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.

A.A. Alternatives: An Empowered Round-up

Live Sensibly reader Faith notes that abstinence is her thing but powerlessness is not. (She writes about her life pragmatically, with refreshing transparency — go take a peek.)

So, it’s as good a time as any to do a quick review of some of the solidly abstinence-based support out there which follows something other than the 12 steps. Along with that, a request to my readers: I’m looking for individuals who are talking about their experiences in these different groups at their personal websites. If you know of any, please drop links into a comment or an email message.

So, here’s a list of empowered alternatives:

• LifeRing Secular Recovery: “Freedom from alcohol, peer support with feedback in a secular setting, and Open architecture: structure your own program.
• Secular Organizations for Sobriety, or Save Our Selves, also located here: “SOS credits the individual for achieving and maintaining his or her own sobriety… SOS supports healthy skepticism and encourages the use of the scientific method to understand alcoholism.”
• SMART Recovery®: Approach “teaches self-empowerment and self-reliance… teaches tools and techniques for self-directed change… evolves as scientific knowledge evolves.”
• Women For Sobriety: “We are capable and competent, caring and compassionate, always willing to help another; bonded together in overcoming our addictions.”

There are also faith-based groups which adapt the 12 steps to their needs. There are professionals who support a wide range of alternatives. Look closely, and you’ll even find folks on the God squad talk about spiritual empowerment and having an adult relationship with God. Find ‘em in the side bar here, or let me know who’s not there yet and needs to be added.

2004.08.15 Update:

The Recovery Resource Center in Cincinnati Ohio has a great page which takes a high-level look at the distinctions between these groups: The Recovery Spectrum.

Harm Reduction

You’ve probably already used harm reduction.

Have you ever:

• Eaten a fast-food burger that didn’t fit your diet, but skipped the french fries, dessert, or sugar-laden drink that also looked good?
• Missed planned workouts, but used the stairs instead of the elevator?
• Had a couple of drinks in less-than-ideal circumstances, but made them lighter than usual, drank slowly, or ate well while enjoying them?
• Held off on starting a weight-loss program but taken steps to ensure you either wouldn’t gain weight, or would not gain weight rapidly?

We manage the risks of driving by buying auto insurance, and the risks of playing sports by wearing protective gear. Harm Reduction is another risk management tool: Understanding the risks and taking steps to reduce direct or potential harm.

An example of harm reduction with drinking.

December 2000 was one of the toughest months of my life. My best friend died quite unexpectedly, much too young, in November. My work situation was deteriorating rapidly. I had the support and love of friends, but my grief was raw and unavoidable.

The happiest, most joyous time of the year? Nope, at least not this time. Nothing I could do would make that month cheery or even peaceful.

My top priority was to survive, not thrive. Breathe in, breathe out. Put one foot in front of the other.

I’d been active in MM for six months, learned a lot, and taken significant steps toward drinking moderately. I knew that functioning optimally was simply not in the cards that month, though.

Lighter, slower, later.

I decided not to worry if I drank daily that December, but to look for ways to reduce harm. To me that meant drinking lighter, taking it slowly, and starting later in the evening (preferably after eating some sort of comfort food).

There were days when I drank more than 4 beers (the recommended daily limit for guys), and days when I didn’t.

When I set unrealistic goals for myself, it’s easy for me to get into rebellious aw-forget-it-I-don’t-care space and do the things that blow the goals apart. Harm reduction was a reasonable, gentle goal that helped me avoid that trap.

I didn’t get crazy drunk, didn’t drink and drive, didn’t wake up to extreme hangovers. When just getting through a day was a challenge, I looked forward to relaxing with a couple beers in the evening and fully enjoyed it when the time came.

In January I began taking small steps back toward my ideals. I abstained for 3 weeks, made necessary job changes, continued grieving yet looking forward instead of backward whenever possible.

Small steps forward are good steps.

Harm reduction is generally not the ideal long-term solution for a drinking problem. The healthiest approach to living with alcohol is one which causes us no harm.

Sometimes the long-term solutions are not within our reach, though:

• We may be working through early stages of change.
• If we’re living in crisis management mode, facing up to other challenges may take precedence for a while.
• We may need time to research our options to figure out which is a best fit.

When the “perfect” answer eludes us, or we’re not ready to put it in motion today, we can still empower ourselves by taking small steps in the right direction. Doing so nurtures our can-do spirit by:

• Reminding us that we can change our behavior.
• Showing us we can take credit for progress made.
• Proving we can add new tools to our skills tool box

Harm reduction: Do something simple. Do it today. Every tiny step forward is a good step.

Intro to What Works

Good health care is possible when we have complete information available. Some examples:

• There are many cancers, and thanks to decades of multi-pronged medical research, many effective surgical, radiological, pharmaceutical, and other treatment options.
• There are many heart problems. They may be treated by any, or a combination of, angioplasty, bypass surgery, anti-cholesterol and hypertension medications, and counseling in nutrition and exercize.
• Depression, as well, varies in form and severity. It may be treated with a wide range of drugs, psychotherapy, coaching, and support.

In each case, early research produced findings which illuminated treatment options, benefits and risks. Additional research added to our understanding of the kinds and severity of different cancers, heart problems, and depression. As knowledge deepened, health care providers adapt their treatment and teaching in sync with the evidence.

Drinking problems are no different. There are many ways we get into maladaptive drinking patterns, multiple contributing factors, and a wide range of steps we can take in response.

In the What Works category, we’ll look at our options.

Disclaimer: Everything doesn’t work for everyone.

Identifying a technique, or a support group, or a program, or a drug that works doesn’t mean that it would work for all of us. (It’s the same as any other medical or behavioral issue that way.) It just means that folks have found it helpful, making it an option for us to be aware of and consider if it is a good fit for our unique circumstances.

(Not complete??? h4 sub-heads? rework the stepping-stone paragraph…)