Willpower, Groupthink, and the Disease Model for Everything

Columbine School Shooting, public domain 

When addicts say, "I can quit using any time I want to," people usually laugh at them and accuse them of being "in denial." I, on the other hand, believe they are telling the truth. Since they are admitting they don't want to quit, they aren't denying anything. Of course, the big question is why they don't want to quit. It can't be because the substance is making them feel good. They are generally some of the most miserable and unhappy people around.

So maybe they have some genetic defect that causes a “disease” that impairs their self control? While it is true that genetic tendencies can make someone a bit more or less likely to engage in certain behaviors, the majority of these effects are relatively small. 

If genes were causing the problem, one wonders how 12 Step Programs, which are based on religious conversion techniques that demonize people’s ability to make good choices for themselves and ask people to surrender to group norms and do what they are told, would ever succeed. Last I heard, changing your religion does not lead to major changes in one’s genome. Or its physiological effects.

I suspect the group’s views and where their ideas come from have something to do with the addict’s problems. Before they quit, they are proving the group’s opinions about the evils of willfulness, and after they quit they are proving the group’s belief system once again, but in a different way.

And is it really true that they can’t control their urges? Does an alcoholic actively engaged in drinking and driving usually take a big swig of Jack Daniels just when a cop pulls up in the lane next to them? Well, I suppose some might, but I suspect that such individuals are again going out of their way to prove their group’s idea that their willfulness is creating their problems. But most will keep the bottle hidden. So I guess they can control their urges even while intoxicated with their favorite beverage.

And of course, as I have previously pointed out, animal models of alcoholism are generally poor because scientists can’t seem to find any rats that hide the bottles. And the bottles that people hide are almost always found eventually. Usually  by spouses and family members. Imagine that.

Another point: Non-academic people in the addiction discussion also talk a lot about how co-dependency and enabling spouses and relatives are part of the problem in someone’s addiction (see Al-Anon), but somehow today’s scientists seem to think these other folks have nothing to do with the addict's problems. Really?? In what alternate universe?

I find it impressive how today’s psychology academics seem to go to any extent to avoid looking at dysfunctional family dynamics as a major cause of behavior that is destructive to one’s self or others. For another example, look at speculation about the causes of the recent spike in students committing mass shootings at schools. If the role of the parents is looked at at all, it seems that their only role is giving their kids access to weapons and ignoring danger signs, but not in creating the environment conducive to motivating their children to act that way in the first place.

Now of course having access to assault weapon is a prerequisite for committing these crimes, but what about the literally millions of homes in the United States in which such guns are found? If the presence of guns were the only problem, these shootings would have been going on at the current frequency for the past decades and decades.  For a similar reason, even overt child abuse alone cannot explain the shootings, as the vast majority of abused children do no such things. There has to be other things going on in these families. What, for example, are the parents saying to these kids and to each other, and how are they reacting in general to kids who start to have fantasies of violence? 

One of the Columbine shooters in the above picture literally collected an arsenal of weapons in his house prior to the act. When interviewed by the press, his mother said she didn't know about it. I wonder how the shooter interpreted the fact that his mother apparently pretended to not even notice the obvious.

No one seems to be asking these essential questions. Sad.

Substance Abuse: Self-Destructive Behavior

 "The surest way to humility is humiliation” ~ commonly heard saying at Catholic 12-Step meetings in Ireland

 

It seems like the debate over whether or not substance abuse is a “disease” is never ending, as described recently by fellow blogger George Dawson. I really don’t want to get into the particulars of that, because the debate is almost always a waste a time due to the multiple definitions of the word disease that get employed and continually conflated in such debates.

 

I’d rather focus on one main issue: How much control do most addicts have over their drug use? My opinion is that the question can best be answered by re-classifying most, though maybe not all, substance addiction behavior as self-destructive behavior. Voluntary. If it were not voluntary, addicts would have next to no control over when and under which circumstances they chose to not indulge, no matter the consequences. Almost no addict is using 24/7 unless they are actively suicidal.

 

Now, some people might argue that substance abuse might be a form of obsessive-compulsive disorder. When people with OCD who have compulsions do not engage in their compulsion, their anxiety level skyrockets. This may be due to clearly abnormal firing of some nuclei in their brain. While they can certainly choose to let their anxiety skyrocket, this choice is indeed very difficult.

 

However, skyrocketing anxiety can have another cause besides the clearly pathological firing of brain nuclei. It can also be caused by panic over anticipated consequences of engaging or not engaging in a particular behavior. If doing so might lead to massive invalidation by everyone a person knows and cares about, then doing so becomes very difficult because of kin selection and tribalism, two subjects I have previously blogged about extensively.

 

Although, due to our current state of knowledge about the brain – literally the most complicated object in the known universe – there is no way of knowing for certain if most substance abusers indulge because of feared consequences of not indulging, or because of abnormal brain firing of some sort. And of course there may be two different types of addicts, so either or even both possibilities may be true depending on which addict one is dealing with.

 

Based on my clinical experience with all sorts of self-destructive and self-defeating behavior in my psychotherapy patients, I’m going to come down on the side of feared consequences for most of them. So am I saying an addict’s family system needs them to continue to be addicts in some way? Well yes, that’s exactly what I am saying.

 

If this is the situation, it does not make sense to ask the question of whether or not the addict wants to be an addict, because in fact they would be ambivalent about it (intrapsychic conflict, the primary concept in psychoanalysis – what a novel idea!). While some substance use in moderation in some contexts is indeed pleasurable, the life of an addict is anything but. They hate what the drug does to them. Many no longer even get high from cocaine after extended use, for example. And if getting high really made them feel so good, then why aren’t addicts the happiest people around instead of some of the most miserable? The problem is that the feeling of existential terror due to kin group invalidation feels even worse. So they indulge. Self-destructively.

 

Now, the family groupthink issue which triggers any given family’s need to have an addict in their mist to remain stable is not always the same, so each family has to be evaluated individually on its own terms. But let me discuss the most common example of such an issue: Puritanism.

 

Puritans on the whole believe, to put it bluntly, that we are nothing but sinful piles of crap in God’s eyes, and that we have to be sinners because, well, all people are sinners who must therefore ask for God’s forgiveness. So, as clearly stated in the 12 steps, which are based on Protestant conversion techniques, our will must be a problem. If we are willful, we simply must come to a bad end. The only way out is to renounce our will and turn it over to a “higher power” - which is actually the group to which we belong. And do what they want us to.

Did someone mention willfulness there?

I’ve heard docs from 12-Step programs give talks at medical meetings during which they would tell the most humiliating stories about their own crazy behavior when they were using – a public version of what they do in meetings. Essentially, these folks are substituting a less harmful form of self-abasement for a more harmful one. Just like the Irish slogan at the top of this post says rather overtly. I suppose that’s the better of the two options, but it’s still self-destructive. But it makes their conflicted parents feel better about not acting on their own forbidden impulses. While having already received vicarious satisfaction of these very impulses watching their children indulge. Heaven forbid anyone might feel good about doing something selfish.

The Role of the Family Black Sheep – The Hidden Aspects

Are you a black sheep in your family? You know, the one that doesn’t seem to go along with the program and acts in ways that seemingly run counter to the values of the rest of the family? Guess what: you are not nearly as rebellious as you think you are.

A frequent topic on this blog and on my blog on Psychology Today is dysfunctional family roles. Because of the biological phenomenon known as kin selection, individuals are often willing to sacrifice their own needs and desires in order to act in ways which stabilize unstable parents and maintain what family systems therapists refer to as family homeostasis. 

The latter is a process by which the family operates by rules, strongly enforced by all family members, in which every family member plays a predictable, designated part. Family rules are originally derived from the culture or ethnic group in which the family has operated as well as by family experiences that necessitated certain behavior. In dysfunctional families, the family rules have become obsolete due to rapid changes in the ambient culture (cultural lag).

Many cultural changes have lead to situations in which individuals are much freer to express their own wants and needs separate from those of the family (self-actualization). If the family is stuck in the past, members (especially the older ones) may be threatened by certain aspects of individual freedom. They may be enticing and seductive, but were strongly forbidden to them by the people that raised them in earlier times.

This desire versus fear dynamic is what the Freudians were talking about with their notion of intrapsychic conflict. What they missed, however, was that the conflict is not entirely intrapsychic, but is triggered and reinforced by an entire family. In fact, the “intrapsychic conflict” is actually shared by all of them! It leads to family members giving off mixed and contradictory messages to one another about what is expected of them.

A big source of shared intrapsychic conflict in families that I have not discussed extensively is changing attitudes toward individual satisfaction involving things such as the proverbial sex, drugs, and rock and roll. There has been a marked cultural shift in the propriety of pleasuring oneself with these pursuits. Because of cultural lag, people will often give lip service to such issues as sexual abstinence or reserving sex for procreation only, while at the same time covertly availing themselves of opportunities seemingly at odds with their expressed values.

This is the situation that leads to one member of the family – often but not always a younger child—to volunteer to be the rule breaker, enjoying that which is attractive to but forbidden to all the others. The others, particularly the parents, get vicarious satisfaction of their own secret desires through watching their children indulge themselves. However, the situation is far more complicated. While black sheep may seem to be having a good time so the parents can do this, that unfortunately is not their only job.

If they have too good a time, and end up being happy and content, a parent who was secretly and subtly pushing them to break the family rules starts to become unstable. Vicarious experience, while mildly satisfying, is just not the same thing as actual experience. The conflicted parents start to wonder about their own choices in life and then become depressed, have marital problems with the spouse that has helped them go along with family rules, or engage in self-destructive behavior.

To prevent this and keep the parents stable, the black sheep must also demonstrate the folly of engaging in the “rebellious” behavior. They do so by, in a sense, finding ways to make themselves miserable because of it. In a sense, they fail at it, so the parents can become once again secure in the knowledge that they made the right decision in sticking to the old prohibitions.

In the process of indulging themselves in sex, drugs, and rock’n’roll, black sheep may develop an addiction, contract a sexually transmitted disease, have an affair and destroy their marriage and their relationships with their own children, have multiple divorces, or become deadbeat dads. The rest of the family can then hold them up as examples that “prove” that the forbidden impulses are forbidden for good reason. The old family rules against self indulgence simply must continue to be followed. 

If they want to redeem themselves, black sheep may have to join a 12 step program and denounce their own willfulness. They need to go back to that old time religion – and the group that they join, in order to maintain itself, also needs someone to do just that. Just like their families need them to do.

Are the National Institute on Drug Abuse and Big Pharma in Bed?

Nora Volkow, M.D.

At the annual meeting of the American Psychiatric Association (APA) in San Francisco in May, Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) was just brimming with a lot 'o news about the square of the hypotenuse. No, I'm sorry, I mean about how much more we know about drug abuse because of brain imagining techniques. This new knowledge she spoke of was summarized in the Psychiatric News, the newspaper of the APA, in the June 21 issue.

The gist of the story was that the drugs themselves impair certain brain circuits, which must then be somehow strengthened through treatment.

One of the points she raised is that drugs like methamphetamine cause dopamine receptor signaling to be decreased in the pre-frontal cortex - the part of the brain known to be crucial in executive control (decision making). Thus, the normal brakes on someone indulging in something are supposedly damaged.

If this be true, one might think that she would be up in arms about the widespread, indiscriminate use of amphethamines like Adderall in children. At the very least, a high percentage of ADHD diagnoses are given to kids suffering from the effects of living in a chaotic environments of one sort or another, and for whom family therapy would be the most important treatment. Perhaps there are some cases of ADHD that are due to neurotoxin exposure or something like that in which the benefits of the use of stimulants outweigh the risks - a questionable assertion itself since the average academic gain for ADHD-diagnosed kids on stimulants is all of about three whole months.

For some reason, however, while she acknowledges in other venues that prescription drug abuse, including that of stimulants, is a major problem, she continues to maintain that stimulants are safe and effective when used for ADHD.

She does admit in one article that ritalin basically works the same way in the brain as cocaine! So is she saying that there is some point at which the alleged adverse affects on executive functioning she was going on and on about at the APA magically become inconsequential?

And yet, she also spends some of her time exaggerating the adverse effects of the devil weed , marijuana, in a campaign to keep it illegal.  It seems there is a double standard she has towards the risks of the drugs sold by Pharma compared to those that are not.

How much worse than the physiological effects of pot, one might ask, are the adverse effects on potheads of jailing them and turning them into felons for the rest of their lives. Or the risks to black kids? They are no more likely than white kids to smoke pot, but are four times more likely to be arrested for it. These are not adverse effects?

"Think about it: Do you want a nation where your young people are stoned?" she was quoted as asking.  I hate to break this to her, but any kid who wants to get marijuana already can. It's like one of the biggest cash crops in several states.

I don't think she has come out in favor of prohibition against alcohol or tobacco, two substances with far more potential adverse physiological effects than pot ever thought about having, so that she might at least be consistent. Does she think that young people aren't already getting "stoned" on booze? As mentioned, she does not seem to be all that concerned about the adverse effects of the stimulants - that she herself describes - when used for legal and "proper" uses. More on that in a sec. Nor does she mention that prescribed stimulants are diverted to "non-medical" uses far more often than even opiates!

It seems almost like she thinks the risks of drugs are entirely dependent on whether or not drug companies make money from them.

I am not surprised by any of this. Many years ago I listened to a talk from someone from NIDA about the horrible effects of dopamine depletion in the brains of regular amphetamine users.  I thought about getting up and asking a question, but someone beat me to it. "Doesn't this happen in kids taking stimulants for ADHD?" the fellow asked. 

The answer? "But the drugs work so well!" As if that were an answer. Now I don't know if NIDA and Big Pharma are in bed together, but that answer sure made me wonder about it.

Another truely breathtakingly bizarre point Volkow made at the APA, as reported in the newspaper (unless the journalist got it wrong):

"Among both lab animals and humans, voluntary initiation of drug use leads to subsequent loss of control and development of addiction among 10% of subjects. The lab rats and mice are uesful for refuting old stereotypes.

Some people still consider addiction moral turpitude, she said. 'But how can you develop the same phenotype in a rat, who have no moral precepts?'"

This argument is a bit of a straw man, since thoughtful mental health professionals these days are not so much concerned with the issue of sin, but more with the question of whether or not drug abuse is due to deliberate and purposeful self-destructiveness. The fact that the 10% figure applies to both rats and people seems to argue for some sort of genetic cause, does it not?

But rats having the same phenotype as human beings? Really?!? I personally have never met any rat that understands the negative effects that a drug might be having on it, or that is able to anticipate the future consequences of continuing to imbibe. People do have these abilities. Furthermore, as I have already pointed out in various venues, scientists still have yet to locate any rats that hide bottles of alcohol.

And now back to that whole executive functioning thing. Methinks she is grossly exaggerating certain of the risks from drugs used entirely to get high. (Anyone remember the scourge of "crack babies?"  Turns out that was all one big - and racist - lie).

Seems to me the supposed "impairments" in executive functioning in addicts that she talks about are awfully specific and limited. In the past, a lot of cocaine addicts, for example, used to burglarize houses and fence the goods to support their habits without even getting caught. It would seem to me that quite a bit of executive functioning is being exhibited in that endeavor. Imagine what master criminals they might be if they had unimpaired executive functioning. It boggles the mind!

And if addicts do have a sort of brain damage, how can some of them suddenly just stop using after attending just one meeting of a 12 step program, and then stay sober by continuing to be in the program? Not as many as we'd like, but still many do. The 12 steps were based originally on techniques used by Protestants to get others to adopt their religious beliefs, not treat brain dysfunction. So how is it that what is essentially a change in cognitive beliefs can fix a brain overnight?

I have argued that many of the brain changes observed in MRI studies are actually conditioned responses due to neural plastic changes in brain structure and function in response to the social environment (No, not all of the observed changes. Some can indeed be due to drug effects, trauma, or disease. Duh). The conditioned changes can indeed happen in relatively short time frames. But literally overnight? Please.

The 12 Steps of Alcoholics Anonymous - a Translation

Getting all of the blame, but none of the credit

One of the central ideas I use in trying to understand the relationships between various theories and treatment models within psychotherapy is that, within all groups of human beings, there is a constant battle (called a dialectic) going on between what Murray Bowen’s protégé Michael Kerr called the "forces of individuality" versus the "forces of togetherness" (collectivism, in politics speak). The dialectic between individual desires and group norms can be seen dramatically within the twelve steps of Alcoholic Anonymous (AA). 

Caveat: while this post may seem critical of some aspects of 12 Step Programs, I want to emphasize that these groups do help a certain percentage of addicts. Being addicted to substances is usually far worse that endorsing any of the problematic aspects of the AA ideology. Until something much better comes along, AA represents the only hope for some individuals. 

The strategy that AA uses to help alcoholics and other addicts is based on techniques used by Protestant religious denominations to convert non-believers. Those, in turn, are based on the techniques that such groups use to enforce group behavioral norms while still allowing a certain degree of individuality, as described by Erich Fromm in his classic book, Escape From Freedom. 

While giving some praise to the individual in a series of clever paradoxes and ambiguities, certain aspects of individuality are ritually denounced - most usually, the "dangers" of unrestricted willfulness. Willfulness, or the desire to follow our own inclinations, is equated with sin, and is seen as leading invariably to de­gredation and despair. 

The alcoholic and the teetotaler really believe much the same thing and need one another desperately. The teetotaler says that self-indulgence leads to ruin, and the behavior of the alcoholic proves the point. Without the example of the latter, the philosophy of the former could not be reasonably maintained. Without the warnings of the non-drinker, the alcoholic would have no one to defy. The success of AA is dependent on a continuing supply of new "sinners." 

The 12 Steps refer to the issue of the individual versus the collective both directly, when the issue of human will is discussed, and indirectly, when they speak of God or a "higher power." To show how often the denigration of individuality arises in Twelve Steps and Twelve Traditions, I am going to list some quotations from the book. 

Admittedly, I am taking these quotes out of context. The reason that I do so is that, as I will show shortly, the context contains large numbers of contradictory statements that are not juxtaposed for comparison, as well as paradoxical statements, which mask the underlying message. Of particular note is that the entire book is written using the collective pronoun we. 

[Page numbers that are referred to are from the following edition: 
Alcoholics Anonymous. Twelve Steps and Twelve Traditions. New York: Alcholics Anonymous World Services, Inc., 1981. (Originally published 1952)]. 

…self confidence was no good whatever; in fact, it was a total liability. (p. 22) 

…the average alcoholic, self-centered in the extreme... (p. 24) 

"How he [the practicing alcoholic] does cherish the thought that man, risen so majestically from a single cell in the primordial ooze, is the spearhead of evolution and therefore the only God that his universe knows!" (p. 25) 

…those filled with self sufficiency who have cut themselves off [from God] (p. 28) 

Now we come to another problem, the intellectually self-sufficient man or woman... far too smart for own good... blow ourselves into prideful balloons... (p. 29) 

cut away the self will... (p. 34) 

The philosophy of self sufficiency is . . . a bone-crushing juggernaut whose final achievement is ruin. (p. 37) 

We want to find exactly how, when, and where our natural desires have warped us. (p. 43) 

It is not by accident that pride heads the procession [of the seven deadly sins]. (p.48) 

It is worth noting that people of very high spiritual development almost always insist on checking with friends or spiritual advisers in the guidance they feel they have received from God. (p. 60) 

It is a spiritual axiom that every time we are disturbed, there is something wrong with us. If someone hurts us and we are sore, we are in the wrong also. (p. 90) 

…any success we may be having [in remaining sober] is more His [God's] success than ours. p. 92) 

…personal ambition has no place in A.A. (p. 183) 

…A.A.'s twelve traditions repeatedly ask us to give up personal desires for the common good... (p. 184) 

Moved by the spirit of Anonymity, we try to give up our natural desires for personal distinction ... p. 187) 

…a loving God as he may express Himself in our group conscience. (p. 
189) 

As I mentioned earlier, these types of statements are intermixed with paradoxes and ambiguities. On page 26, we are told that the AA group does not demand any belief or behavior — that all twelve steps are merely suggestions. Of course, on page 174, we are told that any group member that defies the "suggestions" has probably signed his own death warrant. 

We are exhorted to keep an open mind while at the same time to "resign from the debating society" (p. 26). We are told that the best way to get rid of self-will is through our willingness to do so. We are told that dependence upon a higher power is a means of gaining "true independence of the spirit" (p. 36). 

One rather frequent ambiguity in the book is that it sometimes implies that its ideas concerning over-indulgence apply primarily to the issue of alcohol, while at other times it seems to apply its concepts far more generally. Page 36 implies strongly that the twelve steps do not apply just to the issue of alcohol. 

Throughout the entire volume, debatable statements about self-indulgence are mixed up with statements concerning over-indulgence that only a fool would debate. Page 44 sensibly discusses instincts running wild, and, on page 65, we are even told, paradoxically, that God does not expect us to fully eliminate all of our natural drives. 

The book's discussion of pride also presents us with a mix of statements that confuse one type of pride — unwarranted pride — with all types of pride. It is also fascinating that, shortly after discussing the alcoholic's generic pride, the book goes on to discuss the alcoholic's generic feelings of inferiority and inadequacy. Are we to assume that alcoholics are both truly proud and ashamed of themselves simultaneously? 

Allow me to translate the 12 Steps from the collectivism vs. individualism perspective. In step one, addicts admit their powerlessness over their own impulses. The way to stop behaving self-destructively, says step two, is to turn to a power greater than ourselves. Step three defines exactly what it is that we are supposed to do in relation to that power. We are supposed to turn our will over to it. We must not trust our own instincts, but only some power greater than ourselves- the collective, of course. 

In step four, we make a moral inventory, in order to discover our liabilities. The type of "defects" under consideration here are spelled out quite dearly. They are the old familiar seven deadly sins. Notice that the issues of the harm that we have done to others and making amends to others do not come up until steps eight and nine — after this moral inventory. We must deal with our own intrinsic evil before we can address the evil that we have inflicted upon others. 

In step five, we are to admit the exact nature of the wrongs discovered in step four to ourselves, God, and another person. We cannot be honest with only ourselves and God; after all, we may be deluding ourselves about God's will. We must confess our sins to others. We must let them know that we were not in control of our impulses. 

The AA book clearly compares this step with the confession of sins in organized religion. In the group meetings, members announce their names and add, "and I am an alcoholic." They say there is no shame in this, but clearly members are ritualistically humiliating themselves in front of the group. 

They may say that they are doing this in order to overcome the denial characteristic of the alcoholic. However, if alcoholism truly is a manifestation of willfulness, then, when practicing alcoholics insist that they can control their drinking whenever they want to, they are telling the truth. The real denial comes when they "admit" that they were not deliberately choosing to drink all along, but were responding to their "disease." 

Steps six and seven involve asking the higher power to remove our shortcomings; again this is to be done before we even consider the harm that we have done to others. The concept of humility and our own powerlessness over our impulses is stressed. 

If we do well in the future, the credit goes to the higher power who has removed our shortcomings. If we screw up?  Well, that's just our own shortcomings.

After we deal with the harm we have done to others in steps eight and nine, step ten involves continuing the process of self-criticism that had begun in step four. The priority goal of this process is self-restraint and the avoidance of pride. This is accomplished by attributing any sobriety we have achieved not to ourselves, but to God. Kindness and love to others arises from our devotion to God, not from our own selfish instincts or will. 

Step 11 involves the personal relationship to God. We are to meditate. and pray to God "as we understand him." On what this understanding is supposed to be based is never specified exactly. In fact, the book takes a religious stance by adopting the notion that the Lord works in mysterious ways which no mere mortal can understand. 

It is clear that what happens in the world is not supposed to happen according to our own notions of right and wrong or our own will. We are to pray for what God wants, not for what we want; we are to ask only for knowledge about God's will for us and His power to carry it out. 

This knowledge does not involve specific answers to behavioral dilemmas, but only knowledge about how we might best forget ourselves and serve the collective. Only then will love, forgiveness, truth, and harmony come about, and we will be rewarded by a sense of belonging to the group. In the twelfth and final step, we are encouraged to spread the gospel, and to apply it to all of our affairs. 

Why are the anonymous groups so powerful when it comes to stopping compulsive behavior? (At the risk of offending the devout, I am going to discount the possibility of divine intervention.) I submit that the answer to the question lies in the fact mentioned above —that both the practicing and the recovering AA alcoholic prove the point that individual will power is a bad thing: Many of the families of addicts are grappling with problems created by the increasing value placed on the individual by society at large, and how the newer prevailing philosophies conflict with the need for their families to function according to an old set of rules. 

Practicing alcoholics appear to be rebelling against collectivist tendencies by indulging themselves with no concern for the health and safety of loved ones or anyone else. They often lie, put others in double binds, defeat expressions of caring and concern, and drive while intoxicated. 

Many individuals and family members directly involved with the problem of alcoholism argue that this behavior results primarily from the influence of the drug, but the 12 Steps argue more convincingly than I ever could that they really do not believe it. The behavior of the alcoholic is clearly attributed to a self-centered attitude. 

The alcoholic's willfulness, pseudo-selfishness (they are really self-destructive), and lack of concern for others, however, does not work. Alcoholics end up depressed, humiliated, and often physically ill. Their rebellion has failed. Willfulness has failed. The only way to happiness is to return to conformity. When they stop drinking and join AA, their lives improve. 

This proves beyond a doubt that conformity is superior to willfulness. By providing such proof, they help to reinforce the role functioning of other family members who are themselves experiencing internal pressures to express selfish impulses at the expense of old established family rules.

Let Go and Let God

Al-Anon is a well known 12-Step program that branched off from Alcoholics Anonymous.  It, along with Alateen for adolescents, is a self-help group for the relatives and spouses of alcoholics.  It considers the people who often live with Alcoholics and who either try to "fix" them or cover for and protect them to be "enablers" or "codependents."

Wikipedia defines co-dependency thusly: "It is a tendency to behave in overly passive or excessively caretaking ways that negatively impact one's relationships and quality of life. It also often involves putting one's needs at a lower priority than others while being excessively preoccupied with the needs of others."  In a sense, the co-dependent is addicted to dealing with relatives and romantic partners who are themselves addicted to alcohol.

The alcoholic hides the bottle; the co-dependent finds it and tries to hide it somewhere else.  In almost all cases, the bottle is somehow found anyway.  (This is one of the limitations to studies that try to employ animal models of alcohol addiction.  No one has ever been able to find rats who hide bottles).

Alanon's basic message can be summed up in one phrase, "Let go and let God."  What this is supposed to mean is that co-dependents, like their alcoholics, are too willful.  They wrongfully think that they should, and are powerful enough to, take  responsibilty for the problem drinker.  Hence, they need to "let go" of this need to be powerful, and surrender their will to a higher power.  They need to "let go" and leave their alcoholic's problems for God to take care of, one way or another.

This is actually helpful advice, but not for the reasons advanced by 12 step programs.  12 step programs are based on Protestant techniques that are used to convert others to that religion.  While there is psychology involved, it is a phenomenon that would be most appropriately studied by social psychologists, and sociologists, since it involves group dynamics.

On the surface, "Let go and let God" seems to be advice to not do anything about the alcoholic's self destructive behavior, but to leave it in other hands.  The paradox, however, is that by not enabling, they are in fact doing something - something, in fact, that is completely different.  As I described in my post, The Mother Teresa Paradox, if you constantly try to protect people from themselves, you interfere with their motivation for taking responsibility for themselves.

But it goes deeper than that.  If you compulsively rescue alcoholics, then they and everyone around you will start to think that rescuing them is something you need to do.  Why, if you did not have an alcoholic around, they tend to think, you would not know what to do with yourself.  The alcoholic will not deprive you of this role, so he or she will continue to drink - just so you can keep performing it!

So, if you buy into the Alanon philosophy, and you quit trying to rescue the alcoholic, you take away his or her motivation to keep you "satisfied" in this peculiar way.  Now of course this does not guarantee that the affected alcoholics will for sure stop drinking.  They may decide to leave the relationship and find another enabler, or start destroying themselves without any help at all.

However, by changing their approach in this manner, the "co-dependent" is increasing the odds that his or her drinker will change for the better.  By not doing something, they are doing something: employing one of the most effective interpersonal strategies that exist.