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In dealing with alcoholics and addicts, politicians and commentators usually would prefer to go with treatment instead of sending these alcoholics and addicts to jail. Rarely is it considered that these victims should be developed spiritually. When alcoholics, addicts, and other people who need such help attend support groups, they come to realize during their treatment that there is a “high power” in which they have to submit to instead of merely finding solidarity within the group. A large portion of the millions of Americans who are treated for alcoholism or addiction of substances are advised to foster a spiritual life through participating in fellowship activities like the Twelve-Step program of Alcoholics Anonymous. This chapter introduces the notion of spirituality and how this is used to help people who practice substance abuse.

This chapter concentrates on the practices of Alcoholics Anonymous (AA) and how they facilitate behavioural change. The author analysed intensive interviews with long-term members of AA using a framework that focused on motivation to engage, structured social engagement (through the activities of AA) and personal agency. The resulting model (presented as a helix to represent progression over time) illustrates the way that individuals use support from AA and the understandings of their problem drinking – reflecting AA language and concepts in what the author terms ‘linguistic echoes’ – to maintain sobriety. Although there may be limits to identity transformation while still engaged with the organisation as ‘sober alcoholics’, the programme emphasises moral reflection and commitment to new norms and beliefs which are key elements of desistance processes.

Many of America's alternative healing systems function as vehicles for the transmission of alternative spiritual philosophies. Chiropractic medicine, Osteopathy, Holistic Healing, Therapeutic Touch, and Alcoholics Anonymous are but a few of the alternative healing systems that have deep roots in the American metaphysical tradition. So, too, do various New Age healing practices such as color or crystal healing that believe in the existence of “subtle energies.” It is clear that many of those who are drawn to our alternative healing systems do so not just for relief from physical ailments but also for spiritual growth and edification.

This chapter presents an integrated, moral-therapeutic perspective on alcoholism. Beginning in the mid-1930s, Alcoholics Anonymous (AA) invigorated the therapeutic trend by convincing health professionals and the American public that alcoholism is a disease rather than a morally bad habit. In contrast, it is argued that alcoholism is both a sickness and a morally bad habit. It is a disorder of agency that has physical, psychological, and moral dimensions. The chapter concludes that beneath the disagreements about alcoholism, there is agreement on many key points: alcoholism raises major medical and moral issues; alcoholism is not dictated by a simple biochemical abnormality; most alcoholics retain significant episodic control; most have difficulty (in varying degrees) in controlling their overall patterns of drinking and need help; drinkers have responsibility to avoid causing harm, to cooperate in solving their drinking problems, and to make amends for the harm they cause; and self-righteous blaming and destructive self-blaming are objectionable on both moral and therapeutic grounds. These conclusions provide a partial roadmap for thinking about additional forms of wrongdoing as sickness.

The focus of this chapter is the account of akrasia in alcoholism suggested by the Alcoholics Anonymous literature. The chapter begins by sketching out this account of akrasia. It then goes on to raise a number of questions about this account. It attempts to resolve these questions in terms of the idea that alcoholic relapse involves a disorder of mental state. Various features of alcoholic action and thought in relapse are traced to characteristic features of this state. The chapter develops the idea that such states as “obsession with alcohol” are malformed varieties of the normal condition of wakefulness, and that aspects of the disorder involved in alcoholism can be explained in terms of this relation.

This chapter considers the life stories of American adults who score low on psychological tests measuring generativity. Research suggests that less generative adults tend to construct life stories that feature contamination sequences — scenes that begin very good but become irrevocably ruined or spoiled — and circular plots wherein protagonists fail to show progress or growth over time. The chapter traces the ideas of contamination sequences and circular narratives in the theoretical writings of Freud and Silvan Tomkins, and describes efforts to undo contamination in life stories of recovery, rehabilitation, and reform. Among the most powerful redemptive narratives in contemporary American culture are those associated with Alcoholics Anonymous and criminals' efforts to reform their lives.

“[M]‌ost alcoholics … have lost the power of choice in drink. Our so-called will power becomes practically non-existent” (Alcoholics Anonymous). In active addiction, when an addict who is trying to control or cease using attempts to choose to abstain, but fails, he chooses against his own will. He has lost the power to choose as he wants. Often, when an abstinent addict relapses, the relapse is preceded by a cognitive dysfunction that selectively disables his willpower in relation to his substance. These modes of disempowerment in choice making are correctly explained by a specific disease theory of addiction, articulated in the literature of Alcoholics Anonymous, and subsequently vindicated by contemporary cognitive/affective neuroscience. The cognitive dysfunction that precedes relapse is caused by stress. Twelve-step programs are effective at relapse prevention and are so because they are comprehensive stress-reduction and management programs.

This chapter considers the mildly, moderately, and mostly shadowed regions in the book’s framework for regionalizing organizations. The shadowed regions are similar to the dark region along any two of the three dimensions in the framework, but not all three. The chapter describes Alcoholics Anonymous and the Ku Klux Klan as mildly shadowed collectives. Skull and Bones and Jackie Evans are characterized as moderately shadowed organizations. Anonymous and U.S. Special Missions Units are presented as mostly shadowed collectives. For all three regions, socialization processes are examined.

This chapter traces the growing distinction between Bill Wilson's personal spirituality and the generic spirituality of Alcoholics Anonymous (AA) through a focus on the emergence of the Twelve Steps and the Twelve Traditions. As a spiritual path, AA centers on the Twelve Steps as worked in the context of groups that maintain their unity through their embrace of the Twelve Traditions. Taken together the Twelve Steps and Twelve Traditions simultaneously position AA as a fellowship that is compatible—but not aligned—with either “organized religion” or “organized medicine” and grounds the recovery of the individual and the unity of the organization in the spiritual principle of anonymity.

One area of American medicine in which spirituality is widely considered a vital aspect of healing is in substance abuse rehabilitation. While mainstream spiritual healing practices are found in the methods used by members of Alcoholics Anonymous, a variety of other spiritual practices are also used in substance abuse rehabilitation. This chapter assesses the role of community drumming and shamanic programs in healing addiction. The putative effectiveness of these practices in treating substance abuse is proposed to derive from the psychobiological dynamics of the altered states of consciousness (ASC) and other psychophysiological changes they produce. The psychobiological and psychophysiological processes underlying shamanic practices are described to illustrate their potential contributions to the resolution of addiction. Cross-cultural evidence supports the contention that shamanism is a cross-cultural phenomenon with universal features based in human psychobiology.

This chapter discusses hope, how it works, and what people in the 1930s hoped for. It begins with a late science fiction story (Isaac Asimov’s “Liar!”) that reveals how hope works or, at least, how those who do not think much of hope think hope works. It then returns to one particularly ambiguous archive of Great Depression hope: the largely unprecedented genre of self-help books and success manuals. Many of these books reflect the tempered hopes of the decade, nowhere more so than in the pages of Alcoholics Anonymous, published in 1939. The skepticism about hope is also reflected in the politics of the decade. Chastened by the blasted hopes of the Depression, the greatest contribution policymakers made during the 1930s was to develop safety net provisions—unemployment insurance, social security—founded on the belief not that everything would turn out well but could turn out badly.

This chapter considers the spiritual aspects of treatment for addiction. It argues that achieving recovery from addiction is a daunting task. To date, treatments that have emerged are, with a few exceptions, only modestly effective. Even as these treatments improve, people will continue to need support outside the professional treatment setting in order to live lives that are both worthwhile and free of alcohol and drugs. Alcoholics Anonymous (AA) is a major resource where countless patients find support for a drug-free life. However, because of its spiritual focus, AA is not for everyone. Other options may be a better match. The chapter also describes the Minnesota Model which has become most widespread model for addiction treatment worldwide.

In 1934, Bill Wilson (1895–1971), a (failed) stockbroker, had an ecstatic experience of a blinding white light while hospitalized for alcoholism, which he associated with the feeling of a “presence” and which gave rise to a vision of a “chain reaction of alcoholics, one carrying this message and these principles to the next.” The vision led to the anonymously authored “Big Book” (Alcoholics Anonymous, 1st edn., 1939) and the Twelve Steps and Twelve Traditions (1953) of Alcoholics Anonymous (AA). This chapter analyzes how Wilson told and retold his story publicly in the context of AA in the 1930s, 1940s, and 1950s. It traces the emergence of a gap between Wilson's personal version of his story and his public account of AA's beginnings.

This introductory chapter provides an overview of the book's main themes. This book analyzes the role of revelatory claims in three groups that emerged in the United States in the nineteenth and twentieth centuries: Mormonism, Alcoholics Anonymous, and the network of students associated with A Course in Miracles. These three case studies are not only richly documented but also present intriguing comparative possibilities. Each had a key figure whose unusual experiences and/or abilities led to the emergence of a new spiritual path and to the production of scripture-like texts that were not attributed directly to them. However, the three groups do not make the same claims for their scripture-like texts, and their respective collaborations generated very different social formations.

Shilts finally addresses his addiction to alcohol and marijuana, including in-patient rehabilitation and Alcoholics Anonymous. Shilts grapples with the death of his friend Gary Walsh from AIDS, and the unexpected death of his mother. Shilts offers a first-person account of physical abuse he suffered as a child for an anthology edited by actor Suzanne Somers. Shilts is passed over for inclusion in the documentary version on the life of Harvey Milk, while rights sold to his Milk bio languish and a film is never produced.

Drawing from insights gleaned in earlier chapters regarding the relationship between retirement and substance misuse, this chapter explores interventions aimed at preventing or treating such problems in older adults. More specifically, the chapter describes and reviews the evidence regarding the efficacy of three main psychosocial interventions for older adult substance misuse, namely, screening and brief interventions in the primary care setting, cognitive behavioral therapy, and group therapy programs such as Alcoholics Anonymous. After conducting a similar review and analysis of pharmaceutical therapies, the chapter explores the challenges and efficacy of applying workplace assistance models to prevent and treat substance misuse among older workers and retirees. The chapter concludes with a discussion of the implications for human resource management in contemporary organizations and, in particular, those employing so-called bridge retirees.

As a teenager growing up in the Minneapolis suburbs in the 1990s, I believed the economy was strong, that liberal democracy, after the Cold War, was the final governmental form, and that the future was a place of unlimited growth. But this self-congratulation obscured the persistence of the long downturn and capitalism’s structural limits. Finance was an engine for creating personal debt and harvesting profits from America’s debtors. Neoliberalism collapsed the citizen into the consumer. David Foster Wallace’s Infinite Jest satirizes this America. It reveals addiction as a general condition within the debt economy. In anticipation of collective self-destruction, it hopes to save its readers from the pains of addiction and loneliness, but proves incapable of resolving the tension between the personal (addiction) and the structural (the economy), and so, instead, spills out toward infinity.

Chapter 7 describes the life history of Vernon, a middle-aged Black man with a history of crack addiction and four prior imprisonments. He moved to Houston in the wake of Hurricane Katrina and has successfully desisted from crime. In self-help, peer-group programs such as Alcoholics Anonymous and Narcotics Anonymous, it is commonly stressed that to manage addiction it is necessary to avoid the “people, places, and things” associated with previous substance use. Doing so is easier said than done, given that a lack of income and limited housing opportunities often push individuals back to the same environments where they used drugs in the past. Vernon’s case adds validity to the notion that residential change can provide the foundation for true behavioral change for people with substance abuse problems by separating them from the people and places of their past and by fostering an alternate set of daily routines and situations.