Why AA Works
Webmaster
Hugh H.
London Ontario
Written by:
Adele E. Streeseman M.D. a friend of Alcoholics Anonymous
Copyright © The AA Grapevine Inc. - Reprinted with Permission

A Psychiatrist's Appreciation of Alcoholics Anonymous – June 1960

AN UNDERSTANDING and appreciation of Alcoholics Anonymous is necessary for those who love and live with and wish to help the alcoholic. By our observing what AA does for him, and how, we can learn what he needs from what and, more importantly, us he does not need and cannot take from us. I have a deep and abiding conviction about Alcoholics Anonymous--that it is theoretically sound and reasonable and that it is practically and impressively successful.

My particular relationship to AA is that of a Psychiatrist who has seen AA's miracles at first hand. We psychiatrists are used to miracles. There is, for a doctor, no joy like that of watching the steady growth into health and confidence of a miserably confused, unhappy and panic-ridden patient. As an analyst, I see every year that deep emotional re-education (which we call Psychoanalysis) take hold, sink in, grow and endure to maturity.

Why cannot we do this with the acute alcoholic? (as a Psychiatrist) Why can AA do it? Why is it so often true that the active, heavy-drinking alcoholic--angry, confused, often without money, usually drunk, belligerent, hopeless, hiding a deep conviction of worthlessness behind an offensive arrogance--is no candidate for psychotherapy? He needs help. Why does he resist it?

It is astonishing to me, now, that we Psychiatrists did not see "why" right away. It is because the alcoholic cannot trust us--he cannot trust anyone, really. Our first step in any Psychotherapy is establishing what we call transference. The patient "transfers" to us for the purpose of a similar emotional education to that of early childhood, an abiding faith in us--so that he takes again the faltering steps of daring to live, of daring to be himself, of daring to make a mistake, of daring to question, of daring to learn, of daring to believe that we will not desert him and that we will not let him fall as he starts on his journey of growing up all over again.

The alcoholic, as he begins his climb to sobriety, cannot possibly do all this. He trusts, implicitly, no one. It is often even hard for him to trust and love God; his fear of Him is so great. Also, I am reminded of the deep truth of the ancient question, "If a man love not his brother, whom he hath seen, how can he love God, whom he hath not seen?" The befogged alcoholic cannot establish a transference--cannot easily love and trust his brother, cannot relate, as a trusting child, to the strange new Doctor labeled Psychiatrist.

But the alcoholic can, even in his despair, open the door of his personality just a little crack, tentatively, to another alcoholic. He does not fear from him either moral condemnation or obnoxious, stooping forbearance, for the other drinker has lived in the same hell as himself. He can begin to feel a kinship with another human being, after having been alone so long. Hence we have the beginnings of that valuable thing we Psychiatrists (who love to label things) call "Interpersonal Relationship." This is to me the essence and firm foundation of AA. It establishes and maintains human relationships.

The next big step toward health is the gradual loss of that sense of uniqueness most patients have. As you go to AA meetings and meet more and more people, suddenly the world is full of problem drinkers, of alcoholics. Among your friends and family, you have been a leper, a pariah, and an unbelievable catastrophe. But in AA meetings, you hear your own story over and over. You begin to feel free to explore this strange phrase "Compulsive Drinker." Even being called an "Addictive Personality" by another in the same boat does not make you fighting mad. With lots of company, you dare to take inventory, to explore your own personality and make-up, to find your soft spots, to read the danger signals and to recognize and accept a limitation in living that you share with all other true alcoholics--that you cannot take the first drink, because you are an addict.

AA has done a wonderful job in establishing clearly the fact that alcoholism is an addiction. No Doctor, no Psychiatrist would tell a heroin or morphine addict that now, since he has been off the stuff for four or five years, he can take a little now and then, socially. But I still see patients in my office, recovered alcoholics, who have been told by well-meaning Psychiatrists that they can become social drinkers after they solve the conflict underlying their drinking problem.

Fortunately, more and more Doctors are learning about alcoholism. The New York Medical Society on Alcoholism is both learning and trying to spread learning in this field, and fewer patients are chasing the mirage, for them, of "social drinking."We have long known "once an addict, always an addict" and since we now understand alcoholism as an addiction, it inevitably follows that "once an alcoholic, always an alcoholic." Perhaps some day, in the dim and distant future of greater knowledge, this may not be so, but for us now, it is clearly established.

This fact--that total abstinence is for always--brings in its wake another need, the need of continued vigilance, of renewed reminders. If the faraway causes of alcoholism in the personality have not been removed (and we certainly do not yet know how to do that), then the danger of those old sleeping conflicts being stirred up and reactivated will always remain. This is true--but this is not frightening. AA is ever available and most AAs sense the need for continued fellowship.

Moreover, something else--something big and wonderful and unbelievable--happens as one goes along in AA. The fight gets easier as the fighter gets stronger. An imperceptible change occurs in the alcoholic. No one is trying to convert him to anything, but he is changing spiritually. The AA program has no creedal affiliation, but it insists you call upon your God, as you know Him, to help you in your struggle for significance and dignity.

In my opinion, not only as a believer in a living God but as a psychiatrist, there is neither significance nor dignity for man in a materialistic, Godless world. A patient must always come to grips with his own deepest personal philosophy of life, its ultimate meaning and significance for himself, before he is whole. What that philosophy is, be he Jew, Gentile or what-have-you, is none of my business. But find it for himself he must. I have had patients of all faiths, as AA has members of all faiths. I must not determine his goal, but I must help him find his own goal, however he spells it.

Learning how to live seems very unimportant if there is no meaning in living, nothing to live for but the little immediate, material joys. There's no bigness, no significance. If man is just a little differentiated blob of protoplasm, mushrooming up to full size and then fading out, wallowing meanwhile in a sea of self-made miseries and fighting the elements, it all doesn't seem worth a long psychotherapy program, or even the hard job of striving to sober up. It must be remembered that science and psychiatry concern themselves with method, with "how to"--never with ultimate purpose, never with "why." This is the business of the patient himself. But we have been too slow in saying that that last touch of synthesis after analysis, that last job of spelling it all out in terms of meanings, is imperative. I always like to pay tribute to one Psychiatrist, Smiley Blanton, who dared to spell it out. He did not content himself with just teaching a patient how to love maturely; he gave mature loving its inescapable alternative in the superb title of one of his books, "Love or Perish."

The glory of AA and, to me, the deepest and strongest reason for its success, lies in its insistence on the spiritual growth of the alcoholic. Like the Psychiatrist it does not chart creeds--but it suggests, over and over, that you find your own chart, your own pathway, to what you call God.

I heard a distinguished Teacher of Psychiatry say, in a lecture on alcoholism, that the addictive personality is a pigmy at heart who uses alcohol over and over, to turn himself into a giant, and who needed ever more and more of the stuff to accomplish the feat. He gave no formula for cure, for reversal of trend. I ask, in rebuttal, what turns all of us pigmies into giants, automatically? The answer is simple: the fatherhood of a living God, living today and loving us.

I think often of what St. Paul said (as says the alcoholic in his despairing heart): "Of myself I am nothing" which is pretty low in anybody's language--and then adding, with a real leap into the grandiose, "but I can do all things [ALL, mind you] through Christ, who strengtheneth me." This is to me the secret of AA's steady growth--whether you worship the God of Paul, or the God of Moses and Abraham, or whether you call Him Allah. You achieve dignity and significance and you hold on to it and grow quietly because you are rooted in a firm and no-longer-debatable conviction of your own worth and your own potential.

In summary, I would recapitulate. To a Psychiatrist who has had close contact with AA and many alcoholics as patients, AA appears theoretically sound and impressively successful in achieving and maintaining true sobriety. It attacks the drinking problem directly head on. No therapy of any kind is possible while the patient is in an alcoholic fog. It offers the alcoholic a desperately-needed opportunity to relate to other human beings on a more or less equal basis. It continues to provide the means of maintaining sobriety after achieving it.

Finally, it insists on the importance of spiritual growth and spiritual strength as the sine-qua-non of any true health at all. It is not a religion, but it values the objectives of religion--that is, it sets its sights far higher than just keeping one sober and alive and somehow functioning. It aims at helping others. It accepts the responsibility to help others through Twelfth Step work and thus gives altruism and dignity to all its effort. It lifts the work of AA beyond self-preservation into nobility.

Truly I believe "God works in mysterious ways, His wonders to perform" and truly I believe AA is one of His modern miracles, worked, as so many of His miracles were, through His favorite medium, mankind.


How AA Has Changed Lives

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