A BLONG: WHO'S DRIVING THIS BUS?

Who the heck is driving this machine?

Following article is intended solely for informational purposes.
In NO WAY is it intended that any of the ideas presented here,
are to suggest a consequence to my blogosphere friends,
who I cherish greatly, as you know!

Please do not shoot down the messenger.

A NEWSLETTER FOR PROFESSIONALS:
ABOUT AA: FALL/WINTER 2002

Singleness of Purpose

George E. Vaillant, M. D.
Class A (nonalcoholic) trustee
A.A. General Service Board

"Singleness of purpose" is essential to the effective treatment of
alcoholism. The reason for such exaggerated focus is to overcome denial. The denial associated with alcoholism is cunning,
baffling, and powerful and affects the patient, helper, and the
community. Unless alcoholism is kept relentlessly in the fore-
ground, other issues will usurp everybody's attention.

Mental health workers, however, have great difficulty with
A.A.'s Fifth Tradition: "Each group has but one primary pur-
pose-to carry its message to the alcoholic who still suffers."
Since mental health workers often admire the success and geo-
graphic availability of Alcoholics Anonymous, they understand-
ably wish to broaden its membership to include other substance
abusers. They also note that pure alcohol abuse is becoming less
frequent, and polydrug abuse more common. In addition, mental
health workers sometimes view singleness of purpose as outmod-
ed and exclusionary. They worry that the Tradition is a holdover
from the early days of A.A. and that the young, the poor and the
minority with a criminal record will be barred. Besides, when
there is no professional drug treatment center or Narcotics
Anonymous (NA) group easily available, mental health workers
find it hard to understand why A.A., with its tradition of Twelfth
Step work, won't step in and fill the breach.

As both a mental health worker and a researcher, it seems to
me that there are two arguments that trump these concerns. First,
the Third Tradition of A.A., "The only requirement for A.A. mem-
bership is a desire to stop drinking," renders A.A. nonexclusion-
ary. Each year A.A. welcomes many thousands of minorities,
many thousands of poor, many thousands of alcoholics with coex-
istent drug problems and tens of thousands of convicts into its
membership. Nobody with a desire to stop drinking is excluded.

The second argument, that "Singleness of Purpose" is neces-
sary to overcome denial, is even more compelling. Given a
choice, nobody wants to talk about alcoholism. In contrast, drug
addiction commands newspaper headlines, research funding and
the attention of clinical audiences. After two years of work at the
Lexington, Kentucky Federal Narcotics Treatment Center, I, a
mere assistant professor, was invited around the world to lecture
on heroin addiction. In the late 1990s, as a full professor and after
25 years of research on alcoholism and its enormous morbidity, I
was finally asked to give a medical grand rounds on alcohol in
my home city. My assigned topic, "Why alcohol is good for your
health!" In short, the greatest single obstacle to the proper treat-
ment of alcoholism is denial.

I first began my psychiatric career at a deeply dedicated com-
munity health center. The community had voted alcohol abuse as
their biggest problem. After its first ten years of operation the
center was still confining itself to addressing the community's
most pressing second, third, and fourth problems. No resources at
all were devoted to alcohol treatment.

I moved to another community mental health center that had
listened to its citizens and had opened an alcohol treatment cen-
ter. In being asked to fill the position of co-director of the clinic I
was the last staff psychiatrist hired by the mental health center.
Significantly, I had had no experience with alcoholism, but no
one else wanted the job.

With the exception of cigarettes, alcoholism is a bigger health
problem and family problem than all other drugs of abuse.

Alcohol abuse costs the nation more than all lung diseases and
cancers combined. After smoking and obesity, alcohol abuse is
perhaps the nation's third largest killer. But it is terribly difficult
to hold this danger in mind. Alcohol abuse claims 100,000 lives a
year, and on medical and surgical wards it costs two to six times,
as much to treat the 25% of patients with coexistent alcoholism
as to treat the other patients.

Yet cost conscious 21st century medical and surgical residencies steadfastly exclude alcoholism from their curricula. There is not enough time, they argue, to pay attention to alcoholism. To combat such denial the principle ofsingleness of purpose becomes a necessity.

Put differently, the experimentally documented success of
A.A. in the treatment of alcoholism is in part because A.A.
groups are the only place in the world where the focus is on alco-
holism and nothing but alcoholism. There is simply no other way
to overcome the denial.

This newsletter may be duplicated for distribution
without obtaining permission from
A.A. World Services, Inc., Box 459,
Grand Central Station, New York, NY 10163