Tuesday, March 27, 2007

Coming Clean: Overcoming Addiction Without Treatment

By Robert Granfield and William Cloud. Foreword by Stanton Peele ISBN: 0-8147-1582-6

Reviewed by Diane Jeanette

In the Winter, 1996 issue of the Journal of Drug Issues, Robert Granfield, a sociologist, and William Cloud, a professor of Social Work, both of the University of Denver, published a 15 page article called "The Elephant that No-one Sees: Natural Recovery Among Middle-Class Addicts." It was a nicely done report on the results of in-depth interviews with 46 survey respondents who had all terminated addictions without formal treatment AND without joining self-help groups.

The authors reported that their subjects had not, for the most part, chosen "addict" or "postaddict" identities, but preferred to view their addictions as "problems they had once had but had now solved." The 46 had avoided treatment and AA/NA because they disagreed with the ideology of "powerlessness," disliked the disease model, found the religious content of the programs offensive, and generally found 12step groups "dependent" and "unhealthy". In addition, most believed in their own abilities to terminate substance use "on their own" and felt strongly that focusing on weaknesses and defects would be counterproductive and shaming.

In the final section of the article, the authors pointed out that their respondents were all employed middle class or stable working class individuals with adequate educations and usually some strong personal relationships. These self-recoverers were almost certainly able to self-recover at least in part because they had external social and economic resources available to them.

This is interesting stuff. If you've ever battled with an addiction or been up against the 12step monolith it's positively fascinating stuff, and you might think there would be a good book in it. Well, Granfield and Cloud decided to spin this material into not one but two books: a scholarly sociological tome and a "popular" guide to various treatment methods.

Unfortunately, they have made bad choices in the presentation of this material almost every step of the way, in both books. Of the two, I would recommend reading Coming Clean, provided you are willing to skim or wade through slabs of the sort of discussion of the literature that is clearly intended to impress, or at least to exhaust, a promotion and tenure committee.

While it is impossible to doubt their sincerity and their interest in helping addicts, it is equally impossible to commend their writing abilities. When you read, in the Preface, that "The title, Coming Clean, denotes two distinct meanings. First, we use it as a way of invoking the popular metaphor for the process of terminating addictions. However, we also use this phrase as a metaphor for lifting the veil of secrecy surrounding the fact that most people overcome their addictions without ever entering formal treatment or participating in 12-step groups such as Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous...." you are reading their prose at its best.

Coming Clean does, however, quote from and analyze those 46 surveys extensively in Part One, "Perspectives on Natural Recovery," and this material is worth wading through. Expanding on their 1996 article, Granfield and Cloud devote chapters to the process of addiction, the "conversion experience" (sociological definition) that leads to and powers early recovery strategies, and their subjects' attitudes toward the "disease concept" and self-labeling as "alcoholic" or "addict."

The last chapter of this section gives the authors' perspective on the social capital that facilitated their subjects' escapes from addiction: "The experiences of our respondents, who subscribed to an individualistic ideology of recovery, actually attest to the importance of the social relationships that surround and envelop them."

Part Two, "Implications of Natural Recovery," is largely devoted to the argument that this social capital should be considered "recovery capital," and treatment policy implications that might flow from this. Somewhat oddly, while the authors are clearly excited by "natural recovery" and disdain traditional treatment, they fuss repeatedly about their fear that their research will be used by those who want to abolish traditional treatment.

Granfield and Cloud plainly sympathize with their subjects' decisions to "resist disease-based significations of the self" and reject "the pejorative genealogies of the addicted self." They take some predictable and mostly deserved swings at the "hegemonic discourse of disease" and are fashionably skeptical about the necessity of abstinence in recovery. This attitude, however laudable, may have caused them to miss a real chance to ask some interesting questions, however.

Over 92% of their subjects chose permanent abstinence as the solution to their addiction problems. Given that these are subjects who furiously reject the disease model, deny that they are "recovering" or in any danger of relapse, and have no use for AA, how did the overwhelming majority among them come to decide on abstinence, as opposed to controlled use? And how do they construct satisfying identities as permanently abstinent but NOT permanently "recovering"?

Unfortunately, Granfield and Cloud are not interested in the issues surrounding the choice of abstinence as such, and indeed downplay the abstinence choices of their subjects, apparently because in their eyes "disease model" = abstinence only; "scientific model" = variety of outcomes. The 92% who chose abstinence and the 8% who chose moderation are all referred to as "natural recoverers," and no distinctions are discussed.

Nor does it seem to occur to them that people who don't believe addiction is a disease but yet choose to abstain instead of moderate probably try to explain this to themselves somehow. As a result, the book is rather baffling at times, as the authors push for a variety of outcomes model that is in fact unsupported by the data they have gathered.

Coming Clean is far from excellent, but it is worth reading, if only to meet the interview subjects who solved addictions by acting on their beliefs that, as one of them said, "it's your own sense of self and your own power over yourself and what you choose to do that matters."

(Also see my review of "Recovery from Addiction" by these same authors)

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