Our Autumn 2017 workshop, ‘Addiction, Powerlessness and 12 Step Programmes’, took place at the University of Essex, in room 1.1 of the Essex Business School, on Friday 24th November 2017.
Addiction is a paradigmatic case of powerlessness. Conversely, powerlessness and the acknowledgement of powerlessness are central to the twelve-step programs, as are references to faith, love and hope. Yet many balk at these programmes’ reliance on trust in a ‘higher power’ and more generally at the crypto-theology they seem to involve. In this workshop, we sought to understand the experiences of powerlessness involved in addiction, to explore the limits of the helpfulness of the twelve-step programs, and to see whether a secular version would be workable.
- Dr David Batho (University of Essex)
- Dr Matt Burch (University of Essex )
- Lisa Caulfield (Independent Researcher)
- Professor David McNeill (Deep Springs College)
- Professor Gabriel Segal (Kings College London)
- Dr Sarah Senker (ATD Research & Consultancy)
- Dr Bhags Sharma (NHS Fife)
Room 1.1, Essex Business School, University of Essex
9.00: Registration (Refreshments Provided)
09.15-10.30: Gabriel Segal ‘Powerlessness, Spirituality and Science’
10.30-10.45: Break (Refreshments Provided)
10.45-11.15: Bhags Sharma ‘A day in the life of the Addictions Psychiatrist – who is powerless?’
11.15-11.45: Lisa Caulfield ‘My Experience of Recovering from Alcoholism’
12.00-12.30: Sarah Senker ‘“It’s definitely a choice, but it’s a choice you can’t understand”’
12.30-13.30: Lunch Break
13.30-14.45: David McNeill ‘St. Augustine, Desire and Addiction’
14.45-16.00: David Batho ‘Addiction and the Recovery From Identity’
16.00-16.15: Break (Refreshments Provided)
16.15-17.30: Matt Burch ‘A Phenomenological Approach to Addiction’
David Batho is the Senior Research officer for The Ethics of Powerlessness: The Theological Virtues today. He has published on phenomenology and moral psychology and is the lead author of each Green Paper report produced by the project.
Matt Burch completed a PhD in philosophy at Rice University in 2009, spent a posdoctoral year at Bergische Universität, Wuppertal, and taught at the University of Arkansas for five years before coming to Essex in 2013. He works on issues at the intersection of phenomenology, action theory, and research in the cognitive and social sciences. At the moment, his research is focused in particular on the stance of objectivity, the phenomenology of risk, and, his favorite topic, the quintessentially human failure to act on one’s better judgment. He also has interests in applied philosophy, and has done such work on several projects with the Essex Autonomy Project (EAP), including an AHRC-funded project on the compliance of the Mental Capacity Act (2005) and the UN Convention on the Rights of Persons with Disabilities, and the Wellcome Trust-funded Mental Health and Justice project. In September 2018, he will begin an Early Career Research Fellowship awarded by the Independent Social Research Foundation. That project, which will also be associated with the EAP, will focus on risk decisions in the care professions.
I am a 50-year-old single mother to 3 children; my youngest is 14 and lives with me. He has autism and has been out of education for a year. I am not in paid employment at the moment but in the past have worked mainly in legal advice. After many years of poor mental health and alcoholism, I began my journey of recovery 2 and a half years ago. Since then I have regularly attended AA and try to follow the 12 Steps in my daily life.
David McNeill is the Robert B. Aird Professor of the Humanities at Deep Springs College. He is the author of An Image of the Soul in Speech: Plato and the Problem of Socrates, and has published articles on Plato, Aristotle, Nietzsche, Sophocles and contemporary Critical Theory. His current research focuses on the role of ethical perplexity in Aristotle’s account of practical wisdom.
Segal has published extensively on Philosophy of Mind, Philosophy of Psychology, Philosophy of Language and cognitive science. He is co-author, with Richard Larson, of Knowledge of Meaning: An Introduction to Semantic Theory (MIT Press 1995), author of A Slim Book about Narrow Content, (MIT Press 2000) and Twelve Steps to Psychological Good Health and Serenity – A Guide, (Grosvenor House 2013) and co-editor, with Nick Heather, of Addiction and Choice: Rethinking the Relationship (OUP 2016) which was Highly Commended in the category of Public Health at the BMA Book Awards 2017. Much of his recent published work focuses on addiction and recovery. He defends the disease model of addiction and is a proponent of Twelve-step programs.
Dr Sarah Senker is a chartered psychologist with a background in Forensic Psychology. Her doctoral thesis considered addiction and recovery in offenders with a history of heroin and crack use. Sarah has published findings from her thesis in Drugs and Alcohol Today and delivers workshops for the British Psychological Society on motivating offenders to change including presenting at the International Association for the Treatment of Sex Offenders in Denmark last year. Since her thesis, Sarah has been working as a successful independent research consultant and has conducted multiple substance misuse needs assessments across the Country, ensuring that substance misuse services including community rehabilitation centres, are fit for purpose and meet the desires of service users. In addition to her research and academic background, Sarah has experience as a practitioner in both community and custody settings, delivering recovery programmes and one to one therapy.
I would describe myself as a ‘Jobbing Consultant Psychiatrist in Addictions’. I have been in the NHS for over 20 years and working in this field for over 15 years, the last 10 of which have been in Essex. Recently I have moved to Scotland. A role of the Consultant has traditionally been to provide clinical leadership in the treatment of addictive disorders.
I am passionate about this field trying to reduce stigma to this patient group. Patients who are inflicted with these difficulties tend to have worse outcomes in terms of their health and wellbeing and I see my role not only to advocate and provide at an individual level, for evidence based treatments, but also to train a workforce to face future challenges.
I have recently stepped down as Chair of the East of England Addiction Forum. I am also a Fellow of the Royal College of Psychiatrists and an elected committee member to the national executive of the Faculty of Addictions at the Royal College of Psychiatrists.
Titles and Abstracts
ADDICTION AND THE RECOVERY FROM IDENTITY
12 Step programmes often encourage members to identify as addicts. This has been controversial. Critics argue that, at the extreme, to identify oneself as an addict is to block the way to full recovery. These critics worry that the self-identifying addict’s life is made to revolve around recovery programmes, rather than being led into new possibilities and contexts outside of addiction. Despite such criticisms, however, there seems to be something right about the thought that ‘once an addict always an addict’. Even if there is reason to worry about over-dependence on recovery groups, it appears that it would be differently problematic to suppose that the addict can simply slough off the addiction, as easily as quitting a job. Whether or not it is problematic to encourage addicts to identify as such, however, depends both on what identification amounts to and the prospects for recovery from such an identity. In this paper, my aim is to describe a number of ways in which one might understand oneself to be an addict and to discuss what it would mean to recover from each.
A PHENOMENOLOGICAL APPROACH TO ADDICTION
Paradox permeates the discourse on addiction: addiction is a disease but quitting is a choice; we pity addicts for their condition but we blame them for their indiscretions; addicts can’t control themselves but they respond to normal behavioral incentives. The list goes on. My presentation will argue that these apparent contradictions in large part stem not from addiction itself but from the way we conceptualize the addicted agent. To put it simply, there is a tendency in philosophy and the cognitive sciences to split the agent into discrete faculties – such as reason and desire – and then to think of addiction as a battle between these faculties, e.g., reason knows better, but desire drives the agent to act against her better judgment. Although this combat model is in many ways intuitive and compelling, I argue that it gets us into trouble when thinking about self-undermining behavior like addiction. As an alternative, I recommend a phenomenological approach that does not divide the agent into discrete faculties but rather attempts to provide a unified description of her experience. This approach, I contend, can i) help us resolve some of the apparent paradoxes associated with addiction and ii) point to promising ways to understand why and how addicts recover.
MY EXPERIENCE OF RECOVERING FROM ALCOHOLISM
I plan to talk about my personal experiences as an alcoholic. The starting point will be my background and early years, progressing through adulthood with an increasingly challenging relationship with alcohol and intermittent crises of mental health. I will go on to describe my experience of “hitting rock bottom”, the start of my journey into recovery. I will talk about my experiences of the AA fellowship and what I have learnt from the 12 Steps, concluding with where I am today and the action I need to take on a daily basis to help to ensure my ongoing sobriety.
ST. AUGUSTINE, DESIRE AND ADDICTION
In the past decade researchers such as Gene Hayman and Marc Lewis have argued against understanding addiction as a chronic relapsing brain disease, a view now dominant in academic and therapeutic contexts, and in favor of understanding addiction as a learned behavior, albeit a commonly self-destructive one. These researchers want to reject both the disease model of addiction and the account of addiction as a moral failing which the disease model has largely displaced. Instead they emphasize the continuity between the neurological changes that occur in addicts’ brains and those that occur in any learned behavior that becomes deeply habitual. In my paper I will argue that while these accounts of addictive behavior are largely persuasive, they need to be supplemented by a richer account of the phenomenology of specific character addictive desire. I will try to take a few steps in that direction looking to an unexpected source for aid: St. Augustine’s account of his conversion in Confession VIII.
POWERLESSNESS, SPIRITUALITY AND SCIENCE
“The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink” (Alcoholics Anonymous p 24). I will explain the way in which an addict’s power of choice is lost. An addict’s choice-making apparatus is severely impaired so that their desires or felt needs to use can easily overcome and even obliterate their will to refrain from using. I will show how Twelve-Step programs solve this problem and restore the addict’s ability to choose in line with their wills. Alcoholics Anonymous offers a conception of addiction as involving a ‘physical allergy’, a ‘mental obsession’ and a ‘spiritual malady’. I shall argue that this conception is correct and largely vindicated by contemporary neuroscience.
“IT’S DEFINITELY A CHOICE, BUT IT’S A CHOICE YOU CAN’T UNDERSTAND”
The focus of this talk will be to present findings from a doctoral thesis, which, in part, explored the concept of choice and disease models within addiction. Offenders with heroin and crack misuse considered the role of choice in their behaviour. Correlations were found with those who were more ‘recovered’; who were more likely to acknowledge the role of choice in their drug-taking even if they had benefitted from a 12 step programme. The aim of this talk is to consider the findings and open the conversation about whether true addiction can ever be defined as a choice.
A LIFE IN THE DAY OF THE ADDICTIONS PSYCHIATRIST – WHO IS POWERLESS?
I will talk about a typical day as a consultant in Addictions to demonstrate the variety and challenges that are faced in treating Addictions. I hope that the theme of ‘Powerlessness’ is captured.