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Making Meaning of AlcoholicsAnonymous for Social Workers:Myths, Metaphors, and Realities

Diane Rae Davis and Golie G, Jansen

Alcoholics Anonymous (AA), the increasingly popular mutual-helpprogram for alcoholics, is often criticized for being Just another

substitute addiction, emphasizing "powerlessness" to alreadydisenfranchised groups, being a religion or cult, adhering to a

medical model of disease instead of a strengths perspective, andother such areas of concern to social workers. Many of these

interpretations are based on viewing AA as an alternativetreatment model or a rational service delivery model. This article

addresses common critiques of AA by offering a way ofunderstanding it as a "normative narrative community," where

identity transformation takes place through the use of metaphorand storytelling. The article suggests alternative meanings of keymetaphors, such as "powerlessness." describes areas of programstrength and potential barriers for social workers, and reviews

current research on AA effectiveness.

Key words: Alcoholics Anonymous; mutual-help groups;narrative communities; referrals; self-help groups

The meaning of the term "AlcoholicsAnonymous" (AA) varies, depending onhow one sees oneself in relation to this in-

creasingly popular mutual-help program foralcoholics. (The word "alcoholic" is used in thisarticle to refer to someone dependent on alco-hol, consistent with its use in the AA program.)Social workers have variously described AA as"a set of principles developed by alcohol-depen-dent men" {Nelson-Zlupko, Kauffman, & Dore,1995), "a very successful model for self-helpgroups" (Borkman, 1989, p. 63), and disem-powering to women (Rhodes 8c Johnson, 1994).

Some feminists (Kasl, 1992) have dismissed it asanother white, middle-class male organizationthat enjoins women to depend on "having aHigh Power, which is usually described as anall-powerful male God" (p. 150) and to followone specific journey to recovery "as defined byprivileged males" (p. 147). For other feminists,the meaning of AA is quite different; Covington(1994) saw it as a "model for mutual-help pro-grams" within which "women can find the mostpowerful resources for healing" (p. 4). Someresearchers have concluded that "without ques-tion AA involvement has been associated with

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vast numbers of alcohol-dependent individualsbecoming abstinent for long periods of time"(Emrick, 1987, p. 421), although others havequestioned whether it is even possible to assessthe effectiveness of this organization in anykind of scientific manner ("Treatment of Alco-holism," 1996). Perhaps the greatest meaning ofAA, from the vantage point of the individualsober member, is that "through its program he(she) attained sobriety" (Kurtz, 1979, p. 157).

Social workers may need more informationabout Alcoholics Anonymous to determinetheir own meanings and interpretations of thecontroversies surrounding this program. Al-though related disciplines have published manyarticles to inform their members about AA andabout ways to use this organization to benefittheir clients, a review of the literature revealslittle recent information on this topic in socialwork journals. Sometimes the information thatis offered is too limited, such as the statementin the recent NASWNews article (Landers,1996) that "the traditional Alcoholics Anony-mous program, well-known as an effective re-covery program for men, does not work as wellfor women, according to experts in the treat-ment field" (p. 3). This statement, which im-plies that AA is not very effective for women,does not identify^ the "experts" and does nottake into account the steadily increasing mem-bership of women in AA. In 1992, women un-der 30 constituted an estimated 43 percent ofAA members, and women of all ages consti-tuted an estimated 35 percent of members,compared with 30 percent in 1983 and 22 per-cent in 1968 (AA World Services, 1993).

This article addresses concerns aboutwomen and other criticisms social workersmay have of AA by reframing the meaning ofAA from an alternative treatment or service de-livery model to an understanding of AA basedon metaphor, using Rappaport's (1993) con-cept of "normative narrative communities" (p.239). The article describes areas of programstrength and potential barriers for social work-ers (and consequently for their clients) and re-views the research findings on the efficacy ofthis program.

We chose to focus on Alcoholics Anonymousfor two reasons. First, it is the prototype for

other mutual help groups that have adopted the12 Steps and Traditions, and second, it offershelp for the least exotic and most prevalent (ex-cept nicotine)—but very damaging—addiction.We draw from a variety of professional and per-sonal experiences, including work with para-professional helpers, refugee women, disenfran-chised people, and addicted individuals, andfrom years of sitting in many hundreds of AAmeetings, as well as from an increasing body ofliterature dedicated to a deeper understandingof Alcohohcs Anonymous. It should be under-stood that the authors do not and cannot speakfor AA (AA literature on various topics can beobtained by writing to Alcoholics Anonymous,Box 459, Grand Central Station, New York, NY10163).

Thumbnail Sketch of Alcoholics Anonymous

Alcoholics Anonymous is an approach to recov-ery from alcoholism developed by and for alco-holics around 1935, at a time when alcoholismwas considered hopeless by the medical profes-sion and a moral failing by almost everyone. BillWilson and Dr. Bob Smith, both late-stage alco-holics and desperate for an alternative, joined tocreate anonymous support meetings that bor-rowed principles from the Oxford Group (anondenominational Christian movement) andcreated other principles important to the recov-ery from alcoholism as they experienced it.Their ideas were eventually written in a book sothick and bulky that the original volume of Al-coholics Anonymous (AA World Services, 1939)was called "the Big Book," a title affectionately,and perhaps metaphorically, used by AA mem-bers ever since, even though after several revi-sions it is now a regular-sized book (Kurtz, 1979).

At the heart of the AA program are the fol-lowing 12 principles "suggested" for recovery,called the 12 Steps of Alcoholics Anonymous:

1. We admitted we were powerless over al-cohol—that our lives had become un- .manageable.

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

3. Made a decision to turn our will and ourlives over to the care of God as we under-stood Him.

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4. Made a searching and fearless moral in-ventory of ourselves.

5. Admitted to God, to ourselves and to an-other human being the exact nature ofour wrongs.

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

7. Humbly asked Him to remove our short-comings.

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

9. Made direct amends to such people wher-ever possible, except when to do so wouldinjure them or others.

10. Continued to take personal inventoryand, when we were wrong, promptly ad-mitted it.

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

12. Having had a spiritual awakening as theresult of these steps, we tried to carry thismessage to alcoholics, and to practicethese principles in all our affairs. (AAWorld Services, 1976, pp. 59-60)

These are specific individual actions, spiritual innature, and "guides to progress, not perfection"{AA World Services, 1976, p. 60). They werepainstakingly designed by fellow alcoholics tohelp a person obtain sobriety and make thespiritual transformation necessary to create asober life worth living. For the developing AAgroups to survive and function effectively, a setof principles called the 12 Traditions evolved toset forth a working philosophy for this mutualhelp community. The foreword to the secondedition of Alcoholics Anonymous {AA WorldServices, 1955) explained the 12 Traditions asthey apply to community:

No alcoholic man or woman could be ex-cluded from our Society.... Our leadersmight serve but never govern.... Each groupwas to be autonomous and there was to be noprofessional class of therapy There were tobe no fees or dues There was to be theleast possible organization, even in our service

centers.... Our public relations were to bebased upon attraction rather than promotion.. . . All members ought to be anonymous atthe level of press, radio, TV and films . . . andin no circumstances should we give endorse-ments, make alliances, or enter public contro-versies, (p. vii)

These 12 guidelines for a "nonorganization,"although not so familiar as the 12 Steps, havefacilitated the creation and stability of morethan 87,000 groups with more than 1.5 millionmembers throughout the world at last count(AA World Services, 1993). The program is rec-ognized by many professionals as one of themost effective and user-friendly resources forhelping alcoholics (Riordin & Walsh, 1994).

Attributes of the program important tomany social workers include the lack of dues orfees, its availability in small towns, and the facttbat in medium to large cities the program usu-ally offers an array of options for a variety ofgroups (such as women, veterans, elders. NativeAmericans, Hispanics, gay men, lesbians, new-comers, and even a group for Grateful "Dead-heads" called the "Wharf Rats" [Epstein &Sardiello, 19901). Also, transportation forhouse-bound people or out-of-town visitors isfrequently arranged through voluntary helpfrom members who are "on-call" for suchcircumstances.

Realities of the Research Knowledge Base

In spite of methodological problems aggravatedby the anonymous, voluntary, self-selection ofAA membership, there is evidence to indicatethat AA is a very useful approach for alcoholicswho are trying to stop drinking. Emrick's(1987) review of surveys and outcome evalua-tions of AA alone or AA as an adjunct to pro-fessional treatment indicated that 40 percent to50 percent of alcoholics who maintain long-term, active membership in AA have severalyears of total abstinence while involved; 60 per-cent to 68 percent improve, drinking less or notat all during AA participation. A meta-analysisby Emrick, Tonigan, Montgomery, and Little(1993) of 107 previously published studiesfound that greater AA involvement couldmodestly predict reduced alcohol consumption.

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Involvement or active participation in AA pro-cesses (such as "working the 12 Steps"), ratherthan just attendance at AA meetings, was re-lated to positive outcomes in these fmdings andsupported in other studies (Montgomery,Miller, & Tonigan, 1995; Snow, Prochaska, &Rossi, 1994).

Recent findings also suggest that length ofAA attendance is correlated with months of ab-stinence (McBride, 1991). Combined with for-mal treatment programs, attendance at AA wasfound to be the only significant predictor oflength of sobriety in a 10-year follow-up studyof male and female patients, suggesting success-ful outcomes for people involved with both(Cross, Morgan, Mooney, Martin, & Rapter,1990). Other studies support the idea that AA isbeneficial as an adjunct to formal treatment andwhen used as a form of after care (Alford,Koehler, & Leonard, 1991; Walsh et ai.,1991).

These positive findings do not satisfy theskeptics. Major criticisms include the large per-centage of alcoholics who drop out of AA (ac-cording to AA's own survey, 50 percent afterthree months) (Chappel, 1993; Galaif &Sussman, 1995); contradictory studies indicat-ing that AA works no better than other ap-proaches, including no treatment (Miller &Hester, 1986, Peele, 1992); and findings thatindicate no significant relationship between AAattendence and outcomes (McLatchie & Lomp,1988; Miller, Leckman, Delaney, & Tinkcorn,1992). In addition, methodological problemsendemic to research on AA lead some research-ers to dismiss such attempts as mere exercisesin speculation ("Treatment," 1996). For ex-ample, despite years of research, no definitivepicture has emerged of the personal characteris-tics that can predict a positive or negative out-come with AA (Tonigan & Hiller-Sturmhofel,1994).

In the meantime, there is adequate (althoughnot perfect) evidence to suggest that many alco-holics who become involved in AA find some-thing they can use to improve their lives on along-term basis (Chappel, 1993) and, conse-quently, that social work professionals and theirclients can benefit from more knowledge of thispotentially valuable resource. Emrick (1987),after his extensive review of the findings from

the empirical literature, concluded that al-though AA is not for everyone (particularly notfor those who just want to reduce their drink-ing), "nevertheless, AA has been demonstratedto be associated with abstinence for many alco-hol-dependent individuals and thus the profes-sional who comes in contact with alcoholicsshould become familiar with AA and utilizethis self-help resource whenever possible"(p. 421).

Myths and Metaphors ofAlcoholics Anonymous

Alcoholics Anonymous describes itself as a"simple program" that has only one require-ment for membership—"a desire to stop drink-ing"—and one primary purpose—"to carry itsmessage to the alcoholic who still suffers" (AAWorld Services, 1976, pp. 58, 564). The appar-ent single-mindedness of this nonpolitical, self-supporting program masks a remarkably subtleand, in some ways, counterestablishmentworldview that challenges dominant culturalexpectations regarding hierarchy, power, andmodels of helping. Because the language of AAis the language of narrative and metaphor, it iseasily misunderstood outside the context oflived experience and of the meaning-making ofthe membership as a whole. It is not surprisingthat AA is miscomprehended and misinter-preted. Flores (1988) noted that many critics ofAA "fail to understand the subtleties of the AAprogram and often erroneously attribute quali-ties and characteristics to the organization thatare one-dimensional, misleading, and even bor-der on slanderous" (p. 203). AA has been calleda "cult," as well as "unscientific," "totalitarian,"and "coercive" (Flores, 1988). Common criti-cisms include the following:

• that AA takes power away from groupstbat are already disenfranchised (such aswomen)

• that AA adheres to the medical model ofdisease, not a strengths perspective ofwell ness

• that the program is a substitute addiction• that AA requires total abstinence• that AA is a religion or cult with a suspi-

ciously white, male, dominant-culture,Christian God

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• that AA forces people to constantly de-grade themselves by introducing them-selves as alcoholics

• that AA meetings are undependable be-cause the meetings are run by nonprofes-sionals.

Because a lack of information and under-standing is the most important factor in socialworkers' reluctance to refer clients to self-helpgroups (Kurtz & Chambon, 1987), these criti-cisms require examination. What follows is anattempt to increase social workers' understand-ing of the AA program that aims to avoid thepitfalls of what Wallace (1983) called the un-wary translator of AA who "may find himselfbanging away at the concrete rather than flow-ing with the analogy" (p. 301).

Framing AA as a Narrative CommunityProfessional service providers who conceptual-ize their work as consisting of treatment, cli-ents, and service models often understand AAas an alternative treatment model. This under-standing, according to Rappaport (1993), islimited for gaining insight into what AA meansto those who join. For a different understand-ing, he proposed reframing the meaning of AA(and other mutual help groups) in terms of anarrative perspective: "In its simplest form, thenarrative approach means understanding life tobe experienced as a constructed story. The sto-ries that people tell and are told are powerfulforms of communication to both others andone's self. Stories order experience, give coher-ence and meaning to events and provide a senseof history and of the future" (Rappaport, 1993,p. 240).

The stories are told in community, and thesecommunities have powerful narratives aboutchange and about themselves and their mem-bers. In this sense AA can be seen as a "norma-tive structure in social experience" (Rappaport,1993, p. 246). It is a "normative structure" be-cause it is more comparable to other voluntaryassociations of people "living lives," such as re-ligious organizations, professional organiza-tions, political parties, and even families, than itis to a social services agency setting where cli-ents come to receive services from professionalhelpers. In the narrative framework, people

joining AA are not help seekers in search oftreatment, but story tellers who through tellingand listening transform their lives. Personal sto-ries become narratives that define a "caring andsharing community of givers as well as receiv-ers, with hope, and with a sense of their owncapacity for positive change" (Rappaport, 1993,p. 245).

Consistent with postmodern thought, thenarrative perspective embraces the idea thatpersonal reality is itself constructed, as in a lifestory, and therefore has the capacity to be re-constructed throughout a person's life. In otherwords, as narrative therapists would say,"people make meaning, meaning is not madefor us" (Monk, Winslade, Crocket, & Epston,1997, p. 33). The AA community provides asafe harbor and a rich tradition of stories onecan use to reconstruct one's life story from thatof a "hopeless alcoholic" to a person with "ex-perience, strength, and hope." Hearing thingsin the stories of others can offer hope that one'sown life can be changed. For example. Smith(1993) cited one woman's experience in herearly days in AA: "A man I met told me that if Ididn't think I belonged, I should hang aroundand I'd hear my story. Then a few weeks later,this girl got up and as she spoke, it started todawn on me. I was so engrossed. . . . Every wordshe said I could relate to where I had comefrom. Here was this woman with seven or eightyears in the program telling my story (p. 696)!"

Smith (1993) elaborated on the process ofindividual integration into the "social world" ofAA by describing how each step in the processof affiliation (attending meetings, sharing "ex-perience, strength, and hope" in meetings, get-ting a sponsor, working the 12 Steps of recov-ery, doing service work to help other alcoholics)enhances the person's comfort level in formingnew relationships with others. It makes it pos-sible for them to take some risks and experiencesmall successes, enhances self-esteem, and leadsto futher commitment to the community. Un-derstanding AA in a narrative framework—as acontext where people tell stories about theirlives within a community—implies a concep-tual shift from a rational (service delivery)model to a metaphorical (spiritual) under-standing. This shift to the metaphorical is the

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framework for the following interpretations ofthe meanings of AA.

Metaphor of Powerlessness"Giving in is the greatest form of control" is akoan (a mental puzzle used by practicing Bud-dhists as meditation material to further enlight-enment) created by "solution-focused" thera-pists to help a practicing Buddhist clienttranslate the first step of AA into somethingconsistent with her Buddhist beliefs (Berg &Miller, 1992, p. 5). It is also a good example ofhow the language of AA can be understood asmetaphorical. A parallel metaphor more famil-iar to Christians might be, "to gain your life youmust first lose it."

Step 1 of the 12 Steps of Alcoholics Anony-mous—"We admitted we were powerless overalcohol—that our lives had become unmanage-able"—is the foundation of recovery for alco-holics trying to get well through the AA pro-gram (AA World Services, 1976; Chappel, 1992;Covington, 1994; Kurtz, 1979). However, froma rational viewpoint, it is also the stumblingblock for many professionals concerned thatAA pushes "powerlessness" on people who arealready powerless in the dominant culture.Wetzel (1991) voiced the following concern re-garding women: "The l2-step program rein-forces one's belief in one's powerlessness andthe necessity to relinquish the self to a 'higherpower' (something most women have been do-ing all their lives in a secular sense)" (p. 23).

For someone who is not addicted to makesense of step 1, it is helpful to view it from in-side the experience of addiction and to look atthe miserable state of affairs most women andmen face when they first begin the road to re-covery. The lived experience of the alcoholic, asone woman observed, is "an endless cycle of T'lldo better tomorrow' and of course I was alwaysdrunk again by 9 o'clock that night" (Davis,1996, p. 154). A study of recovering alcoholicsattending AA revealed an extremely high rate ofpsychological distress in the first three monthsof recovery comparable to that of psychiatricinpatients (DeSoto, O'Donnell, & DeSoto,1989). The authors commented, "with a lifesituation in disarray, suffering a protractedwithdrawal syndrome, and experiencing cogni-

tive deficits, it is a challenge indeed for an alco-holic to abstain from the drug that promises atleast temporary relief (p. 697).

The hard facts of being out of control withthe addiction, no matter what one tries to do,and recognizing that one's life is in shamblesroughly translates to the understanding of"powerlessness" that is the starting point in theAA program. AA invites people who declarethemselves eligible to survey their world and toembrace the idea of step I: "1 am powerless overalcohol, and my life has become unmanageable"(AA World Services, 1976, p. 59). In otherwords, step 1 says face the reality and give upthe illusion that you are in control. If peoplehave doubts about their status, the Big Booksuggests that they figure it out for themselves,experientially: "Step over to the nearest bar-room and try some controlled drinking. Try todrink and stop abruptly. Try it more than once.It will not take long for you to decide, if you arehonest about it. It may be worth a bad case ofthe jitters if you get a full knowledge of yourcondition" (AA World Services, 1976, p. 31).The organization invites those who have "lostthe power of choice in drink" and have "a desireto stop drinking" to join the fellowship (AAWorld Services, 1976, pp. 24, 58).

Accepting the metaphor of powerlessness,and thereby accepting individual limitations,goes against the dominant Western culturalmessage of "pulling yourself up by the boot-straps," independence, competition, and willpower. Bateson (1972) suggested that AA pro-vides a paradoxical metaphor (much like thekoan at the beginning of this section) in that"the experience of defeat not only serves to con-vince the alcoholic that change is necessary; it isthe first step in that change.... To be defeatedby the bottle and to know it is the first 'spiritual'experience" (p. 313). Kurtz (1979) interpretedthis as a necessary step for alcoholics to altertheir views of themselves from omniscient to"not Cod": "Every alcoholic's problem had firstbeen, according to this insight, claiming God-like powers, especially that of'control.' But thealcoholic at least, the message insists, is not incontrol, even of himself; and the first step to-ward recovery from alcoholism must be ad-mission and acceptance of this fact that is so


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blatantly obvious to others but so tenaciouslydenied by the obsessive-compulsive drinker"(p. 3).

The AA notion of powerlessness in the con-text of such group narratives transforms thealcoholic's competitive stance with those whohave tried to force him or her to stop drinkinginto complementary relationships with otheralcoholics who are in the same boat, in the samemeeting, and weaving and sharing similar sto-ries of "experience, strength, and hope." There-fore, powerlessness in this context is a meta-phor of connectedness, not isolation. Brown(1994) called AA's concept of powerlessness a"power from within model" instead of a "powerover" model (p. 26). Similarly,Riessman (1985) called it "self- ^ ^ ^help induced empowerment";he stated that "when peoplejoin together with others whohave similar problems to dealwith those problems. . . theyfeel empowered; they are ableto control some aspect of theirlives. The help is not given tothem from the outside, froman expert, a professional, apolitician" (p. 2). ^ ^ ^ ^

AA's concept of powerless-ness is very different from themeanings of powerlessness associated with con-temporary social and behavioral sciences, suchas alienation, anomie, victimization, oppres-sion, discrimination, and poverty (Borkman,1989). Understanding this alternative meaningof powerlessness is helpful in resisting thetemptation to oversimplify and interpret AAlanguage in terms of social science terminologyinstead of the language of transformation.

Metaphor of DiseaseAA is often criticized for its support and pro-mulgation of the "disease concept" of alcohol-ism (Rhodes & Johnson, 1994; Riordan 8cWalsh, 1994), especially by some social workerswho adhere to the strengths perspective. Thesetwo concepts have been presented as competingmetaphors. The disease concept is negativelydescribed as emphasizing the pathological, notthe healthy; physicians and clinicians assume an

AA's concept ofpowerlessness is very

different from themeanings of powerlessness

associated withcontemporary social and

behavioral sciences.

expert role, clients are in denial and not respon-sible for their predicament, and recovery goalsare designed and directed by treatment staff.The strengths perspective is optimistically por-trayed as emphasizing wellness; helping rela-tionships are nonhierarchical and collaborative,and recovery goals are coconstructed by facilita-tors and clients (Evans & Sullivan, 1990; Rapp,1997).

Although these comparisons may not do jus-tice to either metaphor, the discourse continuesto be fueled by the current interest in collabora-tive models of helping (feminist, narrative, so-lution-focused, and motivational interviewingmodels) and perhaps a desire to set these mod-

els apart from the medical^ ^ ^ ^ model of helping. Further

obscuring the issue of alco-holism as disease is the gen-eral inability to agree on justwhat "alcoholism" is, toachieve consensus on whatconstitutes "disease," or toagree on a single theory thatadequately describes theetiology of alcoholism(McNeece & DiNitto, 1994).

^ ^ ^ ^ Apart from the controversy,the disease concept has pro-vided a means of expanding

the diagnosis and treatment (and funding oftreatment and research) of alcoholism and hasdone a great service in relieving the burden ofguilt from both alcoholics and their familymembers (Burman, 1994).

In theory the AA program leaves the debateto the professionals; it treats the controversy ofalcoholism as disease simply as an "outside is-sue," following the principle of the 10th Tradi-tion of AA, which states, "Alcoholics Anony-mous has no opinions on outside issues; hencethe AA name ought never to be drawn intopublic controversy" (AA World Services, 1976,p. 564). Although the Big Book avoids the term"disease," it does use the terms "malady," "ill-ness," and "allergy" to suggest the hopelessnessof the condition of active alcoholism. Kurtz(1979), in his historical analysis, stated that BillWilson (cofounder of AA) "always remainedwary of referring to alcoholism as a 'disease'

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because he wished to avoid the medical contro-versy over the existence or non-existence of aspecific 'disease-entity'" (p. 22). It is somewhatironic that in many current versions of the con-troversy, AA is linked firmly to the promulga-tion of the disease concept (for example, Bur-man, 1994; Rhodes & lohnson, 1994).

However, as Kurtz (1979) suggested, "theAlcoholics Anonymous understanding of alco-holism begs for exploration within the insightthat disease can also be metaphor" (p. 200).Disease as metaphor has been prevalentthroughout history, including leprosy as "sin,"the black plague of decaying Europe, the "whitedeath" of tuberculosis in the slums of industrialcities, and the malignancy of cancer in the post-modern era of uncontrolled growth and greed."Alcoholism" and "addiction" are similarlymetaphors for modern-day isolation and despair.

Many individual members of AA see "alco-holism" as a three-fold "disease" involvingspiritual, mental, and physical factors. This viewimplies a holistic frame familiar to adherents ofNative American traditions, Christian creation-ist philosophy, and Buddhist meditation,among others. Modern isolation and discon-nectedness can be understood as arising from afoolish and doomed attempt to separate theseunified parts of the whole person. To be fijllyhuman (and in the case of the alcoholic, to wantto live sober), the physical, mental, and espe-cially spiritual parts must be integrated. AAmembers attempt to live out this metaphor on apractical level by working on a spiritual pro-gram that attends to the physical, mental, andspiritual needs of the alcoholic who still suffers.

Metaphors of Dependence, Independence,and InterdependenceAnother major criticism of AA is that it pro-motes dependency in the alcoholic by providinga substitute addiction or "crutch" (Walant,1995). This is assumed to be bad, because itgoes against the modern idea that the cure fordependence is absolute and total independence(Kurtz, 1979). Inherent in the metaphor of thedominant culture is the notion of self-reliance.In contrast, the AA approach to extreme depen-dence (alcoholism) is to embrace the metaphorof connectedness. AA teaches that humans are

limited and dependent on other humans. Con-necting with others through the fellowship ofmeetings, sponsors, and AA-sponsored eventsare ways to strengthen one's identity, not shrinkit. As one woman remembered, "by the end ofthe meeting 1 knew I was at home. I belongedthere. Someone told their story and more thananything I felt connected to people again that Ihadn't done in so long" (Lundy, 1985, p. 137).According to Van Den Bergh (1991), the op-portunity for human connection may explainsome of the increase in participation in 12-stepgroups today: "Patriarchy engenders isolationand anomie; recovery groups provide an anti-dote to the pain and angst of believing one isalone. Individuals come together to share their'experience, strength and hope'; through thatprocess a feeling of personal empowerment aswell as community affiliation is experienced"(p. 27).

The same criticisms about "creating depen-dence" are aimed at psychotherapy, welfare as-sistance, certain religious communities, moth-ers, or any other entity that offers a port in thestorm of life. In spite of the dominant culturalsuspicion that there is "something undesirableabout all dependence" (Riordan & Walsh, 1994,p. 352), levels of dependence usually shift natu-rally as a person becomes more stable. In AAnewcomers may spend entire days in meetingafter meeting, and it is routinely suggested thatthey attend "90 meetings in 90 days." As thelength of sobriety and stability increase, partici-pation generally shifts to helping others (mak-ing coffee, chairing meetings, sponsoring oth-ers). Many "old-timers" with years of sobrietycontinue participating to provide sponsorshipand support for newcomers, and they dependon AA meetings to help them maintain theirspiritual program, not just their sobriety. Inde-pendence in the American sense of "doing italone" is not the goal; instead, the individual(isolated by alcoholism and an array of negativesocial consequences) is taught in small stepshow to depend on others and how to allow oth-ers to depend on him or her.

One Day at a TimeThe basic text of Alcoholics Anonymous (AAWorld Services, 1976) suggests that "for those


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who are unable to drink moderately the ques-tion is how to stop altogether. . . . We are as-suming, of course, that the reader desires tostop" (p. 34). A fundamental concept of the AAprogram is the need for self-assessment; its ba-sis is the belief that all alcoholics want to stopdrinking precisely because their own experienceand numerous experiments tell them they canno longer control it once they start. Thevoluntariness of this approach is often not em-phasized by alcohol treatment programs, courtsystems, licensing boards, and certain employ-ers who require abstinence, drug testing, andattendance at AA meetings. In contrast, AAmembers who begin working with other alco-holics are advised to "be careful not to brandhim as an alcoholic.. . . Let him draw his ownconclusion" (AA World Services, 1976, p. 92).AA recommends their program only to thosewho realize, as a result of their own self-assess-ment, that they can no longer control theirdrinking.

However, abstinence (in the sense of "neverdrink again") was considered too unrealistic,too absolute, and perhaps too frightening to thealcoholics who created the AA program. In-stead, they developed the idea of limited con-trol, that is, not drinking "one day at a time,"instead of forever. According to Kurtz (1979),this message serves both to "protect againstgrandiosity and to affirm the sense of individualworthwhileness so especially important to thedrinking alcoholic mired in self-hatred over hisfailure to achieve absolute control over hisdrinking" (p. 105).

The concept of limited control and the em-bracing of human fallibility are other examplesof how the AA program stands apart from thedominant culture's obsessive drive for perfec-tion. Several AA slogans underscore the conceptof limited control, such as "progress not perfec-tion," "easy does it," and "one day at a time."Recovery is seen as an ongoing process, more intune with the feminist principle of emphasizing"process not product" (Van Den Bergh, 1991).

The AA premise of stopping drinking "oneday at a time" is certainly not the only approachto recovery. Other approaches and resourcesthat have had some reported positive outcomesinclude acupuncture, biofeedback, pharmaco-

therapy (such as methadone maintenance forheroin addiction and antabuse and naltrexonefor alcoholics), behavior modification, cogni-tive restructuring, and traditional Minnesotamodel treatment programs that range from in-tensive inpatient to outpatient services and thatare usually abstinence oriented. The problems,consequences, and social context associatedwith alcoholism are so varied that a single treat-ment strategy is unwise ("Treatment," 1996).The AA program does not take a stand on vari-ous treatment strategies, saying instead "upontherapy for the alcoholic himself, we surelyhave no monopoly" (AA World Services, 1976,p. xxi).

In the addictions field, programs or researchthat suggest that an alcoholic can return to"controlled drinking" are seen as diametricallyopposed to the AA premise of stopping drink-ing (McNeece & DiNitto, 1994; Riordan &Walsh, 1994). On one level of meaning, it is notsurprising that the idea of teaching an alcoholiccontrolled drinking strikes the AA member asabsurd, because in AA the alcoholic is self-de-fmed as a person who cannot control his or herdrinking. For those who can control it (throughwhatever means), the message is "our hats areoff to him" (AA World Services, 1976, p. 31).

On another level of meaning, focusing oncontrolling drinking misses the point. Accord-ing to AA, the alcoholic that has lost controldoes not just have a bad habit and does not justneed to stop drinking. That is only the first stepin eliminating an "alcoholic" lifestyle based onself-centeredness, immaturity, and spiritualbankruptcy (Flores, 1988; Kurtz, 1979). BecauseAA views the alcoholic as having a three-foldproblem, involving mental, spiritual, and physi-cal suffering, eliminating drinking is only thefirst step, although it is both necessary and es-sential, to begin the process of recovery.

Metaphor of a Higher PowerLamb of God, Ancient Thing, Buddha, Yahweh,Love, Truth, Oneness, the Light, Mother God,Mother Nature, God, the Thursday evening"insanity to Serenity" AA meeting, the Friday 7A.M. "Eye-Opener" meeting: All of these termsand many others may describe an AA member'sHigher Power. The encouragement to choose


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the nature of this power is a freedom that un-derlies the spiritual nature of the AA programand distinguishes it from an organized religiousprogram. The emphasis is not on what kind ofHigher Power is embraced, but rather an accep-tance of the idea of human limitations and "aPower greater than ourselves." In AA meetings,this is often expressed by a variation on step 2("Came to believe that a Power greater thanourselves could restore us to sanity"): "Wecame, we came to, we came to believe.''

For some, the Higher Power is located withinthe self. For example, in Covington (1994),Maureen described how important it was to letgo of the "ego" on the outside and seek the"bigger self inside: "Developing a sense of selfis critical to my well-being.. . . There is a powerin me that's greater than the small self I've beenaccustomed to; it's larger than the way I'vebeen trained to think about who I am. It's mysoul-self. In cooperating with it, I surrender to apart of me that carries wisdom and truth. Itbrings me back into harmony and balancewith myself—that's what spirituality is for me"(p. 35).

Step 2 and step 3 ("Made a decision to turnour will and our life over to the care of God aswe understood Him") (AA World Services, 1976,p. 59) are the spiritual cornerstones of the AAprogram. These two steps suggest that alcohol-ics connect with the healing energy ("grace,""Godness") of the world and within themselvesand become receptive to spiritual guidance,whether the source be the wisdom of their AAgroup on staying sober or some other version ofa power greater than themselves. A literal read-ing of these two steps has been interpreted bysome feminists (Kasl, 1992) as sacrificing andmartyring oneself for the sake of others, notablymen. However, as Clemmons (1991) noted,step 3 "does not promote this kind of detrimen-tal repression, but it does suggest that we mustbe willing to let go of people and situations out-side of our control. . . . 'Letting go' halts the al-coholic/addict's efforts to control the uncon-trollable and focuses on developing andlistening to the true self (p. 104). In otherwords, power is seen not in relational termswith other people, but vis-^-vis the addiction.The power of the alcohol or the "small self," as

Maureen put it, is "let go" through the shift toaccepting a Higher Power.

AA is fundamentally a spiritual program(Kurtz, 1979). Many social workers have diffi-culty with this position; as a profession, theyhave historically focused rationally on the tem-poral conditions of clients and their environ-ments, excluding the spiritual. In that mindsetit is easy to misconstrue AA's concept ofHigher Power as religion and the metaphor of"letting go" of "things we cannot change" aspassive dependence.

Storytelling as Metaphor

Many observers of AA fail to grasp the complexand metaphorical meanings of common termsand practices as they are used by AA members.Wallace (1983) noted that "the extended mean-ings that characterize the AA language systemwill continue to elude external observers whoremain at literal, concrete levels of analysis andfail to consider the nature of symbolic commu-nication and the purposes it serves in complexsocial contexts and transactions" (p. 302). Forexample, it is common practice (but not re-quired) to introduce oneself in AA meetingswith one's name, followed by, "and I'm an alco-holic." As members talk, they identify them-selves by their first name only, not their profes-sion, not their family name, not where they live.The practice of anonymity is considered bymany AA members to be a spiritual necessityfor recovery (Chappel, 1992).

This greeting has been interpreted by somecritics to be a countertherapeutic reinforcementof a negative label ("alcoholic"), but as Smith(1993) pointed out, "it is understood by AAmembers that the word takes on a different andpositive meaning in the context of AA" (p. 702).Using Wallace's idea of illustrating how a com-mon AA slogan can have various meanings de-pending on the context, the meaning of the"I'm Joe, and I'm an alcoholic" greeting in thecontext of an AA meeting could be any or all ornone of the following:

1. 1 have faced the reality that I am an al-coholic and cannot control my drink-ing.

2. I have suffered and caused others to suf-fer, just like you.


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3. I don't buy in to the shame attached tothis label by the outside world.

4. Even though I am an alcoholic and mynatural state would be to be drinking, I'msober today and participating in thismeeting to help my mental, spiritual, andphysical recovery.

5. Even though I'm not drinking today,there is a part of me that is immature andself-centered, spiritually bankrupt, ego-tistical, superficial—that is, an "alcoholicpersonality" that sometimes operates inthe world in a "drunk mode" or "drydrunk mode." I claim this part of myselfinstead of trying to hide my problems byliving under a superficial sheen of perfec-tion.

6. I'm grateful to be an alcoholic becausehaving this condition put me on a spiri-tual path that I never would have foundotherwise.

7. I'm not unique, better than, worse off, orany different from any of the rest of youIn this meeting. We are here to confront acommon problem and to help each other.

This list illustrates the extended meaningsthat can occur within the context of a particularmeeting, depending on the circumstances andhistories of the individuals introducing them-selves. Central to the meanings of AA phrasesand language is a redefinition of the experienceof being an alcoholic. A "practicing alcoholic"(one who is currently drinking) may be betterunderstood in AA as practicing a flawed way oflife dominated by self-centeredness, superficial-ity in relationships with others, and spiritualbankruptcy. The personal stories told in AA,"what we used to be like, what happened, andwhat we are like now" (AA World Services,1976, p. 58), are vehicles for making sense of thechaos of the typical alcoholic's life by redefiningit within this logic. As Marion described theprocess in Maracle (1989),

The more I went to meetings, the more Iheard what other people said, I'd come homeand think about it. I'd reflect on my own life,far back, up close, when I started drinking,what happened, how much of my life was re-lated to alcohol, drinking. That's how I began

to connect the depression and the drinking. 1began to connect information, to put piecestogether. I'd really LISTEN at meetings. HEARwhat people said. And think about it all. Andabout me. I got real serious about trying tounderstand, (p. 154}

Thune's (1977) analysis of AA from a phe-nomenological perspective argued that it is pre-cisely because AA members are taught to rein-terpret their alcoholic life stories as spirituallybankrupt that they can give meaning to a pastfilled with degradation and chaos and havehope for the creation of a different future. Thus,the AA approach to recovery, which aims for atransformed life based on spiritual principlesinstead of "alcoholic" strategies, is quite differ-ent from approaches to alcoholism as merely adisease or a bad habit to be reformed. Thealcoholic's deeply individual transformation,within the context of the narrative community,transcends the dichotomies of self-other, exem-plifying the embedded interdependence of thesecommunities.

An Invitation

Rappaport (1993) posited that it is through thetelling and listening of stories that members ofAA transform their lives; it thus is importantfor social workers to put themselves in a posi-tion—that is, to go to a meeting—to hear thesestories and observe the context of the AA "nar-rative community" to understand it better. At-tending one "open" AA meeting may not besufficient to get a good idea of the range of waysthe AA program is implemented. Montgomeryand colleagues (1995) found a wide variationamong AA groups in terms of their social struc-ture and characteristics, such as cohesiveness,agressiveness, and expressiveness. Visitors areinvited to attend any meeting identified as"open." "Closed" meetings are reserved forthose who wish to stop drinking.

Information regarding meeting times andschedules (which change frequently) can befound in the yellow pages of the phone bookunder "Alcoholism" or in the classified ads inthe local newspaper. In larger towns, the volun-teers (never paid staff) of the AA central officefor the area can provide the meeting schedule.


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Visitors and newcomers may be asked to iden-tify themselves by their first names only whenthey attend an open meeting. As a respectfulvisitor, a social worker must honor this tradi-tion (for further descriptions of AA steps, tradi-tions, and meetings, see Chappel, 1992; Riordan& Walsh, 1994).

Conclusion

Much more could be said about the AlcoholicsAnonymous process of recovery, but this articleis limited to introducing social workers to theorganization as a narrative community whereidentity transformation takes place through thetelling of stories and the identification of per-sonal meanings of metaphors. Instead of viewingAA as an alternative treatment model or a ratio-nal service delivery model, social workers areinvited to shift their understanding of AA to ametaphorical and transformative (spiritual)framework. Making this shift is difficult for aprofession that adheres to a practice model of"regarding people as recipients of services" andthe principle that "the alternatives available tothem are viewed as treatments or programs"(Rappaport, 1993, p. 241). In addition, the real-ity ("always there and typically ignored," accord-ing to Riessman, 1985, p. 2) is that the help givenby our profession is embedded in the context ofpaid services, whereas the help provided by mu-tual aid groups such as AA is free of charge.

Although the habits of context and practiceare very different between professional socialworkers and members of AA, there is somecommon ground. Both systems embrace em-powerment, connectedness, and interdepen-dence and, most important, the principle thatpeople can change, regardless of how oppressedthey find themselves by their circumstances. Tobetter advise clients on their options, socialworkers are encouraged to discover their ownmeanings in the similarities and differences be-tween their professional practice and the mu-tual help offered by AA by experiencing first-hand the narrative community of AA and thehope it offers to many. •

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Diane Rae Davis, PhD, ACSW, is assistant pro-fessor, and Golie G. Jansen, PhD, is assistant pro-fessor. Inland Empire School of Social Work andHuman Services, Eastern Washington University,526 Fifth Street, MS-19, Senior Hall, Cheney,WA 99004; e-mail: [email protected]. The authorsacknowledge the support and suggestions of BobNeubauer, professor. School of Social Work, East-ern Washington University.

Original manuscript received September 4, 1996Final revision received January 2, 1997Accepted March 18,1997

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