Relapse prevention: Going AA or solo?

         Oftentimes you here about people who have stopped drinking or taking mood or mind-altering drugs on their own without the help of Alcoholics Anonymous (AA) or any other recovery program. These people are unusual, but their stories deserve some attention.

         There is such a thing as spontaneous remission in addictions. It seems that there is a very small percentage of people who were once pathologically addicted to alcohol or other drugs who stopped using one day on their own. These people defy the odds, but they have testified to the ability to use willpower to withstand the forces of cravings and urges to drink or take drugs again. One day, as if by a miracle, they woke up from the drug-induced denial they had been experiencing, and declared they would not use any more. These people exist and they are usually very anxious to tell the world how easy it was to stop what was once a compulsion to use.

         But, the vast majority of people who stop using alcohol or other drugs on their own do so over time. They add up the threats or consequences that have come to them in the form of DWI’s, eviction from the family, or loss of a job due to drinking or drug use, and they conclude it wasn’t worth it to use these chemicals. Many of these people found something in their life that was more important to them than drinking or drugging. Their family relationships, driver’s license, job, or peace of mind gave them more pleasure than the chemicals. They were able to reason themselves to stopping the use of alcohol or other drugs, i.e., they added up the consequences, thought about how to make better decisions about their use, and concluded that they could resist using based on their application of willpower to the task.

         Accomplishing abstinence through either spontaneous remission or rational recovery methods is incredibly hard to do. One of the reasons is that addiction is a disease of the brain that alters the way nerve cells in the brain communicate about such things as willpower and the freedom to choose the best solution. This disease is very powerful because our brains literally get re-wired by the alcohol or other drugs so that they perpetuate their use. The pressures that an addicted brain can put upon a person who decides to not use are considerable. We call them cravings and urges to use alcohol or other drugs and they can move people to do things they ordinarily do not want to do.

         It’s not to say that AA involvement makes it necessarily any easier to resist using alcohol or other drugs, but there is a feature to the AA program that makes it attractive to many people who seek recovery from addiction. When someone has tried everything else to stop using – psychiatry, counseling, medicines, religion, forced abstinence situations, or even willpower through rational thought – and still been unable to stop using, then AA tends to be a very attractive and useful answer to the problem. One of the reasons for this is that AA deals with the spiritual components of a person’s life that most people don’t like to think are involved with dealing with addictions.

They say in the AA meeting rooms that “Religion is for someone who is afraid to go to hell, but spirituality is for someone who has already been there.” There is no typical member of AA. Yet, to the extent one can say anything about the people who practice recovery through AA, there is the common denominator of having a “God-shaped hole inside” that can’t be filled by any other means. This means that there is some kind of spiritual void inside a person, some missing emotional piece of their being, which is absent in many people who have used alcohol or other drugs to cope for many years.

It is that missing spiritual aspect of recovery that AA addresses. Even many people who have had spontaneous remissions or developed the capacity to “just say no” to alcohol or other drugs will freely admit that their abstinent lives are not very happy. There is a tendency in life for all people to have people, places, things, or situations overwhelm them as they struggle to solve problems in these areas. For the person who has stopped using the psychologically soothing “medication” of alcohol or other drugs to cope with these problems, life can be hectic, confusing, and painful. AA tends to focus more on achieving not only abstinence, but also the peace of mind (serenity) that can come within a life that has been spiritually transformed. Dealing with life on life’s terms becomes easier once there is the knowledge that there is a spiritual system that can help someone cope with problems.

It's the journey, not the destination

I was talking with a friend of mine the other day about the differences between Alcoholics Anonymous and Narcotics Anonymous. She knew that I had recently decided to stop attending NA meetings and withdraw from all my service commitments in NA, and was curious as to why I had done so. The conversation gave me a good chance to publicly state some of the things that have been rumbling in my mind for the past several years.

She said something interesting I had never heard before: She said that the big difference between AA and NA was that AA found something outside herself - alcohol - to be the problem while NA found that something inside herself - the addiction - to be the core problem in her life. She preferred to think of addiction as something deeply within her core rather than something "out there" that had to be avoided. In essence she was saying that AA finds its focus on a known commodity - alcohol - while NA finds that the core issue - addiction - lives within. This struck me hard. I had to think about the consequences of what she was saying for my own life.

Since the first day I got clean, I have been going to NA meetings. I was exposed to NA when I was in a treatment facility in January, 1988. I had stopped using about a month before when I collapsed in a puddle of emotions during my self-imposed detox process. I had been to one AA meeting since the day I stopped and I felt AA "was not for me," so, by the time I got to the treatment center I was confused about 12 Step programs and didn't think they could help me. But, when a man named Jerry brought a meeting into the treatment center and talked about his addiction and how NA had saved his life, I suddenly recognized that he was talking to me about my own addiction. I found NA and the people in it a welcome relief from the isolated suffering I had been going through.

For more than 25 years, NA was the vehicle for my expression of my recovery. I threw myself into meetings in those early years and gave myself to service work through the Hospitals & Institutions subcommittee of NA that talks to people in prisons and detoxes and hospitals. I was content with NA despite some developing difficulties.

During that whole period of time I found that it was not cool within NA to talk about AA. There is great pressure within the NA fellowship to see NA as a stand-alone recovery program that does not rely on AA. Founded in 1953, the NA movement has worked very hard to distinguish itself from AA and worries about blurring the lines between the two programs. You can't use the word sober in NA. You can't quote Bill W. or use the AA Big Book as a source. You aren't supposed to go to AA meetings or have an AA sponsor. And, you basically have to tolerate a lot less positive talk about recovery in meetings that are dominated by people still addicted to drugs and the lifestyle of the drug addict.

A few months ago that all changed. I had gotten into a debate with a fellow NA member over a technicality about "promoting" NA as opposed to allowing NA to "attract" new members. He was taking a dogmatic approach to the NA message, and I wanted a more expansive approach. He refused to budge. I began wondering what I was doing the service garden I was laboring in. So, I basically gave a voice to what lay within me about AA vs. NA and decided to move back to the practice of my recovering through the AA program.

I realized that for many years I had been squelching the urge to talk about my love of the AA program, its history and especially my affection for Bill W. I had long ago abandoned the AA Big Book as a source of reading about recovery and a guide for my life. I always felt guilty when I thought about Bill and his wisdom. I always felt that I was missing something by not being able to talk about my relationship to the AA fellowship. So, it became clear to me that I needed a change.

So, about three months ago, I started to go back to AA meetings. I bought the new edition of the AA Big Book and started reading again. I read a biography of Bill W. I dove into the meetings. All of a sudden I felt rejuvenated. I felt young again in my recovery. I felt a new sense of purpose and meaning in my recovery. In every sense it felt just plain good to be a regular member of the fellowship without the weight of expectations that falls upon someone who is clean 25 years within the NA system. No...I was just your everyday AA member, and I loved it.

For me today it doesn't make any difference whether the addiction lives outside of me in a bottle or whether is is something that is within the core of me. I think the AA principles handle all of that very nicely when AA says that drinking alcohol in itself is just a symptom of a larger issue of who I am as a man. And, the 12 Steps go deeper by telling me that abstinence is not the goal of the process...serenity is. AA found "a solution to the drink problem" and it lies within the changes that I make within me to live a life that is happy, joyous and free.

It's not that my friend and I disagree. We get to the same place by different routes. She knows that addiction itself is the core problem, and I realize that alcohol is not the only demon I have to cope with. It's the journey, not the destination that is the key difference between us, and I relish the chance to be on that sojourn again with the likes of Bill W. and Dr. Bob and the millions of other alcoholics who recover one day at a time. So...it's not so much that I am leaving NA behind as it is that I am rejoining the troupe of like-minded people in AA who have a deep and rich tradition of recovery based on the practice of spiritual principles in life. And, it feels very, very good indeed!

All the best,

Roger W.

The illusion of control...

Most people confuse two words: control and power do not mean the same thing.

To try to control people, places, things, or situations in our lives is a feeble attempt to ward off anxiety that is brought on by the insecurity of not knowing the future with any degree of certainty. In fact, many of us spend an inordinate amount of time trying to control our world under the pretense of an argument that says "I am the one who has to harness the unpredictable forces of good and evil in my world because there is no one else who is going to do so." Thus, we spend time in our day trying to act in a way that suggests to ourselves and anyone else who is watching that we have our lives together and that we are secure against the demons at the door.

Now, for most people, this is not a big deal. Many are not overly troubled by their attempts to control things around them and they have a modicum of success handling what comes their way. If they manage to control things, then their world goes along without skipping a beat. If they fail at controlling, they muster up their courage to tackle the next set of unpredictables and forge ahead. But, for the alcoholic and drug addict, things can be quite different and the attempt at control can set them up for the feeling of failure...a deadly set of emotional responses that can (and usually does) lead directly to the bottle or the bong. Alcoholics and addicts are famous for setting up an impossible scenario for the God of their understanding when they whine that they have tried everything within their power to control the forces bearing down upon them and, because they have not done so, blame their God for forsaking and failing them. They are usually reinforced this way to believe that they must go it alone in a dog-eat-dog world.

What many alcoholics and addicts fail to understand is that in order to control some things in their lives they need power. Usually, after coming off a bender of a day or a decade, the average alcoholic and addict realizes that they haven't got much power over the forces in the universe to effect positive change in their lives. They have usually squandered any power sources they may have had and find themselves bereft of any of the usual power sources that can help people. They then erroneously conclude that there is no power in the world available to them and despair at ever being able to make a difference in their own lives. Alcoholics and addicts are famous for thinking that if they can't do it alone, then it's not worth doing at all.

So it is that I was intrigued recently when I read a paragraph in the AA Big Book that addressed this problem (it's always true for me now that the Big Book has an answer for everything that bothers me!). On page 386 of the new fourth edition, the writer talks about how he came to see that he had gained power in his life simply by being sober:

Here (in AA) I found an ingredient that had been lacking in any other effort I had made to save myself. Here was - power! Here was power to live to the end of any given day, power to have the courage to face the next day, power to have friends, power to help people, power to be sane, power to stay sober....Moreover, I am deeply convinced that so long as I continue to strive, in my bumbling way, toward the principles I first encountered in the earlier chapters of this book, this remarkable power will continue to flow through me.

It's here we see that the real source of power for recovering people as being the belief that, through spiritual principles inherent in the AA program, they are able to control their lives. It is by giving up the attempt to do everything themselves, and by giving themselves up entirely to this simple program, that they gain the power to actually work through adversity and suffering... and live. This is what we call the paradoxical effect of the belief in powerlessness as it is expressed when we find we are defenseless against alcohol and drugs: By giving up the attempt to control, we gain it.

Always, this is a giving up of oneself to a power greater than oneself. And, that's usually where the rub happens for the average alcoholic or addict struggling with recovery. Many people don't want to give up the illusion of control and they continue to tell themselves they are able to control their drinking and drugging behaviors as well as every other aspect of their lives. When they fail it justifies drinking or drugging. In fact, usually alcoholics and addicts who an enlightened, and see themselves as unable to muster that power within themselves, turn to a God of their understanding to help them. And, it works.

Such belief provides the power to do what we can no longer do for ourselves...the power that the alcoholic on page 386 has found in his life and freely passes on to us.

All the best,

Roger W.

What's the World Coming to?

This morning I heard a radio ad for the National Traffic Safety Board. The punchline to the ad was, "Driving buzzed is driving drunk."

This tag line implies that there are some people out there who believe that it is OK to drive with an alcohol/drug buzz and that this is not actually driving drunk. I had never heard this before, and I run across quite a few excuses for using alcohol and other drugs in my line of work. It means that some people have so cleverly deluded themselves into believing that they can alter their consciousness to a certain extent and not run afoul of the law...therefore, they do not have an alcohol or dug problem. In fact, nothing could be further from the truth, and I can make the argument that any person who has to go to that length to justify drinking has a bigger problem than many people who drink and drive.

I think it's all part of the changing mores in America that allows certain kinds of behavior if that behavior can be defined in a certain way. I think the most egregious example of this was in the 1990s when then-President Bill Clinton emphatically told the American people..." I did NOT have sex with that woman." He defined sex differently than most people do and this, to him, justified his behavior to have certain kinds of sexual experiences with a woman that did not fit the definition of what would ordinarily be reprehensible behavior for a President.

I think it also goes for young people today who frequently define sex as only sexual intercourse and engage in a raft of behaviors that are sexual, but that are not technically (to them) a violation of some weird moral code. I also think it goes to the growing argument since the old 1960s civil rights days where today people who have no genuine civil rights concerns assert their civil rights to defend all kinds of behaviors. I think of reverse discrimination claims and the gun nuts who will kill in order to protect their civil rights.

This is too bad. It is really unfortunate that we not only allow this to happen, but that most of us sit idly by while these perpetrators of revisionist definitions of key human principles are allowed to get away with this in the public discussions of alcoholism and other social problems. We allow right wing conservatives to define marriage the way they want and we accept that their insane thinking is on a par with common sense. We allow people who have a religious axe to grind to define when life occurs, what stem cell research ought to be, and even what the term rape refers to.

I feel the need at times like this to stand up for common sense. Drinking while driving is a problem! It makes no difference if your blood alcohol level comes in a .79 - just below the legal limit. You have a problem that needs to be dealt with if you go that far to justify your compulsive behavior. It speaks to the overall ignorance of most people about what the illness of chemical dependency is and feeds into the notion that it is a moral problem - I can change the morality if I simply define it away. It is not a moral problem...it is a biological brain problem. Moreover, it is crystal clear to most rational people that this biological problem has changed the way the brain works to the extent that one might foolishly try to justify something as stupid as drunk driving.

Too bad we need a public service announcement radio ad to tell people the truth.

Roger W.

Teaching...

The teaching I do continues to go very well. In every sense, my regret is that I never started teaching earlier in my life. But, it certainly comes at a time when I need a career rejuvenation.

I teach at the Graduate School of Addictions at a well-known treatment program in the mid-West (they refuse to allow me identify them in my blog - such is the way of massive bureaucracies). This graduate school class in Group Therapy Theory and Practice has 23 students from around the world. They are all adult learners who are highly motivated and passionate about their chosen career. They will all become licensed alcohol and drug counselors when they get their Master's degrees. And, they are a joy to be with every week.

Of course, it's immodest of me to say (but this is a blog, after all, and I guess I'm supposed to brag a bit!) but I have become an expert in group psychotherapy. I've practiced it with my patients for the vast bulk of my 24-year career and this has taught me quite a bit about how you use my skills as a therapist within the context of group therapy work. But, I have also studied this subject thoroughly and know about the cutting edge theories and practices that make group therapy a powerful intervention for people with addictions. Group therapy is not what many people believe it to be: Group experience does not rely on "spilling my guts" in front of people like many who have either never done group work or fear it believe. Instead, it relies on working in the here-and-now of the present moment that the members find themselves in the group room...working on relationships that people have to one another and presenting or solving psychological problems through those relationships. My students are learning about ways they can make this kind of therapy effective in peoples' lives and it is gratifying to see them change during the semester.

I also teach at Augsburg College - or, I used to teach there. The semester ended last week for the Principles of Psychology course I taught to undergraduate students. Now, I've moved on to teach psychology to prisoners inside one of the state's maximum security prisons at Stillwater through Augsburg where the prisoners will get their degrees. I start the semester in June, and I will have 23 men to teach then. I am very much looking forward to the experience of teaching inside a prison. The last time I was in one was when I worked in Massachusetts inside a maximum security prison as a drug counselor on a unit with 61 men. That was a difficult job in that you were really in an adversarial relationship with the prisoner and there was constant tension. Now, with the teaching, I am no longer in a confrontational position with prisoners - I am there to help them learn and this will be quite a difference from my past experience.

By all accounts, I am a good teacher. The student evaluations that follow each semester from all my students have been very good, if not glowing. The Dean's at the respective schools are very pleased that they essentially took a risk with me because I have not had that much teaching experience, and that this risk has paid off for them because they find me to be a really good teacher. That is incredibly gratifying to know. I feel blessed with skills that make me a good communicator and I have empathy for people wanting to learn. Couple that with a passion for both topics, group therapy and psychology, and I am able to motivate students to learn the material.

This all comes at a time in my life where I am struggling with my counseling job. I really dislike the administrative atmosphere I have to function in at the treatment center where I work. There is an institutional snobbishness about the place where I work that is not backed up by performance: The place has ingrained administrative procedures and norms that are imposed on counselors because "we are the best" or "we know this works" when neither of those statements is really true. I think the place does injustice to patients sometimes when it has high caseloads, refuses to allow patients to determine their own need for a level of care, and treat counselors poorly because they are at the bottom of the pecking order. But, I know, this is not really any different than at other places that treat addicts and alcoholics.

I think the real problem is me. I have been on the front line of addiction counseling now for 24+ years. I have always pushed aside opportunities to supervise other people and eschewed other management responsibility in agencies where I worked. This has led me to now be in a subservient position where I am not able to effect any institutional decisions, and have no power. Couple that with being so burned out that I am crispy around the edges, and I have to work very hard every day to not express my true feelings and just march along to the drumbeat. I think my attitude suffers also because, as my friends and colleagues begin their retirement years, I am stuck having to work four jobs at my age. This leads to resentment and I have to work every day on not allowing that to run my emotional life.

So, the teaching is the fresh air I need to breathe every day that sustains me. In the classroom I am relevant, purposeful, necessary, powerful, and in control...all qualities I cannot realize in my day job. I am grateful for that because some people don't even have the opportunity to realize those qualities in their work life. I just hope I can continue teaching into my very old age.

All the best,

Roger W.