Writing Now

August 7, 2014 by

“…before everything got written so far wrong.”

– from “Liquid Paper” in Liquid Paper: New and Selected Poems by Peter Meinke

Over half would work for me

“Everything got written so far wrong” when I tried to stop drinking and couldn’t.

I felt horror and sorrow. I felt determined to find out why and what it meant. I felt enraged and ashamed.

I drew my feelings this morning in the order in which they came to me, right to left.

I began this blog on August 17, 2013 with this “end in mind” drawing. I could no longer keep my writing voice silent, but I kept secret what was most plaguing me – that I was  7 1/2 months abstinent from alcohol and writhing.

On July 28, 2014, I had been abstinent from alcohol for 19 months. I am writhing less. But I am appalled at how hard abstinence is for me. Others early in abstinence, or trying to become abstinent, share their stories with me and they writhe, too.

Unacceptable.

That determined face is the one that’s writing.

Filed Under: Drawings, Recovery Story Tagged With:

Still Sober After Reading The Sober Truth

August 4, 2014 by

Finding myself deeply inspired by Lance Dodes’s theory that a feeling of helplessness underlies addiction in Breaking Addiction: A 7-Step Handbook for Ending Any Addiction – the first part of which I excerpted here and applied to my own life here – Lance and Zachary Dodes’s 2014 book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry was a must-read.

Lance Dodes, co-author of The Sober TruthI felt shaken by The Sober Truth, both as a counselor and as person recovering from alcoholism. (I am still pondering and will share when I have insights.)

The Sober Truth has been extensively reviewed. Jake Flanagan offered brilliant commentary in The Atlantic. It was reviewed negatively in The New York Times; co-author Lance Dodes was featured on NPR. The book was challenged here by some heavyweights in the addictions field. Dodes replies to each charge with calm erudition.

When I read the extensive comments to Dodes’s replies, so many thoughtful and rational, others dogmatic and shrill, including distressing personal attacks of Dodes and other commenters, I felt as if were observing a microcosm of the very state of disrepair in the addictions field that Dodes criticizes.

After reading features and reviews and hundreds of comments, interlaced with Dodes’s rather heroic attempts to converse respectfully and reasonably with commenters, eventually I found his voice missing among the increasingly frantic and repetitive comments. Did he feel helpless and give up?

When I thought of entering a room full of commenters and commentators on The Sober Truth and attempting to find common ground among them – necessary to derive a vision and plan for the future of addictions treatment – I felt helpless. So helpless, in fact – as Dodes might predict – I wanted a drink.

“[B]y believing that AA [Alcoholics Anonymous] is the right approach for everyone, we have failed to adequately use or study other approaches that may be more helpful for the majority of sufferers. Although some people claim that our book ‘bashes’ AA, it is actually an effort to create a more sensible way to deal with this major public health problem.”
– Lance Dodes, comment

Excerpts from The Sober Truth follow.

[All text is quoted directly except when in brackets. Bracketed text is added for clarity. Page numbers are at ends of sections.]

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. 1

While it’s praiseworthy that some do well in AA, the problem is that our society has followed AA’s lead in presuming that 12-step treatment is good for the other 90 percent of people with addictions. 2

A treatment for alcoholism may be called successful if an individual no longer drinks in a way that is harmful in his or her life. 34

An objective calculation puts AA’s [Alcoholic Anonymous’s] success rate at 5 to 8 percent. Controlled, randomized studies, on the other hand, have revealed an even more discouraging picture: no such study to date has been able to prove that AA is effective at all. 56

Is this industry [the addiction rehab industry] actually helping people? 60

All this begs the questions: given that virtually every rehab is an elaborate expansion of 12-step meetings, why do people spend a fortune for programs that aren’t fundamentally different from what they could find for free in a church basement? 61

How does anyone know that thirty days is the right number of days to treat addiction? 62

How did standardized, education-like group therapy become the predominant mode of treatment at rehab centers…? 69

“Any serious treatment center would study its own outcomes to modify and improve its approach. But rehabs generally don’t do this. For example, only one of the three best-known facilities has ever published outcome studies (Hazelden); neither Betty Ford nor Sierra Tucson has checked to see if their treatment…” 39% on Kindle

What can we conclude from this [research on the success of rehabs in achieving abstinence for those they treat]? At minimum, as the researchers themselves write…”There appears to be a loss of treatment effect over time.” It appears that the benefits of being away…do not last long…[T]he single foundational treatment offered by Hazelden and most other rehab centers is the 12-step program, whose success rate we know. Rehab’s poor outcomes in light of these limitations are, therefore, not surprising. 75

[Lady MacBeth’s] compulsive behavior is universally comprehensible in human terms: a symbolic gesture to undo her guilt. 90

Once addictive behavior is defined through the prism of compulsive behavior, it can be treated just as pychotherapists would treat any emotionally driven compulsion, using talk therapy to root out the deeper meanings and purposes behind the behavior. 90

[Excerpt from case story on Marion:] By deciding to take a pill, Marion has chosen to do something within her own control, something that would make her feel better. Gone was the unbearable sense of powerlessness, replaced by a liberating sense of control. 91

[Three pieces of the addiction puzzle:]

[1] The psychological function of addiction is to reverse the sense of overwhelming helplessness. 91

[2] If reversal of helplessness is the function of addiction, then the powerful drive behind addiction is rage at that helplessness. 92

[3] Every addictive act is a substitute for a more direct behavior. 92

The drive to reverse utter helplessness is an explosive force, the natural human rage to fight against being trapped. 91-92

If addicts can learn to address their rage at helplessness directly, then it [rage] manifests simply as an assertive act. When people act directly, there can be no addiction. 92

[Addiction] becomes ordinary, no more or less manageable than any psychological challenge; it needs no special category; it is a psychological problem and can be managed as such. 93-94

People who have this symptom [the psychological symptom of addiction] can learn how it works within them and develop the agility to solve the issues that lie behind it. For instance, once people view their addiction as a mechanism to solve feelings of overwhelming helplessness, then it becomes critical to identify what is overwhelming for them – what sort of events or feelings carry powerful emotional significance. Being stuck on a call with the bank is frustrating for everybody, but for someone who used to spend hours every week as a child wait to speak to his estranged father by phone, it carries a particular resonance and power. 94

[A]ddiction can be understood, managed, and ended through learning about oneself. 94

Programs that apply community-based encouragement and little or no individualized care are poorly designed to treat emotional symptoms, including addictive behaviors…12-step treatments are trying their best to solve a problem whose fundamental essence they do not understand. 95

[S]elf-understanding is the key to treating all psychological symptoms. 121

[The] goal of therapy is to help people recognize feelings and thoughts that lie beyond their awareness. 121

[G]ains made throughout sobriety can quickly evaporate as the addict discovers that the very same feelings of intolerable helplessness have returned. 130

Insight is a form of empowerment that cannot be wrested from your grasp. 131

[C]urrent members [of Alcoholics Anonymous] respond with rage when pressed to consider different viewpoints or countermanding data. The visceral power of these responses should be a clue to the psychology behind them: we save our fiercest defenses for an attack on that which keeps us whole. 131

What can be done to make use of that which is useful in the program [of Alcoholics Anonymous]? Since AA is helpful for a small minority of people with alcoholism, and often neutral or detrimental to others, it should be prescribed carefully. The current practice of referring addicts wholesale to a 12-step group is unwise and dangerous. 132

People who make it clear they find 12-step meetings and ideas to be offensive, stupid or wrong should not be encouraged to ignore their feelings. They are telling us in clear language that they are simply not candidates for this particular approach. Conversely, those who like 12-step programs and benefit from them are telling us they may belong in that small group of committed and helped members. 132

Directing people toward the best approach for them is one of the most basic forms of medical care. We have generally failed at applying thoughtful triage like this to addiction in this country. 133

[If] consequences alone were enough to make someone stop repeating an addictive behavior, there would be no addicts. One of the defining agonies of addiction is that people can’t stop despite being well aware of the devastating consequences. That millions of people who have lost their jobs, marriages, and families are still unable to quit should be a clear indication that loss and despair, even in overwhelming quantities, aren’t enough to cure addiction. 135

Asking them [addicts] to surrender their free will in response to this problem is diametrically opposed to what they need to do: feel empowered. 136

Yet slips [from abstinence] are hardly rare and not remotely apocalyptic. Most people will experience some lapses as they grapple with their addiction. This is completely predictable, given the fact that addictions arise from deeply personal emotions and experiences that can take months and years to work through. 137

The word “drunks” also defines addicts by their addiction, further reinforcing the notion that addicts are somehow different from the rest of us, as if addiction is an innate quality rather than an acquired behavior…[it says] addiction is not something you do, it’s something you are… Addiction appears within every possible socioeconomic level and in people who run the gamut of emotional health… The core issues [and underlying distress] that lead to feelings of overwhelming helplessness, and thence to addiction, are as varied as the people who experience them. 138

The idea that having an addiction makes people so different from others that only other addicts could possibly understand them is demeaning. Nobody would ever suggest that a doctor must have had cancer to treat cancer, yet in the 12-step model, addiction is accorded this special designation of “otherness.” 145

Addictive thoughts are never random. 94

[A]ddiction itself isn’t a remotely insane thing to do. Addiction has its own logic and its own purpose…[A]lthough addicts may engage in deeply destructive behavior, crazy they are not. 144

[A]ddiction works psychologically – as a fundamentally healthy drive to feel empowered when it seems like there is no other choice… 145

“It turns out that AA’s emphasis on denial is misplaced; denial itself isn’t the problem – it’s shame, coupled with a lack of understanding of the nature of addiction that makes ‘denial’ necessary.” 145

But they [who judge addicts’ problem to be denial] do terrible harm to the very addicts whose recovery depends on understanding themselves without judgment. 145

Most people who do good work in education or the humanities know that deeply significant truths cannot be measured…Most good, worthy, and verifiable ideas don’t belong in a spreadsheet. 148

What’s missing from this literature [published research on addictions] is any study that revisits the fundamental questions once and for all: What is addiction? How should we treat it? Why does it occur in some individuals and not in others? 150

The addiction field has been dominated by two colossal institutions, neither of which is trained or interested in looking beneath the surface of any behavior to its underlying causes. One of these forces is AA. The other is [a shift in research and thinking in the field of psychology that includes] …the very popular notion that addiction is a disease. 155

Image: Screenshot from lancedodes.com

Filed Under: Recommended Reading

Helpless Rage Theory Makes Sense to Me

July 31, 2014 by

I became addicted to alcohol because of helpless rage.

That’s the essence of Lance Dodes’s explanation for the origin of addictions in Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (2011).

To discover if Dodes’s work could be meaningful to me, I excerpted sections important to me in story form here.

I’ve formulated his theory this way:

childhood hardship over which one feels helpless > rage at helplessness > overwhelming feeling of being trapped > aggressive feeling of need to escape > no direct action to take > an indirect, addictive action taken

And I’ve diagrammed it in the accompanying image.

Anne on Dodes on Addiction

(Note: Some people I work with hesitate to use the terms “neglect,” “abuse” and “trauma” to describe their pasts but are open to this generalization about their early years:  “What should have happened didn’t. What shouldn’t have happened did.” In the diagram, I used “abuse” and “neglect” as shorthand.)

So let me apply Dodes’s helpless rage theory to my own story.

When I look back at my childhood – and I can’t know if they were or not – this is only my perspective, my chicken painting – I experienced my mother and father as upset with themselves, upset with how their lives were unfolding, and upset with each other. I felt born into upset. I can’t remember a time I wasn’t determinedly trying to un-upset them or to keep them from getting upset with me or with my sister. My father drove me to and from sports practices; my mother tutored me in math. I had a fine middle class upbringing. Always present, however, was just-about-to-blow upset. I wan’t conscious of it at the time but, yes, words like “trapped,” “caged,” “imprisoned” work for how I felt. I felt powerless and helpless and hopeless to transform that situation into one in which I could just relax.

Dodes asserts that the natural response to entrapment is rage. When he described the furious, direct action one would take if buried alive in a cave-in*, I could feel the rage.

“All animals react with aggression to being trapped; it’s a necessary survival instinct…This fury in addiction is actually quite normal.”
Lance Dodes, M.D., Breaking Addiction

Because what one wants to do one is forbidden to do – the direct action I wanted to take was to beg my parents to please handle their lives and just love me and not make me do all the work to calm them – Dodes believes we substitute indirect actions.

I shared in my drinking history that alcoholism didn’t start for me until in 2007. A lot happened that year for which I felt the urge to take direct action.

In 2007 when the student pushed me off balance, what I really wanted to do was push him back, possibly throw myself on him and attempt to beat and beat him. (That sounds weird and there’s more to that story but I’m observing Babette Rothschild’s caution about reliving trauma. Just writing that much makes my scalp prickle. Enough.)

I felt helpless rage over his act. Instead of responding directly, physically, I tried a lot of indirect actions to relieve my outrage. Which one would work? The glass of wine that night helped my helplessness fade. Same thing when the kid threatened to shoot me. When Cho killed my fellow Hokies and himself, I had no one to beat. I felt rage and despair and helplessness and hopelessness. Only when I had a drink did I feel like I was doing something, anything, to hold together my broken soul.

And then I couldn’t not drink.

I was 19 months abstinent from alcohol 3 days ago, on July 28. I have become aware that every time I want a drink, just before it, I have thoughts and feelings. Yes, one of those feelings could be described as “helpless rage.”

. . . . .

*When you first find yourself trapped in a tight, dark space you might try to stay calm, but that won’t last for long. Soon you’ll be banging on the rocks, clawing at them to get out. Your hands will be bloody. You might break your wrist in the desperate effort [to do something, anything to get out.] But that wouldn’t matter. At that moment the normal rage in such situations is the dominant force…It’s good to keep in mind that if you and they [people who consider addictions unusual] were trapped together in a cave-in…you would all be furiously pounding on the rocks just the same.”
– Lance Dodes, M.D., Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (2011).

To see how his thinking has evolved since 2011, I’m now reading Lance Dodes’s latest book, co-written with his son, Zachary Dodes, published this year (2014), The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. I’ll share what I discover.

For further reading:

Filed Under: Addiction, Drawings, Recommended Reading Tagged With:

What I Read on Summer Vacation

July 28, 2014 by

Excerpts from Breaking Addiction: A 7-Step Handbook for Ending Any Addiction,
Lance Dodes, M.D., 2011

[All text is quoted directly except when in brackets. Bracketed text is added for clarity. Page numbers are at ends of sections. Excerpts are from introduction through page 42, and page 58, paperback edition.]

The fact is, if you suffer with an addiction you are not different at all from anyone else. 36

Since an addiction is no more and no less than a psychological symptom – just one of many human mechanisms for dealing with emotional life – having an addiction places you squarely in the mainstream of humanity. 36

Because addictions are efforts to deal with the most important emotional issues of your life, it is impossible to understand them without understanding yourself as a person. 42

…addictions are a kind of shortcut to understanding yourself… 13 (note)

Since addiction is   a way to deal with certain overwhelming feelings of helplessness, once you know what the key issues are for you, you are in position to manage and ultimately end your addictive behavior. 21

Addiction is a behavior intended to reverse a profound, intolerable sense of helplessness. This helplessness is always rooted in something deeply important to the individual. 12

…when there is no direct action a person feels he or she can take to deal with overwhelming helplessness, he finds a substitute (or a displaced) action. 18

Addictions are all substitute (or displaced) actions. They take the place of a more direct response to feelings of helplessness in a particular situation. 18 People perform addictive acts in the face of overwhelming feelings of helplessness because they feel trapped and don’t see more direct ways to handle a given situation. 18-19

[Analogy of the Cave-in: Dode compares being trapped under ground to the drive behind addictive acts.]

When you first find yourself trapped in a tight, dark space you might try to stay calm, but that won’t last for long. Soon you’ll be banging on the rocks, clawing at them to get out. Your hands will be bloody. You might break your wrist in the desperate effort [to do something, anything to get out.] But that wouldn’t matter. At that moment the normal rage in such situations is the dominant force. 16-17 It’s good to keep in mind that if you and they [people who consider addictions unusual] were trapped together in a cave-in…you would all be furiously pounding on the rocks just the same. 40
All animals react with aggression to being trapped; it’s a necessary survival instinct…This fury in addiction is actually quite normal. 16

[The emotional energy that drives aggression against feeling trapped and helpless] arises not just in realistic circumstances like being trapped in a cave, but also in situations that feel overwhelming and confining…] 17

The drive in addictive behavior is rage at helplessness. It is this particular kind of rage that gives addiction its most conspicuous characteristics of intensity and loss of control. 16

In fact, if you think of how rage reveals itself, you will see that it looks remarkably like addiction. In the throes of rage people are overwhelmed with their anger; their rational thinking process and their self-control dissolves. They become unconcerned about the long-term consequences of their actions. Everything in their lives that they normally care about becomes secondary to the expression of the rage…it is a kind of rage that drives addiction. 15-16

Ron’s decision to drink relieved his feeling of helplessness. He could, entirely in his own control, take an action that would make him feel better. He was the master of his internal life, of his feelings. And he was taking control over not just any helplessness, but the kind that touched on the central emotional problem of his life…[the kind of helplessness] that was now, and always had been, intolerable to him. 11-12

If you compulsively substitute drinking for a direct action, then we say you have alcoholism…[although the] form of an addiction does not have special meaning. 18

Habits are very different from addictions. They are automatic behaviors that don’t have deeper meaning. 27

[Do you have a repetitive, excessive behavior that you worry is an addiction rather than a habit? Ask yourself:] When does my addictive act (or even just the thought of it) arise? Is it when you are feeling helpless about something – being insulted, left out, used or abused, ignored, hopeless, or any other feeling that for you leads to that intolerable sense of helplessness? Of course, you may not know what is setting off thoughts of your addictive act until you have a chance to think carefully about it. But if the behavior you are concerned about is triggered by this kind of emotional upset, it is much more likely to be a true addiction. 25

People have habitual ways of dealing with anxiety, sadness, fear, anger, and other feelings. These emotional defenses are pretty much permanent aspects of their personalities – techniques settled upon early in life to deal with emotions. Because these ways are so settled, once you recognize your own emotional defenses for managing difficult feelings, they can be used as sign-posts, or even warning signals [of an impending emotional distress-relieving, addictive act]. 58

…addressing feelings of helplessness is key to treating addiction. 13

For further reading:

 

 

Filed Under: Recommended Reading

18 Months Sober and Still Not Happy?!

July 19, 2014 by

I’ve been questioned about my lack of happiness. Shouldn’t I, after 18 months without a drink, be experiencing some of the joys of recovery?

Eschewing a postmodern deconstruction of the definition of “happiness” – feel free to radically, relatively and tediously define it as you will – here are the reasons I think I’m not happy.

Bamboo continues to happenIt’s a time thing. A friend told me that she doesn’t want to relapse, not because she doesn’t want to do year 1 over again, but because she doesn’t want to do year 2 again. Dan Smith refers to 18 months sober as a “dangerous time.” A mentor says, “Time takes time.” I haven’t done year 2 before and I would describe it, generally, as hellish, a different kind of hell from year 1. I’m probably as far along as I can get. At this time.

It’s a brain thing. I’ve messed up my mind. Anhedonia – the inability to feel pleasure – happens to abstinent alcohol and drug users. Anhedonia + relapse happens. How to treat a decreased ability to feel pleasure (happiness?) remains uncertain. Time will heal some of it. And I can think and regulate my way to accelerated improvement. But I can’t will myself to be happy any more than I could will myself to stop drinking.

It’s a human thing. I can’t say alcohol made me happy, but it gave me a complex experience of relief, release and comfort. It ceased my distress. I am never, ever to have that again. What alcohol did for me is now not being done. I am not the self I was. And addiction makes me long for what I used to have. I have to handle distress, loss, grief, longing, all at once. That’s just humanly hard. And it’s hard to feel humanly happy when one has to work that desperately hard.

It’s a life thing. Life happens. My divorce – my second – will be final this month. My mother died three years ago next month. Bamboo invades the foundations of my townhouse. Will it give me a surprise through the toilet next? Eh, life.

However…

I’m trying. I think trying will eventually work. I’m not sure how to define “work,” but I expect to be happier in the future than I am now.

I’m trying different things. A gift of being in recovery and working against addiction with other people is their help becoming more aware more quickly of when I am doing the same things over and over again and getting the same unwanted results.

Recovery from addiction requires a person to be his or her own treatment team leader, working 24/7/365, to create and execute a customized, individualized treatment plan. I live in a small town with limited resources for addictions recovery.  I’ve done my best to create days filled with treatment. Members of my recovery community give me feedback on my progress and create an intimate, expert Google. I can make queries and receive – given generously and plentifully without scolding or shaming – ways that have worked for others.

I am shoulder to shoulder with others. As a member of a recovery community and as a counselor working with other alcoholics and addicts, I spend my days sharing, working, talking, and listening with people who are also trying to be happier. Stopping drinking was too much for me alone; staying stopped feels like too much for me.  And happiness?! Some seconds, minutes, hours, days, months – happiness is impossible. I’m not the only one on the job, though. Being a member of a community that intentionally seeks insights and understandings, and who gives and receives to each other intentionally, soothes, warms and inspires me.

I am doing my best to use my gifts. I have a sense that addiction to alcohol worked on me like an inner solvent. Parts of my self, my mind, my essence got dissolved forever. I am trying to exercise what’s left, however, and build it. I am trying to open my half heart to loving more, to feeling more compassion. In my work, I’ve had the amazing opportunity to know closely, not dozens or even a hundred people, but thousands. Hence, I know a lot about people. I approach learning as a scholar, not as a hobbyist, and I know a lot about a lot. I remember having a passion to delve, then distill. I can still read and study and synthesize large quantities of complex information into little blog posts and stick figure cartoons – a former student remembers and terms them “stickies” which is balm for my sore heart – even into processes for apps.

Yeah, so maybe I’m not as happy as I would like or others would like me to be. But, sheesh, I haven’t had a drink for 18 months. I think I’m doing all right.

Update 9/25/19

I wrote this post in 2014 – just over 5 years ago – and it receives more traffic through search than any other post on my blog. The feedback I’ve gotten is that people are entering “sober but unhappy.”

In 2014, we didn’t know as much about substance use as we do now.

For me, the year of change was 2016 with the publication of Unbroken Brain: A Revolutionary New Way of Understanding Addiction by Maia Szalavitz and Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health.

The research on addiction was now available for all to read. I learned that I am one of the 2/3 of people with substance use concerns who has experienced trauma. In 2014, abstinent from the substance that eased my mind and heart, I wasn’t just unhappy, but on fire with untreated PTSD symptoms.

Having been treated for trauma, this is now what it’s like to be me, a person in remission from the health condition of addiction. Here’s a typical day in my life following an evidence-based treatment plan. And here’s a plain language summary of what the research suggests can help people who want or need to abstain.

I’m now in private practice as a counselor and publish all the materials I create for my clients for all to use as they wish. I so hope they or other sources may help ease your way.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. 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.

Filed Under: Recovery Resources, Recovery Story
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