Alcoholics Anonymous (A. A.) and W.S.J.

Alternatively titled, This Doc Says Thumbs Up When it Comes to A.A.

I'm going to say it. I know it sounds hokey. But some of the best people I've ever met in therapy (patients of mine) have been people who got sober in Alcoholics Anonymous.

What makes someone "best?" And what's W.S.J. got to do with A.A.?

I think of people as "best" when they give back, work hard, think of others, delay gratification, know how to appreciate and use their own gifts, and know what it means to be grateful to be alive. I could add to the list, I guess, but those are starter goals for humans.

Okay, the W.S.J. is the Wall Street Journal. W.S.J. just published in defense of A.A., Alcoholics Anonymous, since A.A. supposedly needed defending. The scientific community has been hankering for the A.A. program to be evidence-based, meaning proven effective scientifically, preferably with double-blind social science experiments.

A.A. members can't participate in double-blind studies because they're in it for the anonymity. There are no lists of members. Oh, and they want to get better, probably, not play around as guinea pigs.

Why does the scientific community have to prove interventions such as A.A. to be evidence-based (or not)? Social science research justifies spending on interventions and programs.

But Alcoholics Anonymous actually costs NOTHING, as the article points out. Revenue from books and charitable contributions last year amounted to 13.2 million. Expenses were 12.9 million (according to W.S.J.) Not particularly a high roller business, you know?

The Journal also mentions that alcoholics who go to therapy and also go to A.A. have three times the abstinence rate of people who go to therapy and don't go to A.A. Way to go, W.S.J. Substantiates what I've thought all along.

That little experiment was possible because if you pay for inpatient treatment (or your insurance pays), then you can become a participant in a double-blind study, with consent, of course. But you are captive in a hospital, so maybe you don't care at the time consent forms are placed in front of you. Your anonymity in the hospital is protected, of course, but you can still be on a list of eligible subjects of study.

Although there are 53,000 different Alcoholics Anonymous support groups in the U.S., there are no lists of attendees to randomize controls for study.

The one thing A.A. has in it's favor, besides the price tag, is 71 years of cumulative coping strategies to pass on to its members. For free.

What kind of strategies?

Many of them are so sensible you wonder how they get to take the credit.

90 meetings in 90 days. Or you can go to three meetings a day for thirty days. Any combination of 90 meetings in 90 days is okay. You have to stay sober, I'm pretty sure, during this time frame. Then you get a coin, a token, and it's very meaningful. You also get one at the end of a year's sobriety. Probably there are others, too.

You have the option of getting a sponsor, someone you can call any time of day and night to scream the following: "I can't take it, blank it, I really want a drink," and your sponsor will say something like, "So where are you, wha'cha' doin', who's with you, let's meet at such and such a place. . ." or will stay on the phone and talk you down.

You make real friends. What's a real friend? A real friend is someone who loves you even though you're not drinking together. The friends of alcoholics are usually alcoholics. They sit and drink together, perhaps grouse and talk, watch sports or soaps, but mainly drink together. That's the bond.

A real friend hangs out, talks, lets you cry on his shoulder, stops you from drinking, suggests better coping strategies, steers you away from doing stupid things, steers you toward the things he/she knows will make you happy.

And the program has all kinds of little affirmations, little sayings that give people hope. I can't think of any just now, I'm not in the program, but occasionally someone will show me a calendar or a daily affirmation book, and they're cool.

Affirmations are life affirming. People who drink too much can get pretty depressed, which usually means their world view becomes the opposite of life affirming. They are also likely to suffer from anxiety disorders. A new study at the University of Illinois in Chicago(yay) found a gene that is missing in mice (well, one of two is missing, I think) that might be associated with the link between anxiety and alcoholism.

Members of A.A. believe it's a good idea to get in touch with a Higher Power daily, or to at the very least think about the meaning in your life, one's purpose, one's place in the world. It can be meditation, prayer, whatever, but a day shouldn't go by without some attention to things outside one's self, the ol' Higher Power bit. Agnostics and atheists have their own groups, of course.

People who go to A.A. start to feel like they're a part of a community, an international community of others with shared values. Values are a very big deal, and yes, they're primarily Judeo-Christian values about loving your fellow man, helping others, getting off the pity pot and diving head first into living.

The little sayings you see on bumper stickers? It works if you work it. One day at a time. Turn it Over. Let Go, Let God. They have thousands of these little sayings that are corny but meaningful and true.

I wrote a post on Turn it Over. Perhaps worth your time, Religious Nut or Not

The 12-Steps? Sometimes they work, sometimes they confuse and obfuscate the purpose of the program, make the immediate task seem so daunting and difficult that people give up on the whole shabbang when they get stuck.

But for millions of people, working the steps can be therapeutic.

I tell people not to get too hung up on steps. Do your best to work a program, to work on steps, but work the A.A. program because it offers much more than the way to Nirvana via a bunch of challenges (steps). The socialization alone is priceless.

Those who feel A.A. won't work for them usually think they can have a drink or two, and that's just fine if it's true.

SO MANY PEOPLE, HOWEVER, CAN NOT DRINK MODERATELY, THAT IT'S GENERALLY UNWISE FOR A PROFESSIONAL TO TELL PEOPLE, GO AHEAD AND BE A "CONTROLLED DRINKER." (controlled drinking is 2 drinks or less, assuming one doesn't get into trouble under the influence of those 2 drinks.)

I'll tell people to try controlled drinking, but to expect to fail. Alcoholics aren't alcoholics because they can control they're drinking. When they find they're still making asses out of themselves, they'll go to A.A.

All of the above, by the way, applies to addictions to other substances like cocaine, heroin, meth, marijuana, etc.

There are better ways to have fun than getting stoned.

IT'S THE COPING STUFF that makes A.A. work for people.

71 years of coping strategies.

I know it's not for everyone, but believe me, one thing A.A. doesn't need is social science to back it up.

Finally a spin from the media on therapy that makes sense.

Copyright 2006, TherapyDoc