9: Evaluation: Clients’ Reactions to Choice Awareness Training

The Choice Awareness Training, as noted above, was initially designed as a part of a comprehensive substance use treatment curriculum and was subsequently applied in the context of a residential correctional substance use treatment program that took place in a program-devoted pod/cellblock of a county jail in Pittsburgh, Pennsylvania.  No quantitative evaluation of this treatment modality has been yet undertaken.  The following are a sample of client statements about Choice Awareness Training.  These statements are taken from a weekly newsletter (“The Weekly Fix”) issued by the inmates that participated in the program in question. 

These reactions provide a touching glimpse into how these correctional substance use clients (most of whom had been previously exposed to the Disease Model of addiction and to the 12 Step programming) responded to the proposition that they are fundamentally free to choose and, thus, to change.  It should be noted that the participation in the pilot program was not accompanied by any legal assistance in the form of early release or sentence reduction.  It should be noted that The Weekly Fix was entirely produced by the inmate population and the program staff exercised absolutely no editorial control over this in-house initiative.

Inmate client J. K. (The Weekly Fix, Issue 1, at the beginning of the program pilot) reveals the paradigm clash: “I must say that the program here <…> is not at all what I expected. <…> I’ve been brought up being told that AA and NA were the only solutions for my drinking and drug using… The biggest difference leading me to problems is step one of NA… This step differs immensely from what is taught here.  We have the power to choose to use or not… In retrospect I can see how my belief that I’m powerless is harmful to me.  It was an easy way out.  All responsibilities for the consequences of my using <are> avoided by this simple belief.  In all actuality these consequences are a direct result of an active choice I made to get high.  Time will tell if I can adapt to this new way of thinking or not.  I believe I can.” 

Inmate client H. T. (as early as in the second issue of the Weekly Fix) begins to zoom in on one of the core ideas of Choice Awareness Training.  In his article “A Really Old Habit” H. T. reframed his substance use from a disease to a habit: “Most of my life, ever since I can remember, I have had the habit of biting my finger nails. <…> I am now 39 years of age, incarcerated for another habit, this one being potentially life threatening.”  So, the denial of having a disease of addiction without the denial of the detriment of one’s habit of substance use can, in fact, co-exist!

Inmate client K. W. (The Weekly Fix Issue 3) opens with an editorial entitled “Turning the Auto-Pilot Off:” “I believe the more aware you are, the better chance you have in recovery.  Being aware of the smallest things can help: like how you dress, how you brush your teeth or how you tie your shoe laces can keep you from going back to sleep. <…> I’ve learned that when I am aware of my options, and take time out to weigh them, and see what fits for me, it seems to make it a better day.  I’m not always going to make the right choices, but as long as I’m awake and aware, I can no longer be on auto-pilot or unaware of my actions.”  These thoughts are a clinical treasure trove. 

In the same issue (The Weekly Fix 3), inmate client who anonymously runs the column “Fact or Fiction, by Someone,’ challenges his peers: “Choice awareness practice keeps me switched off the auto-pilot.  And makes me aware that there is a number of options available to me, and when I choose an option, it is chosen mindfully.”  This “someone” is obviously no longer another anonymous statistic of powerlessness in the Alcoholics Anonymous or Narcotics Anonymous, but a “somebody” aware of his power to choose and to change.

In the same issue (The Weekly Fix 3), J. S. H. announces the arrival of his agency with the following title: “I Have the Strength Within.”  He continues: “The power is within me.  I realize that I can’t look to others for 100% guaranteed support. <…> In recovery there might not be anyone there (for you) at all.  In times of weakness, I need to search myself and then look to others.”  Note the wisdom: the client is sober that he can’t solely rely on home groups, sponsors and support networks.  His recovery is portable because it is based on his own strengths.  Note that this is not reactive pouting to a lack of conjugal visit: the client is not dismissing others’ help, but merely no longer willing to rely on it as an exoskeleton to carry his weight.

 The former anonymous “Someone,” now a “Somebody,” per his pseudonym, albeit still anonymous, offers a unique take on the Choice Awareness Practice exercise in the Weekly Fix issue 4: he offers a game of “Dare and Catch Yourself.” For example, “dare – to try and break an old habit, to not keep repeating the words “for real… for real;” and “catch yourself – tapping or humming, reacting over and over in the same way, asking question that have already been answered.”  This “somebody” is certainly showing some (creative) mind.  Choice awareness, by virtue of opening up new options, has the effect of opening up the mind.

Speaking of opening the minds:  inmate client D. F. (The Weekly Fix, issue 5) observes – “It’s kind of funny how our minds work.”  He offers a choice awareness prank.  Ask a peer: “How do you spell “silk?” Then, ask: What do cows drink?  The usual response will be milk.  Then you say: that’s what people drink, cows drink water.”  D. F. is catching on to the vulnerability of mindlessness.  His writing echoes a sentiment that was frequently noted by clients: they were quick to realize that stimulus-bound mindlessness is rife for exploitation. 

The Weekly Fix, issue 8:  an alpha-male inmate client “G.” champions a full-on head-on with the notion of addiction being a disease.  “I am glad to have the confirmation that I don’t have a disease.  For a long time I subscribed to the disease concept of addictions.  This came from a lot of cognitive distortions I’ve picked up from attending N. A. and A. A. meetings.  I am not doomed! <…> I am truly excited to learn that there is another way of staying clean. <…>  The more I learn, the more it makes sense to me.  A big part of my life, my decision making process has been to act on impulse <…> almost as if I had no choices.  Rational recovery introduces me to phrases like “auto-pilot,” “choice awareness,” and “self-regulation,” along with plans for lapse and relapse prevention, just to name a few.  (This) gives me a “wonderful opportunity” to flex my “choice muscles.”  Come to think of it: this is all I ever wanted to do in the first place.”  This “testimony” speaks for itself.

C. P. asks in The Weekly Fix (issue 11): “Have you chosen to be free?”  The misleading simplicity of this question conceals this client’s in-depth understanding of the issue at hand: freedom manifests through an act of conscious choice.

Inmate client D. F. (The Weekly Fix, issue 11), in a drawing entitled “Mind Garage,” amidst the drawings of a bicycle, a lawnmower, a garden hose, and an oil spill, has thrown in a self-affirming pearl: a call out that reads “You are not a victim.”  D. F. carries the theme over to the next issue (The Weekly Fix, issue 12): in the same “mind garage,” among the same objects, in the driveway, he writes: “Potential impact of the disease?  Inescapable fate…”  D. F., here, seems to be in the midst of spring cleaning of his “mind garage,” getting rid of the clutter of the victim identity and the disease identity. 

 H. T. (The Weekly Fix, issue 13) proclaims: “Choice awareness expands our options. <…> I find that there are seemingly endless choices.”  Well said.

 In the same issue, we learn of the identity of the anonymous “Someone” who began the rubric “Fact or Myth.”  Having initially signed off as an anonymous “Someone,” and having then progressed to a still anonymous “Somebody,” he finally reveals his identity: he is N. M.  In challenging his peers, he asks:  “Choice awareness is all about being told what to do… Fact or myth?”  We can safely guess his answer.  What remains a mystery is the progression from anonymity to reclaiming one’s identity: could it be the effect of a humanistic treatment approach?  One thing is for sure: N. M. took the responsibility for his penmanship.  Nobody told him what to do…

D. F. (the “Mind Garage” author, in the issue 14 of The Weekly Fix) offers a very cogent insight: in an article, entitled “Preset Recovery,” he writes: “ I was listening to my radio the other day trying to find a song <…> and realized how used to the pre-set channels I was.  So I figured: what a wonderful opportunity to practice my Choice Awareness, so I changed the pre-set stations. <…> Each and every day I am getting closer to not living a pre-set life.”  D. F.’s essay is a glimpse into a mind free of pre-set recovery dogma. 

Issue 5 of The Weekly Fix has a telling and humorous cover element.  You see the following text encased in a rectangle: “I made a choice to put a rectangle around these words.”

Issue 16 features clear thinking from J. F.: “Some things are not comfortable when not run on an auto-pilot.  <…> But with pain, there’s gain.  I need to exercise my choice muscles which make me mindful so that I don’t limit myself with mindless decisions. <…> When you take the time to consciously look around at everything around you, there are many options and life is limitless.”  J. F., who also signs off on this article as the “3d Eye” has his vision back.

D. F. (in The Weekly Fix issue 16) shows the readers his new acquisition for his “Mind Garage:” “It helps to be willing to change.” Indeed.

M. H., in the same issue, shares: “When I come to jail I just get into the mix of things. <…> Then I get out and go right back to the same thing.  It just becomes a cycle of using and coming back to jail. <…> This time I make a choice to use this time mindfully.  <…> I know something is different this time.  That something is me.”  M. H. here speaks of the revolving door of incarceration, but he might as well be speaking of the revolving door of the kind of recovery that takes the agent of change out of the equation of change.  After all, what use would there be for M. H. in the equation of disease?

The editors of The Weekly Fix devoted the 21st issue to Choice Awareness Practice (which in the program was known by the acronym C. A. P.).  The cover features a ferocious baseball cap, the bill of which is drawn in a manner of tooth-ful scowl.  The text above the C. A. P. reads: “Put On a Mean Cap.”  The text below deciphers the in-house acronym: “Choice Awareness Practice – mornings, evenings, afternoon, nights.” 

Jumping ahead (for the interests of space) to the 32nd issue, we see the following thoughts by T. G.: “When I first heard about auto-pilots, the idea was to break them.  By breaking them I slowly began to wake myself up.  I found a lot of good out of becoming the thinker behind the thought. <…> I feel that this is going to be the one most important thing to keep me on top of my recovery.” 

Inmate client M. S., writing in the same (32nd) issue notes: “Before I never thought I had options <…> because I was in a deep sleep.  I lived most of my adult life absent from my thoughts. <…> I have learned how to switch off my auto-pilot by doing two or three five minute choice awareness practices a day.  It (practice) lets me be more aware and awake. <…> When I do some simple C. A. P. (Choice Awareness Practice), it lets me know that I am my own agent of change and that my life is up to me.”

In reviewing the last, 33d issue of The Weekly Fix, at the very back of the issue we find an anonymous vignette entitled “Recovered or Recovering.”  The very phrasing of this item highlights an awareness of an option that for most of the participating clients did not phenomenologically exist.  Choice Awareness Training is designed to help clients recover their sense of control, and with it their prognosis of recovery.