Answer Addiction

Tag: 12 step alternatives

  • 5 Myths About Leaving 12-Step Fellowships

    5 Myths About Leaving 12-Step Fellowships

    We have a responsibility to do whatever we can — even if that means pointing someone to an alternative (non-12-step) pathway of recovery.

    I’ve lost count of the number of conversations I’ve had with people who are frightened to leave 12-step fellowships. They contact me because they heard that I left Alcoholics Anonymous and Narcotics Anonymous over a year ago, and want to see if it’s true that I’m okay — that is, stayed sober.

    It’s true: I left 12-step fellowships in March 2017, and not only have I stayed sober, but my resilience, independence, and emotional well-being have grown exponentially. I’d even say that my sobriety has evolved more over the last year than the five years I spent in AA.

    What saddens me the most about these conversations — which echo my own fears of leaving — is that some members of 12-step groups believe sobriety is contingent upon their membership in AA or NA. So deep-rooted is this conditioning that they believe that if they stop attending meetings, they will return to using alcohol or drugs. Well-rehearsed 12-step myths say that without a program a person will become a “dry drunk,” or that they lack gratitude. Yet another surefire way of keeping people in the program is to tell them that leaving means they are unwilling to help newcomers.

    My experience, along with that of many others who have left 12-step fellowships, is that these beliefs are dogmatic conditioning. I will never tire of debunking these myths.

    Last month, a woman who spent over 20 years in a fellowship contacted me because she was tired of attending, fearful about leaving, and concerned that people mistakenly thought the length of her sobriety meant that she had the secret to long-term recovery. Such was her sense of responsibility that she blamed herself for the unfortunate fate of some people in the program. I’m saddened that someone in long-term recovery felt so confused and frightened about leaving.

    Today, my recovery represents independence. I now understand recovery as a knowing of myself and reclaiming my instincts. After six years in recovery, I’d like to think that I can make decisions based on what is right for me, rather than on the judgments of others if if I go against the grain. But this isn’t the reality for many who attend 12-step groups and they believe they have no control over their own sobriety other than showing up at meetings and working the program.

    These are just a few examples of the reasons many people have contacted me to discuss these very real fears and they’re always the same. Here is what I have to say about some of these common myths:

    • How will I help newcomers if I leave?

    First off, newcomers don’t always show up in meetings. They need someone to tell them that a meeting exists before they know to walk through that door. Second, there are a million ways to share a message of recovery: writing about your journey; giving peer support at a recovery center; sharing your experience in a treatment center or prison; offering help to someone who is struggling; or telling your friends, family, and doctor that they can refer someone who needs help to you. By leading a fulfilling life in recovery, you’re providing a real example to others that healthy and happy recovery is possible. I’d argue that all of these examples of helping a newcomer are equally, if not more, powerful than sharing your story and your telephone number in a meeting.

    • If I leave, I’ll relapse..

    This most pervasive myth of all has proven false for me and for hundreds of people I know who have left 12-step meetings. We feel a sense of freedom from breaking free of the dogmatic messaging and have taken back our power by choosing a pathway that is right for us.

    If someone wants to use drugs, they will find a way to do so whether they attend meetings or not. I don’t use substances because I choose not to, and because I care enough about myself to stop harming my body and preventing my ability to lead a fulfilling life. I no longer believe that I have a monster living inside of me, or a disease doing pushups in the parking lot waiting for me to mess up. Those are simply myths designed to keep me surrendering my will to an illusory bearded man who lives in a church basement, listening to people’s sad stories.

    • AA is the only way to recover.

    This statement is simply untrue. There are many effective pathways to recovery. In fact, a leading study shows that tens of millions of Americans have successfully resolved an alcohol or drug problem through a variety of traditional and nontraditional means. Specifically, 53.9 percent reported “assisted pathway use” that consisted of mutual-aid groups (45.1 percent), treatment (27.6 percent), and emerging recovery support services (21.8 percent). 95.8 percent of those who used mutual-aid groups attended 12-step mutual aid meetings. However, just under half of those who did not report using an assisted pathway recovered without the use of formal treatment and recovery supports.

    Another study comparing 12-step groups to alternative mutual aid groups found that LifeRing, SMART, and Women for Sobriety were just as effective as 12-step groups. Study author Dr. Sarah Zenmore and her team reported that “findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems.”

    • If you don’t feel suited to a 12-step program, you’re incapable of being honest with yourself.

    We’ve all heard of that paragraph in AA’s Big Book, “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.” Really?! What about atheists who feel uncomfortable at the idea of handing over their life to God? I’d argue that it is being honest with yourself to acknowledge that the 12-step program doesn’t align with your values and beliefs.

    It is harmful to suggest that you are the problem if AA doesn’t work for you. If the 12 steps are so powerful, how come their success rate varies wildly from 20 percent to only 60 percent? Shaming isn’t the answer to long-term recovery — that only deepens an already desperately low self-esteem. Supporting someone as they find the right pathway is a far more compassionate, helpful approach. When so many people are dying from substance use disorder, there is no room for shame. We have a responsibility to do whatever we can — even if that means pointing someone to alternative pathways of recovery — so that we have a fighting chance at saving some lives.

    • My desire to leave is my disease talking.

    You don’t have a monster with a different voice living inside you. Yes, our behavior changes when we use drugs, and yes, drugs override our ability to make rational choices. We also have a desire to avoid painful realities — that’s what got most of us in the habit of using drugs in the first place. But attributing your realization that something isn’t right for you to a walking, talking disease is utter nonsense. I decided to leave because I was sick and tired of entering church basements in a cloud of cigarette smoke to hang out with people eating candy, drinking tar-like coffee, talking through people’s shares, and listening to the same old story on repeat. There was a time that community was helpful, but a point came where I wanted to go out and live my life. After all, this program was designed to be a bridge to living normally.

    View the original article at thefix.com

  • Microaggressions: How Subconscious Biases Affect Recovery

    Microaggressions: How Subconscious Biases Affect Recovery

    An example of a microaggression in the recovery universe: someone from NA asks someone who’s considering Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved, but the fellow member is left feeling disparaged.

    Politics and Religion: we’re encouraged to avoid these conversations, socially. Conviction can escalate to hostility, hurt feelings and polarization, turning a fun-loving conversation into… “Awkward.”

    Has anyone noticed polarization-creep migrating from political intercourse into our addiction/recovery discussion? A diversifying recovery community means different tribes and subcultures with differing views on recovery and addiction. Many Fix readers are members of a mutual-aid group that gives a sense of identity and belonging. Being tribal is human nature; so, what’s the problem? Maybe it’s a hangover from the current political climate but I’m feeling a little microaggression-fatigue. It’s great to cheer hard for the home-team; but does that mean diminishing the other(s)?

    “We tribal humans have a ‘dark side,’ ironically also related to our social relationships: We are as belligerent and brutal as any other animal species,” says author and UC San Diego Professor Emeritus Saul Levine, MD, in “Belonging Is Our Blessing, Tribalism Is Our Burden.” “Our species, homo sapiens, is indeed creative and loving, but it is also destructive and hostile.”

    Levine cautions that for all the psychological good that belonging offers us, “Dangers lurk when there is an absence of Benevolence. Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships. Estrangement can easily beget prejudice, nativism, and extremism. These are the very hallmarks of zealous tribalism which has fueled bloodshed and wars over the millennia.”

    How does “zealous tribalism” present in the recovery community? Abstinence-focused tribes have dearly held views that differ from our harm-reduction fellows. Inside the abstinence-model tribe, it’s not all Kum Ba Yah, either. Refuge Recovery clans, SMART Recovery, Women for Recovery and the 12-step advocates may feel a superiority/inferiority thing that comes out in how we talk about each other. SMART followers may look down on 12-stepping as stubbornly old-fashioned. 12-steppers might see Life Ring or other new tribes as acting overtly precious with their dismissal of tried-and-true methods. Focusing in even more, we see NAs, CAs and AAs each rolling their eyes at each other’s rituals or slogans. In AA, secular members and “our more religious members” finger point at each other about who’s being too rigid and who’s watering down the message. These are examples of what Levine calls “belonging without the benevolence.” Finding “our people” is great. Part of what makes us feel included might also over-emphasize the narcissism of small differences.

    “Meeting makers make it!”
    “That’s not sober; that’s dry. The solution is clearly laid out in the 12 steps—not meetings!”
    “AA’s a cult that harms more people than it helps!”

    These are tribal battle cries—sincerely held feeling based in part on our unique lived experience and in part on an ignorance we’re not conscious of.

    If you love the fight and you don’t care what others think of you, this article might not hold your attention. We’re going to talk about how to get along better. On the other hand, if you see yourself as empathetic and regret falling prey to us vs. them conflicts, let’s talk about cause and corrective measures.

    Recovery professionals curb their own biases through professional practices; we can borrow their best practices to avoid getting defensive or dismissive with people who hold divergent worldviews. If our goal is to connect with others, an increasingly diverse world of others presents challenges.

    “In my early career, I was adamant about abstinence as the only viable solution to alcohol and other drug problems,” recalls William White, author of Recovery Rising: A Retrospective of Addiction Treatment and Recovery. As a historian and treatment mentor, White learned from lived-experience, clinical practice, study and research. His 2017 book advocates for treatment professionals to exercise “professional humility and holding all of our opinions on probation pending new discoveries in the field and new learning experiences. Many parties can be harmed when we mistake a part of the truth for the whole truth.”

    If 100% of my knowledge about harm reduction is from harm reduction failures who tell their story of decline in a 12-step meeting, I could “mistake a part of the truth for the whole truth.” What would I know about harm reduction success stories if I only go to 12-step rooms?

    Treatment professionals are adapting to cultural diversity in their practices. Bound by a Code of Ethics, NAADAC (the Association for Addiction Professionals) has embraced the concept of “cultural humility.” Cultural humility is a fiduciary duty for professionals to be sensitive to client race, creed, sexual orientation, gender identity and physical/mental characteristics when providing healthcare.

    “Cultural humility is other-oriented. Cultural humility is to maintain a willingness to suspend what you know or what you think you know based on generalizations about the client’s culture. Power imbalance between counselor and client have no place in cultural humility. There is an expectation that you understand the population you’re serving and that you take the time to understand them better,” explains Mita Johnson, the Ethics Chair for NAADAC, who teaches cultural humility to addiction/treatment professionals. Dr. Johnson says, “Addiction professionals and providers, bound by ethical practice standards, shall develop an understanding of their own personal, professional and cultural values and beliefs. Providers shall seek supervision and/or consultation to decrease bias, judgement and microaggressions. Microaggressions are often below our level of awareness. We don’t always know we are doing it.”

    Microaggression—today’s buzzword—google it. In The Atlantic’s “Microaggression Matters,” Simba Runyowa elaborates on the insidiousness of this behavior: “Microaggressions are behaviors or statements that do not necessarily reflect malicious intent, but which nevertheless can inflict insult or injury. … microaggressions point out cultural difference in ways that put the recipient’s non-conformity into sharp relief, often causing anxiety and crises of belonging on the part of minorities.”

    Here’s how that might look in our recovery universe: someone from NA, a complete abstinence-based fellowship, asks someone who’s thinking about medication-assisted treatment with Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved but the fellow member is left feeling disparaged. Maybe the well-intended NA had a negative experience with medically assisted treatment (MAT) and has a visceral feeling about it, “Taking drugs to stop drugs isn’t clean.” But NA doesn’t work for everyone. Yours or my anecdotal experience will bias us. Maybe expressing my own personal experience, or just listening without commenting, would be more culturally humble.

    The same is true of the MAT fan who says, “12-steppers are deluded by a faith-healing 80-year-old modality; only five-percent of people get helped from the 12 steps.” These types of arguments are not other-oriented. This is tribalism. 

    A simplistic solution to avoiding lane-drift is to listen more and share in first person. Prescriptive communicating—as opposed to a descriptive narrative—will, inadvertently, engage us in microaggression.

    Just when “Why can’t we all just get along” seemed hard enough, there’s more than one subconscious microaggression we need to be aware of. Derald W. Sue, Ph.D., a psychology professor at Columbia University, describes three microaggressions: micro–assaults, micro–insults and micro–invalidations.

    Micro–assaults are most akin to conventional discrimination. They are explicit derogatory actions, intended to hurt. Here’s an AA example: disparaging a humanist AA in a meeting by quoting Dr. Bob’s 1930s view, “If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you.” No one feels “sorry for” their equal. Inferiority is implied.

    “A micro–insult is an unconscious communication that demeans a person from a minority group,” Dr. Sue reports. Using another 12-step creed-based example, “CA includes everyone; it’s ‘God as you understand Him.” Who is likely to feel demeaned by Judeo/Christian-normative language?

    We could rightfully credit 1930s middle-America Alcoholics Anonymous founders for their progressive—always inclusive, never exclusive—posture; “everybody” in 1939 America meant Protestants, Catholics and Jews. The AA of the 1930s was culturally humble. Today, inadvertently, this same language is less effective at gateway-widening. Today, just 33% of earthlings embrace this interventionist higher power of the early 12-step narrative. According to the Washington Times, globally, 16% of people have no religion and 51% have a non-theistic, polytheistic faith. Sikhs or Muslims may share monotheism, but they worship a genderless deity; no room for “Him” of any understanding. Cultural humility accommodates all worldviews, without asking others to speak in the language of the majority.

    “Minimizing or disregarding the thoughts, feelings or experiences of a person of color is referred to as micro–invalidation.” This is how the American Psychiatric Association rounds out Dr. Sue’s three types of microaggression. “A white person asserting to minorities that ‘They don’t see color’ or that ‘We are all human beings’ are examples.”

    Disregarding or minimizing in our community might be telling someone: “You can participate in your online groups if you like but don’t treat InTheRooms.com like real meetings. Face-to-face is the only way to connect with real people.” If expressed in first person, instead of disregarding the other, the message could relate a personal experience and an informed belief. Have we learned everything about the person we’re talking to? Social anxiety disorder or a dependent partner, parent or child at home could be reasons why the online meeting is the superior option for them.

    To William White’s point, what do I really know about the comparative benefits of online community vs. traditional meetings? Maybe I could consider his informed advice of “holding all of our opinions on probation pending new discoveries in the field and new learning experiences.”

    Mita Johnson identifies a challenge with microaggression—it’s subconscious. How do we correct subconscious behaviors? Dr. Sue authored a couple of books to help combat microaggression at an individual, institutional and societal level: Microaggressions in Everyday Life: Race, Gender and Sexual Orientation and Microaggressions and Marginality. Sue offers five steps to help connect us with more varieties of addicts/alcoholics. “Microaggressions are unconscious manifestations of a worldview of inclusion, exclusion, superiority, inferiority; thus, our main task is to make the invisible, visible.” Here are Dr. Sue’s five practices:

    1. Learn from constant vigilance of your own biases and fears.
    2. Experiential reality is important in interacting with people who differ from you in terms of race, culture, ethnicity.
    3. Don’t be defensive.
    4. Be open to discussing your own attitudes and biases and how they might have hurt others or revealed bias on your part.
    5. Be an ally. Stand personally against all forms of bias and discrimination.

    I gave it a try. Taking inventory—in these five ways—of my prejudices and preconceived ideas helps identify my insensitivities. It helps thinking/acting more other-oriented. Secondly, more than ever, it’s a good time for more active listening and less instruction. Getting defensive, even to microaggression coming my way, escalates the divides. Admitting my assumptions and the faulty conclusions is a version of “promptly admit it” that is so familiar. Finally, how can I “Be an ally?” It’s not hard, today, to stand up for myself when I’m being disrespected. Now will I say something when someone else is being invalidated, insulted or dismissed? Yes, there’s a time to mind my own business but if I’m committed to “be an ally,” can I stay silent when another is being ganged up on by the tyranny of the majority?

    When I’m tempted to be tribal when confronted with other individuals or recovery groups, I try to remember that all people who suffer from process or substance use disorder have been subjected to microaggressions. William White identifies a few of the more cliché slights we all face:

    • “Portrayals of the cause of substance use disorders as personal culpability (bad character) rather than biological, psychological, or environmental vulnerability.
    • Imposed shame, e.g., being explicitly prohibited by one’s supervisor from disclosing one’s recovery status out of the fear it would harm the reputation of the company.
    • Misinterpretation of normal stress responses as signs of impending relapse.”

    In this regard there is no us vs. them. Just “us.”

    Not everyone believes that shining a light on microaggression will solve hostilities towards each other. “There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory,” Althea Nagai argues in “The Pseudo-Science of Microaggressions.” Nagai identifies confirmation bias found in almost all focus groups and the problem of unintended consequences when institutionalizing anti-microaggression policy.

    Nagai’s National Association of Scholars article continues, “There is nothing in the current research to show that such programs work. I suspect most fail to create greater feelings of inclusion. Research suggests they create more alienation and sense of apartness. The recent large-scale quantitative studies suggest that increased focus on ethnic/racial identity exacerbates the problems they are supposed to address. In other words, ‘social justice’ and diversity programs may actually backfire, creating less inclusion, more polarization.”

    Dr. Sue cautions us about weaponizing microaggression; other-oriented cultural humility is to take inventory of my microaggressions—not to fault-find other’s behaviors. Social psychologist Lee Jussim in Psychology Today says keep it personal—not global: “To understand how we can all unintentionally give offense through our own ignorance or insensitivity—thereby increasing our ability to make the same points without being hurtful.”

    “I’d rather step on your toes than walk on your grave,” is a rationalization we hear in the rooms. How do I neither pussy-foot around and avoid being a dick? Beyond intellectualizing, cultural humility is introspective. In “Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes,” cues from professionals show me how to re-frame how I interact with others: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique to redressing the power imbalance in the patient-physician dynamic and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and the defined population.”

    For me, this nails how to stay other-focused: Professionals (or anyone who wants to relate to others better) should “relinquish the role of expert and become the student of the patient with a conviction and explicit expression of the patient’s potential to be a capable and full partner in the therapeutic alliance.”

    I don’t need a course or a degree to “become the student” of others. Instead of acting like I know what’s best for others, I can be a fellow traveler; think about other-focused approaches globally; but act locally.

    View the original article at thefix.com

  • SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    Many people on MAT feel unwelcome at meetings, and this sense of alienation and rejection often leads to relapse. That’s where MARS™ comes in. We want people on MAT to be embraced and accepted in recovery.

    Held at Royce Hall on the UCLA campus in Westwood, the 13th annual SAMHSA (Substance Abuse and Mental Health Administration) Voice Awards recognized an essential figure in the national battle against the opioid epidemic. As the founder of the Medicated Assisted Recovery Support (MARS™) Project, Walter Ginter was honored with a Special Recognition Award for his efforts in combating the opioid epidemic and helping people who use Medicated-Assisted Treatment (MAT) stick to the path of recovery. In the greater recovery community– ranging from treatment centers across the country to 12-step groups—many people have a negative view of MAT which has led to a lack of support for people trying to overcome opioid addiction. 

    SAMHSA has been at the helm of national efforts to destigmatize the medications typically used in MAT such as buprenorphine, methadone, and naltrexone. Beyond supporting physicians and researchers, SAMHSA has tried to reduce the negativity associated with traditional perspectives on opioid recovery. According to many loud voices in Narcotics Anonymous (NA), if a person is on medication that has been prescribed to help them overcome opioid withdrawal symptoms or to refrain from using heroin or other illicit opioids, then they are not really clean. In contrast to this judgmental perspective, the SAMHSA website states: “Medicated-Assisted Treatment (MAT) is the use of FDA- approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

    Indeed, a “whole-patient” approach is what is needed to stem the tide of what has become the greatest drug epidemic in U.S. history. With the introduction of fentanyl and other powerful prescription narcotics to the illegal drug trade, the stakes are higher than ever before. According to the National Institute on Drug Abuse, “Every day, more than 115 people in the United States die after overdosing on opioids.”

    Given such a devastating statistic, Arne W. Owens hopes the SAMHSA Voice Awards can raise awareness by bringing the recovery community together with the entertainment industry. As the Principal Deputy Assistant Secretary, Owens was the highest-ranking member of SAMHSA at the Voice Awards Show on August 8, 2018. Asked by The Fix how the Voice Awards can make an impact on the opioid epidemic, Owens said, “We hope to incentivize more positive portrayals in film and television of treatment and recovery for substance use disorders. We believe hearing positive stories about treatment and recovery helps to inspire others, shifting negative attitudes. For example, it would be good to see writers and directors positively represent MAT in film and television. Beyond raising awareness, such representation would help to reduce stigma.”

    Walter Ginter is an ideal example of someone who has dedicated his life to reducing stigma and raising positive awareness about MAT. Dedicated to improving the recovery community, Ginter has been a board member of both the National Alliance for Medication Assisted Treatment and Faces & Voices of Recovery. In collaboration with the New York Division of Substance Abuse, Yeshiva University and the National Alliance for Medication Assisted (NAMA) Recovery, Walter Ginter became the founding Project Director of the Medication Assisted Recovery Support (MARS™) Project.

    MARS™ is designed to provide peer recovery support to persons whose recovery from opioid addiction is assisted by medication. To be in a MARS™ group through the Peer Recovery Network PORTAL™, a person has to be in a MAT program. As Ginter writes on the MARS™ website, “The Peer Recovery Network was created as a way for peers in recovery to more effectively organize their community, to communicate with each other, and to have a stronger voice for advocacy efforts.”

    In 2012, Ginter helped create the Beyond MARS Training Institute at the Albert Einstein College of Medicine. With a variety of models and options, Ginter created a curriculum where opioid treatment programs and recovery professionals can be trained to implement MARS™. The original MARS™ project has expanded from its beginnings to include 17 programs across the United States and two in Haiphong, Vietnam. Ginter believes this is just the beginning of the expansion, both nationally and internationally.

    On the red carpet before the Voice Awards ceremony, Walter Ginter spoke with us about the struggles he has faced as an early advocate of MAT, revealing both an innate decency and a keen sense of humor. With a smile, he mentioned how people always ask him why MARS™ uses the trademark symbol. Some of them even think that he’s trying to corner the name of the planet for profit.

    But MARS™ has a trademark for a particular reason, Ginter explains. In the vast majority of cases, the organization does not mind when people use the name. They do enforce the trademark, however, when people who are not certified as trainers try to set-up MARS™ groups and conduct MARS™ trainings. In most cases, rather than follow the protocols, they are hijacking the name to do what they want and make a profit. As an organization with a mission that envisions “the transformation of medication-assisted treatment (MAT) to medication-assisted recovery (MAR),” Ginter believes that protecting the integrity of the organization must remain a priority.

    Sitting inside, away from the hot Los Angeles sun and the red carpet, Walter Ginter went into more detail about the early struggles that MARS™ faced. “Very few people come to MAT as their first course of treatment. In the vast majority of cases, they’ve already been to 12-step meetings, particularly Narcotics Anonymous. Although they initially felt welcomed at those meetings, those feelings shift after they start to work a program that includes medication-assisted treatment. Suddenly, you no longer feel welcome at the meetings, and this sense of alienation and rejection often leads to relapse. To fill in the resulting hole, we want MARS™ to give the same type of mutual support that 12-step provides. We want people on MAT to be embraced and accepted in recovery.“

    We asked Walter Ginter to detail this rejection in context. Scratching his chin, he said, “Look, telling people that they are not in recovery is evil. People on MAT were told that they couldn’t share in NA meetings since they weren’t really clean. By not allowing people to talk in meetings, they become alienated. However, it’s worse than alienation because it undermines what they’re doing to get well. The thought process goes something like this: If taking the medication that I need means I’m not in recovery, then why should I act like I’m in recovery? What does it matter if I do a line of coke on the side or have a drink?”

    Walter Ginter saw too many people on the verge of getting well through medication-assisted treatment subvert their recovery with this line of thinking and some other thought processes as well. Not wanting to take any chances, he set up MARS™ as a viable alternative both to treatment centers hostile to MAT and non-supportive recovery support groups like many NA meetings. In the past several years, MARS™ has had remarkable success with people on MAT. It has helped them find true recovery, a fact that has left initial opponents quite frustrated.

    In fact, Ginter ended our talk with a description of one of these encounters. As he told the following story, Ginter’s smile appeared again. “One day an opioid treatment counselor from a local New York rehab burst into my office and banged her fist on my desk. She said ‘What kind of voodoo are you doing here?’ Surprised by such an accusation, I replied “Excuse me?” She went on to explain: “Well. I have a client that wouldn’t stop doing coke. She would get off the heroin, but she always tested positive for cocaine. Since she’s joined your program, now she’s not only off the heroin, she’s no longer testing positive for coke or any other drug. How did you make that happen?’”

    Ginter shook his head as if he’d gone through the same rigmarole many times before. He describes how he sat the recovery counselor down and explained to her quietly: “There’s no magic or voodoo or anything else. We simply gave her medication that worked while telling her that she was now in true recovery. We gave her a vision of medication-assisted recovery, then let her make her own choice. She realized on her own, ‘Well, now I really can be on medication and in recovery. However, I can’t be in recovery if I’m still doing other drugs on the side. Today, I like being in recovery and the future it promises, so I’m going to stop doing the coke. Indeed, I will embrace this path that is set before me.’” 

    Given the promising picture that he painted, it makes perfect sense that Walter Ginter was honored with the Special Recognition Award at the 2018 SAMHSA Voice Awards. After all, how many people are dedicating themselves in such a precise fashion to saving lives by shifting perspectives and offering a viable alternative like Medication Assisted Recovery Support (MARS™)?

    View the original article at thefix.com

  • Is There Life After AA?

    Is There Life After AA?

    I was fed up with the fear-based conditioning of being told that if I left, I wouldn’t stay sober, and I was tired of the constant message that my future was up to some mystic higher power.

    When I walked into my first AA meeting, I felt like I was broken into a million pieces. My bloated body housed a mosaic of a woman whose sense of self was shattered. I had zero self-confidence, and my self-esteem was so fragile that if you poked me, I’d erupt into a blubbering mess. My life seemed like a blur. I had no comprehension of where most of my twenties had gone—they seemed to have been washed away by a tsunami of wine and drugs. I’m not sure what I expected when I stepped foot through that door, but I distinctly remember feeling utterly defeated, completely lost, with no idea what to do next. I knew I had to stop and this is where I was told to go.

    I quickly adjusted to life in AA; they welcomed me, guided me through building social supports, and gave me a framework to live by. Initially, it stuck, and I stayed sober. The 12 steps seemed to be a very simple way to live my life as a sober person. At that time my life was simple: it consisted of endless meetings and a shitty job. But I couldn’t shake the feeling that something wasn’t right. It was like I was wearing someone else’s hand-me-downs: every time I looked down I was acutely aware of my long limbs being two or three inches too long—they were functional, but they weren’t the right fit and I felt constricted.

    Those feelings would resurface every time someone in the rooms gave me a suggestion, or made a remark, that seemed overly-controlling or dogmatic. Some of the highlights include one sponsor screaming down the phone at me for 30 minutes until I was in tears because I wasn’t doing what she wanted me to do. Another memory is of her sponsor insisting I call on a daily basis to “check out my thinking” and report my plan for the day. Then there were the messages that those who leave the program were destined for one of two fates: returning to alcohol/drug use, or death. Certified Recovery Specialist and MSW Adam Sledd, recounts: “The biggest lie of all was the one that said I couldn’t manage my own recovery. This myth singlehandedly disenfranchises millions of people.” Another damaging myth that keeps people from exploring other potential methods of recovery is that if you are able to get sober somehow without 12-step programs, you must not have been a “real” alcoholic to begin with.

    While I do not discount that AA contributed to my development as a woman in recovery—I stayed sober and I built social supports—I reached a point that it hindered the development of my sense of self. I had no life outside of AA and I felt like my core values of integrity, justice, and equality were reframed as character defects.

    In retrospect, I can see that having other people in recovery guiding you through the twelve steps leaves a wide margin of error. They are not trained therapists and they are not trauma-informed, leaving the risk of misinterpretation and potential harm. Through intensive therapy, I now see that my core values weren’t character flaws—they are a fundamental aspect of who I am. I also discovered that I suffer with complex PTSD, so being conditioned to believe I was powerless and had these presumably fatal character flaws wasn’t helpful—it was harmful. I needed to empower myself, not diminish vital parts of my identity. 

    Even though I rigorously applied the steps, I found myself increasingly numbing out feelings of doubt with food and cigarettes. It became clear that even though I wanted to stay sober, my life in 12-step fellowships wasn’t a life I wanted. I was depressed and didn’t want my life to revolve around sitting in church basements telling sad stories and disempowering myself by identifying as the same broken woman who walked through that door two years earlier. I was no longer that woman, and I was sick of suppressing the new person I had become. I was fed up with the fear-based conditioning of being told that if I left, I wouldn’t stay sober, and I was tired of the constant message that my future would be determined by some mystic higher power.

    In writing my blog and interviewing people around the world about what recovery looked like for them, it became startlingly clear that there were endless ways to recover—dispelling all of the myths and dogmatic conditioning we hear in the rooms. I began to see through the lived experience of others that the parts of me that I’d considered to be broken were actually the making of me. No longer was I defined by my past and instead I could embrace my core values and personality traits. That experience led to the realization that I had not been thinking big enough. I was shrinking myself to fit into a program that didn’t work for me, and I was too frightened to leave.

    Moving to America gave me the impetus to cut ties to 12-step fellowships in favor of trying something new and expanding my life. It was difficult at first. When you build a recovery founded upon the belief that you have to rely upon others to survive, it is inevitable that you will wobble once you remove those supports. But once you realize that you are in charge of your recovery, everything changes.

    I started to break free of those dogmatic beliefs that were simply untrue for me. I saw the evidence that many people just like me were thriving without a 12-step recovery. Gone was the conditioning of looking at myself as broken. Instead, I realized that I am no longer that woman who walked through the doors of AA six years ago. I no longer have to shrink myself or berate my character for being out of line with the core beliefs of a program that doesn’t work for me. I see much more value in looking at what is right about me, what I have endured and overcome, and rising to the challenge of helping others to see their strengths and striving to have a fulfilling, self-directed life.

    That experience stills saddens me today. The fear-based conditioning is still occurring in 12-step fellowships and in online forums in spite of a body of evidence demonstrating that there is more than one way to recover. In my work as a writer, I challenge perspectives on recovery by pointing out this evidence on a near daily basis. I passionately believe in showing others that they can find and succeed in recovery another way if the 12 steps do not work for them.

    To that end, I set up a Facebook Group, Life After 12-Step Recovery. The purpose of the group is to provide hope, tools, and resources for people who leave AA, NA—or any other A—because it wasn’t the right fit for them. I wanted to provide the real-life experiences of people thriving once they have left these fellowships and taken control of managing their own recovery.

    In setting up the group, I asked people on Facebook who had left 12-step groups about their experiences. I was inundated with examples of people leading fulfilling, empowered, and self-directed lives. And there was one person who said: “I know lots of people who have left 12-step recovery. They are all drunk or dead.” I think this illustrates not only the need for this group, but the need for articles like these to dispel such untruths.

    While I equally respect and consider the views of people who find the 12 steps do work for them, the reality is that we all have choices in our recovery, and we have the power to decide what works for us.

    View the original article at thefix.com

  • 5 Tips For Staying Sober In College

    5 Tips For Staying Sober In College

    At the end of the day, the college experience is about so much more than just alcohol.

    For most people, college is not associated with sobriety.

    Such was the case for me during the first two years I spent away from home. I drank often and partied hard, convincing myself that it was normal. I liked to be the one outdoing everyone else, thought there was some badge of honor I could earn by doing so. And honestly, I had a blast—until I didn’t. I didn’t realize this right away, but I drank differently than my peers. While they knew how and when to stop, I didn’t. I all too often crossed from having fun to being a sloppy, drunk mess, saying and doing things I regretted come morning light.

    It all came to a head at the end of my sophomore year, when I ended up hospitalized with a .34 blood alcohol content. My parents gave me an ultimatum: get sober, or I wasn’t allowed back home for the summer. I went along with getting sober, never planning for it to actually be something I stuck with. I wasn’t even 21 and was still in college. Who got sober in college? I didn’t know of anyone, and I didn’t intend to be that person.

    But as time passed and I refrained from drinking, I realized that I felt good, both physically and emotionally. I liked being in control of my actions, knowing what happened the night before. It felt freeing. So, I ran with the whole sobriety thing, staying sober my junior and senior year of college, and now, for the three years following college.

    I won’t lie, maintaining a social life while being sober in college wasn’t easy. In fact, at times it was one of the hardest things I’ve done. But it is possible. Along the way I discovered a number of tricks that helped remind me why I was sober and made it easier to stay that way. Here are a few:

    1. Be honest with the people close to you. Sobriety isn’t easy. But it’s even harder when you try to do it alone. It’s understandable that telling people about your decision to stop drinking is scary. It’s not something very many people choose to be open about, especially in college. But if you can, pick two or three people you are close to and tell them the truth. Tell them why you decided to get sober and why it’s important to you to maintain that sobriety. If they ask how they can help, tell them. Express what you need, what makes you feel supported. They wouldn’t ask if they didn’t genuinely care and want to do what is best for you. Give people the chance to surprise you with their support, because they often will.
    1. Make self-care a priority. It’s easy to let self-care fall to the side in college. You get so busy with classes, with friends, with study groups, with sports, that you forget to take time for yourself. This is always important, but even more so when you are sober. In sobriety, you need to know when and how to take time for yourself. This means different things for different people. For one person, it may be a bubble bath and reading a book for fun. For another, it could be working out, or journaling, or attending 12-step meetings. Whatever the case, make sure you identify what it is you need and make it a priority in your schedule.
    1. Remind yourself you won’t be hungover come morning. For some reason, this was always a powerful tool for me. Just knowing how physically awful hangovers felt and how unproductive they made me for the entire next day was usually enough to quell any desire for a drink. When I first got sober, someone told me hangovers are actually a form of withdrawals from alcohol, which is why mine had been getting progressively worse. Reminding myself that the morning would be clear and I would be able to be productive and reach my full potential always brought me back to reality when I found myself wishing I could drink with my college friends.
    1. Connect with sober peers. Though it’s somewhat unlikely you will find these people in college, it’s not impossible. But if you don’t, there are other options. Because I went to a semi-small college, there were no other people my age who had gotten sober. But by going to some 12-step meetings and joining online communities, I was able to connect with people who shared my experiences and who were in situations similar to mine. Having that connection with others in recovery is vital in moments when you need support and understanding, or even need someone to tell you it just isn’t worth it to pick up a drink.
    1. Remember that the main reason for college is to receive an education—an expensive one, at that. This may sound odd, but for some reason it really helped me when I was wishing I could have a “normal” college experience and drink with my friends. I found it helpful to remind myself that first and foremost I was at college to get an education so I could pursue the career I wanted to pursue. College is not a cheap investment by any means. If I had continued to drink at the rate I had been, I likely would have wasted a good amount of money and not received the quality education I had hoped to attain at the college I chose. But today, I can say I got the most out of my education (the last two years of it at least) because I was fully present and invested.

    At the end of the day, the college experience is about so much more than just alcohol. Sure, at times this may be hard to remember. There will be days when it may seem like everyone around you is drinking or talking about drinking. It’s easy to feel left out, like you’re missing out on a college rite of passage. But that’s not true. These are the days it’s important to remind yourself why you set out to live a sober life and why it’s important for you to continue to do so.

    View the original article at thefix.com

  • Using Marijuana to Treat Opioid Addiction

    Using Marijuana to Treat Opioid Addiction

    When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing.

    If you believe that medication-assisted treatment (MAT) for opioid use disorder (OUD) is wrong because it’s “just substituting one drug for another,” then you’re really not going to like this article. It’s not about one of the three major forms of MAT approved for opioid addiction: buprenorphine, methadone, or naltrexone. It’s about another medication, which does not cause a physical dependency, nor does it contribute to the 175 drug overdose deaths that take place each day in the United States. It has fewer harmful side effects than most other medications, and has even been correlated with a reduction in opioid overdose rates. Nonetheless, it is more controversial than MAT and, in most states, less accessible. In fact, Pennsylvania is the only state that has approved its use for OUD—and only as of May 17, 2018. In New Jersey, it was recently approved to treat chronic pain due to opioid use disorder.

    The medication I’m describing is, of course, marijuana.

    Abstinence-based thinking has dominated the recovery discussion for quite some time. Since Alcoholics Anonymous began in the 1930s, the general public has associated addiction recovery with a discontinuation of all euphoric substances. Historically, that thinking has also extended to medication-assisted treatment, even though MAT is specifically designed not to produce a euphoric high when used as prescribed by people with an already existing opioid tolerance. The bias against MAT is finally beginning to lift; there is now even a 12-step fellowship for people using medications like methadone or buprenorphine. But marijuana, which is definitely capable of producing euphoria, is still under fire as an addiction treatment.

    In addition to the ingrained abstinence-only rule, another reason that most states don’t approve the use of marijuana for OUD is that there is little to no research backing its efficacy. Even in Pennsylvania, the recent addition of OUD to the list of conditions treatable by marijuana is temporary. Depending in part on the results of research performed by several universities throughout the state, OUD could lose its medical marijuana status in the future. And other states that have tried to add it have failed, including Maine, Vermont, New Hampshire, and New Mexico. It’s not that any research has shown marijuana doesn’t work for OUD. There simply has not been much—if any—full-scale research completed that says it does.

    But street wisdom tells a different story. Jessica Gelay, the policy manager for the Drug Policy Alliance’s New Mexico office, has been fighting to get OUD added as a medical marijuana qualifying condition in New Mexico since 2016. Although she recognizes that research on the topic is far from robust, she believes cannabis has a real potential to help minimize opioid use and the dangers associated with it.

    “Medical cannabis can not only help people get rest [when they’re in withdrawal],” says Gelay, “it can also help reduce nausea, get an appetite, reduce anxiety and cravings…it helps people reduce the craving voice. It helps people gain perspective.” I can relate to Gelay’s sentiment, because that’s exactly what marijuana does for me.

    I am five years into recovery from heroin addiction. I don’t claim the past five years have been completely opioid free, but I no longer meet the criteria for an active opioid use disorder. Total abstinence does not define my recovery. I take one of the approved drugs for OUD, buprenorphine, but as someone who also struggles with post-traumatic stress disorder (PTSD) as the result of physical and sexual assault, I experience emotional triggers that buprenorphine doesn’t address, leaving me vulnerable to my old way of self-medicating: heroin. But what does help me through these potentially risky episodes? Marijuana. For me, ingesting marijuana (which I buy legally from my local pot shop in Seattle, Washington) erases my cravings for heroin. It puts me in touch with a part of my emotional core that gets shut down when I am triggered. When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing—probably the way it seems to someone who doesn’t have an opioid use disorder. It’s not a cure-all, but it stops me from relapsing.

    High Sobriety is a rehabilitation program based out of Philadelphia that provides cannabis-based recovery for addiction, with a focus on addiction to opiates. Founder Joe Schrank, who is also a clinical social worker, says that treatment should be about treating people where they are, and for people with chronic pain or a history of serious drug use, that can often mean providing them a safer alternative—one that Shrank, who does not personally use marijuana, says is not only effective, but even somewhat enjoyable.

    “[Cannabis forms] a great therapeutic alliance from the get-go. Like, we’re here with compassion, we’re not here to punish you, we want to make this as comfortable as we possibly can, and the doctor says you can have this [marijuana]. I think it’s better than the message of ‘you’re a drug addict and you’re a piece of shit and you’re going to puke,’” says Schrank.

    People have been using this method on the streets for years, something I observed during my time in both active addiction and recovery. Anecdotally, marijuana’s efficacy as a withdrawal and recovery aid is said to be attributed to its pain-relieving properties, which help with the aches and pains of coming off an opioid, as well as adding the psychological balm of the high. The difference between opiated versus non-opiated perception is stark, to say the least. The ability to soften the blow of that transition helps some users acclimate to life without opioids. Even if the marijuana use doesn’t remain transitional—if someone who was formerly addicted to heroin continues to use marijuana for the rest of his or her life instead—the risk of fatal overdose, hepatitis C or HIV transmission through drug use, and a host of other complications still go down to zero. Take it from someone who has walked the tenuous line of addiction: that’s a big win.

    Marijuana may also be able to help people get off of opioid-based maintenance medications. Although there is no generalized medical reason why a person should discontinue methadone or buprenorphine, many people decide that they wish to taper off. Sometimes this is due to stigma; friends or family members who insist, wrongly, that people on MAT are not truly sober. Too often, it’s a decision necessitated by finances.

    For Stephanie Bertrand, detoxing from buprenorphine is a way for her to fully end the chapter of her life that included opioid addiction and dependency. Bertrand is a buprenorphine and medical marijuana patient living in Ontario, Canada. She is prescribed buprenorphine/naloxone, which she is currently tapering from, and 60mg monthly of marijuana by the same doctor. She says that marijuana serves a dual purpose in her recovery. It was initially prescribed as an alternative to benzodiazepines, a type of anxiety medicine that can be dangerous, even fatal, when combined with opioids like buprenorphine. The anxiety relief helps her stay sober, she says, because she’d been self-medicating the anxiety during her active addiction. She now also uses a strain that is high in cannabidiol (CBD), the chemical responsible for many of cannabis’ pain relieving properties, to help with the aches and discomfort that come along with her buprenorphine taper. She says the marijuana has gotten her through four 2mg dose drops, and she has four more to go.

    Bertrand would not have the same experience if she were living in the United States. MAT programs in the States tend to disallow marijuana use, even in states where it has been legalized. But studies tell us this shouldn’t really be a concern. Two separate studies, one published in 2002 and the other in 2003, found that MAT patients who used cannabis did not show poorer outcomes than patients who abstained. Although this reasoning alone doesn’t mean marijuana helps with recovery, these findings set the groundwork for future research.

    Do the experiences of people like me and Bertrand represent a viable treatment plan for opioid use disorder? It will likely be a few years before we have the official data. Until then, it’s high time we stop demonizing people in opioid recovery who choose to live a meaningful life that includes marijuana.

    View the original article at thefix.com

  • More Than One Way to Recover: A Guide of Pathways

    More Than One Way to Recover: A Guide of Pathways

    Regardless of how we achieved recovery, it is our responsibility as members of the recovery community to better inform ourselves (and others) of the other options out there rather than suggesting that our way is the only way.

    We live in a country where 45 million American families are affected by addiction. The statistics are frightening: over 20 million adults have substance use disorder and 17 million people have alcohol use disorder. 64,000 Americans die from drug overdoses each year and over 88,000 die from alcohol related causes. Sadly, less than 10 percent of people suffering with substance use disorder, and less than 7 percent of those with alcohol use disorder, get the help that they need.

    In spite of this public health crisis and the tragic and very preventable deaths, the recovery community is divided in its efforts. While on the one hand we are making great strides by publicly speaking up to put a face and a voice to recovery in order to fight stigma and boost efforts to gain greater resources and access to treatment, there is still some infighting within the community about the best way to recover. If we’re fighting to eliminate the stigma that marks us as “less than” to the general public, we should also be fighting the stigma within our more insular community. How can we effectively tackle this crisis if we’re not helping each other?

    There are many people in 12-step recovery who bicker in online forums and sit in church basements purporting to know the only way to recover and anyone who disagrees must be wrong. I have lost count of the times I’ve heard of someone relapsing or expressing their discomfort with the 12-step program, only to be told that the problem is actually them and their lack of willingness. As evidenced in the Big Book:

    “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.”

    This passage simply isn’t true. According to Zachary Dodes, who co-wrote The Sober Truth: Debunking the Bad Science Behind 12 Step Programs and the Rehab Industry, the success rate of AA is actually somewhere between five and 10 percent, with only one in every 15 people entering the rooms achieving and maintaining sobriety. This is in stark contrast to AA’s self-reported figures in 2007 of 33 percent of members having 10 or more years of sobriety. A 2012 survey revealed 24 percent of members were between one and five years sober, 13 percent of members were sober between five and ten years, 14 percent between 10 and 20 years, and 22 percent beyond 20 years sober. 

    In fact, of the people who are fortunate to recover—22.35 million—half of those do so in various mutual aid groups. A recent study was conducted to determine the difference in attendance, participation, and recovery outcomes of 12-step groups versus alternatives of SMART, Women for Sobriety, and LifeRing. The study concluded that the alternatives were just as effective, if not more so, than 12-step programs. Study author Dr Sara Zemore recommended that professionals refer patients to these 12-step alternatives—especially when patients are atheist, or when they are unsure of whether they wish to pursue complete abstinence or a method of harm reduction.

    I’m not the first person to say that 12-step groups didn’t work for me. And I did throw myself into the program for four years, completing the steps in both AA and NA. I reached a point where I could no longer ignore my feelings: I did not believe in the program—I found it positively disempowering and I found it self-limiting to refer to myself as something I used to be, a person with alcohol use disorder. And I’m not alone, there are articles published every day that echo my point of view, offering experiences of people who have successfully found recovery through alternative pathways.

    As the recovery community expands and gains traction in fighting stigma and making resources more accessible—although we still need significantly more if we’re to end the crisis—we are starting to see greater emphasis on alternative pathways. What’s more, we are seeing that these pathways are presented on an equal footing as more and more research becomes available to support their efficacy. Just this week, Facing Addiction brought out a comprehensive guide, Multiple Pathways of Recovery: A Guide for Individuals and Families. Facing Addiction’s view is that just as substance use disorders are unique, so too is recovery—it’s dynamic and evolving, utilizing a collection of resources, or recovery capital.

    The different pathways of recovery are:

    1. Inpatient or outpatient treatment
    2. Therapy
    3. Holistic therapies
    4. Natural recovery
    5. Recovery housing
    6. Recovery mutual aid groups. These include:
      1. Refuge Recovery,
      2. Celebrate Recovery,
      3. Women for Sobriety,
      4. LifeRing,
      5. Phoenix Multisport,
      6. Moderation Management,
      7. SMART Recovery,
      8. 12 Step groups.
    7. Faith-based recovery services
    8. Medication-assisted recovery, including MAT groups
    9. Peer-based recovery supports
    10. Family recovery
    11. Technology based recovery
    12. Alternative recovery supports
    13. Harm reduction.

    There are a wide variety of pathways and resources that can be used to recover in a way that suits the unique needs of the person recovering. Whether we subscribe to one or more of these methods or pathways, it is our responsibility as members of the recovery community to better inform ourselves (and others) of the other options out there rather than suggesting that our way is the only way. Just because something worked for us does not mean that it must work for everyone. If a person doesn’t find success with the 12-steps, it doesn’t mean that they are just not willing enough or “constitutionally incapable” of being honest with themselves. Perhaps if we stopped judging, became more informed, and met people where they are in their individual recovery journey, we might have a fighting chance at ending this epidemic.

    For more information on all of these pathways, click here.

    View the original article at thefix.com