One month ago, on the eve of my 58th birthday, I fell down a short series of stairs in the dark and broke my foot. That morning, as I had nearly every morning for a decade, I exercised. I ran 3 miles on so many days a week for so many years that I didn’t break a sweat or breathe hard. On non-running days, I swam 30 minutes straight, again, without losing my breath. I lifted weights each week with a trainer and didn’t get sore. I concentrated on consistency and form and, at 57, except for belly fat, had solid fitness, a low pulse rate and good muscle tone.

Today, I am deciding whether or not the trips around my house in a walking boot to gather my things, the trip to the car in the boot, taking off the boot, getting in the car and driving with a sore foot, arriving at the pool, putting on the boot, getting out of the car and walking to the locker room, taking off the boot, and limping to the pool to get in it, making my foot sore from swimming, and then going through the reverse is worth it. It will take about 2 hours to do a 20-minute swim. I’ve had chronic pain in my back and hamstring from old injuries that exercise manages. They’re aching away, along with my foot in its boot.

I feel like I’m decomposing, like a pile of leaves, little particles dropping off bit by bit from my structure.

People break bones all the time. Why am I having such trouble? I’ve known a long time that I’ve got some conditions in my life that aren’t helpful to handling the human condition, whether a stubbed toe or a broken foot. I’m partner-less, childless, motherless, and live alone. I work at part-time jobs primarily out of a home office. Most of my work involves process rather than results. I’ve had trouble finding groups and communities in which I feel a sense of belonging. In isolation, each experience can feel magnified.

Oh, yeah. And that other thing. Fucking alcoholism.

I have worked my ass off to not have this. For four solid years, I have longed to drink and not. I have tried every treatment I could access, tried every way of thinking and re-thinking and feeling and re-feeling and doing and doing differently and it just won’t let up. I am exhausted.

I didn’t know how much my daily freedom to exercise intensely to my heart’s content and my mind’s calming and my body’s relieving meant to me until I lost it.

I continue to marvel at how people who have this condition, and don’t have the resources I have, stay abstinent. I have employment, housing, transportation, health insurance. And a gym membership. Maybe they make it because they have someone who loves them? I have people who love me, of course, but at a distance. As it should be. They’re living their lives. I am to live mine, too.

How to live a solitary life with a chronic illness? Gee. It’s just not the question I expected to answer at 58. Barbie, Ken, Baby, Cinderella, Handsome Prince. That’s my paradigm!

Yesterday was hard, today is hard, and tomorrow will be hard.

That’s actually been mostly what it’s been like to be me during these four years of abstinence from alcohol.

For me, turning towards the truth, not away from it, is a relief. And the truth is that this is just hard as hell, harder than I ever could have anticipated, possibly harder than I have the capacity for. And way harder than anyone who’s tried to help me has found it to be. This just seems intractable. And it may be. I just might not triumph. Okay! That’s the deal!

I think it was my 8th grade math teacher, Mrs. Hooper, who first taught me how to do proofs: start with the givens. Given that 1) today will be a day of deprivation, i.e. no alcohol and no significant exercise, both of which would offer a blessed break, 2) today will be a day of above average physical pain, 3) nothing known today can make tomorrow better, 4) intimate, connected contact won’t happen, but general contact might, 5) the top recommendation for politics-induced anxiety is, wait for it, physical activity, how, Anne, would you like to spend the day?

I would like to write a blog post on my blog stating my truth, and I would like to say, yeah, I might relapse but it won’t mean much of anything, just a bout with a chronic illness after a pretty significant period of remission.

I would like to give swimming a go, I would like to try to use Uber to get to the Neuroscience of Addiction class I’ve been given permission to attend at noon, I would like to anticipate that my elder cat might sleep on my chest during a nap, I would love a post-nap Starbuck’s coffee but that requires the boot so I dunno, I would like to wait on my younger cat who has me on an intermittent but insistent schedule, I would like to (sigh, see, this is where the despair starts) eat a pleasant dinner at home, but everything makes me fatter and I have no groceries and wouldn’t know what to put on the list if someone wanted to shop for me, and I would like to try to just be there for myself today, moment to moment, truthfully. No demoralizingly simplistic slogans, no admonitions to serve others, no phony rah-rah. Just be there for myself and acknowledge to myself that, yes, this is really tough and it’s probably just going to be a moment-to-moment thing. And not push, or scold, or measure myself. Just keep myself company through a really hard time.

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.

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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