Chapter II
Literature Review
Introduction
The emphasis of this chapter is to review the major emphases related to this study. These emphases lend themselves to summarization in three perspectives, 1) the support-group model, such as Alcoholics Anonymous (AA), 2) the scientific/medical view, and 3) the spiritual model. Each of these perspectives will be examined in light of their relevant and current distinctions.
Support-group Model
A support-group is a group of people observing the tenets of confidentiality as they discuss related issues of distress so that they have a greater sense of hope in reaching a common understanding of how to properly deal with them. AA is generally accepted to be the model for successful support-groups (Sandoz, 1999).
Recognition is given to AA’s founding to be in 1935, when Bill Wilson met with Dr. Bob Smith in Akron, Ohio. This meeting was later described as the founding of one the first organized methods to address addictions, specifically the addiction to alcohol. Addiction to alcohol had familiarly become known as alcoholism.
Wilson and Smith had chronically struggled with alcohol and its adverse consequences for many years. Several months prior to their meeting, Bill Wilson had been introduced to a method of dealing with compulsive drinking that gave him the first genuine hope of remaining alcohol free. Dr. Smith was to require several months longer to achieve and internalize the same vision. Dr. Smith died in 1950, after abstaining from alcohol for fifteen years. Bill Wilson died in 1971, after remaining free from alcohol for thirty-six years. Together, they devised a process to remain alcohol free that became known as Alcoholics Anonymous, and more familiarly recognized as AA (Alcoholics Anonymous, Alcoholics Anonymous World Services, 1939).
Prior to this meeting in 1935, attempts to deal with alcoholism and alcoholics were largely unsuccessful. Dr. William D. Silkworth, one of AA’s earliest and strongest medical influences, treated over 50,000 alcoholics. Many of them had been diagnosed as hopeless (Thomsen, 1975). Since Silkworth became medical director of the Charles B. Towns hospital in New York in 1924, his own estimate of success was ‘approximately 2 percent’ (Kurtz, 1979, p. 22). Occasionally a triumph could be noted, but they were too few to enable replicatable results.
Many perceived the inability to transcend alcoholism as simply a moral failure that could be and should be considered a function of will-power, that is: simply decide to abstain from alcohol in any form and maintain that decision. Such a line of reasoning held that people of good character and proper up-bringing would choose to live according to honorable standards including moderation in all things except alcohol consumption.
AA has gained such a reputation of success that it has spawned many other twelve step clones. For example, any metropolitan telephone book will reveal listings for Gamblers Anonymous, Narcotics Anonymous, and Overeaters Anonymous, to name a few. The AA influence is indeed widely felt and widely known.
Bill Wilson’s zeal and dedication to promoting recovery from alcoholism was prompted by an experience in Towns Hospital in 1934 that he later termed a ‘spiritual awakening’ (Cheever, 2001). In terms of the effect of the experience, he was reluctant to directly make the connection between that experience and power of God. However, so profound was this event, it came to be the cornerstone of his understanding of the meaning of recovery.
Bill knew alcohol was killing not only his marriage and his future, it was also gradually killing himself by slowly destroying his body. His best efforts to control or manage his alcohol consumption were of no avail, as were the efforts of those who cared about him. From his childhood, Bill had always believed in God, but not in a personal way. His first encounter with ‘religion’ as a practical assistance to recovery came through an old friend who was also an early drinking buddy, Ebby. Through Ebby he began to see the value of some kind of association with God, but he couldn’t define it in biblical terms (Thomsen, 1975).
Early on, AA gained validity from the medical community. In the mid 1940′s the professional medical community began to assert that alcoholism was a disease (Dr. Foster Kennedy’s comments to the Medical Society of the State of New York, 1944). This recognition further complicated an already complex issue. In 1951, the Lasker Award was given to AA ‘in emphasizing alcoholism as an illness, the social stigma associated with this condition being blotted out…’ (Alcoholics Anonymous, 1984, p. 571-3). Thus, the medical model significantly diminished personal focus and accountability by giving credibility to external responsibility for addictions, the “disease.”
Wilson’s spiritual awakening assured that the spiritual dimension of AA would remain unmistakable. However, the casual observer cannot help but wonder how effective spirituality is in recovery from alcoholism in the short term as well as for the long run. The plethora of AA meetings around the world today would tend to indicate that their success is phenomenal. If AA was indeed phenomenally successful, at the end of the 20th century, it was virtually impossible to explain why an estimated 60% of all automobile accidents and 50% of all occupied hospital beds were affected directly or indirectly by the results of addictions, usually identified as alcohol consumption (Healthcare Cost and Utilization Project, 2000).
AA as an organization has existed for a little over 65 years. The disease concept of alcoholism has enjoyed a little over 50 years of notoriety. Spirituality, considered a foundation cornerstone of the AA recovery movement, has existed for thousands of years. There seems to be quite a large contradiction and incompatibility here. Logically the spiritual component deserves stronger attention.
One of AA’s mottoes is “Keep It Simple.” The implication is that concentration on the basics minimizes tendencies to make it more complicated than it is. The success of AA over the years in seeking a personal solution to alcoholism was based on removing the technical language, such as “biogenetic predisposition to compulsive behavior,” from the daily process of recovery. Technical theory and language tend to foster complexity, which tends to remove any attempt at simplicity.
Relationship is defined for the purpose of this study as having two parts: 1) the interaction, understanding and acceptance of any two people having dealings with each other, and 2) that fulfills the qualities of integrity instilled by spirituality. The motto “Keep It Simple” stresses one component of relationship, the horizontal element, and virtually overlooks the other component, the vertical element. The horizontal element is the honest interaction between peers, and the vertical element is between self and God as well as between self and God’s appointed leaders. The motto also implies that simplicity will logically lead to abstaining from alcohol for abstinence’s sake. It virtually ignores that meaning tends to be derived from the presence of an objective, and not the absence of an objective or the absence of an improper and undesirable objective. One function of supplantation, the simultaneous rejection of unwanted behavior and commitment to desired behavior, and relationship minimizes complexity and maximizes simplicity in a logical methodology.
AA’s overall acceptance has resulted in many cases generally regarded as successes. Many have committed for years to the AA philosophy of “don’t drink and go to meetings,” which implies that is enough for success. However, if we subscribe to the infallibility and sufficiency of the scriptures, clearly more is needed than the over-simplified AA precept of ‘don’t drink and go to meetings’ for those cases termed as successes to be regarded as genuine successes.
AA groups meet periodically, usually weekly, and encourage their members to develop meaningful individual same-sex relationships outside of the meetings. Further, they strongly suggest that each member get a sponsor. A sponsor is someone who already has quality time in personally applying AA’s philosophy (AA calls it “working the steps”) and who has become comfortable, confident and secure in their own understand and application of recovery. The function of the sponsor is to provide a sounding board of stability for the sponsoree, who is often referred to as ‘pigeon’ by AA old-timers.
The sponsor – sponsoree connection is one of relationship. The concept of relationship is truly biblical. However, the scriptural view of relationship adds a dimension too often otherwise overlooked, which is accountability from a personal perspective.
The Scientific/Medical View
Addictions have been viewed from the scientific perspective, or medical model, since acceptance as a disease model in the late 1940′s. The scientific view of addictions, objectively described in The DSM-IV (Diagnostic and Statistical Manual, 4th Ed. Electronic DSM-IV (2.0) PLUS (1994) states that the criteria for substance dependence is:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1) tolerance, as defined by either of the following:
a). a need for markedly increased amounts of the substance to achieve intoxication or desired effect
b) markedly diminished effect with continued use of the same amount of the substance
2) withdrawal, as manifested by either of the following:
a) the characteristic withdrawal syndrome for the substance …
b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3) the substance is often taken in larger amounts or over a longer period than was intended
4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
6) important social, occupational, or recreational activities are given up or reduced because of substance use
7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
Notice how elaborate, specific and detailed the criteria are. The DSM-IV was created as a diagnostic tool to aid psychologists and psychiatrists in their attempts to identify and address mental illness issues. However, it not only serves as a diagnostic tool for the professional community, government agencies and the insurance industry have adopted it as a labeling tool. Unfortunately in many instances this assigning of a human need reduces the complexity of the need. This system, being secular in nature, excludes any scriptural observations from the pathology of human emotions. The use of this technical nomenclature in the professional community has largely relegated the scriptural data to the arena of the irrelevant.
It is important to note that in recent years evidence has appeared that the secular professional community is admitting the need for the spiritual in dealing with human problems (cf. Dossey’s Healing Words (1997), Siegel’s Love, Medicine and Miracles (1986), and Benor’s Spiritual Healing (2001)). There seems to be a growing consensus that the whole man is greater than the sum of his parts. A recent computer search using the words “spiritual” and “counseling” produced 64 journal articles written since 1990.
The Spiritual Model
Among others, Clark (2000), Frye, (2000), Hindson and Eyrich (1997), and Montgomery (1974) have provided persuasive arguments for the sufficiency and inerrancy of God’s Word, synonymously known as the Holy Bible. They postulate that these Scriptures hold solutions for all of humanity’s needs. Such is the foundation premise of Trinity College and Theological Seminary’s basis for all curricula leading to various academic degrees, especially Doctor of Philosophy in Biblical Counseling. Accepting the truth of Biblical sufficiency and inerrancy gives rise to the conviction that this same truth applies to the treatment of addictions and compulsions.
The Bible’s view of addiction is not one of disease but one of sin. Holman’s Bible Dictionary (CD-ROM, 1991) defines sin as: “Actions by which humans rebel against God, miss His purpose for their life, and surrender to the power of evil rather than to God.” One Hebrew word for sin, chata, means to miss the mark (Strong, 1998). Missing the mark has more application than violating one of the Ten Commandments. Addiction does not directly violate one of the Ten Commandments, but it does cause the missing of the mark which is sin.
One avenue of permission for sin to enter a human life is to allow something to interfere with the sovereign responsibility to choose good over evil. Paul aptly states in Corinthians 6:12: “Everything is permissible for me but not everything is beneficial. Everything is permissible for me, but I will not be mastered by anything.” In that verse he says he has the ability to choose but the choice must not control him, or master him. Addiction is the choice becoming the master.
One way of preventing the addiction from maintaining its supremacy is to employ the fundamentals of relationship. Throughout the Old and New Testaments relationships have been of paramount importance. The most profound example of relationship in the Bible is that of the interaction of the Trinity: God the Father, God the Son, and God the Holy Spirit. Since we are created in God’s image (Genesis 1:26), we are unmistakably created in the image of relationship with a supernatural God. Of the two dimensions of relationship, vertical and horizontal, that is the vertical dimension. Clearly it comes first, but it does not define the wholeness of relationship that is biblically ordained. Accepting Jesus Christ as Lord, Savior, and Master makes us part of the kingdom of God, part of the family of God. That creates the horizontal dimension: everyone in the family is related – no one stands alone without relationship. These are the peer relationships that provide continuity of accountability, and complete the fullness of relationship of biblical standards.
Several programs have been devised to address addictions that draw on the fundamental truths of the scriptures. The creators of these programs borrow bits of biblical wisdom to augment their own understanding of the recovery process. Several such programs exist, some of which have gained modest distinction and are gaining favor as alternatives to AA.
One such program, Alcoholics Victorious, has attempted to provide a biblically based alternative to AA as a supplement not as a replacement (AV Web Site, 1999). Alcoholics Victorious is a network of Christian support groups for chemically dependent persons. It is comprised of alcoholics, drug addicts and people with other compulsive disorders. They believe that alcoholism is an addiction, and that the alcoholic is an individual who cannot, as a matter of willpower alone, control his or her own dependency. Their program was established in 1948, but has been slow to become widespread and widely known. Their focus, like AA, being one of attraction not promotion, seeks not to advertise its existence or purpose but to reach those in need by individual recommendation.
Another program, Overcomers Outreach, also attempts to provide an alternative to the spiritually bland philosophy of AA. Its keystone scripture is John 16:33b, “In this world you will have trouble, but take heart, I have overcome the world.” Overcomers Outreach is a ministry that was born out of a deep need of a support system for individuals and families within evangelical Christian churches. Overcomers Outreach support groups use the Bible and the 12 Steps of Alcoholics Anonymous to minister to individuals who are affected by alcohol, mind altering drugs, sexual addiction, gambling, food and other compulsive behaviors or dependencies. Family members are welcome at their meetings. Overcomers Outreach bills itself as a ‘bridge between AA and the local church’ (Bartosch & Bartosch, 1996).
Both of these nationally available programs borrow from multiple disciplines to create a hodgepodge program instead of an application grounded in one discipline. If believing the Bible is sufficient to meet the needs created by addictions and compulsions, the best of all possible attempts to address these needs would logically and intuitively originate from that Biblical source.
The Twelve Steps – A Spiritual Journey (1994) is a workbook attempt designed as “a guide for healing damaged emotions” (subtitle). It’s intent is to apply the 12-steps of AA in a group format “based on Biblical Teachings” (cover description). It was not created to be a bridge between the secular and the sacred, but it was constructed as a blend of the secular 12-steps with the sacred scriptures with the goal to focus on emotions.
Credit:ivythesis.typepad.com
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