Social Compassion for Alcoholics.

AA is a little bit different in different places. And a lot the same everywhere. I have been to AA meetings in four countries and seven states. Hardly a huge sample. And except for Missouri, California, and my current home state, I haven’t been to enough meetings anywhere to really judge what AA is like in those places. The meeting I went to in Bermuda was small and cozy, and felt just like home. The meetings in New Zealand and Norway were somewhat depressing. A lot of people who had fallen very far down on the scale, and very few who seemed to have made strides into the core bedrock of sobriety.

In St. Louis, there are meetings of both types. And the same is true here in ECC. Of all types. Meetings composed mostly of people with longer-term sobriety, living comfortable lives. Others composed mostly of recent drunks and felons, struggling to find a way forward. And meetings where these groups mix fluidly. My one-meeting-each experience in other countries isn’t enough to provide me with any evidence about the actual state of sobriety, from an epidemiological perspective, in any of them.

But I do wonder anyway. In both Norway and New Zealand, I was told that AA hasn’t really taken hold. Compare that with the UK, where, though I don’t know the meetings personally, many people (including the writer of the excellent “Guitars and Life” blog, Furtheron) tell me AA is said to be more universally accepted. Is it the language? Lots of ideas just don’t come across as well in translation. Is the program of AA one of them? I have no idea.

But one thing that was said to me in Norway was interesting. I no longer remember the phrasing, so file this under “things I think a drunk once told me…”. And that was that in Norway, drunks don’t think they need AA. They don’t think they need recovery at all. Because society protects them far, far better than America protects our drunks. In Norway, I was told, in the cities, anyway, being a drunk is really easy. There’s excellent and inexpensive public transportation (and the penalties for drunk driving are incredibly severe). So drunks tend to get in fewer traffic accidents. Health care is free, and emergency rooms will dry you out, perk you up, and send you home.

Suffice to say, the impression that was conveyed to me was that it’s harder to hit bottom in Norway. The social contract provides for addicts in ways that we do not here in the US. The result is that probably fewer people die from acute effects of addiction. But I was also told that it takes much longer for the average person to decide they need to find sobriety. This was supported (again, n=1), by the fact that there were no young people in the meeting I went to. I, 37 at the time, was the youngest in the room by a decade. In New Zealand there were younger people in the room. But they were largely heroin addicts. The strict alcoholics in the meeting were, again, mostly older and with only a few years of sobriety.

I’m forced to wonder if all this social investment in the addict actually helps us. The answer, surely, is complicated. I’ve written many times about the problem in addiction treatment with the chasm between statistical and clinical significance. A drug that increases mean relapse time from 3 days to 9, p<0.0001, is almost useless. Because 9 days of abstinence avails me nothing. Some will say, “It gives the addict time to ‘get it’!”. Maybe. But clearly, not many are ‘getting it’ if they’re relapsing so rapidly.

When I went to rehab, I took medicines. I think they helped me feel better through my withdrawal. We all know benzodiazepines save lives, when an alcoholic is in acute detoxification. I’m not anti-medicine. And I’m not anti-rehab. But these things are not necessarily required for recovery. Incredible efforts and funds are spent investigating and treating alcoholism. I fear often for the worse. For alcoholics like me, I think certain things are true:

– I think that a large proportion of alcoholics will always die of alcoholism. I think that that proportion is depressingly high. And short of sequestering the alcoholic away from drink, there is very little that can be done about this.

– I think that addressing alcoholism in one’s life requires a complete sea-change in how one approaches the world. It is not enough to try to avoid alcohol and use mnemonics and slogans. It is not enough to dry out and try really hard to stay clean. It can never be enough.

– I think the social contract that cares for and provides comfort for alcoholics prolongs a lot of lives, but it doesn’t save them. I think it makes our alcoholic deaths slower, sadder, and more perplexing. We had all the help in the world, and couldn’t stop drinking! I think some of us need less help. Until we’re ready for the kind of help that works.

– I think we make the choice as a society to try to help people with addictions through methods that don’t actually help us. They relieve us of the burden of recovery. They transfer the responsibility for our addictive behaviors from the addict to the physician. To the institution.

– I think that alcoholism is a terminal illness with a very poor remission rate. Frequently, our medical interventions seem designed to keep the alcoholic alive, drinking, and dying slowly and miserably.

We say in AA that we recover when faced with jails, institutions, or deaths. But there are no institutions, really, that do what they did when those words were written. That lock up the alcoholic permanently for alcoholic insanity. And so today, the choice is really between jail, death, and recovery. But we have a medical apparatus that makes the “death” option much slower, and perversely attractive. We can keep drinking. And in places where the medical system is more robust, my own experience is that it does not usher alcoholics into recovery. But my experience is far from evidence.

What is the solution? I think more alcoholics would probably recover if more alcoholics are dying in the snow. But of course, I don’t and can’t advocate that. I think more alcoholics would recover if HIPAA didn’t prevent AA members from working with hospitals. But I don’t think I can advocate that either.

I don’t know that I have a solution. Except to say, there is no bleaker image for me than the one in which alcoholics are repeatedly brought back from the brink of desolation only to drag themselves back to the edge. To die slowly, surrounded by exasperated and impersonal medics, vacillating from withdrawal to indulgence. In my experience, alcoholics like me recover when we reach a point where, emotionally, even if not in actuality, we have no more options. And when the social structure provides endless options, we just find a way to use them to ever more lugubrious ends.