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People – politicians, public health officials, treatment specialists – frequently express the idea that we need more treatment for addiction. By this, they mean more rehabs, more referrals to AA, more disease diagnoses.
But resisting/avoiding/reacting against these things is exactly why the large majority of people with addictive problems eschew standard treatment programs – along with their cost and isolation from people’s ongoing lives.
So what is the alternative? It is to bring treatment to people you know who need it. That is, to offer them help or to find places where they may be helped without turning themselves over to the machinery of powerlessness and depriving them of what they rely on and are comfortable with.
In considering this, I call on the work of the great addiction researcher, theoretician, and practitioner, Harold Mulford. I was inspired in my “Life Process Program” by Harold’s “Natural Processes Model”:
This way of thinking challenges the traditional notion that alcoholics are all-of-a-kind entities and that there is a single cause, or even a single set of causes, that account for the drinking of all alcoholics, or that explains the drinking of the same person at different times.
Rather, it directs us to consider the dynamics of the changing combinations of interacting social, psychological and physiological forces influencing a person’s drinking behavior as he progresses in the several processes.
Harold’s greatest innovation was to build a community resources model throughout Iowa. It consisted of hiring one local, non-professional community coordinator in each place. The coordinator served the function of connecting the individual up with existing community resources which could include AA, or a church, or a shelter, or legal aid, or a counselor. The service was so cheap – one person’s Iowan salary in the 1960’s – 1970’s and a rented space (there was a brief training for the coordinator) – yet this helper approach was immediate, active, pervasive, integrated, and caring.
Part of my argument against our centralized, disease-based treatment system – or perhaps the best example of its dysfunction – was the dismantling of the Iowa Community Alcoholism Service in the mid-1970’s. In its place, recovering alcoholic and former Iowa Governor/then-Senator Harold Hughes created the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
The NIAAA focused on in-patient treatment. And as Harold M. woefully pointed out, the cost of one individual residential treatment episode could equal the entire budget for one community coordinator for a year – who might help in an ongoing way scores – perhaps even hundreds – of people with addiction during that year.
Instead, utilizing in-place individual, family, and community resources in interventions is so simple, it’s, well… stupid – as in “keep it simple, stupid.”
Part of my argument against our centralized, disease-based treatment system – or perhaps the best example of its dysfunction – was the dismantling of the Iowa Community Alcoholism Service in the mid-1970’s.-Stanton Peele
Let me describe utilizing such an approach in my own experience – and not in a small Iowa town, but in Brooklyn, New York! I know a prominent New York musician with whom I hook up at a Park Slope bar. He had a close friend with whom he used to consume a variety of substances. At one point, my friend’s wife put her foot down, and my friend retreated to happy hour beers. But his friend went off in another direction…badly.
Two weeks ago, my friend (let’s call him “Tom”) arrived at happy hour with his instrument. The bartender (a woman who knows my friend’s music) was playing James Brown, who once asked Tom to go on the road with him. I asked him if he would play along with the CD, and he did. After about 40 minutes, Tom packed his axe up. He said, “You owe me.”
Tom requested that we go to the famous New York City public hospital, Bellevue, where his friend (let’s call him “Paul”) has been sent to a homeless residence on the Bellevue campus. Tom asked me to check out the situation, to see if I could make therapeutic contact with Paul, or else to help to set up an outpatient therapeutic contact at Bellevue for him.
Keep in mind that, in nearly every case, those with addictions will need to return to their actual lives, unless or until they are finally fully incapacitated.-Stanton Peele
This therapeutic intervention is currently in progress. Of course, Paul is now institutionalized, a state which took him years, even decades, to achieve. En route to that outcome, he repeatedly failed at rehab and rejected AA and 12-step solutions. But his loved ones and friends, like Tom, saw no other route to assist him.
But they might not have been as powerless as they felt. This is not to put more pressure (or certainly blame or guilt) on people for any addictive difficulties their friends or loved ones have. However, at the same time, we shouldn’t discount our power to be helpful, or to find helpful mechanisms for those they care about in the immediate setting. Keep in mind that, in nearly every case, those with addictions will need to return to their actual lives, unless or until they are finally fully incapacitated.
In the same vein, I translated my residential Life Process Program, which was manual-driven, into an inexpensive on-line version. Through this effort, like Harold Mulford’s, I want to lower the boundaries and cost of finding help by making help more accessible, with lower entry boundaries, on an as-needed basis.
And this effort is a precious gift you may be able to give someone too, if we all think actively and creatively.
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