Carrying the message into the new Millennium – A doctor’s opinion
Alcoholics Anonymous is a highly successful and effective organisation from the standpoint of the winners. Unfortunately it is not sufficiently successful at attracting newcomers. Neither is it successful at keeping newcomers involved once they have attended the first few meetings. We all know these facts and we ignore this information at our peril.
Alcoholism treatment has now moved out of the traditional psychiatric hospital arena to become community based. This means that HLOs have to interact with a large number of health professionals. This poses problems in identifying contacts and setting up and maintaining links etc and many HLOs bemoan the loss of the old system where they felt that their efforts were much more successful. Again, we have to ask ourselves if that is really accurate in view of the very slow growth of the Fellowship.
It is my view that in terms of attracting newcomers (new blood) AA is an ailing organisation. To tackle it, I believe that we need to do more than simply repeat what we did in the past with a larger number of professionals. If it did not work well enough then, why should more of the same be any better. Insanity!
I would like to suggest that AA members alter the nature of the interaction between themselves and the healthcare professional e.g. doctor, nurse, midwife, community psychiatric nurse (CPN), social worker, community alcohol team (CAT) member etc. The traditional share is a vital part of the attraction and identification but very often in liaising with professionals, it can be too long and too personal and may not hold the attention of the person hearing it. You will not hold a doctor’s attention for a period longer than 5 minutes unless you add in some scientific data which is meaningful to them.
The programme of Alcoholics Anonymous is poorly understood by outsiders. Meetings are generally considered to by useful for keeping drunks off the streets and the programme is widely believed to be a pseudo religious American cult. I suggest that it is time for us to alter these misconceptions. In order to do this we could provide information under 4 headings:
1. The principles of the programme of Alcoholics Anonymous are scientific and closely follow all the helping therapies which lead people to emotional wellness.
2. The focus of the Programme is spiritual.
3. Referral to Alcoholics Anonymous is cost effective.
4. Research has failed to identify any helping resource which is even close to Alcoholics Anonymous in terms of effectiveness in helping people to achieve long term sobriety.
1. The Scientific Principles of AA and Emotional Wellness
· The programme teaches us to behave ourselves into new ways of thinking and of feeling. It is easier to change what we do than what we think or feel so we do things in that order. In AA, people are asked to go to meetings, read the big book, talk to others (these are all behaviours). Eventually their thinking and their feeling changes. This type of behavioural change is the basis of many therapies.
· It is emotionally healthy to live in the day … in the here and now. No point in saying ‘If only …’ The past is gone. Equally, no point in saying ‘What if…’ we can’t control the future. Professional therapists teach people to live in the present.
· It is emotionally healthy to accept our past experiences, however painful, as past events and move on to a richer, more fulfilling future.
· It is emotionally healthy to surrender and accept things over which we have no control.
• It is emotionally healthy to prioritise problems. The Serenity Prayer is the greatest exercise in prioritisation.
• It is emotionally healthy to accept that we cannot change a particular situation but we can change the way we react to it.
• It is emotionally healthy to be honest with yourself and with others, also to be open and willing to change, to experiment, to encounter new situations.
• It is emotionally healthy to accept yourself as you are.
• It is emotionally healthy to see your environment and interact with it as it is and not as you wish it would be.
• It is emotionally healthy to associate or be in contact with other human beings.
• It is emotionally healthy to be altruistic – to help others without question or expectation.
• It is emotionally healthy to anticipate – to plan for future discomfort or crises. Therefore Step 2 for Step 3, Step 4 for Step 5, Step 6 for Step 7, Step 8 for Step 9.
• Humour and fun are emotionally healthy. Recovery is not gloom and doom. AA is full of humour.
• It is emotionally healthy to be able to temporarily suppress painful feelings or conflict and to think or work on it later when it is more manageable.
The above are just some illustrations of how the Programme works. You might wish to use some examples and relate them to the programme in terms of Steps, slogans, literature, meetings, sponsorship, service etc.
2. The Spiritual Programme
It is important to let professionals know that the programme of Alcoholics Anonymous is uniquely spiritual. It is also important to explain that it is not religious. Spirituality and religiosity are different.
I find it helpful to use Dr. Robert Lefever’s definition of spirituality in order to understand and to explain the difference: –
What is spirituality?
A continuing sense of peace and hope and love.
Recognition that there is more to life than practical day-to-day matters: these are important but not totally important.
A sense of trust that one can learn from experience, however bitter and hurtful, and place it in perspective as a past event from which one can progress to create a richer, more fulfilling future.
A sense of commonality with other human beings.
An awareness that God, as each may understand Him, or Higher Power of some kind (perhaps “the group” or “the creative human spirit within all people”) can give one more understanding and tranquillity than one can gain for one’s self in isolation and that this source of help is dependable.
Addiction to me seems to be about loss of spiritual values:-
Loss of belief in self and others.
Loss of trust in self and others.
Loss of hope in a better future.
Loss of the ability to function in loving relationships.
Belief, trust and love are the great spiritual values. They are restored to people who work the programme of Alcoholics Anonymous. Therefore the Programme is a spiritual programme.
3. Cost Effectiveness
25% of male hospital admissions are alcohol related. 11
Health spending on alcohol related problems is currently estimated at £150 million per year or 4.4% of the total health budget. It is probably much higher than this.
Excessive alcohol consumption is a common cause of high blood pressure, strokes and obesity.
3% of all cancers are linked to alcohol.
Alcohol is a factor in 15% of road deaths, 26% of drowning’s, 39% death in fires.
4,500 people are admitted to hospital each year because of mental health problems due to alcohol.
65% of all suicide attempts are linked with excessive drinking.
The above are just a few of the statistics. You might like to suggest to health professionals that AA could help some of these people and thereby reduce costs.
We need to stress that meetings are widely available. Weekly, same venue, same day and time. There is no cost to the professional and no monetary cost to the alcoholic (although the cost is high to the alcoholic who almost loses his/her life before getting there).
A Different Kind of Share
Another suggestion you might like to consider is to identify an AA member who is prepared to look at the cost to society of his or her drinking, taking into account the obvious costs like hospital admissions, loss of earnings, social security and other benefits paid, accidents, court cases etc. Such a person, if willing, can then share (without going into detail) that his alcoholic drinking took place over an X number of years. The costs can be vast! Then he or she can say that he took his last drink on such and such a date as he found sobriety in AA and that from this moment his cost to society has been ZERO. Doctors and managers will be very interested in this kind of information. Sadly, it may be of more importance to them than hearing about the personal, spiritual and relationship harm you have suffered.
a) Short Term Abstinence
There is plenty of research about which shows that AA is effective in the short term. There is also lots of research which shows that other things are effective in stopping people drinking. These include therapies and counselling, substitution of other drugs like Valium! Also use of Antabuse. Please note that I am not advocating these, I’m just saying that people can produce research to say they work and reduce health care costs.
You will find that professionals can produce research papers in support of almost anything. They can blind us with science.
It is worth knowing that there is a recent breakthrough in the form of 2 alternative drugs called Naltrexone and Acamprosate which are used to suppress craving. These drugs are particularly useful with relapsers and AA members should be aware that they are a useful scientific advance – they are not in the same category as Valium!
b) Long Term Sobriety
However, long term sobriety i.e. years to lifetimes is a different matter altogether.
You can make the point, with absolute confidence, that there is no research anywhere which says that anything is superior to AA in helping people to achieve long term sobriety! Therefore, it makes sense to introduce AA at an early stage and to use AA in combination with other forms of treatment such as counselling and the anti-craving drugs mentioned above.