Monday, March 24, 2014

AA and Other Addiction Recovery Groups 'Don't Work'? And Are 'Dangerous'?

I’ve just read a report on the NPR website discussing a new book purporting to debunk the ‘bad science behind 12-step programs and the Rehab industry’.  The article, 'With Sobering Science, Doctor Debunks 12-step Recovery' reports the findings of psychiatrist Lance Dodes, who purports to expose the misleading claims of AA and its related addiction groups with respect to recovery.  Focusing specifically on alcoholism and the growth of Alcoholics Anonymous as the primary means of helping people recover from their addiction to alcohol, Dr. Dodes concludes that 12-step programs simply do not work, despite anecdotal evidence to the contrary.  ‘We hear from the people who do well,’ says Dodes; ‘we don’t hear from the people who don’t do well.’  The book cites studies that indicate that AA has only a 5-10% success rate.  The reason it works for some people has to do more with the supportive structure of the program than with the 12 steps themselves, according to the authors.

Alternatively, Dr. Dodes and his coauthor Zachary Dodes suggest a more nuanced ‘psychological’ approach to treating addiction: ‘When people are confronted with a feeling of being trapped, of being overwhelmingly helpless, they have to do something.  It isn’t necessarily the “something” that actually deals with the problem…  Why addiction, though, why drink?  Well, that’s the “something” that they do.  In psychology we call it a displacement, you could call it a substitute…  When people can understand their addiction and what drives it, not only are they able to manage it but they can predict the next time the addictive urge will come up, because they know the kind of things that will make them feel overwhelmingly helpless.  Given that forewarning, they can manage it much better.’

So far, so good.

But Dr. Dodes goes on to claim that groups like AA do actual harm to the vast majority of their participants, 90% by his reckoning.  It’s the 90% who ‘don’t do well’.  And it’s harmful because ‘everyone believes that AA is the right treatment.  AA is never wrong, according to AA.  If you fail in AA, it’s you that’s failed.’

This has not been my experience of recovery programs in the AA mold.  And the AA/NA/SA/SAA/SLAA literature itself makes no claim to universal applicability or efficacy, stating only that this is something that ‘we’ have found effective for us.  I dare say that AA and related programs are not for everybody, and that many people find themselves forced to attend by the courts or by spouses or in last-ditch efforts to save jobs/families/reputations.  The 12-step program requires serious commitment and serious change.  And not everyone is willing or able to go there.  But the 12-step programs that I am aware of are all upfront about these things.  And what makes the program both realistic and powerful is that it was devised by addicts for addicts, not by courts for addicts, nor by psychologists for addicts.  And while the AA program values the insights that can come through counseling, and encourages addicts to make use of whatever means they can to help themselves, they have through experience a pretty good idea of what addiction is and what needs to happen to escape it.

Moreover, the great problem Dr. Dodes fails to admit (at least in the article) is that there is no ‘successful’ treatment for addiction.  There are, instead, a host of tools that can be used to help someone out of the pit of whatever addiction they find themselves in.  Any one of these tools, or any combination of them, may or may not work.  But every person is different, every circumstance is different, every pathway into the addiction is different.  Which might suggest that every pathway out may be different as well.  To their credit, the authors acknowledge that AA does not claim to be a ‘treatment’ per se, but rather a fellowship or ‘brotherhood’ of addicts who realize they have come to the end of their rope.  Those whom I know involved in AA, NA, SA SAA and SLAA have often come to the conclusion that their addiction is beyond the power of a meeting or two a week to handle, and are themselves seeking further help through counseling, seminars, and residential treatment.  If addiction were easy to resolve, there would be a lot more whole and healthy people walking around.  But the roots often go very deep.  And attempts to deal with symptoms only end up seeing the addictive behavior pop up again and/or elsewhere in short order.

It’s one thing to criticize an organization that has provided relief to many, many addicts as being ultimately ineffective for the vast majority of women and men who attend its meetings.  It’s another thing entirely to suggest that their own method is the holy grail, when the same criticism they level at others could just as easily be leveled at their own methodology.  If a better method could be demonstrated, I for one would be first in line.

12 step programs – what do you think?  Are they useless?  Do they work?

Saturday, March 22, 2014

Not By Sight

‘Your path led through the sea;
Your way through the mighty waters.’
Psalm 77:19

Enslaved in Egypt was bad enough.  But the order from Pharaoh’s office that all baby boys were to be collected and thrown to the crocodiles in the Nile turned oppression into misery.   Later as a punishment for paying attention to Moses, the slaves' straw rations would be cut off, making them scour the countryside for stubble, all the while forcing them to produce the same quota, slaves were pressed to the breaking point. And these are just a few of the pictures we have of what it was like to be a slave in Egypt 3500 years ago.  The day to day reality must have been appalling.

After having witnessed the slow-motion ten-act triumph of their God over the gods of pharaoh and Egypt’s elite, culminating in the night of death for Egypt’s firstborn, but of the angel of death’s flyover of the Israelites’ blood-marked homes, Israelites young and old, strong and feeble, carrying a child in one arm whilst holding the hand of another, driving what livestock they had before them, carrying on their backs what possessions they could, put their life in Egypt behind them and set out for what they hardly knew.

God himself leads them.  They can tell because of the ‘pillar of cloud’ by day/’pillar of fire’ by night that went before the slow-moving miasma of newly liberated slaves.  From a group that would become notorious for its ‘grumbling’ and second-guessing, it is striking that nobody questioned the fearsome manifestation out there in front.  Must have been a rather persuasive presence.

Imagine the confusion, the distress, the upset when the Persuasive Presence leads them, not up the coastal highway straight north towards their Canaanite destination, but west northwest, across a barren wasteland, straight onto the beach of the Yam Suph, the Sea of Reeds.  WTF!?
Nobody is happy.  Not the newly liberated slaves.  Not Moses.  Nobody.  Not only that, but Pharaoh has been afflicted with second thoughts as the scope of his humiliation becomes apparent.  He sends his army after the rabble.  This is not a ‘bring them back alive’ mission.  Pharaoh has been shamed and is out for revenge.  But the army commanders are just as surprised as the Israelites at this turn of events, and as they crest the last hill and see the camp spread out along the shore, they wonder at the stupidity of whoever is leading this horde.

When the Israelites see the Egyptians: terror, pandemonium.  And who can blame them.  These people do not know how to swim, and the world’s most powerful army is coming after them.  And there is no way out.

Moses of course receives the brunt of their terror.  ‘Do something!’ they cry.  To which he can only respond by crying out to God, ‘Do something!’

It’s at this point that God, the Persuasive Presence, does something.  Just as the Egyptian army comes within bowshot of the Israelites, something happens, the effect of which is to put the Egyptian army into darkness and confusion, and the Israelites into shelter and light.  And then God tells Moses to go forward, to lead the Israelites straight into the sea.  This of course makes no sense.  But as Moses puts his staff into the water, a path appears, wide enough for him, and as others follow, wide enough for them, too.  And it’s dry ground, with water billowing up on either side. 

The whole mass of Israelites turns and watches with mouths agape. Even they know this is not something that is supposed to happen, a violation of the rules of nature as they understood them.  And when it is their turn, they too pick up what they have and step by step walk in and through the sea.  And up and out on the other side.  At which point, God has decided that it is the Egyptians turn.  They too see the divided sea, the path through the middle, and their quarry scrambling up the other side.  And so they too participate in this miracle.  Only things begin to go awry. They encounter mud.  The wheels of their chariots get stuck and come off.  And just as it collectively dawns on everyone from commander to foot soldier that this is not a good idea, the walls of water behave like water once again and crash over the armored heads of pharaoh’s vaunted army.  And just like that they are lost.

The Israelites would go on to have further adventures and would prove not to have very good memories.  But I have been struck by the phrase, used by a psalmist hundreds of years later as he/she was reflecting on this event, ‘Your path led through the sea’.  ‘We were following You,’ he seems to say, ‘but the way You led us brought us to the very end of our ability to cope, our capacity to survive.  We found ourselves face to face with the sea to our front, and the Egyptian army to our back.  And we don’t know how to swim.’

I can relate.  I thought I was following the Persuasive Presence, taking care to do the right thing, being vulnerable about my sins and shortcomings, getting the help that I needed.  But my challenges have gotten worse and worse.  I’ve sought help, gotten counsel, done what I could, to no avail.  I have been walking this path and it has led me to this place. The armies of what feels like certain destruction are breathing down my neck, and as I break through the forest I run across the beach and come face to face with the sea.  I never dreamed I would be standing in this place.  I will not deny that I am afraid, and that I do not know what happens next.  And I am tempted to say, as the Israelites did, ‘Did you lead me out of Egypt just so my dead body might fall here in this blasted wilderness?’  Oh, and I don’t know how to swim.

Elder Paisios of Mount Athos (1924-1994) once said, ‘In the darkness God sees us more clearly.’

I so want to be able to sing¸ ‘Your path led through the sea, Your way through the mighty waters.’  But I am still on this side of all of that.  And I will not deny that time feels like it’s running out. And I no longer pretend to know how this will all end.

Wednesday, March 19, 2014

Kenyan Humor on Those Pestiferous Matatus that Swarm Kenya's Highways and Byways and the Policepeople Who Love Them.

File this under
Seen this; been there.  Classic example of codependency, Nairobi-style.

From the online edition of Kenya's Daily Nation newspaper.

Tuesday, March 18, 2014

When Headlines Become Personal

‘Terrorist takeover of Kenyan Mall’ takes on a whole new meaning if one just happened to have coffee at a café in that very mall a few months before.

‘Revolution in Ukraine’ and ‘Russia takes over Crimea’ resonates much more deeply if one just happens to attend a Ukrainian Orthodox Church in Virginia.

‘Egyptian Coptic Christians Face Persecution’ if one just happens to have Egyptian Coptic friends in Nairobi.

‘Turkish Christians Arrested in Izmir’ hits very close to home if it just so happens that the church that was raided was one that I preached at.

‘Beijing Pollution Obscures Skyline’ becomes all the more alarming if one’s daughter just so happens to be planning on visiting Beijing in the near future.

‘Deteriorating Security Situation in Afghanistan [or Iraq]’ gets one’s attention if one’s possible future job might require a posting in one or the other.

‘Poaching Decimates African Elephant Populations’ has a visceral impact if it just so happens one lives 8 miles from the elephant orphanage that tries to save babies left to die left by poachers.

‘Climate Change Expands Malaria Mosquito Range’ is alarming if one so happens to catch malaria whilst living in Nairobi in what was always before a malaria-free zone.

‘Conservative American Christians Back Israel’ makes little sense when a significant minority of Palestinians are Orthodox Christians and are being persecuted by both Jews and Muslims. 

‘Virginia Beats Duke for ACC Championship, Given #1 Seed in NCAA Tournament’ reads differently when one is both a Duke grad and father of Daughters who are both UVA grads.


Saturday, March 15, 2014

Three Years Ago Today

Three years ago today my mom died.  I got the news whilst giving a lecture to my Modern Theology class in downtown Nairobi.  My students refused to let me continue and sent me home.  To help me process my grief, this is what I wrote:

My Mom Died Yesterday

My sister called me with the news just as I was about to begin a lecture on some forgettable aspect of contemporary theology.  It is striking how quickly such things become trivial when the subject changes suddenly to matters of real life and real death.

My mom’s death was not unexpected.  Several years of alarming decline punctuated by a Christmastime illness from which she never recovered, instead dwindling into a fragile shell of the woman we knew.  And when the final infection struck on Sunday, there was nothing left with which to fight back.  Her exhausted body was undone in a matter of hours.  It says something profound about what we were meant to be that death, what it is and what it does, seems so outrageous, so unnatural, this destruction of our bodies, this severing of all ties with loved ones, this removal from the stage of the living.  We recoil from death, we shrink from dying.  And rightly so.  Those who argue that death is just a natural part of life must not be acquainted with death.  Death takes a human life, something that was created good and made in the image of the Holy Trinity, death destroys that life.  Death takes a person, capable of love, capable of good, capable of astonishing acts of fantastic cooking (!), death reduces that person to nothing.  Death erases, so that she who once was so alive and so present and so here, she is now no more.  The voice that called or laughed or sung is silenced.  The hand that helped or touched or caressed moves no more.  The eyes that looked in wonder or wept tears of sadness or crinkled in a smile are closed never to open again.  Death has taken my mom.  Her voice I’ll never hear again.  Her hand I’ll never hold.  Her eyes I’ll never look into and wonder what she’s thinking.

I am finding that my mom’s death is an invitation to remember.  And remembering her I find is the same as remembering myself.  My mind sparks with fifty years of flashbacks. 

My mom was married at sixteen and a mother a seventeen.  She helped get my father through college and medical school.  By the time I came along, my parents were on the cusp of living the American Dream.  It took me many years to realize it, but I was born into immense privilege.  As I was growing up, this, of course, just seemed normal.

My mom was always driving me places.  In a massive station wagon.  Always smoking cigarettes.  Even as a little boy I remember plastering my face as close as I could get to the inch or two opening in the window so I could breathe.  I have my mother to thank that I was never tempted to take up smoking when teenager rebellion kicked in!  I just never saw the attraction in choking and pretending it was somehow cool. 

But my mom endured the kindergarten runs, the baseball practice runs, the music lesson runs, the basketball practice runs.  She had famous brothers who excelled at basketball and football at the University of Kentucky.  But if it ever bothered her that own her son was completely unlike her brothers, so ungifted in the athletic arts as to be doomed to be the last one chosen for whatever team, she in her mother’s love never let on.  But if such things are awarded in heaven, I am sure she will get a medal, not just for insisting that I practice playing the viola, but then enduring the consequences.  Daily.  I don’t know, maybe she had invested in ear plugs.

There were wonderful, happy days.  I would hear my mom laugh.  We would go out to the lakehouse for the hot South Carolina summer, and of course we kids would live in the water.  But it was always special when mom would decide to get in her floating chair with the special built-in Styrofoam beer can holder (before such things became standard in all South Carolina boats and cars) and float out into the cove while the rest of us swam and dove and splashed .  All was right with the world. 

There were a few secret blackberry patches that I’m sure nobody in the world but me knew about.  And with great anticipation I would wait until just the right time in June when I knew they were getting ripe.  And I would head out with my bucket and bare feet and pick blackberries until the bucket overflowed (which took longer than it might otherwise because I probably ate one for every two that ended up in the pail).  The picking was fun (even more so because the chances of coming across a black snake were significant), but the real reason to pick blackberries was because mom would then feel obligated to make a blackberry cobbler.  Oh my goodness, need I say more?

My mom could cook!  She excelled at southern comfort food, or what I later learned is called White Trash Cooking.  Of course, for me, it was just supper.  One of my favorite growing-up meals was meatloaf on which I would put ketchup and one of those individually wrapped Kraft cheese slices, which of course would not actually melt.  It’s debatable if such ‘cheese’ was even digestible.  But I love my mom, because she would buy me Krispy Krème donuts, and she kept me fed.  And if anyone has ever been responsible for feeding teenage boys, you will know that that is no small accomplishment.

Southern cooking is all about casseroles, and my mom mastered the art of the southern casserole.  My mouth waters just thinking about it.  She and her friends contributed recipes to a cookbook that remains sought-after to this day (Carolina Cuisine).  Her Thanksgiving dinners and Christmas dinners were exquisite.  Her oyster pie and sweet potato casserole and pecan pie and cranberry and crème cheese strawberry jello salad… oh my.

Mothers are goddesses to their children and can do no wrong.  But as we grow older, we realize that our mothers are real people.  The transition can be disorienting.  When the transition is accompanied by trauma, it can be devastating.

My parents separated when I was fourteen and divorced when I was fifteen.  Our family was shattered.  Everybody hurt.  But my mom somehow managed to keep our day to day lives as normal and stable as she could.  She tried to keep home a safe place for us.  Somehow, she managed to hold us all together.  Those years were unspeakably hard.  All of us were wounded and scarred.  But I am convinced that I and my sisters have been able to accomplish what we have done because our mom held the center of our family together.  For our most important years, mom was ‘home’.  I told my mom thank you for this when I saw her for the last time in January.  I’m so glad I did.

Mom became a Christian shortly after the divorce.  She had been a long-time church-goer.  But something happened that suddenly made Jesus and forgiveness and a new life real for her.  She would tell whoever asked the right question that this was the most important decision of her life.  Since that time, I never knew her not involved in a church.  Whenever she moved, her first priority was to find a church to join and hopefully a small group bible study to be a part of.  In Anderson, SC, it was Central Presbyterian, in Lexington, KY, there was first a Methodist church, and then a Presbyterian church.  In Cleveland Heights, OH, it was a Baptist Church.  And in Watkinsville, GA, it was the Baptist church just down the street.  Mom was never pushy about religion.  But if anyone took five minutes to get to know her, it would become obvious that she took Jesus very seriously, which means she took Jesus’ promises seriously.  For all her faults, and she had her share, she never wanted to impose her suffering on anybody else.  I used to think she was just being stoic.  But now I see that mom was actually trusting that God would do what he promised to do.  God promises to save us from our sin and from the consequences of our sin.  Mom trusted that God will keep his promise.  God promises to transform our self-centered character into a character that demonstrates Jesus’ love.  Mom trusted that God will keep his promise.  God promises to raise us from the dead and give us a new body to live in his new creation that is free from sin and death.  Mom trusted that God will keep his promise.  I know because we talked about these things, back in 1976, and two months ago this past January.  My mom will not make sense unless you are willing to hear her out on what she thought was the most important thing.

All of my sisters I know have their own stories and could write their own additions.  We all left home and went to college.  I married Stephanie and we began our own life and family together.  And so our lives grow apart.  Phone calls on special days.  Packing up children for the long drive to Grandma Donna’s house for Thanksgiving.  And then for us, moves overseas, first to the UK, then to Ethiopia and now to Kenya, with our own children growing up and heading off to college.  And the cycle continues.

But at some point, health challenges start to mount.  And, gosh, mom looks older.  Surgery follows surgery, and the recovery is never as robust as one might hope.  And as her body fails, her world begins to shrink.  And so the long slow decline begins.

My mom died yesterday.  Just another name on the nursing home records.  Just another paragraph in the local paper’s obituaries.  Just another number for the insurance company.  Just another little old lady slowly pushing a cart at Kroger.  A nobody according to the way our world measures somebodies.  Who came into this world with nothing, and left with the same.

No monuments.  No highways named after her.  No books or scholarly papers to achieve immortality in libraries and online databases.  No companies that bear her name.

The only thing my mom appears to have left behind are a few lives, lives whose hearts have been touched, lives whose character has been influenced, lives who shared a laugh or enjoyed a meal or experienced something good.  But given the fact that monuments will crumble, and accumulated treasure will waste away, given that nothing most people pour themselves into will last or be remembered, it could be that touching a few lives may turn out to be by far the most important thing.  Thanks, mom.  Memory eternal.

Mom, from the 1970s, when I was a teenager.