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A rant about current treatment models

aihfl

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Between Christmas and New Years, after 10 months of sobriety, I had a relapse which landed me yet again in detox. This time, I decided I need to take aftercare seriously and began "shopping" for intensive outpatient programs. I called one facility where I had been enrolled in an IOP several years ago and had two primary questions for them: 1. Is there a 12 step meeting attendance requirement, and 2. I am prescribed Ativan for panic attacks, which I am unapologetic about because I don't abuse them under normal circumstances and use it quite sparingly (I already have an alcohol problem, I would rather NOT have a benzo problem in addition to that) and that there were a handful of times during my 10 months of sobriety where the Ativan was the only thing standing between me and booze.

The intake therapist informed me that yes, they require attendance at 4 meetings per week outside IOP. I then told her I've been trying to recover using 12 step for 4+ years, and if it was going to work for me, it probably already would have. I then pointed out that 12 steppers always like to ask, "What's the definition of insanity?" and in my case, continuing to go to these meetings I find extremely boring, listening to people pontificate about God, drinking shitty coffee and dealing with meddlesome sponsors is insanity. She then went on to say that they require it because 12 step is EVIDENCE BASED. I wasn't even diplomatic at this point. I told her that if trying to pray away your addiction is what passes for evidence based treatment at their facility then I consider them a bunch of quacks.

She then informed me that if benzos turned up in my urine panel, that would be an issue and told me that there are plenty of alternative medications such as Vistaril (which I already take for general anxiety but is shit for panic attacks) and Buspar, which as far as my current shrink and I are concerned, is basically a placebo.

So this is why I have an issue with all this. I am enrolling at the IOP at the facility where I was detoxed, which is much more progressive. Rather than use the outdated 12 step treatment model (is any other condition treated the same way as it was in 1930?), they use the Substance Abuse and Mental Health Services Administration's "Matrix Model," and they told me as long as my Ativan prescription is legit, their psychiatrist knows about it, and I'm not abusing it, then if it keeps me from drinking, by all means use it when you need it.

My rant all boils down to this: here we are, in the 21st century, where there really are science and evidence based treatment models, and the dominant treatment model is still stuck in the early 20th century and is supernaturally based. I was fortunate over the course of my drinking career I never got a DUI, but it's well established legal precedent now that AA is a religious organization and attendance CANNOT be coerced by government. You bet your ass if a judge tried to send me to AA I'd sue.

Rant over...
 
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simco

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Good job, man. It's insane to me how condescending and bullying (and poorly informed) many addiction professionals are. I hope your case will remind readers how crucial it is to advocate strongly for yourself when dealing with such people and institutions.

So, have you started the new IOP yet? I hope it's helpful.
Sim
 

aihfl

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This facility where I was detoxed has a crack team of therapists, the best I have encountered. The things that really stuck with me are:

1. Unstructured time is deadly to sobriety, which in the case of my last relapse proved true. It was in the lull between the holidays when I got the "fuckits."

2. I can be accountable to other people and organizations other than AA. She pointed out that I am a member of a sailing club, a kayaking and paddleboarding group (I actually used to lead trips for it), and a cycling group. I can be accountable to these organizations instead.

Even though it sounds off the wall, she told me, I know you have a dachshund - teach it to do obstacle courses. She said when she first got sober, she got an Aussie shepherd puppy and she spent time that would have been otherwise unstructured teaching the dog to do stuff.

It boggles the mind how many treatment professionals still think that 12 step is the only way out. Thank God I found a place that doesn't.
 
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Jabberwocky

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Well fucking done aihfl!!! I very hope your upcoming treatment experience is as good as it sounds it could be. And your definition of insanity, priceless, LOL =D

Great thread.
 

cj

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Im glad you found somewhere decent. I am convinced the reason most places use the 12 step models is because it allows them to hire people with no qualifications beyond being sober in a 12 step program as "counselors"
 

Jabberwocky

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Exactly! It is a super effective ways to provide a low cost "treatment" that support the primary function of rehab centers: to make money. Ironically, outpatient based ORT programs are still (A LOT) cheaper than 12-step models inpatient treatments, which accounts for the vast, vast majority of inpatient providers out there.
 

aihfl

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Before I continue my rant, I just went on a bike ride with two friends. We made two loops around Orlando International Airport (they kicked my ass - 20 miles in an hour and a half). There was an amazing moment where a London or Manchester bound Virgin Atlantic 747 went directly overhead. It sure beat sitting around a room listening to quasi-religious palaver for a hour.

Now, to continue the rant:

1. The more I thought about it, who the fuck are these people to tell me I'm not allowed to take medication that for whatever reason my own doctor has seen fit to prescribe? It just strikes me as the height of unprofessional behavior to invalidate the judgment of a colleague. Even when I did inpatient rehab, they weren't particularly delighted about the Ativan, but they didn't say no mas either.

2. For years I tried following the advice, "If you don't like a meeting, keep looking for one you like." I've tried probably 30 different meetings, both AA and NA (AA meetings are skeevy enough but NA, man, they're on a whole other level) in Greater Orlando, and fact of the matter is the meetings are all disingenuously cliquish to some degree, and the young peoples' meetings are the worst. They're not welcoming, and every last one of them, to some degree, is all about lording themselves over the newcomer. My ex hit me with a restraining order about a year and a half ago, and as a result, I had to attend court ordered therapy. But I learned one muy importante lesson. The therapist, used to dealing with "real" criminals, did not mince words and told me she does not buy the 12 step party line of, "You're not a shitty person, you just have a disease." She finally got it through my skull that I was simply a shitty person that drank. Big difference and something 90%+ of the 12 steppers out there that I've encountered should think about. They might not be drinking or drugging anymore, but they're still shitty people. And if you read unbiased, unvarnished accounts of what Bill Wilson was REALLY like, well he's exhibit A.

Rant over for now, I'm too tired, but I'll probably think of something else by morning. Thank you everyone for your comments and support.
 
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Jabberwocky

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What's also very sad is how twelve step based treatments result in a well established 90%+ failure rate at under two years, whereas MAT/ORT results in an over 50% success rate at 2 years. Given all the shit and misinformation that is spread about MAT and ORT among the twelve step community and the 40+ years of research that has found ORT a highly successful treatment (currently the MOST effective treatment for the populations they apply to), it's pathetic to say the least.

You experience with meetings mirror my own. I got to an abstinence based recovery community meeting once in a while (granted, not twelve step, Refuge Recovery) just to remind me how disfunction, insular and unsupportive abstinence only based communities are. While I do get something out of the occasional such meeting, they're always brutally painful.

They are however a GREAT teacher in patience and compassion for our less enlightened comrades who are still stuck in paradigms straight out of the stone ages of medicine though. One of my favorite teachers always likes to say how the things we find most activating tend to be our greatest teacher. But IME it only is up to a point ;)

I honestly would love to find a truly inclusive, supporting twelve step meeting out there. I kinda dream of one day doing so. But I don't have high hopes in the meantime...

And, umm, that bike ride sounds ABSOLUTELY fucking wicked :) Bike is a huge part of keeping myself sane, even though I live in LA and don't own a care anymore (it's faaar from a bike friendly city, but as I only tend to get bit by back drives on their phones in the more affluent areas like Beverly Hills and the drivers are always more than happy to write me a check so I don't sue them, I can deal) 8)
 

cj

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Yeah refuge recovery was a big fucking let down. Its like AA with some quasi eastern religion BS thrown in. I haven't used heroin in almost 2 years thanks to methadone Ill go with that.
 

Drink_Tea_Love_Cat

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I want to rant about this too so badly, thanks for bringing it up - but I'm going to bed right now. Will make a philosphical post about this at some point I reckon ;)

Suffice to say, the fundamentalism that I endured and the "confrontational therapy" sessions we did at my treatment centre left me traumatised, depressed, cynical and... just generally lacking in life in skills, tools for my mental health, tools in general, drive, empathy, whatever.... (so I "relapsed") I have always believed there was another better way, intuitively, and logically.

I have since come to the conclusion that demonising drugs and preaching abstinence is a simple and obvious solution to what are really very complex emotional and behavioral problems. The problems aren't the drugs, the drugs are just salts, plants, compounds, whatever. The problem is what we do with those substances, and then what we do afterwards. In essence, drug use is a behavioural problem... to just abstain from drugs and replace drug use with an addiction and dependence to abstinence programs is not an answer to a behavioral problem. The answer is learning how to behave and cultivate healthy habits in life in general, will in turn facilitate healthy behaviour towards and around drugs (within reason).

Ahhhh, so much to say about this, anyways - I agree - it's all bullshit and the model is totally based on biased fundamentalist thinking that doesn't allow itself to be challenged or improved merely out of principle.... This model is handed down from generation to generation, and anyone who ever questions it is ostracised or their take is spun to reveal some sickness or disease within itself. I realised that something wasn't qutie right with the method when my best friend in treatment, that rock of sobriety that I looked up to for 6 months, decided to overdose a couple months out of treatment.

The last thing I texted him was "I hope you're not dead" as a joke...., then the call came a few hours later from the mutual friend "..... he's dead...." :(
 

aihfl

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The answer is learning how to behave and cultivate healthy habits in life in general, will in turn facilitate healthy behaviour towards and around drugs (within reason).
AMEN!!! At this IOP program I was in several years ago that I'm currently ranting about, a friend I made in the group and I were publicly taken to task in front of the group for going to a burger joint that happened to have a bar in it. I read Jack Trimpey's Rational Recovery over the summer, and I just want to be a normal person that just so happens not to drink. These people in AA live in mortal fear of alcohol. That can't be healthy. I'm not going to avoid eating out with friends just because one of them might want to eat at a place that has a bar, or God forbid, one of them wants a beer or other alcoholic beverage. That doesn't mean that >I< have to drink for fuck's sake.

TPD, I never thought I'd say this, but Orlando is on it's way to becoming a bike friendly city. I don't miss that little shitbox garage apartment I lived in near downtown, but I do miss being able to bike just about everywhere I needed to go (grocery store, PO, SunRail station etc.). My condo is about 5 miles NW of downtown and there are bike lanes connecting my area to neighborhoods closer to downtown, but it's on the side of a major four lane road and I just don't trust Florida drivers on such a busy road. A recreational path is under construction though and once that is finished, I'll be a frequent user. I'm still just a little too far removed from a grocery store to run bike errands, and biking to the PO entails negotiating too many gnarly intersections, but I suppose home ownership is worth it.
 

Jabberwocky

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I want to rant about this too so badly, thanks for bringing it up - but I'm going to bed right now. Will make a philosphical post about this at some point I reckon ;)

Suffice to say, the fundamentalism that I endured and the "confrontational therapy" sessions we did at my treatment centre left me traumatised, depressed, cynical and... just generally lacking in life in skills, tools for my mental health, tools in general, drive, empathy, whatever.... (so I "relapsed") I have always believed there was another better way, intuitively, and logically.

I have since come to the conclusion that demonising drugs and preaching abstinence is a simple and obvious solution to what are really very complex emotional and behavioral problems. The problems aren't the drugs, the drugs are just salts, plants, compounds, whatever. The problem is what we do with those substances, and then what we do afterwards. In essence, drug use is a behavioural problem... to just abstain from drugs and replace drug use with an addiction and dependence to abstinence programs is not an answer to a behavioral problem. The answer is learning how to behave and cultivate healthy habits in life in general, will in turn facilitate healthy behaviour towards and around drugs (within reason).

Ahhhh, so much to say about this, anyways - I agree - it's all bullshit and the model is totally based on biased fundamentalist thinking that doesn't allow itself to be challenged or improved merely out of principle.... This model is handed down from generation to generation, and anyone who ever questions it is ostracised or their take is spun to reveal some sickness or disease within itself. I realised that something wasn't qutie right with the method when my best friend in treatment, that rock of sobriety that I looked up to for 6 months, decided to overdose a couple months out of treatment.

The last thing I texted him was "I hope you're not dead" as a joke...., then the call came a few hours later from the mutual friend "..... he's dead...." :(
Well said!
 

simco

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I gotta chime in after cj... I also found Refuge Recovery to be a let-down. The differences between a RR meeting and an NA meeting seemed like window dressing. Also, the idea that meetings begin with a period of meditation (in the ones I went to, it was 20 mins of sitting) struck me as laughable. Fuck, I can't meditate on a good day. Imagine if someone desperate for help showed up all detoxing and freaked out...making them meditate for 20 mins (while a noble enough ideal) seems unrealistic, bordering on cruel.
 

Drink_Tea_Love_Cat

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AMEN!!! At this IOP program I was in several years ago that I'm currently ranting about, a friend I made in the group and I were publicly taken to task in front of the group for going to a burger joint that happened to have a bar in it. I read Jack Trimpey's Rational Recovery over the summer, and I just want to be a normal person that just so happens not to drink. These people in AA live in mortal fear of alcohol. That can't be healthy. I'm not going to avoid eating out with friends just because one of them might want to eat at a place that has a bar, or God forbid, one of them wants a beer or other alcoholic beverage. That doesn't mean that >I< have to drink for fuck's sake.
yeah, it's the default stance of mistrust in yourself from the 12 steps I experienced that leaves me wanting. There was so much self criticism at my rehab.

I discovered what it felt like to live a sober life, and I abstained because I wanted to, because I had better things to do and more valuable things at stake. There's something about being in the flow of a productive lifestyle that intuitively prevents you from wanting to destroy it through poor behaviour using drugs. So, in your example, it wouldn't matter if you were in the room with a bar, because you were having more fun just eating the food with friends than you would if you got drunk and blacked out or whatever. Or, to push it even further, it wouldn't matter if you had one drink, because you knew that your life and everything you had going for you was more valuable to you than to sacrifice it all for a chemical beverage.

Of course, there are many shades of grey and some individuals on the spectrum can only live with abstinence. But even those (especially those) will only have a happy life if they cultivate good habits and behaviours. It's when you have little left to lose and everything is already shit, that oblivion seems like the best option. When I lost general (academic and career) direction and got involved with an unfaithful woman (which led to many emotional problems), was when I really started to abuse drugs again and let that behaviour ruin my life. It wasn't simply me + drugs = failure, it was me + drugs + some other problem = bad behaviour around drugs = failure.

I think I always intuitively believed that emotional problems come first, drug use 2nd. But I was always shut down and told "stop using drugs and then deal with your problems". Or worse, "the drugs are the problem, full stop".

EDIT: what my 12 steps experience showed me was they often ignore the emotional and focus only on the drug use. Generally "self pity" was seen as a negative emotion and one that was used to "to use". So basically if you ever felt sorry for yourself you were shut down and criticised. But if you use self pity as an excuse to use, shouldn't the issues that lead to the self pity be addressed on some level, instead of just labelled "bad" because it gets in the way of the ideal of abstinence?

Hope this helps/is interesting, might be a hint of rambling here so might edit it later ;) So glad to write about this stuff, it's been running around my head for years...! Best wishes.
 
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Jabberwocky

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I gotta chime in after cj... I also found Refuge Recovery to be a let-down. The differences between a RR meeting and an NA meeting seemed like window dressing. Also, the idea that meetings begin with a period of meditation (in the ones I went to, it was 20 mins of sitting) struck me as laughable. Fuck, I can't meditate on a good day. Imagine if someone desperate for help showed up all detoxing and freaked out...making them meditate for 20 mins (while a noble enough ideal) seems unrealistic, bordering on cruel.
Yeah, the qualities of the meditation at RR meetings suck, it's really, really poor. That said, I've only been to the two originally meetings. I imagine those elsewhere to be of slightly lessor quality. In my book RR and NA/AA is basically the same - the only difference is really the quality of the literature IMO. Well, and the fact the original meetings have folks who are generally a lot of more welcoming; and the fact I'm not forced to identify by anything other than my name.

The face I can't bring myself to go more than once in a blue moon definitely speaks for something though ;)
 

cj

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I would like to see a study done to see if personality type plays a role in the efficiency of self help groups. I always figured it worked better for extroverts rather then introverts like myself
 

aihfl

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I discovered what it felt like to live a sober life, and I abstained because I wanted to, because I had better things to do and more valuable things at stake. There's something about being in the flow of a productive lifestyle that intuitively prevents you from wanting to destroy it through poor behaviour using drugs. So, in your example, it wouldn't matter if you were in the room with a bar, because you were having more fun just eating the food with friends than you would if you got drunk and blacked out or whatever. Or, to push it even further, it wouldn't matter if you had one drink, because you knew that your life and everything you had going for you was more valuable to you than to sacrifice it all for a chemical beverage.
Absolutely, and that's what kept me sober for 10 months, the longest I'd been sober since I was 17. I heeded the words of my therapist and threw myself full tilt into the activities I enjoy, which was far more preferable to being passed out on my couch.

I've made peace with the fact that for me, nothing good can come of alcohol consumption. It's been proven over and over that there's no such thing as me having only one drink or cutting loose for one evening. Each and every time, I'm going to drink until I black out and wake up still very much drunk the following morning. But that doesn't mean I have to sequester myself away from friends who can walk away from a glass with a little bit of beer still left on the bottom or even enjoy a refreshing cold NA beer myself. I can still have a life.

Thanks everyone for the headsup about Refuge Recovery. The closest meeting is an hour away at the beach and you guys saved me the gas and time of driving over there and finding it a bust.

I had my IOP intake assessment this morning and am feeling good about things, so now we just play the waiting game to see how many days Blue Cross Blue Shield is going to give me.
 
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Stargazer

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What a great thread. I agree wholeheartedly w everything said. Ive felt like I was in crazy town at meetings sometimes. One lady, that went to a meeting I did also, actually hit me with her car when I was on my bike (this was when I lived in Florida) and she took off!!! She denied it-but would tell anyone that would listen that it never happened. I told one person about it and never talked about it. I think the lady protests too much.

Another real gem of a person- who was self-righteous showed up high as shit to meetings. Nodding out...she put her cigarette out in her nose. True. She was smoking an Eve 120 or something- and when she nodded out it went up her nose- I heard it go out. Jesus Christ. And this is a person that was judging all of us I often left meetings feeling inadequate-like I wasn't getting that moment of clarity like everyone else. Anyway- really great thread.
 
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