I recently read an article entitled, “The irrationality of Alcoholics Anonymous.” In it, the author ascribed to the 12-Step way of life beliefs, a philosophy, and practices that are often discussed by individual 12-Step members but certainly not “Conference Approved” as any official tenet of a 12-Step programs must be. There are over a hundred12-Step programs. Most are modeled on AA who generously offered the use of their steps and traditions as public domain to any who might need them. Conference approval, or similar vetting processes in fellowships other than AA, means that the item in question stands for all of their particular membership. There are 12-Step groups in India, China, South America—in fact, all over the world who have won the right to call themselves by the name of the parent organization because they band together for mutual help, avoid using a specific substance or substances, and carry a message of hope to others who wish to stop excessive use of those substances.
I am a Certified Alcohol and Drug Counselor, having assisted two states in establishing the protocols for establishing that profession. In full disclosure, I am a recovering person with nearly 35 years of recovery which I define as not having to use, a day at a time. Early on in my 43 years of professional practice, I saw 12-Step programs in the same yellow light as that running in the article. I told persons that I counseled that they could overcome their addiction and put it behind them if they would just do as I suggested. I downplayed the need for using 12-Step recovery programs. I did not have the experiences, then, that I have now. I have come to realize that the disorder called addiction is progressive. I have seen evidence of that in family members who stopped using only to pick up again, later, and be quickly slammed into the worst physical and mental health that they had ever experienced, as if their period of recovery had done nothing to restore them to health.
Eventually, I turned to a teetotaling substance use disorder counselor by the name of Colleen Dill working in a community mental health setting, for help, with an out-of-control addicted family member. I name Colleen here because I have lost touch with her and would love for her to know the immense difference she has made in my life and the lives of those I love. She surprised me when she referred me to a 12-Step program for family members of addicted persons, When I refused to attend, on principle, she refunded my fee money, sent me home, and suggested that I only return when I had tried the program “in good faith,” and could show her proof of my attendance! After working with her for two years and attending those meetings, I surprised her by owning my own addiction and began to attend those other meetings. All these years later, my family member continues to struggle with attempts to control the damage done by use of substances, perhaps because of my initial self-righteous heavy-handedness before I sought help. I have had to learn a thing or two since I tried that approach, Colleen was my first teacher.
12-Step programs have a policy of being “friendly with our friends,” namely doctors and addictions counselors. Some recovering individuals are so grateful to escape sure death that they will advise anyone to stay away from doctors and drugs…blaming people and substances rather than genes, habitual access, and environmental influences for the problem. For me, the thought of using was more comfort than beginning to open the bottle for another run: I knew I would have to sober up, sooner or later to pay the bills. Personally, I was just happy to find something that rescued me from the awful connundrum of loving the thought of a feeling I could no longer find, in using my chosen poison.
What strikes me as irrational today is the consistent 12-Step bashing, done by professionals, of programs that make no claims on having the market cornered. It has been my experience to see many folk try that way of life and move on. It has also been my unfortunate experience to see folks try it, find nothing else helpful, and die miserably from the effects of untreated addiction. Nor are those 12-Step programs “in the market.” That is precisely what makes them affordable to a huge segment of our addicted population who arrive at treatment penniless. (The standing joke is: “Are you kidding, If I had any money left I would have bought something [to use] instead of coming to…” a 12-Step program.) 12-Step programs will not even debate their beliefs in a public forum to avoid the taint of self-promotion, preferring person-to-person recommendations. Even their PSAs are a new development and very low key, meant only to be informative.
I believe that most treatment is out of reach of the newly recovering person. Several years ago, national medical coverage was provided to persons with addiction who were disabled by virtue of their addiction. And they were required to get help to keep their income. Congress soon realized how expensive that proposition was going to be and rescinded that rationale for disability. Today, addiction is the leading killer of every segment of our population. The Affordable Care Act has opened some treatment doors, and promises to open more. Many treatment centers and providers are still scrambling to position themselves as providers under the ACA. Given our experiences from the days of the Welfare Reform Act (that relied on Congress to see the importance of covering addiction treatment costs) we must not rely on government largesse to fund this growing health care problem.
I propose that we find a way to fund treatment outside of the traditional medical funding streams. I suggest legislation that creates an entity, similar to Social Security, funded by a dedicated premium from drug sales, including alcohol. In this way, users of substances would begin to pay the freight for whatever problems might occur from the drugs used. This entity would underwrite all addiction treatment as a standard of coverage in all health and accident insurance. Addiction treatment, at every level, must have a dedicated fund, safe from easy manipulation by a marauding Congress bent on covering its excesses. The Substance Abuse & Mental Health Services Administration would become incorporated into this entity, and cease relying on special Congressional funding initiatives. This entity would regulate treatment and treatment providers according to researched and proven protocols, to assure the efficacy of treatment. This funding must be available to all residing in our borders. It’s that, or prepare to watch as our families suffer terrible losses from deaths caused by addiction.
12-Step programs are self-supporting. Are the rest of us who hope to help in that arena prepared to shoulder all of our own costs? If not, we may want to be friendly with our friends in finding a new approach to substance use disorder services funding. People who live in glass houses should not throw stones…it’s irrational.