Lying in bed at his often frequented alcoholism treatment hospital in 1934, long time drunk and skeptical agnostic Bill W had the epiphany that would both lead to the creation of the world’s largest alcoholism recovery program in Alcoholics Anonymous, and simultaneously discredit him forever more in the eyes of much of the medical world. He called it his “Hot Flash” and, as the story goes, it came at the peak of his despair as he shouted to his empty ward, “I’ll do anything! Anything at all! If there is a God, let him show himself.” Immediately there was a sensation of bright light, a feeling of ecstasy and a new serenity. Bill W never drank again.

How can a quasi-religious organization be the number one go to option for people suffering the medically diagnosable disease of alcoholism?

The story is familiar—rough times, a vision from God, new beginnings and saved souls—it’s been the pretext of countless religious movements throughout the ages, some legitimate, many less so. What it had never been, however, was the founding of a medical model, the solution to a medically specific disease. Yet with AA this is what it became. With his new recruit Dr. Bob (cartoon character names are an unfortunate side effect of anonymity), Bill W set about translating his epiphany into a set of principles which, they claimed, would release even the most hardened alcoholic from their addiction. It seemed to work. Four years later popular demand had him publishing his doctrine in a book, streamlined into a 12 step approach. 80 years on and AA is the largest self help organization in the world (discounting organized religions), with 2 million members and counting.

Yet AA’s success has never calmed the skeptics. How, they ask, in an age of scientific empiricism, can a quasi-religious organization be the number one go to option for people suffering the medically diagnosable disease of alcoholism? How can we trust an organization that, with its decentralized structure and condition of anonymity, is largely unaccountable and virtually unverifiable in terms of efficacy, with some of society’s most fragile members? And, most frustratingly, how can you get these questions heard by AA itself when it conducts no internal inspections, no research of its own and it largely relies on Bill W’s distinctly suspicious sounding “Big Book” to provide answers? Indeed, with its honeycomb of cells united only by a shared problem and an unflinching ideology, it looks more like an underground terrorist network or religious sect than a medical institution. Whichever way you look at it, AA is certainly an anomaly in a world of empirical science and medical rigidity.

But then, addiction is an anomaly among diseases. It can’t be caught, it can’t be cured and although it eventually manifests itself through physiological changes within the brain (hence its qualification as a disease) it can’t be traced to a common origin among its sufferers. In short, addiction is still largely a mystery. The medical disease model understands well its symptoms and can treat them with relative success. But for long term recovery this is often not enough. For this we need to look further back, to the uncertain territory from which addiction grows, and forward to the equally elusive factors through which it can be overcome.

Bill W’s revelation may have come to him in a flash, but his linking of addiction with a spiritual longing was by no means a new concept. The previous fifty years had seen writers, from Nietzsche to Jung, William James to Viktor Frankl, acknowledging the history of drug and alcohol use as a means to achieve spiritual transcendence. They pointed to the frenzied Dionysian rituals of the Ancient Greeks, the peyote induced space-outs and drunken soul-searching of the Native Americans, the plain language of the Latin term for alcohol- spiritus. But times had changed, and with it so had drinking. These explicitly spiritual rituals were long gone by the beginning of the 20th century and the role of religion in the day to day life of the western world was dwindling. In its place a new kind of faith was being sold, one that relied on the power of the individual and guaranteed freedom and happiness was yours for the taking- all you needed was the money to buy it.

But old habits die hard. The thirst for booze was greater than ever, egged on by advertising and a cult of macho competition. Meanwhile, a need for transcendence of some form, as old as culture itself, remained strong, diverted but intact. Speculatively at first, Jung put two and two together; “addiction to alcohol might represent a misplaced longing for spirit” he wrote. Frankl would later agree, talking of a loss of meaning in the materially fixated modern world and the existential vacuum this opened up within society. When not addressed, he warned, the vacuum’s “companions, addiction, depression and aggression become the threat not only to the individual, but to society as a whole.”

This does not mean, contrary to their critics’ indictments, that without religion we are lost- meaning and spirituality are not that stringent in their sourcing. It does however suggest that in order to find lasting happiness, we must look beyond the immediate and the material, whether it be to love, friendship, work, meditation or indeed prayer. Addiction may arise from the opposite of this, the search for self in the bottom of a bottle, the diversion of a need for transcendence into instant escapism. Drugs and alcohol offer control, connection, a sense of infallibility and the capacity to alter consciousness. When they make this offer alone, emerging as a solution to an absence or awareness of human limitations, they often divert into addiction.

Maybe then, by applying these theories to a pragmatic approach of treating alcoholism, Bill W was onto something after all. The size of AA and the huge number of its 12 steps spinoffs certainly suggests so. Further, the institution’s exponential growth across the world over the last 80 years suggests that, rather than being an anachronism, relevant only within the context of its origins, the philosophy espoused in the Big Book contains something approaching a fundamental truth. If addiction is a spiritual problem, then treating it requires a spiritual approach; in the words of Jung, Spiritus Contra Spiritum– Spirit against the ravages of spirits.

Thus arises the most important and most controversial of the 12 steps: (we) “Came to believe that a power greater than ourselves could restore us to sanity”. This contains much of what is central to the philosophy of AA; that in order to regain happiness an addict must relinquish control, that they must accept their position as ordinary (the very definition of humility) and they must acknowledge that there exists something greater than themselves and that life contains more than the immediacy of personal experience. Only then can the cycle of dependence be broken.

But it also contains almost everything AA’s detractors need in order to undermine its legitimacy as anything other than a cult. With the assumption of insanity and the demand that you surrender yourself to an abstraction (in the idea of a higher power), this is, they argue, the language of an authoritarian belief system. Throughout the rest of the steps, the religious connotations become even more direct. God, or Him, is mentioned a total of eight times, while “steppers” are advised to complete a distinctly Christian moral prescription, including having to “make direct amends” for all past misdeeds.

Wendy Dossett, a lecturer in religious studies at Chester University in the UK, is convinced that the “God Squad” allegations are largely unreflective of the reality within AA. Over the last year she has been working on the ongoing Higher Power study, collecting personal accounts from AA members of how they consider their “higher power.” Only around thirty percent, she claims, relate it in any way to a recognizably Christian conception of God, the rest referring to more broadly spiritual ideas such as “a loving presence that gives me a sense of connectedness with other people and the earth” or even social ideas like “the fellowship and friendship within AA.” The idea that AA is essentially a quasi-Christian organization, she says, is derived largely from the language used in the Big Book which, after 80 years, is inevitably being re-interpreted by contemporary practitioners. “If we actually listen to the voices of the people in the fellowships we will hear that their experience of spirituality is extremely diverse”’ she says. “Whilst AA certainly contains a minority of practicing Christians (like the general population), the dismissal of AA as an overtly Christian organization is really a misrepresentation of the reality.”

For Stanton Peele, the author of the anti-12 steps book Resisting 12 Steps Coercion, this argument doesn’t hold. “You can’t have an organization that is explicitly Christian in nature and call it secular” he says. “A conception of the spiritual may be useful in overcoming addiction, but the 12 steps clearly defines spirituality for you. You can’t just ignore all those mentions of God.” Why would it matter anyway if the 12 steps do have a Christian bent? “People are forced into 12 step programs everyday in America as a condition of their parole, regardless of their religious views. Not only is this a violation of the First Amendment, which states explicitly that a government agency cannot compel anyone to participate in a religious practice that you don’t personally believe in, but it can also do people serious damage. Addicts entering recovery are at their most fragile. If they are told that their addiction is a moral or religious problem, then relapse automatically becomes a moral or religious failure. Think how much harder that is to deal with.”

This could, of course, be argued in and out forever—ambiguity is another unfortunate side effect of anonymity. The dearth of data surrounding AA means that conclusions are drawn mostly from conjecture, both sides of the argument falling back on anecdotes to reinforce their ideological positions. But something in AA is working.

Daniel Gerrard, a counselor and interventionist with the 12 steps based addiction advice group, Addiction Helper, sums it up succinctly. “AA doesn’t teach you how to stop drinking,” he says. “It teaches you how to live without drink. It understands something that too many doctors and councilors forget; bad habits need substitutes. If you use drugs and alcohol to fill a vacuum in your life, then the substitute needs to address that vacuum in a positive, long term and non-materialistic way. If this is spirituality, then spirituality is what it takes.”

12/11/13… “The Fix“

Luke Dale-Harris is a London based journalist who writes for The Guardian.