In the last few years, there have been several new voices in the chorus calling for new and innovative treatment and recovery modalities. Lawrence Dodes, David Sheff and Anne Fletcher, among others, brought forth new research and asked some very pointed questions about the dominant model. Last year, William White and Ernie Kurtz wrote an article in defense of AA entitled, “The Resilience of Alcoholics Anonymous”, which boasts of AA’s longevity and enumerates its organizational strengths. The article reads almost like an industry piece from Bloomberg or Forbes. In it, White and Kurtz basically assert that in order for anything to survive and function as long and as well as AA, it basically needs to look and behave exactly like AA, and should be measured with a yardstick of AA’s calibration. These self-referential criteria severely limit the possiblities for conceptualization of new recovery solutions. The distinguished authors furthermore insist that AA be compared with other addiction recovery mutual aid groups. When one plant is choking out the rest of the garden, any comparison with the growth of the other plants is invalid. I was a bit surprised that Mr. White failed to mention several other reasons for AA’s phenomenal success and monolithic domination of the treatment and recovery paradigm, all of which can be found in his well-known, must-have publication, Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
In the early days, AA enjoyed the support and public acknowledgement of well-placed celebrities and professionals as well as prominent mentions in press, radio and film. Even the federal government assisted in establishing the legitimacy of AA when Bill Wilson, Marty Mann and Howard Hughes testified before Congress, resulting in the founding of the National Institute on Alcohol Abuse. No other mutual aid group has garnered so much attention and publicity, or had so much credibility conferred upon it.
Also, AA was, and still is, promoted by the majority of treatment centers, often touted as the only way to recover. Treatment programs have been designed around its steps and principles, blurring the line between clinical methodology and recovery mutual aid groups, and establishing a foundation for AA’s scientific validity. This began with the Minnesota Model, and has been continued by treatment professionals such as Terence Gorski and this guy. To this day, countless professionals working with many social systems feed millions of people into AA and other 12-step fellowships. AA may not promote itself, but others do the job very thoroughly; and its substantial attendance is certainly not due to attraction alone.
Regardless of how AA grew into what it is today, it was unquestionably a monumental breakthrough in recovery eighty years ago. AA got noticed instantly because they did something completely different; something no one had ever done before. If we are to carry anything forward from the example of AA, it is this: the catalytic process of accidental invention; the bastard offspring of creative collaboration; good old American ingenuity. There is something to be said for organizational resilience, endurance, and longevity; but revolutionary ideas are birthed by innovation.
A good example of this is the “Birmingham Model”, a community-based treatment initiative that was recently featured on Marc Lewis’ Memoirs of an Addicted Brain blog. Reach Out Recovery is a public program supported by the city of Birmingham, UK in which shop owners in the community can receive training in order to help people seeking support or treatment. They put special ROR signs in their windows, and can provide anything from a friendly conversation, to a connection to a peer mentor, to access to treatment resources. (If this sounds a little questionable, compare it to the equally innocuous notion of a failed stockbroker sitting down to chat with a surgeon about his drinking.) This is exactly the kind of thing that could grow into a real solution. As Marc writes, “treatment must be interpersonal if it’s to have any chance of working.” When recovery is supported at the community level, it helps to increase awareness and alleviate stigma. This, in turn, encourages more recovery innovation. It inspires people to seek new solutions and creates an atmosphere in which more of these solutions can see the light of day.
Another area of innovation in treatment and recovery is the application of mindfulness techniques. This versatile toolbox for brain training, relaxation and personal spirituality has massive potential across settings. Mindfulness techniques have been used in concert with 12-step programs and as an alternative, and can range from meditation to cognitive behavioral therapy. They are used for psychoeducation as well as relapse prevention and long-term recovery maintenance. Mindfulness is a more personal experience and does not lean as heavily on interaction or community.
One of the biggest mistakes we can make with innovation in recovery is to try to shoehorn it into the same old mold. One example of this is the fusion of Buddhist spirituality with the 12-step model, which has been around for years. In theory, the spirituality in the 12 steps can be personalized; however in practice, the steps are much better suited to Judeo-Christian belief systems; and at the end of the day, it’s still AA. This all changed when Noah Levine created Refuge Recovery, a Buddhist recovery program that uses the Four Noble Truths and the Eightfold Path in recovery, viewing addiction as an attachment disorder rather than an ego-based spiritual malady. In the true Buddhist model, the self is empowered rather than flagellated and shunned.
All of these innovative models have one thing in common: the meanings of addiction and recovery are completely reconceived. New theories of addiction are being presented from many disciplines. Is it an attachment disorder? A learning disorder? An emotional or post-traumatic disorder? A brain chemistry disorder? It is all of these, depending on who you ask. The most important idea to take away from all of this new information about addiction is that we cannot necessarily classify it as the same thing for everyone. People will experience addiction in diverse, individual ways; therefore our approaches to recovery must also be diverse, flexible, and innovative.
If we revisit the business model and look at innovation in terms of organizational culture, it is a well-known fact that innovation is often suppressed in the interest of preserving the status quo. One technique for doing this is the use of data “…to confirm the current culture and not to stimulate change.” (David Weiss, The Art and Practice of Leading Sustainable Innovation in Your Organization) In the post-industrial business world, the smart money knows that innovation is the name of the game. The modern recovery world is clamoring for something new, for innovation, and lives depend on it. Those who wish to make recovery attractive, accessible and attainable to more people must “think outside the book” and shatter the old paradigms. We don’t need another AA. We need another breakthrough.