I’ve never heard anybody who successfully quit smoking refer to him/herself as a smoker, a recovering smoker, a recovered smoker, or a smoker in recovery. Yet attend any AA meeting, and substitute ‘alcoholic’ for ‘smoker,’ and you will hear just that. It doesn’t matter whether a member has been sober for five days, five years, or fifty years. This is because the overwhelming majority of AAs embrace a unique disease model of alcoholism.
AA’s concept of alcoholism is a synthesis of a 1930’s medical hypothesis, which posited that chronic alcoholism was an allergy of the body, and an obsession of the mind, and a nebulous spiritual malady, which was postulated by AA’s founding members.
AAs characteristically believe that alcoholism is an unabating, chronic biopsychospiritual illness which can be arrested, but never be cured. Some members profess to being born alcoholic, and others claim they became alcoholic. There is little controversy or disagreement in the rooms surrounding this, as the overwhelming majority hold one belief in common: born or bred, ‘once an alcoholic always an alcoholic.’
Most professionals would perhaps agree on a practical level: if one has a history of maladaptive drinking, then one will, more often than not, be unable to safely use alcohol again. AAs, however, take it one step further. They believe that the very essence of who they are is inherently alcoholic, and filter all of their internal experiences through this self-concept.
This ‘inherent’ alcoholism, is essentially experienced by a member in three ways: wet (drinking), dry (abstinent, but not recovered), sober (abstinent and recovered); which leads us to a common AA refrain: abstinence is not the same as recovery.
For most AA members, remaining abstinent and regularly attending meetings isn’t enough. Members steadfastly believe it is vital to achieve and maintain a spiritual awakening, and that remaining sober is utterly contingent on a progressive spiritual condition. This is because the founding members asserted that only after the spiritual malady had been overcome, would the chronic alcoholic recover mentally and physically. Those attendees who do remain abstinent, but merely attend meetings are somewhat ingloriously labelled ‘dry drunks.’
A so-called ‘dry drunk’ is an alcoholic who, although abstinent, behaves in ways which are deemed unspiritual. In AA parlance, they are selfish, self-centred, self-seeking, dishonest, resentful and fearful individuals. Additionally, it’s not uncommon to hear members with time in the program refer to ‘being on a dry drunk.’ These are attendees who, for the most part, try to live by spiritual principles, but who have temporarily fallen back into old ways, yet remained abstinent; a spiritual relapse if you will. It is perhaps worth noting, however, that AAs rarely ever use the term abstinent, and will refer to themselves as sober, whether they are ‘dry’ or ‘living the program.’
AA’s understanding of alcoholism is arguably ambiguous and outdated. It undoubtedly served a tremendous purpose in the early days of AA in moralistic, Protestant America. In the modern secular world, however, which prefers a science-based approach to human affairs, the question remains as to whether AA’s biopsychospiritual model of alcoholism and its antidote have much of a future.
Unfortunately, the decentralised structure that has enabled AA to be so successful, may prove its eventual undoing. As a fellowship of laymen and laywomen, the current contention surrounding the definition of alcoholism amongst professionals would be seen as an outside issue – something AA wishes to avoid at all costs. Members attitudes are very much of the ‘if it worked for me, it will work for everybody’ variety.
What members fail to realise, however, is that AA doesn’t actually need to embrace a new model of alcoholism or even engage in such dialogue. It could simply add a historical footnote in its basic text, the Big Book, outlining how alcoholism was understood when AA was founded. Additionally, it could include that whether members and professionals believe alcoholism is a disease or a maladaptive behaviour is irrelevant: recovery, however defined, is possible.