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According to the National Council on Alcoholism and Drug Dependence (Alcoholism, 2000), alcohol is among the three largest causes of preventable mortality in the United States. Contributing to approximately 100,000 deaths annually, only tobacco and diet/activity patterns contribute to greater death tolls. The Council also estimates that, despite laws against underage drinking, approximately 13.8 million Americans over the age of 18, representing about seven percent of the population, have experienced difficulty controlling their alcohol consumption, including 8.1 million people who are alcoholics. It is particularly disturbing to note that the prevalence of drinking problems is among those individuals within the 18 to 29 age group with a greater number of men experiencing problems than women by a factor of almost three to one. Despite laws against underage drinking, more than half of all high school seniors in this country have reported being drunk at least once and a third of them have reported have three or more drinks in a row in the weeks prior to the survey while another 76 million people, almost half of all Americans, have reported being exposed to alcoholism within the home (Alcoholism, 2000). These numbers are particularly alarming as studies continue to show that individuals who have started drinking before age 15 are up to four times more likely to develop alcoholism than those who started at age 21 and there is a greater tendency for alcoholism to run within family lines. Alcohol can affect not only the physical health of the individual but can have long-term repercussions on their psychology and social life as well, strongly affecting the way they relate to the world and those around them and only controllable through life-long voluntary measures such as Alcoholics Anonymous.
Physically, alcohol can have a dramatic impact upon an individual’s body particularly as it affects the liver. According to Dennis Koop (2007), alcohol damages the body in numerous ways thanks to the way in which it processes the substance when it is introduced. As alcohol enters the liver, it is metabolized by an enzyme called CYP2E1. In this process, toxicity levels are increased in the production of compounds Koop calls reactive oxygen species (ROS) which are formed when oxygen gains an electron, thus reducing the levels of oxygen in the body and functioning to damage other cellular molecules. Animals who have been treated with this compound have proven that the presence of CYP2E1 does indeed increase the level of chemical damage in the body by free radicals, particularly as they affect the lipid components of cell membranes in the liver cells (Dey & Cederbaum, 2006). This is because when the levels of CYP2E1 are high, there is a greater level of lipid peroxidation within the liver, thus a lower ability of the liver to fight against the toxins that have been introduced (Koop, 2007). Thus, the liver damage widely suspected to be directly caused by alcohol consumption is proven and unavoidable. With this knowledge in hand, it becomes a concern regarding why individuals might continue to choose to drink to the point of it becoming an uncontrollable habit.
According to reports by Psych Central, alcoholism does appear to have some hereditary connections. Those individuals who learn they have a high tolerance for alcohol should also be alerted to the fact that they may also have a greater tendency to fall victim to alcoholism while those who have a low tolerance generally do not develop alcoholic tendencies (Psych Central, 2006). This concept is supported by studies conducted with identical twins. According to Hicks et al (2004), “identical twins have a higher concordance for drinking behavior and possibly alcoholism than fraternal twins”, who do not share the same genetic record. In a twin study involving 542 families, there was a trait found for conduct disorder and alcohol dependence that was determined to be highly heritable regardless of gender. At the same time, it was also determined that a father’s alcohol intake could predict children’s alcohol dependence later in life (Hicks et al, 2004). While this did not indicate that all children of heavy-drinking fathers would grow up to become alcoholic, the combination of poor environment caused by the father’s heavy drinking (i.e. – lack of solid parent-child relationships and poor peer groups) with these hereditary danger signs created a difficult scenario for these children to escape.
Alcoholism is not always the result of hereditary factors, however. For example, while addictive personality can also contribute to the development of alcoholism, there has not been a single type of addictive personality positively identified with alcoholism and these personality types are not considered to be hereditary (Gold, 2006). Nevertheless, there are many addictive personality types who also become alcoholics despite the absence of the illness within the family line. Instead, it is presumed that these personalities turn to alcohol as a result of anti-social behavior within the home, perhaps as the result of poor home life or abusive parent or sibling. It is also not believed that alcoholism is the cause of aggressive behavior in individuals as not everyone who drinks becomes aggressive with the introduction of alcohol. “In trying to elucidate the relationship between alcohol consumption and aggression, researchers have suggested that people with a psychiatric condition called antisocial personality disorder (ASPD) may be particularly susceptible to alcohol-related aggression” (Moeller & Dougherty, 2001). Given that the illness is so complex, involving so many factors including heredity, environment, childhood influences, personality characteristics, and disorders, finding a cure for alcoholism has been impossible. However, there has been some support for self-help groups in maintaining control over the disease for those willing to put in the effort.
The most well-known of these groups is known throughout the world as Alcoholics Anonymous (AA). This organization was founded in 1935 as a means of providing a supportive peer group to individuals battling their own issues concerning alcohol consumption. The program is centered upon the concept of total abstinence from alcohol consumption and provides a series of 12 steps that participants are expected to work through as a means of breaking their addiction to alcohol (Mayo Clinic, 2006). Analyzing the quality of life issues, research suggests that participation in these programs does indeed have a positive effect on recovering alcoholics. Referring to Alcoholics Anonymous and similar programs as Mutual Help programs, a study conducted by Ritsher, McKellar et al (2002) indicated participation in the program during the first and second year of sobriety had “a robust relationship with year 5 … remission for both groups.” It was hypothesized that this was due to the increased peer support with like-minded people. An earlier study on the same subject indicated “previous research suggests the relationship between mutual help and positive (Substance Use Disorder) outcomes is mediated by such factors as increased active coping, improved social support for abstinence and improved self-efficacy” (Finney, 1995). Another study followed several men who were first interviewed at their admission to treatment and six months later. According to this study, of the 80 percent of individuals who were re-interviewed, significant improvements were seen regarding drinking behaviors in terms of frequency, quantity, and reported problems. “Frequent AA attendees had superior drinking outcomes to non-AA attendees and infrequent attendees (Gossop, M. et al, 2003). In a Harvard mental health letter (In Brief, 2003), men who had at least four drinks a day were interviewed yearly for a period of two years after hospital release. “At the time they were hospitalized, only 9 percent of the men had attended more than 10 AA meetings in the previous three months. After one year, that figure had risen to 56 percent, and after two years, it was 49 percent.” These men were also reported to have fewer alcohol-related problems and were drinking less.
Not all the research supports the idea that quality of life without alcohol is directly correlated to Alcohol Anonymous meeting attendance, though. Taking a more objective approach, Watson et al (1997) compared four groups of men on issues such as alcohol consumption, number of times jailed, hospitalization, detoxifications, lost jobs, and other related factors during the period of one year. Because they were grouped by the number of Alcoholic Anonymous meetings they attended during their first month after discharge, it was possible to compare whether active participation in the program had any effect on the quality of life following treatment. “Attending meetings frequently did not make a difference among the groups on the average amount of alcohol drank daily,” however, those who attended meetings drank less alcohol daily on average than those who did not attend meetings. Although those who attended meetings were jailed fewer times than non-attenders, other quality of life measures that were compared did not show any significant differences.
There is a personal testimony that Alcoholics Anonymous or similar programs have brought about significant quality of life changes. For many, the changes in lifestyle can be profound. According to one man who had known the founders of Alcoholics Anonymous and achieved his own lifetime sobriety in 1934, it was through the precursor to the 12-step program that he was able to save his marriage. “Houck lost his wife to cancer in 1988, but believes the lessons learned from the Oxford Group gave him a life he had not been sure was possible. ‘A marriage that wasn’t supposed to last one year lasted 57 years.’” (August 2004). These types of changes are thought to be the result of significant changes in personal worldview.
Hoffman (2003) describes the mental progression, or moral career, of entry and participation in these programs as a series of states that were first outlined in a study on psychiatric patients. “Light’s (1980) study of the moral career of psychiatric residents proposes a singular model of residents’ socialization, consisting of five stages: feeling discredited, moral confusion, numbness and exhaustion, moral transition, and self-affirmation.” The first stage is the point at which Hoffman suggests the alcoholic is brought into treatment, whether by self-volition or court, or another mandate. They are discredited by the community at large, by themselves, and then by the members of the meetings as they learn their thinking has been completely false all along. This leads to a state of moral confusion, in which the participant is struggling to identify which beliefs are incorrect and which are acceptable moral behavior. Acceptance of the 12 steps of the program leads to a highly optimistic “pink cloud period of recovery” that “contrasts sharply with the period of isolation and alienation that characterized the member’s life before entering AA.” This is followed by a period of exhaustion that, if successfully navigated, leads to a “moral transition” that allows the participant to “relieve the anxiety and guilt stemming from her past deviance” (Hoffman, 2003). Through this type of experience, another member of Alcoholics Anonymous explains “you’re no better and you’re no worse than the person sitting next to you, but you’re all better for being there and for trying” (Orange, 2004). This interaction enables participants to remain open to change and explore new behaviors in a relatively ‘safe’ setting. “A 51-year-old African American male AA member said that his recovery program made it possible for the first time to get along with other people and to learn necessary social skills, such as being able to tolerate criticism, put up with frustration and accept the viewpoints of others” (Kurtz & Fisher, 2003).
Most research suggests the reason for these significant changes in quality of life is thanks to the inherent nature of such groups to provide an empowering setting in which these individuals can redefine and relearn necessary living skills. “Researchers who investigated empowering settings identified the contextual characteristics as critical to the formation of psychological empowerment” (Maton & Salem, 1995) which “leads to organizational empowerment by providing strengths and competencies needed for social action” (Rappaport, 1984; Zimmerman, 1995). Organizers of successful programs say “our mission is not just to get people to stop drinking. It’s all about living a better quality of life. … This is a chronic illness, and we’ve learned that people need a continuum of aftercare services. We don’t send people home cured. We empower them to understand their addiction and make changes in their lives” (Newhouse, 1999).
That this empowerment does happen can be seen in the various individuals who have proceeded from their participation in Alcoholics Anonymous to affect change in their greater communities as these experiences with others helped them reshape their ideas and their methods of communicating with others as they redefined what was important to them and changed their perspective to include others. One man described his awakening to the value of “knowing oneself and one’s culture. NA led me to go on a quest to meet my family in Cuba. I took the program with me to Cuba and would never have done that in a million years if it wasn’t for NA. Coming back and working with the community, I saw how I am representing my Hispanic side in terms of the frustrations, substance abuse and poverty. I look at the numbers of who’s dropping [out of school], and its Latino young men and women. … NA has taught me how to be strong and how to take on a fight and make a change” (Kurtz & Fisher, 2003). Another individual reported the recovery process, which included attendance at Alcoholics Anonymous meetings, gave her the self-confidence and ability to challenge herself. “I’m the type of person who just can’t be happy with the status quo. I’ve never been that way. Sometimes you accept the status quo because it’s bigger than you in a sense, but I don’t have to believe in it … So I constantly try to keep my values and ideals up front. Recovery has given me the strength and the wherewithal to do that” (Kurtz & Fisher, 2003). Although these people have elected to go into community service with their newfound abilities, these cases provide tangible evidence of the boost in quality of life afforded those who have such secure places in which to correct misguided thinking and gain support for an alcohol-free lifestyle.
It can and has been argued that a large degree of the success of the Alcoholics Anonymous program is due to the spiritual path upon which it sets its members’ feet. Although the 12 steps as outlined specifically outline a spiritual path, it particularly steps 2 and 3 that address the issue directly, calling on members to “believe that a power greater than ourselves could restore us to sanity” and to make “a decision to turn our lives over to the care of God as we understand him.” It is important to note that this is phrased as a completely non-denominational, non-religious context, allowing members to believe in the ocean if that was what it took to find a power they could not stop and therefore greater than themselves. By introducing members to a world that exists beyond themselves and providing the space necessary for individuals to absolve themselves of guilt and obtain forgiveness for past deeds as well as a way of making up for past wrongs by encouraging active participation in some form, Alcoholics Anonymous provides a doorway into a new life.
This process is begun within the first three steps of the program and is reinforced throughout the 12 steps and the cycle of continuation outlined within the program. It is also essential to its members’ success within the program. “AA’s world view asserts that self-centeredness lies at the heart of alcoholics’ suffering; hence, overcoming alcoholism requires overcoming self-centeredness by committing to helping others and by surrendering to a higher power” (Humphreys & Kaskutas, 1995). In one study regarding spirituality in Alcoholics Anonymous, one member of the group said “AA makes you aware of other people. I think the major problem with most of us is that we were always too concerned about ourselves. Now, it’s different. You have to realize that alcoholism is a physical, mental, and spiritual affliction and that AA is more than just not drinking – it’s a way of life, a spiritual philosophy” (Rudy & Greil, 1987, p. 54).
For many alcoholics, the deeds they have done in neglecting their families and supporting their habits may have proven too much to bear, driving them to further drink as a means of forgetting about them. To bring these individuals out of this cycle, the spiritual journey of Alcoholics Anonymous includes the confession of past wrongs and a direct atonement where applicable or indirect atonement in the form of community involvement (within the Alcoholics Anonymous group at least) for those cases in which direct interaction would cause more harm than good. It is by going through this process that these individuals are able to both face the wrongs they have done and receive encouragement to continue on the path of recovery. One man, “After he decided on Dec. 12, 1934, that he would never drink alcohol again, he made restitution with his wife and others he had harmed. ‘I started telling my wife what kind of a fellow I was,’ he says. ‘I did this for three nights to get all of the garbage out. I wanted to be honest about everything in my life.’ He says his wife was grateful for the talk and then understood his behavior. ‘Now we could start our family and raise the children with the same guidelines. We had family quiet time every day. That’s the way we raised the whole family.’” (August 2004).
Through the increased or introduced spirituality offered through 12 step programs such as Alcoholics Anonymous or any of the many other programs that have developed for various other disordered behavior/addictions, participants in these programs are able to find a path to a better quality of life and a more complete way of interacting with other people. Both research and personal testimony have demonstrated that this seems to be the case, with varying degrees of agreement regarding the impact on quality of life. Yet even the most pessimistic of research studies have indicated that participation in Alcoholics Anonymous leads to a reduction in alcohol usage, which subsequently leads to a reduction in alcohol-related problems including imprisonment. Meanwhile, connections have been made between the level of spiritual involvement and the length of time spent actively within the program, showing a cyclical relationship in which spirituality feeds recovery and recovery feeds spirituality. Although it is apparent that alcoholism isn’t curable thanks to a variety of mitigating circumstances, it can be controlled when those affected by it are willing to put in the necessary work and find a positive and supportive group to join.
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