I. Statement of the Problem
According to the Seventh Special Report to the U. S. Congress on Alcohol and Health, use of just the drug alcohol in the United States is correlated with approximately 50% of automotive fatalities, 38% of drowning deaths as well as significant percentages of fatal and non-fatal falls, burns, suicides, domestic violence and many other personal and social ills. It is clear that problems related to the use of alcohol and other drugs are of serious concern.
When we look at the contemporary state of the field of addictions we discover four main developments.
(1) The initial surge in professional, governmental and popular interest in the various types of addictions followed the advent of Alcoholics Anonymous (AA) in 1935. AA grew from two members to 73,000 groups in 1987 according to AA World Services. This rapid growth, combined with anecdotal accounts of AA's success, helped to set the stage to establish the National Council on Alcoholism in the 1940s. The NCA's purpose was, in effect, to endorse AA's concept of alcohol dependence as a disease. The efforts were successful and led to a surge of treatment centers in the 1970s along with, it would appear, an increase of alcoholics. In the 1940s it was estimated that there were 100,000 alcoholics, in 1946 more than a million, in the 1950s 5-6 million and in the 1980s 1-20 million Americans were possibly alcoholic as reported by various professionals in the field.
(2) Professional treatment methods used to address problems related to alcohol and other drugs that have been developed subsequent to AA appear to be discouragingly ineffective. The U. S. government reports that in just the twelve months between October 1986 and 1987 1.43 million people were treated in various alcohol treatment centers. This same report is conspicuous in its lack of figures reporting evidence for the efficacy of the treatment. However, others have pointed out that recovery rates for those who received professional treatment for alcohol dependence, or for addictions to other drugs, may not be significantly different than for individuals who did not receive professional treatment. According to Stanton Peele, a leading critic of the current state of the addictions field, "It has been remarkably hard to find systematic proof that treatment for alcoholism and other addictions accomplishes anything at all." Medical insurance companies were quick to discover the relative ineffectiveness of professional treatment for addictions and were equally as quick to reduce benefits for such treatment. The U. S. government has expressed such concern with the problems stemming from the use of alcohol and other drugs that it has declared a "war" on drugs. This "war" however, has also produced less than sterling results and it has been alleged that in its zeal the U. S. government treads perilously close to violating the Constitution if, in fact, it has not already done so.
(3) This "war" on drugs and growth in consumer-oriented treatment programs, and the inflation of the numbers of potential consumers, was fed by a concurrent development in the understanding of the term "addiction". It was no longer understood (in some circles) as a purely biological disorder. It had been the case that a person who was addicted to some drug, such as alcohol, could be assured of a painful, perhaps even fatal, physical withdrawal should the drug be removed too quickly from one's body. Today, there are those who would maintain that an addiction is such only in the classic, physiological sense of the term, and those who would define addiction, in the words of one proponent, as "...any process or substance that begins to have control over us in such a way that we feel we must be dishonest with ourselves or others about it." Such an approach effectively relegates just about any human behavior to the list of possible "addictions" and thus "diseases". Hence, there has blossomed countless self-help groups, all modeled on AA, for "addictions" to such things as eating, love, sex, religion and even being a child of an alcoholic or other "addicted" person.
(4) The addictions field, now understood in its broadest sense, has spawned a powerful class of paraprofessionals and self-styled "experts" whose credentials may be no more than membership in some type of Twelve Step group. This professional inclusiveness originally began when clinical settings included members of AA in their treatment programs in order to orient newcomers to the Twelve Steps. It has led to the rise of a vast realm of popular literature on the subject that is often dubious in its scientific rigor, but quite amenable to talk show confessions and market demographics. Writes Peele, "The media have been essential in the creation of the addiction treatment industry." Peele goes on to trace this popular growth in what can be identified as an "addiction" from children and spouses of alcoholics to eating, exercise, sex, gambling, shopping, etc. , in short, to any behavior that can alter our moods for the better.
As a result of these four developments the clinical state of the addictions field might best be described as confused. While addictions (especially to drugs such as alcohol) continues to be of grave social concern, the field itself is in retreat as it discovers its inability to define terms, the inadequacy of its understanding of the phenomenon, and the ineffectiveness of its treatments. It is this confusion that spurs the present research.
Whether we talk about addictions in the narrow sense of physiological addiction to drugs, or in the broader sense of any inordinate mood altering behavior, we end up having to confront the Twelve Steps of Alcoholics Anonymous. AA was the first treatment for addictions that seemed to work and, until recently, just about all treatment programs included AA and its Twelve Steps as a central component of the treatment. The AA program is unabashedly and unequivocally spiritual. And it may be this fact that is primarily responsible for the four developments in the addictions field that have been identified above.
It is certainly the reason that we are now seeing a backlash against AA which began primarily with Jack Trimpey's The Small Book. Trimpey has set up an alternative to AA meetings based upon Ellis' Rational-Emotive Therapy precisely because of the religio-spiritual content of AA He writes:
Because of the organizational success of Alcoholics Anonymous and its 12-step spiritual healing program, it has become a universal component in addiction care. Unfortunately, millions... ...are not good candidates for spiritual healing, and can best regain control of their lives through a program that does not require their moral betterment or belief in a Higher Power, a Supreme Being, or other articles of faith.
In another indication of the backlash against AA those convicted of driving under the influence have successfully challenged court orders to attend AA meetings on the basis of the separation of church and state.
If searches of the literature are any indication, the fact that the AA program is spiritual in nature is a stumbling block to professionals in the field. There is no shortage of books and articles on the spirituality of the Twelve Steps in the popular literature. However, there is a conspicuous silence in the professional literature, especially odd given the prevalence of professional support for AA and AA's clear spiritual stance. One would think professionals would be intrigued by a phenomenon that can pull late-stage alcoholics out of the gutter as well as "shopoholics" out of the malls. While there is ample material on Alcoholics Anonymous in medicine, psychology and sociology little of it appears to treat the specific topic of the spirituality of AA. The Twelve Steps are often mentioned as a side line or from within the writer's unique academic perspective. If spirituality is mentioned it is vaguely defined, and is often confused with more abstract psychological theories-- a problem especially within the popular literature. What is even worse, is what appears to be a professional willingness to simply ignore the writings of Bill Wilson-- not to mention the "hot flash" experience that led to his sobriety. (For instance, there is a rebuttal to Trimpey's position, "Whether such a person can quit upon a non-spiritual basis depends upon the extent to which he has already lost the power to choose whether he will drink or not.") This researcher finds this seemingly willful disregard of the body of writings around the Twelve Steps nothing less than astonishing.
Theology does a little bit better by specifically addressing the Twelve Steps, and in the past five years or so there have been increasing numbers of dissertations written on the topic. However, even these are often from within the framework of a particular theological view, usually the Christian, or from within a psychological school conducive to using the word "spiritual" such as the Jungian. Neither approach provides the clinician with the generally applicable constructs needed to comprehend the Twelve Step's claims of spiritual disorder and recovery and thus assist the client.
II. Focus of this Research and Some Limitations
It is the position of this researcher that the theoretical and clinical problems in the addictions field result from an inability, due to lack in understanding of human spirituality, to truly comprehend the Twelve Steps and thus devise effective clinical supports for the teaching of and practice of the Twelve Steps for both recovery and prevention of these problems. The purpose of this project is to support and demonstrate that the central insight of the Twelve Steps-- that the inordinate engagement in mood altering behaviors is primarily a spiritual problem-- is correct and can be understood in a theoretically sound manner that could lead to more effective clinical practice.
The focus of this project is not on addictions per se, nor on addictions as they may manifest as primarily physical, social or psychological, but will be limited to two goals. They are: (1) To articulate an understanding of spirituality, and thus of the Twelve Steps' claims of the spiritual foundations of addictions and their effective treatment, that could be utilized to address the concerns professionals and others have with the religio-spiritual content of the Twelve Steps. (2) To describe possible clinical approaches for the prevention and treatment of addictions based upon that understanding of the spirituality of the Twelve Steps.
This project is thus a theoretical-practical prolegomenon that could lead to clinical praxis and testing.
III. Methodology and Structure of the Research
The structure of this research will contain (1) a brief review of the literature exploring the Twelve Steps as specifically spiritual, (2) analysis of the Twelve Steps as spiritual in light of the theoretical paradigm of the new discipline of Formative Spirituality, illustrated by means of various theorists and the Muslim tradition, (3) discussion of the understanding of mood-altering behaviors as symptomatic of spiritual disorder that is derived from our analysis, and (4) discussion of the possibilities for clinical practice.
THE DISCIPLINE OF FORMATIVE SPIRITUALITY
I shall be relying primarily upon the work of Adrian van Kaam to situate our analysis of the Twelve Steps. Van Kaam has written extensively on the topic of spirituality and is the primary theorist to date within a project to develop a new branch of science he calls by various names such as the science of formative spirituality, the science of proximate human formation, or the science of foundational human formation. He writes, "...the science of formation is a new transpsychological field of study. (Its formal object) is the ongoing spiritual formation of people..." "(It) explores the experiential transcendence dynamic inherent in human life." And more completely, "The formal object of spiritual formation comprises the potential or actual formative relationships initiated by the transcendent mystery as communicating itself to unique persons usually through formation traditions."
The new discipline of Formative Spirituality is such that if it operates, at least partially, in congruence with its stated goals it should provide us with the theoretical foundations necessary to approach the Twelve Steps as a specifically spiritual program. Formative Spirituality is distinct from both theology and philosophy and aims towards an empirical, clinical value.
By utilizing formation theory we should be able to avoid reducing our analysis of the Twelve Steps to a particular religious or psychological outlook as have other attempts to approach the Twelve Steps as spiritual. There has as yet been little critical analysis of either formation theory or of van Kaam's thought. Duquesne University's Institute of Formative Spirituality (IFS), where van Kaam has done most of his work, and where this new discipline was established, did invite Donald Polkinghorne and P. J. Philibert to critically analyze the project. Their views were generally favorable to the project and to van Kaam's approach. There has also been some attention on the dissertation level.
This project is not primarily a critique of van Kaam, nor will it be using his thought in toto. Until there is a greater degree of critical analysis of his writings it would be premature, in this researcher's opinion, to attempt to utilize the entirety of van Kaam's theoretical structure. Given the complexity of what he proposes, as well as the long and evolutionary history of his thought, it may well nigh be impossible in a single volume work. Therefore, for the purposes of this project, we will single out some of the identified assumptions, principles and basic dynamics in this new discipline as they have been articulated in van Kaam's later writings. These assumptions, principles and dynamics will allow us to articulate an understanding of human spirituality that is relatively independent of particular schools of thought and religious traditions, thus keeping us safe from the reductionism present in other writings on the topic. From within this framework we will be enabled to provide an analysis of the Twelve Steps as spiritual.
Part of the difficulty in understanding van Kaam's writing is the lack of citations of other writers who may have expressed the same or similar points. In addition, van Kaam's position as the primary theorist within this new discipline rests upon not only his own genius, but also upon the work of the students of the IFS. In discussions with some of these students, this researcher has often heard expressed the idea that van Kaam's later work is one of synthesis. That is, his gift and genius consists of pulling together and integrating movements within various fields. The lack of reference, however, can hinder understanding of his thoughts. For this reason part of the structure of this project will entail illustration of van Kaam's constructs (as they pertain to the main topic) by means of other more familiar theorists. Such an approach is possible not only because van Kaam's work is one of synthesis, but because the theoretical structure of Formative Spirituality is, in its nature, open. In addition, and as mentioned above, van Kaam's writing is so extensive and "in process" that we need to restrict our use of his work to some of his most basic and consistently present theoretical constructs that would also be utilized by other theorists in the field.
Formative Spirituality is based upon a particular understanding of the human. This anthropological view is articulated by means of essential ontological assumptions as well as by the principles and dynamics that have been imaginatively intuited from those assumptions. Van Kaam's theorizing attempts to respond to the contradictory edifices built upon the presuppositions of positivism and idealism. This is in keeping with the open-ended, dialogical and integrative nature of formation theory.
Formative Spirituality does not direct our attention upon behaviors per se. It attempts to simultaneously view any human phenomenon from a number of perspectives by means of the formation field. The construct of formative dispositions provides the coherent theme across the ranges and dimensions of the human field of formation.
Healthy, that is, formative as opposed to deformative, human formation is dependent upon how the individual responds to, or orients him/herself vis a vis the mystery of formation. This is the central construct in the anthropological view of Formative Spirituality. It is the key to understanding human spirituality. The human form is confronted with what van Kaam calls the "primordial formation decision". The human form, consciously or unconsciously, decides whether the mystery of all formation is positive, negative or indifferent vis a vis the consonant unfolding of the human form.
In this basic option they choose to believe in the meaningfulness or the meaninglessness of their life formation. It is a choice either to abandon themselves to this mystery or to feel abandoned in this cosmos as in a meaningless and careless system closed in upon itself. Our primordial formation decision is thus a faith option for positive or negative abandonment.
This foundational decision and its subsequent disposition underpins all particular formation decisions and subsequent dispositions. In some way it coforms and colors all the daily decisions we make."
THE TWELVE STEPS
Alcoholics Anonymous, and thus the Twelve Steps, originated out of the experiences of Bill Wilson. This is a key point-- that the Twelve Steps developed out of experience. They did not originate out of speculative thought or out of some attempt to devise a treatment for alcoholics, but out of actual lived formation experience. They originated out of the experiences of late-stage alcoholics finding and, what was new, maintaining sobriety.
Bill Wilson was a successful stockbroker whose life was destroyed by his alcohol dependency. He was unable to hold down a job, was in and out of hospitals, and was unable to maintain sobriety for more than a few months. He often told what came to be known as "the bedtime story" of how he finally got sober. It is the story of a dramatic conversion that Bill, in his humorous way, described as a "hot flash".
Following this rather dramatic experience Bill began to attend meetings of the Oxford group, an evangelical movement very popular at the time. This seemed to provide him with the guidance he needed and the means to understand his experience. (As did William James' Varieties of Religious Experience and the work of Carl Jung, both of which found their way into "The Big Book".) It was the principles of this movement as well as his "bedtime story" of the "hot flash" that he first brought to drunks. His efforts were largely unsuccessful.
AA proper was born one day when Bill was in Akron, Ohio attempting to rebuild his shattered career. He really wanted a drink. It struck him that if he could talk to another alcoholic he would avoid taking a drink. He met the second founder of AA, Dr. Bob Smith, who was soon sober. Together, Bill and Dr. Bob began the work of approaching other alcoholics and sharing how they were able to maintain sobriety. Slowly, the small group of sober alcoholics grew.
For a while, these people continued to follow the principles of the Oxford groups. Trouble developed on two fronts. Non-alcoholic Groupers began to resent the separate meetings for the alcoholics and Bill himself began to realize that certain principles and structures of the Oxford Groups were inadequate when applied to alcoholics.
In 1937-38 it was decided to write a book in order to broadcast more effectively the possibility of recovery for alcoholics. Bill Wilson wrote what was to become "The Big Book", but the process was one of copious amounts of input and discussion from and among the other members of AA-- some of it quite heated. Originally, Bill came up with six steps. These were derived from Oxford Group principles (though they did not have a similar program of "steps"). Out of concern that active alcoholics would not be able to comprehend such large chunks of information they were broken down into twelve.
The actual working of the steps is not done in isolation. One of the key elements of AA, in addition to the Twelve Steps, is that AA is a fellowship. Attendance at meetings, getting a "sponsor" as well as hearing about other sayings of AA such as "one day at a time" are germane to inducing the reformation promised by the Twelve Steps.
THE MUSLIM TRADITION
Of the three Abrahamic religious traditions, Jewish, Christian and Muslim, the Islamic is the least known or understood in the U. S. It is also the only one of the three that completely bans alcohol. Recent surveys have identified Islam as America's fastest growing religion. This is due to immigration, procreation and conversion. Islam has already begun to confront the problem of mood-altering behaviors, and has begun to incorporate the Twelve Steps.
Our use of the Islamic tradition in this project serves a number of purposes. (1) As said, it will serve to illustrate aspects of our analysis in light of the establishment of the new discipline of Formative Spirituality. In addition, most students of formation theory write utilizing various aspects of the Christian tradition. The use of Islam should serve as a source for other researchers in this new field. (2) As Islam grows in America addictions professionals will increasingly encounter those of the Muslim faith. As part of our goal of contributing to possible clinical applications our use of Islam will serve to provide a basic orientation to Islamic thought on the issue of addictions for use by clinicians. (3) The historical experience of Muslims is one of a successful prohibition of mood-altering drugs and behaviors on a community-wide scale. Such an occurrence demands some analysis and explication of the contributing factors (with a reminder that we are limited here to the factors pertaining to spirituality). (4) With wine and gambling prohibited in the same breath, so to speak, Islam anticipated today's issue between the strict definition of addiction and the broad definition.
However, it is also in this part of the research project that we confront some rather severe limitations on the part of the researcher. Muslim assumptions-- the foundation of all Muslim thought-- are contained in the Qu'ran and the sunnah. Both of these sources, as well as the majority of Muslim scholarship, is in Arabic-- a language the researcher does not know. The Qu'ran in particular is considered so untranslatable that it is only considered "the Qu'ran" in the Arabic. So, we shall be limited to English language commentaries and translations. This should not pose too much of a problem in that we shall be utilizing some very basic Islamic constructs that have generated ample English literature by Muslims. In addition, key Arabic phrases are beginning to find their explication in English. Their basic position within Islamic ideology should not be confused with familiarity by non-Muslims. It is this researcher's experience that non-Muslims' understanding of basic Islamic constructs is almost non-existent. Any explication, even relying on English texts, should be welcome and enlightening.
IV. Discussion and Praxis
In Pennsylvania's Allegheny county alone there are twenty-two different Twelve Step groups according to the Self-Help Network. These range from Alcoholics and Narcotics Anonymous, to Overeaters, Smokers, Emotions, Employment, Debtors, Unwed Parents, and Fundamentalists Anonymous as well as three separate groups for "sexaholics". There is one common element among all these "addictive" behaviors that require a Twelve Step group. All of these are behaviors that make us feel good by changing our mood for the better. This is obvious in the case of the groups responding to problems people may have with chemicals such as Alcoholics or Narcotics Anonymous. In our present diet-obsessed culture we are all increasingly familiar with the idea of eating food for comfort and in response to emotions such as depression or loneliness. Once pointed out, this mood-altering dynamic is obvious in other behaviors as well. For instance, there has recently been more attention paid to gamblers. What has been discovered is that the addicted gambler continues the behavior not because of the promise of money, but for the high he/she gets just before the roulette wheel stops or the last card is played. All anxiety, all stress, all concerns are temporarily set aside as we engage in the mood-altering behavior. In our consumer-oriented society how many of us have not gone out and bought something we didn't need, and may not have even wanted, in order to make ourselves feel better?
Now only an extremist type of Puritan would argue that this is necessarily a bad thing. However, the behaviors can be said to be inordinate, or pre-addictive, when they begin to produce negative consequences in other areas of our lives. The addiction develops when the person continues to engage in the behavior regardless of the negative consequences.
This deformation can be quite severe, and astounding to the people around the addict. It is not unusual to hear of people making $15,000 per annum with five credit cards, each with a $5,000 limit, each maxed out to the limit. Their houses are filled with clothes they never wear and items they never use. We all know people, without glandular problems, who are morbidly obese. We watch in amazement as they choose a candy bar to eat for a snack. Anyone who has ever known an active chemical addict knows first hand how absolutely bizarre and incomprehensible an addict's behavior can appear.
It almost seems common sense to see these as purely behavioral problems, or the result of some deep-seated emotional problem. But the fact is, our current methods of treating such disorders appear to be largely ineffective in the long run except for, it would appear, the working of the Twelve Steps. Now this is not to deny that there may be physical, psychological or social contributors to the addiction. Our project is to explicate the spiritual aspects of these disorders.
Formation theory allows us to appropriate an understanding of spirituality that is both contemporary and practical. In many ways, van Kaam's main insight into the experience of the mystery of formation and the implications therefrom are very simple. When presented properly the human ability to apprehend this mystery is obvious-- in front of our faces. Like a fish discovering water Formative Spirituality points out what has been in front of us all the time. And yet, this discovery is potentially earth-shattering in its implications. Contained within this discovery is an implicit demand to reassess the manner in which all social service professionals understand and address the issues with which they are faced.