Is belief in a Higher Power required for recovery from addiction disorders? This question comes from the experiences and observations of the author following 20 years of active participation in the program of Alcoholics Anonymous. The purpose of this essay is to explore the addiction research literature as well as anecdotal reports of several members of AA and alternative recovery programs, and to suggest changes that might be required to maximize the effectiveness of addiction treatment. For this critique I have found it necessary to examine the concept of spirituality currently underlying programs of recovery such as Alcoholics Anonymous.

Although much has been learned, since the 1930s, of the general altered metabolic processes that occur in the alcoholic, the scientific threads of addiction disorders are only beginning to be unraveled. Several pieces of the puzzle remain to be placed. Though the research in this area is extensive, current knowledge of addiction must be regarded as strongly suggestive rather than definitive. As this body of knowledge continues to grow, however, a consistent database is emerging that provides support for the hypothesis that biological rather than psychological processes ("character defects") constitute the primary causal factors in addiction. It is also becoming evident that similar neurochemical processes underlie a variety of addictive disorders: The same altered metabolism in the central nervous system can be demonstrated in those addicted to alcohol, opiates, or nicotine.

What does this body of data mean for the addict in recovery, or for the development of effective treatment and/or recovery techniques? Do they support the treatment modalities currently in vogue?

The evidence would suggest that current models of recovery, including the program of Alcoholics Anonymous, may require considerable rethinking and a strong shifting of focus if we are to significantly increase the probability of successful recovery from addiction. Most current models of addiction treatment have assumed that the psychosocial aberrations or maladaptive behaviors seen in addiction were causative factors for the addiction. Hence, the focus in treatment has been on behavioral change as a necessary condition for recovery.

If it can be demonstrated that biological factors are sufficient to explain the development of addiction disorders, than one must question the validity of any treatment approach that emphasizes psychological change as anything more than an adjunct to, rather than a primary focus of, medical treatment. And, if psychological change is deemed to be nonessential for the primary phases of recovery, then there would be little advantage in further pursuing spiritual change as an essential treatment element.

The problems faced in treating addictions in this — the last decade of the century — have been further complicated by the tendency of existing programs, such as AA, to be self-perpetuating and unchanging. Although this inflexibility to change is characteristic of any long established program or institution, the consequences of failure to change when change is necessary are particularly dire when the topic is addiction. The toll is enormous in terms of human lives and misery for the addicted and their families, as well as the innocent victims of the addicts’ actions (criminal behavior, traffic and workplace accidents, etc.). One must also consider the heavy financial burdens on society, the labor market, our institutions, the taxpayer, and the criminal justice system. A recent article in Times Magazine estimated the combined social and medical cost of drug abuse to exceed $240 billion.

From the humble premises of Bill Wilson’s model of "one drunk sharing with another" addiction treatment has developed into a nationwide, complex delivery system that is, for the most part, professionally staffed. This addiction-recovery industry imposes continually escalating costs for the government, the insurance companies, the medical community, and our academic and training institutions. We annually turn out thousands of certified "experts" in the fields of addiction to fill the needs of a growing population of addicted persons (or, at least, an increasing number of recognized and identified addicts). The addiction industry, along with the criminal justice system, has come to serve as a primary conduit into AA and related programs of recovery for nearly all addicted persons.

The professionalization of addiction treatment in this emerging industry has added its own support to the inflexibility of AA-type programs of recovery, accepted treatment modalities, and fundamental concepts of addiction.

Why would professional members of this addiction industry desire the 12-Step programs to remain unchanged? Partly, because many of these members attribute their own recovery from addiction disorders to 12-Step programs. Also, it costs nothing to have a client engage in such programs. Hence, one may show "concern" over the drug abuse problem without incurring any significant expenditure of funds or support of research into alternative methodologies. Treatment agencies can continue to receive federal funding for at least appearing to "do something" for those with addictive disorders, even though there has been no empirical evidence that these programs work better than doing nothing. Nor do these agencies have to demonstrate successful results in order to maintain their service delivery systems. By supporting a program that believes that those who relapse or do not recover "did not work the program" one is freed from accepting any meaningful responsibility for the treatment outcomes, whether they are successful or not. To realistically consider alternatives to the AA-style programs would require a change in focus, as well as established practices, that few professionals in the addiction industry have shown a willingness to even consider, let alone implement.

Historically, in the development of any institution or identifiable group from the religious to the technological, the entity has often evolved into a structure that diverges considerably from, or where members may not even be aware of, the statements, precepts, and tenets of its founder. The various religions under the umbrella of Christianity reveal considerable differences in their emphasis, tenets, and doctrines of belief. However, all of them presumably stemmed from the sayings and doctrines of Jesus Christ. The divergence of Bhuddism from the teachings of Bhudda, or of capitalism from the statements of the founding fathers of our country’s democracy, and these utterances from the early Greek models of democracy, are readily cited examples. The current status of Alcoholics Anonymous, reinforced by the impact of the addiction industry, has not escaped this trend. The AA model has become entrenched in the treatment system as a result of more than five decades of being the only game in town. This situation remains, even though the AA model is based upon faith rather than empirically reliable data.

The present "fellowship" of differs markedly in beliefs and practice from the tenets of Bill Wilson and the founding group. In 1939, the "fellowship" of AA was identical to the Big Book, which took the name of the group "Alcoholics Anonymous." That is to say, the original 100 members presented the precise methods by which they had recovered in the book Alcoholics Anonymous; and, therefore, the book and the membership referred to one and the same thing.

In critically evaluating the program of recovery, one must be careful to distinguish between what is presented in the Big Book of Alcoholics Anonymous from what has become common practice within the current AA structure. Nowhere in the Big Book, for example, will one find the advice that the newcomer should attend "90 meetings in 90 days," "Take what you need and leave the rest," or "You can work the program and steps to tailor your own program of recovery." These are but a few of the hundreds of statements heard in the rooms of AA that have no basis in the program’s literature or in the early history of the fellowship. They are the results of free interpretations of the Big Book’s program of recovery by many generations of. Sponsors. Nor do these common statements and beliefs find support in the later observations and writings of the founder, Bill Wilson, through the late 1950s.

Where does the addict go to obtain a fuller understanding of his or her addictive disorder? Is AA’s official definition of alcoholism as a disease consistent with the use of this term in medical science? Is it interpreted as a disease in the medical sense of the term, or an illness; a metabolic imbalance or a primary psychological problem. In determining appropriate treatment, should the addict seek help from: (1) The "fellowship" or the "founders" (that is, the Big Book)? (2) The treatment philosophy of one or more specific addiction models? (3) One of the many different institutions or treatment centers in the addiction industry? or, (4) Anti-addictive medicines that have resulted from past or current research data on the addictive process (e.g., methadone and antibuse or the more recent introduction of anti-dopamine agents)?

Is s/he given a choice? And if a choice is offered, is sufficient information made available as well as any needed counseling, so that an informed decision might be made, as would be the case for a patient deciding to accept a particular treatment for any other medical condition.

These different sources of addiction information will provide the addict with highly varying definitions of his or her addictive disorder:

• The prevailing psychiatric model focuses on maladaptive behavior stemming from failures of the individual to develop effective coping strategies for life; behaviors that lead the affected person to increasing reliance on addictive drugs. Twelve Step programs attempt to reduce the "character defects" that they believe constitute the roots of addictive behavior.
• One of the more popular current biogenic models define addiction in terms of maladaptive genes that produce and maintain the craving for the addictive substance(s) as a result of altered metabolism in "reward" centers within the central nervous system.
• The Big Book of AA accepts a biological basis of "craving," adds the behavioral disorder as part of what is called a "mental obsession" and, having concluded that the addicted individual is powerless over both of these conditions, seeks a solution for a maladaptive spirituality. The Twelve Step philosophies, in effect, give equal weight to the physical craving (which only occurs after the addictive substance is ingested) and the character defects which form the basis of a "mental obsession" that ensures that the addicted person will return to the substance(s) of addiction.

According to who one confers with, the definition of addiction may range from defective genes to the lack of God, with all stages of psychopathology in between. And depending upon your definition of addictive disorder, the focus of treatment will differ as well as one’s goals in recovery. It is the old nature/nurture argument again with a difference: human lives hang in the balance! We come back to the dilemma of whether the addict must change the product of his or her genes, psyche, or conception of God.

There has recently been an encouraging trend away from these traditional models. In separate press releases, the medical schools of Harvard and Duke Universities recently announced that they intended to develop medical courses and research in addiction. It was evident that both schools were searching for qualified personnel outside of their existing faculties. This is probably the first time that these institutions have publicly acknowledged that their current medical staffs, including the formerly-accepted "addiction experts" in their Departments of Psychiatry, have not made significant progress in understanding and delineating the dimensions of addictive disorders.

It comes as no surprise that a large proportion of recovering alcoholics have difficulty in understanding the true nature of their disease. The presentation by Dr. Silkworth in the 1930s, which formed the basis of many fundamental assumptions by Bill Wilson in laying the foundations of the "program of action," was limited by the paucity of available data at the time. By insisting that the program of recovery remain unchanged, and practiced as it was in the 1930s, however, AAs have ensured that any advances in medical knowledge of addictions and addictive disorders would not be incorporated nor would they have any impact on the traditional AA program of recovery.

The very AA Traditions that curtail members from presenting information or sharing with one another from a "professional" standpoint during meetings effectively act to keep AA groups ignorant of current findings in addiction studies; they are assumed to have no place in the program of recovery. This cry of "professionalism" was originally designed to ensure the equality of all participants in the program of recovery, AA traditionally being based upon one drunk sharing his or her experience, strength, and hope with another. The current fellowship of AA, however, has diverged in so many regards from the original program that any information that sounds as if it were based upon professional opinion comes to be regarded as suspect and is, therefore, discouraged. Anything above the level of a drunkalog is met with a stern admonition to "keep it simple." Neither is any current information on addiction research presented in the Grapevine, the official publication of the organization. Dissident cries from members, when permitted to be published, are mild and fully supportive of maintaining the traditional focus. The misinterpretation and suspicion regarding "professionalism" has extended into areas that no member should responsibly tread.

I am specifically referring to those members who feel quite comfortable in providing advice and counsel on matters far removed from the types of sharing suggested in the original program of action. This includes sharing on personal marital issues with counseling and advice, labor market and job related issues and practices, and stating opinions on the suggestions and diagnoses that were made by members of the legal and medical professions. Other matters are also freely discussed and opinions given, even though they transcend the tradition that we limit our sharing to our experience, strength and hope regarding recovery matters. I have even heard sponsors advising those they sponsor to refrain from using medications that were prescribed by professionals and, presumably, deemed necessary for the treatment of other medical or psychological problems of the individuals. Occasionally, sponsees will admit that they haven’t informed their sponsors of medically prescribed drugs they are taking for fear of a critical response.

However, most members, under the banner of defending our Traditions, would fight vociferously to maintain such practices as ending each meeting with a group chant of The Lord’s Prayer, regardless of the fact that religion is supposed to remain a separate issue from spirituality in the AA program (a questionable feat, even if it were possible)!

Although the newcomer is often admonished to take his own inventory and not that of another person, members feel free to comment on the medical, legal or marital counsel received by other members! Many 12-Step program members have become self appointed physicians, lawyers, legislators and counselors and feel justified, presumably on the basis of their knowledge of alcoholism, to provide advice to others on these issues. Old timers may often be heard advising that everything one needs to know is within the first 164 pages of the Big Book. This popular attitude stems from a misguided belief that the Big Book has answers for all psychiatric, medical, and legal problems the recovering addict is likely to encounter. According to this belief one does not need the services of medical personnel, psychiatrists, or any other professional services that do not conform with this prejudicial attitude. Medications of any kind are disparaged, and any diagnosis of disorder other than the Big Books disease concept of alcoholism meets with strong opposition. The parallel with "faith healing" should be obvious and the same pitfalls are present. To such individuals, there is no such thing as clinical depression. Anyone familiar with the writings of Bill Wilson will recognize that these belief systems were never the intention of the AA program.

The many deaths that have been attributed to failure to obtain adequate medical treatment observed among family members of a number of "natural" religious groups comes to mind as a parallel case. How many disasters, including death, has this misguided practice of AA members contributed to? On what basis do so many AA members assume that they are qualified to advise on matters for which they have no training? The practice, as has been noted, is in sharp contradiction to those Traditions that state that we share only our experiences, strength and hopes with one another, not our opinions.

The AA Traditions regarding professionalism have been, effectively, turned around and members consider themselves justified in stating their opinions on any matter as they believe that the professionals (particularly the medical profession) are not to be trusted; that medical personnel don’t understand the nature of our disease, and they frequently mis-prescribe for us. Up until recent times, there was some truth in this statement. In the early medical treatment of alcoholism, valium and other tranquilizers were frequently prescribed by medical personnel, a result of the commonly held belief that addiction was a maladaptive response to stress.

These early professional practices, however, do not condone the medical advice freely given by AA members to the newcomer. What it does reflect is an excellent example of what psychologists have classically called "projection." The alcoholic’s characteristic untruthfulness before medical personnel, which gave rise to the medical professional’s perception of the alcoholic as being untrustworthy, has been turned about so that the recovering AA member comes to distrust the physician and the medical community. The presumption is that only an alcoholic can truly understand alcoholism; a belief that comes from confusing one’s understanding of what a disease feels like from what the disease is. The foolishness of this position is clearly seen if the situation were extended to any other illness. Must you be a diabetic in order to provide treatment for other diabetics? If you suffer from diabetes, do you distrust any physician who is not also a diabetic?

These attitudes are as insidious in AA as they are widespread. From the statements I have heard over the past twenty years, I have found it most difficult to restrain myself from asking an older AA member "…how many persons would you estimate that you have killed with that statement?" Or "… how many of those who believed themselves AA failures and returned to drinking and using do you believe your statements inspired?" To which (I need not question) I would receive the response, "It takes what it takes," and the statement would be delivered with pursed lips of smug satisfaction.

The purpose of writing the 12 Traditions by Wilson in the 1940s, and the 12 Concepts for World Service, was to ensure that the program of action remained precisely as it was written at the time of the first publication of the Big Book, the year 1939. Why did he bother? Every AA member states that he owes his recovery to the 12 Steps and 12 Traditions but few actually follow them; many don’t even know them! The present author would have far less complaints if Wilson’s purpose had been accomplished. The above references to current AA behavior show how little the Traditions are truly followed. They are preached, but not practiced.

I have never met a group of individuals for whom personalities mattered so much more than principles. Yet the 12^th Tradition not only states the reverse principle, but begins with these lines: Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities. Several AA members devoutly quote one or more of the illustrious local Speakers that have gathered considerable followings within their sector of the country, and many consider it a very prestigious honor to be sponsored by one of these gurus. No "professionalism" huh?

It is interesting to note that Wilson’s beliefs were far more progressive than those of the fellowship he founded. Among his speeches before the American Medical Association during the 1950s, he recognized that alternative therapies would emerge and welcomed them. A typical excerpt from 1958 may be cited that shows Wilson’s readiness to accept medical knowledge and willingness to work with medical experts in furthering our understanding of addiction disorders:

Bill Wilson came to accept that AA was clearly not the only show in town. The irony of the inflexibility of most members in the AA fellowship today is that, believing that they and their groups are practicing the 12 Steps for recovery and adhering to the 12 Traditions of AA, they remain unaware of how divergent their program of recovery has become from the program of action that Wilson presented in the Big Book. There is a natural human feeling of comfort in believing that you are adhering strictly to tradition when, in fact, your actual practice is very different from what you preach.

A typical statement of an older AA member sums up this thinking: Looking back over the 60 year history of the AA program it is easy to confuse longevity of existence with success and so one hears "If it ain’t broke, don’t fix it." Well folks, for untold thousands of addicts AA is broke and has been for many years! To which, of course, the old timers may tout "This is a program for those who want it, not for those who need it." According to this argument a desperately suffering addict who finds difficulties in grasping AA-styled programs must not want recovery enough!

Researchers have demonstrated that a cocaine high, for example, is accompanied by a surge of dopamine in the "reward centers" of the brain (see the Times Magazine endnote). This purely biological response would presumably occur whether the individual wanted to stop using or not. To the extent that the fundamental characteristic of addiction is that the individual is not capable of deciding whether to use or not, then the issue of "wanting" vs. "needing" recovery is not a basis upon which to judge or predict the failure or success of a treatment program.

Both of these statements encompass a fundamental bias among AA members; if the AA program doesn’t work for an addict, the fault must lie within the addict, for the program has worked for them (right up to the very moment that many of them relapse). One might suppose that the same argument applied to other medical disorders would lead to the following statement: If you don’t respond to a specified medical treatment, regardless of your illness, the fault lies within you rather than the treatment. If chemotherapy fails to cure your cancer, it is because your cells didn’t want life hard enough, they didn’t show enough gratitude, or they didn’t seek the grace of God. In short, one tends to blame the victim; for the treatment works, by God!

Although such a statement might be considered a gross exaggeration, anyone familiar with the attitudes and convictions of current AA members will recognize that this bias of blaming the victim is, unfortunately, a characteristic of today’s AA program as currently practiced. As legions of sponsors have added their interpretations to the program of action and transmitted these ideas to those they sponsor as indisputable facts, the lack of any consistent approach to recovery among AA members, as well as the confusion this situation presents to newcomers, continues to muddy the status of AA in addiction treatment.

The program of recovery outlined in the Big Book has been bastardized and diluted into a program of individual interpretation. Each sponsor determines for himself, and those s/he sponsors, what aspects of the program are important, and which "suggestions" may be put on the shelf until the newcomer is better prepared to handle them. A smorgasbord, cafeteria style approach has replaced the program of action that Wilson originally wrote as a series of instructions to be followed precisely for recovery. In fact, Bill Wilson, while writing the Big Book, fought vehemently to present the program of recovery as a set of "directions" to be followed precisely, though the founding members forced him to change the expression to the word "suggestions." What remains of that original "program of action" in today’s practice is evidence of the overly liberal interpretation of those "suggestions."

Throughout this essay, the comments will specify when they refer to the original program of action developed by Wilson and not the "leave what you don’t need" approach typical of today’s AA "program". Today, clearly, there is no single program of action that all AA members would agree upon, no matter how strongly they will argue and believe that they are following the Big Book. At least, most of them quote it accurately!

Over time, many recovering addicts in AA simply come to "follow suit," and within their AA rooms state that they have "surrendered." There are so many cliched phrases in AA that one questions the extent to which each member seriously considers his or her recovery in terms of the AA-required personal spiritual development. An affliction with any other type of fatal disease would be eventually accepted by the individual, gracefully or not. The disease acceptance process would not bring up concepts of "powerlessness," "gratitude," or "surrendering." Why are these concepts so prevalent in recovery from alcoholism?

The implication of "surrendering" appears to be that one has given over control of the disease to the care of a God whose "grace" is then sought through prayer in order to maintain a progressive recovery. AAs typically introduce themselves as "grateful," "powerless," "surrendered," "recovering" or "real," alcoholics to emphasize the characteristic of the recovery program that is most meaningful to them (or the concept which they believe confers the higher social approval within their meeting rooms). I have even heard members identify themselves as a "sick alcoholic" or "slowly recovering addict" and other self-disparaging phrases. Apply these terms to patients seeking recovery from any other medical illness and there meaningless significance becomes clear (e.g., "I am a sick diabetic," "I am a surrendered, grateful cancer patient," "I am a powerless epileptic," or, "I am a real schizophrenic.")

To the professional and scientific community, the AA concept of "recovery" and "disease" has absolutely nothing to do with medical uses of the terms, and, as mentioned, one cannot regard the AA program as a true "treatment" modality. A great deal of the problem lies in the insistence on a spiritual solution to addiction; the focal topic of this essay.

The belief in an absolute, supernatural power who has concern for the course of recovery for the individual sufferer comes from traditional Western religious thought, in general, and the Judeo-Christian religions, specifically. Even with the strongest of faith in such a mystical force, there is no more evidence today than in biblical times that such a superhuman, absolute power with concern for the actions and fates of individuals exists. In fact, any rational observation of individuals with addiction disorders would lead one to conclude that by placing the burden of responsibility for one’s recovery on a mystical force upon whose "grace" that recovery depends, one has accepted a level of irresponsibility that might explain the frequent relapses of many recovering alcoholics.

It has not been the intention of this essay to argue the relative merits, or their lack, of Judeo-Christian religions, nor to disparage the efforts of any AA members whose beliefs have, indeed, produced remarkable progress in recovering from this fatal illness. Nor will I address the issue of theistic belief in a superhuman being in this essay as it has been well treated throughout the ages, from the Roman philosopher and statesman Seneca, through philosophers, metaphysicians and others, particularly during the last century (Spinoza, Kant, David Hume, Bertrand Russell), as well as scientists of our present century (Einstein, Asimov).

What concerns me is whether the traditional insistence on the development and improvement of a "conscious contact" with a Higher Power on the order of the Judeo-Christian God is an essential aspect or even an effective basis for recovery. Furthermore, I must question whether it is not evident that the considerable turmoil, confusion, and difficulty so many members face in accepting the program of action, as delineated in the 12 Steps, may not be traced to the inconsistency that presents itself in embracing a recovery program that mixes the concept of "treatment" with "religion", even if the latter be of a benevolent but absolute supernatural spirit. How does one increase ones conscious contact of such a being (Step Eleven states that we "sought through prayer and meditation to improve our conscious contact with God ... asking only for knowledge of His Will for us and the power to carry that out")? How does this process relate to the addiction process as a medical condition with a well understood progression? And is there any evidence for believing that a link between spirituality and addiction would provide an empirically meaningful construct for the development of treatment techniques?

Let the reader be warned: If you ask many old timers in AA such questions, you are likely to receive the response: "Simply trust in God and Clean House. That’s all you need to know!" Well thank you for sharing that. Perhaps one of them could tell me what one does in this process called "trust in God" that relates to my addictive disorder. But most would consider this question both irrelevant and irreverent.

Of course, the more fundamental query to be asked is whether alcoholism, as a disease, requires anything more than treatment of the increasingly evident biogenic factors that research has consistently demonstrated to be the more probable causative roots of addiction. This is not to deny the necessity in most cases for psychological, social, and other adjunct therapies for the addict to abstain from the addicting substances. But such therapies, if required, would appear to be secondary to the primary treatment.

To the extent that the biogenic models continue to gain support as the most relevant causal factors in addiction, than a focus on psychosocial or spiritual aspects in recovery becomes meaningless in primary treatment. With this focus, our recovery programs would amount to little more than treatment of nonexistent disorders! If those with addictive disorders cannot be shown to differ significantly in the spectrum of psychosocial maladaptive behaviors from the nonaddictive population, or if no differences can be demonstrated between the childhood experiences of the groups, are we not wasting our time?

To the extent that research continues to support biogenic conditions as causal agents in addiction, and no consistent evidence has been presented to support the notion of an "addictive personality," then our focus on psychosocial and spiritual remedies become, in effect, treatments for iatrogenic (medically and AA induced) illnesses that have relatively little to do with the actual addictive process. In this regard, treatment of alcoholism as a disease is tantamount to treatment of an AA-created disease! The first three steps of the program define or "create" the disease; the remaining steps provide a "cure" for it. Underlying the entire process is the assumption, reinforced with the first step, that we are "powerless."

Although few would argue over our inability to control the craving once we have begun to use an addictive substance, the extension of this concept to include a sense of powerlessness over "people, places, and things" can only lead to a continuing feeling of victimization. Our continued reliance upon drunkalogs at meetings, in which we attempt to explain the "development" of our addictions as a result of our past histories, is evidence of this victimization construct. "Alcoholism" defined by this interpretation of the Big Book among so many current members of the fellowship has become a disease created by AA. It has little to do with the disease presented by Silkworth in the Big Book! How many purely human situations and problems are presented by 12-Step members as being an integral part of their alcoholism: "My cat died, but I didn’t have to drink today," "I didn’t get the promotion I deserved but I called my sponsor and did not have to pick up a drink; etc." These situations are heard in AA rooms as though they were the sole province of alcoholics. This author’s experience has shown that the most liberating realization in recovery was recognizing the fact that the majority of the difficulties I faced in life were not the fact that I was an alcoholic; it was the fact that I was human. I came to recognize that all persons suffered grief, loss, and disappointments in the course of living and that these experiences had nothing to do with the fact that I was alcoholic.

To attribute all of life’s difficulties to one’s addiction is to extend the disease concept of alcoholism into areas of life that no treatment program or method could conceivably bring recovery. And to attribute every psychological disturbance to one’s addiction places the addict in a position where recovery becomes impossible. As this fact becomes increasingly evident, then it is equally clear why so many recovering addicts relapse: the primary illness has received no treatment whatsoever! The importance of the development of that necessary personal sense of responsibility towards abstaining from the first drink or first use of drugs is absent in much of current AA thinking. The victimization construct in which only a Higher Power can provide solutions leads, ultimately, to a self-defeating program of temporary abstinence interspersed with longer and more devastating periods of inebriation. Perhaps this is why so many treatment practitioners seem to view alcoholism as a chronically relapsing disease!

Somehow, the recovering addict must acquire a sense of individual responsibility for remaining sober if sobriety is to be attained at all. That is, one must escape from the Higher Power-victimization cycle if recovery is to occur at all in today’s AA program.

Religions have always had their castes of individuals who were believed to have inside knowledge on God’s intentions (priests, prophets, etc.). What has any of this to do with treatment modalities or recovery? If it were not for our Traditions, we would undoubtedly have developed our own sect of AA "priests" who would dictate the manner in which our recovery program and meetings would be conducted. We would probably read scriptures rather than share our experiences, strength and hope.

In providing the foundations of this program of recovery, Bill Wilson left the description of the disease to Dr. Silkworth. It is very important that we understand Silkworth’s comprehension of the disease, based upon evidence available to him in the 1930s, for the program of recovery that was developed is heavily based on the doctor’s recommendations. Silkworth points to two aspects of alcoholism — a physical craving that is believed to be an allergic reaction to alcohol, combined with a mental obsession which, when the desire to drink is strong, enables the person to believe and justify the most irrational thoughts in his or her pursuit to satisfy the desire. Since Silkworth’s definition includes both physiological (the "allergy") and psychological components (the "mental obsession"), Bill concluded that the only possible solution must be from the "third sphere" of existence, the Spiritual. The failure of psychotherapy to effect a solution (specifically Carl Jung’s failure with one alcoholic), and the recovery of his friend Ebby Thatcher from a "spiritual experience" reinforced this conclusion.

Of course, neither Silkworth nor Wilson considered the possibility that the "mental obsession" might be the result of many years of neurological damage with repeated use of addictive substances, rather than a "cause" of the disease. If this proved to be the case, then no psychiatric or psychosocial solution would be required for effective treatment, and the question of the required "spiritual experience" becomes a moot point.

As mentioned previously, since the 1930s the physiological basis of "craving" has been well documented and the biochemistry of the altered metabolism of the alcoholic is now well understood (anyone interested is directed to the Sobriety Education Project reading list, on the internet site unhooked.com, or URL sites such as the National Institute on Drug Abuse). Recent research provides consistent support for a genetic basis of addiction involving dopamine D2 receptors in the limbic areas of the brain (the so-called "reward centers"). In fact, there seems to be a biologic commonality between the genetic basis for most addictive behaviors, from alcoholism, opiate addictions, nicotine addiction, and other compulsive disorders such as gambling, overeating, and sexual promiscuity.

What has not found consistent support or demonstration is reliable empirical evidence for any collection of common or identifiable psychosocial factors that might support the widely prevalent concept of an "addictive" personality. No reliable psychological studies have been performed that support the "addictive personality" concept, and no set of criteria or personality factors have been isolated from which one might predict whether a child would or would not be likely to develop addiction disorders. The same childhood fears, feelings of inadequacy and lack of self esteem reported by most alcoholics in their drunkalogs, have been commonly observed among children, in general. These childhood characteristics are not predictive of later addiction.

In the aforementioned review of the field by Times Magazine, the following statements are made:

Throughout the article the term addictive "disorder" is emphasized over the concept of addictive "abuse" or "disease." This choice of terms emphasizes the biological basis of addiction. The popular expression "drug abuse", on the other hand, emphasizes the personality characteristics of the addict, an emphasis that naturally leads to treatments focusing on changing personality, or "character defects" in order to cure addictive behaviors.

We might ask, therefore, that since there is no convincing evidence of an addictive personality, might this fact explain the extremely low percentage of "successful" psychological and psychiatric treatment techniques applied to addiction? And if there are no common psychosocial factors that distinguish addicts from nonaddictive persons, where is the basis for assuming that there might be "spiritual" differences?

Amazingly, at the present time, medical students are only presented with but a few days of course work on the disease of alcoholism. Since psychiatrists have assumed the role of "experts" in treatment of addiction, physical medicine has pretty much left the field to them; even though their rate of successful treatment of addicts has been embarrassingly low. In addition, several members of the medical community, including psychiatrists, by their actions and disdain at treatment of alcoholism, apparently still cling to the idea that the alcoholic lacks morals and/or will power. Since this is a popular conception, it is no wonder that we thought ourselves morally bankrupt and lacking in will power.

The "spiritual" aspect of recovery, if this approach can be shown to provide any consistent benefit (and the anecdotal evidence is not very convincing), leads us once again into that area of practical and philosophical speculation relating to the existence of an incorporeal part of the body (i.e., apart from the physical body). In Western religions, this is considered to be the "soul." Perhaps we should look more critically at how this trifold understanding of the "parts" of the human arose, for even today, it is common to separate the physical from the mental and "spiritual" parts of the body. What the "immortal soul" has to do with a treatment modality is the very question this essay attempts to examine.

On firmer biological and evolutionary grounds one might argue that a more meaningful separation of "components" of the human being, would be the physical, mental, and social, not spiritual. This argument would assert that the highest level of human development is in man’s relationship with his fellow man; not the attainment of salvation, a highly personal and ego-fulfilling goal. And there is only one "religion" that can be successfully applied to this conception of spirituality, one that has been present in all cultures since pre-Christian times, and that would be the "religion" of the Golden Rule.

Knowledge of the physiological differences between alcoholics and nonalcoholics, therefore, still leaves the question of whether there is any merit in considering the so-called psychological components of the illness, often referred to as the "ism" part of the disease. Dr. Silkworth, and Bill Wilson — through the information available to them at the time — accepted that only a spiritual solution to the "mental obsession" component of the disease was possible.

Of course, as mentioned, one should bear in mind the fact that, to date, no reliable empirical evidence of an "addictive" personality exists. From the available research, it would appear that any sociopathology or psychopathology observed in addicts would most probably be the results of several years of addictive behavior rather than the cause of the addictions.

The nature of the proposed spiritual solution is ill defined in the prefatory chapters of the Big Book, though it is repeatedly emphasized that the program of action (the 12 steps of recovery) is designed to produce the profound "psychic change" necessary for one to have this vital spiritual experience, or spiritual "awakening." Without this vital spiritual experience, recovery is not considered to be attainable. This emphasis leads one to question the definition of the term "spiritual" as it was used in 1939, the date of publication of the book Alcoholics Anonymous, for if recovery depends upon having such an experience, or awakening, then no investigation could be more meaningful. The effects of these decisions for the developing program of AA have profound implications for its predicted effectiveness. Hence, a major focus of this paper is to investigate the matter of spirituality more critically. We must look at different interpretations of the term, and derive certain conclusions and predictions about the present day success, or lack thereof, of the program of Alcoholics Anonymous as a treatment modality (which, of course, it is not in any medical sense of the term).

As mentioned above, most definitions of "spiritual" emphasize the incorporeal; that is, the spirit or soul, as distinguished from the physical body. Yet, one may note, that secular organizations such as Ethical Humanism and Ethical Culture have shown that the term may be employed in a far more productive manner: these philosophies refer to "spiritual" as those aspects of human interaction that encompass the realms of ethics and morals. To be spiritual, in this regard, is to have developed a set of ethical and/or moral principles that dictate the highest possible interactions between human beings on a social level. This definition also serves to eliminate the artificial separation of the human into mental, physical, and spiritual (i.e.. "soulful") components. Many Ethical Humanists, and particularly the Long Island New York branch, consider themselves "religious," in that they sanctify human life and the human "spirit."

The first objection to the Big Book’s conclusion of a necessary, vital spiritual experience, lies in the implicit and assumed separation of mind from body and, ultimately, the concept of an immortal soul, that has plagued mankind (and delighted theists) ever since Descartes created this separation in the early 1800s with his famous statement: "I think, therefore I am." None at the time questioned the fact that Descartes, apparently motivated by a desire for equal fame as Harvey for the latter’s well publicized treatise on the circulation of the blood, developed an elaborate fantasy that attempted to explain the circulation of the "animal spirits," the source of their movement being actions of the pineal gland (the "third" eye of amphibians). Fortunately, medical science has not taken Descartes’ description seriously and, in fact, recognizes the pineal gland to have been a primitive photosensitive device that is, in mammals, regarded as vestigial.

Unfortunately, once Descartes had separated mind from body, it has been extraordinarily difficult for scientists, researchers, medical professionals, and philosophers to put the two back together again. The rise of psychology and, in particular, psychiatry, as distinctly separate fields from physical medical science is evidence of this continued tendency to regard the mind as separate from the body. In those areas where psychological processes are clearly correlated with specific physical disorders, there arose the field of psychosomatic (or, literally, mind-body) medicine whose influence has been so pervasive that I am certain there are some who would claim that ingrown toenails are correlated with certain psychological dispositions!

As so often happens in the development of solutions to problems, we err when we begin by presuming that assumptions that have become part of "common knowledge," are in fact statements of unquestionable truth. Such statements are generally attributed to one or more "authorities." These "truths" have simply been repeated and passed down to the young through folklore and wives tales. Today’s youth are far less likely to listen. In the context of this discussion, the concept of an immortal soul is inevitably linked with spirituality. It is reinforced by all Western religions and structured immutably with the concept of an all powerful, absolute, supernatural God. This God of the Scriptures is, and always has been, an anthropomorphic creation of man who in more primitive times, ascribed to any phenomena not immediately apparent a supernatural answer. Although I readily acknowledge the fact that many persons have gained solace and comfort through their religious convictions, the point is that any number of religious or nonreligious beliefs could conceivably have produced the same results. The Judeo-Christian God is but one of many theisms that, combined with several nontheistic approaches, may be shown to provide come comfort in dealing with life’s trials.

This anthropomorphic process is not very different from the tendency of many to believe that the earth was being visited by aliens from distant worlds when Flying Saucers were reported, most notably in the turbulent fifties. Throughout the history of man, the "unknown" is all too readily believed to be unknowable; an assumption which makes the results of scientific inquiry suspect to those who demand immediate answers to mysteries that occur. Some have become so adamant about these issues that they are willing to conclude that the government knows about phenomena such as Flying Saucers but, for reasons of national security, keeps silent on this issue.

Where has it ever been shown that knowledge of a subject leads to more harmful results than ignorance and superstition? And how could any government stifle the international freedom of science to explore, discover, and reevaluate all phenomena? To call an object an UFO (Unidentified Flying Object) is the rational mans response to the seemingly purposeful movements of light sources across our sky. Most of these sightings have, in fact, been proven to be weather balloons or other natural phenomena. Impatience, however, in awaiting the results of scientific inquiry, can result in one’s attempt to provide an explanation in terms of what one presumes to know. This tendency leads to anthropomorphic interpretations of unexplained phenomena.

Once one has called the phenomena a "flying saucer" (assuming that something worthy of the name "phenomena" actually occurred!) human experience with moving objects would lead one to speculate on where it came from, how did it manage to maneuver in a fashion unlike anything in the individual’s experience (planes, cars, etc.), and what was its purpose. Our experience would lead us to believe that any movement that was not erratic had to have had a purpose.

Since one rarely goes anywhere without a goal in mind, we attribute these human qualities to our Flying Saucer. Since the movement of the object was considered far superior to anything in the observer’s experience, then it becomes natural to believe that the source of the object was superhuman. Not once have we questioned whether what we observed was an actual object and not a result of atmospheric changes, lights reflected from an earthly source, or any of several alternative arguments. What we saw was a true, God-unfearing Flying Saucer from Mars (or whatever planet or star had been recently in the news).

Of course, one might also ask why the presence of Flying Saucers and the often claimed abduction of humans by aliens has not, to my knowledge, been reported on a sunny afternoon in downtown New York or Los Angeles in the presence of thousands of witnesses. Creatures with the power to traverse millions of light years to reach Earth would hardly need limit their activities to remote regions of the Ozarks or Appalachia, unless like the Judeo-Christian God, they also wished to "move in mysterious ways…" If so, then the backwoods of our southeastern states would appear to have become enormously popular sites for alien visits and abductions. And aliens must be particularly fond of obtaining their information on homo sapiens through interviews with toothless, grinning, tobacco chomping, backwater Alabamans rather than more socialized, scientific representatives of the species. They certainly are more colorful!

We must also be skeptical when evaluating knowledge gained from our perceptions. At one time it was believed the earth was flat, for our worldly experience gave no other perceptions to counter the appearance of the horizon as the "edge" of the world. The perceptual limits to our view of phenomena, limits our knowledge to human experience, unless we are willing to suspend judgement pending further scientific study by skilled scientists. Generally, we tend to forget that the perceptual distortion produced by our limited sensory apparatus (eyes, nose, ears, touch, etc.) means that the world we perceive and the phenomena we observe are "colored" by these essential limitations. Without recognizing these limitations, we use our human experience as a basis for understanding that which appears to be unexplainable. Even in our higher universities (e.g., Duke University), "researchers" continue to study so-called paranormal phenomena with results akin to showing how talking kindly to one’s plants encourages their growth.

Thus, our UFO becomes anthropomorphized into a Flying Saucer that was guided to earth by superhuman powers; for only superhuman powers could do what that "thing" did. Our conceptions of an absolute, controlling God can also be seen as an anthropomorphic result of early man’s attempts to explain the "unexplainable" in terms of a superhuman power. Usually, this gives rise to a special group of men who have been granted (or more likely, assumed) some special skills in interpreting, instructing, and (often) implementing actions that are in accordance with the "will" of the superhuman power. Many of this class claim to have had personal contact with the superhuman being in question; though, it may be noted, this is not an unfamiliar characteristic of several classes of psychotic individuals. The Witch Doctor is not very different from the priesthood, yet historically, the latter has proven itself far more formidable and dangerous (consider the Crusades, the Spanish Inquisition, Creationism teachings, the Ku Klux Klan, etc.).

Since the purpose and will of this superhuman power is not understood by most men, this special body of men who believe themselves to have gained (or been given) insight into the behavior and will of this God — the priestly class — traditionally has become the most powerful force in their communities or areas of influence. Their interpretations of the will of this God and the implications of these "findings" for man’s behavior has, historically, formed the basis of nearly all religions. It has also led to more bloodshed and demonstrations of human intolerance than the death toll from all of the world wars combined!

In these terms, a "theist" is simply one who believes that this "God" exists and, as s/he typically has little scientific background or basis for such a belief, invokes the concept of "faith" as a necessary means of attaining the special favors of this God. Denying science, it is evident that theists have readily accepted the separation of mind and body and transformed that part of mind that is "controllable" by their God into a separate, invisible part of man: the immortal soul. The promise of an afterlife, where this immortal soul may enjoy the rewards of having served this God is the principle appeal of Western religions, regardless of how they differ in dogma, tenets, and specifics of worshipping Him. We are, however, speaking of a plurality of God’s, each with its own religious sect believing that their God is the only true God. Maybe so. But who really cares? Every person who is concerned with whether their children are being taught Creationism rather than Evolution; or are being taught to hate rather than love their neighbors; or to respect every person for having inherent dignity and worth (worth being independent of "value.") We should all care.

Applying these thoughts to the treatment of alcoholism, one must first recognize that the founders, along with Bill Wilson, were Christians and Christianity pervades the Big Book. Although most references to "God" are qualified by the expression "as you understand Him," the capital H in Him reinforces the concept of an absolute, all powerful, supernatural God. "As you understand Him..." admits of several different faiths within the Christian religion, and can even be stretched to embody Gods of Eastern religions, but the key concept here is the tie of spirituality with religion in a textbook on recovery from a fatal disease. Nowhere in the Big Book is the social interpretation of a "spiritual awakening" suggested; yet it is in precisely the social sphere that most alcoholics are lacking (feelings of being less than, not apart of, different from others are commonly shared by all alcoholics).

Bill Wilson was a better salesman than most realize. He capitalized well on the successful approach used in religions in developing his Steps. In order to have the vital spiritual experience, or awakening, necessary for recovery, the Big Book stresses the approach common to religions:

Herein lies the greatest deviation of the program, as a treatment modality, from traditional medicine. The curative agent, as in medicine, is external to the individual but in the case of AA, the curative agent becomes supernatural and can only be attained through the acquisition of "faith."

I do not believe that if I sought the counsel of medical personnel for the treatment of any other disease this answer would satisfy me. In fact, such a statement would send me running for the nearest exit! Nor would I expect medical personal to accept my pleas for their grace, rather than a check, for their services!

The problems inherent in this approach to recovery may be seen more clearly by comparing AA’s recovery program with treatment approaches used in the arrest, cure or maintenance of other diseases. Do diabetics require faith and a belief in a Higher Power for recovery, or may they safely rely on the knowledge that to the extent they follow their regimen of diet and insulin they may lead a normal and productive life should they choose to? Is a higher power required for treatment of diabetes, psoriasis, schizophrenia, Parkinsonism, cancer? Why then do we feel that the conditions of addiction require anything more that the direct treatment of the individual’s desire for and continued use of the addictive substance?

Society and addiction "experts reinforce the belief that psychosocial factors are involved when they refer to addictive behavior as drug abuse. Why do we not call diabetes "sugar abuse," or psoriasis "skin cellular abuse" and employ similar psychosocial implications to our description of multiple sclerosis or several other diseases? Because in the arena of addictions the tendency is to view the diseased individual as one who willfully continues to use substances that are toxic to his physiognomy. In short, concepts of addiction tend to blame the victim! We have seen in an earlier section that this practice relieves the therapist for assuming responsibility for outcomes. If the addict relapses one can always state that the relapse was due to the fact that the individual did not work the program.

Since AA has accepted the psychological "illness" concept, the Steps proceed logically to inform us how we can remove the "character defects" that cause our addictions, and underlie our willful use of addicting toxins. Our "willpower" is deemed useless as evidenced by our continued willful "badness." Presumably, if we can begin to grasp what this all powerful external God’s will is for us, turn our will over to this force and follow that direction, we may recover. Notice that this understanding does not require any agreement on our part, exercise of our own "will" or motive incentives, nor are we encouraged to take responsible control of our lives. The First Step tells us that we are powerless, anyway (not responsible). We are even discouraged from thinking about this aspect of our recovery ("Your best thinking got you here!" is frequently heard in AA rooms). To any questions by the newcomer as to his or her role in recovery, they are told "Keep it simple!" Generally, this is stated not in a positive way, but in a manner that attempts to discourage questions the older AA member probably could not, or dare not, answer. "We are like sheep ..." as Handel tells us in The Messiah, and ours is "not to question why."

I can remember being told early in sobriety that I thought too much; that I was to "utilize, don’t analyze!" I have greater strength of conviction today, and recognize that it is my analytic thinking that not only keeps me sober but strengthens my understanding of my recovery from the psychological consequences of many years of drug abuse. For my best thinking involves informed judgements, and I don’t become informed without consulting with and sharing with others. It was my immature, irresponsible, self-indulgent and self-justifying thinking that got me to AA. And mostly, the lack of practicing ethical standards of behavior towards myself and others, which I learned from childhood, reinforced my feelings of alienation and being "different."

The result of this emphasis on the development of a religious concept of a Higher Power is to produce profound confusion among many newcomers to the fellowship of AA. Their refusal to even hear of something that sounds (and is, to be sure) religious turns them off. Unfortunately, it also turns them away from a program of action that, in essence, was the only proven method of recovery for alcoholism in over 50 years! This is the irony. We had an excellent and workable set of tools for recovery for the psychosocial consequences of addiction that could work in all cases of alcoholism. Why need we distort the excellence of this aspect of the program with references to religion, and to a specific set of religious dogmas at that?

Although newcomers are told that they have a disease that is both physical (the craving) and mental (the obsession), it has been my experience that very few old-timers can provide you with even Dr. Silkworth’s definition of alcoholism. They can regale you with numerous scattered quotes from the Big Book, and site page numbers, but how many of them have you known to have a sound understanding of alcoholism as a disease? And how many, presented with current neurochemical and genetic research findings on the biogenic basis of addictions, would look more critically at the AA program of recovery? The very thought would be heresy!

I firmly believe that grasping the facts about the disease of alcoholism has been a primary factor in distinguishing those who do recover in AA, from those who do not, or those who simply stick around and become old-timers because they have no life outside of the AA rooms. Hopefully, more AA sponsors will be willing to look more critically at their own sobriety and that of those they sponsor, and become willing to gain greater knowledge of current findings on addiction; specifically the growing tide of research evidence pointing to a common biological basis for addictive disorders. With some time and a minimal practice of a few of AAs principles, nearly all alcoholics can remain drug free for an indefinite period. Removing the physical aspects of the disease is readily accomplished by all who stick with it just long enough for it to work.

The reader should be aware that although this paper has presented the disease of alcoholism from a biological standpoint, there has been no attempt to minimize the tremendous need for support and therapy services once the addictive substance(s) have been removed. Ultimately, these processes must be designed to assist the individual in developing psychological and social skills necessary for enabling (and empowering) one to set meaningful life goals and to become more autonomous and independent. Learning to become more responsible for one’s happiness, to acquire greater skills in relating with our fellow humans in all walks of life, represents true recovery from the mental consequences of addictive disorders. But are these processes necessary for one to remain sober? I think not. I do believe that one can be an ethically bad person, a sociopath, a selfish and self-indulgent individual, an atheist, a nonconformist and yet remain sober. In short, I don't believe that being good in the Christian sense has anything at all to do with maintaining sobriety.

On firmer grounds, the need for ongoing counseling and support has a more biological basis. Although the addictive substance may be removed within a relatively short period of time, the altered neurochemistry of the addict may take years for a return to a semblance of normal functioning. Most opiate addicts report that long after the drugs ceased to make them high, they continued to use just to feel normal. That is, their neurochemistry had been sufficiently altered so that feelings of discontent, irritability, nervousness and lack of focus could only be dissipated by repeated use of the drug.

Living a sober life requires the development of several substitute habit patterns and associations to assist the recovering addict in attempting to live life in the absence of drugs as well as to remain abstinent during this prolonged period of readaptation of the neuronal metabolic system. Hence, there is an immediate need for counseling and supportive services following the post detoxification period that has little to do with general psychological processes of adjustment and the development of responsible life choices. These aspects of addiction recovery were not known in the 1930s and their full impact is only becoming clear with the results of research within the last decade.

Most AA members remain ignorant of these aspects of recovery from addiction and find little similarities between their dependence upon alcohol and the addiction processes that other addicts undergo. Yet the basic principles of the program of action have been shown to work as well for recovering opiate addicts as for alcoholics, or for recovering overeaters, smokers, and the sexually compulsive. This is what one would expect if there were a biological commonality among all addictive disorders.

There are many old timers that I have met that have never acquired positive, life embracing psychological or social skills. Under the guise of "keep it simple," they share only about booze and wish to hear nothing about socialization and integration of the personality with society. They don’t need to hear this, for they have no social position or interest aside from whatever status they have gained in the halls of their particular AA groups. I would imagine that in their homes and communities they remain the same self-righteous, difficult to live with individuals that they were before AA. I may not enjoy their company, I may criticize them on their lack of service or concern for others, but I cannot deny the fact that they do remain sober.

For most newcomers, accepting "powerlessness" over an addictive substance is not the primary problem, just as accepting a state of powerlessness over any other illness of the body would not provoke much objection. The person who develops an allergy to seafood, for example, cannot alter the metabolism that rejects the chemicals in fish and other sea products. But are they powerless over whether or not they continue to consume fish? I believe not. They are only powerless over their altered metabolic response to the specific substance that triggers the allergic reaction. This carefully limited concept of powerlessness is perfectly acceptable in Step One. But with any other illness, the acceptance of personal powerlessness would not necessarily lead one to conclude that a power in the form of a religious God would be one’s only recourse. Personally, I would hope the medical profession might intervene before that choice became necessary. The fellowship of AA has extended this concept of powerlessness to encompass the entire notion of "disease" and included our relationship with "people, places and things."

With this needlessly extended concept, the recovering addict is placed in a position of victimization rather than empowerment in every aspect of his or her life. The consequences of this have been presented earlier. To the extent that one accepts this degree of "powerlessness" than personal responsibility for ones actions does not become a primary consideration. We enter AA in utter defeat, self loathing, and feeling less than human. It is, in fact, a relief to hear that we suffer from a physical disease and that we are not morally weak or bad people.

Step Two, in a broad sense, should also not pose a problem. Just as we turn are lives over to the care of a physician for most diseases, we turn our lives over to the care of the program of action, in general, and the fellowship, specifically, that has produced recovery in other alcoholics. We know that the program works because we can see men and women living relatively fulfilled lives, drug free and with joy; something we have been entirely unable to attain. So we believe what we see and can agree that "It works. It really does." In the same vein, a stripped-down reading of Step Three would simply involve a decision to commit oneself to this program of action.

One point of continued confusion regarding this step is the often remarked concept of "turning it over," by which most AAs imply giving up control of a situation that doesn’t appear to be under one’s control. Since it is assumed that the situation is turned over to the care of God, modern AA members have developed a new problem: leaving the issue with God. In this interpretation, however, Step Three says nothing about the often heard remark about "turning it over" and "taking it back."

In the light of the Big Book’s chapter Into Action, one acquires a different conception of the concept of "turning it over." In the program of action, to turn a situation over is not to give it to one’s Higher Power, but rather to attempt to view it from a different perspective; that is, to turn it over and look at it from another point of view. This is a more productive use of the concept than the traditional idea of giving something up to one’s Higher Power. It may also be noted that the presentation of this concept in the Big Book differs markedly from the equivalent sections of the Step Book. Steps Six and Seven emphasize humility and prayer to remove the character defects that AA contends maintain our active alcoholism. These steps emphasize that it is our Higher Power which removes the character defects that AA contends maintain our active alcoholism. The Big Book’s presentation of the same material is far more action oriented, requiring responsible counter actions by the recovering addict to avoid or reduce those situations that bring continuing stress, anxiety, or resentments.

When we pray for the individual that we feel resentment for, we "turn it over" in that our attitudes towards that person change to a level where they no longer produce the level of intense resentment they may have originally.

Within the context of the Serenity prayer (in knowing those things I can and those things I cannot change) I take full responsibility for my behavior and my own happiness. Whatever it is that is turned over and taken back needs to be looked at more critically by those who complain of this problem. Step Three is, after all, only a decision. The program of action starts with Step Four.

Since Steps One, Two and Three require no action on your part, simply acceptance of the nature of your disease, the solution for recovery, and a decision to commit oneself to the plan of action required, I have often questioned just what members mean when they state that they "practice" these steps every day. I know what my disease is, I know the solution, and am committed to the program of action required to arrest my alcoholism. What is there to practice?

It is at the beginning of Step 4, however, that we run into difficulties. We come to recognize that the "power greater than ourselves" that we turn our lives over to for care and recovery is not medical personnel, not the AA group, and not even the fellowship of AA; it is the old, religious big guy in the sky; the very one that many of us recoiled from at early ages of our lives. In essence, we are asked to turn our will and lives over to the care of what I personally consider to be the controlling, fear-inducing, jealous, cruel, life-dictating God of the Judeo-Christian religions. This not only provides a convenient alibi for continued inappropriate social behavior, it effectively relieves the recovering alcoholic from assuming any meaningful responsibility for his or her own recovery!

Furthermore, with Step Four, we are informed that it is our defects of character ("sins") that are the roots of our alcoholism. I find this and the following three steps as offensive as they are medically and scientifically unsound. As was stated earlier, there has been no research that has demonstrated a personality difference between addicts and the nonaddictive. To imply that one has some "defective" character traits that only a God can remove for recovery, is not only medically unsound and unfounded, but personally objectionable. Is there any other medically definable disease that would require a change in personality characteristics, or appeals to a God to remove one’s sins, in order to attain recovery?

This is not to say that many years of addiction have not produced emotional and psychic scars that may require some form of therapy in order to restore the individual to a state at which s/he may function responsibly in life. But, as presented earlier, these psychosocial deficiencies are consequences, not causes, of our addictions. Concentrating on their removal would be equivalent to trying to remove a life threatening skin cancer by covering it over with makeup.

And if one cannot buy the character defect notions of addiction, their removal by the development of spirituality in the form of a Higher Power will prove even more objectionable. Regardless of your creed, I believe you must agree that here is where AA steps outside of the realm of treatment and, in many regards, becomes but another religion!

It matters little that the phrase "as you understand Him" suggests freedom of choice; that capital H spells the Judeo-Christian religious God of old. And of course the main question remains: Is this necessary for sobriety? Whether the newcomer continues to gain sobriety and recovery from then on depends upon factors that have little to do with this religious God. For example, we may find motivation to return to meetings because there we satisfy the need for social acceptance; the need to love and be loved; the need to be needed; the feeling that we are not alone. All of these factors keep the newcomer coming back for these are basic human needs, and the fellowship of AA does a very good job at fulfilling them for many alcoholics. So it is the experience of AA in recent years that many people remain sober without having gained any meaningful or conscious contact with the God of religions (or any other for that matter).

But what of those AA members who do not attain sobriety? And, unlike the case in 1939, far fewer than 50% of members maintain continuous sobriety for any appreciable period of time Several studies report statistics or estimates that indicate that nationally, less than 10% of recovering alcoholics maintain sobriety for more than one year. That is an incredibly low success rate! Were this percentage evident in any other area of medical treatment, it would stimulate much research into alternative or revised treatment methodologies.

Of course, AA is not a "treatment" in the medical sense and with its spiritual foundation, never could be. And, yes, the statistics are based upon anecdotal data. However, it is the experience of many AA members of more than five years sobriety that provides evidence for the fact that the majority of their fellow AAs do not remain sober. Simply ask these members: How many of those you have sponsored or known have remained drug free? Relapses are commonplace and many do not return to the rooms of AA.

What prevents 90% of those entering the program from completing the program of action and adopting AA’s way of life? One possibility is that the program of action was, from the inception, irretrievably locked into a program of religious belief; and the specific belief system involved the theistic concept of a Western Judeo-Christian God. Anyone who doubts this may reflect on the extremely low percentage of Eastern and Asian members of AA in our meetings. The Buddhists, Confucianists, Hindus, and other religions are not even addressed in the Big Book, let alone present at a typical AA meeting, at least in our nation. Yet each of these religions emphasize the same set of basic ethics embodied in our program of action. They may differ in creeds, but not in what is accepted as ethically responsible deeds.

If, as is stated in the prefatory sections of the Big Book, it is only through a spiritual awakening that recovery is possible, and this spiritual awakening is dependent upon belief in a religious God, what of those thousands of individuals who find the concept of an absolute, supernatural and superhuman God as understandable and meaningful as the Flying Saucer from Mars? The Big Book would maintain that, for them, recovery would not be possible.

I do not blame the founders for their lack of foresight in this regard. They could not have foreseen the radical changes in science, economics, social values, and modern day pressures that have created enormous stress conditions for teens as well as older persons. They did not live in an era in which teen drug abuse and teen suicide was so common. They could not have foreseen that most individuals that grew up during the 60s and 70s would be multiply addicted with drugs that were not even known in the 30s.

Perhaps, more significantly, the founders could not have foreseen that AA would be largely viewed as a follow-up program for a government supported multimillion dollar addiction industry characterized by professionals directing large treatment facilities, in opposition to the original model of "one drunk talking to another." Nor could they have known of the tremendous advances that have taken place in our knowledge of the biological basis of addiction. What they did see was that of those who followed their program of action precisely as it was outlined in the Big Book, 50% recovered without a relapse and remained sober for the remainder of their lives. We may note that this statement of Bill Wilson is not accompanied by any references relating to how this statistic was deduced, and one must assume that it is as anecdotal as current data.

One should also bear in mind that a recovery rate of 50% has a predictive accuracy not statistically different from chance; that is, tossing a coin would also predict that 50% would recover, whether they attended AA or not! A further problem involves the many enlightened individuals today who are familiar with the mass of biological data on the nature of addiction through the mass media and television specials. Many of these persons recognize that their religious beliefs, or lack thereof, have absolutely nothing whatsoever to do with recovery programs for addiction.

To the extend that these statistics may be regarded as indicative, we must conclude that the early success of AA was sufficiently impressive that it is understandable that members remain highly reluctant to make any changes in the program or its literature. But perhaps in the light of the later statistics mentioned above, we need to seriously rethink the "spiritual" aspects of the program of recovery. Certainly, in the light of what is currently known of the biological basis of the disease, the psychogenic model needs to be reconsidered, if not dropped, as a main thrust of treatment.

What works for the old-timer of 20 or 30 years sobriety or more, as far as the spiritual aspects of the program are concerned, needs some rethinking for today’s population of alcoholics. The program of action with the caveats mentioned, I believe, works as well in the 1990s as it did in 1939, for the founders, in their emphasis on relatedness, tapped into the very essence of the major personality consequences of the disease of alcoholism (though that was not how the founders thought of it). They tapped into the basic social needs of all humans that alcoholics, for whatever reasons, had denied themselves or felt themselves unworthy of receiving. A program of action would, therefore, work across all national and religious boundaries to the extent that it was based upon ethical principles regarding the relationships between people; for these are universally accepted (consider, for example, that the Golden Rule exists in every culture and has existed since Egyptian early history).

What is the most common experience shared by recovering alcoholics? That they felt less than, not equal to, or different from their fellow men and women, and that these feelings led to increasing isolation and alienation. Perhaps the most consistent aspect of the disease of alcoholism is not the fact that we are alcoholics, but the fact that we are human and have been unable to accept our limitations as being simply human limitations. This becomes particularly reinforced as we come to recognize the various psychosocial aberrations to be consequences of the disease; not causes of it.

Hence the socialization aspects of the program, from the assessment of those character attributes which prevented one from relating to others, to accepting responsibility for harms done oneself and others, making amends, and being of service, work effectively because mans social needs have not changed. The question that must be asked is simply this: Is anything more than this required to ensure continued recovery and growth? I believe not, for I firmly believe that the socialization process intrinsic to the 12-Step program of action involves a very strong aspect of spirituality: our ethical and moral relationship with and obligations to our fellow men and women. What the program fails to provide is an effective solution to the biological factors that form the basis of the disease of addiction. Hence, the socialization aspects of AAs program of recovery are meaningless unless one first attains physical sobriety.

Attaining physical sobriety is a biological problem that is centered around the addicted individual’s acceptance of the biological basis of his or her disease and the subsequent development of sobriety as the most important priority in one’s life. Ultimately, this requires a daily act of the individual’s will power. No God, nor any program that focuses on altering the psychological or social imbalances that arise as consequences of a life of addiction can be effective until the addict first attains physical sobriety. On this issue it is decidedly dangerous for a recovering addict to believe that the "powerlessness" described in Step One of the AA program relates to his fundamental addiction. Here is one place where one’s own will is desperately needed if recovery is to take place at all. One may accept powerlessness over the ability to change the addictive nature of ones physiology; one is not powerless over the ability to refrain from using the addictive substance. I know that arsenic is a toxin; that my body will attempt to reject it and failing this, I will die. Therefore, I do not ingest arsenic. To the alcoholic, alcohol is as toxic as arsenic. The first step in becoming drug free, therefore, is to learn how to prioritize sobriety, to make it independent of the quality or nature of one’s life, one’s mental state, or any other aspect of one’s existence. It is what SOS calls the "Sobriety Priority." You do not drink no matter what happens in your life!

I would contend that any person who has successfully recovered from their addictions have done so by a daily exercise of their own will in refraining from the use of the addictive substances! The Higher Power concept may have provided some guidelines for reparation of the psychosocial imbalances that the addictions produced, but cannot resolve the biogenic aspects of addiction.

Suppose we were to broaden the conception of a Higher Power to allow greater divergence of opinion, and therefore, more personally tailored conceptions of "God." Would this, in any significant way, dilute the effectiveness of the basic program of action? In my experience it would not, and has not. My personal conception of a Higher Power is a nontheistic one; one that has nothing to do with the supernatural or superhuman but, rather, is an intrinsic part of what I choose to call my higher consciousness. Since my God is within me, I have little difficulty gaining knowledge of HP’s "will" for me. Ironically, however, I have found that meditation alone has limitations for proper self direction. In fact, it is through the fellowship and the sharing of my experiences with nonjudgmental peers that I gain greater conscious contact with my HP. My ethical humanistic philosophy provides the most consistent guide for the development of my relationships with my fellow man:

"By seeking and helping to bring forth the Highest in others, I continue to discover the Highest within myself. The key to self awareness lies within service to others."

This sense of ethical responsibility requires me to make informed judgments and decisions regarding my intended actions and behavior, and I do not become informed without the honest sharing and reflections of a friend.

Since my knowledge of the God within me is dependent upon my willingness to share honestly and openly with other men and women, and to attempt to assist them in seeing the highest within themselves, relatedness becomes a central theme to my recovery. As mentioned, I believe that the program of action works because it taps into the one area of denial that characterizes all alcoholics: the feeling of being alone, alienated and different from others.

I came to understand that the "character defects" revealed through Step Four had one common characteristic: in one way or another, they reinforced my feeling "apart" from my fellow man and, therefore, alone. I have considered them as personal indices of alienation: whether it be selfishness, lust, false pride, stealing, or dishonest behavior, they all serve to set me apart from others from whom I must hide the truth. The fact that I am aware of the truth is my built in reminder of the Higher Consciousness within me. The denials of my active alcoholism allowed me to ignore old HC and, of course, led me to my bottom. During the heights of my active disease, I was able to hide the truth from myself as well, at least during short periods of time. The great benefit of the fellowship of AA is in the recognition that I no longer need be alone, fearful, or feel different.

The AA meetings, and the fellowship of AA itself, are excellent laboratories for learning how to relate to other persons in an honest open fashion. The meetings may not be the best place for finding potential mates (though, if that gets you to them — go for it!), but I can guarantee you will find one person you will begin to like: Yourself! This is the learning that is most absent in our education and applies to all human beings, alcoholic as well as nonalcoholic. We need to be taught how to express our thoughts clearly to other persons, to make our needs understandable to others, to listen carefully to what is being shared with us, or as often stated by AA members "we must learn to listen so that we may listen to learn." Learning relatedness skills is a need of all humans, not just those with addictive disorders. Lack of communication skills underlies the failure of most relationships.

From this, it should be evident that many of us have tried to drown in alcohol our fears of being "less than" and apart from others, only to discover in AA that most people, just like us, don’t know much more about forming good relationships. There is no evidence that the divorce rate is higher for alcoholics in recovery than for nonalcoholics and that should not be surprising. After all, we are talking about the need to love and to be loved, to belong to a social group, to be recognized by one’s peers and accepted for ones unique gifts; needs as biological as our need for air, food, shelter and sunshine.

As a result of the habits and associations we acquire over many years of addiction, we became so self absorbed in our dilemma that we failed to notice that we were no different than anyone else: we continued to judge our insides by other people’s outsides, or appearances. We turned inward, rather than outward, and only in that longed for state of drunken oblivion could we fantasize that we were the same as everyone else. A couple of examples from my experience should illustrate this point.

I can remember one meeting during which my sponsor asked me to list all of the things about myself I didn’t like. After listing race, physical stature, looks, finances, etc., he observed that, by my description, I was nothing more than a bunch of negatives. He then asked me to look around the room and to choose someone who I thought I would be happy being. Looking around, I saw a handsome, well built, Nordic blond with a radiant smile, surrounded by many admirers. I told my sponsor that he was who I would want to be. For many years later I think back to my sponsor’s response. He said simply, "Yes, but you forget one thing. He is in here too." At one time, I thought I would be just fine if I looked like Robert Redford. I realize today that Mr. Redford, at his present age, would probably also want to look like Robert Redford of 30 years ago.

Could a bar stay in business with out that social lubricant that makes all participants feel a part of a "family?" The difference, is that the nonalcoholic eventually goes home to accept the responsibilities of his family role(s). As an alcoholic, I was unaware that I had a metabolism that changed the effects of alcohol’s normal degradation by bodily enzymes; it is this change that underlies the phenomenon of "craving," as well presented by Dr. Silkworth in the 1930s.

The current state of addiction research would lead one to conclude that two processes must be attended to.

• First must be the breaking of the physical addiction; the "cellular thirst" for the addictive substance. Although most individuals can be detoxified in a relatively short period, maintaining sobriety in the absence of psychological and social support becomes an almost impossible task for the addict.
• Second, we must break the habits and associations that reinforce drug taking behavior. So many habit patterns and associations have been learned as a result of long term addiction that the detoxified individual will most likely return to the addictive substance unless therapy is directed at changing ones perceptions.

It would appear that dealing with this second critical part in breaking the cycle of addiction has received the most attention. These efforts have consistently failed due to the fact that the habit patterns have been viewed as the primary cause of the addictive behavior. Since the anecdotal reports of addicts in recovery would indicate that the emphasis in post-detox treatment should be on relatedness, then it becomes apparent that relatedness must become the primary basis for our maintained sobriety — not a belief in an absolute God.

It is interesting that though the Big Book of AA looks towards a spiritual solution, every step from Step Four on speaks of this lack of kinship with our fellow man ("Of true brotherhood, we had small comprehension"). What the Big Book fails to recognize is that, given an evolutionary history of being naturally social creatures, our relationship with our fellow men and women, is the province of ethics, not morals! Were we to change this aspect of the suggested program of action, it is very possible that the AA program of recovery might be more effective than it has been with the spiritual focus.

Of course, none of the Steps deal with the initial physical recovery and, therefore, the focus of treatment remains confused as long as it is tied with reducing "character defects." Sobriety must come to be regarded as the most important priority of an individuals life for without sobriety, no life is possible. How this simple fact escaped the founders of the AA program is unclear, though, as mentioned above, persons with long term sobriety have learned that sobriety had to be regarded as a priority independent of any other aspect of one’s life. That is, regardless of whether or not one had a good day, suffered the loss of a loved one, lost a job, or in any other way experienced "life happening," one did not pick up a drink or use a drug. In short, "you don’t drink or use no matter what."

We are social beings and develop ethical rules and laws so that the majority of those in a democracy are best served. Personal spiritualism, in so far as saving ones "soul" is concerned, does not require any particular social or ethical action on the part of the individual. It is in our actions, not our thoughts, beliefs or our creeds, that others judge us to be responsible adults. In recovery, we must learn to judge ourselves by the same ethical standards. This has been my key to self esteem and a feeling of self worth.

My daily meditations proceed something as follows: Have I acted fairly this day? Have I performed actions that were selfishly motivated, thereby robbing another person of their rights? Have I treated all persons I came into contact with dignity and respect? Or, have I played only the role of the Ku Klux Klan type of personality: virtuous in creed, disastrous in deed. These are the thoughts that guide my search to improve my conscious contact with my HP (Step Eleven) and, in essence, these are the questions that guide my meditations.

As for prayer, I have little use for it. It brings up the unnecessary question of: To whom? I do not need the "grace" of some absolute power any more than I require the blessings of a Witch Doctor, or to be granted permission to own or possess that which I have earned, or to be kept from temptation and actions that I know in my heart are damaging to myself or another. I need not beg for my daily bread; I obtain it the hard way — I earn it.

Some feel that a thorough change from the spiritual aspects of the AA program is needed. In the mid-80s an alternative to AA came into existence. It is called SOS, Secular Organizations for Sobriety (or Save Our Selves, a significant acronym). SOS has an internet site at www.unhooked.com, filled with SOS information, news, events, meeting notices and readings, and its sponsoring organization has another at www.secularhumanism.org/sos/ for anyone  interested. In reviewing their literature, I believe that they were founded in response to meet the needs of those alcoholics and drug addicts who were uncomfortable with the spiritual content of AA. "SOS credits the individual for achieving and maintaining his or her own sobriety, without reliance on any ‘Higher Power.’"

The program founder, James Christopher, recognized the need for support of the recovering addict immediately after effective detoxification, but believed that the nature of aftercare services is highly dependent upon individual preferences, medical histories, and other personal habit patterns and associations that might interfere with one’s ability to make sobriety a primary priority in one’s life.

In effect, SOS and other secular approaches to addiction treatment, do not attempt to impose a life style upon the individual; believing that a sober individual is capable of deciding the individual course s/he wishes to take in attaining the "good" life. Unlike the assumption in AA that the recovering addict requires guidance in these areas of life, SOS and similar organizations believe in the fundamental dignity of each and every human being and propose that once a stable sobriety has been attained, the individual is capable of choosing his or her own life goals and making informed judgements as to the course that s/he wishes to follow in attaining these goals. In SOS, the individual is encouraged to think, to reflect, and to evaluate; in AA, the individual is encouraged to leave the brain at the door.

SOS group meetings are held in a free-style manner in which members express their concerns and obtain the counsel of others in gaining the insights necessary to deal with emerging life issues. The meetings are purposely nonstructured, cross talk is frequently encouraged as long as it remains constructive, and perhaps most characteristically, there are no prescribed steps or suggested goals towards which members of the group aim. The only bond that holds these recovering addicts together is their agreement on the Sobriety Priority as a fundamental condition without which no meaningful life is possible. Individuals attend on an "as needed" basis, with some attending only once a month. As there is no sponsorship, no oversight control, and the only one of AAs traditions that is maintained is the 7^th, members feel free to develop their own approaches to continued recovery. Members therefore live life styles according to their own dictates, and no common set of precepts are presented or encouraged. For this reason, no specific service to the group is expected or required.

If one feels the need to develop higher moral or ethical principles, chooses to seek a better understanding of spirituality, or, conversely, desires to make no major changes in his or her life, s/he is encouraged to make these decisions and they are accepted by the group. As many solutions to the problems of living are acceptable to the SOS groups as there are recovering addicts. In addition, the SOS groups gather not only atheists and agnostics, but theists who feel that the issues of religion and sobriety should remain separate. The common belief is that religion cannot provide a meaningful solution to problems of addiction as the presence or absence of religion has not been demonstrated to have any particular causative relationship with addiction.

I am firmly in agreement with these tenets. Not only does SOS emphasize the lack of empirical evidence for the "addictive personality" that has been the traditional focus of treatment, it concentrates almost exclusively on the one area that the AA program consistently confuses: How to maintain physical sobriety as an issue that remains independent of any other aspect of an individual’s life. Regardless of one’s character, one’s personality, or even one’s social or psychological pathology, the detoxified addict is capable of remaining sober. This is a research fact. Neither religion nor psychotherapy, nor any other behavioral treatment, is necessarily required for continued sobriety. The failure of psychiatry in successfully treating addictions is proof of this point. This is consistent with the observations made throughout this paper.

In groups such as SOS, one cannot hide irresponsibly behind concepts of personal "powerlessness" or wait on the sidelines for the grace of a higher power to provide recovery through a reduction of character defects that were (and still are in AA) assumed to cause the addiction; character defects that are currently known to be consequences of the addictive behavior. If your personal history was characterized by drug abusing parents, and your childhood witnessed physical and sexual abuse, or your father beat you over the head with a hammer daily — SOS and related secular groups would argue that you can stay sober, for these very things have happened to individuals who did not become addicts. Your history is not the cause of your addiction! You would be more productive praying for God’s grace in removing your defective genes or your parents than your "character defects."

I feel that a good deal that SOS hopes would be attainable within the AA program as long as the emphasis on relatedness was considered paramount, and the current focus on spirituality was de-emphasized and reduced to a matter of personal choice. Unfortunately, these changes are not likely to occur given the mutual reinforcement of AA principles and traditions by members that attempt to maintain the program exactly as it was in 1939!

Some change is possible in AA to the extent that sponsors become more aware of alternative interpretations of "spiritualism," and sensitive to the needs of those they sponsor. If we are to truly provide a meaningful service to the newcomer, then we must educate ourselves to be maximally sensitive to the social/spiritual needs of those whom we sponsor. We must also become more literate and appreciative of the research literature on addiction in order to recognize that the "spiritual" solution can not possibly work as the primary problem is not religious, but biological. The "Suit Up! Show Up! and Shut Up!" school of thought is for prisoners; not humans attempting to recover from a fatal illness.

Perhaps we old timers need to have those egos trimmed a bit and rethink our carefully guarded program a little more critically. We should also become more literate regarding the current changes in our understanding of addictive processes. And perhaps, also, we need to retire the bind between treatment and religion in our recovery program. A start would be to refrain from a group chant of the "Lord’s Prayer" at the close of so many meetings!

The bottom line for any program of recovery from addiction is simply this: If one does not remain sober, and accept personal responsibility for this effort, one gains no life worthwhile talking about so the matter of spirituality remains a moot point! To the extent that the AA program could be successful in this regard, more newcomers might remain sober, and more might stay around long enough to feel a need for a change in their skills of relatedness and their ethical concepts of man’s proper relationship to his fellow man.