12-Step Coercion

SRbear · Jun 9, 2004

I could tell many a story about what happened while I was being "treated", what happened and what did not happen, what should have happened. I could tell you of one person required by the board to attend 1 meeting a week for 4 years, to go to 90 AA meetings in 90 days, but never attended even one, never went to an AA meeting or had a sponsor, never even read the 12 steps, or said 1 single prayer. My point..well, that person is still a nurse today.

Tweety, BSN, RN · Jun 9, 2004

That's what I'm wondering. I guess my thought is that, as someone said much earlier, our licensure is a privilege, not a right. If we mess up and have our capability of carrying that licensure called into question, then we are subject to whatever mandates are placed upon us by our governing body. I can understand the objection to a religiously based mandation (and both sides of whether or not AA is religious have already been argued) but hopefully we're not questioning the need for treatment of some sort in cases where drug abuse is an issue.

I think there's a lot of bitterness on this board by non-addicts that have fallen through the cracks and had "treatment" forced. I probably would feel the same way. I'm sure there are plenty of victums of unfair judgement out there.

But what can you do? SRbear says he/she has a story to tell. But any of us in nursing for any length of time also has some stories to tell about addicts. Like the nurse that took 500 mg of Demerol and tried to work with critical care patients in my hospital, on and on and on.

I agree AA is "religious" while not actually being a religion and shouldn't be forced. But I'm afraid I agree with mandated treatment of some sort. If AA is the only treatment available in the area they should still have to do something, although I'm not sure what.

The hallmark of addiction is denial, which makes it a tough issue to wade through the innocents and the addict. I'm afraid some innocents, as those on this board have stated, fall through the cracks.

Good discussion so far.

Tweety, BSN, RN · Jun 9, 2004

Lemmonhead states "In response to the "too angry to be objective." "Anger" can propel a person to educate themselves and understand every aspect of a cause they are pursuing..ignorance does not. "

As I'm the one who made the statement you're responding to, let me say that's an excellent point.

By calling us "ignorant" as you have a couple of times, I presume you mean that we don't know what it's like to be falsely accused of being an addict and thrown into the system. So yes, I am ignorant of that. But don't assume I'm not educated on addiction or 12-Step programs.

I apologize for saying you weren't objective enough to discuss this from all sides, as you've obviously taken into consideration all sides. But you're anger and bitterness is intense. Understandably so.

vwgirl · Jun 10, 2004

This topic is of the utmost importance in this nursing forum--there are many nurses that DO lose licensure over these issues--because they cannot comply with the demands of meetings that conflict with personal, religious beliefs. These meetings are not, in any way,monitored and there is no way for any person to state unequivocally what does and does not happen in them. If a nurse can prove abstinence in another program or another method, that should be acceptable--and THAT defines "option".

I agree that there should be other options; random hair sampling would be one. (Not urine, 'cause if you really are an addict, a fake clean urine is too easy to score!) But what are the demands that the 12 step program places? In my decade in NA nothing has ever been demanded of me, not to share, not to show up, not even to stop using. Things are suggested, as these are the things that have been proven to work with previous addicts, but whether I took these suggestions was, and is, totally up to me. Or did you mean the demand by the BON of having to attend the meeings? I'm not being sarcastic, just genuinely curious.

tommyperkins · Jun 10, 2004

To the OP: Okay, if you don't want people 'coerced' into attending AA or NA meetings, what would you suggest they be mandated to do?

Inasmuch as someone may be mandated to AA for breaking a rule, I would suggest that they be mandated to not breaking that rule again. That's what I call a second chance, not religious coercion, which is in itself rule breaking by the coercers.

And why so judgmental toward the boat builders and topless dancers and factory workers---do they have nothing of value to offer, simply because they occupy a lower position on the socioeconomic food chain than you do?

I think you have me mixed up with someone else. I assume OP stands for original poster and that is me. However, you should read the messages more carefully. I never brought this up. I'm a topless dancer myself, not professional but when I sing in the shower I sometimes dance too.

Havin' A Party!, ASN, RN · Jun 10, 2004

... I'm a topless dancer myself, not professional but when I sing in the shower I sometimes dance too.

Hahahahahahahahahaha!

Guess I'm a topless and bottomless singer then. :)

NP2BE · Jun 10, 2004

Inasmuch as someone may be mandated to AA for breaking a rule, I would suggest that they be mandated to not breaking that rule again. That's what I call a second chance, not religious coercion, which is in itself rule breaking by the coercers.
I think you have me mixed up with someone else. I assume OP stands for original poster and that is me. However, you should read the messages more carefully. I never brought this up. I'm a topless dancer myself, not professional but when I sing in the shower I sometimes dance too.

Well, its not a puishment, its a way to get help, and it helps more people than it hurts, Im all for it

tommyperkins · Jun 10, 2004

it helps more people than it hurts

I disagree. I believe it hurts more people than it helps.

Big Bab's · Jun 10, 2004

I agree that there should be other options; random hair sampling would be one. (Not urine, 'cause if you really are an addict, a fake clean urine is too easy to score!) But what are the demands that the 12 step program places? In my decade in NA nothing has ever been demanded of me, not to share, not to show up, not even to stop using. Things are suggested, as these are the things that have been proven to work with previous addicts, but whether I took these suggestions was, and is, totally up to me. Or did you mean the demand by the BON of having to attend the meeings? I'm not being sarcastic, just genuinely curious.

I can only speak for myself here...The program that I was mandated to by the state board requires me to 1) call in every morning by 11am to listen to a recording to see if it is my day for a UA, we are required to do 24 per year (some people are required to do more for various reasons, but 24 is the standard), along with the UAs come the cost of them, for me its $35.00 each, but I am lucky and have a lab that does the collection for me for free, in other states the price tag is MUCH higher and they have to do more of them.....2) I am FORCED to attend at least 3 12 step meeting per week, after inpatient rehab I had to do 90 meetings in 90 days, for me the meetings are the worst, it goes against all my beliefs, its blasphemis and I despise going to them, what DOES work for me is Rational Recovery but that is not an option that I am allowed, other programs they could let choose from are RR, Smart Recovery, Women in Recovery, and I know there are more that I am forgetting.....3) I am required to have a work site monitor who sends a monthly report on my "progress"......4) I have to do a monthly self report as to how I think I'm doing.....5) a monthly calendar showing meetings I've attended, when, where, topics...etc....6) I'm am required to have a sponsor and be at that persons mercy and beck and call....7) A monthly monitoring fee........anyway these are the big parts of it, I'm sure theres small stuff I'm forgetting.....other states require much much more than this....Now here's an interesting tidbit, if your monthly payment is late, its considered a "level 1 relapse behavior" and can be reported to the BON, so let me get this straight!?!...If I can't afford the bill, that means I'm relapsing?!?!?!?!!......What kind of logic is that?!?!.....Honestly, the only part I can't stand about my program is the meetings, I hate them I absolutely hate them...BUT that's MY choice!!....If it works for somebody else GReat!!!!...but we should have some choices of other programs than AA/NA, period.....the emphasis with alternative programs should be on TOTAL ABSTINENCE for mood altering substances and it shouldn't matter HOW you maintain that abstinence, the fact that you DO maintain it should be enough......and how do they monitor your abstinence??...thru bodily fluid testing or hair if you like......The kicker here is that the program I'm in is considered VERY progressive and new, it is a cake walk compaired to other states.....Anybody here from Ohio???.....Ohio is a prime example of a BON and government that considers "impaired nurses " to be garbage, and that's not my wording its THEIR's!!!!!!......Anybody else wanna tell what their program requirements are??...Maybe it would help people not in a program to understand it better, just a thought......Anywho, does that help as far as the "big picture" and what other things we are required to do??.....If I've offended anyone I apologize, but can you see why we get as upset and as angry as we do??...I'm not trying to justify anyones bad behavior but maybe this will help explain it........It's very frustrating to feel that your control has been stripped and now somebody in a far away town is running my life....Thanks for listening.

Big Bab's · Jun 10, 2004

Oops!!....forgot to say that this monitoring is a 5 year contract.....EEK!!....that seems like forever!!....well 2 1/2 years to go!!

Quailfeather · Jun 10, 2004

Someone posted earlier, asking for options other than mandated 12-step attendance. There are many secular organizations available to recovering people. One poster has already mentioned Rational Recovery. There is also S.M.A.R.T. Recovery, Secular Organization for Sobriety (SOS), Lifering Secular Recovery, and Women for Sobriety to name a few. These alternatives should be offered to recovering nurses instead of the one-size-fits-all approach taken by state boards. Although I do not personally subscribe to the disease concept of addiction, the nursing boards do. They openly describe addiction as a disease that is chronic, progressive, and ultimately fatal if not treated. Yet the "treatment" that they mandate is religious conversion. As Tweety has already pointed out, AA is not a religion, per se, but it is a religious program. God, "higher power", or "spiritual" is mentioned in seven of its twelves steps. Alcohol is only referred to in the first step. Recovery, treatment, and abstinence are not addressed in any of the steps.

As nurses, we are taught to treat each patient holistically. We are also expected to respect the autonomy and self-determination of our patients. Yet if a nurse falls victim to addiction, whether their drug of choice is vodka or vicodin, they are all herded into the same program. Even Bill Wilson, the founder of AA, realized that one approach may not suit everyone. In his address to the New York Medical Society on Alcoholism in 1958, he stated:

"Your President and other pioneers in and outside your Society have been achieving notable results for a long time, many of their patients having made good recoveries without any A.A. at all. It should here be noted that some of the recovery methods employed outside A.A. are quite in contradiction to AA principles and practice. Nevertheless, we of AA ought to applaud the fact that certain of these efforts are meeting with increasing success."

Address to the New York City Medical Society on Alcoholism, April 28, 1958. Online at http://www.historyofaa.com/billw/med1958.htm

AA is not the only road to recovery. As a matter of fact, more people sober up and recover outside the rooms of AA. AA Trustee and Harvard Prof. George Vaillant, MD, admitted this in an interview in May 2001 for AA's news magazine, the Grapevine:

"... it doesn't hurt at the level of GSO for AA to have humility and understand that 60 percent do it without AA."

Complete interview in The Grapevine, May 2001, online at http://www.aagrapevine.org/archive/interviews/GVMDInterview.html

Addicted nurses deserve the right, just as anyone else, to recovery options. That way they can make an informed consent by choosing the option that fits best with their personal and philosophical beliefs. The boards do have the right and responsibility to mandate abstinence and monitor compliance, but they go beyond their ethical scope when they dictate how a nurse is to achieve that abstinence. Recovery is a very personal journey. Nurses should be allowed to chose their own path while maintaining their accountability through drug testing and self/peer reports. If said nurse's integrity becomes compromised because they are not making an honest recovery effort, then the board is obligated to terminate them from the program and take action against their license. Those, I believe, are fair options.

Tweety, BSN, RN · Jun 10, 2004

.....Ohio is a prime example of a BON and government that considers "impaired nurses " to be garbage and that's not my wording its THEIR's!!!!!!......Anybody else wanna tell what their program requirements are??...[/quote']
Are you saying they used the words "impaired" or "garbage"? Here in Florida they use the word "impaired" as well I think. My spouse's part time job is with the Intervention Project for Nurses here in Florida (I think that's what's it's called) and the requirements sounds pretty similar to yours. He says they don't mandate AA meetings, but mandate some sort of meeting, I'll have to ask him again the number of meetings required a week.
The problem being when Florida says you must attend 3 meetings a week, if you don't live in a major metropolitan area, there aren't going to 3 alternative type meetings a week, and in some areas only AA is available. Tough issue. Spouse says you just gotta take what you need and leave the rest.
I don't think though that drug testing alone is good enough. I have to say I agree with the mandated meetings of the persons choice. A lot of people can quit addiction through will power alone, and drug testing can prove that, but I still think in the best interest of patient safety that person needs a recovery program beyond just drug testing.
Quailfeather, excellent post. :)