Tag: recovery pathway

12-Step vs SMART Recovery: Are You Powerless or Making a Choice?

The problem with powerlessness is that it becomes all-encompassing and paralyzing. But the idea that addiction is a choice fails to consider many people’s experiences. Maybe there’s a middle ground.

As someone who attends (and serves/facilitates) both 12-step and SMART meetings, I am struck by how often they are seen as presenting two very different belief systems about addiction. Although I know many recovering people who attend both, or have swapped one for the other, it is generally decreed that they hold completely opposing views. Though both are mutual aid groups based on the premise that connection with others in recovery can strengthen one’s own recovery, 12-step fellowships are based on a program of spiritual principles, while SMART recovery uses an evidence-based, cognitive-behavioral approach.

Similarities and Differences

While there is some overlap in the programs themselves — mindfulness in SMART correlates with the 11^th step, and SMART’s thought-challenging worksheets are like 10^th step inventories — their starting points could not be more different. Step One states that we are “powerless” over our addiction which is often explained by the disease model, even though this was never the original intention of the founders of AA, the pioneering 12-step fellowship. When we are in active addiction, we have lost the power of choice and cannot overcome our addiction alone. SMART takes a different view. Focusing on empowerment rather than powerlessness, we are encouraged to take ownership of our choices and behaviors. Without shaming anyone for their irrational choices, addiction is still ultimately a choice, not a disease.

The debate between these two approaches has raged for decades, with most people coming down on one side or the other. My intention here is not to rehash these arguments but rather propose that instead of an either/or dualism, concepts of powerlessness versus choice are instead opposite ends of the same spectrum. For many, the truth of their lived experience may be somewhere in the middle, and polarizing views can lead to many people — certainly myself included — feeling that neither viewpoint really “fits.” This is important, because this ongoing debate influences how we treat, perceive, and support those recovering from addiction.

The Problem with Powerlessness

The problem with the concept of “powerlessness,” as understood in the context of the 12-step program, is that it becomes all-encompassing. Not only are we said to be in a state of powerlessness when we are in the throes of active addiction and finding it seemingly impossible to stop – an experience many former addicts will recognize all too well — but the dogma that has grown up around the concept over the years tells us this is a permanent state. We will always, even after years of sobriety, be powerless over our addiction, the threat of relapse forever hanging over us and ready to descend the moment we stop attending meetings, working the program, or listening to our sponsor. Neither is our addiction the only thing we are powerless over — we also have no power over “people, places and things.” While this can be a useful maxim in terms of reminding us that we cannot control other people or outcomes, it can also become stultifying, leading to apathy and a sense of complete dependency upon the program. In this view, the second line of the oft-quoted Serenity Prayer — the courage to change the things we can — is all too easily forgotten.

Small wonder then that for many, SMART burst onto the scene like a breath of fresh air, telling us that we do have a choice, that we can take ownership of our actions, and that a rational rather than spiritual (assuming that the two are mutually exclusive, an attitude with which I disagree) approach is the best way to recover. SMART claims to have an evidence base, and indeed it does — yet in recent studies it has not been shown to be significantly more or less effective than the 12-step approach. Nevertheless, SMART offers an alternative for those who take issue with being told they will always be powerless. Social justice researchers have pointed out that telling people in minority communities in particular that they have no power and must be dependent on a program forever only increases their sense and experience of oppression.

Addiction as a Choice Is Equally Problematic

Yet the idea of addiction as a choice is, I believe, equally problematic. Firstly, no matter how much researchers and SMART advocates stress that a choice model is empowering and should not contribute to stigma, there is no doubt that in terms of the wider society, labeling addiction a choice can all too easily contribute to the criminalizing of those suffering with addiction and substance misuse, not to mention making it easier for insurance or health care providers to refuse to cover the cost of addiction treatment. Also, and this seems to have been somewhat overlooked, blanket statements that addiction is a choice fail to consider the experiences of some significant populations, such as people who are using drugs to self-medicate undiagnosed mental health conditions or to deal with debilitating after-effects of trauma. Simply stating addiction is a choice which they can rationally think their way out of is of little use in such situations and may have the opposite effect, pushing people further into self-destructive cycles. Of course, the 12-step program may also have little to offer in these scenarios.

If addiction is a choice, it is usually a severely impaired one. Addiction researcher Maia Szalavitz argues in Unbroken Brain that rather than seeing addiction as a chronic disease or a set of bad choices, we recognize the parallels with developmental learning disorders. Like a child with ADHD behaviors, or a teenager caught in a maelstrom of emotional dysregulation, those suffering with addiction (and possibly co-occurring trauma, mental health disorders, or external oppression) find their ability to make rational choices increasingly impaired, until “using” becomes a survival instinct. At this point we may indeed feel utterly powerless. However, we can learn over time to take control back and make better choices.

Both approaches have something to offer people in recovery — but only if we start recognizing the middle ground and gray areas between the two. It’s time to start tailoring addiction treatment to fit the individual, rather than trying to tailor the individual to fit the treatment.

View the original article at thefix.com

12 February 2019
She Recovers Brings High End Feminist Recovery to Los Angeles

I could say a hundred things about every incredible woman I encountered over the weekend and it would not hold a candle to the inspiration I felt. The only catch? The price of admission.

One year ago, Harvey Weinstein and men like him were purged from their high positions in industry jobs due to allegations of sexual assault, misconduct and worse. Across the nation, dominoes fell while survivors locked arms and commiserated. Crooked Rehabs and their rapey cult leaders were dethroned or taken to prison along with Bill Cosby—their paternal halos were tossed back into the stream that raged forward without them. Me Too and Time’s Up have gained momentum as women insist on equity and diversity in every corner of our lives whether it’s work, rehab or the Olympics.

On Friday, September 14^th, hundreds of women redefined recovery for themselves with a fresh, feminist lens at She Recovers, a conference held at The Beverly Hills Hilton. She Recovers was founded in 2011 by Dr. Dawn Nickels, a warm, honey-haired overly credentialed sober badass from Victoria, Canada who has accumulated decades of 12-step recovery and one prescription drug relapse after she lost her mother to Leukemia. With years in AA, Dr. Nickels saw a missing piece of the Big Book that excluded women. She wanted to offer an alternative for women who long for that missing piece.

She Recovers is branded around the idea that we are all struggling to recover from something—not only drugs and alcohol. This expanded view of recovery has the potential to reach women who have survived sexual assault, abuse, cancer, heartache, self-harm, homelessness, eating disorders and all kinds of suffering. The weekend was dedicated to healing. The only catch? The price of admission.

I received a few emails from Dr. Nickels confirming the schedule of events and I was really excited to attend. Not only did the line-up include comedians and authors I’ve long loved like Cheryl Strayed, Janet Mock, Amy Dresner, Sarah Blondin, Tara Mohr, Mackenzie Phillips, Laurie Dhue and others, but there were several workshop panels offered with helpful, vital topics like “Changing our Relationship with Food” (Shelly-Anne McKay), and “Money as Power” (Allison Kylstad), “Standing our Ground” (Darlene Lancer), and even “Finding Forgiveness” (Ester Nicholson). The mind, body, spirit approach to recovery was factored into the weekend to include fitness classes like Yoga by Taryn Strong, Pilates, meditation, and an early morning run.

I drove to the Beverly Hills Hilton and arrived after registration opened at around 3:30 p.m. After getting off the elevator, I stepped into a conference room that was turned into a temporary mini-marketplace. Tables and fashion racks displayed oceans of lotions, soaps and mood lifting supplements, dark chocolate and yoga pants. Postcards and stickers offered the promise of energy shifts and emotional well-being. I figured if I was going to focus on recovery all weekend, I wanted a mental lubricant in the form of a dopamine supplement. I was being marketed to like a mofo and the rhetorical trope was tailored to fit. The buy message on tap was this:

You are perimenopausal and you are raging. Your sleep is shit and your relationships are strained. You are horny. You are prickly. Take the gummies and no one gets hurt.

I snatched the vegan, non-GMO dopamine-enhanced gummy bears and pocketed the chocolate for later.

Around the corner, a half-dozen aggressively kind, smiling women sat behind long plastic registration tables handing out laminated passes. They directed me to where the opening reception was held.

The Beverly Hills Hilton is a fancy place. And She Recovers attracts fancy women.

According to their website and other sources, the bulk of paying attendees are the wealthy, white feminist elite ages 30-69 with a household income of 80K and over. Registration costs $500, not including the rooms or the parking.

I asked Dr. Nickels how she planned to engage younger women, women of color, other-abled and the LGBTQ community. She replied, “The thing that we are most proud of related to LA is that we awarded 40 scholarships. We have been attracting WOC and members of the LGBTQ to our community – especially LGB – but we recognize much more needs to be done. We also need to work harder to include other-abled women to join us. We were very fortunate to have already made close connections with some amazing WOC and thus our program exhibited much more diversity than we had been able to do in NYC. Janet Mock is a powerhouse – and we loved having her – but despite efforts to do so, we didn’t have any success making direct contact with influencers in the trans community in LA to ensure that the trans community knew about our event.”

Given the steep cost of the weekend and the fact that registration for the conference was sold out, I wondered if presenters were paid or not, so I asked around. Those who answered requested anonymity.

Some presenters were not offered payment, but their registration fees were waived. The speakers and presenters who were not paid were happy to be asked but some were disappointed they were not offered the opportunity to have a book signing. Two of the speakers were paid high fees (between 16 and 20K) to speak. Those who were not paid used the weekend to promote their materials and businesses; they also wanted to share their experiences and connect to other women in recovery. So, who gets a seat at the table? Follow the money and you can see that She Recovers prioritizes celebrity.

This is where AA (and other 12-step programs) and She Recovers part company: AA has no red carpet; AA doesn’t cost money to attend and speakers are not paid at meetings. AA is an anonymous program that does not acknowledge celebrity or participate in the cult of personality—at least not as outlined in the traditions. While it has its own shortcomings, AA welcomes everyone.

Outside on the grass, several women stood in small clusters by a table of pastel colored macaroons. One of them was Shelly-Anne McKay, a delightful woman from Sasquatch Canada who led the panel on our relationship with food. Another woman told us she had just arrived from France. Others chimed in from the Bay Area, Washington and Oregon. When I asked the group what they were recovering from, the ones that replied stared up at the cerulean late afternoon sky and said, “Everything.”

I asked Shelly-Anne McKay what brought her here. She replied: “I love the She Recovers philosophy that every woman’s path to recovery may be unique. Not everyone finds solace in AA.”

I should tell you now I’m 23 years sober in AA and have studied the Big Book (the basic text of Alcoholics Anonymous). It was written by and about men. The language is old-timey and urges men to check their overinflated egos, to give up “golf fever” and to dive into service instead. The narrative of the shattered, broken self is a theme that is relieved by the belief in a higher power. The one chapter to women, “To Wives,” is heteronormative and sexist, designed to pacify neglected women and encourage them not to make waves.

She Recovers was designed for wave-makers.

Back in the ballroom, the first keynote speaker was wave-maker Cheryl Strayed. Interestingly, Strayed is not in AA and does not consider herself an addict (to my knowledge). But before she spoke, Paula Williams took the stage.

I was concerned for Williams the same way I am for any person with no public speaking experience who collapses under the pressure of adrenaline and stage fright. She seemed mortified to be center stage and she spoke to that. In that moment of terror, I fell in love with her rawness. Williams constructed an art installation — definitely my favorite thing in the mini-marketplace room — called “Shame Booth” (also the name of her podcast) where a person could sit alone inside a vintage phone booth and confess their secrets into a silent ear piece and then leave. Segments of their voices are recorded here: Shamebooth Audio. The only piece of that secret they took home was a new pair of strangely oversized white briefs with the big red words “No Shame” on the butt. And yes, I got my granny panties.

Cheryl Strayed brought the house down with her seasoned message that illuminated the question: how do we do the thing we cannot do? Her personal stories contained humility, resilience and heart. I’m very familiar with her content because I teach her memoir and essay collection “Dear Sugar” to my nonfiction students at UCLA extension. The crowd was enthralled as Strayed discussed the suffering she endured due to her mother’s illness, the aftermath of her grief, and the hopefulness she offered as a reprieve to that grief. She answered questions that were not really questions for a long time. At some point while listening to her, I realized that — whether we were addicts or not — the room vibrated with undeniable hopefulness and willingness to carry that which we thought we could not carry; but in the end we find that we can, we have — and we will.

I could say a hundred things about every incredible woman I encountered over the weekend from Friday evening until Sunday afternoon and it would not hold a candle to the inspiration I felt. I only wished there had been some scheduled time for us to all connect and mingle in one place away from the speaker/workshop/formal dinner format. The schedule was jam-packed and felt a bit rushed. The highlight for me was Saturday night: The Gala Dinner.

I never know what to wear to formal events, so I brought a couple of options. I decided that nothing says Formal Gala like clear stripper heels with red rhinestone hearts in the middle and shiny black Bad Sandy (from Grease) pants. A petite brunette with tattoos on her arms was looking around. She looked as lost and overwhelmed and alone as I felt so I asked her if she wanted to find a place to sit with me.

The dinner honored celebrated change-makers and wave-makers who dared to break the silence of addiction and alcoholism like Betty Ford and the woman who started a movement to disrupt sexual violence, Me Too activist Tarana Burke, but the speaker who got a standing ovation (which seemed to befuddle her) was My Fair Junkie author and comic Amy Dresner.

The opulent ballroom fell silent as Dresner walked up to the podium wearing a vintage Indian jumpsuit with billowing legs. She did a funny dance and squatted.

“I was attempting 70’s super model but I’m way more Genie, don’t you think?”

After explaining how neuroscience proves we can burn new pathways of stability in our minds by taking consistent, disciplined action, she said, “If you’re waiting to take the action, you’ll be waiting forever.”

Dresner’s journey of addiction to recovery was a beacon of inspiration and the best part of the weekend. Her talk embodied all that She Recovers hoped to convey because her story contained universal, gritty humor and you can’t package that. Her message was the very thing I craved the whole weekend. She told us the worst thing that ever happened to her was definitely the best thing that ever happened to her, but she could only see that after experiencing jail and street sweeping. The room erupted in laughter.

Dresner ended by telling us that after getting three years sober for like the 14^th time, she asked her dad, “Are you ashamed of me? When you talk to your friends do you feel ashamed?”

“My friends wish their kid was as unbreakable as you,” he said.

Then, looking out at the 500 wet faces, she told us: “Remember, that’s what all of you are: unbreakable.”

And dropped the mic.

View the original article at thefix.com

18 October 2018
How Do You Define "Recovery"?

Our time would be better spent trying to help people recover in whatever way is most effective for them rather than pushing and shaming everyone into one particular recovery pathway.

I’ve lost count of the number of times I’ve heard someone say that a person might be sober, but that they’re not in recovery, or describe them as a “dry drunk,” because the person doesn’t attend some defined program of recovery. I find that attitude divisive, dogmatic, and unhelpful, particularly because it shames others to believe in only one gold standard of recovery. This simply isn’t true. And it’s harmful; we have too many people dying of substance use disorder. Our time would be better spent trying to help people recover in whatever way is most effective for them rather than pushing and shaming everyone into one particular recovery pathway.

This kind of mindset originates from 12-step fellowships — where members often believe that these programs, combined with abstinence, are the only effective way to recover — and from the outdated professional definition of recovery provided by organizations like the American Society of Addiction Medicine (ASAM). However, with the emergence of recovery science, this outlook is beginning to change. Leading researchers are painting a much broader, more inclusive picture of recovery. Instead of accepting dogmatic perspectives, we can now turn to science, which shows us how people recover, the impact of the language we use, the complexities we face as people in recovery such as trauma and co-occurring disorders, and offers more cohesive definition of recovery.

In 2005, according to ASAM: “A patient is in ‘a state of recovery’ when he or she has reached a state of physical and psychological health such that his/her abstinence from dependence-producing drugs in complete and comfortable.” Over the years, this definition has evolved. Other thought and policy leaders in addiction recovery have also updated their definitions, including the Betty Ford Institute (2006), William L. White (2007), the UK Drug Policy Commission (2008), the Scottish government (2008), the Substance Abuse and Mental Health Services Administration (SAMHSA, 2011), researchers John Francis Kelly and Bettina Hoeppner (2014), and the Recovery Research Institute (2017).

One of the most popular definitions, and one I’ve favored as a writer in this field, is SAMHSA’s: “Recovery from mental disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” What I like particularly is that SAMHSA doesn’t define how someone should recover and they have no opinion on abstinence or the use of medication in the process of recovery.

Cognizant of the varying definitions and the lack of general consensus among experts in the field, recovery scientists and professionals from across the country came together to formulate a new concept. The Recovery Science Research Collaborative (RSRC) met in December 2017, evaluated various definitions of recovery, and reviewed essential components of recovery in order to more clearly define the process.

I spoke with Robert Ashford, one of the recovery scientists in the collaborative, about the process of formulating a new definition.

The Fix: What would you say were the main limitations of previous definitions that led to your aim to define a new concept of recovery?

Robert: We were hoping to bring together our understanding of recovery with the real-world empirical and practical evidence. Our desire for inclusivity was due to the high prevalence of co-occurring disorders (mental health and substance use disorder (SUD)) and the lack of inclusion of non-prominent recovery pathways (e.g. medication alongside abstinence modalities). We wanted to give the individual autonomy in self-directing their recovery process, both with and without clinical and other professional or peer recovery supports.

In reaching a consensus for a new definition, what were the main components that were critical to include?

It was a direct reflection of previous work describing the contention in recovery definitions, both real and perceived, by those in different “recovery” camps and between mental health and substance use disorder. Personally, I don’t believe recovery is reserved for the most severe and symptomatic individuals. If we conceptualize recovery as a series of interpersonal growth stages over time and in different settings or contexts, then recovery is a broad phenomenon that can apply to a range of issues. Our definition allows this to exist as a self-directed and intentional process that frames recovery as different in approach, style, and intensity depending on the range of diagnosis. Perhaps a good way to frame this, within the context of a continuum of SUD, is that recovery is also possible along a continuum that is proportional to the severity and type of SUD (mild, moderate, or severe), with most not needing to ascend along that continuum completely.

Our definition: “Recovery is an individualized, intentional, dynamic, and relational process involving sustained efforts to improve wellness.”

One of the main disputes within the recovery community is the belief that “true” recovery means complete abstinence. How did this belief factor into your discussions? And what would you consider to be the challenges of such a point of view?

I think the field at large stands to benefit, at least from an empirical perspective, because not having the focus solely on abstinence allows us to capture, estimate, and perhaps even predict, recovery in different pathologies, different severities, and at different life stages. This recovery typology is only possible with an inclusive definition in mind. The advocacy community also stands to benefit. Inclusive definitions allow the size of the population, or the prevalence of recovery, to increase — which is a good talking point and a strong policy lever for behavioral health. There is a potential for the “watering down” of recovery for the most severe of cases and for those traditionally following an abstinence modality, but this potential is moderated in my mind through the potential benefits.

At the end of the day, abstinence shouldn’t be excluded from the idea of recovery, but it should be situated where it best fits — as a potential outcome for a person who needs it. The definition of recovery can expand without diminishing those who are in abstinence-based recovery, and the expansion doesn’t negate anyone. If anything, not doing it negates the reality of millions of people seeking wellness.

View the original article at thefix.com

15 October 2018