Sober or not: Defining substance use for yourself

…by Jenny Valentish…

Not everyone enjoys the label ‘sober’. I personally don’t call myself an ‘alcoholic’ or ‘identify as an addict’. I’m also far too English to use a dramatic phrase such as ‘in recovery’.

teaIn my book, Woman of Substances: A Journey Into Addiction and Treatment, I don’t call myself ‘sober’ either, partly because the term reminds me of ‘sombre’, ‘sob,’ and ‘so boring’, but also because, since stopping drinking eight years ago, I’ve taken drugs. I ate a hash cookie at a dinner party; a hashcookiespsychedelic in the spirit of self-exploration; and then there’s been silly, teenage stuff for the ridiculousness of it – a whiff of amyl nitrite in the red light district of Paris, a balloon of nitrous while watching Twin Peaks. This freedom was a decision I made after two years of total abstinence, and it’s about joyous bursts, rather than the grinding self-medication of yesteryear.

Personally, having that pressure-relief valve feels safer to me. Telling myself ‘you can if you want’ doesn’t provoke the imp in my brain into leaping for the chandeliers because, as we all know, being given permission to do something immediately takes away the appeal. By contrast, telling myself I’m abstinent for life might result in an almighty blowout one day as the pressure builds. No system is infallible.

martiniThere will be people reading this with anger burning in their heart. To someone who is truly sober, my generous ‘you can if you want’ policy borders on betrayal. I know how that feels. I remember when a couple who had quit drinking told me that they’d each had a beer at a wedding, and reported with pleasure that they twobeersdidn’t enjoy the beer and now they knew they didn’t need to wonder about it again. I felt an inexplicable fury. For me, alcohol was an absolute no-go zone; never worth risking. So that was the root of my rage: they’d made a decision that had worked out just fine for them, but it threatened my new blueprint for life.

Whatever your personal policy, drug and alcohol treatment shouldn’t be one-size-fits-all – and it isn’t, if you spend a little time investigating the options.

While some people classify as hardcore poly-drug users, most people have a leaning towards one type, such as sedatives, or stimulants. As a pertinent example, I’ve interviewed Marc Lewis, and he told me, ‘I don’t imagine I could continue moderate use of opiates, but a drink is okay for me because it’s not my drug of choice.’

suboxoneBill Wilson, the co-founder of Alcoholics Anonymous, quit drinking in the thirties but experimented with LSD with Aldous Huxley in the 1950s. He even hoped LSD could prove to be beneficial to those in recovery. These days, debates rage on recovery forums as to whether opioid replacement therapy is medicalpotokay for NA members, or whether a ‘marijuana maintenance plan’ is acceptable when attending AA. In fact it might make sense to go to an outpatient drug and alcohol service and collaborate on a plan that includes, say, moderate pot use in the service of quitting methamphetamine (this option is already available in the UK and Australia).

Geoff Corbett is a senior clinician who works with young adults in Brisbane, Australia. He tells me this:

There are always going to be outliers that AA and NA can put on a pedestal, but there will be another thousand people that AA and NA won’t work for, which is why we [in Australia] provide options. If we work from our harm-minimization framework, abstinence can be at one end and safer use can be at the other end. The client chooses options in between. It requires good assessment and really good treatment planning to look at achievable goals and put some parameters into place. We keep in mind that a person’s life is in flux and we can move the goalposts any time we want.

Australian dry-community website Hello Sunday Morning also has a flexible approach to tackling alcohol use. Founder Chris Raine has this to say:

helloNowhere do we dictate what a person has to do to be a part of Hello Sunday Morning. Our wording – ‘reassessing your relationship with alcohol’ – turns it into a subjective experience. Even government campaigns in Australia are starting to use that kind of wording, and that’s a good cultural shift. It’s not about ‘Are you an alcoholic? Are you addicted or not?’ It’s about ‘What relationship with alcohol would you like?’ It could be none; it could be some.

Certainly for some people, abstinence is the only safe option – and they know that. There’s a spectrum of severity, and I can’t compare my former levels of dependence to, say, those of the brother of a friend who died after continuing drinking post-liver transplant, or those of my mate who winds up in a hospital or psych ward every time she drinks.

The most important thing is to accept that mistakes, lapses, relapses, busts, lessons, errant evenings, experimental breaks – whatever you want to call them – are statistically likely, no matter what route you choose. That means maintaining vigilance for old behaviors creeping back in, whether it’s six months, five years, or twenty years after you’ve curtailed your habits. Vigilance, purposefulness, meaningfulness, curiosity, goals and altruism – they’re your new stash. Keep them close.

For more about Woman of Substances, go to the Amazon page or the author’s website.

54 thoughts on “Sober or not: Defining substance use for yourself

  1. matt July 6, 2017 at 5:27 am #

    Thanks for this, Jenny! I agree, and also ponder the obstinacy of belief, and the relief of acceptance in all this. I literally died and came back from substance misuse– due to major depression. To viscerally know that I am “in control” of that– that I am making the choice, not my desire for relief– is freeing. It is freedom. Knowing that I can do this if I want to gives me that freedom, that control. It reassures me. I can do this if I want to.

    I don’t want to.

    • Jenny Valentish July 6, 2017 at 5:08 pm #

      Hi Matt, I hear you. And that seizing of control, for me, extends to knowing when I’m starting to struggle and then going to see a professional (I see an addiction counsellor every month or as needed). When I used to go to AA meetings I did find the ‘let go and let God’ ethos of handing over control useful in one way – it curbs impulsive, kneejerk decisions if you just… pause. But after I stopped going I figured I would adapt that ethos to just be mindful of my impulsivity and to not be reactive.

    • Terry July 6, 2017 at 6:25 pm #

      Hi – I live in Australia and I have no knowledge of controlled Pot use being available for Ice users – I wish it was, and more generally for many heavy drug use problems and it should definitely be legalised. The current only available replacement therapies are Methadone and Buprenorphine both of which it can be debated are worse that the drugs they replace. As for labelling I also am a past “alcoholic” but i am “recovered” although even that suggest i was sick and I reject disease models. I reject notions of sober, or recovery or any other label that distinguishes myself from any other human, as we all have habits and many of those habits become primary and are called addictions but only those which relates to chemicals (and a couple of behaviours) attract social judgment, discrimination and punishment. why is an elite sportsperson any different from a drug addict ? both devote their lives and their days to their activity at the expense of everything else, both feel good as a result of what they do (for a time), especially when a medal and heroism is the reward, and both can’t stop the behaviour very easily etc. All of my habits, and I still have plenty (one doesn’t give up having habits, we just replace addictions with other things) are my attempt to provide myself with security and deal with the anxiety that exists in simply being human and that which results from the traumas that are a “normal” part of life. Being sober is a fantasy in my view and a notion that simply seeks to place some “addicts” above others. So many sober people I used to see in AA were anything but in so many other ways.

      • Jenny Valentish July 6, 2017 at 6:44 pm #

        Hi Terry. It’s not controlled in the sense that it’s supplied by the service, it’s about drawing up a plan with the clinician of what your own controlled use would look like. I’m talking about the harm-minimisation framework, of going to a service to discuss cutting down use rather than outright quitting. And so it’s not limited to ice/pot. The idea is to reduce harm first and foremost, and if the client is only confident they can quit one thing, you start with that.

        Totally get you on the fact that we tend to replace one vice with another; I really cycle through them.

        • Terry July 6, 2017 at 7:04 pm #

          Cheers Jenny. Yes I agree totally about harm min approaches and some form of controlled use is always worth trying before attempts at abstinence and I also think there are many substance use “addicts” who can’t achieve abstinence as it appears they need some form of chemical assistance forever and struggle so much with relapse and the impossible demands to be “sober and straight”. This is where I think notions that there may be some deficiency in intrinsic drug production in the brains of chronically addicted persons is about the only way a notion of disease can be presented in this realm. In fact I would go so far as to say that in many cases illicit drugs (which should be made licit) could be prescribed as treatment. we throw the baby out with the bathwater and forget the benefits to people of using illicit drugs. how many “addicts” would have gone mad or killed themselves but for the drugs they have used.

          • Jenny Valentish July 6, 2017 at 7:22 pm #

            Hi Terry, the idea of a big chunk of the population being, say, dopamine deficient is very interesting (and almost impossible to gauge, since it’s not something you can figure out from a piss test!). I agree with all your points there.

            • Terry July 6, 2017 at 7:28 pm #

              and even if you could what we do about it ?? – other than prescribe drugs to stimulate or suppress production which is exactly what illicit drugs do ?? Medicine has not produced drugs that are as effective as some illicit drugs. this area of neurophysiology is Mark’s area of expertise …

              • Jenny Valentish July 6, 2017 at 8:16 pm #

                Yeah, exactly. I know Kenneth Blum came up with some dopamine boosting supplement, but cannot personally vouch for it!

  2. Louise Sutherland-Hoyt July 6, 2017 at 5:35 am #

    I ditched the “alcoholic” “addict” labels plus the “disease” model not only personally but in my private practice as well and when presented as “always an option” , stigma and pressure are deflated. Even ASAM is moving away from the Disease model as is NIDA, which refers to addiction as a “reward-driven behavior”. How refreshing!

    • Marc July 6, 2017 at 5:51 am #

      Is NIDA *really* moving away form the disease model?! That is amazing news…and hard to believe. Do you have a link you can give us? Or are you just noticing more alternative phrasing on their website and articles?

      • Louise Sutherland-Hoyt July 6, 2017 at 5:15 pm #

        Hey, Marc. I most certainly stand corrected though the semantics in play show a trend away from disease, i.e. disease of the brain beginning in childhood. What is missing is that more than 3/4 of those reporting themselves as “addicts”, including other compulsive behaviors also have a significant history of complex trauma. And moreover, the so called treatment programs fail to assess for trauma, i.e. the ACES. I like it that ASAM sort of implies perceived reward as the main driver and I think it’s only a matter of time before we put that disease model to bed, once and for all.

        • Jenny Valentish July 6, 2017 at 5:54 pm #

          Yes, that trauma aspect – which applies to so many people whose substance use is severe enough to warrant seeking treatment – is glossed over with the disease model so far as I can see.

    • Jenny Valentish July 6, 2017 at 5:10 pm #

      Yes, I’m interested to hear about the move away from the disease model too. When the AP Stylebook recently updated and advised journalists to avoid labels such as substance ‘abuser’, ‘addict’, ‘alcoholic’, etc, it was still referring to a disease.

  3. April July 6, 2017 at 5:58 am #

    Love this! I feel exactly the same way. My current choice happens to be abstinence from alcohol (and I never used any other drugs anyway) but I never call myself sober. If anyone asks, I say “abstinent,” but really it’s no one’s business! I don’t ask them if they’ve had a piece of cheesecake in the last week. Sober has too many Puritanical connotations. I’m sure at some point I’ll make other choices – I’m not afraid of alcohol or that one drink will kill me. What I’ve learned is that it’s my choice, and should be made out of consideration for my goals, not out of fear. While I get a PhD and launch a freelance career, it helps to be very clear headed. But on vacation, who knows? I’ll order your book!

    • Jenny Valentish July 6, 2017 at 5:13 pm #

      I agree, April. I was actually on a panel with Chris Raine, the founder of Hello Sunday Morning (which has helped more than 120,000 people and even has a research arm), and because it all began as a blog when he quit drinking, of course he gets asked about his ‘status’ all the time. He said it’s ever-changing. In periods of a big work load it might be nothing. At other times, something.

  4. Alan Smith July 6, 2017 at 6:46 am #

    Thank you so much Jenny for a very thoughtful Post. You were very generous to put your thoughts and experience on this site and I appreciate your honesty. I learned a lot and you helped me to crystallise my own thoughts.

    I particularly like your emphasis on a person’s subjective experience. What relationship do I want with alcohol or other substances? For that matter, what relationship do I want with sugar, coffee and sex?

    As an adult who has not drunk alcohol or taken substances for quite a while only I can make that subjective choice based on my experience. And giving myself the freedom to make that choice has not triggered my impish brain to dance off to a liquor store. I might have a drink with friends at some stage but there is no rush. I’m much more likely to dance off to a chocolate store.

    As you say, Bill Wilson experimented with LSD. I enjoyed a few trips back in the day but they were in the context of being with friends, clubbing and happy. I’ve never craved LSD, but in the right context again I would enjoy it. Gosh, I would enjoy it. Life is way too short to be sombre.

    But I wouldn’t enjoy the hash that spun me out in Amsterdam so that would be off my list. I know my subjective experience. And so it goes for any substance. I don’t drink too much coffee because that makes me tense.

    Bill Wilson smoked cigarettes and died of emphysema and pneumonia. Everybody dies of something. Abstinence will not ward off mortality forever so “Gather ye rosebuds while ye may”.

    There is nothing wrong, and much benefit to be had, with letting go and having some fun. As you say, “This freedom was a decision I made after two years of total abstinence, and it’s about joyous bursts, rather than the grinding self-medication of yesteryear.”

    I would be surprised if anyone ever robbed an adult shop because they were craving amyl nitrite and couldn’t get enough. I never considered that a drug myself. Merely an adjunct to good sex.

    “No system is infallible”. Puritanism and absolutism can be harmful over the long term unless a person subjectively knows and decides that a substance would not be in their best interests. “I’ve interviewed Marc Lewis, and he told me, ‘I don’t imagine I could continue moderate use of opiates, but a drink is okay for me because it’s not my drug of choice.’”

    Marc Lewis has made an informed, subjective choice. I would make a different choice, preferring opiates now and then, and not alcohol. My experience is different.

    As adults, in the end, we all have to make our own choices and we do. Everybody does. We weigh our subjective experience with the things in the world that bring us happiness. We weight the effect that a substance/thing/person has on our lives and then decide the relationship we want with that substance/thing/person.

    “That means maintaining vigilance for old behaviors creeping back in, whether it’s six months, five years, or twenty years after you’ve curtailed your habits.”

    Very true. I maintain that vigilance whether I am using a substance or not. I may not be using any substances but hurting myself with workaholism and burnout. Or a dysfunctional relationship. Other things can be far more destructive than substances.

    “Abstinence only” has a very poor success rate, particularly over the medium and long term. That, couped with the needless guilt and shame of abstinence only programs, can drive people to self harm. They sense themselves a failure. Of program that fails.

    For those who prefer abstinence only and say that it works for them that is great. We all make our own choices based on our subjective experience and our changing priorities. But one size does not fit all and we are not all the same. We are at different stages of life, with different priorities, different goals and different sets of experiences.

    Thank you so much again, Jenny.

    • Jenny Valentish July 6, 2017 at 5:19 pm #

      I find myself saying yes, yes and yes to your every paragraph!

      On your point “one size does not fit all”, I am interested to hear whether the US treatment industry can/does actually support people who want a tailored plan. In Australia it’s all about harm-minimisation, so if a person is only ready to quit the most harmful substance(s), they will be supported in that. Of course, that’s only outpatient treatment. You wouldn’t be able to continue using in a detox or rehab.

      • Cheryl July 7, 2017 at 6:04 pm #

        Here in the US, at least where I live. Mental health counselors (who have my records for addiction treatment) suggests AA,NA every time I go back. More accurately they tell me AA,NA is the only way. I disagree. I recently started counseling for Anxiety…. Which at 13 I believe led to substance abuse.

  5. tim Greenwood July 6, 2017 at 8:48 am #

    This is awesome and speaks totally to my own experience. I am not crazy about term “sober” myself but know for some it is very powerful and empowering. At this point in my life I have chose to abstain from all substances as I have young teenage children and know if they make it through their teenage years without using substances in any significant way this will be very useful for the rest of their lives. It is no great sacrifice for myself. I might change when they enter their twenties.

    • Jenny Valentish July 6, 2017 at 5:21 pm #

      What a great plan, love it. And yes, many people do indeed find the language of recovery empowering, which is great – I’ve seen many a Facebook group debate about that!

  6. Annette July 6, 2017 at 8:53 am #

    Thanks Jenny, a very thoughtful post. I agree with all your points! I’ve also been an HSM member for over 2 years – it helped me successfully moderate, quit (for a year) and now I have the occasional small bottle of cider.

    I create my own rules: no wine, ever (my former poison), no drinks at home (drinking den) and cider <5% or less. I think that the majority of people can moderate, but it takes a lot of trial and error, and removing the GUILT associated with having a glass or two. Abstinence is right for some, but too harsh for many. My aim is to be in the "not bothered" category when it comes to booze. No drugs for me – saw my younger brother's descent into heroin addiction and much later, suicide.

    Thanks again. There is a mindful way out of every addiction, with Community, Compassion and good, daily Choices…..

    • Jenny Valentish July 6, 2017 at 5:24 pm #

      It’s the guilt and anxiety that kneecaps us, isn’t it? Particularly in this age of technology when we have Fitbits and whatever else to monitor our exercise, our calorie intake, our sleep patterns. We’re punishers. And we can really self-impose a feeling of failure if we’ve broken one of myriad rules, which can then lead to the “ah, sod it then” drink. My addiction counsellor aims to get me into the ‘not bothered” category (as you say) if I choose to drink again. But if that doesn’t work I’ll have to be honest with myself! I’m really glad you’ve found your groove.

      • Annette July 7, 2017 at 8:46 am #

        Thanks Jenny. I shared your post on http://www.hellosundaymorning.org, which got 13 likes AND also on Club Soda. I think people in recovery are amazing!

        • Jenny Valentish July 8, 2017 at 3:10 am #

          I talked to the founder of Club Soda when I was in the UK – it’s a great idea. Thanks!

  7. Ira Brent Gnesin July 6, 2017 at 9:16 am #

    Thanks Jenny,

    Thought provoking stuff. I like the idea and agree that one hat cannot fit everyone. I also know some pretty severe heroin addicts with 15-20 year habits that got clean and broke away from the NA bunch and know drink socially and smoke abit of weed every now and again. Personally over my 16 years of active addiction i tried every different way possible to “just use this or just use that” and fortunately or unfortunately it never worked for me. Total abstinence was the only way forward for me. I work in the rehab industry so im around addicts all day but on the whole when i go our with “normal friends” for dinner, i dont sit there and think wow im an addict. I think as recovery progress it becomes more mature, the more i become apart of society the less i worry about being an addict. I dont feel different anymore, im part of society and i found that was when my recovery really started to kick in…i was so sick of being the “black sheep” always in rehab or hospital, always feeling different because i was so dysfunctional.
    I might get shot down for this statement but i had to prove to myself that NA was not the be all end all for me like it is for so many people, i mean if NA disappeared in my town there would be a whole lot of relapsing going on. So i didnt go for a long time and i learnt other ways to cope, i took the principals that i learnt in the fellowship and applied it elsewhere and it worked. Also i always felt abit too comfortable sitting in that room with a whole bunch of dysfunctional people, judging and scoping out the ladies…i felt so comfortable in dysfunction that it had to be different for me, that was not the life i wanted, i had to outgrow NA. i wanted to go out with “normal folks” and feel comfortable in functionality. I wanted to talk about politics and all that “NORMAL” stuff, about how expensive food is these days…
    I wanted to be normal, i didnt want people to look at me and think, wow that dude is fucked. I wanted people to look at me and think, he is really in touch with himself and has a peace about him. I think i get that from time to time, got a great group of non addict friends and a core group of addict friends. i have since returned to NA with very different motives this time, i just want all those people fighting the loosing fight to know that its possible to get this, that there is hope out there.

    thanks again for your article was great.

    • J July 6, 2017 at 12:06 pm #

      Ira,
      Your comment about “outgrowing” the recovery community is spot on.It’s no place for someone who has successfully moved on to linger.
      It’s a gift to others if you pop back once in a while to show what the view ahead looks like, but it’s a bit like swimming, when you’ve got your confidence you can strike out on your own and clinging on to the life raft is only going to hold you back.
      Thanks for the comment
      J

      • Louise Sutherland-Hoyt July 6, 2017 at 5:20 pm #

        I can say affirmative to outgrowing AA, especially after years as a rogue treatment provider going after the perceived reward, i.e. Connectedness, Autonomy, and Safety (think Glasser). In retirement and with a private practice, I find using EMDR to undo the perceived reward is helpful to many.

    • Jenny Valentish July 6, 2017 at 5:32 pm #

      Hi Ira, thanks for your nice words. Yeah, it’s tempting at NA/AA to fall into the trap of thinking ‘these are my people’ to the extent that everyone outside of the organisation is ‘other’, ‘normal’ and ‘okay’. (Oh, and ‘boring’. Why not.)

      I think the huge strengths of NA are structure, peer support, sponsoring (aka volunteering, which releases lots of lovely serotonin – though I’m sure Marc can correct me if I’m wrong) and spirituality (aka a sense of meaning). But as you’ve found those things can be found elsewhere, if not quite as conveniently!

      • Marc July 8, 2017 at 2:58 am #

        Or perhaps more conveniently. Spirituality and a sense of meaning can be lighter and more portable without religious overtones. And okay, maybe serotonin, maybe oxytocin. One way or another. your brain decides that these people are in-group and others are out-group. And that affects almost all social behaviour.

  8. Minerva July 6, 2017 at 10:29 am #

    Thank you too for your thoughtful human non-binary, nonjudgemental and human response to relationships with alcohol. I felt listened to the moment I started reading your article. The shaming, blaming, isolation, and put the victim in a box mode of treatment is far outdated, inconsiderate and not what someone suffering from an imbalance in their relationship with alcohol needs.I appreciate your open mindedness with honesty that that open mindedness gets challenged sometimes, and needs to be worked through.

    • Jenny Valentish July 6, 2017 at 5:33 pm #

      I’m really thrilled you felt listened to, because that’s my aim with the book. Thank you.

  9. Cheryl July 6, 2017 at 2:17 pm #

    Thank you for your article. I wish I had read it sooner. I supported my son who is an opiate addict through a costly abstinence only recovery centre. He attended NA and AA meetings, did everything he was asked and was a star student after 90 days. Unfortunately after just one week he overdosed on fentanyl. I have now come to believe that recovery centres that preach abstinence only are out dated and perhaps even dangerous.

    • Jenny Valentish July 6, 2017 at 5:40 pm #

      Hi Cheryl, thank you so much for sharing that. I’m by no means an expert here, but I have heard a few parents say something similar – that if there had been, say, safe injecting rooms, their child might well still be here. Here in Australia I believe there is only one such place in the whole country, a medically supervised one.Similarly, as you say, if a person didn’t feel that they had only two options – total abstinence or full-blown using out in the wilderness, they might feel much more confident about their ability to just cut down and eventually stop. I really, really hope this abstinence-or-you’re-on-your-own attitude changes.

    • Annette July 7, 2017 at 8:54 am #

      Cheryl, so sorry for your loss. My younger brother, Eric, was a heroin addict, and then registered methadone user for 20 years. He was able to work and was very stable when in a loving relationship: living with our mother for 11 years, until she died, and then 4 very happy years with an older man. (When he latter died, Eric committed suicide shortly afterwards.) The rest of the time was chaotic. All of us (non-addicts included) need loving relationships to thrive, imho, don’t we?

      I think Portugal’s model is the best: public health issue, not crime related. Use substances safely, so they can lead a normal life. I really recommend Johann Hari;s book: “Chasing the Scream”.

      If you’re in the UK, DrugFam provide excellent advice and help via their helpline.

      http://www.drugfam.co.uk/

    • Marc July 8, 2017 at 3:04 am #

      Cheryl, I agree that preaching abstinence is not only outdated but dangerous. The problem is that most residential rehab stints end in “relapse.” That’s widely known. But the relapse comes with a greatly reduced drug tolerance, so people who “slip up” are far more vulnerable to overdose.

      I’m not saying that abstinence is a bad thing. For many people it’s the best possible solution. But it shouldn’t be “preached” — it should be taught.

      I’m very sorry to hear about your son.

  10. Carlton July 6, 2017 at 9:36 pm #

    Jenny, Great seeing the word; “Yourself” in your title.

    We are gaining ground on the understanding of what addiction is, and what Freedom from an addiction is ( I don’t think “Recovery” is an apt description of what occurs.)

    That being said, I was curious if you have defined, discovered (or modified) a model of addiction, or find one that “fits” how you currently feel, believe, and think about these two things.

    Best,
    Carlton

    • Jenny Valentish July 7, 2017 at 3:33 am #

      Hi Carlton

      I align with the biopsychosocial model, which posits that addiction is learned behaviour and is a complex interaction between the individual’s biological, psychological and environmental factors, and the drug.

      Treatment-wise, I like the harm-minimisation framework of Australia, which of course has abstinence at one end of the spectrum.

      I’m not fond of the word ‘recovery’ either, because, for a start, for many people their drug and alcohol use is/was a result of underlying mental illness and/or trauma, so unless those things are dealt with, it’s not a recovery. I also personally don’t like the idea that people are *forever* in recovery.

      I should say, I’m a journalist, not a practitioner, but these are the things that make the most sense to me.

      • Carlton July 7, 2017 at 9:50 am #

        Fascinating and great to hear, and it sounds like the biopsychosocial model has become established and accepted right along with the previous models.

        The term, “Alternative Model” finally be a thing of the past 🙂

        Things are Changing!:-)

        Carlton

      • Cheryl July 7, 2017 at 6:25 pm #

        I myself am trying to get help for Anxiety that I believe drove me 1st to food as a pre-teen, and then substances. Currently, alcohol use is very rare and no drug use. Yet, the counselors still focus on addiction. I want help for underlying Issues. I have an appt coming up, I will keep on. The A programs are not for me. I went and did steps, had sponsors, chaired meeting, made coffee. Enough!

        • Jenny Valentish July 8, 2017 at 3:25 am #

          I agree, Cheryl. If there’s no acknowledgement of the underlying issues, then all that is likely to be achieved is the individual’s habit is kept in check (though others may pop up in its place). It’s like cutting down a weed instead of ripping it out, then being surprised when it grows back. It seems to be only the really expensive residential rehabs for women that try and additionally tackle things like trauma and eating disorders under the one roof. Other than that the individual has to seek out multiple services. Good luck with your appointment!

  11. Fred July 7, 2017 at 1:39 pm #

    In the sexual recovery fellowships of SLAA and SAA, members works with their sponsors to define their own personal “bottom line”/”inner circle” behaviors, which are used to measure “sober” time. Interestingly, these “bottom lines” typically change over time based on each person’s experience, becoming more strict or less strict as needed and desired. This model aligns somewhat with Jenny’s piece – each person needs to honestly assess what works for them, and situations do change over time. The goal is not permanent abstinence from any particular behavior, but a life of integrity that supports healthy relationships with self and others.

    • Jenny Valentish July 8, 2017 at 3:26 am #

      That sounds much more progressive, Fred – the individual defining what’s problematic and what isn’t. I would imagine Overeaters Anonymous works in the same way.

  12. LouAnn Jones July 8, 2017 at 8:32 am #

    All I know, is that I HAVE to stay away from alcohol. If I have one, there Will be 5 to 10 more following It! I have been sober for 10 years now, and like it, no, Love It! I attend A.A meetings regularly, and it’s the BEST life I could ever imagine. It works for ME!

    • Marc July 8, 2017 at 10:02 am #

      I’m glad that the abstinence perspective is getting its share of air time, LouAnn. Same with AA. I don’t think Jenny, me, or anyone else is suggesting that abstinence isn’t a highly effective way to control addiction. It’s just that it shouldn’t be viewed as the only possible way (for everyone — though it might be the only possible way for you).

      • Richard Henry July 10, 2017 at 9:37 am #

        Amen to that Marc…
        I just took on a new personal challenge of making 90 videos in 90 days. I will be promoting the site soon. Helping all throughs with a better understanding through Education and Experience… Here is one…
        https://youtu.be/rqL7Rf9gLOg

      • Carlton July 10, 2017 at 11:11 am #

        Yes, great to see different models talked about with civil thoughts and opinions.

        Marc, Control and Strength are not the only reasons people stop depending on an addiction.

        Abstinence can SEEM to be an act of control or strength in order to keep an addiction at bay,

        But there are other reasons, people no longer partake.

        People on your Blog Have tried occasionally put into words to this, but it is a difficult thing to explain.

        It is not simply some conversion to a religion or something, nor is it just saying “I don’t want to anymore”.

        A clear examination and description of this will shed important new light on the understanding of Addiction I think.

  13. Carlton July 8, 2017 at 9:09 am #

    Jenny, your last 2 lines sound somewhat like descriptions of recovery that AA, SMART and other recovery program refer to;

    “That means maintaining vigilance for old behaviors creeping back in, whether it’s six months, five years, or twenty years after you’ve curtailed your habits. Vigilance, purposefulness, meaningfulness, curiosity, goals and altruism – they’re your new stash. Keep them close.”

    However, another definition of Freedom from an addiction,( i.e. recovery) is discovering you don’t have to do anything relating to the addiction anymore.

    Being Vigilant, means the addiction still has a place in your heart, which, with a large percentage of people, it may be for life, but then again, feelings can and do change,
    and that has not been looked at in the addiction/recovery field.

    And just to clarify, could you describe a bit more about the “safety valve” you mentioned?

    BTW-I too am not a practitioner and certainly not a word person, but in hindsight, years after leaving of AA, SMART, and accitental and consiuos tests with with drinking,
    I think new research of what Freedom-from-an-addiction is,( i.e. recovery) , may ultimately lead to a universally understood and accepted and definition of Addiction.

  14. Joanna Free July 9, 2017 at 9:10 pm #

    It’s wonderful seeing this respectful exchange of ideas and experiences here. Thanks, Marc, for creating the space where this is possible, and to Jenny for this great post.

    I was trained in psychotherapy and addiction, and in the disease model. Worked in rehabs – and went to one, too, in my time – where working the Steps was the only option offered.

    A few years ago, I left those traditions/paradigms. Today I see symptoms as sources of information – sometimes painful sources! – but always worth exploring for what’s truly needed.

    For me, alcohol was negotiable, tobacco wasn’t. Other things have landed on either side of that line.

    I loved 12 Step fellowship for years, then left. Didn’t miss the dogma, but missed the fellowship, terribly.

    Last year, after several years of struggling with something entirely non-substance-related, a friend called to tell me of a new fellowship she’d joined, one is which I clearly qualified and in which one does define their own version of well-being and determine their own path, entirely. No dogma – just brilliant ideas and an abundance of tools… and a fellowship that far surpasses the one I’d so missed.

    I’m a people who needs people… today I feel lucky in that.
    I’ve found my people.

    • Marc July 14, 2017 at 6:30 am #

      That’s great to hear, Joanna. Would you care to tell us what/who you found? I’ve always thought that the fellowship aspect of 12 Step was its greatest (and least controversial) benefit. The rest….seems to depend on who you are and the character of the group you find.

      • Joanna Free July 15, 2017 at 11:07 am #

        Thanks for asking, Marc. I wasn’t intending to bait anyone here – just to say: there are different perspectives and experiences, and this is mine, now.

        I’m not comfortable with sharing the specifics of that in a blog post response;12 Step programs are clear about anonymity at this level; it’s part of their traditions. I’ll honor that.

        Anyone who would like to learn more is welcome to contact me one-on-one through this post. I don’t expect that to be a lot of people, in this community. 12 Step language and philosophy is off-putting for many. For me, the community is life-changing – so I take what I can use and leave the rest, as they say. And I express my own perspective there gently, respectfully, mixing it in with what I hear. Each one of us can shape communities, too. That applies to all of them, 12 Step or otherwise.

        Just one perspective I’ll offer to anyone considering whether membership in a cohesive, quirky, global fellowship might be part of what they’re yearning for, as it was for me.

        Thanks for asking.

  15. meshack July 10, 2017 at 3:44 am #

    What is drinking held me back from? I can think of a few items that drinking held me back from: Staying up late. I usually passed out early.driving anywhere I wanted to whenever I wanted to.Getting any reasonable exercise.
    Feeling mentally normal. I was always in a damned alcohol induced fog.
    Learning new things – i’d always sit back and read new material with beer. I wouldn’t remember most of it by the time I was done.
    Feeling socially normal. At some point my friends quit drinking so much and I didn’t. I turned into that ‘drunk guy.’
    I was just riding my own coattails. I had learned alot in the years before I started drinking and I managed to pull together enough work ethic to pull things off. But I was just treading water, never learning anything new, always feeling like crap.
    I hope you give yourself some time to think this through. If alcohol has a hold on you, it won’t be an easy decision.

  16. Rick Jonie July 14, 2017 at 12:45 pm #

    Thank you for your insight. This post helped me better under the journey of long-term recovery a loved one is on. Stigma kept us from getting the help that was needed, and to see stigma being taken away from words such as “sober living” and giving individuals power over their lives is a really important concept when choosing to stay clean from some, or all substances.

  17. Carlton July 15, 2017 at 8:50 am #

    Hi Jenny,
    you wrote:

    “By contrast, telling myself I’m abstinent for life might result in an almighty blowout one day as the pressure builds. ”

    A realizing that the alcohol or drug was never an original “safety valve”, can change a persons feelings of guilt and “breaking rules” such as this.

    It also can can the perspective and understanding of the addiction and themselves.

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