In April 2015 The Atlantic published an article by the journalist Gabrielle Glaser titled ‘The Irrationality of Alcoholics Anonymous’. I first read the article when it was published, at a time when I was struggling with my own relationship with alcohol and deeply ambivalent about AA. Even then I was irritated by the article’s treatment of AA. I recently came across the article again, nearly eight years later and nearly seven years sober, with entirely different experience and a very different (but still ambivalent) relationship with AA and I find myself still irritated by the article. It’s a mess, flawed in every conceivable way and above all, deeply, deeply dishonest. At some point I’ll thoroughly and comprehensively address the article’s many misrepresentations of AA, it’s faulty logic, take it apart piece by piece. But for now I will limit myself to addressing one aspect of the article, its attack on abstinence as the core of AA’s approach to recovery from alcoholism.

The insistence on abstinence is the first aspect of AA that Glaser takes on. She leads her article with the story of J.G., a lawyer in his early 30s.  J.G. started drinking at 15 and by the time he was in college, already had a serious drinking problem. Already, back then, in college and law school, J.G. would occasionally “pull back” from drinking, going cold turkey for four to six weeks at a time. But he’d always be drinking again before long. By the time he was a practicing attorney, J.G. was often drinking a liter of Jamison an day, starting after his first morning court appearance. He installed a breathalyzer in his car. After some time, J.G. decided he needed help and went to a rehab, which, like most rehabs relied heavily on AA and its twelve steps. After leaving rehab, he kept going to AA meetings, even though he was put off by the spiritual aspects of the program. As it turns out, J.G. didn’t stay sober, instead going off on a cycle of bingeing and abstinence. Sound familiar? It does to me. I had a very similar experience. But through some clever storytelling, Glaser presents a surprising conclusion: AA did not only not help J.G.. It actually caused the cycle of bingeing and abstinence that he experienced after going to AA. That’s right. A mere two paragraphs after describing J.G’s years’ long history of bingeing and abstinence before he ever went to a single AA meeting, Glaser tells us that the bingeing and abstinence he engaged in after going to AA were actually caused by the very messages he heard in AA!  

Here’s what she says exactly: “Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.” This is followed immediately by “J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence”. Let’s take a close look at this. People in AA told J.G., who started drinking at 15, was bingeing and going on the wagon by college, was drinking as much as liter of Jameson a day by the time he had become a young professional, and who had installed a breathalyzer in his own car before seeking help, that he had a chronic and progressive disease. Let’s leave the word “disease” alone – some people may have reasons to dispute that. But who would dispute that, disease or not, J.G.’s drinking was chronic and progressive? Nothing could be more clear.

But what about the second part, that “if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender”? To be clear, the sentiment in this sentence is a way of expressing an unquestionably key AA teaching, really the core of AA’s description of alcoholism. In meetings it appears as the oft-repeated refrain that “it’s the first drink gets you drunk.”

The first drink gets you drunk? Huh?

People in AA will say things like “Waking up in a stupor and trying to make sense of what happened the night before, I tried to figure out if it was the 10th or 11th shot of Jameson that did me in. But after coming to these meetings for a while, I realize now that it was the first drink that got me drunk.” It’s meant to be counter-intuitive and a little bit funny when people say this; normal drinkers are familiar with the experience of “having one too many” and of course alcoholics especially tend to drink in large volume and also to have high tolerances for alcohol. But it also expresses the core of Alcoholics Anonymous’s definition of alcoholism.

In the last section of the preface to the Big Book, titled The Doctor’s Opinion, Dr. William Silkworth, a medical doctor with whom the founders of Alcoholics Anonymous worked, describes a “phenomenon of craving” that sets in when an alcoholic consumes alcohol. According to his description, this phenomenon is limited to chronic alcoholics and “never occurs in the average temperate drinker.” It is precisely for this reason, according to this understanding, that once a person becomes alcoholic, he can never safely drink again. He can’t moderate because with the first drink, a “phenomenon of craving” sets in.

Now, in the years that I spent drinking and even in the years I’ve been sober, I’ve spent a good amount of time with people who drink, around people when they are drinking. My wife is a normal drinker. She enjoys a cocktail from time to time. I’ve even been with her, literally once or twice, when she’s had “one too many.” I’ve been with her when she’s had a drink, enjoyed the way it made her feel, and really wanted another. I’m not sure I’ve ever heard her say it, but I can imagine her saying something like that she’s been craving a gin and tonic all day. Is that what we mean? Except that with an alcoholic, it’s really bad? Except that unlike the normal person who (occasionally) looks forward to a drink all day and wants another when the first one makes them feel good but has the good sense and self control to stop before turning themselves into a complete mess, the alcoholic lacks the willpower and self control to stop?

Well, yes and no. And the no is the important part.

According to the AA literature, the phenomenon of craving distinguishes the alcoholic from other people. It only happens to alcoholics. And the Big Book goes through great pains to distinguish heavy drinkers from alcoholics. Every alcoholic knows people who drink a lot but who are nevertheless not alcoholics. Most of us spend a good portion of our early sobriety envying them. We also tend to envy, early on, the way they can have a drink, enjoy it, want and enjoy another, maybe even get a bit carried away, maybe even do something embarrassing, and yet go on with their lives without any negative consequences. We see how they can do it and we can’t.

Because the when we talk about craving in the alcoholic sense, we don’t mean it as a hyperbolic description of someone wanting something, but as an an intense, urgent, or abnormal desire or longing.

And while a key difference between the normal or even heavy drinker and the alcoholic is, in fact, related to a lack of willpower on the part of the alcoholic, this lack is not one of degree. It is absolute. Binary, on-off, true-false, yes-no. Boolean. The craving for more alcohol is compulsive; it overpowers the will to such a degree that, for the alcoholic, as regards alcohol willpower is no longer a meaningful concept.

Experience of this abnormal, compulsive desire for more alcohol after taking the first drink is, finally, the definition of alcoholism: people who suffer from alcoholism experience an intense craving upon a single drink. Part of the reason non-alcoholics have such trouble understanding alcoholism is that, while they may enjoy the pleasant sensation of a drink or two, and may want more of that sensation, they don’t experience it as a craving. They may at one time or another have too many, as a form of questionable judgment, but they still have a capacity for judgment that is lacking in alcoholics.

As such, the alcoholic who set out to have just one drink will invariably continue drinking after the first one, even if the first one provided a great amount of relief and comfort and even if he knows rationally that continuing to drink will almost certainly lead to problems.

There may be instances in which the craving is not immediate, occasions where the the capacity to resist another drink is not immediately hindered. This is part of the reason the word cunning is often used to describe alcoholism, as it was in the warnings to J.G.from people in AA. There may be times when the alcoholic can get away with a drink for a short period of time. But for real alcoholics attempts to drink moderately invariably lead to consumption that escapes control.

“All of us felt at times that we were regaining control, but such intervals usually brief were inevitably followed by still less control, which led in time to
pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.”

I KNOW THIS EXPERIENCE MORE INTIMATELY AND WITH GREATER CERTAINTY THAN I KNOW ANYTHING IN MY LIFE.

I quote the Big Book not because I take it as an authority. I can say that I learned this in AA, but the truth is that AA gives language to something I have learned by repeated experience. I read those early chapters and say, yes, that is my experience exactly. I am grateful someone else knows it, because the non-alcoholics in my life can only imagine these experiences in an abstract way. Please believe me when I say that I have fought to disprove this doctrine with more vigor and determination than I’ve fought for anything in my life. I really, really wanted to learn to control my drinking, to become a moderate drinker. I spent years trying, both before and after going to AA. It’s an important part of my story.

There’s a lot in the Big Book that doesn’t really speak to me these days. To Wives is embarrassing to read. We Agnostics is, for me, not remotely compelling. But the early chapters that describe the condition of active alcoholism really nail it; they describe my experience to a T. The most important passage in the entire book, for me, comes in the chapter More About Alcoholism: “The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death.”

There are people in AA who mangle the messages and ideas, who take a dogmatic or otherwise unsophisticated approach to the program and the twelve steps. Discerning the (let’s say) “high quality” AA from less good AA is one of the main reasons for this blog. There are also things that are actually part of the program, mangled or not, that I find worthy of criticism. But in probably two thousand meetings I can’t recall ever hearing anyone say that one drink might as well be a hundred, certainly not in the sense that J.G. conveyed in Glaser’s article. I can’t imagine anyone I’ve ever known in sobriety telling someone who has just taken a drink that he might as well have 99 more.  If one alcoholic in AA calls another alcoholic in AA and tells him that he’s had a drink, unless the person calling is at risk of physical withdrawal, the first thing the person called will do is have whatever alcohol is present in the residence removed. No one would ever say, now that you’ve had one you might as well as have a hundred. 

There’s no way to know whether it’s deliberate rhetorical trickery on Glaser’s part or misunderstanding on J.G.’s or Glaser’s part, but to say that “if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender” simply does not mean the same thing “one drink might as well be 100”, especially and certainly not as a bit of advise offered by a sober alcoholic to another alcoholic who has just had a drink. It’s also rather astonishing how credulous Glaser is in accepting J.G.’s explanation of his continued bingeing and abstinence post-AA. Same behavior, new cause. Again, any recovering alcoholic will immediately call bullshit on this. Nearly all of us have vast experience of blaming others and finding excuses for our drinking. Wrestling with and overcoming such thinking is an important part of our recovery. It happens as part of taking the steps.

It’s also noteworthy that despite presenting the abstinence protocol as a primary criticism of AA, at three different points in the article Glaser cautions against actually trying it. Referring to the addiction specialist Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, whom J.G. is seeing as of the time of the article’s publication, Glaser says the following:

In his treatment, Willenbring uses a mix of behavioral approaches and medication. Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence. He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. (According to the DSM‑5, patients in the severe range have six or more symptoms of the disorder, such as frequently drinking more than intended, increased tolerance, unsuccessful attempts to cut back, cravings, missing obligations due to drinking, and continuing to drink despite negative personal or social consequences.) Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support. “We can provide treatment based on the stage where patients are,” Willenbring said. It’s a radical departure from issuing the same prescription to everyone.

But AA doesn’t issue the same prescription to everyone; it issues the same prescription to alcoholics, i.e. people whom the DSM-5 criteria designate as having severe alcohol-use disorder. In fact, the Big Book goes through great pains to distinguish alcoholics from heavy drinkers and specifically asks people considering the program to try some controlled drinking tests to determine whether they really belong there. “If anyone who is showing inability to control his drinking can do the right- about-face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!”

At the end of the article we learn that J.G. now sees Dr. Willenbring every 12 weeks, where Willenbring refills his prescription for baclofen, a muscle relaxant, and occasionally prescribes valium for J.G.’s anxiety. J.G. says he has “successfully drunk in moderation on occasion, without any loss of control or desire to consume more the next day”. Even still,  “J.G. doesn’t drink at all these days, though he doesn’t rule out the possibility of having a beer every now and then in the future.”

What can we conclude from this? For one thing, we can conclude that it’s possible to quit drinking completely with the aid of regular visits to a healthcare professional who prescribes muscle relaxants and valium. I certainly agree that it is possible for people, even severe alcoholics, to quit drinking without AA, especially if they have some other kinds of drugs to take the edge off. I did that for years with marijuana. Many alcoholics may even stay completely sober without the aid of AA. I believe that more and more as I spend time away from the program as such. But J.G. ’s role in the article was to challenge AA’s insistence on abstinence for alcoholics and nowhere in J.G.’s story do we see anything like a sustained ability to drink moderately. In other words, if anything, by the end, J.G.’s story appears to validate abstinence..

Ah, yes, but he doesn’t rule out the possibility of having a beer every now and again in the future! So, yeah, he’s abstaining. But he doesn’t, like, have to, you know?

One seriously wonders if Glaser is trying to advocate for some sort of “reverse psychology” gimmick in which even though it is known that the alcoholic can’t really ever drink successfully again, he is told that he may be able to drink again one day. And that the false sense of freedom and power over alcohol keeps him from rebelling in the form of a binge. Because remember, it was people telling him he couldn’t drink that caused him to binge. Maybe this is less laughable to you than it is to me. Maybe Glaser is thinking of something like people who are put on overly strict diets, denied all gastronomic pleasure in the form of fats and carbs and sugar, who finally blow it all binging on potato chips and ice cream. But even this fails as a criticism of AA and abstinence because one will almost never hear anyone in a meeting ever tell another person they can never drink again. What you’ll hear instead, over and over, is “one day at time”.

And tens of thousands use it to stay sober today even if they maybe will drink tomorrow.

I say that knowing I will never be able to drink successfully is the most important thing I’ve learned in AA but that isn’t altogether true. I’ve learned this through countless attempts to drink moderately, countless variations, implementation of countless rules. Writing this now, I hear a hypothetical person saying “Yeah, but maybe there’s still some other thing you could try, some other therapy, some other treatment!” But why? That’s the voice of someone who desperately wants to still be able to drink, someone who for some reason thinks drinking is some great thing that a person shouldn’t have to live without. That’s not me. I have no desire to drink today. That desire has left me completely, and that is the direct result of working the program of AA. I begrudge no-one for whom drinking is a fun and enjoyable activity.  My wife drinks. I have many friends who drink. I even have friends who drink quite a bit, who may occasionally regret how much or things they did when they drink. I don’t try to get any of them to AA and my AA friends don’t try to push their non-sober friends into AA either. Nor do I try to convince people who come to AA unsure of whether they should be there that they can never drink again.

I don’t know who else is an alcoholic and I’m not an expert on the spectrum of problem drinking. But I do know with absolute certainty there there are people for whom successful drinking is no longer possible, for whom abstinence is the only solution. And I know that I am one of them. That is the meaning of being powerless over alcohol; I will never bend it to my will. I learned this that hard way, chasing a dream ability to drink normally to the brink of insanity. Whatever role AA plays in my future, this conviction must remain. I must presently and forever smash the thinking that I can drink like normal people. In acceptance of that certainty I am free.