Alcoholics Anonymous describes itself as a "simple program" that has only one requirement for membership—"a desire to stop drinking"- and one primary purpose- "to carry its message to the alcoholic who still suffers" (AA World Services, 1976, pp. 58, 564). The apparent single-mindedness of this nonpolitical, self-supporting program masks a remarkably subtle and, in some ways, counter-establishment worldview that challenges dominant cultural expectations regarding hierarchy, power, and models of helping. It is not surprising that AA is miscomprehended and misinterpreted. AA has been called a "cult," as well as "unscientific," "totalitarian," and "coercive" (Flores, 1988). Common criticisms include the following: • that AA takes power away from groups that are already disenfranchised (such as women) • that AA adheres to the medical model of disease, not a strengths perspective of wellness • that the program is a substitute addiction • that AA requires total abstinence • that AA is a religion or cult with a suspiciously white, male, dominant-culture, Christian God • that AA forces people to constantly degrade themselves by introducing themselves as alcoholics • that AA meetings are undependable because the meetings are run by nonprofessionals. Because a lack of information and understanding is the most important factor in therapists’ reluctance to refer clients to self-help groups (Kurtz & Chambon, 1987), these criticisms require examination.
Metaphor of Powerlessness
"Giving in is the greatest form of control" is a koan (a mental puzzle used by practicing Buddhists as meditation material to further enlightenment) created by "solution-focused" therapists to help a practicing Buddhist client translate the first step of AA into something consistent with her Buddhist beliefs (Berg & Miller, 1992, p. 5). It is also a good example of how the language of AA can be understood as metaphorical. A parallel metaphor more familiar to Christians might be, "to gain your life you must first lose it." Step 1 of the 12 Steps of Alcoholics Anonymous- "We admitted we were powerless over alcohol—that our lives had become unmanageable" is the foundation of recovery for alcoholics trying to get well through the AA program (AA World Services, 1976; Chappel, 1992; Covington, 1994; Kurtz, 1979). However, from a rational viewpoint, it is also the stumbling block for many professionals concerned that AA pushes "powerlessness" on people who are already powerless in the dominant culture. Wetzel (1991) voiced the following concern regarding
women: "The l2-step program reinforces one's belief in one's powerlessness and the necessity to relinquish the self to a 'higher power' (something most women have been doing all their lives in a secular sense)" (p. 23). For someone who is not addicted to make sense of step 1, it is helpful to view it from inside the experience of addiction and to look at the miserable state of affairs most women and men face when they first begin the road to recovery. The lived experience of the alcoholic, as one woman observed, is "an endless cycle of I’ll do better tomorrow' and of course I was always drunk again by 9 o'clock that night" (Davis, 1996, p. 154). A study of recovering alcoholics attending AA revealed an extremely high rate of psychological distress in the first three months of recovery comparable to that of psychiatric inpatients (DeSoto, O'Donnell, & DeSoto, 1989). The authors commented, "with a life situation in disarray, suffering a protracted withdrawal syndrome, and experiencing cognitive deficits, it is a challenge indeed for an alcoholic to abstain from the drug that promises at least temporary relief (p. 697).
The hard facts of being out of control with the addiction, no matter what one tries to do, and recognizing that one's life is in shambles roughly translates to the understanding of "powerlessness" that is the starting point in the AA program. AA invites people who declare themselves eligible to survey their world and to embrace the idea of step I: "1 am powerless over alcohol, and my life has become unmanageable" (AA World Services, 1976, p. 59). In other words, step 1 says face the reality and give up the illusion that you are in control. If people have doubts about their status, the Big Book suggests that they figure it out for themselves, experientially: "Step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once. It will not take long for you to decide, if you are honest about it. It may be worth a bad case of the jitters if you get a full knowledge of your condition"
The AA notion of powerlessness in the context of group narratives transforms the alcoholic's competitive stance with those who have tried to force him or her to stop drinking into complementary relationships with other alcoholics who are in the same boat, in the same meeting, and weaving and sharing similar stories of "experience, strength, and hope." Therefore, powerlessness in this context is a metaphor of connectedness, not isolation. Brown (1994) called AA's concept of powerlessness a "power from within model" instead of a "power over" model (p. 26). Similarly, Riessman (1985) called it "self-help induced empowerment"; he stated that "when people join together with others who have similar problems to deal with those problems. . . they feel empowered; they are able to control some aspect of their lives. The help is not given to them from the outside, from an expert, a professional, a politician" (p. 2). AA's concept of powerlessness is very different from the meanings of powerlessness associated with contemporary social and behavioral sciences, such as alienation, anomie, victimization, oppression, discrimination, and poverty (Borkman, 1989). Understanding this alternative meaning of powerlessness is helpful in resisting the temptation to oversimplify and interpret AA language in terms of social science terminology instead of the language of transformation.
Metaphor of Disease
AA is often criticized for its support and promulgation of the "disease concept" of alcoholism (Rhodes & Johnson, 1994; Riordan 8c Walsh, 1994), especially by some therapists who adhere to the strengths perspective. These two concepts have been presented as competing metaphors. The disease concept is negatively described as emphasizing the pathological, not the healthy; physicians and clinicians assume an AA's concept of powerlessness is very different from the meanings of powerlessness associated with contemporary social and behavioral sciences. In the expert role, clients are in denial and not responsible for their predicament, and recovery goals are designed and directed by treatment staff. The strengths perspective is optimistically portrayed as emphasizing wellness; helping relationships are nonhierarchical and collaborative, and recovery goals are co-constructed by facilitators and clients (Evans & Sullivan, 1990; Rapp, 1997). Although these comparisons may not do justice to either metaphor, the discourse continues to be fueled by the current interest in collaborative models of helping (feminist, narrative, solution-focused, and motivational interviewing models) and perhaps a desire to set these models apart from the medical model of helping. Further obscuring the issue of alcoholism as disease is the general inability to agree on just what "alcoholism" is, to achieve consensus on what constitutes "disease," or to agree on a single theory that adequately describes the etiology of alcoholism (McNeece & DiNitto, 1994).
Apart from the controversy, the disease concept has provided a means of expanding the diagnosis and treatment (and funding of treatment and research) of alcoholism and has done a great service in relieving the burden of guilt from both alcoholics and their family members (Burman, 1994). In theory the AA program leaves the debate to the professionals; it treats the controversy of alcoholism as disease simply as an "outside issue," following the principle of the 10th Tradition
of AA, which states, "Alcoholics Anonymous has no opinions on outside issues; hence the AA name ought never to be drawn into public controversy" (AA World Services, 1976, p. 564). Although the Big Book avoids the term "disease," it does use the terms "malady," "illness," and "allergy" to suggest the hopelessness of the condition of active alcoholism. Kurtz (1979), in his historical analysis, stated that Bill Wilson (cofounder of AA) "always remained wary of referring to alcoholism as a 'disease' because he wished to avoid the medical controversy over the existence or non-existence of a specific 'disease-entity'" (p. 22). It is somewhat ironic that in many current versions of the controversy, AA is linked firmly to the promulgation of the disease concept (for example, Burman, 1994; Rhodes & Johnson, 1994). However, as Kurtz (1979) suggested, "the Alcoholics Anonymous understanding of alcoholism begs for exploration within the insight that disease can also be metaphor" (p. 200). Disease as metaphor has been prevalent throughout history, including leprosy as "sin," the black plague of decaying Europe, the "white death" of tuberculosis in the slums of industrial cities, and the malignancy of cancer in the postmodern era of uncontrolled growth and greed. "Alcoholism" and "addiction" are similarly metaphors for modern-day isolation and despair. Many individual members of AA see "alcoholism" as a three-fold "disease" involving spiritual, mental, and physical factors. This view implies a holistic frame familiar to adherents of Native American traditions, Christian creationist philosophy, and Buddhist meditation, among others. Modern isolation and disconnectedness can be understood as arising from a foolish and doomed attempt to separate these unified parts of the whole person. To be fully human (and in the case of the alcoholic, to want to live sober), the physical, mental, and especially spiritual parts must be integrated. AA members attempt to live out this metaphor on a practical level by working on a spiritual program that attends to the physical, mental, and spiritual needs of the alcoholic who still suffers.
Metaphors of Dependence, Independence, and Interdependence
Another major criticism of AA is that it promotes dependency in the alcoholic by providing a substitute addiction or "crutch" (Walant, 1995). This is assumed to be bad, because it goes against the modern idea that the cure for dependence is absolute and total independence (Kurtz, 1979). Inherent in the metaphor of the dominant culture is the notion of self-reliance. In contrast, the AA approach to extreme dependence (alcoholism) is to embrace the metaphor of connectedness. AA teaches that humans are limited and dependent on other humans. Connecting with others through the fellowship of meetings, sponsors, and AA-sponsored events are ways to strengthen one's identity, not shrink it. According to Van Den Bergh (1991), the opportunity for human connection may explain some of the increase in participation in 12-step groups today: "Patriarchy engenders isolation and anomie; recovery groups provide an antidote to the pain and angst of believing one is alone. Individuals come together to share their 'experience, strength and hope'; through that process a feeling of personal empowerment as well as community affiliation is experienced" (p. 27). The same criticisms about "creating dependence" are aimed at psychotherapy, welfare assistance, certain religious communities, mothers, or any other entity that offers a port in the storm of life. In spite of the dominant cultural suspicion that there is "something undesirable about all dependence" (Riordan & Walsh, 1994, p. 352), levels of dependence usually shift naturally as a person becomes more stable. In AA newcomers may spend entire days in meeting after meeting, and it is routinely suggested that they attend "90 meetings in 90 days." As the length of sobriety and stability increase, participation generally shifts to helping others (making coffee, chairing meetings, sponsoring others). Many "old-timers" with years of sobriety continue participating to provide sponsorship and support for newcomers, and they depend on AA meetings to help them maintain their spiritual program, not just their sobriety. Independence in the American sense of "doing it alone" is not the goal; instead, the individual (isolated by alcoholism and an array of negative social consequences) is taught in small steps how to depend on others and how to allow others to depend on him or her.
Metaphor of a Higher Power
Lamb of God, Ancient Thing, Buddha, Yahweh, Love, Truth, Oneness, the Light, Mother God, Mother Nature, God, the Thursday evening "insanity to Serenity" AA meeting, the Friday 7 A.M. "Eye-Opener" meeting: All of these terms and many others may describe an AA member's Higher Power. The encouragement to choose the nature of this power is a freedom that underlies the spiritual nature of the AA program and distinguishes it from an organized religious program. The emphasis is not on what kind of Higher Power is embraced, but rather an acceptance of the idea of human limitations and "a Power greater than ourselves." In AA meetings, this is often expressed by a variation on step 2 ("Came to believe that a Power greater than ourselves could restore us to sanity"): "We came, we came to, we came to believe.'' For some, the Higher Power is located within the self. For example, in Covington (1994), Maureen described how important it was to let go of the "ego" on the outside and seek the "bigger self inside: "Developing a sense of self is critical to my well-being.. .. There is a power in me that's greater than the small self I've been accustomed to; it's larger than the way I've been trained to think about who I am. It's my soul-self. In cooperating with it, I surrender to a part of me that carries wisdom and truth. It brings me back into harmony and balance with myself—that's what spirituality is for me" (p. 35). Step 2 and step 3 ("Made a decision to turn our will and our life over to the care of God as we understood Him") (AA World Services, 1976, p. 59) are the spiritual cornerstones of the AA program. These two steps suggest that alcoholics connect with the healing energy ("grace," "Godness") of the world and within themselves and become receptive to spiritual guidance, whether the source be the wisdom of their AA group on staying sober or some other version of a power greater than themselves. A literal reading of these two steps has been interpreted by some feminists (Kasl, 1992) as sacrificing and martyring oneself for the sake of others, notably men. However, as Clemmons (1991) noted, step 3 "does not promote this kind of detrimental repression, but it does suggest that we must be willing to let go of people and situations outside of our control. .. . 'Letting go' halts the alcoholic/addict's efforts to control the uncontrollable and focuses on developing and listening to the true self (p. 104).
- Davis, D., & Jansen, G. G. (1998). Making Meaning of Alcoholics Anonymous for Social Workers: Myths, Metaphors, and Realities. Social Work,43(2), 169-182.
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17 The "disease" of addiction is a metaphor for what two things?
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