The elevator doesn't work in alcohol recovery: Taking the steps on 12/12

Many self-help groups employ the 12 steps originated in the book, Alcoholics Anonymous, 74 years ago. The group named after the book, AA, remains the most successful organization in handling the disease of alcoholism today. The only membership requirement: A desire to stop drinking.

The Substance Abuse and Mental Health Services Administration (SAMHSA) in 2008 reported an annual average of five million people 12 and older attended a group self-help meeting in the prior 12 months. One third also went for one-to-one counseling or group therapy. Because 12-step groups are so widespread, most one-to-one counseling and group therapy is based on the 12-steps and those counselors encourage participating in 12-step group self-help to boost sobriety. In fact, the National Treatment Center Study Summary Report from the University of Georgia found 90 percent of 450 treatment centers are based on the 12 steps, while 10 percent rely on “Behavior Therapy.”

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seems to endorse the 12-step approach in group therapy as well. In 2008, it found Behavioral Therapy less successful than 12-step methods. “Individuals in 12-step oriented therapy have increased subsequent Alcoholics Anonymous (AA) participation and it is the AA involvement that leads to better outcomes by buffering the effects of social pressures to drink. AA exposes a person to a network of people who have a goal of sobriety and support one another in achieving that goal.”

Group therapy requires signing up and showing up. Group self-help like AA requires only showing up. One thing to note though, if it is confidentiality you seek, one-to-one counseling is the only route 100 percent confidential. Anonymous is not a synonym for confidential. Ask yourself, though, does recovery really need to be confidential? Far too many get ticklish about talking “publicly” about their shame and other stressors. The alternative is not talking. And that leads to relapse. A twelve-step meeting is not the town newspaper. Even if it was, some alcoholics’ under-the-influence feats were more public than anything they’d say in a group self-help meeting ever would be.

These are safe venues in which to communicate. They consist of people who share the exact same struggles. Talking things out among them is cathartic. You don’t need to talk about every confession you have. You don’t get style points for deeper traumas. You do get style points for creating a climate of trust by putting on the table the things that are giving you challenges in sobriety.

Alcoholics risk reaching out because they need a new label, a new place to belong, and there is safety among others who are also trying to shed old labels and stressors. If You’re Not Normal is the three-word death sentence to recovery, Me Too is the two-word pardon alcoholics get at 12-step meetings.

Even if an alcoholic does not ever buy into the 12 steps as a design for living, they are suggested, not required, for membership. “The only requirement is a desire to stop drinking,” the literature says. Twelve-step meetings are places to be among others who feel the same, wore the same masks, suffer the same struggles and have a desire to communicate rather than drink over them. “The most desperate need of mankind today is not a new vaccine for any disease or a new religion or a new way of life,” wrote Taylor Caldwell in the novel The Listener. “His real need, his most terrible need, is for someone to listen to him, not as a patient but as a human soul.”

Everyone, no matter how gifted, healthy or wealthy, encounters an issue that baffles them or breaks the spirit. Twelve-step groups are where alcoholics can communicate the baffling and the spirit-breaking. What all are trying to do together is acquire back self-esteem.

There are alternatives to 12-step groups, such as Women for Sobriety (WFS) and Self-Management and Recovery Training (SMART), however none have the track record of success AA boasts, and none are as widely available. Other 12-step groups are available for a number of addictions, from gambling to narcotics to overeating.

The Higher Power thing is tough for some people to swallow. Some people stay away from 12-step meetings because they don’t see themselves in the people around the tables or hear their stories told in the tragic stories of others. That is the point in going: To make sure you’re communicating what is stressing you before you go back to the drinking and become those tragic stories.

From a strictly medical standpoint, alcoholism is remarkably easy to arrest. It’s a lot less complicated than arresting cancer or diabetes. Abandon the bottle long enough and detox and biological functioning returns to something close to normal in a few weeks or months. From that point on, it is a matter of not going backward. That’s the drawback to having a disease that can be arrested but not cured: While it is under control it’s all too easy to forget what life was like when it wasn’t. Twelve-step groups remind alcoholics what it was like. Without the stigma.

One of the most treasured AA stories in print says, “Above all, AA taught me how to handle sobriety. I have learned how to relate to people… deal with disappointments and problems that once would have sent me right to the bottle. How do we do it? By sharing at meetings.”
-- Adapted from the recovery book, Every Silver Lining Has a Cloud. Photo credit: Marcus, Free Digital Photos
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Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at alcohologist.com... and please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK. 

SUNDAY SNIPPET: November 17

Grieving is something in which few aspire to be experts.  Even non-alcoholics are poor performers in accepting and grieving their losses... but an Alcoholic in recovery had better not skip over the grief process. This excerpt from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety shows the vital connection between successful long-term recovery and transcending loss.

You will not find recovery without the process of mourning. Most of us try to pull that off, but we can’t. Period. There is no conceivable scenario to avoid mourning in sobriety. You cannot go from drinking to recovery by skipping the pain of grief any more than you can go directly from Kindergarten to college. “After all, if our life is altered so dramatically by our trauma that we can hardly recognize it as our own, we might think it as a death,” says Kathryn Cramer. (Staying on Top When Your World Turns Upside Down, Penguin Books, New York 1990) “In a small but real way our life as we once knew it has died.” Death and grief go hand in hand.

You have a grievable loss. Failure to grieve, failure to grieve appropriately (e.g. without booze), or failing to even identify our losses as losses, sacks more attempts at long-term recovery than any other stressor. One thing few people respect or even notice about Alcoholics is the upheaval and loss we go through. Instead people seem more interested in the upheaval and loss we create.

Attention in group therapy is showered on abstinence. But look to those who have the most experience in their own recoveries and you’ll see people who have identified their losses, grieved them and transcended them. Every single one of them knows fully what he or she lost and is over it. Grief—the process, not the noun—belongs in treatment for Alcoholism. A full, real grief process. Not the infomercial version. It doesn’t happen in a series of handouts or a couple of DVDs. There are no shortcuts, and because there aren’t it is often overlooked in short-term treatment efforts. Mourning has to be an essential part of recovery’s curriculum. The carnage Alcoholism causes in our lives needs to be seen in the same light as grief counselors view a loss such as a natural disaster or untimely death.
--  Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pg. 72
www.alcohologist.com

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at alcohologist.com... and please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK. 

SUNDAY SNIPPET: September 29

Alcoholism is the only disease where successfully getting it into remission relies heavily on paraprofessionals outside the medical community.  When those resources come from within the criminal justice system, the results are statistically below average, as this excerpt from my previous book What the Early Worm Gets begins to point out.

"The professionals and paraprofessionals handling the treatment are critical to the success. And to build that success you need credibility, especially because there are so many paraprofessionals affiliated with recovery. It’s their duty to adhere to a code of ethics simply not embraced in a correctional environment. Knowledge and competence—not necessarily a degree—are required, and trust. Where do those with alcohol problems place their trust? Others who have walked a mile in their shoes. Because you really don't know how it feels to be alcoholic unless you are alcoholic.  A mechanic isn’t a metallurgist even though the material with which he works with is metal. You still need a multi-disciplinary team including medical doctors or psychotherapists, however having someone who is in recovery helping facilitate the recovery process gets better results.

The most important facet of good treatment is alleviating guilt, shame and grief. We look through life’s window which can get coated with a grime of guilt and shame and grief. Those are precisely the three features the criminal justice system uses in its programs to make sure you’re sorry, make sure you know you’re sorry and won’t do it again. Positivity and attitude are the window cleaner that can clean the window of the grimy shame. The criminal justice system doesn't do windows.  They put bars on them. They will work to make sure you don’t forget your shame.

Recovery can be spontaneous. It does happen. However, true rehabilitation is based on Opus Contra Naturam—working against what comes easily— and few people are successful working against what comes easily without help.  Few people are successful for long when that help comes from a corrections environment designed to warehouse people, not provide meaningful treatment."
--from What the Early Worm Gets, pg. 73

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SUNDAY SNIPPET: September 15

Guilt and shame are two of the four stressors behind the Symptoms of Sobriety. Every Silver Lining Has a Cloud, compares the two in the segue between chapters dedicated to each.  Here's a brief excerpt.

"One of the first TV newsrooms in which I worked had an old-school assignment editor who had above his desk a framed photo from his reporter days. He was on the Patty Hearst story in California. In the 1970s, the newspaper heiress was kidnapped by a violent left-wing activist group that forced the 19-year-old into a role in a series of crimes for which she was put on trial in ’79. The photo shows her outside the court in a t-shirt that read, “Being kidnapped is always having to say you’re sorry.” Drop kidnapped and insert Alcoholic and that shirt could communicate how it sometimes feels when you’re working toward recovery. First, a violent abduction from your day-to-day life makes you a hostage, then your guilt and shame subject you to years of feeling as though you won’t ever be able to atone for it.

Guilt and shame are different. Psychiatrist Helen Block Lewis points out, “Shame and guilt often occur together. They’re frequently fused and therefore confused with each other.” (The Role of Shame in Symptom Formation, Lawrence Erlbaum Inc., Hillside, NJ 1987) Shame is the feeling we get from others that we are wrong . . . guilt is the feeling we give ourselves when we do wrong. In guilt, you’re reviewing your own irrational beliefs and telling yourself you didn’t do enough and you punish yourself for it . . . in shame, someone else is saying you didn’t do enough based on their own irrational beliefs. The former is caused by your values . . . the latter is caused by others imposing their values on you. The gap between your performance and your expectations of yourself is guilt . . . the gap between your performance and others’ expectations of you is shame. When you feel guilt over being Alcoholic, you feel the disease has made you a monster . . . when you feel shame, other people behave as if you are a monster.

As for their impact on cortisol, guilt and shame have the same outcome even though their origins are so different. The cortisol doesn’t make a distinction between whether others are judging you or you are judging yourself. The judgment is that Alcoholism is not “normal.”

These words that can derail sobriety more than any others are: You’re Not Normal. Shame carries that kind of whallop."

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 49-50

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