Book review: the science behind 12 Step recovery

Nowinski’s excellent popular science book If You Work It, It Works! The Science Behind 12 Step Recovery (2015) makes it pretty clear: AA only works if you participate.

Dr Joseph Nowinski’s name came up a bunch of times when I was doing research into international best practice in treatment and support for alcoholics and risky drinkers.  I was completing this work at the same time my drinking was at its white-spirit-worst and, because of that, I nearly lost the job for good.

In fact I’m pretty sure Nowinski’s Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence(1999) was even on the shelf when I was poking around in the literature cupboard at my last rehab. By that stage I had decided AA was definitely some kind of cult. Why else would people willingly go out of their way to help perfect strangers? Surely they had some other motive?

It turns out they did have an alterior motive. But they weren’t trying to sell me salvation proportionate to my income. No, helping others made them feel better.

Nowinski

Project MATCH :/

Dr Nowinski contributed to Project MATCH (1989-97), the largest alcohol treatment trial ever conducted involving 1726 alcohol dependent volunteers over several treatment sites in the US. The aim of Project MATCH was to find out if different types of ‘alcohol abusing or dependent patients’ respond differently to the most widely used treatments for alcohol dependency: Cognitive Behavioral Therapy (CBT), Motivation Enhancement Therapy (MET) or Twelve-Step Facilitation (therapists introduce patients to AA, explain some of the concepts and get them to attend meetings. The focus is on AA’s steps one to five).

Project Match’s data dissapointed a lot of people in the addiction and recovery field. It reinforced what many suspected: that matching the right treatment to individual alcoholics is difficult, and that treatment outcomes are similarly dissapointing across the board. In other words, Project Match didn’t offer a silver bullet for treating alcoholism.

Yet, the fact that a treatment protocol based on AA’s 12-steps – an unscientific, quasi-religious oddity – could achieve similar results as CBT and MET was notable, given that AA costs nothing to taxpayers and provides critical post-intervention (e.g. hospital E.R., detox, rehab) support in the community.

AA only works for those who take action

The title of If You Work It, It Works! is intentional because, as Nowinski points out, only half of us who attend AA stay active in the fellowship after three months.

I recently lost 20kg because I changed my diet and started running. Thinking about it didn’t get me healthy.

Nowinski analysed AA member surveys to find out what actions people take in AA to stay sober and found attending at least two and preferably three meetings a week, joining a home group, and getting a sponsor were the top three responses. These same three actions kept me sober in my early days of sobriety.

Nowinski examined a range of research on AA attendance and involvement, and treatments that encourage AA attendance. The results show that:

  • Getting into some form of counseling and starting AA at the same time is a winning combination if you want to stay sober.
  • Getting involved in the AA Twelve Step fellowship leads to superior results than simply attending meetings.
  • Identifying yourself as an AA member makes a positive difference.
  • Therapy that actively facilitates AA involvement is superior to treatment that does not include this focus.

He also notes that there is a spectrum of alcoholism and problem drinking and that, for some, controlled drinking may have its place after a period of conditional abstinence.  For those like me, who have tried and failed at controlled drinking and have ridden the ‘just one’, drink-drank-drunk *crash*, remorse cycle so many times the very idea of controlled drinking is laughable, Nowinski says that abstinence should be ‘the most appropriate goal’.

How it works

1. Social networks

Like me, Nowinski attributes much of AA’s value to the relationship between social networks and recovery. He uses a number of published studies to show how both involvement in AA, and the people in an alkie’s regular social network, are critical to long-term recovery. AA involvement seems to act as a buffer, particularly where a person’s regular social network includes frequent or heavy drinkers. Some people use AA as an alternative social network, particularly when there is always drink at home. I’m lucky that my immediate family are not huge drinkers and my best mates, while still capable of epic feats of party mayhem, are generally pretty sensible and respectful of my non-drinker status.

Interestingly, problem drinkers in a person’s social network exert a more powerful and negative influence on recovery than non-drinkers. In other words, surround yourself with drunks and you’ll probably end up just that – drunk. Surround yourself (at least some of the time) with AA members and you’ll probably stay sober. Dead simple.

2. Spirituality and sponsorship

As a scientist, Nowinski doesn’t engage in spiritual or theological argument. Instead, he presents published studies that have examined the role of spirituality in recovery. Obviously there are limitations in this data because concepts like spirituality are open to interpretation – particularly by sick people responding to surveys. The studies show that greater involvement in AA leads people to become ‘more spiritual’ over time, which is, in turn, positively associated with sobriety. This is not suprising, since AA is a program that emphasises the benefits of spirituality, particularly prayer and meditation.

The other aspect of AA’s spirituality Nowinski finds beneficial is the focus on personal values and self-reflection. He concludes that ‘spirituality, as it is reflected in AA’s emphasis on honesty, humility, and personal renewal, as opposed to formal religious observance, may be the key dynamic responsible for this change’ (p.148).

Nowinski’s message is clear: AA spirituality is not about joining a cult or a church. It’s about ‘pursuing a life of meaning and values. These include honesty, the courage to admit to shortcomings, humility, and altruism. Within the AA culture these values are demonstrated through action’ (p. 160).

Studies on sponsorship are pretty unequivocal: getting a sponsor early greatly increases your chance of not drinking again. However, this effect seems to decrease with time. Nowinski says that the adage ‘better late than never’ probably applies here, and I have to agree with him.

3. Neurological factors

Alcohol kills brain cells. That bit we knew already. But, if you drink like I did, it also greatly increases your chance of suffering from depression and/or anxiety, as well as PTSD and schizophrenia. The point is that most alkies seem to have some sort of psychiatric comorbidity or dual-diagnosis to party with their alcoholism and other addictions.

Nowinski reviews the evidence on recovery for alcoholics with dual-diagnosis and finds that, as long as people work their AA program, these illnesses ‘do not appear to consitute a major barrier to recovery’ (p. 181).  He concludes that recovery (and particularly Twelve Step recovery) has healing powers of its own.

Is it worth reading?

In a word, yes. Nowinski’s book is:

  • a much needed kick in the pants for alcoholics like me who forget to put in the action each day. Treatments for diabetes and heart disease are never effective 100 percent of the time, because they are dependent on whether or not a patient follows the treatment recommended by their doctor. As Nowinski puts it: ‘the best we can say, then, is that these treatements are likely to work if the individual works them’; and,
  • an excellent introduction to the medical literature on alcoholism and recovery, which shows that AA has some good, recent scientific studies supporting its approach to recovery.

Working with others

Alcoholism is a chronic, relapsing condition that, if left untreated, can be fatal. The main treatment I and millions of others around the world find effective is to work with fellow alkies and follow a few very simple principles based on honesty and respect for others. But, for me, it’s primarily about a unique human connection – one that is based on empathy. Or, as the old timers say, ‘the magic happens when one alcoholic works with another alcoholic’.

A great example of this is found in the AA Big Book in chapter 11 (pp.156-8). The story refers to Bill and Bob’s first visit to a guy who would become AA’s third member; a visit that resulted in AA’s first group at Akron, Ohio in 1935.

Bill W and Dr Bob had only just figured out that they needed to ‘keep spiritually active’ by working with other alcoholics, so they called up a local hospital and spoke to the head nurse:

They explained their need and inquired if she had a first class alcoholic prospect.

She replied “Yes, we’ve got a corker. He’s just beaten up a couple of nurses. Goes off his head completely when he’s drinking. But he’s a grand chap when he’s sober, though he’s been in here eight times in the last six months. Understand he was once a well-known lawyer in town, but just now we’ve got him strapped down tight.”

…Two days later, a future fellow of Alcoholics Anonymous stared glassily at the strangers beside his bed. “Who are you fellows, and why this private room? I was always in a ward before.”

Said one of the visitors, “We’re giving you a treatment for alcoholism.”

Hopelessness was written large on the man’s face as he replied, “Oh, but that’s no use. Nothing would fix me. I’m a goner. The last three times, I got drunk on the way home from here. I’m afraid to go out the door. I can’t understand it.”

For an hour, the two friends told him about their drinking experiences. Over and over, he would say: “That’s me. That’s me. I drink like that.”

The man in the bed was told of the acute poisoning from which he suffered, how it deteriorates the body of an alcoholic and warps his mind. There was much talk about the mental state preceding the first drink.

“Yes, that’s me,” said the sick man, “the very image. You fellows know your stuff all right, but I don’t see what good it’ll do. You fellows are somebody. I was once, but I’m a nobody now. From what you tell me, I know more than ever I can’t stop” At this both the visitors burst into a laugh. Said the future Anonymous: ‘Damn little to laugh about that I can see.”

The two friends spoke of their spiritual experience and told him about the course of action they carried out.

He interrupted: “I used to be strong for the church, but that won’t fix it. I’ve prayed to God on hangover mornings and sworn that I’d never touch another drop but by nine o’clock I’d be boiled as an owl.”

Next day found the prospect more receptive. He had been thinking it over. “Maybe you’re right,” he said. “God ought to be able to do anything.” Then he added, “He sure didn’t do much for me when I was trying to fight this booze racket alone.”

Bill and Bob continued to work with the man, and after three days he had become ‘willing to do anything necessary’, including to give his life to the ‘care and direction of his Creator’.

That afternoon he put on his clothes and walked from the hospital a free man…He never drank again. He too, has become a respected and useful member of his community.

Eight decades have passed since two alkies working together became three, then four, and now millions worldwide. And yet, the story remains relevant.

Aside from my wish to resurrect the phrase ‘as drunk as a boiled owl’, this is one of my favourite sections of the Big Book because it provides hope to those of us who are still suffering and can see no way out.

Most of the people I know in AA who have been to a rehab or detox have also drunk either on the way home from their treatment, or soon after. Just like our formerly-respected-lawyer-Anonymous #3. I did too, on two separate occasions. When we discuss these events we speak of unnatural, sanitised environments that do not prepare us for life after our time in confinement is up, certainly not if we return to our communities with no lifelines (I have many AA members’ numbers in my phone who I can call on at any time). This phenomenon – the relapsing nature of the condition – continues to challenge the medical profession and policy-makers alike.

But, for eight decades, AA has been keeping people sober on little more than a pay-it-forward faith in something more powerful than the individual.

The Big Book likes to call this something God. Today, AA teaches that it just has to be something other than ourselves. Even the AA group – a thoroughly humanistic Higher Power if ever there was one – can be this special something.

But, most of us have found that we can’t just rely on gods and goddesses to get us well. We have to put in some work too.

 

The knife

I’ve just spent some time at my folk’s place in coastal Victoria, Australia. It was my annual, seasonal ritual delayed: family (and dogs) converging for ham and plumb pudding in the second week of January. The sun was hot and the March flies (who clearly don’t give a toss about human inventions like the Gregorian Calendar) were hungry for blood.

My parents gave me a knife as a sort of weird family heirloom, given that it was thrown at, and narrowly missed, my grandfather during a post-footy game riot in Melbourne’s Western Suburbs not long after WW2.

Pa was a VFL (aussie rules football) club champion during those years. A quiet family man and boilermaker – not the type to attract would-be knife throwing ninjas, but a prime target for pissed idiots nonetheless.

The knife has an iron cross and some other etchings, suggesting it was made for the German army, most likely the Luftwaffe or so I’ve been told. Anyway, it has the balance of a throwing knife (the chips out of the bone handle suggest it has seen some use).

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My grandparents old house was up for sale, a few doors down from my parent’s place and where my dad and aunt grew up. Apart from a lick of paint, the house and large block of land with the tennis court my Pa built remains unchanged and miraculously undeveloped.

I had a walk through the ‘classic beach shack’ and viewed the realtor’s slick promotional video for the sale, complete with aerial drone footage. I’m not sure what Pa would have made of all that fuss. He was a no-nonsense kinda guy.

Going home always seems to bring back memories.

I had my first alcoholic dream in what feels like an eternity the other night: the full-bore, wake up in a cold sweat, dry mouth, heart palpitations, ‘oh fuck I’ve drank’ panic. In the dream, I was drinking in my old haunt, at the pub down the road from my folk’s place, and got so pissed I couldn’t climb the hill to get home. The road turned into a vertical cliff face before the dream dissolved and the panic of a bust subsided into lingering feelings of remorse and guilt.

During my 20s  and early 30s I used to go to that pub with the intention of having a couple of drinks. Instead, I routinely woke up on various mates’ couches among the empty bottles, ciggie butts and drug paraphernalia – evidence of the previous night’s hedonism. On those mornings, that damn hill felt like a cliff face.

Fortunately, I don’t plan on scaling any cliffs today. Just some hills with the scent of eucalyptus in the air.

One day at a time (still)

Kermit

I had to come home early from my planned trip away because I needed to get my back fixed (official story) and my head fixed (most importantly). You see, if I drink again I’ll end up back on the couch passed out most of the time, which is about the worst thing you can do for a crook back.

The back took 35 minutes with the physio.

The head? I’ve been to a bunch of meetings and spoken with other alcoholics. I’ve gained a fresh perspective and have become right sized again. Not a mean, small little man who is resentful when things don’t go his way. Or the grandiose, obnoxious oaf. Just right sized.

I have also finished an inventory and have realised a few things:

1 I am still an alcoholic and even if I don’t drink today, my addiction is still there lurking. Like a fucking lurker. If I don’t treat it, I turn into an asshole and nobody needs that.

2 The symptoms of my untreated alcoholism, for example feeling restless and irritable seem to increase as I take more things for granted. My sponsor said to start doing a gratitude list again, so I have. Right now, I’m grateful I’m not dead in a ditch, am living in Australia where I don’t have to worry about getting shot walking down the street, and for mangos. Mangos are amazing.

3 When I’m not working my program I tell more people, more regularly, to fuck off. This is unfair to them and marks me as someone incapable of polite conversation. I will also busy myself taking other people’s inventory: I’ll believe it is my right to find the error in someone else’s ways and (worse still) I am arrogant enough to think I can change them. Rather, I should concern myself with cleaning up my side of the street in personal relationships. After all, the only person I can really change is myself.

The other night I went to a meeting in a small coastal town, which was unlike any other I have ever been to. It seemed to be operating more like a personality cult than a healthy AA group, with one guy completely dominating proceedings, including sharing and questions and answers from the floor. I heard that the group doesn’t encourage newcomers to share, with the message they have nothing useful to contribute. What a load of crap.

I believe newcomers are the lifeblood of meetings. I still attend meetings every few days, when I can, to remind myself that I can’t take my eye off the ball. Don’t get me wrong, newcomers aren’t like poverty porn. There is no voyeurism in AA. I just need to hear their stories and see their shakes to remember my own worst moments. To feel my own worst moments.

I also believe AA is at its best when its traditions are observed, particularly the principle that the group is more important than the individual and that no-one is ‘in charge’ in AA. Still, I bit my tongue: it is up to the group to work it all out.

I just wish I could bite my tongue more when I speak to loved ones and people that piss me off in the street.

In sum: AA is not just about putting down the bottle. It’s about learning to live without alcohol. I need to be willing to change the way I think about things and how I react to situations.

A miserable bastard

Season’s greetings from a tiny island in the south Pacific, where the landline to our house has been dead for three weeks and mobile internet is patchy.

Christmas and New Year can be a tough time for we alkies. This is the time of the year where drinking copious amounts of alcohol is normalised. Not surprisingly, AA meetings see a lot of new faces in early January as the hangovers subside and the consequences of bad behaviour coalesce into New Years’ resolutions.

We alkies, however, have learned hard lessons about making promises we can’t keep. Stay sober for a whole month? A whole year? No beer in this weather? You’ve got to be fucking kidding me. This is why we focus on just staying sober today. One day is doable.

However, staying sober for one day becomes a tad more difficult when those things that AA recommends (going to meetings, phone a friend/sponsor, work with other alcoholics) are absent. There are no AA meetings here for reasons I haven’t quite fathomed, however there are plenty of alkies begging for coins on the streets. Unfortunately, my knowledge of the local language is insufficient for conversing with these drunks. After all, it is hard enough trying to work out what a pissed Palangi (whitefella) is saying in English, let alone in an unfamiliar language. In short, I find myself on an island and in a house full of booze with no AA meetings, poor access to online meetings/chatrooms, terrible phone reception and sweaty, thirsty weather.

AA believes that alcoholism persists even after a person has put down the bottle. My behaviour in the last week has been evidence of this: I have been, to use the AA term, a ‘dry drunk’.

I’ll give you an example: I hurt my lower back carrying my pack around during a day in transit. Since I arrived I have been eating Nurofen like popcorn, and blaming everyone else for my condition. My highly anticipated days of getting tubed under the tropical sun have been thwarted, but not completely so. Regardless, I’m full of resentments and have become a nasty, miserable bastard.

Fortunately, I had the wherewithal to call my sponsor yesterday, who told me to write this narrative down. This is because the other narrative that has been on high circulation in my head – e.g. ‘if I didn’t have to lug my heavy pack around because of {insert person or situation}, I’d be having a great time now’ – only serves to create and sustain resentments and does not make me accountable.

Its funny, but when I write this stuff down it loses its potency. I can see that I have been behaving like an overgrown toddler. I will try, today, to do better.

Be more Dog

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Today, I am grateful for the support I receve from my family, close friends and fellow members of AA to keep the good ship H.M. Beagle on an even keel. However, it would be remiss of me not to pay special mention to my non-human kin, otherwise known as dog, because he too has been central to my recovery story.

For starters, you could do worse than have dog’s outlook on life. He wakes up to a new day full of promise. Everything is excellent. He neither dwells on the past, nor worries about the future, because the present is all that matters. He loves unconditionally and doesn’t get grouchy unless it is absolutely called for. A few weeks ago he had his ear pierced by an out-of-control Kelpie. Dog didn’t care, in fact I don’t think he even felt it and wanted to play with the foul beastie.

Also, dog is my best mate and shadow. In the absence of other people being around, he is an excellent companion. But this hasn’t always been the case. When I was drinking, the dog didn’t want to know me.  This isn’t suprising, however. Have you ever smelled a wino in the street? Surely I had the same piquancy, hidden under freshly laundered clothes. I probably didn’t even smell like the same person.

My dog doesn’t care if anyone else has a drink. Just me. He’ll quite happily hang out for beers and the occasional dropped chip. But if I start drinking? Nope. I suspect this is because, dog knows, I have a radical and profoundly negative change in perspective and behaviour when I drink and thus become diminished in the esteem of my peers and pack.

When humans gaze into each other’s eyes, for example a baby looking at its mother, we bond emotionally in a process mediated by the release of the hormone oxytocin in the brain. A group of Japanese scientists found that this gaze-mediated bonding also exists between humans and our closest animal companions, dogs. Nagasawa et al. show that the human-dog bond is facilitated by the interaction of oxytocin feedback loops that evolved over the course of canine domestication:

Urinary oxytocin variation in dog owners is highly correlated with the frequency of behavioral exchanges initiated by the dogs’ gaze. These results suggest that humans may feel affection for their companion dogs similar to that felt toward human family members and that dog-associated visual stimuli, such as eye-gaze contact, from their dogs activate oxytocin systems. Thus, during dog domestication, neural systems implementing gaze communications evolved that activate the humans’ oxytocin attachment system, as did gaze-mediated oxytocin release, resulting in an interspecies oxytocin-mediated positive loop to facilitate human-dog bonding. This system is not present in the closest living relative of the domesticated dog [Wolves].

So, if you feel that you have a closer bond to your dog than you do to most other humans, you’re probably correct. Certainly so if you spend a lot of quality time together.

I never intentionally hurt dog when I was drinking, but the effects of alcohol on our loved ones are not always physical. I was never violent with my partner either. Dog always got given his biscuits and his water bowl never ran dry. He got walked, but like me, he grew soft and nebulous from inactivity. No, fortunately the wounds I afflicted on dog were temporary. I think he was genuinely confused and worried.

Funny as it sounds, I’m committed to making an amends to dog for the perceived hurt and confusion I caused when I was drinking, in addition to the missed walks and adventures when I was comatose on the couch. It is, what we call in AA, a ‘living amends’. This means that we undertake, through our words and actions, to be a better person. To be more Dog.

In practice, this simply means that I make our daily walks and adventures an additional non-negotiable in my routine, along with AA’s suggested actions that include taking care of my nutrition and physical wellbeing, getting enough sleep and exercise, meditating (or praying, if that’s your thing), attending meetings and working with other members.

*Miho Nagasawa, Shouhei Mitsui, Shiori En et. al., ‘Oxytocin-gaze positive loop and the coevolution of human-dog bonds’, Science, 17, Apr 2015, pp.333-336.

 

 

We Agnostics Podcast

It is with great excitement that I share with you a brand new Australian podcast focussing on the recovery of non-religious members in AA.

We Agnostics is ‘a weekly dose of recovery for the non-religious’ with the excellent humanist motto: We may not believe in the supernatural but we believe in you.

The podcast is being developed by a dear friend who shares a similar ethos and athiest/humanist approach to 12-step recovery and sobriety as I do.

Check out We Agnostics (https://weagnosticspodcast.podbean.com/)

(In)dividuality

Walk into an AA meeting on any given day or night, in a library or church hall, pretty much anywhere in the world, and someone will probably attribute their failed attempts at 12 step recovery on their prideful individuality. It is likely they will say something along the lines of ‘I wasn’t ready to get sober because I was terminally unique’. This means that a member was not ready to accept that the methods others had used to get and stay sober could also work for them. I have heard all kinds of reasons for this e.g. I am an atheist, I have done too many awful things, I’m too broken, or I’m not broken enough. However, I suspect any excuse is as good as the next if it shortens the distance to another drink.

This post reflects on what I’ve learned in AA about individuality and what it means to be an alcoholic, to own the past and not repeat the same mistakes in the future. Individuality, here, means much more than just being ‘terminally unique’ as we like to say in AA. It is about how we conceive of ourselves as being distinct from others, and even distinct from earlier versions of ourselves, even if we think these ‘versions’ are nothing more than a chin-stroking possibility. Am I the same person sane and sober, compared to when I was a clearly insane drunk (insanity measured by repeating the same mistake daily)?

The idea of individuality is even murkier when we consider the distinctions we make between mind and body, consciousness and unconsciousness, memory and forgetting, the spiritual realm of the sacred and the mundane world (Durkheim’s ‘profane’), ideas of a separation at death between physical self and soul, or between parts of our personalities (e.g. ego) and our total, composite selves.

AA’s concept of the individual is located in the present rather than the past or the future. In AA meetings, we share our experiences of what it was like when we were drinking, what happened, and what life is like now. The emphasis is on the present, with the past providing context and a resource for learning what not to do. According to AA, the future is a place best left well alone. This temporality, the value AA places on focussing on the present, is best explained by the old AA trope: ‘I had one foot in the past, one foot in the future, and I was pissing on the present.’ It is believed that meditation/prayer, attending meetings and working with other members can assist an AA member to anchor themselves in the present.

Anthropology has always focussed on communities of people, anthro- (people) -ology (study), rather than individuals per se. However, it has lots of really interesting things to say about the nature of individualism, given a person’s ethnicity, culture or religion. For example, Mark Mosco, an anthropologist who has spent considerable time in Melanesia, writes that anthropologists have conventionally thought of Christianity, including the versions spread by various missionaries throughout the Pacific, as being unrelentingly individualistic. Mosco (2015:371) instead writes that many Christians conceive of themselves as composite beings consisting of a physical body and a soul that is a ‘detachable sacred part of the total Christian person’.* Through this, Mosco suggests that ‘dividual personhood’ and agency might actually be more common to the human experience than the so-called possessive individual of modern capitalist society.

On reflection, the ideal ‘possessive individual’ probably doesn’t exist, or if it does, he or she is most likely to be found inside an investment banker’s cocaine den on Wall Street. Too often we remove the grey scale to make black and white distinctions. Regardless, my point is that it’s ok to feel weird, fragmented, or torn between conflicting desires for stability and risk or autonomy and relatedness, because that’s all part of the human condition.

It’s ok to be weird

One of the great things about working in the public service in Australia is the generous working conditions that are a legacy of past, strong unionism in the public sector. These conditions include flexible work hours, ergonomic furniture and the ability to take plenty of leave, including medical leave to get sober.** The public service also throws buckets of money at staff development and training, and this week was my turn to learn about resiliance. I also learned that I am apparantly ill-suited to my workplace!

A consultant walked our class of mid-level public servants through a few quick personality tests that outed me as THE ONLY YELLOW, amid a wiggle*** of blues, reds and greens. We even had to stand on a Twister-style mat on the floor in our respectively coloured sectors. I proudly occupied a whole quadrant in solitude. Apparently I was the only ‘risk taking, artistic, always-asking-why, big-picture type’ amidst a sea of perfectly-suited procedural mandarins. I find this both appropriate and fucking hilarious.

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Nice Digs! Setting up a wombat mange control dosing station under old farm machinery.

There was some good discussion of things like mental toughness, post-traumatic growth, dealing with difficult people, wellbeing, thinking skills, positive psychology strategies, and action planning. All of these things are a familiar part of my AA toolkit, so it was good to see that ‘normies’ can access similar tools as we alkies, albeit transmogrified into the language and neoliberal logic of business psychology.

These days, my boss knows my AA meeting schedule as well as I do during the week. He understands that, like him, I need to go to the gym at lunch to boost my endorphins and keep my stress levels in check. But I also have to get to a few meetings as an additional ‘non-negotiable’. This is part of the natural give-and-take of a high functioning work team and is as it should be. Unfortunately, not too many alkies I know get this degree of flexibility and support at their place of work.

Pride and individuality

Gregory Bateson, social science’s MacGyver, was curious why we alkies are so proud that we are literally willing to drink ourselves to death before we ask for help.**** Bateson (1971:446) suggested this principle of alcoholic behaviour has roots in the strange epistemology characteristic of Western capitalist civilization. For Bateson, the wordview of the ‘West’ or the ‘Occident’  is means-to-an-end driven and hyper-competitive and, if he were alive today, he would probably point to Instagram’s platform of hyper-individualised personal branding and marketing as a shining example of a world gone awry.

While the active alcoholic seeks only to satisfy her or his own immediate needs and wants, primarily alcohol above all else (including the needs of loved ones), Bateson suggests that the alcoholic who wants to get sober tilts even further towards the extreme end of individualism. Bateson (1971:447) writes that sobriety, at this point, is no longer the appropriate context for the individual’s pride. Rather, ‘It is the risk of the drink that now is challenging and calls out the fatal “I can. . . .’

For me, this explains well my stepping off point from so-called functional alcoholism, to disastrous drunk. The whispered challenge that, on this occasion, things will be different and that one drink would be safe, set me on course for week-long benders of self destruction.

Bateson also noted that ‘A.A. does its best to insist that this change in contextual structure shall never occur.’ He explains that:

…they [AA] restructure the whole context by asserting over and over again that “once an alcoholic, always an alcoholic.” They try to have the alcoholic place alcoholism within the self, much as a Jungian analyst tries to have the patient discover his “psychological type” and to learn to live with the strengths and weaknesses of that type. In contrast, the contextual structure of alcoholic “pride” places the alcoholism outside the self: “I can resist drinking.”

Tragically, we alkies and addicts are like the kid who touches the hot stove again and again to check that it is hot. Rather than acknowledging the folly of our own behaviour, Bateson saw that we alkies instead get resentful at the stove, or the universe:

It is all very well to test once whether the universe is on your side, but to do so again and again, with increasing stringency of proof, is to set out on a project which can only prove that the universe hates you.

These days, I don’t have a voice whispering things like ‘just grab a beer, you’ll be right after three years’, because I own my alcoholism daily. I go to meetings to remind myself of this simple fact, and I try to volunteer and engage in random acts of unsolicited kindness as often as possible. AA teaches that the best way to get over yourself, and your own selfish needs and wants is to do something nice for someone else. When in doubt? Pay it forward! Sometimes all this has to be is a phone call, out of the blue, to another AA member to say “how’s it going”? If they are having a rough day, they’ll appreciate it.

AA allows isolated individuals the opportunity to re-engage with society and relearn how to have healthy social relationships again. It teaches that no person is an island, and that even the worst of us can change and make amends. We learn, through reviewing our behaviour and motivations, that we are happiest when we are part of society, not apart from it.

*Mark Mosco, ‘Unbecoming individuals: The partible character of the Christian person’, HAU Journal of Ethnographic Theory, 5(1), 2015, pp. 361-93. Note: italics are his emphasis.

**It is no revelation that these favourable conditions are currently being eroded by prolonged slow wage growth, an ideological war by conservative governments to quell the influence of unions in the economy, and low union membership by historical standards.

***A ‘wiggle’ seemed to be as good a collective noun as any. Also, a group of wombats is a wisdom. See here for more info about ACT Wildlife Volunteers’ program for treating mangey wombats.

****Gregory Bateson, 1971, ‘The Cybernetics of Self: A Theory of Alcoholism’, Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology, University of Chicago Press,  pp.440-56.

A reply to Antze

If you google ‘anthropology’ and ‘alcoholics anonymous’ you will likely come up with a hit for a chapter in a book edited by Mary Douglas.* In ‘Symbolic Action in Alcoholics Anonymous’, Paul Antze (1987) offers a Geertzian-style symbolic anthropology of how AA works. I’m sure Antze’s chapter reads perfectly well to other anthropologists, but as an alkie, and an AA member, it grates. Let me explain why.

Cocks!

Now that I got your attention: symbolic anthropology was very much in vogue in the early ’80s, a decade after Clifford Geertz’ Deep Play: Notes on the Balinese Cockfight (1972) had inspired a new direction in writing about and understanding cultural situations. Geertz’ analysis of the Balinese Chook Thunderdome**, includes some of the obvious penis puns that one would expect, as outlined in this lovely bit of writing:

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Similarly, if you hang around AA members long enough you will realise that we really only share one thing in common, and we are as much defined by our relationship with this dangerous-yet-alluring substance as we are by its absence: Alcohol is our defining symbol par excellence.

Unsuprisingly, Antze makes a good fist of likening AA to totemic societies who practice avoiding something because they belong ‘to a category of persons uniquely endangered by it’:

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As an anthropologist, I understand Antze’s analogy well, having researched the patrifilial totems (an identity passed down from father to son) of a number of Koori groups in south-eastern Australia. Indeed, a close friend of mine has a particularly badass bird of prey as his personal totem. He is responsible for holding and looking after the country that sustains that magnificent bird. Alcohol, by comparison, is a shitty totem and, I might add, the comparison is rather low hanging fruit.

What Antze is also doing here is distilling alcohol – separating the substance from its deeply embodied affects on we alcoholics (for example, memory loss, brain damage, anxiety, sweating, heart palpitations etc etc etc). He is doing this, presumably, because he has never experienced these sorts of things as a result of his drinking. Although, we never know, because, science.

It reminds me of something Bree Blakeman, an Australian anthropologist, intersectional feminist, anarchist, blogger and all round excellent human, wrote (albeit in a different context):

I remember one of my most admirable anthropology teachers once commented (upon reading my work) that my use of theory visa vi the subject of analysis was ‘like trying to dissect a microchip with a carving knife’. It’s kind of how I feel about anthropological analysis of emotion and morality without an understanding and account of how individuals learn and process both thoughts and emotions. This stuff happens in the brain (and yes, in the body – the brain is in the body).***

By distilling alcohol from its affect on the addicted bodies and minds of alcoholics, Antze’s symbolic analysis similarly feels like carving ivory with a chainsaw.

Reflexivity

My main beef with Antze’s take on AA is that he steadfastly holds a perspective of the rigorous, dispassionate, objective observer throughout. From an AA member’s perspective it reads like he’s spread the collective, addicted body of AA open on a glass slide, made a few well-placed slices with a scalpel to splay out the good bits, and recorded and analysed the ordeal with a jeweller’s loupe.

But, does he drink like a fish, and should we care?

More importantly: is he one of us?

Or is it none of our business?

Antze provides a rare glimpse into his research methodology in the footnotes, stating that he mainly relied on printed AA materials along with ‘observation at meetings’ that provided ‘an essential check on the relative importance that various teachings assume in the thinking of members’. He attended at least two dozen AA meetings in Chicago and Toronto. By my calculations, Antze’s period of fieldwork totalled less than two whole days in the field, given an average AA meeting runs for 90 minutes.

Anthropologists have long talked about the need for reflexivity in their work. Reflexivity is when an anthropologist looks and accounts for their own subjectivity (things like personal failings, biases and relationships with their informants) in recording or documenting a cultural situation. It is also about something similar to the observer effect in physics – or how an anthropologist’s consciousness is altered when they engage in a cultural situation that they are observing.

Remember Erwin Schrödinger’s 1935 thought experiment, where he presented a scenario about a poor cat that may or may not be both alive and dead? I like to imagine Erwin was hanging out at a particularly hip pre-war party:

Erwin: I call this quantum superposition. The cat is linked to a random subatomic event that may or may not occur. It’s like the wave collapses upon observation.

[Passes joint to Klaus]

Klaus: Duuuuuude.

Now, I don’t mean that an anthropologist’s informant suddenly disappears *whoosh* when they hang out together. Rather,  I think reflexivity stresses the need for researchers to be critically self-refective, to recognise that our personal objectivity has limits, and that anything we do necessarily places us in the thick of the action – thereby making us accountable.

This is like doing AA 12 step work.

A good example of reflexivity in practice is found in our old friend Geertz’s notes on the illegal cockfight, where he sets the scene by describing how he and his wife were caught up in a police raid, and bolted in fear along with everyone else. Once they had caught their breath, Geertz noticed that the Balinese were pretty impressed by the white folk’s footspeed:

But above all, everyone was extremely pleased and even more surprised that we had not simply “pulled out our papers” (they knew about those too) and asserted our Distinguished Visitor status, but had instead demonstrated our solidarity with what were now our covillagers. (What we had actually demonstrated was our cowardice, but there is fellowship in that too.) Even the Brahmana priest, an old, grave, half-way-to-Heaven type who because of its associations with the underworld would never be involved, even distantly, in a cockfight, and was difficult to approach even to other Balinese, had us called into his courtyard to ask us about what had happened, chuckling happily at the sheer extraordinariness of it all.

Dr Blakeman describes these times where we lose our shit as ‘Geertzian moments’:

These are pivotal moments when something in one’s disposition and social relations shifts dramatically. Often it’s a moment of losing oneself and behaving in a way that one wouldn’t have expected or couldn’t anticipate, and it’s not until afterwards when you pause and reflect that you realise what has just occurred. It is in that moment of reflection that the ethnographer realises they’ve reached some tipping point of enculturation. This tipping point, in turn, changes the way that the ethnographer is perceived and treated. You become less of an outsider and start to be considered and treated more like ‘one of us.’ In this sense, there’s an element of intimacy and trust involved and I suspect this is because so-called ‘Geertzian moments’ are often triggered by some stressor and the ethnographer’s response often leaves them vulnerable or exposed in some way.****

Unfortunately, we never get this from Antze’s chapter. He doesn’t lose his shit, or at least if he does, it doesn’t get acknowledged. And yes, I have a resentment about this.

Resentments, or throwing out the baby with the bathwater

And you thought you’d get through a whole AA blog without having to read about resentments! It’s true, AA understands that one of the fastest routes between recovery and another drink is to nuture a resentment.

Every single AA meeting has a story about a resentment, and how that resentment is causing an individual to feel restless, irritable and discontent. In most cases, it is a niggling, piddly thing: 99 percent of something might be perfectly ok, but we choose to focus on the one percent. Then we fertilise and water it until it grows unruly.

My resentment against Antze’s chapter can be summarised as:

  1. I identify as a member of AA – a member of the ‘in-group’ of Antze’s study
  2. I feel that group identity is threatened. This is an irrational fear, and
  3. I look for and focus soley on the weak points in Antze’s argument, rather than weighing the contribution of the chapter as a whole.

What Antze does particularly well is show how medical concepts – such as the idea of alcoholics being sick people – become ‘common sense’. He argues, quite rightly, that the popularity of this idea in medicine actually comes from AA, and AA’s therapeutic successes.

But, like a surfing buddy probing a fleshwound for coral, Antze presses straight on the raw nerve: he questions our unthinking acceptance of our alcoholic status.

Then, he applies 30 percent hydrogen peroxide with a nail brush and scrubs out the wound to remove any polyps: he suggests that we exist in a feedback loop, dependent upon our willingness to define our experiences in the terms ascribed by the institution of AA.

You know the hydrogen peroxide is working when it fizzes.

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Good anthropology should make a reader question their reality by making contrasts – pulling apart bits of meaning for interpretation and analysis. Antze does this in spades.

However, should an anthropologist ask the subject of their inquiry to question their reality – for example, an individual’s belief that recovery from a progressive, ultimately fatal illness is contingent upon their willingness, acceptance and observance of AA’s philosophy? That is a different moral question entirely.

Fortunately, I didn’t read Antze’s chapter in early sobriety. If I did, I probably would have used it as a reason to drink again. Picking apart holes in AA logic was a favourite sport of mine, along with many of my fellow heathen alkies. These days, I’m happy just to accept that it appears to be working,

 

* Paul Antze, ‘Symbolic Action in Alcoholics Anonymous’, in Constructive Drinking: Perspectives on Drink from Anthropology, Routledge, London, 2003 (first published 1987), pp.149-80.

** Clifford Geertz, ‘Notes on the Balinese Cockfight’ in The Interpretation of Cultures, Basic Books, New York, 1973, pp. 412-54.

*** Bree Blakeman, Zigon on Morality and Ethics in ‘Ethos’, Fieldnotes and Footnotes, 4 December 2009.

**** Bree Blakeman, ‘Geertzian moments (or, “when ethnographers lose their shit”)’, Fieldnotes and Footnotes, 19 March 2016.

Three years

It’s my third AA birthday today so I feel it is my duty to share with you a picture of Johnny Cash, sitting in a bush eating cake. You are most welcome.

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Uncredited – circa 1971

FYI – an AA birthday is the number of years you have of continuous sobriety from grog, as distinct from your belly button birthday. Also, I’ve heard bearded, heavily tattood 150kg leather-clad bikers refer to their ‘belly button birthday’, which is rather hilarious until you point it out to them. Also, it’s a good thing said bikers have a cumilative age of 55 years of sobriety up, and a saintly degree of patience with newly sober smart asses (I know this to be true after going to a punk gig with them last year. Their patience in the mosh pit – with beer soaked shoes being pushed into their faces by crowd surfers – was a thing of beauty.)

On my AA birthday, I just want to reflect on how far I’ve come in three years. For starters, remember how I said I wanted to punch a sanctimonius catholic? Well, he’s my sponsor. We drink coffee once a week at Maccas and he gives me good advice on home repairs.

Also, I don’t recoil when I see the word GOD on the AA banners or in the big book any more. I realised that I have a niggling resentment against organised religion, although despite some work on my part it still persists.

You’re such an inspiration for the ways
That I’ll never ever choose to be
Oh so many ways for me to show you
How the savior has abandoned you
Fuck your God
Your Lord and your Christ
He did this
Took all you had and
Left you this way
Still you pray, you never stray
Never taste of the fruit
You never thought to question why

A Perfect Circle, ‘Judith’, Mer De Noms, 2000.

AA only says that you need a higher power. It doesn’t specify what that has to be, excepting yourself. I suspect this is why AA also believes an alcoholic’s ego is all powerful when they drink. As soon as I have a drink, the only thing that matters is my own selfish needs and wants.

So, if we have to be able to hand our power (or personal agency) over to something of a higher order, it just has to be something external. It could be your dog, for example (god spelled backwards – see what I did there!), The Force, or Odin the Norse god.* You can break up G.O.D. into an acronym if you’re feeling particularly clever and wordsmithy. I quite like Group of Drunks. I don’t particularly like Good Orderly Direction, but that might have something to do with my problem with authority.

For a while I was just happy to let the fellowship of AA be my higher power, and my trust in my fellow human beings was well placed. These days it’s more of a holistic, literal not-me, best accessed by being in nature or with other people.

The AA third step dawned on me one day when I was surfing, scratching around on a freshly-minted Firewire frantically like a chicken chasing worms after rain.

Made a decision to turn our will and our lives over to the care of God as we understood Him.

The surf was excellent, but entirely random and shifty. I was getting frustrated because everywhere I looked there were gold nuggets, except for where I was sitting at the time. But what if I just sat there and let the opportunities present themselves, rather than attempting to control an uncontrollable situation?

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Tasman Sea peaks under a stiff sou-wester: 1hr, 30 mins from Australia’s inland capital.

 

I’m not sure if Huey acknowledged my newfound hippy spiritualism, but he sent the wave of the day.

I mentioned previously that my epistemological change (change in perspective) has been more of a slow burn than the thunderbolts and lightning of a profound spiritual experience. A good example of this is found in my notes following my first ever AoD consultation – the one where they ask you a series of questions to figure out how sick you are.

For context: I was trying to obtain a doctor’s letter to cover my ass with work. I was not trying to give up alcohol – just hoping to:

a. ameliorate my immediate problems of unexplained absences and pesky bosses

b. give my partner some confidence I was actively doing something about my problem drinking, and

c. find a magic pill to let me drink like normal people.

I was ushered into a consultation room with an exhausted-looking but very kind, patient and capable AoD specialist.

These days, to be diagnosed with an Alcohol Use Disorder (AUD), we need to meet criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Version 5 (2013). Under DSM–5, anyone who scores two or better out of the following 11 criteria during the same year receives an elephant stamp and a pat on the head (just kidding, a diagnosis of AUD.)

The severity of your AUD—mild, moderate, or severe—is based on the number of criteria met. I like to imagine I walked into my local AoD in 2013 and walked out with POOR IMPULSE CONTROL freshly branded and steaming across my forehead. Alas, it was not meant to be.

AoD workers will ask something like …’in the last 12 months, have you:

  • Had times when you ended up drinking more, or longer than you intended? Yep
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t? Aha, every day.
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects? Errryday.
  • Experienced craving — a strong need, or urge, to drink? Your head turned into a beer ten minutes ago.
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems? *tears*
  • Continued to drink even though it was causing trouble with your family or friends? Even the dog avoids me like the plague when I’m drunk.
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink? I’ve forgotten what interests me and gives me pleasure, apart from alcohol. Everything else can get fucked.
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)? All of the above.
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout? I can’t remember a thing after I have my first beer.
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before? I used to drink other people under the table. Now my only drinking buddy is the table.
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there? I give up.

The funny thing is, after mentally checking off each of the DSM-5 criteria, I answered ‘nope’ to all bar the first two. I also wrote that the ‘guy had no idea’. I was chatting to my friendly AoD specialist after I had a year’s sobriety up. He laughed and said ‘of course I knew you were bullshitting’!

I mentioned previously that this is an AA related blog with an athiest/humanist bent and a bit of a punk attitude. I will be sharing some resources I find helpful on here soon: including a selection of AA related literature and other online content that is written and created by, and for, we heathens. In addition, there are a range of athiest, agnostic, humanist and/or freethinker meetings in Australia, and internationally, as well as online support groups.

An example of this genre of writing is ‘Get Up’ (2008) by US spoken word artist, author and recovering alcoholic Bucky Sinister. Sinister draws on his time spent drinking and later recovering within the US West Coast punk scene. This book opened a crack in my mind that let recovery in. It is a brilliant book, at turns funny, thought provoking and genuinely inspirational.

I’m going to celebrate three years by throwing a 10kg ball up a wall a bunch of times listening to Puya – a Puerto Rican progressive metal band a dear friend got me hooked on. Good times!

* Bucky Sinister, Get Up: A 12-step Guide to Recovery for Misfits, Freaks, and Weirdos,  Conari Press, San Francisco, 2008, p. 57.