By Kate SugdenGabor Mate, the renowned Vancouver based addiction physician, states that fewer than 5% of his patients in Vancouver’s Downtown Eastside overcome their heavy, and often multiple, drug addictions. But addiction is not always as extreme as having to have several hits of heroin and cocaine every day. For the average addict, the odds are hopefully a little better.
Most, if not all, addicts go through a denial period in which they fail to recognise that their consumption of whatever substance has become a problem, followed by repeated attempts to change their habit, which ultimately end in relapse. Friends, family and professionals make the comment that the person will only recover when they are truly ‘ready to change’ – at which point they will be handed over to some rehab program, where presumably some therapeutic magic will happen. This is how recovery is usually represented in the media, in shows like Intervention, where the story ends as soon as the person agrees to get treatment. An alternative version of the show could begin with the person deciding to seek help, and follow them for years as they try different treatment programs, cycling in and out of recovery and relapse, although that might not be as entertaining as watching an hour of their most shocking pre-intervention behaviour while their family complain about them and everyone cries.
Probably the most well-known intervention for addiction is the 12 step model, used by Alcoholics Anonymous, Narcotics Anonymous, Co-dependents Anonymous, and so on for every other addiction ever identified in large enough clusters to get a group started. According to the Canadian Office of Made-up Statistics, at least half the people reading this article have attended a 12-step meeting of some kind. So what were the steps again?
The original 12 steps of AA are:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory, and when we were wrong, promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Note therefore that one prerequisite for recovery through AA is belief in God, but also pay attention to steps 4 to 10, and their reference to ‘moral inventories’, ‘defects of character’, ‘wrongdoings’ and so on. How is that going to go down for someone whose addictions are the direct result of wrongdoings onto them, such as child abuse and oppression for example, like, you know, 100% of Gabor Mate’s patients? It might not go down too good.
In 1991 a feminist psychotherapist, Charlotte Kasl, proposed an adaptation of the 12-step plan, which includes a more balanced reference to past wrongdoings:
- We make a list of people we have harmed and people who have harmed us, and take steps to clear out negative energy by making amends and sharing our grievances in a respectful way.
The acknowledgement of harm done to as well as by the addict can provide the validation needed by many that their addiction has its roots in past events – it is not All Their Fault. The stigma of moral failure is removed from addiction, and a focus placed on empowerment, rather than responsibility, to change.
Advantages of programs like AA include the social support gained from group sessions, being sponsored (a form of personal mentorship) and sponsoring others, free cake, and having someone to go to the pub with after meetings. But what are their actual success rates like? It’s incredibly hard to say. What constitutes success? Abstinence? Just showing up? There are so many different step-wise recovery groups out there, so many ways to define recovery, and so many individual experiences, that it’s hard to know how to start collecting the data, never mind drawing meaningful conclusions from it. Furthermore, when the statistics do show a relationship between group attendance and recovery, it is hard to know whether people recovered because they joined AA, or whether people joined AA because they were already recovering.
In one sample of over 4000 American alcoholics, of whom one quarter had sought help for their addiction, those who had both attended 12 step groups and received formal treatment had the best outcomes, in terms of either abstinence or cutting down their drinking to less problematic levels. People who attended 12 step groups were the most likely to become entirely abstinent, which figures, as that is the prescribed goal in such programs, and those in recovery from more severe alcoholism were more likely to become abstinent compared to those who had been less severely dependent, who were more likely just to cut down. In other studies, more middle-aged than young people either cut down or became abstinent, and either quitting or cutting down often followed life events like getting married or finishing university. In a 3-year study, those who quit drinking entirely had lower relapse rates than those who just cut down, but this difference got smaller with age, and older people also relapsed less often than young people overall. Basically, some people just kind of grew out of it, including many who did not attend any groups or therapy.
In the world of heavy and multiple long term addictions, in which Mate states that full recovery is unrealistic for over 95%, he and most other professionals focus on reducing the harmful impacts that addiction has on an individual. The Harm Reduction model states that relapse is part of recovery – it is expected, time and time again, and it does not constitute failure. Any decrease in substance use, or positive change in health or behaviour is recognised as a success in itself. If someone goes from smoking crack 31 days of the month to only 25 days, this is a positive outcome. The focus on what’s realistic allows small improvements to be recognised and protects against giving up hope when ideal outcomes are impossible. Unsurprisingly, considering the deep-rooted psychosocially initiated, biologically perpetuated causes of severe addiction, there is no treatment yet available that can make people ‘ready to change’.