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other addictive behaviour, would hotly disagree with this clinical approach - but they would, wouldn't they?
Ultimately the nature of recovery depends on what one considers to be true "recovery". This is a very different concept from mere abstinence from a particular addictive substance or behaviour. My own belief is that recovery should comprise:
These three characteristics of true recovery give life its colour and meaning. Anything less is, to my mind, less than patients deserve from us as their professional advisers. They deserve to have their neurotransmission disease fully addressed by people who understand it fully rather than have it treated half-heartedly.
Alcoholics Anonymous advises "we should be fearless and thorough from the very start". I totally support that principle with regard to all the addictive outlets of any individual patient and would agree that the best time to deal with them is right at the very start. As Alcoholics Anonymous points out, when patients say "What an order! I could not go through with that", we should reply, "Do not be discouraged. No one among us has been able to maintain anything like perfect adherence to these principles". However, this particular quotation refers to working the Twelve Step programme rather than only to being abstinent. As far as addictive substances are concerned, it is perfectly possible to be totally abstinent. Where the addictive behaviours are concerned, one can be abstinent from using that particular behaviour in an addictiveway For example, we all have to work and take exercise and shop and spend, but we do not have to do any of these things addictively (along the lines of the twelve addictive characteristics outlined earlier). Addicts of one kind or another know perfectly well when they are using an addictive process for its mood-altering effect rather than primarily for the purpose that any nonaddict would use it. When an addict works or exercises, shops or spends addictively, it is primarily for the mood-altering effect rather than for what one might achieve as a member of the normal population. "Perfect adherence" may indeed not be possible in this respect - but one can give it an extremely good try, particularly if one does it alongside other people who are working the same programme of recovery.
When running a treatment centre, such as PROMIS, one has to temper the ideal with the practical. I once made the decision that the PROMIS Recovery Centre should be completely non-smoking. Immediately I lost four patients and two members of the counselling staff. Furthermore, I got a reputation "on the street" for being extreme - rather than for trying to be helpful - and this affected our recruitment of further patients. Faced with the prospect of going out of business altogether, I had to backtrack and say that we would help and encourage patients to give up smoking but would not insist upon it. I let the staff go.
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