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Alcoholics Anonymous: Cult or Cure?
by
Arthur H. Cain
A
useful idea has turned into a religious movement—and
a hindrance to research, psychiatry, and to many alcoholics
who need a different kind of help.
In
the beginning “They” created Alcoholics Anonymous.
(“They” have not yet been credited with the
creation of the heavens and earth, but, if present trends
continue, they will be.) “They are “W.W.”
and “Dr. Bob”--cofounders of a movement which
is becoming one of America’s most fanatical religious
cults: “AA”
To
be sure, the late Dr. Bob and the very current W.W. did
not want to be deified. They joined forces in 1935 simply
to help each other stop drinking. Today the fellowship they
started claims a membership of over 300,000 “arrested”
alcoholics in 85 countries. The A.A. idea was based on psychological
and spiritual concepts very similar to those of Frank Buchman’s
then-famous Oxford Group. Conceived in Akron, Ohio, the
first AA. Group was formed in New York City. In A.A.'s first
five years no more than a few hundred people joined.
Then,
in 1941, an article about A.A. by Jack Alexander appeared
in the Saturday Evening Post and gave the movement an overnight
boost. Membership leaped to over eight thousand by the end
of the year.
A.A.'s
basic tenet is that only an alcoholic can help another alcoholic;
that psychiatric and other treatment is usually unsuccessful;
but that alcoholics can, by banding together in a spirit
of mutual help and understanding (and “by turning
their lives over to God as they understand Him”),
manage to lead relatively normal lives. Above all, they
must face the fact that they must never again taken even
one drink of alcohol.
As
long as it restricted itself to informal organization and
group “therapy,” A.A. enjoyed--and deserved--universal
respect. But a disquieting change has developed over the
past fifteen years. A.A. is now highly formalized. The meetings,
believed to be absolutely necessary, are ritualistic. And
any suggestion to members that The Program is less than
divine revelation evokes an irrational outcry.
I
have no personal axe to grind. As a practicing psychologist
who specializes in alcohol problems, I have been active
since 1947 in both therapy and research. I have worked closely
with Alcoholics Anonymous. I have also worked for the National
Council on Alcoholism and for the Christopher D. Smithers
Foundation, a charitable organization whose major interests
are alcoholism and cancer.
I
am disturbed by the fact that, for many members, A.A. is
not as effective as it once was.
Moreover,
I feel that much-needed scientific research is being diverted
to other fields because of A.A.'s omniscient attitude. And
I am not alone in my concern. Frequently in my practice,
disillusioned men and women appeal to me: “Doctor,
I’ve tried AA. over and over and I still can’t
stay sober. There must be something else dreadfully wrong
with me! What is it?”
My
friends in psychiatry, psychology, and pastoral counseling
often ask me in discreet tones, “What’s happening
to AA?” Then, embarrassed at sounding critical, they
add hastily, “It is a wonderful organization.”
Dr. E. M. Jellinek, dean of researchers in alcohol studies,
pleaded at a workshop on alcoholism -held at Columbia University
in June 1959 that A.A. leave science alone--so that scientists
might get along with the business of objective research
into the problem.
While
serving as public-relations counsel to the National Council
on Alcoholism in 1959, I attended A.A. meetings in a dozen
major cities. This personal survey of AA. groups convinced
me that there is a widening breach not only between A.A.
and scientists, but also between practicing A.A.s and other
alcoholics.
`What
has happened to the excellent program that once helped alcoholics
stop drinking when medicine and psychology failed? Why has
A.A. become a cult that many men and women reverentially
call “the greatest movement since the birth of Christianity”?
“UTILIZE--DON’T
ANALYZE”
I
attended my first A.A. meeting in 1947 and was enormously
impressed by the sincerity of the members. They were not
professional do-gooders. The speakers seemed genuinely “humble,”
not piously proud of their humility. The “A.A. Personality”--identifiable
by a studied air of serenity and steadfast smile (which
I have come to think of, uncharitably, as the "A.A.
Smirk”)--had not yet come into existence. It is a
product of “AA.: the Cult” as opposed to “A.A.:
the Fellowship.”
But
one remark disturbed me even then. One man arose--a forerunner
of the seer-and-pundit type now prevalent in A.A.--and declared,
“There’s an aggregate of two thousand years
of drinking experience in this meeting room. If we don’t
understand alcoholism then nobody does.” My own reaction
was that nobody understood alcoholism (no one does now,
either) and it was ludicrous for a group which admittedly
had lost control of its drinking to claim superior knowledge
of the subject.
As
I began to attend meetings regularly, other aphorisms troubled
me. One favorite cliche appeared to be of special importance
and still is: “Utilize--don’t analyze.”
For
some members this was fine. They were weary of trying to
figure out how to drink normally; or how to endure sobriety
now that it was achieved; or why they had become alcoholic
in the first place. They were ready to accept blindly anything
that would end the agonies of compulsive drinking.
But
for others, such faith was impossible.
Some
people simply must analyze--it is their most characteristic
personality trait. Perhaps, during the early, frightening
days of their newly found sobriety they take comfort in
letting others think for them. But as their heads clear
and their nerves stop quivering, the need to comprehend
ideas intellectually is reasserted and they find themselves
examining their own behavior with healthy curiosity. As
one relapsed member mournfully described his “slip”:
“I had been dry for over a year and, like the window
washer, stepped back to appraise my handiwork. I woke up
two weeks later on the Flight Deck [the violent ward at
Kings County Hospital] wondering what had happened.”
Relapses
occur frequently among such alcoholics trying to stay sober
in A.A. Many A.A. members are unsympathetic to these less
fortunate brothers, whom they regard as “hopeless
psychotics” or “nuts who aren’t ‘real’
alcoholics at all.” Thus, we see in A.A. two disturbing
tendencies: (1) to define an alcoholic as a person who stays
sober in AA.; and (2) to relegate all other problem drinkers
to the limbo of psychosis.
AAs
are fond of quoting such “statistics” as: “Fifty
per cent of all alcoholics coming into AA get sober and
remain sober; 25 per cent have one or two slips, then ‘get
the program’ and maintain sobriety; the other 25 per
cent are either psychotic or not alcoholic at all.”
A
question arises: how do A.A. members garner these figures.?
Because A.A. considers itself a deliberately permissive
fellowship made up of autonomous groups which do not keep
exact records, no real statistics exist. Nevertheless, individual
members advance these generalizations as incontrovertible
truths.
This
kind of misinterpretation has narrowed A.A.'s once flexible
philosophy into exclusive dogma. One undesirable effect
is that those alcoholics who are not able to make A.A. work
for them lose all hope; they fear that nothing is left for
them except insanity (Korsakoffs Syndrome or the dreaded
“wet brain”) or death. This is not so. Many
alcoholics achieve a sobriety made happy and creative through
medical, psychiatric, psychological, and pastoral techniques.
The sometimes-tragic misunderstanding--that only AA can
help--is fostered by A.A.'s growing rigidity.
If
A.A.'s intolerance were confined to its own community, we
could “live and let live,” as it exhorts its
members to do. But A.A.s are indefatigable crusaders who
greatly influence the national crusade against alcoholism—a
malady which today afflicts five million Americans and costs
taxpayers and industry over a billion dollars annually,
according the National Council on Alcoholism. The Department
of Health, Education, and Welfare has called alcoholism
the nation’s fourth most serious public-health problem,
ranking in importance with heart disease, cancer, and mental
illness.
AAs
hold key positions in city, state, and private agencies
dealing with alcoholism. Many executive directors of local
committees and information centers are members of AA. This
means that public education on alcoholism is almost entirely
in the hands of AAs. Furthermore, nearly all information
about research, treatment, and community action is disseminated
by public-relations directors who adhere to the A.A. party
line. Thus, almost everything we read on alcoholism in newspapers
and magazines is A.A. propaganda.
Zealous
members spread this propag- anda, not for personal gain,
but to “flush out” alcoholics and help them
share their own dubious serenity. I have had the unnerving
experience of hearing a spontaneous remark made by an AA
speaker in New York on a Monday repeated as gospel in Chicago
on the following Friday. Much worse, I have heard a federal
department chief publicly parrot a “statistic”
I knew had been invented by an A.A. the week before. It
is perhaps no coincidence that the A.A. publication is known
as “The Grapevine.”
Alcoholics
Anonymous is hostile to criticism from any source. “All
we ask is to be left alone,” they cry. But they do
not leave the American public alone. They influence public-health
officials; they write extensively; they take positions on
medical subjects such as diet and drugs (tranquilizers,
sedatives, and stimulants all fall under the rubric of “goof-balls”
to AA), and hold themselves up as final arbiters on any
matter pertaining to alcoholism.
One
result of this authoritarianism is that well-meaning laymen
organize committees and -sponsor
“research’‘--which leads qualified professionals
to assume that the job of fighting alcoholism is getting
done. But it isn’t—largely because of a basic
fallacy in A.A. thinking: that it takes an alcoholic to
understand an alcoholic. The trouble lies in defining the
word “understanding.” Scientists agree that
alcoholics are more empathetic to other alcoholics than
anyone else; but when they venture the opinion that trained
specialists might be better equipped to conduct formal treatment
and research than untrained alcoholics, they run into a
storm of protest. AAs seem almost afraid that science will
come up with a “cure” (an absolutely taboo word
in the A.A. lexicon) and render A.A. unnecessary.
“What
will we do if someone discovers a pill that cures alcoholism?
It’s our dedication that’s keeping us sober
and serene!” the executive -director of an influential
agency on alcoholism recently said to me. Needless to say,
this person and most of this agency’s staff are practicing
members of AA. All are dedicated to combating alcoholism.
But just as sobriety is a vocation for many A.A.s, for many
agency people it is a career.
SOBRIETY
. . . NOT SLAVERY
Another
dangerous aspect of A.A. as a religious cult is the concept
of sobriety as the ultimate goal of life. The very word
“sobriety” has taken on a religious flavor and
is uttered with hushed awe, rather than spoken of as a condition
necessary to health and happiness. Practically all members
who have passed the pigeon, or novice, stage speak of the
quality of so-and-so’s sobriety, as if evaluating
degrees of spirituality.
Sobriety
has, indeed, become the A.A.'s end which justifies any means.
I know men whose wives work and support them so that they
may devote their full time to “A.A. Work.” I
have talked with these women at Al-Anon meetings (groups
formed especially for the spouses of alcoholics). Most are
not complaining about their lot as A.A. wives; they insist
that anything is better than living with a practicing alcoholic.
But other women confess that eating, sleeping, and talking
A.A. twenty-four hours a day is almost worse than having
an alcoholic husband. The masculine point of view was summed
up by a legendary souse at a bar who indignantly denied
that he was an alcoholic. “I’m no blankety-blank
alcoholic,” he shouted, “I’m a drunk!”
When asked about the difference he retorted, “Alcoholics
have to go to those blankety-blank meetings all the time!”
I
have heard husbands of alcoholics complain that A.A. has
become a network of women’s auxiliaries devoted to
gossip and the “chanting of A.A. litanies such as,
There but for the Grace of God.. . '; ‘Easy does it’;
and ‘Living one day at a time.“’
A.A.
dogmatism has prevented many people from seeking a more
moderate solution: sobriety in Alcoholics Anonymous without
slavery to it.
And
there are still other possibilities such as psychotherapy
or pastoral counseling. But AAs would probably retort, justifiably,
that they’ll stick to what they’ve got until
something better comes along. Many alcoholics who come to
A.A. have had unhappy experiences with psychologists or
psychiatrists. Some therapists follow their own party lines,
usually Freudian, too strictly and write off alcoholism
as "just a symptom of some underlying emotional disorder”--implying
that once the disorder is uncovered the problem of alcoholism
will automatically be solved. Too many alcoholics are worsened
by this oversimplified approach. Many others instinctively
know better, especially when psychoanalysts begin probing
their Oedipal Situations. However, most psychotherapists
now understand that alcoholism is a complex, distinct illness
and must be treated accordingly.
“ARRESTED”
OR “RECOVERED”
But
AAs veer to the other extreme. They assert vehemently that
there’s nothing wrong with alcoholics except alcohol,
and all the alcoholic has to do is to stay away from that
first drink. (There is a standard gag in A.A. about the
alcoholic who always orders two drinks and only drinks the
second one.) The facts are: (1) the alcoholic obviously
wouldn’t be an alcoholic if it weren’t for alcohol
(what would he be?) and he certainly must abstain from it
if he is to get well; but (2) he undoubtedly is suffering
from some sort of psychological disorder: emotional, mental,
or social. Unfortunately, “psychology” is a
synonym for “psychosis” to most A.A.s. When
a recent Ph.D. dissertation on alcoholism was published
in popular book form (Sever Sinners, by Arthur King, Harcourt,
Brace and World, 1961), A.A.s immediately took the author
to task for suggesting that alcoholics could be placed in
categories of psychopathology like any other victims of
a behavior disorder: the manic-depressive or compulsive-obsessive
cases, for example, complicated by uncontrolled drinking.
What was the big idea of saying alcoholics were a bunch
of nuts, A.A.s demanded. Yet, they insist that “alcoholism
is a disease.” The President of the National Council
of Alcoholism, an exceptional executive with a scientific
mind, goes further, calling alcoholism a respectable disease.
It can happen to anyone, he implies, and should not have
social or moral stigma attached to it. I couldn’t
agree more heartily.
But
AAs prefer to regard alcoholism as a purely physical disease:
organic, glandular, metabolic, dietary--anything but mental.
The only time this dread word is used is in an AA. definition
of alcoholism: “A physical allergy, coupled with a
mental compulsion.”
According to the American Medical Association (Journal of
the American Medical Association, May 25, 1957), “alcoholism
can be classified into (1) primary alcoholism, which includes
(a) those patients who from the very first drink of an alcoholic
beverage are unable to control their desire for it and (b)
those who through use over a great many years have developed
an inability to take a drink or leave it alone and have
become like group (a); and (2) secondary alcoholism, which
includes those who use alcohol for its sedative action as
a means of escape from reality and, in particular, from
their personal problems. . . . This secondary group comprises
by far the majority of patients suffering from alcoholism;
however, most alcoholic patients prefer to be in the primary
group.” (Emphasis mine.)
By
refusing to take into account problems of mental confusion,
emotional immaturity, and social maladjustment, A.A.s are
seriously hindering not only their own recovery, but scientific
research as well.
If
AAs are to be rescued from fanaticism, they must thoroughly
understand two crucial words--“arrested” and
“recovered.” These are terms used to describe
alcoholics who do not drink any more. Most members of A.A.
fall into the former category; that is, they have arrested
the development of their disease and have learned to live
with it. To these men and women, alcoholism is something
real in itself, like an incurable cancer. “Once an
alcoholic, always an alcoholic” is one of A.A.'s most
holy doctrines. They mean that once a person has lost control
of his drinking he will never again be able to drink normally,
even to the extent of one glass of beer. He must work regularly
at the business of not taking that first drink.
This
means he must practice A.A. in all his affairs; attend meetings
without fail; do “Twelfth Step Work” (the analogy
between A.A.'s “Twelve Steps” and the Ten Commandments
is unmistakable); and proselyte other alcoholics into Alcoholics
Anonymous. If he doesn’t live AA., he’s sunk.
He gets drunk again sooner or later and--alcoholism being
in the dogma of AA. A progressive disease--he’ll be
worse off than ever.
It
is true, of course, that the drinking alcoholic becomes
worse and worse in his drinking behavior. But what A.A.
does is to superimpose this concept on the behavior of the
non-drinking alcoholic. According to A.A., the disease itself
progresses. This is erroneous thinking. An alcoholic who
relapses after a period of abstinence may very well get
sicker than ever, but because he has aged, not because his
alcoholism has “progressed.”
The
term “recovered” means something different:
it implies that the patient’s alcoholism is no longer
a problem. He may not be able to drink normally again, although
some investigators such as D. L. Davies, Dean of the Institute
of Psychiatry at the Maudsley Hospital, London, believe
there are many such cases. This hospital’s work has
been conscientiously reported by the Quarterly Journal of
Studies on Alcohol (at the Rutgers Center of Alcohol Studies;
“Normal Drinking in Recovered Alcohol Addicts”’
March 1962). Here is an excellent example of -the true scientific
method, for the Quarterly Journal reports both fact and
theory. It is not surprising that Dr. Davies’ article
has been either ignored by A.A., or brushed off with typical
illogic: “Well, if these people drink normally, then
they couldn’t have been alcoholics in the first place.”
No AAs I queried had actually read the piece, though all
were firm in their denunciation of it. I have heard A.A.s
say that the report was immoral on the grounds that they
might be tempted to drink again after hearing of it. Scientific
truth was of no consequence.
The
expression “recovered alcoholic” means that
the patient no longer has to treat himself or take treatment
from others at least twice a week for the rest of his life.
He accepts life without alcohol; he makes certain adjustments
within himself and in his attitude toward society; and he
gets back into the mainstream of life. He might devote part
of his time to helping alcoholics or others—probably
he does--but because he can and wants to, not as a device
to keep himself sober.
TRY
A.A. FIRST, BUT…
There
are many such recovered alcoholics, both in and out of Alcoholics
Anonymous. These men and women have learned one thing: neither
A.A. nor psychotherapy, nor any other treatment is more
than a bridge between alcoholism and real recovery. Good
bridges, perhaps. I still believe that A.A. provides the
best possible way, at present, for most alcoholics to get
sober and start a new life without alcohol. Others need
some form of psychotherapy and/or pastoral counseling--perhaps
in conjunction with A.A. These disciplines are especially
helpful to people who cannot, without professional guidance,
sincerely practice certain of A.A.'s Twelve Steps, such
as Step Four--“Make a Searching and Fearless Inventory
of Ourselves”; or Step Ten--“Continue to Take
Personal Inventory and When We Are Wrong Promptly Admit
It”; or those Steps that refer to “a Power greater
than ourselves.”
Alcoholics
Anonymous is not a sustain- ing Way of Life. Sobriety can
never be a satisfactory ultimate goal; it is, after all,
merely the absence of intoxication. It is what one does
with one’s sobriety that is important. AA. is a man-made
means for attaining this sobriety.
Alcoholics
Anonymous should not be a cult for the retardation of the
“arrested” alcoholic. I do not suggest for a
moment that a single A.A. quit
the fellowship. On the contrary, I strongly urge sticking
with it. To anyone who is having trouble with alcohol I
say: try A.A. first; it’s the answer for most people.
But to those who insist upon serving A.A. as if it were
a holy and apostolic church, I say, Beware. Observe those
members who seem genuinely serene. Talk with those who have
been in A.A. a long time and who really practice “live
and let live.” Though A.A. is an important part of
their lives, it is an adjunct, not the whole. They have
crossed the bridge from arrested alcoholism to true recovery.
And
if even then they cannot stay sober and happy, they should
not despair. There are other ways, other bridges--physicians
and psychiatrists, psychologists and pastoral counselors,
who are capable and anxious to help them. Some specialize
in helping alcoholics who have conscientiously tried A.A.
and failed. Most agree that there’s no such person
as a hopeless alcoholic.
A.A.
as a group must recognize its real function: to serve as
a bridge from the hospital or the jail to the church--or
to a sustaining personal belief that life is worthwhile.
It must not pose as a spiritual movement that provides everything
the alcoholic needs to fulfill his destiny. It must not
teach its young (as it does in Alateen, its Sunday School
for the children of alcoholics) such catechisms as: “We
will always be grateful to Alateen for giving us a way of
life and a wonderful healthy program to live by and enjoy.”
It must realize that “the actual coffee pot Anne used
to make the first A.A. coffee (shown in “Alcoholics
Anonymous Come of Age,” Harper 1957, a commentary
on the A.A. bible, Alcoholics Anonymous, Works Publishing
Company, 1946) is not the Holy Grail. The cake and coffee
served after meetings are just refreshments, not the body
and blood of Jesus Christ.
Only
then will Alcoholics Anonymous “come of age.”
Then, perhaps, more of its members will become “recovered”
instead of “arrested” alcoholics. Science may
then be stimulated to further research. And those alcoholics
who are unable to make A.A. work for them may look elsewhere
and find their serenity, too.
Arthur
H. Cain, who has a Ph.D. from Columbia and is a graduate
of Yale (now Rutgers) School of Alcohol Studies, is the
author of Young People and Drinking, to be published by
John Day. A licensed psychologist practicing in New York
City, Dr. Cain recently made a research tour of the world
studying drinking customs and sexual habits.
(Source:
Harper’s Magazine, February 1963)
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