Anecdotes Get in the Way of Science — A Dialogue with Dr. Judson Brewer
Discovering Dr. Jud Brewer’s work a year ago was life-changing for me. His science-based approach to helping people heal from addictions was just what I needed to get a handle on all my unhealthy habits. I devoured his books — first Unwinding Anxiety and then The Craving Mind — and bought a paid subscription to his Unwinding Anxiety app. I recently re-subscribed to the app and am working through it for the second time.
I used to recommend Dr. Jud’s work to anyone who struggles with addiction or who loves someone who does, but now that recommendation comes with a a great big caveat.
With curiosity (Dr Jud’s favorite tool — and mine as well!), I’m discovering an invalidating tone in some of the advice in the UA app and in his books. I’ve looked at some of the critical reviews of his bestselling books and realize I’m not alone in sensing a misconnect with people not privileged with resources and support. My gut has been telling me that something isn’t quite right, and I’m starting to trust it. Experts make mistakes too! Good experts learn from those mistakes.
I’m curious if Dr. Jud will stay in the arena with me. Would he rather be right or would he rather be kind? Sometimes we can’t be both.
I’m sharing a dialogue Dr. Jud and I had in the on-line Community for his Unwinding Anxiety app. So far I’ve been disappointed with his responses, but I’m not deterred. I’m continuing to work the program, but this time through a new, more critical, lens.
I’m currently focused on evaluating if the UA program is trauma-informed. Does it provide useful tools for those of us who struggle with complex trauma and addiction — a link that has been well-established in trauma-informed circles (refer to work by Gabor Maté, Bessel Van Der Kolk and many others)? If not, why not?
Based on the work by Pete Walker, I have come to understand that virtually all addictions (unhealthy habits) are “flight” trauma responses (an attempt to escape pain), and to successfully recover from addiction, we must address the traumas that are at the root of the unhealthy habits we’ve developed. When we bypass the trauma (spiritually as in 12-steps or psychologically as in UA) we often just trade one addiction for another. Unfortunately, the more I see similarities between UA and 12-steps, the more skeptical I become regarding the universal usefulness of Unwinding Anxiety methods. Is UA like 12-steps — only helpful for privileged people who have resources and support?
Hi Dr. Jud -
Thank you so much for your kind response to my question about the “tantruming child”. I had to stay away for a few days because I feared a gaslighting response. This is precisely what happens to people who struggle with trauma from gaslighting abuse, we don’t feel safe anywhere!
Now that I feel safer with you, I’m going to go out on a limb and ask your honest opinion of 12-step programs.
Can you imagine an expert doctor not having a stance on a therapeutic treatment that has an estimated 5–10% success rate? Would you trust a practitioner who recommended such a treatment?
I’m a psych nurse working towards becoming a trauma-informed coach. I want to recommend your program to my patients, but I can’t do it if I don’t know your stance on AA, as many of my clients/patients are in recovery from the harm done by 12-steps.
If I believed in 12-steps, I’d say I’m at the 12th step where I want to use my experience to help others. As a boundary to protect myself, I’ve sworn off practitioners who are unable to acknowledge the damage done by 12-step programs.
I’m looking for other practitioners who are trauma-informed and value evidence-based medicine.
I’m looking for compassion.
Respectfully,
Tempestinateapot
Dear Dr. Jud -
Interesting. I don’t mean to be difficult, but I am struck by the cognitive dissonance I experience when discussing 12-steps with addiction professionals.
Harm-reduction for whom? Primarily privileged white people? What about those of us who have been harmed by 12-step programs? I used to think I was alone, but now I understand that I am likely one of millions. What about us?
“Whatever they feel is best for them”?
Can you imagine an oncologist saying this about a cancer patient who felt that faith healing was their best option?
Or a psychiatrist saying this about a patient struggling with schizophrenia who felt that staring at the sun was their best option?
Those of us who struggle with mental health conditions, including substance use disorder, look to experts to guide us on our journeys. We put our trust in you to help us recover. We recover by sharing our stories with compassionate others and filling our toolboxes with various science-based methods that actually work. When we are recovered enough, then we can choose which of those tools work best for us.
You hold a great deal of power; integrity requires you to use that power with great care. If we are offered choices that are not based in science, we don’t know who or what to trust.
Your programs DO seem evidence-based, which is why I’m so enamored of them. I’m curious what science you have to show that allowing patients to “choose” their own treatments is evidence based.
I look forward to your new module on trauma. I hope it addresses trauma as the result of a lifetime of bullying = complex-PTSD. Virtually everyone who suffers with mental health struggles, including substance use disorder, has a history of CPTSD.
The blaming/shaming and self-righteousness inherent in 12-step programs — the gaslighting of “knowing best”, using labels, convincing people they are defective and powerless, making them return to step 1 whenever they make a mistake, rejecting people when they fail the program (instead of recognizing that the program is failing them) — are all bullying techniques and go against the science you teach in your programs.
12-steps increases the stigma of mental “illness” by seeing addiction as a moral failing rather than the trauma response that it is. 12-steps encourages people to spiritually bypass their trauma, which is no way to recover.
The only way out is through.
Your programs encourage people to get curious about their brain, their behavior and their trauma responses. That kind of recovery is enduring and real. We don’t just replace one addiction (a substance) for another (self-righteousness), instead we replace addiction with awareness and curiosity.
I’ve drawn out multiple habit loops around this topic. I’ve also completed several Trigger Inventories (an excellent tool for curiosity). I have a robust toolbox after several years in the system as both a patient and a practitioner. Not one of my tools makes me feel defective or powerless.
Invalidation from professionals is what makes me feel defective and powerless. How do I make it stop?
These are the heartbreaking anecdotes you don’t hear about. This is the way I felt — suicidal from feeling alone and unseen. It’s not ok. Those of us who have been traumatized aren’t even safe in this Community.
“Pray (meditate, try) harder” is bad medicine. We wouldn’t say that to someone with a cancer diagnosis. We shouldn’t be saying it to anyone with any type of illness or anyone who is struggling/suffering.
With kindness,
Tempestinateapot
Dear Dr. Jud -
Interesting response. Unfortunately, it plays right into my narrative of invalidation from professionals.
Not only is your response overly simplistic, but it’s condescending and ignored the intent of my inquiry.
Maybe I’m misunderstanding, but I’m trying to stay curious about this topic and hope that you will stay curious too. This topic is critical to trauma-informed care.
Your response communicates that I need to work harder to understand my habit loops, that it’s my responsibility when I am made to feel powerless and defective. Perhaps you believe that these are cognitive distortions on my part? You may not be telling me directly that I’m powerless and defective, but 12-steps does, and that’s what I’m curious about. It’s not a cognitive distortion when it’s written right in the Big Book.
“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”
Do you truly believe that some addicts are constitutionally incapable of being honest with themselves? That seems to contradict your assertion that with curiosity and awareness we can all change our unhealthy habits.
My concern is that yours is precisely the kind of “advice” from a person in a position of power that is so damaging to those of us who suffer due to complex-trauma — we already take on responsibility for everything, even our own abuse. We struggle with cognitive dissonance as we work so hard to understand ourselves and why we behave the way we do.
To heal we need reassurance that we are not defective or powerless, and that we can recover — not by giving up our power and following harmful rules/steps/advice, but by sharing our stories with other compassionate souls who understand us. We need reassurance that we aren’t responsible for the abuse/gaslighting behavior done by others.
We need to learn healthy boundaries that don’t push others away but open others up to connection and engagement. That’s what I’m attempting here, healthy engagement on a topic that is central to my own recovery and the recovery of millions.
This is my second stint through UA. I know the program very well. I’ve done a great deal of work and I’m finally feeling really good about my self-compassion. This conversation is proof of my fierce compassion for myself — the protective, providing, motivating YANG side of compassion.
I’m being kind and loving to myself by standing up for myself in this correspondence. As Brené Brown would say, I’m choosing courage over comfort. I’m staying in the arena instead of running away in fear or resorting to blaming and shaming.
Running away or blaming/shaming were my trauma responses for the majority of my life. They’ve been hard habits to break, but now I understand that ignoring/avoiding/gaslighting and/or blaming/shaming are the behaviors of cowards. They are behaviors that I find prevalent in 12-steps and in the mental health community in general.
We all need to get comfortable with discomfort. That discomfort — the walking on eggshells — is telling us that something needs changing, either in ourselves, or in the systems we live in.
I’ve changed myself drastically. Now it’s time to change the system that created and exacerbates my mental illness.
Will you stay in the arena with me?
Tempestinateapot
I have not yet received a response to my last post (from 2 weeks ago) — and I suppose it’s time to accept that a response is probably not forthcoming. That’s the easiest way for an Expert to avoid tough questions — ignore them and hope questioners will give up and go away.
My fierce self-compassion won’t allow me to give up. I want to change the systems that are causing me, and many others, harm. I seek a more compassionate mental health care system — and it’s starts with me.
I’m left with many, many questions. I will remain curious as I seek answers.
More reading on Institutional Betrayal, Addiction, Recovery, and Trauma:
