alcohol rehab for atheists

[bashir]

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I've read a couple of articles in the general press recently (The Atlantic had a pretty good one: http://www.theatlantic.com/features...irrationality-of-alcoholics-anonymous/386255/) about the paucity of evidence-based alcohol treatment centers and the dominaton of the scientifically unsupported AA-based treatment model.

Just as I've been thinking about this problem abstractly, from the perspective of a soon-to-be intern, it became much more real to me when a good friend told me he wants to seek treatment for his alcohol use and asked for advice on where to go. This friend is an atheist and by disposition particularly ill-suited to the AA model. At first blush this may seem like a strange question for a national forum, but I'm not sure that there is any local facility (we're in Omaha) that fits the bill, and if you're going to spend the kind of money that private rehab facilities charge, traveling long distances starts sounding like a reasonable option.

My friend has no insurance or money but does have family willing to foot the bill, so public facilities with a sliding scale as well as private facilities are on the table. Any recommendations?

Also, what's the deal with chemical dependency evaluations? Some places I've called say you have to have one before admission. Does it matter who does it or is just a check the box thing?

 

[OldPsychDoc]

I thought that the Atlantic article really rather overstated the extent to which AA infuses clinical Chemical Dependency programs in the real world*. I felt at times that the author had essentially learned everything they knew about "rehab" by watching dramatizations on TV, and sets up these more dogmatic AA-centered approaches as strawmen to advance his argument against "rehab as usual". Many treatment programs do indeed use some form of 12-Step facilitation, but usually only as a part of a program which pulls in bits and pieces of many other forms of therapy, including Motivational Enhancement, CBT-based relapse prevention, Health Realization, elements of DBT, etc. And certainly medication-assisted treatment as well--Suboxone, naltrexone, etc. Even the Hazelden "Mother Ship" Center City campus in the "Land of 10,000 rehabs" is more open-minded than this article portrays.

What's available does vary by locale. Some states have a fairly generous policy of underwriting treatment for the indigent, others not so much... What is required in terms of CD eval will vary depending on who is paying for it--but is sometimes done at the time of intake into a program, other places done in a social services agency, or in a detoxification center or hospital, etc. It's a bit more than "checking the boxes", since most programs are going to stratify the client by ASAM criteria as to what level of care is required (and can be reimbursed by the payer.)

As far as the atheism piece--they will probably want to seek out a program that utilizes the Health Realization model as its core principle: http://www.practicalrecovery.com/no...n-compared-to-12-step-programs-in-drug-rehab/ Such programs do indeed exist, but may take some searching.

* I still think that the 12-Step model is an invaluable community peer support network, though--and I strongly recommend it to 95% of my patients. And the cost can't be beat!

 

[Bartelby]

Not sure about inpatient rehabs as most facilities where I train are much more detox-and-discharge focused. Do take a look at SMART recovery if/when an outpatient support system would be helpful (http://www.smartrecovery.org/), it sounds like it could be a better fit given your friend's belief system.

 

[Shikima]

I thought that the Atlantic article really rather overstated the extent to which AA infuses clinical Chemical Dependency programs in the real world*. I felt at times that the author had essentially learned everything they knew about "rehab" by watching dramatizations on TV, and sets up these more dogmatic AA-centered approaches as strawmen to advance his argument against "rehab as usual". Many treatment programs do indeed use some form of 12-Step facilitation, but usually only as a part of a program which pulls in bits and pieces of many other forms of therapy, including Motivational Enhancement, CBT-based relapse prevention, Health Realization, elements of DBT, etc. And certainly medication-assisted treatment as well--Suboxone, naltrexone, etc. Even the Hazelden "Mother Ship" Center City campus in the "Land of 10,000 rehabs" is more open-minded than this article portrays.

What's available does vary by locale. Some states have a fairly generous policy of underwriting treatment for the indigent, others not so much... What is required in terms of CD eval will vary depending on who is paying for it--but is sometimes done at the time of intake into a program, other places done in a social services agency, or in a detoxification center or hospital, etc. It's a bit more than "checking the boxes", since most programs are going to stratify the client by ASAM criteria as to what level of care is required (and can be reimbursed by the payer.)

As far as the atheism piece--they will probably want to seek out a program that utilizes the Health Realization model as its core principle: http://www.practicalrecovery.com/no...n-compared-to-12-step-programs-in-drug-rehab/ Such programs do indeed exist, but may take some searching.

* I still think that the 12-Step model is an invaluable community peer support network, though--and I strongly recommend it to 95% of my patients. And the cost can't be beat!

I've never seen anyone hurt from doing 40 in 40.

 

[JesusSaves]

I remember reading that part of the effectiveness of AA is that it creates a new identity. The old identity associates everything with drinking, which is why a new identity is created. Self-identity has a lot to do with addiction... I don't know of any groups that do that for atheists, if it is even possible. Maybe he would benefit from at least trying AA. Is the existence of God a really touchy personal subject for his current psyche? If so, he seems like the perfect fit for the AA model. After all, the idea is to bring about a completely new beginning.

 

[Ceke2002]

I've read a couple of articles in the general press recently (The Atlantic had a pretty good one: http://www.theatlantic.com/features...irrationality-of-alcoholics-anonymous/386255/) about the paucity of evidence-based alcohol treatment centers and the dominaton of the scientifically unsupported AA-based treatment model.

Just as I've been thinking about this problem abstractly, from the perspective of a soon-to-be intern, it became much more real to me when a good friend told me he wants to seek treatment for his alcohol use and asked for advice on where to go. This friend is an atheist and by disposition particularly ill-suited to the AA model. At first blush this may seem like a strange question for a national forum, but I'm not sure that there is any local facility (we're in Omaha) that fits the bill, and if you're going to spend the kind of money that private rehab facilities charge, traveling long distances starts sounding like a reasonable option.

My friend has no insurance or money but does have family willing to foot the bill, so public facilities with a sliding scale as well as private facilities are on the table. Any recommendations?

I'll put out a call on one of the mental health support groups I visit if you like. I can't promise anything, but they have a section for Addiction so someone there might know of a facility or treatment program that is suitable for an Atheist. Good on you as well for respecting your friend's right to not be involved in a spiritually based recovery program when it runs contrary to his own personal position on such. Trying to push an Atheist into a spiritually based anything treatment program would kind of be like me trying to push a Christian into a Wiccan healing circle - completely disrespectful to that person's individual right to believe, or not believe as they see fit.

 

[Ceke2002]

Just out of interest as well, if anyone ever requires it for one of their patients, there is also a 12 step program, set up by Selena Fox* of Circle Sanctuary, that caters specifically to the Pagan community. Having known a Wiccan friend who was badgered in traditional AA meetings for wanting to (quietly) say the names 'Aradia and Cernunnos' at the beginning of the serenity prayer, in accordance with the higher power they prescribed to, I'd say having an alternative available is a necessity.

Pagans in Recovery Resource Packet:

http://www.circlesanctuary.org/store/index.php?route=product/product&product_id=337

When Goddess is God: Pagans, Recovery and Alcoholics Anonymous

http://www.circlesanctuary.org/store/index.php?route=product/product&product_id=339

(* Selena Fox is a trained counselor/psychotherapist with membership in the American Psychological Association, American Counseling Association, Association for Transpersonal Psychology, and American Academy of Religion)

 

[peppy]

I have no firsthand experience/knowledge, but I have heard of this program as an alternative to AA that does not have a religious orientation:
http://en.wikipedia.org/wiki/Rational_Recovery

Personally, I feel that one of the biggest reasons AA is worthwhile for addicts is that it gives them an opportunity to build new relationships with people who are sober (hopefully). I think your chances of sobriety are much better if you are able to break ties with the people that you used drugs with. Some AA groups seem more laid-back than others so it is possible that your friend could find an AA group where they would encourage him to interpret it in a secular way.

 

[notdeadyet]

There are plenty of AA programs that do not stress a religious component. Many programs stress something bigger than yourself as metaphor, not to be synonymous with God.

At the end of the day, the only requirement for participation in AA is a desire to not drink. The God thing is only as big an issue as folks make it.

At the end of the day, the strength of AA is being surrounded by a community of people committed to not drinking. Studies have shown a dose-dependent response to AA (the more you go, the better for relapse prevention). I don't know any studies that control for Godliness.


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[TexasPhysician]

Nothing wrong with 12 steps for atheists.

 

[doubledeuce80]

i recommend mutual help groups to all my pts with SUDs. i really don't care if it's aa/na, lifering, or smart recovery. lots of agnostics/atheists in aa, but some pts get hung up on spiritual aspect and it's not particularly productive arguing about it. i encourage ppl to try at least 3 different meetings till decide it's not for them.

i would recommend looking up local addiction psychiatrists in your area via the american academy of addiction psychiatry physician locator at: http://www.aaap.org/patient-resources/find-a-specialist/

i just did and there are 2 hits in omaha and 4 in nebraska total

an addiction psychiatrist could do an evaluation and/or point u towards appropriate local resources. Not everyone needs residential treatment, but some do.

fyi
smart recovery: www.smartrecovery.org

lifering: lifering.org

 

[JesusSaves]

Personally, I feel that one of the biggest reasons AA is worthwhile for addicts is that it gives them an opportunity to build new relationships with people who are sober (hopefully). I think your chances of sobriety are much better if you are able to break ties with the people that you used drugs with. Some AA groups seem more laid-back than others so it is possible that your friend could find an AA group where they would encourage him to interpret it in a secular way.

It is much more than that. AA aims to build a whole new psyche. Like I said before, an addict's psyche associates EVERYTHING they see with their addiction. If an alcoholic is cooking eggs for breakfast, it reminds them of drinking. When they drive it reminds them of drinking. Brushing their teeth even. Everything reminds them of drinking.

The only way to break that is to build an entirely new psyche - rebirth. You can't do that without God. The person wrestles with their thoughts and their addiction, but God is who gives birth to them in the Spirit.

This would be particularly effective for an atheist. The goal is to completely wipe the slate clean and be reborn.

I don't see why he wouldn't want to give it a try. The worst that could happen is him just walking out. He might end up liking it.

Without a rebirth, he WILL relapse.

This is the main reason AA is so effective. I met an ex-alcoholic who hadn't touched a drink in 2 years thanks to his rebirth.

 

[touchpause13]

It is much more than that. AA aims to build a whole new psyche. Like I said before, an addict's psyche associates EVERYTHING they see with their addiction. If an alcoholic is cooking eggs for breakfast, it reminds them of drinking. When they drive it reminds them of drinking. Brushing their teeth even. Everything reminds them of drinking.

The only way to break that is to build an entirely new psyche - rebirth. You can't do that without God. The person wrestles with their thoughts and their addiction, but God is who gives birth to them in the Spirit.

This would be particularly effective for an atheist. The goal is to completely wipe the slate clean and be reborn.

I don't see why he wouldn't want to give it a try. The worst that could happen is him just walking out. He might end up liking it.

Without a rebirth, he WILL relapse.

This is the main reason AA is so effective. I met an ex-alcoholic who hadn't touched a drink in 2 years thanks to his rebirth.

Oh come on. Unless you accept god, you are going to relapse? That's some nonsense
Why on earth do you think god has to be a part of it? This is the type of attitude that OP is likely trying to get away from!

 

[F0nzie]

Believing in God is not a requirement at AA. The only requirement is a desire to stop drinking.

 

[JesusSaves]

Oh come on. Unless you accept god, you are going to relapse? That's some nonsense
Why on earth do you think god has to be a part of it? This is the type of attitude that OP is likely trying to get away from!

I never said anything about accepting God. God has to accept YOU. Some people are confused and think God accepts everyone. He is willing to, but he doesn't.

I specifically said without a REBIRTH he will relapse. You are twisting my words up.

There is only one way I know of to be reborn.

You seem to think that his attitude is something that needs to be catered to. His attitude needs to be erased, he needs a complete transformation in his psyche. Right now, he even associates atheism with drinking. Guarantee it.

 

[touchpause13]

I never said anything about accepting God. God has to accept YOU. Some people are confused and think God accepts everyone. He is willing to, but he doesn't.

I specifically said without a REBIRTH he will relapse. You are twisting my words up.

There is only one way I know of to be reborn.

You seem to think that his attitude is something that needs to be catered to. His attitude needs to be erased, he needs a complete transformation in his psyche. Right now, he even associates atheism with drinking. Guarantee it.

Can you not?
You can be reborn without Jesus/god/whatever. And your whole first point is semantics.
My thought was that the reason why AA works so well is that people are given a whole new community, I don't see how OP's friend is going to find and trust a community if he feels like they are trying to convert him to christianity - I sure as shet wouldn't!

 

[chazwars]

I signed up to respond to your post and hope to be of service in some way.

Without getting into the whole "atheist in AA" debate, the reality is that these 12 Step principles as well as active spiritual practices are deeply embedded in 99.99% of treatment modalities. CENAPS, Matrix, Hazelden manuals all use the 12 steps as a form of support but not necessarily the intervention or treatment strategy. Those strategies are where the evidence based practices are most applicable. I've worked in the addictions field for nearly a decade as a therapist and a part of almost all treatment approaches. I can say from an experienced opinion that the breakthrough for anyone is during the 90 days of post-treatment (primary as well as extended treatment). This occurs with proper followup care, including individual therapy, family therapy, and some form of supportive groups (AA, SMART, Celebrate, etc).

Regarding actual assessments, I've created biopsychosocial assessments based on what payer's need to see (ASAM) but nothing that has proper reliability or validity. These assessments are pretty standard in private sectors, and likely many of the public sectors. The only useful assessments are screening instruments and ultimately one's own admission of a problem. Considering that the 28 day inpatient model was based on active duty pilots and not efficacy, inpatient helps to calm a person down long enough to identify the need for help, but follow up care is where success really occurs. Follow up care helps with the post acute withdrawal which is ultimately the most difficult aspect of recovery from chemical dependency. As they say in AA, "I don't have a stopping problem, I have a staying stopped problem."

 

[Ceke2002]

Believing in God is not a requirement at AA. The only requirement is a desire to stop drinking.

Unfortunately some, not all but some, AA groups don't seem to have received that particular memo. Now in the case of my friend I mentioned above, she had the fortitude to step away from a particular group/meeting place, and find one that was more inclusive and didn't insist on attempting to push a 'one true way' model of belief on her - unfortunately I know others (not just those in the Wiccan/Pagan community) who have been turned off completely and not sort out alternate meetings. Frustrating, but sadly true (again in *some* cases).

 

[TexasPhysician]

Unfortunately some, not all but some, AA groups don't seem to have received that particular memo. Now in the case of my friend I mentioned above, she had the fortitude to step away from a particular group/meeting place, and find one that was more inclusive and didn't insist on attempting to push a 'one true way' model of belief on her - unfortunately I know others (not just those in the Wiccan/Pagan community) who have been turned off completely and not sort out alternate meetings. Frustrating, but sadly true (again in *some* cases).

Large cities have AA groups that focus on specific populations. Some are all Christian, some all female, some only medical professionals. One of the most important things to tell patients is that AA groups vary significantly. The key is finding one where the patient feels comfortable.

 

[clusterF]

Poor Hitch, he had nowhere to turn.