| Volume 1, Number 7
During the past three decades I’ve had people ask me about new advances in recovery. Some advances have been made; however, there also have been many ideas come and go because they sounded good but just didn’t work. In the seventies I went to Freedom Fest in Minneapolis, Minnesota. There were over fifty thousand people there. Movie actors, politicians and treatment centers participated. It was all about supporting addiction recovery. On the grounds around the stadium were numerous stands with a wild variety of recovery plans. I asked an old timer in the recovery business what he thought about some of them. He said he was “aware that about fifty different recovery systems a year come and go, wait and check out the ones that last.”
I have come to view the recovery business like treatment of other potentially fatal illnesses. Look for the ones that have the most long term survivors. If they don’t have live bodies to support their ideology, beware.
Ernest Hooker, NCAC II
If you have friends who are interested in addiction treatment and recovery please forward this newsletter to them. If you have suggestions for a topic, contact me and, if possible, I will include the information in a newsletter.Some Thoughts on Early Sobriety
Here are some ideas for those ready to quit drinking alcohol or those who just recently quit and are finding it difficult.
First get a copy of “Under the Influence: A Guide to the Myths and Realities of Alcoholism” by James Robert Milam, Katherine Ketcham or “Beyond the Influence: Understanding and Defeating Alcoholism” By Katherine Ketcham, William F. Asbury, Mel Schulstad, Arthur P. Ciaramicoli. If money is tight you should be able to check out a copy at your local library. Read one of books, study it, and you will have the basic information needed for recovery.
Next, get a copy of Big Book of Alcoholics Anonymous, read it, and discuss it with someone who knows something about addiction recovery. Consider attending A. A. meetings; choose Back to Basics meetings if they are available. They have four educational sessions that have been extremely helpful to new people and also to some older members that have been disenchanted with regular A.A. meetings. Step meetings and Big Book meetings have often been the most helpful to new people.
If you don’t do anything else see a physician and have a complete physical with all necessary lab work. One of the most often overlooked problems areas in recovery is not recognizing the tremendous physical toll from alcoholism. There is agreement by the recognized experts that it takes a minimum of three years to heal physically from alcoholism. Do not minimize this or your recovery will be impaired. You do not need to see a psychiatrist unless referred. If you do need psychological help for a mental health issue your physician will refer you. It is important to have a doctor who is knowledgeable of alcohol addiction. If available go to a physician who is ASAM certified. But your family physician in most cases will be very helpful. Be very honest with him or her. In some cases physicians have been unfairly criticized when they didn’t have all the information they needed. Patients and families don’t always realize how important it is to have all the relevant historical information. This does not include story telling; what I am referring to is drug history (this includes all drugs, even those that are not mood altering), disease symptom history, legal history, mental health history and any other factual data the physician may need.
Consider treatment. It can save you, your family and associates a lot of misery. You can find your local treatment facilities by going to my website and click on substance abuse treatment facility locator; this will take you to a government treatment center referral database. Do not make the choice of treatment by yourself. Your physician and/or a certified addiction counselor should be part of the decision making progress. A certified or licensed addiction counselor can make that first year of recovery a lot easier and more rewarding, and you won’t have to reinvent the wheel. Beware of those who say they want to help but don’t have proof of the required training in the addiction field. Being a licensed therapist or psychologist does not guarantee any knowledge of addiction recovery.
An area that can be overlooked is the length of time for detoxification. Example: a woman enters treatment for alcoholism. She is in detox for a few days and then goes into treatment groups. Primary detoxification for alcoholism is only a few days. After twenty one days in treatment she has a seizure and eventually it is discovered that she was also withdrawing from valium. She failed to give that information to the staff. She actually was just starting on withdrawal from valium which takes several weeks. Those who use marijuana often receive very little benefit from the first few weeks of treatment and have significantly impaired cognitive ability. They also are often preoccupied with craving. Marijuana is very slow to leave the system and traces can be detected even after a month of abstinence. Sometimes patients fail to mention their marijuana use because they do not recognize the danger and they believe they can quit use of alcohol or other drugs and continue to use marijuana. Some cannot recognize this until several months of abstinence when the “brain fog” has started to recede. There are those who use Tylenol regularly and are not concerned because it isn’t an addictive drug. The problem is that Tylenol can be extremely toxic to the liver and kidneys, and in combination with alcohol or other drugs can end up being deadly. This is certainly not a complete list; however, it may help to inform you of the need for an accurate and complete history.
Next understand the protracted withdrawal syndrome. After the acute phase of withdrawal the next problem is the protracted withdrawal. The acute phase of withdrawal with alcohol is usually only a few days, withdrawal varies depending on the drug or drugs that were used. The protracted withdrawal syndrome is caused by malnutrition, autonomic nervous system damage, cortical atrophy and brain amine deficiency. The alcoholism interferes with nutrition on several levels so even when the alcoholic eats regularly and takes supplements, he/she still is malnourished. Work has been done to show that alcoholics in sobriety have problems reaching adequate serum levels of the B vitamins. Another area overlooked is the matter of minerals and this can be even more of a concern than the vitamins. Some of the best work on nutrition and addiction has been done by Katherine Ketcham. The nervous system has been damaged as has the brain chemistry; repair can take at least several months. Early recovering people will suffer from insomnia, agitation, moodiness, and craving for alcohol or other drugs.
Much of the suffering from the protracted withdrawal syndrome can be avoided with education followed by proper treatment. Ordinary knowledge of nutrition is not necessarily adequate to address the nutritional problems of the early recovering alcoholic or addict. One of the dangers of relying on healthcare professionals who do not have training in addiction recovery is that the symptoms resulting from the protracted withdrawal syndrome are often mistakenly understood for psychiatric problems. This can result in frustration and relapse for the patient; and often additional time and money is wasted. I am not denying that psychological damage has been done by the addiction process, I am clarifying that it is only part of the underlying problems. There are those (even in healthcare) who believe that once the acute detoxification is completed the person is back to normal, and any problems that show up after that are not related to the addiction process. That is as simple-minded thinking as believing that if a truck runs over your foot, as soon as the truck is gone the foot should be back to normal.
Don’t forget that physical recovery from alcoholism takes a minimum of three to five years. The good news is that for those that get the right recovery information and treatment, after about three months you will feel much better. Often I have had patients came back after a month and say “I am so much better - finally I am back to normal.” This frequently goes on for a year or more and at some point they will say “I forgot just how good it feels to be normal.” Usually, with good care, they level off at about five years. You will only be able to assess how miserable your addiction was after the fact.
If you use prescription or nonprescription medication always check with you pharmacist to learn if there is any addiction potential or other possible recovery concerns.
| | Volume 1, Number 8
I have heard feedback about what works for recovery and what gets in the way of recovery from patients who have anywhere from a few months to thirty years or more of sobriety. I have been most impressed by the stories of how often the helping professionals were one of the obstacles on the way to sobriety.
In the early eighties I did a study on one hundred alcoholics (some also used other drugs) through UC Berkeley Extension. All had completed three to five weeks of inpatient treatment and were offered intensive follow-up. Out of one hundred about fifty percent didn’t drink or use for the full year. Twenty-five percent used one time up to a maximum of forty eight hours. The other twenty-five percent returned to their usual alcohol use or could not be monitored close enough to count in anything but the using column.
Some of the results didn’t fit with what I believed at the time about relapse. The first thing I didn’t expect was what most of those who relapsed said about the same thing: “I don’t know why I drank, things were never better.” The ones who went regularly to twelve step meetings seemed to fit into two groups: those who went to a lot of meetings and those who did step work that included a fifth step. Those who just went to meetings stayed sober at a rate of fifty percent; those who did significant step work stayed sober at a rate of ninety-five percent.
As I carefully looked over other studies which were much more detailed and organized I found similar results.
Some Thoughts About Surviving Early Recovery
Old beliefs die hard and in addiction treatment and the mental health system some have a belief system that is more like a religion than a science. It is popular to believe alcoholics drink because they feel inadequate, have suffered a traumatic event and/or are emotionally fragile. If you believe that, then what follows is to treat the trauma or lower the emotional distress and their drinking will cease or return to normal. That sounds good but the only problem is it doesn’t work in real life.
When A.A. first started they were concerned that maybe recovering alcoholics couldn’t stand the emotional pressure others faced. When World War II started there was some fear that the sober alcoholics wouldn’t be able to stand up under the pressure the other solders encountered. What really happened altered their belief, those who served on the war front had a better record of staying sober than those who didn’t serve. They conducted themselves at least as good as any of the other solders.
Some years later numerous studies were completed to attempt to prove alcoholics had more mental illness and/or personality disorders than the general population. Stubbornly, it kept showing up that prior to the onset of the alcoholism the rate of mental illness was the same as the general population. Another troubling fact also adding to the puzzle was that after a few years of sobriety the rate of mental illness in alcoholics was the same as the general population.
One fact that became clear to all but the most stubborn was that the mental illness that showed up in advanced alcoholics was the result of the alcoholism and not the cause. The Natural History of Alcoholism, by George E. Vaillant, was awarded the Biennial Jellinek Memorial Fund Prize for the Best Research on Alcohol Abuse in the World. Sidney Cohen, M.D. was a powerful force in a new understanding of addictive disease by the many books he authored on addictive disease. There were also many others who were equally helpful.
However helpful the above mentioned information was on studies and research on alcoholism, the information was read by only a few professionals in the field, often medical doctors.
When Sidney Cohen, M.D. was asked about “the addictive personality” he said there is none. This was reinforced by other respected sources.
What really changed the understanding for most people was “Under the Influence: A Guide to the Myths and Realities of Alcoholism” by James Robert Milam and Katherine Ketcham. This was information based on realistic studies and research and presented in a style that was easy for anyone to read or look up a question. This started a change in much of treatment and it started many alcoholics on the road to recovery.
Shortly after the book came out in paperback we kept a stock at the hospital chemical dependency program. We gave patients a copy and at times I would give a copy to a person who came for an interview but didn’t get admitted to the program. I started hearing back from people who said it helped them get a new understanding of addiction and was a primary reason why they started recovery.
One case was particularly significant. It was a department head in the same hospital where I worked. She wouldn’t even discuss her problem until she was satisfied it would be absolutely confidential. She said if it got out she would lose her job. All the solutions to her alcohol problem were rejected by her except a “maybe” on A.A. I gave her a copy of”Under the Influence” before she left. For several months I only saw her in the hallway or cafeteria but she looked OK.
One day after several months she stopped in and saw me in the office and said she had been sober since very shortly after that first session. She now was going to A.A. and felt great. She said the key was reading “Under the Influence” because it made sense about alcoholism and for the first time it significantly reduced her shame. She said she had talked to therapists before and it had only increased her shame and reduced her self confidence. She kept getting this picture presented to her that she was this emotionally fragile, pathetically neurotic female and the stresses of ordinary life were just too much for her and that is why she drank. She said, “I now realize what a bunch of bullshit I was getting, while I made their car payments.” Although she had insurance coverage for her therapy sessions she paid for them in cash, she didn’t want word to get back through the HR department.
Shame is one of the great barriers to treatment and recovery from alcoholism. At times it can be obvious and other times it is very subtle. When going to treatment for alcoholism, whether it is inpatient or outpatient, it frequently is one of the worst times in the person’s life and any talking down to the patient or discounting what they say can put a real damper on their treatment.
I have heard endless complaints about A.A. Most of the time it had nothing to do with what A.A. has to offer, it usually is someone who is speaking for A.A. and has little or no knowledge of the program. I have heard psychologists complain about how A.A. is too religious and a cult plus making other negative comments. I asked one of them, “Have you ever been to a meeting?” he said “No.”, or “Have you ever read the Big Book?” he said “No.”, “Have you ever read the twelve steps?” again it was “No.” Yet this person felt qualified to make lengthy negative judgments.
Many people don’t realize there is no shortage of atheists and agnostics in A.A. who are doing just fine.
Sponsors at times can cause problems. I have had patients tell me that their sponsors told them to divorce their wives, quit taking their medication, and ignore their physician’s advice. The above advice can be devastating to a newly recovering person. Sometimes even deadly.
An important point here is that it can easily be avoided by going to the Big Book or Twelve by Twelve and reading the truth. So if you are skeptical of anyone’s advice about A.A. go to the source material. Don’t believe anyone unless it can be backed up in A.A. approved literature.
When you are getting recovery advice you may be betting your life on that information, so just like any other potentially terminal illness make sure it is the best information available.
How do you do that? Information is available on counselor certification and/or licensure
through NAADAC, a national organization, and they can direct you to your state organization. ASAM has both physician information and referral and medical information regarding addiction treatment. Feel free to question any healthcare professional about their background in addiction treatment and if it doesn’t completely satisfy you go elsewhere.
If the situation is urgent and you have little time, go to my website and you will find a link to a government treatment facility locator where you can find treatment help in your local area. Another source is to see your primary care physician or a local physician; most have some knowledge of addiction and can help with referral.
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