Click here to contact Deborah and/or see her GoodTherapy.org Profile

When it comes to eating and food-related problems, various philosophies determine how eating problems are defined and addressed. When the eating disorders treatment field was in its infancy, professionals often based their approaches on those used in the treatment of alcoholism and drug addiction. The addictions model has been used to salvage the lives of alcoholics since the formation of Alcoholics Anonymous (AA), in the 1930’s. AA spawned myriad other 12-Step programs for addressing various addictive problems. One of the earliest of these was Gamblers Anonymous (GA). Overeaters Anonymous (OA), a 12-Step self-help program for people who feel compelled to overeat, was created in 1960, modeled after GA. OA philosophy views compulsive overeating as an addiction to both a substance–various types of food–and to the behavior of overeating compulsively. As OA grew, people suffering from all types of eating problems began attending, and found help there.

However, as research on eating problems proliferated, and eating disorders came to be better understood, health care professionals began to recognize that while 12-Step programs offer members an unparalleled access to peer support, a practical spiritual philosophy, and a systematic approach to healing at nominal (donation-only) cost, the 12-Step philosophy doesn’t always translate well from its originally intended formula as a treatment of alcoholism to an effective means of treating disordered eating.

Applying an addictions model to eating problems means believing that a person has a disease that causes them to be addicted to certain types of foods, certain eating behaviors, or both. The recovering person practices abstinence, the corollary to an alcoholic’s sobriety. This might mean eating only at meal times, or refraining from eating refined sugars, or from other types of food or eating behaviors. Thus, a between-meal snack or a piece of pie at the end of dinner would be as much a break of abstinence as a no-holds-barred eating binge. This perspective dangerously mimics eating-disordered thinking, which says that eating outside of certain pre-determined rules is bad and that the person who does this is a pig.

Eating-disordered thinking comprises certain thought patterns that are common to all types of eating problems. These patterns include the beliefs that the person thinking the thoughts is weak and lacks willpower, and needs to follow certain eating guidelines to feel safe and good about him/herself. Some tenets of the addictions model, e.g., that the sufferer has a disease from which she can never be fully recovered, that sufferers cannot trust themselves, and that self-confidence is a liability rather than a strength, are quite resonant with the voice of the eating disorder itself. Eating disorders sufferers feel intense shame about their appetites and desires. The addictions model, when misapplied to disordered eating, attributes these appetites and desires to “the disease,” rather than exploring their significance.

The disease concept helps relieve alcoholics and addicts of the shame they experience. It helps them understand that their behavior is not a function of personal weakness or flaws, but of an affliction they have. However, it also teaches them that they can never fully trust their thinking because their disease might be influencing it, that they must learn to live with it. A common saying in 12-Step programs is that it’s important not to become complacent because the disease is “always in the next room, doing push-ups.” While this perspective can be very useful for a recovering alcoholic or gambler, it can backfire on a disordered eater.

While eating disorders treatment professionals often find it helpful to separate the disorder from the person, much as addictions philosophy does with the disease concept, the focus is on developing a strong sense of self-confidence and self-worth, and letting go of an eating disordered-identity. The goal is to learn to live without the disorder. Appetites and desires for all kinds of foods are regarded as normal and healthy, and when they surpass desires for “normal” amounts, they are seen as indicative as hungers for other things a person needs.

An integrative model of recovery encourages attention to the body’s wisdom, a reconnection to hunger and satiety signals, and development of self-trust. It says that while recovering people often benefit from nutritional guidance and eating plans, there are no off-limits or bad foods, no rules to be broken. A commitment to stop dangerous behaviors such as purging via laxatives or self-induced vomiting, compulsive exercise, and bingeing, comes at different points in people’s recovery.

An integrative approach to treating disordered eating draws on therapies that address behavior, cognition, emotions, body image, and spirituality. It helps people who struggle with food-related problems to connect to the parts of themselves that are hungering for something bigger and deeper than food, and to feed those hungers appropriately. For people in 12-Step programs for their disordered eating, an integrative approach can incorporate the positive aspects of an addictions approach, while empowering them to return to a state of balance and self-trust, and develop an intuitive and satisfying relationship with food and with themselves.

©Copyright 2010 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

When we think of children who have been sexually abused, we think of fear, anger and violence. Most sexual abuse survivors talk of the terror and disassociation surrounding the abuse. Many still feel that way as adults and don’t enjoy sex now, even in a loving relationship. But there are those who have a more complicated story to tell. These survivors may have hated their abusers but experience an unspeakable shame over the fact that their bodies responded sexually to the abuse. They cannot live with the knowledge that they were sexually stimulated even as they were being raped. Now they are not only healing from the abuse but from the additional belief that they were partially responsible for the abuse – and that they may even have deserved it.

While adult survivors can intellectually understand that as children they were victims of their abuse, they don’t always feel that way. And they certainly can’t accept that fact if they responded sexually. Many of them can’t imagine how a child could respond sexually. So they believe that not only are they dirty, but that they are freaks as well. Yet children do have sexual feelings. Toddlers can sexually arouse themselves. And as they get older, many of them experiment and discover that their bodies respond. The myth that hormonal changes occurring at adolescence are the beginning of sexual feelings is just that, a myth.

I worked with a 27-year-old woman for four years before she admitted to me that the only time she had ever had an orgasm was with the uncle who raped her beginning at age six. This woman had been trying to put the abuse behind her so that she could finally enjoy sex and have an orgasm with her boyfriend now. She told me the most intimate details of her life but had never been able to reveal her darkest secret – as she got older she started to enjoy the sex and the power that she thought she had over her uncle. He bought her gifts – at first to keep her quiet. Later, she asked for things and gave him sex in return. She could never admit this before and now she was convinced that she could never forgive herself. She began to understand that she wasn’t closed down sexually because of the abuse but because of her response to it.

How do you help a survivor in this situation understand that they are not to blame? The first step in this instance was for the young woman to finally acknowledge those feelings to another human being who didn’t judge her the way she was judging herself. The next step was to help her understand that she was coping with the situation in the best way she could. Sexual stimulation is instinctive and not a choice. Using whatever power she thought she had in the relationship was a survival tactic. As human beings we adapt and survive in whatever way we can. It cannot be said enough times, whatever she did in response to the abuse, she is not to blame; the abuser is the criminal.

Unlike other incest victims, I could not honestly say to this young woman that no one would ever think that she was in any way to blame for what happened. Because unfortunately there are those in our society who will not understand. We are uncomfortable with sex. We have a hard enough time naturally accepting adult sexual feelings. Accepting childhood sexual feelings is beyond the pale.

I am opening a dialogue about this issue so that other survivors of sexual abuse who have had this experience know that they are not alone.

©Copyright 2009 by Roni Weisberg-Ross L.M.F.T. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Roni and/or see her GoodTherapy.org Profile

Click here to contact Mary Ellen and/or see her Profile
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The “Bucket of Crabs” is one of our favorite analogies. Pulling crabs out of traps on Kodiak Island, we’d just toss them into a big bucket – no need to put a lid on the bucket.

Why not?

Because as soon as one crab would start to climb out, the other crabs would drag him, or her, right back down into the bottom of the bucket. There’s no escape to life back in the ocean. And that keeps happening until all of the crabs end up in the steamer.

The point?

Pick your support group with care. Most so-called alcohol support groups are, in fact, merely a bucket of crabs who will keep dragging you back down to their level. Try and escape and you’ll be warned that it’s too dangerous to get a life, or to mingle with “normies,” or grow up. It’s too dangerous to stop building your life around alcohol.

So you stay in the alcohol bucket, drinking or not, or complaining about your spouse, or parents, or children, or……

And what’s the point of all of this?

Obviously the point is to avoid actually making any real change. That’s what groups like AA and Alanon and Alateen do best, they help you maintain the “security of familiar miseries” – as we termed it 25 years ago – instead of fixing your life.

But why would you want to trade the illusory security of the crab bucket for an actual life out in the real world?
Remember, despite all of the con men and hucksters, alcohol abuse is a choice and you are free – not powerless – to make a different choice at any time. If you’re the spouse, parent, or child of an alcohol abuser, you are also free to make choices, including the choice to get a life of your own. Not a life focused around another’s alcohol abuse.

You can always choose to be recovered, not in crippling, life-denying, “recovery.” You can choose to be an ex-drinker just as many of us are ex-smokers. You can also choose to be someone who used to waste you life on a drinker but got a grip, got over him or her, and got a life of your own.

Please, alcohol abuse is a choice, not a disease, and you can escape the AA/Alanon Bucket of Crabs. Don’t let the doomed continue to drag you back to share their misery and their fate.

©Copyright 2009 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Last month we wrote about the first two of the “6 Secrets Ex-Drinkers Know That You Don’t, And 12 Step Programs Don’t Want You To Find Out.” We started with the notation that AA/12-Step based programs, 98% of US treatment programs, are based on premises that both research and experience indicate are not only unfounded, but actually prevent you from getting over your problems and leave you with less than a 5% chance of recovery over five years.

Here are Myths 3 and 4:

Myth #3 – An Addict Must Hit Bottom

“Hitting Bottom” is a very destructive myth. Why would you wait until after you’ve lost you’ve everything to seek help? At that point, why would you bother to sober up?

Suppose for a moment that alcohol abuse actually were a disease. Then we’d be interested in prevention, then regular checkups, then early detection, then. Wait a minute…early detection? What happened to “hitting bottom?”

That’s the problem. With actual illnesses, we don’t wait until the patient is nearly dead before beginning treatment. Treatment is begun, good follow-up maintains progress, and changes in the patient’s life are instituted that will sustain the recovery. That’s an effective model.

It shouldn’t be surprising that this same process works well for diverting a client from alcohol abuse and dependence. The trouble is people have been discouraged – by mythology, stigma, and “lifelong recovery” – from getting help in the early stages when complete remission is not possible, likely, and relatively straightforward,.

How did that happen? AA/12-Step based programs make a common mistake – they generalize from themselves. And generalizing from a tiny number of terminal alcoholics to drinkers in general, simply doesn’t work. Not that it worked all that well for the AA originals either.

If you are thinking you could use a little help, don’t be lulled by thoughts like: “I’m not that bad off;” and “I don’t drink as much as Larry;” and other rationalizations. You don’t need to “hit bottom,” whatever that may mean to you. Get effective help early.

But be equally careful not to be sucked into the treatment industry, labeled a powerless diseased alcoholic, and sentenced to a lifetime of recovery and senseless meetings that only reinforce drinking even more.

Yes, options do exist. Look for programs and counselors who offer real research based solutions.

Myth #4 – Residential Treatment is Always Necessary

Now for the most expensive, and least effective myth of all: “You Need 30, 60, or 90 Days of Residential Treatment!

If you’ve been looking at treatment programs you’ve probably found that they want you to spend a minimum of 30 days with them, and that most are now pushing for 90 days. Why? Mostly because programs have found it easier to scare people into staying longer than they have to attract new clients. With a less than 5% success rate that’s hardly surprising.

Regardless, even if they were effective, you’d find yourself asking, “Where am I going to find the time, or the money, to do 30 days of rehab, much less 60 or 90? Or do it confidentially?”

Fortunately, you don’t have to. You may need a few days respite and sorting time, but you don’t need to waste your time and money, or suffer the disruption, or exposure.

You’ve probably been told that the longer you stayed the better your chances of success. It’s not true. Unless you buy the creative definitions of “success” 12-Step based programs cough up. “Was not noticeably intoxicated while here,” is a common one. Stay three times as long and you’re automatically three times as successful! Of course once you leave…..

Another aspect is their insistence that you fit yourself to “The Program.” Obviously the more time they have to isolate you and indoctrinate you the more apt you are to “fit.”

Not much different than military basic training – take a vulnerable person, confine them, and mold them. We don’t much like that model, especially for smart, creative, mature adults. We think you should develop your life, not convert to someone else’s religion.

“But everyone goes away to rehab, so it must be better than outpatient treatment – right?”

WRONG! We’re biased, of course, since we do outpatient, but we also do it because, usually, it’s far more effective, cheaper, less disruptive, and designed around you – not “The Program.”

Most of your time in a residential program will be spent on filler. Let’s take a quick look at a typical day: Breakfast; Chores; 12-Step meeting billed as “group counseling”; An hour with your counselor (maybe); Lunch; 12-Step meeting; Journaling and working on your “steps”; Recreation time; Quiet time; Dinner; Evening presentation on “the Steps”…and so on.

One-on-on counseling (from someone whose only qualification, frequently, is that he or she can mostly stay sober while working at a treatment facility) probably won’t add up to more than an hour or two a week, if that. Not much to show for your $30,000 to $200,000 vacation from reality.

You’d be far better off planning your own vacation than going to residential rehab.

We are not so biased, however, that we don’t recognize that you may need some relief and protection, and enough rest to sort your thoughts and options. Some people can do that in a few days, others need longer. Just choose your “retreat center” with care – and, yes, we know that can be extremely difficult to do when your world is crashing around you.

Still, the point is that your alcohol abuse exists within the context of your day-to-day life and ending it will happen within that context. Change the context and the alcohol abuse goes away. Take a vacation from your life and the context is still waiting when you return. It shouldn’t be a surprise that you drinking will return with you. It would be almost astonishing if it didn’t.

Treatment programs, consciously or not, are designed to create relapse. They reinforce all of the myths that encourage a return to abusing alcohol: powerlessness; disease; life long recovery; labels; and all of the usual secret cult rituals, tokens, badges, and isolation from reality.
So, please, be careful with yourself – they won’t be.

©Copyright 2009 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Last year we wrote a free download that we posted on our website entitled “6 Secrets Ex-Drinkers Know That You Don’t, And 12 Step Programs Don’t Want You To Find Out. It’s been popular, though not without controversy. Indeed, one Canadian who described herself as a “Therapist, Counselor, and Alcoholic” declared we were downright dangerous and had to be stopped!

That made us think we needed to get the facts into wider circulation so here’s a newly minted rendition of the first two “Secrets” for you consideration.

We started with the notation that AA/12-Step based programs, 98% of US treatment programs, are based on premises that both research and experience indicate are not only unfounded, but actually prevent you from getting over your problems and leave you with less than a 5% chance of recovery over five years.

Myth #1 – “You’re Powerless”!
What happens if or when you attend your first AA meeting? Shortly after you arrive you sit down and then one of the first things you’ll hear is that you’re powerless over alcohol. And just when you’ve finally taken the initiative to do something about your drinking problem, you’re told you’re powerless. Probably not exactly what you want or need.

Are you truly powerless? Is it even helpful to see yourself as that way?

Does this basic principle of AA apply to you? Or is it complete nonsense?

Are you truly out of control in other aspects of your life? For over 95% of us the answer is a resounding NO. Like all of us, you’ve experienced both success and occasional disappointment. But you were hardly powerless.

And you are no more helpless today. Quite the opposite.

When someone tells you you’re powerless to deal with alcohol it’s a cop out, an easy way to deny your responsibility and never actually make any progress in resolving the problem. But once you’re hooked on the idea that you’re a victim and the only people who can help you is the 12-Step group, how much progress do you think you’ll make?

In a word NONE!

You actually do, however, have the power to change. What you need is expert guidance in how to exert your personal control.

Imagine if you were struggling to lose weight and someone told you that you were powerless. You’d be doomed to failure. That’s what will happen to you if you buy the idea that you have no control over alcohol.

Is that what you want? Or do you want to be someone who is in charge of your life and on the track to success? If it’s the latter, you’re thinking is going in the right direction and you can achieve your goals. The real “first step” is to ignore the idea that you’re powerless.

You have the power to make choices and changes and don’t need groups, labels, and more irresponsibility to go with it.

Research shows that people who believe they are “powerless” are far more prone to relapse into destructive drinking than those who don’t, and actually increase their binge rate four to seven times what it was before they “admitted they were powerless.”

Don’t let failed models keep you from seeking help in the early stages of alcohol abuse.
And…

Myth #2 – You Have An Incurable Progressive Disease!
If you have ever been to alcohol rehab or AA or talked to almost anybody about alcoholism, you have probably noticed that nearly everybody immediately puts on solemn faces and then they say “Well, you know, it’s a disease. You’ll need to stay “clean and sober” for the rest of your life, or it will kill you.” Wrong!

There is no evidence that it’s a disease and ample evidence that it isn’t progressive. Alcoholism is a symptom and a coping mechanism that’s gotten out of control.

It’s easy to forget that alcohol is a drug, and, as its popularity shows, an extremely effective one. It reduces anxiety and tension with speed and effectiveness – not to mention availability – other drugs can’t hope to match.

So stop thinking about alcoholism as a disease and think about it as a symptom of other things in your life that are not working. Drinking too much is a behavior that needs to be modified or eliminated. You do it with other behaviors all of the time, you can do it with alcohol, too.

You might be asking, “So where’d this “disease of alcoholism” come from?”

Partially it came from treatment programs hoping to cash in on medical insurance – if it’s a disease insurance should pay to treat it. The problem was the insurance companies quickly realized that “disease” based programs didn’t worked, so they quit paying for them.

What the disease concept does provide is an “out” for people who wish to continue an alcohol centered life under the guise of being “powerless” victims – people who wish to maintain the behaviors but escape the criticism of spouses, employers, and judges while they “work their program.”. You have to admit there is some appeal there.

But what if you actually want to fix your life? Then it simply becomes a stumbling block, one which, if you embrace it, will kill you. You will just keep going to meetings, relapsing, bingeing, and “recovering” until you’re dead, never realizing that quitting is a choice you have – a choice you can exercise.
Don’t you want to be a fully functional person who re-asserts control over your life?

So skip being powerless over a non-existent disease. Instead, do as one recent client summed it up, “Get a grip. Get a life.”

You can, you know. It’s your choice.

©Copyright 2009 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

A colleague recently asked me for my assessment of the applicability of the “disease model” of alcoholism with regard to Native Americans. She asked not only because my adopted children are Inyupik, and from alcohol devastated families in northwestern Alaska, but also because I have worked in non-traditional ways of combating alcohol abuse for over twenty years.

My answers have evolved out of the past forty years of my experience, work, observations, research, discussion, and reflection.

To begin with, the repeatedly discredited “disease model” negatively impacts everyone suffering from alcohol abuse – not just Native Americans; and second, “Native American” is also a counter-productive term, one implying that there is only one homogeneous group indigenous to North America. Nothing could be farther from the truth.

To exemplify, Alaska alone, is home to three distinctly different “Native” groups: Aleuts; the Yupiks and Inyupiks (“Eskimos”); and over twenty different “Indian” tribes. Within and between these entities the degree of alcohol use and abuse varies widely and so do solutions to their alcohol related problems.”

However, it is true that across the continent, including Alaska and Canada, Native Americans do exhibit a higher percentage of alcohol abuse and dependence than many other groups, though again, not in every case. Still, given the high incidence it’s tempting to want alcoholism to be a disease, rather than looking for more complicated and less forgiving causes. However, regardless of the group being considered, alcohol abuse and dependence rates really are a reflection of an accumulation of contributing social, psychological, biological, and cultural factors.

Consider for a moment one such factor: that alcohol use is frequently a matter of learned behaviors based on community and cultural expectations. Most of us adopt alcohol use, and abuse, as patterns from our family, our community, and society at large. Who introduced alcohol to Native Americans? Prospectors, whalers, soldiers, and others whose immoderate alcohol “use” is now reflected in many of today’s Native American’s usage, and these stereotypical patterns continue to be handed down from one generation to the next.

Of course these learned behaviors could be changed if they weren’t serving a purpose, which, unfortunately, they do. For example, in many cases being drunk is a readily accepted excuse to diverge from cultural norms – an excuse to act out aggressively rather than adhering to a passive conformity, for example. Community members hesitate to criticize someone for getting drunk and acting out this week when they may themselves want to get drunk and do the same next week. (Again, however, please remember that this isn’t a pattern unfamiliar to many other communities.)

Drinking is also a way of achieving some temporary respite from crowded living arrangements that don’t allow for any privacy. Thirty years ago my neighbor on the upper Yukon was one of eight people occupying a cabin roughly fifteen by twenty feet – a cabin without electricity, running water, or any distractions. Who could blame him for disappearing into an alcohol induced stupor from time to time?

Alcohol also helps blot out the depression and frustration that comes from a seemingly hopeless future. In many communities the most capable people have left, pursuing educational, vocational, and social opportunities. Generations have seen a steady decline in leadership, stability, and ability. In some cases, nearly all of the women have left, preferring the easier life available to them with non-Native husbands, college education, or city jobs. Who can blame them for leaving, or for the hopeless young men left behind from drowning their loneliness?

In addition to personal and community factors there are also political factors. Leadership within some Native American entities, like other ethnic or religious entities, is sometimes jealously held by families or individuals who see promoting alcohol abuse as a way of maintaining their positions and preventing rivals from threatening their power. “As long as they’re drunks, and their children are drunks, my children’s future is secure,” is how one Fairbanks Athabascan matriarch put it to me over twenty years ago, echoing her western Alaska Yupik counterpart two decades before that. They were right.

The unending problem, of course, is that alcohol also makes all of the problems it “solves” worse; providing temporary fixes which preclude long term solutions. Depression that encourages alcohol abuse, while making the depression worse, is only one of a number of short and long term “Catch 22” features of alcohol misuse.

Returning to my colleague’s original question, viewing alcohol abuse as a “disease” makes maintaining the status quo easier for everyone. It obscures the real problems and sidetracks everyone from seeking and implementing real solutions.

On the other hand, if it’s a choice, , then changing the habits of use and abuse becomes matters of individual, family, community, and political choice. Predictably, however, there aren’t a lot of people anxious to sign up for responsibility when being a victim is so much more appealing, at least for today. After all, having a disease over which I am powerless is the perfect excuse to keep on drinking. Changing, on the other hand, requires a sustained effort along with the acceptance of responsibility for one’s own situation and decisions.

The picture I have painted in this brief essay is, of course, a simplification – a picture that includes only some of the major factors that contribute to the ongoing destruction of what? Nor have I discussed the individuals, communities, and tribal groups who have successfully navigated through alcohol’s traps and temptations and achieved a sober and satisfactory life. Many more could, and would, with social and political supports that addressed the underlying needs and factors from a realistic perspective.

Is that apt to happen? Not as long as “treatment” reinforces the hopelessness and powerlessness that that failed industry provides and depends upon. Not as long as leaders externalize the causes they profit from financially and politically rather than addressing the real needs, problems, and attitudes which support continued alcohol dependence. Not as long as “alcoholism” is seen as a cause rather than a symptom. Not as long as being a victim is preferable to assuming responsibility for ourselves and for our communities.

Clearly, alcohol abuse is not a disease, and the solutions – including real assessment of individuals and communities; the provision of active opportunities vocationally, socially, and recreationally; and the refutation of a passive “disease” mentality – are no different for Native Americans than they are for the rest of us. But it requires the courage to acknowledge the mistakes of the past, to implement real change, and to withstand the objections and sabotaging of those who profit from business as usual.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2009 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
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“Two things will be believed about any man whatsoever, and one is that he has taken to drink.” -Booth Tarkington

It isn’t unusual for people to seek treatment for their alcohol abuse problems when divorce is looming on the horizon. Indeed, probably two thirds of our clients come to us with crumbling marriages. What is surprising is that at a few of these clients don’t really have an alcohol problem and many of the rest are abusing alcohol, but aren’t alcoholics.

How does that happen?

Simply put, the treatment industry has promoted a Catch-22 model: if you’re accused of being an alcoholic and you agree, then obviously you are. But if you don’t agree then you still are – you’re just in denial. As Mr. Tarkington observed long ago, it’s a label that can be hurled at anyone and it will stick. And divorcing spouses like to use it just for that reason, it will stick and they will be able to leverage it to get what they want or at least make your life miserable for a while longer.

What is the reality? At a recent conference in western Canada, one presenter after another pointed out what a few of us have known for a long time, most people seeking help with their alcohol problems aren’t alcohol dependent “alcoholics” – they’re alcohol abusers who can be cured. But you won’t hear that if you go looking for help, or, God help you, an honest evaluation.

Why not? Because over 95% of all alcohol treatment programs are based on the assumption that you’re a powerless and diseased alcoholic, or you’re an alcoholic who’s in denial. Regardless, the outcome of any evaluation will be to put you in one of those two categories and “treat” you accordingly. It’s not an attractive prospect for anyone who actually cares about their future.

Options? Your choices are few and far between, and you’re probably in a vulnerable state, too. Not the best circumstances for making life altering decisions. But before you allow yourself to be labeled through a process that has only one outcome and one prescription, protect yourself by doing at least a bit of research.

First, simply go to a few AA meetings. You will know almost immediately whether or not this model will work for you. If it does, then simply continue. You don’t need to waste tens of thousands of dollars on 12 Step based treatment that’s already available to you for free right in your own neighborhood.

Second, if you don’t find yourself at home at these meetings, then there’s little point in going to traditional treatment. Paying to go to meetings isn’t going to make them any more effective – just the opposite. Most treatment programs will also leave you with a permanent, and public, label. That’s something that can come back to haunt you in the future whether you decide to run for public office or buy life or health insurance.

Third, consider the options. Read through the web sites of organizations like Moderation Management ( www.moderation.com ), the Harm Reduction Network (www.hamsnetwork.org ), and GoodTherapy.org for programs and individuals who do not ascribe to traditional – and ineffectual – treatment.

Finally, resist being labeled, demeaned, and railroaded. Regardless of whether you are being smeared, or are abusing alcohol, or are indeed alcohol dependent, you deserve to be assessed and helped with respect, care, competence, and confidentiality. Do not allow yourself to be diminished and manipulated by others’ agendas.

Remember, there are alternatives, and you aren’t powerless.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
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Over the past decade research has found that for many women the onset of alcohol abuse coincides with changes in hormone levels – changes that many women are unaware of in the early stages. When this is combined with other stresses in their lives – job changes, health concerns, children leaving home – women can find themselves abusing alcohol for the first time in their lives.

In our teens, 20s and 30s, our ovaries and adrenal glands produce a form of estrogen called estrodiol. Later, during our mid to late 40s and early 50s, our ovaries begin producing less estrogen, leaving more of the work to our adrenal glands. As the adrenal glands take over the job, estrogen drops, spikes and drops again—rather erratically. At this point, many women report that they start to get forgetful and experience “foggy thinking” and moodiness. That’s because our brains work better when estrogen levels are steady. These are the first signs of menopause and, sometimes, the beginning of escalating alcohol consumption as a means of easing various unfamiliar discomforts.

While normal menopause is a gradual process that starts between the ages of 45 and 55, there are a number of things that can lead to this whole process starting earlier than normal, in other words – premature menopause. Sometimes these are a result of lifestyle choices that include the following:

1. heavy drinking (defined as more than 1 glass of wine, 12 ozs. of beer, or 1.5 oz. of liquor daily);
2. heavy smoking;
3. poor nutrition;
4. chronic stress to the body – including excessive athletic training.

Indeed, heavy alcohol consumption alone may hasten the onset of menopause by as much as five years.

As we reach full menopause, our estrogen production will have dropped by 75%-90% and we normally start experiencing other menopausal symptoms – hot flashes, tiredness, and difficulty sleeping. Many of us also experience a drop in libido (sexual desire) which can continue well beyond menopause.

Unfortunately drinking alcohol at this stage of life causes more problems than it solves. For example, alcohol itself can trigger hot flashes and increase sleep disruptions. For those of us in midlife who are already experiencing hot flashes and sleep problems (because of the night sweats that accompany hot flashes), alcohol only compounds the problem.

Additionally, Jasmine Lew, a researcher at the Howard Hughes Medical Institute, has found links between the amount of alcohol women consumed and a higher risk of cancer. In particular, Lew and her colleagues found that alcohol increased the risk for the most common types of postmenopausal breast cancer. And the more we drank, the higher the risk, so, while drinking one serving of alcohol resulted in only a 7% increase of risk, drinking three servings of alcohol per day resulted in as high as 51% increase in risk.

Further problems occur in the area of bone density because alcohol increases the amount of calcium excreted in the urine, causing a calcium deficiency and eventually osteoporosis. And of course heavy drinking increases our risk of liver disease, falls, DUIs, and motor vehicle accidents.

So what are we to do? Peri-menopause, menopause, and post menopause are clearly times of risk for those of us who find we are drinking too much. With that in mind, if you are over 40 you should consider hormonal shifts as a contributing factor in any change in your alcohol use. It should also be a consideration if you become concerned about alcohol abuse and seek help. Look for a program that will address all of the possible contributory factors, not one that consigns you to a “disease” model as well an unnecessary and inappropriate “lifelong recovery.”

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

We recently returned from a conference on alcohol treatment called “New Perspectives.” The conference, hosted by Edgewood treatment center in Nanaimo, Vancouver Island, British Columbia, was, indeed, as advertised. Presenters echoed the same theme: the usual methods of “treating” alcohol abuse and dependence don’t work. While this isn’t news to some of us who’ve looked at the statistics for over twenty years, it is the first time we’ve ever attended a conference that wasn’t hyping the same old failed models. Perhaps being Canadian – a country not quite as enamored with the Minnesota 12-Step Model – helped. Whatever the case, it was a refreshing change.

Happily, the conference’s focus was on differentiating between clients engaging in alcohol abuse and those suffering from true dependency, and differential treatment based on the individual’s condition, not a monolithic “one-size-fits-all” regimen. The presenters’ stats paralleled our own experience – 85% of people with alcohol problems are abusers and only 15% are the dependent ones for whom a “disease” label may be warranted. That estimate correlates with our experience, but we go a step further and suggest that the very few in the “dependent” category ever seek treatment and that the perspective client population is more like 95% alcohol abusers and only 5% dependent.

What difference does that make? For starters, it means that 95% of current treatment practices are only applicable to 5% of the client population, if that. Frankly, current practices serve no one but the industry that employs them – a revolving door business dependent on promoting ineffective methods and relapse in order to keep profitable beds filled.

Since current practices aren’t effective, what is? The research is clear, and has been for a long time: motivated clients with outside support and a belief in their ability to change their alcohol abuse have an excellent prognosis. Clients especially benefit from intense, short-term, outpatient treatment with support from anti-craving medications and the use of Cognitive Behavioral Therapy.

So why are we still stuck with ineffective programs? There really are two major reasons – first, treatment is a multi-billion dollar industry with no financial incentive to change. The marketing of the “powerless, disease, forever-recovering, 12-Step” model has been spectacularly successful and no one has any incentive to prune that money tree simply because it doesn’t help clients.

Secondly, effective treatment is hard work and requires staff with actual skills, knowledge, and expertise – something beyond merely having stopped drinking last month or last year. But residential programs require huge numbers of low level staff and have hundreds of hours to fill. How better to accomplish that than by employing “lifers” who can’t stay dry outside of continuous treatment, and an endless repetition of the “Steps” as “doing something,” and meetings passed off as group therapy?

Are things changing? Not really. Twenty years ago we were told that our research based methods were “twenty years ahead of the times.” Two decades later we’re still eighteen years ahead. The problem is that providers have no incentive to change, the public has been effectively brainwashed, and most programs start off based on false premises which even the best intentioned reinforce.

For now, the real message is clear – if you want help with your alcohol problem, be very, very careful where you get it. Most programs will not only take your money, but will also leave you drinking more within a few months, and frequently within a few hours, of discharge. Sadly, treatment centers have no motivation to do what actually helps – quite the opposite. Remember that when you look for help for yourself or someone else.

In our next installment we’ll take a look at the disease model and why it’s so popular, both with providers and with some clients

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

We work with clients very intensively – four or more hours a day for five to seven days – and with a well defined presenting problem – alcohol abuse. Following this initial treatment phase, during the ninety days of follow-up, we frequently see family members sabotage progress once clients return home. Undermining progress is rarely intentional, but nonetheless it is the second most common factor in clients reverting to old behaviors. Only clients’ self-sabotage is more destructive. Combine the two and any progress will be stopped dead in its tracks.

Why do spouses in particular, but other family members as well, attempt to drive clients back to their old drinking behaviors – behaviors they claimed they wanted changed, and whose elimination they frequently demanded? The answer is that, unhappily, we all tend to find that we really like what we refer to as “the security of familiar miseries.”

The biggest problem with any significant life change is that the outcome is unpredictable. Most of us quickly learn that unpredictability creates more anxiety than even negative, but predictable, behaviors. Sadly, most of the time we all prefer knowing what’s coming, even if it’s a train wreck.

Other factors also come into play. When one person is the “designated client” who has a well defined “problem” the other spouse and/or family members have probably been spending years using the “problem” as a way of avoiding looking at their own problems. When the client makes progress it starts disturbing their comfortable, and saintly, role. Few family members, particularly spouses, are up for having a role reversal thrust upon them. Adolescent children usually aren’t too happy about a parent who suddenly develops consistency and an accurate memory either.

We spend a lot of time preparing clients for re-entry home and sometimes astonishing receptions. After ten days one woman recently flew home to find that her husband had thoughtfully purchased and stocked the refrigerator with a half dozen bottles of her favorite wine. Another wife literally dragged her husband out of treatment when the combination of Naltrexone and cognitive behavioral therapy actually stopped his drinking in its tracks. She wasn’t about to lose her controlling, self-righteous, manipulative role.

The outcomes can also be mutually positive. One couple, learning that his drinking paralleled her eating, and that the same loneliness underlay both habits, have successfully worked with us to modify their lives in ways which address both “behaviors” and the underlying issues without wasting time on blame. Happily, our inclusive approach creates this type of outcome more often than not.

It is important to remember that sabotage, both intentional and unconscious, will always be a factor in any client’s progress regardless of the therapeutic issues. Addressed openly it can be mitigated and clients can be supported through the first difficult months while everyone adjusts to a new equilibrium. Ignored, it will doom clients who otherwise could be healed.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Have you ever been told a person has to “hit bottom” before they can begin to recover? What do you suppose that even means? Exactly what is “hitting bottom?”

Do you suppose it’s really a good idea to wait until you’re divorced, or bankrupt, and/or facing another DUI before looking for an answer to your drinking problem? We don’t think so.

The concept of waiting to hit bottom isn’t just useless – it’s dangerous. How? Consider how that tenet would play out in the case of a real disease, cancer.

“Well, you know,” they’d say, “you really can’t do anything about cancer until it’s metastasized.” Huh?

But that’s most alcohol treatment providers’ party line.

Let’s look at alcoholism as if actually were a disease. What do we know about real illness? Well, first there’s prevention, then there’s regular checkups, then early detection, then… Oops. Early detection? What happened to “hitting bottom?”

Of course that’s the problem. With illness, we don’t wait until the patient is nearly dead before beginning treatment. Effective treatment is begun, good follow-up maintains the progress, and changes in the patient’s life are instituted that will sustain the recovery. It shouldn’t be surprising that this same model works well for diverting a client from alcohol abuse and dependence. The trouble is people have been discouraged – by mythology, stigma, and “lifelong recovery” – from getting help in the early stages when remission is not only possible, but likely.

How did that happen? 12 Step based programs make the same mistake we all do – they generalize from themselves. And generalizing from a tiny number of terminal alcoholics to drinkers in general simply doesn’t work. But treatment programs have almost always been founded by that 1% for whom the model seems to work – true believers who think that they’re typical. In fact, they’re very isolated cases and methods drawn from their experience aren’t applicable or effective for most of us.

But if “true believers” keep saying something loud enough for long enough, and if they drown out dissent, a lot of people will be convinced. Remember, not too long ago, everyone believed the world was flat and that the universe revolved around Earth, That’s exactly what’s happened with 12 Step based programs. Now everyone from Dear Abby to the DUI courts assumes that these programs are an effective treatment model, and that underlying mythology is somehow gospel.

So, don’t be lulled by thoughts like: “I’m not that bad off;” and “I don’t drink as much as Larry;” and other rationalizations. You don’t need to “hit bottom,” whatever that may mean to you. Act before drastic measures are needed and dire consequences appear. Get a handle on your problem while it’s still that, a problem, not a life threatening avalanche hanging over your head.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

When we were scratching around wondering what to call our counseling practice we coined and rejected a lot of possibilities. Some names we considered were obscure, some taken, some boring, and a few were just plain silly. Then we took a look at what it is we actually do, and what we don’t do. The main thing that separates us from most alcohol rehab programs is the fact that we don’t have a “program.” What we do have is a lot of experience and research into what works for different people. The primary offering we have for our clients is the certainty that the solution to their specific problems and set of circumstances will be, like themselves, unique – it will truly be their empowering solution, not ours, or AA’s, or Moderation Management’s, or someone else’s canned prescription. We don’t dictate, we help you find Your Empowering Solution.

Happily that let our logo be Y.E.S., which is good since we spend a lot of time and effort on getting people to “just say yes.” Yes to getting their lives back. Yes to regaining health and independence and friends and family and joy and laughter.

We don’t believe in “just say no.” That’s about as un-helpful a piece of advice as has ever been coined. Saying no takes zero time, energy, attention, and effort. All it really does is create a behavioral vacuum that inevitably sucks the client right back into the same old familiar behaviors – especially when the old behaviors are justified by unfounded or irrelevant beliefs in “powerlessness,” and “disease,” and “genetic predestination.”

If a client wants to alter a behavior, she or he will have to start saying “yes” – yes to new behaviors that will ultimately result in a life that is more satisfactory than the old one. Changes that don’t result in a better life will simply lead to relapse, discouragement, and despair.

Facilitating client based solutions, however, means that clinicians must also be willing to say “yes.” Yes to new ideas, methods, therapies, models, and supports. It means not replaying old programs, formulas, steps, or any of the other standardized regimens traditional treatment force feeds to clients. It means acquiring skills, listening attentively, working creatively, and respecting clients’ strengths, interests, and abilities. It means working through their powerfulness.

It’s hard work. It’s exciting work. It’s rewarding for both counselors and clients, but it isn’t for the timid, whether clinician or client.

Searching for new solutions with each and every client means taking in information: personal and inter-personal history; financial, legal, educational, vocational, and social status; ethnic and cultural considerations; age and gender issues; and emotional/psychological development factors. It means parsing out relevant information and integrating that into a comprehensive treatment plan. It means constantly amending that plan as circumstances require and measuring success in the clients’ terms. It means having a very high tolerance for ambiguity.
It also means holding clients’ accountable for their behaviors. Past, present, and future. This is where a lot of clients will drop out, preferring the secure conformity of traditional disease and powerlessness based models with their unending “recovery,” alcohol fixation, and predictable relapses. Let them go. Wish them well. That too may be their empowering solution. Not everyone is cut out for an independent and creative life.

Perhaps the hardest part for us as providors is admitting that we are not the right program for a lot of potential clients, maintaining a good referral base, and using it. Most of us are loathe to admit that we don’t have “the answer” to everyone’s problems. The truth is, for any of us, of the clients who present themselves, we are the right choice for about a third of them, an adequate choice for another third, and the wrong choice for the rest. That’s our down and dirty self-evaluation model. What’s yours?

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

There are many types of alcohol consumption ranging from the healthy to the deadly. Some people of the prohibitionist persuasion will ague that any use is destructive, but neither medical research nor personal experience supports that conclusion. Unhappily, most “screening” protocols are heavily weighted towards a diagnosis of addiction justifying punitive treatment approaches and “abstinence only” outcomes. In reality, many different degrees of alcohol use exist, and the following thumbnail guide can be helpful in deciding what category is appropriate, and in predicating various – as well as usual – outcomes.

Healthy alcohol consumption has been found to be approximately two drinks of distilled spirits, two bottles of beer, or one half bottle of wine per day for an adult man, and half that for an adult women. These amounts confer the most health benefits without any associated detrimental effects. Obviously, not everyone consumes these set amounts, nor do most people who drink necessarily always stop at one or two. Certain social settings may find one consuming more over the duration of an event, for example, but the average should remain within the recommended parameters.

People who clearly fall into this category may, unfortunately, still find themselves in need of help. Particularly in child custody disputes, but in other legal matters as well, unfounded accusations are frequently hurled and difficult to refute. As John Donne noted, “Two things will be believed of any man whatsoever, and one is that he has taken to drink.”

Alcohol abuse is defined as consumption which consistently exceeds the recommended levels and/or is done in isolation rather than socially. Frequent contributing factors include loneliness, exhaustion, and a paucity of peers or activities. At this stage, remediation is common enough to be the norm, with a return to healthy use the usual outcome. Counseling may expedite the process and help with the underlying causes.

Clients who find themselves at this level can usually benefit from a process of assessment, skill building through Cognitive-Behavioral Therapy (CBT), and the adoption of non-alcohol related activities. As in more serious conditions to follow, the key lies in the creation of a life with reduced alcohol use that is more satisfactory than the current one. An onerous life, or a continued focus on alcohol, will nearly guarantee a return to misuse.

Alcohol dependence occurs after long periods of excessive use leading to social, physical, and emotional dependence. Drinking becomes a primary coping mechanism across multiple categories; for example, socially, recreationally, vocationally, and spiritually. Symptoms may include physical withdrawal following cessation, depression, increased isolation, significant weight gain, decreased liver function, and possible legal, financial, and/or employment problems. As multiple problems need attention, counseling can help with the reorganization, prioritization, and systematic accomplishment of necessary changes.

While a return to moderate or healthy use is normal, a period of abstinence, possibly one to two years, is recommended. Many people who do this never return to drinking at all, having successfully modified their lives in satisfactory ways.

Alcohol addiction, or alcoholism, results when a person’s physical, emotional, and psychological being is permeated by alcohol and its consumption. Distinct withdrawal symptoms – physical (i.e. tremors, seizures) and psychological ones (i.e. blackouts) – are present and alcohol related disintegration in several areas of life (i.e. financial, legal, vocational, marital, recreational, social, medical) is present. While approximately a third of diagnosed alcoholics return to moderate drinking, this is not generally recommended.

At this stage both medical and counseling help is usually necessary given the physical, social, emotional, and psychological aspects. Recovery prospects are uncertain at best and outcomes vary. As always, motivation, spousal support, and a belief in personal efficacy, as opposed to “powerlessness,” are the primary factors in success.

In general, alcohol problems of all magnitude are remarkable for both their persistence over time (being stabile rather than progressive) and their frequent spontaneous remission. While some individuals do follow a path from use to abuse to dependence to addiction, and death, they are the exception, not the rule.

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

Between us, we have been helping people get over alcohol related problems for over twenty years. Sometimes it’s his or her own use, sometimes a friend’s, family member’s, or employee’s. We’ve always helped each client to find their own unique solution to whatever troubled them. In the course of thrashing around looking for these individual answers we’ve learned a lot about what works and what doesn’t and for whom.

The first lesson learned is that nothing works for very many people – AA and the other 12-Step based programs have about a 5% abstinence rate over one year, and less than 1% over five years. Other one-size-fits-all and abstinence based programs have similar rates as far as anyone can tell.

The second lesson is that a lot of people get better on their own – perhaps as many as a third or more of “alcoholics” in any given year. They just don’t talk about it. Like ex-smokers, it’s no longer an issue, concern, or interest.

Third, successful behavior change is pretty much the same whether quitting or moderating drinking, or weight, smoking, or any other significant life alteration. People who succeed find ways to motivate themselves, with or without outside help, believe they can change, find support that works for them, assume responsibility, and act. Professionals can help with the process, but we can also do more harm than good by promoting debunked concepts such as “powerlessness” and “disease” models that only serve to justify relapse and victim status. Unhappily, that’s exactly what most of us do when it comes to clients with “addiction” problems.

We are, of course, well aware that many people do not wish to accept responsibility for either their behaviors or changing them. We’ll always have the clients whose interest lies only in appearing to want to change. For them there are plenty of programs happy to help. But, as ethical, caring, competent, professionals, we don’t have to help with that charade.

In addition to direct services to a wide array of clients, we are always involved in research, outreach, education, and community service. The columns we write here will undoubtedly follow those priorities and activities, beginning with the next one describing the various levels of alcohol involvement we typically see in clients and others and what the prospects for change are.

We hope that you will find our columns thoughtful as well as thought provoking, and that you will help us by responding and debating and asking. We don’t have all of the answers and we continue to look for more. We’re sure you’ve found many we haven’t.

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.