I’ve been getting quite a bit of communication from people studying to be in the addiction treatment field lately. Most are aggressive and insulting off the bat – and some even pretend to want to have a productive discourse while doing this! Here’s an example of a recent exchange (I have changed identifiers and bolded some notable segments):
From: John
To: Steven Slate
I get the feeling you are just trying to make a buck off the misfortune of others. Slamming programs and concepts that are beneficial, without actually backing up the critique lacks credibility. “Pointing out problems without offering solutions does little good”, Terance Gorski said that and I agree.
Although you are quick to state you have worked with many addicts over many years, you do not give specifics as to the nature of that work. You stated you possess no formal degree (in either Chemical Dependency Counseling or Psychology?) I believe any accredited treatment facility requires such for clinical work with clients. Of course you may have facilitated groups in arts and crafts, which is beneficial, but not pertinent to your claims.
Lastly you cite no approved research studies you have had an effect on. ie; stating the success rate of your hypothesis.
I hope you take all this the right way, as I am studying for my degree in CDC, I have completed training in Recovery Coaching (CCAR) and Peer-Mentoring with xxx-xxx. But most of all I am a recovered crackhead and a friend of Bill’s.
I look forward to your reply and God willing a fruitful and beneficial continuing discourse.
Be Well,
John
Hi John,
I love discussing and debating these issues more than anything. I need to have some mutual respect in discussing it though. When you come out of the gate saying that I’m “just trying to make a buck off the misfortune of others”, how should I take that? I take it as a sign of disrespect; as a questioning of my motives – because that’s what it is.
If you are willing to give me the benefit of the doubt that I truly want to help people, then I am willing to discuss a lot. Are you willing to grant me that? If so, tell me, and we can go from there. My assumption about everyone who works in the field is that they truly want to help, and I assume it of you.
Now I will address a few things you raised:
– “Slamming programs and concepts that are beneficial, without actually backing up the critique lacks credibility.”
I have actually received many praiseful communications from PhDs and others who are impressed by the level of citation and references I put into my articles here. So I have a hard time with this criticism, especially being so broad and unspecific. If there’s a specific article where you think I’ve done this, please cite it specifically to me, including the specific claim you you feel I haven’t backed up, and I will happily respond. But as a blanket claim, I do find it insulting, and can’t really give a substantial answer to it, other than to say look all over the site and you’ll see plenty of citations backing up my claims, and where specific research isn’t available to directly back a claim, you will at least see my reasoning.
– “Although you are quick to state you have worked with many addicts over many years, you do not give specifics as to the nature of that work.”
My FAQs page – which you should read before asking further questions – lists some of my work experience, most of which has been done with Saint Jude Retreats. We do not believe addiction is a disease, thus we do not purport to treat addicts. We have an educational program, designed to inform people of an alternative way of looking at addiction and substances. I am an instructor of this program – not a counselor, therapist, or any sort of addictionologist providing treatment – hence, no treatment credentials are needed. Our organization went to bat with New York State’s treatment agency, OASAS, and it was determined that we were not in fact a treatment program, and allowed to offer an educational program for people with substance use problems, outside of the traditional treatment models.
– “You stated you possess no formal degree (in either Chemical Dependency Counseling or Psychology?) I believe any accredited treatment facility requires such for clinical work with clients. Of course you may have facilitated groups in arts and crafts, which is beneficial, but not pertinent to your claims.”
Do you see how I might find this insulting? Arts and crafts? We did 16 years worth of follow up studies at Saint Jude Retreats, and found that our program graduates have a 62% abstinence rate, and many become moderate users as well. Of course it isn’t all roses, there are people who continued to use heavily, and didn’t find the program helpful – but the fact is that a majority find it helpful, and they often thank us for “showing me I had a choice.” It’s more than arts and crafts – I give people accurate, and thus helpful information and ideas.
– “Lastly you cite no approved research studies you have had an effect on. ie; stating the success rate of your hypothesis.”
My main hypothesis here is that addiction is not a chronic disease, and thus people are fully free to stop/decrease their substance use without treatment or help of any kind. I have repeatedly presented results of epidemiological studies showing that most people quit/reduce to non-dependent levels, even though most don’t receive treatment (this is laid out in my TEDx Talk, this page contains that talk and some citations backing it up: http://www.thecleanslate.org/steven-slates-tedx-talk-tahoe-city/ ) . I have also given information demonstrating that rates of recovery for treated addicts are no better than rates of recover for untreated addicts (here’s that point regarding alcohol: http://www.thecleanslate.org/self-change/substance-dependence-recovery-rates-with-and-without-treatment/ )
Again, let me know whether you’re willing to give me the benefit of the doubt on my motives, as I have given you, and we can talk further. And please be very specific about any further questions, otherwise I will need to write an entire book in response, and that isn’t manageable over email 😉
Best
Steven
Dear Steven,
I am impressed with your timely reply and the effort it must have taken to do so in such a thorough manner. I would like to apologize for your feeling insulted, but as that was not my purpose or intent, I fear it would be meaningless. I did notice you “assume” it is the intent to be helpful which calls all who work into the field. This assumption seems to me to be idealistic. As I have personally attended a for-profit rehab who could not or would not reveal their success rate and regularly admit repeat clients. I would also think that rehabs which use a cookie cutter approach to treatment do not have the clients best interest in mind.
The recidivism rate of addicts is well known to be at least 80%(according to studies I have accessed).
While Project-Match as demonstated 3 different models have each achieved 25% success (in completion) rates, the implementation of these models seems lacking. It seems to me that if your program has achieve success rates of 62%, the authorities would be beating a path to your door to obtain your methods. Either your numbers are skewed or the revolving door is prefered to those whose only claim “is to be helpful”.
Suffice it to say I’m still interested in any theory which offers even a glimpse of hope, even if it is only that one addict may benefit. Obviously it then becomes a problem of matching which addict needs which program. A situation which truly is beyond my ability to assess, surely there are those that can. But again this would interupt the continous flow of clients ie; dollars. This I think is a good time to address the primart point in your statements, the disease model. It seems that by the time many of the addicts reach the point of despair, aka; hit bottom, they are unemployed and without means to pay for treatment(help,if it pleases). Unfortunately resourses such as medicaid respond better if it is a disease to be addressed in this circumstance. As they prefer only to pay for “climical” services. These are costly, and still play into the conumdrum of greed vs. being helpful. You had mentioned New York and the governing body of OASAS. I must assume your inqiury with them happened sometime ago. We are now gearing up to implement the strategy of Recovery Coaching and Peer-Montoring. The reimbursement for which is minimal and only pursued by those of us who truly whish to be helpful in lue of personal(financial) gain. Perhaps you seek to much compensation for being helpful, I don’t know.
I would like to end with yet another point which saddens me. In the effort to promote your book, YOU take pot shots at AA. I was once powerless over my addict and my life had truly become unmanageable. But by the grace of God I found solace and healing in the fellowship, at no charge. Seems their only aim was to be helpful and for this I shall ever be greatful. Please know I thank God for giving me the insight to aversion therapy. A self-admistered technique which reqiured nothing more than a bag of rubber bands.
I appretiate any desire you have to be helpful, I just don’t understand why you stand against others doing the same. If CBE is as powerful as you claim, I hope those who can benefit get the opportunity to employ it. Our local SOS chapter failed, the leader of which was a huge Jack Trimpey fan (Rational Recovery,AVRT) and the current SMARt group is led by a slightly out of touch sex addict (although he is not seeking to adjust that malady). I am aware of the gains made with the application of CBT in the BPD realm, although the time frame would not suffice in the world of addict.
I hope I have not offended your senceabilities, as I am only seeking to find answer to be shared. I shall continue to follow your progress, even share your CBE techniques, atleast those I can aqiure free of charge as I am a mere peer working with other peers free of charge. If you would care to donate a book I would be grateful.
Be Well,
John
John,
I think I laid out very reasonable terms on which we could have a productive discourse. They were to simply agree to give each other the benefit of the doubt that we both have good motives and want to help people. I then asked you to confirm to me whether you were willing to grant me that benefit of the doubt on this matter.
That you replied by criticizing my assumption of good motives, and never confirmed that you would give me the same benefit of the doubt, tells me you don’t want to have a productive conversation with me. I cannot have productive discussion with people who assume I am a huckster. The absurdity of this is that you could have just pretended you don’t believe I’m a huckster, if you really wanted to have a productive discussion, but you didn’t even choose to do that. I take your apology as wholly and transparently insincere, as was your wish that “I hope you take this all the right way” while expressing hope for a “beneficial continuing discourse” after taking shots at me in your first email. Shots which, incidentally, I asked you to back up more specifically so that I would have a fair opportunity to respond to them. You haven’t done that either.
Feel free to read my site to learn what I believe and the evidence I use to back that up. You’ll probably find links on there next year to a free copy of my upcoming book. But personally, I don’t think we can have any more correspondence.
Best,
Steven
Steven
You are truly an awesome individual. Again and again I am impressed with the content of your site and even more so with your honesty, integrity, humility and patience. I am truly amazed at the respectful way you responded to the provocateur, John. I wish I had your patience but I don’t. I just want to kick the living shit out of pretentious, condescending assholes like John. Oops, I strayed momentarily. My apologies.
The ability to think clearly and logically [which is what you promote here] is a definite asset for people who are recovering from an addiction. This is the complete opposite of the type of thinking that most “chronic brain disease,” 12 step addicts have learned to rely on because of dishonest treatment center counselors and CDC degree CCAR pricks like John.
Using reason and logic in recovery—-rather than relying on bubble-gum theosophy, and incessant juvenile whimpering about a fake chronic progressive brain disease that allows them to escape accountability—- is a new way of dealing with the world.
Using critical thinking skills will mean that the recovered addict/alcoholic is less likely to make decisions purely on the basis of emotions or irrational beliefs. Those who can think critically not only make better decisions, but they also find the whole process of dealing with difficulties to be easier. It is possible for addicts to develop their critical thinking skills as they recover and this can help to strengthen their sobriety.
Papamick
P.S. Justifiably you wrote: “I take your apology as wholly and transparently insincere” … and it “WAS” oily and smugly insincere…He didn’t apologize to you at all. He wrote: “I would like to apologize for your feeling insulted.”
A person cannot apologize for another person’s “feeling.” This demonstrates what a clown this guy really is.
What I am now noticing is that the choice model gets misrepresented even by many opponents of the disease model, mostly those who are classifying it as a learning disorder. For example, Lewis recently summed it up this way:
“So what are the alternatives? One idea is that addicts voluntarily choose to remain addicted: if they don’t quit, it’s because they don’t want to. Anyone who has spent even a little time with someone struggling with addiction can see the shallowness of this view.”
https://aeon.co/essays/why-its-high-time-that-attitudes-to-addiction-changed
That’s all he says about it in his newest article.
What do you think? Is this an accurate, sufficient and honest description of your views?
Marc Lewis’s work is very important in some ways, particularly, when he says things like this in that same article:
Of course, I’ve been saying that for years, and I feel like it’s my novel contribution to the pushback on this brain disease argument. If I wasn’t the first to discover that point, I think I might be the first to popularize it. But I’m just a guy without letters behind my name – Lewis is a PhD, and a neuroscientist no less. So having him out there making this point repeatedly, and succinctly, is doing a great service to my cause of showing people this isn’t a unique brain based problem, but in fact an ordinary problem.
But then, Lewis remains committed to explaining this in neural terms, and I think that’s wrong and unhelpful, precisely the neural adaptations in addiction are so ordinary and unremarkable. Alva Noe said trying to explain addiction in neural terms is like explaining a dance in terms of muscles – and I like that. It points out how irrelevant all this talk of the brain really is. To the degree that Lewis then goes on to talk about the brain endlessly, I don’t think he’s helping.
I don’t think he believes in free will at all. I think he’s fully a determinist, and so we’ll never find full agreement, but I recognize his important contribution.
To the quote you posted – “if they don’t quit, it’s because they don’t want to.” – I obviously disagree with his dismissal of this. I believe that wanting to quit is everything. The challenge of making a change in such a habit is finding a way to really want the change. Those who don’t quit really don’t want to. They may like the idea of quitting; they may want to be done with problems; they may hate the costs of their habit – but they still see quitting (or moderating) as less preferable than continuing heavy use. They see a reduction as a loss, a punishment, as something they’re obligated to do, should do, have to do – etc. But they don’t see abstinence/moderation as something that they really want – as something that they would enjoy more than heavy use. If they did, they would easily do it.
This is reflected all the time in the answers of why people go back. They tell you life is too stressful without it, they’re too depressed without it, they feel tortured without it, life is boring without it, etc – which all says they don’t prefer life without it. You can learn to prefer life without it/less of it, but it takes seriously rethinking how you view drugs and life without drugs or less drugs. It takes questioning what you think the drugs can and cannot do for you. It takes questioning whether the life of moderation or abstinence can be happier then you have believed in the past. It takes believing you have the ability to enjoy life more with less substance use. This goes to the core of self-esteem, self-efficacy, and confidence issues.
Learning is involved in all of this, and I’m afraid that Lewis thinks of learning a bit more in the behaviorist conditioning terms. But I think we’re close. When you get to Maia Szalavitz, you’re completely off the deep end though. She fully pushes a different brain disease model – a learning disorder model, rooted fully in the brain that I could never find any agreement with.
I think addiction is a matter of learning a preference – a preference built on what you think the drugs can do for you, and what you think your other options are. I think the neurology of habit is involved, but that it pales in comparison to the meanings we learn to assign to substances. I think we can unlearn and relearn, and learn new information that changes our substance use preference – and that neurological information is just a footnote about what happens in the brain while we learn these new things, More important is the act of reaching out to find new information that will inform your present and future choices regarding substances and the new preferences you will build.
Thanks for the very long explanation! Very interesting.
In terms of the creation of meaning, it reminds me of some philosophical writings I’ve read recently that show how not everything can be explained by brain neurology. Here’s the idea, Frank Jackson’s black-and-white Mary (similar to Thomas Nagel’s ‘What is it like to be a bat?’), summarized by Laurence BonJour :
“Mary is a brilliant neurophysiologist, who lives her entire life, acquires her education, and does all of her scientific work in a black-and-white environment, using black-and-white books and black-and-white television for all of her learning and research. In this way, we may suppose, she comes to have a complete knowledge of all the physical facts in neurophysiology and related fields, together with their deductive consequences, insofar as these are relevant — thus arriving at as complete an understanding of human functioning as those sciences can provide. In particular, Mary knows the functional roles of all of the various neurophysiological states, including those pertaining to visual perception, by knowing their causal relations to sensory inputs, behavioral outputs, and other such states. But despire all of this knowledge, Mary apparently does not know all that there is to know about human mental states: for when she is released from her black-and-white environment and allowed to view the world normally, she will, by viewing objects like ripe tomatoes, learn what it is like to see something red, and analogous things about other qualitative experiences. ‘But then,’ comments Jackson, ‘it is inescapable that her previous knowledge was incomplete. But she had all the physical information. Ergo there is more to have than that, and Physicalism is false.'”
I’m no philosopher, but I suppose we could replace “red” with “addiction” and it would make just as much sense.