Different Strokes…

Momdog shares her thoughts on her son’s experience with AA…

“My son is currently thriving in a sober house that follows the 12 steps. He has bonded tightly with the other guys in the house & finds the community that AA provides in his house and at all the meetings he attends to be the cornerstone of his sobriety. He admits he has trouble buying into all the spiritual elements, but doesn’t see them to be so rigidly required that they get in the way of the positive elements of the program. He was on suboxone during a prior period of sobriety but relapsed in part because he didn’t change friends, habits, and ways of thinking and admits he relied on the medication rather than do all of that hard work.

From my perspective, different things work for different people, and different things work at different times in their lives and the course of their addiction. There doesn’t seem to be much research on the effectiveness of various options based on age, length of substance use, life experiences, personality, genetic inheritance, etc. We have a long way to go.”

Agreed, we have a long way to go in understanding what treatments or approaches work best based on the characteristics of a Loved One.

One large study that attempted to do so was Project Match. For 8 years starting in 1989, a group of people with alcoholism were assigned to three types of treatment: Cognitive Behavioral Coping Skills Therapy, Motivational Enhancement Therapy, and Twelve-Step Facilitation Therapy.

While the subjects weren’t assigned to one treatment over another randomly, they were tagged by a list of possible characteristics they had going in: level of anger, gender, social networks, etc. Here is a good write-up of Project Match.

Outcomes of note:

There were few significant outcomes in this study. All three treatment approaches had similar rates of success. There were a few differences based on characteristics, such as the more angry people doing better with Motivation Enhancement Therapy; those with strongly pro-drinking networks did better with Twelve-Step Facilitation Therapy. Overall, though, the differences were unremarkable.

This study has received a lot of criticism over the years and nothing on this scale has since been attempted. Project Match received a lot of criticism, for not having a control group (a group that would have not been offered treatment and would have allowed the observation of the “natural recovery” process (http://www.peele.net/lib/projmach.html) and for missed opportunities to study those who succeed and fail in recovery rather than professional approaches for treatment (George Vaillant).

From my experience, I know what you say to be absolutely true. Different approaches for different people at different times. I also wonder about a cumulative effect that comes into play, as in:

“You’re wearing me down with all your treatments and I’m wearing myself down with all these drugs, so I give. I’m tired. I see the pattern now.”

I also believe that treatments work better when the housing is safe, stable, and available; when there is structure to the day, and something meaningful to do, a way to give back, and to feel the connection with another human being (or animal).

There is a lot we have not yet quantified in studies. Addiction is a very complicated condition that is best served by multiple levels of professional and lay support, and the structures that underlie safety, meaning and purpose.

Thank you for writing in. We are thrilled to hear your son is doing well.