Ch 11. Compulsive Drinking ☆

Whether life is worth living may depend upon the liver.
--ANONYMOUS

Alcoholics Anonymous (AA) is a highly active multimillion dollar organization, whose name is very familiar to most people. It has fathered numerous other self-help groups run on similar principles, like Gamblers Anonymous, Overeaters Anonymous, and Smokers Anonymous.

Some readers may be amazed that I would even think of criticizing AA. Isn't it just a mutual support group for people trying to stop drinking? And doesn't it actually enable a lot of people to stop drinking? Who could object to that?

In fact AA is a religious organization with some very specific views, deriving from the religious body known as "The Oxford Group Movement" or "Moral Rearmament," associated with Frank Buchman, who was extremely controversial both because of his political views (he said some friendly things about Hitler) and because of his intrusive, hard-sell methods of proselytizing.

AA is now quite independent, it is far from being a narrow sect, and most AA members have never heard of Buchman. Indeed, Buchmanism as a distinct sect has largely passed away. But AA was founded by two members of Buchman's movement, and most AA members share adherence to the famous "12 Steps." The 12 Steps, or principles, are the philosophy behind the AA approach. As a matter of historical fact, the 12 Steps did derive from Buchman's teaching (see the recommended reading at the end of this book). Many AA members still regard the 12 Steps with reverential awe, as an absolute creed almost equivalent to the Ten Commandments. Incidentally, a court has found that AA is a religious organization, and that therefore requiring alcoholic offenders to go to AA, by favoring one religious sect, is an unconstitutional breach of the separation of church and state.

AA has been so successful at disseminating its distinctive views that many people suppose that these views are not controversial. For example, AA holds that "once you're an alcoholic, you're always an alcoholic." According to AA there can be no such thing as an ex-alcoholic or former alcoholic. Hence the well-known statement ritually made at AA meetings: "I am an alcoholic." It is never, "I was an alcoholic"-even if the individual has not taken a drink for years.

Associated with this belief is the notion that alcoholism is a disease for which there is no cure, and that the only salvation for the alcoholic is to give up drinking alcohol completely and at once. People influenced by AA propaganda are usually quite surprised to discover that many researchers who have studied problem drinking do not agree with any of this. Excessive drinking is not a bodily ailment, something over which the individual has no control, and many people who have had serious problems of over-drinking have been able to reform their habits so that they can then engage in moderate, enjoyable, and harmless drinking. (Some research indicates that moderate intake of alcohol with meals is beneficial and leads to a longer life.) Some problem drinkers find it easier to curtail an addiction by gradual tapering off than by abrupt "cold turkey." More often, the best strategy for overcoming compulsive drinking involves total abstinence for many years or even for a lifetime.

Brad's Bender

Bradford, a likable, blond 23-year-old, came from a wealthy Texas family but had left home at 18 to hitchhike across the U.S. with the vague notion that he would "seek his fortune." When his money ran out in Portland, he decided to stay there. After two years of bumming around he started to experiment with drugs, including heroin and crack cocaine. His strained relations with his family became worse, and the family's financial and emotional support was reduced to a thin trickle. He felt spurned by them and became a heavy drinker, working only sporadically and living in a rundown apartment in a squalid neighborhood.

Dissatisfied with his life and looking for help, Bradford contacted AA, attended AA meetings regularly, and stopped drinking. After a few months on the wagon, he went on a bender and then began to drink so heavily that gainful employment was out of the question. Brad's family gave him an ultimatum: "Get into therapy, and we'll pay for it, or you will never see another penny from us as long as you live." And that's how Brad came to me.

As I questioned Brad closely about his drinking, it became clear that he had thirstily imbibed the AA message. When he had one drink after months of abstinence, he was totally convinced of the AA dogma that having a second and a third drink was not an option but an automatic response. A voice in the back of his head reminded him of what he had learned in AA meetings: "Remember, Brad, you are powerless over the bottle! You have no choice; it's a symptom of your illness."

Brad still believed this, of course, when he came to see me, and he had been inclined to believe something like it even before he had joined AA. Many movies, novels, and songs tell us that unfortunate or disliked behavior is not under the individual's rational control. AA was a finishing school for Brad who now firmly believed: "I'm an alcoholic for life!" Brad's case was therefore a long, hard, uphill struggle, since he had to be dissuaded of intellectual convictions that he had held most of his life and that were endlessly reinforced by popular culture.

One of Brad's sticking points was his opinion that heavy drinkers never stop of their own accord. I was able to prove him wrong by citing such cases as Robert Redford, Bing Crosby, Mickey Mantle, Frank Sinatra, and Johnny Carson, all of whom ceased their heavy drinking without any help from AA or professional counselors (See The Truth about Addiction and Recovery by Peele, Brodsky, and Arnold).

It took Brad several debates with me and many Three Minute Exercises to completely disabuse himself of the wrong beliefs that were plaguing him. (He also came to understand that other people, including his family members, did not HAVE to like him, respect him, or help him.) He eventually got his drinking completely under control, and the last time I had contact with him he had passed six years as a moderate, social, and occasional drinker. He had worked steadily, with several promotions, in a new career at a health club, had restored cordial relations with his family, and was happily married. Brad knows that a person who drinks heavily, with sadly unfortunate consequences, is currently choosing to behave foolishly, but is not sick or possessed, and does not need a doctor or an exorcist.

Here is one of the best of the Three Minute Exercises Brad employed to disinfect his "musty" thinking:

  1. (Activating event): I went on a drunken binge after staying sober for five weeks.

  2. (irrational Belief): I MUST never have a single relapse from sobriety. Since I have had a relapse, this proves I'm powerless over my drinking problem.

  3. (behavioral Consequence): Continued drinking.

  4. (Disputing): Why MUST I not have a single relapse? Where's the evidence that having a relapse proves I'm powerless over my drinking?

  5. (Effective new thinking): No law of the universe (AA notwithstanding) says I MUST never have a relapse or I'm an incurable "alcoholic." Relapses and setbacks are part of any learning process--two steps forward and one step back! But if I'm convinced that I'm a powerless victim of my addiction, then my silly beliefs may cause me to turn normal setbacks into a life of alcoholism.

    I control my decisions and actions. If I pick up a glass and pour the contents down my throat, that is my action, and obviously I am in control of it. I can choose to cut down my drinking to a sensible level, and if this is important enough to me, I can plan, scheme, plot, and conspire to achieve that end. This won't be easy-why SHOULD it be? There may be further relapses, but there is simply no evidence that I'm fated to fail.

  6. (new Feeling): Determination to make sensible decisions about drinking, but no superstitious dread of a single drink.

Twelve Steps To Chronic Dependence

AA's First Step states: "We admitted we were powerless over alcohol, that our lives had become unmanageable." This is a fundamental tenet of the AA religion. The individual is powerless over the Demon Drink and must acknowledge it. Only with the help of a "higher power" can any individual control his or her drinking problem. No less than six of the 12 Steps refer directly to the supernatural power AA calls "God."

The AA recruit is told that without the help of a supernatural power, he has no choice but to continue to imbibe recklessly. This claim is false. Many people recover from habitual drunkenness on their own. But someone convinced of this false dogma has a ready excuse for giving up the struggle for self-control: "I didn't attack that bottle of Johnnie Walker: it attacked me!"

The dogma of individual powerlessness leads the individual to seek to serve the "higher power," which in practice means the group of people who represent that higher power. The individual exchanges dependency on the bottle for dependency on a lifetime's supply of AA meetings. While this is easier on the liver, it undermines personal independence and clear thinking.

The dogma of powerlessness is allied with the AA theory that drunkenness is an incurable disease, and that therefore everything hangs upon not taking that first drink. Swallowing a single drink is regarded as a catastrophe. AA converts are taught that if they succumb to temptation just once, they will automatically relapse into all the berserk behavior of the benighted boozer.

This wrong-headed and scientifically questionable theory encourages extremist thinking: "At all costs, I MUST not take a single drink." It means that when the individual has one drink, he may believe that his struggle for sobriety is already lost, so he might as well give up and go on an alcoholic binge.

Paradoxically, the "one drink and you're lost" theory may also be harmful in just the opposite way. The individual has a single drink, discovers he is still in control of his behavior, and begins to feel blithely overconfident about the dangers of drinking. It would be better if a person with a past history of excessive drinking thought: "That drink I have just consumed sounds a warning bell. If I have a few more drinks right away I will be taking a serious risk."

A similar danger lies in the U.S. government's propaganda in its "war on drugs." Much of what the government says about drugs is so exaggerated and melodramatic that those people who are frequently around drug users know that the government's claims are hopelessly overblown and inaccurate. This may lead such people-the very people most at risk to serious drug abuse-to pooh-pooh the real dangers. There is, for example, no substance which automatically leads to dependency after one dose, or even several, and to talk as though there is such a substance encourages many young people with direct experience of drugs to discount all warnings about their harmful effects.

Am I An Alcoholic?

Andy looked a bit like the stereotypical gangster out of a grade B movie: black hair slicked back, pencil-thin mustache, toothpick dangling from his lower lip, dark gray double-breasted pinstripe suit, and glossy black Oxford shoes. In partnership with his father, he owned and managed a successful clothing manufacturing plant. He led an exciting life, traveling to exotic corners of the world, sometimes in his own plane or yacht. Andy had a lavishly well-appointed home and a beautiful wife with expensive tastes, which he could well afford to indulge and thoroughly enjoyed indulging. He also had a serious drinking problem.

"Am I an alcoholic?" was Andy's main concern when he came to see me. He had imbibed enough AA propaganda to be convinced of the view that the world is divided into alcoholics and nonalcoholics, and that the application of this label explains everything.

I informed Andy that I do not regard it as helpful to view people as "alcoholics." I see them rather as individuals in their own right, possessing innumerable traits-good, bad, and neutral. People make mistakes, but it can be misleading to turn the mistakes into nouns and speak as though the mistake is the person.

"All right. So I'm not an alcoholic. But I guess I do drink too much, and I can't seem to keep my drinking under control. I'm not miserable, and I really get a kick out of life. So why do I drink so much?"

Andy couldn't understand why he was turning increasingly to alcohol when life had so much to offer him. He feared that he might be afflicted by a genetic defect that made him prone to alcohol dependence (one of his grandfathers had had the reputation of a notorious drunk).

Questioning Andy, I noticed a pattern: He had begun his drinking socially and moderately, then had gradually become aware that he could deal with the slightest anxiety by drinking, even when alone.

"You may be using alcohol to run away from something," I suggested. "But what could I be running away from?" he queried.

"The one distinctly unpleasant, uncomfortable emotion you experience in your life-anxiety."

"I don't think that's it," he responded. "I'm hardly ever anxious."

"Exactly. But that could be part of the pattern I have in mind. Is there something you nearly always do whenever you anticipate feeling anxious?"

"Well, I dunno, have a drink, I suppose. Oh, I see. Maybe you do have a point there."

"I think so. And what is it that you tell yourself just before you take a drink?"

"That I am about to feel upset or apprehensive-and that I don't need that. So I'll have a couple of drinks and feel better."

"Yes, you're concerned that you might feel anxious."

"And that's why I drink?"

"Not exactly. It's not the anticipation of the anxiety that makes you drink. It's what you're telling yourself about that anxiety."

"What I'm telling myself . . . ?"

"Right. How you view the prospect of feeling anxious. What it means to you."

"Oh, that I don't like it."

"More than that."

"That it's AWFUL. That I CAN'T STAND it?"

"Exactly!"

"Do I really tell myself that?"

"Yes. Your basic philosophy is that you MUST feel relaxed and comfortable, and it's TERRIBLE if you don't, even for a few minutes. So when the specter of anxiety rears its head, your instant, panicky reaction is that this is not to be tolerated for a moment, especially when there is an easy, comfortable, short-term escape."

Andy was not berating himself for having emotional problems. He was not worried about himself, but he was worried about discomfort. To make progress, Andy trained himself to embrace the fact that anxiety and discomfort, though unpleasant, can be survived and accepted.

Andy's Three Minute Exercise

  1. (Activating event): In a few hours I have a business meeting with my father in which I will let him know that I was late in placing an order, so that certain fabrics were not delivered when we needed them. I anticipate that when he hears this he will go through the roof. I'm getting anxious about this.

  2. (irrational Belief): Life MUST be free of anxiety. I CAN'T STAND being anxious. I MUST escape with a gin.

  3. (behavioral Consequence): Swallow six gins.

  4. (Disputing): What's the evidence life MUST be anxiety-free? What's the evidence I can't stand being anxious?

  5. (Effective new thinking): I don't like this temporary anxiety, but I can stand it. I am perfectly capable of tolerating what I intensely dislike, including extreme discomfort. Although a few gins would make me feel better for the moment, it's destructive in the long run, so I will refuse to give in to the temptation for immediate escape. Impulsively escaping anxiety through drink just sets me up for lifelong problems. I'm determined to accept discomfort as an unavoidable aspect of being human.

  6. (new Feeling): Acceptance of some discomfort as part of life and willingness to tolerate some anxiety rather than drinking to flee from it.

With exercises like these, Andy's interest in drinking waned. In turn, he became a more responsible business partner, so that he and his father began to get along better. These changes in Andy's life did not come quickly or easily, but rather as the result of concentrated, regular, and sometimes tedious practice, repetition, and reinforcement.

Staying Sober

"I'm the world's leading expert on quitting drinking," Lonny told me, making a joke I've heard countless times about all forms of addiction. "I've done it so many times."

A close look at Lonny's otherwise handsome, intelligent face revealed the beginnings of the blotchy redness caused by broken capillaries, indicative of heavy drinking. Lonny was 53 years of age, had been not too happily married for 35 years, and told me he had been drinking heavily "off and on" for nearly 30 years.

Lonny had a relapse problem. He had many times decided to stop drinking alcohol, but in every case he had "slipped" and gone back to heavy drinking. I introduced Lonny to Three Minute Refutations, a technique for defeating the tendency to relapse.

Three Minute Refutations are a matter of recognizing the thoughts--the excuses--that encourage drinking and then demolishing these excuses. Here are some of the common excuses:

  • This will be the last time I drink

  • I've done so well lately, I can have one little drink

  • It's been a hard day, I'll just have one to unwind

  • Everyone else is drinking at this party, so how can it hurt if I join them?

  • I'll just finish the wine in the cupboard before I stop altogether

  • If I don't have a drink now, I won't get to sleep, and then I'll be a wreck tomorrow.

Lonny's Search and Destroy Mission

Three Minute Refutations involve the "search and destroy" mission: First recognize the addictive excuses, then get rid of them by answering them with defensive missiles--the refutations. One way to do this is to write out the excuses and then write out the refutations.

Here's one that we came up with in Lonny's case:

Excuse:

"It's OK to drink right now, because it'll be the last time."

Refutations:

  1. Previous "last times" never were. What makes me think this would be different?

  2. This "last time" could mean losing my job and ruining my career.

  3. How many days is this bender going to last?

  4. When I say to myself, "this is the last time," I know I'm lying.

  5. If I can make this next time "the last time," why can't I make the last time "the last time"?

  6. If I refuse to imbibe now, the discomfort will be temporary, not forever.

  7. This "last time" could destroy my marriage.

  8. This is just an excuse to drink--pure and simple.

Whenever you feel the urge to drink, identify the thoughts that make drinking seem reasonable. Then you can launch the counterattack.

When practicing Three Minute Refutations, it's often not enough to say the sentences over to yourself. It's usually far better to write them out. And it's even better, having written them out, to read them, preferably out loud, no less than five times a day. The object is to train yourself, so that when an excuse appears, you instantly recognize it, and instantly respond with a barrage of smart missiles: the refutations.

The Sober Truth About Problem Drinking

The root cause of alcoholism is unrealistic thinking. Such thinking can be changed, and in this way addictive behavior can be overcome.

Alcoholics Anonymous has some good points-for instance, emphasizing the present rather than the past. It helps some people terminate their alcohol addiction, but AA teachings make it more difficult for other people with drinking problems to change their ways. AA encourages replacing addiction to alcohol with addiction to a religious movement.

Finally, here are some of the ways in which Three Minute Therapy differs from AA:

  1. Three Minute Therapy is derived from a scientifically developed, coherent theory of psychotherapy, Rational Emotive Behavior Therapy, whereas AA is an essentially religious organization, its teachings adapted from the Oxford Group Movement.

  2. The theory underlying Three Minute Therapy has been supported by hundreds of rigorous studies published in the psychological literature, whereas AA's claims about the nature of alcoholism and its treatment are not supported by research studies.

  3. Three Minute Therapy encourages self-reliance and individual autonomy, while AA encourages each member to rely on the group, for example, by each member having another member as "sponsor" and guide.

  4. Three Minute Therapy acknowledges the power of the individual to drink or not to drink. Whether an individual drinks or not is governed by that individual's beliefs, which can be changed. By contrast, AA disseminates the unfounded myth that individual "alcoholics" are "powerless" in the face of their "illness."

  5. Three Minute Therapy aims to help people avoid addiction to therapy or to recovery meetings. AA offers the "alcoholic" no alternative to meetings and yet more meetings, until death parts the member from the AA church.

  6. Three Minute Therapy always points out that the root of our drinking problem lies not in a disease, nor in our dysfunctional families, nor in our addicted parents, nor in our "codependent" partners, but in our beliefs. (We invent and maintain these beliefs all by ourselves, though we may receive encouragement from our irrationally-minded families, friends, and partners.) AA does not expose these fallacies, but rather tends to reinforce them.

  7. Three Minute Therapy attacks "musty" thinking and teaches clear thinking, whereas AA is an active disseminator of muddled and "musty" thinking.