Friday, June 5, 2009

'Til Death Do Us Part or 'Til You Piss Me Off ... Whichever Comes First


By Michael Rice
Madeira Publ. Co., Mesa AZ 2009
ISBN 978-0-578-02237-6

Reviewed by Marty N.


This book came to my attention because the author, Michael Rice, was a speaker at the Choice Theory conference held in Sacramento May 30, which I attended.

As the catchy title suggests, the book is an analysis of why marriages fail and what can be done about it. The answer, in brief, has to do with control.

Our culture teaches us to try to control other people to make them do what we want them to do. Dr. William Glasser, the founder of Choice Theory, catalogued methods of control as the "seven deadly habits": criticizing, blaming, complaining, nagging, threatening, punishing, and bribing.

Relationships go bad when participants use these methods on one another. If one partner begins, the other usually responds in kind. Before very long, love, trust, and the desire to be together go out the window.

Rice includes a number of case studies from his practice as a family therapist. In the cases where he was successful, it was because the couple adopted the seven healthy habits: support, encourage, listen, accept, trust, respect, and negotiate. If one partner begins using these healthy habits, the other partner eventually reciprocates, and the relationship grows stronger.

This slim volume doesn't pretend to exhaust the subject of marriage problems and their resolution, but the central insight is clear and helpful, and the suggestions are practical and within the reach of just about everyone.

-- M.N.

Thursday, April 23, 2009

Natural Process of Quitting Forever: Explicit Instructions

William Weber, M.A.

ISBN-10: 1434397769
ISBN-13: 978-1434397768

Reviewed by Alceon


I was excited by the title of this book and couldn't wait to start reading.

My advice is don't waste your money or your time. I have plowed my way through the entire 96 pages of single-spaced typewriter style font on 8 1/4 x 11 inch paper and spent the majority of the time arguing with the book. The book is repetitious beyond belief. He goes over and over and over and OVER the same points, which are mostly based on bashing AA.

On page 4 is a full-page chart called "Quitting Forever" and subtitled "Explicit Instructions" The six steps didn’t quite make sense to me. Step (1) you Think about quitting forever, then (2) Intend on quitting forever, (3) Decide on quitting forever, (4) Maintain Abstinence then (5) Permanent Exit. The final step is (6) Deliberating.

I thought why do you start Deliberating if you’ve already made a Permanent Exit? Well, I'll keep reading. It’s not until I finally got to page 38 that I found two pages explaining his explicit instructions for quitting forever.

It’s kind of like Steve Martin’s advice on how to make a million dollars: "First, you make a million dollars." Well, first, you examine all your reasons then you say "I quit forever." That makes it a decision so you no longer need reasons. You’re free! You can now go anywhere and do anything and no longer be a "second class citizen" because you’ve quit forever.

You don’t need to go to meetings or support groups or forums or read sobriety books to help you quit forever (or stay quit) because once you’ve said "I quit forever" it is now a done deal. It's now a decision, which makes it a value, so you don’t need reasons anymore except the one reason that you said you quit forever. Reasons aren’t good because for every reason to quit you’ll also have to argue with an opposite reason for using and that’s all just words in your head that you can just observe as "mind chatter" and ignore. And if for some reason you drink or use after saying you’ve quit forever it’s because you like getting high or loaded and didn’t *really* quit forever.

He says the Brain-Recovery model is very complex so he will explain it in a way that’s easier to understand. He has several cartoon-like illustrations of the brain and his main proof that the model is wrong is because (and he says you can look in "any anatomy of biology book" you want and see) there are no nerves that directly connect the portion of your brain that makes you want to drink with the portion that controls your hands. So just because one part of the brain makes you want to get high or loaded, it’s biologically impossible for that part to make your hands move.

He also contradicts himself in other parts of the book and says that the whole brain works together.

The back cover of the book says that Mr. Weber "is a licensed Alcohol and Drug Abuse and Marriage and Family Therapist" with "more than 18 years of experience talking with people about quitting forever." These are very fine credentials and yet I frankly think all he knows about addiction is from the books he studied to become a therapist and talking to clients. Nothing rings true and his tone struck me often as quite patronizing.

He talks about cravings as if they were just 1 or 2-dimensional words on paper or in your mind -- not the 3-dimensional war that seems to rage in your entire body when you’re first getting sober -- and sometimes even drops in for a visit months or years later.

He completely doesn’t get the idea of quitting one day at a time. He says it means you haven’t quit forever and have to keep making a new decision to quit every single day. I say it’s because the concept of "forever" to an addict is too hard to even conceptualize at first and even though you know your commitment is to never drink again, cutting that into bite-sized one-day chunks -- and sometimes hours or minutes -- is all that makes it achievable at first.

I was also disappointed to find out that you haven’t *really* quit forever if you count days or time since your last drink. He says it means you’re really only quitting one day at a time and every day you have to decide again to quit for another day. (Damn. Guess that means all those days of freedom I’ve counted since quitting forever four years ago this Sunday don’t mean a thing!)

There is less than 1/2 page of references and there are no notes or footnotes -- but there is an almost 4" tall picture of the author's face on the title page. There are numerous spelling and grammar errors throughout the book and one area where the same two paragraphs are repeated twice.

There are one or two good points in the book but you have to dig hard and far to find them. It’s not worth the search. LifeRing’s motto DDNMW says it all much better.

Sunday, April 12, 2009

Cocaine and Methamphetamine Addiction: Treatment, Recovery, and Relapse Prevention



Arnold Washton, Ph.D.
Joan Ellen Zweben, Ph.D.

ISBN 13: 978-0-393-70302-3

Reviewed by Alceon


Cocaine and Methamphetamine Addiction
is a revision of a book published in 1989 originally called Cocaine Addiction. This new edition contains additional information about methamphetamine use and recovery as well the latest research and developments in addiction treatment.

The authors bring decades of personal experience in the drug rehabilitation field. They speak quite clearly of the need for complete abstinence from any mood-altering drug in order to maintain complete recovery from addiction regardless whether the drug is a stimulant or depressant such as alcohol.

Even though this book is specifically about treatment for and recovery from stimulant drugs, I think it would be of interest to anyone seeking information about recovery from drug abuse of any kind. I approached it from the standpoint of a past alcohol addiction and came to the very clear understanding that an addiction is an addiction regardless of the drug.

Washton and Zweben discuss the difference between a stimulant addiction vs. alcoholism (pg. 221 and chapter 2) and state that while there are "noteworthy differences" add that "most of these differences stem from the fact" that the progression to addiction from the first use of cocaine or methamphetamine is much more rapid (weeks to months) than that of alcohol, which may take 15 to 20 years to clearly develop. Thus the indications of addiction appear quite rapidly and are much more visible to others.

The authors address many issues in this book, beginning with an overview of the history and progression of stimulant drug use in this country. Chapters address the following information:

  1. Cocaine and Methamphetamine Use in America
  2. Understanding Stimulant Drugs
  3. Stimulants and Sex
  4. Treatment Approaches and Considerations
  5. Quitting Strategies
  6. Relapse Prevention Strategies
  7. The Role of Self Help Programs
  8. The Role of the Family
The primary focus of the book is on treatment and treatment options. In their practices, Washton & Zweben have noticed a synergistic effect when professional counseling is combined with group and/or self-help programs. Although 12-Step programs are the primary self-help groups discussed (mainly because AA/NA meetings are the most readily found world-wide) the authors are careful to address the reluctance many people have about the 12-Step protocol and discuss ways to address those issues. They also include a section about other self-help programs and LifeRing Secular Recovery is the first group mentioned in this section. Other groups include SMART Recovery, Women for Sobriety and SOS.

The book is extremely easy reading and contains many case examples from the authors' practices. There's no fancy medical jargon, just a lot of straight talk. Multiple charts throughout the book address topics such as Comparison of Cocaine and Methamphetamine, Quitting Strategies, Drug Triggers, Relapse Prevention Strategies and Points for the Family to Remember.

The Appendix has a 3-page list of Substance Abuse Web Sites and LifeRing Secular Recovery at
http://www.unhooked.com/ is included.

There are 15 pages of References and a nicely compiled index.

For more information about this book and the authors, follow this link to the publisher's website:
http://www.wwnorton.com/NPB/nppsych/070302.html

Thursday, March 19, 2009

Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery


By Martin Nicolaus

ISBN-10: 047037229X
ISBN-13: 978-0470372296

review by Alceon

This is the latest book by our very own Marty N., one of the founding members and first CEO of LifeRing. These are only a few of the reviews from the Buzz page at unhooked.com:


  • "This introduction to LifeRing Secular Recovery’s principles [and] philosophy for overcoming addiction—without the religious underpinnings of most 12-step programs—will be well received by those seeking support on their road to recovery. Highly recommended for university libraries supporting the helping professions and larger public libraries.Background: Nicolaus (Recovery by Choice), founder and CEO of LifeRing Secular Recovery, a nonreligious addiction recovery treatment alternative to Alcoholics Anonymous, provides an engaging guide for individuals and addiction treatment professionals seeking nonspiritual support and strategies. The author distinguishes LifeRing Secular Recovery from 12-step programs, includes numerous testimonials from members, and focuses on informing readers rather than converting them.—Dale Farris, Groves, TX, in Library Journal 3/27/09.


  • "In the words of our president, 'it’s time for a change' and nowhere is this more evident than in the field of addiction treatment. Nicolaus has written a wonderful book that presents LifeRing, a new model for self-help groups. A model based on empathy, scientific evidence, and giving people the power make their own choices about treatment options. Indeed, change has come." -- Joseph R. Volpicelli M.D., Ph.D., Executive Director of the Institute of Addiction Medicine, Philadelphia, Pennsylvania, and co-author of Recovery Options: The Complete Guide.


  • "Introduces a new, rational approach to addiction recovery, grounded in secularity, and informed by modern science. The LifeRing program mobilizes the power of caring and connection to liberate the sober self that lives inside everyone who struggles with addiction." -- Tom Moon MFT; columnist, San Francisco Bay Times


  • "Thoughtful and provocative -- issues a long overdue challenge to the accepted wisdom surrounding recovery from addiction, and illuminates a viable, alternative perspective on recovery." -- Sarah E. Zemore Ph.D., Scientist, Alcohol Research Group, Emeryville California


.Read all of the reviews on the Buzz page here and more about the book and Marty here.


Now available for sale at the LifeRing Press.

Tuesday, November 6, 2007

Drugging the Poor: Legal and Illegal Drugs and Social Inequality


By Merrill Singer
WaveLand Press 2008
ISBN 978-1-57766-494-9

Reviewed by Marty N.


A marker for addiction is continued use despite negative consequences. Prof. Merrill Singer’s Drugging the Poor reminds us that those negative consequences have a more devastating impact on those at the bottom of the wealth distribution curve than at the top. Looking at addiction through the perspective of Critical Medical Anthropology (CMA), an academic discipline that merges the insights of public health and political economy, Prof. Merrill finds that the use of drugs such as nicotine, alcohol, and illegal psychotropics tends to perpetuate and accelerate the widening gap between the rich and the poor.

At the heart of Prof. Merrill’s book is a description of what he calls “drug capitalism.” The dividing line between legal drug pushers (the corporations in the alcohol, tobacco, and prescription drug businesses) and the illegal ones is much more blurry than is popularly believed. Respected corporations in fact frequently engage in illegal conduct and should be classified as criminal recidivists. Illegal drug organizations, on the other hand, have on occasion provided important social services and made charitable contributions. The illegal drug trade is exceedingly violent, but its mayhem seems petty by comparison with the blood-drenched birth of the tobacco and alcohol industries, both built on the slave trade. Even today, there is evidence that Big Tobacco has a hand in wholesale smuggling of cigarettes into third world countries (to evade taxes), and Big Pharma knowingly produces vastly more psychotropic drugs than are sold through legal prescription channels. The underground merchants who run the global trade in these mood-altering commodities readily switch between product lines – now liquor, now heroin, now pills, or whatever – as political-economic conditions dictate.

This fact-laden volume is the best short critical introduction available today to the pillars of the contemporary drug business, legal and otherwise. Every open-eyed person knows that individual drug use takes place in a social setting, and that personal decisions and the social environment are webbed together. That social environment is powerfully shaped and determined by its major economic and political institutions, including those that profit from addiction to alcohol, tobacco, and other drugs. Prof. Singer’s CMA perspective provides a readable and research-rich overview of the influence that these power centers have over our culture, and in particular, over the culture of the poor, including the lucrative and devastating marketing efforts targeted at African-American and Latino minorities.

Although the book applies a searing spotlight to the major pillars of the drug economy, and will raise hackles in the board rooms of Altria, Anheuser-Busch, and many others, it is also in some ways a na├»ve book. One looks here in vain for a discussion of deliberate governmental injection of drugs into oppressed communities, on the model of Britain’s drive to establish opium addiction in China (hence the Opium Wars), or of more recent instances, such as the flooding of Los Angeles with crack to finance the Contra insurgency, the CIA’s role in transporting opium out of the Iron Triangle during the Vietnam years, and the current resurgence of heroin production in Afghanistan thanks to the U.S. invasion. Prof. Singer rightly criticizes the “War on Drugs” as wholly ineffective in curbing the supply of illegal drugs, but he does not suggest, as have others, that this outcome is intentional. Perhaps there are limits to what a professor at the University of Connecticut can safely write. Nevertheless, this book merits a place on the bookshelf of any person concerned with the cultural contexts in which contemporary addiction occurs. Particularly noteworthy is the final chapter, which briefly describes a selection of grass-roots efforts to abridge the power of legal and illegal drug pushers in the community.

-- Marty N.

Thursday, October 11, 2007

Dancing with Tina

By Terry Oldes

ISBN-10: 1934187151
ISBN-13: 978-1934187159

Reviewed by Carol


Man has sex with man. Man has sex with two men. Man is naive about gay man's life style. Man has sex in bathhouse. Man does TINA, the street name for Methamphetamine, (Meth), and has sex. Man meets man, man has sex and falls in love. Man has 3 month relationship. Relationship ends due to TINA. Man has sex with three men. Man has sex in gay bar. Man has sex with man he meets on-line. Man has sex for 14 hours. Man invites man over to his house to have sex. More men arrive to join in and have sex. Man has protected and unprotected sex. Man is careful not to have sex with HIV positive men. Man does more TINA in different ways and has more sex. Man meets new friends and has sex. Man goes to parties where many people are having sex. Man dresses up in costumes and has sex. Man watches TINA destroy lives. Man is now a walking gay life style encyclopedia and dictionary. Man has sex.

Anyone who is interested in learning about the gay life style would benefit from this read. You learn about TINA, or Methamphetamine, the high it produces and the different ways Meth is administered. You also learn about the gay community and the life style of a gay man. There is not much of a plot so after a while it's just monotonous.

I would not recommend the book unless you are a naive gay man coming of age.

Wednesday, April 11, 2007

Feeding the Fame: Celebrities Tell Their Real-Life Stories of Eating Disorders and Recovery



Compiled by Gary Stromberg and Jane Merrill
ISBN 978-1-59285-350-2

Reviewed by Marty N.


The seventeen chapters of this book contain fourteen stories of anorexia and/or bulimia, and three stories of obesity. The slant toward disorders of emaciation is very probably due to the choice of celebrities as contributors. There aren’t any Hollywood A-list megastars here, but these interview subjects are all established in their fields and speak from experience about the pressures that the entertainment industry – aided and abetted often by their own dysfunctional family backgrounds – puts on its players. As Catherine Hickland observes: “For actresses our looks are like our instruments; we are hyperaware of appearance, weight, and beauty.” And so we learn of obsessive dieting, and obsessive exercise, and of the delusion that one is always “fat” even though one’s bones stick out, and of the rediscovery of the ancient Roman trick of vomiting, and of the ruinous consequences of that method for the teeth, and much else that is hidden from the eyes of those who are uninitiated into eating disorders.

The standout piece in the collection is by the jockey, Shane Sellers, winner of more than 4,000 horse races and more than $130 million in purses. He did everything that anorectics and bulimics do, on a daily basis, but framed as an iron professional discipline, not as a neurosis. His essay is a revealing look into the brutal world of the jockey’s locker room, where there’s a basin alongside the toilets for “heaving,” and a sweat box for “pulling” pounds of water out of the body in order to make riding weight. It is a system that promotes bulimia, and it kills people. After rising to the top of this regime, Sellers became an outspoken reformer, advocating (and sometimes winning) changes in track rules to protect jockeys’ health.

There aren’t any similar reformers among the anorectic/bulimic actresses in the book, agitating for changes in the Hollywood horse-racing business to promote a more reasonably-sized, healthier image of women. But a number of the interview subjects here have done much good by campaigning and touring to speak out about their own eating disorders, and by so doing, they have helped break the silence and isolation in which many non-celebrities suffer the same ordeals. There’s a good deal of comparison here of eating disorders with alcoholism and other drug addictions, and the contributors have a diversity of theories about the nature, cause, and cure of their conditions. Except for the obese comedy writer and actor Bruce Vilanch, who cheerfully denies that he has a problem, they have all experienced a sense of recovery, and all say that they are able now to eat in a healthy middle way, without starving or bingeing. They testify to a great diversity of recovery pathways, such as anti-anxiety medications, psychological counseling, nutrition therapy, dialectical and cognitive behavior therapies, will power, self-discipline, surgery, and a handful who used 12-step. The book sometimes tests the reader’s patience with the contributors’ narcissism – what do you expect from celebrities? – but it is, all the same, a useful and readable collection of anecdotal material about its topic.

The Sober Kitchen



By Liz Scott
ISBN1558322213

Reviewed by Patricia Gauss.



Liz Scott, professional chef and recovering alcoholic, wanted to create a cookbook for others in recovery. Her original intent was to “use my training,palate, and a little creativity to develop new recipes and redesign old ones that would be sober safe and maybe even healthier and tastier than the original.” During her search, she recognized the lack of, and need for, basic information on diet and nutrition for recovering alcoholics. The Sober Kitchen (copyright 2003, Harvard Common Press) is her answer to that need, and offers a wealth of nutritional information geared specifically for recovering alcoholics.

The Sober Kitchen is organized to address the various stages of recovery beginning with Phase One, early recovery, and (what else?) nonalcoholic beverages. Also in this section are information and recipes for healthy snacks, bar food, and simple comfort foods like soups, as well as tips and recipes for some sweet treats and quick fixes for cravings.

Phase Two focuses more on complete meals and sobriety maintenance, including dinner entrees, side dishes and veggies, breakfast items, desserts and baked goodies. Phase Three gets into a more intermediate cooking level with sections on vegetarian cooking, foods that are rich in omega-3 fatty acids and other important supplements, and foods prepared with more unusual ingredients (like curry and soy products). Finally, Scott gives us nonalcoholic recipe makeovers for dishes such as beef burgundy, chicken marsala and beer battered shrimp.

Scattered throughout the book are anecdotes, information on alcoholism and a little culinary history, too. She warns that alcohol may be lurking in some very conspicuous places (Pam cooking spray, who knew?), and dispels the myth of all alcohol “burning off” during the cooking process (as much as 85% can be retained depending on the method and length of time cooking). These things are important, she notes, because even trace amounts of alcohol can be enough to trigger very powerful cravings, especially during early
recovery.

There are mini-primers throughout on such topics as essential vitamins and minerals, buying and storing herbs, cuts and cooking guidelines for beef, pork, lamb and chicken, and different types of mushrooms, potatoes and salad greens. She also provides some tasty and creative substitutions for alcohol, such as strong tea mixed with molasses for macerating fruit, and flavored vinegars, fruit juices and nonalcoholic extracts to substitute for brandies and wines in a variety of entrees and desserts.

The Sober Kitchen doesn’t end with the last recipe, however. Ms. Scott offers both an extensive bibliography and an excellent list of titles for suggested reading, along with some culinary resources and a list of recovery organizations. While written for the recovering alcoholic, The Sober Kitchen is an interesting, nformative and readable cookbook, worthy of shelf space in any foodie’s collection. You can visit Liz Scott's web site at http://www.thesoberkitchen.com/.




The Tipping Point: How Little Things Can Make a Big Difference



By Malcolm Gladwell

ISBN 0-316-34662-4.

Reviewed by Marty N.


The book table in Toronto’s Pearson International Airport offered a wide range of titles, most of them unfamiliar to me. My hand ranged over the display like a dowsing rod, and when it came to this white-covered paperback, it twitched. The plane was over Nevada before I could put the book down, finished. We all know the miraculous parable of the butterfly whose flapping wings set off an intercontinental storm. The Tipping Point explains how the butterfly did it. Using examples from marketing, medicine, literature, politics and other spheres, Gladwell shows the basic moves and conditions that can transform a small change into a sudden mega-metamorphosis. Along the way, he throws new light on many familiar themes, such as subway graffiti, Kitty Genovese, Sesame Street, athletic shoes, and teenage smoking, to name just a few. A former Washington Post journalist and now staff writer for The New Yorker, Gladwell has put together a well crafted, fast-moving, fact-intensive and highly readable book that deserves its national best-seller rating.

Three factors must be present to tip a social epidemic. Gladwell calls them the Law of the Few, the Stickiness Factor, and the Power of Context. They’re worth reviewing in some detail.

A gonorrhea epidemic in Colorado Springs affecting thousands of people stemmed from just 168 individuals living in four neighborhoods and frequenting the same six bars. Each of these exceptionally active individuals transmitted the disease to dozens or even hundreds of others. Successful social movements, Gladwell says, are like epidemics. A handful of people makes them happen: people who are unusually energetic, connected, knowledgeable, persuasive, or otherwise influential among their peers. Gladwell finds three types of such extraordinary people: Connectors, Mavens, and Salesmen.

A famous Connector from history was Paul Revere, a member of every militia committee who knew all the important people in the American independence movement up and down the New England coast. When he rode north of Boston at night to warn that “the British are coming,” people immediately paid attention and moved to action, because they knew who he was and he had credibility. His countryman William Dawes, by contrast, carried the same message to other towns, and nobody paid attention, because he was an unknown and he didn’t know which doors to knock on. Modern studies of social networks show a great asymmetry. There are only six “degrees of separation” between everyone and everyone else because a rather small number of people each having vast numbers of connections act as junction boxes. Connectors are “people with a special gift for bringing the world together.” They aren’t intimately familiar with all of them, that wouldn’t be possible. Instead, they cultivate what sociologists call the “weak tie” – friendly acquaintanceship. Many Connectors move between a range of different subcultures and niches, cultivating connections in all of them. They tend to be gregarious, outgoing, helpful, and nonjudgmental. They are the people to know when you need a job, because they’ll know somebody who knows somebody. They’re also the people who need to adopt an idea or a product before it can become an epidemic.

Great networkers, however, aren’t sufficient. Connectors take their cues from information specialists, whom Gladwell dubs Mavens. Marketplace mavens are people who read all the product reviews, know exactly who is selling what for how much, and debunk all kinds of promotional hype. When you’re buying a car or a computer, you naturally turn for advice to a friend or an uncle who is a car nut or a computer maniac, and this person will tell you where to shop and what to look for and how much to pay, and may offer to go with you and help you out. They not only read Consumer Reports, they write letters to it. There are mavens not only in the marketplace, but in every subculture. They make or break the reputation of any new thing that comes along, because they study everything in their area of specialization deeply, share what they know, and win respect for their expertise.

Nothing big would happen, however, without Gladwell’s third type, the Salesman. Connectors connect, Mavens inform, but Salesmen twist arms and motivate people to action. Gladwell profiles several super salesmen. What makes them successful persuaders? Gladwell’s answer is fascinating. Subtle cues in body language, such as facial expressions and head movements, are much more powerful than the spoken message. Microanalysis of videotapes shows that when two people talk, they engage in an elaborate rhythmic dance punctuated by muscle movements (shoulder, cheek, hand, eyebrow, etc.) that quickly synchronize with each other and with the flow of the words. In this synchronicity, one person tends to become the leader or transmitter who initiates muscle movements signaling emotional states that the other person mimics, producing the same emotional state within them. Emotions travel from inside to outside in the sender and then from outside to inside in the receiver. Great salesmen have the ability to enter into this unspoken dance quickly and to establish themselves as the emotional leader or sender in short order. In a fascinating experiment, researchers found that powerful emotional senders could transmit their emotional state and induce the same feeling in more receptive individuals in a matter of two minutes face to face, without a single word being spoken. People who are emotionally contagious in this way are exceptional individuals. When an idea or a product enrolls these essential few -- Connectors, Mavens, and Salesmen -- it is well on its way to tipping into an epidemic.

But another factor is still lacking, that Gladwell calls “stickiness.” Stickiness is a specific quality of the message that makes it memorable and spurs people into action. Big budget advertisers buy memory space with incessant repetition – it takes at least six repetitions for people to remember a brand name. Stickiness is a low-budget equalizer that grabs people’s imagination on the first or second exposure. A seemingly small or trivial property of the message – the gold box on a record club coupon, a campus map on an informational pamphlet, the mixing of puppets and real people in Sesame Street, the literal narrative format of Blues Clues – resonates with the audience and grabs and holds their attention. The stickiness factor is a simple way of packaging a message that makes it irresistible in the right circumstances.

Circumstances and their decisive influence in creating trends form a major portion of Gladwell’s exposition. He begins with the infamous case of Bernhard Goetz, a white New York stockbroker who shot four young black men on a New York subway in 1984 and was later acquitted on charges of assault and attempted murder. Gladwell points out that New York City was at that time in one of the worst crime waves of its history and that the subway system in particular had degenerated into a hellhole of graffiti, garbage, and lawlessness. Yet a decade later, the crime wave broke, felonies declined steeply, and New York became a much safer city. Why? Gladwell argues that the explanation lies in criminologists James Q. Wilson and George Kelling’s Broken Window theory. Broken Window theory holds that a seemingly trivial environmental cue, such as a broken window, sends a message that no one is taking care of property, and this is an invitation to all kinds of more serious crimes. Operating on the Broken Window theory, New York transit authorities eliminated graffiti from the trains – how it was done makes a fascinating side story – and then stopped fare-beaters, people whose flagrant jumping and jamming of the turnstiles, although financially trivial for each violation, extended a larger and much more costly invitation to all kinds of lawlessness in the system. Gladwell’s point is that much of behavior is situational. The famous Zimbardo experiments at Stanford, where ordinary ‘normal’ individuals turned into brutal prison guards when placed into a simulated prison setting, showed that the situational context can overwhelm inherent character traits. In another set of experiments, researchers demonstrated that such supposedly inherent character traits as honesty are in reality quite situational – most people will cheat in certain situations, but not in others. There is a name for the common fallacy that attributes behavior to character instead of to context: the Fundamental Attribution Error. People shown two basketball scenes, one in a well-lighted gym and the other in a dark gym where the basket is barely visible, invariably conclude that the brightly lit players are more talented. Thirty-eight people watched Kitty Genovese being raped and killed and no one called for help – precisely because each of them assumed one of the others had already done so. Seminarians on their way to present a brief sermon on the parable of the Good Samaritan stopped to help an injured man on the street when told they had a few minutes to spare; if told they were in a rush, they literally stepped over the victim on their way to the pulpit. Their personality profile had no bearing on their behavior. The notion that innate character, disposition, personality, genes, and similar traits determine behavior fails the evidence test. Trying to change people’s “character” is usually a wild goose chase. Making small, seemingly trivial changes in the environment, such as fixing broken windows, is a much more powerful method of starting or stopping a social epidemic, Gladwell argues.

Another dimension of context, Gladwell reasons, is the critical role that groups play in social epidemics. He credits the success of Methodism as a religion to John Wesley’s insight that fundamental change in people’s beliefs and behaviors could not be sustained without creating a community that would practice, express, and nurture these beliefs. The runaway success of Rebecca West’s Divine Secrets of the Ya-Ya Sisterhood was in large part a function of the book study groups that sprang up around the work, and of West’s assiduous cultivation of these circles. Gladwell sheds fascinating light on the quantitative aspects of group dynamics. Referring to a function of the brain called “channel capacity,” he argues that groups in which we have deep emotional interactions begin to max out and to cause overload somewhere between 10 and 15 participants. Groups where we have more casual connections, such as schools, workplaces, and other institutions, max out at about 150 people. Working groups larger than this size tend to become dysfunctional and toxic, and cell division is the only cure. The implication for larger movements is that “in order to create one contagious movement, you often have to create many small movements first.” (192)

There is much more of interest in the book. Gladwell’s case studies include some fascinating insights into the nature of addiction. He says – rightly, in my opinion -- that the progression into addiction is not a linear scale, where you become a little bit addicted with each dose of the drug. Instead, “there is an addiction Tipping Point, a threshold – that if you smoke below a certain number of cigarettes you aren’t addicted at all, but once you go above that magic number, you suddenly are.” (249) I am skipping over a great deal of additional interesting content here to get to Gladwell’s general conclusions.

If you are interested in starting a word-of-mouth epidemic, Gladwell says, your resources ought to be solely concentrated on the Connectors, Mavens, and Salesmen. Beyond that, you need to package your message in ways that are rarely obvious, but that somehow touch a nerve in the messy, chaotic tangle of people’s emotions. To find that nerve, you need to test your intuitions empirically and be ruthless about revising and revising again until you find the sticky point. To engage in this kind of quest, which can take enormous effort and energy, requires “a bedrock belief that change is possible, that people can radically transform their behavior or beliefs in the face of the right kind of impetus.” (258) The fact that Tipping Points do occur is “a reaffirmation of the potential for change and the power of intelligent action. Look at the world around you. It may seem like an immovable, implacable place. It is not. With the slightest push – in just the right place – it can be tipped.” (259)

Naturally, I found this message reinforcing and even inspiring, as have hordes of other readers. The addiction landscape does indeed seem like an immovable, implacable hellhole sometimes, not unlike the old New York subway catacombs. As the Robert Wood Johnson Foundation rightly concluded a few years ago, substance abuse is the country’s number one public health problem today. There cannot be the smallest doubt that major change is required. Yet the quest for “just the right place” to give this world the “slightest push” that will tip it has so far proved elusive. Despite brilliant marketing and promotion -- brilliant precisely because packaged as non-marketing and non-promotion -- the 12-step movement has made no discernible dent in the monster’s armor. Most people who do get sober don’t use it. Drunks and other addicts, including veterans of 12-step involvement, continue to die prematurely by the hundreds of thousands each year. The social cost of addiction continues to mount into the uncountable hundreds of billions of dollars. Public policy, by and large, is becoming more expensive, more punitive, and less effective over time. If ever a Tipping Point were needed, it is here.

If we follow Gladwell’s analysis, we will look at addiction as an epidemic, much like the HIV plague, and we will try to find the Connectors, the Mavens, and the Salesmen who drive it. Are there people who have a wide network of connections and who promote heavy drinking and drug use? Of course there are. Is anything being done to identify these people, to reach them, and to try to change their message or shut them down? Are there Mavens of drinking and drug use? Yes, there are such people. Is anything being done to identify them, to study their appeal, and to undermine their message? Are there Salesmen of addiction? We know there are, and many of them are hired by the beverage companies to work their emotional charisma on television. Together, the connectors, mavens, and salesmen of alcoholism and addiction are a social scourge comparable to the promiscuous carriers of STDs who infect hundreds of others and cause isolated small problems to escalate into major epidemics. Where is the social service agency, project, or governmental unit that identifies these contagious carriers of addiction and launches effective countermeasures against them?

Addiction is “sticky” by definition, as Gladwell observes in his interesting chapter on combating teen smoking. All the more reason why addiction recovery messages need to develop their own powerful stickiness, to resonate somehow with the addicted person’s own inner strivings to get free of the drug – with their “S.” The traditional message of powerlessness and God resonates only with a small percentage; it drives countless thousands of others away. Many proponents of the 12-step approach take a perverse pride in the difficulty of their road, scorning “softer, easier ways,” as if recovery were like the old Inca capital of Macchu Picchu, reachable only via a steep and treacherous path. We need to redefine the City of Recovery as more similar to a metropolis like Rome – a place reachable by many roads. That is not optimistic propaganda; it is fact.

Much of addiction treatment today is based on the Fundamental Attribution Error. Persons who get addicted are defined as having an addictive personality, and are told that their character defects lie at the root of their addiction. That seems to be intuitively correct. But decades of psychometric research have blown the “addictive personality” theory out of the water, and we now know that most of what we label character traits, such as the honesty/dishonesty axis, is predominantly situational. Addicts tend to show negative character traits because addiction tends to lead us into negative situations. The quest to cure addiction by reforming character is tilting at windmills.

Groups, finally, are critical to starting or stopping epidemics, if Gladwell is correct. The existence of groups that perpetuate the epidemic of addiction is obvious. Most bars, cocktail lounges, and dispensaries of illegal addictive substances contain the nodes of such groups – informal social networks that push the substance, glorify its consumption, lie about or minimize the risk of addiction, and rationalize away the harmful consequences. On the legal side, powerful economic interests protect these networks and provide public validation for them. On the underground side, no less powerful economic interests do essentially the same. Hundreds of thousands of new recruits enter into these networks each year and some of them, sooner or later, join the ten per cent of drinkers who consume 90 per cent of the booze – the alcoholic heart of the beverage economy. Although the basic sickness of beverage economics is well known and there are good exposures of the industry, as far as I know very little has been done to identify the informal social networks that perpetuate addiction, and to intervene in their process. In the early 1900s, a woman driven to desperation by the harm of alcoholism seized a hatchet and began smashing bar rooms. Surely there must be methods more sophisticated than Carrie Nation’s blunt surgery for disrupting the social networks that spread addiction. One of the great merits of Malcolm Caldwell’s Tipping Point is to raise this kind of question.

A Postscript for LifeRing Convenors:

If you are concerned as I am with making LifeRing grow into a beneficial social epidemic, you will read Gladwell’s book as a how-to manual. For the past five years or more I have been urging LifeRing participants to connect with treatment professionals to the extent possible, because each treatment professional is a gatekeeper who may steer hundreds of recovering people into support groups every year. Thanks to Gladwell’s book, we now have a new term for such professionals; they are a kind of Connector. They have contact – weak contact, but contact – with much larger numbers of recovering people than any ordinary person has, and enlisting their support is absolutely crucial to the growth of our network. Another aspect of this point is that LifeRing convenors are themselves Connectors. The basic role of the convenor, to bring people together in recovery, is core Connector work. Effective convenors act as Connectors far beyond the limited circle of the meeting. They connect different meetings together. They connect the meetings with treatment professionals and with other healing institutions. They connect with many other forces in the larger community and mobilize those connections to grow the organization. Such convenors make a big difference in a community. A good example is Jason Kelly in Guelph. I was impressed during my recent visit by the great number of people in diverse circumstances in the town who knew Jason and whose support he had enlisted for the 2005 LifeRing Congress. With even just one such Connector/convenor in a community, LifeRing quickly becomes a real presence. In towns where our convenors are not also Connectors beyond the circle of the meeting, our network languishes.

Mavens exist in the recovery world, as everywhere else. One of Gladwell’s omissions is the fact that Mavens frequently disagree with one another, and one Maven may dispute another’s expertise. Recovery has long been a field where cacophony reigns among Mavens. It is hopeless to try to win a Maven consensus in this field. The best we can hope for at the outset is recognition and validation from at least a few. As the new kid on the block and the underdog, we have to present real achievements to win Maven endorsements. In this regard, we have the material in the Presenting LifeRing Secular Recovery booklet, we have the 300-p. Recovery By Choice workbook, and we have the 250-p. convenor’s manual, How Was Your Week. Much of this is material is Maven food. These books contain enough hard substance to pass the scrutiny of open-minded Mavens and elicit their commendation. Author William L. White, for example, is a recovery Maven par excellence. His signed endorsement for the back cover of How Was Your Week, and his co-authorship of a forthcoming journal article with an identified LifeRing spokesperson, are important Maven nods. Alan Ogborne and Ronald Warner, who spoke at our Guelph Congress, are Mavens in Canada. There are many more Mavens to reach, but we are well on our way in this area.

The growing priority at this point is to develop more and better Salesmen. I have seen one or two charismatic persuaders emerge in the past, but they had trouble selling themselves on sobriety. In our field, perhaps more than in others, you have to walk the walk in order to sell the talk. We have some relatively new convenors now coming to the fore who display the talents that Gladwell finds in great Salesmen. In order to attract such people, you have to have a product that inspires deep confidence. I’m beginning to sense that the LifeRing package is eliciting that kind of emotional investment from persuasive people. If so, we will have strength in all parts of Gladwell’s trilogy of the Influential Few. It would not hurt if LifeRing convenors were to reflect on how each of us can do a better job transmitting our positive feelings about LifeRing recovery whenever we do what Gladwell calls the dance of conversation with a newcomer. A much bigger problem for us is developing what Gladwell calls “stickiness.” He uses the word to mean retention in memory, which leads to name recognition, which translates as acceptance, and motivates action. This is related to but different from “stickiness” as used by web designers, namely the propensity of visitors to view many pages and to make many return visits to a site; and it is different also from “stickiness” in meeting attendance. Gladwell’s mnemonic stickiness may be a matter of making trivial changes in packaging and presentation, or it can involve the narrative sequence, content, and format of the message. The developers of Sesame Street, Gladwell relates, had an excellent gauge for measuring the stickiness of episodes before they aired. They would sit kids in front of a screen showing the episode, with another screen next to it that displayed rapidly changing randomly sequenced images of animals, landscapes, geometric figures, whatever. They called this device the Distractor. They tracked the kids’ eye movements between the episode and the Distractor. If the episode wooed the kids’ attention away from the Distractor less than 80 per cent of the time, it went back to the drawing board. We could use a similar device to refine our message. One reason why I encourage as many convenors as possible to stand up in front of groups and speak about LifeRing is that this multiplicity of voices acts as a sort of random mutation generator. Most of the small variations that different presenters introduce into our basic message have no deeper significance, but one of these days someone is going to hit on a phrase or an image that taps straight into the collective subconscious of a recovery-hungry culture and makes bells ring. The A and S circle diagrams that I like to use in my talks come close to achieving this kind of memory registration. I have seen audience members reproduce them almost perfectly a week afterward. I would also like to run some side-by-side comparisons of our stickiness when we use the name LifeRing Secular Recovery v. the name LifeRing Recovery in our print materials. Achieving stickiness, Gladwell advises, is an empirical quest – you have to try it out and see.

When it comes to changing the larger external conditions that affect change, there is not a great deal that we can do at this time. However, there may be some important visual cues in our immediate environment that are within our power to influence. On the walls of some meeting rooms in treatment centers, there are large posters containing the program or organizational principles of a recovery group other than our own. Never mind that this implied merger of the treatment center and the recovery group violates that group’s own professed principle of separateness from institutions. For us, the presence of these posters in the meeting room is a “broken window” that signals our second-class status. This signal invites unequal treatment for us in referrals, and inspires covert or overt bashing of the LifeRing approach in the facility where it is tolerated. Where these posters are fixed to the meeting room wall, we need to ask respectfully to have them removed. Where they are mounted on roll-up shades, we need to roll them up while we occupy the room, and if the shade mechanism is rusty or broken, the facility needs to replace it. Moreover, we need to develop our own poster-size displays and ask for wall space on a parity basis. In this regard, it may also be well for convenors to remember the importance of LifeRing door signs and directional signs. When these are missing, the Force is disturbed: a hesitant newcomer may not reach us, and six months later there is no capable new convenor to carry on the meeting. Small environmental cues, as Gladwell reminds us, can tip major long-term consequences.

In many ways, The Tipping Point is a goldmine for LifeRing convenors. Its basic thesis is one in which we, as a fledgling social movement, are deeply interested. Although Gladwell’s exposition may overlook some important constriction points in the transmission of ideas – I am thinking of factors such as the concentration of the press and electronic media, censorship, the chilling impact of terror and other violence, and the role of the institutionalized transmission of ideas in schools – the work is a fresh and stimulating read that encourages all of us little people to follow our big dreams.

--5/15/05

Drunkard's Refuge: The Lessons of the New York State Inebriate Asylum


By John W. Crowley and William L. White;
ISBN 1558494308

Reviewed by Marty N.


The state of Maine was in the 1820s the most besotted territory of America. Its residents, by one estimate, spent on drink in every generation a sum equivalent in value to all the property in the state. Lawlessness, chaos, misery and demoralization stamped every town and village. Out of this stinking swamp arose a man possessed from his early adulthood with a healing vision: to build a refuge where the inebriates of the whole nation would be treated on medical principles. Joseph Edward Turner, M.D., brought to this vision a zeal commensurate to the challenge. To raise funds, he had more than 120,000 doors shut in his face, was turned down by more than 1,100 wealthy men, and was bitten six times by their dogs. But in June, 1864, with a grant from the New York State legislature, financed by a portion of the excise tax on liquor, the nation's first "Inebriate Asylum" opened its doors at Binghamton, New York. Drunkard's Refuge is the story of this pioneering institution, based on recently unearthed documents.

Those who seek here for a story of medical or moral uplift on an institutional scale will come away disappointed. Turner, his board, his staff, his patients, and the nearby town were in almost constant friction before the doors opened. Two arson fires, cynical maneuvering, power struggles, schisms, corruption, and numerous instances of abuse marked this institution's relatively brief life before it closed its doors in 1879. Few are the testimonials of men who achieved lasting remission of their addiction within its walls.

Much of the book attempts to draw the lessons of the asylum's demise for today's treatment institutions and for the larger recovery culture within which they operate. The authors are eminently qualified for such a task. John W. Crowley is the author of The White Logic: Alcoholism and Gender in American Modernist Fiction and William White wrote Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Many themes of the latter book are recapitulated and interwoven with the story of Turner's asylum.

It would be interesting one day to compare and contrast this high-profile institutional Titanic with the much longer and more successful story of the Washingtonian Home, which opened its doors in Boston seven years before the Inebriate's Asylum and survived in various forms until modern times. For those who seek to understand treatment institutions and their conceptual underpinnings, Drunkard's Refuge is an illuminating microcosm, a universe seen in a grain of sand. It's also a good read, without a dull chapter. Recommended.

Tuesday, April 10, 2007

You Can Free Yourself From Alcohol and Drugs: Work a Program That Keeps You in Charge



By Doug Althauser, M.Ed., CSAC, MAC.
ISBN 1-57224-118-7

Reviewed by Marty N.


Kaiser Permanente is the largest Health Maintenance Organization in the United States, and practically all of its centers include Chemical Dependency Recovery Programs (CDRP). When the Program Coordinator of one of these CDRPs writes a book about recovery, it pays to sit up and listen. Doug Althauser is Program Coordinator of the CDRP at Kaiser in Honolulu. His book, based on nearly ten years of clinical experience, is a fascinating effort to move beyond the old spiritual paradigm of the 12 Steps into a newer, more secular and more self-empowering recovery model. The book is of special interest to LifeRing members because many of its themes resonate with our own concerns.
In the Introduction to this book, Althauser makes the following historical observation:
In the 1970s, the culture of North America changed. People became less likely to discuss God or spirituality in informal group settings like AA or NA meetings. Furthermore, people began to express pride over their individual characteristics, like their culture, their gender, race, ethnicity, or personal philosophy.
This independence made it tough for a lot of addicts and alcoholics to accept the spiritual philosophy of Twelve-Step programs. Not surprisingly, chemically dependent people began to ask for alternatives to the Twelve Steps. As a result, three different groups began on a national level helping people to recover: Women for Sobriety, Secular Organizations for Sobriety (or Save Our Selves), and Rational Recovery. These groups provided an alternative to Twelve-Step programs. More importantly, these alternative programs worked.
(p. 2). Althauser’s clinical practice has led him to construct a recovery program that is better adapted to this newer, less traditionally spiritual, more diverse, and more proudly independent recovering population, and that has a higher appreciation of the alternative support groups.
What all different kinds of recovery approaches have in common, he says, is three basic things: (1) abstinence as a lifelong goal; (2) changes in lifestyle to minimize risks of relapse; and (3) use of a support group of some kind to maintain sobriety over time. When he says "of some kind," Althauser really means it. He recognizes that the 12-Step groups are much more widely available than the alternatives, but he intends his program to be compatible with any kind of group that helps a person stay abstinent, regardless of its ideology. He regards all such groups as more or less equally valid and helpful, and specifically includes LifeRing’s predecessor (SOS).
When Althauser begins to detail his program, it may seem at first sight that this is another in the long series of attempts to make the 12-Step program palatable by selectively ignoring and sugar-coating what it actually says. Thus, Althauser’s program consists of "Ten Goals" that must be done in order, like steps. The first goal is to admit that one is chemically dependent, somewhat like the First Step; and each of the subsequent goals is similarly developed via a brief interpretation of the corresponding points in the 12-Step program. On the surface this looks at first like another 12-Step clone.
But this appearance deceives. Althauser’s project is to extract from the Steps what he sees as "the therapeutic, that is, the non-spiritual recovery concepts" and to leave the rest behind. His effort, in his words, is to use from the 12 Steps only "the parts that work for everyone." He advises at the outset that his program is not a 12-Step program, that it has nothing to do with any 12-Step groups, and that 12-Step groups neither asked for the book to be written nor reviewed or approved it in any way.
Central to the Steps is "God" and a "Power greater than ourselves." Althauser handles this issue by translating all such references into the concept of "sources of support." These sources, he says, need not be "powers greater than oneself" but merely people one can trust to help one stay abstinent. He has no problem with clients who include God in their list of sources of support, but he advises that only people who can give you direct feedback can really be effective for you. So, for example, the list "God, Jesus, Holy Spirit, Virgin Mary, Saint Mary Magdalena, my rosary, my priest, the Pope, the Bible and my church" contains only one possibly effective source of support, the priest, and he is probably too unavailable to give much feedback. The patient who made this particular list, Althauser recounts, soon relapsed.
Althauser’s approach throughout is informed with clinical experience and inspired by common sense. There is a good array of checklists to help a patient decide whether a self-diagnosis of chemical dependency is warranted. There is an excellent chapter on why abstinence is the appropriate lifetime goal. There is a wealth of good advice about high-risk and lower-risk lifestyle choices. Althauser wisely advises leaving deep psychological self-examination aside during early sobriety and focusing instead on examining one’s everyday behavior patterns. He gives numerous anecdotes to illustrate healthy and unhealthy lifestyle decisions among his patients. This book is a good compendium of sound information and advice for living sober.
At the center of Althauser’s program (around goal six) is "drafting your own sobriety plan." The plan is based on two lists: a list of one’s high-risk lifestyle elements and a list of the elements in one’s current life that help one maintain abstinence. The plan consists of detailed, specific actions that move away from the relapse-prone toward the more securely abstinent behaviors. Relapse or near-relapse is simply a sign that the program needs to be revised. Althauser emphasizes that each person’s plan must be based on that person’s actual individual life situation, and cannot be simply copied from a formula in a book. Althauser expressly recognizes that this individualized approach will result in a group whose members will have different sobriety plans. This diversity – perceived as threatening in traditional programs, where therapeutic uniformity is the goal -- is actually a sign that the program is working, and is a source of its strength.
This book may be particularly useful to that large number of early recovering people who are treading in 12-step waters without any real sense of direction. The book extends a branch to them by which they can pull themselves up to some solid therapeutic ground. The book belongs in every LifeRing member’s recovery library. It would make a good gift for a person newly embarking on the recovery path or a person still drinking but actively contemplating a change.
There are some weaknesses. Althauser contends at several points that his program captures the "real meaning" of the Steps by interpreting the words as they were understood when written in 1935. This effort is based on nothing more than a 1934 edition of the New Century Dictionary, and it isn't particularly persuasive. Also, to someone like myself who has had the privilege of doing all my recovery in LifeRing (formerly SOS), Althauser’s continuous effort to explain his program in terms of the 12-Step framework appears unnecessary and counterproductive, sometimes annoyingly so. I find myself wishing sometimes he would just "kick out the jams" and say what he means to say without trying to harmonize it first with the 12-Step viewpoint. But I can very well understand why someone in charge of a major treatment program in this day and age would still find it necessary to jump through that series of hoops.
In my view this book is an important one for LifeRing members. To my eyes there are two main lessons here. One is that the secular, do-it-yourself-with-group-support approach that LifeRing espouses is finding more and more echoes within the walls of the professional treatment community. What was once a closed shop where only 12-step groups need apply for recognition is opening up, little by little, to acknowledge the validity of alternative approaches, including LifeRing.
Althauser’s program, at its core, is built around the same idea as the LifeRing view, namely that if given the proper support and tools, each motivated recovering person can and will construct the sobriety program that works for that individual. It is gratifying to find prominent voices in the treatment profession who resonate with this important therapeutic idea, central to the LifeRing approach.
The main portion of the book is addressed to persons in recovery. The presentation is clear, respectful of the recovering reader’s intelligence, and filled with illustrative anecdotes. The author adds a postscript (Chapter 12) addressed to other treatment professionals. Here, Althauser lets his hair down and explains the "ten goals" in terms that have nothing to do with the 12 Steps but speak the language of cognitive behavioral psychology. There is much practical and strategic material here for staff meeting discussions; really, this last chapter contains the compressed outline of another whole book. I hope Althauser writes that sequel soon.
This review appears under the tittle "A Clinical Protocol Based on the Sober Self-Empowerment Concept" in Presenting LifeRing Secular Recovery: A Selection of Readings for Treatment Professionals," LifeRing Press 2000. Go http://www.lifering.com/.

Whiskey's Children



By Jack Erdmann and Larry Kearney
ISBN 1-57566 305 8

Reviewed by Charlene C.


This is a book that hit me so hard, I read it in two sittings. Jack Erdmann, former salesman, presently an author and lecturer in San Francisco, captures the pure hell that is alcoholism with wit, grace and brutal honesty. Working with Larry Kearney, a poet and novelist, he relates the history of the Erdmann family, his great grandfather Louis, dead of DT's at 56, his grandfather, Arthur, who made his wine and beer in the basement, and his great uncle, Emil, who sold his father's Colt pistols for a pint of rye.
Erdmann does not cast the blame for his affliction on his ancestors. Rather, "I don't want anyone to think that this the story of a child abused by a family - it isn't - it is the story of a family abused by alcohol." And the alcohol takes him to dark places, to drunk tanks, crisis centers where the orderlies look like bouncers, to empty train stations where the sun is always going down.
We get a sense of a jazzman's life in the early Twenties: "bathtub gin, speakeasies and open touring cars at night with empties clanking on the floor." His father ran with the likes of Pee Wee Russell, Beiderbecke and Teagarden. Men who played and drank hard. We are shown the terrible paradoxes of his father, on one hand he is capable of beating his son, on the other he patiently teaches his son the words to "My Wild Irish Rose". His mother, too, a complex woman, soft and frivolous on the outside but with a tough core, which stands firm in the midst of the chaos. Even in genteel middle-class neighbourhoods, brutality, fueled by alcohol, blithely takes place behind lace curtains.
The story moves along like a movie, sometimes in soft focus, sometimes raw and jittery. The lines of reality are blurred, run into each other, get smudged by hallucinations, paranoia and the all encompassing need for that next drink. The obsession simply takes over an alcoholic's life. Erdmann says: "..for anyone born with the disposition, the first drink will open him up like a flower, physically and emotionally, and he'll keep coming back for more. The fact is alcohol is a chemical and its effects are cold, mechanical, and predictable. When you begin drinking alcoholically, you get on a train. You neither grow nor learn emotionally, you just ride. The last station is hell. And when you get there, you remember you left behind tickets for your children."
One excerpt that sums up the terrible damage alcoholism does to families:.."it's always the same--the same goddamn pain romanticized and trivialized, the dully accepted. It wires families together for generations, the children learning to keep their shoulders tense against the random shocks. They think it must be "their" fault. And then "they" raise children who have tense shoulders and chests full of jangling fear and grief. None of it's necessary. It's time to stop."
In "Whiskey's Children", it's all there: self-loathing, blind repetition throughout the generations, false starts, rationalizations and utter exhaustion. The constant sense of a life put on hold, in limbo, in between train stations. The healing begins when another drunk puts out an albeit shaky hand to one who still suffers .."those who have nothing share the only substance they can find." Call it empathy, call it the kindness of strangers or simply call it as Erdmann does, "visible grace." This is a convincing story of rehabilitation, the reconciliation of a scarred and broken family, an inspiring chronicle of one man's return from the hell that is alcoholism.

Understanding the Alcoholic's Mind: The Nature of Craving and How to Control It



By Arnold M. Ludwig, M.D.
ISBN 0195059182

Reviewed by Diane J.

I have a confession to make (no, no, not THAT one)--I bought this book strictly because of the subtitle. And it was definitely a good impulse: Understanding the Alcoholic's Mind is a fascinating and elegant little book on craving and relapse, the cognitive distortions that accompany both, and methods used by successfully sober alcoholics to "avoid or resist temptation." The strength of this book is in its vivid presentation of thinking patterns that support drinking and of thought techniques that can be used against these.

Ludwig, a member of the Department of Psychiatry at the University of Kentucky and a prolific researcher and author, begins his book with the flat acknowledgement: "There is no general agreement about the nature, cause, or treatment of alcoholism"--a truism he drives home with a brief discussion of the "paradoxes and contradictions" in current attitudes. Searching for "a common area of overlap" that will allow a clear description of "what individuals need to do to insure sobriety", Ludwig proposes that the answer is "in the mind," and sets out to describe the ways in which alcoholics can change "their thoughts, attitudes, and motivations."

As you may be aware, the alcoholic's mind is an interesting but not exactly low-maintenance piece of work, and Ludwig does it some justice in the chapters that follow. In "The Lure of the Sirens", he traces the ways in which some alcoholics "covertly maneuver to arrange a slip", complete with some disconcertingly plausible examples, and links this to a persistent unconscious belief that one can SOMEDAY, SOMEHOW learn to drink safely again, that "this time will be different." (In a lengthy footnote essay, Ludwig ties this insight into an interesting critique of Marlatt and Gordon's work on the 'abstinence violation effect'.)

The following chapter details nine "drinking scripts" Ludwig identified in the course of his research, patterns of thoughts and attitudes that tend to accompany and intensify craving. Ludwig notes that this kind of thinking is hardly unique to alcoholics, but that it presents special dangers for them given the possible severe consequences of acting on it. He considers the scripts "private self-statements, a type of nonvocal inner speech" that mediates between the intention to drink and the actual act of drinking.

The scripts, which are vividly described and quite recognizable, include "the escape script" (all I want is a little peace....); "the relaxation script"; "the romance script"; the "to-hell-with-it script" (a personal favorite); "the self-control script" (more popularly known as the "I'll just have one--maybe two" script); and, for good measure, the "NO control script": "Just as believing in one's ability to handle alcohol intake is usually a setup for relapse, the attitude of not being able to control cravings virtually insures it."

Having surveyed the distorted thinking that accompanies craving, Ludwig turns his attention to "the mystery of craving" itself, in a chapter that combines anecdotes about craving with an excellent and balanced survey of cognitive-behavioral studies of craving, including research into environmental cues, conditioned responses to emotional states, and the highly individual nature of each alcoholic's personal "Pavlov's bells". (It should be noted that Ludwig makes little attempt to deal with the biology of craving, except to note that it increases markedly if the craver actually drinks.) His ultimate point is that craving is not a mysterious or uncontrollable event, that an individual can learn to predict the likelihood of craving and to resist it, and that it weakens and disappears if the alcoholic abstains for an extended period.

All well and good, but how exactly is this craving, drinking-thinking, planning-for-relapse alcoholic going to be motivated to abstain for long enough to weaken those cravings? And what techniques can she or he possibly bring to bear against powerful cravings triggered by personal cues and the seductive "logic" of the inner drinker whispering from the favorite "drinking script"? I do not think Ludwig has done a particularly persuasive job of answering the first question, but his answers to the second are intriguing and useful.

Ludwig's discussion of the "devloping the proper frame of mind" (adequate motivation) for sobriety is preceded by his survey of the often dismal recovery statistics and review of practically every available treatment modality. The chapter title, "On and Off the Wagon", gives some indication of his tone. While he is generally approving of AA, he does not shrink from the low success rate, notes the existence of other sobriety organizations, and suggests that "the very process of group affiliation" may support abstinence. He then proceeds to discuss "hitting bottom", in what is probably the weakest section of the book, piling up suitably striking anecdotes about various "bottom experiences" and "spiritual conversions to AA" without much analysis. It is clear that he believes that the "spiritual experiences" he portrays have purely psychological explanations, but he escapes by making reference to William James in the text, burying his scientific explanation in a 7-page footnote, and concludes with "If God doesn't intervene, alcoholics will have to find a way of resisting temptations on their own." (Thank you, and about time, too.)

Back on his own cognitive-behavioral ground, Ludwig spends the rest of the book detailing ways of resisting temptations, and they are good ones. He opens by pointing out that some commonly used thought-control techniques are relatively ineffective. Direct counterpoint thinking, "fighting a craving head-on", can fuel it. Resolving NOT to do something can create more difficulties than it solves, as "The picture of NOT doing triggers an image of doing what the individual is resolved not to do...[but] individuals cannot visualize "NOT", so the image of drinking may grow in intensity if you merely oppose it with the idea of "NOT DRINKING." He suggests that you should instead picture a substitute behavior every time the image of the unwanted behavior occurs to you.

Other "mind-control" techniques covered include "distraction", "substitution", "thought-ignoring" and "thought-stopping," "postponement", "playing the thought through" and "immediate negative conditioning". If some of these sound like methods you are already using, they probably are: the advantage of Ludwig's presentation is that he gives a clearly organized description of each one and notes its strengths and weaknesses. He also discusses their similarity to Buddhist meditation techniques for focusing concentration.
The nine "drinking scripts" from the earlier chapters are matched by five "sobriety scripts" drawn from Ludwig's interviews with recovering alcoholics. These are "the negative consequences script," the "benefits of sobriety script", the "rationality script", the "avoid-the-first-drink script", and the "prayer script". Again, you will probably recognize some or many of these, but they are vividly detailed, often in the words of the interview subjects, and you will probably find ideas and phrases that will work for you.

The final chapter, "The Sober Mind", is a brief and rather pedestrian discussion of "living sober." The most interesting portion of it is an extended footnote essay in which Ludwig offers his "personal sobriety formula".(Since this is the third time I have had to refer the reader to the footnotes, let me just urge you to READ the footnotes: there are several full-length essays in there on subjects ranging from Marlatt's Relapse Prevention theory and Gregory Bateson's "The Cybernetics of Self" to drug-induced religious experiences. Ludwig could have used a more adventurous editor.)

All in all, I found this to be an interesting and very useful book. It can be quite valuable to have a "classification system" for those drink-fighting thoughts, and at least one of those drinking scripts is guaranteed to hit a nerve if you are familiar with alcoholism.

Under Your Own Power: A Secular Approach To 12 Step Programs

By Ronald L.Rogers and Chandler Scott McMillin
ISBN 0-0399-51849-5

Reviewed by Don G.

This is the second Rogers/McMillin book that I’ve reviewed for BookTalk.
In their introductory, entitled "Recovery for The Non-Believer", they discuss their experiences as addictions treatment facilitators, where for every believer they encountered either an atheist or agnostic or non-believer that was recovering "under their own power".
Chapter Two discusses the challenge of faith for the non-believer. The authors contention is that even though you don’t need God to recover, you do need faith. They discuss different approaches to faith: The Traditional Model - "God Is Everything" , The Twelve Step Model - "God of our Understanding", and faith in what they call The Chronic Disease Model - "Whatever Works" . However, in the concept of "Whatever Works" they issue a caution to look out for people\institutions that are simply out to deceive you and not help you in your recovery.
Chapter Three looks at Ten Milestones on the Road to Recovery. Chapters Four and Five discuss working the Twelve Steps and Twelve Traditions for the non-believer. Self Help groups discussed in this section include AA, SOS, Rational Recovery and Women For Sobriety.
The last two chapters are lengthy, but contain much information on understanding addiction and the paradox of relapse. Some of the subjects covered in these two chapters include an excellent discussion on the stages of addiction, as well as the stages of recovery.
As mentioned in their earlier book, Relapse Traps, (also reviewed in BookTalk), much use is made of visualization exercises and of analysis of cognitive distortions that the alcoholic/addict suffer from. Overall, I liked the book. The views given are balanced and not biased towards any approach that I could see.
Comment by Diane J.:
Don: Thank you for the thoughtful reviews of the Rogers/McMillin books, but I wish you would consider altering the last sentence or two of the new one. "Under Your Own Power" really isn't "balanced and not biased toward any approach." It's a pretty heavy-fisted sales job for AA and the 12 steps (I think the subtitle should have been "How to train yourself to believe in God while pretending that's not what you're doing"--laugh).
And the deck-stacking examples and mind-games they play with "faith" vs. "religion" are straight out of the "It's a SPIRITUAL program, dummy" school of AA argument. (They also offer one of the versions of the Milam model of addiction as a possible appropriate target of your faith, without any acknowledgement of the truth that it is one theory among several, all non-proven.)
There are good things in it, of course, particularly in the "relapse traps" discussions, as you point out so well, but I think the review would be stronger for acknowledging that this is a book with a very pro-AA bias, IMHO.
Thanks again for the reviews. It's clear that you want to be very fair to the books you comment on; I think this time you might have been a little TOO fair (laugh).

Under The Influence: A Guide to the Myths and Realities of Alcoholism



By Dr. James R. Milam and Katherine Ketcham
ISBN 0553274872

Reviewed by Don G.


This "classic" book on alcoholism is a fascinating, yet complex read (in the reviewer’s opinion!)
Milam describes in his opening chapter the deep schism that exists among scientists, physicians and addiction treatment facilitators over the nature of the disease of alcoholism. Alcoholism among many researchers and legislators in the United States is still regarded as a moral issue rather than a disease -- even though the American Medical Association has recognized it as a disease since 1956!

Chapter Two discusses alcohol itself - as a chemical, as a drug and as a food. The chapter describes how the body processes alcohol, and that it is selectively addictive - affecting only about 10% of the world’s population. Chapter Three discusses the predisposing factors that make an alcoholic what he/she is. Alcoholics and non-alcoholics essentially drink for the same reasons -- but at some point the alcoholic’s drinking changes from that of the non-alcoholic.
"The alcoholic appears to be using alcohol to solve his problems. The reality, however is that an abnormal physiological reaction is causing the alcoholic’s increasing emotional and psychological problems. Something has gone wrong inside." (pg. 33-34)

Chapters Four through Six discuss in great detail the progression of alcoholism from adaptation in the early stage (increased tolerance, improved performance) to the middle stage (physical dependence, craving, loss of control) to the final, deteriorative, stage of the disease (physical damage to the body from drinking, including fatty liver, cirrhosis, and pancreatitis - among a few of many ailments).

Chapter Seven shows an alcoholic as he progresses through the stages of the disease as discussed in Chapters Four through Six. Chapters Eight and Nine discuss getting an alcoholic into treatment and also discuss guidelines for looking for a treatment program. While these two chapters are helpful, there is a strong pro-AA stance to them. Milam also describes what he feels a Model Treatment Program should offer the person entering it, and what should be expected of the patient while in treatment.

Chapter Ten is on Drugs and the Alcoholic. Milam discusses how alcohol in combination with other drugs can be deadly -- especially tranquilizers. Alcoholics suffer from cross-tolerance ..." their cells are already chemically altered by long exposure to large doses of alcohol, and these alterations affect the cells’ reactions to other drugs...it accounts for the alcoholic’s ability to continue to function with tranquilizer or sedatives doses which would be incapacitating or even lethal for non-alcoholics.’ (pg.172) Milam also discusses cross-addiction in Chapter Ten.

Chapter Eleven is entitled "Beyond Prejudice and Misconception." Here, Milam discusses where he feels changes should be made in how we look at alcoholism. One of his main points is that there should be definitions that all of the scientific and medical community agree upon when it comes to alcoholism and its treatment. He discusses the need for setting alcoholic research priorities, prevention and education. One of the major points he makes is that the medical, law and insurance professions must change in their view of alcoholism.

This was considered a groundbreaking book when in was first published in 1981. In 1998, there is still much of the book that will interest the alcoholic who wants to know how the disease affects them, and what can be done about it.

Trauma and Recovery



By Judith Herman, M.D.
ISBN 0-465-08730-2

Reviewed by Marty N.


Craig W. turned me on to this book at one of our Book Nights at the Thursday night SOS meeting in Oakland. As the title implies, it is a book about recovering from trauma. Craig said that even though he had not suffered any particular physical trauma, such as being beaten or sexually abused or shellshocked in war, nevertheless the book spoke to him very centrally. After reading it, I came to agree, and began to understand why.

Dr. Herman spent twenty years studying women who had been raped or violently abused as children, as well as men who had been prisoners of war or had the Vietnam vets’ syndrome. She makes a strong case that the prevalence of violent trauma in our society is much greater than is generally believed. She puts herself in the shoes of the victims of societal atrocities and tries to describe what that feels like, and what happens inside.

The central experience of trauma, Dr. Herman writes, is powerlessness. When the organism first confronts a threat, it goes into a fight-or-flight reaction. But when neither fight nor flight avail, the human defense mechanisms disintegrate. Overwhelmed, the emotional and cognitive systems become severed (disassociated) from each other, so that the person thinks without feeling or feels without thinking. The victim adopts a permanent state of aroused vigilance, even when no immediate triggers are present. Echoes of the traumatic event intrude on ordinary activities. Finally, the victim may go into surrender mode, numbing down all except the most constricted systems, and frequently resorting to collaboration with the abuser.

There is a well-known link between childhood trauma and adult alcoholism, particularly among women. Dr. Herman describes alcoholism and other drug addictions as among the common traits found in survivors of childhood abuse, along with insomnia, sexual dysfunction, dissociation, anger, suicidality, and self-mutilation. She describes excess use of alcohol and drugs as a method of dissociation and constriction that many trauma victims employ when they are unable to achieve these protective altered states spontaneously.

While abuse of alcohol and drugs is a frequent sequel of trauma, the experience of being addicted to alcohol can be a kind of trauma in its own right. The realization that one is trapped in a joyless cycle of chemical self-destruction is authentically terrifying. I remember well those many mornings when I looked in the mirror and saw a slave. In those days, neither resistance nor escape availed. The experience of powerlessness is ingrained in the life of an active addict. And so, with that background, I began to read Dr. Herman’s book, just as Craig did, as a book about surviving and recovering from a trauma called addiction.

Part II of the book is entitled Stages of Recovery. Dr. Herman opens it with these words:
"The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation…. The first principle of recovery is the empowerment of the survivor. She must be the author and arbiter of her own recovery. Others may offer advice, support, assistance, affection, and care, but not cure. Many benevolent and well-intentioned attempts to assist the survivor founder because this fundamental principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interests."

I quoted this at length because it seems to me that this understanding is central to what we try to do, and largely succeed in doing, in our SOS meetings. As everyone knows by now, we do not see ourselves as owners and vendors of a magic "Program" which we try to impress on newcomers. We stress to the contrary that the recovering alcoholic can and "must be the author and arbiter of her own recovery," exactly as Dr. Herman writes. What we supply to each other is support, assistance, affection, care and advice if asked for, but not "cure." Because we adhere to "this fundamental principle of empowerment," we steer clear of ideologies that would assign the recovery-creating power to supernatural beings, or to magical objects such as doorknobs, because such an assignment takes away from the survivor a power that is rightfully and necessarily hers, and this cannot foster recovery, no matter how benevolent it may appear.
The principle of empowering the patient gives some therapists a great deal of trouble, accustomed as they are to seeing themselves as powerful and the patient as helpless. Dr. Herman is a vigorous advocate of "patient power." She speaks from two decades of experience of working in groups for battered and abused women, survivors of childhood abuse, incest, rape and other atrocities, as well as with men exposed to traumas of war and imprisonment. These are individuals who manifest all kinds of dysfunctionality, as do we alcoholics and addicts. Nevertheless, or rather, precisely because of this fact, insists Dr. Herman, "the more the therapist accepts the idea that the patient is helpless, the more she … disempowers the patient." Likewise, I think it’s fair to say that when addiction counselors begin with the premise of the alcoholic’s or addict’s helplessness, they disempower the patient’s recovery and become part of the problem rather than the solution.

Dr. Herman’s experience in her battered women’s survivor groups indicated that the first task is to establish a sense of safety. No progress can be made until the person feels and is safe. (p. 159) This is a point that applies to our recovery groups as well. We usually understand the "safety" issue as one of anonymity and confidentiality. These are basic, but there is more. A good atmosphere in a meeting is where participants feel free to speak about their personal experiences, but don’t feel pressured to disclose more about themselves than is comfortable for them at the moment. Sometimes our participants only offer their opinions on a topic; they say "I think " such-and-such and "I agree with X" or "I disagree," but rarely disclose any of their own experiences. This superficial level of talk suggests that these speakers don’t feel safe in the meeting, and if this becomes the standard for the whole meeting for a prolonged period, then it’s time to stop and reassess. Not much healing or empowerment will take place if people don’t feel safe to talk about what really is going on with them. Similarly, not much progress will be made if people talk in slogans or formulas.

Talking – the simple act of talking in a group about one’s experiences – is a therapeutic process. Members of self-help groups know this. Dr. Herman’s treatise validates it scientifically. In a remarkable chapter, she writes that even the medical symptoms of trauma, the "physioneurosis," can be reversed "through the use of words." Talk in a safe environment that comes straight from the heart, and allows repressed feelings to surface without premeditation, creates privileged moments of insight. This kind of talk is very probably the real active ingredient of all successful self-help groups. It is the reason why they work when they work. All the rest is ornament or baggage. SOS is wise to concentrate its effort on constructing and facilitating this central process, and in deflecting any effort to burden this force with any programmatic, religious, spiritual or political overlay.

The third and last stage of recovery, in Dr. Herman’s view, is reconnection with others. Here again the self-help groups play a vital role. In the groups, the individual survivors begin to experience bonding with one another, recover a sense of self-worth, and learn methods that allow them to make changes in their real world pathways. For many survivors at this stage, it is helpful to become engaged in campaigns to address the causes of their victimization, and in educating the public.

In conclusion, this is not intended as a book about alcoholism or addiction. On those occasions when Dr. Herman speaks of recovery from alcoholism directly, her text does not rise above the brainless rubber-stamping of 12-step methods that marks the run of the mill, and this is a definite weakness of the work. But if we look at the larger picture, this is one of the most illuminating books about addiction that has been written in recent years. If we understand addiction as not merely a sequel of trauma, but as a trauma in its own right, then the work is rich in insights and lessons for us. I am grateful to Craig W. for sharing the work and I would recommend it unhesitatingly to anyone interested in understanding more about the recovery process.

The Thinking Person's Guide to Sobriety



By Bert Pluymen
ISBN 1-880092-40-9

Reviewed by Don B.


I was immediately drawn to this book while browsing through the recovery section of a bookstore by its title -- after all, I consider myself to be a "thinking person." I just had to read it -- and glad I did. It's now a permanent part of my recovery library.

The book is largely anecdotal (primarily the author's own story, plus many others -- which can become tedious) combined with interesting scientific facts and studies. Although each recovery involves AA, it's not excessively pro-AA. The author is very open-minded when it comes to alternative support groups -- mainly Women For Sobriety and SOS. He provides his e-mail address and we have communicated frequently, ever since I read his book, about SOS. If there was a meeting in Austin, I'm sure he'd be there.

The author is a self-described "high bottom" alcoholic, recognizing his alcohol addiction before getting into serious legal, financial, or career problems. He prefers the term "alcohol addiction" to "alcoholism" and stays away from "disease theory" -- although he does bring up hereditary, ethnic, economic, and environmental contributions towards addiction.

Overall, I consider this to be one of the best recovery books I've read -- and shared with others at our SOS meeting. While not revealing anything that was new to me, it is well-written and an enjoyable read. Also of interest, is a separate section dealing with women and alcohol that is especially good.

(January 1998)