1Q - How do you justify calling alcoholism an illness, and not a moral responsibility? (The Disease Concept)

1A - Early in A.A.'s history, very natural questions arose among theologians. There was a Mr. Henry Link who had written "The Return to Religion (Macmillan Co., 1937). One day I received a call from him. He stated that he strongly objected to the A.A. position that alcoholism was an illness. This concept, he felt, removed moral responsibility from alcoholics. He had been voicing this complaint about psychiatrists in the American Mercury. And now, he stated, he was about to lambaste A.A. too. Of course, I made haste to point out that we A. A.'s did not use the concept of sickness to absolve our members from moral responsibility. On the contrary, we used the fact of fatal illness to clamp the heaviest kind of moral responsibility on to the sufferer. The further point was made that in his early days of drinking the alcoholic often was no doubt guilty of irresponsibility and gluttony. But once the time of compulsive drinking, veritable lunacy had arrived and he couldn't very well be held accountable for his conduct. He then had a lunacy which condemned him to drink, in spite of all he could do; he had developed a bodily sensitivity to alcohol that guaranteed his final madness and death. When this state of affairs was pointed out to him, he was placed immediately under the heaviest kind of pressure to accept A.A.'s moral and spiritual program of regeneration -namely, our Twelve Steps. Fortunately, Mr. Link was satisfied with this view of the use that we were making of the alcoholic's illness. I am glad to report that nearly all theologians who have since thought about this matter have also agreed with that early position. While it is most obvious that free will in the matter of alcohol has virtually disappeared in most cases, we A.A. 's do point out that plenty of free will is left in other areas, It certainly takes a large amount of willingness, and a great exertion of the will to accept and practice the A.A. program. It is by this very exertion of the will that the alcoholic corresponds with the grace by which his drinking obsession can be expelled. (N.C.C.A. 'Blue Book', Vol.12, 1960)

2Q - What is meant by mental obsession and the obsessional character of alcoholism?

2A - Well, as I understand it, we are all born with the freedom of choice. The degree of this varies from person to person, and from area to area in our lives. In the case of neurotic people, our instincts take on certain patterns and directions, sometimes so compulsive they cannot be broken by any ordinary effort of the will. The alcoholic's compulsion to drink is like that.

As a smoker, for example, I have a deeply ingrained habit - I'm almost an addict. But I do not think that this habit is an actual obsession. Doubtless it could be broken by an act of my own will. If badly enough hurt, I could in all probability give up tobacco. Should smoking repeatedly land me in Bellevue Hospital, I doubt that I would make the trip many times before quitting. But with my alcoholism, well, that was something else again. No amount of desire to stop, no amount of punishment, could enable me to quit. What was once a habit of drinking became an obsession of drinking - genuine lunacy.

Perhaps a little more should be said about the obsessional character of alcoholism. When our fellowship was about three years old some of us called on Dr. Lawrence Kolb, then Assistant Surgeon General of the United States. He said that our report of progress had given him his first hope for alcoholics in general. Not long before, the U.S. Public Health Department had thought of trying to do something about the alcoholic situation. After a careful survey of the obsessional character of our malady, this had been given up. Indeed, Dr. Koib felt that dope addicts had a far better chance. Accordingly, the government had built a hospital for their treatment at Lexington, Kentucky. But for alcoholics - well, there simply wasn't any use at all, so he thought.

Nevertheless, many people still go on insisting that the alcoholic is not a sick man - that he is simply weak or willful, and sinful. Even today we often hear the remark "That drunk could get well if he wanted to."

There is no doubt, too, that the deeply obsessional character of the alcoholic's drinking is obscured by the fact that drinking is a socially acceptable custom. By contrast, stealing, or let us say shop-lifting, is not. Practically everybody has heard of that form of lunacy known as kleptomania. Oftentimes kleptomaniacs are splendid people in all other respects. Yet they are under an absolute compulsion to steal - just for the kick. A kleptomaniac enters a store and pockets a piece of merchandise. He is arrested and lands in the police station. The judge gives him a jail term. He is stigmatized and humiliated. Just like the alcoholic, he swears that never, never will he do this again.

On his release from the jail, he wanders down the street past a department store. Unaccountably he is drawn inside. He sees, for example, a red tin fire truck, a child's toy. He instantly forgets all about his misery in the jail. He begins to rationalize. He says, "Well, this little fire engine is of no real value. The store won't miss it." So he pockets the toy, the store detective collars him, he is right back in the clink. Everybody recognizes this type of stealing as sheer lunacy.

Now, let's compare this behavior with that of an alcoholic. He, too, has landed in jail. He has already lost family and friends. He suffers heavy stigma and guilt. He has been physically tortured by his hangover. Like the kleptomaniac he swears that he will never get into this fix again. Perhaps he actually knows that he is an alcoholic. He may understand just what that means and may be fully aware of what the fearful risk of that first drink is.

Upon his release from jail, the alcoholic behaves just like the kleptomaniac. He passes a bar and at the first temptation may say, "No, I must not go inside there; liquor is not for me." But when he arrives at the next drinking place, he is gripped by a rationalization. Perhaps he says, "Well, one beer won't hurt me. After all, beer isn't liquor." Completely unmindful of his recent miseries, he steps inside. He takes that fatal first drink. The following day, the police have him again. His fellow citizens continue to say that he is weak or willful. Actually he is just as crazy as the kleptomaniac ever was. At this stage, his free will in regard to alcoholism has evaporated. He cannot very well be held accountable for his behavior. (The N.C.C.A. 'Blue Book', Vol. 12, 1960)