“You could try AA, but they're a funny lot. And you alcoholics tend to be a clever bunch ...” So said the counsellor my friend was seeing about her problem drinking. She was flattered: “Oh, how we alcoholics love to be told that we're extra-clever!”. AA, it seemed, was cultish, prescriptive, quite possibly exploitative, and clearly to be avoided. It was another four years before she overcame her prejudices, went to AA and found a way out of drinking.
Like many GPs, I didn’t encourage patients to go to AA, and I wonder how many lives we condemn as a consequence. Most organisations dealing with alcohol problems are run by professionals whose approach we understand. For us, AA doesn’t fit in the box. A bunch of recovering drunks helping other drunks? Can you imagine the patient who sits by the war memorial with cans of Tennent’s Super standing up to say “I am Pete and I am an alcoholic”? The businessman saying “I am Simon and I am an alcoholic”? What about the religiosity of AA’s ‘Twelve Steps’ programme? It’s not going to work.
But it does. Talking to people who have quit drinking through AA has opened my eyes, and if this article sounds like an advertisement, it’s because I think we fail our patients if we don’t give them a realistic picture of an organisation which might be the answer for them. AA works. Not for everyone, of course, and there have been no controlled trials, but many people can testify to its efficacy.
What drives people to AA? When my friend faced the humiliation of being too drunk to take part in the lunch party she had organised, she was desperate enough to take that first step and admit that she could not control her drinking. Others reached the turning point less dramatically, but all eventually recognised that they were on a one-way trip to an ignominious death. They describe walking into their first meeting unable to stop drinking and walking out at the end feeling that they had a choice.
A few facts. AA takes the view that for alcoholics, drink has become a mental obsession and a physical compulsion. Alcoholics, like those with severe allergies, are only safe if they forswear the substance which harms them. So, like most agencies dealing with addiction, AA would answer the patient who asked me “Can’t I be a part-time alcoholic?” with a resounding ‘No”.
Thousands of meetings take place every day, organised by the members themselves. AA receives no subsidies but membership is free. Those who can, contribute to the costs of hiring the venue.
AA is always there. Many alcoholics ask doctors for immediate help, but few organisations are able to see them there and then. It is said that the waiting tests the alcoholic’s commitment. Is that a rationalisation of our inability to provide a same-day appointment with an alcohol service? So, are we missing the window of opportunity to address their problem? In towns there are often several AA meetings a week; in cities there will be meetings every day. One alcoholic remembers his GP printing off the list of local AA meetings. He went along that evening and has been dry ever since. And he still attends regularly. “I’d been through all the usual agencies. I’d had all the advice. I still couldn’t keep off the booze. At AA I found the understanding that only other alcoholics can offer. A new social environment gave me strength and it still does. It’s like aftercare.”
When you join a group you have to own up to your alcoholism, but since everyone there has had a drink problem, you are among peers. “For the first time in years, I had no need to lie.” Of course, it isn’t all plain sailing. My friend returned home from her first meeting to a domestic emergency. Waiting for the plumber, she wrestled with the voice in her head which told her that it was a crisis, and a drink in a crisis was OK. Surviving that hour was the start of her recovery.
Yes, AA does have a spiritual side, which everyone I talked to felt was the key to its success for them. It may be a paradox, but they find that their own powerlessness is redeemed by a higher power. For some, it is God, for others the group, or whatever image gives them the willpower to live without alcohol.
The ‘aftercare’ includes having a sponsor – someone with a longer experience of abstinence, who acts as a counsellor – so members always have someone to help them find an alternative to reaching for a drink. Being a sponsor can be affirming. “For the first time for years I feel useful and valued.” Milestones are celebrated. “I thought I would feel ridiculous, but the cake for my first anniversary made me feel special.”
AA is worldwide. My friend, posted to Italy, continued to go to meetings. They helped her stay sober during a stressful year away from home, and what better way to meet local people and improve her Italian!
Some doctors know a lot about AA. Medicine is, after all, a profession with a high rate of alcoholism. Doctors may be anxious about encountering their patients if they join a local AA group. One doctor found the British Doctors and Dentists Group a good place to start, but now goes to AA as well. There seems to be an egalitarian acceptance and a security in AA groups which gives doctors the confidence to go down to the Saturday morning meeting in their local church hall. And even celebrities. On Desert Island Discs recently, footballer Tony Adams chose the AA Big Book to take to his island.
After listening to people talk about their experiences, it seems that AA is effective because it is different. But AA is not a cult. It does not demand that you surrender your worldly goods or your soul to the organisation. It doesn’t demand separation from your family. In fact, the reverse. Looking inwards to the group, these alcoholics have gained the strength to look outwards and engage with the world again.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…