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.
Will, thanks for this post, lots to think about.
ReplyDeleteFirstly, 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’.