How it doesn’t work – the dogma of the 12 steps

Imagine being diagnosed with cancer, going through a regimen of chemotherapy only to have the cancer return within months, and being told by your doctor that there must be something wrong with you and that he can’t treat you unless you let the chemo do its work.

Absurd right?

12-Step dogma

Everyone wants to know if they can become addicted

Unfortunately, if you replace the cancer above with addiction, the chemotherapy with the 12-steps, and the doctor with 12-step dogma, you have what we know as the ________ Anonymous model (fill in your favorite blank). It’s even written in what 12-steppers call The Big Book (officially called “Alcoholics Anonymous”) and often read as part of the “How it Works” section.

“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… They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty.”

Well, as far as I’m concerned, this is where the 12 steps lose credibility with me. In any other field, if one treatment doesn’t work, another one is tried, and another. Different people with different conditions may need slightly different approaches. If no known treatment works, experimental ones are attempted. This is how medical science advances. Still, the notion of a physician blaming the patient for a treatment not working is ridiculous. There’s an entire field built around intervention research and I’m pretty sure that simply dismissing the patient as constitutionally dishonest isn’t a common technique.

Treating chronic conditions

In diabetes, like in addiction, there is a rate of compliance with prescribed treatment. And just like among addicts, that rate is relatively low, averaging around 30% or less. Relapse is also pretty common in other chronic conditions like diabetes, asthma, and hypertension, and rests around 50%-60%, not far from estimates for addiction.

Some patients are better at following one regimen while others do better with a different schedule, different doses, or different treatment methods altogether. Similarly, while some addicts respond beautifully to CBT, it seems to help some very little. The same is true for the 12-steps, religion, and a host of other practices. As far as I’m concerned, this means that when an addict seeks treatment, their provider should take a good assessment of the issues, prescribe the treatment that seems to fit best, but if that one doesn’t work, try another method, not throw them out because the favorite approach didn’t cut it.

12-step Dogma Vs. Progress

And therein lies the problem with the 12-steps, whether supporters acknowledge the religious nature of the program or not is tangential, the important thing is that they cling to a book written decades ago much like believers hold onto a bible. Both are collections of stories and messages passed on that no one is willing to re-examine and, if needed, change. Medical texts, and indeed any textbook seeking to stay relevant, stay current by issuing new editions that incorporate new knowledge, but the 12-steps haven’t been touched since 1939, or since the beginning of world war II!!!

Advancement requires flexibility

1939 was an important year, with the 3rd Reich beginning its exploits, Steinbecks’s “Grapes of Wrath” seeing its first publication (another book without major edits since), the first stocking ever sold, and the emerging use of penicillin. I think many of us would agree that there have been some serious advances since that time.

When it comes to addiction, those advances include our vastly improved understanding of the neuroscience, genetics, and general brain function involved. Additionally, the development of very effective treatment modalities, like Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Contingency Management (CM), has given providers a much more complete toolbox with which to deal with addiction problems. Unfortunately, many within the 12-step community have never heard of any of these methods, or of the use of medications (like Bupropion) to help with cravings. Personally, I think that’s just sad.

How it works. Really.

It’s time to dust off the covers, and incorporate the 12-steps into the bigger picture of addiction treatment. When 12-steppers wonder why people can’t just see the value of the program, I automatically think of the preacher who sat in on of my addiction class and kept yelling that if only addicts accepted Jesus into their lives, they would be saved. Laugh all you want, but not only did the 12-steppers dismiss him, they missed an opportunity. He had a point- those who accept Jesus into their lives fully may succeed in recovering from addiction on that basis alone – but those who fail to do so should be given every other treatment tool available so that they may also.

This is supposed to be the age of inclusion, a time for Change with a capital “C.” Let’s make ourselves proud and help those suffering by making sure that we’re offering every treatment option possible.

A million ways to treat an addict

When I was still attending my addiction counseling classes at UCLA, we often discussed the many different tools now available when treating drug abuse (CBT, 12 step, medications, rapid detox, etc.). Still, most of the class members focused on how many of these don’t work with everyone and how some have actually resulted in problems for certain patients. I think this is a mistake.

Like a physician treating any other chronic disease, I think that practitioners in the field of addiction need to come to terms with reality: Chronic conditions (and I don’t mean smoking good weed) are difficult to treat. Still, cancer treatment works by trying the best possible method, then the next, and then the next, until all options have been exhausted. In the addiction world, most therapists and counselors still stick to their guns with the method they believe work best.

Unlike with roses, an addict is not an addict, is not an addict… Different methods will work for different people. It isn’t hard to believe this when you consider the fact that while many addicts recover within outpatient substance abuse treatment settings, others need an intensive residential program, and some recover spontaneously with no real intervention.

It’s time to start focusing on results in this field and leave the moral dogma behind. If there’s a tool that can help, we need to put it into action. It’s that simple.

Top down + Music = Loving life – 3 steps for remembering what’s important

In my opinion, the purpose of all this stuff about recovery from addiction is about loving your life again. Let’s face it, if addictive behavior continued to be enjoyable, few of us would look to end it. But the reality is that what seemed like fun at first become the bane of our existence, driving us deeper and deeper into a black hole that, due to so many of the things I’ve talked about on this site, is seemingly impossible to escape.

Regaining your life after addiction

So you get help, and it makes things a little better, and you seek social support, and things improve even more, and then you hit a wall. Your life becomes an endless cycle of trying to control that part of you that gets you in trouble and destroys everything you’ve ever loved and worked for. But is that all there is?

I don’t think so – I believe there’s a way to actually love your life again. Not only because it’s no longer the mess it used to be, but simply because, well, it’s amazing!

My recommendations for getting your life back

  1. Find a purpose – It sounds simple, but if you’ve ever tried it, it’s anything but. For me, education was the general purpose, but within a few years it became clear that education that leads to improvement in knowledge about, and treatment of, addiction was to be my calling. But you need to find your own. It should make you happy to work even when the work itself sucks and it should make you feel like what you’re doing matters. Aside from that, it can be anything: Cooking, drawing, gardening, a law career, and on and on. Find your calling.
  2. Get rid of the stigma you yourself hold – I’ve talked before about how much I dislike the fact that others still view addiction as a moral failing. But you know what? Even though I now know for a fact that they’re simply wrong, I find myself doubting my own ability to be a great person. Fortunately I have a wife that reminds me that these doubts are in my head, but they can be hard to shake. Lose your doubt in your own ability. Just because you tend to be impulsive, a little rash, or well, even a little hard-headed and stupid sometimes, doesn’t mean you aren’t great. In fact, research with animals has shown that the exact same characteristics that make animals leaders also lead them to take risks that shorten their life expectancy. The take home? Recognize who you are but don’t discount your strengths.
  3. Have funOnce again, like the rest of these pearls, this one sounds easier than it is. In the middle of all our daily storms, with our own self-doubt, life’s challenges, and well, simple hardships, it can be hard to remember what’s important. Some self-support groups have you draw up a “gratitude list” and those can be helpful, but I’m talking about simpler things: Put the top down on your car (if you can, this works even without a convertible) and blast some music you love, go to a park and throw a ball around (or kick one), play with your dog like you’re 8 years old, or go to the beach and jump in the water no matter how cold it is. Life is to be enjoyed, and in the process of bettering ourselves, many of us seem to forget that. But  at the end, why live if you’re not enjoying it? My father’s been holed up in a hospital room for months and is understandably depressed. Last week, on a visit to NYC, where my parents live, I put music in his room and played some of his old favorites. It didn’t make his cancer go away, but it made him tap his feet and fingers and remember what living is about. Do that for yourself.

That’s it for this one. Nothing I said in this post is too difficult, but psychological research supports that little things that elevate mood can do wonders for people’s overall well being. So remember, improve your life, make yourself a better person, but at the end, remember that the reason you decided to get your act together was that life stopped being enjoyable and you wanted to be happy everyday when you woke up. Follow the three simple steps above and you’ll be a lot closer!

What makes the 12 steps (and other social support groups) a good part of addiction treatment aftercare?

I’m not a devout 12-step believer, though I think that AA and the offspring programs have some serious merit, especially when it comes to addiction treatment aftercare. In this discussion, I’m talking about all group-support based programs, including Smart Recovery and others. I’m personally a fan of non-religious groups, but that’s just me.

Chronic conditions require long term care

I’ve already talked about my view of addiction as a long-term, chronic condition. Regardless of the “disease” moniker, I think it’s undeniable that, at least for some people, addiction treatment needs to continue long past their initial “quitting” phase, regardless of whether they went through an inpatient or outpatient treatment (or quit alone at home).

Without getting hung-up on my misgivings about 12-step programs (I have a few), I’d like to talk about some of the factors that make me believe in the system as a continuous aftercare resource:

  1. It’s free – Most people, especially given current insurance limitations, can’t afford ongoing outpatient help be it through a psychologist or an addiction-treatment provider. While the latter two are can be superior in their knowledge about recent developments in addiction, they cost money.
  2. It normalizes behavior – One of the difficulties many addicts share is in talking to non-addicts about their problems. They feel ashamed, misunderstood, or judged. Being with like-minded individuals can eliminate some of those issues. Nevertheless, people often find understanding only regarding the specific issue a program deal with and therefore find they need to attend many different support groups to address all their issues.
  3. It provides ongoing support outside of meetings – The social connections people make in meetings can often help them outside the rooms. Your psychologist isn’t likely to do the same.
  4. It keeps the focus on relevant issues – When following the 12 step rigorously, one is always working on bettering his/her program. That sort of attention can help catch problems early on before they develop into real difficulties.
  5. It keeps people busy – Some addicts need to stay occupied to keep out of trouble, especially in the transition from their acute treatment back to everyday life. Attending social-support meetings can make the time go faster while providing a relatively safe social environment.

Even with all these advantages, I can’t help but object to some of the AA dogma, especially when it comes to religion and to the unwavering resistance to adapt their system as it was handed down in the late 30s. We’ve learned a lot since and I think 12-Step programs could benefit greatly by incorporating recent knowledge. In fact, reviews of studies regarding the effectiveness of AA find it no more useful than other interventions overall. This is why I believe that 12-Step programs are best used along with, and no instead of, additional treatment options.

Citation:

Cochrane Review – Alcoholics Anonymous and other 12-step programmes for alcohol dependence

About addiction, my self, and the fight to be altruistic

One of the core personality traits that many addicts, including myself, eventually identify in themselves in a strong streak of selfishness. The question is: What do I do with this insight once I’ve gained it?

I’m starting to come up with my own answer and hopefully my solution will help others find their own.

The beginning of my efforts

Since my arrest, incarceration, and rehabilitation for my own problems with drugs, I’ve dedicated my life to the study of addiction. My hope was that through my knowledge, I’d be able to finally figure out what happened to me. As I continued learning, I began seeing that I could offer some real help to others who are still suffering, stuck in their own, or another’s addiction.

That was how All About Addiction, and its parent company, California Treatment Services, came to be. I wanted to share the knowledge I was gaining with others, hoping that like me, they would find relief in understanding the disorder that has so profoundly messed-up their life.

The All About Addiction experiment

When I started out, I knew nothing about the craft of writing an online blog. I called every post a blog, I wrote like I was trying to get another academic paper published, and no one came to read my boring, overreaching, dense stuff.

My first month I barely broke the 5 reader mark – I was discouraged, but soldiered on. Month after month, post after post, I kept writing, editing, rewriting, learning more, and gaining readers. Since that humble beginning, with the help of some great mentors, help from other bloggers, and good old experience, I improved. As of right now, All About Addiction, is read by about 13,000 people monthly and we’re trying to expand our efforts to give actual real-world help to readers with our recent Free Treatment Contest.

Nowadays, I get dozens of emails asking for specific help, letting me know how much people appreciate what I write, and yes, even the occasional online fight with a reader who disagrees with me. I finally feel that what I’m doing is making a real difference in the world. But that’s where I’ve run into a little unexpected snag.

My fight with altruism

One of the greatest gifts I received when I first cleaned up my act was some relief from the constant noise in my head about my relationship with everyone around me. All the people that owed me money, all the people I owed; the fights with my “employees” and the constant struggle to rationalize my life; the girls, the sex, and the constant mistrust, stealing, and betrayal. It was exhausting, and even though I’d found myself broke for the first time in 5 years, I was more relaxed than ever. There’s no doubt that the people I associated with when I was using were, for the most part, not good for me. Being a student allowed me to take a place back in society and be invisible for a little while. But not for long.

It all started up again when I excelled in my Masters program at Cal State Long Beach. All the accolades and praise made me feel like I was somehow special and better than others. Getting into UCLA’s doctoral program despite the incredible odds (thank god they don’t ask about a conviction record) only made things worse. Now, with thousands of people listening to me on a monthly basis and a consistently growing body of work, my big head and ego are back full force.

I wake up in the morning and rush to my laptop to check on my visitor counts and the most recent comments. I do this at least 100 times a day. I’m obsessed. When people fail to flock to a recent post, I feel down and when they come en mass, I am joyous and feel redeemed. I’m no longer relying on drug deals and money to keep me feeling worthy, but the reader count is my new drug. I have a problem.

Once again, my self-worth is tied up in others, and that’s not a safe place for me to be. If I’m relying on you to make me feel worthy, I’m setting myself up for failure. This is especially true because of my perfectionist, obsessive, personality. Nothing is ever good enough and I won’t stop until everything is perfect. Seems like a trap, doesn’t it?

My solution, for now

My solution isn’t going to involve my not writing anymore. I think it’s helping people and I want to help – I just want to remove my own self-perception from the equation. I’m also beginning to realize that my obsessive nature is never going to go away. It, along with my inattention, is going to remain a lifelong challenge that I will have to learn to live with.

This is tied very closely to my struggles with addiction. Every time I think I have it beat, the same tendencies pop-up somewhere else, reminding me that this fight isn’t going to be won easily. I haven’t used meth in over 8 years now and hopefully I never will. Still, the same obsessions, discomforts, and personality traits that kept me using for so long are here, and they’re not going anywhere. And that’s without even mentioning that randomly inserted cravings that can take over my mind at any minute.

So for now, I vow to do my best to write without concern for what others think. I will write, as best I can, to help others through encouragement, tips, and education. The results, any prestige or acknowledgement I may get? Those are out of my hands and none of my concern.

The many different options to getting sex addiction help

We’ve talked about the fact that sex addiction (or love addiction) is defined by the inability to regulate sexual behavior despite negative consequences. We also mentioned already that it affects millions of Americans. But how does one get sex addiction help?

Addictive sexual behaviors can range from compulsive masturbation and porn watching, to compulsive cheating, to pedophilia. If left untreated, sexual addiction can severely interrupt daily functions and prevent meaningful relationships from forming. Fortunately, specialized treatment centers for sexual addiction are becoming more and more available. In fact, David Duchovny, an actor known to have sexual compulsion issues, just checked himself into one of those treatment centers.

Sex addiction help options

There are a number of behavioral and pharmacological therapies that are commonly used to treat compulsive sexual disorders. This review of sex addiction help options is not exhaustive by any means, but it’s long, so take your time:

Individual therapy can help patients address any underlying issues that may be contributing to their abnormal sexual behavior. Surveys of sex addicts show that up to 40% have anxiety disorders, 50% have substance abuse disorders, and 70% have mood disorders (1). Resolving these issues can greatly increase a patient’s chances for a successful recovery from sexual compulsion. There are many different forms of individual-psychotherapy, including Freudian, humanistic, and object centered. The important thing is to find a therapist that fits the patient’s individual style and that makes them feel comfortable.

Cognitive-behavioral therapy (CBT) is very common in treating sexual addiction. CBT teaches its patients to correct irrational thoughts, beliefs, and feelings that lead to addictive sexual behavior (1). In practice, this is often done by role playing, journal keeping, and actual workbook homework. By adopting a healthy mindset, patients can better understand their urges and prevent relapse into unhealthy sexual behaviors. CBT can be practiced within individual sessions or as a form of group therapy.

Group therapy and 12-step programs based on the Alcoholics Anonymous model provide a non-hostile environment where patients can share their experiences and provide support for each other during recovery. Shame, a major issue for sexual addiction, is often best dealt with in a group setting. (2)

Family counseling and couples counseling are also common during recovery. Counseling can help rebuild trust and intimacy that has been lost as a result of compulsive sexual behavior (3). Like individual therapy, these forms of counseling allow for a slightly more tailored, personal approach.

Drug therapy may be used in conjunction with psychotherapy to treat sexual addiction. Selective serotonin reuptake inhibitors (SSRIs) and lithium have been reported to reduce the frequency and intensity of urges to engage in addictive sexual behaviors (2). In more serious cases of sexual addiction such as sexual predation, gonadotropin-releasing hormone and chemical castration agents may be administered to reduce sexual drive. These forms of therapy can allow a reduction in the compulsions that drive the behavior, sometimes allowing the patient to better focus on the therapeutic efforts.

Sex addiction bears great resemblance to substance abuse. However, the goal in treating sexual addiction is not abstinence, but the development of healthy sexual practices (who wants a life without sex?). Compared to substance abusers, it generally takes longer for sex addicts to adopt a healthy lifestyle.

What to expect from sex addiction help

The first year is the most turbulent and poses the greatest risk for relapse as the patient is often experiencing difficulties with their occupation, relationships, or health as a result of their addiction. From the second year of recovery and onward, patients begin to regain the ability to form meaningful relationships and move forward in their personal life (4). However, patients often find that the struggle with their addiction is ongoing, at least for the first few years of their “recovery.” Considering how long it took for the unhealthy habits to develop, it’s no surprise that a substantial amount of time is often needed to reconfigure them.

The important thing is to have support and to take your time. My wife and I work with couples and individuals who struggle with sex addiction and intimacy issues and often times, in addition to the work, it requires patience and the passage of time. Success often comes on the 2nd, 3rd, or even on a later treatment attempt. If the motivation is there, the chance of beating sexual addiction is good. Keep your focus and try different options or combinations.

If you’re interested in working with us, please contact us and we will be in touch as soon as possible.

Citations:

1. Briken, P., Habermann, N., Berner, W., and Hill, A.(2007) Diagnosis and Treatment of Sexual Addiction: A Survey among German Sex Therapist, Sexual Addiction & Compulsivity,14:2,131 – 143

2. Schneider, J.P. & Irons, R.R. (2001) Assessment and treatment of addictive sexual disorders: Relevance for chemical dependency relapse, Substance Use & Misuse, 36(13).

3. Salisbury, R.M.(2008) Out of control sexual behaviours: a developing practice model, Sexual and Relationship Therapy,23:2,131 – 139

4. Goodman, A. (1998) Sexual addiction: Diagnosis and treatment, Psychiatric Times, 15(5)

About addiction: Exercise, stigma, marijuana, and friendhip.

Here we are again. I’ve been slacking on this, but check out the new crop of great articles about addiction. As usual, if you press the title of this post, you’ll be rewarded with our relevant posts!!!

MSNBC: Exercise may help prevent substance abuse – Here’s an article that reports on some of the findings I’d recently talked about here.

Addiction Inbox: Treating addicts like human beings – About the stigma and shame associated with addiction.

Addiction tomorrow: Marijuana – a gateway drug?

Addiction recovery basic: Friendship in recovery – Having social support and friends is important, especially when trying to make huge changes in lifestyle like quitting an addiction.