by Lance Dodes
Eventually he came to realize that this odd coping mechanism made a certain kind of sense. By making a decision to drink, he was empowering himself—he no longer felt helpless. Once he understood the connection between his lifelong feelings and his urges to drink, he was able to view them with some perspective for the first time. He found that he was able to predict when his drive to drink would return, since it always tended to surface right after that old, unbearable pressure to perform. He developed enough awareness into what was beneath these urges that he could take a step back and deal with those issues more directly and appropriately. Over time, he was also able to work out the underlying narrative forces that had led him to feel so helpless throughout his life. He had, in other words, supplanted the notion of a Higher Power with something far more personally empowering: sophisticated self-awareness.
THE REHAB FICTION
Dominic’s history follows the same contours as thousands of others. But one part of his story warrants special attention: the series of failed attempts at rehabilitation. Dominic’s family lost close to $200,000—their total retirement savings—on this string of ineffectual programs.
Rehab owns a special place in the American imagination. Our nation invented the “Cadillac” rehab, manifested in such widely celebrated brand names as Hazelden, Sierra Tucson, and the Betty Ford Center. Ask the average American about any of these institutions and you will likely hear a response tinged with reverence—these are the standard-bearers, our front line against addiction. The fact that they are all extraordinarily expensive is almost beside the point: these rehabs are fighting the good fight, and they deserve every penny we’ve got.
Unfortunately, nearly all these programs use an adaptation of the same AA approach that has been shown repeatedly to be highly ineffective. Where they deviate from traditional AA dogma is actually more alarming: many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction. Some renowned programs even have “equine therapists” available to treat addiction—a fairly novel credential in this context, to put it kindly. Sadly, there is no evidence that these additional “treatments” serve any purpose other than to provide momentary comfort to their clientele—and cover for the programs’ astronomical fees, which can exceed $90,000 a month.
Why do we tolerate this industry? One reason may sound familiar: in rehab, one feels that one is doing something, taking on a life-changing intervention whose exorbitant expense ironically reinforces the impression that epochal changes must be just around the corner. It is marketed as the sort of cleansing experience that can herald the dawn of a new era. How many of us have not indulged this fantasy at one time or another—the daydream that if we could just put our lives “on pause” for a while and retreat somewhere pastoral and lovely, we could finally make sense of all our problems?
Alas, the effect is temporary at best. Many patients begin using again soon after they emerge from rehab, often suffering repeated relapses. The discouragement that follows these failures can magnify the desperation that originally brought them to help’s door.
What’s especially shocking is how the rehab industry responds to these individuals: they simply repeat their failed treatments, sometimes dozens of times. Repeat stays in rehab are very common, and readmission is almost always granted without any special consideration or review. On second and subsequent stays, the same program is offered, including lectures previously attended.
Any serious treatment center would study its own outcomes to modify and improve its approach. But rehabs generally don’t do this. For example, only one of the three best-known facilities has ever published outcome studies (Hazelden); neither Betty Ford nor Sierra Tucson has checked to see if their treatment is producing any results for at least the past decade. Hazelden’s follow-up studies looked at just the first year following discharge and showed disappointing results, as we will see later.
Efforts by journalists to solicit data from rehabs have also been met with resistance, making an independent audit of their results almost impossible and leading to the inevitable conclusion that the rest of the programs either don’t study their own outcomes or refuse to publish what they find.5
CHAPTER TWO
THE RISE OF AA
AA IS UNDENIABLY AN international phenomenon, but its rise to world consciousness was neither easy nor inevitable. The story of AA’s ascendance and ability to beat out so many competing ideas is a tale of tremendous will and effort that rests largely on the shoulders of its tireless messengers—none more so than AA founder Bill Wilson, known in recovery circles simply as “Bill W.”
Bill Wilson was a lifelong alcoholic with a string of business failures under his belt before he managed to marshal America’s most august institutions to the cause of AA. These included such household names as the Rockefeller family, the Saturday Evening Post, Yale University, and later, the American Medical Association. Some of this lobbying occurred in the open, in the form of public testimony and press, but a greater portion took the form of private navigation among the power players of America’s medical elite.
To tell the story of AA’s ascendancy properly, we must begin at the beginning and ask a simple question: What did people do about alcoholism before the advent of AA?
BEFORE AA: DARKNESS AND DIPSOMANIA
Alcoholism has almost certainly been with us for as long as alcohol itself. Fermented fruits, primitive spirits, and home-brewed wine feature broadly in indigenous rituals, and some of the earliest writings in Eastern and Western literature make reference to prodigious drinking.
A landmark essay in 1774, “Mighty Destroyer Destroyed,” discussed alcoholism for the first time in American letters.1 This was followed a decade later by Dr. Benjamin Rush’s “Inquiry into the Effects of Ardent Spirits on the Human Mind and Body,” a widely circulated monograph that sought to describe “chronic drunkenness” from a scientific perspective, and to redefine the problem as a disease worth treating. This second essay became something of a foundational document for one of the more powerful political moments in American culture: the temperance movement.2
The term temperance was shorthand for a religiously inflected approach to the problem of “chronic drunkenness,” one that held that alcohol itself was dangerous and addictive. More focused on drinking than on drinkers, the temperance movement gained momentum as a mass effort to rid homes and taverns of alcohol and, expressly, to restore morality to America. Protestants and Catholics alike endorsed different versions of the platform, and more than a million people had signed on with the movement by 1837.
None of these advocates seems to have spent much time seeking to lighten the burden of the “incurable drunk.” The era’s prevailing treatments consisted of detoxification, hospitalization, institutionalization, and prayer. But Americans wouldn’t have long to wait for an innovation that might serve the “drunks” themselves; a major breakthrough was just around the corner.
In 1879, an Irish émigré named Dr. Leslie Keeley made a startling announcement: “Drunkenness is a disease, and I can cure it.” The statement electrified the nation. Keeley had a secret sauce, a “tonic” of chemicals administered via injection, which he claimed had the ability to eradicate the craving for alcohol. Not much is known about these injections today, but some historians have speculated that they contained a mixture of “atropine, strychnine, cinchona [basically quinine], glycerin, and gold and sodium chloride.” This was a tonic that, as one modern historian noted, required one “to possess a strong constitution to withstand the treatment.”3 Keeley was nonetheless famously bullish on his eponymous cure, telling anyone who would listen that it had no injurious effects, and that it worked 95 percent of the time.4
The Keeley method spawned a cottage industry of Keeley Institutes—some 120 nationwide—that would eventually “treat” as many as 500,000 alcoholics between 1880 and 1920. Alas, despite the storied fortitude required to withstand Keeley
’s needle, alcoholism itself was more than up to the task. Keeley’s method fell out of favor as the public eventually recognized it as a scam. His branded network of rehab centers was completely shut down by the end of World War I.
Contemporaneous with Keeley’s clinics was a rise in so-called inebriate hospitals—institutions dedicated specifically to drying out alcoholics. These institutions’ philosophy, not so different from today’s rehabilitation facilities, was that people could detoxify, heal, and eventually flourish if they were deprived of any alcohol for a period of time, often up to one year. But the inebriate hospitals were somewhat different from today’s palatial rehabs in one important way: patients were often subjected to cold showers and typically housed alongside society’s cast-offs—the blind, those suffering from syphilis, the mentally ill, orphans, even prisoners.5
The inebriate hospitals also adopted another new procedure for alcoholism: prefrontal lobotomy. This, painfully, failed to cure the “disease” of alcoholism, with one account famously relating that, “[f]ollowing the procedure, the patient dressed and, pulling a hat down over his bandaged head, slipped out of the hospital in search of a drink.”6
The nation soon lost its appetite for these pernicious facilities, and most of them closed by the end of the nineteenth century. Many alcoholics were consequently forced to seek help wherever they could, often in the “foul wards” of public hospitals as well as insane asylums.
Just as private institutions devoted to specific alcoholism treatment began to disappear, American legislation was seeking new ways to vilify drinking as a moral weakness and societal scourge. Various state laws passed between 1907 and 1913 called for “the mandatory sterilization of ‘defectives’: the mentally ill, the developmentally disabled, and alcoholics and addicts.”7 Then in 1919, a watershed: the Eighteenth Amendment was passed, enshrining into law a nationwide prohibition on the sale of alcohol. Any promising treatments that may have arisen between that day and the amendment’s repeal in 1931 were almost certainly doomed to obscurity, as nobody could legally be said to be purchasing and drinking alcohol on a regular basis. Overnight, a public health issue became a legal one, and the public’s appetite for treatment seems to have collapsed. Even the popular Journal of Inebriety shuttered during this era, erasing one of the only scholarly forums on the causes and treatment of alcohol addiction.8
At the threshold of AA’s invention, America carried a population of alcoholics deeply fatigued by many decades of barbaric treatment, imprisonment, and isolation; rattled by errant snake oil “cures”; and suffused with a widespread sense of hopelessness. Bill Wilson was just such an alcoholic.
BILL’S STORY
Although Bill Wilson would later become the primary architect of Alcoholics Anonymous, it was many years before he came to acknowledge his drinking addiction, and even longer before the famous religious conversion experience that led to the creation of AA. Given his essential role, it is useful to consider the man himself—not just for what his life has to teach us about AA, but for its power as an example of one man’s descent into the agony of alcoholism.
William Griffith Wilson was born on November 26, 1895. He came from a moderately well-to-do Vermont family, raised in a home large and impressive enough that it would later become a country inn. But Wilson’s home life was chaotic, and his childhood was scarred by a series of wrenching abandonments.
Nearly every man in Wilson’s family had a drinking problem. Wilson’s grandfather, widely known for his alcohol consumption, struggled with addiction for most of his life, signing popular promises of the day known as “Temperance Pledges” on more than one occasion. Like many men of his time, he was also bamboozled by a series of traveling revival-tent preachers who arrived promising absolution and salvation from drinking via the power of the Lord.
Nothing worked until the fateful day when Wilson’s grandfather had, by his telling, a miraculous conversion experience: “[I]n a desperate state one morning, he climbed to the top of Mount Aeolus. There, after beseeching God to help him, he saw a blinding light and felt the wind of the Spirit. It was an experience that left him feeling so transformed that he practically ran down the mountain and into town.”9 Wilson’s grandfather’s “miracle” became the stuff of legend in town. He never drank again.
Bill Wilson grew up heavily influenced by his grandfather, especially so because his parents divorced and his father moved away when Wilson was just eleven. It would be nine years before Wilson saw his father again. During this period, his mother left him as well, never returning for longer than a short visit.
Wilson had his own way of managing the feelings associated with his parents’ dual abandonment. Many accounts of his formative years describe a fierce defensiveness against his peers and an overweening desire to “prove himself”—by force if necessary—whether or not any judgment had been directed his way. If Wilson could be described as an angry person, however, there is one direction in which he seemed never to direct his resentment: “Astonishingly, Wilson never blamed his father for his absence or expressed any anger toward him” for abandoning his family for nine years, without correspondence or child support of any kind.
Wilson’s pain showed itself in other ways. He struggled in school and swung between significant highs and lows in morale. Securing a popular girlfriend in high school began an upward cycle of contentment that saw him named class president, but her death during emergency surgery devastated him, sending him into a deep depression. Wilson also suffered from occasional panic attacks, which left him convinced that he had a heart condition. As a consequence, he failed nearly every physical test he was given after eventually matriculating to military college. He suffered through many years of listlessness and deep melancholy.
Wilson also struggled with controlling his behavior. As his biographer put it, “Bill was compulsive, given to emotional extremes. . . . Even after he stopped drinking, he was still a heavy consumer of cigarettes and coffee. He had a sweet tooth, a large appetite for sex, and a major enthusiasm for LSD and, later, for niacin, a B-complex vitamin.”
Indeed, he was such a heavy smoker that the effects of tobacco would rob him of his mobility and, eventually, his life. One account recalls that he continued to smoke even in his old age when he needed frequent doses of oxygen just to make it through the day. Friends who arrived at the house reported seeing him struggling to decide whether he should take oxygen or smoke another cigarette. The cigarette won every time.
A similar pattern arose around a different behavior: serial adultery. Wilson’s need to sleep with women outside his marriage was legendary—so much so that AA members eventually put together a “Founder’s Watch” committee designed to steer him away from any tempting young women at the numerous events he attended.” Tellingly, one of Wilson’s close friends noted the utter helplessness Wilson evinced in the face of what appears clearly to have been a sexual compulsion: “I think that was the worst part of it,” [the friend] said. “Bill would always agree with me. “‘I know,’ he’d say. ‘You’re right.’ Then, just when I would think we were finally getting somewhere, he would say, ‘But I can’t give it up.’” These multiple compulsive behaviors, including alcoholism, smoking, and sexuality, foreshadow our later understanding of addiction as being a global problem not restricted to any particular substance or behavior.
Throughout his life, Wilson also suffered with bouts of depression. These episodes were frequent and paralyzing and would hound him until his death with overwhelming feelings of worthlessness and hopelessness. Once alcohol was no longer in the picture, Wilson turned to faith as a salve for these feelings. He would find temporary relief under the care of Father Edward Dowling, who “compared Bill’s malaise to that of the saints.” (Dowling would later go on to write the first Catholic endorsement of AA; he was especially impressed by the Big Book’s parallels to the Spiritual Exercises of St. Ignatius Loyola.) Wilson never wavered from his conviction that his depression was caused by “a lack of faith.”
Wilson may have experienced ambivalence about the ideal form and structure of his belief system, but unalloyed faith was fundamental to him. Wilson claimed that “God was the source of the goodness and guidance alcoholics could rely on to help them put an end to their drinking and restore wholeness to their lives.” He maintained that people who doubted the existence of God “were standing with their backs to the light.” He never doubted the presence of a miraculous divine spirit in his own famous conversion experience, which closely mimicked his grandfather’s: Wilson “felt lifted up, as though the great clean wind of a mountain top blew through and through.”
Yet if Wilson’s embrace of religion was absolute, it was also eclectic and fungible. He once famously described himself as “a shopper at the theological pie counter.” He dabbled in Christian Science at one point and Catholicism at another. He and his wife, Lois, hosted a number of séances, which they called “spooking sessions,” throughout the 1940s and ‘50s; Lois would later claim with pride that they levitated the table “on a number of occasions.” She also liked to tell about Wilson’s spiritual powers, bragging about gifts such as automatic writing, something that reportedly meant a great deal to him.
It is essentially impossible to separate Wilson’s passion for the spiritual from his founding of AA, despite the organization’s frequent protestations that it is nonreligious in nature. Of course, Alcoholics Anonymous members have every possible view about religion. But the organization is clearly permeated with Wilson’s religious beliefs.
