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Eclectic Recovery
In Eclectic Recovery (ER) the biopsychosocial model of recovery from
addiction to drugs or alcohol is utilized. Various (some seemingly incompatible) methods
are used including spiritual (e.g. 12-Step), cognitive-behavioral, psychodynamic, Gestalt,
rational emotive, reality based, and pharmaceutical. As such, ER attempts to integrate
several aspects of these techniques and combine them in a comprehensive way to give the
individual a stronger and more adaptive program of recovery.
Recovery Net is a website which promotes ER
through its bulletin board, discussion group, and links to many internet resources.
Introduction:
Eclectic Recovery (ER) is a method of recovery from addiction to drugs or alcohol which utilizes the biopsychosocial model. In ER ideas from various (some seemingly incompatible) recovery programs are integrated and combined in a comprehensive way to give the individual a stronger and more adaptive program of recovery.
ER is a program based on science, logic, and accepted psychological theories. ER draws from the experiences of individuals who have remained clean and sober for at least three years. ER integrates what has helped such individuals obtain and maintain their recoveries, while it also examines those factors which have been felt harmful, probably contributing to relapse in others.
The theoretical basis of this program is that no one method of recovery is essentially any better than any other. Strong support of this premise can be found in modern research as was done in Project Match. This supports the observation that one's ability to recover is strongly dependent on internal factors such as motivation to stay sober and ability to cope and be content without the use of mood altering substances. The objective of ER is to help the individual find tools achieve this end.
ER maintains one simple rule: Don't use drugs or alcohol. An exception to this rule would be the use of a substance like methadone under the careful supervision of a Methadone Maintenance Treatment Program (MMTP). ER is a program for those who are motivated to stay clean and sober permanently. ER is not a "one day at a time" sobriety program, nor is it a program that endorses moderation. Coping with life's difficulties and problems one day at a time is fine, but ER requires a lifetime commitment to complete abstinence. This is because when it comes to recovery, ER is a program for those willing to change themselves into a person who will never risk the dangers of addiction again. ER views the desire to drink moderately, or the thought of staying sober on a day at time basis, as a resistance to permanent recovery. Examination, suppression, and abandonment of such thinking which can lead to relapse is a major part of ER.
It must be stated that withdrawal from alcohol and certain drugs can be LIFE THREATENING, and any program of recovery should be initiated with the consultation of a licensed health care professional.
Theory:
ER maintains that people become addicted to drugs and alcohol because in the early phases the substances make them either feel good, or feel better. Eventually using such substances becomes a way of life, but the beneficial effects diminish for both psychological and biological reasons. This often results in requiring using larger and larger amounts more often to achieve the same desired effect. Eventually, as use increases, the benefits of use decrease, and the harmful consequences of increased use manifest, the individual finds themselves addicted. While the individual may want to cut down or quit, they find such discontinuation is painful emotionally and sometimes physically. As a consequence the compulsion to use successfully is repeated with continued failure.
As such, ER views addiction as a misguided attempt for individuals to seek pleasure. Pleasure at times can be considered the absence of pain, both physical and emotional. ER recognizes that people vary in their vulnerability to addiction based on genetic and physiological factors. These factors may even play a role in differences in brain activity and neurotransmitter levels in addicts. ER maintains that classifying addiction as a disease (like diabetes) is both wrong and harmful. ER holds that it is wrong because it is both unscientific and misleading. ER maintains that it is harmful because while the disease concept might work in getting people into recovery, and in gaining public support for treatment, ultimately like most forms of deceit, there are long term negative consequences.
Initial treatment:
Initial treatment often consists of inpatient or intensive outpatient programs. Such treatment can be helpful to one's recovery, and medical detoxification may be essential. Many of these programs are limited by their adherence to a particular recovery method (e.g. over 90% of inpatient treatment centers use the 12-Step approach).
Inpatient treatment for "detox" and "rehab" during initial recovery can offer several benefits. The isolated environment can protect one from some of the usual triggers to use. This allows some time for the acute cravings associated with early sobriety to dissipate. Simultaneously coping skills to stay sober outside of the inpatient atmosphere can be learned. For many, inpatient treatment is also their first exposure to the usefulness of group therapy. Besides these biological and psychological benefits, the patient may also experience, for the first time in years, that it can be fun being sober while being in the company of new found friends who are also learning to be sober. Other aspects of inpatient treatment should include patient education and the possible facilitation of family involvement and education. In all of these ways, inpatient treatment can provide increased hope, and be the basic boost needed for motivation to continue in recovery.
An alternative to inpatient treatment can be what is know as intensive outpatient treatment. This type of treatment can be somewhat less expensive while offering many of the same benefits of inpatient treatment.
ER acknowledges that it is well known that many individuals who have not needed a medical detoxification have entered excellent recovery without either inpatient or intensive outpatient treatment. ER encourages that all options be considered, and at the very least consultation with a licensed professional should be obtained.
Recovery groups:
12-Step self-help groups like Alcoholics Anonymous or Narcotics Anonymous and "alternative" programs such as Rational Recovery (RR), Self Management And Recovery Training (SMART), and Secular Organizations for Sobriety (SOS) are fairly well known. In general such programs promote their own style of recovery. While in reality there is much overlap between the principles of these programs, there is much debate among members as to which program is best. In general one may only argue that the program that worked for them is the best for themselves. Unfortunately, it seems that many taking part in such debates really seem to believe that their way is the only way for everyone. Similarly, it is unfortunate that some programs even promote this attitude.
ER encourages that the individual be open minded to what has worked for others and to not get caught up in these debates.
ER, Spirituality, Religion, and 12-Step Recovery:
ER advocates that spirituality and religion be integrated into recovery when this is satisfying to the individual. 12-Step programs are the best established self help organizations for recovery. 12-Step programs are also considered spiritual or religious programs. ER recognizes that the belief in God and spirituality are somewhat important for many individuals to recover. ER encourages such individuals to make use of traditional 12-Step programs for this purpose. ER only asks that when such programs are utilized, the individual be honest to themselves about the religious basis of such programs. Similarly, ER encourages one to be active in their chosen church if they find this meaningful.
Even agnostics and atheists are encouraged to make use of 12-Step groups. It is a reality that not too many other self help groups exist. If there are not others available, or if one is forced to attend a 12-Step group by court order etc. there is still a lot of recovery "wisdom" to be gained in such groups. Such "wisdom" offered by group members is often no different from coping skills taught in psychologically oriented programs. It is a basic principal of ER that the individual is allowed to take what they find helpful from this wisdom and leave the rest. Another principle is to not rationalize rejecting such groups based on that they are religious programs.
ER encourages non-religious individuals confined to 12-Step recovery to make use of "alternate 12-Step" models. Several such models have been developed as a basis to organize a recovery program for those already familiar with traditional 12-Step recovery. This model allows those restricted to traditional 12-Step programs to adapt the steps so that they are more meaningful and helpful in the context of their belief system.
For example, here are the Twelve Steps of Alcoholics Anonymous and their translation by an "Agnostics" group interested in making the steps more available to persons of humanistic, agnostic or atheistic beliefs:
1. We admitted we were powerless over alcohol, that our lives had become unmanageable. (Group-Same)
2. Came to believe that a Power greater than ourselves could restore us to sanity. (Group-Came to believe and to accept that we needed strengths beyond our awareness and resources to restore us to sanity.)
3. Made a decision to turn our will and our lives over to the car of God as we understand him. (Group-Made a decision to entrust our wills and our lives to the care of the collective wisdom and resources of those who have searched before us.)
4. Made a searching and fearless moral inventory of ourselves. (Group-Same).
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. (Group-Admitted to ourselves, without reservation, and to another human being the exact nature of our wrongs.)
6. Were entirely ready to have God remove all these defects of character. (Group-We are ready to accept help in letting go of all our defects of character.)
7. Humbly asked Him to remove our shortcomings. (Group-With humility and openness sought to eliminate our shortcomings.)
8. Made a list of all persons we had harmed, and became willing to make amends to them all. (Group-Same.)
9. Made direct amends to such people wherever possible, except when to do so would injure them or others. (Group-Same)
10. Continued to take personal inventory and when we were wrong, promptly admitted it. (Group-Same).
11. Sought through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of his will for us and the power to carry that out. (Group-Sought through meditation to improve our spiritual awareness and our understanding of the AA way of life and to discover the power to carry out that way of life.)
12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principals in all our affairs. (Group-Same).
Similarly alternative steps have been written by the renowned psychologist B. F. Skinner as an alternative to the traditional 12-Steps for nonreligious newcomers. First published in "The Humanist" they state:
1. We accept the fact that all our efforts to stop drinking have failed.
2. We believe that we must turn elsewhere for help.
3. We turn to our fellow men and women, particularly those who have struggled with the same problem.
4. We have made a list of the situations in which we are most likely to drink.
5. We ask our friends to help us avoid those situations.
6. We are ready to accept the help they give us.
7. We honestly hope they will help.
8. We have made a list of the persons we have harmed and to whom we hope to make amends.
9. We shall do all we can to make amends, in any way that will not cause further harm.
10. We will continue to make such lists and revise them as needed.
11. We appreciate what our friends have done and are doing to help us.
12. We, in turn, are ready to help others who may come to us in the same way.
Presented below is yet another way that the individual (addict) may interpret and use the original 12-Steps to develop both psychologically and spiritually. This is essentially accomplished by the process of substituting narcissistic defenses that are associated with addiction with more mature defense mechanisms such as altruism while gaining self-insight.
Step 1. We admitted we were powerless over alcohol--that our lives had become unmanageable.
This step can encourage the addict to be extremely honest with himself. With this step the addict can carefully review his own psychosocial history to learn how there has been a direct relationship between his life's failures, problems, and disappointments and the use of substances. Euphoric recall of using experiences can be put into perspective. The addict can come to realize that his desire to use is as strong as any other instinct, and that his urge to control the use is simply an obsession which always succumbs to the biological drive to use.
When this step is taken as such, the addict can begin to understand his defenses of denial and rationalization that underlie his obsession to use. It is at this point that the obsession to control is lessened, and the addict is free to grow psychologically and spiritually.
Step 2: Came to believe that a power greater than ourselves could restore us to sanity.
This step can be taken to be about openness to a new way of living. To understand the sanity for which he is looking, the addict may reflect on its opposite which is the insanity of past experience with substances. Many an addict knows the insanity of the disease. As for example going out drinking fully knowledgeable of the pain the hangover the next day will bring. For example taking the first hit of crack knowing that it is going to lead from a brief euphoria to a downward attempt to get that feeling back that might last three days and cost several hundred dollars and be followed by days of fatigue and depression. When this notion of insanity sinks in, the addicts is better prepared to search for sanity. He may look to the outside world as well as his inner self for help, this is the core of step 3.
Step 3: Made a decision to turn our will and lives over to the care of God as we understood him.
Note that only a decision need be made in this step, the actual belief in God or a higher power is not required. For many this can bring further relief from a narcissistic view of the world, one may start to accept themselves as part of nature and a greater order.
Step four: made a searching and fearless moral inventory of ourselves.
This can be a generalized version of step one. The addict can do an honest self evaluation of his life. He examines his resentments towards others. He evaluates what defense mechanisms he has used in many life situations.
Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
This, just like psychotherapy, can give the addict relief and insight by talking about the problems in his life.
Step 6: Were entirely ready to have God remove all these defects of character.
Now that the addict better recognizes his personality defects, he may be more motivated to change. For example, the addict can prepare himself to give up his obsessions, avoidant behaviors, and self centeredness. To many this may seem a simple task, but for some addicts it is giving up the coping mechanisms that they have used most of their lives.
Step 7: Humbly asked him to remove our shortcomings.
This step may be taken as a further renouncement of narcissism by using humility, one of the weakest attributes of the narcissist, to transcend the narcissism itself.
Step 8: Made a list of all persons we had harmed, and became willing to make amends to them.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others.
Steps 8 and 9 can be executed by putting new found selflessness into action, thereby taking responsibility for past actions.
Step 11: Sought through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of His will for us and the power to carry that out.
At this point the addict has achieved increased self honesty, insight, and selflessness. But addiction is a relapsing disease. The addict can regress back, and to avoid this he may continuously seek deeper self insight and understanding of how he is part of a greater scheme.
Step 12: Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and practice these principles in all our affairs.
At this point the addict may have a somewhat more mature set of defenses. He has grown through a type of insight oriented therapy. Now he can continue to practice his new way of life, and he can share with others what he has learned. This is a form of altruism.
ER, Psychological and Psychiatric treatment:
ER strongly advocates the use of modern therapeutic techniques in addiction recovery. These include both psychotherapy and pharmaceutical interventions when indicated. Current psychological therapies applied to addiction include cognitive behavioral and rational emotive. Psychologists and groups like SMART, RR, and SOS use such techniques. Individual therapy including supportive, psychodynamic, and psychoanalytic can also help. While ER does not discourage the use of sponsors in 12-step programs, it recognizes that such persons are laymen who may be misleading and even harmful. ER takes the position that such sponsors are not a substitute for therapists with professional training, and when such individual guidance is sought, professional help should be considered.
Pharmacotherapy is helpful adjuvant to recovery for some. Modern medications that can decrease craving and prevent relapse are being developed. Also, addiction is often accompanied by other psychiatric disorders where symptoms can be relieved with psychotropic medications. It is essential for the patient to understand that addiction stems from within, and that much of the cure also comes from within. In this light it is important for him to realize that adjuvant pharmacotherapy should not be depended on completely for the cure to addiction. The tendency of some addicts and alcoholics to look externally for both the cause of their problems and their solutions needs to be kept in mind. Psychotherapy can be especially useful in this respect.
ER, Education, and the Internet:
ER is not a "simple" program. It encourages hard work in recovery at many levels. As such, as much education about recovery and coping skills associated with recovery should be obtained as possible. This can done by attending groups, individual therapy, and by study. Study can involve formal education, reading, and using other resources such as the internet. When one is isolated from having groups to attend, such studies can be especially useful. Furthermore, groups like Rational Recovery, SOS, and SMART, all have published literature concerning their recovery methods. Many such materials can be found on the internet (check out the links from Recovery Net). The internet can also serve as a good medium for self help through discussion groups and chat rooms (again, check out the links from Recovery Net). Internet discussion groups and chat rooms can also afford one more anonymity than public meetings do.
While ER is not a "simple" program and encourages one to be intellectual about recovery, ER discourages "intellectualization" about recovery. Intellectualization is an unconscious defense mechanism whereby people might discuss or debate the academic issues on a topic in order to avoid the emotional issue. ER encourages individuals to remember that the emotional issue is how to stay sober!
ER and Healthy Living:
While ER is mostly concerned with sobriety, it considers healthy living as an essential part of advanced recovery. Healthy living is considered to involve both the mind and the body. ER encourages regular exercise (as approved by a physician), a healthy diet, and smoking cessation. It is well known that regular exercise and a healthy diet can help promote a general sense of well being. Furthermore, some studies show that cigarette smokers die on average at a younger age than do alcoholics. In essence ER takes the attitude that while recovery may start with sobriety, it is a continuous life long process.
Summary:
ER encourages the individual to use various techniques to recover from alcoholism and drug addiction. Religion, spirituality, psychology, and psychiatry may be integrated together to help achieve this end. Several programs such as 12-Step, RR, SOS, SMART, and individual therapy were discussed as a means to achieve one's goals.
As such, ER makes use of the biopsychosocial model for recovery. Biological treatment starts with cessation of drinking and using mood altering substances. This may require a medical detox, and a licensed professional should be consulted as withdrawal from alcohol and some drugs can be life threatening. Additional biological techniques can include healthy diet, exercise, and medications to treat comorbid mental illness and prevent relapse when indicated. Psychological techniques include personal growth and the learning and execution of coping skills. Personal growth is the general goal of psychotherapy. Coping skills can be learned in self help groups and in individual therapy. They are applied in everyday living. Social techniques involve one's lifestyle and religious practices. This can include attending meetings or going to church instead of going to a bar for example. It also involves accepting the help of others and avoiding "persons, places, and things" that stunt personal growth and can trigger relapse.
ER is not a single program, but leaves it up to the individual to learn and experience what works best for them with the option to take many approaches to recovery. In this way the individual can become more autonomous in taking responsibility for their own health. Many resources to help achieve this can be found in Recovery Net . Recovery Net also provides links to a discussion group and chat room which are specific to the concept of Eclectic Recovery.
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