The alarming rise in alcoholism has not received the publicity it deserves, and there are no signs of the urgent action that the figures demand. While doctors can claim no more than a four per cent recovery rate and clerics are more concerned with saving souls, Alcoholics Anonymous claims that only a quarter of those who apply to it for help fail to stop drinking. Why is it that only about one per cent of the country's alcoholics do get help from Alcoholics Anonymous? R. L. Wild analyses the organisation and concludes that it would help more if it stopped preaching.


THE LATEST REPORT of the National Council On Alcoholics, revealing an appalling rise in drunkenness, has suffered the fate of its predecessors — almost complete lack of press notice, a notable exception being the Morning Star. Its figures differ little from those of the Home Office report showing an increase in alcohol-related offences from 70,499 in 1966 to 90,198 in 1973, an increase of twenty-eight per cent. More alarming is the thirty-nine per cent increase in drunkenness among adolescents. Although alcoholism is gradually becoming accented as a disease, few deviations from `normal' behaviour have had such nonsense talked about it. Its definition, aetiology, symptoms, signs, diagnosis, treatment and prognosis bewilder students. Many psychiatrists still refuse to classify it as a disease. Journalists do not find it newsworthy.
    It is estimated that there are some 800,000 alcoholics in the UK. The World Health Organisation say that at least five times that number are in some way affected. Yet still drunkenness increases and society talks. Committees are formed, antediluvian bodies in whom rigor mortis has crept. Much learned discussion on The Philosophy and Evaluation of an Alcohol Programme ensues amid cigar and brandy fumes and such gems as Alcohol and Oral Passivity. Treatises, pamphlets and books spew from presses on the Enzyme Activities and Ethanol Preference in Mice and Sympathomimetic Effects of Acetaldehyde on the Electrical and Contractile Characteristic of Isolated Left Atria of Guinea Pigs. Neil Panton, MRCS, LRCP, has concluded that `the onset of alcoholism must commence with the consumption of alcohol'. Doubtful. In my humble opinion science will eventually cure the disease, foresee and forestall its onset. Before a drop of alcohol has passed the potential patient's lips.


Help — if you apply
    It would seem that, like political economy, the matter is now too urgent to be left to professionals and academics. Why have we achieved so little in this advanced technological and scientific age? The medical profession can claim no more than a four per cent recovery while clerics are more concerned with sending sober souls to heaven. The law can, does, stop drinking to excess. By locking up the ‘offender’.
    Yet there is an organisation boasting of a high success rate. Alcoholics Anonymous. It claims that of those who apply to it for help half stop drinking immediately, a quarter ultimately and a quarter never. Obviously the vast majority of the alcoholics population does not apply. AA faults the press, with certain justification. A few articles have appeared over the years in more or less specialised periodicals. Griffith Edwards in New Society, myself in Occupational Health, a few others. In the popular press Renee McColl on Brendan Behan in the Daily Express some years ago, others on Dylan Thomas. Recently, because of the filming of The Great Gatsby many have jumped on the Fitzgerald bandwagon. Presently, one of the greatest, practising alcoholic writers since Jack London (if not for all time) Malcolm Lowry, is making news.
    The US has given alcoholism and AA more publicity. Six years after the fellowship's inception, in 1941, Jack Alexander published his ‘famous’, breakthrough article in the old Saturday Evening Post. Membership jumped from a little over 1,000 to 8,000. Since then Readers' Digest and other large-circulation media have run pro-AA features. Quite recently Time made Alcoholism its cover story. Membership of AA in the USA is said to be 350,000. The alcoholic population is not to hand. It is however considered to be a far greater problem there than in the UK.
    The latest statistics on the economics of alcoholism show that in lost work, medical expenses and road accidents the cost is running at £10.000 million a year, a rise of two-thirds in three years. One in seven high school students admits to getting drunk at least once a week. In passing, there now appears to be strong evidence that a combination of heavy smoking and drinking increases the risk of mouth and throat cancer. If it can be assumed that there are at least four to five million sufferers in the States, the AA's membership of 350,000 after thirty-nine years hardly dents the surface.


One member too many
    An unacceptable face of our own economics is enlightening. In 1967 £25 million was spent on advertising alcohol in the UK. The National Council an Alcoholism struggled through 1973 on £43,000. There are 600 AA groups in the UK with a total membership of, at the most, 8,000 members. A mere one per cent of the estimated population of practising alcoholics. Why is it that such transparent success in methods of recovery has not produced a more impressive figure? Because AA has one member too many. God!
    If it be true that only a recovered alcoholic can help one still suffering and that ‘the only qualification for membership is an honest desire to stop drinking’, unless God has a drinking problem ... and if he existed I would feel he had . . . he is neither qualified for membership nor for helping the alcoholic. Despite those members who say, ‘We are not a God-thumping society’, God is too much with it. Seven times too much. All kinds of semantic acrobatics are employed to soothe the incoming unbeliever. He is welcomed. But in a faintly patronising way and with the smug assumption that as sobriety progresses he will come to God. To ‘God as we understand him’ initially, to the one, true and only God of the Christians ultimately. Many veteran members make no bones about being ‘sorry’ for the recovered alcoholic whose intellectualism resists, first the insidious approach, then the direct onslaught. It is made patently obvious that the highest quality of sobriety is impossible to maintain without God's help.
    Behind the persistent religious undertone contaminating AA is the fact that the two co-founders attributed their ability to stay sober to the Oxford Group, now the Moral Re-armament Association. Both, if not agnostic, had been disillusioned by the God to whom they had pleaded in vain over the years of deterioration. Now it seemed they had been ‘cured’ by a miracle. Nevertheless, having found a therapeutic approach to their problem, quickly realising that to keep sober they had to extend the therapy to those still suffering, the futility of pushing God made itself apparent to the over-zealous evangelists. The sanctimonious ‘purity’ of the Oxford Group failed to produce a single extra recovered alcoholic by the end of the first year. After much heart-searching the conclusion was reached that God was no better at sobering up with the Oxford Group than without it. Yet they could not bring themselves to declare God redundant. It was easier to break with the Oxford Group and enrol with the embryonic AA.
    And there he continued to repel rather than attract. In typical alcoholic fashion all kinds of excuses were made, all kinds of early restrictions were eased. The rockbottom was raised, ‘peculiarities’ were admitted. In spite of the attitudes of new applicants, who wanted sobriety without or at least before God, the founding fathers could not bring themselves to dispense with him. But unless AA, so transparently close to the answer, was going to abort, something had to be done urgently. It was. God was taken out of the front line, heavily camouflaged, positioned well to the rear. To be brought forward when it was thought necessary.
    God was soft-pedalled for the initiate. The most fervent are advised not to introduce him on twelfth-step jobs or at meetings where a new, or relatively new, member is shaking himself into sobriety. As was, and still is, hoped, many who had deserted or felt deserted by God, ‘having come to believe that a Power greater than ourselves can restore us to sanity, having had a spiritual awakening as a result of these steps, made a decision to turn our will and our lives over to the care of God as we understand Him’. Many, unwilling to accept biblical and theological contradictions, but being egged on to feel that serenity is impossible to attain without a higher power, resort to belief in a yet more mysterious ‘God as we understand Him’. Truly is God created in man's image; often a concoction of C.S. Lewis, Dr. Weatherhead, Jung and a gas stove.
    This attitude is nothing less than emotional blackmail. It is now widely accepted that the alcoholic is emotionally immature. When he comes to AA he is usually morally, mentally and physically bankrupt and has probably spent much of his adulthood dedicated to the long suicide, desiring death, fearing death. Then it happens. The miracle. Believe in a Higher Power? What a small price to pay for serenity. He would practise yoga on burning coals if told that this must, or should, be done to achieve and maintain contented sobriety.
    The twelve suggested steps to recovery mention God seven times. Five by name, two by pronoun. It must be emphasised that they are not commandments. So the unbeliever who has arrived at his Humanism by scientific reasoning can take or leave what he needs of the programme. This however is not the case with a number of alcoholics. They have not killed God off so much as discarded him or crossed the floor in Faustian manner. Even those who had killed him find little difficulty in resuscitating him. The means justify the end. Better a sober God-server than a drunken atheist. An argument not easy to refute. But who can say that Malcolm Lowry with Under the Volcano has not contributed more to society than a thousand bovinely contented ex-boozers?
    The goal for the recovering alcoholic is contented sobriety as opposed to the misery of merely going ‘on the wagon’. A goal that remains far from reach without simultaneously striving for emotional maturity and moral integrity — all of which are virtually impossible without rigid self-honesty. ‘Honesty’ and ‘open-mindedness’ are constant subjects. The AA open-minded are the kith and kin of the Christian open-minded. The doubter should keep his mind open until he arrives at the believing state of mind. When it is not only permissible, but imperative, to close it. Tightly.
    But the sincere unbeliever finds the programme dishonest. The attempt is to nurse him through from disbelief to agnosticism on to belief in the supernatural. When a degree of sobriety has been achieved the pressure is applied with insidious and increasing intensity to bring him to God. In short, a programme requiring honesty is built on dishonesty. And whether he approves or not most meetings will begin and end with a prayer. Some actually close with the Lord's Prayer. To a gathering that can often consist of atheists, Christians, Muslims, Hindus, Buddhists, Jews and agnostics it is off-putting to say the least and has lost many an aspirant.
    A scanning of the literature before joining could well produce nausea. Neil Kessel and Henry Walton in their Pelican, Alcoholism, cite a number of AA failures. One says:


Fair enough comment on the face of it. But I do not go along with it whole-heartedly. The alcoholic will do anything to stop drinking — except stop. The desire not to drink has to replace the desire to drink. A year is quite a while for a thinking, sober, mind to decide about AA. But if that person continued to experiment with alcohol during that year he would be unable to concentrate on the valuable items in the therapy. It has been proved that the message cannot be passed to one ‘under the influence.’ No one is as knowledgeable about abstinence as the still-drinking alcoholic. He will advise a man with twenty years' sobriety under his belt on the best way to achieve it.


Too class conscious
    But there is much that could be changed if AA is to progress more impressively. It is too conservative, too unwilling to change. And not only is there too much God, there is too much class. Because of God, that too-too respectable bourgeois. Perhaps it is inevitable that in class-ridden UK the classlessness of AA does not operate conspicuously beyond the meeting room,
    This inhibitory factor, slowing growth, has led to a form of apartheid, to the creation of middle class and working class groups. One well known group was unashamedly formed for City types. Not that other types are, or can be, barred from attending. But there are more ways of killing a cat than stuffing it with cream. And a roomful of decorous but dull City gents in uniform is hardly conducive to the sobering up of a labourer sleeping rough. I take great pride in having played a tremendous role of democratising that lot and in relegating God to as minor a function as possible. But God is a persistent fellow ... not a bloke ... who will rear his ugly head, as he is understood or misunderstood . . . at the hint of a murmur of his name. It is significant that in at least two London groups he is not qualified for membership. One of these, operating as a discussion group, is said to offer the finest AA in the country, boasting an excellent record of recovery and rehabilitation.
    Despite all this, AA would still seem to be the best bet. Given a radical clean-up it could be infinitely better. Some Scandinavian groups have reduced the twelve steps to seven and have eliminated God. The present programme, if carried through to its ultimate would produce, does produce impeccably sober cabbages. The member is advised to shun controversy, excitement, emotional stress, intellectualism. Alcoholically game to the last it battens on a conclusion reached by a bunch of psychiatrists in the USA some years ago that alcoholics are of above average intelligence. They can still fool me, and themselves.
    Consequently AA attracts some peculiar characters, repels thousands who might inject it with new vitality. What is needed is a kind of Humanist AA where the therapeutic value can be exploited constructively in a nonspiritual manner. A new, up-to-date programme, a more determined onslaught on this killer disease by the medical profession and the powers ... temporal ... that be, wider publicity. AA should be secular, scientific, rationalist.


No good alternative
    What are the alternatives to AA? I offer no apologies for stating dogmatically that there are practically none. Its recovery success still surpasses that of the medical profession by thousands. Expensive clinics, like slimming centres, more or less succeed during residency. They both curtail consumption. So does prison.
    As for psychiatry, there are almost as many gimmicky ‘cures’ as there are psychiatrists. Some are sympathetic to AA, a few are actually pro. Dr M.M. Glatt, MD, DPM, was responsible for setting up AA groups in St Bernards and Warlingham hospitals and Dr Griffith Edwards, late of the King's College group of hospitals, co-operated wholeheartedly. An early collaborator, Dr Lincoln Williams, recognised a bandwagon when he saw one. He would dry out a patient in his own clinic for a hundred guineas or so then send him along to AA. He died a number of years ago but a number of sober veterans still bear witness. He was great on the spiritual side of AA, after having looked after the material.
    Doctors Harrison Trice and Paul Roman are quoted by Time as saying, ‘Despite lay leadership, AA has apparently achieved a success rate that surpasses those of professional therapies.’ Exactly. AA almost invented group therapy. Dr Edward Gottheil of the Coatesville Veterans' Administration in Pennsylvania, despite his own peculiar method of giving alcoholic patients drink, admits that, ‘Until the researcher is able to demonstrate some better practical techniques, the AA approach continues to merit our admiration and endorsement.’ (Time, April 22, '74).
    Professor Camps considers the situation in this country regarding alcoholism to be mostly due to the prejudice of the medical profession, to which I would add, ‘and ignorance’. Some doctors suggest tapering off. The time needed for an alcoholic to taper off depends on how long it takes him to die. Antebuse, like all drugs, is the facile recourse of others. Shock aversion induces the desire for a drink to get over the shock. Ad infinitum.
    This critique is written with the best intention by one who has been associated with AA for almost twenty years. One has ‘to be cruel to be kind’. AA has all the ingredients necessary for recovery. But I feel it an arrogance to assume that God plucks mediocrities from the gutter while leaving Einsteins to rot. The sufferer from toothache does not expect AA to extract the diseased tooth. AA is for his alcoholism, the dentist for his teeth. For those who want God, churches there are in abundance. If it's magic he is after he can slip across the Channel and pray to St. Amand in Saint-Amand-des-Eaux. He would be wise to keep his powder dry via AA.


The following letter appeared in the February 1975 issue of The New Humanist, and the reply by R.L. Wild appeared in the March 1975 issue.

Alcoholism
RECENTLY the Guardian published a letter in which I replied to the Rev Trevor Beeson, who had sneeringly reviewed Margaret Knight's excellent new book Honest to Man. I accused him of refusing to give blame where blame is due, and so placing faith before honesty. The same honesty now requires me to accuse R.L. Wild in his article about Alcoholics Anonymous (January) of giving blame where no blame, but some little credit, is due, and so placing nonfaith before honesty.
    After forty years' membership of the RPA I now count myself a mature Humanist, and feel that Humanism has a weak side which it is ostrich-like to ignore. It does demand a certain degree of mental and moral robustness, which is not confined to any one social or educational class. Where this quality is lacking, it apparently has nothing to offer. Christianity claims to cure everything and to be the religion for all men, including `sinners' and alcoholics. The state of the world shows these claims to be exaggerated, but as socially responsible people we ought, without compromising on our legitimate differences, to give credit for any genuine success, however small, achieved in those terribly difficult fields where we don't compete.
    The rational arguments against excessive drinking must be known to everybody. An alcoholic is one for whom reason is no deterrent. Mr Wild says the medical profession claims only 4 per cent recovery and that the matter is too urgent to be left to professionals and academics. So what can be the objection to letting the irrationalists have a bash? For every alcoholic cured by swallowing the Great Placebo in the Sky, there is one social problem less. Mr Wild seems to admit that AA have affected some cures by theotherapy (my word!); if AA were denied this method they would lose those cures and gain nothing but Mr Wild's useless approval.
    Is Mr Wild deprecating honesty and open-mindedness when he says that these ‘are constant subjects. The AA open-minded are the kith and kin to the Christian open-minded. The doubter should keep his mind open until he arrives at the believing state of mind. When it is not only permissible, but imperative, to close it. Tightly’?
    I shouldn't have been surprised to find this in the Standing Orders of the Salvation Army, but it is rotten rationalism. Only faith entertains the idea of Absolute Truth, justifying closure of the mind. The Rationalist's motto should be ‘dum spiro speculo’ — ever doubting and probing ideas, making better and better approximations to a truth that can never become absolute, but remains relative to his own ever-increasing knowledge and experience. Only death brings finality.
    I dare not ask for more space now, but I should be happy, Mr Wild, to continue the discussion with you at a strictly rational session in some local pub. I know most of the best ones in East Sussex. You, dear Editor, and even Trevor Beeson, will be welcome too.
                        WALTER BROUGHTON
                        Friston, Eastbourne


Alcoholic gap
WALTER Broughton's letter (February) criticising my article about Alcoholics Anonymous (January) merely confirms how difficult it is to ‘get the message of alcoholism across’. In this instance it seems I've hardly succeeded at all. And yet a great deal went into the writing of that article. Not only a lifetime of experience — twenty-six years of compulsive, increasingly heavy drinking, followed by twenty years of AA sobriety (still going strong) — but years of study, a considerable amount of research both on the disease and the history of AA worldwide, and a sizable number of case histories, my own and those of many of the alcoholics I have helped to recover; plus an immense quantity of sweat, tortuous periods of thought and, worse, doubt before the final stance could be adopted. A longstanding member of AA does not criticise lightly. But when he does he has to he honest! Or endanger his own sobriety. I also hoped my article was constructive.
    As a rationalist member of AA, I feel myself fully entitled to criticise the ‘spiritual evangelism’ of AA. That is, of those members who persist so doggedly. More, it is my obligatory function to point out to still-suffering alcoholics deterred by the MRA overtones of the recovery programme that it is possible to find contented sobriety in the association without the help of the supernatural. Never have I tried to deprive of their god those in need of such superstition to help them recover, people who I know could not possibly do so without it. My objection is to the smug attitude adopted by the god-fearing majority towards the faithless minority, the ‘superior’ assumption that full and contented sobriety is impossible to achieve without belief in a higher power — whatever that means. Electricity? Humanism may indeed, as Mr Broughton says, ‘demand a degree of mental and moral robustness’. But recovering from compulsive drinking, and aiding someone to recover, is a very delicate operation. One whiff too many of the god-gas and the initiate, scared out of his wits, is off.
    I had hoped to convey the very opposite to the interpretation put upon my article by Mr Broughton. Surely I am not depreciating honesty and open-mindedness. It is the alleged open-mindedness of the religious closed minds I am depreciating. Mr Broughton also talks of ‘cure’. No such thing I'm afraid — yet. As I said in my article, science will most probably find a cure eventually. Possibly prevention. But neither the medical profession nor AA nor any of the many bodies concerned with alcoholism attempt to cure. Once an alcoholic always an alcoholic — who can recover, and need never touch a drink again.
    It can be seen without further explanation that I must decline Mr Broughton's invitation to one of his ‘best’ Kent pubs. It is a long way to go for a bitter lemon. It is not that I am anti-pub. That is the beauty of recovering from alcoholism the AA way. We are not a temperance society, we are not prohibitionists. It is simply that I now have no personal use for pubs except for the odd, brief visit with friends and relations to what doubtless would once upon a time have been my local. And daintily sip a mineral. Ugh!
                        R. L. WILD
                        London SW 16


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