A number of years ago I was concluding a counseling session with a client. He was in his 30's and wasn't happy about his alcohol dependency but grudgingly accepted it. I suggested he attend AA and read their book as a means of gaining acceptance of his alcoholism. He didn't much care for this suggestion.
This man described AA in rather condescending terms. He seemed to feel it was for stupid people. Perhaps he had attended a meeting and had heard someone say "you can be too smart for this program but you can't be too stupid." I wish people wouldn't say things like that as it might run some people off. I suggested he might try a different meeting and give the AA "Big Book" a read. He clearly was not ready for a solution because he rejected this suggestion. (When you go to someone for advice and then reject the advice that is clear evidence you do not want a solution.) He added that the Big Book was out of date having been written prior to WW II. He said he would like something newer, more up to date, something based on science unlike the Big Book.
Now here was a question which gave me some pause. Sure I liked the Big Book and believed it to be just about the most helpful book ever written, but how well does it align with current knowledge about addiction? Well actually it does remarkably well.
Approximately a decade and a half after the Big Book was written the American Medical Association [AMA] first recognized alcoholism as a disease. The AMA definition of addiction has been amended recently specifying that addiction is a brain disease. This not withstanding the older wording remains describing alcoholism as a "primary, progressive and chronic," illness with characteristics such as "obsession" with alcohol, a "compulsion" to continue drinking once drinking is initiated and ongoing drinking "despite negative consequences." The definition from the AMA includes "distortions in thinking, most notably denial."
The description of alcoholism contained in the Big Book of AA includes all of the above. The Big Book states that "over any considerable period we get worse never better." This is a clear statement about the progressive nature of addiction. Denial is described in the Big Book as "The idea that somehow, someday he will control and (emphasis is mine) enjoy his drinking is the great obsession..." Actually the entire AMA definition of alcoholism is really a summary of the first 164 pages of the Big Book.
What about these latest brain disease findings? http://www.drugabuse.gov/publications/science-addiction/drugs-brain A few years ago a friend and I happened to be attending a lecture on addiction and the brain at UTMB Galveston. The talk was based on ten years of recent research. The speaker described how for persons with a history of addiction certain neuropathways are bypassed and others are selected when the subject is presented with a visible stimulus related to the substance they are or were addicted to. Basically all the pathways involved with inhibition and judgement are bypassed and those involved with instinctive actions are selected. In other words the subject was found to be "powerless over alcohol" his or her decisions evidenced that "our lives had become unmanageable."
The truth is that the Big Book is not a science book as such. It is not based on decades of controlled experimentation. However the hypothesis put forward by the Big Book has been validated by years and years of experimental evidence. The ideas contained in the Big Book of AA represent a theory of alcoholism and actually a theory of addiction which appears incontrovertible. Unless future research entirely negates current knowledge your best bet for comprehending and overcoming addiction are contained in the pages of the book Alcoholics Anonymous.
Russell Mai, LCDC, AAC
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