Dr. John Kelly: 12 Steps And Continuum Of Care

If A.A. could talk, it would wave a John Kelly flag and say “See? See?”

But, since Alcoholics Anonymous has no opinion on outside matters, no president, no spokesperson, John Kelly gets no public recognition from the fellowship’s two million members. But he sure does from the many hundreds of addiction treatment centres splashed across the continent.

Kelly is the man with the proof. He is the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School. He is also the Founder and Director of the Recovery Research Institute at the Massachusetts General Hospital. He has consulted on matters of addiction to the United Nations. To the U.S. government. He has published over 200 peer-reviewed articles and was an author of the US Surgeon General Report on Alcohol Drugs and Health. The list of his accomplishments is extensive.

And, somehow, he has been able to maintain a very approachable manner. He returns phone calls. He answers all questions. He is clearly an advocate of recovery, one that Aurora holds in the highest esteem.

Aurora’s president, Steve Low, says John Kelly’s significance to the recovery movement cannot be understated.

“He’s incredible at linking all the research to the need for recovery management systems – a system we are in the process of establishing here at Aurora,” said Low. “Dr. Kelly is making sense of, and supporting, with solid research, the need for a continuum of care with residential treatment being just one piece.”

With over 30 years himself in the business of helping others find the way out of substance use, Low says having John Kelly do the circuit of conferences explaining the scientific effectiveness of the 12 Step model demystifies the process so many of Aurora’s patients go through en route to recovery.

“I have personally experienced individuals approach me after I have shown one of his videos, completely affected by what Dr. Kelly had to say. One told me he was ‘dead set against A.A. but, after watching that, I am willing to give it a chance.’ That’s incredible,” said Low.

And it turns out he’s a really good guy, he says with a smile.

“He’s so willing to share his experience and wisdom – for a busy guy, he really makes himself available to a guy like me.”

Early next month, Aurora is one of the sponsors of a major event at which John Kelly will be a keynote speaker. The Recovery Capital Conference is an annual get together of addiction counselors, doctors, employers, students and many non-professionals living in recovery, where they educate and collaborate on the latest information available on addiction medicine.

Though it is normally a two-day event offering plenty of opportunities for comparing notes with peers in the realm of recovery providers and those interested in the topic, this year Covid-19 had other plans. As such, the 2020 conference will take more of a one-day webinar form, with plenty of Aurora influence.

One of the marquee speakers – first out of the gate actually – is Dr. Kelly, who will share on the topic of The New Science on Addiction Recovery at 10 a.m. CDT.

We asked Dr. Kelly to share with Aurora’s members some of his insights regarding matters of 12 Step Facilitation and its place in the recovery continuum.

1) What is your stock answer when somebody says the treatment industry is hung up on the 12 Step facilitation model to the detriment of other models?

I think the answer is another question: What does the best available science tell us is the optimal way to address Substance Use Disorder (SUD) for individuals seeking help? Twelve-Step Facilitation (TSF) treatments for alcohol use disorder have been shown to be at least as effective in recent rigorous systematic reviews of the evidence as well as highly cost effective.  Such approaches should be incorporated into the clinical mix given that the majority of patients in treatment typically have AUD (Alcohol Use Disorder) and many patients who have other SUDs can also benefit from TSF to other mutual-help organizations such as Narcotics Anonymous and Cocaine Anonymous – although there is less formal evidence regarding the effectiveness of those linkages. 

 2)   When it comes to staffing a treatment centre, what are your thoughts on recovery experienced counselors/clinicians versus Masters’ Level clinicians who have not experienced SUDs?  

There is limited and mixed quality evidence on having counselors with the lived experiences of addiction versus not, on being able to better engage patients in treatment and on being more effective with them. On a personal note, I have known and worked with fine and expert addiction counselors who have not been in recovery as well as those who were. So, from a clinical delivery standpoint, at least, it might be more about the passion and ability of any counselor to help patients with SUD rather than whether they’re in recovery or not; the patient on the other hand, may have a different view and prefer or not prefer someone in recovery, but I’ve never seen a study asking patients about that.   

3)   What is the biggest misconception in your mind, when it comes to the way 12 Step/Mutual Aid Societies have helped addicts?

I think they’re often dismissed as religious or folk medicine or otherwise not to be taken seriously. However, mutual aid fellowships have been shown to confer benefits in ways and through therapeutic mechanisms similar to those conferred by professional treatments but do so over the long-term for free in the communities in which people live and work. Also, when groups like AA have been subjected to same rigorous scientific standards as other clinical interventions, it fares at least as well on all outcomes and does better on abstinence and remission and produces large health care cost savings.

4)   The state of addiction treatment in North America today… many say it isn’t working well enough. What can be done to improve outcomes in your mind, say three main improvements.

1. Better measurement of during treatment and post-treatment outcomes to enhance accountability, quality, and effectiveness.

2. Stronger focus on the continuum of care and assertive linkage and recovery monitoring

3. Enhanced recognition of the many pathways to recovery and that all should be honored, encouraged, and celebrated. 

 5)   Aurora is focusing on a continuum of support, a recovery-oriented system of care as it goes forward. What are your thoughts on models like these?

See my three recommendations above. These are important aspects of treatment to focus on.

For more information on the 2020 Recovery Capital Conference and keynote speaker Dr. John Kelly, go to the website https://recoverycapitalconference.com