a program of action

The psychic change as continual behavioural change?

When I came into AA I remember hearing the words “the need for a psychic change” which was the product of a spiritual awakening (as the result of doing the 12 steps) and that the 12 steps are a program of action!

The Big Book of Alcoholics Anonymous clearly states this need “The great fact is just this, and nothing less: That we have had deep and effective spiritual experiences* which have revolutionised our whole attitude toward life, towards our fellows and toward God’s universe.”

The question is whether this spiritual change is the result of behavioural change?

As I was told when I came into recovery that if I did not change my actions, and how I acted in this world, my actions would take me back to where my actions had taken me before – back to drinking.

This is the cornerstone of AA recovery; thinking, feeling differently about the world as the result of acting differently in the world, as to when we were active drinkers.

Otherwise one does the same things and ends up in the same places, doing the same things, namely drinking. It is a behavioural revolution; a sea change in how we act.

In line with this thinking, it is we that need to change, not the world.

According to one study (1) which examined whether personality traits were modified during prolonged abstinence in recovering alcoholics, two groups of both recovering and recently detoxified alcoholics were asked via questionnaire to  see if they differed significantly from each other in three personality domains: neuroticism, agreeableness and conscientiousness.

The recovering alcoholics were pooled from self help groups and treatment centres and the other group, the recently detoxified drinkers were pooled from various clinics throughout France.

Patients with alcohol problems obtained a high “neuroticism” score (emotions, stress), associated with a low “agreeableness” score (relationship to others).

In the same vein, low “conscientiousness” scores (determination) were reported in patients who had abstained from alcohol for short periods (6 months to 1 year).

In this study, recently detoxified drinkers scored high on neuroticism. They experienced difficulty in adjusting to events, a dimension which is associated with emotional instability (stress, uncontrolled impulses, irrational ideas, negative affect). Socially, they tend to isolate themselves and to withdraw from social relationships.

This also ties in with what the Big book also says “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were unhappy, we couldn’t seem to be of real help to other people.“

In contrast, regarding neuroticism, they found that recovering persons did not necessarily focus on negative issues. They were not shy in the presence of others and remained in control of their emotions, thus handling frustrations better (thereby enhancing their ability to remain abstinent).

Regarding agreeableness (which ties back into social relationships), the researchers also found that recovering persons cared for, and were interested in, others (altruism). Instead, recently detoxified drinkers’ low self-esteem and narcissism prevented them from enjoying interpersonal exchanges, and led them to withdraw from social relationships.

Finally, regarding conscientiousness, they observed that, over time, recovering persons became more social, enjoyed higher self-esteem (Costa, McCrae, & Dye, 1991), cared for and were interested in others, and wished to help them.

They were able to perform tasks without being distracted, and carefully considered their actions before carrying them out; their determination remained strong regardless of the level of challenge, and their actions are guided by ethical values. Instead, recently detoxified drinkers lacked confidence, rushed into action, proved unreliable and unstable. As a result, lacking sufficient motivation, they experienced difficulty in achieving their objectives.

Recovering persons seemed less nervous, less angry, less depressed, less impulsive and less vulnerable than recently detoxified drinkers. Their level of competence, sense of duty, self-discipline and ability to think before acting increased with time.

 

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The authors of the study concluded that “these results are quite encouraging for alcoholic patients, who may aspire to greater quality of life through long-term abstinence”.

However, in spite of marked differences between groups, their results did not provide clear evidence of personality changes.

While significant behaviour differences between the two groups were revealed, they were more akin to long-term improvements in behavourial adequacy to events than to actual personality changes.

This fits in with the self help group ethos of a change in perception and in “taking action” to resolve issues. In fact, 12 steps groups such as AA are often referred to as utilising a “program of action” in recovering from alcoholism and addiction and in altering attitudes to the world and how they act in it.

The authors also noted the potential for stabilization over time by overcoming previous behaviour weaknesses, i.e. in responding to the world.  Hence, this process is ”one of better adequacy of behaviour responses to reality and its changing parameters.”

In fact, treatment-induced behaviour changes showed a decrease in neuroticism and an increase in traits related to responsibility and conscientiousness.

In line with our various blogs which have explained alcoholism in terms of an emotional regulation and processing disorder, as the Big Book says ““We were having trouble with personal relationships, we couldn’t control our emotional natures”  the authors here concluded that  “rational management of emotions appears to be the single key factor of lasting abstinence”

If we want to to recover from addiction we have to change how we behave.  We have to start by following a recovery program of action. 

No by thinking about it, or emoting about it but by doing it!

Action is the magic word.

References

Boulze, I., Launay, M., & Nalpas, B. (2014). Prolonged Abstinence and Changes in Alcoholic Personality: A NEO PI-R Study. Psychology, 2014.

Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

 

Impulsivity is an Independent Predictor of 15-Year Mortality Risk among Individuals Seeking Help for Alcohol-Related Problems

In yesterday’s blog we looked at how AA membership and the 12 step program of recovery helped reduce impulsivity in recovering alcoholics.

We mentioned also that impulsivity was present as a pathomechanism of alcoholism from vulnerability in “at risk” children from families, were there was a history of alcoholism, right the way through to recovering alcoholics in long term recovery (i.e. many years of recovery).

We cited and used excerpts from a study written by the same authors as the study we cite now (1).

This study shows and highlights how, if untreated, by recovery programs such as AA’s 12 steps, that “trait” impulsivity can lead to increased mortality in alcoholics.

This study interestingly shows there is a difference from “state-like” impulsivity in early recovery when recovering people are still distressed and “trait-like” which is after Year 1 of recovery when some of the severity of withdrawal from alcohol has long since abated and some recovery tools have been learnt.

The fact that this impulsivity continues to contribute to relapse and mortality may suggest it is a trait state in alcoholics and possibly a vulnerability to later alcoholism also.

In effect, it illustrates the role impulsivity plays as a pathomechanism in alcoholism, i.e. it is a psychological mechanism that drives addiction and alcoholism forward to it’s chronic endpoint.

Again research shows us how we can learn about a pathology from the recovery from it!

 

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“Abstract

Background

Although past research has found impulsivity to be a significant predictor of mortality, no studies have tested this association in samples of individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes. The current study addressed these issues in a mixed-gender sample of individuals seeking help for alcohol-related problems.

Results

…higher impulsivity at baseline was associated with an increased risk of mortality from Years 1 to 16; higher impulsivity at Year 1 was associated with an increased risk of mortality from Years 1 to 16, and remained significant when accounting for the severity of alcohol use, as well as physical health problems, emotional discharge coping, and interpersonal stress and support at Year 1. In addition, the association between Year 1 impulsivity and 15-year mortality risk was moderated by interpersonal support at Year 1, such that individuals high on impulsivity had a lower mortality risk when peer/friend support was high than when it was low.

Conclusions

The findings highlight impulsivity as a robust and independent predictor of mortality.

Introduction

…personality traits related to impulsivity (e.g., low conscientiousness) have been identified as significant predictors of poor health-related outcomes including mortality (Bogg and Roberts, 2004; Roberts et al., 2007). Although there is a well-established association between disinhibitory traits and alcohol use disorders (AUDs) (Labouvie and McGee, 1986; McGue et al., 1999;Sher et al., 2000), to our knowledge, no studies have tested these traits as predictors of mortality among individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes.

Predictors of Mortality Risk among Individuals with Alcohol Use Disorders

Relative to the general population, individuals with AUDs are more likely to die prematurely (Finney et al., 1999; Johnson et al., 2005; Valliant, 1996). Accordingly, several longitudinal studies have aimed to identify the most salient risk factors for mortality in this population (for a review, see Liskow et al., 2000)

…more reliance on avoidance coping, less social support, and more stress from interpersonal relationships increase the risk of mortality among individuals with AUDs (Finney and Moos, 1992; Holahan et al., 2010; Mertens et al., 1996; Moos et al., 1990).

Impulsivity and Risk for Mortality: Relevance for Individuals with Alcohol Use Disorders

Despite the litany of variables that have been examined as predictors of mortality among individuals with AUDs, tests of the significance of individual differences in personality are noticeably absent from this literature. In the clinical and health psychology literatures, however, personality traits have long been identified as possible risk factors for mortality (Friedman and Rosenman, 1959), with low conscientiousness emerging as one of the most consistent, trait-based predictors of poor health and reduced longevity (Kern and Friedman, 2008; Roberts et al., 2007). Conscientiousness is a broad domain of personality reflecting individual differences in the propensity to control one’s impulses, be planful, and adhere to socially-prescribed norms (John et al., 2008).

(previously) no studies in this literature have tested impulsivity as an independent predictor of mortality in a sample of individuals with alcohol-related problems. This is a surprising omission, given that impulsivity is a well-established risk factor for alcohol misuse (Elkins et al., 2006; McGue et al., 1999; Sher et al., 2000) and therefore may be an especially potent predictor of mortality among individuals with AUDs. Furthermore, the role of impulsivity as an independent predictor of mortality risk among individuals with AUDs is relevant from the standpoint of the stage of the alcohol recovery process.

Thus, we sought to examine the impulsivity-mortality link at baseline and one year after participants had initiated help-seeking for their alcohol use problems. At baseline, participants were in a state of distress due to their problematic alcohol use, whereas at Year 1 most participants had obtained help for their alcohol-related problems and reduced their drinking (Finney and Moos, 1995).

Given prior research on acute clinical states and self-report assessments of personality (e.g., Brown et al., 1991; Peselow et al., 1994;Reich et al., 1987), we hypothesized that individuals’ self-reports of impulsivity at Year 1 would be less a reflection of their alcohol problems – and therefore more likely to be independently linked to mortality risk – than their reports at baseline, which may be more closely associated with concurrent alcohol use and problems (i.e., state effects).

Discussion

…impulsivity at baseline was a significant predictor of mortality risk from Years 1 to 16; however, this effect was accounted for by the severity of alcohol use at baseline. In contrast, impulsivity at Year 1 was associated with an increased risk of mortality over the subsequent 15 years…

In addition, a significant interaction was observed between impulsivity and peer/friend support at Year 1, which suggested that, among individuals high on impulsivity, the mortality risk may be reduced for those high on support from peers/friends. Collectively, these findings highlight impulsivity as an independent risk factor for mortality in AUD samples…

…It is also conceivable that, given participants were in a state of crisis at baseline, their reports of their impulsive tendencies at that time partly captured “state” effects (e.g., psychiatric distress from concurrent substance use; withdrawal symptoms) and therefore were less an indication of their typical or “characterological” pattern of impulsivity, independent of alcohol use. However, at Year 1, most participants had reduced their drinking and were not in a state of crisis; thus, their reports at that time may have been a better reflection of their “trait-like” pattern of impulsivity, which in turn may be a more robust independent predictor of long-term outcomes such as mortality. Accordingly, future studies that seek to test impulsivity as an independent predictor of mortality among individuals with AUDs should consider the stage of the alcohol recovery process.

Moderation of the Impulsivity-Mortality Link via the Social Context

The results of the moderator analyses suggest that the effects of impulsivity on mortality may become manifest through interactions between traits and socio-contextual process (Friedman, 2000). That is, the dire effects of impulsivity on risk for mortality may not reach fruition for individuals who are able to maintain a strong peer support network. Conceivably, by virtue of their strong bond with a high-risk individual, such peers may have sufficient leverage to discourage expression of the individual’s impulsive tendencies and encourage consideration of the long-term consequences of his/her actions.

Such a perspective is consistent with evidence from the AUD treatment-outcome literature that social support networks are a key mechanism by which Alcoholics Anonymous (AA) and other psychosocial treatments can improve long-term drinking-related outcomes (Humphreys and Noke, 1997; Kaskutas et al., 2002).

Furthermore, from the standpoint of treatment, the present findings suggest that interventions for AUDs may benefit from an ecological perspective that considers the contexts in which dispositional tendencies, such as impulsivity, become expressed in individuals’ everyday lives. Notably, based on prior work with this sample, longer duration in AA and alcohol treatment was associated with a decline in impulsivity (Blonigen et al., 2009). In combination with the present findings, it appears that formal and informal help for AUDs may include “active ingredients” that can help curtail expression of impulsive tendencies (e.g., social integration, peer bonding; Moos, 2007,2008) and buffer the otherwise deleterious impact of such tendencies on health and longevity.

References

1. Blonigen, D. M., Timko, C., Moos, B. S., & Moos, R. H. (2011). Impulsivity is an Independent Predictor of 15-Year Mortality Risk among Individuals Seeking Help for Alcohol-Related Problems. Alcoholism, Clinical and Experimental Research, 35(11), 2082–2092. doi:10.1111/j.1530-0277.2011.01560.x

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.

128px-Amyg

 

Sorry for so much detail. I have read so much about medication recently which does this or that to reduce craving or to control  drinking but what about the underlying conditions of alcoholism and addictive behaviour? These are rarely mentioned or considered at all.

 

We always in recovery have to deal with alcoholism not just it’s symptomatic manifestation of that which is chronic alcohol consumption. This is a relatively simple point and observation that somehow alludes academics, researchers and so-called commentators on this fascinating subject.

Anyway that is some background to this study which demonstrates that long term AA membership can reduce this impulsivity and perhaps adds validity to the above arguments that improved behaviour inhibition and reducing impulsivity is a very possible mechanism of change brought about by AA membership and the 12 step recovery program.

It shows how we can learn about a pathology from the recovery from it!

Indeed when one looks back at one’s step 4 and 5 how many times was this distress based impulsivity the real reason for “stepping on the toes of others” and for their retaliation?

Were we not partly dominated by the world because we could not keep ourselves in check? Didn’t all our decisions get us to AA because they were inherently based on a decision making weakness? Isn’t this why it is always useful to have a sponsor, someone to discuss possible decisions with?

Weren’t we out of control, regardless of alcohol or substance or behaviour addiction? Isn’t this at the heart of our unmanageability?

I think we can all see how we still are effected by a tendency not to think things through and to act rashly.

The trouble it has caused is quite staggeringly really?

Again we cite a study (1) which has Rudolf H. Moos as a co-author. Moos has authored and co-authored a numbered of fine papers on the effectiveness of AA and is a rationale beacon in a sea of sometimes quite controversial and ignorant studies on AA, and alcoholism in general.

“Abstract

Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, we review our work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUD) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity…

Among individuals with alcohol use disorders (AUD), Alcoholics Anonymous (AA) is linked to improved functioning across a number of domains [1, 2]. As the evidence for the effectiveness of AA has accumulated, so too have efforts to identify the mechanisms of change associated with participation in this mutual-help group [3]. To our knowledge, however, there have been no efforts to examine links between AA and reductions in impulsivity-a dimension of personality marked by deficits in self-control and self-regulation, and tendencies to take risks and respond to stimuli with minimal forethought.

In this article, we discuss the conceptual rationale for reduced impulsivity as a mechanism of change associated with AA, review our research on links between AA and reduced impulsivity, and discuss potential implications of the findings for future research on AA and, more broadly, interventions for individuals with AUD.

Impulsivity and related traits of disinhibition are core risk factors for AUD [5, 6]. In cross-sectional research, impulsivity is typically higher among individuals in AUD treatment than among those in the general population [7] and, in prospective studies, impulse control deficits tend to predate the onset of drinking problems [8–11]

Although traditionally viewed as static variables, contemporary research has revealed that traits such as impulsivity can change over time [17]. For example, traits related to impulsivity exhibit significant mean- and individual-level decreases over the lifespan [18], as do symptoms of personality disorders that include impulsivity as an essential feature [21, 22]. Moreover, entry into social roles that press for increased responsibility and self-control predict decreases in impulsivity [16, 23, 24]. Hence, individual levels of impulsivity can be modified by systematic changes in one’s life circumstances [25].

Substance use-focused mutual-help groups may promote such changes, given that they seek to bolster self-efficacy and coping skills aimed at controlling substance use, encourage members to be more structured in their daily lives, and target deficits in self-regulation [26]. Such “active ingredients” may curb the immediate self-gratification characteristic of disinhibition and provide the conceptual grounds to expect that AA participation can press for a reduction in impulsive inclinations.

…the idea of reduced impulsivity as a mechanism of change…it is consistent with contemporary definitions of recovery from substance use disorders that emphasize improved citizenship and global health [31], AA’s vision of recovery as a broad transformation of character [32], and efforts to explore individual differences in emotional and behavioral functioning as potential mechanisms of change (e.g., negative affect [33,34]).

Several findings are notable from our research on associations between AA attendance and reduced impulsivity. First, consistent with the idea of impulsivity as a dynamic construct [18, 19], mean-levels of impulsivity decreased significantly in our AUD sample. Second, consistent with the notion that impulsivity can be modified by contextual factors [25], individuals who participated in AA longer tended to show larger decreases in impulsivity across all assessment intervals.

References

Blonigen, D. M., Timko, C., & Moos, R. H. (2013). Alcoholics anonymous and reduced impulsivity: a novel mechanism of change. Substance abuse, 34(1), 4-12.

Love is the Drug!

Science as we have shown in many blogs has given us unprecedented insight into brain mechanisms implicated in addiction. It has shown us how various neural networks governing reward/motivation, memory, attention and emotions seem to be usurped in the addiction cycle.

Important aspects of “the self” are taken over in other words. It has shown how those vulnerable to addiction seem to have decision making deficits, suffer impulsivity, choose now over later, do not tolerate distress or negative emotions etc. Over react to life!!

It shows how addicts have difficulties in  regulating stress, and that stress systems in the brain are altered to such an extent that they rely for brain function on allostasis not homeostasis.

They show us that various neurotransmitters are also reduced in the addict’s brain such as GABA, the inhibitors or brakes of the brain. We are deficient in natural opioids, dopamine, serotonin etc. Our brains are different to “normies” to “earthlings.

Science suggests the majority of addicts have had abuse or trauma, neglect or adverse experiences while in childhood and this too contributes to addiction vulnerability via stress and emotion dysregulation and a heightened sensitivity to the stimulating effects of drink, drugs and certain behaviors such as eating, sex, gambling, gaming, internet use  etc.

Science also offers suggestions on treatment. It offers the use of chemicals or antagonists to reduce “carving” and it suggest the effectiveness of CBT, Mindfulness and DBT but it seems to know little about how or why 12 step programs work.

Science can’t quite bring itself to believe that laypeople, fellow addicts, can help solve each others’ problems. It scratches it’s head about “spiritual maladies” and “spiritual solutions”; how the 12 steps could bring about such a cathartic change in personality to change someone from a hopeless addict to a person in recovery.

It wonders how helping others and taking fearless and honest inventory can bring about the psychic change sufficient to help some with addiction recover. To be restored to sanity.

 

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In various blogs we have suggested the spiritual malady can also be viewed as a emotional disease and that the 12 steps also allow us to process emotions and regulate feelings in a way we could not before.

It helps us process the many negative emotions of the past via steps 4-9 and sets us free by consigning these emotions to long term memory instead of having them swirl around forever in explicit memory, forever tormenting us.

For us, 12 step programs offer a workable definition of the addict. The “spiritual malady” mentioned in the Big Book does however refer to all people, not just alcoholics/addicts, and is borrowed directly from the Oxford Group.  But reading around this, there are many examples of emotional and stress dysregulation in the BB, some 70 plus examples in the first 164 pages  of  how our emotions dominated us and how we were shot through with fear.

It is the description of alcoholics in the BB that highlights we have an emotional as well as spiritual  disease. What is a spiritual disease if not manifest in negative emotional states such as resentments, false pride, anger, jealousy, and so on. The need to control, to be better than, to know best, all also signs of emotional immaturity.  The BB clearly show us alcohol(ism) has made us very emotional irresponsible. We step on the toes of our fellows and they retaliate.

We have a spiritual malady but, from descriptions of ourselves, it seem more extreme than normal people. It is not only in terms of alcohol that “the delusion that we are like other people, or presently may be, has to be smashed.”

The definition is thus workable because it allows one to act in relation to it. For example, if I am aware of the nature of my defects of character I am in effect aware of what cuts me off from the “sunlight of the spirit”, aware of what keeps me spiritually and emotionally ill, what keeps me in a state of unprocessed emotions, of emotional dysregulation, of undealt with distress. Of what keeps me in resentment in a viscous circle of unprocessed negative emotions.

It shows me how this dysregualtion effects other people and gives me the tools to correct my mistakes, to make amends for the mistakes I have made. To relieve distress. It gives me a framework, a program of action which allows me to live with others, on life’s terms, although I might not immediately agree with those terms, which is often the case!

It gives me a choice that I never had before. It says to me you can live with unregulated negative emotions and cultivate your misery or you can choose to use the program to free yourself from these negative unregulated emotions and by processing them be restored to to sanity. It can help me get out of the past/future and into the now, the present.

The solution to my spiritual and emotional malady is this simple. Identify, label, verbalise either to God or to another human being the nature of these wrongs/sins/defects/shortcoming/negative emotions – those factors that trapped me in self propelled distress – and they are quite simply removed. That is my experience. Honesty, openness, willingness, the how of getting out of self. Repeatedly during the day. When I do not do this I suffer emotionally, and others suffer too.

The steps allow me to reduce my distress and this control of distress and stress via the cultivation of serenity, balance, selflessness deactivates my illness for a while allows me to be happy, joyous and free as this appears to be the state of freedom from self, in my experience, this seems to be a state of Grace in other words. The sunlight of the spirit that Bill W mentioned.

It is the solution. I drank to get away from myself. To exhale some air and go “phew!”  I do not not have to even consider that now because I can do that via the steps, by simply taking inventory and letting go. It is our emotions that hold on to negative thoughts, that grow them in the dark shadow of our souls like fungus. Honesty is a light that extinguishes them. By letting go, by allowing my emotions to lower in intensity, to label and identify them and thus allow via, God’ loving Grace, for them to be removed (and stored away where they belong in long term memory).

But there are so many more reasons why 12 step programs work! If the majority of us have had abusive upbringings then it suggests perhaps that there are attachment issues present in many of us. For me my insecure attachment to my primary care giver, my mother, may have caused an insecure attachment which has certainly kick started my later addictions. In fact some observers have gone so far as to view addiction as an attachment disorder.

I will blog on this in the next weeks or two. I will blog on this attachment disorder as perhaps causing that “hole in the soul” that many addicts talk about in meetings.

That not belonging, being separate from. That isolation – these may all stem from insecure attachment. Insecure attachment can shape the brain in a way that makes it difficult to regulate stress and emotion and thus contribute to later addiction. It may cause the differences in emotions mentioned above. It may also point to heart of the problem and why 12 steps groups work in treating addiction.

12 step groups seem to directly treat the “Hole in the soul” by instantly giving an addict a sense of belonging which is particularly powerful after many years in the desolation of addiction. I know that I stayed in AA because I have finally found the club, the tribe, that I belong too. This   like other families is a group of people I love, but sometimes have problems with, fall out with, return to and see in a new light. It is an organic relationship. It has never been wonderful at all times but that says as much about me and my distrust of others, my insecure attachment as it does AA.

I had grown up not even feeling part of my family. The required psychic change happened to me in my first meeting I believe.  Others have commented on how I walked into the meeting a different person from the person who left the meeting. I had a spiritual experience of some sort in my first meeting, purely through identifying with the other recovering alcoholics in the meeting. Not about their drinking, but by identifying with their spiritual malady. I identified with there emotional disease and I realised that if they could find a solution then there was a chance, however small, that I could too. The first flickers of hope happened in that very first meeting.

I knew in my heart I had somehow returned home in a strange way. I had found my surrogate family, those who would help love me back to health and recovery.
Perhaps this is what Science is generally not getting about 12 step groups, the powerful therapeutic tool of talking with someone who has been where you have, who shares your disease and who can help you recovery, as they have. Even now sitting in an AA meeting is the most spiritual thing I do. More so that attending Chapel, visiting monks in isolated monasteries.

Identification with those in the same boat as you is profound. It tells you are not alone. It tells you I need to help you to help me. We are in this together, not you and I. Us, together.

It accepts you as you are, at your lowest ebb, at your rock bottom, your most degraded self. It offers your affection when you are your most unlovable, most wretched.

This for me was the key, being accepted into a group I knew I belonged in. My new home. My new secure attachment. I believe this secure attachment and the love you have for fellowships, sponsees and the love you can now show yourself and your family and friends and people in your life is that solution. To Love and be loved.

I felt in my active addiction I was not deserving of love, that you shouldn’t give me your love. I didn’t know how to give you mine. Now I have so much love inside of me. It is this love that has filled up the hole in my soul.

Okay, it has also increased my natural opioids, raised my dopamine via belonging, raised the GABA brakes in my brain. It has also increase my serotoninergic well being and happiness, it has lower my excitatory glutamate. It has restored more neuro-chemical balance in my head. By prayer and mediation and helping others it restores sanity, fleeting periods of homeostasis, balance, serenity. It most importantly reduces stress/distress, silences my addiction, long enough for me to think of others, help others. And there is not greater buzz that helping others. Love is the drug that I have been thinking off. Love is the solution.

Trust someone enough so that you can begin to allow them and God to love you and you will eventually love them back. A whole new world, full of love and being whole awaits.

The journey is from the crazy head to the serene heart. 

Measuring the “Psychic” Change

Prolonged Abstinence and Changes in Alcoholic Personality?

When I came into AA I remember hearing the words “the need for a psychic change” which was the product of a spiritual awakening (as the result of doing the 12 steps).

The big Book of Alcoholics Anonymous clearly states this need “The great fact is just this, and nothing less: That we have had deep and effective spiritual experiences* which have revolutionised our whole attitude toward life, towards our fellows and toward God’s universe.”

This is the cornerstone of AA recovery; thinking, feeling and acting differently about the world to when we were active drinkers. Otherwise one does the same things and ends up in the same places, doing the same things, namely drinking. It is a behavioural revolution; a sea change in how we perceive and act.

In line with this thinking, we came across this French study which measured via questionnaire the very same changes that occur in recovery. The French study uses different term for alcoholics and recovery but is saying the same things – it is we that need to change, not the world.

This study aimed to examine whether personality traits were modified during prolonged abstinence in recovering alcoholics. Groups of both recovering and recently detoxified alcoholics were asked via questionnaire to  see if they differed significantly from each other in three personality domains: neuroticism, agreeableness and conscientiousness   The recovering alcoholics were pooled from self help groups and treatment centres and the other group, the recently detoxified drinkers were pooled from various clinics throughout France.

Patients with alcohol problems who were administered the NEO PI-R had previously obtained a high “neuroticism” score (emotions, stress), associated with a low “agreeableness” score (relationship to others; Loukas et al., 2000). In the same vein, low “conscientiousness” scores (determination) were reported in patients who had abstained from alcohol for short periods (6 months to 1 year; Coëffec, Romo, & Strika, 2009)

In this study, recently detoxified drinkers scored high on neuroticism. They experienced difficulty in adjusting to events, a dimension which is associated with emotional instability (stress, uncontrolled impulses, irrational ideas, negative affect). Socially, they tend to isolate themselves and to withdraw from social relationships.

This also ties in with what the Big book also says “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were unhappy, we couldn’t seem to be of real help to other people-“

In contrast, regarding neuroticism, they found that recovering persons did not necessarily focus on negative issues. They were not shy in the presence of others and remained in control of their emotions, thus handling frustrations better (thereby enhancing their ability to remain abstinent).

Regarding agreeableness (which ties back into social relationships), the researchers also found that recovering persons cared for, and were interested in, others (altruism). Instead, recently detoxified drinkers’ low self-esteem and narcissism prevented them from enjoying interpersonal exchanges, and led them to withdraw from social relationships.

Finally, regarding conscientiousness, they observed that, over time, recovering persons became more social, enjoyed higher self-esteem (Costa, McCrae, & Dye, 1991), cared for and were interested in others, and wished to help them. They were able to perform tasks without being distracted, and carefully considered their actions before carrying them out; their determination remained strong regardless of the level of challenge, and their actions are guided by ethical values. Instead, recently detoxified drinkers lacked confidence, rushed into action, proved unreliable and unstable. As a result, lacking sufficient motivation, they experienced difficulty in achieving their objectives.

Recovering persons seemed less nervous, less angry, less depressed, less impulsive and less vulnerable than recently detoxified drinkers. Their level of competence, sense of duty, self-discipline and ability to think before acting increased with time.

 

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The authors of the study concluded that “these results are quite encouraging for alcoholic patients, who may aspire to greater quality of life through long-term abstinence”.

However, in spite of marked differences between groups, their results did not provide clear evidence of personality changes. While significant behaviour differences between the two groups were revealed, they were more akin to long-term improvements in behavourial adequacy to events than to actual personality changes.

This fits in with the self help group ethos of a change in perception and in “taking action” to resolve issues. In fact, 12 steps groups such as AA are often referred to as utilising a “program of action” in recovering from alcoholism and addiction and in altering attitudes to the world and how they act in it.

The authors also noted the potential for stabilization over time by overcoming previous behaviour weaknesses, i.e. in responding to the world.  Hence, this process is ”one of better adequacy of behaviour responses to reality and its changing parameters.”

In fact, treatment-induced behaviour changes showed a decrease in neuroticism and an increase in traits related to responsibility and conscientiousness.

In line with our various blogs which have explained alcoholism in terms of an emotional regulation and processing disorder, as the Big Book says ““We were having trouble with personal relationships, we couldn’t control our emotional natures”  the authors here concluded that  “rational management of emotions appears to be the single key factor of lasting abstinence”

 

References

Boulze, I., Launay, M., & Nalpas, B. (2014). Prolonged Abstinence and Changes in Alcoholic Personality: A NEO PI-R Study. Psychology, 2014.

Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.