D:   Would you tell the readers about Muscala Chemical Health Clinic.

B:   I think that what I would say about what I've tried to do for the last 20 years since opening the clinic is that - it may sound strange but I think it's a place where we try to be able to have fun. It may sound weird - "Why are you trying to have fun? This is a very serious problem - people having addiction difficulties that are creating a lot of trauma and havoc to themselves and to other people." It is very tragic, and it is very serious; but one of the things we try to do there is to maybe learn how to be intoxicated, how to have fun, how to be light in your shoes and not so heavy in your heart - and be able to do so without having to consume alcohol or other drugs.

   That's a lot of what one of my teachers taught me, who was a great man from the University of Minnesota by the name of Dr. John Brantner. In his career at the University of Minnesota, Brantner was a psychologist and was the most often-requested speaker from the University of Minnesota in the 1970's. He wrote a couple of articles and used to do a presentation called, "The Psychology of Intoxication". He gave that lecture probably 200 times, and I made the only 16 mm film and videotape of it before his death. [He said] a lot of the problem - and I think this is true - is that people have forgotten how to have fun, how to be able to be disinhibited, forgotten how to be able to experience love and warmth and intimacy other than through the mechanism of the use of some kind of substance which gets them there. It's almost like the key which lets Alice get down into the underworld, if you will, in Alice in Wonderland.

   Whether you're looking for God or looking for love or looking for peace or looking for relaxation or looking for excitement, if you realize that you know how to do that already and knew how to do it as a kid in a fashion that didn't require you to use alcohol and other drugs, then I think you have a chance of being well. It may be a funny answer to the question, but I think maybe - at the clinic - one of the things we try to be able to do is to be able to remember how much of a nut case, an idiot, you can be - and be able to do so without use of any of the substances whatsoever.

   As the leader of this group of nut cases apparently, I have the greatest responsibility to try to be as much kidding around as possible because I can be very, very serious - way too serious, way too Norwegian, way to Catholic, much too stoic, and I think that's a breeding ground for use of intoxicants.

   Maybe [our way at the clinic] is best described as: we are helping fifty individuals and families try to find a solution to their particular problem, and we pride ourselves on focusing on one client at a time, not trying to put everybody together in a group - we don't even have the same standard for each client. For example, one client told me last week, "You know, Bob, I can tell that I've changed because a year ago when I wouldn't have shown up for my sessions I wouldn't even have thought about it; now, this year, when I don't show up I feel bad." It means he's actually developing a conscience. He's got a ways to go here to be able to have better chemical health, but the standard we use for him is not the same standard we might use for a 17-year old who is periodically using marijuana or the 56-year old who's been hiding his use of alcohol from his spouse for the last 15 years. I think it's exciting to be able to help each one of these individual people find a solution to their problems.

D:   Does the clinic offer services to individuals who complain of other addictions Ð non-chemical addictions?

B:   We do, but we don't advertise it very much. We're not advertising ourselves as an addictive behaviors clinic or a clinic that deals with all addictions. I think I have a fondness for the terminology of "chemical health", and I was the first one to use that terminology back in 1975 and coined the term; and I have a particular interest in chemical health problems. I would say that some chemical health problems have an addiction component to them, but some of them simply have kind of a lack of an ability to be your own person and stand separate, and apart from the peer group, phenomenon.

   In terms of other addictions, I think that there are things that interest me from time to time, so you might have kind of a Special of the Month or Special of the Year award. This year, we're probably specializing in trying to help people who are addicted to feeling bad or people who are generally addicted to behaving badly as a way of being able to draw attention to themselves. I think that all of us have some of that in us; some people have more of it than others. I've got some clients who have been severely depressed and really miserable for a lot of years, and you can give them medications which will help them feel better, then they will stop taking their medications after about 7 or 8 months and go back in the toilet again and start complaining and moaning and staying in bed and indicating they can't hold a job, etc. So everybody in the family has to pay attention to them again. How do you explain that other than, "I kind of prefer to be miserable, I kind of prefer the attention I get when I'm miserable."

   A few years ago, we had kind of a special going on - not because we were out soliciting business but because we had two people approach us indicating they were addicted to lying. I had not had anyone approach me since about 1989 or 1990 indicating that they had that problem. Two people came at that time, so we took them on as clients. I think we made some improvements in their situations, but I don't think we did as well as we do in regard to chemical health problems because that's our specialty.

D:   As a preface to this interview, we were discussiong that there are two solutions to addiction - moderation or abstinence. Are there strategies out there that don't frown on "moderation" as a goal or a possibility?

B:   I think there are organizations like Rational Recovery [RR] which understand that there is a huge difference between those people who would be considered to be "alcohol dependent" and those people who are "problem drinkers". So, Rational Recovery says: "If you're not ready to be able to quit drinking, you might want to try Moderation Methods, maybe some organizations like Bill Miller from the University of New Mexico at Albuquerque, Audrey Kishlein, or people like Martha Sanchez Craig at the Addiction Research Foundation in Toronto who have come up with methods to be able to help people moderate their drinking." Somebody like Jack Trimpey [of RR]Ð and Rational Recovery is very much an abstinence-based organization Ð sees the value of trying to be able to help all people with all chemical health problems.

   That's one of the primary complaints I have with the AA community, that they really don't seem to be very interested in the rest of the people that have chemical health problems. They are only interested in those people who fit their viewpoint of what an alcoholic is, and that person should be able to agree to the following steps and have the following kinds of personality characteristics. And if you don't fit those AA characteristics, it's not that you need a different program - AA generally tends to say to people, "Obviously, you haven't experienced enough pain yet, so why don't you go home and screw up a little bit more for a longer time period and then maybe you'll be willing to come back to our program". I think that's a really unethical and terrible black mark on the heart and soul of many treatment programs, as well as AA.

   Rational Recovery, I think, is responsive. You've got Seculars on Sobriety that also understand that there also is a need for having the moderation program available for some people, not necessarily for the folks that belong to their organization. With the exception of the real strong disease concept kind of AA fanatical believers, I think most of the people that work in this field recognize there are ten times more problem drinkers than there are alcoholics or alcohol-dependent types. There should be 10 clinics that have Moderation Methods available for every 1 clinic that has abstinence available if you're really going to help the 10-15 million people that ostensibly have chemical problems in this country.

D:   What is the disease concept?

B:   As best as I know it - and I'm certainly not a spokesperson for the disease concept - I think there are several different conceptualizations of what the "disease" is. Locally, and maybe historically and conventionally, what you have is the notion that once somebody becomes . . . crosses that line between a social drinker and an alcoholic, they have permanently changed their physical chemistry so that they can never go back to being a social drinker again; and that this is the disease of 'alcoholism', that they now have incited inside of their bodies. I think that's one interpretation.

   Some other people believe that there is actually a genetic - not just a predisposition, but almost "I was born to be alcoholic, I was born to be alcohol-dependent. From the very first time that I drank, something peculiar happened, and I realized that I was not a normal drinker right from the very first time."

   I don't deny that some people have these experiences, but I think that the generalization that, because some people have had these experiences, therefore all people who have chemical problems have either had this experience or are in denial is kind of silly. I think that some people's problems can be far more physical in nature. I have clients who have clear allergies to some of these drugs, and at the use of very small amounts of alcohol or marijuana, their behavior changes in ways that are very peculiar. These people are not normal in the way that they react to these substances.

   We might say, to a certain extent, that women have a 'disease', or have a condition anyway, that renders them less capable of drinking than men are. We that there is actually an enzyme in the stomach that women tend to not have very much of and men have a lot of, and this (enzyme) is what allows most men to be able to drink more than women can and which makes women sensitive. We don't say that therefore women have a 'disease' that causes them to develop some kind of a problem; we say that they have a condition that they need to take into account. So, I think that, instead of the "disease concept", I'd be more of a fan of the "conditions" concept.

D:   Are there pharmacological solutions to alcohol and opiate addictions.

B:   There is an increasing effort to try to find good ones. You have to remember that Ð and IÕm a registered nurse by training Ð nurses and doctors have not particularly done a very good job historically of being able to help people with drug addictions. Even Florence Nightingale, who is one of my favorite role models, was guilty of one of the first American pharmacological treatments for morphine addiction. There were lot of Civil War soldiers that came out of the Civil War who became morphine addicts because of all the morphine they needed to take for their tremendous wounds. So they had to come up with a solution, and they came up with a new drug and called the drug heroin. It got the name heroin because it was to be like a hero or heroine and was going to save the soldiers. That was a pharmacological treatment for morphine addiction, but it had a lot of other side effects associated with it.

   We have Zyban, which is nothing other than Welbutrin, an antidepressant being used to help people stop smoking, and it works for some people, and we don't know why.

   The drug, Naltrexone, helps to block Ð for some people Ð the alcohol high. So if my parents wanted to stop me from getting high on alcohol, they could put Naltrexone in my Cream of Wheat in the morning or something and I could drink alcohol but I'd never feel intoxicated from it, so therefore I wouldn't find it attractive. At least, that's the way the argument goes.

   You have a drug like Antabuse (or disulfiram), which some clients use with tremendous success - and it's actually enjoying a renewed popularity, I would say. If I'm not able to control my compulsions and attraction to alcohol, I could take a drug like Antabuse which will help me avoid it because, if I drink, I'm going to get deathly ill. I have clients who use Antabuse as a way to help them sustain long-term abstinence, and it works wonderfully for them.

   I think there are other drugs like these, and there are pharmacological treatments that people can use.

D:   Let's talk about self-help that's not pharmacological - such as RR, Women for Sobriety?

B:   The terminology of "self-help" confuses me a little, so I've tried to be able to un-confuse myself by maybe coming up with another way of looking at it. A lot of people have said that AA is a self-help program, and that's not true - you're being helped by other people who are in this program; you're actually being helped by the program, if you will. Self-help in maybe its most virgin form would be those things or those ideas I come up with myself to try to change my own behavior - ideas I came up with myself. If I get an idea from another person, that's not self-help any more, that's help from another person. Whether that's from my mom or my dad or my brother or my friend or somebody in AA or a counselor, it's "other" help. If I read a book that gives me some ideas, is that self-help or is that book help? I think they call it biblio-therapy in the mental health field, so maybe even using a book is not actually self help.

   Things that may be more like self-help might be: if you go on the internet and search around there to try and find things yourself, you primarily are doing it yourself; these are resources that are out there. If you are reading a book, you're the one who is reading the book - the book isn't reading itself to you, so you're primarily having to that yourself. I would differentiate those things from Rational Recovery, Moderation Methods, AA, Seculars on Sobriety. These are more the volunteer help organizations, "other" help organizations.

D:   As opposed to professional?

B:   Professional help would be if you went in and paid for assistance. AA might be classified more as a volunteer group-oriented or peer-oriented help program. All of these things have demonstrated their success for some people. All of them have demonstrated that they are worthless for most people. Just like any book. Someone can say: "Well, I used that book", or "I used Zyban, and it really helped me a lot." There are going to be more people who are not helped by Zyban than are actually helped by Zyban. There are going to be more people who are not helped by AA than who are helped by AA. There are more people that are not helped by Rational Recovery than are actually helped by them.

   So my thought is that we should have like Old Country Buffet! Just lay out all these different options, and people can kind of sample them. If you like it, you can come back and have some more. If you want to come back next Tuesday night, you can have the macaroni and cheese again or the Rational Recovery version of cole slaw. If you lay out all the options for people and educate them about them and teach them how to be a good consumer, that doesn't mean they are necessarily going to make the 'right' choice right away, but they're going to know that they don't have to stick with that choice if it doesn't work for them and that they can switch gears and go in another direction.

   Because of the increasing number of options, I think it's becoming harder and harder to become a consumer; it's not like we just have one Model T Ford - which is what AA has been for many, many years - one car that everybody in the United States drove. Now, there's Dodge, Plymouth, Chrysler, Lincoln, foreign imports coming in. Oh my goodness, now it's going to become very confusing about what to be able to drive. All of these are very good vehicles but I, myself, don't like many of them, and I prefer my own. I think it will be that way in the chemical health area.

D:   Is there compatibility or will one approach nullify another?

B:   I don't think any of these approaches is going to nullify another. I think we're going to see an accumulation of options. I think some of them will go out of style after a while. You have to remember that the alcohol and drug field, the addictions field in general, is the newest field of health care. Its sister field, the mental health field, is about fifty to sixty years older at least, maybe even older than that. We're going to come up with things, I'm sure, in the 21st Century that are going to make some of the techniques that we're using now laughable - like heroin for morphine, if you will. I'm sure we'll continue to make mistakes in the 21st Century. Will there ever be a perfect solution that will eliminate addiction? Not a chance; not a prayer; not any more than Prozak is going to eliminate all mental health problems. Prozak has helped a great deal, as have all advances in the mental health field, but there are always going to be mental health problems, and there are always going to be chemical health problems.

D:   Would you like to explain any particular program or philosophy such as Twelve Step, Rational Recovery or SOS? Do they all adhere to the disease concept, meeting attendance, support.

B:   I'm certainly not the best spokesperson for Alcoholics Anonymous, and I've spent my whole career trying to come up with alternatives to AA and the way that they approach people. I think somebody from their organization could do a much better job of explaining their fine program than I could. I'm more interested in the development of additions to, and alternatives to, AA. Not all the alternatives are available in Minnesota, unfortunately. Minnesota is kind of addicted to AA; the Court systems are pretty addicted to it, a lot of the schools are certainly, and so are the health care systems addicted to it - even the HMO's. When I had a chance to contact the director of the alcohol and drug programs inside Group Health, now known as HealthPartners, and said "We brought Rational Recovery to Minnesota in 1991 and would like to see Group Health be one of the sponsors of this program", they flatly turned it down and indicated they didn't have "enough time". They certainly have plenty of time to sponsor all kinds of Alcoholics Anonymous-based programs but didn't seem to have enough time to be able to offer Rational Recovery.

   The VA Hospital in Minneapolis was really the only organization that came forward to say they were willing and able to sponsor a Rational Recovery program, and were willing to stand behind it and thought it was something that should be made available to their patients and for the community in general.

   You've got Rational Recovery; you've got Women for Sobriety; Moderation Methods. Those are the principle philosophies available as alternative-to-AA philosophy, not only from a self-help and reading standpoint (there are books to back up every one of these things - a tremendous amount of books if you're willing to investigate it on your own and do the homework, you can learn a lot).

   From the Rational Recovery standpoint (and RR is an abstinence-based organization; they believe abstinence is best), the basic differences would be: they focus on people who are alcohol-dependent; they don't serve people who are alcohol abusers or problem drinkers but want to be able to help the person who is plagued with an alcohol-dependence, an alcohol-addiction problem. They are a much more humanist and secular organization. Alcoholics Anonymous has been criticized for many years as being far too Fundamentalist and Christian in orientation. Even in their programs, you have to be able to acknowledge that you are powerless over alcohol and that you're willing to turn your life and will over to the Power of God as you understand Him.

   There are a lot of people whose problems are not so severe that they are willing to turn their life and will over to the power of God as they understand. I'm a Catholic by tradition and I'm actually offended by that part of the AA program. The Catholic God in the way that I was raised wouldn't want responsibility for my life and will; He's far too busy with other things like making sure the hungry in Ethiopia are having a chance to be able to eat - if He is doing anything whatsoever. It's my job to be able to live my life as best I can, and if, at the end, I did it in a good way, I go to heaven; if I didn't, I guess we know where I'm going in that point in time. But He's not going to accept responsibility for my life and will.

   So Rational Recovery basically says, "You have the obligation to be able to make these changes. You can rely on all kinds of help: if you want to use God as part of your own program, that's great, but it's not a requirement here; if you want to be able to have your wife join you in meetings here, come along - she doesn't have to go to a special Alanon meeting; she can come right here to the Rational Recovery meeting with you. We're going to show you some techniques by which you can manage your addiction rather than have your addiction manage you."

   This would be viewed as heresy in the Alcoholics Anonymous community - they have a different approach, a different idea about things. In Rational Recovery, the notion of developing a stronger and stronger commitment to abstinence, developing a bigger plan for abstinence, being able to understand that the voice inside your head that kind of asks you to go out and buy drinks or have some drinks is not really you; that's the addiction you've created inside of yourself. It's not a disease; you've actually created a need inside yourself, like you might have a "need" for food or "need" for sex or "need" for money. That's why this thing keeps barking at you all the time, and you've gotta find some way to manage that need in a different way. It's a different philosophy and different orientation.

   Women for Sobriety - you have to give their organization maximum credit because this is really the first organization that stood up - not only locally but nationwide - to AA and said basically, "To hell with you! We're going to do our own thing; we don't want to have to believe any of the stuff you've got there - we're going to come up with our own ideas, and we'll be just fine, thank you very much." It's a group of very, very strong, independently-minded women under the organization and tutoring of Jean Kirkpatrick, who's their founder from the East Coast. They came up with a program that's more positive in its orientation, more self-affirming, much more focused on the belief system that, to be able to help a woman overcome an addiction, you don't tear her down and call her an "alcoholic".

   In the beginning of an AA meeting, I might say: "Hi, my name is Bobby, and I'm an alcoholic." In a Women for Sobriety meeting, you get up and say: "Hi, my name is Bobby, and I'm a very competent person; and I'm going to use my competencies and my desire and zest for life as a way to be able to put this addiction behind me; I'm going to capitalize on my strengths; I'm not going to worry about confessing my weaknesses on a regular basis", which is more of an AA concept, i.e., "Get over your weaknesses." In Women for Sobriety, I think it's more, "Discover what your strengths are in this regard."

   A lot of other people have picked up on that theme, people like Stan Peele with his own "Life Process" program, which are kind of strength-oriented program in that regard.

   Women for Sobriety is an abstinence-based program, but I think in Rational Recovery and Women for Sobriety, you see greater openness to chemotherapies [pharmaco-]. Do you realize there are some people who go to AA meetings, including some clients of mine, who are afraid to say that they're taking antidepressants because they're going to be ridiculed by the group or by their sponsor in some way as being "kind of on drugs." This is so out of line with current scientific thinking that somebody ought to go in and kick butt with regards to those AA groups because they are actually keeping some people seriously depressed by contending that these drugs are not in their best interest.

   In Women for Sobriety, I don't think you'd see that. I think those people are genuinely much more in tune with the scientific literature, with the here and now. AA adheres itself to traditions and hasn't changed for forty or fifty years, and it doesn't intend to change. Women for Sobriety is going to always change; and I think the same is true for Rational Recovery.

   WFS and RR are abstinence-based organizations, but they are more tolerant of the differences among people, and they understand the differences between people. They're not trying to make everybody into the same alcoholic. AA seems to have a need to be able to have everybody adopt the same personality characteristics as the two guys who were founders of their organization.

D:   Is SMART Recovery similar to either of those?

B:   SMART Recovery is a very interesting alternative to AA. I don't know that I would ever have seen this in my lifetime - I felt as lonely as the Maytag repair man back in 1979, sitting in my office with some good ideas but nobody was calling - but I am pleased to say that now AA alternatives are so popular that there are even alternatives to AA alternatives - the AA alternatives are sprouting alternatives to each other. SMART Recovery is a break-off of Rational Recovery. Some people, who are clinicians in the community and don't like my particular way of being able to do things, will go out and do things in a little different fashion because they don't think things should be done entirely the way that Bob Muscala does them. Good! I think there should be a thousand alternatives to Bob Muscala, but with an open mind about things.

   SMART Recovery is basically a group of psychologists that are trying to bring good psychological materials to people with chemical health problems. They're basically saying: "We think the reason that you have a drinking problem is that you've been using this as a way to cover up or medicate some kind of anxiety, difficulty or self-consciousness you've got, or irrational beliefs about how the world should operate. We think you're unnecessarily agitating yourself and other people and, therefore, are creating situations where you need something to calm you down. So, we're going to show you some ways to be able to abstain; once you do that, we're going to show you some ways to be able to change your belief systems so you're not so agitated all the time." They use a lot of Albert Ellis's materials on Rational Emotive Therapy, and they are very, very effective at being able to teach these things.

   In SMART Recovery, you find a group of people who maybe would say: "These clients really had more of a mental health problem and then developed a "chemical health" problem because of it." Instead of jamming them all into AA or RR or MM, let's put them in a SMART Group where they probably will relate to each other better and probably feel more kinship with one another." I think that's one of the beauties of the diversification that's going on out there.

   SMART is also an abstinence-based program but also very tolerant of moderation and obviously very tolerant of medication, properly used, from a mental health standpoint because their primary audience is comprised of those people who also have co-existing mental health problems for the most part or could identify them as such.

   In the Moderation Methods area, you really have people who are not ready for the extreme treatment of abstinence; they're not ready for the extreme treatment of identifying themselves as "addicts" or "alcoholics" or "alcohol-dependent". They might be able and willing to describe themselves as a "problem drinker" or a "problem user" and would like to have some ways to modify their behavior so they're not creating so many problems for themselves and other people.

   There are tried and true, scientific principles about how to be able to moderate your behavior so you get it down into a range where you're not irritating you health, irritating your spouse, irritating your children. They'll show you the path to be able to make that happen.

D:   Do you believe in Recovery Group Disorders - pathology from being in a recovery group, as does Jack Trimpey?

B:   I think the best book on the subject is one that you can't even buy any longer unfortunately. It's called The Co-dependency Conspiracy, written by Dr. Stan Katz. It came about 1991. He basically came to the conclusion, and I agree with him - that Alanon and Alateen and Alatot and Alafamilies and Families Anonymous and Ala-lalalala, whatever it is, is really teaching a terribly kind of victimization philosophy and mentality to people. That is, that your problem is that you care too much about other people. Maybe the problem isn't that you care too much about the people; maybe the problem is that the other people don't reciprocate enough; maybe you should ask for a little bit more in return.

   Any time you get a recovery group that starts to take on kind of a "cultish" format - and Alanon certainly has, and I think AA has - there are so many people in that organization who don't belong there and are really inappropriately there out of loneliness, out of the sensation of not belonging in the community and are just trying to find some place for themselves that they start to develop problems where they didn't have them before to be able to fit in [to the group]. I think that's a kind of Recovery Group Disorder that you can develop.

   Another kind of Recovery Group Disorder is É the conventional treatment idea, which was that "You will never be able to recover from your problem; you will always have this addiction, and the best you can do is be able to keep it arrested by constantly being involved inside an AA group." There are a lot of people who left AA and said, "BS - I'm not doing this for the rest of my life, and I've actually changed completely and I have recovered." That was so controversial! In the general community, AA-ers pretend that those folks don't even exist!

   I think AA might make fun of those folks, saying: "They left too early" or "They're kind of digging their own grave", setting them up for failure, when they don't really need to do that.

   I think Jack Trimpey in his own way is creating a Recovery Group Disorder too. I believe that he's creating an elite group of people in recovery who can easily change and easily sustain their change and don't need any kind of support group. I think he's contending that everybody should be that way. That's ridiculous. There are some people who love the Rational Recovery philosophy who may, in fact, need to be in an RR group on a continuing basis for the rest of their lives. Why do we have to belittle each other because "You're not recovering in exactly the right way" or "You're not doing it the way that I did it" or "I'm not doing it the way that you did it"? It's like having discussions about the Middle East - you're not being a proper Palestinian, and I'm not being a proper Jew. For God's sake, let's just stop the chaos and noise here. There is no One Correct Way to be for everybody. There's a good way for you to be; there's a good way for me to be. Maybe I know what that is; maybe you know what yours is. If you've been able to achieve that, I want to be able to hear about it, but I'm not necessarily going to adopt that as a lifestyle, nor am I going to adopt that as a standard for the next 15 people I meet. I'm not looking for the New Messiah in the chemical health area. I believe everybody changes differently. When you get to be too much of a scientologist and start to think the entire world revolves around Ron Hubbard or Jack Trimpey or Bob Muscala or the founders of AA, I think that's the worst Recovery Group Disorder you could have.

D:   How can viewers contact your Clinic?

B:   If people want to call us, the number is (952) 920-1351. We are around to answer the phone lines between 10:00 a.m. and 6:00p.m. Monday through Friday. Our interest is trying to make sure peopleget to the right place. We often don't have openings for new clientsinside the Clinic - we're very popular and packed most of the time - butwe will give you names and telephone numbers and addresses of othergroups. You're welcome to come to our Clinic in Edina any time and lookthrough our library of materials at no charge; you can sit down inside aluxurious reading room and read to your heart's content and learn aboutthese things to decide if you want to buy any of the books. You don'thave to buy them from us, you can order them from bookstores. We do ourbest to help get you directed to the right place.