Wasted: An Alcoholic Therapist's Fight for Recovery in a Tragically Flawed Treatment System (42 page)

Stanford’s Dr. Humphreys also
doesn’t fault
AA
. He offers insight into the zeal with which so many of its members proselytize, perhaps in ways not intended by its founders.

“Why is it hard for people to admit there are many pathways to recovery? I think part of it has to do with the intense experience of addiction and recovery. To do that (through
AA
) and then be able to say, ‘I’m not going to advise the same thing
for someone else,’ that’s hard.”

Dr. Humphreys would like individual members to consider the power of their proselytizing. It can do good, but it can also harm. He’s hoping to hear more of a mature approach to treatment from
AA
members, something that might sound like, “‘I accept that someone else may walk a different path, and they’re not lesser than me for doing so.’ That takes some
emotional work and it takes some community-building.”

In my experience, the unshakable faith of many
AA
members that their way is the one true way hurts the rest of us for whom the program doesn’t work. It underscores our failures. It promotes the notion that we are without willpower. And if you play that out, there are too many of us who die because we were not offered another option.
That may not be the original intent of Bill W. when he envisioned the program, but it has become reality for too many of us. I’m thinking now about one young man who came through one of the recovery homes I stayed at,
six times.
Each time he returned, other residents’ derision increased. He died after he jumped into the ocean to evade police last year. There are hundreds, thousands of stories
like this.

I believe the superior attitude displayed by some
AA
members is in part responsible for the contempt toward substance users that permeates our culture. We all know someone for whom
AA
succeeded and we’ve all had judgmental thoughts about those for whom it didn’t. Even me, until addiction knocked the smugness out of me.

At the worst of my addiction, a
TD
bank manager
in White Rock cut up all my credit and bank cards at the customer service counter. Not in a discreet back office. The memory of that moment still stings.

I recently had the honour of speaking to the Credit Counselling Society of British Columbia. Members of the audience spoke of how frustrating it was to deal with people like me, people who can’t remember who all our creditors are, or
where on earth the last mortgage statement is. One man spoke with exasperation about how he couldn’t get anyone to commit to his debt reduction plans. I thought back to the hell my life was when I sought credit counselling. Never mind where the mortgage statement was—I lived in a place where I needed to keep my shoes tied to the bed so they didn’t disappear overnight. The reality of my situation was
incomprehensible to the person charged with helping me clean up my financial mess.

I paused for a moment and said, “Sir, it’s not about me committing to you. It’s about you committing to me.” After my talk, he came to me and apologized.

In my ideal world, that’s the shift I’d like to see in our culture, and it starts with primary care physicians. Substance use disorder is complex,
often accompanied by serious mental illness. Tell me what my medical treatment options are, then direct me to a support group of my choice
.
Voluntary is how Bill W. intended
AA
to be. So send me to
AA
if that’s my choice
,
or to groups like
SMART
Recovery—Self Management and Recovery Training, a non-profit organization that offers supportive, science-based recovery to families and individuals struggling
with addiction.

In the many articles written about
AA
, most journalists cite the Cochrane Collaborative, one of the most respected scientific review organizations in the world. The last Cochrane Review on addiction treatment back in 2006 found “No experimental studies unequivocally demonstrated the effectiveness of
AA
or Twelve Step Facilitation (
TSF
) approaches for reducing alcohol dependence
or problems.”
2

Dr. Humphreys says randomized trials since then have shown a different outcome. He and his colleagues will be updating the Cochrane Collaborative. Their new review may conclude that
AA
and twelve-step facilitation are effective programs. In a display of how I’d like to be treated, I encourage anyone for whom the twelve steps works to stick with it. Each problem substance
user must be allowed the dignity of charting his or her own path to wellness.

• 52 •

FOR REAL CHANGE
to come about, we need to recognize our fundamentally conflicted attitudes toward substances. Dr. Miller puts it best.

“I think as a society, we’re profoundly ambivalent about psychoactive substances. Just watch television commercials: the message is you should never have to be uncomfortable even for a moment.
Take something. That’s fundamentally a drug-taking, drug-seeking kind of message. I think we feel bad enough about it so when you see it out there or somebody’s doing that, it’s easy to project onto them, ‘Well that’s a bad person.’”

This flawed thinking continues even when we embrace the idea that addiction is a disease, says Dr. Miller. “The upside of what has been called the ‘disease
concept’ is that it was an attempt to get humane treatment for people. And that’s what Bill W. was all about, just helping people. But what the disease model became in America is this black-and-white, you-have-it-or-you-don’t rule. If you have it (alcoholism), you’re a person who can never ever drink again. And that was never scientifically true. I think it was our national solution to the repeal
of Prohibition. For several decades we taught that alcohol is a horrible drug that nobody can use safely, that if you drink it, you’re headed for death or insanity. And then suddenly, we made it legal and you could serve it all over and it was okay again.”

• 53 •

THINK ABOUT HOW
surgeons learn to be better surgeons. The field has a more than century-long history of openness to scrutiny. Early surgical theatres were surrounded by seats so eager young physicians could watch and learn. Now many procedures are videotaped and are even available for viewing online. That openness
to learning and sharing is more difficult to cultivate in the field of mental health, where privacy is more of an issue. For that reason, Dr. Miller says addiction treatment is really in kindergarten in terms of implementing evidence-based treatment.

“We need to bring treatment out of the closet. We need get used to being recorded, get used to other people not only hearing what’s going
on, but getting involved in a lively dialogue about how could we do it better. Most of us work in terrible isolation. Without feedback, we don’t learn.”

Dr. Miller says one of the best-replicated findings in psychotherapy research is that there’s no relationship between how long you’ve been practising psychotherapy and how good you are at it. “Isn’t it depressing that after thirty years
your outcomes are about the same as they were when you started? That’s not true of surgeons. There’s a huge practice effect with surgeons. If you’re going to have your gallbladder out, find somebody who’s done a thousand of them. Why is that not true of our field? Because there’s no feedback. But I think we’re moving in the right direction that we recognize we ought to be delivering the things that
we know are backed by the best evidence of helping people. Certainly in training the next generation of providers, they should learn this from the beginning.”

• 54 •

WHAT I EXPERIENCED
and observed in my alcohol use disorder death spiral didn’t leave me with much hope. I saw treatment, or lack thereof, fail too many. I wish every person battling a substance use disorder would find a clinician who uses the approach suggested by Dr. Miller. “We have a great menu, we’ve got a whole array of good approaches to try. We can tap into
people’s own wisdom. We can try something first and if it is not the right approach for you, we’ll try something else. And I’ll stay with you until we find what works for you. That’s so much healthier than, ‘I know the one way and you do it that way or you’re not going to make it.’”

I am blessed to have discovered that menu of treatments as we filmed our documentary. New drugs, repurposed
older drugs, proteins, amino acids and peptides are all in the research pipeline. They promise freedom from the anguish of protracted withdrawal, and one day, may even prevent addiction from taking hold. There are new therapies that help the problem substance user become motivated to change. And the biggest discovery of all: from the experts in the film, an acknowledgment that we, the sufferers,
have wisdom about our condition that we can bring to the table. And that wisdom deserves respect.

Almost a year since my motorcycle accident, I am well once again. Thanks to my Vivitrol injections, the help of a great therapist, and the unconditional love of good friends and my partner Maureen, I have not had a devastating backwards slide into addiction. I am happy to drive across the
border once a month and pay for an injection—the sense of wellbeing and complete lack of craving I feel makes it worth it.

When I relapsed, I felt that old surge of shame at “failing.” But now I realize the recurrence was yet another opportunity to learn. The gift I’ve been given, of course, is a broader wisdom that I bring to my professional practice and a stronger conviction to fight
for better treatment for those battling substance use disorders. I have experienced better treatment. That is where hope lies.

There’s been much discussion and debate in recent years over exactly what addiction is: self-medicating, disease, disorder, learned behaviour, lack of willpower, spiritual malady, hijacked reward circuitry. That debate may continue for some time. I only know, regardless
of what you call it, we end up ill. So ill, we may die. Like anyone else gravely ill, we deserve the best compassionate, evidence-based care available. You, the taxpayer, continue to foot the bill for failed treatment and failed policy. There is very likely someone you know or love suffering from a substance use disorder. It’s time they got the treatment they deserve.

To my sons:

I am grateful to all those who stayed with me through the insanity and loved me when I wasn’t very lovable, and perhaps even more so to those who couldn’t stay, especially my son Taylor. Hoping to rebuild my relationship with him one day was powerful motivation to stay sober. Thank you, Brennan, for always taking my calls and for coming to my
one-year anniversary sobriety cake ceremony. Jonathan: for being there the day I was released from prison, thank you.

To my family:

To my mother and her husband, Paul, there are no words to describe the depth of gratitude I feel toward you. I’m blessed that you are still in my life and I am sober. I love you, Mum. I also wish to thank my dad and stepmum Christel for coming through
with cash at the critical moment. To my ex in-laws, Armond and Doreen, who came to see me in the hospital and in the recovery house: your acceptance was a soothing constant in my life. To my siblings, Danette, Loretta and Roger, thank you for allowing me to share painful parts of your private lives too. And finally, Rhonda. Thank you for all the great years and happy times. I am sorry for all
the heartache and stress I put you through. As an ex-wife and mother they don’t come much better.

And to Rhonda’s partner, Andy, thank you for being her “rock,” and for being there for my sons when I couldn’t be.

To those who helped create
The Couch of Willingness
, the first edition of this book:

Trena White and Jesse Finkelstein, who created Page Two Strategies, a new
model for ensuring high-quality publication in the digital age. Their vision, warmth, belief in the story and dedication to detail made publishing this book a gratifying experience. Trena arranged the initial meeting with Greystone and it’s because of her we have a publisher and a second edition. A huge thank you to Tamara Chandon of the University of British Columbia’s Booming Ground non-credit Creative
Writing program, who edited our first draft and provided vital feedback and coaching throughout. Tamara, thanks for seeing the potential and believing in it.

To our friends, author Claudia Casper and her husband, James Griffin, and filmmaker Helen Slinger, who read the first draft and told us we’d crafted a page-turner. Your support and deep friendship mean the world to us.

To
the Canadian Broadcasting Corporation:

To Sue Dando and
F.M.
Morrison at
The Nature of Things
, for wanting to help close that fifteen-year gap between advances in research and treatment by allowing me to reveal all those new evidence-based treatments on camera. Our shoots provided the basis for all of the new content in this book.

To Ron Eckel, our agent at the Cooke Agency:

Thank you for believing this story of ours has legs.

To Greystone Books:

Thank you to Rob Sanders and Nancy Flight, for seeing the potential in a new edition, and to everyone who helped in putting it together: editor Jennifer Croll, designer Nayeli Jimenez, and proofreader Stefania Alexandru. And much gratitude to Jennifer Gauthier and Andrea Damiani for marketing and publicity
support.

To those who helped on the path to sobriety:

I’d love to use your real names: members of Alcoholics Anonymous, doctors, nurses and social workers who never gave up on a drunk, but you know who you are. Thank you.

I can’t forget the other drunks, addicts and homeless guys who quite literally gave me the shirts off their backs so that I could get back to work. Rob,
who made my birthday cake, who scrounged in ditches for empties so I could raise a week’s bus fare, who performed so many selfless gestures, thank you. Wherever you are, buddy, I wish you peace and sobriety.