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I just want to say thank you for the responses to my blog. It is great to hear thoughtful and interested views. I am struck by the comments from the USA. It sounds like there is a more fundamentalist ethos there .
Although the recovery movement does seem to be raising its profile in the UK , I think approaches to working with addiction here are still very broad based in attitude, theory and goals. Although we probably all have views about how useful some of these approaches are, maybe it does allow for a level of debate that can be developmental to recovery.
Thank you
Lisbeth
The passion that has arisen in the discussion following the blog about the article in DDN regarding female victims of abuse has amazed me, and yet sadly does reflect the defensive and dogmatic approach which is expressed by some (and only some) AA stalwarts.
I wonder why there is the need to be so defensive about a programme of recovery which clearly is helpful for many people. If we are secure in our knowledge and experience of this, why is it not ok to accept that not everyone will benefit from AA and 12 steps for a whole range of reasons that may be about them, or about the groups they attend?
There are times when AA members respond much more like members of a religion rather than members of a recovery support fellowship. What is often present in committed members of a faith is
1. A totally unwillingness to accept or believe that any way apart from their way is ok
2. A response to any questioning or criticism of their beliefs to be dismissed as due to a lack of faith or understanding on the part of the person who dares to question
3. Presenting dogma and irrational answers to questions of why or how does that work
4. A fear that any challenge to their understanding or acceptance of their faith could jeopardise their salvation
I am a Christian and am often dismayed by what seems like a requirement that I leave my brain at the door of the church in order to be a part of my faith. I feel this is incredibly insulting to God who gave me my intellect and is surely big enough to be questioned and explored with mind and heart.
I also have ‘faith’ in AA and the 12 steps being valuable and important in recovery but this does not have to be on the basis of disregarding any research, experience or thoughtful questioning which could, wow, here’s a thought, allow AA to develop and grow in a way that might allow it to work even better.
What is going on in these discussions? Is it okay to question or is AA actually a religion and the pagans and infidels need to just shut up?
Last night, I watched the Horizon programme ‘Do I drink too much?’ and found myself (as is often the case) shouting in frustration at my television. Don’t worry too much about my state of mind, I do know that neither the BBC nor John Marsden were able to hear me.
I had high hopes of the programme as I am well aware of John Marsden as an expert in this field and have also been encouraged by the attention that the media have given of late to alcohol issues.
There were some useful parts to the programme, most notably the work on the effects of alcohol on teenagers which presented some very worrying evidence to suggest that teenagers can drink larger amounts that adults before experiencing intoxication. They may even be able to drink amounts taking them close to overdose levels before experiencing significant intoxication, obviously a very risky situation.
This suggests that early drinking experiences could be setting young people on the road to alcohol dependence more readily than adult drinking experiences. Unfortunately, this evidence was not explored in detail and I think would be worthy of a programme in itself.
To share my frustration with other parts of the programme:
1. The scientist developing 3 (non addictive) tablets to offer an alternative to alcohol. Has anyone pointed out to him that this is how heroin was developed, as a ‘safe’ non-addictive alternative to morphine?
Do we really need another recreational psychoactive substance available? How does he consider that any substance which we take to feel good is not going to be addictive? Are we not going to want to repeat that effect again and again?
2. John checked out the effects on his health by one health check on his liver which would only have shown serious liver damage. How is his blood pressure, his heart, his kidneys, his LFT? Does he have digestive problems which could show the beginnings of gastritis, ulcers etc? Does he not understand the extent of the physical damage done by alcohol? Or is the audience not encouraged to?
‘Anyone using heroin for 30 years would be dead by now but that is not the case for drinkers,’ he said with authority. Really? Does he include in that assessment victims of road traffic accidents and violence whilst drunk? Does he include the people killed falling downstairs whilst drunk? Does he include the suicides whilst drunk?
Having worked for many years with addicts of drugs and alcohol, I have known many more alcoholics than heroin addicts die.
I am also aware that many heroin addicts will be topping up their heroin with Special Brew, benzos, zopiclone, and what is especially hazardous is this cocktail rather than the heroin itself. I would also suggest that for many heroin addicts the Special Brew add-on becomes more of a risk than the heroin itself.
Does John Marsden really not know this, or does he prefer not to see it as he tells us he does not want to cut down his own alcohol intake.
Alcohol deaths are largely hidden statistically. A drug overdose (even if it involves alcohol) will tend to be registered as that but accidents, suicides, murders and indeed heart attacks, strokes etc, even if the direct result of alcohol use will not be registered as death by alcohol.
And by the way I have known heroin users of 20+ years use who were not dead. Get real John.
What will viewers take from this programme? Will they look critically at their own drinking and question it? Or could they look at John Marsden and say ‘Well, if it is ok for him, it is ok for me.’
Just signed up to this forum today after reading this month’s Druglink. I am trying to formulate a response to some of the articles in it. I have a sense of a move away from the fragmented approach to treatment philosophies and services that have, in my view, constantly undermined their effectiveness in recent years.
I am encouraged by the shift in paradigm which is considered. However, I am concerned that whilst drug and alcohol services remain a political pawn, changes will continue to be in dogma and strategies wheeled out to attract votes rather than as a thoughtful response to the wealth of service user and practitioner insights and valuable research in this field.
I have come to believe over the years that both my desire as a practitioner, and the implicit organisational desire of DAATs, NTA, PCT etc to find a magic bullet solution, is a reflection of the clients’ desire. Addiction is at it’s core the need for a quick fix; an immediate answer to ‘I want to feel better/differrent and I want it now’.
As a practitioner, I embrace this urgency by seeking out more and more training and guidelines. I am faced with human beings suffering and I want to make it better NOW. Within policies and government guidelines we see this.
Another strategy, another policy, another funding stream, another recommended treatment style – try it, do it now, give us the stats and then, oh dear still not better NOW, so lets change everything again.
As you can see I am frustrated. We do, in the field, know a lot.
We know that people are whole human beings and just fixing one bit does not work, for long anyway, if none of the other bits are changed. Detox a heroin addict and then send them back out to live in a crappy flat that their mates are using to shoot up in and without having any understanding of how to cope with stress without getting ‘out of it’ and they will use again very soon.
We know that change will only take place when someone is ready to change (good old Prochaska and DiClemente). So pushing someone into treatment when they are, at best, contemplative will not be effective without a lot of motivational work.
Popping them on a script at this stage will just add another substance to those already used. Although there may be some harm reduction benefits, it is unlikely to lead to abstinence. In many prescribing clinics demand on resources limit appointment times to 10mins or so, a quick health check and confirmation of dose is the most that can be acheived in this time.
We know that addiction has essentially the same qualities whatever the substance and that an illicit drug user will quickly and easily become dependent on alcohol as a more available ‘top up’ or ‘add on’ to their drug of choice.
So we cannot push alcohol treatment out of substance use services. It is almost always a part of the problem and, lets face it, is a big enough problem in its own right.
We know that what is without fail shown to be effective in any treatment is a stable, trustworthy, understanding therapeutic relationship. This cannot exist if we do not have stable, reliable services. Retendering for contracts for services and short term contracts for workers result in disruptive, broken services and dissilusioned, insecure workers.
At my most cynical, I wonder if there is a wish in society to offer a way to change to those trapped in addiction. Society loves a scapegoat. If we can blame crime, poverty, family breakdown, mental health problems on drugs and alcohol we don’t need to look at values in society.
I want it and I want it now is clearly the cry of the addict but is it not also the cry of our society.
Was it not the expectation that led us to the credit crunch? Is it not also the demand behind consumerism without concern for the consequences?
Okay, I am entering too big a philosphical debate and I aimed only to introduce myself in this blog. So if any of this makes sense to you, or not, let me know
