This past weekend I attended the "Mobilizing Recovery Through Technology" Conference jointly sponsored by the National Council on Alcoholism and Drug Dependence (NCADD) and Joint Together Online (JTO) in New Orleans.
This three-day event brought together approximately 100 people involved in substance abuse treatment as providers, administrators, or lobbyists. There were also a number of grassroots groups doing treatment-related projects. My intent was to (1) make the LifeRing name known to these people and (2) become more educated about the issues that treatment providers face.
As to (1), I had the great good fortune to witness the historian William L. White mention LifeRing twice in his keynote plenary address on the opening day of the conference. White is, of course, the author of the book "Slaying the Dragon - The History of Addiction Treatment and Recovery In America" that I reviewed enthusiastically a couple of years ago in the BookTalk section of unhooked.com. White at that time had sent me a note to thank me for the review. As it happened, I bumped into White an hour before the opening session of this conference and he remembered the review and was very friendly and said some kind things about unhooked.com and asked me for information about our recent history. In his plenary address, he stressed that there is more than one avenue to recovery and in that context he specifically mentioned LifeRing Secular Recovery. The second time he mentioned LifeRing, he pointed me out as "my friend Marty" and I had to give a wave of acknowledgement. White is a very popular speaker and he was the only speaker at the conference to get a standing ovation.
With that kind of introduction I was assured a good reception from just about everyone at the conference, and I felt encouraged to shamelessly approach total strangers and make my little spiel. My main tool was the new "Presenting LifeRing Secular Recovery" booklet, of which I brought a quantity. I spoke to and put copies of the book into the hands of the following people:
I also gave out copies to other individuals whose names I don't all remember, including people from Vallejo, CA., St. Paul MN, New York City, and Jacksonville FL. To each of the people with whom I talked, I mentioned our local meetings in their area. I kept a stack of copies of the book and some of our handouts on a coffee table by the registration desk, and I saw these being picked up. Several people came up to me in the lobby and elevators and asked for the literature. I had short conversations about the LifeRing philosophy with a number of people over meals or during breaks between workshops, and tried to work the word "LifeRing" into the conversation as many times as possible without becoming obnoxious. I got into no arguments, managed to curb my sarcastic tongue in public the whole three days, and I believe I made a creditable impression for our organization.
As to (2), what I learned, I came away with the impression that these are times of considerable flux in the treatment profession and in the recovery movement, and that this flux creates a window of opportunity for us. Bill White's address was titled "Toward a New Recovery Movement," and it was his thesis that the old paradigm of the 1940s was exhausted and that we were in the ferment preceding the birth of a new concept, which he defined as a multi-pathway recovery model. He has written up his ideas in a new paper that he is going to modify so as to include the LifeRing name in it, and he has given me permission to post it then on unhooked.com. It is to be published in a few months in a scholarly journal. In several of the other presentations, I heard recurrent threads of concern that caught my attention, namely:
Anonymity. From a considerable variety of sources I heard dissatisfaction with the anonymity principle that is fundamental to the 12 Traditions of AA. Speaker after speaker felt that in order to persuade the American people that "treatment works," it was necessary to "put a face on recovery" and show the public positive examples of people who had recovered or were recovering. There is an effort to mount a big March on Washington in a few years, consisting of people in recovery behind a slogan such as "Treatment Works" or "Demand Treatment," and many feel that the anonymity principle is an obstacle toward this project. There was much concern with the stigma that still attaches to the alcoholic and addict, and there was a widespread feeling that recovering addicts had to come out of the closet in order to show the public that many of us can and do return to functioning, worthwhile lives.
The LifeRing consensus on anonymity is that we protect the confidentiality of other people in our meetings, but we have the option to disclose our own participation if we wish. I found that this position met with approval from people who were concerned that the anonymity rule was holding back the recovery movement. In future LifeRing presentations I will make a point of emphasizing this position as a way of attracting people concerned with the anonymity issue.
Incidentally, I also found much support for our openness to all addicts without segregation by "drug of choice." NA people, in particular, were inclined to speak bitterly in private about AA's attitude toward drug addicts, and everyone involved in treatment understood that of course the typical modern addict uses several drugs, and that it makes sense to deal with them all in the same group.
Managed Care. In the past fifteen years, substantially less public and private money has gone into substance abuse treatment, and the money that is there has been administered differently. Managed Care, the new system, has divided the treatment profession. Many treatment providers complain about the unfairness, inequities and bungling that MC has brought with it, and about the chaos that MC purse-keepers have caused in treatment planning. But MC also had its defenders at the conference. MC is identified with tracking program quality by patient outcomes, matching treatment modalities to patient needs, opening the field to a greater variety of vendors, and requiring higher professional qualifications for treatment staff. Those are not bad concepts.
Managed Care, historically, is a vote of no confidence in the Minnesota (12-Step) Model of treatment. I heard several people say that the Minnesota Model was "dead," although this surely was hyperbole. There was widespread agreement that the field was in turmoil and no one could foresee where it was going. This is a situation that creates a definite opening for us and for other alternative (non-Step) support groups. I believe that the climate in the treatment profession is going to be more hospitable to alternative groups than it has been in a long time, and that to a certain degree programs are under pressure from above to demonstrate that they offer patients choices and are "multi-modal." In future LifeRing presentations, I plan to emphasize the virtues of our individualized approach, and to remind treatment vendors that they must include alternatives to be considered "multi-modal" and therefore "quality" programs. I believe our forthcoming workbook is going to have a good reception.
Disease model. There was much discussion at the conference about the national drift over the past 15 years to criminalize the substance abuse problem and to stigmatize the addict as immoral. This is another swing of the pendulum in the historic struggle for ownership of the substance abuse problem between the penal industry and the treatment industry. Central to the treatment industry's claim is, of course, the disease model. A key luncheon speaker at the conference was David Lewis, M.D., who with three other nationally known physicians has just published a policy paper in the Journal of the American Medical Association (JAMA), reasserting the disease theory of addiction. I will be posting this on unhooked.com shortly. The authors argue, in brief, that addiction is a chronic disease comparable to diabetes, hypertension, asthma and others, and that the relapse and remission rates for addiction are no worse than they are for these other illnesses; ergo addiction treatment ought to be judged by a similar standard, and financed accordingly. This paper is likely to be important in shaping medical opinion and ultimately public opinion, and may raise the disease debate to a higher level.
The last time we debated this issue within LifeRing, we had both advocates and opponents of the disease model in our ranks. Although I tend to side with the disease advocates, my basic view is that we ought to continue to encourage a diversity of views on this issue within the organization. What the debate is about is, at bottom, whether the doctors, therapists and counselors, or the judges, prison guards and parole officers ought to control the addict in recovery. Our primary allegiance is neither to the doctors nor to the judges but to the addicts. From that standpoint, it is often difficult to tell the difference between the two approaches, particularly in the public system. Apart from the few oases of private treatment where science and clinical experience are brought to bear, many treatment centers resemble jails, and counselors blend into prison guards. I believe that the interests of the addicted are best served by continuing to make the latest findings of medical research available for study, as we try to do on www.unhooked.com, and allowing the addicted to make up their own minds whether the medical model or the penal model, or some hybrid of the two, or something else entirely, best serves them in remaining abstinent over the long term. We ought to continue to be a free-thought forum on this issue. The behavior of abstinence, the living practice of recoveries, the personal demonstration of successful solutions, rather than compelled adherence to one or another credo about the origin of the problem, ought to remain our focus.
Local Recovery Organizing. Among the most vivid memories I brought away from the conference were from three local organizing projects. In a small town in Connecticut, a local project (Connecticut Community for Addiction Recovery) mobilized people in recovery for political advocacy connected with housing, rehabilitation, access to treatment, court policy, and other issues that confront the addicted who seek recovery. In Portland OR, the Recovery Association Project linked up with several other community advocacy groups to mobilize recovering people as a local political force to promote more rational and effective community handling of the addiction problem. In Dallas TX, the Alliance of People Affected by Addiction serves as a consumer advocacy group representing the interests of recovering people and their families as distinct from, and sometimes in opposition to, the interests of treatment providers and administrators. The idea that people in recovery have legitimate opinions about how they are being treated - opinions to which treatment providers and funders must pay attention -- is a particularly innovative one in this field. Each of these local efforts stepped outside the old box of thinking about recovery, and stands as evidence of historian Bill White's thesis that there is a "new recovery movement" in formation. I don't know that we are ready, even in the San Francisco Bay Area, to take on the kind of organizing challenges that these other projects have begun, but I felt that there are important things to be learned from them in terms of putting a human face on recovery, being "out" as recovering people in the community, and speaking up for our rights and interests.
Technology. Although I got some interesting insights from the conference into the current state of the addiction treatment industry and of its problems, the "Through Technology" portion of the conference title fell considerably short of its promise. This was not a techy crowd. I was the only participant, other than a couple of presenters, to bring a laptop computer to the event. Most of the presenters used transparencies with overhead projectors. There was one video and one CD-ROM, both done by the local recovery projects. There was only one PowerPoint presentation, a competent survey of web recovery resources, by the JTO delegate Eric Helmuth. He asked for a show of hands, how many people participated in email lists, and only about eight hands went up. Eric's laboriously mounted computer lab in a hotel room next to the plenary ballroom went practically unused. It seemed to me that our little secular alternative is way ahead of the curve on the technology issue, as far as this conference went.
In the evenings, informal dinner parties formed and we went out and tasted the gastronomic delights of New Orleans. The city lived up to its reputation as a good eating town. A group of us cruised Bourbon Street completely clean and sober, and it was no big deal.
In conclusion, I want to thank Mike B. of Santa Rosa CA for notifying me of the conference, and particularly our CFO Marjorie Jones for nudging me to go and for finding a great air ticket price. Current LifeRing financial policy is that officers and directors are not reimbursed for organizational expenses, and in compliance with that policy the cost of the trip came out of my pocket and I will take it as a charitable deduction. I did, after all, have a great time and I thoroughly enjoyed myself.
-- Marty N. 10/24/00