What gets you sober — God or your neurons?

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…by Lisa Martinovic…

There’ve been times during the life of this blog that the Great 12-Step Snowball Fight has erupted — as is typical for any blog, podcast, or article on addiction. I’m not a fan of AA, but I’m not a 12-step basher either. I like to keep an open mind, and I thought this essay was so good that it’s worth giving the Steppers another think.

……………..

In the thirty-four years since I cleaned up, paths to sobriety have proliferated in tandem with rates of addiction. At last count there were some 14,000 treatment facilities in the US alone. If you have good insurance it might cover a stint in one of them. Private therapy is always an option for those who can afford it. For everyone else, it mostly comes down to white knuckling it or AA. But in recent years 12-step programs have been attacked on many fronts, charged with being churchtoo religious, dogmatic, disempowering, cultish. Which is unfortunate because although 12-step is not the only way to get sober, it is one way, and it’s been effective for millions of people over the past 80 years.

I certainly had a lot of judgments when I first started going to AA, but in my state of utter ruin I was in no position to be picky. I dove in despite my aversion to all things Christian. The internal conflict I experienced as an atheist and a feminist being told to ‘turn my will and my life over to the care of God’ was agonizing. I thrashed against concepts like “powerlessness” and “character defects,” made grand pronouncements in meetings, and challenged my long-suffering sponsors. Over time, I made peace with the program and have been clean and sober since 1982. Though I haven’t been to meetings in some fifteen years, I will always sing their praises.

glowbrainIn recent years I’ve been studying neuroplasticity on an informal basis and applying its principles to my daily life, especially vis-à-vis my addictive propensities: Chocolate truffles! Mad Men! Facebook!

Not long ago, musing about how 12-step really works, I realized that one of the oft-repeated AA sayings was in fact a description of neuroplastic change: “We don’t think our way into a new way of acting, we act our way into a new way of thinking.” If you take action to foster your sobriety deliberately, repeatedly, and within a supportive community, change happens precisely because you are altering the very structure of your brain. And it happens, I argue, whether or not you believe in God.

This may come as a surprise to those who think that the program is all about ‘turning it over.’ Countless people do precisely that, but sobriety doesn’t happen in the absence of a tremendous amount of real-world footwork. And footwork, be it psychotherapy or working the steps, is what changes your brain and paves the way from addiction to freedom.

As with any new practice, consistent participation in 12-step programs gradually and methodically builds new neural networks. Every sober foray into a situation you used to get high for — first date, party, being alone and lonely — openheadstrengthens your capacity to do so again. Thanks to your malleable brain, the more you do something sober the easier it becomes. But you may need to muddle through a thousand situations sober before it comes as naturally as it did when you were drunk. It’s hard for most of us to stick to our resolve that many times. But with the support of others it is possible.

useitAA contends that because our willpower has “failed utterly” to get us sober, we have no recourse but God. Really? Well, what does every participant at every meeting find every time? What is the common denominator? Not God, but other people getting sober. We find community. The generous support of other human beings carries us when we cannot carry ourselves.

I was thrilled to discover, through Marc’s books and others, that my theory about how we get sober is corroborated by science. By integrating the research into my own experience, I have developed a pragmatic approach to recovering from addiction—an unauthorized 12-step workaround.

I want to share this approach with addicts who know they need help but are unwilling to explore the 12-step route. I wrote an essay in STIR Journal for them, their loved ones, and those who would help them, and Marc has generously invited me to share it here.

By unpacking the neural mechanisms through which we achieve behavioral change I give addicts who hate “the God thing” a different way to access the 12-steps—and recovery.

Read the full essay here.

 

Marc: Also see this article for a recent court case pitting the 12-step oligarchy against one person’s atheism.

Comments

41 responses to “What gets you sober — God or your neurons?”

  1. CM

    Alistair Hardy

    The Biology of God

    Reply
  2. Colin Brewer

    Or as a Greek philosopher put it over 2000 years ago:

    “We become temperate by abstaining from indulgence and we are the better able to abstain from indulgence after we have become temperate”. (Aristotle. Nichomachean Ethics, II)

    The French equivalent of ‘Practice makes perfect’ translates as ‘By doing the work of a blacksmith, you become a blacksmith’.

    Supervised disulfiram helps people to practice abstinence and to become good at it – or at least used to it.

    Reply
    1. Lisa Martinovic

      So true, Colin. I cite a related quote in my full essay.

      “The science has finally caught up with AA, and for that matter, Aristotle, who observed much the same thing some 2,000 years ago: “We become just by performing just actions, temperate by performing temperate actions, brave by performing brave actions.” Indeed, in 2015 the National Institutes of Health published a peer-reviewed manuscript that describes how working the twelve steps changes one’s molecular neurobiology — the very foundation of the case I’m making here.”

      Reply
  3. April Wilson Smith

    The same could be said of anything you do repeatedly that replaces a behavior you wish to quit. I did yoga every day for ninety days, overlapping with my 90 in 90 AA meetings, dutifully carried out as a good little girl post-rehab. There’s nothing magic about 12 Step – any community that is supportive and offers multiple points of contact would work. Unfortunately there aren’t many alternative communities that have the same kind of reach and prevalence as AA. I’ve founded two alternative recovery groups in my area, SMART Recovery and HAMS (Harm Reduction, Abstinence and Moderation Support.) I am exhausted from single-handedly trying to provide an alternative for those who want support but do not buy into AA’s patriarchal, disempowering message.

    Personally, I found AA damaging. I quit doing the steps when my sponsor seemed to think it was fine that I blamed myself for childhood sexual abuse. I got sick of the slut-shaming, the isolation from non-AA friends, and the general silliness.

    I think the most damaging part of AA is the insistence that if you have one drink, you are bound to go on a bender. They program people to relapse. In SMART, we say, if you have one drink, no big deal. Just reconsider your goals and get back on track. In HAMS, we encourage you to find your own goals, be it abstinence, moderation, or just safer drinking. Most people recover without treatment, and more recover into non-abstinent recovery, drinking safely or moderately.

    Marc is of course very well acquainted with all this evidence, but for those who aren’t, here’s a great summary by our mutual friend Kenneth Anderson:
    http://www.rehabs.com/pro-talk-articles/the-outcome-of-alcoholism-is-not-jails-institutions-or-death/

    Reply
    1. cheryl

      Agree with both April and Kenneth’s findings but if AA works for you great. I just don’t care for any one faith to tell be there is only one way which is “their way” that is cultish.

      ….+

      Reply
      1. April Wilson Smith

        Agreed. I also have a problem with religion masquerading as medical treatment and collecting health insurance money. If you want to go to church, great. I do, every Sunday. But it’s not medical treatment.

        Reply
    2. Lisa Martinovic

      I agree with you, April. I don’t know if you read my full essay but I am very careful to emphasize that twelve-step is only one way to get sober and that there are many others.

      “If you drank every day for ten years, that’s 3,650 times you reinforced the neural pathway that associates alcohol with relaxation or fun or sex or whatever else you used it for. Drinking releases feel-good neurochemicals. So do vigorous exercise and creative challenges — too much work if there’s an easier, softer way. When it comes to triggering the release of yummy endorphins and dopamine, your brain became a one-trick pony. It’s going to take a while before sobriety feels comfortable, let alone pleasurable. Which is why most people need support trading their neural superhighway for what is initially a mere footpath to recovery. It could be inpatient treatment, therapy, an exceptional network of family and friends, or a twelve-step program.”

      SMART and HAMS were not around when I got sober. As an atheist there’s no question but that I would’ve chosen one of those paths instead, and it probably would’ve worked just as well. And yet, as you say, it is the very ubiquity of twelve-step programs — and the fact that they cost nothing — that can make them useful for desperate people who have no other resources.

      Also, in my full essay, I speak to your point that “The same could be said of anything you do repeatedly that replaces the behavior you wish to quit.”

      “I took actions often enough and consistently enough that I changed the way my brain functions. Repetitive actions give rise to neuroplastic change, which is the bedrock of behavioral change. These changes happen no matter our opinion of them, for the brain is essentially amoral. It has no preferences; it merely implements change in response to how we live our lives.”

      Sadly, I am well aware that many people are harmed by AA. I’m so sorry that you experienced slut-shaming and an abusive sponsor. There is definitely a danger for vulnerable people who may put their trust in people that should not be entrusted.

      Reply
      1. April Wilson Smith

        Thanks so much for your reply Lisa! This is an excellent and engaging conversation.

        There will probably always be the small percentage of people who find AA works for them. This is why I try not to publicly bash AA, in spite of all that is problematic about it. For those few people, it should be there.

        What I and others in Harm Reduction often say is, “We’re here for the other 99%.” As a treatment and as public policy, AA has been a gigantic failure. If it were limited only to private, entirely optional religious practice, I would support it entirely, just as I support other religion’s right to practice. My problem is that it dominates the treatment industry, the court system and even most of the healthcare system, squeezing out other options. I get a lot of people at my SMART meeting who were told they had to go to AA by courts, family or treatment professionals. For those who don’t vibe with AA, this sets them up for failure.

        Not sure where you’re located, but if you find yourself in Philly, drop by my SMART meeting on Sunday afternoons or HAMS on Wednesday evenings. It’s a fellowship with a totally different flavor. You’re always welcome!

        And my name really is my name – total bizarre coincidence that I have the two last names of the founders of AA! Very few people notice…

        Reply
        1. Lisa Martinovic

          Thank you for your invitation, April. I’m in the San Francisco Bay Area and according to the SMART website there are a couple of groups near me. (I’m actually surprised there aren’t more.) I’d like to check out a few meetings just to round out my education in this arena. I’m curious, do they have anything analogous to sponsors? If so, is there potential for the kind of abuse we sometimes see in 12 step? I notice they have a protocol for Problematic Behavior Reporting, which is fantastic. Wish they had the equivalent for 12 step meetings.

          I have always felt strongly that court mandated AA is a bad idea on multiple levels. First, you can’t force people into recovery who don’t actively want it. Second, now that there are options like SMART, people should be given a choice. Same goes for the treatment and healthcare industries. Entrenched bureaucracies typically change at a glacial pace, but hopefully, with advances in the science of addiction, along with valid alternatives to twelve-step, we’ll start seeing more treatment options made available to everyone who needs them.

          In my first response to you I said that if SMART or HAMS had been available in 1982 I probably would’ve gone that route and it probably would’ve worked just as well. On reflection, I’m not so sure. I definitely would have made the experiment — anything but God! — but if I had been told that moderating my use was an option I likely would have rode that horse to the grave. I knew I had a problem very early on and tried for years to moderate my use, to absolutely no avail. As I told Annette in a later comment here, all-or-nothing people like me need absolute limits.

          But there’s another piece, something deeper. I have a strong bias towards wanting to live my life as mindfully and as consciously as possible. Drugs and alcohol cloud my consciousness. It’s why I used them in the first place! But my mandate for the past 34+ years has been quite the opposite. I want to deal with all of life without crutches and filters. I do my best, but even without chemical inebriants, there are infinite ways to avoid being fully present in our lives — from food to the range of digital addictions. Which is where it gets tricky because of course we do have to eat, and in the modern world we pretty much have to be plugged in. Thus moderation is our only option. I grapple with this and related issues in my recently published essay: Has Binge-Watching Hijacked Your Dopamine?

          https://theestablishment.co/has-binge-watching-hijacked-your-dopamine-290e16b2daf5#.5c74jyuxy

          Reply
          1. April Wilson Smith

            Hi Lisa,

            Thank you for your reply! SMART very consciously does not have sponsors, or anyone who is set up as an authority. Facilitators have to take a 30 hour training in order to hold the post, but there is no “time” requirement – we don’t encourage counting days, though members are welcome to do as they please. SMART is an abstinence based program, or so it says, but since it can be used for addictive behaviors like food or shopping, it’s very flexible. I try to practice SMART principles in all my affairs (I was in AA long enough to learn the language 🙂 and apply SMART tools to my eating, drinking, working, even relationships.

            We differ from AA in other ways too. For instance, while members are welcome to socialize with whom they please, we don’t pass around a sheet for numbers, and we don’t push members to socialize with other members. We encourage people to mobilize the support system in their own lives, and we even work in meetings on ways to do that.

            We also don’t encourage lifelong attendance. The literature says that about 8 months is usually about right. We encourage people to solve their problem and move on with their lives. While we don’t take a position on the disease model, and SMART can definitely be used by people who believe they have a disease, our structure does not reinforce the idea that one has a permanent disability. We look at changing behavior in lasting ways. If you choose to stick around SMART to give back to others, or even become a facilitator, that’s great, but we encourage people to move beyond their addictive behavior and not make it the focus of their lives going forward.

            We also suggest once a week attendance, not daily attendance. Of course people are free to attend as often as they choose, but we actually don’t want people to build their lives around the group. We work with people to find other, productive routines, such as reconnecting with hobbies or an exercise plan. We don’t want people to become dependent on meetings. I’ve seen many a participant in the SMART meeting I founded replace nightly alcohol use with a nightly trip to the gym.

            I’d love to hear what you think of SMART once you attend a meeting. There are also great tools online, and the SMART Recovery Handbook is available on the website too. There are online meetings as well. Lots of people go to both SMART and AA. There’s no contradiction if you don’t look too deep, though SMART’s belief that we do have the power to choose our own actions could be interpreted as in opposition to the concept of powerlessness.

            Some people say that SMART is not right for people who have lost too much – friends, family, job, place to live – but I’ve seen SMART work incredibly well for people who were recently homeless and in active heroin and crack use. One of my closest friends is now a certified SMART facilitator herself, and just last week had 300 days abstinent from heroin and crack (as well as alcohol and all other “Drugs” though she does smoke cigarettes). She was homeless, having been kicked out of her family’s house and lost her own apartment, and was in and out of the hospital because in addition to being on drugs, she has Type 1 diabetes and nearly died of it multiple times. SMART has been her primary recovery group and tool, and she now facilitates a meeting in a professional therapy center as well as taking over the meeting I founded. She brings a friend who is still homeless and in active use, and he is gradually making healthier choices as he hangs around people who are focused on positive change.

            SMART is especially good for smart people. Since many of us grew up with Cognitive Behavioral Therapy in the air, the approach seems more natural than the evangelical Christian approach of AA. I’ve seen people who are creeped out by AA take like fish to water to SMART, and solve their problems. I overlapped – got my certification in SMART facilitation a few months before I quit AA all together. I found that while I never felt comfortable in AA, SMART feels natural and empowering.

            Re: moderation vs. abstinence – everyone has to make their own choice, and that choice may evolve over time. I’m glad I had a long period of abstinence to reset my whole life. Now I’m really happy with my choice of moderation. Following the HAMS elements, and applying some self-discipline, I no longer have difficulty controlling my alcohol. However, I do stay away from the benzos – I find the cognitive effects of those are just not worth any benefit, and now that I no longer drink to excess, my anxiety has pretty much gone away.

            Enough from me… really enjoying chatting!

            April

            Reply
            1. Lisa Martinovic

              Wow, April, thanks for the detailed description of SMART. It really lines up with my belief in supporting the autonomy of each individual, and in supporting members to develop lives outside whatever program they are a part of. I’m glad to know it exists and hope that it flourishes.

              On a related front, I’ve always been curious about people who once identified as so far gone that they needed outside help with their addiction, who go on to achieve abstinence, get their lives together — and then later enjoy using in moderation. I don’t doubt that this is possible for some people, maybe even for most, and I support people to find their own way. What I’m wondering is, why do you drink and/or use at all? Is it to relax? De-stress? Be more sociable? Because you like the taste? I’m not being flip here, I’m genuinely curious. If this feels like too personal a question, feel free to ignore it.

              But I direct the question to Marc also. Towards the end of Memoirs of an Addicted Brain, suddenly Marc is enjoying martinis along with a new romance. Which is fine, of course, but it felt like it came out of the blue; there was no discussion of his process around deciding to be a social drinker. In the context of such a thorough and original explication of intoxicants, addiction, and the brain, I was surprised that such an important part of the story—and of the debate about non-abstinent recovery— was left unexplored.

              Reply
              1. April Wilson Smith

                Hi Lisa!

                Not too personal a question at all! I’ve been wanting to write an article about non-abs recovery, just haven’t got around to it. In terms of the facts, there really shouldn’t be a debate (yet of course there is) – just as many if not more people who at one time had alcohol dependence recover into non-abs recovery, most without treatment. Best straightforward article on that with references:

                http://www.rehabs.com/pro-talk-articles/the-outcome-of-alcoholism-is-not-jails-institutions-or-death/

                As to why I choose to drink in moderation: I like it. I was a wine enthusiast from a pretty young age – my parents are big wine drinkers – and I missed the taste and the rituals of enjoying good wine with good food in good company. I also find that a little wine improves my creativity. I’ve written many things stone cold sober, but I do find that if I consistently have some wine in any given week, my creativity is better all around.

                As a very social person, I enjoy the social aspects of alcohol. I like having one glass of chardonnay at an office happy hour, and I frankly felt left out, freakish and deprived when I was totally abstinent.

                While I was at rehab, I for the first time got intensive trauma treatment that I had needed for years. A succession of mental health professionals previously had missed that I was suffering severe PTSD following three sexual assaults. They were so focused on the drinking I was doing to medicate anxiety and panic that they missed the obvious. The people at rehab (Caron, to be exact) immediately saw that I needed trauma care and were really great. I then was extremely fortunate that I had enough money saved up that I could take two months off from working before I went back to school full time for my MPH. During that time, in addition to doing my 90 in 90 as instructed, I engaged in very intense yoga practice and other exercise, attacking the trauma through the body. I remained abstinent for 11 months. By the time i decided to try drinking, I had read Marc, Kenneth Anderson, Stanton Peele, Maia S., and done two semester’s worth of MPH research into the scientific literature around alcohol use. I knew the facts were in opposition to what I had been taught in AA – most people drink again safely. There is no uncontrollable disease – unless you think there is. So I walked into a bar, drank two glasses, walked out, and nothing happened.

                Years ago, I did hardcore Calorie Restriction for longevity. People would ask me, how can you survive never having takeout Chinese? Don’t you miss cheesecake? They just couldn’t comprehend how you could live without certain high calorie foods. In our society it’s perfectly acceptable to not want to give up cheesecake, even if you’ve been obese and had health problems. No one would tell a formerly obese person who had lost the weight that she could never have a piece of cheesecake because it might cause her to eat uncontrollably. The neurological processes behind overeating are pretty much the same as those behind overdrinking. Yet we have this myth, perpetuated by AA, that people who’ve ever had a drinking issue can never drink again. it’s irrational, disproved by evidence, and I think it stops a lot of people from getting the help they need early on, when there’s still time to minimize the damage a drinking problem can cause.

                Personally, I hate cheesecake and would be happy if I never saw another one in my life. But I understand how someone who had loved cheesecake would not want to give it up forever, but might want to learn to enjoy it in moderation, maybe one delicious slice on Saturday night after dinner, instead of a whole cheesecake every day.

                When I was abstinent, I developed an obsession with ice cream, and would head for this ice cream shop in my neighborhood with the same intensity and out of control feeling that I used to have on the way to the bar. I’d literally walk right past a bar where I used to hang out and head to the ice cream shop. Two scoops turned into four scoops and I felt like i was going into a sugar coma, but I couldn’t stop.

                I used SMART tools, over a few months, to stop using the ice cream. I was abstinent for a few months, and then I would go back from time to time and enjoy one scoop. I realized the other day that I hadn’t been there since summer, so this weekend, when I was planning a small dinner party, I picked up two pints from the shop (Chipoltle chocolate and sweet potato burnt marshmallow!) and served a scoop of each kind as dessert last night, after a meal of Thai red curry beef with vegetables and a Thai sesame lime salad. We enjoyed our ice cream, and I put it away. No one had seconds. It’s sitting quietly in my freezer, and I’m not tempted to eat it. I’ve made peace with the ice cream. It’s no longer a forbidden fruit, it’s just something I can enjoy when I chose.

                There’s also a bottle of wine, half consumed, on my table. In the past, I would have been afraid to have a bottle of wine in the house, for fear that I’d go on a binge and drink night and day. Now I’m not afraid at all – I have no reason to drink during the day, and many other things I need to do. It would not occur to me to drink it until tonight, when my boyfriend and another friend are coming over for tacos (cooking for others is my favorite hobby!) My friend and I will have a glass of wine, my boyfriend will not because he only drinks once a week, and then only drinks whiskey. Almost twenty years ago, after having a drinking problem, losing jobs and ending up homeless, he discovered Harm Reduction and developed a pattern of drinking once per week. He shuts off his phone, watches Japanese movies without subtitles, and enjoys his whiskey. It’s his night off. I despise whiskey and don’t speak Japanese, so that would not be a good time for me. But he encourages everyone to find the pattern that works for them.

                He is actually the founder of Harm Reduction, Abstinence and Moderation Support, (HAMS). We have a vibrant Facebook group that you might want to check out, just to see what it’s like. We help people at all stages of their journey to find their own path. If you just look up Harm Reduction Alcohol on FB you’ll find it, and Ken can add you. We also have in person meetings, a very informative website at hams.cc, and Ken’s book, How to Change Your Drinking, is great. It’s a revolutionary way of looking at alcohol, and it really works for a lot of us.

                Really enjoying dialogue! Marc’s blog is such a great resource and community!

                Have a great weekend!
                April

                Reply
                1. Lisa Martinovic

                  April, it sounds like you’ve created for yourself a life that is satisfying, productive and free of compulsive behavior. Congratulations! I hope you write up your experience for publication. It will be a lifeline for many who still suffer.

                  In your description of how it works, there are two threads I’d like to pick up on. First, I don’t know what the numbers are but it’s undeniable that countless people in the throes of addiction have found themselves there as a result of trying to medicate either physical or mental trauma. I’m glad that you got the help you needed and only wish that it were available for everyone regardless of their ability to pay. And there’s also the social stigma to be dealt with. Why do we as a culture have compassion for people who use drugs to address physical pain but scorn for those who use it to alleviate emotional pain? It’s madness!

                  Second thread: I’m intrigued by this notion of your feeling “freakish and deprived” when totally abstinent. For me that would be a red flag. And if I drank — even moderately — to overcome feelings of psychic discomfort, I would have missed an opportunity to develop new skills, explore different ways of navigating life. I don’t want to need anything external — be it a substance or a relationship — to be comfortable in my skin and at peace with myself. That’s just how I choose to live, not a prescription for anyone else. As Carlton points out, there are many ways to create a successful life post-addiction.

                  Reply
                  1. April Wilson Smith

                    Hi Lisa,

                    Thank you for your comments!

                    As to drinking to overcome feelings of psychic discomfort… I don’t really feel it that way. It’s more that I enjoy having a glass of wine socially. Much as others would prefer to eat at a dinner party than to abstain from eating, the way I often did when I practiced hardcore Calorie Restriction. No one looks askance at the practice of eating in fellowship with others, yet we apply different standards to drinking, even moderately.

                    I think it is an illustration in the difference between Harm Reduction thinking and Abstinence Only thinking. Abstinence Only folks are in pursuit of an idealized perfect state – one free from mind altering chemicals – yet us HR folks see them smoking cigarettes and downing cookies and coffee at meetings and note the hypocrisy of it. Harm Reduction is about meeting not just others where we are, but meeting ourselves where we are. We recognize that our goals and our circumstances may change, and we reject the idea that there is some normative ideal state. My “successful” life may be quite different from someone else’s.

                    For me, a challenge about becoming a Harm Reductionist has been really taking ownership of my own goals and rejecting societal standards of “good.” Especially for a woman. I had lived my entire life in pursuit of perfection and others’ approval, either real or imagined. A perfectionist Harm Reductionist is like a Zen Koan – it’s designed to make your mind blow up! It is impossible to be a perfectionist if you fervently reject the idea of perfection, or even a normative standard. This has been both challenging and liberating for me. My central struggle, and the way I define recovery, is to find a way to live life authentically, in my own voice, with respect for others but without bending myself to suit their every need and want. This is a long term journey, and one in which I expect I will evolve for the rest of my life.

                    At my rehab, they gave us a very clear vision of who we were supposed to be. Abstinent, adhering to conventional Christian morality, attending meetings for a lifetime, dressing conservatively (your shirt has to be long enough to cover your butt if you’re wearing yoga pants!) and chaste or in a monogamous relationship. I’m bi, poly AF, have no interest in having children, and am mostly driven by intellectual pursuits, such as working on my PhD. In rehab they told me I read too much and thought too much – classic AA anti-intellectualism. I’m grateful that they so perfectly distilled all the repressive, Puritan American ideas I had spent my entire life struggling with, so that I could eventually see that I want no part of that value system.

                    The obsessive focus on staying “sober” (which I put in quotes because it’s taken to mean something different in the case of folks with a past alcohol use disorder vs. people who just happen to not be drunk at the moment) seems to me to obscure dealing with other issues that might be driving the drinking or drugging. When I hear someone is over-using a chemical, I don’t ask about the chemical usage. I ask, “What’s hurting? What’s going on?” I suspect that very few people wake up and decide to get wasted all the time for no particular reason.

                    Totally true re: ability to pay for treatment. I didn’t get any help for years because even though I sought help and had insurance, my providers ignored the trauma and focused only on the substance. I credit my return to a happy life largely to the fact that I had the money to take significant time off. Most people don’t have that luxury. I don’t know how they do it. I recently wrote at recovery.org – stress is the enemy of recovery. Early recovery is such a fragile time for most – minimizing stress is key, and not always possible.

                    Off to bed… my little cat is warming a spot for me!

                    April

                    Reply
                    1. April Wilson Smith

                      Morning all! This is a great resource on how we in Harm Reduction view things, from the HAMS website:

                      http://hams.cc/book/damagecontrol.pdf

                    2. Lisa Martinovic

                      April —wow — the description of what was asked of you at your rehab is shocking. I’ve never seen anything remotely like that at a 12 step meeting. I wasn’t kidding when I wrote that in San Francisco it was completely acceptable to declare a lightbulb as your higher power. The very idea that your clothing was policed is unfathomable. I wouldn’t have lasted a day. Nor was I ever told that I read too much or thought too much. But what happened to you was in a rehab, and though it may claim to be twelve-step based clearly it was not. At best it was their twisted version of it. Conflating your rehab with all of AA is reductionist and denies the complexities of the many paths to recovery. My experience was very much like another commenter here, Deb, who said she felt she’d be welcome if she said Satan was her higher power. And yes, I know that many people have had bad experiences within 12 step so I’m certainly not denying that.

                      I think it’s unfair to characterize people who’ve gotten sober but continue to smoke cigarettes as hypocritical. I was one such person in early recovery. I quit alcohol, meth, coke, heroin and pot all at once, but I recognized that I needed to continue using coffee and cigarettes in order to cope with an otherwise sober life. After three months I quit caffeine and cigarettes but gave myself permission to eat a whole lot of sugar. I couldn’t have quit smoking otherwise. In a sense, my strategy was a form of harm reduction: I released addictions starting with the most toxic and working my way up to the socially acceptable ones. I knew full well that I was addicted to cigarettes and then to hot fudge sundae’s even as I was sober from drugs and alcohol. I was neither in denial nor being a hypocrite.

              2. Carlton

                Hi Lisa,
                Many of the SMART meeting check-in (similar to AA Testimonials) were by people who were considered “far gone”, to use the term.

                A large percentage of them (including myself) would mention repeated Detox, Recovery programs, Hospitalizations, even close-to-death and suicide issues due to the desperation the feeling of addiction generates.

                Interestingly, aside from the SMART program itself, being able to observe people change, or “recover” from “far gone” scenarios and drift away from attending the Recovery meetings, was a unique, novel and exciting thing 10-15 years ago.

                It was indicative that an comprehensive model for Addition was still to be discovered and described, but it is too big of a topic for a blog on the internet.

                As to your query about returning and enjoying moderate drinking;

                Currently, it is presumed that a fear-of-returning-to-a-state-of-addiction is the reason, but I think for a large percentage of ex-addicts, it is more like the reason people do not return to a significant-other or a spouse who ws once a substantial factor in ones life.

                It is because deep feelings have changed, realizations have occurred, and discoveries have been made.

                I think a large percentage of ex-addicts find intoxication or engaging in the old addiction no longer generates feelings of freedom, relaxation or pleasure, but does not generate fear either.

                Another percentage seem ro find it pleasurable to return to drinking or drugging socially again, as some have posted.

                In any case, these scenarios, as a whole, are again, indicative that an comprehensive model for Addition is still to be discovered and described.

                Reply
                1. April Wilson Smith

                  Lisa –

                  I think that tackling the most dangerous addiction first and then working your way on to others is great, and a fantastic example of harm reduction! What gets to me is when people who smoke cigarettes claim to be “sober” and therefore better than those who, for instance, are on Medication Assisted Treatment. Abstinence is socially constructed – abstinent from what? We choose what drugs to accept and what drugs to demonize. That’s what I oppose. I believe that everyone has the right to choose what they put into their own bodies, and that the drug war has been a tragic failure.

                  My experience with AA goes well beyond rehab. I did my 90 in 90 and continued to go, was even secretary of my home group. I went to women’s meetings, LGBT meetings, young people’s meetings, all of them. I also read extensively and followed several AA Facebook groups. Again, I’ll say the same thing: it’s great that it works for some. For the very small percentage of the population who find it helpful, it should exist. It should not be considered medical treatment for addiction and should not be covered by Medicare, Medicaid or private insurance. No one should be court ordered or even family pressured into AA, just as no one should be ordered to attend any particular church. AA is a religion, not a treatment. If it were treated as a religion by the healthcare system and the courts, I’d have no problem with it whatsoever. The rehab industry that profits off what can be had in church basements for free needs to be completely reformed, if not destroyed.

                  Reply
                  1. Lisa Martinovic

                    Though it is based on religious princ based on religious principles, AA is not a religion. One could argue that it is a cult, and many do, with some justification. Aside from that, it appears that we agree broadly on these core principles:

                    — twelve-step programs work for some people and not for others
                    — non-abstinent recovery works for some and not for others
                    — a range of low or no-cost treatment options should be made available to those seeking to free themselves of addiction
                    — the courts should not remand people to AA
                    — we should all have the right to bodily self-determination

                    My only qualifier on that last point is “as long as it does not harm anyone else.” Which is where it gets tricky. I’m thinking here of the children of smokers whose health will be forever compromised as a result of their parents’ choice. California just this year enacted a law prohibiting smoking in cars when children are present. It’s a good start but doesn’t address what happens in the home where children spend most of their time. There’s also the matter of thirdhand smoke, which is not only toxic but also mutagenic according to Lawrence Berkeley National Laboratory. This raises vexing questions around where your rights and end mine begin. Do you have the right to pollute my body in the process of polluting yours?

                    http://newscenter.lbl.gov/2013/06/20/berkeley-lab-confirms-thirdhand-smoke-causes-dna-damage/

                    Reply
                    1. Lisa Martinovic

                      that should read: where your rights end and mine begin.

                      and, to be clear, these are general questions, not directed at April.

  4. Annette

    I’ve heard many positive and negative comments about AA. From great support, to creepy older members trying to get their hands on new, vulnerable females 🙁

    I think there’s a HUGE opportunity for groups which promote the Joy of living an alcohol free life. AA has no appeal to me, because I don’t believe in ‘powerlessness.’ I had a bad booze habit, but it was a habit, not a life sentence!

    Almost 2 years ago, I found an online community: http://www.hellosundaymorning.org, based in Australia and funded by the government! It encourages people to quit, beginning with a 3 month trial period. The community there are very honest and supportive.

    I discovered that many relapse. I did. It didn’t matter, because reading about neuroscience, I understood that lapses are part of the journey, and it enabled me to dig deep and think about better ways to respond to inevitable triggers. I read and posted there most days as part of my new lifestyle.

    I prefer the word Discovery, rather than Recovery, because the best solution for bad habit is good habit: yoga, gym, hiking, dog walking, photography, cooking great meals, cafes, not pubs etc. etc.

    Today, I arrange Meetups in the UK for HSM. I’ve learnt humility, a constant focus and the joy of living without a “booze brain” (which caused severe depression – now disappeared.)

    For everyone trying to quit: I send you courage and solidarity!

    Reply
    1. Lisa Martinovic

      Annette, it’s fortunate for addicts and society at large, that the science around addiction has evolved so tremendously in recent years. Our thinking is much more nuanced than AA’s all-or-nothing approach. That said, I was, for decades, an all-or-nothing person, and if I had been told early on that I could moderate my use I’d probably have died long ago. Some of us need hard and fast boundaries while others thrive in a non-absolutist environment. I would never insist that everyone needs complete abstinence, but I do think it’s a good way to start, while one is getting on one’s feet, and discovering what is possible for them.

      Speaking of which, I love your use of the word (and concept) Discovery over Recovery. It fits in with my practice of approaching life from a place of curiosity, always asking: What can I learn from this comment, this person, this situation, etc?

      Reply
  5. Gary Sutherland

    AA is a cult and encourages the ‘victim’ mentality. If you have given up alcohol, why would you want to be defined by your previous consumption of it and surrounded daily by those who place it on an altar? Bizarre.

    It’s also very dated in it’s thinking. Each to their own, though.

    Reply
  6. Carlton

    This a is a question for Lisa;

    Dear Lisa,

    Your Essay is an engaging read on this topic, and would like to add to the comments here, but before doing so, you used a Term; “self-directed sobriety.”

    Could you describe that in a reply/post here?

    Thanks much,
    Carlton

    Also, from my take, your ideas seem to dovetail with Marc’s “ADDICTION as HABIT FORMATION.”

    Perhaps another recovery approach could soon take root?

    Reply
    1. Lisa Martinovic

      Thanks for asking, Carlton. By self-directed sobriety I mean that I incorporated the most effective elements of everything I’d learned in the previous 15 years — via twelve-step programs, individual therapy, group therapy, wise, supportive friends and family, Buddhism, and all manner of New Age spiritual hoo-ha — and forged my own path to, well, personal evolution, really. Because at 15 years I was perfectly comfortable being clean and sober, I did not feel at risk for relapse. But there were still countless ways in which my behavior fell somewhere on the continuum between dysfunctional and less-than-ideal. So I maintained my sobriety AND made dramatic changes in my thinking and behavior by employing the tools and principles that worked for me in other contexts. Thus, by self-directed path I mean… I made it up. But I could only self-direct after many years of learning and practicing and sobriety. Which is not to say someone else couldn’t self-direct from the start. Nor is it to say that everyone will ultimately be able to make their own way without ongoing help. . The path to sobriety, like the paths to individuation and to wholeness, is different for everyone. Others may be capable of making comprehensive changes in their lives without being sober, but not me. I speak only for myself.

      And yes, my approach very much dovetails with Marc’s understanding of addiction as habit formation. I started to question the disease concept even back in the 90s. But now I have science corroborating my gut, thanks to Marc!

      Reply
  7. Kathi Murray

    I personally had many beefs with AA too. It works for some, not all. In many cases people replace their drug or alcohol addiction with AA addiction. One thing I find ironic that not everyone knows is the founder of AA was a sex addict and adulterer, so he too replaced one addiction with another…..but I firmly believe what Marc has discussed that addiction is more of a learning disorder than anything else. It is certainly NOT a disease. As soon as main stream comes to acknowledge that too, than more addicts can get help that actually makes a difference instead of being treated like a pariah or criminal.

    Reply
    1. Lisa Martinovic

      Kathi, I agree with you and Marc that addiction is not a disease but rather a very fierce and entrenched habit…that can be undone! In my essay I describe how going to meetings and working the 12 steps engenders neuroplastic change — regardless of whether or not you see addiction as a disease, and regardless of whether or not you believe in God.

      Reply
  8. Julia

    As Marc has repeated often, there is no one-size-fits-all road to recovery. Just as there is no simple map for moving through life. We each have to figure it out for ourselves and if others’ experiences help us find our way, all the better.

    My problem with the discussions around AA or other “spiritually” based approaches is that there is no point in arguing about the meaning of words like “god” or “higher power.” The words mean whatever they mean to the individual. If they put you off (as they do me), then using that method had an additional hurdle to deal with beside the hurdle of getting sober. Why add any additional hurdles?

    But if you can just ignore the word and what it may mean to someone else, as I have done when attending meetings, and if other aspects of the program work for you, then great! Even though the words are spoken by others, there’s no requirement (at least in meetings I’ve been to) to use them yourself.

    As for sponsors and individual relationships or interactions within a recovery community, that is definitely an issue to be aware of, as it is in any group/organization/community. No one has the right to take advantage of someone who is vulnerable, whether they are a boss, a sponsor, a parent, a teacher, etc.

    Learning to protect oneself and pay attention to one’s own inner voice about what’s OK and what’s not is a big part of recovery, not to mention growing up altogether!

    Here’s to growing up, the hardest thing any of us gets to do… Thanks for the forum!

    Reply
  9. Fred

    I appreciate this post because it offers some harmonizing insight – that the actions involved with working a 12 step program of recovery are entirely consistent with the actions one would take to rewire ones neurons absent a spiritual program.

    Perhaps, as the author suggests, the 12 steps work for so many, not because they’re spiritual, but because they promote neuroplasticity.

    Of course, it must be acknowledged that there are some for whom the notion of a spiritual awakening has been a literal life-saver, opening a gateway for lasting change in all areas of their lives. For others, that notion has been a source of alienation, shame and abuse.

    For those who can’t abide the spiritual dimension of the 12 step fellowships, I’m grateful that there are emerging alternatives such as SMART. But if SMART or similar support isn’t available, maybe the perspectives of this essay could allow an atheist to participate in the 12-step rooms in a way that supports healthy change without taking on unwanted spiritual baggage.

    Reply
  10. April Wilson Smith

    It’s funny… now that I’ve made a complete conversion to Harm Reduction, the obsession with “Sobriety” strikes me as weird. Almost like worshiping a low number on the scale, and attributing more moral worth to people who weigh a lower number on the scale. Given how many people recover from alcohol dependence into non-abstinent recovery, the festishization of abstinence is irrational. Lisa makes a good point that some people can make major life changes while not being “sober” (though I suspect they are sober, in the sense of not drunk, most of the day!) and she had every right to say that she can’t, and to choose what she puts in her body or does not.

    Sobriety, purity, virginity… all social constructs. Watching people claim 30 years of “sobriety” while they puff away on cigarettes in spite of barely living through a heart attack just shows how arbitrary the lines are. Cigarettes are okay because Bill Wilson smoked.

    On his death bed, Bill asked for whiskey. The poor man was dying, a horrible death due to his smoking. How could whiskey have harmed him? His wife and friends wouldn’t give him whiskey. I think this epitomizes the moralistic, irrational nature of AA. It’s not about actual harms or actual quality of life – it’s just about “sobriety.”

    Poor Bill. A harm reductionist would have brought him a bottle.

    Reply
    1. Jim

      AA has always noted that certain drinkers are able to moderate. The response to such people is “good for you.”

      As to your claim that AA is not about quality of life, you are setting up a straw man, taking the most ardent AA members as typial…here is what the program says about itself:

      “None of us makes a sole vocation of this work…elimination of our drinking is but a beginning….a much more important demonstration of our principles lies before us in our respective homes, occupations and affairs.”

      If one’s quality of life does not improve in AA, one is doing it wrong and focusing just on abstinence…

      AA was developed for people who truly cannot moderate. Surely you know that these type people exist.

      AA has been deeply misused by rehabs and courts who have distorted its message. By taking a program designed for a minority of the addict population, and by applying to everyone who has some substance trouble, judges and doctors have created an impression of AA as a monolithic, non-diverse, cult.

      It isn’t.

      I’m an atheist who rejects the disease model and I am welcome at meetings even in the small town southern town where I live and where way too many AA’s are religious. If I lived in a bigger city, I could find a whole group of like minded people. (google AA Beyond Belief).

      It may be dangerous for certain substance abusers to try an abstinence they can’t manage. But it’s way more dangerous for the minority addict (who needs abstinence) to try and moderate. We buried a 26 year old girl last week who thought she could drink moderately…altho some people talked to her and urged her to stay in the program, when she insisted on her way, everyone accepted the decision and most remained friends with her, tho we wondered what would happen. We don;t recruit members. We don’t collect fees or dues. We don’t prosyletize. Most of us wish the courts would quit making people attend meetings.

      I like most of what you say here at the blog, but I think you are misrepresenting actual AA.

      Reply
      1. April Wilson Smith

        It is definitely a disaster that AA has been taken up by the courts and used by the “treatment” industry. Though my experience of AA outside of those was pretty much what I describe. I’m glad others have better experiences.

        I would have no problem with AA if it weren’t a) forced on people – that we agree on b) so ubiquitous in the culture as to be the only method that people hear about or see on TV, etc for improving one’s relationship with substances.

        Most of the AA folks I’ve interacted with, both in person locally and online worldwide, are very negative about other approaches such as SMART Recovery (which is an abstinence based program, btw). Just yesterday one of my SMART participants who also attends AA told me that his sponsor said, “Why do you need to go to SMART? Do you think this is stupid recovery?”

        SMART intentionally does not take a position on other fellowships or programs, and all are welcome to attend as they please.

        I’ve met some really great, kind, helpful and seemingly well-integrated people in AA. I imagine that’s the majority.

        Reply
  11. Deb W.

    I was pleasantly surprised and pleased to find this today after following Marc’s blog posts. In many ways, Lisa’s experience mirrors my own. I got sober in AA in1983, kicking and screaming about the patriarchal, religious, cultish nature of AA. Two things kept me coming back. One was it was free, and the other was the lack of centralized leadership.
    I certainly encountered some of what others here have commented on, almost superstitious fears of being struck drunk, a sometimes cult of personality within a meeting or group of meetings. But after 33 years, AA has become a revelation for me. Within those dingy rooms full of people I might otherwise never have meet I found my way into being human.

    I’ve “worked the program” my way and no one has ever told me I can’t. I’ve said I aim to be the person the new comer looks at and says, “well, if she can stay sober…”. I’m not sure it working for me doesn’t have something to do with the neurobiology of community. I’m not sure we don’t re-wire better in the company of others. And I know for me, a skeptical, mistrusting, introvert, with a deep mistrust of authority, that wasn’t going to happen just anywhere (perhaps the internet offers that sense of belonging for you young’ins.

    As much as I’d like to be otherwise, I’m an agnostic, if not an occasionally angry atheist. But I’m not sure I haven’t benefited from the twisty creativity I’ve had to exercise as a member of this fellowship, for the privilege of walking into basements and through backdoors all over the world and finding bad coffee and welcoming people. I don’t ever tell people they should go because that wouldn’t have worked for me. But I’d just be sad for anyone out there struggling to be afraid to try whatever help was available.

    Sometimes it’s harder than others, but I’ve found with a little work there’s always a meeting somewhere, where if I said Satan was my higher power, they’d just smile and tell me to keep coming back.

    Reply
  12. rapiddetox

    Nice Post! I totally agree with you. This post will help drug addicted people in recovery. It will work as rapid drug detox treatment

    Reply
  13. A.J. Barnett

    “We don’t think our way into a new way of acting, we act our way into a new way of thinking.”

    I agree with this. If you take the steps to maintain sobriety, you eventually will create new habits and behaviors that will change the way you think about yourself, about life, and about sobriety. You have to deliberately make choices that you don’t want to do that eventually with foster change, altering your brain structure much like your addiction did in the beginning. It takes time, but it is worth it in the long run.

    http://amandajbarnett.weebly.com/

    Reply
  14. Tim Greenwood

    Brilliant piece of thinking and writing. Stirs up lots of thoughts. Will certainly share with others. As someone who went through periods where out of pain I created my own prison where it felt like I was addicted to almost everything – hard to explain but very real – my realization is that there is a way to freedom from these patterns – which are ultimately prisons created within my own brain (the well-worn path) and the way out for me was and felt “spiritual” in that it required all of my resources and the support of others. I know I experience my own “Higher Power” as being within and part of me. Don’t know if it’s “God” but it is my “God”. So to me neuro plasticity and this understanding and learning is just part of the “spiritual path” meaning trying every possible thing and trying it again and learning what works.

    Reply
  15. Tim Greenwood

    Just wanted to add a few more thoughts that came over weekend:
    Hi Lisa:
    Your thoughts and some conversations I had this weekend got me thinking. I have practised the 12 Steps, gone to Tony Robbins and used him for 20+ years, meditated for close to 30 years, read and done some study of Buddhist thought, begun to practise Wim Hof and read the works of Marc Lewis and some others on the role of the brain and learning in addictions.
    I realize that the journey for each of us is “finding our own Middle Way”. It has been said that if we meet the Buddha on the road we should kill him – meaning we have to test everything and find our own inner authority.
    I am coming to think and believe that “The right Middle Way” for each of us is actually finding a path in our own brains – finding ways to alter unhelpful neural connections and then finding ways to create new ones that lead us to more optimal fulfillment. We want to create a new well worn path in the brain/mind that leads to us being awake and alive and thriving. All Spiritual Paths in their commision create new pathways in the brain over time and these pathways lead to the light. I can imagine the work we do in setting down these new neural pathways could be likened to the single monk in the early morning light making his dedicated walk and the light of day and awakening coming on. This is the work Bill Murray in his countless lifetimes in Groundhog Day and the work of all of us who know it is possible. Namaste. Let us all move toward the light to forge the paths of awakening.

    Reply
  16. Mark

    Marc,

    Do you think it would be an interesting experiment/intervention to put drug users
    on a high regimen, strength-training program, since much
    of the cerebellum’s brain’s cells ARE devoted
    to motor movement.

    http://www.alphagalileo.org/ViewItem.aspx?ItemId=172817&CultureCode=en

    Reply
  17. Linnea Amara

    Great Post! I totally agree with you. This post will help drug addicted people in recovery. It will work as rapid drug detox treatment

    Reply
  18. Elina Smith

    Some information on alcohol- While congeners are present in all alcohols, darker fluids tend to cause more trouble. Gin and vodka hold less, while bourbon and red wine carry the most making white wine the safer choice.
    Be sure to read the blog on how long does alcohol stays in your system?

    Reply
  19. Al Bottner

    This information is very useful and helpful for those who want to drug treatment. Thanks for share this information with us. Keep it up.

    Reply

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