Society is rarely keen on constructive measures to help alcoholics. Aid is expensive and grossly intrusive (alcoholism is, I think, the only non-infectious physical disease for which you can be sectioned or locked away for the good of society). There are no votes in it as there are, say, in breast cancer, child leukaemia, or even – after Leah Betts, killed by injudicious intake of Ecstasy – adolescent pill-popping. The condition is notoriously intractable and drunks are (as most think) a wholly lost cause by the time that medical intervention becomes an issue. Say ‘cure’ to an alcoholic and he will see in his mind’s eye incarceration and the straitjacket, not the happy-ever-after of a sober life.
Society uses an arsenal of blunt instruments to keep drinking in check. Licensing was brought in – after some dramatic explosions – during the First World War to stop munitions workers (flush with all the overtime pay) drinking before and during work. In T.S. Eliot’s 1922 poem, the call ‘Drink up, please, it’s time’ was as topically new as ‘I did not have sexual relations with that woman’ was in 1998. The law has been gradually relaxed, and licensing, after 100 years, is virtually a dead-letter in the UK. In metropolitan areas, the dedicated drinker can find a sales outlet at any hour of the day or night. There remain some vexatious anomalies (sometimes you have to buy a meal, or pay a membership fee to some fictional club; there are price hikes for drinking at anti-social hours). It may be a good thing. Informed opinion suggests that licensing actually exacerbates problem drinking, encouraging as it does ‘bouts’, ‘binges’ and ‘Time, ladies and gentleman, please!’ gulping.
Excise duty on drink is one of the oldest and most easily collected forms of taxation (it can be traced back to the Anglo-Saxon period). As a ‘sin tax’, it has the added attraction that it can be raised to astronomical levels (as it has been in Scandinavian countries) without effective protest. Indeed, this can be seen by the official mind as a form of taxation that is actually good for the taxpayer. Of course, it never works that way. It is astonishing what other comforts of life drinkers will do without to carry on drinking. Excise is the one source of income the Exchequer can always rely on: boom or slump. (I have always thought it significant that the Chancellor traditionally sips whisky and water while delivering his annual Budget statement.)
Prohibition in Western societies is nowadays imposed by age qualification (the ‘RU 16?’ query in British pubs, ‘carding’ in American bars where the age of permission is, in many states, an absurd 21). Ever since the ‘noble experiment’ failed in America, total banning of drink – a war on alcohol equivalent to the war on drugs – has not been attempted in a Western society (there is a persuasive revisionist reading of American Prohibition, which argues that it did, for a short period, produce a healthier if unhappier population).
Over the last 50 years, savagely punitive strategies have been selectively applied, partly in response to pressure from such groups as MADD and moral panics about football hooligans. Drunks are more likely, nowadays, to find themselves in prison (or walking to work). Paradoxically, there has been at the same time greater social tolerance for skid-row destitution. Time was, 50 years ago, that street inebriates would be moved on or arrested as drunk and incapable. Now, in most Western cities (unless there is some great public event, like the Olympic Games), they are permitted to lie in the gutters and doss in doorways unhindered.
Sex and drug education is a big deal in schools. But not alcohol education. Bizarrely, in Britain, serious instruction on ‘sensible drinking’ is outsourced to the suppliers of drink, through such bodies as the Portman Group (a lobby subsidised by the brewers and distillers; foxes and hen-coops come to mind).
In America, bottles and containers carry warnings (especially for pregnant women); but not in the UK. Education of the young – incorporating practical experiments in the classroom – might well be a very effective way of training the young to handle a risky product, as they'll be bombarded with advertising for it every day of their adult lives. But no political party is going to risk electoral suicide by advocating seminars on controlled boozing in schools. The unofficial drinking schools that form in university union bars are notoriously reckless: nurseries for alcoholism ten years down the road.
The cures which the medical profession has devised for alcoholism have their vogue, only to be replaced with more voguish successors. All seem to say more about the period in which they originate than the nature of the condition. What they have in common is a general tendency not to work. The one remedy which does (perhaps) work is Alcoholics Anonymous.
AA was the invention of two men. Robert Smith (‘Dr Bob’), a proctologist, stolid by nature, and a heavy drinker (at least, given his specialism, he never had to breathe in his patients’ faces), had, despite his habit, contrived to hold down his professional job and family in the middle-sized mid-American town of Akron, Ohio. In 1935, when he touched bottom, the other man, 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 happy thought that talking to another drunk might stave off another disastrous session. One thing led to another: clandestine meetings, the invention of the ‘anonymity’ gimmick, the Big Book, ‘12 steps’, ‘12 traditions’, worldwide expansion.
AA had some obvious historical precursors (notably the Washington Temperance Society). And one can speculate plausibly about supra-personal, socio-historical forces that combined to form AA at this particular time: 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.
From the apostolic few who gathered in the basement of King School in Akron, Ohio, in June 1935, AA has grown into the largest secular self-help organisation for sick people in the Western world. It’s bigger than the Masons, Oxfam, the Rotarians, the Elks, the Trades Union Congress, the White Aryan Resistance, the Samaritans, the Ku-Klux Klan, the Women’s Institute, and – in terms of dutiful weekly attendance – the Church of England.
AA is big. So is alcoholism. But the fellowship’s corporate grandeur 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 effective the ‘Program’ is therapeutically. Estimates vary from the 75-per-cent success rate claimed in the fellowship’s more optimistic promotional material to the bleak word-of-mouth wisdom (current in LA meetings) that ‘only one in 30 makes it to a six-month chip’.
There is some evidence for the pessimistic view. ‘Old-timers’, as they are affectionately called, observe that in most groups newcomers outnumber them. If, as they like to say, ‘It works!’, the population of the long-term sober in AA should grow year by year into a majority. It doesn’t. Is it because members graduate from the fellowship into truant sobriety? Or, horrible thought, do most of those who pass through the meetings ‘lapse’?
AA, one concludes, is either the only nationwide, affordable alcoholism treatment that truly works, or it is a gigantic con: the drinker’s grandest illusion. No one knows for sure. My own view (based on two decades of intermittent attendance in the US and the UK) is that AA rescues three kinds of alcoholic. ‘Low-bottom’ drunks who have lost everything else can creep into the fellowship and live an institutionalised existence. Like Poor Tom’s hovel, AA is their shelter from the storm of the real world.
The second kind to derive help from AA is the ‘high-bottom’ alcoholic on the brink. Someone, that is, who still has a job, a family, a place in society – but who is in imminent risk of drinking all that away. For such drunks (I was one of them), AA supplies a breathing space and a springboard back to a sober, or at least more controlled, way of life.
The third, and most interesting of those who thrive in AA, are the virtuosos of the fellowship: mystics of sobriety and gurus of recovery. My guess is that the majority of those who come to meetings eventually go out to continue their drinking careers as unsaved by AA as by all the other remedies: atropine aversion therapy, antabuse, ECT, acupuncture, snake-pits – and, doubtless, in a year or two, gene-replacement therapy.
Authorities in the US take a very upbeat view of AA; it is, after all, as American as its airline namesake. The Program is integrated into court-sentencing practice in many states. Convicted DUIs (intoxicated drivers) are routinely obliged, in addition to other humiliations (handcuffing, a night in the drunk tank), to attend a course of AA or NA (Narcotics Anonymous). Typically, this means attendance at a dozen meetings.
In large conurbations these pressed men can nowadays make up a sizable part of the AA 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 pissed in both the American and British senses of the term, they can’t wait to get their court cards signed and reclaim their driving privileges.
Whether attendance is conceived by American judges as condign punishment (like Volpone being confined with the incurabili), as rehabilitation, or as moral tagging is unclear. It’s likely the courts do it as a sop to the immensely powerful pressure group, MADD (who would really rather drunk drivers were strung up on piano wire). Court-coerced drunks benefit little from AA – but they give the organisation a valued seal of official approval.
AA has similarly come to serve as an approved outpatient facility for the American health industry. Medical-benefit policies are specific about what treatment they will provide for addiction – typically a chronic and intractable condition. Coverage tends, in most plans, to be limited to a month per year, per family member.
Residential care for alcoholics – in what used to be called sanatoriums – is costly: the cheapest institutions run at around $5,000 to $10,000 a week; the most fashionable (such as the Betty Ford Clinic, at the delightfully named Rancho Mirage) cost much more. They are strange institutions, with something of the penitentiary about them. Their anthem should be Amy Winehouse’s ‘Rehab’ (she, tragically, died of drink aged 27).
The health management organisations (HMOs), which were set up in the US in the 1980s specifically to keep medical costs under control, take a similarly dim view of alcohol rehabilitation. If you are hospitalised for a drinking problem in the US, what routinely happens is a crash-course of ‘detox and counselling’, after which (within a few weeks at most) the still trembling patient is released into AA on a fire-and-forget basis. The prospect for these unfortunates is poor.
In its totality, 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 directly communicate with each other, with HQ, or with the outside world. The Tenth Tradition is fundamental to the operation of these bodies: ‘AA has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.’ The fellowship has no views on politics or on anything (even alcoholism). It is 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.
Nothing is emptier than the AA purse. The organisation accumulates no cash, capital or material assets. There are good reasons for this austerity. Alcoholics (whether practising or recovering) are hopeless with money. As well give them whisky. Those groups which collect funds to set up their own premises or accumulate treasuries for good works inevitably collapse 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 with a dollar in the basket – 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 any harm.
The ritual of the AA meeting is familiar even to lifelong teetotallers from (usually melodramatic) depictions on film and TV. The alcoholic enters the meeting denuded of his or her identity, with only a forename between them and the similarly nameless group. The speaker ‘qualifies’ by confession: ‘My name is [Nicholas or Mary] and I am an alcoholic.’ If the speaker is a newcomer, a hearty round of applause will follow this bald proclamation. After that, beans are spilled. It is not merely identity that is blanked out by the anonymity gimmick – but social rank and hierarchical status. It is conceivable that a judge and the criminal he has sentenced can meet in a meeting. I once, to our mutual embarrassment, came face to face with a junior colleague.
There are two main varieties of AA meeting: ‘Speaker’ and ‘Participation’. As the names suggest, in one you will listen, in the other you may talk. The discourse in the Participation groups is distinctive. Dialogue (in AA-speak, ‘cross-talk’) is proscribed. One does not address one’s fellow-alcoholics, one ‘shares’. It looks to the outsider like seminar discussion but isn’t. It’s a bunch of people musing aloud; a kind of self-willed collective autism; pure Samuel Beckett. The ban on cross-talk is, like much else in AA’s procedure, prophylactic. Bad things happen when alcoholics communicate too directly with each other, as any bartender knows. Tempers are lost, fists are raised, nails brandished, knives and guns come out.
The disciplines and practices of AA are paradoxical in the highest degree – but not crazier than drinking, as its members never tire of pointing out. Warmth is overpowering within the group. But outside the group members shun each other’s company. There are no Masonic handshakes or codewords. 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 socket 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 dutifully attends, the newcomer will probably need day-round support: a babysitter, 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-sponsee relationship flouts the non-hierarchical conventions, the prohibition on cross-talk and the anonymity principle. It can lead to emotional dependency and exploitation. There are suggested safeguards. Cross-gender sponsorship is strongly discouraged. Ideally, the sponsor should be the elder of the pair (in years and sobriety) – allowing a mellowly avuncular relationship to develop. But sponsoring is fraught with difficulty and is a component of the AA machine that often goes wrong. It is abuse of the sponsoring relationship that led, most recently, to accusations that AA is a cult – scientology for drunks.
Bill W. and Dr Bob’s organisation is, of course, much nobler than L. Ron Hubbard’s bunco scheme. AA meetings are, with baseball games, the only truly democratic events in America. The typical AA group is an omnium gatherum in which all sectors of American life and society are represented in conditions of genuine social equality. Alcoholism is no respecter of class.
Clustered around the big meetings are myriad self-selecting grouplets (usually Participation meetings) of a more homogeneous kind: tinkers, tailors, soldiers, sailors, rich men, poor men, beggar-men, thieves all have their own AA sessions. These tend to be closed occasions, unadvertised in the fellowship’s ‘blue book’ or websites. They can be hard to find unless you doubly ‘qualify’. Many Hollywood stars, for example, attend AA. But you won’t find yourself sitting next to Christian Slater or Robert Downey Jr– unless you happen to be in the industry and making seven-figure alimony payments. There is no copyright on the 12-step Program and any number of imitative therapies have borrowed it: Al-Anon, Al-Ateen, Chocanon, MA (Marijuana Anonymous), Weightwatchers. Most are pallid imitations.
AA’s theology and medical science are primitive but serviceable. The movement was largely inspired by Frank Buchman’s Oxford Movement (the same movement that gave us Moral Rearmament and Mrs Whitehouse). True to its enthusiastic origins, AA believes in the regenerating effect of ‘total’ confession of sin and human 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 ‘Power’). Evangelical Christianity remains the dominant flavour in AA’s ideological mix. There are few more culturally perplexing sights than seeing a group in, say Beverly Hills, composed largely of alcoholic Jews having to finish a meeting with a choric recitation of the Lord’s Prayer.
The ‘higher power’ to which AA members are obliged to surrender themselves as their second step to sobriety is manifestly the deity of Billy Graham, Lord Longford and Jeanette Winterson’s mother. AA has always been an aggressively evangelical movement. The twelfth and final step – that of carrying the AA message to the ‘alcoholic who still suffers’ – imposes the role of proselyte on every active member of the fellowship (if I were conscientious, I would insert a website address here).
Medically, AA cleaves to the disease concept of alcoholism. Those ‘alcoholics who still suffer’ are conceived to be in the grip of an illness that is ‘cunning, baffling and powerful’. The recovering alcoholic is never cured – but must imagine himself in a kind of protracted 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 the alcoholism progresses inexorably, even when you are not drinking. Should you fall off the wagon, after 20 years of 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 alcoholics, by the end of their drinking careers, have not committed offences that the sober mind shudders at. But, although AA subscribes to the disease of alcoholism, it despises the medical establishment whose business disease is. Routinely at meetings, scorn is 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 for disliking doctors and psychiatrists and for jeering at their ignorance (despite the fact that doctors themselves are notoriously prone to alcoholism). Traditionally, the medical schools and teaching hospitals of America and Europe have given their students abysmally inadequate instruction on the nature of the ailment.
Many alcoholics who apply for treatment find the conventional health services too busy to mollycoddle sots like them. There are patients with real illnesses to treat: broken bones, cancer and acne. Sitting two hours after appointment time in the waiting room at the Maudsley hospital in south London (Bedlam, as it once was), with a splitting hangover, in the company of the stark staring mad is a foretaste of hell. AA bases its good works on the shrewd analysis that drunks know better how to deal with fellow-drunks than doctors for whom drunks are a job of work or raw material for a 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. And genuinely wanted.
The trickiest aspect of the AA Program is its moral prescriptions. While accepting that the alcoholic is sick, AA enjoins them none the less to ‘make direct amends’ for past misdeeds committed under the influence. From a purely practical point of view, this Ninth Step is a vital part of the Program. It requires the penitent husband and father, 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 AA applies to this phase of recovery. AA, originating as it did in small-town America, is strenuously 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 the victim of disease – no more responsible for his misdeeds than a tubercular is for coughing. Yet, at the same time, he should regard himself as a repentant sinner who must fully atone for what he has done. Recovery, as AA defines it, requires energetic doublethink to be brought to a successful conclusion.
The architecture of the AA meeting is a mixture of the rigid and the fluid. Speaker meetings are organised around a liturgy of quite stunning tedium: readings from the Big Book, 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 freefall or those whose sobriety is fragile. The structure is always there and always the boring same; a reassuringly solid thing in a dangerously liquid world.
What is rarely boring is the drunkard’s tale, which every Speaker meeting features. 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 theatrical display of ego. The dominant rhetoric is a kind of Twainian vernacular. At American AA 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 red-neck 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.
Can AA survive? It has outlasted the death of its founders (Dr Bob went 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 tricky. The Big Book, the fount of AA wisdom, is – after 60 years and some ten million sales – creakingly anachronistic. A glaring example is the crucial Fourth Step, which obliges alcoholics to make ‘a searching and fearless moral inventory of ourselves’.
‘Making moral inventory’ is a figure of speech that would have made perfect sense to a 1930s white-collar clerical worker – a Dagwood Bumstead or a Babbitt – 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’). The notion of ‘making inventory’ makes less sense to multi-addicted Hispanic kids from the barrio for whom small stores are something you break into.
What is most valuable in AA and should not be lost is the set of pragmatic tools that it has evolved over the years; its working parts. It remains, as a no-cost and (probably) effective treatment for an insolubly epidemic problem, the brightest of America’s thousand points of light. But the movement desperately needs a New Testament and a Messiah for the new millennium. Jesus C. where are you?