Tribes of the Recovering Community

303451_192353640882543_1968585459_aThis week’s tribe is Millati Islami:

Millati Islami is a fellowship of men and women, joined together on the “Path of Peace”.  We share our experiences, strengths, and hopes while recovering from our active addiction to mind and mood altering substances.

We have sought to integrate the treatment requirements of both Al-Islam and the Twelve Step approach to recovery into a simultaneous program. Our personal thanks and appreciation goes to the Narcotics Anonymous and Alcoholics Anonymous programs from which we borrowed. Just as Narcotics Anonymous was founded out of its need to be non-specific with regard to substance, so Millati Islami was born out of our need to be religiously specific with regard to spiritual principles.

Millati Islami, by G-d’s will, (masha-Allah) offers a fresh perspective on age old ideas for treating our fallen human conditions. We pray further that it will serve as a model for successfully understanding and addressing the special problems encountered as recovering Muslims and substance abusers in a predominately non-Muslim society.

(The “Tribes of the recovering community” series is intended to demonstrate the diversity within the recovering community.I have no first hand knowledge of most of the tribes, so inclusion in this series should not be considered an endorsement.)


Tribes of the Recovering Community

lacflag_sThis week’s tribe is International Doctors In Alcoholics Anonymous:

IDAA is a group of approximately 6000 recovering health care professionals of doctorate level who help one another achieve and maintain sobriety from addictions.

IDAA strongly supports mainstream AA as the basis for everyone’s recovery program and that needs to be first and foremost. We are not terminally unique! However, specific issues do arise for healthcare professionals and impaired doctors that are hard to deal with in regular AA meetings. Many of these issues are explored in the safe environment of the IDAA annual meetings and in the online email-based meetings on this website. There are no dues or fees for membership, just the desire to stay sober and off mood-altering drugs.

Its history:

International Doctors in Alcoholics Anonymous had its origins in the garage of Dr. Clarence Pearson in upstate New York in 1949. Dr. Pearson, a recovering alcoholic and practicing physician, and his wife Polly invited other physicians and their families for an AA retreat at their summer home near the Canadian border.

Attendance at that summer meeting totaled 34. Doctors from the United States, three from Canada and the presence of a psychologist as well as physicians, made the meeting both international and interdisciplinary. Hence the organization International Doctors in AA was founded.

Since that time, annual meetings of IDAA have been held in early August in various locations around the country. The format has changed to some degree from the early years, but the core remain the same – good fundamental AA meetings. Al-Anon and Teen fellowship meetings have been added through the years. IDAA meetings are truly a family affair for many.

Attending the annual IDAA meeting and interacting with many other recovering healthcare professional helps greatly in dealing with professional issues involving recovery and living clean and sober. There are also cosponsored scientific presentations, carrying CME credits, addressing the state of the art in the field of alcoholism and allied diseases.

International Doctors in AA is a fellowship of doctors and their families whose primary purpose is to support one another in recovery from alcoholism and other drug addictions. There are no dues or fees to join. We are self supporting through our own contributions. The only requirement for membership is the doctor’s desire to belong.


IDAA (International Doctors in Alcoholics Anonymous) – Home.


Tribes of the recovering community

From the Fifth Chapter MC Rochester Charter
From the Fifth Chapter MC Rochester Charter

I remember getting sober and learning about the Sober Riders and Fifth Chapter. This recovery stuff was a whole new world, and I never imagined there’d be tribes like them. There are sober MCs (motorcycle clubs) all over the country.

Our local Sober Riders describe the MC this way:

The Sober Riders is a fellowship of Men and Women who live by the principles of the 12 step program of recovery, and promote, through attraction, the creation and preservation of a brotherhood for motorcyclists in a sober, drug free and safe environment.


The adoption of 12-step practices and beliefs.

Evidence by billaday
Evidence by billaday

We’re seeing a growing body of research on the mechanisms of change in 12 step recovery. Tonigan and Greenfield recently published an article in Psychology of Addictive Behaviors

Working the 12 steps is widely prescribed for Alcoholics Anonymous (AA) members although the relative merits of different methods for measuring step work have received minimal attention and even less is known about how step work predicts later substance use. The current study (1) compared endorsements of step work on an face-valid or direct measure, the Alcoholics Anonymous Inventory (AAI), with an indirect measure of step work, the General Alcoholics Anonymous Tools of Recovery (GAATOR); (2) evaluated the underlying factor structure of the GAATOR and changes in step work over time; (3) examined changes in the endorsement of step work over time; and (4) investigated how, if at all, 12-step work predicted later substance use. New AA affiliates (N = 130) completed assessments at intake, 3, 6, and 9 months. Significantly more participants endorsed step work on the GAATOR than on the AAI for nine of the 12 steps. An exploratory factor analysis revealed a two-factor structure for the GAATOR comprising behavioral step work and spiritual step work. Behavioral step work did not change over time, but was predicted by having a sponsor, while Spiritual step work decreased over time and increases were predicted by attending 12-step meetings or treatment. Behavioral step work did not prospectively predict substance use. In contrast, spiritual step work predicted percent days abstinent. Behavioral step work and spiritual step work appear to be conceptually distinct components of step work that have distinct predictors and unique impacts on outcomes.

What good is religion?

AA meeting sign
AA meeting sign (Photo credit: Wikipedia)

Sigfried Gold on what religion and 12 step fellowships get right:

The work of self-transformation can be done through psychotherapy, religious practice, reading self-help books, independent resolutions and intentions, consulting coaches, gurus, psychics, body healers, mind healers and faith healers of all stripes. People come to the work of self-transformation in moments of despair, moments of hope, after long reflection, through happenstance…

Religions have certain advantages in the self-transformation arena that can’t be matched by secular forms of this work. One is the ideal–if not actual attitude–of religions towards money. Although the financial costs of religion can be quite high (giving away a tenth of one’s income is not uncommon), payment is generally voluntary; newcomers and poorer congregants can usually enjoy all the benefits of community, moral guidance and support, meaningful rituals, comfort in times of adversity, without having to pay more than they choose. Disingenuously or not, religions claim to be motivated by concerns beyond money, and obligate themselves to at least put on a show of providing services unattached to remuneration. For people outside the social welfare system, secular self-transformational help must be paid for. Much of the support in a religious community comes from other congregants rather than from paid clergy. As a special case, 12-step recovery fellowships, which include some of the largest organizations in the world, offer their members access to daily or hourly support, essentially for free, that could only be matched among secular service providers by extremely expensive in-patient treatment centers or psychiatry wards.

Are these the thoughts of an evangelical seeking to extend the reach of the church into more lives at their most vulnerable moments?

Nope. The writer is an atheist.

I have no nostalgia for the bad old days of clerical authorities browbeating us into morality with their hands in our pockets. But I fervently yearn for a day when people wishing to be better have easy access to free or donation-based support, offered primarily by their peers, possibly facilitated by modestly paid clergy, and offered without coercion, without insistence that one set of beliefs is right and the rest are wrong, offered because people who actively pursue their own paths towards meaning, fulfillment and some vision of the good feel a generous desire to share what they’ve learned on those paths with others. Religions may be declining in their ability to provide that kind of altruistically motivated, communally organized support, but we have few other models to work with.

This is an interesting observation in the context of the concept of a monoculture that is organized around economics. This monoculture’s emphasis on individuality helps explain our cultural aversion to a recovery solution that is free, relational and demands interdependence..

Marc Maron on AA and psychiatry

Marc Maron
Marc Maron (Photo credit: lanskymob)

This is great. I love Maron’s fearless questioning and the interviewer’s (a psychiatrist) tolerance for vulnerability and honesty:

Slate: How did A.A. figure into your getting sober?

Maron:For practical tools to deal with the addicted brain, the stuff I learned in Alcoholics Anonymous and the community of A.A. just totally worked for me. If you would have told me back then that I wouldn’t desire a drink or that I wouldn’t desire to do drugs at some point in my life, I don’t think I would have believed you. I still have my vices—I drink a lot of coffee and I’m hopelessly addicted to nicotine in the form of lozenges. But those aren’t destroying my life or my health like other things would have.

Slate: It’s not like you’re going to wrap your car around a tree because of some lozenges.

Maron: Exactly.

Slate: A big problem for psychiatrists when it comes to understanding addiction is that there are many of us who have no experience with it on a personal level. So sometimes there’s a built-in disconnect between the treater and the patient.

Maron: Well, yeah, because you guys are just taught to medicate and suggest things. [Pauses.] Have you even read The Big Book?

AA Big Book
AA Big Book (Photo credit: Wikipedia)

Slate: No…

Maron: Why not?!

Slate: I know, I should… I treat people who swear by it and I haven’t even looked at it.

Maron: Yeah, see, that’s the thing with all you guys. Most therapists have never read that fucking book. But you send people to A.A. meetings, don’t you?

Slate: I do.

Maron: But you have no understanding of what the program is! I can’t understand why it’s not assigned to you guys.

Slate: That’s a really good point. Looking at my shelf right now I see The Neuroscientific Basis and Practical Applications of Psychopharmacology, but books that people in recovery actually use were never assigned to me. I could read them on my own but they’re not part of the curriculum.

Maron: I think a lot of you guys see it as some sort of goofy spiritual system. But there’s a certain brilliance to it. The program uses very simple language, so it works for people who are geniuses or for people who are morons. And it works everywhere—there are programs going on in rooms all over the world and the feeling in all of them is the same. The emotional hunger, the need, the selfishness—it’s all the fucking same! Everybody in those rooms has been to hell and back twice. They’ve fucked up so much that now they’re these demons in exile.

Read the rest here.

Thanks for the evidence

i_love_evidence_based_medicine_key_chains-r33ff90ead6aa425ea368e31ca9ee70e5_x7j3z_8byvr_512Anna David points us toward some positive press for AA. One of the articles focuses on a lecture by Marc Galanter

Galanter said that AA uses many of the psychosocial features that operate in any charismatic membership group: social cohesion through attendance at regular meetings; a belief system embodied in the book Alcoholics Anonymous; a behavioral program of action requiring an individual to practice the 12 steps; and an emphasis on cognitive change by altering habits and avoiding “people, places, and things” that serve as triggers for alcohol or drug use.

Galanter said that a feeling of “belonging” is essential to success in AA. “When joining a charismatic group, an individual experiences relief in distress in direct relation to how closely affiliated he or she feels with the group,” he noted.

He outlined seminal studies looking at variables associated with successful long-term sobriety. In one 2006 study of 628 alcoholics in the VA system, successful abstinence at 16 years was related to AA attendance but not to the quantity of medical treatment.

Two 2003 studies found that engagement in AA was not associated with prior motivation or religiosity. But interestingly, while spiritual beliefs at baseline did not predict abstinence at three-year follow-up, a “spiritual awakening” by three years was associated with three-times higher abstinence rates.

Wait. There’s evidence for the effectiveness of AA and twelve step facilitation? You mean it’s not just a cult bent on evangelizing others into magical group-think?

It begs the question, “Why is there so much professional hostility to the suggestion that twelve step facilitation is an important and evidence-based treatment strategy?”

Thanks Anna!

Women, Alcoholism and AA

AA meeting sign
AA meeting sign (Photo credit: Wikipedia)

An interesting new blog has a great post on Women, Alcoholism and AA.

Admitting that I was an alcoholic has had a profound effect on my life. Most of my friends from the old days are not around anymore; they didn’t want to hear about my alcohol problem and some understood it so little that it somehow led to me being characterized as a drama queen. They’ve have been replaced with people who are willing to share all of their experience, strength and hope with me over a coffee.

But perhaps even more interesting than what the WSJ piece had to say about women and drinking is what it had to say about AA. It essentially summarizes AA as a haven for sexual harassment and abuse of women, explaining that the female population of AA is left vulnerable because they’re made to feel further victimized and powerless over their lives. Having spoken to several female members of AA, I have found the exact opposite to be true. The women I spoke to, in fact, found nothing but continued support and understanding through their battles with alcohol from both the male and female members in the program, and took pains to point out how they felt safe and nurtured. As one woman put it, “I find AA no different than any situation in life where males and females socialize. There will always be flirting and attempts at hooking up, but the vast majority of men I have met are very respectful and considerate.”

Gender Differences in AA Benefits

AA meeting sign
AA meeting sign (Photo credit: Wikipedia)


A recent study reported that men and women benefit from AA in different ways:


For both men and women, participation in AA increased confidence in the ability to cope with high-risk drinking situations and increased the number of social contacts who supported recovery efforts. But the effect of both of those changes on the ability to abstain from drinking was about twice as strong for men as for women. In contrast, women benefitted much more than men from improved confidence in their ability to abstain during times when they were sad or depressed. “It is striking that this effect was virtually absent in men while it was a major contributor to women’s ability to remain abstinent and to limit the number of drinks they consumed when they did drink,” says Hoeppner. Several factors that helped to reduce the intensity of drinking in men – such as less depression and fewer friends who encouraged drinking – did not appear to be as important for helping women.

Kelly says,”AA helps both men and women stay sober following treatment by enhancing sober social networks and boosting confidence in coping with high-risk social situations. In terms ofalcoholism recovery more generally, we found the ability to handle negative moods and emotions was important for women but not for men. Conversely, coping with high-risk social situations – which could be attending sports or other events where people are likely to drink – was important for men but not women. These differences suggests that, for women, finding alternative ways to cope with negative emotions may yield recovery benefits, while among men, a greater focus on coping with social occasions that feature drinking may enhance recovery.



a protective wall of human community

Graphic of Carl Jung, published in 1912.
Carl Jung (Photo credit: Wikipedia)


Sentences to ponder:


In a 1961 letter to AA’s co-founder, BillW., the renowned psychoanalyst, Carl Jung, described two main ways in which individuals with severe alcohol addiction might recover. One was through ‘real religious insight’; the other was through ‘the protective wall of human community’ characterized by a ‘personal and honest contact with friends’ (AA, 1963) [62]. Although AA has more earnestly expressed the former as being the principal pathway to recovery in its main texts [33,63] perhaps inadvertently, stemming from its social orientation and structure, it has also tapped into the curative facets of the latter—protective and positive social influence. While other factors are certainly involved to varying degrees, this AA-facilitated combination, in particular, appears to help individuals suffering from alcohol addiction to find and sustain recovery.


[Hat tip: Matt]