Hello readers and welcome to this special interview with Jeff Kamen, a licenced chemical dependency counsellor based in Austin, Texas and the administrator of the Your Choice Recovery and Medication Assisted Recovery Anonymous – MARA Facebook pages.
Jeff quite interests me because (unlike many counselors I’ve crossed paths with in the past) he’s not fixated upon any one particular paradigm – “because one size does not fit all” in his view – and he’s really quite interested in modern treatments such as The Sinclair Method.
As he says on his Your Choice Recovery Facebook page:
“One particular avenue which deserves to be noted up front is The Sinclair Method which boasts – and rightly so – a 78% success rate of turning heavy drinkers or people with AUD (Alcohol Use Disorder) into moderate, safe drinkers. Whether or not you come to Your Choice Recovery to meet with a counselor, I highly recommend that you take a good look at the Cthreefoundation.org website. You will find a great deal of information about how The Sinclair Method works. In addition, any videos by Claudia Christian about TSM are worth watching, especially her 50-minute documentary, One Little Pill. The book The Cure for Alcoholism by Dr. Roy Eskapa describes a medically proven way to eliminate alcohol addiction. If we determine that TSM is appropriate in your case, as your counselor, I will help you keep a drink log, remain compliant, discuss any unforeseen obstacles which may arise. You may want total abstinence as your goal. There are many ways to achieve it. I will be happy to describe each one for you in order to help you choose the best route for you!”
So just carrying on from our conversation over Messenger I’d like to again thank you for agreeing to this interview… and I think the question I asked (“What’s wrong with you?? You’re a treatment provider who actually wants to CURE people?!? Don’t you realise what such a good gig you’ve got going with the revolving door thing – why do you want to do yourself out of a job?!???”) is probably quite a fun place to start.
Okaaaay… over to you, Jeff. 🙂
I would love if everyone were cured. However if TSM grows and becomes accepted by the mainstream recovery community, including doctors, judges, counselors, etc., there remains issues which can then be brought up. One such issue is that TSM is being used for alcohol use disorder. At this point if an addict tries TSM I believe he will be able to drink (alcohol) moderately, however he will still crave drugs. There is no program presently in existence in which TSMers can speak about problems they’re having.
The case I am making is that even among the advocates of TSM, I don’t feel that it is accepted for a drug addict/alcoholic to do TSM. As a chemical dependency counselor who is totally behind TSM, I still only offer to help someone with it if they have no other drug abuse history. There needs to be a program that will help a person follow TSM while working some sort of program of recovery for their drug use history. Imagine going to a 12-step program where it’s okay to talk about your usage of TSM, while still working a program of recovery on the other addictions. Presently, AA (even though drugs are an “outside issue”) does not consider a person sober if they use drugs. Conversely, NA doesn’t consider someone sober if they drink alcohol. I hope that wasn’t too confusing.
To more simply answer your question Gary, I would gladly find another career path if there were no more need for drug counselors. Unfortunately, I don’t think that will be happening anytime soon.
Regarding your comment “even among the advocates of TSM, I don’t feel that it is accepted for a drug addict/alcoholic to do TSM…”… that’s an interesting point, but according to chapter 15 of The Cure for Alcoholism (“The Sinclair Method as a Blueprint for Treating Other Addictions”) doesn’t TSM also have applications for things like opiate, amphetamine and cocaine addiction?
Using TSM for Amphetamine, Cocaine Opiate Use Disorders is promising. It would be difficult to work on them together. “I took my Naltrexone an hour ago so now I’ll go shoot a Speedball (usually Cocaine with heroin).” We know the heroin may have no effect after taking an Opiate antagonist. The Cocaine may work similar to alcohol in the way of Pharmacological Extinction. It gets confusing. I doubt, at this point in time, a doctor will write a prescription for anything with dosing directions stating “Take this pill one hour before shooting Cocaine (or other chemicals).” Perhaps an addict who got the medication some other way, might try it. If they did, the method may very well work (with full compliance). Many addicts have multiple addictions. The addiction to mood-altering Substances simply became an addiction to “More.” (Anything that changes my mood and I like the feeling, I want More!) To avoid present-day confusion and controversy with Pharmacological Extinction, it would be easier to have a more accepted method of recovery in place but modified to include TSM’ers.
TSM works. That being said, it is only accepted by a small minority at this time. Attracting more professionals to help believe in and spread the word about TSM, needs to be done with as little confusion (and no ethical resistance) as possible. Therefore sticking with TSM for AUD treatment while adding a program of recovery for other Substances, may be adding the least amount of controversy to a subject that should not be controversial at all, yet is!
‘The addiction to mood-altering Substances simply became an addiction to “More.” (Anything that changes my mood and I like the feeling, I want More!’
…Interesting that you should say that. I’m paraphrasing, but something that Robert Rapplean was saying in the very recent podcast interview that I did with him was along the lines of “some people drink or drug not so much because they’re driven by craving, but by a need to alter how they’re feeling”… which puts me in mind of the classic example of what happened when thousands of heroin addicted veterans of the Vietnam conflict returned home to the states – the majority of these soldiers quit very quickly and with very little difficulty.
So would you say that, if you’re a therapist, the question then becomes “Well, just where does the individual in front of me fall on the alcohol use disorder spectrum?”… i.e. how much of this can be addressed through anti-craving medication like naltrexone using The Sinclair Method and/or how much of a need is there to address other internal or environmental difficulties?
Interesting question Gary. It reminds me of an early reply when I stated that there needs to be a program of recovery for people taking TSM. I think if someone has all other issues in their life in healthy order, TSM is enough. In cases where there is more needed, such as when the person has no support group, the person will most likely (about 78%, so they say) become disinterested in alcohol. However they will not have other needs met.
There’s another program which talks about the “emotional hangover.” If there is something missing from a person’s life which is causing them to be unhealthy this will cause increasing stress over time. As far as I know lack of a support group is the number one cause of relapse and an inability to handle stress is the second.
When using TSM you may want to consider not being compliant as a type of relapse — or lapse as some prefer. Becoming disinterested in alcohol, to me, is partially because I know that no matter what I am going to take my naltrexone an hour before I drink. If an individual runs into what I like to call “The Perfect Storm (e.g., gets fired, car breaks down, spouse leaves all at the same time), there will be a high amount of stress. At that point something needs to be in place to handle it. Either the person has great stress-coping skills or a support group to help them deal with the stress.
When these things are missing it may be tempting to make a bad decision and skip the naltrexone at the next drinking session. I can imagine someone who has had great success with TSM may feel that they can’t handle the way they’re feeling at the moment. I can imagine them thinking that they can go back on TSM after they get through this rough patch.
Summing up the answer to your question: I do not think it matters where the person “fall(s) on the alcohol use disorder spectrum.” It does matter what other balance the person has in their life – is their life in balance both before the stress hits and when the stress hits? Balance has a great deal to do with recovery.
I honestly cannot make any assumptions about other people’s motivations for non-compliance and subsequent re-addiction, Jeff. Everyone is different.
It is an area that needs more research – we need to learn from our failures. [Though “failure” is perhaps too unforgiving as a choice of word, given that many people get back on the horse and subsequently course-correct quite well]
Clearly, education is key here. But speaking for myself, because I read The Cure for Alcoholism quite thoroughly prior to starting TSM I was therefore very well aware of the importance of “the golden rule”.
Another factor is that I’m one of these people who has been plagued by bad luck all my life… seriously… I’m not kidding – I never ever, ever, ever win anything in games of chance; I always lose (hence why I don’t even bother with the lottery).
Being prone to such poor luck has resulted in my becoming someone who doesn’t take uncalculated and emotionally-driven risks lightly.
…Hence why when I read something that more or less says “The odds are that you will very likely become re-addicted quite quickly if you do this…” I tend to take notice, given this weird hex which I have.
Moreover, despite having the experienced the most godawful “perfect storm” and having very little support myself on numerous occasions over the last couple of years dealing with the fallout of my mother being murdered and then the subsequent trial what’s most interesting is that though I could have given myself an easy excuse, my attitude toward compliance instead actually hardened because my motivation then became one of: “As much as this is a godawful waking nightmare I need to be 100% present 24/7 in order to be there for my family”.
But other people are different and their “perfect storms” are very different so I cannot make any judgements here. In terms of willpower I cannot claim to be any stronger or any weaker than anyone else.
Another thing – and this is going to probably sound very weird to you, Jeff… but another factor in my success has been spite, as crazy as that sounds.
To explain: the evil bastard that robbed and murdered my mum and then set fire to her home was a crack cocaine addict… so, you see, what happened was that my own continued compliance and abstinence (despite what I was going through) then became a defiant “f*** you” to the perpetrator and his defence team during the trial, should they have ever attempted to use his addiction as a mitigating factor or as a way to make the jury feel sorry for him.
…Anyway: I got sidetracked and ended up just talking about myself again! Haha! You must be thinking “It’s all me, me, me with this guy”. Sorry, Jeff.
Going back to what you were saying, Though I see some value in one-to-one counselling (should someone require help for whatever issue) I’m not so sure that TSM peer support groups (whether they be in “the real world” or virtual) are always a recipe for success for everyone, but education most definitely is when it comes to TSM.
Despite many people’s fears that TSM will put many addiction professionals out of work by virtue of making things like the need for detoxes obsolete, the fact is that there will always be a need for good educators.
I definitely do not think you’re all about “me, me, me”. You help others daily.
Interesting that we both mentioned the need or lack of need amidst hearing about MARA. I am truly happy for your current success!
I do think many people lack the ability to deal with stress. I took a class once and there was a test about coping skills. The results (be they valid or not) were that I was going through the highest stress factors in the class at the time but that I also had the highest level of stress coping skills in the class. To me, it meant that I have the knowledge to deal with stress (life) but it didn’t help unless I actually put that knowledge into action.
Support groups can help with accountability and help the individual get through tough times. Not everyone is strong enough to do it on their own.
It might also assist in spreading the word of TSM.
Well, when it comes to MARA (Medication-Assisted Recovery Anonymous), my attitude is that I’m all for newer, more inclusive interpretations of the 12 Steps; which is why I’ve been a fan of things like AA Agnostica and AA Beyond Belief for quite a while.
Despite my not being “a group person” and despite my own previous negative experience with AA (which I speak openly about HERE) and also despite the fact that I cannot minimalize the legitimate criticisms that many people have of the Minnesota model, I have a real respect for people within the movement who are actively trying to change it from the inside. I think that’s really gutsy, in fact… I consider such people real pioneers.
Which is why when I read the recent Slate article which covered what Megan McAllister had done setting up MARA I immediately reached out to her and said “Well done”.
This is what a lot of people don’t quite get about me, Jeff: the fact that I’m not anti-AA. What I really am is “pro-choice” when it comes to recovery. Though I do have a clear bias toward The Sinclair Method for treating alcohol addiction and would recommend it as the first choice for the majority of people with an alcohol addiction, I’m all for people having as many options as they can at the end of the day.
…And on that note I’d like to thank you for a wonderful interview, Jeff. It’s been a pleasure speaking to you. And well done on what you’re doing with setting up your own MARA group – it’s inspiring!