WHAT A.A. CAN OFFER PROFESSIONAL SCHOOLS AND WHAT IT CANNOT

John Norris

Hanover, N . H . Dartmouth College Medical School

It has been my privilege to be a member of the Board of Trustees of Alcoholics Anonymous for many years and, for the past several years, its chairman, so I can speak with knowledge about what AA can offer professional schools and what it can't. Incidentally, I am not an alcoholic and, therefore, cannot be a member of A.A. The initiation fee in suffering is much too high for me.

A.A. has been a most significant factor in the alcoholism picture for more than 30 years. It is increasing in significance as public interest in alcoholism and the willingness to talk about it in our society increases. A.A. is increasingly important also as the numbers of people who find their way out of the squirrel cage that is alcoholism into A.A. increases. By definition, no one can know this number; the stigma associated with this illness and the absence of generally accepted diagnostic criteria make statistical surveys difficult. We have no A.A. statistics with which we can feel comfortable. We have felt the need for something more than the guesses the alcoholism literature has employed. We know with reasonable certainty the number of groups in this country and around the world. An article in the Decem- ber, 1969, issue of the International Journal of Addictions reviews these data in some detail; however, groups vary widely in size, and we need more specific data about people. In the summer of 1968, Alcoholics Anonymous conducted a broad survey of

A.A. activities in the 50 states of the United States and in the nine provinces of Canada. The study was made under the supervision of competent research tech- nicians and covered more than 11,000 alcoholics who attended 466 A.A. meet- ings, about five percent of the groups on this continent. The results of this have been published in pamphlet form. People in attendance at meetings were asked to fill out a questionnaire at the meeting. These were distributed within a brief period of time, and it was requested that no one fill out a second questionnaire in the event that he happened to be attending more than one meeting where the questionnaires were distributed. We believe that there are few, if any, duplicates. There may have been some persons in attendance who did not wish to fill out a questionnaire. There was no attempt made to promote attendance or reach any of those who were less active at the moment than they had been in previous months or years. The ratio of men to women was three to one. Seven percent were under 30 years of age, 57 percent between 30 and 49. Twelve percent had been abstinent for ten or more years, a significant figure! Thirty-three percent had been abstinent for more than five years, and 33 percent had been sober from one to five years.

A.A. had its beginnings only 35 years ago in the almost chance meeting of two men. They had been given up as hopeless drunks by their families, friends, business associates, and physicians. A.A. has no promotion or financial support from any person or organization except its own membership; h e amount any one member may contribute is limited to $100 per year (this has recently been raised to $200) ; considering these limitations the growth and effectiveness of this

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62 Annals New York Academy of Sciences fellowship has been phenomenal. We-as professionals and scientists-must ob- serve and try to understand and work with this movement, which has returned to happy and constructive lives so many alcoholics whom we of the helping profes- sions have thought hopeless. It is only as we push our preconceived notions into the background, discard our biases, and look at this movement as students that we can be really effective in referring people who come to us in trouble with alcohol. After we have carried out our primary function of diagnosis and detoxi- fication and begin restoration of the physical body, we make our referrals to A.A. You may &k why we should refer our alcoholic patients to laymen or an organiza- tion made up of nonprofessionals. In the first place, we of the medical profession have not been outstandingly successful in helping these people meet their prob- lems. Many, if not most of us, have refused to care for them. This picture is changing slowly, but often those physicians who will accept alcoholic patients are frustrated at the repetition of episodes of acute poisoning and the failure of these people to follow instructions in other ways. It is encouraging that most physicians are at least recognizing alcohol as a factor in other medical conditions as well. From several sources recently, I have heard it stated that from 30 to 50 percent of admissions into the general medical wards of our hospitals are alcohol-related. I have also learned recently that in two hospitals in New York State alone, house staff and medical students have asked for training in alcoholism. As earlier papers in this monograph have pointed out, almost nothing has been given in our medical training about alcohol or alcoholism.

In addition, the close follow-up frequently needed to meet the emotional and personal needs of the alcoholic is more wearying and timeconsuming than most practicing physicians can tolerate. A carefully selected A.A. member will gladly meet and talk with any alcoholic whom we have persuaded to accept such a meeting. In most instances this will result in some contact with an A.A. group and bring the patient into active membership. In addition to saving a physician’s time, A.A. membership is usually cffective in keeping these people happily sober. I use the word “happily” advisedly. Our advice to stop drinking or not to drink so much is impossible for the alcoholic to follow for any length of time and rarely leads to happy sobriety. Unless it is happy sobriety it is likely not to last.

What can A.A. offer to professional schools, and what can we in the profession not expect from the organization or its members? First, it offers the opportunity to become acquainted with people from all levels of society who are recovering from alcoholism. In almost every large community in North America there is a central A.A. office-usually called an Intergroup. Intergroups are always listed in the telephone directory under Alcoholics Anonymous and are usually manned by an A.A. member. Calls for help are received, and members throughout the area who can most conveniently answer the call in person are alerted. Individual members of A.A. are always willing to talk with a patient in the hospital, at home, in a jail, or wherever he happens to be, when a physician, social worker, or clergy- man has persuaded the patient to meet someone who has found his way out of difficulty with alcohol. If they select a member of A.A. who has similar interests, background, or experiences with alcohol, acceptance by the patient is made easier. The better we know A.A. members, the more able we are to select the right one to sponsor our present candidates.

Some of the groups have Institution Committees whose members support and promote groups in hospitals, including mental hospitals and tuberculosis hospi- tals. Intergroup can provide a contact or group in the home town for a patient

Norris: What A.A. Can and Cannot Do 63 being discharged from a hospital that may be some distance from his home, forming a bridge back to normal living. Intergroups also know of A.A. members in their area who are willing to speak to groups of professional people, students in professional schools, or any other group wishing to know more about Alcoholics Anonymous. They can arrange for professionals to attend “open” A.A. meetings.

A second way in which A.A. can help professional schools is through making available at a national level a variety of literature, including personal histories of A.A. members, details of the A.A. program and how it works, and pamphlets for special audiences. By writing to Post Office Box 459, New York, N.Y. 10017, anyone can get a list of available book and pamphlet literature. This is also avail- able through many local Intergroup offices, and at individual’ A.A. meetings.

A.A. members make excellent, well-motivated candidates for alcoholism-coun- seling schools. But, like anyone else who is asked to do a professional job, they require a period of special training. In many places on this continent, A.A. members are serving as full-time counselors in industries, clinics, courts, or other special facilities for alcoholics. Sometimes this has worked very well; at other times it has been disappointing. Perhaps I’m prejudiced in A.A.’s favor, but in many instances misunderstanding has developed when the A.A. member was not carefully enough selected or given enough training and direction in what he could do and under what circumstances he should ask for help and why. If all the A.A. member has to offer is the experience of years of trouble with alcohol and a few months of membership with A.A., the results may be unfortunate for all con- cerned.

What is A.A. not equipped to do for professional schools? A.A. does not furnish initial motivation except by the attraction of example. It does not solicit members or try to persuade anyone to join. A.A. does not keep membership records or case histories, except in so far as some of these have been included in the books and pamphlets and the monthly periodicals, and this is always, of course, with the permission of the person who tells his story. A.A. does not follow up or try to control its members at the public level. It does not make medical or psychiatric diagnoses or prognoses; it does not provide drying-out or nursing services, drugs, medical, or psychological treatment of any kind except as the meetings-both open and closed-meet many psychological needs. It does not offer spiritual or religious services, except as friendship given without stint or thought of reward is a spiritual service. It does not engage in or sponsor research or propaganda about alcohol. It does not join councils of social agencies or provide housing, food, clothing, jobs, money, or other welfare or social services, including domestic or vocational counseling. However, many A.A. members participate in some or all of these activities as individuals-with, it is to be hoped, some expertise. Also, A.A. does not accept money for its services or any contributions from non-A.A. sources. A.A. members maintain personal anonymity as members in relation to the press, film, and broadcast media. Many of these restrictions, spelled out in the tradition, developed out of sad experiences of earlier times in A.A. when trouble developed- usually another episode of drinking on the part of those involved. In some national magazines in the recent past, articles have appeared that have gone into some detail on this point. A.A. members aren’t all perfect, either. As a society, A.A. is somewhat unique in its structure and activity. There are none of the controls that exist in the business corporation; for instance, A.A. is a fellowship, a society of peers or equals. Each one is entitled to an equal voice in all of the

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&airs of the local groups or of the state or national unit. Therefore the occasional uninformed or overzealous member whom you may encounter does not neces- sarily represent responsible groups or A.A. as a whole. I ask your patience with and understanding of these people.

I am Chairman of the Board of Trustees of the General Service Board of A.A., but this does not give me authority to speak for A.A. as a whole. I cannot refuse membership to anyone, I cannot ask one who considers himself or herself a member to resign, deny anyone an office or the opportunity to state an opinion. In the fellowship any member is entitled to express himself on any phase of the program, but in doing so he commits no one else to his point of view. What I have given here is one man’s opinion-mine-based on my o m experience and what I have learned from the experience of others. This has been a process near enough in time to have been observable in a lifetime. We can trace the evolution from the first face-to-face confrontation of one alcoholic with another, nearly 35 years ago, through the formulation of the Twelve Steps by the first hundred or so members, to the traditions developed out of the stresses and strains of groups learning to live and work together. The formation of the General Service Board, the Trustees, the General Service Conference, and the General Service Office here in New York followed soon after. Two more things I would like to mention briefly: the tradition of self-support and the tradition of anonymity. It has been a most unusual experience for me to be a part of a Board of Trustees that refuses to accept legacies, some of them in five figures. A couple of years ago we were threatened with suits for refusing a legacy. Is this important in the recovery process? I think it is. One of the failings of the drinking alcoholic is his refusal to take any responsibility for his actions, especially where money is concerned. Until he accepts this responsibility, his recovery is limited. Members should accept the financial responsibility for the whole, in my judgment. And this is in addition to the fact that property and its maintenance could become an intolerable burden, requiring compromise at times.

The tradition of anonymity is a little more complicated, and it has two aspects. Most drinking alcoholics have persuaded themselves that nobody knows they are in trouble with alcohol. This is hard to believe, but in my experience it is almost universally true. The moralistic nature of the stigma of alcoholism makes them want to hide their problem. The realization that tpeir membership will not be divulged by anyone except themselves removes a major hurdle in their becoming a part of it. At least as important, in my opinion, is that this prevents the power- hungry, the publicity seekers, from using their membership in A.A. for personal aggrandizement. It avoids destructive competition between its members and forces us to put principles before personalities. One does things not for credit but because the job needs doing. Talking with people presently in trouble and, as they say in A.A., “sharing their experience, strength, and hope” is seen as a privilege and a necessary part of one’s own continued sobriety. For this no credit is due; it’s a privilege. One of the most effective speakers in A.A. and one of the most able people in keeping an audience with him all the time pokes a bit of fun at himself in this connection. He says he will drive 500 miles to lead a silent prayer but won’t walk across the street to go to a meeting to hear someone else talk. There is a lot of that kind of psychotherapy-deep psychotherapy-throughout the A.A. pro- gram. I hope that each of you will take an objective look at Alcoholics Anonymous and learn how you can help it grow in strength and usefulness. Go to meetings. You will be welcome at open meetings, and I hope that you will help in the train-

Norris: What A.A. Can and Cannot Do 65 ing of A.A. members so that they may work effectively as counselors in clinics and hospitals. Guide young professionals in training to know how to work with groups and members in their home towns. We must work together to alleviate or prevent many of the tragedies associated with the irresponsible use or abuse of the beverage alcohol.