A postscript to Persephone: 12-step recovery as prolonged PTSD

Hi all—

Here’s an announcement before the main act: Please look at the Guest Memoirs page if you haven’t already. The first four memoirs are terrific, and hugely different. I hope that we’ll soon get more, and I hope people will leave comments on those already posted. It may seem hard to “comment” on something autobiographical….but just saying “I get how you must have felt,” one way or another, can mean a lot to someone who has just exposed themselves so openly.

The main act:

I haven’t published a post in a few weeks. I’ve had one part-written since the day after Persephone’s amazing post (see previous), but it remained in note form while I was busy with other things. Those things included my twin 6-year olds. Mama (my wife, Isabel) was in the States for 10 days, doing research (and staying in fancy hotels) while I slaved away here. It was more work than I’d expected, because the boys now go to an after-school daycare, where I need to pick them up, but I never seem to get there without getting lost and ending up in farm country.  So that’s an hour out of my day, getting them to school in traffic is another 45 minutes, Dutch lessons plus practice – 4-6 hours per week, showing up for work at the university once in a while, cleaning up an amazing amount of trash left over from the intense Halloween party we had a couple of weeks ago (fabulous costumes, lots of food and wine, even a fire juggler) but did we have to buy 30 rolls of toilet paper so the kids could have a dress-the-mummy contest? Yet the main time drain was none of the above: it was keeping a lid on the kids. With Mama gone that long, they were bouncing off walls, ignoring my commands, arguing more, breaking rules. So I spent a lot of time disciplining these adorable little buggers…not my favorite parental duty.

Which brings me back to Persephone’s post. The main problem with the 12-step approach, she says, is the freeze on emotional development they seem to demand, intentionally or not. So recovery becomes a way of not moving – it’s static. According to Persephone, the epitome of successful recovery in NA/AA is to sit around with the same people, year after year, sharing stories about how shitty it was being an addict, so that you can REMAIN clean or sober. It’s all about remaining a certain way rather than growing. As Persephone saw it, they tell you that your addiction is doing push-ups in the parking lot, or waiting to leap on you, so the only safe course is to stay here with us – stay being the operative word. And the result is that you continue to define yourself as an addict. In other words, not only the way you govern your life but your whole self-image is frozen in place. This is what you are, and if any change occurs, be warned: it’s going to be a change backward – back to being an addict who’s no longer in control.

Persephone proposed the following: With your behavior, your choices, your capacity to explore, and your self-image all frozen in this way, and with the horror stories of your addiction constantly resurfacing, you are in the same condition as someone with PTSD – post-traumatic stress disorder. What a concept! People with PTSD live with continuous anxiety, denial and avoidance mechanisms, intrusive thoughts, and more, about what happened to them, whether it was a serious accident, a mugging, physical or sexual abuse, rape, getting wounded in a war… And the therapeutic principle for recovery is pretty simple: you have to free yourself from those fears, from the anxiety that it’s still happening or will happen again, by reprocessing the event, with some sense of acceptance. Yes, it happened, but it’s over now. You have to do that before you can move on. Then you shift from a static state to a fluid state, let down your defenses, allow for the unexpected, and find the confidence that you can handle whatever comes.

So here are my kids in a state of anxiety. They’re not old enough to conceptualize how long 10 days will last. As far as they’re concerned, Mama is just plain gone. They love me a lot, and we sure got closer during this period. But their anxiety changed everything! They regressed, they became more moody, aggressive, shut-down, or simply unregulated. And to continue the analogy with NA/AA, I became like their sponsor. Come to Papa when you start to lose it, and then do exactly as I say. Because the thing/person you really want is missing from your life, and you’re in danger of going from bad to worse. My style of parenting changed. Everything became more rule-bound, there were a lot more time-outs, consequences dished out, time deducted from weekend TV… In brief, living with anxiety takes its toll. I knew this as a psychologist anyway – I just got reminded: anxiety diminishes cognitive flexibility and creativity, and it draws attention to the negatives – whether you’re a motherless 6-year old or a boozeless 60-year old.

My kids became dry drunks for over a week.

One of the coolest (but still experimental) treatments for PTSD is to relive the traumatic event while you’re taking beta blockers, drugs that reduce sympathetic arousal. This article describes the approach. So why should that work? Are you just relieving anxiety over time? No, the theory says you are interfering with the maintenance of traumatic memories. Memory strength and endurance depend on a kind of rehearsal process. You have to keep on reliving the memory (at least some version of it) while feeling the emotions that came with it – e.g., the fear unleashed when a trauma occurs, or maybe that stew of shame, anger, and horror that comes with addiction. (I still vividly remember the time I shot the heroin left in “the cotton” from a junkie with yellow eyeballs, broadcasting hepatitis – and I get a jolt of disgust and shame each and every time.) Without that emotional charge, the memory fades…just like other memories.

Memories are encoded in the connections (synapses) between brain cells. You have to reinforce those connections (keep strengthening those synapses) to keep vivid memories vivid. Strong emotions like anxiety activate or facilitate synaptic cascades (e.g., in the amygdala). Anxiety also does the job of connecting novel events to that ball of fear at the core of the trauma, thus extending the synaptic network still further. With beta blockers in your blood, you can relive the memories without the anxiety, allowing the memories to become diluted or dissipated. They start to dissolve and lose their hold on you. Then you can spread your wings and fly, rather than remain frozen with your wings permanently clipped (Persephone’s words, with a nod to Lennon & McCartney). That’s when your emotional world starts to grow again.

According to Persephone, many/most 12-step groups intentionally reinforce a PTSD-like state: Be afraid…be very afraid… Sort of like the opposite of trauma treatment using beta blockers, many 12-step groups seem to kindle the very emotions that cement your already vivid memories of when you were seriously fucked up. Almost like telling scary stories to keep little kids in line.

But sometimes it works: because living with PTSD is one way to keep away from danger. After getting mugged or raped, you won’t go strolling through city parks at night, you’ll stay inside when the parade comes by, you’ll avoid people of a certain type, you might avoid eye-contact with strangers altogether, and you’ll continue to see yourself as a victim or a loser. Not only is that a static state; it’s also an unhealthy state. It maintains anxiety rather than relieving it. You stay clean because you stay scared.

If that’s the solution offered by many 12-step programs – to plug yourself into a static state of PTSD in order to avoid the dangers of relapse – then I can sure see why a lot of people don’t sign on, or stay for a while and then get out. I can see why the notion of a lifetime addict can be a self-fulfilling prophecy. And I can see how people get hurt, sometimes badly hurt, when they try to break free: because they may actually get chastised for wanting to leave their PTSD behind — and that hurts.

For the most serious, interminable addictions, this might well be worth the price. We’ve heard a number of claims to that effect. But for those who do have the capacity to continue growing, leaving their addictions behind and moving on, it doesn’t sound like an ideal solution.

Please note! I’m not trying to rekindle the debate as to the pro’s and cons of AA/NA. Been there, done that. I’m just trying to build a clinical and neural extension onto the perspective of one person – who seemingly reflects the experiences of many others (judging from comments received!) – people who didn’t find what they needed.

Next post, coming in a few days, I’m going to zoom in on the relation between anxiety, memory, and habit formation – both in the development of addiction and in recovery seen as a developmental process — by looking more closely at what’s happening in the brain.

51 thoughts on “A postscript to Persephone: 12-step recovery as prolonged PTSD

  1. fredt November 18, 2012 at 6:47 pm #

    Yah, and somebody does not know what they are talking about. What right do you have to criticise my lift, you bully.

  2. Carolyn Kay November 19, 2012 at 5:26 am #

    Except that what you describe isn’t what I’ve seen. What I see is people sharing the bad times to show themselves and others that good times can follow. The sharing can be a freeing experience.

    And seeing the growth, especially the rapid growth of newcomers, is a very beautiful thing.

    I hadn’t been to meetings for a long time, but I’ve started going back, thanks to some of these discussions.

    • Marc November 19, 2012 at 11:17 am #

      I can appreciate that there are many diverse experiences. We’ve seen plenty of that diversity on this blog, but AA/NA is famous for turning some people on and some people off. So let’s just accept it. People are different, addictions are different, and groups are different.

      The group I attended (and posted about 3-4 posts ago) also seemed warm and cozy. But I’m no veteran myself, and I have to accept what people report from both sides of the fence.

      • JLK November 19, 2012 at 11:47 am #

        Hi Marc

        I assume I am allowed on the post since I am still on your “send list”. Your comment about using Beta Blockers while reliving the trauma.

        The problem I see is that such a large number are combat experiences and in my Shrink’s stepdaughter’s case a car accident involving her mother being very seriously injured while sitting next to her.. How in the Hell do you replicate that….hypnosis?

        I am also going to ask THE question. I challenge Persephone to the amount of experience she has with what you call “12 Step” programs. A few meetings? And more importantly has she (I assume/hope) been to DIFFERENT meetings.

        There are “stasis” meetings out there but they usually attract the more hard cores that can’t quit without some drill sergeant-like sponsor yelling the 3rd step or whatever in their ear.

        If i find myself at one of those I go exactly ONCE or maybe just walk out). Flexibility is the key and personal growth is the goal. Not stasis!

        Even the “Big Book” says that specifically, so I am not so sure about the amount of experience behind these expert-sounding words.

        JLK

        • Persephone November 19, 2012 at 2:55 pm #

          Wait, what? You’re challenging me now, JLK? In this thread? You could’ve just engaged in the debate the last time around, but fine.

          Yes. I may not have horrendously long 12 step cred, but I have enough. I rejected the premise outright, even in desperation, that someone or thing outside of myself was the key to my personal salvation–but only after a few years of giving it an honest go.

          You seem rather belligerent in your comments to Marc, as well as dismissive of me generally, so I don’t think I want to play this game with you, aside from what I’ve just stated. Thanks.

          • Marc November 20, 2012 at 10:01 am #

            Just a point of clarification: you attended meetings for a few years? That seems pretty long…. Am I missing something?

            • Persephone November 20, 2012 at 5:42 pm #

              Marc, I did, due to pressure from family, but it was off and on. I was never in the program for that solid period of time.

          • Kevin Cody December 10, 2012 at 10:55 am #

            I will chime in one last time on the XA, thing…i was a regular for 7+years and I feel the same way as Marc and Pers…it does work for some. But it did not for me…it was at best damaging to my recovery. It was run by bullies, generally speaking and folks who could not tell you exactly why it worked for them. I always suspected it was the person and not the “program” which really isn’t a program at all, it is a ersatz club at best and not at all a fellowship. I kept looking and hoping to find a fellowship…oh well live and learn, become indoctrinated and become indoctrinated.

            I am happy to report though I am about recovered from my 12-step recovery…LOL

            Flame on?

            peace.kc

        • Marc November 19, 2012 at 3:44 pm #

          I don’t think someone has to go to a certain number of meetings, or a certain proportion of different meetings, to have a strong opinion about AA/NA.

          I thought I made this clear: we are finished debating whether AA/NA is generally good or generally not good. People have very different opinions, and we have to accept that. The “my opinion of AA vs. your opinion of AA” wars have to end on this blog.

          And yes, you could have questioned Persephone’s credentials in comments following her post. The post above is mine, not hers.

          Surely we can accept that such a large organization, realized so differently by different groups, can induce different experiences.

          I’d still like to hear about people’s experiences, but it is not necessary to challenge or besmirch others’ experiences to communicate your own!

      • Carolyn Kay November 20, 2012 at 4:48 am #

        Maybe we see what we expect to see.

        • Marc November 20, 2012 at 10:09 am #

          I’m not sure what you mean, Carolyn. If you mean that people get from a treatment program only what they expected to get, then I don’t agree. I’ve been disappointed in treatment/therapy trials many times, though I was hopeful to begin with.

          Many people hope for the best in 12-step programs and end up disappointed. This shouldn’t be surprising. The outcome statistics alone show that the program does not work for many people.

          Of course, it does work for some people. There is no contradiction here!

          • Persephone November 20, 2012 at 11:04 am #

            I think we see what we have been trained by our life experiences to see. People coming from a background of emotional abuse will likely see certain aspects as a continuation of the belittlement they have experienced (character defects, etc.), trauma survivors will be viewing through a different lens, those who recognize in themselves a similarity to the ideas of ego-centrism will likely see that aspect of the program. People of the Christian faith will see the program differently than people of other (or no) faiths. Many very open minded people are still seeing this through a lens of personal experience, which I’m not sure can be helped.

          • Carolyn Kay November 20, 2012 at 3:10 pm #

            We carry all of our biases and preconceptions into every situation we face. If we expect people to try to dominate us and manipulate us, that’s what we’re likely to see from them, whether that’s what they intended or not.

            It’s only when we do our best to step outside our egos that we have a better chance of seeing others for what and who they really are, instead of what we expect them to be.

            • Marc November 20, 2012 at 3:33 pm #

              Will you people talk English?! I’ve spent several decades discussing the dark mysteries of transference/countertransference, and it all gets pretty murky. I can’t even tell whether you’re arguing or agreeing with each other!

              • Carolyn Kay November 20, 2012 at 3:38 pm #

                What is the sound of one hand clapping?

                • Marc November 22, 2012 at 8:28 am #

                  I think normal prose works better for you than Zen koans. Your discussion with Persephone below is very useful!!

              • Donnie Mac November 21, 2012 at 12:39 pm #

                Best Post Ever !

                • Marc November 25, 2012 at 8:13 pm #

                  Thanks!

            • Persephone November 20, 2012 at 5:39 pm #

              Carolyn, I’m not talking so much about biases and preconceptions here as responses trained into people by experiences. Please pardon me as my education and training are not in psychology, but people who have suffered from trauma and abuse aren’t merely “biased”, they are traumatized! This isn’t a blank slate brain any of us go into when we are introduced to 12 step programs. It’s a series of learned responses to external stimuli, many trained into people since birth.

              This is one of my problems (not to rehash, apologies again Marc) with this notion that we come into that system (12 step) as merely by-the-book addicts/alcoholics, having led a life scripted and preordained somehow. It doesn’t even line up with the rest of the field of psychology, to my understanding.

              Or, in short, without a LOT of therapy and prior emotional development, an addicted person with an abuse/trauma history cannot simply “step outside our egos”, and to even suggest that these people are wrapped up in their egos (to suggest it to them, at a vulnerable time, such as very early sobriety) simply compounds the abuse. In other words, it’s not a choice for some, how they view the world, it is trained into them. Adding onto that that the entire problem is due to them and their faults, well, that really compounds the abuse, and is the core of the program as it was taught to me.

              Marc, I’m sure you can elaborate much better than I on the nature of these problems without even getting into the 12 step-good-or-bad side of things.

              • Carolyn Kay November 22, 2012 at 7:49 am #

                Biases and preconceptions ARE trained into people by experiences. That doesn’t mean they should guide our behavior in every case.

                Maybe i’m just lucky that my introduction to AA was by way of a loving outpatient treatment facility. When they told me I’d have to attend AA meetings, I protested that I didn’t want to go to places where people wave their hands in the air and shout halleluja.

                They told me they didn’t like places like that either, and that I should just give it a chance and be sure to take what I wanted and to leave the rest. I took that advice seriously, and I found what I wanted from the people I wanted to get it from.

                We seek out friendships with people who help us with positive feelings, why shouldn’t we get the same from those we meet in 12-step programs?

                • Carolyn Kay November 22, 2012 at 7:50 am #

                  Oh, and I was in my 40s when I started, so not exactly and impressionable kid.

    • Persephone November 19, 2012 at 3:08 pm #

      I do appreciate what you’ve seen and what you report here, Carolyn. That I didn’t experience it myself doesn’t mean that others don’t experience it. I have just seen too many abuses of people to make up for the good, and also have seen this system on steroids in the form of the treatment center version of AA/NA (not to mention the AA/NA therapist version).

      I know many members will claim, “but that’s not *real* AA!”, and can only reply that this is done by members of these groups, using the literature of the program as published by AAWS. So while I know that there are good members out there with good intentions (I know many personally), I also know enough who use their status in the program (clean-time/sobriety) as a bully pulpit or to abuse people paying huge sums of money for supposed medical treatment with pseudo-psychological nonsense. I almost, quite literally, did not survive it (and others did not).

      Not just the treatment center, but the meetings as well with their air of hopelessness. You have seen newcomers blossom, and I have as well. I have also seen them spiral into despair when saddled with this “knowledge” that to enter into the program they were also permanently saddled with a lifelong “disease” (with no proof shown scientifically for this). That they must attend 90 in 90, that they must attend meetings lifelong, etc. For some in early sobriety, this seems like a welcome, a new family, an answer. For some it seems like a sentence to hell on earth in a belief system that they cannot accept.

      I apologize as well for the lasting venom that that experience has left me with, I do realize that it seems outlandish and would feel that it is almost too dramatic had I not read so many other accounts online of similar experiences. My life is quite a happy one now, and this is past. But right now it is someone else’s present, so I feel compelled to keep writing about it for the sake of others.

  3. Jo November 19, 2012 at 5:44 am #

    Hi Marc,
    Another interesting read. Thank you. Thinking back to my own experience (AA/NA) I did end up feeling I had to move on, and I have, I feel I should share that without going through the steps process (luckily for me with a person who was all about learning to understand what I was feeling, and how to live my life with those feelings, instead of reacting to my emotions) I’m not sure if I would be alive today. But I am. I no longer attend meetings and have very little to do with those who do because of the ‘reliving’ experience and my desire to let go of the past. I did end up feeling stuck in the trauma, but the steps process definitely helped me to see I didn’t have to. In a strange way the NA program actually taught me how to move on, not only from addiction, but from NA/AA also.
    Cheers, Jo.

    • Marc November 20, 2012 at 10:23 am #

      What a great reconciliation you provide!! The steps helped you to launch into a truly developmental pattern — so they were incredibly valuable both for recovery and for ongoing development. And they eventually led you to a place where you no longer had any need for them and felt yourself to be in a different place. This resonates with what others have said about 12-step programs best fitting the needs of people early in recovery.

      It also resonates with many classic tales about learning wisdom from a master. The Karate Kid (yes, I’m showing my age), Luke’s break with Yoda (still pretty old), well I’d try to reference to some Taoist lessons but I can’t remember the details. The point, of course, is that the best teachers make themselves obsolete because the student eventually surpasses them.

  4. Elizabeth November 19, 2012 at 8:32 am #

    It is encouraging that several people have found that AA/NA actually taught them to move on. Carolyn, I also find it intriguing that you sometimes go back to meetings as a way to stay on top. I haven’t been back to my group in 6 months. In some ways, I do miss the community. My craving isn’t for drugs, but, like drug taking, I feel an intense drive to engage in ritualistic calorie-counting and restricting food intake. I miss talking to others that understand how difficult it is to suppress that desire, to not have the eating disorder “friend” to turn to during times of stress. Sometimes just being reminded that I am understood removes some of the guilt and burden from the struggle so I can move on to developing other facets of my life. I just know that if I attend those meetings regularly, I will come to view discussing my disorder as a part of my being. The goal is to minimize it’s presence as much as possible and to not incorporate “sharing about my disorder” as a part of my being.

    • Marc November 25, 2012 at 8:25 pm #

      Hi Elizabeth. Like Jo, above, you offer a wise and cohesive reconciliation. Yes, it is a wonderful feeling to feel understood. Yes, it is almost a direct antidote to shame. The attraction to attending meetings is palpable for me. I once attended a therapy group for a few months…. But that very attraction can have a negative underbelly, somewhat like the attractions that got us in this mess to begin with — a point that has also been raised by others here.

      So what do you do? Some stay, some go. For those who go, I think the quitting is a little like quitting the addiction. You miss it….but you feel it’s for the best. For those who keep going to meetings, I think it’s more like continuing to attend family events. You know that your relatives are far from perfect, but they’re family after all, and the “stasis” that’s at the core of a family doesn’t have to prevent one’s own growth.

      • Elizabeth November 29, 2012 at 10:12 am #

        “So what do you do?” I agree, this is the conundrum. I find myself still attached to the eating disorder/addiction community (although I don’t currently attend any groups and have recently stopped individual therapy), but attached in a different way than I started. I have a desire to share my ability to overcome strong urges to relapse in order to help others. It is not my goal to identify with others based on my current struggles. Perhaps some that still attend groups feel the same? They use the groups as a way to share insight and help those that struggle, rather than continuing to relate as if they are still addicts?

        Does anyone else have any insight into group dynamics/how individuals identify themselves within a group and overcoming addiction? It seems like being a group “leader” may not be a bad thing, but continuing to identify as an addict would potentially hamper progress.

  5. Michele November 19, 2012 at 9:35 am #

    This makes some sense to me but mostly through my experience in Al Anon, rather than AA, where I think it is disturbing in a different way.

    People in Al Anon talk about the alcoholic people they are in relationships with and how to let go of controlling them and concentrate on one’s own life. I attended Al Anon for a few years while with an alcoholic, addict, petty thief husband. I left the group after hearing one woman say that Al Anon was helping her as she hadn’t had sex with her alcoholic husband in eight years but now felt ok about it!!!

    • Marc November 25, 2012 at 8:30 pm #

      That gave me a chuckle. I thought you were going to say that you left when you left your alcoholic, addict, petty thief husband.

      You do bring out an interesting perspective on the “stasis” we’re talking about. Does Al Anon help people to simply maintain an impossible relationship….and feel ok about it?

  6. Persephone November 19, 2012 at 6:05 pm #

    Marc, I have been wondering, as we’re on the topic of anxiety here, what your thoughts on post acute withdrawal syndrome (PAWS) are and how they weigh into people trying to get rid of their addictions. There seem to be few pharmaceutical options short term, or perhaps they’re just not used correctly, I don’t know. Do beta blockers do the trick for a lot of people? (Unfortunately for me, no matter how anxious I was in early withdrawal one which I believe was a different earlier class blocker just kept dropping me to 70/30 until I passed out, so I couldn’t just stay on them as any form of treatment, but I was offered a beta blocker for PAWS at an earlier point and found I couldn’t exercise on it.)

    Just curious.

    • Marc December 10, 2012 at 7:59 am #

      Sorry, Persephone, I missed this. It’s been awhile since I’ve kept abreast of these issues. I know that different kinds of sympathetic arousal blockers are used, which would include beta blockers and so-called “alpha blockers”. I guess this explains your astounding blood pressure numbers. Good old diazepam and its cousins can also help, by releasing extra helpings of GABA, the main inhibitory neurotransmitter. For more complete info, you’d have to go to Google.

      As far as the role of withdrawal symptoms in addiction? It’s the first hurdle we have to clear if we’re physically addicted as well as psychologically addicted. But I’ve always thought that the psychological addiction is much more difficult to beat in the long run. Withdrawal symptoms….you can actually face them rather heroically, IF (and it’s a big IF) you really do intend to remain clean from now on. Otherwise, it’s just physical torment heaped on top of psychological torment. Not fun!

      • Persephone December 10, 2012 at 8:59 am #

        Interesting. Withdrawal/fear of withdrawal/PAWS were my biggest hurdles period. It wasn’t the using I wanted to continue, it was the not feeling utterly horrible for 6 (or more) mos. But then, everyone is different.

        It’s not personally relevant to me anymore, but considering others who are currently facing this I figured I’d at least drag this issue back into the light. I’ve seen some shake a heroin habit within a week with minimal symptoms, others (on heroin or any other opiates) spend months suffering horribly. I have seen many relapse (and did myself) not because they (I) wanted to get “high”, but because the physical suffering was so extreme. I think acknowledgment and adequate treatment of this would go a long way in helping people stop long term.

        • Marc December 13, 2012 at 6:23 am #

          I certainly agree that physical withdrawal has to be managed very carefully, either with drugs or with a very gradual step-down — or both. When I said the “first big hurdle” maybe I should have said “really big”. It can be devastating, and it can easily knock us back to square 1. I’ve been there. And I have a friend who “escaped” from the Betty Ford clinic one night because they wouldn’t help him with his withdrawal symptoms and he couldn’t stand it any more. They wouldn’t even give him a Valium for sleep.

          So he started using again, right away. He’s dead now. Thanks, Betty Ford.

          • Persephone December 13, 2012 at 2:27 pm #

            Damn Marc, that is harsh. I saved some money by not going to Betty Ford (family’s 1st choice) because my calls to them beforehand pretty much guaranteed that sort of treatment. From a consumer advocate perspective, I think that it shows not only a definite lack of “help” that is promised, but also a demand for centers that will actually provide some real care. When this old model fails, it fails on rather devastating levels, as you indicated.

            Eventually I would like to see a comprehensive list of treatment centers along with pros & cons, with patients (clients) able to list complaints (that the centers would have to answer to in order to keep a good rating) and less ability for these places to hide their (lack of) success rates, which they’re currently able to do. Something similar to what we have in the U.S. in the form of both the BBB (Better Business Bureau) and Angie’s List.

            Which of course doesn’t even answer your original comment, that the dangerous lack of care for people in early withdrawal can draw the line between life and death, and I have also lost friends in the same scenario you described above. It is so unnecessary, IMHO, to not help people through this.

            Wow, I really have to apologize, I am not a gloomy person, but from my posts here it would be difficult to discern that….then again, this isn’t easy subject matter. Still, sorry to drag everyone down.

  7. Kerryn November 20, 2012 at 1:17 am #

    Hi Marc

    Anxiety is horrible!!! I had a terrible attack of dread rising inside me at my therapists office which became that bad that my heart raced above 110 beats a minute and I started to hyperventilate badly I thought I was going to die. Have had the ol black dog following me I believe since before drugs. But never anything like this. It’s become the fear of my anxiety.

    And I also want to say welcome to what it feels like to be the mum and be continually relied apon for everything, it can become metally exhausting . I told you I was free for 12 years then relapse last May and haven’t used since June now. Apart from the bedtime joint, I started some anti depressants duloxetine 60mg and quetiapine 100mgs I was on esipram/lexapro since the change my whole life has turned around. I am positive and focused on the future not the past. I at last have opened a new shop body piercing, my shop looks fantastic and professional. My marriage has improved too. But the fear of that pure raw dread scares the hell out of me. I often get anxious about becoming anxious if that makes sense. Interestingly my brother has no history of addiction but also suffers from anxiety, he has been my biggest help in controling and understanding it actually.

    Btw just wanted to add we also have 6yo b/g twins and a 7yo and my husband is a farm contractor and farmer so I am often the only one here, it’s also nice when Dads home and says “LISTEN TO YOUR MOTHER!” its not much but it helps tremendously.

    cheers Kez

  8. Kerryn November 20, 2012 at 1:31 am #

    oh sorry forgot to say I have way more energy and interest in life is it the duloxetine ajusting my noradrenalin hence giving me more energy because before the relapse I couldn’t move myself of the couch I slept most afternoons before I pick up the kids and was always tired. But not now weight is falling off and I am loving life again.

    Penny for your thoughts lol
    Kez

    • Marc December 10, 2012 at 8:14 am #

      Hi Kez, Sorry for such a late reply. I think it’s very natural to develop anxiety about anxiety. We can develop anxiety about just about anything: anxiety about shame, about loss, about being hurt or dying…so of course we can develop anxiety about the crippling effects of anxiety itself. I picture the core anxiety as a crater or pit in a landscape of possible states. But as you feel yourself getting closer to that pit, start inching toward it, then you enter its field so to speak. Anxiety now radiates out and gets stronger and stronger the closer you get to the core.

      It sounds like you and your brother have anxiety symptoms as a prespecified part of your personality. This could be purely biological, in other words it could result from inheriting an unfortunate combination of genes, or it could be the product of childhood traumas of various sorts — or a combination of the two. It’s not surprising that you became an addict. Anxiety is a major precursor for addiction for many, and if you look back through the comments on this blog you’ll see quite a few examples. But that fate is not carved in stone, as proven by your brother — and by your current recovery.

      As for the mood-enhancing drugs that have been so helpful to you, I say Congratulations! The brain is a rich, complex soup of neurochemicals anyway. There’s nothing wrong with changing the recipe a bit through external ingredients, and this can be especially helpful if the soup you come with on your own isn’t quite right — which is certainly the case with ongoing anxiety symptoms. Sometimes you have to fight fire with fire, and it sounds like you are doing a great job of it.

      As for me and my kids, I do a lot of parenting even when Mama is at home. We share it pretty much equally — we don’t keep score, but it just works out that way. It’s just that they missed having her around, as I did. Their anxiety was actually quite mild — but it was observable, especially at night. I guess that speaks well for Mama: she knows she is needed!

  9. Janet November 24, 2012 at 9:57 am #

    Alanon has been a safe and healing place for me to go for many years. My experience has been the constant discovery of a setting of strength and learning. No rehashing horrors. We come there to be well. We are forward looking and lift each other up. Taking responsibility for our own reactions, feelings, and recovery. I would wish this for everyone. I feel so “unstuck”. Whereas before I was truly stuck.
    The other cornerstones of my recovery have been laughter, nature, music, and the courage and permission I have given myself to be happy. Reading, listening, learning, and keeping an open mind. And most importantly … above all else… to be unafraid.
    Peace and healing to all. Janet

  10. eva November 25, 2012 at 3:28 am #

    Hello,
    I live in the netherlands and would like to join this blog.
    I have been using heroin, cocaine and methadon for 10 years until my 30th year.
    Now i practice Chinese Medicine and i love doing so.
    The Chinese medicine gives me a lot of explanations for many questions i had.
    Maybe someone in this blog has experienced acupuncture or herbs?

    Eva

    • Marc November 25, 2012 at 8:35 pm #

      Welcome, Eva! Since I now live in the Netherlands too, and it’s such a small country, you might be just down the road from us. Anyway, please do join the discussion.

      I personally know nothing about acupuncture and herbs in relation to addiction, except that there’s supposed to be some meridian that goes through the ear…that helps to reduce cravings?

      Beste groeten,
      Marc

  11. eva November 25, 2012 at 4:38 am #

    i”m sorry, i just found out that i put a reply in the wrong place, sorry for that.

  12. Suzy November 30, 2012 at 9:44 am #

    The not growing and being okay with things that are not okay was why I left Al Anon. I did finally choose a sponsor in Al Anon and she didn’t return my calls. That was it for me.

    I could not get into AA because I found it triggering and wanted to drink after a meeting. I didn’t want to connect with the people that scared me much less choose a sponsor that would be in such a powerful position over me. Historically people with power over me hadn’t done me any favors. Why would I choose an “alcoholic” to advise me? It just didn’t make sense. But I was told again and again that I had to go there to recover so I thought maybe there was something wrong with me for not “getting it”. (There is also a predatory undercurrent in AA which makes it a dangerous place for young, attractive, vulnerable women.)

    I finally found a different program when a counselor of mine was out and her fill-in was using materials from Rational Recovery. He told me about SMART and I gathered my courage and began attending meetings a few months later. When I went to the meeting I felt understood and supported for the first time ever in a meeting. I also learned that I can trust my own mind and think for myself without dire consequences. I can be empowered to do that. It brought me something I had lost, hope.

    This program does make sense to me. With some simple tools that help us gain perspective we can think and emote ourselves sober. We don’t have to transfer our addiction to an addiction to meetings. Many find AA helpful and that is good for them. I didn’t but that doesn’t mean there is anything wrong with me or that I can’t remain abstinent. I’ve been sober for 2.75 years. I think that part of this is external vs internal locus of control. If you don’t think you’re in the driver’s seat of your life to begin with then a program with a rigid structure probably works. However, if you do believe that you are in the driver’s seat of your life, then it doesn’t work. I’ve been a critical thinker since I was a small child and I was always looking for the evidence that people’s lives were so great now that they were “in the program”. I didn’t see it!

    I was really angry when I found SMART because I had been in therapy for 13 years and neither my psychologist nor my psychiatrist ever mentioned it. But I am happy to have learned that 12 step is not the only way. Also relieved to know that I can trust my own mind, my self, to guide me in recovery.

    • Marc December 10, 2012 at 9:28 am #

      I found the SMART program for families listed right below the Al-Anon site on Google. Clearly these are different approaches, founded on very different principles and mechanisms, and people can choose. I didn’t want to get back into the pro vs. con debate with respect to AA, but you will find your position jibes with that of a lot of other commenters if you go back to the previous post. So far the vote is roughly 50-50…but who’s counting?

      I do agree with your comment: that different personality types are more or less likely to benefit from AA vs. SMART recovery. And it would save a lot of hardship if people could figure this out in advance. On the other hand, there seems to be no reliable formula for matching personalities to treatment types. There’s so much variation from one group to the next, that group atmosphere also matters hugely. I’m glad you found something that WORKED for you. That’s the main thing.

      • Suzy December 12, 2012 at 8:53 am #

        Thanks Marc. No there is no reliable formula but it is important for mental health professionals to present people with options. The assertion that AA is the only way is outdated. The book “Sober for Good” by Anne Fletcher presents evidence that there are as many paths to recovery as there are people in recovery.

        I think it’s important to support folks in what works for them. Instead of helping me find other options my ex therapist kept pushing me back to what wasn’t working, I couldn’t get myself to go, and thought there must be something wrong with me (again). That was not helpful.

        I found AA very triggering for panic and pushing through it just didn’t work. There is probably a meeting out there that I would like but the ones I tried weren’t encouraging. However, for people who do not find other people threatening, that wouldn’t be an issue.

        Other countries like Australia and the UK are ahead of the US in presenting other options to people with addictive problems. Interestingly here in the US in prisons “Inside Out” is used which is based on some of the same principles as SMART.

        For me part of why SMART was attractive was it has the trained facilitator. That added enough of a feeling of safety for me to continue to attend groups that I otherwise would have found threatening.

  13. aidel November 30, 2012 at 7:29 pm #

    First, you are clearly not a very involved parent when your wife is home or you wouldn’t be having these issues (you don’t know where to pick your kids up??) Second, you are dead wrong about 12 step programs. The emotional growth that takes place within those rooms is remarkable. Many come to 12 step programs with PTSD but the meetings, more than any psychologist, help you live with what has happened to you while bringing you back to live in the present. You need a new soap box.

    • Marc December 10, 2012 at 9:34 am #

      As you see, there’s plenty of healthy debate about 12-step programs above and below your comment. We allow both sides of the argument on this blog, so I don’t actually need a soapbox.

      And not that it’s any of your business, but my wife normally picks up the kids because she normally has the car.

  14. Kevin Cody December 6, 2012 at 6:01 pm #

    It is interesting to note the difference in “Per’s” post and this one, her’s was more about now and future, this one delves back into those awful memories (eg cotton shot)…very similar to the stasis of the “rooms.” Yuck.

    thanks Pers for your post, that was new and refreshing not the same old folk medicine offered by7 traditional 12-steps (noit helpful after a couple hundred times hearing the same old thing…just another addiciton in my op)

    Peace all!

    KC

    • Marc December 10, 2012 at 9:36 am #

      I also noted a parallel: between being absolutely certain one’s opinion is the ultimate truth and the assumption that one size fits all when it comes to treatment.

  15. Kevin Cody December 10, 2012 at 10:30 am #

    Duly noted, though this is in my opinion purely theory/lip service (no offense/no animosity from me). Because in practice, my experience in literally thousands of 12-step meetings/book studies/speaker meetings in three rather large metros (Kansas City, Chicago and NYC) the overwhelming feeling is one does not speak about nor take prescription drugs nor question the efficacy of the faith based program of AA/NA. Taboo subjects abound (if feels like a cult) and one does not “share” out loud anything not “approved” by the AA central committee and one is expected to tell, many times, how long sober.

    In AA whether or not one like’s it is the AA way or the highway. That’s why i no longer attend. I experienced what i believe to be severe cognitive dissonance. AA is a total immersion program if it is to be successful was my observation. And even then many sober people in AA/NA were so dry you couldn’t light a match around them. No offense. No real anger or hatred towards AA’s or advocates of course.

    But of course what do i know, am a chronic relapser/lapser.

    And in the area of addiction treatment I am bit more limited in experience, but the success rate is appalling..thus i read your book- wish i could afford to go to a good facility which could help me be abstinent, alas i cannot. I was accepted to Habilitat (30 month inpatient treatment/bootcamp) in Hawaii under full scholarship however, I am probation for possession and the court would not approve of it (they said it was too far in case I flunked they couldn’t bring me back or something like that. Read: no we can’t stick you back in jail to make federal money of you so easy)….so really seems everything is stacked against addicts who seek help and want help and find help-the system is so broke.

    Your book help me realize very deeply, that I have depression problems and severe anxiety. I am unfortunately unable to recognize anxiety as well as depression.

    I have tried several primary care physicians and 3 outpatient and one partial in-patient when I had insurance. Now I haven’t any so I am today volunteering for a VA based research study here in Kansas City. If any one like me needs such info it can be found at

    http://clinicaltrials.gov

    I loved your book by the way, except for the AA/NA stuff of course, I understand the well-meaningness of course. Your book and Gabor Mate’s book absolutely convince me some medication might help me out of the cycle, but really i haven’t the resources-thus I will guinea pig myself at the va as a non-vet-my luck I will get the placebo…LOL

    Thanks Marc, I try very hard to be a practicing Buddhist and I am so jealous…tell His Holiness “Hi” for me, pls!

    You probably have seen the videos regarding HH in Miami, I think at a neuro-science summit-great stuff about meditation and recovery through calming brain/thoughts and alpha waves. He seems to be a great fan of education/science-pretty odd for a spiritual leader, no?

    Maybe if there is a clinic or something you hear of which might admit a indigent addict who has a permanent scarlet letter (F for FELON- Missouri hasn’t any way to expunge drug possession…go figure) lemme know please. I’d love to be someplace safe and effective but i shan’t hold my breath.

    All the Best,
    KC

    Good luck in India, see if you can get to Tibet while there maybe and see the Potala Palace…you might start jogging. I hear the air is pretty thin…no coca leaves
    😛

    KC

    Thanks again for your book and work.

    • Marc December 13, 2012 at 7:22 am #

      Hi KC. Thanks for sharing your misery and your mirth with us. Much of what you say about the 12-step program has been expressed and debated here, so I’m trying to steer away from the pro/con debate. Also, did not touch on it in my book, but I’m glad you liked the book regardless.

      Good luck with your treatment plans. Hope you’re not in the placebo group (that was funny) unless they’re trying out something really nasty like krokodil. It does sound like your options are getting pretty narrow…..not a bad motivation to actually quit, by the way.

      I’ll say hi to HH for you when I see him, and yes, he loves science. I think he’s actually a geek in disguise, but an awfully nice one.

    • Persephone December 16, 2012 at 9:55 pm #

      Kevin, that was a rather harrowing tale. I hope this doesn’t follow you too terribly long, the problem with the expungement. I did look up some resources for your area, and it appears that there are SMART meetings available for patients at the VA (I don’t know if your clinical trial status would qualify you). I don’t know much about that group, but it might be something different for you to try or look into.

      Best of luck to you, and I’m glad you’re here commenting.

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