What recovers in Recovery? – Cognitive Control over emotions?

 In recent blogs we have called for an increase in research into the neurobiology of recovery to add to the extensive research already published on the neurobiology of the addiction cycle.
There has been extensive research into the neurobiology of addiction, most of this has focused on reward and motivation networks of the brain.  In effect this suggests there is a pathological wanting in addicts, an excessive motivation towards drug taking over all other rewarding activities.
This view does not fully consider that this pathological wanting is in itself a product of dysregulated stress systems in the brain, many the product of neglect, abuse and maltreatment in childhood. These stress factors are also reflective of the role of emotional distress in the addiction cycle . This distress is we feel a product of the emotion processing and regulation deficits commonly seen in all addictive behaviours such as alcohol and substance addiction, eating and gambling disorders and sex addiction etc (and often reflective of childhood maltreatment).
In fact , this emotion processing and  regulation deficit is also apparent in certain children of alcoholics and may be a vulnerability to later alcoholism as these children demonstrate a deficit in impulsivity (common to alcoholics and addicts) and a decision making profile based on choosing now over later (short term gains based) and which recruits more subcortical and motor expressive (compulsive) parts of the brain rather than cortical and reflective/evaluative parts of the brain.
This means they make decisions to alleviate the distress of decisions (as undifferentiated emotions appear to be distressing) not via evaluative processes). This has obvious consequence for decision making over a life span.
This emotion dysregulation is also seen in active addicts and alcoholics and at the endpoint of addiction there is a fairly complete reliance of this compulsive decision making profile, which begs the question, does the decision making deficits seen in at risk children simply get worse in the addiction cycle via the neuro toxic effects of substance abuse?
This emotion (and stress) dysregulation also potentiates reward (makes things more rewarding) so alcohol is seen as more stimulating than for non risk children. This vulnerability may lead to the need  to regulate, especially negative, emotions ( and low self esteem ) via the stimulating and highly rewarding effects of alcohol make perpetuate the addiction cycle to it’s chronic endpoint where chronic emotional distress acts as a compulsive stimulus to the responding of chronic alcohol and drug use.
This emotion dysregulation also seems to play a huge part in relapse – so it begs the question does this emotion regulation improve in time via recovery, particularly long term recovery?
In the next two blogs we look at how the emotion regulation areas of the brain become reinforced, strengthened by the process of recovery or in other words we appear to develop the brain capacity for controlling and regulating our emotions more adaptively and this reduces the stress/distress which often prompts relapse.
Personally, I can wholeheartedly say, that the one main aspect I have developed in my recovery has been the awareness and skills in regulating/controlling emotions. Via recovery I have learnt to identify, label, describe by verbalising and sharing with others how I feel. This processes and regulates the emotions that used to cause me so much distress.
I have also developed a more acute awareness of the the emotional expression and needs of yours. These were previously aspects of my life which were completely lacking and frustrating/confusing as a result.
By emotionally engaging in with the world, by becoming more emotionally literate, I can converse with the world in a way that was previously beyond my capabilities.
The research we look at in the next two blogs asks the question – is cognitive control over emotions, lacking in active addiction, one of the main brain functions that improve in recovery?
A core aspect of alcohol dependence is poor regulation of behavior and emotion.
Alcohol dependent individuals show an inability to manage the appropriate experience and expression of emotion (e.g., extremes in emotional responsiveness to social situations, negative affect, mood swings) (1,2). Dysfunctional emotion regulation has been considered a primary trigger for relapse (1,3) and has been associated with prefrontal dysfunction.
While current alcohol dependence is associated with exaggerated bottom-up (sub-cortical) and compromised top-down (prefrontal cortex) neural network functioning, there is evidence suggesting that abstinent individuals may have overcome these dysfunctional patterns of network functioning (4) .
Neuro-imaging studies showing chronic alcohol abuse to be associated with stress neuroadaptations in the medial prefrontal and anterior cingulate regions of the brain (5 ), which are strongly implicated in the self-regulation of emotion and behavioral self-control (6).
One study (2) looking at how emotional dysregulation related to relapse, showed compared with social drinkers, alcohol-dependent patients reported significant differences in emotional awareness and impulse control during week 1 of treatment. Significant improvements in awareness and clarity of emotion were observed following 5 weeks of protracted abstinence.
Another study (7) which did not look specifically at emotional regulation but rather on the recovering of prefrontal areas of the brain known to be involved also in the inhibition of  impulsive behaviour and emotional regulation showed that differences between the short- and long-abstinence groups in the patterns of functional recruitment suggest different cognitive control demands at different stages in abstinence.

In one study, the long-term abstinent group (n=9) had not consumed cocaine for on average 69 weeks, the short-term abstinent (SA) group (n=9) had an average 0f 2.4 weeks.

Relative to controls, abstinent cocaine abusers have been shown to have reduced metabolism in left anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC), and greater activation in right ACC.
In this study  the abstinent groups of cocaine addicts showed more elevated activity in the DLPFC ; a finding that has also been observed in abstinent marijuana users (8).
The elevation of frontal activity also appears to undergo a shift from the left to right hemisphere over the course of abstinence.  The right is used more in processing (labelling/identifying) of emotion.
Furthermore, the left inferior frontal gyrus (IFG) has recently been shown to be important for response inhibition (9) and in a task similar to that described here, older adults have been shown to rely more on left PFC (10). Activity observed in these regions is therefore likely to be response inhibition related.
The reliance of the SA group on this region suggests that early in abstinence users may adopt an alternative cognitive strategy in that they may recruit the LIFG in a manner akin to children and older adults to achieve behavioral results similar to the other groups.
In longer,  prolonged abstinence a pattern topographically typical of normal, healthy controls may emerge.
In short-term abstinence there was an increased inhibition-related dorsolateral and inferior frontal activity indicative of the need for increased inhibitory control over behaviour,  while long-term abstinence showed increased error-related ACC activity indicative of heightened behavioral monitoring.
The results suggest that the improvements in prefrontal systems that underlie cognitive control functions may be an important characteristic of successful long-term abstinence.
Another study (11) noted the loss of grey matter in alcoholism that last from 6–9 months to more than a year or, in some reports, up to at least 6 years following abstinence (12 -14).
It has been suggested cocaine abuse blunts responses in regions important to emotional regulation (15)
Given that emotional reactivity has been implicated as a factor in vulnerability to drug abuse (16)  this may be a preexisting factor that  increased the likelihood of the development and prolonging of drug abuse
If addiction can be characterized as a loss of self-directed volitional control (17),  then abstinence (recovery) and its maintenance may be characterized by a reassertion of these aspects of executive function (18)  as cocaine use has been shown to reduce grey matter in brain regions critical to executive function, such as the anterior cingulate, lateral prefrontal, orbitofrontal and insular cortices (19-24) .
The group of abstinent cocaine addicts (11) reported here show elevations in  (increased) grey matter in abstinence exceeded those of the healthy control in this study after 36 weeks, on average, of abstinence .
One possible explanation for this is that abstinence may require reassertion of cognitive control and behavior monitoring that is diminished during current cocaine dependence.
Reassertion of behavioral control may produce a expansion (25)  in grey matter  in regions such as the anterior insula, anterior cingulate, cerebellum, and dorsolateral prefrontal cortex .
All brain regions implicated in the processing and regulating of emotion. 
References
1. Berking M, Margraf M, Ebert D, Wupperman P, Hofmann SG, Junghanns K. Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. J Consult Clin Psychol. 2011;79:307–318.
2.  Fox HC, Hong KA, Sinha R. Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Alcohol Clin Exp Res. 2008;33:388–394.
3..Cooper ML, Frone MR, Russell M, Mudar P. Drinking to regulate positive and negative emotions: A motivational model of alcohol use. J Pers Soc Psychol. 1995;69:990
4. Camchong, J., Stenger, A., & Fein, G. (2013). Resting‐State Synchrony in Long‐Term Abstinent Alcoholics. Alcoholism: Clinical and Experimental Research37(1), 75-85.
5. Sinha, R., & Li, C. S. (2007). Imaging stress- and cue-induced drug and alcohol craving: Association with relapse and clinical
implications. Drug and Alcohol Review, 26(1), 25−31.
6. Beauregard, M., Lévesque, J., & Bourgouin, P. (2001). Neural correlates of conscious self-regulation of emotion. Journal of
Neuroscience, 21(18), RC165
7. Connolly, C. G., Foxe, J. J., Nierenberg, J., Shpaner, M., & Garavan, H. (2012). The neurobiology of cognitive control in successful cocaine abstinence. Drug and alcohol dependence121(1), 45-53.
8.  Tapert SF, Schweinsburg AD, Drummond SP, Paulus MP, Brown SA, Yang TT, Frank LR. Functional MRI of inhibitory processing in abstinent adolescent marijuana users.Psychopharmacology (Berl.) 2007;194:173–183.[PMC free article]
9. Swick D, Ashley V, Turken AU. Left inferior frontal gyrus is critical for response inhibition. BMC Neurosci. 2008;9:102.[PMC free article]
10. Garavan H, Hester R, Murphy K, Fassbender C, Kelly C. Individual differences in the functional neuroanatomy of inhibitory control. Brain Res. 2006;1105:130–142
11. Connolly, C. G., Bell, R. P., Foxe, J. J., & Garavan, H. (2013). Dissociated grey matter changes with prolonged addiction and extended abstinence in cocaine users. PloS one8(3), e59645.
12. Chanraud S, Pitel A-L, Rohlfing T, Pfefferbaum A, Sullivan EV (2010) Dual Tasking and Working Memory in Alcoholism: Relation to Frontocerebellar Circuitry. Neuropsychopharmacol 35: 1868–1878 doi:10.1038/npp.2010.56.
13.  Wobrock T, Falkai P, Schneider-Axmann T, Frommann N, Woelwer W, et al. (2009) Effects of abstinence on brain morphology in alcoholism. Eur Arch Psy Clin N 259: 143–150 doi:10.1007/s00406-008-0846-3.
14.  Makris N, Oscar-Berman M, Jaffin SK, Hodge SM, Kennedy DN, et al. (2008) Decreased volume of the brain reward system in alcoholism. Biol Psychiatry 64: 192–202 doi:10.1016/j.biopsych.2008.01.018.
15, Bolla K, Ernst M, Kiehl K, Mouratidis M, Eldreth D, et al. (2004) Prefrontal cortical dysfunction in abstinent cocaine abusers. J Neuropsychiatry Clin Neurosci 16: 456–464 doi:10.1176/appi.neuropsych.16.4.456.
16.  Piazza PV, Maccari S, Deminière JM, Le Moal M, Mormède P, et al. (1991) Corticosterone levels determine individual vulnerability to amphetamine self-administration. Proc Natl Acad Sci USA 88: 2088–2092. doi: 10.1073/pnas.88.6.2088
17.  Goldstein RZ, Volkow ND (2002) Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 159: 1642–1652. doi: 10.1176/appi.ajp.159.10.1642
18. Connolly CG, Foxe JJ, Nierenberg J, Shpaner M, Garavan H (2012) The neurobiology of cognitive control in successful cocaine abstinence. Drug Alcohol Depend 121: 45–53 doi:10.1016/j.drugalcdep.2011.08.007.
19.  Liu X, Matochik JA, Cadet JL, London ED (1998) Smaller volume of prefrontal lobe in polysubstance abusers: a magnetic resonance imaging study. Neuropsychopharmacol 18: 243–252 doi:10.1016/S0893-133X(97)00143-7.
20.  Bartzokis G, Beckson M, Lu P, Nuechterlein K, Edwards N, et al. (2001) Age-related changes in frontal and temporal lobe volumes in men – A magnetic resonance imaging study. Arch Gen Psychiatry 58: 461–465. doi: 10.1001/archpsyc.58.5.461
21. Franklin TR, Acton PD, Maldjian JA, Gray JD, Croft JR, et al. (2002) Decreased gray matter concentration in the insular, orbitofrontal, cingulate, and temporal cortices of cocaine patients. Biol Psychiatry 51: 134–142. doi: 10.1016/s0006-3223(01)01269-0
22.  Matochik JA, London ED, Eldreth DA, Cadet J-L, Bolla KI (2003) Frontal cortical tissue composition in abstinent cocaine abusers: a magnetic resonance imaging study. NeuroImage 19: 1095–1102. doi: 10.1016/s1053-8119(03)00244-1
23.  Lim KO, Wozniak JR, Mueller BA, Franc DT, Specker SM, et al. (2008) Brain macrostructural and microstructural abnormalities in cocaine dependence. Drug Alcohol Depend 92: 164–172 doi:10.1016/j.drugalcdep.2007.07.019.
24.  Ersche KD, Barnes A, Jones PS, Morein-Zamir S, Robbins TW, et al. (2011) Abnormal structure of frontostriatal brain systems is associated with aspects of impulsivity and compulsivity in cocaine dependence. Brain 134: 2013–2024 doi:10.1093/brain/awr138.
25.  Ilg R, Wohlschlaeger AM, Gaser C, Liebau Y, Dauner R, et al. (2008) Gray matter increase induced by practice correlates with task-specific activation: A combined functional and morphometric magnetic resonance Imaging study. J Neurosci 28: 4210–4215 doi:10.1523/JNEUROSCI.5722-07.2008.

Life in Recovery

The cost of addiction and the benefits of recovery are clearly illustrated in this survey from last year.

“Faces & Voices first-ever nationwide survey of persons in recovery from addiction to alcohol and other drugs was conducted by Alexandre Laudet, PhD.  The survey documented dramatic improvements in all areas of life for people in recovery from addiction and documents the heavy costs of addiction.

During their active addiction, 50 percent of respondents had been fired or suspended once or more from jobs, 50 percent had been arrested at least once and a third had been incarcerated at least once…

The dramatic improvements associated with recovery affected all areas of life including a 50 percent increase in participation in family activities and in paying taxes compared with their lives in active addiction.

Well the many costs of active addition are well documented, very little is known about the changes in key life areas as a function of entering and sustaining recovery, or when they occur. The survey measures and quantifies the recovery experience over time — less than 3 years; 3 to 10 years; and 10 years or more.

ADDICTION RECOVERY IS ASSOCIATED WITH DRAMATIC IMPROVEMENTS IN ALL AREAS OF LIFE

  • Involvement in illegal acts and involvement with the criminal justice system (e.g., arrests, incarceration ) decreases by about ten-fold
  • Steady employment in addiction recovery increases by over 50% greater relative to active addiction
  • Frequent use of costly Emergency Room departments decreases ten-fold
  • Paying bills on time and paying back personal debt doubles
  • Planning for the future (e.g., saving for retirement) increases nearly three-fold
  • Involvement in domestic violence (as victim or perpetrator) decreases dramatically
  • Participation in family activities increases by 50%
  • Volunteering in the community increases nearly three-fold compared to in active addiction
  • Voting increases significantly
  • Reports of untreated emotional/mental health problems decrease over four-fold
  • Twice as many participants further their education or training than in active addiction

 

THE BENEFITS OF ADDICTION RECOVERY OVER TIME

  • The percentage of people owing back taxes decreases as recovery gets longer while a greater number of people in longer recovery report paying taxes, having good credit, making financial plans for the future and paying back debts.
  • Civic involvement increases dramatically as recovery progresses in such areas as voting and volunteering in the community
  • People increasingly engage in healthy behaviors such as taking care of their health, having a healthy diet, getting regular exercise and dental checkups, as recovery progresses
  • As recovery duration increases, a greater number of people go back to school or get additional job training
  • Rates of steady employment increase gradually as recovery duration increases
  • More and more people start their own business as recovery duration increases
  • Participation in family activities increases from 68% to 95%.

ABOUT THE SURVEY

The online survey was developed, conducted and analyzed in collaboration with Alexandre Laudet, Ph.D., Director of the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc.  It was conducted between November 1 and December 31, 2012 and collected information on 3,228 participants’ sociodemographics, physical/mental health, substance use, and recovery history, and 44 items representing experiences and indices of functioning in work, finances, legal, family, social and citizenship domains…”

This survey help us see that recovery studies help us a societies to look beyond the illness to the recovery of the illness. It helps change our views.There is active addiction and recovery from addiction. We need to keep doing research into this wonderful new world of recovery.

It all helps de-stigmatise this condition so that many more can join us on the road to recovery.

I am not just the disease of addiction, I am the recovery from it.  

Reference

http://www.facesandvoicesofrecovery.org/resources/life-recovery-survey

 

 

Healing Communities via Recovery

Recovery is healing. From the personal to the communal. Here is a great example of recovering in recovery communities. It illustrates how recovery is a gradual move from isolation from,  to commune with other people.

We recover via communal contact and interaction with others. It is the new “secure attachment” with others which helps heal and also repair the neurobiology impaired by addictive behaviours.  It helps heal not only us but also our families and the communities we belong to. Love is the drug for me (and us).

The Healing Power of Recovery – Connecticut  Community of Recovery – how community recovery also helps individuals overcome feeling stigmatised by their condition and can feel more encouraged to seek treatment for their addictive behaviours.  So in a sense we can see recovery communities are passing the message of recovery on to others by putting a “face on recovery” acting as role models of recovery. Attraction and promotion.

For me this recovery community is showing the world “how it works” in a sense, the collective wisdom of recovery we often share among ourselves in recovery meetings but now share this with the wider society; this is what we got and what you can have.   We will help you get it too if you want it. This is how we all get better, recovering together.

 

Recovery is Contagious

In our final blogs on the invaluable insights into the Recovery process given by the research and experience of William White we finish by looking at the rise of recovery communities in the US in particular and discuss whether this “New Recovery Advocacy Movement” is the future of recovery (treatment) which is much more long term recovery orientated rather than simply treating this chronic condition of addiction as an acute disorder which is generally what treatment centres do.

We may have to move away from a narrow neurobiology of addiction (disease model) to a wider neurobiology of recovery (recovery model). We may have to make it more plain to the world that recovery happens all the time and that millions upon millions around the world are in long term recovery, and have a very high chance of remaining so.

That is not to say we should not continue to look within the brains of addicts to learn which neural and affective mechanisms propel this disorder forward but that research into addiction needs to be much less lopsided and negative. It needs to look at vulnerability and the progression of this condition but it also needs to more fully address the recovery stage too. It is like reading a page turning novel only to find the riveting denouncement has pretty much been omitted. Research needs to move from diagnosis of the problem to prognosis of the solution, i.e. recovery.

The shares of a 12 step meeting are some of the greatest stories of redemption you are likely to hear. The outside world needs to know how these stories are created, yes, but also how they are resolved via recovery. The outside world needs to hear the story does not end with recovery, in some ways this is where the story really gets interesting. The spiritual voyage of recovery is a story those suffering from addictive behaviour need to hear. Otherwise, research demoralises, rather than encourages. It perpetuates a unnecessarily negative view and a false picture about the reality of long term recovery for many millions of people, their families and communities.

Clinical neuroscience, in particular, needs to show the images to go with these stories otherwise it is falling down on it’s obligations to society and the greater world.

Science has not sufficiently shown us how the brain is altered in a positive, adaptive, healthy manner by behavioural changes associated with long term recovery. The major role of science is to predict behaviour. It needs to start demonstrating and confirming that if an addict starts doing certain behaviours, certain positive outcomes will follow. It needs to illustrate the neuroplasticity so that suffering people can clearly chart, in a rational manner, the course of wellness ahead.

I remember seeing the Jellinek Curve in treatment and was re-assured that this was a disease that one could clearly recover from and within a defined trajectory. It showed me rationally how others had done this recovery thing and how I could and would if I wanted to achieve what they had achieved.

Rather than the constant search for a “magic pill” should we not be celebrating in research this wonderful success story called long term recovery. Isn’t this one of the greatest stories out there?

Anyway, back to William White and his powerful advocacy of recovery communities which as he suggests may make students of us all when some of use thought we were teachers.

The story moves on, becoming more enriching and inspiring.

There is a movement towards the management of long term recovery from an acute treatment model. There have been new developments like recovery coaches which show an increasing focus on long term recovery.

There is also an emergence of a recovery movement that has not historically existed before. “Recovery is everywhere” campaigns organised not by treatment centres but by local, grass-root, recovery community organisations. They are not mutual aid or treatment based. They have never had a category to put them in until now.

We are seeing the mobilisation of people in recovery. We are seeing a number of New Recovery Support Institutions such as Recovery Community Centres, offering non clinical recovery support services for individuals and families in long term recovery, Recovery Homes, Recovery Schools movement, Collegiate recovery programs, recovery industries who realise that people in recovery make the best and most hard working employees, recovery ministries, religious base recovery communities like including Celebrate Recovery which is attached to over 10,000 churches throughout the US, Recovery Cafes, and an ever increasingly elaborate interconnection of recovery resources.

William White ends with an intriguing suggestion that we may, via these increase recovery support organisation and via our own long term recovery be able to break the chain of dependence in our own children.

This way seem somewhat far fetched to some but equally it may be possible to identify the ways genes are expressed by certain behaviours in certain environments and for these to be altered by a change in these behaviours as the result of recovery and for environments to be changed too.

If, as we have suggested, addiction is at heart an emotion processing and regulation disorder, we could intervene to shore up these skills in those vulnerable to alter addiction by teaching sharing emotions, identifying and labeling of emotions, verbalisng of emotions etc, because we are attacking the pathomechanism of addiction, the mechanism by which addiction is propelled.

In doing so we may have a fighting chance of altering the course of possible addiction. So what has always been seen as inevitable (drunks beget drunkards) may for the first time in history not be so straight forward, so inevitable. This pathomechanism may be malleable and be susceptible to us changing the course of a likely disorder. In doing so, it will affect the chain of genetic inheritance from one generation to the next?

Fanciful or possible?

We discuss our ideas and William White’s ideas on this in another blog.

Let’s be Friendly with our Friends?

Cross fertilisation among Recovery Fellowships

I have unfortunately heard sometimes not very complimentary remarks about different recovery groups and fellowships which I have never found particularly helpful or useful in attracting the alcoholic or addict who is still suffering. The simple reality is that people recover from alcoholism and addiction by a wide variety of means, and recovery regimes.

My father recovered via the Catholic Church and was probably not even aware of 12 step or other recovery groups?

People seem to recover in a myriad of ways – unassisted, via religious, spiritual and secular means.

The Big Book says we (AA) have no monopoly on God – I would add we have no monopoly on recovery or treatment either, however widely and prolifically used 12 step programs have become internationally.  We may benefit more from a position of love and tolerance and understanding of the reality we are in recovery from a potentially fatal malady and support each other however we can, no matter what our recovery affiliation is.

It may be that each and every group have many useful recovery knowledge and skills to learn from each other. Showing a united front as a greater recovery community may have a profound effect on attracting suffers of addictive behaviours to recovery.

In this video, William White explains how co-attendance between different fellowships is becoming much more common, as recovering individuals stray over to check out other recovery groups and fellowships. For example for woman for sobriety to attend woman’s groups in AA, perhaps brought to together by a general  “woman in recovery” generality.

It is not unusual for secular groups in recovery to also attend AA meetings especially atheist and agnostic groups with AA. Again a commonality in a more  non theist approach may be a commonality here, especially as there is  rise of agnostic and atheist  approaches within recovery, and especially 12 step groups, such as AA Agnostica. In fact, the Ernie Kurtz and William White have researched this rising trend in much detail.

 

In fact William White writes about this in his website – in the blog “Further reflection on Dual Citizenship” by himself and John Kelly, another leading researcher into recovery.

The Dual Citizenship Phenomenon

“Dr. Tom Horvath recently posted a blog on the “dual citizenship phenomenon”–individuals who concurrently participate in SMART Recovery and AA or other 12-step meetings.

Dr. Horvath’s interest in this phenomenon was sparked by recovering people simultaneously being involved in secular, spiritual and religious recovery support groups–groups whose core ideas and practices would on the surface seem to be incongruous.

The degree of dual citizenship in recovery is revealed in the membership survey of various recovery mutual aid groups.  In Gerard Connors and Kurt Dermen’s survey of Secular Organizations for Sobriety (SOS) members, 30% of (SOS) respondents reported concurrent AA attendance with an average of more than 50 A.A. meetings attended in the past year.

Lee Ann Kaskutas’ study of Women for Sobriety (WFS) revealed that about one-third of WFS members also concurrently attend AA meetings. 

In the LifeRing Secular Recovery Survey, 35% of LSR members surveyed reported co-attendance in another recovery support program–57% of those reporting attending AA. 

The most recent survey of SMART Recovery membersrevealed that 32.4% of SMART Recovery members also attend AA, NA or another 12-step program, 13.8% attend meetings of another secular recovery support program, and 10.5% participate in a faith/religious/spiritually-based program.

(Typically these dual citizens report that “I attend AA for the fellowship and community, and SMART Recovery for the tools.” These individuals, I suspect, would not attend AA if SMART Recovery were as large and had the same depth of community – certain individuals who seem equally committed to both organizations and both approaches –  these individuals are the true dual citizens.)

Such surveys reveal considerable eclecticism in recovery support participation across what are often portrayed as quite distinct frameworks of addiction recovery support.”

 

More recovering individuals are looking at themselves as members of a greater recovery community rather than simply identifying themselves within the confines of fellowship membership.

My own recovery has hugely enhanced by researching the neuropsychology of addiction and recovery over the last 5-6 years, in fact, on occasion this research has saved my life from probable relapse. My blogs seek to embrace aspects of DBT, CBT, psychological and psycho-analytic theories of addiction etc.

I have come to an understanding of my own addictive behaviours as being driven by an inherent emotional dysfunction mainly via academic research. For me the spiritual malady of AA can also be explained in terms of emotional dysregulation as can the processes of positive behavioural change prompted by working the 12 steps.  These views are not opposing but complementary, mutually supporting views.

I have a “critical” head which is not at odds with 12 step spirituality. I have not given up on self, but chosen to exercise self under the direction of my Higher Power, a HP that does not act via fear. My critical head has helped me explore my spirituality.  I do not leave my reasoning brain at the door when I enter the rooms of AA and I don’t suggest any one else does either.

In fact my initial understanding of myself as an alcoholic is primarily based on the perceived wisdom of AA members in their lived experiences  as recovering alcoholics –  I believe AA is as much about this shared recovery experience as it is the contents of the Big Book.

The “traditions” of AA are also borne out of the lived experience of recovery, compiled and organised by Bill Wilson from the lessons learnt in a multitude of recovery settings and recovery group experiences throughout the US and beyond over a number of years.

The Big Book described this illness in one way nearly 80 years ago and this way is still valid today but it should never preclude us from adding to this sum of knowledge, from explaining this illness given the understandings which have been developed in that 80-year time frame. We now know a huge amount about this condition and increasingly about recovery.

Bill Wilson himself commented that he feared the Big Book would become “frozen in time”. As someone who looked at different possible supplements to recovery, such as vitamin therapies, one can be sure that he were alive today he would be absolutely fascinated with  developments in our knowledge base about this condition and it’s recovery.

He may even have some pride that he helped in no small part, by  prompting such inquiry. Bill Wilson was fascinated and intrigued by alcoholism and his fellow alcoholics. For him anything that alleviated  the suffering of alcoholics would be considered helpful. He after all asked us to be “friendly with our friends”?

Isn’t that we are all trying to achieve, a greater understanding of the underlying mechanisms of this emotional disorder, this spiritual malady? A greater awareness of the recovery process and possible outcomes of recovery? For ourselves and our families and communities.

Isn’t this a wonderful journey that we can all share?