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  Resistances to AA Attendance
Floyd P. Garrett, M.D.

The fundamental resistance to any form of recovery from addiction is the addiction itself, which infiltrates the addict's self and alters his perspective and judgment in a fashion congenial to itself and hostile to any form of recovery. Whatever is or may become a threat to the addiction is typically targeted, devalued, and when possible, destroyed. Because this distortion and subversion of the true self takes place largely outside the addict's consciousness he is usually helpless to resist it. Lacking the ability to separate himself(his true self) from his addiction(his addicted self) he falsely believes that his thinking is free and unfettered when it fact it is wholly subservient to the requirements of his addiction. In a certain sense it might even be said that it is the addiction that is doing his thinking for him, though of course he does not recognize this and would defiantly deny it if presented with it. There is a terrible irony in the characteristic defiant individualism of the addict - for there is nothing at all individual about the stereotyped biological process of addiction, and the defiance that is commonly encountered in active addicts has almost nothing to do with their true selves and what is good for them but with their false selves and what is good for the addiction. "Give me liberty or give me death," for the active addict, really means "Give me my addiction or give me death," - and even, at times, "Give me my addiction even if it causes my death!"

Because the active addict sees the world through the eyes of his addiction he necessarily notices those things that are favorable to his continuance of his addiction and he neglects or actively negates those that are not. This psychological fact alone virtually guarantees that a well-known recovery method such as AA will one way or another be found wanting by the alcoholic to whom it has been recommended. Except under ideal and unfortunately exceptional circumstances, i.e. when the alcoholic has truly and conclusively had enough and is therefore willing to do whatever it takes to recover from his alcoholism, the active alcoholic can be expected and predicted to dislike and avoid AA meetings for the simple and obvious reason that such meetings pose a formidable threat to the survival and progression of his addiction. The same might be and in fact is true of any method of recovery from alcoholism, e.g. inpatient or outpatient rehabilitation programs. The disadvantage under which all such potential interventions labor in the mind of the drinking alcoholic is the fact that they aim to interfere with his drinking and have some history of success in doing so for others! Therefore, unless he is in a desperate and thus unusually receptive state, he avoids them more carefully than he sometimes seems to avoid the risk of his own death from the complications and accidental misfortunes of his alcoholism. (One is sometimes reminded of the old movie vampires, hissing and shrinking from the Cross, by the way desperately ill alcoholics in need or treatment or AA flee in fear and loathing from the very things that can help them, even save their lives. Could it perhaps be not the person but the disease that has, vampire-like, overpowered and enslaved him which fears and thus attempts to hide from everything that might save the person by harming the disease?)

This general resistance to anything that might threaten the addiction is the foundation upon which more specific and localized resistances rest and from which they draw their strength and, as it were, "take their orders." Resistance to recovery from addiction is a complex and highly adaptive(for the addiction, not for its host!) dynamic process that draws upon the complete resources of the self and engages all of the ingenuity and creativity of the person to protect the addiction and to obstruct recovery. Specific obstacles and resistance to recovery include fear, shame, embarrassment, humiliation, ignorance, grandiosity and denial. All of these roadblocks to recovery from addiction are commonly involved in the remarkably stereotyped aversion to AA attendance manifested by the typical alcoholic to whom such attendance is recommended by friends, family, or medical professionals.

Simple fear of the unknown is a significant, often a principal factor in resistance to AA attendance. It requires great courage -or great desperation- for an alcoholic individual to walk into an AA meeting for the first time. Many alcoholics have transient or ongoing anxiety disorders which add to the natural fear associated with such a new experience. Although some people are able to identify and acknowledge their fear, many are not. Male alcoholics especially may be ashamed of their fear and hence deny it, focusing instead upon any number of largely dishonest rationalizations or red herrings to justify their AA avoidance. Shame and embarrassment are nearly universal responses of alcoholics to the prospect of attending an AA meeting. To show up at an AA meeting, after all, makes a proclamation to all who are present, but also and more importantly to oneself that he is or might be an alcoholic who has been unable to solve his drinking problem by himself. There are actually at least two distinct sources of shame and stigma here: (1) that there has been a serious problem with alcohol, and (2) that the individual needs or that he even might need AA to deal with the problem.

Although society in general is more enlightened about and hence less judgmental towards alcoholics than ever before, the interesting and highly significant fact is that drinking alcoholics themselves are among the most intolerant and intransigent critics of the so-called medical model of alcoholism. The vast majority of drinking alcoholics view alcohol problems as matters of will power and moral values. Alcoholics, in other words, before they get sober, seldom understand or have any respect for alcoholics - a Dilemna that obviously complicates and obstructs their own chances of recovery from alcoholism. Thus what ought to be an occasion for healthy pride and self-congratulation - being honest with oneself about an alcohol problem and taking appropriate action to overcome it - more often than not feels to the alcoholic thinking about attending his first AA meeting like an enormous and almost unbearable personal failure and something itself to be ashamed and guilty about.

Because in the majority of cases the alcoholic's cup of shame and guilt runneth over, i.e. becomes too intense and painful for him to bear, the psychological defense mechanism of paranoid projection commonly steps in to externalize and thus distance his feelings of self-loathing and self-condemnation. By projecting his negative feelings about himself onto others he at least removes them one step from himself and can say to himself "It is not I who despise and condemn myself, it is those other people who judge or are about to judge me negatively."

Paranoid projection permits the alcoholic to gain a sense of control by engaging in defiant-oppositional behavior against an imaginary external adversary and also to take avoidance precautions by simply staying away from situations in which "They" might see and judge him. All of this of course gravely impairs and in many instances interdicts entirely the formation of trusting and supportive relationships necessary for recovery from alcoholism. Newcomers to AA meetings are sometimes so terrified of "running into somebody they know" at a meeting that they will travel far across town or even to another city to attempt to avoid what is for them the terrifying prospect of being seen at a meeting by someone who they fear could broadcast their awful and shameful secret to the world. This dread of detection is a projection onto imaginary others of their own intense feelings of shame and self-disgust. Unfortunately for the alcoholic in need of the help that AA can provide, the easiest and simplest way to avoid being seen, talked about and condemned by "Them" is to stay as far away as possible from "Them," namely from the vicinity of an AA meeting where "They" are certain to notice and talk unfavorably about one.  And this in fact is the usual and customary paranoid phobic-avoidance defense most shame- and guilt- ridden alcoholics employ. But what seems to them the safer and easier course is in reality the harder and more deadly one: for by avoiding healthy and emotionally corrective experiences with other people who have also struggled with alcohol problems, the frightened and self-despising alcoholic is isolated, cut off from help, and worst of all, shut up entirely with and within himself and his disease of alcoholism. The usual result, of course, is continued drinking, more guilt, more shame, more paranoid projection and externalization, and more phobic-avoidance of those who could be of the most help.

The exceptional alcoholic who manages to overcome, frequently by the pressure of a still greater fear or force acting upon him from behind,  the formidable obstacles above and who as a result actually shows up, often full of fear and trembling at an AA meeting, faces still more perils and pitfalls before he can hope to tie up his weather-beaten ship and disembark in a safe harbor. Selective attention and inattention cause him to pay particular attention to some things and to neglect or minimize others. The general focus of attention will of course be upon maintaining his security and self-esteem as he ventures onto new and generally forbidding terrain for the first time. Guided by the "fight or flight" response he will be sensitive to every cue that suggests a real or perceived threat to his already threatened self. The mental defense mechanism of paranoid projection described above causes him to experience his environment and the people in it, including other alcoholics, as sinister and potentially critical, shaming and rejecting. This naturally puts him on "on guard" and on the lookout for danger.

One sometimes hears from alcoholics that as soon as they walked into an AA meeting for the first time they felt safe, secure and accepted - but a far more common response is precisely the opposite one, in which the alcoholic feels, quite unrealistically, less safe and secure in an AA meeting than just about any place else in the world. Since a stereotyped and indeed highly adaptive response to danger is to flee from it, and since the typical alcoholic attending his first AA meeting will, by the mechanism of paranoid projection described above, feel himself to be in danger that comes from outside him and from which he can at least in theory run away, a natural response is to scan and interpret the environment in such a fashion as to build a compelling case to justify the common and entirely visceral or gut level desire to run away and never come back. Such "case building" is of course reactionary propaganda and rationalization, for the primary "flight response" has already been activated, may in fact have been activated before the alcoholic ever even set foot in the meeting for the first time. But it is usually necessary to provide ourselves with a plausible face-saving excuse for actions that we suspect may be contrary to common sense or against our best interest, especially when they are driven by powerful emotional and therefore irrational forces which we do not care to admit openly to ourselves, much less to others. Alcoholics are no exception to this universal human tendency - indeed, they may represent spectacular exaggerations of it, just as they sometimes seem to do of other common human failings and foibles.

In many, perhaps most instances the newcomer will be searching by default for signs of differences and disagreements with others rather than for evidence of similarity and agreement. The reason for this is obvious: the more evidence he can amass to convince himself and anyone else who might be interested that he "doesn't really belong in AA," the faster and more honorably he can beat the hasty retreat that both his addiction and his damaged and threatened ego desire him to make as soon as possible. Thus if he is not careful and conscious of the process he may very swiftly compose a litany of grievances and differences that will, at least in his own eyes, fully justify his own version of Caesar's famous boast: "I came, I saw, and I decided AA was not for me."

Further complicating these common psychological resistances are the direct and indirect effects of alcohol and often other drugs on the brain, effects which impair judgment, attention, information processing, impulse control and mood regulation. And it should not be forgotten that the alcoholic who is only hours, days or weeks away from his last drink is always in a state of active alcohol withdrawal which further disrupts normal central nervous system functioning and characteristically results in an anxious, irritable, negativistic state of mind. On top of all this, a significant number of individuals suffering from alcohol dependence(alcoholism) also exhibit symptoms of a mood disorder such as depression or manic-depression(bipolar disorder) as well as a primary anxiety disorder such as social phobia(social anxiety disorder).

Given all of the powerful obstacles and resistances to AA attendance and acceptance, the wonder is not that so many alcoholics refuse to go to meetings or, if they go, decline to return - but that any at all do so and that at least some of these keep going back until they are able to connect with the program and begin to receive help from it. Many, though certainly not all, of these success stories have simply reached a point or been placed in circumstances in which the prospect of AA attendance, frightening and distasteful as it may at first be to them, is nevertheless for them the lesser of two evils, e.g. incarceration, job loss, divorce, emotional misery or death from medical complications of alcoholism.


Discussion Forum - For individuals new to or considering Alcoholics Anonymous or other 12 Step Programs. Unofficial, not affiliated with AA or others.

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