Stepping Out

So you’ve decided to quit drinking.

Sure, you can chug them down with the best of them. You’re the life of the party. But when you drink, your life always seems to self-destruct in some bizarre sort of fashion. Maybe you got nabbed by the CHP at a sobriety checkpoint. Perhaps you stumbled out of a promising relationship or lost a job. Or maybe you’ve never had a problem with alcohol, but you know someone who has, and their life is a mess. Shit happens, as they say in Alcoholics Anonymous. If you have an alcohol problem and are seeking help, get used to hearing pithy little sayings like that. They’ve got all kinds of them in “the program.”

The program is Alcoholics Anonymous. Founded in 1935 by Bill Wilson and Robert Smith, a stockbroker and a physician who got together to help each other stay sober, the quasi-religious organization has blossomed into a worldwide fellowship with millions of devoted adherents. The 12-step recovery program, first outlined in Alcoholics Anonymous (the so-called Big Book published in 1939 and in its fourth edition), has been adapted to treat substance abuse by Narcotics Anonymous, so thousands of drug addicts have been exposed to the program as well.

Today, “the program” dominates America’s approach to drug and alcohol treatment. After indoctrinating clients into the 12-step system, many, if not most, 28-day treatment centers, public and private, strongly suggest that newly clean alcoholics and addicts attend 90 A.A. or N.A. meetings in the first 90 days upon their release. In addition to wallet-busting fines and driver’s license restrictions, local judges frequently require convicted DUIs to attend A.A. meetings.

Such mandatory sentences have increased since Proposition 36 went into effect in July of last year. The proposition, overwhelmingly approved by voters in 2000, mandates that adult drug offenders not convicted of violent crime be sentenced to drug treatment rather than jail. According to Rosa Escutia, spokeswoman for the California Department of Alcohol and Drug Programs, 2,192 convicted offenders were sentenced to drug treatment statewide during the first three months the program went into effect. In Sacramento, between July and October, 728 offenders were remanded to treatment instead of jail. And treatment, almost without exception, means indoctrination into the 12-step program of Alcoholics Anonymous.

“It is such an accepted philosophy in the field of treatment, that it’s very possible that many of the treatment centers incorporate that philosophy into their programs,” Escutia said, adding that the state does not require treatment centers to adhere to the 12-step program, and doesn’t keep track of such information.

Nevertheless, if you’ve been convicted of a drug- or alcohol-related crime, chances are high that you’re going to be sentenced to a program steeped in religious dogma, even if you’re an atheist. You will be told that you have a chronic, lifelong disease that can only be cured through abstinence and the practice of spiritual principles. Despite the fact that there may be no scientific basis for that claim, if you have a drug or an alcohol problem in Sacramento, you’re going to run into the program and their principles sooner rather than later.

Rebecca Fransway and Pam Helm know the program from a long way back. They seem perfectly normal now, a couple of nice-looking women in their 40s, both mothers of two, sipping tea and coffee at the Lyons in Davis. There’s nothing that indicates that Fransway spent a 20-year span wandering in and out of A.A. meetings. Nothing to tell you that Helm spent most of the ’90s in the program.

But not too long ago, Fransway was a down-and-out drunk. She’d pop open a beer on Friday afternoon and the next thing she knew, it was Monday morning in the county detox. She felt sick and scared, crumpled up among the pee-stained winos. She vowed never to repeat the scene, but dogged by relentless depression, she always started drinking again, with the same results.

Helm started shooting cocaine at age 35, shortly after the unexpected death of her husband. The cool rush of cocaine helped ease the pain of her loss, but she continued sticking needles in her arm long after the sorrow subsided. She switched to speed to keep costs down. One day she looked out the window and realized she’d fired up crank every day for seven years straight. The one-time chairwoman of the local March of Dimes drive had become one of the biggest methamphetamine dealers in Davis.

Both women spent years working the 12-step program, and both women had profound experiences in A.A. Helm, who now works as a consultant for court-mandated drug and alcohol treatment programs, has a “take the best and leave the rest” attitude when it comes to the program. She followed the advice that made sense to her, challenged information when she didn’t agree with it, and after a bumpy start, strode the 12 steps into sobriety. Helm is grateful that A.A., with its free meetings and large fellowship, was there when she needed it.

Fransway’s experience was equally profound, but in reverse. In fact, she assembled nearly 50 essays on her experiences in the program and the experiences of others, which were published in book form last January by See Sharp Press. The title? 12-Step Horror Stories: True Tales of Misery, Betrayal and Abuse.

Because Fransway suffered from untreated depression and alcohol dependence, a condition known as “dual diagnosis,” a therapist who might have otherwise prescribed an anti-depressant sent her to A.A. in 1978.

Fransway had been to some A.A. meetings the year before. She recalled waiting for the volunteer to pick her up for her very first meeting. She was in possession of the sole qualification required for A.A. membership, a “sincere desire to quit drinking.” By admitting that she was “powerless over alcohol,” that her “life had become unmanageable,” she had accepted the first of the 12 steps. It wasn’t all that hard. It really seemed like she was powerless over alcohol; her life had become unmanageable. She was hopeful, yet nervous at the same time. She’d heard that A.A. was a deeply religious program, but Fransway firmly believed her problem was too much alcohol, not too little religion. The arrival of the volunteer, a woman named Doll driving a beat-up station wagon, did little to alleviate her apprehension.

“I tried to kill my four kids,” Doll informed her on the way to the meeting.

“How did you get sober?” Fransway asked.

“God got me sober,” she replied gruffly.

Things went downhill from there. The meeting began with the Lord’s Prayer; a scary-looking old woman in the corner eyeballed Fransway with contempt. Overweight and unhealthy, she listened intently for anything that might help her stay sober.

All she heard was more religion.

People tried to explain to her that the Second Step, “We came to believe that a Power greater than ourselves could restore us to sanity,” didn’t necessarily refer to God with a capital G. An individual’s “higher power” could be anything—the group, the Big Book, the family pet. The important thing was the realization that the problem couldn’t be tackled alone. “Your best thinking got you here,” programmers like to say.

Fransway tried to listen, but there it was again in the Third Step, the dreaded G-word: “We made a decision to turn our will and our life over to the care of God, as we understood him.” And again in the Fifth: “We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.” The Sixth: “We were entirely ready to have God remove these shortcomings.” The Eleventh: “We sought through prayer and meditation to improve our conscious contact with God as we understand him, praying only for knowledge of his will and the power to carry it out.”

It sounded like religious brainwashing to Fransway, like a cult. “Fake it till you make it,” members advised her, meaning that she should concentrate on staying sober and not worry about the religious aspects of the program. You don’t buck the program in A.A. You’ll soon find yourself ostracized. At least Fransway did. She stopped attending after three meetings and lapsed into her familiar pattern of periodic depressions followed by disastrous drinking binges.

It would be 1996 before Fransway received treatment for her depression. She spent the intervening years getting sober, going to A.A. meetings, and relapsing every time she got depressed. The way she sees it, the program did her a lot of damage. Three times over the years, 12-step oriented therapists sent Fransway to A.A. meetings rather than prescribe medication. She recorded her 18-year nightmare in the essay, “Stupid Therapists.”

How did two women, Fransway and Helm, come to have such profoundly different experiences in the same program? It’s as simple as this: Alcoholics Anonymous, along with all the other 12-step programs, works fine for some people. Contrary to popular belief, they don’t work for everybody. Not even close.

Critics of 12-step programs have been pointing this out for more than a decade. When the number of people who pass through 12-step programs is compared to the number who actually stay in them and get sober, the percentage is not high. Nor is it clear that 12-step programs are all that effective when people do stay in them. According to social psychologist Stanton Peele, author of 1989’s Diseasing of America: Addiction Treatment Out Of Control, “It has been hard to find systematic proof that treatment for alcoholism and other addictions accomplishes anything at all.” In fact, Peele quotes several studies that show patients who receive treatment sometimes do worse than patients who don’t. Even generous reports estimate the success rate of A. A. and other 12-step programs at no more than 10 percent.

Yet the public perceives that 12-step programs are much more successful than that, Peele writes. One reason for this is that A.A. has its own publicity arm that, among other things, has advised Hollywood on high profile, influential drug and alcohol recovery movies ranging from 1945’s The Lost Weekend (which won Ray Milland the Academy Award for his portrayal of a crazed, relapsing alcoholic who’s saved by A.A.) to 1988’s Clean and Sober to 1999’s 28 Days. All three movies accept the disease model of addiction first promoted by A.A. without question, promoting the idea that the 12 steps are the only solution.

Another reason the efficacy of A.A. has been accepted, Peele says, is that 12-step programs tend to focus on success stories, ignoring the fact that many people with drug and alcohol problems, perhaps most, drop out quickly to continue drinking and using drugs or get sober on their own. Peele says that there is little evidence that the number of alcoholics per capita has decreased since A.A. was founded, despite the increase in the number of public and private addiction treatment services, from free local A.A. and N.A. meetings to expensive 28-day inpatient treatment clinics like the Betty Ford Center. Almost all of these services are 12-step based or related. Peele calls the phenomenal growth of drug and alcohol treatment services during the past 50 years “the addiction treatment industry.”

Thanks to the disease concept promoted by A.A., Peele says it’s become a matter of conventional wisdom in the substance abuse field to view alcoholism as a chronic, progressive illness that is probably passed on through the genes. There is no known cure, only “recovery” through “treatment”—going to A.A. meetings and working the 12 steps. Yet according to Peele, not only is there no credible scientific evidence that 12-step programs help, there’s no definitive evidence that a genetically inheritable, chronic, progressive disease called “alcoholism” exists.

“It’s not a disease,” agreed Jack Trimpey, who with his wife Lois founded Rational Recovery in 1986 as an alternative to A.A. “It’s chemically enhanced stupidity. It’s a love affair with alcohol. But it’s not a disease.”

Trimpey wrote the ironically titled The Small Book and fired it across A.A.’s bow in 1989. Like Fransway, the Northern California licensed clinical social worker had spent 20 drunken years attending the occasional A.A. meeting. After he sobered up on his own (Lois had insisted), he went after the program with a vengeance. He and Lois now operate Rational Recovery out of their home in Lotus, a small town east of Placerville. Rational Recovery, or R.R., is openly hostile to virtually every tenet of the 12-step program, particularly the disease model of addiction and the endless meetings A.A. requires from true believers. In fact, Lois says it’s their organization’s goal to “destroy A.A. and the disease model of addiction treatment.”

In Trimpey’s model of substance abuse, he defines addiction as willfully doing something that you know is bad for you, regardless of the consequences. He’s got no use for A.A.’s concept of “denial,” meaning that the alcoholic, afflicted with the disease of alcoholism, conveniently forgets he or she is a problem drinker after taking the first drink. It’s not a disease that causes drunks to do this, but a natural, positive drive—namely, the pleasure drive. What the addict craves is the “deep pleasure” of, say, downing a pint of Jack Daniels or mainlining $20 worth of black tar heroin. “That’s D-e-e-e-e-p pleasure!” Trimpey emphasizes.

The addict or alcoholic realizes that the drive for this deep pleasure is harmful, but ignores his or her own best advice because the drive speaks in the “addictive voice” of “The Beast.” The Beast is a metaphorical entity Trimpey locates in the same primitive area of the brain that controls the pleasure drive. To understand how The Beast works, Trimpey suggests that any alcohol- or drug-dependent person ask himself, “What is my plan concerning the future use of drugs or alcohol?” The voice of resistance that pops up in the person’s head belongs to The Beast. It craves the deep pleasure of extreme intoxication, but because it does not control the arms, legs and other extremities, it needs the alcoholic or addict’s cooperation to get it.

The Beast counts on the addicted person’s continued, willful stupidity—similar to what the folks in A.A. call denial. But by learning to recognize the voice of The Beast using a process he developed called AVRT (Addictive Voice Response Training), Trimpey claims that anyone with a substance abuse problem can silence The Beast and recover completely in a matter of days. No lifetime of meetings with drug addicts and dope fiends. No 12 Steps. No program. Trimpey markets his various publications, videotapes, and four-day AVRT crash course sessions via the Internet, but he doesn’t peddle his wares all that hard. He insists that recovery—permanent, lifelong, total recovery from drug and alcohol addiction is possible for anyone by simply clicking through the free AVRT crash course at rationalrecovery.org.

What Peele calls the addiction recovery industry, Trimpey calls the “12-step monopoly” or “12-step syndicate.” In his book, 1996’s Rational Recovery: The New Cure For Substance Addiction, he claims that various research studies have shown “fully 40 percent to 70 percent of those who recover from serious addictions do so without getting help of any kind, including attending self-help and support groups.” Trimpey argues that the 12-step syndicate, which includes prominent members of the physician community, has falsely persuaded the public that alcoholism is a disease, and that such programs often do individuals more harm than good.

Dr. Jerome Lackner, a prominent Sacramento physician who treats alcoholics and drug addicts at the Silkworth Memorial Fund Clinic in Midtown and supervises a popular A.A. meeting Friday nights at Sutter Cancer Center, begs to differ.

“I need to tell you that this is not like pneumonia or diabetes,” Lackner said. “You don’t follow people for a year and say they are recovered. This is a chronic, progressive, relapsing disease.” Then he segued into the tale of how Bill W. and Dr. Bob met in Akron, Ohio, back in 1935, a story that’s familiar to anyone who’s ever read the first person account in the Big Book.

“June 10, 1935—that’s the beginning,” Lackner said. “In 67 years, 2 million drunks and dope fiends have gotten sober using the principles in the 12 steps. No other program can boast that kind of recovery rate.”

It’s tempting to ask just how many people passed through 12-step programs during those 67 years, but such numbers are difficult to obtain, due in large part to the anonymous nature of 12-step membership and the persistence of alcoholism or drug addiction in specific individuals over long periods of time. It’s truly remarkable that 2 million drunks and dope fiends have gotten sober using 12-step programs. But how many didn’t? We don’t really know, because it’s too hard to track them all.

Lackner says that patients who have dual-diagnosis like Fransway are more difficult to treat because “they have more than one hole in their boat.” Perhaps that explains why Fransway wandered in and out of A.A. meetings for 18 years before her depression was treated. She had suspected that her bouts with depression might be at the root of her drinking problem when she saw that psychologist in 1978. After confirming Fransway’s self-diagnosis of depression, the psychologist neglected to prescribe medication and instead referred her to a local A.A. meeting, even though she protested. As it turned out, both the psychologist and his wife were members of the local A.A. group in good, sober standing.

Finding people to staff the addiction treatment industry hasn’t been a problem. It’s built right into the program, in the Twelfth Step: “Having had a spiritual awakening as a result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs.” Longtime 12-steppers say, “It’s a selfish program,” and they mean it. By helping other alcoholics and addicts, they believe their own sobriety is enhanced. If they happen to get professionally paid for the services, better yet. More often than not, the people who provide drug and alcohol treatment services today are former substance abusers who have successfully participated in 12-step programs.

Fransway discovered that telling such people that the 12 steps wouldn’t work for her had little effect, even when the person was a trained professional. They simply told her she was in “denial” about the disease and to “keep coming back” to the meetings until she got it. So that’s what she did. In the early 1990s, she pulled what programmers call a “geographic” by moving from Vacaville to Davis in order to get away from her drinking buddies. She started faking it in the hope that somehow she would make it. She turned her will and her life over to the care of God. She conducted countless searching and fearless moral inventories, the Fourth Step, and shared the long list of her secret faults and transgressions with her A.A. sponsor, the Fifth Step.

The Fourth and Fifth Steps are among the most mentally grueling in the program. Imagine that you’re the average drunk or dope fiend, and after 20 years of scamming to get drunk or loaded, all of a sudden you’ve got to make a list of everything you’ve ever done wrong. Every horrible, secret little thing. And then you have to apologize for it.

It can take days to go over such a list, and then your sponsor might accuse you of leaving something out, like the time the next-door neighbor flashed his penis at Fransway when she was 13 years old. “You must have done something to provoke him,” Fransway’s sponsor told her. It seemed like anything bad that had ever happened to her was her fault. When Fransway got pregnant, another sponsor refused to take her Fifth Step unless she got an abortion. Unfortunately, she miscarried.

Fransway met Pam Helm at an A.A. meeting shortly after moving to Davis. Although they have quite different personalities—Fransway tends to be an introvert and Helm is an extrovert—the two quickly became friends.

Like Fransway, Helm came to A.A. the first time on her own. Helm wasn’t acquiescent like the other women in the fellowship. If someone said something she disagreed with, she let them know about it. She got off to a rough start. Eight months after admitting she was powerless over methamphetamine, Helm found an ounce of crank she had stashed in her house during her using days. That started a six-month run, but she remained undaunted. She refused to beat herself up for relapsing and at the urging of Jack M., a former using buddy, she rejoined the program. Jack had been in and out of A.A. for years, and had once told Helm that after dissecting the Big Book a thousand times, he was convinced the program didn’t work. Yet now he was claiming that through rigorous application of the 12 steps, he had remained sober for a year. If a down-and-out drunk and dope fiend like Jack could do it, so could she, Helm thought.

Helm and Fransway began attending special meetings devoted to studying the Big Book. Fransway devotes an essay to these meetings, “Big Book Cult,” in 12-Step Horror Stories. The special meetings were held in private homes and featured speakers who had taken on a guru-like aura within the program, thanks to their knowledge of the Big Book. Jack M. became something of a disciple to one of these gurus. Eventually, he reached a level of dogmatism that caused Helm, whom he had talked into returning to the program a few short months earlier, to lose all respect for him.

At one of the Big Book meetings, Jack had started off by circling all the “I, me, mines” in Bill W.’s famous story in the Big Book. This was supposed to demonstrate the selfishness of alcoholism, the disease. “What do you expect, Jack?” Helm snapped. “It’s a first-person narrative.” Jack would have none of it, and grew angry. She realized that Jack, whom she had known since high school and considered a brilliant man, had stopped thinking for himself. For Helm, thinking for herself, after years of listening to the voice in her head telling her, “just one more fix,” was what recovery was all about.

“What I found is that A.A. gave me the courage to follow my own intuition,” Helm says. Her intuition was totally shot when she first started going to meetings. But by speaking out and challenging information she disagreed with, she was able to start thinking for herself, which she equates to having a spiritual awakening, one of the rewards that allegedly awaits those who work the steps. “I got the promises,” she says. “The meetings provided a safe place to test whether my intuition was on or not.”

Fransway watched her rebellious friend with concern. She figured Helm had to be using speed again. She was just too damned agitated all the time. But Fransway was the one who was in danger. After a long period of sobriety, the depression hit again, and she holed up in a cheap hotel room with her backpack and her beer and her wine and her hard stuff and called Helm. She wasn’t home, so Fransway left a message.

“I’m just calling to tell you that I’m drinking again, and I intend to drink until I die,” she said. “The only thing you can do to help me is bring me more booze.”

People in the fellowship say there’s nothing worse than “going out with a head full of program,” meaning, if you’ve just spent a large portion of your life sitting around in smoke-filled rooms drinking really bad coffee while you discuss in great detail all of the reasons why you’re such a diseased mess and why only God can save you, but only if you work the 12 steps just right, and then you decide to go out and use drugs and alcohol, well, stand by for a massive dose of humiliation, friend. You thought you were bad off before?

Fransway was plunged back into the nightmare world of detox centers, mental wards and quack therapists. One doctor prescribed Antabuse, the drug that causes convulsions in patients if alcohol is consumed. That worked for a while, until she got horribly depressed and stopped taking the drug so she could drink. Then a therapist diagnosed her as bipolar and prescribed lithium. That left her feeling flat, and when she complained, he scolded her for not attending A.A. meetings.

There seemed to be no way out. At A.A. meetings, when she complained about her depression, they chided her for getting on her “pitty-pot” and accused her of “stinking thinking.” Yet every time Rebecca attempted to discuss her depression with a therapist, she was sent back to A.A. The only things left were jails, institutions and death, the unholy trilogy A.A. promises awaits those alcoholics who can’t follow the 12-step program with rigorous honesty. Fransway had already spent time in jails and institutions. Death was the only option left. She’d already had alcoholic hepatitis once. Her final binge landed her in a mental ward, and for the first couple of days, Fransway was just crazy enough to fit in.

But then she regained her senses. She wasn’t crazy. She just drank too much. If she could just quit drinking! And then one day not long after that, she found the answer she was seeking, embedded in the text of The Small Book. Constantly going over her past failures depressed Fransway even more than she already was. Eventually, after reading The Small Book and leaving the program, she was diagnosed with clinical depression. A doctor prescribed Prozac, and after two days, Fransway felt better than she had during all those years in A.A. That was five years ago, and she’s been sober ever since. All Jack Trimpey did was tell her she wasn’t powerless. She could beat The Beast, all by herself.

“People aren’t looking for religion or a social club to get sober,” Trimpey insists. “They come to Alcoholics Anonymous seeking answers, and all they get is mystery.”

Dr. Lackner calls Trimpey and Rational Recovery a fraud.

“You have a beast inside of you?” he scorned. “That’s bullshit.” He accused Trimpey, who charges $1800 for his four-day AVRT sessions held at his home and $999 for R.R.’s 12-pack videotape collection, of making money off the disease.

“What these people have inherited is that when they take a drink, they get an immediate physical demand to drink more,” Lackner continued, noting that R.R. no longer has meetings and therefore cannot provide anything close to the services the free fellowships of A.A. and N.A. provide to alcoholics and addicts. “Quitting is not the problem. Staying quit is the problem.”

Trimpey is used to A.A. acolytes accusing him of being in it for the money, and shrugs it off by pointing out that his rates are considerably less than the average 28-day inpatient recovery program, which can cost more than $30,000. Besides, he has to make a living—just like all the 12-steppers working in the treatment centers or as private therapists. Who have been doing a bang-up business since Proposition 36 passed, Pam Helm will tell you. She should know. After all, she works in the addiction treatment industry too, consulting for those court-mandated drug treatment programs.

Rebecca Fransway and Pam Helm remain good friends, despite their differences in opinion about the effectiveness of A.A. Helm unabashedly thanks the program of Alcoholics Anonymous for leading her to sobriety. She thinks the 12-step program, if approached with an open mind, can lead to a type of spiritual awakening that can be helpful to anyone who is trying to overcome an addiction.

Naturally, Fransway completely disagrees.

“A.A. and the steps interfered with my conscious contact with God,” she says. “I was so afraid of getting drunk again. I did so many Fourth Steps.”

Fransway has gotten a lot done in the short time that she’s been well. She nailed down a decent job at the public TV station in Davis and she’s gotten some poetry published. And there’s the book, of course. With it, she closed a 20-year chapter in her life that’s best described as a waking nightmare.

Picking winners here is easy: Rebecca Fransway and Pam Helm, both of whom are now leading sober, productive lives. Choosing the recovery method that’s for you, or that anonymous friend of yours who got the DUI on New Year’s Eve, is a little trickier. One recovery program says these women and others like them suffer from an incurable disease that can only be arrested, not cured, by abstinence and faith in God. The other says that addiction speaks in the voice of The Beast, and that if these women and others like them learn to hear the voice, and they can forever keep it at bay, they can be cured. Each method points to numbers that demonstrate its own superiority and the other program’s inferiority. One program, Alcoholics Anonymous, continues to carry the day. But programs like Rational Recovery are gaining ground. Does either program work?

Yes, they both do.

Rebecca Fransway and Pam Helm are proof enough of that.