Discussion on the merits of Alcholism Treatments

[Mona Lisa]

I agree that the study needs to be followed up/replicated.

What I find interesting about the study is that its results suggest that improved functioning is possible without total abstinence. The SMART recovery group did better than the AA group in terms of measures of actual life functioning. So even though the AA group was more likely to be abstinent, they weren't doing as well.

Again, however, this was a rather small study and there was no control group so we don't know how well people who didn't go to either group would have done.

ML

[JustTrying]

Sorry Allen just a plain ol alcoholic here... I don't know anything about drugs..... I use as Allen said what I can use and leave the rest. I have gone to AA and I do not think they are the demon... although I choose to not make AA my life like many of the people there do... some of their suggestions are helpful... I also have read all the Rational Recovery Literature and have been to the SMART website and Life Ring.... Tried Moderation Management... That didn't work for me.

When I feel I need to connect with a fellow alcoholic in recovery... I have a slew of websites I can go to and AA phone numbers I can call. I am sorta following what works for me... What works for me may not work for another.... but they are free to find their own path....

OH and let's not forget God....When noone else it there I turn to God and pray and meditate... not just about my addiction , but about my life.

JT

[Guest ASchwartz]

Hi Justtrying,

No need to apologize for being "a plain old alcoholic."

That was not my point in making my comment. It had more to do with the endless bashing of AA because that gets everyone nowhere at all. Despite the fact that this thread is not about AA, the implication is that it is partially about that.

However, it is a point that I agree with that we need to talk about various treatments for alcoholism and here is my input:

Whether a person goes to AA or any other type of program, I firmly believe that psychotherapy needs to be an important part of the recovery process.

Now, having said that, I want to clarify that some people seem to be able to recover on their own initiative without either therapy or self help groups. Perhaps it has to do with motivation. On the other hand, there are motivated people who just don't seem to be able to do it on their own. They need help.

For those who are not motivated, the hope always is that some day they will find the motivation to stop drinking or drugging.

One last thing: I have no problem with limiting the discussion to alcohol in this thread but I want to gently point out the idea that addiction is addiction, regardless of the drug, and remember, alcohol is most definitely a drug.

Lastly, there are medications that are being used to help people stop drinking and remain abstinent. However, a lot depends on motivation with this as well. Medicines are neve a cure all.

Allan

[Mona Lisa]

Whether a person goes to AA or any other type of program, I firmly believe that psychotherapy needs to be an important part of the recovery process.

Allan, perhaps you could explain to us why you believe psychotherapy to be helpful. Also, are you referring specifically to Freudian psychoanalysis (which I understand is your area of expertise)?

On a personal note, I saw a therapist (not a psychoanalyst though) both before and after I quit drinking. I found the therapist to be extremely helpful (much more helpful after I quit). I consider myself quite lucky that she was not 12 step oriented and helped me to find my own path.

ML

PS: I think everything we're saying about alcohol applies to drugs as well. The only reason I talk about alcohol is that I only have experience with that. I never took street drugs or prescription drugs.

Edited November 29, 2009 by Mona Lisa

[JustTrying]

OK... we eill call it addiction then!!! I actually like NA better.

As far as therapy goes.... I agree.... I think there is more to the addiction than just drinking or drugging... I believe there is an underlying reason. Undealt with issues etc...Myself I am not dependant on anything... I can go without a drink whenever I wasnt to and not go into DT"s... at one time I couldn't, But that was when I was drinking everyday.

I can't even tell you why I drink... I always black out.. so if I have fun I don't remember it.... Some of it is bordom... and habit. Then there is depression... depression makes me want to drink and drinking makes me depressed./... so that's not a good thing to do.

I am in therapy and have been for 5 months.... I am still scared to QUIT drinking.... I feel like I would be loosing part of myself.... I truely do turn into another person when drinking... sometimes alot of fun, and sometime the Bitch from Hell!

I just turned my life story in to my therapist and now we get to discuss all the childhood issues and other issues... that Ihave been trying to hide from.... After we go through all that we will burn my "life" story and try to let all that go.... or at least as much as I can.....

I believe to quit drinking or drugging one myust treat the MIND, BODY AND SOUL. It alspo otakes a certain amount of willingness and stubborness.....

JT

[xenophon]

I agree that support/advice/information is needed by many people with substance abuse problems. people have the right and responsibilty to choose what fits them.

I think that drinking/drugging to excess indicates, in many cases, significant underlying problems. Getting professional help to clarify these problems is a good idea. It does depend upon the individual.

Sometimes, drinking/drugging too much is just that. Drawing a line under it basically solves the problem. If stopping the behavior does not clear things up, get professional help.

[Ray Smith]

I agree that a person does not necessarily need to continue in support groups forever in order to maintain sobriety. I am aware of the AA attitude towards this and I do not agree. It is an individual decision.

That is my point: There are things about AA that are useful and others that are not. Pick and choose what you need and what you reject.

What concerns me about this endless discussion of the pros and cons of AA...

Can we get to talking about those problems???

PLease???

Allan:confused:

Allan,

People are routinely pushed into AA for all sorts of offenses. Many of my dual diagnosis clients who were NOT alcoholics have ended up in AA where they started abusing alcohol and drugs like never before. Schizophrenics who drink three or four times a year when trying to lessen their symptoms or pass out that come to the attention of the police twice in a year get branded alcoholics and mandated to 12step treatment and meetings. Social Services seems to think that AA is a babysitting service, a place for people to get free group therapy. Some therapists and SS workers are two hatters who think everyone could benefit from the 12 steps.

AA is the knee jerk reaction to a multitude of situations. People get worse when they receive treatment improper treatment and their real problems are ignored. "When all you have is a hammer, the whole world looks like a nail" doesn't work.

We can't talk about alcohol and drug treatment without talking about 12step treatment because that is the starting place for most.

How do you expect people to know what is good and what is not about AA? How are they supposed to know what to pick and choose in a program that dismisses "cafeteria-style AA"? You stated that you believe psychotherapy should be used in conjunction with treatment, but one in eight AA members speak out against the use of medications and therapy. Who is a person going to listen to anyway? The suit he sees once a month or his insta-friends that he sees several times a week who claim to know better?

[JustTrying]

Allen and Ray.....

I have to agree as an alcoholic... if that is what you want to call me... that therapy is a key factor in SOME people getting well... For some AA or RR or MM or SMART are helpfull..... I know many LIFETIME AA'ers and that turns me off... I do not want to be dependant on anything.... I do on occasion goto AA and it is a good place to meet sober people and have a network of people that you can call if you are in a crisis situation and sometimes a meeting can take the place of a drunk.

I tend to go more with there is more to the addiction than just drinking/drugging. In may case and probiably many others there are underlying reasons why they drink. To self medicate.... I love to black out and pass out myself.....To not have the crazy dreams that I have sober is wonderful...To escape the anxiety of living life.... or many other reasons....

I feel that if one feels good about themselves and have dealt with the demons that we call life..... they can get the resolve and motivation to quit drinking.

I know therapy has been a God send to me....... Just my Humble 2 cents.

JT

[Ray Smith]

....the increasingly severe and dangerous problem of drug addiction in our society. It feeds into violent crime, gang activity the destruction of individuality and human dignity. Now, it not only is alcohol but an endless list of other drugs that pale in comparison to alcohol, not to imply that alcohol is harmless because it is not: it is dangerous. But people smoking battery acid in the form of Meth. Amphetamine, is even more dangerous and destructive.

Allan:confused:

Part of the problem I had as a teenager was the "Reefer Madness" approach to all drugs, which these days have been extended to alcohol. If society demonizes everything how is a person to understand the degrees of harm associated with different substances? After finding out that society lied about pot, why shouldn't I try other substances? My peers were saying that it's fine. The penalties for small amounts of one drug are hardly different from another. I grew up with "Better living through chemistry". There were a lot of mixed messages and a lot of hypocrisy during a very confusing time in my life.

How are they supposed to know the difference between legitimate warnings and scare tactics when both are being used simultaneously?

The root of this and many of our problems in my opinion is too many people.

Think "the Rat Park experiment".

"The disintegration of rational society started in the drift from hearth and family; the solution must be a drift back." - G. K. Chesterton, 1933.

Unfortunately, we can't put that genie back in the bottle. Until such time that nature makes the decision for us, we'll be putting band-aids on our wounds as fast as we can.

[John Rutledge]

I know I am breaking my resolution, but ... on what I hope is a not-too-controversial point ...

Looking back over the last few posts in this thread, I notice that the issue of motivation to kick (whatever) the habit came up. I have long been convinced that there is a big difference between "wanting to quit" and "wanting to want to quit". I was in the latter state for a long time before I attained the former. Still not sure exactly how I made the transition but, eventually, I did. And then (allowing for a couple of relapses, not recent) I stopped.

It seems to me that few systems or "programs" give much recognition to this distinction. Certainly, AA with its "sincere desire to quit", does not. Nor does Rational Recovery; I have a lot of time for RR but, again, it seems to start from the point at which there is a definite and rational (as distinct from "sincere") determination (as distinct from "desire") to quit. I cannot speak with direct knowledge of SMART or other "programs" but, from what I do know, I cannot see much recognition of the distinction between "wanting to quit" and "wanting to want to quit".

I am convinced, from my own experience, that it is fatal (sometimes literally) to get stuck at "wanting to want"; and quite difficult to make the transition to actually "wanting".

I do not know much about motivational interviewing. I have read some suggestions that, while it has limitations in terms of addressing substantive problems of addiction, it is useful in helping sufferers to determine whether they wish to make the "step" from "wanting to want" to the stage of actually wanting to quit. Does anybody In Here have any comments on this ?

Hope this does not sound too confused,

With very best and friendly regards,

JR

[Ray Smith]

Hi all,

Here's an interesting study:

http://www.u.arizona.edu/~penn/Brooks&Penn_2003.pdf

ML

Excellent find.

Couple of things:

The Smart group engaged in more marijuana use, but the 12step group had more than twice the number of people on probation/parole. The consequences of usage were different and could account for the difference.

"Twenty-one clients (39%) completed the 12-step program, whereas 29 clients (50%) completed the SMART program (difference not statistically significant)."

I think 11% is significant, especially when more than 1/3 of the people in the 12step group were on probation/parole and dropping out could affect their legal status. In fact, the study does mention that the ones who stayed in treatment were more likely to be those with legal problems which begs the question, "How many would have stayed if their had been no legal reason for staying?"

"A client-centered approach that was welcoming and nonjudgmental was

stressed in both groups."

Sorry, that is not typical 12step facilitation.

In talking about SMART:

"In general, revised cognitions increase a sense of empowerment and decrease a sense of victimization, so people feel more empowered in general, which can lead to specific as well as more generalized behavior change."

Whereas, 12step promotes powerlessness over addiction and can lead to feelings of helplessness in many.

Still, both SMART and 12step are only dealing with half the problem. The program I work for uses Motivational Interviewing, which statistically, offers the highest outcomes for the dually diagnosed over a two year period. We don't just deal with substance abuse or even substance abuse and mental health, but also housing, employment, education, and all the areas that affect quality of life. I believe the most important factor in in reducing harm is the client's belief that they are better off not abusing substances. It's one thing to tell a person, quite another to help the person experience it.

[xenophon]

Motivation, coupled with determination. I think that comes close to a controlling factor. That was the driver for me. That was preceded by facing facts. Drinking was in my way. If I were to have a meaningful life , the drink had to go. It did.

Of course, it was early days for me. I did not do it for long -- only about a year. And, I had a reason to do it - oblivion. When I no longer wanted oblivion, the rest was automatic.

[Nightwatch]

Nice to see you back, JR. I wanted to address what you wrote about SMART Recovery, as follows:

I cannot speak with direct knowledge of SMART or other "programs" but, from what I do know, I cannot see much recognition of the distinction between "wanting to quit" and "wanting to want to quit".

The entire SMART program is structured around the Stages of Change theory, which means that it actually does make a distinction between wanting to quit and wanting to want to quit.

"Wanting to want" would correlate to the contemplation stage, where you are thinking about it but aren't committed. For people in this phase, SMART uses a tool called a cost-benefit analysis (essentially a list of pros and cons) to assist people in seeing the benefits of quitting as opposed to continuing to use.

"Wanting to quit" correlates to the action stage, where you've made up your mind to move forward with change. Here, SMART has tools for helping people get through the actual quitting process--primarily tools to assist in coping with urges.

Hope this helps.

Edited December 13, 2011 by Nightwatch

[John Rutledge]

Claire,

Thank you for the clarification.

With kind regards,

[David O]

Still, both SMART and 12step are only dealing with half the problem. The program I work for uses Motivational Interviewing, which statistically, offers the highest outcomes for the dually diagnosed over a two year period. We don't just deal with substance abuse or even substance abuse and mental health, but also housing, employment, education, and all the areas that affect quality of life. I believe the most important factor in in reducing harm is the client's belief that they are better off not abusing substances. It's one thing to tell a person, quite another to help the person experience it.

Ray,

You raise possibly the most important issue. While I'm a strong supporter of the SMART Recovery model (despite it's severe limitations when using a holistic approach) the model we've used (and the one you're touching on) over the past 25 years follows a project we began in the mid 1980's thru NIMH called the CASSP system of Care. In this model, we concluded and then provided several multi-million dollar implementation grants (>$250 million now) to states to develop the holistic approach-- housing, mental health, substance abuse, family dynamics, poverty issues, employment, education, access to health care, prevention services, tertiary care, etc. The model was designed for individuals with a severe emotional disturbance and was actually an extension of the adult mental health system model of assertive case management (which came out in the 60's).

Our view (there were 12 of us who designed this) was that problems rarely exist in a vacuum, but are more so the product of many stressors and life situations. It seems that you're approach closely matches this sociological "System of Care" view-- this would partially explain it's success rate.

Incidentally, now, >25 years after the design and publication of the monograph, the model's revisions have resulted in a one-dimensional focus of treating the individual and largely ignoring the systm that may sustain and reinforce the destructive behavior.

Thanks for sharing,

David

Edited December 3, 2009 by David O

[Ray Smith]

Incidentally, now, >25 years after the design and publication of the monograph, the model's revisions have resulted in a one-dimensional focus of treating the individual and largely ignoring the systm that may sustain and reinforce the destructive behavior.

Thanks for sharing,

David

What we do in ACT (Assertive Community Treatment) would be considered assertive case management.

I was unfamiliar with CASSP, I did a little reading on it this morning. Could you expand on how has it changed and how the system reinforces destructive behavior?