A Doctor's Opinion
A transcript of Dr. Jacqueline Chang's paper published in 1999
This article is based on a transcript of Dr. Jacqueline Chang's paper given to the National Workshop for Health Liaison in York in 1998 and published in the Winter 1999 edition of the AA News. Dr. Chang is a medical practitioner and was a Non-alcoholic Trustee of the General Service Board of Alcoholics Anonymous.
The principles of the programme of Alcoholics Anonymous are scientific and closely follow all the helping therapies which lead people to emotional well-being.
The focus of the programme is spiritual.
Referral to Alcoholics Anonymous is cost effective.
Research has failed to identify any source of help which is even close to Alcoholics Anonymous in terms of effectiveness in helping people to achieve long term sobriety.
The AA programme teaches us ultimately to change our alcoholic way of thinking and feeling. As it is easier to change our actions than change our thoughts and feelings, AA starts by helping us to change our behaviour. People are asked to go to meetings, read the book Alcoholics Anonymous, talk to others ( these are all behaviours) and gradually alcoholic patterns of thinking and feeling change also. This type of behavioural change is the basis of many therapies.
1. The Scientific Principles of AA and Emotional Well-being.
AA proposes living " One Day at a Time". It is emotionally healthy to live in the day ... in the here and now. No point in saying "If only ...". The past is gone. Equally, no point in saying "What if ..." we can't control the future. Professional therapists teach people to live in the present.
AA encourages members to share their experience, strength and hope with other members. It is emotionally healthy to accept our past experiences, however painful, as past events and move on to a richer, more fulfilling future.
Step 1 in the AA programe is " We admitted we were powerless over alcohol - that our lives had become unmanageable". It is emotionally healthy to surrender and accept things over which we have no control.
"God grant us the serenity to accept the things we cannot change, courage to change the things we can and the wisdom to know the difference" is the Serenity Prayer used at every AA meeting. It is emotionally healthy to prioritise problems. The Serenity Prayer is the greatest exercise in prioritisation.
It is emotionally healthy to accept that we cannot change a particular situation but we can change the way we react to it.
It is emotionally healthy to be honest with yourself and with others, also to be open and willing to change, to experiment, to encounter new situations.
It is emotionally healthy to accept yourself as you are.
It is emotionally healthy to recognise your environment and interact with it as it is, not as you wish it would be.
It is emotionally healthy to associate or be in contact with other human beings.
It is emotionally healthy to be altruistic - to help others without question or expectation.
It is emotionally healthy to anticipate - to plan for future discomfort or crises. This is the function of the AA Step programme.
Humour and fun are emotionally healthy. Recovery is not gloom and doom. AA is full of humour.
It is emotionally healthy to be able to temporarily to suppress painful feelings or conflict and to think or work on it later when it is more manageable.
2. The Spiritual Programme
The AA programme is uniquely spiritual but NOT religious.
Spirituality and religion are different.
It is helpful to use Dr. Robert Lefever's definition of spirituality in order to understand and to explain the difference.
What is spirituality?
A continuing sense of peace and hope and love.
Recognition that there is more to life than practical day-to-day matters: these are important but not totally important.
A sense of trust that one can learn from experience, however bitter and hurtful, and place it in perspective as a past event from which one can progress to create a richer, more fulfilling future.
A sense of commonality with other human beings.
An awareness of God, as each may understand Him, or Higher Power of some kind ( perhaps "the AA group" or the "creative spirit human spirit within all people") can give one more understanding and tranquillity than one can gain for one's self in isolation and that this source of help is dependable.
Addiction seems to be about the loss of spiritual values :-
Loss of belief in self and others.
Loss of trust in self and others.
Loss of hope in a better future.
Loss of the ability to function in loving relationships.
Belief, trust and love are the great spiritual values. They are restored to people who work the programme of Alcoholis Anonymous. The programme is therefore a spiritual programme.
3. Cost effectiveness
25% of male hospital admissions are alcohol related.
Health spending on alcohol related problems is currently estimated to be GBP150 million per year or 4.4% of the total health budget. It is probably much higher than this.
Excessive alcohol consumption is a common cause of high blood pressure, strokes and obesity.
3% of all cancers are linked to alcohol.
Alcohol is a factor in 15% of road deaths, 26% of drownings, 39% death in fires.
4,500 people are admitted to hospital each year because of mental health problems related to alcohol.
65% of all suicide attempts are linked with excessive drinking.
Maybe AA can help some of these people and help reduce the costs.
AA meetings are widely available throughout the country and are held weekly at the same venue, same day and same time.
There is no cost to the medical profession and no monetary cost to the alcoholic. ( Although the cost is high to the alcoholic who almost
loses his /her life before getting to AA ).
a) Short Term Abstinence
There is plenty of research which shows that AA is effective in the short term.There is also lots of research which shows other things are effective in stopping drinking. These include therapies and counselling, substitution of other drugs like Valium . Also use of Antiabuse.
Other drugs have become available which are used to suppress craving, these are Naltrexone and Acamprosate.They are not in the same category as Valium.
b) Long Term Abstinence
However long term sobriety is a different matter. There is no research anywhere which says that anything is superior to AA in helping people to achieve long term sobriety.
It makes good sense to introduce AA to alcoholic patients at an early stage and to use AA in combination with other forms of treatment such as counselling and the anti-craving drugs.
The National Helpline for Alcoholics Anonymous is 0800 9177 650.