The reader’s objection and the response below concern “Back to Vice & Sin,” Ray’s review of Addiction and Virtue: Beyond the Models of Disease and Choice, by Kent Dunnington, posted on Amazon, where both can be read by clicking on the link. The review can be read also in “Ray’s Book Reviews” by clicking on this latter link.
Comments from Henry Clayton [Printed verbatim]:
You say 'This conception of powerlessness is the basis of the AA claim that “once an alcoholic, always an alcoholic,” a claim Dunnington downgrades to a “slogan.” Far from being a slogan, that statement is central to the AA understanding of what an alcoholic is'. So what happens to the whole edifice of AA once that foundational tenet is empirically demonstrated to be false? 'Once an alcoholic, always an alcoholic' is true in the *minority* of cases. Most alcohol addicts, like most drug addicts, kick their addiction permanently, with or without treatment, & those who do it without 12-step do it with greater success. The one thing 12-step can 'boast' of is higher rates of absolute abstinence, which perhaps, coupled with the AA doctrine of powerlessness & permanent threefold disease, helps to account for the significantly higher relapse rate for recovered addicts who've recovered through AA or its offshoots. If you truly take to heart those ideas, then perhaps, precisely because of having taken them to heart, '[you] cannot drink again, ever. If [you] do, [you] revert to drinking alcoholically; [you] will not be able to take it or leave it as other people do'. This is just factually untrue of most alcoholics. And so AA promotes an understanding of human nature which is false & pernicious.
As for the anecdotes beloved of addiction recovery addicts, I have a few of my own, drawn from within my own family. My brother was so addicted to marijuana that when he & I took our families to Disneyland, he 'had to' go off into a bush or behind a ride to fire up literally every fifteen minutes. I recall standing in line to the Matterhorn & he openly fired up while standing line multiple times, until somebody went to get a Disneyland staff to report him. He was totally oblivious, I alerted him however & he avoided discovery. But, Disneyland, for Christ's sake! Fast forward several years. He's making a drug deal & somebody throws acid in his eyes. He's blind for months. He says to himself 'What am I doing? This is stupid.' He quits cold turkey. Fast forward several more years. Despite being around heavy users constantly, including two other brothers who run a medical marijuana grow house, he doesn't relapse. He's done with it. My brother has no special endowment of willpower, nor is he a moral saint (though he is a tremendously good person). AA's crippling message of powerlessness would have blinded him far more than the acid in the eyes did.
Thank you for your comments, Henry. You object to AA’s understanding of an alcoholic as one who is powerless over alcohol. As the paragraph from which you quote explains, central to this understanding is the idea that “once an alcoholic, always an alcoholic,” meaning that “Once the disease progresses to the point where I become alcoholic, I do not stop being alcoholic; that is, I do not regain control. What that means in concrete and practical terms is simple: I cannot drink again, ever. If I do, I revert to drinking alcoholically; I will not be able to take it or leave it as other people do.” You characterize this as a “crippling message” which “promotes an understanding of human nature which is false & pernicious.”
According to you, the AA concept of powerlessness has been “empirically demonstrated to be false,” since “once an alcoholic, always an alcoholic” implies complete abstention and this is only “true in the minority of cases,” because “Most alcohol addicts, like most drug addicts, kick their addiction permanently, with or without treatment.” To support these claims, you cite your brother’s experience with marijuana. You also provide a link to an article1 about a study2 which presumably contains the empirical rebuttal of AA.
Like many arguments, yours arises from a confusion of terms. It rests on the ambiguity of the term “alcoholic” and its conflation with other, equally ambiguous terms, leading to a rather elastic interpretation of them. The AA concept of powerlessness over alcohol is narrow in its application. It refers only to a certain kind of drinker.
The paragraph from which you quote makes this clear:
“There are of course many understandings of what an alcoholic is, but in AA, an alcoholic is by definition a person who has no control over alcohol and therefore cannot drink normally or safely like other people.”
When AA (by which I mean the books Alcoholics Anonymous and The Twelve Steps and Twelve Traditions, which contain the AA program), talks about alcoholics, it is talking only about that kind of alcoholic. It is not talking about any other kind of drinker who others may call “alcoholic,” or ”alcohol dependent,” or “substance abuser,” or “addict,” or anything else.
These other categories didn’t exist when AA began to use and popularize the term “alcoholic.” Still, AA has always recognized the existence of a wide range of “problem” drinkers, to use what is perhaps the broadest category of all. It has also recognized that these may find a variety of other ways to stop or moderate their drinking. It has never claimed that its 12-Step program is for all of them. Nor has it ever tried to decide for anyone whether he or she is an alcoholic in the AA sense of powerless, which includes, but is not limited to, complete abstinence. It has always maintained that is a decision for each individual person to make.
The class of problem drinkers is huge. The class of those who may now be considered alcoholic, or dependent, or addicted, is also huge, and as we have suggested, elastic. It is a given, therefore, that the AA category of the powerless constitutes only a “minority” within it. But it is illogical to argue from the size of the category that the category is false. Ditto for the argument that most addicts kick their addiction permanently. That’s a category error. “Addict” is an even more—and steadily expanding—elastic term. AA is not talking about most “addicts,” whatever that means. It is only talking about a certain type of alcoholic.
The study which purportedly demonstrates AA’s concept of the powerless alcoholic to be false demonstrates no such thing. It is not about that type of alcoholic. It is about the category of “alcohol dependence” (“Recovery from DSM-IV Alcohol Dependence, 2001-2002”3). Again, this is a very elastic category. Its criteria for such dependence is an affirmative answer to three of seven questions asked a sample of the population. Its criteria for a related category of “alcohol abuse” is an affirmative answer to one of four questions.
Consider three of the questions for alcohol dependence4. “In the past year, have you”:
Many a “hard” or “problem” drinker can answer affirmatively to such questions. The same applies to any combination of those three and the other four.
Consider next one of the questions for alcohol abuse. “In the past year, have you”:
Again, many a hard or problem drinker can answer such a question affirmatively. Same with the other three questions.
The study and the questions it asks are no doubt useful and can help identify drinkers who may have a problem with alcohol and who may need help. Some of them may be alcoholics of the AA type or on their way to becoming so.5 Nevertheless, the study does not demonstrate that the AA concept of powerlessness over alcohol is false. Again, that concept applies only to a certain kind of alcoholic, and the study is about a much larger universe of drinkers.
Nor is the empirical value of such studies to be overestimated. Their type of research is not on a par with that which governs the hard sciences, nuclear physics, say. In fact, DSM-IV has been superseded by DSM-V, which drops the category of “alcohol dependence” completely and sets up new categories and new criteria.6
As for your brother’s experience with marijuana, one can only be grateful that he has quit, apparently without anybody’s help. He is very fortunate. But that has no bearing on AA’s understanding that some drinkers (not marijuana users) are powerless over alcohol (not over marijuana). It doesn’t proof it to be false.
Still, let me use your anecdote to shed more light on the concept of powerlessness as regards the alcoholic. You give details which seem to indicate your brother was truly addicted to marijuana. Yet he quit cold turkey. So have many apparently “addicted” alcoholics. Following one bad experience or another (we call it "hitting bottom"), they quit on their own, without any help. That would seem to prove that they are not powerless over alcohol. Yes, but only in the limited sense that they had enough control to stop that one time. In the AA understanding, however, if a person is not powerless over alcohol, she doesn’t have to stay stopped. She can resume drinking any time she wants, drink only as much as she wants, and stop any time she wants. She can routinely control her drinking. That’s power over her alcohol. Stopping and abstaining doesn’t prove power. Drinking like most people does.
Many of us powerless alcoholics have stopped and abstained numerous times, for weeks, months, even years. Then we pick up, and we are back on the rollercoaster. We can’t drink like everybody else. We are powerless over alcohol.
But, again, that’s only some of us. AA is not saying that applies to all who have a problem with alcohol. Nor does it claim its program offers them a solution. It doesn’t even claim to have the only solution for alcoholics of the powerless type. It welcomes any and all efforts to help.
You make three more points which call for clarification. In arguing that most “addicts” kick their addiction permanently with our without treatment, you add that “those who do it without 12-step do it with greater success.” However, the study in question only refers to the “Ever treated.” It doesn’t differentiate between 12-Step and other types of “treatment.”
You also allege that although 12-Step programs claim “higher rates of absolute abstinence,” they also show a “significantly higher relapse rate.” You’re comparing apples and oranges. In any case, there are no statistics in the study to support your allegations.
Finally, you attribute the supposedly higher rates of relapse to the “AA doctrine of powerlessness & permanent threefold disease.” AA nowhere refers to our threefold disease (physical, mental, spiritual) as being permanent. It clearly states that what it calls the “mental obsession” can be removed. To that extent we can recover from our alcoholism. However, we remain susceptible physiologically. We don’t recover from what it calls our “physical allergy.” That’s why we can’t drink safely. As for the spiritual aspect of the disease, that involves a continuing process of recovery.
As this suggests, the AA concept of powerlessness does not refer only to a mental or a physical problem. Indeed, it is fundamentally a spiritual concept. If our problem were only physical, medicine might solve it; if it were only mental, psychology. But because it is spiritual, we need a different kind of help. Because we are powerless over alcohol, we need the help of a Higher Power.
This view of powerlessness is not based on anecdotal evidence. It follows from long and bitter experience. It originates with the experience of one Rowland H., who tried everything to stop drinking—including psychiatry and religion—but could not. Though the Swiss psychiatrist Carl Jung had helped many alcoholics stop, he could not help this one. His only hope was a spiritual experience, he told him. He did have such an experience, and he did stop.
Jung’s diagnosis of our type of alcoholic was supported by another leading psychiatrist of the time, William James, who was also a philosopher. His Varieties of Religious Experience documented numerous cases of spiritual experiences which had radically transformed the lives of people afflicted with intractable disorders for which no other solution had been found, including alcoholics.
Jung and James are the two pillars on which AA’s concept of powerlessness rests. It is hardly a “crippling message.” This understanding of a certain kind of alcoholic has spawned a worldwide movement which has helped millions of previously hopeless men and women to recover from a terrible disease and build happy and productive lives. Millions more have been helped to recover from a variety of other destructive “addictions” as its 12 Steps have been adapted by other groups around the world. It has also inspired a broader movement of self-help and spirituality which has helped countless millions more who could not find help in established medical, religious, and governmental institutions. Indeed, AA’s message helped change the ways these institutions looked at alcoholics and addicts in general—including what is now the National Institute on Alcohol Abuse and Alcoholism.8
Accepting the concept of powerlessness doesn’t come easily to anyone. AA acknowledges that. “Every natural instinct cries out against the idea of personal powerlessness,” says one of our two basic texts.7 So yes, the idea is contrary to human nature. But it is not pernicious. What is pernicious in human nature is the thirst for power. It leads to what AA calls “playing God.” We alcoholics did that. It destroyed our lives. When we admit we’re powerless over alcohol and quit drinking, we also quit our addiction to power. It is then that God’s power can work in our lives. It is our first step toward liberation.
My thanks again for your comments, Henry.
For an extensive treatment of AA’s concept of powerlessness—which is what’s behind the saying “Once and alcoholic, always an alcoholic—see PTP123, Step One, Chapter C: Lack of Power: Our Dilemma; excerpts for sections titled Surrender and A Humble Admission can be found on this site under Step One on the menu). See also on this site: “I’m Ray, and I’m an Alcoholic,” in Reflections.
For original book review, please please click on "Back to Vice & Sin."