Answer Addiction

Tag: 12 step alternatives

  • Better is Better: Stories of Alcohol Harm Reduction

    Better is Better: Stories of Alcohol Harm Reduction

    Unlike most recovery groups, abstinence (sobriety) is not a requirement for HAMS. HAMS encourages all positive change, from abstinence to moderation to safer drinking.

    The following is an excerpt from HAMS’ (Harm Reduction, Abstinence and Moderation Support) new book, in which members tell their stories of success and struggles along the way. Find more information about HAMS at the end of this excerpt.

    Jessica’s Story

    I had been a heavy drinker for 10 – 20 years. The increase in my drinking happened gradually, but then one day I became very ill after drinking and realized I could have been going through withdrawal. Yet it didn’t sink in and I continued on my path to destruction.

    I work in drug addiction so I wasn’t oblivious to harm reduction, but the consensus where I live is that it doesn’t work, and everyone pushes AA. I didn’t want to go to AA and felt I couldn’t because I am in a very public position in my career in the addiction field. So I started to Google around and came across the HAMS website, but I didn’t join yet. 

    Then in December of 2016 I took a bad turn. I had been binge-drinking on a public holiday, and I was very sick, but I had to go into work on Monday. That’s when I finally joined HAMS. It was the first time I ever expressed to anyone, even myself, that alcohol had become a problem. Being able to do that in a safe environment was very important to me. There were so many people on so many different paths, including many who had been abstinent for years or moderating successfully, as well as those who had serious problems. 

    I was a member of HAMS for several months before I embarked on a taper. It had its limitations because I work long hours and I don’t drink during work so obviously with the consumption of alcohol I used to have during my hours off work it was very difficult to taper while not drinking for 12 hours a day. But tapering works. I did a long taper – perhaps it was more psychological than physical, but I live alone and I didn’t want to risk DTs.

    I tried moderating, but it didn’t work for me. Once I start to drink, there is no stop button. So I made the decision last year to be alcohol-free. Once I tried moderation again, but drank way too much. It wasn’t even stress or trauma: I just thought I deserved a treat so I tried it again, but once I started I kept going. I contacted a doctor I knew from Facebook who was a specialist in addictions and who I knew would keep my confidence, and he prescribed an at-home detox with Ativan. Unfortunately, I still had to go to work, and I don’t know how I managed but I did. So I came to the conclusion last year that I need to be alcohol free because this moderation thing does not work for me. 

    I found the HAMS Facebook group very helpful because sleeping has always been a problem for me, and it was especially acute when I first stopped drinking. I am in Central Europe, so when I couldn’t sleep at night, everyone in the US was up. When I couldn’t sleep at 2 or 3 am my time, there was always someone in the group I could talk to. I’ve made a lot of good friends in HAMS, and we usually don’t even talk about alcohol. We talk about other things in our lives. My mantra has always been that I am much more than my alcohol problem, so talking with HAMS friends about things other than alcohol keeps me focused on the life I have beyond alcohol. 

    Another thing I like about HAMS is how many members are female. Women have a very different experience with alcohol than men do, and I feel that most treatment is geared to men. Women often have more at stake: a woman I know went to the ER because she was in withdrawal, and they called child protection services on her. I didn’t want to join AA because as a female, I didn’t want to be preyed upon by the men there. Women are so vulnerable, especially when we first stop drinking. I know of many women who have been taken advantage of by men in AA. That doesn’t happen in HAMS. I’ve never felt pounced upon or been contacted in any inappropriate way. 

    The support in HAMS has made it possible for me to become alcohol-free. The fact that it is international, I can get support any time day or night, and I don’t have to worry about my identity being exposed in the country where I work, have all been important. I want us to continue to grow and help people all over the world see that changing your drinking really is possible. With HAMS, no matter who you are or where you live, you are never alone. 

     

    HAMS – Harm Reduction, Abstinence and Moderation Support – is an over 5,000-member group of people worldwide who are working to change their drinking. Unlike most such groups, abstinence (sobriety) is not a requirement for HAMS. HAMS encourages all positive change, from abstinence to moderation to safer drinking. Members are encouraged to set their own goals and make a plan for achieving them. HAMS provides confidential, 24/7 online support through closed Facebook groups, including a 1,000-member group for women only. Members interact with each other from the privacy of their own homes, and no judgement is allowed – just support and encouragement. HAMS provides support for those who want to set their own goals, think for themselves, and improve their drinking.

    HAMS’ original book, a science-based, step-by-step guide to changing your drinking, can be found at How to Change Your Drinking by Kenneth Anderson. HAMS website is https://hams.cc/ and Facebook groups include HAMS: Harm Reduction for Alcohol, HAMS for Women, Alcohol Harm Reduction, and Alcohol Free Hamsters, a group for those who choose abstinence.

    View the original article at thefix.com

  • Common Sense Recovery: An Atheist's Guide to Alcoholics Anonymous

    Common Sense Recovery: An Atheist's Guide to Alcoholics Anonymous

    Our recovery is not up to angels, demons, or gods. It is up to us.

    An audio version of Common Sense Recovery is now available on Audible. 

    Science Is Not a Four-Letter Word

    A lot has been learned since Bill and Bob first met. I like to think that they did not so much set things in stone as set them in motion.

    But we must always keep in our minds that the deep roots of AA in religion have set into our fellowship a long standing tone of anti-science and anti-learning. Religious organizations such as Alcoholics Anonymous tend to be subtly, if not overtly, hostile to new ideas, to science, to change, and to anyone or anything which calls into question their traditional view that the big and important questions have all been answered, and the answer is God.

    I am not an expert on the subject matter, and this is not going to be a science paper. Yet we would be doing ourselves and all the suffering alcoholics, now and in the future, in and out of the rooms, a huge disservice if we failed to recognize the ways in which a rapidly expanding body of knowledge might enhance our efforts. So, for example, there is an ever-growing body of scientific data to support the view that positive thinking and associated actions can literally re-wire the brain’s circuitry.

    So let’s consider just one important area of investigation which will suggest the kind of exploration I think we have an obligation to more diligently pursue. Recent findings in the neurosciences suggest that the human brain is more malleable than once thought to be. Our experiences can actually rewire our “plastic” brain. Simply put, when we form habits of behavior, such as drinking or any of the destructive habits of thought associated with the alcoholic lifestyle, we forge strong pathways in our brain, neural connections that are reinforced over and over again, becoming stronger and stronger each time we repeat the patterns of thought and behavior.

    The good news is that change is possible. The even better news is that positive change, consistently different thoughts and actions, will re-wire our neural pathways, literally changing our brain’s structure. The more we engage in the new behavior, the more that particular set of neurons fires together and wires together. The new connections, perhaps very tenuous at first, grow stronger and stronger with each reinforcing positive thought and activity. Meanwhile, the old pathway literally begins to atrophy from non use. The old habits fade, while the new ones become stronger and stronger with each repetition.

    I find it encouraging that we have this growing body of evidence supporting many of our traditional teachings. Repeated alternate behavior choices can actually restructure our mental map. “Fake it till you make it” is scientifically verifiable. “Living our way into right thinking” is not a mere slogan on the wall, but an empirically verifiable technique for altering our brain chemistry and, thereby, our entire lives. How encouraging to know that, as hard as it may be at first to have an “attitude of gratitude”, habitually cultivating one through practice and repetition can, over time, literally change the way we see the world at the most basic level.

    One of the more influential books I have ever read in my own personal recovery is an old school classic called A New Pair of Glasses, by Chuck C. Amongst many other insights, the book offered up the idea that god was in fact, simply, a new way of seeing the world, a new pair of glasses. This idea is suggested throughout the Big Book. The whole point of the AA experience is to initiate a “psychic change” (p. xxix), one which will “revolutionize our whole attitude toward life” and “toward our fellows”. (p. 25. Here, as in many places, I intentionally edit out Bill and the old timers’ copious references to god, spirit or higher power. This is quite intentional, and represents in fact a main thrust of my argument: Alcoholics Anonymous is replete with a wonderful and useful toolkit that can help anyone stay sane and sober if they are willing, even after we take out all the unnecessary, distracting, obfuscating religious language.) They may no longer be with us, but I suspect that Bill and Bob, Carl Jung, Dr. Silkworth and Chuck C. would all have been impressed by the correlation between this focus on a new pair of glasses and contemporary findings in the brain and behavioral sciences.

    So, scientific findings support our experience: we can act our way into right thinking. We can ultimately enjoy lasting, whole scale changes in our personalities through seemingly small, incremental changes in behavior. Every time we experience a desire to drink and, instead, go to an AA meeting, call a friend, or work with a newcomer, we weaken that demon and strengthen that angel. We do the next right thing and, at some point, we realize that all these slow incremental steps have produced a significant, “miraculous” transformation. Our brain is literally being rewired, slowly but surely reprogrammed.

    The AA tradition is to call this kind of change “spiritual” for two reasons. First, because of tradition. This sort of personal transformation, prior to the last couple hundred years of human history at least, was generally considered the sole province of religion, the handiwork of angels and deities.

    Second, the caulk thing again. We find the radical change inexplicable, so we apply the magic, one-size-fits-all explaining power of theism as a metaphysical caulk in order to satisfy the never-ending human thirst for understanding or explanation.

    Most importantly, these responses are not merely unnecessary; they are demeaning and disempowering in a very important sense. Our recovery is not up to angels, demons, or gods. It is up to us. We are responsible for taking the necessary actions that ensure the necessary changes which make for lasting, contented sobriety. Furthermore, supernatural explanations such as this give the false impression that we know all we need to about the phenomenon in question. As such, they tend to stand in direct conflict with the kind of curiosity and exploration which will grow the recovery sciences and our understanding of the relevant social and psychological processes.

    The Real Higher Power

    The most miraculous and inexplicable force at work in Alcoholics Anonymous may be fellowship itself. Even the most devoutly religious members depend upon our society, upon the power of the group. Often they will describe their fellow AAs, in a typical example of religious interpretation, as the mouthpiece through which god speaks to them. The fellowship is understood as a mere vehicle, or as a temporary expedient to be replaced by the real Higher Power when the newcomer finally “comes to” or “comes to believe”. But the experience of most recovering alcoholics is that, what guides and sustains us on a day-by-day basis are peer support, empathy, mentor guidance, and the emotional reinforcement of group membership. In short, what keeps us sober from day to day is fellowship. 

    Consider these three suggestions, probably the most common ones made to an alcoholic who is suffering:

    1. Go to a meeting
    2. Call your sponsor
    3. Work with another alcoholic

    What do all three have in common? They all entail immersion in the society of recovering peers, a meaningful connection with our newfound tribe. Reams of data from social psychology, evolutionary biology and a host of other disciplines attest to the essential role played by peer groups and societies in determining both our values and our action choices, in shaping our thoughts and behaviors. Scientifically, mounting evidence suggests that the social group is the source of an important kind of basic emotional nurturance that is fulfilling to tribal hominids such as we at a most fundamental level.

    Our brain evolved to be what it is over the course of five million years spent in small, familial tribes, within which complete immersion and total dependence were essential for our very survival. We are, at our core, not so much individual animals as we are pack members. Gathering in fellowship is the most important practical tool we have borrowed from religion and the church. But, in the end, the power of the group is undoubtedly a little less miraculous, a little more ancient, and a little more explicable, than once thought.

    The tribe functions as the disseminator and teacher, the source of encouragement and reinforcement, that which empowers the addict to live a better life on a daily basis. The fellowship offers new ideas, role models who practice them, wise guidance and counsel, reinforcement of values and goals, and essential emotional rewards to its members. It empowers us to practice new and different behaviors until they become new and different habits. As time passes our membership within the tribe is the source of life enriching friendships.

    But it also becomes an important source of a newfound sense of value and purpose as, over time, we transform into seasoned members who reap significant benefits from passing guidance and support on to the next member in need. This life sustaining mutual exchange is a huge part of recovery. It builds a web which sustains us all, a web of support that is fundamentally tribal. Our lives are saved, shaped and defined by the herd. We survive by running with the pack. The fellowship is the most tangible instantiation of a “higher power” in our lives. I would argue that we need seek no further.

    For humans, isolation is death. Community is life. We overestimate the value of religious belief and faith in god: in fact, the community of fellows is the vehicle, whether it is church, temple, ashram, therapy group, mosque, sangha, a meeting of Alcoholics Anonymous, or the meeting after the meeting.

    Keep in mind how miserable and close to disaster Bill Wilson was in spite of his life-changing experience at Towns Hospital. AA lore unwisely exaggerates his alleged spiritual experience. This was, in all probability, merely a side effect of the quasi-toxic, hallucinogenic Belladonna cure being administered at the time.

    But when Bill went out into the world and engaged with other alcoholics, he ultimately found what he was looking for. It was not more white light, or god, or a higher power that he found, but a drunken country doctor named Bob. The lasting good they created is a society of peers who gain synergetic strength in numbers, loving support from each other, and much wisdom gleaned from years of collective experience.

    The above is an excerpt from the book Common Sense Recovery: An Atheist’s Guide to Alcoholics Anonymous. The book was originally written as a journal by long-term member Adam N., as he sought to bridge the gap between the religious language and perspectives of AA, and his own increasingly secular, atheistic understanding of the fundamental principles of recovery. Now in its third edition, this work continues to be a valuable guide for many who struggle with the religious nature and language of AA and contains important insights for the future of the fellowship.

    View the original article at thefix.com

  • Atheist Nurse Wins Fight to End Mandatory 12-Step Addiction Treatment for Health Staff in Vancouver

    Atheist Nurse Wins Fight to End Mandatory 12-Step Addiction Treatment for Health Staff in Vancouver

    B.C. health authority settles human rights complaint with Byron Wood, who lost his job after quitting AA.

    Health-care professionals who work in Vancouver-area hospitals and medical clinics will no longer be required to attend 12-step programs if they want to keep their jobs after being diagnosed with addiction.

    The change comes as a result of a settlement between public health authority Vancouver Coastal Health and former nurse Byron Wood, who filed a human rights complaint alleging he was discriminated against as an atheist when he was fired for quitting Alcoholics Anonymous.

    Wood told CBC the agreement was reached after a month of negotiations. 

    “I’m really happy about the outcome — it means that VCH employees are not required to attend 12-step rehab centres, 12-step meetings, or participate in any 12-step activities if they object for religious reasons,” he said in an email.

    “It’s what I’ve been fighting for, for the last six years.”

    As part of the settlement, Wood said he has to keep many details of the agreement confidential.

    But he did say Vancouver Coastal Health employees who require addiction treatment will now have a way of “meaningfully registering their objection” to 12-step programs.

    They won’t have to attend AA and similar programs “if that approach to treatment conflicts with their religious or non-religious beliefs,” Wood said.

    Nearly 14,000 people work for the health authority, including 5,500 nurses and 2,700 doctors.

    Officials at VCH have yet to respond to requests for comment, but a spokesperson confirmed the settlement terms outlined by Wood.

    ’12 step does not work for everyone’

    The settlement could have implications in other professions and across the country. Researchers who study addiction treatment for health-care workers say it’s common for employees to be required to participate in 12-step programs in the interest of protecting public safety.

    Vancouver lawyer and workplace consultant Jonathan Chapnick said mandatory AA has long been the standard approach for workplace addiction issues in Canada.

    “I think it makes sense for employers to look at something like this and do their own research and make their policy better reflect the research evidence that’s out there,” he said of VCH’s change in policy.

    “Twelve step does not work for everyone. And, in fact, it doesn’t work for most people.”

    Six of AA’s 12 steps directly refer to God or a higher power, including one that requires members turn their will and lives “over to the care of God.”

    “The 12 steps are a religious peer support group, not a medical treatment. They shouldn’t be imposed on anyone,” Wood said.

    “When you’re a medical doctor, and you specialize in only one condition, and the only treatment that you offer for that condition involves God, you shouldn’t be practising medicine.”

    Wood was working as a registered nurse on Vancouver’s Downtown Eastside when he was diagnosed with substance use disorder after a psychotic break in the fall of 2013. 

    His professional college was informed, along with his union and Vancouver Coastal Health, his employer at the time. 

    He was referred to a doctor specializing in addictions, who created a plan that Wood would need to follow if he wanted to return to work. AA was a mandatory component.

    As an atheist, Wood suggested alternatives to the 12-step program, including secular support groups like SMART Recovery and LifeRing Secular Recovery, but his doctor rejected them, according to emails Wood provided to CBC News. 

    He also asked for a referral to a new doctor, but his union informed him it only uses addiction specialists who follow the 12-step model, the emails show.

    The AA meetings didn’t help, Wood said, and he lost his job as well as his registration as a nurse when he stopped going.

    Since then, he’s been fighting to get his job back while dealing with his addictions using a drug called naltrexone, which blocks the intoxicating effects of alcohol and opiates. He says he is healthy and no longer meets the criteria for substance use disorder.

    Plans to re-apply for nursing licence

    While many people say AA has been instrumental in their recovery from addiction, scientists have long questioned the overall effectiveness of the program, and say choice in treatment plans is key to recovery.

    Wood’s complaint to the B.C. Human Rights Tribunal was bolstered by letters of support from scientists, doctors, psychotherapists, lawyers, the B.C. Civil Liberties Association, the B.C. Humanist Association, and the Centre for Inquiry Canada, an Ontario-based humanist charity.

    The complaint originally named the B.C. Nurses’ Union as a respondent, but that portion was dismissed by the tribunal earlier this year.

    Wood said he plans to apply to the College of Nursing Professionals for reinstatement of his licence, with the hope of finding a new job in nursing.

    This article originally appeared on CBC.ca and is republished here with permission.

    View the original article at thefix.com

  • Happy Destiny or a Life Sentence: Thoughts on Leaving AA

    Happy Destiny or a Life Sentence: Thoughts on Leaving AA

    If you do decide to leave, there are many alternatives to AA, places where you can meet likeminded people, share your experience, and make social connections just as in 12-step meetings.

    I don’t know if I’ve left Alcoholics Anonymous for good, but it’s been a while since I’ve been to a meeting. In the past, I’ve left for long periods of time and then come back. I’d come back because I missed the people; yet the “simple” program confused me more and more. Still, I loved making connections. Even though I’m not a group-type of person, it was obvious to me that the “magic” of the whole thing was being able to relate to people with a similar problem and helping one another. 

    I’ve had slips while very much in as well as while out of the program. I’ve slipped after months of not going to meetings, but I’ve also taken a drink right after an AA retreat. There were years where I did the steps and stayed sober and years when I didn’t do the steps and stayed sober. For those reasons, I might not be the best judge of the effectiveness or the harm of AA. I know of many people who stayed in and flourished, many who stayed and relapsed and came back, and many who have left and are still sober despite keeping their distance. 

    AA has always been controversial. It keeps even the most hopeless drunks abstinent, but it’s known for its dogma and ritualistic—some say cult-like—practices. It has saved many people (although there are no reliable statistics) from death from substance use disorder, and it’s helped to mend many families and relationships. Attending AA is also frequently court-mandated for those charged with Driving Under the Influence and other alcohol-related convictions, including domestic violence. For many years AA seemed to be the only effective solution for those who wanted to keep abstinent from alcohol or other drugs. 

    But I’ve noticed a shift, and it’s been happening for a while. As new programs and methods of getting clean and sober pop up on the horizon, some AA members choose to leave despite the ominous farewells of members who believe that leaving AA always equals a relapse. It’s no accident that one of AA’s most popular slogans is “Keep Coming Back!” The way I used to interpret it was that the AA’s door was always open but later, as I became a little disillusioned, it read as if I was doomed to rely solely on AA as a place to recover. I was terrified to leave. Often it felt as if I was nailed to those plastic chairs by fear. 

    So I stayed. It started to feel like a life sentence. 

    Ego Deflation

    David D. Bohl, addictions specialist and author of the acclaimed memoir Parallel Universes, left AA recently. He says, “I went to a hospital to check in because they told me I was going to have seizures if I didn’t. I had medically monitored and supervised detox. That was the beginning of my stabilization. And then they sent me to an inpatient or a residential treatment facility that included 12-step facilitation. So I stabilized in treatment and through the 12 steps.” Bohl got sober in AA but it took a long time before he was able to address other issues, such as his trauma due to adoption. 

    Today, Bohl believes he would have healed faster if he’d had more access to other resources—such as ongoing therapy—on top of having to go to meetings. For him, the side effect of being in AA was “ego deflation.” 

    “No one gave me informed consent that if you don’t have ego strength, this could destroy you. You come to AA and don’t know where to go from there. No one explained that to me. So, had I known that there were (other resources) out there and offer other forms of support, knowing that I had no ego strength, I would’ve gone another route. I would have opted for something else, no doubt about it. The message that I was hearing–whether it’s an AA message or not–is that because of my lack of ego strength, AA was the only safe place for me. And my experience was: ‘if you fail at this, David, you failed at everything. Even not just sobriety. You failed at connecting with people. You failed at life.’”

    But he hasn’t failed and today, 14-plus years sober and calling himself “recovered,” Bohl is embarking on a journey to create individual recovery services, hoping to help people with substance use disorder and their families. He says he will, of course, connect people to AA—if it’s something that would suit them—but he will also offer all kinds of other recovery options. 

    Alternatives to AA

    If you do decide to leave, there are many alternatives to AA, places where you can meet likeminded people, share your experience, and make social connections just as in 12-step meetings. Currently, I’m attending a group that applies Dialectic Behavioral Therapy (DBT) and offers trauma therapy among its methods. The members are free to respectfully comment on each other’s shares (this is discouraged in AA). In SMART Recovery, which is commonly suggested as an alternative to AA, there is sharing and a sense of community, but there is an official facilitator and you graduate when you’ve completed the program. There is also Refuge Recovery, which uses some Buddhist teachings and meditation, as well as sharing. Secular Organizations for Sobriety (SOS) is a network of groups devoted to sobriety and abstinence. And there are brand-new programs like She Recovers (founded in 2017) that just deal with recovery in general, be it from trauma, an eating disorder, or addiction. Google “leaving AA” and you’ll get hundreds of happily-ever-after accounts, as well as resources devoted to helping you find an alternative method of obtaining and sustaining recovery and making connections with other sober people. 

    I haven’t closed the door on the 12-step program yet. I will still go to meetings and I will keep the friendships I’ve made. But I’m also surrounding myself with other programs, groups, and methods because I need some extra mental-health padding to feel fully realized and like I can rejoin the world, sober. 

    I’ve realized that Alcoholics Anonymous is not the only road to recovery.

    View the original article at thefix.com

  • The Other Side of Service: When Giving Back Becomes Exploitation

    The Other Side of Service: When Giving Back Becomes Exploitation

    Being of service means sharing our story of recovery to someone who is struggling or taking a newcomer to their first meeting, not taking away someone’s ability to support themselves.

    The greatest travesty in our field is exploiting people with lived experience for free labor. Peers and other recovery support specialists should be paid a fair, living wage. -Robert Ashford

    I have lost count of the number of times I’ve been asked to provide some kind of service — giving a talk, organizing an event, facilitating a panel discussion, attending and supporting a conference, writing a blog, or reviewing a website — for no pay, under the guise of giving back to the recovery community. 

    There is this notion within the community that because we found recovery, we should show our gratitude by giving back. This thought process originates from 12-step fellowships — specifically Step 12: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” 

    Exploitation Presented as Service

    The literature goes further to suggest that our recovery is incumbent upon that giving: “The joy of living is the theme of A.A.’s Twelfth Step, and action is its key word. Here we turn outward toward our fellow alcoholics who are still in distress. Here we experience the kind of giving that asks no rewards. Here we begin to practice all Twelve Steps of the program in our daily lives so that we and those about us may find emotional sobriety. When the Twelfth Step is seen in its full implication, it is really talking about the kind of love that has no price tag on it.”

    But asking someone to work in the recovery space for free isn’t service — it’s exploitation. 

    That statement sounds harsh, but I’ve found it to be true. And I learned the hard way. I found my recovery in a 12-step fellowship, and I dutifully gave back in abundance: I had several service positions at two to three meetings for the majority of my first five years. I’ve held literature, chair, secretary, treasury, and coffee/tea person positions. I have sponsored. I have learned that when you give, you also commit to regular attendance and are there to help newcomers. 

    While I don’t dispute that service helps others and is helpful for continued recovery, there comes a point where it can have a detrimental and potentially harmful impact. 

    I found that people began to take advantage of the commitment I made to show up. They did not arrive to perform their own duties, leaving me to do their jobs. Sometimes the coffee person showed up at the start time of the meeting rather than earlier as planned. A literature person would only show up halfway through the meeting, or not at all, and treasurers would show up at the end of the meeting. So I had to set up the room, unpack and set out the literature, make tea and coffee, buy milk, welcome the newcomers, and start the meeting. This was a regular occurrence, and I thought it was my duty to put up and shut up. I did this for many years, until I got fed up and realized that I wasn’t there to carry other people: I was there to support my recovery. 

    When I left AA I felt a tremendous relief. There was a lot about the program and fellowship that didn’t work for me. I was able to leave and find a pathway that was better suited to my needs. In doing so, I realized a number of truths, one of which is that my recovery isn’t incumbent upon what I give away for free. My emotional sobriety and sustained recovery depend on my continued development — in therapy, and through various other means of self-development and care. 

    The problem of service is not isolated to the rooms of 12-step meetings. It is an issue that is prevalent in the recovery community at large: there is an assumption that if you inhabit the recovery space within any capacity, you can rightfully ask someone to provide a service for free. I’m not talking about sharing at a meeting, hospital, or other institution, I’m talking about the request to provide professional help for free in the name of service. 

    I have lost count of the number of times I have been asked to write for free, to attend a conference and speak (and to pay for the ticket to the conference as well as all other travel expenses), to interview someone on my website or promote someone’s product or service, and to provide my online content expertise by reviewing business websites. All with no compensation offered. On the contrary, I was expected to provide these services for free, and the underlying presumption was that I should feel grateful to do it.

    I learned the hard way that while I want to help out anyone who is trying to pursue their dreams, I cannot do that at the expense of my well-being. I burned myself out by saying yes all the time. I also kept my earnings in a low-income bracket because I was afraid to say no. How would that reflect on me and my recovery? I was terrified that someone would think I wasn’t willing to help another person in recovery, or that I wasn’t grateful for what I had been freely given to me. 

    But here is the important difference: I wasn’t being asked to give back the hand of recovery; I was being asked to perform a specialized professional service — using the experience that I have gained by working incredibly hard (mostly seven days a week for several years) — for free. The irony is that these requests typically come from organizations and employees who are paid. An event, for example, generates income and typically has sponsors. Many of the attendees at these events work for organizations in a paid position and are given the luxury of attending during work time or are sponsored or paid to attend. These employees also have benefits: health and dental insurance, as well as paid leave. 

    What makes this particularly hard to digest is that many of these grassroots organizations are advocating for the better treatment of people in recovery and with substance use disorder, but they are unwilling to instill those values by paying the people who work to further their cause. 

    Placing Value on Expertise

    I am a full-time freelance writer and content strategist. The only way I pay my bills, and the exorbitant fees of running a business, is by getting paid for the work that I do. And often this involves having to negotiate fair pay from highly profitable businesses within the recovery industry — where executives earn six figures — because they do not value or understand what goes into being a writer. I haven’t had a vacation since I have been self-employed, and I pay for my own insurance.

    Apart from the role recovery culture plays in the idea of labor as service, I think the expectation of free labor also comes down to a lack of knowledge, value, and respect for the role of writers and what we do. 

    Writers don’t just sit down and the words flow onto a screen in 20 minutes. We spend hours, days, and weeks formulating content. We put in the emotional labor of transforming our emotions and experiences into words that others can relate to. We spend months — years even — developing relationships with researchers and other stakeholders within the community to provide reliable sources of information. We do research in order to gain different perspectives. And then we go back to the work and rewrite it, again and again. It is beyond a full-time job. The same goes for speaking: it takes time and energy to prepare and deliver a speech. I could write an entire essay on how long it takes to develop regular business, too. Work doesn’t just fall into our laps. 

    So if you work within the recovery industry, before asking someone in your community to do something for free, ask yourself whether you would do it for free if you didn’t have any other source of income. Ask yourself if you would ask any other professional to do that for free. When you ask someone to attend and participate in your event for free, ask yourself if you are taking away that person’s opportunity to pay their bills by working for someone willing to pay them and show respect and value for their work. 

    The True Meaning of Service

    I think it’s time that we revisit the true meaning of service: sharing our story of recovery to someone who is struggling. That means sharing at a meeting, or taking a newcomer to their first meeting. It doesn’t mean taking away someone’s ability to support themselves.

    That said, I am still here because some organizations do value my work. Others take note of my boundary that I won’t work for free and change their perspective. Then there are some community organizations that are already leading the way, like the Alano Club of Portland. Executive Director Brent Canode says, “As a recovery community organization, we feel a moral obligation to pay our dedicated staff fair and competitive wages for the important work they do to support recovery in our community. Our industry has a checkered past when it comes to labor standards and capitalizing on the free service of recovering men and women who naturally want to help others. We must always strive to set the bar high when it comes to valuing our recovery workforce because who else is going to if we won’t?”

    View the original article at thefix.com

  • 6 Amazing Benefits of Giving Up Alcohol and Joining a Sober Community

    6 Amazing Benefits of Giving Up Alcohol and Joining a Sober Community

    We no longer look for short-lived highs followed by compounded messes and erratic emotions. In our willingness to be present, to be aware of our inner lives, step by step we create the lives we really want to live.

    Hi, I’m Karolina and a proud member of the sober community. I didn’t really think I’d ever find myself here. Sure, I had a love-hate relationship with alcohol that filled me with more hate after each hangover, but who doesn’t? I didn’t identify as a “problem” drinker as a lot of my drinking looked like what everyone else was doing. Was I even allowed to quit?

    And yet there was that unease, that cognitive dissonance; I knew I was made for more than hangxiety and regret. After years of feeling stuck, I finally tried sobriety as an experiment and fell in love with my new life. It turned out everything I truly wanted was just on the other side of my fear: happiness, purpose, friendships, love, and growth.

    And so here I am. I’m not in AA or traditional recovery (although I’ve been working on my self-development through other tools, books, and community groups since I quit). I don’t relate to words like “relapse” or sayings like “one day at a time.”

    I wondered: did I fit in here? Into this landscape of sober people? For a long time, I didn’t even like using the word “sober,” because it felt so antithetical to what I was experiencing in my alcohol-free life. I was discovering joy(!) and gratitude, not somber misery. Why was it painted to me so grimly before? This was life in HD technicolor.

    The love I have for my new life is the result of the connections I’ve made with sober women and men. In all the other associations and lives I’ve led, I have never found such an openhearted, empathetic group of support and friends. Adding my own voice to the sober community and sharing advice with those who are still on the other side of fear has given me a new purpose. A sense of place. A calling.

    And yet it’s such a diverse space. We all have different stories, different identities, and life experiences. And we use varied methods and paths to find our happier selves. Some of us are in AA, some of us make our own way. Some of us have experienced deep trauma, others are the epitome of privilege or luck. Some of us turn to logic-based approaches, while others turn to spiritual ones.

    We may have our own unique paths, but we have so much more in common:

    1. We No Longer Settle

    We knew it well. Waking up frazzled, in pain, sad, and ashamed. Is it possible to have a hangover without having an existential crisis at the same time? Who was that person last night? Why did she do this to me? I can’t keep on like this. And yet it keeps happening, because alcohol is our plus one. The world told us to drink. We listened. And even though it feels miserable at times, drinking seems safer and easier, a comfort zone of sorts.

    And then one day it hits us. Screw “safe” and “easy.” We stop settling for hangovers. We stop settling for complacency. We stop settling for mediocrity. And it trickles down into our lives, because when you stop asking yourself if your life is okay and instead ask if it’s actually fulfilling, you get to the real heart of the matter.

    2. We Look for Deeper Connection

    Scientists say humans are prone to addiction when they are isolated and lonely. And what’s lonelier than pretending everything is fine? Or fake friends forged over boozy conversation that you can’t remember the next day? It’s a disconnection that hurts our souls, and once we go sober, it doesn’t stand. We can no longer fake it, and we open up to the vulnerable inside us.

    We look for real connection, with people who really see us and honor our life. We strengthen bonds with loved ones, free to finally be comfortable in our skin instead of always looking for something outside of us to find comfort. And we look to see our empowering lifestyle reflected in other badass men and women. The friends I’ve made in the sober community have completely transformed my life. It’s a space designed for love and support, ever growing with enthusiasm. Just look at the sober parties, the meetups, the community groups. We are hungry for the real deal of connectedness, and not the flimsy social glue served in a cup.

    3. We Are Present in Our Lives

    Life comes with feelings and stressful situations and doing hard things. And it also comes with joy and meaningful development and growth through adversity. Instead of being present with our feelings, we’re taught to have a drink, release a chemical reward, and numb uncomfortable thoughts. Abracadabra, instant gratification. A drink, the easiest solution to not deal with your life. And to train your brain to look for the easy rewards, to find entertainment so passively, you literally just sit on the couch.

    But screw “easy,” we said. We want to be active agents in our life. We want to create, build, dream, and we want to feel. We no longer look for short-lived highs followed by compounded messes and erratic emotions. We embrace the uncomfortable and do hard things. Because that’s how you build your dream life. In our willingness to be present, to be aware of our inner lives, step by step we create the lives we really want to live. Finding gratitude, awe, beauty and the fulfillment that comes with awareness of your true desires.

    4. We Rebuke Societal Conformity

    How many people wouldn’t dare refuse a social drink for fear of standing out? Or because they worry others would assume they have a problem?

    We sober folk not only have the bravery and courage to say no to drinks at cocktail parties, and networking events, and lately even yoga studios, but we also say no to societal conformity and the whole idea that alcohol is requisite to a fun and fulfilling life. Who said? Who profits when we believe this? We don’t and instead we question that entire line of reasoning and find our own self-actualization instead. When you look past societal pressure and a desire to fit in, you can find your true voice. It’s not just passing up a drink at the company happy hour. We don’t want to be like everyone else. We want to be exceptional.

    5. We Smash Our Self-Limiting Beliefs

    If we can quit alcohol, our Achilles heel, in a booze-soaked society, we can do anything. And we finally start to believe this ourselves. My love-hate relationship with alcohol led me to believe a number of things that weren’t inherently true about me: that I couldn’t have fun without booze, that I was awkward at socializing, that I couldn’t do hard things like run long distances or launch a business. And that most of all, I couldn’t go against the grain and opt out of drinking.

    But I did it anyway. I smashed my self-limiting beliefs about alcohol, giving me the courage and confidence I needed to do a whole host of things I was scared of. I’ve seen it all around me in the sober-sphere. We speak up, write books, launch businesses, share our stories, run marathons, show our children healthier coping skills, and do so many things that our drinking selves were way too stuck to even attempt.

    6. We Know the Art of Transformation

    Our lives are masterpieces. We came here to expand our souls; we were meant to evolve and grow. And the role alcohol played in our lives and the ways we surmounted that allowed us to completely change everything. Most people say quitting alcohol was just the very first thing. The foundation that allowed everything else to fall into place. Our lives are dedicated to health and well-being and love and connection that not too long ago were overrun with shame and despair and insecurity. We practice gratitude and self-acceptance and self-love.

    That’s the art of transformation and we know it well. We feel such hope and possibility for anyone coming to the same questioning about alcohol in their lives, because we know how much happiness and fulfillment lies on the other side. Change is scary and uncertain. And yet by letting go of what no longer served us, we completely reinvented our lives for the better.

    From the very outset, I’ve been in awe by the bravery, whole-heartedness, and full embrace of life I’ve seen here. That set my aspirations way above a happy hour and allowed me to completely reinvent my life. Thank you for welcoming me.
     

    What joys and epiphanies have you experienced in your new sober life? Tell us in the comments: What would you add to this list? 

    View the original article at thefix.com

  • Everybody Knows: 10 Lessons from 10 Years of Sobriety Without AA

    Everybody Knows: 10 Lessons from 10 Years of Sobriety Without AA

    In early sobriety, someone told me that since I’d gotten sober without AA, I wasn’t an alcoholic, and that since I didn’t go to meetings and ate the occasional mushroom, I wasn’t sober.

    On May 26th, I celebrated ten years of sobriety. People have found my story noteworthy because I got sober without rehab and stayed sober without AA. I don’t understand my story to be a unique miracle; in my travels in the last ten years, I’ve encountered a lot of folks with similar experiences. But I struggled in early sobriety with no roadmap for recovery. Much of what “everybody knows” to be true about alcoholism, getting sober, and recovery simply did not apply to me.

    Here’s what I learned as I forged my own path and created my recovery. Whether you’re deeply immersed in sobriety, newly sober, considering getting sober, or just feel like the structure of AA isn’t serving you, I hope this will help. 

    1. You Don’t Need to Be an Alcoholic in Order to Stop Drinking

    Seems obvious, doesn’t it? But when the monolithic sobriety support group that eclipses all others has “alcoholic” in the title, it’s a small logistical leap in the mind of someone reluctant to quit drinking.

    “It says ‘Alcoholics Anonymous,’ and I’m not totally sure I’m an alcoholic, and everybody knows that AA is the only way to get sober so… let’s do shots!”

    After 17 years of problem drinking, I still wasn’t certain I was an alcoholic. I’d filled out questionnaire after questionnaire — haven’t we all? Sure, there were a few warning signs: I’d blacked out repeatedly and I’d pissed the bed repeatedly and I drank alone and I sometimes drank in the morning and my life had become an uncontrollable mess… But there were still a lot of loopholes. Several times, I had been able to quit drinking for a week or a month or a couple months; once even a year. I didn’t drink at work or show up late or call in sick. Sometimes I was able to have one drink and go straight home (usually when I was already so hungover I felt like my heart was going to stop, but they didn’t ask for those specific details in the questionnaire). 

    For simplicity, I’ve winnowed all those questionnaires down to one question: Would your life be better, easier, more manageable if you stopped drinking? If the answer is yes, then stop drinking, just for a month. If you can’t do it, then yes, you’re an alcoholic and you need to stop drinking. And if you can, why not just go another month? And then another? Once you’ve been sober for nine months, then let’s tackle the scary question of whether you’re an alcoholic or not. I think I’d been sober for nearly a year before I could cop to that ugly word and by then I was so entrenched in sobriety that there was no turning back.

    2. AA Does Not Define Alcoholism or Sobriety

    In early sobriety, someone told me that since I’d gotten sober without AA, I wasn’t an alcoholic, and that since I didn’t go to meetings and ate the occasional mushroom, I wasn’t sober. This neatly dismissed my life-defining problem, my hard-won solution, and the humiliating, laborious hell I had endured in order to find a solution to my problem. I wish I’d had the confidence to respond with one word: bullshit.

    The Oxford English Dictionary defines alcoholism as “addiction to the consumption of alcoholic drink; alcohol dependency.” It defines sober as “not affected by alcohol; not drunk.” Dependence upon AA is not specified as a requirement for alcoholism. Nor is there any mention of attendance at AA as a necessary qualifier for sobriety. Another secretive society that tries to own both the illness and the cure is Scientology, which is to say these tactics are the mark of a cult. If you have accepted that you’re sick and you recognize that you are getting better, do not let anything slow you down.

    3. If You’re Waiting to Hit Rock Bottom, You’ve Stumbled Into Something Worse

    “Everybody knows” that an alcoholic has to hit bottom before they’re ready to quit drinking. A friend once marveled to me that I plowed through life-changing experience after life-changing experience without changing at all. Similarly, I endured low after low without making any corrections.

    A staple of my childhood cartoon viewing was The Mighty Hercules, a low-budget animated series created in the 60s that played early mornings on public access TV in the sticks in Canada where I was born. Nearly every episode revolved around the evil wizard Daedalus nearly destroying Hercules before he put on his magic ring and… listen, it hasn’t aged well. But the show was my first introduction to the concept of a bottomless pit, this horrifying sensation of falling for all eternity.

    That bottomless pit is where I found myself in early 2009. The Handsome Family neatly capture the alcoholic’s escapist conundrum in the final lines of their song “The Bottomless Hole”:

    And still I am there falling, down in this evil pit / but until I hit the bottom, I won’t believe it’s bottomless.

    I never found bottom. Mercifully, I had the realization one day that I never would, that I would just keep falling. In terror, I stopped immediately. I never went back.

    4. There Is No Singular Epiphany, No Billboard From God Stating YOU MUST CHANGE YOUR LIFE

    When I quit drinking, I had no inkling that I was quitting for good. I just knew that I couldn’t go on. I put a couple of days together, then a couple weeks, then a couple of months. After ten years, yes, I recognize now that I was quitting for good. But it wasn’t because I knew the next bender would kill me. It was an accumulation of small grievances that, in aggregate, made me want to die. I always had a headache, I never had any energy, I was always nauseous, I had exhausted all excuses and apologies beyond reason, I had no prospects, I knew my drinking life was unsustainable, and I couldn’t see a future. You can waste your entire life waiting for that crystalline, cataclysmic epiphany. Instead, I made a big change for small reasons and discovered a new life.

    5. Cry As Much As You Can

    Quitting is hard. Jesus, before you even get to quitting, life is hard, mornings are a hell both reliable and surprising, working for a living is a sustained slow-motion nightmare. Quitting drinking is admirable and you should not be expected to suffer in stoic silence. It’s okay to feel sad, it’s okay to get mad, it’s okay to mourn your old life and fear the future and hate yourself. Soak your pillow every chance you get. Eventually, you’ll run out of tears. You’ll cry yourself dry and you’ll have to get on with the living.

    6. Quitting Drinking Immediately Makes You a Hero, But It Doesn’t Immediately Make You a Good Person

    In early sobriety, I was lost. I was depressed, humorless, anxious, silent as a stone, exhausted and insomniac, quietly fuming and easily enraged. I imagine my friends hoped I wouldn’t relapse… and also prayed I would so they could bear to hang out with me again.

    Be generous and forgiving with yourself as you ride out these extended unpleasant withdrawals. Be forthright with your peers if you can, and ask them to be generous and forgiving with you. Getting sober is to be admired and supported even in the ugliest phases. In the first few days, the first few weeks, even, let it be enough just to not drink. The rest will come, in time.

    7. Emotions Are Temporary

    The word “emotion” is comprised mostly of “motion,” which is to say emotions are always in flux, storming into us with no warning and often retreating as suddenly. I had poison ivy often as a kid and I learned that cold water temporarily lessened the itching, but if I could submit myself to a blazing hot shower and moments of torturous itching, the heat burned the itch receptors out and then I’d feel no itching at all, sometimes for hours.

    In early sobriety, I was subject to unexpected attacks of fury or terror or paralyzing sadness. Fighting the feeling only prolonged it, sometimes for the entire day. Sitting in it, marinating in the negative emotion —actively trying to get as mad or scared or sad as possible for as long as possible — burned through it quickly and released me.

    8. Every Illness Is a Physical Illness

    Mental illness lives in the brain… but the brain lives in the body. If you deny a schizophrenic water, dehydration will end their life before mental illness can even damage it. I once made the mistake of posting a Bill Philips quote on my Facebook — “Food is the most widely abused anti-anxiety drug in America, and exercise is the most potent yet underutilized antidepressant” — and watched my feed catch fire, my friends suffering from mental illness protesting that they didn’t need to go for a walk in the woods, damn it, they needed their pills, and how could I diminish their suffering?

    Mental illness is real. But if you smoke cigarettes, pound coffee and soda and energy drinks, eat Burger King and Sour Patch Kids and lie on the couch in front of the TV all day, you won’t need mental illness in order to feel insane. I have clinically diagnosed anxiety and depression. When I got sober, I treated it with anti-depressants… and exercise and sunshine and tons of fresh fruits and vegetables and vitamins and lots of water. I’ve been off meds for years now, but I think getting a clinical diagnosis and a prescription for psychiatric medication were integral to my early success. If you need medication, by all means, take your meds and feel proud for practicing self-care. But caring for your body — exercise, sunshine, sleep, fresh fruits and vegetables, lots of water — helps everything.

    9. Getting Sober Doesn’t Have to Mean Being Reborn; Reinventing Yourself Is Optional

    I wanted to quit drinking for years but I feared AA and “inspirational” sobriety so much that I was willing to endure the worsening horrors of my alcoholism. When I finally stopped, I certainly didn’t feel like an image on Instagram of a sun peeking through clouds. I felt shell-shocked, with no idea who I was. Could I still laugh at dick jokes? Could I still resent America and fear capitalism and think the world was basically full of shit? Could I still play in fun, dumb, dead-end bands and listen to the Murder City Devils and flip off assholes who cut me off on the BQE? Yes, yes, yes.

    Sobriety doesn’t come with mandatory enrollment in some flowery cult of positivity. Making the decision to quit alcohol means that and only that, everything else is optional. Sobriety and long-distance running helped soften my dead-end nihilism and my contempt for humanity but that’s because it was a change I elected to make. After ten years of sobriety, I’m healthier and happier and less self-loathing but still largely the same cynical prick I was before, because that works for me. 

    10. There Are No Straight Lines in Nature, There Are No Straight Lines in Recovery

    In my ten years of sobriety, I’ve infrequently used marijuana, mushrooms, DMT, MDMA, prescription painkillers, etc. Pot has always felt like a flawed way to unwind, usually just a waste of time. CBD, on the other hand, has been tremendously helpful for managing pain and getting to sleep at night. Mushrooms have been integral to my sobriety, and I honestly believe they’ve made me a better person. DMT was painfully intense and deeply transformative, too complex to describe as “good” or “bad” but I’m grateful to have done it. None of these substances have ever made me crave alcohol. Painkillers have gotten me through muscle spasms and surgery and MDMA has provided great connection with people I care about, but neither has felt particularly therapeutic and both have left me depressed and craving alcohol at times.

    Though some of these experiences have not supported my sobriety, none of them have compromised my sobriety. I am a pure alcoholic and I know one drink would be my undoing. But as my sobriety is solely my creation, I own it. I define its parameters.

    Two months after my “official” sobriety date in 2009, I flew out to Colorado for three days to play a music festival. I got drunk before my flight and stayed drunk the entire weekend. I blew an important show, I embarrassed myself in front of a woman I’d had a crush on since we were kids, and I threw up scotch out of my nose on the street. I drank on the flight home but when I woke up the next day, I went right back to sobriety and haven’t taken a drink since.

    When I tried to write about this episode in The Long Run, my first narrative about getting sober, my editor took it out. When I wrote it into a book proposal, my agent took it out. When I wrote it into my memoir, I Swear I’ll Make It Up to You, my editor took it out. People love this bullshit Hollywood narrative of “hopeless alcoholic hits bottom, has a lightning bolt epiphany, and goes forth to never drink again.”

    Fuck that. Getting sober is a messy process. Stick with it, it’s worth it.

    View the original article at thefix.com

  • How AA Hijacked Addiction Science and Came to Dominate Treatment: An Interview with Joe Miller

    How AA Hijacked Addiction Science and Came to Dominate Treatment: An Interview with Joe Miller

    The scientists at Yale liked what AA did, but they did not by any stretch think that AA was a cure-all for alcoholism. Neither, by the way, did Bill Wilson.

    Back when he was struggling to control his drinking, Joe Miller failed on a nightly basis. He would get stumbling drunk every evening, and suffer through every day. His treatment providers all delivered the same message:

    “Go to Alcoholics Anonymous.”

    That was hardly surprising advice — AA has long dominated alcoholism treatment in the United States. But Miller, an English professor at Columbus State University in Georgia, eventually learned that numerous other options were available to him at the time, such as Naltrexone, SMART Recovery, and Moderation Management. Why hadn’t anybody mentioned them?

    That is the question that Miller sets out to answer in The Us of AA, a slender, provocative book that tells the story of how Alcoholics Anonymous grew into the gargantuan organization that we know today, even though some evidence suggests that other treatments may be more effective.

    Miller is not “anti-AA.” He believes that there is little to be lost — and perhaps much to be gained — by trying 12-step solutions. But he adds that alcoholism is more complex than the AA model suggests. Miller holds that problem drinkers should explore an array of potential strategies, not just one. Though he writes with powerful indignation, The US of AA is not a tendentious or overly polemical book; it is based on careful analysis of a huge and diverse range of sources.

    I had the pleasure of speaking to Joe by phone on May 11, 2019. This interview is lightly edited for length and clarity.

    Many people know a bit about how Bill Wilson helped start Alcoholics Anonymous, but you argue that Marty Mann may have played a more pivotal role in building AA. What do we need to know about her?

    Absolutely, I think she is largely responsible for our nationwide concept of alcoholism as a disease, and our idea that AA is the go-to cure for alcoholism. She ran one of the most brilliant PR campaigns of the 20th century. She helped build a huge network with local chapters across the country, which distributed information at the individual level and the community level, [then progressed] to lobbying in state houses, and eventually, the federal government.

    Alcoholics Anonymous has the 11th Tradition, which states, “Our public relations policy is based on attraction rather than promotion.” But Mann started out being a spokesperson for AA in the New York area — she was an excellent public speaker — and during that process, she developed a vision for a national campaign that would bring about a new understanding of alcoholism.

    You say in the book Marty Mann, and others in AA, were adamant that alcoholism should be understood as a disease.

    Yes. From the beginning, that was part of AA’s cure mechanism. AA said that alcoholism is not a moral failing. Rather, it’s an indication that something is wrong with you physiologically or psychologically (or some combination of the two). It’s beyond your control. You need to believe this is a disease.

    One thing Marty Mann did was reach out to a scientist at Yale, named Bunky Jellinek, who was kind of an odd character. (There’s some mystery about whether he had even earned a college degree.) But, by all accounts, he was an extremely energetic person, really passionate about the problem of alcoholism, and he seized upon Mann’s idea. He says, “Okay, we can have this PR campaign and it will help shore up our scientific research. We’ll sell the public on alcoholism as a medical problem and not a moral failing, and this will help us.”

    To boil this whole story down, the scientists got the cart before the horse. They didn’t have the money to research their theory that alcoholism was a physiological disease, but they got behind that idea, so the money would come. Then, when the money came, they learned that alcoholism was far more complex than the model they were using. The scientists at Yale liked what AA did, but they did not by any stretch think that AA was a cure-all for alcoholism. Neither, by the way, did Bill Wilson.

    That was something I learned in your book. I was surprised by Bill Wilson’s intellectual humility.

    All throughout his career, he could see that AA was not working for everybody. He worried about AA beliefs hardening into dogma, and he said “Just because something works for us, that doesn’t mean it will work for everyone.” Some of his later work was devoted to trying to find ways to get people other types of help.

    All along, the folks who were not beholden to AA’s story — i.e., the scientists who weren’t — had the sense that alcoholism is this really complex problem, which could be approached in numerous ways. At Yale, when Marty Mann was doing her campaign, researchers were developing treatment programs in Connecticut — some pilot programs. And AA was just one small part of them. It was very much like what science nowadays says is the way to go: You’ve got to use an array of different approaches to tackle alcoholism. It’s different for everybody.

    Today, many treatment programs are rooted in AA doctrine. And you say in the book that some forces in the treatment industry actively tried to suppress other approaches to helping people.

    It actually goes back to the 1960s. This psychiatrist in England, named D. L. Davies, found that a significant number of patients who went through alcoholic treatment programs later resumed drinking at levels he described as “normal.” He wrote a paper on his findings, and a number of big players in the AA movement disputed the study. One of them was Marvin Block, a doctor from Buffalo who had spearheaded the AMA’s (American Medical Association) campaign to recognize alcohol as an illness. Block said, “Well, the [people who learned to drink normally] must not be real alcoholics,” even though these men had been hospitalized for severe drinking problems.

    Another example is Mark and Linda Sobell. They did a study where they trained people in moderate drinking, and they found that a significantly higher number of them fared better [after practicing controlled drinking] than those in AA. Afterward, there was a fierce attack against them, which was publicized on 60 Minutes. It almost cost them their jobs, and it really set back any work in the area.

    My pet theory is that sobriety spreads in AA through “social contagion.” If a person who is discouraged about their drinking walks into an AA meeting, they’re likely to find a large group of people who have enjoyed substantial periods of sobriety, and who are willing to help them. I think people in AA are mimicking each other’s behaviors and attitudes – just like we do in other phases of life.

    I’ve had two quite long stretches of sobriety in AA, one when I was in college, in Boulder, Colorado, and another for about seven years in the 2000s, in Kansas City. In both cases, it was because I had strong social connections, and healthy routines. In Boulder, the meetings were almost a pretext for us to go out and socialize afterward. For the most part, I found the AA meetings in Kansas City to be insufferable. But there was a meditation house nearby, and after meditating, we’d go out for Mexican food afterwards. And that was enough to help me stay sober.

    But AA itself did not work for me. Especially after going through the steps, and really working them hard — and I really freaking worked them hard! — and hearing people say, “After you do that fourth, boy, it really changes your life.” And hearing them say that, over and over again. I just thought, “No. I do not believe this. It’s fine for you, but I just don’t believe in it.”

    In a recent New York Post article, you talked a bit about your drinking habits now. You practice moderation, but you say it takes some effort. Can you explain?

    It’s going well. I don’t take Naltrexone anymore, but that drug really helped disrupt my drinking patterns. I would take it and almost magically, I would drink about 50 percent less in a night.

    I combined that with that an app called CheckUp & Choices, which was developed by a psychologist, Reid Hester. That’s a kind of cognitive behavioral therapy app, where you do a very extensive questionnaire that gets you thinking about the situations in which you get triggered, and when you drink, and how much you drink. It helps you keep track of your frame of mind about drinking. Exercise is also a key part of my program. Having my spouse on board with this is also huge — evidence suggests this can make a difference, if you have spousal support.

    If you were to find out down the road that this approach does not work for you — if, heaven forbid, you fall back into full-blown alcoholism — are you confident you’ll be willing to revisit your approach?

    Yes. But I don’t see that happening. I see the opposite. I see, down the road, no drinking at all. That’s the direction we’re going. The direction is continually toward drinking less.

    I share many of your thoughts about AA. Sometimes I even have doubts about its strict emphasis on total abstinence and continuous sobriety. I heard a segment on NPR last week suggesting that AA’s chip system may even be counterproductive, because it can cause people who slip up in the program — or who drink very occasionally — to feel demoralized and ashamed. And as any treatment provider will tell you, those are precisely the feelings that may lead to even more drinking.

    That said, I think AA’s line about alcoholism being “cunning, baffling and powerful” is spot-on. People who struggle with addiction or alcoholism are prone to rationalization and self-deception. Everyone is a bit different, but it is obvious that some people should simply never drink under any circumstances whatsoever. If they do drink, the consequences can be devastating. This seems to me a difficult and tricky subject.

    I think the best answer to this is something one of the psychologists I interviewed said to me: if AA works for you, that’s the easiest and most effective solution. Similarly, with moderation, many people find in time that it’s much simpler to just stay away from that first drink than it is to try to control drinking.

    But if you look at large-scale statistics on drinking and recovery, most problem drinkers do not follow the traditional AA path of complete abstinence forever. Even those who are in AA for a while, working the steps and staying sober — statistics show that many will one day have another drink. What’s most dangerous in these cases, I think, is the belief that one drink will lead automatically to alcoholic behavior. That might be true for any given individual, but it’s not the truth for all, and studies have shown that believing it’s true tends to make it true.

    Purchase US of AA: How the Twelve Steps Hijacked the Science of Alcoholism on Amazon. For more about the book and its author, check out Joe Miller’s website.

    View the original article at thefix.com

  • 12-Step vs SMART Recovery: Are You Powerless or Making a Choice?

    12-Step vs SMART Recovery: Are You Powerless or Making a Choice?

    The problem with powerlessness is that it becomes all-encompassing and paralyzing. But the idea that addiction is a choice fails to consider many people’s experiences. Maybe there’s a middle ground.

    As someone who attends (and serves/facilitates) both 12-step and SMART meetings, I am struck by how often they are seen as presenting two very different belief systems about addiction. Although I know many recovering people who attend both, or have swapped one for the other, it is generally decreed that they hold completely opposing views. Though both are mutual aid groups based on the premise that connection with others in recovery can strengthen one’s own recovery, 12-step fellowships are based on a program of spiritual principles, while SMART recovery uses an evidence-based, cognitive-behavioral approach.

    Similarities and Differences

    While there is some overlap in the programs themselves — mindfulness in SMART correlates with the 11th step, and SMART’s thought-challenging worksheets are like 10th step inventories — their starting points could not be more different. Step One states that we are “powerless” over our addiction which is often explained by the disease model, even though this was never the original intention of the founders of AA, the pioneering 12-step fellowship. When we are in active addiction, we have lost the power of choice and cannot overcome our addiction alone. SMART takes a different view. Focusing on empowerment rather than powerlessness, we are encouraged to take ownership of our choices and behaviors. Without shaming anyone for their irrational choices, addiction is still ultimately a choice, not a disease.

    The debate between these two approaches has raged for decades, with most people coming down on one side or the other. My intention here is not to rehash these arguments but rather propose that instead of an either/or dualism, concepts of powerlessness versus choice are instead opposite ends of the same spectrum. For many, the truth of their lived experience may be somewhere in the middle, and polarizing views can lead to many people — certainly myself included — feeling that neither viewpoint really “fits.” This is important, because this ongoing debate influences how we treat, perceive, and support those recovering from addiction.

    The Problem with Powerlessness

    The problem with the concept of “powerlessness,” as understood in the context of the 12-step program, is that it becomes all-encompassing. Not only are we said to be in a state of powerlessness when we are in the throes of active addiction and finding it seemingly impossible to stop – an experience many former addicts will recognize all too well — but the dogma that has grown up around the concept over the years tells us this is a permanent state. We will always, even after years of sobriety, be powerless over our addiction, the threat of relapse forever hanging over us and ready to descend the moment we stop attending meetings, working the program, or listening to our sponsor. Neither is our addiction the only thing we are powerless over — we also have no power over “people, places and things.” While this can be a useful maxim in terms of reminding us that we cannot control other people or outcomes, it can also become stultifying, leading to apathy and a sense of complete dependency upon the program. In this view, the second line of the oft-quoted Serenity Prayer — the courage to change the things we can — is all too easily forgotten. 

    Small wonder then that for many, SMART burst onto the scene like a breath of fresh air, telling us that we do have a choice, that we can take ownership of our actions, and that a rational rather than spiritual (assuming that the two are mutually exclusive, an attitude with which I disagree) approach is the best way to recover. SMART claims to have an evidence base, and indeed it does — yet in recent studies it has not been shown to be significantly more or less effective than the 12-step approach. Nevertheless, SMART offers an alternative for those who take issue with being told they will always be powerless. Social justice researchers have pointed out that telling people in minority communities in particular that they have no power and must be dependent on a program forever only increases their sense and experience of oppression.

    Addiction as a Choice Is Equally Problematic

    Yet the idea of addiction as a choice is, I believe, equally problematic. Firstly, no matter how much researchers and SMART advocates stress that a choice model is empowering and should not contribute to stigma, there is no doubt that in terms of the wider society, labeling addiction a choice can all too easily contribute to the criminalizing of those suffering with addiction and substance misuse, not to mention making it easier for insurance or health care providers to refuse to cover the cost of addiction treatment. Also, and this seems to have been somewhat overlooked, blanket statements that addiction is a choice fail to consider the experiences of some significant populations, such as people who are using drugs to self-medicate undiagnosed mental health conditions or to deal with debilitating after-effects of trauma. Simply stating addiction is a choice which they can rationally think their way out of is of little use in such situations and may have the opposite effect, pushing people further into self-destructive cycles. Of course, the 12-step program may also have little to offer in these scenarios.

    If addiction is a choice, it is usually a severely impaired one. Addiction researcher Maia Szalavitz argues in Unbroken Brain that rather than seeing addiction as a chronic disease or a set of bad choices, we recognize the parallels with developmental learning disorders. Like a child with ADHD behaviors, or a teenager caught in a maelstrom of emotional dysregulation, those suffering with addiction (and possibly co-occurring trauma, mental health disorders, or external oppression) find their ability to make rational choices increasingly impaired, until “using” becomes a survival instinct. At this point we may indeed feel utterly powerless. However, we can learn over time to take control back and make better choices.

    Both approaches have something to offer people in recovery — but only if we start recognizing the middle ground and gray areas between the two. It’s time to start tailoring addiction treatment to fit the individual, rather than trying to tailor the individual to fit the treatment.

    View the original article at thefix.com

  • There's Nothing Wrong With You If AA Doesn’t Work

    There's Nothing Wrong With You If AA Doesn’t Work

    It isn’t that you’re incapable of being honest with yourself, or that you’re not working a “program” well enough. You are not too broken, or too far gone.

    I spoke to a friend, Damien, last week. He was devastated at losing someone close to him to alcohol use disorder. What is particularly harrowing about this person’s passing is that it might have been prevented. Damien’s friend was repeatedly pushed toward Alcoholics Anonymous (AA), even though it clearly wasn’t the right fit for him. Just like many others, instead of being supported by peers and professionals and given alternative options, this friend was left feeling that the problem was him.

    “It’s really frustrating to see friends die because the default treatment option doesn’t work for them,” Damien says. “We are losing far too many people with substance use disorder who find 12-step incompatible with their life experiences and belief systems.”

    He goes on to say, “It’s not because they aren’t willing. It’s not because they can’t ‘get it.’ It’s because, for many people, treating addiction requires more than hope, spirituality, and fellowship. And yet, the only option most are presented with is founded on those three pillars. If the recommended treatment for bacterial infections had the same success rate as the 12 steps, then antibiotics would not be our go-to treatment plan for staph infections.”

    My overarching message is: There is nothing wrong with you if AA doesn’t work. It isn’t that you’re incapable of being honest with yourself, or that you’re not working a “program” well enough. You are not too broken, or too far gone. You simply haven’t found the right pathway for you.

    These kinds of beliefs stem from the Big Book of Alcoholics Anonymous, which states: “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.” [emphasis added]

    During my five years of attending countless AA and Narcotics Anonymous (NA) meetings, I have heard many members criticize those who come in and out of the rooms but return to using in between, categorizing them as unwilling, or incapable of being honest. “They just need to surrender to the program and work it like their life depends on it,” was the kind of statement I heard over and over again.

    I threw myself into the program because there were no other options for me in the northwest of England. I was so desperate to find something that would help me that I believed anything members said, even if there was no evidence to back it up. I did a fair amount of perpetuating these myths too. I was instructed to ignore my instincts and critical mind (because that was my “disease talking”), and do what I was told. Giving away my free will to a person in the sky or a church basement seemed weird, but I went with it for several years. After all, it had worked for many other members.

    With a period of sobriety under my belt, I couldn’t ignore my inner doubts any longer. They became louder. It was as though, even after years in recovery, I suddenly woke up. And I started to slowly unpack all the myths I’d been told.

    In particular, I tried to unpack “it works if you work it.” There is substantial evidence that shows there’s no one-size-fits-all method when it comes to recovery. If this program were suitable for everyone with substance use disorders, its success rate would be much higher. The fact is that success rates of 12-step programs vary wildly, from as low as 5 to 8 percent, with dropout rates from 69 to 86 percent, to as high as 42 percent after four years. I should point out that these dropout rates are a reflection of the attrition rates of addiction treatment generally. This underscores the point that the way we treat addiction isn’t appropriate for everyone and we need to get better at personalizing care based on individual circumstances.

    When I moved to the U.S., it was like my world opened up. I saw that despite what I’d been told in AA — that it was the only method for successful recovery — there was actually an open landscape of diverse recovery pathways.

    A leading study shows that tens of millions of Americans have successfully resolved an alcohol or drug problem through a variety of traditional and nontraditional methods. That means:

    • 9 percent recovered with “assisted pathway use” that consisted of mutual-aid groups (45.1 percent), treatment (27.6 percent), and emerging recovery support services (21.8 percent). 95.8 percent of those who used mutual-aid groups attended 12-step mutual aid meetings.
    • Just under half of those who did not report using an assisted pathway recovered without the use of formal treatment and recovery supports.

    I’m aware that an ideal model of treatment, individualized based on the person’s particular medical and psychological needs, is not always available to most people. Not all of us have the luxury of therapeutic treatment from a psychologist or psychiatrist. This is another reason mutual-aid groups are the most accessible form of recovery pathway — they’re free! We’re fortunate in the U.S. to have plenty of other support groups that are not all based on religion, and some have a solid evidence-based program. They include Refuge Recovery, LifeRing Secular Recovery, SMART Recovery, Moderation Management, Wellbriety — among many others listed here — and they have been shown to be equally as successful as 12-step groups.

    A study comparing 12-step groups to alternative mutual aid groups found that LifeRing, SMART, and Women for Sobriety were just as effective as 12-step groups. Study author Dr. Sarah Zemore and her team reported that “findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems.”

    Despite my reporting about AA’s success rate and some of the myths perpetuated by the fellowship, I’m not here to bash AA. I’m here to shine a light on the false statement that it is the only successful way. There are many others. For those AA does work for, I respect your path. We just need to have a clearer picture of what recovery looks like so when someone is suffering, instead of saying they are the problem, we can be better informed to direct them to what may be a more suitable pathway. After all, we all have the same goal: recovery.

    View the original article at thefix.com