A recovery community can foster military-like camaraderie

As my staff and I were discussing the launch of our new curriculum based on the 2001 television mini-series “Band of Brothers,” a co-worker of mine began musing about how many principles of the curriculum related back to his own experience. “I feel like my recovery really happened in my treatment dorm room every night after curfew—that’s where the real work was happening—talking to my roommates, getting real, getting clarity and figuring out what this whole recovery thing was about,” he said. “It was just us, being raw, wearing no masks, and not trying to impress staff.”

What mattered most when he remembers getting sober was his own Band of Brothers. As treatment professionals, we often make the mistake of overestimating our influence in the process of change. The people who have the most influence in an individual’s recovery process are most likely those who are in the trenches with them. But how can treatment professionals help create an environment to support those healthy bonds?

As we studied “Band of Brothers,” a 10-part HBO mini-series that chronicles the experiences of young men who served in the 101st Airborne Division of the U.S. Army during World War II, I couldn’t help but think of my grandfather. He never missed a reunion of his Navy crew that he served alongside in the Pacific during World War II. He loved those men until the day he died. He cherished those reunions. In honor of him, I am excited to reflect on what we can learn from “Band of Brothers,” and the military in general, in creating effective group cohesion.

In watching “Band of Brothers,” I was fascinated by how many parallels I saw to the recovery and treatment process. As the owner and clinical director of an extended-care program for young-adult men, I want to foster a brotherhood that changes the lives of each of our clients.

Preparing for battle: boot camp

In “Band of Brothers,” the first few episodes focus on boot camp and the preparation of each individual and the group as a whole. No one goes to war without rigorous and meticulous training. Bootcamp is unrelenting—and I propose that addiction treatment should be the same way (of course, within proper ethical boundaries and with unconditional positive regard for each client).

I believe that treatment can and should be one of the hardest things an individual will ever do. It’s not supposed to be fun or relaxing. You are challenging yourself in ways you never planned, getting vulnerable when you don’t want to, and diving into territory you would rather leave alone. In an article published in the Journal of Consulting Psychology, scientist Dael Wolfle outlined four basic principles of learning that are woven throughout military training protocols.(1) These principles encompass how and why treatment works:

1) Overlearning is useful. As a transitional-living provider, I often hear clients complain when they step down from residential treatment to outpatient or aftercare that “I just did all this for the last 30 days,” or “We are talking about all the same stuff they were at my treatment center.” My response? Yes. Exactly. When the paratroopers were dropped on D-Day, “Band of Brothers” depicts that all they could rely on was their training and following the plan they had gone over a million times. Even though half of them lost their weapons, they just kept moving, which is what they had been taught to do.

In early recovery, individuals won’t have all the accountability mechanisms available to them in the real world, such as a counselor on site seven days a week, or a required morning meditation group. But even if they don’t have everything they think they need, they usually have enough to keep moving. The role of the treatment professional is to remind, reinforce and encourage them to keep moving forward.

2) A skill is lost during periods without practice. When we do “relapse autopsies” with clients, it always traces back to when they quit practicing the disciplines and principles of recovery. There are no breaks in recovery—you’re either going backward or forward. Even after intense, deadly and exhausting battles, soldiers must keep training and must keep in fit condition for the next battle.

3) Training situations should be as much like real-life combat situations as possible. David Grossman, a former U.S. Army Ranger and West Point psychology professor, wrote On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace with former police officer Loren Christensen.(2) Grossman believes that training as realistically as possible is important, and that repeated drills and exercises allow the individual to act without thinking, as though they were on “autopilot.” Grossman makes a case for what he calls “pre-battle veterans,” or individuals who have gone through training that was sufficiently stressful to prepare them for real-life engagements. He believes training should not be over until the trainee has completed whatever goals indicate survival in the test, because in real-life encounters, it is life or death. Recovery also should be a constant “here and now” exercise in how individuals' actions and thoughts affect their real life, right now.

Should treatment always be a “safe place” for healing and rest, or should it be a training zone for real life? I by no means believe in militant and abusive treatment for addiction. But I’m also not sure that treatment is meant to be a safe incubator where the focus is always on comfort and safety. I believe treatment is meant to be a pressure cooker that is intentionally stressful, allowing conflict and discomfort in order to teach real-life coping skills and self-regulation.

4) Learning by doing—drills, drills, drills. Instead of talking about recovery and the 12 Steps, it is important to actually do the work in treatment. We learn by doing. Military training exercises are done repeatedly until everyone gets it right. This can be miserable, but it pays dividends in the long run. Recovery is the same way. Treatment isn’t about having a discharge plan with lots of good ideas. It’s about actually doing the work, practicing the disciplines, and taking the action, again and again until everyone gets it.

Most people don’t like being told what to do by people in authority, especially being told over and over, which each of the aforementioned principles requires. As a young therapist working with addicts in treatment, I had to learn very quickly to be OK with being disliked by the clients. Similar to the drill sergeant in boot camp, the staff is always the enemy. To the clients, it is always “us against them.” They gossip about us. They plot against us. They have uprisings. While this love/hate relationship requires an immense amount of mutual respect and trust to work, I have oddly enough come to appreciate this phenomenon as a key component to make the process work. By hating us, they begin to create necessary bonds among each other to develop healing and accountable relationships.

Creating the necessary bond

Studies on military effectiveness consistently point to the necessity of bonding among military personnel for successful outcomes in military operations. Likewise, research clearly has established the positive impact of social support and social networks in the recovery process from addiction.(3,4,5) Also, much writing has been done on the development of a kinship among military peers and individuals in early recovery who live together, where individuals create family-like relationships with peers.

The lasting bond that is created through painful, intense and vulnerable common experiences is necessary for growth and success. Common experiences, training, language, goals and outcomes foster these intimate relationships. We often ask our clients, “Which of these guys would you want in your foxhole?” Through this, you learn a lot about the relationships in the community.

Neurologist Foster Kennedy, MD, is quoted in the Big Book of Alcoholics Anonymous (AA) as saying, “This organization of Alcoholics Anonymous calls on two of the greatest reservoirs of power known to man, religion and that instinct for association with one's fellows … the 'herd instinct.' I think our profession must take appreciative cognizance of this great therapeutic weapon. If we do not do so, we shall stand convicted of emotional sterility and of having lost the faith that moves mountains, without which medicine can do little.”

The longer I work with drug addicts and alcoholics, the more convinced I become that Kennedy is right. Instead of relying so much on our professional know-how, we need to learn how to use this great therapeutic weapon. But how?

In an article in the journal Armed Forces & Society, Guy Siebold discusses the importance of the four types of group cohesion, which has a lot to do with the leadership of the group.(6) As this relates back to developing positive peer communities in recovery, I believe it is essential to understand how we as treatment professionals can foster the creation of all levels of cohesion:

1) Peer bonding. This describes the process of creating intimate personal bonds. Being in the trenches together, stuck in a foxhole together, grieving the lost together, helping the wounded. In “Band of Brothers,” the cohesion and bonding among the men was often depicted as deepening with every loss and shared trauma. Some of the deepest connections I have ever seen occur when the recovery community comes together to grieve over a loved friend who has lost the battle. As odd as it seems, sometimes shared pain is the best way to get a client engaged in treatment, which as we know is usually 90% of the battle.

2) Leader bonding. This describes the process of squad members bonding with their direct leader. This trusting bond is captured in “Band of Brothers” through the powerful character development of Major Winters, the first in command of the squad. He led by example, put himself on the line, knew his men and was willing to be one of them. They would have followed him anywhere, and they did. We should strive to facilitate this healthy bond with our direct-care staff at treatment centers—the house managers, the recovery techs, the counselors and even the drivers.

3) Organizational bonding. This describes the bonding with and loyalty to the military company and battalion. The overarching organization holds the charge of giving purpose and creating culture. Part of the experience of bonding among peers is having a sense of value and mission in what is taking place. Clients take pride in their treatment center, and their association as alumni can have great meaning.

4) Institutional bonding. This describes the relationship with the large institution of which one is a part. This institutional bonding is credited with creating a sense of purpose and meaning that is linked to the larger culture and society. As clients begin to embrace recovery and the 12-Step fellowship, they find a purpose and link that goes far beyond their treatment center, their staff or their treatment friends. They find a new identity with a sense of belonging to something larger. Exposure to this larger recovery community is something that is easy to incorporate into any treatment program.

The Big Book of AA says it best: “You are going to meet these new friends in your own community … Among them you will make lifelong friends. You will be bound to them with new and wonderful ties, for you will escape disaster together and you will commence shoulder to shoulder your common journey.”

In my experience, the peer community either can make or break the treatment experience for an individual. Communities that work have better outcomes—those that create their own Band of Brothers, hold each other accountable, take recovery seriously, lead by example, help their wounded, and have a common purpose. We as treatment professionals can influence that process by creating a foundation for connection and a safe environment to explore, train, and be challenged. Leading by example, creating an accountable environment and giving purpose is the framework by which professionals can influence the formation of a healthy recovery community.

Heidi Voet Smith is a Licensed Professional Counselor who, with her husband Michael, founded Chapter House Sober Living and Counseling Center in Dallas, a transitional-living program for young-adult men. She serves as Chapter House's clinical director.

References

1. Wolfle D. Military training and the useful parts of learning theory. J Consult Psychol 1946;10:73-5.

2. Grossman D, Christensen LW. On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace. Millstadt, Ill.: Warrior Science Publications; 2008.

3. Beattie MC, Longabaugh R. Interpersonal factors and post-treatment drinking and subjective wellbeing. Addiction 1997;92:1507-21.

4. Humphreys K, Mandowski ES, Moos RH, et al. Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Ann Behav Med 1999;21:54-60.

5. Longabaugh R, Wirtz P, Beattie MC, et al. Matching treatment focus to patient social investment and support: 18-month follow-up results. J Consult Clin Psychol 1995;63:296-307.

6. Siebold GL. The essence of military group cohesion. Armed Forces Soc 2007;33:286-95.