Interview: A Doctor Speaks

George E. Vaillant, M.D., joined AA's General Service Board as a Class A (nonalcoholic) trustee in 1998. He is professor of psychiatry, Harvard Medical School, director of the Study of Adult Development, Harvard University Health Services, and director of research in the Division of Psychiatry, Brigham and Women's Hospital. The author of The Natural History of Alcoholism Revisited, a comprehensive study of alcoholism, George lectures widely on alcoholism and addiction and is one of the foremost researchers in the field.

This article appeared originally on the AA Grapevine Magazine on May, 2001, Vol. 57, No. 12. Available on: http://www.aagrapevine.org. Reprinted with permission.

Grapevine: In an article about alcoholism in Harvard Magazine, you were quoted as saying that 50 percent of the people brought into emergency rooms with fractures are there as a result of alcohol, but that blood-alcohol levels are never checked. It made me curious about the way medical professionals view alcoholism today. Can you tell us something about that?

George Vaillant: What happens in emergency rooms is actually much more dramatic than that. Probably 50 percent of all the people brought into emergency rooms had blood-alcohol levels over .25 - which is enough to make any nondependent person comatose, not just prone to accidents. And even though this is a clear biochemical fact staring doctors in the face, no referral is made - nothing is done about it - because when it comes to treating alcoholism, the medical profession feels so helpless, so without hope. And for a doctor, feeling powerless is reason enough to put his head in the sand.

Grapevine: Why do you think that feeling persists?

George Vaillant: You have to remember that very few doctors have ever seen a recovered alcoholic. If you're recovered, you don't have any reason to tell your doctor you're an alcoholic. And if you're not recovered, you go back to see him a hundred times, so you're forever etched in his memory. Consequently, doctors overcount the failures and have no knowledge of the successes. They don't understand that 40 percent of all recovery has probably occurred through Alcoholics Anonymous.

Grapevine: What could be done to change that?

George Vaillant: The two simplest ways that I know are both within the power of the Fellowship. One is to take your doctor to open meetings so he or she can see for themselves these well-dressed people in nice suits who look like anybody else and have been in recovery for years. It was terribly important for me to get inside of open meetings and see sober alcoholics for myself because they're terribly inspiring.

The second is to twelfth-step your doctor - not to teach him about alcohol or Alcoholics Anonymous, but to give him a list of names that motivated patients could call. Doctors aren't experienced enough in their practices to find recovering alcoholics, so recovering alcoholics must either say "I will talk with patients," or give doctors referrals. What medical professionals need is a list of referral sources, clearly typed, and some success using those referrals, so they have hope rather than hopelessness.

Grapevine: How did you, a nonalcoholic, get to know AA?

George Vaillant: I was working for an alcohol clinic where it was a condition of employment. I had to go to a meeting a month. In addition, half the staff were recovering alcoholics, and they were the first people whom I'd met at Harvard in ten years who knew anything about the disease.

Grapevine: Is there any movement afoot to establish that kind of requirement for medical students today?

George Vaillant: For the last ten years, medical students in many medical schools have been required to go to one or two AA meetings, due in large part to the activity of AA's CPC (Cooperation with the Professional Community) committee. But the problem is that in your first two meetings, there's so much going on that you don't always get the feeling of, "My God, these people are recovering." It's more about learning what a terrible disease alcoholism is and not about realizing that the people in the meeting are the same people you see in your emergency room with the fractures.

What people are only slowly learning is that you can teach medical students anything that's noble and good about people and they get it right on the exam. But where medical students learn how to be doctors is on the hospital wards and in the emergency rooms, where they're working with residents. And interns, for very good reasons, hate active alcoholics with a passion. Therefore, the educational program has to begin again after residency. And that really is something patients can do for their doctors - not by teaching them about AA, but by telling their stories and offering whatever suits them of the Twelve Steps. And, as I said, by giving them a number to call when the roof is falling in.

Grapevine: You said about 40 percent of the people who remain abstinent do it through AA. What about the other 60 percent? Could we in AA be more open, more supportive of these?

George Vaillant: Yes. You know, if you're batting 400, it's all right to miss a few. I think the fact that AA knows the answer to an extremely complicated problem is probably all right.

But it doesn't hurt at the level of GSO for AA to have humility and understand that 60 percent do it without AA. It's also true that most of those 60 percent do it with the AA toolbox: their spirituality doesn't come from AA; their support group doesn't come from AA; and what I call "substitute dependency" doesn't come from AA. But they still use the same ingredients that AA uses.

And I don't think there's anything that the other 60 percent are doing that AA needs to learn from, except: "If it ain't broke, don't fix it." If you meet someone who has stayed sober for more than three years and they're pleased and boasting that they did it without AA, thank your Higher Power for another recovery. You know, there's "little" sobriety, being dry, and there's sobriety with a big S, which includes humility and not thinking that you're the center of the earth. So if someone is doing something without your help, good enough.

Grapevine: What have you discovered about AA since becoming a trustee? Or as you put it, what if anything has made you say, "Aha!"

George Vaillant: I'd never seen the General Service Manual before, and to me as a nonalcoholic, it is a great piece of world literature, like the American Constitution. It is a great contribution to human thought.

I've also learned something about spirituality. Every time there is a board weekend, I arrive thinking, "Oh my God, this is another weekend I'm not with my family." Then I spend the next two days bathed in love and acceptance that is not from my being anyone special. So I've learned another definition of spirituality: we are each like the beautiful wave that's about to crash on the beach, saying, "This is it. This is forever." Then a voice from behind says, "Don't worry, son. You're not a wave; you're part of the ocean."

Grapevine: There is still a great deal of debate about the role of addicts in AA. What are your views on that?

George Vaillant:This is a terribly important question. AAs should focus on alcoholism. They're right. They've got enough to do, and there are enough alcoholics to go around in the world that they should never fear for their primary purpose.

But because there are a lot of people with mixed addictions, it's important for individual groups that can tolerate them to be tolerant and inclusive. There are some groups that welcome white, middle-aged Protestant males. And that's okay; they should be there, even though the rest of AA may regard them as hopeless dinosaurs and politically incorrect. And there are other groups that tolerate people who spend a little bit too much time talking about their $5-million cocaine habit and not enough time talking about alcoholism. And that's the wave of the future. There are increasingly fewer alcoholics. So some groups are going to have to change.

Grapevine: What are some of the other challenges that AA faces?

George Vaillant: I think there are two, really. One is to come to some meaningful terms with the individuals who are frightened that AA is a religion. This will involve some work and growth in AA to incorporate its diversity without losing its traditions. This is in keeping with the question of keeping the first 164 pages that Bill W. wrote in the Big Book and at the same time including contemporary stories about things some groups might be horrified by.

The second challenge (and this may be more important to me as a class A trustee) is to convey to the world what an extraordinary organization Alcoholics Anonymous is - not only in its ability to cure alcoholism but in its ability to conceptualize the fact that we're all one planet.

Just as an example, groups that are supposed to know about human beings and to be peaceful - the Christian church, the psychoanalytic movement, and the peace movement - are constantly splintering and fighting with each other. And somehow for sixty years, AA has kept two million very diverse individuals, who in their past lives were often a lot less peaceful than the Christians, the psychoanalysts, and the advocates of peace, working together for a common good.

I'm not sure that's a challenge to the Fellowship, or necessary to keep people sober. It's simply to me a challenge that people appreciate the depth of this message, which is expressed more in the Twelve Traditions and Twelve Concepts that in the Twelve Steps.

Grapevine: When you spoke of religious skeptics or of those fearful that AA might have a religious agenda, were you thinking of professionals in the field of alcoholism, or alcoholics themselves?

George Vaillant: Oh, both. Alcoholics, because of the shame, are enormously sensitive to exclusion. So to say, "If you want what we have, you have to believe in a Higher Power; you have to be spiritual, or you have to fake it till you make it" is enormously threatening to some people. They're still at a point of self-absorption; the idea of depending on a power greater than themselves is something they're going to have to learn. Think of it this way: there are a lot of things parents believe, like the value of working hard and completing an education, that make no sense to an eighteen-year-old. And for some alcoholics, spirituality is like one of those things that you learn when you get older. AA has to constantly remind itself that it needs to meet people where they are and that it can only make loving suggestions.

Bill W. spells out very clearly that Alcoholics Anonymous is not a religion. And he makes it clear that there should be nothing about AA that excludes anyone who's a suffering alcoholic. But how you get people who've grown up in one tradition to understand how the world looks to people who've grown up in another takes ongoing discussion. Universality is very hard to achieve. And AA, in its effort of world unity, is constantly having to evolve. It's not a question of changing. It's a process of growth.

Copyright 2001, AA Grapevine Magazine, Inc., All Rights Reserved