Saturday, January 23, 2010

The "Higher Power" Obstacle

When embarking on a goal of abstinence from alcohol/drugs, which for many is the only realistic goal, self-help groups are certainly a key resource, whether or not the individual is involved in professional treatment. Self-help groups (which would more accurately be called mutual-help groups) offer a number of advantages – some level of relatively constant availability, a sense of comradeship with others in the same position, a venue for support, acceptance, congratulation, empowerment, etc., a wealth of practical advice – as much as needed, and at no cost (and no need for managed care authorization).

By far, the majority of self-help groups follow the Twelve Step model (mainly AA and NA). SMART Recovery also has a meaningful presence, at least in Massachusetts, but the sheer number of available meetings pales by comparison. (Comparing these two programs can wait for a later column.) In some states, other programs such as Women for Sobriety are also prevalent. Given the prominence of AA/NA, not to mention the impressive history of 12-step programs since their inception in 1935, it makes sense for most people in what is often called “early recovery” to at least sample AA meetings.

My experience, however, is that the majority of people, early in their exposure to AA, don’t like it. There are a range of reasons given, including a perception that “their problems are worse than mine” (and of course, an underlying preference to avoid getting involved with an organization that symbolizes loss of the beloved substance), but the obstacle about which I hear most frequently is “the God stuff.” There is, of course, no denying that AA itself began as an offshoot of the Oxford Group, a non-hierarchical Christian movement of the 1920s and 1930s which emphasized many of the themes still echoed in AA (but in the context of seeking to place oneself, nation, and world under God’s control). On the other hand, AA is explicitly not a religion, and invites multiple and individualized interpretations of “higher power;” in reality, there are many atheists and agnostics who make use of the AA program. But the wording of the 12 Steps can be a problem. The term “God” is used repeatedly, followed twice by the phrase, “as we understood Him” – making it sound as if the adherent must surrender to a God of the sort that could have a gender, and that in fact the gender is male.

A person of more secular, 21st Century sensibilities may well conclude, “This is not where I belong,” and walk away from a program that could, in fact, have much to offer him or her. In order to continue making use of AA, s/he must view terms like "God" and "Him" as metaphors for some alternative concept of a higher power. Some ideas on how that might be done coming soon.
© 2010 Jeffrey Fortgang

Sunday, January 10, 2010

Seeking The Answer

As I read a Boston Globe article the other day about the emergence of personal coaching as an alternative to psychotherapy (more oriented, they tell us, to goals/future/happiness than to addressing problems or illness), I picked up a glimmer of what must be a typical reader reaction: Now, finally, there's a new, better, right answer. Now I can access the people who really have the answer to happiness, rightness, etc. (Even though we learn that many coaches, though they have no widely supported standards or certification,are themselves mental health professionals, maybe that have just found a better path -- certainly one that allows them to charge more without having to deal with health insurance.)Within the established mental health field, of course, new/better/"the answer" therapy techniques never stop appearing. Each brings a series of books and traveling experts, and draws a slew of therapists who are, themselves, looking for an approach that will help them feel more effective and successful. Some of these techniques become passing fads, while others take root and hang around. Quite often, the new/better/special approaches eventually seem less different from what already existed, and blend in, to become partof the ongoing, fluid collection of perspectives on which the average therapist draws. The same thing happens with new medications – it is said, in jest but also accurate social perspective, that one should make sure to use new meds within the 1st 2 years, since after that their effects will become much less impressive.

In other fields, there is no scarcity or end to exciting new answers from the worlds of nutrition, exercise, and of course religious leaders (whose role in the last century has largely been transferred to mental health professionals).

Alas, it turns out to be a rare event when there is something genuinely new under the sun. And I’m not sure that anyone has The Answer. I recall, years ago, during the heyday of Stress Management, getting to know a professional who developed a nice sideline giving talks and workshops about stress. The techniques she had for making her audience aware of their stress level were eye-opening, and the relaxation techniques in which she guided them were, indeed, relaxing and provided a delightful break from the pressures of the day. So she was a local stress management guru, much like the long line of inspirational speakers on which we can overdose by watching PBS at fund-raising time. I got to know her, and liked her very much, but found her to be no less stressed than the rest of us and, in fact, to be juggling an untreated addiction. She was a very fine person and I’m sure she eventually addressed that issue – my only point is that we are all flawed, trying to get through, and not likely to be either finding or providing The Answer.

Yet we yearn to find a sage to follow and idealize, in our quest for a level of perfection and happiness which are not realistically attainable. We look at others, and they seem to be happier or more fulfilled or more successful, etc. Around 12-step circles, one sometimes hears the extremely useful guidance: “Don’t compare your inside to someone else’s outside.”

Of course, we should always be seeking more effective treatments and ways to alleviate suffering and advance wellbeing. But let’s abandon our fantasies of achieving flawlessness if we just find the right guru or hear the right infomercial.

As various forms of therapy/counseling/coaching/guidance come and go, and as those that seemed cutting-edge come to seem obsolete, what seems to be constant is that a crucial element in therapeutic outcomes is the quality of the relationship between patient/client and therapist – genuineness, acceptance of self and other, human connection, and appreciation of the moment – that’s probably as close to perfection as any of us can get, and maybe that’s enough.

Friday, January 1, 2010

Insane College Drinking

A recent episode of the wonderful NPR program, This American Life (which not only offers entertainingly quirky slices of life each week but can also be so much more informative than most of what we get from any media), trained its radio lens on the college drinking scene, and on the college deemed the nation's "#1 Party School." I recommend it to everyone. (

I have often noted that it is difficult to impossible to accurately diagnose Alcohol Dependence (colloquially, “alcoholism”) in college students – to identify those young men and women who will go on to function alcoholically long after college. Or, in other words, those who won’t radically curtail their drinking after moving on to the next chapter in their lives. Part of the problem is that, since so many college students so often choose to get very drunk -- because it has become normative! -- it is hard to know which individuals are losing control of their consumption, and which ones are choosing to drink like someone who has lost control.

The NPR program describes how one attempt after another to reduce college drinking through education, offering alcohol-free alternatives, etc. has failed to make a difference. What's so bad about binge drinking among the college crowd? The worst consequence is the recurrent deaths, through alcohol poisoning and dangerous (often unintentionally so) behaviors. And of course there is also collateral damage -- to property, people's jaws, private parts, or integrity, friendships, driving privileges, and, oh yeah, one's education.

I can't say I got the maximum benefit from my own college education. At that time, we were very distracted by the war in Vietnam and the many-faceted “Revolution” But I have to say I feel lucky that the drug of choice, at that time and place, was marijuana. It certainly presents multiple dangers of its own, and I'm not recommending it, but it does not approach alcohol in the potential havoc it wreaked on one's body, behavior, brain, legal status, family life, etc. Of course, most people engage in “normal” drinking in a way that produces little or no harm -- but it's hard to find anything like it at college, at a time of life when the brain is still developing. So, happy new year, and here's to those of us who somehow manage to survive our educations!