Take It Easy

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From Failure to Enthusiasm

Guest Post

By Andy

"Success is walking from failure to failure with no loss of enthusiasm." —Winston Churchill

One of the reasons I love this quote, is because for many of us, being able to keep our enthusiasm up in the midst of trying times can be very difficult to achieve. But once you figure out how to never lose it, no matter how hard life can get, it will mark the difference between giving up and succeeding. I love this quote and remind myself every time that sobriety success is shaped by my attitude. In this post I’m going to take you through my personal sobriety journey.

The Addict/Alcoholic

When I was 4 years old my parents made the life changing decision of moving from Colombia to California. It was 1986 and the situation in my country was scary and very violent. Upon arrival in California my parents took on many jobs to be able to provide for me and my siblings; they worked really hard to make sure we would have a life full of opportunities.

The great thing about latinos is that culturally not only are we very hard working people, but we are also very happy people who love to party. And of course, no Colombian party is ever complete without that anise-flavored drink called Aguardiente. Not that all Colombian’s are drunks, it’s just simply something they enjoy once in awhile, when there’s a good excuse to celebrate.
The first time I got drunk was at a family friend’s house party when I was nine years old. I was always a pretty mischievous kid, therefore at the party my cousin and I played a game to see who could steal more shots of aguardiente without getting caught.

After a few shots I was feeling very different inside. I felt comfortable, more secure, I danced salsa with my sister and all my cousins, I felt great. From that night on I drank every time I had the chance.
At 15 a friend introduced me to marijuana. Although today teen drug use is declining, back when I was a teenager the statistic was increasing and at 19 I attended a party and some guys introduced me to meth and so began the downward spiral. At 23 I found myself incarcerated in Idaho on drug related charges for two years.

You might be wondering why I left so many parts of the story untold. Well, I’m not writing this to reminisce on war stories, being eight years sober now I believe myself to be a bit wiser and truth be told, a little tired of recounting my crazy times. Jail in Idaho was the starting point of my recovery, and that is the part of THIS story I really want share.

AA and NA

When you are in prison, any activity that can take you out of your cell is welcomed with open arms. So when I was told that I could attend the Alcoholics Anonymous meetings I did not hesitate. At the time I was not interested in recovery, in fact, I thought I didn't have a drinking problem or substance abuse problem. I just needed to do something else than read in bed. So I attended meetings without participating. It took three months of going to these meetings to realize that I might have a slight drinking and drug problem.

One day, a fellow inmate told the story of how he hit rock bottom. He was a high level accountant abusing drugs in order to deal with the insane amount of work and stress at his job, until one day, having suicidal thoughts, he got drunk and drove his car into a local store. He lost his job, his wife filed for divorce, his family had lost hope (this wasn’t his first run in with the law). He shared that apart from coming to terms with his drug and alcohol problems he had also realized that he also had an anger management problem, he concluded that “rage spawns from anger, anger spawns from hurt, hurt spawns from getting your feelings hurt.”

Like I said before, I thought I didn't have a problem. I was convinced that I was fine, that I wasn’t hurting anyone. But thanks to that inmate sharing his story and his realization my eyes were opened: I had hurt the only person I had to live with for the rest of my life and the damage I had done to myself needed to be repaired. I had a drinking problem, a drug problem, a personality problem...a life problem.

The Workaholic

Prison was everything but easy, but attending the AA and NA meetings and the friendships I built helped me get through it. Once I was released I had a new sense of responsibility, I knew I needed to find a job, and be able to provide for myself. But it wasn't easy. Having a criminal record made it a challenge to find a good job, so I struggled for months. And when I finally found one, I was unmotivated and feeling trapped in a routine. Despite attending my AA and NA meetings on a regular basis, I relapsed. I lost my job and life seemed unbearable, hence my voluntary check in to a rehab center in Idaho.

After 3 months in rehab I moved back to California where I landed a job selling knock-off cologne. Being closer to my family helped me immensely, therefore my motivation was higher than ever. I would wake up at 5:00 am to pick-up my co-workers and go to gas stations, shopping center parking lots, flea markets, etc. to sell perfume out of the trunk of my car. After a few months I had become very good at selling. I had learned how to approach strangers, how to pitch my product, make people feel comfortable and how to overcome rejection. The job was purely commission based, thus if I didn’t sell, I didn’t make money. There is a great feeling about making cash on a sale that I cannot really describe. It is a feeling of accomplishment, it is a feeling that I wanted to replicate time and time again. I was determined to keep working harder and harder.

Months went by and next thing I knew I was training more than 10 people to sell perfumes and other beauty products on the street. I had my own office, had ads running in the paper, had a secretary taking calls, etc. In that year I had lost ten pounds, I had zero friends, and I barely saw my family.

After a long conversation with a friend he presented me with a book by Jeffery Combs called Psychologically Unemployable (Jeffery is also a recovering addict). One of the most important things said is that you should never confuse obsession with passion. After reading it and studying it for a few weeks, I understood that I had simply traded drugs and alcohol for work. It was an addiction and it wasn't any better. I was getting physically sick and emotionally unstable from the pressure I was putting on myself.

The Entrepreneur

I sold my perfume business and moved into my parents house. It was really important in my road to recovery to have their support. After a month I got a job at Target, so I could help my parents pay the bills and have some sort of income. I had no passion for that job whatsoever, and I was completely unmotivated in that point of my life. I couldn't find balance between success and a healthy, happy life. Being afraid of relapsing I started attending weekly AA/NA meetings. I acquired a really good sponsor that I am very grateful for. He gave me the task of taking a class at the local community college.

At the time I was not very happy to do the task. I felt old and I thought there was no point in taking a measly course. I just wanted to go to work, do my job and pay my bills, that was it. Nevertheless, I forced myself to take a class. The class I took was called Introduction to Website Development (HTML). I liked computers and websites, so I thought, why not give it a shot?

You should have seen my bedroom after three months in the class. I had stacks of books and papers about HTML and website design. I found myself at the computer for hours, coding, creating, learning. Finally, one day I thought to myself that it would be great if I could make a business out of my new acquired skill.

Nine years later I co-own a successful digital marketing agency. I have a great team that I feel are like my family, in fact, my brother is part of it. We are based in Medellin, Colombia, which means my life has taken a 180 degree turn. 30 years ago my parents left Colombia to give my siblings and I a better life, now I am back with that better life.

I still go to meeting and try to keep in touch with some of the good friends I made on my way to recovery. We always give each other support during rough times. Being sober has become a part of my life now. My attitude defines me and I do not let anything take control of my emotions, it only gets easier with time. I have learned to attend dinner parties and skip the wine; to dance with my colombian friends and kindly decline those beers and still enjoy myself. In regards to my business, I didn't let myself get lost while pursuing success. I have learned that balance is what makes you successful. Being able to work hard for months enjoying what you do, but also taking a weekend off to recharge has proven to be a critical part of my work-life balance. I feel very fortunate because I went out and found something I was passionate about, put my skills and knowledge to work and built a business. Sobriety, just like building a business, does not happen overnight, one has to commit to it and work hard.

It’s Not All About You

When you are in the process of recovering, every single thing you do to maintain your sobriety seems to be about you. Every one of the 12 steps you complete, every single task or piece of homework your sponsor gives you, every book or article you read is all about you and your recovery. But after a while you realize, there's a bigger picture. And going back to that Winston Churchill quote, "Success is walking from failure to failure with no loss of enthusiasm," learning that failing is just a part of the process. Behind the most successful people are years of failure, even if it's on their way to sobriety or on their way to being a successful entrepreneur. The issue is not failing, since we all will go through it, it's to never lose enthusiasm. Good luck and thank you for reading my story.

Graphics: https://pocketperspectives.com

Hazelden Offers Companion to the “Big Book”

New guide attempts a modest AA update.

The founders of AA published their book, Alcoholics Anonymous (The Big Book) back in 1939. The world has changed a great deal since then, so it’s not surprising that there have been periodic calls for an update. Barring an official revision, which is unlikely, Hazelden, the Minnesota treatment organization, has published an updated companion volume to the Big Book. (Narcotics Anonymous published their version of the basic text in 1962). “The core principles and practices offered in these basic texts hold strong today,” says Hazelden, “but addiction science and societal norms have changed dramatically since these books were first published decades ago.”

Hazelden’s book, Recovery Now, billed as an easy-to-follow guide to the teachings of Alcoholics Anonymous and Narcotics Anonymous, dispenses with the divisive question of medications for withdrawal straightaway. In a foreword by Dr. Marvin D. Seppala, chief medical officer at Hazelden, the doctor makes it clear: “I agree with the majority of treatment professionals who support using these meds to help with cravings when it is appropriate to do so. Addiction is a disease that calls for the best that science has to offer.” The unnamed authors of the “little green book” agree, stating that “for some mental health disorders, medications such as antidepressants are needed. These aren’t addictive chemicals and so professionals, as well as AA and NA, accept that we can take them and still be considered clean and sober (abstinent).” There are now, as well, specific Twelve Step groups for those with both addiction disorders and mental health disorders: Dual Diagnosis Anonymous and Dual Recovery Anonymous among them.

As Seppala points out in the foreword, when some alcoholics and other drug addicts hear about the research showing that addiction is similar to many other mental and physical disorders we call diseases, it reorients their thinking amid the shame, stigma, and negative emotional states associated with active addiction. For some, it opens the door to treatment.

Okay. Hazelden, Betty Ford, and many other major treatment providers are no longer fighting a rear-guard action against a host of medications, from buprenorphine to Zoloft. But two-thirds of the Big Book consists of stories of how people recognized and dealt with their sundry addictions. That’s really about it, which tracks well with AA’s core operating principle: one drunk helping another. AA believes that much of its success stems from the fact that the program is run by the members, without direct rule setting and intervention from organizations, including their own. (All statements hold for NA as well).

What else? Recovery Now takes on another sticking point for many: the fact that “the AA Big Book and other writings include traditional male-focused and religious language, like discussing God as a ‘he.’” And there is the matter of “the realities and stereotypes of the 1930s, which is why it contains a chapter titled ‘To the Wives.’” Hazelden continues the recent tradition of broadening acceptable interpretations of “higher power.” One example given is from Samantha, a young cocaine and alcohol addict: “My higher power is the energy of this group. I call her Zelda.”

The book presents some of the psychological aspects of the AA program as a sort of reverse cognitive behavioral therapy. CBT attempts to teach people how to unkink their thinking and turn harmful thoughts into helpful ones. AA attempts to convince people to first change their behavior—“fake it until you make it”—and helpful thoughts will follow.

Perhaps the genuine sea change lies in this passage, which can be contrasted with the faith and certainty with which the Big Book proclaims that AA will work for all but the most stubbornly self-centered. Even with the myriad of choices of AA groups now available, Hazelden acknowledges that “a group based on the Twelve Steps doesn’t work for all of us. Some of us have found help in recovery groups that offer alternatives to the Twelve Steps, such as SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.”  This is a change of heart, given that groups like SMART Recovery don’t necessarily buy the idea of total abstinence, and often structure recovery as an exercise in controlled drinking. Hazelden also suggests that many of “us” have found the necessary ongoing support for recovery at churches, mental health centers, and nonreligious peer support groups.

As for anonymity, Recovery Now states: “While Twelve Step members do not reveal anything about another member of the group, any one of us may choose to go public with our own story.” Another promising development is the proliferation of Twelve Step meetings catering to specific populations—AA meetings for African Americans, Latinos, Native Americans, women, seniors, gays, and drug-specific (Cocaine Anonymous).

In the end, one of the best arguments for attendance at the AA program (free of charge) is that many addicts have “worn out our welcome” with families and friends, “and they have a hard time putting all that behind them and supporting us completely. But at most Twelve Step recovery meetings we can find the support we need.”

Looking For the Science Behind the Twelve Steps

Transcendence, or nonsense?

What is it with the Twelve Steps? How, in the age of neuromedicine, do we account for the enduring concept of spiritual awakening available through “working the steps?” In Hijacking the Brain, Dr. Louis Teresi, former chief of neuroradiology at Long Beach Memorial Medical Center, along with Dr. Harry Haroutunian of the Betty Ford Center, sets themselves a formidable goal: “The sole intention of Hijacking the Brain is to connect the dots between an ‘organic brain disease’ and a ‘spiritual solution’ with sound physical, scientific evidence.” (For those who have grown weary of the overuse of “hijacked” brains in science writing, Teresi notes that an earlier term for the same idea was “commandeered.”)

Twelve Step programs remain popular, work for some addicts, and have their very vocal advocates in the recovery community. Outsiders are sometimes surprised to learn, writes Keith Humphreys, research scientist with the Veterans Health Administration and a professor at Stanford, that many of the people most profoundly and successfully affected by the 12-Step Program had “little or no interest in spirituality.”

The primary manifestation of this is the Twelve-Step Facilitation model (TSF), or Minnesota model, in honor of the Hazelden treatment facility in that state. Put simply, how do we go about explaining, in scientific terms, how a program like AA can have direct effects on a disease of the brain?

According to one strongly held view, we can’t. If there is something spiritual about recovery, it’s not anything that a medical doctor, who should have oversight of drug recovery and treatment programs, ought to be directly concerned with. Since the Twelve Step principles are explicitly spiritual in nature, how they apply to an organic brain disease is not at all clear. If you have cancer, your oncologists first line of thought is not usually, “why don’t you join a self-help group?” Writing for The Fix, health journalist Maia Szalavitz notes that “for no other medical disorder is meeting and praying considered reimbursable treatment: if a doctor recommended these religious or spiritual practices for the primary treatment of cancer or depression, you would be able to sue successfully for malpractice.” 

At an immediate level, the “power of the group,” which AA and other Twelve-Step Programs seems to tap into isn’t so hard to understand. Here are some of the obvious advantages of group work, as Teresi sees it:

--A reduction in the sense of isolation addicts feel.
--Useful information for addicts who are new to the processes of recovery.
--A way for people to see how others have dealt with similar problems.
--Additional structure and discipline for people whose living situations are often chaotic.

Teresi follows a common methodology, splitting the question into three dimensions: physical (an “allergy of the body driven by exaggerated limbic activity), mental (cognitive obsessions and compulsive drug use), and spiritual (an existential dilemma; a malady of the “soul”.) But the “spiritual awakening” that relieves this feeling and allows the addict to enter sobriety remains maddeningly ineffable: “The personality change sufficient to bring about recovery from alcoholism (addiction) has manifested itself among us in many different forms,” the Big Book cryptically affirms.

What makes it click for many addicts is what Teresi terms “empathic socialization,” defined as follows: “Positive socializing experiences received in support and therapeutic groups, such as praise, affection and empathic understanding, activate the brain’s reward centers as much as other natural rewards and similar to addictive substances. More importantly, belonging to an empathetic group reduces stress, a predominant cause and catalyst of addiction.”

Most people have only a hazy idea about what the Twelve Steps entail—something about admitting powerlessness over drugs, making amends for past wrongs, invoking a vague power higher than oneself. And the payoff? The reward for all the strenuous self-searching and personal honesty?

As Teresi sums it up: “inner peace, freedom, happiness, intuition, and alleviation of fear.” A heady package, indeed. All in return for achieving an emotional state called gratitude. Where are we to find the science in these claims?

Even though he doesn't solve the mystery, Dr. Teresi does offer  thoughts on some of the mechanisms in question, one of which is commonly referred to as an “attitude of gratitude” among Twelve-Step practitioners. “Gratitude for blessings received,” as it says the Big Book, is biochemically effective, Teresi argues. “In this regard,” Teresi writes, “grateful people show less negative coping strategies; that is, they are less likely to try to avoid the problem, deny there is a problem, blame themselves, or use mood-altering substances. Those with gratitude express more satisfaction with their lives and social relationships.”

And stress is where Dr. Teresi focuses his argument. More precisely, the working of the steps in Alcoholics Anonymous and kindred organizations involves “letting go” of high-stress states such as fear, guilt, self-loathing, and resentment. In Teresi’s thinking, the “power of the group” resides in its ability to reduce stress responses—and to raise levels of the “tend-and befriend” hormone, oxytocin. Oxytocin interacts with dopamine to increase maternal care, social attachments, and other affiliative behaviors and emotions. Thus, social rewards stir up a fair share of dopamine in reward centers of the brain, too. When alcoholics admit to powerlessness over alcohol, they are moving from a state of high autonomic nervous system tone to a more relaxed, “thank goodness that burden has been dropped” modality. This admission, when made as a conscious cognitive choice, and internalized through repetition and group motivation, lowers blood pressure and stress hormone levels, creating a more relaxed metabolic tone.

That is, in any event, how Teresi sees it. By confronting stress in this fashion, he believes that people with addictions can draw strength from group experience, even in the absence of personal religious belief.

Measures of Twelve-Step success will never be as precise as people would like. Not only does the national organization of AA generally avoid engaging in follow-ups, but the structure, or lack of it, works against precision measurements as well. As Teresi writes, “Anyone can start a Twelve-Step group by contacting the general service counsel of the organization of their interest, finding a meeting place (sometimes a person’s home) and adopting a readily available meeting protocol.” In fully monetized form, the Twelve Steps become Hazelden, or the Betty Ford Center. In supercharged upper income mode, it’s Passages and Promises. There is more going on here than simply a call to the pre-existing church-going addict. “AA,” says Keith Humphreys,  “is thus much more broad in its appeal than is commonly recognized.”

Teresi’s stated goal of connecting the dots isn’t an easy one. AA Twelve Steps and Twelve Traditions states unambiguously that the steps are “a group of principles, spiritual in their nature, which, if practiced as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole.” In another passage, the Big Book refers to this as a personality change “sufficient to bring about recovery from alcoholism (addiction).” The explanations and definitions are maddeningly circular—unless you happen to be one of the people for whom the obsession to drink has been expelled through this practices.

Teresi believes it is possible to explore this terrain in a “belief neutral” manner, “with findings applicable to those who believe in a single God, multiple gods, or no God at all." Spiritual practices, Teresi believes, promote recovery in three ways. Meditation and some forms of prayer reduce stress levels. Techniques that lower stress have also been shown to stimulate limbic reward centers, “modulating emotion while strengthening attention and memory.” Finally, “spiritual practices, through improving morals and interpersonal behavior, foster closeness and a sense of community with one’s fellows and satisfy our instinctual need for social connection, also reducing stress.”

John Berryman and the Poetry of “Irresistible Descent”

“The penal colony’s prime scribe.”

“Will power is nothing. Morals is nothing. Lord, this is illness.”
—John Berryman, 1971

A year before he committed suicide by jumping off a Minneapolis bridge in 1972, Pulitzer Prize-winning poet John Berryman had been in alcohol rehab three times, and had published a rambling, curious, unfinished book about his treatment experiences. Recovery is a time capsule. If you think we have little to offer addicts by way of treatment these days, consider the picture in the 60s and 70s. In Recovery, treatment consists almost entirely of Freudian group analysis, and while there is regular talk of alcoholism as a disease, AA style, there is no evidence that it was actually dealt with in this way, after detoxification.

Best known for “Dream Songs,” Berryman taught at the University of Minnesota, and was known as a dedicated if irascible professor. Scientist Alan Severence, Berryman’s stand-in persona in the book, comes into rehab hard and recalcitrant, despite his previous failures: “Screw all these humorless bastards sitting around congratulating themselves on being sober, what’s so wonderful about being sober? Great Christ, most of the world is sober, and look at it!” And he is suffering from “the even deeper delusion that my science and art depended on my drinking, or at least were connected with it, could not be attacked directly. Too far down.”

Berryman was a difficult man, and knew it. He quotes F. Scott Fitzgerald: “When drunk, I make them pay and pay and pay and pay.”

Alcoholics, writes Berryman, are “rigid, childish, intolerant, programmatic. They have to live furtive lives. Your only chance is to come out in the open.” Berryman catches the flavor of group interaction after too many hours, too much frustration, and too much craving. One inpatient lashes out: “You’re lying when you say you do not do anything about your anger. You get bombed. It is called medicating the feelings, pal. Every inappropriate drinker does it. Cause and effect. Visible to a child. Not visible to you.”

Berryman was a shrewd observer, a singular writer, and, after all, a poet. He is extraordinary on the subject of alcoholic dissociation: “I found myself wondering whether I would turn off right towards the University and the bus home or whether I would just continue right on to the Circle and up right one block to the main bar I use there, and have a few. Wondering. My whole fate depending on pure chance…. as if one were not even one’s own actor but only a spectator.”

Berryman puts it all together in a horrific capsule description of the “irresistible descent, for the person incomprehensibly determined.”

Relief drinking occasional then constant, increase in alcohol tolerance, first blackouts, surreptitious drinking, growing dependence, urgency of FIRST drinks, guilt spreading, unable to bear discussion of the problem, blackout crescendo, failure of ability to stop along with others (the evening really begins after you leave the party)… grandiose and aggressive behavior, remorse without respite, controls fail, resolutions fail, decline of other interests, avoidance of wife and friends and colleagues, work troubles, irrational resentments, inability to eat, erosion of the ordinary will, tremor and sweating… injuries, moral deterioration, impaired and delusional thinking, low bars and witless cronies….

Berryman had no illusions about his failed attempt to hide behind the mask of a social drinker: “It seems to be loss of control. Unpredictability. That’s all. A social drinker knows when he can stop. Also, in a general way, his life-style does not arrange itself around the chemical, as ours does. For instance, he does not go on the wagon…”

In the end, he was "pleading the universal case of hope for abnormal drinkers, for all despairing and deluded sufferers fighting for their sanity in a world not much less insane itself and similarly half-bent on self-destruction…”

As the head nurse in the facility tells the group: “You are all suffering from the lack of self-confidence… often so powerful that it leads to consideration of suicide, a plan which if adopted will leave you really invulnerable, quite safe at last.”

And as Saul Bellow wrote in the introduction to Recovery: “At last there was no more. Reinforcements failed to arrive. Forces were not joined. The cycle of resolution, reform and relapse had become a bad joke which could not continue.” Berryman agreed. Toward the end, he wrote: “I certainly don’t think I’ll last much longer.”

“There’s hope until you’re dead,” a woman tells him during his final stay in rehab. Sadly, that hope ended a few months later.


Photo posted by Tom Sutpen for the series: Poets are both clean and warm

What Does Harm Reduction Mean?

A rift in the addiction treatment community over abstinence.

What is harm reduction? How does it differ from the approaches traditionally associated with drug recovery and rehab?

Originally, I became interested in harm reduction because its advocates were highlighting the folly of prison terms over treatment for drug addicts—a sentiment with which I wholeheartedly agree. Also, the various harm reduction organizations worldwide were fastened tenaciously to the issue of clean needle exchanges as a means of reducing HIV transmission—another approach I heartily support. And at its core, harm reduction has always been about reducing the number of deaths by drug overdose. At its essence, harm reduction is sensible and necessary, given the failures of the drug war, and the inability to make a significant dent in addiction statistics by traditional socioeconomic approaches.

Harm reduction, as formally defined by Harm Reduction International, concerns itself with “policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families, and the community.” It’s a hopeful mission statement. But reducing harm without necessarily reducing drug consumption? What does that mean, exactly?

Lately, activists in the harm reduction movement have been leaning hard on the notion that abstinence is just so much humbug; an archaic admonition that need not be automatically imposed on addicts. Who said addicts have to become abstinent for the rest of their lives? Are we forever hostage to the religious zealotry of the Cambridge Group and it’s successor, Alcoholics Anonymous? If an alcoholic drinks one drink less today than yesterday, or a junkie shoots up a bit less junk today than yesterday, that is harm reduction in action.

But now that harm reduction has become intimately associated with the abstinence debate, egged on by activists like Stanton Peele and Jack Trimpey, the ground underneath the movement has shifted. Many harm reductionists are becoming wary, and sometimes completely hostile, to the notion of addiction as a disease syndrome with a distinct, lifelong, and incurable timeline beyond the reach of notions like “Rational” or “Smart” recovery. “Your best thinking got you here,” AA likes to say, reminding alcoholics that “being smart” or feeling full of “will power” often have less to do with recovery than one might suppose.

But in order to free themselves of the need for abstinence, extreme harm reductionists often deny that addiction is in any meaningful way a medical disorder. This has created a rift in the treatment community, and complicated the mission of recovery programs based on abstinence. Kenneth Anderson, a harm reduction advocate and the author of How to Change Your Drinking, framed it this way for me in an email exchange: “The more alcohol related problems you have, the more you need to practice harm reduction by planning safe drinking strategies, until you resolve your alcohol related problems by quitting or developing a non-problematic drinking pattern.” Like many harm reductionists, Anderson is no fan of Alcoholics Anonymous. One of the book’s sections is headed: “Everything You Always Wanted to Know About Alcohol—But you got told to go to AA and not ask.”

Anderson said that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) “tells us that about half of people who overcome alcohol dependence do so by quitting, the other half overcome it by cutting back.” If even the nation’s premier scientific agency for researching alcoholism doesn’t seem so sure about whether alcoholics need to strive for abstinence, why should abstinence be a stated goal at the outset of treatment at all? Said Anderson: "When abstinence is forced on people against their will, it often backfires and leads to more drug or alcohol use."
 
A few weeks ago, on Denise Krochta’s excellent podcast, Addicted to Addicts, I suggested that part of the argument over abstinence vs. controlled drinking stemmed from a confused bundling of “problem drinkers” and “alcoholics”—a move that the National Institute on Alcohol Abuse and Alcoholism, whose very name is a testimony to the institute’s fundamental ambivalence, has been championing lately. This has helped harm reductionists center the battle precisely where the definitions are fuzziest: at the point on the spectrum where “problem drinking” becomes “alcoholism.” Nonetheless, by focusing on this imprecise edge, harm reductionists make a legitimate point: Culture and environment are major influences on the course of heavy drinking.

“I do not use the word alcoholism [in the book], because it has no scientific definition in the current day and is not found in the DSM IV” Anderson told me. “Although there is some heritability of alcohol dependence, it is a great error to overlook the importance of environmental factors. Alcohol dependence is not located on a single gene--currently there are dozens of genes implicated in alcohol dependence.” And he’s right. These are legitimate caveats that apply to many of the disease models of addiction now at play in the scientific community.

The counter-argument here is that genuine alcoholics do not have, and cannot develop, a “non-problematic drinking pattern,” any more than a serious diabetic is likely to develop a non-problematic sugar doughnut strategy. What alcoholic hasn’t tried controlled drinking? Again and again? And failed? Where are the legions of former drunk-tank alcoholics who have rationally transformed themselves into social drinkers?

These are some of the terms of the current debate in the addiction recovery community. But we do a disservice by concentrating solely on points of departure. The harm reduction movement, at street level, has some very sound contributions to make regarding addiction and public policy. Anderson, in his book, drives home the overlooked but essential point that there is no one-size-fits-all treatment for destructive drinking:

• “Harm reduction never forces people to change in ways which they do not choose for themselves.”
• “Harm reduction recognizes that each of us is a unique human being different from all others.”
• “Harm reduction recognizes the need for ‘different strokes for different folks.’”
• “Harm reduction supports every positive change.”

I fervently hope that 12-Step Groups and Harm Reduction Groups can work their way toward a rapprochement. And so does Kenneth Anderson. But what stands in the way of this is, I fear, is the disease model of addiction—and medical addiction researchers aren’t likely to turn their backs on that premise any time soon. Still, we cannot say what future research will reveal. And I agree with harm reductionists that the best attitude we can bring to the subject of addiction and recovery is open-mindedness, and a willingness to treat each case as unique, in order to forestall “metabolic chauvinism.”

Graphics Credit: http://hamsnetwork.org 

My Name is Roger

A famed movie critic tells his story.

Excerpted from :
“My Name is Roger, and I'm an alcoholic.”
By Roger Ebert, Chicago Sun Times
Posted on “Roger Ebert’s Journal,”
August 25, 2009.
© Sun-Times News Group

In August 1979, I took my last drink. It was about four o'clock on a Saturday afternoon, the hot sun streaming through the windows of my little carriage house on Dickens. I put a glass of scotch and soda down on the living room table, went to bed, and pulled the blankets over my head. I couldn't take it any more.
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At about this time I was reading The Art of Eating, by M. F. K. Fisher, who wrote: "One martini is just right. Two martinis are too many. Three martinis are never enough."
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In my case, I haven't taken a drink for 30 years, and this is God's truth: Since the first A.A. meeting I attended, I have never wanted to. Since surgery in July of 2006 I have literally not been able to drink at all. Unless I go insane and start pouring booze into my g-tube, I believe I'm reasonably safe. So consider this blog entry what A.A. calls a "12th step," which means sharing the program with others. There's a chance somebody will read this and take the steps toward sobriety.
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I know from the comments on an earlier blog that there are some who have problems with Alcoholics Anonymous. They don't like the spiritual side, or they think it's a "cult," or they'll do fine on their own, thank you very much. The last thing I want to do is start an argument about A.A.. Don't go if you don't want to. It's there if you need it. In most cities, there's a meeting starting in an hour fairly close to you. It works for me. That's all I know. I don't want to argue with you about it.
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I've been to meetings in Cape Town, Venice, Paris, Cannes, Edinburgh, Honolulu and London, where an Oscar-winning actor told his story. In Ireland, where a woman remembered, "Often came the nights I would measure my length in the road." I heard many, many stories from "functioning alcoholics." I guess I was one myself. I worked every day while I was drinking, and my reviews weren't half bad. I've improved since then.
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The God word. The critics never quote the words "as we understood God." Nobody in A.A. cares how you understand him, and would never tell you how you should understand him. I went to a few meetings of "4A" ("Alcoholics and Agnostics in A.A."), but they spent too much time talking about God. The important thing is not how you define a Higher Power. The important thing is that you don't consider yourself to be your own Higher Power, because your own best thinking found your bottom for you.

Photo Credit: chicagoist.com


addiction drugs alcoholics anonymous

The Cybernetics of Alcoholics Anonymous

Is there a secular Higher Power?

Hitting bottom, in A.A. terms, may come in the form of a wrecked car, a wrecked marriage, a jail term, or simply the inexorable buildup of the solo burden of drug-seeking behavior. While the intrinsically spiritual component of the A.A. program would seem to be inconsistent with the emerging biochemical models of addiction, recall that A.A.’s basic premise has always been that alcoholism and drug addiction are diseases of the body and obsessions of the mind.

When the shocking moment arrives, and the addict hits bottom, he or she enters a “sweetly reasonable” and “softened up” state of mind, as A.A. founder Bill Wilson expressed it. Arnold Ludwig calls this the state of “therapeutic surrender.” It is crucial to everything that follows. It is the stage in their lives when addicts are prepared to consider, if only as a highly disturbing hypothesis, that they have become powerless over their use of addictive drugs. In that sense, their lives have become unmanageable. They have lost control.

A.A.’s contention that there is a power greater than the self can be seen in cybernetic terms—that is to say, in strictly secular terms. As systems theorist Gregory Bateson concluded long ago after an examination of A.A principles in Steps to an Ecology of Mind:

“The ‘self’ as ordinarily understood is only a small part of a much larger trial-and-error system which does the thinking, acting and deciding... The ‘self’ is a false reification of an improperly delimited part of this much larger field of interlocking processes. Cybernetics also recognizes that two or more persons--any group of persons--may together form such a thinking-and-acting system.”

Therefore, it isn’t necessary to take a strictly spiritual view in order to recognize the existence of some kind of power higher than the self. The higher power referred to in A.A. may simply turn out to be the complex dynamics of directed group interaction, i.e., the group as a whole. It is a recognition of holistic processes beyond a single individual—the power of the many over and against the power of one. Sometimes that form of submission can be healthy. Many addicts seem to benefit from being in a room with people who understand what they have been through, and the changes they are now facing. It is useful to know that they are not alone in this. “The unit of survival—either in ethics or in evolution—is not the organism or the species,” wrote Bateson, “but the largest system or ‘power’ within which the creature lives.” In behavioral terms, A.A. enshrines this sophisticated understanding as a first principle.

Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008

Photo Credit:www.zazzle.com.au

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Coffee and Cigarettes

Recovering alcoholics and their drugs.

It's no secret that alcohol and cigarettes go together. And it is common knowledge--and an AA truism--that recovering alcoholics take to strong black coffee like ducks to water.

Now comes a study of Alcoholics Anonymous participants in Nashville, to be published in the October issue of Alcoholism: Clinical and Experimental Research, which verifies the obvious, with a twist. Of 289 AA members interviewed by Dr. Peter R. Martin and coworkers at the Vanderbilt Addiction Center, 56.9% of respondents were cigarette smokers (approximately 20% of all adult Americans smoke cigarettes).

When it came to coffee, however, 88.5% of AA attendees were coffee drinkers, and a third of them drank more than 4 cups a day. "The most important finding," said Dr. Martin in a Vanderbilt University press release, "was that not all recovering alcoholics smoke cigarettes while almost all drink coffee."

Does all that coffee guzzling and cigarette smoking help or hinder recovering alcoholics in their quest for sobriety? The answer is: nobody quite knows. Dr. Martin, professor of psychiatry and pharmacology at Vanderbilt and lead investigator of the study, entitled "Coffee and Cigarette Consumption and Perceived Effects in Recovering Alcoholics Participating in Alcoholics Anonymous in Nashville, TN," put it this way in Science Daily: "Is this behavior simply a way to bond or connect in AA meetings, analogous to the peace pipe among North American Indians, or do constituents of these natural compounds result in pharmacological actions that affect the brain?"

"It's possible that coffee is even a gateway drug, with coffee drinking beginning at about the time persons begin using alcohol," said Robert Swift of the Brown University Medical School. "In addition, a potential negative interaction is coffee's known negative effects on sleep."

Selena Bartlett of the Ernest Gallo Clinic and Research Center of the University of California, San Francisco, offers the same concerns about cigarettes. A reliance on smoking by recovering alcoholics has a biological basis, she believes, and may increase the odds of relapse. In a HealthDay article by Steven Reinberg, Bartlett said: "My prediction would be that the relapse rates among smokers is higher." Since nicotine and alcohol addiction are so often found together, Bartlett thinks they should also be treated together, and is studying the anti-smoking drug Chantix for this purpose. "The drug inhibits the effect of nicotine, and by doing that, you may also reduce the euphoric effects of alcohol at the same time," she said. "We already have some evidence that it may work."

Varenicline, currently marketed by Pfizer for smoking cessation under the trade name Chantix, caught the attention of alcohol researchers when it dramatically curbed drinking in alcohol-preferring rats. The synthetic drug was modeled after a cytosine compound from the European Labumum tree, combined with an alkaloid from the poppy plant. An estimated 85 per cent of alcoholics are also cigarette smokers. (Chantix has lately been implicated, along with a dozen other anti-seizure medications, in suicidal ideation in some patients).

"I think it is important for alcohol researchers and clinicians to know that alcoholics, even those who do not use other illicit drugs, are not just addicted to alcohol, but use other psychotropic drugs like caffeine and nicotine," said Professor Swift of Brown University. "A second important aspect is the finding that rates of smoking are much higher in alcoholics in recovery than in the general population.... Yet, AA tolerates or otherwise does not address smoking in its members."

Dr. Martin said that more detailed analyses of the results will help determine "whether these changes in coffee and cigarette use are predictive of recovery from alcoholism per se."

Photo credit: AA-Carolina.org


alcoholics anonymous smoking nicotine

Does AA Work?

Bill W., co-founder of AA








Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.


Despite recent progress in the medical understanding of addictive disease, the amateur self-help group known as Alcoholics Anonymous, and its affiliate, Narcotics Anonymous, are still regarded by many as the most effective mode of treatment for the ex-addict who is serious about keeping his or her disease in remission. A.A. and N.A. now accept anyone who is chemically dependent on any addictive drug—those battles are history. In today’s A.A. and N.A., an addict is an addict. A pragmatic recognition of pan-addiction makes a hash of strict categories, anyway.

Nonetheless, under the biochemical paradigm of addiction, we have to ask whether the common A.A.-style of group rehabilitation, and its broader expression in the institutionalized form of the Minnesota Model, are nothing more than brainwashing combined with a covert pitch for some of that old-time religion. As Dr. Arnold Ludwig has phrased it, “Why should alcoholism, unlike any other ‘disease,’ be regarded as relatively immune to medical or psychiatric intervention and require, as AA principles insist, a personal relationship with a Higher Power as an essential element for recovery?”

The notion is reminiscent of earlier moralistic approaches to the problem, often couched in strictly religious terms. It conjures up the approach sometimes taken by fundamentalist Christians, in which a conversion experience in the name of Jesus is considered the only possible route to rehabilitation. But if all this is so, why do so many of the hardest of hard scientists in the field continue to recommend A.A. meetings as part of treatment? Desperation? Even researchers and therapists who don’t particularly like anything about the A.A. program often reluctantly recommend it, in the absence of any cheap alternatives.

In 1939, Bill Wilson and the fellowship of non-drinkers that had coalesced around him published the basic textbook of the movement, Alcoholics Anonymous. The book retailed for $3.50, a bit steep for the times, so Bill W. compensated by having it printed on the thickest paper available—hence its nickname, the “Big Book.” The foreword to the first printing stated: “We are not an organization in the conventional sense of the word. There are no fees or dues whatsoever. The only requirement for membership is an honest desire to stop drinking. We are not allied with any particular faith, sect or denomination, nor do we oppose anyone. We simply wish to be helpful to those who are afflicted.”

In short, it sounded like a recipe for complete disaster: naive, hopeful, objective, beyond politics, burdened with an anarchical structure, no official record
keeping, and a membership composed of anonymous, first-name-only alcoholics.
......................
Amid dozens of case histories of alcoholics, the Big Book contained the original Twelve Steps toward physical and spiritual recovery. There are also Twelve Traditions, the fourth one being, “Each group should be autonomous except in matters affecting other groups or A.A. as a whole.” As elaborated upon in Twelve Steps and Twelve Traditions, “There would be real danger should we commence to call some groups ‘wet’ or ‘dry,’ still others ‘Republican’ or ‘Communist’…. Sobriety had to be its sole objective. In all other respects there was perfect freedom of will and action. Every group had the right to be wrong. The unofficial Rule #62 was: “Don’t take yourself too damn seriously!”

As a well-known celebrity in A.A. put it: “In Bill W.’s last talk, he was asked what the most important aspect of the program was, and he said it was the principle of anonymity. It’s the spiritual foundation.” Co-founder Dr. Bob, for his part, believed the essence of the Twelve Steps could be distilled into two words—“love” and “service.” This clearly links the central thrust of A.A. to religious and mystical practices, although it is easily viewed in strictly secular terms, too.

Alcoholics Anonymous recounts a conversation “our friend” had with Dr. C.G. Jung. Once in a while, Jung wrote, “…alcoholics have had what are called vital spiritual experiences…. They appear to be in the nature of huge emotional displacements and rearrangements.” As stated in Twelve Steps and Twelve Traditions, “Nearly every serious emotional problem can be seen as a case of misdirected instinct. When that happens, our great natural assets, the instincts, have turned into physical and mental liabilities.”

Alcoholics Anonymous asserts that there are times when the addict “has no effective mental defense” against that first drink.

Bill Wilson wrote:
"Some strongly object to the A.A. position that alcoholism is an illness. This concept, they feel, removes moral responsibility from alcoholics. As any A.A. knows, this is far from true. We do not use the concept of sickness to absolve our members from responsibility. On the contrary, we use the fact of fatal illness to clamp the heaviest kind of moral obligation onto the sufferer, the obligation to use A.A.’s Twelve Steps to get well."

This excruciating state of moral and physical sickness—this “incomprehensible demoralization”—is known in A.A. as hitting bottom. “Why is it,” asks Dr. Arnold Ludwig, “that reasonably intelligent men and women remain relatively immune to reason and good advice and only choose to quit drinking when they absolutely must, after so much damage has been wrought? What is there about alcoholism, unlike any other ‘disease’ in medicine except certain drug addictions, that makes being in extremis represent a potentially favorable sign for cure?”

Hitting bottom may come in the form of a wrecked car, a wrecked marriage, a jail term, or simple the inexorable buildup of the solo burden of drug-seeking behavior. While the intrinsically spiritual component of the A.A. program would seem to be inconsistent with the emerging biochemical models of addiction, recall that A.A.’s basic premise has always been that alcoholism and drug addiction are diseases of the body and obsessions of the mind.

When the shocking moment arrives, and the addict hits bottom, he or she enters a “sweetly reasonable” and “softened up” state of mind, as A.A. founder Bill Wilson expressed it. Arnold Ludwig calls this the state of “therapeutic surrender.” It is crucial to everything that follows. It is the stage in their lives when addicts are prepared to consider, if only as a highly disturbing hypothesis, that they have become powerless over their use of addictive drugs. In that sense, their lives have become unmanageable. They have lost control.

A.A.’s contention that there is a power greater than the self can be seen in cybernetic terms—that is to stay, in strictly secular terms. The higher power referred to in A.A. may simply turn out to be the complex dynamics of directed group interaction, i.e., the group as a whole. It is a recognition of holistic processes beyond a single individual—the power of the many over and against the power of one.

“The unit of survival—either in ethics or in evolution—is not the organism or the species,” wrote anthropologist Gregory Bateson, “but the largest system or ‘power’ within which the creature lives.” In behavioral terms, A.A. enshrines this sophisticated understanding as a first principle.

alcoholics anonymous