On the Air with Audrey Chapman

It was my great pleasure this morning to appear via telephone on the Audrey Chapman show, broadcast in the Washington DC area on WHUR-FM at 96.3 and via the Internet at http://www.whur.com. Audrey is a relationship specialist who has written several books on love and its problems. She's active as a writer and speaker and also maintains a busy counseling practice. She talks with radio listeners every Saturday morning from 8 - 10 am (5 -7 a.m. my time), and her show is said to have a huge morning audience up and down the East Coast.

From the first words, you can see why Audrey has such a following. She's calm, she's clear, she's relaxed; she projects empathy without judgment. You immediately feel comfortable talking to her, telling her your problems. She also sees right to the heart of an issue. She couldn't have had much time to read my new book, but she clearly understood the main points. Her questions were relevant and moved the conversation forward.

Audrey thrives on the freshness and urgency of listener calls. And her callers didn't disappoint. In just a few conversations, much of the huge panorama of addiction problems in the society was laid out before us. A grown up woman was concerned with the drinking of the auntie who raised her. A mother was troubled by her teenage son's drinking. A father worried that his own drinking was leading his son into alcoholism. And so on. Addiction is an enormous problem, and there are people everywhere struggling with it.

We don't yet have LifeRing meetings in the D.C. area, but I had the opportunity to tell listeners about www.lifering.org, our website. I was pleased that Audrey asked me to stay on into the second hour of her show. There was still much more that could have been said, and I had to bite my tongue once or twice when callers pushed concepts and solutions that have very limited utility. But I loved the live interaction, and I could see myself engaged in a longer and very interesting conversation with Audrey on some other occasion. She's smart and she has an open mind and a great way with people.

Check out her website at audreychapman.com.

Seattle police chief tapped as 'Drug Czar'

Rumors last month that Rep. Jim Ramstad was headed for the post of 'Drug Czar' proved unfounded, as Pres. Obama has reportedly nominated Seattle Police Chief Gil Kerlikowske for the post, instead.  Kerlikowske has earned generally positive reviews, but it's too early to say, if he's confirmed by the Senate, what he's likely to do as top commander of the 'war on drugs.'  Obama is on record that this 'war' has been a colossal failure.  There's grounds for hope that Kerlikowski will redirect the mission of this cabinet-level office more toward treatment, prevention, and a public health approach, rather than the nightstick-and-prison medicine that has prevailed.  For an eloquent statement advocating such a change in mission, read Victor Capoccia's op-ed in the Baltimore press, here.  Capoccia is head of the Closing the Addiction Treatment Gap initiative.  

Well said, in Washington

The Bush years, by wide consensus, were a dismal era for science.  But by a strange paradox, some bright stars emerged in what is normally a dismal field under any administration: addiction science.  

One is the brilliant Nora Volkow, who brings a rare mix of research experience, clear thinking, and leadership ability to the National Institute on Drug Abuse (NIDA).  

Another is Mark Willenbring, Director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).  In a letter to the current New Yorker (the one with the cartoon of Obama as George Washington on the cover), Willenbring precisely skewers a piece that this normally astute mag published in its December 1 issue.  The article, titled "Special Treatment," by Amanda Fortini, featured a Los Angeles area deluxe treatment facility.  

After a string of well-worn 12-step platitudes about addiction and the difficulties of recovery, the owners of the facility claimed that in essence treatment could make no difference, everything depended on the addicted person's motivation.  So why bill the client for clinical services on top of the normal cost of luxury room and board? 

Willenbring's letter goes directly for the jugular.  He writes that the piece:

... shows the irony that paying more does not guarantee access to the most current therapies... The program that Fortini describes appears to base its services on a treatment model that is more than thirty years old .... Although clients may or may not receive some benefit, they are vulnerable to unnecessary relapse risk if more contemporary treatments are not also made available.  For example, research funded by the National Institutes of Health has identified several medications that reduce relapse in early recovery from alcohol dependence.  Newer behavioral approaches, such as cognitive-behavior therapy and motivational interviewing, also increase recovery and provide alternatives to the traditional Twelve Step approach (which in updated form is also effective).  This menu of services makes possible truly individualized treament and  increases client choice and engagement, but only if people have access to it.

The treatment program Fortini described in her article was so clinically clueless and bereft of ideas that the piece might have been a subliminal parody.  It isn't often that I get to cheer somebody in Washington for saying the right stuff.  Could this be the beginning of a change we can believe in?  

Aggressive enforcement reduces drunk driving deaths

Aggressive enforcement of DUI laws has brought major reductions in alcohol-related fatalities and injuries in the suburbs of Washington DC, police say. Details from the Washington Post here.

Brief interventions effective for alcohol abusers

Doctors and nurses should screen and counsel patients for alcohol abuse during routine visits, a doctor-led advocacy group recommended in a recent report.

Dr. Thomas Esposito, co-chairperson of End Needless Deaths on Our Roadways (END), [web site] said studies have determined that 5- to 15-minute counseling sessions have proven effective in decreasing consumption among at-risk drinkers.

The recommendation is part of an annual report ranking the deadliest states of the union in terms of drunk driving. Washington D.C. and Hawaii topped the list this year. Connecticut, Illinois, Montana, Rhode Island, South Carolina, South Dakota, Texas, Wisconsin, Alaska, Arizona, Delaware, North Dakota, and Washington also made the list of the bloodiest states. Details.

Afghan regime protects bumper opium crop

This year's Afghan opium crop will set a record, the Washington Post reports. Crop eradication efforts are only a figleaf on the booming illicit trade carried on with the blessing of top officials in the Afghan regime.

Because of security concerns and local sensibilities, all eradication is done by Afghan police, and corruption is a major problem at every level from cultivation to international trafficking. Although the drug trade is believed to provide some financing to the Taliban, most experts believe it is largely an organized criminal enterprise. According to a major report on the Afghan drug industry jointly released last week by the World Bank and the U.N. Office on Drugs and Crime, key narcotics traffickers "work closely with sponsors in top government and political positions."

The report drew specific attention to the Afghan Interior Ministry, saying its officials were increasingly involved in providing protection for and facilitating consolidation of the drug industry in the hands of leading traffickers. "At the lower levels," the report said, "payments to police to avoid eradication or arrest reportedly are very widespread. At higher levels, provincial and district police chief appointments appear to be a tool for key traffickers and sponsors to exercise control and favor their proteges at middle levels in the drug industry." Source.

Opium production was practically wiped out under the Taliban, the paper reports, but recovered when the U.S. led invasion overthrew the Islamic fundamentalist regime. Now Afghan opium supplies 90 per cent of the world's heroin.

The Post's account corroborates the account of Antonio Maria Costa, the executive director of the United Nations Office on Drugs and Crime, writing in the Beirut Daily Star:

Opium money is corrupting Afghan society from top to bottom. High-level collusion enables thousands of tons of chemical precursors, needed to produce heroin, to be trucked into the country. Armed convoys transport raw opium around the country unhindered. Sometimes even army and police vehicles are involved. Guns and bribes ensure that the trucks are waved through checkpoints. Opiates flow freely across borders into Iran, Pakistan, and other Central Asian countries.

The opium fields of wealthy landowners are untouched because local officials are paid off. Major traffickers never come to trial because judges are bribed or intimidated. Senior government officials take their cut of opium revenues or bribes in return for keeping quiet. Perversely, some provincial governors and government officials are themselves major players in the drug trade.

As a result, the Afghan state is at risk of takeover by a malign coalition of extremists, criminals, and opportunists. Opium is choking Afghan society.

Source. Costa also notes, in guarded tones, "It is a bitter irony that the countries whose soldiers' lives are on the line in Afghanistan are also the biggest markets for Afghan heroin."

For a blog that makes the same point more directly, see "Bush Policies Create Terrorism on Our Streets," here.

Author of crack sentencing bill calls it a mistake

The author of the 1986 bill that mandated a 100-times more severe sentence for crack cocaine than for powder now calls the bill "a terrible mistake."

Eric Sterling was the lawyer for the House Judiciary Committee from 1979 to 1989 and wrote the mandatory sentencing bill that requires five years imprisonment for possession of five grams of crack cocaine.

In an op-ed piece, Sterling also says that the way the Justice Department has enforced the bill has been "a disaster."

Sterling writes that "almost all federal crack prosecutions involve people of color. Indeed, for years no whites were prosecuted for crack offenses in many federal courts, including those in Los Angeles, Chicago, Miami, Denver, Dallas or Boston."

Fixing the 100-1 disparity is only part of the solution, Sterling writes. It's also necessary to focus prosecution on the big dealers, the people who import the drug by the tens of kilograms. Federal prosecutors have wasted millions of dollars and countless hours prosecuting small time neighborhood dealers and couriers, Sterling says.

Read the full article here.

Source.

Step 13: Invade someplace with oil

Seymour Hersh, the Pulitzer Prize-winning journalist who helped expose the My Lai massacre in Vietnam in 1969, told a McGill University audience Oct. 30 that Bush's war in Iraq had led to a series of atrocities.

“In Washington, you can’t expect any rationality. I don’t know if he’s in Iraq because God told him to, because his father didn’t do it, or because it’s the next step in his 12-step Alcoholics Anonymous program,” he said. Source.

Economists to Congress: Don't Cut Liquor Taxes!

Some of America's most distinguished economists today called for what they say are long-overdue increases in federal excise taxes on alcoholic beverages to help offset the massive economic and social costs of alcohol. In a declaration to Congress organized by the Coalition for the Prevention of Alcohol Problems (CPAP, photo), the economists, who include four Nobel laureates, say legislation promoted by the alcohol industry to reduce such taxes would damage public health, increase budget deficits, and threaten the safety of Americans, especially young people.

"Through neglect, Congress has allowed effective rates of tax on a substance that does more harm than any illegal drug to fall dramatically, even as the federal budget has sunk far into the red," said Henry Aaron, senior fellow in economic studies at the Brookings Institution.

"Tens of millions of dollars a year already are spent marketing alcoholic beverages to underage consumers," said George A. Hacker, director of the Alcohol Policies Project at the nonprofit Center for Science in the Public Interest and a CPAP convener. "Lower taxes and lower prices will only further entice young people to drink. Calls for an alcohol tax reduction clearly are designed to line the pockets of the alcohol industry, without regard to the consequences."

Hastert receiving drug payoffs, whistleblower says

House Speaker Dennis Hastert (he of the Mark Foley coverup) is on the receiving end of bribes that lubricate the opium traffic out of U.S.-occupied Afghanistan, according to a recent interview with Daniel (Pentagon papers) Ellsberg, relying in part on testimony of whistleblower Sibel Edmonds. Source.

AA Obstacle to Effective Treatment

Effective modern treatment methods aren't reaching the majority of people who need them because the addiction treatment field is molded on the AA model, and most people don't want that, says a report today in the MIT Technology Review. Source.

Mark Willenbring (right), director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, says:

The treatment system we currently have [for alcohol dependence] is separated from mainstream health care and mainstream mental-health care. It was devised in 1975, when all we had for treatment was basically group counseling and AA. So when people think about getting treatment for drinking, they envision going somewhere like the Betty Ford Center.

That system has three main problems: First, most people don't want it; they have to be forced into it. The second problem is that patients within the general health and mental-health system are not getting located or treated. Third, because the programs are built around counseling, they are not staffed by medical personnel. So there's no one there to talk about medications available for treating alcohol dependence. And a lot of counselors don't really believe in [medication].

Consequently, the new treatments we're developing are not being implemented.

Willenberg says that "Over the next 10 years, I think we'll see a paradigm shift in the kinds of treatments that are available and how they are offered."

Crack laws target Afro-Americans: ACLU

Federal crack cocaine sentencing laws have filled federal prisons with small time users, mainly African-Americans, while white powder cocaine users get off easier and dealers run free. So says a report by the American Civil Liberties Union released today on the 20th anniversary of the mandatory minimum sentencing laws.

The law "established a 100-to-1 disparity between distribution of powder and crack cocaine," the report points out. Distributing just five grams of crack gets you five years in federal prison. To get the same sentence for powder cocaine, you'd have to distribute 500 grams -- a metric pound.

The mandatory sentencing law for crack cocaine has been used to fill the federal prisons with African-Americans.

Recent data indicates that African Americans make up 15 percent of the country’s drug users, yet they make up 37 percent of those arrested for drug violations, 59 percent of those convicted, and 74 percent of those sentenced to prison for a drug offense. More than 80 percent of the defendants sentenced for crack offenses are African American, despite the fact that more than 66 percent of crack users are white or Hispanic.

African-Americans on the average get an almost 50 per cent longer sentence for possessing the same amount of the drug as other ethnic groups, the report points out.

Most of those filling the federal prisons are small time users or street corner dealers. The law has not been effective against major distributors. It has not made a dent in the wholesale side of the supply pipeline for the illicit drug.

A summary of the ACLU report is here. Full text here. Good audio segment on NPR here.

The Health Care Blog calls the 20-year old crack law "possibly the worst single bill ever passed by Congress." Source.

Book Says Faith-Based Programs Just Political Ploys

David Kuo, a conservative evangelical who was second-in command of the Bush administration's Office of Faith-Based Initiatives, has come out with a book in which he says that Bush's people privately made fun of the faith leadership and used faith-based program money mainly to gain votes.

In public, Bush and his top advisers coddled and kissed up to the born-again religious leadership, but behind their backs called them "nuts," "ridiculous," "out of control," and "goofy." Faith-based program initiatives were thinly disguised events to get out the vote for Republican candidates, and awards of faith-based funds were made mainly on the basis of loyalty to the administration. Read more. Bush's faith-based addiction treatment funding initiatives, misleadingly called Access to Treatment, can be seen as part of this cynical framework. More about that here and here.

Foley's Alcoholism Phoney?

Directly after resigning from Congress, Mark Foley (R-FL) made a public admission of alcoholism and checked himself into an addiction rehab program.

Foley's claim of alcoholism is not convincing a lot of people who knew him. One of his own colleagues, Rep. Peter King (R-NY) told Fox the claim is "a gimmick." Source. Advocate.com, the LGBT website, quotes sources close to Foley as doubting that he had a drinking problem. Source. From this perspective, Foley's quick public entrance into an alcohol rehab clinic was a convenient exit from further public questioning about his sexual advances to underage male pages.

True, as a psychiatrist pointed out to the press, many alcoholics manage to hide their addiction for fear of being stigmatized. But Foley had other stigmas to worry about. He was a closeted gay Republican -- but his orientation was an open secret in Washington and in Florida. He was also sexually interested in the male Capitol pages -- but this fact was widely known among the pages themselves and evidently at least some in the House leadership. Does the stigma of alcoholism carry a more painful sting than homosexuality and pedophilia, such that Foley would guard the secret of his drinking more closely than his other secrets? Hard to believe. Especially in Washington.

Foley wasn't alone in taking dubious refuge in alcohol rehab. Rep. Bob Ney (R.-OH) declared himself an alcoholic and checked into rehab last month hours after pleading guilty to corruption charges in the Jack Abramoff influence-peddling scandal.

The parallel has been a feast for skeptics. The Maine Morning Sentinel's editorialist observed that "claiming an addiction becomes the last resort of the poorly behaved." Source. Another commentator thinks that checking into rehab is becoming standard procedure for cornered politicos. Source.

Writer William Saletan had fun with this emerging pattern in Slate. Politicos in trouble should follow a 10-step program, he writes, including:

4. Call yourself an alcoholic. Foley adopts the label directly: "I am an alcoholic." This is vital, because when you're also a crook, anti-Semite, or pervert, "alcoholic" sounds so much nicer. Millions of people are alcoholic or love someone who's alcoholic. Embrace the label, and they'll embrace you. Roth adds a nifty twist to this maneuver, calling Foley "a closet drinker." Everyone knows Foley had a closet. The only question is what's in it. Booze is the least shocking answer he can hope to get away with. Source.

The conservative pundit Mona Charen also wasn't buying it. She wrote: "A fly on the wall of these treatment centers would doubtless discover that some of their celebrity clients are not alcoholics at all, but simply charlatans anointing themselves with alcoholism to wring sympathy from an infinitely forgiving public." Source.

So, at least if you're a celebrity, the "alcoholism" label, far from stigmatizing you, makes you downright lovable. NCADD, are you listening?

It's a perverse world. The huge majority of alcoholics who need treatment can't get it. Source. Scarce and understaffed emergency detox centers have waiting lists. Source. But for a handful of public figures, alcoholism treatment serves as a convenient moral refuge, a beggar's cup for sympathy, and a safe harbor from public inquiry.

P.S. A number of the commentators on Foleygate are mixing up his case with Mel Gibson's. While Foley's "alcoholism" seems too convenient to be true, there's no doubt about Gibson's bona fides in this department. See earlier blog posts here and here.

"We are not 12-step sponsors for pay"

BURBANK, CA: H. Westley Clark, M.D., J.D., M.P.H, director of the Center for Substance Abuse Treatment of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), gave the keynote at the annual addiction counselors' conference in Burbank this morning. In the course of reviewing the high rate of turnover, the low level of educational preparation, and the low pay scale in the addiction counseling profession, he said that some people are confused about what counselors do. "We are not 12-step sponsors for pay," Clark emphasized. "I love 12-step programs but we are not. We are driven by state of the art knowledge in a very complex field."

The remark drew vigorous applause from maybe a third or half the audience of several hundred addiction professionals in the ballroom of the Burbank Hilton. The main reason for the low pay and the low esteem in which addiction counselors are held is the constant recruitment of 12-step graduates who see the job primarily as a service opportunity, work for peanuts, and bring with them little but their own experiences. A lot of people in addiction counseling are in fact no more than "12-step sponsors for pay," and this holds back the profession.

At the start of his Powerpoint presentation, Clark showed a photo of Pres. Bush with a sentimental quote about people helping people. As a high federal employee, Clark probably had to show such a slide. Not a single person in the audience applauded.

Congress One Big AA Meeting

“If we could turn Congress into one big A.A. meeting,” he said, referring to Alcoholics Anonymous, “where people would be required to say what they mean and mean what they say, it would be a lot better Congress.” -- Representative James Ramstad, Republican from Minnesota, quoted in the NY Times today. Source.

Oh, where to start?

If Congress were one big AA meeting:

• Floor debate would consist of canned monologues, Bible readings, and speeches full of cliches and slogans
• The members with the longest tenure would run the place
• Nobody in the country would know who's really making the decisions
  
• Nothing said in Congress would become public knowledge except if leaked through the rumor mill
• A good portion of those present would be drunk or hung over
• The members would proclaim that all their decisions were inspired by God
• Funding for secular programs would be cut and diverted to faith-based programs

Wait a minute! Maybe Congress already is one big AA meeting. The Times article quotes a source saying there's "a very powerful recovering community" (read: 12-step) in the capitol, and points to an informal caucus of about 60 unnamed representatives who lobby for legislation affecting treatment for addiction and mental health. Names outed: Ramstad, Rep. Patrick Kennedy (D.-R.I.), several former members.

For a religious take on this gem of a quote from Ramstad, browse to The World Views Blog

Thank you, Rosa Parks!

Luck would have it that I was in Washington DC the weekend that Rosa Parks lay in state in the Capitol Rotunda, the first woman and only the second black person ever to be accorded this honor. The line to get in to see Ms. Parks' coffin on Sunday night Oct. 30 stretched for miles, and after waiting for more than two hours in a queue that barely moved, the cold D.C. night got to my temperate California constitution and I gave up. But I was back the next morning and this time I got in without delay. Her simple wooden closed coffin lay between two floral arrangements and a military honor guard in the center of the lofty Rotunda. As I walked around, the words "Thank you!" came to my lips. In a few seconds, it was over and I was back outside the Capitol in the bright morning sun.

I never met Ms. Parks, but the movement that her courageous act inspired touched my life. As a college student at Wesleyan in Connecticut, I answered an appeal from a group called the Northern Student Movement to come down to the D.C. area and help integrate lunch counters and other public facilities along the main Washington-New York highway. A handful of us assembled at the home of historian Howard Zinn in New Haven, and then drove to Howard University in D.C., where we learned freedom songs and received training in nonviolence. The next day we matched up with pairs of black students from Howard and set out for Glen Burnie, MD, a Baltimore suburb. At this time -- it was 1960 or 1961, I don't recall exactly -- the national chains like Woolworths still had separate counters for whites and blacks, and in the local movie theatre, blacks had to sit in the balcony. At the first lunch counter, when our integrated group of four sat in the white section, the place emptied within minutes and all the serving staff seemingly disappeared. We waited for what seemed like an hour. Eventually someone came and took our order: coffee. After a long time, it came. We tasted it carefully, wisely -- they had put salt in it. Still, we counted it a victory: we got served. We moved on to other restaurants, got served in some, got refused and told to leave in others. In the afternoon, about ten of us formed a picket line in front of the movie theatre. Under darkening skies, about 20 to 30 local rednecks gathered around and taunted us. Two sheriff's deputies came and watched. The rednecks took to throwing pennies at us and spitting. It looked like it was going to get ugly. Just then, the clouds opened up and a deluge defused the situation. We all scattered.

A few years later, in 1964, after the civil rights workers Chaney, Schwerner, and Goodman were murdered in Mississippi, there was an appeal for more volunteers to go south to replace them, to send a message that terror would not deter us. I was part of this second wave, arriving on election eve 1964. I stayed until the next spring. I've written something about this experience elsewhere. All the countless scores of us civil rights activists, locals and Northern volunteers alike, were in some measure the children of Rosa Parks.

Marx wrote somewhere that the philosophers have only interpreted the world; the point, however, is to change it. Social change does require people who merely interpret the world, because they help to prepare public opinion. It requires philosophers, preachers, pundits, and many others who act in words. But all these words are nothing, and may be sheer hypocrisy, worse than nothing, without the crystallizing power of a strategically chosen direct action. After all the ink is spilled and the sermons have stopped ringing, someone has to put their body on the line. That was Rosa Parks.

It was particularly delicious to think that here in the Rotunda, the highest place of honor that the capital city knows, the president, prominent senators, and many others from the ruling establishment came to pay homage to someone for breaking the law. In this post 9-11 era, when the Patriot Act and the president's "war on terror" zealots have whipped much of the American public into a sheeplike trance, it was like a breath of fresh air to celebrate someone who was an outlaw in her time and place. This feeling ran strong among many of the more than 30,000 people who waited in the cold and the dark outside the Capitol on Sunday night. Yes, there are laws and customs that are stupid, dishonest, and unconscionable. Yes, it is much easier to obey them and blend in than to stand up to them. But those who have the vision and the courage to challenge the cruel and stupid laws and customs of their time do sometimes receive respect and recognition -- even if it takes fifty years.

The example of Rosa Parks shines far beyond the civil rights movement and the race issue in America. The disability rights movement, for example, acknowledges her act as the inspiration for wheelchair activists fighting for access to buses and other public transportation. Thoughtful advocates of social change generally -- in a broad range of domestic and foreign policy arenas -- cite Rosa Parks as a model. It is a sad but important truth that progress in important matters only comes through acts of resistance and disobedience to entrenched authority. Thank you, Rosa Parks.

We who are in recovery from alcohol and drug abuse should also join in honoring Ms. Parks and in learning from her example. This is true in two senses. Addiction is a stupid and cruel authority entrenched within our own minds. It is surely no coincidence that the words addiction and dictatorship share the same root. To live in an addicted mind means to serve a ruthless despot that manages our lives. Addiction governs what we do with our time, how we choose our friends and associates, how we view and evaluate reality, how we feel and react, virtually everything about us. Addiction is a 1984 of the mind; it is a Big Brother whose self-propaganda turns white into black, lies into truth, down into up, pain into pleasure, death into living, and defeat into victory. Against addiction, sermons and lectures are powerless. Making promises to yourself, making good resolutions, massaging yourself with words of good intention has no effect, and can even delay your liberation. The only thing that begins to work against addiction is a planful act of disobedience. Put the drink down, pour it out; flush the drug down the toilet, take a hammer to the pipe and other paraphernalia and throw them into the trash. When you stop drinking and using, and only when you actually stop, then you begin to sit in the front of the bus of your own mind. Thank you, Rosa Parks.

Another brutal and stupid dictatorship that many people encounter in early recovery is the "my way or the highway" recovery authority. Whether a self-appointed guru or a paid professional, they think they have The Answer and they're going to push it down your throat, "for your own good." They may pose as helpers, gurus, and wise counselors, but they are psychological thugs and cutthroats who know next to nothing about recovery and care nothing about you. Inside their soul burns a big ego fire, and you are nothing but fuel. When a newly recovering person encounters this sort of bully, the easiest and most natural response is to go out and drink and use. "If this is recovery, I prefer addiction." Please, friend, don't go there. The best revenge against recovery gangsters is to stay sober. Ignore them, or tell them off if it makes you feel better, but by all means stay sober. If you relapse, they'll gloat: "I told you so!" If you stay sober without them and despite them, you challenge their world view in the most fundamental, irrevocable manner. If you stay sober, you deflate them and shrink their malignant flame. If you stay sober, you help others like yourself who come after you to recognize that recovery must sometimes begin with defiance of established authority. Thank you, Rosa Parks.

Bush Taking the Axe to Recovery

The Bush Administration is in power for another four years, and the “Christian” right, which claims credit for the electoral win, is pressing to impose its agenda. I put Christian in quotes because I was raised in that religion, but I can’t match up what I learned as a kid with what I see this administration doing. Whom would Jesus bomb?

One of the first patients I met in a local psychiatric hospital ward, where I was doing a LifeRing meeting, was a woman with a nasty bruise in one eye and a bandage over her head. When her husband found out she was using heroin, he bludgeoned her with the family Bible until she collapsed. I’m concerned that the faith-based recovery agenda that the administration is now pushing with renewed vigor is coming from this same kind of moralizing and punitive outlook.

“Drug addiction is not a disease, it’s a SIN” read the sign over the door of a church-based addiction treatment center in Houston, one of the pilot programs established when Pres. Bush was Gov. Bush. Under the 1997 legislation Bush sponsored, church-based treatment programs in the state are exempt from licensing and inspection requirements of traditional centers. Addiction treatment professionals vigorously opposed the program. See May 2000 coverage in Washington Post. Now the faith-based Texas pilot program — despite atrocity stories featuring physical abuse of patients — is going national, under the label “Access to Recovery.”

The American chemical dependency treatment industry — more or less the only place where a person hooked on addictive substances has a hope of getting clinical therapy — is already in disarray. The Journal of Substance Abuse Treatment reported last year that about 40 per cent of the nation’s substance abuse treatment facilities had either gone out of business or reorganized during the previous two years, and that the turnover among treatment staff at all levels had reached the level of “extreme instability.” More than half of program directors surveyed nationwide had served in their positions less than one year.

Now add to this unstable mix a legion of well-meaning churchmen and women unsullied by clinical experience with addiction, and fueled by $100 million in federal vouchers. That’s the initial price tag of the administration’s faith-based “Access to Recovery” program; the projected total is $600 million. Thousands of people looking for recovery will be getting “treatment” in church basements and parish halls instead of in licensed clinics and counseling centers. Chances are that much of that “treatment” will consist of getting bludgeoned with the Bible — metaphorically, at least. At taxpayer expense.

NAADAC, the National Association of Addiction Professionals, rightly lobbied the administration to require that the new legions of faith-based providers be held to “the same set of licensure and certification requirements that secular counselors have adhered to for decades.” Those are the words of Jonathan Westin, NAADAC’s Director of Government Relations, writing in Addiction Professional. At last report, that won’t happen nationwide, any more than it happened under Gov. Bush in Texas. There will be no comparable licensure and certification requirements. For addiction professionals who have been struggling to raise the level of the field, including the compensation and status of counselors, the administration’s “Access to Recovery” has to be a bitter pill. “Taking the Ax to Recovery” is a more fitting name.

The backstory is that most addiction treatment programs have done little to deserve the label “secular” or to elevate the professional level of the field. About 90 per cent of the programs in the U.S. dispense the faith-based 12-step model. Too many treatment programs are happy to hire staff whose main professional qualification is their own recent recovery, and whose only professional reference is a phone call from their sponsor. They work cheap, and it’s unclear why they should be paid at all. The other month a counselor was telling me about the wonderful step study meeting he and his patients attended, and how step study would be the focus of their recovery work in the weeks ahead. That may be fine, but in what sense is this a “secular counselor”? Why should people pay for step study in treatment programs, when they can get it for free in AA?

In trying to take a stand on secular professionalism, NAADAC’s lobbyists are on slippery ground. There’s just not that much secular professionalism in evidence. If the administration’s legions of subsidized vendors of faith-based addiction “treatment” end up laying waste to the already shaken industry, as seems possible, it will be because the industry’s unhealthy dependency on the faith-based 12-Step paradigm has left the door open to precisely this kind of invasion. Cynics would say that “Access to Recovery” is nothing more than a $600-million government subsidy for the most Bible-thumping wing of the 12-step movement, which has never seen much value in clinical treatment anyway, other than as a funnel to fill the rooms.

The core reason for the disarray in the treatment industry, in my opinion, is that its dominant paradigm doesn’t work well enough to earn solid, sustaining public trust. You don’t have to parse the outcome statistics — deplorably scarce as they are — to see the pall that hangs over the industry. Prof. George Vaillant of Harvard, who is a Trustee of Alcoholics Anonymous, reported in his book The Natural History of Alcoholism that the success rate of his 12-step based model treatment clinic in Boston was no better than the spontaneous recovery rate among the untreated. Prof. Alan Marlatt of Seattle found that the most common outcome of treatment — which 90 per cent of the time means 12-step treatment — is relapse. That’s not to say there aren’t treatment success stories. I’m one of them. There are laudable islands of quality treatment, and I was lucky enough to have access to one. But the Big Picture is not confidence-inspiring. Faith-based treatment and faith-based support groups have had a virtual lock on the American recovery scene for about fifty years, but they haven’t made a dent in the addiction problem. If anything, substance abuse is more widespread, more severe, more costly, and more notoriously out of control than when the 12-step movement started.

In a sense, every addict can relate to what the Bush administration is doing here. The faith-based approach isn’t getting us off, so what’s needed is a stronger dose of the same thing. The “God as you understand Him” of the 12 steps is too wishy-washy; what addicts need is the God of the Ten Commandments. Recovering addicts aren’t straightening other addicts out fast enough; what’s needed is staff who’ve never given in to sin and can provide stern moral examples. The experiment has led to the same negative result ten thousand times, so we need to repeat the experiment again, but harder. And if that leads to terrible consequences, too bad. We’ve all been there.

It’s too early to predict the shape of treatment in 2008. But one thing is certain: in the next four years the case for a caring, rational recovery path such as LifeRing will become more compelling than ever. Wherever there is an action, there is a reaction. The comparatively mild faith-based approach of the 12 steps has always driven thousands of people away in search of an alternative. The hard faith-based approach that may dominate the next four years under Bush will drive away many more. They will be looking for another road, and we need to be there for them. In the treatment profession, the progressive crumbling of the dominant paradigm will lead some individuals to put their heads into the sand, hoping that change won’t occur if they don’t see it. Many others will be jostled into awakening, rethinking old assumptions, and looking for new ideas. This may be a bumpy period, but it will also be a period of great opportunity for moving forward and reaching larger numbers.