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BEYOND AA

Alternatives for alcoholics who resist the program's religious approach

By Laura Flynn McCarthy

HEALTH Magazine, July/Aug. 1991

Mary Pretorius stood apprehensively in the doorway of her first meeting of Alcoholics Anonymous (AA). Inside, 100 men and women were talking about the mistakes they had made in the past and their current reliance on a "higher power" to help them stay clear of alcohol.

Pretorius quickly decided that AA wasn't for her. "I didn't like the intense religious focus, and reiterating my past just made me want to drink," says the former nurse. "And I felt uncomfortable talking about my personal problems among men; I was trying to save my marriage--which had been strained by my drinking--and I was also caring for my sick mother and my new baby."

Pretorius's therapist told her of a new nationwide support organization for alcoholics called Women for Sobriety (WFS). Together they started a branch of this group on Long Island. "In WFS, I felt that I was taking charge of myself, rather than turning my life over to a higher power. I'm the one who drank, so I'm the one who had to stop," says Pretorius.

Pretorius has been sober now for 16 years. "By focusing on the positive aspects of my new sober life, WFS helped me realize that I didn't need alcohol to cope."

There are more than 15 million alcoholics in the United States. But until recently, those who wanted the support of fellow problem drinkers had only AA to turn to. Like Pretorius, many alcoholics are uncomfortable both with AA's notion that they are powerless against alcohol without the help of a Higher Being, and with the group dependency the organization engenders.

For them, relatively new support groups like WFS may be the answer. These programs do not mention God or a higher power in their statements of philosophies. Instead, they emphasize nurturing one's self-reliance and personal strengths.

AA under fire

Since its founding in the 1930s, AA has helped thousands of people overcome dependency on alcohol. As further testimony to its success, the program's 12-step format has been the model for other addiction recovery programs, including Narcotics Anonymous and Overeaters Anonymous. These 12 steps are designed to help alcoholics first admit that they have a drinking problem, then to change their behavior. Some of the steps also provide guidelines for coping with future troubles.

For example, if a member's drinking led to the breakup of his marriage, he might be referred to step eight: "Made a list of all persons we had harmed, and became willing to make amends to them all." Then through group discussion he might explore ways that he could communicate with his spouse and perhaps mend the relationship. A member may also turn to his or her individual sponsor--a fellow AA initiate who serves as a source of support and encouragement throughout the recovery process.

In response to criticisms of its apparent religious bias, supporters of AA emphasize that it leaves the term "higher power" to individual interpretation. "For many AA members, belief in a higher power simply means belief in something greater than themselves, such as the group, or one's community," says Susan Meyers, (This name has been changed.) an AA staff member who has been sober for 22 years.

Still, most meetings end with a prayer. In addition, God is referred to in five of the 12 steps. For example, in steps five through seven alcoholics state that they: "Admitted to God, to ourselves and to another human being the exact nature of our wrongs; Were entirely ready to have God remove all these defects; Humbly asked Him to remove our shortcomings."

For many people, the approach works. "One of the basic steps in overcoming any addiction is to gain a sense of identity apart from the bad habit you're trying to overcome," says Rebecca Curtis, Ph.D., a professor of psychology at Adelphi University in New York. "The spiritual dimension of AA is one way to do this."

But some alcoholics prefer to take the credit for defeating addiction, just as they accept the responsibility for drinking in the first place. This could be particularly important for women. "Women are socialized to have a lot of dependencies, particularly on men, and AA just fosters that tendency," says sociologist Jean Kirkpatrick, Ph.D., the founder of WFS. "From the day you stop drinking, you need to start taking responsibility for yourself and your actions."

Proponents of secular support groups also criticize AA for urging alcoholics to harp on their character flaws or past mistakes. "I had an instant aversion to AA because of the self-flagellation it encourages," says James W. Cain, who had tried AA on and off for about 20 years.

Thanks to a new group, Secular Organizations for Sobriety (SOS), he has been sober for more than a year. "It was depressing to focus on my faults and to feel that I had no control over my life. At SOS meetings, I developed a sense of self-empowerment, and that has made all the difference in my recovery."

AA supporters counter that reviewing your prior mistakes can provide you with the insight to prevent them from recurring. "For example, AA's fourth step involves doing a `searching and fearless moral inventory of yourself,' and learning from your mistakes new ways of dealing with problems," says Robert G. Mellen, Ph.D., director of the Mellen Recovery Center in Santa Monica, California. The point of this soul-searching, he explains, is to review both the bad and the good things that have occurred in the past, so that the alcoholic can better understand himself.

New choices

It is becoming increasingly evident to experts that the reasons people drink are as varied as the types of alcohol available to them. "We need diversity to treat diversity. Until recently we had one standard self-help program [for alcoholism], AA, and we ran everybody through it, even people whose problems weren't that severe," says Arthur T. Horvath, Ph.D., a San Diego-based psychologist who specializes in non-12-step treatments of addiction.

In many ways, AA and the largest secular groups are similar. Each offers a non-judgmental atmosphere in which alcoholics can discuss the issues affecting their lives and their recovery from alcohol addiction. All of these organizations encourage complete abstinence. Meetings last an hour to an hour and a half, and are free of charge. (Donations of no more than two dollars are requested at each meeting, however.) The only requirement for joining any of these groups is a desire to stop drinking.

Because none of the four treatment programs listed here have reliable statistics about success rates, choosing one is somewhat subjective. Without a solid track record to go by, the best way to pick a program is to become acquainted with the philosophies and methods of each group. Then you can choose an organization that fits your personal needs and lifestyle.

- Alcoholics Anonymous.

The big advantage of AA is its accessibility. Membership is more than 2 million in 134 countries worldwide. Some groups are designed to meet the needs of specific types of people--men, women, gays, doctors, lawyers. Of course, these "specialty" groups are more likely to exist in large cities. Meetings vary in size from small workshops to "open" gatherings that consist of 100 or more people. AA suggests that new members attend daily for the first 90 days, and at least once weekly post-recovery for the rest of their lives. The structure of meetings falls into many categories. "Beginner meetings offer newcomers tools to stop drinking, such as what to do at parties and in other situations where alcohol is offered. General open meetings may focus on the principles of AA or feature speakers discussing how they overcame alcoholism. `Step' meetings revolve around one of the 12 steps and how to work it into one's lifestyle," says Meyers.

- Rational Recovery (RR).

Founded only five years ago, RR now has chapters in 33 states nationwide as well as Italy and Australia, and at least 10,000 people have passed through the organization. RR teaches that what leads to persistent drinking is a belief in your own powerlessness and incompetence. Though meetings do not follow a specific format, discussions center on helping people to recognize the "addictive voice" within them and then come up with strategies to avoid succumbing to that voice.

For instance, the moderator, usually a recovered RR member, might open up a general discussion by asking the question, "Who has been thinking about drinking?" And during the ensuing conversation, other underlying problems may surface. "Someone may come to a meeting and talk about how she just got fired from her job, and how she's thinking about drinking again, `just until I can sort things out,'" says founder Jack Trimpey. "She might say `I was sober and I still got fired, so I might as well drink again and enjoy myself.' That's the addictive voice revealing itself. The group might then discuss other ways she can pick herself up, begin job-hunting, become a better family member."

Groups are generally limited to 14 people. Unlike the other three self-help organizations, each RR group has a professional adviser--a medical doctor, psychiatrist, psychologist, professional social worker or nurse--who acts as a resource and sometimes moderates meetings. RR members are encouraged to attend no more than two meetings per week, in order to prevent developing an undesirable dependency on the group. "After about the first six months or so, you should find yourself missing meetings, and eventually getting away from the group altogether," says Trimpey. "We feel you should be on your own two feet within a year and shouldn't need to attend meetings thereafter."

- Secular Organizations for Sobriety.

James Christopher, a former alcoholic, founded SOS in 1986 in North Hollywood, California. The program now has about 20,000 members in more than 400 groups across the United States, Canada, Europe, Asia and Australia. "Our group focuses on self-empowerment, self- responsibility and human support," says Christopher. Rather than stating a strict philosophy, SOS emphasizes dealing with alcoholism by taking things one day at a time. "Each group is autonomous and holds meetings in the way that best suits members' needs. We want to maintain a loose structure in order to avoid becoming too bureaucratic. As our organization grows, we want to stay dogma-free," says Christopher. "Our only request is that the gist of the meetings be kept secular. We're not anti-religious, but we believe that religion and sobriety are separate issues."

Each SOS group has a maximum of about 20 people who take turns acting as moderator. Meetings consist of general discussions about specific issues concerning specific members, and end with a round of applause in honor of the group's continued sobriety. Individual sobriety "anniversaries" are acknowledged. Groups also discuss cross-addictions to other drugs. Meetings are open to non-alcoholic family members and friends. New members are advised to attend at least one meeting a week for the first six months, and then on an as-needed basis.

However, Christopher stresses that different people have different needs--for some people, this may mean attending monthly; for others a "booster meeting" every six months may be enough. The point is, he believes going to meetings even after one is recovered helps to maintain sobriety. "We don't want to obsess on the fact that we're alcoholics, but we don't want to become complacent either; maintaining a deliberate awareness of alcoholism can help people stay sober," he says.

- Women for Sobriety.

Kirkpatrick founded this organization in 1975 because she was frustrated by the lack of programs aimed specifically at women. WFS has about 5,000 members in almost all of the 48 contiguous states, as well as Canada, Iceland, Switzerland, Australia and South Africa. WFS views addiction to drinking as an illness spurred by the tendency of alcoholic women to feel--and therefore act--unloved and incompetent: They turn to drinking as a tool for coping with their poor self-image.

The organization also stresses that women alcoholics are often judged more harshly by society than their male counterparts. This puts them at a further disadvantage: Because they feel isolated, they have more difficulty recovering. WFS meetings are moderated by ex-alcoholics who have been sober for at least one year, and who have been trained in the principles of the group.

Each session opens with the moderator reading the organization's 13 statements of philosophy--which include "Problems bother me only to the degree I permit them to," and "I am responsible for myself and for my actions." To end meetings, members join hands and recite the group's motto: "We are capable and competent, caring and compassionate, always willing to help another, bonded together in overcoming our addictions." In between, members might talk about personal problems related to recovery, or perhaps one of the statements of purpose. Meetings, ideally limited to 10 people, are generally held once a week, but phone numbers are exchanged so that members can be available to each other whenever necessary.

Laura Flynn McCarthy writes frequently about health.

Source: HEALTH Magazine, July/Aug. 1991, pp. 40