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"Even though a number of people have tried, no one has yet found a way to drink for a living." (Jean Kerr)
The Business of Addiction
Throughout this whole process the one question that has been excruciatingly hard to answer is the question of motive. What does A.A. get out of this? A.A. makes no profit, so it can’t be money, or is it? If you were to look at A.A. you would have to deduce that the likelihood is that in truth it makes very little money, and any money it does make is put back into it. Due to the lack of a power structure and central rule, any fraud would have to be petite, if at all. Any treasurers in A.A. are replaced every two years, in keeping with its internal rules. You may ask how this is enforced with no leaders, but it is stringently adhered to and is enforced by its members. Once I realised that I ceased to investigate financial reward as a possible motive. But a thorough investigation, and a much closer inspection revealed that I had been looking in the wrong place. There is more to A.A. than its meetings. Whilst searching the Internet I came across an article titled, ‘The Business of Addiction.’ It then dawned on me that A.A. does not make money, but that does not mean other organisations don’t make money out of A.A. The obvious example is of course, treatment centres. Without A.A., which is what they sell, they would have no product. A.A is the product. Treatment centres are the primary feeder for A.A. groups, because they rely on A.A. to survive. This is where I want to bring back to the fray my suspicion that A.A. has an investment in relapse. A.A.’s investment is that relapse increases dependence, but for a 12 step treatment centre, relapse (or relapsers) may as well be called what normal businesses would call a repeat customer. Again this leads to the question, but if people relapse, why do they go back? The treatment centres I went to did not ‘cure’ me, but I still went back there. This is because its not that the program did not work, it’s that I did not work it, or so they sell it to us. And what is the first message they tell you when you arrive? A.A. is the only way, so as soon as you relapse you go back to them in belief of this, blaming yourself for not working the program. The majority of people in treatment with me had been in treatment at least once before. I cannot find the statistic, but somewhere it states that the more expensive the treatment the less effective it is. In other words, it pays to fail in the business of addiction. And what is the criteria of a relapse? It is the use of any chemical. The rules are unrealistic, but failure feeds this whole beast, and our failure is their success.
My personal experience of treatment over the last 9 years:
As an ‘alcoholic’ when I reached my rock bottom and had no option but to turn around and ask for help, I was reintroduced to the 12 steps. Eight years earlier I had been in sobriety for 9 months until one evening in treatment I decided to have a drink. I was asked to leave the rehabilitation centre and given 20 minutes to pack my bags. At the time I felt it was a fair reaction, after all we cannot have people drinking or taking drugs in a rehab. But if I take the time to think about what had happened in those nine months, it is amazing that I managed to survive 8 years ‘out there.’ I put that in inverted commas because that is how ‘alcoholics’ refer to their drinking days. I assume this is in reference to not being ‘in the rooms.’ Being ‘in the rooms’ constitutes being a sober ‘alcoholic’; ‘working’ the 12 steps of Alcoholics Anonymous, and attending meetings. You might be confused because I had been admitted into treatment for heroin addiction, but I left an ‘alcoholic’ despite the fact I had hardly ever drunk. Very early on in my treatment I was told I could never drink safely again because I was a heroin addict, and ‘it’s all the same stuff.’ I began to adopt this approach and belief until eventually I started identifying myself as an ‘alcoholic/addict’. 8 years later, having been thrown out of rehab for drinking, I returned to treatment for what was now my realised alcoholism. Initially my reaction was to surrender to the program, and the counsellors as they had been right all along; I was an ‘alcoholic’ after all. The following extract gives an explanation as to why this may have been the case…
Unfortunately, many non-religious alcoholics do drink themselves to death after investigating AA and rejecting it because of its religiosity. In all too many cases, that appears to be the result of their acceptance of the AA myth that alcoholics who reject AA are doomed to an alcoholic hell. This belief frequently becomes a self-fulfilling prophecy. If those too honest to “fake it until [they] make it” believe that their only choice is between abandoning their integrity (by embracing AA and participating in an endless series of dreary religious meetings) or continuing to drink, it’s little wonder that a great many eventually do drink themselves to death. (Bufe retrieved here.)
So what happened in those 9 months 8 years ago? Exactly what’s happened in the last year I have been sober. Let’s start at the basics, an addict’s first meeting. Mine was at The****** Hospital in ********** in 1997. I was 19 years old. I cannot remember much except for one very important ‘fact’ being aired in the room. This so-called ‘fact’ was that Alcoholics Anonymous was the only proven way to stay sober and those who don’t surrender to its principles will drink. To the average temperate drinker that might not seem overly significant until we consider the other subtle messages coming from the people in that room. AA instils a belief in its members early on that as ‘alcoholics’ to drink is to die. No one ‘in the rooms’ says if you don’t work the steps you will die, but many say if you do not work the steps you will drink in one sentence, and then in another they will say, if you drink you’ll die, but they never say those two things together. In chapter 5 of the Big Book of Alcoholics Anonymous it does go as far as to say,
It is plain that a life which includes deep resentment leads only to futility and unhappiness. To the precise extent that we permit these, do we squander the hours that might have been worth while. But with the alcoholic, whose hope is the maintenance and growth of a spiritual experience, this business of resentment is infinitely grave. We found that it is fatal. For when harboring such feeling we shut ourselves off from the sunlight of the Spirit. The insanity of alcohol returns and we drink again. And with us, to drink is to die. (Note this paragraph starts with a reasonable statement about resentment, but somehow ends in equating resentment to death. J.G.)
In that meeting they made me feel very special and labelled me the newcomer and with that the most important person in the room. They reassured me that everything in AA is suggested and that there are no rules. I remember feeling that these were very friendly people who would go to any lengths to help me. And thus my initiation into AA was complete.
The treatment centres I went into adopt what is called the Minnesota model of recovery which combines the 12 steps with conventional therapy. Attendance at meetings is mandatory as is an acceptance of the 12 steps as the only form of recovery available to addicts. On top of meetings patients are required to attend workshops, all meals, one to one and group therapy sessions. I remember the head of the ATD telling us (the addicts and alcoholics) that we were not to eat with the other patients in the hospital, and any contact with them should be minimal. Patients rarely question the goings on. No one ends up in treatment on a winning streak, and we arrive there with some hope for the first time in a long while, and for many of us that hope is all we have. We go there in the belief we will be helped to sort out our problems, and most of us are desperate to do just that. We assume we are in the hands of experts in the field of the solution to our problem, the treatment of addiction. For all these reasons coupled with the fact we want to get well, we trust these experts. When we walk through the doors we are effectively saying I cannot manage, can you show me how? It did not occur to me to question anything, or anyone. Acceptance of AA came very easily to me. I am not sure acceptance is the right word. Let me explain. When I arrived in treatment, and thus the rooms of AA, everyone in my life was angry with me and I felt very alone and very isolated. I soon realised these people would give me the one thing I craved which of course was acceptance from people but at a cost. In order to be accepted by them I had to accept ‘the program.’ My addiction had forced me into the role of people pleaser. In other words I would do almost anything to be liked by anyone. I started saying things I did not even believe, and quoting passages from AA literature and preaching to the other people in treatment. I wanted approval from the only authority in my life at that time, the counsellors. It is important to note the majority of these were members of 12 step fellowships.
J can be contacted at firstname.lastname@example.org