Sunday, July 31, 2016

AA, it's personal

AA, it's personal 

I love the fellowship of Alcoholics Anonymous. Most of the friends I have made in my adult life I met in the fellowship. It was in AA that I learned to make friends again. AA didn't get me sober, but it helped me stay sober. Does AA help people? If you ask my wife and daughters they will tell you yes. Lacking a higher power it was often their voices that told me I needed a meeting. They were very aware of the transformation that occurred during the time I went to a meeting and the time I came home. AA helped me be a better version of myself.

The 12 Steps... I'm not so thrilled about. I'm a nonbeliever and white I can manage "higher power" as a metaphor I don't believe in the power of prayer. I love books, but I don't like to live my life according to the contents of a book. If I do it's by chance, not design. I have multiple copies of AA's Big Book, I haven't touched any of them for over a year. I went to AA for 7 and 1/2 years and will likely hit a few meetings in the future but I never did the 12 steps. Maybe step 1, but I've since reconsidered it. I learned from the steps, I learned to try and make amends and that doing so requires more than saying "I'm sorry." So what is my problem with AA?

This was/is my personal experience. It's an experience colored by my life situation, socioeconomic status, education, and white male privilege. Even as an atheist I found I was able to be an open atheist surrounded by believers yet I didn't feel like an "other" or "outcast." Because I have supportive parents, because I have a supportive spouse, because my children are heathy and I could get financial support when I needed it I was able to approach AA at my own pace and on my own terms. 

Luck, really good luck played a role. My first sponsor didn't stick but my second (hope he's still reading this) was a perfect match. When I said I wasn't comfortable with the Big Book or with all 12 steps he said "if you don't like 12 Steps, do 3. 1) don't drink, 2) don't think, 3) go to meetings. This 3 step approach worked very well for me.

So though I may sound critical of AA in some of my posts I don't really have a problem with the program itself. AA kept me alive for years, it was there for me when I needed it and it gave me what I needed.

What I have a problem with is this:

1) Court mandated AA. I think the founders would not have liked mandatory meetings either.

2) no training for sponsors. I had/have a great and ethical sponsor, but that is not always the case. Sponsors that are not ethical answer to no one.

3) AA in a clinical setting. AA is free. Anyone in any city in the United States can get free 12 step work. So why would 12 step work be part of  a $50,000 treatment stay? 

4) The rejection of medication assisted recovery. I don't think AA has an official position on methadone. However, the influence of the 12 step movement has been a barrier for people who need methadone and other medications in treatment. Again this is not AA's fault, it's the fault of treatment programs.

If asked about AA in a professional setting I treat it like church. Are you going? Do you think it helps? If yes, keep going. It should always be a choice.

The reason I rarely attend AA these days is also personal. Where I lived in Minnesota AA was pretty much all that was available. SMART Recovery meetings existed but they were few and far between.* after moving to Rhode Island and checking out several AA meetings that didn't quite feel right I went to my first SMART Recovery meeting. I've been going to SMART for a year now and I find it better meets my needs. If things go right I will soon be facilitating my own SMART meeting soon. I also don't have a problem with using SMART tool professionally. They are REBT tool that are very appropriate for a clinical setting and will work for people of any or no faith. Still I know I haven't attended my last AA meeting.

Sunday, July 24, 2016

What are you selling?

The the practice of using half truths and outright scare tactics over science has left an indelible scar on the credibility of anyone in the recovery profession.  In the defense of myself and colleagues in the field our profession was started by faith healers, not scientists and these mystics have passed their trade from one generation to the next shouting down many attempts by the scientific and medical community to turn substance abuse treatment into anything like real medicine. While the mystics have been historically hostile to the legitimate researchers of the world they have been by comparison very welcoming to the snake oil salesman, and why not? They are the ones who sign our paychecks* and the close proximity with them has transformed many of us into a hybrid of the two. There are some promising changes happening right now which may lead us to better treatment for those who come to us for help but the first step is to stop pretending we know more than we do.

I started writing Grey's Recovery not to be a guru but with the hope of starting a conversation about things like this and in that spirit I'm going to start a list of things I learned both in treatment and while training to be a drug and alcohol counselor that turned out not to be true and I invite anyone who is still reading or happens to stumble upon this blog to add to the list. In the same spirit, if you see something that you think doesn't belong on the list please say so, and why.


1) Addiction has been proven to be a brain disease 

why not drop the big bomb first. Addiction has not been "proven" to be a brain or any other kind of disease. It has been "recognized" as a disease by several powerful medical organizations but this is a fairly recent development and it's my understanding this was done largely for billing purposes. It's hard enough to get an insurance company to pay to treat anything, even harder if what is being treated isn't an official disease. 

The truth is whether or not addiction is a disease is still very controversial. I personally feel the Learning Disorder model advocated by Maia Szalavitz in her book "The Unbroken Brain" does a better job of explaining the symptoms of addiction than any other to date.  The truth is the Brain Disease model explains very little. If drugs alter the brain in a specific way that causes addictive behaviors then why doesn't everyone who uses the drug become addicted? Why do compulsive gamblers and "sex addicts" have almost identical behaviors sometimes with no drugs at all? The Learning Disorder model explains this, the disease model doesn't. 

I feel I must tip my hat to Stanton Peele who has been arguing against the disease model since the70s. He has been a pariah in recovery circles for 40 years and I highly recommend people both in and out of the field read his work.

2) Addiction is ALWAYS progressive and ALWAYS fatal

This came right from an instructor in my first month of training said with braveheartian passion and made me feel an exquisite mix of fear and righteousness! I was very disappointed when I first read the watered down version in my text book replacing "always" with "sometimes," implying that addiction was often neither progressive or fatal. The truth is someone with any type of substance use disorder can remain stable indefinitely, and trying to force a change too soon is at least as likely to make the behavior worse than it is to bring about recovery. I've heard people who know better reply this myth as the truth in an attempt to get a resistant client to engage more in treatment which I see as nothing short of malpractice.

To my knowledge there is no reason for an otherwise healthy person to rush into treatment as long as there are no physical or psychological problems which combined with continued use might put the person's life at risk. If the person is stable, they will likely remain so at least for the near future and if left to their own devices may even recover on their own.  

3) The 12 Steps of recovery are the only "proven" treatment for addiction 

As a person who attended AA regularly for over 7 years it's hard for me to admit that this one is wrong. Many of us in recovery have a strong emotional attachment for the way we recovered and in this I am no different. But the truth is there is very little evidence either for or against 12 Step work. What evidence does exist is highly suspect and even the little that supports 12 Step involvement doesn't support it very well. I do feel being in AA was helpful to me, I found a good meeting where people respected the fact I am an atheist, and a good sponsor who did the same. I needed friends in early recovery and I found them in AA. But after moving to Rhode Island I just couldn't find an AA meeting that felt right so I found SMART recovery. 

SMART unlike 12 Step organizations is very open to scientific scrutiny. There is still the issue of anonymity and SMART attendees are not required to participate in studies or even give their names but in spite of this there is some very promising data that speaks to its effectiveness. I'm not saying that SMART is a cure all, I only mention it because most people in the recovery field have no idea that SMART Recovery exists and that it is at least as effective (and possibly more effective) as the 12 step alternative, but it wasn't mentioned once that I can remember in either my treatment or my training.

4) If you have a problem with ___________ you will never be able to use it normally again.

The watered down version of this is that some people are able to moderate use again but that the number is so small that it is statistically insignificant. Unlike the other things on this list it is possible that this is true, but I doubt it. The truth is we have little idea how many people are able to moderate use after showing addictive behaviors for a substance. What little data there is show that of people who had diagnosable alcohol dependency the percentage of people who may be able to someday drink with moderation is between less than 5, or slightly above 50 percent. I wouldn't stand behind either number, the truth is I just don't know. As hard as it is to count addicts it is even more difficult to count those who return to moderate drinking. In the field we only meet with those who try and fail, so it looks to us like a %100 failure rate, but the ones who achieve moderation don't come back to visit us. If they do they don't tell us they are drinking moderately. If they did we would treat them with suspicion. So we don't see them at all. Many of those who have achieved sustained abstinence may be able to return to moderation but don't try, because we tell them it's impossible. 

The few times a client has felt comfortable enough to share with me that they are thinking about returning to use I tell them I have no idea what their odds are. I do know that people who attempt lifelong abstinence often experience relapse so even that is no guarantee of success. So I tell them to be careful and to come back and visit sometime, even if they are successful.

Obviously the list could go on much further but I'm getting tired of writing. My advice is to avoid speaking in absolutes as they are usually false and to research any "fact" you find yourself repeating more than once a week.

Please feel free to call me a madman or a genius in the comments, I will consider either a compliment.

* when referring to snake oil salespeople I am not referring to my current employer or anyone I have worked for in recent years. I have been lucky.