make history as the great-granddaddy
of all freestanding, intensely A.A.-oriented facilities
was High Watch Farm in Kent, Connecticut. Bill W relates
in, A.A. Comes of Age "Up in the hills of Connecticut..
a group of farms belonged to a dear lady known affectionately
to countless A.A.'s as Sister Francis (Mrs. Francis Helling].
This wonderfully good soul, out of her own pocket, had operated
these farms for charity—for the aged, for children
and for any wayfarer who passed by." Sister Francis called
it the Ministry of the High Watch, and she apparently had
special compassion for the plight of the alcoholics who
sought her help. "In the summer of 1939," Bill continues,
"Marty M. . . conducted a party of us to Connecticut to
meet Sister Francis" and to see the farm. Marty M. recalled
later that after she and Bill had admired the serene beauty
of the setting in the Berkshires and found themselves in
a room that served as a chapel in the pre-Revolutionary
Colonial farmhouse, they were overwhelmed with the spiritual
presence around them. Bill turned and murmured softly, "God,
Marty, you can cut it with a knife!"
to Bill, "Sister Francis seemed to be as delighted with
us as we were with her. She offered us use of the place
if some of us would create a board of trustees to look after
it." This came about, and High Watch Farm has operated ever
since. It has none of the aspects of an institution. There
are no physicians or nurses in residence, and no counselors.
But every person on the board and on the staff is a member
of Alcoholics Anonymous, and the "treatment" consists of
the A.A. recovery program.
cannot mention treatment of alcoholics—and the influence
of Alcoholics Anonymous in treatment—without describing
the Minnesota experience. In 1985, Minnesota had a total
of 3,800 residential beds for the treatment of alcoholics,
plus outpatient programs with an enrollment of another 1,000.
As early as 1912, Wilimar State Hospital treated drunks
(among whom it was called "the jag farm") along with mental
patients. With the advent of A. A., the hospital became
"heavily influenced by the thinking of a relatively small
group of recovered alcoholics, all members of Alcoholics
Anonymous," according to Dan Anderson, Ph.D., a Willmar
staff member at the time (and later a recognized national
authority as director of Hazelden). As a result, in 1950,
it made "a radical departure from psychiatric tradition
and from the conventional understanding of alcoholism."
This change required acceptance of hypotheses which are
taken for granted now but entirely new and extremely controversial
in those days. Among these new assumptions, as outlined
by Dr. Anderson, were the following:
Alcoholism exists. Although it was recognized that skid
row inhabitants drank too much, the condition was not otherwise
acknowledged by professionals, alcoholics themselves, or
their families. Partly through A.A. members, the Willmar
staff came to realize that alcoholics all shared certain
signs and symptoms in common. "Alcoholism did exist."
Alcoholism is an illness. Continued pathological drinking
in the face of disastrous consequences and loss of control
persuaded the professionals that this behavior was not voluntary
but was indeed an illness.
Alcoholism is a multi—phase illness—i.e., it
is complex, including physical, mental, social and spiritual
aspects, all of which had to be treated if the alcoholic
was to recover.
Alcoholism is a chronic, primary illness. It is not just
a symptom of an underlying disorder, but must be treated
directly as an illness in its own right.
was no accident," says Dr. Anderson, "that our basic program
philosophy came very close to...the Twelve Steps of Alcoholics
Anonymous. In fact, the A.A. movement was the only viable
new approach. . . worth exploring. . . On the negative side,
it was a voluntary program and the practicing alcoholic
had to be motivated to want it...it also appeared to be
quite dogmatic, and it was not really well-known or understood
by the general public.
on the positive side were its remarkable results. A.A. could
sober up alcoholics and sustain them for extended periods
of what appeared to be happy sobriety. These sober alcoholics
were then able to describe their condition—the power
of the addictive need and the personality changes that took
place not only while drinking but in recovery as well. A.A.
members were also willing to work with practicing alcoholics
and alcoholics in treatment..."
devising a program structure and strategy, Willmar departed
radically from existing psychiatric practices. "To properly
utilize the philosophy of Alcoholics Anonymous," Dr. Anderson
continues, "we needed on staff one or more recovered alcoholics
who were practicing members of A.A.—"counselors" [the
first use of that term] to work directly with the patients.
Not only were these recovering alcoholics needed to communicate
the philosophy of A.A., it was also hoped that they would
act as role models for the patients. . . The A.A. way of
life, through the influence of the new counselors, gradually
became more and more a part of treatment program. . . The
influence of Alcoholics Anonymous on our program cannot
then, was the origin of the so-called "Minnesota model"
of treatment for alcoholics, as practiced first at Willmar
and later exemplified at Hazelden after Dr. Anderson became
its director in 1961. Hazelden had been started in 1949
by several A.A. members at a lakeside setting near Center
City, not far from Minneapolis-St.Paul. It was named after
the daughter of the family from whom the property was purchased.
Lynn C. was its first director. After some financially rocky
years, Pat B., the recovered-alcoholic scion of a prominent
family, became interested in Hazelden, and three generations
of the B. family were to be the principal benefactors and
leaders of the facility.
B., with the concurrence of the other Hazelden Foundation
trustees, was also responsible for starting a treatment
center for women alcoholics in 1956 on another lakeside
estate near Dellwood. It was called Dia Linn, a Gaelic name
meaning "God be with us." Ten years later, Dia Linn was
incorporated into Hazelden at Center City, making it coeducational.
1985, with a 194-patient capacity, Hazelden draws from all
50 states and scores of foreign countries. It has a staff
of 793 full- and part- time persons, including 20 interns
and 42 trainees. For, since 1966, has also trained other
treatment professionals, and so has become the model for
other facilities through the u.s. and in. other countries
other famous, A.A.-oriented treatment centers in Minnesota
was Pioneer House in Minneapolis. It was started by Pat
C., founder of Minnesota A.A. (See Chap. 4), and John McD.
It maintained ties with Hennepin County Hospital and the
Veteran's Hospital for medical treatment, but it was
also America's first treatment center to require the
Fifth Step of its patients before release. A 21-day program,
it served approximately 400 men per year. Pioneer House
was purchased by Hazelden in 1981.
Hospital in Minneapolis opened its alcoholism treatment
unit in 1968. It became known for its aggressive and confrontive
approach. It acquired such an impressive record of success
that it has attracted patients from all over the country
and usually has a waiting list. Abbott-Northwestern Hospital
followed in 1970 and St.John's in St.Paul in 1971.
In the early '70 's, in the wake of the Hughes Bill (see
below), the Twin City saw the opening of Metropolitan Medical
Center, Golden Valley, Deaconess, Mercy, Unity, Mounds Park
and St.Joseph's. In other Minnesota locations, Rochester's
Methodist Hospital set up a unit in '72 in cooperation with
the Mayo Clinic. In Pine City in the northeastern part of
the state, Pine Manor I began in '69, followed by Pine Manor
II in Nevis in '72. Among other outstate facilities were
NAEVE in Albert Lea; St.Cloud Community Hospital; Miiler-Dwan
in Duluth; and St.John's in Morehead. The list is
only fragmentary, but indicative of the breadth of treatment
offered—almost invariably heavily A.A.-oriented.
A.A. groups spread, hospitalization for the drunk was a
prime concern—and, in the early days, a critical problem.
Any listing here is necessarily very incomplete, but among
the hospitals and other facilities mentioned in archival
records are these. In Cincinnati, Good Samaritan Hospital
agreed in 1941 to work with drunks sponsored by A.A. In
Milwaukee, St.Michael's Hospital and Meta House were cooperating
in the '40's. Philadelphia A.A.'s Jim B. and Bob M. made
arrangements in April 1945 with Dr. Wilson, superintendent
of Episcopal Hospital to open the city's first detox unit;
and the next year, Serenity Farms near Hickory, Pennsylvania,
was opened. In Pittsburgh, at about the same time, four
hospitals opened their doors to alcoholics. St.Margaret's,
Presbyterian, Pittsburgh, and Western Psychiatric. Perhaps
the most famous rehab facility in Pennsylvania was—and
is-Chit-Chat Farms, near Reading, opened in 1959 under the
direction of the legendary Dick C.
was the County Hospital in Rochester, Benedictine in Kingston,
St.Peter's in Albany, and Samaritan in Troy, New York. The
first facility in Kansas was The Shrine on the Hill in Kansas
City, started in 1942 by Dr. Miles N. and still operating.
Near Arkansas City, hundreds of alcoholics found their sobriety
at Jim J. 's ranch. Valley Hope was the name of a center
started by (WHO) in (WHEN) at (WHERE), and now embraces
units at (NAME THEM)—all A.A. oriented. Although not
an alcoholic rehab as such, the noted Menninger Clinic in
Topeka has an historic understanding of alcoholism and of
Alcoholics Anonymous. (Dr. Carl Menninger is credited with
the insightful statement that "to an alcoholic, a drink
is a desperate attempt at self-medication.")
County Hospital in Seattle, Washington, began admitting
drunks under A.A. sponsorship in 1948. California A.A. had
an early history of being generally anti-treatment-centers.
However, in Los Angeles, County Hospital played a key role
in the birth of A.A. there (See Chap. 4) and in northern
California, thousands of A.A.'s got sober at Duffy's (GET
CORRECT NAME AND MORE INPORMATION) (ALSO JOE PURSCH AT LONG
BEACH AND OI~ANGE COUNTY, BETTY FORD' S PLACE AT PALM SPRINGS,
1953, the Trustees had an Institutions Committee (including
A.A. work in both correctional facilities and hospitals)
and the Headquarters office had created a separate desk
to coordinate activity by the groups and to correspond with
the institutions. It was reported to the Conference that
there were 101 hospital groups with 2,253 members. Two years
later, out of 200 hospital groups, 11 were in Australia
and six in Great Britain, with plans to start groups in
Germany, South Africa and Japan. And by 1955 represented
40 states, four Canadian provinces and eight foreign countries
represented among 211 groups with 4,952 members. And the
office distributed an "Exchange Bulletin" to institutions
groups even before the new "A.A. Exchange Bulletin" for
regular A.A. groups began that May.
separate Institutions Directory was developed the following
year, "since it is impractical to list them in the large
A.A. Directory." Feeling the need for more A.A. experience
in this field, the Trustees' Committee conducted two
surveys: one of hospital groups, the other of hospital administrators
where groups existed, in order to strengthen service to
them. The surveys revealed, "growing acceptance of A.A.
by institutional administrators." The Conference sought
ways to encourage hospital group sponsorship as a basic
Twelfth Step activity. The same survey was repeated in 1964
and revealed the same encouraging acceptance by administrators
and the same problems obtaining sufficient participation
by outside groups and members.
number of hospital groups continued to burgeon. In 1960,
there were 302 hospital groups (including three new ones
in Norway) with 6,509 members; in 1965, 547 groups and 12,913
members; in 1970, 767 groups and 18,604 members. As exciting
as this growth was, it was only a prelude to the explosion
that took place during the decade that followed. With the
passage of the so-called Hughes Bill, huge sums of Federal
money were poured into the field of alcoholism, stimulating
the opening of literally thousands of treatment centers,
both in hospitals and free¬standing. This resulted in
the number of hospital/treatment center A.A. groups doubling
again in ten years, reaching (HOW MANY) groups with (NUMBER)
members in. 1980; and by 1985, (HOW MANY) groups and (NUMBER)
accompanying increase in work load for the Conference Institutions
Committee was one factor in its being dissolved by the 1977
Conference and replaced with two committees: one for correctional
facilities and one for treatment facilities. The Trustees'
Institutions Committee followed suit. A new pamphlet, "A.A.
in Treatment Facilities," appeared in 1979, replacing "A.A.
in Hospitals." And the following year, Dr. Norris made a
talk, also published as a paper, on "Bridging the Gap."
It stressed the critical role of A.A. groups and members
in the community in helping the alcoholic patient make the
transition from the treatment center to the outside world.
Concern over reaching the older alcoholic in treatment centers
surfaced in the Trustees' Committee in 1981, and an article
on the subject appeared in the "Treatment Center Bulletin"
before there was a Trustees' Institutions Committee or a
General Service Conference, there was institutions work
going on at the grass-roots level. Local A.A. members—either
acting as individuals or working through their Intergroups/Central
Offices or through their District and Area Committees—have
always borne the responsibility for dealing with the administrators
of hospitals and treatment centers and for carrying the
A.A. message to alcoholics within those institutions. Institutions
Committees existed before anyone tried to coordinate their
efforts. Until the late '70's, these committees usually
served both correctional facilities and treatment facilities.
After the Conference Institutions Committee was split into
two separate committees in 1977, a ripple effect spread
to many—but not all—Institutions Committees
out in the field. The result is that in 1985, there were,
in the U.S./Canada, 221 Treatment Facilities Committees,
243 Correctional Facilities Committees, and 240 Institutions
Committees probably serving both.
California, which has a reputation for doing things differently,
the Hospital & Institutions Committees (better known
as H&I Committees) grew up as a separate service entity—separate, that is, from Central Offices and from the
General Service Structure. (MORE ON THE HISTORY AND SCOPE
AND ACTIVITY OF H&I COMM'S)
of this diversity of experience and of methods used among
the committees on the firing line, the Conference felt the
need to coordinate their activity and lay down guidelines.
One result, in 1978, was a Conference recommendation which
read, "A.A. members who meet with the administration of
a treatment facility concerning the formation of an A.A.
group on its premises should explain group autonomy as well
as what A.A. can and cannot do (Traditions), and also should
have a good understanding of the facility's rules
and regulations. After mutual agreements are reached, it
is important that this information be shared with the A.A.'s
who will be attending the group' s meetings. It was
suggested that groups meeting in treatment facilities try
to abide by the self-support Tradition. If money for rent
is not accepted by a facility, groups should contribute
in some other way. It was also felt that A.A.'s employed
by the facility should not run the groups at the facility."
This general policy recommendation was affirmed by the 1984
giant step forward in. helping local committees was taken
in 1985 with the preparation of the Treatment Facilities
Workbook. It was the product largely of the efforts of staff
member Eileen G. and Class A Trustee Joan K. Jackson, Chairperson
of the Treatment Facilities Committee.
place of Alcoholics Anonymous in the treatment center was
summed up in. a professional paper written in 1976 by Or.
Frank Herzlin, Medical Director of Freeport (L.I.) Hospital
one of the better known treatment centers. (Dr. Herzlin
also served as a non-trustee member of A.A.'s Treatment
Facilities Committee.) He said, in part: "As a general rule,
I take the view that a person who does not become involved
in Alcoholics Anonymous will not be successful. This is
communicated to the patient in no uncertain terms. A.A.
should be explained to the person whether he or she has
had exposure to (it] or not. A program of involvement in
A.A. is outlined including frequency and types of meetings,
the Twelve Steps, and what the participant can expect to
derive from the program. Sponsorship should be arranged
A.A. program is, and must be, the foundation of any successful
treatment program. Those professionals who avoid its inclusion
will fail most of the time. I cannot emphasize this point