Transcript LifeRing

An Introduction for Addiction Professionals
By Martin Nicolaus MA JD
CAADAC Region 4 Training
Sept. 19, 2009
Objectives
 To understand basic facts about LifeRing
 To get how LifeRing works
 To pick up tools that can be used with clients
 To facilitate client involvement with LifeRing
Outline
 Hour 1: Basic Facts About LifeRing
 Hour 2: The Three-S Philosophy
 Hour 3: How LifeRing Works
 Hour 4: The Meeting Format
 Hour 5: How To Build Personal Recovery Programs
 Conclusion: It’s Time for Choices in Recovery
Hour 1
 Basic facts about LifeRing
 What is LifeRing?
 Where is LifeRing?
 Who goes to LifeRing?
What is LifeRing?
 LifeRing is a network of recovery support groups
 LifeRing is not a treatment program or a treatment
protocol
 LifeRing is compatible with any abstinence-based
treatment approach
Where are LifeRing meetings?
 There are more than 50 LifeRing meetings in Northern
California
 More than 12 in Canada
 2 each in Ireland and Sweden
 Growing
Where are LifeRing meetings (2)
 Locally, LifeRing meetings are at:
 Kaiser CDRPs (Oakland, Union City, Vallejo …)
 Herrick Hospital
 Merritt Peralta Institute
 Mills Peninsula Hospital
 Center for Recovery (Concord)
 Mandana Community Recovery Center
Where are LifeRing meetings (3)
 Mary Isaak Center (Petaluma)
 Bayside Marin (San Rafael)
 Sierra Council (Roseville)
 Strategies for Change (Sacramento)
 The Effort (Sacramento)
 Veterans’ Administration Clinic (Ft. Miley)
Where are LifeRing meetings? (4)
 LGBT Center (SF), Pacific Center (Berkeley)
 Alano Club (San Francisco)
 Sutter Medical Center (Santa Rosa)
 Home of Truth Spiritual Center (Alameda)
 St. Paul’s Episcopal Church (Benicia)
 First Presbyterian Church (Livermore)
 St. Joan of Arc Catholic Church (San Ramon)
 Unitarian-Universalist Church (Walnut Creek)
Where are LifeRing Meetings (5)
 Greenwich Hospital (CT)
 St. Patrick’s Hospital (Dublin, Ireland)
Also: Meetings Online
http://lifering.org
(a/k/a http://unhooked.com)
 Chat room
 Email lists
 Forum
 Social network
LifeRing comes recommended
“LifeRing has been
extremely popular with
our clients, and we offer
it every Wednesday
evening. MPI would
recommend LifeRing
with enthusiasm and full
support to any other drug
treatment program.”
LifeRing comes recommended (2)
“Our treatment team believes
that there are many viable paths
to recovery, LifeRing being one
very positive adjunct to our
traditional offerings. The
LifeRing meeting is a bright spot
in the patients’ week, and staff
find that participation in the
meeting enhances patients’
motivation to get well.”
LifeRing comes recommended (3)
“I am happy to state that
LifeRing has always been able
to coexist harmoniously with
other support meetings.
Patients report being satisfied
with the format and some say
they attend LifeRing and 12step support meetings. I am
happy to recommend LifeRing
to any drug treatment
program.”
Who goes to LifeRing?
 According to 2005 membership survey (n = 401):
 37 % were referred to LifeRing by a counselor
 34% found it on the Internet
Who goes to LifeRing (2)
“What parts of your LifeRing experience gives you the
greatest satisfaction?”
56%: Absence of religious content
56%: The atmosphere is positive, empowering
53%: Building personal recovery programs
52%: Crosstalk is encouraged
Who goes to LifeRing (3)
“Will you recommend LifeRing to your friends?”
Yes: 98 %
Who goes to LifeRing (4)
“Have you participated in other recovery groups?”
83% participated in 12-step groups in the past
14 % participated in no other groups before
Currently:
45 % do LifeRing only
36% do both LifeRing and 12-step groups
Who goes to LifeRing (5)
Average length of sobriety: 2.74 years
Average age: 47.8
Gender: 58 % male, 42% female
High school graduates: 97%
College degrees: 24%
Professional-technical: 40%
Blue-collar: 15%
Who goes to LifeRing (6)
Raised in religion as a child:
38% Protestant
25% Catholic
4% Jewish
8% Other religion
24% Not raised in a religion
Who goes to LifeRing (7)
In the past year, attended church (or other house of
worship) at least once: 41 %
Every week: 10%
About once a month: 9%
Did not attend during past year: 59%
(National averages:
Every week= ~20 %
Not during past year = ~ 40%)
Source: http://en.wikipedia.org/wiki/Religion_in_the_United_States#Church_attendance
Who goes to LifeRing (8)
In the past year, received some type of professional
counseling for substance use issues: 47%
In past year, received diagnosis for co-occurring
disorder: 45 %
33 % Depression
17 % Anxiety
Details at http://lifering.org/survey/2005_lifering_participant_survey.htm
Who Goes to LifeRing: Summary
• A fairly average cross section of recovery
• Above average educational levels
• Below-average religious involvement
• High level of involvement in treatment
How is LifeRing Organized?
 LifeRing is a 501(c)(3) nonprofit corporation
 Annual Congress of meeting delegates
 9-member Board of Directors
 All officers and directors are volunteers
 Bylaws
History of LifeRing
 Founded locally May 23 1999 in Albany CA
 Founded nationally Feb 17 2001 in Brooksville FL
Hour Two
Basic facts about LifeRing (continued):
The Three-S Philosophy
The Three-S Philosophy (1)
1.
2.
3.
Sobriety
Secularity
Self-Help
1
Sobriety
= Abstinence
Persons with the aim of moderating or
controlling are referred elsewhere
 Persons who have relapsed are welcomed and
praised for coming back

The key is intent
Sobriety (cont’d)
 Grounds:
 Personal experience that moderation or control do not
work for us
 Commitment to living with all senses clear
 Urge to realize our best potentials
+ Drugs suck
Sobriety (cont’d)
 Abstinence not only from alcohol but also from all
other medically non-indicated drugs

For example, a person abstaining from alcohol but using
marijuana is not “sober” by LifeRing standards
 Background:
 Modern trend: Poly-addiction  Poly-abstinence
 Segregation by “drug of choice” obsolete
 All together in the same room (“one-shop stopping”)
 Same as integrated treatment model
Sobriety (cont’d)
Nicotine:
Not required but strongly encouraged to quit
All meetings are non-smoking
Support on quit anniversaries
Education on web site (lifering.org)
Sobriety (cont’d)
Nicotine (Background):
 Nicotine kills more alcoholics than alcohol does
 Negative example of AA founders
 More successful outcomes if you quit both
 Long-term goal: smoke-free LifeRing
Sobriety (cont’d)
Medications
(Typically: anti-depressants, anxiety meds)
 Supported on two conditions:
1. Patient honest with physician
2. Physician competent in addictions
 Medications = sobriety tools
 LifeRing convenors are not physicians!
Sobriety (cont’d)
 Medications (background)
 Too many persons harmed by refusing medications
 Too many physicians’ treatments undermined
 Medications hold potential as recovery aids

(Ref: disease model)
Sobriety (cont’d)
Methadone
 Exhaustively tested as effective v. heroin
 If used as prescribed, should be sobriety tool
 But wide gap between ideal and reality
Medical marijuana
 Widespread abuse, “medical” scams
 If used legitimately (e.g. cancer), should be OK
 Not much experience to date
Secularity
 Secularity = Inclusiveness in matters of
belief or disbelief
Secularity (cont’d)
Secular
Ecumenical
Protestant -- Catholic – Jew -- Muslim
Unaffiliated
Secularity (cont’d)
 NB ~ 40% of LifeRing participants say they
attend church
 But they prefer to perform their religious
observances in church, not in recovery
rooms
 In the LifeRing meeting room, your belief or disbelief
remains your private business.
Secularity (cont’d)
 LifeRing not a religious organization
 No prayers in meetings
 Non-religious change agent (TBD)
 Ref: Court decisions re First Amendment
 Inouye v. Kemna, 504 F.3d 705 (9th Cir. 2007)
 Parole officer should have known that coerced referral to
12-step groups violates Establishment Clause.
 Coerced referral to 12-step liable for $$ damages

More: Brochure, Counselor article, CAADAC talk
Secularity (cont’d)
 LifeRing not an atheist-agnostic organization
 No atheist/agnostic advocacy in meetings
 No attacks on religion in meetings
 Peaceful Coexistence of all faiths and none
 No attempt to modify client’s belief system

(e.g. God who observes v. God who controls)
 Many believers prefer secular environment
 Compare: family reunion
Secularity (cont’d)
 Secularity lets people relax and be real
 Absence of implied moral judgments
 Be what you are
 Safety and freedom in the atmosphere
Secularity (cont’d)
 Secularity is science-friendly
 E.g. animal research showing that addiction is the
product of ingesting addictive substances; not of
character attributes or moral qualities
 E.g. human research showing that every personality type
is equally liable to become addicted
 E.g. research with pharmacological recovery tools
Secularity (cont’d)
 Secular spirituality
 (Not: supernatural spirituality)
 LifeRing meetings are strong on
 Empathy
 Concern
 Caring
 Love
 Respect
 Other positive feelings
  TBD
Secularity (cont’d)
 Participants who want to explore theological issues:
 Refer to churches, synagogues, etc.
 Refer to other qualified professionals
 Our limits as LifeRing members:


Considerable experience with addiction & recovery
Not qualified to teach theology
(3) Self-Help
 Personal responsibility for one’s own recovery
 Cannot be delegated away (to God, physician, etc.)
 Implies a capability to take the responsibility
 Implies a duty to work and fight
 Can be a shocking premise for recovering people
Self-Help (cont’d)
Moment of Existential Panic: Two Outcomes
 Energized
 Paralyzed
 Stimulated
 Defeated
 Takes Charge
 Passive
 Gets to Work
 Waits for recovery to happen
Important for treatment providers to offer choices so that both can prevail
Self-Help (cont’d)
 Personal Recovery Programs (PRP)
 Universal element: Abstinence
 All other elements: Individualized
Personal Recovery Programs
Abstinence
 Abstinence
Self-Help (cont’d)
 Rationale for Personal Recovery Programs:
 "1. No single treatment is appropriate for all
individuals. Matching treatment settings,
interventions, and services to each individual's
particular problems and needs is critical to his or
her ultimate success in returning to productive
functioning in the family, workplace, and society."-National Institute on Drug Abuse
(NIDA), Principles of Drug Abuse Treatment -- A
Research-Based Guide (1999)
Self-Help (cont’d)
 "The roads to recovery are many."-- AA Cofounder
Bill W., The AA Grapevine, Sept. 1944, Vol. 1 No. 4.
Self-Help (cont’d)
 “Treatment should be individualized to accommodate
the specific needs, personal goals, and cultural
perspectives of unique individuals in different stages
of change.” -- Center for Mental Health Services and
Center for Substance Abuse Treatment, Substance
Abuse and Mental Health Service Administration
(SAMHSA), 2006
Self-Help (cont’d)
 “There does not seem to be any one treatment
approach adequate to the task of treating all
individuals with alcohol problems. We believe that the
best hope lies in assembling a menu of effective
alternatives, and then seeking a system for finding the
right combination of elements for each individual.” -Hester & Miller, Handbook of Alcoholism Treatment
Approaches, Effective Alternatives, 1996, p. 33
Self-Help (cont’d)
 “With our two centuries of accumulated knowledge
and the best available treatments, there still exists no
cure for addiction, and only a minority of addicted
clients achieve sustained recovery following our
intervention in their lives. There is no universally
successful cure for addiction – no treatment specific.” –
William L. White, Slaying the Dragon, p. 342
Self-Help (cont’d)
 “Each patient or client develops problems in unique
ways and forms a unique relation to the substance of
choice. Common sense dictates that treatment must
respond to the needs of each individual.” -- Joyce
Lowinson, editor, Substance Abuse: A Comprehensive
Textbook, 1996, p. xi.
Self-Help (cont’d)
What goes for treatment goes for self-treatment
 Formula treatment plan + Personal Recovery Program =
 Individualized treatment plan + Formula recovery program =
 Individualized treatment plan + Personal Recovery Program =
Self-Help (cont’d)
 The clinician’s plan and the patient’s plan
The most successful client in resisting relapse is one
who “confidently acts as his or her own therapist.” –
Dimeff & Marlatt, Relapse Prevention, 1995
“Every patient carries his or her own doctor inside.” -Albert Schweitzer.
Self-Help (cont’d)
 When given a chance, people who were asked and
involved in creating their treatment would regularly
prescribe for themselves treatment that would
work. Sometimes my only contribution to their
success was believing in them until they believed in
themselves.“ -- Lori H. Ashcraft and William A.
Anthony, “Breaking Down Barriers,” Behavioral
Healthcare (April 2008) p. 8
Self-Help (cont’d)
 “The first principle of recovery is the empowerment of
the survivor. She must be the author and arbiter of her
own recovery. … No intervention that takes power away
from the survivor can possibly foster her recovery, no
matter how much it appears to be in her immediate
best interests.” -- Judith Lewis Herman, Trauma and
Recovery: The Aftermath of Violence (Basic Books,
1997) p. 133.
Self-Help (cont’d)
 “Alcoholics recover not because we treat them but
because they heal themselves.” -- George Vaillant MD,
Natural History of Alcoholism Revisited, 1996
 The dominant role in determining treatment success
or failure is the role of the patient. (Study cited by
Vaillant)
Self-Help (cont’d)
What LifeRing does is to
 take seriously the role of the patient in healing
themselves,
 raise this project into consciousness,
 legitimize it,
 and provide support and tools for its accomplishment.
Self-Help (cont’d)
 HOW does the recovering person build their PRP?

Deferred to Hours 4 and 5
 Other dimensions of Self-Help

Deferred to Hour 6
The Three-S Philosophy Summary
How LifeRing Works
How it works: Outline
 Empower Your Sober Self: What it Means
 In more depth:
 The Divided Self
 Horizontal Synergy
 Confrontation v. Support Strategies
How it works
The main LifeRing motto is
What does that mean?
How does it work?
A
Metaphor only – not brain
anatomy
Dominant inside the active
alcoholic/addict’s head is the Addiction
(A).
Some people call it the Disease, the
Beast, or the Devil. By whatever
name, it controls the active
alcoholic/addict’s behavior most of the
time.
A
S
But also present in the active addict’s
head, at the time when they are ready
to commence recovery, is another
force: a part of the personality that
wants to be clean and sober (S).
This is the “sober self.”
Let’s have another, let’s get
wasted, damn the
consequences …
A
S
No, it’s stupid, we
can’t afford it, it’s
boring, I have to
work tomorrow…
The inner conflict between these two camps in the mind is a common
and unhappy experience of alcoholics/addicts.
A
A
S
S
When two or more addicts/alcoholics come together, their
interaction can produce two kinds of changes:
A
A
S
S
If they meet in a drinking/drugging setting, and if the “Addict” parts of the
two brains make mutual contact …
A
A
S
S
… they will reinforce one another’s addiction …
A
A
S
S
… at the expense of the sober place in the brain …
A
A
S
S
… ultimately leading to …
… overdose, irreparable body damage ...
… and death.
A
A
S
S
But if these same individuals come together in a recovery environment,
and …
A
A
S
S
… if the sober place in one connects with the sober place in the other …
A
A
S
S
… and the other connects back, completing the circuit …
A
A
S
S
… then the “S” in both of them will grow and become stronger …
A
A
S
S
… and stronger …
A
A
S
S
… until the sober self rises …
S
A
S
A
… and becomes dominant within the person …
S
S
A
A
… so that sobriety stops being an uphill fight …
S
A
… and becomes comfortable and almost effortless.
S
A
The “A” never vanishes entirely. Putting “fuel” into the body would make
it come roaring back. In every other way, the person can lead a normal,
happy, productive life.
A
S
S
A
Positive reinforcement is the “magic” that makes this transformation
possible.
S
S
This is the basic meaning of the LifeRing motto:
“Empower your sober self.”
How it Works -- Background
 (1) The Divided Self
A person who is addicted
is a person who has
an inner conflict
A
S
The Divided Self
The Divided Self
The Divided Self
The Divided Self
The Divided Self
Not just a literary metaphor but a clinical reality
“Addicts simultaneously want – more than anything –
both to maintain an uninterrupted relationship with
their drug of choice and to break free of the drug.
Behaviorally, this paradox is evidenced both in the
incredible lengths to which the addict will go to
sustain a relationship with the drug and in his or her
repeated efforts to exert control over the drug and
sever his or her relationship with it.” – Wm. L. White
The Divided Self
“[T]he fierce power of an addict’s obsession with drugs is
matched, when the timing is right, by an equally
vigorous drive to be free of them.” – Lonny Shavelson
MD
The Divided Self
“The majority of substance abusers […] are intensely
ambivalent, which means that there is another
psychological pole, separate from and opposite to
denial, that is in delicate, frequently changing balance
with denial and that is a pole of healthy striving.” -Dr. Edward C. Senay, University of Chicago
The Divided Self
“Alcohol abuse must always create dissonance in the
mind of the abuser; alcohol is both ambrosia and
poison.” – George Vaillant, MD, Harvard Medical
School
The Divided Self
Addictive substances set off an “opponent process” in
the brain’s neurochemistry, part pleasurable and part
anti-pleasurable – George Koob MD, Scripps Institute
San Diego
The Divided Self
DSM-IV Criteria for substance dependence include:
“a persistent desire or unsuccessful effort to cut down or
control substance use” or
“knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been
caused or exacerbated by the substance.”
(In other words: inner conflict)
The Divided Self
 In short:
The Basic Model
of Addiction
Psychology
A
S
The Divided Self
The divided self appears to be a bad thing:
“Paradox” – “fierce power v. vigorous drive” – “intense
ambivalence, frequently changing” -- “dissonance in
the mind” – “opponent process” – “knowledge of
having a problem”
The inner conflict may feel like torture
In division lies hope for change
But without the Divided Self, recovery would not be possible
If we see the person as all “S”,
there is no reason to change:
If we see the person as all “A”,
there is no way to change:
S
A
There are no living addicted persons who match either of these two diagrams
Division is the basis of change
 A reason to
change
A
 A basis for
change
S
“The doctor within” – Albert Schweitzer
Another view: Disease Model
 Disease
A
 Immune
System
S
“Treatment rests entirely on recognition of the factors contributing to the
resistance of the patient.” -- Vaillant
Two therapeutic strategies
Support the S
Attack the A
Confrontation
Attack therapy
“Tough love”
Synanon
Many TCs
Steps 1 - 8
A
S
Strength-based
MI
CBT
REBT
DBT
SFT
(Fellowship)
(LifeRing)
Confrontation Doesn’t Work
 “Four decades of research have failed to yield a single
clinical trial showing efficacy of confrontational
counseling, whereas a number have documented
harmful effects, particularly for more vulnerable
populations. … Clinical studies show that more
effective substance abuse counselors are those who
practice with an empathic, supportive style.” William
R. Miller and William White, “Confrontation in
Addiction Treatment,” Counselor (October 4, 2007),
Examples of support strategy
 From Lonny Shavelson’s book, Hooked: Five Addicts
Challenge Our Misguided Drug Rehab System
Examples of support therapy
 Example 1: Darlene
Example of support strategy (1)
 Darlene: “If an addict doesn't want to get off drugs, you
can just talk at them until your eyes turn blue, and they'll
just tell you to fuck off."
 Dr. S: "Just possibly, that person who you're speaking about
may have the teeniest of desires to deal with her drug
problem.”
 Darlene: "Well, what if that person only has the teeniest,
teeeniest, tiniest wanting to be off drugs?“
 Dr. S., shakes Darlene’s hand: "Then I would think that
such a person would do very well in this clinic."
(Shavelson 2001:281)
Example of support strategy (1)
 Client has “teeniest,
tinyest desire to be off
drugs”
 Counselor shakes
hands, forms therapeutic
alliance with client’s “S”
A
S
Example of support strategy (2)
Glenda
Counselor Evelyn
'Evelyn tells me,
“Glenda, you're a
strong, wise lady.”
She says all kinds
of things about me
that make me feel
really good.' -(Shavelson 2001:204)
Example of support strategy (2)
Evelyn
A
S
Example of support (3)
 Drug court counselor
Marillac
 Runs a group with Drug
 Shavelson asks: Why do
Court clients, mandated
you do that? Shouldn’t
to be there
you be reading them the
 Instead of talking tough
riot act?
to clients, spends time
bringing out clients’ good
points
Example of support (3)
 Marillac “It's just the opposite. I have to be more
relaxed with them here. The fact that they're
mandated to be in rehab doesn't make their treatment
easier, it makes it harder. They have to show up, but
then I have to win them over to wanting to change their
lives. If I act tough, all I get is an addict who's pissed at
another authority figure. So I've got to grab at what
good they have inside of them, and they have to see me
grabbing it, bringing it out – accepting them.” -(Shavelson 2001:232)
Example of support (3)
Marillac
A
S
Summary
 Different aspects of empowering the sober self:
 Recognizing
 Validating
 Pouring love into
 Building alliance with
 Holding up to light
 Honoring
 Responding to
 Relating to
The LifeRing Meeting
The Engine
A
A
S
S
Circle seating
Large circle
Short Opening Statement
 Basic meeting philosophy (Sobriety, Secularity, Self-
Help)
 Confidentiality
 Format
 Welcome
 Takes less than 2 minutes
“How was your week?”
 Highlights and heartaches of recovery this week
 Plans and expectations for coming week
My week went like this … I did … I felt
… I thought … and then …
Next week I face … my plan is …
S
How was my week?
 How was my week? My boss made me go to the office
party, even though there was alcoholic punch and I
was just a week sober, and I did it and I didn't drink. I
feel great.
 I got together with my sober buddy and we watched
the Raiders game and didn't drink, for the first tim e I
can remember.
 I drove home and there were my parents in the living
room smoking crack. I ran out of the house and got
back in my truck and peeled out of there.
 My sister and I talked and hugged each other for the
All* LifeRing Meetings Encourage Cross-talk
I had something
very similar
happen … did you
mean? … I think
what you did is
cool …
S
S
*Except meetings in special settings with highly vulnerable populations
Cross-talk is powerful
S
S
What happens if you only hook up one wire in the jumper cable?
Cross-talk is powerful
Horizontal synergy
S
S
S
Crosstalk is feedback
 “One general finding in the motivation literature is the
persuasiveness of personal, individual feedback.
Lectures and films about the detrimental effects of
alcohol on people in general seem to have little or no
beneficial impact on drinking behavior, either in
treatment or in prevention settings.” -- (Hester &
Miller 2003:138)
Some limits on Meeting Talk
 No attacks or confrontations
 No unsolicited advice
 No bashing other recovery programs
 No religion, pro or con
 No politics
 No uncivil behavior
These are general rules of friendly conversation
Crosstalk is just another word for conversation
Aim: Living Room atmosphere
 Friendly, safe, candid
“How was your week?” Format
YES
 Here and now focus
 Personal experience
 Small decisions
NO
 Drunkalogues and
Drugalogues
 Book recitals
 Infomercials about how
the program saved them
Pluses of the HWYW Format
 Low entry barrier -- most people speak on Day 1
 Speaking leads to self-knowledge
 One’s own sobriety meaningful to others
 Ever-changing panorama of issues
 Democratic, equal-opportunity format
 Brings sober scrutiny to life decisions
 Encourages sober planning
 Helps people carry the meeting with them
 Atmosphere is positive, encouraging, motivating
Negatives of the HWYW Format
Limits size of meeting
Meetings may split into two
NB Some LifeRing meetings modify the format or use a
topic format
Closing ritual
Round of applause for one another, because:
 The outside world little understands or appreciates our
recovery journey. They tend to believe that we can 'just
say no‘ and be done with it. But we who fight this
battle every day know the inner struggles we go
through and the work that's involved in rebuilding our
lives. We appreciate the courage that it takes to be
here. Recovery is an estimable project, and we have
earned the sober self-esteem that we feel today. We are
heroes and winners.
Meeting facilitators
 Meeting facilitators are ordinary persons in recovery
(peer leadership)
 “Convenors”



con = with, together
venire = to come
“People who bring people together”
 Six month minimum sobriety requirement
Practical details
 A signup sheet is passed
 To facilitate people’s contacts between meetings
 Phone and email
 A basket is passed for voluntary donations
Other issues
 Labels are optional
 Depends on how label affects person’s A-S balance


For some, “alcoholic” label heightens vigilance
For others, “alcoholic” label paves way to relapse
 It’s the individual’s choice whether to use label or not
Other issues
 Time keeping is optional
 But convenors must have six months
 Officers must have 1 year
 Directors must have 2 years
 Relapse = resignation
Other issues
Sponsors
 Role in 12-step
Pilot through 12-step program
2. Consult between meetings
1.
 PRP is not a formula-type program
 Usually no role for a pilot (authority figure)
 Everyone encouraged to consult everyone else between
meetings


Everyone can be the sponsor of everyone else
Each person can have any number of sponsors
Convenor Handbook
http://lifering.com
How people build Personal
Recovery Programs (PRP)
Two Pathways to PRP
1. Through the “How Was Your
Week” Meeting Format
2. Through the
Recovery by Choice
workbook
(1) PRP via HWYW meetings
 “Random access”: progress and sequence of program
construction depends on what happens in meetings
and who happens to be present
 In each meeting, person may pick up a “nugget” that
works for them, and make it part of their recovery plan
 Like making a mosaic from found stones
(1)
“Random
Access”
Sequence
(HWYW
Meetings)
(2)
Structed
Sequence
(Workbook)
(1) PRP via HWYW meetings
 Advantages: companionship, feedback, all the
benefits of positive social interaction
 Disadvantages: little control over subject matter, may
not want to expose private issues, group chemistry may
or may not be good fit
(2) PRP via RBC Workbook
 Advantages: control over sequence, timing, subject
matter; thorough range of topics; complete privacy;
benefits of writing things down; ability to reflect back
later; usefulness of a permanent record of one’s own
recovery
 Disadvantages: Cost, lack of social interaction, literacy
requirement
 Possible synthesis: Workbook study groups
Nine Domains (Work Areas)
My
Decision
1 My body
9 My
Treatment
8 My
Culture
2 My
Exposure
The Relapse
Chapter
7 My
History
3 My
Activities
4 My
People
6 My Life
Style
5 My
Feelings
My
Recovery
Plan
My Decision
A
Should I move in with D?
How it would reinforce my A
How it would reinforce my S
 D’s main squeeze is probably a
drunk

 D’s other roommate keeps wine in
fridge
 There is a liquor store right on the
corner
 I’ll have to work longer hours to
afford it
 I hate the purple paint trim in the
hallway, makes me want to drink
 I’ll have to listen to D’s dog barking
at night sometimes, drive me nuts










D does not drink or use or smoke
I will be in a neighborhood with less drugs
I’ll have a nicer room, less stress
It’s quieter, not so much loud partying
I’ll be able to bicycle to work, save commute
money
I’ll live closer to F and L (sober friends) and
spend more time with them
I’ll get away from my druggy roommates
I’ll get to play with D’s dog
There’s a washer-dryer there, don’t have to go
to the stinky laundromat
Good light, I can have house plants
Eventually I can find my own place in that
neighborhood
S
The A-S T-chart
 Main point:
 To evaluate every decision in terms of recovery
 Will my plan strengthen my Sober Self (“S”) and lead
me toward a stronger, broader, more satisfying
recovery, OR
 Will my plan strengthen my Addict Self (“A”) and lead
me in the direction of relapse?
The A-S T-chart
 Question: isn’t this narrow and dogmatic?
 If I always choose for the S, all my potentials can be
realized. The S is the doorway to everything else
 If I opt for the A, the doors will shut and everything
will go down the drain
Domain 1: My Body
2 Telltale Signs
__ I have some telltale visible signs of my drinking/using on my body, namely:
__ red eye
__ burst veins in nose / face
__ pot belly, overweight
__ anemic, emaciated
__ needle track scars
__ nose damage
__ stained fingers
__ skin abscesses
__ burst veins in legs
__ shaky hands
__ scar, fracture or other injury I got while under the influence
__ bad teeth, gums
__ other, namely _____________________________
__ Nobody could tell I drank/used, I look completely normal.
Domain 1: My Body
12 Exercise
__ I am physically active and get plenty of exercise each week
__ I get some exercise each week but a little more wouldn’t hurt
__ While I drank/used I was an active athlete and in good physical condition
__ While I drank/used I got very little exercise other than bending the elbow
__ I am seriously out of shape now
__ I’ve noticed that I feel better when I take some exercise
__ I would like to exercise more but can’t figure out how or what or when
__ I know perfectly well how to exercise more but I just don’t do it
__ I have noticed that when I exercise it is easier to resist my cravings to drink/use
__ I am disabled and cannot exercise except in very limited ways
__ I am going to exercise more, starting __________ (date)
__ I am not going to change my exercise patterns
Domain 1: My Body
Domain 1: My Body
Domain 4: My People
Domain 4: My People
Domain 4: People
Domain 4: People
Domain 4: People
Nine Domains (Work Areas)
My
Decision
1 My body
9 My
Treatment
8 My
Culture
2 My
Exposure
The Relapse
Chapter
7 My
History
3 My
Activities
4 My
People
6 My Life
Style
5 My
Feelings
My
Recovery
Plan
Relapse Chapter
Relapse Chapter
Relapse Chapter
Relapse Chapter
Relapse Chapter
Nine Domains (Work Areas)
My
Decision
1 My body
9 My
Treatment
8 My
Culture
2 My
Exposure
The Relapse
Chapter
7 My
History
3 My
Activities
4 My
People
6 My Life
Style
5 My
Feelings
My
Recovery
Plan
Pulling the PRP Together
Pulling the PRP Together
Pulling the PRP Together
Pulling the PRP Together
Result: Diversity of Programs
Abstinence
 Abstinence
Pros and Cons of PRP
Cons
 May be more difficult
than working a formula
program
 No answer book
 Tough questions
 Forces you to THINK
 No authority figure
 Not for everyone
Pros
 Investment
 Motivation
 Comfort
 Portability
 Adaptability
 Resilience
 Efficacy
Why PRP (more)
 The most successful client in resisting
relapse is one who “confidently acts as his or
her own therapist.” – Dimeff & Marlatt, Relapse
Prevention, 1995
Why PRP (more)
“The assembly-line approach ... may work when the
content is purely cognitive. But when it comes to
emotional competencies, this one-size-fits-all
approach represents the old Taylorist efficiency
thinking at its worst....We change most effectively
when we have a plan for learning that fits our lives,
interests, resources, and goals.” -- Daniel Goleman,
Working with Emotional Intelligence (2006)
Why PRP (more)
 “A strong and consistent finding in research on
motivation is that people are most likely to
undertake and persist in an action when they
perceive that they have personally chosen to do
so.... When clients are told that they have no
choice, they tend to resist change. When their
freedom of choice is acknowledged, they are freed
to choose change.” --(Miller 1996:93-94).
Why PRP (final)
 Thirty years ago, at the beginning of the HIV crisis, the
blood banks desperately needed more donors. They
commissioned a study to find out how to reduce donor
discomfort and increase donor repeats. They
discovered two “magic words” that dramatically
reduced donor discomfort and brought them back to
donate again and again.
“Which arm?”
Chase & Dasy, Harvard Business Review 2001:83
LifeRing is a strength-based
approach
2. It’s time for choices in recovery
1.
(1)LifeRing is a Strength-Based Approach
We see both the A
and the S, but we
concentrate our
energies on
building up the S
A
S
What we see when we see the strengths
Seeing only the A
Seeing the S
 Insane
 Capable of reason
 Can only surrender
 Able to fight
 Morally defective
 Morally mixed
 Focus on errors
 Some wrongs, some rights
 Menace to others
 Some harm, some help
 Clueless
 Capable of planning
 Diseased
 Capable of healing
 Genetically defective
 Not genetically programmed
 Powerless
 Able to abstain from No. 1
What we see when we see the strengths (cont’d)
Seeing only the A
Seeing the S
 Nothing inside to build on
 Solid basis to build on
 Nothing within to respect
 Ground for respect
 No inherent dignity
 Has inherent dignity
 No goodness inside
 Has inherent goodness
 Can be helped
 Can help themselves
 Needs to hide
 Can well be seen
 Should be ashamed
 Should be proud
 Deserves pity / contempt
 Deserves respect & credit
 No hope within
 Ground for hope within
It makes a difference!
In the Herrick 4N 51-50 ward:
 “The LifeRing group approach encourages patients to
look within themselves and to each other for the
strength to achieve abstinence and a healthier lifestyle.
… We have found that this approach encourages
patients to begin to think positively about themselves
and to find a reason to live productively…. The
LifeRing meeting is a bright spot in the patients’ week
and staff find that participation in the meeting
enhances patients’ motivation to get well.”
(2) The Aim of LifeRing is Choice
 LifeRing does not aim to undermine or to
replace any other support group or
treatment approach
 The aim of LifeRing is to provide recovering
persons with an additional choice of
recovery pathways
 And to provide the treatment professional
with “another arrow in the quiver”
We need more choices
AA Retention Rate; graph adapted from Don McIntyre, “How Well Does A.A.
Work? An Analysis of Published A.A. Surveys (1968-1996) and Related
Analyses/Comments,” Alcoholism Treatment Quarterly, 18, No. 4, 2000.
AA affiliation rate: 5 per cent
 More than 80 % walk away within 30 days
 90 % walk away within 90 days
 At the end of a year, only 5 % are left
Choice should not be controversial
"The roads to recovery are
many."-- AA Cofounder Bill W., The AA
Grapevine, Sept. 1944, Vol. 1 No. 4.
It’s time for more choices
"It is time that the recognition of multiple
pathways and styles of recovery fully
permeated the philosophies and clinical
protocols of all organizations providing
addiction treatment and recovery support
services." -- William White, MA and Ernest Kurtz,
PhD, "The Varieties of Recovery Experience: A
Primer for Addiction Treatment Professionals and
Recovery Advocates" (2005)
What can providers do? (1)
 Get familiar with all the available support options
 Get, display, and distribute literature from all available
support groups
 Make room space available to meetings
 Provide a level playing field in support group referrals
 Provide choices at first contact
 Eliminate “bounce” referrals
 Neutralize program forms and literature
 Neutralize signage and decorations
What can providers do? (2)
 Hire and retain staff with multi-path competency
 TSF and/or MI and/or CBT and/or DBT and/or Choice
Theory and/or SFT …
 Provide clients with multiple treatment pathways
 Via multi-path protocol in same group, or
 Via separate groups with adapted protocols
 Support client initiative in building PRP
 Mesh with program’s own individualized trx plan
Choice is good program policy
 The 5% retention rate for AA holds lessons for
treatment programs
“The treatment system we currently have ... was
devised in 1975, when all we had for treatment was
basically group counseling and AA….Most people
don't want it; they have to be forced into it.“ -Mark Willenbring, Director of Div of Treatment and
Recovery Research, NIAAA, in Technology Review (MIT)
October 27, 2006
Choice is good program policy
 Single-path approaches limit and erode
program census
 Widespread program camouflage
 Choice attracts and retains clients
More choices = more recoveries
LifeRing
12-Step
Other
Recovery
For more information:
 www.lifering.org – LifeRing, the organization
 www.lifering.com – LifeRing Press e-commerce
store
 LifeRing Service Center, 1440 Broadway, Ste. 312,
Oakland 94612
 [email protected]
 1-800-811-4142
Available literature (1)
 Empowering Your Sober
Self: The LifeRing
Approach to Addiction
Recovery
Published 2009 by Jossey-Bass, a
division of John Wiley & Sons;
with a foreword by William L.
White.
ISBN 978-0-470-37229-6
Available literature (2)
Recovery by Choice: Living
and Enjoying Life Free of
Alcohol and Drugs; a
Workbook
Third printing, LifeRing Press
2006
ISBN 0-9659429-3-7
Available literature (3)
How Was Your Week:
Bringing People
Together in Recovery
the LifeRing Way
Version 1.00, LifeRing Press
2003
ISBN 0-9659429-4-5
Available literature (4)
Presenting LifeRing: a
Primer for Treatment
Professionals
Third ed., LifeRing Press
2006
ISBN 0-9659429-5-3
Available literature (5)
What is Recovery? A
Quality of Life
Perspective
By B.J. Davis, Clinical Director,
Strategies for Change
(Sacramento)
55-minute DVD
LifeRing Press 2009
Available literature (6)
LifeRing 101
45-minute CD
Slide show
Runs on computer only
LifeRing Press 2001
Available literature (7)
Brochures
 Welcome to LifeRing
 If This is Day One
 Sobriety is Our Priority
 Secular is Our Middle
Name
 Self-Help is What We Do
 LifeRing Online
 We Come
Recommended
 Give Something Back
 Choice of Support
Groups: It’s the Law
 Food for the Sober Mind
 A Different Kind of
Workbook
Available Tchotchkes (1)
LifeRing Lapel Pin
The End