These Are Only Suggestions

By David B.

I like AA – especially the fellowship. In most locales, it’s the only show in town and the price is right.

When I was a kid, my family went to the Baptist church and my Baptist friends badmouthed Catholics. I married a Catholic and found out most Catholics were good people. Why did the Baptists think they were so bad? Catholics believed the wrong dogma (unchangeable beliefs). I ended up rejecting the dogmas from both groups and tend to believe that uncritically accepting any group’s dogma is fuzzy thinking. AA has a bit of dogma, despite Bill Wilson’s efforts to soften some of what’s in the Big Book: “We only know a little … future studies will show us new ways … these are only suggestions” … or some such language, talking about his book and the steps.

As opposed to dogma, the scientific method never claims to arrive at the absolute truth. The latest and best evidence is accepted for what it is – simply the latest and best evidence. The bottom line is subject to change whenever new evidence shows up. Dogma becomes kind of obsolete when you try to think like a scientist – and there are other questionable things about dogma.

suggestionbox2 Dogma has a tendency to be “all-or-nothing” about issues. So I understand, earthly phenomena, including most human behaviors, fall somewhere along a Bell-shaped curve. Things aren’t black or white nearly as often as they are various shades of gray. And there are multitudes of variables in epidemiological studies (such as alcoholism), making them notoriously difficult to interpret.

A couple of years ago, with the help of AA Agnostica, a group of us heathens in San Antonio started a secular AA group. At our meeting, for six minutes I can talk about whatever’s on my mind and nobody interrupts me. After everyone’s had their turn (usually a real treat to listen to), we might have a bit of cross talk before reciting the Responsibility Pledge. Some of us like the steps and some don’t. Some of us have had sponsors and some haven’t. One of us wears a t-shirt that says, “Science doesn’t care what you believe.” Only a few of us are the least bit religious and we have good discussions and fellowship.

I like some of the AA slogans – for example, “Don’t drink, no matter what”, “Don’t take yourself so seriously”, “It’s a 24-hour program”, “I may not be much but I’m all I think about”, and my favorite, “Take what you like and leave the rest.” Other AA slogans, I don’t like – for example, “Let go and let god” – and any others advocating simplistic reliance on ghosts.

Just an example of how AA dogma doesn’t follow current scientific literature is a commonplace AA belief about recovery. A couple of weeks ago after a meeting, a disagreement surfaced about the likelihood of spontaneous remission from alcoholism. The discussion that ensued is what prompted me to write this article. One of my buds (Sam) thought recovery without treatment was extremely rare and unlikely – an opinion many AAs would agree with. Others of us had read the literature and believed untreated recovery to be commonplace. Sam spent hours the next week researching articles about the subject and the scientific papers behind the articles. As a result of his study, he changed his mind. The following week, he showed me an article that he thought represented the best and most current knowledge: “Recovery from DSM-IV Alcohol Dependence” – Dawson, et al.

I read it – like trudging through a morass of statistical swampland in hip-boots. Ten or so pages of excruciating, hairsplitting detail including four lengthy tables. More information than I signed up for but I got the point. Here are a few of their conclusions, summarized better than I could have by Maia Szalavitz with the Pacific Standard.

Contrary to popular belief, most people recover from their addictions without any treatment — regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted (the Dawson study) found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.

Unfortunately, compared to the rehab narrative, the stories of people who get better without treatment are rarely as compelling. They tend to consist of people leaving college and realizing they can’t binge drink or take drugs and hold a job and care for a family. And since most people who straighten out on their own never show up in treatment, the worst cases congregate in rehab and make addiction recovery seem quite rare.

—Maia Szalavitz, “After 75 Years of Alcoholics Anonymous It’s Time to Admit We Have a Problem”, The Pacific Standard, February 10, 2014

There is room for argument about these conclusions (epidemiological studies being difficult to interpret). And you may have noticed the subtle debunking of another sensitive item – that some people who’ve been diagnosed with DSM-IV can learn to drink socially. We could throw in whether alcoholism qualifies as disease – but I’m not interested in arguing any of those things (although I have limits – it’s not an allergy). My point is, I don’t buy all of AA’s dogma but I still like AA. Despite its flaws, it’s a remarkable organization that serves people around the world. I believe many people who don’t “keep coming back” still benefit from their experience with AA, including, at times, varying degrees of recovery. And that those who continue to go to meetings profit from their participation whether or not they follow the common tenets of AA.

take-what-you-needThere are some who have joined our secular group for only a couple of weeks to several months, but then left, never to be seen again. I choose to believe our brief fellowship did them some good. Hopefully, some came to grips with their drinking problem and moved on with their lives. I’m also pretty sure some didn’t (come to grips). But they probably didn’t all immediately spiral into oblivion simply because they weren’t going to meetings.

Most attendees at our meetings don’t like the (sometimes overwhelming) religiosity at regular meetings and many don’t like various aspects of AA dogma. The good news is, you can believe whatever you want and still be a valuable member. The only requirement for participation is a desire to stop drinking and you’re a member if you say you are. You truly can “Take what you like and leave the rest”. Those who insist you do your program their way may not like it when you don’t (do their program), but you don’t have to change your program, harbor a resentment, or even take them seriously.

My catchphrase might be, “It’s the fellowship, stupid” – no insult intended. Not only can I talk about my latest efforts on becoming a better human but I get to hear others in my group do the same. It’s the best game in town.

Audio Version 

Audio narrated by Len R., Jasper, GA 


About the Author, David B. 

Dave B. is also the author of  “A New Agnostic AA group and a Hat Tip to Unitarians”, published in  AA Agnostica  on March 15, 2015.  He is a physician who is pleased and proud to have been sober now for twenty-six months.  He achieved nonbeliever status during his senior year at an ultra-religious college. Since then, he claims, “the longer I live, the more it looks like nobody’s watching.”  His home group is Mostly Agnostics AA of San Antonio – check out their website at  Mostly Agnostics AA.  He and his Catholic wife have six kids, all married and productive, for which he is grateful.  He takes as much credit for their success as his wife will let him.

 

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  1. Galen T November 21, 2016 at 9:26 pm - Reply

    Thanks very much for your article, David.  It well illustrates the difficulty of making any categorical statements about alcoholics, even ones based on research.  The study described by Maia Zzalavitz, for example, raises more questions that it resolves.  For starters, on what basis were the persons under study diagnosed  as alcoholics?  Many studies, not to speak of many opinions about alcoholics, are complicated by unclear distinctions between heavy drinkers and the true alcoholic. This is the case even with the raised bar to which Bill W. refers in the Big Book.  Of course there is no way to draw a clear line between what used to be called alcohol abuse and alcohol dependence.  While the distinction is inexact, since there is no commonly agreed upon definition of alcoholism, this does not mean it is without significance, particularly when the alcoholics being referred to might be better described as heavy drinkers. The latter, we know, are far more likely to recover without formal treatment or AA involvement than the classic alcoholics like myself who drink between a pint and a quart of the hard stuff every day for years on end and eventually find their lives in shambles. Without using the same language, this distinction between severities of drinking and its attendant consequences, is used by William White to predict recovery outcomes, whether mediated or not by formal treatment.

    Second, are we really justified in rejoicing over spontaneous alcoholic remissions when the duration of measurement is only one year.  Knowing what we do about relapse, it would be more instructive to revisit these cases after three years, or even five.

    Third, and most important, the study cited repeats the common assumption that abstinence is equal to full recovery.  Getting abstinent is one thing. Developing a sober manner of living is something else. And AA is not an abstinence enforcement organization but a program of recovery. Did those one-year wonders recovery from their alcoholism or merely stop drinking? Everybody who has spent time in a recovering community knows he difference.

    David, I welcome your message of tolerance and humility. I have attended thousands of regular, old-fashioned AA meetings and have developed a few impressions. I value the steps and think that everything else being equal, those who “do” them have a good shot at a contented and productive recovery.  But I know people who have given only a passing nod to the steps and nonetheless recover through their grounding in the fellowship.  The Back to Basics folks think newcomers should take the steps immediately and streak through them as quickly as possible.  I am highly skeptical, but I gather this plan of attack helps some people. The point is that I know what has worked and still works for me.  I offer my experience to others and am glad if they find it instructive, but undaunted and unbothered when they don’t. I am always interested in hearing about different and unorthodox ways of gaining and maintaining sobriety. The experience of others can only enrich my own and it may even change the way I think.

    Where I think AA needs the most tolerance and mutual respect is in the area of religion and spirituality.  I hope we are getting to the point when AA can embrace people regardless the flavor of their spiritual convictions or lack of them.  Some people fear that diversity will undo us.  I doubt it.  The heart of AA has always embraced evolution and change as we learn more and experience life more richly. Just because a certain cast of mind and set of practices worked in the late 1930s doesn’t mean it will work well today. AA’s best bet for continued longevity and vitality is to bring open minds to our mutual experiences and a readiness to be enriched by one another.

    • Peter T. November 30, 2016 at 10:49 am Reply

      “AA is not an abstinence enforcement organization but a program of recovery” – if I may… AA is a fellowship (see the rest of the preamble) and AA HAS a suggested program.  The “AA IS a program” thinking is what fuels the dogma, and a misunderstanding widely accepted at face value.  I’m sure you didn’t mean otherwise, but I find I need to be very careful with the language here, when trying to explain my point of view to the zealots.  Thanks for taking the time to put together your comments.

  2. Dave B November 21, 2016 at 5:06 pm - Reply

    Thanks to you folks who took the time to respond – your comments were better than my essay.  And thanks for the clever visual aids, Doris.

  3. Victoria November 21, 2016 at 1:01 am - Reply

    May I add that I do love Beyond Belief and Agnostica precisely because it feels like a safe middle ground for me. The Middle Way, if you like, between the sometimes rabid / fevered anger of the various leaving / left / can’t stand AA sites, and the equally rabid / fevered evangelistic dogmatism of AA-Under-The-Influence of back-to-basics and its offshoots.

    So, thank you, BB and Ag.

  4. Victoria November 21, 2016 at 12:51 am - Reply

    Great piece, David, thanks so much. I’ve been cogitating a great deal on all the matters raised by you, your sources and of course respondents here in (my very calming space of) AA Beyond Belief (and Agnostica). Being Australian, there are virtually no (that’s almost zero) meetings like you guys have – as I always mention, there’s ONE here in my city Melbourne, but I can’t easily get to it.

    So, I just beaver away on my own research  and work in multiple ways on my massive problem with alcohol addiction with a dual diagnosis of mental health probs plus a few chronic and progressive physiological illnesses that can only be ‘managed’. For me, with AA,  the simple getting together with some others a few times a week or whenever must be now – for my sanity! – construed and viewed as just a kind of ‘meetup’ per the online network, with some extremely eccentric people.

    Some of them are frightful, and downright abusive in covert and not-so-covert ways with their dogmatism; some are lovely, warm and non-judgemental; some are very quiet, in the background as it were, with some clearly long-standing psych problems – but they don’t foist them on others.

    Those latter, I’ve noticed in the five years I’ve been around the rooms, seem to exemplify take what you need and leave the rest, so they smile or just nod a greeting, say g’day (if not ultra-shy), and the few times they rise to share if asked (how they do it mostly here in Aus, in i.d. meetings whether AA or NA, the chair randomly asks person x or y if they’d like to share), they speak of their story very simply. No jargon, no not-very-subtle hectoring, very little if any florid, breathless statements like ‘my life is AWESOMMMME’ etc etc. Many of this sort I’ve noticed have been around the rooms with or without long-term sobriety, but for years, many years. I suppose it’s a safe place (?) maybe for them, a routine even.

    Personally, I’ve come to see that I don’t want to be stuck in meetings multiple times a week, and certainly not like that for years on end for the rest of my life. I don’t always rack up lots of sober ‘time’, either, and have also come to accept that. Have I been a fully alcohol dependent ‘patient’ in the eyes of my GP, rehab staff, and according to the (always changing!) criteria at government and DSM level? Too right I have. But having come into the world of addiction recovery – not just AA, but abstinence-as-a-totality – pretty late in life, I’m becoming more and more clear about my limitations. If and when I drink again, which I sometimes do, I have to practice harm reduction – which has gained reasonable traction in the broader Australian environment more than in the States, although still not as strongly re alcoholism as for other drugs. I do NOT want to go through yet another miserable relapse back into dependency with all that goes with that. I also have to clearly insist on giving myself the chance to work on my mental health and manage my other illnesses, through the numerous forms of therapy and sensible coping mechanisms available now, if we avail ourselves of them and practice them – just like with sobriety, physical and emotional.

    This crucial intermeshing of ‘treating’ our addictions _alongside_ any comorbid, and / or un-related, conditions is, in my considered experience and opinion from vast research, where much of AA’s selective blindness is enhancing its irrelevance. Indeed, it’s becoming a bit dangerous for so many. NO surprises then to see so many newcomers disappear quickly, even aside from the mad god-n-morality-evangelical stuff. As lifej has noted, and if I may add a gloss: in effect, I believe that if the Bill W of his more-considered later writings were alive now, well into the 21st century, he’d possibly be the first to (humbly?) observe – ‘shit, more HAS been revealed. How could we have been so closed-minded?’

    • life-j November 21, 2016 at 4:07 pm Reply

      Victoria, have you ever looked into Naltrexone/Nalmefene as medications to stop or cut back to safe levels of drinking? I wrote an article both here and at aaagnostica about it. One of the doctors at the convention told me that for some the side effects are more problematic than often mentioned, but anyway, have a look.

  5. life-j November 20, 2016 at 11:11 am - Reply

    Dave you were right, I do like this article (and good to meet you!).  Though valid objections can be raised to almost anything and everything (including the objections) we do need to start coming out of the trenches that AA has dug for itself. I think a lot of hardcore AA people people are scared, and with good reason that once we start critisizing one part of the program the whole house of cards is going to come down, and AA will fall apart so they choose to insist that every bit of it is right, instead. And it could very well happen if we keep holding on too much longer. (The Emperor has no clothes)

    If we could only stick to what we’re good at “It’s the fellowship”, and that certainly looking at where we went wrong and looking at ways to fix it, sharing with each other etc, and accept that those are really good tools for a large group of alcoholics *who respond well to that particular approach*, but not universally end-all and be-all tools, if as a fellowship we could only let go and let god as Steve gets into – or, as Marya Hornbacher puts it – open up our tight little fists – and let go – of the program, accept that we don’t own recovery, we would do a world of good.

    AA has helped a lot of people, but like most religions, by monopolizing recovery it has probably doomed more people to an alcoholic death than it has helped.

    We need to stop being the only game in town.

  6. Dan L November 20, 2016 at 11:07 am - Reply

    Thanks for the essay David.  You bring to mind a question I have been asking of myself and others about spontaneous remission.  I drank heavily for a lifetime and could safely say I knew most of the drunks in my area which is fairly well defined.  I do a lot of community work these days and I have the good fortune to have access to professional help on a regular basis.  I know who is in recovery and who is drinking and who has died and who has simply disappeared.  The question is where is this crowd of spontaneously recovered addicts hiding?  What is their story?  Can they offer experience, strength and hope?  Can we tap into their secrets?  I just do not know where these huge numbers of recovered addicts are hiding.  Maybe they have their own country.  Thanks again.

  7. Pat N. November 20, 2016 at 10:52 am - Reply

    Good article, David-thank you. In lieu of “Let Go and Let God”, how about the trite old phrase “It Is What It Is”, which has consoled me any number of times?

    I think it’s fruitless to argue about numbers and percentages of alcoholics in and out of recovery, what recovery means anyway, what an alcoholic is, etc. The exception is attempts to study issues scientifically, like the one cited-scientists have to establish criteria for what they’re talking about. I often debate hardline statements like “millions of people have gotten sober through AA”. Nobody knows, and why should we care? It is what it is, and it can help lots of us.

    Problem drinking, whether called alcoholism or chemical dependency or whatever, is a problem. So is being overweight. Some folks are able to reduce weight on their own, some live with it, and some need intense interventions. Of course overweight hasn’t the dire effects on others that problem drinking has, but the questions about “recovery” are similar.

    I understand my parents stopped drinking alcoholically in the 1920s, well before AA, and I don’t know how. Dad stayed sober (I think) until he died in 1950, and Mom did until she relapsed in her 70s. Were those years of sobriety worthwhile? I’m grateful for them, but where do they fit statistically, and who cares? I think our focus should be on helping drunks get sober, with whatever assistance needed, AA or not, for as much of their lives as possible.

    A big part of my alcoholism involved feelings of worthlessness and isolation, and I don’t know if I would have sobered up without the acceptance and love I found in AA (and I don’t care). Other alkies may have other paramount needs, or meet them in other ways. It’s all good if they stop drinking.

    That’s why we need to keep widening the AA doorway-some alcoholics might not make it without us.

    Thanks again.

     

     

  8. Bob K November 20, 2016 at 8:33 am - Reply

    There are things in the piece with which I agree, most particularly, reference to the Bell curve. Human characteristics and behavior tend to fall along a continuum.

    Although I have a BSc, I have some problems with science in the study of alcoholism – this sort of thing.

    ” Men were defined as risk drinkers if they drank more than 14 standard drinks per week, on average, or if they drank 5 or more (5+) drinks in a single day one or more times in the past year. Women were defined as risk drinkers if they drank more than seven standard drinks per week, on average, or if they drank four or more (4+) drinks in a single day one or more times in the past year. A standard drink was defined as 0.6 ounces of ethanol.”

    Throughout the history of the treatment of alcoholism, the very unscientific gathering of mutual aid societies have been more effective than anything yet offered by the scientific community. To me, descriptions of “at risk” drinking, as above, just don’t “get it.” Science doesn’t really “get it.”

    Ladies – 7 or more drinks a week (on average)???????????????????????????????
    More than 4 in a day at least ONCE in the past year?????????????????????

    Is that some bad-ass drinking??

    C’mon.

    Prior to his cessation of drinking in December, 1934, I could do an analysis showing how WELL he was doing. He drank less days than he didn’t drink. Total booze volume – WAY DOWN.

    For people like me, anything less than total abstinence is fanciful. If that worked, I’d be doing it, I certainly tried hard enough.

    • John S November 20, 2016 at 8:54 am Reply

      I don’t think that I could have quit on my own. I had a really difficult time even with AA. Drinking interrupted my life, actually it made living a normal life impossible. I had to measure my drinking in terms of time because I could never keep track of bottles. I would typically drink for 8 to 10 hours or more at a time. I started at 5:00 when I got off work and quit at 3:00 am when the bars closed or I passed out. I would stumble into work the next morning still drunk and paranoid.

      After being arrested for drunk driving three times in three years, I ended up losing everything that I had, and I still wanted to drink. AA was the only place where I felt comfortable talking about this. I couldn’t open up to family, friends or medical professionals. So, the Fellowship really did save my life.

      Today, I see many people come through our doors for the first time who are in some sort of crisis in their life with alcohol pointing to their problems. Many of them come around for several months and then I don’t see them anymore. I prefer to think that they are doing well, that they only needed our meetings to get through that crisis, and they have moved on happily with their lives.

      I’ve known too many who have died from drinking, and it was as impossible to reach them as it is to reach someone lost in psychosis. I guess like everything, alcoholism or “problem drinking” runs on a continuum. Maybe the Big Book was right about the ability for one to stop on their own as being dependent upon how bad the problem has gotten.

    • Bob K November 20, 2016 at 8:39 am Reply

      Sorry, I was referring of course to Bill Wilson.

  9. Lech Lesiak November 20, 2016 at 8:14 am - Reply

    Good article.

     

    I’m one of those who might be put into the spontaneous recovery category.

    I quit drinking almost entirely for a period of nine years.

    I only went to AA when my drinking began to increase again, and I could see some of my

    old patterns coming back.

    During this latter stage I never drank at what I would deem to be an alcoholic level.

    I agree “It’s the fellowship, stupid!”.

  10. Tommy H November 20, 2016 at 7:53 am - Reply

    In the paragraph starting “Compared to the usual rehab stories,” you use closing quotation marks but not opening.  Is it a quote from somewhere, and, if so, where?

    • John S November 20, 2016 at 8:01 am Reply

      Thank you Tommy. We have corrected this by including the quote from Maia Szalavitz in block quotes. Thanks for pointing that out.

  11. Steve K November 20, 2016 at 7:21 am - Reply

    Thanks for your well written article David. Although I enjoyed reading it, I do disagree with some points you argue. In relation to your objection to dogma being absolutist and the observation that most things are not “black and white” I agree; however, I often find agnostic and particularly atheist viewpoints equally as rigid and self-righteous at times.

    In reference to the saying “let go, let God” for example, why not see the the inherent principle rather than the religious language? For me, the saying can suggest: “let go of control and surrender to life”….” get out of the way of life” ….”acceptance of what is”…..”no escape, face life and grow” …”face life and trust in good”. These are all helpful sayings or concepts for notoriously fearful, neurotic, and therefore controlling and life avoiding alcoholics. My point being is that I find it helpful to look past the literal meaning of AA’s more religious language to the underlying helpful principles it contains.

    In respect of spontaneous recovery from addictions without treatment you maybe interested in this excerpt from an essay of mine Is Addiction A Disease?”   …..
    Lewis and others cite the research that in community populations most with addictions resolve them without help from treatment services.
    According to William L White (the addictions researcher), in an email to me, they fail to mention the difference between community and clinical populations in respect of addictions ending ‘spontaneously’.

    “People often note my reference to resolution of alcohol and other drug problems without professional treatment or recovery mutual aid involvement, but they often fail to mention (because it doesn’t support their argument) the tandem conclusion that the probability of this sharply declines as problem severity, complexity, and chronicity increases—this is the major difference between follow-up studies of community samples and follow-up studies of clinical samples.”
    Bill White. November 6th 2015.

    • Galen T November 23, 2016 at 12:07 pm Reply

      Steve- You got me thinking about the slogan “Let go and let God,” which seems questionable on a couple of fronts.  First, let go of what, exactly.  Let go of the need for absolute control–yes.  Let go of taking responsibility for our life–no.  And how about the “let God” part.  I am doubtful that the secular translations you cite mean the same thing.  Most people will interpret “let God” to mean letting God take control of our life or our will, and this strongly implies belief in a theistic God.  It is hard for me to see the principle behind the religious language without turning it into another principle altogether.

      Some of the slogans have enduring relevance.  Others, like the one under discussion, can be both baffling and, to agnostics and atheists, off-putting.  Another anachronistic slogan is “Think, Think, Think,” whether right side up or upside down.  True, we can overthink ourselves into trouble. But at other times we need to think rather than act impetuously. For example when I feel like taking a drink.  Then I would be well advised to “think the drink through.”

      Let’s have an article on the slogans! Which ones still work and which ones not so much.

      • Steve K November 24, 2016 at 3:26 am Reply

        My point is we are allowed to interpret AA literature in a way that is individually meaningful (p. 47 Big Book), and that is what works for me, rather than fighting AA’s historical religious roots. We don’t have to be literal in our interpretation.

        My translation may not work for you, but it does for me. Many in the fellowship can’t get past the word God, and struggle to disassociate it from the christian or religious understanding, and that, I feel, is why my translation doesn’t work for you and others. A bit of imagination helps I find, and we don’t have to follow our conditioning re the God idea.

        “Let go”, for me, means letting go of things beyond my control, which is most things. However, my fearful ego doesn’t seem to accept this reality. The slogan is a helpful reminder that my power is limited. I’m responsible for my actions and how I respond to life and others, but beyond that I have no control. I also need others’ help and support, and need to develop healthly dependencies – mutuality or interdependence – beyond myself, in order to manage my life well.
        The Fellowship of AA has often been criticized for encouraging dependence, both upon a higher power and upon the Fellowship itself. This viewpoint lacks appreciation of the difference between immature dependence or co-dependency and healthy mutual dependence or interdependence. In time, mutual aid, as encouraged within AA and by the practice of the Steps, will develop healthy dependence and independence. 
        This is one way I can relate to the “Let God” part of the slogan, but there are many other sources of spiritual strength that I can turn to for guidance and support in life.
         

  12. Thomas Brinson November 20, 2016 at 6:50 am - Reply

    Wonderful,  cogent, well-reasoned article, David, with hints of a wry sense of humor that more and more in recovery I come to appreciate and relate to — Thank you. !~!~!

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