If
mental health professionals find problems with my ideas, senior members
of the various Twelve Step groups may well join them in the complaint
department because I suggest, in the pages to follow, some re-wording
of those basic Twelve Steps.
Times
and people have changed in the seventy years or so since William Wilson
wrote his program for recovery in Alcoholics Anonymous. Our courts have
increasingly classified Alcoholics Anonymous, and, by extension, all
similar Twelve Step programs, as religious organizations. The words God and Higher Power
appear in the steps for recovery, and meetings often begin and/or end
with group prayer. The problem with this arises when professional
treatment programs order their patients to attend such groups as a part
of treatment. It amounts, in the eyes of the law, to enforced religious
attendance, and the courts have ruled in favor of those who filed
complaints.
We
may not like what the federal courts decide, but it is the law.
Learning to obey and respect the law, it seems to me, is fundamental to
personality development and to the recovery of normal living. In the United States,
we practice the separation of church and state and so, by extension, we
cannot use government money to force religious participation.
Fortunately, I think there is a good way out of this problem.
Religion
is, of course, a matter of personal choice. And I do not agree with
treatment programs that enforce attendance in any particular self-help
group program as a part of their treatment, whether or not is contains
religious elements. Very often, paid professional addictions counselors
attend community groups along with patients and run the meetings. This,
of course, is in violation of the traditions of Alcoholics Anonymous as
we shall see later. Good treatment would involve suggested
exposure to, and study of, any and all self-help programs offered in
the community. Recovering addicts cannot learn to make good choices if
choice is taken from their hands by the treatment staff.
As
far a traditional A.A. meetings go, if someone is abstaining and is
comfortable in their recovery, there is probably little point in
changing what works for them. As senior members of self-help groups
know, however, some newcomers take a long time to accept parts of the
recovery program. Most newcomers, in fact, leave after a few meetings;
the retention rate in Twelve Step groups is low, and this is sad
because there really is not much long-term help available outside of
these Twelve Step groups. Although the dropout rate is high, many new
members eventually return. Growth and understanding take time to
develop. Professional treatment programs last only for a matter of days
or weeks, and then the person is alone once more. Professional
treatment is very expensive. The self-help groups will always be there,
however, and they are free.
It
has been my impression that even if a person leaves a Twelve Step group
after a short time, he or she has learned something of importance,
perhaps just a thought or bit of information that may surface months or
years later to lead them on to a better abstinence and back to the
group. We have no way of knowing the long-term benefits of attending
even a few meetings, but something, I think, is always learned and
retained.
There
is a tendency among mental health professionals to ignore the Twelve
Step recovery programs. They may leave clients in the hands of
recovering peer counselors who themselves are abstaining addicts paid
for their work. Professional treatment sometimes does not even
recommend or encourage attendance at meetings of any of the various
groups that have the word anonymous in their names. Some mental
health professionals, in fact, warn clients to avoid self-help groups
that offer any kind of spiritual education. Ethically, the professional
therapist cannot force attendance in self-help groups although in the
past our legal system sometimes has done so as a condition of parole or
probation, but we should at least encourage clients to try them.
Professional
psychotherapy is restricted by financial resources, but many addicts
see psychotherapy as more noble or perhaps more effective than
long-term participation in any of the groups of anonymous fellow
sufferers. In my opinion, it is a disservice to honor the client’s
belief that he or she is too good or too complicated for self-help
groups. It is a disservice to offer the hope that some relatively quick
therapeutic magic can eliminate a serious addiction. Obviously, once
treatment is finished, once the bills are paid, the client is again
alone to cope as best he or she can. Experience shows that without the
continuing compassionate care of groups such as Alcoholics Anonymous or
Overeaters Anonymous, the chances of good abstinence and improved
quality of life are significantly reduced.
[BB]
In
many cases, when professionals sell treatment for the various addictive
disorders, they have little to offer beyond a few psychological tests,
perhaps a captive meeting of Alcoholics Anonymous, and whatever number
of group therapy sessions health insurance plans are willing to
subsidize. A rare treatment program here and there bothers to collect
and publish its success rate where success is defined in terms of
abstinence and improved quality of life. Psychotherapy is still very
much an act of faith when it is offered by itself as a treatment for
addiction.
The
Anonymous groups are free, and they will be there long after therapy is
over. They offer in their philosophy certain profound and necessary
conditions for normal living. Related groups for loved ones of the
addict offer help and support to others in the addict’s life through
the practice of the same value system.
One
advantage of a well-trained doctoral level professional should be a
broad view of the individual client, and of all the other possible
problems that may be discovered. On the other hand, members of Twelve
Step groups have a great depth of understanding in the particular
problem with which they deal. It would be my preference to see
professional treatment as an auxiliary to Twelve Step or other kinds of
community groups, not the other way around. In my estimation, only
about twenty percent of addicts have problems that require professional
attention, the rest in some way are able to cure themselves or use the
folk psychology of recovery groups such as Alcoholics Anonymous.
Many
psychological problems for which professional treatment might be
helpful seem to emerge later in abstinence; frequently an attempt at
psychotherapy is ineffective in the early days of sobriety. The first
step is to acquire some degree of emotional stability through sobriety
or abstinence, a stability that includes a resolution to do whatever is
required to keep and improve the quality of abstinence. More than
abstinence, sobriety is a state of mind that can be learned, practiced
and taught to others. This is a state of mind that all addicts must
learn. I use sobriety and sober to refer to a mature state of mind as much as to non-intoxication.
The
first priority is always to stop using and, sadly, many therapists
still try to work with clients who are practicing an addiction when
they should suggest the client attend a recovery self-help group and
have a medical detoxification program if needed.
It
is my strong opinion, then, based on experience with addictive disorder
clients, that professional treatment should support and compliment a
Twelve Step Program or other long term community self-help program.
Professional therapy is not, however; a replacement for it. So, I have
a problem: how do I encourage attendance in what the courts have
decided is a religious organization, attendance that I think is often
essential in long term abstinence?
The
legal system is not alone in questioning the religious content of
Twelve Step programs. Some newcomers in the Twelve Step anonymous
groups are put off by prayer and the use of words like God and Higher
Power. My goal here is to analyze the ideas contained in the Twelve
Steps in terms of their practical importance to recovery from any
addiction, not to encourage any kind of religious practice. We must,
beyond this, find ways to use Twelve Step philosophy without giving
even the appearance of religiosity if we expect the broad support of
the professional community and the legal system.
Some will say this is impossible, but please keep an open mind and bear with me.
[BB]
My
ambition is to improve the quality of life on this earth. I take no
position on questions of religious belief and leave the reader to
formulate what, if any, of such beliefs seem appropriate and helpful for themselves but not for others. Religious
elements in any Twelve Step program should, I believe, be considered as
personal and private options, never as essential and required elements.
This issue, then, is the one on which some readers may take offense. I
beg their tolerance for the time being. In rejecting religious aspects
of recovery I am not rejecting their value in society or the person who
may hold those ideas.
Those
who wish to incorporate religious values and beliefs into their
recovery programs should certainly be free to do so while respecting
the right and ability of non-believers to profit from the basic
concepts contained in the Twelve Steps. Tolerance of diverse religious
beliefs is essential, and would include, I think, avoiding persuasive
attempts to change the religious beliefs of others when such efforts
properly belong in the domain of religion itself. In other words,
abstinence from addiction and the repair of the damage done by it are
the essential areas of focus. Everything else is arbitrary and
optional. No matter how important and valuable you have found your
religion to be, I suggest you leave it at home and in the church,
temple or mosque when you attend a public self-help group.
All
that said, some sort of conversion experience to new values, not to
mystical religion, is a significant feature in most abstinence and
recovery stories. The phenomenon of the spiritual experience will be discussed in columns to follow. The word spiritual is here used in a non-religious sense of the human spirit,
and includes motivation, drive, insight or enlightenment. Nothing,
however, should deter the individual from privately adding religion to
their lives if they wish, but there is no substitute for a new way of
acting and thinking here, today, in this material world of ours. Just
putting in the concept of God and saying a few prayers cannot
substitute for real personal growth and change. On the other hand, no
obstacle, not even in the wording of the Steps themselves, should be
placed in the path of an agnostic who needs the concepts and values
offered in the Twelve Steps yet cannot honestly be comfortable with
religion.
The admonition to carry the message
does no refer to the religious tradition of teaching the insights of
religion in the non-religious. As used in A.A., it means to carry the
message of sobriety and recovery. It is a message of optimism for a
better life now, in this world, not a promise of a place in Heaven.
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