Vol.14, No. 3
Welcome to the June edition of Tips and Topics. I’m glad you could join us this month.
David Mee-Lee M.D.
Last month I provided a few tips on “mainstreaming” people with co-occurring addiction and mental disorders (COD) into Alcoholics Anonymous (AA) and Narcotic Anonymous (NA) as support groups. If you missed it, you can check out the May 2016 edition: May 2016 Tips and Topics
There were a number of readers who took the time to write and give feedback, corrections and further suggestions. Here is their wisdom and perspectives as a follow-up.
Readers in long-term recovery share about their experience and advice
Hi, My name is Lynda and I have 31 years clean. I also am an LCSW and CADC. (Social Worker). I am very active in NA as well as AA. I agree with your article except how NA/AA may tell people not to take medication. That is an outside issue and it has been years since that kind of thought process has been around. If anyone has said it, it is rare and an individual’s opinion. Even in the recovery literature it says, “We are NOT doctors”.
Lynda K. 31 years clean in NA/AA
Thanks, Lynda for writing and for the feedback. I’m glad to hear that it is rare that anyone would say anything about medication. I know the recovery literature has been more advanced in that thinking but wasn’t sure if old-timer members had moved on.
Thanks for the info.
As a longtime member of AA, I want to thank you for a wonderful piece on integrating newcomers into the program. We have two kinds of members — those who know they have COD and those who think they are exempt (but are not) — we all have issues, whether we face them or not. Remember our expression, “some are sicker than others”! As a thinking person, I try to maintain the spirit of the Big Book and also debunk some of the nonsense that has grown up in the rooms. AA’s 12th step says “practice these principles in ALL our affairs” — to me, that means accept all comers with love, without discrimination as to what substance they used — or what “problems other than alcohol” they may have.
I read with great interest your article on Mainstreaming. I would add to your list that the 3rd Tradition of AA states that the only requirement for membership is a desire to stop drinking. I remind persons of this Tradition when I suggest AA meetings. As a long time member of AA (42 years) I have seen many transitions while still maintaining the “singleness of purpose” that helps us survive and thrive. Just as we AA’s have accepted persons with other addictions, we are beginning to hear more persons share that they have been treated for mental disorders. The important thing to remind persons attending AA is that all are welcome but we focus on our problems with alcohol in an AA meeting. If he or she does not have an alcohol problem, then another meeting is more appropriate. Every meeting is different, but my bias is towards meetings that concentrate on “recovery” – what happened, and what it is like now – with that approach the drug of choice or behavior is not emphasized.
Lynda K, Phyllis B and Susan B have between them, many decades of long-term recovery. I appreciate their perspective on newcomers with COD attending AA/NA. Just as “every meeting is different” as Susan said, different members may have different perspectives too.
Reader #4 below shares his view. I have excerpted and edited his message as English is not his first language, but I wanted to share his gratitude for long-term recovery and his perspective too.
I would like to share information on choosing 12-Step support group meetings, coming from my 15 1/2 years of experience. In choosing a 12-Step Anonymous meeting an individual has to be informed of the language of the 12-Step meeting. What I mean by that is, in certain meetings like AA you have to identify as an alcoholic to speak from the podium and they promote mainly discussing and sharing about alcohol. If you don’t speak about alcohol, a member will point that out in whatever way fits their personality and it can cause embarrassment to the newcomer.
In NA when you speak from the podium or should I say “Share your Experience, Strength and Hope” there is certain language/words that are used and their concept about the disease of addiction is different. They don’t believe “Once an addict always an addict”. They seem to believe at some time or another you are cured. Their NA booklet teaches differently from AA concepts of the 12-Step program. As for speaking from the podium in NA it is not favorable to use the word “sober”. They use the word “clean”. You are shot down, yelled at, and not in an appropriate way, embarrassed. Surely the newcomer will feel “less than” and inadequate, and probably never attend a 12-Step meeting again.
I did not read in your information about Cocaine Anonymous (CA). In their 12-Step meetings they have adopted the 12-Step program outlined in AA. The meetings are warm and welcoming, and they welcome you to come as you are. They allow you to share your experience, strength and hope in any way that is comfortable for you. You do not have to walk on eggshells in Cocaine Anonymous. “We are here and We are Free” Please visit ca4la.org. I love Cocaine Anonymous and the 12-Step program outlined in the Big Book of Alcoholics Anonymous. It got me in contact with a Power that was greater than me, that Power I choose to call God. I understand this is not a religious program but a spiritual program that saved my life after 29 years of drugging.
I am currently attending a local university completing my Masters degree as an Marriage and Family Therapist in October 2016. God is Good!
DH – “Willing to be of Clean and Sober Service”
Finding the meeting that is right for you takes some experimentation and willingness to try different groups. So when a person says, “I tried AA or NA and didn’t like it” or “It didn’t work for me”, check out how many meetings and locations they tried. Too often they respond with something like: “I went to a couple of meetings 3 years ago.”
Dear Dr. Mee Lee,
I read with great interest your article on “mainstreaming” people with co-occurring disorders into AA/NA meetings. As a recovering 12-step member with a co-occurring mental health issue – and a peer certified recovery coach who works in the addictions field – I can assure your readers that many, many people with substance use disorders also have co-occurring behavioral health disorders. People with CODs are welcome at any Open 12-step meeting, and at Closed meetings if they believe or know they have a problem with drugs or alcohol.
While several of your diagnosis-specific tips for clients attending their first meeting are on point, your suggestion that someone with Borderline Personality Disorder (BPD) work with 3 sponsors is not something 12-step groups endorse. T he problem with multiple sponsors is that the sponsee can “play” sponsors against one another, much like children play parents against the other – getting a “No” from Mom, and seeking a “Yes” from Dad. Because of this possibility, 12-Step fellowships suggest working with one sponsor.
Your suggestion to recognize similarities with others rather than differences is one of the most important things a newcomer can do. Addiction is one disease that manifests in a multitude of ways. Whether an individual abuses alcohol, street drugs, club drugs, marijuana or prescribed medications, he or she can typically identify with the feelings of despair and desperation that brings us to the rooms of AA, NA and other 12-step groups. This identification allows a newcomer – with or without a COD – to hear the life-saving message of recovery that these support groups offer.
Thank you for your ongoing commitment to the fields of addiction and behavioral health.
Thanks, Lisa, for all that information. Yes, I understand your points about the importance of one sponsor; and I should be careful as that was a bit of tongue in cheek, though a suggestion I had thought of as possibly viable. What should someone with BPD actually do? Would they just end it with the sponsor who might be burning out and start with a new one? Thanks for your advice.
Not all mutual help groups are 12-Step. Consider SMART Recovery and other groups too
I just read your article on mainstreaming people with COD into AA/NA meetings. I am an ardent supporter of SMART Recovery and urge you to refer to SMART and other alternative support groups such as Women for Sobriety and others. The 12-Step model while being around for a long time doesn’t work for many people. All too often the “keep coming back” admonition is counterproductive. If people know that there are other groups whose approach is self-empowering, the chance of achieving sobriety is increased and your helping to educate the public through your publications will help that.
I was introduced to SMART Recovery about 5 1/2 years age when I was a patient in Cincinnati. I attended regularly and after about a year I took the facilitator training course offered by SMART. I have been facilitating meetings since that time including one, which another facilitator and I started in the local county jail. In January 2015 I began a term as one of the board of directors for the SMART national organization and am now the interim secretary.
I would be happy to do what I can to promote SMART, either by providing further information myself or asking the President Dr. Tom Horvath and or Treasurer and founder Dr. Joe Gerstein to do so.
David, great advice regarding Schizoid/Avoidant personalities. I have met one or two who do well with online meetings. I’ve recently begun a SMART recovery meeting at our treatment program. Any thoughts?
My response and comment
I think it is great that you are starting a SMART Recovery group; and thanks for mentioning the option of online meetings. We need as many options as possible to give choices to match what works for people.
Two readers shared thoughts and skills coming from their long-term recovery.
Consider these tips to pass along to your clients and staff team
I’m glad you addressed the topic of introducing 12-Step (especially AA and NA) fellowships to clients with co-occurring mental health issues. I especially appreciated your specific suggestions pertinent to particular diagnoses.
Some other thoughts that seem relevant:
1. Look for fellowships in your area that specifically invite individuals with co-occurring disorders such as Dual Recovery Anonymous (draonline.org)
2. Invite local fellowships to offer Hospitals & Institutions panels at your facility. (Meeting people who attend local meetings in this way can make it easier for someone to attend those meetings because they will already find a familiar face.) Have staff available to debrief clients about how they felt about the panel afterwards.
3. If possible, take clients to some local meetings so they can become familiar with them (but be respectful: sensitive to the size of the meeting so that your clientele does not dominate it, and prepared to address clients’ possible disruptiveness).
4. Encourage clients to go to meetings together so that they can offer each other mutual support and thereby feel more comfortable than showing up in a roomful of strangers. Having one or more “trudging buddies” helps stabilize and sustain meeting attendance.
5. Demystify some of the 12-Step meeting/fellowship arcana using psychoeducation:
* How do I introduce myself during a meeting? (To avoid shaming, alert clients to language: people at AA meetings often are touchy about having participants introduce themselves as “addicts” or even “alcoholic/addict”; NA meeting members, likewise, can be feisty about participants who introduce themselves as “alcoholics.”)
* Why do people always introduce themselves, every time they speak, by adding “addict” or “alcoholic” to their name?
* What if I don’t feel like saying prayers or saying the word God?
* Why are most meetings so careful to discourage or curtail “crosstalk” and whyis this important?
* What is the role of, and what are appropriate expectations from, a sponsor?
* Do I have to say I believe in God to be a part of a 12-Step fellowship? How do Ideal with feeling excluded if I’m a non-believer?
* If I am called upon to speak by the person leading a meeting and I do not want to talk, how do I say no?
* When the (7th tradition) basket is passed for donations, how do I avoid feelingshame if I do not have enough money to contribute?
6. People who work with a substantial number of clients they wish to refer to 12-Step fellowships should themselves gain familiarity by attending an array of meetings and having the best possible working knowledge of the steps.
7. For clients adamantly resistant to 12-Step fellowships, seek out other community mutual aid groups but investigate the quality of meetings before making a referral. Some of these “secular” support groups are not peer-led and organized by traditions that curb zealotry; some of their self-selected leaders are incompetent or inappropriate.
There are a lot of good practical tips for clients and team members in what Michael G listed. Worth passing onto others.
Your tips on offering some AA/NA etiquette programming are excellent. We do a lot of that in our program, and it does help. Thanks.
Offhand, the only additional tips I would offer regarding how to prepare COD clients for AA or NA:
1. I would encourage them to focus on the truly basic reason we go, to “share experience, strength and hope.” Anything at all that departs from that central focus could be seen as a product of our merely human natures. We should practice tolerating and forgiving.
This relieves us of the worry brought about by having to memorize a list of responses to various eventualities. And it’s good practice for a sober life.
2. I encourage my very mentally ill clients to do exactly as you advised – just go. Desensitization can set in, in a positive fashion, as some of the good stuff rubs off. But, I have had schizophrenic clients’ misguided attempts to work the 4th and 5th steps, build themselves up to such a state of over scrupulous introspection, that they developed unnecessary delusions and hallucinations e.g., visualizing archangels in the sky, brandishing golden tablets and swords and whatnot. I told one guy to just stop working the steps, just “don’t drink, go to meetings, and fellowship.”
3. All my clients I advise – be yourself. Just be yourself sober. Don’t worry. Be honest, change just enough today to stay sober today, and take it easy.
My client Kevin, IQ 72, said, “I don’t understand the steps. I don’t know what you are talking about when you talk about the steps. But I know that when I drink, I get drunk, drive a car, and go to jail. So I’ll come here instead.” And all the guys with college degrees shut up and listened to Kevin.
Anyway, thanks, and nice work.
Anonymous Mike W
More good practical tips for clients and team members in what Anonymous Mike W wrote, especially in serving people with severe mental illness.
I consider myself a well-traveled, somewhat road-warrior type used to all kinds of travel situations. But…. earlier this month when I stayed at the Anaheim Marriott Hotel in California, I was blown away by the elevators. I had never seen anything like it before.
How often, in a large high-rise, multi-floor hotel, have you stood at the base of a bank of elevators after pushing the “UP” button, only to see all the elevators ascending to other floors and nothing coming down to pick you up any time soon? Or there are six choices of elevators, and you wonder which one will reach you first as you track their progress through each floor (of course when you want it in the Lobby level, it is on the 20th floor). A bell rings signaling an elevator car door has opened. You look around trying to find which one it is, only to see the doors shut. You’ve missed that one and now the process starts all over again.
This does not happen at the Anaheim Marriott (no royalties were paid for product placement in this SOUL section). Here’s what intrigued and delighted me:
If I didn’t explain that very well, through the wonders of the internet, I found this link that explains more (if you are really into this): Thinking outside the elevator box
Every time I used the elevator that conference week, I remained equally impressed with the efficiency and effectiveness of these new “magic” elevators. Want the 10th floor? Just punch in “10” and very quickly the elevator was whisking me to the 10th floor. No floor number buttons to further search and press inside the elevator. No missed elevator cars because the mini screen told me which of the A – F doors to wait for and where.
This may be way too much information about a silly little elevator story. Perhaps this is something you probably have to touch and experience for yourself to get the full impact. But for an old road warrior, who thought he had seen just about everything USA hotels had to offer, this was a truly novel experience.
Next time you visit a high-rise, big city hotel notice how inefficient the elevator experience is – unless, that is, you are at the Anaheim Marriott Hotel, California or the Sheraton in downtown New Orleans. (Now I’ll hear from scores of readers who’ve seen these elevators for years and I’ll know how naïve I really am.)