Friday, 23 November 2018

In praise of fellowship

Last night I went to my first ever Alcoholics Anonymous (AA) meeting.  It was an open meeting, specially put on for Alcohol Awareness Week.  I’ve been meaning to go to an open meeting for years, and there are opportunities every month, but (like so many things) it’s only getting a date in the diary that made me do it.  I was encouraged that a number of other professionals were there too, representing local support and care organisations from midwifery to probation.

I found the meeting genuinely moving – but of course I would.  Who wouldn’t, hearing stories being shared not only from two regular meeting attendees, but also someone who attends Al-Anon – the sister organisation of AA that supports people whose loved ones have issues with alcohol.  The moving thing wasn’t simply those testimonies, but something about bringing home the human side of my job.  I don’t mean this in the way we often do: slightly patronising, remembering there are ‘service users’ not just numbers in spreadsheets.  I mean something about real human connection.  One person who is alive speaking to another.  I know this sounds both cryptic and trite, so I’ve tried to write something here that explains what I mean.

Sitting in the room, I felt like I was somehow back in the past.

Writing that on its own makes me feel like I’m perpetuating a stereotype of AA, of people sitting in a cold, damp church hall, wearing unfashionable clothes, drinking flavourless coffee.  My experience was far from that.  The coffee was decent, the room was warm, modern and comfortable – and I’m certainly in no position to comment on anyone’s dress sense.

What I mean is that the kindness, community and somehow ordinariness reminded me of the stability and community of my childhood.  I felt like a weight had been lifted.

I tried to explain this afterwards to someone else there, but failed.  I said that sitting there, listening to people’s stories, made me think (as I have about social work in the past) that, done well, this kind of fellowship and community and the genuinely mutual aid it offers would be of benefit to most people.

Of course, the person I was speaking to reasonably and carefully explained two things.  First, that these groups were open to and designed for people who had issues with alcohol.  Second, that these ‘issues’ were of a particular kind – as a doctor quoted in the ‘Big Book’ that I picked up there stated: ‘the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class … These allergic types can never safely use alcohol in any format at all’ (p.xxviii).

I hope I’ve always been respectful to this point of view.  To praise the general principle of mutual aid isn’t to deny the special nature of ‘alcoholism’.

But here’s where I may have been slightly less respectful.  I get caught up in intellectual games and the pleasure of having a neat (ideally slightly unexpected) position when I write about alcohol and other drugs – though I nearly always end up sitting on the fence somehow.

The intellectual game that fascinates me is the classic discussion of structure versus agency, as sociologists would put it.  Or in terms of alcohol problems, does the issue lie in the person or in the bottle – and I like to say that things are complex, nuanced, shades of grey.  (In work, by contrast, I generally tend to want to know ‘the answer’ and get on to ‘do something’.)  This interest in nuance (or fence-sitting) has led me in the past to question whether ‘addiction’ really exists, and to emphasise that if ‘alcoholics’ exist then they are a small sub-section of the group of people who have problems with alcohol, and if we get too caught up in defining ‘addiction’ we’ll fail to pay attention to the whole range of people who are struggling.

So I’ve not really had too much time for this concept of a particular ‘class’ of ‘alcoholics’, as the quote in the ‘Big Book’ puts it.  (Though re-reading some of my old pieces this morning, maybe my love of ‘nuance’ has meant I’m more reasonable than I think.)  There are certainly those who see the use of terminology like ‘alcoholic’ as not only stigmatising but limiting people’s autonomy and potential for recovery.

Having now been to a meeting, though, I feel I’ve been a bit too cold and detached in my assessment.  It’s the same way I feel, on reflection, about the things I’ve written saying that the 2016 Psychoactive Substances Act could, in the long term, be helpful for UK drug policy debates.  The problem with intellectual games, abstract principles and ‘long term’ policy debates is that they’re not human, they don’t feel.  (In the long run, we are all dead.)

The most revealing moment in the meeting was, for me, when various people spoke about ideas of ‘God’ and a ‘higher power’.  This is one of the most debated features of AA, and the one many sceptics leap upon to discredit or disengage with it.

One person explained that, sitting in a church, he wouldn’t feel like he was surrounded by people who understood him, whereas in AA he knew ‘these were my people’.  This is a bit like a phrase I remember Mark Gilman using a few years ago when he came to speak in Dorset, describing an ‘alcoholic’ as someone who has ‘got the spots’ – but it’s also something more.  It’s not just sitting in a room with people who have the same condition or ‘illness’ (many of us have done that at one time or another, and it’s not always useful or fulfilling); it’s about the sense of fellowship.  As someone else explained, for her the ‘higher power’ was something outside of, beyond, herself: the other people in the room.  This is the human, feeling element that I am somehow too easily able to switch off when analysing or writing.

The term ‘alcoholic’ is used in this context without shame or judgement.  It’s seen as a description of a ‘class’ of people, and this ‘class’ isn’t simply defined by alcohol consumed.  It’s a class for whom, as one person put it to me afterwards, just stopping drinking isn’t the solution – in fact, without some wider support, that can often make things worse.

Of course, such people are not the only people who suffer harm from alcohol.  And we need to be flexible in our idea of ‘rock bottom’ (and whether someone actually has to hit it to find recovery).  But it’s hard to sit in that room and feel anything but warmth and admiration for what this fellowship – these people – have done and continue to do.

So going to the meeting helped me remember another way of being in the world.  Somehow more relaxed, more grateful, more structured.  There are various reasons I feel I’ve lost that recently.

But it also made me consider my own drinking.  I’ve not got very far in reading the ‘Big Book’, and so I keep coming back to that section at the beginning by a doctor – William D Silkworth.  There’s a revealing sentence that opens a paragraph describing the nature of ‘the alcoholic’: ‘Men and women drink essentially because they like the effect produced by alcohol’ (p.xxviii).  I certainly do.  I drafted this post last night, and was already envisaging the train back from London on Friday night where I’d enjoy a couple of cans of ‘train beer’.

I’m not suggesting my drinking is ‘alcoholic’, but two things in the past week have made me question my relationship with alcohol.

One was meeting staff and PhD students when I went back to Bournemouth University last Friday to teach a session on ‘controversial cultures’.  Discussing ‘binge’ drinking culture as potentially controversial, I was asked if there was something in the British psyche that means we can’t drink sensibly.  Thinking of James Nicholls, I argued that there isn’t a single, fixed British drinking culture and, anticipating this week’s Alcohol Awareness theme, I emphasised that ‘change’ is possible at a population as well as an individual level.

And the second moment was last night at the AA meeting.  The description of how drinking, for some people, was a way of avoiding the discomfort of living, the anxiety of navigating the world, the awkwardness of being oneself.  (These are all poor phrases to represent what people actually described.  I can’t represent their eloquence in my writing.)

This is why I drink too.  It takes the edge off.

And this, generally, is why people use any drug.  As I remember Wulf Livingston arguing persuasively at NDSAG, much drug use can be seen as functional in some way, even when it’s part of what would generally be labelled ‘misuse’: if the drugs weren’t serving some purpose, people wouldn’t use them.  Perhaps in the long term there’s a better solution, but drugs, too, are a solution of sorts.

Most of us just don’t reach the point described by several people at the meeting, where they were so tired of the repeated pattern of using/drinking that they no longer wanted that life (and therefore no longer wanted a drink because they knew how that ended).  For those of us still drinking, we’ve decided at some level that the benefits still outweigh the costs.

And I don’t just mean a small glass of wine over dinner.  I haven’t tried many drugs, but for the moment I can certainly say that alcohol is ‘my’ drug.  I respect that this isn’t true for everyone (or even most people), but fundamentally I struggle to genuinely understand why people wouldn’t like the feeling of drunkenness.  Why, if there were no commitments tomorrow, wouldn’t people always say yes to another drink?

But sitting in that room, I wondered about that.  Is it a healthy, happy approach to life: when I can, I try not to be fully conscious or present?

Just like my writing, I wonder if my drinking is an attempt to show off, to be special.  Am I trying to be one of Steve Earnshaw’s intellectual, ‘existential alcoholics’?  (Just without the courage of their convictions to be truly destructive.)

And that brings me back to that starting point, which could be seen as simultaneously undermining and celebrating the principles and practices of AA.

(Wait for it, but just so you’re warned, this is the supposedly clever conclusion bit I always aim for when writing a piece like this.  In this case part of me is thinking that it’s particularly clever because I’m being self-referential and self-critical given that I’ve recently been questioning Johann Hari’s claim that the opposite of addiction is connection, and yet here I am praising connection as a solution to addiction.)

The value of AA, to me, is this reminder of the ‘miracle’ of an ‘ordinary’ life, and the benefits of ‘fellowship’.  These are amazingly special things, affirming the value of AA – and yet they are also surely universal (as much as anything can be), which leads me to question how ‘special’ this approach really is.

But although we could all perhaps learn from AA, and despite the fact that this ‘class’ of ‘alcoholics’ aren’t solely defined by their drinking habits, there remains something unique: fortunately most of us are never placed in situations so extreme that we have to think in this way.  And this is perhaps where all of us can take a moment to express what was so fundamental for so many people in the room last night: gratitude.

1 comment:

  1. Will, thanks for this post, lots to think about.

    Firstly, I would like to clarify that when I argue against use of the terms alcoholic/alcoholism, I am definitely not calling for those who self-identify with it to refrain from doing so. I do not question that AA and other mutual aid groups play a very important role for many people. Rather, my point is that applying disease model labels in the context of broader drinking populations and narratives has many potential consequences that I believe outweigh any positives. As you identify, in this broader context it can be ‘not only stigmatising but limiting people’s autonomy and potential for recovery’, and there is empirical evidence to support this.

    Having said that, there is also some evidence of negative effects for those who do self-label, most famously perhaps the abstinence violation effect. A more complex effect may be that of self-stigma, such that people seek self-protective strategies to help them overcome the internalisation of commonly held negative beliefs and attitudes about problem drinkers (see Hill & Lemming’s excellent 2015 paper ‘Reconstructing the alcoholic identity..’). Thus when you say ‘The term ‘alcoholic’ is used in [AA] context without shame or judgement’, I think that’s true in the general sense but actually there are probably some implicit and other aspects arising from self-stigma through which this could be challenged. But I do not think these exist as a case for arguing against self-application of the term, rather than adding to the argument for seeking to reduce wider stigma around alcohol problems.

    For me, the really interesting point though concerns your own reflective assessment of your drinking and how, despite clearly attending in a distinct capacity from those attending as ‘AAers’, you were still prompted to contemplate your own drinking. Hearing how people in a sense described their drinking to deal with the often uncomfortable experience of life reminded me of Nick Heather’s quote of addiction as a ‘problem of living’. Perhaps it is common for any regular drinker attending an open AA meeting to wonder ‘am I so different from these people? What if my life had have taken another path? Etc.’. As you state though, you drink at least in part to “take the edge off” and indeed many people’s drinking motives relate to affective regulation, or more simply because they feel ‘happier’ in that moment (Baumberg & MacKerron 2016).

    I think this nicely illustrates essentially why recognising alcohol use and/or misuse as existing on a continuum is so important (which essentially a binary alcoholism paradigm undermines if applied beyond AA etc). Anybody who drinks could surely benefit from appraising their drinking motives as best as possible. Certainly, for those who successfully moderate or change their drinking behaviours, accurate reflection or drinking motives and its relation to mood etc are important strategies.

    As such, it sounds like you attended the open AA meeting with an implicit assumption that you were fundamentally different from those sharing their recovery experiences – as indeed most people would. However on hearing their stories, you could relate these to your own drinking motives, albeit that ‘most of us don’t reach the point described by several people at the meeting’. As such, a continuum makes sense if we consider the extent to which all drinking motives can vary in their degree, and which in combination with a wide range of other variables existing with their own scales of extremity, can lead to varying degrees of alcohol use/misuse. However our strong human essentialist tendencies have created and embedded the idea alcoholics exist as a distinct and fundamentally different group. For those who end up self-identifying with that group, AA becomes a potentially life-saving opportunity. For those that don’t, it may hinder problem recognition by allowing us to place ourselves on the ‘safe’ side of the binary, distinct from the ‘alcoholic other’.