LifeRing at the National Association of Addiction Professionals' Conference

From Andy Ross, who represented LifeRing at the annual meeting of the National Addiction Professionals' Association (NAADAC) in Kansas City:

I'm back in Wichita from the National Conference of NAADAC, the National Association of Alcohol and Drug Counselors; combined with the annual conference of KAAP, the Kansas Association of Addiction Counselors; and NALGAP, the National Association of Lesbian and Gay Addiction Professional, which was held last weekend in Overland Park, Kansas. I do not have a count of how many attended though it seemed to me to be not a great many more than attended the last KAAP conference I went to a couple of years ago.

Perhaps the increased cost of travel, the date being the Labor Day holiday weekend or the fact that somehow Overland Park has escaped the world's notice as a premier "destination" city contributed to a turnout that was a bit lower than I expected. Nonetheless, there were several hundred attendees, many from Kansas, Nebraska, Missouri and nearby states but also representatives from all of the regional centers in the nation and a few international members.

I arrived at the Overland Sheraton Wednesday, August 27th, around 4:30 or 5:00 p.m. and found the exhibit hall about half full of exhibitors booths already set up or being set up and, with a little fumbling on my part, was able to get the LifeRing booth set up properly.  There were perhaps 40 - 45 other exhibitors, ranging from SAMHSA, NIDA and a few other government agency reps; to a Narcotics Anonymous booth, Hazelden (the Minnesota based treatment program and publishing house), providers of urinalysis and drug testing kits, nutritionists, meditation music and literature providers; really, a whole gamut of services.  The government booths, especially,  provided a plethora of free literature and information. 

The exhibitor's hall was open Thursday, Friday and Saturday at 7:30 a.m. and just about everyone attending hit the hall each morning bright and early as that was also where the free continental breakfast, juice and coffee were served each day prior to the beginning of workshops and plenary sessions.  Again, as to the total number of attendees, I can only make a guess but the most I saw, based on a quick guesstimate-headcount at a plenary session, was about 175.  I believe quite a few attendees, especially from Kansas and Missouri, came for only a part of the conference and returned home and they were coming and going throughout the weekend.

Our booth was at a junction of two aisles of exhibitors and directly across from the coffee tables so we had excellent traffic flow past the booth and many people stopped and chatted with me about LifeRing's philosophy and about the nuts-and-bolts aspects of how we operate.  The one pamphlet I wish now I had thought to request more of, specifically, was the LSR Online booklet.  Because the majority of attendees were from the middle of the country, where LifeRing has few face-to-face meetings, our online presence particularly interested many. 

Attendance in the exhibitors' hall was pretty spotty and sparse whenever workshops and meetings were in session which gave me time to browse the other booths and to attend some workshops myself.  LifeRing got an unexpected and unsolicited plug at the workshop of Gary Blanchard, MA, LADC1, whose presentation focused on his book, Success Centered Addiction Recovery Facilitation.  Mr. Blanchard had been by the booth and picked up pamphlets and spoken to me and he was very impressed with LifeRing's approach, which neatly dovetailed with his own "non-traditional" philosophy of addiction treatment. He urged everyone at the workshop to check out our booth and I spoke with most of those in his workshop later in the day as they came by to see what we were about.

Thursday was the busiest day at the booth and Friday morning was a continuation of that but the traffic tapered off by late afternoon.  Saturday, by contrast, was quite light and by early afternoon a number of the other exhibitors were already breaking down their booths or leaving them largely unattended.  In retrospect I wish I had kept a log of how many came by and perhaps taken notes as Marty did in Nashville.  I'll know to do so in the future!  Trusting to memory proved to be a less than adequate method of tracking contacts.   Everyone I met expressed  interest in alternatives to traditional recovery support and also acknowledged the very great desirability of such alternatives. 

Just from memory I did meet with counselors from Oregon, Washington, Idaho, Montana, Colorado, Nevada, New Mexico, Nebraska, Massachusetts, New York, Vermont, W. Virginia, Kentucky, Florida, Missouri, Oklahoma, Texas, Mississippi, Alabama, Vermont, New Hampshire and Minnesota as well as a man from Kenya and three counselors from Reykjavic, Iceland.  It was an exhausting weekend from which I am still not quite feeling fully recovered; but tremendously rewarding and well worth the time and effort.  I encourage anyone who has the chance to attend similar events to do so and represent LifeRing to the people best placed to refer newcomers to recovery to our philosophy and support!

LifeRing at CAADAC '07

My plan was to leave home at 6 a.m. and arrive at the conference hotel when the Exhibit Hall opened at 7:30, but I overslept my PDA’s alarm and didn’t arrive at the Marriott in Rancho Cordoba, a suburb of Sacramento, until 8:30. That turned out to be fine. The volunteer at the registration desk quickly found my name tag and I as quickly found the LifeRing table in the Exhibit Hall. The exhibit tables were crammed into the hall like sardines, and there was only room for two of our three pop-up displays. Setup took only a few minutes, and – there being no one in the Exhibit Hall but other exhibitors – I dropped in on the plenary opening session in the large ballroom next door.

There, the keynote speaker, a Dr. Kevin McCauley, a former Navy surgeon now running a private addiction practice in Salt Lake City, was holding forth with a PowerPoint slide show on the disease model of addiction. CAADAC is the California Association of Alcoholism and Drug Abuse Counselors, and had chosen a speaker from Utah to kick off its annual event. Dr. McCauley’s talk impressed me with the positive attitude he showed toward addicted people. It was refreshing to hear a treatment professional speak of the good qualities of alcoholics and other addicts, not just of their character defects. He said, for example, that the heroin addicts he knew were “sweet, affectionate” persons, and that addicted persons generally shared character traits of great sensitivity and empathy – traits that they used addictive substances to mask and obliterate. Other aspects of Dr. McCauley’s talk impressed me less. His model of brain functions in addiction was so crude as to be a caricature. He worked the issue of sexuality for laughs like in a sit-com script for a teen audience. He delivered a number of opinions that may have been popular with many in the crowd but were blessed with little in the way of supporting evidence – for example, that author James Frey (A Million Little Pieces) was a “sociopath,” or that people who recovered without treatment were not really “alcoholics." I got the uncomfortable sensation that the doctor was catering to the lowest common denominator – an impression that was shared, it appears, by others with whom I spoke later in the conference. As a keynote presentation, to my mind, it set the bar low.

At the first coffee break I was back at the LifeRing exhibit table. The aisles between the tables were so narrow that traffic was discouraged, and if one person stopped to chat, the aisle was nearly blocked. Nevertheless, people came; and all of them were drug and alcohol counselors.

As I had done at the NAADAC and the APA conferences, I buttonholed people, saying “Let me tell you about LifeRing. LifeRing is an answer to the question, ‘What do I do with clients who are willing to give recovery a shot, but they tell you that 12-step is not their cup of tea.’ Do you have clients like that?”

Not a single person answered in the negative. Some said, “A few.” Many said, “I have a lot of those.” A few counselors said, “Practically all of them.”

“What you can do with those clients,” I continued, “is send them to LifeRing.” While listening for and responding to the customer’s questions, I gathered up a bundle of LifeRing literature and put it in their hands. The LifeRing “magazine” that we published last year was still new to nearly everyone with whom I spoke. The great majority of people who stopped at the table had not heard of LifeRing before, but it seemed to me that the minority who knew our name was a bit greater than at last years’ event in Burbank.

Very gratifying was to hear the number of enthusiastic responses to the presence of LifeRing. A program director from Bakersfield gave me her card and said her facility had available meeting rooms that we could use for a LifeRing meeting, for the asking. A Sacramento program director offered assistance in starting LifeRing meetings there. The owner of an inpatient facility on the coast near Monterey offered to host a LifeRing meeting on their site. Quite a few professionals from Southern California expressed interest in learning about future LifeRing meetings and activities in their area. Several members of the CAADAC board of directors and the organization’s Executive Director, Rhonda Messamore, stopped by the LifeRing table and spoke words of appreciation for our participation.

After the coffee break I had the good fortune to attend a workshop on “What is Recovery and How Do You Measure It” by B.J. Davis, Psy.D., Clinical Director of Strategies for Change, a large outpatient facility in Sacramento. Dr. Davis quoted extensively from published research on treatment outcomes, and supplemented the findings with research projects he had undertaken personally at his facility and in his prior academic positions. The most powerful factor in bringing about successful outcomes, he reported, was the counselor’s ability to forge a therapeutic alliance with the client. The specific counseling ideology, by contrast, was a very minor factor. Accordingly, Dr. Davis said, the counselor’s ability to empathize with and to work out a treatment plan collaboratively with the client was a key to success. The most effective treatment is that which the client is motivated to follow, whatever it may be. The use of positive reinforcement is highly effective, whereas negative reinforcement – punishment – usually fails. Dr. Davis criticized treatment strategies that rely on control. Too many counselors think that treatment is about imposing their program on the client, thus rendering the client even more powerless than before. Treatment should be about empowering the client and working collaboratively. Too many counselors are lazy; they have only one treatment plan for everyone: “get a sponsor, work the steps.” They know nothing else. What would we say to a doctor that handed out Prozac to every patient, regardless of their individual profile? We would consider it malpractice. Yet we do the same kind of thing all the time in drug abuse treatment. Counselors are well-intentioned but good intentions aren’t enough. In conclusion, Dr. Davis presented a number of instruments for measuring the Quality of Life in recovery – based on the profound truth that clients will have difficulty maintaining sobriety unless they achieve a subjectively satisfactory quality of life in their recovery.

Dr. Davis was not only a well-informed but also a powerful speaker, charismatic and humorous, who led his audience forward and upward, even if this meant entering a discomfort zone. The Association would have done well to have selected Dr. Davis as its plenary keynote speaker.

Lunch this day was a two-hour membership meeting, featuring reports by the various officers and committees. I have been a CAADAC member for several years and attended with voting rights, symbolized by a green plastic wristband. I learned among other things that CAADAC has 1,678 full members, plus about 1500 student members and about 1700 “recovery workers” (aides), and that CAADAC is one of nine competing organizations of addiction counselors in California. The highlight of the session was a report from a CAADAC-affiliated project at San Quentin prison, initiated by prisoners, designed to train the inmates as fully qualified addiction counselors on their release. Nine of the eleven inmates who took the test for CAADAC certification passed it. One of the recently released prisoners, Brian Smith, spoke briefly and received a standing ovation. When that was done, there was no time left over for membership Q and A or for floor debate on motions presented, and the session closed without anyone having the opportunity to use the green wristband symbolizing their voting rights.

I spent the afternoon in conversations with visitors at the LifeRing exhibit table and with other exhibitors. Among others, I chatted with the woman at the California Department of Alcohol and Drug Programs about the impact of the recent Ninth Circuit Court of Appeals decision affirming that AA/NA were religious. She was only vaguely aware of the decision. She did not believe that people were coerced into attending 12-step programs, or that they should have the right to sue if they were. She believed that secular alternatives existed everywhere, if the client asked for them. She did promise to take the LifeRing literature I gave her to her supervisor. I also ambled over and had a friendly chat with one of the fellows at the Narcotics Anonymous exhibit table. He told me that NA was able to use the 12-step program and other literature of AA free of charge, whereas all the other “Anonymous” organizations had to pay AA royalties. I explained LifeRing to him and he listened. We had a friendly chat. I cruised some of the exhibit tables representing inpatient treatment programs. One program had only four beds, yet turned a profit. Another did very well with ten beds, even at 80 per cent occupancy. Three of the larger programs occupied adjacent booths and I learned that they were owned by the same company, which owns more than 240 separate treatment facilities nationwide. I met a new hire whose sole job was marketing for one of these programs. I got the impression that there is some serious money being made in the private for-profit treatment industry, even in this difficult economy.

The next morning’s plenary presentation centered on workforce development in the addiction profession. The presenters discussed an ongoing survey of addiction workers, with considerable detail about the questions asked, but little in the way of results, as they had not yet evaluated the answers. Much of the ongoing survey dealt with addiction workers in the public sector (those working for counties, cities, and the criminal justice system). Fortunately there was time for questions. I raised my hand, was recognized, and asked what plans the Association had to help its members working in the public sector in the wake of the recent Ninth Circuit ruling that AA/NA are religious. A counselor in the public sector who gives a client only the choice of “get-a-sponsor-work-the-steps or go to jail” can be sued. What is being done to make secular treatment options and secular support group options more widely available?

After a few clarifying exchanges -- the speaker was not familiar with the decision – the reply was denial that people are coerced into 12-step programs. The speaker thought that secular treatment alternatives were available practically everywhere. He did, however, promise to give the topic further study.

I had unusually heavy traffic at the LifeRing table immediately afterward from people thanking me for asking that question and expressing their frustration at the speaker’s denial that 12-step coercion occurs. It occurs all the time. People shook my hand and smilingly called me a troublemaker, sh*t-stirrer, and similar compliments.

Minutes later the hairy beast was in full evidence. I attended a workshop on “Therapy in Conjunction with Adult Drug Court” – Drug Court being one of the main settings where clients risk being coerced into 12-step programs – and the presenter provided a five-page handout containing on its last page a copy of the 12 steps.

During an early question break, I asked: “I see from your handout that working the 12 steps is part of your Drug Court treatment program.” -- “Yes, that’s right.” -- “And if the client is not compliant with the treatment program, they go to jail, correct?” -- “Yes, that’s right.”

I then explained the Ninth Circuit decision in a few words. The speaker had apparently not heard of it, and manifested some trouble wrapping his mind around the concept of client choice, but with some prompting from others in the audience, he eventually got it. He then retreated into the same denial as I had seen earlier. “Oh well, if the client brings in some other program they want to do, if they’re not just playing games, the court evaluators will certainly look at it.” And, “the county has secular programs available.”

A woman behind me muttered something hostile about “judges legislating from the bench,” and the session showed signs of flying off the rails, but I backed off and the speaker resumed the droning exposition of his counseling approach. After a while I had to leave or risk falling off my chair with boredom. In retrospect I blame myself for not making a bigger fuss over the issue; it might have been a healthy thing, a spur to positive change, not to mention a relief from tedium, for this workshop to blow up in a floor fight over the First Amendment issue.

An excellent workshop followed lunch, titled “The Ethical Issues of Nicotine Use by Care Providers.” The presenter, Steve Sarian, is director of the U.S. Navy’s Drug and Alcohol Counselor School, an ordained Buddhist priest, and a hospice chaplain. He conducted the session in a highly interactive way, which made for a lively time. Sarian was eloquent in showing that nicotine is a mood-altering addictive drug, and that counselors in addiction treatment programs face ethical issues if they are nicotine users. He also cited research showing that alcoholic smokers are more successful in achieving durable abstinence from alcohol if they also quit smoking. Sarian used a light touch in outlining the issues surrounding nicotine use, an approach that was highly effective in stimulating participation and mental processing in the audience. I gave him very high marks.

After a final afternoon session at the LifeRing exhibit table, during which I sold the remainder of the workbooks I had brought, I packed up the displays, left a few brochures and magazines on the table for tomorrow’s session, and hit the road. The big awards dinner in the evening, if it was anything like last year’s, was eminently missable – a round of Good Ole Boys giving each other wall ornaments. The conference program had half a day to run on Sunday, but traffic at the exhibit tables typically would be very light, and several other exhibitors were also packing as I left.

In looking back over this experience, several thoughts occur to me.

(1) It was good to be able to combine the role of exhibitor with the role of meeting participant. Many of the other exhibitors merely sat in the cramped exhibit hall talking to one another or playing games on their PDAs between coffee breaks. Boring. By participating in the workshops I learned things, and I was able on a couple of occasions to ask questions and to raise issues that will in the long term help LifeRing to penetrate the secular market niche where we belong. Being an active participant was also a lot more fun.
(2) The CAADAC organization has a long way to go before it becomes an effective advocate for the addiction profession. Its main problem is that its wheels are stuck in the 12-step rut. Content-wise, the 12-step approach is dead. It cannot be developed further. One can only repeat it as an article of faith, over and over, like a Nepalese prayer wheel. Scientific progress on this basis is an oxymoron. Twelve-step doctrine may be a viable foundation for a lay priesthood, but not for a modern healing profession. So long as this religious doctrine remains the core teaching of the profession, parity with the medical healing professions, which CAADAC so fervently seeks, can never be achieved. Moreover, the constant influx of 12-step recruits possessed of nothing but their personal experience, and willing to work as counselors for the minimum wage or less, means that a general elevation of salaries and benefits, so crucial to professional workforce development, will remain a Sisyphean effort. In order to advance, the association must take a firm and clear stand that personal experience with the 12-step approach is insufficient qualification for a professional. The organization must actively learn, teach, own, and promote secular alternatives, or it will die a lingering death.
(3) The national organization, NAADAC, is probably no less an alter ego of AA than is CAADAC. In both organizations, in any session, if you say “Hi, I’m Joe, I’m an alcoholic,” most people in the room will reflexively respond, “Hi, Joe.” But the eyes are a bit more open and the brains have been working a bit harder in the national group. So, for example, in the national’s conference program in Nashville, the 12-step meetings at the start and/or end of the day were labeled “Optional.” The CAADAC program lists them without that qualifier. NAADAC’s headline speaker was Carlo DiClemente, speaking on Motivational Interviewing – a secular approach that has little in common with 12-step but much in the way of helpful insights for treating addictions. CAADAC’s choice of the doctor from Utah, McCauley, as keynoter, tended to massage the soft belly of the status quo instead of kicking its hind end forward, which is what needs to happen. The NAADAC conference program had only one workshop specifically devoted to a 12-step issue, and that one was canceled. The CAADAC program was larded with pablum for the faithful: “The Medicine Wheel and the 12 Steps,” “A Musical Journey Through the Twelve Steps,” “Spirituality in Recovery” (by Father John), and others; and even where the Step approach was not in the workshop title, it was frequently present in the content, as in the Drug Court program. On balance, therefore, my feeling is that CAADAC’s continued affiliation with NAADAC is probably a good thing to the extent that the more advanced thinking of the national group may be able to pull the local organization forward.
(4) Virtually all the people I met both in CAADAC and NAADAC are sincere, well intentioned, hard working, and approachable. When I first entered these halls a year ago in Burbank I felt apprehensive, as if in potentially hostile territory. I no longer feel that way. These are good people and they can be talked to. LifeRing should definitely continue to participate in these organizations. As more and more of our members become treatment professionals themselves, they should be active in these groups and, in an appropriate situation, play leadership roles. Although there are people in these groups who have tunnel vision, most participants subscribe to the philosophy “whatever works,” and if we can make our aims and methods clear to them, they will be powerfully helpful to us in giving their clients the option of attending LifeRing support groups if they so choose.

-- Marty N. 10/7/07

Report from the NAADAC conference in Nashville

Getting Ready

The two LifeRing signs that Wilbur W. had printed and mounted for LifeRing at the September 2006 NAADAC conference in Burbank were so banged up at the end of the American Psychological Association Conference in San Francisco in August 2007 that the only thing to do was give them a decent burial. Furthermore, the log-cabin charm of the PVC pipe frame that hung the signs had worn off. For NAADAC ’07 in Nashville, we needed fresh new signs and a frame to hang them on.

Inspired by some commercial designs I saw at APA, I designed and built a set of three pop-up frames using PVC pipe, lawn sprinkler fittings, fiberglass tent poles, and bead chain. The biggest headache was the tent poles. There are two wilderness supply stores near my house that have a bin for miscellaneous poles, cheap. When I built the pilot for the new frames a few weeks earlier, poles were plentiful and I got a set for $6. When I returned to that store shortly before the NAADAC event to get two more sets, the pole bin was stripped. It was the same story at the other store – nothing but bent poles, poles without ferrules, and odd ends. Why? The clerk said, “Burning Man.” The annual desert festival drew scores of tinkerers and experimenters who built creative structures and sculptures, and they had cleaned out the odd-pole bin at the local stores. I had to plunk down nearly $40 to get two sets of brand new factory-made replacement tent poles. A can of silver spray paint gave the PVC pipe construction a semblance of commercial gloss. The frames looked respectable.

Now to the posters. I drafted the posters, 24” wide by 52” high, in Macromedia FreeHand, and emailed the files to Wilbur, who is a photographer who owns a wide-carriage printer. Unfortunately, Wilbur does not have FreeHand; he uses Adobe Illustrator, which I don’t have. After several unsuccessful tries to convert my files to Adobe PDF, I found a conversion utility that claimed to turn FreeHand files into Illustrator files, and Wilbur was able to open them and printed them on Monday morning, Labor Day, the day before my plane left for Nashville. When I got the posters home and unrolled them, I saw with dismay that two photographs included in my design were missing. The file conversion utility had quietly ignored them. Time to get creative. One of the photos was small enough for me to print out on my letter-size photo printer. That solution would not work for the other, which was the group shot on the cover of the workbook, blown up to 12” high by 20” wide. Photoshop to the rescue! I teased out the five faces from the photo as individual pictures, blew them up, and printed them individually. Then it was just a matter of mounting the photos to the posters with rubber cement. Apart from some buckling due to the cement, the solution worked, and from a reasonable viewing distance the posters looked fine.

The whole display package – posters rolled into mailing tubes, PVC pipes and chains stuffed into a pillow case – weighed just over 12 lbs. Weight was an issue because I was also carrying books and brochures and the airline had a 50-lb per suitcase weight limit. After considerable juggling and trimming, I got the whole package including my personal stuff into two suitcases just under the weight limit, plus my carry-on.

Some months before the event I had posted on several email lists that it would be nice if someone in Nashville had a couch where I could stay during the conference, to save hotel expense. Three people offered, but as the event came closer, each had to withdraw. Mike because they had no room, and Gregg because of a family and job issue. At the last minute Bettye had to cancel because of a gall bladder flare-up that sent her to the hospital. There was no alternative but to book a hotel. The downtown Renaissance hotel where the convention was being held was way too expensive for the LifeRing budget. After considerable online searching, I reserved a room at the Red Roof Inn (an East Coast motel chain) near the airport and on a bus line going downtown.

Tuesday

At the APA I had bought a four-wheeled Tutto brand suitcase from another exhibitor, and this proved a blessing, as I was able to pile the second case and the carry-on on top of the rolling suitcase. During the long BART trip to the airport, I did sometimes feel a bit like a mule hauling a truck, but the gear did the job, tolerably if not brilliantly, without breaking my back. The airline checked my hefty bags without incident.

The flight was uneventful. I was wearing a “Cal” hat – the UC Berkeley Golden Bears had beaten the Tennessee Volunteers 45-31 the previous weekend – and the bantering started at SFO, when a gentleman with a biscuits-and-gravy accent asked whether I was going to Nashville with that hat. I grinned and said I was. He said not to worry, “Those folks in Nashville don’t care for the Vols anyhow.” That turned out not to be entirely true. A waitress at the Waffle House near the Red Roof Inn – there’s nothing but franchises near the airport – said she couldn’t stand to look at the hat, and I would be charged double if I wore it, and there was more kidding along those lines.

Arriving at the Nashville Convention Center / Renaissance Hotel Wednesday evening, I found the NAADAC registration table set up, but not yet in peak mode. The first set of instructions given to me sent me to a dark and cavernous exhibit hall on the ground floor. On my return to registration, sweaty from hauling my truck over carpet, a very competent NAADAC woman named Diana Kamp took me in hand and led me to the proper floor. There, the table reserved for LifeRing near the entrance of the Exhibitors’ Hall, like most of the other tables in that room, turned out to have no space behind it to display our new pop-up posters. It was just a table against the wall. I had expected a booth, like last year in Burbank. There were suitable tables, however, in the hallway, still awaiting setup. The resourceful Ms. Kamp quickly switched booth assignments for me, and LifeRing now had a good table with ample space behind it. Thanking her, I began the setup. Note to self: when packing long bead chains, wrap them separately. During the flight, the six chains for the three frames, each chain 84” long, had mated and formed a Gordian knot of tiny metal beads. The setup, which should have taken fifteen minutes, took well over an hour. Finally, it was done.

Tired and hungry, I hit the restaurant strip on Broadway next to the convention center. This is a three-block string of honky-tonk bars and souvenir shops. Each of the bars featured a heavy-set barker in cowboy hat and boots trying to lure the tourists into his den of burgers, beer, booze and country music. Not much for a recovering alcoholic to like, there. At the end of the strip, around the corner of Second Avenue, I spotted a Japanese restaurant. Ah!

Unfortunately, when booking the motel near the airport, I didn’t check the bus schedule thoroughly enough. I now learned that the last outbound bus from downtown had left at 5:30 p.m. The inbound bus in the morning cost only 60 cents with my senior discount, but getting back to the motel at night would add an average of $20 in taxi fare to the $42 per night room bill.

The taxi driver on the ride to the Red Roof Inn was a young man from Somalia. When he won the green card lottery in Somalia he didn’t know anybody in the USA, but a neighbor of his had a brother in Nashville who promised to help him. So he went. It was the first time he had heard the word “Tennessee.” Fate got me here, he said. That is how fate is. He asked me whether it was true that families had moved out of San Francisco because of the gays. I said I didn’t think so. He wanted to know how many gays there were, and much else. When we had exhausted that fascinating subject I asked him how come the back seat of his cab didn’t have seat belt anchors. He said the drunk college students broke them. Another drunk pushed out a side window and tried to walk away. A group of drunk college girls once trashed his CD player and his meter. He said they were very nice, from good families, but when they got drunk they didn’t know what they were doing. I could relate.

My room at the Red Roof Inn is a “handicap accessible.” That means you can roll a wheelchair into the shower. My mind flashed on returning veterans from Iraq. I felt grateful that my own disability – amputation of alcohol and “drugs” – allowed me complete mobility and the free exercise of all vital functions.

Wednesday

The bus driver outside the motel said that my Cal driver’s license for proof of age was worthless, I needed a senior pass from the MTA, but he “would take care of me.” I got into town for 60 cents. At the convention center, Mike G. from Nashville showed up at the LifeRing table even before 9 am. Having Mike there at the table was great. Not only was he good company – we had to remind ourselves sometimes to focus on the customers instead of chatting with each other – but he also knew some of the local counselors and was able to build local rapport as I could never have.

• The very first counselor that morning was eloquent on the problems his clients encountered with 12-step programs. “Too many walls,” he said. There was the powerlessness wall – the biggest one -- the God wall, and a series of others. He said that the 12-step approach was “a hard sell” with his clients. He had had more than a hundred clients in his small Midwestern town and only three of them had formed a stable attachment with a 12-step group. “People need to find a group that fits who they are. The important thing is social support for recovery.”
• A counselor from Central Indiana said that an alternative was very much needed in her town, but that it would be hard to get it going. It was hard to get AA going.
• A counselor from Tucson stopped and said she had done AA herself but she was open to alternatives. She knew about SMART and had attended a couple of meetings but felt that the people there had more serious mental health issues than she was comfortable referring her clients into. She hadn’t heard of LifeRing. I told her that when the Tucson meeting started up she would be contacted. She nodded OK.
• A counselor from a residential center about 45 miles west of Nashville took all of our literature and said there was plenty of room in this “recovery Mecca” (Nashville) for all different kinds of approaches. She left her business card.
• A program director from a program in Nashville specializing in professionals said he would be happy to help get a LifeRing meeting going.
• A counselor from a federal prison in Arkansas said that her clients find God when they arrive, and leave him when they go. She currently has people who are interested in the 12-step approach and others who are not. She wants to know about whatever alternatives are available, and took the literature.
• A DUI counselor from the city said most of his people don’t want to go to any support groups because they don’t realize they have a problem, but it was good to offer them choices because it takes away one of their excuses.
• The owner of the Recovery Today newspaper stopped by and listened to my complaint that the paper had refused to list LifeRing as a resource. He said I should contact Linda at the paper and she would put in a listing for us. He said it’s not their policy to list only 12-step groups, they’ll list any support group that works for anybody. We’ll see.
• A counselor for an Army treatment center in Hawaii says she’s been in the counseling profession long enough to know that 12-step doesn’t work for everybody. They’ll go and they’ll come back to her and say there must be another way. She’s taking our literature back with her.
• A counselor from a program in Tullahoma, near Nashville, wants to be notified when a meeting starts.
• A counselor from Aurora, Ontario, north of Toronto, chatted for a while and took literature, saying she was interested.
• A counselor from Denver said he’s heard of LifeRing and has a LifeRing presentation scheduled at his program. He bought the workbook, saying it would help him understand LifeRing better.
• A counselor from Birmingham AL said “for sure” there are people who do want to do recovery but don’t want to do it the 12-step way, and is interested in hearing what we have to say.
• A young counselor from Metro Public Health in Nashville said that patients who object to the 12-step approach are “very common” but the only alternatives available are church-affiliated. She took our information and wants to be notified when we have a meeting going.
• Another counselor from Tullahoma bought both the workbook and How Was Your Week and expressed strong interest in having a LifeRing meeting in her town.
• A counselor from a local program gave us the name of a program director at a facility out of town who believes in offering people choices, and said we should call her.
• An exhibitor from the Vivitrol table stopped by and we chatted for about ten minutes. Vivitrol is the time-release form of Naltrexone, an anti-craving medication. She probed for our attitude on medications. I told her that if a patient was honest about their use with the physician, and the physician was competent in addictions, then we would support the patient taking their medication as prescribed. The medication was a sobriety tool, not a sobriety breach. She told me that it was refreshing to talk with somebody “who gets it.”
• A counselor from Vermont said that the issue of clients wanting to do recovery but not 12-step “comes up a lot” in her practice.
• A counselor from a very small town in Iowa, when I asked her whether she had clients who said yes to recovery but no to 12-steps, replied “Yes, most of them.”
• A senior counselor from Helena, Montana, said he “absolutely” has clients who are interested in recovery but not in 12-step. He said, “We need something, we need something.”
• A counselor from Dayton Ohio says he has “a lot of clients” who don’t want to do the 12-step approach. He said, “It’s awesome that you’re out there. It’s so great that you’re here.” He took all of the literature and left a business card.
• A counselor who works with adolescents near Nashville says she “definitely” has clients interested in recovery but not 12-step and wants to know more about us. She left her card so that we could notify her when a local meeting starts.
• A woman from a recovery bookstore said she was glad we were here because people need more approaches than just 12 steps.
• A counselor from a healing center in Memphis stopped and gave us encouragement.
• A counselor from a Lesbian center said she was very much interested and she would look us up online as soon as she got home.
• A young woman from a treatment program for professionals chatted and took our literature.
• A teacher from a recovery high school said they refer their students to 12-step meetings. I asked her, what if the students aren’t comfortable with that approach. She said, yes we do have that issue, and we’re not entirely sure what to do about it. She took our literature. If we got a meeting going, she would “definitely” refer people to it “if appropriate.”
• Three counselors from a small town in southwestern Tennessee stopped by. One of them said, “We have enough trouble getting 12-step going in our town, but this would definitely be interesting.” They took literature.
• A drug court counselor from GallatinTN and two counselors from a small town north of TN took literature and said that their clients needed options in addition to 12-step. The drug court counselor recognized Mike and said she was happy to see him there; would he be willing to volunteer some of his time to meet with their clients.
• A counselor from Indiana said he was interested and took literature.
• A counselor from Seattle said “I’m open to whatever works. As counselors we can’t just send people to AA or tell them not to use medications. Whatever works, is the motto.” I told him about the Seattle LifeRing meeting at the Good Shepherd Center.
• Chip Drotos, the publisher, and Gary Enos, the editor, of Counseling Professional magazine came by and we chatted about the article about LifeRing that I submitted more than two years ago and that they haven’t published.

After a while, I stopped taking notes. There was a definite theme here and we were hearing it with minor variations from all over the country. Just about everyone who talked to us told us that there was a need for broader options for their clients besides 12-step. One counselor told us that the need was “urgent” but she dare not bring our literature into her program as it was strictly 12-step and she would be written up. But most of the professionals who chatted with Mike and me at the LifeRing table professed to be open minded and supportive of alternatives. We put our literature into many dozens of friendly and receptive hands.

In the afternoon, the NAADAC program listed “focus groups” where people were invited to come talk to NAADAC leaders about how the organization could better serve them. I attended the first one. Two NAADAC staffers, one of them a specialist in curriculum development, plus a junior assistant who took notes, listened to a focus group of three. When it was my turn, I made a plea for greater recognition by NAADAC of recovery alternatives. I asked for links to LifeRing on their web site, and for end-of-day LifeRing meetings alongside the “Optional 12-step meetings” listed in their daily program. Notes were taken and my hopes were raised that some of these ideas might be acted on.

I returned to the LifeRing table and then showed Mike the labyrinthine path through the hotel to the second focus group session, where he was to inquire about job opportunities in the counseling profession, while I returned to cover the table.

At a few minutes to 4 pm I went to another hard-to-find meeting room in the hotel to give my Mirror Neurons presentation. This is the same talk I had given at the LifeRing Congress in Denver in May. I had expected to find no one at the workshop at all. Seven other presentations were scheduled in the same late-afternoon time slot. But four people were already waiting, with more coming in, and, counting stragglers, I ended up with an audience of fifteen. I was pleasantly surprised. The talk went down well. There were thoughtful, positive questions. A couple of people said it was the best, most stimulating presentation they had heard at the conference so far. Several people stopped to shake my hand and thank me and say kind things about the talk. Later I asked for and saw the feedback forms from the session. I had eight responses that were all “Excellent,” the highest grade, and four that were mixed “Excellent” and “Good” or all “Good.” One person complained about the lack of handouts. One person wrote that it was “inspiring” and another wrote that it was “the best session of the day.” This good feedback should be helpful to pave the way for other presentations in future years.

Traffic was slow when I returned to the LifeRing table. Mike was happy about his Focus Group session, and got something close to a job offer out of it. After waiting a few minutes for stragglers, we closed the table and went to find a late-running workshop put on by the LGBT folks (NALGAP – National Association of Lesbian and Gay Addiction Professionals, co-sponsors of the conference). This event, however, centered on evaluating an all-day training session they had just concluded, which we of course had not been able to attend, and after listening for some time, fighting sleep, Mike drifted away, followed a bit later by myself.

After an indifferent solo dinner I talked an airport shuttle driver into dropping me at the Red Roof motel instead of the airport; it was strictly against regulations, he said, but it was late and I was the only passenger. I saved a couple of dollars off what a cab would have charged.

Thursday

Early bus to downtown. Walked around and got a bit of a stretch, took a few photos.

The draw today was the Carlo DiClemente presentation on Motivation and the Stages of Change. With traffic slow at the exhibits tables, I joined the two or three hundred people gathered in the large ballroom to hear this main event. DiClemente with Felix Prochaska is the creator of the so-called TransTheoretical Model (TTM), best known for one of its components, “The Stages of Change.”

There’s hardly a PowerPoint presentation anywhere in the substance abuse field that doesn’t contain some reference to this paradigm, which has clients moving through distinct stages from pre-contemplation to contemplation, pre-action, action, and maintenance. The counselor needs to identify the stage the client is at and tailor the treatment appropriately.

Key to the client’s progress through the stages – or lack thereof -- is motivation. DiClemente got an appreciative laugh from the audience when he said that counselors who call the client unmotivated are usually mistaken. The client may be highly motivated – but not necessarily to do the things the counselor wants them to do. In any treatment relationship, DiClemente said, there are always two plans: the counselor’s plan, and the client’s own plan. At the break, I gave DiClemente a copy of the Recovery by Choice workbook, explaining that there were of course many books setting out counselor plans, but this was the only workbook that a client could use to build the client’s own treatment plan. He appeared impressed and interested.

DiClemente’s exposition of client motivation largely followed and built on the key chapter in the Hester-Miller Handbook that I reviewed on unhooked.com some years ago, and I won’t recap that here. When the client appears to lack motivation, he said, the problem is often not with the client but with the treatment approach. Quoting Pogo, he said, “We have met the enemy, and it is us.”

DiClemente concluded the exposition by urging counselors to reframe the client or patient as a consumer. Borrowing from the consumer rights movement in other areas of health, including mental health, DiClemente urged treatment professionals to focus on the consumer’s needs and wants, not on the imperatives of the treatment program.

Di Clemente’s PowerPoint slide to illustrate the shift in perspective to a consumer perspective said:

• Pathology to Problems
• Pulling or Pushing to Persuasion
• Patient to Partner
• Provider to Facilitator
• Outcomes to Options
• Management to Motivation and Marketing
• Reactive to Proactive Care

Consumers have the power to choose, he said. They have a broad array of interests; they are persons of value and must be treated as such. “You will change what you do if you treat patients as consumers.”

In the question period, I raised my hand, was recognized, and stood up to ask, “You advocate treating patients as consumers who have the power to choose. Isn’t that going to be a difficult transition for programs where the first lesson they teach is that the patient is powerless and needs to stop making choices and surrender?”

Di Clemente’s answer began with a bit of fancy verbal footwork that didn’t stick in my memory. But he ended on a strong note, defending the principle of patient choice as the foundation of patient motivation and commitment to change.

As the session ended and I walked toward the exit, I caught a lot of appreciative smiles from faces in the audience.

Lunch this day was divided into regional caucuses. I had the opportunity to sit in a small room with counselors from California, Hawaii, Arizona, Nevada, Utah, and New Mexico. Much of this session revolved around governance issues of NAADAC. I learned among other things that the California group, CAADAC, was by far the largest affiliate of the national association, with a correspondingly large contribution to the national’s budget, and this gave rise to some issues and tensions. NAADAC leadership people at the session made a strong pitch for more people to become involved, pointing out that practically all the work was done by a relatively small handful of people. I could relate to that. Mike meanwhile attended the much larger caucus of the southeastern region, which included the host state, Tennessee.

The hot spot of the afternoon’s program was a seminar for counselors on working with “GLBTQQAi” clients. That’s Gay, Lesbian, Bisexual, Transgender, Queer, Questioning, Allied, and intersex. NALGAP President Joe Amico, an ordained minister fired by his mainstream church after he came out as gay, and psychiatrist Penny Ziegler led this session to a packed room. The objective was to familiarize counselors with key points of the gay movement and to sensitize them to the issues that their clients were probably struggling with at different stages of the process of coming out. Although the workshop was a bit dry and on the academic side, I feel it was helpful in raising my awareness of issues that might confront the significant and growing number of “GLBTQQAi” participants in LifeRing. At a reception later in the evening, after being assured that one did not have to be a professional to join, I took out an individual membership in Amico’s organization.

Late in the afternoon, Mike and I attended a reception thrown by NAADAC for conference exhibitors, where we had a chance to chat with conference organizers and with various service providers, learn about their concerns and teach them about LifeRing. I also found that other exhibitors shared my feeling that about everyone who was going to visit the exhibit tables had probably already done so. Several confided that they would pack up and leave on Friday, skipping the last day of the event.

After that workshop, I caught just the concluding few minutes of a workshop on leading organizational change, by motivational speaker Jim Burgin. He compared the current state of the addiction treatment field to Georgia after Sherman’s march. Sherman is supposed to have said that he left Georgia so devastated that a crow who intended to fly across it had better bring its own corn. Likewise, addiction professionals entering the field now, he said, had better bring their own corn, and plenty of it. I’m not sure how motivational the attendees found this powerful image, but it certainly stayed with me.

Friday

On Friday morning, Mike and I met at the LifeRing table and we talked about how to move toward starting up a LifeRing face meeting in Nashville. We already have a potential core membership: Mike himself, Gregg F. who has been active online and in person for eight years, and Bettye D., who moved here after several active years in LifeRing, including experience as a convenor, in Oakland. At the conference, we had gathered up perhaps a dozen business cards from local area counselors who told us with every sign of sincerity that they wanted to be notified when a LifeRing meeting got going and they would include us on their referral list. I had copied the cards and given them to Mike. All the elements of a meeting appear to be in place. With that done, I packed up our displays, left a stack of literature for Mike, shook hands, and headed for the airport.

Next year’s NAADAC conference will be in Kansas City, on the Kansas side. I feel that this year’s event, even more than our maiden venture at the Burbank NAADAC conference in September ‘06, was time and money well spent, and I look forward to participating again next year.