Power and responsibility in all the wrong places

This guest post is by Peter Sheath, another good friend, who, like Matt, I’ve only met in the flesh for a few hours. Peter knows a great deal about addiction and rehab. Here’s what he’s got to say about power and powerlessness…

 

I have been student of addiction for many years. Much of it involving the personal and, sometimes, painful elements of self-experimentation. I’ve talked to thousands of people and I’ve experienced the privilege, honour and genuine unfettered pride that comes when a person decides to trust me and invites me to share some of their journey. There is something very special that inhabits almost everyone I have come across who struggles with addiction. I see it in their art, I feel it in their performance. Read anything by Hemingway, The Old Man and the Sea in particular, or watch a Tennessee Williams play. Watch Philip Seymour HoffmanHoffman as he steals the show. Working with addicts, when you are really with them, is much the same. It’s almost as if they have a magnifying glass attached to them that blows up every little human characteristic to an almost unbearable level of magnitude. Beyond all the ego, bravado, and defiance are, almost always, frightened children. Who have lost their way and come to rely on the predictability of substances. Until they’re ready to move on.

To try to work with these people I firmly believe that I have a professional responsibility to work with myself. I need to be able to see beyond the narcissism of self and meet them exactly where they’re at without wanting to control them. In a line from a song, Willie Mason says, “It’s a hard hand to hold that’s looking for control.” That reinforces the idea that, if I do not have the presence to meet someone and accept them as they are, I shouldn’t bother meeting them in the first place. I have found, through bitter experience, that if I’m not with them it becomes my space that I’m working in. A space often populated by my dark side: a space I need to control.

Unfortunately many of the people working in treatment do not see any need for self-reflection and continued self-development. They have come to believe that they simply don’t have time. I’ve travelled all across the UK, delivering training, coaching and consultation, and it’s the same everywhere. Blame, intimidation, threats and arrogance become the tools of rehab, the vehicles of control. It’s just easier that way.

During a training session I was delivering a couple of weeks ago, one of the delegates said that the training was great but how was she supposed to do it when she had 70 people on her caseload? She was genuinely upset and was expressing her sense of being overwhelmed by the situation. I invited her to just take a step back, consider the situation as an observer, and overwhelmedtry to see the 70 people as 70 individual opportunities for change. I said that each of those 70 people had the propensity to take responsibility for their own lives, begin to address the risks they were currently involved with, make some decisions and commit to actions to help with their wellbeing. Not rocket science, but it really did help her to see the situation differently, and  to realise that, by approaching her work in a different way, by handing over responsibility, she may have a lot less to carry on her own shoulders.

Unfortunately, and here’s the rub: when we have absorbed the ideology that addiction is a disease and we need to sort it out or cure it, we are unknowingly removing from the person the very thing that is going to get them well. By assuming the “expert” status we are telling medicalteampeople that they are sick and, as such, unable to take responsibility for their recovery. Walk into any treatment centre anywhere and suddenly you become completely incapable. You can’t even fill in a form yourself and you certainly have no capacity or competence to manage your medication. Even if you begin to take responsibility by getting honest and telling the workers you have used again, they will need to take a confirmatory drug test to prove it! “You will need to undergo an assessment, looking at everything that’s wrong with you…” Using a form filled out by a worker, because you can’t do it yourself. The process is repeated by any further “expert” you may need to see. Any initiative on your part will be viewed the same way: as an obstruction. If you don’t want a script or you want to go straight to detox, you will be met with, “you’re not ready for that yet”, or the classic, “people die doing it that way.”

In fairness, it is beginning to change, but I believe that change needs to begin with the workforce. It needs to begin with an admission that we’ve got it wrong. Then recovery can become a team process that includes the person doing the recovering.

 

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77 thoughts on “Power and responsibility in all the wrong places

  1. David Clark June 19, 2014 at 4:34 am #

    Brilliant blog, Peter, really enjoyed this. Nail(s) on the head stuff!

  2. Ron Henderson June 19, 2014 at 4:40 am #

    Thank you for your unique perspective.
    Having been in numerous treatment centers over the years I have encountered the “your best thinking got you here” mentality consistently.
    No. My best thinking got me a career, a family and a sense of accomplishment. My worst thinking got me a lifetime of self abuse.
    Once I removed myself from those programs and approaches I have started to get better.
    You see I am not only one who has engaged in addictive behavior I also have bipolar. I’m not some shady character hiding out in a shooting gallery waiting for a fix. I have been but not today.
    With my co occuring disorder I sometimes have racing thoughts then bouts of grave depression. During those times I have found solace. Yes, solace in drugs.
    By working with people that realize I am not some title. You notice I do not call myself an addict. I have been able to regain a meaningful life.
    I am now a faciltator for Smart Recovery. I am surrounded by many that are not “just like me.” Even better. They are unique and respected as unique.
    Your approach to hand holding instead of berating is key to more widespread recovery.
    Thank you for sharing an enlightened view of recovery and rehab.

    • Peter Sheath June 20, 2014 at 2:08 am #

      Thank you Ron, I do believe that how we help people with addiction problems is beginning to change. The work that people like Marc, Bruce Alexander, John McKnight, Kelly Wilson, Steve Hayes and many more are doing is beginning to make a difference. A friend of mine often describes accessing treatment as like entering into a travel agents that, up until recently, only had one destination. We now have loads of destinations but people are still convinced that only one is available.

  3. Matt June 19, 2014 at 5:31 am #

    Thank you, Peter! For this post and the important work you do. My experience in residential was slowed by my being thwarted at attempts at self-treatment, self-management. I remember being called into my counselor’s office to see if I was decompensating or secretly using because I pushed my need for exercise and meditation, to no avail. I would go out onto the grounds in the morning and sit and meditate, walk around the woods, exercise as best I could before sitting through another day of interminable meetings. At another time, I tried to convince the staff that allowing me to jump in the nearby ocean would vastly improve my mood. Many therapists now use cold water therapy, particularly for morning depression. At one point, in desperation I just decided to be inscrutable. I started keeping a liter bottle of my own piss out in the open in my room. The staff, residents (and my wife) were dumbfounded. The bottle sat on the directors desk for days (to my delight, everyone’s head scratching) I reasoned to them that there was such a preoccupation with clean piss in this place, I just wanted to keep it on hand in case anyone needed any or I couldn’t go during the monitored random piss test. (talk about dehumanizing).

    It’s much easier to withhold and shut things down than it is to open up and present one the opportunity to experiment with their own recovery. But that is what we all have to do eventually. Why try to suppress the very thing that leads to recovery and reintegration?

    • Peter Sheath June 20, 2014 at 2:17 am #

      Hi Matt
      My belief is that treatment has been, in many ways, corrupted by adopting an acute medical model ideology. The underpinning idea being that, as the experts we know best so we do things to you until you get better. Trouble being that it just creates a learned helplessness, dependency and adapted/rebellious children. Everything becomes reactive and the belief is that the problem can be contained and/or managed by increasingly rigid disempowering structures. Whereas in real life it’s the opposite of this that will make a difference

      • Matt June 20, 2014 at 7:17 am #

        Thanks, Peter! Well-said. I’m familiar with the learned helplessness influenced by the medical/disease model. I was raised by a mother who practiced it rigorously.

  4. Jo June 19, 2014 at 6:20 am #

    Yes I like this article to…it does indeed hit the nail on the head…I needed empowering not depowering….too many people become counsellors that need to look at themselves.

    People like myself who suffered profound neglect need available people on hand to encourage and hold metaphorically…..they need to be present with themselves and very emotionally functional…. the process of opening up and trusting again after alot of abuse and without the protection of chemicals leaves a person very vulnerable to further abuse, something i experienced in treatment…one therapist was a sex addict and coming onto me (harassing)….wouldn’t happen today as I am switched on and alive…others in centre using drugs cheating the piss test and counsellors codependent and in many ways protected them thus maintaining an unsafe environment! I wont go on….

    • Matt June 19, 2014 at 6:36 am #

      If you did, it would go on for pages, right?

      • Jo June 19, 2014 at 3:30 pm #

        Unfortunately I look back now and see that it was very lacking but when your vulnerable and been in addiction for 17 years since age 12 you don’t have a clue whats ok and not ok!!

        • Matt June 19, 2014 at 8:19 pm #

          Thanks, Jo. This is a very important observation. Could you say some more about it? Your experience? When did you begin to feel you had a clue to what was ok and not ok? What did it feel like?

          • Jo June 20, 2014 at 3:52 am #

            I would say i started to know what was ok & not ok when i went and asked for help as reality of situation laid out in front of me…so originally at this point of asking for help…

            However i believe this got knocked out of me as i was easily swayed into self blame having being scapegoated growing up and encountering difficult situations in a rehab.

            Its a minefield this as a few counselors were good… but i believe the system created more trauma for me in hindsight and it was still tricky to trust my perception if questioned by someone in “power”

            Perhaps controversially I see that this victimisation due to my own vulnerability and background and choices i made over the years left me open to more trauma via 12 step meetings. If i had to do it all again i would seek a much different approach as this has been a very difficult journey.

            Hope that answers your question.

            • Matt June 20, 2014 at 6:13 am #

              Very eloquently. You make two very good points. One is that asking for help can be very empowering, not disempowering. It shows that you’re beginning to know yourself, your limitations, and that you recognize the gravity of the problem. The majority of people who get into treatment are confused and vulnerable; they have given up a primary coping mechanism. They are raw and reactive, like an exposed nerve. It is difficult to tell which counselors are bright and compassionate, and which are full of shit and ego problems. But as the haze clears, it emerges and you begin to trust your own judgment. That’s the bright side of this whole debacle.

              The other point is that the poorly trained and monitored treatment community (not all, but most of it), often exploits these vulnerabilities to meet institutional goals, instead of as a springboard to self-awareness and empowerment— which will be different for everyone. This approach can be damaging for many. It is done by good, well-meaning people with the best intentions, hamstrung by the product, not process-oriented approach of society. By regulations, stats and lack of training or experience. If you get out the other side, it makes you a better person. But I wouldn’t recommend it as an exercise in character building…

              • Jo June 20, 2014 at 8:39 am #

                Me neither!! thanks for your thoughts.

          • Jo June 20, 2014 at 4:16 am #

            Hi Matt, I typed a reply and lost it so here we go again. I guess I knew my addiction was out of control and that was not ok hence asking for some help for the first time. I knew early on that i wanted to get fit as it was something i loved as a child and that i wanted to be outside and be around positive people and start living.

            As for the rehab some of it was ok and a few staff self-realised so safe but i guess it was a business. I was very scapegoated by my family and alot of that involved questioning my reality so when i thought that is not ok and questioned it i would not challenge any further if disagreed with. I had very little confidence and no way of negotiating standing up for myself. It would have been good to have had a supportive family or at least the experience of some support as impossible to know some stuff was not ok. However one therapist who had issues with sex started calling me when i left the rehab and my instinct told me it was not right so i told him to stop and left it there. In hind sight which is a great thing as we know i should have perhaps got in touch with the place and let them know what he was doing. I did however when told when knew at my rehab that he was my therapist have a feeling he was not right in someway and say i needed a female therapist. I had people spitting in my food because i would stand up and say i belived they were still using and got told by staff that i needed to stand up to them!! wow these situations made people not want to get involved (other residents) as the people using were scary they threatened to kill me at one point!!! Its unreal its crazy looking back, i didn’t know how to make a fuss about it but confused as message from rehab conflicting.

            I then believe controversially but it is my experience that I got further traumatised and beaten down by message via 12 step programme, the more honest i became the more i was told i was not ok…i think they call this trauma bonds…all it goes to show is very vulnerable when first clean/sober and great need for safe supportive and encouraging of own thoughts belief so very important as the chink of knowing what is ok is there as ones intuition returns its very confusing to distinguish the difference between this and instinct which i am sure you will know if very off course when you first stop and for me remains that way if i don’t keep up self reflection. Hope this answers your question.

            • Marc June 20, 2014 at 6:28 am #

              This is a very touching story, Jo. Whether you replied to Matt once, twice or three times….putting the pieces together reveals a lot about how people’s vulnerabilities interact with problems in the rehab community. Thanks for sharing this.

            • Matt June 20, 2014 at 6:41 am #

              Comprehensively. Thank you, Jo. And it brings up another issue. This treatment community is rife with sexual harassment and misconduct issues, between and among residents and counselors.

              Issues of honesty, gossip,dominance and retribution blow out of proportion in these little pressure cooker communities, much like a prison. In fact, many residential centers have diversion contracts with the DOC. The prisoners often do well as residential rehab is like summer camp compared to what they’re used to. And it’s a good way for them to gradually re-assimilate into society…

            • Janet June 20, 2014 at 8:32 am #

              Jo, How brave of you to be able to tell this story and to show yourself love. I know from my son that institutional recovery can be very brutal. He had never been bullied in his life until he was in a program in jail where he was really trying to get better. He said that the more sincere he was about trying to work the program, the more the group turned on him. I am so proud of you, Jo. The pain will pass, you will remain. Keep loving yourself. You are not alone. With each breath, you are healing.

              • Jo June 20, 2014 at 8:44 am #

                Janet yes this is exactly what happened to me it was jail mentality…I would get up early exercise, meditate to stay sane…so thank you for your kind words to and I wish your son well

            • Suzy June 24, 2014 at 5:55 pm #

              Jo, it is courageous of you to share your experience here. I have felt re-traumatized in groups, especially 12-step. I have similar issues with not trusting my perceptions. I had trouble with one group of people (not 12-step in this case) that I believed was supportive and encouraging but the way they were treating me was not lining up with that belief. I struggled to accept they weren’t good for me because I thought I needed these recovering people to help me. I became more and more anxious and depressed and got further away from any identity resolution. But I did finally move on from them and started doing things for myself and trusting my own perceptions.

              There is no one-size-fits-all approach. I don’t like 12-step because my gut just churns when I hear statements in meetings that are antiquated or downright harmful. The undercurrent of moral judgement is still in the program which is not at all helpful. The program was created by men and many of the steps don’t even apply to most women. When do we NOT make amends? We mostly harm ourselves and not others.

              After 12-step meetings I wanted to drink. Instead I would eat something sweet. Every meeting left me feeling triggered. Hearing drunkalogues and then not talking about practical ways to deal with our current circumstances was so frustrating. I wondered how revisiting and revisiting and revisiting could be helpful. I thought, “I don’t want to go over all that again I want to talk about the good stuff. What can I do instead of drinking? What have people further along done?” I wanted more talk about the present and the future and MUCH less about the past. I didn’t understand a program that was so old and yet never evolved.

              Jo, I don’t think you are the only one who has felt traumatized by rehab. I am glad Anne Fletcher’s “Inside Rehab” came out because she informed that the least intrusive treatment method that will be affective is best. So people do not necessarily have to go to rehab despite conventional “wisdom.”

              I had a therapist who kept telling me I had to go to 12-step meetings. Every time I went to one I felt worse. I thought there was something wrong with me, that I wasn’t getting it. I was really happy to find SMART and realize I wasn’t crazy and that 12-step isn’t for everyone, that many people had the same response to 12-step, that I could be successful doing recovery my own way.

              One thing that is good about SMART is there is a trained facilitator in every meeting. I think this is helpful for trauma survivors as there is at least that one person who can be trusted. I felt far safer in those meetings than any other. Also, you can really talk with participants. As long as you are supportive, encouraging, etc., you can share your experience and validate others’ experiences. This is much more natural than at 12-step meetings where someone shares something painful and then it just hangs there in the air. I find that so unsettling.

              There is a good book called “A Woman’s Way Through the 12 Steps” that is helpful to reframe the steps but I still didn’t like them. None of the women in my womens’ sobriety group would go. Our group counselor asked us every week how many meetings we’d gone to and the vast majority of us said none. She, to her credit, stopped asking this question. However, she seemed to fall into providing no structure at all to her group session. That wasn’t good either as we were clearly flailing.

              “Treatment” for addiction is crazy. Finally, one of the counselors at that hospital told me I did not need them to get better, I could do it for myself. Honestly I think that is the most helpful thing I learned there! That and a fill-in counselor was using Rational Recovery information and pointed me to SMART when I asked him about the source of his teachings because they made sense.

              • Jo June 26, 2014 at 11:24 am #

                Hi Suzy,
                Great to read your piece very supportive to know someone else has had the same experience around meetings…am doing some cognitive stuff to change my thinking apart from that getting busy making some new non recovery friends, may try Smart.

                I started getting triggered by meetings a while ago but it has taken time to get confidence to walk away. Moral judgement really demoralising and negative for me…Also had counsellors saying i needed to attend meetings in rehab…i used to say i would go mad if I had to attend so didn’t…

                Good luck with your healing.

                • Suzy June 29, 2014 at 5:42 pm #

                  Thanks Jo! I have read other women’s’ accounts of 12-step not being helpful and at worst the 13th-stepping. Good for you for standing up to your counselor and saying you’d go mad if you HAD TO go to meetings. One thing I like about SMART is they don’t tell you that you have to do anything. You have the space to do what works for you. SMART is so anti-coercion and about showing us that we CAN trust our thinking (the healthy parts of it) and ourselves. Take care!

              • Marc June 26, 2014 at 11:35 am #

                Suzy, This is a VERY useful summary of what can go wrong in the 12-step world. In fact, I’ve already quoted a couple of paragraphs in an informal review of a book chapter I’ve sent to a strong advocate of the 12-step approach.

                If I weren’t afraid of another 12-step war on the blog, I’d ask you to make this into a guest post. But it seems very difficult to share these views without eliciting volatile reactions, which then lead to opposing volatile reactions, etc, etc. So, maybe we should let it lie for now.

                But thank you. Your account is particularly useful because it’s so personal and seemingly objective at the same time. That balance is rarely achieved.

                • Suzy June 29, 2014 at 5:52 pm #

                  Okay you quoted me, that’s cool! Lol. I think Women’s way through 12-step book does make the point regarding harm but perhaps not as cogently as you say. I will have to refer back. Plus it goes through how to do the step of telling another the exact nature of your wrongs which I don’t believe in at all.

                  I remember questioning the relevance of some of the steps way back when I went to my first Al-Anon meeting but only with my inside voice. You can’t question them out loud!!! ;)

                  I have thought about writing such a book so thanks for the vote, I do appreciate that. I feel very passionately about women having their own voice and being taken seriously in recovery and elsewhere. So often we are called unbalanced or emotional when there is all kinds of gas-lighting and other things going on around us. We are told not to trust our perceptions and that is what is most real to us. So that can really knock us off kilter in 12-step which has us constantly doubting our perceptions and that can lead to a dark place.

              • Marc June 28, 2014 at 7:43 am #

                And I have to add: your comment, “when do we NOT make amends,” is magnificent. I just read it to Isabel, who agrees. Has anyone really made this point so cogently before? The book you mention….sounds like it doesn’t.

                If you were ever to write a book, you should think about making this the theme. Or even a magazine article? For The Fix maybe, or else a wider audience.

                • William Abbott June 30, 2014 at 10:43 am #

                  As a Smart Recovery facilitator I’ve seen scores of people describing what’s being posted here about 12 step experience and particularly about feeling more like drinking on leaving than when arriving. I’m a good example myself .I did both AA and Smart for a while since I thought “It must be helpful or why is it still here “but understand a little better now. And realize that the 12 steps have some major psychological flaws. Sorry folks that’s just my opinion.
                  There are basically two responses to the 12 steps: you either like it and it helps or you don’t and it doesn’t. Based on the known science of locus of control, this is understandable. And hence the major advance of opportunity of alternatives to 12 step for those more favoring the internal side. And having that alternative, Smart Recovery only being one, celebrates the known self-empowerment of choice.
                  As regards the plight of women, I’m sorry but it still exists in some AA groups that women aren’t “ real “ alcoholics or otherwise “ inferior” humans – an attitude unfortunately still somewhat pervasive in parts of the US. This leads to the most objectionable behavior known as 13th stepping – whose prevalence is often under recognized when in fact we have no clue as to frequency – since it’s oft not reported… Some say rampant and some say negligible. I say significant no matter what the number. Like they say about drinks “One is too many ….”
                  One real plus about having facilitator led meetings is, there is a zero tolerance policy enforced if need be, about any form of harassment. I have seen it or heard of it and have dealt with it – period.
                  This might sound like I’m one of those anti-AAers who want to see it closed down- I’m not. It provides safety and community for many even if they don’t believe in the steps. I just wish they would evolve their thinking a bit since the 1930’s and realize that its change all who have these problems seek and women have equal rights in that sharing. And that choice as to how you do it is the most potent factor of all

                  • Gary July 3, 2014 at 8:16 am #

                    Reflections!~
                    Hi William…Just wanted to comment on “Perceptions” as indicated in your post. Perceptions are basically all we have with respect to what is decided by the individual as good (effective) or not so good (not-effective). It’s not only what exists within a “program” be it SMART Recovery or Self-Help but what the indiviual brings as well.

                    If and/or when a person can see the inherent “goodness” if you will, inside of themselves they won’t necessarly need a “program” because as a result of seeing, change will be the result.

                    Sometimes it takes walking into and then away from programs in order to develop and discover yourself, perhaps for the very first time. Praising or degrading a program in and of itself isn’t helpful.

                    I certainly don’t see one way as being better than another way. However, I do know, for myself, that change is and has to come from within. As long as a person is chasing programs, people or methods to help transfom them they may fail to know that life’s energy flows from within their own being.

                    The concept of “self-help” to me, is much more than a concept and in fact is the only reality for true inner change. There can only be one authority where change is necessary and that authority is you.

                    I have difficulty in the definitive meaning of the word “change” which, can instill fear in many people who are looking to change. Change may translate into sometime other than who I am or who I think I am. Perhaps change is really about being your authentic self and not a perception of the authentic self.

                    Freedom is not a program or perception but a realization that my ego isn’t any longer being fed by negativity internally or externally. It’s kind of like saying “poor me”! “poor me”! pour me a drink! The ego looks for justification. However, knowing that you know what the ego is doing is in and of itself freedom. Trying to let go only feeds the ego more!~

                    • William Abbott July 3, 2014 at 9:31 am #

                      Gary , I think we are in agreement here but saying the same thing in a different way. At least I agree with your points.

                      Let me say this about ” letting go” tho. I come at that from the mindfulness ideas which themselves come from buddhist teachings.

                      So if you are letting go by trying to let go- ie actively then you are right it is egoic. Where as if you allow the thought or the emotion, and you let it take its natural course and go away on its own, you are separating yourself from it , that is non identification with it, which becomes a positive event– even a coping event.

                  • Marc July 10, 2014 at 4:11 am #

                    This is very useful, Bill. The internal vs external locus of control idea is an economical way to capture the difference between 12-step and SMART-like programs. I also like what you say about the importance of a facilitator. And the plight of women in AA groups is so ironic! Do you really mean that women, being inferior, are not inferior enough to be “true” alcoholics?! What a whacky cultural dead-end that is.

                    Did you see the recent NYT piece about total abstinence vs. “alternative” goals in addiction treatment? It’s very thoughtful, even though I know this doesn’t square perfectly with the AA debate. I’ll quote a paragraph that I found informative. I didn’t know that the famous Cochrane reviews had stretched into the addiction world. Check it out:

                    “In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America. (http://www.nytimes.com/2014/07/06/nyregion/a-different-path-to-fighting-addiction.html?action=click&contentCollection=Science&module=MostEmailed&version=Full&region=Marginalia&src=me&pgtype=article&_r=0)

      • Jo June 19, 2014 at 3:37 pm #

        Yes Matt it would….bet you have a similar experiences..?.I had trouble going for short runs in treatment like you said, still doing it to this day 15 years later and no adverse affects yet! Just a way to keep positive 20 minutes a day in local park.

  5. Carolyn June 19, 2014 at 6:47 am #

    Excellent blog Peter. We should all be using self examination in every aspect of our lives. You have started my day off perfectly, Carolyn.

    • Peter Sheath June 20, 2014 at 2:20 am #

      Hi Carolyn
      I honestly can’t see how anybody can work with people with addiction problems without constantly looking at themselves

    • Marc June 20, 2014 at 6:29 am #

      Glad to hear it!

  6. Gary June 19, 2014 at 7:03 am #

    Really good topic and one that I can relate to in parts especially around being vulnerable. Somehow, unless or until I became vulnerable change probably wasn’t going to happen which transcended my vulnerbility into a form of humbleness. Looking back, I can see also how I identified myself with my addiction and it took time to realize that I was much more than the label but perhaps that was part of my own internal growth. Not everyone moves beyound the label and may even find comfort in self-identifying in the word addict, alcoholic etc… I also come to realize that although I didn’t know who I was I began to better understand who I was not! In fact! I had pondered the term “Recovery” and thought “do I really want to recover to a place that brought to addiction in the first place”? Then I “discovered” there is much more about me about being human and the numinousness inherent in all of us. The “observer” and the observed are the same unless the ego forms a barrier separating the observer from the observed. There is nothing or no-thing that is wrong with anyone that isn’t part of all humanity, at least, to some degree. To the degree that we can free ourselves from our own ego’s, thoughts processes, minds and internal dysfunctions will become the measure in the extent of freedom or enlightenment we will come to know. I was listening to Ekhart Tolle on my way to work this morning because my drive is two hours one way, and realized that in his description of enlightenment that even a rock, under enough pressure, transcends into a crystal and perhaps a diamond. I is most helpful in terms of “therapy”, “counselling” or otherwise, to be on equal ground with clients learning to really listen without judgement. “Wherever you are going you are already there”!~ GG

    • Marc June 23, 2014 at 5:38 am #

      Gary, this is such an optimistic, uplifting way to understand addiction as belonging to everyone, such that moving beyond addiction is not a matter of correcting something wrong but rather a matter of growth in a rich and meaningful direction — one of many. I also don’t like the word “recovery” for much the same reason. There is no gain and in fact no way to go backward.

      • Gary June 24, 2014 at 6:45 am #

        Thanks’ Marc…

        Inner growth is essential but can only happen when we “let go”.

        Long before I ever developed a “drinking problem” I had developed a “Thinking problem” about drinking. In other words in the context of my family, drinking was modeled in such a way that drinking for the purpose of intoxication was deemed “social drinking”. Though I came from a long line of alcoholic’s from both sides of my family doesn’t mean I’m not responsible for my own life. “Blaming” others and/or circumstances for my addictive behavior, for me, is just an excuse to stay stuck. However, if I can turn it around and determine that it all makes sense, then perhaps out of the “non-sense,” I can truly grow. Awareness is the key that opens the door to a new way of being. As Jiddu Krishnamurti says: “Be A Light Unto Yourself”, in which, ultimately, you realize there ought to be no outside authority per se. This is why , for me, “Change” has to be, and is, an inside job.

        • Marc June 24, 2014 at 8:45 am #

          Gary, I don’t think that discovering cause-effect relations in one’s family history is anything close to blaming others for our problems. Our backgrounds are loaded with context: associations, conditioning, social learning processes. The more you know about what went on for you as a child, the more you know yourself!

        • Marc June 24, 2014 at 8:46 am #

          And I think Krishnamurti would agree. I used to read him avidly.

          • Gary June 24, 2014 at 9:12 am #

            Thank you for your comments Marc…I do believe in cause-effect, however, if I am continually stuck there how can that help me to grow? In other words, don’t expect me to be responsible because my parents weren’t responsible isn’t useful whatsoever. I think the more I understand what went on in the context of my family the less I knew who I actually was. However, I certainly knew who I was not, meaning I was not someone who could continue to live the way I was living. In the deepest part of me I knew there was more and that I could detach from the old patterns despite my family upbringing.

            My old saying years ago was “the more you reveal the more you can heal” and “the more you conceal the more it will steal”.

            More than anything, for me, change can only happen from a point of nothingness where no-thing can be a distraction in order to understand my true nature.!~ If there is a direction that within itself is a distraction and illusion.

  7. Janet June 19, 2014 at 8:09 am #

    Terrific. Absolutely terrific. And I truly hope that this is the direction of addiction “recovery. “Healing”. My favorite word. We can all heal. Thank you, all of you, for changing the world. For caring. For being so brave. We are all in this together. Heal well. With love.

  8. Peter Sheath June 19, 2014 at 9:04 am #

    Many many thanks everyone for your kind words, especially Janet with a reply that reached out and touched me so much it brought a tear to my eye. It makes me more and more convinced that treatment should involve hospitality and the creation of a safe and secure space where both healing and learning can occur. This space should also contain easily accessible wisdom that people can tap into, beginning the healing process until their own personal inner wisdom can be accessed and self healing take over.

    • Matt June 20, 2014 at 7:31 am #

      I ditto Janet’s sentiments. I think this is one of the most informative collocations of views and discussion on this topic I’ve seen!

  9. Nicolas Ruf June 19, 2014 at 9:39 am #

    The question remains can the acute brain changes induced by mind-altering drugs become chronic? Isn’t it clear yet that substance abuse and behavioral disorders like gambling lie along a continuum, becoming more and more refractory and autonomous as they progress? For those more vulnerable or predisposed or damaged systems, when they could quit they won’t because the reinforcement is too strong, and later, when they would quit they can’t because the pattern has become set. For them questions of choice, decision, and freedom are like asking if Ted Nugent is free to choose to support gun control. Of course he is, but the chances are pretty slim. What would it take for that to happen? An epiphany, a bolt from the blue, a sudden revelation, a spiritual awakening, a moment of clarity? A decision to quit won’t do it in the same way that thinking a happy thought won’t alleviate depression.
    None of this is meant to say that those at the lower end of the continuum can’t just quit or modify their behavior; there’s still flexibility and adaptation in the system. If you have ever had the experience of suddenly realizing something, that flash of understanding, then you know how different from a decision it is.
    And as far as responsibility goes, one may not be responsible for a condition but be responsible for treating it and recovering from it.

    • Peter Sheath June 20, 2014 at 2:31 am #

      Hi Nicholas
      Many thanks for this. I do believe that there is something in responsibility in helping people begin to understand their addiction and, hopefully, find recovery. I read a couple of weeks ago about a public park in Amsterdam that had been taken over by a group of very chaotic alcoholics and addicts. The park had become a complete no go area, full of paraphernalia and human waste. The city council tried everything to no avail until someone came up with the idea go giving the alcoholics and addicts responsibility for their own mess. They were given brushes and shovels and, if the park was clean at 5.00pm they were given five cans of lager. Guess what, within a couple of days the park was immaculate and all of them had reduced their drinking. They told people off for dropping litter and the public began to use the park again. This is the kind of responsibility I’m talking about.

    • Marc June 20, 2014 at 3:02 am #

      Hi Nick and Peter. I know about that project, Peter. Yes, it’s an amazing example. Still, Nick, you put up a good argument. You always have. I’ll just add to what Peter says from the brain side.

      You say: “The question remains can the acute brain changes induced by mind-altering drugs become chronic?”

      Of course they can…..so can the changes induced by mind-altering lovers and mind-altering religions and mind-altering political causes? Drugs aren’t the only thing that changes the brain.

      The brain easily forms habits. But it never loses the plasticity to form alternative habits, except in cases of severe biological damage. I’ve been shouting this from the rooftops for a couple of years now, as you know, as I did in your living room.

      It’s all about the disease model of course. Is insurgency a disease? Chronic, irreversible brain changes? Try getting your favourite ISIS jihadist to change his ways and you will have your work cut out for you. But the disease label becomes absurd.

      We have to move on and recognize how complex and self-organizing is this human system, body and mind.

      Yet, I also see your point, Nick, about therapists taking responsibility for people who need support. That’s just a different usage of the term “responsibility”. I’m responsible for my children too. But they let me know when I’m no longer the one to call the shots, very often correctly.

      • William Abbott July 1, 2014 at 9:38 am #

        Interesting thoughts about chronicity . I agree with Marc that the answer is yes. and also that these operate even when not acutely intoxicated– as in you function differently as an” addict” from before you became that.

        The other point Marc and others point out – which is very powerfully potent in a positive way is they can change ” back” or better they are reversible with now absitinent beaviors.

        Remembering of course that once the pathway has been established, it can be re inforced and reawakened quickly as many who have relapsed relate– they get into trouble faster than the first time — and each time they do it gets worse

    • Matt June 20, 2014 at 9:07 am #

      Thanks Nicholas. You reminded of something that drives treatment models and the dissension between them. The whole idea of whether it’s a choice or decision is a distraction, a red herring. It’s trivially obvious. The question of what came before is what’s important: your learning, your background, etc. What led up to the choice? The only way it becomes a choice, is when you are fully detoxed and the brain is relatively clear. Then you can make a “volitional” decision. But even then, the criteria for that choice is different for everyone.

      Here’s a forced metaphor. It’s like saying respiration is a choice. It’s both voluntary and involuntary. But if you hold your breath long enough your body is gonna make you breathe— or you die. That can be the decision for some. Comparing persons of widely diverse backgrounds, developmental history, socio-economic status etc. as identical is preposterous. We detox, and eventually learn or relearn a healthier habit to replace the maladaptive one. Choices and decisions run along a continuum too.

      • Nicolas Ruf June 21, 2014 at 10:57 am #

        Thanks all; pretty interesting perspectives. Here’s a question: with clients whose histories of use comprise loss of control, compulsivity, and continued use despite adverse consequences is strengthening resolve or letting go going to benefit them more?
        Haven’t you had clients who swore up and down and sincerely that they weren’t going to use and/or faced severe consequences if they used and they used anyhow? Or clients who were abstinent but miserable?
        If the ‘addictive’ setting didn’t remain intact but dormant during abstinence how explain its reinstatement so quickly in relapse?
        From what I’ve seen the power of or freedom of choice comes after giving up, surrendering, letting go, whatever it is; then one can choose not to pick up. The dorsal striatum link (Pavlovian conditioning) is broken, but not the operant conditioning one of continuing an established behavior that was once reinforcing if the person picks up (binging).The willpower stuff is too stress inducing to last.

        Check this out: http:www.amaye.org/wp-content/uploads/2013/04/med-connectivity-EEG-tomog.pdf.

        • Marc June 23, 2014 at 5:53 am #

          Looked at the article. It’s interesting, though I don’t really see the relevance. To avoid going through the same argument each and every time, I’ll try on your formula: Admit that one is helpless first. Ok, that’s a major psychological reorganization.. Could be productive in the change process. That’s pretty much what Brodie went through before he started working for the good guys (the CIA) after his stint as a jihadist. I’m talking about Homeland….very gripping TV series.

          Yes, recognition of helplessness changes things……but in ways that are quite difficult to predict. For some it’s a taste of the absolute rock bottom, which relieves the anxiety of falling further. I’m willing to admit that helplessness can serve a temporary beneficial effect — but only if you’re willing to admit the parallel between other self-destructive, rigid, overlearned behaviors and addiction…..and drop the disease label .

          : — )

          • Nicolas Ruf June 23, 2014 at 5:51 pm #

            I think the relevance of the meditation article is that the ‘self processing’ which tightens the noose along the continuum of addictive disorders, so that one gets locked into an increasingly rigid behavior pattern, begins to loosen, detach. It’s the opposite process from addictifying: a letting go instead of a controlling.
            And I totally agree that other over learned, rigid habits are similar if not the same. That’s the whole point of the true believer brain study, closed systems and kindling, n’est pas? Once the behavior pattern is set and stored so that it can be activated by a trigger or cue, without higher brain input, it is activated intact: driving in a blackout e.g.

  10. Simon June 19, 2014 at 5:00 pm #

    What a great article Peter. As a person in long term recovery, I know the reality of responsibility around my continued recovery. It wasn’t until I took responsibility for it that things changed for me, and that took some doing, as responsibility wasn’t a modus operandi that I particularly favoured. I now own a rehab in Australia, and we constantly try to empower people with this fundamental principle for successful and long term recovery. In fact, our view is “You (the client) have all the answers…”, and we shift hell and earth trying to help them see that. Trying to control people of any description and for any reason is akin to herding cats.

    The juncture at which someone seeks help with addiction is sacred and often fleeting, and needs lots of care and understanding. We try to listen to understand what is happening for them, and from there, and with them, put something in place that offers the client input into their own recovery right from the get go. We are all individual, and one of the many benefits of running a smaller (12 bed) operation is the ability to run a pretty “open” system that is I believe reasonably flexible around individual needs. So far so good. Since December 2103, we still have all clients clean and sober, and leading productive happy lives. Somethings going right.

    Self care and self examination is essential in this field. I have seen quite a few people think they can stop working on themselves because they are working in this industry, all with disastrous consequence. A person here recently was in active gambling addiction running a rehab until it all came crashing down, and the place was closed and clients evicted rather unceremoniously, all on headline news.

    Personally, I the day I become unteachable is the day I am in deep trouble. I value being confronted and even triggered by people, places and things in my path that constantly make me have a good long look at myself, and still seek help and guidance from other professionals who help me find answers and grow. In this way, I can be the best “me” I can be…for myself and for others.

    • Peter Sheath June 20, 2014 at 9:19 am #

      Hi Simon
      Thanks for your response my friend, and loads of love heading your way for your continued work South of the border. I really believe that we should invest in creating the very environment that you so eloquently describe. Over the past couple of days I’ve sat in on quite a few treatment plan reviews. They were undertaken by a variety of clinicians but empowerment and personal responsibility taking were definitely not on the agenda. There were agreements reached and compromises made but hardly any of it was in response to what the person actually felt they needed. It was almost as if the clinicians had assumed that the client had a innate inability to form a constructive decision so needed an “expert” to make them for them. I must add that I don’t think that this is any fault of the clinician, they are trying to do their best within the acute medical model framework they find themselves in.

  11. Matt June 20, 2014 at 9:20 am #

    Such a great perspective, Simon. If we are going to embrace life, we also need to embrace our addiction, for it’s part of who we are and stronger for it. In that sense, I’m very grateful for my experience with addiction.

    • Janet June 20, 2014 at 6:00 pm #

      Yes.

  12. Donnie Mac June 21, 2014 at 7:08 pm #

    Hey All , thought I would share this with you and see what you think ? I have posted here before but nothing so personal . Here is the backstory :
    In December of 2010 , I was involved in a workplace accident . A client in the non profit transition housing organization I worked for became engulfed in flames , How ?, I have no idea . I put him out with a blanket , I had to turn his head to put the fire out on his face , the skin from shoulder to shoulder had sluffed off to one side . He did not make a sound , I thought he was dead . He spent 4 months in hospital , one month in the ICU . I was left with a P.T.S.D injury . For reasons to stupid to comprehend I was terminated from that job 10 days after the accident . My drinking became suicidal , I was stealing liquor to keep up , I just wanted to be blacked out all the time . I had a raging case of P.T.S.D . Eventually Workers Compensation caught up with me , for the next 10 month I drank heavy and saw several Doctors . I told one Dr I needed to go to treatment , he agreed and made the recommendations . I had been to treatment 3 times before , once after the death of a girlfriend , once after the death of my Father and once to keep a job . I drank to deal with hopelessness , sadness . This time was different , I was drinking to die . I did not sleep as the night terrors were horrendous and the hyper vigilance in the day was exhausting . Since I had been to treatment before , I knew what I wanted / needed . I had been a flag flying member of A.A in the 1990 ( when it was the only game in town ) and had found it not only disempowering but replete with sociopaths , sexual predators , disingenuous freaks of every flavor , lightly seasoned with some fine human beings . The latter were hard to find . I tried to get the Workers Compensation board to send me to a treatment center that dealt with P.T.S.D as this was a primary concern . Instead ( and out of a bad version of Intervention ) I was forced to go to a very expensive rehab here in Canada ( West Coast , named after a tree or trees ) The following is a “word for word ” 30 day report from the treatment center to Workers compensation on the treatment of my “disease” . This is a $30,000 document . Enjoy :

    ” Don arrived at Cedars and presented as sceptical and opinionated . He said he did not believe in 12 step based recovery and was conserved about attending Cedars . He met with this writer and continued to speak openly about his reservations regarding the 12 step philosophy . He did however indicate a recognition of the fact that it is a pathway to healthy living . His main concern appeared to be the notion of God and although different options were presented to him , Don continued to state that he did not believe. Don also presented with a sense of entitlement and often tended to separate himself from his peers , giving the distinct impression that he was unique in some way .
    In terms of verbalizing a recognition of the extent of his personal powerlessness over his addiction , Don was quite open about that . He verbalized recognition of the impact of his disease on his relationships , but did not give a sense that he felt any impact of his behaviours on an emotional level . Don tended to intellectualize a great deal and seemed to want people to acknowledge his intelligence . He uses a great deal of humor to deflect from his emotions .
    Don’s scepticism around the program of Alcoholics Anonymous appears to be lessoning although he took a stand against “God” ( I have to chime in at this point , I am not Christian so the ideas of steps 2 , 3 , 5 ,6 , 7 and 11 are a bit silly to me . I believe in the God of Abraham and spoke of him often , this was lost . I used the word “Seminal ‘ once and the man who wrote this didn’t know what it meant , this was me being intelligent , back to our story ) He appears to have difficulty with or balk at the suggestion of ” as we understand him :. He seems to want to debate constantly and continually presented with a sense of entitlement . Don maintained his stance as unique and took great issue with the phrase “Terminally unique ” when the concept was presented to him that by separating himself , he would be in fact jeopardizing any type of recovery .
    Don gave the impression often that he was onboard with the principles here and what he was being taught but appeared to be more in compliance than surrender . Don spoke a length about the impact of his addiction on his Mother in particular , but continued to be on a cognitive level than emotional . There was little to no mention of his P.T.S.D ( they would not know it if it was kicking them in the head ) but when he spoke of his symptoms , he appeared to recognize how they lead to increased substance use , in a self defeating attempt to cope .
    Don tended to speak positively about treatment around people who also spoke positively but would quickly engage in negativity around people who did likewise . He appeared to conform to whatever surroundings dictated . As Don speaks he gives the impression that he lacks the life skills needed for recovery . He also continually challenges anyone he perceives as an authority figure and at times appears to be playing a game rather than being invested in the recovery process .
    Don is very intent and focused on speaking for one hour per week by phone with his psychiatrist , his reason for this at present is unclear ( because I was loosing my mind ) He appears to hold on to the idea that he needs an entire team of professionals to help him with his unique issues . At present we are supporting the sessions with his psychiatrist providing they are to assist with dealing with his P.T.S.D .
    Don identifies his lack of living skills as his impediment to his recovery and stated that he would be willing to move into the extended care program post primary treatment as well as considering locating to Victoria in order to live in a recovery house . ”

    No shit here ” word for word ” , Whatcha Think ?

    Donnie Mac / 14

    • Donnie Mac June 23, 2014 at 7:29 pm #

      Too Much ?

    • Marc July 24, 2014 at 11:01 am #

      Hi Donnie. Your recent comment on the most recent post reminded me that I hadn’t read this comment thoroughly. I just did. Wow!!! I’m glad you posted this. First of all, I really would like to place it in the Guest Memoirs section. It is an amazing story: both in terms of how you got there and in terms of the way you were received.

      You told me before about the burning incident and how it affected you. I have no doubt that this would leave any sensitive person with some form of PTSD or other major rift in their psychological wellbeing. But the way your personal style and conduct were interpreted by the “professionals” at this high-end place…is almost as funny as it is pathetic. I’m glad you quoted the report word for word. The smug moralistic stance of this person, combined with the narrowness of his/her vision and lack of any sense of humour or creativity…epitomize what people have to put up with in (even high-end) residential treatment centres. It seems that some of the worst sins committed are these bizarre equations that get concocted:

      uniqueness/individuality = entitlement
      skepticism = cynicism or defiance
      non-Christian religious perspective = rejection of any spiritual values
      argument or debate = again, defiance or “negativity” or, God Forbid, “oppositional” behaviour

      I can see that this was a miserable experience, and your description really gets at the idea of a “false self” — having to present yourself as having a particular set of (desirable/normative) characteristics but at the same time having to be (and being told to be) honest and authentic. And the way that 12-step-based programs seem to overwrite or dismiss any personal psychiatric/psychological problems…it’s just creepy. Sounds like a horrendous experience.

      Let me know if I can include this in the memoir section. You don’t have to do anything…I’ll edit it a bit if you say the word.

      Also, check out this new book: The Couch of Willingness, by Michael Pond and Maureen Palmer, written by an (ex) alcoholic who lives in your neck of the woods…He writes about his experiences in and out of rehab with beautifully dry humour and insight….It’s a hair-rising memoir AND extremely well written. I think you’d like it.

      Let me know about the Guest Memoir issue okay? And drop me a line some time — I’d like to hear how you’re doing.

      Cheers,
      Marc

      • Donnie Mac July 25, 2014 at 7:26 pm #

        Yes of course you can use it as a guest memoir , if I can add to it as it goes along that would be great . It’s not the end of the story by a long shot.

        In retrospect my trip to this rehab had it’s benefits . Before I went ( I had been to rehab before )
        I made a decision that :
        A) I needed and good detox as I was super sick from substance and mental health issues .

        B) I would make the best of a unwanted situation , to be perfectly honest I was being paid to be there and some of my best friends currently are folks I have meet in rehabs . I was so desperately lonely at the time ( I had become Agoraphobic from P.T.S.D ) that I would try anything to get some relief .

        The man who wrote this letter is a “Senior Counselor” there and appears to be well liked . I was in treatment for over 100 days so we got to know each other . He is a nice guy , he wakes in the morning kiss’s his wife and young child and makes the long drive to work just like most folks do . Once a week the “Clinical Team ” meets and some 9-10 counselors , directors of programs and Doctors discuss the clients needs , mood , activities and so forth . They all speak in the language of “Recovery” , this is their medicine for the “Disease” of addiction . The great irony here is that because they are a “For Profit ” business they can sell whatever they wish , being held accountable to no one . If they took a nickel from the “Public Trust ” , Provincial Government , Provincial Health Care , Federal Government … etc , there would be no way ” In Hell” this program would be allowed to exist , None . They simply are not funding 12 step “Boot Camps” like this . No one from an outside agency looks over the usefulness or if clients are getting value for money or being sold a bridge . One client I became friends with had been to this rehab , and others several times , he had spent several hundred thousand dollars of “treatment” , he died alone . The Rehab just stands back and says that’s the reality of this “Disease” , people die . They or no other outside agency looks into the treatment process or what this rehab is selling . The rehab itself will admit to at best a 5-10 % success rate after a year of leaving the program . clients sign an aftercare agreement that includes 4- 5 AA meeting a week , AA has become the “Tailings Pile ” of the rehab industry , once they have your money it’s off to AA for the rest of your life .
        Me , I just made the best of the situation , got some time away from booze and met some nice folks .

        The super nutty part about this whole adventure is not the cost or lack of accountability or evidence that their program is highly ineffective and people die from it . It’s that “Senior Counselor” ( remember him ? ) and all the staff there truly believe they are doing “The work of God’.

        Donnie Mac / 14

  13. Jasmine June 22, 2014 at 6:49 am #

    Dear Peter (and Marc):

    Peter: I send you a HUGE Bravo for such an honest, authentic and resonant post. If you haven’t been thanked, I say “Thank-you,” and to Marc as well for such a fitting passing/sharing of the proverbial torch.

    Okay, so here’s my “beef,” or (being veg) “tofu”: I’m so confused about the addiction as disease paradigm. It’s not that I disagree with it. I just hear/see so many people (ok, Mother stuff aside ;), that addiction is a choice. I know first-hand that depression and anxiety pre-dated my addiction (in addition to my genetic pre-disposition – on both sides).

    I also struggle with the individual vs. system stuff, which (IMHO) can never be “conquered” in a single blog/post etc., but that’s prob more fitting for another post. I digress…

    Anyway, sending Blessings and Gratitude,
    Jasmine ‘)

    • Peter Sheath June 22, 2014 at 10:48 am #

      Jasmine thank you for your reply. Marc and I talked extensively about the disease paradigm over the past few years. In fact we exchanged emails a couple of weeks ago with the quandary that why is it that addiction has such an impact on some people and not on others? Pretty much the same as yourself, I feel that there was something going on a very long time before I picked any drug. It was like there was something missing and, in my early days in 12 step programs, having an attachment to a disease paradigm helped me to understand it. It also helped me to slow down the enormity of the guilt and shame I needed to confront whilst I came to terms with some of the things I had done. As time has passed, and I’ve seen hundreds of people struggling with addiction, the genetic/disease paradigm has lost more and more of it’s credibility. I don’t know if there’s an easy answer, addiction is, pretty much the same as being human, a very complex thing. Describing it as a disease implies that it has a biomedical cause yet, as in almost all mental health conditions, there are no biomedical markers. Perhaps it’s simply part of being human, an extension of normal brain function, pretty much what our brains were designed to do?

  14. marcus June 22, 2014 at 2:03 pm #

    “In fairness, it is beginning to change, but I believe that change needs to begin with the workforce. It needs to begin with an admission that we’ve got it wrong. Then recovery can become a team process that includes the person doing the recovering.”

    That paragraph sums it up pretty well for me. When the very treatment you receive is wrong, primarily because the hypothetical addiction causation premise is inaccurate & incorrect, the cards begin to stack up against. It will be a great day when & if it ever gets acknowledged that the current addiction causation paradigm, that controls everything from prevention, detox, rehab, recovery to research, is flat out wrong, scientifically baseless and needs to be corrected. What other health care business can you, often times purposely, use proven invalid theories to treat clients thus insuring a constant flow of clients and repeat clients? Specifically, the so-called hi-jacked brain hypothesis (see Alan Leshner) was scientifically & clinically false from inception. Until this mess gets sorted, nothing will change. In my view, it is the biggest healthcare fraud of all time.

    • Marc June 26, 2014 at 6:34 am #

      Marcus, this is precisely my own take on it. As you probably know from this blog, I take issue with the disease model at almost every step of the way. I guess I was already in that position when I started all this a few years ago, but the comments I’ve gotten from readers on the blog, plus a lot more reading on the subject, has brought me to the point of being an anti-disease-model crusader, so to speak. I even participated in a debate in front of 100 medical students, with a psychiatrist who was so sure of himself…. Until he heard what I had to say about addiction as a developmental process, pulling in the neuroscience data as I went. At the end the audience voted: how many see addiction as a disease vs. how many see it as something else. I won by roughly 95 to 5. I’m not just crowing. This is an argument we can take to the labs, the funders, and the treatment world — as exemplified by Peter’s post –and we can win it.

  15. Stephen Creagh Uys June 23, 2014 at 12:17 am #

    Hi, I am always delighted when a new post arrives from this blog. I am always impressed. I truly think the model of ‘powerlessness’ as put forth by the 12-steps runs contrary to the instinctual needs of survival. I survived a 30 year heroin habit by taking control of my life with methadone and really delving into what I wanted. I was empowered to taper at a rate set by me, or to continue. I chose the former, but would have accepted the latter, if I found it best. In the face of situations where we truly are powerless, the human being instinctually tries to survive, (war, accidents etc….) I think that you really advance the argument for empowered recovery with this post. I do not mean to belittle those who choose to believe the 12-step model, as I have many friends who are alive because of it, but, they cannot seem to grasp that their involvement is a choice, nor can they accept other routes. I feel the true powerlessness in recovery is dictated by a model which dismisses other choices, and its seeming monopoly on treatment. By using morality as a weapon, they probably do, in actual numbers, more harm than good. Acceptance of the full spectrum, from Harm-reduction in active addiction to complete abstinence (which is also harm-reduction) we stand a better chance of surviving. Thank for this guest post.

    • Marc June 24, 2014 at 9:08 am #

      This is potent stuff, Stephen. The way you talk about empowerment in your recovery provides a compelling example of the approach advocated by Peter in the post.

      What a shame that the 12-step model is so often seen as the antithesis….and yet everyone knows people who’ve been “saved” by it. It sure does seem to cut both ways. I guess it’s all about “using morality as a weapon”…. That’s got to leave some casualties.

  16. Gary June 24, 2014 at 7:27 am #

    In terms of Choice!~

    I believe there was a time when I had a choice to use or not use. However, there also came a time when I believe “choice” was absent or at least that part of the brain barely functioned. When I think of “disease” or the disease model I relate it to how my life was functioning and how “un-easy” it was or perhaps a “Dis-ease” in the way I thought and lived. The more I didn’t want to live in such a way the more dysfunctional my life became. I tried and tried to quit and change my life only to realize that this was a pattern as well, which, didn’t work. Trying to push away something I don’t has a tendency to increase it’s power and grip on me similiar with tobacco addiction, which, by the ways kills more people than all of the other drugs combined. However, once I sensed the “goodness” within myself and could imagine a life without the use of drugs freedom was a result. Which ever “modality” one chooses, to me, this is also an illusion, at least to some degree, in understanding the true nature of humanity. Unless we start from a Tabula Rasa or a clean slate in which to begin a new start then the pattern starts all over again perpetually. In what is deemed, “client-centered” there ought to be no model what-so-ever. If one wants to travel together (Client/Clinician), one has to let go of any preconceived notions so they can be present and attentive. Real change happens once you realize that there is nothing in you (clinician) and nothing in the (client) as much as what happens between you that determines change or not. Modalities, ideaologies, methods and such can be absolute distractions for a client and clinician. The best “therapists in the world have two good ears and a mind to listen.

    • Marc June 24, 2014 at 9:01 am #

      But you know, these dichotomies can also muddy up our thinking. Choice vs. disease? All choices are biased, none are perfectly rational. Choice is not clear cut, so I don’t see how it can be one pole of any polar dimension. See what I mean? And having a “mind to listen” does not mean a tabula rasa…. That mind will have models, assumptions, hunches, etc, even for the young infant. Young infants follow certain moving objects with their gaze and then reach for them because they have a “model” of what are reachable (chewable?) objects. Using methods they’ve found to be effective. Clinicians can bring a wealth of knowledge with them……

      But I know, I’m sounding like a hopeless academic. Hopelessly abstract, that is. I do know what you’re saying, and I agree that spontaneity and vulnerability are marvelous qualities in a clinician. Knowledge should be a springboard rather than an air-tight case.

      • Gary June 24, 2014 at 10:18 am #

        Hi Marc…

        I totally agree with your comments regarding models, assumptions, hunches etc…

        That is the problem!~ Why is it we believe that there is a way or a method or perhaps even a path. I believe its so the Brain has a sense of Order. The Brain, without question, requires Order.

        Sometimes, with all due respect, “Brains” actually gets in the way and becomes a barrier. Every single brain has been conditioned from the past. I wonder if there is another realm or deeper beingness behind the brain or perhaps behind the thinker. If someone experiences an “AHUH” moment time itself is left out of the equation and it’s instantaneous. If we were able to clear the debris of the conditioned mind we might possibly gain instant clearity and insight.

        So I wonder if there is a way to listen, to be with, full attention without labels, names, etc… The problem comes when I believe there is “a way” and then translate the way. Perhaps the answer is always in the question and by embracing the question, fully, thus the answer reveals itself.

        It is difficult to grasp that perhaps all the thinking and recording that the brain has been doing for years, that just maybe, it was” thinking” that caused the so called “dis-order” in the first place. Too many labels, diagnoses, boxes if you will, that somehow brings meaning. I do believe its the complexiety of simpilicty. The intellectual brain strives perhaps for complexity and loves to figure things out.

        If there was a “workshop” on freedom or just a simple open door to freedom I wonder what most people would choose?

        • Marc June 25, 2014 at 9:28 am #

          Gary, I’ve also thought about a truth behind knowledge..and that sort of thing. But 1. I can’t really “think” about it — by definition and 2. I really like and respect science, and I kinda like the brain… So I’d prefer not to give order and knowledge such a bad name.

          Here’s a marvelous quote from Maria Popova (http://www.brainpickings.org/index.php/about/) about how you can have knowledge, experience, biases, insights, and freedom, all in the same bite:

          “The core ethos behind Brain Pickings is that creativity is a combinatorial force: It’s our ability to tap into our mental pool of resources — knowledge, insight, information, inspiration, and all the fragments populating our minds — that we’ve accumulated over the years just by being present and alive and awake to the world, and to combine them in extraordinary new ways. In order for us to truly create and contribute to the world, we have to be able to connect countless dots, to cross-pollinate ideas from a wealth of disciplines, to combine and recombine these pieces and build new ideas.”

          • Gary June 25, 2014 at 10:46 am #

            Hi Marc…
            I too!! like and respect science and absolutely believe that everything has a place. My intent is not to attack science whatsoever, and apologize if that is how my comments were reflected. In context, manys things are not only important in life but perhaps necessary. There are many things about being human that we do not understand yet we have the capacity from the inside out sometimes in the quietness there is a knowing that cannot be measured.

            • Marc June 26, 2014 at 6:26 am #

              Hey no worries. I just feel like being contentious once in awhile. I really appreciate your voice here, and your message is so important. I also sometimes go to places that have no ground or context to make sense of them. Wonderful places. I wish I was going there more often, but I live in this very analytical brain — so I make the best of it!

            • William Abbott July 1, 2014 at 9:40 am #

              Nothing wrong with attacking science or scientists . A good scientist is also a skeptic

              so fire away

  17. Jasmine June 24, 2014 at 9:25 pm #

    Hi All,

    What interesting responses! I will explain a bit more as to my initial query. Firstly though, just want to express my appreciation for such thoughtful insights.

    Gary – some of what you wrote really resonated for me (re: in terms of choice), so thanks!

    In trying to make sense of, package, and hopefully advance some models/windows etc., I think it is often a matter of competing perspectives. So, I’ll break it down into, or divide “it,” (for now ;) into the seemingly “public” and the “private” (*not sure what else to call these realms for conceptual understanding…).

    Okay, private: the dis-ease model seems more palatable in relating with those we are close with – those who are not familiar with the more “public” realm. Those who – even explaining the “hyphen” to would take some time. However, that does not seem to be the mainstream discourse among these realms. Rather, the model of choice seems to reign, which can be very frustrating and invalidating.

    This debate still exists in public realms too. Quick story: my ex-partner’s daughter (my G-d daughter) had a horrible heroin addiction; she had needle marks with gangrene on her wrists etc. She turned to me, and I tried to get her to go for help, which she was resistant to. I then went with her Mother to the Justice of the Peace (with evidence), to at least get her detoxed, and we were dismissed. WHY? Because the JP did not see addiction as part of mental health! For real!!

    So, clearly, we have a long way to go in some parts of those areas too.

    And, for those more connected to the field – in whatever way – I really love the idea of just seeing/supporting the individual, without the paradigm. Unfortunately, I believe that is the serious minority.

    To sum it all up, I guess I’m wondering if it is/n’t all about just navigating whatever system you’re working with (or against?). I’m not trying to sound apathetic, so perhaps a more common discourse might be warranted. For example, I believe that almost all addicts feel major shame and guilt, which prevent proper treatment and support.

    Maybe I’m just wondering about trying to find common ground before trying to live on islands (whether some are lacking infrastructure – or otherwise)…

    Thanks for reading!
    Jasmine ;)

    • Gary June 25, 2014 at 10:35 am #

      Hi Jasmine…thank you for your kind comments !

      I’m sorry to hear the difficulties that you were faced with with respect to your G-daughter!~ For me, in terms of “Shame” it is the core factor that shaped the course of my life during my using days. As John Bradshaw stated in determining the difference between “Guilt” and “Shame” is Guilt means I’ve made a mistake, whereas, Shame- I AM A MISTAKE!~ Huge difference. Unless we can meet a person on an equal plane would it ever be possible to truely understand and care for them? All we ever have to do is “Be” human, which, we already are, yet! it appears that unless there’s a model or modality, for some, or perhaps even “evidenced-based” it isn’t effective.

      Sometimes it’s as though we are learning more and more about less and less. Have we gotten lost in our heads and completely lost the ability to be human. Bradshaw also meantioned, in one of his many videos, that “we have become human-doings” and “not human-beings”. You see “being” requires absolutely no action which is difficult for most people. In fact, when you ask many people how they are doing a usual response is “wow” I am so so busy” as if there is value in that.

      Perhaps we ought to trust our hearts and intuitions a little more. Is it that we think there is a way to be human. There is nothing more healing than the abundance of Love inside the human heart and I think Marianne Williamson has it covered in her book “A Return To Love”!~

      Addiction in my own personal opinion is nothing less than a by-product of the society in which we live. Addiction is only the symptom, the tip of the iceberg, and we ought to all look at the ways in which we live, love and truely care for one another. There are so many distractions, taking us away from ourselves in order for us not to stop and feel what we really feel. Examples: drugs, alcohol-,which, is a drug including tobacco, work, money, gambling, food, sex, technology etc… Maybe at the core a person is so lost and/or disconnected from themselves that in order to feel they have to engage in particular activities.

      As I have mentioned in prior posts, real change only comes from within. In other words, i believe the “outer world” may just be a reflection of our “inner world”. If this is the case we need to find peace and love for each other!~

      • jasmine June 25, 2014 at 3:06 pm #

        Gary:

        Thanks sooo much for your attuned and thoughtful comments. Made me think of this super awesome documentary I watched recently that I’m certain you’ll enjoy, and hopefully other site bloggers as well:

        http://www.youtube.com/watch?v=UrAgb1-UKQ8

        Lovingly,
        Jasmine

    • Marc July 24, 2014 at 12:05 pm #

      HI Jasmine.
      I never replied to this, and Gary’s reply (below yours, above this one probably) seemed to cover the shame/guilt issue and also extend your perspective in a way that was both heartfelt and insightful. Let me just add one thing: I don’t think the “choice” model is the dominant perspective these days, not at all. Rather, most people, and certainly much of the treatment community (including 12-step based programs) AND much of the research community (NIDA being the hub of that) define addiction as a disease, a chronic brain disease at that.

      In my work, and the focus of the book I’m nearly done writing, I reject the disease model for all kinds of reasons. But that doesn’t mean that I think addictive behaviours are run by (free) choice. In fact, it really troubles me to think that this false dichotomy is usually the final resting place of most debates about addiction. Volkow vs. SMART, Hyman vs. Heyman (seriously: Gene Heyman vs. Steven Hyman — one says “hey!” — the other says “high!” :–)) …To me it seems that the idea of “choice” has been totally twisted by “choice” proponents of addiction. Choice is almost never free. When we “choose” to go shopping, the moment of action is actually driven by opportunity (is the bus coming? is the car available?), circumstance ( how far? how much? open or closed?), need (is there food in the fridge? enough for another day? did the holes in the kids’ shoes finally become unmanageable? am I hungry or thirsty?), biases, associations, etc, etc. Nothing free about it. Choice is often a point where you expend a bit of self-direction in an ongoing stream of events that are not chosen at all).

      I could go on and on. Instead, I’d better finish the book so you can read it. But what I think you’re mostly concerned with is the way people use the notion of “choice” as an accusation, a way to point the finger and induce shame and guilt. A great example is Peter Hitchens in Britain, who’s made this his personal anthem… Check this out. Let me just say that people also use the notion of “disease” for unsavory purposes. The Betty Ford clinic, for example, makes a LOT of money for every “patient” they “treat” for their “disease”….not to mention the moral authority many 12-step groups assume when they coerce participants to admit that they are “ill”.

      Phew. Better shut off the valve. But we all agree on one thing: shame and guilt are absolutely the most serious impediments to quitting, recovery, getting on with your life, etc. And my point is that the finger-pointing can take on many different guises!!

      Thanks, as always, for your thoughtful and moving contributions.

  18. Peter Sheath July 9, 2014 at 9:45 am #

    Hi Everybody and a massive thank you to everyone that has responded here, loving kindness being sent out to each and every one of you. I believe what we have in this thread is a very strong evidence base for the diversity of addiction and recovery. I love the enthusiasm and depth of knowledge contained here and it confirms my day to day experiences. I would like to take the liberty to share with you some of my last couple of weeks which, kind of, confirms what has been written here.
    I am working on a working document designed to help people, both staff and service users, who have, often as a result of the system, become stuck in treatment. This has enabled me to spend some time with a person, who I admire greatly, and has been in receipt of Opiate Substitute Treatment successfully for many years. He has achieved lots of things in his life, is happily married, works and has a grown up family. OST has definitely worked for him and, has made me realize, is just as important to him and his recovery as 12 step, SMART, etc. is to others.
    Although my recovery choice is total abstinence, some 12 step stuff and loads of spiritual exploration, I also spent some time in the last few weeks at a festival with some other people who’s recovery choice involves some controlled drinking. All of them had started in 12 step recovery, but as discussed above, found it difficult because, as time went on, they found there was more things that conflicted with their changing belief system than concurred. As far as I could see, they enjoyed a bloody good time, got a little drunk, but experienced none of the doom and gloom hell fire damnation that 12 step circles warned would happen. I can hear it now, “ah but they’re not proper addicts, they don’t have the disease or dis-ease of addiction”. Well believe me, I used with these guys. They did everything I did, went to the same depths of depravity. So, in my humble opinion, the argument just doesn’t exist and the recovery choices they are currently making are just as valid as someone opting for total abstinence.
    Lastly over the past four days I’ve had the absolute pleasure of spending some very intimate, not sexual, times with another good friend who has chosen Christianity for his recovery pathway. We’ve sat fishing until all hours of the night, talking in depth about each others beliefs, values, experiences and, of course, fishing. He hasn’t once tried to convert me in any way shape or form. I also knew him well back in the day and today he is one of the most beautiful people I know.
    We should learn to celebrate the diversity of recovery and recognise that there is wonderful little packages of golden learning opportunities within everything, including the recovery choices people make. Maybe the key for all of us is to remain compassionately curious, because when the student is ready the teacher will appear..

    • Marc July 10, 2014 at 4:27 am #

      Peter, This is just lovely. I’m literally moved to tears. Sometimes I think about and write about the continuum of addiction-to-quitting as a developmental process, implying of course growth, moving forward, becoming more knowledgeable about oneself and others, becoming more gentle and accepting of oneself. But the way you put it here takes the developmental idea to a whole different plane. Not just developing but blossoming. Of course! diversity in our paths and our insights, both in a psychological and spiritual sense. That’s what we’re here for.

      (I NEVER use the word “spiritual” — look what you’ve done to me)

    • Marc July 11, 2014 at 12:23 pm #

      Addendum: these words are very moving:

      “wonderful little packages of golden learning opportunities within everything, including the recovery choices people make”

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