Learning To Live Again
Recovery Guide Information
All information contained in this booklet is taken from
LEARNING TO LIVE AGAIN
A Guide for Recovery from Chemical Dependency
By Marlene Miller, Terence T. Gorski and David K. Miller
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Contents
Chemical Dependency Is a Disease
Chemical Dependency is a Primary Disease
Effects Of Chemical Dependency On The Body
Psychological Effects Of Chemical Dependency
Behavioral Effects Of Chemical Dependency
Social Effects Of Chemical Dependency
Seven Attempted Steps To Control Drinking/Drug Use
Recovery From Chemical Dependency
Symptoms Of Recovery
Recovery and Creating A New Life
Sobriety-based Symptoms Of Recovery
Factors Which Complicate Recovery
Stress and Recovery From Chemical Dependency
Developmental Phases Of Recovery
Physical Recovery
Psychological Recovery
Behavioral Recovery
Social Recovery
Relapse Prevention Planning
The Disease Of Alcoholism
Work The Twelve Steps
The Twelve Steps Of Alcoholics Anonymous
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4
5
6
7
8
9
11
13
16
18
25
27
30
33
34
36
40
44
49
59
63
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Chemical Dependency Is A Disease
The term chemical dependency or addictive disease is confusing and often misunderstood.
Throughout the following information sheets we'll be using terms like addictive disease,
addict, chemical dependency and chemically dependent person interchangeably. Terms
like alcohol dependency, alcoholism and alcoholic refer to chemical dependency to a
specific substance. Essentially these terms all mean the same thing. They are used to
describe an illness which is progressive, incurable and often fatal. Hopefully these
information sheets will help to dispel the many untruths and half truths that have developed
about chemical dependency. If you have addictive disease, it will help you recover if you
learn as much about it as possible.
Chemical dependency is a disease. Like other diseases such as heart disease, diabetes,
and cancer, chemical dependency has specific symptoms which keep the body from
functioning properly. Acceptance of chemical dependency as a disease acknowledges
certain things it is not.
Chemical dependency is not a moral weakness. Alcoholics are not persons of weak
character. They do not drink because they lack will power. They drink because of their
disease. People are not considered weak because they cannot control their sneezing if
they are allergic to dust. They may be expected to separate themselves from the problem,
but they are not considered weak because they have the problem. Addicts cannot control
certain factors in their bodies that determine their responses to drugs, but that is not a sign
of weakness.
Chemical dependency is not a mental illness. The number of addicted people who have
psychiatric problems is no higher than the number of people in general who have
psychiatric problems. It is true that as the disease progresses it causes problems that
appear to be mental problems. But these problems are a result of the disease, not a cause
of the disease nor the disease itself. It is also true that from time to time a person may
have both chemical dependency and mental disorders, but they are separate problems,
probably resulting from different causes. Addictive disease is not a mental illness.
Chemical dependency is not just a disease of the homeless or unemployed male. Only 3 to
5% of all alcoholics are on skid row. Most addicts are employed and have families.
Addictive disease is no respecter of persons. It can affect men, women, young, old, rich,
poor, executives, housewives, factory workers, employed, unemployed. Station, status,
sex, race, and age have little to do with chemical dependency.
Chemical dependency is not a hopeless condition. Like most other chronic diseases, it is
treatable. It is not curable. An addict will always be an addict. But it can be controlled, just
as diabetes can be controlled. Many chemically dependent people never get treatment
because they don't believe there is any way out, and because the important people in their
lives do not believe there is any hope. There are thousands of addicts alive and well, free
from the pain of their disease because they found the hope that they could recover. There
are no hopeless addicts; just addicts without hope.
Chemical dependency is not just a physical disease. There are also psychological,
behavioral, and social symptoms of the disease. This means that the disease not only
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affects the body (physical), but it also affects how you think and feel (psychological), how
you act (behavior), and how you relate to other people (social).
It may help to understand the psychological, behavioral, and social effects of chemical
dependency by thinking of the common cold. You feel bad physically; you have a sore
throat, headache, and congestion. This affects your thinking and your emotions. You feel
irritable and maybe somewhat depressed or angry. Your attitude affects your behavior.
You may slam the door or kick the cat. This affects the people around you, and you
interact with them in a negative way (maybe an argument results).
There are psychological consequences to the disease of chemical dependency. As the
need for alcohol or drug use increases and as impairments to body organs and the
nervous system occur, addicts alter the way they view themselves, others, and the rest of
the world. They begin to see things as they must to live with their addictive disease.
This in turn affects behavior as they begin to react to altered perceptions and beliefs.
Behavior triggers a response from family, employer, friends, and acquaintances so that
social interaction is altered. So a continuing sick cycle is created with each of these areas
reinforcing the other and keeping the process going.
Recovery from chemical dependency means recovery in all areas – physical,
psychological, behavioral, and social. Part of the recovery is understanding the disease
and how it affects all areas of your life as well as understanding what is necessary to
restore health to all areas.
In order to better understand this disease, we need a definition.
Chemical dependency is a primary physical disease that is activated by a progressively
pathological reaction to the ingestion of alcohol and/or mood-altering substances. Physical,
psychological, behavioral, and social symptoms develop as a direct consequence of and
as a compensatory, adaptive mechanism to the primary physical pathology.
What does that mean? First let's just look at the dictionary definition of some of those
words:
 primary: first or original
 physical: pertaining to the body
 activated: set in motion, made active
 progressively: ongoing, moving forward
 pathological: having to do with disease
 reaction: response
 ingestion: consuming, taking in (smoking, injecting, snorting or sniffing), eating or
drinking
 psychological: thinking or feeling
 behavior: actions or functions
 social: relationships with people
 symptoms: conditions or signs indicating disorder or disease
 consequence: result
 compensatory: a way to make up for
 adaptive: adjusting or changing
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In the following material we will look at this definition of chemical dependency and help you
to understand what it means in your life and to your recovery.
Points to Remember:
1. Chemical dependency is a disease.
2. Chemical dependency is not a moral weakness.
3. Chemical dependency is not a mental illness.
4. Chemical dependency affects persons of all ages, race, sex, station, and status.
5. Chemical dependency is not curable, but it is treatable.
6. There are physical, psychological, behavioral, and social symptoms of chemical
dependency.
7. Recovery from chemical dependency means physical, psychological, behavioral, and
social recovery.
Chemical Dependency Is A Primary Disease
Points to Remember:
1.
Chemical dependency is a primary disease.
2.
A primary disease is the original disease; not the result of another disease.
3.
Treating the diseases resulting from addiction (the secondary diseases) will not
bring about recovery.
4.
Recovery from chemical dependency must begin with removal of alcohol and other
drugs from the body.
5.
The body of an addict does not react to alcohol or drugs in the same way that the
body of a nonchemically dependent person does.
6.
When a nonalcoholic drinks there is usually a sedative reaction, a feeling of
relaxation.
7.
When a person who is in high risk of becoming alcoholic drinks there is an initial
feeling of relaxation followed by a period of control-level drinking during which the person
feels good and functions well. Overdrinking can result in an episode of rapid onset
intoxication.
8.
Even a small use of a drug by an addict results in a feeling of urgency and a
compulsion to use more.
9.
When the feeling of agitation is relieved by more alcohol or drugs, there is a period
of control-level use when the addict feels good and functions well in spite of a high
concentration of the chemical in the blood stream. This is tolerance.
10.
Dependence or a physical need for the personal drug of choice develops as the
body cells change to tolerate higher levels of the substance.
11.
Loss of control occurs when the addict uses beyond the level of control. As
addiction progresses the episodes of loss of control become more frequent.
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12.
The chemically dependent person is powerless to control his or her body's response
to their drug use.
13.
Any person who uses drugs regularly and heavily should have his or her use
evaluated by an addictions counselor to determine the risk of chemical dependency.
PROFILE OF THE ADDICTED PERSON
There are three stages or phases through which the disease of addiction progresses. These are
referred to as the EARLY, MIDDLE, and LATE stages. Each phase has a number of indicators,
which make up the symptoms of this disease. Read through each phase and place a check mark
next to any of the indicators that you have experienced. Then write a few sentences about how this
symptom has affected you. (check off the ones that apply to your drinking and/or using).
1.)
EARLY PHASE
Symptomatic Drinking/Drug Using
A person begins to use alcohol or drugs for personal reasons rather than social reasons. A social
setting becomes an excuse to use.

Increased Tolerance
Tolerance is the progressive loss of sensitivity to the effects of a drug. Tolerance develops to
different effects at different rates. Tolerance develops to euphoric effects first. The increase in
tolerance is gradual and the drinker or drug user seems to handle larger quantities of alcohol or drug
effectively. The person is proud of their ability to drink or use a lot.

Blackouts
Alcoholicamnesia. Blackouts can last from a few minutes to several hours or days. The drinker
may not appear to be intoxicated. They may be able to drive a car, talk lucidly, etc. The drug user
may experience periods of memory loss. Blackouts are usually seen as an early sign of addiction
but some addicts never have a blackout and some who have blackouts do not become addicted.

Sneaking Drinks or Concealing Drug Use
Because of rising tolerance the person finds a need to drink and/or drug more to achieve desired
effects, but does not want to reveal this to others. They may have a few primers or volunteer to act
as bartender. They may begin keeping a “Stash” of drugs for personal use.

Preoccupation
Psychological dependence. Life centers around the using and every possible opportunity to use is
taken. The person begins to give up social and leisure activities in favor of drinking and/or
drugging, or begins to see alcohol and/or drug related activities as more desirable than non-using
activities.

Gulping Drinks/Excitement Anticipating Using
The person is more concerned with getting effects of alcohol than drinking to socialize. Drink a
few as quickly as possible. The drug user feels a growing sense of excitement as they prepare to
use their drug of choice.

Avoid Reference
The person senses a change in their drinking and/or drugging pattern, perhaps some guilt. He/she
will avoid talking about their using behaviors to minimize there is a problem.
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
Frequent Blackouts
An individual will have blackouts on many drinking and/or drugging occasions

2.)
ACUTE OR MIDDLE STAGE
Loss of Control
Addiction is firmly established with the inability to control the amount consumed and an inability
to stop once the using has begun. This phase is not total at first. With the “Bender” type there is an
inability to stop once using has started. There may be an ability to abstain for periods of time, but
once even a small amount of alcohol and/or drugs are ingested, loss of control once again happens.
The “daily maintenance” type, who has carefully maintained his/her intake, suddenly finds that they
cannot control the balance. The appearance of sobriety can no longer be maintained. They get
drunk or really stoned in inappropriate times.

Alibis
The individual makes excuses for absenteeism, or drinking/drugging behavior.

Reproof by Family
Addiction has an impact on the family. Wives try to get the user to stop by pleading with,
threatening, or rejecting. Children may be mistrustful or afraid of their addicted parent. Non-using
spouse will often flip between berating the addict and “mothering” during sober spells. Males often
have a more difficult time accepting their spouse as addicted.

Extravagance/Grandiosity
Extravagance in the form of paying for rounds at the bar, buying expensive gifts for wife and
children, abuse of credit, writing bad cheques, etc., creates as much guilt as it tries to eliminate.

Aggression
As the disease progresses, addicts may reveal deep seated, repressed hostility. May become violent
or obnoxious, usually towards family and friends. Aggression may be used as a way of seeking
rejection. To confirm feelings of inadequacy and to provide excuses for continued alcohol and/or
drug use. Aggressiveness can take the form of physical, verbal, emotional, or sexual abuse of
other.

Persistent Remorse
Following drinking and/or drug using bouts, the addict experiences deep feelings of guilt and
remorse concerning their using behavior. Sincere promises to modify drinking and drug use are
often made.

Rationalization
Drinking and/or drug using is seen as a result of problems rather than a cause of problems. An
individual tries to rationalize and justify their addictive behavior to themselves.

Attempts to Quit/Water Wagon
To keep promises made to stop drinking and/or drugging the addict will “go on the wagon” or “kick
the habit”. This is a clear awareness that he/she realizes that drinking and drugging is out of
control. Professional help is needed, to stay sober, as the addict is unwilling to go for help.

Changing Drinking and/or Drug Using Pattern
After repeated attempts to go on the water wagon or kick the habit the addict will try different ways
to control their using. They may switch from hard liquor to beer only. They may decide to only
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
drink at home or never drink alone. They may quit using “hard” drugs and just smoke pot. These
attempts may or not be successful for short periods of time.
Loss of Friends
Embarrassed by the addict’s behavior, friends will drift away, or the addict drifts away from their
friends because he/she fears judgement. They replace former friends with people who use similarly
to them or they use more.

Loss of Jobs
The addict may be fired for using on the job, or for absenteeism. The addict’s nerves are on edge
especially if he/she has a hangover and may have personality conflicts with employers and fellow
workers. Often they will quit jobs to avoid being fired. This represents a serious problem because
without a job the supply is cut off.

Family Changes
An unpredictable lifestyle causes the family to withdraw from normal social activities. Children
may experience problems in school and not want to bring friends home. The family is strained to
the breaking point yet most often the problem is concealed and denied.

First Hospitalization
Physical illness is generally due to poor nutrition, also a variety of gastrointestinal, circulatory and
heart problems, liver damage, and nervous conditions are common.

Resentments
The addict resents isolation from community, friends and family. Feels no one understands. They
rationalize that their drinking and/or drug using could be controlled if others would give him/her a
chance.

Geographic Escape
Attempts to change or modify alcohol and/or drug usage by moving to a new area are tried. They
are convinced that a fresh start will improve conditions. The problem is that the addict takes the
disease with him/her.

Protecting Supply
Alcohol and/or drug use is seen as the only means for coping with life. The thought of being
caught without a drink and/or drug is frightening. They will stash bottles. They will sacrifice
everything in order to maintain their supply.

Morning Drink or Drug Use
The addict drinks or uses to ward off the withdrawal effects of hangover or “crash”. The hangovers
or “crashes” become more severe and may include shakes and tremors, sleeplessness, irritability,
nausea, headaches, sweating, crawling skin, D.T.’s, depression, anxiety or paranoid thinking.

3.
CHRONIC PHASE
First Bender/Onset of Daily Drug Use
A complete loss of control, frequently blind drunk or stoned (more that just high). The addict feels
alone in the world, with alcohol and/or drugs as their only consolance. The fear of sobering up or
getting straight is very great and they may use anything just to escape withdrawal.

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Ethical Deterioration
An individual’s sense of worthiness deteriorates and with it moral, social, and religious values. The
addict may hit skid row, jail, completely lose motivation, etc.

Paralogic
Even in the late stage of the disease, the addict continues to see their behavior as blameless, that
they are victims. Often they become fatalists thinking, “I’m not hurting anyone but myself”.

Decrease of tolerance
Tolerance drops unexpectedly due to physical deterioration. One or two drinks or only a few “hits”
will have the same effect as a dozen once had. The body rejects alcohol or drugs; it takes several
drinks for one to stay down.

Indefinable fears
Deep persistent anxiety and fear of punishment sets in. Paranoid beliefs that people are criticizing
them, along with jumpy nerves is an indication of late stage addiction.

What are some of the fears that you have that drive you to keep on drinking or using drugs?
Tremors
Tremors of the arms and legs. Loss of sensation in the extremities may occur.

Psycho Motor Inhibition
Nervous system is seriously affected. Sudden freezing up while performing simple tasks is an
indicator of central nervous system damage.

Religious Need
The addict may make tentative and uncoordinated attempts to live a spiritual life.

Vicious Circle Drinking
The addict now drinks or drugs solely in an attempt to relieve the effects of their use.

Chemical Dependency Is A Progressive Disease
Points to Remember:
1.
Chemical dependency is a progressive disease.
2.
Without treatment chemical dependency always gets worse, never better.
3.
There are three main stages of addiction: early stage, middle stage, and chronic
stage.
4.
In the early stage there is an increased tolerance.
5.
Increased tolerance means the alcoholic can drink large quantities of alcohol and
behavior improves.
6.
In the middle stage there is progressive loss of control over drinking and/ or
drugging behavior because of the increasing dependence.
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7.
Dependence means cells have changed to tolerate higher levels of the drug and
have come to need the substance.
8.
In the chronic stage there is marked deterioration resulting in: physical damage,
emotional and thinking problems, behavior problems, and social problems.
9.
In the late chronic stage tolerance for alcohol or drug of choice becomes nearly
nonexistent and all the pleasure of drinking or using is gone.
10.
Eventually all areas in the life of an addict become unmanageable.
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Effects Of Chemical Dependency On The Body
impaired thought processes
lowered stress tolerance
blackouts
muscle weakness
muscle cramps
nerve palsies (shaking)
chest pain
hypertension (high blood pressure)
headaches
malnutrition
anemias
calcium deficiency
hemorrhoids
colitis
acne and psoriasis
Vitamin B-1 deficiency
fractures
shortness of breath
loss of appetite
weight loss or gain
eye and ear infections
bone marrow depression
jaundice
personality change
diarrhea
intestinal cramps
constipation
ulcers
slow healing
bladder infections
alcoholic hepatitis
fatty liver
impotence
birth defects
gastritis
pancreatitis
bronchitis
pneumonia
tuberculosis
heart attack
blurred vision
bleeding disorders
esophageal varices
low platelet count
polyneuritis (inflammation of
nerves)
hypoglycemia
stroke
adrenal insufficiency
kidney infection
arteriosclerosis (hardening of the
arteries)
interruption of protein synthesis
interruption of enzyme response
interruption of hormone response
suppression of leukocyte production
suppression of metabolism of
nutrients
pituitary disturbances
sterility
peripheral neuropathy (numbness,
tingling, paralysis)
muscle myopathy (muscle wasting)
cardiomyopathy
convulsions
psychosis
Points to Remember:
1.
Each system of the body has a special function.
2.
All systems work together.
3.
Damage in one system affects the other systems.
4.
All body systems are affected by the disease of alcoholism.
5.
At first the damage is acute and temporary.
6.
Eventually damage is chronic and permanent.
7.
Acute damage means there is inflammation in an organ system. Acute damage can be
repaired.
8.
Over a period of time, inflamed tissue dies and is replaced by scar tissue.
9.
Scar tissue is permanent and cannot be repaired.
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Psychological Recovery From Chemical Dependency
The more isolated a person is, the more destructive will be the power of his wrongs over
him, and the more deeply he becomes involved in them.... Wrongs want to remain
unknown. They shun the light. In the darkness of the unexpressed they poison the whole
being of a person.... They must be brought into light... openly spoken and acknowledged. It
is a hard struggle until wrongs are admitted.
(from Life Together by Dietrich Bonhoffer)
It is this principle of admission that gives the statement, "I am Mary and I am an alcoholic,"
its power.
AA Steps 6 and 7 say, “Were entirely ready to have God remove all these defects of
character, " and “humbly asked Him to remove our shortcomings. "This is a process, not
an event. It doesn't happen suddenly. It occurs over a period of time. The recovering
chemically dependent person takes one day at a time and is satisfied with progress. It
cannot be overstated that recovery takes time. You can be reassured that it is taking place
as you take the steps that make it possible.
Identifying, expressing, and responding appropriately to feelings that are obstacles to
recovery can bring freedom from anxiety, fear, depression, and anger.
Points to Remember:
1.
Psychological problems (relating to thinking and feeling) result from chemical
dependency and do not disappear by removing chemicals from the body.
2.
Some psychological problems during recovery are the result of post acute
withdrawal.
3.
Other psychological problems are the result of a change in lifestyle and attitude.
4.
Change creates stress, both positive and negative.
5.
Mood swings are common in recovery; sometimes you may feel very good,
sometimes you may become depressed.
6.
The worst thing you can do is to keep depression and self-destructive thoughts a
secret. Unspoken thoughts continue to get worse.
7.
Depression often results from guilt. Steps four through ten will give you active
methods of resolving guilt.
8.
Anger is an involuntary response to something that happens. It is not a choice; it
simply happens.
9.
Sometimes an active response to anger is appropriate.
10.
A recovering person has a tendency to overreact so needs to learn to express
anger in safe surroundings.
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11.
Step 4 enables you to look at your character, beliefs, and attitudes. It helps you look
at your strengths as well as weaknesses.
12.
Strengths you used to maintain your chemical dependency can be used to maintain
your sobriety.
13.
Denial is not conscious lying. It is being dishonest with yourself.
14.
Denial, minimizing, avoiding, scapegoating, "flight into health," and rationalizing are
ways to escape the truth. You must be honest with yourself in order to make a fearless and
searching inventory.
15.
Emotions are what you feel; judgments are what you think.
16.
Some people have trouble expressing feelings because they can't find the right
words to describe their inner experience. A list of feeling words can help you if this is your
problem.
17.
When feelings are kept inside, unexpressed, they are energized until they are acted
upon. Step 5 urges admission of your "wrongs."
18. Removal of defects is a process, not an event (it doesn't happen suddenly).
19.
Identifying, expressing, and responding appropriately to feelings that are obstacles
to recovery can bring freedom from anxiety, fear, depression, and anger.
Social Effects of Chemical Dependency
Points to Remember:
1.
Chemical dependency has social consequences; it affects the lives of people the
alcoholic or addict lives with, works with, and associates with.
2.
The chemically dependent person isolates because of use and using behavior.
3.
Communication skills are lost.
4.
The family is affected by fear, guilt, resentment, and their own ways of coping with
the pain of addiction.
5.
When the chemically dependent person abandon their roles in their families, other
family members take on their responsibilities.
6.
The entire family needs help to rebuild trust, reestablish communication, and learn
to feel good about themselves.
7.
The job is usually the last aspect of the chemically dependent person's life to be
affected by alcohol or drug use.
8.
Deterioration in the area of the job often motivates the chemically dependent person
to seek treatment.
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Seven Attempted Steps To Control Drinking/Drugging
Because chemical dependency is a chronic disease, there is a high risk of relapse. Most
chemically dependents return to drinking/drug use at least once after they make a decision
to stop. For many it is a way of life. "It will never happen again." And then it does. There
are seven steps most alcoholics and addicts go through in attempting to control their using.
1.
They practice unregulated use. There is no attempt to control until life becomes
disrupted.
2.
They attempt to regulate alcohol or drug use by controlling quantity of intake. They
attempt to control by setting limits on how much they drink or use. It may work for a while
but not permanently.
3.
They attempt to control use by changing the type of alcoholic beverage consumed
or the drugs they use. The addict hasn't yet learned that it is mood swing they seek and
not the type of substance that activates the disease.
4.
They attempt to control drinking or drug use by pursuing definite periods of
abstinence with the goal of returning to using. They come to believe that if they can stop
for a month or six weeks, control will return. And they stop for a while. They prove they can
stop, but they know they will drink or use drugs again. Addicts can do amazing things on a
short-term basis. This proof of control is worth the pain of these periods of experimental
sobriety. But in the long run things continue to get worse.
5.
They make the decision to stop using permanently, but they refuse to change their
lifestyle. They learn they can't drink or drug. They've tried everything they know to control it
and realize that control is not possible. So they stop. What's the big deal? They continue to
pursue the lifestyle that requires alcohol or other drugs to make it complete. They find
things get better for a while, and then things slowly become confused, frustrating. The
chemically dependent person has not yet learned that addiction is a chronic disease that
has symptoms that persist even with abstinence.
6.
They make a decision to use sedatives or other mood-altering drugs to assist in
controlling their drug of choice. Once addicted to one drug, addicts are predisposed to
addiction to others. Using different drugs helps the withdrawal symptoms go away, but
soon they find they are overdoing these drugs and can't stop.
7.
They make a decision to stop using permanently while pursuing a program to
change lifestyle. The solution to addiction is finally found. They stop drinking and drugging,
learn about the illness and change their way of living so that they can comfortably adapt to
the chronic symptoms of chemical dependency that persist even with abstinence. This is
called sobriety – abstinence plus attitude and lifestyle change.
Because chemical dependency can only be arrested, not cured, the addict cannot expect
to resume drinking or drugging. Any drug use will reactivate the symptoms of the disease
at any time. Total abstinence is necessary to control addiction, but abstinence is not the
only requirement. Remember that the addict has developed a way of life to accommodate
the illness. Because it takes a long time to get sick, it takes a long time to recover.
Recovery requires long-term, total treatment which promotes physical recovery (healing of
the body), psychological recovery (healing of attitudes and beliefs), behavioral recovery
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(the changing of habits from supporting illness to supporting recovery), and social recovery
(readjusting to a lifestyle of health rather than illness).
Points to Remember:
l.
Chemical dependency is a chronic disease.
2.
Chronic diseases come on gradually over a period of time.
3.
Because chemical dependency progresses slowly, you are able to compensate for
and adapt to the disease.
4.
Chemical dependency is never cured, only controlled.
5.
Chemical dependency carries a high risk of relapse; there is always a danger it will
recur.
6.
Most addicts return to drinking or drugging at least once after making a decision to
stop.
7.
Total abstinence is necessary to control chemical dependency.
8.
Recovery requires long-term physical, psychological, behavioral, and social
treatment.
Recovery From Chemical Dependency
There are three things that must occur to free chemically dependent persons to recover.
1.
They must come to believe they are sick.
2.
They must come to believe they can recover.
3.
They must take some action to allow the recovery process to begin.
Acceptance is the first step of recovery. Denial of addiction is part of the disease of
chemical dependency. But progress in recovery cannot be made until denial is replaced by
acceptance.
Step 1 of AA states: “We admitted that we were powerless over alcohol, that our lives had
become unmanageable. " We have shown already how you are powerless over the way
your body responds to drugs. We have shown how addiction makes your life
unmanageable.
Perhaps the idea of acceptance or surrender seems like weakness to you. Perhaps it
seems weak not to be able to control your response to alcohol and drugs and to be unable
to manage your life. Perhaps it seems like giving up and not being willing to fight. Not so.
Acceptance of those things that cannot be changed enables you to do something about
those things that can be changed. When addicts are able to admit powerlessness over the
disease of chemical dependency, they are able to learn to manage the disease and to
restructure their lives to accommodate its limitations. Acceptance becomes strength.
Step 2 of AA states: “Came to believe a Power greater than ourselves could restore us to
sanity.” As long as chemically dependent people believe there is no power within them or
outside of them that can make their lives any better than they are, they have no hope that
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they can change or that their lives can be changed. They are trapped by the "insanity" that
has controlled their lives. When they come to believe that there is more power available
than the power they have utilized in the past, hope is born. And with hope comes trust in
that additional power. They begin to trust the power that can bring about recovery. There is
an illustration of what it means to believe in and trust a power beyond what we have
experienced before in The Edge of Adventure, An Experiment in Faith by Keith Miller and
Bruce Larson.
The following letter was found in a baking powder can wired to the handle of an old pump
that offered the only hope of drinking water on a very long and seldom-used trail across
the Amargosa Desert:
“This pump is all right as of June, 1932. I put a new sucker washer into it and it ought to
last five years. But the washer dries out and the pump has got to be primed. Under the
white rock I buried a bottle of water, out of the sun and cork end up. There’s enough water
in it to prime the pump, but not if you drink some first. Pour about one fourth and /et her
soak to wet the leather. Then pour in the rest medium fast and pump like crazy. You’ll git
water. The well has never run dry. Have faith. When you git watered up, fill the bottle and
put it back like you found it for the next feller. ”(signed) Desert Pete. “P. S. Don’t go
drinking up the water first. Prime the pump with it and you’ll git all you can hold.”
If you were a thirsty traveller, would you trust Desert Pete, a person you didn't know,
enough to risk priming the pump? Remember, if you drink any water, you won't have
enough to prime the pump. Step 2 asks that you believe in a power that can give you
something better than what you have. This is the hope of recovery.
Step 3 of AA states: “Made a decision to turn our will and our lives over to the care of God
as we understood him.” This is the act of surrender that allows the recovery process to
begin. If the word "God" is difficult for you, underscore as we understood him. Just allow
that power within you or outside of you – that power you have not utilized before and have
only now come to believe can restore you to health – to begin the process. In three steps
you have come from denial to surrender. You have come to believe you are sick; you have
come to believe you can recover; you have taken action to allow the recovery process to
begin.
Surrender is a difficult word for some people because it implies losing control. Remember
that alcohol and drugs controls the lives of addicts. They are not in control of their lives.
Only through surrender to this reality and to the power that can restore health are they able
to free themselves of the bonds of addiction that have controlled their lives. They are then
free to recover.
Points to Remember:
1.
In order to recover you must come to believe you are sick.
2.
Acceptance of the disease – admitting powerlessness over alcohol and other drugs
– is the first step in learning to manage the disease.
3.
In order to recover you must believe you can.
4.
Trust in a power beyond yourself opens the door to hope that you can recover.
16
5.
In order to recover you must take some action to allow the recovery process to
begin.
6.
Making a decision to turn your life over to that higher power is the action that allows
the recovery process to begin.
Modified First Three Steps of AA:
Step 1: I can't do it alone.
Step 2: There is someone else who can help me.
Step 3: I think I will let Him.
Symptoms Of Recovery Based On The Jellinek Chart
The Jellinek Chart describes that this is what you can expect as you progress in recovery.
1.
Honest Desire for Help
Chemically dependents become willing to admit that they need to get better.
2.
Learns Chemical Dependency Is an Illness
The primary treatment for chemical dependency is education. Chemically
dependents need to learn they are chemically dependent and can recover. They must
learn the relationship between alcohol and drug use and life problems.
3.
Told Addiction Can Be Arrested
Finding out that there is a way that the illness can be arrested is what gives the
chemically dependent hope.
4.
Meets Former Addicts Normal and Happy
This is the beginning of the social rebuilding process. Chemically dependents find
out it is true that there are people who recover from the illness of chemical dependency.
5.
Stops Taking Alcohol and Drugs
Learning that chemical dependency is an illness, finding out it can be arrested, and
meeting others who have recovered give chemically dependents the courage and the
strength to stop drinking and drug using.
6.
Assisted in Making Personal Stocktaking
They begin evaluating their lives in terms of establishing priorities and begin taking
an inventory of personal traits that can be utilized or modified or eliminated in the recovery
process.
7.
Right Thinking Begins
With the elimination of alcohol and drug use and with the help of others, the
recovering person is able to begin making appropriate decisions about how to conduct life.
8.
Physical Overhaul by Doctor
With the help of a doctor, the person begins improving physically. Physical illness is
identified, and appropriate treatment is initiated.
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9.
Onset of New Hope
As the person feels better and thinks better, the sense of hope becomes stronger.
10.
Start of Group Therapy
The person gets involved with a group of people discussing the issues of recovery.
It may be AA/NA or a professional group or both.
11.
Regular Nourishment Taken
The person starts eating a balanced diet and feeling better physically.
12.
Diminishing Fears of the Unknown Future
Fears are diminished as confidence increases because of new hope, new
relationships, and improved health. Taking things "one day at a time" promotes
confidence.
13.
Realistic Thinking
Realistic thinking replaces wishful thinking and pipe dreams. The person begins
identifying true cause/effect relationships and begins recognizing personal alibi structures.
14.
Return of Self-Esteem
Because of new feelings of control over life, self-esteem is reborn. Self-esteem is
directly proportional to the level of control people feel over their own lives. Paradoxically
self-control comes by "turning over" unsolvable problems to a higher power and focusing
on what is solvable here and now.
15.
Natural Rest and Sleep
Sleep pattern disturbances begin going away. Sleep is more natural and fears
concerning sleep patterns are diminished.
16.
Desire to Escape Leaves
The desire to escape decreases as reality becomes less frightening and as control,
self-esteem, and self-confidence are restored.
17.
Adjustment to Family Needs
The person becomes reinvolved with the family and becomes aware of and more
responsible to needs of other family members.
18.
Family and Friends Appreciate Efforts
The family begins to give positive feedback as they begin to believe that this time
the chemically dependent is going to make it.
19.
New Interests Develop
Life is no longer just drinking and drug using. Until this point, the chemically
dependent's life has been alcohol and drug use centered – obsessed with drinking and
drug using or obsessed with not drinking and drug using. From this point on, ridding self of
the obsession and going beyond alcohol and drug use-centered thinking becomes the
issue.
20.
New Circle of Stable Friends
New interests and lifestyle change enable the person to establish new relationships
involving activities other than drinking and drug using.
18
21.
Rebirth of Ideas
Original value systems are rebuilt – usually the value system they had as
adolescents.
22.
Facts Faced with Courage
There is less need to run from reality. They can see things as they are and are
capable of taking hard and serious looks at self and attitudes.
23.
Increase of Emotional Control
Emotional recovery is taking place, and chemically dependents become aware they
are able to control their own responses to feeling, anxiety, and stress. Mood swings
become less dramatic.
24.
Appreciation of Real Values
They begin to appreciate that they can have some pride, some courage, and some
dignity. They develop an awareness of people, and relationships, and a spiritual program.
25.
First Steps Toward Economic Stability
They are able to initiate financial planning and to take responsibility for their own
financial situation.
26.
Confidence of Employer
As work performance improves, the employer is able to see that the person has
some future and places more confidence in him or her.
27.
Care of Personal Appearance
A new sense of pride and dignity brings about a change in appearance.
28.
Contentment in Sobriety
The struggle not to drink is no longer the whole focus. The person is finding
pleasure in non-drinking and drug using activities and having a sense of satisfaction in
sobriety.
29.
Rationalizations Recognized
The person is able to catch self in denial and rationalizations before they begin to
cause problems.
30.
Group Therapy and Mutual Help Continue
The group help process becomes an important part of the lifestyle. Relating to other
recovering chemically dependents enables one to be more accepting of self and more
comfortable in one’s own situation.
31.
Increasing Tolerance
Recovering chemically dependents become more accepting of others, less
judgmental of family, less critical of friends. Old resentments are released and
appreciation of others increases.
32.
Enlightened and Interesting Ways of Life Open Up With Road Ahead to Higher
Levels Than Ever Before
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At this point, the person enters into a new phase of recovery – a period of selfassessment followed by a reevaluation of values and birth of a new lifestyle built around
new and expanding values.
Recovery and Creating A New Life
Fear not that thy life shall come to an end, but rather fear that it shall never have a
beginning. (J.H. Newman)
Recovery from disease affords a person the opportunity to create a new way of life, a new
beginning. Disease causes losses, but it is possible to look beyond the losses and see the
potential for gain. Disease may take away certain aspects of a person's current lifestyle,
but it also provides the challenge of building new and more meaningful ways of life. I may
sound strange to hear someone say, "I am grateful that I'm an alcoholic," but many people
mean it. Their addiction has taught them something about life because they chose to
recover. The struggle with chemical dependency has taught them about their strength,
their courage, the joy of giving and receiving help, and the depth of life that is possible
despite the burdens of life.
Whenever people are forced to create a new way of life, they experience three distinct
feelings;
fear - doubting their ability to change
loss - emptiness experienced when saying goodbye to old habits, friends, situations
excitement - generated by the prospect of facing something new
Unfortunately most chemically dependent people focus on the fear and loss, totally
ignoring the excitement.
Change is always a two-sided coin. Fear is on one side and excitement is on the other. To
ignore the fear invites a dangerous plunge into the unknown. To ignore excitement invites
a fearful retreat into the comfort of old self-defeating habits.
Recovery and Trust
You must always ask questions about your treatment, but you must also come to trust the
treatment system. You must learn how to have faith in the process and trust that treatment
will help you get well. It is difficult to trust people because we know that they are fallible.
But the hope of recovery requires that, despite human fallibility, you make the decision to
trust the recommendations of someone else. There is a saying in NA that an addict alone
is in bad company.
Trusting people is difficult for chemically dependent people who have lost the ability to trust
in themselves. The countless efforts at controlling their alcohol and drug use has put them
in the habit of failing. They have stopped asking for help and have unintentionally cause
many of the people in their lives to support the failure pattern. Every newly recovering
person has a fear of failure. To deny this fear is the first step toward failure. In the
darkness of denial grows failure. You must believe that you have the inner courage and
strength to withstand the demands that your disease places on you.
Learning that you do not have to fight this disease yourself is a key to recovery. To
recover, it is necessary to trust someone or something other than yourself. AA is based on
this principle. They call this object of trust a "higher power". Trust means taking risks. The
reality is that we are most often hurt most by those we trust most. To trust is to give
another human being not only the power to help but also the power to hurt. Being human
20
we sometimes accidentally hurt the ones we care about. You must enter treatment with
your eyes open to the potential for pain. But you must ask yourself, "Is this an excuse to
avoid trusting others and asking for the help I need to recover from my disease?"
Recovery and Risk
Nothing in this world is guaranteed and this includes recovery. Recovery is a risky process.
A person must be willing to, must want to take the risk of recovery. Through treatment, the
risks are minimized and the chances of success are increased. Do the potential benefits
outweigh the risks? The answer to this question becomes obvious when the consequences
of untreated chemical dependency are explored. The consequences of untreated addiction
are insanity or death. Treatment is risky, but continued drinking or drugging has a definite
and catastrophic outcome.
Relapse, a return to drinking or drugging, is a systematic surrender of the human spirit to a
mood-altering chemical. Addicts who return to using surrender their human spirit – their
dignity, honour, courage, pain, triumph and failure – in exchange for a magic chemical
which for a little while allows them escape from the awesome realities of their own
humanness.
Points to Remember:
1.
The disease of chemical dependency may take away certain parts of life, but it
provides the challenge of building a new and more meaningful way of life.
2.
chemically dependent people must learn to trust the treatment process and also
learn to trust themselves.
3.
People can use fear of being hurt as an excuse to stop trusting or they can look
beyond being hurt and find that survival is possible.
4.
A commitment is a pledge to do everything in one's power to complete the terms of
an agreement.
5.
Persons entering treatment must make commitments to themselves, to others, and
to the recovery process.
6.
Treatment helps addicts go beyond planning to acting.
7.
The only way to face the future is by living fully today.
8.
Treatment is a risk – there are no guarantees.
9.
Recovery is worth the risk.
Sobriety-based Symptoms Of Recovery from Chemical Dependency
The choice to pursue a course of sobriety is the beginning of recovery. But abstinence is
not recovery, only the beginning. You did not become sick overnight, and you will not
recover overnight. It is a process that is experienced one day at a time.
Just as there are symptoms of chemical dependency that are triggered by using, there are
symptoms of the disease that are triggered by abstinence. These sobriety-based
symptoms emerge as a result of removing chemicals from the body.
21
Withdrawal from chemicals has some immediate and some long-term effects. Recovery
from chemical dependency means detoxification or ridding the body of toxins. It also
means recovery from neurological (brain and central nervous system) damage as well as
organ system (liver, heart, pancreas, etc.) damage. Knowing what to expect during the
time that recovery is taking place makes it more manageable.
Acute Abstinence Syndrome
Acute withdrawal symptoms are different for various types of drugs. It is impossible to
describe in detail the withdrawal effects for a wide variety of drugs. Because alcohol
withdrawal is by far the most frequent, we will describe it in detail here and then give an
overview of withdrawal from other drugs. sedative withdrawal is very similar to that of
alcohol withdrawal.
When the blood alcohol drops below a certain level in the chronic stage alcoholic, the
drinker will experience symptoms of the acute abstinence syndrome (AAS). AAS is what
causes alcoholics to drink again within a few hours of their last drink, eventually causing
them to drink in the morning or even in the middle of the night. They must maintain certain
blood alcohol levels or experience withdrawal symptoms because the body has developed
a need for alcohol. If the alcoholic is unable to get alcohol or chooses to abstain, AAS
symptoms can become severe and last from one to ten days. There are two types of AAS.
In Type I there are five stages of acute withdrawal. Stage I is marked by hyperactivity of
the nervous system. This takes the form of the following symptoms:
1. Tremors
2. Loss of appetite
3. Sweating
4. Nausea, vomiting
5. Low stress tolerance
6. Hyperactivity
7. Confusion
8. Poor memory
The next stage is hallucinosis. Although persons know who they are and where they are,
reality around them becomes distorted. There is the illusion that things are happening
which are not happening. Objects may appear to move, noises may be heard, physical
sensations may be experienced which in reality are not occurring. The person may be
aware that things are not as they are perceived, but the strong illusion creates confusion,
fear, and even panic.
The next stage is delirium and disorientation. At this point persons lose touch with reality
and become confused as to where and who they are. Hallucinations usually occur with the
belief that they are real. The person is confused, excited, incoherent, and frightened.
The fourth stage is convulsive seizures. These are major seizures in which the person
loses consciousness, the eyes roll back, and the body muscles contract. The seizures last
a minute or two, and if persons are protected from hurting themselves, the seizures are not
dangerous. Seizures are most likely to occur within 48 hours after the last drink but can
occur up to one week later.
The fifth and most serious stage of Type I is called delirium tremens, DT's, and with good
medical care can usually be prevented. DT's is the rapid progression of all the stages of
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acute withdrawal repeatedly. The agitation and tremors become severe. The delusions and
hallucinations are severe and terrifying. There is usually a fever along with fluid loss and
physical exhaustion. The DT's can be very serious and death can occur. This stage of AAS
always requires medical care.
The second type of AAS is marked by internal anguish. Patients don't shake or vomit or
hallucinate; they are not in pain. Patients often report that they feel as though they are
being torn apart inside, that their joints are vibrating, that they are about to explode or have
a thousand butterflies inside. They want to scream, to run, to do something to get away
from it. But they can't get away because the anguish is inside.
If alcoholics don't understand this feeling, they think they are crazy. They hide their
feelings and these build up like a pressure cooker. Sometimes the pressure will explode
and the patients become violent. The violence scares patients. They don't understand it.
They feel guilty and upset. They fear it will happen again, and this makes the inner pain
and anguish worse.
Withdrawal Symptoms of Other Drugs
It may be helpful to keep in mind that as a general rule symptoms of withdrawal from a
drug will be the opposite of the primary effects of the drug. If you are taking drugs that
quiet the nervous system, then without these drugs you will feel agitated and stimulated. If
you have been taking drugs that stimulate the nervous system, then without these drugs
you will feel depressed and lethargic.
Symptoms of withdrawal from depressants (downers) such as sedatives, barbiturates and
tranquillizers usually include anxiety, agitation, tremors, nervousness, headaches,
delerium, hallucinations, convulsions, and insomnia. Narcotics (pain-killers) such as
heroin, codeine, and morphine create some of these same symptoms along with
hypersensitivity to pain.
Symptoms of withdrawal from stimulants (uppers) such as cocaine, amphetamines,
nicotine, and caffeine can include lethargy, depression, tremors, confusion, and abnormal
heart rates. Withdrawal from hallucinogens (mind benders) such as LSD and PCP and
from cannabis (marijuana) is likely to include confusion, disorientation, flashbacks, and
paranoia.
Withdrawal In General
Withdrawal can be serious and without proper medical attention can be life threatening.
When people with chemical dependency are admitted for detoxification, they are observed
very carefully. The main goals of hospital care for people during the acute phase of
withdrawal are the prevention of complications and the assessment of damage in the body.
These goals are accomplished in two ways, by medical management and by behavioral
management.
The doctor usually orders medication which prevents the body from overreacting to the
stress of being without the addictive substance. this medication depends on the drug being
withdrawn from. For alcohol or sedatives, this medication is a depressant which acts in a
similar way to alcohol. The amount is gradually reduced to nothing. The doctor also usually
prescribes vitamins to supplement those which are needed by the nervous system for
healing and which were destroyed by addictive using. The doctor also orders tests such as
23
cardiogram, x-rays, and blood analysis to rule out or to confirm more serious body
damage.
Most of the time the high anxiety, confusion, sleep disturbances, and memory problems
which are part of AAS need another kind of care. This is called behavioral management;
and it mostly consists of individual attention, talking about the pain (physical and
emotional), stress management exercises, and reassurance that what is happening is
normal and predictable and will end soon.
The seriousness of any type withdrawal should not be underestimated. The person suffers
emotionally as well as physically from the experience, and it should not be undergone
alone if there is a choice. Anyone suffering withdrawal symptoms needs personal support,
and if there is any question about the severity, medical care should be sought.
Post Acute Withdrawal (PAW)
After the symptoms of the acute abstinence syndrome have subsided, the symptoms of
post acute withdrawal (PAW) begin to emerge. Post acute withdrawal syndrome is a group
of symptoms resulting from neuropsychological (brain and central nervous system)
impairments that persist into recovery. PAW surfaces 7 to 14 days into abstinence and
grows to a peak intensity over the next three to six months.
The post acute withdrawal syndrome affects thought processes, emotional processes, and
memory. Symptoms include problems with abstract thinking, concentration, and memory.
The addicted person also becomes stress sensitive. There is an overreaction to stress and
lowered tolerance to stress. The intelligence of a person is not affected. It is as if the
computer in the head is not functioning properly. The impairment can be corrected, but it
takes time and it takes some effort.
Sometimes the brain cannot translate short-term memory into long-term memory; so you
may forget you were to give Sally a message. Sometimes the information is there, but it is
jumbled and confused. You may remember to give Sally the message but give it
incorrectly. When the thoughts of recovering chemically dependent people become chaotic
and confusing and when they find themselves unable to concentrate or to remember how
they solved problems before, they may believe they are going crazy. They are not. These
experiences are normal during recovery and they will pass.
The paradox of recovery is that recovery from neurological impairment requires
abstinence, but neurological impairment interferes with the ability to abstain. This means
that everything possible must be done to control the effects of PAW while recovery is
taking place.
There is a direct relationship between elevated stress and the severity of PAW. Each tends
to reinforce the other. Stress aggravates PAW and makes it more severe; the intensity of
PAW creates stress which further aggravates PAW. Recovering people can learn to
identify sources of stress and develop skills in decision making and problem solving to help
reduce stress. Proper diet, exercise, regular habits, and positive attitudes all play important
parts in controlling PAW. Relaxation can be used as a tool to retrain the brain to function
properly and to reduce stress. Learning about the symptoms of post acute withdrawal,
knowing what to expect, and not overreacting to the symptoms increase the ability to
function appropriately and effectively. Remember, the symptoms of PAW will pass with
continued sobriety.
24
State Dependent Learning
In addition to the memory problems that stem from post acute withdrawal, there are
sobriety-based memory problems that occur as a result of state dependent learning.
Anything that you learn is most easily recalled when you are in the same mental state in
which you learned it. This means that what you learned while you were using, you will be
able to remember more easily when you are using and may have difficulty recalling when
you are sober.
If you started drinking or drugging at a young age, many social skills including
communication skills, dancing, and the ability to assert yourself may all be dependent on
using. You may find that it is very difficult to function socially without chemicals. There may
also be problems in expressing affection and in functioning sexually. You may have
difficulty remembering how to do any activities that you have always done while drinking or
using other drugs.
Recovering people feel they should be able to do these things because they have done
them many times before. When they attempt to accomplish the behavior that was learned
state dependently, they find themselves running into a brick wall. They can't do it in spite of
their efforts. They feel that there is something wrong with them. They feel they are crazy or
incompetent. A minor limitation is turned into a major crippler. They believe they cannot
perform and become very embarrassed and humiliated. As a result they avoid situations in
which relearning can take place.
Rather than admit to the limitation and handicap, most chemically dependent people tend
to lie to themselves about it. They rationalize, “Dancing isn't any fun anyway." Or "AA
meetings are enough, who needs to go out and have social good times?” This avoidance
of relearning situations is tragic because addiction treatment has demonstrated that skills
that are learned state dependently are rapidly relearned.
Adjustment Reactions To Sobriety
The recovering person has to develop a new lifestyle in order to maintain sobriety. A way
of life centered around drinking or drug use will not maintain sobriety. This requires the
formation of new habits. It is not easy to change habits that have been part of your life for a
very long time. You must develop new patterns of living, build new friendships, find new
sources of recreation and leisure, find your place within your family, and learn to
communicate in new ways. You must find new ways to cope with stressful living and to
respond to social pressure to drink or drug.
Some painful reactions to so much adjustment at one time is normal. It is important to
remember, however, that changes in habit get easier and easier. The first time you do
something new it may be difficult, the next time not quite so bad. Each time it will become
a little easier until the new habit is as much a part of you as the old habit was. Then there
will come a time when the old habits are no longer a part of your lifestyle at all and you will
be more uncomfortable with your substance-centered lifestyle than you have ever been
with drug-free living.
Sobriety-based Denial
Denial of chemical dependency while you were drinking or drugging was a normal part of
the disease. All denial does not cease when you are able to say, "I am an alcoholic." or "I
am an addict." Acceptance of the disease does not necessarily interrupt all denial patterns.
Sobriety-based denial may continue. This may take the form of denial of shortcomings or
25
personal problems that interfere with recovery. You may deny the reality that you can
never drink or use drugs again or that you need to make a plan to prevent relapse. There
may be denial of your need to change your lifestyle to support sobriety. Whatever form the
denial takes, it may or may not be conscious denial. Most denial is subconscious and the
person is not aware that it is there. A searching and fearless moral inventory as described
in the fourth step of AA and NA is necessary to interrupt sobriety-based denial that can
block your progress in recovery.
Alcohol and Drug Cravings
The nature of alcohol and other drug cravings has never been fully established, but some
recovering people do experience obsession and compulsion to use. They feel compelled to
drink or drug and develop definite cravings for the effect. These cravings can be
responsible for a return to using when you least expect it.
If you experience cravings you should have a plan of action that can be utilized at any time
the cravings occur. Your plan of action should involve other people and provide a place
where drinking or drugging is not likely to occur. People who encourage drinking, or using,
and places where alcohol is readily available should be avoided if cravings occur.
Personality Style Conflict
Before developing problems with chemical use every person has a personality style or way
of reacting to life. Some people have extremely independent personalities. They believe
they must be very independent and cannot accept help from anyone. Other people are
extremely dependent. They do not recognize their own strengths and rely on others to
function. The third personality style is counterdependence. People with this personality
style appear to be extremely independent but are actually deeply insecure. They appear
strong and confident while in reality they feel weak and helpless.
A healthy style of personality is the functionally independent personality, one that enables
you to recognize your strengths and abilities but allows you to acknowledge your
limitations and be willing to ask for help.
Progressive chemical dependency forces a personality change. A personality style
develops that will support drinking or drug use. A chemical-centered personality style
develops. When alcohol or drugs are removed this chemical-centered personality is no
longer effective. A conflict arises between the chemical-centered personality style and the
need for a new personality style that will promote recovery.
It is important to identify the personality style you used to support your drinking and what
you need to do to develop a functionally independent personality style that will support
your recovery.
Sleep Disturbances
Chemical dependency affects sleep patterns during the time of using and after using has
stopped. No one knows exactly why drinking or drugging has so much effect on sleep
because there is so much about sleep that we don't understand. Much research has been
done, though, on what happens while you sleep.
It is known that there are different types or stages of sleep. Sometimes you sleep very
deeply and quietly. Other times you experience more "active" sleep. It is during this active
26
stage of sleep that you dream. Your eyes move rapidly back and forth during the dream
stage so it is called REM sleep (Rapid Eye Movement).
There is evidence that the human body requires a definite amount of time spent in REM
sleep. If this required REM sleep is not obtained, a person will make up the required REM
sleep on following nights.
A person who is deprived of sleep for a long period of time can experience serious
emotional and thought disturbances. If a person does not receive REM sleep for up to two
weeks, the need for REM sleep can become so great that REM activity begins to break
into waking behavior. Disorientation, delusions, and hallucinations can result.
Some drugs including alcohol can reduce the amount of REM sleep one obtains. Six
ounces of alcohol before retiring can eliminate REM sleep entirely for the first half of the
night. You will then sleep large amounts of REM the last half of the night. Because alcohol
is a central nervous system depressant, it can help put you to sleep. And for the first few
hours of the night, alcohol may help you to sleep soundly. But as the blood alcohol level
lowers, a large amount of REM will occur. Alcohol also speeds up the sleep cycle. A large
dose of alcohol can speed up the time it takes to go through all the sleep stages from 90
minutes to as little as 10 minutes. Sleep becomes more restless and agitated. Interruption
of sleep and nightmares may occur. This agitated sleep can be a temptation to awake in
the middle of the night and have a few more drinks to return to sleep or to sleep soundly.
Drinking more than six ounces of alcohol in a night can almost eliminate REM sleep for the
entire night. You seem to sleep soundly. Yet the next night, without drinking, you will
experience a large amount of REM. Sleep will be restless and filled with nightmares.
Again, you may find you need a few drinks to sleep soundly. Drinking heavily for several
nights can eliminate REM for several nights in a row, and a large need for REM develops.
While actively drinking or on a binge, alcoholics obtain almost no REM sleep although they
may feel they are sleeping soundly and normally. Alcoholics can spend 100 percent of
their sleep time in REM for the first ten to fourteen days of abstinence. When they try to
stop drinking, most alcoholics are troubled by nocturnal waking, confusion, nightmares,
and even hallucinations. It seems very likely that the actively drinking alcoholic is depriving
himself of REM sleep and that some of the nocturnal nightmares, disorientation, agitation,
and hallucinations of alcohol withdrawal are, in fact, an expression of REM rebound.
The REM sleep pattern of the alcoholic usually returns to normal by the third week of
abstinence from alcohol. This does not mean that the alcoholic's sleep pattern has
returned to normal. Alcoholics routinely report sleeping less than eight hours per night with
no adverse effects during recovery.
Other drugs such as stimulants and hallucinogens can have the opposite effect.
Amphetamines can cause a person to be deprived of sleep for several days and the
resulting "crash" can amount to being deprived of the REM state when the person stops
using. LSD can cause short-term psychosis in which the person will experience vivid and
unsettling dreams for several days after they stop using.
It is important that the chemically dependent person and the family recognize that it is not
abnormal to sleep less during recovery than before. Often addicts worry that they are not
getting enough sleep, and the worry is more harmful than the lack of sleep. Or they may
27
resort to sleeping medications which are also more harmful than not sleeping. Sedatives
and barbiturates should not be used except during acute alcohol withdrawal. The use of
this medication intensifies disturbances in the sleep pattern.
Sometimes marital problems arise because of the change in sleeping habits of the
recovering person. Because addicts need less sleep, they may go to bed later or get up
earlier, which may interfere with affectionate or sexual experiences with the spouse. If the
chemically dependent person goes to bed later or gets up earlier, the spouse may interpret
that as rejection, especially if their sleep needs were similar before chemical dependency.
One person solved this problem by going to bed and getting up with his wife but getting out
of bed after she was asleep at night and staying up until he was sleepy.
This inability to sleep is not insomnia, and it will not be helpful to try to force sleep. It is
better to get up and do something meaningful to you. Don't worry unless you feel sleepy
and are still unable to sleep. In that case it would be a good idea to talk to a physician.
The essential thing to remember about sleep and chemical dependency is that drinking
and drugging does profoundly affect your sleep. When you recognize this, it is easier to
understand what is happening and to find appropriate ways to handle it.
Points to Remember:
1.
Withdrawal effects differ depending on the chemical being withdrawn.
2.
The chronic stage alcoholic must maintain a certain level of alcohol in the blood or
will experience withdrawal symptoms called the acute abstinence syndrome (AAS).
3.
The stages of Type I AAS are hyperactivity of the nervous system, hallucinosis,
delirium and disorientation, seizures, and delirium tremens (DT's).
4.
DT's can be very serious and always requires medical care.
5.
Type 2 of AAS is marked by internal anguish, a feeling of severe internal agitation
which can result in violence if not managed.
6.
Post acute withdrawal (PAW) emerges after the symptoms of the acute abstinence
syndrome have subsided (7-14 days into abstinence).
7.
Post acute withdrawal symptoms include problems with abstract thinking,
concentration, memory, feelings and emotions, and the ability to tolerate stress.
8.
Recovery from neurological impairment requires abstinence, but neurological
impairment interferes with the ability to abstain.
9.
There is a direct relationship between elevated stress and the severity of PAW.
Each intensifies the other.
10.
Recovering chemically dependent people can learn to manage PAW by proper diet,
exercise, relaxation, and life management skills.
11.
The symptoms of PAW will pass with continued sobriety.
28
12.
What is learned while drinking or drugging is most easily recalled while under the
influence of alcohol or drugs. This is state dependent learning.
13.
In sobriety you may have difficulty remembering how to perform many tasks you
learned while using.
14.
Skills that are learned state dependently are easily relearned.
15.
Sobriety-based denial may cause you to avoid doing those things that are
necessary to your recovery.
16.
If you experience chemical cravings you should avoid people and situations that
would make it easy to drink or drug.
17.
Conflicts may arise between a personality style that supported drinking or drugging
and a personality style necessary for recovery.
18.
The dream stage of sleep (REM) is necessary, or emotional and thought
disturbances occur.
19.
During abstinence the body will seek to catch up on dream sleep (REM) missed
while using.
20.
As the body seeks to catch up for long periods without REM sleep, nightmares and
restlessness will occur.
21.
Chemically dependent people routinely report sleeping less than eight hours per
night with no adverse effects during recovery.
22.
Chemically dependent people need to learn a new way of living that enables them
to adjust to and overcome the limitations imposed by the effects of addictive disease that
persist into recovery.
Factors Which Complicate Recovery From Chemical Dependency
From time to time certain conditions or situations can make recovery from chemical
dependency more difficult. These conditions or situations must be dealt with directly, and
special care must be taken to protect the recovering person from the consequences from
them and from a return to drinking or drugging that might be triggered by them.
Coexisting Illness
People with chemical dependency do get sick, just like everyone else. They may have
acute illnesses such as colds or flu, or they may have chronic illnesses resulting from their
addiction, or completely unrelated to their chemical dependency. They may have diabetes,
or arthritis, or ulcers or mental illness. These conditions require treatment by a trained
professional. Special care must be taken to protect against relapse into chemical
dependency. When coexisting illness requires medication it is important to inform your
doctor that you are a chemically dependent person and should not take mood-altering
chemicals. Ask them if there are medications that are not mood altering. If not and the
medication is absolutely necessary, then ask your physician to help you monitor the
medication carefully with a time-limited supply. You should inform you counsellor and
29
sponsor of your use of these medications to help you control them. If you experience any
withdrawal symptoms when you stop taking the drug, be sure to get special help and
support.
Chronic pain is a real problem for chemically dependent people. the stress that coexists
with the pain can aggravate post acute withdrawal. Make sure that chronic pain is being
treated by a professional who understands that you are a chemically dependent person.
Polydrug Use
Addiction is a serious problem. There is a strong tendency to become easily crossaddicted. People who were addicted to more than one drug need to get clean from all
drugs in order to recover. Sometimes people will focus on the one drug that seems to be
causing them the most problems, like alcohol or cocaine, and insist that they can handle
another that hasn't caused them many problems, like marijuana for instance. They fail to
consider that if they continue to smoke pot they are less resistant to saying no to alcohol or
cocaine. Because of the progressive nature of chemical dependency they will likely move
further into problems associated with another mood-drug if they use it.
Substitute Addictions and Mind-altering Behaviours
Recovery involves abstaining from all mind-altering chemicals. Switching from one drug to
another is not sobriety. People can also become dependent on activities like over-working,
gambling, spending, relationships, sex, and eating. These activities can release internal
brain chemicals like dopamine, endorphine, adrenaline, and serotonin. People can come to
anticipate a "rush" or feeling of euphoria when these are released. An abstaining
chemically dependent person in long-term withdrawal will be looking for something to
relieve pain and discomfort. Compulsive and excessive use of any mood-altering habit and
behaviour must be avoided. Compulsive behaviours can trigger stress reactions which in
turn can aggravate post acute withdrawal.
Children of Alcoholics
Chemical dependency has been found to have a strong genetic link, therefore many
people who are in recovery from addictive disease have one or both parents who are also
chemically dependent. Growing up in a family with chemical dependency is traumatic.
Often severe abuse is experienced, abuse which leaves scars which linger into adulthood.
If you are the child of an alcoholic or chemically dependent parent you probably developed
defense mechanisms which are strongly ingrained. These survival strategies can be
stumbling blocks to recovery. It is important to work the issues from your childhood through
with a trained professional when it is appropriate to do so. Care must be taken, however,
not to shift the focus away from your own recovery when doing so. Working on serious
childhood trauma issues can trigger a relapse if your basic recovery program is not in
place. No matter how long you have been in recovery, you should have support from
people who love you and care about you when you are going through therapy.
Situational Life Problems
From time to time there are major crises in life that require special action to protect
sobriety. Death, separation, financial problems, or family emergencies may be difficult,
especially if alcohol and other drugs were used to cope with such times in the past. During
these times you may need special counselling -- grief counselling, family counselling, job
counselling, premarital counselling -- and special support to help you maintain the
structure of your recovery program. A crisis that requires special attention is the accidental
ingestion of alcohol or another drug. You may unintentionally use a medication that
30
contains alcohol or a sedative or a narcotic. Such ingestion can trigger a strong physical
craving. Any time you use alcohol or sedative medication it will disrupt the recovery
process. You should observe carefully the ingredients in everything you consume and you
should seek assistance any time accidental ingestion occurs.
Points to Remember:
1.
Sometimes there are special problems that require special care to protect sobriety.
2.
Illness or pain can create stress that can jeopardize sobriety without special support
and special ways of managing the problem.
3.
Mood-altering medication should be avoided or, if absolutely essential, carefully
monitored.
4.
Cross-addiction (alcohol in combination with other drugs) creates unique reactions,
withdrawal symptoms, and sobriety-based symptoms.
5.
Use of substitute chemicals or behaviours to cope with pain can create new
addictions and increase the risk of relapse.
6.
People who are recovering from chemical dependency and are also children of
alcoholics may have behaviours that interfere with recovery
7.
Resolution of ACOA issues is necessary for full recovery but should not be
undertaken until sobriety is secure.
8.
Any life crises or situational problems need special action to protect sobriety.
31
Where is your stress Level at today?
10
Lo ss o f Control
9
Over React
8
Become Defen sive
7
Spa ce Ou t
6
Need To self-Mo tivate
5
Stre ss Difficulty
4
Mode rate Stress
3
Al ert
2
Calm
1
Rela xe d
As leep
32
Stress and Recovery From Chemical Dependency
Effective management of stress during recovery from addictive disease is very important.
The inability to effectively manage stress will often lead to relapse for the recovering
person. In most chronic stage addicts there is neurological (brain and central nervous
system) damage which causes the person to overreact to stress and decreases the ability
to tolerate stress. Stress intensifies the symptoms of post acute withdrawal. Post acute
withdrawal creates stress which intensifies the PAW which may trigger a return to drinking
or drug using.
Stressors
In your life there are many stressors. These are situations or events that cause you to
react in a stressful way. Stressors may be noise, hurrying, your boss yelling, your children
being sick, your grandmother's death, your car breaking down, losing your job, the phone
ringing in the middle of the night, your son running away, stubbing your toe, losing your
hair, moving, your daughter getting married, your dog dying, the alarm going off.
Some stressors are minor, others very serious. What may be a stressor for me may not be
a stressor for you. What may be a stressor at one time for you may not be at another time.
Change is a major stressor for anyone. Because of the tendency to overreact to stress
during your recovery, you should try to avoid unnecessary change during the first two
years of sobriety. Necessary change should be carefully planned to minimize stress. As
time goes by you will be better able to handle the stress created by change.
Take a sheet of paper and list some common or frequent stressors in your life. After you
have finished, ask yourself if they are all stressors or if some of them are your reactions to
stressors. Then ask yourself if you can eliminate, postpone, or alter any of your stressors
in order to facilitate your recovery.
Involuntary Stress Reactions
When stressors occur, you react to them. This reaction is involuntary. You do not make a
conscious decision to react. It just happens. This reaction is physical. You can feel it in
your stomach or your head. Your muscles may become tight. Your body releases
hormones and chemicals that change the way you feel. You may develop stress-related
illness because of these physical reactions. Do you experience any of these symptoms of
physiological stress?
You respond to those stressful physical feelings with a stress response that is
psychological, behavioral, or social. You may cry, laugh, yell, hit someone, slam the door,
throw the alarm clock against the wall, walk away, smile, take a drink, call a friend, or
choose to do nothing at all. Whatever you choose to do is your response.
Some ways of responding become new stressors. We call those stress cycles. If you hit
your boss in the nose when he yells at you, your response becomes a new stressor and
you are creating stress cycles. Choosing to respond in this way usually makes things
worse rather than better.
A delayed stress response is using some means to escape the stressor which causes the
situation to become worse because of the delay. Alcohol or other drugs are often used as
33
a means to delay a stress response. But the stressor does not go away, and the delay
itself becomes a new stressor.
There are ways to respond that can reduce the stress. These are stress reduction
responses. One way of reducing stress is to solve the problem which is the stressor. As
you recover you should develop your problem solving skills. Some helps are given in the
Behavioral Recovery handout.
There are natural stress reducers that you can use in your recovery. Some natural stress
reducers are: daydreaming, laughing, playing, sex, physical activity, story telling, singing,
and fantasizing. It is important to learn how to have fun and enjoy yourself. It will help you
reduce stress naturally.
There are also relaxation techniques that you can learn that will reduce stress. Are you
aware that your muscles cannot relax and tense at the same time? You can learn to relax
your muscles when you choose and therefore reduce tension. You can also learn to form
pictures in your mind that will help you relax. And you can learn to talk to yourself (this is
called self talk) in a way that will reduce tension and increase your feelings of comfort and
relaxation. Some relaxation techniques to help you reduce stress are given in the handout
called Physical Recovery.
Some stress is necessary in life to keep you functioning. Otherwise, you would not take
care of yourself or go to work or do anything for your family. Too much stress is harmful,
though. Finding the level of stress that is useful without being destructive is important to
your recovery. You can relapse because of too little stress (no constructive concern about
your addictive disease) or because of too much stress. But there is an alternative. You can
protect your sobriety by developing stress management skills for a healthy, comfortable
lifestyle.
Points to Remember:
1.
The inability to effectively manage stress will often lead to relapse for the recovering
person.
2.
Post acute withdrawal creates and intensifies stress which intensifies the PAW.
3.
Stressors are situations or events that cause you to react in a stressful way.
4.
Rules of change in recovery:
A. Avoid unnecessary change.
B. Necessary change should be carefully planned.
5.
You will have an involuntary, physical reaction to stressors. You may develop
physical illnesses because of those reactions.
6.
You will respond to physical stress reactions in psychological, behavioral, or social
ways.
7.
Stress responses that become new stressors or that are delayed responses usually
make things worse.
34
8.
You can learn ways to respond that will reduce stress. Natural stress reducers
include daydreaming, laughing, playing, sex, physical activity, storytelling, singing, and
fantasizing. You can also learn relaxation techniques to reduce stress.
9.
Too little or too much stress may lead to relapse. You can protect your sobriety by
developing stress management skills.
Developmental Phases Of Recovery From Chemical Dependency
Recovery from chemical dependency unfolds in phases. It is a progressive movement
through specific developmental periods. This means that each phase of recovery requires
the completion of specific recovery tasks that must be accomplished in order to prepare
the recovering person for the next phase of recovery.
The developmental periods of recovery are: transition, stabilization, early recovery, middle
recovery, late recovery, and maintenance.
TRANSITION. During this period you learn by the law of consequence that you cannot
drink or use drugs safely. The disease becomes a teacher. As the disease progresses, the
consequences of continued using become more severe until you are forced to recognize
that your drinking or drug use is not normal. The end of the transition period is often
marked by a motivational crisis, an event that results in recognition that drinking and
drugging is causing such severe problems that you need help.
STABILIZATION. The stabilization period of recovery includes detoxification and the
beginning of abstinence. The major tasks of this period are recognizing the pattern of crisis
that has been emerging, relating that pattern of crisis to drinking and drugging, and
developing the motivation to pursue long-term treatment. An initial plan for sobriety should
be made under the direction of treatment professionals who know what is necessary for
recovery.
EARLY RECOVERY. During this time you review the events of the stabilization period and
consciously determine the meaning and significance of those events. It is necessary to
take an in-depth look at the motivational crisis and the chemical-related life problems that
will persist into recovery. It is during this time that you develop the firm belief that you are
suffering from addictive disease. You develop an honest desire to recover and a strong
belief that it is possible to recover from this disease.
MIDDLE RECOVERY. The middle period of recovery occurs after you have made a
commitment to long-term treatment. You learn about the disease and develop a selfregulated recovery plan that is reasonable, logical, and based upon the most accurate
information available about chemical dependency and recovery. You recognize that
addiction has caused a variety of physical, psychological, behavioral, and social problems
that need to be identified, and that reversal of these problems is possible with appropriate
treatment.
LATE RECOVERY. During this period you put your recovery plan into action. You
consistently pursue the resolution of the long-term problems that have developed because
of chemical dependency. Once these problems are resolved, you will explore your current
value system and learn to distinguish chemical-centered values from sobriety-centered
values. You will come to believe that you can create a lifestyle in sobriety that will bring
35
you a greater amount of pleasure than you received from using. You will put new values
and goals into your life that will bring about a more meaningful and fulfilling life. You will
seek to establish or reestablish a sense of spiritual identity. The focus of your attention will
be drawn more and more to learning to live again in a way that is in harmony with sobriety
and that generates a sense of serenity and peace of mind.
MAINTENANCE. You are in remission from addictive disease when you are maintaining
abstinence, when you have completed the major tasks of recovery, and when you have
developed the competence to live productively. Chemical dependency, however, is a
chronic disease that is subject to relapse. Full remission can only be maintained by
recognizing the life-long need for a strong maintenance plan consisting of a daily program
of ongoing recovery and personal growth. You need to maintain a program of recovery that
will help you recognize the limitations imposed by your disease and be alert for relapse
warning signs. You will need to regularly review your progress with a counselor or sponsor
and to construct a network that will make it easy for you to get help if problems develop.
Treatment can fail at any one of these phases. The failure can be total or partial, but for
most addicted people the relapse is based in partial failure. The Big Book of Alcoholic's
Anonymous calls it "half measures."
Part of you believes you are chemically dependent; part doesn't. You are in conflict with
yourself. You are conducting an internal argument. As this argument rages, stress
increases. As stress increases, the need for a drink or use drugs grows. As the need
grows, this need energizes the argument, "You are not an addict and you don't need
treatment. You can use if you want to." If that side of the argument wins, you return to
using.
Or you may develop an honest desire to recover but believe that there is no hope. This
feeling of "hopelessness and despair" based on the belief that "recovery is impossible" or
"treatment won't work" acts to raise anxiety and stress levels and the need for a drink or
drug grows and the cycle begins again.
You may live permanently in partial recovery. You may stay sober but miserable, longing
to be able to drink or use drugs normally. Or you can live a full and productive life with no
ongoing compulsion to use. You can develop a meaningful life based upon values and
goals that support recovery. The key to full recovery is complete treatment through all the
phases of recovery.
Points to Remember:
1. The phases of chemical dependency treatment are:
transition
stabilization
early recovery
middle recovery
late recovery
maintenance
2.
There are recovery tasks for each phase of recovery.
36
3.
During pretreatment you learn by experience that you cannot drink or drug without
painful consequences.
4.
Stabilization provides detoxification, motivation for ongoing treatment, and an initial
sobriety plan.
5.
During early recovery you review the events of the stabilization period, develop a
strong belief that you have the disease of chemical dependency, and develop the
motivation for lifestyle change and long-term treatment.
6.
During middle recovery you learn about the disease and recovery, and you
establish your own recovery program.
7.
During late recovery you put your recovery plan into action and learn to live in a way
that is in harmony with sobriety.
8.
You will enter remission when you have completed the tasks of recovery and are
maintaining abstinence.
9.
To maintain remission you must maintain an ongoing recovery program that will
enable you to live productively and to recognize relapse warning signs should they occur.
Physical Recovery From Chemical Dependency
Points to Remember:
1.
Physical health is an important part of the total process of sobriety.
2.
Recovery requires abstinence from alcohol and mood-altering drugs.
3.
A balanced diet is necessary to rebuild a body damaged by chemical use and
malnutrition.
4.
Nutritious snacks help sustain energy and combat fatigue and nervousness.
5.
A nutritious breakfast provides a source of energy early in the day and helps
prevent weakness and depression.
6.
Concentrated sweets and caffeine cause nervousness and restlessness.
7.
Establish proper eating habits that will help you keep your weight within 10% of your
ideal.
8.
Exercise helps rebuild the body, keeps it functioning properly, and reduces stress.
9.
Sleep should be regular and consistent; lack of sleep causes irritability, depression,
and anxiety.
10.
Relaxation exercises can be used to manage the symptoms of PAW.
37
11.
Fears and anger affect body functioning and increase the risk of relapse in addictive
disease if not resolved daily.
Psychological Recovery From Chemical Dependency
The more isolated a person is, the more destructive will be the power of his wrongs over
him, and the more deeply he becomes involved in them.... Wrongs want to remain
unknown. They shun the light. In the darkness of the unexpressed they poison the whole
being of a person.... They must be brought into light... openly spoken and acknowledged. It
is a hard struggle until wrongs are admitted.
(from Life Together by Dietrich Bonhoffer)
It is this principle of admission that gives the statement, "I am Mary and I am an alcoholic,"
its power.
AA Steps 6 and 7 say, “Were entirely ready to have God remove all these defects of
character, " and “humbly asked Him to remove our shortcomings. "This is a process, not
an event. It doesn't happen suddenly. It occurs over a period of time. The recovering
chemically dependent person takes one day at a time and is satisfied with progress. It
cannot be overstated that recovery takes time. You can be reassured that it is taking place
as you take the steps that make it possible.
Identifying, expressing, and responding appropriately to feelings that are obstacles to
recovery can bring freedom from anxiety, fear, depression, and anger.
Points to Remember:
1.
Psychological problems (relating to thinking and feeling) result from chemical
dependency and do not disappear by removing chemicals from the body.
2.
Some psychological problems during recovery are the result of post acute
withdrawal.
3.
Other psychological problems are the result of a change in lifestyle and attitude.
4.
Change creates stress, both positive and negative.
5.
Mood swings are common in recovery; sometimes you may feel very good,
sometimes you may become depressed.
6.
The worst thing you can do is to keep depression and self-destructive thoughts a
secret. Unspoken thoughts continue to get worse.
7.
Depression often results from guilt. Steps four through ten will give you active
methods of resolving guilt.
8.
Anger is an involuntary response to something that happens. It is not a choice; it
simply happens.
9.
Sometimes an active response to anger is appropriate.
38
10.
A recovering person has a tendency to overreact so needs to learn to express
anger in safe surroundings.
11.
Step 4 enables you to look at your character, beliefs, and attitudes. It helps you look
at your strengths as well as weaknesses.
12.
Strengths you used to maintain your chemical dependency can be used to maintain
your sobriety.
13.
Denial is not conscious lying. It is being dishonest with yourself.
14.
Denial, minimizing, avoiding, scapegoating, "flight into health," and rationalizing are
ways to escape the truth. You must be honest with yourself in order to make a fearless and
searching inventory.
15.
Emotions are what you feel; judgments are what you think.
16.
Some people have trouble expressing feelings because they can't find the right
words to describe their inner experience. A list of feeling words can help you if this is your
problem.
17.
When feelings are kept inside, unexpressed, they are energized until they are acted
upon. Step 5 urges admission of your "wrongs."
18.
Removal of defects is a process, not an event (it doesn't happen suddenly).
19.
Identifying, expressing, and responding appropriately to feelings that are obstacles
to recovery can bring freedom from anxiety, fear, depression, and anger.
Behavioral Recovery From Chemical Dependency
When you are putting on a shirt or coat, you have developed a habit of putting one arm in
the sleeve first. Some people put on a coat with the left arm in first; others will start by
putting the right arm in first. Your assignment is to change. Every time you put on a coat or
shirt, start the process by putting the opposite arm in the sleeve first. Notice any feelings or
reactions when you try? These feelings are stress.
Have we made the point? CHANGE = STRESS
During the first two years of sobriety, keep unnecessary change to a minimum. If there are
necessary changes, be sure to plan carefully for change. The question is often asked,
"What is necessary change?" The answer is simple – a change is necessary if any of the
following exist:
There is a life area that creates high levels of stress or pain that may interfere with the
ability to stay sober.
Change is forced upon you by circumstances beyond your control.
You become aware in sobriety that certain areas of your life seriously compromise your
value system or sense of personal integrity.
39
Guidelines for planning necessary change:
1.
In changing any life area, make the minimal change necessary to accomplish your
goal.
2.
Only plan to change one area in your life at a time.
3.
low.
Plan changes to occur during periods of your life when stress from other sources is
4.
Avoid big changes by learning how to break down major change into small steps
that can be accomplished over a period of time.
5.
Plan for periods of rest in between changes.
6.
Practice a strong program of relaxation training during periods of change.
7.
Intensify your recovery program. (Attend more meetings, spend more time with your
sponsor, etc.)
8.
Plan for the worst so you have confidence that no matter what happens, you can
handle it.
9.
Expect the best; keep a positive frame of mind by using constructive self-talk and
fantasy techniques.
10.
Plan for "stress escapes," periods of a day when you can mentally get away from
the stress.
11.
Plan for fun recreational activities that will reenergize you to face change.
12.
Once you have determined that change is necessary and made the decision for
change, follow through. Backing out and starting over again makes the change more
stressful than necessary. Here are some helps in maintaining change once you have
decided it is necessary.
A.
Change your self-talk habits. Change the way you talk to yourself. Say things to
yourself that will support your new situation rather than the old situation.
B.
Use fantasy to accomplish what you intend to change. For anything to be physically
accomplished, it must be mentally accomplished first. Plan your change carefully in your
mind.
C.
Use memories to reinforce change. You must give up the "good old days"
syndrome, the tendency to remember how good things were before. Search for those
memories that will make change easier, memories of those things that are making the
change necessary rather than the memories that cause you to want to bring back the past.
40
WHAT CAN YOU CONTROL?
The following is reprinted from Living With Stress, published by Christopher News Notes:
Is concern over the past or future a major source of stress in your life? Consider the
conclusion reached by a woman who came to the sudden realization that fears were
ruining her peace of mind. She took a pencil and made a tabulation of her worries,
estimating as well as she could their nature and origin. These were her conclusions:
40% – Will never happen; anxiety is the result of a tired mind.
30% – About old decisions which I cannot alter.
12% – Others’ criticism of me, most of it untrue.
10% – About my health, which gets worse as I worry.
8% – “Legitimate” since life has some real problems to meet.
Adding it up, 92% of that woman’s worries are unproductive. What would your worry
balance sheet look like?
You can control some areas of your life. And you can reduce stress in them.
Look for causes. Who or what is at the bottom of the stress? Dealing directly with the
person or issue may be the best approach.
Examine your relationships. What can you do to put more warmth, more communication,
and more mutual support in them?
Evaluate. Not every argument is worth trying to win. Defend values that are important. But
learn to ignore lesser issues.
Be positive. If you fail don’t concentrate on failure. Deliberately recall past successes. It
helps self-esteem.
Seek advice. Confiding in a friend can uncoil the tightly-wound spring of tension. Seek
professional assistance when needed. You're worth it.
Do something for others. Reaching out can take the focus off self and reduce the stress
caused by brooding.
Do one thing at a time. The seconds pass in single file. Yet how quickly they become
minutes and hours. You’ll get more done with less “hassle” when you concentrate on each
job as it comes.
Learn to pace yourself. You can’t operate in high gear all the time. Take a break. Go for
a walk. Look out the window. Do something else.
Exercise. Physical exercise can refresh you after heavy mental work. Reading a book can
relax you after demanding physical action.
Create a quiet place. Take time to meditate, to pray. Recent studies show that we can
train ourselves to relax.
Points to Remember:
1.
Behavioral recovery is developing the courage to change the things you can.
2.
Recovery may require learning or relearning skills to organize and restructure your
life.
3.
A healthy balance in the use of your time that allows time for work, time for play,
time for family, time for friends, and time for yourself is essential for recovery.
4.
Neurological retraining may enable you to overcome handicaps resulting from the
symptoms of post acute withdrawal. It may enable you to rebuild areas of impairment, to
41
force another part of the brain to take over functions of the impaired area, or to learn to
adapt to the impairment by using other behaviors.
5.
Skills that cannot be recalled because of state dependent learning can be rapidly
relearned through structured practice, usually by role play, practicing in a safe environment
the skill you are attempting to relearn.
6.
Skills training is breaking down complex skills into simple steps, learning each step
and then putting the steps together.
7.
You must learn behavior that will protect you from an overreaction to stress that
might put your sobriety in jeopardy.
8.
Respecting your own needs and rights and expecting others to respect your rights
(as you respect theirs) will help protect your sobriety.
9.
In order to protect yourself from stress, you must first identify your own stress
triggers and learn to avoid those situations, or interrupt those situations, before they
become out of control.
10.
Developing skills in problem solving will enable you to handle difficult situations
before they become stressful.
11.
All change is stress producing. During the first two years of sobriety, you should
avoid unnecessary change and plan necessary change carefully.
12.
Practicing the Serenity Prayer of AA helps control stress levels:
God grant me the serenity to accept the things I cannot change,
courage to change the things I can, and
wisdom to know the difference.
Social Recovery
Social recovery occurs as a person reorients his or her lifestyle around values that are nonalcohol
centered. It involves a resolution of family, work, and social problems that were created by active
alcoholism. It also invloves the development of new and more meaningful social networks.
Reorientating your lifestyle around values that are nonalcohol centered is an essential part of
recovery. The values that you developed in order to allow yourself to keep drinking will not allow
you to stay sober. A lifestyle conducive to drinking is not conducive to sobriety. Friends who
encourage drinking do not encourage abstinence. Places where it is easy to drink are not places
where it is easy not to drink. New friends, new activities, new social contracts are part of social
recovery.
Points to Remember:
Social recovery occurs as a person reorients his or her lifestyle around values that are nonalcohol
centered.
Social recovery involves a resolution of family, work, and social problems that were created by
active alcoholism.
Social recovery involves the development of new and more meaningful social networks.
Communication skills must be relearned in sobriety. Communication skills are learned by practice.
42
Communication is the ability to express your thoughts and feelings clearly and accurately to another
and to receive the thoughts and feelings of another with understanding.
AA is a valuable source for establishing a meaningful social network.
The family must be a part of the recovery program. The whole family needs to recover together.
It may take time to rebuild trust so that family members can feel safe in trusting you to perform
tasks that you were unable to fulfill responsibly in the past. Communication is the key to
reestablishing family relationships. You must learn to talk to one another.
WHAT IS COMMUNICATION?
Communication is the ability to express your thoughts and feelings clearly and accurately to another
and to receive the thoughts and feelings of another with understanding. We see good
communication when the speakers reach a conclusion satisfactory to both of them – when they end
feeling that they have really understood one another, or when they end just feeling good about
having been able to say something that they wanted to say to another person.
Communication is never one way; it must be at least two way. Therefore, speakers who only think
about their own feelings and their own ideas when they are in a conversation are not really
communicating – they are only verbalizing.
CHARACTERISTICS OF GOOD COMMUNICATION
Those people who are good communicators have such characteristics as the following:
1.
They are good listeners. It is often true that the main ingredient in good communication is
careful listening.
2.
They help those speaking to them to be complete and accurate by giving them verbal and
nonverbal encouragement while listening.
3.
They do not dominate the discussion. There is sensitivity to the other person or persons in
the conversation.
4.
They give total attention to what is being said, rather than thinking about how they will
answer what is being said.
5.
They express themselves in ways meant to send meaning accurately to the others in a
conversation, rather than to impress listeners with how smart they are.
6.
They are sensitive to how much talking is needed to communicate well. They do not
overtalk a point because they know this may cause listeners to lose interest.
7.
They know how to stress the main points they want to communicate by the verbal and
nonverbal emphasis they give to certain words or sentences.
8.
They are open and honest in what they say, but are also sensitive to the feelings of others in
the conversation. They know that an angry listener is a poor listener.
43
9.
They know they must be understood if they are to communicate effectively. Therefore, they
are careful to speak clearly and in words that will be understood by the listener.
10.
They try to identify feelings as well as thoughts of others in the conversations, and they
make sure to check their interpretations for accuracy with others in the conversation.
CONVERSATION KEYS
How do you get a conversation off to a good start? Equally important, how do you bring a
conversation to a good close? People often find themselves not knowing how to begin or end a
discussion, and sometimes feel uncomfortable about awkward moments in the middle of a talk.
While there is no magic formula to avoid such situations, the following skills should help with these
and other problems of communication:
1.
Leads: The direction that a conversation will take is determined by the new ideas and
material that are introduced. When new subjects allow for a response by conversation partners, it is
called a lead. When it does not allow for any meaningful response by another, then it is only a
verbalization. A lead has these elements:
a.
It includes material that the speaker can reason- ably assume will be of interest to the
listener.
b.
It is presented in such a way as to allow the listener the opportunity to respond in a way that
includes his own opinions, interests, attitudes, or feelings.
c.
Sample leads
1)
How do you feel about...?
2)
Do you agree that...?
3)
I don’t know what you might think about this, but I feel....
4)
I'm interested in what you think about....
5)
Tell me about....
6)
What do you think about...?
2.
Responses: The reaction made to a lead is called a response. It gives the speaker information
about how the lead has been received. The nature of the response has an important influence on the
way the conversation will go. It should be understood that all conversations will include talking that
is neither a lead nor a response, but just verbalization. This cannot be avoided, and is not bad, as
long as there are plenty of real leads and responses to balance the verbalizations. Responses may
take many different forms – even a short silence, a pause, may be a good response to a particularly
important or emotional lead. A good response usually has these two parts:
a.
It refers to information (facts, feelings, thoughts that have been introduced in the speaker's
lead.
b.
It includes persona/ interpretations or feelings brought about in the responder by what the
speaker has said. Comments that do not relate in some way to the material of the lead, are not really
responses; they are just verbalizations.
c.
Sample Responses
1) Let me give you my reaction to....
2) What you said made me think about....
3) What you said helps me to....
4) You said something that is very important to me. It is....
5) / like what you said about....
6) I see your point about but I feel that....
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3. Verbal Flow: In order for leads and responses to be effective links for building an efficient,
satisfying conversation, the persons conversing must observe verbal flow. This means that new
leads only happen when there is no longer any need to continue a topic that had been discussed
earlier in the conversation. It also means that responses stick to the main pointsof the lead, rather
than ignoring the lead and jumping to a new topic.
4. Paraphrasing: This is the act of summing up in a brief way what has been said and the feelings
that have been expressed. It is used to check with the speaker to see if the responder has understood
the main ideas and the general feelings or attitudes of the speaker. This helps both persons
understand each other better, and make communication much better.
5. Questions: Questions are a very important part of communication because they help to form
connections between the thoughts and feelings of the persons who are communicating. Questions by
a speaker help him see if his thoughts and feelings are getting across to the listener. They also help
the speaker to get the listener involved in the conversation by getting the listener's opinions and
feelings into the conversation. Questions by a responder help to bring out the speaker’s thoughts
and feelings more clearly, and often help the speaker to better understand his own thoughts and
feelings.
There are three types of questions that must be considered:
a.
Open questions: These are questions which allow the responder to talk freely and expand his
thoughts and feelings. Open questions start with such leads as “How do you feel about...? What
else...? Could you tell me more about...?" Open questions help the speaker to continue his lead.
b. Closed questions: These are questions used to get necessary facts or missing information needed
by the listener. They should be used for these purposes only, because closed questions do not help
to make easy, uninterrupted communication. Closed questions start with such leads as “When
did...?” “How much...?” “Where...?” When you feel a question is needed to keep a conversation
going well, try to use an open question rather than closed questions.
c.
Why or accusing questions: These are questions which are not really meant as questions.
Rather, they are usually asked to accuse or place blame on the other person in the conversation. An
example of this is seen by the mother who, when she sees her five-year-old accidentally knock
down the cookie jar while reaching into it for a cookie, says to the child – “Why did you knock over
the cookie jar?” or “Why aren’t you more careful?" This does not mean that the words “why"
should never be used in a question. It just means that when you are thinking of asking “why,” make
sure you are not using it to make a useless accusing statement to another person with whom you are
communicating.
6.
Closing: The way a conversation ends is very important. It is the strongest memory a person
has of a talk once it has ended. It can determine a person’s evaluation of a conversation no matter
what happened while it was actually going on. The type of close that is proper depends upon the
purpose of the communication. In general, however, the following guidelines will help assure a
good communication close:
a.
There should be an action close, or agreement on the next steps that should result from the
conversation. Of course, if the communication is not concerned with any kind of possible future
activity, this will not be necessary.
b.
There should be an opportunity for each communicator to check with the other to see if there
is any important clarification to make, or if any important missing information must still be
supplied. This checking can be done quickly, even through gestures or facial expressions.
45
Relapse Prevention Planning For Chemical Dependency
Proper action on the part of the chemically dependent person and key persons in his or her
life can prevent or interrupt relapse before the consequences become tragic. Planning for
relapse minimizes its destructive potential. Chemically dependent people can utilize
intervention skills at any time before drinking or drug use becomes out of control if they are
prepared to recognize and understand the relapse process.
The chemically dependent person is ultimately responsible for all behavior and decisions
that accompany relapse. They pay most heavily for relapse. Many addicts relapse because
they don't understand the process and don't know what types of behavior change are
necessary to prevent it. Most relapse in addiction is unnecessary. It stems from lack of
knowledge.
Chemical dependency is a disease prone to relapse. If you had heart disease your family
would know the warning signs and what to do in case of heart attacks. The same would be
true if you were diabetic or epileptic. Any condition with high relapse potential should be
treated with respect. The relapse pattern should be systematically explored and prevention
tactics individually designed.
Proper relapse prevention plans can give you and the concerned people in your life a
deep-seated sense of security. All involved can know that they are doing everything that is
necessary to prevent relapse. They can develop a plan and a checklist of warning signs.
As long as you follow that plan and watch for warning signs, you can be confident that
recovery is following a successful course.
An essential part of the treatment process is the establishment of a relapse prevention
plan. The plan should include the individuals in your life. Each person should be informed
of the potential for relapse and their responsibility and appropriate action if you
demonstrate early signs of relapse. The steps of relapse prevention planning are:
1.
Stabilization: The first step in preventing relapse is stabilizing from the relapse that
has just occurred or, if this is your first time in treatment, stabilizing your sobriety.
2.
Assessment: If this is your first time in treatment, you need to assess whether you
are ready for relapse prevention planning. Do you believe that you are really chemically
dependent and that you need to change your lifestyle? If you are not sure, you need to
work on these issues before you are ready to develop a relapse prevention plan. You have
to believe that you have a disease that is subject to relapse before you can do what is
necessary to prevent that relapse. If you have relapsed previously, then you need to
cooperate with your therapist to assess that relapse and other relapses you may have
experienced to determine what contributed to the relapse process and what could have
prevented it.
3.
Education About the Relapse Process: You need to learn about recovery and
relapse. You need to understand the sobriety-based symptoms and what it takes to
manage those symptoms. You should review the 37 warning signs of relapse and learn to
describe examples of the general process and specific symptoms.
4.
Warning Sign Identification: Develop a list of warning signs or indications that you
may be in risk of drinking or drugging. The warning list should be developed from past
46
experiences with relapse warning signs. Try to identify at least ten specific and clear
indicators that you are moving away from productive and comfortable living and beginning
to set yourself up for relapse.
5.
Review of Recovery Program: Recovery and relapse are opposite sides of the same
coin. If you are not in the process of recovering, you are in the process of relapsing. A
good recovery program is necessary to prevent relapse. Has your previous recovery
program been working for you? How can it be improved? Develop a new recovery program
based on what has worked for you and what has not worked for you in the past.
6.
Inventory Training: Any successful recovery program involves daily inventory. AA
Step 10 says, “Continued to take personal inventory and when we were wrong promptly
admitted it." The addicted person must learn to challenge himself in his day-to-day living
patterns. "Am I living up to my own standards and values? Are those standards and values
realistic? Am I acknowledging my addiction and managing its symptoms? Am I attending to
my overall health needs?" For a relapse prevention plan you should design a special
inventory system that monitors the warning signs of potential relapse. Develop a way to
incorporate this inventory system into the fabric of day-to-day living. The key issue is this:
You now know the personal warning signs. How are you going to determine if any of these
symptoms have been activated in your life?
7.
Interruption of the Relapse Warning Signs: It is now important to establish new
responses to the identified warning signs of relapse. Determine what you are going to do
about each symptom when you are able to recognize that it is working in your life. And
practice each new response until it becomes a habit. The response must be available in
times of stress. Only habits are dependable in times of stress. You must practice in times
of low stress until the response becomes a habit.
8.
Involvement of Significant Others: Make a list of all the people with whom you have
daily contact. Select from that list those people that you think would be important in helping
you stay sober and avoid a relapse. Determine how each person has interacted with you in
the past when you have shown symptoms of relapse. Has it been helpful or harmful to your
sobriety? What could they have done that would have been more helpful to your staying
sober? Now determine what you would like each of these people to do the next time
symptoms of relapse are recognized. Bring the key people in your life together for a
meeting. Explain to them your list of personal warning signs and form a contract with each
support person as to what they will do when relapse symptoms are recognized and what
they will do if you begin drinking or drugging.
9.
Follow-up and Reinforcement: Recovery from addictive disease is a way of life.
Since relapse prevention planning is part of the recovery, it too must become a way of life.
Relapse prevention must be practiced until it becomes a habit. We are all enslaved by our
habits. The only freedom we can find is to choose carefully the habits to which we allow
ourselves to become enslaved.
For the recovering person, it is especially true that there is freedom in structure. It is only in
the habit and structure of a daily sobriety program that the alcoholic can find freedom from
enslavement to chemicals.
Relapse is a process. A process is different from an event. When an event has taken
place, it is unchangeable. A process can be changed or interrupted at any time. It is
47
ongoing; it is occurring; it is not fixed in time. To see a process as an event blocks change.
Death is an event; grief is a process. To experience grief as an event locks you into grief
as though it were the event of death.
Relapse is not an event; it is subject to change or interruption. Relapse begins long before
the first drink, toke, pill, line or poke. There are warning signs and symptoms that pave the
way. These symptoms can act as early warning signals to chemically dependent people
and their families. By understanding the process, unnecessary pain can be avoided.
Proper action by addicts and the key people in their lives can prevent relapse or interrupt
the relapse before the consequences become tragic.
Points to Remember:
1.
Most people do not make it after the first attempt at sobriety.
2.
People relapse because they fail to do what is necessary to stay sober.
3.
There are a variety of behavioral setups which make a return to drinking or drug use
an alternative in spite of known consequences.
4.
Relapse begins long before the first drink or drug use. There are 37 warning signs
of relapse.
5.
Proper action by you and the key people in your life can prevent or interrupt relapse
before the consequences become tragic.
6.
A relapse prevention plan is an important part of treatment and needs to be
practiced until it becomes a habit.
THE DISEASE OF ALCOHOLISM
David L. Ohlms, MD
Much recent news from medical science seems to be discouraging: all kinds of everyday things
have been found to cause cancer, heart disease, lung disease. There are even diseases turning up that
we hadn't heard of a few years ago. But there is good news about one of mankind's oldest diseases –
alcoholism. Not too many years ago nearly everybody thought it was hopeless. We don't think so
anymore.
I suppose the first part of the news is that alcoholism is a disease, a true disease, like cancer or
diabetes or high blood pressure. It probably sounds strange to call that "good" news. But I can show
you why it is good. And to do that, I have to tell you a story.
AA Leads the Way
The story begins in the late 1930s when people who were suffering and dying from alcoholism got
tired of going to professionals (physicians, psychiatrists, psychologists) because the professionals
couldn't seem to help them – the alcoholics just kept on dying. Or wound up in lunatic asylums or
jails. So alcoholics banded together and formed an organization to help themselves – Alcoholics
Anonymous – and lo and behold, they did discover a way to stop dying and make themselves better.
AA members not only stopped dying and got healthier; they discovered a method that let them give
up drinking and lead as normal a life as anyone else. That's the second part of the good news. But in
48
order to help fellow alcoholics, AA first had to decide that alcoholism was a treatable disease. Let's
go back to that half of the good news now.
This is my favourite part of the story. You have to remember that early AA members weren't
medical research scientists – they were businessmen, salesmen, carpenters, waitresses – and they
were all seemingly hopeless drunks who only recently had been able to stop drinking. But the AA
program was so successful that finally, after several decades, medical science felt forced to take a
good look at it. Why did it work? Why was it that these ordinary people, doing what they did, were
able to get well, while we professionals, treating them medically and psychiatrically, seemed to
make them sicker rather than better?
The first thing we noticed was that Alcoholics Anonymous people were saying that alcoholism is a
primary disease. It is its own disease. It causes its own symptoms – it is not itself a symptom of
some other disease – and AA treated it this way. And medical science finally had to admit that AA
was right! In 1956 the American Medical Association officially recognized alcoholism as a true
disease – an entity of and by itself, that created its own problems, its own symptoms, that had its
own treatment – and the AMA published this view in a major paper.
This turned a lot of things around. It led to legislation that required hospitals to admit alcoholic
patients, whereas before they hadn't wanted anything to do with those "drunks." Before 1956,
doctors would often have to fix alcoholics up with phoney diagnoses in order to get them
hospitalized at all. And then alcoholic patients would often be treated for secondary illnesses – liver
disease, for example – while their major problem was ignored. So patients would go home with
slightly improved livers – and completely unimproved alcoholism which soon wrecked their livers
all over again! But since 1956 treatment centers have been opened throughout the United States,
and indeed throughout the world, where people can go and get decent and humane care for their
alcoholism. This has been, believe me, the best possible news for livers.
Tripping Over Definitions
Now in order to go on with our story, we need to say something here about disease. I think we need
to define it, and that's not easy to do. When I went to one of the very expensive medical dictionaries
that I struggled to buy in medical school, it said that "disease is an illness." Very useful. When l
looked up "illness" it defined illness as a "disease." I threw the book away and went and got a 99c
pocket dictionary at a bookstore, and it had something I really liked. It defined disease as anything
that interferes with the ability of the human being to function normally. That may be an infection
such as tuberculosis, which can destroy your lungs. It may be the broken leg you got while pushing
your car on an icy road. Whatever it is, however you caught it, a disease prevents you from living
your life as efficiently as you ordinarily would.
And, from my point of view, a disease like alcoholism interferes with normal life even more than
any other disease, because it lasts so long and because the person suffers from it for so many years
before anybody really detects the problem and tries to give him help. The average adult alcoholic
that I treat today has had at least 10 years of heavy alcohol abuse and significant physical and
emotional problems caused by their drinking before they get help, before they enter treatment. The
alcoholism has been there interfering for a long time and will continue to interfere as long as the
alcoholic continues to drink. So I like that 99c definition very much.
But this definition is rather philosophical, and unfortunately philosophical definitions don't satisfy
hard nosed critics. So we need to go a little further and deal with the concept of alcoholism as a
disease -but from a very scientific, very medical point of view. And if we're going to do that, we
need to come up with some definitions of what alcoholism is. Here's the official AMA definition:
49
Alcoholism is an illness characterized by preoccupation with alcohol; by loss of control over its
consumption, such as to usually lead to intoxication or drinking done by chronicity; by progression
and by a tendency to relapse. It is typically associated with physical disability and impaired
emotional, occupational and/or social adjustments as a direct consequence of persistent and
effective use.
Whew! Pretty wordy, isn't it? You could have four drinks while just reading the thing. For this
reason, the AMA definition is not a particularly good one. It's accurate, yes. Very valid, yes. But
who could remember it if they really needed to? Here's the definition I use and one that I prefer:
Alcoholism is a chronic, progressive, incurable disease characterized by loss of control over alcohol
and other sedatives.
Now let me explain some of the major words in this much shorter definition.
Chronic is self-explanatory. It lasts a long time. I've already mentioned that the typical adult
alcoholic will have 10 or 15 years of sick drinking and lots of secondary problems before he gets
help.
Progressive is fascinating. It's one of the unique features of the illness, and one of the reasons why
most people in the helping professions – medicine, counselling, etc. – don't like alcoholics.
You have to remember that many helping professionals, like many of the rest of us, have at least
one alcoholic somewhere in their family. They, just like the rest of us, have that Uncle Jack or Aunt
Jane who never got better no matter what anybody did. Poor old Jack. Poor embarrassing Aunt Jane.
The family tried everything it possibly could to help Jack and Jane and that poor wife or husband
and those poor kids. An army of experts was brought in – doctors, psychiatrists, psychologists,
social workers, financial advisors, the people who were experts in child-rearing and development –
and none of it helped because Jack or Jane (who didn't deserve much sympathy after a while) went
right on drinking. Eventually Jack or Jane died or was "put away" in a "home," and the professional
was secretly relieved by it. But now the professional is one of those experts himself – and he's
surrounded by Jacks and Janes on his job. Oh Lord! On one hand (in his head) he knows that the
alcoholic is sick, that he or she can be helped if only some heed will be paid to the professional's
years and years of expert training. On the other hand (in his heart, in his experience with the first
Uncle Jack or Aunt Jane) the professional knows it's no good. This disgusting person will start
sneaking drinks again immediately after discharge from the hospital or other facility.
So that's part of the meaning of progressive – it goes on and on and on. And it demoralizes everyone
involved. It tends to make them say "What's the use?" almost from the beginning.
Alcoholism Doesn't Go Away
The other part of progressiveness that fascinates me is that, as already mentioned, as the alcoholic
continues to drink the disease can only get worse: progressively worse. But let's say that Jack or
Jane stops drinking. Maybe because of some formal treatment; maybe he or she Just goes on the
wagon, and there is a prolonged period of sobriety for, say, 10 or 15 or even 25 years. (In my own
personal clinical experience I have had patients who were absolutely off alcohol for over 25 years.)
And then for some reason, usually very trivial, Jack or Jane decides that they can drink again, and
tries to return to the normal, social, controlled type of drinking that any non-alcoholic can get away
with. But poor alcoholic Jack or Jane can't.
50
Within a short period of time, usually within 30 days, the symptoms that the alcoholic will show are
the same symptoms showed when drinking was stopped 25 years before. And usually worse. It's
almost as if the alcoholic hadn't had that 25 years of sobriety, as if they meant nothing. An alcoholic
cannot stay sober for a while and then start over and have early symptoms of alcoholism. An
alcoholic cannot enjoy a few years of good drinking before it gets as bad as it was before. It's right
there waiting and takes up where it left off. I know this is shocking – it has a hint almost of the
supernatural – but later I think I can give you a scientific explanation as to why it is a medical fact.
In Pursuit of Definition
But let's go on with the definition. Alcoholism is an incurable disease – that to me is undeniable.
We've already touched on this in the paragraphs above. Uncle Jack or Jane can return to normal life,
but only for as long as drinking is stopped. You will come upon occasional rare medical study (the
Rand Report, for example) that says differently – that says an alcoholic can be taught to handle
controlled social drinking. If you're an alcoholic, don't believe it. Science has so far given us no cure
for alcoholism.
Now we've said that alcoholism is a chronic, progressive incurable disease characterized by loss of
control over alcohol and other sedatives. It is characterized by loss of control. That may sound so
obvious as to be trivial but it is a very important medical definition. It's what makes this disease
different from other chronic, incurable diseases such as diabetes and arthritis of some types. Loss of
control does not mean, as many laymen and indeed professionals seem to think, that when an
alcoholic takes a drink – every time he takes a drink – he's going to drink to excess and get drunk.
That's very rare. Alcoholics usually understand this far better than the professionals who treat them.
Most of my patients tell me that there were times right before they landed in the hospital when they
had a drink or two on a given occasion – and then stopped. They had no more alcohol that day. And
if you would look at just that little 24-hour period, you would assume that such people were normal,
controlled drinkers. But what loss of control means is that once the alcoholic takes that first drink
after a period of being sober or abstinent, he can't predict with any reliability whether he's going to
have a normal or abnormal drinking episode.
Look at it this way. On Monday, Uncle Jack gets off work at 5:00 he plans to stop by the Circle Tap
Barroom, have a couple quick ones with colleagues, and then get home in time for supper. And he
does exactly that. On Wednesday – it may have been a bad day, a good day, it doesn't seem to
matter – Jack drops by the Circle Tap and has the same first couple of shots with the same
colleagues and the very same intentions. The next thing he knows, the bar is closing. His friends are
long gone. He climbs in his car, gets a drunk-driving ticket or kills somebody on the way home; or,
if he's lucky enough not to do that, he discovers, when he does get safely home, that the wife has
packed her bags and left with the children.
Jack couldn't have told you that morning which way the day was going to go. The decision wasn't in
his hands. He's lost the ability to predict His drinking behavior, and that's what loss of control
means. He no longer controls alcohol, as most of us do; it controls him.
Alcoholism = Sedativism
Now this is probably a good place to tell you that alcohol is a sedative, and to point out the
implications of that fact. Alcoholism is a chronic, progressive, incurable disease characterized by
loss of control over alcohol and other sedatives. The alcoholic has lost control over not just the drug
alcohol – for alcohol is basically nothing more than a widely-available, socially-acceptable, nonprescription and inexpensive tranquillizer or sedative. It's one that you go buy in the liquor store or
supermarket rather than a pharmacy. But if you look at it as a drug – if you look at what it does to
51
the brain – it's a sedative. It works by putting brain tissue to sleep just like a tranquillizer or sleeping
pill.
You can probably see that we've got a tricky issue here. Because if the alcoholic has lost control
over alcohol, that's not the only drug he's lost control over; he's lost control over all other sedative
drugs as well. And indeed, one of the really big problems in current treatment, at least among the
patients I see, is that the majority (60%) are not only abusing ethyl alcohol. They're also at)using
minor tranquillizers and sleeping pills – sedative drugs that, interestingly enough, they usually get
by prescription legally from physicians who don't know they're treating alcoholics or don't know
how to treat alcoholism and don't recognize alcoholism as a disease that is characterized also by loss
of control over the very drugs that they are prescribing.
So you can rapidly end up with someone who is not only addicted to ethyl alcohol but also hooked
on tranquillizers and sleeping pills, and he'll probably switch back and forth from one to the other.
Or he may stay dry but hooked on pills, in which case the basic disease goes right on destroying
him. But the chances are that the alcoholic will mix liquor and pills, and that will only speed the
destruction process. Mixing sedatives compounds the risks tremendously. Probably all of us have
read in the papers about famous celebrities killed by accidental overdoses of combined sleeping
pills, tranquillizers and ethyl alcohol. It's becoming an extremely common cause of death.
All right, we now know what alcoholism is: a chronic, progressive, incurable disease characterized
by loss of control over alcohol and other sedatives. This is the definition I like to use clinically. IF I
have a patient sitting in my office and I'm trying to make the decision ("Does Jack or Jane have
alcoholism?"), this is the definition I go to work with. Loss of control is the most important clinical
factor. Does this individual have predictable behavior when he drinks? If he does, then he's not
alcoholic. But if his behavior isn't predictable when he drinks – if he simply can't tell what will
happen next – then I know the disease has got him in hand.
How Medicine Defines "Disease"
But then I'm a physician specializing in the diagnosis and treatment of alcoholism. Many doctors,
maybe including your family physician, refuse to this day to believe that alcoholism is a disease;
they see it as a character or moral flaw, a simple lack of will power. (And we understand why they
do. Remember what we said about the reasons many helping professionals don't like alcoholics.) So
for them (and perhaps for the lingering doubters among you) we need to talk about alcoholism in a
still more specific and scientific way. We need to do this because it can help rescue some people
from alcoholism.
When we doctors talk about a disease we usually start off by asking about the cause or "etiology."
But we're going to put that off for just a minute. Every good story needs a certain amount of
suspense.
Though doctors like to talk about a disease's etiology, necessity compels us to look first at signs and
symptoms. Signs are the physical marks a doctor can literally see in a sick individual: the red welts
on the skin we call hives, for example, or the fever that accompanies pneumonia or the sugar that a
diabetic will have in his urine. Symptoms are the complaints that bring a sick person to the doctor's
off-ice in the first place. A diabetic will tell you that he's tired all the time or insatiably thirsty. Our
question here, of course, is: Are there unique signs and symptoms for the mysterious disease we call
alcoholism? Absolutely! There are probably more than for most diseases, and we now know a good
deal about them. Forty years ago, Dr. E. M. Jellinek in this country and Dr. Max Glatt in England
put together a precise description of the progression of alcoholism from early stages to middle and
late stages. They had the symptoms down so well that they could see a patient only once and tell
52
what stage of the disease he was in. The stages of a person's disease, incidentally, are what
physicians call the pathogenesis.
I won't go through all the signs and symptoms – there are fifty or sixty common ones, and many
others not so common – but I do want to mention a few that might be called highlights. In the early
stages, for instance, you have what is known as relief drinking. An individual uses alcohol to get
relief from something: physical pain, emotional pain, money worries – it could be anything. Drunk
driving commonly occurs in the early stages of alcoholism. Also memory blackouts. That's a period
of amnesia that occurs while the person is drinking. Aunt Jane may look fairly normal – you know
she's been drinking, but she's still functioning, she's still walking around the room, carrying on
conversations, etc. But tomorrow Jane will be amnesiac; she won't recall what happened the night
before. It's a very common symptom of alcoholism, and indeed if you know an individual who's had
that experience more than once or twice, the odds are that person is alcoholic. Relief drinking,
drunk driving, blackouts – these are all early stage symptoms.
Then we get to the middle stages of the disease. This is commonly called the crucial stage because
it's here that most alcoholics can be detected and gotten into treatment. It's also the period when, if
you don't get them into treatment, the chances for recovery go way down; so it is in fact extremely
crucial.
It's in this stage that we see the classic symptoms: absenteeism from. work, poor job performance,
financial problems, family problems, the changes in moral or ethical behavior that tend to occur as
the disease gets worse (and help the alcoholic to be so disliked). There are the signs and symptoms
that make the disease fairly visible and detectable – it could be a lucky time if the afflicted person
somehow starts to get some treatment. And treatment is certainly needed because this is the
beginning of alcoholism's physical problems as well. It's toward the end of this middle or crucial
stage that the liver starts to go bad. Marital problems on a physical basis – impotence – begin to
show up. The alcoholic is in sadder shape than even he knows now. The trouble is that he's probably
not sober enough to know how much it hurts. And we're about to cross a grey line here. Once the
deterioration of the body starts, the alcoholic has entered the late or chronic stages of the disease.
Most of us, when we think of an alcoholic, picture the chronic-stage person: the semi-human down
there with the body gone rotten, the liver shot, the brain only flickering a little and about to go out.
Generally we picture the skid row bum who, in fact, makes up 3, maybe 4% of the alcoholics in the
world today. Most alcoholics aren't fortunate enough to live to reach that stage. Most will die
traumatically – on a highway, or at home with a cigarette that they forgot to put out and it burns up
their bed with them in it. You probably know how risky it is to spend even one evening drunk in the
modern world. It takes 20 to 25 years of heavy drinking to reach the chronic stage. There aren't a lot
of veterans.
Life-Saving Value of Disease Concept
All right. We've now become very gloomy – which is the natural pathogenesis of alcoholism when
it goes its way without treatment. But the wonderful thing about the disease concept is that it allows
us to detect the alcoholic's symptoms and get him into treatment before the damage is irreversible.
And once in the proper treatment, complete and total recovery is highly probable.
So yes – thank God – there are signs and symptoms of alcoholism. I can take first year medical
students and teach them the signs and symptoms in an hour, and then they will be able to make the
right diagnosis. But – I'm having to say but a lot in this story – far too few medical students are
taught to recognize alcoholism's signs and symptoms. Far too few, even today, are taught to
recognize alcoholism as a disease. This, I honestly feel, is a national, indeed world-wide disgrace.
53
In the United States today roughly 34.5 out of every 36 people who have alcoholism are going to
die from it, one way or another. It's going to kill them. And they will never have been treated for it.
Oh, they will have been treated. They'll have been in a lot of hospitals – they'll have been in there
for all the physical problems that go with being an alcoholic: the stomach problems, the liver, the
pancreas, the nerves, They may even have been frequently hospitalized in psychiatric units where
all kinds of psychiatric labels are routinely attached to them. They will be "manic-depressives"
because they have episodes of depression regularly. Well, I'd be depressed too if my wife had left
me, if I'd lost my job and my body was rotting out from underneath me. I think I might have
episodes of depression.
Alcoholics get all kinds of labels stuck on them. And a lot of treatment – frequently with other
sedative drugs which drives the addiction in even more deeply and shoves the alcoholic downhill
even faster. Treatment is available but it's often simply the wrong treatment. Therefore, naturally...
the alcoholic dies.
The luckier ones die. About half of one per cent of every 36 – will go insane. They will wind up
with physical brain damage: "wet brain," which you've probably heard about. So much of the brain
tissue is destroyed in these late stages of alcoholism that the only thing to be done with the alcoholic
is to put him in a state hospital or nursing home. There we feed him, clothe him, bathe him and try
to keep booze out of his reach. He'll still be smart enough to sneak liquor, if that's in any way
possible. But he won't have the brains to take care of anything else.
So a significant number of alcoholics will eventually have their minds destroyed by the disease.
About 34 out of 36 will be killed by it in one way or another. One out of 36 will get treatment, will
recover and get well. That's a tragic statistic. It's tragic because it's unnecessary. For we do have the
proper treatment now – the treatment of alcoholism as a primary disease – and with proper
treatment these awful numbers are changed completely around.
Look at these statistics. Let's say that we've caught someone in the throes of middle-stage
alcoholism. The classic case is someone who is still employed but has been forced into treatment by
an employer because of deteriorating job performance. In this situation, recovery rates are as high as
80%, Eight out of ten middle-stage alcoholics can get well! We can't expect the same for late or
chronic-stage alcoholics, but even there – among skid-row types, the worst cases you can think of –
the recovery rate runs from 25 to 30 to 35%. By "recovery," I mean people regaining their health
and going back to normal, functioning, working lives. This is another strange aspect of the disease
we call alcoholism. There are very few chronic, progressive, incurable illnesses where 25 to 80% of
those who have them can get well again.
Alcoholism – The Cause
Now we obviously have an interesting mystery here. We've described a certain disease, and we've
said that without the proper treatment for it, the chances for recovery are almost nil. We've said that
with the proper treatment, the chances for recovery are pretty good. Why on earth, then, aren't most
alcoholics getting proper treatment?
Remember when several pages back we started to talk about the "etiology" – the cause – of a
disease? What causes alcoholism? Many laymen, and unfortunately many helping professionals,
would ascribe it to the alcoholic's personal weakness, his lack of character and willpower, his
simple inability to say "No" to a temptation that the rest of us find the gumption to refuse. But we're
mainly remembering obnoxious, often disgusting "drunks" when we think this way. Since its
beginning in 1935 Alcoholics Anonymous has helped some two million people recover from severe
drinking problems. Modern treatment centers have helped many more. How have these millions
54
suddenly developed the will power to quit drinking? The weak character theory seems to raise more
questions than it answers.
What causes alcoholism? We're not entirely sure, and we should admit that. I can't tell you I know
the etiology of alcoholism, because I don't. But we do have more knowledge about what might
cause it than we do about most other diseases. We certainly shouldn't say (as some doctors will) that
because we don't know the cause of alcoholism, it can't be described as a real disease at all. If that
were true, then cancer and diabetes and arteriosclerosis aren't real diseases either; because we don't
really yet know what causes them. Yet every day I hear professionals say that about alcoholism. It's
a back door way of saying that alcoholism is caused by weak character. Or it might be just the bad
luck of the alcoholic. Or maybe a voodoo curse.
The Family Connection
What causes alcoholism? We don't know for sure, but we now have some pretty good ideas.
Medical research has shown, for example, that alcoholism runs in families. (You've probably
noticed that tendency from your own observation.) Family histories taken from patients indicate
that, 95% of the time, yes indeed, the mother had a drinking problem, or the father did, or an uncle
or brother. Usually, when there is one alcoholic in a family, you'll find many more in the
background. Nor is this largely a matter of environment – the atmosphere one learns to drink in as
one grows up. That question has been pretty well answered in the past 20 years, and especially in
the research done in the 1970s. Heredity studies, done all over the world, clearly show that genetics
is far more significant in determining whether or not you'll be an alcoholic than any other single
factor examined. Genetics is more significant than any combination of social or environmental
factors examined.
Now I'm not saying a person is born an alcoholic. No. I've never met an alcoholic who didn't drink.
But I think it's conclusive that some people are indeed predisposed to alcoholism because of their
heredity; and if they ever start drinking they run an unbelievably high risk of developing the
disease.
TIQ – Biochemical Culprit
Of course, in medicine we have a lot of diseases that work that way. Diabetes has a high family
predisposition. So, probably, does heart disease. Now, when medical science notices a family
predisposition toward a disease, it will look for some abnormality in body chemistry. What about
the body chemistry of alcoholics? In just,is past ten years we think we've found it. Here's a story
within a story – another of my favorites.
It all started down in Houston, Texas with a medical scientist who was doing cancer research. For
her studies she needed fresh human brain - which is not widely available; you don't run down to the
store and buy it. So she'd ride out with the Houston police in the early morning, and they would
pass along Skid Row and collect the bodies of the winos who died overnight. The researcher would
take the temperature of these bodies in a manner I'll leave to your imagination. The warm bodies, so
to speak, were rushed back to her hospital; there she removed the brains for her cancer research.
One day while talking to some doctors in the hospital cafeteria and telling them about some findings
of her laboratory studies, she said: "You know, I never realized that all those wineos used heroin as
well as booze."
55
Before THIQ
After THIQ
Now these were hardened emergency room doctors; they just laughed at her. "Come on," they told
her. "These guys don't use heroin. They can barely afford a bottle of cheap muscatel." She shut up
and went back to her lab. But she was onto something, and she knew it. She had discovered in the
brains of those chronic alcoholics a substance that is, in fact, closely related to heroin. This
substance, long known to scientists, is called Tetrahydroisoquinoline – or (fortunately) TIQ for
short. When a person shoots heroin into his body, some of it breaks down and turns into this TIQ.
But then these people hadn't been using heroin; they had just been simple alcoholics. So how did the
TIQ get there? That’s where the researcher's studies were to lead her for the next few years. Now
I'm sorry, but we're going to have to leave the intrepid researcher behind us here. Also – don't flinch
– I'm going to have to teach you a little bit of biochemistry.
When the normal adult drinker takes in alcohol, it's very rapidly eliminated at the rate of about. one
drink per hour. The body first converts the alcohol into something called acetaldehyde. This is very
toxic stuff, and if it were to build up inside us, we would get violently sick and indeed we could die.
But Mother Nature helps us to get rid of acetaldehyde very quickly. She efficiently changes it into
acetic acid, which we know as vinegar, and then changes it a couple of more times – into carbon
dioxide and water – which is happily eliminated through our kidneys and lungs. That's what
happens to normal drinkers. It also happens with alcoholic drinkers, but they get what we might call
something a little extra.
What was discovered in Houston, which has been extensively confirmed since, is that something
additional happens in the alcoholic. In them, a very small amount of poisonous acetaldehyde is not
eliminated; instead it goes to the brain where, through a very complicated biochemical process, it
winds up as this TIQ I mentioned before. Researchers have found out fascinating things about TIQ.
First, TIQ is manufactured right in the brain, and it only occurs in the brain of the alcoholic drinker;
it doesn’t happen in the brain of the normal social drinker of alcohol.
Second, TIQ has been found to be highly addictive. It was tried in experimental use with animals
during the Second World War when we were looking for a pain killer less addicting than morphine.
TIQ was a pretty good pain killer, all right, but it couldn't be used on humans. It turned out to be
much more addicting than morphine. So scientists had to forget about it, and they've left it all these
years up on some dusty shelf.
The third fascinating item about TIQ also has to do with addiction. There are, as you might know,
certain kinds of rats that cannot be made to drink alcohol. Put them in a cage with a very weak
56
solution of vodka and water, and they'll refuse to touch it; they'll literally thirst to death before they
agree to drink alcohol. But if you take the same kind of rat and put an unbelievably minute quantity
of TIQ into that rat's brain – one quick injection – the animal will immediately develop a preference
for alcohol over water. It will scurry across the cage to get to that vodka and water. In fact he'll be
happier if you mix his drink with less and less water. So we've taken a teetotaling rat and turned him
into an alcoholic rat. And all we needed was a smidgen of TIQ.
Other studies have been done with monkeys, our close animal relatives in medical terms. We've
learned that once TIQ is injected into a monkey's brain, it stays there. You can keep a TIQed
monkey dry, off alcohol, for as long as 7 years; then when you sacrifice him and study his brain,
that weird stuff is still there. This, as you've probably already seen, takes us back to the
progressiveness of the disease. Remember that person who's been sober for 10 or 25 years, and then
suddenly starts drinking again? The alcoholic will immediately show the same symptoms displayed
years before – and it's no wonder! The human alcoholic is still carrying TIQ like those man-made
alcoholic monkeys and rats.
I caution the reader that TIQ involvement in the development of alcoholism is still a theory. The
precise way TIQ, or other chemical or group of chemicals, influences the development of
alcoholism might not be known for years. In my opinion, the discovery of the TIQ factor is
important mainly because it has sparked literally hundreds of research projects into the
neurochemical aspects of addiction disease and other behaviors. After hundreds of years of moral
condemnation of the alcoholic, science is on the threshold of exorcising the mythic devils of
addiction. After all, medical science has helped eliminate the myths and prejudice surrounding all
kinds of historically misunderstood and despised diseases: epilepsy, leprosy and schizophrenia to
name just a few. It shouldn't surprise us when science turns demon rum into a natural allergy.
Neurobiology – The Next Frontier
This booklet is much too short to tell you all the exciting things that are happening in the area of
brain chemistry research into the basic nature of addiction. It should be enough to say that
everything is pointing toward inherited abnormalities, or maybe I should say treacherous differences
in the way some people respond to alcohol and other drugs. And these differences underlie the
development of addiction. In fact, researchers like Dr. Robert Cloninger at Washington University
in St. Louis and Dr. Kenneth Blum at the University of Texas have gone far beyond the TIQ theory.
Blum has tied the development of addiction to lower levels of certain brain chemicals. Cloninger
has actually identified different types of alcoholism. Blum has worked extensively with the alcoholseeking rodents I mentioned earlier and has found marked differences in the alcoholic rodent's
inherited ability to produce certain neurochemicals which make them feel good. These chemicals
are called endorphins. The amazing thing is that both alcohol and TIQ can mimic our body's natural
endorphins and make the brain feel it is perfectly alright, even desirable to ingest as much alcohol
as possible. Of course, this behavior is highly addictive and plays havoc with the rest of our body
and will utterly destroy our ability to live normal, happy lives. But at the neurochemical level, the
brain neither cares nor knows what's going on. Some of the best research into alcohol addiction
being produced by Cloninger in his laboratory at Washington University Medical Center in St.
Louis. Cloninger believes (as I do) that the evidence that alcoholism is a hereditary predisposition is
conclusive. Cloninger has even identified "types of alcoholism such as early onset and late onset
alcoholism. Early onset usually occurs in adolescence and early adulthood and involves extreme
alcohol seeking behavior and rapid, troublesome addiction. Don't we see this all the time? Late
onset is the gradual loss of control over a much longer period of time. Amazing! For years I've been
seeing very young people who drink and show all the signs and symptoms of alcoholism practically
from the first drink. I've also seen older adults who have had a number of years of more or less
57
controlled drinking before losing control. How do we explain this? Environment? Nope. All the
research points to genetics and neurochemistry.
The Pieces Begin to Fit
You see how beautifully these laboratory findings fit in with what we specialists in alcoholism have
long noticed in our clinics. Uncle Jack is brought in, and he's drunk again, and even though it's
slowly killing him, he somehow can't stop drinking. When he's sober enough we'll get a family
history. Yes, there are other alcoholics in his family; there's a family predisposition – an
abnormality in the family body chemistry – which we only saw the shadow of before. But now we
see it much more clearly: it's a predisposition toward making TIQ.
Now alcoholics don't intend to make TIQ when they start drinking. They don't mean for their brains
to manufacture something stronger than morphine – they've been warned about the evils of
narcotics all their lives. But they've heard a good deal less about the evils of alcoholism. Most
normal Americans take a drink now and then, and the young alcoholics-to-be want to be normal. So
they take a drink now and then, too.
Unfortunately, the alcoholics-to-be aren't normal. That's too bad for them but then it could have
been a lot worse: they could have been born blind or with crippled arms or legs. On the other hand,
of course, potential alcoholics certainly would know about the blindness or the crippling disability.
But they don't know about the predisposition toward the TIQ-making their brain chemistry has
inherited. Nobody knew about it until fairly recently. So Jack and Sane and a new generation of
alcoholics have their first few drinks, and everything seems cool.
The alcoholic has his or her early drinks, and now we can go back to our little lesson on
biochemistry. The alcoholic's body, like yours and mine, changes the alcohol into acetaldehyde, and
then it changes most of that into carbon dioxide and water, which in the end it kicks out through the
kidneys and lungs. Except, of course, that alcoholics bodies won't kick all these chemicals out. The
alcoholic's brain likes them for some reason and holds a few bits back and transforms them into
TIQ. So the alcoholic-to-be starts drinking, and he or she may well be very moderate at first. Just a
few on Saturday nights. Maybe a couple of beers with football games on TV. Maybe a nip or two to
calm down while fixing dinner for the family. Two or three drinks to quiet the jitters before high
school graduation. In the beginning, the alcoholic-to-be only gets seriously drunk, say, once or
twice a year. So far, so good. But all this time the alcoholic brain is humming away in there
building its little cache of TIQ, just like the brains of our rats and monkeys. At some point, maybe
sooner, maybe later, the alcoholic will cross over a shadowy line into a whole new way of life.
Now medical science still doesn't know where this line is – doesn't know how much TIQ an
individual brain will pile up before the big event happens. Some predisposed people cross the line
while they're teenagers – or earlier! It won't occur in others until they're 30 or 40 or maybe even
retired. But once it does happen, the alcoholic will be as hooked on alcohol as he would have been
hooked on heroin if he'd been shooting that instead – and for very similar chemical reasons! Now
comes that loss of control we talked about early in this story. Now its chronic, progressive,
incurable nature is obvious to practically everyone who knows the alcoholic. Now it's all too clearly
a disease. And now – all too often – it's a disease that will mainly get treated with other sedatives.
Far too often alcohol addiction is treated with pills that keep the disease raging. When we're done, if
the alcoholic is still alive, he'll be about as functional as a TIQed rat.
Good News!
But then I did promise you good news, didn't I? Well, we're just about to it, and you may well
understand it already. Alcoholism is a disease – and that's good news. Alcoholism is not the
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alcoholic's fault – and that's good news, too. Alcoholics can today get proper treatment for the
disease, which is certainly good news, and that treatment begins when we tell them these facts. The
alcoholic patients I see are usually hugely relieved to hear that it's not their fault, because they've
been carrying tons of guilt along with the alcoholism – and that guilt was often worse than useless.
Now instead of guilt, the alcoholic person can take on some responsibility.
Now that the alcoholic knows the facts, he or she can, with treatment, take the responsibility of
stopping the drinking; alcoholics can refuse to put more TIQ in their brains and they can refuse to
reactivate the TIQ that's already there. Alcoholics can't get rid of their TIQ, but they can, with
treatment, be taught how to control it. Alcoholics can learn how to live like normal, healthy
grownups again. That's good news for all of us. That's the best news any human being can ever
expect.
Working the Twelve Steps
There is a program of recovery from addiction; it is called the Twelve Steps. The Steps can be studied
thoroughly by reading 12-step literature. No amount of study will be excessive. There cannot be too much
knowledge of these twelve priceless principles.
They are called Steps so we will take them one at a time. They are numbered one through twelve in the
order we take them.
After we have completed Step One, where we admit our disease, through Step Twelve, where we recover,
we will learn to use the Steps selectively to meet specific situations. Until then we do the Steps in the
following order:
1.
We
admitted
that
we
were
powerless
over
(alcohol/other
drugs/nicotine/sex/relationships/porn/gambling/etc) — that our lives had become unmanageable.
STEP ONE is called the step of despair and is the foundation of our recovery. It opens us up to the secrets
we have been dening and sets us free from isolation. As we become aware of the denial we may feel
shock, remorse and shame. As we come out of isolation we discover we are not alone. We feel
understood and accepted by others with similar feelings and stories. Gradually the shame and quilt lifts
and we realize we have been powerless. The relief we feel gives us hope and a sense of self-respect. Only
when we define our problem accurately can we find the best solution. We acknowledge it is impossible to
exert any control over addiction, (for most of us this also includes any form of mood altering drug or
mood altering behavior). We accept it is hopeless to try to manage any part of our lives, including our
compulsive eating. We cannot do it. It is useless to try. We admit it and move on.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
We must believe beyond doubt that our sanity is in jeopardy whether we are using food or not. This Step
must apply to us in order to take it. To recover we must take all Twelve Steps. Trying to manage
unmanageable lives is insanity. Trying to control what cannot be controlled is irrational. Persistently
trying to manage our lives proves we are not recovering. If we cannot manage our lives, who can? Only a
Power greater than ourselves. We need not believe this Power will restore our sanity, we need only believe
such a power "could restore us to sanity." If we think it might, we move on.
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3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
We decide to do it, not to postpone it. Without delay we place everything we ever will be on a great
unknown that might not be there. This is a step in faith! We do not ask. We do. We place 100 percent of
the management of our lives into God's hands. We give up all control. He alone becomes responsible for
every feeling, thought, and act. We surrender unconditionally. In answer to, "Who is going to run my life?
I? Or God?" We consciously contact our Higher Power and say, "God, I need You to take charge! Direct
me in all of my thoughts and actions!" No longer forcing control over our lives, we move on.
4. Made a searching and fearless moral inventory of ourselves.
We examine our behavior. We write an inventory, not a history. What is good about us after we put God
in charge? What is bad? Are we greedy or generous? Cruel or kind? Brutal or gentle? Possessive or
tolerant? Dishonest or trustworthy? Manipulative or permissive? Resentful or forgiving? Insecure or
confident? Guilty or innocent? Narrow-minded or accepting? Domineering or modest? Arrogant or
humble? jealous or trusting? Fearful or courageous? If fear is blocking the way to doing this exercise we
pray to our Higher Power to give us strength. If fear is controlling is it not a fearless inventory. Repeat
Step Three. Let God stock our inventory. With Him in charge there is nothing to fear.
Are we violent or peaceful? Distressed or serene? Angry or at ease? Hateful or loving? Self-pitying or
grateful? Gloomy or cheerful? Pessimistic or optimistic? Reckless or careful? Disdaining or caring?
Trouble-making or considerate? Sneaky or straightforward? Selfish or generous? Close minded or willing
to learn? Stubborn or ready to change? Do we smoke, overeat, drink too much coffee, try to control
ourselves or others, overwork, overspend, or cling to other alternate compulsive behaviors?
Put it all down. Search for every symptom of illness. It is uncovering who we are, not therapy.
That comes later. After we jot down every symptom of how ill we are today, we move on.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
What is behind the defective behavior noted in Step Four? Now we analyze those symptoms. Why do we
lie? Why do we steal? Why are we jealous? Is it because we do not believe God will protect us unless we
manage to conceal the truth? Are we afraid God will not provide enough unless we manage to steal? Do
we believe God will let someone else have what belongs to us unless we manage to hang on to it? We
think we turned our lives over to God. Does our behavior indicate we still try to manage our affairs better
than God can? Does the exact nature of our problems involve our lack of trust in God?
Are we angry at what someone does or at God for letting it happen? Are we agitated because we do not
believe God will solve our problems? Is grasping control away from God the exact nature behind our
wrong behavior?
We look behind every defect. We admit directly to God what we find. We admit it to ourselves and
another person. That individual can be a friend, stranger, sponsor, therapist, or clergyman. It is only
important that this person is understanding of what we are trying to do. We tell God we do not trust Him
enough. We tell ourselves we trust ourselves too much. We admit this exact nature of our wrongs to
another human being. We do not seek advice about this behavior. We simply admit to these three entities
what is really wrong. Having deeply diagnosed and acknowledged the nature of our disease, we move on.
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6. Were entirely ready to have God remove all these defects of character.
In the two previous Steps we listed exactly what we believe are our defects. Either we are ready to have
them removed by God, or we are not. If we still want to work on our defects, we are not ready for Step
Six. How do we get ready? By going back over Steps One through Five until we are ready. If we think we
can manage to remove even one defect on our own, we need to go back to Step Three and admit we are
powerless to do so. If we do not believe God can remove them, we need to go back to Step Two until we
think He might. We have not recently taken Step Three if we are not ready to have Him do what He wants
with our defects. If we are not yet convinced nothing less than removal of these defects will make us
happy, we better stay with Steps Four and Five until it becomes obvious. If we want to hang on to one
defective trait we better go over Steps One through Five until all resistance vanishes. After all it was our
defects of character that often led us into taking that first bite.
Being entirely ready to have God remove all these defects without our help is a state of grace. It comes
only when we acquire sufficient humility to step out of the way and let Him do the work. When we are
fully prepared to have our entire personality changed as only God can change it, we move on.
7. Humbly asked Him to remove our shortcomings.
We consciously contact the Power greater than ourselves. We do not ask God to help us remove our own
shortcomings. This is not a self-improvement program. It is a program where we let God improve us. We
do not specify know what defects we want removed. We listed all we could. Now we allow our Higher
Power to take away or leave what He wishes. Some traits we listed as assets will be removed because they
are really defects. Some characteristics we thought were defects will remain because they are strengths
instead of weaknesses. We let God determine our good and bad points. We do not dispute how He
changes us. We must be humble enough to let Him recreate us. We accept what we become.
The true test of humility is whether we let God do what we ask Him to or not. With no strings
attached we ask our Higher Power to remove our shortcomings. We then leave them alone and
move on.
8.Made a list of all persons we had harmed and became willing to make amends to them all.
Unlike our Step Four inventory of what is in stock now, Step Eight is a review of our personal
histories. We search our past. We list all former acts that hurt other people. We include when our
failure to act hurt others. It is important to remember to place ourselves on this list. We need to
make amends to ourselves in order to truly set the record straight with others. We do not put
ourselves at the head of the list. This may be the first time we have ever placed the welfare of
others ahead of our own. We write down every instance we can remember when we deliberately
or unintentionally injured someone else. We list all harm done to others whether they deserved it
or not. We keep listing the hurt we did to others until we regret it and want to make it up to them.
When we are willing to make total restitution and correct whatever damage we have done, we
move on.
9. Made direct amends to such people wherever possible, except when to do so would injure
them or others.
A direct amend is more than an apology. We confront those we harmed and make restitution for the
damage we did. We replace what we stole. We repay what we owe. We take blame for misdeeds we
allowed others to be blamed for. We settle unpaid bills. We compensate with love, deeds, or money to
those we mistreated. We expect neither gratitude nor forgiveness in return. We take whatever action
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necessary to set things straight. We spend whatever money it takes to make things right. Where we were
guilty of abuse, we now lavish love.
If trying to correct past damage will cause further damage to anyone other than ourselves we let the matter
drop. We cannot heal those we hurt by reopening old wounds or inflicting new ones. We make no
restitution, which will result in punishment for accomplices. We make no confession that reveals another
person' s guilt. We do not include ourselves among the others we must not harm.
It may not be physically possible to make direct amends to some people. They may have died or have
moved away and cannot be found. It is important that we are honest about the reasons why we cannot
contact someone. Are we making a cop-out? Are we simply not trying hard enough? Remember "Half
measures availed us nothing…" When we have corrected every possible rotten thing that harmed
someone else, we move on.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
The inventory we took in Step Four and admitting the exact nature of our wrongs in Step Five
were so important that we are now going to continue to look at our strengths and weaknesses.
We will do this one-day at a time for the rest of our lives. The word continued means two things:
we are never going to be finished taking inventories and we will never be through finding wrongs
for God to remove.
Having learned what to do in our written Step Four inventories and our shared Step Five analysis of the
exact nature of our wrongs, we now make daily use of these techniques of self-diagnosis.
It will not always be convenient to write down our continuing inventories. We may need to take them
faster than that to handle life's daily problems. In any emergency we can ask ourselves, why am I angry?
Why do I worry? Why am I envious? We can answer, I am angry because I don't like the way God is
running my life. I worry because I don't expect God to handle things correctly. I envy someone else
because I don't trust God to give me what I need. The answer is always the same: I don't trust God. I am
agitated because I grabbed control back from my Higher Power. I think I can handle things better myself.
Then all we have to do is renegotiate the Step Three contract we have broken. Put God back in charge. We
may return to Step Seven and ask Him to remove this shortcoming of trying to take charge ourselves.
We start a daily habit of recognizing and admitting when we usurp God's job of running our lives. Then
we move on.
11. Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for us and the power to carry that out.
In the previous Steps we have established conscious contact with our Higher Power. In Step Three we
turned our will and our lives over to Him. We could not do that without making contact. In Step Five we
admitted to God what we had learned was the nature of our wrongs. We had to contact Him to do that.
Step Seven had us ask Him to remove our shortcomings. When we asked we made contact. Now we
improve the conscious contact we already have with God.
Step Eleven teaches a new way to pray. In our old way of praying we ask God to fill specific needs. This
Step suggests we no longer do that. It proposes praying only for knowledge of His will for us and the
power to carry that out. We petition God. That is prayer. We listen to God. That is meditation. The
purpose of meditation is to help ourselves empty our minds of personal concerns so the Higher Power may
enter. There are many techniques to do this. Practice one of them.
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Praying that only God's concerns enter our mind blocks our personal wishes. Asking only for knowledge
of His will for us and the power to carry that out empties our mind so the Higher Power may enter. We do
not always have to use some other form of meditation. Praying only for God's will and the power to carry
it out is meditation.
We spiritually awaken in this Step when we realize we never again have to spell out what we want God to
do. We awaken spiritually secure in the knowledge that we need never pray for more than knowledge of
His will for us and the power to carry that out. Committed to praying only that way for the rest of our
lives, we move on.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message
to others, and to practice these principles in all our affairs.
Step Twelve confirms we had a spiritual awakening only because we took all eleven previous
Steps. Now we carry this Twelve Step message to others still suffering. To do so we continue to
attend meetings. We apply Twelve Step principles to every aspect of living. By means of the
Twelve Steps we let God manage us in everything we do rather than trying to control things
ourselves.
This program offers one path to recovery. We can recover if we practice the Twelve Steps. We do not
recover unless we take them and continue to work them. Those who follow the Steps recover; those who
do not follow the Steps continue to suffer.
Our disease of remains incurable even after we recover. All we need to do to destroy our recovery is to
take that first substance/behavior. The Twelve Steps will keep our addiction in remission. Once
recovered, we need never again suffer any symptom of it. All we need to do to stay well is continue to go
to meetings and practice the Twelve Steps.
Only those who are still sick believe recovery means they can safely use again. This is not so. Recovery
means we no longer need to practice those insane behaviours. Our compulsion is lifted.
We will also recover if we dedicate our lives, just for today, to working the Twelve Steps. Learn how to
abstain from our addiction, Read recovery literature, get a sponsor, go to lots of meetings and use between
meetings. Be one of many millions of individuals who have recovered through the twelve steps.
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