A really beautiful and serious thing

[Mark]

(JR - hope your cat is feeling better today.)

You know - it may be that I'm thinking about 1) what could I do as an individual (therapist), and 2) what would be a good edition to what is out there today, whereas you maybe were thinking what would be good for you. these might be two entirely separate things. I'm not trying to force any particular program on anyone. Just to try to expand the universe of programs that might be helpful to someone. I stand by my assertion that some support program is generally better than none for the majority of people, even while I also get it that you (and many others) have felt harmed or at least an uncomfortable and ill fit with the support programs that exist. My though was, hey - maybe if we could rewrite the foundational documents of AA, someone might want to pick up on that and do a more rational support program based on them. and that sort of program might be a better fit for some percentage of the people feeling like they are harmed by being forced to consume religion with their sobriety. If you're not into a support program at all, none of this would apply. And no matter what I do or not, therapists will still push some program over none - becuase they are making statements that seem to be most helpful to the average person (which includes many people but definitely not all). It's not a perfect world, and all we can do is to try to make it better.

I went out and actually read over the big book text yesterday and it is copywritten, so any actual rewriting will have to take place offline - we could only post what we had already revised. Or outlines thereof. But in reading over the text, it seemed clear to me that the book itself is mostly motivational writing and that only a small percentage of it is active ingredient (e.g., the steps themselves). The part about athiests and agnostics needs to be excised, as prejudiced and unnecessary and the whole thing needs to be put on a rational and consistent basis - I think the best such basis I can think of right about now would be to formulate it in terms of what is known about developmental psychology and how identity forms over time. At least that is the way I see it in my head right now.

Xeno - do you think that we'd need a full typology of all the different personality varietys of alcoholic? that could be done within the framework of DSM already probably, but if we did it that way, we'd be already saying that this is a disorder/disease.

What shape would you want this revision to have?

[John Rutledge]

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[Mark]

12 step without God/supernatural being is easily possible. 12 step without transforming identity change probably isn't. That Gregory Bateson article from the 1970s I mentioned previously shows the way. Calling the first step a "surrender to a higher power" is just a religous way of talking about what could also be thought of as a developmental identity transformation from a position of self-centeredness (normally characteristic of a child, say, but often persisting into adulthood) into a position of consciousness of interrelatedness with other people. You could talk about it as a simple growth of compassion; a maturity; a loss of selfishness. It's not an either/or black or white thing; it's a process. you tiptoe into it and at some point it becomes clearer. The "higher power" is the consciousness that other people matter and will be harmed if you don't stop yourself. It's probably quite possible to get sober without undergoing this normal transformation of consciousness that occurs during maturation, but then again, it is also possible to get sober without surrendering to a higher power (as you and ohters have pointed out). Just stopping drinking works fine if you can manage it (which many can't/don't)

Glad to know your cat is a little better. That sucks - feline diabetes. At least animals are pretty adaptable.

[xenophon]

mark, reforming AA is not possible. Revealed truth of the 12 step sort and logic are a contradiction in terms.

You would be better off forming your own group.

I realize that dual diagnosis is tough. You would be better off, clinically, if you seriously looked into harm reduction and motivation training.

I very strongly suggest that you into the whys and wherefores of those who quit on their own. You may learn a great deal from those folks. They do know how and why it was done.

[Mark]

You would be better off forming your own group. You would be better off, clinically, if you seriously looked into harm reduction and motivation training.

No tall order there I've got five minutes uncommitted tomorrow. that should be enough time to formulate it all

I'm aware of most of the good work that has been done with regard to the psychological treatment of addictions. I agree that it should be more widely available. Kind of shocked that it isn't.

I'm not thinking I can convert anyone who doesn't want to be converted. I'm not interested in converting anyone. Nothing like that. There are just a lot of athiest/agnostic AA malcontents out there who feel harmed by how AA is practiced. I'm just seeing a way that the good ideas inherent in AA can work independent of religiosity or spirituality. A varient of AA would work just fine if formulated in entirely humanistic/developmental/secular terms. it would only appeal to those people who are today frustrated with their personal experience of AA, but nothing wrong with that.

Of course, it would make sense to try to build in some of what has been learned about motivational interviewing and relapse prevention, etc.

Curious: Do you all think that rational ideas about recovery are less inherently appealing to people than religious ones? What is it about a recovery paradigm that makes it sell?

[John Rutledge]

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[xenophon]

Quite seriously, I see two important selling points for AA/NA: it is very low cost. And, it is readily available.

Secular group meetings are much harder to find. These organizations are much newer than AA.

SOS and LifeRing are more practical in nature. SMART Recovery is more intellectual. More thinking.

I am not a huge fan of self help groups that are focused on a common problem. I think that there are factors at work within a group that militate against the dynamic of some individuals.

If these factors are known, they may be minimized with professional leadership.

Such a group does not solve the problem. The group is a permissive factor. It provides factual information; it provides encouragement and support; it provides a place to be instead of drink. There are others. But, I think that those are the big three.

There is no one set of ideas that apply to all. Some flexibility of treatment methods seems indicated to me.

[John Rutledge]

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[Mark]

Because one is religious, it does not follow that one can accept the Word according to Bill.

True dat (as they say on The Wire). The larger 'malcontent' complaint is that people resent being forced into a mold that conflicts with their basic identity, beliefs and values

I don't know where my choice of 'malcontent' came from but I like the sound of it. I have not seen that show you refer to.

By the way, my experience of AA is not terribly extensive and almost completely external. I know it primarily through the experinces of others. I have not been shy about sharing that.

AA without its very particular religious take would not be AA.

You're all being emphatic on this point. Is that important if whatever would be created would not be AA but something else?

I think the steps could be retained without the idea of a higher power, however and still be just as transformative and useful. Instead of saying "salvation comes from the higher power", you can talk about it as the emergence from one organization of consciousness into another. more like buddhist enlightenment than christian salvation - no higher power required - (although I have something far more developmental psychological in mind than anything buddhists would come up with). I guess I'm not being very clear in my description, however. I recognize this would not be AA anymore, but that is not so important to me what it would be called. I'm really just interested here in finding a way to help people if for the moment only with words. And not having too much success just now

(the group) It provides factual information; it provides encouragement and support; it provides a place to be instead of drink. There are others. But, I think that those are the big three.

This is important stuff! Vital for many. Not to be trivialized (not that you are doing this). It also provides a plan and structure, and a way to think about what is happening and what the end goal looks like. It provides a place to go back to and make reports (which helps with sustaining motivation). All important.

I would have to say that I would think long and hard about trying to organise an alternative here.

Is there something to be afraid of here that I'm not comprehending? That's certainly possible. I'm thick enough to miss something completely

Are you suggesting that an alternative such as we have been discussing would be actively suppressed, or that it would be just ignored.

[xenophon]

Mark -- if you want to take on this onerous task, you could organize a group of your own. You do group therapy? It would be a good analogue.

Investigate the 12 steps. What do they address? If 12 step is the answer, what is the question? What is useful there?

Investigate SMART REcovery. It is largely REBT/CEBT.

Same with SOS and LifeRing [ they are similar]. And, Women for Sobriety.

What is useful in those venues?

Mix everything up, and make your own.

I think disregarding Harm Reduction and motivational interviewing would be unwise. Going from a pint of gin a day to nine ounces a week is progress.

AA has acquired the inertia of motion. It runs on momentum alone.

[Guest ASchwartz]

I am also concerned about the amount of hostility expressed towards AA. I have known many people who have recovered from alcoholism thanks to AA. If the spiritual part is that annoying to people there is another alternative called Rational Recovery. However, I do not believe they use group meetings.

It seems to me that, despite what the Big Book says, it is the group cohesiveness that plays a large role in the recovery process. Having a place to meet, find support for the addiction issue, speak to people who are also recovering, all of this is what helps move people toward recovery.

Is AA for everyone? No. Does it work for all people? No. Is it perfect? No. Are there other alternatives? Yes, and one of them is Rational Recovery. Also, there is now very effective medication that helps the addict by blocking the craving for alcohol. I have seen some people greatly helped by this.

But, what is puzzling to me is why there is so much anger at AA?

Allan

[John Rutledge]

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[xenophon]

Why the hostility?

It is earned.

Slogans:

You best thinking got you here

Take the cotton out of your ears and put it in your mouth.

My mind is enemy territory.

There are other amusing slogans, as you may guess.

Bad conduct:

Clancy Imislund

MidTown group

Just two examples, I do not want to gild the lily.

Sponsorship: Speaks for itself.

AA has three priniciples of operation:

ego deflation

shame induction

guilt induction

hidden/deniable control

Those are most important.

[John Rutledge]

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[xenophon]

Well John, it is sad.

It is real shame that destructive drinking is treated with a doctrine of despair and self defeat. This is 2008; not 1930. I would think that reality testing would have intervened long before this. This thread, if logic and reality meant anything, would not exist. 12 step should have been off the table years ago.

12 step is a doctrine of defeat -- ego deflation, shame induction and gulit induction. Not exactly a recipe for success. It reads as if it were written by a narcissist for narcissists. Not for depression, anxiety, bi polar, borderline. For narcissists. The rooms are full of them. The depressed, anxious, etc are kicked to the curb. Root, hog; or, die.

I hope, one day, reality testing will appear. I am a survivor and and optimist.

[Ray Smith]

I do know that AA now accepts the fact that many people must be on psychiatric medications of one type or another.

Allan Schwartz

Some people in AA may accept that people may need medications, but there is still a very vocal anti-medication, anti-therapy faction of AA.

I worked with an ACT team in upstate NY for a couple of years, all our clients were dually diagnosed, almost every one of them complained that people treated them like dirt for taking medications. Several were persuaded to quit taking their medications causing dire results.

Perhaps AA doesn't do that in some of the upper class, professional, suburban groups, I wouldn't know, but they certain do in the groups frequented by those who are mandated by the courts or by Social Services and other government agencies.

[Ray Smith]

I'm not saying that AA is practiced secularly; I'm just saying it could be.

What mental gymnastics allow you to pray to a God and expect results from that prayer and call it secular?

[Ray Smith]

... In other words, an individual can make use of AA without subscribing to its religious approac in a literal way and, from people I know who do attend, that is a common approach. The particular meeting makes a big difference, an since there are many meetings, one does not have to attend one that over emphasizes religion. At least, that is my thought.

Allan

One could conceivably go to a church and sit there without joining that faith, but for what purpose?

Look at the steps, read the Big Book, read the history of the group, AA is a religious organization, its main purpose it to get right with God; getting sober is a byproduct, not the goal.

[Ray Smith]

Intellectually, I understand that point very well. Emotionally, I'm resisting it. Not becuase I'm interested in converting people to any particular faith. Because if I accept that principle, (speaking as a generic therapist), then I have patients who are dictating to me what their therapy needs are.....people need to be witnessed and supported - that is a lot of what therapy and none-sick family is about) There is a hole where an important support ought to be.

Perhaps AA ought to fork (split) into orthodoxy and reform movements, the reform movements re-writing the founding book with the aid of what is now known from scientific study of addiction therapies, but still preserving what I think is a vital part of the recovery process from a philosophical point of view - the notion of surrender to a higher power - which we can simply restate as a surrender to benign social influence - the stopping thinking (privately and publically both) that you have all the answers and are self-contained and don't need other people or can operate without impacting them and involving them in your problems. This would be the birth of an ecological self of self rather than a selfish one - the birth of humbleness inside what was perhaps before a very egotistical persona.

The re-writing of the book could be done online - in wiki format perhaps. We could do it here. It would be an interesting exercise at any rate, and maybe it would prove to be useful in practice too. Would that be worth pursuing here does anyone think?

Mark

I see so many things wrong with this post I barely know where to begin:

You have a problem with clients "dictating what their therapy needs are"? Since when is AA "therapy" and what makes you think your clients are completely clueless? Do you listen to your clients, how do you know what they need?

I had therapists tell me that if I quit drinking, my depression would magically go away. I explained that depression was a pre-existing condition, that I am an atheist and had tried AA on several occasions and each time gotten suicidal, yet I kept getting pushed into AA in order to receive mental health treatment.

Support?! What kind of support do you think an atheist gets in the rooms? Ask any atheist you find in the rooms and I'll bet he or she staed in the closet about their non-beliefs until they had a few years under their belts, faking it until they were making it in this "honest program". After the treatment I received in the rooms, someone claiming that AA offers support can set me off. I've attended hundreds of meetings in five states over a 20 year period and I haven't seen any more difference than I find differences in McDonalds from one location to the next.

Rewriting the Big Book? Don't make me laugh...suggest it at a meeting, you may get lynched. They haven't changed a word of the first 164 pages since it was written. The Big Book isn't a text book that gets updated, it is a holy text.

[Ray Smith]

I went out and actually read over the big book text yesterday and it is copywritten, so any actual rewriting will have to take place offline

AA lost the US copyright some time ago.

[Ray Smith]

12 step without God/supernatural being is easily possible.

Only if you ignore half of the steps. It's about the same as trying to be Roman Catholic without a belief in God.

It's a RELIGIOUS program. Every time the question has come before a higher court, the final outcome has been at least that AA "is religious in nature".

AA is an offshoot of the Oxford Group, a Christian sect. It defines God, tells you what God will and will not do for you. Meetings open and close with Christian prayers.

People who claim "spiritual not religious" need to look up the definitions of those words; the best one might be able to claim is non-denominational, not non-religious.

[Ray Smith]

There are just a lot of athiest/agnostic AA malcontents out there who feel harmed by how AA is practiced.

You paint a pretty picture of those who are dissatisfied with AA. They're not all atheist/agnostics, you know. Many that have an understanding of the concept of Free Will also have problems with AA. And then there's that pesky "miracles on demand" that most Christian religions denounce. And then there's the more fundamentalist Christian that object to Bill and Dr. Bob's experimentations into the occult. Did you know that Bill claims to have "channeled" the steps from a 15th century monk named Boniface?

AA appeals to lapsed Christians, not people of firm Christian faith, other faiths, or no faith. AA is a religion unto itself, a person unwilling to replace whatever beliefs they hold with those of AA is not going to be made welcome in the rooms.

[Ray Smith]

I think disregarding Harm Reduction and motivational interviewing would be unwise. Going from a pint of gin a day to nine ounces a week is progress.

I'm a firm believer in Motivational Interviewing; not only does it work, it appears to work best for those who are dually diagnosed.

Study after study shows that AA works for about 5% of people, the same as no treatment at all, and that people exposed to AA tend to fail more spectacularly than those who attempt sobriety on their own.

I believe one of the things that is being overlooked here is that dual diagnosis people do not even achieve the 5% abstinence rate that others do. Kathleen Sciacca claims that their success rate in traditional 12step treatment is "too small to be accurately measured". Sciacca achieved a double digit abstinence rate at the end of a two-tear period using MI, impressive for any group of people, but especially impressive for dually diagnosed clients. And the majority of her clients who chose to moderate reported an increase in their quality of life.

More people CHOOSE abstinence and achieve abstinence using harm reduction methods that achieve abstinence through 12step methods. This is evidence-based practices; where are the studies that prove that AA works? There are none, why is this debate still going on?

[Ray Smith]

I have known many people who have recovered from alcoholism thanks to AA...But, what is puzzling to me is why there is so much anger at AA?

How many people failed in order for you to see those successes? It's like looking at a professional sports team, how many people didn't make it in order for you to see the successes? I get very frustrated when I see intelligent people make such foolish remarks based on testimonials by a few true believers.

You will hear the same things from those who got sober while in Narconon (Scientology) or in the Moonies, or in VA programs. People rarely get sober on their first try, but if they keep trying, almost all will eventually get sober. Wherever they were at the time gets the credit.

I can tell you why I get angry, I know what I went through in the rooms, and I see clients going though the same things. Professionals who ought to know better are telling desperate people the same things I was told a quarter of a century ago, telling them to go to a program based on faith healing.

I do not understand where you get the idea that AA is some wonderful support group. People with mental health issues are snubbed, shunned, and often taken advantage of. It is a minefield for those who are mentally fit and how many are when they get to the rooms? Have the abuses in the Midtown Group shown us nothing?

From the Orange Papers:

"Dr. Brandsma found that A.A. increased the rate of binge drinking, and

Dr. Ditman found that A.A. increased the rate of rearrests for public drunkenness, and

Dr. Walsh found that "free A.A." made later hospitalization more expensive, and

Doctors Orford and Edwards found that having a doctor talk to the patient for just one hour was just as effective as a whole year of A.A.-based treatment.

Dr. George E. Vaillant, the A.A. Trustee, found that A.A. treatment was completely ineffective, and raised the death rate in alcoholics. No other way of treating alcoholics produced such a high death rate as did Alcoholics Anonymous."

[John Rutledge]

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