Addiction Education

A Brief Outline Of The 12 Steps — Step 10

This is the tenth in a series of posts in which we hope to acquaint our readers with some of the details surrounding the programs that we recommend. There are a variety of other programs, but because we and most other facilities shape our treatment plans around the 12 Step fellowships, those are the ones on which we will concentrate.

Step 10 reads: “Continued to take personal inventory and when we were wrong promptly admitted it.”

The principle behind Step 10 is perseverance.

Scan of original image, (C) DigitalZen

Addiction is more than the compulsion to use alcohol and other drugs.  Over time, we adjust our thoughts, our ethics, our relationships, and our ways of looking at the world in order to accommodate the necessity of getting high.  Recovery is about changing those things.  During the first nine Steps, we dealt with the reality of our past and its effects on ourselves and others.  We worked hard on our recovery, traveled a long path, and — except for one thing — the hardest parts are behind us.  That one thing is making sure that we don’t fall back into our old ways of thinking and behaving.

In AA, they have a saying: “When you sober up a horse thief, all you get is a better horse thief.”  Unless we have progressed through the steps, genuinely and carefully, we run the risk of either losing their benefits or simply avoiding many of them in the first place.  Only after sobriety has become a habit do we really gain all of its gifts.  Only then are we truly “happy, joyous and free.”

Step 10 is about turning sobriety into a habit and keeping it that way.  To begin with, many of us sat down at the end of the day and actually wrote out a brief inventory of the day, perhaps in our journal.  We listed both the skillful and unskillful ways that we handled situations, and considered our part in any controversy and how we might have handled things better.  

We might have fallen back into an arrogant attitude at work, might have avoided responsibilities, might have had an argument with a spouse or co-worker, might have been unkind or thoughtless when dealing with a child.  Whatever it is, we look honestly at our part in it, and we do what we have to do — we make it right.  We make these little amends sincerely, and we do it before the situation worsens.  That avoids developing resentments, which are much harder to deal with.

If we carry out these little exercises consistently, we find that being honest with ourselves and admitting our mistakes becomes easier.  After a time, we find that we apply our new personal standards to things before they happen.  We think about better ways to handle situations, instead of just reacting with our old addict instincts

Finally, over time, our new ways of dealing with life become new instincts, and we move out of the world of early recovery into the realm of genuine sobriety.

A Brief Outline Of The 12 Steps — Step 3

This is the fourth in a series of posts in which we hope to acquaint our readers with some of the details surrounding the programs that we recommend.  There are a variety of other programs, but because we and most other facilities shape our treatment plans around the 12 Step fellowships, those are the ones on which we will concentrate.

“Made a decision to turn our will and our lives over to the care of God as we understood Him.”

Step three has been the source of a great deal of controversy over the years.  It seems to be the reason for most objections to the 12 step programs, as well as the cause of most claims that they (especially AA) are religious cults.  Let’s deal with the cult issue first.

The overriding issue in defining a cult is harm: is it harmful or helpful to its followers?  All cults have three things in common:

  • Material and/or social gain on the part of an individual or individuals, with an essential disregard of the effects on the rank-and-file.  
  • Coercion of followers to remain in the group.
  • Isolation of members from the rest of society in various ways.  

There are others, but these three things are common to all cults.  The twelve step groups fail to meet any of the above criteria.

  • There is no material gain. Members can donate a dollar or two to help defray expenses such as rent, if they wish — or they can attend for months without contributing a penny.  
  • There is no social gain for leaders, because there are no real leaders.  “Our leaders are but trusted servants, they do not govern.”
  • Although some few people might argue otherwise, it is difficult to sustain any real suggestion that the fellowships do not help members.  Certainly it would be hard to support an assertion that they do them harm.  Obviously, for many, they do a great deal of good.
  • There is no coercion or isolation of members.  The general attitude among groups is that you are welcome, but that if you want to leave and try something else, or go back to your drug or activity of choice, then you are perfectly free to do so.  That is not to say that no one will attempt to talk you out of it, but that is the extent of any effort to prevent your leaving.
  • Finally, the entire purpose of the 12 step approach is to help people remain abstinent, deal with their issues, and return to a normal life.  Although there may be suggestions that a member limit contact with some people and situations in the beginning, in order to avoid temptation and stress, the ultimate purpose is to help them become productive members of society.  

The principle behind the Third Step is Faith.  If we do not believe that our course of action is in our best interest, we are unlikely to sustain it long enough to gain from our efforts.  When the steps were formalized, the expression “care of God as we understood Him” was an easily-understood way of expressing the need for faith.  In the 70-odd years since, it has become socially acceptable to think of religion in a variety of ways that were not common — or were left unspoken — in 1939.  

Religious people today adhere to the literal meaning of the words, but others choose to think of them as simply an expression of the need for faith in the process in order for it to have much chance of succeeding.  Many, this writer among them, have succeeded in remaining sober without faith in the religious sense.  

However, belief that we cannot do it alone (Step Two), and faith in the process of “working” the steps are essential.  Those who remain around the groups long enough will witness change in other members, and themselves.   They will grasp that the program works when people are serious about it.  Such direct, personal observation should be all the proof that anyone needs, if they are open-minded and willing to change.  

How do you deal with dual diagnosis? Which issue comes first?

Dual diagnosis, a situation where a patient has a mental disorder in addition to an alcohol or drug problem, is quite common. It is a complex situation, and treatment is not an issue of deciding which comes first. To achieve a successful outcome it is necessary to treat both together. However, the specific treatment will vary depending on how recently the individual has been using alcohol or other drugs, and on the underlying condition.

It is not uncommon for people to self-medicate because they have found that they can relieve the symptoms of other problems to a degree. On the other hand, it is not uncommon for drug and alcohol abuse to create mental problems, complicate existing problems, or both. Depression, for example, can be an underlying problem, the result of drug and alcohol use, or both.  The complexity and need for flexibility in treatment make it extremely important that recovering people with other mental issues be treated by professionals who are specifically trained and have experience dealing with dual diagnosis. They will be able to deal with the underlying causes, rather than simply treating the symptoms.

Generally, a treatment protocol would have three aims:

  • First we would want to support the patient by reducing symptoms of the organic disorders while she withdraws from the addictive substances.
  • Then we would work on maintaining them comfortably until sufficient time has elapsed to allow an accurate diagnosis of underlying problems.
  • Finally, we would work on supporting their recovery from addiction while actively seeking solutions to the other disorders.

Dual disorders can be treated successfully in most cases.  However, it may take time to arrive at the correct combinations of medication, therapy and outside support.  Like everything else in recovery, we need to approach it one day at a time.

Are there ways to deal with pain without addictive drugs?

Q. Are there ways to deal with pain without the use of addictive drugs?

Chronic pain is a major problem for millions of Americans. Many billions of dollars are lost every year to employee leave, insurance, disability payments and other care costs.

If we were addicted to pain medications, two things most likely happened: as we built tolerance to the drugs we needed more and more to get relief, and continued use made us unable to stop. The amount of drugs we took is not an issue. Prolonged use of opioid drugs eventually and inevitably results in addiction. Switching narcotic drugs didn’t help the problem, because as far as our bodies are concerned, one opioid drug is pretty much the same as the next.

So now we want to get clean, and we’re terrified of the prospect. Not only are we worried about the issues surrounding detox from drugs, but (perhaps even more) about the management of our pain after we have them out of our systems. It is nowhere nearly as well known as it should be, but there are a wide variety of alternatives to opioid drugs for management of chronic pain. Although we may have used some of these techniques for short-term relief, a long-term regimen conducted by professionals can have results that we never imagined.

Non-narcotic pain management tools include:

  • Physical Therapy: Yes, we had it before, but the presence of the drugs is likely to have prevented our obtaining the results we needed. It is probably the most important of all, because conditioning the rest of our bodies to support the weak areas relieves much of the pressure causing the pain.
  • Heat or Ice Therapy
  • Relaxation Techniques: There are a variety of these. A professional can help you find the right one for you.
  • Biofeedback: a specialized form of relaxation that can help you relax the area that is the source of pain.
  • Massage Therapy
  • Alternative Medicine: Chiropractic, acupuncture and accupressure, reflexology, and similar methods of relieving stresses on the body
  • Proper Diet: A healthy body will enable us to better perform other therapies, and will assist the body in building strength and muscle balance. If we are overweight, this is of particular importance.
  • Psychological and Psychiatric Support: Any program specializing in addiction and chronic pain will have appropriate counselors and psychiatrists to aid in pain management.
  • Medications: There are a variety of non-narcotic medications that, in combination with a good program of treatment, can support our pain relief.
  • Occupational Therapy and Vocational Guidance: Wouldn't it be great to be able to work again? With the aid of professionals, this may be possible.
  • Setting Goals: Once we have arrived at a level of acceptance of our pain, it is imperative that we begin setting specific goals that, once reached, give us hope and raise our self-esteem.
  • Family Therapy: Our family is our first line of support. It’s imperative that they understand not only our pain reduction program, but also our addiction.

As you can see, there are many options. We may have tried some, but with the drugs out of our system it's a whole new ballgame. For more detailed information about chronic pain, please go here.

Geographic Cures and Denial

Q. I've heard people at meetings refer to “geographicals,” or “geographical cures.” What's that about?

Hand-drawn map of North America, 1811 -- Library of Congress, Geography and Map Division

A geographical cure is an attempt to avoid the reality of our addiction by changing location.  They are a form of denial, a defense mechanism in which we are faced with a fact that is too uncomfortable to accept and so we convince ourselves that it is not true despite what may be overwhelming evidence.

Excuses are a major form of denial. We learn their usefulness as small children: “She hit me first!” We usually grow out of that phase, but for addicts the need to make excuses and convince ourselves and others that we're really okay is our way of protecting the addiction. We say things like, “If you were married to that bitch,” or “If you'd seen the things I've seen…,” all of which, we have convinced ourselves, justify our drinking, drugging or whatever we may prefer not to look at too closely. (If we did, we might have to do something about it.)

So, when things get rough, we sometimes convince ourselves that all we need is a fresh start in a new place, and we'll be able to get our lives back under control. However, unless our geographical cure has also involved detox, treatment and a program of recovery, we discover that it doesn't take long for the things that we thought we'd left behind to hop out of the trees and right onto our backs again.

We failed to consider one of life's major truths: No Matter Where You Go, There You Are!  We need to change our way of living, not where we live.

Hitting the road doesn't solve our problems, it just means that we have to face them in a strange place, among strangers.  If, however, we decide to get out of the old neighborhood and get some help, that's not necessarily such a bad idea.

How do I do this on the outside — stay sober on my own?

You're asking the wrong question.  What we really need to know is how to find support on the outside so that we won't need to try to stay sober on our own.

One of the outstanding characteristics of active addicts is isolation.  Even when we're in a crowd, pontificating and running the show (or believing that we are) we don't really share the space with anyone else.  We don't have meaningful conversations.  We don't listen to what others say.  Our attention is turned inward, toward what we think, what we want others to think, what we want to keep secret, how this can work to our benefit — without concern for its effect on others.  We're concerned with how we can get our next drink or drug, how to manipulate others, how to bolster our nonexistent self esteem, and so forth.

We may share what's happening on the surface, but that's the problem: when it comes to our relationships with others, we're all surface.  What they see is not what's there.  We don't even know how to be honest with ourselves, and we surely aren't able to be honest and open with others.  That would put our relationships with our drugs in jeopardy, and no addict is going to chance that.  We don't know how to trust, because we can't afford to.

If you knew what I'm really like, you'd be disgusted.  Worse, you might take my drugs — my only friends — away from me.

So, one of the most important things about recovery is learning to relate to other people honestly.  We do that by developing relationships with people who will accept us as we are, who will be honest with us, and who will help us learn to be honest with ourselves.  We do that by gradually learning to trust others, so that we can be honest with them

We learn to relate to others honestly by developing relationships that are based on healthy ways of looking at life, outlooks that can take the place of a lifestyle centered around drinking, drugging, and the behavior connected with those things.  Eventually, we trust enough that we are willing to accept guidance in repairing other relationships, whether they be with family, friends, employers or the legal system.

We stay clean and sober by making in our lives, and in the way we approach life.  We get help doing that from people who have done it themselves.  We do it by developing a support group where we can practice recovery.  In short, we do it in AA, NA, or some other fellowship or group that can help us learn to live a lifestyle that is healthy physically, emotionally and socially.

If we don't do these things — if we continue to think the same way, relate to the world the same way, behave the same way — it is only a matter of time before we use again.  Why wouldn't we?

We don't do it on our own.

To paraphrase Dr. Phil, how was that working for you?

Permanent post:

Newly Sober? PAWS Still Has You In Its Claws!

Early recovery can have its rough spots. If you've been having more bad days than good, you might want to take a look at this article. It could make things a lot easier. (Hint: You're not going nuts!)