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.

The political left and prohibition

"Legalization Now" Banner At The May...
“Legalization Now” Banner At The May Day Immigration Rights Rally (Washington, DC) (Photo credit: takomabibelot)

Andrew Sullivan picks up on Jack Meserve’s discussion of the political left and prohibition:

Meserve:

Think of a few of the currently illegal vices: recreational drug use, gambling, prostitution. With some exceptions, the left has been in favor of legalization or decriminalization of these activities. Now think of legal vices: gluttony, cigarette smoking, alcohol use. On these habits, we’ve supported bans, onerous restrictions on place and time of consumption, and increasingly aggressive fines and taxes. There seems very little consistency between these positions, and few have even attempted justifying the differences. Progressives have been guilty of letting our temperament rather than our reason guide the policies; bans on activities like drug use are seen as naive or old-fashioned, but legal vices like cigarette smoking are public-health or collective-action problems to be solved through brute government action.

Then, Sullivan offers some reader reactions to Meserve. Here are just a couple:

…legalization isn’t being pursued as a public health issue.  It’s being pursued to make sure people don’t face fines, criminal charges, arrest, or jail time for using a substance that is less harmful and addictive than other legal substances.  Any public health aspects come into play when you discuss how pot would be regulated ONCE it is legal.  But Meserve doesn’t discuss or raise any public comments about what happens post legalization in the piece.

another:

Why is the pot legalization initiative on the ballot in Washington when legalization has failed to qualify so many times before, despite our alleged libertinism?  Well, this one contains a 25% excise tax dedicated to substance abuse prevention and healthcare in general, a state-run store regime was added, age limits put in, and specific concentrations of THC in the bloodstream for DUI were defined.  These things were absent in prior initiatives, meaning that had they qualified and passed, anyone could have set up shop across from a kindergarten to sell. It’s almost instead of us being a bunch of stoned hippies just out for a good time, we wanted to make sure that this vice was legalized in the most thoughtful, responsible way possible, while also making provisions for ameliorating possible social harms caused by legalization.  That’s left-wing social engineering at its best.

When the bubble bursts

A bubble.
A bubble. (Photo credit: Wikipedia)

A while back, a colleague introduced me to Shattered Assumptions. The book posits that we are able to engage in our day to day life because we assume:

  • The world is  benevolent
  • The world is meaningful
  • The self is worthy

When a traumatic event destroys these assumptions, rebuilding them is a task that is central to recovery from the trauma.

At any rate, Andrew Sullivan linked to an article talking about the assumptions of the middle class:

My friend is not a member of the middle class, as you might have guessed. He has a high school education, grew up the son of a factory worker in a family of nine children, works part-time as a house painter and DJ, lives hand to mouth, and gets by with a little help from his friends. He’s been in AA for a long time, has seen a lot of people pass away. “I hope you can get there before it’s too late,” I said. “Hey,” he said, not unkindly, “we could both die before her. You never know what’s going to happen.”

I am a member of the middle class, as you might have guessed, and the moment made me realize something about the way we see the world. No one in the middle class imagines they could die at any minute. The middle-class idea is quite the reverse: that the world can be controlled, risk eliminated, fate mastered. Grades, admissions, credentials—the steady, predictable climb up the ladder of professional success—that’s the idea. We’re going to live a long time, and the world is not going to take us by surprise.

Has there ever been another group of people, in all of human history, that’s possessed that kind of attitude? Of course, there are reasons it’s emerged when it has: our enormous modern life expectancy, our inconceivable prosperity, our overwhelming military power. But I wonder about its spiritual perils. My professor used to say that it was easy for Nietzsche or Sartre to do without God, because they had so much else to sustain them.

Failure to rescue

Atul Gawande found that hospitals have high rates of variance in post surgical complications but the reason is not what he expected.

But there continue to be huge differences between hospitals in the outcomes of their care. Some places still have far higher death rates than others. And an interesting line of research has opened up asking why.

Researchers at the University of Michigan discovered the answer recently, and it has a twist I didn’t expect. I thought that the best places simply did a better job at controlling and minimizing risks—that they did a better job of preventing things from going wrong. But, to my surprise, they didn’t. Their complication rates after surgery were almost the same as others. Instead, what they proved to be really great at was rescuing people when they had a complication, preventing failures from becoming a catastrophe.

Scientists have given a new name to the deaths that occur in surgery after something goes wrong—whether it is an infection or some bizarre twist of the stomach. They call them a “failure to rescue.” More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more.

This is something that Dawn Farm has invested a lot of energy into. I wonder if this is also what separates the best treatment centers from the rest?

[via Andrew Sullivan]