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Recently, several of my close associates have gone back out. People with time measured in years, not months. People who were doing all the stuff that people in recovery are told that we must do in order to keep on keeping on. People who were working steps, had service commitments, went to meetings, used their sponsors, read the literature, took care of themselves, lived up to their responsibilities, had deeply held religious beliefs and practices to match.
So far, they were all lucky enough to make it back into the rooms of recovery. So far, they are all staying in. So far, so good.
They all have said it is a struggle to remain clean now. More of a struggle than before. They have had various consequences for their relapses. What those consequences are is of no importance to anyone reading this blog post. None of them "got away with it."
I had my lapsing and relapsing during the first nine months of my attendance at x.a. meetings. Then I began to understand that I had to quit all of it and not just the drugs that I perceived of as having been or helped to create the biggest problems in my life. So I did. I got honest. [Unlike my buddies, I was not honest about what drugs I was still taking during those first nine months]. I started over. Starting over was tough. Staying away from all of the drugs was much more difficult for me than staying away from some drugs.
There is something here I've been thinking about a lot. We-- at least here in the United States-- really do not know enough about how to treat addicts in the throes of their addiction. Most of the addiction treatment industry organizations here are heavily dominated by twelve step approaches and philosophy with bits of pop psychology and pseudo-religion thrown in.
The stats from the rehabs that are honest about the results of treatment via long-term follow-up are dismal. I've heard various percentages ranging from ten percent on up through thirty-three percent. One in three down to one in ten will remain abstinent. The other figure I've heard tossed around is one in four will relapse some percentage of the time and therefore are declared to be "improved."
These figures ought to be unacceptable. They certainly are unacceptable to me.
The best that professionals in our country can offer is "Well, some of you will be dead. Some will bounce in and out. A very few of you will remain clean."
But meanwhile,
...if you relapsed, then your program or the way that you worked the program sucked or wasn't good enough.
...if you relapsed, then you quit going to meetings or didn't go to enough meetings or got disconnected from meetings even if you were going to meetings.
...if you relapsed and killed yourself, then you weren't working the program and forget all the foolishness about whether or not you had a separate disorder that has suicidal ideation as a prominent feature.
Furthermore, your relapse had nothing to do with
...our treatment protocol,
...our failure to give you culturally competent treatment,
...our failure to screen you for other disorders,
...our failure to help you determine what support systems you want to use in order to not use again after you leave us,
...our failure to recognize that x.a. programs may not be the best way to go for everyone,
...our failure to lobby for more research into the best ways to treat people with addiction, especially if some of those ways just might include stuff other than a twelve step philosophy.
Beside that,
...One quasi-religious group is heavily involved in the addictions treatment industry for adults as well as in prevention programs for school kids. The adults are treated with mega-doses of certain vitamins and exposure to the group's ideology. The kids pledge not to use drugs and are also given links to certain websites where they too will be exposed to the group's ideology.
...a certain troubled teen industry group whose founder and staff are predominantly of a certain religion are heavily involved in the addictions treatment industry for teens. Those teens are lumped in with all the other "troubled teens" in their residential schools hell pits of torture.
I am not a fan of the quasi-religious group nor am I a fan of those places where staff go beating on kids and throwing them into extended periods of isolation and otherwise severely mistreating them.
We are at a crossroads and we don't even know it.
sapphoq itching for another coffee says: People are complex. The etiologies behind addictions are multi-factorial. By subscribing to total immersion into the twelve steps and x.a. culture, the majority of the organizations involved in the addictions treatment industry are failing to recognize that more ways of treating addicts seeking relief from active addiction need to be researched and developed.
By failing to do so, other organizations which are not noted for their honesty or humane practices will step in to fill the void. These other organizations claim to have better outcomes. We don't call them on their dishonest stats for fear of litigation or because we figure they are the experts or perhaps we've learned we ought not to criticize those agencies which are religious in nature.
Because we fail to broaden our scope and we fail to demand ethical research into other more efficient ways to treat addicts in order to yield more successful outcomes, addicts will die. Addicts who could have been saved if only we knew more about how to treat them. Period.
In my unasked for opinion, blaming the client/ customer/ participant/ patient for a failure of the system to treat that human being competently-- or at least adequately-- sucks. I've been alive long enough to know that this cookie cutter treatment that almost all of the newer folks in recovery are being subjected to is a sham. It is more than unfortunate that twelve step philosophy in general and A.A. in general [with a passing nod to N.A.] is presently dominating the addictions treatment industry.
Now that we've all been edumacated into the disease concept-- alcoholism is a disease, drug addiction is a disease, gambling addiction is a disease, internet addiction is a disease, obesity is a disease...-- it is obvious to those profiteers of the misfortune of the addicted that a "disease" requires "treatment" that insurance companies ought to pay for. The identified addict is shuffled into counseling, drug courts, mental hell courts, detox, in-patient, out-patient, halfway houses, houses for people who have been identified as having both a mental problem and an addiction problem world without end amen. The identified addict is subject to inspection, psycho-socials, team meetings, social workers, case managers, and fishbowl living. Add on to all of that feelings groups, employment groups, recreation groups, spirituality groups, house meetings, and group groups.
I have been witness to more than several rather dramatic "treatment failures" through the years. Three people I knew committed suicide. Two were drunk and one was not drunk at the time of the taking of their lives. Shotgun [drunk], overdose of prescribed meds [drunk], jumping off of a bridge on purpose [sober]. Not easy ways to die for sure. The common reaction to the news of a suicide is something along the lines of "He or she wasn't working THE program." Countless people have left rehabs and day programs and halfway houses and other residences early and against the advice of the professionals and para-professionals. A few have opted for serving prison time rather than completing drug court. Some have been kicked out when it was determined that their addiction was complicated by more serious issues such as a rampant eating disorder or sexual abuse trauma.
The drug court folks complain of fishbowl living. And that seems to be accurate. Anyone from the community can call the drug court staff in order to rat out a drug court defendant [NOT participant] for things like giving someone a ride home from a bar, being near a bar, bowling with a bowling team [hey, there's booze at the bowling alleys Jack]. What's even worse are past graduates of drug courts who have the ears of drug court staff. They report that one woman "looked" upset before a [12 step] meeting or that a guy "is not paying attention" during a [12 step] meeting. They should know better. So should the drug court staff.
Folks who live in a residence with staff oversight have complained that staff have stolen their property, held back their checks, insisted that they attend a dance or other social event put on by the agency that runs the residence, treats them like children. They too are under constant surveillance.
Groups conducted at the residences and those conducted at treatment facilities sponsor the viewpoint that all of the attendees are "sick" people with a "disease" who must rely on a "Higher Power" [supposedly of their choosing but commonly referred to in the literature as male and monotheistic] in order to halt the progress of their "disease." Atheists are pressured to find a "Higher Power" regardless of how sincerely an unbelief may be held. At the very least, an atheist should be encouraged to re-write the steps into something that is pertinent to him or her. Even better is a system that offers alternatives to twelve step meetings as a means to facilitate abstinence. Also [usually] missing is the opportunity to engage in treatment geared toward harm reduction. Some folks can cut back. Others may find that they are unable to cut back and then opt to go for total abstinence.
Twelve step meetings have helped some [very low] percentage of people to abstain from their addictions. Other folks may do better in a secular group or in harm reduction or gasp! on their own. [According to Harvard studies, approximately 77% of those people who themselves choose to quit drinking do so without any formal treatment or attendance at 12-step groups]. Some folks may opt for opioid replacement therapies for a time. [Others may have this option forced on them]. More research is needed on issues such as when treatment is needed and what kind is optimal to the individual. It is far too easy to assume that all identified addicts should be steered to a twelve step program. The real work is in helping a patient to determine what resources he or she want to access in order to mitigate or stop a given self-destructive behavior.
Professionals and para-professionals do a grave disservice to their patients and drug court defendants by assuming that they know better than the individual being subjected to their knowledge does about what might truly help and heal. Until the system changes its operating premises that all of the clients are sick and diseased and too stupid to figure out what they need, there will be treatment failures. And these "treatment failures" are human beings.
sapphoq itching for a coffee says: It is past the time when the dominance of a twelve step approach should be acceptable in treatment protocols for all identified addicts. Blaming the customer is bad practice. While there certainly are very dedicated professionals and para-professionals working in the addiction treatment industry, the overbearing system inhibits their ability to shine and to put the needs of their patients and drug court defendants first.
