Available treatments for Addictions

[David O]

As one who has followed the ongoing discussions surrounding addiction and AA in particular, I’m concerned that our site’s addiction page identifies only the 12 step treatment model and makes no mention of others. The site should list the following links alongside AA:

http://www.smartrecovery.org/

http://www.moderation.org/

http://www.rational.org/

http://www.cfiwest.org/sos/index.htm

http://www.womenforsobriety.org/

http://www.unhooked.com/index.htm

http://www.recovery-inc.com/

[xenophon]

Bravo , sir. Wel land truly done

[karuna]

David. As someone who has a family member who is addicted to drugs, I am seeking as much information I can get my hands on. This forum was confusing to me because I was trying to glean some insight, but I found I was not on the same page, so to speak. Thank you.

[SweetSue]

:)Good on yer David:)

[Claire Saenz]

David,

I agree completely. Thanks for bringing this up; I think it's quite important.

Claire

[David O]

Karuna,

Is there anything specific you're looking for? I'm a strong believer in SMART Recovery, it is an evidence based program that uses strong cognitive-behavioral elements. In my practice I will refer clients to most of the programs listed (but primarily Smart Recovery) based on who and where they are in the recovery process.

As an aside, I do not refer to AA/12 step and will generally not see anyone who is involved in AA since the AA/12 step model teaches that one is powerless ---- whereas, therapy is about self empowerment. My clinical experience (>30 years) suggests that most clients who come in while in AA/12 step programs, struggle with self reliance, self confidence and self determination-- byproducts of not being self empowered.

Please understand that my intent is not to bash AA/12 step programs, that serves no one and may even be harmful to many-- it is merely to point out an observation based on work with the severe and persistently mentally ill.

Good luck and I hope this helps,

David

[JulianP]

David,

You are a long overdue and a very, very welcome breath of fresh air.

Thank you, thank you, thank you!!!

JP

[karuna]

David,

I have used the S.M.A.R.T. system in my business and I find it useful. I'll have to read about the SMART program for addiction. I strongly believe self empowerment is the answer for many and specifically for my nephew's personality and life situation.

I have to learn more about what program his lawyer is suggesting for him. My nephew said he would prefer to remain in jail than live dependent on drugs, both emotionally and physically--to go back where he was. He never responded well to AA.

Are there any reading materials, you can recommend, that may help me understand addiction and how I can help empower him as well as myself through this process?

Thank you.

[David O]

Karuna,

You must be talking about the Simple, Measurable, Actionable, Relevant and Time-framed model for objectives setting in business-- I also use this as part of my Hoshin strategic planning?

SMART Recovery stands for Self Management and Recovery Training--- you can find a good summary with additional links at:

http://www.his.com/~washdcsmart/jan99.htm (http://www.his.com/%7Ewashdcsmart/jan99.htm) (brief 1 page but good summary)

http://smartrecovery.org/resources/library/Newsletters/Newsletters/summer2009.pdf (This is an excellent read)

http://smartrecovery.org/resources/library/Newsletters/Newsletters/spring2009News&Views.pdf (This is an excellent read)

The bottom 2 links are the SMART Recovery Newsletter, which you should be able to subscribe to and even go back thru and get a good sense behind the science and logic of the program. SMART's basic model (which is highly comprehensive, evidence based and well grounded in the cognitive and behavioral sciences), "offers specific tools and techniques for each of the program points:
1) Enhancing and maintaining motivation to abstain
2) Coping with urges
3) Managing thoughts, feelings and behavior (problem-solving)
4) Balancing momentary and enduring satisfactions (lifestyle balance)"

Good luck and I hope this helps.
David

[Claire Saenz]

Good suggestions, David. I am involved in SMART Recovery as a meeting facilitator, and I believe it is a great approach. I only wish that 11 years ago when I presented myself for medical treatment for my addiction, I had been told about SMART and other programs instead of simply being shunted into AA. Of course, that would have been unlikely since my treating counselor was himself an AA member and uninterested in any other approach.

Claire

[xenophon]

As a personal estimonial, I found SMART Recovery on line quite useful. The use of the tools helped to get back to my normal stoical self; the message board and on line meetings someone 'talk' to besides the cat. The cat is quite an empath; but, not sentient. I did no live meetings. I could have; but, I am not that sort.

I considered AA as an option. But, I read what was available on line. I chose SMART.
During that turbulent year of 'magical thinking' - the year in which everyone that I cared about died - it is doubtful that anything would have provided succor. " A verb is anything that signifies to be; to do; to suffer. I Signify all three." That sentence by Gen. Grant describes the matter perfectly.

[John Rutledge]

David,

I think that these references are present somewhere in the wild margins of this site - but I am not sure where. In any case, their restatement here is timely.

Thank you.

Yours from Trimpeytown,

[David O]

Claire and xenophon,

Thank you for your responses. In my experience with AA/12 step, I found that clients who were either involved with or who had stopped going to AA, often required several sessions of "deprogramming" from a worldview of powerlessness and dependency on others to one of self determination and self empowerment. The mindset was deeply ingrained via a series of slogans (e.g., let go and let God; turn it over; if God seems far away, who moved?; I can't handle it God- you take over; admit that you're powerless, etc.) and further solidified in the meetings and thru the sponsorship program.

I have found no such deprogramming sessions to be necessary with clients from SMART Recovery or any of the other recovery programs sited in the initial post here. What I also found was that clients required a certain amount of venting or catharsis (there was much anger and feelings of being damaged and lied to) as they distanced themselves from AA/12 step: no such venting/catharsis was required or observed from clients involved in the other programs.

I do want to add that I've attended 100-200 AA/12 step meetings in the US and other countries-- there was a consistent, patterned message in each of them. Given this, it seems AA/12 step programs are globally uniform.

Over the years, I found this to be very telling. Once again, I need to be clear that my intent is not to bash AA/12 step, but more so to report my experiences over the decades. I have never been an alcoholic (in fact I have rarely consumed alcohol), so my perspective is that of an outsider looking in.

However, my real goal was to have other treatment models included on this site as reference links, side by side with AA/12 step so that options can be readily available to anyone seeking help with their recovery.

JR, yes these references/links are mentioned elsewhere; however, they are not easy to find (thy're in the "wild margins" you mention) and require several window openings to get to. I thought it best to have them front and center, side by side with AA.

David

[John Rutledge]

David,

As I have said, I agree, completely. However, I have a vision of you, sitting on a bench in the Mead Hall, sipping your San Pellegrino. Suddenly - a loud pounding on the door ...

Yours from the Mists of Time,

[Abbadun]

Hi David

Here is some great Supplementary Material:

Sober for Good by Anne M. Fletcher

She gives a good review of many different paths to sobriety.

http://www.annemfletcher.com/sober.html

William


As one who has followed the ongoing discussions surrounding addiction and AA in particular, I’m concerned that our site’s addiction page identifies only the 12 step treatment model and makes no mention of others. The site should list the following links alongside AA:

http://www.smartrecovery.org/

http://www.moderation.org/

http://www.rational.org/

http://www.cfiwest.org/sos/index.htm

http://www.womenforsobriety.org/

http://www.unhooked.com/index.htm

http://www.recovery-inc.com/

[xenophon]

I can easily see why deprogramming/debriefing would take place after serious involvment with AA. I read the 12 steps and the 12 traditions when looking for a good place. I found them to be very problematic, in practical and philosophical terms. Far too problematic for me to take that sort of risk.

Of course, the worst was over; my state of mind was far less turbulent and disordered than it was earlier.

A sort of salient point: I think that mental illness are linked; if not under the same yoke.

[Tony J]

Claire and xenophon,

Thank you for your responses. In my experience with AA/12 step, I found that clients who were either involved with or who had stopped going to AA, often required several sessions of "deprogramming" from a worldview of powerlessness and dependency on others to one of self determination and self empowerment. The mindset was deeply ingrained via a series of slogans (e.g., let go and let God; turn it over; if God seems far away, who moved?; I can't handle it God- you take over; admit that you're powerless, etc.) and further solidified in the meetings and thru the sponsorship program.

David


David, are you talking about people with serious mental illness needing to be 'deprogrammed' Or are you implying that the average AA member will require this ?

I find myself to be much more empowered in all areas of my life when I use the AA philosophy. I need to go to meetings often in order to keep myself 'programmed'. That is the most common response to AA. It works but requires persistent effort. If that effort is not applied the effect slowly wears off.

Deprogramming is hardly required. Most alcoholics will easily lapse into their old ways. I'm sure the other programs you suggest will work much the same. If the patient keeps up with them, they'll continue to stay sober and grow. If they slack off, they'll regress. We are, after all, creatures of habit.

[malign]

Can I vote to make this thread sticky, so that those resources remain at the top of the page? It makes sense that people be allowed to choose.





Sorry Mark... I was supposed to quote you and mistakenly wrote over your comment, thus the editing at the bottom-- mea culpa!

[David O]

Hi Tony,

Thank you for your respectful response and excellent question. I realize all to well that this is an ongoing debate within the forum and have avoided involving myself in it given that much of the debate surrounds those who benefit from AA, and those who both have been/or feel quiet damaged by AA/12 step involvement and who see limited efficacy for it (i.e., the research has yet to provide evidence based support for its effectiveness despite 70+ years of existence).

Never having been involved as a recipient of the AA/12 step therapy model, I can’t offer an opinion on whether it would work for me or not (although I have attended >100 meetings). I thus confine my comments only to direct observations, which are based on both populations, those with and those w/o a severe and persistent mental illness. While many feel empowered by the AA/12 step model (as you do), many do not. The lion’s share of those who did not benefit did require some backwards work to undo much of the ingrained ideology, which was counter intuitive to self empowered decision-making and judgment, and to the therapy process.

Tony, I would request that you approach this objectively before you go further… not as an AA/12 step member, but as someone carefully examining the logic, science and reasoning of empowerment as taught by AA/12 step and that of empowerment as taught in the behavioral and social sciences. The definitions are remarkably different, manifest in significantly different ways and result in completely different convictions regarding self determination and self efficacy.

I did want to address one comment in your response: “I need to go to meetings often in order to keep myself 'programmed'. That is the most common response to AA. It works but requires persistent effort. If that effort is not applied the effect slowly wears off.” Many of the other programs do not require long term meetings or persistent effort as you describe, and the effect does not wear off over time. In fact, as in therapy, once the skill set is applied repeatedly, one's success rate increases, which in turn strengthens the skills set-- there is no weakening of one's resolve over time when one uses the other models mentioned. Many of the other programs provide their participants with a specific cognitive and behavioral skills set (based on behavioral and cognitive research) for preventing and reducing the risk of relapse.

I welcome any scientifically informed and substantive discussion that this creates, but will not argue this as it seems to spiral downward quickly as seen elsewhere on the site.

Best regards,
David

[David O]

Can I vote to make this thread sticky, so that those resources remain at the top of the page? It makes sense that people be allowed to choose. I think this a great idea! It will, of course, be most helpful if it doesn't spiral downward where it loses its capacity to provide a helpful and informed service to the community

[David O]

David,

As I have said, I agree, completely. However, I have a vision of you, sitting on a bench in the Mead Hall, sipping your San Pellegrino. Suddenly - a loud pounding on the door ...

Yours from the Mists of Time,

Jr... you really do need to stay off the ole Belgian and Cream ale whilst you're able!:D

[Claire Saenz]

Hi David

Here is some great Supplementary Material:

Sober for Good by Anne M. Fletcher

She gives a good review of many different paths to sobriety.

http://www.annemfletcher.com/sober.html

William

Yes, Sober for Good is excellent. I also like AA is Not the Only Way:

http://www.amazon.com/gp/product/0976247992/sr=8-1/qid=1142549231/ref=pd_bbs_1/102-8086526-2365752?_encoding=UTF8

and Recovery Options: The Complete Guide

http://www.amazon.com/Recovery-Options-Complete-Joseph-Volpicelli/dp/047134575X/ref=pd_sim_b_1

[Tony J]

Dave : Many of the other programs do not require long term meetings or persistent effort as you describe, and the effect does not wear off over time. In fact, as in therapy, once the skill set is applied repeatedly, one's success rate increases, which in turn strengthens the skills set-- there is no weakening of one's resolve over time when one uses the other models mentioned. Many of the other programs provide their participants with a specific cognitive and behavioral skills set (based on behavioral and cognitive research) for preventing and reducing the risk of relapse.


I have trouble taking that at face value. Human beings are never static and any life changing discipline requires constant practice and attention to detail.

Exercise is only effective for so long. Then it wears off.
An academic study is the same way. It's hard to conjugate your verbs 20 years after your high school English class.

In my experiece with therapy, it's the same. I agree that a skill set can be learned in a fairly short time but it can also be neglected and forgotten in an even shorter time.

AA is not the only way a person can get and stay sober, of course.
But I suspect the addict will have to work just as hard in any program or method of recovery. If a person likes their medicine, they're more likely to take it, but if they want to get better at some point they need to take the medicine.

[xenophon]

There is a lot involved here. One is the connection between a particular method and the individual. Some methods will resonate with a particular person that will not with another. That is why having options avaiable is important here.

Another is state of mind. if you believe something is impossible -- it is.

Mental illness is involved as well. People tend to fall between the cracks here. We do not have a good grip on either mental illness or substance abuse. We, certainly, do not have a good grip on how they combine in human individuals. The human mind is very complicated; and, real people refute stereotypes.
Sometimes, drinking too much is drinking too much.

[David O]

Tony,

Your perspective is one I’ve heard from those who have been using the AA framework for conceptualizing addiction. If I understand it correctly, the 12 step model views the addict as powerless and in need of a higher power to intervene-- empowerment therefore comes from an outside force/source.

In contrast, the social and behavioral sciences increasingly view addiction recovery using the Transtheoretical (Stages of Change) Model which conceptualizes change in terms of several major dimensions, all of which presuppose that the locus of control lies within the individual addict rather than in an external force (higher power). The core constructs, around which the other dimensions are organized, are the five (for some six) stages of change. These represent ordered categories along a continuum of motivational readiness to change a problem behavior. Transitions between the stages of change are effected by a set of independent variables known as the processes of change. The five (or six) stages are:


Precontemplation: Individual has the problem (whether he/she recognizes it or not) and has no intention of changing.
Contemplation: Individual recognizes the problem and is seriously thinking about changing.
Preparation for Action: Individual recognizes the problem and intends to change the behavior within the next month.
Action: Individual has enacted consistent behavior change for less than six months.
Maintenance: Individual maintains new behavior for six months or more.
Termination Individual has zero temptation and 100% self-efficacy and is not inclined to return to old unhealthy behaviors.

Using the Stages of Change model, individuals who have reached the maintenance/termination stages have incorporated change within themselves and do not require constant reinforcement from a group or feel a continual need to identify themselves as diseased- which significantly decreases dependency on others for one's health, impulse control and decision-making. This redefinition of no longer being an addict or diseased results in an identity shift to self empowerment, self determination, self regulation and self responsibility—all of which have a significant and positive effect on self esteem, self evaluation and self image (lots of selves here).

Tony, is there a direct correlation between self esteem and self image, and drinking behavior? If there is, imagine the effects of this shift in focus from other (external) to self (internal) empowerment!

Thank you for your response and I hope this explains my reasons for wanting the information of other models more visible.

David

[John Rutledge]

David,

Thank you for that. I would agree, from my own experience, with the gerenal pattern suggested. I do feel that, in real life, the progression is often more complex, and may involve the help (not "intervention") of others along the way. That having been said, I do believe that self-empowerment, and self-actuated recovery, is likely to be the key and that even people who embrace the "helplessness" model are really, fundamentally, helping themselves if it "works".

Where "helpnessness" is really induced, I believe that this may be dangerous. It holds within itself the potential for a relapse - perhaps even an excuse for it.

Thanks again,

[xenophon]

If you believe that something is impossible -- it is.
You will not be able to make a real effort, if you make one at all.

There are reasons -- particular to a discrete individual - why a person does not succeed in drawing a line under it. frequently, that failure to quit may be mental illness.

[Tony J]

Tony, is there a direct correlation between self esteem and self image, and drinking behavior? If there is, imagine the effects of this shift in focus from other (external) to self (internal) empowerment!

I hope not. My reputation number goes down every time I post and it's not helping my self image very much.

[David O]

John: You're right, while the model appears to be linear, it's actually much like Maslow's hierarchy of needs, they cycle back and forth, slowly progressing 3 steps and regressing 2, but the trajectory is typically forward with a few derailments along the way. This is the unpredictability of our beautiful humanity!

And I think you're right on count 2--if you "embrace helplessness", it can result in relapse, whether incidental or instrumental.

xenophon: Mental Illness is always one of the biggest factors in the equation. Co-morbidity always makes the issue much more complex, which is why when working with the dually diagnosed, one has to be more structured, deliberate and careful with treatment.

Tony: I'm not sure what to say about your reputation loss. Is there anything in your behavior that might be resulting in this? It would seem you're the common denominator! I have 3X more posts than my wife and she has 2X more reputation points than I do (of course she's much smarter than I'll ever hope to be)-- go figure!:D

[Tony J]

Dave thanks for the info. I do have a few things to comment on.
(besides my rep)

Your perspective is one I’ve heard from those who have been using the AA framework for conceptualizing addiction. If I understand it correctly, the 12 step model views the addict as powerless and in need of a higher power to intervene-- empowerment therefore comes from an outside force/source.

I would say that your understanding is not exactly correct. The 'model' is, I suppose, a sort of sin/redemption model that assumes that God is not working in any effective way until the convert is...well, converted. But once this union is achieved (between God and convert) then the God power is now available to the convert. The convert is in a state of some sort of new power (ie. he is not 'powerless'). Many, AA's will testify that God dwells within them and will never leave. To make too much of the internal/external contrast is really splitting hairs. The transformation in the AA model must be internal. That is pretty much universally understood by AA's.

In your model the therapist will affect a very similar change. The patient will learn how to develp skill and use tools that will allow them to overcome the addictive behavior.

The end result in both cases is a person who can now live his life without the burden of addiction.

One problem with the AA model would be that a radical atheist would refuse to use it, because it would challenge their world view (at a time when their world view is changing more than they can bear anyway). I say 'radical' because there are quite a few atheists who not only get sober in AA but enjoy it. But they are people who don't feel threatened by theistic ideas.


Using the Stages of Change model, individuals who have reached the maintenance/termination stages have incorporated change within themselves and do not require constant reinforcement from a group or feel a continual need to identify themselves as diseased- which significantly decreases dependency on others for one's health, impulse control and decision-making. This redefinition of no longer being an addict or diseased results in an identity shift to self empowerment, self determination, self regulation and self responsibility—all of which have a significant and positive effect on self esteem, self evaluation and self image (lots of selves here).

I still don't agree with stage 6. In my practical experience any addiction is very apt to lie somewhere below the surface and pop back up at some point.
We all know the smoker who picks up after 10 years and now can't quit, or people who yo-yo up and down with weight. The behaviors seem to be hard wired at some level and constant effort is needed so as not to reactivate them. That's my take on it. I can be wrong. If your patients don't drink. I won't mind.

Tony, is there a direct correlation between self esteem and self image, and drinking behavior? If there is, imagine the effects of this shift in focus from other (external) to self (internal) empowerment!

You know, for a person who drinks because of poor self image you may be correct. I may have done that some time in the distant past, but my last years of drinking were due to the compulsion of physical and mental addiction.
I drank, in other words, because I was an alcoholic. No reason greater or less than that.

As far as considering myself 'diseased'. I don't see that as something that hurts my self image. The fact is, that AA teaches that everyone is 'diseased' in one way or another. So if I see myself as flawed (and in need of redemption via the sin/redemption model) but I also see everyone else as flawed then the playing field is even. My self image is much better now than before I joined AA. And I don't expect or demand quite as much from others.

Now, if I heard that 'I' was diseased and no one else was (as I'm sure some do even if it's only 'how' they hear it) then I would have to agree with you. That message would be very destructive.

Peace.

[xenophon]

You have people who are mentally ill, with all the different ailments, and each, I imagine, has its' own complications and impediments. I see this as real issue. Others may not. But, I do.
Especially with personality disorder. Misdiagnosed and mistreated.

There are those who drink too much because they drink too much. They are much like any other man, only more so. They are not, technically, mentally ill. Nor, do they have troubles from drinking. Nor, would many consider them to be drunkards. But, they get diseases, like cirrhrosis. Another group falls through the cracks.

All sorts of different people drink too much; for all sorts of reasons. real people refute stereotypes.

[John Rutledge]

One cannot see anything in there. Nor is one intended to. It is a matter of feeling the heat. Whether one wants to or not.

Yours from Nibelheim,

[progree]

Alternatives to A.A. (Alcoholics Anonymous) and N.A. (Narcotics Anonymous)
Descriptions of 7 A.A. / N.A. alternatives at mentalhelp.net

www.mentalhelp.net/poc/view_doc.php?type=weblog&wlid=6&id=443&cn=14

Below is a listing of the A.A. / N.A. Alternatives discussed at the above link, plus additionally "HAMS: Harm Reduction for Alcohol and Other Substances". The below list doesn't include "Recovery, Inc." because that organization is for mental help, primarily anxiety, and nothing specific to chemical addictions. (Thanks Ray raysny)

SOS (Secular Organizations For Sobriety, also known as Save OurSelves)
www.sossobriety.org/
http://health.groups.yahoo.com/group/sossaveourselves/

SMART Recovery
www.smartrecovery.org
http://smartrecovery.org/SMARTBoard/

LifeRing
www.unhooked.com/index.htm
http://forums.delphiforums.com/lifering/start

Women For Sobriety
www.womenforsobriety.org

Moderation Management
www.moderation.org

HAMS: Harm Reduction for Alcohol and Other Substances
http://www.hamshrn.org/index.html
http://health.groups.yahoo.com/group/hamshrn/

Rational Recovery (no support groups)
www.rational.org

================================================== ==
Alan,

You were wondering what we're upset about in the "AA & Religion" thread. Well, one thing that upsets me is that the Addiction home page
http://www.mentalhelp.net/poc/center_index.php?id=14&cn=14
lists only 12-step groups.

I hope you will include the above groups at this link. The listing at the URL at the top of this message, while commendable, is too deeply buried for most Addiction / Addict visitors to find.

The other thing that particularly irks me about 12-step groups is that they claim to be "not religious", while pressuring people to work the 12 Steps (or even requiring it). Take Step 11 for example:

Step 11 "Sought through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of his will for us and the power to carry it out."

Now what concept of "God" fits in the above other than a prayer-answering deity? Do you pray to the group, a light bulb, a tree?

Or take Step 3 - "Made a decision to turn our will and our lives over to the care of God as we understood him"

What besides a deity would a person turn their will and lives over to? I sure wouldn't turn my will and life over 100% to any human institution or group of humans. Not when they (many groups though not all) tell people to quit taking prescribed medications and quit seeing therapists.

They also push people to read the Big Book -- which is full of insults to non-believers, particularly the "We Agnostics" chapter where they call non-believers "vain", "fooling ourselves", "perverse", prejudiced", "obstinant" and on and on. How is this slamming of non-believers not religious?

What if I called you "vain", "fooling yourself", "perverse", prejudiced", "obstinant"? I bet you would be pretty angry, right?

As others have said in the A.A. & Religion thread, we are angry, very angry, that people are forced by court order and employer mandates to attend such a mendacious program that, despite its claims of "rigorous honesty", it mendaciously claims to be spiritual and not religious. And it pulls this deceptive bait-and-switch stunt -- we're not religious but you had better work the 12 Steps and listen to us blather endlessly about how a prayer-answering favor-dispensing deity is doing all these great things for us (while letting millions starve, but who cares).

Progree

[xenophon]

When I was on line checking for groups, I found them. And, checked out each one carefully. I found them all good. My 'plan A' was SMART Recovery. If I had become disenchanted with SMART, groups like SOS & LifeRing would have been 'plan B'. This doesn t refect ill upon either. Just my personal call.

[David O]

To all who commented, thanks so much for your feedback and interest.

The purpose of this thread was to present side-by-side options/choices to AA/12 step on the addictions page. As a sticky, this has been already done. Given this, the thread is now locked from further comment.