Answer Addiction

Tag: AA

  • Ring of Shame: How Getting Ringworm Triggered My Alcoholism

    Ring of Shame: How Getting Ringworm Triggered My Alcoholism

    Even medical people are treating you like a second-class citizen. Is this really about ringworm or is this reminding you of what it’s like to be a person with addiction?

    So one day I see this pink round patch on my forearm. It itches. I immediately start Googling eczema and psoriasis. Nope, looks nothing like that. But it does have that distinctive red ring so I look up pictures of ringworm and voila, there it is, my new friend.

    When I was smoking meth and shooting cocaine, I never got sick. I never got staph or scabies despite lying around with a bunch of gutter punks. But at six years sober, out of nowhere, I get ringworm. I don’t deal with children. Colonel Puff Puff, my cat, doesn’t have it. What the fuck is going on?

    Despite its grotesque and misleading name, it has nothing to do with worms. Ringworm is a type of skin fungus akin to athlete’s foot and jock itch. Trying to make light of the situation, I tweeted: “I was super depressed and smoking again but suddenly I got ringworm and that cheered me right up.” I was hit with a bunch of questions like “Is that the one that makes you skinny?”

    No dear, that’s a tapeworm, but thanks for the concern.

    I’d heard ringworm was very contagious so I went straight to urgent care where they confirmed it was indeed ringworm. I was prescribed a cream that burned like the fires of damnation and told to “keep it covered” at night to protect the Colonel. (When the Colonel last got ringworm, it cost $2,500 for multiple lyme dips, shavings, and numerous vet visits to get rid of it. It’s a persistent motherfucker.)

    I went to the pharmacy, pulled up my sleeve, and told the pharmacist I had ringworm. 

    “I don’t know how I got it,” I said, annoyed.

    The pharmacist pulled up the leg of her capri pants and said, “I got it working here! I was really stressed out because I was getting married and my mom had a stroke and boom.”

    We both laughed and then I took my supplies home, hopeful things would soon return to normal.

    Once I informed my friends of my condition, nobody would touch me. Friends and neighbors wouldn’t come into my apartment nor let me into theirs. 

    “We love you and your ringworm,” they’d chant from the other side of the door. I was beginning to feel very leper-like even though it was one fucking red ring. My sponsor told me I could still go to meetings but I didn’t want to take the chance of giving it to anybody…(except maybe a few specific people).

    Two nights after following the urgent care doc’s protocol, the ringworm seemed to be getting worse. I saw a new circle sprouting up and there was a clear red rectangular demarcation from the band-aid. Kill me.

    Panicked that I would soon be a walking petri dish of ringworm, I went to my primary care clinic as a walk-in patient. This clinic treats a lot of homeless people and has quite a few tents parked permanently outside with adjacent grocery carts packed with stuffed animals and recyclables and blankets. People are allowed to shower in the downstairs bathroom and it often gets crowded in the waiting area. But once I told the receptionist of my “condition,” I was quickly escorted to an empty room and quarantined. 

    Four long hours I sat in that room, my phone dying, sneaking out to smoke and feeling more and more depleted and well, just gross. A triage nurse came in briefly and told me that the urgent care doctor had made a huge error by telling me to cover the ringworm. It had created a tiny greenhouse, capturing the moisture and providing the perfect breeding ground for the ringworm to reproduce. Perfect.

    Finally, I was taken to another area to see a doctor. As I waited, I looked at the white cabinets. Two were locked. Where were the syringes, I wondered. 

    Wait, what? An enormous urge to use had come over me. I wanted to get high, call my ex, die…. It’s just ringworm, I tried to tell myself. Calm down. Why the sudden impulse to use? 

    “You’re disgusting and poor and getting old and nobody loves you,” my head said. 

    Thankfully interrupting my horrible inner dialogue, the doctor, a big ruddy guy in his mid-30’s who looked like an ex-linebacker, came in and shook my hand. I cringed inside.

    “I hear you have a rash,” he said.

    “I have ringworm,” I corrected him, hanging my head in shame.

    “Okay, let’s take a look.” He put on gloves initially but then took them off.

    “You have one ringworm,” he said. “The rest of the redness and that other circle is contact dermatitis from the bandage. You’re allergic to something in that bandage.” He touched the irritated area with an ungloved hand.

    “Oh.” I was near tears.

    “I’m going to give you another cream and just wear long sleeves if your cat sleeps with you. Better yet, take him to the vet to get him checked out. This stuff is everywhere. It’s really a reaction to your own flora. Do you do yoga?”

    “No.”

    “It’s very common among wrestlers because of the mats and sweat and body contact.”

    “No wrestling and unfortunately no body contact.”

    “You could have gotten it anywhere. If your immune system is compromised from stress or HIV or chemotherapy…”

    “Stress is my hobby these days,” I said. “Everything feels itchy, doc, like especially my head.”

    “Do you want me to check your scalp?” 

    “Please.”

    I took down my bun and into my dirty hair he plunged with bare hands. I felt ashamed but grateful that somebody was touching me.

    “You’re good,” he said.

    “Thank you for making me feel like a human being. Really…”

    He smiled.

    But as I drove to the pharmacy, I still felt depressed and still felt like using. Why? 

    The answer, as usual, came in a phone call from my friend, addictionologist and psychiatrist Dr. Howard Wetsman.

    “I understand people being scared about the ringworm because of its name and reputation. But what you’re experiencing is being shunned and isolated. People are treating you like your presence can hurt them. Even medical people are treating you like a second-class citizen. Is this really about a skin fungus or is this reminding you of what it’s like to be a person with addiction?” he asked.

    Whoa. 

    “When we’re isolated or feel ‘less than,’ the dopamine receptors in the reward center actually stop being available. You can’t feel your own dopamine as well as before. We need those receptors to keep up dopamine tone, and without that we’re back to feeling restless, irritable, and discontented. And that only goes to one place, right?”

    “Yeah I really wanted to use and it freaked me out.”

    “When you’re an addict and your dopamine tone is lowered, your brain goes ‘we gotta fix this fast.’ It doesn’t care if it’s an éclair or heroin or death…”

    “That’s why I’ve been smoking…”

    “Nicotine will give you dopamine for sure. But let’s talk bigger picture. When we go to treatment and we’re told to sit down and shut up, when we’re treated like stupid people who abused a substance that everyone else was smart enough to stay away from, when we’re told to wait three hours sitting on broken plastic chairs for someone who doesn’t give a shit, the deck is stacked against the treatment working. No healthcare system that systematically lowers people’s dopamine, much less one that treats addiction, will succeed,” he told me.

    “It’s the same in the rooms,” he continued. “The reason the 12 steps work is because you don’t have to feel ‘better than’ to not be ‘less than.’ The two messages you should get from an AA meeting are that you are never alone again and you aren’t less than anyone. But when people don’t sponsor with love, when some old-timer wants to be the boss, when it’s all about some guy with more time being right instead of helping, you lose those messages. That’s not a problem with the message; that’s a problem with the messenger. Don’t let the messenger fuck up the message. You aren’t less than anyone!”

    I sign every copy of My Fair Junkie with “fuck shame” and I don’t think I really knew why until just now.

     

    For more on dopamine and feeling “less than,” check out Dr. Wetsman’s youtube talk.

    View the original article at thefix.com

  • Alone in Sobriety: How I Deal with Dark Thoughts, Cravings, and the Urge to Isolate

    Alone in Sobriety: How I Deal with Dark Thoughts, Cravings, and the Urge to Isolate

    In the beginning of my sobriety, I went to meetings as simply a way of getting out of the house and not being alone. However, a cherished bonus—and one I was not expecting—was the feeling of being loved.

    I’m supine on my couch, peering through my bay windows. The eucalyptus tree gently waves, the sun bouncing off the greyish green foliage. Oh my, never really noticed that before, the way the sun hits the trees… almost looks like diamonds are attached to the leaves. I sigh at the beauty of the agate blue lake against the backdrop of pink hills. In my celestial reverie, I think: Ah, this is the life. I need nothing but my view, my books, and of course my oxys and chardonnay. Life is, um, well, perfecto! I don’t need anybody! Life is dope! Ha, ha, pun intended! 

    But as we all know, the nefarious love affair with our substances has to end—unless we’re recreational users. You know, the type that can indulge, but ends up moving on to smarter and better things—like careers, marriage, and kids.

    But the addicted end up with no such future; and our fate comes at a staggering cost: numerous rehabs, jails, hospitals, and sometimes the ultimate price, death. So, if we want any chance at a decent life, we end up doing a program like AA or NA, or we join secular self-help groups such as SMART, or depend on MAT (medication-assisted treatment such as a methadone or Suboxone program). Others get well through individual therapy or exercise or church. And of course (not to leave anyone out), there is that rarefied set that quit on their own—no help needed.

    Sobriety or Self-Destruction

    But the point is: we get better or we blow up our lives.

    I chose rehab, a Suboxone program (six-month duration, thankfully done), and AA meetings to get well. And now, things . . .are better. 

    In the beginning my sobriety was no fun at all: when I looked through those same bay windows at the same beautiful view, a huge dose of anhedonia would hit me. Who cares if it’s beautiful? I’d think, seamlessly segueing into darker thoughts like: What a loser you are, or aren’t you a little old to still be blowing up your life?

    But gradually (I can’t stress this enough), I recovered and those ugly thoughts subsided. I still have them, but nowhere near as bad. 

    They told me in early sobriety to “stop isolating” and be around people. I found this exceedingly hard because while using, I’d convinced myself that I was an unrepentant misanthrope. Well, when I got sober I realized I didn’t really dislike anyone, I was more afraid of folks. So, again gradually (they call it “slobriety”), I’ve lost my fear of people and have learned to socialize more. Even though I’m a loner by nature, I know that humans are social animals. At the very least, I am going against biology when I’m alone all the time. 

    Learning to Love 12-Step Meetings

    Meetings can be one way to escape isolation without having to be super cheerful or interesting. In the beginning of my precarious sobriety, I went to meetings as simply a way of getting out of the house. However, a cherished bonus—and one I was not expecting—was the feeling of being loved. During my many failed sobriety attempts years ago I scoffed at the “let us love you until you can love yourself” platitude—only because where I came from, love was almost always conditional. Image was everything and being a woman of propriety was paramount (never mind what happens behind closed doors!). 

    But finally I was so desperate to get well that I took love wherever it was freely given. And I was pleased to discover there is nothing wrong with getting unconditional love from random people—because eventually those random people became my friends.

    There are times when being alone is inescapable, and this is when my thoughts can get downright dark. But at least now I have tools to deal with them. I can do some cognitive therapy and challenge my thoughts: “Oh, come on! You are getting better!” Or: “Oh come on! You’re trying, give yourself a break.” If that doesn’t work, I get on my knees and pray.

    “God, please direct my thinking! Give me the strength to manage my life!” Even though I’m not sure I believe in God, I do it as a gesture of humility. And sometimes a calmness, a sense of focus, a clarification of the next “indicated step” presents itself, and I say a prayer of gratitude to the Universe for getting me out of my head and into action. 

    If the silence gets too deafening, I’ll call someone. To “get out of self,” I generally reach out to someone who may be having a harder go at it than me. Or sometimes I just do something goofy like turn on some old school rap like Too Short’s Shake that Monkey and just jam out like an oblivious white girl. My twerking leaves a lot to be desired, my butt is just too flat. But it’s remarkably good exercise.

    Fear, Rumination, and Acceptance

    Sometimes, I’ll force myself to sit with these dark thoughts: acknowledge my insecurities, my chaotic and destructive past, my fear of never measuring up. This last trajectory can be dangerous because it can immediately put me in an even darker mood that lasts for days where I end up ruminating in obsessive, sad, or angry loops that keep playing like a film projector that won’t shut off. 

    But I do believe that recognizing these dark corners of my psyche and accepting them, then coming up with a plan to negate any further damage by changing my actions to more positive and kinder ones is probably the best way to go. Because sometimes keeping busy in order to avoid thinking is like the old expression: brushing it under the rug. The dirt piles up in my mind, making me toxic.

    When I’m alone and the cravings for drink and pills get fucking intense, I’ll walk around the block like a demented person, or even worse: I’ll go to the smoke shop and buy one cigarette at a time. 

    When I have no social engagements and there are no meetings, self-pity can overwhelm me, my thoughts of loneliness so deep I’ll find myself obsessively checking my phone to see if anyone has texted. This is probably the hardest “alone” time there is, when you realize you’re alone because you have no one to be with. And I want to scream: “I know I fucked up! I know I acted the fool high! But I’m sober now and a totally different person!” Usually there is no answer from the heavens and I have to sigh myself into a grudging acceptance. 

    Remembering “This Too Shall Pass”

    Sometimes the only consolation for being sober is my stubborn refusal to get high no matter how lonely and sad I feel, and the knowledge that this too shall pass. And it always does. That day will surely come again where I’ll be outside, gazing at a gorgeous old Victorian home in the historic part of San Diego, or walking in the woods, or snuggled up with my hubby watching some improbably good show on Netflix, and I’ll say to myself: “I am, right now, presently, 100% good with the Universe.” A warm contentment will engulf me—much subtler than the synthetic euphoria of oxy. But it doesn’t matter because here’s the thing: I earned it, and that alone makes it a far more powerful and beautiful experience than drugs ever gave me.

     

    How do you handle the dark times in sobriety? Let us know in the comments.

    View the original article at thefix.com

  • The Ugly Side of Dating in 12-Step Programs

    The Ugly Side of Dating in 12-Step Programs

    When someone acts perfectly, their best selves, when that’s what they present to us, we often fall for it. I wasn’t special or not special. I was typical.

    Recently I was in a relationship with a guy I met in the program. We’d been together about four months, on again-off again. Really twice on, twice off.

    The first breakup wasn’t pretty — we’d had an argument one evening and when we parted he wasn’t happy. I’d say he was disappointed, but it was more than that. But after years of working my AA program, my “people pleaser” was quick to reassure him we were “good.” In fact, while the argument wasn’t really that bad and could have even been food for growth, his anger had frightened me. I’m eleven years sober, he had four years. I thought the recipe was for love, not disaster.

    The truth is: I’d been on the fence about him since we met.

    On our first date, he told me that he’d threatened to kill someone during a relapse. This left me feeling unsettled, but when I told my friends and therapist, I learned it was apparently really, really bad. I thought well, it was a relapse, not the type of thing he would do sober. I remembered him also telling me of a breakup that had happened when he was still using. Maybe all of his negative behavior was when he was using. I’d been through this before with sober men, and it was altogether confusing. An ex had gotten physical with a few women before I knew him, and I assumed it was while he was drinking. I learned at the end of our relationship that it was actually during a dry period. 

    I sound so judgmental. I guess we all have to be, to some extent, while we’re choosing who and who not to date. But apparently I’m not judgmental enough. I ended up dating the man who’d threatened someone’s life, and now here we were, post-fight, all my protective feelings swirling around inside me. I hate it when people say they were a hot mess, because it implies that they are or were hot, which is a little too narcissistic for my taste, so let’s just say I was a mess. (Not that I’m completely free of narcissism, but I choose to believe in the good in myself and focus on my character defects one at a time, rather than bundling them together.) 

    I’d like to say I was fine, but really I wasn’t fine. I was going to act like I was, though, to maintain the status quo. In other words, I’d said everything was okay, so I’d act like it was. Acting as if is a skill I learned fairly early in sobriety, and it had served me well.

    The morning after the fight I awoke to a long Facebook messenger message, really a few long messages from him, clustered together. This was the guy I was dating exclusively, and sleeping with, and basically in a “sober” relationship with. His messages were angry and spiteful. I’d thought all was okay enough to at least be civil to one another, but no such luck. And I felt sick about it. 

    I can’t remember if we spoke after the messages, but I don’t think we did. I was livid and hurt, an ugly combination of emotions. I broke up with him. Over messenger. The way we loved, we died.

    The Resurrection

    Until he started love-bombing me. I call it “The Resurrection.” It started with things he was going to give me, restaurants he wanted to take me to. He gifted me with a very personal family heirloom… and on and on. After about a month, I caved. Our second-round first date was at a park near my home. When this guy was on, he was on. We ended up kissing at my place, just kissing, and I was falling in love like I never had with him before. When someone acts perfectly, their best selves, when that’s what they present to us, we often fall for it. I wasn’t special or not special. I was typical. 

    The love affair lasted about two days, and then the old him reappeared: not listening well, an underlying frustration, a continuation of great and comforting sex (that’s where the connection stemmed from). All in all, except for the sex, nothing very exciting. Except I’m leaving out my behavior in the whole episode. Knowing I didn’t feel as strongly about him as he did about me, I should have ended it the first time around.

    Then the second time, about a month in, we went to a couple of galleries and walked around on a Friday night when everyone in New York City, like us, was mulling around for free. I wasn’t in a very good mood; my insecurity and self-hatred were getting the best of me. We had an argument — again, not so bad — but he got too angry for the situation.

    I woke up the next morning, upset and out of sorts, and called my sponsor, as I had a few times during our courtship. I asked her if I should keep my date with him that night. For the third time, she suggested I take a break from seeing him, but I didn’t listen. Suggestions are just that, I told myself, and at 11 years sober, who was I to have to listen to my sponsor.

    I went over to his place around six that evening. We took a taxi to a restaurant we liked, and the whole ride there was awkward, with short bursts of forced conversation. It got worse at the restaurant and culminated in me telling him I didn’t have the same feelings for him that he had for me. Read: My Part. I shouldn’t have gone in the first place, should have broken up with him the night before (as I didn’t hesitate to mention during what I now realize was a fight from the minute I set foot in his apartment).

    But then his anger moved in, like a dark cloud.

    “I’m breaking up with you, bitch,” he said and slammed his hand on the table. He started to walk out, which I feared would leave me stranded, far from home, with no means of getting back to my warm apartment and my sweet cat. At times of high stress, I, like so many others, go to the worst place, a place of abandonment and rejection. And as much as he really might have been rejecting me, I knew in my heart I had left the relationship months ago.

    I ended up begging him to let me ride home with him — that feeling of being stranded, scared, and alone that reminds me of all the reasons I drank and drugged — and we ended up sharing a taxi back to his apartment so I could take the subway the rest of the way home. During the 45-minute ride he alternated between yelling at me and saying he wasn’t going to be mean to me any longer, an agreement he broke countless times during the drive. He spewed hate at me while I mainly stayed silent and looked out the window. And then he said the most danger-filled and threatening thing anyone’s ever said to me: “if you think this is bad, try pouring alcohol and coke on it.”

    The moral? I should have left sort-of-well-enough-alone. After I knew who he was, I never should have gone back and dated him the second time. Or, if I am honest with myself, the first. I’m glad I got out before something really awful happened, though I remain worried that he might stalk me. I don’t know if that’s his style, but he did tell me that I had reason to be terrified of him. He said there are only a few people in the city who he hates, and they are scared of him.

    I’m dating again and it’s hard. I’ve had difficult breakups, in and out of sobriety, but this has to be the worst. It’s an all-time low; the one that leaves you with the most vile taste in your mouth. I don’t even know if I want to publish this, for fear he might read it, for fear you might. I’m going to go with HP on this one — pray like there’s no tomorrow, pray to be of service, to learn what HP has brought me in offering me this experience which I have embraced and then, finally, un-embraced, and to affirm that whatever happens, I’ll be taken care of.

    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

  • 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

  • Why You Should Embrace AA Groupthink and Shed Your Terminal Uniqueness

    Why You Should Embrace AA Groupthink and Shed Your Terminal Uniqueness

    AA encouraged me, a sauced snowflake loaded on liquor and individualistic narcissism, to put aside enough of myself to embrace two traits required to curb my alcoholism: discipline and structure.

    Addiction has a grand irony: For a disease whose treatment thrives on identification with fellow sufferers, its symptoms are extraordinarily individual. Precisely how addiction manifests in each of us — drug of choice, length of active substance abuse, depth of debauchery — varies more widely than nearly any major affliction.

    This is because addiction, like no other ailment, turns us insane and then turns us loose on the world. Ours is not a disease subject to controlled clinical settings; we find ourselves in circumstances that, though certainly following a pattern, have variables as unique as life is complicated. I have a recovering friend who, unlike me, has never sideswiped a taxi in the Holland Tunnel, blind drunk, and kept going. But alas, I’ve never been so creative as to hide vodka in a vase, as he has (#HappyHourFlowers).

    As an alcoholic, then, my addiction-fueled adventures differ from the experiences of other problem drinkers. These exploits also are so abnormal in terms of their setting — namely, civilized society — that they feed another peculiarity of addiction: the “terminally unique” mindset that I am, somehow, alone in my inability to stop drinking at any cost.

    For me, the result was a hopeless alienation that, in turn, only further fed my alcoholism. Afraid and isolated, I gave up trying to give up.

    Amid this lonesome landscape lies the tailored times in which we live. A solid case can be made that we are in the single most individualistic era in human history.

    Take me, for example. Like most people Gen X or younger, from early childhood I’ve been called unique, singular, special. I’ve been told I can do anything, be anyone, and was perfect exactly as I was. I am, it appears, a gentle snowflake.

    Fast forward to today’s iWorld. We have made-to-order music playlists, binge TV watchlists, e-newsletter subscriptions. Our Facebook and Twitter feeds serve up personally-algorithmed news items between posts from our personally-constructed list of cyber-friends. From our social media silos, we see, hear, and click on hyper-customized content — our own little gated communities in the World Wide Web. For God’s sake, even our sleep is customized.

    We do exactly what we want, when we want, how we want. We ultra-individualize, then wonder why modern society is so uber-fractured.

    And then, those of us with addiction get too high or too drunk for too long, and need help. Suddenly, we uber-individuals need help from… well… ourselves.

    And when we walk into the rooms of Alcoholics Anonymous, that’s exactly what we get.

    AA Pluribus Unum

    Despite its imperfections — including those noted by yours truly — nothing has ever made me feel so simultaneously special and ordinary as my early experiences in Alcoholics Anonymous. As a newcomer, I was told I was the most important person in the room; but as a person in the room I was told that, though our experiences may be vastly dissimilar, we were all here for the same reprieve to the same disease.

    First and foremost — before I ever considered that I may have found a solution to my compulsive, destructive drinking — AA provided a cure for my self-diagnosed tragic uniqueness. I wasn’t sure I could quit drinking but, after just a few meetings of identifying with the similar compulsions of fellow alcoholics, I was damn sure that I wasn’t the only one who had this affliction. A lot of acronyms get thrown around in AA; perhaps one should be Alienation Antidote.

    For me, this prerequisite to recovery — this normalization of my abnormality — was an immediate and amazing upside to AA, one that fortunately superseded or masked some of my preconceived concerns.

    Like most people, I skidded along the bottom before finding recovery. Months before my eventual sobriety date, I’d been warned by peers during an unsuccessful rehab stint that AA was a cult or, at least, cultish in its groupthink. I was told that there would be a lot of people spouting a lot of nonsense and, worse, telling me what to believe while they did it.

    And you know what? They were partially right. AA did indeed ask me to set aside some of my individualism — my preconceived notions, my longstanding perceptions, the personal penchants that made me me — in favor of a program that, I was told, had a well-established track record of helping alcoholics achieve sobriety.

    AA encouraged me, a sauced snowflake loaded on liquor and individualistic narcissism, to put aside enough of myself to embrace two traits required to curb my alcoholism: discipline and structure.

    Structured Settlement

    I came into AA a stone-cold atheist and remain a skeptical agnostic, and for a long time I thought AA’s first requirement for newcomers was that they develop faith in a higher power.

    I now realize that this isn’t true. Before AA asks for anything enshrined in the 12 steps (the higher power concept is introduced in Step 2), AA asks us to stop having complete faith in ourselves — or, at least, the drunk and desperate versions of ourselves that, alone, simply cannot stop drinking.

    The salve for this outsized self-reliance comprises some of the very same group-centric activities many AA-haters find cultish: chants like the Serenity Prayer offering a simplified perspective; readings like “How It Works” providing experience-driven direction; ubiquitous signage with familiar phrases and, of course, the ever-present Twelve Steps.

    As someone who entered AA as the Smartest Person on Earth (an unofficial title, it turned out), I fully understand how threatening this can seem. Even as a scared newcomer in desperate search of a solution, I didn’t want to trade my hellish life for a post-apocalyptic Zombieland. Despite the attraction of folks who’d clearly found a way to stay sober, I’ll admit to checking the coffee machine for Kool-Aid during my first few meetings. 

    But what I soon realized was that there was a simplistic beauty to AA’s anti-individualism that, for me, was extraordinarily effective in early recovery. My rehab roomies, I found, were just so full of themselves that, when confronted with a different approach, they reflexively labeled it full of shit.

    Are there cultish aspects to AA? Absolutely. Even Catholic masses don’t end with everyone standing in a circle holding hands. Anyone wondering why some people duck out of meetings five minutes early should re-examine that ritual.

    But by and large, AA’s so-called groupthink offers newcomers a keep-it-simple structure that — as fledgling sobriety becomes longstanding recovery — can be selectively shed. It asks spiritually disarmed newcomers to buy the whole standardized toolset… then allows us to return some piecemeal as we acquire new, more customized tools.

    I for one needed some discipline to replace the chaos my life had become. I also needed certain concepts — powerlessness over alcohol, the hurt I was causing others, the incredibly alien concept that there was, in fact, hope — beaten into my brain. In hindsight, I realize AA is repetitive for a reason.

    I see a lot of newcomers enter the rooms as customized as they are clueless. For them as for myself, rigidity en route to freedom is an entirely worthwhile tradeoff. There is value in a traditions-based organization with agreed upon rules that, when adhered to successfully, work well for many people.

    How has AA’s emphasis on the group helped you? Let us know in the comments.

    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

  • Does Everything Actually Happen for a Reason?

    Does Everything Actually Happen for a Reason?

    “Everything happens for a reason” conflicts with AA principles: it misleads recovering alcoholics into thinking they are special—that they are somehow more worthy of salvation than the addict or alcoholic who perished.

    “Because genocide.”

    That was me, in my typically understated fashion, explaining to a newly recovering alcoholic why he shouldn’t heed the single silliest phrase permeating the rooms of Alcoholics Anonymous: “Everything happens for a reason.”

    In my seven-plus years attending AA meetings, I’ve come to know and loathe my share of cliché recoveryisms. For example, to me, “Let go and let God” overshoots otherwise sound advice against trying to control everything into a place of irresponsible complacence. “If you spot it, you got it” blames an observer simply for noticing wrong behavior or thinking, while “All of us only have today” weighs equally the experience, strength and hope of a wise old-timer and a wild-eyed newcomer. We don’t all just have today—we have all the days before it.

    And it is baffling why the Our Father—a prayer praising a conventional paternalistic, heaven-dwelling religious deity—still closes many meetings, as it directly contradicts the organization’s stated non-alignment with any sect or denomination, per its Preamble.

    So yes, AA phraseology has its share of eye-rolling headscratchers. But none are as cringe-worthy and counterproductive as the concept that every single thing that transpires in life does so as part of a grand, predestined scheme.

    In an everyday setting, “Everything happens for a reason” can be brushed aside easily enough. Outside the realm of recovery, it becomes little more than a difference of opinion; your churchgoing aunt believes God is in heaven treating us like marionettes, while you prefer a puppeteer-free existence. To each his own.

    However, AA’s penchant for preordainment is particularly problematic, due to the specific forum in which it is propagated. In a recovery setting, the notion that all occurrences— good, bad or indifferent—are part of some predetermined master plan is a double-edged sword that does a disservice to all involved, believer and nonbeliever alike.

    Unreasonable Expectations

    Let’s start with those in my column: recovering alcoholics who, though they may embrace a spiritual higher power—a rhythm of the Universe, let’s say, don’t ascribe to a god that directly intervenes in our lives. If you wonder why athletes thank the Lord after a big win, you’re in my boat. Call it the “God doesn’t score goals” perspective. 

    When people who don’t believe in an interventionist deity are told to see the hands of God in everything, there is no common ground. Many of us, myself included, were stone-cold atheists upon entering AA; some of us, myself not included, still are. A healthy agnosticism is the best many of us can muster while—and this point is crucial—retaining a recovery-capable level of self-honesty. Few stay sober by lying to themselves about something as mission-critical as spirituality.

    Upon entering AA, we were assured by both literature and longstanding members that our spiritual skepticism was fine, as long as we were willing to put faith in some sort of higher power. Many of us took Step 2 with the group itself in that role and, in Step 3, turned our will over to… well… something as best we could without the whole endeavor feeling so forced that it forced us out the door.

    And then… “Everything happens for a reason”? That’s a bridge too far­—and one apt to collapse carrying newcomers who are left feeling betrayed by the agreed upon rules of repeated spiritual engagement. It also leads to inferiority complexes, when these newcomers compare themselves to AA members who seem to take God’s Great Chess Game of Life at face value.

    Replacing that collapsed bridge is a wall. There’s no kind way to say this: Many people who don’t believe everything happens for a reason find those who do simultaneously pretentious and unsophisticated—an oxymoronic mélange of know-it-all-ism and naiveté. When I hear someone in AA insist upon God’s almighty plan, it makes me respect what they say next significantly less.

    And no, comment thread, that isn’t my arrogance—it’s the phrase’s. “Everything happens for a reason” is a condescendingly cocksure nonstarter that cleaves members off from each other. Worse, it does so completely unnecessarily, since its veracity is entirely irrelevant to the greater principles and practices of AA’s primary purpose: recovery from alcoholism and addiction.

    How many newcomers, I often wonder, have gone back out and died because they didn’t realize “Everything happens for a reason” is by no means AA dogma, but rather AA dog… something else. Even one is too many.

    And if the true believers can’t stop saying it for nonbelievers, maybe they can stop saying it for themselves. Here’s why.

    No Good Reason

    In Alcoholics Anonymous, “Everything happens for a reason” conflicts directly with the program’s principles. It does so by misleading recovering alcoholics into thinking they are special—that they are somehow more worthy of salvation than the addict or alcoholic who perished. The result is a sort of unintentional hubris that flies in the face of sobriety-bolstering ego deflation.

    By implication, declaring yourself selectively saved by an all-intervening God acknowledges that this same deity let others perish. He took Prince, Amy Winehouse and Philip Seymour Hoffman, but left… you? Forgive me if I find that conceited.

    On a macro level, I also find it insulting. This Calvinistic approach to human existence means God assents to tsunamis, earthquakes, war crimes. If you sincerely believe that God greenlighted the Holocaust, I simply don’t have much to say to you. Again, this notion of intra-organizational separation is all caused by a concept completely unnecessary to that organization.

    Unfortunately, a major obstacle in all this is utter obliviousness. From where I’m sitting, the vast majority of those who espouse, ad nauseam, that “Everything happens for a reason” do so from custom rather than castigation. By and large, religion—or, rather, a sophomoric interpretation of religion—has weaned them to believe they are somehow saved, chosen or otherwise privileged. There is an entrenchment to this flawed view of eminence that makes it as intractable as it is unpalatable.

    In this manner, “Everything happens for a reason” is an unreasonable phrase often repeated for no good reason other than a “sure, why not” reluctance to challenge outdated thinking. It’s one of those grandfathered-in phrases that should be retired, along with the uber-sexist “To Wives” chapter in the AA Big Book.

    In late 2011, as a 32-year-old just drying out off a DUI and with a wife halfway out the door, AA’s preordainment problem nearly made me explore other sobriety options. This would have been a mistake, considering how well-suited the literature, the 12 steps and the fellowship turned out to be for my recovery.

    It is in line with this concern—attracting and retaining newcomers—that a concerted effort should be made to retire “Everything happens for a reason” from the rooms of AA. And I for one believe that doing so depends entirely on our efforts, not God’s plan.

    View the original article at thefix.com

  • Is AA Too Religious for Generation Z?

    Is AA Too Religious for Generation Z?

    “What I try to teach is: if you don’t buy into any kind of a supernatural higher power, navigate the 12-step world, filtering the god-stuff out, working the program in your own way; there is lots that really works.”

    Are today’s mutual-aid recovery groups ready to satisfy Generation-next?

    “More than any other generation before them, Gen Z does not assert a religious identity. They might be drawn to things spiritual, but with a vastly different starting point from previous generations, many of whom received a basic education on the Bible and Christianity. And it shows: The percentage of Gen Z that identifies as atheist is double that of the U.S. adult population.”

    Released early this year, Barna Group’s Generation-Z Report (Americans born between 1999 and 2015) surveyed over 2,000 13 to 18-year-olds. The oldest of this generation turn 20 in 2019.

    According to AA’s most recent triennial membership survey, 1% of AA is under 21—that’s about 20,000 sober teenagers in AA rooms right now. What’s my personal affinity with this demographic? It’s two-fold: I have two millennial children and one 18-year-old stepson; secondly, while I am a grey-haired Baby Boomer, I was a teen at my first 12-step meeting. My 20th birthday was 1980, three months shy of my fourth anniversary clean and sober.

    I was a second-generation AA member and—like Barna’s youth focus group—my worldview seemed incompatible with the old fogies of 12-step rooms. My mother mused about finding god’s will for her from meditation or her daily horoscope. She was such a Virgo, you know. Horoscopes, higher powers, legends of Sasquatch, these were all fictional symbols as far as I was concerned. Reasonable people didn’t take such constructs literally, did they?

    Bob K, like me, is a second-generation AA. He’s currently between historical book projects; Key Players in AA History will soon have a prequel. Bob’s follow-up research will produce a book about pre-AA addiction and treatment. At age 40, Bob made it into AA as a result of his dad 12-stepping him. He also was uncomfortable with the emphasis on “God.” 

    “When I was a month sober, it was ‘God-this, God saved me’ and I was going to put my resignation in. I didn’t think I could stand it in AA any longer. I went to the internet of the day—which back then was the library—and I looked for non-religious alternatives to AA. They had them in California but nothing in Ontario Canada. So it was AA or nothing. If I tried to brave it alone, I’d be drunk; I knew it.”

    Today, Bob enjoys the likeminded company at his Secular AA home group, Whitby Freethinkers, which meets in the local suburban library just East of Toronto. 

    If I were confronting addiction/recovery as a teen today, I wonder if I would go to AA or NA? If AA was once “the last house on the block,” today it’s one house in a subdivision of mutual-aid choices. Today, newcomers have access to Refuge Recovery, SMART Recovery, Secular Organizations for Sobriety (SOS), or Medically Assisted Treatment, none of which existed in the 1970s.

    On Practically Sane, therapist Jeffrey Munn states: “I like to take a practical approach … I’m not a fan of the ‘fluff’ and flowery language that is often associated with the world of psychology and self-help.” Jeffrey came into the rooms at 20, stayed sober for 2 ½ years, relapsed, came back and is now 13 years clean and sober.

    “I was mandated to three 12-step meetings per week to stay in the program I was in. Since I was young I have been agnostic. I wanted to find a higher power that was common sense-based, but in the rooms I felt pulled towards a more dogmatic spiritual idea of higher power. Back then, I needed to come up with my own conception of what was happening on a psychological level.” Recently, Jeffrey wrote and published Staying Sober Without God: the Practical 12 Steps to Long Term Recovery from Alcoholism and Addiction.

    “I looked at SMART Recovery,” Jeffrey tells The Fix. “I looked at Moderation Management, too—that one struck me as being an organized resentment against AA—I wasn’t feeling it. When it comes down to social support and a practical plan of action, it’s hard to beat 12-step programs. What I try to teach is: if you don’t buy into any kind of a supernatural higher power, navigate the 12-step world, filtering the god-stuff out, working the program in your own way; there is lots that really works.”

    Barna reports, “Nearly half of teens, on par with Millennials, say, ‘I need factual evidence to support my beliefs.’” Jeffrey hopes Staying Sober Without God—which joins a growing secular 12-step recovery offering—offers the rational narrative today’s youth crave. Barna calls today’s youth “the first truly post-Christian generation [in America].”

    Certified Master Addiction Counselor David B. Bohl of Milwaukee understands the value of other-oriented care. David tells The Fix: “As head of a 20-bed coed dual-diagnosis treatment center, emerging adults, 18 to 25 years old, came into our care. I wouldn’t say that they universally shrugged off the 12-step approach but almost universally, in reaction to our volunteers, alumni, and traditional AA community, younger clients didn’t want what the volunteers and alumni had. And I wouldn’t say it was the religiosity always. Sometimes it was an age-thing or life approach. So, our recovery management function became that much more important in terms of building individualized treatment that suits everyone.

    “In the USA, 75% of all residential treatment centers identify as 12-step facilitators,” David tells us. “In the simplest form, our job is to introduce people to the language and the concept of the 12 steps and then to introduce the clients to support groups or people in support groups when they are discharged from acute care.

    Where trauma is involved—religious trauma in particular—traditional AA language and rituals trigger that shame they feel from negative formal religion experiences.”

    Let’s put this overbearing religion caution to a real-life test: Suwaida F was the second oldest of 11 children to Somalian refugee parents who fled to Canada in the 1980s.

    “In Kindergarten I didn’t have to wear a hijab; my parents weren’t super religious. I went to an Islamic school in grade one. It was normal for teachers to have belts with them, they would hit you; child abuse was normalized. They didn’t really teach us that much math, science, history. The Islamic teachers weren’t that educated. My parents took me out and put me in public school. Then, some of my mom’s Somalian-Canadian friends started moving their kids to Egypt. My friends would stay in Egypt two years, finish the Qur’an and the girls came back wearing burqas and head-scarves. Some Muslim friends would come to school in their hijab, take them off and put them back on when they went home. We called them The Transformers.

    My parents really wanted us to learn the Qur’an; I don’t speak Arabic, so it was difficult. And I never believed it. I asked my mom and dad, ‘How do you know that this stuff is real?’ They got frustrated and mad and said, ‘Don’t ever ask that question again.’ I knew it wasn’t real. Mom got more and more religious. Pictures of her at age 19 — she wore no head-scarf when she was my age. My mom expected me to be religious and I rebelled. I had to leave home.”

    Suwaida misses her sisters. She feels unwelcome in the family home unless she is dressed in the Islamic custom and that wouldn’t be true to herself. Away from home, Suwaida found the welcoming community she craved in the booze and cocaine culture.

    “It wasn’t a matter of having no money; I had no sense of hope. People at work didn’t know I was hopped from shelter to shelter at night. One winter I was told, ‘Suwaida, you’ve been restricted from every youth shelter in the city of Toronto.’” As addiction progressed, Suwaida recalls an ever-descending patterns of compromises, bad relationships and regrets.

    “Today, it’s like I still never unpack my suitcase; I’m always ready to go.” During a stay at St. Joe’s detox, Suwaida went to her first NA meeting.

    “At 7 PM, a woman spoke. I made it clear that I thought it was stupid; I wouldn’t share. At the end, everyone was holding hands to pray and I said, ‘I’m not holding any of your hands.’ I didn’t go back. When I was discharged, I went drinking at the bar with my suitcase, not knowing where I was going to stay that night.

    My second meeting I consider my first, because I chose it. I thought I should go to AA. I googled atheist or freethinker AA to avoid a repeat of my NA experience. I found Beyond Belief Agnostics and Freethinkers Group on the University of Toronto campus. I went there last February. For a while, I had wine in my travel-mug, and I didn’t say anything. In August I felt like the woman beside me knew I was drinking, and I ask myself, ‘What am I doing?’ So, my next meeting, I went sober. I’ve been clean and sober ever since.”

    Despite the child-violence of Islamic school and rejection from her family, Suwaida isn’t anti-theist. “I do believe in God or in something. I feel like I’m always looking for signs. I don’t believe in a god in the sky but to say there’s nothing beyond all this doesn’t make any sense to me. Sometimes the freakiest things happen. Maybe it’s because I’m a storyteller, I try to make a story out of everything; you think of someone, then they phone you, is that random?

    I feel a part-of in secular or mainstream AA meetings. My self-talk still sounds like, ‘Don’t share Suwaida, you have nothing to add.’ Maybe it comes from not being able to express myself when I was growing up. I have no sense of self. I guess I have something special to offer but I don’t know how to articulate it. It’s hard; I have limited self-confidence.”

    “Give them their voice; listen to them,” is Kevin Schaefer’s approach. He co-hosts the podcast Don’t Die Wisconsin. He’s also a recovery coach.

    “I’ve been in Recovery 29+ years. I’m a substance abuse counselor and I got into addiction treatment through sober living. When I started working in a Suboxone clinic, I came to realize that AA can’t solve everything. I always come from a harm reduction standpoint: meth, cocaine, benzos; I ask, ‘Can you just smoke pot?’ and we start building the trust there.

    Medically Assisted Treatment (MAT) is geared towards this generation. Most kids coming through my door know a lot about MAT, more so than people in AA with the biases and stigma that they bring. Kids sometimes know more than the front-line social workers. Their friends are on MAT, that’s how they gather their information (not to say their information is all correct). But a lot of therapists don’t understand medication. Medication can be a ticket to survival out on the streets.”

    The Fix asked Kevin his opinion on the best suited mutual-aid group for this generation.

    “Most of the generation you’re talking about walks in with anxiety and defiantly won’t do groups.” We talked about the role of online video/voice or text meetings for a tech-native generation. “Yes—where appropriate. Women especially, because from what I’ve seen, most females have suffered from trauma. I have heard women who prefer online recovery; that make sense to me. I’ve been to InTheRooms.com; as professionals we have a duty to know what’s out there. And there are some crazies online.

    If someone has an Eastern philosophy bent, I’ll send them to Refuge Recovery; I’ve been there. If I can, I’ll set them up with somebody that I know can help them. And let’s not forget that some youth, if Christianity is your thing, Celebrate Recovery is amazing — talk about a community that wraps themselves around the substance user. There are movie nights, food, all kinds of extracurricular activities. The SMART Recovery Movement? Excellent. SMART momentum is building in Milwaukee. They are goal-oriented and the person gets supported whether they’re on Suboxone or, in one case I know, micro-dosing with LSD for depression; they’ll be supported either way. My goal with youth is: ‘Try to get to one meeting this month; start slow.’ Don’t set the bar too high and if they enjoy it, then great.

    The 12-step meeting I go to, it’s a men’s meeting. There are people there on medication and they don’t get blow-back. I wish more of AA was like this. When I came in, almost 30 years ago now, I saw all the God-stuff on the walls and I thought, ‘Nah, this isn’t going to work’ but thank G… (laughs), thank the Group of Drunks who said, ‘You don’t have to believe in that.’ The range in my meeting is broad—Eastern philosophy, Native American practices, Yoga, I was invited to Transcendental Meditation meetings at members’ houses. I was fortunate to fall into this group. You know, the first book my sponsor gave me was The Tao of Physics—not The Big Book—it was this 70’s book with Buddhism, Taoism, Hinduism, correlated to physics and contemporary science.”

    So, as to the question that kicked this off, some mutual aid meetings are ready to meet the taste of a new generation; results may vary. Who’s heard: “If you haven’t met anyone you don’t like in AA, you haven’t gone to enough meetings”?

    The reverse is true, also. If the peer-to-peer meetings I’ve sampled seem too narrow or dogmatic, maybe my search for just the right fit isn’t over. And if I don’t want a face-to-face meeting, there’s always Kevin’s podcast, virtual communities like The Fix, or I can order one of Bob or David or Jeffrey’s books if that’s more to my taste.

    View the original article at thefix.com

  • Alcoholics Anonymous: A Different Perspective

    Alcoholics Anonymous: A Different Perspective

    Rather than seeking knowledge through scientific methodology to gather more and more evidence regarding the factual attributes of successful recovery, AA emphasizes scripture, tradition, and the word of authority figures.

    I recently read an essay on another recovery-oriented site, a site whose focus is on people in 12-step recovery yet who are disinclined to religion. The topic was “moments of clarity.” Now, this phrase, for those who have spent years in the 12-step subculture, has obvious connotations. Having the knee-jerk, familiar response to the phrase is one of those cult-like behaviors which make me happy I am no longer an AA member, no longer speaking the lingo nor “drinking the Kool-Aid.” For this free-thinking addict/alcoholic, 60 years old and having spent more of my life in recovery than out, it brought to mind something very different from what was intended. This was a profound and life-changing experience I had, in which the following truths hit me like the proverbial ton of bricks:

    1. I am an atheist.
    2. Alcoholics Anonymous is a religion, like Christianity and Islam.
    3. Such religions tend to impede the development of scientific knowledge regarding natural phenomenon.
    4. Alcoholism, addiction, and the process of recovery are entirely natural phenomenon.
    5. AA has a very low success rate.

    Before going on, I should make clear that I am not merely another AA-basher. I am a former long-term member and Alcoholics Anonymous was central in my life for decades. I learned a great deal, much of which I utilize to this day. I also mean no disrespect whatsoever to the author of the original essay, and I apologize for being tangential. I have problems with the “program,” but not with any individual members. My focus is on all those who suffer because, like myself, they are forced to choose between the rock of active addiction and the hard place of joining what is essentially a Christian sect.

    Alcoholics Anonymous as Religion

    “If it walks like a duck and quacks like a duck…”

    • Twelve Steps

    The chapter We Agnostics is a thinly veiled effort at proselytizing by a devout Christian. Its goal is to use the concept of “open-mindedness” to convince readers to buy into the dualism of old-time religion, with its antiquated belief in the existence of both a natural and a supernatural realm, complete with supernatural entities or “higher” powers. Attaching “as we understood him” to a couple of steps is similarly disingenuous. It is nothing more than a manipulative sales pitch by a professional salesman, one which pales in the shadow of the heavy-handed religiosity of his “12 steps of recovery.” So, for example, in Bill Wilson’s steps you will find: 

    God four times,
    Him or His four times
    Prayer and meditation
    Spiritual awakening and
    A power greater than ourselves.

    Surrender of the personal will, faith in God, confession, prayer and meditation, ultimately even proselytizing and missionary work are promoted as essential attributes of recovery. Here again, the steps promote religious dualism, with its denial of the value of naturalistic, or scientific, knowledge. Even in the 21st century I distinctly recall hearing this erroneous, anti-science perspective espoused in meetings, with god and the supernatural realm presented as the source of all the good stuff, while the natural realm and the animal known as Homo sapiens served as the source of all the bad.

    • Scripture

    The highlighting, underlining, and prodigious dog-earing; treating the book as a sacred object like the Quran; studying and re-reading, with study groups like the Bible; carrying it everywhere; quoting and citing as if anything between the covers is self-evidently true or “gospel,” so to speak; and the unwillingness to change a word of the first 164 pages: all of these attest to a belief in the Big Book as the kind of scripture or divine word which serves as the foundation for religious traditions like Christianity, Islam, and others. I can recall many times in the rooms when I heard the view that the Big Book was divinely inspired, the ludicrous notion that a supernatural entity was speaking through Bill Wilson when he wrote Alcoholics Anonymous.

    • Tradition

    Rather than seeking knowledge through scientific methodology to gather more and more evidence regarding the factual attributes of successful recovery, AA emphasizes scripture, tradition, and the word of authority figures. These are the criteria that many religions use to justify “knowledge” as they understand it. Ironically, even though America is one of the greatest scientific nations in history, we also suffer a populace which is largely hostile to science and academics. The members of AA comprise a microcosm of this larger population.

    • Faith is NOT a Virtue

    Faith is claimed to be a virtue, but in the 12-step context it is actually the acceptance of something for which zero evidence, facts, or data exist. That is, the adulation of ignorance, a trait which walks hand-in-hand with America’s mistrust of science and of academics more generally. This approach teaches us to be mistrustful of science, yet obedient and sheep-like with religious authority. The main reference to science in the “first 164 pages” is one line which states that “science may one day cure alcoholism, but it hasn’t done so yet.” Importantly, this one reference is often read sarcastically, with derisive snickers and mocking asides, illustrating a cocky certainty of its implausibility.

    • Authority and Obedience

    As with religions like Christianity and Islam, unquestioned obedience to authority figures is of the utmost importance in Alcoholics Anonymous. We are all familiar with the phrase “take the cotton out of your ears, and put it in your mouth.” In some places this is an actual rule, with newcomers in their first 30, 60, or 90 days advised to only listen. Unquestioned obedience to authority is a major distinction between religious perspectives and secular, humanist, and scientific approaches. The adulation of Bill, of Bob, of circuit speakers and old-timers, of sponsors, the use of quotes as meeting topics, and the current emphasis on temporally-measured sobriety, encouraging both pride and the development of a hierarchy, all convincingly mirrors the religious emphasis upon blind faith and obedience to the words of authority figures.

    • Conservatism

    Conservatism in this context means a profound reticence to change. I believe that the Catholic Church recently apologized to Galileo, only 450 years overdue. Both Christianity and Islam still treat women as if we were living in Biblical times. This intransigence, this resistance to progress, is one of the primary characteristics of Alcoholics Anonymous. AA causes people to become narrow-minded and inflexible, unable to consider new, different, or contrary approaches to treatment methods. When I have broached these subjects with current members, they have consistently become defensive and “circled the wagons.”

    Religion as Impediment

    “So what?” you might ask. “So what if AA is a religion?”

    The problem is, as a result of their fundamental dualistic nature, these types of religions stand in the way of us acquiring knowledge and, in particular, cultivating a more naturalistic, scientific understanding of addiction, alcoholism, and the truly essential attributes of recovery.

    Problems and Solutions

    You admit you have a problem. Then you find a “spiritual solution.” What do you do? In AA, as with Islam and Christianity, you are discouraged from seeking an alternative solution. You are even encouraged to proselytize, to go out and “spread the good news.” Religious converts, recipients of the “one true word,” are trained to be blind, even hostile, to alternatives, particularly naturalistic ones, while enthusiastically promoting the one and only true supernatural solution.

    So around 8 or 10 years into sobriety we go and get our counseling certificates, then get a job working or volunteering at a nearby treatment center. The faculty, staff, and volunteers at the facilities, and at the couple of behemoths in the addiction treatment field, are largely AA members, AA trained, and generally convinced that with the 12 steps and our “spiritual solution,” the problem has been solved. I believed this too, for many years. This fundamentally biases the treatment process, leaning it towards 12-step and away from any alternatives.

    Conservatism Revisited

    Another consequence of AA’s conservative bent is that people in the program become so convinced that the Big Book and the program are perfect exactly as they are, that they do not hear what atheists or skeptics like myself have to say. This is a form of cognitive bias called confirmation bias, which simply refers to how, even when confronted with facts or data challenging their beliefs, people will nonetheless cling to their original views. In fact, people will even double-down on their faulty original position when confronted with fully rational, fact-based alternatives. This bodes ill for our efforts to update recovery by embracing more empirical, evidence-based knowledge, especially if it conflicts with AA tradition, scripture, or authority.

    Anti-Naturalistic Thinking

    These religious traditions started out as pre-scientific efforts to understand ourselves, the greater cosmos, and our place within it all. Their most significant error was the introduction of the afore-mentioned dualism, an imagined schism between the natural and the supernatural. Ever since Darwin, we have known that the 100% natural animal Homo sapiens builds new knowledge on top of old knowledge, accumulating knowledge over time until we figure out how to solve all manner of worldly, natural problems. This includes curing diseases that were once deemed completely beyond our comprehension or scope, requiring prayer, sacrifices, and incantations to mysterious gods.

    Rather than attributing meaning to the words “bless you” when someone sneezes and seeking to bring supernatural elements to bear on the demonic entities which allegedly cause a person to become sick, we have instead discovered the germ theory of disease. I am simply suggesting that we stop thinking in such medieval, archaic terms when it comes to addiction, alcoholism and recovery and instead fully embrace empirical, scientific methods which might yield more fruitful results.

    God of the Gaps

    The strongest argument for religion as an impediment would be the “god of the gaps.” For millennia humanity has inserted supernatural answers into the gaps in our knowledge. If a hurricane blows or an earthquake hits, god (or, if you prefer, a higher power) did it. However, over time, naturalistic answers have replaced supernatural answers, one by one, consistently, and with far more accuracy.

    Complex psycho-social maladies like ours are particularly mysterious and therefore highly prone to such supernatural interpretations. AA’s founding fathers were steeped in a social context in which radical personal transformations were deemed mysterious and supernatural. We had absolutely no idea what was involved, so we labeled such experiences as “psychic” (Silkworth) or “spiritual” (Jung), which merely perpetuates the fallacious dualism, as a result of both the unclear meanings and supernatural undertones of such key terms.

    Over the course of human history our questions have found their best, most accurate answers not in the supernatural but instead in knowledge gained through approaches emphasizing the scientific method. As atheist author Greta Cristina and others have wisely observed, there exist precisely zero accounts of this process moving in the opposite direction. Nonetheless, AA remains an obstinate hold out.

    It’s time to embrace facts and data, to give science a real shot at addressing this global scourge. AA members must become more open to approaching the problem anew. If, when confronted with Galileo holding that the earth revolved around the sun, the church had simply said “well, let’s check out what the evidence says,” that would have been great. But they did not. Instead, like AA members have done to me—and I’m no Galileo—they cry “trouble maker” and play hear no evil, see no evil…

    Alcoholics Anonymous as a Failure

    None of the above would matter if Alcoholics Anonymous really, truly worked.

    But it does not.

    I was told by the senior counselor in my second treatment center that only 10% of us would “make it”. That’s an admitted failure rate of 90%. This was not merely manipulative sales-speak. Such extremely poor success rates are similar to what a variety of differing studies have found. We all know this, anecdotally. If you look, you can see that the only thing busier than the coffee pot at an AA meeting is the revolving door. And such disheartening research does not even scratch the surface of our failure, as most of the world’s millions of addicts and alcoholics never even darken the doorways of AA in the first place, for a number of very good reasons.

    “It works if you work it” is a classic example of the kind of un-falsifiable claim which characterizes religious traditions. Scientific claims, on the other hand, are characterized by falsifiability, which simply means that they can be tested. Then we can either discard them, modify them, or build upon them. It is by utilizing precisely such scientific approaches that we have discovered cures for polio, small pox, malaria, and so much more. The more complex, psycho-social disorders, such as depression or bi-polar disorder, are likewise yielding to our efforts to address them as purely natural phenomenon.

    By any and all measures, there is a staggeringly large amount of room for improvement. The religious perspective merely serves to block our way at this point in history. In the short time it took you to read this essay, thousands of lives were shattered or ended. It’s time to move on and aggressively seek empirical, naturalistic solutions to this deadly global scourge.

     

    Thoughts? Rebuttals? Please share in the comment section below.

    View the original article at thefix.com