AL-ANON: ANTI-RECOVERY AND ANTI-SCIENCE

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

AL-ANON: A LEADING CAUSE OF DEATH FOR ALCOHOLICS/ADDICTS

Unsubstantiated Malarkey Versus Evidence Based Programs that Improve Outcomes

Question:
How many Al-Anon members does it take to screw in a lightbulb?

Answer:
None, they just sit there and watch it screw itself.

Al-Anon in a nutshell.

“Let Go, Let God”

Watch your family members and friends suffer while you do nothing – until you realize that doing nothing is resulting in your loved one’s physical and mental deterioration and impending death. 

The Too-Often Bitter Postmortem

For too many parents, there is the bitter, heartsick, recurring postmortem: Why didn’t I try something sooner?  Often triggered by news of what actually works for effective addiction treatment, I learned after several chance encounters never to tell these survivors what I do for a living because it inevitably leads to tears. 

The tragedy is, of course, that following Al-Anon’s teachings lead to relapses and missed opportunities to pursue effective recovery strategies.  Meanwhile, the disease progresses along with attendant negative self-destructive behaviors.

Contingency/Recovery Management Works

For years, treatment centers have known about the highly successful programs for doctors and pilots, where medical boards and airlines are involved in intensive recovery management and oversight for several years. 

  • Referred to as contingency management, more and more research supports this approach as an effective treatment for addicts and alcoholics. 

However, attending Al-Anon, and its message – “Let Go, Let God” – continues to be promoted by family programs, counselors and treatment centers, in spite of the widely available studies documenting models much more successful than doing nothing (i.e., waiting for the light bulb to screw itself).

Behavior Modification for Behavioral Health Disorders (Duh)

Substance dependence and mental health concerns are behavioral health disorders.  As such, it is logical to implement behavior modification techniques (e.g., positive reinforcement), while identifying and reducing negative reinforcers, to encourage addicts to change their behavior.  Similarly, the habit guru, Charles Duhigg, views addiction as a pleasurable habit gone bad, with recommendations on transitioning to new activities without the drink or the drug. 

According to an excerpt from a review by Harvard’s Recovery Research Center on Addiction:

A common hurdle for practitioners and families is successfully engaging youth in treatment so that they stay engaged until treatment completion. Health behavior change research suggests that one way to address this issue is to directly counteract potential barriers …

Parents: No letting go here!  Are you getting the message? 

Whether you call it contingency management, therapeutic leverage, recovery management — they all require parental involvement.  All improve outcomes.

More from a high school parent letter to our local paper:

If it takes a community to raise a child, without doubt, it takes that same community to keep a child off drugs.  He is fortunate to have such a community of committed supporters, holding him accountable to staying on a good path.

What is she doing that so many parents are told by Al-Anon and treatment centers not to do, but absolutely should? 

  • No secrets – Addiction hides in secrecy. 
  • Multiple accountability sources – Limits the addict crafting different stories for different people.
  •  Openness about the “path” – Friends and family know the recovery plan. 

The very opposite of Al-Anon. 

Why Continue to Promote An Unproven, Destructive Philosophy?

“Letting Go” is ossified advice to family members completely unsubstantiated by evidence or research and contrary to best practices.  It is responsible for needless suffering for so many alcoholics and addicts.  It would be one thing if there was proof that following the Al-Anon philosophy improved recovery rates, but there is none.  Anecdotal evidence is just the opposite, and its continued practice is a primary reason why recovery rates are so low.

  • One wonders why treatment centers continue to promote this ineffectual approach to recovery. 

What are the origins of this advice and supposed theory?  And what benefits inure to treatment centers by centering family program curriculum for parents/relatives on the Al-Anon steps and principles? 

Two reasons:

  1. Bill Wilson, AA founder, developed the principles underlying Al-Anon.
  2. Treatment centers find it very convenient to promote a doctrine that tells family members to ask no questions about treatment.

Both reasons will be addressed in the next two sections.

Bill Wilson’s involvement in developing Al-Anon principles

Bill Wilson wrote the chapter in Alcoholics Anonymous “To Wives,” pretending to be a wife while giving advice to wives!!! 

Key messages:

  • Never be angry.  Patience and good temper are most necessary.  (p. 111)
  • Never tell him what to do about his drinking.  (p. 111)
  • Do not set your heart on reforming your husband (p. 111)
  • You must be on guard not to embarrass or harm your husband.  (p. 115)
  • We never, never try to arrange a man’s life so as to shield him from temptation (p. 120)
  • God has either removed your husband’s liquor problem or He has not. (p. 120)

What could be more perfect for an addict than to have family members never criticize your drinking, treat you with kindness and to never suffer consequences?

My strong suspicion is Wilson wrote these words because, when drinking, he wanted to keep doing so without consequences and with no accountability after he quit.  Some cursory online research indicates that his wife, Lois, was not happy about Bill writing the chapter in the guise of a wife, but she kept quiet to keep the peace.  The upshot is that when Lois started the first Al-Anon group, the program content was heavily influenced by Bill and the “To Wives” chapter in Alcoholics Anonymous.

In any event, letting go and hoping God will intervene is a completely ineffective responsive to a deadly disease.  The combat slogan “Praise God and Pass the Ammunition” is a much more apt phrase, as we need to combat addiction, not hope it disappears.

  • For example, there is a wealth information supporting removal of alcohol from the home during early stages of recovery due to the well-documented research on the power of environmental cues.

But there are still treatment centers not mentioning this topic or, when such questions are raised, saying it does not matter. Continuing to give advice in this vein constitutes malpractice and, as mentioned, is one reason for high relapse rates.

Final quote from Bill (as wife):

Never forget that resentment is a deadly hazard to an alcoholic.  We do not mean that you have to agree with your husband whenever there is an honest difference of opinion.  Just be careful not to disagree in resentful or critical spirit. (p. 117)

Remind me to reproduce this advice from the expert in ALL CAPS 20-pt. font and post it in multiple locations around the house!!!  Thinking about attending Al-Anon?  Hold that thought. Once again you have been bamboozled by an alcoholic.

Promoting Al-Anon Enables Treatment Providers to Avoid Accountability

The natural inference or corollary to Letting Go and asking no questions of your substance dependent loved one (LO) is to refrain from directing questions to treatment centers or counselors regarding your LO’s treatment.  That would be “controlling,” “interfering in the treatment process,” or one of the many other pejorative comments directed at families or outsiders seeking information on diagnosis, progress or aftercare plans. 

As commentators note, treatment centers are welcoming and solicitous towards family when selling the benefits of their programs, but once that credit card is charged or the check written, the door closes.  You may have just shelled out $30,000-$50,000, but common questions (see below) are not answered, even in family meetings with the patient present:

  • Using history, including substances
  • Diagnosis
  • Program plan
  • Treatment progress
  • Factors supporting use
  • Post-treatment recommendations
  • Relapse plan

As to the last item, given that relapse is the most common outcome of treatment, one would think this would be an important topic.  But no, it is similar to He Who Must Not Be Named.  If relapse is discussed, it is more likely to happen.  If this sounds like voodoo treatment, it is, akin to Letting Go and Letting God. 

  • Do nothing.  Say nothing.  See nothing.  The treatment center mantra for families.

You can’t imagine the pushback we get from many treatment centers when we obtain patient releases and start asking questions or giving input on programming and aftercare.  

Delayed Treatment

The crucial bottom line from the continued promotion and prevalence of the Al-Anon philosophy in the addiction/recovery community is delayed treatment.  Delayed treatment means substance dependence metastasizes from mild/moderate to severe and chronic (cancer analogy deliberate), increasing the odds of disability and death.  For those of us who are conflict avoidant, Al-Anon provides the rationale for doing nothing and waiting for our family member with the problem – whether it be an addiction, eating disorder or mental health concern – to seek help. Inevitably, there will be a reckoning. 

  • Postponing is NOT a successful strategy – it is NO strategy.

Assuming it is not an emergency, it’s better to wait while you find qualified, professional help as part of the process of addressing the problem.  One goal of this counseling process is for family members to form on a consensus on moving forward.  Otherwise, your LO will exploit the divisions to avoid treatment, a topic for further elaboration in my next piece on why Al-Anon needs to be relegated to the graveyard of failed recovery theories.