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).
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?