Sunday, December 8, 2013

Hazelden Offers Companion to the “Big Book”


New guide attempts a modest AA update.

The founders of AA published their book, Alcoholics Anonymous (The Big Book) back in 1939. The world has changed a great deal since then, so it’s not surprising that there have been periodic calls for an update. Barring an official revision, which is unlikely, Hazelden, the Minnesota treatment organization, has published an updated companion volume to the Big Book. (Narcotics Anonymous published their version of the basic text in 1962). “The core principles and practices offered in these basic texts hold strong today,” says Hazelden, “but addiction science and societal norms have changed dramatically since these books were first published decades ago.”

Hazelden’s book, Recovery Now, billed as an easy-to-follow guide to the teachings of Alcoholics Anonymous and Narcotics Anonymous, dispenses with the divisive question of medications for withdrawal straightaway. In a foreword by Dr. Marvin D. Seppala, chief medical officer at Hazelden, the doctor makes it clear: “I agree with the majority of treatment professionals who support using these meds to help with cravings when it is appropriate to do so. Addiction is a disease that calls for the best that science has to offer.” The unnamed authors of the “little green book” agree, stating that “for some mental health disorders, medications such as antidepressants are needed. These aren’t addictive chemicals and so professionals, as well as AA and NA, accept that we can take them and still be considered clean and sober (abstinent).” There are now, as well, specific Twelve Step groups for those with both addiction disorders and mental health disorders: Dual Diagnosis Anonymous and Dual Recovery Anonymous among them.

As Seppala points out in the foreword, when some alcoholics and other drug addicts hear about the research showing that addiction is similar to many other mental and physical disorders we call diseases, it reorients their thinking amid the shame, stigma, and negative emotional states associated with active addiction. For some, it opens the door to treatment.

Okay. Hazelden, Betty Ford, and many other major treatment providers are no longer fighting a rear-guard action against a host of medications, from buprenorphine to Zoloft. But two-thirds of the Big Book consists of stories of how people recognized and dealt with their sundry addictions. That’s really about it, which tracks well with AA’s core operating principle: one drunk helping another. AA believes that much of its success stems from the fact that the program is run by the members, without direct rule setting and intervention from organizations, including their own. (All statements hold for NA as well).

What else? Recovery Now takes on another sticking point for many: the fact that “the AA Big Book and other writings include traditional male-focused and religious language, like discussing God as a ‘he.’” And there is the matter of “the realities and stereotypes of the 1930s, which is why it contains a chapter titled ‘To the Wives.’” Hazelden continues the recent tradition of broadening acceptable interpretations of “higher power.” One example given is from Samantha, a young cocaine and alcohol addict: “My higher power is the energy of this group. I call her Zelda.”

The book presents some of the psychological aspects of the AA program as a sort of reverse cognitive behavioral therapy. CBT attempts to teach people how to unkink their thinking and turn harmful thoughts into helpful ones. AA attempts to convince people to first change their behavior—“fake it until you make it”—and helpful thoughts will follow.

Perhaps the genuine sea change lies in this passage, which can be contrasted with the faith and certainty with which the Big Book proclaims that AA will work for all but the most stubbornly self-centered. Even with the myriad of choices of AA groups now available, Hazelden acknowledges that “a group based on the Twelve Steps doesn’t work for all of us. Some of us have found help in recovery groups that offer alternatives to the Twelve Steps, such as SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.”  This is a change of heart, given that groups like SMART Recovery don’t necessarily buy the idea of total abstinence, and often structure recovery as an exercise in controlled drinking. Hazelden also suggests that many of “us” have found the necessary ongoing support for recovery at churches, mental health centers, and nonreligious peer support groups.

As for anonymity, Recovery Now states: “While Twelve Step members do not reveal anything about another member of the group, any one of us may choose to go public with our own story.” Another promising development is the proliferation of Twelve Step meetings catering to specific populations—AA meetings for African Americans, Latinos, Native Americans, women, seniors, gays, and drug-specific (Cocaine Anonymous).

In the end, one of the best arguments for attendance at the AA program (free of charge) is that many addicts have “worn out our welcome” with families and friends, “and they have a hard time putting all that behind them and supporting us completely. But at most Twelve Step recovery meetings we can find the support we need.”

7 comments:

rachelrachel said...

Hi, Dirk. You wrote:

"This is a change of heart, given that groups like SMART Recovery don’t necessarily buy the idea of total abstinence, and often structure recovery as an exercise in controlled drinking."

However, the SMART Recovery website says something different:

http://www.smartrecovery.org/professionals/

SMART Recovery’s mission is to offer donation-requested, self-empowering, science-based, face-to-face and online support groups for abstaining from any substance or activity addiction.

And further down the page:

Our program is abstinence-based and also welcomes those considering abstinence, but who are not yet committed to such a plan. . . These newcomers are invited to attend several SMART Recovery meetings, to gain an understanding of the program and tools, and to enhance their motivation to determine if they choose to pursue abstinence.

And here’s another page from their website, this one on the topic of “Abstinence vs. Moderation”:

http://www.smartrecovery.org/resources/library/Articles_and_Essays/Additional_Articles/abstinence_vs_moderation.htm

What we know is that after one has developed a severe addiction, the simplest, easiest, safest and surest way to keep from repeating past behaviors is total abstinence. . . It actually is much easier to just give it up entirely than punish yourself trying to moderate or control your addictive behavior. Studies have shown that regardless of the method employed to become sober, the number one factor for sobriety success is a permanent commitment to discontinue use permanently; a commitment to abstinence.

Dirk Hanson said...

Yeah, I didn't mean to suggest that SMART recovery was anti-abstinence. I've read the Handbook. I've also had some exchanges with Jack Trimpey, but clearly SMART is less fixated on alternatives to abstinence than some groups. Here's a blog post I did on the issue of clean and sober vs. drinking less: http://addiction-dirkh.blogspot.com/2012/02/harm-reduction-advocate-takes-on.html

Lindsey Leonard said...

This is great that a newer version has been drafted and published--even if it's a companion volume. I'd probably say that an updated companion version is more valuable than the outdated version even though it's the official/base version. Great post!

Jon Helm said...

I do think that total abstinence has its place in the recovery process for addicts, but there should definitely be a part of the program that forces them to deal with being around it and enjoying it responsibly. Yes, "responsibly" could be taken differently in the eyes of individuals, but there's definitely a public identification of what's responsible. I'm glad they made those changes to the book!

Wayne Brown said...

That really is a great part of what AA provides--coming forward on your own terms. People can really get a lot more out of a program when they choose to identify in their OWN way as a part of that recovery program.

Anonymous said...

"AA attempts to convince people to first change their behavior—“fake it until you make it”—and helpful thoughts will follow."

No it doesn't. The books clearly state we can not wish away our defects away anymore than we could our drinking. Some members say "fake it till you make it" on occasion but that is not part of the AA program.

Ez said...

"I didn't mean to suggest that SMART recovery was anti-abstinence. I've read the Handbook. I've also had some exchanges with Jack Trimpey..."

Wonderful, but Trimpey currently has nothing to do with SMART, he heads Rational Recovery.

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