A nurse that I used to work with developed an addiction a number of years back. When it came out, in order to have any hope of getting his job and his nursing license back, he was required to see an addictions specialist and adhere to the treatment plan that was set out. One of the elements of the treatment plan this doctor came up with was attending Alcoholics Anonymous (AA) meetings.
This nurse is an atheist. He tried AA but didn’t find it helpful at all, as it just didn’t mesh with his personal brief system, so he refused to continue going to meetings. Despite being keen to engage in other forms of treatment, he was fired by the health authority for not following his treatment plan. He ended up taking the issue to the provincial Human Rights Tribunal, complaining that he was discriminated against on religious grounds because he was an atheist. According to an article on the CBC website a couple of months ago, a settlement was reached between the nurse and the health authority. As a result, the health authority will no longer require health professionals to attend 12-step groups if it goes against their religious beliefs.
AA and the higher power
While AA is Christian-influenced, it isn’t associated with any particular religion or denomination. Still, a higher power plays a major role in the 12 steps.
It’s possible to substitute some non-deity form of higher power, but it requires some mental and spiritual acrobatics, although there certainly are atheists in AA. If God isn’t your thing, it’s hard to avoid given how enshrined God is in the AA program. For myself, as an atheist, what I wouldn’t be comfortable with is the shift in locus of control from self to higher power; that’s just not the way I look at the world. Whether that higher power is a deity or not, with the lens through which I view the world, it’s not up to a high power to remove defects of character or shortcomings or restore me to sanity; it’s up to me (granted, I don’t have an addiction, so it’s kind of a moot point).
Other options
While AA (and its other 12-step variations like Narcotics Anonymous, etc.) works for some people, it doesn’t work for everybody. It’s generally not considered an evidence-based treatment for substance use disorder, as there isn’t solid research to show that it works. That being said, it absolutely is effective for some people.
While a self-help fellowship isn’t a bad thing, it seems strange for an addictions doctor to insist on it as a non-negotiable part of a treatment plan. It’s not as though there aren’t other treatments available. There are other group-based programs available, such as SMART Recovery; it’s based on a form of psychotherapy called rational emotive behaviour therapy. My former colleague was highly motivated to participate in secular groups like SMART Recovery, but the addictions doctor wouldn’t accept that as a substitute for AA. The CBC news story also mentions that for this particular nurse, the game-changer in really moving forward with his recovery was the medication naltrexone, which blocks the effects of opioids and alcohol.
The right fit for the individual
I can see that an addictions physician who treats healthcare professionals would be in a difficult position. They need to make sure someone isn’t going to go back to work and put patients at risk. But insisting on AA when someone says that it’s just not the right fit for them seems inappropriate. A person isn’t necessarily lacking commitment to recovery if a specific treatment isn’t a good fit for them; if they show motivation to engage in treatment, it doesn’t make sense that one particular type of treatment should be considered the be-all and end-all.
I’ve never had a substance use disorder, but if I did, I can say with certainty that AA would not be a good fit for me; it’s just very different from my way of looking at the world. If I wasn’t interested in treatment at all I’d probably be trying to say no to a lot of different things, but I think someone can be fully committed to recovery and still not want to do AA. For me, SMART Recovery sounds like it would be right up my alley.
Just because someone is a health professional doesn’t mean they shouldn’t have the right to patient-centred care with evidence-based treatment tailored to what’s suitable and effective for them. I’m really impressed with this nurse for fighting this fight, even though it’s taken years.
No single treatment works for everyone
When it comes to any form of addictions treatment, what works for one person won’t work for another, and it’s hard to know which it will be until someone tries the particular form of treatment.
If addictions treatment providers are so rigid that they want to adhere to their own plan rather than go with what’s most effective for the patient with the addiction, that’s really not accomplishing much of anything. It’s just like if a doctor was trying to treat me with their antidepressant of choice; if it wasn’t working, I would expect them to switch me to their second choice antidepressant rather than keep me on the first because they were so confident that it was the only one that would work.
Do you think AA should ever be forced on people who don’t believe in God in any form?
No, I don’t think AA should be forced on anyone. If you don’t believe in its approach you are not going to be able to commit wholeheartedly to the program. That means its effectiveness is likely to be limited at best. It would be better to be in some other kind of supportive, professionally led self-help group with other participants who also want to get free of their addiction. (Supplemented with individual counselling.)
I agree.
Forced therapy doesn’t work (most of the time). You have the choice to chose the approach best suited for you. Imagine someone would ‘find out’ that only psychoanalysis works for OCD. Could we force all the people with OCD on Freud’s couch? Or maybe psychodynamic therapy? Or maybe Jung? Or Klein?
If I was forced to go to AA it wouldn’t help me and it wouldn’t help them either. It is in no ones interest to be ‘treated’ against their will. Ooops that is a whole other discussion! 😉
I think it’s pretty par for the course for health professionals with addictions to be required to get treatment if they want to continue on with their careers, but using a form of treatment that doesn’t work for someone makes no sense,.
Yes that was what I was trying to explain. (long day….sorry)
With forced treatment I was thinking more in terms of forensic psychiatry, what does work but where timing is also important.
When you’re not functioning on the job as you should (and it’s not solely the jobs fault) I understand fully that it can be acquired that you take action towards resolving the problem at hand. Only you should be free to chose in what way you do that. What if a ‘sweat hut’ became acquired? I have too many fantasies about which ‘treatment’ ‘should/could’ be proposed to a certain problem, of course without any science to it!
Health professionals with addictions are dealt with pretty strictly, and I can see why that would be, but If any treatment should be required, it should be evidence-based, which AA is not. And also based on what works for that specific person.
I have learnt something new today about AA groups. I didn’t know that. I myself don’t believe in God. When ticking forms on paperwork for religion, I tick none. If none is not available, tick other. So if AA was enforced on me, I would kick up a stink. Where as a supportive group without the religion bit, I would find acceptable.
Yes the religion aspect wouldn’t work for me either.
Wethinks the root of addiction is relevant to treatment modality efficacy. What are we trying to “cure”?
We had a hospital-met friend who was kicked out of a world-renowned alcohol treatment facility after friend’s x-th time (10, 12?) through their rehab program. Why? The root of friend’s addiction was trauma. They said friend was not recovering because the addiction was a symptom of friend’s problem, not the core problem.
Friend went to residential trauma program for 5 weeks. They also used AA at the hospital.
It was just too late. Friend said the 46-year alcohol addiction (begun age 6 😭) was too ingrained.
Friend passed away one year after trauma therapy.
“Low-dose” Naltrexone is being touted as a wonder drug: maybe some cancers, Crohn’s, auto immune, etc. It was recommended to us for our DID, because it blocks endogenous opioid craving, which is ostensibly the reward system for dissociation!
We opted no because dissociation is often how we stay alive. If we can’t dissociate, would we get better or worse? Still something for us to consider. Maybe you’ll someday write about this wonder drug?
A pattern of dissociation probably would never get started in the first place if it didn’t serve a useful purpose at the time. ❤️
And yes, I’ll do a post about naltrexone. 🙂
Your words often feel like a hug. Thanks 💕❤️
I agree, trying to force treatment on people who don’t want it doesn’t work, except in perhaps a few cases where enforced clean time allows another underlying disorder to be treated properly, and that allows them to get motivated,
Fortunately, I do not suffer from either mental health issues or addictions, but I have a lot of friends who have been there. Yes, I do believe people with addictions NEED help, especially before resuming their jobs. AA specifically may not be the answer, however, they now have programs with a proven track record that are not set with religious overtones and the Bible as their guide. .
Yes it’s good that there are other options available now so people are more likely to find something that’s effective for them.
Absolutely.
Forced into the AA program? No. Forced into rehab for a short time? Maybe. I can see the benefit in getting someone sober to at least then have them make a rational choice about whether they want treatment. Can someone who is high and still under the influence of drugs even make a rational choice or think things through? I think a short forced rehab stint is better than jail time anyway for just simple usage of drugs. Once someone is sober, they may be able to think about the things their addiction is stealing from them and maybe they would be more likely to accept further treatment.
Yeah if jail is the alternative, forced treatment is far more likely to give some sort of benefit.
No….
AA doesn’t work for everyone. In fact, I can imagine that for some people, it might even lead to relapse. As with mental illness, treating addiction should be individualized, rather than the “one size fits all” approach
Absolutely.
Very much so agree that forcing any type of anything on anyone will never work!! I can understand an employer requiring someone to meet standards for continuing the work but it shouldn’t be specified which kind they have to do as long as they’re not putting themselves or others in harms way.
Yeah as long as something is working, it really shouldn’t matter what.
Yes!! Exactly 🙂
I think failure starts when you force people to believe in what you believe in.
Belief or disbelief in God should be a freewill business.
Definitely.
Wow, interesting story. I think a treatment plan for any kind of illness whether it’s addiction-related or not should be between a person and his/her doctor. Because as you summed it up perfectly – what works for one person may not work for another!
Yes!
Hmmm. In general, I don’t think therapies (AA, rehabilitation, talk therapy) are as effective when they are forced on people; it’s much more effective when people WANT to change. But I also think that forced therapy is better than forced jail time. In the case that you mentioned, I think your colleague should have had the option to seek a different recovery program, as he was receptive to the idea of recovering. And like you said, recovery plans will differ from person to person!
Yeah if there are other workable options it makes sense to go with that.
I didn’t go to NA when I got sober. Or rehab. When I did research, I came across SMART & if there had been meetings here I woulda went. But it’s a small town & some are dedicated to AA/NA. It’s not for me. I also don’t like how they tell you all medication is bad. They judge opiate addicts if they use medication to get through withdrawals & cut cravings. Some even judge people for taking antidepressants. Not all but some.
Yeah that’s a huge problem with the AA/NA model.
This is a very big discussion. Thank you for sharing your thoughts
Being in a 12 step fellowship myself, no one should ever have to be forced to do anything let alone go to a recovery program. in Any form of recovery the person has to be willing and make the choice for him/herself, otherwise it doesn’t work. the 12 step program is a spiritual program and not a religious one. Using the term God has many, but many connotations in the program. What God means for some, doesn’t mean for another. The good thing about this program is that You don’t have to believe in anything. You can make Elvis your HP if you want. As long as you define what your HP is for yourself. The 12 step program works, and that is because of the HP element. It only works if you work it. Its a flawless program. And to understand and grasp this concept one has to experience it. No, its not for everybody, and its not for those who need it. Its only for those who want it. when it comes to addiction, its the only program that brings long term sobriety. one can debate all they want, this is the truth. IF you understand addiction, you understand this. I enjoy reading your blog, interesting topics.
“It’s the only program that brings long term sobriety.” I think I’ll have to disagree with this. Maybe you see it that way because it’s what worked for you, but I work my own program and it’s worked so much better for me than sitting in a room repeating “I’m an addict.” To me, that kind of introduction is contradictory to the label we want society to drop. We can’t expect the world not to see us as ONLY addicts, if we’re constantly calling ourselves one behind closed doors. To each his own I suppose, but to say it’s the only program that brings long term sobriety is a bold statement. I’ve made amends, I’ve worked on resentment, forgiveness, cutting out negative influences, setting boundaries, being present, letting go and letting God, made connections with people in recovery, and I’ve done it all on my own. It’s not easy, but it’s not impossible. It takes work, dedication and and incredible amount of self awareness to maintain sobriety. In the end, I would probably say it was ultimately my faith that saved me and keeps me going.