5 Things Everyone Should Know About Schizophrenia

By Mike Hedrick

Living with Schizophrenia: One Man’s Journey

An attempt to dispel some common misconceptions.

I’ve lived with schizophrenia for 10 years, and there are questions that seemingly always pop up whenever I trust someone enough to disclose my diagnosis. There are also things that catch me off guard about the state of knowledge surrounding major mental illnesses that I’d like to confront. These myths perpetuate the stigma surrounding mental illness and someone needs to dispel them. Here, in no specific order, are 5 things you should know about schizophrenia:

1. We are not violent.

Numerous studies have shown that people with major mental illnesses are more likely to be the victims of violent crime than the perpetrators. Of course, the narrative surrounding school shootings and massacres suggests that only people with mental illness perpetrate these crimes. While those individuals may have mental illness issues, evil is not an inherent facet of mental illness. People with mental illness are some of the most sensitive, creative, and kind people you will ever meet. We’re all just struggling to fight both this misconception and the things in our heads.

2. We are still people.

Just because we have a mental illness doesn’t mean we are any less human. We still think and feel, sometimes more deeply than other people. If we do something weird, we are simply reacting to the things our brain is telling us. We are just trying to get by, and sometimes our minds play tricks on us. We are just as scared as you are, if not more so.  

3. Schizophrenia is not split personalities.

It’s a huge misconception that schizophrenia is the same as dissociative identity disorder. These are two different disorders, but thanks to Hollywood and the media, people have come to believe that schizophrenia and dissociative identity disorder are the same thing. While schizophrenia in Latin means of two minds,” it does not mean there are two different personalities inside of us. We have psychosis. This means that the main facet of schizophrenia is the belief that we see or hear or experience things that are not there. Whether it’s a delusion or a hallucination or paranoia, the main thing is that we are experiencing something which isn’t real. Sometimes we don’t know this fact and, because of that, we tend to get confused about things.

4. We’re not lost causes.

There’s a notion among people both inside and outside of the mental-health field that schizophrenia is a life sentence of limited capabilities and an inability to function normally in society. But it’s nothing more than an illness—an illness that can be dealt with and overcome. While we may never get rid of some of the symptoms, we are just as capable as anyone else of being a contributing member of society. The illness may even spur us to great things in an attempt to prove this notion wrong. Before you dismiss us, know that we want normalcy, too.

5. Not everyone has the same symptoms.

Some people think that there are major common symptoms of schizophrenia present in every case, but the truth is, each individual is unique. Some may only experience psychosis, while others may have hallucinations. I’ve only ever had psychosis, paranoia, and delusions. Schizophrenia is a spectrum disorder, which means there is a vast range of possibilities for how the illness may manifest. There are some common symptoms, but each of us is different.

Mainly, living with schizophrenia means trying to maintain a tenuous balance between the things our brain is telling us and reality. We’re all just trying our best to live normal, balanced lives. The last things we need to deal with are outdated media conceptions that we are violent monsters or dangerously unhinged. We want normalcy just as much, if not more, than anyone else. We are kind, sensitive, smart, creative and deeply caring, so please don’t put labels on us that paint us as anything different. We just want to be OK.

Accept Yourself Unconditionally (Even When You’re Struggling)

By Brianna Johnson

“Self-acceptance is my refusal to be in an adversarial relationship with myself.” ~Nathaniel Branden

Have you ever thought that you accepted yourself fully, only to realize there were conditions placed upon that acceptance?

There was a point in my life when I realized I had stopped making tangible progress with my emotions, self-esteem, and habits. I’d made some profoundly positive shifts that remained with me, like eating healthier, practicing yoga, and phasing out negative friends. You could say I was “cleaning house” in a sense—getting clear on what I wanted my life to look like and discarding the rest.

I began my first truly healthy relationship in years, had a small freelance business that was thriving, and even became a certified yoga teacher. I was no longer a slave to self-doubt and social anxiety like I was in college. However, I didn’t feel like I could vulnerably bare all like other yoga teachers seemed to do so effortlessly.

I was still experiencing some of the same old negative feelings I always had, like dreading social situations and feeling somehow “behind” in life despite all my progress.

I would still slip into self-sabotaging thoughts, mentally talking down to myself when I didn’t teach perfectly. I would still compare myself to other women my age, coming up with stories as to why they were “better” or “further ahead” than I was.

Despite knowing how critical it was to stop doing this, the sense of self-doubt seemed overwhelming and inevitable at times. Upon realizing that these issues were still present, I promptly abandoned myself. Rather than practicing self-care, I “relapsed” into shame. I was ashamed of feeling shame.

“I’m a yoga teacher. I’m not allowed to get in these moods anymore. I should not still struggle with these feelings,” I thought.

During this period, I dwelled hard. I didn’t reach out to anyone. I felt a nauseating fear in the pit of my stomach that made me want to give up on everything. The light at the end of the tunnel had all but flickered out. Convinced that I was alone in these feelings, I stubbornly forgot that other people went through these same emotions all the time.

“I’m not normal. I’ve learned nothing after all this time. I’m foolish and completely hopeless. Who would even want to be around someone like me?”

These may seem like words from the journal of a severely depressed, or maybe even suicidal person. When you read these words you might think, “Eek. I can’t believe she shared that publicly!” Or you might wince and turn away in discomfort, briefly recalling your own dark and “ugly” thoughts. But in truth, these are just two of the sentences I spewed out into a Word document on a particularly bad day.

I no longer buy in to the belief that these kinds of thoughts make me “bad” or a “failure” as a teacher. Years ago, I wouldn’t have admitted to such heavy thoughts. However, I’ve learned not to restrict myself when I’m venting onto a blank page. I dig deep into the negativity I feel, because if I don’t, I truly don’t know what emotions lie beneath the surface—or why they exist.

Writer Flannery O’Connor once said, “I write because I don’t know what I think until I read what I say.” I know this is true for me, and I’m sure it probably applies to many of us. Sometimes we don’t really know how we feel until we start expressing it, whether it’s through writing or speaking. We can surprise ourselves with beliefs and emotions we didn’t know existed within us.

This practice of exploring the darker thoughts led me to the realization that I still wasn’t completely showing up for myself. In other words, I needed to consciously support myself and engage in positive self-talk more often.

As a self-proclaimed self-aware person, this realization initially caught me off guard. I thought I knew myself inside and out. But as shadow work practitioners would say, nobody really knows their shadow—not until it is carefully lured out into the light.

It takes time, effort, courage, and brutal honesty to get acquainted with your darker emotions. Our instinct is to run, but we need to dedicate ourselves to our shadows rather than condemning them.

Whether you work through heavy feelings in a blank Word doc like me or with a trusted friend or coach, it’s important to stop shying away from the “ugly” stuff, like anger, jealousy, fear, and judgment.

These things shouldn’t be off limits. Furthermore, these things don’t make you bad, they don’t make you worthless, and they don’t mean you’re crazy. They are simply the heavier, unacknowledged sensations waiting to be heard and healed—waiting for their moment in the spotlight.

In addition, it’s crucial to realize that this self-awareness process never ends. You will never get rid of all the negative you experience, and frankly, wouldn’t life be boring if you did?

Dark emotions rise up not so we can feel ashamed, but so we can integrate them and forgive ourselves. This process is the foundation of healing, self-care, and self-acceptance.

A good way to tell if you are conditionally or unconditionally accepting of yourself is to look at your expectations and attitudes.

  • Do you only cheer yourself on when you feel positive and/or accomplish external goals?
  • Are you “allowed” to have an off day or an unproductive week without lapsing into self-judgment and self-loathing?
  • Do you stand up for yourself when others discourage you?
  • Do you give yourself the benefit of the doubt in difficult or confusing times?

Answering these questions will reveal if you accept yourself only conditionally. Conditional acceptance means you only love yourself when you’re performing well. (Spoiler alert: In this case, it’s the achievements you love rather than your actual self.)

This is an incredibly easy trap to fall into, especially in the beginning of any self-acceptance journey. For many of us, self-acceptance is a foreign path that we only embark on after years of self-rejection. A lot of the things you must allow yourself to do will seem counter-intuitive, like expressing dark thoughts or letting yourself surrender to pain rather than fighting it.

So what can you do if conditional self-acceptance is the only kind you know how to practice?

For one, don’t berate yourself for it! Any berating or negative judgment just keeps you in the vicious cycle. Think about it: Yelling at yourself for yelling at yourself? Not effective.

Secondly, admit to any feelings that oppose unconditional self-acceptance. Don’t deny them or refuse to look at them. Instead, explore them. Let them coexist with the positive stuff until they have taught you whatever they needed to teach you.

And lastly, incorporate self-care when it is easy. When your mood is light and you are full of energy, use these periods to wholeheartedly implement self-care routines. I like to implement self-care through everyday sensory experiences, like lighting some incense, taking a hot shower when it’s cold, or taking the time to cook a really good healthy meal.

The momentum of positive habits will make your lows less treacherous. Having that stable found of self-respect already built into your daily life will remind you that it’s ok to struggle.

Struggle is temporary. Struggle makes you human. And it certainly doesn’t make you any less whole.

Alternatives to Alcoholics Anonymous that don’t involve god or going cold turkey

By Tracey Anne Duncan

Aug 21, 2019

Alcoholics Anonymous saved my life and I don’t care if that makes me a cliché. When I stopped using opioids cold turkey after an addiction in 2017, my life was a mess, I needed a plan, and AA delivered. But as I got deeper into my recovery process, AA started to feel itchy. I quickly found that I was wholly allergic to the thinly veiled Jesus-y underpinnings. The world’s most famous recovery support group is based firmly in traditional platitudes of Christian faith and guess what? Not everyone is Christian. A lot of young people, especially, aren’t even religious at all. For that reason (and a few others, including the heteronormativity of the program), I’ve explored a lot of alternatives to AA over the past two years. 

No one should have to adhere to “mainstream” ideals just to get a little support during addiction recovery. If you don’t feel like you fit in at traditional meetings because their religious ideals don’t align with yours — or their ideas about identity or addiction feel outdated — here are some other recovery support programs that have proven track records.

Recovery programs for folks who aren’t sure about the whole God thing

SMART Recovery is an evidence-based (versus spirituality-based) “self-management and recovery training” program. Their 4-Point Program is designed to help people change their behaviors in a gradual, step-by-step process. According to their literature, individuals struggling with addiction must first build the motivation to change, cope with urges, learn to manage their emotional state effectively, and finally, make a plan for living a healthy sober life. SMART Recovery is shown to be an option with positive benefits for people who have substance abuse issues as well as those with behavioral compulsions, like overeating. Their program is free and they have meetings worldwide.

If that doesn’t sound like a solid fit, there are a bunch of other secular recovery alternatives to AA. LifeRing is a group geared towards personal empowerment (think Tony Robbins style positivity). SOS (Secular Organizations for Sobriety) is a network of local autonomous secular recovery groups, and they provide a loose connection between unaffiliated local secular groups. There’s even AA Agnostica, an organization explicitly formed to counteract the negative experiences that some non-religious folks had in AA. 

Recovery programs for people who aren’t into abstinence

A lot of programs have been developed that don’t ask you to abstain from all substances now and forever, since abstinence is not necessarily the best way to get sober for some people. While most established programs encourage a period of total abstinence from your addiction, whether it’s to sex or to Sazeracs, there’s some research that suggests that some folks who want to cut back on drinking can still dabble with it.

Moderation Management is a support group network for people who want to change their lives by drinking less. It’s based on the seemingly simple idea that people can change their behavior (as opposed to AA’s notion that the alcoholic is powerless over alcohol) and the kinda revolutionary (in traditional recovery circles) idea that folks should be offered choices about how to change their behavior. MM is free and they have meetings all over. HAMS, or Harm Reduction, Abstinence, and Moderation Support is also a very useful peer-run resource.

Recovery programs for people who are spiritual, but not Christian

Y12SR, or Yoga for 12-Step Recovery, is a yoga-centered holistic recovery program that has both the physical postures and philosophy of yoga as its foundation. It is an up-and-coming approach to recovery that integrates somatic trauma recovery techniques with 12 step-inspired group support techniques. Founded by Nikki Meyers, it’s also the only internationally recognized recovery group created by a woman of color. Y12SR is free for individuals, and while there aren’t as many meetings as some other options, new groups are constantly forming.

Recovery Dharma — formerly Refuge Recovery — is one of my favorite programs, despite the fact that its previous ownership experienced some alleged controversy. (When I contacted a local former Refuge Recovery leader for comment about Noah Levine, who still runs Refuge Recovery, he said that Levine is not affiliated with Recovery Dharma.) Recovery Dharma is a program based on Buddhist principles. The meetings center around meditation and mindfulness practices, are free and world wide, and are full of punks and feminists with an eye for social justice.

There are, unfortunately, no organized programs for sober witches, but there’s a book for pagans in recovery and also a guide for sober Satanists. Amen. I mean, Blessed Be. I mean, Ave Lucifer. Whatever works for you.

Recovery programs geared more toward women and LGBTQ

I’m not the only one who has complaints about the heteronormativity of AA, or about 13th Steppers (old-timers in AA who hit on newcomers). As a result, recovery options have developed specifically to meet the needs of women and queer folks..

Women For Sobriety is a program designed to “meet the very special needs women have in recovery,” as they say on their site. The rhetoric sounds a little trite but the program itself is actually pretty feminist. WFS is free and while they don’t have very many meeting options, they can connect with you by phone. LGBTeetotaler is a blog that is working to connect sober queers. Tempest is a paid online “sobriety school” that promises to teach you how to be a happy sober person, and is mostly geared toward young-ish women.

Some people balk at for-profit addiction recovery resources, but personally, I think there’s a big difference between medicalized treatment centers that make billions off of people managing addiction, and recovery coaches who are just trying to make a living helping people, like Holly Whitaker, who runs The Tempest and Hip Sobriety.

I still go to AA-related meetings, but I stick with Al-Anon and ACoA (Adult Children of Alcoholics & Dysfunctional Families), both groups for folks whose lives have been affected by alcoholics or people with other addiction issues. I’ve personally found that those groups tend to have an approach that is more accepting of difference, and definitely less predatory, than some of the rooms.

If you or someone you love is in crisis, please call the SAMHSA (Substance Abuse And Mental Health Services Administration) hotline 24/7 at 1-800-662-HELP.

Addiction is not a disease

How AA and 12-step programs erect barriers while attempting to relieve suffering.

Defining addiction as a disease is marketing for the rehab industry — and an excuse when treatment doesn’t work

MARC LEWIS

The idea that addiction is some kind of disease is unquestionably the dominant view in government, medical, and most scientific circles around the world. So dominant in the West, for example, that US vice president Joe Biden introduced the Recognizing Addiction as a Disease Act for debate in the US Senate on March 28, 2007.

S. 1011: Recognizing Addiction as a Disease Act of 2007

(1) Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain’s structure and manner in which it functions. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs. The disease of addiction affects both brain and behavior, and scientists have identified many of the biological and environmental factors that contribute to the development and progression of the disease.

Yet the concept that addiction is a disease is certainly not new. In fact, it’s been promoted and rebutted since the time of Aristotle (and other Greek and Egyptian scholars), and it has grown exponentially in authority and popularity since the early 1900s. This quote from a hundred years ago captures the flavour of the disease concept when it began to proliferate in the West:

The author considers it very unfortunate that the terms “morphine habit” and “opium habit” have been, and are still, so universally employed when referring to narcotic addiction (disease). They are misleading and do not, in any wise, accurately describe the condition present. . . . Habit implies something that can be corrected by an exercise of the will. . . . This is not true of narcotic disease; therefore, it is not a mere habit and should not be spoken of as such. . . .

The man who is addicted to a narcotic drug is as truly a diseased man as one who has typhoid fever or pneumonia.

How did this definition arise, and how has it evolved in our own time?

Society’s conceptualization of addiction has always reflected its policies for dealing with it. While Shakespeare referred to addiction in”Henry V,” nobody at the time advocated treatment centres for debauched nobility. Public alarm began to rise over “demon rum” and other spirits early in the nineteenth century. By the end of that century, temperance movements vociferously demanded total abstinence. In the early twentieth century, alcoholics and addicts were seen as both doomed and damned if they could not or would not dry up. And when those warnings didn’t work, Prohibition was launched in the United States as the next-best solution. Temperance activists saw alcohol itself as the cause of alcoholism, much like contemporary disease theorists see drugs (rather than environments) as the cause of drug addiction. When Prohibition was repealed to allow for social drinking, hard-core alcoholics were nevertheless reviled as morally depraved and undeserving of help.

Public policy thus maintained its moralistic and puritanical slant well into the 1930s. But then the view of medical practitioners, that addiction was a malady rather than a personal failing, picked up support from an unexpected source. Bill Wilson and Robert Smith started Alcoholics Anonymous (AA) in 1935, launching a new era in society’s perception of addicts and their treatment. The premise of AA was that alcoholics were suffering human beings who had the right and the obligation to try to relieve their suffering. Through principles of mutual support, ongoing group attendance, self-honesty, and spiritual transformation, AA helped millions of  alcoholics overcome their addictions, as it still does today. It also spearheaded society’s recognition that addicts need help, not rejection, and that they can get better.

The founders of AA did not see addiction as a disease, exactly, but as a mental and spiritual “malady.” Physical sensitivity to alcohol was initially conceived of as an “allergy,” while the spiritual malady expressed itself in perpetual discomfort with life on life’s terms, an inability to be at peace in the moment. Booze first seemed to soothe this discomfort but ultimately exacerbated the physical sensitivity. The result was a lifelong disorder that remained treatable, though never actually curable. AA counselled its members to stay vigilant about their vulnerability and to keep it firmly in mind by reciting metaphors, chanting slogans, and telling and retelling personal tales of failure and of success. A crucial springboard to sobriety was realizing that you were powerless over alcohol—you were not capable of moderate or occasional drinking. The twelve steps of AA begin, still today, with an admission of powerlessness and a commitment to trust in a higher authority. It turns out not to matter as much anymore whether that authority is God, the group itself, your sponsor, or the medical community. What does matter is the acknowledgement of a serious deficit, which is—not coincidentally—the state you find yourself in when the doctor says you have cancer or pneumonia. That’s when you know you need help.

While AA’s emphasis was on the mental and spiritual aspects of addiction, the idea of a biological sensitivity to alcohol opened the door to a more specific (and broadly accepted) definition of addiction as a disease. In the early 1950s, when Narcotics Anonymous (NA) and Hazelden’s “Minnesota Model” got off the ground, the disease nomenclature began to flourish. NA, an outgrowth of AA, was established to treat those addicted to heroin and other drugs, and it was considered self-evident that the drug was what caused the disease of addiction. The Minnesota Model, which blended twelve-step philosophy with principles of residential care and education, became the gold standard for treatment centres by the 1960s. The Minnesota Model specifically labelled alcoholism a disease that overcame people physically, mentally, and spiritually. At the same time, an influential book by E. M. Jellinek, “The Disease Concept of Alcoholism,” articulated a medical model that traced the progression of alcoholism through a series of phases leading to loss of control, insanity, and death. Now the “disease” terminology began to appear in the literature of twelve-step programs throughout North America. And the American Medical Association classified alcoholism as an “illness” in 1967, making it official. In retrospect, the concept of a biological deficit, reified by AA, helped pave the way for the disease concept of addiction, and a medical term became standard parlance in the world of addiction treatment.

Today the disease definition is used by twelve-step programs around the world, though its meaning continues to morph and vary from group to group. Moreover, twelve-step methods have become central in the world of institutional treatment, where the disease definition has been imported wholesale. There is a basic incompatibility between AA philosophy and the impersonal character of institutional care, and the disease label just reinforces the resulting fallout. Addicts seeking treatment, or those coerced into treatment by the justice system, are compelled to follow a recipe for recovery targeted to what is viewed as their disease, independent of their personal beliefs, which are often dismissed as irrelevant. If they do not follow the recipe, they may be denied any treatment at all, a policy that is fundamentally at odds with official twelve-step literature (though some twelve-step groups adopt the same punitive methods). For many addicts, this pressure tactic is a deal breaker, and that helps explain the acrimonious tone of the criticisms expressed by those who’ve quit or been excluded from twelve-step-based care.

There are other ways in which twelve-step practice has helped erect barriers while attempting to relieve suffering. First, the AA framework and the medical notion of disease share the core assumption that addiction is a lifelong disorder and total abstinence is necessary to arrest it. The graded (e.g., occasional, social) use of any substance is deemed self-destructive, inevitably leading to relapse. This position often strikes former addicts as exaggerated and untenable, and epidemiological research shows that many recovered alcoholics are capable of social drinking. (The debate about moderation versus total abstinence is contentious and volatile, and I won’t attempt to get into it here. Suffice it to say that many sources of evidence point to highly individualistic outcomes and resting points along the route to recovery. And whether or not total abstinence is necessary has little bearing on the disease concept, regardless.) Second, the collaboration between the twelve-step movement and institutional thinking asserts the need for treatment through recognized programs. This policy discourages addicts from finding their own way to recovery, and it blocks their access to benefits that might help pay for alternative resources. Moreover, it ignores compelling data, collected by a variety of independent organizations (most famously the National Epidemiologic Survey on Alcohol and Related Conditions, NESARC), showing that most addicts and alcoholics do recover, and that a majority of those—up to three-quarters, depending on where you get your statistics—recover without any treatment. Third, twelve-step literature maintains that the disease of addiction is built into one’s character. Experts including Stanton Peele have shown how destructive this attribution can be, especially for young people whose identities are still under construction.

Finally, and most troubling, is the confusion that surrounds AA’s emphasis on recognizing one’s “powerlessness” as a condition for overcoming addiction. For those helped by twelve-step methods, powerlessness is usually viewed as a hinge point for surrendering unworkable strategies and admitting that one has to start over and revamp one’s design for quitting. However, others interpret the emphasis on powerlessness as suggesting ongoing helplessness, perhaps because their thinking has been distorted by submission to a set of impersonal rules imposed by the courts, institutional policies, or overly severe group leaders. As I noted earlier, many experts highlight the value of empowerment for overcoming addiction. In fact, most former addicts claim that empowerment, not powerlessness, was essential to them, especially in the latter stages of their recovery. Sensitivity to the meaning of empowerment in recovery may be greatest for those who’ve been disempowered in their social world, including women, minorities, the poor, and those with devastating family histories.

It’s an open question whether the disease nomenclature, partially absorbed into the AA mainstream, has alienated more members than it’s helped. Here’s a comment I received about a year ago, following a blog post on the disease label:

I am a Registered Professional Counsellor and I have personally struggled with alcohol addiction in my life.

After the last three years of intense psycho-therapy and group work focused on healing personal wounds from our childhood and dealing with our traumas, I have managed to come out of my addiction on to the other side.

I have many friends who still rely heavily on the AA program, and with no disrespect to the program—I can see how it works for them, it just does not work for me.

I have had a long hard look inside about how I feel personally about addiction. I do not feel that I have or had a disease. I see my past drinking as a behavioral problem, a learned response to dealing (or not dealing) with emotional pain and stress. Once I achieved the excavating of my wounds I no longer lived with the same anxiety or sense of dread/guilt and shame. . . . I have completed the steps—however, I see them as steppingstones rather than a Solution.

The disease concept evolved from a description to a model in the 1990s—“the decade of the brain.” Neuroscientists began to show new synaptic growth in morphine-addicted lab rats and neural rewiring in human cocaine addicts: clear evidence of brain change. With other drugs the story was sometimes more complicated, but the fundamental message was the same: drug use messes up brain wiring, and the mess doesn’t disappear when you quit. Many of the reported structural changes were related to changes in the release and absorption of dopamine, a neurochemical associated with reward in subcortical systems but with cognitive control in the loftier reaches of the cortex. In study after study, dopamine levels went up and down with drug availability—and not much else. Dopamine was increasingly released by getting high, or by cues that predicted getting high, or by cues that predicted cues that predicted getting high, and decreased in relation to other formerly pleasurable activities like sex, food, and watching your kids grow up. The brain receptors that absorb and use dopamine were also found to change in structure or efficiency over months and years of use.

Because the action of dopamine enhances the formation of new synapses (and the corresponding loss of older ones), changes in the dopamine system bring about structural changes in synaptic networks—the basic wiring diagram of the brain. And they do so most significantly in a brain region called the striatum, the area responsible for pursuing rewards. These brain changes were seen as direct evidence that an insidious force—namely, drugs—had “hijacked the brain,” a phrase first uttered by Bill Moyers on a popular PBS television series but quick to catch on in addiction debates everywhere. I’ll delve more deeply into brain change in subsequent chapters. For now, what’s important to emphasize is the impact of such findings on the conceptualization of addiction, comfortably defined as a “chronic brain disease” from the late 1990s to the present.

It makes sense that medical practitioners (and their colleagues in related professions) readily jumped on the bandwagon. First, it jibed with psychiatrists’ long-standing efforts to “medicalize” psychological problems, to see mental illness through a biological lens, so that medical doctors (especially psychiatrists) remained the ruling experts on psychological matters. Second, by fitting addiction within a medical category, the disease model provided coherence and closure in a field customarily sown with discord. Doctors rely on categories to understand people’s problems, even problems of the mind. Every mental and emotional problem is identified with a medical label, from borderline personality disorder to autism, depression, anxiety, and addiction. These conditions are described as tightly as possible and listed in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) and the International Classification of Diseases (ICD). In fact, the DSM is famous for categorizing every nuance of personal disturbance as a type or subtype of disease, and the latest rewrite of the DSM—creatively labelled DSM-5—can be seen as leading to more medicalization because it includes more symptoms. It would be strange indeed if addiction were not invited to join the club.

Since our opinions and convictions are so firmly guided by the dictates of medicine, the disease concept has become a juggernaut, overtaking diverse arenas of public opinion and public health. Thousands of self-help books, websites, and YouTube videos spread the word: Addiction is nothing to be ashamed of. It’s a brain disease.

As argued earlier, the disease model probably does more harm than good for most addicts. Yet its benefits for other players are clear. The disease model is excellent news for the owners and managers of the more than fifteen thousand drug and alcohol rehab centres operating in the United States and Canada, because it means We know what your problem is, and we’re the ones to fix it. Drug and alcohol treatment and rehab represents a multibillion-dollar industry in the Western world. (Costs vary from country to country but are generally above $2,500 per week in the United States and Canada, slightly lower in Britain and Europe.) And while the size of the problem may justify the enormous size of this network, we must recognize the industry as a special interest with much to gain and much to lose.

The definition of addiction as a disease, endorsed by the medical and scientific communities and most Western governments, may be the most powerful marketing tool there is for the rehab industry. It’s not only a great way to get people in the door—clearly people with a disease need treatment, and judges in the United States have fully endorsed this logic—but also a way of explaining what goes wrong when treatment doesn’t work. Because no doctor, nurse, or shrink will ever tell you that they can fix you for sure. All they can say is that they’ll try. And if you end up not getting fixed, well, that’s the way it is with diseases. And probably you didn’t quite follow the regimen you were instructed to follow. The wagging finger isn’t hard to visualize. The disease concept is also a useful tool for the insurance industry, because it defines and delimits the kind of treatment that will and won’t be covered, for how long, and at what cost. Closer to home, most addicts’ families (76 percent in a recent Gallup poll) also see addiction as a disease, because it makes the disgraceful behavior of their loved ones comprehensible and even forgivable. So the disease model becomes a convincing framework for understanding addiction from the outside—even when that definition is ineffective, inaccurate, or harmful for addicts themselves.

Adapted from “The Biology of Desire: Why Addiction Is Not a Disease” by Marc Lewis.  Reprinted with permission from PublicAffairs. All rights reserved.

What Is SMART Recovery?

A Look at Another Support Group Option for Addiction Recovery

BY EILEEN STREET 
JAN. 12, 2020

LEXINGTON, Ky. – Often when one is in recovery for addiction, they turn to a 12-step mutual support group, but there are also other options. One of those is called Self-Management and Recovery Training (SMART Recovery).

At the start of a meeting, participants only introduce themselves by name.

“I’m just Craig. So sometimes I’ll say I’m in recovery or I’m in long-term recovery, but typically, I just introduce myself as Craig,” said Craig Wilkie, who was initially introduced to SMART Recovery when he was in treatment in 2018.

That’s because SMART Recovery doesn’t use labels. 

“It’s refreshing to not introduce myself as an alcoholic,” Wilkie said.

Bill Greer, the President of SMART Recovery USA, said the non-profit offers a no blame, no shame approach to recovery. 

“We regard addiction as a medical condition. It’s a problem with how you behave. It’s not who you are,” Greer explained over a Skype interview.

After everyone checks-in on how they are doing, participants work on SMART Recovery’s 4-Point Program through discussion and a workbook, which focuses on: building and maintaining motivation; coping with urges; managing thoughts, feelings, and behaviors; and living a balanced life.

SMART Recovery uses evidence-based techniques, such as cognitive behavioral therapy, to help participants look at their behaviors and decide what they need to change.

“Like making sure I put myself in situations that are beneficial to me. So maybe not going to an event at a brewery because that could lead me to a very easy way to have another drink. Instead, maybe I’ll just go to the movies,” Wilkie told Spectrum News 1.

SMART Recovery is not a therapy or treatment program, but the free meetings are led by trained facilitators.

“If someone brings something up they are dealing with, we point out maybe skills they could use to cope better,” said volunteer facilitator Cassie Stephens, who has been sober for over two years.

During meetings, participants do exercises in SMART Recovery’s handbook and share what they wrote, such as writing their top five values. For Wilkie, these worksheets have been the most beneficial aspect of SMART.

“And the ‘AHA!’ moments you can have,” Wilkie added. “When you put it down on paper, again, if you list everything that’s important to you, and you realize that you didn’t list alcohol or your substance of choice.”

One reason Wilkie was drawn to SMART Recovery is because it doesn’t use or mention a higher power in its meetings or program. 

 “We focus on self-empowerment, helping people find the power within themselves to recover as opposed to surrendering to a higher power,” Greer said.

In 2017, a systematic review on SMART Recovery looked at literature and twelve studies on the program. It concluded that although positive effects were found, the modest sample and diversity of methods prevented conclusive remarks about SMART Recovery’s effectiveness as a viable recovery support option and further research was needed.

“We do know that it has staying power, and it’s expanding. So that is one kind of evidence that it works at least for some people,” said Founder and Director of the Recovery Research Institute of Massachusetts General Hospital, Dr. John Kelly. In 2019, SMART Recovery celebrated its 25th Anniversary and currently offers over 3,000 meetings in the United States.

Dr. Kelly was on the team that conducted the 2017 systematic review of SMART Recovery. Now, he is leading a rigorous five-year study funded by the National Institutes of Health. In part, the study will look at SMART Recovery’s effectiveness compared to 12-step programs. 

“My guess would be…I put my money on the fact that SMART Recovery will be as effective as other groups like AA, NA, and other 12-step groups. That would be where I put my money,” Dr. Kelly told Spectrum News 1 during a Skype interview.

Dr. Kelly explained the basis for that reasoning is because of hundreds of rigorous studies on clinical treatments and interventions that all have shown roughly the same outcomes.

“It matters less about the specific content or technical aspects of what is done, but the most important thing is that in groups like SMART Recovery and 12-step, is that they do it over the long-term,” Dr. Kelly explained.

He added that it’s important when treating a chronic illness, which is susceptible to relapse like substance use disorder, to have ongoing support over the long-term.

“Not just for 30 days or 60 days or 90 days. Treatment does a good job at stabilization, and providing that initial support, and skills building, but it really just points people in a direction. And what’s important when people go back to the communities in which they live, is that they have something that can support their recovery over the long-term,” Dr. Kelly said. “And groups like SMART Recovery are there around the corner form where people live.”

For Wilkie, SMART Recovery has already proven to help his recovery journey.

“I’m able to make choices that benefit me in recovery, but also people that have to live with me be happy,” Wilkie said. “Ultimately, it’s my life, and I am enjoying living in recovery now.”

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