The next issue of DDN will be out on 2 June — make sure you send letters and comments to email@example.com by Wednesday 21 May to be included.
I write in response to the article about homeopathy-based treatment in your recent edition (DDN, April, page 16). At a time when tough decisions are being made about financing services in our sector, it is alarming to hear that commissioned services are continuing to entertain pseudo-science, when other frontline services offering legitimate evidence-based treatments are under threat.
As a manager in Wales it is reassuring that public money on this side of the border is being scrutinised to prevent this kind of nonsense; only interventions endorsed by NICE will receive public funding. I hope that progressive services and boroughs in England will properly consider the evidence (and of course the study design and quality of that evidence) before offering vulnerable service users potentially damaging treatment options that are based on thin air.
For a summary of the evidence relating to homeopathy, your readers – and hopefully the ‘progressive commissioners’ in South East England – might want to consider the two articles below. Googling homeopathy, pseudoscience or quackery will uncover many others.
James Varty, by email
Stanton Peele’s deeply critical article (DDN, April, page 8) about 12-step mutual aid groups accuses them of denying the reality of recovery and driving out other more effective approaches.
It saddens me that treatment professionals continue to seek out ways to attack organisations that abide by a tradition of having no opinion on outside issues and themselves refrain from commenting on other approaches or modes of treatment. Something about 12-step fellowships seems to bring out the worst type of prejudices in a minority of members of the treatment community.
The fact remains that NA currently has 62,000 meetings and AA 114,000 meetings worldwide and they want nothing more from society than to be allowed to exist. They don’t cost the taxpayer a penny, refuse any outside financial contributions and save tens of thousands of lives.
PHE has recently published guidance encouraging treatment providers to take a more proactive approach to facilitating access to mutual aid for service users (including SMART Recovery and 12-step). This guidance was based on a review of the hundreds of published scientific studies on the efficacy of these groups and a helpful summary is available on their website.
My own organisation, the Bridge Project, has been using these techniques for some time and we can testify to the benefits of hosting mutual aid group meetings on our premises and employing volunteers who take clients to meetings. There is still plenty of demand for our other services, such as opiate substitution therapy and psychosocial interventions – we just believe in giving our clients choices.
Jon Royle, chief executive, Bridge, Bradford, www.bridge-bradford.org.uk
I write in response to Stanford Peel’s eloquent but emotive piece in which he raises questions about the integrity of AA and 12-step facilitation (TSF) approaches to overcoming addiction.
I have worked in the substance use and mental health field since 1986, when Henck van Bilsen’s paper Heroin addiction: morals revisited was something of a lodestar where I first worked. As good as (I thought) we were at providing an alternative to a regressive norm in residential treatment, we too had problems with our approach. If AA and TSF can be characterised as overly dogmatic and prescriptive, the alternatives can sometimes appear dangerously vague or ill-defined in practice – especially with good intentions but little training.
To say that practice was sharp in many of the residential treatment services of the time would be something of an understatement. There are countless first and second-hand stories of shaming and shameful practices, informed by many approaches – often with little underlying theoretical rigour and certainly without much competence. These were generously funded by a state only beginning to become concerned about the complex causal and maintenance factors in drug use and associated problems – many of which we continue to learn about, hopefully adapting our views as we go.
Bad advice, on psychiatric medication for example, is not solely the purview of AA or fellowship groups. Many people’s experience of psychiatric medication is the embodiment of trial and error learning. Some principles espoused by AA do appear to undermine personal resourcefulness and self-efficacy. Many fellowship members, on the other hand, are among the most resourceful you could hope to meet and provide something of a model for people who are beginning to think about making changes for the first or 21st time.
Moreover AA and other fellowship groups are notable for their accessibility on all counts, where many centrally funded services simply fail at 5pm – although recent years have seen considerable improvements in operating hours.
An ambivalent subscriber to DDN initially, it seems like a good proxy for how views in the substance use field have become more inclusive over time. Likewise AA – at least in my experience – has become increasingly pragmatic and leaves Stanton’s account of steps 3, 5, 6 and 7 looking somewhat hackneyed. Add to this the profusion of services and providers working more pluralistically and practising in person-centred ways, like Motivational Interviewing (MI) or the steady growth of SMART groups, and the picture becomes more nuanced than Stanton would have us believe.
If our shared goal is to support individuals by meeting them ‘where they are’ and when they most need support, I am certainly keen to hear about ways of doing this better. In my view Stanton veers dangerously close to the line of self-promotion while accusing AA and TSF groups of doing just the same.
The prospectus offered by his curious UK drugs worker, ‘A’ (whom I hope reads DDN and may be given to join the discussion) is seductive but faulty. There is very little that’s ‘handy and convincing’ in the drugs field. I, for one, am curious about Stanton’s perfect method, but not at the cost of overlooking the good works of fellowships of all hues – and their members – over time.
Richard Craven, lecturer, University of Abertay Dundee
Respect what works
I work in a 12-step treatment centre and am a 12-stepper myself, and I don’t agree with Stanton Peele’s critique of the 12-step programme. Firstly, the 12 steps form a spiritual, not religious programme. I feel that I have been empowered by the programme, it has given me the ability to recognise and make choices that I never knew that I had before.
The language of the steps can be off-putting to newcomers, but when examined in detail they are all about increasing people’s power and choice. An acknowledgement of powerlessness over one’s addictions gives power and choice over all other aspects of one’s life.
Step 3 is really about letting go of control. As a using addict I wanted to control every aspect of the world around me; in recovery I realise that all I truly is control is myself, my actions and the way I respond to events. For example, if I go for an interview, I might prepare properly, I might answer all the questions to the best of my ability and yet the result of that interview is out of my hands. Step 3 allows me to recognise what I can do and let go of what I cannot do.
Steps 6 and 7 have, contrary to what Stanton Peele suggests, given me a deep level of self-knowledge and self-acceptance. I know, through working these steps, who I have been, who I am and who I can become if I choose to.
Far from driving other therapies out, most of the 12-step treatment centres I have come across embrace other therapies. One of the spiritual principles that all 12-step fellowships adopt is that of ‘open-mindedness’. Most fellowships encourage members to explore and find the things that work for them as individuals.
Stanton Peele confuses the programme with those who try to practise it. Of course there are people, and even groups of people, within the fellowships who are so scared of relapsing that they become dogmatic and rigid in their views – but the fellowships do not encourage this. Twelve-step fellowships embrace individual freedom, freedom of thought and practice to the extent that they accept and embrace members of widely differing views, knowing that they will change when, and if, they are ready to.
I have talked about my own experience, but I have also seen others benefit greatly from the programme and the support that the fellowships give. I would not say that the 12 steps are the only way, but they are very effective for some people.
Marc Meyer, by email
A first step
One can agree with Stanton Peele that there is much to criticise in the original concept of the 12 steps, but how many of today’s groups actually run on the 1935 model? Observers report that practices vary considerably from one group to another.
Because the majority of residential rehabs do nothing to flush out of an addict’s body the store of drug metabolites and toxic residues built up by prolonged addiction, leakage of these back into the blood stream is the main cause of restimulation of desire and return to usage. So it is at the time of such an unfortunate relapse that the fellowship of a 12-step group provides the support a wavering member needs to stay on the track towards full recovery.
The missing factors in most rehabilitation procedures are an understanding of the real reason why individuals become addicts – plus trained knowledge of effective and decades-proven addiction recovery techniques.
The beauty of such training is that, in addition to allowing an addict to cure him or herself of alcohol, cannabis, cocaine, crack, heroin, methadone and other already known addictions, it provides an immediate response to the ‘legal highs’ increasingly available and preferred because they avoid legal penalties.
Kenneth Eckersley, CEO Addiction Recovery Training Services (ARTS)
I have read your magazine for many years, but never felt the need to write until I read the Stanton Peele article. Anyone can produce stats to debunk anything – look at how the tobacco industry claimed smoking was good for you and buried the research stating otherwise.
My evidence may be anecdotal, but I am like an awful lot of other people who have recovered, and am still recovering, from chronic drug and alcohol use and live a good life far beyond just stopping drinking and using.
For him to suggest that people should just sit and wait to ‘grow out of addiction’ places a death sentence on the likes of me and condemns my family to a living hell. Twelve step is not for everyone, I know, but it works for me when all his other suggested methods failed.
Keith Loughran, director,
Xroads Recovery, Wirral
Reading ‘A Step Too Far?’, one can’t help but notice the absence of any reference regarding the value of 12-step fellowship meetings, which are actually the core of the 12-step tradition, rather than 12-step facilitation within a treatment context.
Literally millions of individuals worldwide have saved their own lives and found renewed meaning and purpose, as well as restored self-esteem and confidence, by attending fellowship meetings that are mutually self-supportive, regardless of personal awareness or understanding of the mechanics of working the 12 steps.
It is not a requirement that individuals become missionaries; rather, there is a simple invitation to embrace abstinence and apply a time-tested structure to their lives that allows a person to recover from active addiction through their own self-effort, whether or not they actually work the steps.
Attendance at meetings is very often sufficient for someone to at least arrest active addiction and begin to recover by way of meeting attendance and identification with peers.
It sounds to me – reading between the lines – that Mr Peele is in breach of the universal medical ethic – ‘above all do no harm’ – given that he is expressing his own personal opinion, which might negatively influence someone who would benefit from embracing abstinence-based recovery within the framework of the 12 steps.
There is a verse in the Bhagavad Gita: ‘The wise person does not disturb the mind of the unwise… rather, they help them accept their lot in life…’ The philosopher Epictetus indicated that we are not responsible for what life presents, although we are responsible for how we react and we therefore need to draw from within ourselves the means to overcome contemporary problems by way of personal self-discipline within communal support.
Fellowship meetings provide the framework for such support and will survive far, far beyond the period when Mr Peele’s personal opinion, misdirected resentment and misunderstanding has faded into nothingness.
John Graham, by email