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An Article and a Book Review from the April-June, 2005 issue A History of Addiction and Recovery in the United States
By Michael Lemanski Reprinted from the April-June, 2005 BASIS In “A History of Addiction and Recovery in the United States,” Michael Lemanski recounts the history of substance abuse counselling the United States. In the process, he describes the almost total failure of the 12 Steps Model of substance abuse counselling. In fact, what the book ultimately does is point to the sweeping control that AA and its offshoots have exerted on the substance abuse counselling profession in this country.Mr. Lemanski does a credible job of highlighting the primary Nineteenth and Twentieth Century movements concerned with curing alcoholism. Alcoholics Anonymous is the current manifestation of a long line of faith-based recovery models which began with the Sons of Temperance in 1842. The Sons of Temperance (and its women’s auxiliary the Sisters of Temperance) was a self-supporting organization that provided financial support when needed to members and members’ families and included among its services an employment assistance program. Anonymity was a novel aspect of this organization. Conversely, this anonymity makes a reasonable appraisal of the group’s efficacy impossible. Lemanski also provides informative overviews of such organizations as The Women’ Christian Temperance Union, The Salvation Army, the Anti-Saloon League and The Prohibition Party, which was founded in 1869 with the goal of prohibiting alcoholic beverages nationally. In 1872, the Medical Association for the Study of Inebriety and Narcotics was formed. This was actually the first formal medical association in America devoted to the study of substance abuse. In 1876, the group began publishing the Journal of Inebriety, which lasted until 1914. Despite the medical framework of this organization, it made little impact on American medical practice and a majority of American health workers continued to adhere to the popular view that alcoholism was the consequence of moral weakness. The author defines the evolution of Alcoholics Anonymous and the rise of the twelve step movement. For all intents and purposes, AA built upon the work done by the Emanuel Movement and The Oxford Movement. The Emanuel Movement was founded in 1906 by an Episcopal priest and consisted of three primary tools: group therapy done in a classroom setting, individual therapy administered by Episcopal clergy and staff and a system of social work for addicts, which was done by volunteers. In 1929, The Emanuel Movement changed its name to the Craigie Foundation and its treatment format consisted of a combination of religion and psychotherapy. Meetings were normally held in churches and consisted of hymns, Bible readings and prayer requests. This religious component was followed by a lecture by someone considered to be an authority in psychology. As with the Emanuel Movement, therapy was done by clergy and church lay staff. In addition to the individual and group models used by the Craigie Foundation, peer support was also included. This consisted of what was called the “friendly visitor” program, whereby a case worker assisted the addict in finding employment, financial assistance and whatever the case worker felt was needed to strengthen the person’s family life. Although one can find parallels between AA and the Craigie Foundation, AA really owes its existence to the Oxford Movement, founded by Lutheran minister Nathan Buchman. Buchman, in response to what he believed to have been a personal mystical religious experience, started the First Century Christian Fellowship in 1921. The goal of this group was to establish a world culture based on what Buchman considered to be the beliefs and practices of the early Christian church. Buchman tended to see everything in the context of a battle between good and evil. His vision was messianic and he equated his work and goals with God. He believed that any philosophy or ideology, particularly Communism, which disagreed with his vision of a world-wide theocracy, was inspired by Satan. He established the Four Absolutes: absolute honesty, absolute purity, absolute unselfishness, and absolute love. He referred to himself as “soul surgeon.” New members of his group were expected to undergo rigorous self-examination, openly confess their sins and weaknesses, surrender themselves to God, and make restitution to anyone they had harmed in the past. Additionally, they were expected to promote the organization for no fee and fund raising was a key activity of members of the fellowship. Buchman also promoted the Four Cs: confidence in Buchman the soul surgeon, confession of sins, conviction (or acknowledgement) of one’s sins, conversion to the principles of the First Century Christian Fellowship, and continuance of practice of the Fellowship rules. Besides the Four Absolutes and the Four Cs, members were also encouraged to live by specific fellowship slogans, which included “give news, not views,” “win your argument, lose your man,” and “J.E.S.U.S. just exactly suits us sinners.” Buchman’s explicitly stated goal was mass conversion that ultimately would lead to humanity being ruled by “God-Control.” The First Century Christian Fellowship grew rapidly in the 1920s. Buchman targeted recruitment activities towards men of power and influence and towards college students. He fully expected his followers to adhere to his dictates totally and to accept the veracity of his mystical experiences without question. Not surprisingly, a considerable amount of negative publicity resulted from his methods of recruitment and his group was often called both a cult and “Buchmanism.” In 1929, following a series of revivals he held in England, Buchman changed the name of his group to the Oxford Group and the organization continued to flourish under the new name. His hatred of communism allowed him to see fascism as a reasonable alternative and in 1936, he was quoted as saying “I thank heaven for a man like Adolph Hitler, who built a front line of defense against the anti-Christ of Communism. Think what it would mean to the world if Hitler surrendered to the control of God? The world needs the dictatorship of the living spirit of God. Hitler is Christianity’s defender against Communism.” Although he later admitted that he had been duped by Hitler, he did not issue a retraction. Understandably, that interview did irreparable harm to the Oxford Movement and in 1939, Buchman again changed the name of his movement, this time calling it “Moral Rearmament.” The influence of Moral Rearmament peaked in the 1940s and its membership declined greatly following Buchman’s death in 1961. Although Buchman’s movement faded from the public view, its message is very much with us in the form of Alcoholics Anonymous, founded by Mr. Bill Wilson and Dr. Robert Smith. Bill Wilson had been cured of alcoholism by a spiritual revelation he believed he had had while at a drying out clinic. The fact that this revelation may be caused by a combination of belladonna and other drugs given to him as part of the drying out process did not seem to have bothered him. Following this experience, he began a crusade to save other alcoholics through religion. While in Akron, Ohio in 1935, he feared that a relapse was imminent and asked an Akron Protestant minister for the name of someone he could talk to who had also been addicted to alcohol. He was given the name of Dr. Robert Smith. He and Smith met and held what many consider to be the first AA meeting. The two of them attempted to cure other alcoholics with such Oxford Group principles as confession, making amends and turning ones’ life over to God. They used Oxford Group principles because Dr. Smith was an active Oxford Group member and was using those same principles with his patients at an Akron hospital. Wilson and Smith considered spiritual faith to be a cornerstone of sobriety and readily subscribed to Buchman’s insistence that the individual alcoholic is powerless and must rely on divine intervention to maintain sobriety. It is worth pointing out that Dr. Smith, although a medical doctor and thus presumably well versed in scientific methodology, did not use scientific methods when treating hospitalized alcoholic patients. Rather, he relied strictly on the religious principles of the Oxford Group. Both he and Wilson remained active participants in Buchman’s group until 1937. The principles of AA were unquestionably taken from those of the Oxford Group. “Frank Buchman’s beliefs in human powerlessness, the necessity of confession of sin, the value of taking a moral inventory of oneself, the value of making amends to others, the necessity of carrying the message to others and redemption through turning one’s life over to God were adopted wholesale by Bill Wilson. Wilson simply took those central Buchmanite principles and formatted them into the 12-Step program of recovery” (Lemanski, 44). In A History of Addiction and Recovery in the United States, Mr. Lemanski goes into considerable detail into the development of the addiction treatment industry in the United States and its overwhelming reliance on the 12 Step Model. Particularly, he discusses the 12-step inspired “Minnesota Model” of inpatient treatment and its absolute failure as a viable treatment method for addiction. Of course, the ultimate question is: Does AA really work? From the standpoint of 12-Step recovery, the scientific data is grim regarding its efficacy. In the 1990s, three meta-analyses of substance abuse treatment were done. These studies indicated that “1. Twelve-step treatment is, as a whole, ineffective; 2. The various components of 12-Step treatment are themselves ineffective; 3. Twelve-step (especially inpatient) treatment is among the most expensive types of treatment; 4. Several cognitive-behavioral treatments are effective. 5. These effective cognitive-behavioral treatments are all either low cost or very low cost.” (Lemanski, 120). In other words, despite the fact that over 90% of substance abuse counselling treatment in the United States is based on the twelve-step model, it is not an effective treatment method for substance abuse and addiction. Mr. Lemanski notes that the success rate for the AA model is about 5% (Lemanski, 102). He points out that many twelve-step recovery centers claim a success rate of 70% and higher but these claims are due to faulty research methodology. For instance, such centers routinely ignore people who drop out of the programs and the studies do not include former patients or clients that the programs have lost track of. Additionally, they use short term sobriety as the criteria for successful outcome – and they don’t bother to use comparison or control groups. Despite the low success for AA model recovery, it continues to flourish. Ironically, despite AA being an abstinence model of treatment, Mr. Bill Wilson experimented later in life with mescaline in a futile attempt to re-experience the mystical state he had had while under the influence of the medically administered drugs given to him at the drying out clinic. Mr. Wilson remained addicted to cigarettes his entire adult life and died of emphysema in 1971.
(A somewhat different version of this review appeared in the January-February, 2002 edition of BASIS.)
 Sloppy Generalized Thinking: "Torture Doesn't Work"
Reprinted from the April-June, 2005 BASIS by Yves Barbero.I hear them often; generalized statements that make no logical sense, but are part and parcel of some religious or ideological notion.
The debate is clearly needed. Whether one likes it or not, the research is going to happen, here or abroad. We cannot bury our heads in the sand. We can only isolate ourselves from clarity. But my purpose is not so much to attack such easy targets as the extremes of the right (or the left), but to show that in our talking-point and sixty-second moral universe, we all fall prey to sloppy generalized thinking. In casual conversation, a friend stated flatly to me that “torture doesn’t work.” We were talking about the latest scandals coming out of Guantanamo and Abu Grav. This was a conversation stopper. Had he said that it wasn’t effective, or that it was bad policy, or even that it was just plain immoral, I would have had something to continue with, such as, “how do you propose we change the policy,” or “how can we make the needed interrogation of prisoners of war more effective,” or even, “why do you think it is immoral?” All I could think of was, “Who told you that?” For him, that was the conversation stopper. We didn’t resolve anything. He’s a bright guy, and I’m not too shabby in that department myself. We both write. Maybe an exchange of ideas could have led to some novel notion that might have crept into the national debate. The fact of the matter is that torture does work in some situations with some individuals. Saying that does not mean that a person cannot be against it as a general policy (I am). For one thing, torture violates the Geneva Conventions. Bleeding-heart do-gooders didn’t put that in place. Hard-headed military men insisted on it. “We won’t torture your guys if you don’t torture ours.” Torture can work with certain low-grade insurgents. The problem, of course, is that they are unlikely to know much, their information is likely to be fleeting, and the people applying the torture will most often be young soldiers easily corrupted by the power handed them. Insurgent leaders, who are more likely to have useful information, are also likely to be hardened by religious or political ideology. The better approach will be to challenge them verbally, trick them into saying something, and putting that together with information gathered from others, to arrive at an intelligence estimate. This requires patience, experience, and maturity. Something young soldiers simply don’t have. They only have commitment. Smart armies insure tactical secrets, not by religion or ideology, but by a sense of comradeship with their fellow soldiers (Soviet prisoners of war who resisted Nazi interrogators didn’t do it because they loved Stalin). Unit loyalty is an effective reason to resist torture. You don’t want to see your buddies hurt. The weakness of an insurgent group based on religion or ideology is that cohesion is based on an abstract belief, not on protecting their fellows, who are expendable. True believers are more likely to be tricked by a savvy interrogator. They might be able to resist torture, but not as able to resist justifying themselves. I cannot absolutely say that torture should never be used. That would be dishonest of me. But I think it should never be policy. A Texas lawyer once said that some people need killing. You just need twelve jurors to agree with you. The bottom line is: could you justify it at a public trial. I leave with two examples to think about... A couple of experienced detectives, with pensions to lose, are interrogating a pedophile. The guy has previous convictions, and some of the evidence indicates that he likes to lock up young boys in dangerous places. They’re pretty sure, at that moment, that he has a young boy buried with a diminishing air supply. So there is urgency in the interrogation, and they are getting nowhere. In fact, the man is enjoying the whole procedure. He’s getting the attention he craves. They know from his record that he is vain. One detective pulls a switchblade, saying, “I’m going to make a permanent scar on that smirk of yours and cut off your...” An arms merchant from one of the countries carved out of the former Soviet Union is being interrogated by American intelligence operatives. He is suspected of smuggling a “dirty” bomb into New York City. If it goes off, it will kill thousands and make a good part of Manhattan unlivable for years to come. He’s sweating. He definitely wants to get out of town. But can his interrogators wait until he really feels the pressure. His timing might be off. They know he’s only motivated by money and fear of his employers if he talks, but they don’t know much more about him. A Russian-speaking consultant, a former KGB man, who has been acting as a translator, suggests torture. “I’ve had some good results at this...”
The world is not simple, even for a true believer.
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The obvious examples, these days, come from the right, and are usually headed by some notion like, “The Culture of Life,” followed by a number of talking points. It becomes impossible to actually analyze anything, as any debate concerning ethics demands, if one party or another is locked into some unassailable notion. How can anyone talk about the ethics of embryonic stem cell research if one party to the debate believes that any fertilized egg is the same as a human being.