Sunday, May 31, 2009

Choice Theory Conference

It was my privilege yesterday to attend the Choice Theory Education Conference at the Hilton in Sacramento. I staffed a LifeRing literature table there, met with LifeRing convenors and future convenors, attended some of the sessions, and met some of the leading figures in the choice movement.

Georgellen Hofine, one of the oldest students of Choice Theory founder Dr. William Glasser (photo), personally welcomed me to the gathering. LifeRing keynote speaker and DVD author Dr. B. J. Davis was the closing speaker on the conference program, and I much enjoyed listening to his presentation and chatting with him informally.

Choice Theory advocates Resa Stendel Brown and Jack Harnden spoke about the application of Choice Theory in education. Author Mike Rice gave a talk on addiction. B. J. Davis, in addition to his own discussion of Choice Theory in addiction treatment settings, introduced a DVD showing how Reality Therapy (an earlier name for Choice Theory) was applied in a prison setting.

I took time out to meet and chat with convenors of the LifeRing meetings in Placerville and one of the Sacramento locations. One of the conference participants expressed determination to start a LifeRing meeting in Lodi. Two of the treatment professionals in attendance spoke of plans to start LifeRing meetings at their centers in the Sacramento area.

It was a very positive crowd, including quite a few people with an interest in addiction recovery, and I should have brought more books, as Empowering Your Sober Self sold out by noon.

The only shadow over the event was the news that Dr. Glasser himself, who had been scheduled as keynote speaker, had been admitted to the hospital with a cardiac issue. There is as of this writing no further news on his condition.

LifeRing in New Living (NY)

An excerpt adapted from Chapter 2 of my new book (Empowering Your Sober Self) appears in the April issue of New Living, a free 20-p health and wellness newspaper published in Stony Brook NY and distributed in the New York City area and Long Island.

This chapter from my book contains a set of tips and exercises designed to help the person who wants to stop using addictive substances to move across the gap from contemplation to action. They include visualization, laughter, self-forgiveness, reframing, exercise, and other attitude-builders. I wrote a 900-word excerpt for the paper.

The editors took some minor liberties with the chapter. They took the sentence, "Becoming drug or alcohol-free can exhilarate you and enable you to accomplish great things in life," and added the phrase "... and perhaps, more importantly, give you gratitude and humility, two spiritual qualities hard to find in most people."

OK, I may not be the most original writer in the world. But I try not to stoop to moth-eaten cliches like "gratitude and humility." But it's good to have the article in the paper, with a plug for the book, and a plug for the two LifeRing meetings in Long Island; and I guess there's a small price to pay for that. I am humbly grateful.

Wednesday, May 20, 2009

Class war in California counseling

In California you need a license to fix cars, cut hair, paint fingernails, give massages, and much else. But not to provide addiction treatment. You can be a high school dropout with a history of petty crime and mental hospital stays, and you may find work as a counselor treating people who suffer from addiction. There are in fact a substantial number of high school dropouts working as front-line counselors in the field today.

Yet, at the same time, the addiction counseling industry insists, almost with one voice, that addiction is a disease. Just like diabetes, atherosclerosis, hypertension, and the rest. Now, if addiction is a disease, then addiction treatment must be a branch of medicine. No?

How many other branches of medicine do you know where the front-line treatment providers -- the physicians and RNs who hold the patient's recovery in their hands -- are high school dropouts? Or high school graduates, without more? Or have junior college degrees, only? There are none. Addiction treatment is way out of line, far, far below the standard of the rest of medicine -- if in fact it deserves the name "medicine" at all.

To be sure, there are quality treatment programs where addiction professionals are held to the same high standard as other providers. At the Kaiser Chemical Dependency Recovery Programs, for example, there is supervision by an MD, and each of the counselors has a professional license or certification as a Licensed Clinical Social Worker, Marriage and Family Therapist, Registered Nurse, or a similar qualification that requires graduate level education and thousands of hours of supervised training. But these islands of quality are, unfortunately, just islands.

Several organizations in California have been trying for years to pass legislation that would require standards of training, education, licensure and certification for addiction counselors comparable to those in other clinical professions. The current effort is Senate Bill 707. It is a complex piece of legislation and I won't try to analyze it here in detail. What's most interesting about it, really, is the controversy that surrounds it.

On the one hand, there are voices crying that it doesn't go far enough. Today's email, for example, brings a post from Dennis W., a member of the board of one of the counselors' organizations, complaining that the draft bill is so watered down as to be useless. It puts counselors with a GED and 350 hours of counseling experience on the same level as those who have a master's degree in addiction studies. He says that the bill in this form "will continue to keep the addiction service profession in California the sub-standard field that all other states in the US look down upon."

On the other hand, the bill has been the target of a barrage of attacks charging that it goes too far. If it passes, say these voices, program costs will rise, programs will go out of business, and counselors by the thousands will be out of jobs. What's that about?

The current newsletter of one of the other addiction professionals' organizations explains:
Simply put, associations representing program owners are attempting to defeat the measure by “scaring” counselors from supporting it. The truth is, they’ve opposed every bill put forward to recognize your professionalism. More than half of the states have licensure and none of their treatment systems were shut down due to licensure or certification. Standards for counselors improves salaries, raises treatment outcomes and reduces the strains on public sector treatment as addicts seek treatment from private practitioners.

So there you have it. It's class war. On one side, the counselors who aspire to professional status and to the salaries, benefits, and respect that come with it. On the other side, associations representing owners of treatment programs whose profit rate depends on filling their staff rosters with people who have little education, training, or other claims to professional advancement.

Now you can begin to understand a little more clearly why much of the addiction industry is so heavily invested in the 12-step approach. The 12-step approach does not require much in the way of professional education. If you've done the steps and you can repeat a basic set of slogans for any occasion, you're qualified to "carry the message" to others. Of course, you're not supposed to be getting paid for doing that, but you're being paid so little as a counselor that you might as well be doing it for free. If Karl Marx were looking at this, he might say that the 12-step organizations continuously generate a "reserve army of labor" for the treatment industry -- a flood of workers willing to work for substandard wages and under substandard conditions. And this "reserve army" necessarily depresses the wages and conditions of the whole labor force. No wonder, then, that the owners' associations oppose the counselors' campaign to pass laws that would upgrade professional standards.

Thursday, May 14, 2009

Don't drink that marshmallow

The marshamallow experiments are famous by now, thanks in large part to Daniel Goleman's Emotional Intelligence books, and their relevance to addiction seems obvious.  In 1968, Stanford psychology prof Walter Mischel presented four-year olds with a marshmallow and the choice: Eat it now, or wait 15 minutes and get two.  The kids who could delay the gratification ended up, a decade and more later, with higher SAT scores, higher graduation rates, better jobs -- in short, twice as many of the marshmallows life had to offer.  

It was often believed that the kids who could delay gratification did so thanks to more "will power."  Mischel -- according to a helpful and informative summary in this week's New Yorker, by Jonah Lehrer -- analyzed what this "will power" really consisted of.  He paid very careful attention to what went through the delaying kids' minds as they resisted the bait.  They succeeded because they had methods of distracting their minds from the lure.  They covered their eyes, or played hide-and-seek under the desk, or sang songs.  "Their desire wasn't defeated -- it was merely forgotten."  The key, Mischel found, was not to resist the marshmallow -- that didn't work --- but to avoid thinking about it.  

In further experiments, Mischel found that children could be taught cognitive tricks that helped them distract themselves.  Even reducing the intensity of the temptation by pretending that the marshmallow was only a picture of a marshmallow or that the marshmallow was really a cloud worked for some children.   

Mischel and other researchers Lehrer quotes are skeptical of finding a genetic basis for the ability to delay gratification.  Too many genes are involved in even the simplest aspects of personality.  The cutting edge of research lies in classroom curricula that teach self-distraction, and in educating parents to cultivate simple cognitive skills in children.  Says Mischel:

"We should give mashmallows to every kindergartner... We should say, 'You see this marshmallow"  You don't have to eat it.  You can wait.  Here's how.'"

Wednesday, May 06, 2009

No Such Thing as a Bad Person Addicted to Alcohol

Had the pleasure today to hear and meet Charles D. Appelstein, author of No Such Thing as a Bad Kid and other works expounding the strength-based approach to working with at-risk youth.  

Charlie was keynoter  at the 12th annual Northern California Tobacco, Alcohol, Drug Educator and Youth Development Conference at UC Berkeley, where I staffed a LifeRing exhibit table.  He's a fun speaker, gets the audience laughing, chanting, and singing, all the time delivering key points of a message that is in many respects revolutionary.  

When a teacher or counselor begins work with troubled kids -- also "trouble kids" -- the key thing is attitude, Charlie began.  The successful attitude, he said, is "I believe in you.  You are a great kid.  You can do great things."  This attitude transfers to the kid; it makes the kids feel good about themselves, it gives them hope, and it inspires them to change for the better.

Afterward we chatted about addiction treatment, and I told him that LifeRing was one of the strength-based approaches in this field.  He expressed great interest.  We also exchanged books; he gave me his and I gave him mine.  

I also had the opportunity to chat with Tom Herman of the State Department of Education, Dr. Alex Stalcup of the New Leaf Treatment Center, Ralph Cantor of the local County Office of Education, and a number of substance abuse program administrators, teachers, cops, and others in and around K-12 education who are concerned with the drug issue.  The message that there's a secular, strength-based addiction recovery support network out there was welcome news to many ears.