There are a couple of recent documentaries on the culture of Alcoholics Anonymous (see The 13th Step the film which documents systemic psychologically damaging dynamics), and the $35 billion dollar business arm called the ‘rehab’ industry (thebusinessofrecovery.com which documents deceptive business practices). Those films have only started being distributed in the last year, and not widely. A book called The Sober Truth: Debunking the Bad Science behind AA and the Rehab Industry by Lance Dodes also takes a good critical look at evidence.
While these are newer attempts to inform the public about real problems with AA, complaints are not new and have been increasing. Rehabilitation programs like Straight, Inc. in the eighties were controversial and faced lawsuits for false imprisonment and abusive practices. In 1999 a doctor won a case against a rehab program for false imprisonment, fraud and medical malpractice. In 2001 the Department of Justice issued a statement that any use of DoJ funds to indoctrinate religion (specifically 12-step programs) was a violation of the 1st Amendment, yet my own investigation found that state programs are still very actively involved in spreading the AA message.
Several cases have set precedent that it is illegal for judges to order people to AA, and yet they still do it. Many doctors who have heard about getting help with an addiction problem entered into Physicians’ Health Programs only to find that they will lose their licenses if they don’t attend a 90-day rehab (at their own expense), 3 AA meetings a week (for years) or try to dispute mandatory, random drug tests (paid for by them). These programs establish behavioral contracts with the license as leverage and any violation adds YEARS to the contract. (see disruptedphysician.com ) Doctors, nurses, pilots who have lost their livelihood, when they don’t kill themselves, sometimes realize they have nothing to lose anymore and decide to speak out. Many of them straightforwardly identify the system as a racket, unfair, and ‘kafkaesque’.
Sober living environments are presented as a treatment option, and often turn out to be not much more than slumlording as a non-profit — no actual treatment, no medical oversight, but maybe a pee testing scheme to make money for each ‘head’ from insurance companies. These places are often even considered ‘rehabs’ or halfway houses but often are nothing but houses with AA members in them.
AA through its pamphlets teaches members how to promote these professional systems and rehabs through the media, and yet denies any involvement or responsibility. What is called the New Recovery Advocacy Movement is the cultural cooption of AA alternatives (like MM and SMART) and tries to gather them all under the umbrella of ‘spiritual recovery’ and the rehab and sober living industry. One example of this is a movie called The Anonymous People which found some data about 20 million people in America being considered ‘in recovery’ because they had a substance use issue and resolved it, and used that to enhance the image of ‘Recovery Culture. In reality there are only about 2 million people in AA and the majority recover without treatment or religious conversion, and there is even evidence that treatment is counterproductive. I could go on and on.
This is all to say that someone approaching AA with a methodological atheist standpoint will be tempted to reinterpret AA in secular terms assuming that the interpretation will explain ‘how it works’, when it actually doesn’t (as treatment). The assumption that it works in the first place is only an assumption. Even the concept of needing a support group is mostly an invention of AA, and prematurely assumed to be an important aspect of any secular approach.
A closer look at evidence, even the positive evidence such as experts claiming it works or that “they don’t force people into AA anymore” doesn’t stand up to scrutiny, and these dynamics (such as the fact that critics may never be allowed to BE professionals in the recovery industry and may in fact not want a piece of it) does more to explain how racketeering, censorship and misinformation works than how a treatment for ‘alcoholism’ works.
I’m talking about not just one therapist, not just her supervisor and the clinical director, but a whole network of over 300 ‘faith-based’ (and state licensed) centers accredited by one organization that seems to have no interest in addressing this.
“Declaration of any particular religious belief is not a requirement for treatment, however, and counselors do not impose personal theological beliefs upon counselees, but instead work within a spiritual context when appropriate.”
I am writing today in good faith to inform as many Samaritan Counseling Centers as possible of a very serious problem that needs to be addressed but has not been in any way shape or form by Samaritan Counseling Center of the Capital Region, the state licensing board, or Samaritan’s accrediting body, Samaritan Institute.
– There is much evidence that 12-step programs are often ineffective in ‘treating’ addiction ( The Sober Truth by Lance Dodes ), often psychologically damaging when ineffective (“keep coming back” to hear that you are “constitutionally incapable”, which has often lead to suicide), illegal and unethical to coerce participation in (according to 1st Amendment legal precedents and all social work professional ethics codes), and that the organization of Alcoholics Anonymous itself seems completely uninterested in promoting safety information for its members or alternative views, scientific data, or health information regarding drug use (which would seem to be its fiduciary responsibility as the ‘hub’ of ‘addiction treatment’.)
– I was (and this is corroborated by records on my website), repeatedly ‘recommended’ to attend 12-step meetings after having attended AA daily on my own for a full year, and finally seeking professional help at Samaritan Counseling. My termination from Samaritan Counseling, based on my records, seems to have been based on my not following these ‘recommendations’ well enough during a full year of therapy.
I understand that some people feel at home in a 12-step environment. My intention is to bring awareness to the fact that not everybody is, and that state-licensed therapists have a responsibility to acknowledge social and public health problems rather than pretend they don’t exist as part of a ‘faith-based’ approach.
It may also seem that I am complaining about nothing, since I did finally decide AA was not for me, and Samaritan is no longer ‘treating’ me. I want to explain, though, why I feel that this has not been addressed, and why it is still a big deal and a serious public health problem.
1. The very real option of leaving AA and thinking of alcohol dependence as a phase in my life (a very common life event backed up by NIAAA’s 2002 epidemiological survey of over 40,000 people representative of the US population) was never presented to me. Even after I had lost all faith in AA, I was still compelled to pay AA members and somehow ‘make it work’.
2. I was discouraged from exploring alternatives. I started SMART Recovery, and was then referred to 12-step rehab. I was terminated for refusing any more 12-step treatment. There may have been other factors in my termination, but the official position of Samaritan was that I had been properly referred to a 12-step interventionist, that they could not help me and refused to try because I hadn’t ‘followed the recommendations’.
3. Therefore, I was cut off from my therapist, which was one of the most meaningful relationships in my journey. Records show that 12-step ‘boundaries’ and ‘tough love’ strategies imposed by 12-step ‘experts’ were involved in preventing me from discussing the situation directly with her.
4. There are several indications that my own therapist was not particularly fond of repeatedly referring me to AA. Her own frustration could have been another factor in my termination. The Clinical Director also indicated frustration with the ‘program’.
5. What this means is that the whole culture/environment of not being allowed or able to openly discuss the failures of AA (which is nothing more than a set of religious ideas that assume they are perfect treatment for just about anything, and deny any role in confusion) shifted blame to actual people: my therapist was being considered unsuccessful in transferring me happily into 12-step treatment, and I was failing to ‘work the program’, which is clearly a Christian or heretical Christian program, while I’m a Buddhist. Faith-sensitive therapy should be able to understand that these views aren’t necessarily compatible.
6. Even more importantly than the fact that referring and re-referring to the same failed treatment is not a very reasonable method, I believe that the dynamics of coercion, dependence, shunning (or ‘blocking’ which is used to protect members from outside information and is supposedly a ‘natural consequence’ of ‘disturbing the recovery community’), invalidating thoughts and experiences, and ‘leverage and consequences’ led to strong transference and countertransference reactions between me and my therapist.
7. It is my contention that trying to ‘treat’ a ‘transference issue’ largely caused BY the 12-step treatment WITH the same treatment can do nothing but compound the problems, and is itself a primary form of mishandled transference.
Those are the reasons I think it is important to address the issue directly. Here is why I feel that Samaritan Counseling of the Capital Region has done the opposite:
1. My simple complaint was never addressed. I was terminate-referred to the same 12-step interventionist. I was told that a therapist has the right to her ‘preferred mode of treatment’. To me, it didn’t seem to be her preference; it seemed to be her job.
2. My extended complaint detailing the problem based on records was never addressed. I was instead told ‘under no circumstances’ was I to have any further contact with Samaritan. This not only cut me off from resolving the relationship issues with my therapist, but felt to me as if I was being told that my experience did not matter to them at all, and they would continue doing this to others as if they just could do nothing about it.
3. My Yelp review was removed by ‘community request’.
4. My complaint to the licensing board was seen as not ‘making any sense’, and I was not allowed to see who was involved in the investigation or what the investigation involved.
5. My second complaint to the licensing board was met with ‘this case is closed’.
6. The first set of records I requested (before filing a complaint to the licensing board) included my complaint correspondences. The second copy of records I requested (after) were missing those documents. (Meaning that much contextual information that might have been sent to a new provider or investigator would simply not be there.)
7. I was told by the licensing board that this is a ‘personal issue’ between therapist and client, but I don’t think that is correct, because it was a systems issue very much related to the business of therapy and the ‘recovery’ industry. Either way, my therapist is not willing to discuss this with me on the personal or the professional level, even though I think it is a resolvable issue (but not to be resolved by me simply shutting up and disappearing into a psychiatric hospital).
Satisfying my concerns would seemingly be a simple thing to do: acknowledge facts about my case dynamics, acknowledge evidence of problems with 12-step culture and treatment, assure me that more options and less coercion will be involved in similar client interactions in the future. Unfortunately, I see zero evidence that any of these reasonable requests have been taken seriously, and this applies mainly to Samaritan Counseling Center of the Capital Region (my experience being anecdotal with evidence that it is a broad policy failure across healthcare systems in America) I want to do my best to raise awareness system-wide so that human and constitutional rights are honored and people can get the care they need without having to convert to or shoehorn certain religious ideas; I hope you appreciate these efforts and do not see this as another offense.
For anyone interested in this topic, I encourage you to look at my blog notpowerless.com (there is a lot of good information there; please excuse and understand that I am indeed very frustrated with my therapist and her supervisors’ handling of this on many levels. It has been my concern for future Samaritan clients seeking help upstairs from the AA meeting, and my refusal to write these therapists off as people that has allowed me to find patterns that go far beyond any of the individuals involved in my case).
Please see my cartoon about 12-step coercion in therapy:
and please consider what Samaritan Institute might be able to do policy-wise to prevent this kind of situation in the future. If this issue can be addressed at the organizational level, it will be a much better resolution than messy termination or attempting to scapegoat any particular therapist (or client).
I have heard that there is a growing number of therapists who find 12-step treatment problematic, and I’m sure there are more than a few in Samaritan Counseling Centers. Please do not hesitate to ‘friend’ me if you would like to continue the conversation or just to show me some good will. There is a lot of interesting information out there beyond the AA conference-approved literature.
Allow me to walk the reader through why this call was so upsetting to me. I think it is a good case study in games ‘Addiction Specialists’ play.
“Cl called requesting appointment. I returned call to assess cl’s readiness to resume treatment with me. I asked how long he had been seeing Jim Garrett”
How is the length of my time talking to a 12-step interventionist in any way related to my ‘readiness’ to have a therapy session that I am asking for?
“He stated ‘since January’ (see contradictory note on 3/20).”
On 3/20 I had quit sessions with the ‘addiction specialist’, because I had just received a letter from Samaritan Counseling suggesting that I was required to see James Garrett for an indefinite period of time before I might possibly be able to resume ‘normal people therapy’. Records show that he told her I was not following ‘my side of the contract’ after being terminated from expensive and ineffective outpatient rehab for complaining about the cost of drug tests and Step One worksheets.
“I asked how frequently. He stated ‘once a month'”.
Yes, I was doing as few addiction counseling sessions as possible because they were $110/pop and I was only doing it so I could get back into therapy.
“I stated that Jim’s message indicated cl. felt ambivalent about seeing me again and asked him to comment on that. He stated he did not know what I meant.”
I was a bit ambivalent about asking for the appointment, because I suspected that she might tell me I didn’t do enough rehab correctly (again). I also suspected that James Garrett would be discouraging her from meeting with me (which turned out to be true). I was not, however, ambivalent about seeing her again; I wanted very much to tell her about my rehab experience, and hoped since she recommended it, she might care about how it went. More importantly, his use of the word ‘ambivalent’ implied that I was ‘addicted to therapy’ and probably needed therapy with him for that.
“I asked if he had consulted with Jim about boundary issues and his transference issues with me. He stated that he did not think he needed to and asked if I thought he needed to do that. I stated it would be a good idea if he did so.”
First of all, I don’t see how refusing to speak to someone unless they pay a lot of money indefinitely for treatment that isn’t helping, or joining a religious cult, is a healthy professional boundary. (A doctor just got evaluated and suspended for requiring everybody to say ‘I’m wonderfully hungry’ before he would speak to them. This goes above and beyond the ridiculousness of that) It’s certainly not my own ‘boundary issue’. If I as a client say “I don’t want anything to do with this AA addiction treatment anymore”, that’s a reasonable boundary that should be respected, and it is most certainly NOT a ‘boundary issue’ that I need to go back to 12-step treatment to resolve. WTF.
As far as the ‘transference issues’, transference is described as a normal phenomenon. A client feels a connection with a therapist after many hours of soul-baring, and feels a range of emotions as part of the therapy process. At this time, I was feeling abandoned and betrayed (because in fact in many ways my own interests WERE being abandoned and betrayed), as well as holding on to the hope that she would be my witness in this process (which was in some sense agreed upon in January). Remember, I had just waited two more months for the opportunity to ask for an appointment, and spent another $220 dollars for ‘addiction treatment’ because I was told I’d get that appointment (by both her and James Garrett). I did not need another $110 12-step lesson in ‘understanding that I can’t get my way all the time’ WITH the very people jerking me around for money and then smirking when I get a case of the ‘fuckits’.
“He said he was engaged in Rational Recovery and wanted to tell me about his experiences with it and began to read me literature related to Rational Recovery. I explained that I did not have time to listen to the literature and stated that, as I had explained to him many times, I was not an addiction counselor and I could not address any of his addiction issues.”
It’s ironic that she didn’t have time to listen to me here, since she had the time to push me into 12-step programs repeatedly for about a year. What I was trying to explain to her about Rational Recovery was that ‘choosing Rational Recovery’ was a decision to avoid all “addiction treatment” because it is almost invariably 12-step indoctrination. Even the addiction specialist did not seem to understand this point and told me I still needed meetings, to which I told him that RR cancelled all meetings 15 years ago because you DON’T need meetings or treatment to stop drinking. He said there were a lot of politics involved. Apparently he hadn’t been paying attention to those politics for at least 15 years, then. Only 8 years before this, he had written a book about using leverage and consequences to coerce people into inpatient 12-step ‘treatment’. I thought it was especially ironic that he was using ‘lack of support in my life’ as a reason for needing meetings, while at the same time basically discouraging my ‘non-addictions’ therapist from supporting me.
“He stated that Jim Garrett agreed with him and that Rational Recovery was working well. I stated that that was excellent and it was good that his treatment with Jim was working out. He then said no, he was not going to be doing any addiction counseling.”
I did not want her to think that ‘treatment with Jim’ was working out well. I wanted her to understand that my decision to LEAVE ‘addiction treatment’ was valid.
“He became upset and stated that he did not understand why he could not just talk to me. He stated that I had ‘promised’ him that if he did counseling with Jim Garrett and rehabilitation, I could see him.. I asked if he felt he had really followed up on the recommendations. He stated that he had done rehabilitation at SPARC (see contradictory note on 2/28). He stated that he thought I had lied about this alleged promise. I reminded him that it was not a promise by a possibility and that he should be working on his recovery for himself, not for me.”
Clearly here she was grabbing at the very reasons my ‘Rational Recovery’ argument was supposed to eliminate. Of course, she didn’t bother to listen to that argument, and Jim Garrett certainly didn’t explain it to her, so how could she have known that saying I didn’t do rehab correctly or enough was no longer an acceptable reason to call me incompetent for normal people therapy? She said ‘You may THINK I promised you something,’ as if I completely imagined the ‘contract’ she supposedly discussed with Jim about 2 months monitoring by Jim before I could meet with her, which is written twice in his notes. I almost had the feeling that this conversation was coached, perhaps by David Olsen who seems to be particularly interested in tough-love ‘boundaries’ that serve the purpose of ‘pastoral excellence’, especially since several times in those last five months she seemed to agree to a meeting and then be dissuaded by the addiction specialist or her supervisor. The fact that she wrote ‘I could see HIM’, could indicate that she may have felt she was not being allowed to do her job. When she told me to work on recovery for myself, not for me, it could have suggested that she knew I was set up for failure if I kept trying to get back into therapy.
“He stated that I was a terrible person and he wanted to die.”
I started crying and then hung up. The whole conversation made me feel like a liar, a failure, and I was just in disbelief at how ridiculous it all was. It gets even more ridiculous after she consulted David Olsen:
“I consulted with my supervisor David Olsen, PhD who state that I should not be alone with cl. again”
I’m not sure how begging for someone to listen to me to the point of becoming suicidal suddenly gets flipped into me being some kind of homicidal maniac.
“and the only possible contact might be a group session with Jim Garrett to complete the transfer and so that Mr. Garrett would fully understand the transference issues”
Again ‘the only possible contact’ suggests she might not have agreed with the whole idea of these ‘clear boundaries’ that James Garrett and David Olsen seemed to be promoting to keep me isolated in treatment. By the way, this session never happened, because I then sent a letter of complaint and got banned from all communications with Samaritan by David Olsen and Jenness Clairmont the Clinical Director, and James Garrett told her to keep clear boundaries because of my ‘Axis 2 (harassing, fixated)’ behavior.
“He stated it was likely that seeing me would cause a relapse and Jim should understand this.”
OK, this is where it just becomes completely absurd and idiotic. How could ‘recovery’ be a state of not being able to speak to a therapist without relapsing? That doesn’t sound like recovery to me in any way. And really, if your therapists are that horrible that the mere sight of them causes relapses, you should either fire them or consider that you might be a paranoid control freak.
I like to stick to the records as much as possible, because that means I’m arguing with their ‘official’ position on it, but I should also mention I got upset because she said [verbatim] “I will never support your decision to use Rational Recovery”. I demanded an explanation as to why she would ‘never support my decision’ to stop drinking and stop going to meetings and treatment that were expensive and confusing. She also said “It wouldn’t be therapeutic” to meet with me, which were the exact words the girl at the rehab used when I wanted to discuss the Step One worksheet, then asked her to put me in contact with my therapist so I could talk to someone else about it then.
On top of that, after five months of jumping through hoops, not being considered ‘better’ or insightful in any way made me want to die, and I actually checked into a psychiatric hospital, which would not have happened if I felt anyone at Samaritan was really listening to me. If you want to call that a mental health relapse, that would be one right there, and “modicum of perceived support or concern from another human being may have prevented it”.
“Clergy sexual misconduct gets the most attention when boundary violations are discussed. Olsen and Devor believe that focus gets in the way of addressing the need for other kinds of boundaries that help ministry to flourish.” – The Christian Century Review of Saying No To Say Yes by David Olsen, Executive Director of Samaritan Counseling and Nancy Devor
I just found this case today and the arguments set forth seem highly relevant, not only because it has to do with Samaritan Counseling, but because it has to do with mishandled transference and employer v. employee liability based on whether the misconduct is within the scope of job requirements.
Here is the Supreme Court of Alaska’s decision. I don’t totally understand all the legal terms.
“Jane Doe argues that Samaritan should be held liable for the acts of one of its pastoral counselors, Reverend/Dr. John Garvin. Doe went to Samaritan for emotional and spiritual counseling. During two of her sessions with Garvin, kissing and fondling allegedly took place. After Doe cancelled her counseling sessions with Garvin, the two allegedly met and had sexual intercourse. Doe claims that she suffered emotional harm as a result of Garvin’s abuse of their therapist-patient relationship. On summary judgment the superior court held that Samaritan could not be held liable for Garvin’s actions on grounds of respondeat superior…
…this relationship was found to have caused the patient emotional problems so devastating that years later she attempted to commit suicide.”
“This illustration suggests that a clinic should not be vicariously liable for a therapist’s sexual misconduct simply because the transference phenomenon the therapist manipulates is a common factor in both a responsible and irresponsible relationship with a patient. The real issue is whether his sole motive in manipulating this phenomenon is for his personal gratification. The very nature of a therapist’s deliberate sexual misconduct indicates that his motive is purely personal because such behavior completely undermines his authorized role as a counselor.”
I would argue that this argument of personal gratification (and the one about noncommercial businesses being incapable of assuming responsibility/liability for things like this because their overall public benefit is more important) is simply Samaritan avoiding responsibility for the dynamics of degradation and control inherent in the 12-step ‘rehabilitation’ process which is not coincidental but ‘part of the job’ at Samaritan Counseling. This article does mention the possibility that *unintentional* mishandling of transference (such as in a supervised scheme of emotional extortion to coerce 12-step treatment) in carrying out the demands of the employer would not absolve the employer of responsibility in the same way.
I would also add that these cases could be handled better (mishandling a mishandled transference complaint, especially in the manner 12-step programs do, is often more damaging than the sexual incident itself) and this piece does seem to say that negligence regarding these imposed dynamics would be a better argument.
“In congregational life, too often clergy become the scapegoat for their congregations.” – David Olsen
Did you know that New York State not only funds 12-step promotional efforts, but actually RUNS 12-step rehabs? They run 12 of them, to be exact, which is kind of cute. One of them is called Dick Van Dyke.
It’s pretty much the state religion. Now that the entire 12-step rehab industry is being exposed as fraudulent and the lack of accountability in 12-step culture is coming under heavy criticism, one starts to wonder what really is OASAS’s purpose and mission, and are they ever going to be capable of seeing outside the confines of their ‘recovery community’? Would it even be possible for this government agency to question the appropriateness of the Big Book of Alcoholics Anonymous as ‘treatment’?
McPike (see picture with founders and Bill W here) is the one I was supposed to go to. I didn’t, because I did not want to be immersed in 12-step nonsense for 30 more days. Here is a tour of McPike. This is not the kind of ‘treatment’ I was looking for when I said AA didn’t work for me.
“A doctor has to say that you’re incapacitated and incapable of making decisions”
Using the ASAM tool or the LOCADTR tool.
On the structure of OASAS:
“We have great staff. One of the things about our staff, there’s a lot of people in our agency who are either in recovery themselves or have family members in recovery, they are committed to the mission.”
“It’s not true that if you’re an OMH social worker, that you’re going to be able to treat someone with an addiction problem”
“Our system treats a lot of mental illness”
“These drugs are scary”
They are trying to create an integrated license so that OASAS is the only license you need to treat both mental health and addiction in a ‘holistic’ manner (and they throw in the possibility of primary care too), because other agencies supposedly can’t treat the addiction part the way they do. Unfortunately, they are just making non-addiction-specialists afraid to handle someone dealing with an addiction. I have personal experience with an actual doctor who was ‘not licensed’ to manage withdrawal (which really is no more than a few days of benzodiazepines and blood pressure monitoring), and a trusted therapist who supposedly could not deal with me because I had an ‘addiction’ (which apparently does ‘pushups in the parking lot’ when I put it aside).
Sounding Board on Merger of Mental Health and OASAS
This is disturbing to me because when we should be considering whether 12-step cultism is a form of mental illness causing confusion, relapse, and suicide, we are instead suggesting that 12-step adherents be put in a position to diagnose not only addiction, but any related mental disorder such as resisting coercion, not quitting the debating team, disrupting the ‘recovery community’ by blaspheming Bill W., etc.
Here are some social work lobbyists going after licensure-exempt state agencies to get better educated, which they have refused to do for a ‘long time’. Exempt agencies overview
There is a follow-up with the other side of the argument. He basically takes takes the attitude of denying there is a problem with the status quo, saying “we have a solution that doesn’t have a problem”.
And here is my own experience of being funneled by a frightened ‘non-addictions’ LCSW toward a confident ‘addictions specialist’ (although well qualified technically, his entire history is geared toward ways to get people into 12-step rehab) when I was actually trying to get away from 12-step thinking, not further immersed.
Ran across an interesting review:
Here is a movie about the rehab industry. Don’t think what OASAS does is not related to this industry.
Here is a trailer for a movie about how 12-step based drug treatment programs have worked out in the past.
And finally, here is the Department of Justice’s previous warning about 1st Amendment violations and OASAS’s proper use of DOJ public funds: On AA in OASAS . There must be a lot of complexity involved in ‘carrying the message’ without saying it publicly.
Hospitals and Institutions committees organize Alcoholics Anonymous proselytizing in hospitals, mental health facilities, and jails. I think hospitals shouldn’t allow this. Informed consent is a big part of medical law, and they wouldn’t want to get sued, would they? Especially in mental health institutions, this is disturbing. Doctor Sex Abuse Investigation
“I was kind of upset when I found out…”
“How are people not getting this information? He didn’t even know what SMART Recovery was… I literally had a counselor there tell me that if I didn’t get involved in NA I would probably die. That was a counselor, someone with their college degree in the field.”
This was my experience too (being shocked that nobody seemed to be aware that rejecting AA is a real option), except I delved more deeply into how and why this happens, which is the focus of this blog.