Recently, I attended an Alcoholics Anonymous meeting, specifically a Step meeting, and we were on Step 3. After the step was read, a gentleman across the table raised his hand immediately and started speaking about his computer system being confiscated by a national security force, that everything he said was being monitored and this had been going on for years. As time progressed and the story gained momentum, several of us glanced at the chairperson, who did nothing. The “share” came to an end 20 minutes later. There was no reference to the 3rd step, no reference to AA, no reference to recovery and no mention of alcoholism.  As I sat, quietly irritated, I asked myself a few questions.

Why oh why God, did I ever pray for patience? I smiled at that.
Will people come back after listening to this? Will I?
What is the appropriate response in that situation?
What does this have to do with recovery coaching?

The last question is what I’ll try to address. I’ve had this topic in my head for a long, long time.  So I proceed with caution (and no small degree of courage).  The topic of addiction recovery and mental health integration stirs up emotion and fortified opinions. I have witnessed and partaken in many robust discussions. I have listened for years to people with a variety of perspectives.

Yet it’s muddy water. Before I dive in, and in full disclosure, I’ll provide some background information. Bob Savage, CCAR founder, hired me in January of 1998.  As CCAR’s second employee, I was woefully unaware of the addiction treatment system, never mind the mental health system.  I had no prior contact with it. Bob had worked within the State of Connecticut addiction system for 30 years. Near the end of his tenure, substance abuse (as it was known at the time) merged with mental health. He vehemently opposed this action, to no avail. His passion remained long after it was a done deal.  Some of that rubbed off on me as I walked by his side in the early years of CCAR’s recovery advocacy.

So, I recognize I have an inherent bias.  I am in recovery from alcoholism and cocaine addiction. That’s how I identify myself. Then again, I was 20+ years in recovery when I discovered that I might have had “social anxiety” when I was a teenager. In fact, a sister mental health advocate lovingly provided me with that diagnosis, “in case I ever need one”.

Over the past two decades, I have identified some defining characteristics that distinguish and separate the two systems.  I believe these factors make integration difficult, like trying to combine oil and water. My thoughts are purposefully concise, to leave room for you to ponder, room to wonder, room to noodle.  The discussion…continues.

Here’s a thought to chew on… Many people believe that everyone who becomes addicted must have a mental illness; otherwise the person would not have become addicted. Some believe everyone (addicted or not) has a mental illness.  For me, I don’t believe everyone has a mental illness. I don’t believe everyone who seeks treatment is “dually diagnosed”. I believe if you drink a depressant (alcohol) long enough, you might become depressed. Would that person be given a diagnosis of depression?

Let’s move to some observations. Here’s my 1st one. Recovery, as proposed by the two systems, has different and opposing outcomes. The addictions system’s primary goal is to move people out. In contrast, the mental health system keeps people in.

2nd The majority of people in long-term recovery from addiction have faith in a spiritual higher power. The addiction treatment system supports this notion. In mental health, the system often points to a medication (or psychiatrist/psychologist) as the higher power. Spirituality is rarely discussed.

3rd. Addiction recovery seeks to involve family as part of the solution. Mental health often refers to the family as part of the problem, even going so far as to isolate the person from the family.

4th Historically, mental health practitioners have not done well in treating people with a substance use disorder (a few best practices at the time – electroshock therapy, sterilization and frontal lobotomies). I encourage you to do some additional research here. Addiction treatment programs are not exempt from poor practices either.

5th and final observation. Many programs “integrated” in my time with CCAR. It was like watching oil and water try to combine.  It was not pretty. And every time an addiction program merged with a mental health program, it became a mental health program. The spirit of recovery was discarded or at best, became an afterthought.

Every time.

What does this have to do with recovery coaching?

Many advocates from both arenas have shared that they don’t think the two roles ought to be combined. Yet, I have heard from administrations (and certification bodies) that we could have one “peer” role to work with people recovering from addiction, mental illness and/or both.

My suggestion is to keep two distinct roles.  Let oil be oil.  And water be water.

In 2015, I finished a thruhike of the entire Appalachian Trail, a trek of 2,189.2 miles. It took 189 days and 6 pairs of boots. During all that time alone with my Creator, my purpose in life became more precisely defined. I am, simply, to coach recovery. Recovery saved me from an early demise and brought purpose to my tattered life. I have learned that I’m a coach to my very core. I am blessed to put the two together. I started work at the Connecticut Community for Addiction Recovery (CCAR) in 1999. I became the Executive Director of this recovery community organization in 2004. I have trained the CCAR Recovery Coach Academy© dozens of times and have a hand in modifying, improving and adapting various recovery coach curricula. I’m old enough now to start considering my legacy. This is a way for me to share things I have learned in my recovery, in my role as Executive Director and a trainer. I find that when I speak I present the same messages over and over. It’s time to write them down.

Phil “Right Click” Valentine
Recovery established 12.28.87

Phil "Right Click" Valentine

Phil "Right Click" Valentine

In 2015, I finished a thruhike of the entire Appalachian Trail, a trek of 2,189.2 miles. It took 189 days and 6 pairs of boots. During that sacred time, my purpose in life became more precisely defined. I am, simply, to coach recovery. Recovery saved me from an early demise and brought purpose to my tattered life. I have learned that I’m a coach to my very core. I am blessed to put the two together. I started work at the Connecticut Community for Addiction Recovery (CCAR) in January 1999. I became the Executive Director of this recovery community organization in 2004. I have trained the CCAR Recovery Coach Academy© dozens of times and have a hand in modifying, improving and adapting various recovery coach curricula. I’m old enough now to start considering my legacy. This is one way for me to share lessons learned in my recovery, in my role as Executive Director and a trainer. When I engage with others, I present the same messages repeatedly. It’s time to write them down.

13 Comments

  • Frank says:

    So what should the Chairperson have done, if anything?

  • Reiki Girl says:

    Hello, Rightclick!
    Yet another great topic and one I’m passionate about. I am working hard to get my masters of social work degree because one of the things I want to explore is becoming a peer counselor. I have both substance abuse and mental illness in my diagnoses and if, at the masters level, I can combine both within my therapy practice I think it will be awesome. In my opinion, of more peers did this then we could reach people with co-morbid diagnoses.
    As always, thanx for your post, Rightclick. Yours in advocacy, Nikki

  • Deborah Reynolds says:

    After 16 years of being involved with a local treatment center I must say that your perspective reflects my own observations. In the beginning there was much more focus on recovery from addiction, but gradually it has shifted and the predominant focus today is on having a dual diagnosis where the “mental illness” takes the spot light.
    In the mental health world we all would wear labels. Yes, we are all broken, but the solution is found in connecting with our Higher Power and learning to use the tools He has readily available.
    I look forward to your posts!

  • Great topic! I am in the work and I really think I agree with a lot of your points. I am a person in long term recovery from cocaine, do I think some of the things I did were outlandish? during active addiction……. yes and yes, I really enjoy your posts, I look forward to reading more. Very thought provoking!

    Thanks,

    John

  • Valery Staskey says:

    Dear Phil,

    I think I understand your point that 12-step treatment and mental health care are worlds apart. As a person living with a dual diagnosis, I felt slighted by your remarks about mental health and addiction. While it’s quite true that more of us have mental health issues than not, many, if not all, preceded our addiction. I did not become depressed because of my adolescent alcoholism, I was indeed “medicating my depression,” to no avail. My substance use disorder and mental illness developed quickly and concurrently. I utilize a variety of addiction support groups, including one for the dually diagnosed. I take my medications as prescribed and have finally, after decades of miserable sobriety, achieved happiness and contentment. I wouldn’t want anyone to be dissuaded from seeking mental health treatment due to your essay.

  • Leslie Murphy says:

    I agree and I also believe the chairperson should have interrupted the person and asked them to stay on topic. They could also ask members to keep their share to 10 minutes or less and keep it related to the topic or AA prior to the meeting starting.

    This is definitely a challenge and I believe we need to be clear and upfront when chairing a meeting and not hesitate to interrupt someone if they’re not on topic.

  • rick pacukonas says:

    In an AA meeting, the chairperson’s responsibility is to keep the discussion on the topic and gently curtail ego-driven ramblings FOR THE GOOD OF THE GROUP. Ranting is always a precursor to resenting. In AA the group comes first, the individual is second.
    I’m not sure what the priority is in Mental Health, but as a person who has been invited to speak at a combined DMHAS seminar, I experienced an awkward inability to find a common language to convey hope to a half-listening audience of widely divergent perspectives.
    After 43 years of service and ministry to recovery people, I have found that the common problem is a far greater bond than the common solution (whatever that is???).
    The simple solution: when a person is at AA or NA or GA, focus on that problem or solution according to that program. And if mental illness is the issue, find an appropriate group and hone in on topics identifiable to those attendees.
    Trying to all be all things to all people, leaves everyone with less.

    Personally I believe the State of CT’s idea to scrunch both branches together was political and financial.
    Maybe Phil can blurb on that “sacred cow” if he wants everyone in the billion dollar industry to hiss at him?

  • Darrell Keim says:

    I run one of 9 RCCs modelled after CCAR in Idaho. We emulate much of what we have seen CCAR doing so very successfully. With one significant exception. Our RCCs were challenged by our initial funder to serve both addiction and mental health populations.

    My experience is that it IS Oil and Water. The two populations are very different. They don’t always mix well! Like Oil and Water, they also have a number of similarities. As we started there was much distrust. The mental health folks didn’t want to be identified with the addiction folks, and vice versa. We have worked hard to overcome this bias by paying attention to messaging, education and volunteer staff training.

    It has been hard work, and the educational process continually evolves. The successes we’ve had make it worth it. On the personal level we’ve seen the evidence and heard the stories of lives on both sides of the equation changed and saved. At the community level the police saw an 8% decrease in drug related calls, a 12.5% decrease in alcohol offenses and a 22% decrease in intoxicated person calls in our first year of operation. Our Center has about 5000 client contacts yearly. Most have co-occurring disorders.

    I suspect our difference from Phils has to do with the differences in our states. Idaho’s entire population is half that of Connecticutt. Geographically, CT is about the size of one large Idaho county. Our town has a population of 25322, half of which attend the local University. Hartford is about 8x that. Our state has very few resources for mental health or addiction recovery, etc.

    In my small, very rural area I believe our wider focus makes for a stronger RCC.

  • Karen says:

    Treatment and the program got me sober but I was barely hanging on. There was no pink cloud for me. Depression, anxiety and dangerous periods of mania brought me to the point where suicide seemed the most logical solution to my problems. Fortunately I survived and spent six weeks at the Menninger Clinic in Houston where I was treated for addiction and co-occurring disorders – namely bi-polar disorder. I was put on medication and found peace. Some of the these medications would cause a great deal of controversy if I discussed them in an AA meeting which I never do. I have a treatment team – a psychiatrist, a psychologist, CB group therapy,.the program, a sponsor, a pastor, close friends and a Pilates instructor. I do not discuss my mental health issues in an AA meeting. Why? Because AA,s singleness of purpose is to help people to put down the drink. Mental health issues can be wildly diverse. The steps do not heal a person with a serious mood disorder.

    I have we been sober for nearly fifteen years. It’s been many years since I’vd had a manic or depressive episode,. In my opinion, people presenting for alcohol or drugs addiction schools be screened for mental health disorders. The conversation at meeting should remain focused on what we can do to stay sober and those with mental issues should, in addition to AA, build a stong support team to address these complicated difficulties.

  • Ruth Riddick says:

    Thank you, Phil! I’ve been struggling with articulating this position, with which I completely agree. Advocacy, thy name is Valentine . . .

  • Phil,
    Couldn’t agree more. I’m trained for recovery, not mental health. I’ll admit we can share with the mental health field because we get so much from our brand of common sense recovery that we know it’s great for life, even depressed and anxiety prone lives. Are the mental health professionals so hard up for customers that they need to steal/share ours or do we happen to have a terrific, healing “product” that they can use, too?

  • Ken Blatt says:

    Thanks Phil for bringing up this important topic. The central theme of your piece is that the two “systems of care” do not mix and should not be integrated into one state department of mental health and addiction services. Your view then is that folks recovering from addiction have a different disease process than folks recovering from a so called mental illness also defined as a brain disease. For you it would be like combining the treatments of cancer with the treatment of sickle cell anemia and developing programs suitable for both. Who would do that?

    You identify as recovering from the diseases called alcoholism and cocaine addiction and find yourself in an AA group where a participant seems to be struggling with a different disease. How to relate this to me you wonder? You’re impatient. Do I return? Of course I can understand. It would be like going to a prostate cancer support group and a young man gets up recounting his experiences with sickle cell crisis.

    How do we empathize with someone whose experience is so different from ours? Shouldn’t we have two different groups? So we again sort ourselves into identifiable separate groups based on a defining criteria like which disease we have rather than coming together as humans in pain. We look upon the man rambling as other- unlike me. We other each other again. We stigmatize each other again.

    So I agree and disagree with you. We should NOT have a department of mental health and addiction services. This is an outgrowth of the predominant medical paradigm that defines almost all forms of emotional distress as diseases of the brain. Yet no one as yet has defined any biological marker or test or pathologic abnormality to be causative of such diseases. We have to abolish DMHAS and seek to establish a state department of emotional wellness. Like in the fall what comes down from the sky, that which nourishes the earth DEW.
    We have to stop othering each other and come together as just people who have endured pain in the infinite ways humans do. Pain is pain and uncomfortable for all. Suffering is suffering and uncomfortable for all. Each of us then seeks what we all need (if we can and have the opportunity) when we are pain. A trusting other (s) who listens to our pain (even when it is disguised behind intense rambling) and doesn’t judge us. I end quoting Henri Nouwen;
    “When we honestly ask ourselves which people in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in a hour of grief and bereavement, who can tolerate not knowing, not curing, not healing, and face with us our powerlessness, that is a friend who cares”

    Ken Blatt

  • Dina Repinecz says:

    I have a few responses. The first is to mention a few of the traditions of Alcoholics Anonymous (AA) which I believe apply here:
    Ten – Alcoholics Anonymous has no opinion on outside issues, hence the A.A. name ought never be drawn into public controversy.
    Eleven – Our public relations policy is based upon attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.
    Twelve – Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.
    I believe that bringing the contents of an AA meeting into a public forum breaks all of these traditions.
    My response to the content of the discussion is as follows:
    Many people have serious mental health issues that arise from a number of causes including biology, family, socio-economic status, and learned mal-adaptive behaviors. Some self-medicate with substances to cope with all of these stressors. Some people have substance use disorders that have relatively little mental health issues. Some people have tremendous amounts of anxiety and depression brought on by the consequences of substance misuse.
    Fortunately, there are many licensed, trained professionals that can sort out which is which and treat both including the symptoms of post acute withdrawal disorder. They know when medications and/or therapy can help people with the tools they need to develop good coping skills and the tools of recovery. AA endorses that when folks need outside help, they avail themselves of trained practitioners.
    I disagree with some of the observations.
    1) The addictions system’s primary goal is to move people out. In contrast, the mental health system keeps people in.
    Good mental health practitioners want to see their clients working, living, having fun, and developing support systems. Many have social activities, clubhouses, cookouts, and much more.
    2) 2nd The majority of people in long-term recovery from addiction have faith in a spiritual higher power. The addiction treatment system supports this notion. In mental health, the system often points to a medication (or psychiatrist/psychologist) as the higher power. Spirituality is rarely discussed.
    I agree to a certain degree. Many mental health practitioners encourage spiritual solutions in church, meditation, yoga, and other practices.
    3) 3rd. Addiction recovery seeks to involve family as part of the solution. Mental health often refers to the family as part of the problem, even going so far as to isolate the person from the family.
    I disagree. Most mental health practitioners offer or refer individuals to family/marital counseling including where I work. I work with patients everyday and welcome them to bring their family members into a session.
    4) 4th Historically, mental health practitioners have not done well in treating people with a substance use disorder (a few best practices at the time – electroshock therapy, sterilization and frontal lobotomies). I encourage you to do some additional research here. Addiction treatment programs are not exempt from poor practices either.

    I disagree. I work with and refer many persons to programs that address both disorders extremely well. A good practitioner can sort out of the issues.

    5) 5th and final observation. Many programs “integrated” in my time with CCAR. It was like watching oil and water try to combine. It was not pretty. And every time an addiction program merged with a mental health program, it became a mental health program. The spirit of recovery was discarded or at best, became an afterthought.
    I disagree. Most co-occurring disorder programs embrace 12 step programs, brings meetings on-site, transporting patients to outside meetings, and encouraging visitors from 12 step programs to visit and call. These programs recognize that a comprehensive program of recovery combines treatment from mental health illness when warranted, community engagement, employment, and spirituality that includes family and friends as well.

Leave a Reply to John Newell III Cancel Reply