Clients Power Cincinnati Recovery Center

“I hate A.A.!”

Jay Stahl hears that from time to time as an addictions counselor, but his clients learn it’s no way to bond with him.

“Be specific” is his reply. “Let’s talk about what works or doesn’t work for you about A.A.”

If the client has attended A.A. meetings where the group members seemed out of touch with his/her concerns, Stahl points out that any peer support group will have its own character, strengths and weaknesses. If the personality mix at a meeting wasn’t a good fit for the client, Stahl may recommend other A.A. meetings that could fit better.

“I’m not powerless.” “I’m not an alcoholic.”

Stahl welcomes these sorts of specifics. They are conversation-starters, not symptoms, in his work as a clinician.

So, Sharon feels responsible and empowered, but wants help asserting herself to quit drinking. Or, Shawn shuns the “alcoholism” label, but is ready to talk about solving the problems his drinking is causing. And, Mike resists committing to much of anything, but promised his wife he would talk to somebody.

Empowered recovery resources in southern Ohio

Stahl is the Executive Director of the Recovery Resource Center, Inc. (RRCI), which provides abstinence-focused care and support in Cincinnati. The RRCI is the brainchild of John Salter, a social worker and addictions care expert who is also an advocate for Rational Recovery, a self-directed approach. He told a bit of his recovery story to Cincinnati weekly CityBeat in January 2003.

Salter envisioned using a mental health model consistent with his social work background in which a Sharon, a Shawn, or a Mike would get help that would:

• Meet them where they’re at.
• Treat them as whole beings, not single problems.
• Place the severity of their drinking on a scale from use to abuse to dependence.
• Identify mental health, relationship, and any other issues or concerns without presuming that addiction is always the cause of the others.
• Empower clients to make informed treatment choices, which might include any of:
  • 12-step meetings,
  • psychotherapy,
  • relationship counseling,
  • Women For Sobriety,
  • SMART Recovery®,
  • LifeRing Secular Recovery,
  • personal practice of Rational Recovery, or
  • other self-directed recovery.

Salter spent 5 years providing services from his basement, in addition to his full-time social work job, starting in 1996. He also spent that time collecting support and funding to open the Recovery Resource Center.

The alternative recovery community in Cincinnati helped Salter build a coalition along the way. Local affiliates of SMART, Women For Sobriety, and LifeRing were already active in the area, and leaders from each stepped forward to serve on the RRCI board. (The RRCI website includes a side-by-side breakout of the high-level distinctions between AA and these alternatives.)

Stahl was brought on board as director in November 2001. The center opened in December, offering a resource library, office space for one-on-one services, and a conference room to host meetings. Early in 2002, the RRCI hosted author Anne Fletcher, as told by the Cincinnati Post, to deliver a couple of lectures.

Jay Stahl’s recovery: Outside the box

The email message I got from RRCI director Jay Stahl in response to my request for a phone interview was friendly:

    From: Jay
    Sent: Monday, August 16, 2004 10:31 AM
      To: Steve Boese
 Subject: Re: Kudos on your services and your website

---

Steve,
Thank you for the kind words — and the link. Please call me … I’ll answer all your questions and maybe even share tidbits of my own (17-year) recovery story. Jay

And yet, to be honest, the whole sharing-our-recovery-stories thang is a little unnerving to me. I can appreciate that Amazing Grace-style “‘twas drunk but now I’m sober” testimonies are heartfelt and real for a lot of folks, but the implicit “you are lost and need to be found” message that often follows them is a turn-off.

It turns out I needn’t have worried. As his September 2003 remarks show, Stahl has seen tough times yet leaves melodramatic hitting-bottom and recovery-as-redemption allusions behind when telling his story.

He chose to quit because drinking was getting in the way of making other changes that mattered to him. A therapist helped him work through issues related to troublesome family dynamics that had preceded and perhaps catalyzed the drinking problems. An avid reader, he dug through books on addictions, relationships, and coping skills. He leaned on friends who modeled the type of person he wanted to be. He also dealt with shades of panic and obsessive-compulsive issues along the way, in each case finding answers from a mix of professional care, peer support, looking at the evidence, and taking responsibility for his mental health.

In the 2003 remarks, he expressed gratitude for friends who supported him:

Their qualities — unconditional love, empathy and understanding, validation and acceptance — nurtured in me the needs of my soul — human dignity, personal liberty, hope and empowerment.

This in turn has allowed me to construct the core of my character — a core which includes responsibility, self-reliance, authenticity, and integrity.

Not yet credible after 17 years?

When he speaks to groups about recovering outside the 12 Steps without relying on a disease model of alcoholism, the pushback has become familiar to Stahl.

“You must not have been an alcoholic” is one of the responses that frustrates him, not so much because of the challenge to his former drinking problems — few alcoholics hit bottom homeless-in-the-gutter style anyway — but because it marginalizes his recovery.

The RRCI doesn’t teach its clients that alcohol itself is an inherently cunning beast, and Stahl doesn’t find a one-size-fits-all disease model of alcoholism to be necessary in his own recovery.

“Then why don’t you just drink?” is a common response when he explains this.

If he chose to cap off a hot day of lawn mowing with a single beer, he isn’t convinced it would catapult him into personal ruin or begin a steady progression to insanity or death. The basic issue with addictions, he notes, is that an attachment to a habit persists despite repeated negative consequences. If he chose to drink, being responsible would need to include consciousness of potential attachments and consequences. While there is no sure way for him to know whether moderate drinking would be viable for him apart from testing it, he doesn’t seem to be interested in finding out.

As he talks about it, his relaxed confidence speaks to a sense of contentment that abstinence is his genuine choice, a proven and joyful path for him, more than his only redemption from dire consequences of the alternatives. That choice also put him squarely in sync with the first of the fundamental principles driving the formation of the Recovery Resource Center: “Abstinence is the best route to recovery.”

And, it bothers him that recovery outside a 12-step model often isn’t accepted as valid or credible, even for a clinician like himself with 17 years of continuous sobriety.

“An incredible uphill battle” for recognition

The Recovery Resource Center’s struggle for recognition and referrals mirrors Stahl’s personal attempts to be integrated and included in communities of recovering folks.

Stahl and Salter have worked to build bridges between the RRCI and public and private addictions policy, education, and treatment groups. Despite making themselves known, they receive few referrals from local agencies, even from those supported by public funds. They have developed their own networks with peers to publicize and promote the RRCI’s educational seminars for addictions professionals after finding that many of the existing communication channels are not receptive to them.

John Salter noted to a CityBeat reporter in 2003:

The four non-traditional programs supported by RRCI have existed for about 15 years, but many of the most influential people in the field of addiction care don’t want to hear about alternatives.

Even the Addiction Studies program at the University of Cincinnati seems to tread lightly, if at all, into the topic of Women For Sobriety and other alternatives to 12-step programs.

It can be bewildering. SMART Recovery and Women for Sobriety have been recognized by the American Academy of Family Physicians. The National Institute on Drug Abuse (NIDA) cites SMART side-by-side with 12-step programs as a valid self-help option, and, after being proven effective with adolescents and in correctional settings, SMART has been adapted for those uses, drawing federal funding in seven digits. It’s hard to make sense of the gap between credentials like those and the barriers to getting the word out about them.

Creating their own system

When it opened, the Recovery Resource Center hosted 3 support meetings per week: One each for Women For Sobriety, SMART Recovery, and LifeRing. Today they’re up to nine.

Stahl says they started out with a vision of becoming an integral part of the addictions care system in southern Ohio, collaborating with local agencies and building up referral traffic between themselves and outpatient and inpatient treatment providers.

The model has evolved, though. Frustrated with limited results after working within the existing system so far, the RRCI is staking out a more assertive role for themselves. They have recently achieved state certification as an outpatient treatment provider and are increasing the availability of certified staff to work one-on-one and in groups with their clients.

They intend to get their options listed with the courts so that clients required to seek alcohol-related care in the wake of being arrested or convicted of driving under the influence will have options.

The plan is to deliver solid, evidence-based treatment and measure its outcomes. Stahl is confident about demonstrating the RRCI’s effectiveness and substantially expanding its base of satisfied clients.

Common recovery processes, but distinct barriers

One of the intriguing things Stahl sees in the addictions field is that core recovery concepts and language are shared by most professionals, peer support groups, and programs: Each promotes getting well, giving up bad habits, examining values, developing healthy coping skills, and getting whatever help, support, and information is needed.

However, the distinctions between disciplines create most of the barriers to folks getting help. That is where he sees the power of offering options. As a clinician, Stahl’s approach doesn’t vary much toward clients who choose 12-step, SMART Recovery, Women For Sobriety, or self-directed approaches.

The program-to-program differences lie not in language nor effectiveness, it seems to him, but in the individual clients’ levels of resistance.

Resistance drops when empowered options are offered to folks who are ready to change but opposed to powerlessness. Progress is made sooner by skeptics of the disease concept when dismantling their objections is no longer a prerequisite. Barriers to treatment soften when questions about the risks of heavy drinking lead to direct answers and encouragement to change based on an internal locus of control. Evidence draws critical thinkers into self-identifying their problems and making informed choices about health care, habits, peer support and professional treatment.

Too often, Stahl points out, treatment providers and well-meaning laypeople “miss it” when given an opportunity to make a positive difference. He’s not immune from missing the target himself. A year into their marriage, he offered his wife the “perfect” solutions to a personal challenge that mirrored one that he had faced earlier: Read these books, write a journal, meditate, and get some physical activity.

“I missed it,” he tells folks when describing the advice he offered her. Her problem-solving style doesn’t include digesting books-full of evidence; introspective journaling was his thing, not hers.

Too often, he says, addictions professionals do the same when they don’t spend time getting to the bottom of their clients’ built-in coping styles and match them to corresponding treatment approaches: Presented with an opportunity to reach a client with workable solutions, they miss it.

As the Recovery Resource Center has proved by reaching over a thousand folks in under three years, the options matter. Empowering their clients to make informed choices works.

Hey Bose. I can't remember how I found this blog (technorati link to mine I think.)

Anyway, as a person who had personal struggles with alcohol in my younger days, I can appreciate many of your thoughts on the subject. I was clean for 9 years outside of a 12 step program (although that is where I started and am grateful) then I lived in successful moderation like what you describe. Without having a personal crash or moral demise I have decided that total abstinence is the way to go for me.

I related to this post very much. I will never knock 12 step programs. One saved my life. At the same time I do think some people can grow beyond the need for them. Today I stay "clean" for personal contentment...not because of "disease."

It's great to discover a program (like the RRC) that meets people where they're at; that treats the whole person rather than one symptom; and that seems willing to offer different responses and treatments to each participant (since people are, indeed, very different).

I strongly believe that many more people would be helped out of their compulsions or problem behaviors if therapists would treat them as unique individuals, not clinical stereotypes.