A GPs view of Alcoholics Anonymous

When we suggest joining Alcoholics Anonymous to patients, the response from the patient is often negative and questioning. 

Many doctors perpetuate misconceptions about the organisation without proper knowledge. I have observed the life shortening problems caused by alcohol to individuals and families by hazardous drinking during 40 years as a GP in one small rural town.  I have observed the various NHS clinical strategies to address problem drinking in my patients, but I keep returning to the original classic from America – Alcoholics Anonymous.

My observation from decades of clinical experience, is to say, “it is the only thing that works”.  

I have several patients who have been alcohol-free for 35, 15, 10 or 5 years, with the help of Alcoholics Anonymous, following my encouragement to them all those years ago. It is indeed very humbling to be thanked for some simple advice you gave so many years previously that has turned around somebody’s life.

I have recently been using AA members as part of GPST teaching and was honoured to speak at their convention and gain a more detailed insight into the mechanics of the organisation. They are very keen to be an educational resource for GP and team training.

What do they do?

Alcoholics Anonymous was formed by a doctor and a stockbroker in the USA in 1935 and has since spread around the world like McDonalds as an American icon.

It is a very interesting organisation as they stick to a classic iconic design- a bit like Harley Davidson motorcycles of the same era! 

Another USA classic engineering statement from experience is “don’t fix what aint broke”! 

The only criteria for membership is a desire to stop drinking alcohol.  They have a policy to refuse all Government money and sponsorship with a local branch structure reliant entirely on self-funding.  Indeed, when the collection box went around the convention hall after I had spoken to the meeting, there was explicit instruction that non-AA members were asked not to contribute!

They hold local weekly support meetings, where they help each other maintain abstinence by working through a 12-step programme of self-understanding and personal growth.

Why does it work?

They have a simple definition question for alcoholism “Is alcohol costing you more than money?”  This is also a simple consultation design classic, which as stood the test of time.  It is a much more accurate predictor of alcohol problems than any CAGE questionnaire on a GP computer.  They take the view that many alcoholics are still in employment, relationships and good physical health.  The caricatured “vagrant definition of an alcoholic” is only one end of their spectrum.

New members have the opportunity to ask an existing member to sponsor them (male for male, female for female) and they operate a strict code of anonymity and confidentiality.

Alcoholics Anonymous, as a group, has no position or comment on anything to do with alcohol.  This public paradox, which prevents them from making public statements against alcohol in the media or to Government, affirms their position that they are just there for individuals.  They remain content to let other people use alcohol responsibly in society and just feel they must address their own personal idiosyncrasies.

They view alcoholism as an illness, which is life-long and take the position that they must be alcohol free for the rest of their lives.  They feel that “controlled drinking” and units for people in their situation is an unrealistic delusion of health professionals. I agree with the AA! 

Their membership attracts all walks of life and they have an oral tradition with strong role models.  Their mission statement logo refers to unity, service and recovery (Ref 1).  They stick together and understand each other’s problems with true empathy. They serve each other and gain strength and life purpose by helping other people.  They continue to declare themselves as “in recovery”, taking each day at a time, despite the passage of 40 years abstinence of one of the local groups’ members.

Many members work quietly and voluntarily in prisons and in support of alcohol rehabilitation units.

What are the myths and misconceptions?

Their 12-step recovery plan refers to abdicating responsibility to a “higher power”. This is a difficult concept to explain without speaking to a member and the “higher power” certainly does not have to be God or any religious being. It is about personal control and dealing with themselves. They develop a very positive view of themselves and the world through alcoholics anonymous, which can transform their own lives and that of their families.

Their sister organisation Al-Anon, is based on a similar structure and principles for families and other people affected by the problems of alcohol.  Al-Anon groups give helpful insight into supporting and non-colluding behaviour to the alcoholic in their lives.

How can Alcoholics Anonymous help General Practitioners?

You just need to give patients the national telephone number 0800 9177650 or help@aamail.org. The patient makes the phone call and is put in touch with their local group. At a personal level, I feel the organisation and its members have given me valuable professional insights into the natural history of people with alcohol problems and their families. It is the best antidote to professional cynicism I know. Just read the dictionary definition of cynicism to send a chill down your professional spine

1.    Distrustful or contentious of virtue, especially selflessness in other
2.    Believing the worst in others, especially that all acts are selfish
3.    Showing contempt for standards of behaviour, especially honesty or morality

Unfortunately, we often only see alcoholics in a crisis, manipulating all around them and demanding Diazepam. This could colour our humanity and an intelligent conversation with a recovered alcoholic will restore your humanity and leave antibodies to attacks of professional cynicism.

In conclusion, before you condemn the individuals or the organisation, consider this simple American icon, which has saved millions of lives since 1935.

REFERENCES

1.    www.alcoholics-anonymous.org.uk

Dr James Douglas, Mb ChB, MD, FRCGP, FRCPE, D Occ Med 
Tweeddale Medical Practice, Fort William

24 1 2020