Journal of Substance Abuse Treatment, Vol. 10, pp. 91-94, 1993 Printed in the USA. All rights reserved.

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BOOK REVIEWS

Learning to Live Again: A Guide for the Recover- ing Addict

Jill Smith and Brian Smith Bradenton, Florida: Human Services Institute, and

Blue Ridge Summit, Pennsylvania: Tab Books, 1991, $8.95, 132 pages.

Presented as a collection of “recovery ideas” (p. xiii), Learning to Live Again, as with many books whose authors propose to “demystify addiction and recovery” (p. xiv), and offer ways “to help the recovering addict achieve long-lasting sobriety” (p. xiv), is grounded in the Disease and Alcoholics Anonymous (AA) models, experiential ardor, and fervor.

Written for “anyone who is concerned about how to counteract addiction” (p. xv), this book is divided into two parts: Part one is for the addict. Part two is for the family, friends, and employer of the recover- ing addict. Chapters one and two paint recovery as a nirvana. “In recovery we have feelings of tranquility, freedom, and excitement. It seems as if we’re so far above everything that we’re looking down at heaven itself” (p. 13).

Such statements make the first two chapters of Learning to Live Again difficult to read, and set up some uneasiness regarding content of the remaining chapters. A key difficulty I have with the above ap- proach is how it sets up those new, and those not so new to recovery for feelings of shame and guilt when they do not feel these feelings of tranquility, freedom, and excitement. Many people in recovery work quite ardently at recovering and do not feel these feelings for a long time, if at all. It is a common conception that failure to reach such feelings is founded in some characteristic of or flaw in the client.

I am an advocate of work towards shifting our thinking about motivation and change in recovery to a strengths model. From a strengths model, the above statement would read: In recovery we might occasion- ally have feelings of tranquility, freedom, and excite- ment. It is at these moments that it seems we’re so far above everything that we’re looking down at heaven itself. This “high” feeling is all too familiar and we must be careful. Like reaching for old drug highs when we were actively using, these feelings are fleeting and ever illusive once experienced. Learning to reach out for feelings of tranquility, freedom, and excitement in recovery, just as ardently as we reached out to drugs,

those fleeting moments can keep our commitment to sobriety alive until the next time the feelings occur.

In chapter 3 the themes of learning and teachabil- ity are used to reveal various ways that recovery is sab- otaged by the “rebel without a cause” (p. 38) attitude of the addict. The need to avoid premature sexual af- fairs in early recovery is emphasized. The authors of- fer the best reason for this that I have heard in my years of practice: “the power of obsessions” (p. 26). Using a vignette, the authors explore issues of obses- sions and the difficulty many addicts have in “remem- bering how painful their drug addiction was” (pp. 33-40). This chapter offers helpful information about defining and counteracting roadblocks to teachability.

In chapter 4 the authors propose a definition of “normal.” The chapter ends, however, without a rec- ognizable definition. The reader is left to sift for a def- inition through a number of descriptors such as “not too high-being rid of those racy, crazy thoughts - and not too low-without guilt and despair” (p. 45); “emotional balance; healthy functioning; a comfortable place to be” (p. 41); and “a calm that is like a perma- nent smile inside . . . not reacting to others’ negative actions and feelings, and just accepting everything and everybody the way they are” (p. 45).

Chapters 5 and 6 are refreshing and by far the most valuable chapters. The themes of learning and teach- ability as staying open to choices and listening for op- portunities to grow continue. The book begins to flow with less of a preachy feel. The authors take more time to clarify the difficulties inherent in choosing the road of recovery.

“Three Newcomer Essentials for Recovery” (also the chapter title) are covered in chapter 5: (a) get a spon- sor, (b) join a home group, and (c) attend 90 meetings in 90 days. These are not new recommendations. The authors, however, present information about sponsor- ship, home group involvement, and reasons for con- sistent attendance that are clear and helpful.

For example, several sponsors are not recom- mended as a rebellious sponsee would turn to each un- til he or she finds the one who says what he or she wants to hear (p. 52). This addresses what I find as a common practice in some groups, highlighting the overt sense of support the recovering addict might feel with several sponsors, and the covert opportunity for manipulation. The use of an “alternate sponsor” is rec- ommended when a sponsor is away on vacation or at work.

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92 Rook Reviews

Chapter 6 begins with the following statement:

Relapses seem to occur more often during these periods: the first five to seven weeks of recovery, the fifth through sev- enth month of recovery, the eleventh month, and the thir- teenth month (p. 57).

This information is variously presented in the AA, NA, and treatment communities. The impact is con- sistent, however. Treatment providers, recovering peo- ple, their families and employers sit up and take note. These are recommended times to be particularly wary, but should not exclude daily alertness to the signs and symptoms of relapse.

A discussion covering topics including compla- cency, defiance, communication, self-pity, powerless- ness, care in the use of medication, an explanation of the AA chip system, and resentments follows. The au- thors provide further advice on how to avoid a relapse: don’t miss meetings (p. 58), pray regularly (p. 59), and have enough contact with sponsor (p. 61). Individual, family, and/or group therapy with social workers, psy- chologist, psychiatrists, or family therapists outside of 1Zstep programs is not explored in this book.

The need to fill time with healthy social involve- ments and hobbies is discussed in chapter 7. In chap- ter 8 the authors address nutrition in recovery. They present a summary of “an amazing experiment con- ducted with two groups of rats . . .” (p. 82) to sup- port their contention that drug and alcohol abuse are typically coupled with poor nutrition and vice versa. Presented as a compelling piece of factual information that supports the need for attention to nutrition in re- covery, this information comes across as anecdotal. Recovering addicts and substance abuse treatment pro- viders with little or no background in research have no way to gauge the relevance, validity, or reliability of the experiment as presented.

The authors provide addresses and phone numbers for such resources as Sexaholics Anonymous (p. 28) when relevant, yet in presentation of supportive em- pirical evidence fall short of providing citations. In chapter 12, for example, one of the authors states “I’ve read about differences between American and Japa- nese attitudes towards enabling- they simply refuse to accept alcohol and drug abuse . . .” (p. 115). There is no information on how the reader can find this in- formation for his or her own exploration. Citations would offer the reader the opportunity to broaden his or her learning experience beyond this book.

Chapters 9 and 10 explore stress reduction and at- titudinal change. A familiar stress reduction exercise is offered. The reader is then subtly introduced to the use of positive affirmations in working toward attitu- dinal change. The authors emphasize “don’t worry if you don’t fully understand the benefits of these state- ments just yet. You will!” (p. 96)

The idea of denial as disease is introduced in chap- ter 11. The role of denial in our society and in “dys- functional” families, more particularly, and ways to combat denial’s mandate to suppress feelings are briefly covered. Learning how to accept compliments with a simple “Thank you!” and direct eye contact is suggested, for example.

The final chapter, 12, is “A Guide to Codepen- dency, for the Family, Friends and Employer of the Recovering Addict.” The authors encourage codepen- dents to “stop being the antidote for the addict’s pain” (p. 109). The definitions and metaphors used for co- dependency and enabling are vivid and helpful. Con- cerned persons are encouraged to avoid rewarding the addict who begins a recovery program, and to discon- tinue the use of punishment and reward as a means of controlling the addict.

The authors seem to contradict themselves when they comment on the impact of being reared in a dys- functional family, “whatever confusion these types of upbringing might have caused, it’s important to put them to rest, now! These events, no matter how terri- fying or embarrassing, are over and done. They are in the past. That part of your life is over, and to re- live it is unhealthy; is not reality . . . Let Go, Let God” (p. 113), and in the very next paragraph they state that “recovery . . . is going to take some time . . . so, Easy Does it” (pp. 113-I 14). However, 12-step programs are filled with such contradictions. One particular phrase I am surprised the authors did not use that fits this idea is “To keep it (i.e., sobriety) you’ve got to give it away. ”

SUMMARY

Learning to Live Again is slow reading in places. It offers refreshing experiential insights in others. Writ- ten in a style that addresses a broad spectrum of prac- titioners as well as recovering addicts and alcoholics, their families, and employers, the authors take a per- functory look at many issues encountered in the recov- ery process.

The newcomer to Alcoholics Anonymous or Nar- cotics Anonymous will become acquainted with the slogans often used. The authors use these slogans fre- quently and offer an interpretation of their meanings and usefulness in the recovery process. Case studies are not used. Several vignettes are provided to help in ex- ploring particular issues.

Readers from the substance abuse treatment arena will find much of the material unremarkable. Chap- ters 5 and 6, however, make for interesting reading and would be ideal as reference material for recovering ad- dicts, their families, and employers alike. Knowing that people in recovery share recommended reading mate- rials with each other, it is often important that practi-

Book Reviews 93

tioners offer material amenable to discussion and understanding in therapeutically unsupervised settings.

Darlene Grant, MSSA, LCSW College of Social Work University of Tennessee

Knoxville. Tennessee

Expanding Therapeutic Possibilities: Getting Re- sults in Brief Psychotherapy

Steven Friedman and Margot Taylor Fanger Lexington, Massachusetts, Toronto: Lexington

Books, D.C. Health and Company, 1991, $39.99, 316 pages.

Expanding Therapeutic Possibilities is really a brief, at times somewhat informal textbook for a type of psy- chotherapy. Its authors intend to pique the interest of psychotherapists in alternative ways of looking at and proceeding in their own psychotherapeutic work.

The heart of their approach is the “possibility par- adigm.” This is most centrally a pithy set of refram- ing techniques. People present problems to these short-term-oriented HMO based therapists. The usual major intervention is to give a different context to the major symptom that brings people to their doorstep in the first place. The symptom, or problem, is gener- ally some discouraging litany, which has become a frustrating, negative, helplessness-inducing, closed, cir- cular behavioral pattern. The task of the therapist is to describe the intention of the symptom in such a way as to render its thrust with positive valence. Rather than looking upon the pathological side of life, possi- bility therapy seeks to right the balance by emphasiz- ing the constructive aims of people who happen to be clients, playing down self/other evaluations that induce guilt and shame, or that reinforce the monotonous rounds of already ingrained devaluation.

Friedman and Fanger make a number of other as- sumptions that are very attractive. They wish to make therapy a positive experience. Emphasizing therapist flexibility, they suggest that this type of reframing is powerful, adaptable to even the briefest of interven- tions, or a small number of sessions, in any event. They throw out the “fifty minute hour,” tailor the length of the session to the problem, constantly seek creative ways of viewing old patterns, do telephone therapy, schedule appointments irregularly if the clients or they feel the need, and assign “homework” between sessions.

The authors also lend weight to both their theoret- ical and practical assertions by drawing upon well- known practitioners and writers about psychotherapy. These are numerous, and drawn from family therapy (Virginia Satir), the Palo Alto school (Bateson, Wat- zlawick), Neurolinguistics (Bandler), and related psy-

chosocial researchers (e.g., Ellen Langer). To my mind, the most important of these influences in this book is Strategic Therapy. As with many such recent books, much tribute is paid to the late Milton Erick- son, an offbeat psychiatrist whose ideas have spread through disciples far and wide, and whose work is at the heart of paradox as a tool for psychotherapeutic intervention. Although the right obeisances and ref- erences are paid to Strategic Therapy, I did think that Friedman and Fanger might have been somewhat more explicit in acknowledging how their approach culls from writers in this particular area.

Expanding Therapeutic Possibilities, though, is largely a practical “how-to” type of manual. The cen- tral chapters of the book are filled with examples, mostly brief, but a number more extended-including edited transcripts-of successful types of intervention. By and large, I found these examples both appropri- ate and illustrative of the points the authors were try- ing to make in the context. The vignettes do both illustrate how to intervene, and suggest ways of build- ing up one’s own repertoire as a therapist, so that the therapist has a backlog of more-or-less standard inter- ventions to try when she/he is unsure how to proceed next in a particular instance. I think this is particularly germane for therapists only now learning this tech- nique, since the range of personal experience available to the therapist, especially under the stress of think- ing immediately in a session, may be somewhat limited.

Substance abuse specialists will look in vain for much direct reference to their own field. There are a few sections, and some minor vignettes directly tar- geted to substance abuse in this book, but very few.

Why, then, should a substance abuse therapist, be she or he counselor, psychiatrist, social worker, or whatever professional, bother with this book? Al- though I do believe the authors could have done a much better job of elaborating on the possible appli- cations to substance abuse, the fact of the matter is that they make an effective and plausible case for the applicability of possibility therapy to many situations. My own feeling is that conflicts in clients, and espe- cially families, around substance abuse often can be profitably reframed. For example, I find myself align- ing with Duncan Staunton (not referenced in this book), who looks for the positive functions that drug abuse serve for a family: to maintain cohesion, draw the family back together, focus affect, etc.

To be sure, this book has many limitations. It suffers repeatedly from the bugaboo of having to disparage psychodynamic and other approaches to psychother- apy, in order to glorify itself. I submit that such petu- lance, common as it is among authors in this genre, only detracts from the main concerns. The authors make a point of their HMO affiliation, but underesti- mate the importance of economic concerns in driving how people practice. For instance, I think I could make