The Premier 12-Step Program Has a Killer Drug Problem

by M.T. May 9,  2001

Members wore masks: To protect their anonymity, members of the Dayton, Ohio, AA Chapter donned masks while posing for the press in 1942.
photo: © Bob Doty/courtesy of Dayton Daily News

I came into Alcoholics Anonymous 15 years ago. I was always made to feel that I was not allowed to share about my drug addictions. There was an AA old-timer who would rap on the table to stop the sharing about drugs. So I shared as an alcoholic and didn't identify as an addict anymore. I was about nine years sober when I started relapsing. I did everything I could get my hands on . . . prescription drugs, alcohol, speed, coke, and downers. My drug use took me to depths I didn't know existed. I could have died. —Angela F.

For 66 years, AA has been the refuge of last resort for millions of desperate alcoholics who have hit bottom. AA has always been free for the taking, and as testament to its revolutionary Twelve Steps, its program has been successfully adapted over the years to over 40 12-step fellowships. But throughout AA's 66 years runs a history of mistreatment of non-alcoholic addicts and dually addicted alcoholics that is not in keeping with AA's own criteria for membership and the spiritual principles the program espouses.

Built into AA's Twelve Traditions, which are the spiritual guidelines for all AA groups, is a flaw, born of the limitations of its time. AA's Fifth Tradition dictates that each group's primary purpose is to help the "alcoholic who still suffers." Many groups follow this literally, not allowing dually addicted addicts to openly share (talk) about their drug use without relating it to alcohol. As a sign at a Boston meeting says: "We only talk about Alcohol here!"

Late last month, at AA's 51st annual General Service Conference held in New York City, the "issue of people sharing about problems other than alcohol" was at the top of the agenda. The Conference took action to emphasize in its literature to health care professionals (from whom AA estimates it gets 40 percent of its referrals) AA's primary problem: people coming in with addictions other than alcohol. As a General Service Office staffer speculated after the delegates departed, "A lot of groups . . . are at their wits' end about what to do about this issue. There are those who say if you keep letting these guys in here, AA is going to pot."

Recently, at a meeting I attended in Wilmington, North Carolina, a man—a regular at that meeting—raised his hand. He said he needed to share about problems he was having with a prescription narcotic he was taking for an injury. It had been stated at the start of that meeting (as it is at meetings throughout the country): "In keeping with our primary purpose, please limit your sharing to your problems with alcohol." The man was immediately interrupted by the leader and told he could not "share about drugs," and someone else was called on. He wasn't the only person in the room that night having an issue with prescription drugs, but after what happened to him, I decided to suffer in silence. (I had tried to find a Narcotics Anonymous meeting, but they weren't listed in the phone book or with the local police.)

This phenomenon is not exclusive to so-called backwaters of addiction enlightenment. For more than two years, I regularly attended a liberal AA meeting that caters to the Hollywood writing community. I was yelled at in the meeting when I shared about plans to do this piece, and was reminded that it was an AA meeting—"addicts" didn't really have any business there.

The irony is that people talk about everything in AA—all the ugliness and degradation that comes with the abyss of alcoholism and the struggles of living sober. As one member put it: "You can talk about wanting to kill your mother, but you wouldn't want to offend anyone by talking about marijuana!"

"Pure" Alcohol

Why are we insisting that people not talk about drugs if it's part of their problem?   It's mass denial in AA, and it's faulty thinking.   Most people in AA are dually addicted.   Alcohol was just a symptom—it's a recovery program, for Christ's sake!—M.M., "pure" alcoholic, 22 years sober in AA

The policy that "The only requirement for membership is a desire to stop drinking," which is stated in AA's Third Tradition, has wounded AA. Nothing demonstrates this as clearly as the organization's declining membership.

In 1939, cofounder Bill W. boasted in the AA bible, Alcoholics Anonymous (a.k.a. "The Big Book"), that "AA's membership is growing at the rate of 20% a year." According to the General Service Office, there has been no membership growth in AA for over 10 years, while Narcotics Anonymous (NA) has grown, and AA's most recent count indicates that membership is declining. Asked about this, a GSO spokesperson said, "AA's primary purpose is not changing, and it's not going to change. . . . We adhere to our historical and spiritual history. We will not adjust for fear of not being here."

Bill W. could not have known in 1935 that alcoholism and drug addiction are the same disease. To say someone suffers from alcoholism is like saying someone suffers from heroin-ism, cocaine-ism, or marijuana-ism. Alcoholism is not a disease separate from addiction. Says Dr. Milton Birnbaum, director of addiction medicine at STEPS and a member of the American Society of Addiction Medicine, "Alcohol is a drug. The basic behavior characteristics are the same for alcoholics and those addicted to other drugs. It's the same disease. There is no difference." In 1989 the American Medical Society on Alcohol and Other Drug Dependencies changed its name to the American Society of Addiction Medicine for this very reason (though AA still uses its oldest name, from the 1970s—the American Medical Society on Alcoholism—in one of its current pamphlets).

Bill W. himself emphasized that AA should seek guidance from the medical community. So why ignore the virtually unanimous research? "We don't get into a drug is a drug is a drug," AA's GSO spokesperson told me. "It's not in keeping with our primary purpose." When I cited Dr. Birnbaum's opinion that addiction covers alcoholism as well as other drugs, she replied, "Well, maybe it does in his field of work, but not in Alcoholics Anonymous."

Still, what's the point of attacking AA? After all, addicts who aren't comfortable in one AA meeting can find another one, or go to NA.

But AA's blind spot on the subject of addiction does matter. AA meetings outnumber NA meeting (the next largest 12-step fellowship) three to one. AA estimates that it has about 100,000 meetings worldwide and a membership of about two million, compared to NA's estimated 28,000 meetings and 500,000 membership.

Many areas outside of major U.S. cities have only AA, and even in areas that have NA, most addicts will end up in an AA meeting by default. In the court system, for example, what fellowship to mandate for drug and alcohol offenders is left to a judge's discretion. AA gets, by far, the most referrals. "Older judges are still sending addicted persons to AA," noted the spokesperson for the NA World Service Office. "It's got better credibility, for lack of a better word. And for many judges, AA is all they know."

Take what happened to Los Angeles addict Bruce M. "When I was arrested for driving under the influence," he explains, "the judge gave me a choice: 100 days in jail or 100 AA meetings. No one ever asked me if it was alcohol I was under the influence of. In fact, I was high on a number of drugs."

What's more, an addict's first meeting is crucial. It's hard enough for newcomers—ashamed and destroyed by drugs—just to walk in. Nor are they well equipped to judge whether they're getting what they need. A bad experience can result in a relapse. And a person's next high on drugs can always be the last.

"When I walked into my first meeting, that was all I could do," said Bobbi, who has 12 and a half years in AA. "People pulled me in and made me a part of the meeting. I saw other people who were told not to share as addicts. It turned them off, and they said they would never come back. So many people. Some I've seen at meetings of Cocaine Anonymous or Narcotics Anonymous. The ones I haven't seen again, I don't know what happened to them. If I had been treated that way, I would not have come back, and I would be dead now."

For a long time AA was all male, virtually all white, mostly Protestant, mostly middle-class, and all "pure" alcoholics. And drug addiction wasn't the only blind spot. AA historically discriminated against African Americans (who were only allowed in as visitors until the mid 1940s, and then were encouraged to start their own meetings) and women.

The AA book Pass It On notes that "even Dr. Bob [an AA cofounder] had expressed uneasiness about admitting women to AA membership when the first few appeared." Alcoholics Anonymous is still gender-specific to men throughout (despite social changes over the last 50 years, purists refuse to alter even one word Bill wrote). The only chapter for women is titled "To Wives."

Women have made some strides in AA since Dr. Bob, but the fellowship's racial demographics continue to reflect its racist origins. As of a 1998 AA survey, an estimated 34 percent of members were women, and AA was 88 percent white.

But what has never evolved is AA's blind spot with drugs.

Bill Turns On

If Bill had found drugs, he'd have done them, and AA would be a different place today. - K.W.

Bill W. did find drugs. He took LSD in 1956, and did so regularly for at least two years. Pass It On recounts that "he was enthusiastic about his experience." There are old AA rumors that Bill did this in an attempt to ease his chronic depression or to test it as a possible cure for alcoholism (which at first some scientists thought it might be). In fact, Bill W. took LSD for the same reasons many hippies later did. He happily turned on non-alcoholic friends and his non-alcoholic wife: "I have felt free to give it to Lois, and she had a most pleasing and beneficial experience. It was not the full dose, and I expect shortly to try that on her. Though she doesn't necessarily connect it with the LSD, there is no doubt she is undergoing a very great general improvement since even this mild administration."

Other AA members were less than thrilled with Bill W.'s experimentation, but like him, they continued to see alcohol and drug use as unrelated. They never thought he lost his 22 years of sobriety and neither did he.

"In AA you could say, 'I shot dope today,' " commented Terry R., founder of Narcotics Anonymous in New York, "and they'd say, 'But you didn't drink!' "

According to AA's GSO, "There is only one definition of sobriety" in AA, and it's the one Bill W. gave in the 1958 AA pamphlet, "Problems Other Than Alcohol." It reads simply: "Sobriety—freedom from alcohol." And the program is limited by it, since AA cannot tell anyone they are not sober if they use drugs, although AA members generally may believe otherwise. An AA spokesperson told me, "It's an outside issue. They are free to decide if they're sober or not. We talk about drinking. That's it."

The main reason given for talking only about alcohol is "identification," a concept argued forcefully by C.I. With 42 years of sobriety, C.I. is a powerful AA figure in the mold of Bill W. He founded in L.A. what may be the single largest AA group in the world, boasting 1200 members, with a reputation for sobering up the lowest of low-bottom drunks.

Says C.I., "Since AA is based so much on identification rather than information, it is imperative that alcoholics talk about their experiences" and that alcoholic-addicts should "glide over their drugs" when they share. For more than 27 years, he has worked with skid-row addicts, and says, "I still get no empathy from hearing a guy who talks about shooting up drugs. I understand it intellectually, but when a guy gets up and talks about why he drank and what drinking did for him, that brings an empathetic bond."

But what of the alcoholic who shared in a meeting that he "shot whiskey and drank morphine." Would C.I. identify with him?

The basic thing we all have in common is not how we used drugs or whether they came in a glass or a needle; it's the similar behaviors we manifest and the feelings that motivate them: the isolating, lying, denial, and unmanageability. It's the mental and physical cravings, obsessions, and compulsions—and these cross substance lines.

Otherwise, how could a wealthy wine connoisseur identify with a beer-drinking truck driver? Or a movie mogul who snorts cocaine relate to low-income crack users who prostituted themselves? As one addict accurately noted, "The disease doesn't care if you're from Park Avenue or a park bench—and it also doesn't care if you drank it, shot it, snorted it, or smoked it."

In NA, they prove daily that alcohol addicts, heroin addicts, cocaine addicts, and others can identify with each other and recover together. They urge everyone to identify as an "addict," regardless of their drug of choice, and they stress listening for similarities instead of differences since "Our stories may be different, but the feelings are the same." And what they find—what we all have in common—is the experience, as Bill W. most aptly described it in "The Big Book," of "incomprehensible demoralization," which is where all our addictions take us regardless of drug of choice.

Smoke and Mirrors

I'd like to see who would be left if you took all the addicts out of AA - just crotchety old men smoking cigarettes and drinking coffee, and no newcomers! —K.W.

In 1983, 31 percent of AA respondents said they were also drug addicts. By 1989 it was 42 percent. After that, the General Service Office stopped asking. Said a GSO spokesperson, "We don't ask that question anymore. It's not in keeping with our singleness of purpose." Another GSO spokesperson said, "Finding out how many addicts are in AA serves no purpose to serving the alcoholic."

Talk about needing a reality check: A 1998 federal study found that just 26 percent of clients in treatment for substance abuse related only to alcohol. When the Betty Ford Foundation opened in 1982, 72 percent of its clientele named alcohol as their sole drug of choice. Today it's 10 percent. The same trend is reflected across the country, from Gracie Square Hospital's detox on Manhattan's Upper East Side to the C.L.A.R.E. Foundation in West Los Angeles, which serves 90,000 people a year—90 percent of whom, according to a spokesperson, are dually addicted.

As Terry R. puts it, "AA is like the King's English. It may be the purest form, but it's not what the majority of people are speaking."

A section of Chapter 5 from "The Big Book," which is commonly read at the beginning of every meeting, says, "Some of us have tried to hold onto our old ideas and the result was nil until we let go absolutely." Bill W. is referring to the change in thinking necessary to recover, but the principle applies to the program itself.

Following the recent move at the New York conference, the GSO staffer attempted to focus the issue: "Sharing about drugs—that's a problem. AA is looking for some way to solve this problem." Though how they'll ever do this by censoring the majority of their members is a bigger problem.

In addition to AA's self-inflicted wounds, the fact that many addicts are now finding homes elsewhere is limiting the program's growth. Given these developments, NA may well be in the 21st century what AA was in the 20th.

© Village Voice

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