Showing posts with label Marty N.. Show all posts
Showing posts with label Marty N.. Show all posts

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, 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 naïve 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.

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 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/.

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.

Thinking in Pictures



By Temple Grandin
ISBN 0-679-77289-8

Reviewed by Marty N.


It begins with "A." It runs in families. Its cause is unknown. Blood tests and similar diagnostic technology can't identify it; the diagnosis is solely behavioral. It's often seen together with depression and other disorders. It was long believed psychiatric in origin, caused by frigid mothering and an excess of stubborn, antisocial character traits. Those who have it are typically wrapped up in themselves, incapable of seeing the other person's viewpoint, given to outbursts of rage but rarely capable of empathy. They are emotionally immature and low in social skills. They are apt to disregard authority and manners, to be dirty, disheveled and rude of speech. The disorder often afflicts persons of above-average intelligence. If not addressed, it may prove totally disabling. There is a great range of presentations. There is no cure; and treatment has confounded experts for many decades. Recovery means learning to identify one's personal triggers, to become attuned to one's bodily and mental warning signs, to experiment with lifestyle, diet, exercise and sometimes medications until something works. Relapse is common and progress is slow. With proper treatment and by taking advantage of support groups, persons who have it can lead productive lives and even make outstanding contributions to society.
No, it's not alcoholism or addiction. Temple Grandin's Thinking in Pictures is the story of her childhood and life with autism. I want to thank Claudia P. of the email list for recommending this book to me. I know a few things about substance abuse but knew nothing about autism beyond what was shown in The Rain Man. I found the book a fascinating education about a neighboring disorder and an inspiring story of personal recovery.

Instead of dwelling on her defects, Grandin took what she was handed and made lemonade. She was almost incapable of verbal thinking, but excelled at visual and spatial thought. She was extremely fearful around people and incapable of catching on to the flow of human emotions; but she discovered that she felt peaceful around cattle and excelled at understanding the perceptions and feelings of cows, sheep and other prey mammals. She was appalled at the stupidity and cruelty with which cattle were being handled in much of the meatpacking industry. Impassioned by the cause of improving the animals' treatment, she developed a career designing better cattle handling equipment in feedlots and slaughterhouses. To get there, she had to break the gender barrier in the industry, becoming the first woman in the feedlots and slaughterhouses and paving the way for many others. She worked with single-minded devotion and energy, amassing an encyclopedic knowledge of animal behavior and of animal-handling equipment. She became a great success in her field. Today more than one third of the cattle in the U.S. packing industry are processed in equipment Grandin designed. She divides her time between consulting in the cattle-handling industry and lecturing about autism.

For the alcoholic and addict in recovery, there are wonderful insights in Grandin's story. She is a strong believer in focusing on the positive. "I think there is too much emphasis on deficits and not enough emphasis on developing abilities," she writes. She found it liberating to recognize that the various psychiatric, psychological and moralistic theories of autism were nonsense; that her problems "weren't the result of my weakness or lack of character," and that the problem lies in the neurochemistry of the brain, particularly the limbic system.

Grandin believes that the perceived defects of many autistic people, such as becoming fixated on a subject, can be turned into assets by cultivating a deep knowledge of a subject area and becoming expert in it. She praises the Internet as a wonderful medium of communication and growth for people with impaired social skills and emotional deficits. She accepts her emotional limitations ("I don't know what a deep relationship is") and, like Einstein, she derives joy and even sensuous pleasure from a successful new insight or design. She wastes no time bemoaning her verbal deficits, but instead celebrates her visual capabilities. Deeply engaged in the daily business of conveying thousands of her hoofed soul-mates to their deaths, she says she lives each day all out, as if it were her last. Incapable of an emotional religious faith, but made anxious by the thought of an unordered universe, she constructs a notion of an impersonal God out of some hypotheses of quantum mechanics, which amount to the belief that all things are interconnected and that what goes around comes around. She disbelieves in an afterlife, and sees that immortality is achieved in this world only by the effect that one's thoughts and actions have on other people.

Thank you, Claudia, for leading me to this book. As a person preoccupied with issues of alcoholism and other chemical dependency, I sometimes get tunnel vision and forget about the many, many other disorders and disabilities in the world. The story of Grandin's education about the physiological basis of her disability and her liberation from moralistic thinking, her unfailing concentration on the positive, and her tremendous grit in the face of opposition, recalled the story of Helen Keller and had a similar moving effect on me. It is good from time to time to put alcoholism in its perspective. On the scale of disabilities and disorders, addiction is one of the most hopeful. Unlike Grandin, once we get started we can expect to recover complete cognitive and emotional functioning, often rather quickly; and the inability to drink or use drugs at all, which remains our lifelong burden, is a trivial deficit in the grand scale of things. Certainly a timely book for Thanksgiving!

Monday, April 9, 2007

The Real AA: Behind the Myth of 12-Step Recovery



By Ken Ragge
ISBN 1884365140

Reviewed by Marty N.


This is the second edition of the authors' More Revealed: A Critical Analysis of Alcoholics Anonymous and the Twelve Steps, whose cover showed a Sherlock Holmes character tearing the sheep's mask off a blood-slavering wolf. It is Ragge's thesis that AA is a cult, that its methods are comparable to brainwashing, and that practice of AA's program "usually makes the underlying problems of alcoholics and addicts much worse."

Ragge begins his exposition with a short sketch of the Oxford Groups, a Protestant evangelical sect out of which AA evolved. He shows that a number of the insidious conversion techniques of the Oxford Groups are alive today in the AA program. After a digression of five chapters in which Ragge expounds his own theory of the addiction problem, of which more later, the author then picks up the attack again in Ch. 9, "Meetings." This describes in a generic way all the elements of an archetypical AA meeting, with the standard speeches, the standard audience responses, and the insecure feelings of the newcomer in the middle of it all. It is Ragge's view that this environment is similar to that of an "addictive family system" in which the individual's own perceptions and feelings are denied and he is made to adopt a synthetic and dysfunctional identity. Ragge finds that the prevalence of cliches in the meeting talk serves as a short circuit for critical thought and is symptomatic of mind-control cults.

The following two chapters then take the newcomer into the organization and through the 12 steps, one by one. Ragge points out that the organization presents itself at the outset as a "broad highway," where everything is only "suggested" and nothing is required. This "soft sell" lures the newcomer in. Then comes the "90 in 90" proposal, where the newcomer is encouraged to do a "trial run" of 90 meetings in 90 days to see if he likes it. The real purpose and effect of the 90/90, according to Ragge, is to separate the newcomer from his social network, isolate him, and envelop him in the AA environment to the exclusion of all else. Once AA has become the sole source of the individual's information and social support, then the newcomer is induced to get a sponsor and do the steps.

The general thrust of the steps, in Ragge's view, is to demolish the individual's sense of self and make him dependent on AA. Ragge calls the Steps "a prescription for helplessness, self-alienation and depression." Ragge points out that around steps four and five, the program takes the newcomer through a fundamental paradigm switch. Earlier, the newcomer's problem was defined as a medical disease, for which the individual is blameless. Now "medical" is morphed into "moral" and the message is that the individual drank because of "defects of character." This immediately reloads the burden of guilt and shame that the medical disease theory might have discharged, and the individual now defines himself as a thoroughly bad and worthless person. Survival beyond this point is possible only through divine grace; redemption is attainable only by bringing in others to start the process anew.

Ragge provides an unflattering portrait of some of the "model recoveries" obtained by this means, including that of AA co-founder Bill Wilson himself, who spent eleven years in morbid depression, and Kitty Dukakis, whose AA involvement led her from a trivial diet pill habit to a major dual diagnosis with an Rx for lithium. In a follow-up chapter, Ragge sketches very briefly the anonymous infiltration of AA into the medical profession, into Congress and state legislative bodies, courts, and the media. Finally, Ragge discusses the plight of the person who leaves AA, isolated, with shattered ego, profoundly depressed, and therefore likely to relapse or commit suicide; Ragge gives some suggestions for surviving this transition and returning to normalcy.

The portions of the book that expose AA are worthwhile reading. Ragge has drawn heavily on AA's own literature and on his own experience in the program, and the chapters ring with credible detail and with emotional sincerity. Obviously Ragge's experience is not that of everyone, and many will dismiss his account as a malicious caricature, but Ragge's core feeling of abuse and manipulation at the hands of the 12-Step program has so many echoes in the personal histories of other survivors that one cannot dismiss it as a mere idiosyncrasy. This is a soapbox polemic, but it is a necessary and readable antidote to the AA-idolatry that dominates the collective brainwaves.

Going into the book in more particulars reveals an uneven product. Some of his insights I have not seen before, e.g. his analysis of the fourth and fifth steps as a bait-and-switch from the medical to the moral model; this I think a valuable contribution to the analysis. Some of this subject matter, e.g. Bill W.'s belladonna trip and his depression, and the role of anonymity in penetrating secular institutions, has been described much better and more persuasively elsewhere, e.g. in William L. White's Slaying the Dragon. Some of it is, I believe, ludicrous, as when he claims that "Shit Happens" is an AA slogan. Some of it is stretched, as in the equation of the Oxford Groups and AA; Ragge admits that AA's anonymity principle represented a complete break with the OG, but he does not see how central this rule is to AA's modus operandi; it is the very engine of AA's secular infiltration. Some of Ragge's terminology I find annoying, such as use of the term "grouper" to describe AA participants; a grouper is a fish. It is also important to realize that Ragge criticizes AA's "spirituality" from a religionist rather than from a humanist viewpoint. And, as might be expected in a pamphleteering effort of this kind, Ragge leaves it a mystery why AA does in fact serve as a vehicle by which a great many drunks successfully maintain abstinence -- more than through any other organized effort at this time. Still, the main thrust of this expose of AA is keenly felt, richly documented, and worth a wider audience. Even if Ragge is only half right, his study goes a long way to explain AA's apparently abysmal retention rate and the low abstinence rate of AA participants, discussed in Ch. 2; and this would tend to shed light on AA's abhorrence at being subjected to quantitative outcome studies.

Unfortunately, this workmanlike pamphlet is undermined by the addition of six or seven embarrassingly thin and unnecessary chapters in which Ragge spins out his own theory of addiction. In a nutshell, he believes that adult addiction is a psychological disorder caused by childhood abuse. Although there is evidence showing that many addicts suffered childhood abuse, there is no evidence that all or even most abused children become addicts. Ragge's chapter attacking the medical disease theory, which long antedates AA, is a clumsy hatchet job, and his analysis of animal experiments is deplorably unsupported by any research of the past 20 years; contrast, for example the monumental work of Eliot Gardner. Ragge advises the drinker to avoid support groups and look for a psychotherapist instead, but to drop instantly any therapist who suggests a diagnosis of alcoholism! In this thin and strained denial that such a thing as alcoholism exists, Ragge reveals himself as an acolyte of Stanton Peele, the writer-for-hire of the alcohol industry, who does a gushing introduction for the book. Predictably, Ragge's pop-psych etiology leads up to the irresponsible conclusion in Ch. 15 that the drinker is probably better served by aiming for moderation than for abstinence. Audrey Kishline's work, which attempts to draw a clear line of demarcation between alcoholics and problem drinkers, is a model of clinical responsibility by comparison. Jack Trimpey, co-founder of Rational Recovery, contributes a laudatory foreword. A firm editorial hand would have greatly improved this title and enhanced the author's credibility by excising the transparently self-indulgent chapters on addiction and moderation so that Ragge's vigorous expose of AA could stand on its own merits.

Sunday, April 8, 2007

The Fifth Discipline and Fieldbook




The Fifth Discipline: The Art and Practice of the Learning Organization
By Peter Senge (1990).


The Fifth Discipline Fieldbook: Strategies and Tools for Building a Learning Organization
By Peter Senge et al. (1994)
Both books reviewed by Marty N.


These two books launched the concept of the "learning organization." Within the world of corporate management theory, the Learning Organization ("LO") is the antithesis of the rigid hierarchical models on which most of the major corporate enterprises of this century have been erected. It is the author’s view that these authoritarian structures are today in crisis because they have failed to engage and to utilize the intelligent passion of the great majority of people who work for them. They have become rigid, dogmatic and blind, and as a result have lost market share to livelier competitors both here and abroad, or have disappeared altogether.
The "fifth discipline" of the title is systems analysis, a way of thinking about organizations in a non-linear manner by studying the consequences, frequently unintended, of every organizational structure and action. The consequence of authoritarianism, Senge holds, is to stifle team learning, discourage personal mastery, foster inaccurate mental models, and kill the vision that motivates. The LO theory aims to transform the resulting giant trunks of deadwood into fresh young saplings before they crash and fall.

Senge is a senior lecturer at MIT and a member of the Center for Organizational Learning at the Sloan School of Management there. Fortune, Harvard Business Review, Business Week and other business publications have pointed to the "learning organization" model as perhaps the most important development in management theory in the second half of this century. Highly in demand for seminars and presentations, Senge has leveraged his books into chairmanship of the Society for Organizational Learning, a collaborative that lists a gallery of Fortune 100 corporations among its sponsors. There are numerous advocates of LO theory and there is a busy mailing list, learning-org, bringing together management people from business, education, nonprofits and the military. Despite the radical flavor of some of Senge’s ideas, these are not the ravings of a fringe lunatic; on the contrary, they seem well on their way to becoming the mainstream, at least in doctrine if not in practice.

The books came to me almost by serendipity. My wife, a schoolteacher engaged in school reform, brought home the Fieldbook and suggested I might find interesting stuff in it. She was quite right. Although addiction is a minor theme in the LO theory, both books can be read with little translation as if they were sobriety manuals. After reading the Fieldbook, I went out and bought the 1990 text. Generally, the early book is more theoretical, and the Fieldbook has more practical detail.

I found LO theory easily applicable to my situation as an engaged member of a sobriety organization. By "learning," Senge obviously means something different from going to classes; it means a lifelong practice of investigating, experimenting, moving, growing in capacity and insight; it means a life of "integrity, openness, commitment, and collective intelligence." That seems to me a pretty fair approximation of the skills that a long-term addict needs to have in order to stay sober. Learning in this sense also points toward the rewards that come when a brain is allowed to work free of addictive substances. Learning is not something separate from doing or living; it is an engaged, intelligent mode of being in the world.

On the larger scale, a "learning organization" is one that creates a reality in which its vision and practice flourish almost effortlessly, and whose members have the feeling of being part of a truly "great team." To get to that point, however, requires a long and strenuous effort, and much "practice, practice, practice."

Senge and his collaborators classify the transformative work to be done into the five disciplines of personal mastery, shared vision, team learning, mental models, and systems analysis. All five lines of work contain useful ideas for being a better member of a sobriety team.

Personal mastery comes, in Senge’s view, when an individual has a clear vision of a goal, combined with an accurate reading of reality. The gap between the vision and the reality sets up a "creative tension" that energizes the individual. In pursuit of personal mastery, the individual acquires the necessary capacities and creates whatever methods and rules are necessary to realize the vision.

Basic to acquiring personal mastery is a dedication to the truth: "Seeing and telling the truth is a fundamental component of personal mastery, and of the related discipline of shared vision.... Because creative tension depends on a clear understanding of current reality, it drains away as soon as people lie to themselves or each other."

The great enemy of personal mastery, says Senge, is the belief in one’s powerlessness and lack of self-worth. He says that the culture indoctrinates most people to believe either that they lack the capacity to get what they want, or that they are unworthy to achieve their goals. These beliefs are very difficult to eradicate. They may create a vicious circle in which we fail to move forward because we believe we are powerless, and we reinforce our feelings of powerlessness because we have failed to move forward.

A key element in achieving personal mastery, Senge writes, is to train and utilize the powers of the subconscious. Our subconscious mind can handle far more complex problems and more quickly than can our consciousness. For example, in driving a car in traffic or playing a musical instrument we perform with seeming effortlessness a task that our conscious minds at first approach could perform only very poorly, if at all. Senge points out that the subconscious "is highly subject to direction and conditioning." After much practice, practice, practice, there comes a "flip of the switch" in the subconscious when we have achieved mastery; for example, we begin to dream in the foreign language we have studied.

These points about personal mastery have obvious applications to our work as persons learning sobriety. Our vision is a sober life; our reality is filled with stresses and problems. The belief in our own powerlessness and/or lack of worth holds us back from realizing our vision, and may lock us in an all-too familiar loop of defeat. But if we can still see and speak the truth, we can break out of that cycle. Many of the sobriety tools that we have available, particularly the Daily Dos and other repetitive acts, are designed to work on the subconscious. Jim Christopher’s Triumph workshops are based centrally on the idea of training the subconscious (the "lizard brain"), very much in agreement with Senge’s theories. Senge’s "personal mastery" discipline holds many useful lessons for persons overcoming addictions.

Shared vision is the glue that holds together the personal mastery efforts of a learning organization’s members. On the one hand, if the individuals have widely disparate personal visions, their efforts will not come into alignment and the organization will not cohere. On the other hand, because individual psychology is so deeply cultural and organizational in its makeup, the organization's shared vision may become the vision that guides the personal mastery efforts of the individuals. A shared vision creates within an organization the same creative tension as within an individual. However, cautions Senge, the shared vision is rarely found in the group’s compulsory mission statement. It may be implicit, unspoken, or even unknown to its members. Discovering and articulating that vision is one of the primary tasks of the organization’s leadership. "Every organization has a destiny; a deep purpose that expresses the organization's reason for existence. We may never fully know that purpose, just as an individual never fully discovers his or her purpose in life. But choosing to continually listen for that sense of emerging purpose is a critical choice that shifts an individual or a community from a reactive to a creative orientation."

Hearing and articulating that vision is not a matter of a handful of people going into a room and drafting a mission statement. It takes much time, considerable philosophical depth, and requires an ongoing process of listening to the organization’s members. An important task of leadership is to organize processes by which the vision can emerge. When it does emerge, it is a powerful energizer, because it taps into the deepest motivation that people have – deeper than money, fame, or power – namely to be part of some effort that is larger than themselves, to be of service to the community and to the world.

It seems to me that one of the useful efforts of our upcoming ’99 SOS convention, and of the preconvention period, is to work on refining and deepening our shared vision. We emerged initially with a "negative" vision, as is the case with most political and social movements (anti-colonialism, anti-slavery, anti-war, etc.). We got together to achieve sobriety "without" something (religion, God, spirituality, dogmatism) and to get "away from" a bad place, like the tribes of Moses fleeing Egypt. There has been growing up, it seems to me, the more "positive" side of that original view, a vision of what we are for. We have a job to do, all of us, to fill in further the design and color of that emergent vision.

Team learning, the "third" of the disciplines (they are actually meant to be worked in any order, as needed), is the process by which personal mastery and shared vision come into alignment. In conventional organizations, a great deal of effort goes into making sure that the organization is not as intelligent as its leading members; this Senge calls "skilled incompetence." This negative distribution of learning is reinforced by methods of communication that communicate as little as possible. Conventional advocacy and "discussion" amount to little more than exchanges of gunfire, and the natural response of all participants is to barricade what they know and cover their behinds. No team learning, much less creation of a learning organization, can take place while its internal conversations are of this type.

Senge views these practices as so ingrained in corporate culture that an outside consultant is usually necessary to introduce management to different modes of discourse ("skilled discussion" and "dialogue"). Establishing actual communication in groups requires that members define each other as colleagues, not enemies, and that each person dares to be vulnerable and to admit to ignorance. Otherwise no learning can take place. The books, particularly the Fieldbook, outline several different games that groups can play to bring hidden conflict to the surface without harm to group cohesion, and for discussing the undiscussable topics that usually lurk beneath the surface of organizations that are stuck.

It seems to me that our normal discourse in our recovery meetings is far better than that of the usual corporate management groups. We are all colleagues in recovery, and generally we are good at admitting our ignorance and being vulnerable. I see "team learning" take place at practically every meeting. I don’t believe that we need outside consultants to make the talk in our recovery meetings flow – on the contrary, we could teach the consultants a thing or two.
However, there is very little if any conversation at present between the meetings. I don’t mean casual social conversation between members of different meetings who know each other. I mean organized dialogue between representatives of different meetings in the same city or area. And if we view the representatives of all the meetings in the country as one team, there is virtually no sustained conversation at all, and therefore team learning at the national level is almost nonexistent.

The national newsletter, with its quarterly schedule, cannot sustain a conversation about current concerns. The convenor’s email list is the only channel that can carry the flow of team learning nationwide and internationally at the present time, and fortunately most convenors now have the ability to go online. Our upcoming convention will be literally the first opportunity ever for many of the attendees to practice "team learning" on the national scale. We can learn from the Senge books about the qualities that will make productive dialogue at the convention: tempering advocacy with inquiry, linking theory with implementation, and speaking in the service of truth and for the interests of the whole.

Accurate mental models are necessary both for elaborating a vision and for understanding the reality. Mental models can be complex theories but are more often simple images, assumptions and stories. Drawing on cognitive psychology, Senge writes that mental models are inner programs that govern our perceptions, feelings, thoughts and actions. Major problems arise when the really operative models lie buried beneath the surface. As the Detroit automakers demonstrated, entire industries can espouse tacit mental models that no longer match reality.
Reshaping mental models is, in Senge’s view, a key point of leverage for effecting organizational change. He offers several exercises for bringing tacit mental models to the surface so they can be examined. A starting point for applying the lever is the gap that often develops between what people really feel and think, which Senge calls the "left-column" items, and what people say in formal business meetings (the "right column").

Achievement of uniformity of mental models is not at all the goal of these exercises, Senge says. Although a successful dialogue may result in an alignment of models, a conformity of mental models in an organization is not necessary and is a sign of mental poverty. Congruency must not be forced, because it leads to shallowness in motivation and lack of resiliency. In passages that sound very much like our Sobriety Handbook, Senge writes:

Don't impose a favored mental model on people. Mental models should lead to self-concluding decisions to work their best. … Self-concluding decisions result in deeper convictions and more effective implementation. … People are more effective when they develop their own models -- even if mental models from more experienced people can avoid mistakes…. It's important to note that the goal is not agreement or congruency. Many mental models can exist at once. Some may disagree. All of them need to be considered and tested against situations that come up.
The existence of multiple mental models within an organization assures that different perspectives are brought to bear on a problem and that the collective intelligence of the organization can be greater than that of any of its parts. Successful organizations bring their diversity of mental models to the surface and cherish their differences. Organizations that have no differences or that suppress them are moribund.

Reading Senge’s remarks about mental models made me feel that SOS as an organization has been on the right track all along on this issue. We have always maintained that individuals can and must develop their own mental models for staying sober, and that only self-developed models can have the depth and inner force to sustain the individual successfully through the challenges that recovery poses. We treasure the diversity of different mental models that exists within our ranks, and we are so bold as to believe that this diversity makes us both more attractive and more effective as a sobriety organization. We would benefit by adding a still greater diversity of mental models to our toolbox, by raising the level of clarity and articulation of the models that we have, and by providing members with threads and maps that allow them more readily to locate what is available and try it on for size.

Systems thinking is the fifth and most fundamental of the disciplines whose practice makes a learning organization. Just as the learning organization is the antithesis of the hierarchical organization, systems thinking is the antithesis of linear thinking. Linear thought assumes that action flows from top to bottom, that motion goes from A to B, much in the manner of most people’s understanding of Newtonian mechanics. Systems theory thinks in circles: an action goes from A to B but there is a reflux action that goes back from B to A – frequently with unintended results.

Senge introduces the topic with "the beer game" (an unfortunate and unnecessary choice of subject matter), a seminar exercise in which a sudden modest increase in consumer demand for the "Lover’s Beer" brand leads the retailer and the wholesaler and the brewery into a massive spiral of overproduction ending in a collapse of the manufacturer – surely an unintended consequence. Dee Hock, a prominent corporate guru aligned with the LO trend, formulates this as a sardonic law of the universe: "Everything has both intended and unintended consequences. The intended consequences may or may not happen; the unintended consequences always do." The Senge books are illustrated throughout with circle diagrams showing various positive and negative feedback loops, either simple or combined into common patterns. It is Senge’s thesis that these reflux effects are frequently unseen and that they form structures which hold us prisoner so long as we are unaware of them.

Senge identifies a half dozen "archetypes" – organizational patterns that recur so frequently that systems thinkers can spot them on sight. The one that is most relevant to the current state of our organization is the archetype Senge calls "Shifting the Burden." In this pattern, a symptom of an underlying structural problem is relieved by a "quick fix," which in turn aggravates the underlying problem, which leads to more reliance on the "fix," and so on, until the organization goes into what Senge calls an "addiction loop." When this occurs, "the addiction becomes worse than the original problem, because of the devastation it wreaks on the fundamental ability to address the problem symptom."

In our case, the underlying structural problem was that we did not have the financial capacity, a decade ago, to sustain an organizational presence at the national level. We shifted the burden of that problem to a single outside funder, the Council for Secular Humanism. The unintended but inevitable consequence of this fix has been that the financial sponsor has complete ownership of the organization on the national level and considers SOS as its "subcommittee." As a consequence, our capacity to sustain a national organization from below has hardly developed and may even have atrophied. We seem to be linked to outside funding in an addictive loop, and what Senge calls "a powerful tendency toward addictive denial" is evident.
Senge’s advice for situations like this is multi-pronged. He suggests reflection: what was the original problem, and how else could it have been solved? He urges openness to hear other people’s views of what the problem is and how it can be fixed. It is crucially important, he writes, to articulate the long-term goals clearly and often, and to work on practical measures that support the underlying solution. If possible, go cold turkey on the addictive fix; if not, gain time to strengthen the long-term solution and develop alternative resources. These are wise words of advice as we approach the business meeting (Delegates’ Assembly) of our ’99 convention.
Senge avoids giving any pat formulas for how leadership in a LO should operate. No amount of reshuffling the organizational structure will produce a LO. But the bias is clearly in favor of decentralization, delegation, and a maximum of local autonomy.
If leadership no longer means issuing orders or playing the charismatic messiah, what does it mean?

Leadership means, firstly, designing the organizational structure – the leader as architect.
Then, the leader is a teacher who facilitates the learning process in the entire organization: assisting people to develop their own mental models, creating an environment in which personal mastery and team learning can flourish. The leader achieves leverage by "helping people achieve more accurate, more insightful, and more empowering views of reality." On the qualities of the leader as facilitator of the members’ self-empowerment process, Senge paraphrases Lao-tzu: "the bad leader is he who people despise. The good leader is he who people praise. The great leader is he who people say 'we did it ourselves.'" Our Handbook makes the identical point, end of Ch. 3.

The leader of the LO may also become de facto the steward of the organization’s shared vision, and this is positive; but the steward must remember that a vision cannot be owned. A vision is like a child, of which Kahlil Gibran wrote: they come through us, but they are not of us.
Finally, and most importantly, the leader models the qualities esteemed in the organization and its members. "Ultimately people follow people who believe in something and have the abilities to achieve results in the service of those beliefs. Or, to put it another way, who are the natural leaders of learning organizations? They are the learners."
The essence of a learning organization, Senge concludes, is being a member of a "great team." Through active participation, the individual experiences a "deep learning cycle," which entails "the development not just of new capacities, but of fundamental shifts of mind, individually and collectively." The evidence of "deep learning" is that we can do things we couldn't do before. We can have real conversation instead of chatter. We can see larger systems and forces at play and we can construct publicly testable hypotheses about them. We become aware of the presence or absence of spirit or vision; we know when we are following our vision, or when we are simply reacting. We begin to "tell a new story." In a learning organization, people become willing to reveal uncertainties and ignorance and incompetence, because only in this way can we learn. Gradually "a deep confidence develops within us," because we have experienced "the power of people living with integrity, openness, commitment, and collective intelligence." These are ideas that resonate deeply with many of us in recovery from lives of addiction.
It seems to me that Senge’s effort to recast the corporate world into this new mold is probably doomed. The inertia of the old behemoths founded on maximization of profit and on the externalization of costs – human, environmental and political – may prove too great, particularly against the background of the worldwide deflation that is in progress as I write this. But the concept of the learning organization may find fertile ground in the little hidden places of refuge where profit is not the prime directive, where people gather to be real with each other, and where "learning" is not only a metaphor for a vibrant way of being in the world, but a necessity of personal and organizational survival.