recovering alcoholics

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.

 

 

Filling that “Hole in the Soul”

When I first  arrived in AA I was told by a big scary looking man that in AA you will get better.

That “we will help you by loving you back to health”.

I was quite alarmed by this situation to be honest “loved back to health”? Was this guy some relic from the hippy era?

What he said, was very threatening to me. It suggested unconditional love, a concept that I was only partially familiar with.

I had always knew my father loved my unconditionally but this was less the case with my mother. I knew she loved me in her vague, through a  distant Valium haze but part of me was always reaching out, crying out for more. More love.

I found that love in liquid form in alcohol. Or so I felt. Alcohol was constant. It always delivered without fail, transported me to the person I would much rather be. Allowed me to escape the person I did not want to be.

I now accept my mother suffered from addiction just like me and I have immense compassion for her because of that, she did the best she could under the circumstances. I forgive her completely and love her completely.

She was not a bad person she as an ill person just like me.

Did this relationship with my primary care giver have any effect on my teenage drinking and later alcoholism?

Like many alcoholics I have spoken to over the years I too seemed to suffer from the  “hole in the soul” they spoke of.

That not feeling whole, like something in you, some part of you was missing.

Having a curious mind, I always wondered what it could be? It must be something that can be discovered? I wasn’t happy to leave it was a vague spiritual condition.

It felt too emotional just to be a spiritual thing, although it is also that.

It felt like I was lacking in something, something in my make up was not there or in diluted measure?

Later I found out that this relationship with my mother was called an insecure attachment and that lots of people in recovery had this insecure attachment with their mothers or whoever reared them.

This insecure attachment they said often resulted in novelty seeking and hunting out some “secure attachment” elsewhere, in a bottle, syringe, sex, a poker machine, food or other addictive behaviours.

It is lonely recently that I found there is a brain chemical linked to this insecure attachment called oxytocin, the “love chemical” which effects all the neurochemical said to be involved in addiction.

Oxytocin is badly affected by the stress reaction to insecure attachment, abuse trauma and a tough upbringing. The oxytocin is then reduced which reduces the other chemicals too and we search for these at the bottom of a glass.

Unfortunately alcohol seems to give us cocktail of these chemicals in liquid form. But never enough.

For a while anyway, it gives us the illusion of attachment, of that fleeting feeling of being part, of being loved.

Through the years all these chemicals start running dry and the drink stops working.

We are then left with the problems we had before we put a glass to our mouths.

So when the drink stopped working and I had to go to AA – not one wants to go  there, let’s face it, it’s because we have to!

So the big scary guy may have been right all along. I have found that he is right over the years of attending AA.

I have found a new, surrogate family  in AA, a “learnt attachment” within the fellowship of others in the same boat as me, who have felt the same as me. I have found this attachment to others, by being looked after and trying to help others – my oxytocin, the “love chemical” the “cuddle chemical” has gone up dramatically while my stress has plummeted as I have bonded with others in recovery.

This connectedness is my spiritual solution to a neurobiological problem.

I now feel part of for the first time, I have filled the hole in the soul with love given and received.

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 (Part 3)

“This story is only starting to be told.

We have much work to do … to challenge the stereotypes of both the general public and our own professionals.

Addiction may well be a chronic, relapsing condition but people can and do recover.

They can change and that change is not only personal but social and societal.”

COMPARISONS:

US & AUSTRALIAN LIVES IN RECOVERY

In the US, a total of 3,228 people completed the online survey and as in the Australian survey just over half of the sample was female.

The samples were also very similar in that the mean length of the substance using career was 18 years in the US and 18.6 years in Australia. The average ages of recovery initiation were also very similar – 34.8 years in Australia and 36 years in the US.

While 75.2% of the US sample described themselves as being ‘in recovery’ and 13.7% as recovered, this was true for 79.8% and 6.3% respectively in Australia.

In terms of problem profile, primary alcohol was the problem for 29% in the US and 35% in Australia, drugs only for 13% in the US and 11% in Australia, and both alcohol and drugs for 57% in the US and 54% in Australia.

In terms of their pathway to recovery, 70.5% of the US sample had received formal treatment, compared to 69.8% in Australia; 94.6% of the US recovery group had attended 12-step meetings compared to 82.0% of the Australian sample. Although a wide range of other mutual aid groups was reported, there was much less frequent use of mutual aid groups other than 12-step in Australia.

There is a higher rate of lifetime mental health problems in Australia – while 62.4% of the US sample had been treated for a mental health condition, 91.5% of the Australian sample reported lifetime mental health problems and 56.8% reported current involvement with mental health services. In the US, 55.6% had a bachelor or graduate degree, while this was true for 41.4% in Australia. At the time of the survey, 70.8% of the US sample was employed compared to 68.2% of the Australian participants. Thus, it is reasonable to conclude that the histories and careers of the Australian sample were very similar to their American counterparts.

THE IMPACT OF RECOVERY IN THE US AND AUSTRALIA

The most dramatic and powerful findings of the US survey, that addiction involves “many heavy costs … to the individual and to the nation” and that “recovery from alcohol and drug problems is associated with dramatic improvements in all areas of life” (FAVOR, 2013, page 1) are clearly replicated in the Australian context.

As in the US, where 4 out of 10 individuals experienced financial problems while in recovery, this was also the case for around one in 3 in Australia who owed back taxes and / or had bad debts. However, there were dramatic effects in Australia as in the US of family functioning with significant reductions in domestic violence.

The Australian study also successfully replicates the US findings around health and criminal justice – with marked improvements in positive health markers such as regular exercise, registering with a GP and regular dental check-ups and significant reductions in negative health factors such as ED attendance and untreated psychological problems.

As in the US sample just over half of the Australian sample had a lifetime arrest history (although significantly fewer Australians in recovery had been incarcerated following sentence), the reduction in arrests and in any involvement with the criminal justice system was even more dramatic – around 40% of the US sample and 90% of the Australian sample had no criminal justice system involvement while in recovery.

There were similarly positive differences in work and study – showing the same overall pattern of reduced burden to the taxpayer and the same improvement in personal, family and community wellbeing and connectedness.

CONCLUSIONS

Similarly, there is a dramatic reduction in involvement with the criminal justice system from around half to less than one in ten, particularly involving the areas of drink-driving and criminal damage. There is also a dramatic improvement in both employment and education, and in successful engagement and retention of jobs. This is a story of overcoming adversity and transforming lives to make a significant and positive contribution in their families, in their communities and to society. These results are consistent with the findings of the US Life in Recovery Survey (Laudet et al, 2013) in showing dramatic reductions in pathology and improvements in wellbeing from active addiction to recovery. This is the first attempt at undertaking a recovery survey in Australia and the results are unequivocal in showing that there is an accessible population of Australians who will classify themselves as being in recovery or recovered and who are willing to complete a survey about their experiences.

There is a critical message here for policy makers and treatment providers – that people in Australia can and do recover from addiction problems.

However, there are two nuanced factors that are important to emphasise.

The first is that this is a long and challenging journey for many people and that there will still be residual and ongoing problems for many throughout the recovery journey.

However, there are two nuanced factors that are important to emphasise. The first is that this is a long and challenging journey for many people and that there will still be residual and ongoing problems for many throughout the recovery journey

The findings also emphasise the fact that those in recovery are a very diverse population and that there is no single road to recovery, with a proportion of those participating describing themselves as in ‘medication-assisted recovery’ and a much larger population having ongoing contact with specialist services for addiction or mental health issues.

Nonetheless, the transition reported from active addiction to recovery is a dramatic one.

This is particularly striking in key areas around social and family functioning where the rate of involvement in domestic violence decreased from more than 50% to less than 10% and in volunteering where participation increased from less than 20% to more than 50%.

Similarly, there is a dramatic reduction in involvement with the criminal justice system from around half to less than one in ten, particularly involving the areas of drink-driving and criminal damage. There is also a dramatic improvement in both employment and education, and in successful engagement and retention of jobs.

This is a story of overcoming adversity and transforming lives to make a significant and positive contribution in their families, in their communities and to society.

These results are consistent with the findings of the US Life in Recovery Survey (Laudet et al, 2013) in showing dramatic reductions in pathology and improvements in wellbeing from active addiction to recovery

Those in recovery for the longest term report markedly higher levels of psychological wellbeing and quality of life and much lower levels of need for professional support for emotional or mental health issues.

The other more surprising domain of consistency with the US results is around the demographics and career factors of those who took part. Average age at time of survey completion, average duration of recovery and average length of addiction career are all markedly similar across two countries with differing cultures, treatment systems and philosophies around addiction and recovery.

RECOMMENDATIONS

POLICY RECOMMENDATIONS

It is critical that the implications from the Australian Life in Recovery survey are acknowledged and addressed at a federal, state and local level to ensure that the achievement of recovery is extended across families, communities and professional settings (such as health and legal systems).

As such, the following policy recommendations are suggested for consideration:

1. Policy makers should acknowledge and recognise in drug and alcohol commissioning the key role that recovery organisations play in the initiation and sustaining of recovery journeys that benefit wider society and challenge stereotypes and stigma around addiction

2. Greater policy and funding commitment to recovery support services to ensure that those who initiate recovery journeys are supported to maximise their own wellbeing and their contributions to family and community

3. That greater funding is provided for alumni and aftercare organisations to enable the informal community support that is essential to build recovery capital and recovery communities

This story is only starting to be told.

We have much work to do – and we hope to do this through academic publications and presentations – to challenge the stereotypes of both the general public and our own professionals.

There is one core message that the data presented here in Australia and by FAVOR in the US

Addiction may well be a chronic, relapsing condition but people can and do recover.

They can change and that change is not only personal but social and societal.

The next step on this journey is to repeat and augment this work. At the date of publication this survey has already been approved and will be conducted in the UK and we we await the survey outcomes with great interest.

This survey has already followed in the footsteps of the FAVOR survey with almost no resources and supports and we should aim both to do this in more countries and to continue to repeat the surveying to allow us to map global changes and implications in recovery pathways (see final recommendations below).

LIFE IN RECOVERY SURVEY RECOMMENDATIONS

1. That the ‘Life in Recovery survey’ is undertaken in other countries to increase the comparability and so that a shared evidence base can be generated.

2. That repeat surveys are undertaken in Australia to assess change in the nature of the recovering population and in the journeys and stories they provide.

3. That the results from this survey are widely distributed and used to contribute to the policy debate about recovery in Australia.

4. That the results from the current survey are used for academic journal publications to augment the empirical evidence base around recovery.

http://www.southpacificprivate.com.au/sites/default/files/2015%20Australian%20Life%20In%20Recovery%20Survey.pdf

 

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.

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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.

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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.

A Brief History of Controlled Drinking – the Irrationality of Science

In a recent blog a few days ago I challenged some of Gabrielle Glaser’s “evidence” in her article   “The Irrationality of Alcoholics Anonymous “, which purported to demonstrate the so-called effectiveness of “controlling drinking”.

Glaser cited the following in her article

“ To many, though, the idea of non-abstinent recovery is anathema. No one knows that better than Mark and Linda Sobell, who are both psychologists. In the 1970s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence.

Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely.”

I responded to this as follows

” What Glaser failed to mention was that in a subsequent study (4) 10-year follow-up of the original 20 experimental subjects showed that only one, who apparently had not experienced physical withdrawal symptoms (thus possibly not alcoholic), maintained a pattern of controlled drinking;

eight continued to drink excessively–regularly or intermittently–despite repeated damaging consequences;

six abandoned their efforts to engage in controlled drinking and became abstinent;

four died from alcohol-related causes;

and one, certified about a year after discharge from the research project as gravely disabled because of drinking, was missing.

Why did Glaser failed to mention this research, a follow up study to the one she mentions and cites?”

The authors attempted to justify this choice in a statement that seems to clearly demonstrate their bias: “we are addressing the question of whether controlled drinking is itself a desirable treatment goal, not the question of whether the patients directed towards that goal fared better or worse than a control group.. .” (Pendery et al., 1982, 172-173)

The interesting aspect about her article for me (and most worrying) was that it highlighted a controversy that goes back to the 1960s – can alcoholics ever control their drinking?

In this blog we will address the origins of this “controlled drinking debate” and demonstrated how it is a castle built on sand.

The original study which supposedly demonstrated so-called controlled drinking or asymptomatic drinking in it’s alcoholic participants did no such thing.

So we now have an ongoing debate about controlled drinking when it has continuously been based on dubious research, bogus findings and bad science.

It is the researchers that Glaser champions that could be accused of irrationality.

The methodological madness started way back in the 1960s.

 While scattered reports of controlled drinking outcomes had occasionally appeared in the scientific literature before 1962, most commentators date the beginning of the controlled drinking controversy to the publication that year of a paper entitled “Normal Drinking in Recovered Alcohol Addicts.” In this paper, D.L. Davies, a British psychiatrist, reports that, in the course of long-term follow-up of patients treated for “alcohol addiction” at Maudsley Hospital in London, 7 of the 93 patients investigated “have subsequently been able to drink normally for periods of 7 to 11 years after discharge from the hospital.” (Davies, 1962, p. 94).

At least two different studies have challenged the findings of Davies:-

“Evidence suggests that five subjects experienced significant drinking problems both during Davies’s original follow-up period and subsequently, that three of these five at some time also used psychotropic drugs heavily, and that the two remaining subjects (one of whom was never severely dependent on alcohol) engaged in trouble-free drinking over the total period”

http://www.ncbi.nlm.nih.gov/pubmed/4010292

“A subsequent follow-up of these cases suggested that Davies had been substantially mislead”

http://www.ncbi.nlm.nih.gov/pubmed/7956756

So four decades of research into controlled drinking were inspired by a study which did not actually demonstrate controlled drinking in the first place!

In addition to the Sobells, Glaser also mentioned the Rand Report of the 1970s.

“In 1976, for instance, the Rand Corporation released a study of more than 2,000 men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that it was possible for some alcohol-dependent men to return to controlled drinking. Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. The NIAAA, which had funded the research, repudiated it. Rand repeated the study, this time looking over a four-year period. The results were similar.”

The first Rand Report was attacked as being methodologically weak  – e.g  it suffered from sample bias (80% of subject dropped out).

The Rand Corporation did a follow up 4 years later.  This time they reported that a smaller figure of 14% of the sample  continued to drink in an unproblematic manner  but other researchers reanalyzing the data arrived at a corrected estimate of 3-4% of the sample were drinking in a nonproblematic manner.

3% is somewhat less than the 22% – why does Glaser not cite these other follow up studies again?  It is difficult to accept any of her arguments as  she picks only studies that support her biased arguments.

jaywalker-t-shirt-men-s_design

It was also noted that alcoholics can often be expected to drink in a non problematic manner for brief periods. In my own experience, I have often heard of alcoholics share about a relapse and state that they thought they had their alcoholic problem licked as they started off drinking in what appeared to be a controlled manner only to find in a matter of weeks that their alcoholism had progressed far beyond it’s original severity prior to the relapse. In other words it can take a relapse some weeks to kick start into even more profound alcoholism than previously.

Researchers need to spend more time around alcoholics to observe what we have learnt through very painful experience, instead of theorising about this reality from academic ivory towers.

As the Big Book of Alcoholics Anonymous states in Chapter 3  “Most of us have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows. Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death. We learned that we had to fully concede to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed. We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals –usually brief—were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.”

 

Why Alcoholics Anonymous Works

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)

Why Alcoholics Anonymous Works

“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.”

 

 

France - Alcoholic Anonymous celebrates its 75th year

 

 

 

Healing Communities via Recovery

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

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

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

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

 

Recovery: can you feel “Better than Well!”?

Degrees of Recovery?

Better than Well – I love this concept and reality and relate to it myself. This is a reality for many recovery people who feel they had an amplified recovery or in simple terms, people who got better than well!

This people did not simply have the pathology of addiction extracted from their lives. These people did not only go on to recover but went on to live incredibly rich lives in terms of the quality of their lives and the service to their communities.

These are people who talk about addiction and recovery as a blessing! These are individuals who suggest that what they achieved after recovery was not in spite of their recovery but because of the strength they drew out from their addiction recovery.

Their fulfillment of life was greater perhaps than if they had never been addicted and suffered from addiction. Their recovery from addiction gave them a meaning that they may not have had, if they had not been addicts.

I believe I am 25% smarter in recovery (can be proved in terms of exam grades), I understand people now in recovery, I am a more empathetic human being in recovery. My life is immeasurably better than it was before. I have a contentment unknown to me previously. A peace of mind I thought impossible.

My roots grasp a new soil! I feel like I have been reborn.

This kinda fits in also with Bill White’s description of recovery as a method of transcending the self or “getting out of self”. This idea and reality relates to various previous blogs on why we need to live “outside” self regulation” systems of the brain as these appear to have been hijacked by the effects of drug and behavioural addiction.

One way of doing this is by using our self in a different way, to use self to serve others. This way we can use our stories to help others in recovery and improve our own self regulation as it strengthens areas of the brain like the ventromedial pre frontal cortex used in self referential information and emotional regulation.

We can get reward not from drugs or behaviour but by helping others which supplants the depleted dopamine, natural opioids, oxytocin of increased attachment and bonding and the serotonin of well being. It improves our orbitofrontal cortex as we become more empathetic, begin to become emotional literate, reading emotional expression in other’s faces.  It reduces stress and distress. Lowers glutamate and increases GABA. We become less fearful and more serene.

Helping others helps us so profoundly.  It changes the neurobiology and hence neuroplasticity of our brains.

The video ends with a brief look at the “hot flash” spiritual awakening of recovery a la Bill Wilson and  the slower more incremental or “educational” variety of spiritual awakening. For me, spiritual awakening can mean emotional catharsis, sometimes so dramatic that it immediately changes how we think and feel about the world and our place in it or the more experiential, where our views and attitudes to the world gradually change. Each leads to the same goal of long term recovery. The latter being, by far, the most common.

 

So What is Recovery?

So, what does recovery mean? It is total abstinence? Is recovery strictly a question of substance use or is there more to it than that?

This study (1) addressed two primary research questions: (1) Does recovery require total abstinence from all drugs and alcohol? and (2) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well?

Many of those in this study who defined recovery as abstinence went on to express the idea that using any mood altering substance would lead back to full-blown relapse.

Recovery meant  in descending order: a new life (22%), well-being (13%), a process of working on yourself (11.2%), living life on life’s terms (accepting what comes – 9.6%), self-improvement (9%), learning to live drug free (8.3%), recognition of the problem (5.4%), and getting help (5.1%).

“I’m in recovery myself because I want to stay clean. And I want to be a responsible person or responsible human being. To do what I was … what I should do or what God put me here to do. And, you know, I got to – I got to remain sober to do these things.”

“To me recovery means getting back what I lost. Myself. I am not talking about materialistic things. I am talking about me.”

“Recovery, I just.. What is it for me? It’s going back to me…

“My definition of recovery is life. Cause I didn’t have no life before I got into recovery.”

 

Qualitative data on recovery definitions provided by the 20.4% of individuals who did not consider themselves in recovery are particularly noteworthy as they echo some of the popular connotations the term ‘recovery’ carries in the general public. Some of the answers were expected, including those of individuals who may have never considered themselves in recovery (e.g., “I wouldn’t know how to define recovery because I’ve never been in it,” “I’ve heard of the term, but I don’t know. What is it? I guess, it’s being committed to being straight”), and individuals who may have relapsed (e.g., “it used to feel free and happy without using”).

About one third of the answers from individuals not in recovery echo the public’s perception that recovery means people are ‘trying’ to remain abstinent: “Someone who is currently on guard about falling off the wagon at any moment.” The idea that for some, recovery suggests a struggle with drugs and/or alcohol is further supported by a number of respondents who indicated that they are not in recovery because they are not experiencing drugs and/or alcohol problems; for example: “Recovery… I don’t know, a glass of wine ain’t nothing to me” and “it’s not a battle for me- I don’t have to recover from anything.” The connotation of recovery as a struggle with substance abuse problems and statements from participants who felt they had overcome their problem suggest that recovery is understood by some as having had a severe problem. This is consistent with the image of AA being a place only for ‘skid row drunks.’

The majority of qualitative recovery definitions among participants who didnot consider themselves in recovery indicated that a specific action … was a necessary part of recovery.

The bulk of the answers implying a specific recovery requirement, however, concerned needing or seeking help – getting treatment and/or participating in 12-step recovery: “Being in treatment and not using drugs or alcohol,” “Abstaining and seeking outside help.” Several answers suggested that recovery implies needing to seek outside help because you cannot quit on your own: “Having trouble quitting, needing help,” “when you get some help, like detox, a program or something-not when you just stop on your own,”…

Benefits of recovery – While participants’ definitions of recovery may speak as much to semantics (i.e., the use of the term ‘recovery”) as to their experience, answers about what is or would be good about being in recovery illuminate the recovery experience itself. Regardless of the term used,significant behavior change takes time, it is challenging and stressful.

The most frequently cited benefit of recovery, mentioned by one third of participants, is that it is a new life, a second chance (“like being born again, not living a state of denial, enjoying life better, whole new wonderful feeling, health, financially”); one quarter (23%) cited being drug-free; other benefits cited in were: self-improvement (22.7%), having direction, achieving goals (17.5%), improved/more positive attitude (17.2%), improved finances/living conditions (16.2%), improved physical and/or mental health (16.1%), improved family life (13%) and having friends/a support network (11%).

Recovery: Process or endpoint? –

One of the more controversial issues when speaking of ‘recovery’ is whether it is process (with no specific endpoint) or a state (i.e., whether one is ever ‘recovered”). This question has potentially critical ramifications especially in terms how recovery is perceived by the public and indirectly, in terms of stigma and discrimination (e.g., prospective employers who view recovery as a lifelong process may be more likely to not hire a prospective worker in recovery for fear he/she will relapse or be unreliable). Findings were reviewed earlier suggesting that the public defines recovery as an attempt to stop using drugs and alcohol, suggesting that it may not be attainable.

Thus while maintaining recovery may be a lifelong process (e.g., maintaining certain practices), it is important to determine whether or not the process is lived as having an end (being recovered). In the US, the view of addiction as a chronic disorder, paired with the strong 12-step influence (“once an addict always an addict”) would suggest that recovery is a never-ending process.

Participants made qualitative statements that speak to whether one ever ‘gets there” – i.e., becomes recovered, suggesting that consistent with the disease model of addiction, recovery is a process with no fixed end point, and that it requires ongoing work

“Recovery is getting back some sort of order in your life, the disease is in remission- it’s not a cure- it has to be maintained daily.”

“Recovery is somewhere people think they’re going to get to and you’ll never get there.”

“I don’t think you ever recover from it, it’s learning how to manage it, stay abstinent & become a productive member of society.”

“you’re never recovered, I mean, it’s always ‘gonna be back there.”

“I think recovery’s a process. Um… for me, it’s just always trying to better myself. Um… and realizing that there may not be an end point, but just a… you know, they always say, like, sometimes it’s better to go through it than to get there.”

“I’m still on this journey because there is hope, you know. There is not a cure. But there is hope.”

“And I keep myself in the right, atmosphere or attitude or what not because there is a whole lot to recovery, you know. It ain’t just getting sober and staying clean. It is like you gotta do a lot of work.”

 

Discussion

Prior exposure to treatment and to 12-step fellowships, both of which encourage embracing abstinence as recovery goal, was significantly associated with defining recovery as total abstinence. Interestingly, both individuals who do and do not consider themselves in recovery embraced abstinence as their definition of recovery. While substance users are often ambivalent about quitting drugs, individuals with a long and severe history of substance use who seek remission may come to the conclusion that total abstinence is required from personal experience with relapses and attempts at controlled use. Most failed remission attempts are based on moderation and abstinence proves more successful (e.g., Burman, 1997; Maisto, et al., 2002). Greater lifetime addiction severity was associated with endorsing abstinence, and some participants who did not consider themselves in recovery indicated that recovery implies struggling and/or needing outside help.

BACK TO ME: DISCOVERY AND RECOVERY

With respect to scope, recovery goes beyond substance use for most. This is consistent with 12-step tenets (e.g., “but sobriety is not enough,” Alcoholic Anonymous, 1939/2001, p. 83). Frequently used expressions to define recovery were ‘a new life,’ ‘a second chance,’ or, life itself. The verb “to recover” is defined as (1) to get back : REGAIN; (2) to bring back to normal position or condition; (3) to make up for; (4) to find or identify again; and (5) to save from loss and restore to usefulness: RECLAIM (Merriam Webster).

Several participants framed this notion as regaining something that was lost – the opportunity of becoming what they were meant to be before they started using drugs and alcohol (section 3.4.2). The Big Book expressed this as “We were reborn” (AA, 1939/2001, p. 63).

NO SUCH THING AS GRADUATING: RECOVERY IS A PROCESS RATHER THAN AN ENDPOINT

Reclaiming oneself is a process of growth and a process of change in attitudes, thinking and behaviors consistent with the rich descriptions and experiences documented by Stephanie Brown (1985).

Recovery as a process should not be interpreted as inconsistent with recovery as abstinence; rather abstinence (a state) is viewed as a requirement of the ongoing process of recovery.

The work of change is what distinguishes recovery from mere abstinence (“You could stop doing anything that you want. It’s about the change that comes in—into it, that’s the recovery part.”). The process aspect of recovery has been reported previously in studies conducted among alcohol- and drug-dependent samples both in the US and abroad (e.g., Blomqvist, 2002; Flynn et al., 2003).

A small-scale study of drug-dependent persons abstinent for an average of 9 years sheds light on the stages of the process(Margolis et al., 2000). Participants reported first passing through a phase almost solely focused on staying abstinent, particularly the first year. Only once this foundation (abstinence) was established could they concentrate on “living a normal life,” where abstinence was no longer the main focus.

Finally, following that transitional period, the individual enters late recovery, a time of individual growth and search for meaning. Our findings on the focus of recovery definitions are consistent with these stages: individuals in remission 18 to 36 months (the transition phase) were more likely to define recovery as a process whereas those in remission three years or longer were more likely to focus on the ‘new life’ aspect of recovery and less likely to define recovery in terms of substance use.

Recovered?

Conceptualizing recovery as a process leads to the question of whether one ever ‘gets there” – whether one is ever “recovered.” This is rarely discussed in scientific literature. Most participants regard recovery as “an ongoing process. There’s no such thing as graduating.” This is consistent with the disease model and with prevalent view of addiction as a ‘chronic’ condition (McLellan, Lewis, O’Brien, and Kleber, 2000; White, Boyle and Loveland, 2002); it is also consistent with reports that resolving addiction often takes multiple attempt and treatment episodes (e.g., Dennis et al, 2005; Laudet & White, 2004).

Other biomedical fields have reached consensus about what clinical ‘remission’ means (e.g., five years disease free in oncology). Whether and when SUD remission ever becomes ‘stable’ in terms of substance use (i.e., when the risk of return to drug use is minimized) remains somewhat unsettled.

Three to five years is the timeframe most commonly used (Finney and Moos, 1991; Flynn et al, 2003; Longabaugh & Lewis, 1988; Timko et al., 2000; Vaillant, 1983/1995) and it corresponds to the experiences of persons in long-term recovery (Margolis et al., 2000). While the risk of relapse does not completely disappear after three or even five years of continuous abstinence (e.g., Hser et al., 2001), it appears to be minimal (e.g., Vaillant, 1983/1995).

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Addiction is a chronic condition; there may not be a complete or permanent solution (i.e., the risk of relapse may remain for multiple years) but it can be treated and managed. There are many paths to recovery (e.g., Moos & Moos, 2005) but treatment is most often needed when dependence is chronic and severe.

Our findings suggest that for severely dependent individuals, recovery is a process of change and growth for which abstinence from alcohol and others drugs is a prerequisite.

McLellan and colleagues (2005) have made the argument that “Typically, the immediate goal of reducing alcohol and drug use is necessary but rarely sufficient for the achievement of the longer-term goals of improved personal health and social function and reduced threats to public health and safety—i.e. recovery” (p. 448). This conceptualization of clinical outcome is consistent with the World Health Organization’s conceptualization of health as “a state of complete physical, mental, and social well-being, not merely the absence of disease” (1985, p.34).

The question remains : whether we are willing to pay for positive health (wellness) oriented services for substance dependent populations is unclear.

Present findings suggest that the benefits of recovery are many (improved health, life conditions, social life etc.) and they are highly valued. Quality of life (QOL) among active users is poor and abstinence, especially sustained abstinence, is associated with QOL improvements (e.g.,Donovan et al., 2005; Foster et al., 1999; Laudet et al., 2006; Morgan et al., 2003).

Higher life satisfaction prospectively predicts sustained remission (Laudet, Becker & White, in press; also see Rudolf & Priebe, 2002) and low QOL may heighten relapse risk (Claus, Mannen & Schicht, 1999; Hoffmann & Miller, 1993). Thus the clinical goal of addiction treatment must go beyond fostering reduction in substance use to improving personal and social health.

The addiction field can seek guidance from the mental health field where…in a working definition set forth in the New Freedom Commission on Mental Health: “Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities” (2003, p.5).

How do clinicians foster recovery? Vaillant (1983/1995) described the conditions necessary to the recovery process as abstinence, substitute dependencies, behavioral and medical consequences, enhanced hope and self-esteem and social support in the form of unambivalent relationships. Persons in recovery consistently cite the support of family and peers (and the need to seek and accept support), spirituality, inner strength and the desire to get better as critical sources of strength (e.g., Blomqvist, 2002;Flynn et al., 2003;Laudet et al., 2002,).

Many clients initiate treatment due to external pressures (family, legal, employment) and may not be initially motivated for change; however, once in the therapeutic environment, even externally motivated clients (e.g., legally mandated) may reflect on their situation and accept the need for treatment (Kelly, Finnney & Moos, 2005). The cessation of substance use is often preceded by a period of cognitive preparation (akin to the contemplation stage Prochaska & DiClemente, 1992 – e.g., Burman, 1997and2003; Sobell et al., 2001); participating in treatment during this period may significantly enhances motivation for change by introducing the notion that behaviors and activities that are not drug-related could have healthier consequences and provide more satisfying reward possibilities (Burman, 2003), thus ‘raising the price’ of subsequent substance use and enhancing the likelihood of abstinence.”

 

There are also the financial implications of spending money on effective treatment for those who wish to recover rather than counting the cost of increased crime, prison sentences, extensive medical care,  etc etc. It makes economic sense to spend money in a preventative sense in addiction, as well as being simply a moral decision  to medically treat those who are chronically ill. First do no harm is part of the Hippocratic Oath. Can we say that spending huge amounts of money on harm reduction, controlled use programs, methadone scripts etc etc is actually “treating” alcoholics and addicts?

To quote Russell Brand, that is “like putting a sticking plaster on a broken soul” – it only sustains the problem not alleviating or treating the underlying conditions.

We can help society and families recover also from the effects of alcoholic and addict behaviour. Recovery involves improved well being for family and society members too.

We have to offer a chance to start over, to have access to a new life much better than we could ever have imagined.

Recovery cannot really be about giving you reduced amounts of whatever is poisoning you, ailing you. It cannot be about substituting one drug for another. Substituting one addictive behaviour for another. It cannot be about yet another chemical straight-jacket or prison.

Recovery has to be about getting better. Improving well being. This is what increased in health when a treatment is successful so why should it be different for addicts and alcoholics.

Many millions of people recover from their addictive behaviours, that is fact! We need to start getting this message out,  “We do recover!”

Recovery is much much better than drinking and drugging ever where. This is what we need to get across.

To be in a fairly constant state of contentment is priceless and something no drug could ever achieve!  

References

1. Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment, 33(3), 243–256. doi:10.1016/j.jsat.2007.04.014