how do we recover?

The Roots of All Our Troubles!?

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Most of my distress and emotional pain in recovery comes from wanting stuff, and not getting my way or not accepting things as they are.

As Bill Wilson noted, we seem to get distressed when we don’t get what we want or feel people or trying to take away what we have.

This was his observation after a decade of psycho analysis with the psycho analyst Harry Tiebout.

A decade of therapy also showed Bill Wilson he has two default settings in his relationship to other human beings – he either tried to dominate them or he became dependent on them for his sense of self and emotional well being. In other words, he became dependent on others, on external means for approval and elevating his self esteem.

This is similar to relying on external means, i.e. alcohol, drugs, addictive behaviours to regulate our emotions and bolster our low self esteem.

We are in a sense co-dependent on other people for our sense of esteem.  We rely on others in terms of how we feel about ourselves.

As a result we are guarded against those that we perceive will reject us or be negative to us, harm us in some way and we seek to dominate these folk or we are dependent on those who are kind to us, help us and care for us. We swing at times between these extremes.

Some of us are “people pleasers”, some of us are dismissive towards others. I can be a dismissive person more than a people pleaser. It is all manipulating our interaction with others to our selfish ends.

Some of these tendencies are the result of our childhoods and how closely attached we were to our parents.

Some of us have this knawing feeling of not being good enough, have a hole in the soul which we are/were kinda always unconsciously trying to protect, shield from the world.

It is a strange feeling of not wanting to be found out of being less than, not good enough. “If people realise what the real me is like, they will reject me!” type thinking although a lot of this is unconscious and does not pop in to our minds as thoughts but is an unconscious self schema that shapes our behaviours.

In simple terms we manipulate via people pleasing or we push people away via being dismissive and putting others down, we guard against any threat of perceived rejection or threats to the self via defense mechanisms such as projecting what we do not like about ourselves on to others.

We often do not like traits in others because they somehow mirror traits in ourselves although we are not always conscious of this.

We have difficulties in our relationships with others, these relationships are often unhealthy and ill.

Some of this is touched on in the Big Book of Alcoholics Anonymous, but much of it comes from later observations by Bill Wilson after the publication of the Big Book and my and others’ observations since.

I have seen in myself how fear and shame seem to drive most of my maladaptive behaviour.

My illness of addictive behaviours.

I have an illness of chronic malcontent, things are rarely good enough and I am rarely good enough, according to my “out of kilter”  thinking which  I usually try to ignore, turn over to God or on occasion challenge via reasoning and sharing with other people.

My thoughts are often not my friends, they are often not in the service of my ongoing well being, quite the opposite in fact.

This is how a mental health disorder manifests itself as distorted fear based thinking which appear, if acted upon, to make one’s situation a whole lot worse.

We can not rely on our thoughts and feelings or, in other words, our Self Will. Our self will has become impaired and is no longer in the service of our successful survival.

I have found over the last decade in recovery that when I turn my Will over to the care of the God of my understanding that I am restored to sanity and my thoughts are sound, they are on a higher plane as the Big Book tells me.

I can become the fullest expression of me in the God, not the ill, deluded version while running under my own self will. That has been my experience.

It is only with God’s help that I get restored to sanity or reasonableness.

When I have a fear of not getting stuff and this is linked to insecurity, as mentioned in the Big Book, it is usually in relation to my pocket book, financial insecurity, personal relationships, self esteem etc.

I will now look at this fear based reaction to my security which is mainly to do with stuff out  there (external) such as work, people and how they affect my sense of self before looking at how my internal sense of self, based on the fear based emotion of shame seems to play a pivotal role in my relationship with others and the world around me.

I am assailed externally by fear of what other’s think about me and internally about what I think of me – when these two line up it can have a powerful and damaging effect on my psyche.

Desiring stuff seems at the root of my fear based stuff – the exquisite torture of desire which soon loses it’s so-called relish and just becomes torturous.

Alcoholics do not seem want stuff like normal folk, but have a pathological wanting, an all consuming need to get stuff regardless of it’s worth or value.

We seem to compulsively seek to relieve an inherent distress of not having what we set out to get. Our decision making seems fueled at times by this need to relieve distress rather than the intrinsic value of what we are seeking.

We seem to become manic in our pursuit of things and end up overdoing whatever we are doing via this stress-based manic activity.

This seems compounded by not always being able to read our emotions or somatic states.

One of my own difficulties is realising I am hungry or tired and I can often end up exhausted by over-doing stuff especially manual work around my house. My stop button broke a long time a ago and probably did not work very well to begin with.

So we have  stress-based compulsive need to do something and very limited brakes in the brain stopping us and very little emotional feedback going on, a limited consideration of  “aren’t we overdoing this a bit?”

Desire obviously runs contrary to the idea of being in God’s will, in fact it is being in Self Will that seems to create distress in many people with addictive behaviours.

I would add to this that I also get distress via fears of rejection from others, I suffer from fear based shame to a chronic extent.

Shame, also the consequence of being in Self Will, was not really mentioned in the Big Book of Alcoholics Anonymous, mainly because it was not really known about as a psychological or psycho-therapeutic concept then.

Much of the Big Book was influenced by  psycho-analysis which did not consider shame, but rather guilt, in psychological disturbance.

In fact, it has only started considering the role of shame in the last few decades.

So I would add fear of not getting what we want or having something taken away is also complemented by shame-based fears of being rejected.

For example there is an undercurrent in fear of things being taken away, of it being because we are not good enough, deserving enough, have failed in some way, which are shame based reactions.

In fact the Big Book gives me a good idea of the “sins” or “defects of character” I have when I have a resentment but does not explain why I have resentments in the first place.

It explains this as selfishness, self centredness… the root of all our troubles.

It does not, for me, clearly explain why we resort to these selfish, immature, emotional reactions or why we persist with resentments?

It does not explain the emotional immaturity at the heart of alcoholism,  this spiritual malady of inappropriate emotional response to the world around us?

Bill Wilson was struck himself, when he started working with other alcoholics, how much they were plagued constantly by various resentments. How they were haunted by memories of situations in the past, how they swirl around and pollute their minds in the present. How they could not let go of events in their past?

For me he was seeing the root of this spiritual malady, this emotional disease.

For me we engage futilely and distressingly in resentment because we have an inability to process and control our emotions, they overwhelm us and we often react by people pleasing (shame) or react via various defense mechanisms (also shame based).

Defense mechanisms are central to psycho-analytic thought – such as projection etc, the idea that we  expel “out of ourselves what we do not like about ourselves onto others.

Sometimes others expel the same negative emotions on to us. I have found this a fairly common trait among male alcoholics in recovery settings and meetings.

I was discussing this with a newcomer last week, how people who seek to “put us down”  do so out of shame and induce in us all the negative emotions they are experiencing themselves!

The newcomer gave me an example of a resentment he was experiencing after this guy at a meeting said “get off your pink cloud” a phrase that refers to the sometimes  mildly ecstatic feelings of early recovery.

This made the newcomer ashamed that he could have been so stupid for being on this pink cloud, as if this was a selfish indulgence!?

I explained to him that his pride had been hurt, he was in shame and his “apparent” depression every since was simply prolonged self pity.

If we leave self pity to fester long enough it becomes depression, that is my experience anyway.

I said the other guy was probably “hurt” to see a newcomer having such a good period of recovery (God does want us to be happy, joyous and free after all) – I said his false pride was hurt too, that he was not having the recovery experience at present of the newcomer (possibly because he wasn’t putting the effort in) and was in shame (not good enough) and self pity. This mesh of negative emotions can link up fairly instantaneously I find.  It is the web my spiritual malady seeks to ensnare me in.

The guy was probably in guilt too as he could been working on his recovery more.

As a result this guy put the newcomer down to alleviate his own sense of self, his low self esteem.

He “had to” react with arrogance, dismissiveness, impatience and intolerance, because his shame, which is a fear based emotion, made him fearful of his own recovery and fear makes one strangely dishonest (at times deluded), This is my experience.

All because a newcomer had the temerity to be enjoying his recovery?

Not completely, this is half the answer.

The other part is that this guy, if an alcoholic like me, has real difficulties accessing in his heart and mind how he actually “feels” at any particular time. Or rather what emotions he is experiencing at any particular time.

This guy could have been experiencing guilt or shame for example.

Instead of saying to himself I am feeling guilt that my recovery is flabby  compared to this newcomer or that I am being an arrogant “know it all”, putting this newcomer in his place because  he had been in recovery longer – although being in recovery and being sober are different things I have found.

Either way, if he could perhaps of had the ability to say this is how exactly I am feeling he could have acted on this emotional information rather than reacted to it.

What do I mean by this?

Well, if I was feeling guilty about this newcomer it would cause a disturbance in me because I have difficulties processing my emotions.

It would have turned up therefore as a resentment of someone having something I do not have and as them taking away the illusion that my recovery was going OK?

I would have found this threatening to my sense of self so I would have reacted via defense mechanisms. I would have strangely blamed this person for making me feel the way I did! Even if this person had no such intention of hurting my feelings I would blame him nonetheless via my defensive reactions.

It is as if my emotional well being is dependent on other people and their behaviours, this is my spiritual malady, my emotional disease.

As I would have had a resentment, it would have had a wolf pack of negative emotions attached.

In this instance I might have have acted differently.

If I had been in God I would have been more sane for a start and had more loving tolerance for a newcomer.

I would have been acting not reacting. I would have had empathy for where the newcomer  “was at in his recovery” as I had been there once too.

This love and tolerance for the newcomer evolves the displaying of virtues (the opposite of defects are virtues).

What virtues? Well as the newcomer was relatively new I would attempted to be patient, empathetic, kind, gentle, tolerant, considerate  etc. These prevent the defects occurring I find.

If we practice virtues instead of defects then the brain changes for the better and we recover quicker. Our positive loving, healthy behaviours change us and our brains via neuroplasticity for the better.

Attempting to live according to God’s Will (which is a state of Love) also helps me not react but to act with Grace.

In Grace we can still experience negative emotions but God allows us to see them for what they are and not react. His Grace takes the distress out of thee negative emotions. This is my experience.

This allows me to do a quick inventory of my negative emotions and a prayer to God to have them removed. My experience is that they are always removed and that we are immediately restored to sanity.

I do not necessarily have to react to my feelings of negativity about myself, someone else does not need to experience the consequence of my resentments.

I can manage my spiritual malady or emotional dysfunction, I have the tools to do so.

I also impressed upon the newcomer that what the other guy was experiencing and was reacting is also how he, the newcomer, reacts and how I react too.

It is what our spiritual malady looks like I believe, it is the map of my impaired emotional responding.

I also impressed upon him that mostly I can manage this emotional dysfunction but often I fail to and get into a resentful anger.

This is why I have to forgive the other guy as I have been forgiven but also to forgive myself (or ask God to forgive me my shortcomings) for my reactions.

We are not perfect, far from it. We are far from being Saints but have a solution Saints would approve and achieve a kind of transient sanctity in this 12 step solution of letting go and letting God.

We have to show love and tolerance for each other as we suffer the same illness/malady. Dismissing others like us for having what we have and acting as we do is like a form of self loathing. We have to forgive ourselves and each other for being ill. Self compassion allows us to be compassionate  towards others.

Also we need to be aware what we project on to other alcoholics is the same thing as they project on to use and sometimes we project if back.

So we have two main ailments, distressed based wanting which results in the same negative emotions as being in a shame- based fear of rejection.

I can get out of the distress of wanting/needing stuff by asking God to remove those negative emotions which block me off from Him.

For example, if I really want something and feel someone is preventing me getting that thing or that they are taking this thing away from me I have a hunting pack of negative emotions running through by heart and pulsating through my veins, propelling me to want that thing even more! As if my very life depended on it?

These feelings are translated as “how dare you take that thing/stop me getting that thing” – False Pride – followed by fear of being rejected – Shame (this is because I am not good enough)  and possible Guilt (for something I must have done wrong as usual) – then leading to “poor me” and feelings of Self pity, all because I am in Self, so I am being Self Centred and not considering someone else’s view so I am Selfish.

I retaliate via by “I”ll show you/I’ll get you” emotions of Dismissiveness, Intolerance, Arrogance and Impatience – my “I’ll put you down to make me feel better!”

All because I am fearful that you are taking away something from me or rejecting  me –  Fear and Fear is always accompanied by dishonesty.

I will act out on these somethings, if I do now use my spiritual tools and let Go and Let God, usually by eating too much, Gluttony, having a shopping spree, Greed, engaging  sexual fantasy/activity Lust of “freezing” through fear in the subltle sin of Sloth (procrastination).

A perceived slight or a rejection can have an incredible emotional effect on me

This is all emotion dysfunction and immaturity. I have resentments because they are a true sign of emotion dysfunction.

The mature way to to access, identfiy and label how one is feeling and use this information to reasonably express how one is feeling. This way we do not retaliate, fight, flee or freeze. Instead our emotions do what they are supposed to do. They are suppose the tell the fronts of our brains to find words for our feelings. Not to tell the bottom of our brains to fight back or run or freeze.

Let me use an example.

I had an argument with a guy once who suddenly proclaimed he was upset by what I had said. I was amazed as this guy was reading his emotions, identifying verbalising/expressing them to me in a way I have never been able to do.

My alcoholism is rooted in an impaired ability to read, identify, label and express my emotions (otherwise called emotion processing) – as a result my emotions have always troubled me and been so troubling in their undifferentiated state that I have always either avoided them or ran away from them.

I have sought refuge from my negative emotions in alcohol, drugs and other addictive behaviours. It is this that propelled my addictions, this inability to deal with my negative emotions. I dealt with them externally via addictive behaviours, not internally via emotion processing.

My emotions became wedded in time to being undifferentiated arousal states that prompted me to seek an external way to deal with these troubling emotional/arousal states.

Today when I engage in the above emotion dysfunction, engage in the above web of defense mechanisms it is because I have not been able to locate in me what feeling is disturbing me ?

On occasion it is, as the guy above said, because I am upset. I have not learnt the ability to say that I am upset etc. The words for these feeling states somehow can continue to elude me unless I am in God’s Grace.

God does for us what we can not do for ourselves!

Finding out what is really going on with us emotionally is at the heart of recovery. That is why we have to constantly share how we are feeling with others so that we can find out what we are feeling.

Unless, we let Go and Let God and ask God to remove these negative emotions/sins/defects of character we end up in a futile increasingly distressed spiral of negative emotions.

We end up cultivating much greater misery.

As soon as you can, let Go and Let God.

 

How Stories Transform Lives

When I first came to AA, I wondered how the hell sitting around in a circle listening to one person talking, and the next person talking and …. could have anything to do with my stopping drinking?

It didn’t seem very medical or scientific? Did not seem like any sort of treatment?  How could I get sober this way, listening to other people talking?

It didn’t make any sense. Any time I tried to ask a question I was told that we do not ask questions, we simply listen to other recovering alcoholics share what they called their “experience, strength and hope”?

How does this help you recover from one of the most profound disorders known, from chronic alcoholism?

I did not realise  that this “experience, strength and hope” in AA parlance, is fundamental in shifting an alcoholic’s self schema from a schema that did not accept one’s own alcoholism, to a self schema that did, a schema that shifts via the content of these shared stories from a addicted self schema to recovering person self schema.

Over the weeks, months and years I have grown to marvel at the transformative power of this story format and watched people change in front of my very eyes over a short period of time via this process of sharing one’s story of alcoholic damage to recovery from alcoholism.

I have seen people transformed from dark despair to the  lustre of hope and health.

One of the greatest stories you are ever likely to hear and one I never ever tire of hearing.

Through another person sharing their story they seem to be telling your story at the same time. The power of identification is amplified via this sharing.

If one views A.A. as a spiritually-based community, one quickly observe s that A.A. is brimming with stories.

The majority of A.A.’s primary text (putatively entitled Alcoholics Anonymous but referred to almost universally as “The Big Book,” A.A., 1976) is made up of the stories of its members.

During meetings, successful affiliates tell the story of their recovery. In the course of helping new members through difficult times, sponsors frequently tell parts of their own or others’ stories to make the points they feel a neophyte A.A. member needs to hear. Stories are also circulated in A.A. through the organization’s magazine, Grapevine.

But the most important story form in Alcoholics Anonymous describes  personal accounts of descent into alcoholism and recovery through A.A. In the words of A.A. members, explains “what we used to be like, what happened, and what we are like now.”

Members typically begin telling their story by describing their initial involvement with alcohol, sometimes including a comment about alcoholic parents.

Members often describe early experiences with alcohol positively, and frequently mention that they got a special charge out of drinking that others do not experience. As the story progresses, more mention is made of initial problems with alcohol, such as job loss, marital conflict, or friends expressing concern over the speaker’s drinking.

Members will typically describe having seen such problems as insignificant and may label themselves as having been grandiose or in denial about the alcohol problem. As problems continue to mount, the story often details attempts to control the drinking problem, such as by avoid-ing drinking buddies, moving, drinking only wine or beer, and attempting to stay abstinent for set periods of time.

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The climax of the story occurs when the problems become too severe to deny any longer. A.A. members call this experience “hitting bottom.”

Some examples of hitting bottom that have been related to me include having a psychotic breakdown, being arrested and incarcerated, getting divorced, having convulsions or delirium tremens, attempting suicide, being publicly humiliated due to drinking, having a drinking buddy die, going bankrupt, and being hospitalized for substance abuse or depression.

After members relate this traumatic experience, they will then describe how they came into contact with A.A. or an A.A.-oriented treatment facility…storytellers incorporate aspects of the A.A. world view into their own identity and approach to living.

Composing and sharing one’s story is a form of self-teaching—a way of incorporating the A.A. world view (Cain, 1991). This incorporation is gradual for some members and dramatic for others, but it is almost always experienced as a personal transformation.

So before we do the 12 steps we start by accepting step one  – We admitted we were powerless over alcohol——that out lives had become unmanageable –  and by listening to and sharing stories which give many expamples of this loss of control or powerlessness over drinking. .

Sharing our stories also allows us to stat comprehending the insanity or out of contolness (unmanageability)  of our drinking and steps us up for considering step 2 –  Came to believe that a Power greater than ourselves could restore us to sanity – through  to step three, so the storeies not only help us change self schema they set us on the way to treating our alcoholism via the 12 steps.

In these stories we accept our alcoholsimm and the need for persoanl, emotional and spirtual transformation. The need to be born anew, as a person in recovery.

Reference

1. Humphreys, K. (2000). Community narratives and personal stories in Alcoholics Anonymous. Journal of community psychology, 28(5), 495-506.

 

 

Trust

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.

 

Why?

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.

The Power of Identification!!

The main reason I am alive today, sober and have recovered from a seemingly hopeless condition of alcoholism is simple!

Or rather the first step can be simple.

The first step on my recovery journey was to identify with the life stories of other recovering alcoholics.

Not necessarily with where they grew up, or the damage alcoholism had inflicted on their lives. Although many alcoholics talk themselves, or their illness talks them, out of the possibility of recovery by saying I am not as bad as that guy, or that woman.

You may not be as bad “YET!” – the “yets” are often talked about in AA – you may not have done the damage others have, yet? Keep drinking and you are bound to. You, like them, will have no choice.

Alcoholism increasingly takes away choice.

It takes over your self will.

Your self will, your self regulation, is a combination of your emotional, attentional, memory and reward/survival/motivation networks.

Alcoholism takes over these networks, progressively, over time.

Neuroscience has shown this, over the last twenty odd years.

A superb longitudinal study, “The Natural History of Alcoholism” by George Vaillant  clearly showed this progression in six hundred alcoholics over a 60 year period!

In my own research and in articles, with two highly respected Professors at a UK University, I have shown how the alcoholic brain progressively “collapses inwards” to subcortical responding.

In other words, we end up with a near constant “fight or flight” reaction to the world,  with alcoholism causing distress based compulsion at the endpoint of this addiction.

All the above neural circuits become governed by a region of the brain which deals with automatic,  compulsive behaviour. All the self regulation parts of the brain progress to an automatic compulsive behaviour called alcoholism and we are then often without mental defence against the next drink!

I identified with this one simple fact – the progression of this neurobiological, emotional, and spiritual disease state called alcoholism. I saw it in my own life, this progression over years of drinking.

The “invisible line” that is crossed, according to AA members, can be viewed on a brain image, I believe.

Can you see it in your life?

Like these recovering alcoholics I had not taken my first drink hoping to end up an alcoholic

It was something that had happened to me,  happened despite my very strong will not because my will is weak. I am as wilful a person as you would hope to me. How come I became an alcoholic then?

I did also relate to other things these people shared.

I identified with the damage caused by alcoholism  in their lives and the lives of their family.  How this illness affects everyone in the immediate and even extended family.

I had never considered the effect on others, apart from me?

I listened and identified with how they talked about a “hole in the soul”, how they never felt part of, felt different from others, detached. I related to this. That was me too.

Alcohol made me feel more me! I became attached to it and grew to love it like someone would love another person, more so perhaps? Alcohol came first, loved ones second.

Alcoholism takes away all the good things in life and then your life too.

All of this was the case with me too.

I identified with all this.

I identified too with their solution.

I identified with and wanted what these now happy people in recovery had.

I decided to take the same steps as they had towards this happiness.

There is a solution.

We do recover!

Life In Recovery – Australia (Part 2)

“After over five years of intermittent relapses and struggling to re-invent myself, I can safely say that I feel at ease in my own company for the first time in my life. I trust that I will do the right thing by myself and my family”.

 

“…all levels of government need to stop focusing on the policing of drug use and distribution, and invest more in recovery services.

That would slash health care, child care and criminal justice system costs racked up by addicts, while drastically cutting crime rates and creating more valuable contributors to society, the Life in Recovery report says.

The survey, by the South Pacific Private and Turning Point treatment centres, suggests addicts in recovery are 75 per cent less likely to drive while under the influence, 50 per cent less likely to get arrested and 40 per cent less likely to perpetrate or be a victim of family violence.

They’re also 40 per cent more likely to volunteer in a community group, and tend to make more significant contributions to the community than the average person, according to the report’s author, Associate Professor David Best.

Government funding is provided for detox services but virtually no money is spent on the difficult recovery process that follows, despite relapse rates of between 50 and 70 per cent in the first year of recovery, he said.

The focus needs to switch to funding support groups and programs that help addicts get back on their feet, like finding jobs and accommodation, he said.

“None of the treatment services are sufficiently well-funded but the complete neglect of after care and recovery services is both inconsistent with the evidence and counter-productive, because it just puts people into this spiral of relapse,” Prof Best said.

from

http://www.sbs.com.au/news/article/2015/05/05/govt-policy-addicts-wrong-report

reported in

http://www.southpacificprivate.com.au/Life-in-Recovery-Survey-first-of-its-kind

Infographic  of some of the Survey Findings

 

 

 

RECOVERY STATUS There was considerable variation in how people described their recovery:

• 79.8% described themselves as ‘in recovery’

• 6.3% described themselves as ‘recovered’

• 4.5% described themselves as in ‘medication-assisted recovery’

• 3.7% reported that ‘they used to have an AOD problem but don’t any more’

• 5.7% used other ways of describing themselves

Thus, for the vast majority of participants, recovery is seen as an ongoing process.

The majority (69.8%) reported that they had accessed alcohol and other drug (AOD) treatment services meaning that 30.2% had never done so. Of those who had, 36.6% had taken medications prescribed by a health care professional to help them deal with their drug and alcohol problems.

At the time of the survey, 41 individuals (7.2% of the total sample), were currently receiving prescribed medication to deal with their drug and alcohol problems.

A higher proportion (82.0%) had attended a 12-step meeting, with 68.8% attending 12-step meetings at the time of the survey. Current 12-step group attendance involved Alcoholics Anonymous for 57.1% of the sample, Narcotics Anonymous for 24.6%, Gamblers Anonymous for 2.3% and Crystal Meth Anonymous for 1.0%.

11.3% were currently attending Al-Anon (as a loved one or family member) and 6.8% reported that they were currently attending other 12-step groups that included Sex and Love Addicts Anonymous, Overeaters Anonymous, GROW (for co-morbid alcohol and mental health problems) and Adult Children of Alcoholics. SMART Recovery was being attended by 0.5% of the survey participants.

 

1. FINANCES

Changes in financial situation from active addiction to recovery There were marked improvements in paying bills on time, in having your own place to live, in having a good credit rating and paying taxes from when participants were in active addiction to when they were in recovery.

WELLBEING & LIFE

2. FAMILY AND SOCIAL LIFE

…  there were marked reductions in the experience of family violence from around half of the participants during active addiction to less than 10% in recovery, that were accompanied by positive improvements in participation in family activities and planning for the future. There was also a clear improvement in children returning from care and a massive increase in participation of community and civic groups.

3. HEALTH

There are marked differences in health functioning as reported by participants with clear improvements in a range of self-care activities – improved engagement with GPs, regular dental check-ups, improved diet and nutrition and regular exercise. At the same time there is a clear reduction in health service utilisation indicated by marked reductions in the frequency of use of healthcare services and emergency department attendance and improvements in the rate of smoking. There is also a significant reduction in experiencing mental health side effects.

4. LEGAL ISSUES

Changes from active addiction to recovery in offending and criminal justice system involvement There are very striking transitions in involvement with the criminal justice system and overall offending with the most marked transition from 82.9% reporting driving under the influence while in active addiction to fewer than 5% while in recovery. Likewise, while more than half of the sample had been arrested in active addiction, this dropped to around 2% in recovery, leading to significant reductions in family disruption as well as significantly reduced costs to society. This is also reflected in the more than 90% reduction in imprisonment from active addiction to recovery, while there were considerable improvements in re-obtaining both professional registration and the right to drive once in recovery.

5. WORK AND STUDY

Missing work and being fired or suspended, which had been frequent occurrences in active addiction, were extremely uncommon in recovery, as was dropping out of school and university. In contrast, there were clear improvements in positive job appraisals, in further education and in remaining in steady employment.

 

THE SOCIAL NETWORKS AND SOCIAL IDENTITIES OF ACTIVE ADDICTS AND PEOPLE IN RECOVERY

Here the position is even more dramatic with the vast majority of participants reporting no contact with people in recovery while they were active addicts, but that this situation is reversed to the extent that 36% of people in recovery have a social network made up only of people in recovery.

This is reflected in ‘qualitative social capital’ – in other words the number of people individuals can rely on. At the peak of their addiction, 38.3% of participants reported that they had nobody they could discuss important things with compared to 2.0% who reported the same in their recovery. By contrast, while 8.6% of participants reported that they had four or more people they could discuss important things with in active addiction, this increased to 65.9% in their recovery. This is reflected in changes in social group membership – a proxy for connectedness and wellbeing.

…our participants’ social identification with addiction had not diminished but their social identification with recovery had grown enormously.

 

PERSONAL ACCOUNTS OF RECOVERY

THE EXPERIENCE OF ADDICTION

he pain and trauma of addiction is clearly illustrated in the reports of participants. Active addiction is seen as having destroyed the person’s own lives and taken many of the lives of their peers.

“Active addiction completely destroyed any semblance of normality in my life. Everything was reduced to absolutes: the need to get drugs so I could not feel sick, and the use of drugs to numb any emotional or physical pain”.

“Ruined my life in all areas, physically, mentally, emotionally and spiritually”

“I am alive, none of my peers from that time are alive. Only 5 of the 33 people I was in rehab with are still alive”.

THE JOURNEY TO RECOVERY

This journey is not perceived as a quick or easy journey by most of the participants. Many recognised that they have had persistent problems long into their abstinence. However, for most people it is a generally positive transition.

“After over five years of intermittent relapses and struggling to re-invent myself, I can safely say that I feel at ease in my own company for the first time in my life. I trust that I will do the right thing by myself and my family”.

 

“Addiction was part of my journey, I don’t regret it but recovery is so much more comfortable”.

THE EXPERIENCE OF BEING IN RECOVERY

Building on the previous section, this was generally very positive and the following examples illustrate the perceived benefits. Many people spoke of what they had achieved since starting their recovery journey.

“I am a productive member of society today: a good partner, parent, employee, daughter, sibling and friend, and I was not any of those things before”

“I experience long periods of peace of mind. I can manage problems really well. I am less inclined to react negatively to adverse events. I have recovered from Hepatitis C. I have deep and meaningful relationships with friends and family. I feel a wide range of emotions and can (mostly) sit with them. I have experienced 15 years of being engaged with and liked by the community instead of being a pest to society and that is absolute gold”.

POSITIVE ROLE OF TREATMENT OR MUTUAL AID

There were a striking number of comments supportive of 12-step groups, as illustrated by the following:

“AA saved my life because I gradually changed and got my self-respect back”

“AA saved my life; I would be dead without AA”

“I have a brand new life thanks to AA. For me, my children and my grandchildren. I am responsible at work and pay my bills”

“In nearly 30 years I have literally witnessed many hundreds of people turn their lives around from chaos and mayhem to lead similarly fruitful lives to the one I live today, overwhelmingly through the agency of their involvement in 12 step programs”

“I could not stop drinking on my own. AA has shown me a new way of living. Life is not perfect but I can now live like a ‘normal’ person. I have self-respect and dignity and I am a good worker and mother”

COMBINED APPROACHES Furthermore, as is consistent with the literature, a number of respondents talked about the benefits of bespoke and blended support from both mutual aid groups and professional treatment services.

“I am an active participant in the AA program – the 12 steps are my program for recovery. Putting the 12 steps in my life and putting the skills I learned at South Pacific Private into my life have given me a life that is full of understanding, patience, great relationships and love”.

“Detox set me on the path to recovery and AA helped me to sustain my recovery”, while a third respondent reported that “recovery through detox, rehab clinic, 12 step program with AA has completely changed my life and my attitude to life. I feel free and have choices and I am happy for the first time in years”

The overall conclusion by the majority of participants is that recovery is experienced as liberation and is an opportunity not just for a normal life but a meaningful and fulfilling one. That does not mean recovery is without regrets or without problems :

“My addiction was hell, my recovery has been amazing. I will be forever grateful for the second chance I was given. It took a long time to feel a part of the world when coming out of addiction. It was so hard to fit in with a world I felt so uncomfortable in. But now I love every day. I suffer with depression, and it has been harder than active addiction was but it is in remission and I have learned to live with it. My children are my greatest blessing and I have been able to break the cycle”.

 

How it (Mindfulness) Works? (Part 1)

Following on from our previous blog Neural mechanisms of mindfulness meditation we now use abbreviated excerpts form a very good researcher Eric Garland into how possible mindfulness helps repair, via meditation based neuroplasticity, those areas and networks of the brain which are impaired or do not function adaptively  in the addicted brain.

In this review paper, they described how mindfulness-based interventions (MBIs) may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface.

“Mindfulness Training Ameliorates Addiction by Targeting Neurocognitive Mechanisms

Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing “savoring” to restore natural reward processing.

Although mindfulness is an English term linked with a set of contemplative practices and principles originating in Asia over 2500 years ago…

MBIs are centered on practices designed to evoke the state of mindfulness, a mindset characterized by an attentive and non-judgmental metacognitive monitoring of moment-by-moment cognition, emotion, perception, and sensation without fixation on thoughts of past and future (60, 61)…During focused attention, attention is sustained on an object while the practitioner alternately acknowledges and lets go of distracting thoughts and emotions. Objects of focused attention practice can include the sensation of breathing; the sensation of walking; interoceptive  feedback about the body’s internal state etc…

Focused attention practices are often the precursor to open monitoring forms of mindfulness meditation. During open monitoring, a state of metacognitive awareness is cultivated wherein mental contents are allowed to arise unperturbed without suppression or distraction while the quality of awareness itself remains the primary focus of attention (61)

Putatively, focused attention and open monitoring emphasize or differentially activate different cognitive capacities during the mindful state, including attentional vigilance, attentional re-orienting, executive monitoring of working memory, response inhibition, and emotion regulation (62).

Engaging in these practices repeatedly over time may induce neural and cognitive plasticity (7); recurrent activation of the mindful state during meditation may leave lasting neurobiological traces that accrue into durable changes in the dispositional propensity to be mindful in everyday life even while not meditating (64).

Germane to the current discussion of neurocognition in addiction, dispositional mindfulness is significantly inversely associated with addiction attentional bias (1) and craving (66), positively associated with autonomic recovery from stress and substance cue-exposure (67), and correlated with various indices of cognitive control (68–70). MBI-related increases in dispositional mindfulness might be mediated through neuroplasticity stimulated by experience-dependent alterations in gene expression (71, 72).

Indeed, cross-sectional studies have demonstrated significant differences in gray matter volume between meditation practitioners and meditation-naïve controls, particularly in regions of PFC that instantiate cognitive control (e.g., inferior frontal gyri) and higher-order associative processing (e.g., hippocampus) (73–77). Moreover, longitudinal research has shown that participants in an 8-week MBI evidenced increased gray matter density in posterior cingulate cortex, temporo-parietal junction, and cerebellum, compared to controls (78), and reduced amygdala volume that correlated with the degree of stress-reduction achieved from mindfulness training (79).

Through focused attention and open monitoring forms of meditation, MBIs exercise a number of neurocognitive processes believed to go awry in addiction. Indeed, MBIs may be fruitfully conceptualized as means of training or exercising prefrontally mediated cognitive control networks which have become atrophied or usurped in the service of drug seeking and use. By strengthening PFC functions and the ability of the PFC to modulate other brain networks in a context-dependent manner, MBIs may provide the global benefit of enhancing neurocognitive flexibility…(e.g., cognitive regulation of automaticity, attention, appraisal, emotion, urges, stress reactivity, reward processing, and extinction learning).

These processes do not operate in isolation; they are linked in mutually interdependent, interpenetrating, recursive networks [for reviews, see Ref. (2, 3)]. MBIs may restructure dysregulated processes by strengthening functional connectivity and efficiency of prefrontally mediated self-regulatory circuits (see Figure2). Below, we propose a number of hypothetical neurocognitive targets that could mediate the therapeutic effect of MBIs on addictive behavior.

FIGURE 2

 

Figure 2. Mindfulness-centered regulation: the central tenet of this model posits that mindfulness-based interventions (MBI’s) may remediate dysregulated habit behaviors, craving, and affect primarily by way of strengthening functional connectivity: (1) within a metacognitive attentional control network (PFC, ACC, Parietal); and (2) between that metacognitive attentional control network and the (a) habit circuit, (b) craving circuit, and (c) affect circuit.

HABIT RESPONSES

Substance dependent individuals typically experience euphoria during initial stages of drug-use. Yet, as experience with the drug increases, the reward associated with drug-taking becomes dramatically attenuated. Despite diminishing returns in positive emotional experiences resulting from substance use, dependent users continue to use their drug of addiction. Undergirded by neuroplastic changes in striatal circuitry, habitual drug-use becomes an overlearned process that can become automatized (12, 80).

Though more investigation is needed to elucidate effects of mindfulness on brain-behavior relations subserving drug-use action schemas, early research on the effects of mindfulness on behavioral measures of automaticity has emerged [e.g., Ref. (82)]. Such research provides a theoretical foundation for the potential efficacy of MBIs for interrupting drug-use action schemas. Hypothetically, mindfulness training may increase awareness of the activation of drug-use action schemas when triggered by substance-related cues or negative emotion, thereby allowing for the disruption of automatized appetitive processes with a controlled coping response.

As posited in our model of mindfulness-centered regulation (Figure 2), mindfulness training may enhance functional connectivity in a cortico-thalamic loop including prefrontal, cingulate, parietal, and dorsal thalamus nodes, strengthening an executive regulatory circuit providing feedback to the striatum and medial temporal lobe. This feedback process is theorized to allow for greater consciousness of thoughts and behaviors that were previously enacted with little conscious awareness.

The practice of mindfulness in daily life is focused on developing awareness of automatic behavior. Indeed, many MBIs prescribe informal mindfulness practices where individuals are instructed to engage in everyday, repetitive tasks (e.g., washing the dishes) with full consciousness of the sensorimotor aspects of the activity. Such informal mindfulness practices are designed to reduce mind-wandering and strengthen conscious control over automaticity.

Potentially as a result of such practices, mindfulness training has been shown to decrease habit behavior (83) and reduce rigid adherence to scripted cognitive responses (82). These findings accord with early theoretical accounts which conceptualized mindfulness meditation as a form of “deautomatization,” whereby patterns of motor and perceptual responses which had been rendered automatic and unconscious through repetition are reinvested with conscious attention (84).

Thus, is plausible that mindfulness training may deautomatize habitual addictive responses through both formal meditations focused on regulating automatic appetitive impulses as well as informal mindfulness practices designed to increase generalized awareness of automaticity. In light of findings suggesting that conscious cognitive control disrupts automatic processing (20, 85–87), mindfulness training may interrupt drug-use action schemas by augmenting top-down control via a frontoparietal metacognitive attention network, facilitating the strategic deployment of self-regulatory processes to reduce or prevent substance use. The effects of mindfulness training on inhibition of habit responses might be indexed with performance on an Emotional GoNoGo task (88), where subjects would be asked to withhold automatized “go” responses in the context of emotional interference from a drug-related (i.e., a drug-related background image) or negative affective stimulus (i.e., an aversive background image).

To be Continued…

References

1. Garland, E. L., Froeliger, B., & Howard, M. O. (2013). Mindfulness  training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Frontiers in psychiatry, 4.

Alcoholics Anonymous and Reduced Impulsivity: A Novel Mechanism of Change

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.

120px-Orbital_gyrus_animation_small2

 

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.

128px-Amyg

 

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.

“Abstract

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.

Participation in Treatment and Alcoholics Anonymous

So keep taking the medicine…

“A 16-Year Follow-Up of Initially Untreated Individuals

Abstract

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:

  1. Is the duration of treatment obtained in the first year after seeking help, and the duration of subsequent treatment, associated with individuals’ long-term (16-year) alcohol-related and psychosocial outcomes? Is participation in treatment in the second and third years … after initiating help seeking associated with additional benefits beyond those obtained from participation in the first year?
  2. Is the duration of participation in AA in the first year, and the duration of subsequent participation, associated with individuals’ long-term (16-year) outcomes? Is participation in AA in the second and third years associated with additional benefits beyond those obtained from participation in the first year?
  3. Many of the individuals who participate in one modality of help (professional treatment or AA) also participate in the other modality. Accordingly, we focus on whether the associations between the duration of participation in treatment and AA and 16-year outcomes are independent of participation in the other modality of help. We also consider interactions between the duration of treatment and AA in that, for example, one modality could compensate for or amplify the influence of the other.

 

Independent Contribution of Treatment and Alcoholics Anonymous

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.

Prior Findings With This Sample

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.

Discussion

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.

Participation in Treatment and 16-Year Outcomes

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).

Participation in Alcoholics Anonymous and 16-Year Outcomes

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.

Independent Contribution of Treatment and Alcoholics Anonymous

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!

References

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

 

Abstinence is getting Sober, Recovery is getting Emotionally Sober.

A very interesting concept in recovery is the idea of Emotional Sobriety which originated with Bill Wilson who found that after 20 years of recovery he suffered badly from  depression. His decades long association with Dr Tiebout, his psycho-analyst, led him to conclude that this was partly due to how he reacted to people. He found he either tried to dominate them or emotionally depend on them.

This emotional immaturity is something we have discussed in previous blogs and may be related to an overall problem regulating our emotional behaviour.

Our emotional responses may be related to an inherent brain allostasis which seems to affect pathological wanting in various aspects of life (not just substances or behaviours – the illness of “more”), to the common emotional and stress dysregulation seen in addicts in active use and in recovery or to habitualized, maladaptive emotional responding which is the legacy of our previous active addiction, which in themselves may have been the consequence also of maladaptive self schemata borne out of childhood maltreatment, or insecure attachment or all these in combination.

As we grow older in recovery, hopefully we also emotionally  mature or become more adaptive or healthy in regulating our emotions and in our decision making and subsequent behaviour.

Ultimately how we deal with our emotions (or how they deal with us!) depends on our motivations.

Roger B offers some great insights into how to overcome this emotional neediness and live in a more emotionally sober way.