I’M TRYING TO BE LOGICAL AND REASONABLE

PLEASE READ THIS ENTIRE POST AND THINK IT OVER…

One of the most troubling aspects of the modern-day “substance use disorder” treatment system is the stubborn reliance on a single pathway of recovery.

Namely, 12-step recovery. Mostly, AA and NA meetings/programs.

I found recovery through 12-step meetings and it is my preferred pathway to recovery.

However, in my professional work, I avoid pushing my recovery onto others. Sadly, the reality is, many providers still push 12-step only recovery.

YOU MUST COMPLY

Mandated programs and compliance programs almost always have a “recovery group” attendance requirement.

And far too often they sadly: ONLY ACCEPT 12-STEP RECOVERY GROUP ATTENDANCE.

This runs counter to all the facts and research surrounding recovery.

For example, let’s review the numbers.

THE NUMBERS

There are 22.35 million people in America who report having resolved a substance use disorder.

• They “had a problem”.
• They “no longer have a problem”.

I hope we can all agree, that resolving a SUD is a good thing. Regardless of how you get it done.

REQUIRED HELP

Of those 22.35 million people, 54% report that they had assistance in getting better.

In other words, 12,069,000 required help.

AA & NA

Of those 12,069,000 who got help, only 45% report that it came via AA or NA.

Therefore, 5,431,050 FOUND RECOVERY THROUGH AA or NA.

THE OTHER ALMOST 17 MILLION

THIS MEANS THAT 16,918,950 PEOPLE GOT BETTER VIA SOME PATHWAY OTHER THAN AA OR NA.

YET WE HOLD TIGHT TO THE IDEA THAT AA AND NA IS THE ONLY OPTION?

And we “professionalize” that by hanging steps in our treatment group rooms and mandating attendance to “12-Step Groups Only”.

FOR 12 STEP ENTHUSIASTS

Pause for a station break.

At this point, if you are a 12-step only enthusiast you have a couple options:

• You can flat out deny the research and simply say “in my experience, this is the only way”.
  As if your experience speaks for the other 7 billion people on the planet. Or you can –
  
• You could deny the math. But run the numbers, it’s indisputable.

WHAT DID BILL BELIEVE

Finally, even the founder of Alcoholics Anonymous would reject this idea of “12-Step Only Recovery”.

Mr. Wilson would be appalled by the hubris and arrogance of promoting one way only.

Here are some quotes from Mr. Wilson.

Thank you to a global Alcoholics Anonymous expert, William White for the research:

• “AA has no monopoly on reviving alcoholics”. (Wilson, 1944/1988, p.98)
• “The average member of Alcoholics Anonymous does not suppose we have a cure- all”. (Wilson, 1945b, p. 239)
• “In all probability, we shall never be able to touch more than a fair fraction of the alcohol problem in all its ramifications. Upon therapy for the alcoholic himself, we surely have no monopoly”. (Alcoholics Anonymous, 1955, p. ix)
• “In no circumstances should members feel that Alcoholics Anonymous is the know-all and do-all of alcoholism”. (Wilson, 1965/1988, p. 332)
• “Then, too, it would be a product of false pride to believe that Alcoholics Anonymous is a cure-all, even for alcoholism”. (Wilson, 1963/1988, p. 346)
• “When you consider the ramifications of this disease, we have just scratched the surface. I think we should humbly remember this”. (Wilson, 1969, p. 9)

ON DOGMA & COERCION:

“It is a historical fact that practically all groupings of men and women tend to become more dogmatic; their beliefs and practices harden and sometimes freeze. This is a natural and almost inevitable process…. But dogma also has its liabilities. Simply because we have convictions that work well for us, it becomes very easy to assume that we have all the truth….This isn’t good dogma; it’s very bad dogma. It could be especially destructive for us of AA to indulge in this sort of thing”. (Wilson, 1965/1988, p. 333)

REASONING

It stands to reason that:

1. The science and evidence supports opening the door to “Alternative Recovery Programs”.
   
2. Bill Wilson would support alternative recovery models.

The questions that naturally arise are:

• Why don’t more providers open the door to “Alternative Recovery Models”?
  
• Why does the system allow such inappropriate conduct?

FOR THE RECORD

For the record, there are amazing programs in Greenville and the rest of the Upstate that completely support alternative pathways.

However, it is troubling that old school hold-outs are still permitted to operate.

Full report: https://www.recoveryanswers.org/…/1-in-10-americans-report…/

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CONFESSIONS OF A DOUBLE AGENT-

MY SECRET LIFE AS A MEDICATION ASSISTED TREATMENT (M.A.T) THERAPIST

I’m sure we can find people out there who know much, much more about medication assisted treatment than I do. There are people out there who understand the technical end of medication assisted treatment better than I do. What do I mean by the technical end? The neurobiological process involved with a partial agonist versus a full agonist. The process of initiating the medication, the appropriate dosages, what you can expect in regards to withdrawal symptoms.

There are certainly people who understand more about medication assisted treatment than I do in terms of running a clinic. This includes all the rules and regulations. How many clients can a doctor have on their roster? What are the rules regarding “counseling” and drug testing?

There are people who understand insurance reimbursement and the business model better than I do. There are people who know more about the status of prescribers  and why we seem to have a shortage. There are also people who have personally been involved with medication assisted treatment and they know more about the lived experience of M.A.T. than I do.

However, there are some areas that I understand more than anyone on the face of the planet:

I know what it is like to be an “independent” therapist who specialized in working with people on medication assisted treatment within a recovery culture that was very hostile toward those on M.A.T. And I did in complete secret and silence.

From 2007 thru 2011 I worked with hundreds of M.A.T clients in western Pennsylvania as the opioid epidemic raged. Suboxone was being prescribed at a high rate and it was, relatively speaking, a new phenomenon. These patients were absolutely marginalized by the larger recovery community.

Truth is they were also marginalized by “traditional” treatment providers. I was an active member of Narcotics Anonymous at that time. NA dismissed suboxone as “being high”. They were not welcomed at NA meetings.

This short quote from NA will give you an idea of this problem.

“Our program of recovery begins with abstinence from all drugs, including alcohol.”

Check out this PDF from NA – Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment

I remember watching this unfold and thinking “this isn’t right”.
But I did not have the courage to speak up.

I was too enmeshed in the group. I wanted the approval of people “ahead of me on the path” and had not yet matured in my recovery. I sat silently as people on Suboxone dealt with the stigma within the stigma. It may be slightly better now. This was 10 years ago. It was ugly, it was brutal.

At that time, the common practice was “dose and go”. Physicians from a wide variety of backgrounds were getting “certified” as buprenorphine providers via a 9-hour online training platform.

There were some stipulations regarding counseling but none of the patients were getting any real coaching or support. This is still the case in many practices today, however, I think it has improved. 10 years-ago it was truly the wild west and most patients were getting their script and nothing else.

Of course, this presented massive problems.

As I stated above, I was an active member of Narcotics Anonymous at that time. Attending daily meetings, sponsoring people, chairing home groups. This was western Pennsylvania where the heroin epidemic has been raging for 15 plus years.

There were countless people showing up at these meetings on Suboxone. And the honest truth about the situation is they were completely marginalized and shamed out of the rooms. I am ashamed of how I conducted myself at that time. I would not participate in the bullying that went on around Suboxone.

I didn’t directly make comments about Suboxone being a crutch. I didn’t make comments like “they aren’t really clean”. However, I would sit by silently.

You see, all organizations or groups operate via social following principles. People fall into line and adhere to the group norms. We do this because we want to be accepted and we want to fit in. Evolutionary psychologists tell us that it is a survival mechanism.

As we evolved and we survived a nasty world it was essential that we be part of a tribe. Being a loner or going against the crowd equaled death. Back then it was physical safety we sought via compliance and group think. Today we follow the tribe to ensure psychological safety. Either way it is hard-wired into our thinking.

That’s not an excuse for my behavior, but it is an explanation.

Keep the reality of social following in mind when you consider what it must be like to be a person seeking recovery via medication assisted treatment attending a recovery support group.

Imagine standing outside smoking a cigarette (which is basically medication assisted treatment in its own right) while your “peers” make comments about people on suboxone. The official literature evens states: we are a program of complete abstinence. People would run from the rooms; and we all know how dangerous it is to try and “do recovery” without supportive people in your life.

NOTE: IT IS RIGHT ABOUT NOW THAT SOMEONE BECOMES OFFENDED BECAUSE THEY HAVE SPONSORED PEOPLE ON SUBOXONE OR THEY HAVE BEEN PART OF A WELCOMING RECOVERY GROUP. I WANT TO ACKNOWLEDGE THAT THERE ARE PEOPLE WHO ARE OPEN TO M.A.T. HOWEVER, IN THE INTEREST OF RIGOROUS HONESTY-WE NEED TO ACKNOWLEDGE THAT IN MAJORITY OF CASES YOU ARE A SECOND-CLASS CITIZEN IF YOU ARE ON M.A.T. AND IT WAS 100 TIMES WORSE 10 YEARS AGO….

With this culture firmly entrenched around me I became more and more distraught about what I was seeing where M.A.T. was concerned.

And then people started dying; at alarming rates.

Now at this time I was a therapist working professionally in the clinical treatment realm. I remember thinking: “OK the recovery community is not going to embrace this. Certainly, the professional community would”.

However, as I explored M.A.T. with traditional treatment programs and outpatient therapists I quickly realized no one was working with these patients.

That’s when I went undercover…

When I decided to start a private practice specializing in M.A.T. It was small initially but steadily grew and I became an expert on working one to one with these clients. However, the entire time I kept this quiet. I never openly discussed this with my support group. I never advertised. I never promoted it among my professional colleagues.

HERE’S THE THING: THE STIGMA AROUND M.A.T. WAS SO STRONG THAT I WAS AFRAID TO EVEN ADMIT I WAS TRYING TO HELP “THEM”.

Now, 10 years later, I could care less now what fellow professionals think about me as I try and help people on M.A.T. I still hear professionals say things like “suboxone blocks the sunlight of the spirit”. Now, instead of being intimidated, I am appalled and stunned that these people are permitted to practice. I cannot believe this type of thinking passes the test in terms of treatment or healthcare.

I have also developed a healthier perspective on the integration of M.A.T. into the larger recovery community. First of all, I think things have improved somewhat in terms of groups embracing M.A.T. It is different in 2017 than it was in 2007. Although, the truth remains that the official company line in most groups is “abstinence” only.

In the recovery rooms you will be accepted on M.A.T. if it is “temporary” and your goal is to get off the medication in the near future. It’s more difficult if your treatment plan includes long term medication maintenance.

More importantly, It is clear that self-help groups bear no burden in adjusting the thinking around medication assisted treatment. These groups are voluntary, free, mutual support programs. They do not charge health insurance. They do not promote themselves as healthcare. Therefore, they have no ethical responsibility to adjust the message.

I may not agree with the way M.A.T. is handled but it is the group’s prerogative.

The burden falls on professional recovery services, treatment and healthcare in general. Treatment and recovery providers who refuse to adopt medication assisted treatment as a viable practice must rethink their philosophy. Treatment providers who refuse to include M.A.T. in their practice should not be eligible to treat opioid use disorders.

These organizations should be denied payment or licensure to work with opioid use disorders; they can stick to alcohol and other drugs but they are a major part of the problem where opioids are concerned.

We must find a way to professionally support these folks and acknowledge how difficult it is to follow traditional pathways. We must bridge the gap through recovery coaching. We need to be there when these people are told “you aren’t clean” so that we can talk them through the reality of the situation. We need to pick up the pieces for the dose and go doctors that are still up and running in many communities.

As for our organization, FAVOR Greenville, we welcome you with open arms if you are on M.A.T.

You are in recovery if you say you are in recovery.

Your involvement with our organization comes with zero strings and no hidden agenda. We will help you identify your personal recovery plan and your personal pathway to recovery; with or without medication.
We don’t care how you get better…we just want to see you get better. Let us help.

The post MY CONFESSION OF BEING A DOUBLE AGENT appeared first on The Recovery Cartel.

FAVOR Greenville champions all Pathways to Recovery.  This includes 12-step recovery meetings.  We believe the fellowships of Alcoholics Anonymous and Narcotics Anonymous are a first option for many of our participants.  In nearly all cases it is the first outside resource discussed via recovery planning.  If people are willing, we run with the plan for meeting attendance.  However, we do not believe that recovery is a one size fits all process and there are many ways to find recovery.  All of these are worthy of celebration.  We just want to see your life get better.

Therefore, when we shine light on one size fits all treatment, we are not doing so in reference to AA or NA.  We are doing so in reference to the professionalization of 12-step recovery and a private system that, in many cases, denies the patient access or information regarding alternative pathways of recovery.  With that in mind I wanted to put forth some random thoughts on multiple pathways.

1) Multiple Pathways Exist: Perhaps the most controversial thought concerns the fundamental reality that multiple pathways of recovery exist.  Because of the stigma and shame surrounding addiction relatively little research has been done on recovery.  Our culture, as a whole, considers addiction a “moral failing” so there is little demand or interest in gaining scientific insight into the recovery process.  In addition, many professionals in the field have little concern with research on recovery.  Especially if they have had their own personal experience in recovery.  This leaves a void of knowledge which has, unfortunately, been filled with clichés and conventional wisdom.  To paraphrase Randy Gage and his new book Mad Genius: this void has allowed the mysterious people in charge of the secret system that runs (addiction treatment) to simply proclaim there is only one way to recover.  I don’t know how many individual people believe this.  It is a very difficult thing to assert and still consider yourself a rational person.  However, the herd mentality frequently kicks in and people jump on board with this type of claim even in the face of evidence to the contrary.      

This void has allowed the mysterious people in charge of the secret system that runs addiction treatment to simply proclaim there is only one way to recover.  No one knows who these people are.  They are the ones who established all the things that have “always been done this way” (adapted from Randy Gage, Mad Genius). 

Typically, the pathway most commonly promoted is 12-step recovery found in Alcoholics Anonymous or Narcotics Anonymous.  AA and NA are the most well-known pathways and many have found recovery through these programs.  In fact, they are the most common “formal” pathway of recovery.  My concern has nothing to do with the programs of AA or NA.  My concern is with the professionalization of AA and NA.    I have heard professional counselors proclaim that AA is the only way to find recovery.  I have heard stories of patients being required to complete steps while in facilities that claim to be licensed inpatient rehabilitation facilities.  This is a big problem.  If you find yourself in the presence of a therapist who says something along the lines of “you must do AA in order to recovery” you should look around for other options.  Insurance should not be paying for 12-step sponsorship.  The responsible thing, from a medical perspective, is to promote all pathways of recovery and develop aftercare plans that are truly individualized.

One of the problems with exploring pathways to recovery lies in the definition of recovery.  Does it mean complete abstinence?  Does it mean complete abstinence plus a defined program of self-improvement?  Does it mean complete abstinence plus a “spiritual awakening”?   Is mediation assisted treatment a viable pathway to recovery?  What about the reality of substance use disorder full remission?  In other words, a person had a substance related problem but no longer does.  These individuals may or may not use, either way they are no longer destroying their lives.  How do we characterize these individuals?  I think that is a good thing if their lives are improving.

When you explore substance use in a realistic manner you find much complexity and nuance.  If you are a self-help attendee, you have little responsibility beyond the black and white.  A person is in recovery if they do “the program”.   However, if you are a professional healthcare or treatment provider you have an ethical responsibility to explore all angles and gain a deeper understanding.   For the sake of research there has been a general agreement on recovery as “remission of symptoms”.  It is the most quantifiable variable and from a public health perspective the most important.

In addition to 12-step recovery, The Recovery Research Institute (RRI) out of Harvard lists the following as “clinical” pathways which have been proven effective:  pharmacology, Acceptance and Commitment Therapy, holistic based recovery services, Community Reinforcement Approach, CBT based approaches, Contingency Management, Relapse Prevention Therapy, Motivational Interviewing/MET techniques, 12-step Facilitation, Behavioral Couples Therapy, and Family Therapy.  Among “non-clinical” alternative services you find: Recovery Community Centers, Peer-Based Recovery Support, Education Based Recovery Support, Employment Based Recovery Support, and Faith-Based Recovery Support.  Furthermore, alternative mutual support groups existing including: SMART Recovery, Rational Recovery, Women For Sobriety, HIP Sobriety, LifeRing, Secular Recovery Organizations and many others.

In addition, some achieve recovery or “remission” without any formal help.  From the RRI:

“Some individuals can achieve substance use disorder remission without formal help from professional treatment or mutual-help organization participation”.

Again, because of the mysterious people in charge of the secret system that runs addiction treatment we have allowed our professional systems to ignore these facts.  Even Bill Wilson knew there were many ways to recover.  The following are all quotes from the esteemed Mr. Wilson:

–“AA has no monopoly on reviving alcoholics.”

–“The roads to recovery are many… any story or theory of recovery from one who has trod the highway is bound to contain much truth.”

–“Upon therapy for the alcoholic himself, we surely have no monopoly.”

–“In no circumstances should members feel that Alcoholics Anonymous is the know-all and do-all of alcoholism.”

Professional organizations, counselors and addiction treatment centers should be held accountable to standards that include a full menu of recovery options.  Are we not “withholding” possible solutions when we discuss only 12-step recovery?  This seems like an advocacy issue that those of us in the recovery management movement should take on.

2) It is likely that “new” pathways will be invented: As we often hear in the rooms of recovery, recognizing and accepting the problem is the first step. If we are in denial of the problem we can never find a solution.  If we are unable or unwilling to look at the situation from a reality based perspective, we will never make a change.

I would argue we are in denial regarding this issue.  90% of the treatment programs in America operate from the same fundamental philosophy, and it is not working.  As it currently stands only 10% of those in need are engaged in services.  It is logical to assume that some of this is the result of a one size fits all approach.  If we opened the door wider more people would walk into the recovery process.  If we offer alternatives and programs that meet people where they are you will see improved engagement.

I also believe there is a shelf life on the current approach.  I do not think this business model is sustainable and people will start to differentiate.  Marketing programs that are all identical will not be effective as you get a more educated and knowledgeable patient base.

And I believe that as soon as we acknowledge the problem we will innovate and develop new solutions.  It is already happening in small pockets around the country.  Including Greenville, South Carolina.  We will develop alternatives that we cannot even envision right now.  Technology will help.  However, I believe the real break-through will occur when we educate, train and supervise a new workforce.  One that emphasizes engagement and connection over dogma and acute care rinse and repeat models.

We will realize that “the way we have always done things” makes no sense.  We will rise up and challenge the mysterious people in charge of the secret system that run the addiction treatment system and develop new protocols, payment systems, and norms.  We will develop an entirely new culture of professional recovery services.  Twenty years from now people will look back on this day and time as the transformation point.  They will wonder why it took so long to make changes.

3) Co-Occurring Recovery will be one of the new pathways: Double trouble or dual diagnosis groups have always existed.  However, they are few and far between and they are not available for many in need.  We know that upwards of 60% of those with a substance use disorder also suffer from some type of mental health issue.  The days of mental health issues being cleaned up via the natural progression of recovery are over.  We can no longer just wait for the person to sober up and see if the depression goes away.  Some studies indicate trauma is present in up to 80% of women in recovery.  Trauma symptoms can be made worse if mishandled and there will be a need for specialized support in these areas.  This is all good stuff.  We have advanced as a society.  We are more informed and educated than we were in the past and our needs have changed.  That is not unusual.  It is predictable and healthy.

In addition, people with mental health issues sometimes struggle to fit into “regular recovery” groups.  Medication is one reason.  Social anxiety would be an example of another reason.  It is likely that new recovery groups will spring up to meet the needs of participants with co-occurring disorders.  At FAVOR Greenville, we are developing a curriculum that certifies a coach as a COD specialist.  This will be a positive development in the fight against addiction. 

4) Medication Assisted RECOVERY will be one of the new pathways: Despite the best efforts of many people in recovery, many people on medication assisted treatment have felt alienated from recovery rooms.  I have no interest in entering into that debate in this blog post.  It would require much more time than I have at the current moment.  Suffice to say, there is likely to coalesce a specific recovery program for people on medication replacement therapy.  A place where they can talk and share openly on all matters including the use of Suboxone or Methadone.  We know this is a very contentious subject in some recovery rooms.  At FAVOR Greenville, we welcome you into the recovery process no matter what stage you are in.  We want you to keep coming back.  Medication assisted or not.  I believe we will see more specific programming and services related to medication assisted recovery.  We know community is exceedingly important to the recovery process and it is going to be necessary to address this glaring issue as we move forward.

In closing I want to reiterate.  At FAVOR Greenville, we are big fans of 12-step recovery.  However, we are also big fans of SMART recovery, Women For Sobriety, FAVOR primary recovery, clinical recovery, medication assisted recovery, and any other recovery you can think of.  Our interest is in seeing your life improve.

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