A Defense of Alcoholics Anonymous
The rationality of the irrational.
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Psychologists regard Alcoholics Anonymous the way Republicans regard Democrats (or vice versa). Their vague vituperation comes off as intimidation rather than information. I’ve heard biologists offer more stable sincerity when talking about intelligent design.
Graduate students who recommend their patients attend an AA meeting have been known to do so without telling their supervisor. Even mentioning AA within the walls of academia without an eye roll never fails to elicit a few eye rolls. I’d say the field’s condemnation of AA is like the Athenian elders’ condemnation of Socrates, but at least that was a trial.
The face-value critiques of AA claim the program isn’t scientific. Concepts like a higher power, tough love, and honesty cannot be measured in the lab, therefore they cannot have psychological validity. Fair enough, but this is like saying a Transformers movie is bad because the plot is incoherent and the characters are glorified cardboard cutouts. Not to mention the cheesy lines that give cheesy lines a bad name. Except Transformers isn’t a movie—it’s a series of images for teenagers to glance at periodically as they go to third base on each other. When scientists try to deconstruct AA from a supposedly rational perspective, they miss the point of the program entirely. This inability to conceptualize irrationality speaks to a larger problem in psychology and how we understand what man is.
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Before we can discuss alcoholism, it’s important to make like the corruptor of the Athenian youth and define the concept. The medical definition is it’s a brain state characterized by certain, low levels of dopamine and serotonin that leads to a preoccupation with alcohol. The new toy in psychology labs is the fMRI machine. So scientists observe brain images of alcoholics, note their lack of dopamine, then conclude alcoholism is caused by a lack of dopamine. And then we look at the MRI of a basketball player’s knee and conclude he plays basketball because his meniscus has deteriorated. This question-begging interpretation of the data is a reminder that fancy machines don’t make us smart. More importantly, it’s a reminder that doing science isn’t the same as knowing what science is. The former requires us to record information like a monkey, the latter requires us to think about problems like a human.
Conceptually—that is, humanistically—alcoholism is, like all addictions, a compulsive disorder. A compulsion is an action we want to stop doing, but we cannot stop doing it through will-power alone. We try to stop biting our nails, yet we wake up, so to speak, in the middle of doing it. We tell ourselves we’re only going to spend a certain amount of money at the store, yet we cannot help but spend more. In compulsive areas of life, we are out of control. This is why some people call addiction a disease, a term that gets a lot of criticism, and for good reason. Though addiction is not technically a disease, it sure feels like one. Calling alcoholism a disease is like calling emotional regulation God—placeholder terminology (ie symbolism) can be helpful when integrating new concepts.
Traditional means of behavior modification through willpower do not work on an alcoholic. If he’s put in jail where he cannot take out his compulsion on booze, the neurosis manifests in other kinds of erratic, dysregulated behavior—like making pruno in his toilet. Compulsion, therefore, is an unconscious protest, a low-order way to deal with the strife of anxiety we cannot, perceptively, manage on our own.
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Alcoholism is mistaken as a bad habit by the scientists. It’s an error based in part on solipsism. They’ve recognized bad habits in themselves, but since the habit wasn’t rooted in a serious compulsion, they were able to change it with behavior modification strategies. They don’t see the irrational in themselves, so they don’t see it in others. It’s similar to the error that has caused the homeless problem in America over the last five decades. One Flew Over the Cuckoo’s Nest came out in the 70s—the hangover decade of the boomers—and we triumphantly concluded as a nation that the mentally ill were no different than the rest of us, so Carter defunded mental hospitals and psychiatric wards. This left the patients on the street, unable to take care of themselves. Then we concluded that we would live in a shelter if we were on the street, so we built more beds than there were homeless, just to be on the safe side of history. The problem persisted, but thankfully, a Republican was President by this point so we could blame it on him.
This obtuse view of addiction has relegated addiction treatment to cognitive-behavior techniques. You’d be surprised how much an alcoholic will pay thousands of dollars to go to a rehab facility only to have a grad student tell him to exercise regularly, make a gratitude list, and eat a piece of cake whenever he felt the urge to drink. Most treatment programs can be boiled down to a moralizing version of Tinkerbell’s “think happy thoughts.”
What scientists find difficult to understand, because psychology isn’t a (hard) science, is alcoholism isn’t a conscious, habituated relationship with alcohol—it’s an unconscious, habituated relationship with anxiety. The alcoholic has been avoiding anxiety for years, which aggravates the anxiety to the point where it becomes a tremendous discomfort, so he is no longer able to manage it on his own without a blackout. No one who has that burden of anxiety would be able to manage it on their own without a blackout. This is difficult for most of us to understand, so the best way for normies to empathize with alcoholics, which I have corroborated with patients, is to imagine the last time we were sick. The runny nose, the coughing, the congested face. These were uncomfortable symptoms we could not regulate on our own. No amount of willpower would get our nose to stop leaking. Any lecture from our father to work hard would only make it worse. We needed to do something counter-intuitive to regulate the symptoms, like drink fluids and binge Netflix. The runny nose isn’t a phenomenon unto itself—it has a deeper cause. Our dopamine levels are probably lower when we’re sick but this doesn’t make them the cause. This is a good approximation of how the alcoholic feels, except instead of being unable to regulate the runny nose, he is unable to regulate anxiety—which feels much worse than boogers. It follows that the alcoholic will gladly prioritize the pint of Popov before even his own progeny.
The Meetings
Only when we understand alcoholism isn’t about booze and never was can we critique Alcoholics Anonymous with insight. The program may not have been formulated through the scientific method, but it was formed by guess-and-check, the hillbilly version of the scientific method. Alcoholics, like our storm god-worshipping ancestors, began to talk with each other about their projections. It made them feel better, so they kept doing it. Anxiety is, physiologically, a neurological load, a stress on the nervous system. In order to manage anxiety in a healthy way, we first need to get comfortable feeling anxiety. Specifically, we need to let our body acclimate to feeling the anxiety. This is what twelve-step meetings unwittingly do.
The meetings generally adhere to the following schedule. A member speaks for about 20 minutes on his experience as a drinker, how he became sober, and then how his life has improved. For the rest of the hour, everyone else relates with the speaker on an emotional level. They take a point in the speaker’s story that resonated with them, and then relate their thoughts and experiences about it. Through this emotional identification, alcoholics train their body to feel the anxiety they’ve been avoiding through booze. By training their bodies to get comfortable with the anxiety, it’s less likely they will drink to feel comfortable with the anxiety. They regulate their anxiety in a healthy way as opposed to avoiding their anxiety through alcohol.
The Twelve Steps
Scientists routinely point to the first step, the admission of powerlessness, as a major fault of the twelve steps. It’s difficult to argue on this point because how can the alcoholic change if he’s powerless? But then I went to an AA meeting to speak with alcoholics. This may not have involved expensive machines but it’s still research. After the first meeting I went for coffee with some of the alcoholics as a psychologist-in-training who had questions about AA. Like innocent men, they were more than happy to talk with me. I challenged them on the powerless point, and their reply was the word only meant they couldn’t become sober by any reasonably method of consciously putting down the drink. They had to go to a meeting and talk with other alcoholics, and through the power of the group they became powerful enough to put down the drink. In my words, they had to regulate their anxiety—which, ultimately, occurs in the presence of others—before they could develop willpower. This of course is the nature of willpower, but I still pushed on the insidious nature of the word “powerless.” They agreed it’s not the best word but no one has to use the terms in the steps, which are more like suggestions than rules. One of the alcoholics had a sponsee who never used the term. Instead of saying “I am powerless over alcohol,” he says “through the power of the group I can be sober.” Which is the truth of addiction. If they could have gotten sober through their own willpower, then by definition they weren’t alcoholics. I went for coffee with AA members after another meeting and asked about the other steps that seemed questionable from the sensibilities of my psychology training. What about emphasis on a higher power? It can be anything, any concept we think is more important than drinking; something we can work toward over and above sobriety. Integrity could be a higher power. Honesty could be a higher power. Emotional regulation could be a higher power. Reality, and contact with it, could be a higher power. Several of the members I met chose connection as their higher power. It’s no coincidence these are all instances of the umbrella term, spirituality. What about step three, which says to turn our will over to a higher power? This is more about the alcoholic’s admission to himself that he isn’t omnipotent, that he cannot control every situation and every person around him. I would call this having a healthy boundary, which delineates what’s in our psychological control from what isn’t, but technicality doesn’t equal profundity. We could all use an admonishment about boundaries, probably every day, probably when we’re in a crowded subway, probably when a girl we like isn’t texting us back. Step four and five involve admitting past wrongs and forgiveness—ie Yom Kippur or Confession for drunks. Steps six and seven involve removing character defects, as AA calls them. I concede this doesn’t make sense because no one knows what removing a defect looks like. If we’re going to remove vanity, for instance, we would need to be the opposite of vain, or vulnerable. But this seems like more of a semantic argument than a reason to throw out the entire program. Steps eight, nine, and ten involve making amends—or connecting with others and being a good human. Step eleven involves reaching out to God. Again, it doesn’t have to be a God, it can be any higher power, supernatural, conceptual, or otherwise. And step twelve requires members to help out each other.
I was surprised by the nonchalance I received from a group that has been criticized for being a cult. Nobody makes a member do a step they don’t want to do. And everyone has their own way of practicing the steps, their own interpretation based on their own set of values. The only common regimen is putting your butt in a chair and helping each other achieve and maintain sobriety. Graduate school is more of a cult than AA.
Certainly, the steps could be worded better, but to criticize the intricacies of AA without seeing how it could be helpful is like missing out on buttering the popcorn because you’re trying to make sense of Shia Labeouf’s backstory.
The Numbers
The scientists are quick to point out AA’s supposedly dismal success rate of five to eight percent. Except these are old numbers based on a guess because meetings are, of course, anonymous. In the past 15 years, rehabs have instituted twelve-step facilitation groups, which are like AA meetings except monitored by professionals. This showed the AA success rate is more like 12 percent, which is the highest success rate of any rehab program. Not even prison deters alcohol use by this much (thanks to the aforementioned pruno). In fact, if the success rate of a single psychologist was even ten percent, as in ten percent of his patients made a full recovery from whatever their neuroses were, he would be the greatest psychologist in the world. When we do find a higher success rate, like at rehabs that boast ones of 70 percent, it’s because their mark of success is based upon the patient’s goal, not sobriety. If a patient’s goal is to have one less beer per week, then that’s a success. If a patient’s goal is to beat his wife one less time per week, then that’s a success. I know of one case in which a 54-year-old woman was drinking three liters of wine per day. Her goal was to cut down to two liters per day, she did, so the facility added that case to the success pile. Two liters (not bottles) per day is a success? This one time I drank about two liters of wine on Thanksgiving Eve and nearly pooped my pants. I cannot imagine how drinking that every day would feel like anything that resembles a success. Of course this patient was divorced, of course she had no children, of course her mom had died recently. But nevermind those issues and her relationship with them. The scientific approach avoids the patient’s anxiety in order to keep the complication to a minimum. The number of drinks is the fact we can quantify; the brute empiricism that undergirds modern science tells us it’s the total of existence. Then we let marketing make her story glisten for the brochure. Success rates will always be high yet sad when there are low standards, which is why postmodern art is terrible.
The truth is, no one knows whether a 12 percent success rate is low. We’re dealing with humans, and though we may be intelligent, we have many interesting qualities that temper our intelligence. An anorexic takes seven trips to rehab to recover. A positive outcome for a schizophrenic is the mere delaying of his inevitable suicide. Psychologists write off physically-aggressive six-year-olds because their chance of a miniscule level of function as an adult is effectively zero. Even the best among us rarely offer the consistency required to change. By criticizing AA on a low success rate, we punish them for their high standards. We could just as well criticize an oncologist whenever a cancer patient dies. But the only people who do that are Suzanne Summers, Jenny McCarthy, and other formerly attractive starlets who get batty as they age. We cannot break down psychology to numbers—all we can do is go on what we know: Anxiety is the cause of compulsions, including alcoholism, and emotional identification helps us to manage anxiety in a healthy way. When it comes to figuring out the complex nature of the psyche, there is, as AA members say, no perfection, only progress.
Narcissus
Scientists take a program that is the best at achieving full sobriety, and in place they offer a hodgepodge of behavior modification that is, at its best, just as good. This makes us wonder whether scientists want to help, or whether they merely enjoy criticizing. One symptom of unmanaged anxiety is compulsive behavior like alcoholism, but another symptom is excessive criticism, or criticism for the sake of criticism, aka perfectionism. It’s true, the twelve steps could be worded better, the literature is stodgy, and “higher power” isn’t the most accurate description of what alcoholics need. But this isn’t the base of the scientists’ criticism. If it was, then they would offer ways to improve AA, to move the 12 percent to 14 percent. Don’t get me wrong, criticism for its own sake is fun, but let’s at least be honest about why we do it. Besides, there’s little evidence we could improve AA by making it technically correct. This has already been done through modifying the twelve-step facilitation groups, and they’re not shown to be any more effective. Indeed, we could argue part of AA’s therapeutic nature is the fact that the twelve steps do not jive with our modern sensibilities and grammar. This indicates a common misconception: therapy is about finding some great truth and bringing it back to the masses—it’s Zarathustra coming down from the mountaintop— it’s the Constitutional Convention developing a philosophy for a nation. Wrong. Psychologists think they’re archeologists when they are in fact the tool makers. Our job isn’t to delve into the depths to bring back great truths. This is philosophy, not psychology. Psychological truth is creating a structure through which we can discover insights about our emotion and behavior. Part of this structure entails connecting with various types of people, especially people we wouldn’t normally associate with. To manage our psychology is to become ever more a part of the world, which means to get along with people who we think are stupid. It means having arguments so we can figure out how to resolve arguments. Alcoholism is a disorder, and so is writing off a group because the number of its steps coincides with the number of apostles.
To think the world must cater to our sensibilities before we can reach out is to be Narcissus. What we forget about Narcissus is that when he became transfixed on his reflection in the pond, he didn’t think he was looking at a reflection. He thought he was looking at someone else. This was his madness. He thought he was with another person yet he was alone. That’s why he didn’t move, that’s why he didn’t grow, that’s why he has served as the symbol of arrested development for more than 2,000 years. And that’s the problem with criticizing AA on its technicalities. The disorder is anxiety, but the aggravator of anxiety is to think we need answers instead of a process.
The AA Effect
When I attended a meeting to research this article, I went as an observer, I went as a student of psychology. My drinking routine suited me quite well thank you very much. But the therapy of the meetings was unexpectedly powerful, and without planning I stopped drinking for more than a month. I didn’t try to stop; I didn’t intend to stop; I didn’t exercise my willpower in any traditional way. The first meeting I attended was on Friday morning, and that night, when I would have usually had a bottle of wine with my steak, I simply didn’t drink it. I didn’t walk by the liquor store—rather, I noticed myself walk by the liquor store as though I was an impartial observer. The meetings create a space where people can be honest with each other, emotionally honest, which is rare. The honesty was healing—honesty always is healing. The man who spoke at the meeting had the same problems I had, he had the same problems we all had. His were quantitatively worse, perhaps much worse, but qualitatively they were the same—anxiety, depression, not fitting in, regret, making a mess of things, hurting others. Sure, I haven’t been arrested 16 times, or stayed up for three days doing coke, or punched my girlfriend in the face. But only a rationalizer who mistakes facts for science would see any difference between the speaker’s life and mine. A single movie, even a Transformers movie, connects millions of people for the same reason. Physical sobriety is the tip of emotional sobriety, and emotional sobriety is the crux of psychological health. It’s natural to turn away from the disorder, but a group of people approaching it allows us to approach it. Their honestly gives us permission to be more honest. Regulation is the archetype for further regulation.
Irrationality is Rational
Last year I ran a 12-week-long therapy group for men. In each session our goal was to get one member to express an emotion, then for the rest of us to feel that emotion and then respond with whatever broken sentences came to mind while feeling that emotion. As in an AA meeting, we were training our nervous system to handle the tension of emotional discomfort. By doing it in a group in a healthy way, we were much less likely to do it alone in an unhealthy way. Science says the rationality of behavior modification and motivation makes us sober, but AA says alcoholism is irrational, and so it cannot respond to rationality. To forge this communication gap, we see the irrational isn’t irrational—it’s merely a language the rationality doesn’t understand. The point isn’t to get one to win out over the other, but for both sides to recognize they’re on the same coin. It’s true in recovery as well as in life. It doesn’t matter what our neurosis is, whether we procrastinate, remain aimless, cower in the presence of anger, or cannot talk to girls. I’ve never seen a man who was able to manage any of these issues with a brute force of will on his own. Rather than try to crush the dysfunction, we press against it. Submersed in the pain, we find will, rationality, or at least a clearer head, ready to do for us what we were unable to do for ourselves.
