The discovery that denial was a significant obstacle to getting people sober encouraged a search for new ways to attack the problem of alcoholism. The Reverend Vernon E. Johnson, an Episcopal priest, believed that it was possible to get help for an alcoholic before he set foot in an AA meeting or was admitted to a hospital. Johnson was an alcoholic who entered Hazelden in 1962. When he left treatment, he began working with a church group that included families of alcoholics in a suburb of Minneapolis. Several years later, he founded the Johnson Institute to develop programs for alcoholics based on research that the institute would conduct.
Johnson realized that he needed a laboratory to conduct the research and persuaded a local hospital to admit sixteen alcoholics for that purpose. One of the first surveys circulated sought answers to the question, why do people who have the disease wait so long to get treatment? The results of the first questionnaire were disappointing. “We repeatedly got reports from recovered alcoholics that they had simply seen the light, that a spontaneous insight had brought them to treatment,” Johnson said. A second questionnaire that sought more information about the events leading up to the decision to quit was more revealing. “[A]ll these people had suffered a buildup of crises that brought them to a recognition of their condition,” Johnson said.21
Johnson saw crisis as an opportunity. Family, friends, and even employers normally tried to help the alcoholic avoid the consequences of his drinking. What if people who were affected by the drunk’s behavior used these crises to confront him with his drinking problem? The first step was to educate the people who were closest to the alcoholic:
[They] do not realize how little he knows of himself and his own behavior. He is not confronted by his own actions; many of them he is not even aware of, although those around him assume that he is. They believe that he seems himself as they see him. In point of fact, he is increasingly deluded.
Once it was understood that the drunk needed help, their responsibility to do something became clear. “[T]hey must take the initiative if the illness is to be arrested,” Johnson said. The Johnson Institute supported strict enforcement of the laws against drunken driving because going to jail was the kind of crisis that would propel drunks into treatment.22
Critics began to complain about the use of coercion soon after the Johnson Institute started arranging interventions, like Betty Ford’s, in which family members, friends, and coworkers confronted drunks and urged them to seek treatment. Johnson was accused of manufacturing crises. “[O]ur response is that we do not invent crisis,” Johnson said. “Every alcoholic is already surrounded by crises. . . . All we have to do is to make those around him knowledgeable enough so that they can start using the crises.” Moreover, while pressure was being applied, the participants in the intervention were people who knew the alcoholic best and were able to confront him with specific incidents that occurred as a result of his drinking. It was certainly not a pleasant process for the drunk, who was frequently angered by the confrontation. On the other hand, some alcoholics were grateful to be offered an escape from a situation that had appeared insoluble. Johnson remembered one woman who had spent four hours fighting with her husband and daughter over their demand that she enter treatment. “If that’s all either one of you cares, the hell with you,” she said. Forty-five minutes later, she surrendered. When Johnson put out his hand to congratulate her, she embraced him. “Thank God, somebody did something,” she whispered.23
Family intervention was powerful but not always successful. Many family members refused to participate because they were not convinced that their loved one was an alcoholic. In the early years of the Johnson Institute, many of the clients were companies that wanted to help an employee to sober up. Employers also had more power than family members because they could fire the alcoholic if he did not agree to accept treatment. At first, this threat applied mainly to executives and other key employees. By 1980, thousands of companies had created programs, including more than half of the nation’s biggest corporations.
At first, there weren’t enough places to put everybody. In 1968, there were only 183 programs for treating alcohol and drug addiction in the entire United States. But the passage of the Hughes bill led to a rapid expansion of federal spending, which rose to $386 million in 1973. More than thirty federal agencies and departments were soon playing a role, including the National Institute of Mental Health, the Veterans Administration, the Department of Justice, and the Department of Defense. In 1978, the number of treatment programs had grown to more than 2,400 and 250,000 alcoholics were being admitted to federally supported treatment every year. Much of the federal money was distributed by the National Institute on Alcohol Abuse and Alcoholism in the form of grants to state and local governments as well as nonprofit agencies in the hope that this would encourage them to spend additional funds. The seed grants achieved their purpose. In 1980, there were more than four thousand treatment units with total expenditures of $800 million.
The growth of private treatment centers was explosive. In 1970, there were only a handful, and Hazelden, which had recently expanded to 167 beds, was the largest. A decade later, there were 3,800 residential beds in Minnesota alone. The expansion of private treatment was made possible by insurance companies. Early in the century, these companies had done their best to deny insurance to alcoholics. Those who quit drinking had to prove they had been sober for five years before they could obtain a life insurance policy. This began to change in 1964 when Kemper Insurance Company added alcoholism coverage to group insurance policies at no additional cost. Many of James Kemper’s competitors believed he would go broke, but he argued that the industry would actually save money by helping alcoholics get sober, saving the cost of their future care. The Prudential Insurance Company and the Hartford Insurance Group followed Kemper’s lead in the early 1970s, and a majority of the companies would follow in the 1980s.
These were exciting days for men and women who were committed to changing the way their communities viewed alcoholics and drug addicts. Suddenly there was money to open halfway houses, clinics, and drop-in centers, and those who ran them were deeply committed to their cause. “Those of us who chose to take on such an upstream battle often brought more commitment than competence, and, as a result, we created work milieus more typical of a social movement than of a service agency,” William L. White, a treatment professional and a historian of the recovery movement, has written. Admissions procedures were informal. “Alcoholics and addicts walked in off the streets and could be in a group a few minutes later,” White said.24
Many of the counselors were alcoholics and addicts who had been in treatment only a short time before. Everyone worked long hours for little pay, but they were driven by the urgent needs of their clients. White quotes another veteran of the period:
This was a time when alcoholics were hanging themselves in jail cells and dying from withdrawal because they couldn’t get adequate medical care. This was an era where every staff member had come face-to-face with alcoholic seizures and had stood over the bed of a dying alcoholic. We knew beyond a shadow of a doubt that, if what we were doing didn’t work, the death of many of our clients was not only possible but imminent.
The danger that the counselors would exhaust themselves was very real. The threat was particularly acute for those who were newly sober, and many suffered relapses. But there are always casualties in a great undertaking, and the fight against alcoholism and drug addiction was becoming a major humanitarian movement.25
AA flourished in these years. Its twelve-step program was a critical component of the Minnesota model of alcoholism treatment, and almost all of the treatment institutions that opened in these years followed the Minnesota model. Sales of the Big Book jumped because it was given to patients who were expected to complete AA’s fourth and fifth steps before they returned home. It had taken thirty-four years to sell the first million copies, which finally occurred in 1973. Another million were sold in the next five years. By 1983, AA was sel
ling 500,000 copies per year. Meetings were overflowing with recent graduates of rehabilitation centers (rehabs). The number of AA groups quadrupled to over 73,000 by 1987. By then, there were 800,000 members in the United States and Canada, and annual sales of the Big Book had risen to over 800,000. AA had also become an international movement with nearly 700,000 members in 109 foreign counties.
While it was growing, AA was also becoming more diverse. In 1970, the overwhelming majority of AA members were middle-aged white men. The number of women had grown significantly from the days when female alcoholics were regarded almost with suspicion, but more than three-quarters of the people at AA meetings were still men. This changed as treatment centers began to focus on the special problems of women alcoholics. Women were a majority of the patients at the Betty Ford Center, which Ford cofounded in 1982 in Rancho Mirage. By the mid-1980s, one in three AA members was a woman. The AA membership had also grown considerably younger. In the early years of AA, young alcoholics were sometimes told that they hadn’t suffered enough to join. But the number of young members tripled between 1968 and 1983, reaching 20 percent of the total.
Many of these new members were addicted to another chemical in addition to alcohol. Women alcoholics had always been more likely than male drunks to be addicted to prescription drugs because the stigma of women who drank was greater and pills were easy to hide. Psychoactive drugs had become a prominent part of the youth subculture. The number of AA members reporting dual addiction almost doubled in just six years. By 1983, they were almost one-third of the members.
AA was also becoming more ethnically diverse and accepting of sexual preference. African Americans joined AA soon after its founding. However, the existence of racial segregation during the early decades of AA inhibited the growth of African American membership. AA groups set their own rules, and many groups in the South excluded blacks. William Swegan, who introduced AA to the military, remembered the hostility that greeted him when he brought African American service members to meetings in San Antonio during the 1950s.
African Americans responded by starting their own AA groups; the first opened in Washington, DC; the first New York City group started in Harlem in 1945. Native Americans began joining AA in 1953 and adapted the twelve steps by replacing references to the Christian “God” with “the Creator” or “Great Spirit.” There were twenty Indian AA groups in 1966. Spanish-speaking groups proliferated with the rapid growth of the Hispanic population. Gay men and lesbians established special meetings where they would feel comfortable discussing their experiences.
The expansion of AA created many problems. The chief of staff of the General Service Office described some of them in 1978:
Groups in the vicinity of treatment centers have been inundated with busloads of patients. Young people bring with them other addictions, explicit language, and free discussion of sex. Court-referred drunk-driving offenders wanted attendance slips signed. These and a thousand other problems have strained A.A. unity and rocked the serenity of many an old-timer.
Many AA members were skeptical about the prospects of newcomers who were attending meetings against their will and irritated by the discussion of drugs. AA had dealt with the drug issue for the first time in the 1940s when dual-addicted people began to speak up during meetings. The fear was that allowing people to talk about their drug addictions, particularly those that involved criminal behavior, would alienate drunks who had not had the same experiences. The agreement at the time, and reaffirmed in the 1960s, allowed drug addicts to attend AA meetings as long as they spoke only about their alcoholism. As the number of dual-addicted members grew, however, talk about drugs increased. The use of profanity also became common, which some old-timers blamed on the drug addicts. As a result, many groups began meetings by encouraging members not to talk about drugs. Some banned both drug talk and profanity.26
By the early 1980s, the complaints had reached a point where some began to worry that AA would not be able to adapt to new challenges, including the growing diversity of its membership. “[T]here appears to be developing within our Society a rigidity, a perceived need for law and order, a determination to enforce the Traditions to the letter, without any elasticity,” the keynote speaker told the AA General Service Board in 1983. “If that attitude became widespread, the Fellowship could not function.”27
Diversity continued to grow. Hundreds of men’s, women’s, and LGBT meetings were organized as a result of a decision to allow the formation of special groups; the only requirements were that they promote sobriety and were open to all alcoholics. The AA General Service Board also made a vigorous effort to recruit alcoholics from minorities that were underrepresented in the membership. Pamphlets addressing specific minorities were prepared and distributed through the literature racks of groups around the country. AA also recognized that illiteracy prevented its message from reaching alcoholics who lived in poverty. It created comics for them and expanded the distribution of AA literature on audio cassettes, which were originally created for alcoholics with impaired vision.
As the number of people in recovery grew, new sobriety groups were created to meet their needs. The first, Women for Sobriety, started in 1975. Dr. Jean Kirkpatrick, a sociologist and sober drunk, believed that women alcoholics needed a fundamentally different recovery program than men. AA stressed the importance of accepting powerlessness over alcohol and turning one’s will over to a higher power. Kirkpatrick said this might be fine for men, but the biggest problem women alcoholics faced was low self-esteem. They already felt powerless. To empower them, Kirkpatrick created Thirteen Statements of Acceptance that emphasized the importance of self-assertion. Unlike AA, Women for Sobriety encouraged its members to offer encouragement and advice during meetings. It shared AA’s commitment to lifetime abstinence and the importance of spiritual reconstruction. A study found that a third of Women for Sobriety members also attended AA meetings.
Many of the new groups were started by alcoholics who didn’t feel it was necessary to acknowledge their dependence on a higher power. The first of these agnostic or atheist groups was established within AA in Chicago in 1975. The founder was Don W., an alcoholic who had joined AA in the early 1960s but quit after six months. “I was unable to work it because of the religious language in which the 12 steps were couched,” he said. He drank for another ten years but finally returned and worked the steps as they were written.28
Four years later, Don W. gave a speech in several Unitarian Universalist churches, “An Agnostic in A.A.: How It Works for Me.” One of the ministers invited him to start a group, and the first meeting of Alcoholics Anonymous for Atheists and Agnostics (Quad A) was held in the church basement. AA meetings for nonbelievers were organized in Los Angeles in 1980 and in New York in 1986. Recognized as a special group in AA, the atheists and agnostics adapted the twelve steps by removing references to God and a “Higher Power,” while continuing to recognize the need to receive help from others to stay sober.
Two other sobriety groups were organized outside of AA in the 1980s. James Christopher, an alcoholic who got sober in AA despite his frustration with references to a higher power, organized Secular Organizations for Sobriety—Save Our Selves (SOS) in 1985. Unlike the atheists and agnostics who remained in AA, Christopher did not believe spirituality was necessary for sobriety. “S.O.S. credits the individual for achieving and maintaining his or her own sobriety,” he wrote. At the same time, SOS shared AA’s commitment to lifetime sobriety and emphasized its respect for AA and other organizations that were helping alcoholics. At its peak there were as many as 450 SOS groups in the United States, but the number declined to 47 in 2016, according to its website.29
The second group, Rational Recovery, was organized the year after SOS and had a similar philosophy. There were six hundred Rational Recovery groups in 1995, but it was closed by its founder several years later following a split in the organization. In 1994, former Rational Recovery members started SMART Recovery to provide “free, self-e
mpowering, secular and science-based mutual-help groups.” In 2013, there were more than 1,000 SMART Recovery meetings around the world, including 470 in the United States.30
The search for recovery in the 1980s was not limited to alcoholics. AA’s program was adopted by many new groups that were struggling with other problems. The wives of early AA members were the first to discover that they could benefit from the twelve steps. They began to form informal support groups in the 1940s to help them deal with the emotional damage caused by their husbands’ drinking, as well as the problems that arose once they were sober. Lois Wilson recognized that she needed help one night when a newly sober Bill made her so angry that she threw a shoe at him. She and a friend, Anne B., established a service office for the family groups, later incorporated as the Al-Anon Family Group Headquarters. Al-Anon grew from 145 groups in 1951 to over 1,500 in 1963. Al-Anon also established Alateen, a program for the children of alcoholics.
The 1950s were also when drug addicts started their own twelve-step organization. In 1953, several members of AA in Los Angeles helped organize Narcotics Anonymous (NA), which emphasized a version of the steps and traditions that had been adapted to apply to drugs as well as alcohol. NA gradually developed its own literature. In 1982, it published Narcotics Anonymous, which serves the same purpose for addicts as the Big Book does for alcoholics. While developing its own language and culture, NA remained committed to the twelve-step program as it grew from thirty-eight meetings in 1971 to forty-four thousand in 2008.
In the 1980s, dozens of new groups began adapting the AA program. AA counted eighty-three in 1987. Some groups sought members based on the drug they abused, including Potsmokers Anonymous, Pills Anonymous, and Cocaine Anonymous. Others formed to help people address problems with gambling, overeating, sex, and other kinds of compulsive behavior. As the decade progressed, the concept of addiction broadened to include people who had suffered as a result of dysfunctional relationships. In 1983, psychologist Judith Woititz published a book describing the problems faced by the children of alcoholics. Adult Children of Alcoholics sold almost two million copies and helped inspire the creation of an organization that adopted AA’s twelve steps with only one change in the first step, applying its admission of powerlessness to “the effects of alcoholism or other family dysfunction.” There were fifteen hundred Adult Children of Alcoholics groups by 1990.
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