The Post-Gazette keeps up with advances in the treatment of alcoholism, including, in April, the FDA approval of a new injectable form of the drug naltrexone, marketed as Vivitrol, which is designed to reduce a craving for alcohol. The dilemma of looking to medication to ease the pains of addiction while many medications often seem to lead to addiction itself is not lost on Dr. Abraham J. Twerski, a psychiatrist and longtime expert in alcohol and chemical dependency.

	Bob Donaldson, Post-Gazette Dr. Abraham Twerski Click photo for larger image.

As founder and medical director emeritus of Gateway Rehabilitation Center, Dr. Twerski spoke last month at the center's Recovery Breakfast, on the topic "Will Chemical Blockers Eliminate the Need for AA?" Below is his Sept. 10 speech:

When I was in medical school, my professor of pharmacology asked me what my plans for the future were, and I told him l was planning to become a psychiatrist. He said, "One day, we're going to produce a pill that will put you all out of business." Well, that's not quite what happened. Rather, they produced a number of pills that made my business skyrocket. First there was Miltown, the tranquilizer that promised "tranquil but alert," and proved to be very addictive. That was followed by Librium, Valium, and a number of other benzodiazepenes, all of which are addictive Then they came out with a sleeping pill that was not a barbiturate, therefore, it was not addictive. It was called Quaalude, remember? Then came Percocet, Vicodan, and now Oxycontin. It's evident that pharmacology has not succeeded in putting me out of business at all.

There are some interesting things happening in pharmacology. Much research is going on in the metabolism of alcohol, and there are drugs that seem to reduce the craving for alcohol in some people. They predict that there may eventually be a drug that will actually eliminate the craving for alcohol. Won't that be wonderful? A pill to cure alcoholism! Just what we've been hoping for, right?

Ironically, I see such a development as a disaster. There are people who have stopped drinking or using drugs without a 12-step program, either because of a serious threat to their life or because the spouse threatened to leave or because they were afraid of losing their job. These are the people that are referred to as "dry drunks." Even though they are not drinking or drugging, their character and personality has not changed, and their behavior is just as pathological as that of an active addict.

Some of you may remember Marty L. Ho spoke on his 20th anniversary of sobriety, and began with, "The man I once was, drank. And the man I once was, will drink again." The reason Marty was not drinking was because he had undergone a character transformation, and this "new" Marty had no reason to drink.

What I'm going to tell you now may be shocking, because it is considered heresy. We disagree with those psychologists who say that alcoholism is a symptom of an underlying psychological problem, and when that problem is resolved, the person will have no need to drink alcoholically, but may become a safe, social drinker. In most cases, therapy can go on indefinitely without results, because while the patient is waiting for the underlying problem to be resolved, he continues to drink, and nothing is ever accomplished with a dysfunctional brain. We dispute the premise that alcoholism or drug addiction is a symptom, and we say it is a primary disease.

Yes, I believe that alcoholism is in fact a symptom. It is a symptom of the absence of spirituality, and the treatment is the development of spirituality.

I must repeat what you've heard me say before, and that is my definition of spirituality. As you know, I have pointed out that spirituality can stand independent of religion.

The human being is a composite creature, comprised of a body plus "something else." The human body is essentially an animal body, with all the characteristics and urges of animals. What makes us distinct and unique are a number of features and traits that humans have which animals do not have. In addition to greater intelligence, some of the more obvious ones are (1) the ability to learn from the history of past generations, (2) the ability to search for truth, (3) the ability to reflect on the purpose and goals of life, (4) the ability to have a self-awareness, (5) the ability to volitionally improve oneself, (6) the ability to have perspective, to contemplate the future and to think about future consequences of one's actions, (7) the ability to be considerate of others and to be sensitive to their needs, (8) the ability to sacrifice one's comfort and possessions for the welfare of others, (9) the ability to empathize; (10) the ability to make moral and ethical choices in defiance of strong bodily drives and urges, (11) the ability to forgive, (12) the ability to aspire, and (13) the ability to delay gratification.

Science defines man as homo sapiens, which in simple English means, "a baboon with intellect." There is no denying that intelligence as important, but it is certainly not the defining feature of humanity. A person can hold multiple degrees and be very intelligent, yet his behavior may be not only animal in nature, but even below the animal level. What makes man unique and defines him as man is the implementation of all the distinctive features that he has which animals lack.

The sum total of all the uniquely human features is what 1 call the human spirit, and it is this spirit that defines man. Without this spirit, a person is just another member of the animal kingdom, albeit a more intelligent animal.

The spirit, then, is comprised of all these unique abilities, but that is what they are, "abilities." If a person implements these abilities he is exercising the spirit, and that makes him spiritual.

What, then, is spirituality? It is being the finest human being one can be.

You will note that I have made no mention of religion. True religion must have spirituality, because otherwise it is merely superficial ritual. However, it is possible for a person to be spiritual even if one is not religiously oriented.

Perhaps it can all be summed up very simply. The nature of all animals is that they are totally self-centered, except for pet dogs who may adopt human traits. Animals do nothing unless it is in some way self-gratifying. The features that comprise spirituality remove a person's self-centeredness. A person who is totally self-centered may look human, but he is merely a homo sapiens, an intellectual animal.

I was fortunate in being introduced to the 12-step program without having paid the admission fee of drinking. Here's how it came about:

I had a patient who, from the age of 20 until 57 was a severe alcoholic. I documented that she had at least 84 detoxes in those 37 years. At each detox, she would be taken to an AA meeting, but promptly relapsed. At age 57, she prevailed on an attorney to have her committed to a state mental hospital under the Inebriate Act, and after a year of enforced abstinence, promptly went to an AA meeting on discharge from the hospital. I wrote about her at length in my book "From Pulpit to Couch."

In my psychiatric training, I learned nothing about alcoholism, and I asked Isabel how she managed to stay sober. "I go to AA meetings," she said. "Who does the treatment there?" 1 asked. "We have discussions and speakers," she said. "Are there psychologists there?" I asked. Isabel said, "There is one psychologist who comes around, but he's still drunk most of the time."

I said, "Look, Isabel, I want to know what goes on at these meetings that keeps you sober. Can you take me to an AA meeting?" "Sure," she said.

At my very first meeting, it became clear to me that this program was far more than just not drinking. All the 12 steps were things that were unique to humans. No animal can become aware that it has no control over its life. No animal can surrender its will and turn its life over to the will of a Higher Power. No animal can do a moral inventory, admit its mistakes to someone else, seek to correct its character defects, and make amends to those it has harmed. And no animal can go out of its way to help others. Because these steps are all uniquely human, they comprise the spirit, and if one lives according to these steps, one becomes spiritual. Inasmuch as I was in pursuit of spirituality, I knew that a 12-step program was for me. I went to my first AA meeting in 1961, and have continued to go to meetings for 45 years. It's just that I've added NA, Al-Anon, Nar-Anon, and GA.

You might say, "But, you are a rabbi. Certainly you learned about proper human behavior in your religious studies. Why did you need the 12-step program to help you with your spirituality?"

I'll tell you why. When we study principles of spirituality in religion, we recognize their importance. However, we do not have a gut feeling that if we deviate from these principles, we die. Even if improper acts are sinful, they are not lethal. But in the 12-step programs, a person who is sincere in recovery knows at a gut level that if he deviates from these steps he is dead. Dead, D-E-A-D. Bill Wilson said it simply: "Without spirituality, we die." The 12-step program is our oxygen. That's the feeling about spirituality that I got from the program.

Marty L. was right. Recovery with AA changes a person. It enables one to identify character defects and to improve upon them. When patients ask me how long they have to attend AA, I say, "Only as long as you have character defects. When you no longer have any character defects, you can stop going to meetings. But then you won't have to stop, because you'll be dead." As long as a person is alive, one has character defects. The only being that does not have any character defects is God. Isn't it strange, though, that He still shows up at all meetings!

AA has helped me enormously with my character defects. They're not as bad as they were 45 years ago, before AA, but they're there. And they have to be there, because don't forget, a major part of me is an animal body that still produces all the drives and urges that an animal has, and I still must struggle to keep them under control My animal self is self-centered, which results in character defects unless I maintain tight control over them.

In the beautiful biblical story of creation, God creates everything in the universe. Then at one point, God says, "Let us make man." That's a bit strange. Whose participation was God seeking? And why does God enlist someone's participation only at this point? He had no problem creating the oceans, the mountains, thc millions of species of living things and the super-galaxies by Himself. What makes the creation of man different?

All living things were created in a state of completion. Little bears become big bears and little alligators become big alligators. No animal has to transform itself into something other than what it was created. Even caterpillars that turn into butterflies do not volitionally transform themselves. The change is programmed in their genes and they have no say about it.

Man is different. Man comes into the world essentially as an animal body, but with the potential of developing himself into something more than an animal, a spiritual being that can function with more than just self-gratification. After creating all the animals in a state of completion, and all the spiritual angels in a state of completion, God wished to create a being that works toward its own perfection. So God took this lump of earth and fashioned it into a human form and said to it, "Look here. 1 can create you as a completely spiritual being, but if I do that, you'll be an angel. I already have all the angels I want. So I am going to create you with the potential to become spiritual by means of your own effort, and then you will become man." That's why God said, "Let us make man." Man must participate in his own creation as man by becoming spiritual. If be fails to do so, he remains just another animal.

You don't have to be alcoholic or drug addicted to be just an animal. One who hasn't developed the unique features of the spirit is an intelligent animal, and a person may live 90 years as an animal and not know it. Actually, alcoholics and drug addicts are fortunate, because when they hit rock bottom they become aware that they must become spiritual if they want to live.

So, I can envision what may happen if they develop a drug to treat alcoholism. People will feel that they have no need for AA, because they're not drinking. But they will still have the self-centeredness, lack of consideration, dishonesty, manipulativeness, finding fault with others, and all the behavioral traits typical in the active alcoholic and addict. Rather than decrease, the divorce rate will soar, and kids exposed to dry-drunk parents will suffer from poor parenting. There will not be a rock-bottom experience to bring people to the awareness that their lifestyle is destructive.

Some people in recovery say, "I'm grateful to be a recovering alcoholic," by which they mean that they are grateful for their recovery. But if one understands all the above, one can realize that just being an alcoholic is something for which one should be grateful.