Treatment (Opinion)AA and NA being prescribed by courts and doctors holds recovery back

[downfallin]

By prescribing to an ideology formed in 1935 that is spiritually based and discourages progress, we are ensuring that we will never be more successful than we are now. And something is obviously not working. The solution is not to double down and get more people into our current recovery system, but to fix the system itself.

Just imagine for a second what would happen if a doctor prescribed a spiritual remedy for something truly accepted as a disease by the medical community such as diabetes. That doctor would be laughed out of the room and possibly lose their license to practice, because then the patient might feel that they didn’t need insulin and possibly die.

Why then, if we are supposedly taking this opiate epidemic/ general addiction problem seriously is it medically and legally accepted to prescribe a spiritual program for it that claims it is the only way and discourages scientific challenges to its beliefs?

I don’t believe NA and AA are bad, my main problem apart from the spirituality aspect is their adversion to change and progress. There are many aspects that they got correct such as the strong community and much of the structure is very helpful. But they will never progress past what they are today or admit things they got wrong and embrace change. They have many harmful ideologies that are preached that are contrary to what science suggests are benificial practices. One of these ideologies is the strict adherence to complete abstinence. Science has shown that for many, having at least a period of maintenance is the much better option.

We need to put effort into scientifically researching recovery and having a model that embraces change as we learn more about the human mind. That model needs to be the GO TO program. The SMART model is the closest thing I’ve seen to this but it just isn’t endorsed like NA or AA.

I think that AA and NA still have their place, just as alternative medicine and religion have their places, but I think to have real progress in this area we need to start endorsing programs that are science based and are open to change. To do this, we also need to dethrone AA and NA from their elevated status as the GO TO methods for judges sentencing and doctors prescribing.

 

[Burnt Offerings]

I agree with you that court-mandated AA/NA is very inappropriate and counter-productive

On the other hand, the scientific explanations themselves often are quite lacking insofar as having providing a comprehensive solution to the problem of substance abuse. It has provided us with the gold-standard for treatment for those with an opioid use disorder, that being opioid replacement therapy...but, on the other hand, the relapse-remission disease model of addiction is of limited usefulness IMO, and (much like AA/NA) often serves to make the individual powerless to get ahold of their own addiction...the individual in this interpretation is similarly powerless, only this time it's attributed to factors couched in medical or scientific language...

Also, from my own limited research on the topic, there doesn't seem to be a tremendous amount of data related to how successful alternative strategies for substance abuse (other than the AA/NA abstinence-only strategy) are. Maybe this is just because such models haven't been widely applied for very long, but I've never seen much good data that goes along the lines of, "this is the traditional way that substance abuse strategies have been implemented [AA/NA abstinence-only], but we decided to try an alternative method, and these are the results of our experiment", etc.

 

[downfallin]

I agree with you that court-mandated AA/NA is very inappropriate and counter-productive

On the other hand, the scientific explanations themselves often are quite lacking insofar as having providing a comprehensive solution to the problem of substance abuse. It has provided us with the gold-standard for treatment for those with an opioid use disorder, that being opioid replacement therapy...but, on the other hand, the relapse-remission disease model of addiction is of limited usefulness IMO, and (much like AA/NA) often serves to make the individual powerless to get ahold of their own addiction...the individual in this interpretation is similarly powerless, only this time it's attributed to factors couched in medical or scientific language...

Also, from my own limited research on the topic, there doesn't seem to be a tremendous amount of data related to how successful alternative strategies for substance abuse (other than the AA/NA abstinence-only strategy) are. Maybe this is just because such models haven't been widely applied for very long, but I've never seen much good data that goes along the lines of, "this is the traditional way that substance abuse strategies have been implemented [AA/NA abstinence-only], but we decided to try an alternative method, and these are the results of our experiment", etc.

Yes, I totally agree that science hasn`t given us an incredibly better option yet and obviously things like maintenance come with their own issues. My problem is that we aren`t giving science and progress much of a chance to begin with. Even in the big book it says that if we can take a pill and make ourselves better we should do it, but until then this is the best way. My problem with that reasoning is it is a black and white fallacy. Just because we don`t have a magic pill to cure ourselves doesn`t mean we should head the exact opposite direction of scientific progress and ensure that addiction treatment stay in the 1930s. When we assume it is a spiritual issue and say that people who aren`t in AA or NA are not truly in recovery, it discourages people to push for better solutions and to implement better systems. This is especially true when this ideology is echoed by the court system and the medical system. People seem to conclude that we just need to get more people into AA, or double down on law enforcement, but not to change the system we set in place.

Like you said, there isn`t much research being done, and there isn`t much of a data pool to draw conclusions from where they compare the results of traditional AA to different models.
Why is this the case though? With the opioid crisis being as big of a problem to everyone as the news seems to imply it is, why are we not rushing to find a better way? I don`t see this as a failing of science, scientists only research areas that are funded. I think we need to make it clear that the system isn`t working and this needs to be addressed.

Another area we could compare this to is cancer. We do not have have a cure for cancer. We don`t necessarily have a great system in place for managing the symptoms either. This does not however make it okay to claim that it is a purely spiritual issue and that no cure will ever be found, therefore we should stop funding research, stop doing chemo, and start prescribing prayer. Even when we aren`t finding cures, we are still gaining valuable knowledge on how cancer works and constantly striving to find more effective methods of treating cancer, even if it`s only slightly better or maybe has slightly less side effects. I think if people truly believed that addiction was a medical issue, and cared about the addicts as they care about a loved one with another medical issue, we would be taking approaches similar to this. I think a big thing holding us back is that by truly accepting that addiction is a medical issue it brings many people into direct conflict with deeply held ideas about morals, spirituality, how the brain works, personal responsibility and other related things. It makes people without addictions question their moral and spiritual superiority.

 

[Burnt Offerings]

Yeah I agree with most of what you said there. I think that there's definitely room for experimental or heterodox approaches to tackling substance abuse issues.

However, I do think that there has been more of a shift in recent years towards the idea that addiction is a disease. Overall I'd say that the "moral failing" concept is outdated and not very popular anymore. So there's two issues: 1) what substance abuse is, and 2) how to treat it. For 1, I'd say that there has been real change...it used to be that it was seen as a primarily a moral failing, now it's not. But, in regards to 2, I don't think there's much change, in regards to strategies to address the problem, and there's definitely room for improvement and resources should be dedicated to that, because it's an issue which a lot of people struggle with and yet the treatment options and philosophies are often woefully inadequate (if not outright scams in many cases)

I think that an interdisciplinary approach which addressed not only the person's medical needs but also the social and environmental context that they live in would perhaps be most beneficial

 

[deficiT]

It helps some people, but certainly not all.

Better harm reduction practice would be giving addicts multiple options when it comes to treatment.

 

[downfallin]

Yeah I agree with most of what you said there. I think that there's definitely room for experimental or heterodox approaches to tackling substance abuse issues.

However, I do think that there has been more of a shift in recent years towards the idea that addiction is a disease. Overall I'd say that the "moral failing" concept is outdated and not very popular anymore. So there's two issues: 1) what substance abuse is, and 2) how to treat it. For 1, I'd say that there has been real change...it used to be that it was seen as a primarily a moral failing, now it's not. But, in regards to 2, I don't think there's much change, in regards to strategies to address the problem, and there's definitely room for improvement and resources should be dedicated to that, because it's an issue which a lot of people struggle with and yet the treatment options and philosophies are often woefully inadequate (if not outright scams in many cases)

I think that an interdisciplinary approach which addressed not only the person's medical needs but also the social and environmental context that they live in would perhaps be most beneficial

I totally agree. I realize I was kind of sounding like I believe the medication side is the only real factor that needs addressing. My point was more that AA have an ideology that shuns different ideas but those ideas don’t have to be medically based. Just statistically shown to be better. Social and environmental factors as you said are extremely important and since we don’t have much of a cure, these things along with practicing coping mechanisms like mindfulness are really the bread and butter of a program.

I just wish the whole system would come around to embracing more progressive treatments. So where this is coming from personally: For me I went to one called Elevate that was non 12 step and non spiritual. (Full disclosure I think it was based of Narcanon, so the Scientologist one but they broke off from that and just kept the good and stripped the weird spiritual aspects). But even that one was miles ahead of other traditional ones I’ve seen/experienced because they based the recovery model on SMART and using mindfulness as a coping mechanism as well as regimented vitamins/supplements and exercise. One thing they said made a lot of sense though. Their ideology was to be an ever changing program, and as new information came out, they would adjust their program accordingly.

That one got me feeling actually good after 3 weeks. Normally it would take me months of depression and post acute withdrawal and sitting through meetings I was convincing myself I was getting something out of to feel okay. And they didn’t get hung up on labeling yourself as an addict or anything. It was just nice and got me wishing everyone could see there is more out there than just AA, but when your first exposure is AA and you’re told anyone else is just a dry drunk and you’re not in recovery unless you’re part of our group... it makes you not look anywhere outside that bubble.

 

[downfallin]

It helps some people, but certainly not all.

Better harm reduction practice would be giving addicts multiple options when it comes to treatment.

Exactly. Just make it know right from the start AA/NA is NOT the ONLY option no matter what they say. When the courts immediately push people into AA and they hear that they tend to never hear anything else. I almost never did either.

 

[F.U.B.A.R.]

As far as I'm concerned, the only help I need is free drugs. Any cunt that comes to me with a religious objective can just fuck right off.

Although it might work for some people, it's not for me.

 

[Bella Figura]

I felt incredibly uncomfortable when I attended an NA meeting. The hand holding and prayer at the end had me out of the room in a split second never to return.

I can see how getting together regularly and having a sponsor would help someone, but I really don't appreciate being told I'm powerless and don't really feel like I'm an addict in the worst sense of the word.

Opium explorer/needle enthusiast sure, even a degenerate dopamine whore sounds better to me...

I used to shit on the spirituality aspect of it all as well, but if it works for some people, who am I to judge. Just leave me be.

Obviously if my options were jail or NA, I'd pick NA.

 

[Jabberwocky]

I have used NA and AA successfully a few times to climb my way out of rock bottom before I got better value from psychiatrists and psychologists. I think 3 times, I did 100 meetings in 100 days to break hardcore IV stimulant addictions. After that 100 days I gave it a way. But I felt it was extremely cheap daily therapy to be able to stand up and talk though my shit while I tried to work it out.

I don’t have any time for the moral failing / lack of character arguments about substance abuse though and ultimately that’s what put me off. But when I was powerless over my addiction I had no problem admitting it to others, and I liked the idea that I had to make it up to the people I had wronged (who were legion).

In Australia though, I’m not sure the courts prescribe AA/NA. There is a diversion program that is more like SMART than AA/NA and when my kid was done for having unprescribed benzos the court just required him to see a psychiatrist and a psychologist for 6 months. Personally, I thought he would have benefitted from doing the 100 meetings/100 days at least once. I probably should have asked the judge to order that.

 

[JessFR]

In Australia though, I’m not sure the courts prescribe AA/NA. There is a diversion program that is more like SMART than AA/NA and when my kid was done for having unprescribed benzos the court just required him to see a psychiatrist and a psychologist for 6 months. Personally, I thought he would have benefitted from doing the 100 meetings/100 days at least once. I probably should have asked the judge to order that.

They don't as far as I know. They usually give you the option to go to some kind of diversion program as an alternative to being directly sentenced.

The only one I'm familiar with personally is NSW's MERIT program, but I think other states have similar programs. I'm not aware of any that require you to go to 12 step meetings.

And nor should they. Not just because the state shouldn't be obligating you to undertake programs based on spirituality or religion, but also because it's not good for the fellowships either to have people attending who are there for no reason but to be able to say they went.

It's really stupid. Fortunately Australia doesn't seem to pull this crap, the courts sent me to attend one of those diversion programs (MERIT) but between a severe heroin habit and being homeless at the time, I dropped out and the courts just sentenced me outright with a huge fine and a year long suspension of my drivers license. In the end I didn't pay the fine either, they let me wave the fine by getting a work and development order that basically meant they'd subtract a thousand dollars from my outstanding fines provided I stayed on a methadone program. Took about a year before I was in the clear. But there was never any suggestion about having to go to NA.

 

[Jabberwocky]

Why then, if we are supposedly taking this opiate epidemic/ general addiction problem seriously is it medically and legally accepted to prescribe a spiritual program for it that claims it is the only way and discourages scientific challenges to its beliefs?

I don’t believe NA and AA are bad, my main problem apart from the spirituality aspect is their adversion to change and progress.

i can see where you're coming from but i don't think its a fair representation. at least in the UK, and i've learned on here that things are massively different in other parts of the world. i do agree that their stance against maintenence therapy is completely unscientific.

but i don't think there is inherently anything in the programs against change and progress, from what i've seen from old timers in NA, a lot has changed over the past few decades. maybe slower than we'd like but doctors don't respond to new developments immediately either.

i also think the spirituality aspect is absolutely vital.

And nor should they. Not just because the state shouldn't be obligating you to undertake programs based on spirituality or religion, but also because it's not good for the fellowships either to have people attending who are there for no reason but to be able to say they went.

Completely agree.

also think its dodgy as fuck to abuse a voluntarily run service in this way. it seems that they are trying to bridge a funding gap for rehab, drug services etc, which should be tailored to each individual. it is plastering over a massive problem that all addicts face- lack of resources to help get clean.

i don't know how much this sort of stuff is mandated here. none of my interactions with the police even involved the suggestion that getting clean might be a possibility for me, but i didn't end up in court. i haven't heard of courts ordering meeting attendance, but there are meetings where you can have it signed that you've been for probation etc, but i think its worked out with the addicts involvement. i don't think it should be mandated cos individuals need treatment programs tailored to their circumstances.

 

[downfallin]

They don't as far as I know. They usually give you the option to go to some kind of diversion program as an alternative to being directly sentenced.

The only one I'm familiar with personally is NSW's MERIT program, but I think other states have similar programs. I'm not aware of any that require you to go to 12 step meetings.

And nor should they. Not just because the state shouldn't be obligating you to undertake programs based on spirituality or religion, but also because it's not good for the fellowships either to have people attending who are there for no reason but to be able to say they went.

It's really stupid. Fortunately Australia doesn't seem to pull this crap, the courts sent me to attend one of those diversion programs (MERIT) but between a severe heroin habit and being homeless at the time, I dropped out and the courts just sentenced me outright with a huge fine and a year long suspension of my drivers license. In the end I didn't pay the fine either, they let me wave the fine by getting a work and development order that basically meant they'd subtract a thousand dollars from my outstanding fines provided I stayed on a methadone program. Took about a year before I was in the clear. But there was never any suggestion about having to go to NA.

 

[downfallin]

i can see where you're coming from but i don't think its a fair representation. at least in the UK, and i've learned on here that things are massively different in other parts of the world. i do agree that their stance against maintenence therapy is completely unscientific.

but i don't think there is inherently anything in the programs against change and progress, from what i've seen from old timers in NA, a lot has changed over the past few decades. maybe slower than we'd like but doctors don't respond to new developments immediately either.

i also think the spirituality aspect is absolutely vital.



Completely agree.

also think its dodgy as fuck to abuse a voluntarily run service in this way. it seems that they are trying to bridge a funding gap for rehab, drug services etc, which should be tailored to each individual. it is plastering over a massive problem that all addicts face- lack of resources to help get clean.

i don't know how much this sort of stuff is mandated here. none of my interactions with the police even involved the suggestion that getting clean might be a possibility for me, but i didn't end up in court. i haven't heard of courts ordering meeting attendance, but there are meetings where you can have it signed that you've been for probation etc, but i think its worked out with the addicts involvement. i don't think it should be mandated cos individuals need treatment programs tailored to their circumstances.

Yeah getting “meeting slips” signed to show AA attendance is a big thing here in America but I’m glad that the UK is a bit more open minded. I’ve had a few friends get sent back to jail for missing meetings/forging signatures. I will say meetings/rehabs that were court mandated were swamped with people who hated it and lowered the quality of the service for people who weren’t court ordered.