Time to Put to Rest this Purveyor of Uninformed Guidance and Malpractice
Founded in 1951 – Stuck in the ‘50s
One significant flaw of Al-Anon is its failure to incorporate new evidence-based practices on what works for recovery into its curriculum and advice packets for family members. Founded in 1951, when AA was the primary path to recovery, the Al-Anon philosophy remains unchanged despite years of research and progress in identifying successful approaches to recovery. Unfortunately, it’s message – “Let Go and Let God” – continues to permeate the alcohol/addiction field, often to the fatal detriment to families and their loved ones.
He Doesn’t Want Treatment
Let’s look at some examples from our practice on why Al-Anon is a significant barrier to successful treatment by first explaining a common experience in working with client families. Once again let’s turn to a parent’s letter to our local paper:
I think often about one of my son’s best friends. His mother is trying tirelessly to get him help, while the boy’s father contends that treatment won’t work because his son doesn’t want treatment.
This statement captures both the Al-Anon message and our experience with families in a nutshell: the notion that we are powerless over our addicted loved ones and must wait until they want treatment. To reiterate, this attitude flies in the face of reputable, proven studies to the contrary, and more importantly, risks further deterioration and possible death, given the availability of legal and non-legal drugs in today’s world.
Wastes Time and Emotional Energy
In our work with clients, one goal is for all the players in the family “system” to be on the same page and commit to an action plan that encourages their LO to seek help. Why?
- An addict is like mercury, if there’s a crack in the system, s/he will slip right through.
We waste a lot of time and emotional energy educating and persuading key participants on the evidence and benefits of a persistent, activist approach in addressing addiction in their LO. This counseling (and money) would be better spent working out scenarios and plans, rather than disabusing a relative or advisor of ineffective Al-Anon nonsense. Plus, families have limited willingness to engage in what can often be a contentious effort. Dissipating focus fending off Al-Anon BS often results in families losing interest in continuing on in what, by nature of the disease, is a long journey.
Al-Anon Pathology Infects Families, Kills LOs
Aside from squandering valuable time and resources in organizing the family system, this notion of letting go and letting the addict take responsibility pervades the whole recovery process and provides the justification for prematurely reducing or terminating oversight services such as recovery management, drug testing and treatment plan adherence. What does this mean in practical terms?
Family Founder Client
The founder will often tolerate our assistance until the crisis passes and then fire us for the ostensible reason that the person with a problem (PWP) needs to take responsibility for his/her own recovery. The real reason is that the founder does not like outsiders interfering with his/her authority within the family. Despite being successful in business, founders reject information about what works for recovery and instead hang on to the siren song of Al-Anon as justification for terminating services.
LOs in Early Recovery
Young addicted adults are used to running free, fueled by family resources, with occasional ostensible attempts at stopping or cutting back. The last thing they want is someone to manage their compliance with treatment recommendations for six months. Shortly after returning from treatment, they begin lobbying to get rid of us, saying they can do recovery on their own, we are too expensive and rigid – whatever argument they think will be most effective within the family.
Family Advisors, Trustees and Professionals
To this group, we are a threat to their authority and client relationships. Often providing ill-informed, ineffective advice to their clients, they are now faced with the prospect of addiction experts supplanting them as trusted confidants.
“The addict/alcoholic in early recovery is doing so well, let’s return to the old system.” And that’s the end of it. So long, family members, with the next news being in the obituaries.
Sustained Remission Starts at 12 Monthsi
What’s happened since 1951? Well for starters there is the DSM, and now the DSM-V.
Think about it.
- What if the Al-Anon website informed viewers that times have changed, and science-based information now exists that will help be more effective in assisting their loved ones achieve stable recovery?
- What if the National Association of Children of Alcoholics website did the same?
And what if viewers were then referred to information based from the DSM-5, or reputable research from academic centers such as Harvard or Yale, or stories as to how families actually implement recovery management or crisis-response planning.
Example – Sustained Remission After 12 Month
The DSM-V denotes the months four through 12 after abstention as Early Remission, meaning whatever you are doing as a family to encourage your LO to stay clean, keep doing it for at least a year.
Example – Crack House Extraction
When Bill Moyer’s son WC was in the crack house, Bill went down and helped get him out. He didn’t “Let Go” and wait for WC to seek help on his own.
If they say crack is wack, then Al-Anon is even wackier – no sane relative waits for their LO to leave a crack house or stop shooting heroin on their own.
Treatment Centers Nix Family Counseling
Several years ago, we partnered with parents in counseling their young adult child on the benefits of treatment. She agreed to enter a 28-day program, with the understanding that we would continue on after she completed her program. We did not hear from the parents and decided to call them about scheduling an appointment. Their response:
While at the family program we asked if we should continue counseling after treatment and we were told there was no need to do so, just attend Al-Anon.
This typifies the archaic thinking all too common in the treatment centers.
(Practice Pointer Aside: Now many centers are capturing the post-treatment dollars by setting up their own counseling services or sending patients to outside groups in exchange for referrals. Particularly if you are from a well-off or well-known family, avoid these post-treatment services at all costs. Find your own resources and fend off pressure tactics to buy their programs.)
Another Consideration: Your LO is Very Likely a Vulnerable Adult
Us users go to inpatient because we have trouble stopping drinking or drugging on our own. When we do imbibe or ingest, on occasion, we become unable to manage ourselves and/or become a danger to others. And, one of the hallmarks of addiction is the inability to make consistently good decisions regarding seeking and following inpatient and post-treatment recommendations.
- Family members play an important role as advocates for their LOs, who by definition, are often limited in their ability to think clearly.
This role is similar to the one performed for relatives facing serious chronic diseases such as cancer, diabetes or aging.
PAWS Impacts Judgement
Post-Acute Withdrawal Syndrome (PAWS) also negatively affects decision-making in early recovery. Providers are well aware of this impaired judgement, but conveniently use HIPAA and Al-Anon concepts to isolate their patient and fend off information-sharing and questions from relatives.
Case Example: Son returns from treatment and tells Dad they told him he could continue to drink and smoke weed, but to stay off the cocaine.
This is segregating the patient and family to the extreme. End result disaster. Shameful practices, but completely consistent for an industry focused on profits and executive salaries, not patient care or outcomes.
Blaming the Substance User
What happens with relapse? We blame the substance dependence person – the person with the problem who has a disease and is a vulnerable adult. It is so easy to do, and the Al-Anon philosophy fits right in: They must want to recover for treatment to work.
- Parents, family members and their support staff are already angry at the PWP.
Most PWPs are so ashamed and frustrated after they first pick up that they are perfectly willing to accept the responsibility for their failings. The benefits of being both in recovery and family-focused is we can step right in and try to intercede with information and persistence, including “The Disease Concept (understanding addiction as a chronic disease)”; “Relapse is not Failure”; and “Let’s Rework the Recovery Plan”.
But it’s a tough slog, given all the misinformation out there.
Let Her Go – Kick Her Out (Flawed Advice!)
Some years ago, I was contacted by parents whose 21-year-old daughter had failed three treatments. They were being advised to practice tough love (i.e., cut her off and let her live on her own). In fact, the three treatment centers were at fault for lousy treatment, and as someone from a wealthy family, she got nothing but crap from her peer group. Who could recover in that environment? After working with the family to try different approaches, I was so disturbed by this very common scenario – blame the addict, kick her out – that I wrote:
Flawed Family Assumptions About Addiction:
What You Think You Know About Alcoholism, Addiction and Treatment Can Hurt You and Your Loved One
Before you get fed up with your son or daughter or relative, read this article. Also look for my third blog on my family’s experience with inaction and a short research review on successful approaches incorporating family/advisors in the recovery process.
[i] Diagnostic and Statistical Manual of Mental Disorders, 5th Ed., American Psychiatric Association