Of the many drinking types described in the Big Book (by no means comprehensively), the Big Book suggests its 12 Step spiritual program of action will work for only one. The one with willingness. The one “with a desire to stop drinking.”
A Desire to Stop Drinking is the only Requirement for AA Membership. -3rd Tradition of AA.
“For those who are unable to drink moderately the question is how to stop altogether. We are assuming, of course, that the reader desires to stop. Whether such a person can quit upon a nonspiritual basis depends upon the extent to which he has already lost the power to choose whether he will drink or not.” Pg 34
Original AA members documented their experience in the Big Book. These members realized a 72% success rate from 1934-1938 (died sober) using this spiritual program of action.
Types of Drinkers from the Big Book:
Alcoholic Addiction - xxv or (xxvii 1st edition) The Doctor's Opinion (Dr. Silkworth)
Chronic Alcoholics - Pg xxv, xxvi, xxviii, xxix, 27 The Doctor's Opinion
The Average Temperate Drinker - Pg xxvi
The Ex-Problem Drinker - xiv, 18, 20 There Is a Solution
The Moderate Drinker - Pg 20 There Is a Solution
The Hard Drinker - Pg 20-21 There Is a Solution
The Real Alcoholic - Pg 21-22 There Is a Solution
The True Alcoholic - Pg 21-22 There Is a Solution
Abnormal Drinker - Pg 30 More About Alcoholism
Normal Drinker - Pg 31 More About Alcoholism
Young People (drinkers) - Pg 33 More About Alcoholism
Potential Female Alcoholic - Pg 33 More About Alcoholism
Serious Drinker - Pg 34 More About Alcoholism
The Actual or Potential Alcoholic - Pg 38-39 More About Alcoholism
“nonalcoholic people who, though drinking foolishly and heavily” can moderate. Pg 39 More About Alcoholism
Alcoholic of the Hopeless Variety Pg 44 We Agnostics
Drinkers Who Want To Recover - Pg 89 Working With Others
The Bad Intentioned Exception - Pg 108 To Wives
Type One: Heavy Drinker - Pg 108 To Wives
Type Two: Showing lack of Control - Pg 109 To Wives
Type Three: Lost Control and Knows it - Pg 109-110 To Wives
Type Four: Complete Despair - Pg 110 To Wives
Problem Drinker - Pg 115 To Wives
Teetotaler - Pg 139 To Employers
Habitual or Whoopee Drinker - Pg 149 To Employers
Unhappy Drinkers - Pg 151 A Vision For You
Desperate Desire To Stop - Pg Forward, 7, 95 & 155 A Vision For You
"...for those who are unable to drink moderately..."
AA Does not say That ALL Problem Drinking is a Progressive Illness
What is says on Pg 30:3, after describing many other types of drinkers (many of whom can stop or moderate), is in regards to “real alcoholics”, who have lost control.
“We are convinced that alcoholics of our type [real alcoholics] are in the grip of a progressive illness. Over any considerable period we get worse, never better.” More About Alcoholism
This paragraph is talking about “real alcoholics” who have lost control over their drinking. Not all drinkers. The AA book is clear that there are many other types of drinkers (many are listed above), some of whom may be able to stop or moderate their drinking. But in the experience of those drinkers who lost control, their illness always progressively got worse.
The Vicious Cycle: This loss of control increased as long as the first drink was taken and without the first drink the alcoholic suffered (irritable, restless, discontent) until the first drink alleviated the suffering, setting into motion the phenomenon of craving and more out of control drinking.
Abstinence and the spiritual program of action was the most successful remedy that was known to arrest this vicious cycle as of 1938-39. However, it was not the only way and people got sober through medical, therapeutic and religious methods, including The Oxford Group.
If he thinks he can do the job in some other way, or prefers some other spiritual approach, encourage him to follow his own conscience. We have no monopoly on God; we merely have an approach that worked with us. But point out that we alcoholics have much in common and that you would like, in any case, to be friendly. Let it go at that. -pg 95
The spiritual program of action outlined in AA promises a "spiritual awakening" at the 12th step. They promise this will be the result of working the previous steps. If the program of action is followed a "daily reprieve" from drinking will occur. This is still the "Gold" standard, the "Highest Way" of recovery, since it involves deep characterological development and spiritual development. Of course, it is not an easy way and not for everyone.
Current Studies and Data
For those interested in rehabs, scientific approaches and current studies plenty of information has been discovered since 1938. At this point, time has proven that the authors of the Big Book were right on target. The bigger issue society faces is that AA is not a rehab or a cure. It is only for those "with a desire to stop drinking" and are willing to do so using a spiritual approach. With so many dying of addiction everyday it is sad to say that very few are willing to take the actions toward "ego deflation at depth" that AA suggests.
National Epidemiologic Survey on Alcohol and Related Conditions -NESARC, Big study. Lots of data.
72% with Alcohol Dependence stop on their own after one 3-4 year episode.
28% have persistent disorder.
1.12% could be statistically calculated as “Real Alcoholics” out of US Population as of 2012, using NESARC data. These have severe recurrent or chronic dependence (Hasin et al. 2007).)
Recovery From DSM–IV Alcohol Dependence: United States, 2001–2002
This was the first study of the prevalence and correlates of recovery from DSM–IV alcohol dependence in the U.S. general population that distinguished asymptomatic risk drinkers from low-risk drinkers and recent from stable recovery. This study examined people who met the criteria for DSM–IV alcohol dependence prior to the year immediately preceding the NESARC interview. Only 25.5 percent of these people had ever received treatment. The analysis found that:
25.0 percent of these people were still classified as dependent in the year before the NESARC interview.
27.3 percent were classified as being in partial remission.
11.8 percent were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse.
17.7 percent were low-risk drinkers.
18.2 percent were abstainers.
Factors associated with recovery included age, gender, marital status, education, interval since onset, severity, age at onset of dependence, tobacco and other drug use, and personality disorder. The analysis revealed that there are substantial levels of recovery from alcohol dependence. Information on factors associated with recovery should be used to improve the prospects for treatment.
http://pubs.niaaa.nih.gov/publications/arh29-2/74-78.htm
Illness not Disease
AA Calls Alcoholism an “Illness” not a “Disease”. As of 2015, medical science still does not know exactly what causes alcohol addiction. As of 2015, “Mental Disorder” or Mental Illness is currently more accurate than “Disease” terminology which is not an AA term and is outdated and for the most part irrelevant to current addiction treatment. It does come from an interesting history and is worth learning more about. Disease theory of alcoholism and Alcoholism: A Disease. Thomas Sasz had some interesting thoughts on the “disease” terminology. There is an intro to him in this article.
There is some great science coming forward on the HPA AXIS and neurosteroid treatments for imbalances in the neuroendocrine system. There are a number of Mental Disorders that are known to be caused by disruption of the HPA AXIS and neuroendocrine system. As advances are made perhaps science will discover a physiological solution to mental disorders such as addiction. If this occurs it may one day be known as a disease of the brain, endocrine, or other part of the body. Until then it is still mostly called a “disorder” or illness and treated as such.
The DSM V Currently Sets the Criteria to Obtain the Medical Codes Required by Insurance Companies. (This allows clinicians to get paid.)
THE AMERICAN PSYCHIATRIC ASSOCIATION - Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. About DSM
DSM IV- 1994 Appendix B: DSM-IV-TR Diagnostic Criteria for Alcohol ...
Alcohol Abuse
Alcohol Dependence
DSM V - 2013 Alcohol Use Disorder
ALCOHOL USE DISORDER (AUD) is Classified here as a “Mental Disorder” (not disease).
Severity based on how many of the 11 Criteria are met:
MILD (2-3)
MODERATE (4-5)
SEVERE (6 or more)