Helping Other Alcoholics Helps the Helper

In the Fall of 1990 Bill Wilson made Life’s list of the “100 most important Americans of the 20th Century” for his efforts, along with Akron’s Dr. Bob Smith, in establishing Alcoholics Anonymous in the 1935. Why do you think AA and its Twelve Steps work for alcoholics in recovery?

The Twelve Steps are as follows:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

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

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all the persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as a result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

The Twelve Steps can be summarized under four key categories:

*recognition that the individual is powerless to overcome alcoholism

*faith and connection with a Higher Power

*deep moral inventory including apology and amends

*service to others, and especially, to other alcoholics

AA literature speaks of the Steps in terms of four interwoven principles: surrender, reliance on a Higher Power, redemption, and service. Each contributes to a transition from egocentrism to concern for others. AA itself defines alcoholism as a disease of selfishness, and understands recovery (a lifelong ongoing process that is never complete) as involving personal responsibility. While current AA literature recognizes genetic susceptibilities to alcoholism, it does not accept a genetic determinism that would diminish responsibility or suggest a passivity in the face of this illness.

(1) Surrendering the Inflated Self

Alcoholics Anonymous, subtitled The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, is called the “Big Book” in AA circles. First printed in 1939 (now in its 2001 fourth edition), the opening segment of this spiritual-moral treatment manual begins with the words “We of Alcoholics Anonymous.” The essence of the program is captured in the passage, “we work out our solution on the spiritual as well as an altruistic plane,…”(2001, p. xxvi). Nowhere is the word “I” to be found because self-preoccupation is considered the root of the problem. Grandiosity is replaced by anonymity and humility. Any solution lies in the “we” of fellowship centered on a Higher Power, and the recognition that “I” cannot rescue myself (p. 201).

Surrender includes becoming a part of a group that reverses the peer pressure to drink. American society accepts and even celebrates the consumption of alcohol, making those who abstain from drinking into deviants. AA is thus a counter-cultural community. Most adults as well as teens need compliments and affirmations from others when they are trying to overcome unhealthy behaviors. In AA, people surrender themselves to a “We” that protects them against the culture of drink.

(2) Reliance on a Higher Power

AA understands that the alcoholic must have a connection to a Higher Power, however loosely defined, which alone is powerful enough to fill the void that was previously flooded with alcohol. Meetings usually begin with the brief “Serenity Prayer.”

Columnist David Brooks of the New York Times (June 28, 2010) quotes the self-reported experience of Bill W, not previously a believer, as he experienced a white light that he perceived as the presence of God. As this occurred in his hospital room at a New York detox center on his fourth day of treatment: “It seemed to me, in the mind’s eye, that I was on a mountain and a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man.” Bill W never drank again after that spiritual experience of December 14, 1934.

Not everyone in AA is equally spiritual, and only some report an intense spiritual experience like that of Bill W. Yet there is a great deal of spirituality among AA members. Some come into AA with a strong spiritual history that is still vital and active in their daily lives. Others come in no longer spiritual or religious, but having been so earlier in life. There are those who have never been spiritually or religiously engaged in the past, but their involvement with AA brings them to spirituality as they are affirmed and seek to acculturate to this healing community.

This spirituality achieves several important things. First, such a Higher Power functions to create an absolute quality to abstinence, which becomes more than a mere human contrivance or a matter of “relative” value. Abstinence is therefore non-negotiable. Second, reliance on a Higher Power takes the place of alcohol in filling the emptiness within. This theme of spiritual emptiness or incompleteness and the misplaced efforts to find fulfillment through things other than spirituality can be found in the writings of western spirituality from the 4th century. Third, this spirituality frees the self to concentrate on contrition and service.

(3) Redemption

Moral inventory, offering apologies, and making amends lies in the center of the Twelve Steps. Call alcoholism a disease of narcissism (psychiatry), solipsism (philosophy) or sin (theology), the language does not matter. The alcoholic is often hopelessly unconcerned about the damage that he or she inflicts on others. Recovery thus involves a major moral transformation. When an alcoholic shares his or her dark secrets and past experiences with alcohol, they reach a fellow sufferer like “no one else can” (AA, 2001, p.89). Transforming past mistakes to good (i.e. redemption) also occurs when an alcoholic faces the wreckage of his past and mends the bridges he burned with others.

Progress is made by the daily pruning of egocentrism: “Selfishness – self-centeredness! That, we think, is the root of our troubles” (AA, 2001, p.62). And further, “Above everything, we alcoholics must be rid of this selfishness. We must, or it kills us” (AA, 2001, p. 62)! The Big Book refers to selfish resentment, dishonesty, self seeking, and unkindness, among other manifestations.

(4) Service

The Twelfth Step reads: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs” (AA, 2001, p. 60). The Big Book is abundantly clear: “Our very lives, as ex-problem drinkers, depend upon our constant thought of others and how we may help meet their needs” (AA, 2001, p.20). The word “constant” indicates that this concern with helping other drinkers must become an enduring daily practice to keep the disease in remission. AA literature teaches the alcoholic to apply the spiritual principle of service in all his affairs, to practice “tolerance, patience and good will toward all men (AA, 2001, p. 70), and to “place the welfare of other people ahead of his own” (AA, 2001, p.94).

The preceding eleven steps must be “accompanied by self sacrifice and unselfish, constructive action” (AA, 2001, p.93). Members of AA understand that as they help other alcoholics, they also help themselves. This principle is clear in the purpose statement of Alcoholics Anonymous (AA): “Our primary purpose is to stay sober and help other alcoholics to achieve sobriety” (AA, 2001, p.100). There is a relevant aphorism: “If you help someone up the hill, you get closer yourself.” There is a deep sense of purpose in such a role, and a powerful new self-identity as a “wounded healer,” one who assists others from one’s reservoir of first-hand knowledge.

The 12 Steps have been practiced daily in the lives of recovering alcoholics since 1935. It is curious that empirical study of the link between helping others and staying sober first manifested only in 2004 (Pagano, et. al., 2004). Using data from Project MATCH, one the largest clinical trials in alcohol research, Pagano and colleagues found that alcoholics who helped others during chemical dependency treatment were more likely to be sober in the following twelve months.

Does helping other alcoholics work? YES. In the one-year period after day one of going “dry” (this probably includes entering detox for several weeks or months at the outset) 40 % of those who report high levels of helping other alcoholics (top half) are still sober. Only 22% of those who report lower levels of helping other alcoholics (lower half) are still sober after one year. So, it appears that robust helping doubles the likelihood of recovering from alcoholism in the first year window. Bill W and Dr. Bob had it right.

So, does all this have value for other social movements? The obvious principle of immediate relevance is mutual aide. Mutual aide can be applied to any number or other social movements, and not just those 300 focused on addiction disorders in which the Twelve Steps are already the international norm. Older adults can and do benefit by serving and volunteering, rather than by just receiving. School children can benefit by tutoring children in the younger grades, as we see in the Montessori system. In health care, organizations from Cancer Survivors to Mended Hearts focus on how they can be helpful to others who are experiencing the same challenges they have faced. Its effects are as considerable for recovery from mild or moderate depression, for example, and a number of institutions have used this as a treatment recommendation.

Below is the Service to Others in Sobriety (SOS) scale that is typically used in studies of “mutual aid” and outcomes. It is based on a rating from 1 to 5 (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always). This SOS scale was developed by Dr. Maria I. Pagano, Ph.D., PI of the Helping Others Project.

SOS items are as follows:

1. Took calls or spent time with a sponsee

2. Guided an alcoholic/addict through the 12-Steps?

3. Held a service position in a 12-Step program?

4. Say something positive to an alcoholic/addict?

5. Listened to an alcoholic/addict?

6. Say hello to a newcomer?

7. Reached out to an alcoholic/addict having a hard time?

8. Shared personal story with an alcoholic/addict?

9. Read program literature to an alcoholic/addict?

10. Encourage an alcoholic/addict to go to a meeting?

11. Donated money to AA/NA?

12. Put away chairs after a meeting?

13. Overall in the past month, how much did helping other alcoholics help you to Not drink or use drugs? (not at all, a little, some, a lot)