Step 1 – Self Diagnosing Alcoholism Successfully

This will be a series on working the steps. My opinions and experience here. I hope you find them helpful.

Step 1 – Diagnosis Step

There are many cliches you’ll hear in meetings about step 1, “We admitted we were powerless over alcohol, and our lives had become unmanageable.”

  • “Step One is the only step you need to work perfectly!”
  • “The first word in Step One is we!”
  • “My life will always be unmanageable!”
  • “The longest journey starts with the first step!”

Like most cliches, while they may sound terrific, they are a wee bit slim on useful details. Plus, that last one – clearly co-opted from the broader cliche lexicon.

For me, the key to Step 1 is self-diagnosing your alcoholism and figuring out if AA is worth your time. Self-diagnosis isn’t easy. Denial and “fooling oneself” is a real thing. So in this article, I will address three factors that might help a newcomer work through Step 1. They are:

  • Why Self-Diagnosis is Hard
  • Getting a Sponsor
  • AA Fundamentalism

Diagnosis is Hard

Step one is about one thing and one thing only – self-diagnosis. Are you an alcoholic or not.

Sounds simple right? It’s not.

And what makes diagnosing alcoholism so complicated? Several things.

  • Alcoholism is a complicated problem with several dimensions, including physical and behavioral ones.
  • There is no definitive and objective medical test or DNA marker for alcoholism or Alcohol Use Disorder. The “diagnosis” includes several factors.
  • The medical view of AUD is one of a continuum, with binge drinking and heavy drinking being two sides of the spectrum where drinking can cause problems. The AA view is a more absolute one as in, “you either have it or don’t.”
  • Complicating matters, if you don’t drink, you’ll never know if you have alcoholism. You have to put it in your systems and see the response to determine if you have it.
  • The AA Big Book test of “stepping up to the nearest bar and having a few control drinks” is not very helpful (or very smart to do). Would you encourage someone to shoot heroin to determine if they are an addict or not?
  • Many with alcoholism are, in fact, poly-addicted to drugs or other behaviors and substances, clouding the AA alcoholism definition and solution.

The bottom line, what should be straightforward and simple isn’t. A loved one, a doctor, the courts, or a pastor sends you to AA to “get help with your drinking,” and the first thing you have to figure out is you are an alcoholic or not. What? Why the heck do you think I’m here anyway.

Hence the big book spends a lot of time explaining alcoholism before it even begins with the program of recovery.  Why go through recovery if you don’t have the problem the recovery addresses? Makes sense.

Add to this, human beings are frequently wrong, especially when assessing themselves. Whether for alcoholism or anything else important there is some very inherent difficulty making an accurate diagnosis. So, my advice in making an accurate assessment, get a sponsor! A sponsor is the best advice I can give you.

Diagnosis with a Sponsor

Most longtimers in AA will tell you the best place to get direction and insight about Step 1 (and all the steps) is from a sponsor who has worked the steps themselves. I’ve often heard that Step Zero is getting a sponsor.

It would be helpful if the often imprecise Big Book made this sponsoring business clearer, but it doesn’t. Thankfully the rooms encourage the practice enough to make this common knowledge to anyone who attends AA. Consequently, most who are serious about wanting to get sober through the AA program get a sponsor.

The sponsor can provide a personalized roadmap and timeline based on their experience to the sponsee with a style that works for that individual. Styles and approaches can be wildly different—some like someone of a similar disposition to themselves.  If the sponsee is chill, a chill sponsor is what they like. Others prefer something 180 degrees from their own style, as in “I need a sponsor to kick my ass!”  I don’t see a clear piece of advice here as I’ve seen both approaches work well.

Moreover, after years of AA, I’ve come to opine that many of the fine details around the “how” of the steps (and sponsorship) don’t matter much; what matters is forward progress toward the goal of abstinence through the action steps of the program done with a sponsor.  So if a sponsor has you write out things to figure out if you’re alcoholic or not, or has you read and discuss the first paragraph of “We Agnostics,” – it’s no matter as both can work, and that is why a sponsor is so important. It all kind of depends.

Remember, the AA value is mostly a pragmatic one and “whatever works” – aka openmindedness – so long as it leads to sobriety.  

AA Fundamentalism

If you’re new to AA, you will undoubtedly hear the Big Book being quoted chapter and verse in meetings sounding a bit like church. You will also hear that the Big Book was “divinely inspired” as should be read and treated as “a textbook toward recovery!” In addition, you’ll hear of sponsors sitting down with their sponsees going line-by-line through the first 164 pages of the big book with a dictionary by their side for deeper clarity on working the steps. Regardless of what you think of this approach, it is often an informative and rewarding process.

This word-by-word literal approach is called fundamentalism – an approach that stresses that the words on the page are the final source of objective truth. Treating the Big Book like a revelatory text is, well, not what I think was intended by the authors. When composing the Big Book, Bill Wilson was actually writing to a deadline as evidenced by contradictions and lack of key details found within (like on sponsorship).

I prefer looking at the Big Book contextually to get a fuller interpretation than just the words. I want to hear what others have done and how they see it as a result. In addition, asking “How did you come to know you belonged here in AA?” is a great way to make a connection. And, it’s the connections that will keep you coming back.

Finally, these new distinctions of binge drinker and heavy drinker from the APA and AMA can be brought into the conversation with this contextual approach. I find these definitions useful as some drink a lot, get into trouble but aren’t full-blown alcoholics. Having a contextual approach allows room for this type of new information and whatever else may be on the way.

In the end, as always with AA, it’s whatever works that matters.

Why Is Diagnosis Important

Quite practically, if you don’t have alcoholism, why would you go to AA and work their program? It just doesn’t make sense. Sure some think AA is great and “everyone can benefit from its spiritual principles!” But, if drinking isn’t your problem, you might be better off somewhere else.

Making this confusing is the segment of AA that believes in bringing in as many as possible without a lot of discretion. The more the merrier approach. You will hear, “no one gets to AA by accident! If you’re in AA, you probably have alcoholism.” This is just not true. Yet, there is little discussion about drinkers who misdiagnosed themselves. In fact, maybe none.

I see the primary source of confusion with self-diagnosis of alcoholism by someone coming to AA around the lack of distinction made in AA meetings and literature between the medically accepted differences between binge drinking and heavy drinking. A binge drinker drinks (5 drinks a day for a male and 4 for a female) enough to cause problems for themselves (and others).

Binge Drinking Diagnosis

But bingle drinking is not an indicator that the more chronic condition of heavy drinking (akin to what AA would call “powerless over alcoholic) will develop. For a binge drinker to predict if they will cross the line into heavy drinking/alcoholism requires an extraordinary crystal ball. Some never cross the line, and drinking was only a problem for a short time in some people’s lives. This complicates diagnosis.

Consequently, this topic is hardly ever mentioned in AA. Practical distinctions between heavy drinking and binge drinking are hardly ever explored in AA meetings (at least in my experience with thousands of meetings).  The default for many AA is they are both the same – if you have problems from drinking your problem with drinking is the same. This just isn’t true.

And, significantly, binge drinkers don’t need to adopt total abstinence as a solution as many end up going through life and never becoming heavy drinkers of the stereotypical “hopeless alcoholic” type. In fact, studies indicate many binge drinkers do go on to control and enjoy their drinking. This idea is a sort of AA blasphemy as it can be all a “real alcoholic” needs to hear to stop trying to stay sober. It’s all very complicated. 

Conclusion

If you find yourself in AA and wondering, “am I really an alcoholic and need to be here?” I would suggest you do a few things.

  • First, give it thirty days. Attend a bunch of meetings. Pay attention. Put your phone away. Do the stories from AA members of not being able to stop drinking sound familiar? Can you relate?
  • Second, try to practice total abstinence from alcohol and all other mind-altering chemicals yourself for at least thirty days. Is this easy? How is your attitude when you stop? Do you become irritable?
  • Third, if after thirty days you feel physically better not drinking, why not get a sponsor?

Again, alcoholism is a complex condition, and the AA program is hardly perfect – but it can be very effective when you actually have the condition.

I hope this context is helpful.

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