Alcoholic

Why Can’t Recovering Addicts Use In Moderation?

A client asks: If we can change our thinking in order to abstain from using alcohol and other drugs, then why can’t we change our thinking to be able to use in moderation?

Why can't addicts use in moderation?  Think about it: why couldn’t we simply use “in moderation” without all the hassle of detox, treatment, and a program of recovery? If we couldn’t do it then, why should we be able to do it now? Those are the real questions!

The key is “change our thinking.” We don’t think our way out of addiction. We make a decision to get clean and sober, and to follow the suggestions of our program of choice, in order to facilitate abstinence. The thinking and process of our programs of recovery relieve some of the emotional pressures we created with our addiction and equip us to live sober lives, but they do not “cure” the addiction.

Abstinence and the subsequent repairs that our bodies are able to effect in our brains allow our addiction(s) to enter remission. Our brains slowly deactivate the extra receptor sites that clamored for more drugs and caused our compulsion to use, and at the same time the production of chemicals normally found in the brain has to ramp back up from being suppressed by the presence of the drugs. Not until this process is complete — and it can take months — do we reach the point of feeling relatively normal, although we begin to feel better long before the job is done.

Feeling better is part of the problem, too. Because the repairs to our brains depend on abstinence, as long as there are any of a wide variety of abusable drugs in our systems, the repairs can’t take place. And because they also take time, and that means that the desire to use won’t go away entirely for quite awhile; it will come and go. We can easily decide that we’ve been clean for a while so we ought to be able to “handle it.” But if we give in and use, even a little, the repairs to our brain will slow down, prolonging the physical recovery process. It is also quite likely that the combination of reuniting with our old obsession, combined with the indisputable fact that people on drugs do stupid things, will cause us to decide more would be better. Continued use will reverse the recovery process and kick us back into full-blown addiction.

Recovery is not a matter of willpower. If it were, we would have simply ignored the compulsion and stopped. The compulsion comes from a part of the brain that isn’t affected by conscious thought. We can’t think our way into sobriety; we need abstinence too. Here at Sunrise Detox, we see a lot of folks who think that they can use in moderation.  Again, and again, and again….

Why Does Sharing Experience, Strength and Hope Work?

In order for me to recover, I have to understand at least some of the ideas flitting around in my head. Telling someone else is the best way to get the mess organized. Saying what’s happening to me in a way that others can understand — putting it into words and sentences — removes the secrecy, the mystery, and clarifies things in my own mind. My thoughts have to stop running around in circles (at least a little bit), and that allows me to see through my own mental static. But there is another powerful reason for sharing our experience, strength and hope.

No one gets into recovery by accident.  We used alcohol, other drugs or behaviors — often all three — because they made us feel better about ourselves.  After they stopped working we kept using them because we were physically and emotionally addicted, and because we didn’t know what else to do.  Eventually something happened that made us willing to take a terrified leap into the unknown, because we could no longer tolerate what was going on in our lives. I didn’t get up one morning and say to myself, “Hey, it’s nice out; I think I'll go to detox!” Neither did you.

But what got us into recovery doesn’t really matter. What matters is that we have to repair the damaged thinking that made acting out our addictions seem preferable to facing reality. As many have said, “I’m not responsible for being an addict, but I am responsible for my recovery!” Back then, we didn’t know any better; now we do.

And that’s where the experience, strength and hope of others matters. In order for us to have faith in the program, we have to see that it works. Listening to other addicts tell how it was with them, what worked for them, the results and their hopes for the future — or maybe just how scared they are — tells us that we're not alone, and gives us hope. I may not believe that I can do it, but if I see and hear that there are people who felt the way I felt, who had many of the same or similar experiences, who suffered the same shame, guilt and despair, and that they've managed to get beyond all that, turned their thinking around and begun to live, then just maybe I will begin to believe that I can do it too.

Further into our recovery, we may listen with a changed ear and be able to hear how we can apply the experiences of others in our own lives. In the beginning, though, we simply need the reassurance that we are not the only ones who behaved the way we did, that others have recovered successfully and are willing to share what they’ve learned, and that we are not alone.

That's why we're told to identify with the lives and feelings of others, and not compare. The details don't matter. The feelings, fears, and humanity that we share with our fellow addicts are the keys.

Experience. Strength. But, most of all, HOPE!

People, Places And Things

Many of the folks who attend the groups at Sunrise Detox wonder about “people, places and things,” and question how merely seeing someone, or being in a particular place, can trigger a powerful desire to drink or use other drugs.

Maybe the best way of understanding this is to consider a number of recent experiments that studied the brain activity of subjects while they were exposed to certain stimuli. Rats, rabbits, and non-human primates will seek the same drugs that we humans abuse, and will begin seeking them again — even after months of deprivation — when exposed to the drugs themselves or to visual cues that they have associated with drugs in the past. Along with these, brain-imaging studies on human addicts indicate that visual cues can cause the addict to recall the pleasure of drug* use, and can cause enhanced activity in areas of the brain that are associated with cravings.

This research shows scientifically what people in the rooms have known for a long time, often demonstrated in sayings like “If you don’t want to slip, stay out of slippery places.” It doesn’t take a rocket scientist to figure out that if you want to stay sober you don’t go into a bar, order a drink, and sit and look at it. There’s a technical term for folks who test themselves that way: relapsers.

It shouldn’t take a lot more thought to see how less obvious things can have similar effects. Ordering a club soda and hanging with our drinking friends, seeing our dealer in a crowded club, passing the shop where we purchased our wine, even sitting in front of the TV with our buddies watching a game — all of these thing can trigger a desire to use, the “just one won't hurt” thought that has killed so many of us .

Stress

Consider that stress is one of the greatest causes of relapse, because it was one of our biggest excuses for using. Family arguments, the presence of people whom we believe disapprove of us, being around other people who are behaving the way we used to, animosity from people we harmed during our addictions — all of these things are powerful stressors, along with financial, legal and romantic complications. Some of these things are going to be parts of our early recovery, but it certainly makes sense not to complicate the problem with temptations and stressors that can be avoided. Of course these things are part of live, and of course we’ll have to deal with them eventually, but that doesn’t mean we should try when our brains are still in early recovery and the likelihood of relapse is at its greatest.

Thus, to the extent possible, we need to avoid the old people, places and things until we have enough sobriety under our belts to deal with the stress and temptation. Even then, smart addicts moderate periods of tension by attending extra meetings, calling people in the program, and generally stepping up their involvement in recovery.

Many sensible strategies, such as living in halfway houses, staying out of home areas, putting off jobs, relationships and other potential stressors can seem counter to the idea of recovery. After all, isn’t it about carrying on with life? That it is, but carrying on with life means doing so effectively, which means clean and sober, with some good recovery under our belts. Recovery is difficult enough without standing at the plate begging for curve balls. Trying to “make up for lost time” is an excellent way to lose even more of it, and perhaps our jobs, families, or even our lives along with it.

*When the writer uses the term “drug” he includes alcohol, which is simply a legal drug.

Sponsors In Recovery — More Questions

Our clients attend group sessions while in detox, and questions come up about sponsors in recovery. Since the subject seems to confuse some folks in the beginning, we like to mention it occasionally with a bit of an explanation. These were a couple of recent questions.

What is a sponsor?

Sponsors in recovery are people with experience in the particular program of recovery, who have completed the 12 steps, and who help newcomers understand and guide them through completion. Along with that, they make themselves available as supports outside of meetings. A sponsor should be of a gender preference that minimizes the possibility of outside entanglement, and the sponsee should remember that age is not a factor in these matters. That is, men sponsor men and women sponsor women, unless the parties are gay.

Most sponsors require that their sponsees call them every day, and want to meet with them on frequent occasions to discuss their program, things that may be on their mind, and help prepare them for the various steps. If they do not have time to do that — and there are many good reasons why that might be the case — then perhaps another choice would be wise.

A sponsor is not a moneylender, legal adviser  marriage counselor or therapist. Their purpose is to help the newcomer focus on the 12 Steps, and to help them come to an understanding of their program of recovery. These other things distract and change the focus of the relationship, and are generally considered detrimental. Furthermore, it is quite likely that they are not qualified in those areas anyway. Although most of us develop friendships with our sponsors, even that is not necessary.  What is required is experience on the part of the sponsor, and our ability to learn to trust them.

The person we choose does not have to like our kind of music, be a sports buff, or even close to our own age, but he or she must show through appearance, actions and words that they are not only working a solid program but are also living a healthy life. There is no such thing as a perfect sponsor, but the best bet is to check out the person at a few meetings or over a cup of coffee, and see that they are not just talking the talk, but walking the walk as well.

Finally, we need to remember that a sponsor’s purpose is to lead us through the steps. If that is not happening, or if they are taking us off on some tangent, we need to understand that we are not married to them, and that we are free to look for another sponsor. We do, however, need to be sure that the incompatibility is real, and not simply a matter of having heard something we did not want to hear. The nature of recovery is change, and a sponsor who is unwilling to dig a little is not doing the job right.

Is it okay to have a sponsor in AA and another in NA?

This is a matter of opinion, to a degree. Generally-speaking, when it comes to those two fellowships, we would suggest that it is best to settle on one or the other for our step work. Every sponsor learns sponsorship from their own sponsors, and styles of sponsorship thus vary quite a bit. Having two individuals risks confusion. For example, one may like to spend more time on a particular step than another, or put more weight on writing as opposed to talking. Neither of those is wrong, but they can conflict.

One of the best reasons for not having two sponsors, however, is the danger that we will play one against the other. In any endeavor, it is best to have only one leader at a time. We recommend that a newcomer choose one fellowship for in-depth work, and attend meetings of the other for identification with those issues as well.

The exceptions to the above occur in the case of specialized fellowships, such as Overeaters or Gamblers Anonymous, or sexual addiction groups. In those and some other cases, the primary purposes are so different (at least on the surface) that it is imperative to have a sponsor who can personally and comfortably address those issues.

Zoloft Put the Pleasure in My Sobriety

I've recently run across the old bugaboo in the rooms related to taking antidepressants. Because not taking them when needed can not only impact our ability to work a program but can also lead to serious debilitation and even suicide, I think this article is a must for everyone in recovery.

“Better living through chemistry” isn't just a slogan: I've been on antidepressants for 20 years, and can still remember exactly when the first one started to work—allowing my recovery to begin for real.
By Maia Szalavitz

Read more at The Fix

What Is Cross-Addiction? Why Can’t A Pill Addict Drink?

One of the more common questions around treatment centers and the recovery fellowships goes something like,”I’m addicted to prescription drugs, not alcohol, so why can’t I have a drink?  What's this cross-addiction I've heard about?”

That’s really not an unreasonable question. Why do addicts who don’t seem to have problems with alcohol need to stay away from it anyway? Why can’t a prescription drug addict have a few drinks?

There are really two reasons:

  • Alcohol reduces our inhibitions and increases the likelihood that we will make bad choices; and
  • Just as they say in the rooms, “A drug is a drug is a drug.”

Number one is pretty much self-explanatory, and can be attested to by anyone who has regretted something he or she did while they were drinking. The parts of our brains that are responsible for taking in information and allowing us to make reasoned decisions are among the first functions to be depressed by alcohol, along with some motor skills. (See any relationship to drunk driving problems there?)

We make poor decisions about driving, about kissing the boss’s wife at the Christmas party, about arguing with large men who carry guns and handcuffs, and all sorts of other things, including whether or not to drink more or use other drugs. “It seemed like a good idea at the time” can become a major problem when we’ve had a couple of drinks. Essentially, booze makes us dumber while convincing us that we’re smarter.

The second reason, known as cross-addiction, is a bit more complicated but makes perfect sense when you understand a few things. Cross-addiction refers to how we addicts, once addicted, are far more likely to get hooked on other drugs or behavior in addition to our drugs of choice.

Why do we drink or use drugs? We may say we like the taste of whiskey, but the fact is that we like it because we associate it with the way alcohol makes us feel. We use alcohol and other drugs because they change the way we feel. They make us feel “good,” or they “relax” us, or they (insert own reason here). Sometimes we use because we’re happy and we want to feel happier, but most of us use drugs and mood-altering behavior because they distract us from reality. Trouble is, the drugs always wear off, and we’re always there, wishing we still felt good. It doesn’t take us long to figure out how to make that happen.

Certain activities stimulate the production of chemicals in the brain that make us feel pleasure. Generally, these relate to things that are mostly beneficial: seeing a loved one or good friend, eating, exercising, playing games — especially if we win — fun, daydreaming, getting a good grade in school, a compliment, sex and so forth. They are quite literally our bodies’ way of insuring that we keep on doing things that are good for us. We refer to the portion of the brain that is stimulated as the reward center.

Alcohol and other drugs also stimulate the reward center, and they do it extremely well to begin with. When we start drinking and using drugs, the feelings are phenomenal. They are much stronger than the normal sorts of feelings, because the drug causes the production of extra quantities of feel-good neurotransmitters or, in some cases, stimulates the receptor sites in the reward center directly. Now that’s a reward, we think (sort of) — a powerful reward for using the drugs instead of our natural system of feeling good. Doing it again seems like a very good idea indeed.

But the goodness doesn’t last. As our reward centers become accustomed to the higher levels of stimulation, they become pretty much immune to the natural reward chemistry. We begin to need chemicals in order to get any sense of pleasure, and eventually just to feel normal. As we increase the levels of drugs, our brain attempts to compensate for the high levels of stimulation in two general ways: first by reducing the production of the natural feel-good chemicals, and also by building new receptor sites to deal with the excess chemicals floating around. It does this in an attempt to keep things to something like normal, but it’s doomed to lose the contest. Eventually, we have to have the drugs in order to function at all. We’re — guess what — addicted.

Now some of you are going to think, “Man, they oversimplified that big time!”, and you’ll be right. Others are going to think, “What crap! I drink…use drugs…whatever…because I want to!” Well, if you only have have a couple of whatevers a week you may be right, but if you’re reading this because you think you might have a problem, you’re wrong and you’d best pay attention.

So what does all this have to do with a prescription addict having a drink? Everything. At the end of the day all drugs, including alcohol, act on the reward center. We get our good feelings from the reward center, and the reward center doesn’t know the difference between one drug and another. We can tell the difference in our conscious mind, because we feel the physical changes in other parts of our brains — stimulation, depression, whatever those effects may be — but the reason we enjoy them is because of the effects on our reward center, which operates mostly below the conscious level. Really now, who would want to get all jittery…or dumb and sleepy…or stupid and hungry if it didn’t feel good?

So, when we take a drink, our reward center is like, “Hello? This feels good, and we know how to make it feel even better, don’t we?” If we’re in early recovery — the first two years or so, say — our brain hasn’t even gotten back to normal yet. It has to deactivate all those extra receptor sites that it created to handle the extra stimulation, and it also has to have time to reactivate the systems that make the natural neurotransmitters. During that time we’re sitting ducks for relapse. Even after the repairs, the receptors are still there waiting to be reactivated by the presence of the drugs. We’re talking repairs here, not new brains.

Any mood-altering drug or activity can affect the reward center, and so any of them can become addictions. Cross-addiction normally refers to substances, but it can also apply to behavior.
People often replace alcohol and other drugs with mood-altering activities like gambling, which is especially dangerous because of all the booze and drugs around (they know it makes people stupid). Other behaviors include relationships, porn, other sexual acting out, exercise, thrill-seeking and other activities that heavily stimulate the reward center. The fact is, you can get addicted to almost anything, if it causes pleasure or distraction from life issues.

That means that the name of the game in recovery is avoidance of all mood-altering substances — okay, not caffeine (in reasonable quantities) — and excess in other areas of our lives. Fun is fine. Pleasure is fine. But when the feelings become the reason for what we’re doing, to the exclusion of the activity itself and the people involved, we are headed for trouble.

The aim of recovery is not eliminating fun, it’s moderating our behavior and learning to live without mood-altering in unnatural ways. Four generations of alcoholics and addicts have demonstrated millions of time that it’s the most reliable way to remain clean. Until someone comes up with something better (and our bet is that it will be a long time) abstinence and a good program of recovery are the best, if not the only, way to go.

Complete Honesty In Step 4 Is Difficult The First Time

This is going to offend some folks, and that’s the point.

Over the years, I’ve spoken with alcoholics and other addicts who have done three and four 4th Steps, and (presumably) a 5th and 6th along with them. I’ve also talked with others who have adamantly stated that they did their 4th Step, cleaned house, and that’s it, that The Book doesn’t say anything about doing it more than once, and The Book is the way they work their program.

Without wanting to seem confrontational, that’s pure b.s. Honesty in Step 4, especially, is nearly impossible in early recovery and The Book doesn't say we shouldn't repeat it, either.  When Bill Wilson wrote the book Alcoholics Anonymous three-quarters of a century ago, there was a boatload of things that he left out simply because no one had thought of them yet. Bill followed up the Big Book with several others that expanded on his thinking, but some folks seem to believe that all essential knowledge about addiction reached its peak in 1938-39. And, let’s be honest, the basic texts of virtually all the other fellowships rely so heavily on the Big Book that they’re practically interchangeable except for the adjectives and a few nouns, so it’s easy to carry that thinking over to those fellowships as well.

Fast-forward 70-odd years, and we know incomparably more about alcoholism and other addictions than Bill ever thought of. For example, there’s a superb article in last week’s edition of The Fix, CBT and the 12 Steps Have a Lot in Common, that compares the Twelve Steps to Cognitive-Behavioral Therapy (CBT).  It establishes in one more way the validity of the Steps as they compare to modern knowledge and theory, and also confirms (once again) Bill Wilson's brilliance.

I recommend the article, but it’s not the point of this one. The real point is that in the first stages of sobriety we aren't able to face and/or talk about all of our issues. Our fragile self-image, just beginning to emerge from the shame of our primary addiction(s), can’t take any more battering, and we’re extremely likely to sweep a lot of stuff back under the pantry door instead of finishing the job of cleaning the kitchen. We aren't able to be completely honest with ourselves, let alone with someone we've known for only a few months, no matter how sincerely we try.

So how can we trust a process we went through in the first few months of our recovery, and truly believe that we've done a good job with that initial inventory? The answer is our old demon, denial. We want to believe that we’re finally okay, and we are afraid to face the facts that mean we are not, that ignore issues that we've failed to address, and that are still screwing up our lives.

My drug of choice was alcohol (not that I didn’t sample many others over 20+ years of active substance addiction) and I was also addicted to some prescription drugs. Fortunately, circumstances in my life precluded easy access to illegal drugs, or undoubtedly I would have been hooked on some of those too. In any case, booze brought me to my knees, and that and the surrounding issues are what I dealt with during my step work. There was enough chaos connected with alcohol that it was easy to ignore some other things that were, in their way, creating dysfunction just as powerful if much less obvious. I’m still working on some of those, many years after that initial step work.

Nicotine, shopping, sex, codependency, gambling, energy drinks, eating disorders of any kind, hoarding, collecting carried to ridiculous extremes, video games (again, to excess), over-exercising — anything that will allow us to distract ourselves and that will give us that brief rush of feel-good brain chemicals — are disorders of our brains’ reward response. They make us feel better, while allowing us to ignore for a bit the normal problems of life that we haven’t learned to face. The trouble is, the good feelings don’t last and we’re so confused we don’t know or remember how to look for them in places less harmful.  Our unhealthy attempts to avoid the normal unpleasantries and pain of life simply increase, along with our dysfunction, until we are in some way forced to contemplate change.

So I put it to you this way, my fellow addicts: If we think we have nothing to deal with but our substance abuse, the chances are we’re fooling ourselves. Until we become willing to revisit Steps 4, 5 and 6, whether in the rooms or with a good therapist who understands addiction, we may be hopping through life on one lame leg, thinking we're just fine. And that kind of movement through life is not only uncomfortable, it also makes us far more likely to fall under a bus.