Nine Candid Thoughts About Substance Abuse Treatment and the 12 Steps
I am 24 years sober today, and of those years, 20 of them have been working in the substance abuse/behavioral health field. I’ve gathered a random sampling of thoughts on treatment and AA. If you agree with all of them, then I have either bored or failed you. Check them out:
1. Cliche to say, but treatment works. It saves lives and ripples to save families. You will hear all sorts of stats, sometimes as low as only 1 in 10 who participate in substance abuse treatment will stay sober for a whole year after discharge, but there are other stats that state almost 50% of those in treatment at any given time will be sober ten years later. It just may take a few attempts for it to stick into long lasting recovery.
Also, ‘treatment’ is such a broad term describing such different levels of interventions. The question is what type of treatment works best, and when. I’ve always felt that inpatient or residential treatment squeezes folks a bit harder to get to some necessary truths and insight. (For when you squeeze an Orange, you get Orange Juice, because that's what’s inside. Well, when you squeeze an addict, you get what’s inside as well.) Inpatient treatment can do this squeezing best in a safe situation and stop a relapse in the early days so that long term recovery can take roots. Yet less restrictive modalities such as day treatment programs and intensive outpatient give the therapist and client real life scenarios to process and do not offer the fantasy scenario of living 24 hours in a therapeutic environment. In general, the world out there wants you go get high, so go fight it, (with friends at your side) and come back to report.
2. Treatment doesn't work, for some folks, at least in a traditional 12-step model. I believe that substance abuse treatment has cast too wide a net, and that there are many patients in substance abuse specific treatment who are actually primarily personality disorder or other diagnoses that are ill-served by giving them traditional CD treatment. For these folks, using drugs or drinking is just one of many symptoms that often include other anti-social traits.
I am not talking about the bipolar or depression diagnosed client where the two disorders feed off of each other and make both set of symptoms worse. I am referring to some axis 2 personality disorders or affective disorders. We throw them into the mix and treat them the same, and it’s a set up for failure for both client and clinician. Asking a client with narcissistic personality disorder to get humble and ask for help is cruel and unusual punishment for all involved. An untreated borderline personality diagnosed patient with acute symptoms sits at a first step table and nobody gains. What happens is, many of the social arenas provided in treatment, including groups and 12 step support meetings, are actually just another stage for the narcissist or anti-social personality disorder member to practice their pathology. This is especially prevalent as cluster B personality disorder traits, who end up in the criminal justice system, are mandated chemical dependency treatment.
3. There are too many recovering addicts treating other addicts. Okay, maybe I contributed to the problem, but I find that when folks become ‘experts’ and well-versed at AA or NA, they tend to expect others to work a program or get sober exactly as they did. These are the folks who do way too much self-disclosure, and every moment is an aa/na meeting, and they have a slogan for every situation. Treatment center staff who gain a masters degree only as an excuse to further their own personal agenda, which is pushing their own way of treatment onto others. Ironically, these therapists are often the most popular and heralded at treatment centers, but maybe not the most effective. They often have a fervent desire to spread their recovery gains to others, and you can’t deny the enthusiasm, but many times it could stay at the tables rather than inside facilities.
4. AA and NA itself is not treatment
Let me explain. The focus of treatment needs to be on clinical issues such as negative, self-destructive thoughts, inability to manage emotions or self-soothe without substances. (just as an example, for there are tons others.) Treatment is facing cognitive distortions, behavioral patterns, and cognitive reframing to find hope amidst despair, as well as identifying concrete and tangible behavioral changes and skills. Treatment should not be a boiler plate of writing out ones first step, listing 3 examples of powerlessness, writing an autobiography, getting a sponsor, identifying a higher power, watching a Father Martin video, etc... These things are essential, I believe, but they are a supplemental. Too often, the steps are seen as the only form of therapy.
5. AA and NA saves lives and understands addicts better than any Counseling theory.