Understanding Addiction

How I quit…at least, how I think I quit

Written by

Marc

in

I am finally caught up! My inbox is clear for the first time since October. I have no classes to teach until after January. I just completed a draft outline for my next book (at 4:30 AM, somewhat hungover). And I’m now starting to communicate with the many people who sent me amazing stories.

There is actually nothing I’d rather be doing than this “research” into others’ addiction stories. I’m pretty much certain that addicts are the most interesting people on the planet.

Oh yeah, and I finished that disease/choice/self-medication set of posts I promised. Phew.

So, now, on to other things.

…………………………….

People often ask me how I quit drugs (roughly 30 years ago, with only minor blips since). So here’s a recent email exchange (lightly edited) in which I try to spell it out. Like others, this reader thought that the passage describing how I quit was too fast and loose. Maybe it was.

> From: “Donna” [not her real name]
> To: marc@memoirsofanaddictedbrain.com
> Sent: Tuesday, 24 July, 2012 2:53:06 PM

> Message: Hi Marc,
…….

> I just finished your book last night–I could hardly put it down. I
> was fascinated with the subjective descriptions of your experiences
> with drugs and how they manifested biologically in the brain. As I
> read I became rather depressed, however–learning about the brain’s
> loss of plasticity, and the feedback loops created by addiction made me
> feel rather hopeless. I was eager to get to the part where you talked
> about how you finally stopped doing drugs, despite having “hit
> bottom” many times.
>
> I have to say that your “NO” mandala was a big letdown. I’m sure I’m
> not the first nor the last to say that. It made me think of Nancy
> Reagan and the whole 1980s Just Say No campaign and here’s your brain
> on drugs–a fried egg. I really don’t understand. How did this work
> for you? How was it “different” from the other times you were filled
> with self-loathing, got your shit together, and ended up clean for a
> period of years? I wasn’t really looking at your memoir as a
> self-help book–I wanted to learn about the neuroscience of addiction,
> and I did learn a lot. But I also couldn’t help thinking about how
> you escaped, and what I could learn from that and how I could apply it
> to my own life. Sadly, I just don’t get it. Given the changes to your
> brain, what happened to enable you to overcome what was essentially a
> biological process?
>

> Best,
>

Hi Donna,

I’m happy to reply to this kind of mail…especially when your question is so clear and credible. Yes, others have expressed similar disappointment in the ending of my book. Let me try to explain how I quit.

First, there were never any periods of more than a few months, more often a few days or at best a few weeks, of being clean in the previous three or four years. So this time was obviously hugely different. How did it work? I’m really not sure. Basically, I reported what happened. The details are accurate. I didn’t have an instruction manual, so I can’t really say what was going on or precisely what I did that time that unlocked a new door.

But here, I’ll try. I had recently endured two particularly shitty events. My girlfriend left me, which broke my heart, and my friends found me, semi-comatose,  on a toilet seat in a public building with a needle sticking out of my arm, which was intensely shame-inducing. I think by then I had built up a lot of rage, not just self-contempt and all that but real rage — toward drugs, I could say, or toward what seemed to be a force or a malevolent spirit, or maybe something like the Greek Orchestra idea of a “fate” that keeps fucking up the protagonist’s chance of getting out of hell. Something pivoted on that particular day, the day I wrote “NO” on a piece of paper, decorated it with the trimmings of a mandala, and stuck it up on my wall. The rage seemed to pivot around and focus on this external entity, rather than on me for a change. And that was a big change. I remember feeling: you have no right! I deserve to live! You can’t do this to me!

That was how it started. There was also the small matter of saying to myself “never again” — rather than never again for at least 2 years, or never again injecting, or other half-assed self-promises. I truly at that moment didn’t want to EVER do it again.

And I just kept going on like that, day after day, telling myself NO fifty times a day….then less and less as the days went by. By the second or third week, I thought it might be really working, but I didn’t know for sure until about two months had gone by. And during all that time, the horror of my recent life kept returning to me in vivid images, and I kept telling myself: I don’t WANT to go there again. This is ME speaking: I DON’T WANT TO. Of course the withdrawal symptoms and the depression and all that were shitty for a week or two, but even within a few days, there were rays of light. Maybe even that first day.

Things like that happen. Big life changes can turn on a dime. How can that be, you may ask, given all the “wiring” that’s already taken place? For one thing, the brain hasn’t lost all its plasticity from addiction. Not at all. It’s just that addiction takes hold through several really fierce feedback loops that continue to gobble up plasticity on a day-to-day basis. I mean the loop of wanting-getting-losing-craving, and also the loop of using/lying/sneaking and shame, which greatly increases psychic pain and makes you want relief at any price. In both cases, there is a massive interaction between dopamine uptake, cue salience, and the potency of desire……that just cuts through the available options — the plasticity — as if there WERE no other options.

I guess another idea is that, while I was building up this elaborate addict network (I mean synaptically), I was also building up an elaborate non-addict network. I never stopped trying. I still wanted to be a regular person with a good life. I went to see a variety of therapists. I remember one who wouldn’t even talk to me (a psychologist, in fact) because he said I was too far gone. In fact, none of them helped much, but it meant (at least to me) that I was trying. Meanwhile, I was applying to jobs in mental health agencies, and getting some, and I was still aiming to get back into school. All that equals a whole OTHER synaptic network. Maybe the pivot point for me had to do with connecting a day-to-day/hour-to-hour sense of self with that second network, long enough for it to “take”…and start sucking up its own helpings of dopamine (I WANT this).

Also, I have no idea if I’d have stayed clean IF I didn’t get accepted into grad school a few months later. I’d like to think so, but I just don’t know.

Since then, I’ve had a number of flirtations with drugs, I sometimes drink too much, but I have never gone back to the hell I lived in before that day.

So there you have it.

And don’t be depressed. Loss of plasticity is relative. There’s plenty left over. Read Norman Doidge’s book if you want to think more about the immense degree of plasticity that’s available, even well into our later years.

Cheers,
Marc

Comments

45 responses to “How I quit…at least, how I think I quit”

  1. Peter Sheath

    Hiya Marc
    You know I fully understand your quitting process, it follows roughly along the lines of many I have heard before. I believe that, just as many people develop addiction/dependency problems in many different ways, there are also many routes into recovery. Because this is a very subjective experience, often involving profound change, people become very evangelical and sometimes quite dogmatic about it believing that there is only one way and that is theirs.
    My quitting process, although very similar, was also very different. I tried the self talk and self denial route many times and always to no avail. I just couldn’t do it on my own, in the community I was living, or without quite a robust programme of change. I have friends who did it with the help of Ibugaine, some others who used electrical currents and black boxes, I know people who have opted for the medical assisted route taking Opiate Substitutes or Opiate antagonists every day, many others use faith groups and loads of others, who just stop.
    Perhaps addiction is a bit like a jigsaw puzzle of issues? For some it is a relatively simple problem of over indulgence and dependency, and for others it’s more about the sustances being a solution to a much deeper set of issues?

    Reply
    1. Marc

      Hi Peter. I agree that there are many ways to be addicted and many ways to quit. It’s especially important what you say about people’s tendency to idealize their particular route to recovery. That must be the way! Do it just like I did, and it will work! And if you don’t, you’re a self-deluding fool…. I know you and I agree that that conclusion does a good deal more harm than good in the recovery world. So it’s important to name it and draw it out of its lair.

      Addiction is like a jigsaw puzzle, yes, in a way. But I think there are strong currents of similarity….. What I mean is that it converges to a particular state or way of being that becomes partly universal. Especially the addiction-medication-addiction cycle I talked about last post. I hope I’m not contradicting myself. Yes, different, but also converging to something with a very specific character and structure — over time. That’s called an “attractor” in nonlinear dynamics, the study of complex systems, etc. Well, I do think it’s like that. Like a romantic relationship breaking up: many variants near the beginning, very predictable by the end.

      Reply
  2. Peter Sheath

    Hi Marc
    Part of your “disease” blog is now on wired in and has already generated some interest so thankyou.
    I meant to mention before but forgot, maybe for some subliminal reason, the whole area of control in addiction. It’s something I have a growing interest in and, I believe, is the predominant force at play in addictive behavior. For me initially it was my desperate attempts to control my feelings and just about everyone around me that led me in to my addictive attachments to substances.
    Ultimately this illusion of control led me to an amniotic soup of chemicals and the womb like mind state of Opiate dependency. Although in many ways I was completely out of control, in my mind I thought I was always in the driving seat. I knew exactly what mind state I would be in at the start of the day and exactly what mind state I would be in by the end.
    It got so bad that I started to believe my own bullshit and found it really difficult to understand why others didn’t. It became like one of those plate spinning acts you see in the circus, eventually some of the plates stop spinning and you don’t have the energy or wherewithall to get to them.
    I remember a poster they had on the wall of a rehab I once went to it read, “when I take control I lose control”. As time has gone on and through practicing meditation I am growing to realise just how true this cliche is.

    Reply
    1. Marc

      Peter, your comments are great. Really candid and revealing, but also connecting to the big picture: the puzzle of trying to understand all this as professionals, addicts, family members, etc, etc.

      The control issue was huge for me, but it was manifested in a very simple way: I loved the fact that I could take things to make me feel a certain way, and I could COLLECT and store those things, in bottles or paper envelopes or whatever. That way, I didn’t have to rely on anybody to feel warm and safe. I didn’t have to ask for it. It was mine to dispense to myself. That was the essence of control in my mind.

      As long as those bottles or other containers weren’t getting too close to empty, I was in control, so it seemed. I would incessantly count my pills and hold the number in my mind all day long. That’s how many I have. That’s how much control I’ve got left.

      Reply
  3. Carolyn Kay

    Sounds like your anger tapped into a part of you that helped you develop a sense that you COULD quit.

    I see more and more evidence that a sense of efficacy affects many aspects of mental and physical health (http://bit.ly/QM35f4).

    Reply
    1. Marc

      I couldn’t agree more.

      Anger is a fantastic way to galvanize your sense of efficacy, because you are now fighting for what YOU need, protecting your tribe of one….and that can make the difference between life and death in addiction.

      I think the real trick is converting shame to anger — not so easily done, but potentially very powerful.

      Reply
  4. Elizabeth

    How inspirational to have found that kernel of self-love! While I was reading your post, I felt like I was also reminding myself that, yes, I too deserve to live and continue on a path to recovery. This is my one body that I get a chance to love. I’ve gotta take it!

    I recently read an article that ties into the power of the will to “choose” to restructure our thought patterns away from a focus on drug/reward pursuit and consumption. I recently read an article that highlights the power of metacognition/cognitive recontextualization and altering brain processes. It argues against the strictly materialist and epiphenomenalist concepts that we are simply the product of neuronal activity. The power that recontextualization can have on the brain is, to me, so inspiring as someone recovering from an addictive disorder. It certainly gives me hope that I have the power to overcome these long-entrenched addictive behavior patterns. I hope others feel the same when they read literature like this:

    http://www.ncbi.nlm.nih.gov/pubmed/17349730

    Perhaps it is the power of cognitive restructuring that makes me wary of ever fully accepting the disease model. I am grateful to have participated in these discussions and challenged in my thinking!

    Reply
    1. Marc

      Thanks, Elizabeth. I’m grateful for your participation too. I’ll try to get to the article soon. Meanwhile, recontextualization seems like jan important word. A big part of recontextualization for me was, and still is, a shift in perspective: that depression, anxiety, and emptiness do not have to be expunged (e.g., by a drug or drink) — rather, they are like scenery we pass on the train. You don’t have to overcome them, they pass by, like everything else.

      Reply
    2. nik

      Elizabeth, thanks for the reference. I think much of ‘recovery’ is about re framing and re contextualizing. For example, one tries to make healthy thoughts and actions the center of one’s existence, not ‘getting off’ or ‘getting high.’ Likewise, there is a view of ‘slips’ as human, but nonetheless staying on a path that’s good for oneself.

      Indeed, those recovering usually have acquired the concept of ‘addictive behavior,’ not to say a view of the choices that maintain it. Issues of blame and shame are reconsidered. If ‘addiction’ is not quite a disease, it’s also not just weak willed or corrupt actions

      Thanks again.

      Reply
  5. Dr Paul

    Hey Marc,
    Did I understand you to say in one of the above post’s that you “sometimes drink too much”? If so, can you consider yourself to truely be in recovery? Maybe i misread.
    Paul

    Reply
    1. Marc

      Hi Paul. It’s true. I sometimes drink too much. I am by no means perfect.

      Luckily, it doesn’t happen very often. I probably achieve a respectable hangover three or four times a year.

      I know some people consider ANY use of any intoxicant to be the wrong side of the line in the sand between recovery and…not recovery. But many do not feel this way. I certainly have recovered from a serious addiction to opiates.

      I would normally be described as a social drinker. And I’m not in the least ashamed of it. But I do understand that many people in recovery cannot drink — not even a bit — and I respect that too.

      Reply
    2. Charlotte

      I do not think you are in recovery, so to speak if you drink alcohol. Just my take on this. Maybe you have engaged in some harm reduction but not clean.

      Reply
      1. Marc

        Yes, I would say that the shift from shooting cocaine and Demerol every 20 minutes — drugs I obtained regularly by burglary — to being a social drinker has reduced A LOT of harm in my life.

        i think we need to respect each other’s definitions of what it means to be recovered, clean, improved, whatever we wish to call it. To me, that’s a lot of what this blog is about.

        Reply
  6. China Krys Darrington

    Along with the “no” I also remind myself, in detail, of all the things I *can’t* do when the drugs have me by the short-and-curlies. I remind myself of all the love I can’t feel and all the beautiful things I just can’t care about because I’m so numb to everything. All the things I won’t do because I’m just in that fugue state.

    Then I add the frosting to that particular cupcake. I pick one of the really humiliating and/or horrific things that happened while I was in the grips of active addiction. I retell that tale, out loud, to myself (for some reason the verbal part seems to engage that really squirmy part of my brain, where just thinking about it I can put some softer edges on the tale) and I tell myself that “no more dope days and you can almost guarantee that will NEVER happen again.”

    When the reward center of my brain is engaged its’ hard get me to believe that dope is a bad thing. I need the reminder of where that “yummy” feeling ends up so I don’t have to go there again.

    Thanks Marc for another brilliant post.

    Reply
    1. Marc

      Great to hear from you! The value of writing for self-healing has been researched by psychologist James Pennebaker. Funny that his name starts with “pen”. Yes, writing allows you not only to go deep and capture the flighty details (the ones you’d rather forget), but it also gives these memories authenticity and permanence. Once you’ve written it, you can’t get away from it, from its potency, its reality. Also, maybe another factor: stories tend to have endings. Even the little stories, the anecdotes (e.g., one time I went out and got some x and did it in the y and got so completely high, but then came…z) have endings, outcomes, results. And these outcomes are often so devastating that, as you say, just seeing them clearly for a moment can bolster your aversion to the whole nasty business. I don’t want THAT ending ever again.

      Good stuff!

      Reply
  7. John Krier

    Hi Marc

    My entry into the world of sobriety started with a stab at what we call “Hollywood Fluff and Buff”) in other words 30 day rehab and Hallelujah I am saved! Then I left after the first day knowing it was bullshit.

    I entered AA the next day and have been going ever since because during a brilliant lecture I attended during my ONE day in Rehab (by Sid Caesar’s son no less) by the resident physician I became convinced that recovery was a LIFETIME struggle and not just 30 days. I also became convinced (finally) that my addiction was not a MORAL faling but a Medical Condition. That was the turning point.

    The problem with your method as I see it is it only works for those with above avg intelligence and the lack of concomitant brain disorders of other types. All alkys are compulsive to some degree but many that I have met have much worse disorderes. Everything from Borderline Personality Disorder to Bipolar. These people need reminders from without not within. Ritual (such as your Mandala), discussion in a group of others who CAN be empathetic etc.

    You already know about mine and without some external help I would be screwed no matter how smart I might be.
    JLK

    Reply
    1. Marc

      Hi John. I don’t know how much of a role intelligence played. I think by then I was just so desperate….what I did was, in my view, more creative than intelligent. I had tried so many things. I even drank my own piss and wrote scathing letters to myself in blood — yes, real blood, my blood. I wanted to stop so badly, but I couldn’t find a way of conducting a message to myself that would last — last through the night or through the week.

      Your medical afflictions seem a bit of a blessing as well as a curse. You found an authentic way not to blame yourself for a moral failing. That’s so useful. And it sounds like you did use your brains to figure out what you needed, what would work. It’s true that people with various medical and/or psychiatric disorders often need a lot of external support to quit and stay quit. For all kinds of reasons.

      The bottom line: different strokes for different folks. Or: try everything until something works!

      Reply
  8. John Yeazel

    That was interesting to read. I am still struggling with my addiction but am close to the end of my rope. My rage is buliding up and I am fed up with where I am at. I have had numerous shitty events happen to me but I still let the psychic pain lead me back to seek relief. My kids and my family have played a big part in the psychic pain. Do you think it is best to stay away from family members and the angry feelings that still reside in me with family members until I am more recovered or at a better place? They still want to throw a lot of shame my way which does not help. My kids have stopped talking with me and will not answer my phone calls.

    Here is my summary of how you got out of the negative feedback loops:

    1) Two shitty events took place in your life: your girlfriend left and that shameful incident in the bathroom

    2) You had built up a lot of rage against the drug or what seemed to be a force or malevolent spirit or a fate that kept you in the hell of your circumstances

    3) Something pivoted on a particular day and you wrote NO on a piece of paper and framed it

    4) The rage seemed to pivot around and focus on this external entity, rather than on yourself- this was a big change in your thinking. You said: you have no right, I deserve to live, you can’t do this to me. That is interesting- you separted yourself from the addiction or the malevolent force or the fate.

    5) You also said to yourself again: NEVER AGAIN and really meant it, ie., with much more conviction than you had said it before

    6) You kept going on like this day after day, ie., saying no almost 50 times a day in the beginning but that becoming uneccessary as time went on without using.

    7) The horror of your recent life kept coming back to you in vivid images; you kept saying I don’t want to go there again.

    8) You kept having occasional withdrawal symptoms and some depression but also rays of light during this time.

    9) You knew that the brain does not lose all its plasticity because of addiction and that is what helped you overcome the feedback loops of wanting-getting-losing-craving and then using-lying-sneaking-shame which increased the psychic pain which fedback to using again. This causes massive interaction between dopamine uptake, cue salience (don’t know what this is) and potency of desire which is what causes plasticity (availability of options) to decrease.

    10) You also used the knowledge that you can either build up your addict network in your brain (synaptically) or your recovery network by continuing to feed your recovery network and not feeding your addict network

    11) You also found that holding on to a vision of being a regular person with a good life was helpful. Thinking about that a lot was also helpful. You continued on with this goal of living that good life and saying no to the obstacles that got in the way.

    12) You stated: “Maybe the pivot point for me had to do with connecting a day to day/ hour to hour sense of self with that second network, long enough for it to take….and start sucking up its own helpings of dopamine (I want this).

    I am going to try the approach you outlined and see if it works for me. I will report back as time goes on. I just interviewed for a new job and I really want it. I don’t want to screw it up like I did my last job I was at for 7 months and doing well. I quit in June for a variety of reasons but started using on the weekends again near the end of the 7 months. Don’t want to go into it.

    Reply
    1. Marc

      It’s hard to express how honoured I feel that someone would try “my method” — break it down to a recipe and then try to follow the steps. Obviously I am hopeful for you and yes, please keep in touch with us, and let us know how it’s going.

      Now as for steps 9 and 10 in your summation: These were realizations that came years later, really as I was writing the book. I knew very little about the brain in those days. But I did have the intuition that there were two me’s — each one a complex and coherent configuration of needs, wants, strengths and weaknesses — and yes, I had a very distinct sense of holding onto, actually becoming, the second me, and saying goodbye to the first me, the addict me.

      Now that I think of it, there was a lot of sadness just in that, in saying goodbye to someone who, in a manner of speaking, had lived with me, in my skin, for years, someone with whom I was so very familiar. I sort of knew I was saying goodbye to this person, forever, and that was HARD.

      Good luck, John. Although I never thought I had “the answer”, I knew I had one answer. And now you are dusting it off and taking it for a test drive!

      Reply
  9. jaz

    Hi Everyone,

    I guess this question is not only for Marc. Speaking about quitting: Is there a chance that we can see a more substantial discussion of ibogaine? How can we (meaning the entire society) afford to take lightly something that may alleviate so much pain? I don’t know how well ibogaine works, what is its liver toxicity, what are other possible problems, but I would sure as hell want to know. Isn’t it time for a sustained research program?

    My best wishes to everyone, jaz

    Reply
    1. Marc

      Hi jaz. Welcome back! I would be delighted to discuss drugs that can help curb or stop addiction. I don’t know anything at all about ibogaine, except what I can get off the net. I do know something about ayahuasca and its capacity to induce massive changes in personality or perspective — often good changes — sometimes including the cessation of addiction.

      Anyone want to get the ball rolling here?

      Reply
  10. doug

    What an interesting revelation it is that the ones who make their living studying and treating addicts in our society, of which there are millions (addicts that is) Who live to get high and dont really know or care about the so called science of addiction, are not actually addicts themselves. Or perhaps have the rich kid flirtation with drugs and think that drinking their urine qualifies them as a true addict. If you have more than four teeth in your mouth, and no teeth marks on your body that you cant explain, and a predictable warm bed to sleep in then you are not an addict. The addicts that are of real concern to society are not gibbering around on these esoteric , poor little me , web sites or writing scholarly publications. They are rotting in jail waiting to get out so they can get high again at any cost, and I dont mean financial. How, can the study of dopamine synergistic warm butterfly synapes help the truly addicted people that we all know about, but pretend dont exist. I dont mean to detrack from the poor little rich boy struggling to make mommy happy self treatement charade, but is anyone interested in helping people with the actual disease of addictiion. Perhaps since you all dont see the disease of addiction as the disease that it is, then we can just write off the addicts as crazy and we just need to raise taxes to house them, since we cant treat somthing that isnt treatable, by definition.

    Reply
    1. Marc

      I never answered this, Doug. It seems like your intent was to insult rather than communicate. Whatever. I’ll just say this.

      A hundred years ago, the suffering caused by tuberculosis and smallpox were immeasurable. Now these diseases are wiped out in most of the world, because of science. I don’t think addiction is a disease, but I do think we do science to make life better and minimize suffering. Literacy is nearly 100% in the world today, a figure unimaginable 50 years ago. Racism is greatly diminished in most countries. Women are recognized in many societies as having the same capabilities as men. All this because people use their brains to think about things and find answers, rather than just flapping their gums.

      We’re just at the beginning when it comes to addiction. We understand so little about it. Of course millions are suffering terribly. I would like to help them. For me developmental neuroscience is an important tool. And there are many other tools.

      What are yours?

      Reply
  11. Alese

    I think reminding people that addiction afflicts most seriously (relatively speaking, on a societal level, not an individual one) the lower socio-economic bracket, those who are also often victims of violence, systematic prejudice, suffer from multiple diagnoses and often are “rotting” in jail is very important. What I think is unnecessary and seriously detracts from an intelligent (and even interesting) discussion is denigrating those who come here to tell their stories, struggle with their assumptions, consider new (and old) ways of understanding addiction and ultimately have the good intention of helping themselves and others who are addicted.

    And for the record, those “real addicts” you mention, rotting in jail just to get out of their next fix may actually have the same neural chemistry at work as the rest of us . Their early experiences with trauma, their constrained opportunities to build experiences that provide the neural hope of ever recovering, these may be the foundations of their suffering as well… and developing the scientific and treatment models that understand these processes better may help early prevention and/or later recovery FOR EVERYONE. This is about addiction in human beings. Separating “the poor little rich boy” addict from the addicted person in jail who doesn’t read science blogs, to me, draws an inhumane line in the sand. Thinking together about what the extra challenges are to reach the more marginalized, more vulnerable, least heard populations of addicts? Better direction. A little less contempt in your posts might help that discussion actually get off the ground…

    Reply
  12. PersephoneInExile

    Marc, I too had to tap into a certain rage I had built up. That becomes difficult to explain, because so many times rage is associated with some sort of blind rage or senseless hatred. I didn’t experience that, but I too said “never again”, and it was a positive experience for me. Anger, while considered a negative and terrible state to be in by many, is a powerful motivator, one of the best, I find. In my case, it served its purpose and led to constantly positive experiences. It seems you had a similar road.

    I’m sorry that you are getting the standard negative comments on your writing here implying that you are not “clean” or not somehow approaching “recovery” correctly. I have seen this more times than I prefer to even write about, but must say that yes, if you went from shooting up ill-gotten drugs every 20 minutes to breaking that behavior, writing a book, and becoming a neuroscientist, you are (at least in my book) doing just about everything right!

    Reply
    1. Marc

      For years I was told that I couldn’t even FEEL my anger. It always seemed to turn into confusion and depression. Now I realize that that in itself was a pretty spooky state to be in. I guess I had amazing defenses. So, yes, good old anger. A powerful motivator indeed. And like nuclear energy, it can be used for good, not evil.

      This is the first post for which I notice some specifically negative comments directed my way. Interesting to see how different people react to me — and how you (as a reader) react to them. But anyway….thanks.

      Reply
  13. Kathleen

    Just don ‘ t use

    Reply
  14. John C

    Great writing here – and great comments

    Reply
  15. Richard Henry

    I like how you said, you have only minor blips, and or a couple of flirtations, for me that’s a better way then saying “Relapse” for the stigma that surrounds relapse is like “Failure” for many. For me I could or would even say today, other than intervenes use which I have been clean from for 15 years now, a couple tokes or a couple beers is more of a treat then a relapse. Since I have regained my right for choice and are no longer dependant on any mind altering substance in my every day life. Provided, no negative consequence arise from these “Flirtations” and are kept at a recreational use I see no harm in a minor “Blip here and there…But I would however strongly discourage anyone from this type of recreational use, for me its been 15 years of struggle in the depths of evil, and only once a person is truly living in the light, and has dealt with all their underline issues, do they have any chance of this type of recreational use. I must admit though, today I prefer to be clean and sober.

    Thanks Mark
    Reg; Richard Henry

    P.S maybe now that your caught up, you might have time to give me some feedback on my transcript of my book “Life In the Game of Addictions”. Its my 50th birthday nov.4 of this year and would really love to somehow publish it, all in the needs of helping others, not suffer as long as I have.

    Reply
    1. Marc

      You sound pretty ambivalent about “recreational” use, blips, or whatever we want to call them. I don’t blame you. For some they are poison: rabbit-holes leading directly back to the hell they’ve crawled out of. For others, they are, as you say, treats. Harmless and perhaps even beneficial. For example, to live in Europe and NEVER drink makes one an odd duck, with the automatic red flag: I’ve had serious alcohol problems and I just can’t do it socially.

      I would never advise anyone one way or the other — In fact I’d advise: don’t mess with it unless you’re really sure you are out of danger. But then again, how can we every be completely sure? There’s always some chance involved.

      I mentioned alcohol and “blips” in this post because I want to be honest and human as a blogger. I’m not perfect, but I’m in good shape these days.

      P.S. If I started reading others’ manuscripts right now, I’d be as backlogged as ever. Sorry, but I just don’t have the time to do it — and I really am sorry. Maybe a professional editor or proof-reader? Think about it.

      Reply
      1. LJ

        Marc-within the viewpoint of the brain and how it works how would you account for being able to drink alcohol in a mannered and controlled way-and do this in such a way you could NOT use a more potent thing like heroin or cocaine? My improving but still shaky understanding of the neuroscience of addiction goes something like this: Drugs interact with our brain in a very direct way…..I always forget what the difference is between serotonin and dopamine ..but I think is it is the dopamine that is more powerful as it has to do with learning and motivation to act. So drugs speed us up, slow us down, or seriously miss with our perceptions. If we continue to use we “learn” that the way the drugs make us feel is the “right” way and we get trapped in a feedback loop where we use but can’t control it or significantly decrease/control our use. So once an addict has quit they have the potential to recover by learning new ways of coping and living without drugs. So would you say that using alcohol in a socially acceptable and moderate way (my best guess as to how you relate to alcohol) does not “trigger” the craving for heroin (and then the use) etc etc? Although alcohol and opiates and stimulants are different classifications of drugs-don’t they all create the generally same action? A long question (with a complicated answer perhaps) that I have been thinking about for some time after following this thread…
        Liz

        Reply
  16. David

    Hi Marc,

    The key in this story for me is connecting to the other. When we try to quit we hold up the addiction as the center of our universe as surely as using. Starting something other allows us to eventually stop and more importantly stop thinking about it.

    thanks

    Reply
    1. Marc

      Connecting to the other indeed has rewards that are more palpable, long-lasting, and often (not always) fewer side-effects. The trouble is, for me and maybe others, that “the other” is pretty damned unreliable. They’re not always there, and they’re not always good to us.

      Reply
  17. nik

    Marc’s book and posts provide an excellent account of
    a kind of ‘mixed’ drug addiction, with emphasis on the
    opiates. His account touches on a number of aspects
    of addiction. He talks of the motives and setting; the cravings
    and finally the self destructive behavior (life becoming ‘unmanageable’
    as it’s commonly stated). So there is an excellent
    map of this territory.

    At some point, with a chance at a new life appearing,
    he “just said ‘no’” to continued hard drug use.
    We know from Fletcher’s “Sober for Life” and
    other sources that some drinkers ‘just stop.’
    Same is true for some smokers and heroin addicts returning
    from Vietnam. It’s valuable to know of this eventuality
    and contingency. Whether it’s 1 in 50
    or 1 in 50,000 is not, perhaps, the crucial issue.
    The point is, it’s not fair, nor scientific,
    to change the the diagnosis, after the fact, and say,
    “Well, there was no ‘true’ addiction.”

    It *is* true that Marc did not experience some of
    very common facets of addiction recovery. He did
    not take any ‘treatment’ or have ‘interventions’ or
    ‘work the 12 Steps.’ He’s not, for this phase,
    a guide or exemplar with direct experience
    resembling that of the majority of addicts, and here
    I include myself–the ones who can’t or don’t ‘just stop’.
    Structure and support, including from other addicts.
    appears, quite commonly, to be needed.

    To take a parallel, occasionally some persons
    with AIDS (or pneumonia, or SARS, etc) have
    spontaneously recovered, untreated.
    http://news.bbc.co.uk/2/hi/health/4432564.stm
    *Maybe* this case was a misdiagnosis, but there are
    other known cases. (See Kelley’s Essentials of
    Internal Medicine, 2001, p.884.)

    They aren’t directly helpful in studying AIDS treatments,
    effects of drugs, etc.– the path(s) a vast majority of the
    afflicted have to follow, or die. In another way, however
    they could, at least in theory, give some clues about
    natural defenses and resistance. So, I suggest
    is the case with Marc. There is no need, in
    my opinion, to try to find the ‘steps’ or a ‘recovery
    procedure’ in Marc’s account. It’s just what
    happened as he remembers it.

    Reply
    1. Marc

      Hi Nik. Obviously I appreciate your support and your clear perspective about my book. Indeed, I really just recorded what happened, and then inserted a second thread — neuroscience of addiction — wherever it seemed to fit.

      Maybe my recovery was not typical….but the more I hear from this community the more I realize that there is no common path to recovery. I think addicts have a lot in common when they are in the midst to their addictions…and when they begin to seek recovery in earnest. Then I think the pathways branch out again. The whole thing looks like an hourglass figure in my mind.

      The stats on “spontaneous recovery” are actually very surprising. With alcoholism they are roughly 50%!!! That means that if you are an alcoholic in your twenties, the chance of stopping by your forties (or so), without 12-step or any other formal treatment program, are about 50%. That is so important to know, and yet it’s often obscured by the “treatment industry.”

      Spontaneous recovery — weird term, actually: my recovery came after roughly 5 years of gut-wrenching efforts. But anyway, what we’re calling spontaneous recovery can indeed teach us a about addiction and recovery. I think I would emphasize this, rather than say it’s possible, in theory. As you say, it’s sort of like spontaneous recovery from medical diseases, which can teach us about bodily defenses. Just so. That word, defenses, describes the tip of an iceberg: highly active processes of energy being expended to bring the whole system — physical or psychological — back to some kind of equilibrium.

      Nothing is magic. Human development is an ongoing process, much of which remains invisible.

      Reply
      1. nik

        Hi Marc,

        Thanks for your comments. Just one small point. You said.

        ML: //The stats on “spontaneous recovery” are actually very surprising. With alcoholism they are roughly 50%!!! That means that if you are an alcoholic in your twenties, the chance of stopping by your forties (or so), without 12-step or any other formal treatment program, are about 50%. That is so important to know, and yet it’s often obscured by the “treatment industry.”//

        To be fair, here, ‘efficacy of treatment,’ –actual and alleged– is an issue for all mental health problems or “psychological disorders” (DSM), is it not?. The “treatment industry”, including pharmaceutical, has this general problem, as far as scientific proof goes, in my opinion.

        For example, Dr. Long’s excellent mental health website says that, for dysthymic disorder–something like moderate depression– there is a 10% annual spontaneous recovery rate.

        http://www.mentalhealth.com/dis/p20-md04.html

        So after 6 yrs, as I reckon,about a half of those afflicted have gotten better. And I don’t think this is atypical for many complaints that get people into ‘professional treatment.’

        Kirsch et al’s (2008) meta analysis on efficacy of SSRIs, reported that, for moderate depression,

        http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

        Kirsch: ///virtually no difference [SSRI vs Placebo] at moderate levels of initial depression///

        Kirsch et al (2008)

        http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

        Reply
        1. Marc

          Hi Nik. That doesn’t surprise me one bit. Spontaneous recovery or natural recovery is, er, natural with mental “illnesses” of the kind you describe. Which is why they should not be considered illnesses per se. I would never consider normal depression to be an illness, though bipolar disorder is a different beast. As many have said on this blog, the notion of illness is in for some serious revision in the next decade or two.

          That said, I don’t think the makers of SSRIs have claimed that antidepressants are your only chance of recovery from depression. That would be highly unethical (even for the pharmas). And yet, the N. American addiction treatment community insists, almost universally, that the 12-step program is the ONLY cure for addiction. Since it doesn’t actually show cure rates above spontaneous recovery, this is not only bullshit, it is also a highly unethical use of bullshit.

          Speaking of placebo effects!

          I just read Stanton Peele’s The Diseasing of America. Very enlightening!

          Reply
  18. LJ

    I’ve only been reading the taglines of the blog for a few weeks but now after reading up on this post I think I may have something useful to say about “quitting”…I quit, at first, because I thought I was literally going to die if I did not. I was on a particular bender of mine, namely various stimulants and lots of marijuana, when I found myself in a situation with a stranger that offered me free use of his cocaine supply. I had never used more then a little coke once before-so this totally blew my mind. I snorted it up and felt like I was some sort of mythical god being that knew everything about the world and that could never be hurt. And when I had that “thought” I became very scared-for I knew I was not in fact a “god” of any kind. I thought to myself “nothing should make someone feel this good”. It’s like I was Icarus being burned by the sun and realizing while it was happening that I was actually destroying myself, physically and mentally. I was then and still am today an atheist. But at that moment it was like “god” was talking to me-telling me that I must quit ALL of the drugs AND even drinking too. I don’t know what was happening in my brain and body to make me think such things-but I like to think that the last thread of sanity and will to live I had in me was shouting in blood red to get my attention. So at 23 I left my lover, moved into my parents basement, went to an out-patient rehab program, and began going to 12 Step meetings everyday. That was 11 years ago and I have been clean for almost nine years now. For me my addiction became so self destructive and I felt so alone that I still draw alot of strength from the twelve step worldview. I think drug addiction/alcoholism is just powerful and deadly..and honestly even being clean and having such a different and better life now, the “lure” of drugs still can talk to me-or should I say my brain and the chemicals in it still remember the initial rush. Looking forward to my 2nd reading of your book Marc!

    Reply
    1. Marc

      HI LJ. That was a particularly heart-rending story somehow. You sound like you really did approach the sun, and felt the burn, and fled back to Earth just in time. I have felt similar feelings on coke, though opiates were always the period at the end of the sentence. But the way you recovered — and especially your perseverance given the fact that it lives on in your imagination…..to me, those are the hallmarks of that particular courage that ex-addicts have, and that others can barely imagine.

      Please keep in touch with the blog. You have a lot to contribute. And by the way, I recently put out a call for people willing to share biographical material for my next book, confidentiality assured. Let me know if you’d be willing to discuss it.

      Best,
      Marc

      Reply
  19. LJ

    Thanks for your thoughts-I would be happy to talk with you….

    Reply
    1. Marc

      Hi again. I’m a bit overwhelmed for the moment. So let’s put further communication on hold for a little while. I have to get a few things off the ground first.

      But thanks very much for offering! I will take you up on it in the near future.

      Reply
  20. Stephen

    Just a quick note of LOVE to all of you amazing people.
    I work as a crisis counsellor at an addiction and mental health agency and your work Marc, somehow writing all this in a coherent and engaging way followed by these deeply insightful posts is absolutely fabulous and sooooooo helpful!!.
    Bravo.

    Reply
    1. Marc

      Thanks, Stephen. That is REALLY good to hear and really inspiring. Let’s just keep at it. I’m always delighted when I find that the blog reaches out to unmapped territories.

      Reply
  21. shaun shelly

    Hi Marc

    Some intriguing ideas here that raise so many questions to research. I love stories of recovery because they seem to reinforce the mantra I carry: “We are unique, but none of us is different.”

    It was the running writer George Sheehan who wrote “We may think there is willpower involved, but more likely… change is due to want power. Wanting the new addiction more than the old one. Wanting the new me in preference to the person I am now.” You seem to echo this sentiment in your experience of personal recovery.

    Your idea of giving yourself time “for it to “take”…and start sucking up its own helpings of dopamine” is very interesting. This is why things like contingency management work; Why we see the discontinuation of self-administration of stimulants in monkeys as they are promoted in the social structure of the troop, and this is neurologically preceded in an increased level of D2 receptors.

    Practically speaking these ideas translate into treatment by helping the “addicted” find out exactly what it is THEY really want – and that is seldom drugs, but if it is, that is ok as well! And by the unconditional acceptance of the individual and by expressing the belief that they can achieve the results of change, we often find that those seeking recovery are motivated.

    I always tell my patients that change is instant, but the results take time (I don’t buy the whole cycle of change, although it is useful as a concept). What this means is that once an individual makes up their mind to stop using, for whatever reason, if they stick by that decision, lapse becomes a learning experience, not a reason for punitive measures (like starting recovery from day 1 again).

    Keep writing, keep asking, keep searching.

    Reply
    1. Marc

      Great points, Shaun. I didn’t notice this comment because it’s so far back, but you articulate really important perspectives, as usual.

      Is change instant? Were there not other times when I definitively wanted to be a different person? I’m sure there were. The problem may be that different parts of ourselves want different outcomes, and these “wants” can coexist or nearly coexist in time. We need to keep thinking about the stream of events that occurs between “really wanting” change and the time “for it to take” — I think that can make or break the intended change.

      I like the fact that you sincerely give your patients unfettered choice. Only once you allow the possibility of remaining an addict, without moral condemnation, can you freely decide that that’s NOT what you want. Very important!

      Also, the association between social acceptance, increased dopamine receptor availability, and decreased drug self-administration in monkeys is fascinating. Can you send me/us a reference for that study? That should be a great anchor for advocating treatment based on social support.

      Reply

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