N.Y. State Journal Of Medicine Vol. 50, July, 1950
By W.G.W., New York City, N.Y.
The first Alcoholics Anonymous group became a reality at Akron, Ohio, in June, 1935. Our fellowship has since expanded into 3,500 groups comprising 100,000 well-recovered members. Originally centered in the United States and Canada, A.A. has spread rapidly throughout the world. About 2,000 recoveries now take place each month. Of those alcoholics who wish to get well and are emotionally capable of trying our method, 50 per cent recover immediately, 25 per cent after a few backslides. The remainder are improved if they continue active in A.A. Of the total who approach us, it is probable that only 25 per cent become A.A. members on the first contact. Carrying a certain amount of indoctrination, the remainder depart for the time being. Eventually, two out of three of these return to make good, for once the AA program has been well presented to the alcoholic, he can never be the same person again. A list of 75 of our early failures today discloses that 70 returned to AA after one to ten years. We did not bring them back; they came of their own accord. When asked why, these persons invariably answered: "For us it became a question of AA or else. We found all other exits blocked. Death or insanity was the only alternative. So, here we are." While not accurate statistics we believe these statements conservative approximations.
Alcoholics Anonymous once stood in a No-Man’s Land between medicine and religion. Religionists thought we were unorthodox; medicine thought we were totally unscientific. The last decade brought a great change in this respect. Clerics of every denomination declare that, while AA contains no shred of dogma, it has an impeccable spiritual basis, quite acceptable to men of all creeds, even the agnostic himself. You gentlemen of medicine also observe that AA is psychiatrically sound so far as it goes and that AA refers all bodily ills of its membership to your profession. Therefore, it is now clear that Alcoholics Anonymous is a synthetic construct which draws upon three sources, namely, medical science, religion, and its own peculiar experience. Withdraw one of these supports and its platform of stability falls to earth as a farmer’s three-legged milk stool with one leg chopped off. That you have invited me , an AA member, to sit in your councils today is a happy token of that fact, for which our society is deeply grateful.
What, then, has Alcoholics Anonymous contributed as third partner of the recovery synthesis which promises so much to sufferers everywhere? Does Alcoholics Anonymous contain any new principle? Strictly speaking it ‘does; not. AA merely relates the alcoholic to time tested truths in a brand new way. He is now able to accept them where he couldn’t before. Now he has a concrete program of action and the understanding support of a successful society of his fellows in which he carries that out. In all probability, these are the long-missing links in the recovery chain.
To illustrate, in 1934, I was pronounced utterly hopeless by a competent physician. Commitment seemed indicated. The usual approaches had been tried. Came, then, a school-time friend, himself once a chronic in even worse shape than I. He told me that he had been "released" from his alcohol obsession. When I asked how, he replied, to my considerable consternation, that he had "got religion." Maybe, I thought, he had substituted one form of insanity for another. Being scientifically trained, I had a phobia about tub-thumping evangelism. But nothing of the sort came out of him.
He first told me his drinking experience, accent on its more recent horrors. Of course, his identification with me was immediate, and, as it proved, deep and vital indeed. One alcoholic was talking with another as no one except an alcoholic can. Then he offered me his naively simple recovery formula. Not one syllable was new, but somehow it affected me profoundly. And in paraphrase, this is the substance of what he had done to get well:
1. He admitted he was powerless to solve his own problem.
2. He got honest with himself as never before, made an examination of conscience.
3. He made a rigorous confession of his personal defects.
4. He surveyed his distorted relations with people, visiting them to make restitution.
5. He resolved to devote himself to helping others in need, without the usual demand for personal prestige or material gain.
6. By meditation he sought God’s direction for his life and help to practice these principles at all times.
And there he sat, recovered, an example of what he preached. You will note that his only dogma was God, which for my benefit he stretched into an accommodating phrase, a Power greater than myself. That was his story. I could take it or leave it. I need feel no obligation to him. Indeed, he observed, I was doing him a favor by listening. Besides it was obvious he had something more than ordinary "water—wagon" sobriety. He looked and acted "released"; repression had not been his answer. Such was the impact of an alcoholic who really knew the score.
Although I drank on for a time, I couldn’t get that conversation out of my mind. I still gagged on his God concept, but finally realized I had better try the formula. I knew I had "hit bottom"; I knew I had an insane obsession to drink that had killed off many a better man than I. All else had failed; this was my only hope.
So I betook myself to my friend of medicine, Dr. William D. Silkworth of Towns Hospital, New York. He had previously taught me the grave nature of my malady. I had been one of his few hopeful cases. But he had finally given up and had told my wife the worst. once more he put me to bed and medicated me into sobriety. Three days later, my friend of school days turned up and repeated his simple prescription.
When he had gone, I fell into a black depression. This crushed the last of my obstinacy. I resolved to try my friend’s formula, for I saw that the dying could be open-minded. Immediately on this decision, I was hit by a psychic event of great magnitude. I suppose theologians would call it a conversion experience. First came an ecstasy, then a deep peace of mind, and then an indescribable sense of freedom and release. My problem had been taken from me. The sense of a Power greater than myself at work was overwhelming, and I was instantly consumed with a desire to bring a like release to other alcoholics. It had all seemed so simple - and yet so deeply mysterious. The spark that was to become Alcoholics Anonymous had been struck.
This, gentlemen, is the essence of what has been happening to AA’s ever since, although I naturally make haste to add that most of their so-called "spiritual experiences" are not sudden at all. What happened to me in six minutes happens to them in six weeks or six months.. But it is the identical thing, the results are the same. Seldom, indeed, does AA work without the Higher Power concept. We have verified that fact thousands of times.
Because, I presume, of a deeper personality disorder, my friend eventually backslid and never quite got well. But I have not had a drink since that day in the hospital, and, of course, I immediately began to present these ideas to other alcoholics. Dr. Silkworth, great human being that he is, offered me nothing but encouragement. Had his scientific conviction got the better of him and had he pronounced my conversion hallucinosis, I shudder to think how many alcoholics would now be dead. So he and I went on together here in New York, at first with no success. I soon learned, however, that working with other alcoholics was a powerful factor in sustaining my own recovery.
Six months later, I met a well-Akron physician, an alcoholic in a bad way. Partners, then, in that town, we formed the first successful A/k group in 1935. My friend, the surgeon, has since treated medically and brought AA to some 4,000 alcoholics, all without a cent of remuneration. And thus he became a cofounder of Alcoholics Anonymous.
Around us a wonderful society grew up. In 1939, our society published a book, titled Alcoholics Anonymous, which amplified the original "word-of-mouth" program into the well-known AA "Twelve Steps of Recovery." This book described the specific application of these steps to the problem of alcoholism, and it is documented by 30 case histories of recovery. Aided by immense publicity and traveling AA members, this publication has found its way to all parts of the world. In many cases, reading the book has proved to be a spectacular specific for alcoholism, although readers at a distance usually form groups around them to insure their own sobriety.
To sum up, now, and more clearly, I trust you see how A/k is bridging the chasm that formerly existed between the alcoholic, his doctor, his clergyman, and his friends; how we secure that powerful identification with each other; how we have created a society with a favorable atmosphere, and how at last we have given each alcoholic something vital to do - and to be - in carrying the message to still others as part of his own recovery.
So, then, it is fair to state that on the surface A/k is a thing of great simplicity, yet at its core a profound mystery. Great forces surely must have been marshaled to expel obsession from all these thousands, an obsession which lies at the root of our fourth largest medical problem and which, time out of mind, has claimed its hapless millions.
Please know that we hold ourselves ready for scientific investigation; that we fully realize that we are but a small part of the total effort going on in this broad field and so wish to aid where we can. And, once more, may I say thank you on behalf of our entire membership.
Dr. Potter: I would like to ask Dr. Davis how an Alcoholics Anonymous can obtain more and cheaper hospitalization for this new treatment.
Dr. Davis: That is a very important economic question. With wages sky high and the hospital beds filled, it is difficult to answer. However, let us not be discouraged by the problem. It has been with us for a long time, and many of us have been working with the alcoholic for many years, but there is gradually coming more and more aid. But, even with the help of private individuals, the various social agencies, and State help, it will be some time before hospital beds will be available to all. However, throughout the country more and more beds for alcoholics are ready and are being made ready at reasonable rates.
Dr. Potter: I would like to add to Dr. Davis’ remarks that in many communities the Blue Cross now recognizes this illness as a disease and will pay for the hospitalization of the acute cases.. .Dr. Brightman, to what facilities may we refer those who suffer from maladjustment’s in addition to alcoholism?
Dr. Brightman: Assuming that you are referring to physical and mental abnormalities in association with alcoholism, we are developing more and more mental and health facilities in the State. Some county health offices have their own facilities to care for these patients, and we hope to see more through the years. Of course, we do not want to wait until the patient has developed a psychosis and is eligible for entrance into a State mental institution. That is what we are trying to avoid
Dr. Potter: I would ask Dr. Block how an alcoholic can best relate himself to the family physician?
Dr. Block: I think a good deal of that reply was covered in my paper. We do find, as Dr. Tiebout stated, that the alcoholic himself is the last to recognize the fact that there is a problem, and his ego does not let him admit that he cannot handle the situation himself. We have any number of telephone calls from families, friends, landlords, and neighbors when these alcoholics get into a state where they will not accept help but will continue to create a disturbance. The family physician cannot prevail upon the individual patient to follow his directions. I cannot tell you what people in other localities are doing about this, but I can tell you what we are doing or trying to do in the western end of the State. We are, through the press, trying to perfect a procedure whereby we have the cooperation of the Health Department and the Police Department. These individuals will, at the call of the family physician, take the patient into the hospital and on the recommendation of the physician keep him for a quarantine period. That does away with the necessity of committing the man under arrest and giving him a police record. At the same time it gives them the opportunity to have the man at the hospital for a specific number of days. When the acute phase has passed the physician will be able to reach the patient in a more efficacious way. He can then take care of the patient where the patient where the patient himself will not ask for that help from his own doctor.
Question (from the floor): Can anything be done for a severe alcoholic who refuses to recognize that he is an alcoholic?
Dr. Tiebout: I think it is always a mistake to assume that every alcoholic is just a stubborn mule. He is a stubborn mule, but he soon recognizes that he is going down a one—way street, but until we can get him sobered up sufficiently to recognize that he is going down a one-way street he is constantly going in that direction. You cannot expect him when you first see the alcoholic to say, "Yes, I am going to quit drinking." but you can begin to plant some seeds of doubt. Our cofounder talked about indoctrination. I think that is pretty good advice to give. The family doctor and friends can help in a better way than scolding, and gradually the patient comes to recognize the need for help.
Question: Dr. Smith, by what means have you followed up your patients after release from the hospital to determine the long-range success of your treatment?
Dr. Smith: Well, I never give figures, that is, percentage of cures, because I do not think we can. I think it is of the utmost importance in evaluating the number of alcoholics cured to consider the time element. If he has stopped drinking for three to six months, I do not think that you have done much for him that could not be done by other means. The patient that we have kept longest was for three years and other patients for various time intervals. I think the most striking thing is that our patients feel well and that is what we are trying to induce, a feeling of well being. We never ask the patient if he has been drinking. All that I can say is that the patients keep coming to the clinic.
Question: What should be the relationship between the Alcoholics Anonymous and the clinics in a given community?
W.G.W. :I think that the Alcoholics Anonymous groups have settled upon a very definite policy in that respect, and that is that we as individual members would like to be in a cooperative relation with all facilities that can be of help to the alcoholic. We are, for our own protection, on the lookout for customers, and whenever our technicians can be used they will be supplied. We would like to keep them in cooperation without advising any institution or any treatment. Otherwise we shall be terribly compromised.
Dr. Potter : I understand that the project at Buffalo is on a limited experimental basis. How long before it will be on a full basis, and how will it work?
Dr. Brightman : It is an experiment in how the alcoholic can be given service and rehabilitation, and also as to the cure of alcoholism. You can separate the two. As far as I know it will stay as an experiment for several years. I would like to emphasize the point of making known what we are doing. We need some statistics. There has been some very fine work done by individuals and groups. The Alcoholics Anonymous has certainly paved the way. There are various hospitals, all of which have made great contributions. And yet when you see how many patients start off with therapy and how many finish up, we still have a lot to learn.
It is not easy to evaluate the alcoholic problem. That would be a very crude criterion. Every method of therapy would have some success. Other criteria are the ability of the person to locate a job, to restore the household, or, where threatened, to maintain himself. Conditions have improved to a great degree. How long it will take to evaluate these trends in Buffalo I cannot say. We think about three years easily. We do not feel justified in making a greater extension of public funds until we know more about our present approach.
Question Why are sedatives dangerous in the treatment of the problem drinker in the late recovery phase of this disease?
Dr. Block : One of the greatest problems in dealing with the alcoholic is the use of sedatives. He gets the same effect from sedation. In other words, his problems are put away, he is asleep, and it is not too difficult for an alcoholic to go from alcohol to sedatives. They easily become addicted to this sedation to the point where one problem is superimposed upon the other, and ‘the last is almost greater than taking alcohol. For that reason it is necessary to consider it seriously. Sedatives should be avoided if possible, and if used’ should be used so as not to have the patient lean upon them too heavily.
Question : What is the general hospital’s relation to the alcoholic patient?
Dr. Davis : I feel very definitely that some means can be obtained whereby the general hospitals can admit and take care of the alcoholic during the acute phase of the illness, when he is a danger to himself and a greater danger to innocent people. I think Dr. Block mentioned a very important thing they are doing in the western part of New York State, and that is the use of a quarantine period because it avoids commitment and arrest. Certainly these people in a fog of alcoholism are not responsible and, if driving an automobile, may kill your child or mine. There should be a means of quarantining them until they are alert mentally and can act as human beings.
Question : Can a doctor contact the Alcoholics Anonymous group, and how?
W. G. W. Well, it depends upon where you are. If you are in a large metropolitan area, you will usually find an office where you can be interviewed and make hospital arrangements, etc. We get about a hundred calls a day and have secretaries on the job. In the smaller communities you will find Alcoholics Anonymous attached to some telephone service. Often the Police Department is called, and they will put you in communication with the proper persons.
Dr. Brightman The District Health Officers have received lists of the telephone numbers of Alcoholics Anonymous in all areas of the State. So any doctor wishing to find out about the Alcoholics Anonymous group can call the Health Officer.
Question : Dr. Tiebout, can the "surrender" of which you speak be produced by psychiatric means, or by the voluntary act of the patient?
Dr. Tiebout I can answer the second part of that question first by saying that I have never seen it actually happen that a patient could will himself to surrender, because the very use of will power means that you are not surrendering. As to the first part of the question. I can only say hopefully that the psychiatrist can often bring the man to realize his condition and need for help.
Question Dr. Smith, when referring to the adrenal extract, do you mean whole extract or D.O.C.A.?
Dr. Smith We use both, but I refer principally to the watery extract.
Dr. Potter: There are hundreds of questions which it will be impossible to answer at this time. I can refer these questions to the individual members of this panel who will be asked to reply. Such questions and replies will be forthcoming, along with the discussions of the papers presented here today, in the New York State Journal of Medicine in the near future. It is also hoped that many thousands of reprints of these papers and questions and answers will be available for distribution.
So I would say that a brief summary of the remarks made this afternoon would reveal that the Medical Society of the State of New York and the New York State Department Of Health recognize chronic alcoholism as a chronic progressive disease; that it is characterized by compulsive drinking which lies at the root of this very important medical and public health problem. Both organizations recognize their obligations in this matter. The New York State approach will be along the lines of prevention.
The program will embrace primary prevention, which calls for avoidance of the disease through progressive public educational activity. And this part of the program will bring into play not only medical and public health facilities, but forces of family guidance agencies, the churches, and the schools. The remaining part of the program will relate to secondary prevention, which involves the arrest of the progress of the disease. This calls for complete evaluation of the patient regarding his physical and mental status and his socioeconomic background, so that all factors contributing toward the state of alcoholism can be determined, and a rational mode of therapy prescribed.
The alcoholism control program will be carried out in Buffalo on an experimental basis within the Chronic Disease Institute, of which it is a part. Here practical methods of therapy will be evolved and evaluated and then applied to the needs in other areas of the State.
It was emphasized that no program can progress very far without the aid of Alcoholics Anonymous. This synthetic connection offers definite contributions to the recovery of the alcoholic. In a new way the alcoholic is introduced to time tested truths which he is able to accept, and which he couldn’t accept before. This is brought about by:
1. Emphasizing the importance of an emotional crisis ("hitting bottom" emotionally) as an essential preliminary before an alcoholic will accept any kind of help.
2. In offering a concrete program of action.
3. Offering the support of an understanding successful society in which the alcoholic carries out that program.
4. Accepting a "Higher Power" concept.
These are the long missing links in the recovery chain.
Disagreement on the origins of the illness was noted. One school of thought leaned toward the psycho-genetic theory, while another favored a physiologic origin. Further research is definitely indicated.
It was agreed that the acute alcoholic should be treated as an acute medical emergency; that general hospitals must be opened for this type of case, and that after the acute phase of the disease has passed the real therapy should commence.
Long sustained therapy involves the coordinating efforts of medicine, sociology, religion, and Alcoholics Anonymous. It must be a cooperative effort. At long last this effort is being made in New York State on an experimental basis.