Saturday, July 28, 2001

People Develop Commitment Through Having Choices: A Lesson From Harvard Business Review

Somehow a copy of Harvard Business Review landed in my office and I started reading it on my commute train. The following article caught my eye and I want to pass along some points it makes.

Richard Chase and Sriram Dasu author a cover article titled "Want to perfect your company's service? Use behavioral science." (HBR June 2001, p. 79, click to read it online). They try to apply decades of behavioral research to illuminate what the service experience feels like to the customer. Here are some main points:

(1) People remember the start and the end of the experience more than the middle, but they remember the end most of all. Therefore, to bring customers back, service providers should end on an upnote. Can we learn from this principle in our context? Many of our local meetings end with a round of applause. This is a feel-good experience and provides an upbeat ending. Score one for us.

(2) If there is bad news, get it out of the way early. At a recent meeting it was known that one member had had a relapse. When the opening statement was done, the meeting convenor could have started the check-in ("how was your week") to his left or to his right. Instead he went straight across the room to the member who had relapsed and asked him to start off the discussion. Good move. The meeting processed the bad news early and ended strong.

(3) People desperately want things to make sense and will concoct an explanation when none is available. In the recovery context, the atmosphere is filled with "explanations" derived from the religious/spiritual 12-Step movement. If we don't step in with our own secular explanations, people will fall back on what's available, even if it's counterfactual or meaningless under scrutiny. Lesson: convenors who study and develop a deeper theoretical understanding of secular recovery principles can fill the vacuum and help people make sense of their experience in a rational manner.

(4) People develop commitment through having choices. "A fascinating study found that blood donors perceived significantly less discomfort when they were allowed to select the arm from which the blood would be drawn. The lesson is clear: people are happier and more comfortable when they believe they have some control over a process, particularly an uncomfortable one. Often the control handed over is largely symbolic (as in the choice of arm). In other cases, it's very real: the medical profession has long recognized the value of allowing the patient to make an informed choice about alternative treatments for cancer and heart disease. These are extremely important, high-stakes decisions, and great value is gained by including the patient in the decision. He or she feels less helpless, less hopeless, and more committed to making the process work." (p. 83).

In a nutshell, our approach of telling the person new in recovery that they have a choice and that they have the power to construct their own personal recovery protocol is sound in principle, with clear support in motivational research. The contrary approach -- telling people that they are helpless and have zero power to choose -- is a substandard, unsupportable practice. Our approach develops and reinforces the most important single ingredient in a person's recovery over the long term: the inner commitment to succeed.

It's always good to learn that we're on the right track, even if the stroke comes from such an improbable source as HBR.

Wednesday, June 27, 2001

Literature Racks Can Offer the Person in Treatment a Choice of Support Groups

On any given day an estimated 900,000 people in the U.S. are in treatment programs for substance abuse. Most of those treatment facilities have literature racks for their patients/clients. Most of those literature racks carry only one kind of literature -- the 12-Step kind. It doesn't have to be so. Literature racks in treatment programs can offer the person in recovery a choice, and can bring people to our LifeRing meetings who would otherwise never have known about us.

Here are some photographs of literature racks in treatment facilities where LifeRing brochures are available. The rack at the right is a standard commercial 12-pocket plastic wall display, mounted in the dual diagnosis ward at Herrick Hospital in Berkeley CA. A small selection of the omnipresent AA literature is in the top row. The five main LifeRing handouts are in the bottom row. Do you recognize them by sight? They are from the left, the San Francisco Bay Area meeting schedule (ivory), the brochure (blue), and then the "3S" trilogy: Sobriety Is Our Priority (green), Secular Is Our Middle Name (gray), and Self-Help Is What We Do (pink). This rack has an empty pocket just waiting for our next brochure.

The next picture shows a custom-made wooden wall rack mounted in the Merritt-Peralta Institute, a 28-day inpatient program, on the 5th floor of Summit Hospital in Oakland, CA This rack was built for full-sheet (8 1/2 x 11) handouts, and standard trifold brochures like ours pretty much sink out of sight into its pockets. Staff assigned us the top rack, and our handouts were all but invisible until a clever friendly patient stuffed a towel into the bottom of the bin so that our pieces would be seen. There isn't enough room to display all the brochures, but it's better than nothing. As in most treatment facilities, the meeting schedules are the fastest-moving items. This rack generally presents a somewhat messy appearance, and I can proudly say that our own shelf usually gets tended to more often, and is more up to date, than that of many of the other organizations with whom we share the rack. Some of the other bins have literature three years out of date, and some have stood empty for months. When we run out of LifeRing meeting schedules in this rack, I usually hear about it immediately, and if I forget to bring a resupply some week, I get raised eyebrows.

The next rack is at the Chemical Dependency Recovery Program of the Kaiser Permanente HMO in Oakland. It's a clear plastic six-pocket commercial rack, available at office stores, that is designed to stand freely on a table. In this treatment facility, AA has a large wire literature rack with space for about 24 different brochures, but there is no place for that rack other than down on the floor, where it's hard to see and presents a trip hazard. For a while we stuffed our brochures into some of the empty pockets in that rack but this didn't seem right. Finally LifeRing member Syl S. hit on the solution of buying our own rack, the cost of which she generously donated. Syl originally obtained a wall rack similar to the first one shown above, but staff denied permission to mount anything on the walls, citing fire regulations. But staff had no problem with a table rack. The display is positioned on a side table within easy view and reach of patients seated in the waiting area near the reception booth of this outpatient facility. Syl made a bright neon label for the front. We use two pockets for meeting schedules here because of the heavy demand for that item. Having our own rack, and such a nice looking one in such a favorable position, is a very pleasing thing, and the literature in it moves at a steady clip into patients' hands.

Last is a single-pocket standup rack -- also a standard office supply store item -- that holds meeting schedules. A label on the rack tells what is in it and gives the Service Center phone number to call for refills and information. We are experimenting with placing these racks in churches, coffee houses, grocery stores and other appropriate sites, wherever someone volunteers to keep them refilled. If you want one of these racks and are willing to keep it supplied, call the Service Center at 510-763-0779.

Literature racks can reach people when you're not present. They never sleep and never go on holiday. They offer their freight of wisdom and support without commentary or attitude. But they are only as good as the hand that fills them and tends them. A literature rack reflects on the organization. A rack that long stands messy or empty bespeaks an organization that has stopped caring or has sunk into chaos. A rack that regularly gets tended and refilled testifies to an organization that has its act together and that cares about people and wants to be approached.

Getting our literature into literature racks in treatment facilities is not always easy. In many cases, permission to stock literature comes along with permission to hold a meeting on the facility, and not before. Thus the literature in the rack helps bring people to the meeting, and the people in the meeting help resupply the rack. But in other cases, we can get literature into a facility before we have a meeting there, on the ground that the patients are looking for meetings anywhere in the community and have an interest in our area-wide meeting schedule.

A number of patients in treatment facilities do not obtain any benefit from the traditional 12-Step approaches, and live in a state of frustration or despair because they are unaware that there are other roads to sobriety. A well-stocked literature rack with LifeRing handouts in it can be their first news that other choices exist. I know people who say that they are still clean and sober today because they found LifeRing from a handout in a literature rack. Getting LifeRing literature into treatment center literature racks presents many patients for the first time with a choice of recovery paths, and saves lives that might otherwise be lost.