Having support that comes from someone other than a clinician is important to recovery, according to addiction specialists. Oftentimes, people find that support in Alcoholics Anonymous and its off-shoot, Narcotics Anonymous.
“In my experience, there are many, many people in recovery today who would have never gotten there without the support and assistance of AA,” said Frank Jans, director of psychiatry for West Penn Allegheny Health Network.
Founded in 1935, AA is a 79-year-old organization that, by its own estimation, has more than 2 million members in more than 180 different countries. Narcotics Anonymous, which grew out of AA, was founded in 1953. It has a presence in 129 countries, according to the organization.
Before either came along, there wasn’t much available for addicts in terms of help and support.
In the early 1900s, alcoholism was viewed as a character flaw, a moral failing, Jans said, and one solution was to physically keep people from the bottle by locking them up in inebriate hospitals or sanitariums.
Shock therapy also was a form of treatment then, he said. And so were aversive therapies in which negative stimuli were administered while the alcoholic drank as much as he or she possibly could.
“By adding the negative to the positive, it made you so sick you didn’t want to drink,” Jans said. “But until AA came along, there really wasn’t any kind of structured program that wasn’t aversive or punishment oriented.”
AA, and by extension, NA, can trace its origins to the Oxford Group, an evangelical movement in the early 1900s. According to AA’s own history, members of the group sought self-improvement though “self-inventory, admitting wrongs, making amends, using prayer and meditation, and carrying the message to others,” all tenets of AA and its 12 steps.
As it happens, one of AA’s founders, stock analyst William G. Wilson (known as Bill W.), was an Oxford Group member. As the story goes, Bill W., an alcoholic who had stopped following a deep spiritual experience, found himself in Akron, Ohio, on business, very much wanting a drink.
But instead of going to the bar, he decided to reach out to a fellow alcoholic. So he consulted a church directory posted on a hotel wall, hoping to find someone who might refer him to someone else, according to AA history.
“A phone call to Episcopal minister Rev. Walter Tunks results in a referral to Henrietta Seiberling, a committed Oxford Group adherent who has tried for two years to bring a fellow group member, a prominent Akron surgeon, to sobriety,” the history said.
Seiberling, who was the daughter-in-law of the founder of the Goodyear Rubber Co., invited Bill W. over, telling him of the struggles of Dr. Robert H. Smith (known as Dr. Bob).
The meeting of the two men took place the next day — Mother’s Day, May 12, 1935, according to AA.
“In the privacy of the library, Bill spills out his story, inspiring “Dr. Bob” to share his own. As the meeting ends hours later, Dr. Bob realizes how much spiritual support can come as the result of one alcoholic talking to another alcoholic, according to the history.
And, thus, AA was created.
“Dr. Bob and Bill spend hours working out the best approach to alcoholics, a group known to be averse to taking directions. Realizing that thinking of sobriety for a day at a time makes it seem more achievable than facing a lifetime of struggle, they hit on the 24-hour concept,” according to the history.
That concept, abstinence achieved through sobriety for one day, one day at a time, is one of AA’s core principles. And so is the recognition of one’s personal shortcomings, an admitted powerlessness over the addiction and belief in the existence of a God — not necessarily the Christian God, but a higher power, said Vince Mercuri, executive director of The Open Door Alcohol and Other Drug Treatment Center.
Mercuri said being Christian certainly is not a prerequisite for recovery. “There are atheists, agnostics, Hindus and Muslims in recovery, too,” he said.
He said the idea of a higher power is meant to recognize man’s spirituality.
“Nobody should ever apologize that the addiction field is spiritual — we are spiritual beings. And so part of fulfilling the wholeness of a person is to be able to have some spiritual program as well,” Mercuri said.
Although for some AA and NA wind up being the treatment, experts say that those programs aren’t necessarily meant to be that. Really, they’re for self-help and mutual support, they say.
“Support is good for everybody, but you don’t expect a cancer support group to treat cancer,” said Dr. Lance Dodes, an author and retired assistant clinical professor of psychiatry at Harvard Medical School.
Dodes, who wrote “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry,” is critical of AA and 12-step programs. In his book, Dodes said that AA has a success rate of between 5 and 10 percent.
Arguably, that might not necessarily be a problem because, after all, the program does show success. However, Dodes argues it is damaging because for most participants it is not effective. And the program, he said, tells those who relapse that they have failed. But no one suggests that it may be the program, not the person, that has failed, he said.
In reviewing studies of the effectiveness of mutual support programs, the National Center for Addiction and Substance Abuse at Columbia University said it is tough to peg a success rate for those programs.
“There are methodological limitations to the effectiveness studies that examine mutual support programs, restricting the extent to which their ability to curb substance use and help manage addiction can be determined,” they wrote.
But they said anecdotal evidence for their effectiveness abounds.
And based on first-hand experience, Jans said he believes those groups should be a part of a treatment plan.
“I think it is an incredibly powerful tool in working with people who have alcohol or other drug problems,” he said.
He acknowledges that that no one thing works for everyone, and therefore, he said, it’s important to avoid becoming locked into one particular support model.
Alternatives to AA include LifeRing and SMART Recovery (Self-Management and Recovery Training). Led by professionals, SMART emphasizes self-empowerment and teaches people in recovery how to maintain motivation and cope with urges.
But no matter an organization’s philosophy, Jans said the thing that is ultimately important is having support and options.
“My belief is that if an individual is going to get clean and sober, the more healthy and helpful resources they have, particularly in the early stages of recovery, the greater the likelihood of success,” he said.