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Addiction Alternatives for Recovery.

Who would have predicted when William Griffith Wilson founded Alcoholics Anonymous in 1935 that his twelve-step program would become the basis of the U.S. recovery movement? Today one can join a twelve-step program for just about any self-defeating or compulsive behavior: Cocaine Anonymous, Debtors Anonymous, Dual Disorders Anonymous, Ethics Anonymous, Gamblers Anonymous, Nicotine Anonymous, Overeaters Anonymous, Sex and Love Addicts Anonymous, Survivors of Incest Anonymous, Workaholics Anonymous, just to name a few. (See my article "The Tenacity of Error in the Treatment of Addiction" in the May/June 1997 Humanist for an analysis of AA and its offspring.)

The AA model characterizes addiction as a progressive, chronic, and ultimately fatal disease that leaves the addict "powerless," experiencing a "loss of control" in the ability to refrain from a drug of choice. The model requires a commitment to total abstinence, the embrace of spirituality, and life-long participation in AA or another twelve-step program, because addiction is defined as treatable but never entirely curable.

Despite the fact that it scarcely works and its cure is worse than its malady, the AA model became standardized within the recovery movement in the United States during the 1950s and 1960s. According to Terence Gorsky, a prominent spokesperson within the field of addictions treatment:
 When these people came to us for help, we took two inexcusable positions
 and said, "Take treatment you don't need, or keep drinking until you get
 really sick, then come back." Both of these positions were stock and trade
 in many chemical dependency programs.

And for decades there has been strong resistance to developing alternative programs because, in the first place, a majority of treatment providers, themselves, have been recovering twelve-step addicts and, secondly, those who have opposed the one-size-fits-all dogma have been viewed as heretics. A. Thomas Horvath, president of the American Psychological Association's Division on Addictions, estimates that today more than 93 percent of U.S. treatment centers are still locked into the AA approach.

However, more and more long-term clinical studies are shattering the basic assumptions of AA, and the model that has dominated the recovery movement for more than sixty years has been coming under increased criticism. According to Dr. Joan Mathews-Larson, founder of the alternative Health Recovery Center, "The whole system is antiquated because it isn't based on science." The basis for current "standard treatment" is religion-spirituality and talk-therapy. In his October 1996 Professional Counselor article "The War Is Over: It's Time to Stop Squabbling," Richard A. Rawson suggests that it is time to move on:
 For many in the substance abuse field, the disease controversy has centered
 on whether addiction was a disease of the spirit, disease of the soul;
 disease of attitudes; or a scientifically defined disorder which could be
 studied using the scientific method and treated with empirically derived
 techniques. This controversy has clearly been resolved in favor of science.
 The anti-science zeitgeist, which pervaded the private treatment system in
 the '70s and '80s, is no longer a meaningful influence.

This change in opinion, which has been emerging gradually since the 1970s, has opened the door to the next generation of recovery programs. Today eight such programs have achieved a significant level of success and staying power. A summary of each follows in the order of their historical development:

Women for Sobriety/ Men for Sobriety P.O. Box 618 Quakertown, PA 18951 (215) 536-8026 (800) 333-16116

Women for Sobriety was founded in 1976 by Jean Kirkpatrick in Quakertown, Pennsylvania, in response to the pronounced male bias of AA. As far back as 1946, a Yale University study of AA indicated a radical difference between the recovery needs of women compared to men, yet twelve-step programs treat all members the same. WFS--and later, in 1994, Men for Sobriety--was designed to correct this obvious flaw.

Women for Sobriety and Men for Sobriety maintain a network of self-help support programs throughout the United States, Canada, Europe, New Zealand, and Australia that are sensitive to the psychological differences in the sexes. Grounded in proven principles of cognitive behavioral therapy that emphasize responsibility and individual empowerment, the programs are free and open to individuals with alcohol-related problems. More information about these programs can be found in Kirkpatrick's books Turnabout. Help for a New Life and Goodby Hangovers.

Health Recovery Center 3255 Hennepin Avenue S Minneapolis, MN 55408 (612) 827-7800

One unfortunate aspect of AA is its refusal to acknowledge special dietary requirements associated with many people addicted to alcohol. AA founder William Wilson began to promote biochemical repair within the organization after a special dietary regime and megavitamin therapy cured him of decades-long depression. However, when it was discovered that Wilson's psychiatrists had also introduced him to LSD, a scandal ensued, Wilson was banned from promoting the treatment, and biochemical repair was largely dismissed as just another form of drug abuse until much later. In response to this, Dr. Joan Mathews-Larson in the mid-1970s formulated a holistic treatment approach that places a strong emphasis on diet and biochemical repair, which reports a success rate of 74 percent within the time frame of a three-and-a-half-year follow-up when used in conjunction with psychological counseling.

Mathews-Larson discovered that many alcohol-dependent persons have some kind of biochemical deficiency. For example, of those who initially entered her program:

* 75 percent were hypoglycemic (low blood sugar), which can result in a variety of symptoms, including depression

* a majority suffered from malnutrition (deficient in several key vitamins and minerals), as excessive alcohol consumption inhibits the body's natural ability to absorb essential nutrients

* tobacco, caffeine, refined sugar, simple carbohydrates, and processed low-nutrient diets were common among recovering addicts (and often recommended as a substitute for alcohol by AA-model treatment facilities) and can induce physical cravings, cause mood swings, and precipitate depression.

These mental states provide internal cues and can lead an abstinent addict to return to alcohol in order to ameliorate the symptoms. Mathews-Larson went on to found her Health Recovery Center in. 1980. More information can be found in her book Seven Weeks to Sobriety.

Secular Organizations for Sobriety 5521 Grosvenor Boulevard Los Angeles, CA 90066 (310) 821-8430 FAX (310) 821-2610 clghouse.htm

Secular Organizations for Sobriety was founded by James Christopher in 1986 in North Hollywood, California. Later adopted by the Council for Secular Humanism, SOS is a forthrightly nonreligious, abstinence-based self-empowerment program that uses what it calls cognitive/visceral synchronization and the principles of cognitive therapy to help its members deal with the issues associated with chemical dependency. It views addiction in terms of three major components: a physiological need, a learned habit, and a denial of the need and the habit.

Membership is free and there are separate support groups for addicts and their family members worldwide. More information about SOS can be found in James Christopher's books How to Stay Sober: Recovery without Religion and Unhooked: Staying Sober and Drug Free and in the Sobriety Handbook: The SOS Way.

Rational Recovery Systems, Inc. P.O. Box 800 Lotus, CA 95651 (530) 621-4374 (800) 303-CURE FAX (530) 622-4296

Unhappy with SOS's basic premise that addiction is forever, the American Humanist Association sought an alternative to offer its members. So when Rational Recovery was founded in 1986 by Jack and Lois Trimpey, based originally on the therapeutic system of psychologist Albert Ellis, it was soon adopted as a project of the AHA. RR has since become independent again and has developed a new method of "planned abstinence" using an approach called addictive voice recognition technique (AVRT), based on the experiences of former addicts.

AVRT is not a treatment, counseling, or therapy; nor does it involve psychology, spirituality, or religion. RR views these as personal matters that have nothing to do with acquiring, maintaining, or ending an addiction. RR maintains that the worst way to quit something you love is one day at a time. AVRT is a thinking skill that helps addicts recognize and resist the internal "voice" that pressures them to use chemicals for their effect--the sole cause of addiction--once and for all time. More information can be found in Jack Trimpey's books The Final Fix for Alcohol and Drug Addiction: AVRT and Rational Recovery: The New Cure for Substance Addiction.

DrinkWise University of Michigan Health System M-Fit Health Promotion Division 24 Frank Lloyd Wright Drive P.O. Box 435 Ann Arbor, MI 48106 (734) 998-WISE (800) 222-5145 FAX (734) 998-9479

An unfortunate aspect of the U.S. treatment system is its refusal to recognize the problem drinker: millions of individuals whose drinking causes considerable harm, yet most of whom are not physically addicted to alcohol. AA doesn't differentiate problem drinkers from alcoholics, so only recently have moderation programs--also called secondary prevention programs--become available.

DrinkWise was inspired by the work of Canadian psychologist Martha Sanchez-Craig, who in the 1970s began research into "controlled drinking" after discovering that some of the alcohol abusers within a half-way house had learned to moderate their drinking to two or three drinks per day. Twenty years of subsequent research has confirmed her initial findings:

* individuals who exceed four drinks per day for more than three days per week begin to exhibit symptoms of alcohol abuse (legal, health, and employment-related problems, such as drunk driving charges)

* physical dependence upon alcohol begins at approximately fifty-six drinks per week (a drink constitutes a twelve-ounce glass of beer, a five-ounce glass of wine, or approximately one and a half ounces of hard liquor).

Therefore, DrinkWise targets those individuals who have between twelve and fifty-six drinks per week as being "at risk." According to Health magazine's Benedict Carey in 1995:
 Since 1991, the Guelph DrinkWise program [where the program was founded]
 has had a 70 percent success rate, matching Sanchez-Craig's original study
 and several other trials of the program among heavy drinkers in Spain,
 Brazil, Mexico, and India. For any substance abuse program, 70 percent is
 respectable. In a more hardened population, for instance, the Hazelden
 Foundation reports a one-year success rate of about 55 percent, but no
 independent researchers have checked this number. The Betty Ford Center
 claims a success rate of 50 to 83 percent, though it, too, has denied
 outside researchers access to its records.

Individuals who are in a state of acute personal crisis, are chronically unemployed and lack social stability, are currently dependent upon illegal drugs, or have serious health problems related to alcohol abuse are not accepted into DrinkWise and are instead referred to other community resource agencies. DrinkWise offers telephone counseling for clients who lack geographical access to the program, and fees are charged on a sliding scale.

Alcohol and Drug Abuse Self-Help Network, Inc. D.B.A. Self Management and Recovery Training SMART Recovery Central Office 24000 Mercantile Road, Suite 11 Beachwood, OH 44122 (216) 292-0220 FAX (216) 831-3776

Self Management and Recovery Training (SMART) evolved out of Rational Recovery due to a divergence in structure and philosophy among RR activists. Originally incorporated in 1992, SMART emerged in its present form in 1994 to manage and supervise an international network of free, secular self-help programs that assist its members in maintaining abstinence from alcohol and other addictive drugs. Based originally upon Albert Ellis' principles of rational emotive behavior therapy (REBT), SMART offers a continuum of recovery primarily focused on quality of life.

The program has three goals achieved through scientific practice and knowledge: abstinence from addictive chemicals, nurturance of emotional independence and self-reliance, and assistance to individuals in giving up dependence on support groups. Within meetings, members learn to identify their own ongoing patterns of self-destructive behavior in order to alter them and, thus, avoid a relapse. Members are also encouraged to adapt long-range life goals and implement short-range objectives to achieve these goals. More information can be found in Smart Recovery: A Sensible Primer by Dr. William Knaus and the SMART Recovery Members Manual available from SMART.

For information on REBT, visit the Albert Ellis Institute website at, which includes a list of audiotapes and books, including the book When AA Doesn't Work for You: Rational Steps to Quitting Alcohol by Albert Ellis and Emmett Velten.

Discovery Empowerment Groups Many Roads One Journey Box 1302 Lolo, MT 59847 (406) 273-6080 FAX (406) 273-0111

The Discovery Empowerment Groups network was organized in 1992 by author-therapist Charlotte Davis Kasl in response to the learned and institutionalized helplessness she says embodies twelve-step programs. Because many addicts find the traditional focus on conformity, confession, humility, and powerlessness counterproductive to recovery, Discovery Empowerment Groups in stead focuses on overall personal growth achieved through a sixteen-step program that allows members to choose their own path to recovery from a variety of diverse alternatives for achieving a high quality of life.

Kasl has reframed the concept of codependency as a form of internalized oppression and encourages group members to address addictive behaviors along with the sometimes related issues of sexual exploitation, child abuse, sexism, racism, poverty, and homophobia. More information can be found in Kasl's books Many Roads One Journey: Moving Beyond the Twelve Steps and Yes You Cant A Guide to Empowerment Groups.

Moderation Management Network, Inc. P.O. Box 1752 Woodinville, WA 98072 (425) 483-5292

Moderation Management is an early intervention program founded by Audrey Kishline in 1993 to provide a group support environment to individuals who have accepted responsibility for moderating their consumption of alcohol. A secular program based upon the principles of cognitive therapy, MM has guidelines for both men and women and stresses that limits on drinks within these guidelines are not approximate targets.

Individuals who are severely dependent upon alcohol, have experienced severe withdrawal symptoms, or use addictive chemicals other than alcohol are not encouraged to attempt MM. Its network of free support groups can be found throughout the United States and Canada. More information can be found in Audrey Kishline's book Moderate Drinking: The New Option for Problem Drinkers.

It is common for resources on addiction recovery and treatment to omit information on alternative programs. And although the American Psychological Association has come out in favor of requiring scientific studies as a measure of program effectiveness, there is no one agency in charge of regulating the field. In Massachusetts, for example, no license is needed to start a recovery group, and addiction counselors receive state certification after completing only one year of instruction. Combine with this the usually anonymous nature of these groups and the possible high vulnerability of their members and the need for consumer awareness becomes especially important.

While this article provides a practical background on alternative programs, individuals looking for assistance in dealing with addictive behavior are well advised to thoroughly explore all available recovery and treatment programs and then make an informed decision concerning which are in their best interest.

Michael J. Lemanski is a member of the National Association for Children of Alcoholics and has been active in the Adult Children of Alcoholics movement since its inception in the early 1980s. He currently serves as coordinator for Self Management and Recovery Training in Massachusetts.
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Author:Lemanski, Michael J.
Publication:The Humanist
Geographic Code:1USA
Date:Jan 1, 2000
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