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May 2014 |
drinkanddrugsnews
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van Bilsen's paper
Heroin addiction: morals
revisited
was something of a lodestar where I
first worked. As good as (I thought) we were
at providing an alternative to a regressive
norm in residential treatment, we too had
problems with our approach. If AA and TSF
can be characterised as overly dogmatic and
prescriptive, the alternatives can sometimes
appear dangerously vague or ill-defined in
practice – especially with good intentions but
little training.
To say that practice was sharp in many of
the residential treatment services of the
time would be something of an
understatement. There are countless first
and second-hand stories of shaming and
shameful practices, informed by many
approaches – often with little underlying
theoretical rigour and certainly without much
competence. These were generously funded
by a state only beginning to become
concerned about the complex causal and
maintenance factors in drug use and
associated problems – many of which we
continue to learn about, hopefully adapting
our views as we go.
Bad advice, on psychiatric medication for
example, is not solely the purview of AA or
fellowship groups. Many people’s experience
of psychiatric medication is the embodiment
of trial and error learning. Some principles
espoused by AA do appear to undermine
personal resourcefulness and self-efficacy.
Many fellowship members, on the other
hand, are among the most resourceful you
could hope to meet and provide something
of a model for people who are beginning to
think about making changes for the first or
21st time.
Moreover AA and other fellowship groups
are notable for their accessibility on all
counts, where many centrally funded
services simply fail at 5pm – although recent
years have seen considerable improvements
in operating hours.
An ambivalent subscriber to
DDN
initially,
it seems like a good proxy for how views in
the substance use field have become more
inclusive over time. Likewise AA – at least in
my experience – has become increasingly
pragmatic and leaves Stanton’s account of
steps 3, 5, 6 and 7 looking somewhat
hackneyed. Add to this the profusion of
services and providers working more
pluralistically and practising in person-
centred ways, like Motivational Interviewing
(MI) or the steady growth of SMART groups,
and the picture becomes more nuanced than
Stanton would have us believe.
If our shared goal is to support
individuals by meeting them ‘where they are’
and when they most need support, I am
certainly keen to hear about ways of doing
this better. In my view Stanton veers
dangerously close to the line of self-
promotion while accusing AA and TSF groups
of doing just the same.
The prospectus offered by his curious UK
drugs worker, ‘A’ (whom I hope reads
DDN
and may be given to join the discussion) is
seductive but faulty. There is very little that’s
‘handy and convincing’ in the drugs field. I,
for one, am curious about Stanton’s perfect
method, but not at the cost of overlooking
the good works of fellowships of all hues –
and their members – over time.
Richard Craven, lecturer, University of
Abertay Dundee
RESPECT WHAT WORKS
I work in a 12-step treatment centre and am a
12-stepper myself, and I don’t agree with
Stanton Peele's critique of the 12-step pro-
gramme. Firstly, the 12 steps form a spiritual,
not religious programme. I feel that I have
been empowered by the programme, it has
given me the ability to recognise and make
choices that I never knew that I had before.
The language of the steps can be off-
putting to newcomers, but when examined in
detail they are all about increasing people’s
power and choice. An acknowledgement of
powerlessness over one’s addictions gives
power and choice over all other aspects of
one’s life.
Step 3 is really about letting go of
control. As a using addict I wanted to control
every aspect of the world around me; in
recovery I realise that all I truly is control is
myself, my actions and the way I respond to
events. For example, if I go for an interview, I
might prepare properly, I might answer all the
questions to the best of my ability and yet
the result of that interview is out of my
hands. Step 3 allows me to recognise what I
can do and let go of what I cannot do.
Steps 6 and 7 have, contrary to what
Stanton Peele suggests, given me a deep
level of self-knowledge and self-acceptance. I
know, through working these steps, who I
have been, who I am and who I can become
if I choose to.
Far from driving other therapies out, most
of the 12-step treatment centres I have
come across embrace other therapies. One
of the spiritual principles that all 12-step
fellowships adopt is that of ‘open-
mindedness’. Most fellowships encourage
members to explore and find the things that
work for them as individuals.
Stanton Peele confuses the programme
with those who try to practise it. Of course
there are people, and even groups of people,
within the fellowships who are so scared of
relapsing that they become dogmatic and
rigid in their views – but the fellowships do
not encourage this. Twelve-step fellowships
embrace individual freedom, freedom of
thought and practice to the extent that they
accept and embrace members of widely
differing views, knowing that they will change
when, and if, they are ready to.
serenity @unclean99 13 Apr
@getintorecovery @DDNMagazine most of the people
blowing trumpet for recovery don’t recognise ‘whole
spectrum’ sadly.
serenity @unclean99 13 Apr
@HantsHOMER_CRI @DDNMagazine unfortunately many,
including @UKRWCharity, claim to embrace wider definitions
but only pay lip service.
Dr Russell Newcombe @TheNewImpostor 12 Apr
@ScottybooSb @DDNMagazine @HantsHOMER_CRI
@UKRWCharity can anyone tell me what drug services
recovery does NOT cover?
John E @getintorecovery 12 Apr
@DDNMagazine The Stanton article is likely to do more
damage across the whole spectrum of recovery rather than
open genuine debate.
Lou @HantsHOMER_CRI 12 Apr
@UKRWCharity @ScottybooSb @DDNMagazine Recovery
means different things to different people.
James Morris @jamesmorris24 11 Apr
Credit to @DDNMagazine for publishing @speele5's bolshy
critique of #AA and #12step #Recovery
Kerry Stewart @Whiterosekitten 11 Apr
@DDNMagazine maybe they should speak to the many 1000s
of recovered addicts across the world and ask what other
measures they tried before.
Kerry Stewart @Whiterosekitten 11 Apr
@DDNMagazine I don't meet many whose first option was 12
step total abstinence. We arrived when all else failed.
UK Recovery Walk @UKRWCharity 10 Apr
No one knows who, when, or how we will recover so everyone
should be given every chance! @ScottybooSb
@HantsHOMER_CRI @DDNMagazine
scott bell @ScottybooSb 10 Apr
@HantsHOMER_CRI @UKRWCharity @DDNMagazine
Recovery is so much more than two sides of one coin.
Broadway Lodge @Broadway_Lodge 9 Apr
@DDNMagazine 98% UK money for community programmes,
2% spent on rehab. 12-step rehabs don’t account for all 2%
but get excellent results!
Buxton & T @DoddNeil 9 Apr
@DDNMagazine Well done for the Stanton Peele piece. There
is a fear of daring to question 12 steps.
Chy-Colom @ChyColom 8 Apr
@speele5 @DDNMagazine well it’s a discussion point and
gone are the days of one size fits all. There are many ways
people can recover.
Peter Hutt @PeterHutt2 7 Apr
@speele5 @DDNMagazine AA has worked for 75yrs and
attacking its values to sell books is not healthy. Alternatives
work. AA RECOGNISES THAT.