WHAT IS AA AND HOW DOES IT WORK?

WHAT IS AA AND HOW DOES IT WORK? Rod Tomczak, MD, EdD Mount Carmel Hospital August 14, 2019

What is Alcoholism? • Alcohol Use Disorder (DSM 5) • DSM–5 integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.

What is Alcoholism? • Under DSM–5, anyone meeting any two of the 11 criteria during the same 12-month period would receive a diagnosis of AUD. The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met.

First Steps in Treating AUD • Every hangover is a sign of withdrawal • GABA (calming) is used up in the brain and Glutamate (exciting) over whelms neurons—The Science of Addiction, Erickson, CK, Norton, 2007. • Withdrawal can lead to seizures • Should genetics be considered?

First Steps in Treating AUD • Diazepams • Magnesium Injections • Fluid Replacement

What is Alcoholics Anonymous? • “AA is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help other alcoholics to recover from alcoholism.” • From The Preamble of Alcoholics Anonymous

SPONSORSHIP • A new member of AA picks a more experienced member of AA to lead the new member through the 12 Steps • Sponsors should not play psychologist, marriage counselor, physician or banker • The new member should not perform any tasks for a sponsor

MEETING TYPES • Open versus Closed • Closed Meetings • At closed meetings only those people who admit they are alcoholics are welcome • Open Meetings • Anyone interested in AA may attend • Healthcare students often attend

MEETING FORMATS • Step meeting • Read from book called 12 steps and 12 traditions then discuss • Discussion • Topic pertaining to AA is discussed • Lead meeting • An alcoholic with good sobriety tells his/her story

What AA Does Not Do • Furnish initial motivation to get sober • Does not “get” one sober • Provide detox or hospitalization • Solicit members • Engage in or sponsor research • Control members • Offer religious services

What AA Does Not Do • Accept money for its services • ACCEPT ANY CONTRIBUTION FROM NON-AA SOURCES • Have an opinion about alcohol or sponsor alcohol education

What AA Does • Offers the alcoholic a program as set forth in the 12 steps to recovery • Offers a design for living that works in some people.

Where Do Those Steps Originate? • The Rule of Saint Benedict of Nursia circa 500 AD • A “Rule for Life” based on vows of Poverty, Chastity, and Obedience • William James • The Varieties of Religious Experience, Renaissance Classics, 2012. • Saint Francis de Sales • Introduction the the Devout Life

Step1 We admitted we were powerless over alcohol—that our lives had become unmanageable • Step 1 means they have realized they need help to quit drinking---can’t quit alone • Have to quit based of all the damage done to oneself and others

Step 2 Came to believe that a Power greater than ourselves could restore us to sanity. • This “Power” does not have to be a “Universal Deity.” • The “group” can be the person’s Higher Power • The group is the source of UNCONDITIONAL LOVE

Step 2 cont. • A young person doesn’t get along of have friends • Finds a group that feels the same way • Conforms to the groups’ norms • Joins in their rituals

Step 3 Made a decision to turn our will and our lives over to the care of God as we understood him Young adults have no concept of God • This step is meaningless to many, and revolting to some • The person must realize that he cannot always get what he wants. • ACCEPTANCE

Step 4 Made a searching and fearless moral inventory of ourselves • Examination of Conscience • Can be a problem for those who have not formed a correct conscience • Bill thinks people drink because of a guilty conscience

Step 4 Made a searching and fearless moral inventory of ourselves • Neglects the abuses done to a person and the guilt and shame he/she carries

“Liquor is but a symptom of our disease.” • Most important line in the Big Book • People drink to escape • Everyone has a drug of choice

Step 5 Admitted to God, to ourselves and another human bring the exact nature of our wrongs. • Exactly like going to Confession • Can be a sponsor, physician, priest, attorney or anyone trusted by the alcoholic

Step 6 Were entirely ready to have God remove these defects of character • The alcoholic makes a firm resolution, with God’s help, to refrain from committing these transgression again.

Step 7 Humbly asked Him to remove our shortcomings • Gossip • Being passive-aggressive • Sarcasm • Trying to be nice to others

Step 8 Made a list of all persons we had harmed and became willing to make amends to them all • Make a written list of all the people you have to ask forgiveness from or really need to pay back for what the alcoholic has stolen, ruined or damaged.

Step 9 Made direct amends to those individuals wherever possible except when to do so would injure them or others. • Especially infidelities • Pay back debts

Step 10 Continued to take personal inventory and when we were wrong promptly admitted it • Admit when wrong and ask forgiveness from the offended • Examine conscience nightly

Step 11 Sought thru prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of his will for us and the power to carry that out. • Become closer to God • Pray for knowledge

Step 12 Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs mwssage AA is a way of life like the spiritual life of saints

How much of Alcoholism is inherited • No one has found a specific gene • Perhaps abuse is a learned behavior • Perhaps genetics loads the gun, but the environment pulls the trigger

No one wants to live under the bridge and drink out of a paper bag • Addiction happens • Relapse does NOT have to be part of addiction

INTERVENTIONS • Generally do not work unless the patient happens to be ready

ANONYMITY • What you see here, say here, hear here, and do here stays here • Anonymity is the cornerstone and foundation of AA • Without anonymity, many people would quit attending

ANONYMITY • An individual may break his or her anonymity • Most people identify themselves by first name only

CADUCEUS • This is the AA program for physicians • Sometimes other licensed health care providers may attend • Attendance sheets

The 12 Steps condensed • 1. Go to a safe place and quit drinking • 2. Figure out why you drink • SELF-ESTEEM ISSUE • 3. Fix it • 4. Be nice to people

WHAT IS AA AND HOW DOES IT WORK?