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Does the Big Book endorse treatment centres?

In short:

  • No. The words "treatment center" and "rehab" never appear in the Big Book's program text. They turn up only in some fourth-edition personal stories, as part of what those writers went through. One writer who was told to go didn't.
  • The 1939 text does favor medical help in its place. It favors hospitalization for a drinker who is "very jittery or befogged" (p. xxvi). It calls physical treatment "desirable, even imperative" for someone just off a spree, but only "a small part of the picture" (p. 143). It speaks warmly of a hospital and a doctor who cooperated with A.A. (p. 162).
  • What the book says actually recovers the alcoholic is not the medical care itself but a spiritual change and working with other alcoholics (pp. xxix, 89, 143), though for many early members that began inside a hospital's walls (p. 162).
  • The Traditions keep A.A. and hospitals apart. Hospitals and "other places of recuperation" are to be "well outside A.A.," and cooperation must never go so far as "affiliation or endorsement, actual or implied" (p. 564).

What the search found

In the first 164 pages, the forewords and the appendices, "treatment" means a doctor's or hospital's care of a drinker. It never means a program that replaces A.A. "Treatment center" and "rehab" don't appear there at all. They appear only in personal stories in Parts II and III, which reflect the membership at the time of the fourth edition (2001). Some examples: - One writer was sent to a treatment center, and it "introduced me to the Big Book" (p. 498). - Another writes: "I didn't have anything against treatment centers then, nor do I now" (p. 315). - Another, asked to enter a treatment center, writes: "I did not go to a rehab" (p. 425). - Another remarks that when their father drank "they didn't have treatment centers" (p. 513).

These are personal experiences, told "in his own language and from his own point of view" (p. 29). They don't make the program text say anything about treatment centres.

What the 1939 text says about medical help

The Big Book isn't against doctors or hospitals. It was introduced by one, Dr. Silkworth, who ran a hospital for alcoholics (pp. xxv–xxvii). Bill W. got sober in a hospital, where "Treatment seemed wise, for I showed signs of delirium tremens" (p. 13). The text: - Favors hospitalization for the drinker who is very jittery or befogged, so his mind is clear before he is approached (p. xxvi). - Uses doctors and hospitals to find drinkers. A member can find drinkers who want to recover by asking "doctors, ministers, priests or hospitals" (p. 89). "Approach through a doctor or an institution is a better bet" than through his family (p. 91). "If your man needs hospitalization, he should have it" (p. 91). - Treats physical treatment as a first step. In "To Employers," for a man still drinking or just off a spree, "a certain amount of physical treatment is desirable, even imperative" (p. 143). "In competent hands, this seldom takes long nor is it very expensive" (p. 143). - Thanks a hospital. Chapter 11 describes "a well-known hospital for the treatment of alcoholic and drug addiction" in the East, whose doctor suggests A.A. to patients able to recover on a spiritual basis. "Many of us, former patients, go there to help" (p. 162).

What it says treatment can't do

The same pages are blunt about the limits: - "Physical treatment is but a small part of the picture." The man "must undergo a change of heart" (p. 143). - Dr. Silkworth: the craving "has never been, by any treatment with which we are familiar, permanently eradicated" (p. xxx), and doctors "have made little impression upon the problem as a whole" (p. xxix). Recovery takes "an entire psychic change" (p. xxix). - The book's own early members had tried "health farms and sanitariums" and voluntary commitment to asylums without success (p. 31). One man "floundered from one sanitarium to another" (p. 26). - The way out it offers is the Steps and Chapter 7's work. Practical experience shows, it says, that "nothing will so much insure immunity from drinking as intensive work with other alcoholics" (p. 89).

The Traditions

The Long Form of the Traditions (written 1946, printed in the Big Book from 1955) answers the question for A.A. itself: - Tradition Six: clubs and hospitals are "secondary aids" that should be incorporated separately and not use the A.A. name, and "hospitals, as well as other places of recuperation, ought to be well outside A.A.—and medically supervised" (p. 564). "While an A.A. group may cooperate with anyone, such cooperation ought never go so far as affiliation or endorsement, actual or implied" (p. 564). - The short form: an A.A. group "ought never endorse, finance or lend the A.A. name to any related facility or outside enterprise" (p. 562). - Tradition Eight: "We define professionalism as the occupation of counseling alcoholics for fees or hire" (p. 564), and A.A.'s Twelfth Step work is never to be paid for (pp. 564–565).

The Foreword to the Second Edition (1955) sums up the stance: A.A. doesn't "take any particular medical point of view, though we cooperate widely with the men of medicine" (p. xx), and "Upon therapy for the alcoholic himself, we surely have no monopoly" (p. xxi).

What this means

The Big Book doesn't endorse treatment centres. The 1939 text speaks warmly of one hospital that treated alcoholics and cooperated with A.A. (p. 162), but as a place where members went to help and found God, not as a substitute for the program; and the Traditions written after it tell A.A. groups never to endorse or affiliate with any such facility (pp. 562, 564). What the book does endorse is short, practical medical care to clear the drinker's head, followed by the spiritual program and one alcoholic working with another. It never treats a hospital stay as the recovery itself.

Read it yourself

Sources

Source Pages Date
Alcoholics Anonymous, whole fourth-edition text (searched) — 1939 text; fourth edition 2001
"The Doctor's Opinion" xxv–xxx 1939
Chapters 1, 2, 3, 7, 10, 11 13, 26, 29, 31, 89–91, 143, 162 1939
The Twelve Traditions, short form and Long Form (Appendix I) 562–565 Long Form 1946; short form by 1950; in the Big Book from 1955
Foreword to the Second Edition xx–xxi 1955
Personal stories, Parts II and III 315, 425, 498, 513 in the fourth edition (2001)

Recovery Starts is independent and not affiliated with Alcoholics Anonymous. Quotations are brief and cited; the Big Book is © A.A. World Services, Inc.

These pages answer questions about A.A. from A.A.'s own published literature, read in full, with every quote checked word for word against the page it cites. Recovery Starts is independent and not affiliated with Alcoholics Anonymous. What we read, and when each source was written.