Several years ago, the British psychoanalyst Enid Balint suggested that people might not necessarily emerge from a group experience less neurotic or psychotic, but invariably, they were more mature.1 Her suggestion is consistent with my clinical experience. Some of the most admirable and mature patients with whom I have worked have been individuals who participated regularly in 12-step meetings as part of their treatment and recovery.
In this book, “What is Alcoholics Anonymous? A Path From Addiction to Recovery,” (Oxford University Press, 2016), Dr. Marc Galanter, a distinguished scholar and clinician, provides a basis to understand how this occurs. He has devoted a better part of his career to the study and treatment of addictive disorders with a special interest in how 12-step groups curtail the unbridled drinking of alcoholic individuals and stimulate a process for their growth and recovery.
Dr. Edward Khantzian
Despite the volumes written about AA, Dr. Galanter maintains that there are few if any scholarly accounts that explain how it works, and how it benefits those who attend. He believes that this book will help the alcoholic who wonders whether AA is for him or her, as it will guide stymied family members and friends who wonder what help to offer, as well as health professionals who need a “coherent and objective sense of what the fellowship is about.”
Dr. Galanter invites the reader to witness the changes he and others have observed that occur in the lives of alcoholics with their encounters and immersion in AA. Allowance is made that not all who try the program benefit or continue, but for those who do, the change and help of AA, as Dr. Galanter repeatedly provides compelling data and touching examples, are transformative.
He offers that an informed appreciation of what AA is about, and most importantly, guides alcoholic individuals to understand how AA can help them, as well as assist their family and friends.
The book also provides health professionals and the public an awareness of essential aspects of the program that meet the needs of alcoholic individuals. Dr. Galanter benefits the reader by providing a brief background on the beginnings of AA, how it governs itself, and the different pathways by which its participants achieve recovery. Helpful chapters addressing controversies such as the God concept and whether alcoholism is a disease are balanced and illuminating, as are the chapters that review the 12 steps and the process of engagement.
He also provides a balanced explanation of the spiritual elements of the program, the different form they take, and how the program helps those who can draw on those elements. In addition, Dr. Galanter reviews the evidence that AA changes the brain, and finally, he concludes with a scholarly consideration and formulation on the effectiveness of AA. His even-handed, scholarly assessment of these issues is refreshing and welcome, given recent polarizations and controversies about the effectiveness AA.
As Dr. Galanter and others see and understand the culture, it is a bottom-up, democratic one in which the guides, and wisdom for sobriety and recovery for its members are garnered from each other and not from authorities on high. To his credit, Dr. Galanter avoids doctrinaire views on rules for participation, such as number and frequency of meetings (in contrast to rigid and strident rules advocated by some members), but describes flexible and alternative ways individuals participate and benefit. Dr. Galanter brings the reader to this experience with his own erudite and investigative accounts, but just as compelling, through the absorbing words and experiences of the many who have experienced the help and wisdom of the program.
I find little to criticize about this book on the merits. It is lucid and well written, and it will be instructive for all who take it up. Dr. Galanter clearly succeeds in getting to the main audiences he targets, namely those who wonder whether AA is for them, for family and friends who worry about those with the condition, and for clinicians who want guidance in how and why the program works. But ultimately, the book will profit anyone who wants a better insight into how AA achieves its successes.
References
1. Int J Psychoanal. 1972;53[1]61-5.
Dr. Khantzian is a professor of psychiatry, Harvard Medical School, Boston, and past president of the American Academy of Addiction Psychiatry.