Chemical dependency Treatment is, too often, Miss-treatment. This is a legacy from its beginning. For, the first treatment “centers,” were not centers at all. They were Therapeutic Communities. Therapeutic Communities began as a grass-root effort to treat addicts, mainly heroin addicts, that did not blend into the culture of Alcoholics Anonymous, and other 12-Step groups. Ironically, much of their language, and practices, are still being enacted in modern Treatment Centers. Even in Treatment Centers that claim to adhere to an AA/NA 12-Step-based model of treatment.
This came to be because of an attempt to jumble two incongruent philosophies: the philosophy, of the Therapeutic Communities (T.C.), and the philosophy of the Twelve Steps Fellowships. To truly understand how this came to be, a brief history of the substance abuse treatment field is necessary.
This brief history begins with Synanon; arguably, the most influential of the Therapeutic Communities. Synanon began with Charles E. Dederick. He had been an alcoholic for twenty years, and a member of Alcoholics Anonymous. In January of 1958, he ” had no job, two cents in my pocket, and was living off unemployment benefits, in a small apartment near the beach in Ocean Park, California.” (Yablonsky, L. 1965. Synanon the tunnel back) He, and other friends from AA, started a regular weekly meeting. In this meeting, mainly because of Charles, or “Chuck” Dederick, as he became known, the discussions became heated.
In this group, people challenged each other to become truthful. Any sign of rationalizing, or escaping responsibility, was met with strong challenges. Another defining feature of this group was that its members began to move close to each other. A small community, of alcoholics, and addicts, rented apartments around Chuck’s home. Chuck’s apartment became the “clubhouse.” The community began to live as one. They would share their resources, and meet regularly for groups in their apartments. They would also attend an A.A. group together.
This AA group met until a dramatic break that solidified the difference between Synanon, and A.A. This is the story as told by Chuck:
“The break with Alcoholics Anonymous occurred about the middle of August (1958)
It happened right in the middle of an A.A. meeting. Our whole gang had taken over the Saturday night meeting of the Santa Monica A.A. group at Twenty Sixth and Broadway and built it up from its attendance of ten people to an attendance of about forty five or fifty. There was some objection on some issue by the members of the Board of Directors of the A.A. club. I recall the leader stopping the meeting. They didn’t like us. The alkies didn’t like the addicts, and they didn’t like me in particular…and they didn’t like my gang because they were mostly addicts. They made things difficult for us. I remember getting up in the meeting and saying, ‘All right, lets go home-the hell with this.’ So the whole meeting got up, and we all got into our automobiles and came down to the club, and we never went back to A.A. again.
We were building something new and different. Although I will always be grateful to A.A. for helping me personally, Synanon has nothing to do with A.A., any more than a rowboat compares with an airplane. We have a live-in situation, with family characteristics. We emphasize self-reliance rather than dependence on a higher being.
We assumed a responsibility; we had to get up the rent, we had to feed the people when they came in, and so on. This was the point at which the few alcoholics in the club began to fall out. They didn’t want any responsibility. In fact, it was even verbalized. ‘We don’t want to do this; we want to have a lot of fun; we want to have a club as a club.’ The alkies began to say, ‘Well, it’s our club,’ and I said, ‘No, it’s my club.’ I became the champion of the addicts, chucked the alcoholics out, and Synanon was then fully launched for addicts.”(Yablonsky, L. 1965)
The differences between 12 Step Programs and TC
This story reveals the significant differences that exist between the 12-Step programs, and Therapeutic Communities. Differences that have become blurry. They became blurry when a new kind of treatment centers emerged. These treatment centers, unlike Synanon, were based on the 12-Step philosophies of A.A., and N.A. These became known as 28 Days treatment centers. The model of treatment that was created in them became known as the Recovery Model.
The problem was, and has been since, that, in order to house, and treat alcoholics and addicts in a living situation rather than congregating in “meetings” and then going home, these centers tried to incorporate the Synanon idea of community. A community in which addicts, and alcoholics would live together. Where they would participate in groups, and form relationships. But, unlike Synanon, they would be exposed to the philosophy, and the way of life of the 12-Step Programs. During their stay in these centers, the addicts, and alcoholics, would be oriented, and encouraged, to continue to participate in the 12-Step Programs, beyond the treatment experience, through 12-Step meetings.
However, structurally, these two models of treatment are different. Although the Recovery Model copied the idea of community living from Synanon, these two communities were based on different principles. Synanon was a grass-root movement. The 28-Day Programs were institutions. Sometimes they were part of established Hospitals. Also, they incorporated a medical, professional, and para-professional staff, while Synanon was staffed by its members, with a stated disdain for professional interventions; here is how a Synanon leader puts it: “This is one of the problems with you professionals. You are all involved with drug addiction. You want to know how an addict uses, how much, and all that crap. Around here we are interested in helping ex-dope fiend grow up, by talking about living clean” ( pg. 9)
As shown by the previous statement, philosophically, the differences are even more contradictory. The Synanon model states that addicts suffer from a character dysfunction. That, their dependence on a drug, and the means that they have used to obtain them, have turned the addict into a “dope fiend” A being without humanity; without morality, and without a sense of responsibility. A being that has lost the ability to live, and function among others, as illustrated by the following quote from another Synanon leader: “My problem wasn’t drugs, even though drugs made me subhuman. What I needed, and still need, is to learn more about proper living.”
In the Synanon model of the active addict is a “dopefiend.” “Subhuman,” as described above. This subhuman-dopefiend needs to be broken down, so that the human being can emerge. In the Synanon model of treatment, this is done by any means: confrontation, punishment, and humiliation, if necessary.
For, according to this model, if any part of the dopefiend survives, “it” will take the person back to drug use, and its accompanying lying, stealing, cheating, etc. Deviations, not only from total abstinence, but from any rule of the community, is seen as an expression of the dopefiend, and is met with severe chastising, and consequences; by the staff, and by the entire community, with the encouragement of the staff. This philosophy is congruent with a structure of discipline, and accountability that facilitated orderly community living.
By contrast, the 12 Step Model is based on the disease concept of addiction; the concept that the addict, and the alcoholic, suffer from the disease of addiction. They are seen as suffering from an affliction that has affected them “physically, psychologically, and spiritually.” That has interfered with their ability to live, and function, normally. That has “high jacked” their brain, and its proper functioning, and this condition has caused negative behaviors that have caused suffering, to themselves, and others.
In the 12-Step model of treatment, the method is encouragement, to “keep showing up” to AA/NA meetings, and begin to “live as if” you are already sober. By practicing this consistently, and “turning over your will to a higher power, “a “miracle,” or “spiritual awakening,” will take place and the person will become sober. During this process, the community will be welcoming, and supportive, even when the person is not sober. There will be no blame, or judgment, but continued encouragement to “keep coming back.” This philosophy is congruent with a loose structure, based on voluntary participation, without coercion, and non-judgmental, unconditional support.
So, the Recovery Model is grounded in the 12-Step philosophy, but seeks to create, and maintain, communal living. By the dictates of its most basic principles, it is a “program of attraction.” Coercion, of any kind invalidates the entire treatment. The treatment must be based on non-confrontation, and unconditional support. But, how can a treatment program, based on such concepts, work with the resistant adolescents that are sent to treatment by their families, or the people mandated to treatment by the law, or the employer, or simply, the addict, and alcoholic, in an acute state of denial about their condition and of the suffering it is causing?
Can you guess the terrible answer? Yes, profess the 12-Steps, enforce the T.C. Teach the 12-Step philosophy in groups, and lectures. And, institute a system in which the “recovering dopefiends” will be dealt with in the T.C. way: punishment, consequences, and humiliation, if necessary. This is when Treatment turns into MisTreatment.
In the following weeks I will be expanding on this theme: the question of how to build a truly congruent treatment model. I would like your input, and discussion.