Above criticism

AA-Groups-ClevelandBill White on varieties of secular AA experiences.

The ongoing evolution of A.A.’s story — its history — suggests that the fellowship will meet this challenge by finding ways to adapt to both religious renewal movements and cultural trends toward secularization without losing its essential character.

But “suggest” is all that history can do. The fundamental question for the future of Alcoholics Anonymous — which necessarily includes the present — is whether its Tradition that having “a desire to stop drinking” remains “the only requirement for A.A. membership” OR if membership becomes reserved exclusively for those who adhere to a verbatim interpretation of the Twelve Steps as they were written in 1939.

In short, will A.A. be able to find ways to embrace more “varieties” – or not?

The hardiness of AA

aa3Bill White and Ernie Kurtz  examine the factors contributing to AA’s resilience in the face of steady attacks

Attacking Alcoholics Anonymous (A.A.) and 12-step oriented addiction treatment has become a specialized industry with its own genre of literature, celebrity authors and speakers, single-focus websites, and promoted alternatives.  Collectively, these critics suggest that A.A. is an anachronism whose effectiveness has been exaggerated and whose time in the sun has passed.  A.A.’s institutional response to these  criticisms has been a consistent pattern of private self-reflection (e.g., Bill Wilson’s “Our Critics can be Our Benefactors”) and public silence (e.g., no opinion on outside controversial issues, personal anonymity at level of press, and public relations based on attraction rather than promotion–as dictated by A.A.’s Traditions).

The concept of organizational resilience suggests not just an institution’s longevity, but the capacity to survive in the face of significant threats to its character and existence.  Such threats faced by A.A., including the intensity and endurance of polemical assaults on A.A., raise the question of how A.A. survived these challenges to become such a dominant cultural force.

Bill and Ernie identify 7 factors. Among them is scientific validity. Read them here.

The Big Book Turns 75

aa3PBS has a nice write up on the 75th anniversary of the publishing of  the AA’s basic text. the “big book”:

April 10, 1939, marks the publication date of “Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism.” One of the best-selling books of all time (it has sold more than 30 million copies), the volume is better known to millions of recovering alcoholics and addicts as “the Big Book.” Its influence on the world’s health and the treatment of alcoholism and other addictions is immeasurable. In 2011, Time magazine placed the Big Book on its 100 most influential books written in English since 1923 (not coincidentally the year the magazine was founded). In 2012, the Library of Congress designated it as one of the88 books that shaped America.

The book’s copyright application, filed April 19, 1939, lists William G. (“Bill”) Wilson, the co-founder of Alcoholics Anonymous, as the sole author. In reality, the book was very much a group effort. Dozens of recovering alcoholics, many who attended the earliest AA meetings and who had an average sobriety time of 1 to 1.5 years, helped Bill Wilson with the writing of the book in 1938. Their express purpose was to spread the life-saving premises of Alcoholics Anonymous.

Read the rest here.

The Doctor’s Opinion – Dawn Farm Ed Series

silkworthResearch continues to shed light on the neurobiology of alcohol/other drug addiction. Modern research supports much of what was intuitively and experientially believed by the medical specialists who supported the Alcoholics Anonymous program in its earliest days.  This program will describe a physician’s view of alcoholism, as presented in the literature of Alcoholics Anonymous and updated with the modern neurobiology of addictive illness. It will include a discussion of Dr. Silkworth’s explanation of alcoholism as a twofold disease affecting mind and body, how Dr. Silkworth’s opinion relates to the modern neurobiology of addictive illness, identification of therapy for alcoholism as promoted by Alcoholics Anonymous, and the relationship of this therapy to Dr. Silkworth’s opinion.

Handouts and other goodies:

Handouts and slides:

Related reading suggestions:

Video

The Doctor’s Opinion on Alcoholism from Dawn Farm on Vimeo.

Slidecast:

View more webinars from Jason Schwartz.

About the presenter

Dr. Herbert MalinoffHerbert Malinoff, MD, FACP, FASAM, is a specialist in chronic pain and addictive illness. He is the Medical Director of Pain Recovery Solutions, PC; and an attending physician at Saint Joseph Mercy Hospital in Ypsilanti, Michigan. Dr. Malinoff is a clinical faculty member of the University of Michigan Medical Center in the Department of Anesthesiology, and a consultant to Michigan Pain Specialists in Ann Arbor, Michigan. He is also a past President of the Michigan Society of Addiction Medicine. Dr. Malinoff received his M.D. degree from the University of Michigan Medical School.

Tribes of the recovering community – Calix Society

calixlogo

This week’s tribe is the Calix Society.

Calix is an association of Catholic alcoholics who are maintaining their sobriety through affiliation with and participation in the Fellowship of Alcoholics Anonymous. Our first concern is to interest Catholics with an alcoholic problem in the virtue of total abstinence. Our second stated purpose is to promote the spiritual development of our membership. Our gathering today is an effort in this direction. Our conversation and our association together should be a source of inspiration and encouragement to each other, geared to our growth toward spiritual maturity. Our participation in all other spiritual activities of Calix, such as the frequent celebration of the Liturgy, reception of the Sacraments, personal prayer and meditation, Holy Hours, Days of Recollection and retreats, aid us in our third objective, namely, to strive for the sanctification of the whole personality of each member. We welcome other alcoholics, not members of our faith, or any others, non-alcoholics, who are concerned with the illness of alcoholism and wish to join with us in prayer for our stated purposes.

(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.)

In Race for Boston Mayor, Former Addicts Back Candidate With a Past

A colleague who specializes in working with at-risk youth was fond of saying that we could look at those kids as predators, victims or resources. Too often we fail to see them as resources.

The same could be said of addicts and alcoholics. The

NY Times shines a light on a recovering mayoral candidate who is using his peers as a resource to get himself elected.

Tom White, who says he used to swig two six-packs of beer while driving home from work, has been sober for 25 years. Now, his Toyota Corolla has a vanity plate that reads “ONEDAY,” a reference to the Alcoholics Anonymous slogan “one day at a time.” On the rear windshield is a sticker for Martin J. Walsh, a candidate for mayor of Boston.

Many people in recovery stay anonymous and protect the anonymity of others, and A.A. itself does not get involved in politics.  But here, a candidate for the city’s highest office is himself a recovering alcoholic. This has moved many former addicts — drinkers and drug users — to step out from the shadows and publicly support Mr. Walsh, 46, a state representative who still attends A.A. meetings after 18 years of sobriety.

But what is especially unusual about his story is how his candidacy has motivated others in the wide universe of recovery to shed their anonymity to support him.

Former alcoholics and drug addicts are not typical voting blocs. Most do not want to be identified. Because of privacy issues, they are hard to recruit. Campaigns do not target them with clever messaging. Some have never voted.

But those who have stepped forward for Mr. Walsh bring an evangelical fervor to their mission. It is the least they can do, some say, for a man who saved their lives.

Some of these supporters try to imagine a day when their potential for political muscle will be harnessed and organized, and they see the Walsh campaign as a step toward empowerment.

“With Marty, we don’t have to hide it anymore,” said Peter Barbuto, 33, who once thought he had ruined his life by stealing money to maintain his drug habit. He said Mr. Walsh, who had coached him in Little League, “called my family and said: ‘This isn’t the end of the world. We’ll take care of him.’ ” Now, Mr. Barbuto is an addiction treatment consultant. Over the weekend, he was distributing campaign literature for Mr. Walsh in South Boston.

“We have a voice, and it’s going to be heard,” Mr. Barbuto said between houses. “Like the blacks and gays are now — they didn’t have any power and then they came out, and now politicians say, ‘We have to get the blacks and the gays.’ One of these days they’re going to be saying, ‘We’ve got to get the recovery community.’ ”

Recovery should not become an ideology

Ideology-ideallery-cm

Andrew Sullivan points to a recent talk by the pope discussing how faith is lost when it becomes an ideology.

The faith passes, so to speak, through a distiller and becomes ideology. And ideology does not beckon [people]. In ideologies there is not Jesus: in his tenderness, his love, his meekness. And ideologies are rigid, always. Of every sign: rigid. And when a Christian becomes a disciple of the ideology, he has lost the faith: he is no longer a disciple of Jesus, he is a disciple of this attitude of thought…

I think the same can be said of recovery. There are real threats to recovery, commercialization and erosion of conceptual boundaries that, in the long term, might render the term meaningless, lead to backlash and make it more difficult to organize and mobilize recovering people. At the same time, turning recovery into ideology is, at least, an equal threat.

It’s important that the word recovery means something, but the humility of AA literature, Bill Wilson’s writings and the 12 traditions certainly offer valuable experience and wisdom.

Howard Wetsman, who is a critic of the irrational exuberance (my words) for the current crop of addiction treatment medications, wrestled with this issue a while back. (original post)

What we’re imagining is a complete cure. This is not a method for, let’s say, alcoholics not to drink, but an actual cure that would take away the illness and allow people with addiction to use just like normal people. This is because the imagined cure takes away the symptoms and the special response. They feel like normal people, and they’d have a normal person’s reaction to, say, a couple of drinks. It wouldn’t do for them what it does for the person with addiction. I’m not saying such a thing exists or that stem cells would or even could provide such a cure, but it’s my thought experiment so I get to make up anything I want.

So what would the mainstream Addiction Medicine doctor think of this? Well, to be honest, their first response would probably be fear for their job or resentment that neurosurgeons would get all their business, but after they got over that they’d realize that their greatest wish had come true; addiction would be gone. I think they’d be deliriously happy… as soon as they found another job.

But what about some of the members of the group I joined? Would they be happy? I doubt it. When discussing addiction treatment with them I heard such things as the necessity of suffering, the primacy of the spiritual experience, the necessity for gratitude for the illness as a way to a better relationship with God. I heard some of these doctors say that medication for addiction was counter to the point of recovery, because the patient would then be robbed of the opportunity to turn their pain into spiritual growth.

Tribes of the recovering community

Yoga Class at a Gym Category:Gyms_and_Health_Clubs
Yoga Class at a Gym Category:Gyms_and_Health_Clubs (Photo credit: Wikipedia)

Yoga of 12-Step Recovery (Y12SR) thinks of itself as an adjunct to 12 step recovery.

Founded in 2012, The Y12SR Foundation is a program of Off the Mat, Into the World® (OTM). Our mission is to empower the lives of individuals and families affected by substance and behavioral addictions with relapse prevention practices that enhance physical, mental and spiritual well-being.

We realize our mission through a holistic approach that addresses all aspects of the multi-dimensional self (physical, emotional, mental, behavior and heart,) promoting a greater understanding of the disease of addiction, peer generated support and leadership development.

There are some meetings in Minchigan. Looks pretty cool. Maybe I’ll check it out and report back. (That should be pretty funny. I’m pretty stiff, have lousy balance and I’ve never done yoga.)

Mental Illness not a barrier to 12 step benefits

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

 

A recently published study replicates findings that addicts with co-occurring mental illness benefit from twelve step facilitation:

 

Background

Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment.
Methods
Young adults (N = 296; 18 to 24 years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12 months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively.
Results
For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p = 0.436) or active involvement (p = 0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor.
Conclusions
Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.

 

 

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.