This time it's personal

And I have known the eyes already, known them all -

The eyes that fix you in a formulated phrase,
And when I am formulated, sprawling on a pin,
When I am pinned and wriggling on the wall,
Then how should I begin
To spit out all the butt-ends of my days and ways?

The lines from Eliot's "The Lovesong of J. Alfred Prufrock" came to mind when I began to look through the third edition of the well-known and influential Problem Drinking* by Nick Heather and Ian Robertson. I have a personal, subjective difficulty with this book. Scientists like to categorise and one of the problems of addictive behaviours, including alcoholism, is that they largely defy categorisation. There is no neat scientific explanation for a vastly complex subject which seems to involve the whole man, mind, body, and soul. That last word would condemn me in the eyes of writers such as Heather and Robertson. It brings an element into the debate with which they feel uncomfortable and to which they demonstrate hostility. But the real personal difficulty with Problem Drinking is that it is an insult to my recovery.

The authors first aim is to debunk the disease theory of alcoholism and promote the theory that alcohol problems are "best seen as examples of socially learned behaviour". It is an aim I should have applauded when I was first in treatment. It seemed to me that the therapists and counsellors looking after me were trying to feed me a lifeline, to provide an escape clause from responsibility. It also seemed at odds with the idea of "triggers", those situations or emotions which lead the alcoholic to pick up a glass. The danger was that, in presenting a front of noble acceptance of responsibility, in asserting the efficacy of my will and masking the fact that I had no control over alcohol. This would have left open the possibility of returning to moderate drinking (which, for me, was a memory of about a fortnight when I was fifteen). It is a stage many people go through in the earliest stages of recovery.

With certain reservations, I can now accept the word disease because it just about fits the circumstances. Given the definition which is strictly medical, it is perhaps unfortunate that the word was used in the first place. Some exponents of the disease model, it is true, speak as though it were established scientific fact, which is clearly nonsense, and which provides ammunition for opponents like Heather and Robertson. The word is a rough and ready way of describing a sufferer's experience of addiction to alcohol. The writers correctly draw attention to one of the original aims of those who first promoted the disease model of alcoholism: the lifting of labels such as "morally flawed" or "weak-willed". In other words, precisely that abnegation of responsibility which I objected to in the drunk farm. Heather and Robertson are probably right when they say that this aim has not been wholly successful. In my view, this is because it is proposing a simplistic solution to a bafflingly complex problem. Addiction does not remove responsibility for actions, any more than a hyperactive libido excuses rape, but it does offer an explanation. Plenty of people suffering from alcoholism may not be able to control their drinking but are still able to make moral choices. Standards may fall, but a total collapse of values is by no means usual. I think other sufferers understand this.

There's the rub. It is quite clear that the authors do not have a problem with alcohol themselves. They may have a considerable understanding of those parts of the subject which can be fixed "in a formulated phrase", but they do not seem to have any insight. This can come from the experience of dependent drinking itself and it can come from empathy.

A great deal of research which supports the theory that alcoholism is a socially learned behaviour is brought forward in Problem Drinking. However, when it comes to scientific evidence, the authors are at times happy to base their argument on some dubious sources. The research carried out at the Maudsley Hospital by D.L. Davies and published in 1962 as Normal Drinking in Recovered Alcohol Addicts is quoted as a reliable authority. This study by Davies, for all the caution he urged, was the foundation of the controlled drinking movement and as such has had a profound effect. Professor Griffith Edwards, at one time Director of the National Addiction Centre at the Maudsley, showed Davies' work to be false. Davies' research was based on 7 patients and Edwards followed these up after one of them reappeared at the Maudsley. "By then [the early 1980s], one of the original 7 had died. The conclusion of the later follow-ups was that 5 of the 7 had in fact shown evidence of alcohol misuse both during the period of Davies' original follow-up and subsequently. Two of them were later readmitted to hospital for alcoholism treatment; the spouse of the third expressed concern over the amount he was drinking and his hospital notes described him as 'a well known alcoholic' six years after he was reported by Davies to be drinking without problems. The medical notes of the fourth referred to his drinking too much and to his wish for further treatment at the time of Davies' original follow-up. The fifth in fact drank heavily with problems, especially marital ones, soon after his original discharge." Of the two other patients, one does not seem to have been a full blown alcohol addict whereas the other's claim to be drinking without problems could not be confirmed and at a later follow-up he refused to give a blood specimen but did smell of alcohol in the middle of the afternoon.**

Professor Edwards' comprehensive demolition of Dr Davies' shoddy research highlights a pertinent point and one which applies to other more thorough pieces of work. Can anyone take seriously as a source of scientific data information supplied by an alcoholic (alcohol addict, or what you will) who is claiming, or even genuinely trying, to drink normally? Ask anyone who actually suffers from the disease (God pardon the mark!) and you will be laughed to scorn. To be fair to the authors, they categorically state that they do not recommend experiments in controlled drinking to alcoholics, but it would not be surprising if some careless reader took it otherwise. It is argued that controlled drinking is an option for non-dependent drinkers who have begun to develop problems with their misuse of alcohol but have not yet shown sign of full-blown alcoholism. In other words, alcoholism is avoidable by an exercise of the human will. There is no way this view can accommodate the concept of powerlessness which is explicitly stated in the 12 Steps of Alcoholics Anonymous.

I should not have felt qualified - other than as a sufferer - to comment on this book had Heather and Robertson not showed such animus towards Alcoholics Anonymous. There is a lot which irritates me about AA: the ghastly little sayings, the evangelical fervour of a few individual members, the "12-step Nazis". But the fact remains, that it works. Heather and Robertson may sneer at the lack of scientific evidence of its efficacy, but they miss the point. There may be all sorts of reasons why the AA approach works for so many (one of which may well be self-delusion), but if alcoholics are able to stop drinking and change their lives, then these are secondary. Of course, there are thousands of people who have tried AA and rejected its approach, a great many, I have no doubt, because they do not really want to stop drinking. In what can only be described as their attempts to minimise the significance of AA, Heather and Robertson suggest that members "differ from other kinds of problem drinker in personality." Now, this is no doubt true, if they mean that the personality of the addict is distinctive in some way from everyone else, including people who have lesser problems with alcohol, but clearly what they are getting at is something different. "AA appears more suited," they say, "to those of a more authoritarian type of personality who see things in black-and-white terms and who enjoy belonging to groups that provide a clear structure for understanding the world." Oh dear! what sad, foolish little prejudices inform this kind of statement. Such nonsense undermines all their other views and any claim to scientific objectivity. AA contains the most disparate group of people I have ever come across. Some, of course, do not have a complex outlook on life, others display the most sophisticated attitudes. No doubt there are some who like black-and-white solutions, but these are equalled by those who view any question as a shading of grey. It would be absurd to say that "the authoritarian type of personality" is a stranger to AA, especially as a compulsive desire to control seems to be one of the traits of an alcoholic. Changing this, it appears not to have occurred to the authors, is part of the point of being in the organisation.

The founders of AA make no great claim to originality - hardly surprising when advocating a programme of common sense and honesty. When I first got to know the the 12 Steps, I telephoned to a friend who is a monk. "These things are just the spiritual life of the Catholic Church," I said. He agreed and directed me to Chapter IV of The Rule of St Benedict which contains the 12 Steps of Humility. I mention this in the hope of irritating Heather and Robertson, armed as they are with prejudices about authoritarian figures who see things in black and white.
The authors use the term "12-step hysteria" to describe the proliferation of variants of the programme. Hysteria is a pejorative term. Heather and Robertson do not like the 12 Steps because this is where God comes in. God means a host of different things to AA members, many of whom were intensely hostile to the idea when they first became associated with the organisation. As it happens, using the 12 Steps in recovery deepened my Catholic faith and allowed me to turn to God in prayer in a way that had been impossible when addicted. Friends in AA whom I love and respect have the greatest antipathy to organised religion, but are themselves using the Steps, as often as not with much greater application than me.

The whole idea of a spiritual dimension to the problem can be a huge stumbling block but the fact is that simply refraining from alcohol is only the first step towards recovery. It is necessary to change the whole person and change those aspects which are part of the addictive personality, if I might use another contentious expression. Members of AA and the proponents of any 12 Step based programme would say that it is no use simply stopping drinking if the result is living as a dry drunk. I had an acquaintance who did just that. He boasted that, without any kind of treatment and without following any kind of programme, he had not had a drink for nearly a year. Unfortunately, he was the same manipulative, dishonest, grandiose, self-pitying, emotionally constipated wreck that he had been when on a bottle of malt a day. At least when he was drunk he passed out occasionally. Many similar examples come to mind.

Heather and Robertson would condemn such stuff as anecdote. Anecdote is a very bad thing and is used as an offensive synonym for experience. It is something else which is not "sprawling on a pin." My experience tells me that the 12 Step programme alters people's lives. I have seen it countless times. My experience is replicated with everyone who has entered recovery through AA. To condemn this experience or the spiritual aspects of the programme as unscientific is like criticising Tower Bridge for being an inadequate tunnel.

The ideological disputes within the world of alcohol problems make Byzantine theologians sound like like-minded friends sharing anodyne views on uncontentious topics and Heather and Robertson do their manful bit to keep them going.

* Problem Drinking, Third Edition, Nick Heather and Ian Robertson, Oxford University Press

** Alert, April 1995; Griffith Edwards, D.L. Davies and "Normal Drinking in Recovered Alcohol Addicts": the Genesis of a paper. Drug and Alcohol Dependence 35 (1994).