by Lance Dodes
My breaking point came at eighteen, when I had an episode so bad that I literally couldn’t get out of bed and couldn’t stand the sunlight and had to force myself to eat. I asked my parents for psychiatric help and tried to describe my problems. They were ashamed and upset but got me an appointment with a psychiatrist. The psychiatrist I saw didn’t seem to understand all my symptoms and gave me a tricyclic antidepressant and told me I shouldn’t feel this way, since I had a college scholarship waiting on me. The medication did very little to help me and I got no insight as to what the obsessional thoughts were and how to stop them. I found a way to make the thoughts stop for a short period of time on my own later that summer when I drank most of a fifth of vodka my Dad had bought months ago to mix some drinks for some occasion. Alcohol seemed like my answer. I proceeded to drink the bottle and take every pill I could find in the house, I just wanted as much relief from thinking as I could get. I was sent to the hospital with an overdose. I was sent on to college that fall.
My relationship with my parents became very bad because of my drinking. By the end of my senior year in college, I sought out a psychiatrist again after a breakup with a boyfriend. I entered graduate school in order to prolong my schooling, now I [realize] because I knew in my heart once I entered my chosen profession of teaching, my anxiety levels would skyrocket out of control.
My teaching career was a very short plummet into hell. My anxiety levels were insane, my depression was taking me down, and I was without contact with my previous doctor. I drank heavily to try to manage my out-of-control emotions, and it only took about a year and a half until I was out of a job and drinking hopelessly. I went in and out of psychiatric units for a year and was put on progressively more intense medications . . . though the doctors I saw knew I was drinking. It was a godsend when I finally fell into the hands of two social workers who sent me to detox and then got me an indigent bed in a twenty-one-day treatment center. My parents were through with me; I had nothing and no one.
I experienced AA for the first time in that treatment center. They would take us to meetings. I had never smoked but I wanted to fit into this group of people so badly I began buying cigarettes. My counselor at the treatment center was a very kind man who was a recovering alcoholic also. It was recommended that I go on to [a rehab] for long-term treatment of about a year. I was happy to do this, since I had nothing and people in the treatment and AA world were treating me humanely.
[At the rehab] there seemed to me to be a very hard push to get people to see sexual abuse in their backgrounds. At the time it seemed that the assumption was that a woman had to have been sexually abused to be an alcoholic. I always felt like they thought I was lying when I told them I was not.
When I left [there] after a year I was going to very many meetings per week. I had a job by then at a factory and all I did was work and go to AA meetings. In fact, I basically did that for years. I didn’t know what to do with myself for a very long time if I had spare time and wasn’t at a meeting; I felt very guilty because people said if you slacked off meetings you would get drunk.
It was about this time that I heard old-timers talk about people not really being sober if they were on psychiatric medications. I had been on Tegretol and Elavil at the [rehab], but had asked the psychiatrist . . . there if I could stop taking these. I didn’t want to feel like my sobriety could be called into question by anyone, and I also mistrusted psychiatric medication at this point and believed my only problem ever was that I had been an alcoholic (pre-alcoholic before I drank). The psychiatrist said that was fine. I only ever saw this lady [the psychiatrist] once when I entered the [rehab] and again just before I left. No one seemed to consider ongoing problems like depression, anxiety, or anything else unless these crept up in some way that disturbed the calm of the [rehab], then that person would go to a psych hospital for a week and get meds, or a change in meds.
I really worried quite a bit about someone questioning my [sober] “time.” I used to worry that a particular local AA matriarch would want me to say I had a year less “time” if she knew I had been on medication when I was in long-term treatment. I obsessed on this. She used to refer to women who were on antidepressants as “Prozac babies” and said that they couldn’t feel enough pain to work the steps properly on medication. I also was terribly afraid of being yelled at in a meeting. I didn’t like to share in meetings because I had seen old-timers yell at people and I had seen people use non-AA phrasing and be shot down and humiliated. One time, when I was a couple of years sober, I was at a meeting and a group of people from a local treatment center were brought to the meeting. One woman introduced herself as an “addict,” and all kinds of rage broke loose from the old-timers at the meeting. The person who brought the group left the meeting and the rest of the meeting was spent with people talking about how that was the only way to handle it. Those incidents were frightening. I lived in fear of being humiliated and getting drunk over it.
Looking back, I was rather lucky in one way when I got sober. I was overweight from the mix of meds I had been given over time and I was working a minimum-wage job. This did not make me attractive to men in the AA meetings I was attending. There were some women I lived with at the [rehab] who were very attractive though, and they were basically harassed by men as if they were merchandise to be obtained. They would get so many phone calls that they would stop coming to the phone. It was disgusting. [The rehab] did not like for any of us to date during our first year, but these ladies were chased by men. I had never seen grown men behave the way they did in AA.
There is such reverence given to “time” in AA—especially to those who have time and have a huge following of sponsees or started a meeting or some such—that it skews the actual aims of “recovery” in my opinion. Certain people can’t be questioned, even when they do questionable things, and humiliating people in meetings becomes “telling them like it is.” There is a certain AA arrogance that exists, one that assumes we “drunks” can only understand each other, the doctors and psychiatrists can never help us. I bought into some of this, but not the cult of personality. I avoided meetings that were run by particular old-timers or those that were very fundamentalist in the way they approached the Twelve Steps.
I saw a fundamentalist strain coming into being when I was about two to three years sober, and these people frightened me worse than the old-timers. In their philosophy, you must do the steps perfectly or you will get drunk. These people always look back on everything that they ever had happen, even as a child, and say it was their “selfishness and self-centered fear” and it showed that they were just an alcoholic. They have a very smooth way of speaking. . . . I have steered clear of groups like this.
I made sure to pick a very benign sponsor. I knew I would not be accepted fully in the AA community without one, and I had to have one when I lived at the [rehab]. I had a great fear of sponsorship; my relationship with my mother has never been good and I did not want some other woman controlling my life. Unfortunately this is what sponsorship is in many cases. Women especially are conditioned in AA to be very hard on themselves. I felt pressure from the first time I spoke about my past at a meeting at the [rehab] to make sure to not “blame” anyone else for anything that happened to me, to focus on it being because of my alcoholism. A person learns to tell their story in the way that others will find acceptable. I feel, and I have heard it in other women’s “stories” an unspoken pressure to . . . shame myself to a certain extent. There was a point where I wondered if I was really telling the truth anymore after years of this. There is an ideal that [if] you have any negative emotion about anything, then you are the person at fault. If you are harmed by someone else then you are at fault for being around them, if something bad happens to you then WHY NOT YOU, you are an alcoholic. I once heard a woman discuss . . . how she read an amends letter at the grave of a man who had sexually abused her as a child. I was very upset by hearing that a sponsor told her to do such a thing. Sponsors often act like some
combination of therapist and parent and are not qualified to be a therapist and should not parent an adult!
I had a woman ask me to sponsor her a few years ago after her previous sponsor, upon being told she had drunk again, went into a screaming rage on the woman. She was so verbally beaten down by that sponsor that after a few months in AA she told me that she just didn’t feel safe in AA and did not return. I don’t blame her. This was a fear I had in the beginning, that I would be on the receiving end of someone’s screaming, raging, insults, and humiliation. AA has to be the only place where completely uncivilized behavior is not only accepted but often applauded. The victim will nearly always be asked what their part was, in effect putting all blame squarely on their shoulders.
Along the way I met a man in AA and we got married. We are still married. There are strong opinions in AA on whether or not someone should or should not marry a fellow member. I know that for me, making a life with someone I feel like I really can trust has been the right decision. I’ve seen others hurt greatly in relationships with fellow AA members.
Throughout eighteen years of my sobriety, I worked hard to try to at least hide my roller-coaster emotions, anxiety, OCD, and off-and-on depression. When my father passed away, I made a decision to seek medical treatment for my depression and anxiety. It was like a veil of misery lifted. My mental health is not perfect but I am so much better that I began to wonder if the exalted Twelve Steps ever did anything for me besides grant me membership into a group of people who at least didn’t see me as worthless. I had run across criticism of AA online here and there and had paused to read it, agreeing with many of the complaints others had. Now I read all I could get, I went all through the Orange Papers [an online site critical of AA] in an afternoon, feeling relief in so much of it. I really think that the moralistic tone of the Twelve Steps is at best outdated, and at worst next to useless.
I do give old-timers, now gone, credit for one thing: they did not push a Christian God at newcomers. The ones I knew took the idea of “a power greater than yourself” seriously and did not rush anyone to decide how they approached it. Now I hear more religiosity in the tone. . . . A problem with AA’s idea of a “God as you understand him” is that the program goes on to tell you exactly how to pray, and many people in AA will insist you get on your knees to humble yourself before God. This is hardly in keeping with the idea of “how you understand.” This has to be quite off-putting to believers and non-believers alike in many cases, and should be. The way the Big Book describes agnostics is very belittling.
I can read the Big Book now and see many parts that are not myself. Bill Wilson made assumptions about the “alcoholic personality” that members of AA are demanded to identify themselves with that I do not believe are true in all, or even most, cases. This is grossly unfair and unhelpful. So much homage is paid to the “Big Book,” and I no longer believe much of it stands up to actual research or even observable reality. Look at some poor person who suffers from an undiagnosed mental illness drinking to self-medicate, [do you] tell them they have an “ego problem” and can’t recover until their ego is smashed?
I still attend one meeting a week . . . [and] I love the people at the AA meeting I attend, but when I am in a meeting I hear many things and think, “That’s not really true; we just have to say that in AA.” I think AA would be a much better organization without its literature. There has to be a better way to help alcoholics. I needed medication for so long but was led to believe my alcoholic status negated that need. Once declared an alcoholic, that became the only problem professionals made any real attempts at helping me with. People need to be willing to actually look at what works and doesn’t work in treating drug and alcohol problems. I think a lot of people are suffering needlessly because they can’t learn to speak AA and live in the AA culture overnight; I think not “getting” this contrived culture is called denial and people are abandoned by AA and by treatment professionals because of it.
COMMENTARY
The above accounts indicate that AA’s strength lies in providing a social network where newly abstinent people can get together comfortably in mutual support. But their stories also reflect some of AA’s serious problems. AA is ungoverned by design, which means it can also be unpredictable and unreliable: there is no consistent quality control. Some meetings are run by mature and thoughtful people, others by unsophisticated fundamentalists. You might get warm and avuncular advice, or you might find yourself on the receiving end of a personally driven, hurtful rant.
These stories also underscore another problem of 12-step programs: misdiagnosis. It is a common belief in AA that if you have alcoholism, all your troubles in life and any psychological issues with which you suffer are also “alcoholism.” Emboldened by an outsized confidence that they know what’s right for people with addictions, many in AA believe they are competent to make such assessments. It is startling that professionals who would never prescribe a drug whose contents were unreliable or send people with emotional symptoms to untrained laymen nonetheless regularly send people to 12-step meetings.
These case studies also highlight one place where AA could do a better job. We have already seen the statistical research indicating that many people dislike the religious nature of AA; these stories underscore just how personal that disillusionment can be. Someone who wanted to design a peer support network for addicts today would be wise to eliminate all vestiges of AA’s fundamentalist roots. This would mean discarding nearly all of the Twelve Steps except for step 4: self-examination. As these accounts show, many addicts note the value of this concept, which makes sense, since self-understanding is the key to treating all psychological symptoms. Unfortunately, AA’s version of this—the “fearless moral inventory”—is sullied by its moralistic character. Since the goal of therapy is to help people recognize feelings and thoughts that lie beyond their awareness, every good psychotherapist must avoid the mistake of imposing a moral agenda.
CHAPTER SEVEN
WHY DOES AA WORK WHEN IT DOES?
AS WE HAVE SEEN, the overall success rate of AA lies somewhere between 5 and 10 percent of all those who enter the program. There is doubtless some portion of those people who would have gotten better on their own, as the data on spontaneous remission is impressive indeed. Still, it is clear that a small number of people get well in AA because of AA. How can we square this fact with all that I have discussed to this point, including the fact that AA’s philosophy is deeply at odds with the psychology of addiction?
The voices of the addicts that we heard in the last chapter give us important clues. One of the principal benefits of AA is its social function. AA is a place where, with some notable exceptions, people feel accepted. Early in the process of quitting drinking, this can be valuable for those who can make use of it. But social support is not what AA identifies as its reason for success: the Twelve Steps are supposed to be the method for treating addiction. If AA’s public statements or literature focused on the supportive benefits of the group and made no claims that it was a specific treatment for addiction, nobody would object. Likewise, rehabilitation centers based on AA would resolve most objections if they simply admitted that getting away from the stress of daily life and into a lovely setting with good food and friendly support was a major part of their effectiveness—and the primary reason their results don’t last.
But support and setting alone cannot account for all of the cases where AA works to treat addiction. As we will see, there are some circumstances in which AA’s approach matches an individual’s psychology in something of a virtuous coincidence. Later in this chapter, I’ll examine why AA works when it does, and try to make sense of this phenomenon through the prism of a more accurate model of addiction.
GROUP DYNAMICS
Time and again in AA’s literature, we find the Twelve Steps referenced as the one true road map to lasting sobriety. You’ll recall that the Big Book itself contains the sentence, “Rarely have we seen a person fail who has thoroughly follo
wed our path.”
But the scientific literature has had a harder time distilling AA’s “secret sauce.” Many studies, in fact, have found strong evidence that AA’s successes are based on elements of the group that have nothing at all to do with the Twelve Steps. Because these factors are common to any group, anywhere, I will call them general attributes.
Much of the evidence about what AA actually does for people seems to point to the curative power of group dynamics more than any specific philosophy. This is hardly new ground in psychology: peer groups have been shown time and again to wield tremendous influence over our beliefs and behaviors, including several recent studies suggesting that similar effects may be witnessed in elementary school and even social networks such as Facebook.1
Many of the studies I have already mentioned cite the power of the group as essential to AA’s action. Both McKellar and Kaskutas outlined these effects in some detail. Kaskutas notes: “Meetings provide an opportunity to share one’s own struggles . . . increase one’s motivation to abstain, and . . . get outside of one’s self . . . by hearing others talk about their problems.”2 He also notes that other studies have found a link to factors such as developing a stronger friendship network. The Moos researchers made essentially the same point, stating that “for some individuals, involvement with a circle of abstinent friends may reflect a turning point that enables them to address their problems, build their coping skills, and establish more supportive social resources.”3 Even David Sack, AA apologist and CEO of the conglomerate that owns Promises Treatment Centers, says, “Health care professionals want to study treatment and that’s understandable. But . . . AA’s view is ‘that’s not our problem if you think it works or not because we are here to help and support each other.’”4
