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ljgeoffI've been thinking about this for a couple of weeks -- the interplay between personality traits (specifically openness to new experience/ conservatism,)the 12-step program of AA and in a general way, how religiosity plays into our current models of treatment and recovery.
A bit of google magic, and I found the 2007 dissertation of Rachel L. Huhra, RELIGIOUS COPING AS A MODERATOR OF THE FIVE FACTOR MODEL OF PERSONALITY TRAITS AND ALCOHOL ABUSE SEVERITY AT SIX-MONTH FOLLOW-UP IN A TWELVE STEP TREATMENT SAMPLE.
Huhra notes:
In substance abuse counseling, or any counseling, it's recognized that change will not occur unless the individual is ready and willing to make a change. To me, this speaks of cognitive dissonance -- that is, when an individual does or says something that is in conflict with how they perceive themselves. When dissonance occurs, the individual will either justify their action, change their perception of themselves, or decry the action and struggle with the need to change their behavior.
An intervention is when a group of people whom the individual loves and/or respects shines a light on the individual's actions, and accents the individual's dissonance. The individual can either say "I'm just a drunk, that's all I'll ever be" or "Fuck you, I'll drink if I want. If my husband wasn't such a jerk, I wouldn't drink." or other "it's not my fault" and "I'm not that bad" and "everybody does it" kind of justifications - or they can decide that they want to change.
Some of our clients are at the center because they've gone through this process - they have said that they want to change. Some of our clients have been forced into treatment because a loved one has made it an ultimatum, or the State has made it an ultimatum. Sometimes the ultimatum acts as an intervention, and the person recognizes the need to change and sometimes they're just going through the motions, fulfilling the letter of the ultimatum.
But no matter what reason a person is in treatment at our center, or whether they're a Type I or Type II substance abuser, the toolkit is the same -- the 12 Step program, some very basic group Cognitive Behavior Therapy, doctor ordered drug therapy, and assistance with obtaining education, housing and job goals.
It is estimated that treatment centers have about a 10% - 12% success rate, where clients are no longer abusing substances one year after treatment.
I don't find this acceptable; if I'm gonna spend my guts at this, I need a better than 10% - 12% success rate. Now, I refuse to believe that 10% - 12% is as good as it's going to get. This may actually be where I fail. But, looking at what we're doing, I cannot believe that this model of counseling is the very best that we can do.
I think that if we looked at which clients for which our current model is appropriate, we would see a dramatically higher success rate. Which leads me to question for which clients is the current model not appropriate? What do those clients need?
If the current model is successful only 10%-12% of the time, for what percentage of the people in treatment is it appropriate? Well, according to Ms. Huhra's dissertation, "the combined effect of high level expression of the Five Factor Model trait Agreeableness and the use of a Collaborative Religious Coping Style had the greatest impact on decreased alcohol abuse." Unfortunately, she stops there. The end of that sentence should be "when the client's counseling is based on the 12 Step model."
I would hazard a guess that about 20% or less of the individuals that were tested had a high level of expression of Agreeableness and Collaborative Religious Coping Style. What about the other 80%? Are they just fucked? The answer, right now, is "yes, Lisa, those guys are fucked, and have to figure out on their own what works for them."
As a final note (if you've struggled through this), I'm studying the manual to ready myself for the FAODP (Fundamentals of Alcohol and Other Drug Problems) test, and came upon this little gem: "Clinical psychologists are not trained to apply research findings." WTF?
A bit of google magic, and I found the 2007 dissertation of Rachel L. Huhra, RELIGIOUS COPING AS A MODERATOR OF THE FIVE FACTOR MODEL OF PERSONALITY TRAITS AND ALCOHOL ABUSE SEVERITY AT SIX-MONTH FOLLOW-UP IN A TWELVE STEP TREATMENT SAMPLE.
Huhra notes:
Positive psychology is the study of optimal human functioning in order to discover and promote the factors that allow individuals and communities to thrive. At the core of positive psychology is the examination of six qualities thought to be associated with development and abilities: wisdom and knowledge, courage, humanity and love, justice, temperance, and transcendence. These traits are studied in relation to how they are expressed through personality, behavior, and choices.
In substance abuse counseling, or any counseling, it's recognized that change will not occur unless the individual is ready and willing to make a change. To me, this speaks of cognitive dissonance -- that is, when an individual does or says something that is in conflict with how they perceive themselves. When dissonance occurs, the individual will either justify their action, change their perception of themselves, or decry the action and struggle with the need to change their behavior.
An intervention is when a group of people whom the individual loves and/or respects shines a light on the individual's actions, and accents the individual's dissonance. The individual can either say "I'm just a drunk, that's all I'll ever be" or "Fuck you, I'll drink if I want. If my husband wasn't such a jerk, I wouldn't drink." or other "it's not my fault" and "I'm not that bad" and "everybody does it" kind of justifications - or they can decide that they want to change.
Some of our clients are at the center because they've gone through this process - they have said that they want to change. Some of our clients have been forced into treatment because a loved one has made it an ultimatum, or the State has made it an ultimatum. Sometimes the ultimatum acts as an intervention, and the person recognizes the need to change and sometimes they're just going through the motions, fulfilling the letter of the ultimatum.
But no matter what reason a person is in treatment at our center, or whether they're a Type I or Type II substance abuser, the toolkit is the same -- the 12 Step program, some very basic group Cognitive Behavior Therapy, doctor ordered drug therapy, and assistance with obtaining education, housing and job goals.
It is estimated that treatment centers have about a 10% - 12% success rate, where clients are no longer abusing substances one year after treatment.
I don't find this acceptable; if I'm gonna spend my guts at this, I need a better than 10% - 12% success rate. Now, I refuse to believe that 10% - 12% is as good as it's going to get. This may actually be where I fail. But, looking at what we're doing, I cannot believe that this model of counseling is the very best that we can do.
I think that if we looked at which clients for which our current model is appropriate, we would see a dramatically higher success rate. Which leads me to question for which clients is the current model not appropriate? What do those clients need?
If the current model is successful only 10%-12% of the time, for what percentage of the people in treatment is it appropriate? Well, according to Ms. Huhra's dissertation, "the combined effect of high level expression of the Five Factor Model trait Agreeableness and the use of a Collaborative Religious Coping Style had the greatest impact on decreased alcohol abuse." Unfortunately, she stops there. The end of that sentence should be "when the client's counseling is based on the 12 Step model."
I would hazard a guess that about 20% or less of the individuals that were tested had a high level of expression of Agreeableness and Collaborative Religious Coping Style. What about the other 80%? Are they just fucked? The answer, right now, is "yes, Lisa, those guys are fucked, and have to figure out on their own what works for them."
As a final note (if you've struggled through this), I'm studying the manual to ready myself for the FAODP (Fundamentals of Alcohol and Other Drug Problems) test, and came upon this little gem: "Clinical psychologists are not trained to apply research findings." WTF?
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(no subject)
Date: 2009-02-27 03:01 am (UTC)A 12 step program, acting alone, strikes me as a weird thing. (I could say "dangerous", but I don't know if it is or isn't.)
I mean, their point is "not (drinking/doing drugs/whatever)". And they shouldn't be encouraging the excuse model ("Well, I only drink because I'm stressed!"), sure. But fixing a drunk won't mean just getting the person "not drinking". It means building the tools the person needs to walk away from alcohol.
And again, I'm not faulting AA for not building complete people who can walk away from alcohol. They can't do that, they don't know how to do that, it's not in their job description.
But it does make me think that there's something missing... that there needs to be a better model than "A used to drink; A isn't drinking now. *WIKTORY!*"
(no subject)
Date: 2009-02-27 05:47 am (UTC)"We admit that we are powerless over our addiction, that a Power greater than ourselves could restore us to sanity, and we have decided to turn our will and our lives over to the care of God as we understand Him." That is the expression of dissonance, -- we are powerless; we will give up the reins and God will fix us.
How can I counsel alcoholics when the 12 steps are abhorrent to me?
I have to believe that there is something else. There is some other way, some way that I can get my head around, some other toolkit. I just don't know what it is yet.
(no subject)
Date: 2009-02-27 06:32 pm (UTC)It's more like, "okay, you were stressed, so stressed that you got anxious at night. And you drank to go to sleep. You're an alcoholic; you have to stop drinking. No, I don't care if you think you need to drink to go to sleep; we're not interested in excuses, there's *always* an excuse. You need to stop drinking!"
And that's true. That's the kind of thing a "stop drinking" program should do. It might even be risky to acknowledge that, gee, maybe you *do* need to do something so you can sleep, sleep is important.
But, that anxiety problem has to be treated. Otherwise, it's not just "I can't drink", it's "this anxious feeling isn't going to go away!"
And wanting the anxiety gone is perfectly normal.
Putting yourself in the hands of a higher power to keep yourself from drinking might work, but I'm not nearly as convince that it'll cure anxiety.
I might be misjudging the programs; it might be that, in every well run program, there will be people who push possible solutions for anxiety in such a case, while not accepting it as an excuse for drinking. But it's a concern; it bugs me.
It reminds me of the slavery paradox. You'd think if you had slaves, you could get them to pick fruit efficiently. But slaves only pick fruit quickly enough to keep the lash off of their backs. Get people paid a fair price per bushel, and they'll work harder and longer, because they want the reward.
Trying to stop something strikes me as less efficient as putting the person on a path to a reward they can earn.
It's how to create and guarantee the reward that bugs me. Can it be done?