Evolution of the field | 1.8.2019

Evolution of the field


In a previous issue (16 December 2018), we included a New Republic article from their 27 June 2018 number, “Rejected by AA.”  In the interval since, I have had three conversations with several AA and NA participants, who regard themselves as members; or, in one case, a former member.  I posed the central question:  “What level of participation is expected from those who receive medication-assisted treatment, specifically opioid agonists?” While not a cross-sectional sample of any power, it was an informed population that included, among others, two with more than 30 years of continuous abstinence, of whom one had recovered from addiction to opioids; three recovering physicians; and two with methamphetamine addiction, including one with alcohol use disorder whose periods of abstinence are serial and sometimes lengthy, sometimes brief, but go back almost 30 years.

 

The responses were consistent, perhaps surprisingly. On the issue of welcoming meeting attendees regardless of on-going substance use, all were in accord.  Two were cautious regarding the level of participation, but both acknowledged that those who are most likely to strain the patience of an audience are not commonly those who are still actively using.  One discussant cited a reference that is traditionally regarded as simply an appeal to spirituality, a commonplace in Alcoholics Anonymous meetings: "More will be revealed."  The quote is normally used to encourage those who are in early recovery, as in the context of an appeal for patience. While such encouragement is certainly a justified use of the expression, context is important. The phrase itself does not occur in the Big Book. It originated most likely as a paraphrase of the passage, “We realize we know only a little. God will constantly disclose more to you and to us. [Alcoholics Anonymous, 4th Ed. 2001, p.164]”, which occurs at the end of the instructional half of that text.  It appears to be a summary statement that defies a summation of the AA program.  As my discussant intimated, the 12-step recovery program as represented by AA in 1935 was unintended to be the final evolutionary stage in a process of recovery, for either the individual or the organization.  Psychotherapies have emerged that interdigitate with the 12-step programs and which promise greater appeal to a broad range of personalities.  Treatment practices such as exercise, diet, and guided mediation reduce co-morbidity and thus add substantially to the likelihood of a long recovery.  Medications have emerged that have certainly improved prospects for those for whom abstinence alone did not suffice as a pathway to restored function, or those who would not have otherwise entered recovery rooms. 

 

Optimism regarding the acceptability of mutually-reinforcing recovery strategies is warranted.  It is only within the past 20 years that smoking has been ushered out of the recovery rooms – and in Hawai`i, even  out of the open-air meetings.  Physicians themselves have not always modeled tolerance and acceptance in addressing changes in medical practice.  In another example involving tobacco use, some are old enough to recall the ambivalence that greeted the early Surgeon-General’s reports. 

- Editor-in-Chief: William Haning, MD, DFAPA, DFASAM