Excerpt from "Spiritual Adrenaline: A Lifestyle Plan to Nourish and Strengthen Your Recovery"

The Twelve Steps and More

At the time Bill W. and Dr. Bob, the cofounders of Alcoholics Anonymous, conceived the Twelve Steps, science hadn’t kept pace in the context of the role of self-care and nutrition in achieving sobriety and preventing relapse. Although the founders lacked the benefit of scientific research, they had lots of common sense and their own experience as alcoholics trying to get, and stay, sober. Let’s take a look back to the early days of recovery: the 1930s through 1960s.

Nutrition and the Steps

When AA was founded in 1935, there was little information available regarding the importance of nutrition and how the substances that compose food could play a role in reducing cravings and helping people stay sober. Early twelve-step members developed their own social culture around the program. Smoking was pervasive and meetings were notoriously held in smoke-filled rooms. Most meetings offered attendees copious amounts of coffee and sugary treats such as cookies or donuts. Socializing after meetings, which became known as “fellowshipping,” often involved diners, pizzerias, or other places that were open late and served inexpensive food.

Twelve-step groups have a principle that they take no position on outside issues that would detract from a focus on the primary purpose of the particular twelve-step group. For example, people attending AA are there to focus on their alcohol consumption. People at Overeaters Anonymous are there to address their relationship with food. If the group’s focus is not on the primary issue of concern, people will likely be turned off and stop going. Among the outside issues in the context of substance abuse are nutrition and exercise. So although speakers at meetings may address these topics if it relates to their subjective experience and members may share on these topics, none of the major twelve-step fellowships servicing the substance abuse community has ever formulated a policy with regard to nutrition and exercise.

That said, Bill W. and Dr. Bob linked modifications in the diet to the overall success of those seeking to stop the vicious cycle of drinking. In the early days, AA recommended newcomers eat certain foods believed to help reduce cravings. These recommendations were based upon the experience of others who had achieved success in remaining sober. Among the foods recommended were frankfurters and tomato paste. An early documented example was an AA member named Eddie. Eddie was constantly coming in and out AA meetings and could not accumulate more than a couple of days sober before relapsing. Eddie would frequently go on drinking binges, and when he did he acted out in a crazy manner. Fellow AA members tried to help him sober up and calm down by feeding him baking soda, which they believed would restore Eddie to sanity. For an unknown reason, the baking soda seemed to work. However, as soon as Eddie would sober up with the help of baking soda and after eating a good meal, “he’d go off his rocker again.”[i]

All this changed when Dr. William Silkworth came to meet and work with Bill W. Dr. Silkworth was a well-known early expert on alcoholism. Dr. Silkworth was responsible for helping members to focus on their diet as part of their overall recovery. Bill W. recalled, “It was Dr. Silkworth who introduced the idea to me that alcoholism had a physical component—something he called an ‘allergy.’ He knew this was a misnomer; he used it to express his intuition that something was physically wrong with most of us, a factor perhaps causative and certainly an aggravation of the alcoholic’s condition.”[ii] Dr. Silkworth’s “allergy” theory was based upon his research into the overall health of and diseases common in alcoholics.

His pioneering research was the first to document the prevalence of hypoglycemia, or low blood sugar, in many alcoholics. He also documented the high percentage of alcoholics with type 2 diabetes, then known as adult-onset diabetes.[iii] Dr. Silkworth understood these conditions were controllable through diet. He encouraged Bill W. and AA to recommend that those in both active addiction and sobriety modify their diet to reduce cravings and prevent relapse. Dr. Silkworth recommended that alcoholics eat small amounts of glucose, sucrose, or other simple carbohydrates and substantial amounts of complex carbohydrates. He also recommended low caffeine intake. Although radical at that time, these principles are well accepted today.

Adopting Dr. Silkworth’s research, Bill W. and, to a lesser extent, Dr. Bob began to recommend certain lifestyle changes to AA members and professionals providing services to alcoholics. In a 1968 communication to physicians associated with AA, Bill W. noted: “We alcoholics try to cure these conditions of hypoglycemia first by sweets and then by coffee. . . . In exactly the wrong way, we are trying to treat ourselves for hypoglycemia.”[iv] Over the years and after the death of Dr. Bob, Bill W. continued to conduct his unscientific research on lifestyle modification.

Bill W. proposed modifications to AA’s Twelve Traditions. He recommended that nutritional guidelines be incorporated into the overall AA program. The AA board rejected his research and proposed modifications. The AA board’s position was based upon the Tenth Tradition of AA—that AA takes “no position on outside issues.” Despite AA’s position, Bill W. continued to advocate for awareness of the interrelationships among food, mood, health, and alcoholism. For example, in 1968 Bill W. wrote a memorandum to AA-affiliated physicians, noting the exceedingly high rate of hypoglycemia in alcoholics. He felt the need to address nutrition in the context of “sister foods” to alcohol, such as refined sugar, soda, white bread, rice, pasta, potatoes, and French fries[v] and how these foods were contributing to relapse in people who identified as members of the recovery community.

Bill W. also recognized the link between vitamins and minerals and medical conditions related to alcoholism such as anxiety and depression. He experimented with niacin and published three pamphlets on his niacin research.[vi] Bill’s experimentation with vitamins and minerals was precipitated by his lifelong struggle with depression that continued even after he got sober.

In 1958, Bill began working with a well-known medical practitioner, Dr. Abram Hoffer, to treat his tension, depression, fatigue, and insomnia. To deal with these issues, Dr. Hoffer put him on a regimen of 1,000 milligrams of niacin, three times a day. Bill noticed that many of his symptoms seemingly disappeared. Astounded by the dramatic improvement, Bill conducted his own unscientific study of thirty people in AA. He began giving them niacin and started to track their progress and their ability to stop drinking. After one month of taking the niacin, signs and symptoms of alcoholism went away for ten people. After two months, another ten people experienced the same effect. The final ten experienced no change.[vii]

Bill W. became a vocal supporter of nutritional therapy as a part of recovery for those suffering with alcoholism. Once again, the AA board of directors distanced the organization from Bill’s niacin advocacy. The AA board took the position that Tradition Ten precluded AA from taking a position on this outside issue. The board concluded that just as nutritional advocacy was not permissible, neither was advocacy relating to supplements. Among other things, the board was concerned that Bill lacked any medical or nutritional qualifications and so was not qualified to weigh in on these issues. Bill was given a choice: to remain on the AA board and cease public advocacy on these outside issues or to resign and continue his advocacy. Bill chose to stay on the AA board. He thereafter discontinued public advocacy for integration of nutritional or supplemental recommendations into AA’s steps or traditions.