12 step recovery

Helping Others Helps Us.

Posted on by alcoholicsguide

In AA they say people who engage in service, i.e. helping out at meetings, sharing, making the tea and coffee, sponsoring others, helping on A A telephone helplines, inter group etc  have a much greater chance of staying sober and in recovery  long term than those who do not.

Although I was scared of my own shadow when I came into recovery and my brain was still incredibly scrambled and disorientated, I believe doing service in AA is one of the main reasons for me still being in recovery nearly 10 years later.

It helped me become part of AA not just someone who turned up and hung around on the periphery. 12 step recovery is a program of action not self absorbed introspection. The spiritual and therapeutic aspect of 12 step recovery is connectedness with others who have the same condition and share the same common purpose of wanting to remain sober and in recovery.

Doing service is an outward sign of one taking responsibility for their own recovery and declaring it too others in the meetings via service. When I see a newcomer to recovery start to do service it gladdens my heart as I know they have dramatically increased their chances of remaining sober and in recovery long term.

This has been my experience.

A reality, however, seems to be that most people are very anxious, lacking in confidence and fearful when they reach the rooms of AA.

When you have spent a long time drinking in increasing isolation, suddenly being at a meeting among strangers can have it’s problems.

When we go to meetings, to begin with, we are often unaware that we are actually in the company of people just like us, sensitive souls. Most have at some time at issues around social anxiety.

It is often said that this social anxiety is linked to the not belonging” feeling that many alcoholics experience throughout their lives prior to drinking.

Some have said it can be traced to insecure attachment to a primary care givers or to trauma or abuse in childhood.

Equally I have known many alcoholics who had idyllic childhoods who also have this feeling on not belonging socially, not fitting in, so I suggest that this social anxiety or not fitting in may be the result of some genetic inheritance which gets worse via the adverse effects of abuse or insecure attachment.

The vast majority of alcoholics I have met over the years have this sense of not belonging, having a “hole in the soul”.

I believe it is some neurochemical deficit, such as oxytocin deficit that has a knock-on effect on other brain chemicals, that decreases our feelings of belonging,  which  we all inherit and which can be made more severe via stressful adversive childhoods.

It often leads to isolation, being a loner, not only in adolescence but sometimes in recovery too. We seem to often like our own company but equally it is something to be wary of.

I have often heard of people relapsing after becoming isolated from 12 step fellowships. They stopped doing service, then reduced meetings and then disappeared off the scene, locked away in isolation.

So we seem to have a tendency to isolate and this may be due to many of us having social anxiety issues. Social events often seem like too much effort and this can be a dangerous thought.

So who do we cope with a room full of people?

I just came a cross a study recently which addressed how AA is almost perfect for dealing with this issue of social anxiety.

I will use some excerpts from it. It relates to youths in recovery but is applicable to all people in recovery or seeking recovery.

“In treatment, youths with social anxiety  disorder (SAD) may avoid participating in therapeutic activities with risk of negative peer appraisal.

Peer-helping is a low-intensity, social activity in the 12-step program associated with greater abstinence among treatment-seeking adults.

The benefits from helping others appear to be greatest for individuals who are socially isolated.

Helping others may benefit the helper because it distracts one from one’s own troubles, enhances a sense of value in one’s life, improves self-evaluations, increases positive moods, and causes social integration.

The myriad of existing service activities in AA are readily available inside and outside of meetings; are low intensity; and do not require special skills, prior experience, time sober, long-term commitment, transportation, insurance, or parental permission.

Peer-helping in AA, such as having the responsibility  of making coffee at a meeting, empathetic listening to others, reading inspirational meditations to others, or sharing personal experiences in learning to live sober, may have the effect of greater engagement in treatment and improved outcomes due to patients’ active contributions.

Learning to live sober with social anxiety is a challenge in society where people can be quick to judge others

Coping with a persistent fear of being scrutinized in social situations often requires learning to tolerate the opinions of others, feeling different, appropriate boundary setting, and enduring short term discomfort for long-term gain—skills that are in short supply among adolescents and those in early recovery.

The low-intensity service activities in AA offer youths—and those with  social anxiety in particular—a nonjudgmental, task-focused venue for social connectedness, reduce self-preoccupation and feeling like a misfit, and transform a troubled past to usefulness with others.

AA should be encouraged for socially anxious youths in particular.

As stated by a young adult, “I wanted to be at peace with myself and comfortable with other people. The belonging I always wanted I have found in AA. I got into service work right away and really enjoyed it”

References

1. Pagano, M. E., Wang, A. R., Rowles, B. M., Lee, M. T., & Johnson, B. R. (2015). Social Anxiety and Peer Helping in Adolescent Addiction Treatment. Alcoholism: Clinical and Experimental Research, 39(5), 887-895.

 

 

Trust

Posted on by alcoholicsguide

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.

 

How do you know when Medicating becomes Self Medicating?

Posted on by alcoholicsguide

A recent blog in the After the Party Magazine  has raised some very pertinent questions about the issue of co-morbidity in alcoholics and addicts seeking recovery via 12 step groups and suggests the extent of this co-morbidity is much higher than may have been anticipated.

This blog raises important issues but ultimately may leave more questions than it answers?

The blog starts “You hear it in 12-step meetings all the time—people who were once on psych meds discovered they didn’t need them after getting sober and doing the steps. Now they’re evangelizing at every meeting in town about how their problem was really just spiritual. Maybe they were never mentally ill to begin with or maybe the steps really did banish their mental illness right out of their brains. But for me, and plenty of others I know, this isn’t the case.”

The author then continues ” If anyone has any questions about psychiatric meds AA has an official stance that’s in a pamphlet called The AA Member—Medications and Other Drugs. ”

I referred to this pamphlet on Monday’s blog Can you be Sober and in Recovery while on Medication?

As I mentioned then the pamphlet appears to be alerting AA members to the reality that certain members “must take prescribed medication for serious medical problems. However, it is generally accepted that the misuse of prescription medication and other drugs can threaten the achievement and maintenance of sobriety”.

As the author notes this pamphlet states ” “No A.A. member should ‘play doctor’; all medical advice and treatment should come from a qualified physician.”

It also states that “Some of us have had to cope with depressions that can be suicidal; schizophrenia that sometimes requires hospitalization; bipolar disorder, and other mental and biological illnesses.

“A.A. members and many of their physicians have described situations in which depressed patients have been told by A.A.s to throw away the pills, only to have depression return with all its difficulties, sometimes resulting in suicide.

“We have heard, too, from members with other conditions, including schizophrenia, bi-polar disorder, epilepsy and others requiring medication, that well-meaning A.A. friends discourage them from taking any prescribed medication. Unfortunately, by following a layperson’s advice, the sufferers find that their conditions can return with all their previous intensity. On top of that, they feel guilty because they are convinced that ‘A.A. is against pills.’ It becomes clear that just as it is wrong to enable or support any alcoholic to become readdicted to any drug, it’s equally wrong to deprive any alcoholic of medication, which can alleviate or control other disabling physical and/or emotional problems.”

The author then suggest that ” roughly 70% people I meet in AA are on meds. A lot people are quiet about it because they don’t want the backlash…”

Is the prevalence of people taking medication in 12 step groups this high? Or is this a sample bias?

Perhaps many of the people I know in AA have simply been keeping quiet about it? I am not convinced that this figure is accurate, based on my own observations?

If this figure is representative then what co-occurring conditions are these recovering people medicating?

There are obviously a host of co-occurring conditions  that recovering people suffer from – from physical, such as back pain, to epilepsy, to anxiety disorders to depression, bi-polar, borderline personality disorder, post traumatic stress disorder, schizophrenia …in fact the list goes on.

Is it  thus reasonable of us in AA and other 12 step groups to expect that all members are medication free or that the 12 steps can treat all co-occurring conditions?

It has been suggested in a AA survey  that over 60% of recovering individuals in 12 step groups seek outside professional help for co-occurring difficulties which suggest that the trajectory of alcoholism and addiction is not straightforward and includes other co-occurring problems which may add to the severity of psychological symptoms experienced.

A very pertinent question is whether these co-occurring conditions are parallel problems or are additional problems that affect one’s addiction recovery.

By this I mean if one suffers, as I do, from PTSD, do PTSD symptoms also add to relapse vulnerability, for example. I can say for myself that the two times I have had issues with relapse have been prompted by manifestation of PTSD symptoms, such as flashbacks.

For me, at least, my co-occurring condition of PTSD affects my recovery from alcoholism and substance addiction. It is inseparable – in fact my PTSD and childhood maltreatment has contributed to my addiction.  Although it doesn’t necessarily follow that my choice of  treatment, e.g. 12 step recovery will straighten out all the factors that contributed to this addiction.

Equally the 12 step and associated fellowship and program for living may help manage this condition too?

I have not relapsed in a decade so the 12 steps etc must be helping with co-occurring conditions as these conditions have to potential to prompt relapse?

I will explain this further, below, in relation to the various sponsors I have had in recovery.

I do not medicate for this condition nor have I sought outside help although I  have considered outside help many times. Perhaps I am edging closer to that.

Equally I believe the process of recovery has helped me recover from PTSD, has made me aware of triggers, etc.

How prevalent is PTSD in addiction? Do others suffer in recovery from this co-occurring condition too?

Approximately 35% to 50% of people in addiction treatment programs have a lifetime diagnosis of posttraumatic stress disorder (PTSD), and 25% to 42% have a current diagnosis (Back et al., 2000; Brady, Back, & Coffey, 2004; P. J. Brown, Recupero, & Stout, 1995; Cacciola, Alterman, McKay, & Rutherford, 2001; Dansky et al., 1996;Jacobsen, Southwick, & Kosten, 2001; Mills, Lynskey, Teesson, Ross, & Darke, 2005;Ouimette, Ahrens, Moos, & Finney, 1997).

Is this the case in 12 step groups?

In order to examine the extent of co-morbidity in recovery I will briefly run through some of the sponsors I have had in recovery, and their co-occurring conditions – self acknowledged or not.

First sponsor – bi polar, not medicated, but also treated via outside professional help – accepts that he will occasionally have very dark days as part of his recovery. His choice is not to medicate as he feels it is a chemical straightjacket although he accepts the right of others to take medication for this condition.

Second sponsor – borderline personality disorder – not medicated – has sought professional outside help.

Third sponsor – no co-occurring conditions  – but would suggest his religiomania contributes to his absolute conviction that recovering people do not need medication of any sort that God can heal everything.

Fourth and fifth  sponsors both PTSD but not fully acknowledged nor treated outside of 12 steps.

All in long term recovery of 12 plus years.

From this very small survey it is clear that there is a common co-occurrence with other conditions, acknowledged or otherwise. There is also extensive childhood abuse of various types.

All of them have not or do not take medication. They may be in some way also be treated by the 12 steps.

I have also sponsored a person with  schizophrenia who needs to take medication because of returning psychosis if he fails to take medication.

What I am saying is that some individuals with obvious co-occurring conditions also choose not to medicate as well and feel their general “recovery” is treated by the steps and fellowship, often together with outside help. Having a co-occurring condition does not mean one automatically takes medication for this condition? Many do not?

This is why I queried the “70%” are on meds above. I do not necessarily disagree that those suffering co-morbid conditions is the majority but would query why so many take medication?

Are some of these on medication assisted treatment to curb urges and cravings too?

In terms of so-called co-occurring disorders such as anxiety and mood disorders such as generalized anxiety disorders (GAD) and major depression (MDD), research has shown that these symptoms often dissipate in the early weeks of recovery.

This had led researchers like Mark Shuckit to call these substance induced disorders and to suggest that co-occurring disorders such as GAD and MDD are distributed in recovery populations as they are in normal population at around 15% prevalence.

This is why I think some 12 steppers are “anti med” as they often see the symptoms of GAD and MDD dissipate in early recovery and thus believe the steps are treating these disorders successfully.

Although these disorders are but temporary substance induced disorders for many, however, for 15%, at least, these conditions of  GAD and MDD are possibly what they suffer from too in recovery.

Regardless of that caveat if we add this 15% to up to 50% who suffer PTSD and the possibility of the occurrence of other conditions such as borderline, bi polar, etc we get closer to the 62% figure of AA respondents that an AA survey in 2012 states  received some type of treatment or counseling, such as medical, psychological, spiritual, etc., (and 82% of those said it played an important part in their recovery from alcoholism).

Whether these conditions require medication is a matter for the person and their sponsor in discussion with medical professionals and not some layperson “medical expert” as often abounds in AA and other 12 step groups.

The issue here is not simply co-morbidity  but whether this co-morbidity is an intrinsic part of the aetiology of addiction from a vulnerability to a relapse  factor. In other words, have other conditions meshed into the overall condition of addiction? Can they be treated by the same treatment?

Regardless,  they often have to be treated  separately.

To conclude it seems that 12 step groups need to appreciate that co-occurring conditions, self acknowledged or not, play an important part in recovery and relapse as well as in the aetiology of addiction.

How effectively the medication used can be dissected from the condition of addiction is still debatable for many?

In short, many feel being on medication impedes full recovery.

How we define full recovery is open to question? Recovery can be measured using many variables related to quality of life. If medication using members feel their lives are steadily improving then who are we to judge?

Equally just because one suffers a condition does not inevitably mean it must be medicated, some of the examples above have “treated”  their co-occurring conditions via the 12 step program of recovery.

I think ardent fans of the right to medication should appreciate that there is a valid counter argument – they may have the same rights to their point of view as the author of this  blog?

All of us has the right to think as they wish and to express their views also.

Live and Let Live may be apropos, we all have the right to be wrong, Love of others is our code.

Alcoholics are such absolutist thinkers, all or nothing, black and white thinkers at times. Recovery is also considering others and their points of view?

Personally speaking if I sponsor, I take it on a case by case basis.

I have had only one sponsee out of 7 who has been on medication.

It is for sponsor, sponsee and family as well as medical professionals to contribute to the debate on continued medication.

My lasting concern, however is the 70% figure cited in this blog. It does not tally with my experience of recovery.

Another part of the AA pamphlet cited also warns,

“Experience suggests that while some prescribed medications may be safe for most nonalcoholics when taken according to a doctor’s instructions, it is possible that they may affect the alcoholic in a different way…”

Again this seems to be alerting us to the question when is medicating actually self medicating?

 

 

This has been my main experience with medication, that those taking them do not always look completely sober.

In order to recovery fully perhaps we have to be fully sober first?

I will continue this discussion in Part 2 of this blog when I discuss also whether considering alcoholism purely as a “spiritual malady” complicates this argument.

In the DSM manual 75% of the disorders contained therein have emotion dysregulation at the centre of their condition. I believe alcoholism and addiction also have although not acknowledged.

Insted DSM states the emotional dysfunction seen in addiction is the result of some of co-morbidites mentioned above. I disagree.

Is it not about time we got our heads together and agreed on what the hell we suffer from?

Isn’t addition an emotional disorder in it’s own right compounded by other co-occurring conditions?

Then we will be in a position to discuss how the 12 steps can treat this condition and related conditions of emotion dysregulation?

The main issue for the blog addressed, is that the author, and many others, cannot understand how a spiritual malady has anything to do with their other conditions, when, in reality, alcoholism is another type of disorder, similar to that with which it often co-occurs .

More on this later…