From the apostolic few who gathered in the basement of King School in Akron, Ohio, in June 1935, Alcoholics Anonymous has grown into the largest secular self-help organisation in the Western world. With its ten million members, it’s bigger than the Freemasons, the Rotarians, the TUC, the White Aryan Resistance, the Samaritans, the KKK, the Women’s Institute and – in terms of weekly attendance – the Church of England.
But if AA is big, so is alcoholism. If you accept the modest estimate that 10 per cent of the adult population of this country are problem drinkers then you will conclude that the LRB readership will contain some 10,000 of them. And that 1.5 contributors per issue might have to be so classified. According to the campaign group Alcohol Concern’s latest bulletin, three out of four British adults have had their lives severely disrupted by their own or someone else’s alcohol abuse.
Alcoholism is destructive: every few months some committee or other tots up the zillions of pounds it costs the country in terms of road accidents, premature death, burdens on the health service, family breakdown, suicide, homicide, assault, domestic violence, homelessness and police time. Not to mention all the personal misery. Yet faced by so much destruction and epidemic unhappiness, society displays an amazing degree of alcohol unconcern. Abuse is serenely tolerated. If a pretender to the premiership boasts of having drunk, in his youth, 14 pints in one day, or the current Prime Minister’s son is found paralytic in Leicester Square after downing many pints, it is seen as a manly rite of passage. Beer Street is as wholesomely British as it was in Hogarth’s day (not so Drug Lane).
AA rests on mysterious foundations. Given the inviolable ‘tradition’ of anonymity (‘the spiritual foundation of all our traditions, ever reminding us to place principles before personalities’) no one actually knows how therapeutically effective its 12-step Program is. Estimates vary from the 75 per cent success rate claimed in its wilder promotional material to ‘only one in thirty makes it to a six-month chip,’ the chip being a plastic counter commemorating half a year’s sobriety. ‘Old timers’, as they are affectionately called, discover that in most groups they are outnumbered by newcomers. If, as AA likes to say, ‘It works!’, the long-term sober should grow year by year into a majority, but they don’t. Is it because members graduate into truant sobriety? Or, horrible thought, do most of those who pass through the meetings ‘lapse’?
In short, AA is either the only nationwide, affordable treatment for alcoholism that works, or the drinker’s grandest illusion. No one knows for sure. My own view is that it rescues three kinds of alcoholic: ‘low-bottom’ drunks who have lost everything else can creep in and live an institutionalised existence – like Poor Tom’s hovel, AA is their shelter from the storms of the real world. Then there is the ‘high-bottom’ alcoholic on the brink, someone who still has a job, a family, a place in society, but is at imminent risk of drinking it all away. For such drunks, AA supplies a breathing space and a possible springboard back to a sober, or at least more controlled way of life. The third, and most interesting, group are those who are rescued by AA, going on to become paragons of sobriety. Aside from these three classes of the saved, however, my guess is that the majority of those who go to meetings eventually re-emerge to continue their drinking careers, unsaved by AA as by all the other remedies: atropine aversion therapy, Antabuse tablets, ECT, Primal Scream Therapy, acupuncture, snake pits – and, in a year or so, doubtless, gene replacement therapy.
Legal authorities in the US take an upbeat view of AA. The Program is taken into account in court sentencing practice in many states. Convicted drunken drivers are routinely obliged, in addition to such other humiliations as being handcuffed and made to spend a night in the drunk tank, to attend a course run by AA or NA (Narcotics Anonymous). Typically, this means attending a dozen meetings. In large conurbations such people can make up a sizeable part of the congregation. They tend to be a surly crew, not least because they have had to come to the meeting by public transport. Baffled by the proceedings and frequently both pissed and pissed off, they can’t wait to get their court cards signed and reclaim their driving privileges.
Whether this compulsory attendance is seen by American judges as condign punishment (like Volpone being confined with the incurabili), rehabilitation or moral tagging is unclear. It’s likely that courts impose it as a sop to the powerful pressure group, Mothers against Drunk Drivers (MADD, who would really prefer drunk drivers to be strung up on piano wire). Drunks forced by the courts to attend meetings benefit little from AA, but they give the organisation a valued seal of official approval.
AA has come to serve similarly as an out-patient facility for the American health industry. Insurance policies are specific about what treatment they will or won’t pay for. Coverage for addiction tends, in most plans, to be limited to a month a year per family member. Residential care for alcoholics – in what used to be called sanatoriums – is costly: the cheapest institutions charge around $5000 a week, while the most fashionable (such as the Betty Ford Clinic, at the delightfully named Rancho Mirage) charge much more. The Health Management Organisations which were set up in the 1980s to keep costs under control take a dim view of alcohol rehabilitation. If you are hospitalised for a drinking problem what you routinely get is a crash course of ‘detox and counselling’, after which (within a few weeks or even days) the still trembling patient is released into AA on a fire-and-forget basis. The prospect for these unfortunates is poor.
Organisationally, AA resembles nothing so much as a terrorist network. There is no central organisation as such, just a honeycomb of cells on the ground, none of which communicates directly with any of the others, with HQ or with the outside world. This is fundamental: ‘AA has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.’ It has no views on politics or on anything (even alcoholism); it’s pure praxis. On the ideological level, it remains faithful to its founder Dr Bob’s dying injunction to the faithful: ‘keep it simple’ – empty, that is, of complicating doctrine or confusing theory.
Nor does AA have any money; it accumulates no cash, capital or material assets. There are good reasons for this austerity. Alcoholics (whether practising or recovering) are hopeless with money, you might as well give them whisky. Those groups which collect funds to set up their own premises or accumulate resources to do good works inevitably come apart in a welter of recrimination and relapse. AA survives by virtue of its peculiar brand of communism. There are no dues, it will not accept bequests. Meetings are self-supporting: usually you put a dollar in the basket – this is the seventh tradition. Any money surplus to immediate requirements (typically, the hire of a dusty church hall, an urnful of acrid coffee and some cookies) is given away before it can do harm.
The ritual of the AA meeting is familiar even to lifelong teetotallers, from melodramatic depictions of it in films and on TV. The alcoholic enters the meeting denuded of identity, with only a forename to share between him or her and the similarly nameless group. The speaker ‘qualifies’ by confession: ‘My name is X and I am an alcoholic.’ If the speaker is a newcomer, a hearty round of applause will follow this proclamation. After which, beans are spilled. It is not merely identity which is blanked out by the anonymity, but social rank and job status, too. It is conceivable for a judge and the criminal he has sentenced to come face to face again at a meeting. Once, to our mutual embarrassment, I came face to face with my secretary.
There are two main kinds of AA meeting, known as ‘speaker’ and ‘participation’. In one you must listen, in the other you may talk. The form of discourse in participation groups is distinctive. Dialogue (in AA-speak, ‘cross-talk’) is proscribed. You don’t address your fellow alcoholics, you ‘share’. It looks to the outsider like a seminar discussion but isn’t; it’s a bunch of people musing aloud: a kind of collective autism, pure Beckett. The ban on cross-talk is, like much else in AA’s procedures, prophylactic. Bad things can happen when alcoholics communicate too directly with each other, as any bartender knows. Tempers are lost, fists are raised, knives and guns come out.
The disciplines and practices of AA are paradoxical in the highest degree, though no crazier than those of drinking, as members never tire of pointing out. Togetherness is overpowering within the group, but outside its members shun each other’s company. There are no Masonic handshakes or code-words. This, too, is motivated by prudence. Alcoholics are typically dysfunctional individuals – particularly with each other. The first informal advice newcomers tend to be given is (1) never borrow money or lend it to a fellow alcoholic; (2) never buy a car from a fellow alcoholic; (3) above all, never fuck a fellow alcoholic. Outside the cloying intimacy of the group, it is a fellowship of strangers.
An exception is made for the ‘sponsoring’ relationship – something universally encouraged but not formalised by the Program. Newcomers are always told to immerse themselves in AA: 90 meetings in 90 days is the standard prescription. At its simplest, this is a weaning process; something to fill the huge hole left in the former drinker’s life where booze used to be. It is also, as any psychologist will recognise, standard induction routine, especially when associated with physical exhaustion (few detoxing drunks sleep well). But however many meetings he attends, the newcomer will probably need day-round support: a baby-sitter, that is, to call when a ‘slip’ is imminent – perhaps at some grossly anti-social hour of the night. This is where the ‘sponsor’ comes in.
Necessarily, the sponsor-sponsored relationship flouts the convention whereby rank or status is ignored, along with the prohibition on cross-talk and the anonymity principle. It can lead to emotional dependency and exploitation, although there are safeguards against this. Cross-gender sponsorship is strongly discouraged. Ideally, the sponsor should be the older of the pair (not only in years but in sobriety), allowing a mellowly avuncular relationship to develop. But sponsoring is fraught with difficulty and is a component of the AA system that often goes wrong. It was abuse of the sponsoring relationship that led, most recently, to accusations that AA is a cult, scientology for drunks.
As well as the big meetings, AA also contains many self-selecting grouplets (usually participation meetings) of a more homogeneous kind: rich men, poor men, beggar-men, thieves all have their own sessions. These tend to be closed occasions, unadvertised in the fellowship’s ‘blue book’ or on its websites. They can be hard to find unless you have a double ‘qualification’. Many Hollywood stars, for example, attend AA, but you won’t find yourself sitting next to Michael Douglas unless you happen to be in the industry and making seven-figure alimony payments. There is no copyright on the 12-step formula and any number of look-alike therapies have borrowed it: Al-Anon, Al-Ateen, Chocanon, MA (Marijuana Anonymous), Weight Watchers. Most are pale imitations.
Both the theology and the medical philosophy of AA are primitive but serviceable. The movement was largely inspired by Frank Buchman’s Oxford Group (the same movement that gave us Moral Rearmament and Mrs Whitehouse), and true to its enthusiastic origins, it believes in the regenerating effect of a ‘total’ confession of sin and inadequacy: ‘We admitted we were powerless over alcohol [but] came to believe that a Power greater than ourselves could restore us to sanity’ (in the original 1939 formulation, the salvationary word was ‘God’, not ‘a Power greater than ourselves’). Evangelical Christianity remains the dominant flavour in the ideological mix. There are few more culturally perplexing sights than that of a group in, say, Beverly Hills, composed largely of alcoholic Jews, having to finish a meeting with a recitation of the Lord’s Prayer. The higher power to which members are obliged to surrender themselves as their second step to sobriety, is manifestly the deity of Billy Graham and Jeanette Winterson’s mother. AA has always been an aggressively evangelical movement. The 12th and final step, of carrying the message to the ‘alcoholic who still suffers’, imposes the role of proselyte on every active member (if I were conscientious, I would insert a website address here).
Medically, AA cleaves to the idea that alcoholism is a disease, seeing those ‘alcoholics who still suffer’ as being in the grip of an illness which is ‘cunning, baffling and powerful’. The recovering alcoholic is never cured – but must imagine himself in a protracted state of remission; as with the diabetic, relapse is always imminent (particularly if you stop going to meetings – the insulin analogy is often made). AA holds to the superstition that alcoholism progresses inexorably, even when you are not drinking. Should you fall off the wagon, after twenty years’ sobriety, your disease will be two decades more terminal. ‘Rust,’ as Neil Young (the alcoholic’s favourite balladeer) puts it, ‘never sleeps.’
The belief that they are victims of an illness allows recovering alcoholics to forgive themselves for the awful things done in drink. Few, by the end of their drinking careers, have not committed offences the sober mind shudders at. But although AA subscribes to the disease theory, it despises the medical establishment whose business disease is. At meetings, scorn is routinely poured on the ‘ignorant professionals’. As a favourite joke puts it: ‘there are those who say doctors don’t know everything. And there are those who say doctors don’t know nothing.’ AA is firmly of the second party. Alcoholics have good reason to dislike doctors and psychiatrists and to jeer at their ignorance (despite the fact that doctors themselves are notoriously prone to alcoholism), for traditionally, the medical schools and teaching hospitals of America and Europe have given their students abysmally inadequate tuition on the nature of the ailment.
Many alcoholics who apply for treatment find the conventional health services too busy to mollycoddle sots like them, when there are patients with real illnesses to treat: broken bones, cancer, acne. Sitting for two hours after appointment time in the waiting room at the Maudsley (Bedlam, as it once was), with a splitting hangover, in the company of the stark staring mad, is the drunken Rake’s foretaste of hell. AA bases its good works on the shrewd analysis that drunks know better than doctors how to deal with fellow drunks. For doctors, drunks are a job of work or raw material for some career-advancing research project. AA places special stress on welcoming rituals, designed to allay the newcomer’s crippling shame and make him feel at home.
The trickiest aspect of the programme is all the moral prescription. While accepting that the alcoholic is sick, AA nonetheless enjoins him to ‘make direct amends’ for past misdeeds committed under the influence. This ‘ninth step’ requires the penitent husband, for example, to go back to his injured family, to square things with his cheated partner, and settle up with his creditors as best he can. ‘Cleaning house’ is the homely metaphor applied to this phase of recovery. Originating as it did in small-town America, AA is vigorously opposed to what it scornfully calls ‘geographical’ cures: that is, making a new start in a new place. You get sober where you got drunk.
The amends business is, however, deeply contradictory. The alcoholic is reassured he is no more responsible for his misdeeds than a tubercular is for coughing. Yet, at the same time, he is to regard himself as a repentant sinner who must fully atone for what he has done. Recovery, as AA defines it, requires this strenous doublethink to be brought to a successful conclusion.
Procedures at AA meetings are a mixture of the rigid and the fluid. Speaker meetings are organised around a liturgy of quite stunning tedium: readings from the ‘Big Book’, repetitious prayers, the award of monthly chips and anniversary cakes (accompanied by toe-curling choruses of ‘Happy Birthday’), hand-holding, embracing, chants (‘Hi, John!’). This is evidently necessary to create a structure for the incoming drunk in free fall or those whose sobriety is fragile. The structure is always there and always the same; a reassuringly solid thing in a dangerously liquid world.
What is rarely boring is the drunkard’s tale, which every speaker meeting includes. It occupies the central position of the sermon in a conventional church service. ‘Our stories,’ as the AA dogma puts it, ‘disclose in a general way what we used to be like, what happened, and what we are now.’ Every drunk has a story in him; AA wants to hear it. Speakers are applauded for their skill and humour in telling their stories (homily and gravity are disliked; a little pathos is OK). For large meetings, the invitation to speak is honorific and the best speakers build up a faithful following.
Participation meetings follow the Quaker pattern. They tend to be patronised by alcoholics well beyond the tremulous 90-day threshold, initiates who have learned how to talk the talk. They talk as the spirit moves. Often an abstract theme will be proposed: ‘Faith’, ‘Hope’ or ‘Charity’, for example. But the subsequent ‘sharing’ quickly becomes a freewheeling affair; anecdotes, not stories, predominate. The dynamics of both kinds of meeting put a premium on eloquence and a theatrical display of ego. The dominant rhetoric is a kind of Twainian vernacular. At American meetings you will find descendants of ring-tailed roarers, pork barrel philosophers, stand-up comedy of a high order, wit and a broad vein of redneck shrewdness. It can be very entertaining. As much fun as drinking, as they like to say, but without the hangover and all for a dollar.
Matthew J. Raphael (a coy pseudonym used to protect his alcoholic’s anonymity) investigates the life and personality of the flakier of the two men who created AA in 1935. Robert Smith (‘Dr Bob’) was a proctologist, stolid by nature and a heavy drinker. William Wilson (‘Bill W.’) was a failed stockbroker and a fully-fledged dipsomaniac. At a Faustian moment in Akron’s Mayflower Hotel – poised between the bar and the telephone – Wilson had the thought that by talking to another drunk, he might save himself from drunkenness. One thing led to another.
Raphael is good on AA’s precursors (notably the Washington Temperance Society) and the socio-historical forces that formed it: the Roaring Twenties, Prohibition, the 1929 crash (which ended Wilson’s good times) and the 1930s cult of heroic drinking (which led to AA’s cult of heroic abstention) celebrated in the work of such contemporaries as Scott Fitzgerald and Ernest Hemingway. Raphael sees Wilson – the moving hand behind the ‘Big Book’ (which came out in 1939) – as primarily a writer: an illuminating approach.
He also touches on the co-founder’s ‘character defects’ (as AA likes to term them): his womanising, his borderline egomania, his recurrent depressions, his dabbling with Catholicism, his bizarre experiments with LSD in the 1960s. Raphael is particularly good on the dilemmas of fame which afflicted Wilson in his later years. After he had appeared on the cover of Time (as ‘Bill W.’ with his face turned away) he felt his ‘true individuality dissolving into a cult of personality that he had himself coveted and helped to create’. He was, by the end of his life, the most famous anonymous man since Junius.
Alcoholics Anonymous has outlasted the death of its founders (Dr Bob died in 1950, Bill W. in 1971), but the fellowship’s apparatus is clearly in need of some doctrinal overhaul – something that its lack of central organisation, or living patriarchs, renders difficult. The Big Book is, after 60 years and some ten million sales, creakingly anachronistic. A glaring example is the crucial ‘fourth step’, obliging alcoholics to make ‘a searching and fearless moral inventory of ourselves’.
‘Making a moral inventory’ is a figure of speech which would have made perfect sense to a 1930s white-collar worker – a Dagwood Bumstead or a George Follansbee Babbit – familiar with small-store stock-control. It would make sense to a grocer’s daughter from Grantham (‘Our name is Margaret, and we are not an alcoholic’). It makes less sense to a multi-addicted Hispanic kid from the barrio for whom small stores are something you break into.
What is most valuable in AA and should on no account be lost are the pragmatic tools it has developed over the years. It remains, as a no-cost and (probably) effective first-line treatment for an insoluble epidemic problem, since no health service in the Western world is going to put real money into helping drunks.