Here’s another guest post, and it’s a winner. Sincere thanks to Matt Robert, a SMART Recovery facilitator I met last June in Boston….
I’ve been spending a lot of time these days going in and out of locked detox units. And it’s interesting because, in most important ways, they haven’t changed very much at all. But I’ve changed, and the reason for my going into them has changed as well. Now I go into them because I want to, and I leave because I can. I go into them now to talk about recovery.
There is a particular flavor of desperation endemic to detoxes. The atmosphere is rife with anger, self-loathing, guilt, shame and defeat. People seem to bounce around among acceptance, denial and hair-trigger reactivity, along with the emotions that trail behind all three. The writing is on the wall everywhere: that one is about to lose everything, and that the way to arrest this decline is clear. Yet alongside these realizations is the feeling that one cannot stop, that one must find again the solace the addiction once provided but is now decimating, one day at a time.
Into this mix come representatives from recovery programs, telling the patients definitively that they are powerless and that they have to accept that. Or that “you are not powerless, you always have a choice.” Both ideas, either taken together or separately, can pave the way to recovery. But when they’re presented as diametrically opposed approaches in a marketplace of recovery programs, they may do more harm than good. Especially in early recovery settings.
It’s confusing when someone who is struggling sees all this wrangling about what’s the best method. And probably most proponents of a particular approach would admit, if pressed: not everything works 
for everyone. In the wake of actor Philip Seymour Hoffman’s death of a heroin overdose, the New York Times convened a panel of experts for an Op-Ed piece entitled “What Is Addiction?” Their views: It’s a disease and needs to be treated as such. It’s a choice and legitimate options need to be made available. It’s a form of learning. It’s a lack of the spiritual development needed to build inner strength. Or…what?
The recovery enterprise is a classic example of humans being human. “If it worked for me, it has to work for you.” But it’s those in the early stages, in detoxes and other harsh settings, who will be most negatively affected by the unintentional arrogance of the well-meaning recovery groups whose method is the “only way” that works. And all the rhetoric about powerlessness, choice, and whether or not it’s a disease may be nothing but a distraction that serves to impede recovery, not bolster it.
In every recovery group there are hardliners who argue that their way is the only way. But there are often others who use their chosen framework to meet people where they are. Although some in SMART Recovery emphasize its difference from “non-scientific” methods, most recognize that everyone is an individual with a unique development, and background, and set of needs, and that the recovery that works best is the recovery that works best for ourselves–even if it’s not in SMART. It will be different for everyone, and the journey to being free of one’s addictive behavior involves discovering the unique combination of things that work. There is no “one size fits all” in recovery.
The beauty of support groups is that they provide a safe place to work on recovery—in fact, many safe 
places. There is now a great array of alternatives to choose from. But as SMART Recovery founder Joe Gerstein said in a 2010 interview with the The Guardian, “the coercion of people into AA, SMART, or other support groups…is ethically wrong, medically wrong and psychologically wrong.” Not to mention pragmatically wrong. And it is in early recovery where this coercion is most likely to happen.
If we could stand up on a mountain and look down at all the different recovery groups, we’d see that, although they differ in some obvious ways, they’re all aiming to do the same thing. Their objective is identical. And that is to achieve and maintain sobriety. Period. Not to advance some treatment agenda, or get funding for research, or compete 
ideologically. It’s not that the exigencies of funding shortfalls are unimportant. Or that changing the attitudes of the powers that be is a trivial enterprise. Or that there is no merit in identifying a scientifically grounded road to recovery. But for the lonely person staring out a window on the locked ward of a detox, this contentious posturing is just a distraction from the dire situation at hand, and from the task of piecing together a recovery that works.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Based solely upon the awareness of how complex and individual our neurophysiology actually turns out to be, eventually the whole world will end up realizing that many approaches to everything – from medicine to economics to education to religion to recovery – is applied best when it’s personalized.
Absolutely. So how can we operationalize this notion that so many of us realize intuitively, but so often gets short shrift in the real world when dealing with humanity en masse. Thanks for this.
What is worse is that treatment centers invite the families of the substance abuser to their center and fills their head with their brand of propaganda. This makes it much harder for the substance abuser to personalize their own recovery when the family has now memorized the “right ” way to move past this thing.
I hope fewer programs in the 21st century lay guilt trips on family and friends. If any of you know of a website where the issue is discussed, I’d like to check it out.
Dave, the CRAFT program uses an entirely different approach than shaming the person struggling with addiction and/or the family. There is a new book available from he CRAFT specialists at the Center for Motivation and Change in NYC, “Beyond Addiction: How Science and Kindness Help People Change,” You can also get support, based on the CRAFT program, from the SMART Family & Friends program. The guilt trips on either side only fuel the addiction and are not helpful.
It’s true. There are some centers with special counseling teams who really try to understand the family dynamic and sit down with EVERYBODY to work out a plan. Unfortunately, they seem to be the exception and not the norm. But you make an excellent point— what a great way to start someone’s recovery by creating more rifts and tension in the family. Thanks for your post.
I’m sure there are many other websites. SMART Recovery has an online meeting “Family and Friends” where this topic could be addressed. It’s on Thursdays from 1:30 to 3pm. There are other chat rooms and online discussions as well. Go to smart recovery.org and there is a link to the online meeting schedule. Thanks and good luck.
Matt, You make such an important, and one would think, obvious, point here and yet it’s not at all obvious. For other diseases (assuming that’s what we’re calling addiction, at least for this purpose), such as cancer, a doctor will consider an array of treatments then figure which to use for each patient. A patient might be treated by one, some, all or none of the available treatments. Yet with addiction, usually one “treatment” is being imposed on a group. The one time I was in a locked detox I was very surprised that I was required to participate in 12-step programming while there, and it was the recommended follow up. The surprise was because I didn’t know. It certainly would make more sense to have a person on site knowledgeable about all treatments to assess which treatment would be best for each individual. It totally makes sense. Reading and thinking about this gives me a sense of how underdeveloped the field of addiction treatment really is.
Yes. And who in their right mind would think that the best time to have a philosophical reckoning would be when someone is in the confused and weakened state of detoxing? But it happens all the time. I like your idea of having some sort of “treatment ombudsman” or case manager to facilitate the transition. Thanks for your insight.
Addiction treatment is big business and subsequently those with services to provide will also have to “sell” the approach as a product. As with any sales technique this includes promoting one brand over another (usually).
The unfortunate reality is that many are drawn to the bright lights and the promises of what they offer (freedom from suffering) but the rhetoric is complex, confusing and often contradictory.
Even the self help movement is propelled by the need to exist despite having no motive beyond wanting to offer help.
The word recovery is often a misnomer as it tends to have its feet firmly established in others views, opinions and approaches (brands).
I wonder what would happen if in an ideal world we called it when I started loving myself enough or when i decided to try something else to see if that could offer less consequences.
morality polarisation and self serving abounds unfortunately at the expense of those seeking a bit of direction and reassurance that everyday with or without help people stop hurting themselves all of the time! it’s just that for some this will seem or may actually be impossible and at the very least extremely tough.
I agree there are many roads, many paths and many ways (even though I have my preferences) none have a monopoly and neither should they! at least that is my opinion and like bum holes we all have one. I dont have the answer but I am ok with that what’s right for me won’t be right for all thats for sure.
Its amazing what love, patience and acceptance can do if a person could actually be in a position to receive it?
Is it even truly possible to be unbiased and completely objective anyway?
I don’t think so, because we’re human. But you are so right— if we could just start from a place of “love, patience and acceptance” it’d be harder to do the wrong thing. Thanks so much for your insight.
This is not simply a question of “paths to X,” as in “what to do about atherosclerosis [blocked arteries]” or “what to do about childhood obesity.”
Recovery, unfortunately is too often not defined. Who will count as recovered?
What does ‘fair degree of improvement’ mean, if anything? What’s it worth?
“I am not them,” my son said to me. It was his expression of loneliness in a sea of “recovery”. “They got it. Now they want me to get it. And I try, but I am not them.”
It is VERY individual. I am not they… they are not me. Healing blooms in every possible variation and condition.
Thank you for such an emotionally articulate rendering of the dilemma from a mother’s perspective. We need a therapeutic middle ground that takes into account the scope and range of the human experience here. There is no one-size-fits-all, cookie cutter recovery, but the expediency that programs are forced to impose may make it seem that way at times.
Janet, that sums it up so beautifully. And it extends seamlessly into the whole other conundrum. They are not “us” either. At what point do we (parents) get that all the way through? Probably never… which is yet another way of highlighting how really alone each of us is…. both the givers and the receivers, so to speak.
Piggybacking on what CM and NN said above, a big part of this is the fuzziness of whole notion of “recovery.” What is that really? Simply not using the target substance?
That definition points towards a disease model or an alien invasion model, as if the addiction were something outside oneself that has to be gotten rid of. As if one’s life were just fine if it wasn’t for this pesky addiction. One can be cancer-free but leaving addiction behind in life is a lot more about what ELSE you ARe doing.
An addict’s whole life needs attention, their whole person needs healing. How we heal from emotional & psychological damage and suffering is still a mystery at bottom. Psychotherapy is in the same boat. What method works best? What is the measure of “cure?” The only ones who demand that the answers fit into a statistical table are those who are selling one or the other theory. Or those trying to measure whether their investment is paying off.
Anyone who is suffering, struggling, in pain, from whatever cause, biological, financial, emotional or otherwise is extremely vulnerable to someone else’s certainty about what will fix the pain. Modern society teaches us to expect hard data and clear answers, causes, remedies.
Unfortunately (or maybe fortunately), life doesn’t follow any one formula. Whatever got me through was a combination of many things. Some things that helped were formal: therapy, acupuncture, groups, etc. But equally as essential were accidental encounters with people, settings, things I read or heard and the wisdom of my own inner compass guiding me through it all.
I think recovery (or whatever we decide to call it) should be celebrated as the miracle it is when it does take hold. Rather than competing among whose system or treatment “works,” let’s honor the individuals who make use of whatever works for them. They (we) are the ones who deserve credit for surviving hell by any means necessary!
I agree with the above post that “recovery” is a really BIG business and is based more on business that it is about any client. I also agree with the above post that we should celebrate anyone’s chosen way to move beyond or out of the rabbit hole one finds themselves in.
Nice posting Matt and as you know I’ve seen it before. However I’d have to make objection to this one statement
“Their objective is identical. And that is to achieve and maintain sobriety. “
This is not the objective of Smart Recovery. Rather, in Smart we seek recovery and teach tools that use self-empowerment that allow success in achieving just that. . Recovery is a path toward wellness and wellbeing, not a continued struggle to stay away from former maladaptive behaviors.
Less “what are you trying to recover from” but more- “what is it you are trying to recover”
12 Step is the opposite and this is one of the reasons that Smart Recovery was started now 20 years ago as a secular alternative-science based self-empowering program to find the ways to do just that-change your behavior and have a better life.
Very very important distinction, in my opinion.
You might check out the 2011 SAMHSAA definition of Recovery.
But a distinction without a difference. I wasn’t making any claims about the long term outcomes for SMART Recovery members. And I think most people would agree there is no recovery without eventual sobriety. And all the noble goals in SAMSHAA’s definition are not achievable without sobriety from the addictive behavior. Yes, It gives incentive, and purpose and promise. The reason I wrote this was for this type of essentializing about what makes a real recovery program. The empowerment is in people, not programs or principles.
I agree that any “recovery” is through the empowerment of people not programs. I don’t agree that there is no “recovery” without eventual sobriety. The percentage of people that remain consistently abstinent is very small. The large percent of people that go through a particular struggle that leads to self medicating with a substance that then leads to a desire for peace learns much along the way about “recovery”. I would say they know more than most about “recovery”. The fact is that life is a journey and no one” recovers” from it completely. We all just learn how to do it better as we move through challenges. Life is one recovery after another and I think that this is the error in treatment centers. Treatment centers are very up front about there being only 2% in a group of 40 that will remain abstinent. If that is the case why aren’t they teaching the other 98% how to move through life in an empowered way that will enable them to move through a bout of using rather than teaching fear based propaganda that does absolutely nothing but damage with the insecurities it creates which creates as many deaths as anything? As someone earlier mentions the field of dealing with substance abuse is very very new and as always a tradition starts with the first breakthrough that many refuse to challenge or move beyond. The more options open to ways of empowering anyone for any reason is what I hope for the future.
I think you’re onto something here. About life being a series of recurrent recoveries….so true. And options, openness and empowerment… so often a person’s world shrinks more and more as addiction progresses, as one’s options become more and more limited. Does that mean that’s necessarily where one has to start, as they find their way back through recovery?
I think the best way to keep moving forward is by trusting that we do know much and we have collected many tools so NO one doesn’t have to bottom out in guilt, shame and self hatred. One just trusts that they know how to move forward and have the tools to do it from where they are. For all people this is a cycle that occurs often in a lifetime for multiple reasons.
Amen. Like I said, you’re on to something…
Cheryl, see above (and new post)….and thanks for the inspiration!
I love the way you put it…
“The fact is that life is a journey and no one” recovers” from it completely. We all just learn how to do it better as we move through challenges.”
Very nicely put, Cheryl
[i] I don’t agree that there is no “recovery” without eventual sobriety. The percentage of people that remain consistently abstinent is very small. The large percent of people that go through a particular struggle that leads to self medicating with a substance that then leads to a desire for peace learns much along the way about “recovery”. I would say they know more than most about “recovery”. The fact is that life is a journey and no one” recovers” from it completely. We all just learn how to do it better as we move through challenges. [/i]
I think the Protestant, even Calvinist idea of the ‘saved’ vs. the ‘damned’ has influenced the talk about recovery, abstinence, etc. In that worldview, it does no good to be 75% improved in the sin and selfishness departments.
Although in practice many 12 Step groups seems to be a bit lenient about those who relapse periodically, it’s never something that they are quite as pleased with as those with the 20year medal.
And it should be mentioned that the talk of abstinence from drugs and alcohol is not applicable to food and sex, among other things. Some sort of moderation IS sobriety.
Cheryl, I like your view: A period of ‘addiction’ is not like a bout of measles that we get past. It’s a period of difficulties–like depression, for example–some of which are intrinsic to living. We must, for example deal with anxiety, loss and so on, and not get swamped, but we are never past the vulnerability–just as you never get past the vulnerability to lack of oxygen in the air (e.g. if there is a fire in your house).
“People never change because they are under threat or under duress. Never. They change because they see something that makes their life seem valuable enough to start moving toward a life worth living.”
That’s a Robert Downy Jr quote 🙂
I was hoping you were onto something rather than on something 🙂 lol
My question is thus however- define sobriety??
And my point is that 12 step focusses on the past– the problems, the negative, and avoidiing it. Smart in contrast focusses on the solutions and the future of a life free of the noxious past problems. Forward looking and positive. .
And how you do that is how you choose to do it.
Thanks, Bill
Sobriety. Good question. It is definitely more than just abstinence and is a major component of recovery. I think ultimately it involves the intention and intrinsic motivation to feel comfortable and vital with who you are as a person. And that means getting your mind and body back to its natural state free of intoxicants. Recovery is the journey and sobriety is the vehicle, the boat that’s gonna get you to the other side.
I’m very heartened to read such a well-worded depiction of what SMART Recovery can support—a positive, forward-looking recovery. There are many who would say the same about their experience in 12-step program, although it sounds like that was not your experience. But we as recovery “professionals”—facilitators, etc., may have very strongly developed opinions about how and whether various frameworks work. My point in this blog post is that those strong convictions may not be helpful when put forward as arguments to people in very early recovery settings.
And the last line of your post says it best: “And how you do that is how you choose to do it.” Amen (figuratively speaking, that is—lol)
Hi William,
You said in part,
//And my point is that 12 step focusses on the past– the problems, the negative, and avoidiing it. Smart in contrast focusses on the solutions and the future of a life free of the noxious past problems. Forward looking and positive. //
And what are the solutions to getting old and dying, to the pain of ‘loss’ of a spouse in divorce, to the haunting memories of past abuse?
Is ‘forward looking and positive’ the key all that’s difficult in life? If so, in concept, is the implementation pretty straightforward for the rational person?
for the non-rational persons?
I wonder, does your ‘scientific approach’ bring happiness where how ‘cults’ and ‘spiritual practices’ do not. I wonder if there is any scientific proof that following a rational ‘scientific’ program of addiction treatments achieves any more than the 30% long-term recovery rate, untreated, *that occurs spontaneously for many addictions, not to say, many non-severe ‘psychological disorders.*
I wonder are ‘addiction problems’ like so many nails– that one just has to stop using one’s shoe (12 Step) and use a proper hammer (rational approach) to drive them all in smartly.
Hi NN. Not a bad metaphor. But why single out the rational approach here? All approaches to recovery should be weighed against the spontaneous recovery rate. Many have found the 12-step outcome stats highly disappointing when held up to this standard.
By the way, where did you get the 30% figure? I thought it was higher. Mind you, I know that these numbers mean very little without a careful analysis of the “control group” — in terms of base rates and everything else.
I have to say Marc, that your blog is a piece of sanity in a crazy world. It’s wearying to seemingly be a lone voice reminding people that there are so many ways to do this thing, sometimes it seems that there are as many ways to approach this as there are people.
I’m a big fan of starting where people are, and with interventions that people feel that they can achieve, and that fit with their view of the world.
Every person is different, their lives are different, and so their recoveries will be different. It’s too bad all the different camps can’t just combine forces to help lick this thing. As Cheryl above suggested, our lives are made up of repeated trials and recoveries, ebb and flow, approach and withdrawal. It’s just a matter of degree and what we do with it. Maybe someday we’ll be able to develop a treatment model that takes this into account and works for everyone…?
Very good to hear that, Tracy. Thanks….
Is it accurate to say “recovery” is a life long process?
That is to say, don’t put the guard down, even after you are clean. You should still think about “recovery” always, work on it, avoid “trigger”, etc… in order to keep clean. Otherwise, relapse would happen?
Short answer, no. (imho) It’s important not to identify with your addiction too much, because as humans we are all more than that. That said, it is important to remember your story, as in any life lesson. To know yourself. Know the red flags of impending relapse, and have strategies to avert it. Therein lies the value of what many people get from meetings. They hear their own story, and learn ways to avoid repeating it.
Thanks for this. It’s a major issue of debate in the recovery community. What do other people think?
Matt and Cheryl: I was inspired by your dialogue here to map out the duality between bold self-trust and cautious self-doubt….. These sound diametrically opposed, and yet they set up a marvelous duality which might even serve as a coherent approach to getting and staying clean/sober.
I got so inspired that I went on at some length about it. So now I’ve made it into the next (today’s) post. See….um, today’s post.
And thanks to you, Jenny, for getting the ball rolling with your question.
The world we live in is complicated enough. Do we really even need to think about complicating it any further? Life is about negotiating hurdles, learning from them, and moving on to the next— from the moment we leave the womb. Do we really need to add another level of complexity and put extra mental energy into second guessing and avoiding the things we don’t want?
A woman in post-acute recovery recently related a story about worrying that she was “substituting” eating for her previous addictive behavior. After encouragement from the group, she realized how unnecessary this was. As people in recovery we receive the gift of a very special lesson in self-knowledge. Do we really need to install a special radar system to monitor our moods and intentional behavior? That we won’t know intuitively when we’re in danger?
We have trials, we recover, we move on to the next right thing. Not away from the last wrong one. What do people think about this?
Last paragraph: I think you mean away from “the last wrong one” — yes? — and I’ve changed it accordingly. Let me know if it’s not okay.
I really like this little heuristic. It’s a good way to summarize your whole approach….viz getting away from the “My name is Eugene and I’m an addict” approach..
Just be aware that people are less likely to reply to comments from posts that are a month old….
Like the piquant bouquet of a stale sourdough…
…”A woman in post-acute recovery recently related a story about worrying that she was “substituting” eating with her previous addictive behavior.” …should have read “for her previous addictive behavior…”
Then not moving away from the next wrong one makes sense.
In editing, as in recovery, little things can make a big difference…like prepositions…
Thanks, Marc
I’m reminded of data that shows that in psychotherapy, 40% of a client’s outcome is due to external factors (spontaneous remission, social factors, etc.), 30% is due to the therapeutic relationship and the simple fact of being in therapy, 15% is due to expectancy (placebo) effects, and 15% due to the specific techniques employed by the therapist. So, if we apply this to recovery, only 15% of the outcome is due to the actual properties of the brand of treatment used, 15% is the addicts belief in that brand, 30% might be captured by the quality of the relationship the addict has to the brand’s recovery community/ambassadors/practitioners (stories here range the gamut), and 40% to stuff that might have happened without any recovery “program” at all. So, what ultimately works for someone probably has much more to do with what fits his or her personality and beliefs than the specific “ingredients” of the program outside of these personal factors.
I love this blog– almost as I love my own ha ha.. which is kind of dormant atm and thats just fine
and this thread in particular.. Ill have a belated response to NN’s comment shortly since his is indeed correct in his observations and I may have overstated a bit ( not the first time in case you hadnt noticed))
They do deserve a thoughtful reply