Prescriptive models have contributed a lot of good to our society. They produce structure and reliability, and offer consistency in the face of irregularities. Prescriptions can also be terribly confining: they work on the assumption that every individual follows them exactly. Of course, we’re all different. You wouldn’t take a pill prescribed for your friend and expect it to work perfectly for you.
Alcoholics Anonymous was born of one man’s journey to find lasting sobriety. Bill Wilson struggled with an alcohol addiction for most of his early life. It upended his career, caused problems in his marriage, and made his life unmanageable. Desperate for relief, Wilson checked himself into the hospital 4 times in a single year, subjecting himself to exhausting detoxes and routine purging, only to be released into a swift relapse.
It was during one of his hospital stays that he met Dr. Bob Silkworth – one of the first physicians to suggest that alcoholics were suffering from a cognitive obsession. He also thought that said obsession was combined with an allergy that made compulsive drinking inevitable, and to break the cycle one had to abstain from drinking, period. The “allergy” idea was a bit weird, but he was close: the disease theory of alcoholism focuses on the physical and mental effects of alcohol on the brain.
The Physical Effects of Alcohol:
A person experiences an urge to drink, and is hit with withdrawal symptoms when the drinking stops. Drinking relieves the withdrawal symptoms.
The Mental Effects of Alcohol:
As one’s intake increases, so does their “tolerance.” However, tolerance isn’t the extent to which alcohol is affecting the person. Everyone is affected by alcohol. An alcoholic person’s brain function has been changed by extended exposure to alcohol. What we popularly understand as “increased tolerance” is actually the brain attempting to restore balance by changing the function of our regular neurotransmitters so that the brain can perform “normally” in the presence of alcohol. That’s why alcoholic people feel “off” or “different” when they aren’t drinking. They quite literally are. This cognitive dissonance is what fuels the addictive nature of problem drinking; the change to one’s brain chemistry makes it a disease.
When they began discussing a radical treatment for rampant alcoholism, Dr. Silkworth and Bill Wilson weren’t thinking about the brain. It was the mid-thirties. The world was dealing with the aftermath of WWI, and then the Great Depression hit: death and malady and self-preservation were common experiences of the 1930s family. If they were going to have success in their quest to help people manage their alcoholism, Dr. Silkworth and Mr. Wilson would need to find a management system that spoke not just to the affliction, but to the changed way people saw the world: a place capable of hosting great fear and unthinkable danger.
In his search for relief from his alcoholism, Bill came upon two significant influences:
- the Oxford Group – a Christian fellowship that would go on to influence the general structure of AA’s 12-step program
- Belladonna detox that led to a hallucination of a God-like figure.
Though the detox-treatment (Belladonna, a plant that causes extreme vomiting upon consumption, was a pretty popular detox treatment for alcoholics at the time) was downplayed during the rise of the AA program, it was the ephemeral experience of a higher power that set the organization’s spiritual belief in place. Combined with Dr. Silkworth’s medical diagnosis of alcoholism as part physical craving and part allergy, AA became a place where people struggling with alcohol addiction could be amongst their peers, obtain new guidance by way of the 12-step program, and receive empathetic understanding of their struggle.
During a time where “alcoholism” was new and damaging territory, to be prescribed any cure would have been a relief. AA has done important, hard work since its launch in 1935. The organization deserves credit for building national awareness around treatment for alcohol abuse, and for working to mitigate stigma and offer a network of support to those looking for help.
Why AA Is Limited
As we’ve come to understand more about alcoholism – what it is, and how it makes our brains work – the world has changed. Each day we are faced with unknowns, variables, and challenges to our core beliefs. We are beginning to understand that the prescriptive model is a limiting one. When treating a disease that is experienced so personally, each individual with their own set of unique challenges, options, and triggers, the more structured and faith-dependent approach of AA isn’t always the best option.
The black and white nature of our culture is shifting, and so must our understanding of treatment. While research supports the community model for early-recovery, so too does it refute the idea of alcoholism being an allergy. Developments in cognitive behavioral therapy, environmental triggers, and ongoing neurological breakthroughs ask that we adapt our expectations of treatment to the information available to us. Treatment is not one-size-fits-all. Our work is to find alternatives. Let us help you with yours.
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