AA and the Disease Concept: A Complex Connection

It is difficult to pick up a book advocating or attacking the disease concept of

alcoholism/addiction without having Alcoholics Anonymous credited as the source
of the modern disease concept of alcoholism. Yet considerable evidence challenges
this popular belief. When AA co-founder Bill Wilson was asked in 1960 about AA’s
position on the disease concept, he offered the following response:

“We have never called alcoholism a disease because, technically speaking, it is not a
disease entity. For example, there is no such thing as heart disease. Instead, there are
many separate heart ailments, or combinations of them. It is something like that with
alcoholism. Therefore, we did not wish to get in wrong with the medical profession by
pronouncing alcoholism a disease entity. Therefore, we always called it an illness, or a
malady -- a far safer term for us to use.”

AA’s use of medical terms reflects not an observation on the source or nature of
alcoholism but its belief about the solution. When Wilson asked Dr. Bob Smith, AA’s
other co- founder, to comment on the accuracy of referring to alcoholism as disease
or one of its synonyms, Smith scribbled in a large hand on a small sheet of his
letterhead: “Have to use disease -- sick -- only way to get across hopelessness.” AA’s
use of medical metaphors served as a reminder of its belief that the alcoholic could
never again safely drink alcohol.

In a paper that looks specifically at whether AA was the source of the disease
concept, historian Ernest Kurtz, author of Not God: A History of Alcoholics
Anonymous, summarizes his review of AA literature and practices:
“On the basic question, the data are clear: Contrary to common opinion, Alcoholics
Anonymous neither originated nor promulgated what has come to be called the
disease concept of alcoholism. In the major texts of AA, there appear no discussions
and bare mention of “disease,” much less of the disease concept of alcoholism. Its
paucity of mention in the officially published works suggests that this
understanding is hardly central to the thought of Alcoholics Anonymous. Yet its
members did have a large role in spreading and popularizing that understanding.
Most AA members, in the year 2000 no less than in 1939, will tell an inquirer that
their alcoholism has physical, mental, emotional, and spiritual dimensions. The
contribution of Alcoholics Anonymous is not the idea of disease but of threefold
disease -- the realization that the alcoholic had problems in the physical, the mental,
and the spiritual realms, the clear understanding that alcoholism is, as described on
page 44 of Alcoholics Anonymous, ‘an illness which only a spiritual experience will
conquer.’ Did AAs use the disease concept of alcoholism? Yes. Did AAs or AA
originate, rediscover or dogmatically push the disease concept of alcoholism?
Clearly, No.”
What AA did contribute inadvertently to the disease concept – its goal was not to
understand alcoholism but to help alcoholics -- was their members’ collective
experience. This experience reflected:
• the reality that alcoholism had a physical, as well as a mental and a spiritual,
component
• the potential helpfulness of medical metaphors (“illness,” “allergy”) in making
sense of drinking experiences
• the portrayal of alcoholism as an accelerating process • the importance of
concentrating on drinking behavior rather than searching for
underlying causes • a belief that loss of control over alcohol could be contained
only by complete
abstinence from alcohol.
AA was not the source or promoter of the disease concept that emerged in the 1940s
as a public policy slogan and an organizing construct for alcoholism treatment. AA’s
peripheral use of such medical metaphors was not a declaration of science but a
simple statement of collective experience. (“It explains many things for which we
cannot otherwise account.” Alcoholics Anonymous, xxiv)

Psychology is often defined as "The science that deals with mental processes and behavior". In the
modern day, there are basically two prevailing schools of thought. 'Geneticists' and 'Behaviorists'...
the old notion of "nature vs. nurture." The Geneticists are inclined to think that human behavior is
derived from heredity and instinct. Often on the news, reports detail how some study claims to find
the 'genetic predisposition' 'to being republican' or 'smoking cigarettes'. This supports the
worldview that we are 'hardwired' in some way and that even subtle nuance of behavior, such as an
inclination for addiction, is genetic or "instinctual" in some way. The Behaviorists, on the other
hand, see the human being as a product of conditioning, as based on the environmental exposure of
that person. Therefore, the actions of a person have a source that is derived from experience or a
triggered train of thought, brought on by a learned understanding. The mechanism of action/belief
therefore is sourced in learning, not heredity or instinct. Which is more relevant? Obviously, both
views are relevant in certain ways. Our interest in surviving and reproducing is imprinted/genetic
in some way, as it is directly associated with fundamental survival. However, the means by which
survival is obtained is entirely based on the social conditioning of that person. If a person grows up
in a scarce, poverty stricken environment, with limited access to employment, they will have more
of a propensity to engage in illegal activity to survive... more so, than say a middle class person
who has basic needs met. On the other side of the spectrum, if a person with great wealth has
grown up in an elitist family and is thus conditioned into thinking that his or her wealth/class
serves as a status symbol, they might often exploit those who work for them or perform illegal
activities to conform to the identity and social arrogance they think is real. The bottom line is that it
is environmental conditioning that really affects 99% of our actions, and all diligent behavior
studies have proven this time and time again. People become alcoholics not because they have a
genetic predisposition, but because of the influence of their parents or friends. If you abuse a child,
very often they grow up to abuse other children. When the mass media promotes a certain idea in
society, such as "terrorism", the public is conditioned into believing this is true and a real threat,
regardless of reality. The fact is, we are emergent, vulnerable organisms and always undergoing
influence, conditioning and change to a certain degree. That 'degree' is largely influenced by the
social/ideological identifications that many have been conditioned to think are immutable. This
particular state of awareness is where paralysis comes in, for there is nothing in nature to support
the conclusion that anything we think about today will not be outdated in the future, for one of the
few patterns we can stand behind with a certain degree of confidence (so far) is the reality that all
elements of nature are emergent. The 'identification' with set understandings for the sake of one's
integrity is a serious distortion in our world, for it is considered a 'weakness' when a person is
proven wrong. This is, of course, absurd, for to be proven wrong is how most learn and it should
not be a feared circumstance. Fritz Pearls once said, "The human species is the only species that
has the ability to interfere with their own growth". This is an important understanding, for our
belief systems, which we think we must keep to support our identities, often stand in the way of
new, changing understandings and personal growth. The most dominant institutions that perpetuate
this paralysis seem to be Theistic Religion and The Monetary System. Theistic religion promotes a
fixed worldview, with a "faith" based understanding that rejects logic and new information. The
Monetary System (in all countries) is based on Competition for Labor and thus Labor for Money.
Very simply, the "competitive edge" can only be sustained through self-perpetuation, and self-
perpetuation/self interest naturally leads to a static institution which prefers not to change, for it
threatens the survival of that business, government or the like. This is unsustainable.

Spiritual Awakening:

Spirit: A particular mood or an emotional state characterized by vigor and

animation.

Strong loyalty or dedication. To impart courage, animation, or determination to;

inspirit.

Spirits: An alcohol solution of an essential or volatile substance. Often used in the

plural with a singular verb. An alcoholic beverage, especially distilled liquor.

Spirituality
Spirituality has a different meaning to each of us, it seems. A
standard definition would be: "A sense of meaning and purpose;
a sense of self and of a relationship with 'that which is greater
than self".
Currently, Religion and Mysticism seem to have the monopoly on
Spirituality. Theistic religion often regards a 'relationship with
god' or divine creator, as a spiritual relationship, while Mystics
will often find a relationship to a 'supernatural' force or power.
The bottom line is that, almost universally, spirituality has to do
with a 'relationship' on one level or another. In most
perspectives, it is associated with a person's 'place' or 'meaning'
in life... whatever that may be.
As subjective as these things can be, we begin to recognize
changes in these notions, for social progress tends to carve a
path for understandings that stand the test of time. In the
modern age, we have the ability to look far in our past and
examine what our ancestors used to consider 'real', and then
compare those ideas to what we understand today. Many
"spiritual practices" which have existed in the past, no longer
exist due the understandings that have come about in regard to
natural phenomenon. As a base example, early religions often “-
sacrificed” animals for certain purposes... this rarely happens
today, as the relevance of such an act has proven pointless in its
desired effect. Likewise, rarely do people perform 'rain dances' in
order to influence the weather... today we understand how
weather patterns are created, and ritual practices have no
provable effect.
Similarly, the idea of 'praying' to a god for a particular request,
has also statistically proven to have little effect on an outcome,
not to mention the evidence to support a personified creator
doesn't exist in any scientific way...rather it is often derived from
ancient historical literary speculation and tradition.
Establishment Religion, in many ways, seems to be rooted in a
perceptual misunderstanding about life's processes. For instance,
it presents a worldview, which often puts the human on a
different level than other elements of nature. This 'spiritual ego'
has led to dramatic conflicts for generations, not only between
human beings, but also inadvertently, between us and the
environment itself.
However, as time has moved forward, Science has shown how
human beings are subject to the exact same forces of nature as
everything else. We have learned that we all share the same
atomic substructure as trees, birds and all other forms of life. We
have learned that we cannot live without nature's elements... we
need clean air to breathe, food to eat, energy from the sun, etc.
When we understand this Symbiotic relationship of life, we begin
to see that as far as 'relationships' are concerned, our
relationship to the planet is the most profound and important.
The medium by which this is expressed, is Science, for the
Scientific Method has allowed us insight into these natural
processes, so we can better understand how we 'fit' into this life
system as a whole.
This could be called a 'spiritual' awakening.
This realization, which has been proven by science, is that
humans are no different from any other form of nature, while our
integrity is only as good as the integrity of our environment, to
which we are a part. This understanding presents an entirely
different 'spiritual' worldview, for it forces the idea of
interdependence and connection, at its core.
The interconnection of the whole of life is undeniable in the most
basic sense, and it is this perpetual 'relationship' of total
interconnectivity that is not fully realized by society overall. Thus,
our modes of conduct and perception are largely out of line with
nature itself... and hence destructive.
Nature itself is our teacher, and our social institutions and
philosophies should be derived from this foundational and,
invariably, 'spiritual' understanding.
The faster this spiritual awakening spreads, the saner, more
peaceful and productive society will become.