“We must choose to come out in the light and be treated with dignity and respect. So let’s stop whispering about this disease.”
– Michael Botticelli, Director of National Drug Control Policy, speaking at the UNITE to Face Addiction Rally, Washington, D.C., 10/4/15, excerpted by 60 Minutes, 12/13/15

If only addiction hadn’t been whispered about three years ago!

If I had discovered this December 28th – in 2015, not in 2012 – that I couldn’t stop drinking, thanks to extensive efforts to educate the public, I would have known that substance use disorder is a brain disease, a medical condition, and I would have started with my primary care physician for science-based, evidence-based, best practices treatment.

Michael Botticelli: We’ve learned addiction is a brain disease. This is not a moral failing. This is not about bad people who are choosing to continue to use drugs because they lack willpower. You know, we don’t expect people with cancer just to stop having cancer.

Scott Pelley: Aren’t they doing it to themselves? Isn’t a heroin addict making that choice?

Michael Botticelli: Of course not. You know, the hallmark of addiction is that it changes your brain chemistry. It actually affects that part of your brain that’s responsible for judgment.

– 60 Minutes interview on 12/13/15 with Michael Botticelli, Director of National Drug Control Policy

Almost three years ago, on December 28th of 2012, however, even though I was trained as an addictions counselor myself, I believed my own lack of oversight of my behavior had caused my addiction to alcohol. I was appalled at myself. My fundamental understanding of my personhood was shattered by my inability to insist to myself that I not drink again, and be unable to stop myself.

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.
– Nora D. Volkow, M.D, Director of the National Institute on Drug Abuse (NIDA), quoted in What We Take for Granted

What we know now – that may have been known in 2012 but wasn’t widely known, and didn’t seem to be known in 2006 when I finished my degree because it wasn’t part of the curriculum – is that addiction impairs the brain’s ability to make decisions, to make judgments, to intend and to make intentions happen. What one most needs to do – decide to stop and stop – is beyond the injured brain’s ability to do.

I not only did not whisper when I realized I had a drinking problem in 2012, I did not speak at all. I told no one. In silent shame, I drove myself to a support group meeting comprised of survivors – well-meaning, amateur volunteers with a set of beliefs about what treats alcoholism.

If you had a brain disease – multiple sclerosis, Parkinson’s, Lou Gehrig’s, Alzheimer’s, for example – would you go to a support group meeting for treatment?

(Hey, WebMD, how about updating your site and adding addiction to your list of brain diseases?)

Not that there’s consensus on what constitutes effective treatment for addiction. This 2003 list of alcoholism treatments excerpted by a private company from a reputable, if dated, source (then linked disreputably by that company to its own products – good grief, how could you, people are dying out here) ranks 40+ treatment modalities. The National Institute on Drug Abuse (NIDA), has a 2012 explanation of principles of addiction treatment that does express current best practices but essentially says, “Try a bunch of stuff.” It states, “Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.” Behavioral therapies? For a brain disease? That’s all we’ve got?!

In terms of addictions treatment, I think we’re still in the era of bloodletting. Most of our treatments are based on belief, not knowledge.

. . . . .

Where does this leave me after six years of imbibing increasing amounts of the neurotoxin alcohol, then struggling three years with abstinence in essentially an untreated, under-treated, even mal-treated state of recovery from a brain disease? And watching the terrible statistics ravage my beloved fellow brain disease sufferers who attempt against miserable odds to survive?

Enraged. Bereft. Exhausted.

And, paradoxically, thrilled. Relieved. Hopeful.

With all the unknowns, now is still the very best time in history to need help with recovery from addiction.

I appreciated hearing in yesterday’s 60 Minutes interview that Michael Botticelli and I have something in common – we both attended a support group when we realized we had a problem, continue to do so, and continue to stay abstinent. (Additionally, I have needed therapy and “a bunch of stuff.”) He and I are among the lucky 1 in 15 who have been able to support abstinence through support group attendance.

I dedicate my voice and my work as an addictions counselor and as a person in recovery to learning other ways for the 14 out of 15 who also need help with this dangerous, destructive brain disease of addiction.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.

I cried when I read Nora Volkow’s state-of-the-science essay on addiction last month. Volkow’s heroic attempt to define the wicked complexity of addiction is probably still too technical and too long for most mainstream readers – much of it for me as well – but I’ve reread and studied and pondered. Of all the research I’ve seen, Volkow’s explanation most closely matches my own experience with addiction.

I wrote a brief commentary on her essay exactly one month ago today and included excerpts. Since then, I’ve followed every English teacher’s guidance – and my own when I was one – to allow the mental act of paraphrasing, as Purdue puts it,  help me “grasp the full meaning of the original” by putting it into my own words.

So, here is my paraphrase of Volkow, applied to express what it’s like to be Anne, addicted:

In 2006, I was just being Anne, just drinking wine in the evenings, and then something turned and I couldn’t stop drinking. Somehow – and I don’t know how – I was able to begin to abstain in 2012. A world, no, a universe of misery unfolded.

No matter how hard I try, I can’t feel much pleasure. I think I remember delighting in orange leaves in the fall, but I’m not sure. I am now highly sensitized to pain, physical and emotional. A back spasm sends me to a neurologist, not for a hot pack. I couldn’t find the serial number on the modem, burst into tears, and only the randomly kind words of a woman in tech support at the cable company got me connected enough to myself to get me connected back to the Internet.

I go down faster and farther, and when I get down, my compromised ability to feel pleasure makes it miserably hard for me to get back up. I am conditioned like Pavlov’s salivating dog to turn to the substance to which my brain turned for release from the incarcerating hell of that intractable, unrelenting down-ness.

And my poor punkin head – my prefrontal cortex – took a hit to its decision-making ability. I might notice an urge but be unable to resist it. I may make a plan but not stick to it. I used to run a company and now I can’t even run my own intentions.

In sum, I am under-sensitized to pleasure, over-sensitized to pain, automated to use my substance to feel normal, and can’t do much about changing any of it because I’m no longer that great at deciding something or sticking with it even if I do.

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.
– Nora D. Volkow, M.D, quoted in What We Take for Granted

In her brilliant, definitive, 2,600-word essay, Volkow offers one sentence about treatment: “Restoring normal balance between reward, anti-reward, and executive systems in the brain may require behavioral interventions and, when they are available, medications.”

“May.” May.

What a bright, bold light Volkow shines on what and why addiction is! How uncertain we are what to do about it!

In her essay, Volkow doesn’t include discussion of the confounding factor that I, like so many others who suffer from addiction, have co-occurring mental illness that snarls and intertwines with addiction. The inner experience of addiction and mental illness, truly, make it almost impossible to feel human or to feel part of humanity.

I’ve heard there’s a t-shirt with the slogan, “I’m out of bed and dressed. What more do you want?” Maybe I want one that says, “I’m out of bed, dressed, and probably against a billion-to-one odds, I haven’t had a drink today. My friend, today, that’s all I’ve got going.”