Recovery from Addiction: A Practical Guide to Treatment, Self-Help, and Quitting on Your Own

Books reviewed by Diane Jeanette

In the Winter, 1996 issue of the Journal of Drug Issues, Robert Granfield, a sociologist, and William Cloud, a professor of Social Work, both of the University of Denver, published a 15 page article called "The Elephant that No-one Sees: Natural Recovery Among Middle-Class Addicts." It was a nicely done report on the results of in-depth interviews with 46 survey respondents who had all terminated addictions without formal treatment AND without joining self-help groups.

The authors reported that their subjects had not, for the most part, chosen "addict" or "postaddict" identities, but preferred to view their addictions as "problems they had once had but had now solved." The 46 had avoided treatment and AA/NA because they disagreed with the ideology of "powerlessness," disliked the disease model, found the religious content of the programs offensive, and generally found 12step groups "dependent" and "unhealthy". In addition, most believed in their own abilities to terminate substance use "on their own" and felt strongly that focusing on weaknesses and defects would be counterproductive and shaming.

In the final section of the article, the authors pointed out that their respondents were all employed middle class or stable working class individuals with adequate educations and usually some strong personal relationships. These self-recoverers were almost certainly able to self-recover at least in part because they had external social and economic resources available to them.

This is interesting stuff. If you've ever battled with an addiction or been up against the 12step monolith it's positively fascinating stuff, and you might think there would be a good book in it. Well, Granfield and Cloud decided to spin this material into not one but two books: a scholarly sociological tome and a "popular" guide to various treatment methods.

Unfortunately, they have made bad choices in the presentation of this material almost every step of the way, in both books. Of the two, I would recommend reading Coming Clean, provided you are willing to skim or wade through slabs of the sort of discussion of the literature that is clearly intended to impress, or at least to exhaust, a promotion and tenure committee.

While it is impossible to doubt their sincerity and their interest in helping addicts, it is equally impossible to commend their writing abilities. When you read, in the Preface, that "The title, Coming Clean, denotes two distinct meanings. First, we use it as a way of invoking the popular metaphor for the process of terminating addictions. However, we also use this phrase as a metaphor for lifting the veil of secrecy surrounding the fact that most people overcome their addictions without ever entering formal treatment or participating in 12-step groups such as Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous...." you are reading their prose at its best.

Coming Clean does, however, quote from and analyze those 46 surveys extensively in Part One, "Perspectives on Natural Recovery," and this material is worth wading through. Expanding on their 1996 article, Granfield and Cloud devote chapters to the process of addiction, the "conversion experience" (sociological definition) that leads to and powers early recovery strategies, and their subjects' attitudes toward the "disease concept" and self-labeling as "alcoholic" or "addict."

The last chapter of this section gives the authors' perspective on the social capital that facilitated their subjects' escapes from addiction: "The experiences of our respondents, who subscribed to an individualistic ideology of recovery, actually attest to the importance of the social relationships that surround and envelop them."

Part Two, "Implications of Natural Recovery," is largely devoted to the argument that this social capital should be considered "recovery capital," and treatment policy implications that might flow from this. Somewhat oddly, while the authors are clearly excited by "natural recovery" and disdain traditional treatment, they fuss repeatedly about their fear that their research will be used by those who want to abolish traditional treatment.

Granfield and Cloud plainly sympathize with their subjects' decisions to "resist disease-based significations of the self" and reject "the pejorative genealogies of the addicted self." They take some predictable and mostly deserved swings at the "hegemonic discourse of disease" and are fashionably skeptical about the necessity of abstinence in recovery. This attitude, however laudable, may have caused them to miss a real chance to ask some interesting questions, however.

Over 92% of their subjects chose permanent abstinence as the solution to their addiction problems. Given that these are subjects who furiously reject the disease model, deny that they are "recovering" or in any danger of relapse, and have no use for AA, how did the overwhelming majority among them come to decide on abstinence, as opposed to controlled use? And how do they construct satisfying identities as permanently abstinent but NOT permanently "recovering"?

Unfortunately, Granfield and Cloud are not interested in the issues surrounding the choice of abstinence as such, and indeed downplay the abstinence choices of their subjects, apparently because in their eyes "disease model" = abstinence only; "scientific model" = variety of outcomes. The 92% who chose abstinence and the 8% who chose moderation are all referred to as "natural recoverers," and no distinctions are discussed.

Nor does it seem to occur to them that people who don't believe addiction is a disease but yet choose to abstain instead of moderate probably try to explain this to themselves somehow. As a result, the book is rather baffling at times, as the authors push for a variety of outcomes model that is in fact unsupported by the data they have gathered.

Coming Clean is far from excellent, but it is worth reading, if only to meet the interview subjects who solved addictions by acting on their beliefs that, as one of them said, "it's your own sense of self and your own power over yourself and what you choose to do that matters."

Having buried interesting material in an impenetrable scholarly style in their first book, Granfield and Cloud (now Cloud and Granfield) proceeded to dish out pedestrian material in a wooden style in their second book, Recovery from Addiction. Presumably, what they started out to write was a how-to book on natural recovery -- an expansion of the miniature self-help guide they included in Coming Clean as an appendix. Why they, or their editors, decided that two authors with no liking for traditional treatment should combine a discussion of natural recovery with a plodding guide to traditional treatment is anyone's guess.

In addition, the authors were clearly ordered to offend no one in the treatment community (the largest potential market for "recovery books"). The result is Part One of this book, which contains little that is specific enough to be useful, although there is a nice short guide to alternative methods and their websites. You can learn, with some effort at parsing rambling sentences, that most inpatient treatment is 12step, that some people don't like AA because it seems religious to them, and that insurers would rather pay for outpatient treatment because it is cheaper. All of this in a style rather worse than the average email.

Here are Cloud and Granfield on the "group interview" process at a therapeutic community: "The experience can be more of a function of who happens to be a resident at the time of the interview than on [sic] the ability of the applicant to demonstrate a need for and willingness to comply with treatment demands." Here are Cloud and Granfield on estimating addiction severity: "If you or the person your [sic] are attempting to help are regularly injecting drugs, chances are that you or that person has a fairly serious problem or will soon have one if injection continues."

The authors themselves seem to suspect that they have not contributed much to the topic. At the opening of chapter 8, "Selecting an Approach that is Best for You", they actually warn the reader twice on the same page to go back and read the beginning of the book: "Before starting, we want to emphasize the importance of your having familiarized yourself with the other material presented earlier in this book. While you may find the suggestions offered in this chapter helpful without exposure to that content, these recommendations will be of limited value if you have not read chapter 2 through 7....If you are seeking assistance for another person....your friends, relatives and neighbors who might provide this kind of information are generally unaware of the serious kinds of treatment and self-help issues discussed in chapters 2 through 7." This chapter does contain a useful list of 10 questions to ask a treatment provider, but you deserve a medal if you manage to read that far.

Part Two, "Quitting on Your Own," is somewhat better. Much of it is lifted wholesale from the Appendix to Coming Clean, but as few people will persevere to the end of that volume, this makes little difference. Cloud and Granfield are encouraging about self-recovery, and make sensible suggestions concerning such subjects as "health and nutrition" (pay attention to it), "work" (do interesting work if you can get it), "physical exercise" (helps a great deal in early recovery) and "insomnia" (don't lose sleep over it). Granfield and Cloud are especially sensitive to the problem of stigma and the reluctance of people to identify themselves as addicts, and they offer some commonsense advice on disclosure. Their comments on "the Challenge of Moderation" are cautious, and respect their research results. Part Two, taken alone, is certainly not a complete guide to self-recovery, but it is a pretty good introduction.

The authors thank their editor, which makes them either the most courteous or the most oblivious of authors. The book is execrably edited throughout: principle for principal, discrete for discreet, and lack of attention to subject/verb agreement. The founder of Addiction Alternatives, Dr. Marc Kern, is "Marc Fern" in the text and "Mark Kern" on the cover blurb. And the endorsement from Jeffrey Schaler, while enthusiastic, has nothing to do with the actual book, which should have been apparent had he even read the subtitle. There was a very good book in there somewhere. I wish the authors had written it.