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

LifeRing Service Center, Press, Move to New Office

A Place Of Our Own
Marjorie posts temporary door sign on our new home.	Gillian gets high on the ladder to brighten up the ceiling.	Chet makes like Tom Sawyer whitewashing the fence.
Chet and Marjorie assembling the rubber-like steel shelving.	Ta-daa! Ready to hold boxes of LifeRing Press books.	Syl fights off the great white cardboard box shark.
Lloyd, George and Ellen get down with the shipping desk.	It got pretty chaotic sometimes but, heck, we're used to that!	Chet prepares to tape Mark.
Lloyd, George, Marty (in rear), Chet pile the wagons high.	Laurie and Mark ham for the camera..	Marylou helps put things back together the next day.
	During the week of April 7-13 '03, LifeRing Press and the LifeRing Service Center moved to new office space. Lots of volunteers made the move short work and a good time. The new space is bigger and more versatile, and more important: it's all our own! Please mark the new mailing address: LifeRing 1440 Broadway Suite 312 Oakland CA 94612-2023 The phone number, fax, and email remain the same: Tel: 510-763-0779 Fax: 510-763-1513 service@lifering.org (Service Center) publisher@lifering.com (Press) Come to the Office Warming Party May 23, 2003
Caroline gets the shipping desk ready for action. She also repaired the supply cabinet.

People Develop Commitment Through Having Choices: A Lesson From Harvard Business Review

Somehow a copy of Harvard Business Review landed in my office and I started reading it on my commute train. The following article caught my eye and I want to pass along some points it makes.

Richard Chase and Sriram Dasu author a cover article titled "Want to perfect your company's service? Use behavioral science." (HBR June 2001, p. 79, click to read it online). They try to apply decades of behavioral research to illuminate what the service experience feels like to the customer. Here are some main points:

(1) People remember the start and the end of the experience more than the middle, but they remember the end most of all. Therefore, to bring customers back, service providers should end on an upnote. Can we learn from this principle in our context? Many of our local meetings end with a round of applause. This is a feel-good experience and provides an upbeat ending. Score one for us.

(2) If there is bad news, get it out of the way early. At a recent meeting it was known that one member had had a relapse. When the opening statement was done, the meeting convenor could have started the check-in ("how was your week") to his left or to his right. Instead he went straight across the room to the member who had relapsed and asked him to start off the discussion. Good move. The meeting processed the bad news early and ended strong.

(3) People desperately want things to make sense and will concoct an explanation when none is available. In the recovery context, the atmosphere is filled with "explanations" derived from the religious/spiritual 12-Step movement. If we don't step in with our own secular explanations, people will fall back on what's available, even if it's counterfactual or meaningless under scrutiny. Lesson: convenors who study and develop a deeper theoretical understanding of secular recovery principles can fill the vacuum and help people make sense of their experience in a rational manner.

(4) People develop commitment through having choices. "A fascinating study found that blood donors perceived significantly less discomfort when they were allowed to select the arm from which the blood would be drawn. The lesson is clear: people are happier and more comfortable when they believe they have some control over a process, particularly an uncomfortable one. Often the control handed over is largely symbolic (as in the choice of arm). In other cases, it's very real: the medical profession has long recognized the value of allowing the patient to make an informed choice about alternative treatments for cancer and heart disease. These are extremely important, high-stakes decisions, and great value is gained by including the patient in the decision. He or she feels less helpless, less hopeless, and more committed to making the process work." (p. 83).

In a nutshell, our approach of telling the person new in recovery that they have a choice and that they have the power to construct their own personal recovery protocol is sound in principle, with clear support in motivational research. The contrary approach -- telling people that they are helpless and have zero power to choose -- is a substandard, unsupportable practice. Our approach develops and reinforces the most important single ingredient in a person's recovery over the long term: the inner commitment to succeed.

It's always good to learn that we're on the right track, even if the stroke comes from such an improbable source as HBR.

Literature Racks Can Offer the Person in Treatment a Choice of Support Groups

On any given day an estimated 900,000 people in the U.S. are in treatment programs for substance abuse. Most of those treatment facilities have literature racks for their patients/clients. Most of those literature racks carry only one kind of literature -- the 12-Step kind. It doesn't have to be so. Literature racks in treatment programs can offer the person in recovery a choice, and can bring people to our LifeRing meetings who would otherwise never have known about us.

Here are some photographs of literature racks in treatment facilities where LifeRing brochures are available. The rack at the right is a standard commercial 12-pocket plastic wall display, mounted in the dual diagnosis ward at Herrick Hospital in Berkeley CA. A small selection of the omnipresent AA literature is in the top row. The five main LifeRing handouts are in the bottom row. Do you recognize them by sight? They are from the left, the San Francisco Bay Area meeting schedule (ivory), the unhooked.com brochure (blue), and then the "3S" trilogy: Sobriety Is Our Priority (green), Secular Is Our Middle Name (gray), and Self-Help Is What We Do (pink). This rack has an empty pocket just waiting for our next brochure.

The next picture shows a custom-made wooden wall rack mounted in the Merritt-Peralta Institute, a 28-day inpatient program, on the 5th floor of Summit Hospital in Oakland, CA This rack was built for full-sheet (8 1/2 x 11) handouts, and standard trifold brochures like ours pretty much sink out of sight into its pockets. Staff assigned us the top rack, and our handouts were all but invisible until a clever friendly patient stuffed a towel into the bottom of the bin so that our pieces would be seen. There isn't enough room to display all the brochures, but it's better than nothing. As in most treatment facilities, the meeting schedules are the fastest-moving items. This rack generally presents a somewhat messy appearance, and I can proudly say that our own shelf usually gets tended to more often, and is more up to date, than that of many of the other organizations with whom we share the rack. Some of the other bins have literature three years out of date, and some have stood empty for months. When we run out of LifeRing meeting schedules in this rack, I usually hear about it immediately, and if I forget to bring a resupply some week, I get raised eyebrows.

The next rack is at the Chemical Dependency Recovery Program of the Kaiser Permanente HMO in Oakland. It's a clear plastic six-pocket commercial rack, available at office stores, that is designed to stand freely on a table. In this treatment facility, AA has a large wire literature rack with space for about 24 different brochures, but there is no place for that rack other than down on the floor, where it's hard to see and presents a trip hazard. For a while we stuffed our brochures into some of the empty pockets in that rack but this didn't seem right. Finally LifeRing member Syl S. hit on the solution of buying our own rack, the cost of which she generously donated. Syl originally obtained a wall rack similar to the first one shown above, but staff denied permission to mount anything on the walls, citing fire regulations. But staff had no problem with a table rack. The display is positioned on a side table within easy view and reach of patients seated in the waiting area near the reception booth of this outpatient facility. Syl made a bright neon label for the front. We use two pockets for meeting schedules here because of the heavy demand for that item. Having our own rack, and such a nice looking one in such a favorable position, is a very pleasing thing, and the literature in it moves at a steady clip into patients' hands.

Last is a single-pocket standup rack -- also a standard office supply store item -- that holds meeting schedules. A label on the rack tells what is in it and gives the Service Center phone number to call for refills and information. We are experimenting with placing these racks in churches, coffee houses, grocery stores and other appropriate sites, wherever someone volunteers to keep them refilled. If you want one of these racks and are willing to keep it supplied, call the Service Center at 510-763-0779.

Literature racks can reach people when you're not present. They never sleep and never go on holiday. They offer their freight of wisdom and support without commentary or attitude. But they are only as good as the hand that fills them and tends them. A literature rack reflects on the organization. A rack that long stands messy or empty bespeaks an organization that has stopped caring or has sunk into chaos. A rack that regularly gets tended and refilled testifies to an organization that has its act together and that cares about people and wants to be approached. Getting our literature into literature racks in treatment facilities is not always easy. In many cases, permission to stock literature comes along with permission to hold a meeting on the facility, and not before. Thus the literature in the rack helps bring people to the meeting, and the people in the meeting help resupply the rack. But in other cases, we can get literature into a facility before we have a meeting there, on the ground that the patients are looking for meetings anywhere in the community and have an interest in our area-wide meeting schedule. A number of patients in treatment facilities do not obtain any benefit from the traditional 12-Step approaches, and live in a state of frustration or despair because they are unaware that there are other roads to sobriety. A well-stocked literature rack with LifeRing handouts in it can be their first news that other choices exist. I know people who say that they are still clean and sober today because they found LifeRing from a handout in a literature rack. Getting LifeRing literature into treatment center literature racks presents many patients for the first time with a choice of recovery paths, and saves lives that might otherwise be lost.

A Sample Letter to Local Referral Sources

This sample is based on a letter that Sue G. sent out to substance abuse treatment providers in the Buffalo area when she opened the meeting. It has generated a good response, and the meeting receives referrals from some of the providers. It proves that letters of this type needn't be complicated. It probably didn't hurt that Sue G. is herself a social service professional with name recognition in the local service provider community. -- Ed.

Dear Service Provider:

I am writing to introduce a new self-help group to your agency. SOAR (Secular Organization for Addiction Recovery) is a local group for people suffering from addictions, which is based on the principles of LifeRing Secular Recovery.

SOAR is an alternative concept that doesn't use the twelve-step philosophy in addiction recovery, rather, it is based on individuals using self-help and learning through experimentation. Steps to recovery are not the focus, but total abstinence from the addictive behavior is the goal. This philosophy recognizes that there is no set pathway to recovery, that no one approach will work for every person. Group members are encouraged to share with each other what works for them, and members can pick and choose their own approach to staying clean and sober.

I have enclosed some more detailed information for your perusal. Please feel free to copy anything that you would like to post or hand out, and to call me at the number on the flier if you have any questions.

I am looking forward to hearing from you.

Sincerely,

Susan J. Gibbons, Convenor

Posted 11/26/00