Four years ago today, I did something I hadn’t done in the preceding 6 years. I did not take a drink of wine or beer or any other type of alcohol.
I didn’t know at the time – but it is known definitively today thanks to the newly released Surgeon General’s report on addiction – that I had developed a brain disorder that manifests as an inability to stop a behavior despite negative consequences. The negative consequences I am open to sharing that I experienced from drinking alcohol are injuring myself from falls and saying things to beloved others that I still profoundly regret. After each incident of harm to myself or others, I continued to drink alcohol.
Unfortunately, I cannot tell you specifically what made December 27, 2012 the day I finished all the wine in the house, then had none the next day. In common parlance, I had no “bottom.” I can’t explain how I was able to override the neurobiology of addiction one day – now numbering 4 years worth of days – but not in the previous days. I cannot identify which, if any, of the probably 100 strategies that I attempted continuously, actually did help me abstain from alcohol. Not knowing is a precarious position to be in because I neither know what exactly to do to help myself today or tomorrow, or exactly what to advise others to do to help themselves.
Here are some things I do know:
I am not an alcoholic. I am a person who has developed a grave brain illness, a medical condition termed a substance use disorder. According to the Surgeon General’s report, the three components of evidence-based treatment for substance use disorders, named in order in the report, are medications and medication-assisted treatment, behavioral therapies, and recovery support services. I do not need to change my identity to the name of an illness. If I suspect I have a substance use disorder, I need to get myself to a doctor.
I understand why people believe I have a moral, mental, or psychological problem – even a spiritual one – rather than a medical condition. My words and actions may well be immoral. Tragically, substance use disorders compromise networks involving the brain’s basal ganglia, extended amygdala, and prefrontal cortex, areas directly responsible for decision-making and impulse control. Many people who love those with substance use disorders find themselves appalled and anguished by the Dr. Jekyll and Mr. Hyde transformations that occur in their good-natured, delightful loved ones. Neuroscience will continue to further explain the cause-and-effect relationships between brain malfunctions and behavior, as well as specific brain structures to target for addictions treatment.
I have an illness which is not curable but is considered to be, according to the Surgeon General’s report, in remission after 4 to 5 years. If I can abstain from substances problematic for me, or in some cases and for some substances, take them as prescribed or, take them as I – in consultation with my treatment team – have concluded works best for me, my odds of a return to problematic use decline dramatically. Personally, I feel better now than I have in 4 years. Perhaps that is due, not to anything I have done, but to the time my particular brain has needed to heal in the absence of the neurotoxin of alcohol. But I don’t know and can’t know for sure.
Brain impairments resulting from substance use disorders are not repaired automatically and immediately by abstinence. Therefore, even if I am abstinent or following my physician’s orders with regard to substances, my words, actions and thinking may confuse me and you. With time, my brain may repair itself or find alternate paths for connections. Expecting myself to return to my pre-use functioning, especially early on, may be frustratingly disappointing to others and dangerously disappointing to me.
I used alcohol for reasons, some of which were unknown to me. When I stopped using alcohol, those banked reasons came back as dragon heads roaring flames. I have no idea how I survived the fire, nor how I kept from returning to alcohol for blessed relief from the burning.
I will never again have the inner experience of oneness with love, comfort and relief I had while I was drinking. Nothing I have done or tried in the past 4 years has even approached generating the feeling alcohol gave me. That makes perfect sense. Alcohol is a substance that chemically takes the brain where it can’t go on its own. My inner experience while drinking was a chemically induced illusion. Every day I don’t drink is a day I deny myself the best feeling I have ever, ever had. So far, I have been able to live without it. In this post, I have included a photo of me intoxicated in early December of 2012. I hope we will never see again that wine-magnified look of joy on my face. Painful. But I get it, and I’m mostly okay with it.
I have more than my share of resources to try anything and everything not to take a drink. I have income and savings, a home, a car, health insurance, and emotional and financial support from my family. I can pay to consult with doctors, psychologists, psychiatrists and other health care professionals to help me.
During one near-relapse, when nothing I could think of to do was helping – and I still believed I had a moral condition instead of a medical one – I had a last-ditch, desperate, radical idea to call my primary care physician’s office for an emergency appointment. The sympathetic assistant squeezed me in, I drove myself to the office, paid the co-pay, and sat on my doctor’s exam table and just cried. I have no idea why or how seeing my doctor helped, but it did. Looking back, the extensive resources, infrastructure and network of connections required to get same-day personal support from a medical professional are available, frankly, only to the privileged. Addiction, however, is over-represented among the poor.
I committed malpractice against myself by attending support groups as treatment for alcoholism instead of getting medical and professional care. As well-meaning and helpful as volunteers at support groups such as Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery might be (these are the substance use disorder support groups available in my town), layperson survivors are not qualified to provide treatment for the brain illness of addiction, for the co-occurring mental and physical illnesses that usually accompany it, nor for the danger and distress of abstinence. According to the Surgeon General’s report, and in my personal experience, support groups can certainly provide the social support beneficial to recovery from addiction, but they’re not treatment. (This guide for treating alcoholism has been available from NIAA since 2014 and advises beginning with a visit to one’s primary care physician.)
“Little is known about the factors that facilitate or inhibit long-term recovery from substance use disorders or how the brain changes over the course of recovery.”
– Page 2-25, “Chapter 2. The Neurobiology of Substance Use, Misuse, and Addiction,” Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health
I know what I don’t know. If you ask me for help with a suspected drinking problem, overuse of painkillers, or worries about any other substances – or with activities such as gambling, gaming, shopping or porn – the first words you won’t hear from me are, “What you should do is ____.” Not only do I not know what you should do, even the Surgeon General doesn’t know.
What you’ll get from me first is empathy, compassion and respect. Then, you’ll get help from me with access to evidence-based care. Given that we at least all know now what the Surgeon General does know – that medications and medication-assisted treatment, behavioral therapies, and recovery support services don’t cure but can assist with substance use problems – we’ll talk about what might be most helpful to do next for you.
. . . . .
The opinions expressed here are mine alone and do not necessarily reflect the positions of my associates, clients, employers or relatives.
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
Last updated 12/30/16
Sorry I can’t read this misery. What is worse than your own misery as a dry drunk is spreading that to others. You are also very arrogant and dismissive of peer support groups the medical profession does not have the answers and gets it wrong in many instances across a wide array of illness and conditions. Do you really think you are informing or helping people get better?
When my late friend Mattie Kargl gave me a five-year AA chip about 18 years ago, he pronounced distinctly for all the world, “Now you can start saying you’re sober. Everything before now was an illusion.” In my case, that was probably true, but dear old Mattie, like so many drunks, tended to limit the addiction experience to his own.
I think others of us believe there are as many ways to get sober as there are alcoholics who want it enough to get 5, 10, 15, 20 or more years of sobriety, the kind that requires abstinence.
I like your work, Anne, because it does not pretend to be more than it is: your experience, your strength, your hope. The Anne Way might work for others, might not. But you are willing to give them the encouragement that they can find their own way by simply sharing yours. That is laudable, courageous, potentially self-sacrificing and it is helpful, even to those of us with far more time without alcohol (or whatever the problem may be) than you.
Keep sober and please keep writing about it. Your work is valuable.
Dan Smith
I felt very touched and moved by your comment, Dan. And *heard* and *understood*! Exactly. The Anne Way is just that: my uncertain set of efforts that, so far as we know – given the mysterious “black box” of addiction – are helping me stay abstinent, but may or may not be helpful for others.
I love that your practical words echo those from the NIAA: “There are many roads to getting better. What is important is finding yours.”
https://pubs.niaaa.nih.gov/publications/Treatment/treatment.htm
I thank you profoundly, Dan, for your help with my travels.