Tiebout had many years of training and experience in the management of alcohol problems before his first exposure to Alcoholics Anonymous. However, his earliest detailed article concerning alcoholism was published in 1944, 5 years into his relationship with AA, and is primarily a description of AA itself. Over the next 10 years, he published a number of articles outlining his theories about alcoholism, the psychodynamic causes of the disorder and his reasons for endorsing AA as the definitive solution.
Howard J. Clinebell, in a book for clergy on alcoholism counseling, recalled that Tiebout "likened the 'runaway symptom' of alcoholism to the dangerously high fever of pneumonia. The fever is a symptom of the underlying infection, but unless it can be lowered, the person may die of the 'symptom"." Psychiatrists, Tiebout felt, had been ineffectual because they ignored the deadly symptom in an attempt to treat a (theoretical) underlying disease. He credited AA with an ability to target the symptom directly. Tiebout's understanding of the alcoholic mind cannot be entirely separated from his understanding of the 12-step approach, but the primary themes in his writings can be summed up under several points.
The alcoholic personality In one of his early papers
The disease model The concept of alcoholism that dominated treatment approaches in the second half of the 20th century, and is still influential today, defined alcoholism as a
disease. The idea that alcohol problems constituted a disease was not new, but the particular synthesis associated initially with the
Yale Center of Alcohol Studies (now at Rutgers) and the National Committee for Education on Alcoholism had unique features not found in earlier theories. Tiebout seems to have been somewhat ambivalent about the disease model, however. In 1955, speaking of the scientific underpinnings of the alcoholism movement in general, he said "I cannot help but feel that the whole field of alcoholism is way out on a limb which any minute will crack and drop us all in a frightful mess." Tiebout introduced a definition of the term "ego" which was to become important in his later writings, particularly those for AA audiences. Although his use of the term was new, the concept behind it had been developed by Tiebout during the early 1940s. Rado hypothesized that the elation induced by alcohol produced a reaction in the form of a "tense depression", which then reactivated the childish
megalomania normally outgrown by adulthood. The result was a type of magical thinking in which "the ego secretly compares its current helplessness with its original narcissistic stature...and aspires to leave its tribulations and regain its old magnitude."
Conversion,
surrender,
confession,
restitution and the necessity of evangelizing others were ideas brought from the Oxford Group to Alcoholics Anonymous by members who had found that the intense religious devotion they inspired was the key to a changed life. Tiebout understood the concepts in a more secular way, and approved of them. Tiebout had found that superficial compliance in therapy often correlated with lack of real change, and he saw in the AA concept of surrender an antidote to this phenomenon. An act of surrender was the only cure, or practically the only one, to the problem of "compliance", or partial surrender to the psychiatrist's authority and the authority of the
reality principle. Tiebout described true surrender as "an unconscious event, not willed by the patient even if he or she should desire to do so. It can occur only when an individual with certain traits in his or her
unconscious mind becomes involved in a certain set of circumstances," essentially the circumstances of "hitting bottom". Conversion, for Tiebout, was a spiritual awakening made possible by the person's recognition of his own egocentricity. The central effect of Alcoholics Anonymous was "to develop in the person a spiritual state which will serve as a direct neutralizing force upon the
egocentric elements in the character of the alcoholic." A "vague, groping, skeptical intellectual belief" would not accomplish this but only a true emotional religious feeling, for "unless the individual attains in the course of time a sense of the reality and the nearness of a Greater Power, his egocentric nature will reassert itself with undiminished intensity, and drinking will again enter into the picture." ==Later life==