Alcoholics Anonymous

Alcoholics Anonymous Meeting               Alcoholics Anonymous is many things, and its role changes over time for those who remain involved in it long term.

Most importantly, AA can be a life line for those who are suffering from the potentially fatal illness of substance abuse. It is a way of achieving freedom from alcohol and drug addiction with the help of supportive peers who have “been there.” At these times AA is about dealing with urgent and basic struggles.

For most people going to an AA meeting evokes both a wish to achieve sobriety and a sense of distrust of any “authority”. This distrust can be enhanced by early experiences because some people deal with the stress of new sobriety by throwing themselves into AA as if it is a missionary religion. Those who are wary about this enthusiasm may feel as if they are the only ones with those doubts, but they aren’t. We have been surprised to find out how often long time AA members will talk about profound misgivings they had when they went to their first meeting.

In the long run, personal success in AA comes with some level of acceptance of the structure itself, which supports people in dealing with the impulse to do self-destructive things in response to psychic anxiety and pain. The supportive structure can be sustaining on a long term basis.

Sometimes AA is falsely felt to be at odds with therapy.

The truth is that AA can supplement therapy, as therapy can supplement AA.

The goal of AA is to achieve a genuine stability and relatedness to others that is essential for those with substance abuse issues and also to deal with overwhelming shame that can make it hard to take care of these problems.

The goal of therapy is to move beyond the negative and to find ways of recapturing the positive qualities that have been twisted or deformed through life experiences.

Both AA and therapy need very powerful grounding in a sense of hope and optimism, and a clear vision of possibilities that are “tailored” to individual needs, and to changes in those needs.

For more information we recommend these sites:

AASF – The AA website with the comprehensive meeting schedule for San Francisco and links to other Bay Area counties meetings. Very complete.

SFNA – The Narcotics Anonymous website for SF. Also a very complete meeting schedule. – We think this is really worth reading. Women for Sobriety is a peer support groups for women in substance abuse recovery. It is non-12-step oriented, but has a very empowering message.

  • Stuart Jessiman

    Hi Peter

    Thanks for your article. There is though one thing I take issue with.

    It is sometimes said that ‘AA is falsely felt to be at odds with therapy.’ I believe it is often at odds with therapy, modern therapy certainly. I believe this because I’ve been in and out of AA for over two decades. Not until five years ago did I final leave. The fact I stayed as long as I did was not love of AA rather some indescribable fear of letting go and the dire consequences that would follow.

    Yes, attitudes to therapy within AA vary with some meetings frowning on therapy believing the twelve step programme is all you need to live a sober, productive life whilst others take a more relaxed view. There isn’t, as far as I know, an official line on therapy. But from experience when first doing AA at some of the big London meetings, as a new comer I was made very aware that these ‘rooms’ were where you got sober and stayed so doing the steps – except I did not stay sober.

    In short, for years I thought it was my failure to do the twelve step programme properly that was responsible for my drinking relapses. ‘Try harder next time’, I would chastise myself and three times I earnestly tried doing the steps again. I was usually face-down on the carpet with a bottle in my hand within months.

    I now believe I relapsed because I was having Bipolar moments I was self-medicating dowsing my manic mind in sedative spirits. But no, it was because I had not done the steps properly and I wasted years feeling guilty about my inability to do ‘good’ AA. I never really considered that AA was not the only means to stay sober – except AA wasn’t of a mind to tell you this.

    If you left AA you were one of the unfortunately ones. I paraphrase the AA big book: those who failed to make the twelve step work were ‘constitutionally incapable of being honest with themselves’ – or words to that effect. Leave AA and you where were to be pitied. Many AA folk are pragmatists and do not take the big book literally. So why keep AA in aspic? Why be so reluctant to change aspects of the practice that could so happily compliment therapies that would help folk in AA to address issues the twelve step programme can never solve?
    But I don’t want to simply bash AA. It has saved millions of lives and many others have successfully lived well using the twelve step programme. I wouldn’t hesitate to take someone suffering from alcohol problems to a meeting. My ‘beef’ with AA is its insularity and unwillingness to accept that what we now know about human behaviour, the physics and chemistry of the brain offers many other forms of treatment for drink related issues. It is over eighty years since Bill W, founded AA. It is a remarkable thing he did. But AA itself despite significant advances in our knowledge of addiction and addictive natures has hardly moved on at all.

    I still carry a degree of loyalty to the organisation. Yet I believe it inadvertently stood between me and the right treatment for my condition for over two decades – through guilt, a small degree of fear, assumptions that AA and only AA had the answer to alcohol abuse kept me anchored in the wrong therapeutic harbour for a long time. I suspect even today there are many at anchor just a reach away from the right modern, scientifically-founded treatment.

    • PeterForster

      I love the thoughtful letter you received, and I wholeheartedly agree that 12 step has surely saved thousands (hundreds of thousands, or millions?) of
      lives. AA actually has evolved over the years, though, and I sure it will continue to do so. It now welcomes all who are on anti-depressants and other medications, whereas in the past it did not. At the same time, it is
      very clearly an abstinence-based program, and I do not see that changing.

      Can an abstinence-based program dovetail with different types of evidence-based therapy? Can it dovetail with harm-reduction or moderation management? Can it dovetail with medication-assisted addiction treatment?

      I believe it can, though others may disagree with me. Addiction is clearly a chronic illness that is often punctuated by relapses. As a dynamic disease, different treatments may work better than others at different times in the course of the illness. Just as important, those who suffer from addiction may find specific treatments, specific therapies, more attractive or palatable at specific times in their lives.

      Best, Matt Tierney

  • Hi Peter

    I agree that AA has evolved to an extent, but it is such a disparate organisation that what becomes the unstated general consensus on the value of other treatments in an established group, is frowned upon in others. There is no policy on such things. Meetings often just evolve around a number of key individuals. Protocol keeps all AA meetings broadly similar, but group dynamic can vary immensely.

    I remain convinced that AA can change without losing it’s core value, the twelve steps. But it remain wedded to the old ways. AA ‘s Big Book, for example, has case studies of alcoholics that date back to the thirties. They have one from a Native American and his story is told in an insulting patois, e.g. ‘Heap big drink cause… ‘. What on earth is this still doing there? It is racist and should have been removed decades ago. But for some the Big book is a bible and is almost sacrosanct.

    I’m aware I ‘m over here in the UK and things may be different, but I doubt it. From an academic perspective AA will be be viewed differently from those of us who did significant time in all sorts of meetings and heard a lot of different things.

    Please don’t take this as an AA kicking session. I’ve praised it’s value in a previous post. But I believe it needs to change – modernise perhaps and compliment the many other forms of treatment out there.