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Christmas Day Smart-a-Thon

2013-12-22T16:58:22Z

For many years, SMART Recovery Online (SROL) has hosted an annual event around the New Year’s holiday entitled SMART Around the World. This was a well-attended event celebrating the New Year as it began in each and every time zone around the globe. Heretofore there is been no celebration on the Christmas holiday.

This year, for the first time, we are pleased to announce that we are hosting, a Christmas SMART-a-Thon. This will be a continuous SROL meeting facilitated by a number of generous, volunteer facilitators every hour. The purpose of this event is to provide a place for those who may be alone, frustrated, in need, or feeling challenged in any way during this holiday. It will be a place to go and communicate with others, find support, and perhaps even work on issues. It will also be a place to celebrate and have some fun!

Each facilitator will likely run their meeting in his/her own particular way. Therefore, there may be or there may not be a check-in at the beginning of every hour or other aspects of a meeting that you may be familiar with. However, as issues are raised throughout the day, appropriate tools will be applied and discussed as the group searches for and identifies solutions for the various challenges.

This is meant to be a fun event!! And hopefully there will be considerable humor and storytelling as well as relating of successes that have occurred over the previous year. The plans are not finalized but we will likely kick off at Noon EST and finish at around 10 PM EST. Visit www.smartrecovery.org for details coming soon.

We wish to extend a special welcome to family and friends of those in recovery who also may be having issues or challenges of their own around the holiday. This is a meeting for EVERYBODY!!!

Due to the nature of the meeting, which is not specifically a recovery meeting, no court verification will be provided.

Be sure to sign up at the message boards so that you can get into the chat room on Christmas Day. Visit http://smartrecovery.org/community/register.php in order to register.

I sincerely wish a great welcome to all on this holiday and look forward to seeing you at the SMART-A-Thon!

Mabb aka Bill

Stinking Thinking

2013-12-11T20:54:33Z

Stinking thinking; negative, destructive self-talk; or irrational beliefs

The TED Talk linked below is about the above titles and more. It is an inspirational 16-minute video by a woman (Valerie Mason-John) who has overcome great adversity, including addiction, by addressing stinking thinking. She sounds like an embodied SMART Recovery meeting without ever mentioning SMART. She includes what is called loving-kindness, a form of meditative practice also called Metta, often used in Mindful Awareness.

This talk is the ABC tool in use as well as disputing cognitive distortions. It encompasses the DISARM tool. It’s about the USA tool and acceptance. It’s about compassion and empathy and forgiveness. It’s about coping with bullying including bullying yourself...

Please be kind to yourself and watch it... and enjoy

https://www.youtube.com/watch?v=5TKR-IKtaCg

New Definition of Substance Abuse??

2013-12-07T18:49:46Z

??New Definition of Substance Abuse??

I’m not sure of the general interest here but thought I’d post and comment for those who may be interested.

I find it interesting for two reasons and I'll comment on each. But first what is it??

Well it’s NOT psychobabble for sure but is sure illustrious of the dilemma of just what is addiction anyway

This rather long article by a much respected psychiatrist proposes a new method of classifying and diagnosing Substance Use Disorder (the new term in the DSM 5). The current way is with a constellation of “symptoms” such as tolerance and withdrawal.

The new way is to calibrate heavy use over time without the adverse consequences in the mix. In concept this idea has merit for many reasons and for sure the potential for de-stigmatizing addiction by framing it as more of a bad habit than a disease or a moral failing or weakness.

On the other hand, it just reemphasizes my criticisms of all the mental health fields fir not using hard evidentiary tools to try to actually quantify in objective terms what is going on. For sure, neuroscience is not there yet, but there are some things that can be used to help clarify diagnoses in a more objective way. We don’t see the kind of objectivity in practice today or in the new DSM 5.

I mean, just what is meant by the word heavy?? And how much time is critical? There is no way that that can be the same for everyone - not withstanding known gender differences. What’s heavy for one might be fine for another. How can you make assumptions about harmful or hazardous use without defining those terms – and then how do you do that specifically? How can you ensure that self or other reporting is accurate in the first place? Who knows just what’s in that pipe or glass? At least we know how much ethanol is in a 1 oz. shot of booze. However, who knows how much THC is in a puff of marijuana?

I’m not going to go on here and will just get this out there. Until the addictions field starts to look at this problem using objective and quantifiable terms and concepts, we are going to stay in the dark.

Nonetheless, the ideas posed here are interesting and worth the time to read.

http://www.medscape.com/viewarticle/813111?nlid=40763_421&src=wnl_edit_medp_psyc&uac=167929HK&spon=12

Mindfulness; a personal perspective and experience. A different look.

2013-12-02T19:13:05Z

Mindfulness; a personal perspective and experience

A different look.

Alas it’s been a long time since I’ve posted on this topic. Partly, I've been bogged down with the struggles over the science piece. I've also been busy getting active in the SMART Recovery Online community. Parenthetically, I invite you all to join me there - it’s become a very active and interesting place. See: smartrecovery.org.

This post was prompted by a recent TED talk I saw — a link to which is added at the end of this blog. It is by an interfaith monk, Brother David Steindl, in a presentation about gratefulness. This description sounds somewhat interesting. However, what the talk is actually about is capturing reality in the present moment or about presence, otherwise known as Mindful Awareness, but without ever calling it that.

Brother Steindl offers the opportunity to experience emotions, both good and bad, being grateful for the ability to do that, and as a result to feel happiness. This is because the good emotions are far more prevalent when you honestly look at the moment with gratitude that happiness is almost automatic — if you allow yourself to experience it.

Steindl clearly points out that a universal wish or desire in all humans is to be happy — we share that. How we attain that state differs, of course. But then he introduces the idea of gratefulness and further that gratefulness leads to happiness, not vice versa.

This state happens because you have received something of value that is freely given, which can lead you to feeling grateful, and hence to happiness. This feeling doesn't happen just once in a while — you can have it all the time. This is because you always have the opportunity for it in the present moment. This is the essence of Mindful Awareness.

Every moment we have is a gift of value and it’s freely given with no strings attached. It’s just here to experience and enjoy it. Thus the gratefulness is for this moment, which is always present, and then the feeling of happiness that stems from that gratitude.

His simple formula to do this: Stop… Look… Go!! The meaning is likened to what we tell a child to do when crossing a street. Stop to experience the current moment, look at what is there, and take some kind of action (go).

This formula reminds me of the concepts of Pause so prevalent in similar approaches.

This is a short and very powerful message and I highly recommend that you spend a few moments to watch the talk.

This is a different look at a much talked about concept which never once mentions faith, mindfulness, or psychology

Cheers.

Click here for talk.

Motivational Interviewing- a quick review

2013-11-27T00:41:40Z

QUICK REVIEW

At last months training meeting we had a workshop on MI or Motivational Interviewing. Here is a reminder/summary of this important technique for us.

Motivational Interviewing: Helping Patients To Be Thankful

Patients, Staff

by stratus

Sometimes we need the help of others to really appreciate what we have. For many of your patients, their lives are improving after weeks, months, or years of continued substance abuse. Now that patients are managing their addiction you can support their progress by using these four fundamental steps of motivational interviewing.

1. Use open-ended questions

Open-ended questions allow you and your patients to have a discourse about their treatment and life. With Thanksgiving approaching maybe they need help pulling out reasons to be thankful.

Examples:

Why did you want to seek treatment?

How does your continued treatment make you feel about your future?

How were you feeling this time last year? How are you feeling now?

2. Affirm patient change talk

By asking questions like the examples listed above, your patients will respond with more in depth answers. If their answers display their desires and efforts to change you can offer affirming statements to show support.

Example:

Patient: Last time this year I spent Thanksgiving using Oxycodone. I don’t remember seeing my family. This year, I’m actually going to my mom’s for Thanksgiving. I haven’t gone in years.

Practitioner: It sounds like you have made some great progress in repairing family relationships. You have come a long way in a year and it’s great that you and your family can see that.

3. Listen and reflect patient’s expectations

Show your patients that you understand what they are saying by using reflective speech. By rephrasing their sentiments your patients will see that you’re listening to them.

Example:

Patient: I sought treatment because I wanted to change my life. I wanted to get a job and see my family again.

Practitioner: It’s good that you want to improve your own life by getting a job as well as by re-establishing your relationships.

4. Summarize

When talking with a patient you can use summaries to transition topics during sessions, or to wrap up the end of a session. Summaries remind the patient of the points of your discussions, as well as supporting their progress.

Example:

Practitioner: While your past holidays have not been ideal, you have shown a lot of courage by taking steps to manage your addiction. Your progress with your family relationships provides support in your continued treatment. Take time to appreciate how far you’ve come and how far you can continue to grow in the following year.

http://www.stratusemr.com/blog/?p=2207

Triggers and Tethers

2013-11-15T13:38:24Z

THIS PIECE WAS SUBMITTED BY MATT ROBERT

In a previous blog, I recommended that SMART abandon their use of the term "crosstalk" to mean "open discussion." Here I'd like to propose introducing a new term into the language of recovery— one that fills an empty space, where a core term might be useful. I'm talking about a positive counterpart to the term "trigger."

Most people know "trigger" as a cue that can initiate a negative behavior. It can be a person, place, a familiar situation— anything that may compel somebody to return to thebehavior they are trying abstain from. Common triggers involve seeing a familiar bar or liquor store, running into a using buddy from the old neighborhood, something that causes undue stress. These are things people spend a lot of time avoiding in early recovery, and developing strategies to manage them more effectively.

But what about the things that help re-engage a person in life— that give their life meaning? Going to church, exercise, meditation, walking their dog—the things that help to hold on to sobriety, not threaten to wrench it away, like triggers do. Things people try to learn or rediscover in recovery, to fill the gap that using once filled. Usually these things are specific activities or events, just like triggers are. Yet there is no general term such restorative habits and activities.

"When I'm tense, I visit my grandchildren. That helps me stay sober, and not want to drink. That's a real (blank) for me." That's a real anchor? Refuge? A lifeline? A solace? That's a real safety?...the thing that stops the trigger?

The diversity of what "trigger" connotes would be mirrored by its positive counterpart, although a single widely accepted term doesn't exist.

Trigger is a useful term mostly because it is a salient metaphor for the particular experience of being influenced to do something reflexively that you are trying to avoid.

So what are some possible examples of metaphors of a functional scenario that aids, or protects, or bolsters one's recovery. Does it restrain you? Does it shield you? Does it protect you? Does it free you? Does it support you?

One possibility is the word, "tether." It has a several shades of meaning, all related to connection, protective restraint and safety. For example, a boat tethered to the dock is safe because its mooring prevents it from being carried out into the open sea. A tether can be a lifeline followed to safety in a blinding blizzard. A tether is the air hose of a deep sea diver, that connects him to the surface, to air, to safety. A tether connects a novice to a more experienced mountain climber. A tether keeps a spacewalking astronaut from floating off into the unknown darkness of space. A tether keeps a dog close to its home, so it doesn't run off and harm itself or others. A tether can be used by an addict to stay attached and close to sobriety, not venturing past unsafe boundaries. And with time, the tether can be lengthened more and more, until it is no longer necessary. Tether can be a metaphor for a connection to safety and sobriety. "After work, I always take a run to ease the stress of the day. That's been a real tether for me."

Having a generic term for these activities or states could facilitate discussion with a catch-all term people could refer to. It could also reinforce the primary importance of this concept in recovery to maintain sobriety.

Trigger and tether are words that describe the two most important emotional states in recovery—the urge to use and the motivation to abstain. Therefore, they would be useful labels in discussion, because they highlight both the negative and the positive aspects of recovery generically. What to pursue and what to avoid. Such discussions can support a healthier balance and move the focus toward the positive, not just the negative— from the prohibitive to the productive.

The world of recovery has plenty of negative terms for relapsing and its causes. Wouldn't it be helpful to have a reliable term for the positive stuff we do to keep it together?

Please contribute to the blog with any preferences, suggestions or recommendations for something to fill this void and enhance our discussions in recovery.

Matt Robert

The Power of Choice

2013-10-02T21:54:42Z

Here is an article I copied from a recent issue of The Atlantic. I believe it is of interest here since really does emphasize the importance of choice in recovery .

Its indeed too bad the author ignores the all important aspect of choice where one now seeking to recover can use that option since there is now a clear choice as to how one wishes to go about it. The real world is just so perpetually dominated by the ideas of 12 step recovery . Its changing of course but not fast enough for me. And all we can do it just keep talking about it . Its really catching on—now over 1000 meetings in face to face format.

The author cites the work of Carl Hart. This is involved in the concept of whats known as delayed discounting – a very real thing in psychology circles . However Id also have to say that Hart’s work is not entirely without criticism because there are some flaws in his research .

However that does not detract from the major message here that choice is important and having it leads to better outcomes in those who exercise it . As weve often said in meetings; its great to live after a while without that stuff ( whatever it is ) and also have the satisfaction of knowing that your success is due to you and your hard work and time well spent in attending to it . Better life and self satisfaction . Cant beat it !!!

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In December 1966, Leroy Powell of Austin, Texas, was convicted of public intoxication and fined $20 in a municipal court. Powell appealed his conviction to Travis County court, where his lawyer argued that he suffered from “the disease of chronic alcoholism.” Powell’s public display of inebriation therefore was “not of his own volition,” his lawyer argued, making the fine a form of cruel and unusual punishment. A psychiatrist concurred, testifying that Powell was “powerless not to drink.”

Then Powell took the stand. On the morning of his trial, his lawyer handed him a drink, presumably to stave off morning tremors. The prosecutor asked him about that drink:

Q: You took that one [drink] at eight o’clock [a.m.] because you wanted to drink?...And you knew that if you drank it, you could keep on drinking and get drunk?

A: Well, I was supposed to be here on trial, and I didn’t take but that one drink.

Q: You knew you had to be here this afternoon, but this morning

you took one drink and then you knew that you couldn’t afford

to drink anymore and come to court; is that right?

A: Yes, sir, that’s right.

The judge let stand Powell’s conviction for public intoxication.

Two years later, the Supreme Court affirmed the constitutionality of punishment for public intoxication, rejecting the idea “that chronic alcoholics … suffer from such an irresistible compulsion to drink and to get drunk in public that they are utterly unable to control their performance.”

Now, fast-forward almost half a century to the laboratory of Carl Hart, a neuroscientist at Columbia University, who has been showing that cocaine and methamphetamine addicts have a lot in common with Powell. When Hart’s subjects are given a good enough reason to refuse drugs—in this case, cash—they do so too.

The basic experiment goes like this. Hart recruits addicts who have no interest in quitting but who are willing to stay in a hospital research ward for two weeks for testing. Each day, Hart offers them a sample dose of either crack cocaine or methamphetamine, depending upon the drug they use regularly. Later in the day, they are given a choice between the same amount of drugs, a voucher for $5 of store merchandise, or $5 cash. They collect their reward when they’re discharged two weeks later.

More often than not, subjects choose the $5 voucher or cash over the drug, except that, when offered a higher dose, they go for the drug. But when Hart ups the value of the reward to $20, addicts chose the money every time.

In his new book, High Price—A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, Hart reports that he was surprised by his findings. Wasn’t addiction a dopamine-driven compulsion “that ’hijacked’ the brain and took control of the will?” he asks. As a graduate student Hart was taught that. It's understood that recovered addicts eschew substances for fear that even a small amount could set off an irresistible craving for more.

Neural changes that occur in the brains of addicts do not necessarily disable their capacity to respond to rewards.

Indeed, this has been conventional wisdom in research circles for at least the past two decades. Many of Hart’s colleagues who teach this support their claim with brain scans showing the addicts’ reward pathways ablaze with neural activation. Butstudies going back to the 1960’s show that many people addicted to all kinds of drugs— nicotine, alcohol, cocaine, heroin, methamphetamines— can stop or modify their use in response to rewards or sanctions.

This means that the neural changes that occur in the brains of addicts do not necessarily disable their capacity to respond to rewards. Leroy Powell had surely experienced alcohol-induced brain changes over years of drinking, but they did not keep him from making a choice on the morning of his trial. Hart’s subjects loved cocaine, but they loved cash even more.

It is certainly true that when people have an intense urge to use, resisting is very, very hard. Yet there’s room for deliberate action in the form of “self-binding,” a practice by which addicts can erect obstacles between themselves and their drugs. Examples include avoiding people, places, or things associated with drug use; directly depositing paychecks or tearing up ATM cards to keep ready (drug) cash out of one’s pockets; or avoiding boredom, a common source of vulnerability to drug use.

The decision to self-bind is made during calmer moments when addicts are not in withdrawal or experiencing strong desire to use. And addicts have many of these moments; as a rule, they do not spend all their time nodding out or in a frenzy to obtain more drugs.

No one would choose the misery that comes with excessive use. “I’ve never come across a single person that was addicted that wanted to be addicted,” says neuroscientist Nora Volkow, director of the National Institute on Drug Abuse and an enthusiastic booster of the brain-driven model of addiction. It is true, drug users don’t choose to become addicted any more than consumers of high calorie foods choose to become overweight. But addiction and poundage is not what they are choosing: what they seek is momentary gratification or relief—a decision that is rational in the short-term but irrational in the long-term.

A typical trajectory goes something like this. In the early phase of addiction, using drugs and alcohol can simply be fun; or it can be a form of self-medication that quells persistent self-loathing, anxiety, alienation, and loneliness. Meanwhile once-rewarding activities, such as relationships, work, or family, decline in value. The attraction of the drug starts to fade as the troubles accrue—but the drug retains its allure because it blunts mental pain, suppresses withdrawal symptoms, and douses craving.

Eventually, addicts find themselves torn between reasons to use and reasons not to. Sometimes a spasm of self-reproach (“this is not who I am;” “I’m hurting my family,” “my reputation is at risk”) tips the balance toward quitting. Novelist and junkie William S. Burroughs calls this the “naked lunch” experience, “a frozen moment when everyone sees what is on the end of every fork.”

In short, every addict has reasons to begin using, reasons to continue, and reasons to quit. To act on a reason is to choose. To make good choices requires the presence of meaningful alternatives. And making a series of good choices leads to achievements—jobs, relationships, reputations. These give a person something meaningful to lose, another reason in itself to steer away from bad choices.

In his book, Hart uses his own story to breathe life into what may sound like a sterile lesson in behavioral economics. He grew up in the 70’s in the benighted Carol City in south Florida, facing poverty, racism, domestic violence, bad schools, guns, and drugs. Hart himself stole and used drugs (though he was never addicted) and peddled marijuana. Yet he ended up thriving due to the many alternatives to drugs in his life. He calls these “competing reinforcers”—high school sports, educational opportunities, and mentors. Hart wants all young people raised in despairing circumstances to have those too.

Progressive rehab programs use rewards to encourage completion of job training and attendance at treatment or meetings.

Combating social ills on such a grand stage may be a pipe dream. But, in the realm of recovery from alcohol and drugs, the principle of competing reinforcers has been scaled down to size and is being replicated across the country. Take HOPE (Hawaii Opportunity for Probation Enforcement), a jail diversion program in which addict-offenders are subject to short periods of detention if they fail drug tests., but receive a clean corrections record if they complete the year-long program. One year after enrollment, HOPE participants were 55 percent less likely to be arrested for a new crime and 53 percent less likely to have had their probation revoked than those in a control group.

Hart draws attention to how progressive rehab programs use rewards to encourage completion of job training and attendance at treatment or Alcoholics Anonymous or Narcotics Anonymous meetings, and so on. Consequences, rather than rewards, or sticks, rather than carrots, can work too. When at risk of losing their licenses, addicted physicians show impressive rates of recovery. When they come under the surveillance of their state medical boards and are subject to random urine testing, unannounced workplace visits, and frequent employer evaluations, 70 to 90 percent are employed with their licenses intact five years later.

Hart believes that both carrots and sticks, when necessary, should be used far more frequently and creatively in the management of addiction.

As Hart says in his book, “Severe addiction may narrow people’s focus and reduce their ability to take pleasure in non-drug experiences, but it does not turn them into people who cannot react to a variety of incentives.” Although addictions are hard to break, it is most useful to view the potential for overcoming them through the lens of choice. It’s not a matter of just saying no—recovery requires far more grit and conviction than that—but it is very much a matter of regarding addicts as people who can rationally choose to use opportunities to their advantage, and working to provide those opportunities.

Looking at the 12 Steps of AA; Part 4

2013-09-24T15:30:29Z

These last 4 steps really don’t relate to each other, however I will briefly discuss each one separately in one posting to finish off the series.

Step 10. Continued to take personal inventory, and when we were wrong, promptly admitted it.

HS: My sponsor recommended that at the end of each day I write briefly about what happened that day, including anything I didn’t feel great about, as well as stuff I did well—and, if I needed to say to someone, “Hey, I’m sorry for X thing,” doing it right away.

AS: Many CBT clients do daily thought records, or mood logs. Daily “homework” in CBT helps the therapist gain insight into the client’s motivation to change, coping abilities and areas of dysfunction. For the client, it creates and maintains awareness of their thought and behavior patterns, and it puts the work done in session into practice in daily life.

ME: This really doesn’t say too much and hence not much to say about it. Kind of keep paying attention to what’s going on in your head and life – being aware and accepting the good stuff as well as the not so good. A very mindful approach. Yes it is a part of CBT, but certainly not a core one, and one certainly one doesn’t need CBT or a therapist to do this. Just is good common sense.

Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

HS: Even though I am an atheist, I pray on a regular basis. (I’m not much one for meditation.) When pray, I think, “God, help me to stay sober today, help me to stay calm, and help me to be generous toward my fellows.” If something in particular is going on in my life that I’m having trouble with—work, say, or a relationship—I’ll often add that into my prayer. I think of prayer as a tuning fork for my mind that will hopefully direct my attention toward what I want to work on or get better at on any particular day.

AS: Spirituality is not part of CBT, but mindfulness is—and prayer and meditation can lead to the sort of mindfulness that is one of the ultimate goals of CBT. Meditation also can be central to CBT, especially when dealing with generalized anxiety disorder. Relaxation techniques—including more guided imagery (“happy place”), breathing exercises and progressive muscle relaxation—are used to reduce anxiety.

ME: This is blatant religious dogma. Who says anything about spiritual awakening in this step altho AS says it. It sounds good but what is it? But the step tells us to pray to God every day for will and power, and for a religious person that’s maybe not a bad idea. But for the rest of us?? Ive debunked this idea enough already, so lets move on

AS just jumps from spirituality to mindfulness and I’m certainly not going to argue against that. However I’ve just finished reading a book by Albert Ellis the originator of REBT, which is a CBT, and he never mentions either spirituality or mindfulness so I’m not sure what AS is talking about. AS also says incorrectly that relaxation, and guided imagery etc. are mindfulness exercises. Not that any of that isn’t positive and helpful, and may be part of AS’s CBT, but they are not really mindfulness. Yes they are meditative but no not really mindful – paying attention in the present moment with non-judgmental acceptance. No big deal though.

As you know I think Mindfulness is just a dandy idea.

Step 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

HS: My sponsor told me to practice the 12th Step it by taking new guys through the Steps, and participating in AA meetings, by talking to newcomers and doing service. When I guide sponsees through the Steps, I feel like it really reinforces my own “stepwork.”

AS: CBT generally is a short-term therapy, focusing on specific life issues. While CBT clients do not, in turn, become therapists by virtue of their experience, many continue to have therapeutic maintenance sessions to continue addressing target behaviors. As with the 12 Steps, the hope is that, after completing CBT, one will possess the tools to cope with any related situations and address similar target behaviors that may arise in the future.

ME: Presuming we have had a spiritual awakening (whatever that is ) and presuming that they are a result of these 12 steps – and are of a mind to do this and not so frustrated with all the stuff that’s come before, it will be a relief to try to help others with a problem like yours. How can I argue that; after all I’m a Smart facilitator.

AS is correct also IF you have had some CBT during your recovery, and IF it’s been effective, it is good to keep practicing it. And if you can help another who is suffering that is good too. We need more of that in our world today. But I doubt it’s a good idea to be telling people what to do as advocated here; that’s counter to all motivational approaches I know of. Most people I know resent being told what to do and often do the opposite. Maybe part of the reason AA has such a poor retention rate.

So that’s it for this series. I’ve enjoyed writing it and hope you enjoy the thoughts expressed. I also hope you don’t feel it’s too harsh- but remember that this is a blog-a place to express opinion. It may not all be correct but it’s mine. Perhaps some good commentary will follow – and any, positive or negative, is welcome.

On to the next subject in the Mindfulness series – the science

Your science guy.

Looking at the 12 Steps of AA, part 3

2013-09-21T19:27:02Z

These two steps go together and speak to making amends to others in our lives that may have suffered because of our behavior when using- alcohol in this case. I will discuss them both together after Step 9

Step 8. Made a list of all persons we had harmed, and became willing to make amends to them all.

HS: Back to the pen and yellow legal pad: I made a list of all the people I’d hurt or offended over the years, whether directly because of drinking- and using-related behavior or otherwise, and listed the particulars of each case. I “became willing,” again, by just praying and thinking about making amends to these people.

AS: Identifying problematic behavior would be among the first things a client and therapist would discuss in CBT. This would include identifying damaged relationships. Volition is a necessity when it comes to therapy, as success will be limited if the client is unwilling.

Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

HS: With my sponsor I went through the list I’d made in Step Eight, and started getting in touch with a handful of people at a time, telling them I wanted to meet up and talk to them about something. The first one I did was an old boss of mine. I met him at a coffee shop and laid out how my behavior had been lacking, and asked if there was anything I could do to make it right. He said that wasn’t necessary, and everything went fine. Other amends I made followed roughly the same script. I felt good when I finished each one, like I had straightened up something in my past that had gotten out of whack.

AS: CBT focuses on curbing problematic behavior in future situations, but that doesn’t mean there’s no room for addressing past consequences. In fact, doing so can bring validation and support of a client’s new, rational way of thinking. An addict doing the 12 Steps, like a client in CBT, might imagine that trying to make amends would result in hateful words or drama, but instead it is usually a validating and liberating experience.

ME: AS doesn’t really address this per se, although what he does say is correct and does validate the new way of thinking. So that’s good. And yes telling those we negatively impacted might be liberating – but might not and one never knows.

It’s hard to argue that regretting our former behavior and things we said or did with others during our period of substance abuse is not a good thing. We need to be a bit careful with this however because to harbor a lot of guilt about it, that can be harmful. And worse, if it turns to shame that can be a very great burden that impedes successful recovery. It might be better to walk away from this, not forgetting it, but considering it the past and done and something you can’t do anything about and move on.

The idea of telling others about it gets mixed reviews from me. If you decide to do that, and if it is in the way of apology or expressions of regret and remorse that you have done hurtful things you said or worse, then that seems ok.

If it’s done with the expectation of forgiveness, then it’s wise not to do it. They may not forgive you.

Further this might just call up previous memories and emotions that are just as well left alone. There is no way to know this in spite of the caution in Step 9. In addition you might get a barrage of negative responses that might send you down a guilt and shame trip that could become dangerous thereby triggering a relapse.

Personally I apologized to my wife and children, and at the same time thanked them profusely for standing with me and supporting me through it all. The rest of the people in my life I just let it lie- often telling them I quit and that was all.

In our addicted lives we lose a lot of the trust from those close to us. Just telling them things like that you are now abstinent etc., does little to rebuild trust. What does the rebuilding is consistent positive observable results. And you might earn it back and you might not. Hopefully that’s not the main reason motivating you to make a change for yourself for the better.

Part 4 soon to follow will conclude the series with the final 3 and not related steps.

Step 10. Continued to take personal inventory, and when we were wrong, promptly admitted it.

Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

Step 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

See you soon, YOur science guy

Looking at the 12 Steps of AA; Part 2

2013-09-12T22:30:57Z

Before I go any further here let me add a word of explanation. Who am I to be commenting on the psychology of anything and AA and CBT in particular? Well basically I’m a scientist by background- a biological one with years of experience in hard science – that is biomedical areas. I conducted years of scientific study in both clinical and basic medical science and know good science from the rest.

In no way am I a psychiatrist or a psychologist and my closest thing to formal education in the subject is with a year’s course in psychology in college- and then exposure to it in medical school. And most recently some courses on line. But, after med school I then went into surgery of the academic sort at a well-known medical school and center in Boston.

Since I retired now 7 years ago and gave up drinking 6 years ago, I have become fascinated by the science of addiction. I have had firsthand experience with it. I, after recovery, have spent several years studying the psychology and biology of addiction. I have also learned quantum physics because I believe that the mysteries of the mind will be found there. I’m not alone in that by the way.

I think I understand the psychology here pretty well now but yet, I continue to study and learn. And if you know anything about the field, it’s often pretty messy and filled with lots of ideas and opinions but not much hard evidence- at least as I would judge it. Psychologists treat patients by the skills and intuition that come from their training and they are good at it mostly. However they really don’t have much in the way of objective measures to quantify things the same way other scientists do. It’s improving but has long way to go.

So I’m taking a fresh look at some of this stuff- an outsider’s view if you will. And perhaps a fresh one without the bias of lots of years hearing the opinions of mentors and colleagues. But I confess, what I write is largely opinion, but opinion largely backed up by careful study of what’s going on in the field.

I claim no correctness, and wrongness is humbly admitted – and I accept criticism gladly. I’m just here to learn too. But I seriously worry about the negative psychology I see in much of the 12 steps, and feel compelled to express it. Take it in the spirit in which it’s written and decide for yourselves.

So let’s now look at the next 4 steps of the 12, which also are a grouping.

Step 4. Made a searching and fearless moral inventory of ourselves.

HS: First, down the left-hand side of a yellow legal pad, I made a column list of all the people, institutions, or principles with whom I was angry, and why. Later, I went back and noted “What part of [my] self was hurt or threatened?” and “Where was I to blame?” Next, I listed all of my fears and why I had them.

AS: Making columns is much like using “thought records” in CBT. These are guided, often written exercises that are used to keep track of behaviors you want to address and to create awareness surrounding your emotional and cognitive responses. This also can give insight into the origins of our trauma, as well as core beliefs about ourselves and negative cognitions and negative self-talk.

ME: This one by itself is a pretty good idea. And yes it fits into a CBT schema. And being searching and fearless implies being open honest and unconditional, at least to me. A good idea.

However the use of the word moral gets my attention right away. It is a bit tough. Just what do they mean by that?

The dictionary I like is Miriam Webster and in there we find this definition:

1 of or relating to principles of right and wrong in behavior: ethical <moral judgments>

2 expressing or teaching a conception of right behavior moral poem>

3 conforming to a standard of right behavior

Wikipedia says this (this is sometimes a good and sometimes not good resource so be careful)

Morality (from the Latin moralities "manner, character, proper behavior") is the differentiation of intentions, decisions, and actions between those that are "good" (or right) and those that are "bad" (or wrong). The philosophy of morality is ethics.

Morality may also be specifically synonymous with "goodness" or "rightness." Immorality is the active opposition to morality (i.e. opposition to that which is good or right), while amorality is variously defined as an unawareness of, indifference toward, or disbelief in any set of moral standards or principles.^{[1HYPERLINK
"http://en.wikipedia.org/wiki/Morality"]HYPERLINK
"http://en.wikipedia.org/wiki/Morality"[2]HYPERLINK
"http://en.wikipedia.org/wiki/Morality"[3]HYPERLINK "http://en.wikipedia.org/wiki/Morality"[4]}

Well this reference to “moral" seems a bit of a setup for passing judgment on ourselves- good or bad. We all know and accept that our addictive behaviors were not good but. This by implication is that it was bad and becomes a lead into feelings or guilt and shame .and therefore I am bad... immoral or amoral etc. And well hear more on that as we proceed.

So let’s see what number 5 says.

Step 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

HS: I met with my sponsor—for several hours; sitting on a jetty in Jersey City—and talked through everything I’d written down during my Fourth Step. He mostly listened, without judgment, interjecting at points where he saw a pattern appearing, or casually noting similarities to his own story.

AS: Step Five is equivalent to bringing your CBT worksheets/homework to the therapist to review. It facilitates mindfulness—a.k.a. attention and awareness towards your experiences, cued into your feelings and thoughts—which is an important concept in CBT. In this case, the sponsor behaved as a CBT therapist might: he engaged you and interjected his insights to help you notice your feelings and behaviors. CBT says that, by becoming more aware of ourselves, we acquire more awareness in moments of choice. This ideally helps us to avoid our more automatic negative thoughts or behaviors.

ME: This one is actually pretty good too. Even if you aren’t into God, being honest with yourself and accepting that what you did wasn’t so good, and telling someone else that you know and trust, is helpful in my opinion. Yes smacks of the Christian dogma of confession, but in that you are telling a priest which is another person. I won’t go into what he's likely to tell you to do to fix the immorality here.

This is what people do in AA when they say Hi I’m an alcoholic or in SR when they say I have a problem with alcohol. Using the term alcoholic has its own downside but that’s off topic here. But this is an affirmation that you recognize that you do have a problem.

So by telling yourself and others that you have this problem implies you are maybe willing to work on it. So AS and I agree that it is in CBT and helpful. However----- look at what comes next in steps 6 and 7

Step 6. Were entirely ready to have God remove all these defects of character.

HS: For this step, my sponsor told me to make two lists: one of my “small” character defects, and one of my “large.” Into the first I put things like, “lack of physical exercise,” while into the second I put stuff like “envy at friends and acquaintances’ success in their careers.”

AS: This step is reminiscent of the part of CBT in which the client and therapist create goal awareness and engage in goal rehearsal. A therapist will help a client identify situations where an undesirable behavior was demonstrated and decide how the client would prefer to react or behave. The therapist will often then use imagery exercises, encouraging the client to imagine himself in those situations and play out the situation using the desired responses and behaviors. The more practice, the more the client is desensitized to undesired emotions that the situation used to evoke.

ME: This is now starting to worry me, but I’ll comment on this one and step 7 together.

Step 7. Humbly asked Him to remove our shortcomings.

HS: The first time I did this step, my sponsor just told to me pray regularly to have my “character defects” removed. The second time, though, my sponsor (a new one) told me to pick one thing from my “small” list and one from my “large,” and to focus and pray about these items regularly, and also try to take action on them “in the real world.”

AS: A common CBT practice is to have a client create a dysfunctional thought record, which consists of writing about a situation and the emotions it precipitated. Then the client takes note of his automatic thoughts about the situation and the evidence that supports those thoughts; notes the evidence that challenges those automatic thoughts; and finally arrives at a new, alternative and more balanced thought. Praying about one’s character defects could have a similar effect, and repetition of an exercise like this should only increase its positive results.

ME: There you have it. Ouch. Every time I read this I hear the song “Officer Krupski” from West Side Story.

By now I’m realizing AS is an AA apologist. What he says is true for sure about CBT approaches to problems. But and I say BUT,

THIS STEP SAYS SOMETHING ENTIRELY DIFFERENT!! I have become my problem and my problem is bad and therefore I am bad- immoral, amoral and defective. I’m in deep doo doo.

Defects of character??—give me a break.

This is a psychological quagmire. Some in AA call this an important tool. I call it a kiss of despair, a real hit to one’s self esteem and feelings of worthiness as a person.

Worse- now we are told that God is the solution-- note not ill defined Higher Power but G O D!!!! They try to cop out here by using the term “as we understand HIM”. Well I don’t know anything other for the word God with a capital G than an omniscient, omnipotent, etc. being with all the known attributes ascribed in western cultures

Now I must admit that I don’t believe in this God idea , but I’m not a rabid atheist. If this belief is helpful to you, I’m fine with it. But it does seem an overreach here to rely on this. Not only that it’s coercive at least in tone. Must !!

So not only MUST I believe in God, I MUST rely on HIM to fix me . NO way thank you .

God in concept as the only solution. It’s rigid and denies the power of choice which a huge scientific literature supports as effective therapy for a whole host of things

Many have criticized that AA is badly flawed and here I happen to agree. This sort of thing really explains the several decent scientific studies that show that actually AA causes harm. It also explains why the retention rate at AA meetings is so low- about 5% by their own statistics. People give up on it.

Remember natural recovery. The vast majority- maybe as high as 90% in recent studies recover on their own- not needing any formal treatment. For those who come to AA and succeed, perhaps this is because they are naturally religious and AA acts as a form of assisted natural recovery.

Of course the same might be said of Smart but at least the assistance that Smart gives is at least a bit more sensical and less coercive. I don’t really know of course so will just move on here.

Now what AS writes here is mostly true? But it’s a very limited viewpoint. Its cherry picking. And because there are elements of CBT in the 12 steps, that does not mean that they are science based nor are 12 steps groups deeply involved with CBT, that is just not so. AA ET all is a religious approach and in the opinion of many (I don’t totally agree) is more like a cult than a therapy.

Well that’s it for this posting. I’ve really tried while editing to be moderate about these steps, but in that this is a critique cannot with honesty conclude with anything other than negatives about this grouping

It’s taking a person who is down on himself, feels lousy because of the chronic physical effects of drug use, and pushing him further down.

In the next posting I will discuss Steps 8 and 9, which I can be a little more kind about. They are

Step 8. Made a list of all persons we had harmed, and became willing to make amends to them all.

Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

See you next time

Step 8. Made a list of all persons we had harmed, and became willing to make amends to them all.

Similar to a 10th Step, many CBT clients write daily thought records, or mood logs.

Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

Step 10. Continued to take personal inventory, and when we were wrong, promptly admitted it.

Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

ME: This is blatant religiosity. In CBT, at least the kind that AS likes mindfulness plays a role, so I agree. But in mindfulness we are primarily focusing on us, not on a supernatural entity.

Step 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

HS: My sponsor told me to practice the 12th Step it by taking new guys through the Steps, and participating in AA meetings, by talking to newcomers and doing service. When I guide spondees through the Steps, I feel like it really reinforces my own “stepwork.”

ME: To me this is the best of the bunch.