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Treatments & Interventions

by Joseph Volpicelli and Maia Szalavitz
John Wiley & Sons, 2000
Review by Shelly Marshall on Aug 1st 2002

Recovery Options

Did you know that in some Siberian tribes, people ingest urine from mushroom eating friends for a magnified mushroom high? That makes two of us. With this slam-dunk opening, "Recovery Options" promised to be a lively treatise on addiction recovery. Through a spirited discussion of the ups of uppers and the downs of downers, the authors were able to reduce the rather complex subject of neurochemical brain chemistry and drugs to a simple lay explanation. Through such droll dialogue as "stimulants mimic the pleasures of the hunt, opiates are all about feasting," this book captivated me immediately.

Because the summary of drugs and their effects was so clear-cut and engaging, I had no hint that once the discussion turned to treatment, it would also turn biased. The change was an unexpected disappointment.

Maia Szalavitz, an author in recovery, and Dr. Joseph Volpicelli, an Associate Professor of Psychiatry, collaborated to write a balanced presentation of the current recovery choices. Unfortunately they end up dancing in a type of love/hate relationship with treatment based on the principles of Alcoholics Anonymous. The authors minimize 12-step effectiveness and then use AA philosophy and group practices to prove their points.  Decidedly biased toward cognitive-behavioral therapies (CBT), their disparaging remarks about 12-step based treatment centers and the "self-proclaimed experts" who work there, suggest they think of them as antagonists to other treatment options. Among the options mentioned were controlled drinking, methadone maintenance, cognitive-behavioral methods, aversion therapy, and harm reduction.

Chapter Five presents the "Great AA Debate" by citing undocumented research while ignoring well done counter studies that refute their claims. Examples include references to the effectiveness of aversion therapy, claims that 12 step-based treatment has little empirical foundation, and the age old assertion that controlled drinking (or using) is a viable goal in treatment. The authors challenge the disease model of chemical dependency, amalgamating inherited, genetic dependency with learning or environmentally sustained substance disorders. They suggest that addiction lays on a continuum and only the last stages at the far end of the spectrum deserve a treatment goal of abstinence. Of particular vexation is the unsubstantiated claim that a majority of women alcoholics and addicts also suffer from collateral psychiatric disorders (apparently most men don't).

In studies that could be verified, summations were somewhat one-sided.  Szalavitz and Volpicelli report that the families trained in CRAFT (community reinforcement approach family therapy) were twice as likely to get their alcoholics engaged in treatment (64%) as those who used the classic Johnson technique (30%), making it seem as if CRAFT techniques work better. What they didn't report was that the Johnson method succeeded in getting the drinker into treatment 75% of the time but that significant others do not go through with the intervention 70% of the time, forcing the statistic to 30%.

When seeking treatment, the book encourages chemical dependents and their significant others to slowly and methodically explore their options while focusing on the cons of continued using and on the attractiveness of a sober life. During this process the significant other is to be nurturing and empathetic, so as not to frighten the addict, make them feel like a failure, or make them think that treatment will be painful. Alcoholics are advised to take small steps, reduce time with drinking buddies, "gradually expose yourself to the negative side of your problem and get beyond your defenses."  They are encouraged to ask questions of different providers, including, "What is the role of confrontation or "breaking denial" in your treatment?" Dare I mention the obvious? If an alcoholic is asking this question of a treatment center they plan to enter, can one honestly say he/she is in denial?

These suggestions make the reader wonder if the authors understand how the disease really manifests. Just imagine Bubba from Alabama who finally admits, after socking his wife in the eye, that he may have a problem with alcohol. Since Bubba would never read this book, we'll say his wife reads it.  Following the suggestions, she doesn't want to frighten him away from treatment, so she asks him gently to consider how wonderful it will be for him to be sober. He thinks "Yeah great, no more watching football with my buds." As he heads out the door, Bubba's wife pleads with him to cut own time spent with his bar buddies in an unhealthy atmosphere and spend time with the minister who doesn't drink. When he stumbles home after the bar closes, having spent his paycheck, Bubba's wife whispers that she doesn't want him to feel bad about himself because she knows "the distortion in your pleasure circuitry" has gone awry. "Maybe," she suggests, "you can talk to a counselor to ease your terror. Imagine yourself as someone who 'used to' drink rather than a drinker." He promptly socks her other eye.

Recovery Options will irritate, but not seriously trouble, treatment professionals because the people it's intended for, the chemically dependent, aren't likely to read it. However, if you combine Part One of this book (The Problem and Search for Solutions) with Part Three (Life After Treatment), Moderation Management groups (designed for problem drinkers who want to cut down) would have a very good basic text. Likewise, if you take Part Two (The Options) and direct it toward professionals and community service boards, you have an excellent reference book on treatment options for the alcoholic/addict. But to insinuate that all substance misuse is part of a continuum aggravated by genetics and environmental stressors, is to ignore the very real scientific advances made in addiction physiology.  Addiction treatment is for the disease of addiction, not help for the person with a learned, reinforced habit that can be unlearned. In what could have been two excellent books, "Solutions for the Problem Drinker," and "A Resource of Treatment Options," Szalavitz and Volpicelli have unnecessarily blurred the very real difference between addiction and abuse.

 

© 2002 Shelly Marshall

 

Shelly Marshall, BS, CDAC is a researcher and specialist in adolescent addiction recovery. A best selling author of recovery self-help books, Marshal also trains counselors Internationally and is a representative to the United Nations for a Russian Charity NAN (Not to Alcoholism and Drug Addiction).