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You Can’t Make Me – But You Can Help Me Find an Alternative to AA
My last column – about mandating AA attendance and how the practice violates First Amendment rights of people in the judicial system, as well as sound treatment practices – generated a plethora of comments on Pro Talk’s Facebook page, LinkedIn discussions, and on our own Pro Talk comments section. Here’s part of one thoughtful commentary:
“I also have been puzzled by the lack of reaction to these inappropriate decisions by clients themselves, and the lack of court challenges to these mandates outside of prison settings. Perhaps clients in the community are too afraid of the power of judges, parole officers and probation officers to assert their rights…Until we move away from using the criminal justice system as a major entry point to treatment and toward primary and other medical care providers, as well as bringing to the general public solid research on what approaches work best in motivating users to seek help… we will continue to have these kinds of difficulties.” -Dr. Frederick Rotgers
I agree that many clients probably don’t take action out of fear – that their children might be taken away, their sentences will be executed (meaning they’ll wind up incarcerated), their probation or parole officers could be vindictive, and the list goes on. Many clients know don’t about the legal rulings in the first place and that they could challenge the mandate to attend 12-step meetings. And most certainly can’t afford a costly legal battle.
I’ve wondered, too, about people outside the judicial system who are issued such mandates – for instance, when a health care professional with a drug or alcohol problem is in a professional monitoring program in order to retain licensure, and one of the requirements is to attend 12-step meetings. Do they not think twice about this, or are they fearful of the consequences of not jumping through the hoops? Many are probably unaware that the practice is not based on good treatment practices, may be a violation of rights, or that there are alternatives.
The Role of Treatment Programs in the Coercion Problem
As stated in last week’s column, AA’s own principles don’t support coerced attendance at its meetings. A psychologist I spoke with for Inside Rehab, who happened to work at a 12-step facility, told me she believes coercion concerning the 12 steps is an overall problem in the treatment system itself and said, “If people are coerced into AA, it doesn’t work. AA describes itself as a program of attraction.” (Subscribing to this, some AA members refuse to “sign” for people who need documentation of attendance at meetings because of a mandate.)
AA and NA are not the coercive agents in this story…Treatment institutions, on the other hand, do reap financial rewards from coercion, and it troubles us greatly that growth in the treatment industry today seems predicated on collaboration with the criminal justice system…-William White + Timothy Edwards
More than a decade ago, William White, M.A., author of Slaying the Dragon: The History of Addiction Treatment in America (just released in a new edition) and attorney Timothy Edwards wrote in an article in Contemporary Drug Problems, “AA and NA are not the coercive agents in this story… Treatment institutions, on the other hand, do reap financial rewards from coercion, and it troubles us greatly that growth in the treatment industry today seems predicated on collaboration with the criminal justice system, employers, and other agents of social control.” In other words, while the situation seems to be slowly changing, the “agents” are often rehabs that benefit from and willingly accept clients mandated to attend their 12-step-based programs – without informing them about alternative approaches – and subtly or overtly pressuring them to subscribe to the 12-step philosophy.
Indeed, it’s difficult to find a drug and alcohol treatment facility that doesn’t use the 12 steps in some way. Although the numbers have dropped somewhat since I published Sober for Good in the early 2000s when more than 90 percent of addiction programs were 12-step based, more recent statistics from the University of Georgia’s National Treatment Center Study suggest that nearly eight out of ten private programs still offer 12-step-based treatment or include the 12 steps as part of their programming. In public programs, nearly seven out of ten are reported to be either based primarily on a 12-step model or include a 12-step component.
…recent statistics from the University of Georgia’s National Treatment Center Study suggest that nearly eight out of ten private programs still offer 12-step-based treatment or include the 12 steps…-Anne Fletcher
A Vicious Cycle
In the visits to the 15 addiction treatment facilities I made when researching Inside Rehab, I found that few staffers went out of their way to tell clients about alternatives to the 12 steps. (The exceptions were at the facilities that promoted themselves as being non-12-step based.) When I asked rehab attendees interviewed for the book if they were ever told about AA alternatives, such as SMART Recovery, Women for Sobriety, or Secular Organizations for Sobriety, very few responded affirmatively. When they were, it was often a suggestion for religious support.
…it’s the obligation of professionals in the field to learn about multiple means of support for their clients…-Anne Fletcher
One retort I commonly hear when talking about the injustices of mandated AA treatment is that there isn’t enough availability of AA-alternative support groups. However, we’ve got a vicious cycle that supports this – when treatment program staffers don’t tell clients about non-12-step support groups and facilitate linkage to them, how can the groups proliferate? At one prominent rehab I visited, an administrator and clinician of many years told me he wouldn’t recommend SMART Recovery for anyone because he didn’t know anything about it. However, SMART Recovery has been around now for 20 years, and it’s the obligation of professionals in the field to learn about multiple means of support for their clients – particularly since we know that “between 55 and 80 percent of alcoholics encouraged to attend AA while in treatment will stop attending AA within nine months.” [personal communication with AA researcher Scott Tonigan, Ph.D., University of New Mexico]
…clients are rarely told about non-12-step alternatives, the groups fail to proliferate, and the many people who don’t connect with AA but who might benefit from another type of support group slip through the cracks.-Anne Fletcher
Another problem in the cycle is that research funding in this area is largely directed to the study of 12-step groups and treatment, not alternative support groups. And while research suggests that people who attend AA frequently and who get involved in the program have better outcomes than those who do not, it’s entirely possible that these findings would apply to non-12-step support groups as well. Yet very few studies have been done on AA alternatives. Accordingly, most rehabs continue to put all of their proverbial eggs in the AA basket, pointing to its efficacy, when alternatives may be just as or more effective, at least for certain individuals. Thus, the cycle remains that clients are rarely told about non-12-step alternatives, the groups fail to proliferate, and the many people who don’t connect with AA but who might benefit from another type of support group slip through the cracks.
The good news is that slowly and surely, things are changing as many paths to recovery are embraced by a growing number of professionals from different walks of treatment and recovery life. Just recently, in his syndicated column, “Beyond Addiction,” Hazelden’s William Cope Moyers gave recognition to the fact that recovery comes in different shapes and form, noting, “… it doesn’t really matter how we get from the bottom to a better place. What counts is embracing that moment of clarity when we realize that our lives are a mess and that we must change.”
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