Friday, February 28, 2014

Disease vs. Choice -- Neither Is Correct

I was recently struck by part of this entry at Naltrexone Confidential:

I’m talking specifically about the determinism vs. free will argument here -  or, to simplify it,  the “disease vs. choice debate” and The Sinclair Method’s place in it… hence why I’ve found myself being harangued by a number of different individuals about how I shouldn’t be “advocating pills” because alcoholism is just “a choice” and blah, blah, blah.

Yeah.  Some of the "it's a choice" folks are almost as militant as the Steppers.

I can see where they're coming from.  Addiction isn't a disease.  Nobody is literally born an addict.  Some people think they were because they fastened on to alcohol immediately after discovering it, but that's not the same thing.  The only way to develop an addiction is through practice.  Even thought I sought alcohol with great determination almost as soon as I discovered it, that was an immature way of coping with pain rather than a true addiction.  The true addiction came later, gradually, as I trained myself into alcohol-seeking behavior.

If addiction isn't a disease, then what is it?  Some conclude that it must be a choice.  Addicts must be choosing their addiction out of a misguided belief that it's their best option for happiness at that time.  This fits some people's experience in that they either matured out of their addictions or stopped through willpower, but (again) it's not the whole story.  I admire people who decide to ditch an addiction and plow through the cravings and deprivation effect by sheer willpower, but that doesn't mean everyone can do it.  For people whose addictions have progressed far enough, changed lives and determination are often not enough.

Put simply, addiction is conditioned behavior.  We humans are different from rats in many ways, but some things are universal, and that's one of them.  Once we're conditioned to drink heavily on a regular basis, we'll keep doing it until something changes.

That something may be as simple as a realization that this life sucks and we'll do whatever's needed to change it.  For most of us, it isn't.

You know how 6% of ex-smokers quit cold turkey and never go back?  You know how the other 94% point out that they're lucky jerks, and the 6% keep insisting that anyone can do it since they did it themselves?  It's sort of like that.  Anyone who passes through youthful smoking and becomes a "real" smoker is likely to have great difficulty quitting.  That doesn't mean that smoking is a disease, but it sure as heck isn't a simple preference, or even a considered choice for personal happiness.

Alcohol addiction is similar in some ways.  No, it's not a disease.  Yes, it's possible to quit just by knocking it off.  That doesn't mean that everyone will be able to do it.  Many won't.

For those people, the thoroughly conditioned who can't just knock it off because they've decided they want a better life, deconditioning is a rather obvious approach which is too often overlooked.

Wednesday, February 19, 2014

Why We Drank: Old Wounds

While doing more thinking about the roots of addiction, I naturally did some research as well.  One of the factors most commonly discussed is unresolved childhood issues.  Certainly there's a strong correlation between abusive childhoods and addiction; that much is well established.  However, there's no really good therapy for resolving unresolved issues from childhood and adolescence.  Some say one thing helped and some say another thing helped, but those people are usually reporting from a time immediately after the therapy.  There's a noticeable shortage of people saying that they used a given therapy ten years ago and have been more content ever since.

I do believe that some of us are wired differently from others in this respect.  Some people seem to recover naturally, and they often don't understand those of us who don't.  They offer advice like "let it go" and "the past is past" without understanding that it just doesn't work that way for some.  It doesn't "go" despite our active attempts to drive it away, and our lives are not the past.

So -- we are all of our ages at once?  That reminds me of the paradigm of the inner child.

While reading about these therapies, I noticed that many of them are about loving our inner child.  We imagine cuddling our infant selves, whispering how we're so glad they're here and how we accept and love them exactly as they are, that they are unique and special and irreplaceable.

I tried this a couple of times, and found it to be just as silly and pointless as it sounded.  I can't help thinking that taking this seriously sounds like a recipe for narcissism.

"Expects to be recognized as superior and special, without superior accomplishments."
"Expects constant attention, admiration and positive reinforcement from others."

Hmm.  Narcissism is a popular diagnosis these days.  Maybe it's just the latest diagnostic fad, but is it possible that the massive self-acceptance and self-praise which became popular in the mid-80s led to an actual increase in narcissism?  I think it might be.

I was one of many who were struck by an article pointing out that our accomplishments are much more important than simply existing.  Slapping on generically positive labels like "nice" doesn't actually make us better people.

Reading the comments on that article is time-consuming but instructive.  Those who took it to heart in 2012 found themselves with better and happier lives in 2013.  Those who disagreed with it . . . no news.  Not a single person reported that self-esteem enhancement, sans accomplishment, resulted in a better life.

This is really just common sense.  We all know, in our heart of hearts, that chanting "I am unique and special" a thousand times has less impact than one single other person saying, "Wow, you are really something special."  So how do we get them to say it?  It's pointless to expect to be "recognized as superior and special, without superior accomplishments" a la narcissism.  We have to do something which merits hearing it.

Your father shamed you, your mother belittled you, your schoolmates bullied you.  So did mine.  I'm not going to tell you to "let it go," because we both know that doesn't work.  I am going to tell you that I, at least, feel a stronger sense of self-worth when I'm doing something to increase my worth than when I offer imaginary comfort to my wounded past self.  Increasing my fluency in Spanish is better therapy than trying to convince myself that I am lovable no matter what.

Tuesday, February 18, 2014

"How Are You Doing? Want to Talk?"

Some people don't like the "cured" term.  They'd rather use "in remission," or use a non-disease paradigm and go with "problem solved" or such.  There are a lot of good arguments against "cured," but I have to call this state something, so I'll go with the c-word for now.

Many, many people don't understand what it means to be cured of an addiction.  Perhaps they're used to the more dramatic paradigm of struggling with inner demons every day, and have trouble believing that those demons can simply be cured.  Perhaps they've heard too much 12-Step stuff and are used to people being endlessly "in recovery" and never recovered.  Perhaps they can't understand how a cure could exist without quickly becoming famous, or don't see how alcohol could be such a big part of our lives and then rather suddenly become unimportant.

One of these people, no doubt meaning well, may ask you if you want to talk about it.  How are you doing?  How's the recovery?  How are you managing a post-addiction life?  "Fine, done, and fine" is true, but doesn't seem to satisfy them.  Explaining that you're truly cured and are no longer an addict may lead to a lot of fireworks if the person is accustomed to the model of endless one-day-at-a-time recovery, but may be the best way to go for the long term. The truth of your words will become evident as you keep living your life.

We cured folks generally just want to get on with our lives, not waste time wallowing in the past.  I personally have to remind myself to come back to this blog -- I have other things I'd rather be doing.  We should realize that this isn't how most people think of addiction, though.  They've been trained to think that people must be "in a program" (as they say on TV) and fighting a bartending inner demon.  It's worthwhile to take a few minutes to explain that the addiction is completely over and that there's really, truly nothing to discuss.

Friday, February 14, 2014

Alcohol Shovelers

I've had the misfortune of knowing multiple people whom I think of as "food pushers" or "food shovelers."  These are folks who want other people to eat more and more and more.

They're not to be confused with people who inadvertently push food once in a while.  I think some of those are honestly ignorant about varieties of normal food consumption.  Consider a man on a date who's surprised that she "didn't eat very much" when in fact she ate a perfectly normal amount of food for a woman, or someone who offers a huge spread for lunch because her family ate dinner at noon, or a cultural difference where one person feels required to offer as long as the other accepts (while the other feels required to accept whatever the other offers, leading to mutual misery).  The common thread is that at least one party truly doesn't know the norms of the other, so that they can differ without either being wrong.

Honest ignorance of others' norms will clear up with time, but some people never seem to get it cleared up.  Indeed, some people plainly just don't care.  I believe these people have some sort of problem.

They monitor you at dinner gatherings, demanding that you eat double helpings of every dish.  When you have finished eating, they bellow repeated offers to hand you more food, any food, as long as you eat more.  If you decline a second brownie they will offer it six more times, then ignore all your refusals to hand you the brownie plate with a knowing smile.  They may even scoop food directly onto your plate, ignoring the fact that this is a gross violation of personal space.  They aren't necessarily prodigious eaters themselves, but they are bound and determined that their target will consume huge quantities of food.

They drive me nuts.

I've long wondered about people who worry about how to explain that they no longer drink or no longer drink heavily.  Why do they think that others will even notice?  Don't they know how to decline?  Why don't they just say that they're fine, thanks, and get on with the business at hand?  Don't they know the common convention of saying that they're "fine" or "okay" to indicate that no further offers are needed?

As I've heard more stories from people using the Sinclair Method, I've come to understand that there really are people out there who closely monitor other people's alcohol consumption and press them -- sometimes quite hard -- to overdrink.  I don't know if these people are alcohol addicts seeking company or are in the grip of some very strange notions about hosting or are just crazy.  Alcohol shoveling makes no more sense to me than does food shoveling, but apparently it exists.

How to handle it?  I know of no way to get these people to stop; the best we can do is to just manage the situation without being forced into overconsumption by them.  Essentially, this means declining all verbal offers and ignoring forced food/drink completely.  If someone offers you a beer twelve times, you decline twelve times.  If he then holds a glass of beer out to you, you ignore the proffered glass and speak of something else.  If he grabs your water cup, dumps out the water, and fills the cup with beer, you ignore the beer and get yourself a new cup of water.

There is no point in trying to reform these people.  If you decline three times and then refuse to decline a fourth because the shoveler is being rude, your silence will be taken as consent and you'll end up with item X.  If you give a reason, even an inarguable one like "I'm full," they will find a way to argue.  Even if you get completely fed up and dump the unwanted item into the sink while repeating that you don't want it, they'll just hand you another portion along with some absurd reason why you should consume it.

These people are infuriating, but fortunately they're not very common.  Most civilized human beings will accept "no, thanks" as answer either upon first hearing or after you've assured them that "I'm fine, thanks."  The shovelers are . . . odd.

Even if you're facing a contingent of several of them, so that they seem to normalize each other, remember -- they're the ones with the problem, not you.  You're not weird or rude for declining.  They're weird and rude for insisting so forcefully.

Wednesday, February 5, 2014

Stepping Is Harmful

Whenever effective new therapies for alcohol addiction are developed, they're presented with an odd timidity.  Most writeups begin by saying that they have absolutely nothing against AA, they know many people recovering in AA, it's a wonderful program which has saved millions of lives, etc.  Even The Cure For Alcoholism, written specifically to tell more people about an actual medical therapy that actually works, opens with the traditional kowtow to AA.

AA is not a wonderful program, and it has not saved millions of lives.  AA itself claims to have about two million members worldwide.  Even if zero of those people were coerced (unlikely) and even if every one of them were abstinent (ha!), we still could not say that "AA has saved millions of lives" because the great majority would not die if they left AA.  It did not save their lives.  They may say it did, and may even believe it did since they are threatened with "jails, institutions, or death" if they leave, but in fact it is one of the least successful recovery methods.

AA is actually harmful.  Every time its success rate has been examined by an objective party, it has proved to be no better than the natural history -- that is, the number of people who become abstinent in AA is the same as the number who become abstinent with no therapy or formal action at all.

But at least it doesn't hurt, right?

Well, actually, it does.  People exposed to AA are more likely to binge-drink.  Not only are AA members nine times more likely to binge-drink than people who receive real therapy, they're five times more likely to binge-drink than a control group who receives no intervention at all  (Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105).

AA causes binge-drinking, and it's binges which generally lead to arrests, DUI accidents, accidental deaths, and the other worst consequences of heavy drinking.

How does AA do so much damage?

The biggest problem is its insistence that we are, in AA's words, "powerless over alcohol."  People feeling the strong compulsion of conditioning may actually believe this.  Even those who know it's nonsense intellectually will be subconsciously affected after hearing it repeated daily for years -- that's just how humans are made.

And now for the big question:  Why am I talking about AA's bait-and-switch failure on a blog focused on the Sinclair Method?

It's because I recently encountered a sad case of someone trying to combine AA and TSM.  The poor guy has been taught that alcohol is too much for him to manage, and even though the conditioning is now broken, he continues to drink too much.

He is not one of the 10% who are not helped by the method.  He's drinking much less than the truly prodigious quantities he used to consume, which would not be true if he were one of the unfortunate 10%.  Yet he says, "I'm pretty sure that I am powerless over alcohol," even though his own direct experience contradicts that assertion.  He's back in the driver's seat, but continues to drive his life where AA told him he inevitably must.

If you've had Step experience that lasted for any length of time, you may need to get 12-Step dogma out of your head before you can accept your own cure.  You are not a helpless person who needs a miracle from a Higher Power.  You're simply a conditioned individual who can break the conditioning and resume life.

Sunday, February 2, 2014

Yes, You Must Drink Alcohol

Some people don't seem to quite get the gist of pharmacological extinction.  If taking naltrexone before drinking is good, taking naltrexone as often as possible must be even better, right?  If naltrexone is an anti-addiction drug, we should take it as often as possible, right?

No, actually.  Taking naltrexone daily is better than nothing -- it was originally marketed as an anti-craving drug, and it's not completely useless in that respect -- but it's most effective when taken an hour before drinking alcohol.

Imagine a rat who has learned to press a lever to get peanut butter.  His life in a cage is pretty boring, so he presses the lever all day long.  At some point he will be thoroughly conditioned to press the lever, and will keep pressing it even if moved to a better environment with lots of climbing and rat toys and such.  He's addicted.

The rat will keep seeking that lever, because he's addicted to it.  He can unlearn the addiction, but the lever must be available for him to do that.  If he presses the lever and nothing happens, he'll gradually turn his attention to other things.  

That lever must be there, though.  If the lever is simply removed then he may do other things, but he'll be back pushing that lever as soon as the lever is reintroduced.

He can't unlearn his addiction to the lever without pressing the lever futilely.  The lever -- in our case, the alcohol -- must be present in order for him to learn that the lever no longer produces peanut butter.

If he presses the lever without getting peanut butter, his addiction will be extinguished over time.  If he doesn't have the lever at all, the addiction will simply lie dormant.