By Larry Getlen
From 1944, Mann’s AA crusade has led to the proliferation of 12-step programs across the country and celebs like Be
6n Affleck and Britney Spears committing to the treatment, even though its success rate is lower than 5 percent.AP
On July 4, 1934, a 30-year-old New York-based writer and publicist named Marty Mann got staggeringly drunk at a party and fell from a balcony. She nearly died, fracturing her leg and breaking her jaw, and spent the next six months in traction.
In the hospital, with her jaw wired shut, she begged friends to smuggle in whiskey so she could drink it through a straw.
A hard drinker since her early 20s, Mann kept on boozing because she didn’t know how to stop. Tired of constantly being drunk or hungover, she attempted suicide twice.
Mann saw doctors and psychologists and tried various treatments, but nothing curbed her problem until one psychologist gave her an early copy of a book, still unpublished at the time, called “Alcoholics Anonymous.”
Written by an alcoholic named Bill Wilson, the book took an approach to the addiction she’d never encountered before.
“As she read it, she felt great relief,” writes Joe Miller in his new book, “US of AA: How the Twelve Steps Hijacked the Science of Alcoholism” (Chicago Review Press), out now.
“The stories the authors told of their hopeless battles with alcoholism seemed exactly like her own. And the book described her condition as an allergy. This struck her like a thunderbolt. Her heavy drinking wasn’t her fault. ”
Mann would soon befriend the book’s author, AA co-creator Wilson, and she began attending AA meetings in 1939. Mann got sober (save for a few short-term relapses over the years) and was an instant convert to the group’s message.
For the rest of her life, Mann would become AA’s biggest booster. She even engineered a PR campaign that would make AA the default treatment for alcoholism nationwide. Soon, it became accepted belief that alcoholism was a disease and AA the only workable cure, that alcoholics could never drink in moderation and that they couldn’t even begin the program until they had basically hit bottom, ruining their life with drink.
While many hail Mann as a hero, Miller — a recovered alcoholic himself — has a different view.
“By AA’s own accounting, 95 percent of the people who come to their meetings looking for help … quit within a year,” Miller writes. “Of that 5 percent who stay a year or more, about half remain members for good, achieving long-term sobriety.”
In addition, most scientific studies show that some alcoholics can drink in moderation and that numerous drugs and therapies could prove more successful than AA in curing alcoholism, Miller writes.
“Out of 50 treatment methods ranked by the strength of scientific evidence, AA comes in 38th,” Miller writes, citing a study by the University of New Mexico.
“AA is below cognitive behavioral therapy and aversion therapy and regular therapy, below marriage counseling and self-help books, naltrexone and another FDA-approved drug called acamprosate, below psychedelic drugs and even placebos.”
And yet, the rise of AA suppressed other possible cures and attitudes toward alcoholism, Miller claims — a suppression that started with Mann.
In the early 1900s, a New York doctor named William Silkworth was the rare medical professional who would work with “drunks,” then regarded as immoral degenerates not worth anyone’s time.
After seeing the desperation among many who couldn’t stop drinking, Silkworth reasoned that this could not be a simple vice or habit — it had to be a compulsion, a disease.
Silkworth wound up treating Bill Wilson in 1934, and this is where Wilson “learned” that his condition was an illness, an epiphany that he and Mann would soon evangelize about to the rest of the world.
According to Miller, though, Silkworth never had any scientific backing for his theory. He just made it up, later adding that the condition was incurable and that drinking in moderation was impossible for an alcoholic. He never offered data or evidence to confirm any of it.
Shortly after reading Wilson’s book, Mann tracked him down and he led her through the brave new world of sobriety.
“He took her to AA meetings and became kind of a mentor for her recovery — a sponsor, in AA parlance,” Miller writes.
“As Mann strung together days and weeks and months of continuous sobriety, she became a kind of unpaid spokesperson for AA,” Miller writes. “Her public-relations skills were well suited to the task, and she began giving speeches to civic clubs and religious groups.”
In time, Mann presented Wilson with a larger vision, discussing a national p.r. campaign extolling the benefits of AA. Wilson told Mann she’d need scientific backing for their claims.
So Mann turned to Elvin Jellinek, a young scientist at Yale University who was working with a new program dedicated to the study of alcohol.
Jellinek not only embraced the plan to “educate the public about the disease of alcoholism” but offered to incorporate Mann into Yale’s strategy — possibly seeing the idea as a way to attract much-needed attention to his department’s work, Miller writes.
Jellinek came to be known as “the father of the disease concept of alcoholism,” despite having co-authored a book several years prior noting that the notion lacked any scientific backing. Furthermore, “historians would later conclude that he … quite possibly never received a bachelor’s degree,” Miller writes.
The story was picked up by newspapers nationwide. Immediately, Mann became the go-to media figure for expertise on alcoholism.
“The press loved Mann,” Miller writes. “She gave good quotes, and she was gifted at the give and take. When a reporter called her an ‘ex-lady lush,’ she corrected him with tongue in cheek: ‘I might be an ex-lush, but I am definitely a lady.’ ”
During her first year with NCEA, Mann was a tireless advocate. She flew 30,000 miles, giving speeches to civic groups large and small while saturating the press.
“She gave more than 400 talks to an estimated 100,000 people and appeared on 38 radio talk shows, carrying her message to an estimated 25 million listeners,” Miller writes.
Mann’s words had a powerful effect. In 1945, a survey conducted by Rutgers University found that just 5 percent of respondents believed alcoholism was a disease. When the study was repeated four years later, that number shot up to 36 percent.
This belief, and the accompanying treatment, became enshrined in the national thinking as the only approach to the scourge of alcoholism. And when others mentioned alternative approaches to the issue, Mann shot them down.
“She even went so far as to help manufacture evidence to back up her claims,” Miller writes, noting that she asked Jellinek to write articles based on a survey AA members conducted of themselves in the AA newsletter. He wrote two articles weakly endorsing her concept but applying “a slew of caveats” about the limitations of the data.
Other scientists, meanwhile, “derisively referred to his project as ‘Jellinek’s doodle.’”
In December 1949, the powers-that-be at Yale — believing that “problem drinking is … an array of disorders that require a variety of treatment approaches” — broke ties with Mann and her group.
“She was generating more publicity than they could have imagined,” writes Miller, “but it was promoting an image of alcoholism they didn’t subscribe to, and it undermined their own efforts to develop scientific approaches to treating the disorder.”
Over time, Mann would find backers, including AA veterans and even presidents, who allowed her to continue her work.
The Kennedy administration was the first to devote federal dollars to the issue, granting $1.1 million for an alcoholism study.
While the eventual findings, issued six years later, would contradict Mann’s message, the study’s very existence strengthened her position on alcoholism as a public-health issue.
But it was Lyndon B. Johnson who threw the full force of his office behind Mann. He issued a proclamation thanking Mann for her tireless work on behalf of alcoholics and announced that the federal government would create an advisory committee, a research center and a public education program on alcoholism.
Mann continued advocating for the issue until her death in 1980.
Her NCEA, now known as the National Council on Alcoholism and Drug Dependence (NCADD), continues her work. On its website, it lists as one of its major legacy accomplishments, “Defined alcoholism as a disease and successfully worked for its adoption by the American Medical Association (AMA).”
Today, AA continues to benefit from glowing publicity, especially from celebrities — such as Ben Affleck and Britney Spears — who’ve committed themselves to the program after going off the rails. But book author Miller, who drank heavily for almost two decades, said he wasted seven years in AA before finding relief from the drug naltrexone. He now blames the program for making him suffer longer than he needed to.
“For seven years, I went [to AA meetings] on average more than once a day, and did all the steps a number of times,” he says, referring to the program’s 12-step model that is now standard in many addiction treatment models.
“When I finished the fourth step, where you take a personal inventory of your shortcomings, it didn’t feel real to me. It certainly didn’t cure me.”
The anonymous nature of AA means there remains very little real research on the program.
“True scientific scrutiny of AA’s effectiveness is nearly impossible,” Miller writes. “As an all-volunteer organization, that holds as one of its most important principles the anonymity of its members, AA defies scientific standards of precise measurement — randomized trials with a control group and a long-term follow-up.”
Meanwhile, the accepted belief that alcoholism is a disease has never been proven. “It’s many maladies, a spectrum of problems,” Miller says, “in the same way that myriad mental-health issues are.”
Because of AA’s dominance, many doctors and scientists wouldn’t even consider studying alternatives to AA for years. The research that should have happened decades ago is just happening now.
In researching his book, Miller visited The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is part of the National Institutes of Health (NIH), and found numerous studies underway.
The Institute even has a fake bar set up where many aspects of drinking are currently being studied, including the effects of a problem drinker’s first drink on their health, and which hormones increase alcohol cravings. This information will eventually be useful for the development of new treatments…