April is Alcohol Awareness Month and the April issue of The Atlantic features a story titled - “The Irrationality of Alcoholics Anonymous” by Gabriella Glaser. The article sheds light on the recovery support service of 12-step programs through interviews with research and practice experts and personal testimonials.
The article reports that while it’s difficult to study, Alcoholics Anonymous (AA) has an estimated success rate between 5 and 8 percent. As the article indicates the notion of a “one size fits all” approach is still very pervasive in addiction treatment and recovery support. And, the one size is abstinence. This, unfortunately, can present challenges to individuals seeking other pathways to recovery such as medication assistance therapy or brief interventions to help reduce use and harm.
Young people are regularly referred or mandated to attend 12-step meetings. Why? I can’t say definitively but my hunch is because it’s available, free, and easy to monitor (i.e., how many meetings did you attend this week?). Plus, there are few (if any) other choices for recovery support services in many communities. Yet, the developmental and cultural appropriateness of 12-step programs has also been called into question. The limited studies that exist have shown mixed results of 12-step programs for adolescents, girls, racial/ethnic minorities, lesbian, gay, bi-sexual and transgender, and those living in rural/frontier areas (Ruiz, 2011). Furthermore, is it really reasonable to think a young person will never have a drink alcohol or take a prescribed pain reliever over the course of their entire lifetime? For some young people this will be necessary, but not for most. This incongruence between personal and 12-step principles, values, and beliefs can deter some from participating. I think the question remains, does the field think that recovery is a process that can be achieved by different pathways? If so, then other options are necessary. Let me be clear, I applaud and respect individuals who have been helped and supported by 12 step programs, but it’s time that young people, families, behavioral health programs, juvenile justice, schools, and primary care have other choices.
In 2008 the Substance Abuse and Mental Health Services Administration (SAMHSA) hosted a consultative session to gain input on designing a recovery-oriented system of care for adolescents and transition age youth with behavioral health disorders (SAMHSA, 2009). The consultants were youth and family members, researchers, program developers/implementers, state and federal policy makers. A report was prepared that provided an overview of the existing evidence and a synthesis of the consultative discussions. The primary areas discussed were recovery values and principles, services and supports, infrastructure, anticipated outcomes, existing challenges and potential opportunities (SAMHSA, 2009). A consistent theme emerged - recovery is a process of change and young people and families should be supported through this process in multiple ways (e.g., family/peers; education; culture and community; access to diverse recovery support services).
Turning to another issue, I think The Atlantic article was unnecessarily harsh on the behavioral health workforce particularly individuals in recovery. More specifically, the article criticized the lack of formal education among individuals in recovery which seemed to negate important contributions to the field. The workforce is quite diverse and includes “graduate trained professionals, direct care staff with on the job training and experience, and persons in recovery from behavioral health conditions. This includes, but is not limited to: psychiatrists, psychologists, social workers, advanced practice psychiatric nurses, marriage and family therapists, addiction counselors, mental health counselors, psychiatric rehabilitation specialists, psychiatric aides and technicians, and peer support specialists and recovery coaches” (Hoge, et. al., 2014, p. 5).
There is no question that as we see more services and supports integrated through formal collaborations, the behavioral health workforce will require different types of academic and professional training. Studies have shown and programs are beginning to experience the critical shortfalls in the number of people entering the workforce. This ultimately affects the individuals and families seeking services and supports. Consequently, it seems practical for the field to support a range of pathways for those interested in pursuing careers in behavioral health. In particular, we should recognize that individuals in recovery, while some may have less formal education, have unique professional strengths such as the ability to (1) establish rapport and provide guidance to people with similar backgrounds, (2) maneuver through and communicate between complex systems, and (3) understand diversity in cultures and communities at an authentic level. Hoge and colleagues (2014) developed core competencies for the behavioral health workforce. These competencies can be applied and utilized for developing job descriptions, employee reviews, identifying training needs and ongoing supervision.
This is a time of great change for the behavioral health field. Leave us a comment to tell us how you are supporting youth, families, and personnel engaged in the recovery process.
Updated: February 08 2018