This is a recording of Ray B.’s opening talk at the Widening the Gateway Secular AA Conference held in Tacoma, Washington on March 31, 2018 followed with a written transcript. Ray is a MD specializing in Addiction Medicine and a recovering alcoholic.
0:00:02 Announcer: Alright, this is the “Widening the Gateway” Conference. It is the 31st of March, 2018, 9:57 AM. We are about to get started.
0:00:53 Willow: Hi, everyone, my name is Willow and I am an addict.
0:00:57 Audience: Hi, Willow.
0:00:58 Willow: Thank you all for joining us for Widening the Gateway 2018, very excited. This won’t take too long but before we get started with our opening speaker, I just wanted to mention a few things. First of all, can I get everyone that was on the planning committee, the panel host and the speakers to stand for a moment? Stand. Planning community.
0:01:26 Willow: Thank you, thank you. So, I really want to thank you guys all for contributing to the planning and creating of the content today. I think this is going to be a really fantastic day and everyone’s been a great help in making that happen. I also want to thank the Olympia Group for planning the first Widening the Gateway that laid the groundwork for us to be here today.
0:01:52 Willow: That was a really amazing experience for me personally, and I’m super glad that we’re able to be here and do it again. It’s really exciting. And before we get into the little bit of business that I wanted to talk about, we have kind of a fun thing that I want to do. So, Michelle is joining us from New York today…
0:02:12 Audience: Miami.
0:02:12 Willow: Oh, from Miami, sorry. East Coast, it’s all east. [laughter] So Michelle is joining us from Miami today and today is her four-year anniversary, and so…
0:02:25 Willow: We’re going to help her celebrate with that. We’re going to give her a chip and what’s more appropriate from the Northwest for a chip than it to be a wood chip.
0:02:35 Willow: So, Michelle, come on up. Happy Birthday.
0:02:47 Audience Member: We’re willing to go to any length.
0:02:54 Willow: Yeah, it was super… There it goes. It’s just got a little delay. I was super glad to be able to do that and like I said, the wood chips that they had… If you’re looking for a chip with no prayer on it, there’s kind of a limitation, so no number, but no prayer.
0:03:13 Willow: So, for a little bit of the business stuff, the schedule for today is available to view on your mobile device. If you just go to the widegate.weebly.com, you can pull that up and scroll through it, you can see it there. We’ve also got it, you can scan the QR code and download it if you want to. Those are taped up in a couple places and we have some hard copies at registration. Everything is happening in this corner of the hotel. So, this room is going to split into two. And then we have this other room on the side over here as well. And that’s where the breakout sessions will be. We have Grace and Dolores out in the lobby also from the Solution Book Store in Burien.
0:03:58 Willow: They’ve got a special selection of items just for our group that they had fun picking out. The lunch buffet will be served from the lobby as well and then you’re welcome to come in and eat your lunch in any of the rooms. They’re going to stay divided through lunch. We’ve got lunch is an hour and then we’ve got a 15-minute cushion on either side for setup and for clean up before we start back into the next session. Each panel’s one hour and 15 minutes with a 15-minute break in between. And if you’re in a panel that wraps up early, please be mindful that others may still be in session. And if you smoke, there’s doors out of this room and out of that room to go outside.
0:04:40 Willow: You could also go out from the lobby. Please smoke away from the doors and be sure to extinguish and dispose of any materials properly. We don’t have a formal dinner plan tonight, but several people intend to meet up into smaller groups and head out for a dinner at some of the great restaurants in the area. If you are interested in joining that, you can check around or you can find me, and you can join us for that. Also, there’s some of us doing a little outing to Northwest Track tomorrow; if anybody wants to join for that, you can see me. And if you have any questions at all throughout the day or need anything, find me. I’ve also got… Tom is helping me. There he is. Raise your hand up high, Tom.
0:05:26 Willow: Tom agreed to be my lackey today as well, so I might send him to help you. And I also want to let everyone know that we are going to be audio recording the opening and closing speakers. And then those will be shared through the AA Beyond Belief website. John Sheldon agreed to edit those and put them up for us from there. And with that, I really, again, want to offer my humble thanks to you all for being here and joining us and I want to welcome Ray B from White Rock, BC.
0:06:08 Ray B: Thanks, everybody. My name is Ray, I’m a person in long term recovery. I’m an alcoholic.
0:06:15 Audience: Hi, Ray.
0:06:16 Ray B.: I’m glad to be here and glad to be sober. I’m really honored to speak to this group. I’ve done a lot of talks to doctors and professionals and addictions professionals over the years, and I’ve, for 30 years, shared in AA meetings. But putting the two together, this makes you a very tough audience. That’s why I’m wearing my work clothes today.
0:06:51 Ray B.: Two weeks ago, I celebrated 32 years.
0:06:58 Ray B.: In three weeks, I turn 71, and in five weeks, Agnes and I celebrate 48 years of marriage.
0:07:06 Ray B.: Agnes is a declared black belt in Al-anon.
0:07:16 Ray B.: So today, the purpose of this talk is to set the day up. It’s a talk that will likely disturb the comfortable and comfort the disturbed. It’s not an AA talk, there’s a lot more science than dogma in it. Some of the things that come up you might find challenging. That’s okay, that’s good. So, if you find yourself reacting, that’s not necessarily a bad thing. I’m going to try to go fast enough to have some time at the end for clarification or points. We should have a few minutes left at the end.
0:08:06 Ray B.: Basically, this is a call to action, because I see groups like this more important than they’ve ever been, more important for alcoholics and addicts than they’ve ever been, but more important, for the survival of AA. And I see this is as within AA, I don’t see this as an alternate AA. I see this very much as… I heard a great line this morning, Theresa, it was, “AA’s not my life but it’s my lifeline.” And I think we are the people, the people in this room are the people who can help AA to make some changes in order to survive, and that’s my call to action.
0:08:53 Ray B.: I’ve chosen a very few topics out of a massive body of science and evidence and clinical knowledge on addiction and recovery. And so, it’s kind of arbitrary what we’re going to talk about, it was hard to select it down. First of all, some disclosures. I’m not tied to anybody, I don’t accept money from anybody. I’m retired now. I’m writing a book on recovery medicine. And like me, it’s in progress. It may never get done but it’s a hell of a good trip. I’m really enjoying it.
0:09:31 Ray B.: Before you decide whether or not you can believe this stuff I’m going to say, I’m just going to introduce myself the way I would be introduced at a medical conference. So, I was a family doctor for 12 years, and then I spent 30 years specialized in addiction medicine. I put in the addiction medicine curriculum at University of British Columbia, directed it, and we won a national award for it in 1995. I wrote a chapter for alcoholism for Conn’s Current Therapy, a medical text. I wrote the medical rules for safety critical railway workers in Canada. I’ve been on the editorial board of the Journal of Addictive diseases for more than 20 years. And the most exciting thing I’ve done in the last decade is I got chosen to be part of a national expert advisory committee for the Canadian Center on Substance Use and Addiction. And we administered a life and recovery survey to Canadians in recovery to find out about what they looked like, because like in the States, people in recovery hideout. It’s the only disease that people hide out. We don’t have advocacy groups. When I run the Boston Marathon, I never see people with signs up, saying, “Alcoholism.”
0:10:50 Ray B.: I see every other disease, but I don’t see that. Sure, there’s reasons for it, there’s anonymity but it’s a damn shame because most of our neighbors don’t know we’re in recovery, and we’re good citizens. And that’s beginning to change, and I think it’s a good thing. I think we do need some advocacy out there. Today, we’re going to talk about what is recovery, what do we need to do to recover? And a concept that I find very useful, recovery capital. How many people here have heard the term “recovery capital” before, heard it used? Not a lot, okay. It’s just a good way to frame what you already know. As we get into it, you’ll recognize it, but when I speak to people getting in the field or working in the field of addiction, especially those who think that treatment of addiction is prescribing a medication, which more of my medical colleagues feel. And prescribing a medication might be part of recovery, but it’s such a small part. And recovery capital is the key to knowing, “What has to happen?”
0:12:03 Ray B.: And then we need to pull it together to set the day up, the conference theme, “Recovery, Service, and Unity”, and they’re all important. And I think unity, most of all, is important. This was taken in 1987. I was one year sober and if you look closely, I was not a happy camper.
0:12:30 Ray B.: People on the outside would have said I was doing very well. Let me just do my drunkalogue very, very quickly. In November of 1984, on a cold day with 10 patients waiting to see me, I was a GP in a small town, small rural town. And I walked out of my office, and I thought I might commit suicide that day because it was hopeless. I didn’t know what the problem was, but I did know a friend of mine, or not a friend, a medical person who’d broken his anonymity at a medical conference and from the podium disclosed that he was in recovery from addiction. So, I phoned him up and told him about this doctor I knew who was in trouble.
0:13:15 Ray B.: This doctor I knew who was drinking himself to bed, to sleep every night, and was stealing drugs from the clinic and shooting some of them IV. And what should I tell this doctor to do? And he told me what this doctor should do, and I did it. My recovery started that day, my last use of substances wasn’t that day, but I date my recovery to that date because that was when the pursuit, the journey began for me. And the active word for me is “pursuit”. I managed to get and stay completely abstinent in 1986. Before that, in 1976, I was just setting up for practice in a small town. Brand new graduate from medical school. Knew absolutely nothing but I thought I knew everything. The phone rang. It was the Department of External Affairs, Canada, saying, “Your parents are in Nepal. They’re in a little cottage hospital. They’re very, very sick. Can you go over there and try to evacuate them?” So being the hero that I was, I went that very day and it took me 40 hours to get there. And I spent the next month there. And dad died there. I managed to get mom back to Toronto and she died promptly there too. And so, what did I do the next week?
0:14:36 Ray B.: Yeah, I went back to work. Numbed out, drank a lot more. And a lot of do-gooders say, “Oh, well, that’s why he became an addict alcoholic.” No. It certainly did speed things up because that was my coping mechanism and I numbed out. I worked harder, which was part of my recovery plan, and I drank and drug a lot. I was a happy kid, a little kid. I didn’t have anything terribly traumatic happen. We had our problems. We were a big family. But it was pretty normal. I don’t think I was abused. And then something happened in adolescence. I’ve probably assessed 1,000 people with addictions. And I’ve heard this from other people that I had this whole anxious apartness, this different from the rest of the world, where I didn’t fit in. I knew there was something wrong and different about me. I could look good in the outside. I could do pretty well in sports and in school if I wanted to, but I knew I was just faking it. There was something terribly wrong. By 15, I was using alcohol.
0:15:48 Ray B.: By 17, I was facing some pretty serious consequences: Jail, injuries, embarrassing behavior. I dropped out of school at age 18 and became kind of an entry-level alcoholic, heading no place, until a supervisor pulled me aside and said, “I saw your vocational aptitude tests and you’re not very good at soldering wires, so I think you should go back to school.” And I did. It was a window. He saved my life. So, I went back, became a top student. Undergraduate honors physiology, I won the gold medal, listen to this, studying the biology, the neurobiology of reward.
0:16:42 Ray B.: Yeah. I went into medical school. I was a class valedictorian. Wasn’t the top student, but I was good at getting along with people. And besides, I supplied about a third of the class marijuana that I grew on my farm.
0:16:57 Ray B.: I married Agnes, pretty mad. She was taking a pretty big gamble. And especially, marrying a guy who drank like I did. And we went to Logan Lake, a town of 1,600 people. Didn’t have a pharmacy. We had to stock all the drugs. Think about that, we had to stock all the drugs at the clinic. Being dedicated, I didn’t give anything to my patients that I hadn’t first researched.
0:17:30 Ray B.: So, in 1984, when I called for help, it was right around Christmas, I was sent off to Ontario to a treatment center. I missed my admission date because of I got drunk thinking at the airport, YVR in Vancouver, thinking it might be my last chance to drink. And it turned out to be the last time I drank, but I missed my plane, so I was a day late getting to treatment. And there was no treatment scheduled on the weekend when I got there. Luckily, they let me come in. The only thing that happened that weekend was probably the best thing that could’ve happened. There were some old farts from Toronto who volunteered their time on a Saturday night over the Christmas holidays to come in and hold an AA meeting. And I went to that meeting. I don’t think I heard a word they said, but I was pretty good at reading people, and they had authenticity, they had something that I wanted.
0:18:24 Ray B.: So, I bought that blue book they were handing out or selling. I bought it, took it back to my detox room, and I started to read it. And I thought, “I can ace this.” It wasn’t very long before I got to the “God” word and I said, “Oh shit.” I worship higher intellect, Newton’s laws, I was very cynical. That was one of my things, I was very cynical. And then the irony of it dawned on me, that here I was, they wouldn’t even let me have my shoelaces and my belt, and here I was, too arrogant to consider reading the rest of this book. So, I read the rest of the book and I swallowed my… I overlooked the non-scientific parts of the book. Those guys really had it. And so, I faked it and I went and I fell in love with AA for a long time. And I came out of treatment. The other thing that happened, I met Gee there, and Gee, at my treatment center said, “Don’t pay much attention to what they tell you here. I learned some stuff.”
0:19:34 Ray B.: But he said, “When you get out, just go to meetings. Just get a sponsor and go to meetings”. And I did it and Gee helped save my life, because I did exactly that. And it turned out to be the beginning of a really important journey. Gee, unfortunately, never made it. Gee was a person who had very little recovery capital. Emotionally traumatized, had been a sex trade worker, awful things had happened to him. He had other problems, psychiatric problems, and he never made it. But ironically, he was an important part of me getting into recovery. When I came back, my recovery was only beginning. When I got to this point, I had been clean and sober for over a year, but my recovery hadn’t gone very far, it hadn’t really begun. At this point in time, if you asked me how I was feeling, I couldn’t tell you. I hadn’t yet the words. I had a thing called Alexithymia, the inability to read, describe my feelings. How on Earth am I going to learn how to handle my feelings if I can’t identify them? That was one of my tasks of recovery. Agnes and I didn’t know how to be married. We’d been married at that point for 15, 16 years, but we didn’t know how to have fights, we didn’t know how to do conflict resolution. I didn’t know about boundaries, and without good boundary skills, you can’t do intimacy, you can’t do very much. I had to learn boundaries. I ended up teaching a boundaries class for 12 years until I really learned them
0:21:16 Ray B.: When I was in my 50s, there was still something missing. And I’m not going to say, if you’re on an antidepressant, stop it. Please, don’t stop it, because antidepressants about… A lot of us have psychiatric symptoms and issues that require medication, and that’s just great. I’d been on a medication, on an antidepressant, for a long time. My daughter, I got word that I was developing heart disease, I was 56 years old. So, when I was 58, they started me jogging, my daughter and my wife talked me into it. And, like Forrest Gump, I started to run. And I ran, and I really fell in love with running. And then I realized that I stopped taking my medication and I felt really good, I was part of a running group. And then I came down here. Ran a marathon in Newport, qualified for Boston, and ran eight consecutive Boston Marathons. I didn’t. Couple of Iron Mans. And I currently hold the silver medal for the world long course triathlon, international ITU for 70 to 75-year-old, so I’m a little bit addictive, I agree.
0:22:34 Ray B.: But we were talking about the role of creativity… A creative outlet being important. But, for me, exercise is a huge part of my… If I can’t drink and drug, my recovery capital requires me to the exercising as one of the many things that I do. Let’s get going here. What is addiction? I love Bradshaw’s definition. Pathological relationship, the mood-altering activity, life-damaging consequences. Sick relationship; I do it, it causes harm, but I keep doing it. The American Psychological Association, who are responsible for the DSM, and the World Health Organization, who come up with the international classification of diseases, basically say that addiction involves loss of control or impaired control over the… Once I start drinking or drugging, I can’t be sure how much I’m going to do. I keep doing it despite negative consequences, family, social, vocational, health, psychiatric. I become preoccupied, it becomes more important, so it crowds out things that were once important in my life. And there may or may not be craving. ASAM, the American Society of Addiction Medicine, I sat on their board for four years, calls addiction a primary disease. In other words, it’s not due to something else. It’s not…
0:24:00 Ray B.: People aren’t alcoholics because they have a psychiatric condition that’s self-medicating. It’s a primary disease like heart disease. It’s chronic, it doesn’t go away. It’s not acute, you can’t cure it. It’s focused mainly in the brain, involving reward, motivation, memory and related circuitry, and it leads to bio, psycho, social, and spiritual manifestations. Interesting that a medical society would include that word. It’s reflected in individual pathology. In other words, we’re all different. One size doesn’t fit all. We’re a very heterogeneous group of people who pathologically pursue rewards. We keep doing it, in a sick sort of way. My wife drinks wine. I think she abuses it because she leaves a half a glass behind.
0:24:58 Ray B.: And he says, “Does it make you feel good?” And she said, “Well, yeah.” For her, it’s like going for a swing in the backyard swings. For me, it was like the roller coaster. It does change the brain. You’ll hear an awful lot about the neurobiology of addiction. It’s a little bit unfortunate. Sure, we’re learning more and more about addiction and the brain, but you know why it’s unfortunate? It’s being used to reduce addictions to a pharmacological cure, which reductionism gets us into real trouble when it comes to alcoholism. When there’s only one way, and it’s my way to do it, and if you’re a pharmaceutical company, guess what the way is. And so, we’re getting this shoved down our throat and I know the neurobiology, I know. And as a matter of fact, it does more brain changes than just at the synapse with the neuroreceptors and neurotransmitters. There’s multiple changes there. But the scarier things is that drugs change the nucleus of the cell, they change gene expression, that’s epigenetics.
0:26:11 Ray B.: Epigenetics, once it happens, is a switch that’s permanent. The Japanese expression, first the man takes the drink, then the drink takes the drink, then the drink takes the man, when the drink has taken the man, that switch has occurred. He’s become a pickle, he can’t go back to cucumber and that’s epigenetic. Some epigenetic changes are actually transmissible through genes, through gametes. This gets really, really scary. Anyway, I won’t go there but we could spend a lot of time on that. We could spend a day on this alone, but this is not an audience that we need to. Just addiction is physical, it has changes in the brain, changes how we think, changes in our character and in our personality. It changes how we behave dramatically. That person that I was, I’m so embarrassed about when I look at it objectively, and I’m not that person, but during addiction, I certainly behave that way. It’s a disease of social isolation and probably the most important therapeutic measure for addiction is connectedness, for surviving addiction is getting hooked into a group of people and there’s a lot of science to back this up, a group of people who support recovery.
0:27:35 Ray B.: And that’s probably why it worked so well but there’s a bunch of other reasons as well. And spiritual, however you define spiritual, both in manifestations but also in recovery for some people more than others. This is why quitting drinking isn’t enough. If somebody comes up like the Schick Shadel treatment center, does aversive conditioning, or the Sinclair method says take Naltrexone and drink and you’ll drink less and it takes away the reward. And it’s true, it does. The way it’s used in Europe, if you take Naltrexone and drink with it, it turns it back from a roller coaster to a swing. You don’t get the reward. But if my problem is bio, psycho, social, spiritual, and I just got a solution to deal with the drinking, what have I really done?
0:28:34 Ray B.: Okay. If we’re going to work on this thing called recovery, what is recovery? What is recovery, that more and more in the last decade, groups around the world, but especially in the English-speaking world, have struggled with what is recovery? Well, most organizations, bodies, panels of experts come up with these four things. There’s a pursuit of abstinence and see that asterisk, we’ll define abstinence. Pursuit of abstinence, improve global health, medical and psychiatric health, person becomes more functional, better at work, better at home, better at school, and better citizens. They give back, they pay taxes, they volunteer. That’s generally the consensus of what is recovery. Well, okay, how many people here think abstinence is essential for recovery? Honest, honest, honest. Okay, now. Okay, keep your hands up. Now, take your hands down if you think you have to be abstinent from all drugs. Yeah, okay. because I was going to end with cigarettes, but we won’t do that.
0:30:02 Audience Member: Or coffee.
0:30:04 Ray B.: Or yeah, or coffee. But the thing about coffee is, coffee doesn’t meet the criteria for addiction for many people even though they use it every day because it has to be a pathological relationship with a mood-altering activity with life-damaging consequences. because people say “Ray, you’re addicted to your running.” Well, I go back to my medical school 40-year reunion and I’m healthier than any of them, so how much of a negative consequence is it? It doesn’t qualify, so you have to… Well, anyway, we won’t argue.
0:30:35 Ray B.: Am I sounding defensive?
0:30:38 Ray B.: The ASAM… We’ve just converted these slides from Mac to PC and the slides have been changed so you can’t see them, but pursuit of abstinence is a pursuit, an intentional restraint from pathological pursuit of reward using a drug. According to their… And one of the reasons ASAM changed their definition is for people on medication, like buprenorphine or methadone, can they be in recovery? And if the person isn’t doing any addictive behavior, is it abstinence? I’m not going to answer that but that might be something that gets looked at because this is a group that uses their head. This is a group that just doesn’t blindly believe. Okay, I was part of the Canadian Centre on Substance Abuse expert advisory committee when we did our life and recovery surveys. In the United States, Australia, and the UK, it was done. We had 855 respondents. We were looking at how did these people seem in addiction? How did they look in recovery? But that’s people who self-defined as being in recovery.
0:31:56 Ray B.: And so, it meant that… And one of the questions we asked them was define recovery, and then we threw out a definition after that and said, “How much of this do you endorse?” We looked at what they considered recovery, but it was a very biased sample because it’s people who would have gone online and filled out this… It’s not a good sample representation of people who used to have a problem with addiction, because there’s a lot of people who used to have a problem with addiction, who never went to AA, who don’t have addiction now, and they don’t consider themselves in recovery. They just say, “I used to have a problem. I don’t know.” The patterns… The highest drug of choice pattern was alcohol, but 93% of them used alcohol, so do they qualify for AA if they have to stop drinking? Do they qualify? The only requirement for AA membership is…
0:32:57 Ray B.: Okay, so they could go to AA even though they had other drugs of choice because they have a desire to stop drinking, so I guess they qualify, but they might not be allowed to talk about it.
0:33:09 Ray B.: Here’s an interesting number. The prevalence of alcohol, smoking… Alcohol addiction in British Columbia in the general population is 18%, in these people in recovery, it’s 31%. Very interesting. Okay. The importance of recovery resources. This I found delightful. With my addiction medicine colleagues, I could say, “Well, 92%… ” AA, or 12-step programs, NA, CA, is the most utilized resource. It’s not treatment. It doesn’t qualify as treatment, but it’s the most utilized, and 80% of those who use it consider it very important in the recovery. That’s a very robust number. Very exciting. Now, those who went through residential treatment, very high percentage of the people who filled out their questionnaire, over half of them had been to residential and they considered it important too. These are the things they used, and these are the importance of our first nation’s, or American Indians you call them… American… What do you call them?
0:34:32 Audience Member: Native Americans.
0:34:34 Ray B.: Native Americans, yeah. For them, a culturally-specific program seems to be very, very important. Okay. And for people who’ve been in a recovery house, an abstinence-based recovery house, really an important resource. This, we’ll just spend a minute on, because for this group, it’s really, really important. What was important in getting you into recovery? Well, my quality of life was crap, I was insane, and my marriage was on the rocks, top three. They remained important but later on… Look at this, only 15% were prompted to get into recovery because of religious or spiritual reasons. 47% later said, it’s important for keeping me sober. For this group, there’s two take home messages. Over half of people who recover successfully do so without any spiritual help at all. Over half. However, almost half find it important, so it’s important to acknowledge that. If we’re going to be inclusive and accepting and have unity, we have to acknowledge… For some, running marathons isn’t important but…
0:35:57 Ray B.: Before we get a reactive exclusive, we know what it’s like to feel excluded in this group. We know what it’s like to go to a program where it doesn’t… Where I don’t fit in. I don’t identify. So, recovery capital definition, Granfield & Cloud came up with this. It’s those resources that can be drawn upon to either… To start and to stay in recovery. Life isn’t fair. I was a white middle-class kid. Didn’t have any abuse and I became a doctor. Recovery capital helped my Yin Yang. Doctors have 80% recovery rate from addiction, including opioid dependence. And that’s abstinence by 80% recovery rate. That’s another reason we force them into it. If you want to be a recovering doctor, you’re going to go to meetings, pee in a bottle, and do the other things we tell you or you’re not going to be a doctor. And it works. Long after, they don’t have to keep doing those things they do, most of them, and they stay in recovery, so it’s those resources. These are some of the recovery capital. The basic ones are housing, finances, safe place to live, but beyond that, these are the things, and some of these for me were barriers to recovery. Like, how could I learn to deal with my rage, anger, and fear? Which, I had no idea, I was going to a meeting. I came home from a meeting and I said, “Aggie, the meeting topic was anger tonight and I think I’ve got some of that.” And she went…
0:37:51 Ray B.: I terrified her with my anger and I didn’t know that I was always angry. But that… I was defended against that. I didn’t have boundary skills. I lacked a whole lot of coping skills. I was very secretive. I didn’t allow myself to be accountable to anybody and I was terribly isolated. Okay. So, recovery capital is a good concept and it can be measured. There are screening tests. There are ways to measure recovery capital. Why is that important? Well, a patient who comes in to me for the first time with low recovery capital is going to need a lot more treatment, lot more specific types of treatment for a lot longer than a person who’s… A person with high recovery capital and mild addiction, those are the ones that you hear learn controlled drinking. I know we hate it. This group hates to talk about them. They exist. Or, that huge group of people with addiction who get well on their own; when I was a evangelical or early recovering doctor who… I knew what everybody needed to do. They needed to do exactly what I did, and I was going to hammer them into that hole.
0:39:03 Ray B.: And I had a woman, middle class lady who was really a lush, and I condescendingly told her what she had to do, and she left mad. And she didn’t do it. And two years later, this good-looking, classy lady in a business suit came in and I didn’t recognize who she was. She just came back to rub my nose in it and tell me, “I didn’t do any of the stuff you told me to do.” I said, “Oh, what’d you do?” She said, “I joined Amway.” [laughter]
0:39:36 Ray B.: You laugh. Think about it. Think about Amway. I don’t know if you know about Amway but, pretty good program. It’s got a spiritual component. It’s got social support. It’s got goals and it’s something to get on… Anyway, and her recovery capital was high. So, one size doesn’t fit all. Recovery capital is not… It’s like your bank account. It goes down, it goes up. When you come into treatment, your recovery capital is at its lowest. And it goes up. You can learn it. You can build it up tremendously. So, we can take people and work with them, sponsor them, get them to do certain exercises, breathe in, breathe out. Just because you feel bad doesn’t mean you’re doing bad. And recovery capital increases. Once we know what the missing pieces for the puzzle are, we can develop them. And it’s not that hard to find out what they are. I used to spend half a day with every… I had the luxury of working in occupational addiction medicine. So, every patient I saw, I’d see for half a day. And this was a big part of what we do, and it became obvious at the end of this.
0:40:46 Ray B.: As a matter of fact, it’s a great exercise. It’s like a fearless and thorough inventory. Not so much moral, but on skills and deficits and strength. And it becomes really useful for following people up because they know, and you know if you’re working with them, where their weak spots, what the missing pieces are. What are some of the tasks? For me, and I just made this slide up because we’re getting to the fringe, the frontiers. There’s lots of research done on addiction and a lot on initiation of recovery, which is treatment. But, treatment is not very important. It’s what happens after treatment that’s important. You might identify with some of these things. When I started using, my maturation sold right down. And if my drug of choice was marijuana and I was a teenager and I stopped when I’m 30, guess how emotionally mature I am? I’m an adolescent. I can catch up. And it’s… But it’s painful and it takes a while. I needed to find out who I was. As Carl Rogers says, that “Only when I accept myself as I am can I begin to change.”
0:42:00 Ray B.: I needed to learn how to say no to drinking and drugging. I needed to learn what my emotions were and how to regulate them, how to get that pause. I needed to take responsibility and accountability. I needed to learn about sleep, nutrition, exercise. Those things are important, if I can’t use drugs, they’re even more important, because if I’m not healthy, I’m not feeling very good. I needed to learn to prioritize, manage my time, set goals, had to learn how to fight. Agnes and I had to learn communication. Relapse, our conflict resolution. We went through a series of conflict resolution courses for couples. We can fight now. We fight regularly. [laughter]
0:42:53 Ray B.: I’m looking for the course on how to win. [laughter]
0:42:58 Ray B.: Freedom expression prove very very important. Laughter, fun, big part of recovery. Learning alternate pleasures. If I can’t do drugs to feel good or hang out with my using buddies, how am I going to feel good. Mindfulness, a huge area in meditation, which has become a big part of my more recent recovery, which is still a work in progress. Getting connectedness, participation in the community. So, if you were to chart out a person’s quality of life on the left and their recovery capital, I don’t know what it would look like, but during the various stages, from initiation, early abstinence, maintenance, and then to long term, it would look something like this. Two important points, after initial pink cloud, it always gets worse. [laughter]
0:43:46 Ray B.: This is when it’s important to keep them away. Any psychiatrist in the room? Because it’s really really easy to get labelled with bipolar II, PTSD, ADHD, whatever, because you’re a really unhappy camper when the pink cloud ends. You’re facing a record to your past, you don’t have any skills, life sucks, you came out of this wonderful soak sheet treatment center or just been surrounded by people who love you in the program, and you’re facing it. And this is where you need to know that this is an important stage in recovery. The other important thing is… Who here has been in recovery for more than 25… Thank you. More than 25 years? Okay, of those people, whose recovery has stopped improving or changing, you feel you’re stuck?
0:44:47 Audience: No.
0:44:47 Ray B.: No.
0:44:47 S4: But I have had periods where I stopped…
0:44:49 Ray B.: Oh, it changes, yeah, but I’m 71, and this isn’t bullshit. My recovery is only limited by the amount of work I put in to it. It continues to improve if I just do the things I was told and keep this life long journey going. Thank God. Nowadays, you know what would happen to me? I was injecting opioids like doctor addict to alcoholic Paul O, just like him in The Big Book, I was injecting. You know what they would do with me now? I would be put on an opioid substitute treatment perhaps forever and I might have been able to recover, but I don’t know. We don’t know. This you’re not going to read. Never mind, never mind. If you’re OCD, forgive me. [laughter]
0:45:47 Ray B.: This is just to say there’s a lot of components in good treatment and most of these are evidence-based. There’s an awful lot of good components to treatment. I just want to compare it to the next slide. These are the components available in 12-step programs. So, AA isn’t treatment. Treatment is something that a professional does to somebody else. AA is a recovery resource. But when somebody says AA is really simple program, they just haven’t done their homework. [laughter]
0:46:17 Ray B.: There are so many layers to it. It’s so complex, and that’s why it’s so important that it survives. But its survival is not a done deal. Because it’s a rigid program. It’s a dated program. People in this room know that there is problems essentially. But people in this room, I believe, are AA people. Yes? So, if we’re within, that’s the only way I can change. It’s also the way rigidity, the AA Nazis, are how it can get destroyed too. But it’s a big task that we are attempting to do. I know we are partly doing this for ourselves because I’m much more comfortable at a secular meeting than I am at a conventional redneck meeting. [laughter]
0:47:12 Ray B.: I didn’t say that. [laughter]
0:47:16 Ray B.: Sorry. But unity, AA needs us, and we have to be mature and we have to be forgiving, even though they weren’t very tolerant of some of us. I took a slide out on, does AA work? And any of you who have ended up in a scientific argument know that there are science-oriented people, including the DC Center, on substance use, that say there is no good evidence showing AA work. Concurrent studies, the concurrent reviews in 2006 showed there’s no good evidence that AA works. What does that statement say? There’s no good evidence that AA works?
0:48:00 Ray B.: There’s no good evidence. Using conventional scientific methodology, there’s no good evidence that AA works. There’s no evidence that AA doesn’t work. As a matter of fact, there’s growing evidence, the last slide, which I won’t get time to show. Lee Ann Kaskutas used the same arguments, the same analysis process. You see there was no good evidence that smoking caused health hazards. And Big Tobacco brought in some big experts to say, “No, there’s no proof. There’s no good evidence that smoking causes health… ” And it because it doesn’t subject itself to good research. Because you can’t do a randomized controlled double-blind prospective study on smokers. Well, AA is just the same. You can’t do randomized controlled double-blind study. So, she used the same criteria that brought down Big Tobacco. And my last slide, which I won’t get to, looks at the six criteria and just blah.. Knocks it out of the ball park. So, we know AA works but now there’s pretty good… So, when anybody says, “There isn’t good evidence,” they’re wrong, because the work’s been done. There’s really good evidence that AA works.
0:49:12 Ray B.: And we could and analyze how it works from many different ways. This is a social theories way, social control theories, social learning theories, stress and coping behavioral economics. Whole bunch of dynamics that work through 12-step programs. But if you look at cognitive behavioral therapy, which is one of the big psychological approaches. CBT, the idea with CBT is you feel bad because you’ve got distorted thoughts. Your thinking is off. People who got depression see the world as a hostile, negative place. They jump to conclusions. They have emotional reasoning. They have cognitive distortions. Have you ever looked at the slogans? Have you ever looked at how the 12-step program and the lingo works? It’s just so woven with CBT. Cognitive corrections, jumping to conclusions, that was the most exercise I ever got, was… [laughter]
0:50:14 Ray B.: Disqualifying the positive. All I could see was the negative. All of those things that kept me feeling bad because of the cognitive distortions. So, there’s an awful lot. So, the thing about AA and 12-step programs, before we discard it, is they have a very deep and wide menu. And that’s why we say, “Take what you like and leave the rest.” And for many people, the spiritual component is not essential for them. And it really bothers us when somebody says, “The only way to get clean and sober is to get this spiritual thing.” And we know they’re wrong because we’re living proof. Does anybody read the blue card at their meeting? The blue card, read this. You’ve all seen it. There’s a closed meeting of alcoholics and Alcoholics Anonymous. There’s nothing wrong, singleness of purpose, there’s nothing wrong with this statement. When discussing our problems, we confine ourselves to those problems as they relate to alcoholism. Well, the thing is, that can be used in a very restrictive way.
0:51:24 Ray B.: That can be used in a way to shut people down. And if my recovery involves talking about other things and I can’t talk about it at my meeting, I’m kind of screwed. And that’s what happened in 1989, my sponsor, who since died, and three of his puppies were at this meeting and they were shoving this down our throat. And he took us like little ducklings behind mommy. And we went downstairs and opened a meeting called As You Are. We didn’t… And As You Are basically is a free-thinkers meeting. And it’s basically, there are no rules and you can do whatever you want, talk about whatever you want here. It has to be respectful and it has to be talking about recovery. And it turns out, we’re mostly agnostics. Wouldn’t you say that, kin? Mostly agnostics at our meeting there. But there’s some people who are highly religious that go to that meeting and we got a few atheists that go to that meeting. Or what’s the word you use? Not atheist.
0:52:29 Audience Member: Apatheist.
0:52:31 Ray B.: Apatheist. You know what an apatheist is? [laughter]
0:52:35 Audience Member: Don’t know, don’t care.
0:52:37 Ray B.: Don’t know, don’t care. Yeah. [laughter]
0:52:40 Ray B.: Okay. So, this is Charles Darwin. It’s not the strongest of the species that survived nor the most intelligent, but the one most responsive to change, which is really interesting because I think the thing that’s going to kill AA, and could harm offshoots, is that locked steel cage of certainty. So external forces are not going to destroy AA probably, but AA’s rigidity could, and AA needs us. AA needs us to change it from within and that’s my challenge for you today. So, this is for me and this is for everybody in the room. And service is part of what we do to stay sober but also we’re a group for other people. But if we don’t have unity, we don’t have anything, because there won’t be a group to turn to. This is a phenomenon that could actually implode if it’s not gently doctored and it needs to be done from within. So, I will open it up for discussion and questions. This is from my last race. [laughter]
0:54:07 Ray B.: Uh oh, you can’t read this. If you want the slides, I’ll send them to you. But it’s healthquest is the word, email@example.com. Anybody who wants the… Or grab me before the day is over, firstname.lastname@example.org. But a more appropriate slide is this one. Comments or questions, we’ve got five minutes. Is that right?
0:54:35 Willow: Yep.
0:54:36 Ray B.: Yeah.
0:54:37 Audience Member: There was one point at which… Would you please speak what your definition of spiritual is?
0:54:46 Ray B.: I don’t know much about spirituality so I’m not an expert in spirituality. But for me, there’s two concepts that have to be addressed. My sense of purpose and connectedness is spiritual. All things non-physical are spiritual. If you study physics, you can’t be non-spiritual because… With Newtonian physics, it was easy, because it was all material things. But now, they’re getting into funny physics, quantum physics, and dark matter that can’t be measured. We have to say, gee, is that spiritual? Are the things that we can’t yet comprehend, that are powerful… As a doctor, I see some magic happen. I’ve always seen people who are going to die, they had no reason to be alive and some kind of a miracle happened, and we don’t like to talk about it because we don’t have any explanation for it. You could call that spiritual. Then there’s religiosity, which is a different thing. That’s a systematized organization of belief. So, I would bet that if we went around this room, we’d have about 80 different, mildly different definitions of what spirituality is. That’s just mine. Other comments, questions, challenges? Not that I’m going to address them. [laughter]
0:56:21 Ray B.: Okay, yeah, one more.
0:56:28 S4: Just real quick, you mentioned something about the evidence that AA works in the slide we couldn’t get to. Would you mind mentioning that out loud just, so we could research it more on our own?
0:56:38 Ray B.: More than that, I’ll take you to the slide I didn’t get to, good thinking. Kaskutas, Lee Ann Kaskutas who took all of the existing evidence, and this is fairly recent, this is, I think, 2015. Took all the studies on AA that have ever been done or 12-step recovery, including the huge match study back 20 years ago, and used the criteria they used against Big Tobacco. So, magnitude to the effect, in other words, if it works, there should be a relationship. People who do a little bit, should get a little bit of a therapeutic response, people who do a lot should get a lot. Though, thing with that… I forgot her definition of the difference between those two. There is a difference, I just can’t remember what it is. Is it consistent? Yes, it is. There’s a problem of association is not cause and people who go… One of the big arguments about AA is, oh sure, all those people who go to AA do well. That’s a trait of people who do well with recovery, is they go to AA. The ones who don’t, don’t go to AA. It’s not because of AA, it’s because of something… Well, no. One of the ways to look at it is, they weren’t doing well until you implemented this intervention.
0:58:06 Ray B.: Once you started doing it, the change, the outcome occurred. Are there theoretical explanations? Yeah, there’s tons of good theoretical explanations of why AA could and should work. It doesn’t matter if you’re a psychologist, a social worker, or a neurobiologist, there’s good reason that AA should work. AA changes the brain. When you look at all of the sources of bias and she went into great detail to do that, ruling out other causes, and AA stands up as well as the tobacco causing health issues. So, it makes a really good exercise for people who want to argue that there’s no evidence for AA. Most people who argue the loudest about AA’s no damn good, what’s motivating them?
0:58:57 S3: They can’t stop drinking.
0:58:58 Ray B.: They can’t stop drinking or they don’t want to stop drinking. What else?
0:59:03 Audience Member: They don’t like AA.
0:59:04 Ray B.: They don’t like AA. You know a common one that I get? Is they had a parent who was an alcoholic, who they didn’t want to let off the hook because AA calls it a disease. So, there’s the familial thing, or they’re an AA orphan. That’s another interesting talk, the reason for being angry at AA.
0:59:33 Audience Member: Ideologically, people who are ideologically opposed because they think AA is religious.
0:59:38 Ray B.: Right, or people who are ideologically opposed because they think AA says, in this time of empowerment, if I’m a woman who’s been abused, you’re asking me to surrender? You’re saying surrender and be powerless? I’d rather eat worms, I’m not going to do that. It’s simply that they don’t understand the concept. If they got diabetes, they’re powerless and they need a power greater than themselves like insulin and dietary change. Yeah.
1:00:08 Audience Member: There’s also a minority of individuals whose persona is introversion and they have a high level of intellect and they’re not comfortable with social treatment as an initial phase and they want to work independently. Those folks may not benefit from working with Alcoholics Anonymous.
1:00:29 Ray B.: Good, yeah, right. Huge numbers of people will find another way. The majority of people with addictions will not go to AA. The majority of people who even find recovery. Who is that?
1:00:45 Audience Member: Well, this sort of touches on another question. But you had mentioned you’d spent half day sessions with treatment for some people and that AA is not treatment. Well, I know, in the US, a large percentage of treatment centers are 12 step-based and so I wondered how that was in Canada, because I don’t believe AA is treatment as well. So why are the treatment centers mainly focused on that?
1:01:08 Ray B.: I’m not affiliated with a treatment center and what I do isn’t considered treatment. It’s assessment. But there is a treatment called 12-step facilitation therapy. 12-Step Facilitation Therapy… I got to wrap up. But 12-Step Facilitation Therapy is indeed a treatment, and the idea there is to motivate and assist the person overcoming barriers so that they can link up. So, it’s a process of getting… I don’t know. I know some treatment programs don’t offer anything other than there’s some people in recovery who are acting like sponsors and that shouldn’t be called treatment. But 12-Step Facilitation is a valid and a validated therapeutic modality. Thank you very much.