Psychotherapy and Addiction.

Odysseus

I know a few people here who work with addicts within the confines of different centres. Anyway, this topic was raised again recently at some training I was at. It's that old school of thought that states they you cannot engage in psychotherapy with those who are still currently using, or the milder version when something traumatic is spoken about [history of abuse, rape, etc] that this must be put aside until the person is out of early recovery [approx 2 years.]

Anyway I have had this discussion with on lots of training courses over the years. DRCC told me they could not work with a client on methadone; they got this guidance from "the experts" the Rutland Centre. Generally this viewpoint is held by those working within a 12 Step model; again generally it can be quite a fundament position.

Whilst I acknowledge that the chaos that accompanies addiction can make it difficult or impossible for some clients to engage in therapy, this does not hold to all. As I am based in a methadone maintenance programme at least 50% of my clients are on methadone, others are just on heroin or another street drug, then the is this those who are clean or concerned persons.

I wouldn't be alone in this belief, I'm in this game about 13 years, but I know others who are in it much longer and concur with me. I have quite a few more thoughts on this topic, but will hold them back in the hope of a discussion starting. So what do you guys and girls think? Is it possible to engage addicted subjects in a therapeutic process?

Finally if anyone have any links or references on this topic please post them.

JuliusCaesar

Not my area of expertise, but isn't this what Motivational Interviewing is about?

Odysseus

JuliusCaesar wrote: »

Not my area of expertise, but isn't this what Motivational Interviewing is about?

MI is more about trying to change behaviour, in this case drug usage. What I'm talking about it engaging with the client around other issues. Be they historical like abuse, the results of a more recent trauma, or dual diagnosis issues. The tradition school of thought which still has quite a strong impact on current practice would suggest that none of the above can be dealt with until the addiction has been addressed, and say with the historical issues that material like that should not be addressed until the person has been in recovery a number of years, otherwise you risk a relapse by provoking memories that the subject cannot manage.

JuliusCaesar

As I said, Odysseus, not my area, but (of course!) I would imagine that many addicts use the substance as a way of dealing with negative emotions, and so negative emotiions would become a trigger for using. And so the addiction would need to be eradicated in order for the person to start implementing new coping strategies for negative emotions. I'll think about this because now that I write it out it doesn't actually make that much sense.

Odysseus

JuliusCaesar wrote: »

As I said, Odysseus, not my area, but (of course!) I would imagine that many addicts use the substance as a way of dealing with negative emotions, and so negative emotiions would become a trigger for using. And so the addiction would need to be eradicated in order for the person to start implementing new coping strategies for negative emotions. I'll think about this because now that I write it out it doesn't actually make that much sense.

I know it's not your area per se, but can I ask which part does not make sense from your perspective?

Darlughda

http://health.groups.yahoo.com/group/hamshrn/files/?prop=eupdate

Not sure if that link will work here. Even in the HSE, when someone presents with depression and is referred etc, the abstinence only model is the one and only at present.

I personally know this is an erroneous idea, and damaging one. Refusing therapy to somebody because they are not emotionally and fully available? Absurd. Unless in extreme examples. However, so many people are either refused therapy or denied further therapy when they are honest about usage of substances, whether it be, alcohol or drugs.

The 12 step programmes are very dangerous areas for many vulnerable people, yet they are the ones encouraged, even by the Alchohol Treatment Units allied to the HSE outpatients units.

Odysseus

That would not be totally correct Darlughda, I work in the HSE Addiction Services and that would not be the model most of us work from, it would be true for the Alcohol Services and if a person presents at our local psych service as soon as drug use is metioned they are passed on to us. However, it is not a model we use a lot.

That is the point of my question, most people who believe in that model don't believe that therapeutic work can be done if a person is using. This has even had an impact on some of the sexual violence organisations, they will not work with a person who was raped or experienced sexual violence if they are a current drug user.

Darlughda wrote: »

http://health.groups.yahoo.com/group/hamshrn/files/?prop=eupdate

Not sure if that link will work here. Even in the HSE, when someone presents with depression and is referred etc, the abstinence only model is the one and only at present.

I personally know this is an erroneous idea, and damaging one. Refusing therapy to somebody because they are not emotionally and fully available? Absurd. Unless in extreme examples. However, so many people are either refused therapy or denied further therapy when they are honest about usage of substances, whether it be, alcohol or drugs.

The 12 step programmes are very dangerous areas for many vulnerable people, yet they are the ones encouraged, even by the Alchohol Treatment Units allied to the HSE outpatients units.

Odysseus

Darlughda, would you mind expanding your thoughts on 12 step treatment? I would not be a big fan, but at the same I must acknowledge that most of the clients I see who manage to stay clean for 5-10 years have used one of the fellowships to some degree either still to that day or at some time in early recovery.

I don't think attendance at something like NA is fundamental, and I am aware of the dangers for some people, but you seem to hold very strong views on the subject, so I'm just interested in your experience around this form of treatment.

I agree that the is nothing worse than that what I call 12 Step Nazi's, especially if they are therapists themselves and its a case of what worked for me will work for you, or that it is the only way to recover. I also dislike the term recovery, I see it as recovery=to recover=to re-cover=to cover over again. For those who it does work for and it must be acknowledged that some fellowships have help 100,000s of people over the world, but it is a change of ideal's from the active addict to the recovering one.

I still think that for some people it is a better outcome that staying stuck in a destructive circle of active addiction, but the dependance on concepts such as a higher power can hold back later therapeutic insights, plus you also can have a dependance on the fellowship itself as oppossed to using it as a resource.

Darlughda

Odysseus wrote: »

Darlughda, would you mind expanding your thoughts on 12 step treatment? I would not be a big fan, but at the same I must acknowledge that most of the clients I see who manage to stay clean for 5-10 years have used one of the fellowships to some degree either still to that day or at some time in early recovery.

I don't think attendance at something like NA is fundamental, and I am aware of the dangers for some people, but you seem to hold very strong views on the subject, so I'm just interested in your experience around this form of treatment.

I agree that the is nothing worse than that what I call 12 Step Nazi's, especially if they are therapists themselves and its a case of what worked for me will work for you, or that it is the only way to recover. I also dislike the term recovery, I see it as recovery=to recover=to re-cover=to cover over again. For those who it does work for and it must be acknowledged that some fellowships have help 100,000s of people over the world, but it is a change of ideal's from the active addict to the recovering one.

I still think that for some people it is a better outcome that staying stuck in a destructive circle of active addiction, but the dependance on concepts such as a higher power can hold back later therapeutic insights, plus you also can have a dependance on the fellowship itself as oppossed to using it as a resource.

Odyseuss, I feel reluctant to expose myself to the onslaught of 12 step defenders, and in addition to expose too much of my private life here.

Nonetheless, it seems you and I are of a similar mindview, and I would rather that more counsellors/therapists in the addiction area would move away from the traditional models that just do not provide a blanket one for all therapy cure solution.

Well, the 12 step movement began with AA. Now, as you have articulated, many, many people have had success with this mode. However, for far too many this can be detrimental. For these reasons:

The AA movement, and indeed the whole 12 step movement claims it is not a religion. However, many who have been damaged by involvement in it have argued that it is in fact a cult.
http://www.csudh.edu/dearhabermas/aacultbk01.htm

The 'disease' idea that is permeated about alcholism is now defunct, and quite frankly erroneous thinking.

The whole idea of each of the 12 steps is potentially hazardous to people experiencing mental health difficulties.
For example,Step no. 1 is 'Admit to yourself that you are powerless over alcohol'.

As you mentioned, Odyseuss, the implications this has for an individual taking responsiblity for their own actions, which I would imagine, is basic abc of the therapeutic model, is diametrically opposed to what is advocated in step no.1, which to me is just a truly destructive ideal or belief.

Below, is iterated the damage done by mental health professionals encouraging the 12 step programmes upon individuals who are vulnerable.
http://hamsnetwork.org/medical/
Complete abstinence is demanded, otherwise therapy is stopped in the HSE, regarding alcohol. Even 1-2 glasses of wine per week is considered to render the client 'unable to process emotionally'. This level of abstinence is demanded 6 weeks prior to commencement of therapy, and is expected to be continous for another 3 months.
The alcohol treatment units nudge you, oh so gently, towards attending your first AA meeting.

If you are experiencing reactive depression, for example a number of things going belly up in your life; divorce, suddenly moving country, bereavement, poeverty isolation etc, well you are still lumped in with people who cannot function without alcohol day to day.

However, it is only in the last couple of years that non 12 step groups such as Lifering have sprung up in Dublin. The notion of Harm Reduction is one the HSE have yet to fully hear. So far it has been, no, no, abstinence only.

Again, I must re-iterate, if the 12 step movement works for you, be it alcohol, drugs, gambling, sex, etc. Good for you. However, it needs to be recognised that the 12 step movement is potentially detrimental for many others, and alternatives must be sought, rather than peddle this kind of cheap healthcare model.

Odysseus

Thanks for your detailed response; I have a look at those links later. It's quite a safe place to discuss the matter here as I have never come across any Fellowship Fundamentalists on this forum. However, I can understand if you do not wish to continue the discussion.

One of the major issues for me is my dual diagnosis clients and people telling them to stop all meds, those to be fair a lot of that is individuals themselves not the programme as the programme acknowledges that some people need professional help and other will have to take meds either at some time or for the rest of the life.

Peel gives quite an interesting overview of Fellowships, but imo he is just as fundamental just in the opposite direction. I remember he gave a talk in Trinity a few years back and one of my mates disagreed with him. Immediately his response was "Sir are you a member of a Twelve Step Fellowship?” which had nothing to do with the topic in hand.

Most private treatment centres in Ireland work from that model, and though the application of it often differs from its theory. I know things have changed a lot since I started in this area, but that breaking through the denial of addiction was often applied in such an abusive manner. Here we have the therapist as The Master, the one who has all the answer, even if they are very simplistic, you are an addict because you have the disease of addiction.

The prejudice within these centres is unreal; we moved buildings a few years back. We know share a large building with one of the community ATU's, because of our harm reduction approach the therapists there would not speak to us for years, refuse to open the door if our staff did not have keys, all of this was because of a difference in treatment philosophies!!!

I do have a good level of respect for fellowships and would never attempt to persuade a client to not attend, but I do not believe this approach deserves the privileged position it current holds. I know one of the ATU's does do a controlled drinking programme for those deemed to be problem drinkers as opposed to alcoholics, but I believe it is held in very low regard by ATU's in general.

Darlughda

That attitude amongst the ATUs was very illuminating, Odysseus. Thanks. Made me giggle too.:D

Indeed, the inclination towards fundamentalism is always a danger on each side of the 12 step debate. I just wish more therapists were as careful not to encourage, as you are not to dis-encourage people attending these groups.

I cannot fathom the real reasoning behind the no-therapy-without-x amount-of-abstinence rule. The simplistic reason of a person being unavailable emotionally to process is just not true in all cases, and quite frankly is nothing more than an inadequate excuse to avoid giving somebody the chance of therapy.

It would make basic common sense that a great deal of therapy is required to understand the need/desire/compulsion for the addiction or substance in the first place.

No support group can provide this. Certainly not a 12 step one.

Odysseus

Darlughda wrote: »

That attitude amongst the ATUs was very illuminating, Odysseus. Thanks. Made me giggle too.:D

Indeed, the inclination towards fundamentalism is always a danger on each side of the 12 step debate. I just wish more therapists were as careful not to encourage, as you are not to dis-encourage people attending these groups.

I cannot fathom the real reasoning behind the no-therapy-without-x amount-of-abstinence rule. The simplistic reason of a person being unavailable emotionally to process is just not true in all cases, and quite frankly is nothing more than an inadequate excuse to avoid giving somebody the chance of therapy.

It would make basic common sense that a great deal of therapy is required to understand the need/desire/compulsion for the addiction or substance in the first place.

No support group can provide this. Certainly not a 12 step one.

The attitude can be quite striking, a few years back I went for an interview in one of our private hospitals. I wasn't really interested in the job but for a few different reasons I put in an application. My Research MA focused on comorbidity from both the ICD-10/DSM IV viewpoint and a psychoanalytic one. The position was for a dual diagnosis therapist, tbh when I started my masters most people in the drug field had no idea what I was speaking about when I said I was doing it on Dual Diagnosis.

Anyway the head Psych Nurse asked me what I would do if one of my alcoholic patients drank, I told that firstly I would invite him to speak about it and that I did not see it as my job to enforce abstinence, and that I would be more interested in hearing why the person drank.

I look over to see this guy going red in the face and eventually he replied quite aggressively with "Do you know where you are?" It was as if I had been in a temple speaking about the devil. That was one job I knew I wasn't getting but then again I couldn't work in a place like that where a relapse is punished with a withdrawal of service until the person stops again.

sambuka41

Odysseus wrote: »

That was one job I knew I wasn't getting but then again I couldn't work in a place like that where a relapse is punished with a withdrawal of service until the person stops again.

Probably a silly question cause im coming at this from the point of view of someone who is only studying for my H Dip, so dont have a great understanding of the subject (hopefully someday I will). But is relapse not part of the cycle of recovery??? (pardon the lack of official names :p)

People engage in all sorts of self destructive behaviour, and i imagine that the initial months of therapy are hard on a patient would it not be common for a relapse of some kind?? Returning to the familiar?? Surely an experienced therapist can tell the difference between someone who is not ready or willing to engage and someone who is trying but is not all the way there yet???

mathepac

Interesting if somewhat flawed thread, already permeated by mis-information, prejudice and incorrect quotes e.g. "For example,Step no. 1 is 'Admit to yourself that you are powerless over alcohol'. " Check the literature please, if you wish to be critical of something at least get the basics right and quote accurately.

The philosophy underlying any 12 Step programme is "The only requirement for membership is a desire to stop drinking" for example in the case of Alcoholics Anonymous.

No ifs not ands or buts - "a desire to stop" is the solitary requirement to join a 12 step programme. A prospective member of a 12 Step programme does not need to have ceased their drinking / drugging / gambling / etc. to attend meetings and engage with other members. If, for example, a group member shows up intoxicated to a meeting, the meeting may be declared an open meeting (sharing is usually limited to generalities and omits personal histories) but will still progress as normal. If the intoxicated member becomes disruptive s/he may be asked to leave, but cannot be forced to leave and the members may elect to adjourn the meeting and reconvene elsewhere.

However neither AA nor any other 12 step programme organises endorses or sponsors treatment programmes run in treatment centres in Ireland or elsewhere and is not responsible for them or to them in relation to how they run their in-house programmes or how they choose to interpret the simple 12 step programmes, details of which are readily available in the public domain. So if treatment centre x or HSE unit y insists on preconditions for engagement with a client, that has nothing whatsoever to do with the 12 step organisations; it is someone else's interpretation of that programme.

If treatment professionals choose to advocate the 12 steps as the only way to treat alcohol dependency, for example, then that flies in the face of AA's own Big Book which states "Who know only a little" - a clear statement that there are more ways to make changes than those described between the covers of a book.

The 12 step programmes are totally elective and there is no coercion mentioned in the Big Book. It states very simply "If you want what we have ... " here is what we did and how it works. The flip side of course is "If you don't want what we have ..." feel free to explore other options. If therapists in the HSE and treatment centres don't allow clients to do this, how are the 12 step organisations to blame?

It all seems very clear and simple to me - where do others see the problems, with 12 step programmes or the apparently corrupt versions being sold as treatment in Ireland?

hotspur

Here's a direct quote from the current version of the big book:

If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic. If that be the case, you may be suffering from an illness which only a spiritual experience will conquer.

To one who feels he is an atheist or agnostic such an experience seems impossible, but to continue as he is means disaster, especially if he is an alcoholic of the hopeless variety. To be doomed to an alcoholic death or to live on a spiritual basis are not always easy alternatives to face.

But it isn't so difficult. About half our original fellowship were of exactly that type. At first some of us tried to avoid the issue, hoping against hope we were not true alcoholics. But after a while we had to face the fact that we must find a spiritual basis of life - or else. Perhaps it is going to be that way with you. But cheer up, something like half of us thought we were atheists or agnostics.

...Well, that's exactly what this book is about. Its main object is to enable you to find a Power greater than yourself which will solve your problem. That means we have written a book which we believe to be spiritual as well as moral. And it means, of course, that we are going to talk about God.

Alcoholism is a disease and the only cure is to turn to spiritualism and God.

Matthepac, some of us think that the science of addiction treatment has moved on beyond Jellinek and the bible. It can be clearly seen from the above quotes that AA proselytises. Many people believe that the fellowship movements promulgate anachronistic misinformation about addiction which encourages the abstinence violation effect and contributes to relapses. Much of what the fellowship movements have disseminated over the years has flown in the face of scientific research.

Ultimately only research quantifying the effectiveness of the approach is particularly interesting to me. It could be a voodoo cult for all I care if it were effective. But the research doesn't support the AA method as being effective. It's always hard to stomach non-professionals and paraprofessionals being dogmatic and fundamentalist about treatments which don't have evidence that they work. And that holds for homoeopathy or AA or angel therapy.

I think perhaps it's the pervasiveness of the ethos that is the bugbear for Odysseus et al. rather than its existence per se. Imagine how you would feel if Scientology's attitude and approach to addiction were to be so prevalent within the services?

Darlughda

mathepac wrote: »

Interesting if somewhat flawed thread, already permeated by mis-information, prejudice and incorrect quotes e.g. "For example,Step no. 1 is 'Admit to yourself that you are powerless over alcohol'. " Check the literature please, if you wish to be critical of something at least get the basics right and quote accurately.

The philosophy underlying any 12 Step programme is "The only requirement for membership is a desire to stop drinking" for example in the case of Alcoholics Anonymous.

Your tone and disengenous attempt to claim that the only requirement to become a member of AA is the desire to stop drinking, is typical of AA fundamentalist evangelists who try to feed you a morsel of the codwallop philosophy one bite at a time.

So you don't need to follow the 'programme', no? The 12 steps are unnecessary?
The 12 Steps Of Alcoholics Anonymous

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and practice these principles in all our affairs.

http://www.alcoholicsanonymous.ie/opencontent/default.asp?itemid=10&section=12+Steps+-+12+Traditions

As you see, I am accurate in quoting what Step no. 1 is.

Odysseus

mathepac wrote: »

Interesting if somewhat flawed thread, already permeated by mis-information, prejudice and incorrect quotes e.g. "For example,Step no. 1 is 'Admit to yourself that you are powerless over alcohol'. " Check the literature please, if you wish to be critical of something at least get the basics right and quote accurately.

The philosophy underlying any 12 Step programme is "The only requirement for membership is a desire to stop drinking" for example in the case of Alcoholics Anonymous.

No ifs not ands or buts - "a desire to stop" is the solitary requirement to join a 12 step programme. A prospective member of a 12 Step programme does not need to have ceased their drinking / drugging / gambling / etc. to attend meetings and engage with other members. If, for example, a group member shows up intoxicated to a meeting, the meeting may be declared an open meeting (sharing is usually limited to generalities and omits personal histories) but will still progress as normal. If the intoxicated member becomes disruptive s/he may be asked to leave, but cannot be forced to leave and the members may elect to adjourn the meeting and reconvene elsewhere.

However neither AA nor any other 12 step programme organises endorses or sponsors treatment programmes run in treatment centres in Ireland or elsewhere and is not responsible for them or to them in relation to how they run their in-house programmes or how they choose to interpret the simple 12 step programmes, details of which are readily available in the public domain. So if treatment centre x or HSE unit y insists on preconditions for engagement with a client, that has nothing whatsoever to do with the 12 step organisations; it is someone else's interpretation of that programme.

If treatment professionals choose to advocate the 12 steps as the only way to treat alcohol dependency, for example, then that flies in the face of AA's own Big Book which states "Who know only a little" - a clear statement that there are more ways to make changes than those described between the covers of a book.

The 12 step programmes are totally elective and there is no coercion mentioned in the Big Book. It states very simply "If you want what we have ... " here is what we did and how it works. The flip side of course is "If you don't want what we have ..." feel free to explore other options. If therapists in the HSE and treatment centres don't allow clients to do this, how are the 12 step organisations to blame?

It all seems very clear and simple to me - where do others see the problems, with 12 step programmes or the apparently corrupt versions being sold as treatment in Ireland?

Well for me it would be the latter, I do think it is a banal treatment, but I do respect it and I would hope that comes across in my posts. Without looking back on them to quote directly; I know I pointed out the difference between individuals and the programme. All of the content of my post's refer to the treatment based upon 12 step work, however, not matter how hard you try to separate the individual from the actual programme, it does in the end reflect back on to the treatment. Personally I think that it would be clear that for the most part this thread has been about the treatment rather than the programme, with the exception of the post you quoted.

Actually, a point on Sept 1 would be I think NA developed the idea nuch better by using the term addiction rather that a particular drug, it covers the concept much better. Though this does not mean I agree with the concept of powerlessness. However, I would not go to the extreme that people like Peel in his Diseasing of America, or The Truth About Addiction, titles like that would make me weary even before I read the first page.

As you said the only requirement for membership is that desire to stop, but I know of people being asked to leave meetings because the have taken something. Of course these are isolated cases, and once again it's that difference between the individual and the programme. This desire to stop sadly is not reflected by treatment programmes which draw upon fellowship. Is it not clear in my posts that I refer to therapists not the programme? I'm around long enough to know the difference. Do any of my posts seem to be directed towards the programme?

However, remember this is a psychology forum meant to discuss ideas relevant to psychology. Whilst I would be very critical of fellowships and the treatments based upon them, I acknowledged in an earlier post that various fellowships have helped 100,000s worldwide, and would never try to deny that. However, what we were doing was having a critical discussion on the topic of treatment based upon 12 step ideology. Can I ask your own viewpoint; would you see any negatives around this model? I ask around the negatives because I aware of the positives.

Odysseus

Just to mention this as it is close to the topic. I just discovered that there is now a 12 Step Fellowship for those with comorbid disorders or dual diagnosis fellowship just started in Ireland. Personally I think this will be a significant step forwards, though it is clear I'm not a big fan, I do respect the approach and I think it will benefit those who need meds and find that some people in NA judge that as not being in "recovery", if they require psych meds.

It's another case of it being the people rather than the programme, but that makes no difference to a person trying to get clean and filling this as a block to that goal. So hopefully this new group will be of benefit to those with a dual diagnosis.

Darlughda

While I understand why you think this is a 'step' forward, Odyseuss, regarding people with dual diagnosis, especially those who have been told or encouraged not to take their meds anymore, I cannot agree with you that this is a positive thing.

The 12 step movement (IMHO)is a rigorous cultish all-or-nothing- submit style movement that will never be of benefit to the many, many people who abhor the idea of following such a programme.

The reason why there are so many in anger, against 12 steps/AA groups on the internet is because of the untold damage done to too many people, including those of dual diagnosis.

Odysseus

Darlughda wrote: »

While I understand why you think this is a 'step' forward, Odyseuss, regarding people with dual diagnosis, especially those who have been told or encouraged not to take their meds anymore, I cannot agree with you that this is a positive thing.

The 12 step movement (IMHO)is a rigorous cultish all-or-nothing- submit style movement that will never be of benefit to the many, many people who abhor the idea of following such a programme.

The reason why there are so many in anger, against 12 steps/AA groups on the internet is because of the untold damage done to too many people, including those of dual diagnosis.

It's another case of it being the people rather than the programme, but that makes no difference to a person trying to get clean and filling this as a block to that goal. So hopefully this new group will be of benefit to those with a dual diagnosis.

I think I can say safely that I both understand and see you perspective and have experienced it too with patients. I actually for more time for the programme than a professional or centre would work that way. I expect better from a therapist; the reason I have some respect for the programme is that a large amount of the clients I see who get 2,5,or 10+ years clean have used a fellowship to some degree. Some still would, others only a few years.

It can have a lot of potential of damage; you have mentioned some there are plenty more; a badly executed fourth step can do a lot of damage. The fellowship Nazi’s don't see they the people we see make the improvements we see, because they don't work with people who use or drink. So for them they do not exist. If you only see people recover through 12 step treatment it means it is the only way;) Because we work with people who are still drinking/drugging ect we see that people can recover in different ways.

mathepac

hotspur wrote: »

... Alcoholism is a disease ...

Which is consistent with the views, diagnostic criteria, classifications etc documented in the DSM-IV, the WHO's ICD10, medical, psychiatric and psychological publications, etc.

hotspur wrote: »

... and the only cure ...

Careful reading of the current or any other version of the big book, will disappoint you as it offers no cure nor does it hold out for anyone adopting the programme any hope of a cure, just on-going treatment to keep them free of the worst ravages of the disease / disorder / illness.

Six years ago I was diagnosed as suffering from type 2 diabetes - no surprise really, family history, poor life-style choices as a younger man, age, smoker, etc. With my GP and various health-care specialists I agreed to certain changes (diet, exercise, giving up smoking, etc.), I was taught to check my blood-sugar levels daily, I was prescribed various drugs to take and was given appointments for various clinics and periodic reviews.

No-one promised me a cure for diabetes, just freedom from the worst of the symptoms for as long as I stuck to the programme that was designed for me. I see this as being analogous with the AA method of treating alcoholism.

hotspur wrote: »

... and the only cure is to turn to spiritualism and God. ...

If you use spiritualism as a synonym for spirituality, which is mentioned frequently in fellowship literature, then yes spirituality is a very important part of the programme.

God in the context of the 12 step programme is explained simply and in detail in Chapter 4 "WE AGNOSTICS" which you have already quoted from selectively.

hotspur wrote: »

... It can be clearly seen from the above quotes that AA proselytises. ...

I don't agree and see nothing in what you quote that supports your contention. Maybe if others want to decide for themselves they might read the other 13 pages of the chapter you have quoted from where the idea of God / Higher Power is expanded on.

hotspur wrote: »

... Matthepac, some of us think that the science of addiction treatment has moved on beyond Jellinek and the bible. ... Many people believe that the fellowship movements promulgate anachronistic misinformation about addiction which encourages the abstinence violation effect and contributes to relapses. ...

While I admire you for airing your thoughts and beliefs and the thoughts and beliefs of others, I'm afaid by your own criteria, these thoughts and beliefs appear to me to fall short of the rigours of the scientific approach / hard evidence you seem to demand that others adopt.

hotspur wrote: »

... Much of what the fellowship movements have disseminated over the years has flown in the face of scientific research.
...

I'm not sure what you mean here, but what I tried to explain in my previous post, evidently very badly as you don't seem to have understood, is that the core message of AA and other 12 step organisations is being corrupted and distorted by commercial interests that have no connection with 12 step organisations; maybe you can explain for me specifically what it is you mean.

hotspur wrote: »

... But the research doesn't support the AA method as being effective. ...

Whose research, whose definition of effective and what do you mean by "the AA method"? I can walk into a room with a 12 step meeting going on and meet men and women who are drug, alcohol and gambling free, who have careers, homes and families, who are not fearful, not in debt, who are law abiding citizens and who point to their introduction to their local support group as the key to keeping them that way. They pay a euro or two for their coffee and for the rent of the room for the couple of hours.

Is this the AA method you mean and would this meet your dfinition of effectiveness?

hotspur wrote: »

... It's always hard to stomach non-professionals and paraprofessionals being dogmatic and fundamentalist about treatments which don't have evidence that they work. ...

The evidence is as close as your nearest AA, NA, GA, OA meeting and I think it's wonderful that people can get together, support each other and maintain decent lifestyles with no need of psychologists, psychiatrists, the HSE or other expensive consultations of questionable value to them (their views, not mine)

hotspur wrote: »

... I think perhaps it's the pervasiveness of the ethos that is the bugbear for Odysseus et al. rather than its existence per se. Imagine how you would feel if Scientology's attitude and approach to addiction were to be so prevalent within the services?

What or whose ethos. AA or other 12 step organisations are not responsible for whatever distorted versions of their message other people or organisations might promulgate. I don't know and don't care if the HSE or any other health-care or so-called treatment organisation promotes scientology, hinduism or a new board-game as their attitude and approach to addiction, it doesn't effect me nor does it effect any 12 step organisations.

Odysseus

Mathepac, firstly welcome to the psych forum, I could be wrong here but I not familiar with you as a regular poster here [correct me if I'm wrong], though that should have no effect on your contributions here of course. I and I think other here will welcome your contributions to this thread, even if we have moved away from the original topic slightly, but that is the norm here.

I'm just on my lunch here so I have to be brief, addiction as a disease is not consistent with the ICD-10 etc as these publications do not comment on etiological factors. CBT with is the currently the most popular form of psychological treatment and it would not see addiction as a disease, the only doctors or psychiatrists I know who agree with the disease model as in a fellowship understanding are either members of a fellowship or work in a 12 Step treatment setting. So I can see where your point of the ICD, psychological, or psychiatric publications being consistent with the disease model.

As a disease model there are two types in my understanding a metaphorical one it is like a disease= fellowship, or the medical model based on neuropsychological, genetics etc. Can I ask are you familiar with Jellineck's research which was the basis for the disease classification by WHO? I ask as I'm trying understand where your coming from, in other words what are you basing you viewpoint on, is it your experience of fellowships or that and some other reseach.

I'm not familiar with the big book, however, I am familiar with the basic text and also have read numerous time It Works, How and Why, these being the NA equivalent. I would also base my opinions on my clinical work with members over the years, I current have a chap who has been in AA for 20+ years, however, apart from that due to my work I have some very close friends who are long term members. I am just stating this to say that I'm not just basing my thought on something I have read or "book learning" as I have heard members describe it, if they want to suggest I do really understand addiction as I have never been there.

You seem to be saying that AA work well for some people [the meeting room you described] and if it doesn't work for others, so be it; and that would appear to be the spirit of fellowships as I understand them. However, have you ever come across members who believe it is the only way, if so are there many? Whilst that would be the individual not the programme, but sadly when a newcomer is asked to leave a meeting because the are intoxicated they do not see the difference, the same when someone is told they are not in recovery because the are on a SSRI, you and me know the difference but the newcomer or a professional who has not got the same experience as us two.

hotspur

mathepac wrote: »

The evidence is as close as your nearest AA, NA, GA, OA meeting and I think it's wonderful that people can get together, support each other and maintain decent lifestyles with no need of psychologists, psychiatrists, the HSE or other expensive consultations of questionable value to them (their views, not mine)

Mathepac, firstly this is a discussion forum with all of the lack of flexibility that such a medium entails. Consequently engaging in such a response to my post as if we were having a real life discussion in person where one could flexibly engage in analytic philosophy type discourse with interminable requests for defining terms and clarification of meaning merely comes across as inauthentic engagement to be honest.

I genuinely would like to hear more of your views on this matter because you are obviously an intelligent and eloquent person with experience of this topic; let's leave the pedantry and rhetoric to other fora.

I doubt many people would seriously disagree that the existence of peer support groups for any mental health problem is a bad thing, and I'm certainly not. But the question is the philosophy of treatment adhered to - is it based on scientific evidence and how effective is it. In other words - could the peer support structure be better utilised with a different philosophy / approach?

The fellowship movements have pretty good press. They are some of the first things people think of when they consider help for an addiction. So it is a matter of no small importance if people could get more effective help via other treatment philosophies.

It is not sufficient to just look at the people it has helped as an aggregate, could it better help a greater percentage of those who seek treatment if it incorporated some different attitudes towards recovery than it has traditionally incorporated?

It is hard for me as someone who has spent years studying the addiction field literature to reconcile aspects of the philosophy of fellowship treatment with the research which has emerged over the last few decades.

Also in an increasingly secularised society I would have difficulty personally working within such an explicitly deistic philosophy if I were an addict looking for a peer support group. I think a spirituality aspect can be hugely beneficial, but I think that a lot of people get essentially excluded from fellowship help due to the heavy emphasis on a God to whom one must supplicate and divest one's power to.

For me the bottom line is ethical. People who want help with addiction deserve treatment and help which is well informed. I just don't think that the adopting and application to addiction of a 100 year old religious organisation's (The Oxford Group) philosophy of overcoming sin as a path to God (pasted below) constitutes a very informed, scientifically based, or modern and sophisticated approach to the treatment of the mental health problem of addiction.

1. The sharing of our sins and temptations with another Christian life given to God.
2. Surrender our life past, present and future, into God's keeping and direction.
3. Restitution to all whom we have wronged directly or indirectly.
4. Listening for God's guidance, and carrying it out.