Saturday, November 27, 2010

Alcoholics Anonymous Anonymity

Anonymity is a spiritual foundation of AA. AA Guidelines are available that say names and pictures should not be used on blogs, face books, myspace or any such social networking with reference to AA. Members of AA should not identify themselves in these internet media in keeping with the recent interpretation of the 11th tradition of AA in this regard. Indeed the Guidelines which are more specific regarding AA group behavior,even at the individual level question use of name or affiliation in email correspondence. A certain 'corporate legalism' seems to be present in the three page document that has recently come out of Central Office New York. This seems to contrast with the message of "keep it simple". But as with everything in AA these are 'guidelines' not 'rules'.
The program is further one of spiritual progress and not perfection. AA is a collection of individuals and one individuals behaviour need not reflect poorly on AA as a whole. I trust where applicable in this blog, this present communication would be considered as amendment. Central Office acknowledges that the area of internet is so fast moving that it welcomes questions and experience from membership.

If I were hypothetically to be an anonymous member of an anonymous organization such as the anonymous organization of alcoholics anonymous, I might well obscure this fact in internet communication by suggesting I was an anonymous member of an anonymous organization. Obviously if I was an anonymous member of an anonymous organization I would not be anonymous in saying that I was anonymously affiliated. Further, if I was hypothetically a psychiatrist who had suffered from a mental illness that caused insanity and death I might well be delusional in saying that I was an anonymous member of an anonymous society. Further if I was a writer and especially a spiritual writer anything I might say about an anonymous spiritual organization would not have any material relevance to speak of. Spiritual people at least would naturally consider anything hypothetically said about anononymity hopefully anonymous anyway. Certainly in future thanks to this clarification I will pray for spiritual progress in this matter.

Originally anonymity was associated clearly with the Christian concept of humility. Individuals protected each others anonymity so those secret drunks and addicts could seek a solution without risk of exposure. Spiritually the lack of self desclosure or self aggrandizement focused attention not on the individual but rather on God and God's Grace. The Big Book of AA uses the St. Francis' Prayer, "Make me a channel of thy peace" to emphasize the work of the higher power not the limited individual or limited ego.

When the cat is out of the bag the Society for Prevention of Cruelty to Animals would prefer that you didn't kill it or forefully stuff it back in the bag. Theoretically the cat will find it's way back to the bag with a little help from his friends.

Now as a doctor I'm in a difficult position because I am routinely called upon to recommend or not recommend AA. If I recommended it from my personal experience without that disclosure of potential conflict of interest or influence would I not be breaching a different ethical and possibly higher ethical consideration relative to my work. This issue is the topic of much discussion in International Doctors in Alcoholics Anonymous. It's especially a major topic for the psychiatrists in AA and even more so for the Addiction Psychiatrists. Indeed there's an increasing lobby for doctors and especially psychiatrists not attending AA. Doctors in small town practices and especially psychiatrists in small towns are in the most tenuous situations because as psychiatrists they are in some aspects advised not to share with patents yet its hard to find an AA meeting without patients and rarely is the anonymity of doctors in AA respected. Further with the new emphasis on "boundaries" doctors are especially discouraged from associating with any 'sick' people and especially members of the opposite sex. Attending same sex meetings is possible in big cities but rare in smaller communities. It's all even more complicated with other 12 step meetings such as NA, SLAA or GA where there are so many fewer meetings. However as AA is considered a treatment of choice for alcoholism denying a doctor membership in AA because of their profession and the anonymity concerns associated with this position would certainly go against a higher principle of health care. Further the "only requirement for membership in AA is a desire not to drink". Anonymity is by this definition not an exclusionary criteria for membership in AA by any means. However 'suggestions' are said like 'guidelines' in AA to be the product of experience and akin to a 'suggestion' on a parachute 'pull string'. As the program is by attraction not promotion it further becomes complicated as doctors are more involved in the legal process which is so public like all institutions utilizing computers are these days. Further computer Geeks will gladly say computers and internet are only secure yesterday. Any advance in speed of computer makes yesterdays security system obsolete and dependent on all best efforts today. Rabbi Twerksi was quoted as saying he'd rather his pilot, doctor, dentist, taxi driver all be in AA because if they were they'd be more likely not less likely to be sober. Without universal drug testing the ubiquity of drug and alcohol abuse in our society at any one time is quite extraordinary. A doctor 5 years sober would be at greater likelihood of being sober than a doctor who had never been diagnosed with alcohol abuse.

In Canada it becomes even more complicated when desperate patients without resources are unable to access treatment centers because of the exclusionary high costs of this service. The discrimination and stigmatization of the alcoholic is such that a diabetic can always get a hospital bed in crisis but an alcoholic not necessarily so. A leading detox and treatment centre locally has Bible reading as part of it's therapy. Yet if a doctor says that's the place where you can go if you want to get off booze and off the streets, he may be seen as promoting a religiously affiliated body. To play it safe the doctor says nothing and doesn't make any recommendation. Indeed the most he could do pharmacologically is write a prescription for a drug which may or may not help. By itself this isn't a biopsychosocial or even scientific approach since the treatment of addiction is most successful if in the context of community and group based therapeutic process. Routinely the only therapeutic modality meeting is criteria is a religious one or a spiritual one like AA.

Alcoholics will use any excuse to avoid treatment. When they are ready they do seem to get it.

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