Tuesday, 3 September 2013

What is the point of advice if you ignore it?

There is advice given by NICE (National Institute for Health and Clinical Excellence - the people who advise the NHS on the most effective treatments to be applied) that states. "...should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles, for example, Narcotics Anonymous and Cocaine Anonymous".  Mark Gilman who is the Strategic Recovery Lead Substance Misuse working for Public Health England states in a recent interview that this advice has "been roundly ignored".

I read this with an ironic smile on my lips, indeed a small mirth-filled chuckle may have escaped them.  The irony of good advice like this being ignored by the health professionals supposedly helping people who spend a great deal of their energy in avoiding/ignoring/countermanding the advice from those around them that care, family/friends/colleagues, that they should really do something about their problem is far from lost on me.

I'm not surprised the advice is ignored by the professionals since AA's programme of recovery is hardly based in the statistical evidence based world of modern medicine. There are some learned papers out there that support with some evidence the AA can work but still to those brought up on "outcomes management" there isn't enough.

I commend Mark's efforts as in Britain the whole addiction treatment landscape has changed to now being devolved to the responsibility of the local authorities so now is the time to implement new strategies.  There is an issue at play here however... AA has certain traditions which are based on hard learnt lessons of the early pioneers in the fellowship.  Some of these brought into focus here include ...

6. An A.A. group ought never endorse, finance, or lend the A.A. name to any
related facility or outside enterprise, lest problems of money, property, and
prestige divert us from our primary purpose.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A.
name ought never be drawn into public controversy
11. Our public relations policy is based on attraction rather than promotion; we
need always maintain personal anonymity at the level of press, radio, and

So AA can never be seen to be intrinsically linked with other organisations (Tradition 6 above).  We can support the local authority in providing them with details of meetings in their area and helplines etc. but we cannot be linked to them.

We have no opinion on outside issues, e.g. local or national policy on drug and alcohol misuse - so again we have to be separate from that, any government can't insist that a meeting is run in a particular area for particular people etc.  It couldn't set one up on it's own.

Finally we have to attract the member on their own, many people come along to meetings with "back problems" - i.e. they've come to get the boss of their back, or their spouse, or family etc.  But once they come they have to stay of their own volition.

AA can't report on a members attendance (outside of some simple attendance certification options), can't report on participation, quality of recovery etc.  We are not like that and it would completely break all the traditions above and more.

It waits to be seen if Mark Gilman can move those that matter to make the recommendation of 12-step fellowships to those in recovery a more regular option by health professionals across England.  What ever we need to move from where we are - The Centre for Social Justice has produce a report that describes Britain as "the addicted man of Europe" whatever your opinions on it if that statement is based on any amount of fact there are an awful lot of people ruining their own lives and those of many around them with their addictions.

Disclaimer - I don't speak for AA anything stated in this post and any replies to comments by me is purely my opinion and my interpretation of AA traditions etc.


  1. So AA can't be linked to the agencies that might point troubled addicts in their direction? Do I understand that correctly? This is confusing to lucky souls like myself who have never had to deal with addiction. I suppose there's a logic there somewhere but it escapes me.

    1. The problem is not one of having agencies point people to AA/NA/CA etc. but one that we have to maintain total independence - even to the point of not accepting any outside contribution, even in kind. Say you set up a meeting and the local hospital offers you a room rent free - you are indebted to them. They advise people to come along, then they ask for "progress reports" or attendance sheets and such like - you'd risk the meeting closing if you didn't produce them.

      It has to remain totally free of these encumbrances so that people feel totally safe there, not pressured or required etc. etc.

      These traditions were created when AA was about 20 years old and reflected where they had seen much trouble in their early years.

      So one thing for example - NA could never say "as recommended by NICE" for example, even though that is true as that would be seen to be supporting or siding with that organisation - the fellowships can never do that and stay true to the principles originally drawn up in AA in the 1950s. It is very different from any other organisation I've ever been involved in, from the outside or to newcomers it all seems a bit restrictive or over the top but over time I've come to align with them and see how they've allowed the movement to grow over 75 years to the global movement it is now... and all that without a CEO, without a board, without money from outside etc. It is a very very unusual and special thing.

  2. Whoever thought up "Strategic Recovery Lead Substance Misuse" as a job title has certainly been overdoing the happy pills.