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June 2014 |
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organisational cultures. Right now,
broadly speaking, 12-step rehab
continues on a rough rule of thirds –
some clients get it, some don’t, and
some might if we went at it
differently. Why is that, and what do
we need to consider here? Long may
we have outspoken commentators
like Stanton Peele to raise questions
which frighten us.
Paul Taylor, couns.super@gmail.com
EACH TO THEIR OWN
Further to last month’s debate, I
also believe there is a great deal of
lack of understanding of 12-step
programmes. Addiction is a life-
threatening problem, and if
something is helping people to
recover their lives without a
substance dictating their days, why
would anyone disagree with that?
I believe there are other ways to
recover. Harm reduction is vital to
begin with, but does it make sense
to spend a life on a substance like
methadone and many other so
called solutions?
AA in particular has had a huge
success rate for many years – if it
works, don’t fix it. I have never
witnessed anyone being kidnapped
to go to a programme, it is their
own choice. If one chooses to go
another path why does 12-step have
to be their problem? Would it not be
a good idea to just get on with their
own solutions and leave others to
get on with theirs?
A final point: 12-step programmes
are free and self funding; would that
be a reason? Or maybe it is the
choice of individuals not to be
abstinent, or they confuse 12 steps
with orders not suggestions – I could
go on and on. Surely the best thing
is to choose your own solution and
stop criticising. It seems that this
debate is looking for what is wrong
and not at what works for many,
though (obviously) not all.
Rita Matthews NCS (Acc), MBACP,
AHPP certified reality therapist,
FDAP, associate member of the
Royal Society of Medicine
I AMWRITING IN SUPPORT
of Stanton
Peele’s exceptional wisdom and
freedom In rejecting the punish-
ment/treatment dichotomy (
DDN
, April,
page 8). Strange as it may seem to
English speakers, Stanton Peele´s views
on addiction and recovery are not under
debate in Scandinavia. Frankly it can be
quite confusing to understand the fuss
and the controversy so openly
expressed in the US and UK.
Long ago when living in Denmark, I
used heroin – extensively and often
combined with other drugs. I almost
died from it. Methadone was available
from the general practitioner, who
prescribed it to me for almost 15 years
– even though no one ever labelled my
condition as a disease, or told me what
I had was a chronic condition. My
physician simply followed the
Hippocratic oath, prescribing an opioid
and consoling and soothing me. This
was not a common attitude among all
Danish physicians, but every general
practitioner was allowed to decide for
themselves whether they wanted to
treat addicts or not. No counselling
was offered, nor any demands of me
changing my lifestyle.
We looked at opiate addictions as
bad habits that you were supposed to
outgrow. And it may be a surprise for
the Americans, but many – including me
– did outgrow their addiction. Sadly this
was not reflected in scientific reports, as
the Danes never really took the issue of
‘recovery’ that seriously. On the other
hand, what you would call harm
reduction measures were from early on
introduced and maintained in Denmark.
Many Danes, once seriously
addicted to drugs, are in good job
positions today, as we grew up as was
expected. This was not a road followed
by all of those addicted to drugs, and
some were left behind, like everywhere
else. Often this was because they were
denied the prescription of methadone
or other opioids. The Danish
perspective changed in the 1990s,
when the 12-step movement started to
colonise Scandinavia through private
entrepreneurs in the form of
professional addicts opening private
treatment institutions. They claimed
that the Danish treatment model had
proved to be a failure and pointed out
the missing communities of recovering
addicts as proof.
At the time I was enrolled at
university finishing my masters degree
in psychology, and had left my drug
and methadone taking days long
behind me. Actually I rarely thought or
spoke about drugs, but with the fuss in
the media from the new ‘recovering
addicts’, I became curious and went to
a newly established 12-step meeting.
There for the first time ever, I learned
that I had a chronic disease, and that
relapse was to be expected. I did not
know the word relapse, and I had
certainly never thought of having one.
But after a few meetings I started
waking up in the middle of the night
with panic attacks and the phrase
‘relapse’ on my mind. What if I woke up
experiencing an uncontrolled relapse? I
reconsidered my desire to attend 12-
step meetings because, furthermore, I
was told that my ability to control my
drinking alcohol proved I did not have
‘the disease’. Not having a deadly
disease has given me freedom to do
whatever I like for the rest of my life,
including using recreational drugs,
drinking alcohol, using pain
medications for serious pains, hanging
out with whomever I like and pursuing
a carrier of my own free choice.
The ‘traditional’ view on addiction
and recovery is still alive and well in
Scandinavia, where most people and
many social workers still see drug
addiction as a passing phase in life that
you can and should outgrow. However,
we now struggle with the two disease
models imported from the US. The NIDA
model embraced mostly by Norwegian
physicians results in patients receiving
methadone or buprenorphine, and they
are told that their medical treatment is
permanent – that they will never be
able to quit. Some patients have
objected and filed cases against the
health authorities protesting that they
have been denied detox or tapering of
their medications, with some even
being coerced into taking huge doses of
methadone they do not want.
Non-judgmental treatment in
Denmark was available in many forms
from the ’60s, even though the Danes
had no working concept of ‘disease’,
but rather defined treatment in the
context of social customs or
prescribing opioids as a kind of
traditional maintenance. Neither
concept of ‘addiction as disease’ (AA’s
or Nora Volkow’s) has improved
treatment quality or rates of success,
which have been documented by the
national addiction research centre. On
the contrary, the disease models have
introduced a range of troublesome
concepts including the chronic and
incurable addict. Harm reduction does
NOT depend on a disease theory –
quite the opposite, in most cases.
Lise Reckee is a Danish social
worker/addiction counsellor, now
working in Norway
EXPORTING THE DISEASE
Lise Reckee brings a Scandinavian perspective
to the debate about the 12-step model
‘The Danish
perspective
changed in the
1990s, when the
12-step
movement
started to
colonise
Scandinavia
through private
entrepreneurs in
the form of
professional
addicts opening
private treatment
institutions...’
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