Sunday, November 23, 2008


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.


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


Shadow said...

those are scary stats. i'd even venture to guess this same high previlance is reflective of other countries across the world. it's such a denied and hidden issue. everywhere.

big Jenn said...

Denial is not a river in Egypt! thanks. jeNN

Banana Girl said...

Enormous morbidity....yep, that wraps it up, no? To die an alcoholic death, in my opinion, is so near suicide by other means, that the only question, in light of AA and all of those who try to help the sufferer is why? The answer put forth here is quite simple and one I always need to hear: Denial. This is a great and sobering post. Thanks for digging it up and sharing it. It was just what I needed to read this morning. j.

AlkySeltzer said...

At one week sober, a member said that to me,

"Denial is not a river in Egypt"...

and I answered with conviction, as if finally "knowing" something, "Yes it is!"

AlkySeltzer said...

J., (Banana Girl) isn't it oddly funny (maybe not funny) that the druggies I know all brag about the different kinds of 'stuff' they've "done"...

and Alkies almost to a fault, tell us they "had two beers" when they mean maybe a half-quart of vodka or Black Jack Daniels( with a splash of Cola--who wouldn't deny THAT?)...and Alkies almost NEVER admit to having a serious, deadly illness, or problem. "Life is GREAT", I always said...BIG denial!

Now I can say that, and be telling te truth. Thanks for your comment.
A Sincere Love,

Lou said...

I think alcoholism is not taken seriously by medical people & not enough money spent on prevention because it is legal.
America has a big obsession with the useless "war on drugs". Like the doc said, less than 1% of the population uses heroin, yet he is asked to lecture on that. I don't know stats, but I would wager at least 20% of people have an alcohol problem, but we are not spending billions to eradicate distilleries.

Syd said...

I have heard so many alcoholics express their concern that AA is losing its singleness of purpose. For the real alcoholic, it's hard to relate to the drug addict. I hope that AA isn't diluted more and retains its primary focus.

Findon said...

First Things First. I hear in meetings lots of the following. The first thing is to get my kids / wife/ job/ house back and I think NO NO NO. I've heard today. I don't need to do many meetings now. I'm sober now and as long as I remember that meetings are here if I need them I'll be OK. And I think No No No. First Things First
Thanks for this. It really is important to here this.

Gabriella Moonlight said...

This is a great post and the statistics are frightening, I know that here where my meetings are the singleness of purpose is taken very seriously.

Thank you,

Zanejabbers said...

That just hit the nail on the head.

Lou said...

Sorry, I guess I missed the intent of the post. It was about druggies coming to AA meetings, not about how alcoholism is ignored by medical & community experts.
Well, I'll stay out of that one.

Faith said...

Just thinking that it is a relief to know that I don't have to be a statistic... I am grateful to be alive.

I like that pic of the plate of cookies - did you and Prayer Girl do some baking? I made cookies last night!


Jess Mistress of Mischief said...

This was an awesome blog post! Really got the ole heart racing.

I do remember those days that I was talking about 3 margaritas into the party failing to qualify that the 3 margaritas were a compilation of a quart of tequila and the rest of the stuff to go in them. Normies do not talk about a quart of tequila as 3 drinks. LOL

vicariousrising said...

I've seen this article somewhere before. I guess I take issue with the idea that AA only deals with alcoholism and only alcoholism because it assumes that all the problem is a pysiological addiction with drinking and not all the other baggage that leads to it. I think most would agree that alcoholism is caused by both biology and environment and that the alcohol is most frequently used as a coping mechanism, which is why a support group works better than just some sort of medical treatment or just locking alcoholics away from alcohol.

I do agree that denial about a drinking problem is very, very easy for many, many reasons. But I am not sure that AA's singleness of purpose is going to be the thing that knocks an alcoholic on their inebriated head and realize the problem. Most of the time, they have had to admit a problem well before entering the rooms of AA. And while many need to be convinced they are alcoholic the rest of the way by attending meetings, I think it is only the people who have been in AA a long time who take issue with other types of addictions being in the meetings than the new people.

Maybe we should dig Bill W up and ask him if by singleness of purpose he meant to exclude drug addicts. I wonder if singleness of purpose might mean to acknowledge an addiction problem rather than pinpoint it to the specific poison. I dunno. Maybe someone knows what Bill intended. I'm not all in the know about the man.