EXPERT WITNESS: Why does AA work?

By Michael G. Brock I suppose it could be debated whether or not AA works, but everyone knows people who have be sober (or, as the Secretary of State's Administrative Hearing Section prefers, abstinent) for years, and has rebuilt a life from the ashes of active alcohol and/or drug dependence. The fact that it doesn't work for everyone and that many people get sober using alternative therapies, religion, or no therapy, but somehow have attained a state of higher consciousness, is irrelevant to the fact that the 12 step method is the most successful model for treating addiction. Not to go all New Age on everyone, but regardless of how it is achieved, higher consciousness is the common denominator to all methods of recovery, and is the most important element of recovery. The AA literature describes this as a "spiritual awakening," resulting in a "personality change at depth." However, not everyone who gets sober has a spiritual awakening, and some don't believe in anything spiritual at all. Therefore, I define higher consciousness as the ability to grasp and internalize that, no mater what circumstances the person finds themself in, they truly are better off substance free that they would be using mind altering chemicals. To understand this better, look at it's opposite. When someone I'm seeing for treatment or an evaluation for driver's license or the court is explaining to me why they relapsed, they might say something like, "I was under a lot of pressure at work, my wife left me, my dog died, I lost all my money in Bernie Madoff's pyramid scheme, and my home went into foreclosure." On the other hand they might just as often say, "I just got a promotion at work, my wife and I put our money into annuities before the crash, we got the house paid off and we decided to take a month long vacation to Hawaii. So I thought, why not celebrate? What harm can one drink do?" To someone who has had serious and repeated problems with alcohol and/or drugs, but who now has a "higher consciousness" it is obvious that there is no situation so bad that a drink or a drug won't make it worse, and no situation so good that a drink won't ruin it. And, as AA members like to say (quoting Albert Einstein), "The best definition of insane behavior is doing the same thing over and over and expecting a different result." But addicts aren't the only ones who engage in this kind of self-defeating behavior. It is part of every person's evolution that they make a mistake a few times and experience consequences, and eventually learn to handle that situation differently and obtain a different result. This concept is portrayed in a very imaginative and entertaining way in the movie "Groundhog Day." Bill Murray's character can't find love until he is able to give the love he is seeking. Or as the Beatles said, "And in the end, the love you take, is equal to the love you make." Call it by whatever name you like, everyone believes in the evolution of consciousness. What AA says is that they have a system of 12 steps, and if you follow those twelve steps you will achieve a higher level of consciousness. There are those who fail, but for the most part they are those who are simply "constitutionally incapable of being honest with themselves." This promised higher consciousness will be evidenced by the fulfillment of "the promises." These promises can be found on page 83-84 of the book "Alcoholics Anonymous." They tell prospective members that, "If we are painstaking about this phase of our development: "1. We will be amazed before we are halfway through. "2. We are going to know a new freedom and a new happiness. "3. We will not regret the past nor wish to shut the door on it. "4. We will comprehend the word serenity and we will know peace. "5. No matter how far down the scale we have gone, we will see how our experience can benefit others. "6. That feeling of uselessness and self-pity will disappear. "7. We will lose interest in selfish things and gain interest in our fellows. "8. Self-seeking will slip away. "9. Our whole attitude and outlook upon life will change. "10. Fear of people and of economic insecurity will leave us. "11. We will intuitively know how to handle situations which used to baffle us. "12. We will suddenly realize that God is doing for us what we could not do for ourselves." These promises clearly represent more than the promise of sobriety; they represent a promise of a higher consciousness for those who earnestly work the 12 steps. The steps include admission and acceptance of the problem, turning one's life over to the care of God, inventorying and confessing negative behaviors and personality traits, making amends to those one has harmed, helping others, and attempting to live these spiritual principles in all areas of one's life. But beyond the twelve steps to a higher consciousness, what does AA offer its membership? First and most obvious, it offers group support from thousands, and perhaps millions of people who have the same condition and are dealing with it successfully. They are having varying degrees of success to be sure, but there are clearly many who are having significant, productive long-term sobriety. The only requirement for membership is a desire to stop drinking. Who can decide if a person has a desire to stop drinking? Only that individual. So, in essence, there is no requirement for membership and there is unconditional acceptance of anyone who chooses to be a member. The goal of the group is to place principles before personalities, so while conflicts may exist they are minimized. In addition to the steps and the group support, it is recommended to obtain a sponsor, or mentor. The idea of a spiritual guide is probable almost as old as the idea of God. However, the notion of a personalized idea of God is central to AA and this concept - the essence of mysticism in any faith - is central to the AA program. To work the program correctly, one has to be a mystic, e.g., one has to practice a personal relationship with God. It is recommended that a person have their own ritual, such as the reading of the "24-hour book," or any spiritual literature the person finds inspiring, and that they spend some time each day praying and meditating. Many members define praying as talking to God, and meditating as listening. However, the recommendation is to pray "only for God's will for us and the power to carry it out." The psychological soundness of this idea should be obvious in that if one prays for a specific outcome and it doesn't come to pass, it is easy to conclude that God has let one down. This focus on God has caused a lot of people to view AA as a religion, but if it is, it is unique in that it is a religion without a theology. One can believe whatever one wants; the proof of one's faith is in the pudding - the ability to stay sober and lead a productive life. Similarly, AA has been called a cult. Interestingly, the most accurate definition I've found for the word "cult" as it is currently used is from Wikipedia: "The word cult pejoratively refers to a group whose beliefs or practices are considered abnormal or bizarre. The word originally denoted a system of ritual practices. The narrower, derogatory sense of the word is a product of the 20th century, especially since the 1980s, and is considered subjective. It is also a result of the anti-cult movement which uses the word in reference to groups seen as authoritarian, exploitative and that are believed to use dangerous rituals or mind control." However, AA follows a policy of attraction rather than promotion and has no interest or involvement in the politics or religious beliefs of its members. It's only absolute is the insistence that alcoholics cannot be taught or learn to drink socially. This is a position agreed with by every responsible healthcare professional. The resentment of AA has been fostered by people being required to attend AA by the courts, employers or other third parties; by addicts in denial (One of my clients recently told me that AA was all about the money, even though they have no dues or fees for membership and maintain a position of institutional poverty); and by those irresponsible health care professionals who cater to clients who are in denial of their addictions and who think they can be taught to control them. AA does offer one opinion regarding addiction which is no longer accepted as consistent with current use of medical or psychological terminology. It suggests that alcoholism is "an obsession of the mind and an allergy of the body." As currently defined, addiction is neither. Obsession in its most accurate usage is a ruminating, circular type of thinking behavior, which its victim takes no pleasure in, but can't stop. Similarly, an allergy refers to a physical toxicity to a substance which generally results a deliberate avoidance of that substance. Addicts receive, or expect to receive, pleasure from both the thought and the act of using their drug of choice. They may feel an overwhelming physical or mental compulsion to use the substance, but the reason for engaging in any addictive behavior is the expectation of pleasure. The fact that it produces more pain than pleasure at the end of the cycle of addiction is irrelevant to the expectation. Moreover, it is the expectation of pleasure that must be treated, and altering this expectation is the goal and result of every successful addiction treatment. So, to return to where we began, AA's goal, and the reason it is successful for so many people, is that it provides a psychologically and spiritually behavioral method and socially conducive environment to achieving and maintaining a higher level of consciousness. The successful AA member internalizes acceptance of his condition, and the conviction that no matter what the circumstances, he and those he loves are infinitely better off if he refrains from the use and abuse of any mind-altering chemicals other than those prescribed by his physician and used according to prescription. ---------- Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte, Michigan. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; (313) 802-0863, fax/phone (734) 692-1082; e-mail, michaelgbrock@; website, Published: Wed, Jul 17, 2013