I was delighted to be asked and honored to take part in one of the excellent “The Hope Interviews” with Steve Jones for the recovery newspaper “Keys to Recovery” – our interview is on page 9 and it was a experience strength and hope type interview from both a 12 step recovery and a neuro-psychological perspective, showing how these perspectives are very compatible and how we need a spiritual solution to a neuro-psychological problem.
“The wounded healer” refers to us, who suffer greatly from shame, helping others via love, tolerance and understanding who also suffer greatly from shame.
We can help others and be helped because we all know what it is like to feel the chronic, toxic shame the drives addictive behaviours.
Our understanding of shame is not out of a book it is real, lived experience. We know how it can drive one into chronic addiction and we know how to recovery from the persistent effects of this shame.
The main thing that struck me when I first went to AA was a lack of judgement which was amazing considering I was very jaundiced at the time.
I was accepted in the group without reservation. This greatly helped my damaged sense of belonging, my not feeling part of.
It made me feel that this is the place I need to be. Have always needed to be?
The “shares” or testimonies of other recovering people made we realise they suffered the same shame as me and had worked to overcome it via the steps, via having fellowships, people in their lives who understood and who helped them. They told me of their triumphs over their emotional difficulties, over their chronic lack of self esteem, over not feeling good enough, of feeling less than.
A failure – they talked about me and how I felt about me. How I had always felt about me!?
I had never been in a group of people who had talked so openly about their intimate feelings which was amazing. In doing so they were talking about my intimate feelings too. This gave me a sense of not being alone anymore. They seemed to be shining a light of hope into the dark recesses of of my shameful psyche.
It addressed my sense of isolation right away.
I had spent my life feeling not good enough, bad, l had that knawing feeling of less than, that hole in the sole.
I was like these people. They were like me.
I felt and continue to feel more like these people than I do my own family.
They became my surrogate family, my newly learnt attachment.
They were like me. They had not learnt this stuff out of a book, by professional observation but by having been through this stuff themselves. This was real not learnt.
They had been there. They were here now for me.
They knew what they were talking about.
This was the beginning of my psychic change. A person who was to become by therapist at the local treatment was at my first meeting and he later said that he felt I had a psychic change at that my first meeting.
I had come in utterly beaten, at death’s door and had left with hope.
The journey started with hope.
I had found a portal in the universe – it was Alcoholics Anonymous but from the shares it might have been called Shame sufferers Anonymous.
Shame ran through every share. They say fear is the corrosive thread which ran through our lives but it is equally the case that shame does too and causes just as much distress and damage.
It is difficult to live life when you do not have your own back, believe in yourself as worthy of the good, healthy, things in life. That you are not worthy them. That these things happen to others. Not you as you do not deserve them.
Why recover at all when you are not worth it?
This is how many of us feel? We are not worth it, this recovery.
The truth is the opposite, we are worth it. We do deserve it.
We are heroes who suffered so much and come through so much. We deserve happiness more than most! As a result we have so have so much to offer others. We are all wounded healers.
We are here to help others like ourselves, in a way that only we can!
It was via others, like parents that we have this shame and these negative self schemas.
It is through human relationships that these start to heal. Shame is a social emotion which needs a social treatment.
We need to reconnect to overcome the isolating force of shame.
You are enough! We are enough!
Does a person with alcohol issues have to hit rock bottom in under to surrender and start recovering?
Does one have to go to the bitter end before surrendering to the recover process?
My own experience showed that I had to concede to my innermost self that I was/m alcoholic and that I needed help from others.
For me it was a “low-bottom” or “last gasper” rock bottom but for many it seems to be a high bottom.
I had lost practically everything and for some they had lost little compared to me but they had seen the road ahead and realised it was not going to get any better without accepting help.
This shows there is more to alcoholism than alcohol, that these people realised their negative behaviours and their consequences were causing them as much distress as their drinking. They did not like who they were becoming or the effect it was having on others around them , their loved ones, families and friends and employers.
I maintain also that there are also many different variables that contribute not only to one’s alcoholism and it’s severity but also in one’s chances of getting into recovery sooner rather than later. Environmental factors such as ethnicity, income, place in society, class can often play a role and social and therapeutic support networks as well as childhood maltreatment such as trauma, various types of abuse, insecure attachment issues etc in alcoholism severity.
Many more alcoholics seem to have stopped drinking before losing what was important to them are motivated to pursue recovery than those who lost nearly everything, including health, family, friends, and jobs.
Individuals are accessing treatment via support networks much earlier in their drinking and may not have to experience the multitude of physiological, mental, emotional, financial, legal relationship and other problems low bottom alcoholics frequently do.
“The concept of hitting bottom persists within Alcoholics Anonymous (AA) even though the backgrounds, addiction experiences, and therapeutic options of AA members are now radically different than they were at the group’s founding. Understanding what AA members now mean by hitting bottom is important because the experience describes the point at which they become willing to seek help—professional treatment, AA, or both.
Among the most controversial aspects of AA is the idea that alcoholics will seek help only when their “illness” has led to “pitiful and incomprehensible demoralization” (AA, 2001, p. 30). Those words originally appeared in the 1939 first edition of Alcoholics Anonymous, but by the time of the publication of the 1953 commentary, Twelve Steps and Twelve Traditions (AA, 1953), the idea had changed in contradictory ways. The instance of help seeking received a name (“hitting bottom”) that suggested an objectively fixed point. On the other hand, the experiences of those entering AA demonstrated that such a point is relative, and not fixed. AA was helping “people who were scarcely more than potential alcoholics” so it was “necessary to raise the bottom” (AA, 1953, p. 23).
Denzin (1987) provided the succinct definition used in this article: “Bottom: Confronting one’s alcoholic situation, finding it intolerable and surrendering to alcoholism. Accompanied by collapse and sincerely reaching out for help; may be high or low” (p. 134). The hitting bottom concept originally reflected the experience and outlook of AA’s founders and pioneers in the 1930s.
“Which description best fits the ‘bottom’ you hit as an alcoholic?” This categorical variable had three potential values: high, middle, or low.
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High bottom: I stopped drinking before I lost what was important to me.
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Middle bottom: I suffered serious consequences but did not lose everything.
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Low bottom: I lost nearly everything, including health, family, friends, and jobs.
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The study found that Whites, religious people, and episodic drinkers were less likely to be low bottoms when they began recovering.
Alcohol-related problems were most clearly associated with level of bottom, supporting recent findings that problems increase the odds that an alcoholic will perceive the need for help and will seek help (Grella et al., 2009).
Findings were – high bottom (36.1%), middle bottom (44.5%), and low bottom (19.4%).
A fundamental tenet of AA is that alcoholism is progressive, so that alcoholics “get worse, never better” (AA, 2001, p. 30). Supportive of this progressive framework is the finding that problems distinguish high bottoms from low bottoms. The difference was most clear in the categories of social and physical problems, indicating that early identification of these problems could signal a need for intervention, particularly if the individual drinks constantly or uses drugs other than alcohol.
A recent study by Field, Duncan, Washington, and Adinoff (2007)reported an inverse relationship between motivation to change and alcoholic problem severity, suggesting low-bottom alcoholics might be less motivated than high-bottom alcoholics to pursue recovery.”
Quenching that Spiritual Thirst
I have been keeping up my regime of getting more spiritually fit – went to mass and then a meeting.
I have also been doing a lot of walking too (approx 5 miles a day).
Although I still blog on the neuropsychology of addiction on my other blog (kinda alcoholic having two blogs isn’t it?) http://insidethealcoholicbrain.com/ my heart and soul is moving noticeably back into the world of recovery and doing recovery.
My head has been learning what my heart knows already.
Not just turning up at a meeting and sharing my experience and insights but also doing low level service, like always helping clear up after the meeting, stacking chairs, moving tables etc.
I have also enjoyed talking to newcomers. It has been fascinating meeting people where they are at.
Rather than using my memory banks to relate my stories of treatment and recovery, I am more interested in their own spiritual journeys of self discovery. I kinda feel excited for them.
It is always spiritually nourishing to see people suddenly get it, to see the light of recognition and acceptance of their condition start shining a new light in their eyes. The beginnings of psychic change and a spiritual awakening about their condition.
I go to chapel but rarely see this type of transformation. Perhaps the people at mass aren’t as spiritually ill as us? I am not so sure sometimes.
I shared this with an earthling/normie who had some experience of 12 step groups and she agreed most enthusiastically that the conversions one sees in 12 step groups appears more profound than any she experienced in chapel.
It makes one think this – how is is that a hopeless drunk can suddenly be so dramatically altered in his or her views of the world and those in it. How come they can come to accept a higher power in their lives so readily? Almost as if they had some strange disposition towards this?
Is this part of the gift of desperation? Is it partly an acceptance of seeing it work in others and this encourages one to explore this themselves?
Is it because there is close link about being humiliated by alcohol and the necessary ego deflation which leads to humility (for me humility is tied up with accepting one needs help and then asking for and receiving it)?
When i came to AA I was determined not to do the God thing but I intuitively understood the spiritual thing.
I had been a practicing Buddhist on and off over a decade or more and firmly believed that all suffering comes from an attachment to the self. I still do.
Hadn’t I already been looking for a spiritual solution to my problems?
Both my parents were very religious and both had issues with alcohol (my father before I was born) and drugs (Valium in my mothers case). In fact my parish priest was an alcoholic and my father would have to go the the parish house at least half an hour prior to mass to make sure he was sober enough to take mass. A beautiful man he was too, our local priest but an active alcoholic.
Was I born into this world with a spiritual thirst, a thirst for communion with the infinite, something beyond the self, with the divine in order to escape the often emotionally painful limitations of the self?
Has it always been necessary for me, spirituality? Does in balance my inherent lackings?
Before I went to mass I meditated for half an hour. I used this Christian meditation where I simply lie in a corpse position on my back and wait or God’s Grace. Sometimes I utter the words “Come Holy Spirit Come” and give myself wholly to His Grace.
Then I have this creeping feeling of peace, of stillness, of quiet.
I have some of the thoughts I normally have but they do not effect me, they are no longer exerting any distress and I no longer react to them. They are no longer propelling me out of bed and into some course of action.
They are my thoughts devoid of anxiety, devoid of emotional pain. But they are still mine but cwtched in the comforting embrace of God.
To be an addict about it – it is like an analgesic, a pain killer in a sense. Like an opiate but without the disappearance from reality, instead remaining still but present in the now, in this moment.
The best way I can help explain further is in relation to the video below where Thomas Merton describes contemplation and mystical union with God.
This helped me a great deal this video because when talking of God we have to be careful we are not creating a self construction of God which leaves us still in the finite parameters of self and self delusion.
It is beyond self but it is a realm in which the self communes with that beyond oneself. Thomas Merton explains it better than I ever could!
It is the sense of the infinite, the escape from the attached self, the transcendence that I have always wanted, craved and finally compulsively sought .
Why did I not find it fully before? Why, well I think this is because I had always had this other way of finding transcendence and that was in a bottle or in a drug or in a behaviour.
I could not fully find this divine transcendence until I saw the lies of this chemically created transcendence.
It had always been getting in the way of what I really need, a full God consciousness, full transcendence from self.
After the meeting I stopped and talked with two elderly woman and then walked them up the street to where they were going. We laughing and carrying on, gently making fun of each other, stopping to talk and go on, then stop again and go on, with silly talk and laughter.
We stopped and staggered our talkative ways on the hill to Main Street. Arm in arm with foolish fun. To the outsider we must have looked like we were acting like three drunks would, talking, and excessively gesturing, caught up in waffly exuberance. Slightly intoxicated by our merriment.
I remember thinking this is similar to going out on the town with friends, who mainly were alcoholics too and are mainly now dead.
We could have looked like three drunks who had finally found what they were looking for!
Drink was never the answer, it got in way of the answer but also kept some of us from killing ourselves while we waited for this answer, His Mercy.
God blesses AA!
In order to fully recover from alcoholism, addiction and addictive behaviours, we find we have to trust at least one other human being.
This might be easy for some, to trust, but for me it was very difficult.
Considering my upbringing, this was a big step but as I had little choice…
I am not talking about trusting my wife, loved ones, family etc.
I am talking about trusting someone in recovery. A practical stranger. Someone who is the same boat as you. Who has been where you have been, felt how you have felt.
Like a sponsor for exammple.
Someone you are going to open up to and discuss intimate stuff with, someone who will ultimately know the shameful secrets that can keep a person spiritually and emotionally sick and will continue to do so until we share this stuff and let it all go.
It chains us to the past and endangers recovery because we drank on shame and guilt.
I certainly know I did?
Sorry for being so direct in this blog, it is a message of hope, there is a way to completely turn your life around.
Shameful secrets can fester in the dark recesses of our minds and inflame our hearts with recrimination and resentment.
They can have constant conscious and unconscious effect on our behaviors, how we think and feel about ourselves and how we interact, or not, with others.
Due to the nature of frequent episodes of powerlessness over our behavior, attached to addiction and alcoholism, we often acted in a way we would never act in sobriety. We had limited control over behaviour at times due to intoxication and acted on occasion in a way that shames us today.
Most of us were determined to take these secrets, these “sins” to the grave.
We often take them to grave sooner rather than later unless we decide to be open and share our secrets with another person.
This has been my experience.
Everyone in recovery has secrets they would rather not disclose, but there are not many “original” sins as one suspects and that haven’t been shared in 12 step recovery.
Almost disappointingly I found some of my sins were quite tame when compared to other people I have spoken to in recovery.
That is not to say I did not frequently hurt others, especially loved ones, but under examination they were not as monstrous as my head made them out to be.
These secrets are the emotional and psychic scars of our alcoholic past and they need to be exposed in order for us to fully heal.
In steps 4 and 5 we listed wrongdoings to others and although initially petrified to share them with another, found that it wasn’t as difficult as we thought it would be, once you wrote down the worst top ten. There was an immediate release in fact. A sense of cleansing almost.
Sharing them was obviously awkward but a good sponsor shares his at the same time.
It is therapeutic exchange and shame reducing to know someone else has committed similar sins or has acted for similar reasons; they were powerless over their behaviours. Just like me, just like you.
Alcoholism erodes our self will and choice.
There is nothing so bad that cannot be shared.
The 12 steps were influenced by the Oxford Group who said sins cut a person off from God, and that there was such a thing as sin disease.
This sin disease had very real psychological, emotional and physical and physiological effect on the mind and body. Sins were a contagion that mixed with the sins of others and the sins of families, groups, societies, cultures and countries.
The sin disease idea became the “spiritual malady” of AA.
We can also see this as years of not being able to regulate our negative emotions properly, if you wish to see them as sins.
I see these “sins” also, and perhaps alternatively, as hundreds of unprocessed negative emotions from the past which were never consigned to our long term memories, so they just swirl around our minds for decades shaping how we think about ourselves and the world around us.
Steps 4 -7 and the amends to those people wronged in steps of 8 and 9 allow us to be completely free and in a sense reborn.
It can be viewed as spiritual or an emotional rebirth.
Isn’t this rebirth, catharsis, renewal, a becoming free from the old self, which was kept us ill in our shame and guilt about the past?
We have the chance to be free from the sick version of our real self, the self that has been in bondage, in addiction.
It is almost miraculous, the sudden transformative effect it can have on us. I have seen it many times with my own eyes.
By freeing ourselves from the past, we become who we really are.
We have a sea change in how we think and feel about ourselves and the world around us.
In fact we never become who we really are until we have examined our past and consigned it to the past.
We do fully recover until we do this I believe.
Otherwise we have not really completely treated our alcoholism.
We have simply got sober, sometimes stark raving sober.
We are not bad people getting good but ill people getting well.
All this because we plucked up enough courage to ask someone we barely knew to be our sponsor.
Because we trusted one person enough.
In reality we asked a fellow sinner to hear our sins and through God’s help have them taken off us, or if one prefers, have had the past finally processed and consigned to long term memory where it will take only a special and quite frankly bizarre decision and effort to go rooting around and digging it up again.
I look at the past fleetingly sometimes to help others but I never stare at it too long.
It is a former self.
I have been reborn, I have become who God had intended me to be.
I have become me.
In the final months of my active alcoholism I was living in the attic room of my house.
I drank about 6 bottles of cheap Spanish wine plus a dozen cans of strong German beer every day.
The alcohol had little effect on me by this stage. I only drank to dampen the delirium tremens, the violent shakes. I often could not control my hand enough to get alcohol into my mouth, holding my wrist steady with my other hand to raise the drink to my mouth.
Usually cracking the bottle or tin can against my teeth.
I was no longer getting drunk anymore.
You know you are fully addicted to alcohol when it does nothing intoxicating any more.
I slept in 5-10 minute fits and busts. I did not eat for months. The television told me to kill myself and voices not belonging to me talked insistently in my head.
Alcohol-related Psychosis it is called.
No one told me this would happen when I bought my first alcoholic drink when I was fourteen years old. There was no health or warning label saying “Could lead to Psychosis and Premature Death!”
Maybe there should be. Or at least alcohol can be addictive for some.
Anyway there is more to alcoholism than alcohol.
In the depths of this alcohol induced madness, I rarely saw my wife, who could not bring herself to look at me and what I had become.
If I could have got it together I might have killed myself.
But I couldn’t get it together. Psychosis is all involving, doesn’t leave much time for planning anything.
So I staggered on. When I say staggered, I could not actually walk more than a few yards or climb more than a few stairs.
By the time I reached my first AA meeting
1. the alcohol had stopped “working”.
2. I had surrendered.
Regardless of these two factors, I could not admit I was alcoholic. My pride and it’s best friend shame were still talking away to me.
I was willing to admit I was addicted to alcohol and that I was about to die from it.
But alcoholic?
We often wonder why some people don’t accept their alcoholism?
How did I start my journey to acceptance?
My wife came to my first meeting of AA, she practically carried me in!
The Chair of the meeting was a person I had drank with before – I though how come he is here?
I spilled more drink than he ever drank?
Then it dawned on me that maybe I should have come here before?
Especially when he shared that he had been trying to get sober and recovered for ten years!?
I then listened to the other alcoholics sharing their stories.
The stories mentioned the progression of the alcoholism, which I obviously identified with.
They also mentioned how they, even now in recovery, struggled with their emotions and anxieties, how they found living life difficult.
They talked about issues which had bedevilled them and me since childhood, this spiritual malady they talked of was like the emotional disease I had suffered from all my life, whether it was depression, panic attacks, anxiety disorders, PTSD, etc.
They had used alcohol to self medicate these conditions, especially as alcohol for them had felt like an elixir for them as it had for me. We all had all dealt with our negative emotions since adolescence in the same way.
Now a new way had to be found.
When we left the meeting my wife had a psychic change similar to the one I had.
She said these people are just like you. They can help you, I can’t.
A week before I had heard a voice in my heart, through the psychosis, saying to go down stairs to my wife and ask her for help. I asked her for help in that round about alcoholic way of “do you think I look a bit jaundice (I actually looked like Homer Simpson with a heavy sun tan!)?
The help I asked for was not to come directly from my wife but she led me to where I could get it. In a room, full of people just like me, suffering the same illness as me.
I will be forever eternally grateful for it being there for me. For them being there.
We will be there for you too!
This blog is written for alcoholics and those who love and live with them, by alcoholics in recovery.
For those who know what it is like to live with alcoholism but would also like to know why alcoholism affects the alcoholic and those around him in the way it does.
We write this blog to help us and you understand how the alcoholic brain works and why they sometimes do the things they do, why they act the way they do?
Why is it sometimes that everything is going great and suddenly the alcoholic in your life overreacts and acts in an emotionally immature way, which can often cause hurt to others around them?
Why do they suddenly cut off their emotions so profoundly it leaves your emotions in limbo, confused and upset.?
We hope to explain this disease state and behavioral disorder, which alcoholics themselves call an “emotional disease” , a “parasite that feeds on the emotions” or quite simply “a fear based illness”.
It appears that alcoholics in recovery are aware to a large extent of what they suffer from so why do they do what they do sometimes if they know what is going on? Are there times when they cannot help themselves?
Why do alcoholics, even in recovery, sometimes engage in endless self defeating resentments?
Why do they project into future scenarios and then get emotionally paralyzed by doing so, get stuck in a cycle of catastrophic thinking?
Why do we run through the list of cognitive distortions on a daily basis?
This is not to condemn but to understand. Knowledge we believe is power. It aids understanding and compassion of another person’s suffering.
We as recovering alcoholics still, after several years of recovery, can still engage in such behaviours. We do not wish to hurt anyone, especially not our loved ones, but sometimes do.
We sometimes get wrapped up in ourselves and act in a selfish, immature and inconsiderate manner.
We need help with this, at times, distressing condition. That is what it is.
Distressing, based on a emotion and stress dysregulation, even in recovery, hence we have to manage it.
On a daily basis. It does not return to normal. To balance. To equilibrium. We have to take certain actions to restore emotional equilibrium.
Hence it can be hard work, hence we sometimes we come up short and emotionally overreact.
We have a distress based condition which has to be managed.
We also have to give ourselves a break, don’t distress ourselves further with perfectionist ideas of “should” – just do your best! That is usually good enough for most people. Why not us?
We are not saints, progress not perfection!
Or as progress not perfectionist!
Recovery changes the brains of alcoholics for the better.
As we are personally well aware, self knowledge does not bring recovery – only action does.
This action could be helping others, praying, meditating, going to meetings, talking to someone who knows what you are going through etc. Connecting with others, in the same boat as you.
It does work, if you work it. It removes the distress that feeds alcoholism and addiction.
The distress that makes us catastrophic thinkers, to having intolerance of uncertainty about the future, struggle with our emotional natures, etc
Recovery helps us deal with negative emotions and anxiety in a rational manner via the help of others.
We become different people in recovery. More considerate of others, more emotionally mature and emotionally sober.
We learn to deal with situations which used to baffle us! In dealing with these we deal with our alcoholism because we solve the problems that used to make us drink or use in the first place.
Impulsivity or lack of behaviour inhibition, especially when distressed, is one psychological mechanisms which is implicated in all addictive behaviour from substance addiction to behaviour addiction.
It is, in my view, linked to the impaired emotion processing as I have elucidated upon in various blogs on this site.
This impulsivity is present for example in those vulnerable to later alcoholism, i.e. sons and daughters of alcoholic parents or children from a family that has a relatively high or concentrated density of alcoholics in the family history, right through to old timers, people who have decades of recovery from alcoholism.
It is an ever present and as a result part of a pathomechanism of alcoholism, that is it is fundamental to driving alcoholism to it’s chronic endpoint.
It partly drives addiction via it’s impact on decision making – research shows people of varying addictive behaviours choose now over later, even if it is a smaller short term gain over a greater long term gain. We seem to react to relieve a distress signal in the brain rather than in response to considering and evaluating the long term consequences of a decision or act.
No doubt this improves in recovery as it has with me. Nonetheless, this tendency for rash action with limited consideration of long term consequence is clearly a part of the addictive profile. Not only do we choose now over then, we appear to have an intolerance of uncertainty, which means we have difficulties coping with uncertain outcomes. In other words we struggle with things in the future particularly if they are worrying or concerning things, like a day in court etc. The future can continually intrude into the present. A thought becomes a near certain action, again similar to the though-action fusion of obsessive compulsive disorder. It is as if the thought and possible future action are almost fused, as if they are happening in unison.
Although simple, less worrying events can also make me struggle with leaving the future to the future instead of endless and fruitlessly ruminating about it in the now. In early recovery especially I found that I had real difficulty dealing with the uncertainty of future events and always thought they would turn out bad. It is akin to catastrophic thinking.
If a thought of a drink entered into my head it was so distressing, almost as if I was being dragged by some invisible magnet to the nearest bar. It was horrendous. Fortunately I created my own thought action fusion to oppose this.
Any time I felt this distressing lure of the bar like some unavoidable siren call of alcohol I would turn that thought into the action of ringing my sponsor. This is why sponsees should ring sponsors about whatever, whenever in order to habitualize these responses to counteract the automatic responses of the addicted brain.
I think it is again based on an inherent emotion dysregulation. Obsessive thoughts are linked to emotion dysregulation.
My emotions can still sometimes control me and not the other way around.
Apparently we need to recruit the frontal part of the brain to regulate these emotions and this is the area most damaged by chronic alcohol consumption.
As a result we find it difficult to recruit this brain area which not only helps regulate emotion but is instrumental in making reflective, evaluative decisions about future, more long term consequence. As a result addicts of all types appear to use a “bottom up” sub-cortical part of the brain centred on the amgydala region to make responses to decisions instead of a “top down” more cortical part of the brain to make evaluative decisions.
We thus react, and rashly act to relieve the distress of undifferentiated emotions, the result of unprocessed emotion rather than using processed emotions to recruit the more cortical parts of the brain.
Who would have though emotions were so instrumental in us making decisions? Two parts of the brain that hold emotions in check so that they can be used to serve goal directed behaviour are the orbitofrontal cortex and the ventromedial prefrontal cortex.
These areas also keep amgydaloid responding in check. Unfortunately these two areas are impaired in alcoholics and other addictive behaviours so their influence on and regulation of the amgydala is also impaired.
This means the sub cortical areas of the amgydala and related regions are over active and prompt not a goal directed response to decision making but a “fight or flight” response to alleviate distress and not facilitate goal directed behaviour.
Sorry for so much detail. I have read so much about medication recently which does this or that to reduce craving or to control drinking but what about the underlying conditions of alcoholism and addictive behaviour? These are rarely mentioned or considered at all.
We always in recovery have to deal with alcoholism not just it’s symptomatic manifestation of that which is chronic alcohol consumption. This is a relatively simple point and observation that somehow alludes academics, researchers and so-called commentators on this fascinating subject.
Anyway that is some background to this study which demonstrates that long term AA membership can reduce this impulsivity and perhaps adds validity to the above arguments that improved behaviour inhibition and reducing impulsivity is a very possible mechanism of change brought about by AA membership and the 12 step recovery program.
It shows how we can learn about a pathology from the recovery from it!
Indeed when one looks back at one’s step 4 and 5 how many times was this distress based impulsivity the real reason for “stepping on the toes of others” and for their retaliation?
Were we not partly dominated by the world because we could not keep ourselves in check? Didn’t all our decisions get us to AA because they were inherently based on a decision making weakness? Isn’t this why it is always useful to have a sponsor, someone to discuss possible decisions with?
Weren’t we out of control, regardless of alcohol or substance or behaviour addiction? Isn’t this at the heart of our unmanageability?
I think we can all see how we still are effected by a tendency not to think things through and to act rashly.
The trouble it has caused is quite staggeringly really?
Again we cite a study (1) which has Rudolf H. Moos as a co-author. Moos has authored and co-authored a numbered of fine papers on the effectiveness of AA and is a rationale beacon in a sea of sometimes quite controversial and ignorant studies on AA, and alcoholism in general.
Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, we review our work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUD) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity…
Among individuals with alcohol use disorders (AUD), Alcoholics Anonymous (AA) is linked to improved functioning across a number of domains [1, 2]. As the evidence for the effectiveness of AA has accumulated, so too have efforts to identify the mechanisms of change associated with participation in this mutual-help group [3]. To our knowledge, however, there have been no efforts to examine links between AA and reductions in impulsivity-a dimension of personality marked by deficits in self-control and self-regulation, and tendencies to take risks and respond to stimuli with minimal forethought.
In this article, we discuss the conceptual rationale for reduced impulsivity as a mechanism of change associated with AA, review our research on links between AA and reduced impulsivity, and discuss potential implications of the findings for future research on AA and, more broadly, interventions for individuals with AUD.
Impulsivity and related traits of disinhibition are core risk factors for AUD [5, 6]. In cross-sectional research, impulsivity is typically higher among individuals in AUD treatment than among those in the general population [7] and, in prospective studies, impulse control deficits tend to predate the onset of drinking problems [8–11]
Although traditionally viewed as static variables, contemporary research has revealed that traits such as impulsivity can change over time [17]. For example, traits related to impulsivity exhibit significant mean- and individual-level decreases over the lifespan [18], as do symptoms of personality disorders that include impulsivity as an essential feature [21, 22]. Moreover, entry into social roles that press for increased responsibility and self-control predict decreases in impulsivity [16, 23, 24]. Hence, individual levels of impulsivity can be modified by systematic changes in one’s life circumstances [25].
Substance use-focused mutual-help groups may promote such changes, given that they seek to bolster self-efficacy and coping skills aimed at controlling substance use, encourage members to be more structured in their daily lives, and target deficits in self-regulation [26]. Such “active ingredients” may curb the immediate self-gratification characteristic of disinhibition and provide the conceptual grounds to expect that AA participation can press for a reduction in impulsive inclinations.
…the idea of reduced impulsivity as a mechanism of change…it is consistent with contemporary definitions of recovery from substance use disorders that emphasize improved citizenship and global health [31], AA’s vision of recovery as a broad transformation of character [32], and efforts to explore individual differences in emotional and behavioral functioning as potential mechanisms of change (e.g., negative affect [33,34]).
Several findings are notable from our research on associations between AA attendance and reduced impulsivity. First, consistent with the idea of impulsivity as a dynamic construct [18, 19], mean-levels of impulsivity decreased significantly in our AUD sample. Second, consistent with the notion that impulsivity can be modified by contextual factors [25], individuals who participated in AA longer tended to show larger decreases in impulsivity across all assessment intervals.
References
Blonigen, D. M., Timko, C., & Moos, R. H. (2013). Alcoholics anonymous and reduced impulsivity: a novel mechanism of change. Substance abuse, 34(1), 4-12.
This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcome…some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.
We focus here on participation in professional treatment and AA among previously untreated individuals after these individuals initially sought help for their alcohol use disorders and address three sets of questions:
Patients who participate in both self-help groups and treatment tend to have better outcomes than do patients who are involved only in treatment (Fiorentine, 1999;Fiorentine & Hillhouse, 2000). According to Moos et al. (2001), patients with substance use disorders who attended more self-help group meetings had better 1-year outcomes.
Similarly, among patients discharged from intensive substance use care, participation in self-help groups was associated with better 1-year (Ouimette et al., 1998), 2-year, and 5-year (Ritsher, Moos, & Finney, 2002; Ritsher, McKellar, et al., 2002) outcomes, after controlling for outpatient mental health care. We focus here on whether the duration of participation in one modality of help (treatment or AA) contributes to long-term outcomes beyond the contribution of participation in the other modality.
In prior work with the current sample, we found that individuals who entered treatment or AA in the first year after seeking help had better alcohol-related outcomes and were more likely to be remitted (in recovery) than were individuals who did not obtain any help. Individuals who participated in treatment and/or in AA for a longer interval in the first year were more likely to be abstinent and had fewer drinking problems at 1-year and 8-year follow-ups (Moos & Moos, 2003; 2004a; 2005b; Timko, Moos, Finney, & Lesar, 2000).
In this article, the distinctive focus is on associations between the duration of participation in treatment and AA and 16-year outcomes. We also consider the independent contribution of participation in treatment and AA to 16-year outcomes.
Compared to individuals who did not enter treatment in the first year after they sought help, individuals who obtained treatment for 27 weeks or more experienced better 16-year alcohol-related outcomes. Individuals who participated in AA for 27 weeks or more in the first year, and in years 2 and 3, had better 16-year outcomes than did individuals who did not participate in AA. Some of the contribution of treatment reflected participation in AA, whereas the contribution of AA was essentially independent of the contribution of treatment.
About 60% of individuals who sought help for their alcohol use problems entered professional treatment within one year. These individuals obtained an average of 20 weeks of treatment. Compared to untreated individuals, individuals who obtained 27 weeks or more of treatment in the first year were more likely to be abstinent and less likely to have drinking problems at 16 years than were individuals who remained untreated. These findings extend earlier results on this sample (Moos & Moos, 2003; 2005b; Timko et al., 1999) and are consistent with prior studies that have shown an association between more-extended treatment and better substance use outcomes (Moos et al., 2000, 2001;Ouimette et al., 1998).
The findings extend earlier results on this sample (Moos & Moos, 2004a; 2005b) and those of prior studies (Connors et al., 2001; Fiorentine, 1999; Ouimette et al., 1998;Watson et al., 1997) by showing that more extended participation in AA is associated with better alcohol-related and self-efficacy outcomes. The results support the benefit of extended engagement in AA, in that a longer duration of participation in the first year, and in the second and third years, was independently associated with better 16-year outcomes. In addition, our findings indicate that attendance for more than 52 weeks in a 5-year interval may be associated with a higher likelihood of abstinence than attendance of up to 52 weeks.
Part of the association between AA attendance and better social functioning, which reflects the composition of the social network, is likely a direct function of participation in AA. In fact, for some individuals, involvement with a circle of abstinent friends may reflect a turning point that enables them to address their problems, build their coping skills, and establish more supportive social resources (Humphreys, 2004; Humphreys, Mankowski, Moos, & Finney, 1999). Participation in a mutual support group may enhance and amplify these changes in life context and coping to promote better long-term outcomes.
Consistent with prior studies (Fiorentine, 1999; Fiorentine & Hillhouse, 2000; Moos et al., 2001; Ritsher, McKellar, et al., 2002; Ritsher, Moos, & Finney, 2002), longer participation in AA made a positive contribution to alcohol-related, self-efficacy, and social functioning outcomes, over and above the contribution of treatment.
An initial episode of professional treatment may have a beneficial influence on alcohol-related functioning; however, continued participation in a community-based self-help program, such as AA, appears to be a more important determinant of long-term outcomes.
Moreover, compared with individuals who participated only in treatment in the first year, individuals who participated in both treatment and AA were more likely to achieve 16-year remission (i.e. still be in recovery) (Moos & Moos, 2005a).
In interpreting these findings, it is important to remember that participation in treatment likely motivated some individuals to enter AA; thus, some of the contribution of AA to 16-year outcomes should be credited to treatment. Another consideration involves the differential selection processes into treatment versus AA. Individuals with more severe alcohol-related problems tend to obtain longer episodes of treatment, but this selection and allocation process is much less evident for AA.
These divergent selection processes may help to explain the finding that AA is more strongly associated with positive long-term outcomes than is treatment.”
…keep making the meetings!
Moos, R. H., & Moos, B. S. (2006). Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals. Journal of Clinical Psychology, 62(6), 735–750. doi:10.1002/jclp.20259
A journalistic piece entitled, “The Irrationality of Alcoholics Anonymous “, written by Gabrielle Glaser, also harshly criticizes Alcoholics Anonymous. AA and similar 12-step programs.
I cite a blog on her criticisms here (1)
“Glaser’s central claim is that there’s no rigorous scientific evidence that AA and other 12-step programs work.
First, she writes that “Unlike Alcoholics Anonymous, [other methods for treating alcohol dependence] are based on modern science and have been proved, in randomized, controlled studies, to work.” In other words, “modern science” hasn’t shown AA to work.”
Glaser appears to lessen her argument by suggesting that AA is difficult to study (so how can she be so sure it is not effective then?).
” Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works.”
Equally there, in her world view, would also be no conclusive data to suggest if doesn’t work? So why make bold claims either way?
” In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”
According to (1), Glaser is simply ignoring a decade’s worth of science, not only here but throughout the piece.
“No, that’s not true,” said Dr. John Kelly, a clinical psychologist and addiction specialist at Massachusetts General Hospital and Harvard Medical School. “There’s quite a bit of evidence now, actually, that’s shown that AA works.”
Kelly, alongside Dr. Marica Ferri and Dr. Keith Humphreys of Stanford, is currently at work updating the Cochrane Collaboration guidelines (he said they expect to publish their results in August).
” Kelly said that in recent years, researchers have begun ramping up rigorous research on what are known as “12-step facilitation” (TSF) programs, which are “clinical interventions designed to link people with AA.”
Dr. Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group who has conducted TSF studies, suggest that TSF outperforms many alternatives.
“They show about a 10 to 20 percent advantage over more standard treatment like cognitive behavioral therapy in terms of days abstinent, and typically also what we find is that when people are engaged in a 12-step-oriented treatment and go to AA, they have about 30 percent to 50 percent higher rates of continuous abstinence,” said Kelly.”
The original Cochrane paper that Glaser cites came out before the latest round of studies did, so that research wasn’t factored into the conclusion that there’s a lack of evidence for AA’s efficacy. In a followup email, Kelly said he expects the next round of recommendations to be significantly different:
Although we cannot as yet say definitively what the final results will bring in the updated Cochrane Review, as it is still in progress, we are seeing positive results in favor of Twelve-Step Facilitation treatments that have emerged from the numerous NIH-sponsored randomized clinical trials completed since the original review published in 2006. We can confirm that TSF is an empirically-supported treatment, showing clinical efficacy, and is likely to result also in lowered health care costs relative to alternative treatments that do not link patients with these freely available recovery peer support services. Another emerging finding is that a central reason why TSF shows benefit is because it helps patients become actively involved with groups like AA and NA, which in turn, have been shown to enhance addiction recovery coping skills, confidence, and motivation, similar to professional interventions, but AA and NA are able to do this in the communities in which people live for free, and over the long-term.
In other words, the most comprehensive piece of research Glaser is using to support her argument will, once it takes into account the latest findings, likely reverse itself.”
In other words, it will also help contradict Glaser’s arguments.
“In an email and phone call, Glaser said that TSF programs are not the same thing as AA and the two can’t be compared. But this argument doesn’t quite hold up: For one thing, the Cochrane report she herself cites in her piece relied in part on a review of TSF studies, so it doesn’t make sense for TSF studies to be acceptable to her when they support her argument and unacceptable when they don’t.
For another, Kelly, Katsukas, and Humphreys, while acknowledging that TSF programs and AA are not exactly the same thing, all said that the available evidence suggests that it’s the 12-step programs themselves that are likely the primary cause of the effects being observed (the National Institutes of Health, given the many studies into TSF programs it has sponsored, would appear to agree).”
“It’s worth pointing out that while critics of AA point it as a bit cultlike…to the researchers who believe in its efficacy, there’s actually very little mystery to the process. “We have been able to determine WHY these 12-step facilitation interventions work,” said Kaskutas in an email. “And we have also been able to determine WHY AA works.”
Simply put, “People who self-select to attend AA, or people who are randomized to a 12-step facilitation intervention, end up having people in their social network who are supportive of their abstinence,” she said.
Reams of research show that social networks…are powerful drivers of behavior, so to Kaskutas — who noted that she is an atheist — the focus on AA’s quirks and spiritual undertones misses the point.
“When you think about a mechanism like supportive social networks, or the psychological benefit of helping others… they have to do with the reality of what goes on in AA, with people meeting others in the same boat as they are in, and with helping other people (are but two examples of these mechanisms of action),” she said.”
At the heart of recovery via 12 step groups may be because it “works for a lot of people, simply by connecting them to others going through the same struggles.”
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