Wednesday 10 December 2014

Unity or Uniformity

     Twelve step programs-- although very much retaining the monopoly on what the majority of American treatment and rehabs offer in terms of how to maintain abstinence-- may not be the best fit for every patient or client or participant seeking to get free from addiction. This is something that we often ignore while bemoaning those who have darkened the doorways of 'our' meetings [and 'our' treatment facilities, if we happen to be staff at one of them] who went back out or continued to use. We are so fond of claiming that various addictions are now a disease of some sort. 

     What kind of people are we when we blame the patient for failing to gain or regain health after one or more bouts with a disease?

     When a cancer patient gets sicker and dies in spite of the chemo or radiation, do we blame the patient?

     When someone gripped in the natural course of a non-reversible dementia progresses and dies in spite of medical interventions, do we blame the patient?

     And yet, the addict seeking help is blamed for his or her return to active addiction. [I use addict to also include those who are addicted to alcohol]. What gives? Maybe we don't really believe in the disease concept. [Okay, I don't. I don't claim acceptance of the disease concept which seems to have swept the addiction treatment industry by storm].

     The problem does not lay in how we define addiction. Whether it is a medical condition with multiple etiologies and a disease-like progression, an actual disease, something else entirely, or a combination of these things is not something that I am taking issue with in this particular blog post. 

     While how we define addiction certainly does determine whether or not insurance companies will pay for treatment, it is not really at the crux of the problem. The problem is the low success rate ascribed to addicts seeking recovery. When making a decision related to my health, I seek out more than one option. And when the success rate for an option presented to me is described as anywhere from ten percent to just under thirty-four percent, I certainly do my research. I want the odds to be in my favor. In cases of severe and/or chronic and/or terminal diseases or conditions, there may not be better odds or very many viable options. Science offers us the opportunity to discover and describe best practices in medicine.

     In the United States, I think what we are suffering from is a lack of rigorous research into the multiple causes of addiction, treatment options, and how to determine the best fit for each client or patient. Twelve step programs have aided many of us in changing our lives thereby enabling us to become and remain abstinent. Yet, some percentage of people fail out of meetings with or without adjunct professional help. Not every human being is able to find a new way of life within the current structure of treatment and maintenance of abstinence. 

     There is no one way to recover. Yet, one way to recover utilizing the twelve steps of various Anonymous programs is what is pushed by the addictions treatment industry.

     We have today other ways to develop social support systems-- there is Celebrate Recovery [for Christians], Secular Organizations for Sobriety [or s.o.s. for non-theists, and for those who may be religious but wish to separate their religious practices from their recovery program], the Red Road [for Native Americans], Women For Sobriety [for women], Double Trouble and Dual Recovery Anonymous [both organizations are for those who also have mental health diagnoses], Rational Recovery [for rational people], Drug Courts [for non-violent offenders-- which include may include attendance at support groups and rehabs and/or a residential program] and more. Some of the programs utilize re-written forms of the twelve steps. Others do not. And some people do maintain abstinence via their religious practices and no attendance at any sort of program.

     Some of us discover that a twelve step program is the only program available to us. Even if we are able to travel some distance to attend a meeting that is not X.A., non-X.A. meetings may not be held as often as we may like.  And yet, there are a number of people for whom a twelve step program is not sufficient, adequate, or appropriate. Fortunately, within the Interwebz, we can find others who are thriving outside of the 12 step rooms.

     The sorry state of treatment programs today does not allow for options other than the twelve steps. People are not told that there are other options or ways to recover. And as far as truly personalizing treatment to the individual addict, that does not usually exist. A few addicts may be lucky enough to land in a program that recognizes that medication-assisted recovery, concurrent mental health treatment, or harm-reduction strategies may be better suited for certain patients but that is not, generally speaking, the experience of many addicts who have sought treatment. And we just don't know enough of how to figure out which addicts will do best in which options. We need more research and more development of alternate resources for those seeking recovery today.

     The thing is, none of us practice recovery in the specific ways it was described in the Big Book of Alcoholics Anonymous. There are scattered groups of individuals who are attempting a return to A.A.'s early times. And that's cool.

     For some of us, that sort of thing is not appropriate or useful. We don't fit. We need the stuff that we resonate with, whether it is participation in X.A. as it has evolved in these times or some other form of social supports. And some addicts do not resonate with X.A. 

     We do not have to be addicts kept in uniforms lined up against the wall waiting for lunch to begin, as if we were still in a regimented high school. The unity of a healthy twelve step meeting is truly a wonder to behold. A healthy group acknowledges that we can practice our unity in spite of our differences.

     We are not all the same. Some addicts need something else in order to recover. So let's quit blaming them for failing out of what we have to offer. Treatment providers need to learn how to fit treatment to each individual addict rather than fitting each addict to their brand of treatment.

     I envision a place where the characteristics of each individual patient is respected and where patients are offered more than one way to recover. Someday, we will know enough to stop blaming those who fail out of the system and instead invest in research that will truly illuminate best practices in addiction treatment. Until then, more of us will die. 

sapphoq badly needing a coffee says: I count myself fortunate that I have been able to make a life for myself within the recovery landscape as it exists today in my geographical location. My hope is that all of us who seek a way out will indeed be able to discover a way out. But that isn't the way it is YET.

For information on how an atheist can remain abstinent in a twelve-step program, buy my e-book "Another Atheist in Recovery." If you aren't an atheist, then buy my e-book "Up the Rebels" which is a hacker/slacker kind of a novel.
Neither e-book has DRM. They are written in ePub format which can be read on many readers and also on your computer via Calibre or other reading program [but not Adobe tm].
I support the torrents so if someone wants to make my e-books available to others for free, that would be really cool-- and supported by the Creative Commons license that I used.