Demystifying Alcoholics Anonymous, a chapter at a time

It has existed for more than 80 years, and it now serves an estimated 2 million members. More than 60,000 groups meet under its banner across the U.S. each week, and nearly 60,000 more meet overseas.

And yet, for as familiar as the phrase “Alcoholics Anonymous” is in the public lexicon, the fellowship remains surprisingly misunderstood—both by the general population and even addiction treatment professionals.

Marc Galanter, MD, professor of psychiatry and director of the Division of Alcoholism and Drug Abuse at the New York University School of Medicine, is hoping to change that with his latest book, appropriately titled What is Alcoholics Anonymous? (Oxford University Press).

“In many respects, AA is underutilized by the medical community because they understand surprisingly little about it, particularly even specialists in addiction psychiatry and addiction medicine,” says Galanter, who is past president of the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry. “I thought it was important to provide them a resource to explain origins of AA and how it works.

“But in looking into it further, it was apparent to me there is no such resource for the general public as well. It’s hard to write a book suitable for both audiences because their backgrounds may differ. But the fact of the matter is AA is not understood well at all by people who are not in the fellowship—whether they are professionals or laypeople, so an introduction for either group would be valuable.”

To help readers understand what they can anticipate about AA for a particular addicted person in their lives—whether it’s a patient for a clinician or a family member’s loved one—Galanter takes them into the workings of AA through those who have experienced it firsthand. The book systemically addresses the disease of addiction, the rise of Alcoholics Anonymous, how it operates and its place in medicine, as well as its outcomes, and alternative and complementary programs for those battling substance abuse to pursue.

The book also aims to clear up common misperceptions about AA. For starters, AA and the 12 Steps its members work through have been written off by some in the addiction field, Galanter says, because AA was started by two individuals struggling to achieve stable abstinence rather than from a base of research.

“It’s very hard to do research on AA,” Galanter acknowledges, “but there are a lot of studies now showing any encounter with AA on the part of a patient is associated with a better outcome and that people can do well in AA even if they had no preference for it beforehand. It’s really now supported on the basis of a lot of clinical evidence, research and experience of clinicians.”

Another common misconception—one perpetuated by Hollywood stereotypes, Galanter adds—is that all individuals who attend AA meetings have been going for many years, continue to go frequently and remain extremely committed. While it’s true that half of those attending AA meetings today have been sober for more than five years, Galanter says the AA meeting experience varies by attendees. Many attend for a short time, become abstinent from alcohol and can remain so long after they stop attending.

As part of his research process for writing the book, Galanter attended several AA meetings and recommends those in the addiction field do the same so that they can become familiar with the fellowship and develop a more personal understanding of how it benefits those who attend meetings and work the 12 Steps.

“What (addiction treatment professionals) do is underestimate the importance of discussing the nature of the experience with their patient or client, and talking about what the patient thinks about the experience, what they feel when they first encounter it and issues that may come up over time,” he says. “This is very important for professionals to understand and to be able to exchange with the patient on that.”

Since the book was published in late May, Galanter says the feedback he has received has been appreciative and he hopes that it continues to serve as a helpful resource for those both in the addiction treatment field and the general public.

“I’m pretty optimistic that it’s going to be useful not only for clinicians and members of the general public, but also to students in training programs for counselors, psychologists or physicians who are going to deal with addicted people,” he says.

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Experiencing AA:
A firsthand account

Understanding the experience of attending Alcoholics Anonymous meetings and the impact they can have is an important part of how addiction treatment professionals can build rapport with patients.

In the following excerpt from What is Alcoholics Anonymous?, Marc Galanter shares the story of how an interview subject began going to AA meetings and how her relationship with AA evolved over time. Ann, the interview subject, had fallen into a two-year pattern of drinking and behaviors she regretted leading up to the following:

She looked up a nearby AA meeting, and describes here what she had said to herself at the time:

“I think I’m going to an AA meeting tonight because they’re the right people to tell me. And you know what, if they’re not, then I’m going off the roof when I get home tonight.” My biggest fear was, What if I’m not [an alcoholic]? What if I’m totally crazy? What if I walked in there and they said no, you’re not an alcoholic, you’re just nuts? It was my last hope, because I knew I could not go on living the way I was. I was so full of self-hatred and fear. I didn’t know what this monster was that was living inside of me, and I really thought I was insane. At the AA meeting that night, I had a little Styrofoam cup and I remember tearing it to shreds, little itty bitty pieces and shaking, shaking, shaking, partly from withdrawal. I remember people saying, “Just come back; you’re in the right place.”

Ann did come back, and when she told me this, she had been in AA for some twenty years. She initially went to meetings almost daily, and now goes every week or so.

Excerpt courtesy of Oxford University Press

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Tom Valentino is Senior Editor for Addiction Professional.