![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 48 to 72 of 72. Go back in thread:
Posted by Elizabeth on October 19, 2001, at 13:42:01
In reply to Re: addiction and recovery - Elizabeth, posted by Greg on October 17, 2001, at 8:37:42
You guys (galtin and Greg) are right. I should have said: "not all alcoholics are especially liable to abuse tranquilizers." Certainly some -- perhaps most -- are (and indeed, nearly all abusers of benzodiazepines are also abusing other drugs, such as alcohol).
My particular concern is that patients with anxiety who have self-medicated with alcohol in the past often don't receive adequate treatment for the anxiety. Instead they are often given ineffective treatments on the grounds that they are "addicts" (and that it is therefore presumed that they will abuse anything they can get their hands on).
A note to Greg:
> I have to watch my Xanax intake very closely as there is a fine line between the use for anxiety, and just "getting high" for me.I've heard that Klonopin isn't very good for getting high, so it might be better than Xanax. (I personally am not impressed with either of them in the "getting high" department :-) ). Librium is another benzo that also has this reputation.
> As far as stims go, I do have an rx for Adderall, but I use it very rarely. Only when I'm extremely fatigued. I really don't care for stims much.
I think this shows that you don't have a generalized "addictive personality," but rather that you prefer tranquilizing drugs to activating ones. I don't get any kicks out of stimulants or benzodiazepines, but opioids are very effective mood-elevators for me and even though I don't have an "addictive personality," I could see myself getting addicted to opioids if I self-medicated with them for more than a brief time. (I'm fortunate in that I don't have a history of self-medicating, so doctors are more willing to prescribe "abusable" drugs to me than they might be otherwise.)
-elizabeth
Posted by MB on October 20, 2001, at 14:21:35
In reply to Re: addiction and recovery, posted by Elizabeth on October 19, 2001, at 13:42:01
Here are a few questions for everybody...just to stimulate conversation. These are tough questions, and I don't really expect hard and fast answers to them, but they are questions that, as an alcoholic in recovery, I have often asked myself.
OK, presupposing that we agree to separate *addiction* from *dependence*, and that we define addiction as "a psychological obsession with (and a compulsive use of) a drug," while defining dependence as "the developement of tolorance to a drug accompanied by withdrawal symptoms upon cessation of that drug"...and presupposing that we agree that dependence often accompanies addiction, while addiction does not necessarily accompany dependence, how would you answer these questions? (OK, that's a lot of presupposing. If anyone takes exception with the above definitions, by all means, please share your opinions). Anyway...
A) What is the differenece between a person who self-medicates a depressive/anxiety disorder and an addict (whom AA refers to as needing alcohol because of a natural tendency to be "irritable, restless, and discontent")?
B) Is there a difference between i) a self-medicater who becomes psychologically attatched to a drug because of the relief it offers, and ii) an addict who becomes "obsessed" (psychologically attatched) to a drug because his/her state is naturally "irritible, restless, and discontent" without it?
C) Are the differences between these two sets of people (and the way in which these people are treated) simply semantic, or are there deeper differences?
D) There is evidence that both addiction and mood/anxiety disorders are heritable. Could it be that inheritance of an addiction to a particular substance is the same thing as inheritance of a "subset" of mood/anxiety disorder for which the use of that drug is particularly efficacious (for the short-term) in alleviating?
In the AA group I attend, there is a dichotomy of people. There are the ones who, after getting clean and "working the steps," seem to flourish. They are depressed at first as they withdrawal, but then they glow. On the other hand, there is the group that, after getting clean and "working the steps," continues to struggle and struggle and struggle.
E) Could it be that one group comprises the "addicts" (getting better once withdrawn) while the other group comprises the "self-medicaters" (declining due to lack of pharmacological treatment)?
There is a selfish reason that I am asking these questions. I've suffered with depression and anxiety since early adolescence, and I'm also a recovering addict. I am really struggling to understand myself and to see where I fit into these groups. There are two polarized opinions I've encountered:
a) that I'm just an irritable person with character flaws who used drugs because I was selfish and too ungrateful for the life "God" had given me; andb) that I suffer from a wholly physiological brain disorder which I attemped to self-medicate with drugs...and that with the proper biological treatment my affinity to illegal drugs and alcohol would become a non-issue.
The first model appeals to my tendency for self loathing, and the second model appeals to my tendency to abdicate responsibility, but both seem completely myopic and inadequate.
I feel like Jackie Chan standing and screaming "who am I??!!" in the extremely cheesy movie by the same name. Or, more philosophically, I want to scream "WHAT am I?"
Posted by Rosa on October 20, 2001, at 19:09:31
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
I think that your questions could just as easily apply to drug addicts as alcoholics.
I believe many of us are in denial about self-medicating, not just alcoholics and addicts but also the elderly. How many bottles of pills do your parents have on the shelf?
Our natural tendency to be "irritable, restless, and discontent" may be the cause rather than the result of alcohol/drug abuse. This makes it psychological or emotional in nature.
It may also be the result of growing up in an alcoholic or dysfunctional home. The word dysfunctional includes emotional illness. Our attitudes are shaped by our surroundings.
Acceptance and approval is a significant factor in our attitude. Perfection and helplessness are only two of the masks we hide behind. How many of us experienced "unconditional love" when we were children?
^^^^^
Here are a few questions for everybody...just to stimulate conversation. These are tough questions, and I don't really expect hard and fast answers to them, but they are questions that, as an alcoholic in recovery, I have often asked myself.
>
> OK, presupposing that we agree to separate *addiction* from *dependence*, and that we define addiction as "a psychological obsession with (and a compulsive use of) a drug," while defining dependence as "the developement of tolorance to a drug accompanied by withdrawal symptoms upon cessation of that drug"...and presupposing that we agree that dependence often accompanies addiction, while addiction does not necessarily accompany dependence, how would you answer these questions? (OK, that's a lot of presupposing. If anyone takes exception with the above definitions, by all means, please share your opinions). Anyway...
>
[snip]
Posted by Krazy Kat on October 20, 2001, at 22:38:01
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
Depression and Manic Depression are CNS disorders, just like MS or Alzheimers. We just don't have the studies yet to undertand them.
I do think "depression" can arise from other illnesses, but all in all, it must be treated medically.
Any guilt associated with depression or manic depression is unfair and ridiculous. Rather strong but I stand by it!
Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
I felt So bad for So long about my use of alcohol until I realized how it played a role in keeping me here.
That will get a lot of negative replies. :) But it's true.
- KK
p.s. Not advocating alcohol as the solution - still working on eliminating it completely from my diet. It definitely interfers with the meds. Just ruminating...
Posted by MB on October 21, 2001, at 11:39:15
In reply to Re: addiction and recovery » MB, posted by Krazy Kat on October 20, 2001, at 22:38:01
< snip >
> Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
< snip >I hear what you're saying, and, when you put it that way, I do see that there would be a difference between someone who just wanted to be high all the time and someone who just wanted to alleviate the pain they feel do to illness. And I think in some cases, the difference might be that cut and dry. My case doesn't seem to fit nicely into either category, though. When I drank and did drugs, people used to ask me why I wanted to be so "f***ed up all the time," and the truth was that I didn't. I would tell them that if there was a drug that alleviated depression as well as booze or heroin (in the short term, at least) but that didn't alter my senses, I would definitely choose the one that didn't alter my senses. People couldn't understand. I didn't drink and do drugs so I could stumble around and pass out. Those effects were just unfortunate side effects. I drank and did drugs because they gave me temporary relief from the horrible depression and anxiety I suffered/suffer from. The only problem was that drugs (especially alcohol) would send me into a really bad mood cycle. I'd drink a beer, feel totally on top of the world like God was flowing right trough my heart, and fifteen minutes later, I'd crash into the worst, suicidal depression ever. Of course another beer would take that depression away again, the second time for only ten minutes, etc, etc, until I was TRASHED!! So I did want to be drunk all the time. But *not* because I liked slurring my words and stumbling and passing out...and *not* because I enjoyed distortion of the senses...but because I thought I was getting somewhere in the illusory process of chasing depression away by consuming larger and larger amounts of alcohol. I have a friend who smokes enormous amounts of pot...not because he has mental illnes, but because he likes getting wasted. He can't quit. I think he is an addict. Then there's my dad. He has anxiety problems. He used to drink too much. Then he was given Xanax, he quit drinking, he got counsiling, and he's doing better. He no longer drinks or takes Xanax. When he was drinking, I would say it was purly self-medication, not addiction. I don't think I fit into either category. I wouldn't have used drugs if I hadn't been suffering with mental illness, but I wasn't simply a self-medicater like my dad. He'd drink until the anxiety went away and then quit. I, on the other hand, because of the mood cycle alcohol would set into motion, drank until I passed out. So in that sense, I was very much an alcoholic. Maybe I'm just both. Maybe I need to quit trying so much to put myself in a nicly defined and labeled box and just concentrate on what makes me feel better. It's been two years since I've had a drink, and I don't feel better. I'm not on medication because that didn't seem to help either. I'm going to get a SPECT scan to see if they can find something that the other doctors missed. I hope the SPECT *scan* doesn't turn out to be a SPECT *scam*. BLAH BLAH BLAH thinks for letting me ramble. I can't shut up.
Posted by Krazy Kat on October 21, 2001, at 12:40:56
In reply to Re: addiction and recovery » Krazy Kat , posted by MB on October 21, 2001, at 11:39:15
MB:
Good luck! I'm sure you've heard it many times here before, but there are so many meds - don't give up if you still feel bad, mho. I feel better now than I did two years when I started the process.
I understand your post. I imagine that some of us really do have the physical propensity to be addicted to drugs and alcohol, unlike others.
Take care.
- K.
Posted by Elizabeth on October 26, 2001, at 17:34:03
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
> A) What is the differenece between a person who self-medicates a depressive/anxiety disorder and an addict (whom AA refers to as needing alcohol because of a natural tendency to be "irritable, restless, and discontent")?
I wouldn't take the AA definition too seriously. But people taking medication (with or without a doctor's permission) do not necessarily have psychological "cravings" (similar to pressing hunger) for drugs. A person can become addicted to a medication; this is rare when the medication is being supervised by a doctor but probably happens a lot when people try to self-medicate with potentially addictive drugs.
> B) Is there a difference between i) a self-medicater who becomes psychologically attatched to a drug because of the relief it offers, and ii) an addict who becomes "obsessed" (psychologically attatched) to a drug because his/her state is naturally "irritible, restless, and discontent" without it?
Yes. If the condition being medicated goes away, a nonaddicted self-medicating person will no longer feel a need for the drug.
> C) Are the differences between these two sets of people (and the way in which these people are treated) simply semantic, or are there deeper differences?
I think the difference is significant.
> D) There is evidence that both addiction and mood/anxiety disorders are heritable. Could it be that inheritance of an addiction to a particular substance is the same thing as inheritance of a "subset" of mood/anxiety disorder for which the use of that drug is particularly efficacious (for the short-term) in alleviating?
Yes, that is quite possible.
> In the AA group I attend, there is a dichotomy of people. There are the ones who, after getting clean and "working the steps," seem to flourish. They are depressed at first as they withdrawal, but then they glow. On the other hand, there is the group that, after getting clean and "working the steps," continues to struggle and struggle and struggle.
>
> E) Could it be that one group comprises the "addicts" (getting better once withdrawn) while the other group comprises the "self-medicaters" (declining due to lack of pharmacological treatment)?I think both sets of people were addicted to begin with, but you may well be right that the people who aren't able to stay off the drug once they detox actually have a chronic condition for which they require the drug (or some other effective treatment). Other factors that could be related to relapsing include the length of time that the person was addicted, psychological resilience, stability of lifestyle (e.g., a job, a home, etc.), and social support (family, friends, etc.).
> a) that I'm just an irritable person with character flaws who used drugs because I was selfish and too ungrateful for the life "God" had given me; and
I'm predisposed to become skeptical when people invoke the supernatural to justify their opinions. :-)
> b) that I suffer from a wholly physiological brain disorder which I attemped to self-medicate with drugs...and that with the proper biological treatment my affinity to illegal drugs and alcohol would become a non-issue.
Well, let me first say that I think the dichotomy between "physiological" and "psychological" conditions is a false one, so the whole question is a bit nonsensical.
But anyway, think about why you started using drugs in the first place. What did they seem to help with, what was their appeal?
I learned when I first took hydrocodone that it made me feel "normal," "okay" -- it was like I'd found something that had been missing all my life. I was lucky enough to be living in Boston, a city where a lot of psychiatric research goes on, so I was able to meet with doctors who had experience treating depression with opioids. I feel lucky; if my circumstances had been different, I might well have gotten into trouble with heroin. As it was, I went through just about all the conventional treatments there are (though not all the possible combinations, of course) before my doctor and I started seriously considering buprenorphine as a potential treatment. If I hadn't had the degree of social support and education that I did, I'm not sure I would have been able to muster up the patience to go through all those trials.
> The first model appeals to my tendency for self loathing, and the second model appeals to my tendency to abdicate responsibility, but both seem completely myopic and inadequate.
Both models are based on a fallacy; IMO, that's the problem. Both models require a black-and-white view of human behaviour and experience.
> I feel like Jackie Chan standing and screaming "who am I??!!" in the extremely cheesy movie by the same name. Or, more philosophically, I want to scream "WHAT am I?"
You're a human being, dude.
Hey, let me know about the results of the SPECT scan -- I'd be interested.
-elizabeth
Posted by Elizabeth on October 26, 2001, at 17:41:03
In reply to Re: addiction and recovery » MB, posted by Krazy Kat on October 20, 2001, at 22:38:01
> Any guilt associated with depression or manic depression is unfair and ridiculous. Rather strong but I stand by it!
Dude, excessive or inappropriate guilt is a symptom of depression! :-) Depression is unfair, sure, but ridiculous?
> Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
The best high in the world for me is being able to function normally, having the will to care for myself, etc. It sounds like you are the same.
-elizabeth
Posted by galtin on October 26, 2001, at 20:44:57
In reply to Re: addiction and recovery » Krazy Kat , posted by MB on October 21, 2001, at 11:39:15
Dear MB,
> > Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
> < snip >
>
> I hear what you're saying, and, when you put it that way, I do see that there would be a difference between someone who just wanted to be high all the time and someone who just wanted to alleviate the pain they feel do to illness. And I think in some cases, the difference might be that cut and dry. My case doesn't seem to fit nicely into either category, though. When I drank and did drugs, people used to ask me why I wanted to be so "f***ed up all the time," and the truth was that I didn't. I would tell them that if there was a drug that alleviated depression as well as booze or heroin (in the short term, at least) but that didn't alter my senses, I would definitely choose the one that didn't alter my senses. People couldn't understand. I didn't drink and do drugs so I could stumble around and pass out. Those effects were just unfortunate side effects. I drank and did drugs because they gave me temporary relief from the horrible depression and anxiety I suffered/suffer from. The only problem was that drugs (especially alcohol) would send me into a really bad mood cycle. I'd drink a beer, feel totally on top of the world like God was flowing right trough my heart, and fifteen minutes later, I'd crash into the worst, suicidal depression ever. Of course another beer would take that depression away again, the second time for only ten minutes, etc, etc, until I was TRASHED!! So I did want to be drunk all the time. But *not* because I liked slurring my words and stumbling and passing out...and *not* because I enjoyed distortion of the senses...but because I thought I was getting somewhere in the illusory process of chasing depression away by consuming larger and larger amounts of alcohol. I have a friend who smokes enormous amounts of pot...not because he has mental illnes, but because he likes getting wasted. He can't quit. I think he is an addict. Then there's my dad. He has anxiety problems. He used to drink too much. Then he was given Xanax, he quit drinking, he got counsiling, and he's doing better. He no longer drinks or takes Xanax. When he was drinking, I would say it was purly self-medication, not addiction. I don't think I fit into either category. I wouldn't have used drugs if I hadn't been suffering with mental illness, but I wasn't simply a self-medicater like my dad. He'd drink until the anxiety went away and then quit. I, on the other hand, because of the mood cycle alcohol would set into motion, drank until I passed out. So in that sense, I was very much an alcoholic. Maybe I'm just both. Maybe I need to quit trying so much to put myself in a nicly defined and labeled box and just concentrate on what makes me feel better. It's been two years since I've had a drink, and I don't feel better. I'm not on medication because that didn't seem to help either. I'm going to get a SPECT scan to see if they can find something that the other doctors missed. I hope the SPECT *scan* doesn't turn out to be a SPECT *scam*. BLAH BLAH BLAH thinks for letting me ramble. I can't shut up.MB,
All the speculation and theorizing in this post and in yesterday's is interesting and beside the point. There is rarely, if ever, one identifiable reason to explain why an addict behaves addictively. The psychological, physiological, and environmental factor are all intertwined.Recently, however, I did have a revelation on the causes of alcoholism, at least my alcoholism. A non-alchoholic friend asked me why it is that I am an alcoholic. After a moment's thought, I replied that the root cause of my alcoholism is that I drink too much. My friend turned the question around: "Why do you drink so much?" This time I did not need a moment: "Because I am an alcoholic." This is all I need to know, partly because it does not matter why I drank so much for 20 years. In fact, there was a considerable period of time near the end of that 20 years during which my trying to figure out the why of my alcoholism was just a way I could avoid doing something about it. Whatever the causes of alcoholism for any given person, they are irrelevant to getting better.
The term alcoholic has no clinical, diagnostic, or clinical standing, so the issue of whether somebody is or is not an alcoholic is at best a distraction. The most precise meaning that the term has is as a self-designation for people in AA. The meaningful question is that of whether drinking is fouling up your life. If so, the second question is, what are you going to do about it. If you want to stop and try to stop but fail, this merely confirms that you are addicted and probably need help.
I may be mistaken, but you sound addicted to me. It is right there in your rationale for drinking--to drive away the anxiety, etc. But in the next sentence you acknowledge that your respite is not only temporary, but then yields to a greater intensity of the feelings you initially tried to escape. A person who maitains this kind of drinking pattern would ordinarily be deterred by the increasingly painful consequences and would stop. To continue drinking in the face of repeated evidence that it not only doesn't "work," but produces worse suffering of the kind that the drinking was originally intended to sooth, strongly suggests a condition of addiction. The fact that you are trying to figure it all out instead of taking constructive action indicates the kind disordered thinking common to those who call themselves alcoholic. Whether you yourself are an alcoholic is irrelevant. Alcohol is screwing up your life.
I am sorry if I sound preachy. I am talking mostly out of my own painful experiences and as a very slooooowwwww learner myself. I hope you can accept your condition (whether it is a "disease or not is, again, irrelevant) and care about yourself enough to get help and support for getting out of your nightmarish cycle.
galtin
Posted by MB on October 31, 2001, at 14:10:48
In reply to Re: addiction and recovery » MB, posted by Elizabeth on October 26, 2001, at 17:34:03
Hey, thanks for the long response to my post...I just now read it...been away from the computer for a while. It's interesting that you mention that if a self-medicator is relieved of their symptoms they will stop medicating. I don't know how I would react if my sense of anxiety and hoplelessness were gone (they've only been gone when I've been on addictive drugs). So...if they were gone without the addictive drugs, would I lose my obsession with the drugs? I don't know. It's just one of those hypothetical questions I may never know the answer to. This SPECT scan will be intersting. I have to be off caffeine for them to get an accurate picture of my brain at "baseline" (gulp!)...
Posted by MB on October 31, 2001, at 14:22:11
In reply to Re: addiction and recovery MB, posted by galtin on October 26, 2001, at 20:44:57
> I may be mistaken, but you sound addicted to me.
I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
> The fact that you are trying to figure it all out instead of taking constructive action indicates the kind disordered thinking common to those who call themselves alcoholic. Whether you yourself are an alcoholic is irrelevant. Alcohol is screwing up your life.Well its not screwing up my life anymore since I've been sober for two years. I think that's pretty constructive as far as action goes. As far as trying to "figure it out," you may have a point. Maybe, on an unconscious level, I'm trying to talk myself into not being an alcoholic (i.e., proving to myself that I'm something else). It could be an unconscious attempt to sabotage my sobriety, and I appreciate the point. On the other hand, humans are rational creatures, and I think it is natural that we try to understand ourselves. Socrates or Plato, or one of those Greek dudes said that an unexamined life was not worth living. So, I appreciate your warning, but I'm not going to go belly-up into zombie-hood by ceasing the self-investigative process.
Peace,
MB
Posted by Elizabeth on November 1, 2001, at 16:19:55
In reply to Re: addiction and recovery MB » galtin, posted by MB on October 31, 2001, at 14:22:11
> I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
-elizabeth
Posted by Rosa on November 2, 2001, at 6:16:04
In reply to Re: addiction and recovery » MB, posted by Elizabeth on November 1, 2001, at 16:19:55
Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
> > I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
>
> I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
>
> -elizabeth
Posted by MB on November 3, 2001, at 15:01:11
In reply to Re: addiction and recovery » MB, posted by Elizabeth on November 1, 2001, at 16:19:55
Yeah, they *do* say "once an addict always an addict." I think they say this because of how many people who, after a period of abstinence, try to go back to their drug of choice and use it "normally." Many of these people find that, even after long periods of abstinence, they quickly become re-addicted when they go back to their drugs of choice. Looking at it this way, I can see the usefulness of saying "once an addict always an addict," because it might prevent a person from saying, "well, I've gone a year without a drink, I think I'll go down to the bar for one beer" when, in fact, they won't ever be able to have just *one* beer. However, I find the statement also extremely annoying because...how can you be "addicted" to a drug if you aren't even taking that drug?
Posted by MB on November 3, 2001, at 15:07:32
In reply to Re: addiction and recovery » Elizabeth, posted by MB on November 3, 2001, at 15:01:11
Let me also cover my ass by saying that, yes, there *are* those few lucky bastards who can overcome their addiction and go back to drinking or smoking pot on a purely social level. My dad is one of those people. He used to get pretty drunk when I was a kid...fired from jobs, etc. Now he can have a drink and its no big deal...sometimes he'll get a glass of wine or scotch AND NOT EVEN FINISH IT!!!! I am jealose of people like this because, right now, I would like JUST ONE BEER to fill the emptiness inside of me...but I know I'd just end up drinking a case and puking....
Posted by galtin on November 4, 2001, at 22:22:55
In reply to Re: addiction and recovery » Elizabeth, posted by Rosa on November 2, 2001, at 6:16:04
> > I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
> > > > -elizabeth
Hi All,
Most alcoholics in AA refer to themselves as a "recovering" alcoholic. The reason for steering clear of the term "recovered" is two-fold. First, all the evidence suggests that AAers can never get over their addiction. In fact, people who "go out," even after 20 years free from alcohol, are soon drinking more than they did ever before. Second, AAers commit themselves to a program of recovery so that they can live a relatively happy and fulfilled life without alcohol. Again, the evidence is that recovering alcoholics who stop "working" the program and who drop away from meetings quickly become restless, irritable and discontent. In other words, they become like actively drinking alcoholics but without the drink. So,just as an AAers abstenance from alcohol must be lifelong, so must her dedication to AA's program of recovery. This is why critics of AA claim that members just trade one addiction for another.But AA doesn't have a monopoly on recovery. Other programs, like Rational Recovery and Women in Sobriety, believe in short-term treatment followed by graduation. Not to mention former AAers, especially women, who believe that AA is useful for a period of years but forces on the alcoholic too much of a loser self-conception. There are also other organizations that offer heavy drinkers a way back to moderate drinking.
I have no idea which approaches work best, but I suspect that there are different kinds of alcohol addicts. Some do well in AA, while others loath it and find answers in Rational Recovery. Then there are those alcoholics like my grandfather. He drank his way through 35 years and then just stopped. Not only that, but had a drink or two, never more, when the mood hit him.
Happily, I don't have to figure out all this multiplicity of addictive treatments and cures. I just need to know what works for the alcoholic I know best.
galtin
Posted by Elizabeth on November 9, 2001, at 21:25:54
In reply to Re: addiction and recovery » Elizabeth, posted by Rosa on November 2, 2001, at 6:16:04
> Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
According to the 12-steppers, you're back to square one if you slip. It's not written in stone, nor does it qualify as scientific fact: it's *just* the dogma of the *-anonymous groups. Some respectable addiction medicine researchers have found that some alcoholics can learn to drink in moderation.
If a person has been indoctrinated (by AA or some other group) into believing that they can't learn to drink responsibly, then they probably won't be able to -- most likely, they won't even try to learn moderate and responsible drinking habits, and when they do slip they'll be more likely to give up and go back to their former pattern of excessive drinking.
(Same goes for other drugs, of course, not just alcohol.)
-e
Posted by galtin on November 10, 2001, at 6:04:41
In reply to Re: addiction and recovery, posted by Elizabeth on November 9, 2001, at 21:25:54
> > Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
>
> According to the 12-steppers, you're back to square one if you slip. It's not written in stone, nor does it qualify as scientific fact: it's *just* the dogma of the *-anonymous groups. Some respectable addiction medicine researchers have found that some alcoholics can learn to drink in moderation.Some AA members have strong opinions, but there is no AA "dogma." Dogma is a belief or set of beliefs required for membership in a group. AA has no such beliefs.
> If a person has been indoctrinated (by AA or some other group) into believing that they can't learn to drink responsibly, then they probably won't be able to -- most likely, they won't even try to learn moderate and responsible drinking habits, and when they do slip they'll be more likely to give up and go back to their former pattern of excessive drinking.
Can people be "indoctrinated" when their attendance is voluntary?
The term "alcoholic" is not a medical or psychiatric term. It is a self-description that people in AA adopt for themselves, partly in order to identify themselves as among those who can't learn to drink moderately or "socially." They have demonstrated this to themselves well before setting sites on AA. The medical/psychiatric diagnoses are alcohol abuse and alcohol dependence. The former is akin to heavy drinking and the latter to what society equates with the term alcoholism.
Researchers like Stanton Peale believe they have demonstrated that "heavy" and "problem" drinkers can be taught to drink moderately. They have not claimed this of alcoholics, since alcoholics are not heavy drinkers, problem drinkers, alcohol abusers or dependents. They are those who have adopted the term alcoholic as a self-designation defining themselves precisely as those unable to drink moderately. Alcoholics are often members of AA, but not always.
galtin> (Same goes for other drugs, of course, not just alcohol.)
>
> -e
Posted by Rosa on November 10, 2001, at 9:49:12
In reply to Re: addiction and recovery, posted by galtin on November 10, 2001, at 6:04:41
> > > Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
> >
> > (Same goes for other drugs, of course, not just alcohol.)
> >
> > -eI recently started smoking again and although I have been able to limit my smoking to 5 cigarettes or less per day, I find that I usually feel lightheaded when smoking. I also do not feel very good physically after smoking. I expect that I will not be smoking very much longer. Smoking does appear to be progressive. Needless to say, it is harmful to my lungs.
Posted by galtin on November 10, 2001, at 11:02:19
In reply to Re: addiction and recovery, posted by Rosa on November 10, 2001, at 9:49:12
> > > > Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
> > >
> > > (Same goes for other drugs, of course, not just alcohol.)
> > >
> > > -e
>
> I recently started smoking again and although I have been able to limit my smoking to 5 cigarettes or less per day, I find that I usually feel lightheaded when smoking. I also do not feel very good physically after smoking. I expect that I will not be smoking very much longer. Smoking does appear to be progressive. Needless to say, it is harmful to my lungs.Hi Rosa,
Just so you know, you are reiterating Elizabeth, to whose post I was responding.
galtin
Posted by Elizabeth on November 10, 2001, at 23:18:41
In reply to Re: addiction and recovery, posted by galtin on November 10, 2001, at 6:04:41
> Some AA members have strong opinions, but there is no AA "dogma." Dogma is a belief or set of beliefs required for membership in a group. AA has no such beliefs.
Isn't there a "big book" or something like that? I know that some meetings don't adhere to the exact formula for what AA is supposed to be, but those that do can indeed be very dogmatic.
> Can people be "indoctrinated" when their attendance is voluntary?
People are often ordered by the courts to attend AA as an alternative to prison (for such offenses as DWI), and in such cases I would say it's coercive. Also, a lot of people don't know about the alternatives like RR and SMART (both of these are self-help groups with a cognitive-behavioral approach); they think AA is the only group that can help them.
> The term "alcoholic" is not a medical or psychiatric term.
This is true. I usually just assume it's roughly equivalent to DSM-IV "alcohol dependence."
> Researchers like Stanton Peale believe they have demonstrated that "heavy" and "problem" drinkers can be taught to drink moderately. They have not claimed this of alcoholics, since alcoholics are not heavy drinkers, problem drinkers, alcohol abusers or dependents. They are those who have adopted the term alcoholic as a self-designation defining themselves precisely as those unable to drink moderately.
Okay, you have a point there. But I suspect that some people who abuse alcohol (but are not alcohol-dependent) are identified as "alcoholics" by family, friends, or others (I believe there is even a ritual known as "intervention" for this), and encouraged to go to AA meetings.
But anyway, it's not true that alcohol dependence is necessarily a lifelong condition, although it often is. People who have been dependent can sometimes -- and perhaps more often than we realize -- learn to drink moderately after having abstained or a while.
> Alcoholics are often members of AA, but not always.
Well, like I said, often they aren't offered alternatives -- they go into rehab, and the only treatment they're offered is 12-step based.
-elizabeth
Posted by Rosa on November 11, 2001, at 7:01:10
In reply to Re: addiction and recovery » galtin, posted by Elizabeth on November 10, 2001, at 23:18:41
> People are often ordered by the courts to attend AA as an alternative to prison (for such offenses as DWI), and in such cases I would say it's coercive. Also, a lot of people don't know about the alternatives like RR and SMART (both of these are self-help groups with a cognitive-behavioral approach); they think AA is the only group that can help them.
>
Elizabeth,Please tell us more about RR and SMART. Are these programs offered by treatment centers? Do they have online support groups or face to face meetings?
-r
Posted by galtin on November 12, 2001, at 22:59:13
In reply to Re: addiction and recovery » galtin, posted by Elizabeth on November 10, 2001, at 23:18:41
> > Some AA members have strong opinions, but there is no AA "dogma." Dogma is a belief or set of beliefs required for membership in a group. AA has no such beliefs.
>
> Isn't there a "big book" or something like that? I know that some meetings don't adhere to the exact formula for what AA is supposed to be, but those that do can indeed be very dogmatic.
>
> > Can people be "indoctrinated" when their attendance is voluntary?
>
> People are often ordered by the courts to attend AA as an alternative to prison (for such offenses as DWI), and in such cases I would say it's coercive. Also, a lot of people don't know about the alternatives like RR and SMART (both of these are self-help groups with a cognitive-behavioral approach); they think AA is the only group that can help them.
>
> > The term "alcoholic" is not a medical or psychiatric term.
>
> This is true. I usually just assume it's roughly equivalent to DSM-IV "alcohol dependence."
>
> > Researchers like Stanton Peale believe they have demonstrated that "heavy" and "problem" drinkers can be taught to drink moderately. They have not claimed this of alcoholics, since alcoholics are not heavy drinkers, problem drinkers, alcohol abusers or dependents. They are those who have adopted the term alcoholic as a self-designation defining themselves precisely as those unable to drink moderately.
>
> Okay, you have a point there. But I suspect that some people who abuse alcohol (but are not alcohol-dependent) are identified as "alcoholics" by family, friends, or others (I believe there is even a ritual known as "intervention" for this), and encouraged to go to AA meetings.
>
> But anyway, it's not true that alcohol dependence is necessarily a lifelong condition, although it often is. People who have been dependent can sometimes -- and perhaps more often than we realize -- learn to drink moderately after having abstained or a while.
>
> > Alcoholics are often members of AA, but not always.
>
> Well, like I said, often they aren't offered alternatives -- they go into rehab, and the only treatment they're offered is 12-step based.
>
> -elizabethElizabeth,
1) The book you refer to, "Alcoholics Anonymous," is a compilation not of dogma but of the experiences of the first 100 members of AA. Like those in any organization, AA members can be self-righteous and closed-minded. This does not demonstrate that the organization itself indoctinates people with an ideology--that is, with a closed system of belief.
2) None of this is the doing of AA. AA does not claim that it possesses the only path to sobriety, merely one path that has worked well for its members.
3) Alcoholic and alcohol dependence are not interchangeable. Although society uses the term alcoholic loosely, it has no medical or psychiatric integrity.
4. The purpose of an intervention is to get a person into treatment, usually the in-patient kind. That many treatment facilities recommend follow-up with AA attendence testifies only to AA's AA's relative ubiquity. There is no causal or implied relationship between these recommendations and any reputed program of "indoctination" on the part of AA.
5) AA does not deny that persons diagnosed as alcohol dependent can find their way to moderate drinking, even though the evidence for this is either anecdotal or a product of the unsophisticated statistical vagaries of the anti-AA lobby. What AA does claim, on the basis of direct observation, is that members of the fellowship who have attempted moderate drinking almost invariably (whether a month or five years later) wind up in full-blown relapse.
6. Fortunately, the number of rehabs that offer non-AA options is growing. Only a tiny minority of people referred to AA by rehabs ever attend. And of those, most soon stop going either because they dislike it or because they want to continue drinking.
The point is not that AA is perfect. There is a small minority of members who have rigid beliefs. There is another minority of members who believe in nothing. There are others who behave just as reprehensibly as they did when they were drinking. And a few lead double lives, feigning sobriety in AA but drinking or using drugs on the sly. But on the point of your original accusation, even if AA wanted to indoctinate members and attendees, such a project would be hopelessly doomed by AA's chronic and deliberate lack of organization, by the reflexive defiance of authority characteristic of most members, and by the sheer heterogeneity of the people joining up over the last ten years.galtin
Posted by galtin on November 12, 2001, at 23:04:35
In reply to Re: addiction and recovery, posted by Rosa on November 11, 2001, at 7:01:10
> > People are often ordered by the courts to attend AA as an alternative to prison (for such offenses as DWI), and in such cases I would say it's coercive. Also, a lot of people don't know about the alternatives like RR and SMART (both of these are self-help groups with a cognitive-behavioral approach); they think AA is the only group that can help them.
Rosa,I agree that this practice is coercive, but on the part of the court systems, not AA. AA, obviously, can't mandate anybody to attend its meetings.
galtin
Posted by gilbert on November 15, 2001, at 0:31:58
In reply to Re: addiction and recovery, posted by galtin on November 12, 2001, at 23:04:35
Well this is very interesting so I thought I would put my 2 cents in since I have been in or around AA since 1979 at the age of 19.
First point I have seen people exit AA and drink again and not have their lives fall apart and I have seen people exit AA and drink again and be dead within a week. So we just don't know how it is going to turn out....nobody really knows if they say they do they are lying or impressing their own beliefs on others however it would be quite a dangerous experiment for sober people to try and I think we figure that out on our own by watching the experiences of others. There is strong scientific evidence that alcoholics process alcohol and create an organic compound which is the addictive element in heroin which atttaches to the dopamine in their brain matter this compound acronym is THIQ. It is the chemical that produces the craving in heroin addicts and this was disovered by doing autopsies on dead homeless drunks in Houston Texas in the 1980's. They assumed they were heroin users.....ooops come to find out they were garden variety drunks. Now this compound THIQ never dissapates even after abstinence, thus the sermon about gettting on the train where you left off. My own experience in and out of AA until 1986 would prove these assumptions correct, but again this is just me. My brother was in AA left and is drinking again and has been doing fine so what gives.
On behalf of Elizabeth's defense in this particular matter.....there is indoctrination into and in AA. There is sayings and quotes used to describe how to succeed such as 90 meetings in 90 days etc. These are almost always used on the newcomer to inform, educate, and let the newcomer know how to have the best chance at success....it is all good intentions however to deny that the cliches, the heirarchy of sponsorship, the literature, the 12 steps, the traditions, the old timers, etc is not idoctrintaion due to it being voluntary is a bit much. The Masons have less indoctrination then AA, they I belive are volunteering as well. The terorist who kill themselves are volunteering as well and I doubt we would sy they have not been indoctrinated into a certain belief system. I think for AA to survive some of this thinking will have to be opened up and changed. After all Bill W. did drop acid to try and relive his depression so the 12 steps were not a cure all for him. When I first got to AA in 1979 my best friend was told to throw out his litium and just work the steps, he ended up in the hospital for 2 months. Times have changed a bit but there still is some ideology spoken at meetings which if followed can be harmfull. These are very vulnerable people looking for help at huge low points in their lives, to dimiss it as a laissez faire volunteer type atmosphere belittles the conditions of most whom arrive at AA......they usually have no other choice, it is not like they can come and go as they please....these are mostly very desperate people willing to hang onto your every word to get some comfort. So yes Elizabeth there is huge indoctrination processes taking place in and around AA wether through repetition of cliches or working the steps or even the seductive shame of a sponsor telling a pidgeon what to do. To say well these people have a choice and this is voluntarily done when people are facing divorce, jail, suicide or plain insanity is not reality, it may be the philosophy behind the fellowship but in my 22 years in and around AA rarely does the philosophy turn into reality.
Gil
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