Finding Peace

Recovery is difficult at times, but with difficulty comes blessings: I am a human being again. I am finding peace.
My body, my mind and spirit have a new strength. The world looks good. I have respect for my family and friends. My work and co-workers are treated positively and productively.
I avoid places I shouldn’t be and people I shouldn’t be with.
If I am tempted towards relapse, my Higher Power is there to lift me up and carry me if need be.
The fellowship has become a home for me where I can always find peace, if I look for it and am willing to accept it.
This is what I always wanted; this is the life I love to live.

Recovery and Sobriety

by Marc Dunn

Much is being written about addiction and recovery, many doctors and scientists are weighing in with their researched studies, and addiction counselors are adding their experiences to the onslaught of information. Occasionally an ex-addict or person in recovery will rush to the defense of whatever program it was that did or did not work for them.

As a recovering alcoholic/addict I am disturbed by the lack of perspective and first hand knowledge leading the discussions.

A new dynamic that has been introduced with more zeal lately is the elimination of addiction through medication. Not new in the sense it has never been tried but that it is the new cure. The opinion among those seeking a non-12 Step cure is that religion plays to big a role in 12 Step Programs and that scientists have developed medications that if taken as prescribed can cure addiction. One of the offshoots of this approach is that some are better off with a life of moderation rather than total abstinence.

The disease of addiction is a gradual deteriorative affliction that devastates entire families and will continue to do so unless the addict member takes action to live a life of sobriety: physically and mentally. It affects the person who is addicted, that person’s family and everyone who interacts with that person.

Consider the following just about alcohol addiction (similar facts exists about all addictions):
• Alcohol dependence and abuse cost the US approximately $220 billion in 2005. For the sake of comparison, this was greater than the amount of money spent to combat cancer ($196 billion) and obesity ($133 billion).
• An estimated 43% of US adults have had someone related to them who is presently, or was, an alcoholic.
• 6.6 million Minors in the US live with an alcoholic mother or father.
• About 24 million US residents battle an alcohol addiction in a recovery program
• Greater than 50% of grownups in the US have had knowledge of someone in their immediate family with an alcohol problem.
• Around a quarter of all children experience some form of alcoholism in their families before they turn 18
• 40% of alcoholism is passed down through the gene pool, while the other 60% stems from unknown circumstances.
• 500,000 US Children ages 9-12 are addicted to alcohol.
• Studies show that the offspring of alcoholics have a greater chance of becoming alcoholics themselves than those whose parents are clean.

It is generally conceded by medical people who even patients seeking a strictly medication cure need a therapy, and only a select few can moderate their drinking for a lengthy period without relapsing into addiction. Another reason that gives rise to this discussion is the small number of people who recover in any treatment programs.

Medication as a cure for addiction is not new; it dates back to ancient times including our own 19th & 20th century flirtations with morphine, Valium, steroids and LSD. Even within the last 50 years doctors prescribed barbiturates and benzodiazepines for withdrawal symptoms. This often led to a new addiction or multi-addictions.

There are now three new drugs being used to break down alcohol and make it less effective, physically repugnant, cut hangovers and to block the receptors in the brain that create the pleasure from drinking/drugging. The data suggest that these medications do reduce the amount of drinking /drugging done by those taking them.

For those of us who are addicts there are two different ways of life: sobriety and/or recovery. All of us with the disease/mental health condition of addiction know this to be fact. We have lived it and can tell the differences.

What is the difference between sobriety and recovery?

Strictly speaking sobriety is the absence of mood altering substances: alcohol, narcotic drugs, pot, non-prescribed pain killers, etc. Sobriety with recovery is much more; it includes lifestyle not just abstinence.

The point of sobriety is life over death. We can make it by self-willed abstinence, the easier and undisciplined way, affording a less stressful lack of commitment, or by the action of recovery, a planned change of lifestyle designed to prolong life and make it more joyous and free. It is a medical fact that long-term alcoholism will result in a shorter more painful life, not just for the abuser but also for those closest to him/her. In abstinence we may be successful for short periods of time or indefinitely. But if the point of sobriety is recovery; then we are searching for a quality of life that includes peaceful happiness, better relationships, less expectations, more acceptance and tolerance, freedom and peace.

The first time I tried to stop drinking for more than a few days or weeks, it was by attending AA meetings and being stubbornly abstinent. I did it to get everyone off my back. My wife had threatened to divorce me and I thought this was the way to lessen the incessant feeling of being scrutinized every time I picked up a drink, which was often. It lasted about 3 years and I got nothing. My life did not get any better. It was a conniving attempt on my part to seem to be better. I would listen to old timers speaking of recovery and burglarize their conversations, repeating what I had heard as if they were my thoughts, pretending to have found some spirituality. It didn’t work.

I was out to dinner after about 30 months and without any premeditation said, “ It’s been 2 ½ years since I had a drink, I can probably have one with dinner.” The naïve responses were, “That’s great.” I was off and running for 6 months. The end came when I totaled my car in a blackout on the interstate, in the middle of the afternoon. Miraculously, I walked away without hurting myself or anyone else. My next step was to try recovery not abstinence. I found that they were compatible and my life could be better.

Addiction is a disease if left untreated has a predictable end, premature death. Addiction was defined as a disease by Dr. William Silkworth in the 1930’s and continues to be recognized as a disease of the mind or mental illness by the AMA and SAMSHA. This is commonly called the disease model, and is 100% part of all 12 Step programs and most treatment centers.

These reports and opinions lead to the conclusion that there may be medication to cut the effects of alcohol/drugs and even repulse the user from using them but they do nothing to change the mental health issues an addict faces. Those issues will drive him/her out again once they either stop taking the medication or just impulsively decide to use.

Addiction is more than a physical obsession and the alcohol/drug is only a symptom. Treating the symptom does not cure the disease.

There is a need for diversity of approaches to recovery; knowledge of cultural differences, mental health issues, fitness and nutrition well-being are all instrumental to being successful. The point is to open the door to a discussion of supplemental types of recovery help that may be available. If it is, as it seems to be, that medication, religious programs, addiction treatment centers and 12 Step Programs alone don’t work for everyone, what are the alternative solutions? What solutions are there for those who repetitively relapse because of their drug and/or alcohol addiction?

It is clear more than ever that no one program is for everyone. One avenue that needs to be explored is including alternative combinations of medication, therapy and spirituality. If we believe that the recovery solution must include a healing of the mind and spirit, then therapy and spiritual seeking is a must.

If 12 Step programs alone are not for everyone and people do get sober without them, what are the alternatives? It is also important to note that forcing a 12 Step program on someone from the onset may trigger a rebelliousness that precludes him or her from ever trying (which they may want to do after some time sober, as the fog begins to clear). One of the things we haven’t done very well in working with those seeking help is updating our approaches from the way they were done 50-75 years ago. It may sound like heresy, but the world has changed drastically; medical approaches are different and better. Much more is known about mental health and addiction as well as the treatment of diseases such as cancer and diabetes. They have certainly changed with improved results. Why would you go see a doctor today that was still examining and diagnosing you based on information he learned in the 1950’s? You wouldn’t.

The point is that there are other ways to change an addict’s life, but certain basic skills and patterns of behavior need to be learned for any of them to be successful. Most addicts don’t have those skills, or have not used them in so long that they need a change of lifestyle.

Recovery from addiction to alcohol and/or drugs is not easy. Most people do not succeed and the concept that one way works for everyone is outdated. The approach and implementation need to be multifaceted, there is not a one size fits all that works universally. Abstinence methods, and various forms of it, have been applied to recovery for more than 100 years in this country and our success rates are only moderately improved.

The Journal of the American Medical Association stated in its 2000 edition, “40-60 percent of people treated for alcohol or drug dependence relapse within a year after discharge.” And, if the anecdotal stories, are true,”80-90% of the people who show up at 12 Step fellowship meetings disappear after 6-12 months.”

Sadly the research about drug and alcohol addiction and our youth is even more disheartening. Research shows that anti-drug campaigns and school programs that focus on the dangers of drug use have not worked, and may even trigger experimentation. For parents and the nation, the facts are terrifying. 30% of teens regularly use marijuana, alcohol, and pills. 15% are addicted in high school. That means 15 out of every 100 high school students are at risk for death before their 20th birthday. And the numbers rise when students enter college.

The enormity of the problems addicts experience, both physically and mentally, and the quantity of human beings who have this disease has grown much over the last decade. As we understand more about it and learn the devastating long-term effect on the family as well, it is more urgent to get the message to as many as possible. If we are to arrest this disease and prevent it from further debilitating of our families we must take action. We can stop the spread of addiction within our own families. It can end with us. What greater gift could we give our children?

My daughter wrote the following about kids her age discussing their ”thing” because everyone has a “thing”, She would ask, “What’s wrong with you, tell me in three words what’s your deal”. She heard them say, “my parents are divorced”, “and my childhood sweetheart died “or” I was raped in college”. My daughter responded to her own question, “Alcoholic, addict father.”

Adult Children of Addicts have had their peace of mind stolen from them. If we are to approach addiction as a health issue and look for solutions to end the cycle of destruction it has caused for centuries then we need to look beyond abstinence, we need to look at the persons and their families that are suffering and seek multi-faceted solutions. Everyone will be better served if they are better educated about the benefits of recovery not just abstinence. The health and the health of loved ones, mental, physical and spiritual, will improve long-term and there will be less of loss of lives and more peace of mind.

We are on the precipice of a revolution of the mind, body and spirit and by becoming the faces and voices of people in recovery we can share a quality of life that includes peaceful happiness, better relationships, less expectations, more acceptance and tolerance, freedom and peace.

Why Is AA OK?

By Joe Nowinski
Yes, there is science behind the 12-step model. Dr. Joe Nowinski, author of “If You Work It, It Works: The Science Behind 12 Step Recovery” lays it out.
My first exposure to the 12-step model took place in the mid-1980s, when I held the position of Director of Student Health Services at the University of Connecticut. At the time, the university was experiencing (as it unfortunately continues to) a virtual epidemic of heavy drinking among students. Along with the drinking came its usual consequences: accidents, fights, emergency room visits and rapes—not to mention a number of academic flameouts directly attributable to chronic drinking. In my earlier graduate training in clinical psychology, I’d been steeped heavily in the cognitive-behavioral approach, which was then in its ascendance, along with some supervision in existential and psychoanalytic therapy during my internship. Needless to say, there was nothing particularly spiritual about any of these approaches. Having decided it would be good for me to learn more about addiction and its treatment, I asked the head of the university’s alcohol education program about possible training programs and was immediately referred to the Hazelden Foundation in Minnesota. At the time, Hazelden offered a unique training experience for professionals like me: we were embedded on an actual rehab unit for seven days. We participated in all of the activities that the patients did. The only differences were that the other men on my unit knew I was a psychologist in training, and our small group met twice a day for seminars to discuss various aspects of the Hazelden program.
The biggest shock for me, though, came on the day of my arrival when four fellow trainees and I were ushered into a small conference room. On the table in front of each of us was a small pile of books: Alcoholics Anonymous, Twelve Steps and Twelve Traditions, and Living Sober, all published by AA. I’d never seen, much less read any of them. Then I looked up at a large poster on the wall. It was the 12 steps. My eye was immediately caught by the word God that appeared there a number of times, and my gut reaction was something like, “Oh no! I’m a cognitive-behavioral therapist! I don’t believe in God!”
The next week proved to be eye-opening, to say the least. I took my turn doing assigned chores on the unit, went to two AA meetings a day, shared meals with the other men, and sat in on self-led groups where they openly shared their experiences of loss, of harm done to others, of grief, abuse, and abandonment. And I began to see, more so than in the group therapy model I’d been taught, the healing power of honesty, acceptance, and group support.
A few years later, I left UConn to create and supervise adult and adolescent treatment programs in a psychiatric hospital. That experience led to my first book on the subject of addiction, entitled, Substance Abuse in Adolescents and Young Adults, published by W. W. Norton in 1990, and based on the 12-step model. Then, shortly afterward, I was invited to meet with a group of researchers at Yale, who told me that they were about to embark on a national clinical trial comparing different treatment approaches to alcoholism. They were frank in telling me that their own biases were with the cognitive-behavioral approach (CBT), as well as a new and emerging approach: motivational enhancement therapy or MET. They told me that they merely needed a 12-step based approach as a comparison to these treatment approaches and expected that it would pale in comparison. Having read my book, they asked me if I’d be willing to sign on to develop that treatment, and train and supervise the therapists who would be applying this 12-step based therapy to men and women who would be randomly assigned to it. This research, dubbed Project MATCH, proved to be the largest psychotherapy outcome study ever conducted. Since then, I have been more or less continuously involved in clinical research in the area of alcohol and drug abuse treatment and have remained aware of other research on the 12-step model. As it turns out, there has been a great deal of rigorous research done in the past two decades on this model, for two reasons. First, the Institute of Medicine issued a white paper in 1989 calling for such research. Second—and much to many people’s surprise—the 12-step treatment used in Project MATCH (Twelve Step Facilitation or TSF) worked! In fact, as William R. Miller, the principal creator of motivational enhancement therapy wrote: “On at least one time-honored outcome measure—the percentage of patients maintaining complete abstinence—those in the Twelve Step Facilitation treatment fared significantly better than did patients in the other two conditions—a substantial advantage of about 10 percentage points that endured across three years.”
Although a significant body of research on the 12-step model followed in the aftermath of MATCH, critics of the approach went into high gear. AA and its 12 steps are regularly accused of being either ineffectual or downright harmful. The MATCH results have been dismissed (despite effective rebuttals from the likes of Drs. Miller and John Kelly of Harvard), and AA itself has been dismissed as an international cult that brainwashes its members. And all the while individuals like myself, who had a different opinion, were left without much of a voice, first because AA itself follows a strict policy of staying out of public controversy, and second because the evidence in support of the 12-step model has remained essentially buried in professional, peer-reviewed journals.
Roughly two years ago, following a series of discussions with colleagues about this dilemma, I got a call from my editor at Hazelden. He asked me if I was up for a major project, which would be to “translate” much of the research on the 12-step model so as to make it accessible both to the general public and to clinicians who may not be steeped in research and its interpretation. It would be a vehicle that would enable clinicians, as well as those dealing with alcohol and drug problems, to make informed decisions as to what to do. It was an opportunity I could not pass by, and the result is If You Work It, It Works: The Science Behind 12 Step Recovery.
The evidence in support of 12-step recovery is substantial and growing. The effectiveness of
Other research has looked at what we might call the “dynamics” of 12-step recovery, or the role that different components might play. It’s been found, for example, that:
· Identifying oneself as a “member” of AA, as opposed to simply attending meetings, is associated with improved sobriety.
· Becoming involved in AA (getting a sponsor, reading AA materials, making AA friends) leads to improved sobriety.
Getting a sponsor early (within three months) is better than getting one later.
· Choosing to seek treatment of some form while simultaneously beginning AA involvement leads to better results – even 16 years later.
· Choosing to attend between 100 and 150 AA meetings a year is associated with better sobriety (up to 75%) even five years after making that decision.
· Attending AA meetings regularly are associated with becoming more spiritual (though not religious) over time (as opposed to spiritual people being drawn to AA from the outset).
· Adding one or two non-drinking friends to your social network can help support sobriety, but not nearly as much as attending AA meetings regularly.
All of the above findings and more have been documented through carefully conducted research. Moreover, this research has not been conducted by individuals who set out with an agenda of proving the efficacy of Alcoholics Anonymous; by and large these studies have been conducted at major research universities. They have gone through extensive peer review in order to be funded, and again in order to be published. For those who would like to verify that, they are all listed in the appendix of my book. I would encourage skeptics to check them out.
As the saying goes, some people refuse to let facts stand in the way of their opinions. Despite all of the evidence, there are those who continue to claim that AA is unproven and even causes harm (to the point of suicide). Then, there is the strange criticism that AA only works for those who “work it” and that this is a miniscule number of people. Miniscule? In comparison to what? The total population? All those who have alcohol or drug problems? As for AA working only for those who choose to work it, psychologist Thomas McClellan, in a personal communication, as well as others, has pointed out that roughly 40 to 50% of individuals with chronic medical conditions do not adhere well to recommended treatments. They take prescribed medications sporadically, or not at all. They do not lose weight, change their diet, or exercise as recommended. The result: their condition continues or worsens, and they have to go back for treatment two or three times. In that same vein, every therapist who treats substance abuse knows clients who have given AA a half-hearted try at best. Why do critics infer from this that medical treatments and AA are ineffective, as opposed to drawing the much more obvious conclusion that any treatment that is not adhered to will not succeed?
With respect to the criticisms that 12-step programs are not run by professionals, vary widely with respect to membership and format, and can potentially expose members to toxic, as well as healing, relationships with untrained sponsors, all of this is obviously true. But these are elements common to all self-help programs and are unavoidable. And yet, critics of 12-step programs conveniently ignore an essential fact, which is that all of these elements are obviously accounted for in the research data! When the dust settles on the entire universe of evidence, the research consistently demonstrates that participation in these programs is of significant benefit. A group of prominent researchers, after surveying the research, published the following joint statement in the Journal of Substance Abuse Treatment:
Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened healthcare costs, there are humane and practical reasons to develop self-help group supportive policies.
Alcoholics Anonymous is not the only fellowship that supports abstinence as a solution to a severe alcohol or drug abuse problem. Others include:
· Women for Sobriety
· Secular Organizations for Sobriety
· SMART Recovery
· Double Trouble in Recovery (for the dually-diagnosed)

AA has been selected as the supportive fellowship in research because it is ubiquitous. Given their shared goals and the commonalities between these approaches, I see no reason to doubt that the outcomes associated with AA would not apply equally to those who would choose these alternate fellowships. As a Clinical Psychologist, I am a firm believer in the efficacy of evidence-based treatments, including and especially psychotherapy, for substance use disorders; as a researcher and scientist, I am a firm believer in the literature that convincingly demonstrates that participation in 12-step programs is evidence-based as well, and a valuable part of any recovery plan.