10/13/17

Feuding Ideologies, Part 2

© Michal Bednarek | 123rf.com

In the first paragraph of “Dying To Be Free,” you are introduced to Patrick, a smiling 25 year-old who had just completed a 30-day drug treatment center. Among his possessions was “a talisman he’d been given by the treatment facility: a hardcover fourth edition of the Alcoholics Anonymous bible known as ‘The Big Book.” It pages were full of highlights and Post-It notes. He was said to be a “natural” 12-step convert. Four days later, his father found him dead of an overdose.

As you read about Patrick’s struggles with addiction, you get a picture of how he and his parents tried to help him establish sobriety. There is a reference to his residential treatment stay as a “30-day wonder,” where he received a crash course on the tenets of the 12-steps. “Staff at the center expected addicts to reach a sort of divine moment but gave them few days and few tools to get there.” In Part 1 of this article, I addressed concerns that an underlying ideology of addiction as a strictly biomedical disease contributed to a biased, distorted picture of addiction treatment in the U.S. by the author of “Dying To Be Free.” Here we will look at how he also misrepresents the recovery philosophy and history of A.A.

There is a preponderance of religious or magical rhetoric when describing 12 Step, abstinent-based change in “Dying To Be Free.” Already we’ve noted the main text of Alcoholics Anonymous, also called Alcoholics Anonymous, was referred to as a talisman and a “bible.” Patrick was a “natural 12-step convert.” Another reference described the AA Big Book as being the size of a hymnal, with an appeal to faith made in “the rat-a-tat cadence of a door-to-door salesman.” Addicts at a certain treatment center were supposed to “reach a sort of divine moment” in treatment or recovery. Entering the drug treatment system, which is dominated by the principles of abstinence embedded in the 12-Steps, was said to require a “leap of faith.”

In a description of the Grateful Life Treatment Center in northern Kentucky, it was noted that the wall above the desk of the center’s intake supervisor had a “Jesus bumper sticker.” Why add that detail unless you are trying to capture the scene in a particularly religious way? When describing treatment facilities modeling themselves on the 12 Steps, not only were recovering addicts said to be cheap labor, they were said to provide the “evangelism” to shape the curricula of the facilities. A resident of Grateful Life was noted to be “as close to a true believer as the program produces.”

At one point, the author of “Dying To Be Free,” Jason Cherkis, said AA came out “evangelical Christian movements.” More accurately, there is a clear historical connection between a nondenominational Christian movement popular during the 1920s and 1930s called the Oxford Group and Alcoholics Anonymous. The two cofounders of A.A., Bill W. and Dr. Bob met as a result of their personal association with the Oxford Group. A.A. approved books, such as Pass It On, Doctor Bob and the Good Oldtimers and AA Comes of Age freely acknowledge the connection and give further details about it. However, a crucial distinction made by A.A. within its 12 Steps is glossed over by Cherkis and others, namely the spiritual, not religious understanding of God and recovery embodied in the Twelve Steps.

Drawn from the thought of the American psychologist, William James, this distinction between religious and spiritual experience seems to underlie the widespread sense of generic spirituality in American culture today. The Varieties of Religious Experience  (VRE) by James had a fundamental influence on Bill W., the formulation of the Twelve Steps and the spirituality based upon them. In VRE James made a distinction between institutional and personal religion. Worship, sacrifice, ritual, theology, ceremony, and ecclesiastical organization were the essentials of what he referred to as institutional religion.

Personal religion/spirituality for his [James’] purposes was defined as “the feelings, acts, and experiences of [the] individual . . . in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.” In the broadest sense possible, this spirituality consisted of the belief that there was an unseen order to existence, and supreme good lay in harmoniously adjusting to that order.

Whether their disregard of the spiritual, not religious distinction is intentional or not, Cherkis and others give an incomplete and biased picture of Twelve Step recovery when they fail to note it. The very heart of Twelve Step spirituality is the permissibility of the individual to formulate a personal understanding of their “god.” So what unites members of Twelve Step groups like A.A. is the diversity of religious and spiritual belief permitted—even to accepting a lack of belief. I’ve written several other articles on the similarities and differences between the spirituality of the Twelve Steps and religious spirituality on this website. There are three particular articles that discuss the influences on the spiritual, not religious distinction of Twelve Step recovery: “What Does Religious Mean?”, “Spiritual Not Religious Experience” and “The God of the Preachers.”

Another example of how “Dying To Be Free” misrepresents the recovery philosophy of A.A. is the following. While introducing a discussion of Charles Dederich and the origins of Synanon, Cherkis said Dederich and others took a “hardline” message” from some of Bill W.’s written philosophy. Cherkis wrote: “Those who can’t stick with the program are ‘constitutionally incapable of being honest with themselves,’ reads the Big Book. ‘They seem to have been born that way.’” The two selective quotes were from the first paragraph of chapter five, “How It Works,” in Alcoholics Anonymous. Notice how the context of the complete paragraph changes your understanding of what Bill W. said in his “philosophy”:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average.

As Cherkis began to discuss the history of the expansion of drug treatment facilities in the 1960s, he quoted Nancy Campbell, a professor at Rensselaer Polytechnic Institute, as saying: “The history of 12-step came out of white, middle-class, Protestant people who want to be respectable.” She added that it offered community and belonging that was predicated on being normal, respectable and having a stake in mainstream society.  Campbell may be a historian, but she seems to have a distorted view of the early history of 12 Step recovery in A.A.

From the sociological perspective of labeling theory A.A. and other organizations based on their 12 Steps, like N.A. (Narcotics Anonymous), can at least partially be seen as social movements that seek to combat negative images associated with socially deviant drinking or drugging behavior, “in effect denying that their actions make them deviants.” This applies the idea of tertiary deviance, first described by John Kituse in: “Coming Out All Over: Deviants and the Politics of Social Problems.” Kituse noted that some people stigmatized as deviant (here as alcoholics) “rebel against their labels and attempt to reaffirm their self-worth and lost social status.” The above quote and reference to Kituse is found in a standard social science textbook by Clinard and Meier, Sociology of Deviant Behavior.  So part of Campbell’s assessment of 12 Step groups as social movements seeking to offer community and belonging, with a “stake in mainstream society” is accurate. However, the quote attributed to her glosses over the early history of A.A., which was the beginning of the 12 Step movement.

A.A. celebrates the anniversary of its founding on June 10, 1935. That was in the midst of the Depression. Bill W. and his wife Lois were living then in a house owned by her father on Clinton Street in New York City. In September of 1936, Lois’s father died and the house was taken over by the mortgage company, which allowed them to stay on for a small rental. In the midst of the Depression, they didn’t want the house to be empty. While struggling with “their acute poverty,” Bill was almost persuaded to accept a position as a paid alcoholism therapist at Towns Hospital, where he himself had been treated several times. He eventually declined the offer.

Almost two and a half years after the founding of A.A., Bill W. was jobless and Dr. Bob was in danger of losing his house. In 1938, through the charity of John D. Rockefeller Jr., $5,000 was approved for a fund that would pay off Dr. Bob’s mortgage and allow a weekly draw of $30 for each of them. Rockefeller told one of his associates afterwards: “But please don’t ever ask me for any more.” In 1939, as the Depression eased, the mortgage company was able to sell the Clinton Street house and Bill and Lois became homeless. They lived “as vagabonds,” as various places for two years. Bill W. and Lois eventually led a respectable, middle class lifestyle, but that wasn’t what it was like for them in the beginning of A.A.

This history is found in Pass It On, published by Alcoholics Anonymous World Services, Inc. In the early days of A.A., Bill W. repeatedly turned down offers to professionalize his work with A.A. This doesn’t entirely sound like a movement trying to gain white, middle class respectability. The Traditions of A.A., formally adopted in July of 1950, articulated this philosophy of non-professionalism and a focus on helping other alcoholics in the fifth, sixth and eighth Traditions.

Tradition Five Reads: “Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.” Tradition Six reads: “An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” Tradition Eight reads: “Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.”

Alternative addiction treatment ideologies regularly attack A.A. as “religious,” ignoring or rejecting the spiritual-religious distinction A.A. made within the Twelve Steps from the very beginning. The abstinent-based recovery philosophy embedded in the Twelve Steps seems to be the primary target of these critiques. I see the same tendency in “Dying To Be Free.” The first part of this article addressed the biased portrayal of abstinent-based addiction treatment by Jason Cherkis in “Dying To Be Free.” The third and final part will address how it skimmed over the problems with MAT, specifically Suboxone.

10/3/17

Feuding Ideologies, Part 1

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In August of 2017, the now former Health and Human Services Secretary, Tom Price, said he didn’t think it was necessary to declare the opioid epidemic to be a national emergency. This was despite the president’s own opioid commission recommending it as the “first and most urgent recommendation.” Two days later, the President reversed Price’s statement, saying: “The opioid crisis is an emergency, and I’m saying officially right now it is an emergency.” The response was mixed. While President Trump’s announcement could be used to help free up federal resources and help to prioritize responses to the disaster, it could also permit the administration to push for new sentencing legislation in order to get “tough on crime” related to drug use.

What isn’t disputed is that the U.S. does have a serious opioid problem and something needs to be done about it. Drug overdose is the leading cause of death in Americans under the age of fifty. Forecasts by STAT News are the annual death rate will increase by at least 35 percent by 2027. The CDC reported that from 2002 to 2015 there was a 5.9-fold increase in the overdose deaths from heroin and non-methadone synthetic opioids.

The latest statistics for the U.S. opioid epidemic is now available in the 2016 National Survey on Drug Use and Health (NSDUH). Among the myriad of statistics reported there was news that heroin users increased 230% from 2002 to 2016, while heroin deaths increased 630%. An estimated 948,000 people aged 12 or over reported they used heroin in the past year. That translates to .4% of the country’s population. There were also an estimated 11.5 million people who misused pain relievers in the past year, 4.3% of the population aged 12 or over. Combined, there are 11.8 million people who misused opioids, 4.4% of the population, in 2016.

The 2016 NSDUH Report can be accessed here. A shorter, graphic-based report of key findings, including those noted above, is here.

One of the treatment approaches often touted to address the opioid crisis is medication-assisted treatment (MAT) with Suboxone. In January of 2015, Jason Cherkis wrote “Dying To Be Free.” His subtitle asked why we weren’t using a treatment for heroin addiction—Suboxone—that actually worked. The opioid problem in Kentucky was the focus of his article, which I found to be rhetorically persuasive and well written. You are introduced to individual after individual who wouldn’t or couldn’t use Suboxone and ended up dead from an eventual overdose.

“Dying To Be Free” was a finalist for a Pulitzer in 2016 for its “deeply researched reporting on opioid addiction” that showed how many drug overdoes deaths could have been prevented. The cover letter submitted for its entry for the Pulitzer by The Huffington Post said it triggered a series of state and federal policy changes that rejected abstinence for opioid misuse and embraced medication-assisted treatment. “‘Dying To Be Free’ offered readers an immersive experience that included audio and video documentaries and photo and data displays.”

This was not fake news. “Dying to Be Free” captured the agony of individuals and families who struggle with opioid misuse. But it also made abstinence-based approaches to treatment and recovery a bogeyman responsible for many of the unnecessary deaths from opioid overdoses. The rhetoric of the article was a straw man attack on abstinent-based treatment while it extolled MAT. Its biomedical treatment bias seemed to dismiss or ignore many of the problems with Suboxone as a MAT for opioid addiction. Nor did it tell the whole story behind Suboxone. It also misrepresented the recovery philosophy of self-help groups like Alcoholics Anonymous. Here’s what I mean.

In the last paragraph of his second chapter, Cherkis said: “There’s no single explanation for why addiction treatment is mired in a kind of scientific dark age, why addicts are denied the help that modern medicine can offer.” This succinctly captures the problem as he sees it with existing treatment approaches to the opioid crisis. Heroin addiction is a medical disease and should be treated as a medical disease. Modern medicine has a scientific treatment for heroin addiction that is resisted because of stigma, a deep-rooted adherence to self-help, and the criminalization of heroin addiction. If you question or oppose MAT, you are apparently mired in a kind of scientific dark age.

To enter the drug treatment system, such as it is, requires a leap of faith. The system operates largely unmoved by the findings of medical science. Peer-reviewed data and evidence-based practices do not govern how rehabilitation facilities work. There are very few reassuring medical degrees adorning their walls.

Dr. Mary Kreeft, one of the pioneers of methadone maintenance, was liberally quoted to support the medical model of addiction. She noted how opioid addiction alters multiple regions in the brain, including those that regulate reward, memory, learning, stress, hormonal response and stress sensitivity. According to Dr. Kreeft, after a long cycle of opiate addiction, a person needs specific medical treatment. Some people may be OK in time. But “the brain changes, and it doesn’t recover when you just stop the drug because the brain has been actually changed.”

An abstinence-only treatment that may have a higher success rate for alcoholics simply fails opiate addicts. “It’s time for everyone to wake up and accept that abstinence-based treatment only works in under 10 percent of opiate addicts,” Kreek said. “All proper prospective studies have shown that more than 90 percent of opiate addicts in abstinence-based treatment return to opiate abuse within one year.” In her ideal world, doctors would consult with patients and monitor progress to determine whether Suboxone, methadone or some other medical approach stood the best chance of success.

This is a rigid, strict medical model of opioid addiction. And it gives a mixed message regarding whether or not the individual will ever be able to stop taking Suboxone or methadone. Neither drug, said Cherkis, is a miracle cure. But they buy addicts time to fix their lives, seek counseling and allow their brains to heal. So far, so good. But here comes the caution: Doctors recommend tapering off the medication cautiously. The process could take years, as addiction is a chronic disease and effective therapy takes time. Then comes the typical analogy of the pure medical model of addiction:

Doctors and researchers often compare addiction from a medical perspective to diabetes. The medication that addicts are prescribed is comparable to the insulin a diabetic needs to live.

There is no mention of neuroplasticity—the brain’s ability to reorganize itself by forming new neural connections. “Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.”

Jeffrey Schwartz and Rebecca Gladding use an almost identical description of neurological action to that given above by Dr. Kreeft to describe how to change the brain; to modify bad habits (including addiction) and unhealthy thinking. In You Are Not Your Brain, they describe how we teach our brains to act in unhealthy ways. The brain does not distinguish between beneficial and destructive habits, “it just responds to how you behave and then generates strong impulses, thoughts, desires, cravings, and urges that compel you to perpetuate your habit, whatever it may be.”

Clearly, the brain can exert a powerful grip on one’s life—but only if you let it. The good news is that you can overcome the brain’s control and rewire your brain to work for you by learning to debunk the myths it has been so successfully selling you and by choosing to act in healthy, adaptive ways.

Neuroplasticity, as described by Schwartz and Gladding, does not reject Kreeft’s neurological description of addiction.  But it does say it isn’t the whole story. An ideology of addiction as a purely biomedical condition seems to permeate “Dying To Be Free.” Addiction, when conceived strictly as a brain disease, rejects or ignores the non-scientific construct of mind. If we are conceived as only biological beings, then addiction is explained and treated within a biomedical worldview. Any treatment approach to addiction not based on this premise is therefore faulty.

Drug treatment facilities were said in “Dying To Be Free” to “generally” fail to distinguish between addictions. They have a one-size-fits-all approach.  Addicts in residential treatment experience a “hodgepodge” of drill-instructor tough love and self-help lectures. Programs appear simultaneously excessively rigid and wildly disorganized. “And with roughly 90 percent of facilities grounded in the principle of abstinence, that means heroin addicts are systematically denied access to Suboxone and other synthetic opioids.”

After describing two older, drug treatment programs with a therapeutic community model of care that used coercive techniques—Synanon and Daytop (Drug Addicts Yield TO Persuasion)— he said:

The number of drug treatment facilities boomed with federal funding and the steady expansion of private insurance coverage for addiction, going from a mere handful in the 1950s to thousands a few decades later. The new facilities modeled themselves after the ones that had long been treating alcoholics, which were generally based on the 12-step methodology. Recovering addicts provided the cheap labor to staff them and the evangelism to shape curricula. Residential drug treatment co-opted the language of Alcoholics Anonymous, using the Big Book not as a spiritual guide but as a mandatory text — contradicting AA’s voluntary essence. AA’s meetings, with their folding chairs and donated coffee, were intended as a judgment-free space for addicts to talk about their problems. Treatment facilities were designed for discipline.

In support of this claim, Cherkis referred to a 2012 study conducted by the National Center on Addiction and Substance Abuse at Columbia University. It apparently was a reference to “Addiction Medicine: Closing the Gap between Science and Practice.” He said the study concluded the U.S. treatment system was in need of a “significant overhaul” and questioned whether the low levels of care received by addiction patients constituted a from of medical malpractice.

While medical schools in the U.S. mostly ignore addictive diseases, the majority of front-line treatment workers, the study found, are low-skilled and poorly trained, incapable of providing the bare minimum of medical care. These same workers also tend to be opposed to overhauling the system. As the study pointed out, they remain loyal to “intervention techniques that employ confrontation and coercion — techniques that contradict evidence-based practice.” Those with “a strong 12-step orientation” tended to hold research-supported approaches in low regard.

The Columbia University study did state a significant overhaul was needed in current treatment approaches; and it raised the question if the insufficient care received by addiction patients constituted “a form of medical malpractice.” It also pointed to the need for medical schools to “educate and train physicians to address risky substance use and addiction.” Unsurprisingly, it went on to say that all aspects of stabilization and treatment with addictions should be managed by a physician “as is the case with other medical diseases.” Remember that the Columbia study and Cherkis were both advocating for a physician-centered, medical model approach to addiction treatment.

However, I couldn’t find where it was supposed to have said the majority of front-line treatment workers were low-skilled and poorly trained. There was a section stating that physicians and other health professionals should be on the front line addressing addiction. Then it said: “Paraprofessionals and non-clinically trained and credentialed counselors can provide auxiliary services as part of a comprehensive treatment and disease management plan.”

It did not say the majority of front-line treatment workers were low-skilled and poorly trained “incapable of providing the bare minimum of medical care.” Yet in the case study examples found in “Dying To Be Free,” that is what Cherkis presented. The Columbia study did cite another study, which found that recovering support staff had little enthusiasm for evidence-based practices. “They also were more likely to support intervention techniques that employ confrontation and coercion–techniques that contradict evidence-based practices.” But these paraprofessionals only made up “24 percent of the treatment provider workforce.”

Cherkis seems to have mis-remembered what the Columbia study actually claimed in this matter. I wonder if, because of his commitment to a strictly medical model ideology for opiate treatment, he was reading into the study. His quote above supported the description of the treatment facilities he highlighted in his article, but wasn’t found by me in the article he cited on the Columbia study.

Another example of how his treatment ideology distorted his portrayal of Suboxone treatment was with how he described Hazelden’s Suboxone treatment program. “Dying To Be Free” mentioned that Hazelden, now the Hazelden Betty Ford Foundation, developed its own Suboxone treatment program for opioid addicts. But it failed to note this wasn’t accompanied by a rejection of “Twelve Step practices.” Within “The History of Hazelden,” on the Hazelden Betty Ford Foundation website, was the statement of how it “integrates the cornerstone Twelve Step practices of mutual support along with multidisciplinary clinical care, evidence-based therapies and the latest research in brain science.” Why weren’t there some case study examples from Hazelden in “Dying To Be Free”?

The facilities Cherkis highlighted in Kentucky were not representative of abstinent-based addiction treatment centers in the U.S.; ones that use the 12 Steps to structure their treatment program. In reading “Dying To Be Free” I see an underlying ideology of conceiving and treating addiction, specifically opiate addiction, through a strict biomedical lens. That is not the whole story of addiction. As a result, the rhetoric of the article constituted a straw man attack on abstinent-based treatment while it extolled MAT. This bias presents readers with an implied choice, a dichotomy, between Suboxone as an MAT for addiction and 12 Step, abstinent-based treatment. Ironically, Hazelden, an historically important treatment center that pioneered 12 Step, abstinence-based treatment, did not choose MAT over the 12 Step-based treatment, but combined the two. But you don’t get that information in “Dying To Be Free.”

Parts 2 and 3 of this article will look at how “Dying To Be Free” misrepresented the recovery philosophy of self-help groups like Alcoholics Anonymous; and skimmed over the problems with MAT, specifically Suboxone.

07/7/17

More Equal Therapies than Others, Part 2

© Allan Swart | 123rf.com

In his introduction to ”The Doctor’s Opinion” in the A.A. Big Book, Bill W. said A.A. favored initial hospitalization for the alcoholic who was “jittery or befogged.” It was imperative that the person’s brain was cleared so he then had a better chance “of understanding and accepting what we had to offer.” The reason to include Dr. Silkworth’s endorsement in Alcoholics Anonymous was to document a “medical estimate” of the A.A .12-Step plan of recovery.  “Convincing testimony must surely come from medical men who have had experience with the sufferings of our members and have witnessed our return to health.” But that was almost eighty years ago; and there have been some radical changes in the receptiveness of 12-Step recovery.

In modern addiction treatment there are a growing number of voices saying A.A.’s 12-Step approach should either be taken out of the treatment game or sidelined as a “recovery support service” (RSS) instead of being an integral part of the addiction treatment process. However, it would restrict or bench a valuable asset to addiction recovery. The rationales given for this generally follows two lines of argument.

One way is to portray A.A. and other 12-Step groups as religious or cultish in nature. This distortion stems from the secularization of American culture since the late 1930s when A.A. began, as well the failure to make a distinction between spiritual and religious consistent with 12-Step philosophy. See “Spiritual not Religious Experience” for a discussion of this distinction and a response to the accusation that the spiritual nature of A.A. disqualifies it from being used within addiction treatment. The second route is to suggest the 12-Step approach does not fit with the modern medical model of addiction treatment.

In the first ten years of A.A.’s existence the fellowship became convinced that organizationally it had to permanently remain nonprofessional. This was eventually formalized in Tradition Eight. Concurrent with that realization, was the origin of what would be called the Minnesota Model of addiction treatment. The Hazelden Foundation (now the Hazelden Betty Ford Foundation) blended professional and trained nonprofessional staff within a treatment approach based on the 12-Step philosophy of A.A. Throughout the 1950s, Hazelden honed it treatment model on three working principles.

First, alcoholism was seen as a primary condition and not just a symptom of an underlying disorder. Second, alcoholism was a disease and should be treated as such. The American Medical Association (AMA) officially identified alcoholism as a disease in 1956. Third, following the A.A. idea of the alcoholic suffering physically, mentally and spiritually, alcoholism was said to be a multiphasic illness. “Therefore treatment for alcoholism will be more effective when it takes all three aspects into account.” Abstinence was an integral goal of treatment.

These principles set the stage for a model that expanded greatly during the 1960s—one that has been emulated worldwide and has merged the talents of people in many disciplines: addiction counselors, physicians, psychologists, social workers, clergy, and other therapists. These people found themselves working on teams, often for the first time. And what united them was the notion of treating the whole person—body, mind and spirit.

Cracks began to appear in the dominance of the Minnesota Model of addiction treatment even as its hegemony grew in the 1960s. Methadone maintenance as a treatment for heroin addiction arose in the early 1960s. In the 1980s, the biological model of psychiatry began its ascendency and in 1991 the AMA took the further step of endorsing a dual classification of alcoholism as both a psychiatric and a medical disease. In 1992 SMART Recovery began. “SMART Recovery is based on scientific knowledge, and is intended to evolve as scientific knowledge evolve.” In 1994 Moderation Management became a self-help group for individuals who wanted to moderate, not abstain from alcohol.

Addiction professionals developed diverse alternatives to addiction treatment centered on 12-step philosophy. Stanton Peele developed Life Process Program as an alternative to 12-Step treatment, which he now offers as an online program. Marc Lewis wrote The Biology of Desire, refuting the medical view of addiction as a brain disease. He conceived it as an extreme form of learning.

Lance Dodes wrote The Sober Truth, purportedly debunking the bad science behind 12-Step programs and the Rehab industry. It claimed to be an expose of Alcoholics Anonymous, Twelve Step programs and the rehab industry—how “a failed addiction-treatment model” came to dominate America.

David Sinclair developed the Sinclair Method, which conceived of alcoholism as a learned behavior, one that can be removed by the behavior modification principle of extinction. “The solution discovered by Sinclair effectively means you have to drink yourself sober!” And there are others. But the medical model, although it has been modified, remains supreme in addiction treatment.

In the 1990s, a movement began in medicine to develop evidence-based practices (EBP). A widely accepted definition of EBP by Dr. David Sackett is that EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”  When applied to addiction treatment, the principle is generally referred to as evidence-based treatment (EBT). The National Institute on Drug Abuse (NIDA) simply referred to EBTs as treatment approaches “that have an evidence base supporting their use.” The website GoodTherapy.org elaborated, saying that EBT was “treatment that is backed by scientific evidence.” This referred to extensive research, which has been documented and demonstrated to be effective on a particular treatment.

Consistent with this understanding, NIDA listed a manualized Twelve Step based treatment model called Twelve Step Facilitation (TSF) as an evidence-based behavioral therapy. TSF actively seeks to engage substance abusers in becoming involved in 12-Step groups, “thereby promoting abstinence.” However, a writer and researcher for Handshake Media, Laurel Sindewald, concluded in her article, “AA Is not Evidence-Based Treatment,” that NIDA wrongly listed TSF as evidence-based.

In Part 1 of this article, “More Equal Therapies than Others,” is a description of TSF and a discussion of how Sindewald’s critique wrongly and inconsistently grouped A.A. and other 12-Step groups with treatment approaches like the Minnesota Model and TSF that use 12-Step philosophy. Her provocative title is the result of mistakenly grouping A.A. and treatment approaches based on 12-Step philosophy together; and then illegitimately transferring her critique of these 12-step treatment approaches to A.A. A.A. sees itself as a fellowship and not a treatment. Here we will briefly look at how Sindewald’s narrowing of the NIDA sense of “evidence-based treatment” allowed her to conclude TSF was not evidence-based.

As was described in Part 1, Sindewald gave a biased description of 12-Step philosophy, stating it viewed addiction as merely “a spiritual disease born of defects of character.” Twelve Step groups supposedly said they were the only cure, “involving faith in a higher power, prayer, confession, and admission of powerlessness.” Contrasted with the NIDA definition of addiction as a disease of the brain, she asked how TSF as a professional medical treatment could be based on an understanding of addiction as a spiritual disease. Note the rhetorical sleight-of-hand in how she conveniently left out the A.A. and 12-Step understanding of addiction as a physical, mental and spiritual illness/disease.

Another place Sindewald used the same tactic was where she defined evidence-based. “In this article, I define ‘evidence-based’ to mean any treatment supported by numerous scientific experiments with rigorous methods that include control groups, randomization of patients to treatments, and bias-free samples. Note how her sense of “evidence-based” is more restrictive than NIDA, GoodTherapy.org and even Sackett’s widely acknowledged sense of evidence-based practice for medicine.  Her criteria seem to be even more restrictive than the American Psychological Association’s criteria for well-established “empirically validated treatment” in the “APA Task Force on Promotion and Dissemination of Psychological Procedures” Refer to Table 1 for the criteria.

Gianluca Castelnuovo wrote an article for Frontiers in Psychology on “Empirically Supported Treatments in Psychotherapy.” Consistent with the broader NIDA sense of evidence-based, he said the term evidence does not have one single definition. “evidence-based practice (EBP) includes many forms of evidence other than data from RTCs [randomized control trials].” There are two contradictory visions of what causes change in psychotherapy. One approach emphasizes the primacy of therapist and technique. The second vision focuses of the patient-therapist relationship and what the client brings to the therapeutic relationship.

The first vision sees the specific methods used by the psychotherapist as accounting for, by far, most of the changes in therapy. “Other factors (e.g., therapist relational qualities, patient–therapist relationship) are secondary, at best. This viewpoint is seen most notably in what have been termed the EST and EBP movements.” This approach conducts tightly controlled outcome studies, where specific treatments are pitted against one another or a control group and applied to specific disorders, usually as defined in the DSM. This describes the Project MATCH study, for which TSF was developed. This first sense proceeds from a medical model of “diagnosis plus prescriptive treatment equals symptom amelioration.”

The second view of psychotherapeutic change attributes most positive therapeutic outcomes to client factors (40%) and the therapeutic relationship between client and therapist (30%). The technique used and the skill of the therapist accounts for the remaining 30% of positive therapeutic outcomes. This so-called “common factors approach” then discourages attempts to pit one therapy against another or against a placebo group of no treatment (clients placed on a waiting list) as ultimately doomed to failure, since all therapies have the same potential for positive outcomes (the dodo bird effect).

When discussing the significance of common factors in “The Legacy of Saul Rosenzweig: The Profundity of the Dodo Bird,” Barry Duncan noted how experienced therapists know psychotherapy requires the unique tailoring of a therapeutic approach to a particular client and circumstance. And if a therapist attempts to do therapy by the book, it often doesn’t go very well. There are limitations to manualized therapies, even TSF.

The structure minimizes the factors brought to therapy by the client. It restricts or eliminates the therapeutic relationship between client and therapist. And it emphasizes the factors (therapist and technique), which typically have the least positive outcome effects. If you want to determine whether a therapeutic approach is “evidence-based” or “more equal” than other therapies when treating a designated DSM disorder, you will likely use a structured, manual-based treatment.

For more information of the therapeutic power of common factors and the dodo bird effect, see the above-linked article by Barry Duncan. Also read the Wampold et al. article, “A Meta-analysis of Outcome Studies Comparing Bona Fide Psychotherapies: Empirically, ‘All Must Have Prizes’”; or “The Dodo Bird Effect” and “Another Brick in the Wall” on this website. If you are interested in exploring “the science behind 12 Step recovery,” try If You Work It, It Works! by Joseph Nowinski.

06/27/17

More Equal Therapies than Others, Part 1

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In the classic novella, Animal Farm, by George Orwell, the animals of Manor Farm revolted and drove the drunken and irresponsible farmer Mr. Jones from the farm. They renamed it “Animal Farm” and adopted the Seven Commandments of Animalism, the most important of which was the seventh: “All animals are equal.” Eventually the pigs cemented their role as the leaders of Animal Farm, and this commandment was modified to say: “All animals are equal, but some animals are more equal than others.”  Barry Duncan adroitly applied this example of double-speak in his discussion of those who apply the medical model of “diagnosis plus prescriptive treatment equals symptom amelioration” to declare that some psychotherapies were more equal than others.

Two other articles, “The Dodo Bird Effect” and “Another Brick in the Wall” explored Duncan’s argument for the power of common factors in psychotherapy and the dodo bird effect, an alternate way of understanding the process of therapeutic change from the dominant medical model of therapeutic change described above. He developed this position in: “The Legacy of Saul Rosenzweig: The Profundity of the Dodo Bird” and a book he coauthored: The Heart & Soul of Change.” Here I want to explore how the Orwellian sense that some therapies are more or less equal than others runs wild in addiction treatment.

The National Institute on Drug Abuse (NIDA) defined addiction as “a chronic, relapsing brain disease” because drugs changed the brain—its structure and how it worked. Here is a short YouTube video of the Director of NIDA, Nora Volkow, discussing this view of addiction. This definition was purely a physiological, biomedical understanding of addiction. Philosophically, it also seems Volkow assumed there is no mind; that human traits like “free will” were products of the biology of the brain. Note where she said “free will” was a product of the biology of the brain.

As in medical practice, addiction treatments are quantified according to an evidence-base of effectiveness. Here, the buzzword is “evidence-based treatment.” NIDA has a listing of  “Evidence-Based Approaches to Drug Addiction Treatment,” which it categorized as “Pharmacotherapies” and “Behavioral Therapies.” The NIDA introduction said the section “presents examples of treatment approaches and components that have an evidence base supporting their use.” One of the behavioral therapies NIDA listed as “effective in addressing substance abuse,” was “12-Step Facilitation Therapy” (TSF).

This 12-Step-based treatment approach was developed by Joseph Nowinski, a clinical psychologist as part of the Project MATCH study into the effectiveness of three different perspectives on how to treat alcohol use disorders (then described as alcohol abuse and alcohol dependence in the DSM, the psychiatric Diagnostic and Statistical Manual). In his book, If You Work It, It Works!, Nowinski said many academic researchers were highly skeptical that TSF would work at all, as A.A. and the Twelve Step approach was poorly understood. “Many academic researchers inclined to think of it more as a cult or quasi-religion than a serious programmatic approach to recovery from addiction.”

The two other interventions, Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET) had been extensively studied. But Twelve-Step interventions had not been the subject of significant, rigorous research. So Nowinski developed TSF, a psychosocial treatment manual based on engaging the individual in 12 Step support groups such as Alcoholics Anonymous (A.A.).

In 1997 published results from the MATCH Research Group showed that all three interventions (CBT, MET and TSF) were effective in reducing drinking and increasing abstinence after treatment. One year after completing treatment those who were in the outpatient section of MATCH were sober over 80% of the time. And TSF was found to be equally effective for individuals who had been diagnosed as an alcohol abuser rather than as alcohol dependent.

These findings were so unexpected that some long-standing critics of AA and its Twelve Step program went so far as to question whether the MATCH data were somehow falsified. Of course, nothing could be further from the truth. The reality, rather, was what some skeptics could not abide: the idea that the Twelve Step approach works.

Nowinski said his goal in writing If You Work It, It Works was to make information on the effectiveness of Twelve Step recovery, now documented in academic journals, available to the general public. His goal was “to stand for the Twelve Step model in the face of long-standing and unchallenged criticism and skepticism, much of which is not based in fact.” Equally important, he hoped that people on the fence about going to an A.A. meeting “will benefit from learning about the science (as opposed to the myths) of Twelve Step recovery.”

Nowinski referred to a long-standing bias against the Twelve Step approach to recovery. He said it was regularly portrayed as a quasi-religious approach, and then rejected because it is not a structured treatment approach. Therefore it lacked a clear demonstration of its scientific, evidence-based effectiveness. If an addiction treatment approach, like TSF, used the 12 Steps or actively encouraged clients to participate in 12 Step groups like Alcoholics Anonymous (A.A.) or Narcotics Anonymous (N.A.), it was often judged to be “a less equal treatment” than others. An article by Laurel Sindewald for The Fix, “AA Is not Evidence-Based Treatment,” illustrates this bias.

The author said she had previously done a literature review that found insufficient evidence to support the use of 12-step groups as treatment, so she was surprised the Surgeon General included TSF as an evidence-based behavioral treatment for addiction in Facing Addiction in America. She admitted to a personal bias, which apparently was against the spirituality of 12-step groups and what she referred to as “12-step philosophy.” It seems that since TSF encouraged participation in 12-Step self-help groups, it was suspect as a “less equal” treatment approach, because it retained “ the spiritual emphasis of 12-step philosophy.” However, she would “set aside her bias” in her assessment of TSF, in order to give it a scientific, objective assessment. But that does not seem to have been the case.

Sindewald noted where the Surgeon General’s Report classified TSF as a “professional behavioral treatment,” but then immediately asked: “How could a professional medical treatment be based on a definition of addiction as a spiritual disease?” She stated (without any supportive citation) that Twelve-Step philosophy stipulated that addiction was a spiritual disease born of defects of character; and that 12-step groups were the only cure. She later compared Twelve-Step literature to religious literature like the Bible and the Qur’an and contrasted Twelve-Step philosophy with medical science. She gave an extended quote from the A.A. “Big Book” of Alcoholics Anonymous, which she said represented Twelve-Step philosophy saying it can never be wrong. Her bias against spiritual/religious philosophy was all through her critique.

The AA pamphlet “How AA Members Cooperate with Professionals,” stated that A.A. is not in competition with anyone. “Our ability to help other alcoholics is not based on scientific or professional expertise.” Unpacking principles articulated in AA’s Twelve Traditions, the pamphlet also said: “A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes.” In his essay on Tradition Six in Twelve Steps and Twelve Traditions, Bill W. gave a brief history of early A.A.including attempts to institute A.A. hospitals and get involved in education. He noted where these activities raised confusion. “Did A.A. fix drunks or was it an educational project? Was A.A. spiritual or was it medical? Was it a reform movement?”

These adventures implanted a deep-rooted conviction that in no circumstances could we endorse any related enterprise, no matter how good. We of Alcoholics Anonymous could not be all things to all men, nor should we try.

In the same chapter of the A.A. Big Book, which Sindewald cited and linked, “How It Works,” there is a discussion of resentment being the “number one” offender, destroying more alcoholics than anything else. “From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick. When the spiritual malady is overcome, we straighten out mentally and physically.” So there is an understanding of alcoholism as a spiritual, mental and physical illness/disease.

Also in that chapter you will find the 12 Steps described as a suggested program of recovery. “The principles we have set down are guides to progress. We claim spiritual progress rather than spiritual progression.” So it seems that AA does not present itself as the only cure; nor does it describe alcoholism merely as “a spiritual disease born of defects of character.”

A clear distinction by the author between TSF, A.A., and rehab programs using the 12-Steps isn’t maintained in her critique. In her article for The Fix, she said she used “12-step approaches” to refer to all 12-step self help groups, all 12-step-based rehab programs and TSF. However, in another article she wrote previously for Handshake Media (linked as her literature review), she said: “TSF is distinct from AA and other 12-step support groups.” Yet in her conclusion for “AA Is not Evidence-Based Treatment” Sindewald said “after exhaustive research” she could assert with confidence that 12-step approaches—including TSF—were not evidence-based treatments. She called for the reallocation of funds away from these approaches to those “that can be studied rigorously and without such crippling methodological limitations.”

With regard to A.A .and other 12 Step groups, she was right when she said they were not treatment approaches to addiction recovery. A.A. is not developed as a treatment approach and doesn’t claim to be a treatment approach. The A.A. website said: “Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem.” It is also self consciously nonprofessional, stating in Tradition Eight, “Alcoholics Anonymous should remain nonprofessional.” As fellowship organizations, A.A. and other 12-Step self-help groups are not structured in ways that can be easily studied by researchers who want to assess their effectiveness within a structured medical model of therapeutic change.

But Twelve Step Facilitation is considered to be a treatment approach. According to the NIDA description of “12-Step Facilitation Therapy,” TSF is a manual-based, structured treatment approach. It is “designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence.” And TSF is listed by NIDA as an evidence-based treatment approach, the same organization, by the way, that Sindewald referenced as defining addiction as a brain disease. Apparently NIDA doesn’t agree with her that TSF is not an evidence-based treatment approach.

It seems Sindewald’s failure to acknowledge the difference of A.A. and other 12-Step groups from the various addiction treatment approaches that apply “Twelve-Step philosophy” was intentional. It sets up a straw man argument that illegitimately transfers a critique of the TSF treatment approach onto 12-Step groups. It also seems that Sindewald’s claim to have set aside her bias while she examined Twelve Step treatment philosophy and TSF was not true.

04/11/17

Love Your Enemies

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Some people mistakenly think that the proverbial saying, “God helps those who help themselves” is some where in the Bible. Well it’s not. Actually, it came from one of Aesop’s fables, Hercules and the Waggoneer. A waggoneer driving a heavily loaded wagon became stuck in a muddy road. The more the horses pulled, the deeper the wheels sank in the mud. So he prayed to Hercules for help, who then replied that the wagoneer should get up off his knees and put his shoulder to the wheel. The moral of the fable was: “The gods help them that help themselves.”

In a similar way, Jesus corrected in Matthew 5:43-48 what had become a misapplication of the commandment to love your neighbor in Leviticus 19:18. In preceding passages of the Sermon on the Mount, Jesus introduced teachings from Scripture with the phrase that begins 5:43: “You have heard it said” (Matthew 5:21, 5:27, 5:33, 5:38). But here “what was said” was not from Scripture. Instead of the command to Love your neighbor as yourself,” it seems that what was being taught was “Love your neighbor and hate your enemy.” Nowhere in the Old Testament does it say, “Hate your enemy.”

There were passages that called for the destruction of Israel’s enemies (Deuteronomy 7:2) or counseled to keep your distance from non-Israelites (Exodus 34:12). Yet you were to feed your enemy (Proverbs 25:21-22) and help them when they were in need (Exodus 23:4-5). The Old Testament teaching on how you were to treat your enemies was complex, according to Leon Morris. In his commentary on Matthew, he said:

All this means that those who summed up Old Testament teaching as calling for love for neighbors and hatred for enemies were oversimplifying. The call for hatred is certainly the kind of addition to the command that many have put into practice.

Again, instead of lowering the bar to the common social standard he quoted in 5:43, Jesus said his followers were to love their enemies and pray for them!

You have heard that it was said, “You shall love your neighbor and hate your enemy.” But I say to you, Love your enemies and pray for those who persecute you, so that you may be sons of your Father who is in heaven. For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust. For if you love those who love you, what reward do you have? Do not even the tax collectors do the same? And if you greet only your brothers, what more are you doing than others? Do not even the Gentiles do the same? You therefore must be perfect, as your heavenly Father is perfect. (Matthew 5:43-48)

Jesus named two groups who were widely seen as enemies by the ordinary Jew—tax collectors and Gentiles (non-Jews). Don’t they take care of their own; don’t they love one another? So if you love only those who love you; if you only greet others like you (your brothers), how are you different from the tax collectors and the Gentiles?

While tax collectors are never popular in any culture (think of the Internal Revenue Service in the U.S.), in first-century Palestine they were particularly unpopular. Not only would they collect taxes for the Romans, they would also be sure to get some extra for themselves. Leon Morris commented, “In the eyes of Jesus’ audience there were no more wicked people than tax collectors as a class.” That’s the point of the encounter Jesus had with Zacchaeus, who was a tax collector (Luke 19:1-10).  They were the last ones you would expect to show love to others. The implied question is shouldn’t your love for others be greater?

The verse about greeting your brother is deeper in meaning than most people realize. When first-century Jews greeted one another, they would say “Peace,” which was in fact like saying a prayer; something like this: “May the peace of the Lord be upon you.” In our culture we say “good-bye” without remembering we are actually saying a shortened form of: “God by with you.” So making a sincere greeting meant you expressed goodwill and welcome to your brother. Shouldn’t your wishes and greetings to others be more sincere than the Gentiles?

The final command in verse 48, “to be perfect, as your heavenly Father is perfect” seems to set an unreachable standard—be as perfect as God the Father.  But that’s not what it means. The sense of the Greek word for “perfect” here pertains to you being fully developed in a moral sense. Look, your Father in heaven lets the sun rise and the rain fall upon both the evil and the good; the just and the unjust. Shouldn’t you do the same? The command to love your neighbor as yourself includes loving your enemies.  Isn’t that the same message as in the parable of the Good Samaritan?

There is an interesting grammatical structure in verse 5:45b called a chiasm, named after the Greek letter chi, which looks like an “X.” The verse reads: “For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust.” The crossing/chiasm is between the “evil” and “unjust” as well as the “good” and the “just.” The crossing pattern is accomplished by taking the first pair of contrasting words, evil and good, and then reversing the position in the second pair of contrasting words: just and unjust. So the chiasm looks like this:

The chiastic structure helps to reinforce the point of the passage. It gives a visual warning to the followers of Jesus: they are not to follow the contrasting advice of loving their neighbor and hating their enemy. Rather, just as their heavenly Father sends sun upon the evil and the good, and rain upon both the just and the unjust, they are to love and not hate their enemies. This action of God’s is known as the principle of common grace, where the good things of the world like sun and rain fall equally upon the evil and the good; the just and the unjust. God does not withhold the gifts of rain and sunshine from people who are evil or unjust. So followers of Christ should withhold love from their enemies.

In an active addiction, addicts and alcoholics make a lot of enemies. The hostility in these relationships can be either a one-way or a two-way street. You resent one another in mutual hostility. But you resent what someone did—or they resent what you did—in one-way hostility. The remedy for this in recovery is stated in Matthew 5:44: love and pray for your enemies. In order to do so, you have to let go of your resentment.

When discussing the Fourth Step in the “How It Works” chapter of Alcoholics Anonymous, Bill W. said: “Resentment is the ‘number one’ offender It destroys more alcoholics than anything else.” It leads to various forms of spiritual disease—“a life which includes deep resentment leads only to futility and unhappiness.” If the alcoholic is to live, they have to be free of anger. Realize that the people who wronged you were perhaps spiritually sick as well. “We asked God to help us show them the same tolerance, pity, and patience that we would cheerfully grant a sick friend.”

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

03/10/17

Let Your Yes Be Yes

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While some oath-breaking leads to serious consequences, oaths just don’t seem to have the same significance in the modern person’s life as they did in biblical times. Most people know oaths occur in legal proceedings, where witnesses swear to tell the truth before giving testimony. Willfully give false testimony in this context is considered to be the crime of perjury. But outside of this sphere, taking an oath in modern times is largely reserved for times of ritual or ceremony.

In American culture, we see a newly appointed or elected government official swear an oath before taking office. Immigrants take an oath of citizenship when they become naturalized citizens of a country. When reciting the American Pledge of Allegiance, citizens pledge or swear loyalty to their country. Doctors and medical personnel take the Hippocratic oath, swearing to practice medicine honestly. So how are we to apply what Jesus says about oaths in the Sermon on the Mount?

Again you have heard that it was said to those of old, “You shall not swear falsely, but shall perform to the Lord what you have sworn.” But I say to you, Do not take an oath at all, either by heaven, for it is the throne of God, or by the earth, for it is his footstool, or by Jerusalem, for it is the city of the great King. And do not take an oath by your head, for you cannot make one hair white or black. Let what you say be simply “Yes” or “No”; anything more than this comes from evil. (Matthew 5:33-37)

In his commentary on the gospel of Matthew, Leon Morris noted this passage was peculiar to Matthew, who returned to the theme when He confronted the scribes and Pharisees in Matthew 23:16-22. “Clearly he [Jesus] was interested in the fact that people seemed very ready to swear oaths.” Oaths played a significant role in the life and culture of the Jews. The Mishnah, the first written record of the oral law, contains a complete treatise on oaths. In biblical and ancient times, oaths bound the person to his or her word.

According to the Lexham Bible Dictionary, oaths imposed a great sense of obligation on the individual; and breaking an oath was unthinkable. They were used to confirm the truthfulness of a person’s word, bind individuals in a contract, or confirm God’s intent to act according to His word. “Even rash oaths were binding and required confession of sin and sacrificial compensation if broken” (Leviticus 5:4-6). Yahweh served as the guarantor of a person’s oath, and here it had its greatest power. Breaking an oath was tantamount to breaking faith with Yahweh. Doing so took His name in vain (Exodus 20:7; Leviticus 19:12).

In this section of the Sermon on the Mount, Jesus was addressing how a series of quotations from Scripture should be understood. In Matthew 5:33, the Old Testament command to not break an oath (Leviticus 19:12; Numbers 30:2, etc) was paraphrased by Jesus. Then He said his followers should not swear an oath at all! However, sometimes it was necessary—Jesus himself responded when the high priest put him on oath (Matthew 26:63-64). So Jesus is not forbidding Christians from taking an oath, as some individuals apply the restriction today.

Rather, he is saying in the strongest terms possible that his followers must speak the truth. They should never adopt the sense that only when an oath is sworn do they need to be truthful.

The Jews held that unless the name of God was specifically mentioned the oath was not binding; there were lengthy discussions about when an oath is or is not binding, and people would sometimes swear by heaven or earth or a similar oath and later claim that they were not bound by that oath because God was not mentioned. Jesus rejects such casuistry.

This was why Jesus mentioned the forms of oaths used to sidestep telling the truth in Matthew 5:33-37. Remember the Mishnah had an entire treatise on oaths. Heaven, earth, Jerusalem, your head, were all somehow linked to God. You cannot escape the requirement to tell the truth by using these hair-splitting differences.  Keep your pledges without insisting that a certain form of words was necessary to make it binding.  Essentially Jesus is saying: “No oath is necessary for a truthful person.”

The conclusion of the matter is that it is never necessary for Christ’s people to swear an oath before they utter the truth. Their word should always be so reliable that nothing more than a statement is needed from them. God is in all of life, and every statement is made before him.

The importance of honesty in 12 Step Recovery is well known. Self-honesty begins with recognizing whether or not you are an alcoholic. In chapter 3, “More About Alcoholism,” it says A.A. doesn’t like to pronounce anyone as alcoholic. The suggestion is to try some controlled drinking—more than once. “It will not take long for you to decide, if you are honest with yourself about it.”

The manner of life demanded of the person who admits being an alcoholic is even qualified further as rigorous honesty.  In discussing what to do after making a personal inventory (the Fourth Step) in chapter 6, “Into Action,” of the Big Book it says: “We must be entirely honest with somebody if we expect to live long and happily in this world.”

As Bill Sees It, a collection of thoughts by Bill W. on the A.A. way of life, cites a 1966 letter he wrote. Bill said that only God can fully know what absolute honesty is. The best we can do is to strive for a better quality of honesty. Sometimes we have to place love ahead of indiscriminate ‘factual honesty.’ In the name of ‘perfect honesty’ we can cruelly and unnecessarily hurt others. “Always one must ask, ‘What is the best and most loving thing I can do?’”

In an August 1961 article for the AA Grapevine,  “This Matter of Honesty,” Bill W. observed how the problem of honesty touched nearly every aspect of our lives. While his intended audience was other A.A. members, I think what he said applies to everyone. After commenting on the extremes of self-deception and reckless truth-telling, he noted there were countless situations in life where nothing less than utter honest will do, “no matter how sorely we may be tempted by the fear and pride that would reduce us to half-truths or inexcusable denials.” He concluded the article with:

How truth makes us free is something that we AAs can well understand. It cut the shackles that once bound us to alcohol. It continues to release us from conflicts and miseries beyond reckoning; it banishes fear and isolation. The unity of our Fellowship, the love we cherish for each other, the esteem in which the world holds us–all of these are products of such integrity, as under God, we have been privileged to achieve. May we therefore quicken our search for still more genuine honor, and deepen its practice in all our affairs.

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

02/17/17

The Adultery of Addiction

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In 1948, at the First International Convention of Alcoholics Anonymous, Dr. Bob gave his last major talk.  He related for those in attendance his recollections of the beginnings of A.A. He recalled that in the early days they were groping in the dark. The Steps and the Traditions didn’t exist; the A.A. Big Book hadn’t been written yet. But they were convinced the answer to their problems was in the Good Book. And one of the absolutely essential parts of the Bible for them, according to Dr. Bob, was the Sermon on the Mount. But there are two verses in there whose application to 12 Step recovery may seem to be a bit strained.

Matthew 5:31-32, which expresses Jesus’ thoughts on divorce, follows right after he addressed how his followers should understand and apply biblical teaching on adultery and lust. As is typical of his teachings in other areas of the Sermon on the Mount, Jesus turns the Jews understanding of what the Law said about divorce upside down. The passage says:

“It was also said, ‘Whoever divorces his wife, let him give her a certificate of divorce.’ But I say to you that everyone who divorces his wife, except on the ground of sexual immorality, makes her commit adultery, and whoever marries a divorced woman commits adultery.”

Jesus began by referring to Deuteronomy 24:1-4 from the Law of Moses, where if a man wanted to divorce his wife, he was required to give her a formal certificate declaring he was divorcing her. At that time, a man was permitted to divorce his wife, but a wife was not allowed to divorce her husband. She could petition the court, and if her plea was accepted, the court would direct the husband to divorce her. Culturally, to moderns this appears to be an unfair, patriarchal practice. But there was a loose interpretation of that section of the Mosaic Law that made it even more one-sided.

Deuteronomy 24:1 said a man could write his wife a certificate of divorce if she fell out of favor in his eyes “because he found some indecency in her.” The word for “indecency” in Hebrew can have a sexual connotation, but here it referred vaguely to some failing or sin. By the time period in which Jesus lived, the grounds for divorce could be a failing as trivial as a wife burning the food she cooked for her husband. We could almost say this was an ancient sense of a husband-centered “no fault divorce.” This was the interpretation of the followers of Hillel, a rabbi and teacher during the time of Herod the Great. The school of Shammai, a conservative Pharisee from around the same time period, limited the sense of the Hebrew word for “indecency” to its sexual sense and only permitted divorce for adultery.

Regardless of how an individual understood divorce, it was an accepted practice in Judaism for a man to divorce his wife. However, her husband could not put her outside of his home on a whim; he had to formally release her from her marriage vows. The certificate of divorce was a protection for the woman, indicating she could legally marry someone else. Remarriage for a widowed or divorced woman provided security in the culture of her time. Leon Morris observed: “In first-century Jewish society how else could she live?”

But, Jesus said divorce should not be granted at the whim of the husband; it’s not simply the right or privilege of a man to dispose of his wife whenever he tires of her. Such capriciousness was sin. Jesus said not only does this kind of husband force his wife to commit adultery by her remarriage, but also the man she marries. In God’s eyes the indecency to justify a divorce had to be serious to break the covenant bond of marriage. Apathy towards the wife of your youth or the desire for a younger, prettier “trophy wife” were not acceptable reasons for divorce.

Clearly Jesus saw marriage as a lifelong union between a man and a woman. Addiction can destroy that bond as effectively as adultery. In fact to a spouse, drug and alcohol addiction often feels like the addict or alcoholic is in an adulterous relationship—even when there isn’t another human being involved. There are frequent promises to their partner they are finished with alcohol … cocaine … heroin. Then the partner discovers those were promises without teeth. The addict didn’t follow through with a permanent breakup with their drug/lover.

Farther on in the Sermon on the Mount, in the midst of discussing treasures on earth or in heaven, Jesus tells his audience that whatever they treasure has their heart. Since no one can serve two masters (or lovers), they will be devoted to one or the other, but not both (Matthew 6:19-24). Being with an addict can feel like that. Your partner is in a relationship with something else; and you can’t compete.

In the A.A. Big Book, chapter 8 is “To Wives.” Counter-intuitively, that chapter was written by Bill W.; not his wife, Lois. In Pass It On, Lois said she was hurt Bill insisted on writing it himself. His given reason, so that it would be in the same style as the rest of the book, seems a bit weak. There was, in fact, a section included in the A.A. Big Book, Alcoholics Anonymous, that was written by another hand. “The Doctor’s Opinion” was written by Dr. Silkworth, the doctor who treated Bill at the end of his drinking. I think it is fair to say Bill W. had a strain of chauvinism in him and it showed up here.

Another way to apply Matthew 5:31-32 to recovery is to reflect on how adultery and divorce were frequently used as metaphors to describe idolatry or unfaithfulness to God in the Old Testament prophetic literature. Here, the adultery would be spiritual adultery; a violation of the individual’s relationship with God.

Ezekiel 16:15-35 frames the unfaithfulness of Jerusalem to God as adultery. Jeremiah 3:1-10 similarly describes how Israel polluted the land with her lovers. Israel and Jerusalem are the unfaithful wives. In Malachi, the priests are described as being faithless to the wife of their youth. Adultery, whether it was literal or a metaphor for spiritual unfaithfulness, violated the individual’s covenant before God.

The Lord was witness between you and the wife of your youth, to whom you have been faithless, though she is your companion and your wife by covenant. Did he not make them one, with a portion of the Spirit in their union? And what was the one God seeking? Godly offspring. So guard yourselves in your spirit, and let none of you be faithless to the wife of your youth. “For the man who does not love his wife but divorces her, says the Lord, the God of Israel, covers his garment with violence, says the Lord of hosts. So guard yourselves in your spirit, and do not be faithless.” (Malachi 2:14-16)

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

01/17/17

Reinhold Niebuhr and the Serenity Prayer

Heath Union Church, Heath MA

In May of 1943 Reinhold Niebuhr completed teaching his classes at Union Theological Seminary and left for a two-month series of meetings, conferences and lectures in England and Scotland. The German Axis forces in North Africa surrendered on May 12, 1943. Four days later, German troops crushed the last resistance in the Warsaw Ghetto Uprising, killing thousands of Jews. The rest were sent to Treblinka. Soon after Niebuhr returned to his family in Heath Massachusetts, Allied troops landed in Sicily on July 10th. On July 24th, the Allies began bombing the German city of Hamburg. By July 25th, Mussolini was overthrown and the new Italian government began peace talks. Somewhere in the midst of these earth-shaking events, Niebuhr preached a sermon at the Heath Union Church and uttered what would become known as the Serenity Prayer for the first time.

The above-described origins of the Serenity Prayer were given by Elisabeth Sifton, the daughter of Reinhold Niebuhr, in her book: The Serenity Prayer. Sifton deftly placed its origins in the midst of the work and ministry of her father during WW II. She said at some point in late 1943 or early 1944, a friend of her father’s, Howard Robbins suggested this little prayer about “grace, courage and wisdom” would be appropriate for inclusion in material he was preparing for army chaplains in the field. Niebuhr gave Robbins a copy of the prayer, and in 1944 it was included in the Book of Prayers and Services for the Armed Forces.

This was its first publication in any form and in any language, and its because of this little booklet that eventually it became famous. . . . A short while later Alcoholics Anonymous, then a fledgling small organization scarcely a decade old, with my father’s permission, also started to use the prayer in their regular meetings.

Sifton said she doesn’t know when or how AA simplified the text of her father’s original version of the Serenity Prayer. And although he let it happen “and didn’t fuss when the wordings were altered,” he did mind the changes. But Niebuhr never copyrighted his prayer. Sifton said it was inconceivable to him to construe prayers as a source of revenue. So he could not and did not control its misquotation, misattribution or embellishment.  The original text for Niebuhr’s Serenity Prayer is followed by the shortened AA version, and one of the longer versions.

Niebuhr’s 1943 version: “God give us grace to accept with serenity the things that cannot be changed, courage to change the things that should be changed, and the wisdom to distinguish the one from the other.”

The AA version appears in the Third Step essay of the AA book, The Twelve Steps and Twelve Traditions: “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.”

One version of the so-called “Complete” Serenity Prayer is in the linked article below by Nell Wing, an A.A. archivist. It is as follows:

God, grant me the Serenity to accept the things I cannot change; Courage to change the things I can, and the Wisdom to know the difference. 

Living one day at a time; enjoying one moment at a time; accepting hardship as the pathway to peace. Taking, as He did, this sinful world as it is, not as I would have it. Trusting that He will make all things right; if I surrender to his Will; that I may be reasonably happy in this life, and supremely happy with Him forever in the next. Amen. 

Elisabeth Sifton said she has no idea where the additional clauses of the “complete” version came from. But their message and tone were not in any way “Niebuhrian.” She noted how the A.A. version simplified the opening and framed the prayer in the first person singular, rather than the first person plural of her father’s original text. It also omitted the spiritually correct, but difficult idea of praying for “grace to accept with serenity that which we cannot change.” Instead, it focused on the simpler idea of obtaining “serenity to accept what cannot be changed.”

Nell Wing, an A.A. Archivist, wrote a paper in 1981: “Origin of the Serenity Prayer.” There she described several different purported “origins” for the Serenity Prayer that A.A. was told over the years. Bill W. and A.A. have attributed their initial discovery of the Serenity Prayer to Niebuhr, but still seem to repeat information about it that conflicts with Sifton’s above-described version—which she was told to her by her parents. For example, A.A. attributes their initial discovery of the (then) anonymous prayer to an obituary found by an early A.A. member in a New York paper in June of 1941. The connection to Dr. Niebuhr didn’t come to A.A.’s attention in the late 1940s.

Wing said an A.A. member reported seeing the prayer in Reinhold Niebuhr’s writings, “as if it were original to him.” She also quoted from a 1951 letter by an A.A.  member to Bill W. The man who had been in contact with Dr. Niebuhr, who confirmed that he did write the prayer and that it had been distributed to soldiers during WWII. Bill W. responded by saying that it was probable the Serenity Prayer existed in some form or other before Dr. Niebuhr. “Now it is pretty certain that Dr. Niebuhr did write the prayer in its present form and we also have on file a letter from him to that effect.” Bill then referenced a September 1950 article by Jack Alexander, which Wing quoted:

 Originally thought in Alcoholics Anonymous to have been written by St. Francis of Assisi, it turned out on recent research to have been the work of another eminent nonalcoholic, Dr. Reinhold Niebuhr, of Union Theological Seminary. Dr.Niebuhr was amused on being told of the use to which his prayer was being put. Asked if it was original with him, he said he thought it was, but added, “Of course, it may have been spooking around for centuries.”Alcoholics Anonymous seized upon it in 1940 [actually1941], after it has been used as a quotation in the New York Herald Tribune. The fellowship was late in catching up with it; and it will probably spook around a good deal longer before the rest of the world catches up with it.”

Wing also referred to several other “origins” of the payer that have been sent to A.A. at one time or another. There was even the reprint of a letter written by Ursula Niebuhr, Reinhold’s wife, which briefly reviewed the background to the Serenity Prayer given above by her daughter.

In the January 1950 issue of the AA Grapevine, there appeared an article entitled: “The Serenity Prayer,” that attributed the prayer to Niebuhr, and even gave what they said his original text. The prayer attributed to Niebuhr in the Grapevine article was not the version quoted above as the Niebuhrian 1943 version. The A.A. article also dated the origin of the Serenity Prayer to 1932. Howard Robbins is said to have received permission to place it in a compilation of prayers he then published in 1934. An A.A. member saw the prayer in an obituary in 1939, and brought it to the attention of Bill W. and others in A.A. The history described here seems to contradict that given above by Sifton. For more on the A.A. understanding of the origins of the Serenity Prayer, see: “The Serenity Prayer and A.A.”

Elisabeth Sifton, her mother and father all seem to have a similar sense of the Niebuhrian version of the Serenity Prayer coming from a sermon that he preached at Heath during WWII. Nell Wing reviewed several other possibilities, some of which were shown to be false. Yet the consensus from A.A. seems to believe the 1943 Niebuhrian version wasn’t the first. Writing for the Yale Alumni Magazine in 2008, Fred Shapiro wrote of his own investigations into the origins of the Serenity Prayer, “Who Wrote the Serenity Prayer?”

Shapiro noted that Niebuhr’s version of the Serenity Prayer was selected by the editor’s of the World Almanac as one of the ten most memorable quotes of the last 100 years. In English and German-speaking countries, he thought it was probably the only prayer to rival the Lord’s Prayer in popularity. Shapiro said Niebuhr himself said it was possible he assimilated its concept from some earlier, forgotten source. Nevertheless, Niebuhr made it clear that he believed the prayer originated with him.

Shapiro’s research found versions of the Serenity Prayer in newspaper databases before 1943. He stated how the evidence was by no means, conclusive; and it is entirely possible Niebuhr composed the prayer much earlier than he himself remembered. When he found at least eight versions of the prayer in newspapers before 1943, he contacted Elisabeth Sifton with his evidence. In response, Sifton commented that prayers evolve, are borrowed, transmuted and revised—by their original writers and others.

Sifton herself noted in her own book where the ideas expressed in the Serenity Prayer existed in previous works by her father. She noted how the tone of the Serenity Prayer radiated throughout Niebuhr’s classic work, The Nature and Destiny of Man. Niebuhr gave a series lectures with the same name at the Gifford Lectures between 1938 and 1940 at the University of Edinburgh. She pointed out where the second volume ended with a consideration of the ideas he was to express in his little prayer just a year or so later:

Wisdom about our destiny is dependent upon a humble recognition of the limits of our knowledge and our power. Our most reliable understanding in the fruit of “grace,” in which faith completes our ignorance without pretending to possess its certainties as knowledge, and in which contrition mitigates our pride without destroying our hope.

The following are two examples of what Shapiro found. Follow the above link to his full article for more.

In the January 16, 1936 edition of the Syracuse Herald, the executive secretary for the Syracuse Y.W.C.A. quoted the following prayer in her annual report:

O God, give us courage to change what must be altered, serenity to accept what cannot be helped, and insight to know the one from the other.

In the February 19, 1939 edition of the Ada (Oklahoma) Herald the home counselor for Oklahoma City’s public schools prayer said the prayer for both parents should be:

Oh God, give me serenity to accept that which cannot be changed, give me courage to change that which can be changed and wisdom to tell the one from the other.

Shapiro said it was possible that Niebuhr introduced the prayer by the mid-1930s in an unpublished or private setting. It was then quickly disseminated with his identification largely forgotten. But he said it must be asked why Niebuhr himself never suggested he had used the prayer in the 1930s. However, he believes a second alternative is more likely. The prayer really was “spooking around for years” and Niebuhr unconsciously adapted it from some already-existing formulation.

Sifton responded to Shapiro’s conclusions in “It Takes A Master to Make A Masterpiece.” You can find her response at the end of the link for Shapiro’s article, “Who Wrote the Serenity Prayer?” She still affirmed her father as the essential author of the Serenity Prayer. Shapiro merely demonstrated that her father’s voice reached far more American churches and organizations than they had previously realized. Prayers are presented orally and become famous orally long before they are put on paper.

Yet the great masterpiece prayers don’t materialize in some random, bubble-up way, either: their power comes from a distillation of complex spiritual truths, and for this we need authors, we need the tradition’s most gifted practitioners. In my book, I quoted prayers from various sources that my father knew well and whose cadences and theology feed into the Serenity Prayer’s concise wisdoms, because I wanted to suggest how the rich texture of worship as experienced by generations of believers nourishes the creation of new prayers. To throw light on this long, often anonymous process was one purpose of my book.

Sifton commented that since the Serenity Prayer has become so associated with the 12 Steps of Alcoholics Anonymous, most people think of it as expressing what we must work on within our “personal self-improvement projects.” Yet it was composed in wartime. It addresses “the inconsolable pain, loss, and guilt that war inflicts on the communities that wage it.”

She said her father drafted his prayers rapidly, or composed them right on the spot, rewording them many times before he felt they were in final form. Most of the prayers she cited in her book were not published until after his death in 1971. But by then generations of student and worshipers had known them well and used them for decades. “The Serenity Prayer was unusual in his oeuvre [body of work], then, only in the odd circumstance of its wartime publication and subsequent diffusion.”

The Niebuhrian version of the Serenity Prayer seems to have clearly come from Reinhold Niebuhr’s 1943 sermon. It also seems likely that the concepts within the prayer had been part of his teaching, thinking and writing in the years prior to that fateful sermon. And yet, religious believers and philosophers for thousands of years have struggled to be at peace or in harmony with the things in life that cannot be changed; to find courage to change the things they can; and to know the one from the other. The dilemma of the Serenity Prayer strikes at the heart of all religious and philosophical quests to know the will of God. Lord, by your grace grant us the serenity, courage and wisdom to know and do your will.

01/6/17

The Serenity Prayer and A.A.

Alcoholics Anonymous and the Serenity Prayer are forever bound together. The prayer originated with the American theologian, Reinhold Niebuhr, but its dissemination within the wider culture occurred through A.A. So there are two distinct historical threads that can be followed in tracing the history and use of the prayer. One thread follows its presence through A.A. itself and another traces its origins with Niebuhr. This article will concentrate on the A.A. connection, while another one, “Reinhold Niebuhr and the Serenity Prayer,” will trace its origins with Niebuhr.

Pass It On is the A.A. approved history of Bill W. and how the message of A.A. reached the world. It described how one of its members saw the prayer in an obituary of an early June 1941 edition of a New York paper, the Herald-Tribune. Pass It On quoted it as existing then in its commonly received form: “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.” An A.A. member had the idea to print the prayer on cards and paid for that first printing out of his own pocket.

It was initially referred to as: “the A.A. prayer” or “God grant us” by A.A. members. But by the late 1940s, it became known as the Serenity Prayer. Nell Wing, the first A.A. Archivist and a secretary to Bill W., wrote “Origin of the Serenity Prayer: A Historical Paper” in 1981. She quoted from a June 12, 1941 letter written by Ruth Hock, the A.A. secretary at that time, to an A.A. member and a printer by trade about getting the prayer printed on a wallet-sized card. He responded:

Your cards are on the way and my congratulations to the man who discovered that in the paper. I can’t recall any sentence that packs quite the wallop that that does and during the day shown it to the A.A.’s that dropped in and in each case have been asked for copies.

In the January 1950 edition of the AA Grapevine, an article appeared that “solved” the mystery of the origins of the Serenity Prayer. Although its origin had been previously attributed to several different sources, the article said it originated with Dr. Reinhold Niebuhr. He was said to have written it around 1932 as the ending of a longer prayer. In 1934 a friend asked Niebuhr’s permission to use the shorter section in a compilation of prayers he was making at the time. Niebuhr was quoted as saying: “Of course, it may have been spooking around for years, even centuries, but I don’t think so. I honestly do believe that I wrote it myself.”

According to the AA Grapevine article, the original form of the prayer, as written by Niebuhr was: “God give me the serenity to accept things which cannot be changed; Give me courage to change things which must be changed; And the wisdom to distinguish one from the other.” The article said Dr. Neibuhr didn’t mind the changes from his original rendering of the prayer, saying: “In some respects, I believe your way is better.”

Nell Wing’s article reviewed the variety of supposed original sources for the Serenity Prayer, which included: St. Francis of Assisi, the early Greeks or Aristotle, St. Thomas Aquinas, St. Augustine, the Dutch philosopher Baruch Spinoza, and even ancient Sanskrit writings. Research done by a German member of A.A. Peter T., attributed the first written form of the prayer to a Roman statesman and Christian philosopher named Boethius (480-524). Nell added in a footnote:

While this is a fascinating story in its own right and appears to correct a long-standing misconception, Boethius’ connection with the prayer remains unclear and haunting! What were his thoughts and ideas that so affected succeeding generations of religious dissidents?

Boethius was born in Rome and educated in Athens and Alexandria. In 510 he became a Consul under Emperor Theodoric. He was accused of treasonable dealings with the emperor in Constantinople, imprisoned and eventually beheaded. While in prison he wrote The Consolation of Philosophy, his most influential work and that from which Peter T. said the first form of the Serenity Prayer appeared. His commentaries on Aristotle became a major source of knowledge of Platonic and Aristotelian ideas in the Middle Ages. More information on Boethius can be found in: New Dictionary of Theology; and Classical Pastoral Care, Volume 4: Crisis Ministries. You can also read this article on him by Carl Trueman: “Boethius: The Philosopher Theologian.”

In Alcoholics Anonymous Comes of Age, Bill W. said when he first saw the Serenity Prayer on that day in June of 1941, “Never had we seen so much A.A. in so few words.” After the cards were printed up, A.A. included one in every piece of correspondence they sent out. This continued for several years, and the Serenity Prayer rapidly came into general use within A.A. After reiterating the possible origins of the prayer, Bill said: “Anyhow, we have the prayer and it is said thousands of times daily. We count its writer among our great benefactors.” Over 950 references have been made to the Serenity Prayer in the AA Grapevine since its first issue in 1944.

What is it about this prayer that gives it so much value for A.A.? Bill W. unpacked its usefulness in his article for the March 1962 issue of the AA Grapevine, “What is Acceptance?” This article is also available in the A.A. published selection of Bill W.’s Grapevine writings, The Language of the Heart. Bill said one of the ways to get at the meaning of the principle of acceptance is to meditate on it within the context of the Serenity Prayer. Essentially it is asking for the resources of grace by which we can make spiritual progress. Emphasized within the prayer is the need for wisdom that discriminates between the possible and the impossible.

Sometimes we need the right kind of acceptance for each day. Other times we need to develop acceptance for what will come in the future. Yet again, we may have to accept a situation that will never change. Then there are misuses of acceptance. “It can be warped to justify nearly every brand of weakness, nonsense and folly.” We can “accept” failure as a chronic condition without failure or remedy. We can pridefully “accept” worldly success as something we did ourselves.

This is why we treasure our “Serenity Prayer” so much. It brings a new light to us that can dissipate our old-time and nearly fatal habit of fooling ourselves. In the radiance of this prayer we see that defeat, rightly accepted, need be no disaster. We now know that we do not have to run away, nor ought we again try to overcome adversity by still another bull-dozing power drive that can only push up obstacles before us faster than they can be taken down. . . .Therefore our very first problem is to accept our present circumstances as they are, ourselves as we are, and the people about us as they are. This is to adopt a realistic humility without which no genuine advance can even begin. Again and again, we shall need to return to that unflattering point of departure. This is an exercise in acceptance that we can profitably practice every day of our lives. Provided we strenuously avoid turning these realistic surveys of the facts of life into unrealistic alibis for apathy or defeatism, they can be the sure foundation upon which increased emotional health and therefore spiritual progress can be built. At least this seems to be my own experience.

I’ve read an article that sees the Serenity Prayer as creating an either/or, black-and-white dichotomy, “as if all of the situations and challenges that a person in recovery is confronted by can be neatly placed into one or the other bucket.” But I don’t see Bill W. using the Serenity Prayer as a black-and-white dichotomy. He said it emphasizes the need for wisdom to discriminate between the possible and impossible. He also said there can be misuses of acceptance—when it is used to justify “weakness, nonsense and folly.” The goal of acceptance in the Serenity Prayer, at least for Bill W. and A.A., is to have humility; to avoid turning a realistic assessment of the situation into an alibi or excuse for apathy or defeatism.

08/16/16

Gaining in Humility

© unkreatives | stockfresh.com

© unkreatives | stockfresh.com

Matthew 5:38-40 in the Sermon on the Mount addresses the very human impulse to get even when someone does harm to you. Jesus succinctly says here, “Don’t do it!” The initial phrase, “an eye for an eye”, has become a justification in our time for getting even with the person who has done something against us. There is an Old Testament principle of reciprocity behind the phrase. When judging injury done to another, if there is harm, pay life for life, eye for eye, tooth for tooth, hand for hand (Exodus 21:23-25). There is a similar call in Leviticus 24:20 when someone injures their neighbor: whatever injury he has given a person shall be given to him.”

Sometimes called the “law of retribution” or lex talionis, this was a legal principle stating that punishment for wrongdoing should not exceed the crime. What’s more, as Exodus 21:22 indicated, judges and not the aggrieved person decided how to apply the principle in any specific case. Jesus clearly says: “Do not resist the one who is evil” (Matthew 5:39). It seems the message here is: “Don’t take the law into your own hands!”

In his commentary on Matthew, Leon Morris readily acknowledged how easily a desire for revenge rises up within us. “We have a natural tendency to retaliate when anyone harms us (or even when the harm is in our imagination!).” But Jesus challenges us to not seek to settle scores; to not hit back when someone hits us. This is again the message in 5:39: “To be the victim of some form of evil does not give us the right to hit back.” Even if someone were to legally deprive you of your tunic, don’t resist. Rather, give him your cloak as well.

Again there is an allusion to an Old Testament regulation in Exodus 22: 26-27 and Deuteronomy 24:12-13. If a neighbor’s cloak was taken in pledge for a loan, you should return it to him before evening, so he has something to sleep in. “A person had an inalienable right to his cloak; it could not be taken away from him permanently. Its voluntary surrender is thus significant.” Craig Blomberg said that in modern context, “coat” and “shirt” are parallels to “cloak” and “tunic” respectively. So the message is to go further than just giving up the shirt off your back.

As if this wasn’t enough, Jesus then said if you were forced to go one mile, go two. Here the reference is to the practice of “impressment,” which allowed a Roman soldier to conscript someone to carry his equipment or some other burden for one Roman mile. This was a legal and customary practice dating back to the time of the Persian government postal service. Both people and animals could be called upon without notice for temporary service. Again there is an echo of a modern saying, that of going the second or extra mile.

John Nolland noted in his commentary on Matthew how this practice could easily be abused by the Romans and resented by the Jews. “Hostility to Roman rule would make such impressment yet more distasteful.” Jesus said the proper response is generous and ungrudging compliance. It seems Jesus intensifies his point by giving a series of admonitions that could be rendered today as: Don’t take the law into your own hands! Don’t just give up the shirt off your back; give up your coat as well. Go beyond what is required of you; go that second mile.

One of the early daily meditation books used in Alcoholics Anonymous was the classic Christian devotional by Oswald Chambers, My Utmost for Your Highest. On July 14th, Chambers reflected on this passage, saying the teaching of the Sermon on the Mount is not to do your duty. Rather it is do what is not your duty. Don’t insist on your rights. Be humble. “Never look for right in the other man, but never cease to be right yourself. We are always looking for justice; the teaching of the Sermon on the Mount is—Never look for justice, but never cease to give it.”

Here we touch on what Bill W. said was the number one offender, destroying more alcoholics than anything else—resentment. In each and every situation Jesus gave in Matthew 5:38-41, resentment for the injury, insult and injustice that occurred would be expected. Jesus is saying, “Don’t go there.” Oswald Chambers says: Don’t look for justice, but never stop giving it to others. In his essay on Step Four, Bill W. said we need to learn that something has to be done about our vengeful resentments, self-pity, and unwarranted pride.

We had to see that when we harbored grudges and planned revenge for such defeats, we were really beating ourselves with the club of anger we had intended to use on others. We learned that if we were seriously disturbed, our FIRST need was to quiet that disturbance, regardless of who or what we thought caused it. . . . Where other people were concerned, we had to drop the word “blame” from our speech and thought.

After the first two or three attempts, the way ahead begins to look easier. “For we had started to get perspective on ourselves, which is another way of saying that we were gaining in humility.”

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”