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/.

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