Saturday, December 29, 2007

Another professional discovers LifeRing

Received at the LifeRing Service Center today:

I am thrilled to learn of the existence of your organization. I am a Treatment professional that deals every day with patients who have been failed by "old-school" treatment modalities, and completely alienated by 12-step groups. Many of them are legally mandated to attend "sobriety-based self-help groups" but have no options other than AA, etc. or some extremely fundamentalist religious groups. There are a few SMART recovery groups around, but not enough. My particular position allows me to specialize in one-on-one counseling with patients who come through emergency room interventions and might not otherwise access help. I utilize a totally strength-based counseling method, which is obviously completely in alignment with your philosophy.

I would like to get my free copy of "Presenting Lifering" so I can begin to distribute it among my colleagues and possibly support some of my successful patients in forming a group of their own.

My Agency is called [...]. I will be looking at solutions to get my company to invest in a full complement of your literature as a healthy alternative to AA. [...]

Thanks so much. I am excited to get started in expanding Lifering.

Monday, December 24, 2007

Learning from educators: "The Virtues Project"

Teaching kids who have got in trouble with the law and are booted out of the regular schools into alternative schools is a challenging educational assignment. You might think that with these "bad kids," teachers have to be super-authoritarian, try to take the kids' power away, and get them to surrender. Guess what, that doesn't work. By contrast, a highly successful approach in use at the Sacramento County Boys' Ranch begins with The Virtues Project. The secretary who handles the kids' enrollment asks:
Do you know what virtues are? Then she launches into how virtues are the 'good seeds' in us which make up our character. Usually, the student is momentarily dazed, first by an adult in an institution asking him personal questions that aren't tied to his criminal or school history, and secondly, by the word itself -- 'virtue.' Given a few examples, the student then looks over a giant poster listing 52 Virtues and selects -- often with encouragement -- one or two that he feels are his 'strength virtues' and explains why. .... Teachers recognize, acknowledge and reinforce the virtues of students, which forges a vital link and connects with them on a level beyond the stereo-typical teacher-student superior-subordinate relationship. A whole new world of significance is opened up for both teacher and student ... which creates greater student buy-in.
("Forging Vital Links with Students in Alternative Schools," by Brett Loring, in The Journal of Juvenile Court, Community, and Alternative School Administrators of California," Spring 2007, p. 10.) Since adult alcoholics and addicts have so much in common with these "bad kids," I thought that educators' experience with these kids might be relevant somehow ....

Friday, December 21, 2007

Once again on the AA dropout rate

Many people are now aware of the statistic that 95 per cent of newcomers in AA drop out during the first year. Out of one hundred who start, at the end of one year, only five are left.

I first learned this statistic from the Bufe volume, reviewed here. Bufe attributed it to AA's own Membership Surveys. However, I drew a blank -- and some hostile looks -- when I visited the AA library up on Riverside Drive in 2005 and asked to see the original survey reports. Since Bufe might be accused of anti-AA bias, I wanted a less impeachable source. Thanks to a very knowledgeable psychology Ph.D., I now have it, and it's very interesting.

Don McIntire of Burbank CA was given access to the AA membership surveys from 1968 through 1996. He is a staunch defender of AA and cannot be accused of negative bias. His article "How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968-1996) and Related Analyses/Comments" in the Alcoholism Treatment Quarterly (Vol 18, No. 4, 2000) centers on the 5 per cent one-year retention rate and attempts to explain it.

The 95 per cent dropout rate is anything but a statistical fluke. AA's own membership surveys demonstrated the identical pattern, give or take trivial variations, in five successive triennial data collections spanning twelve years. McIntire depicted the trends in a graph (inset) showing a fairly tight braid whose strands are the data sets from different years. The five per cent figure is the average of the five studies.

Most of the attrition, McIntire's analysis shows, comes during the first 30 days. This is not obvious from the graph. The graph begins at 30 days. If you can read the tiny numbers on the x axis, you will see that the bundle of line graphs begins at around the 20 per cent mark. If the graph began at Day One and 100 per cent, the lines would drop almost like a rock.
  • McIntire found that an average of 81 per cent of AA first-time attendees dropped out during the first 30 days.
  • At the end of 90 days, 90 per cent of newcomers have dropped out; only ten per cent are left. (This gives a new dimension altogether to the "90 in 90" slogan, doesn't it?)
  • The attrition curve from 90 days to a full year is, by comparison, rather gentle: from ten per cent to five percent, a relative loss of "only" fifty per cent.
McIntire, who (as I said) is a staunch defender of AA, argues that the attrition during the first 90 days should just be ignored, and that AA should claim a 50 per cent success rate based on the trend from 91 days to one year.

The author's apologetic argument is that the FTA's (first time attendees) who drop out quickly aren't really alcoholics, or aren't really trying to get sober, and so they shouldn't count. Although that has a ring of plausibility for some cases, the author presents no data as to percentages.

AA co-founder Bill W., looking at numbers of this type, asked "What happened to the 600,000 who approached AA and left?" (Reported in White, Slaying the Dragon, p. 139) Despite Wilson's concern, apparently nobody in AA has ever, yet, bothered to try to contact any of the 95 per cent to try to find out their reasons for leaving.

We know from other data that alcoholics who don't do AA can nevertheless succeed in achieving long-term sobriety. In fact, the AA Grapevine has conceded that the majority of alcoholics who achieve the milestone five-year mark do it without using AA. (Vaillant., 1996, 2001)

Consequently, it's extremely unlikely that lack of motivation to get sober accounts for the 95 per cent AA dropout rate. Lack of desire to get sober is undoubtedly a part of the picture, but there has to also be a healthy percentage of the 95 per cent dropouts -- perhaps a majority -- who want to get sober but drop out of AA for other reasons.

McIntire's article never looks at this bigger picture. To do so would be to confront the reality that AA is driving people away who have a sincere desire to get sober (and many of whom will achieve that aim).

Thursday, December 20, 2007

Letter to a columnist

The letter below is by Michael Walsh, convenor of the soon-to-be-started LifeRing meeting in Victoria BC Canada. He addresses it to Sharon Kirkey, a columnist who penned an article on alcoholism read throughout Canada, that mentions only AA as a resource.

Dear Sharon,

I am happy to see your latest writings on alcohol however I am dismayed to see that the only choice you provide alcoholics is AA. I have been in recovery for six years, five of which I have been completely clean and sober. I did use AA for the first three years but the religious aspect of the program does not sit well with me and does not sit well for thousands of others. Please see how many times God is used in the steps below. You also say AA is a self-help program which it is absolutely not. The old timers of AA would read that and scoff because they know (in their AA washed minds) that you cannot do anything without God. You are seen as a powerless soul and that your best thinking got you into the rooms of AA.

I know Dr. Cunningham as well as I went through Homewood Health Center myself and was provided an excellent experience.

Sharon, I am not knocking AA right off of it’s mantle but even AA head office in NYC will tell you that their retention rate is only five percent in the first year of one’s recovery. Further, sixty percent of people who go into recovery do so without the use of AA. Bill W is quoted as saying that there are many paths to recovery.

There are many ways in which people recover and I would really like to see people who are going to write a column in which tens of thousands of people read do more research and provide more than one route. It is like Starbucks or Tim Horton’s.

Treatment facilities, drug and alcohol counselors and medical/mental health professionals are actively looking for alternatives for their clients because many do not want to go the AA route or they stop going. Any counselor should tell you that a recovery program is different for everyone and AA is definitely not for everyone. Does anyone ever look into and talk about the failure rate of AA? No!

One such viable alternative group is called LifeRing out of California. It is slowly starting to get the recognition it deserves as major treatment centers in the USA are starting to buy into it’s program. Their website is I am about to start a meeting here in Victoria next month. Vancouver Coastal Health Authority has bought into LifeRing as of late also.

Sharon, you would be doing readers a great service by providing them with more than one choice in recovery. I will also add that Bill W and his partner both died of lung cancer due to smoking cigarettes. Bill W’s last speech showed him being rolled up in a wheel chair with oxygen tank in hand. There is so much tobacco use at AA meetings which is another reason why I do not go.

Thanks for listening and I implore and beg you to please issue a column related to my e-mail to you today. Many people will thank you for that.

Happy season to you.

Michael Walsh

310 – 283 Michigan Street

Victoria, BC

V8V 1R4


  • Step 1 - We admitted we were powerless over our addiction - that our lives had become unmanageable
  • Step 2 - Came to believe that a Power greater than ourselves could restore us to sanity
  • Step 3 - Made a decision to turn our will and our lives over to the care of God as we understood God
  • Step 4 - Made a searching and fearless moral inventory of ourselves
  • Step 5 - Admitted to God, to ourselves and to another human being the exact nature of our wrongs
  • Step 6 - Were entirely ready to have God remove all these defects of character
  • Step 7 - Humbly asked God to remove our shortcomings
  • Step 8 - Made a list of all persons we had harmed, and became willing to make amends to them all
  • Step 9 - Made direct amends to such people wherever possible, except when to do so would injure them or others
  • Step 10 - Continued to take personal inventory and when we were wrong promptly admitted it
  • Step 11 - Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out
  • Step 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

Friday, December 14, 2007

Empowerment in Two Minutes

I sat in on a LifeRing meeting the other day with 29 people in it. That's considerably larger than the average LifeRing meeting, but it's normal for this particular group. It convenes during lunch hour at a treatment center. There's a treatment group session immediately afterward in the same room. There's no way to stretch the meeting time. Bottom line, if people are going to get their sober self empowered in this meeting, they each have an average of two minutes for it to happen.

There were times when the meeting was sparkling. The face of the person speaking was animated with feeling. People's eyes were focused on the speaker. There was quick, positive feedback. The convenor added a few choice words. The group gave the speaker an enthusiastic round of applause.

At other times the meeting was flat. The speaker's face was a mask, and their recital was unrevealing. People looked away. There was no response. There was perfunctory applause. The convenor gestured to the next person to go.

I wondered, can we define what makes a good check-in under these circumstances, when time is at a premium? Can we, as convenors, deftly intervene so that the meeting enjoys a larger proportion of the sparkling contributions, and fewer of the flat?

Here's the basic elements of a participant's check-in:

(1) Introduction. (a) Name: "My name is ___________." In many settings, this may be followed by (b) Label: "I'm an alcoholic/addict" and by (c) Time: "I have _______ days clean and sober."

(2) Story. "My week was _________."

(3) Feedback from other participants. "I had a similar experience .... (etc.)"

(4) Conclusion, and transition to next person.
Four simple elements, usually present in any check-in, no matter the length. How can we handle them so that something useful happens in an average of two minutes? Let's see.

(1) Introduction.

(a) Name. If the person forgets to say their (first) name, that's not good. The convenor or someone should ask them to say it. It's good for people to put their names out. Saying your name is a way of declaring membership in the circle, of connecting with the group dynamic. It's a friendly thing.

(b) Label. Whether a person then labels themselves ("I'm an alcoholic/addict") is optional in LifeRing. It's mandatory in some treatment settings and in many 12-step settings, but not here. The glue in LifeRing is the commitment to a common behavior -- abstinence -- and not to any particular label, diagnosis, or theory about what's wrong with us. Research suggests that on the average, people can stay clean and sober whether they label themselves or not. Moreover, in LifeRing it doesn't make any difference whether your "drug of choice" was alcohol or meth or whatever, so there's no need for people to declare whether they qualify for this meeting (alcoholic if AA, heroin addict if NA, etc.). Everybody is welcome. Bottom line, if the convenor senses that people in the meeting are labeling themselves because they think it's required of them, or because they mistakenly think they're in a 12-step meeting, it may be wise to say a few words to indicate to people that it's optional. "In our LifeRing format all we ask is that you say your name; the rest is optional." Save a few seconds; it all adds up.

(c) Time. Many treatment centers and 12-step groups require people to declare, in their introduction, how much clean and sober time they have. In LifeRing, it's definitely optional. In the particular session I observed, the treatment center's format had penetrated into and become part of the LifeRing meeting's format. Each person said their time ("I have 11 days"), and the room gave each person a round of applause for it. After a while that ritual started to feel repetitive, and the applause tapered. A person early in the hour with 5 days would get twice as much applause as a person later in the hour with 10 days. When I convene this kind of short-format meeting, I try to shift these time declarations to the end of their story. True, it's empowering to receive applause for your time. But it's much more empowering for you, and more instructive for the rest of the group, to receive applause for some specific victory you won that got you to this count of sober days. This brings us to the main element of a person's two-minute share, the content or story.

(2) Story. "My week was _________." The dullest, flattest shares here consisted of nothing but an adjective or two: "My week was fine." "My week was bad, but I made it." An adjective or a string of adjectives don't amount to a story. The person who tries to get by with this contribution is not participating. They're not revealing anything about themselves. They're not putting anything out that other people can relate to. The convenor now has to make a quick decision: is this person unclear about what's expected, or is this person refusing to participate? Everyone has a right to refuse to participate, and if that's the case, the convenor and the group have to respect it and go on to the next person. However, it's very rare for a person in a LifeRing meeting to refuse to participate. After all, we're not asking for the story of their life or their innermost secrets or their opinions about some book passage that they haven't read. We're just asking, "How was your week?" The convenor who runs into a participant who says "My week was fine" and then looks to the next person, needs to nudge a little. "So what was the finest thing that happened to you?" "What were your highlights and heartaches?"

LifeRing meetings don't revolve around the recital of life stories, but that doesn't mean the abandonment of stories as such. On the contrary, stories are the heart and soul of the check-in. "How was your week?" is precisely a request for a story.

A hundred years ago, asking for a story probably meant settling in for a half hour or more. Today, people have sat through tens of thousands of stories each told in 30 seconds or a minute. TV and radio commercials are miniature narratives that assume the audience has a limited attention span, and they probably over time generate ADHD-like symptoms in the brains of those who spend much time watching TV. Zillions of amateur videos posted on You-Tube tell their tales in less than two minutes. Bottom line: in our culture, asking people to present a story inside of two minutes or less in a LifeRing meeting is not an unreasonable request. It can be done and it's done all the time.

And what stories people tell! How was my week? My boss assigned me to ladle out the rum punch at the office party, and I did it and I didn't drink. -- I got together with my sober buddy and we watched the Raiders game and didn't drink, for the first time I can remember. -- I drove home and there were my parents in the living room smoking crack. I ran out of the house and got back in my truck and peeled out of there. -- My sister and I talked and hugged each other for the first time since my daughter killed her daughter in a car accident when she was drunk, following in my footsteps. Now that I'm sober, we're talking again. -- I have no money now, nothing at all, and I went to my mom and asked her if I could move back home, and we cried. -- The week has been a roller coaster of feelings. Sometimes I felt ecstatic, other times I thought I was going insane. -- Today is my birthday, and if I make it to bed sober it'll be my first sober birthday since middle school. -- And so on, in infinite variety.

Stories like these, which can be spun in a few sentences, have a three-dimensional vividness that many people in the meeting can resonate with. Mere adjectives -- "my week was fine"-- are barricades. Narratives told from real life are doors and windows that invite people in and create emotional relationships. I feel an emotional bond with a person who tells me a story from their week, even if nothing remotely like the same incident has happened to me; just the fact that they opened themselves up and shared it with me inclines me to view them with respect and attachment. And if I have experienced something similar, the affinity bonds can be quite strong and lasting.

In the brochure "Self-Help Is What We Do" and in other LifeRing publications, there are diagrams showing arrows going between the "S" and the "S" in two people -- reinforcing connections that strengthen the Sober Selves. It's in the telling of real-life stories that these arrows of empowerment issue out of the narrator, fly across the room, and hit their targets in the viscera of the listeners. The LifeRing slogan, "Empower Your Sober Self," has a very broad set of meanings; but in the specific context of a 30-person 60-minute meeting, the process of empowering the sober self flies on the wings of personal narratives, stories.

(3) Crosstalk. Can there be crosstalk in meetings where the average time available is two minutes? My experience is that there can be and should be. When the person has finished their story, if I am the convenor I always look around the room and ask: "Comments? Feedback?" Sometimes no one has anything to say, but often there is one hand, or two, and then more, and webs of connections get spun across the room in several directions. True, with crosstalk, the time allotted to this person may go well over two minutes; but if the topic is interesting and animates the group, that's worth doing. Other speakers will finish in a shorter time and stimulate no crosstalk at all. Two minutes is an average, not a rigid mold. We don't keep an egg timer, an oven timer, or a stopwatch with a bell. As the convenor gains experience, you develop a gut feeling for when to allow a dialogue to go on, and when to cut it off and move to the next person. Frequently the feet of the participants will tell you; if a lot of feet twitch, tap, and twist, it's time to move it.

(4) Conclusion. Psychologists have found that the opening and the ending of a presentation are the most memorable parts, and of these two, the more memorable is the ending. The speaker's vivid narrative generated flashes of sober empowerment all around, but to engrave that experience more permanently in memory, a strong and positive conclusion is necessary. It's here at the end, more than in the speaker's introductory recital of their sober time, that a solid note of applause is called for.

In a two-minute presentation, sometimes the speaker will end on a note that draws a strong audience response. Sometimes a crosstalk contributor will supply the cue for a round of applause in support of the speaker -- for example, "You WILL have a sober birthday today! I'm rooting for you!" If that doesn't happen, the convenor can do a lot of important work here with just a few words. The goal is to frame the speaker's story in empowering terms, as a sober victory. For example, to follow along with the illustrative stories outlined in an earlier paragraph:

"Shame on your boss for making you serve the rum punch. Congratulations to you for surviving that experience clean and sober! You deserve a hand!" -- "That was smart, to get a sober buddy to watch the Raiders game with! And it worked -- the Raiders won!" (Laughter). -- "That's hard, coming home to parents who are smoking crack. I would have done the same as you -- peeled out of there! Let's give him a hand!" -- "I feel really moved by how your family is coming back together thanks to your sobriety. That is so inspiring!" (Applause) -- "Moving back home is hard. But now you have a second chance, a new start. Good for you!" (Applause) -- "You stayed sober even though you were riding an emotional roller coaster. That is awesome!" (Applause) -- "You WILL stay sober on your birthday today, we're all pulling for you!" (Applause)

What is being done here? The convenor is taking the gist of the speaker's story and defining it as a sober victory, as a gain in the power of the speaker's sober self. Sometimes the speaker is aware that her story is a victory, but often she isn't. She may, in fact, begin by feeling distressed; for example, by the emotional roller-coaster ride. Someone in cross-talk may have reassured her that this is a common experience. The convenor can go further and compliment her on sticking to her sobriety despite the distress that she felt; if she can stay clean and sober through this kind of extreme experience, most likely she will do very well with time, when the emotional swings become milder, as they typically will. The convenor is reframing her story in way that builds her confidence.

Reframing for the positive works even if the speaker has just had a disastrous relapse. "I don't have any days clean and sober -- I only have hours." -- "I admire you for your decision to come back into recovery and for being here at the meeting; that wasn't easy. Let's give her a round of applause for that!"

Positive reframing is possible 99 per cent of the time, but not always. In a recent meeting I convened, one person said they were there on a DUI and just had the bad luck to be caught, but they had no problem with alcohol and considered it just another food choice. I probed, optimistically: "So, have you decided that because of the trouble drinking has got you into, you want to give abstinence a try?" The answer was, "No, I have no problem with alcohol and I intend to keep using it." My instant response: "Next person, please; how was your week?"

Note that positive reframing isn't dispensing advice ("You should ____") or otherwise telling the speaker what to do. The convenor is not playing therapist, doctor, or sponsor. All that the convenor is doing is to summarize the speaker's own story in such a way that a sober empowering element in the speaker's own story becomes more visible and more memorable, both to the speaker and to the group. The ownership of the positive element always remains with the speaker.

Ending on a positive note is, of course, the necessary platform for the group's applause. I'm a strong believer in the power of group applause for an individual's sober victories, no matter how small. I watch the faces of people who are being applauded, and most of the time, what shows is genuine happiness. Happiness about one's own recovery is the vital fuel of of progress. Moments of happiness, a few seconds long, may give people the courage to keep going for days or weeks. Sober happiness powerfully expands the sober self and shrivels the addict self inside. So, in this LifeRing meeting with 30 people in recovery (not counting the one misplaced DUI parolee), the group will applaud at least 30 times. Because frequent applause can eventually lead to fatigue, in a meeting of that size I may discourage people from mentioning their sober time at the beginning of their check-in, the usual cue for applause in this environment (see section 1 (c) above). Applauding the count of sober days is good, especially if there's nothing else of substance to applaud ("My week was fine"), but applauding a vivid short narrative is much, much more empowering, both for the speaker and for the group.

At the end of the ring, I will ask the group for one more round of applause, for everyone present, as in the usual LifeRing meeting format. Because of all this clapping, LifeRing hours with 30 people tend to sound more like a pep rally than like group therapy. No doubt, participants in smaller LifeRing meetings -- a comfortable size is 8 - 12 -- have more opportunity to explore their issues in depth. But circumstances don't always permit the small group format. Luckily, the LifeRing process is flexible and scalable. The buzz after the 30-person 60-minute meeting I convened was clear: "Great meeting!" "Really enjoyed that." "Got a lot out of it." "Glad to be here." And they come back. If we pay attention to the basics of the LifeRing process, we can deliver sober self-empowerment in two-minute packages.

I have even experienced the LifeRing format further compressed to serve rooms with 45 - 50 people inside of an hour. LifeRing convenor Henry S., who leads the Thursday evening meeting at the Oakland CA Kaiser CDRP, has honed the short format to a fine art. From down the hall, this meeting sounds like a basketball game: every minute or so, there's loud cheers and applause. It may not be a place for deep, meditative reflection, but it's sober, it's secular, and it's self-help. Moreover, it's consistently popular. As LifeRing grows, we're going to gain more and more experience with participatory formats for larger gatherings.

Sunday, November 25, 2007

They found each other in chat

From the convenor of a meeting in Northern CA:
The coolest thing happened at our meeting a couple of weeks ago. One Saturday morning two women who had never attemped recovery, who had never been in a chat room before both found the LifeRing website on Google and both went in the chat room on They realized they both lived near [our meeting] and decided to come to the meeting and meet. That was day one for them. They have now been to three meetings and both have three weeks of sobriety and are great friends. It 's an inspiration to us all!

More Help from Professionals

This email came to the LifeRing Service Center a couple of days ago:

Hello LifeRing;

I am researching LifeRing and seriously considering getting a meeting started here in ______. ... I am looking for some guidance on how to become a convenor and start a meeting. ... I have 19 months sobriety this time around, almost exclusively without a 12 step program. I'm a participant at my CDRP at Kaiser Permanente. In fact, it is my therapist who suggested looking into starting a meeting.

I am very impressed with what I've discovered so far about LifeRing. I just finished listening to LifeRing 101 on my computer. I just ordered the workbook and "How's your week" from the website. ...

Any help you can give is greatly appreciated.


Note the line, "it is my therapist who suggested looking into starting a meeting." A very similar thing happened a few weeks ago in another city hundreds of miles away from the above: a counselor not only suggested that the client start a LifeRing meeting but set up the room and the time slot.

Another Professional Seeks LifeRing

Received yesterday at the LifeRing Service Center:

This is ___________ the owner of [Treatment Program]. I have space and would like to have an onsite LifeRing meeting on Friday evenings at our site. The ideal time frame for this meeting to start would be at 6pm and end at whatever the typical time frame is for meetings. We can however be flexible about the time if something else works better.

So, I need a facilitator and help getting it set up and listed. I will do anything you want me to do to help with this process. People being treated at our program would be encouraged to attend as well as it being open to the public. There would be no charge for the use of the space, we just want to offer the support group to our clients and the community.

Our only request would be that the room is cleaned up, materials put away, and that the building is locked up when finished.

Please let me know if this is doable and what are next steps. Thank you advance for considering us to provide this important service.


Wednesday, November 7, 2007

Choice philosophy gets boost

The choice philosophy that LifeRing advocates, and that forms the core of the Recovery by Choice workbook, has received a major boost from two recent publications by well-known treatment professionals.

The first publication, the report of a 2005 recovery conference under the auspices of SAMHSA, the federal agency, contains a summary of recovery principles beginning with the important basic truth that there are many roads to recovery. An excerpt containing the entire summary is in my New Recovery blog here.

The second is a new monograph titled Recovery: Linking Addiction Treatment & Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches, by William White, MA and Ernest Kurtz, Ph.D. A PDF copy of the whole 80-page essay is here. It's published by the Addiction Technology Transfer Center, a SAMHSA project.

The Preface, by Charles Bishop and Michael Flaherty, summarizes the main point in these words:
This paper’s most important focus is on recovery and the suffering addict’s (client) needs and perspectives as the most important throughout the entire recovery process. This paper emphasizes how each person has both the responsibility for and a philosophy of choice in his/her recovery. Thus, the counselor and clinical treatment system staff become supporting partners along with a rainbow of community-based, non-professional mutual aid recovery fellowships, all working to help the addict. (emphasis added).
Anyone familiar with modern medicine may be tempted to yawn here, because the concept of patient choice and responsibility is by now entrenched and familiar there (source). But much of addiction recovery is still in the Middle Ages, so the notion that the patient has a choice in recovery -- and that this is to be recognized and supported -- is nothing less than revolutionary. What's even more significant is that this recognition comes from two heavyweight authors with solid-gold credentials in the 12-step universe. White is the author of the definitive history of addiction treatment in America, Slaying the Dragon, reviewed here; and Kurtz's Ph.D. thesis, Not God, is one of the classic texts in AA history.

The authors zero in on the subject of choice on p. 19. After a preface that takes note, without comment, of widespread allegations that the 12-step approach does not work for everyone -- a point that virtually every front-line treatment professional would readily concede -- the authors "recommend promoting a choice philosophy and monitoring each client’s ongoing responses to recovery support group participation."
The Choice Philosophy: A choice philosophy is based on the recognition of multiple pathways and styles of long-term recovery and the recognition of the right of each person to select a pathway and style of recovery that represents the individual’s personal and aspirational values. (emphasis added)
Here's what a choice philosophy would look like in the practice of a treatment center:

■ Professional counselors, recovery coaches and volunteers represent the diversity of pathways and styles of recovery.

■ Professional counselors and recovery coaches are knowledgeable about the full spectrum of religious, spiritual and secular recovery support groups and can fluently express the catalytic ideas used within each of these frameworks.

■ Professional counselors and recovery coaches are aware of patterns of co-attendance (concurrent or sequential participation in two or more recovery support structures, e.g., co-attendance at WFS and A.A. meetings, N.A. participation with later transitioning to A.A. as one’s primary recovery support structure).

■ Individuals and their families are educated about the variety of recovery experiences and the legitimacy of multiple pathways and styles of recovery.

■ Informational materials, lectures and structured exercises that people receive represent the scope of recovery support options, e.g., posting all local recovery support meeting schedules on the treatment agency website and facility bulletin boards, giving each client a wallet card with the central contact numbers of local recovery support groups, profiling local recovery support groups in agency/alumni newsletters.

■ Individual choice is respected; individuals receiving services are not demeaned or disrespected for the recovery support strategies they choose; clinical strategies involve motivational interviewing principles and techniques rather than coercion and confrontation.

■ Professional counselors and recovery coaches are encouraged to self-identify and bring to supervision negative feelings they may have about a particular pathway of recovery chosen by a client.

This is an excellent, useful list. Persons shopping for treatment programs might print it out and ask marketing reps to what extent their facility matches this picture. Patients currently enrolled in programs might use the list to advocate for reforms in the way programs are operated. Staff members could bring up points from the list at staff meetings to suggest improvements in patient services. Program administrators could circulate the list for discussion at staff retreats.

The authors go on to raise some of the central theoretical and practical issues in choice philosophy:

Choice and the Stages of Recovery: To implement a choice philosophy, addictions counselors and recovery coaches must reconcile the philosophical and therapeutic value of choice with the growing evidence of how neurological impairments can impair the choice-making abilities of individuals in active addiction and early recovery (Dackis & O’Brien, 2005). The challenge for the addictions counselor or recovery coach is distinguishing authentic choice from what A.A. calls “stinkin’ thinkin,’” what Rational Recovery calls the addictive voice or “Beast,” what Secular Organization for Sobriety refers to as the “lizard brain,” what LifeRing Secular Recovery calls the “addict self” (versus the “sober self”), and what Christian recovery groups refer to as the “voice of the Devil.” Given the dichotomy between the sober self and the addicted self, the question becomes “Who’s really choosing: Dr. Jekyll or Mr. Hyde?” Some would frame this as separating what each client wants/needs from what his or her disease wants/needs.

One way to partially reconcile this dilemma is to view recovery as a progressive rehabilitation of the will—the power to reclaim personal choice (Smith, 2005). At a practical level, this means that the first day of detox may not be the best time to rely exclusively on client choice. Without rehabilitation of the power to choose and an encouragement of choice, we get, not sustainable recovery, but superficial treatment compliance. To effectively apply a philosophy of choice will require discretion and skill where immaturity, acute psychiatric symptoms, drug impairment and impaired ability to read social cues severely limit choice generation, choice analysis and capacity to stick with any personal resolution. In such cases, we must carefully plot a path between complete autonomy (total choice and clinical abandonment) and paternalism (no choice). Scientific confirmation of this stance is found in a study in which people with severe alcohol problems, recognizing their impaired decision-making capacities, preferred therapist—set goals in treatment; whereas those with less severe problems preferred self-set goals (Sobell, Sobell, Bogardis, Leo & Skinner, 1992).

Creating Informed Consumers: A philosophy of choice is viable only with persons who have the neurological capacity for decision-making, who believe they have the right to make their own choices and who are aware of and can evaluate available service and support options. Creating informed, assertive consumers of addiction treatment and recovery support services can be enhanced by: 1) affirming the service consumer’s right to choose, 2) distributing and reviewing consumer guides on treatment and recovery support services published by recovery advocacy organizations, 3) teaching service consumers how to recognize quality services, 4) encouraging consumers to visit service options before making a decision (versus taking whatever is offered them), and 5) defining the criteria by which the client and service specialist will know if participation in a particular group is working or not working (Bev Haberle, personal communication). Similar considerations need to be extended to educate the family members of those needing or seeking recovery.

There's a lot here, more than will fit into one blog commentary. The authors clearly see the main issues. They have framed the topic in a way that can lead to useful discussion and to therapeutically important program reforms. LifeRing convenors, who have been facilitating the practice of choice philosophy in recovery for a considerable period of time, will have much experience to contribute to this discussion. It is gratifying to those of us who believe that recovery by choice is the wave of the future that these concepts are now being understood, formulated, and endorsed by respected and learned voices in the addiction treatment profession.

Monday, October 8, 2007

LifeRing at CAADAC '07

My plan was to leave home at 6 a.m. and arrive at the conference hotel when the Exhibit Hall opened at 7:30, but I overslept my PDA’s alarm and didn’t arrive at the Marriott in Rancho Cordoba, a suburb of Sacramento, until 8:30. That turned out to be fine. The volunteer at the registration desk quickly found my name tag and I as quickly found the LifeRing table in the Exhibit Hall. The exhibit tables were crammed into the hall like sardines, and there was only room for two of our three pop-up displays. Setup took only a few minutes, and – there being no one in the Exhibit Hall but other exhibitors – I dropped in on the plenary opening session in the large ballroom next door.

There, the keynote speaker, a Dr. Kevin McCauley, a former Navy surgeon now running a private addiction practice in Salt Lake City, was holding forth with a PowerPoint slide show on the disease model of addiction. CAADAC is the California Association of Alcoholism and Drug Abuse Counselors, and had chosen a speaker from Utah to kick off its annual event. Dr. McCauley’s talk impressed me with the positive attitude he showed toward addicted people. It was refreshing to hear a treatment professional speak of the good qualities of alcoholics and other addicts, not just of their character defects. He said, for example, that the heroin addicts he knew were “sweet, affectionate” persons, and that addicted persons generally shared character traits of great sensitivity and empathy – traits that they used addictive substances to mask and obliterate. Other aspects of Dr. McCauley’s talk impressed me less. His model of brain functions in addiction was so crude as to be a caricature. He worked the issue of sexuality for laughs like in a sit-com script for a teen audience. He delivered a number of opinions that may have been popular with many in the crowd but were blessed with little in the way of supporting evidence – for example, that author James Frey (A Million Little Pieces) was a “sociopath,” or that people who recovered without treatment were not really “alcoholics." I got the uncomfortable sensation that the doctor was catering to the lowest common denominator – an impression that was shared, it appears, by others with whom I spoke later in the conference. As a keynote presentation, to my mind, it set the bar low.

At the first coffee break I was back at the LifeRing exhibit table. The aisles between the tables were so narrow that traffic was discouraged, and if one person stopped to chat, the aisle was nearly blocked. Nevertheless, people came; and all of them were drug and alcohol counselors.

As I had done at the NAADAC and the APA conferences, I buttonholed people, saying “Let me tell you about LifeRing. LifeRing is an answer to the question, ‘What do I do with clients who are willing to give recovery a shot, but they tell you that 12-step is not their cup of tea.’ Do you have clients like that?”

Not a single person answered in the negative. Some said, “A few.” Many said, “I have a lot of those.” A few counselors said, “Practically all of them.”

“What you can do with those clients,” I continued, “is send them to LifeRing.” While listening for and responding to the customer’s questions, I gathered up a bundle of LifeRing literature and put it in their hands. The LifeRing “magazine” that we published last year was still new to nearly everyone with whom I spoke. The great majority of people who stopped at the table had not heard of LifeRing before, but it seemed to me that the minority who knew our name was a bit greater than at last years’ event in Burbank.

Very gratifying was to hear the number of enthusiastic responses to the presence of LifeRing. A program director from Bakersfield gave me her card and said her facility had available meeting rooms that we could use for a LifeRing meeting, for the asking. A Sacramento program director offered assistance in starting LifeRing meetings there. The owner of an inpatient facility on the coast near Monterey offered to host a LifeRing meeting on their site. Quite a few professionals from Southern California expressed interest in learning about future LifeRing meetings and activities in their area. Several members of the CAADAC board of directors and the organization’s Executive Director, Rhonda Messamore, stopped by the LifeRing table and spoke words of appreciation for our participation.

After the coffee break I had the good fortune to attend a workshop on “What is Recovery and How Do You Measure It” by B.J. Davis, Psy.D., Clinical Director of Strategies for Change, a large outpatient facility in Sacramento. Dr. Davis quoted extensively from published research on treatment outcomes, and supplemented the findings with research projects he had undertaken personally at his facility and in his prior academic positions. The most powerful factor in bringing about successful outcomes, he reported, was the counselor’s ability to forge a therapeutic alliance with the client. The specific counseling ideology, by contrast, was a very minor factor. Accordingly, Dr. Davis said, the counselor’s ability to empathize with and to work out a treatment plan collaboratively with the client was a key to success. The most effective treatment is that which the client is motivated to follow, whatever it may be. The use of positive reinforcement is highly effective, whereas negative reinforcement – punishment – usually fails. Dr. Davis criticized treatment strategies that rely on control. Too many counselors think that treatment is about imposing their program on the client, thus rendering the client even more powerless than before. Treatment should be about empowering the client and working collaboratively. Too many counselors are lazy; they have only one treatment plan for everyone: “get a sponsor, work the steps.” They know nothing else. What would we say to a doctor that handed out Prozac to every patient, regardless of their individual profile? We would consider it malpractice. Yet we do the same kind of thing all the time in drug abuse treatment. Counselors are well-intentioned but good intentions aren’t enough. In conclusion, Dr. Davis presented a number of instruments for measuring the Quality of Life in recovery – based on the profound truth that clients will have difficulty maintaining sobriety unless they achieve a subjectively satisfactory quality of life in their recovery.

Dr. Davis was not only a well-informed but also a powerful speaker, charismatic and humorous, who led his audience forward and upward, even if this meant entering a discomfort zone. The Association would have done well to have selected Dr. Davis as its plenary keynote speaker.

Lunch this day was a two-hour membership meeting, featuring reports by the various officers and committees. I have been a CAADAC member for several years and attended with voting rights, symbolized by a green plastic wristband. I learned among other things that CAADAC has 1,678 full members, plus about 1500 student members and about 1700 “recovery workers” (aides), and that CAADAC is one of nine competing organizations of addiction counselors in California. The highlight of the session was a report from a CAADAC-affiliated project at San Quentin prison, initiated by prisoners, designed to train the inmates as fully qualified addiction counselors on their release. Nine of the eleven inmates who took the test for CAADAC certification passed it. One of the recently released prisoners, Brian Smith, spoke briefly and received a standing ovation. When that was done, there was no time left over for membership Q and A or for floor debate on motions presented, and the session closed without anyone having the opportunity to use the green wristband symbolizing their voting rights.

I spent the afternoon in conversations with visitors at the LifeRing exhibit table and with other exhibitors. Among others, I chatted with the woman at the California Department of Alcohol and Drug Programs about the impact of the recent Ninth Circuit Court of Appeals decision affirming that AA/NA were religious. She was only vaguely aware of the decision. She did not believe that people were coerced into attending 12-step programs, or that they should have the right to sue if they were. She believed that secular alternatives existed everywhere, if the client asked for them. She did promise to take the LifeRing literature I gave her to her supervisor. I also ambled over and had a friendly chat with one of the fellows at the Narcotics Anonymous exhibit table. He told me that NA was able to use the 12-step program and other literature of AA free of charge, whereas all the other “Anonymous” organizations had to pay AA royalties. I explained LifeRing to him and he listened. We had a friendly chat. I cruised some of the exhibit tables representing inpatient treatment programs. One program had only four beds, yet turned a profit. Another did very well with ten beds, even at 80 per cent occupancy. Three of the larger programs occupied adjacent booths and I learned that they were owned by the same company, which owns more than 240 separate treatment facilities nationwide. I met a new hire whose sole job was marketing for one of these programs. I got the impression that there is some serious money being made in the private for-profit treatment industry, even in this difficult economy.

The next morning’s plenary presentation centered on workforce development in the addiction profession. The presenters discussed an ongoing survey of addiction workers, with considerable detail about the questions asked, but little in the way of results, as they had not yet evaluated the answers. Much of the ongoing survey dealt with addiction workers in the public sector (those working for counties, cities, and the criminal justice system). Fortunately there was time for questions. I raised my hand, was recognized, and asked what plans the Association had to help its members working in the public sector in the wake of the recent Ninth Circuit ruling that AA/NA are religious. A counselor in the public sector who gives a client only the choice of “get-a-sponsor-work-the-steps or go to jail” can be sued. What is being done to make secular treatment options and secular support group options more widely available?

After a few clarifying exchanges -- the speaker was not familiar with the decision – the reply was denial that people are coerced into 12-step programs. The speaker thought that secular treatment alternatives were available practically everywhere. He did, however, promise to give the topic further study.

I had unusually heavy traffic at the LifeRing table immediately afterward from people thanking me for asking that question and expressing their frustration at the speaker’s denial that 12-step coercion occurs. It occurs all the time. People shook my hand and smilingly called me a troublemaker, sh*t-stirrer, and similar compliments.

Minutes later the hairy beast was in full evidence. I attended a workshop on “Therapy in Conjunction with Adult Drug Court” – Drug Court being one of the main settings where clients risk being coerced into 12-step programs – and the presenter provided a five-page handout containing on its last page a copy of the 12 steps.

During an early question break, I asked: “I see from your handout that working the 12 steps is part of your Drug Court treatment program.” -- “Yes, that’s right.” -- “And if the client is not compliant with the treatment program, they go to jail, correct?” -- “Yes, that’s right.”

I then explained the Ninth Circuit decision in a few words. The speaker had apparently not heard of it, and manifested some trouble wrapping his mind around the concept of client choice, but with some prompting from others in the audience, he eventually got it. He then retreated into the same denial as I had seen earlier. “Oh well, if the client brings in some other program they want to do, if they’re not just playing games, the court evaluators will certainly look at it.” And, “the county has secular programs available.”

A woman behind me muttered something hostile about “judges legislating from the bench,” and the session showed signs of flying off the rails, but I backed off and the speaker resumed the droning exposition of his counseling approach. After a while I had to leave or risk falling off my chair with boredom. In retrospect I blame myself for not making a bigger fuss over the issue; it might have been a healthy thing, a spur to positive change, not to mention a relief from tedium, for this workshop to blow up in a floor fight over the First Amendment issue.

An excellent workshop followed lunch, titled “The Ethical Issues of Nicotine Use by Care Providers.” The presenter, Steve Sarian, is director of the U.S. Navy’s Drug and Alcohol Counselor School, an ordained Buddhist priest, and a hospice chaplain. He conducted the session in a highly interactive way, which made for a lively time. Sarian was eloquent in showing that nicotine is a mood-altering addictive drug, and that counselors in addiction treatment programs face ethical issues if they are nicotine users. He also cited research showing that alcoholic smokers are more successful in achieving durable abstinence from alcohol if they also quit smoking. Sarian used a light touch in outlining the issues surrounding nicotine use, an approach that was highly effective in stimulating participation and mental processing in the audience. I gave him very high marks.

After a final afternoon session at the LifeRing exhibit table, during which I sold the remainder of the workbooks I had brought, I packed up the displays, left a few brochures and magazines on the table for tomorrow’s session, and hit the road. The big awards dinner in the evening, if it was anything like last year’s, was eminently missable – a round of Good Ole Boys giving each other wall ornaments. The conference program had half a day to run on Sunday, but traffic at the exhibit tables typically would be very light, and several other exhibitors were also packing as I left.

In looking back over this experience, several thoughts occur to me.

(1) It was good to be able to combine the role of exhibitor with the role of meeting participant. Many of the other exhibitors merely sat in the cramped exhibit hall talking to one another or playing games on their PDAs between coffee breaks. Boring. By participating in the workshops I learned things, and I was able on a couple of occasions to ask questions and to raise issues that will in the long term help LifeRing to penetrate the secular market niche where we belong. Being an active participant was also a lot more fun.
(2) The CAADAC organization has a long way to go before it becomes an effective advocate for the addiction profession. Its main problem is that its wheels are stuck in the 12-step rut. Content-wise, the 12-step approach is dead. It cannot be developed further. One can only repeat it as an article of faith, over and over, like a Nepalese prayer wheel. Scientific progress on this basis is an oxymoron. Twelve-step doctrine may be a viable foundation for a lay priesthood, but not for a modern healing profession. So long as this religious doctrine remains the core teaching of the profession, parity with the medical healing professions, which CAADAC so fervently seeks, can never be achieved. Moreover, the constant influx of 12-step recruits possessed of nothing but their personal experience, and willing to work as counselors for the minimum wage or less, means that a general elevation of salaries and benefits, so crucial to professional workforce development, will remain a Sisyphean effort. In order to advance, the association must take a firm and clear stand that personal experience with the 12-step approach is insufficient qualification for a professional. The organization must actively learn, teach, own, and promote secular alternatives, or it will die a lingering death.
(3) The national organization, NAADAC, is probably no less an alter ego of AA than is CAADAC. In both organizations, in any session, if you say “Hi, I’m Joe, I’m an alcoholic,” most people in the room will reflexively respond, “Hi, Joe.” But the eyes are a bit more open and the brains have been working a bit harder in the national group. So, for example, in the national’s conference program in Nashville, the 12-step meetings at the start and/or end of the day were labeled “Optional.” The CAADAC program lists them without that qualifier. NAADAC’s headline speaker was Carlo DiClemente, speaking on Motivational Interviewing – a secular approach that has little in common with 12-step but much in the way of helpful insights for treating addictions. CAADAC’s choice of the doctor from Utah, McCauley, as keynoter, tended to massage the soft belly of the status quo instead of kicking its hind end forward, which is what needs to happen. The NAADAC conference program had only one workshop specifically devoted to a 12-step issue, and that one was canceled. The CAADAC program was larded with pablum for the faithful: “The Medicine Wheel and the 12 Steps,” “A Musical Journey Through the Twelve Steps,” “Spirituality in Recovery” (by Father John), and others; and even where the Step approach was not in the workshop title, it was frequently present in the content, as in the Drug Court program. On balance, therefore, my feeling is that CAADAC’s continued affiliation with NAADAC is probably a good thing to the extent that the more advanced thinking of the national group may be able to pull the local organization forward.
(4) Virtually all the people I met both in CAADAC and NAADAC are sincere, well intentioned, hard working, and approachable. When I first entered these halls a year ago in Burbank I felt apprehensive, as if in potentially hostile territory. I no longer feel that way. These are good people and they can be talked to. LifeRing should definitely continue to participate in these organizations. As more and more of our members become treatment professionals themselves, they should be active in these groups and, in an appropriate situation, play leadership roles. Although there are people in these groups who have tunnel vision, most participants subscribe to the philosophy “whatever works,” and if we can make our aims and methods clear to them, they will be powerfully helpful to us in giving their clients the option of attending LifeRing support groups if they so choose.

-- Marty N. 10/7/07

Saturday, October 6, 2007

Three little anecdotes

These three things all happened the week that I marked my 15th anniversary clean and sober:

A young man came from the Kaiser Chemical Dependency Recovery Program in Oakland and told me about a session he had with his case manager. Now that he was in phase three of the program, he must "get serious" about his recovery. That means -- the case manager told him -- he must either get a sponsor and work the steps, or he must work the LifeRing Recovery by Choice workbook.

A not-so-young man came to the workbook study group, first time, and said that he had been busted for growing marijuana. His case fell under Prop. 36, the California law that mandates the option of treatment instead of prison for certain drug-related crimes. The judge told him that he could not sentence him to attend AA/NA because they were religious. Instead, he sentenced him to ten weeks of LifeRing.

The program director of a new inpatient treatment program in a nearby suburb telephoned the Service Center and said they had reviewed the LifeRing materials (they had ordered a set earlier) and found them excellent, and could we please arrange to hold a LifeRing meeting at their facility.

Letter from a counselor about the workbook

My Agency is _________. We are part of ______ medical center. I have read the 3rd edition [of the Recovery by Choice workbook] and loved it. ... Ideally I would like to use samples from the book to have the client work on between my 10 session relapse prevention groups. I have already encouraged one of my clients to buy the book online and gave him your website. I have discussed what I am doing with my supervisor but still need to talk our director to see if the hospital will fund this or whether me and my supervisor will have to foot the bill. Ideally I would want all counselors to use the book and encourage their clients to buy it. So I am still working on the details of my project. I am going to talk to our director this week about the project but in the mean time I am encouraging my clients to purchase the book on line.


Thursday, September 13, 2007

More on the recent court case about AA/NA and religion

The recent court case holding that AA and NA were religious comes as no surprise. Two other federal circuits, including the middle-of-the-road Second Circuit (NY) and the conservative Seventh Circuit (Chicago) had already said so in the 1990s. See my New Recovery blog; see for the older cases.

What's surprising in the opinion is the lukewarm endorsement given to the 12-step programs' efficacy. On the surface, the court nods to the "fine work of AA/NA," but footnote 10 to that passage is much more equivocal. The footnote says:

The confidential nature of AA/NA treatment makes testing efficacy difficult. There is, however, some data to suggest that the programs, as part of a larger treatment strategy, have helped many people maintain their sobriety, at least for a period of time. See Max Dehn, How It Works: Sobriety Sentencing, The Constitution, and Alcoholics Anonymous, 10 MICH. ST. U. J. MED. & L. 255, 269-74 (compiling efficacy data).
"Some data to suggest ... many people ... at least for a period of time" is not exactly a ringing endorsement.

Monday, September 10, 2007

Report from the NAADAC conference in Nashville

Getting Ready

The two LifeRing signs that Wilbur W. had printed and mounted for LifeRing at the September 2006 NAADAC conference in Burbank were so banged up at the end of the American Psychological Association Conference in San Francisco in August 2007 that the only thing to do was give them a decent burial. Furthermore, the log-cabin charm of the PVC pipe frame that hung the signs had worn off. For NAADAC ’07 in Nashville, we needed fresh new signs and a frame to hang them on.

Inspired by some commercial designs I saw at APA, I designed and built a set of three pop-up frames using PVC pipe, lawn sprinkler fittings, fiberglass tent poles, and bead chain. The biggest headache was the tent poles. There are two wilderness supply stores near my house that have a bin for miscellaneous poles, cheap. When I built the pilot for the new frames a few weeks earlier, poles were plentiful and I got a set for $6. When I returned to that store shortly before the NAADAC event to get two more sets, the pole bin was stripped. It was the same story at the other store – nothing but bent poles, poles without ferrules, and odd ends. Why? The clerk said, “Burning Man.” The annual desert festival drew scores of tinkerers and experimenters who built creative structures and sculptures, and they had cleaned out the odd-pole bin at the local stores. I had to plunk down nearly $40 to get two sets of brand new factory-made replacement tent poles. A can of silver spray paint gave the PVC pipe construction a semblance of commercial gloss. The frames looked respectable.

Now to the posters. I drafted the posters, 24” wide by 52” high, in Macromedia FreeHand, and emailed the files to Wilbur, who is a photographer who owns a wide-carriage printer. Unfortunately, Wilbur does not have FreeHand; he uses Adobe Illustrator, which I don’t have. After several unsuccessful tries to convert my files to Adobe PDF, I found a conversion utility that claimed to turn FreeHand files into Illustrator files, and Wilbur was able to open them and printed them on Monday morning, Labor Day, the day before my plane left for Nashville. When I got the posters home and unrolled them, I saw with dismay that two photographs included in my design were missing. The file conversion utility had quietly ignored them. Time to get creative. One of the photos was small enough for me to print out on my letter-size photo printer. That solution would not work for the other, which was the group shot on the cover of the workbook, blown up to 12” high by 20” wide. Photoshop to the rescue! I teased out the five faces from the photo as individual pictures, blew them up, and printed them individually. Then it was just a matter of mounting the photos to the posters with rubber cement. Apart from some buckling due to the cement, the solution worked, and from a reasonable viewing distance the posters looked fine.

The whole display package – posters rolled into mailing tubes, PVC pipes and chains stuffed into a pillow case – weighed just over 12 lbs. Weight was an issue because I was also carrying books and brochures and the airline had a 50-lb per suitcase weight limit. After considerable juggling and trimming, I got the whole package including my personal stuff into two suitcases just under the weight limit, plus my carry-on.

Some months before the event I had posted on several email lists that it would be nice if someone in Nashville had a couch where I could stay during the conference, to save hotel expense. Three people offered, but as the event came closer, each had to withdraw. Mike because they had no room, and Gregg because of a family and job issue. At the last minute Bettye had to cancel because of a gall bladder flare-up that sent her to the hospital. There was no alternative but to book a hotel. The downtown Renaissance hotel where the convention was being held was way too expensive for the LifeRing budget. After considerable online searching, I reserved a room at the Red Roof Inn (an East Coast motel chain) near the airport and on a bus line going downtown.


At the APA I had bought a four-wheeled Tutto brand suitcase from another exhibitor, and this proved a blessing, as I was able to pile the second case and the carry-on on top of the rolling suitcase. During the long BART trip to the airport, I did sometimes feel a bit like a mule hauling a truck, but the gear did the job, tolerably if not brilliantly, without breaking my back. The airline checked my hefty bags without incident.

The flight was uneventful. I was wearing a “Cal” hat – the UC Berkeley Golden Bears had beaten the Tennessee Volunteers 45-31 the previous weekend – and the bantering started at SFO, when a gentleman with a biscuits-and-gravy accent asked whether I was going to Nashville with that hat. I grinned and said I was. He said not to worry, “Those folks in Nashville don’t care for the Vols anyhow.” That turned out not to be entirely true. A waitress at the Waffle House near the Red Roof Inn – there’s nothing but franchises near the airport – said she couldn’t stand to look at the hat, and I would be charged double if I wore it, and there was more kidding along those lines.

Arriving at the Nashville Convention Center / Renaissance Hotel Wednesday evening, I found the NAADAC registration table set up, but not yet in peak mode. The first set of instructions given to me sent me to a dark and cavernous exhibit hall on the ground floor. On my return to registration, sweaty from hauling my truck over carpet, a very competent NAADAC woman named Diana Kamp took me in hand and led me to the proper floor. There, the table reserved for LifeRing near the entrance of the Exhibitors’ Hall, like most of the other tables in that room, turned out to have no space behind it to display our new pop-up posters. It was just a table against the wall. I had expected a booth, like last year in Burbank. There were suitable tables, however, in the hallway, still awaiting setup. The resourceful Ms. Kamp quickly switched booth assignments for me, and LifeRing now had a good table with ample space behind it. Thanking her, I began the setup. Note to self: when packing long bead chains, wrap them separately. During the flight, the six chains for the three frames, each chain 84” long, had mated and formed a Gordian knot of tiny metal beads. The setup, which should have taken fifteen minutes, took well over an hour. Finally, it was done.

Tired and hungry, I hit the restaurant strip on Broadway next to the convention center. This is a three-block string of honky-tonk bars and souvenir shops. Each of the bars featured a heavy-set barker in cowboy hat and boots trying to lure the tourists into his den of burgers, beer, booze and country music. Not much for a recovering alcoholic to like, there. At the end of the strip, around the corner of Second Avenue, I spotted a Japanese restaurant. Ah!

Unfortunately, when booking the motel near the airport, I didn’t check the bus schedule thoroughly enough. I now learned that the last outbound bus from downtown had left at 5:30 p.m. The inbound bus in the morning cost only 60 cents with my senior discount, but getting back to the motel at night would add an average of $20 in taxi fare to the $42 per night room bill.

The taxi driver on the ride to the Red Roof Inn was a young man from Somalia. When he won the green card lottery in Somalia he didn’t know anybody in the USA, but a neighbor of his had a brother in Nashville who promised to help him. So he went. It was the first time he had heard the word “Tennessee.” Fate got me here, he said. That is how fate is. He asked me whether it was true that families had moved out of San Francisco because of the gays. I said I didn’t think so. He wanted to know how many gays there were, and much else. When we had exhausted that fascinating subject I asked him how come the back seat of his cab didn’t have seat belt anchors. He said the drunk college students broke them. Another drunk pushed out a side window and tried to walk away. A group of drunk college girls once trashed his CD player and his meter. He said they were very nice, from good families, but when they got drunk they didn’t know what they were doing. I could relate.

My room at the Red Roof Inn is a “handicap accessible.” That means you can roll a wheelchair into the shower. My mind flashed on returning veterans from Iraq. I felt grateful that my own disability – amputation of alcohol and “drugs” – allowed me complete mobility and the free exercise of all vital functions.


The bus driver outside the motel said that my Cal driver’s license for proof of age was worthless, I needed a senior pass from the MTA, but he “would take care of me.” I got into town for 60 cents. At the convention center, Mike G. from Nashville showed up at the LifeRing table even before 9 am. Having Mike there at the table was great. Not only was he good company – we had to remind ourselves sometimes to focus on the customers instead of chatting with each other – but he also knew some of the local counselors and was able to build local rapport as I could never have.

• The very first counselor that morning was eloquent on the problems his clients encountered with 12-step programs. “Too many walls,” he said. There was the powerlessness wall – the biggest one -- the God wall, and a series of others. He said that the 12-step approach was “a hard sell” with his clients. He had had more than a hundred clients in his small Midwestern town and only three of them had formed a stable attachment with a 12-step group. “People need to find a group that fits who they are. The important thing is social support for recovery.”
• A counselor from Central Indiana said that an alternative was very much needed in her town, but that it would be hard to get it going. It was hard to get AA going.
• A counselor from Tucson stopped and said she had done AA herself but she was open to alternatives. She knew about SMART and had attended a couple of meetings but felt that the people there had more serious mental health issues than she was comfortable referring her clients into. She hadn’t heard of LifeRing. I told her that when the Tucson meeting started up she would be contacted. She nodded OK.
• A counselor from a residential center about 45 miles west of Nashville took all of our literature and said there was plenty of room in this “recovery Mecca” (Nashville) for all different kinds of approaches. She left her business card.
• A program director from a program in Nashville specializing in professionals said he would be happy to help get a LifeRing meeting going.
• A counselor from a federal prison in Arkansas said that her clients find God when they arrive, and leave him when they go. She currently has people who are interested in the 12-step approach and others who are not. She wants to know about whatever alternatives are available, and took the literature.
• A DUI counselor from the city said most of his people don’t want to go to any support groups because they don’t realize they have a problem, but it was good to offer them choices because it takes away one of their excuses.
• The owner of the Recovery Today newspaper stopped by and listened to my complaint that the paper had refused to list LifeRing as a resource. He said I should contact Linda at the paper and she would put in a listing for us. He said it’s not their policy to list only 12-step groups, they’ll list any support group that works for anybody. We’ll see.
• A counselor for an Army treatment center in Hawaii says she’s been in the counseling profession long enough to know that 12-step doesn’t work for everybody. They’ll go and they’ll come back to her and say there must be another way. She’s taking our literature back with her.
• A counselor from a program in Tullahoma, near Nashville, wants to be notified when a meeting starts.
• A counselor from Aurora, Ontario, north of Toronto, chatted for a while and took literature, saying she was interested.
• A counselor from Denver said he’s heard of LifeRing and has a LifeRing presentation scheduled at his program. He bought the workbook, saying it would help him understand LifeRing better.
• A counselor from Birmingham AL said “for sure” there are people who do want to do recovery but don’t want to do it the 12-step way, and is interested in hearing what we have to say.
• A young counselor from Metro Public Health in Nashville said that patients who object to the 12-step approach are “very common” but the only alternatives available are church-affiliated. She took our information and wants to be notified when we have a meeting going.
• Another counselor from Tullahoma bought both the workbook and How Was Your Week and expressed strong interest in having a LifeRing meeting in her town.
• A counselor from a local program gave us the name of a program director at a facility out of town who believes in offering people choices, and said we should call her.
• An exhibitor from the Vivitrol table stopped by and we chatted for about ten minutes. Vivitrol is the time-release form of Naltrexone, an anti-craving medication. She probed for our attitude on medications. I told her that if a patient was honest about their use with the physician, and the physician was competent in addictions, then we would support the patient taking their medication as prescribed. The medication was a sobriety tool, not a sobriety breach. She told me that it was refreshing to talk with somebody “who gets it.”
• A counselor from Vermont said that the issue of clients wanting to do recovery but not 12-step “comes up a lot” in her practice.
• A counselor from a very small town in Iowa, when I asked her whether she had clients who said yes to recovery but no to 12-steps, replied “Yes, most of them.”
• A senior counselor from Helena, Montana, said he “absolutely” has clients who are interested in recovery but not in 12-step. He said, “We need something, we need something.”
• A counselor from Dayton Ohio says he has “a lot of clients” who don’t want to do the 12-step approach. He said, “It’s awesome that you’re out there. It’s so great that you’re here.” He took all of the literature and left a business card.
• A counselor who works with adolescents near Nashville says she “definitely” has clients interested in recovery but not 12-step and wants to know more about us. She left her card so that we could notify her when a local meeting starts.
• A woman from a recovery bookstore said she was glad we were here because people need more approaches than just 12 steps.
• A counselor from a healing center in Memphis stopped and gave us encouragement.
• A counselor from a Lesbian center said she was very much interested and she would look us up online as soon as she got home.
• A young woman from a treatment program for professionals chatted and took our literature.
• A teacher from a recovery high school said they refer their students to 12-step meetings. I asked her, what if the students aren’t comfortable with that approach. She said, yes we do have that issue, and we’re not entirely sure what to do about it. She took our literature. If we got a meeting going, she would “definitely” refer people to it “if appropriate.”
• Three counselors from a small town in southwestern Tennessee stopped by. One of them said, “We have enough trouble getting 12-step going in our town, but this would definitely be interesting.” They took literature.
• A drug court counselor from GallatinTN and two counselors from a small town north of TN took literature and said that their clients needed options in addition to 12-step. The drug court counselor recognized Mike and said she was happy to see him there; would he be willing to volunteer some of his time to meet with their clients.
• A counselor from Indiana said he was interested and took literature.
• A counselor from Seattle said “I’m open to whatever works. As counselors we can’t just send people to AA or tell them not to use medications. Whatever works, is the motto.” I told him about the Seattle LifeRing meeting at the Good Shepherd Center.
• Chip Drotos, the publisher, and Gary Enos, the editor, of Counseling Professional magazine came by and we chatted about the article about LifeRing that I submitted more than two years ago and that they haven’t published.

After a while, I stopped taking notes. There was a definite theme here and we were hearing it with minor variations from all over the country. Just about everyone who talked to us told us that there was a need for broader options for their clients besides 12-step. One counselor told us that the need was “urgent” but she dare not bring our literature into her program as it was strictly 12-step and she would be written up. But most of the professionals who chatted with Mike and me at the LifeRing table professed to be open minded and supportive of alternatives. We put our literature into many dozens of friendly and receptive hands.

In the afternoon, the NAADAC program listed “focus groups” where people were invited to come talk to NAADAC leaders about how the organization could better serve them. I attended the first one. Two NAADAC staffers, one of them a specialist in curriculum development, plus a junior assistant who took notes, listened to a focus group of three. When it was my turn, I made a plea for greater recognition by NAADAC of recovery alternatives. I asked for links to LifeRing on their web site, and for end-of-day LifeRing meetings alongside the “Optional 12-step meetings” listed in their daily program. Notes were taken and my hopes were raised that some of these ideas might be acted on.

I returned to the LifeRing table and then showed Mike the labyrinthine path through the hotel to the second focus group session, where he was to inquire about job opportunities in the counseling profession, while I returned to cover the table.

At a few minutes to 4 pm I went to another hard-to-find meeting room in the hotel to give my Mirror Neurons presentation. This is the same talk I had given at the LifeRing Congress in Denver in May. I had expected to find no one at the workshop at all. Seven other presentations were scheduled in the same late-afternoon time slot. But four people were already waiting, with more coming in, and, counting stragglers, I ended up with an audience of fifteen. I was pleasantly surprised. The talk went down well. There were thoughtful, positive questions. A couple of people said it was the best, most stimulating presentation they had heard at the conference so far. Several people stopped to shake my hand and thank me and say kind things about the talk. Later I asked for and saw the feedback forms from the session. I had eight responses that were all “Excellent,” the highest grade, and four that were mixed “Excellent” and “Good” or all “Good.” One person complained about the lack of handouts. One person wrote that it was “inspiring” and another wrote that it was “the best session of the day.” This good feedback should be helpful to pave the way for other presentations in future years.

Traffic was slow when I returned to the LifeRing table. Mike was happy about his Focus Group session, and got something close to a job offer out of it. After waiting a few minutes for stragglers, we closed the table and went to find a late-running workshop put on by the LGBT folks (NALGAP – National Association of Lesbian and Gay Addiction Professionals, co-sponsors of the conference). This event, however, centered on evaluating an all-day training session they had just concluded, which we of course had not been able to attend, and after listening for some time, fighting sleep, Mike drifted away, followed a bit later by myself.

After an indifferent solo dinner I talked an airport shuttle driver into dropping me at the Red Roof motel instead of the airport; it was strictly against regulations, he said, but it was late and I was the only passenger. I saved a couple of dollars off what a cab would have charged.


Early bus to downtown. Walked around and got a bit of a stretch, took a few photos.

The draw today was the Carlo DiClemente presentation on Motivation and the Stages of Change. With traffic slow at the exhibits tables, I joined the two or three hundred people gathered in the large ballroom to hear this main event. DiClemente with Felix Prochaska is the creator of the so-called TransTheoretical Model (TTM), best known for one of its components, “The Stages of Change.”

There’s hardly a PowerPoint presentation anywhere in the substance abuse field that doesn’t contain some reference to this paradigm, which has clients moving through distinct stages from pre-contemplation to contemplation, pre-action, action, and maintenance. The counselor needs to identify the stage the client is at and tailor the treatment appropriately.

Key to the client’s progress through the stages – or lack thereof -- is motivation. DiClemente got an appreciative laugh from the audience when he said that counselors who call the client unmotivated are usually mistaken. The client may be highly motivated – but not necessarily to do the things the counselor wants them to do. In any treatment relationship, DiClemente said, there are always two plans: the counselor’s plan, and the client’s own plan. At the break, I gave DiClemente a copy of the Recovery by Choice workbook, explaining that there were of course many books setting out counselor plans, but this was the only workbook that a client could use to build the client’s own treatment plan. He appeared impressed and interested.

DiClemente’s exposition of client motivation largely followed and built on the key chapter in the Hester-Miller Handbook that I reviewed on some years ago, and I won’t recap that here. When the client appears to lack motivation, he said, the problem is often not with the client but with the treatment approach. Quoting Pogo, he said, “We have met the enemy, and it is us.”

DiClemente concluded the exposition by urging counselors to reframe the client or patient as a consumer. Borrowing from the consumer rights movement in other areas of health, including mental health, DiClemente urged treatment professionals to focus on the consumer’s needs and wants, not on the imperatives of the treatment program.

Di Clemente’s PowerPoint slide to illustrate the shift in perspective to a consumer perspective said:
• Pathology to Problems
• Pulling or Pushing to Persuasion
• Patient to Partner
• Provider to Facilitator
• Outcomes to Options
• Management to Motivation and Marketing
• Reactive to Proactive Care
Consumers have the power to choose, he said. They have a broad array of interests; they are persons of value and must be treated as such. “You will change what you do if you treat patients as consumers.”

In the question period, I raised my hand, was recognized, and stood up to ask, “You advocate treating patients as consumers who have the power to choose. Isn’t that going to be a difficult transition for programs where the first lesson they teach is that the patient is powerless and needs to stop making choices and surrender?”

Di Clemente’s answer began with a bit of fancy verbal footwork that didn’t stick in my memory. But he ended on a strong note, defending the principle of patient choice as the foundation of patient motivation and commitment to change.

As the session ended and I walked toward the exit, I caught a lot of appreciative smiles from faces in the audience.

Lunch this day was divided into regional caucuses. I had the opportunity to sit in a small room with counselors from California, Hawaii, Arizona, Nevada, Utah, and New Mexico. Much of this session revolved around governance issues of NAADAC. I learned among other things that the California group, CAADAC, was by far the largest affiliate of the national association, with a correspondingly large contribution to the national’s budget, and this gave rise to some issues and tensions. NAADAC leadership people at the session made a strong pitch for more people to become involved, pointing out that practically all the work was done by a relatively small handful of people. I could relate to that. Mike meanwhile attended the much larger caucus of the southeastern region, which included the host state, Tennessee.

The hot spot of the afternoon’s program was a seminar for counselors on working with “GLBTQQAi” clients. That’s Gay, Lesbian, Bisexual, Transgender, Queer, Questioning, Allied, and intersex. NALGAP President Joe Amico, an ordained minister fired by his mainstream church after he came out as gay, and psychiatrist Penny Ziegler led this session to a packed room. The objective was to familiarize counselors with key points of the gay movement and to sensitize them to the issues that their clients were probably struggling with at different stages of the process of coming out. Although the workshop was a bit dry and on the academic side, I feel it was helpful in raising my awareness of issues that might confront the significant and growing number of “GLBTQQAi” participants in LifeRing. At a reception later in the evening, after being assured that one did not have to be a professional to join, I took out an individual membership in Amico’s organization.

Late in the afternoon, Mike and I attended a reception thrown by NAADAC for conference exhibitors, where we had a chance to chat with conference organizers and with various service providers, learn about their concerns and teach them about LifeRing. I also found that other exhibitors shared my feeling that about everyone who was going to visit the exhibit tables had probably already done so. Several confided that they would pack up and leave on Friday, skipping the last day of the event.

After that workshop, I caught just the concluding few minutes of a workshop on leading organizational change, by motivational speaker Jim Burgin. He compared the current state of the addiction treatment field to Georgia after Sherman’s march. Sherman is supposed to have said that he left Georgia so devastated that a crow who intended to fly across it had better bring its own corn. Likewise, addiction professionals entering the field now, he said, had better bring their own corn, and plenty of it. I’m not sure how motivational the attendees found this powerful image, but it certainly stayed with me.


On Friday morning, Mike and I met at the LifeRing table and we talked about how to move toward starting up a LifeRing face meeting in Nashville. We already have a potential core membership: Mike himself, Gregg F. who has been active online and in person for eight years, and Bettye D., who moved here after several active years in LifeRing, including experience as a convenor, in Oakland. At the conference, we had gathered up perhaps a dozen business cards from local area counselors who told us with every sign of sincerity that they wanted to be notified when a LifeRing meeting got going and they would include us on their referral list. I had copied the cards and given them to Mike. All the elements of a meeting appear to be in place. With that done, I packed up our displays, left a stack of literature for Mike, shook hands, and headed for the airport.

Next year’s NAADAC conference will be in Kansas City, on the Kansas side. I feel that this year’s event, even more than our maiden venture at the Burbank NAADAC conference in September ‘06, was time and money well spent, and I look forward to participating again next year.