Report from Hawaii

Now I've had a chance to dig out from under the backlog and the frontlog that piled up while I was in Hawaii, I'm going to take a few minutes and jot down a report and some memories, and post some photos.

The main purpose of this trip was to try to get LifeRing started in Hawaii. To do that we needed someone or someones in Hawaii to come up with the airfare and hotel. Would you believe it took almost two years to get that done?

The principal engineers were Lorraine Robinson, head of a women's prisoner re-entry program; Eddie Merseneaux, head of a North Shore recovery program; and Bernie Strand, representing Access to Recovery (ATR), a federally funded granting and training council.  In this team, Lorraine was the sparkplug, Eddie was the engine, and Bernie was the fuel pump -- she found and moved the money.  Here's me with Lorraine, photo above.  Lorraine's program is called Ka Hale Ho‘ala Hou No Na Wahine-- Hawaiian for The Home of Reawakening for Women. More about that later.

My main job was to do an all-day workshop explaining LifeRing to treatment professionals.  Even though this had been talked about for many months, the authorization for the money didn't get cleared until three weeks before the date of the workshop.  I was a bit concerned that there might not be much of a crowd, with so little time to prepare.  But Lorraine and Eddie and Bernie each turned out their staffs and their contacts, and Eddie's email blast hit just about every addiction and mental health professional on the island -- an impressive list. It also helped that the island of Oahu is not all that big, and almost everybody knows almost everybody.  Result: the conference room was full up with 50 people, all but one being staff at one or another treatment agency.  

Some very senior people attended, including the counselor who heads all substance abuse training in the State of Hawaii; at least one psychiatrist medical director; and a lot of younger staff as well.  Here's a photo of me with Eddie.

We met in a kind of unusual location: the conference room of Hilo Hattie's, probably the leading vendor of all things Hawaiian in Honolulu.  You wandered to the conference room through aisles and aisles loaded with Aloha shirts and every other conceivable item of Hawaiian merchandise, and soft hula music wafted in the background.  That was lovely and very relaxing, but there was a downside.  The conference room walls didn't reach to the ceiling; they were just partitions.  Moreover, there was another conference room directly to one side, where another program was going on.  And after lunch, a hula class began on the other side. But the price of the room was right!  Luckily, I have a robust set of vocal cords, so that even after the microphone gave out, which it did, I was able to reach the back rows without too much trouble.

I started the program by asking people to identify themselves and say why they were here, and I was struck by how closely these folks followed the consensus of other treatment professionals I had met at conferences such as NAADAC, CAADAC, and APA (search this blog for those acronyms for details).  That is, they all had clients who were willing to do recovery, but the 12-step approach was not their cup of tea.  They were looking for additional tools, choices, to offer their clients. OK, that's why I was there. Hilo Hattie's provided a nice big flatscreen TV on which to run my PowerPoint, and I presented a somewhat modified and expanded version of the 200-slide workshop I had given previously to two different CAADAC audiences in Oakland and in Sacramento.  You can download the original version from lifering.org here.

At lunch, we had a prominent guest speaker, Gary Hooser (right), the outgoing majority leader of the Hawaii state senate and candidate for Hawaii lieutenant governor. I had the privilege of being introduced to Gary before his talk, and gave him a LifeRing lapel pin, which he wore during his talk. He spoke mostly about political realities in general, but also disclosed that his father was an alcoholic and his brother was a drug addict, so he knew something about the topic of our concern.  I've met a number of politicians in my time but I thought Gary was rather special in his frankness, directness, and courage.

After lunch, I started off by showing the 1 min 37 second Flash animation of how LifeRing works (here).  I'd not had the chance to test this with a live audience before.  It was fun to switch back and forth between the screen and audience faces to gauge the reaction. Somebody important once said that the measure of a good idea was whether you could explain it in 30 seconds as well as in 3 days, and I like to think that the LifeRing idea is passing that test, at least on the short side.  On the long side, both Eddie and some other listeners felt at the end of the day's presentation that there had been enough material presented for three days, and encouraged me to prepare a longer workshop. I have to agree; I barely scratched the surface of the Recovery by Choice workbook, for example, and never touched on some of the issues in the later chapters of Empowering Your Sober Self. There were some great questions asked. BernieStrand asked a brilliant one, namely whether it made sense to talk about building a Personal Recovery Program with a person on day one of their recovery, in view of the presence of cognitive distortions, etc.  I could have spent an hour on that one alone.  Here's a photo of Bernie and me, to the right.  A longer workshop format would leave time for more audience participation, breakouts, demonstrations, one-on-ones, and the like.  So, that's for the future.

After the day's workshop, Lorraine took me to her program for a short visit, and I got a chance to meet three of the residents.  Lorraine's program is a six-month residential program that helps women who have been released from state prison on parole to try to reintegrate into the community.  I got a lucky break there.  One of the women, M., told the story of her job interview earlier in the day, when she was turned down because of her felony rap.  She said that on the bus ride afterward, her mind was a battleground between part of her that wanted to say "f*ck it" and get drunk and go back to prison, and the other part that boosted her courage and urged her to hang in (she did).

The next day, Lorraine invited me to give a short talk to her program residents, and then lead them in a LifeRing meeting.  We met on plastic patio chairs under a canvas awning in the parking lot that forms the internal courtyard of the program.  I had given a few LifeRing talks to parolees, but never to an all-women group, and I mentally listed about 10 different ways that I could screw it up. I chose to use M.'s story about her mental battle after the job interview as the boat on which to sail into my talk about the A and the S and about empowering your sober self.  That was a happy approach, and after I had finished my introduction, I started the round of "How Was Your Week?" to my left and sat back to watch. The residents took to the format like ducks to water. It took just a tiny nudge to start the crosstalk, and I was treated to a phenomenally excellent LifeRing meeting, with the women giving each other support all across the circle.  The sun set and we had a few showers as the meeting went on. We spent two hours going around, and I worried that fatigue and short tempers would set in, but no need.  The engaged body language and the animated facial expressions of the women sustained the session until we were all the way around the circle.  We then broke for refreshments, prepared by the residents, and I got excellent one-on-one feedback from several of the women, who contrasted the LifeRing approach positively with other kinds of meetings they had attended.

An evaluation survey filled out by the residents the next day gave LifeRing very high marks; I'm going to post that separately.  There was strong support for having the LifeRing meeting at this facility once a week.  One of the guests at this meeting was a counselor from a related program, who volunteered to be the convenor.  Plans were laid to transition the meeting to an outside location, where nonresidents of Lorraine's program could join in.

That was the end of my LifeRing business in Hawaii, but I had planned to stay for the weekend and do some R&R. After all, it's Hawaii. My new friends were exemplary in their Aloha spirit, driving me literally all around the island to see the beautiful beaches and other sights.  I also got to eat poi, the traditional Hawaiian dish, which tasted like lightly grape flavored ice cream (not at all like library paste, as I'd been warned).  Hawaiians are legendary for hospitality, and my friends were shining embodiments of that legend.  I took a ton of pictures (like these plumerias), which I will post somewhere when I get the time, and I have a head full of wonderful memories.

Well, working to get LifeRing started in Hawaii was a tough assignment, but somebody had to do it.  LOL.

P.S.  I just heard from Rachaell at the Service Center that a Hawaii agency has ordered more than 100 LifeRing books.  That's a good sign.  Lots of people told me they wanted to help LifeRing get started in Hawaii, but one never knows how serious it is until they cut the check.

Adolescents of All Ages

I had the pleasure on Thursday morning of attending and staffing a LifeRing exhibit table at the 13th Annual Northern California Tobacco, Alochol, Drug, School Wellness & Youth Development Conference for Educators, held at the Clark Kerr Conference Center of UC Berkeley.

The attendees were teachers, counselors, and community leaders from seven Northern California counties. All were concerned with prevention and treatment of the tobacco, alcohol, and other drug issue among young people, particularly teenagers.

The most frequent question to me was "Do you have meetings for teens?"  Since, at the moment, none of our meetings is limited by age group, my answer had to be, "Our meetings are open to adolescents of all ages."  That got a laugh.

There was a universally positive reaction to a secular option for sobriety support.  A number of people volunteered that a lot of teens tended to resist the religious aspects of the 12-step groups.  

The problem is how to convert the positive reception we get from educators working with teens into actual meetings -- or some other organized presence -- in the schools.

A few years ago the counseling staff at a local high school wanted to start a set of support groups, including LifeRing, on campus.  The initiative was killed by the principal, not because of any animus toward LifeRing, but -- observers believed -- because the program would call attention to the campus drug problem and taint the school's reputation.

I had brought only 50 local meeting schedules to the conference, and these went quickly. This wasn't a book-buying crowd -- didn't sell one book -- but the schedules and brochures got into a lot of hands.  Maybe some of them will trickle down into the hands of some wide-awake students.

The keynote speaker at the conference, Dr. Ken Winters of the U of Minnesota, presented a PowerPoint entitled "This is Your Brain on Adolescence."  It featured MRI scans of brains lit up by cocaine and charts of dopamine levels -- the scenes a faire of addiction lectures.  It carried a sound and important message about the lifetime dangers of early alcohol and other drug use.  The adolescent brain is engaged in a major neural reorganization, a very bad time to be throwing addictive drugs into the works.

Still, the notion that teen behavior and attitudes generally, and the proclivity to do drugs in particular, are rooted in developmental brain anatomy, is overly broad and unfair. Only a minority of teens do drugs.  Some teens are impulsive, others are cautious.  Some take risks, others avoid them.  For every teen who has impaired judgment, there is another who is wise beyond their years.  We certainly see kids who do drugs and hide it from their parents, but we also see kids who fight hard to get their parents off drugs and into treatment.  Bottom line:  teens deserve as much respect as adults for their individuality, their wisdom, and the choices they make.  

Letter to My Addiction

One of the exercises in the Recovery by Choice workbook -- and it's an old exercise, widely used, not invented by me -- is writing a letter to one's addiction. You write a "Dear Jane" letter to the addiction, then you write your addiction's response to the letter, and you conclude by replying to the response. In the framework of the "A" (addict self) and "S" (sober self) metaphor, it's a dialogue between the S and the A.

Mark J. did this exercise last month and read it out loud to his group. So many people commented on it that it came to my attention, and with Mark's permission I'm reprinting it here:

Dear Jane,

I am writing you this letter in regards to discontinue our relationship altogether. I want to be forthright with my stance on this. We have spent a time in our lives that for life safety reasons I realized needed to be ended. I ask of your acceptance of this as I need to move on and pursue a life that is productive to my development and responsibilities. There were good times, yes. However the damage to my well being both physically and emotionally has caused me to seek recovery and I’ve found it to be a life worth living. Let me not leave out the fact that I have caused damage to others as well when we were together. Let me state again that I am taking action at this writing to cease relations with you permanently.

Sincerely,

Mark

Mark,

I have read your letter and think you maybe need a break for a while and I am more than willing to let things cool off (or until you finish your phase). But let’s be serious, you know we are meant to be together. A break from this relationship is fine with me, but to consider never seeing each other again is not like you. You are the one who sought me ought and wooed me with your words, touch and actions in all situations when you felt the need. You came to me! Through those times we produced the best sensations and moments of true genius that you demonstrated to others. The music on computers you made was untouched in individuality. You were afraid of talking to the people you really wanted to talk to until we were together. When we were together you consciously new it was better than sex and you ignored sexual advances with the thought that sex would get between you and I. We had mystique. It was I with you the greatest spiritual moment in your life happened, and you dare wonder if it was real or imagined. Of course it was us. Do I need to go on? I think you know the answer to this question. So now after all I have given to you, this is suddenly something you would never consider again? I know you romanticize about me and you think you can shut out or use your bullshit recovery techniques to stop yourself from me. However, I’m always here and that makes you wonder doesn’t it? You can’t forget about us can you? I understand you are going through some voluntary brainwashing to delude yourself from our relationship, however to think you’ll leave me for good is not something I’m worried about.

In remembrance of old times,

Jane

Dear Jane,

I have read your reply and cannot overstate the fact that you and I together is life threatening to me. I will die and hurt others along the way. While it is true that there were times together that still bewilder me, I am working towards moving into the now and there is evidence that this is happening. I simply enjoy being sober more than the ups and downs of being with you. The adventure of life is unfolding and I know in my heart that I can always find a way sober no matter what may happen. The past experiences with you brought a change in how I wanted to live. I don’t want to shut my memories out and accept that I will remember the “good times” as well as the bad. This is not a war and I will not fight you. I just simply will not take you. The things that I thought I needed you to do with me I now am doing myself and I don’t need an audience to tell me when I know something is right. From this moment on I choose a life worth living.

Mark

Recovering from opiate use in LifeRing

A blogger who focuses on recovery from opiate addiction observes that there are now recovery options besides 12-step, including LifeRing, but wants to talk with people who use them to find out what it does for them.

If you are recovering from opiate use in LifeRing, you might want to sign onto that blog and share your experiences.  

Choice philosophy gets boost

The choice philosophy that LifeRing advocates, and that forms the core of the Recovery by Choice workbook, has received a major boost from two recent publications by well-known treatment professionals.

The first publication, the report of a 2005 recovery conference under the auspices of SAMHSA, the federal agency, contains a summary of recovery principles beginning with the important basic truth that there are many roads to recovery. An excerpt containing the entire summary is in my New Recovery blog here.

The second is a new monograph titled Recovery: Linking Addiction Treatment & Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches, by William White, MA and Ernest Kurtz, Ph.D. A PDF copy of the whole 80-page essay is here. It's published by the Addiction Technology Transfer Center, a SAMHSA project.

The Preface, by Charles Bishop and Michael Flaherty, summarizes the main point in these words:

This paper’s most important focus is on recovery and the suffering addict’s (client) needs and perspectives as the most important throughout the entire recovery process. This paper emphasizes how each person has both the responsibility for and a philosophy of choice in his/her recovery. Thus, the counselor and clinical treatment system staff become supporting partners along with a rainbow of community-based, non-professional mutual aid recovery fellowships, all working to help the addict. (emphasis added).

Anyone familiar with modern medicine may be tempted to yawn here, because the concept of patient choice and responsibility is by now entrenched and familiar there (source). But much of addiction recovery is still in the Middle Ages, so the notion that the patient has a choice in recovery -- and that this is to be recognized and supported -- is nothing less than revolutionary. What's even more significant is that this recognition comes from two heavyweight authors with solid-gold credentials in the 12-step universe. White is the author of the definitive history of addiction treatment in America, Slaying the Dragon, reviewed here; and Kurtz's Ph.D. thesis, Not God, is one of the classic texts in AA history.

The authors zero in on the subject of choice on p. 19. After a preface that takes note, without comment, of widespread allegations that the 12-step approach does not work for everyone -- a point that virtually every front-line treatment professional would readily concede -- the authors "recommend promoting a choice philosophy and monitoring each client’s ongoing responses to recovery support group participation."

The Choice Philosophy: A choice philosophy is based on the recognition of multiple pathways and styles of long-term recovery and the recognition of the right of each person to select a pathway and style of recovery that represents the individual’s personal and aspirational values. (emphasis added)

Here's what a choice philosophy would look like in the practice of a treatment center:

■ Professional counselors, recovery coaches and volunteers represent the diversity of pathways and styles of recovery.

■ Professional counselors and recovery coaches are knowledgeable about the full spectrum of religious, spiritual and secular recovery support groups and can fluently express the catalytic ideas used within each of these frameworks.

■ Professional counselors and recovery coaches are aware of patterns of co-attendance (concurrent or sequential participation in two or more recovery support structures, e.g., co-attendance at WFS and A.A. meetings, N.A. participation with later transitioning to A.A. as one’s primary recovery support structure).

■ Individuals and their families are educated about the variety of recovery experiences and the legitimacy of multiple pathways and styles of recovery.

■ Informational materials, lectures and structured exercises that people receive represent the scope of recovery support options, e.g., posting all local recovery support meeting schedules on the treatment agency website and facility bulletin boards, giving each client a wallet card with the central contact numbers of local recovery support groups, profiling local recovery support groups in agency/alumni newsletters.

■ Individual choice is respected; individuals receiving services are not demeaned or disrespected for the recovery support strategies they choose; clinical strategies involve motivational interviewing principles and techniques rather than coercion and confrontation.

■ Professional counselors and recovery coaches are encouraged to self-identify and bring to supervision negative feelings they may have about a particular pathway of recovery chosen by a client.

This is an excellent, useful list. Persons shopping for treatment programs might print it out and ask marketing reps to what extent their facility matches this picture. Patients currently enrolled in programs might use the list to advocate for reforms in the way programs are operated. Staff members could bring up points from the list at staff meetings to suggest improvements in patient services. Program administrators could circulate the list for discussion at staff retreats.

The authors go on to raise some of the central theoretical and practical issues in choice philosophy:

Choice and the Stages of Recovery: To implement a choice philosophy, addictions counselors and recovery coaches must reconcile the philosophical and therapeutic value of choice with the growing evidence of how neurological impairments can impair the choice-making abilities of individuals in active addiction and early recovery (Dackis & O’Brien, 2005). The challenge for the addictions counselor or recovery coach is distinguishing authentic choice from what A.A. calls “stinkin’ thinkin,’” what Rational Recovery calls the addictive voice or “Beast,” what Secular Organization for Sobriety refers to as the “lizard brain,” what LifeRing Secular Recovery calls the “addict self” (versus the “sober self”), and what Christian recovery groups refer to as the “voice of the Devil.” Given the dichotomy between the sober self and the addicted self, the question becomes “Who’s really choosing: Dr. Jekyll or Mr. Hyde?” Some would frame this as separating what each client wants/needs from what his or her disease wants/needs.

One way to partially reconcile this dilemma is to view recovery as a progressive rehabilitation of the will—the power to reclaim personal choice (Smith, 2005). At a practical level, this means that the first day of detox may not be the best time to rely exclusively on client choice. Without rehabilitation of the power to choose and an encouragement of choice, we get, not sustainable recovery, but superficial treatment compliance. To effectively apply a philosophy of choice will require discretion and skill where immaturity, acute psychiatric symptoms, drug impairment and impaired ability to read social cues severely limit choice generation, choice analysis and capacity to stick with any personal resolution. In such cases, we must carefully plot a path between complete autonomy (total choice and clinical abandonment) and paternalism (no choice). Scientific confirmation of this stance is found in a study in which people with severe alcohol problems, recognizing their impaired decision-making capacities, preferred therapist—set goals in treatment; whereas those with less severe problems preferred self-set goals (Sobell, Sobell, Bogardis, Leo & Skinner, 1992).

Creating Informed Consumers: A philosophy of choice is viable only with persons who have the neurological capacity for decision-making, who believe they have the right to make their own choices and who are aware of and can evaluate available service and support options. Creating informed, assertive consumers of addiction treatment and recovery support services can be enhanced by: 1) affirming the service consumer’s right to choose, 2) distributing and reviewing consumer guides on treatment and recovery support services published by recovery advocacy organizations, 3) teaching service consumers how to recognize quality services, 4) encouraging consumers to visit service options before making a decision (versus taking whatever is offered them), and 5) defining the criteria by which the client and service specialist will know if participation in a particular group is working or not working (Bev Haberle, personal communication). Similar considerations need to be extended to educate the family members of those needing or seeking recovery.

There's a lot here, more than will fit into one blog commentary. The authors clearly see the main issues. They have framed the topic in a way that can lead to useful discussion and to therapeutically important program reforms. LifeRing convenors, who have been facilitating the practice of choice philosophy in recovery for a considerable period of time, will have much experience to contribute to this discussion. It is gratifying to those of us who believe that recovery by choice is the wave of the future that these concepts are now being understood, formulated, and endorsed by respected and learned voices in the addiction treatment profession.

Dealing With People Who Relapse a Lot

--- In convenors@yahoogroups.com, "fibejebe" charli883@i... wrote:

"...The truth sometimes hurts but it is still better than a load of bullshit. Any comments?" -- Fiona.

Not long ago, on LSRmail, one of our members who's been struggling with repeated day-1's since first becoming involved with LSR late last year, in referring to the response from Ellesarians to his latest slip, put up a post which included this line:

"...When I drank 9 days ago a lot of lsr's said don't worry about it, get back on your feet, move on. Should I still take that attitude?"

My response is copied here:
___________________________________________________

What attitude makes the most sense to you, XXXXX? It seems to me that somebody who's made a sincere decision to end the admittedly devastating, suicidal lifestyle of active addiction would not take lightly any episode of drinking, regardless of the circumstances.

Addiction is serious business, and the only known way to arrest it is abstinence. Lapses in abstinence, if dismissed too casually, can become seen as inevitable, or "no big deal". The danger in that attitude, of course, is that the lapses will become more frequent and last longer.

When does one cross the line from being committed to recovery and really making a concerted effort to change, back over to being resigned to a life of struggling with alcohol?

When does a pattern of slips become nothing more than active alcoholism in the form of periodic or binge drinking? I'm not sure there's a clean line there. I'm very sure the danger exists, because that's exactly what I did some years ago.
So, when I hear people suggesting that one "Don't worry about it, get back on your feet, move on...", what I hear is "Don't spend a lot of time wallowing around in guilt and embarassment, by all means stop drinking immediately, and redouble your efforts to attain stable abstinence."

What I don't hear is "Hey, no big deal, forget about it." It is a big deal. It's a failure to achieve what you set out to do. It's a disappointment, a frustration, a bummer. It's an indication that you've more work to do, that there are things you might consider doing differently. It should not be forgotten about, it should be looked at very carefully to see what can be learned to prevent it from happening again.

I guess I'd say the worst attitude one might assume in the midst of, or in the wake of a slip would be, "See? I can't stop drinking. I'm a failure. Screw it, it's too hard, I can't do this, the hell with sobriety." A much better attitude might something like, "See? I'm human, I'm not invincible, I let my guard down and got bitten hard. But I'm not beaten, I'm going to learn what I can from this and do what I set out to do for all the reasons I know in my heart I must, if I'm to live a meaningful life."

I would find it a bit worrisome that after a damn good period of sobriety you drank, then about a week later you drank again...that's a disturbing trend developing. Time to get serious, if you're serious about sobriety. And I believe you are.
_________________________________________________
And that about sums up my personal view on the question, except to add that the better I know an individual, the better feel I have for what attitude to take in my support of them. I, personally, am likely to pay more attention and actually think about what's being said if I get some straight, no BS talk (and maybe a slap or two) from someone I trust and respect. At the same time, I realize people react differently, and it takes time to get to know what's the best way to get through to somebody. When in doubt, I'll lean toward the "gentle" approach.
Rick Booth 5/30/03