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.