A COLLECTION OF TWENTY-EIGHT REVIEWS
OF THE BASIC TEXT OF ALCOHOLICS ANONYMOUS
NEW YORK TIMES, June 25, 1939
BY Percy Hutchison
Alcoholics Anonymous. 400 pp. New York: Works Publishing Company. $3.50
Lest this title should arouse the risibles in any reader 1st me state that the general thesis of "Alcoholics Anonymous" is more soundly based psychologically than any other treatment of the subject I have ever come upon. And it is a subject not to be neglected, for, irrespective of whether we live under repeal or prohibition, there will be alcohol addicts, precisely as there are drug addicts. It is useless to argue that under one legal condition or another the number will be less or more. When populations are to be reckoned in the million, fractions cease to count. Under prohibition alcohol will be manufactured and bootlegged, as it was during our late "noble experiment," precisely as narcotics are today smuggled and bootlegged. It is, consequently, the individual only who has to be considered, not the problem of supply and dissemination. Alcoholics Anonymous is unlike any other book ever before published. No reviewer can say how many have contributed to its pages. But the list of writers should include addicts and doctors, psychiatrists and clergymen. Yet it is not a book of personal experience, except in a limited sense, any more than it is a book of rules and precepts. Whether the author of any given chapter can be physician or addict, the argument comes hack to a single fundamental; and that is that the patient is unable to master the situation solely through what is termed "will power," or volition. One contributor, who thought he had "got by" on a diet of milk, one day said to himself that he could safely add a little whiskey to his lacteal nourishment. He did. And then a little more, and then a little more. In the end, he was back to the Sanitarium. His "will" was operating one hundred Per cent; yet there was a fallacy somewhere. It is to root out this fallacy and supplant it that this book has been compiled. The present reviewer, since this is no ordinary publication, believes it only fair that he should state that at one time he advanced fairly deeply into the field of psychology and he is free to state that the entire superstructure of "Alcoholics Anonymous" is based on a psychology of volition that he himself once advanced but which was never universally acceded to. And that is what we glibly call "will," and usefully so in general practice, should for scientific accuracy be reduced to more elemental terms. And, such an effort made, what results? Just this. That volition, "will power," tracked to its source, is the automatic and irrefutable working of a dominating idea. Consider Napoleon, the man of indomitable will. What does it, in this final psychological analysis, came down to? It comes down to the fact that so exclusively did Napoleon's mind contain the idea that he was the man of destiny that there was no room for any other idea, so that every act, every "willed" action, was the unconscious result of, flowed from, that idea. Here, then, is the key to "Alcoholics Anonymous," the great and indisputable lesson this extraordinary book would convey. The alcoholic addict, and why not change, should it seem we have become too intense, to "the drug addict," cannot, by any effort of what he calls his "will," insure himself against taking his "first dose." We saw how the chap with his whiskey in milk missed out. There is one way for our authors, and but one way. The utter suffusion of the mind by an idea, which shall exclude any idea of alcohol or of drugs. Better, let us say the usurpation of the entire ideational tract by this idea. The idea itself may be, perhaps, fairly trivial. Such as: I do not like alcoholic drinks. In fact, my stomach revolts at their mention. Those who appear to dominate these pages apparently would not subscribe to so simple a formula as I have proposed. But my point is that it might be sufficient; and I base this on the book itself, provided only that their thesis flood, so to speak, the entire ideational tract. Yet would that be possible? Or possible for long? That is the question. And, as a matter of fact, those several authors give it short shrift. I have advanced it solely to exhibit the stark psychological trail on which we have walked. The thesis of the book is, as we read it aright, that his all-embracing and all-commanding idea must be religious. Yet here again should the reader pause, for the writers are talking of what William James celled "Varieties of Religious Experience" rather than matters of individual faith. There is no suggestion advanced in the book that an addict should embrace one faith rather than another. He may fall back upon an "absolute," or "A Power which makes for righteousness" if he chooses. The point of the book is that he is unlikely to win through unless he floods his mind with the idea of a force outside himself. So doing, his individual problem resolves into thin air. In last analysis, it is the resigning word: Not my will, but Thine, he done, said in the full knowledge of the fact that the decision will be against further addiction. Most readers will pass this book by. Yet of such a majority many might not be amiss in turning its pages. There but for the grace of God, goes_____. A few will reach for it furtively. It is a strange book. The argument, as we have said, has a deep psychological foundation.
JOURNAL-LANCET, Vol.46, July, 1939
A NEW APPROACH TO PSYCHOTHERAPY IN CHRONIC ALCOHOLISM
By W.D. Silkworth, M.D. New York, New York
The beginning and subsequent development of a new approach to the problem of permanent recovery for the chronic alcoholic has already produced remarkable results and promises much for the future this statement is based upon four years of close observation. As this development is one, which has sprung up among alcoholic patients themselves and has been largely conceived and promoted by them, it is felt that this new treatment can be reported freely and objectively.
The central idea is that of a fellowship of ex-alcoholic men and women banded together for mutual help. Each member feels duty bound to assist alcoholic newcomers to get upon their feet. These in turn work with still others, in an endless chain. Hence there is a large growth possibility. In one locality, for example, the fellowship had but three members in September, 1935, eighteen months later the three had succeeded with seven more These ten have since expanded to ninety.
It is much more than a sense of duty, however, which provides the requisite driving power and harmony so necessary for success. One powerful factor is that of self-preservation. These ex-alcoholics frequently find that unless they spend time helping others to health they cannot stay sober themselves. Strenuous, almost sacrificial work for other sufferers is often imperative in the early days of their recovery. This effort proceeds entirely on a good will basis It is an avocation. There are no fees or dues of any kind, nor do these people organize in the ordinary sense of the word.
These ex-alcoholic men and women number about one hundred and fifty. One group is scattered along the Atlantic seaboard with New York as a center. Another, and somewhat larger body, is locate in the Middle West. Many walks of life are represented, though business and professional types predominate. The unselfishness, the extremes to which these men and women go to help each other, the spirit of democracy, tolerance and sanity which prevails, are astonishing to those who know something of the alcoholic personality But these observations do not adequately explain why so many gravely involved people are able to remain sober and face life again.
The principle answer is each ex-alcoholic has had, and is able to maintain, a vital spiritual or "religious" experience. This so-called "experience" is accompanied, by marked changes in personality There is always, in a successful case, a radical change in outlook, attitude and habits of thought, which sometimes occur with amazing rapidity, and in nearly all cases these changes are evident within a few months, often less.
That the chronic alcoholic has sometimes recovered by religious means is a fact centuries old. But these recoveries have been sporadic, insufficient in numbers or impressiveness to make headway with the alcoholic problem as a whole.
The conscious search of these ex-alcoholics for the right answer has enabled them to find an approach, which has been effectual in something like half of all the cases upon which it has been tried. This is a truly remarkable record when it is remembered that most of them were undoubtedly beyond the reach of other remedial measures.
The essential features of this new approach, without psychological embellishment are:
1. The ex-alcoholics capitalize upon a fact, which they have so well demonstrated, namely: that one alcoholic can secure the confidence of another in a way and to a degree almost impossible of attainment by a non-alcoholic outsider.
2. After having fully identified themselves with their "prospect" by a recital of symptoms, behavior, anecdotes, etc., these men allow the patient to draw the inference that if he is seriously alcoholic, there may be no hope for him save a spiritual experience. They cite their own cases and quote medical opinion to prove their point. If the patient insists he is not alcoholic to that degree, they recommend he try to stay sober in his own way. Usually, however, the patient agrees at once. If he does not, a few more painful relapses often convince him.
3. Once the patient agrees that he is powerless, he finds himself in a serious dilemma. He sees clearly that he must have a spiritual experience or be destroyed by alcohol.
4. This dilemma brings about a crisis in the patient's life. He finds himself in a position, which, he believes, cannot be untangled by human means. He has been placed in this position by another alcoholic who has recovered through a spiritual experience. This peculiar ability, which an alcoholic who has recovered exercises upon one who has not recovered, is the main secret of the unprecedented success, which these men and women are having. They can penetrate and carry conviction where the physician or the clergyman cannot. Under these conditions, the patient turns to religion with an entire willingness and readily accepts, without reservation, a simple religious proposal. He is then able to acquire much more than a set of religious beliefs; he undergoes the profound mental and emotional change common to religious "experience" (See William James' Varieties of Religious Experience). Then too, the patient's hope is renewed and his imagination is fired by the idea of membership in a group of ex-alcoholics where he will be enabled to save the lives and homes of those who have suffered as he has suffered.
5. The fellowship is entirely indifferent concerning the individual manner of spiritual approach so long as the patient is willing to turn his life and his problems over to the care and direction of his Creator. The patient may picture the Deity in any way he likes. No effort whatever is made to convert him to some particular faith or creed. Many creeds are represented among the group and the greatest harmony prevails. It is emphasized that the fellowship is non-sectarian and that the patient is entirely free to follow his own inclination. Not a trace of aggressive evangelism is exhibited.
6. If the patient indicates a willingness to go on, a suggestion is made that he do certain things which are obviously good psychology, good morals and good religion, regardless of creed.
a. That he make a moral appraisal of himself, and confidentially discuss his findings with a competent person whom he trusts.
b. That he try to adjust bad personal relationships, setting right, so far as possible, such wrongs as he may have done in the past.
c. That he recommit himself daily, or hourly if need be, to God's care and direction, asking for strength.
d. That, if possible, he attend weekly meetings of the fellowship and actively lend a hand with alcoholic newcomers.
This is the procedure in brief. The manner of presentation may vary considerably, depending upon the individual approached, but the essential ingredients of the process are always much the same. When presented by an ex-alcoholic, the power of this approach is remarkable. For a full appreciation one must have known these patients before and after their change.
Considering the presence of the religious factor, one might expect to find unhealthy emotionalism and prejudice. This is not the case however; on the contrary, there is an instant readiness to discard old methods for new ones, which produce better results. For instance, it was early found that usually the weakest approach to an alcoholic is directly through his family or friends, especially if the patient is drinking heavily at the time. The ex-alcoholics frequently insist, therefore, that a physician first take the patient in hand, placing him in a hospital whenever possible If proper hospitalization and medical care is not carried out, this patient faces the danger of delirium tremens, "wet brain" or other complications After a few days' stay, during which time the patient has been thoroughly detoxicated, the physician brings up the question of permanent sobriety and,' if the patient is interested, tactfully introduces a member of the ex-alcoholics group. By this time the prospect has self-control, can think straight, and the approach to him can be made casually, with no intervention by family or friends. More than half of this fellowship has been so treated. The group is unanimous in its belief that hospitalization is desirable, even imperative, in most cases.
What has happened to these men and women? For years, physicians have pursued methods, which bear same similarity to those outlined above. An effort is being made to procure a frank discussion with the patient, leading to self-understanding. It is indicated that he must make the necessary re-adjustment to his environment. His cooperation and confidence must be secured. The objectives are to bring about extraversion and to provide someone to whom the alcoholic can transfer his dilemma.
In a large number of cases, this alcoholic group is now attaining these very objectives because their simple but powerful devices appear to cut deeper than do other methods of treatment because of the following reasons:
1. Because of their alcoholic experiences and successful recoveries they secure a high degree of confidence from the prospects.
2. Because of this initial confidence, identical experience, and the fact that the discussion is pitched on moral and religious grounds, the patient tells his story and makes his self-appraisal with extreme thoroughness and honesty. He stops living alone and finds himself within reach of a fellowship with whom he can discuss his problems as they arise.
3. Because of the ex-alcoholic brotherhood, the patient, too, is able to save other alcoholics from destruction. At one and the same time, the patient acquires an ideal, a hobby, a strenuous avocation, and a social life, which he enjoys among other ex-alcoholics and their families. These factors make powerfully for his extraversion.
4. Because of objects aplenty in whom to vest his confidence, the patient can turn to the individuals to whom he first gave his confidence, the ex-alcoholic group as a whole, or the Deity. It is paramount to note that the religious factor is all-important even from the beginning. Newcomers have been unable to stay sober when they have tried the program minus the Deity.
The mental attitude of the people toward alcohol is interesting. Most of them report that they are seldom tempted to drink. If tempted, their defense against the first drink is emphatic and adequate. To quote from one of their number, once a serious case at this hospital, but who has had no relapse since his "experience" four and one-half years ago: "Soon after I had my experience, I realized I had the answer to my problem. For about three years prior to December 1934 I had been taking two and sometimes three bottles of gin a day. Even in my brief periods of sobriety, my mind was much on liquor, especially if my thoughts turned toward home, where I had bottles hidden on every floor of the house. Soon after leaving the hospital, I commenced to work with other alcoholics. With reference to them, I thought much about alcohol, even to the point of carrying a bottle in my pocket to help them through the severe hangovers. But from the first moment of my experience, the thought of taking a drink myself hardly ever occurred. I had the feeling of being in a position of neutrality. I was not fighting to stay on the water wagon. The problem was removed; it simply ceased to exist for me. This new state of mind came about in my case at once and automatically. About six weeks after leaving the hospital my wife asked me to fetch a small utensil, which stood on a shelf in our kitchen. As I fumbled for it, my hand grasped a bottle, still partly full. With a start of surprise and gratitude, it flashed upon me that not once during the past weeks had the thought of liquor being in my home occurred to me. Considering the extent to which alcohol had dominated my thinking, I call this no less than a miracle. During the past your pears of sobriety I have seriously considered drinking only a few times. On each occasion, my reaction was one of fear, followed by the reassurance, which came with my new found ability to think the matter through, to work with another alcoholic, or to enter upon a brief period of prayer and meditation. I now have a defense against alcoholism which is positive so long as I keep myself spiritually fit and active, which t am only too glad to do."
Another interesting example of reaction to temptation comes from a former patient; now sober three and one-half years. Like most of these people, he was beyond the reach of psychiatric methods. He relates the following incident:
"Though sober now for several pears, I am still bothered by periods of deep depression and resentment. I live on a farm, and weeks sometimes pass in which I have no contact with the ex-alcoholic group. During one of my spells I became violently angry over a trifling domestic matter. I deliberately decided to get drunk, going so far as to stock my guesthouse with food, thinking to lock myself in when I had returned from town with a case of liquor. I got in my car and started down the drive; still furious. As I reached the gate I stopped the car, suddenly feeling unable to carry out my plan. I said to myself, at least I have to be honest with my wife. I returned to the house and announced I was on my way to town to get drunk. She looked at me calmly, never saying a word. The absurdity of the whole thing burst upon me and I laughed and so the matter passed. Yes, I now have a defense that works. Prior to my spiritual experience I would never have reacted that way."
The testimony of the membership as a whole sums up to this: For the most part, these men and women are now indifferent to alcohol, but when the thought of taking a drink does come, they react sanely and vigorously.
This alcoholic fellowship hopes to extend its work to all parts of the country and to make its methods and answers known to every alcoholic who wishes to recover as a first step, they have prepared a book called Alcoholics Anonymous*. A large volume of 400 pages, it sets forth their methods and experience exhaustively, and with much clarity and force. The first half of the book is a text aimed to show an alcoholic the attitude he ought to take and precisely the steps he may follow to affect his own recovery. He then finds full directions for approaching and working with other alcoholics. Two chapters are devoted to working with family relations and one to employers for the guidance of those who surround the sick man. There is a powerful chapter addressed to the agnostic, as the majority of the present members were of that description. Of particular interest to the physician is the chapter on alcoholism dealing mostly with its mental phenomena, as these men see it.
By contacting personally those who are getting results from the book, these ex-alcoholics expect to establish new centers. Experience has shown that as soon as any community contains three or four active members, growth is inevitable, for the good reason that each member feels he must work with other alcoholics or perhaps perish himself.
Will the movement spread? Will all of these recoveries be permanent? No one can say. Yet, we at this hospital, from our observation of many cases, are willing to record our present opinion as a strong "Yes" to both questions.
*EDITOR'S NOTE. The book, Alcoholics Anonymous ($3.50) may be secured from The Alcoholic foundation, Post Box 658, Church Street Annex, New York City.
Works Publishing Company
Church Street P.0. Box 657
New York City...400pp....
Reviewed by - DR. HARRY EMERSON FOSDICK
This extraordinary book deserves the careful attention of anyone interested in the problem of alcoholism. Whether as victims, friends of victims, physicians, clergymen, psychiatrists or social workers there are many such, and this book will give them, as no other treatise known to this reviewer will, an inside view of the problem which the alcoholic faces. Gothic cathedral windows are not the only things, which can be truly seen only from within. Alcoholism is another. All outside views are clouded and unsure. Only one who has been an alcoholic and who has escaped the thralldom can interpret the experience.
This book represents the pooled experience of one hundred men and women who have been victims of alcoholism -- many of them declared hopeless by the experts -- and who have won their freedom and recovered their sanity and self-control. Their stories are detailed and circumstantial, packed with human interest. In America today the disease of alcoholism is increasing. Liquor has been an easy escape from depression. As an English officer in India, reproved for his excessive drinking, lifting his glass and said, "This is the swiftest road out of India," so many Americans have been using hard liquor as a means of flight from their troubles until to their dismay they discover that, free to begin, they are not free to stop. One hundred men and women in this volume, report their experience of enslavement and then of liberation.
The book is not in the least sensational. It is notable for its sanity, restraint, and freedom from over-emphasis and fanaticism. It is a sober, careful, tolerant, sympathetic treatment of the alcoholic's problem and of the successful techniques by which its co-authors have won their freedom. The group sponsoring the book began with two or three ex-alcoholics, who discovered one another through a kindred experience. From this personal kinship a movement started, ex-alcoholic working for alcoholic without fanfare or advertisement, and the movement has spread from one city to another. This book presents the practical experience of this group and describes the methods they employ.
The core of their whole procedure is religious. They are convinced that for the hopeless alcoholic there is only one way out - the expulsion of his obsession by a Power greater than himself. Let it be said at once that there is nothing partisan or sectarian about this religious experience. Agnostics and atheists, along with Catholics, Jews and Protestants, tell their story of discovering the Power Greater Than Themselves. "WHO ARE YOU TO SAY THAT THERE IS N0 GOD," one atheist in this group heard a voice say when, hospitalized for alcoholism, he faced the utter hopelessness of his condition. Nowhere is the tolerance and open-mindedness of the book more evident than in its treatment of this central matter on which the cure of all these men and women has depended.
They are not partisans of and particular form of organized religion, although they strongly recommend that some religious fellowship be found by their participants. By religion they mean an experience which they personally know and which has saved them from their slavery, when psychiatry and medicine had failed They agree that each man must have his own way of conceiving God, but of God Himself they are utterly sure, and their stories of victory in consequence are a notable addition to William James' "Varieties of Religious Experience."
Although the book has the accent of reality and is written with unusual intelligence and skill, humor and modesty mitigating what could easily have been a strident and harrowing tale. - Harry Emerson Fosdick
THE CHRISTIAN SCIENCE MONITOR
Boston, August 17, 1939
BREAKING THE DRINK HABIT
In view of the extent of liquor consumption in the United States since the repeal of national Prohibition, a book recently published on the subject of liquor addiction and its remedy seems designed for a wide usefulness. This volume is entitled "Alcoholics Anonymous," issued by the Works Publishing Company in New York and contributed to by authors with experience in the overcoming of the drink habit.
The thesis of this book, as summarized by one reviewer, is that will power is not enough to enable the patient to break the hold of alcoholism, that he is more likely to win through if he suffuses his consciousness completely with some commanding idea which excludes the thought of alcohol or stimulants, and that for the surest prospect of success this overwhelming interest should be religion - "the idea of a force outside of himself."
It has indeed been proved true in case after case that something more than individual will power - or "won't" power - is necessary in order to heal what at least one special sanitarium recognizes in its advertising as "a disease "What indeed could be more effective than an absorbing conviction that, in the words of David, "God is my strength and power and he maketh my way perfect." fortunately thousands are finding this knowledge a sure and gratifying defense.
JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION
ALCOHOLICS ANONYMOUS: By various writers. Cloth price $3.50. Works Publishing Co., 17 William St., Newark, N.J.
Over one hundred men and women who have recovered from a seemingly hopeless state of mind and body have contributed to this book. The stories of these individuals in their struggles physically and mentally to overcome alcoholic addiction are gripping. A physician writes in the introduction that the action of alcohol in chronic alcoholism is a manifestation of allergy. Therefore, hospitalization and proper treatment is often necessary to free the patient from his craving for liquor. When the mind is clear he is a candidate for psychological measures. This book deals principally with such measures as exemplified in the stories of alcoholics.
NEW ENGLAND JOURNAL OF MEDICINE
Vol. 221(15), October 12, 1939
ALCOHOLICS ANONYMOUS: The story of how more than one hundred men have recovered from alcoholism. 400 pp. New York Works Publishing Co., 1939, $3.50.
The psychological aspect of alcoholism taxes the entire skill and intuition of the therapist, and the authors of this book claim that in the long run the ex-alcoholic patient who is properly trained in psychological method is an extremely effective person to bring about the cure of the neurotic alcoholic individual.
The first part of the book discusses methods, with particular stress on twelve steps in the recovery program. This program includes the general principles of psychotherapy found in such books as those by Durfee and Peabody. There is, however, an essentially new note, namely, that the alcoholic individual should be helped to admit to God, to himself and to another human being (preferably an ex-alcoholic patient) the exact nature of his personality deficit Some will perhaps shy from the emphasis on God and religion until it is realized that the alcoholic patient is asked in this relation to believe sincerely in a power greater than himself. He then sees that his life is really unmanageable without this power.
The second part contains the stories of twenty-nine individuals who were cured by the method of working out their character problems in relation to God, themselves and another human being. All these individuals were "convinced by an ex-alcoholic therapist" Those who at some time must deal with the problem of alcoholism are urged to read this stimulating account
The authors have presented their case well, in fact, in such good style that it map be of considerable influence when read by alcoholic patients.
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Vol. 113(16), October 14, 1939
ALCOHOLICS ANONYMOUS. The story of how more than one hundred men have recovered from alcoholism. Cloth. Price $3.50. 400 pp.. New York: Works Publishing Company. 1939.
The seriousness of the psychiatric and social problem represented by addiction to alcohol is generally underestimated by those not immediately familiar with the tragedies in the families of victims or the resistance addicts offer to any effective treatment. Many psychiatrists regard addiction to alcohol as having a more pessimistic prognosis than schizophrenia. For many pears the public was beguiled into believing that short courses of enforced abstinence and catharsis in "institutes" and "rest homes" would do the trick, and now that the failure of such temporizing has become common knowledge, a considerable number of other forms of quack treatment have sprung up. The book under review is a curious combination of organizing propaganda and religious exhortation. It is in no sense a scientific book, although it is introduced by a letter from a physician who claims to know some of the anonymous contributors who have been "cured" of addiction to alcohol and have joined together in an organization, which would save other addicts by a kind of religious conversion. The book contains instructions as to how to intrigue the alcoholic addict into the acceptance of divine guidance in place of alcohol in terms strongly reminiscent of Dale Carnegie and the adherents of the Buchman ("Oxford") movement. The one valid thing in the book is the recognition of the seriousness of addiction to alcohol Other than this; the book has no scientific merit or interest.
ILLINOIS MEDICAL JOURNAL
January 20, 1940
TO THE EDITOR: Of great interest to the medical profession is the new approach to a cure for chronic alcoholism developed by alcoholics themselves.
Every physician has been confronted with the problem of the incurable alcoholic. He who although sobered and apparently sane as a result of medical aid suffers the usual and expected relapse and returns to the physician or to the sanitarium for another round of treatment. In his remorse he solemnly rejects alcohol in any form. He then endures a short period of sobriety and again returns to drunkenness.
Alcoholics are the last to admit their ability to "drink like gentlemen," and therefore are prone to devise ways and means, or systems for indulgence, which although inaugurated with sincere intent at the time seem never to serve their purpose. They act only as the forerunners to bigger and better sprees.
The chronic alcoholic seldom can be cured until he reaches a point at which he admits his inability to cope with his problem and has in addition a sincere desire to achieve complete and lasting sobriety.
The chronic alcoholic resents the efforts made by his relatives and friends to help him. He feels they do not understand him nor his problem. But when he talks to people who themselves have been drunkards he realizes that these people do understand for they have had the same personal experiences.
WITNESS: There is a book on alcohol you should read. It is published by The Alcoholic Foundation of New York (P.0. Box 658, Church Street Annex, New York). It's title: "Alcoholics Anonymous "The unnamed alcoholics write their own stories, and those stories are dynamite.
Two-thirds of them, they claim, have laid the foundation for permanent recovery. "More than half of us have had no relapse at all (after treatment) despite the fact that we have often been pronounced incurable "How were they cured? The method is simple: first of all they admitted they were powerless to overcome alcohol by themselves; second, they came to believe that "a Power greater than ourselves could restore us to sanity;" third, they made a decision to "turn our will and our lives over to the care of God as we understood Him"
There is more to the cure, but that's the heart of it. There may be some confirmed drinkers who will sneer at the method and the procedures, but they can't laugh off the fact that it has worked where other methods and procedures have failed.
JOURNAL OF NERVOUS AND MENTAL DISEASE
Vol. 42(3), September 1940.
ALCOHOLICS ANONYMOUS: How more than one hundred men have recovered from alcoholism. (New York: Works Publishing Company, Church St. Annex P.C., $3.50.)
As a youth we attended many "experience" meetings more as an onlooker than as a participant. We never could work ourselves up into a lather and burst forth in soapy bubbly phrases about our intimate states of feeling. That was our own business rather than something to brag about to the neighbors. Neither then nor now do we lean to the autobiographical, save occasionally by allusion to point a moral or adorn a tale, as the ancient adage put it.
This big book, i.e. big in words, is a rambling sort of camp meeting confession of experiences, told in the form of biographies of various alcoholics who had been to a certain institution and have provisionally recovered, chiefly under the influence of the "big brothers get together spirit." Of the inner meaning of alcoholism there is hardly a word. It is all on the surface material.
Inasmuch as the alcoholic, speaking generally, lives a wish-fulfilling infantile regression to the omnipotent delusional state, perhaps he is best handled for the time being at least by regressive mass psychological methods, in which, as is realized, religious fervors belong, hence the religious trend of the book. Billy Sunday and similar orators had their successes but we think the methods of Forel and of Bleuler infinitely superior.
AMERICAN ASSOCIATION OP PSYCHIATRIC SOCIAL WORKERS
(The story of how more than one hundred men have recovered from alcoholism.)
Publishing Company; 400 pages
This review covers the book, a discussion with the authors, and attendance at the meetings of the New York City group of Alcoholics Anonymous. Contact with this group increases one s respect for their work. To the layman, the book is very clear. To the professional person it is as first a bit misleading in that the spiritual aspect gives the impression that this is another revival movement. The book is simply and clearly written. It gives a vivid picture of the emotional predicament of the person suffering from serious alcoholism. It presents the disorder as a disease; a fatal disease in the social and physical sense. People who have benefited from the treatment tell their story in simple, compelling language. There are excellent descriptions of what happens to the family of an alcoholic. There is a sincerity and enthusiasm about the writing of this work that commands attention.
ALCOHOLICS ANONYMOUS seems to have succeeded in cases where the physician, the clergyman, the psychiatrist, or the social worker have failed. The method works only with the patient who really wants to get well; who is willing to face the truth about himself - his prejudices, his infantilism, his evasions. It effects its most phenomenal results with the patient who has gone so far that unless he does something drastic he will either become insane, kill himself in drink, or commit suicide. The patient must be willing to admit that he has failed, that he has no power over his drinking, that the "wet-nursing" of his family only makes him worse, that he must do this thing alone. In this frame of mind he selects someone to listen to his story but for the first time in his life he is being really honest with himself and admitting that he is responsible for the mess he has made of his life. When he must prove that he is willing to face reality by trying to patch up some of the antagonisms he has created around him. Then he is ready for some deeper reorganization of patterns. It is a sink or swim psychology; there is no pampering by the group and no protection. The group accepts the newcomer as an adult who really wants to get well; they will show him how but they won't do it for him. Having admitted he has no power over his drinking, he must be willing to allow a higher power to help him. This is no ready-made spiritual formula; it is not a church religion. It is a spiritual experience that somehow even extreme atheists seem to have been able to achieve. (One can watch the process of this change at the meetings of the group). The last step in the cure, the part that keeps the patient from slipping back into drink, is that he devotes himself to helping other alcoholics. The movement is kept alive by this type of work.
It is more impressive to the professional person to watch the technique in action than to read the book. The New York City group is made up of intelligent people, many college graduates, and many professional people. There is no holier-than-thou spirit prevailing, there is good fellowship, gaiety, fun, and a real desire to stay sober.
The work is organized under an Alcoholic Foundation, which prevents and alcoholic from obtaining a salary for doing the work. One or two of the group tried using the approach on a fee basis, but the spiritual aspect which keeps these people sober seemed to have died when the patient tried earning money this way; these few people found themselves drinking again and so returned to the volunteer relationship.
This new resource is developing groups all over the country. Social workers will find them of great help with the extreme cases of alcoholism. The book describes the method in detail - it is a layman s approach, a layman's book. It needs no explanation for the patient and should certainly be read by every alcoholic.
Lee R Stainer
New York City
CHURCH SCHOOL MAGAZINE
ALCOHOLICS ANONYMOUS: Works Publishing Company. 1939. $3.50.
Here is an impressive story of the achievement of more than one hundred men in gaining freedom from alcoholism. Evidence in this volume seems to indicate that medicine and psychiatry are powerless to cure many cases of alcoholism: heretofore there was no end in sight except death or insanity. But here is factual evidence that the worst alcoholic can gain mastery over this temptation if he admits that he is powerless and turns himself completely over to God. This spiritual technique demands genuine humility, sincere efforts to make amends for all wrongs done, continued fellowship with God through prayer and meditation, and efforts to help other alcoholics who are ready to relinquish the belief that they can resist alcohol through their own will power. The experience of these men seems to offer real hope that an effective technique has been discovered for conquering an enemy that has baffled doctors, psychiatrists, pastors and thousands of distressed families.
ALCOHOLICS ANONYMOUS: Works Publishing Company, New York, $3.50
Here is an unusual book. It is the dramatic recital of the experience of more than a hundred men and women in their fight against alcoholism, their victory, and their desire and determination to pass on to others the secret of their release. The group who has contributed to this book began with two or three alcoholics whose similar experiences drew them together. "To show other alcoholics precisely how we have recovered from a seemingly hopeless state of mind and body," says the introduction, "is the main purpose of this book."
Let it be said at the outset that there is nothing sensational in these stories, although they are filled with the drama of conflict, failure and final release. These writers believe that there is but one cure for the alcoholic. That is the realization of his own inability to cope with his repeated failures and the recognition of the reality of that Power greater than himself, whom we call God, to drive out his obsession. The head of one of the nation's great hospitals for the treatment of alcoholism and drug addiction contributes a statement to the introductory pages declaring that here is the working out of the principles of a sound "moral psychology."
The discussion of these principles is free of emotionalism. It is neither sectarian nor partisan, for men and women of all religions and of none, have contributed to the book "In our personal stories," says one writer, "you will find wide variation in the way in which each teller approaches and conceives of the Power greater than himself. One proposition, however, these men and women are strikingly agreed. Every one of them has gained access to, and believes in, a power greater than himself. This power has in each case accomplished the miraculous, the humanly impossible."
The movement has grown and spread without formal organization and groups are widely scattered over the country. Its members, mostly business and professional folk, go about their usual work, their avocation being to help others through their friendship and moral concern to find release.
For ministers, social workers, psychiatrists, and all others who are concerned with the rescue of those sick in mind and body, from the possession of the liquor habit, this book is a source of suggestion and inspiration.
Vol. 25(2), April 1941.
ALCOHOLICS ANONYMOUS: New York: Works Publishing Company, 1939. 400pp.
TWELVE AGAINST ALCOHOL: By Herbert Ludwig Nossen, M.D, New York:
Harrison-Hilton Books, 1940. 246pp.
These two books are similar in that both present in great detail case histories of patients who are suffering from alcoholism. In this way many old established facts about alcoholism are brought again to our attention, such as the individual's early resort to alcohol as a means of solving his problems or temporizing his major adjustments in life, and the tragic and dramatic way in which the alcoholic drags down his entire family with him, to say nothing of the other social and economic repercussions. Reading these case histories, one becomes more than ever convinced that the excessive drinking of alcohol is one of the relatively minor phases of the individual's whole problem, particularly when one considers the faulty psychosexual adjustments and general immaturity and infantile characteristic of the alcoholic
For the successful treatment of a person who has become addicted to alcohol, there must of necessity be a revolutionary change in the patient's personality. The achievement of more adult attitudes and the marked turning away from older selfish, infantile patterns of behavior must involve an emotional upheaval. We are all aware that this inner emotional change is more necessary than a merely intellectual appreciation of one s difficulty, or what is called intellectual insight.
It will be interesting to see how the religious program set forth by Alcoholics Anonymous will work. It is not entirely new; it has been tried before.
James H Wall
The New York Hospital, Westchester Division,
White Plains, New York.
One of the most significant redemptive movements of our time is expressed in a large book of testimonies called Alcoholics Anonymous. It is written with the enthusiastic flair of discovery though its main thesis is as old as the history of Christian redemption.
Alcoholism is a disease. Physicians and psychiatrists have been working on it for years. It is a disease with an increasing prevalence. Many practicing physicians write it off as incurable. The present movement began with an individual who had been given up by the practitioners as hopeless. He was converted to religion and began to work out the practical effects of his conversion by trying to help other alcoholics. This method was found amazingly successful and has some of the professional physicians mystified. These alcoholics find that they need spiritual support and that their own cures are best secured by helping others with like affliction. They are forming an informal group of the saved. It is a movement worth encouraging.
SOME FACTS ABOUT THE BIG BOOK
THE A.A. GRAPEVINE
The new edition has 612 pages, as against 400 pages in the old. In terms of cost it is the best non-fiction buy in the country. No other commercial publisher in America could match the book, in size and format alone, at its retail price.
The first edition runs to 100,000 words, the edition just off the press is 168,869.
The old edition contained 29 stories, about 1,800 words each, the new edition has 37 -- 24 of them brand new -- and all of them running to twice the length (or about 3,300 words) of the earlier work. The new stories are more detailed and more explicit, more revealing, and of more useful contrast and variety.
The geographical spread, in the new book, is far greater: 15 cities, 10 states, and two foreign countries.
The vocational range is immense: buyer, industrial executive, surgeon, banker, writer, educator, soldier, insurance agent, advertising executive, furniture dealer, stock farmer, beautician, charwoman, truck driver, insurance investigator, salesman, real estate agent, promoter, accountant, sculptor, journalist, upholsterer, organizational executive, patent expert, lawyer, doctor, and housewife. The most numerous in this list is the housewife -- with six stories.
There are 110,000 words of absolutely new material, yet the practical, therapeutical, and expository first 175 pages of the original work are here intact. These pages have already gone into the American legend as the "greatest redemptive force of the twentieth century." And these pages will remain there, through the full history of man's pursuit of maturity.
Vol. 15: 96, August 15, 1955
ALCOHOLICS ANONYMOUS (Second Edition)
Alcoholics Anonymous Publishing Co., July 16, 1955.
This book is a revision of the first edition originally published in 1939, which has gone through 300,000 copies. Not only does it tell the appalling story of alcoholism, but it also serves to give a deep insight into the philosophy and functioning of A.A.
Five chapters devoted to the relationship of the alcoholic to his wife and family contain many instances of marital and domestic difficulties, their meaning and methods of handling them. Spouses and families that have been spared the presence of an alcoholic can never fully appreciate what it means to have a family member a victim. These chapters dispel many of the misconceptions and false notions of how the alcoholic should be treated, and they offer many sound suggestions in this area.
The second part of the book contains thirty-seven case histories of alcoholics. Twelve of these relate to pioneers of A. A.; twelve tell about people who stopped drinking in time. The remainder are inspirational in nature.
At the present time A.A. numbers more than 150,000 members. In view of its short history, less than twenty years, this is a phenomenal growth. Since we have over 800,000 problem drinkers in the U.S. it is immediately obvious that hospitalization is impossible even if it were feasible. Because of this fact, efforts like A.A. take on a practical urgency. As the book well indicates, A.A. does not seek to supplant the psychiatrist or medical man. However, the group experiences of A.A. have evidently been sufficiently strong to help chronic alcoholics take the steps necessary for their rehabilitation.
This book is a welcome addition to the literature on alcoholism. It has value for the alcoholic who is seeking help, his family and friends and even the persons professionally concerned with his treatment and recovery.
Vol. 38, August 27, 1955
"THE BIG BOOK" BIBLE FOR ALCOHOLICS
There was a time when the organization known as Alcoholics Anonymous, which has become one of the greatest boons to the drunkards of the world, had a membership, which was a little lopsided. On its rolls the Bowery was better represented than Park Avenue, a fact deplored by the organization's leaders. So, recognizing that the rich can become just as alcoholic as the poor, the organization decided to do something about it. Acting on its long-held tenet that only a sober ex-drunk can cure a down-and-out drunk, the A.A. leaders looked around for an ex-drunk with glamour and the ability to speak the Park Avenue language. They found it in an ex-drunk countess. The result: Park Avenue became as well represented as the Bowery on the rolls of A.A.
Now, in the past few years, another change has taken place in the membership of A.A. -- a change that has proved even more important than that accomplished by the countess, but which was comparatively unnoticed by the public-at-large until last month. At that time A.A. held its bone-dry twentieth-anniversary convention and, in conjunction with the ceremonies, issued a revised, second edition of an oversized, ocean-blue volume, which is familiarly known to all A.A members as "The Big Book." The new edition, like its predecessors, is jacketed in a reversible dust cover, one side of which is blank, which allows it to be read in trains and buses without attracting the eyes of the curious. But, unlike its predecessor, the new edition is not intended solely for alcoholics of the last-gasp variety. Right in the middle of it lies a whole section devoted to drinkers who have not yet lost their businesses or broken up their homes or, as most of A.A.'s original members seem to have done, landed in jail. Says ex-A.A. president Bill W. (who still keeps his last name anonymous, though he has now stepped down from his executive position): "Now we're getting cases whose drinking has merely become a menacing nuisance, and we're glad for them"
In the same way that A.A. discovered that the Park Avenue set could not be reach' by the Bowery set it soon learned that potential alcoholics of the "menacing nuisance" variety cannot be reached by a membership composed largely of ex-last-gasp drunks. The solution: A.A. members made an effort to get a few representative "menacing nuisances" into the fold and, having accomplished this goal, found that its roll call of these "nuisances" soon began to increase by leaps and bounds. In the new edition of "The Big Book" appear twelve well authenticate self-confessions by former "menacing nuisances." The section is subtitled "They Stopped in Time" and it will, A.A. leaders hope, bring even more "menacing nuisances" into the organization. "Half the people coming into A.A. today are in this group," Bill W. says, "and the membership of this new class immediately identify with each other. Otherwise we couldn't keep them"
Who exactly are these "menacing nuisances?" For A.A.'s purposes they are that segment of drinkers who are potential alcoholics. According to Bill W., there are certain well-defined symptoms by which they can be distinguished from other drinkers, e.g.:
A persistent lack of control over your drinking even when you want to control it and when it is necessary that you do control it.
An underlying maladjustment from which the excessive drinking usually stems.
Like all A.A. 's, the new members find themselves in one of the most cleverly constructed organizations of modern times. It accepts no money from outsiders, so that even if you wanted to leave a bequest to A.A. the money would be refused. It also insists on the public anonymity of its members. (Last year Bill W turned down an honorary degree of Doctor of Laws at Yale because it would have brought him a personal type of glory frowned on by A.A) Yet these two rules alone have been credited with bringing the organization more really worthwhile publicity (i.e., the kind of publicity that reaches alcoholics who need A.A.) than could have been achieved by any other public-relations policy. (Good A.A. 's, for example, disapprove of such authors as Lillian Roth, who has publicly broken the shell of her A.A. anonymity to write such a best seller as "I'll Cry Tomorrow." Says one A.A, spokesman privately in this connection: "We have many members who have pulled themselves up by their own resources.")
By equal cleverness, A.A., which has baffled psychiatrists and religionists, has at the same time been approved by both psychiatrists and religionists. There was a time when the Catholic Church, for example, did not see eye to eye with A.A., believing that its religion was enough to cure any alcoholic. Then A.A. pointed out to the Church that many of its own priests, far from being able to pull themselves up by their religion, had joined A.A. to be cured. As a result the Catholic stigma was removed from A.A. Yet the basis of A.A itself, which once was closely associated with the Oxford Moral Rearmament Group, is a highly individualized religion that has been made palatable for even the most adamant atheist. Organized, as what Bill W. describes as "everything from a benign anarchy to a democracy to a republic," the organization is one in which no member can be compelled to contribute anything to it or to believe in any particular dogma "If you believe," says Bill, "that the hen came before the egg or that the egg came before the hen you have enough religion to join A.A." Even the most scientific alcoholic, he says, has to admit that by the time he gets around to A.A. he can't help himself. Therefore, he has to admit that there's a higher power than himself and, says Bill, "We put teeth into this belief by telling him that God in effect is saying, 'I hope you boys behave' but John Barleycorn is saying 'You dam well better behave, because if you don't.'
By such methods A.A. leaders estimate that they have now corralled 150,000 to 200,000 former alcoholics into their organization, although accurate membership figures are hard to come by, partly because all members of A.A. are allowed to make their own decisions on how closely they will work with the organization and partly because there are thousands of A.A.'s who, being isolated from cities where A.A. groups are able to meet, must in their own words "stay sober" solely by means of "The Big Book." and by means of A.A.'s monthly magazine, The Grapevine. Sales figures of the first edition of the book alone reached a mammoth 300,000 copies -- a figure, which has helped convince A.A. leaders that their membership extends far beyond their records. They know, for example, that by means of their tried-and-true methods the French membership has jumped a great deal from a time when the only A.A.'s in France were American alcoholics in Paris. They also know that A.A. has transcended many international boundaries which are normally not transcended: for example, A.A.'s meet together from both North and South Ireland, crossing the boundary line to do so. One boundary still to be got across, however: the Iron Curtain. But in time even this boundary as well as others may disappear for, as A.A. leaders say, they have a built-in self-perpetuating system: in order to stay cured every alcoholic has to spend some time helping another drunk to be cured or otherwise he may very well sink back into drunkenness himself.
Today for those alcoholics and potential alcoholics who would like to join A.A. but who are remote from all A.A. groups the new and revised edition of "The Big Book" is now available for $4.50 a copy. (To groups the price is $4.00) If you cannot find it in your local bookstore the book can be ordered from Box 459, Grand Central Terminal Annex, New York City. Nobody - not even A.A. leaders - can speculate what the demand for this book will be. Only one thing is certain: that is that this edition will do better sales wise than did the original edition when it was first published in 1939. In that year A.A. publishing Inc., was left with 5,000 copies of a book which nobody seemed to want and for which the unpaid printer's bills were so alarming that A.A. headquarters was actually visited by a deputy sheriff bearing a dispossess notice. Fortunately for everybody, however, the old Liberty Magazine published an article on the struggling organization and shortly thereafter John D. Rockefeller, Jr., sponsored a dinner for the organization. From that moment on A.A. was a success and so was "The Big Book."
By Robert Payne
Vol. 41(1), January 1957
ALCOHOLICS ANONYMOUS: New York, Alcoholics Anonymous Publishing Co., 1955. 2nd. Edition, 575p.
This is the second and greatly enlarged edition of a book first published in 1939. Three hundred thousand copies of the first edition have been sold.
The second edition presents identical material for the first 164 pages. The second part, made up of personal records, has now been enlarged so that it contains 37 histories. These are divided into three sections. The first contains the history of 13 pioneers of Alcoholics Anonymous. Part two, labeled "They Stopped in Time," contains 12 more histories. Except for additional introductory material and the changes in the case histories, the book is identical with the first edition.
For those unfamiliar with the first edition, the book starts out with an introduction, followed by historical material and a discussion of the aims of Alcoholics Anonymous. There is a good deal of detail about the program of recovery, and enumeration of the now well-known 12 points, which express the fundamental beliefs of Alcoholics Anonymous. There are special chapters for wives, for families and for employers. The last chapter, titled "A Vision For You," is an appeal to the alcoholic to make use of Alcoholics Anonymous and adopt its procedures.
The book presents the philosophy of Alcoholics Anonymous, a philosophy which has had quite unexpected success, since the reviewer doubts that any of those who witnessed the beginning of Alcoholics Anonymous had any concept of what it would achieve.
The personal stories of the 37 alcoholics can be recommended as reading to anyone who wants to get the first-hand history of alcoholics who have managed to overcome the habit.
The whole book presents the viewpoint of Alcoholics Anonymous, which can be considered as one approach, and one of the most successful, in dealing with the problem of the alcoholic. Reading the book may make it comprehensible to the reader why this program works with some persons and not others. It is a limited approach, which takes in only certain aspects. It frankly admits its own inability to deal with certain types cases. It does, however, show a remarkable record of recovery for quite a large group, and on this basis has clearly won an important status in any plan in dealing with the alcoholic.
This book should be required reading for anyone who wishes to understand or deal with the problem of the alcoholic. Viewed as an approach which has been developed by a special group of alcoholics, it makes very interesting reading and gives a much better understanding of many of these cases.
- Karl M Bowman, M.D., San Francisco.
QUARTERLY JOURNAL OF STUDIES ON ALCOHOL
Vol. 20 (1), March 1959
ALCOHOLICS ANONYMOUS: The Story of how Many Thousands of Men and
Women have Recovered from Alcoholism. New and revised edition. Pp.
xxx+575; cloth; $4.50 New York, Alcoholics Anonymous Publishing,
ALCOHOLICS ANONYMOUS COMES OF AGE: A Brief History of A.A.
Pp.xiii+335; cloth, $4. New York, Alcoholics Anonymous Publishing
Inc., 1957. Also published as: Alcoholics Anonymous Comes of Age.
By a Co-Founder. Pp.xiii=335; cloth; $4. New York; Harper; 1957.
The book Alcoholics Anonymous can be reviewed only by a nonmember of A.A., for any evaluation of the "Bible" of this fellowship by a member must be obvious. But perhaps even a non-A.A. cannot hope to compose an objective evaluation of a work of this sort. To treat it as literature would be pointless. It does not claim to be a moral tract or a scholarly treatise or a scientific exposition. It is, in fact, a book that for many alcoholics has the function of supplementary holy writ.
When I first heard about A.A. more than two decades ago, the original Alcoholics Anonymous book had not yet been published. The story was that a few alcoholics had gotten together and formed a club or society to help one another overcome their problems of drunkenness. Later it became known that they had written a book describing their method, and they believed they had found the golden key, the solution to the problem of alcoholism. It sounded like another crackpot scheme, like so many other "cures" for alcoholism, many with "books" to explain them; it was bound to fail in wide application. Years after, when the movement persisted, it was unavoidable to read the book. It became possible to recognize that here was an exception. Indeed, it was not impossible not to recognize that this book was a phenomenon, that in spite of the disadvantages of collective authorship it spoke from and to the heart and carried something rare in literature: a positive therapeutic potential.
The meaning of "therapeutic potential" as used here is admittedly vague. All one can say is that the book gives the impression of a piece of literature capable of promoting healing in some people who are psychically distressed. It was a work seeming fit to be classified in some such needed category as "bibliotherapeutic." Any wonder at the persistence of A.A. could be laid aside, and it was possible to contemplate that the group, which produced this work and lived by its implications, could actually help alcoholics.
The book had its faults, being a decidedly human product. And fortunately its composers were sufficiently immodest to take the credit for its contents, though anonymously, without imputing any of it to supernatural inspiration. Thereby they made it possible in the course of time to act upon the obvious fact that portions of it were dated and growing more so, and that other parts could be improved by taking into account the knowledge and experience accumulated in some twenty years. The leaders of A.A. deserve to be congratulated for the courage to secularize the fellowship's bible by judicious revision. They have a better book now. They have done no harm -- that is, they have not taken out any of the original feel of sincerity and capacity to start a process of healing. Instead, by their revision they have insured that it will continue for another period to be as useful as up to now in helping many alcoholics get started on the road to recovery.
The book Alcoholics Anonymous is not just for alcoholics. Every non-alcoholic who wishes to gain insight about alcoholics and alcoholism should read it.
The newer book, Alcoholics Anonymous Comes of Age is a valuable companion volume. Not in the same class and not intended for the same purpose, it will be vastly useful to those who want information on the history and development of the fellowship and as a picture of its organization and principles.
THE A.A. GRAPEVINE
FOR MAN'S PURSUIT OF MATURITY
THE NEW BIG BOOK
ALCOHOLICS ANONYMOUS Second Edition, revised. 612 pages. A.A. Publishing, Inc. Reviewed here by an A.A. who is, among other things, a professional book critic. Price to be set by the General Service Conference, June 1955
This book is so full of wisdom; each of its stories is so dead on the target, that Alcoholics Anonymous should be left on the alcoholic's night-table for continuous reference, for active and unexpected support, for the comfort of sudden insight, the re-enforcement of forgotten incidents, the reminder of chagrin, of hysteria, wreckage, betrayal, and loneliness that can be described only as outer-spatial.
We were all these, many of us for years, and these re-visits in their multitude on the one hand and their merciful objectivity on the other - now that we are calmly passing the cage instead of whimpering on its floor - are the most moving and powerful paragraphs of our past that we can encounter in the days of our sobriety. This is an album of our individual past, in all its grotesquerie, its homicidal ebullience, its sophomoric idiocy, its abuse and obscenity, its marathon emptiness of talk, its gulping fantasy. It is a good thing for us to traverse this rutted acreage once more; this pitted pothole promenade. It's an important refresher course in our unbroken need - not for glimpses of what we were and where we went - but for hard cold steady-eyed explorations of it; deliberate returns to it; continuous meditations upon it.
Reading the new book, as with reading the old, is part of our life and of our continuing education in continuing self-discovery. We can't stay sober without thinking about being sober; thinking actively and purposefully about it. The editorial selection of new material is especially commendable. Here, indeed, is a tour-de-force of today s miracle, one bravura story after another, all familiar yet all unendingly new, each one providing its special and deeply personal increment to the full treasure of what is without any doubt the richest story in print of human salvage out of the jaws of human degradation and spiritual catastrophe; of last-minute rescue at the edge of insanity, of total recovery from total insanity.
The fascination of the dilemma of obsession in the known and acknowledged presence of abhorrence seizes the reader's imagination all over again. And it seizes his remembrance too, for all the known antidotes come back in these pages to straighten our sights, refortify our nerve, and reemphasize the importance of one of A.A.'s basics: the constant thought of others. It's a joy and a sudden challenge too, to re-encounter the blunt question: "Why don't you choose your own conception of God?"
Who can quarrel with propositions so basically sporting as this? What arrested alcoholic can hold back a slight shudder when he reads this once more:
"If you want to test yourself, go to a bar and do a little controlled drinking. Drink, then stop"
It is stabilizing and reassuring to go over, in careful but compassionate prose, the description of the mental states that precede a relapse; to be reimpressed with the sameness of the distortion that afflicts the alcoholic and the insane; to behold once again the great resource for rationalizing that both share. It is good for us all to be warned again: that there is no safety in a long sobriety; that patterns of susceptibility are as set as blood types; that the disease is progressive, whether we're drinking or not drinking.
The meditations on the problem of agnosticism become more illuminating as the years pass; acquire more meaning and a greater sympathy with the pragmatic challenges, which the serious agnostic puts up to the face of Faith. If the sincere agnostic -- and there are millions -- can find a safe sobriety while denying the existence of God, surely he cannot read these pages in Alcoholics Anonymous without feeling a sudden dispersion of the pressures of his own life; a lessening of his built-in prejudices; a falling away of antagonisms. "We've stopped fighting anybody or anything. We have to" "Who are you to say there is no God?"
Newcomers to A.A (there are 6,000 groups of us now) can have a disturbing time - old-timers an amusing one - in going over the list of methods we alcoholics use (or used to use) to prove we weren’t t alcoholics. Do you remember them? Beer only? Never more than two drinks' (or three or four?) Never to drink alone? To drink only at home? To drink only at parties and never at home? Never to drink in the morning? Never to keep liquor in the house? Switching from Scotch to Brandy? (A gruesome lateral, as this reviewer can testify) Taking a trip? Agreeing to resign if caught drunk? More exercise? Changing towns? Going to health farms? Committing ourselves to the loony-roost.
We had fun playing this game, didn't we? With no defense against the first drink, with our power of choice lost for all time. The book's explanation as to how so many alcoholics can go on and on for long periods of time - even for pears - though drinking hard, is as simple as it is penetrating: the will, unable to combat liquor, can remain strong in other respects.
As A.A. gets older, it is also getting younger and younger. For those just coming in, or thinking about sampling what it is that we have, the diagram for sensible living is laid down in these pages, the testimony of those whose eloquent first-person narratives of the unbelievable wreckage they have survived is here given; the strange but visible phenomenon of our interdependence - as alcoholics - for our continued serenity; the promise of a safe return to it after the occasional departure: this is our diagram.
If, when drinking, we "extreme examples of self-will run riot," when not drinking we're pretty useful and fairly good company. We derive our strength from each other, in the group. And from a higher power by whatever name. Where it comes from, none of us entirely knows. But how to find it is told, in rich detail by many who have been all the way there and have come all the way back, in the new edition of Alcoholics Anonymous.
M.W., New York City
THIRD EDITION OF BIG BOOK IS NOW IN PRINT
THE A.A. GRAPEVINE
The third edition of Alcoholics Anonymous providentially came off the press just as the last printing of the second edition had been exhausted. The new big book had been years in preparation, going through the same careful process that keeps all A.A. literature as close as possible to an expression of the Fellowship s group conscience
That phrase "new Big Book" may sound startling. We have all heard A.A. talks that recall a newcomer's alcoholic arrogance with the words "At first I wanted to rewrite the Big Book." Upon opening a copy of the third edition, the warp reader will be relieved to find that the Big Book has not been rewritten. The basic text (pp. 1-164) is unaltered, so is the section of personal stories headed "Pioneers of A.A." In the section headed "They Stopped in Time" and "They Lost Nearly All," 17 stories have been retained from the second edition, and 13 new stories have been added, to reflect present-day membership more accurately.
In 1939, when the book Alcoholics Anonymous was first published, it gave its name to a hitherto "nameless bunch of alcoholics," then numbering about only 100. More than 300,000 copies of that edition were eventually printed, playing a powerful role in A.A.'s growth to a membership of about 130,000 by 1955, when the second edition was produced. Successive printings brought the combined distribution of these two editions to a total of 1,450,000 by the spring of this year, when the third appeared. Its cover is a lighter shade of blue; the title is printed in a more modern type face that emphasizes the initials "A.A." - meaningless before 1939, but now meaning life itself to over 1,000,000 alcoholics.
EMPLOYEE ASSISTANCE QUARTERLY
Vol. 1(1), Fall 1985
ALCOHOLICS ANONYMOUS: Third Edition (1976). New York. Alcoholics
If there is a published review of Alcoholics Anonymous, maybe better known as the Big Book, the editorial staff of the Quarterly has not been able to locate it. To compensate for its absence from the literature, we approached three outstanding professionals in the field of addictive behaviors and posed this task: review the Big Book. Addressing the task are Albert Ellis, Ph. D., internationally renowned psychologist and founder of Rational-Emotive Therapy; Alan Marlatt, Ph.D., Director of Addictive Behaviors Research Center at the University of Washington; and Abraham Twerski, M.D., Medical Director of Gateway Rehabilitation Center (near Pittsburgh) and author of "Kindness Can Be Dangerous to the Alcoholic"
Each reviewer was asked to organize his review of the Big Book around the following questions:
- In light of current professional views of alcoholism, is the Big Book still appropriate in understanding the nature of the alcoholism and/or other addictive behaviors?
- Does the Big Book provide an adequate explanation of alcoholism recovery?
- Is the therapeutic approach to alcoholism, as depicted in this text, consistent with contemporary efforts to treating addictive behaviors like alcoholism?
- Does this text adequately reflect how Alcoholics Anonymous and other self-help groups currently practice?
- In your opinion, does the Big Book represent an effective therapeutic model for alcoholism and/or other addictive behaviors?
Dr. Ellis' review, which was extrapolated from his other paper, "Why Alcoholics Anonymous Is Probably Doing Itself and Alcoholics More Harm Than Good By Its Insistence on a Higher Power," chose only to address the last question regarding the Big Book as an effective therapeutic model for alcoholism/addictive behaviors. He did so in a rational and logical manner. Dr. Marlatt, in his paper entitled "Is Reliance Upon a Higher Power Incompatible With Learning Skills?" arranged a general but scholarly response to all of the questions. In an effort of resolution, he drew parallels between social scientific and Alcoholics Anonymous approaches to understanding alcoholism and recovery Dr. Twerski complied with all the questions through his prescription, "Go to the Patient, Not to a Book." In his review he clarified the purpose of the Big Book;" ...it does not seek to treat nor teach by its contents...it is a description of a program that is effective."
WHY ALCOHOLICS ANONYMOUS IS PROBABLY DOING ITSELF AND ALCOHOLICS
MORE HARM THAN GOOD BY ITS INSISTENCE ON A HIGHER POWER
Albert Ellis, Ph.D., Executive Director
Institute for Rational-Emotive Therapy
New York, New York
Alcoholics Anonymous is a complex and profound book that has probably helped millions of addicts. It includes so many good -- and so many questionable - points that I find it impossible to review it in the 500 words I have been allowed. Nor can I possibly answer the five important questions the Associate Editor has asked of reviewers. Let me focus, therefore, on the last of his questions: "In your opinion, does the Big Book represent an effective therapeutic model for alcoholism and/or other addictive behaviors?" As a psychotherapist for more than 40 years and as the founder of the most popular form of cognitive- behavior therapy, rational-emotive therapy (RET), I shall - all too briefly! - review the 12 steps outlined in Chapter 5 of Alcoholics Anonymous in regard to their therapeutic effectiveness.
The seven therapeutic steps in A.A. that seem very useful to many alcoholics are steps 1,4,5,8,9,10, and 12. These urge them to admit their addictive and self-destructive ways, make amends to those they have harmed, acquire a philosophic awakening, and carry their message to other alcoholics. The five A.A steps that are of dubious value and that may easily do more harm than good in keeping people away from Alcoholics Anonymous and in preventing their sobriety are steps 2,3,6,7 and 11. These urge alcoholics to believe in, rely on, and humbly pray to a Higher Power who will remove their shortcomings and give them the will to stop drinking.
Steps 2,3,6,7 and 11 are potentially unhelpful and dangerous for many reasons -- which I expound in detail in an article I am writing, "Why Alcoholics Anonymous Is Probably Doing Itself and Alcoholics More Harm Than Good By Its Insistence on a Higher Power." Let me (very briefly!) summarize some of the points I am making in this article:
1. Obviously, not everyone needs a Higher Power to stop drinking, since millions have done so while remaining agnostics and atheists.
2. Believing in a Higher Power is an indirect, and I would say hypocritical, way of believing in your own power to stop drinking. For you clearly choose to believe in this power and you choose to assume that it exists and will help you.
3. There is no convincing evidence against the existence of a Supreme Being who personally audits and obeys human supplication.
4. For every person turned-on to A.A. by its insistence on belief in a Higher Power probably two or three are turned-off and will not join or remain a member.
5. Belief in a Higher Power or God may easily lead to devout belief in Absolute Truth and other forms of dogma that (a) are often serious emotional disturbances in their own right and that (b) leads to dictatorship, terrorism, war, and enormous social harm.
6. By calling on God to remove your defects of character, you falsely tell yourself that you do not have the ability to do so yourself and you imply that you are basically an incompetent who is unable to work on and correct your own low frustration tolerance. Since God presumably only helps those who help themselves, this is essentially a lie - and a lie that strongly contradicts A.A.'s fine therapeutic stand for honesty.
7. To pray for knowledge of God's will is again hypocrisy. For who decides that there is a God, that He or She has a will, and that this deity will give you "Godly" knowledge and power. Patently, you do. So "God's will" is largely your choice and your invention. Which, if you want to be truly honest, and fight the rationalizing that often goes with addiction, you had better fully admit!
8. Although you may well have a philosophic awakening as a result of taking A.A.'s 12 steps, calling this (in step 12) a "spiritual" awakening is unscientific and antitherapeutic. "Spiritual" is a vague word that means anything from intellectual and philosophical to incorporeal, sacred, and ecclesiastical. Many people who have had a profound philosophical and intellectual awakening and have thereby quit drinking have been distinctly agnostic, atheistic, and not at all "spiritual."
In sum, Alcoholics Anonymous or the Big Book has some excellent views and directions - and again, has unquestionably helped millions of alcoholics to stop drinking. But for the above reasons (and many more I could add) it also contains some questionable and often iatrogenic ideas. I fervently (but prayerfully and unspiritually!) hope that these will be revised before the fourth edition appears. A.A. is too good an organization to bow to the will of anyone - including any hypothetical Higher Power.
IS RELIANCE UPON A HIGHER POWER INCOMPATIBLE WITH LEARNING SELF-
G. Alan Marlatt, Ph. D., Director,
Addictive Behaviors Research Center,
University of Washington
Psychologists are often critical of A.A. as a psychologist trained in the behavioral tradition, I was taught to view alcoholism not as a physical disease but as an acquired behavioral disorder, a vicious habit cycle, locked in by layers of conditioning based on years of reinforcement, both positive (the high of the buzz) and negative (the relief from withdrawal). We were taught that alcoholics were made, not born, and that anyone is susceptible to developing a drinking problem, not just those with a genetic predisposition or "allergic reaction" to alcohol. In short, we believed in science and the experimental method of discovering the truth about alcoholism. As budding scientists and research-oriented clinicians, we rejected out of hand any approach that smacked of religion or any other nonscientific values.
Despite my scientific training, my intuition (perhaps based on early experiences with several alcoholics in my own family) told me that alcoholism was more of a psychological "dis-ease" of the spirit than a physical disease of the body. I found some statements in the Big Book that seem to echo this philosophy e.g., "Therefore, the main problem of the alcoholic centers in his mind, rather than his body" (p.23), and Dr Bob's reputed claim that alcoholism "was more of a moral or spiritual illness than it was a physical one" (p.219). In addition, I cannot help but be impressed with the amazing success of A.A. over the past 50 years of its existence. If alcoholism is really a disease of the spirit (for which alcohol is no real solution), then it makes sense that the religious fellowship of A.A provides fulfillment of the alcoholic's underlying craving for union with a Higher Power. Especially if it keeps its members sober, which A.A often does.
But what about those who fail to maintain abstinence, those who relapse? As the poet and writer John Berryman so aptly points out in his alcoholic autobiography, Recovery (N.Y., Farrar, Straus & Giroux, 1973), acceptance of the first step in A.A. is not always an easy task. For those fortunate individuals who experience a classical religious conversion experience similar to those described in the Big Book (e g., p.56 "In a few seconds he was overwhelmed by a conviction of the presence of God. It poured over and through him with the certainty and majesty of a great tide at flood"), all is well and they seem to be protected from further temptation by the protective umbrella of the Higher Power. As the Big Book states, "The alcoholic at certain times has no effective mental defense against the first drink. Except in a few cases, neither he nor any other human being can provide such a defense. His defense must come from a Higher Power" (p.43). Does this mean that those who return to drink have been abandoned by God? Does a slip mean a fall from grace or a moral sin in the eyes of God or the alcoholic? What factors precipitate a relapse? Here the Big Book and scientific data seem to agree. According to the Big Book, "The greatest enemy of us alcoholics are resentment, jealousy, envy, frustration, and fear" (p.145). Anger and resentment are frequently described throughout the Big Book as psychological precipitants of the first drink. In our own research on determinants of relapse, we found that the negative emotions such as frustration and anger, along with interpersonal conflict and social pressure, represent high risk situations that are associated with 75% of the initial relapse episodes reported by alcoholics. Frequently, these initial steps are preceded by certain psychological "early warning signals" such as rationalization excuses and unrealistic expectancies about the effects of alcohol as a means of coping with stress or transforming unpleasant mood states. To the extent that people can be trained to recognize and act upon these warning signals and learn to cope more effectively with high-risk situations for relapse, they may be able to prevent or minimize the severity of their relapses. Forewarned is forearmed, as the saying goes. These methods, along with research supporting the effectiveness of these procedures in the treatment of alcoholism, are described in a forthcoming book by Marlatt and Gordon (Relapse Prevention, N.Y.: Guilford Press, 1985).
There may be a way of resolving the apparent dilemma between relinquishing personal control to a Higher Power vs. learning self-management skills in the prevention of relapse. For those who experience a profound religious conversion experience, no coping skills other than a reliance on a Higher Power may be necessary. In Appendix II of the Big Book it is stated, however, that such religious "transformations, though frequent, are by no means the rule." Most of our experiences are what the psychologist William James calls the 'educational variety' because they develop slowly over a period of time" (p.569). It is for these latter individuals that coping skills for relapse prevention are particularly helpful. I would encourage A.A. members to share their "survival skills" with new members or with those who are experiencing setbacks. In this way, the "higher power" of group support and shared coping experiences can be made available to all members. As it says in the Big Book (p.135), "First Things First"
GO TO THE PATIENT NOT THE BOOK
Abraham J. Twerski, M.D.
Gateway Rehabilitation Center
In 1527, Paracelsus assembled his medical students at the University of Basel, gathered the authoritative medical textbooks, and threw them into a huge bonfire. "You wish to learn medicine? Go see your patients," he said.
Whereas one cannot totally dismiss the written word, there is truth in Paracelsus' directive. Furthermore, advances in modern medicine occur at so rapid a pace that most texts are partially obsolete by the time they are published.
The continuing relevance of the Big Book to today's alcoholic is precisely due to the fact that it does not seek to treat nor teach by its contents. Rather, it is a description of a program that is effective, and provides testimonials of people whom the program has helped. In other words, this is a book that says, "Go to the patients, both the suffering and the recovering. They will help you, not a book; not even this book."
From the vantage point of a psychiatrist with 20 years of experience and involvement with 32,000 patients afflicted by alcohol and/or chemical dependence, I have found this to be true. The Big Book works because it advocates the program, and it is the program that works. Searching for the secret of A.A.'s effectiveness is akin to saying, "it works in practice, but how does it hold up in theory." The famous 5th chapter is appropriately titled "How It Works," not "Why It Works."
The Big Book approaches alcoholism phenomenologically, and thus remains valid, genetic and neurophysiologic findings not withstanding. The quasirational insanity of alcoholic thinking described in the personal accounts is as applicable today as a half-century ago, as are the endless manipulations with which the modern alcoholic can identify.
Many psychiatrists and psychologists consider all cases of alcoholism to be symptomatic of an underlying disorder. The Big Book seems to consider all alcoholism as primary. Given the consensus in the field that the ratio of primary to secondary alcoholism is 4:1, the Big Book's approach has greater likelihood of success in an unselected population.
The effectiveness of the 12-step program in other addictions, especially narcotics, gambling, and food, indicates that the Big Book's value extends far beyond ethanol. This is because the 12-steps are a protocol for personality, for growth, and for self-realization, a process of value to even the non-alcoholic or non-addicted individual. Thus, even if science will someday discover a physiologic solution to the destructive effects of alcohol, the personality enhancing value of the Big Book will continue.
Within the firm guidelines of its 12 traditions, Alcoholics Anonymous has evolved and adapted to cultural changes. Nor does the Big Book advocate a rigidity that would stultify recovery. The Big Book and A.A. remain as effective today as the day they came into being, and are likely to remain unfettered by the continuing passage of time.
PERCEPTUAL AND MOTOR SKILLS
Vol. 69,258. 1989.
READABILITY OF ALCOHOLICS ANONYMOUS:
HOW ACCESSIBLE IS THE "BIG BOOK?"
Kenneth, R. Mills
Iowa State University
The book Alcoholics Anonymous (A.A. World Services, 1976), popularly referred to as the "Big Book," presents the A.A. 12-step plan of recovery from addiction through several autobiographical case histories. This book is often used as the central element of bibliotherapy in drug and alcohol treatment programs. For this to be an effective component of treatment, however, it must be comprehensible by the client. Readability becomes an especially salient issue for treatment programs in which a significant number of patients manifest borderline literacy. A review of the literature yielded no previous studies of the readability of any edition of the "Big Book." The purpose of this study was to determine the readability and difficulty level of the most current edition of this widely used component of addiction treatment.
A readability formula developed by Flesch (1974) was used. The Flesch formula involves a weighted combination of average sentence length and number of syllables per 100 words to arrive at a reading ease (RE) score, which may be converted to reading difficulty by grade level. Thirty page numbers were randomly generated by computer. A 100-word sample, beginning with the second paragraph, was taken from each selected page; however, paragraphs of editorial, italicized, or introductory content were not included. Average sentence and total syllable count were determined for each of the 30 samples. A Flesch reading ease score was then calculated.
RE scores range from 0 to 100, with reading difficulty diminishing as scores increase. The resultant RE score for Alcoholics Anonymous was 70. 60, which rests at the division between the categories of "standard difficulty" and "fairly easy." The grade level corresponding to this RE score is 7.1, so an individual who reads at the level of the average beginning seventh grader would be expected to be able to read this material adequately.
These results indicate the "Big Book" to be a readable text. Care should be exercised, however, in the prescription of any bibliotherapy to assure that the reading assignment is within the capability of the client. While the material in this text appears to be within the reading proficiency of most clients, it would be an inappropriate assignment for those individuals who read at levels significantly below seventh grade. For such clients, use of audiotapes of the text could be considered.
A.A. World Services. (1976) Alcoholics Anonymous. (3rd ed.) N.Y.
Flesch, R.F. (1974) The Art of Readable Writing (25th anniv. ed.)
New York: Harper & Row.
THE AUTHORITATIVE GUIDE TO SELF-HELP BOOKS
Santrock, J.W., Minnett, A.M., Campbell, B.D.
The Guilford Press, N.Y., N.Y., 1994.
ALCOHOLICS ANONYMOUS (3rd ed., 1976). New York: Alcoholics Anonymous World Services
In the national survey, this was the highest rated of the three books published by Alcoholics Anonymous World Services. Revised twice since the first edition was published in 1939, the book is the basic text for Alcoholics Anonymous self-help groups. These groups are open and free to anyone, nonalcoholics as well as alcoholics. The average period of sobriety for A.A. members (who call themselves A.A.'s) is 52 months; 29% stay sober for more than 5 years. Members range from teens to the elderly. Increasing numbers of young people have joined A.A. in recent years. About twice as many men as women belong. The number of A.A. members addicted to substances other than alcohol has increased to an estimated 38% overall. The principles of Alcoholics Anonymous have been revised and adapted by a number of self-help groups such as Narcotics Anonymous, Gamblers Anonymous, and Al-Anon (for people with a variety of addictions and their families).
Called the "Big Book" by A.A.'s, Alcoholics Anonymous is divided into two basic parts. The first part describes the Alcoholics Anonymous recovery program, which relies heavily on confession, group support, and spiritual commitment to God to help individuals cope with alcoholism. Extensive personal testimonies of A.A. members from different walks of life make up the latter two-thirds of the book. Successive editions of the book have expanded the case histories to describe examples of alcoholics from a variety of backgrounds in hope that alcoholics who read the book can identify with at least one of them. The chapter long stories record the experiences of pioneers of A.A. (such as Dr Bob, a co-founder of A.A.), individuals who stopped in time (such as a housewife who drank at home, hiding her bottles in dresser drawers, but recovered through A.A.), and people who nearly lost all (such as a middle-aged man who began drinking heavily in college and didn't beat the addiction until he joined and stayed with A.A.). Brief appendices include the Twelve A.A. Steps and Traditions and several testimonials to A.A. by ministers and physicians. The book also explains how to join A.A. and attend meetings.
Alcoholics Anonymous was given a 4-star recommended rating by the mental health experts in the national survey. A.A. has helped millions of individuals throughout the world to cope effectively with their addiction to alcohol. The positive and supportive atmosphere created by recovering alcoholics at A.A. meetings - which are held daily -- make a difference in helping many people to become sober.
A.A., however, is not without its critics. A.A. works for many but not all alcoholics. Some agnostic or atheistic alcoholics have difficulty relating to A.A.'s strong spiritual emphasis, although A.A. welcomes these individuals to join its groups. Three self-help groups that have sprung up in recent years, as alternatives to Alcoholics Anonymous are Rational Recovery (RR), Secular Organization for Sobriety (SOS), and Women for Sobriety (WFS). Put off by A.A.'s religious emphasis, the new groups leave God out of their battle with the bottle and rely more on willpower than on higher power. While A.A. calls drinking a disease and urges members to accept their helplessness against it, the newer groups emphasize the importance of taking personal responsibility for recovery.
Several of the mental health professionals in the survey said that A.A. is too "cultish" and that an adequate research base to support the success of A.A. over other treatments has not been established. Another mental health expert commented that in most cases A.A. is not a replacement for therapy but can be useful when it precedes or is combined with therapy. Such qualifications of the A.A. approach by some mental health professionals in the national survey meant a 4-star recommended rating for Alcoholics Anonymous rather than a 5-star, Strongly Recommended rating.