A culture of communion

kintsugi

Jim Contopulos writes about the beauty in brokenness he witnessed when his (now deceased) son took him to an NA meeting.

Years before we lost Nick to the diseases of addiction and mental illness, he invited me into a Narcotics Anonymous meeting. I had never attended one, but of course, I said “yes” to his invitation. I loved being with Nick and I loved watching his love for recovery. Immediately following the NA meeting, Nick asked me what I thought. I told him that I absolutely loved it, and that my only wish was that church would be more like this. Although I didn’t understand it at the time, here was my first exposure to true community – a community of brokenness.

To be sure, the men and women who crowd these smoke-filled rooms were broken. Their lives were shattered and in shambles and they needed each other. Desperately needed each other for life. As I continued on in my own room of recovery, I admired them for their courage, their openness, their vulnerability and their humility birthed from brokenness. While I was prepared to admire them, what I was not prepared for, was that I began to envy them. Yes, they are the fortunate ones.

Out of their great need, they built communities of care, honesty, openness, and service to one another. In that atmosphere, they ‘held each other’ in tenderness and understanding, while healing continued. Here, brokenness began to become something beautiful. It began to resemble the ‘upside down’ world that Jesus introduced by His Beatitudes. The world where service to each other is the hallway that leads into the ballroom of mutuality. There is no “us” and “them”; it is “we”.

I envied them, because, apart from these rooms, this ‘culture’ of communion was notably absent elsewhere.

 

Recovery anniversaries unscientific and crazy?

Colorful_birthday_cake
Ban the cake!!!

Robert DuPont has something to say in response to the media blitz for Dodes’ new book attacking AA. He’s more strident than I’d be in defending AA, but he makes some great points.

. . . Dodes criticized AA and Narcotics Anonymous’ (NA) “tally” system, which recognizes incremental periods of continued sobriety by awarding chips. “The dark side is, if you have a beer after six months of sobriety, you’re back to zero in AA,” Dodes said. “That makes no sense. It’s unscientific. It’s simply crazy. If you have only a beer in six months, you’re doing beautifully.”

What’s wrong with Dodes’ thinking on the matter?

The bright line drawn by AA and NA — the sobriety date that marks the last time a recovering addict used alcohol or other drugs — is essential. It differs radically from the academic and professional standard for drug and alcohol addiction , which tolerates slips and relapses. The bright line of the sobriety date is a matter of importance and of huge pride for fellowship members — it is a core marker of identity in the fellowships, and a fundamental defining part of the disease of addiction. One of the true joys of this fellowship is attending a group celebration that commemorates a recovering addict’s “clean time” anniversary.

The all too common academic, professional views on addiction, well represented by Dodes, run counter to the AA and NA goal of sobriety. Many professionals and academics see continued alcohol and drug use as OK but “problem-generating use” as not quite as acceptable. They encourage controlled, responsible alcohol and drug use. They encourage cutting down, but not stopping. They view drug and alcohol use by addicts as a lifestyle alternative that, like sexual orientation, should not be “stigmatized.”

That is a reckless view. An addict who has one beer after six months of sobriety is not doing “beautifully.” Instead, he or she is courting catastrophe, and likely to easily fall back into active addiction. An addict cannot just have one beer, or one cigarette, or one pill. True lifelong recovery does not happen that way, and anyone who believes that it does is heading for a major relapse.

There are endless examples of skeptics like Dodes who seek alternatives to AA, or approaches that attack AA. I suggest to my patients who reject AA that they find one of these alternatives, and see what they think of it. They tell me that such programs are hard to find. I ask them, “Why do you think that is the case? Doesn’t that tell you something?”

Tribes of the recovering community

naheadr2

Narcotics Anonymous has gotten a lot of attention this week after Philip Seymour Hoffman’s death, so it’ll be this week’s tribe:

Narcotics Anonymous is a global, community-based organization with a multi-lingual and multicultural membership. NA was founded in 1953, and our membership growth was minimal during our initial twenty years as an organization. Since the publication of our Basic Text in 1983, the number of members and meetings has increased dramatically. Today, NA members hold more than 61,000 meetings weekly in 129 countries.

More on the history of NA here.

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.)

 

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.

 

 

A culture of communion

kintsugi

Jim Contopulos writes about the beauty in brokenness he witnessed when his (now deceased) son took him to an NA meeting.

Years before we lost Nick to the diseases of addiction and mental illness, he invited me into a Narcotics Anonymous meeting. I had never attended one, but of course, I said “yes” to his invitation. I loved being with Nick and I loved watching his love for recovery. Immediately following the NA meeting, Nick asked me what I thought. I told him that I absolutely loved it, and that my only wish was that church would be more like this. Although I didn’t understand it at the time, here was my first exposure to true community – a community of brokenness.

To be sure, the men and women who crowd these smoke-filled rooms were broken. Their lives were shattered and in shambles and they needed each other. Desperately needed each other for life. As I continued on in my own room of recovery, I admired them for their courage, their openness, their vulnerability and their humility birthed from brokenness. While I was prepared to admire them, what I was not prepared for, was that I began to envy them. Yes, they are the fortunate ones.

Out of their great need, they built communities of care, honesty, openness, and service to one another. In that atmosphere, they ‘held each other’ in tenderness and understanding, while healing continued. Here, brokenness began to become something beautiful. It began to resemble the ‘upside down’ world that Jesus introduced by His Beatitudes. The world where service to each other is the hallway that leads into the ballroom of mutuality. There is no “us” and “them”; it is “we”.

I envied them, because, apart from these rooms, this ‘culture’ of communion was notably absent elsewhere.

 

Youth Recovery Contexts

hands by katerha

Another study brings good news about adolescents and 12 step recovery:

Results

The proportion attending 12-step meetings was relatively low across follow-up (24 to 29%), but more frequent attendance was independently associated with greater abstinence in concurrent and, to a lesser extent, lagged models. An 8-item composite measure of 12-step involvement did not enhance outcomes over and above attendance, but separate components did; specifically, greater contact with a 12-step sponsor outside of meetings and more verbal participation during meetings.

Conclusions

The benefits of 12-step participation observed among adult samples extend to adolescent outpatients. Community 12-step fellowships appear to provide a useful sobriety-supportive social context for youths seeking recovery, but evidence-based youth-specific 12-step facilitation strategies are needed to enhance outpatient attendance rates.

A New Paradigm for Substance Abuse Treatment

From Robert DuPont, MD:

Substance abuse treatment is committed to abstinence from nonmedical drug use. Yet, continued nonmedical drug and alcohol use and relapse are so common that they are often defined as part of the disease itself.

A “new paradigm” for care management has been pioneered over the past four decades by the state Physician Health Programs (PHPs).PHPs provide diagnostic evaluation, treatment referral, close monitoring and support services to health care professionals who have conditions, including in particular substance use disorders, which can impair their ability to practice medicine with reasonable skill and safety. In dealing with substance use disorders, PHPs use a zero tolerance standard for any alcohol or other drug use, enforced by intensive random testing and close linkage to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous to produce remarkable long-term outcomes. These outcomes set a far higher standard for success in treatment and they cast doubt on the definition of addiction as being characterized by relapse. They demonstrate that the environment in which the decision to use or not to use alcohol and drugs is a powerful determinant of outcomes.

YES!!!!

While some may dismiss the PHP results because physicians are a uniquely advantaged patient population, a similar approach has produced outstanding results in a dramatically different population of addicted people — convicted felons on probation. A randomized control study of the pioneering HOPE Program showed that compared to a control group of standard probationers, HOPE participants were 55 percent less likely to be arrested for new crimes, 72 percent less likely to use drugs, 61 percent less likely to miss appointments with probation officers and 53 percent less likely to have their probation revoked.3 HOPE probationers were sentenced to 48 percent fewer days of incarceration.

The new paradigm of long-term monitoring with swift, certain and serious consequences for any detection of drug or alcohol has the potential to substantially improve long-term outcomes for substance abuse treatment.

Now, I’m not interested in a paradigm that makes consequences a central element.

However, what’s important here is that there is a very effective treatment for this chronic illness and, like most treatments for chronic illnesses, we struggle with engagement and compliance. In the case of addiction, why do we respond to those struggles with a lowering of the bar?