It was a run-of-the-mill 911 call, a guy down the block with the DTs (delirium tremens) from alcohol withdrawal. I don’t think my partner and I even turned on the siren. At the apartment, we found an unshaven, grey-haired man, sitting in a threadbare recliner. He had an embarrassed grin on his face. His hands were violently trembling and the place stank of booze.
A big part of my job as a New York City Fire Department emergency medical technician was picking up drunks – or as we called them “frequent flyers.” Typically, they were smelly, annoying, uncooperative characters I took in stride. This particular call, however, ticked me off. “Why’d you wait so long to call 911?” I snapped at the patient’s wife. “You’re a block from Harlem Hospital.” She said she’d finally phoned for an ambulance because her husband refused to get help for himself and she didn’t know what else to do. My partner, a female veteran of the force, told the patient that he needed to pull himself together and stop drinking. Only she put it a lot more colorfully. The rheumy-eyed old fellow, just sat there. As I took his blood pressure, he looked me in the eye. That look gave me the shivers. A second later, the patient’s hands stopped shaking. He seized and died.
After work, I went to my local Cineplex with a bottle of Jack Daniels, sat alone in the dark, and got hammered. I’d had patients die on me before, but the look that guy gave me really got to me. Something had passed between us. It was as if he knew that I often went to the movies just to get drunk; as if he knew that I had a drinking problem, too. That little encounter in Harlem had made it clear where my story was heading. Even so, I managed to polish off most of the bottle that night. I don’t remember how I got home.
I may seem like I’m a perfect candidate for Alcoholics Anonymous. In fact, I have made it a point to avoid AA at all costs. Why? Because for the vast majority of people who abuse alcohol, Alcoholics Anonymous is useless. Statistics Canada reports that about 641,000 Canadians are dependant on alcohol. That’s about 2.6 percent of us. Some 324,000 of these people claim they cannot resist their strong urge to drink. These are the folks routinely directed by well-meaning advice columnists, the court system, and even health care professionals to Alcoholics Anonymous meetings.
Established in 1935, AA is a world-wide fellowship of alcoholics promoting total abstinence. Members are required to follow a strict doctrine based on the teachings of the Oxford Group, an evangelical Christian movement from the 1920s. (The Oxford Group’s founder, Frank Buchman, became famous in 1936 for saying “I thank heaven for a man like Adolf Hitler.”) Because Catholics were initially offended by AA’s Oxford Group teachings – as well as its use of the King James Bible at every meeting – AA’s founders thought it necessary to retool the organization and create a bible of their own. In Alcoholics Anonymous (aka “The Big Book”), first published in 1939, Oxford’s “five procedures” toward spiritual awakening became AA’s “12 Steps” to sobriety. (AA chose the number 12 because there were 12 apostles.)
To mollify alcoholic Catholics, the group became “spiritual, not religious” and “confession” became “sharing”. Alcoholic atheists were also encouraged to attend – so long as they renounced atheism. Any AA member who did not admit to the “possible existence of a Creative Intelligence” was proclaimed “arrogant,” “in denial,” and “doomed to an alcoholic death.” To this day, this message has not changed. In fact, in the entire 70 year history of Alcoholics Anonymous, no part of the program has ever been adapted or modified.
There are now more than 100,000 AA groups in 150 countries, with an estimated membership of two million. With such impressive numbers and overwhelming societal approval, one would imagine that there is a ream of scientific data showing the effectiveness of the Alcoholics Anonymous philosophy, or that AA would initiate clinical studies of its own to prove its value. Not so.
No official membership or attendance records are kept at any level in AA. The Alcoholics Anonymous General Service Organization (GSO) does conduct triennial surveys of its members, but does not release the results to the public. In 1990, the GSO prepared an internal document entitled Comments on A.A.’s Triennial Surveys in which it averaged the results from the five surveys taken between 1977 and 1989. The findings were abysmal. The report showed that 81 percent of the people who joined AA dropped out after only one month. After three months, 90 percent were gone. After six months, 93 percent were gone. And at the end of one year, a mere 5 percent remained with the program.
One of the things researchers know about alcohol abuse is that each year, in any given group of alcoholics, approximately five percent spontaneously abandon their addiction. Over time, 50 percent of all alcoholics somehow manage to free themselves from their dependence. Of course, 50 percent don’t. Are the five percent who maintain a long-term relationship with AA the same five percent who would have quit drinking anyway? It’s hard to say. AA didn’t even count people as “members” until they had attended a minimum of 10 meetings. In an interview with ABC News, one AA spokesman estimated that 95 percent of all newcomers do not come back for a second meeting, an even more abysmal dropout rate than the GSO survey found. If true, this would put AA’s success rate somewhere between one per cent and zero – far behind spontaneous remission. Indeed, it might even suggest that joining AA is detrimental to recovery.
Clearly, regular attendance at AA meetings does not necessary imply recovery. It’s no secret that not everyone in AA is continuously sober. Many people in AA relapse, binge, and repent multiple times. (In fact, half the people featured as personal recovery stories in the original The Big Book later relapsed and returned to drinking.) One study shows that AA members are four times more likely to binge drink than those recovering with no treatment – and nine times more likely to binge than those receiving cognitive-behavioural therapy.
According to another study referenced in the Harvard Mental Health Letter, about 80 per cent of the people who manage to get sober and stay sober for a year or more do it without any treatment or formal support group. For those who feel they need support, researchers find it difficult to recommend any one form of treatment over another. Studies comparing alcoholics in control groups with those in 12-step programs or cognitive-behavioural therapy – and even those receiving both 12-step and CBT together – show that all methods of recovery are more or less equally effective. Anything works if the alcohol abuser is motivated. And no treatment is just as effective as treatment of any kind, as long as the abuser has arrived at that mysterious point at which the addiction no longer fulfils his or her need. That’s the dirty secret of AA.
And here is my dirty secret: although I made it a point never to drink when I was on duty, I had few other boundaries when it came to alcohol. I drank alone. I drank in bed. I packed liquor in my suitcases. I stole liquor from my friends. I vomited in public. I blacked out. I drove drunk. When I quit the NYC Fire Department (astonishingly, with an exemplary record) and moved to Toronto, I remained a closet drinker and a highly-functional drunk.
And then one day, I stopped. At my annual checkup, the doctor asked how much I drank. I said I was a social drinker. “Meaning what?” he asked. “You have one or two drinks a week?” “Well, no,” I said. “I have 15 or 20 a day.” I date my recovery to the look he gave me. At that moment, I became one of the five per cent of alcoholics (32,000 people in Canada) who, in a given year, simply quit drinking. It took one step, not 12. That was five years ago.
Could a 12-step program have saved the old fellow with the DTs? It’s doubtful. Could anything? Recovery from alcoholism depends primarily on personal motivation. He obviously didn’t have it and no one could have forced it on him. I’ll tell you one thing, though. I still remember the look he gave me in the last moments of his life. Like my doctor’s expression, it has stayed with me and helped me stay sober. He may be gone, but as long as I’m around, he’ll never be anonymous.