By Steve K.

“Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.”

Chapter 5, p.58, Alcoholics Anonymous, 3^rd Edition.

I have mixed feelings about this opening passage from chapter 5 of Alcoholics Anonymous (aka, the Big Book). It can be used by some to suggest that indeed the individual is at fault if the 12 Step program of AA isn’t working for them. In effect, used as a shaming stick with which to beat those already suffering from poor self-esteem. The truth is that the AA fellowship and its program of recovery is not a good fit for everyone with an alcohol use disorder. However, my experience does suggest that there is also a great deal of truth in this influential paragraph.

Alcoholics Anonymous (AA) views alcohol use disorder (referred to in AA as alcoholism) as an illness of the mind, body, and soul. It’s a more holistic perspective than the purely medical model and includes a spiritual dimension which suggests an illness of the ego. AA’s program of recovery focusses upon a spiritual solution via the 12 Steps, although its fellowship also provides support emotionally and socially for its members. For me, AA’s approach is a more comprehensive viewpoint in terms of the dysfunctional relationship those suffering from addiction have with the psychoactive drug alcohol, with themselves, and other people. It’s an approach that considers the problem of addiction biologically-psychologically-socially and spiritually.

What are the factors that can prevent an individual integrating into the AA fellowship successfully and being able to maintain their sobriety through its 12 Step program? Speaking for myself, I did struggle to fully accept my lack of control in relation to alcohol and, therefore, let go of my dependency upon it. I experienced denial to a certain degree which is an unconscious defense mechanism manifesting a dishonesty with self. This ongoing struggle with the problem of addiction prevented me from wholeheartedly connecting with the 12 Steps of AA. I was stuck at Step One for a long time and was unable to move forward into full recovery, and consequently maintain physical or emotional sobriety. My reality at that point is described perfectly in Step One of the ‘Twelve Steps and Twelve Traditions’…

“We know that little good can come to any alcoholic who joins A.A. unless he has first accepted his devastating weakness and all its consequences. Until he so humbles himself, his sobriety—if any—will be precarious. Of real happiness he will find none at all. Proved beyond doubt by an immense experience, this is one of the facts of A.A. life. The principle that we shall find no enduring strength until we first admit complete defeat is the main taproot from which our whole Society has sprung and flowered.”

pp. 21-22

I believe that a large part of my difficulty with letting go of my emotional dependency upon alcohol was the fact that I also suffered with ongoing clinical depression and anxiety related to unresolved developmental trauma. My addiction problem was a complex one, complicated by co-occurring mental and physical health issues. These chronic problems weren’t adequately understood or treated at the time and made a sober life seem unbearable for me. I struggled with suicidal ideation for years while being a member of AA and took an overdose not long after I joined the Fellowship. AA literature prescribed the 12 Steps for my ongoing difficulties, which I felt were inadequate for the complex problems I needed help and support with. Many within the AA fellowship agreed with me and suggested I seek outside help on several occasions.

Like the co-founder of AA, Bill Wilson, I was unable to fully embrace and live by the spiritual principles contained within the 12 Steps of AA due to my difficulties with depression and my unwillingness to let go of my unhealthy dependencies. Therefore, like Wilson, any lasting emotional sobriety evaded me. Wilson writes openly about his problems with depression and emotional sobriety in his 1958 Grapevine article ‘The Next Frontier: Emotional Sobriety’ (p.236, The Language of The Heart).

In the article, Wilson writes about how his immature dependencies led to his depression, and that to fully grasp and live by spiritual principles he would need to let go of these dependencies absolutely. He would find no lasting emotional sobriety otherwise. Similarly, unless I was able to surrender my unhealthy dependency upon alcohol as an emotional crutch for life, I would find no lasting physical sobriety, let alone any freedom from depression, or emotional balance. At the time this felt like a catch 22 position to me. I felt that my problems with depression and anxiety and my existential life struggles made it impossible to let go of alcohol and embrace recovery completely. They did make it much harder in my humble opinion, but eventually I realised that I had to give up my relationship with alcohol regardless of my problems with depression, anxiety, or any other life problems that I was required to face.

While mental health problems do make recovery more challenging, as the passage from chapter 5 of the Big Book suggests, they don’t make it impossible; and acceptance, self-honesty, open-mindedness, and willingness sees many with co-occurring mental health conditions find long-term recovery within AA. However, those with severe and enduring mental illnesses that are poorly managed maybe better served by groups specifically aimed towards supporting those with a dual diagnosis. They should also be supported professionally on a one to one basis in my opinion (E.g., counsellor, psychotherapist, CPN, social worker or psychiatrist).

21^st century AA now produces literature (A.A. for Alcoholics with Mental Health Issues) aimed at those with co-occurring conditions. Seeking outside professional help and treatment for mental health problems is now routinely suggested by most responsible sponsors and members within the AA fellowship.

Despite my ongoing issues with depression, anxiety, and physical ill health I’ve managed to maintain freedom from the urge to drink any alcohol for the last 16 years at the time of writing this post. Miracles do happen! Consequently, I manage my problems with depression and anxiety much better than I once did and they’re a lot milder in comparison. I would also suggest that I’ve developed a maturity of character and that I am more emotionally balanced these days, suffering to a much lesser degree from my lifelong difficulties with anger and aggression. I’ve been able to connect to the spiritual principles within the 12 Steps increasingly over the years which I believe has made these changes possible. I’ve also engaged with other therapeutic sources of support outside of AA which have been necessary for me to grow as a person.

My evolving spiritual awareness and more balanced emotions are not just wishful thinking on my part as my friends in recovery will authentically testify. I feel that I have realised some of the Big Book’s Promises to a certain degree in relation to the changes in attitude that will transpire within the alcoholic through the ongoing practice of recovery principles… “sometimes quickly, and sometimes slowly.”

These changes may have taken a long time for me, but they have ‘materialized as I’ve worked for them.’ The beneficial changes within me have taken a very long time and have been somewhat limited by my ongoing struggles with clinical anxiety and depression. In all honesty, I still have some way to go to fully realise the freedom, joy, peace, and serenity described in the literature of Alcoholics Anonymous (pp 83-84, 3rd ed). Who knows if I’ll ever truly get there, but I’m committed to trying and helping others along the way.

Related Reading:

For an explanation AA’s relationship to the Disease-Concept of Alcoholism see William L White’s article: AA and the Disease Concept: A Complex Connection. The post clarifies AA’s more holistic perspective in relation to alcoholism being an illness of the mind, body, and soul.