The Dangerous Institutionalization of Recovery Dogma

What is dogma? When you ask "the google" you get the following definition: "a principle or set of principles laid down by an authority as incontrovertibly true".

Religious dogma = principles and "commandments" that ultimately lead to your salvation. Laid down by the "church" or other established religious hierarchy. In most countries and cultures, the hierarchy has no official power over the dogmatic followers. They are held in line by fear of eternal damnation.

Political dogma = principles or talking points laid down by the party leaders and most vocal activists. In most cases, the political party leaders have no official authority. The dogmatic followers are held in line by fear of tribal alienation.

How about recovery dogma?

Recovery dogma = principles or beliefs that define the one true way to "fully recover" from substance use disorder. But how are the dogmatic followers held in line? Among other things, it turns out there are official authority figures involved.

There are many reasons people promote the “one way only” philosophy of recovery.

1) Dogma: All human groups tend toward dogmatism. Dogma certainly contributes to our stubborn commitment to one size fits all models. Bill Wilson warned us of this possibility in 1965:

“It is an historical fact that practically all groupings of men and women tend to become more dogmatic; their beliefs and practices harden and sometimes freeze. This is a natural and almost inevitable process.... But dogma also has its liabilities. Simply because we have convictions that work well for us, it becomes very easy to assume that we have all the truth....This isn’t good dogma; it’s very bad dogma. It could be especially destructive for us of AA to indulge in this sort of thing”. (Wilson, 1965/1988, p. 333)

2)Institutionalization of “one way only” recovery (this is particularly tragic part of the story):

A group of people, focused on mutual support, becoming tied into “the one true way” is natural and unavoidable. Recovery dogma is a less intense version of religious denominations. There are tens of thousands of different religious denominations and sects. Each one claiming the true pathway to salvation. In recovery, we proclaim knowledge of the one true pathway to recovery. However, recovery dogma has also become institutionalized. There are authority figures who demand adherence to 12 step only recovery. In effect, it's state endorsed recovery.

Things get very complicated and problematic when state authority figures, defacto treatment experts, and perceived “addiction medicine” experts proclaim the one way only dogma. Once the 12 step only dogma became institutionalized the public debate was over. Actually, it never got started. This model was cemented into the American psyche as the only way to recover. The dogmatic principles of 12 step recovery have been systematically reinforced over the decades. This "one way only" thinking underlies most substance use disorder policy and procedures. Unfortunately, this paradigm guides nearly all other government and social institutions as well (in terms of their response to substance misuse).

For example. There are professional monitoring programs embedded within agencies that claim to embrace “multiple pathways to recovery”. However, the monitoring program will only approve 12 step recovery. Another example. We have court systems and child welfare programs that will reject medication assisted treatment as a viable option for parents trying to get their kids back. There is very inconsistent and highly variable levels of institutional support for multiple pathways to recovery.

Less obvious, but just as problematic, 95% of government funding is funneled into clinic based, compliance models. Acute care “come and get it when you are ready” is part of the solution. But it is not 95% of the solution.

STATION BREAK: LET'S EXPLORE THE SCIENCE OF RECOVERY:

• Please check out the science of recovery. The evidence is overwhelmingly clear, 12 step recovery is NOT the only route to recovery. It is one of many pathways.
• 22.35 million in recovery (remission). They had a problem. They no longer have a problem. I hope we can all agree that remission is a good thing. No longer destroying your life with substances is good, regardless of how it gets done.
• Of those 22.35 million: 46.1% (10.3 million) FIGURED IT OUT ON THEIR OWN (did not use assisted pathways). 53.9% (~12.05 million) GOT SOME HELP (used assisted pathways).
• Of the 12.05 million who got some help. 45.1% (5.4 million) reported using some type of "mutual aid". This is the category 12 step recovery falls under. Take note: there are other mutual aid groups that fall into this category as well. For example, SMART recovery, rational recovery, All Recovery. It is safe to assume, however, that the majority of the mutual aid group used 12 step recovery. It is the most successful and most available alternative in the mutual aid category.
• This means, of the total number of recovering people (22.35 million) only 24% required 12 step, abstinence based model.
• And this means, 76% got it done some other way.

So why are we hell bent on institutionalizing 12-step only pathway?

The picture below summarizes the research surrounding recovery. Here is a link to the full article: National Recovery Study

3) Stating the obvious. Recovery dogma is reinforced by the private treatment industry business model (rehab especially). A business model that can't miss if the “you must be willing” ideology is universally accepted. In this "hit bottom and surrender" model there is no such thing as bad treatment. There is only a bad patient. An unwilling patient. Furthermore, the answer is to send him back for more treatment. Over and over. Until he gets it right. This is a pretty sweet deal for the treatment provider. No so much for the patient. Of course, there are high quality providers. Of course, there is always going to be a need for acute stabilization and private treatment. However, none of this overrides the fact that the standard operating model is off target at best. Dangerous and unethical at worst. Illegal and full of malpractice at the far end of the spectrum.

4) This final point focuses on the individual. Any one of us may be afraid to open up to multiple pathways because we were conditioned to believe “there is only one way” in early recovery.

If we believe the research discussed above what does that say about us? Why did we make those one size fits all statements if the research does not back it up? And, does this realization make us vulnerable to getting off track in our own recovery. If I believe there is another way....am I going to make a mistake in my recovery.

Some people bear a latent and shadowy fear that any “crack in the foundation” will lead to relapse and death. Because we were told that early on. And it saved our lives during our most vulnerable periods. We were told: Do not think for yourself. And it worked.....This scared straight type psychology works early on. At least it did for me.

However, as time goes by, you can open your mind.

If you are years into recovery you can explore multiple pathways without abandoning your chosen pathway. Indeed, open-mindedness and being teachable are fundamental to the recovery journey.

Can a devout Christian explore the tenets of Islam?

Can a staunch progressive Democrat explore the merits of conservatism? ??

Can a died in the wool 12 step veteran explore the necessity of life saving addiction medicine?

And if you can not do so....can you still call yourself “open-minded”?

Richard Jones is the CEO of a highly innovative and influential recovery community organization serving South Carolina since 2012. FAVOR Greenville has received national recognition from SAMHSA and the Department of Justice. Our highly effective FORCE program (serving overdose survivors) has been accepted into the National Institute of Drug Abuse (NIDA) clinical trial network. See this link for more information on this clinical trial.

Richard is also the co-founder and Chief Strategy Officer of YOUTURN. Youturn is a ground breaking online psycho-education, early intervention and solutions oriented program for individuals and families in need of a support for substance misuse.