Microkhan by Brendan I. Koerner

The Bottle

June 24th, 2010 · 23 Comments


Regular readers know that I’ve been spending the better part of 2010 working on a Wired piece about addiction. Well, the feature is finally live, and now the full truth can be revealed—the article’s central narrative is about the history and science (or lack thereof) of Alcoholics Anonymous, which just celebrated its 75th anniversary. Here’s the essence of the tale:

It was in June 1935, amid the gloom of the Great Depression, that a failed stockbroker and reformed lush named Bill Wilson founded the organization after meeting God in a hospital room. He codified his method in the 12 steps, the rules at the heart of AA. Entirely lacking in medical training, Wilson created the steps by cribbing ideas from religion and philosophy, then massaging them into a pithy list with a structure inspired by the Bible.

The 200-word instruction set has since become the cornerstone of addiction treatment in this country, where an estimated 23 million people grapple with severe alcohol or drug abuse—more than twice the number of Americans afflicted with cancer. Some 1.2 million people belong to one of AA’s 55,000 meeting groups in the US, while countless others embark on the steps at one of the nation’s 11,000 professional treatment centers. Anyone who seeks help in curbing a drug or alcohol problem is bound to encounter Wilson’s system on the road to recovery.

It’s all quite an achievement for a onetime broken-down drunk. And Wilson’s success is even more impressive when you consider that AA and its steps have become ubiquitous despite the fact that no one is quite sure how—or, for that matter, how well—they work. The organization is notoriously difficult to study, thanks to its insistence on anonymity and its fluid membership. And AA’s method, which requires “surrender” to a vaguely defined “higher power,” involves the kind of spiritual revelations that neuroscientists have only begun to explore.

As some of y’all might have guessed, I really went through the wringer on this piece. I spent months attending AA meetings, then reeled off ten drafts before the finished product was ready for Wired‘s august pages. (Three or four drafts is the norm.) The big challenge was getting a handle on the question of efficacy, which has never really been resolved due to AA’s curious organizational principles. And needless to say, the pro and con sides are extremely passionate about their takes on AA; for lots of people, AA is either an life-saving miracle or an insidious cult.

There was a ton of great material left on the cutting-room floor, so I’ll be writing several AA-related posts over the coming days. In the meantime, if you have any questions about the Wired story or AA in general, please leave ‘em in comments and they’ll be answered pronto.

(Image via Bat Country)

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23 Comments so far ↓

  • omellet

    Awesome, I’m going to read this as soon as I have a few spare minutes. I’m curious if you’ve read “Infinite Jest,” and have an opinion about Wallace writes about addiction.

  • Brendan I. Koerner

    @omellet: Funny you should mention Wallace. A couple of Wired readers have already taken me to task for not mentioning his take from “Infinite Jest”–a book which, regrettably, I have yet to read. I’m starting to get the sense that this constitutes a major oversight on my part.

  • OCD

    I haven’t had a a drink since 1995. I don’t go to meetings much anymore except birthday celebrations or to speak but I don’t think I could have made it through those first 5 or 6 years without going 4-5 times a week. Just one drunks opinion.

  • Brendan I. Koerner

    @OCD: Thanks for the comment. I’ll be discussing exactly this issue in an upcoming post, so keep an eye peeled. I was pretty taken aback by the frequency of attendance for the newly sober. I remember this one guy saying that he was on his third meeting of the day, and was going to another one afterwards.

  • scottstev

    The one thing that struck me reading the Big Book a few years ago is how little of it is actually dedicated to abstinence, and how much of it is a guidebook to being a mensch.

    The other is that as far as religion, the Big Book (my only direct exposure to AA) seems to open as wide a tent as possible. I remember a story in my edition where the agnostic author basically told herself that God was the doorknob, and addressing the doorknob was enough to get her through that step and make progress.

    Of course individual chapters might vary on how strictly religious they are and the Washington Post had a great article a few years ago about an AA chapter that had basically morphed into a sex cult for the founder and his inner circle. So much so that other chapters were warning prospective members from that particular group. I’m pretty sure an acquaintance mine was caught in their clutches based on how intrusive they got in her personal life. Seems like having some authority to revoke charters would be of help. I’m sure a fair method of creating an executive committee could be worked out, though I understand the reasons why it wasn’t created at the organization’s inception.

  • Brendan I. Koerner

    @scottstev: I address the quality control issue in the piece, though I wish I could have fit in a bit more about the problems you mention (particularly the sexual exploitation, or “13th Stepping”). A reader made a good point to me in an email I just received:

    “I’ve been to meetings dominated by those dominated by ornery old-timers but went down the block and found a meeting that was not. AA meetings are like bars.Once I found a bar I didn’t like but that did not keep me from drinking I just went down the block and found a bar I did like. AA meetings are the same.”

    I heard the doorknob anecdote a zillion times while researching the story, but never in an actual meeting room. I did run across a few admitted agnostics, but their Higher Powers were always less tangible than a doorknob. I have very vivid memories of one woman telling a meeting that her Higher Power was AA itself.

    Also, for the record, I couldn’t get all the way through the Big Book–just not my cup of tea. But I do see the appeal–almost a bloggy writing style.

  • Jordan

    Great piece. Definitely a lot to think about.

    I always find the neurochemistry really interesting. Given that alcohol has been a part of human society for 10K+ years, one has to wonder if there’s some aspect of an addiction-susceptible brain that is otherwise advantageous. Seems like it would have been selected out fairly quickly if there wasn’t some benefit.

  • Brendan I. Koerner

    @Jordan: That makes me think of perhaps my favorite Winston Churchill quote (passed along to me by my dad): “Always remember that I have taken more out of alcohol than alcohol has taken out of me.”

  • martin

    @jordan: seems more likely the susceptibility is similar to cancer or other problems that never manage to wipe out the race, but are still pretty common.

    @brendan: wilson thought he saw god while dosed on belladonna, and lsd can produce similar spiritual/religious experiences. do you think psychedelics could be used to treat alcoholism?

  • Andrew

    @Brendan,

    Long-time reader, first-time commenter.

    I was wondering if you could recommend some further reading on the scientific understanding of addiction, or a good overall survey of the current state of knowledge on addiction? I’m looking to learn more about addiction but want to avoid self-help books and the like. I want to understand the neurological and behavioral side of things.

    Thanks in advance.

  • Brendan I. Koerner

    @martin: A fascinating topic. I’ll be posting about the belladonna angle early next week, so keep an eye peeled for my take on that. As for the therapeutic potential of psychedelics, I believe there is some promise, but we’re a long ways away from legit medical usage–at least as we understand that phrase. I just don’t think such drugs have predictable enough results, and those results can vary widely from session to session. True, that’s in part because there has been close to zero research over the decades, due to the impact of the War on Drugs. But we have to be careful about administering treatments whose side effects can be a crapshoot, and which can do psychological harm in some cases.

    That said, I’m in favor of conducting more research on the therapeutic potential of LSD and related compounds. And I do think that psychedelics can be used as part of one’s spiritual practices–though that’s not the same thing as medical use.

  • Brendan I. Koerner

    @Andrew: Great question. Believe it or not, no good books come to mind (with the caveat that I’m not super well-versed in the popular literature on the topic). In reporting the story, I got the most out of interviewing scientists who had good communication skills. One thing I definitely recommend is this lengthy interview with George Koob, who’s on the cutting edge of understanding how substances hijack the addictive brain. I referred back to it a bunch while writing the piece:

    http://www.thirteen.org/closetohome/science/html/koob.html

  • Gramsci

    I never knew that Wilson drew from James’s Varieties– that’s really interesting. James is basically doing with religion as such what your article does with AA– trying to ask what works for whom and try to map out how to improve upon religion going forward. James, like you, wonders about the “bottoming out” moment of meaningless and despair (he even slips in his own such moment in the guise of a French youth). Neuroscientists should do likewise– what does bottoming out signify neurologically and, as you muse in the article, how much of becoming sober comes from going through that?

  • Shaina

    Thanks for the article Brendan

  • growler

    Wow, you are in for a crapload of attention, both positive and negative. Hope Wired has good fact-checkers, ’cause people are going to go over the story with the finest-toothed combs.

    I’m interested which meetings you attended, and what you thought of them. But, really, you don’t need to answer. Especially if you tried closed meetings, since people will give you grief for having done that.

  • growler

    Oh, and not having read “Infinite Jest” is a major oversight, but his take on addiction and AA is the least of it.

  • Aaron Cael

    Excellent article and a ballsy topic to take on. I loved the analogy to the open-source movement, going to have to research other organizations/organisms that take the same approach.

  • Brendan I. Koerner

    @growler: I only attended open meetings, which was difficult–they probably constitute only c. 10 percent of all the AA meetings in Manhattan. I generally attended each meeting only once.

    Will get to “Infinite Jest” one of these days–though probably not until the kid is more self-sufficient. I feel like most of my non-work energies these days are dedicated to getting him to accept the tragedy of bedtime.

  • Brendan I. Koerner

    @Gramsci: Ah. great point re: the chemistry of the bottomed-out brain. Where were you when I was writing the article? I should’ve flicked at that idea.

  • Brendan I. Koerner

    @Aaron Cael: Glad you liked that analogy. Earlier drafts of the story were more focused on AA’s organizational quirks, rather than the neuroscience. There’s no question that AA’s ubiquity is due in large part to its anarchic structure. But the Twelve Traditions also include some safeguards that prevented AA from collapsing under its own weight, as some previous mutual-aid movements had.

    I’ll be posting about this topic either today or Monday.

  • scottstev

    @Aaron Cael – I remember a business book written a few years ago about such flat organizations. The other example is Visa (prior to its current form) which is basically an independent entity made up of the various major banks that were members.

  • stephen mayes

    I am really happy to know there is still interest in AA, outside of just the Alcoholics. I always hate to hear bad stories about certain groups or meetings. Having read the first 164 pages of the Big Book multiple times, I know (and I’d never thought I’d say this) that it was divinely inspired. I understand that Bill W. learned a lot from the Oxford Group and even the Washingtonians (more so from their disappearance of the face of the Earth than anything). The steps do come right out of the bible, I believe from the book of James. The meetings provide a community setting in order to recover. Carl Jung believed “evil” can only be overcome in a community of like minded individuals, or with an overwhelming and personality changing experience with a higher power. Which if you think about it, everyone is some form of community at work, school , etc etc. The alcoholic and addict can find themselves alone and in dereliction and degradation unlike anything the other 90% of the population understands. There is a wonderful book called “Not God” written by a Harvard Professor. It might be the best book on AA and how it formed. I myself parted ways with AA. I love AA with all my heart, but as a heroin and cocaine addict- I went over to another 12 step fellowship, Narcotics Anonymous and have been clean ever since. I don’t know why this stuff works (although I have some theories), but it does. I have never seen anyone in either fellowship come in and really work the steps, use sponsorship, have a home group, do service work , read literature, and pray return to active alcoholism or addiction. It’s the craziest miracle I have ever been witness to!

  • stephen mayes

    Oh, and sorry about all the spelling and grammar mistakes

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