“narrative truth”

booksThis reminded me of something from Bill White.

At the heart of Perry’s argument — in line with neurologist Oliver Sacks’s recent meditation on memory and how “narrative truth,” rather than “historical truth,” shapes our impression of the world — is the recognition that stories make us human and learning to reframe our interpretations of reality is key to our experience of life

Bill said the following in Pathways [emphasis mine]:

Each person’s life is series of events and experiences. Those events to which one attributes special meaning get selected, abstracted, and massaged into stories that communicate to others the nature of one’s identity. Identity – that sculpted perception of self in relationship to the outside world at any given moment – springs from and is in turn shaped by storytelling. Life is a continuing process through which one adds new elements to his personal story, eliminates old elements from the story that no longer fit, and revises the old story to achieve new meaning. Story Construction forms the bridge between self perception and one’s self-presentation to others.

One’s story places oneself in a particular relationship with the world. The construction of personal history shapes both present and future. It is the justification and defense of one’s existential position. It can dictate the lines one has in a play with terrifying predictability. Each of us plays out the scenes and chapters in our lives in line with the motifs embedded within our own story. The construction of the past shapes the future. By telling you who I am, I tell you my fate. To change my fate, I must redefine who I am; I must reconstruct my story.

Many addicts have a carefully constructed life story that portrays them as being victimized by people and forces and conditions over which they have no control. The “victim” status and role serve as a righteous justification for continued self-destruction through addiction. It is as if revenge against the world can be achieved through obliteration of oneself. Through treatment and recovery, the addict’s history must be reconstructed, portraying the individual not as a victim but as an active player who contributed to the past through personal choices. Addicts present their history through stories of what the world did to them; recovering addicts speak of who they were, what they did, what they valued, and how they thought. Projection of blame is replaced by taking personal responsibility for ones past.

When the addict begins to disengage from the world of addiction, his or her personal story must be reconstructed. The old story will not enhance recovery; it provides permission for relapse. For recovery, the addict must be helped to reconstruct the story of his or her life – a story that will reflect a different conception of self, a different view of the world and a new value system. An essential milestone of recovery is the sobriety-based construction of one’s story. The story that will get the addict through the early months of sobriety will continue to evolve throughout the recovering addict’s life.

It is not particularly necessary that the first story constructed by the addict in treatment or early recovery be factually correct. Factual omissions and distortions are to be expected. It is necessary that the addict’s life be reframed within the story in a manner that supports recovery. The self-story in recovery must be different than the self-story in addiction. Whether factually true or not, the self-story in recovery must be metaphorically true. The story must give some meaning to one’s own suffering. The story must explain the suffering that one has caused others. Factual truth – which the addict may be incapable of in the earliest days of recovery – is secondary to emotional truth. The freedom achieved through purging the emotional content of the story and the power of the injunction for change that emerges from the story should take precedence over factual accuracy. As recovery proceeds, the story will evolve in ways that bring factual and emotional truth closer and closer together.

For me, a critical part of reconstructing my story was reconstructing my stories about the world I lived in and the people in it. My narratives that people would/could not understand and the dangers of vulnerability might have been more challenging to change than my narratives about who I was.

 

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

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.

 

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.)

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.

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.

 

 

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..

Let’s sensationalize recovery

It just so happens that Dawn Farm is co-sponsoring a screening of the film next week.

One Crafty Mother has a post responding to The Anonymous People.

That last bullet point is the one I want to focus on. [There are over 23 million people in long term recovery in America alone.] Changing the public’s perception of addiction by TALKING ABOUT RECOVERY. Because, everyone, RECOVERY WORKS. There are more people in recovery from addiction than there are suffering from it.

Here’s the rub, though. People don’t recover on their own. Every single recovery program focuses on community – on finding other addicts and alcoholics who understand where you are and can help you navigate life without alcohol or drugs.

It doesn’t matter what program of recovery you follow. Recovery advocacy is for EVERYONE.

You don’t have to talk about HOW you recovery, just THAT you recover.

For those of us in programs that have anonymity as a tradition and who are confused about breaking this tradition, this point is KEY. How you stay sober isn’t relevant. You do not have to be a mouthpiece for an individual program of recovery. You can talk about recovery without ever mentioning how you do it. When someone who is suffering asks you how you stay sober (and if you talk about recovery they will ask, I guarantee it), then you are free to share – in the sacredness of a one-on-one (or group) setting – how you do it.

But until the public understands that RECOVERY HAPPENS, people are going to stay stuck in addiction. People are going to misunderstand what addiction means. People aren’t going to know it is quite literally on every street in America. Every street has someone stuck in the darkness and isolation of addiction, and every street has someone thriving in recovery. We have enough coverage of the destruction of addiction. We sensationalize the stories of celebrities crashing cars, going in and out of rehab. We condemn the havoc alcoholism and addiction bring to society.

We are sensationalizing the wrong thing. Let’s sensationalize recovery.

She’s got a great message and very gracefully addresses a couple of potential pitfalls. I like encouraging advocacy while also respecting traditions of anonymity. I also like her emphasizes that there are lots of ways to be an advocate and each recovering person can find their own advocacy approach.

I love her passion and clarity. I’m going to have to watch this blog.

I’ve got one quibble with the statistic the film uses–23 million Americans in recovery. That is based on surveys asking people something to effect of, “Have you previously had a problem with drugs or alcohol and no longer have one?” That kind of question is going to get a lot of false-positives for what we think of as recovery.

The point, however, is there there are large numbers of people in long term recovery in the U.S. And, unfortunately, when people think of addiction, they don’t think of recovering people like me or friends who are doctors, nurses, lawyers, business owners, moms, dads, bothers, sisters, etc. Instead, they think of us as social parasites, or worse, scary people committing a violent or property crime.

Telling our stories is powerful. Dawn Farm often takes clients or alumni to speak to community groups like the Lions, Optimists, Rotary or school groups. The response is always the same–shock that the clients are just like their niece, nephew, neighbor, grandchild, etc.

how do you want your loved one to return?

Red_Drug_Pill---recoveryAnna David has an interview with Earl Hightower that really gets at the informed consent issues I’ve been talking about here.

AD: Should the parents just accept the first recommendation or should they ask for more?
EH: I think the first question they should ask should be one they ask themselves, which is how they want their son to return.

AD: What does that mean?

EH: Well, the majority of the treatment centers out there are 12-step based, which means that the goal for them is for their clients to achieve abstinence. This would be the choice to make if the parents want to get their son back in the same condition that he was in before he got on drugs: drug-free.

AD: But you can’t say for certain that a 19-year-old who was doing Oxy for nine months is definitely an addict who will need 12-step.

EH: You can’t. Maybe he was just dabbling; treatment would be able to help determine that. But maybe treatment will prove something else—maybe treatment will prove that this wasn’t an isolated incident. Maybe he’ll get in there and confess that he’s been using pot since he was 12 and maybe other conversations will turn up the fact that there’s a genetic predisposition toward addiction in the family. And if that’s the case, I believe he will need community-based support in staying clean once he returns home. It could go either way: good ongoing clinical assessment is the backbone of early treatment to determine the direction of care.

AD: But not all rehabs recommend 12-step or even full abstinence.

EH: Yes. And that’s why parents—people—need to know is that if an addict is going to a facility which subscribes to medication-assisted treatment and recovery, the goal is different. Loved ones need to know what medication-assisted treatment really means, which is that treatment will be radically re-defined and their child could be put on a medication which he would remain on for a long time, if not the rest of his life.

AD: So that’s what you mean when you talk about parents asking themselves how they want their child to return.

EH: Yes. But I can tell you from 30 years of doing this work that most parents want their child to come home drug-free—or they at least they want a shot at that. But some members of the treatment community will tell parents—or the addicts themselves—that we have to let go of this notion of abstinence and move more in the direction of medication-assisted treatment. And that means that people who could thrive without being on anything at all are leaving treatment centers on very powerful opiate replacement drugs.

Of course, Hightower has a strong bias toward abstinence-based treatment, but he’s describing a choice patients and parents never really get to make for themselves, with treatment providers of all types. As with a lot of health care decisions, there’s a problem of asymmetrical information and patients are at the mercy of whatever practitioner they land in front of.

Read the rest of the interview here.

The internal combustion engine of AA

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

 

Service to others.

 

Bill White posted earlier this week about the evidence base for the benefits of alcoholics helping other alcoholics.

 

Now, National Geographic has posted an article about research into AA that covers some of the same territory:

 

Lee Ann Kaskutas, a scientist with the Alcohol Research Group, has faced skepticism from colleagues for studying A.A., in part because of the numerous spiritual references that go with the 12-step program. It puts A.A. on “the fringe” in the minds of many scientists, Kaskutas said.

Kaskutas, a self-proclaimed atheist, said that the 12 steps bear fruit regardless of one’s spiritual beliefs. “If you don’t believe in God, the way it weasels in is in the help and behaviors that the 12-step group inculcates.”

Helping others, Kaskutas said, “is the internal combustion engine of A.A. I think that is the connection to spirituality.”

People feel better about themselves after helping someone else, Kaskutas said. “So it’s reinforcing—when you help somebody, I think your brain chemistry changes.”