Tag: 12-step programs

  • Brad Pitt Praises Alcoholics Anonymous

    Brad Pitt Praises Alcoholics Anonymous

    “You had all these men sitting around being open and honest in a way I have never heard,” Pitt said in a recent interview.

    Brad Pitt may be one of the most famous movie stars on the planet, but when he turned to an Alcoholics Anonymous group in a time of need, he found the compassion and anonymity that he was looking for. 

    “You had all these men sitting around being open and honest in a way I have never heard,” Pitt told The New York Times about the 18 months that he spent attending AA meetings. “It was this safe space where there was little judgment, and therefore little judgment of yourself.”

    Sharing in a Safe Space

    Despite his celebrity, Pitt felt that he could open up in the meetings, without worrying about other people spreading his stories. That helped him heal, coming off his divorce from actress Angelina Jolie. 

    He said, “It was actually really freeing just to expose the ugly sides of yourself. There’s great value in that.”

    Pitt and Jolie reportedly split after an argument about his drinking. In 2017, six months after he got sober, he told GQ, “I can’t remember a day since I got out of college when I wasn’t boozing or had a spliff, or something. I stopped everything except boozing when I started my family. But even this last year, you know—things I wasn’t dealing with. I was boozing too much.” 

    When his drinking was at its worst, he could “drink a Russian under the table with his own vodka. I was a professional. I was good,” Pitt said. 

    He had to make a change, and decided to take control of it. “I had taken things as far as I could take it, so I removed my drinking privileges,” he told the Times.

    Taking Inventory

    Going through his divorce and getting sober forced Pitt to take an honest inventory and face some long-time challenges that he had been avoiding. 

    “The fact is, we all carry pain, grief and loss,” he said. “We spend most of our time hiding it, but it’s there, it’s in you. So you open up those boxes.”

    Part of that was realizing the impact that fame had on him. 

    He said, “In the ’90s, all that attention really threw me. It was really uncomfortable for me, the cacophony of expectations and judgments. I really became a bit of a hermit and just bonged myself into oblivion.”

    Now, he has learned to deal with those anxieties in a healthier way, or to put them out of his head entirely.  

    “Those dubious thoughts, the mind chatter, the rat in the skull—that’s comedy,” he said. “It’s just ridiculous that we would beat ourselves up that way. It doesn’t matter. I spent too much of life wrestling with those thoughts, or being tethered to those thoughts, or caged by those thoughts.”

    View the original article at thefix.com

  • 12-Step Program For Muslims Celebrates 30th Anniversary

    12-Step Program For Muslims Celebrates 30th Anniversary

    Millati Islami, which follows a similar format to other 12-step programs, was established in September 1989 at a mosque in Baltimore.

    Last Saturday (July 27), Millati Islami World Services—a 12-step program for Muslims—celebrated its 30th anniversary in Camden, New Jersey, home to the program’s longest-running chapter in the region.

    “Millati Islami is a fellowship of men and women, joined together on the ‘Path of Peace.’ We share our experiences, strengths, and hopes while recovering from our active addiction to mind and mood altering substances,” according to the official website of Millati Islami World Services. “We look to Allah (G-D) to guide us on Millati Islami (the Path of Peace). While recovering, we strive to be rightly guided Muslims, submitted our will and services to Allah.”

    There’s no shortage of heated debate about the role of religion in 12-step programs like Alcoholics Anonymous and Narcotics Anonymous. Some choose to define their “higher power” as God from the Christian or Catholic religion. For those who don’t subscribe to any religion, secular meetings are available.

    However, one religious group that isn’t often discussed in the recovery realm is Muslims. The Quran advises one to avoid intoxicants like drugs and alcohol. It’s not hard to understand why there would be a stigma against Muslims who struggle with substance abuse.

    “We are a part of this society, and we suffer the good and the bad that comes with the society,” said Ameen Abdur-Rasheed. “And I believe that within the past 10 years, the stigma for Muslims of being an addict or an alcoholic is diminishing because it is so widespread in many of our families.”

    Abdur-Rasheed held recovery meetings for Muslims in West Philadelphia back in 2007, but the lack of attendance meant that he was not able to maintain the group.

    All Are Welcome

    Millati Islami, which follows a similar format to other 12-step programs, was established in September 1989 at a mosque in Baltimore, Maryland. By adapting Islamic principles to the 12 steps, Muslims are provided a program that they can relate to. Nonetheless, they make a point of welcoming all people to the program.

    “We are in the business of saving lives and that’s why we try to encourage everybody of any status in life of any faith to come,” said Stephanie Adams, who is the secretary of the Camden chapter of Millati Islami.

    Adams joined the fellowship a decade ago. “Now Millati Islami has been there for me in some hard times,” she told WHYY. “It helped me through depression, it helped me through heartbreak. The most help I received from Millati Islami was in the last four years because it teaches you that there is nothing that can ever make you go back to using.”

    View the original article at thefix.com

  • Letting Go of Control: How I Stopped Trying to Force Solutions

    Letting Go of Control: How I Stopped Trying to Force Solutions

    Recognizing that I am not responsible for and cannot fix other people’s feelings is powerful; it frees up so much space and time for me to do my own healing and growing.

    When I was a little girl, I remember becoming so overwhelmed with feelings that I would send myself to my room until I could cry through enough of them to clear my vision. If I got in a fight with someone, I would write an apology note and beg them to take it off my hands. I didn’t seek to understand who was at fault, I only wanted to ease the uncomfortable tension. I was sorry it happened and I wanted to undo it. I needed to erase it, but I could rarely get the resolution I was so desperate for. Adults told me: “Not everyone is ready to resolve a conflict as quickly as you.”

    No one told me: “It’s not your responsibility; you cannot fix it.”

    I respond too strongly to my perception of others’ reactions. I always wonder if I read physical and social cues too strongly. I consider the presence, the look, and the tone of voice more important than the content of what they’re saying. Maybe I’m right in my assumption, maybe I’m wrong, but if someone doesn’t want to tell me how they’re feeling, I can’t make them.

    I have lived the majority of my 32 years on earth in this way: A conflict arises and all I want is for the issue to go away and be resolved immediately. If it isn’t fixed, I feel my world is collapsing and I freak out. I cry and panic and become desperate for resolution. My mother recalls that I was predisposed to such behavior in my very early years. She told me that even as a toddler I had these panicky freak-outs.

    I hate the idea of causing hurt feelings, and particularly disappointed feelings, in others. But other people are often more well-adjusted and can handle the blows of disappointment as easily as a ship rises over a large swell. It’s not comfortable, but it’s a normal part of the ups and downs of life. Yet I’ve always handled it like my ship is about to wreck. I know I’ve had feelings of being over-sensitive and disappointed from a very young age. I didn’t want anyone to be mad at me, ever. It’s a part of how I’ve always understood or misunderstood the world.

    I never knew any other existence. I didn’t know that I didn’t have to force a solution. I didn’t know how to balance emotions—I didn’t see it as a possibility.

    My feelings run deep and the current is disproportionately strong. I am headstrong and emotionally reactive. I struggle with the tendency to overreact, but life is not as dramatic as I make it out to be. There are times when I need to be reminded of the true proportions of what is happening, so I can weigh them against my feelings and try to cut some of the excess heft. I’m not exaggerating my feelings; I feel so intensely and so deeply that learning to balance myself in a world that does not feel this way has been a lifelong challenge.

    Imagine a life full of dramatic conflicts, and you can never control the level of your emotions; they always overflow or break the dam. Joy is out of this world happiness and sorrow is the deepest despair. But the ups and downs are consistent and the rocking from one to the other is comforting because it’s familiar. Then, after decades of this you begin to feel different. It’s not overnight and it isn’t that the pendulum has stopped the perpetual swinging. But you feel different, as if now there’s more light than dark. You realize you can feel angry or anxious or sad without flooding or sinking.

    That’s me, right now. I feel generally content and I don’t know what to do with it. The mellow ups and downs of a content – even happy — life feel too safe. Part of me is waiting for the next massive swell. Of course, something will happen, that’s life, but this normalcy that feels so good can sometimes feel so strange. It’s like waking up in a new home and forgetting, for a moment, that you moved there.

    I still struggle with feeling responsible for everyone’s feelings. And the feelings I have are not just imaginary: I might sometimes actually be left out, or I might sense someone else’s sorrow. Someone might dislike me and I might realize it. When I sense tension, it might not be a delusion, but my awareness of it doesn’t mean I’m responsible for it (or for fixing it). Making someone like me isn’t my job. I am not here to be an emotional sounding board for everyone who is suffering.

    Recognizing that I am not responsible for and cannot fix other people’s feelings is powerful; it frees up so much space and time for me to do my own healing and growing.

    My life was so filled with panic and fear; that panic of needing to resolve the issue immediately. I felt that way in any interpersonal conflict, whether real or imagined. I had to force a solution. I felt as if my worth was intrinsically tied to the other person’s acceptance of me. This set the stage for an abusive relationship where the other person never validated me, which further reinforced my own negative self-image.

    I have been discovering my own sense of serenity over the last five years. I started going to therapy and then to a psychiatrist and then to a 12-step program followed by two other step groups. The combination of these different sources of support has changed my life. I don’t feel such intense panic over real or imagined conflict with others. I still feel anxious sometimes, but my response is much healthier. I am becoming more capable of controlling my behavior and my reactions, even when the feelings linger. I can usually put my well-being first and don’t follow through when I get the impulse to explain and rationalize my behavior to others.

    You can’t change other people; you can only do something about your own perspective. I always had the capacity to do that, I just hadn’t acquired the coping tools to handle my own feelings and respond to others.

    View the original article at thefix.com

  • Dear AA, We Need to Talk

    Dear AA, We Need to Talk

    You weren’t straight up so now we’re on the rocks.

    Dear Alcoholics Anonymous,

    I’m leaving you. I’ve had enough after 31 years and that’s not even counting the 2 before that. Oy, those were rocky. You sounded way too Christian with just a spritz of Buddhism thrown in for a twist. We’d be nothing but a sour mix because I’m a devout Jewish atheist.

    “Trust me,” you cooed. “Alcohol is cunning and baffling. I can help.” But when you strongly suggested I pray on my knees, I lost it.

    I screamed, “Jews don’t pray on their knees!”

    You weren’t alarmed but you asked that same old tired question. “How can you be an atheist and a Jew?”

    Before I could explain culture versus religion to you with my secular “bagel Jew” crack, you cooed at me:

    “That doesn’t matter. Anything can be a higher power—a chair or a doorknob. Just as long as you know you’re not it.”

    With an eyeroll, “A doorknob? What’re you, high? That makes no sense.”

    Unfazed, you kept trying to lure me in. “You’ll see the hoop you have to jump through is wider than you think.”

    But, oy vey, the goddamn god stuff left me feeling shaken so I split. Then when alcohol stopped working all together, I ran back. I dreamed about you warming me up like a stiff scotch used to. But instead of giving me euphoria, you said I needed to admit I was powerless over alcohol. If I surrendered this time, you said I could pour my sadness into you. I was lost and you were gentle, so when you told me to close my eyes, I did.

    You asked, “Can you think of anything that’s more powerful than you?”

    “Yes,” I said. “Rain. No matter how much I screamed at the sky, it wouldn’t stop raining.”

    Your face lit up. “You got it!”

    I beamed. “Oh! And the ocean, too,” I said. “Waves will keep crashing no matter what I do.”

    “Right. You’re powerless over alcohol and I can restore you to sanity.”

    Hands on hips, I yelled “I’m not insane!” But I was still shaken, not stirred.

    “You can use G.O.D. as in Group of Drunks,” you reminded me, then led me to a dark church basement where you said I’d feel welcome. But the pathetic coffee left me craving something stronger; I wanted to be under the influence till I was over the limit. Yet, still attracted to the liquor-free confidence there, I decided on the GOD acronym. Until the speaker cracked the Big Book open and read Step 11.

    You smarmy liar! And I was vulnerable, trying to quit getting lit. You gaslit me:

    “To certain newcomers and to those one-time agnostics
    who still cling to the A.A. group as their higher power….”

    Still desperate and confused, I kept going because people were nice to me. At a lunchtime meeting, the speaker talked about her fifth step. It sounded so much like confession I got excited and whirled my head around scanning the room for communion wine. Those early meetings taught me to pray—for a liquid lunch.

    You said it was a spiritual program so I had to accept the idea of a higher power. That nearly crushed me. You really didn’t understand that some people know there isn’t any god. I’d held out hope that you were going to unveil yourself as top shelf stuff but most of the time, you seemed like Mad Dog. Especially when you said stupid shit like, “Your best thinking got you here.”

    I wanted to be with you in the rooms, but most of the time I was dragging my ass around. But now I’m sick of feeling trapped. I hate your smoke and mirrors trickery. Your demand for rigorous honesty can cramp my style. When we almost broke up and I wanted to bolt, I cheated on you with meetings for atheists. The problem was there were so few of them and they were just as dogmatic.

    I can hear your disdain when you call me one of those “unfortunates” who can’t get the program because I’m constitutionally incapable of being honest. Now that’s grandiose. I’m sick of your self-righteous finger wagging at me, saying you’re not judgmental but then labeling me the belligerent one if I challenge anything you say. But come on, the idea of a looming spirit in place of intoxicating spirits is ridiculous.

    Okay, I admit I’m grateful that you always took me back. You’ve been patient and kind and most of all, you stuck by me. But damn it, I’m sick of being barked at for doing things that aren’t suggested. So I’m at a crossroads. The fear of leaving is a biggie. You and all of our friends will pull away from me if I leave you. The pressure to stay feels a lot like the bar pressure to do one more shot.

    If I went that route, at least I could take breaks from feeling everything so acutely while also stuffing down any critical words about you. Whenever I express frustration about how hypocritical you can be, I get looked at with pity: “Poor Dee. She’s taking her will back. Let’s pray for her. It only works if you work it.” 

    I wince at that crap. I refuse to wear a cone of shame if I save a seat, or gossip, or don’t feel like stacking the chairs some days. A lot of people think it’s healthy to fear slipping but I no longer want to fear anything. Peer pressure reminds me of junior high.

    Please quit telling me if I’m upset it’s because I’m obstinate, immature, and willful.

    Uh oh. But what if you’re right? If I leave, would I regress? I never want to be the sorry sot I was before we met. Those stakes are too high. I was afraid to give up alcohol and drugs because I “knew” I needed them. Then you proved me wrong. If I storm out, does that make me a brat who won’t take my medicine?

    You’ve always been a good listener and who else would love me in spite of my god rants? Maybe I am at the right party now. Though I long for the schnockered nights, I ain’t in my twenties anymore. I don’t even know if I could still stay up till four in the morning, much less hit the after-hours until the Tequila Sunrises. Yearning for wild nights of yore could be euphoric recall — rosy as a maraschino on top.

    Maybe staying together is fine after all. We’ve talked so many times about my expectations and you’re right—it’s stupid to blame you for being imperfect. I mean, look at me.

    G.O.D. can stand for good orderly direction, with Buddhism’s tangy flavor: a god within. Now that I’m thinking things through, I suppose a frothy soy milkshake could satiate me more than White Russians ever could. And, seriously, who wants a shit-faced higher power within anyway? No marriage is 100 percent bliss; perhaps I just caught a 31-year itch. My mind easily wanders back to booty calls with sexy bar pickups. Libidos on fire. At weak moments I ache to go back there. Then I snap out of it.

    Truth is, I love Netflix nights chillin’ with decaf chai latte from Starbucks. You’ve been there for me time after time. So, let’s hold up the paper cup. Cheers, AA. I’m not going anywhere.

    What’ll it be tonight? Barfly or Leaving Las Vegas?”

     

     

    How have you handled boredom and frustration in recovery? Or did you decide to leave your 12-step program? Tell us in the comments.

    View the original article at thefix.com

  • Radical Sobriety: Getting (and Staying) Clean and Sober as Subversive Activity

    Radical Sobriety: Getting (and Staying) Clean and Sober as Subversive Activity

    Alcoholism has medical, economic, and social implications, none of which actually serve any kind of bohemian or utopian yearning, but deceive the sufferer into believing that they do.

    Sometime in the autumn of 1798, a middle-aged chief of the Seneca tribe led a hunting party from their home near the Finger Lakes of upstate New York through the verdant woods of western Pennsylvania, bringing a cache of venison and buckskin to a small settlement at the forks of the Ohio River called Pittsburgh, where they traded their goods for a barrel of whiskey. Historian of religion Peter Manseau writes in his One Nation, Under Gods: A New History that afterwards the “hunters had lashed their canoes together into a single barge and managed to make their way upriver as the liquor continued to flow,” as they made their way home to the Iroquois settlement of Jenuchshadego. Manseau records from primary sources that the returning party terrified the villagers, that they would “yell and sing like demented people,” and that “they are beastlike.”

    The Code of Handsome Lake: An Early Recovery Movement

    The Sachem Cornplanter, Handsome Lake’s half-brother, had seen the Seneca decimated by alcoholism, and so he banned liquor within the confederation. Handsome Lake fell into the withdrawal symptoms of delirium tremens, though as Manseau writes “it was believed that he was [also] suffering from a spiritual malady.” Expecting death to take him, Cornplanter let Quaker missionaries tend to his dying brother, until one day “some strong power” took command of Handsome Lake, and he awoke seemingly cured of his affliction. The chief told his people that while convalescing, he had a mystical vision of three angels who imparted to him the creed of a new faith that was to be known as the Code of Handsome Lake, or the Longhouse Religion. Central to Handsome Lake’s prophecy was a belief that liquor was a narcotic whose specific purpose was the anesthetizing of humans, of reducing them to bestial impulse so as to make them easier to control. For Handsome Lake, both drinking and sobriety had profound political implications, with Manseau explaining that the chief’s temperance “became the conduit for the promise of a broader redemption.”

    There is no narrative of sobriety which I do not find inspiring; there is no story of recovery which is not useful to me. As different as Handsome Lake and I may be, there is an important experience which we share. Because though he is an 18th century Indian chief there is some combination of brain chemistry which makes us similarly powerless before barrels of proffered whiskey. We’re both conversant with his older contemporary the English lexicographer Dr. Johnson’s observation that “He who makes a beast of himself gets rid of the pain of being a man.” But there is something important and distinct in Handsome Lake’s example which I think is worth reflecting on: his faith wasn’t just one of personal redemption, but also of an understanding that there are radical implications in recovery, that abstinence can be subversive, that sobriety can be counter-cultural.

    Trying to Make It as a Drunk Bohemian

    Easy to think when we’re actively using that there’s a cracked romance in being an alcoholic: all those drained shots and pint glasses, living our best imitation of the 19th century French poet Charles Baudelaire’s commandment that “You have to be always drunk.” I probably never needed much justification to getting blackout drunk – I liked it. But sometimes rationalization was a helpful salve when I woke up the dozenth time in a month shaking, hungover, going through my text messages to see whom I offended. The disease’s conclusions may be universal, and our symptoms are largely the same. But there’s always some variation. Mine was of the pseudo-bohemian, aspiring Romantic kind; dog-eared pages of Charles Bukowski and Jack Kerouac initiating me into a society of the ecstatic, of those who “burn, burn, burn like fabulous yellow roman candles.” More fun to think of myself as among “the ones who are mad to live” rather than as the one who pissed his pants.

    To clarify, I don’t blame any of those writers, some of whom I still enjoy, for my affliction. I even still have a beloved copy of Baudelaire’s Flowers of Hell. No, what I mean to suggest is that whatever the reasons why I drank, through it all I had some sort of warped sense that the damage I was doing to mind, body, and spirit served some supremely radical role, that I was a renegade against the strictures of regulated, uptight, square society. Part of me still feels that buzzed euphoric recall of dangerous nostalgia. And I didn’t quit because I rejected that gin-flavored narrative so much as that I realized in a moment of clarity that seems to have miraculously stuck (so far) that if I didn’t put down the bottle, absolutely nothing good would come of it. But what I’ve also realized, as I approach the midpoint of my third year of sobriety, is that there is something just as subversive in rejecting alcohol as in embracing it.

    The Radical Potential of Narrative to Treat Addiction

    In his excellent book Drunks: The Story of Alcoholism and the Birth of Recovery, Christopher M. Finan credits Handsome Lake with founding the first real fellowship that could be said to treat the disease with the radical potential of narrative. Handsome Lake is the first in a line of visionaries, from the six reformed drunkards who founded the 19th century Washingtonian Movement to Bill W. and Dr. Bob of Alcoholics Anonymous, who crafted what was fundamentally a counter-cultural ideology which rejected alcoholism, but also the servility which came with it. Finan writes that for the Seneca of Handsome Lake’s era, the “euphoria of intoxication brought temporary relief from the pain of dispossession and death.” Same as it ever was, because addiction’s particular form of mental slavery pretends to treat both profane concerns, such as making us ignorant of our own dispossession, as well as more transcendent fears, like how we can almost believe that we’re immortal for the price of a pint or 20. We prayed for art when we were drunk, but as Lewis Lapham writes, “Alcohol’s job is to replace creation with an illusion that is barren.”

    What these fellowships have always promised isn’t denunciatory scolding, but rather a rejection of a narcotic which helps to keep people in physical and spiritual bondage. Alcoholism has medical, economic, and social implications, none of which actually serve any kind of bohemian or utopian yearning, but deceive the sufferer into believing that they do. Meanwhile, the addict’s world constricts into a smaller and smaller circumference. Odd to consider that temperance as a reform movement was often grouped alongside abolitionism and suffragism, since we so often see it as fundamentally anti-freedom. And prohibitionist and neo-prohibitionist arguments have been social and moral disasters, maybe especially for the individual suffering with addiction. But the grouping of temperance (as distinct from Prohibition) with those radical political movements is not strange, for the personal rejection of intoxication has a certain radicalism to it as well, a turning away from an exploitive thing-of-this-world. That is before we consider how addiction has been used to target marginalized communities, how it can be a function of poverty and class, and how the criminal justice system and the media treat different sufferers in different ways. As Finan writes, the struggle to get sober, and the ways in which alcoholics have been able to help other alcoholics get and stay that way, deserves to be understood as one of the “great liberation movements” of American history.

    The Myth of the Bar Stool Revolutionary

    When I sat on a bar stool feeling the electric thrum, or when I passed out on my apartment floor, or on a city street, I may have imagined that there was something subversive about my antisocial behavior, but in sobriety I’ve developed a more jaundiced view of how my own particular predispositions were exploited in a way that was anything but counter-cultural. I had my radical political poses, my underlined copies of bohemian poets and political theorists, and I could talk a big game about being “anti-capitalist,” but I had no compunction about shoveling out thousands of dollars over the years to pad the bank accounts of liquor and beer companies, apparently seeing no irony in paying for the very poison that was killing me. Once I recall formulating a bar-stool argument that the local tavern was one of the last democratic institutions in the United States, and I think there is still some merit to that, but I’ve found far-more radical potential in how groups like the Longhouse Religion, the Washingtonians, and AA are organized.

    Not much is actually anarchistic about active addiction other than the chaos that characterizes your life, but the non-hierarchical, egalitarian, horizontal organization of 12-step fellowships makes them one of the few successful, genuinely counter-cultural movements in American life. Author Michael Tolkin describes AA as having a “cunning structure; no due, no tithes, no president, protected from permanent officer and the development of cults by a rotating leadership for each separate group, no other requirement for membership than the declaration of fellowship in a shared condition.” What they offer is something in genuine opposition to the gods of this world, the market system that will profit off suffering while promising you paradise, what Tolkin describes as “spiritual slavery to the internal compulsion engine.”

    To turn down a drink, that which is pushed through advertisement and neighbor alike, that edifying, enjoyable, relaxing nectar, is to reject the status quo in a way which courts its own type of infamy. The only drug you’ll kick where you’re viewed afterwards as being a bit suspicious. “Can’t you have just one?” As with Handsome Lake’s realization that liquor wasn’t just physically killing him, but holding him in a sort of bondage, so recovery has radical implications that go far beyond health and self-care.

    Recovery as a Liberation Movement

    The fundamental brilliance of such fellowships is the sharing of a common affliction and the communal support of those who’ve been where you have. This is the same brilliance of all great faiths. Where the endless addictions of capitalism build you up only to tear you down (for profit of course), the process of recovery is one where you must first be torn down to be built up. Religion at its best is a process of ego diminishment, an understanding that you are one of many, and that ultimately you are something infinitely more precious than a mere consumer — you are a human. When Finan talks about recovery as a liberation movement, he means the way in which there isn’t just a physical freedom promised in sobriety, but a mental, emotional, and spiritual one as well. No longer chained to the endless cycle of believing that one more drink will promise something immaculate in “just fifteen more minutes” which never comes.

    Apart from the political, I think that the most radical potential of recovery is something a bit more personal, something that is an issue of transcendence itself. It’s all well and good to claim that addiction is a good metaphor for those things which oppress us in life, but addiction is also literally addiction. Followers of mystical paths have always advocated behaviors which others specifically can’t, won’t, or don’t do, from celibacy to fasting. Sobriety is in its own way such a radical, unexpected, unconventional behavior, as author Peter Bebergal has written: “Sobriety is its own kind of altered state of consciousness.” In Too Much to Dream: A Psychedelic American Boyhood, Bebergal writes about how in early recovery “A cup of coffee in the basement of a church… tastes like the nectar of the gods. A roast beef sandwich is like… something from Eden,” and the most profoundly true of observations: “Sleeping for the first time sober and waking up clean is a mystery of boundless grace.”

    “Mystery” and “grace” are religious terms, and indeed 12-step recovery often gets libeled as a type of religious mysticism. I would only take offense to that were I against religious mysticisms. But Bebergal is right, the first time you go to bed sober and wake up clean does feel like a mystery, because it’s so antithetical to who you have been, and it does feel like grace because for once you have a sort of freedom you’ve never known before. It’s a staking out of agency, of personal sovereignty, and it’s a declaration of independence. “Freedom” is simply another word for grace, and there is never anything more powerful, radical, or subversive than freedom. Bebergal writes that “Removing the pall of daily addiction is like flash powder going off in your face,” as it was for Bill W., as it was for Handsome Lake, as it was for me, and as it possibly can be for you.

    In addiction there is that pursuit of freedom, the lie that one more drink will get you closer to the comfort and safety of a home you’ve never known. The radicalism of sobriety is that it actually gets you there.

    View the original article at thefix.com

  • What Is Evidence-Based Addiction Treatment?

    What Is Evidence-Based Addiction Treatment?

    12-step programs are an incomplete approach and do not meet the requirements for evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

    When looking for treatment for addiction, there is a lot of information out there and countless opinions. Friends, family, doctors, researchers, and people in recovery all have their own beliefs about what you need to do to get well. Unlike in other areas of healthcare, addiction treatment is often deemed “effective” based on anecdotal reports. In fact, most people who seek or are forced into treatment do not receive health care that is aligned with evidence-based practice.

    A frequently-cited definition comes from a 1996 article in the BMJ Medical Journal: evidence-based “means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Other definitions also include the patient’s individual circumstances, preferences, expectations, and values.

    These variables are not necessarily constant, and there is no one-size-fits-all solution; any list of evidence-based treatments is going to include a wide variety of approaches.

    What is Addiction?

    In the United States, addiction is still treated more as a crime than as a chronic illness or disorder. Until that perspective changes, treatments will not meet their full potential and will not be as effective as they could be. Addiction, or substance use disorder (SUD), is a chronic medical condition that has remissions, relapses, and genetic components.

    Are Relapses Normal?

    A relapse is not a failure but a symptom. The brain of a person with SUD has gone through neurobiological changes that increase the risk of relapse because the damaged reward pathways stick around much longer than the substances stay in the body. Stressful events and other painful life experiences can trigger that maladaptive coping mechanism and cause a relapse.

    For other chronic illnesses we would consider a relapse to be an unfortunate symptom of the disease, and we might call it a recurrence instead of a relapse. When successfully managed, the condition is considered to be in remission. Remission is a term that is relatively new in addition treatment; substance use disorder was not always believed to be a disease but rather a moral failing and a problem of willpower. We now understand that addiction is a chronic medical condition and that remission is the goal of treatment. Remission, as defined by the American Society of Addiction Medicine, is “a state of wellness where there is an abatement of signs and symptoms that characterize active addiction.”

    What Is Successful Addiction Treatment?

    Let’s take a look at what it means to have an effective treatment outcome in terms of addiction. The primary goal is usually abstinence or at least a “clinically meaningful reduction in substance use.” To measure effectiveness, we must look at how and if treatment improves the quality of life for the patient. Improving quality of life is the aim when treating all chronic conditions that have no cure.

    Evidence-based therapies do not support the notion of “hitting bottom.” As with any chronic disease, early intervention is going to provide the best outcomes. Even more effective than early intervention is prevention because SUDs are both preventable and treatable.

    Pharmacotherapies to Treat Substance Use Disorders

    Addiction is an overstimulation of the brain’s reward pathways, and as the condition progresses, the brain becomes less sensitive to the rewarding effects of a drug and requires more of the substance to get the same effect. This overstimulation can play tricks on memory recall, turning experiences that were not good into ones that seem better than they actually were. It creates false memories to encourage re-indulging in the addictive substance or behavior.

    From a medical standpoint, this disparity needs to be interrupted and corrected. Akikur Mohammad, the author of The Anatomy of Addiction, argues that successful treatment of addiction “must first address the biological component and correct the brain’s chemical imbalance in the process.”

    Pharmacotherapy is used in medication-assisted treatment and recovery. Depending on the patient’s individual drug history, different medications may be used to mitigate the brain’s compulsive race to stimulate the reward loop.

    Therapy for Substance Use Disorders

    Most research on therapy for substance use disorders has been done on cognitive behavioral therapy (CBT)—a form of typically short-term psychotherapy that combines talk therapy with behavioral therapy. Patients are taught how to adjust their negative thought patterns into positive thoughts. There is clinical evidence that CBT can be as effective as medications for many types of depression and anxiety. For treating SUD, CBT has been shown to have a “small but statistically significant treatment effect” but doesn’t necessarily have a long-lasting effect. As it’s a chronic illness, it stands to reason that SUD requires further maintenance beyond any short-term treatment.

    Are 12-Step Programs Evidence Based?

    Alcoholics Anonymous and other 12-step programs use a social model of recovery. They are built on the basic notion of peer support in a safe environment. There is research on the efficacy of 12-step programs, which shows it works for some people and that there are benefits to this social model of recovery. The steps, or rather the principles of the steps, must be internalized into a person’s psyche in order for the person to achieve lasting abstinence. 12-step programs are an incomplete approach and do not meet the requirements for the classification of evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

    One central tenet of the 12-step solution requires turning one’s will over to the care of a higher power. Certainly, letting go of the notion that force of will can change the trajectory of addiction is necessary for any treatment. It’s a disease, and willpower will no sooner cure addiction than it will cure diabetes or heart disease. An evidence-based approach could mean that a doctor recommends a patient attend a 12-step program, or other support group, as part of a maintenance regime.

    The addiction treatment world is overrun with rehabs that primarily utilize 12-step programs, which are touted as the only treatment for addiction. That simply isn’t true. Addiction researchers have found that individually, cognitive and behavioral therapies, including social supports like 12-step programs, are incomplete treatment for a chronic disease that is both physiological and genetic in origin. From a treatment perspective that is grounded in evidence-based practice, involvement in a support group would be merely one piece of the puzzle.

    Holistic Care

    In evidence-based practice, the treatment process individualizes care and uses a holistic perspective to see what combination of resources will work best for a particular patient. The combination of treatment tools depends on a clinician’s specialized knowledge, the patient’s values and preferences, and the best research evidence. We need more specially trained addiction clinicians who can help people with SUDs make informed treatment decisions.

    Are you in recovery from addiction? What worked for you? Tell us in the comments!

    View the original article at thefix.com

  • How Does AA Work? A Review of the Evidence

    How Does AA Work? A Review of the Evidence

    AA is cloaked in misconceptions and mysticism: a society of “former drunks” who tout spirituality as a means to cure the chronic, genetic, and life-threatening disease of alcoholism.

    Alcoholics Anonymous (AA), as an organization, “neither endorses nor opposes any causes.” But AA, as a societal symbol, is very controversial. People have strong opinions about its benefits and its dangers. It’s an organization cloaked in misconceptions and mysticism: an anonymous society of “former drunks” who tout spirituality as a means to cure the chronic, genetic, and life-threatening disease of alcohol use disorder (AUD). There is no denying that many have found support and achieved recovery through involvement in 12-step programs. That has left researchers with the question: what mechanisms are at work behind the scenes?

    Peer Support Groups like AA Increase Oxytocin

    Participation in mutual help programs may increase levels of oxytocin, the feel-good hormone. Nicknamed the “love hormone,” it is released when people bond socially or physically. A neurobiological view of addiction recovery might look at how oxytocin plays on the brains of people in a treatment program. Oxytocin increases when bonding socially with others in AA and there are other neuroplasticity rewards that come from 12-step program participation. Interactions with other members improve the connectivity between the part of the brain that makes decisions and the “craving behavior” part of the brain.

    The oxytocin system is created before age four and its development can be affected by variables such as genetic differences within the receptor itself, or environmental causes like stress or trauma. An underdeveloped oxytocin system is a risk factor for drug addiction. Healthy levels of “oxytocin can reduce the pleasure of drugs and feeling of stress.” Creating opportunities for healthy oxytocin production could benefit people in recovery from addiction.

    Oxytocin also boosts feelings of spirituality, according to Duke University research. The study defined spirituality as “the belief in a meaningful life imbued with a sense of connection to a Higher Power, the world, or both.” Study participants who received a dose of oxytocin prior to meditation reported higher levels of positive emotions and feelings of spirituality. The effects lasted until at least one week after the initial experience.

    Do AA Prayers Reduce Cravings?

    Researchers at the NYU Langone Medical Center used brain imaging to see what, if any, effect praying has on the brains of AA members. They were able to see increased activity in the areas of the brain associated with attention and emotion during prayer which correlated with a reduced craving for alcohol. When exposed to triggers such as passing a bar or experiencing an emotional upset, people who were abstinent from alcohol but not members of AA were significantly less likely to experience the benefits of “abstinence-promoting prayers.” This brain activity seems to also be associated with a “spiritual awakening.”

    A spiritual awakening is not necessarily about the divine; rather, it’s an awareness of needing resources that are beyond the reach of a person’s individual ego. This awareness causes a shift that alters one’s perspective about drinking. There are also physiologic changes that seem to occur with increased spiritual awakening/awareness. In previous research, those who were directed to pray daily for four weeks drank half as much as the study participants who were directed to not pray.

    Research published in the last five years has tried to find ways to measure effectiveness in 12-step programs, in a way that is unbiased and scientific. One such study published in 2014 discovered that spiritual (rather than behavioral) 12-step work was important for later abstinence.

    Spirituality Is Not for Everyone

    Not everyone who enters AA experiences a spiritual awakening. According to a review of 25 years of research, it seems that only a minority of people with severe addiction experience this spiritual Aha! moment. While a sense of spirituality creates changes in the brain that can be measured on an MRI machine, there are other aspects of AA — social, mental, and emotional — that aid recovery for the majority of participants.

    Twelve-step programs can help addiction recovery because of their ability to propagate therapeutic mechanisms similar to the coping tools and behavioral strategies that are utilized in formal treatments. AA has a lot of parallels with cognitive behavioral therapy (CBT). CBT is an evidence-based form of psychotherapy that is effective over just a short period of time. In CBT, patients learn new habits through increasing self-awareness, overcoming fears, taking personal responsibility, and developing shifts in perspective. These are the same underpinnings as the 12 steps.

    Clinical interventions that encourage 12-step participation are more successful than clinical interventions that do not encourage attendance. Meeting attendance, sponsorship, and active involvement have come up in multiple studies as being positively correlated with continued abstinence, highlighting the critical nature of connection to others as part of an effective plan for managing addiction long term.

    12-Step Programs as a Useful Management Tool

    Addiction is a chronic illness with no cure, according to AA literature as well as the medical community, and chronic illnesses require lifelong management. AA can be a good ally in the quest to maintain a healthy lifestyle free of active addiction.

    The International Journal of Nursing Education published a study that sought to learn about the quality of life for those attending AA as opposed to those who are not attending AA. They found a significant difference, with those who attend AA reporting a better quality of life than non-attendees.

    When looking at meeting attendance over long periods of time, abstinence patterns can be predicted. For people who went through inpatient treatment, the pattern shows that meeting attendance is highest during treatment and reduces at a steady pace afterwards. With reduction in attendance there is also a reduction in abstinence from using drugs or alcohol. Findings from many long-term studies suggest that meeting attendance is important in early recovery and for successful long-term recovery. The reasons for this echo other research findings: community matters.

    Dangers Inherent to 12-Step Groups

    The nature of AA and other 12-step programs leaves them to be individually organized and without a central governance. There is no oversight and no quality controls. Abuse, inappropriate behavior, bad advice, and social ostracizing can happen.

    Perhaps most dangerous is when a single solution is pushed on someone for whom a different angle would work better. Individual satisfaction with treatment plays a major role in “subsequent psychiatric severity,” which means that recovery rates are lower for people who are unsatisfied with the addiction treatment they receive. The World Health Organization suggests that to improve treatment outcomes and engagement with treatment, patient satisfaction ought to be a focus when caring for people with substance use disorders.

    AA provides a range of pathways to recovery, but it is not the one-size-fits-all approach it claims to be. It’s particularly challenging for people who also have a diagnosis of (or just struggle with) social anxiety. It’s common for AUD to exist alongside social anxiety. The fear of being negatively appraised can impede progress in recovery. Long-term participation in mutual aid groups such as AA may reduce social anxiety but overcoming that hump in early recovery may require clinical interventions or alternative treatments.

    Did you find recovery in 12-step programs or did you have a negative experience? Let us know in the comments.

    View the original article at thefix.com