Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety. – A.A. Preamble

Alcoholism is known to social work today as one of the most complex and baffling problems the worker faces as he attempts to help families solve their problems. Few are the social workers who have not heard of Alcoholics Anonymous and its great success in enabling tens of thousands of alcoholic men and women to win their way back to sobriety. Many have been curious to know how this group has succeeded when so many other individuals and groups have failed; to learn more about its workings; and finally, to discover how they can relate to Alcoholics Anonymous for the benefit of their clients. Any social worker who is contemplating working with A.A.1 as it is commonly known, would do well to read very carefully the statement that appears at the head of this article. This is A.A. as the members see themselves. This is a description of Alcoholics Anonymous which is read at the opening of virtually every A.A. group meeting around the world. If the social worker who wishes to work with Alcoholics Anonymous will take the time to study the statement carefully, he can avoid many of the difficulties that are encountered in working

with A.A. and have a better chance of securing the help of this fellowship for his client. First of all, as the statement says, Alcoholics Anonymous is a fellowship. This is probably the best word that could be chosen to describe this unique group of men and women. It is not an organization in the commonly accepted sense of the word, with structure, charter, bylaws, officers, directors, executives, and so on. It is not an agency in any sense; A.A. members would strenuously resist being described as a welfare agency. It is not, of course, a church, although as we shall see later it has a deeply spiritual basis. There is no executive with whom the social worker can consult and whom he can call in the way he might call the executive of another social agency. There is no board of directors whose interest must be solicited. Rather, it is a loosely knit group of men and women who have banded themselves together, as the Preamble says, for the sole purpose of helping each other stay sober, and to carry the message of how they did so to other alcoholics. In the framework of A.A. – for it does have a structure of sorts – each group is completely autonomous. Each is organized as it sees fit; conducts its affairs in its own way; holds as many or as few meetings as it wishes; uses literature prepared by headquarters as it desires or, if it does not like this literature, prepares its own. It may have a committee directing its affairs, or merely a secretary charged with some of the basic responsibilities of providing a place to meet, getting speakers, providing for the coffee and doughnuts that follow the meeting. In larger communities, there may be an intergroup association which correlates the services of all the groups in the area and serves as an information center for all concerned. A.A. also has a General Service Office in New York City which has no authority over local groups but serves them as they may wish service: with preparation of literature, publication of A.A. books and the publication of the monthly magazine, The Grapevine, and contact with groups and individuals around the world. It provides, however, no direct service to alcoholics; it is the A.A. central referral agency to put interested alcoholics or their families in touch with the A.A. group nearest to the inquirer. If the interest of Alcoholics Anonymous is to be obtained in behalf of a client, the social worker must expect to be working with several people at first until the client settles down with one sponsor, to whom he will relate

more closely as time goes on. The sponsor may change: A.A. is extremely flexible. THe social worker must be constantly m t i n g that there will be changes in the relationship as it develops. He should also note that the only requirement for membership is a desire to stop drinking. A.A. has none of the problems of membership present in other groups. There is no formal sponsorship, no admission committee, no potential blackball, no fees or dues for membership. Rather, if the alcoholic expresses any interest at all in maintaining sobriety, he is entirely welcome from that moment on. It is important for the social worker to realize the absolute independence on which A.A. insists. This statement declares that “A.A. is not allied with any sect, denomination, politics, organization, or institution.” Through sad exprience, members have learned that their groups can be utilized for ends with which all the members do not agree – that if the organization becomes involved with any particular sect or group or political organization, this will be divisive for its membership. Its strength and safety depend on committing itself wholeheartedly and solely to the program of helping its members to achieve sobriety, leaving to individual members to join or not join, support or not support, to oppose or accept any group or cause they may see fit. One of the “Twelve Traditionsu of the A.A. movement reads as follows: “An A.A. group ought never to endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property and prestige divert us from our primary purpose.” This does not mean that A.A. is hostile to social work, or to churches or hospitals or doctors or psychiatry, or to any person. A.A. members have had difficult experiences with many of these agencies and groups and have their personal views about them, but the movement as a whole is not opposed to or in favor of anybody else – rather, it is glad of the interest and concern of any other group for the welfare of alcoholics. A.A. people work very closely and successfully with doctors, psychiatrists, clinics, hospitals, church groups, and others in helping alcoholics. There is no reason why a similar effective relationship cannot be established with a social worker in behalf of any client.

There have been considerable discussion and speculation as to why A.A. has been able to succeed in helping alcoholics while other methods have been so lamentably ineffective. Various people have various explanations. This writer’s is that it succeeds because it meets the basic needs of the alcoholic at the time he is confronted with the A.A. program. 1. The first thing the alcoholic needs is hope – hope that he can recover. No social worker who feels that alcoholics cannot recover can be of any assistance whatever to an alcoholic. No matter what the worker says, the alcoholic will sense his lack of hope and react to it. The alcoholic has heard for years from all sources – from his family, his friends; from doctors, nurses, and hospitals; sometimes from ministers and priests, sometimes from social workers – the word that he is “hopeless.” As he hers this day in and day out, week in and week out, he comes to believe it himself. As long as the alcoholic believes he is hopeless, any program of recovery is bound to fail. By merely introducing him to a group of recovered alcoholics, Alcoholics Anonymous automatically restores hope to him. As he looks at the A.A. group, he consciously or subconsciously says to himself, “If they can do it, I can.” Hence, in the very first contact with this group one of the alcoholiclsbasic needs – hope – is met. 2. The second need is to be received back as a member of the human race. The alcoholic’s experience during his days of acute alcoholism is that of universal rejection. His life is a succession of closing doors. His friends1 houses are closed to him because his behavior is such that they can no longer tolerate having him around. The doors of employment slam in his face and may be actually bolted against him through a black-list. It may seem that the doors of his church are shut against him, and he has known for some time that entrance to most hospitals is firmly barred. Finally – and this is most tragic of all – the doors of his own home may be closed to him. Sometimes it seems that the only remaining open door is that of the jail or the mental institution, and this is closed and locked behind him when he is forcibly thrust in. The alcoholic comes to think of himself as one who has no importance whatsoever to anybody else in the world; he suffers from a loneliness so

intense that few nonalcoholics with the greatest power of empathy can appreciate it. It is this feeling of utter despair, of complete loneliness, of essential meaninglessness to others, that produces a kind of frantic, hectic drinking to achieve forgetfulness and blot out the horror that life has become. Here again, from the first contact when he is welcomed with open arms by the members of A.A., the alcoholic feels that he is back in the human race again, no longer an outcast. No one asks him where he has been; no one asks him if he is sorry; no one suggests that he ought to be ashamed of himself; nobody points a finger of scorn. Rather, he is asked if he wants to do something about his drinking, and is told that he is entirely welcome. He learns that he has a much status from the day he joins the A.A. movement as those who have been in it for perhaps fifteen or twenty years. The value of this acceptance is incalculable; it is one of the tremendous supports A.A. provides for its new members. 3. The alcoholic needs to accept his alcoholism. It is difficult for the nonalcoholic to believe that alcoholics cannot clearly see that drinking is the cause of their difficulty. The alcoholic, given perhaps even more to rationalization than the average person, points to explanations outside himself for his drinking. He will tell you that he got drunk because he was tired, or sick. He will tell you that he got drunk because his mother-in-law came to town, or because she left; that he drank because he was given a raise, or was fired; that he drank too much because the Democrats won, or because the Republicans won. All these reasons that seem good to him are, of course, totally spurious. He is drinking because this is the nature of alcoholism: the alcoholic drinks in an uncontrolled fashion, and the fact that he cannot control it is evidence of his sickness. A.A. again fulfills a real need by confronting the alcoholic bluntly with the nature of his problem. The members brush aside his explanations of why he drinks and tell him that he is drinking because he is an alcoholic and cannot help himself. They tell him that, until he accepts this fact about himself, he is powerless over alcohol – that his life has become unmanageable and he will be unable to recover. Here again is an enormously important step in the therapeutic process which A.A. has discovered: that without this recognition

of the nature of the problem, the person who suffers from it will never be able to come to grips with it. 4. A.A. also fulfills another need of the alcoholic, which is to accept himself as a human being. Alcoholics are apt to be rather Utopian in their concepts. In their immaturity, they have felt that people could be perfect and, finding that neither they nor others have been perfect, have become cynical and disillusioned. Without consciously doing SO, A.A. shows the new members what it means to be a human being; what it means to have strengths and weaknesses, virtues and flaws; to recognize that every day there will be failure and every day perhaps some success. They show the alcoholic how he can settle for being a human being, accept himself and live with himself and, being able to do SO, learn how to live with other human beings. A.A.’s talk a great deal of the virtue of tolerance; they learn by association with each other how to tolerate themselves and, being able to tolerate themselves, are able to get along much.betterwith others.

While all these processes are going on – they do not occur, of course, in the chronological order presented here – the A.A. novice is also being introduced to the basic source of A.A. strength: the relationship with God as the members understand Him. It was noted in quoting from the Preamble that A.A. is not related to any religious sect, and this is true. On the other hand, virtually any member of Alcoholics Anonymous to whom the social worker talks will state that the basis for recovery depends on the ability to relate to a “Higher Powerw which is described by the Alcoholics Anonymous group as “God as we understand Him.” This concept is important for the social worker to grasp. It is not a creed to which the members are asked to adhere; there is no theological description of the Deity. Rather there is the admonition to the new member that if he would remain sober he must develop some concept of God which will be good enough for him to rely on to enable him to break the grip of the alcoholic obsession that is destroying his life. The concepts of God with which members work are sometimes very crude and slightly shocking. They are very disturbing, sometimes, to ministers and representatives of organized religion; but as the members mature in A.A.,

their concepts tend to become more conventional, and many relate themselves firmly to a church. The needs outlined above are largely met as the members struggle to live by what they call the program of “Twelve Suggested Stepsn to recovery. Social workers will be interested in reading these steps which are printed at the end of this article, to detect the spiritual and psychological principles upon which they rest. At this point a word of warning may be helpful for the worker. If he cannot accept the validity of a belief in a higher power as a source of strength for an individual’s life, he must not try to work with Alcoholics Anonymous. It is not necessary for him to be a believer himself, but he must be willing to recognize that those who believe do find this strength and direction for their lives. This acceptance of GOd is not easy for the average alcoholic, but what is amazing is that so many who have been fearful of Him or hostile to Him all their lives, come to a strong and close relationship with Him. They find that in this process they gain release from the grip of the obsession that has chained them so long. So real is this relationship that for many members of Alcoholics Anonymous is in itself a religion. This is perhaps not fortunate and has dangers implicit in it, which many or the older members recognize. But with the absolute freedom given to each member to interpret the program as he sees fit, members who would recognize that A.A. is not, cannot be, and should not be a religion accept this as valid for those to whom it has meaning. It is true, as noted before, that generally the Alcoholics Anonymous groups would describe their program as resting on a spiritual base and are free to give the credit where they think it belongs. On any one day, at any given moment, in thousands of groups around the world people are standing up and saying, “1 am sober, thanks to A.A. and the grace of God.” In countless A.A. meeting halls and cl~brooms, banners, placards, and illuminated manuscripts hang on the wall, displaying the words “But for the Grace of God.”

No one can really understand the A.A. program by merely reading about it. The social worker who is interested should inquire as to the location of an

A.A. group and learn when it will have an open meeting he can attend. It is likely that he, as all others that come in contact with the group, will be stimulated, excited, and deeply moved by what he sees going on in the group. The groups vary in their methods. As a general rule, a number of speakers At each A.A. meetings describe their alcoholic experiences. The closing speaker will, perhaps, attempt to sum up what all the others have said, and frequently will discuss the twelve steps of which the recovery program is composed. There is always an offering – passing the hat, as it is called – and the money is used to pay for the coffee and doughnuts and perhaps a modest rental on the meeting place; for literature to give to new members and outsiders who may be interested; and for support of the national headquarters in New York. Any social worker who wants to get in touch with A.A. can consult the phone book. Alcoholics Anonymous is listed under this name in most of the larger comities in the country and many smaller ones. If it is not in the book, the local policeman may know where the groups meet; sometimes the judge knows. If the worker cannot find out in his own c o m i t y , he can write to Alcoholics Anonymous, PO Box 459, Grand Central Station Annex, New York 17, New York, for the location of the nearest group. It would be wise for the worker to acquaint himself with the working of A.A. groups near him before attempting to enlist their help in behalf of a specific client. If he could go to one or two groups, introduce himself to the members, search out the secretary and ask for a telephone reference which he could use, acplaining his own work and desire to enlist A.A.Is support, he would undoubtedly meet with a universally ready response. As noted above, A.A. has only two purposes: to help its members stay sober and to help others achieve sobriety. In pursuit of the second purpose (normally called “carrying the message”), A.A. members are eager to be called on for what they speak of as “twelfth-step work1′ – so-called because the twelfth step of the program describes this obligation to help others. Once the contact has been established and a working arrangement developed, the social worker should always make sure that the client is willing to discuss his problem with a member of A.A. before asking A.A. to come in. Invariably the A.A. member, when approached for help, will ask if the other person wants to see him. It does not have to be any passionate desire or

any great interest; a passive willingness to talk to a member of A.A. will-:& adequate. If it is possible, the social worker should arrange to introduce the A.A. member to the client, either bringing the member to the client’s home or taking the client to the A.A. meeting or the A.A. person’s home. Referal is not good enough and should be avoided wherever possible referral, that is, in the sense of merely sending somebody somewhere else. The alcoholic has had a long experience of being passed along from person to person, with each one apparently eager to be rid of him. Referral in this way way will merely convince the alcoholic that the social worker is like all the rest. If, however, the worker says, “1 want to take you to the A.A. meeting,” or “I’d like to bring a member of A.A. with me when I come to call on you tomorrow night,” the situation is completely reversed and the alcoholic is assured at least of an interest deep enough to account for the social workers trouble in providing the introduction. THe worker must make sure the alcoholic understands that he is not just being abandoned to A.A., but that he (the worker) hopes to keep in touch with him and his family to help in any way possible. But he will tell the client that he believes that if he can utilize the services of A.A., this will be the best possible thing for him in the months to come. The worker should avoid the impression of dropping his responsibility because A.A. has been brought into the picture. The social worker may find that, while A.A. attracts the client, the latter falls away again. He must be prepared for this and be willing to try some other A.A. group. A.A. groups are not all alike. IN some parts of the city they are so specialized that they do not have the general appeal that is necessary. A business or professional man, for example, will do better in a group composed of people of similar background than in a group made up of workingmen. By the same token, a woman may feel terribly lonely in an A.A. group where she is the only woman, but will be happier in a group with other women members. A.A. groups themselves will be helpful in matching up their people with the client. Occasionally, the social worker may get a refusal from A.A. When the name of the client is mentioned, the A.A. spokesman may say that this man is well known to them and they do not believe that he has much interest. The social worker must not be disturbed by this, but may say that he was not aware of it

and will talk to his client further. Perhaps the client will admit that he has been exposed to A.A. before and that it has not seemed to work. If he is willing to try again, A.A. is usually willing to take another chance with him.

Finally, if the social worker is not able to help the alcoholic, he does have an obligation to help his family. There is a fellowship related to Alcoholics Anonymous called the Al-Anon Family Groups, composed of sober relatives of alcoholics. These are predominantly wives, but also husbands of alcoholics; mothers and fathers, sisters and brothers, and even children do belong to Al-Anon groups in certain parts of the country. This movement is growing rapidly, with between 700 and 800 groups in all parts of the United States. The contact with the local Alcoholics Anonymous group will usually produce the name and address of the responsible person for the Al-Anon group in a given c o m i t y . If none is known in the immediate area, there may be one nearby and its address can be ascertained by writing to the Al-Anon Family Group Headquarters, 125 East 23 Street, New York, New York. The members of Al-Anon meet not, as one might suspect, to discuss the frigtful behavior of the alcoholic husband or wife or son or father, but rather to learn how they, the sober ones, have been contributing to the problem – to discover how they can live with alcoholism and still maintain the home – how they can become better persons themselves. The Al-Anon groups use the same twelve steps and apply the same kind of group sharing of their “experience, strength and hope.” Most wives think their alcoholic husbands are unique. They imagine that no woman has ever known such sorrow and wallow in self-pity. Al-Anon provides a strong corrective to this exaggerated view and brings the problems down to a size where it can be grappled with. Family members learn the techniques of living with an alcoholic and frequently become the medium through which the alcoholic is guided to A.A. and recovery. This group also sponsors a third organization called the Alateen group, composed of the adolescent children of alcoholic parents. There are not as many of these, but in some comunities they, too, are quite effective in enabling the youngsters to work out their own problems through a group.

Childrechildren suffer the torments of the damned living in a home with one or both parents alcoholic, until they learn what the situation is. But they, like members of Al-Anon, can be guided to acceptance of alcoholism as a sicknessr enabling them to maintain their love and respect for the alcoholic parent even while the drinking goes on. Adolescents advise each other at Alateen about the problem of inviting a date to the house where the father may come home drunk; they learn how to cope with the cruel comments other children make about their parents; they discover how to “handlen mother or father when they are drunk. For all the social workers who wish to help alcoholics, the fellowship of Alcoholics Anonymous provides one of the most effective sources of assistance. All that is necessary is acceptance of the concept of alcoholics as sick people and a recognition that they can be helped, that none of them is hopeless, that each of them is a completely unique individual whose alcoholism has roots which may never be apparent, but whose drinking must be stopped if his life is to be saved; that Alcoholics Anonymous, while not necessarily able to help every person, is able to help a great majority of alcoholics, and that its members stand ready and willing to assist if called upon and enabled to function in their own ways. Social workers must be prepared to see members of A.A. violate many techniques and procedures that seem to them almost sacred. If they are wise, however, they will let the A.A. men and women work at their own tempo and in their awn ways, for while they are not very strong on theory, they have worked out excellent pragmatic methods of helping alcoholics. The writer can assure any social worker who avails himself of the support and help of Alcoholics Anonymous of a fascinating experience and a deeply rewarding one. If he has a faith, he will find it deepened. If he has none, he will find his curiosity aroused.