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Newsletter Volume 1, Number 1
I
developed and implemented programs including inpatient and outpatient
dual diagnosis, inpatient and outpatient codependency and intern
training programs.In the thirty plus of my background: I worked in the
addiction and psychiatric field for more than thirty years. My
positions ranged from Counselor to Director of Dual Diagnosis in a
psychiatric hospital. During the years I worked in the addiction field
I observed numerous changes in the treatment field. Interestingly, much
of those changes were never noticed by the news media. Many popular
attitudes are very similar to those from fifty or more years ago.
Ernest Hooker, NCAC IIPopular Beliefs about Addiction that are Merely Outdated Myths
In
this first newsletter I want to address some popular beliefs about
addiction that are simply not true. One of the leaders in research and
studies in the addiction field was the late Sidney Cohen, M.D. Much
has been said about his ability to get to the truth in the field of
addiction and it may be summed up by Robert L. DuPont, M.D., former
Director, National Institute on Drug Abuse. He said “When Sidney dealt
with a topic, what he said was simply the way it was.”
Doctor
Cohen was asked about the addictive personality. His reply was “There
is none.” The theory of an addictive personality is one of the myths
that persist.
Personally, I see it as three areas that are not
considered in a specific way. First, there is physical addiction to the
drug; second, there is habit; third; there is compulsion. Many people
see addiction as just a compulsive personality before and after the
fact. The truth is after a few years of successful recovery there are
no more compulsive problems with alcoholics than in the general
population.
Another belief is that drug and alcohol addiction
is self-medication. Doctor Cohen states “From clinical experience this
reasonable assumption does not hold true.” He goes on to discuss how
often the drug user uses the very drug that makes his or her condition
worse. At other times it has no relevance. Another myth bites the dust.
If
you are interested in Doctor Cohen’s work check your local library or
go to http://www.alibris.com/ and do a search for Sidney Cohen, M.D.
They have many used books at a moderate price.
The Evolution of Addiction Treatment
In
the fifties inpatient alcoholism treatment started in a state hospital
in Willmar, Minnesota. Shortly after that the Swift family donated land
in Center City, Minnesota for a nonprofit treatment Center. Hazel
Swift had operated Hazel’s Den on that land, and so the treatment
center was named Hazelden.
In the fifties and sixties addiction
was most often viewed as drinking or taking too much drugs. This
included believing the addiction ended up that way due to character
flaws. Sad to say, even in this day and age I have heard healthcare
people describe the problem as drinking too much. That implies that if
only they would control the quantity everything would be fine.
Alcoholics and addicts in treatment often sensed there was something
wrong with this model. For a few decades treatment was a battleground
where all the focus was on confronting denial.
Gradually,
multi-disciplinary models developed and treatment started to change.
Some ways for the better and other ways possibly not so good. In the
early days if they could be medically stabilized enough to attend
twelve step meetings the meetings were highly effective. They had a
“perverse” desire to have new people actually work the steps
immediately!
Recognition of dual diagnosis issues started
showing up in treatment programs. At first, those who worked in the
mental health field recognized mental illness in the addicts and
thought treating the mental illness would also straighten out the
addiction. Those in the addiction field tended to believe that working
on the addiction would fix the mental illness. Of course, they were
both wrong. Later they found treating both problems concurrently was
quite successful.
Along came a new model of addiction by James
R. Milam and Katherine Ketcham. A key point is that alcoholism is
primarily physiological, and alcoholics become addicted because their
bodies are physiologically incapable of processing alcohol normally.
This brought up a howl of protest from mental health professionals and
numerous others. The only thing that was in favor of the “Under The
Influence” crowd was that it worked. Families and patients accepted it
in droves, there was less confrontation in treatment and more people
recovered with less effort. It made sense to patients and families.
Many people reported their recovery was entirely due to reading the
book “Under The Influence” written by Milam and Ketcham.
During
the eighties treatment centers were full and every day new treatment
centers were being opened. This flooded twelve step programs with new
people that were fresh out of treatment. Many had their own ideas of
how to improve these twelve step programs. In many instances, working
the steps became a chore that could be put off for the more “important
work” of new members expressing their negative emotions and innovative
ideas.
In numerous cases twelve step meetings became
ineffective. At some point this was recognized and a Back to Basics
twelve step program emerged. Which has been highly effective! If you
are interested in a history on Back to Basics go to:
http://aabacktobasics.com/
More at another time.
Ernie
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Newsletter Volume 1, Number 2
I have observed
numerous changes in the treatment field and not
always for the better.
Ernest Hooker, NCAC II
What was lost when treatment decided to improve on the twelve steps
In
this second newsletter I want to discuss the role of step work,
specifically step one from a treatment outlook. Several years ago step
one powerlessness was viewed as loss or grief work. Most treatment
centers had specially trained clergy counselors to assist with various
phases of step work. The clergy was very well equipped to guide
patients in the grief process. This makes sense when you consider that
financial, professional health and other losses due to addiction are
huge. Strong feelings of grief were the result of addiction and not the
cause.
Particularly in the eighties treatment centers were
growing at a fever pitch. Consequently large numbers of employees were
hired to work in the treatment field. Some had degrees in various
disciplines while others had little or no experience or training. Many
had little or no working knowledge of the twelve steps and yet they
were expected to assist patients with step work. In general it was a
disaster and in some cases it diluted twelve step groups and treatment
groups to the point that they were no longer spiritual or therapy
programs.
In the late seventies I worked in a state hospital
with six separate treatment units. One of the clergy counselors was a
Catholic priest who was very involved in Alcoholics Anonymous. He
brought in a stack of pamphlets about eighteen inches high and said
they were all separate guides to working on step four. He went on to
show us that most of the authors did not demonstrate any actual
knowledge of understanding step work. Now, don’t misunderstand me, I
believe that psychologists, physicians and other disciplines can be of
enormous help to alcoholics and addicts; however, they need to stay in
the role where they are qualified to treat patients.
Hazelden
has been training clergy counselors for many decades. The last report I
had indicated it was a fifty-five week full-time course. To assume such
a role without any specific training appears to be quite courageous.
Several
decades ago the book “On Death and Dying” by Elisabeth Kubler-Ross was
very popular and gave some insight into the stages patients go through
when they know they are dying. Somehow this was considered by some to
be a therapy book on all forms of grief and loss. That simply wasn’t
true. Elisabeth Kubler-Ross never claimed her work to be a therapy
strategy. It was just what it was supposed to be - an excellent study
of the stages of grief when a person is dying. Some still teach this as
a gold standard in therapy for loss. There is excellent information on
grief, loss and step work at Hazelden and other sources. My favorite is
the Grief Recovery Institute.
Along the way focusing on
powerlessness as loss became out of fashion in much of treatment. The
patient might get some generic label of depression instead. In some
cases this attitude was taken into twelve step groups and then venting
and discussion replaced the original step work. It was at the point
where hard core twelve step people had to be very careful about their
choice of groups. Some even had groups that were not commonly known
about to keep the original focus on the steps.
Patients at
times ended up with the best advice from their local church. Patients
that recognized grief as a primary problem and attempted to seek a
therapist that would focus on grief often had a difficult task.
Therapists frequently preferred to talk about a generic diagnosis of
depression and avoid any mention of grief or loss. Of course, there
were also those who ended up being prescribed antidepressants for their
problem. Now I don’t have a concern about the use of antidepressants
for certain depressed patients; however, I think it is an inadequate
answer to grief issues.
Due to the lack of help for the
recovering alcoholic working on loss the Grief Institute was started. I
know of no other place that offers more to the recovering alcoholic or
addict on dealing with loss. I strongly believe that anyone directly or
indirectly affected by addiction should at the very least have the “The
Grief Recovery Handbook“. The Grief Recovery Institute can be contacted
on the internet at: http://www.grief-recovery.com/
They offer training for professionals with certification, personal workshops and more.
Both the Grief Institute and Alcoholics Anonymous Back to Basics came out of an unfulfilled need.
Ernie | |