We’ve walked and watched the sun rise over the bridge. There is a little tent encampment, 3 or four with litter on the beach there. A rough feeling place. The park is the university Chancellor’s administration park. Homelessness, poverty, criminality, lack of opportunity, drugs and alcohol, burnt bridges, lack of hope and future, I’m planning on going to church and AA today. Both provide tremendous assistance to people in need but so often it’s the ego that ‘blames’ and ‘I’m the victim’ and “I want a free lunch”, and I want to do it my way though my way didn’t work
Dr. Bob had all the new comers to AA get down on their knees and pray for help, God of my understanding, something outside myself, not me.
The idea of ‘bottom’ is readiness, willingness.
Motivational Therapy research has found that the vast majority of services offered people are wasted because the individuals seeking ‘help’ are really seeking ‘their own idea of what that is’. Mostly money and ‘license’. License is differentiated from Freedom because License removes accountability. We are all free to do what we want but are held accountable for our actions. Maturity from childhood to adult is learning the rules and understanding consequences. If you don’t want to do the time, don’t do the crime.
Motivation therapy divided individuals in the the following groups:
1 Precontemplatioon - these people don’t think they have a problem . Don’t with to change, Don’t have a problem themselves with their behaviour. They often get angry if you suggest there is a problem. Millions of dollars and untild number of resources were criminally wasted on ‘do goofing’, ‘same old, same old’ , ‘makes me feel good and like I’m doing something’ but has no effect and no change, The person is not at their ‘bottom’. The idea of a bottom wasn’t anything stereotypical. It’s just the point on the down elevator a person wants to get off. It’s the depth one digs that says it’s deep enough for a grave. It’s the point of being lost where one may consider the map.
2. Contemplation - this is the phase at which a person might be willing to consider their path and wonder if maybe they’re going the wrong way. This is when a person is willing to take direction. Most people think their problem is unique. As a doctor I’ve seen this with every symptom. It’s sometimes the source of black humor., A person with a fractured limb saying they don’t need a cast or surgery, ‘isn’t there just a pill or herb’. I don’t need to go to AA they say I just need to drink a little less beer or wine. The trouble is all the excuses have been heard , All of the attempts made. People are forgiven immensely. When a family or a community says no today it’s usually after multiple trials. The ‘enablers’ in society are generally utterly ignorant of human behaviour yet perceive themselves as authorities. I’ve always maintained that these people who are the obvious ‘critics’ should be obligated to take people into their home, They are the absolutes masters of telling other people what to do while being the greatest hypocrities. They are a serious problem in the politician class and in business have increasingly been identified and dealt with. In corporate board room these ‘critics’ are told they can’t ‘criticize’ without offering an alternative. Problem solving is no longer emotional knee jerk response, With people with problems we will commonly make lists of what has been tried. How did that work for you? Ultimately the idea is a do something ‘different’ and ‘new’ or ‘better’. With alcoholism people will commonly describe ‘initial success’. In disease treatment we think that the medication was stopped too soon or not high enough dose. If one is to return to AA after a relapse it helps to have some change and some plan to handle whatever occurred to cause the relapse.
3. Determinations - is a plan. This is best achieved with another and written down. It’s the foundation of behaviour change of all kinds done with doctors. Patient says they plan to exercise more, skipping lunch, and the ‘accountability’ measure which works is being asked ‘how is that plan working’ in a week or month. So often people needs a ‘coach’. In AA this is called a sponsor. One on one is the best though most expensive form of treatment and education. Apprenticeship and mentorship all work on this basis.
4. Action - a person is participating in a new change behaviour that to have significant benefits. Healing is now understood to have a length of recovery. After a fracture 6 weeks of immobility are beneficial for healing. After a wound is sutured the stitches aren’t removed for a week to 10 days usually. There are always exceptions. The joke is the instructions on a parachute are just suggestions. Changing a serious habit (bad habit, addictions) first takes a week, then a month, then a season, then a year. The relapse rate after a year of change truly significant, something like 30% while 3-5 years results in over 50% success and in cancer is called ‘remission’. Doctors and pilots who had addiction are generally no longer required to have urine monitoring. Probation in the jail system takes into account the same stats for ‘behaviour change’.
The success and cure are known but the problems persist because of ‘enablers’ and the lowering of the bar. Homelessness was addressed in the 50’’s and resulted in the ghetto. There is a long history of ‘solutions’ that worked for a while. Today ‘harm reduction’ is a consideration, In cancer therapy there is ‘curative’ therapies and ‘palliative care. Abstinence cures the problem while ‘harm reduction’ is the equivalent of ‘palliative care’. The question is resource management and immense resources are being given today to harm reduction and the question arises regarding public funding. Should we be paying doctors and nurses to be bar tenders and drug pushers or should that money be spent on cardiac surgery where there are proven results. The element of choice is removed in the jail system and it’s been very successful to address recurrent noncompliance and relapses in behaviour with injectable antipsychotics and injectable suboxone. The sober living communities and Elizabeth Fry Society solutions and AA are all effective and work. The question is already whether or not a person is ‘ready’ to change’ has found their ‘bottom’ or wants to continue to drive on a dark night down a dark road any further before checking the GPS
Humility remains the number one problem and that’s an issue of spirituality as well.
Posts
No comments:
Post a Comment