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Newsgroups: alt.recovery,alt.recovery.aa
Subject: Alcoholism, Post 5.  The Study about AA
The Relationship of Alcoholics Anonymous to Abstinence
(12 steps follow)
Any such rigid set of beliefs that are religiously adhered to but not
scientifically proven (be it macrobiotics, fundamentalist Christianity
or insistence upon daily jogging) tends to irritate the scientific
community.  The fact that Seventh Day Adventists really do live longer
by no means mitigates the mistrust that many thoughtful people have
toward their dogmatic prohibition of coffee, cigarettes, and alcohol. 
Researchers prefer to study variables that they can experimentally
manipulate and observe without bias.  But like the study of political
parties within ones own country, the study of AA tends to polarize its
observers into believers and nonbelievers.  Perhaps AA resembles the
pickier her treatment is
available, the impact of AA on general remission rate is minimal.”  But
the immediately add: If attention is directed to this outcome (total
abstention) only, regular AA participation appears to make a
substantial and consistent difference.  Indeed, their actual figures
suggest that even when alcoholics opted for alcohol treatment centers,
they were *twice* as likely to be abstinent for six months if they
attended AA (during that time).  In their most recent four year follow
up, Polich, Armor, and Braiker (1981) suggest that AA may be the *most*
effective treatment to induce abstinence.  Four years after admission,
74 or 14 percent of their total sample attended AA “regularly” (as
opposed to occasionally).  Forty five percent of these 74 men had
been abstinent for a  year and another 12 percent for six months or
more.  The was three times the percentage of abstinence in the sample
as a whole.
The Armor study, however, does not address the challenge put forth by
Orford and Edwards:  “Directing clinic patients toward Alcoholics
Anonymous can enhance the likelihood of AA involvement, but evidence
for the contribution of AA as an adjunct to clinic treatment is not
easily found... attendance may actually cause improvement for a small
subgroup, or AA attendance may be an epiphenomenon.”  In other words,
abstinence may facilitate AA attendance,not vice versa.
A second reason for the scientific communitys skeptical view of AA is
that thus far follow-ups have been too short.  What most investigators
ignore is they are parochially concerned only with the subgoup of
alcoholics who attend their clinics.  
In contrast, Alcoholics Anonymous, a community grass-roots
organization, remains in a position to influence the alcoholics
behavior for a much longer period of time.  An individuals
relationship to a community based self-help organization is
intrinsically different from his relationship to a medical model
clinic.  He belongs to the first; he only visits the latter.
  One visit to an alcohol clinic may be far more effective than a
single visit to an AA meeting; but AA involvement, if it develops is
often measured in hundreds of visits spread over years, and the people
who find AA early in their alcoholic careers do not come to 
clinics.  
Thus, in this books examination of alcoholics drawn from the
community, a higher percentage of Core City alcoholics became abstinent
through their association with AA than with clinics, and more of the
College sample became abstinent through AA than with psychotherapy. 
When a sample of 100 clinic attenders (the Clinic Sample) were followed
for eight years, 48 percent of the 29 remitted alcoholics eventually
attended 300 or more AA meetings; but such a finding would not have
been observed on short-term follow up.
In the Core City sample, the nature of involvement with AA among the
currently abstinent varied enormously.  For some, AA was merely a
catalyst that was important only in the first weeks of abstinence.  For
others AA attendance was frequent for a year or two and then declined. 
For still others, AA became a part of their stable life structure.  The
18 men whom AA specifically helped had attended an average of 300
meetings, but a few of them had attended fewer than 75 meetings.
Certainly the way the four factors in Table 4.3 interact (Substitute
Dependency, Behavior Modification, Enhanced hope/self esteem, and
Social Relations) with and are incorporated by Alcoholics Anonymous is
complex and the  process by which AA becomes effective in reversing
alcohol dependence is not always sudden.
(Two specific case histories follow)
Not every alcoholic, of course, has Freds (one of the case histories)
gift for substituting people for alcohol.  Besides incorporating the
natural healing factors in Table 4.3, AA may be effective for other
reasons as well.  As Bales suggests, will power and self-control can be
enormously enhanced if they are derived from belonging to a group. 
Edwards and his colleagues articulate this issue well:
Identification is the very essence of the affiliation process.  The
role played by the sponsor may sometimes be important, but can be
exaggerated.  Identification is not with any one established member so
much as with fragments of a whole series of life histories which are
synthesized into identification with the group ideal.  The importance
of identification in group dynamics was stressed by Freud, and
identification assumes particular importance in the leaderless group
which must have a clear and firmly established picture of the ideal
member.  Although this picture may partly be based on the statistical
norm, it derives also in some measure from the group’s fantasy and wish
fulfillment.
AA transforms conflict solution via direct expression of impulses
(acting out) in reaction formation (turning instinctual wishes into
their opposites); alcohol, instead of being a source of instant
gratification, becomes the cause of all life’s pain.  Freud summed up
this process of reaction formation by the quip: A young whore becomes
an old nun. Not only does AA capitalize on group identification, but
also, with its unyielding insistence upon abstinence, AA capitalizes on
reaction formation.  But by definition, reaction formation is an
unstable, fragile defense. 
 Thus, it is far easier to maintain a regular daily pattern of
pleasureless early morning jogging than to alternate such a pattern
with weeks of self-indulgent sleeping in.  Trying to reestablish
training and self-discipline is more difficult than maintaining it in
the first place.  Thus, it seems self evident to both alcohol clinics
and old timers in AA that it is frequently disastrous for an alcoholic
(or a smoker) to return to social drinking (or smoking) after rigid
abstinence.  Indeed , once relapse has occurred, once adherence to a
rule of absolute abstinence is broken, previously sober alcoholics
often find it enormously difficult to return effectively to a program
they *know* is successful.  Undoubtedly, factors like shame and concern
with social acceptance by sober AA members also play a part.
The role that maturation and defensive transformation play in remission
from alcohol dependence is difficult to assess.  Often the evolution of
an impulse-ridden life into one of temperance seems intimately
associated with the same process of reaction formation by which the
adolescent free spirit becomes over 30.
Among the Core City sample, the process of maturation was epitomized by
one of the real sociopaths in the study.  In spite of superior
intelligence and a better-than-average family environment, he had spent
much of his young life flirting with organized crime.  He had
experienced many arrests for violent behavior and had spent more than
two years in jail.  At 40, without any kind of treatment or contact
with AA, he stopped drinking.  As he looked back on his life, he
sounded like the most brainwashed AA member:   “I just quit cold.  The
more I thought of what I’d blown in the past, the more I didn’t want to
drink...I traced all my troubles and stupid things I did to alcohol...I
have the slightest inclination to touch it now...I got a good look at
myself and realized I could not be a social drinker, I always had to
empty the bottle.  I thought I was having a ball at the time, I
couldn’t see the light for the trees...you think you're so sharp with
the guys but you really a shitbum.  After 40, he deliberately sought a
new circle of friends with whom to identify, to replace his street
drinking friends.  He said he still tried to have one or two drinks at
New Year's but "I couldn’t drink last New Year's.  I had a small
whiskey and water and couldn't finish it.  The development of such a
shift in life course cannot be explained by such simple terms as
“hitting bottom,burning out,  or growing up.  Rather the process
by which intrapsychic structures change and produce lasting changes in
character and modulation of impulses is one of the most complex, if
poorly understood processes in psychology.
AA also counters the tendency of the alcoholic to project all his
problems onto the outside world with a credo of assuming responsibility
for *all* his problems--a position that some critics of AA regard as
gross oversimplification.  But the insistence of AA on this point
transforms externalization of responsibility into self-responsibility. 
Lastly and perhaps most important, in AA denial of alcoholism is
transformed into a public, almost exhibitionist insistence upon the
admission, "I am an alcoholic."
However, Alcoholics Anonymous was not a universal panacea for the Core
City alcoholics.  Some Core City men, especially under compulsion,
attended AA for up to 200 meetings without real improvement in their
drinking patterns over eight years.  Some men in the Clinic study
attended 100 AA meetings without improvement;  often such attendance
was the price of admission to detoxification units and halfway houses. 
But there was no evidence that such individuals then recovered through
other means.
Although a few individuals report that their contact with AA began when
they were compelled to attend, to force regular attendance does not
seem generally useful.  As with church or country club membership,
reliance upon AA has to be an individual decision.
....
None of the other significant predictors of mental health in Chapters 2
and 7 (such as childhood environmental weaknesses, childhood emotional
problems and boyhood competence) predicted AA involvement.  Adult
outcome measures like education, adult mental health, sociopathy, adult
social competence, and maturity of defensive styles as an adult were
also insignificantly correlated with the use of AA.
In a thoughtful study, Edwards and his colleagues speculate that AA
excludes those who would threaten its cohesion.  However, neither in
their study nor in this one did criminal records, introversion, or
sociopathy distinguish members from nonmembers.  To the degree that it
exists, exclusion from AA probably depends more upon issues of
identification or nonidentification on the part of prospective members.
 An AA motto is “Identify, don’t  compare.”  As in church or fraternal
order membership, alcoholics, if they are to make use of AA, must find
members with whom to identify.
Perhaps the best testimonial for AA was provided by a 60 year old
socially sophisticated member of the College sample who long had
scoffed at AA:
“I’ve been in AA only about 2.5 months now (At this writing, two years
later, he is still in AA) and my only regret is that I didn’t join the
fellowship about 25 years ago.  Then, it might have seemed to me to be
not more  than a bunch of meetings with odd people in church basements.
 Now those meetings, which I attend almost every day except weekends,
come to me as a revelation.  Most alcoholics, I believe, grow up in a
glass isolation booth which they build for themselves to separate
themselves from other people.  The only person I ever communicated with
was my wife...AA shows us how to dissolve the glass walls around us and
realize that there are other people out there, good loving people...I
rarely talked to a woman without wondering whether we were going to
wind up in bed and I rarely talked to a man without trying to figure
out who outranked whom.  I discovered friendship in AA, a word which
had always sounded phony as hell to me.  This is more important to me
than their help in keeping me off booze.  I haven’t had a drink since
joining the fellowship but except for three days, booze
 had not been a problem for me in about two years.  Those three days
scared me, however, for obviously drinking was becoming compulsive
again and I was on the way back to the nightmares of two years ago and
before that.
   I love the AA meetings and love being able to call people up when I
feel tense.  Occasionally, someone calls me for help and that makes me
feel good.
    I get much more out of this than I got from decades of psychiatry. 
My relationship with a psychiatrist always seemed to me to be
distressingly cold.  I hated the huge bills.  For $ 50 an hour, one
doctor kept assuring me that I was nutty to worry about money, and the
time I couldn’t keep up my life insurance, I wish there were some form
of Alcoholics Anonymous for troubled people who don't drink.  We old
drunks are lucky.
End.......1995 
... Anything free is worth what you pay for it. L.Long
--- PPoint 2.00
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