FROM ‘INEBRIATION’ TO ‘SEVERE SUBSTANCE DEPENDENCE’ … OR LONG DAY’S JOURNEY INTO LIGHT

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A Paper Presented at the 4th New South Wales Addiction Medicine Training Day, ‘Involuntary Treatment for Substance Disorders in NSW’, at Northern Sydney Education Centre, Macquarie Hospital, North Ryde NSW Australia, on 4 December 2012. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. See also my SlideShare PowerPoint presentation entitled The Drug and Alcohol Treatment Act 2007 (NSW) and Administrative Decision-Making. Disclaimer: The information contained in this publication does not constitute legal advice of any kind. The author Ian Ellis-Jones does not guarantee or warrant the current accuracy, legal correctness or up-to-dateness of the information contained in the publication.

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FROM ‘INEBRIATION’ TO ‘SEVERE SUBSTANCE DEPENDENCE’ … OR LONG DAY’S JOURNEY INTO LIGHT

  1. 1. From ‘Inebriation’ to ‘Severe Substance Dependence’ … or Long Day’s Journey into Light A Paper Presented at the 4th New South Wales Addiction Medicine Training Day, ‘Involuntary Treatment for Substance Disorders in NSW’, at Northern Sydney Education Centre, Macquarie Hospital, North Ryde NSW Australia, on 4 December 2012 By Dr Ian Ellis-Jones BA, LLB (Syd), LLM, PhD (UTS), DD, Dip Relig Stud (LCIS), Adv Mgmt Cert (Syd Tech Col) Solicitor of the Supreme Court of New South Wales and the High Court of Australia Lecturer and Legal Adviser, New South Wales Institute of Psychiatry Former Senior Lecturer, Faculty of Law, University of Technology, Sydney Minister and Convener, Sydney Unitarian Chalice Circle, Sydney NSW Australia ‘None of us can help the things life has done to us. They’re done before you realize it, and once they’re done they make you do other things until at last everything comes between you and what you’d like to be, and you’ve lost your true self forever.’ ― Eugene ONeill, Long Days Journey into Night. ‘Be transformed by the renewing of your mind.’ ― Romans 12: 2 (NIV).I am greatly honoured---and humbled---to be asked to address you this morning at this 4thNew South Wales Addiction Medicine Training Day.Purpose of this paperThe purpose of my paper is essentially twofold: first, to provide some historical and contextual background---from a practising lawyer, wellness practitioner and instructor, and someone who know firsthand the problem of alcohol addiction----to the more important legislation in the State of New South Wales with respect to the care, control and treatment of persons with ‘severe substance dependence’; secondly, to recount my own recovery story---my journey from darkness to light--- and, in so doing, to offer, perhaps a little presumptuously, my own views on the process and nature of recovery from the disease of addiction.Inebriates Act 1912 (NSW)This paternalistic, inflexible, indeed draconian piece of legislation, now (thankfully) in itsdying days, was originally introduced as a bill in 1897. That bill was passed in 1900 as the Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 1
  2. 2. Inebriates Act 1900 (NSW). The legislation was subsequently amended in 1909, and thenconsolidated in 1912 as the Inebriates Act 1912 (NSW). There have been few significantchanges to the legislation in the past 100 years.The Inebriates Act 1912 makes provision for the care, control and treatment of people whohabitually use intoxicating liquor or intoxicating or narcotic drugs to excess. An ‘inebriate’ isdefined in s.2 of the Act to mean ‘a person who habitually uses intoxicating liquor orintoxicating or narcotic drugs to excess’.1The 1897 bill drew its inspiration---if inspiration be the right word---from certainrecommendations of the Intoxicating Drink Inquiry Commission, which reported to the NSWLegislative Council in 1887.The legislation reflected what were clearly the prevailing views at the time the legislation wasenacted as to alcohol dependence, although even those words---and that concept---wouldnever have been articulated at the time or for several decades thereafter. What we wouldnow refer to as dependence was then referred to as ‘intemperance’. The goal, in the wordsof the Report on the [NSW Legislative Council] Standing Committee on Social Issues(2004)2 [the ‘SCSI Report’], was ‘enforced abstinence as the mechanism to achieve the twinobjectives of curing the “diseased” individual and guarding the proper functioning of thecommunity’.3Although the intention of the Inebriates Act 1912 has always been to ‘address the cycle ofarrest, release and re-arrests among habitual drunkards by diverting them from the prisonsystem’,4 the Act---with its antiquated language and concepts and quite arbitrary criteria forinvoluntary detention and treatment---deals with alcoholism and other habitual drug use asthough they are an offence in themselves. In particular, alcoholism and other habitual druguse are treated for the most part in a punitive and custodial fashion rather than in a remedialone.5 This is evident from even a cursory reading of the Act. For example, Part 3 of the Actis entitled ‘Convicted Inebriates’, and ss. 3(1) and 11(1) of the Act set out orders which maybe made by a Court whereby ‘inebriates’, as well as offenders declared to be ‘inebriates’,1 Under the (now repealed) Intoxicated Persons Act 1979 (NSW) an intoxicated person was identified as ‘aperson who appears to be seriously affected by alcohol or another drug or a combination of drugs’.2 Standing Committee on Social Issues, Legislative Council of the Parliament of New South Wales, Report on theInebriates Act 1912, Report 33, August 2004.3 SCSI Report, para 2.15, p 17.4 Ibid.5 See also Parliament of New South Wales, Royal Commission Report of the Hon Justice McClemens into CallanPark Mental Hospital (Sydney, Government Printer, September 1961) [‘emphases mainly custodial owing to lackof staff and amenities … there is little active treatment or rehabilitation’], p 7. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 2
  3. 3. can be committed to, among other places, State mental institutions6 for up to 12 months.7However, the procedures set out in the Act do not sit well within the current legal and judicialsystem of NSW, nor do they sit well with what is one of the most basic and fundamentaltenets of human rights---namely, the freedom from arbitrary detention.Pursuant to the Act, the court may also order an inebriate to enter into a good behaviourbond to abstain from intoxicating liquor for 12 months or more. However, courts have seldommade use of such bonds for the obvious reason that undertakings given by chronicallyintoxicated persons to abstain are often broken because the persons in question have adiminished capacity to abide by such undertakings.8 Then there’s s. 3(1B) of the Act whichstates that a person declared an inebriate may be arrested should they ‘escape from thecustody’---please note those words---set out in the order, despite the fact that they have notbeen found guilty of any offence.The Inebriates Act 1912 makes little or no mention of the importance of the interests of theperson in question or that alcoholism or drug dependency is a medical condition. Althoughthe long title of the Act does contain the phrase ‘care, control, and treatment of inebriates’,the language, general thrust and effect of the Act enshrine the belief---or rather misbelief---that the habitual use of intoxicating liquor or intoxicating or narcotic drugs to excess---thewords used in the Act---is something more in the character of criminal behaviour thatrequires some form of punitive action.Indeed, the Hon J M Creed MLC, the architect of the bill that in time became the InebriatesAct, spoke of the need for ‘habitual drunkards … to submit to … proper restraint’.9 He alsospoke of the social problems of ‘poverty’ and ‘crime’ which, he said, were in large measuredue to ‘drink’---note that word ‘drink’. He also said that the children of habitual inebriateswere ‘more likely to become lunatics’---note that word ‘lunatic’, a word which would remain6 Private hospitals are not classed as a ‘prescribed residence’ under the Act, which means that any such hospitalis not able to prevent an inebriate from leaving the facility. The State institutions for ‘inebriates convicted ofcertain offences’ provided for in s.13 of the Act were never established.7 It was not until 1929 that mental hospitals were gazetted as the State institutions for the reception, control andtreatment of inebriates. The Inebriates Act 1900 did not include psychiatric hospitals (‘hospitals for the insane’) inthe list of institutions that could be used to house and treat inebriates. Hospitals of that kind were considered apossibility but were rejected as being unsuitable for the purpose. Instead, the prison system, along with variousprivate and charitable facilities, was used to house and treat inebriates. The Inebriates Act 1912 continued thesame principle. Prior to 1929 the only State institution for inebriates was the Shaftesbury Institute (orReformatory) under the control of the (then) NSW Prisons Department.8 The SCSI Report notes that recognizances have ‘little credibility as an effective tool for addressing serioussubstance misuse’: see SCSI Report, para 3.39, p 40.9 Hon J M Creed MLC, Legislative Council, Hansard, vol 94, 13 October 1898, p 1402, as quoted in SCSI Report,para 2.16, p 17. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 3
  4. 4. in common popular, legal and medical parlance for many more decades---and also ‘verylikely to become criminals’.10Drunkenness, in this State and in many other jurisdictions as well, was a crime for a long,long time, and prisons were overcrowded with ‘drunks’. Something had to be done about theproblem---the ‘evil’11 (his word) to which Creed referred. Another major factor which led tothe enactment of the Inebriates Act was ‘pressure from families of alcoholics for thegovernment to provide suitable treatment facilities’.12 However, in all of this there was scantregard for the needs of the so-called inebriate.The Inebriates Act 1912 has always given enormous discretion to the magistrate but virtuallynone to the doctors. The responsible medical practitioner may think a patient is well andready for discharge, but a formal detailed case has to be made to a magistrate to allow thepatient to be discharged. There have always been many other problems with the Act,including the absence of any review mechanism under the Act,13 the process of seeking aninebriates order is ‘cumbersome, extremely inefficient and frustrating’,14 and the inability toenforce orders.15The provisions and the paradigm of the Inebriates Act 1912 have been the subject ofconsiderable judicial and other criticism over the years. For example, Buddin J in R v RobertJohn Strong (2003) NSWCCA 123 at para [110], when referring to the Inebriates Act 1912(NSW) and the Habitual Criminals Act 1957 (NSW), stated: The procedures under the Acts are archaic and do not correspond with current practice.The Law Society of New South Wales, in its submission to the [NSW Legislative Council]Standing Committee on Social Issues (2004), stated:16 The Inebriates Act is draconian legislation, with a stigmatising impact.The Police Association of New South Wales, in its submission to the Standing Committee,stated:1710 Ibid.11 Ibid.12 SCSI Report, para 2.20, p 18.13 Ibid, para 3.27, p 37. In addition, there is no supervising board, as required under s.29 of the Act, currently inoperation: see SCSI Report, para 3.39, p 40.14 Ibid, para 3.29, p 37.15 Ibid, para 3.31, p 38.16 Submission 36, Law Society of New South Wales, p 3: see SCSI Report, p 17, fn 98. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 4
  5. 5. The Inebriates Act in its current state acts as an empty shell, not making available to either Police or family members of inebriates any suitable means of providing treatment to those who desperately require it.Then there’s this submission from Nick O’Neill, the then President of the NSW GuardianshipTribunal:18 [T]he Inebriates Act is based on the false premise that confinement in a place where alcohol or drugs are not available, of itself, will help those seriously affected.Many years earlier, in the 1957, the [Trethowan] Report on Psychiatric Treatment in NewSouth Wales had severely criticised the inadequacies of the Inebriates Act 1912.19 In 1969,J G Rankin, in his paper ‘Definitive treatment of alcoholism’,20 rhetorically asked whether theInebriates Act was ‘only a means of removing society’s misfits and rejects from public view,as it is the vagrant, homeless, unemployed chronic alcoholic who is caught up in the Act.’(The appropriateness or otherwise of compulsory treatment of persons for alcohol or otherdrug dependence within psychiatric hospitals has always been a major concern to almost allkey stakeholders.21)A couple of years later, in 1971, D S Bell, during the development of a plan for a drugdependence service for New South Wales, criticised the Inebriates Act for merely consigningalcoholics to the limbo of country mental hospitals and that it provided treatmentprogrammes under which relapse was the rule rather than the exception.’22 Then, in 1989,the [Edwards] Mental Health Act Review Committee recommended the outright abolition ofthe Act.23 When reviewing the provisions of the (now repealed) Mental Health Act 1958(NSW), Dr G A Edwards noted that the Inebriates Act: ... contained very broad commitment criteria ... There was no onus on the judge or magistrate to satisfy himself that the person was unable to manage his affairs as was required when determining unsoundness of mind under the Lunacy Act. As well, there17 Submission 40, Police Association of New South Wales, p 12: see SCSI Report, p 17, fn 99.18 Submission 44, Mr Nick O’Neill, President, Guardianship Tribunal, p 7: see SCSI Report, p 17, fn 101.19 See also Parliament of New South Wales, Royal Commission Report of the Hon Justice McClemens intoCallan Park Mental Hospital (Sydney, Government Printer, September 1961) [‘emphases mainly custodial owingto lack of staff and amenities … there is little active treatment or rehabilitation’], p 7.20 J G Rankin, ‘Definitive Treatment of Alcoholism’, in Symposium Alcoholism---Problems in Treatment(University of Melbourne, 1969), pp 31-39.21 See SCSI Report, para 3.40, p 41.22 th See, more generally, L G Kiloch and D S Bell (eds), Proceedings for the 29 International Congress onAlcoholism and Drug Dependence (Sydney: Butterworth, 1971).23 The (then) NSW Health Commission had proposals for the repeal of the Inebriates Act as far back as the mid-1970s. In 1991 there was an Inebriates Act Review Committee, and in 1992 the Director, Drug and AlcoholDirectorate, NSW Health Department, established an ad hoc review committee to consider the Act, due to recentchanges in the treatment of mental health, alcohol and other drug problems. Apparently, the discussion paperfrom this committee was never released. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 5
  6. 6. was certainly no requirement for the judge or magistrate to consider issues of 24 dangerousness to self or others when making an order.In short, it has long been recognized that the provisions of the Inebriates Act 1912 do notreflect contemporary community standards nor the general consensus of professional,informed opinion on the proper treatment of the disease of addiction. More recent legislation,in particular the Guardianship Act 1987 (NSW), the [now repealed] Mental Health Act 1990(NSW), and the Mental Health Act 2007 (NSW), contain much more effective mechanismsfor responding to the conditions and problems that arise from mental illness as well assevere alcohol or other drug abuse.The Inebriates Act 1912 does not conform to the United Nations Principles for the Protectionand Care of People with Mental Illness to which Australia is a signatory. These principlesensure that involuntary treatment occurs only in cases that satisfy certain specified criteria.Relevant aspects of those principles which the Inebriates Act appears to contrive include thefollowing: Involuntary treatment may be given only on the condition that a independent authority is satisfied that the person lacks the capacity to consent or unreasonably withholds consent, and that the proposed treatment is in the person’s best interests. Alternatively, it may be given where a medical practitioner determines that it is urgently necessary to prevent imminent harm to the person or others. Such treatment shall not be prolonged beyond that which [is] strictly necessary (Principle 11, paragraphs 6 and 8) Involuntary admission may only occur when a person is considered by a medical practitioner to be mentally ill, and as a result, that there is a serious likelihood of immediate or imminent harm to that person or others, or that failure to admit the person is likely to lead to a serious deterioration in their condition or will prevent the giving of appropriate treatment (Principle 16, paragraph 1) The right to [the] best available care (Principle 1, paragraph 1) Determination of mental illness is to be made in accordance with internationally accepted medical standards (Principle 4, paragraph 1) The right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment Principle 9, paragraph 1) Treatment [should] be based on an individually prescribed plan (Principle 9, paragraph 2) Treatment [shall] be directed towards preserving and enhancing personal autonomy (Principle 9, paragraph 4) Involuntary admission or retention shall initially be for a short period [as] specified by domestic law for observation and preliminary treatment pending review (Principle 16, paragraph 2) Various other provisions for review, procedural safeguards, access to 25 information and complaints (Principles 17, 18, 19 and 21).24 G A Edwards, Mental Illness and Civil Legislation in New South Wales, MD Thesis, University of Sydney,quoted in M G MacAvoy and B Flaherty, (1990) 9 ‘Compulsory Treatment of Alcoholism: The Case Against’, Drugand Alcohol Review, pp 267-72, at p 268.25 United Nations, Principles for the Protection of Persons with Mental Illness and the Improvement of MentalHealth Care, Adopted by General Assembly Resolution 46/119 of 17 December 1991, as quoted in SCSI Report,pp 31-32. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 6
  7. 7. In recent years, for the reasons already referred to, there has been little invocation of theInebriates Act 1912, although it should be noted that the Act has always been useddisproportionately against indigenous people.26 Interestingly, Schedule 1 to theMiscellaneous Acts (Mental Health) Repeal and Amendment Act 1983 (NSW) madeprovision for the full repeal of the Inebriates Act 1912. However, that 1983 Act was repealedbefore its Schedule 1 was commenced.There is a principle known as the ‘principle of rational humaneness.’ It is said that the great19th century radical, the British Liberal statesman, writer and newspaper editor John Morley---Viscount Morley---coined the phrase ‘rational humaneness.’ That may or may not be thecase. Gordon Hawkins, who was my lecturer in criminology back in the 1970s, describedrational humaneness in these terms: This means a rationality which is informed by consideration and compassion for the 27 needs and distresses of human beings.I have always found the ‘principle of rational humaneness’ to be a most useful one to judgethe decency of any legislative, executive, judicial, administrative or other act. One asks: is itrational, and is it also humane?The Inebriates Act 1912 (NSW) fails on both counts---miserably. The Act belongs to thosedreadful days when psychiatric patients were chained in padded cells, strapped intostraitjackets and half drowned in ice baths.Mental Health Act 2007 (NSW)The Mental Health Act 2007 (NSW), which was assented to on 15 June 2007, came intoeffect on 16 November 2007, when the Mental Health Act 1990 (NSW) ceased to haveeffect.28 The principal (but not the only) object of the 2007 Act is to make provisions withrespect to the care, treatment and control of mentally ill persons and mentally disorderedpersons and other matters relating to mental health.26 See SCSI Report, para 3.9, p 33. See also Supplementary Submission 43, Emeritus Professor Ian WebsterAO, Chair, NSW Expert Advisory Committee on Drugs, p 3, cited in SCSI Report, fn 111, p 33.27 G Hawkins, ‘Humanism and the Crime Problem,’ in I Edwards (ed), A Humanist View (Sydney: Angus &Robertson, 1969), pp 170-181, at p 180.28 Previous NSW legislation on mental health and related matters included the Dangerous Lunatics Act 1843(NSW), the Dangerous Lunatics Act 1845 (NSW), the Dangerous Lunatics Act 1846 (NSW), the DangerousLunatics Act 1849 (NSW), the Lunacy Act 1878 (NSW), the Lunacy Act 1898 (NSW), the Lunacy Convention Act1894 (NSW) [which adopted the distinction between unsoundness of mind and mental infirmity], the Lunacy Act1898 (NSW), the Vagrancy Act 1902 (NSW), the Mental Health Act 1958 (NSW), the Intoxicated Persons Act1979 (NSW), and the Mental Health Act 1983 (NSW). Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 7
  8. 8. The Mental Health Act 2007 resulted from a review of the legislation initiated by the thenState Government and involved extensive consultations with consumers, carers and serviceproviders. The Act retains many of the significant principles of the 1990 Act, builds on patientand carer rights and protections; and provides for modern models of service provision. Manyof the provisions in the Mental Health Acts of 1990 and 2007 (when the latter was still a bill)---together with its stated objects (especially the object that involuntary detention be theexception29 and not the rule)---have served as a model for several of the key provisions ofthe Drug and Alcohol Treatment Act 2007 (NSW) to which I will now refer.Drug and Alcohol Treatment Act 2007 (NSW)The first recommendation of the Report on the [NSW Legislative Council] StandingCommittee on Social Issues (2004) was as follows: Recommendation 1 That the Inebriates Act 1912 be repealed and replaced at once with legislation 30 reflecting subsequent recommendations of this report.Subsequent recommendations of the Report made provision for, among other things, theestablishment of a system of short term involuntary care for people with substancedependence who have experienced or are at risk of serious harm, and whose decisionmaking capacity is considered to be compromised, for the purpose of protecting theperson’s health and safety.31In due course, the former NSW State Government announced that it had accepted theStanding Committee’s overall findings on the need to ‘reform’ the Inebriates Act 1912 so asto provide better support and treatment for substance dependent people. The Governmentannounced that there would be a special 2-year compulsory treatment trial in WesternSydney at Nepean Hospital,32 with the Inebriates Act continuing to operate outside the trialarea.29 Section 3(c) of the Mental Health Act 2007 (NSW) lists as the third enumerated stated object of that Act---‘tofacilitate the provision of hospital care for those persons on a voluntary basis where appropriate and, in a limitednumber of situations, on an involuntary basis’ [emphasis added].30 SCSI Report, Summary of Recommendations, p xviii.31 See, in particular, Recommendation 2, in SCSI Report, Summary of Recommendations, p xviii.32 The 2-year trial at the Nepean Hospital of the Drug and Alcohol Treatment Act 2007 and the trial for involuntarydrug and alcohol treatment ceased on 30 June 2011. The Drug and Alcohol Treatment Regulation 2012 (NSW),which commenced on 4 September 2012, now prescribes the whole of NSW as the area to which the Drug andAlcohol Treatment Act 2007 applies. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 8
  9. 9. The Drug and Alcohol Treatment Act 2007 (NSW), which was assented to on 15 June 2007(being the same day on which royal assent was given to the Mental Health Act 2007), andwhich commenced on 9 February 2009, was created in the first instance to provide the legalbasis for a 2-year trial of short-term involuntary care and treatment during which this group ofpersons with severe substance dependence would undergo detoxification to rebuild theirhealth and be linked in a planned and considered way to longer-term rehabilitation andsupport.In her ‘agreement in principle’ speech in the NSW Legislative Assembly on the bill whichultimately became the Drug and Alcohol Treatment Act 2007 (NSW), the then NSW Ministerfor Health, The Hon Reba Meagher MP, said, among other things: The Government does not take the concept of involuntary treatment lightly. Every effort has been taken to ensure the bill provides a therapeutic framework in which people enter the trial only when they will benefit from the treatment with all controls being the least restrictive possible. As honourable members would know, the New South Wales Government has long been committed to reducing the level and impact of drug and alcohol related harms in the community. We highlighted this commitment through the Drug and Alcohol summits and continue to do so under the new State Plan, which has specific priorities related to reducing the incidence and impacts of illicit drug use and risk drinking. The bill arises from a Government commitment in response to the 2003 Summit on Alcohol Abuse that recommended an inquiry into the Inebriates Act 1912, given concerns that the Act could better reflect modern medical practice treatment options and legal safeguards. The New South Wales Government asked the Legislative Council Standing Committee on Social Issues to undertake this inquiry and we thank those honourable members who were involved for their comprehensive and compassionate work and report on this issue. The Government also thanks the medical, legal, academic, government agency and community representatives who contributed their expertise and experience to the inquiry and its report. The bill gives effect to the Governments response to the inquiry, which was released in January this year. In that response the Government adopted the majority of the committees recommendations. However, in line with our evidence-based approach to drug and alcohol policy, the Government has agreed to first trial the proposed new framework for involuntary care before considering wider application. I will now take the House through some of the key provisions in this bill, which has been developed in consultation with Emeritus Professor Ian Webster, AO, the chair of the Governments Expert Advisory Group on drugs and alcohol; the Chief Magistrate; Aboriginal Justice Advisory Council; Professor Bob Batey; clinicians from Nepean Hospital; and government agencies that will be implementing the trial.The main provisions in the Act---most notably those with respect to involuntary detention---are modelled on similar provisions in the Mental Health Act 1990 (NSW) and the MentalHealth Bill 2006 (NSW), which, when enacted, became the Mental Health Act 2007 (NSW). Itgoes almost without saying that the legislative and psycho-medical paradigm enshrined inthe Drug and Alcohol Treatment Act 2007 is altogether different from that contained in theInebriates Act 1912. Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 9
  10. 10. As most if not all of you would know by now, the first people to be treated under the Drugand Alcohol Treatment Act 2007 were part of the Drug and Alcohol Involuntary TreatmentTrial and resided in the Sydney West Area Health Service catchment area. The Drug andAlcohol Treatment Regulation 2012 (NSW), which commenced on 4 September 2012, nowprescribes the whole of NSW as the area to which the Drug and Alcohol Treatment Act 2007applies.Under the Act, an accredited medical practitioner is empowered to issue a dependencycertificate. That means the person can be detained for up to 28 days in the first instance.A magistrate must review a dependency certificate as soon as practicable after it is issued,and the magistrate can discharge the patient or uphold, extend or shorten the time ofinvoluntary treatment under the dependency certificate.A dependency certificate---similar in law and effect to the ‘scheduling’ of a person under theMental Health Act 2007---may be issued under the Drug and Alcohol Treatment Act 2007 inrelation to the person only if the accredited medical practitioner is ‘satisfied’ (that means, inlaw, ‘reasonably satisfied’, which refers to a state of satisfaction that can be arrived at by areasonable person of the kind in question who properly understands and applies the correct‘test(s)’ to be applied without irrelevant considerations being taken into account or otherwiseacting whimsically, arbitrarily or capriciously)33 as to all of the following matters: the person has a ‘severe substance dependence’ (as defined in s.5(1) of the Act,34 with words such as ‘tolerance’ and ‘withdrawal symptoms’ being given their ordinary accepted meanings in the medical and psychological sciences), and care, treatment or control of the person is ‘necessary’ (that means, in law, ‘reasonably required’ as opposed to ‘absolutely essential’)35 to protect the person from ‘serious harm’ (being physical harm or psychological harm and possibly also including other forms of harm as well),36 and33 See, relevantly, R v Connell; Ex parte Hetton Bellbird Collieries Ltd (1944) 69 CLR 407 at 430 and 432 perLatham CJ.34 The statutory definition of ‘severe substance dependence’ is to be applied for the purposes of the Act,regardless of what might otherwise be the position in ordinary clinical practice (cf DSM-IV-TR).35 See, relevantly, Commonwealth v Progress Advertising & Press Agency Co Pty Ltd (1910) 10 CLR 457;Attorney-General v Walker (1849) 154 ER 833.36 Cf Re J (No. 2) [2011] NSWSC 1224 (NSW Supreme Court, White J). That was a case on the Mental HealthAct 2007 (NSW). White J came to no firm conclusion as to whether the expression ‘serious harm’ as used in thatAct included serious financial harm, but stated that there was much to be said for the submission that ‘seriousharm’ in s.14 of the Mental Health Act 2007 (NSW) refers to either physical harm or psychological harm. In lightof this decision, it would now appear that, even in cases of financial harm (which are generally able to be dealtwith by other statutory measures except, perhaps, in a few exceptional cases), the basis for involuntary detentionunder that Act would rarely, if ever, be justifiable.Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 10
  11. 11. the person is ‘likely’ (arguably [here] meaning, in law, ‘a real chance or possibility’, that is, a real and substantial and not remote chance or possibility regardless of whether it is less or more than 50 per cent)37 to benefit from treatment for his or her substance dependence but has refused treatment, and no other appropriate and less restrictive means for dealing with the person are reasonably available.The accredited medical practitioner can also take into account any serious harm that mayoccur to children in the care of the person, or other dependants.The objects section of the Act---section 3---makes it clear that the primary object of thelegislation is the protection of the health and safety of those with severe substancedependence, and that involuntary detention and treatment of those persons, whose interestsare ‘paramount’, is a ‘last resort’. As the [Burdekin] Inquiry into Human Rights and MentalIllness (1991-92) pointed out, involuntary detention, for any reason and under anycircumstances, is an extremely serious matter involving curtailment of several fundamentalrights the most important of which is the right to liberty.Now, section 3 of the Act is so important I will read it in its entirety: 3. Objects of Act (1) The objects of this Act are: (a) to provide for the involuntary treatment of persons with a severe substance dependence with the aim of protecting their health and safety, and (b) to facilitate a comprehensive assessment of those persons in relation to their dependency, and (c) to facilitate the stabilisation of those persons through medical treatment, including, for example, medically assisted withdrawal, and (d) to give those persons the opportunity to engage in voluntary treatment and restore their capacity to make decisions about their substance use and personal welfare. (2) This Act must be interpreted, and every function conferred or imposed by this Act must be performed or exercised, so that, as far as practicable:37 See, eg, Tillmans Butcheries Pty Ltd v Australasian Meat Industry Employees’ Union (1979) 42 FLR 331 at345-348 per Deane J; Randwick Municipal Council v Crawley (1986) 60 LGRA 277 at 279-281 per Stein J;Jarasius v Forestry Commission (NSW) (1988) 71 LGRA 79 at 94 per Hemmings J; Bailey v ForestryCommission of New South Wales (1989) 67 LGRA 200 at 211 per Hemmings J; Drummoyne Municipal Council vRoads and Traffic Authority of NSW (1989) 67 LGRA 155 at 163 per Stein J. See also Boughey v The Queen(1986) 161 CR 10 per Mason, Wilson and Deane JJ with whom Gibbs CJ agreed (Brennan J dissenting) in whicha majority of the High Court of Australia found that the phrase ‘likely to cause death’ in s.157(1) of the CriminalCode 1924 (Tas) conveyed a notion of substantial, real and not remote chance, regardless of whether it wasmore or less than 50 per cent. The majority held that, in that context, the word ‘likely’ should not be construed tomean more likely than not or to assume a specific degree of mathematical probability not conveyed as a matter ofordinary language or by the statutory context. It is strongly arguable that the same interpretation should be givento the word ‘likely in, relevantly, s.9(3)(c) of the Drug and Alcohol Treatment Act 2007 (NSW).Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 11
  12. 12. (a) involuntary detention and treatment of those persons is a consideration of last resort, and (b) the interests of those persons is paramount in decisions made under this Act, and (c) those persons will receive the best possible treatment in the least restrictive environment that will enable treatment to be effectively given, and (d) any interference with the rights, dignity and self-respect of those persons will be kept to the minimum necessary.Assuming, of course, that you otherwise act lawfully in all respects, you cannot go ‘wrong’ inyour actions and decision-making under the legislation if you keep in mind and give effect tothose objects at all times. The stated objects are more than pious platitudes—they are a‘living symbol’38 of the principle of rational humaneness in action. Never forget that.My own story of recovery---and how I see ‘things’Forgive me for the self-indulgence that follows, but I think---and hope---that what I am aboutto say may help others in recovery from severe substance dependence.I have lived---if that be the right word, which it isn’t---a big part of my life in bondage toaddictions of various kinds. I have known the loss of freedom---indeed, the horrible self-slavery, self-loathing and suffering---that is always the result of unhealthy, life-destroyingattachments, cravings and obsessions. I am free now, and I intend to stay that way. I chooseto live differently now---and I am very much alive!It is said that we are born free. Well, never entirely free. However, part of the ‘price’ we payfor ‘Spirit’ (that is, the livingness of life) descending into matter, for the ‘Word becomingflesh’, so to speak, is that we invariably find ourselves caught up, indeed trapped, in a time-bound, self-centred prison which is not entirely of our own making but which becomes moreand more escape-proof as we choose, hundreds and thousands of times, to identify with our‘false’ (or ‘illusory’) sense of ‘self.’3938 The Greek word sumbolon (‘throwing together’) means really a correspondence between a noumenon and aphenomenon, between a reality in the ‘higher’ archetypal or ideal world and its outer physical expression ineveryday life (the so-called ‘real world’). A living symbol not only ‘symbolizes’, ‘represents’ or ‘stands for’something else (the ‘inner reality’ or ‘meaning’), it is actually instrumental in bringing about that reality---and, invery truth, is that reality.39 I am aware that the concept or presupposition of ‘self as an illusion’ is not universally accepted and ordinarilyhas not been maintained in Western general psychological practice. The concept is, however, maintained inBuddhist psychology and in much recovery literature and its associated healing movements and programs, and itformed the cornerstone of the ‘self-illusion therapy’ successfully conducted by the Sydney-based psychologist,the late Jim Maclaine, over several decades at a number of different Sydney metropolitan private psychiatrichospitals specialising in drug and alcohol rehabilitation. In more recent times in the West, the idea that ‘self’ is nota thing but a construct has been gaining considerable momentum: see G Watson, ‘I, Mine and Views of the Self’,in G Watson, S Batchelor, and G Claxton, The Psychology of Awakening: Buddhism, Science and Our Day-to-day Lives (York Beach ME: Samuel Weiser, 2000), pp 30-39; R Hanson with R Mendius, Buddha’s Brain: ThePractical Neuroscience of Happiness, Love & Wisdom (Oakland CA: New Harbinger Publications, 2009). ItCopyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 12
  13. 13. Now, this is how I and many others see it. I am very much aware that it is not the wayeveryone sees it---which may well be a good thing! The ‘self’ does not exist40---at least itdoes not exist in the sense of possessing a separate, independent, unchangeable, materialexistence of its own---even though we try, ever so hard, to convince ourselves---that is, theperson41 that each of us really is---that we actually are those ever waxing and waning,arising and subsiding, hundreds and thousands of ‘I’s’ and ‘me’s’ (‘selves’) that, in adynamic, ongoing, ever-changing and seemingly endless process of ‘self-ing’, parade beforeus as our consciousness (or mental wallpaper)42 from one moment to the next. Having saidthat, it is a paradox of immense proportions that, for something which has no separate,independent, unchangeable and material reality of its own---and certainly no singularity---thenon-existent so-called ‘self’ causes us so much damn trouble---mainly because we let ‘it’.43We perceive life through our senses and our conscious mind. Over time, beginning from thevery moment of our birth, sensory perceptions harden into memories formed out ofaggregates of thought and feeling. In addition, we are conditioned to think in certain waysand to believe certain things about life. In time, the illusion of a separate witnessing [or so-called ‘transcendental’] self emerges.44 Nevertheless, I am firmly of the opinion that ourshould be noted that even William James (the ‘Father of Modern Psychology’) wrote, ‘In its widest possiblesense, however, a man’s Self is the sum total of all that he can call his.’ (1981 [1890]) Principles of Psychology(Cambridge MA: Harvard University Press), p 279.40 My view on this matter is somewhat coloured by the fact that I am a practising Buddhist. Now, it has beenwritten, ‘No anattā doctrine, no Buddhism.’ The concept of anattā is bedrock to Buddhism. Anattā means ‘not-self’or ‘non-self’ rather than ‘no-self’. The Buddhist teaching of anattā---of which there are several different (and evendiscordant) interpretations in Buddhism---affirms that there is no actual ‘self’ at the centre of our conscious---oreven unconscious---awareness. Our so-called consciousness goes through continuous fluctuations from momentto moment. As such, there is nothing to constitute, let alone sustain, a separate, transcendent ‘I’ structure orentity. We ‘die’ and are ‘born’ (or ‘reborn’) from one moment to the next.41 A person is ‘a human body-mind as a whole, an autonomous and dynamic system that arises in dependenceupon human culture and the natural world’: R Hanson with R Mendius, Buddha’s Brain: The PracticalNeuroscience of Happiness, Love & Wisdom (Oakland CA: New Harbinger Publications, 2009), p 211, citing MMackenzie, (2010) ‘Enacting the Self: Buddhist and Enactivist Approaches to the Emergence of the Self’,Phenomenology and the Cognitive Sciences, vol 9, issue 1 (March 2010), pp 75 - 99.42 ‘Being convinced that self, manifested in various ways, was what had defeated us, we considered its common rdmanifestations’ Alcoholics Anonymous [3 edn] (New York: Alcoholics Anonymous World Services, 1976, p 64).43 ‘According to the teaching of the Buddha, the idea of self is an imaginary, false belief which has nocorresponding reality, and it produces harmful thoughts of “me” and “mine”, selfish desire, craving, attachment,hatred, ill-will, conceit, pride, egoism, and other defilements, impurities and problems’: W Rahula, What theBuddha Taught (New York: Grove Press, 1959), p 51. The AA ‘Big Book’ says more-or-less the same thing:‘Selfishness, self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurtus, seemingly without provocation, but we invariably find that at some time in the past we have made decisions rdbased on self which later placed us in a position to be hurt.’ Alcoholics Anonymous [3 edn] (New York:Alcoholics Anonymous World Services, 1976, p 62). Both Buddhism and Maclaine’s ‘self illusion therapy’ arebased on the psycho-spiritual principle of ‘letting go of self’.44 It is generally acknowledged that the ‘self’ has many aspects including but not limited to the ‘reflective self’, the‘emotional self’, the ‘autobiographical self’, the ‘core self’, the ‘self-as-object’, and the ‘self-as-subject’. ‘In sum,from a neurological standpoint, the everyday feeling of being a unified self is an utter illusion’: R Hanson with RMendius, Buddha’s Brain: The Practical Neuroscience of Happiness, Love & Wisdom (Oakland CA: NewHarbinger Publications, 2009), p 211.Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 13
  14. 14. mental continuity and sense of identity and existence are simply the result of habit, memoryand conditioning. Also, as you all would know, genetics has a bit to do with it as well. At anyrate, hundreds of thousands of separate, ever-changing and ever-so-transient mentaloccurrences (‘selves’) harden into a mental construct of sorts which is no more than aconfluence of impermanent components (‘I-moments’) cleverly synthesized by the mind in away which appears---note that word, appears---to give them a singularity and a separate,independent, unchangeable and material existence and life of their own. Now, it is throughthis perception of an internally created sense of self that we experience, process andinterpret all external reality. With alcoholics and other addicts, this false or illusory sense ofself also becomes chemically altered (seemingly for all time)---with truly disastrousconsequences for the addict and those associated with him or her.In my own life, as a result of my addiction to alcohol in particular, I discovered that themind—my mind—had become its own---and my own---prison. The mental construct of ‘self’which I had built up over many years of self-obsession imposed severe limitations on how Isaw life. My life’s experiences were filtered through a distorted lens comprised of the totalityof my various self-images. I did not see things as they really were because of this distortedlens. It was a classic case of ‘self-will run riot’,45 to borrow a phrase from the ‘Big Book’ ofAlcoholics Anonymous. I am talking about all manner of selfishness, self-centredness, self-absorption and self-obsession---self, self, self! I am reminded of what the well-knownBritish New Thought writer James Allen wrote, namely, Self is the lusting, coveting, desiringof the heart, and it is this that must be yielded up before Truth can be known, with its abidingcalm and endless peace.In July 1995 I entered St Edmund’s Private Hospital at Eastwood.46 My alcoholism hadspiralled totally out-of-control and my life was an absolute mess. My actions whilst grosslyintoxicated had brought me into big trouble with the law---not a good thing for anyone, butespecially not for a lawyer. Intervention came as a result of the actions of my former lawpartner and my wife (from whom I was separated for some time until I finally got my acttogether). They made enquiries of St Edmund’s, and I went in as in-patient, straight from theHornsby courthouse. There I did the 4-week programme in ‘self illusion therapy’47 conducted45 rd Alcoholics Anonymous [3 edn] (New York: Alcoholics Anonymous World Services, 1976, p 62).46 I had been a member of Alcoholics Anonymous since January 1991, but my longest period of sobriety in 4.5years was only 12 months.47 See J Maclaine, Breaking the Bondage of Self: An Approach to Recovery (Sydney: Interact Health ProgramsPty Ltd, [July] 1983), Program Notes (Sydney: Interact Health Programs Pty Ltd, 1987), When Someone YouLove is Addicted to Alcohol or Drugs (Sydney: Bantam Books, 1988), Self Illusion Therapy [leaf] (Sydney: InteractHealth Programs/St Edmund’s Private Hospital, nd); J Maclaine with H Townsend, When Someone You Love is ndAddicted to Alcohol or Drugs (Sydney: Bantam Books, 2001) [revised and expanded (2 ) edn].Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 14
  15. 15. (and developed) by the late, great Jim Maclaine, and I went back to the hospital as a day oroutpatient one day each week for some time thereafter.The first thing I had to do was to accept that I was a ‘person among persons’ (to use JimMaclaine’s words)---a vital and integral part of lifes self-expression. I was told that I was notthat witnessing [or so-called ‘transcendental’] self, which was nothing more than a smallpart of the aggregation of the hundreds of thousands of ‘I-moments’ (‘inner self images’) Ihad manufactured in my lifetime (‘image in a person’, in Maclaine’s words).48 None of thoseimages were the ‘real me’ (the person). The second thing I had to learn was to recognizethat, although I had been living in a chemically altered state of self-obsession,49 the person50that I am and have always been was nevertheless still in direct contact with external reality---that is, with what is---even though I was scarcely aware of it at the time. Now, once I hadfully accepted those facts---along with the admission that I was powerless over alcohol andmy life had become (totally and hopelessly) unmanageable---I was then able to start to livedifferently … and mindfully … one day at a time and from one moment to the next.In my own writings, lectures and speeches I have quoted often these immortal words ofWilliam Temple, a former Archbishop of Canterbury: ‘For the trouble is that we are self-centred, and no effort of the self can remove the self from the centre of its own endeavour.’Those words are very powerful, and very true. I will repeat them---‘For the trouble is that weare self-centred, and no effort of the self can remove the self from the centre of its ownendeavour.’51 As I see it, that is the fundamental problem faced by the alcoholic and otheraddicts. How can ‘self’---which, in any event, is in total bondage to itself---change ‘self’? Itcan’t. The ego-self has to be thrown off-centre, and a ‘power-not-oneself’ needs to be found---perhaps deep inside the person in question---in order to find the necessary power to toss48 G Watson notes that ‘recent studies’ in the West support the view that the sense of self is ‘not a thing but aconstruct, and one that appears to be considered as ever more widely distributed’: G Watson, ‘I, Mine and Viewsof the Self’, in G Watson, S Batchelor, and G Claxton, The Psychology of Awakening: Buddhism, Science andOur Day-to-day Lives (York Beach ME: Samuel Weiser, 2000), pp 30-39, on pp 30-31.49 Maclaine would explain to patients just how in addicted people the alcohol or other drug permanently changedthe inner self images that gave one the ‘deepest sense of identity’. The alcohol or drug created a ‘new,enormously satisfying, self image’.50 As Maclaine explained it, ‘self’ was ‘inside’ and was nothing but ‘image’; the ‘person’ was ‘outside and actual’---a ‘person among persons’. The philosopher John Locke wrote of the distinction between the two: ‘We mustconsider what Person stands for, which, I think, is a thinking intelligent Being, that has reason and reflection, andcan consider it self as it self, the same thinking thing in different times and places.’ (1975) Essay ConcerningHuman Understanding, II 27.9. Similar views on the ‘illusory’ nature of the ‘self’ have been held by the neurologistJohn Hughlings Jackson and the philosophers David Hume, Friedrich Nietzsche and Bertrand Russell (amongmany others).51 Maclaine similarly wrote: ‘Self is very circular; the part of you that you are working on becomes the part of youthat is working on it’ (Breaking the Bondage of Self: An Approach to Recovery, p 36); ‘the part of you that wastrying so hard to control [the addiction], was already in the grip of it … an endless battle with yourself’ (ibid, p 2).Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 15
  16. 16. and overcome all forms of self-obsession and ‘mental furniture’. Self-liberation52 is the goal,but the alcoholic or other addict must be very careful in how they go about this, for as manyso-called mystics have found out over the years, the denial of the self tends only to increaseone’s obsession with oneself. In the words of Dr Norman Vincent Peale, who for 52 yearswas the senior minister of Marble Collegiate Church in New York City, and who was awonderful supporter of AA right from its very infancy---few ministers of religion have ever hadPeale’s understanding of alcoholism and addiction---the person in recovery must experience‘a shift in emphasis from self to non-self.’ By a ‘sense of non-self’ Peale means a ‘sense ofbe-ing’---that is, a sense that we, the person that each of us is, can do that which the ‘self’(or rather ‘selves’) in us cannot.53In addition to working as a lawyer, educator and trainer, and a consultant and an author, Iam also a Unitarian54 minister of religion, and a wellness (mindfulness) instructor andpractitioner. Now, few people know of the existence of a very early and important connectionbetween the 12-step recovery program Alcoholics Anonymous and Unitarianism.55 On 26November 1939, when AA was still very much in its infancy, the Reverend Dr DilworthLupton, then the minister of the First Unitarian Church (Universalist-Unitarian), Euclid at East82nd Street, Cleveland, Ohio, preached a famous sermon entitled ‘Mr X and AlcoholicsAnonymous’,56 printed copies of which were distributed widely during the early days of AA inthe United States of America. Mr X was one Clarence Snyder, who was one of the52 Self-liberation, self-realization, enlightenment, salvation---to me, they are all the same thing. In the words of theZen Buddhist Alan Watts, we are taking about ‘a state of wholeness in which the mind functions freely and easily,without the sensation of a second mind or ego standing over it with a club: A Watts, The Way of Zen (PenguinBooks, 1962), p 43.53 I like these words from Vernon Howard: ‘A free mind is one that failed so dismally in living up to its flatteringself-images that it gave them up entirely’: V Howard, Cosmic Command (Boulder City NV: New Life Foundation,1979), # 1923.54 Unitarianism (also known as Unitarian Universalism) can hardly be called a religious denomination any longer,or even a religion in the sense of its being one single, cohesive religion among other world religions, havingexpanded a long time ago well beyond its Christian roots, with many modern day Unitarians embracingHumanism, agnosticism, various forms of theism, non-theistic belief systems such as Buddhism, progressiveChristianity and earth-based spirituality. Unitarianism---being post-Christian and ‘post’ many other things as well---is more in the nature of a paradigmatic approach to religion and a praxis, that is, a particular and quite distinctiveway in which certain spiritual principles (such as the inherent worth and dignity of every person, a free andresponsible search for truth and meaning, and the interdependent web of all existence) are engaged, applied andput into practice. As such, Unitarianism may be termed a metareligion. Unitarianism has always had a broad andliberal spiritual focus, imposing no particular creed, article or profession of faith upon its members and adherents.Unitarians are therefore free to explore and develop their own distinctive spirituality and are encouraged to do soin a responsible way, using reason and free inquiry, with a spirit of tolerance for the views of others.55 See I Ellis-Jones, ‘Unitarianism and Alcoholics Anonymous’, An Address Delivered Before the SydneyUnitarian Church on Sunday, 6 February 2005, <http://www.slideshare.net/ianellis-jones/unitarianism-and-alcoholics-anonymous> (viewed 30 October 2012).56 A copy of the printed sermon can be found online at, among other sites,<http://silkworth.net/aahistory/mr_x.html> (viewed 30 October 2012). On 27 November 27 1939 the ClevelandPlain Dealer printed Lupton’s sermon and it was met with a very positive reaction by the readership. It alsobrought about some inquiries about the new movement of AA and pleas for help from both alcoholics andmembers of their families.Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 16
  17. 17. contributing authors of the ‘Big Book’ of AA entitled Alcoholics Anonymous, which was firstpublished in 1939.57Snyder’s wife Dorothy had often implored Dr Lupton to speak to Clarence about his alcoholicdrinking. Lupton did speak with Clarence on a number of occasions. Unfortunately, Clarenceat that time was unable and unwilling to quit drinking. (He later did quit drinking.) Now, fromhis conversations with Clarence Snyder and with other members of the Cleveland group, DrLupton stated that he was convinced that the success of AA came through the application offour religious principles that, in Lupton’s words, were ‘as old as the Ten Commandments’.Lupton identified the four principles as being as follows: 1. The principle of spiritual58 dependence---being reliance upon what Lupton referred to as a ‘power-not-oneself’ (which need not be a ‘higher’ power59 as such, or a traditional God-figure,60 but simply a power other than one’s ‘self’, the reason being, as I have already said, that ‘self cannot change self’). 2. The principle of universality---that is, anyone can recover from alcoholism and other addiction regardless of their particular religion or even if they have no religion at all. 3. The principle of mutual aid---that is, people tend to have the best chance of successful recovery when they have an opportunity to be exposed to the energy of association with, and the power of example of, likeminded people. 4. The principle of transformation---that is, a ‘revolutionary change’ can take place in the alcoholic or addict’s life when reliance is placed on a power-not-oneself; the57 Snyder wrote the chapter entitled ‘Home Brewmeister’ (p 274 in 1st edition, and p 297 in 2nd and 3rd editions,of the ‘Big Book’, Alcoholics Anonymous (New York: Alcoholics Anonymous World Services)) and was anoriginator of Cleveland’s [AA] Group No. 3.58 That is, non-material or non-physical. Jim Maclaine, who developed his own distinctive recovery program andform of recovery psychotherapy (‘self illusion therapy’) from a number of different sources, ideas and techniques(including but not limited to Buddhist philosophy and psychology, cognitive behavioural therapy (CBT), and theideas and teachings of J Krishnamurti and Christian mystics), used to say that AA and all the other 12-stepprograms were ‘spiritual’ programs of recovery because they used ‘non-physical’ means of recovery---namely,words (both written and spoken), ideas and concepts as a result of, among other things, the energy ofassociation with likeminded people and the power of example, all of which serve as a ‘power-not-oneself’. That isnot to deny the place of pharmaceutical drugs and the like in the fields of addiction psychiatry and addictionmedicine.59 Although I respect those who like the expression, I personally dislike the expression ‘higher power’ as it tendsto suggest that there are supposedly ‘higher’ and ‘lower’ levels or orders of reality (which, on both philosophicaland scientific grounds, I firmly think is not the case). Significantly, Step 2 of ‘The Twelve Steps’ speaks in termsof a power ‘greater than ourselves’ [emphasis added]. In addition, there are only 2 places (on pp 43 and 100,respectively) in the 4th edn of the ‘Big Book’ of AA where the actual expression ‘Higher Power’ is used, but thereare numerous other places in the book where other expressions are used to refer to the need to find a ‘power’ orsimply ‘Power’ (to overcome the problem of ‘lack of power’) and to the ‘God’ of ones own understanding.60 Buddhism, for the most part, is a nontheistic religion---to the extent that it is a religion at all. The ‘higher power’(or ‘power-not-oneself’) for a Buddhist might be, for example, The Triple Gem, the Dharma, or Buddha nature.Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 17
  18. 18. transformation results in a radical alteration of one’s attitudes and outlooks, one’s habits of thought. ‘In the face of despair and impending collapse, [the person] has gained a new sense of direction, new power.’I have seen these four principles work wonders in my own life and in the lives of countlessothers with whom I have been associated.61I want to say this---most sincerely and (hopefully) non-patronisingly---to each of you who isinvolved in various ways in the fields of addiction psychiatry and addiction medicine, that is,in helping others to recover from severe substance dependence. You are all engaged in amost noble enterprise. Personally, I can’t think of anything more important. Interventionworked in my own life. Without the intervention of others, I don’t think I would have everrecovered. As you all know, when it comes to the process of addiction there is no one rock-bottom, rather it is a bottomless pit. Unless and until a person can be brought to the pointwhere they want recovery more than anything else---more than family, friends, job,reputation, and even life itself---there can be no recovery. Want-power---as opposed to will-power---is what is needed. However, when an alcoholic or other addict comes to therealization that ‘there is [or, at the very least, may be] a way out’, that they don’t have tocontinue living in the way they have been living, and that they really want what others haveobtained in and through the process of recovery, remarkable and seemingly miraculousthings can and do happen.Thank you, and bless you all. O housebuilder! You have now been seen. You shall build the house no longer. All your rafters have been broken, Your ridgepole shattered. My mind has attained unconditional freedom. Achieved is the end of craving. 62 ― The Dhammapada, verse 154.61 For an accessible and authoritative study of the relevance and application of Buddhist philosophy and practicein the modern Western world, see G Watson, S Batchelor, and G Claxton, The Psychology of Awakening:Buddhism, Science and Our Day-to-day Lives (York Beach ME: Samuel Weiser, 2000); R Hanson with RMendius, Buddha’s Brain: The Practical Neuroscience of Happiness, Love & Wisdom (Oakland CA: NewHarbinger Publications, 2009).62 The ‘housebuilder’ is the false or illusory ‘self’ (or rather ‘selves’ in us), held together by the ‘ridgepoles’ and‘rafters’ of dependency. When we come to see ourselves [sic] as we really are, we will attain ‘unconditionalfreedom’---or, to quote from the ‘Twelve Promises’ of AA, we will come to know ‘a new freedom and a new rdhappiness’ and ‘self-seeking [sic] will slip away’ (see Alcoholics Anonymous [3 edn] (New York: AlcoholicsAnonymous World Services, 1976), pp 83-84).Copyright © Ian Ellis-Jones 2012. All rights reserved. Fair use permitted. Page 18

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