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When we suggest joining Alcoholics Anonymous to patients, the response is often negative and questioning and many doctors perpetuate misconceptions about the organisation without proper knowledge. After 29 years of practice on the West Coast of Scotland and clinical observation of the escalating problems of alcohol and the various failed clinical strategies to address problem drinking for my patients, I keep returning to the original classic from America - Alcoholics Anonymous.
My summary of my prejudice, from experience, is to say "it is the only thing that works". I have several patients who have been alcohol-free for 25, 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(1) teaching and was honoured to speak at their convention and gain a more detailed insight into the mechanics of the organisation.
Alcoholics Anonymous was formed by a doctor and a stock-broker 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 design like iconic Harley Davidson motorcycles. In another USA classic, they stick resolutely to "don't fix what ain't broke!" The only criteria for membership is a desire to stop drinking. 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 round 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.
They have a simple definition question for alcoholism "is alcohol costing you more then money?" This must be a simple consultation design classic, which has stood the test of time. It is a much more accurate predictor of alcohol problems than any CAGE(2) questionnaire on a QOF(3) 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 are given a male or female sponsor 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 only have to 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 as an unrealistic delusion of health professionals.
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 others 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.
Their 12-step recovery plan refers to abdicating responsibility to a "higher power". It 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.
You just need to give patients the national telephone number (0800 9177 650). 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
Distrustful or contentious of virtue, especially selflessness in others.
Believing the worst in others, especially that all acts are selfish.
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, take a look at this simple American icon, which has saved millions of lives since 1935.
Dr James Douglas, Tweeddale Medical Practice, Fort William PH33 6AQ
No conflict of interest declared
Not submitted anywhere else
Copyright assignation to Hootlet RCGP Scotland
Personal views of the author
(1) GPST - General Practitioner Specialist Training
(2)The CAGE questionnaire is a widely used method of screening for alcoholism
1.Have you ever felt you needed to Cut down on your drinking?
2.Have people Annoyed you by criticizing your drinking?
3.Have you ever felt Guilty about drinking?
4.Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
(3) QOF - Quality and Outcomes Framework