Episode 93: Dr. Ray Baker-The Science of Addiction and Recovery

In today’s episode, I’ll be speaking with Dr. Ray Baker, an expert in the field of Addiction Medicine. Recently, Dr. Baker served on a national expert committee for the Canadian Centre of Substance Abuse, where he helped design and analyze Canada’s National Life in Recovery Survey. Dr. Baker was the opening speaker at the “Widening The Gateway” conference in Tacoma, Washington. And he will be speaking at the International Conference of Secular AA to be held from August 24th through August 26th in Toronto, Ontario. Without further ado, my conversation with Dr. Ray Baker.

Podcast Transcript

00:25 John S: In today’s episode, I’ll be speaking with Dr. Ray Baker, an expert in the field of Addiction Medicine. Recently, Dr. Baker served on a national expert committee for the Canadian Centre on Substance Abuse and Addiction, where he helped design and analyze Canada’s National Life in Recovery Survey. Dr. Baker was the opening speaker at the “Widening The Gateway” conference in Tacoma, Washington, and he will be speaking at the International Conference of Secular AA to be held from August 24th through August 26th in Toronto, Ontario. Without further ado, my conversation with Dr. Ray Baker.

01:11 John S: Ray, welcome. How you doing?

01:13 Dr. Ray Baker: I’m well. Thanks for having me.

01:15 John S: Oh, it’s great to have you here. It’s really interesting to speak with somebody like you that has a background, a personal background in recovery with 12-step programs, but also has the professional background as a doctor who practices Addiction Medicine. What’s it like for you to have those two perspectives?

01:34 Dr. Baker: Well, it varies. Early on in my career when I went from Family Medicine to Addiction Medicine, it was very helpful because we didn’t learn very much about addictions in medical school and in internship, and hospital training. So what I learned from AA and from being around people in recovery, was really my foundation for getting motivated and understanding recovery. So, the addiction medicine I learned was on a network of recovery oriented care, which nowadays is an important distinction. I learned about addiction, not just from a pharmacological, physiological, a disease point of view, but from a recovery point of view which has stood me well.

02:26 John S: It’s interesting. I was listening to a talk from the Austin convention. There were a couple of doctors who were speaking on addiction medicine. I was surprised when they talked about how little is taught in medical school about treating addiction. I don’t know if that’s changed much, but that was the case they were relating.

02:47 Dr. Baker: It is. I had the honor between 1990 and 1995 of bringing in the first extensive Addiction Medicine curriculum at the University of British Columbia, and it was very popular with students. As a matter of fact, it won a national award for its quality. However, interestingly, as the curricula changed and was updated and clinical studies were increased, academic classroom teaching was decreased. It fell off the curriculum completely. So, we’re back in Canada to not having undergraduate addiction medicine taught, which is kind of criminal. The other thing is, at a graduate level with the residents and fellows in Addiction Medicine, the brand of addiction medicine they’re learning now is much more entry level initiation or pharmacological treatment. They learn an awful lot about the disease, and the brain disease of addiction but it’s been reduced to focusing on a pharmacological fix, which is okay as long as it leads to what we know as the breadth and depth of recovery. They learn very little about recovery even at a fellowship level, at least here in Canada.

04:16 John S: That’s an interesting difference between treating addiction and recovering from it. You mentioned in your talk in Tacoma that there might be a role for a medical solution or a medical treatment up to a certain extent, but that it doesn’t really assist with the recovery.

04:34 Dr. Baker: There’s some good science out there that shows treatment serves a very important role. Most types of treatment whether it’s intensive inpatient treatment, intensive outpatient treatment, other forms of psycho-therapeutic treatment or pharmacological treatment, they share the common desire to get people started or initiation of recovery. But if that’s all people get with this chronic disease, it’s not enough, and it doesn’t lead them very far. It’s followed with high rates of relapse in people who are sick enough to really need treatment. What really does correlate with long-term recovery is once initiation of treatment occurs, whether people get there on their own or through treatment, the thing that really correlates with being successful in the long run is affiliation with the mutual support group. Predominantly 12-step, largely because that’s what’s out there. We just don’t have the data on the other mutual support group programs. 

05:44 Dr. Baker: The evidence is really accumulating that for 12-step programs, people who affiliate and participate in the programs, the fellowship, and the incredible depths of therapeutic assistance they get there have much, much higher rates of long term sustained remission. The further out you go from treatment, the less important treatment is, and the more important involvement with the mutual support group is.

06:09 John S: That makes sense from my own experience and observations. I also read a book a couple years ago that I found pretty interesting. It was written by Dr. Joseph Nowinski, and it was titled, If You Work It, It Works!  He was involved in the study here in the United States called Project MATCH, where they looked at 12-step facilitation treatment. He actually wrote the, or was part of a group that wrote the 12-Step Facilitation Handbook. It was interesting. He wrote about the challenges of studying the effectiveness of 12-step programs, but that there is data behind the effectiveness of one’s chances of achieving sustained sobriety through participation in a support group.

06:57 Dr. Baker: Yes, and the strength of the data is getting more so all the time. Project MATCH was the biggest study ever done of its kind, and for some people it was very disappointing because it showed that expensive, intensive treatment delivered by mental health professionals did not result in any better outcomes than 12-step Facilitation Therapy, which it’s important not to confuse. Sometimes I read writers who confuse 12-step Facilitation Therapy, which is a kind of treatment, with 12-step. They’re very, very different of course as you know, 12-step Facilitation Therapy is a treatment, which means there’s a therapist, a therapeutic relationship, and a patient. The whole idea with 12-Step Facilitation Therapy is to overcome barriers or gaps— to get people to go and keep going to meetings, to 12-step meetings. Whereas when people go to a meeting at AA or NA, that’s not treatment, that’s very different. There isn’t a therapeutic relationship between a treater and a person, and that’s where recovery and treatment really distinguish themselves.

08:14 Dr. Baker: And the quality of the evidence since 2006 is becoming more and more robust, so that anybody who says, as the Cochrane Review said in 2006, and it’s still often quoted, when it said, “What we lack is good quality evidence demonstrating the efficacy of 12-step programs.” What they really said is, and I feel a little bit guilty of being part of the problem having been out there treating people with addiction since the 1980s, is that there’s a lack of evidence. It doesn’t say that AA and NA don’t work. What it says is, there’s lack of good quality evidence, which was true at the time. But since 2006, when they wrote that summary on review of the evidence, some really good work has been done, and I outlined a little bit of it in my talk in Tacoma, by people like Dr. Lee Ann Kaskutas, and by a number of other people who’ve documented, John Kelly, in Boston, who documented the depth and the wealth of evidence that’s accumulated. The evidence for 12-step efficacy is greater than any pharmacological treatment out there. 

09:35 John S: Why do you think it is? What do you think is so effective? Is it the socialization that we have with one another? Is it the actual process of going through the steps? What do you think it is?

09:47 Dr. Baker: That’s a really good question, and I would be speaking beyond the science. We certainly know that it works, and we also know that there are a wide variety of modalities woven into 12-step work. There’s the psycho-education. There’s non-chemical coping skills that we learn. There’s emotional maturation, learning accountability and responsibility. There’s more intangible, some might call them spiritual effects of being accepted into a group of people.

There’s something about when people get together. Human beings, when they isolate, they get sick and die, they’re mentally and physically less healthy. When you put people together, they do better. I don’t think we can entirely understand what is that about. For some people, one of the reasons that the secular movement, or the agnostic and atheist movement within AA is so interesting, and it’s been there since the beginning, during the early formative stages in the 1930s. The non-spiritual, non-religious group were vocal and involved and did very well, thank you very much, without a religious or spiritual, overtly spiritual content. But for some other people, and our Life In Recovery Survey showed that, for some other people, the religious or the spiritual or whatever you want to call it aspect, are vitally important to them.

11:36 Dr. Baker: So, what that tells me is that this is a very rich therapeutic process. I can recognize other modalities that are used. For instance, Project MATCH compared three different modalities, Cognitive Behavioral Therapy, Motivational Enhancement Therapy, and 12-Step Facilitation Therapy. Well, all three of those are heavily woven through 12-step programs, and Rudolf Moos, who has studied recovery from addiction and mutual support group programs for many, many, many years has identified at least four therapeutic processes woven through 12-step programs giving theoretical underpinning to why they work. But if you get down to what I think is the most important one, I think it’s just… It’s something about people getting together and caring for each other. It’s basically love I think.

12:38 John S: I see it that way too. We probably all have that memory of the time in our life when we realize that we needed help. I think most of us, or a lot of us anyway, describe it as feeling alone and isolated, a kind of a despair. Then, we find this group of people who understand us, and that’s what helped me so much. I think hiding my problem for all those years, and then walking through the door to an AA meeting, in my case, and listening to people who understood me was an amazing experience. I think I was driven to come back because of that. Yeah, I went through the steps and I think that they’re useful, but what I learned from all the many people who I met at all those AA meetings was more valuable than I could ever put a price on. 

13:38 Dr. Baker: John, that was my experience too. I remember almost… I think I did weep with relief at the combined feelings of I’m no longer alone, and I’m not shameful… It relieved my shame and continued to do so for quite some time, but in order for that to happen, there was more than just fellowship. There was storytelling, and I think you could just study the effect of telling stories, telling our stories, listening to each other’s stories. I think that’s a rich, rich source of a study by itself.

14:21 John S: Hey, you mentioned the survey. You were a member of the Canadian Centre for Substance Use and Addiction, and you were involved in a survey of people in recovery. Can you talk about that survey, and what you learned from it? 

14:39 Dr. Baker: Okay. I was part of a group that was formed in 2015. The federal government of Canada was feeling kind of desperate about what to do about the growing opioid epidemic at the time. And they struck this national committee, a National Summit on recovery. In the United States, you had done it sometime before. So, people from across Canada who were involved in treatment and our fledgling recovery movement were called together to come up with some ideas about recovery in Canada, and to give the government some guidance about where to go from there. It was brought out that the United States, Australia, and the UK had already done a life in recovery survey, looking at their population of people in recovery to find out more about who they are, what they look like, what they did in order to enter and sustain recovery, and what it’s like now, what kind of citizens are they, what are their attributes? I was fortunate enough to be assigned to the Expert Advisory Group to help the CCSA in designing, administering and analyzing this survey.

16:05 Dr. Baker: So, we put it out. Now, it was done online as a computerized internet survey, which if you’re a scientist, you’d say “Aha, there’s a source of some bias there.” Because the people who would participate as respondents in the survey are people who are motivated, who see themselves as in recovery, and who would have the wherewithal to complete an online survey. Those are all valid criticisms, but still with those in mind, it’s the same methodology that was used in the three other countries, and it still gives us some good information. It was administered in 2016, and we got 855 respondents, which for our population of 30 million people isn’t bad. We analyzed and we looked things like, what was their drug of choice and what was the age of first use? What was the age of addiction, what they defined recovery as, and then what they found helpful for entering recovery, what they found helpful for sustaining recovery.Then we looked at what their lives are like now, as far as level of function, healthcare utilization, their overall health, their quality of lives, their giving back, their tax paying, their debts, their use with the legal system. So, it provided us with a wealth of really, really useful data. Some of it that countered popular beliefs.

17:48 John S: What was in there that surprised you or that might have countered those beliefs?

17:53 Dr. Baker: Well there were a number of things. One that wouldn’t surprise you or me, for instance was the age of first use and the age that addiction occurs. If you’re going to initiate prevention, you’ve got to do it early because kids start using in their mid-teens or early teens, and addiction has occurred. It’s a disease of adolescence. Canada’s in the process of legalizing marijuana as I speak, and the interesting thing is that marijuana will still be an illicit drug for adolescents because the age of legal use will be over 19, and addiction has pretty much occurred. The median is around 19, so it’s already occurred by then, so the increased availability of course is going to increase use—just as it did when prohibition ended for alcohol. So, we’re going to see some interesting outcomes. So that was one finding. 

19:11 Dr. Baker: Another finding was that people have a nihilistic approach to addiction and they say, “Well, treatment doesn’t really work. Addiction, it’s kind of pathetic because everybody keeps relapsing.” Well, that’s not true for our respondents. Of the 855 people who responded, 51% of them did not have a single relapse. So yeah, but the people who you keep seeing back at treatment, of course, are the ones who keep relapsing. The people who end up in treatment to begin with are the ones whose own measures have already failed. Those who could get well using their AA group, or a private counselor, or many, many other methods to increase their levels of what we call recovery capital. We’re already selected out, so that was really, really important to realize that the majority of people can and do recover, and they can sustain recovery without relapsing. Those who did relapse, the majority of them, within two or three relapses were into sustained long-term recovery. The other findings, again, you won’t find surprising is that we become quite successful, happy, healthier, than the general population. We become contributing members of society, and that’s really important with my agenda because that gets government’s attention. We’re not using precious healthcare resources, we’re giving back and we’re voting.

20:39 John S: You mentioned something that reminded me of your talk in Tacoma. You were talking about how “addiction has occurred”, when you mentioned that it occurs on average at age 19. You also mentioned in your talk in Tacoma that addiction changes the genes, and once that happens, that’s a permanent situation.

21:13 Dr. Baker: Yeah.

21:13 John S: Am I understanding that right?

21:15 Dr. Baker: There is an old Japanese saying, “First, the man takes a drink, then the drink takes a drink, then drink takes the man.” It represents the process of addiction rather well, and it also represents a larger change that happens with many pharmacological fixes when they’re taken for a long period of time. The human body has this incredible ability through homeostasis to maintain an internal environment that’s constant. It’s consistent, so there are many feedback loops built in to keep the chemistry just the same. So, we tend to be reductionists, we don’t know that much, we still don’t know that much about the neurobiology, the neurochemistry of the body, and especially of the brain, but we know a little bit. We’ve learned in the last 40 years about neurotransmitters, and we’ve discovered that, aha! In certain conditions, in depression, there’s things like serotonin and dopamine and norepinephrine that are depleted. In the disease of addiction, it seems the final common path in addiction appears to be a deficit in the dopaminergic, the dopamine-mediated system, and the mesolimbic or the reward system in the brain, part of the brain that’s responsible in part for hedonic tone and reward.

22:40 Dr. Baker: Those of us with addiction discovered that early on, as we used our drugs of choice or our behaviors of choice, because they cause that part of our brain to go squirt, to work, and so we do it. Medications can be used to change these levels of neurotransmitters, and initially, it works. So, the reason we used our alcohol or marijuana, or whatever our drug of choice was, wasn’t because it was a problem, it was because it was a solution. It worked and it made us feel better, and so we did it. But eventually, by definition, that’s the definition of addiction, or  a component of it— it stops working. It requires more to get the same effect and then it causes harm, and we keep doing it, despite the fact that it causes harm, because in our mind, at least, there’s enough benefit built in to outweigh the harm. Our logic may be a little bit off because of defenses, so someone looking at us might say, “No, no, its consequences are way worse than its benefits.” But from our logic, our internal perspective, it’s still worth doing until it’s not, until we reach that point that some people call hitting bottom or that momentary awareness that the cost outweigh the benefit.

24:00 Dr. Baker: Now, what happened though, when we continued to use the drug is, first of all, there’s an adaptation that occurs at the neurotransmitter, and that adaptation is that the neurotransmitter will decrease its sensitivity or decrease its production. In other words, it’s going to try to get back to the way it was, because that’s homeostasis. So, there’ll be local adaptations, and the way you know that has occurred is because you develop tolerance, it takes more drug to get the same effect, or you get withdrawal when you stop taking the drugs, you get stereotypical symptoms that are exact opposite of the effects of the drug. So, if the drug was a sedative, you feel agitated, you feel insomnia, irritability, you might even get seizures.

24:45 Dr. Baker: So that’s the second, that’s the drink, taking a drink. So the drink, the drink took a drink. Then with prolonged use, there’s a more sinister change that occurs., and this is new science of the last, not a little more than a decade of epigenetics, where we learned that our code that operates our equipment or everything that happens in our body, all of our enzyme systems, all of our functions are governed by proteins and proteins are synthesized based on a code that comes from our DNA. And that’s intracellular internuclear machinery. Well, that can get changed, can get adapted by environmental factors, by pharmacological factors, by alcohol, and other drugs. So, with continued, continued use, there are changes in gene expression. We don’t know exactly how it happens. We know some of the mediating molecules that happen, but what then we’ve got a change, an epigenetic change. In other words, the actual DNA isn’t altered, but how it expresses itself, gene expression is altered, and this seems to be more irreversible. It’s only partly reversible.

26:09 Dr. Baker: So, once that switch has occurred, then… “Once a pickle you can’t go back to being a cucumber,” was the model that was used to help explain alcoholism. The really scary thing about epigenetics is that it appears to be transmissible to the next generation in certain cases. It’s really quite spooky not just with alcohol or other drugs, but when we look at the amount of medication we’re doing with other drugs that can cause these epigenetic changes that changed the function of the organism and changed it somewhat permanently if you take them for long enough. That’s one of the scary things, and that’s why 32 years later, I’m still going to meetings, and I’m still working using all of the things that I found helpful in my own recovery to not go back to using alcohol and other drugs, but to maintain my level of hedonic tone to feel good, if I can’t use drug.

27:18 John S: Isn’t that interesting how it could actually be passed on.

27:26 Dr. Baker: Yeah. I’m not saying that earning addiction is necessarily transmissible, genetically. We just know that epigenetics, in some cases, can affect the next generation, and we just don’t know. It’s quite scary though.

27:46 John S: Yeah. It really is. It’s very interesting. It’s good information to have, though. It’s something that I think that those who are responsible for setting policy for treatment and drug enforcement, and so forth might want to take into account. So, let’s talk now about your experience in Tacoma, what you thought about that and your takeaway from that entire experience; and then I’d like to go into some of the issues  you see with AA that could be problematic for our future, and any hope you might have.  Would you like to talk about Tacoma? 

28:25 Dr. Baker: Oh, it was wonderful. [chuckle] I’m relatively new to AA’s secular atheist and agnostic freethinkers splinter group, and it’s not a splinter group at all. That’s the wrong way to describe it because it’s been there since the beginning. The most reassuring thing about it is that it’s very much AA, and it’s very much from within. It’s not an external destructive force, it’s an internal force, which I now see as potentially very corrective and very therapeutic for mainstream AA.

29:04 Dr. Baker: I think I’ll give you a little bit of background of how I ended up at Tacoma. Since I don’t describe myself necessarily out loud as an atheist or agnostic, I think I would describe myself as a secular humanist. In 1989 or 1990, I was attending AA meetings, and I was at a meeting and my sponsor happened to be at the same meeting, and they were just reading this new blue card, and it was being read with relish by somebody who was enjoying the rigidity of it and was saying, “Please confine your comments to only your struggles with alcohol.”

29:47 Dr. Baker: It was meant to be… It felt like it was exclusive, it felt like it was rigid, exclusive, and my old sponsor, may he rest in peace, was kind of a rebellious old guy who didn’t like to be confined and told what to do. So, we left that meeting and he says, “We’re starting another meeting and there’s not going to be a lot of rules.” And so, we did and it was called, “As You Are” and it’s still running, it’s still very healthy 30 years later, and it’s basically based upon “as you are”. It’s definitely an AA group.

30:26 Dr. Baker: However, if you’ve got issues you need to talk about— talk about them. There are no rules and as a matter of fact, even the format of the group is without rules. It’s up to the chairman of the night to set the format and you can’t do it wrong because we’re based upon tolerance and acceptance. And we’ve always attracted people who were kind of outliers, who really were attracted to AA, but didn’t feel comfortable with some of the dogma, some of the rigidity.

31:03 Dr. Baker: So, we’ve got a lot of old-time sobriety, and probably the majority of us are agnostic, and a lot of professionals at it. So, that was my brand of AA for the last 30 years, and I was very comfortable with it. It didn’t occur to me that it was different than mainstream, except when I travel and I go to other meetings and I sometimes find some rigidity…And it seemed to be a growing sense of rigidity. Some religiosity, some… But I see the religiosity more… Funny, it’s more in the States than in Canada. But I see it as just part of that crystallization, that growing rigidity that I don’t think I used to see so much in AA. So, when I went to a couple of nearby meetings that were just starting up secular atheist agnostic meetings, I felt very much at home, and it was there that I got invited to talk at Tacoma. I felt like a bit of an imposter, because I’m not going as a member of an AA agnostic meeting, but just as a person in AA and an addiction medicine doc.

32:22 Dr. Baker: So, to be given that speaking spot, I felt a little bit like an impostor, but I felt very comfortable. The excitement at the Tacoma conference, felt like when I started into addiction medicine in 1985-86, when it was pioneering times. These were new times, and it was such sparkling, bristling excitement. I get that feeling every time I’m around this movement, and I’m very excited by it, because I think the direction is going to be so healthy for AA, that it can only do good things for AA as a whole.

33:03 John S: Yeah, I think we’ve already begun to make a difference. I’m pretty new to the whole secular AA thing. I’ve been in AA for a long time. In July, I’ll be coming up 30 years of sobriety, and for 25 of those years, it was just in a traditional AA group, and it was one of those more rigid groups that you’re describing, that felt as though the Big Book was just an amazing document, and we just studied it and we wanted to do things just the way they did it back in the ’30s. So, that was my AA life, until I realized I was an atheist. Then I searched out people like me, and that’s how I learned about all of this. I’m losing my train of thought. It always happens when I start talking about myself. [chuckle]

33:50 Dr. Baker: Well, congratulations, John. 30 years! Good for you.

33:54 John S: Yeah. But I can’t remember what I was going to say about that. [laughter]

33:58 Dr. Baker: I’m reading Ernie Kurtz right now, and I finished Robert Thomsen’s wonderful biography of Bill Wilson. The interesting thing about the early roots of Alcoholics Anonymous, is they’re far from homogeneous. I mean, if you compare the Akron group to the New York group, they’re incredibly different from each other. Some of the generalities that have been made about the roots of AA is that it always has been a conglomerate, heterogeneous… It was never meant to become dogmatic. It was never meant to be turned into a religion, and the writings were never meant to be in God’s written word—they were a start. It’s meant to be a very fluid program. If we turned it into a religion, turned into a fixed and rigid thing—that would be the end of it. That’s just not how it happened.

35:01 John S: Yeah, and I think that was the great strength of AA, that we created this idea that every group is autonomous. So, no matter where you go, it will take on the personality of that city and that group, and that location. That’s like you described, how the New York people and the Cleveland people, the Akron people, took very different approaches. I think that is a great strength of AA.

35:31 Dr. Baker: I just thought of a neat research project. Somebody should do this. Take a 100 people, randomly selected from different AA groups and say, “Write me a paragraph on what it means when you say, ‘I work my program.’ What does that mean?” And I bet you, the range would be incredible.

35:52 John S: Oh, it would. Even within the community of atheists and agnostics, there’s a lot of diversity and people are surprised by that.

36:01 Dr. Baker: Yeah.

36:01 John S: Even those people who describe themselves as atheist. You have atheists who though they have no belief in a god or any theology, they consider themselves as spiritual. [chuckle] Then, there are other atheists who who have nothing to do with spirituality. We just run all over the place. I think it’s important that we allow that to happen. That we don’t force, whether it be an atheist agenda or a religious agenda. That everybody just have whatever explanation or way of describing it, that works for them, that makes sense to them, which in my case has changed anyway.

36:41 Dr. Baker: I agree. I think the test for a good meeting, a good atheist agnostic meeting, would be if a person who was highly religious could come to that meeting, share their beliefs and what they do to recover from the disease of alcoholism, and be loved, respected, and supported in what they’re talking about. That’s a good meeting.

37:04 John S: I agree. So, I think, where I was going with this is that since I’ve been involved with and meeting people from secular AA, I found that a good number of us have been involved in general service within Alcoholics Anonymous. We’re working within the fellowship. We’ve made friends and connections with people from other AA groups that are not secular, and we’ve been able to get a lot of things done. The Grapevine published an issue dedicated to our stories. The Grapevine is putting out a book of our stories this year, the General Service Conference just approved to adapt The God Word pamphlet from the United Kingdom. So, I think that we’ve been helping AA adapt to a changing world. I think it was our involvement that has helped that process along,and I’m feeling hopeful for AA’s future, as I watch this unfold. Are you familiar with any of that, and are starting to sense some hope that, maybe that rigidity is being addressed now? 

38:19 Dr. Baker: I’m very reassured by what you just said, and I suspected that was happening. I made a choice early in my AA involvement to split my professional from my personal life. I understand that I could be criticized for it, because I’ve spent most of my life somewhat anonymous in my professional life. But what I decided was that, as an expert in addiction medicine who does an awful lot of influencing the public, that I could be most useful by keeping… Not necessarily keeping my history of addiction confidential, but keeping my involvement in 12-step programs to myself. That way, I could be seen to be more than a person with lived experience. I could be seen to be what I thought I was, and that is an expert in the science and clinical practice of addiction medicine.

39:19 Dr. Baker: I was never very good at doing sponsorship, and before I retired, I was so busy, I didn’t have a whole lot of time to do service work. So, I rationalized and I said, “You know, I’m going to stay sober and use my own program in my private life, but my service is going to be through deepening the field of addiction medicine through my clinical, scientific, and educational work.” I don’t feel badly about that. I like it.

39:51 Dr. Baker: But there’s a parallel here, and that is this newfound recovery movement that’s occurring in North America, led by the United States, starting in the 1990s and with organizations such as Faces and Voices of Recovery, and picked up by certain states where the decision makers like in Connecticut, and now in Ohio, places in Illinois, where they’ve picked up implementing recovery-oriented systems of care, and then putting some support behind the recovery movement in the community. 

40:31 Dr. Baker: I think those changes, if they can be sustained and right now, since the last Administration, we’ve had some setbacks in healthcare in general. But I think that this has got legs, that this is going to move. So, the parallel between AA institutional change and our healthcare systems in North America, and ours is very different from yours, I think there’s a parallel there, and we can infiltrate and influence the decision makers. We have to do it on the ground. We have to have the grassroots influence, and that’s where the Tacoma Conference, and that’s where your very valuable website and podcasts come in. But also, the decision makers within the actual program for survival of AA and 12-step programs.

41:19 John S: Isn’t that interesting? I agree with that, and I think you’ve done a tremendous service with your work.

41:24 Dr. Baker: Well, thank you.

41:25 John S: Taking your experience as a person in recovery into the professional community like that, I think is tremendous. So, just to wind things up, Ray, I understand that you’ll be speaking at the International Conference of Secular AA in Toronto this August. Any thoughts about that?

41:42 Dr. Baker: I’ve just been told that I’m no longer going to be a breakout session, that I’ll be speaking to the whole convention. So, I’m kind of terrified [chuckle] and humbled by it all. I feel like that old impostor who came into a treatment center a day late because because I missed my plane, because I had what might be my last drink and I got drunk and missed the plane. [chuckle] Well, I feel kind of like, “Wait a minute. What if they discover I’m just an impostor and I don’t know anything at all?” I’m honored, actually.

42:18 John S: Yeah, it’ll be a lot of fun. Did you go to any of the other conferences? They had one in Santa Monica, and then they had the one in Austin.

42:25 Dr. Baker: No, I discovered the AA Agnostica website and I had been starting to read it, and I think both of those had occurred before I even got involved in starting to follow this movement. So no, my very first large organization of like-minded people was in Tacoma. So I’m delighted and looking forward to the Toronto conference.

42:51 John S: The first time I experienced that was in Santa Monica, and that really changed my whole trajectory in AA. 

42:58 Dr. Baker: Oh, did it?

43:00 John S: Yeah, when I got to that place where I was realizing I was an atheist, I wasn’t sure if I was going to stay in AA or not, and how I was going to fit in. But after meeting all these people, I got more involved in AA than I’ve ever been, and more excited about it than I’ve ever been. I just love it. But the friendships that I made in Santa Monica, I still have to this day. In fact, one of those good friends, Doris, she’s our Chief Editor for AA Beyond Belief, and I work with her all the time. We’ve been friends since 2014 because of this, and I always make new friends at every conference, so it’s a lot of fun.

43:34 Dr. Baker: So John, let me ask you a question. At Tacoma, I noticed a delightful observation, and that was that there were a lot of people with more than 25 years, more than 20 years recovery at the conference, a huge number. And of the people that I listened who told their story, there was very frequently a common trajectory, that for them AA worked for a long time and they fit in. They thought they fit in for a long time, and then gradually, they became more aware as they… They sort of… Their recovery was so successful, they outgrew AA emotionally and spiritually. They ended up being very uncomfortable, and thank goodness, they found this and they got a new rejuvenation or a brand-new excitement about their recovery. Is that a common trajectory?

44:35 John S: I think it is. I think you have these two groups of people. You have the people like me, who, oh, they may have been religious, they may not have been religious, but whatever. They just kind of fell in line with the AA program and they learned the language of AA meetings, and they were very comfortable, until they started embracing their secular point of view and thinking about their program in a more secular way, and tried to express that at meetings—and you have what you already described as a kind of a growing rigidity within a lot of AA groups. We experienced a kind of a conflict.

45:11 John S: In my case, it started from reading some books by Richard Dawkins and Christopher Hitchens, and I think there’s been a growing awareness, in society as a whole, about a more secular view on life. So, maybe people in AA were reflecting what was going on in the general society. Yes, I think that is a fairly common experience. We got to this point where it’s like, “Wow, I can’t be who I am at my meeting. I’ve changed. I don’t feel this way anymore.” Then, you also have another group of people who have, their entire life, have always had this atheistic point of view and were comfortable with it, and never had to have that conflict. So, there’s a lot of diversity, but I think it’s fairly common, the experience of all of  realizing, “Wow, I’ve changed. I no longer can say these things that I used to say or believe.”

46:15 Dr. Baker: You know, in 30 years, well more than 30 years of clinical practice of addiction medicine, I think of the failures, the people who I saw who should have been able to make it into recovery who didn’t, and how many of them, when they came back for a reevaluation or a recheck visit said, “I just can’t handle all the religious stuff,” and made a decision based on that to not affiliate with any mutual support group. And because of that, they didn’t make it. I think if this movement grows and is more available, and people are aware that there’s a secular option, I think that we can be more useful to more people who are recovering from this disease.

47:00 John S: What a lot of people are learning now, is that those of us who stayed, we did so because we love AA, and that’s why we’re so involved with it, because we believe in it. So, as you described it earlier, this is a movement that is very much within Alcoholics Anonymous. We’re not some separate outside force. Pretty cool.

47:18 Dr. Baker: Pretty cool.


47:20 John S: Thank you very much for taking some time to speak with me for this podcast, that was a very generous and kind of you to do that, and it’s been a pleasure speaking with you this morning. I enjoyed your talk in Tacoma, and I look forward to meeting you in Toronto and listening to you speak there as well.

47:41 Dr. Baker: The pleasure has been mutual, thanks, John.


47:49 John S: Well, that concludes another episode of AA Beyond Belief, the podcast. Thank you for listening, everybody. I hope you enjoyed that conversation with Dr. Baker. I certainly learned a lot. We mentioned the International Conference of Secular AA, where he’ll be speaking this August. To learn more about that, visit the website secularaa.com. That’s secularaa.com.


Podcast Transcript in PDF

Addiction Medicine on Wikipedia

Canadian Centre on Substance Abuse and Addiction

Canada’s National Life in Recovery Survey

International Conference of Secular AA

Mental Health Issues and Recovery Panel at ICSAA in Austin

Doctor Baker’s Talk in Tacoma

If You Work It, It Works!, by Dr. Joseph Nowinski

Project MATCH

12-Step Facilitation Handbook

Cochrane Review

William White Interview with Dr. Rudolf Moos

Get the Facts on the Opioid Epidemic in Canada

Recovery Capital: A Primer for Medical Professionals, by William White, MA and Wiliam Cloud, PhD. 

Not God, by Ernest Kurtz

Bill W Biography by Robert Thomsen

AA Beyond Belief Article about Grapevine Issue for Atheists and Agnostics.

Faces and Voices of Recovery

AA Agnostica