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31 October 2014

I received an interesting email from a friend today who writes about the recovery and substance abuse industry. She asked me why I thought that places like Huffington Post, and Salon, and are so reliably anti-treatment, anti-12 step, and even anti-addiction as a concept. Obviously, I wish I knew, and I wish I knew how to fix it. All I can do is speculate.

One of the things we talk about in AA is that it’s ok that people outside the program don’t get it. We don’t need you to get it. And most of the people writing about substance abuse, and studying addictions, and developing treatments are not addicts or alcoholics. Most of them don’t understand how if feels and what it means to be an addict. That does not mean they have nothing to contribute.

Enormous strides in treating alcoholism and addiction have been made by people who have no personal history with the disease. We know now how to prevent lethal seizures in alcohol detox, for example. We have ways to block uptake of opiates. All kinds of medicines which assist in treatment and recovery. And that’s a good thing. But medicine alone cannot treat addiction, because real recovery requires the engagement of the addict to progress and prevent relapse. Unless the individual is engaged, they will accept no medicine. And if they are engaged, once through the initial detox, they need none.

But the denial that addiction even exists? That’s a peculiar state of denial. I can understand the denial of one’s own addiction. I did that for years. But to deny that addiction exists, as some on the alternative-medicine left do, is fundamentally foreign to me. There’s a great difficulty in getting good evidence about effective treatment for addiction. But there is no difficulty at all demonstrating that addiction exists in humans and other animals.

At the core, I don’t think this is about addiction. I think there’s a strange complementary nature between the anti-science right and the anti-medicine left. And I think both are probably about hope, and about searching for control in a world that defies us. When we are confronted by terrifying things that either science insists are happening or that medicine cannot cure, it is seductive to decide that science and medicine must be wrong, rather than our world is huge and horrifying and uncontrollable.

Autism seems like a devastating diagnosis. So if I believe my child will not develop it if I don’t vaccinate, if I believe I can assert control, then that seems like a rational thing to do. And if my fear is substantial enough, and my need for control powerful enough, then I will be recalcitrant to the truth that vaccines and autism are entirely unrelated. Similarly, if climate change threatens my way of life, my economy, my cultural identity, and my fear and my need for control are enough, I will search for anything I can cling to that says I don’t need to change.

Hope and fear are useful tools. There are reasons we can experience them and they serve us in myriad ways. But they can become toxic when they become paralyzing. They can lead us to making terrible decisions that fly in the face of the truth. That then can combine with defensiveness, or arrogance, or greed, to produce phenomena like “Rolling Coal”, or the vaccination rate in some southern California enclaves dropping to levels normally associated with war-torn failed states, or bans on research into gun violence, or homeopathy for cancer.

In recovery we work to examine how our fears and our assumptions and expectations drive us. Now, I’ll make no claims about how recovery impacts a person’s politics, but in Alcoholics Anonymous we do have, right in our literature, that we are not doctors, and that listening to physicians is appropriate in recovery. Though, many will claim that the spiritual aspects of 12-step programs are no different from homeopathy. And that’s fine. They don’t need to get it. As I’ve written here many times, I think there is absolutely nothing magical about the spiritual aspect of AA, and I am not a spiritual person. But these concepts are useful tools for recovering from specific aspects of addiction. At least, my manifestation of addiction.

I am not an “evidence-based” stickler when it comes to medicine, because I have seen what passes for “evidence” in many cases (read everything by Dr. Trish Greenhalgh, right now.) and it’s disturbing what scientists and physicians will declare constitutes evidence, and then how they’ll apply it in deeply unscientific ways. And I believe that in many cases, the plural of anecdote in fact is evidence, because we lack the capacity to study outcomes in a metrizable way.

But we should not deny or ignore evidence where it exists, and is good. And there is no better evidence in any field of medicine than there is for the fact that vaccines are safe, and have saved millions, maybe billions, of lives. Just as there is ironclad evidence that the climate is warming. Nor should we ignore obvious truths simply because we don’t know how to perform a randomized controlled trial on them.

But mostly, I think so much of this denial stems from feeling frail and hopeless in the face of enormous, implacable nature. Nature that does not care what we want, and is not aware we exist. But upon which we have profound impacts regardless of our intentions or beliefs. We are thirsty and dowsing. Any drops of water we find feel like confirmation we looked in the right spot. But often, there is a river just beyond the knoll where we could simply kneel, and drink.

Stuck in Acceptance.

29 October 2014

One of the core elements of the program of Alcoholics Anonymous is the Serenity Prayer. I’m sure everyone knows it, but for reference:

God, grant me the serenity to accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference.

It actually goes on from there, I’m told, and has additional verses. But for sobriety, those three lines have all the important messages. Alcoholics, as a rule, tend to rage against the things we cannot change, trying to correct them over and over, failing, and developing toxic resentments that end up ruling us, driving us to try to drink them away. Resentment is more poisonous than alcohol. And so learning acceptance, learning to relent from steel grip on rage and simply allow the world to have its way is a powerful tool in our recovery.

Acceptance is the bane of madness. My house leaks. The new door will be more than $2000. This is after many thousands of dollars of plumbing and mold and electrics work. Such is life. I can accept it. I’m in a position to be responsive to these demands, and other courses of action which I might have taken would likely have further disrupted my peace of mind and likely not have resulted in the kind of satisfaction I fantasize about. By focusing on acceptance, and thinking through my circumstances, I can come to peace about the situation, and shed my resentment.

But just as the prayer goes on, so must we. It is possible to get stuck in acceptance, and not move forward in life. Another common character defect of alcoholics (and many others) is to wallow in victimhood. This can masquerade as acceptance fairly easily. We can tell ourselves, “I accept where I am in my life, and I must accept the things I cannot change.” And not actually examine if we have the strength and capacity and opportunity to change our circumstances. This can rapidly become a kind of indulgent self-pity. Poor me, subject to forces I cannot contend with, unable to make progress.

This is especially troublesome for us when we truly are legitimate victims of circumstances beyond our control. Health issues, societal structures, family problems, crimes. These are real things that we cannot control which cause disruptions and difficulties which we must learn to accept if we are not to swim in a morass of resentment. To live freely, we must come to acceptance with real problems.

But there comes a point when we need to step beyond mere acceptance. We need to relinquish our victimhood and take up our courage, and change what we can. At some point, even the most serious and legitimate affronts become wallows that we languish in if we do not move ourselves on. And we cannot blame others for seeing us as perpetual victims – and for their diminished sympathies – when we do not make efforts to rise above the difficulties in our lives. Acceptance of our circumstances is crucial to sobriety, to serenity. But we do not end there.

Change takes courage, and investment, and labor. And once we have accepted our misfortunes, it is time to overcome them.

A Resolution in October.

20 October 2014

I am a goal-driven person. That’s how my ambition manifests. I often think, when imagining taking on some new project, that “I don’t want to die without having done it.” That’s how I felt about writing my symphony, a work still unfinished. I will work on it again one day. I think I’ll finish it. I will probably never publish it (I don’t have the slightest idea how one publishes music). But I’ll finish it. Probably.

Lately, my goals have been professional, and relational, and physical. Professionally, I am achieving the things I set out to achieve. I’m advancing at work. My papers are getting slowly-but-surely published in venues I’m pleased to have them in. I’ve been promoted and my work is well received in my institution. Soon I will have employees who report to me, and my influence will be even more pronounced here. Other people who are moving up the chain of management are invested in my efforts. I’m excited.

My relationship is blossoming. I feel less and less like this is an appropriate venue to discuss it. But I am feeling more closely and more intimately connected in a romantic partnership than I ever have. I feel grateful and fortunate to have someone understanding, supportive, exciting, ambitious, adventurous, and thoughtful to share my life with. It’s more than I deserve. It’s far, far better than I’ve earned.

My physical goals have become prominent for me. Mostly, these revolve around running. This weekend, BB and I ran a total of 12 miles, 5 Saturday and 7 Sunday. We took the pace easy and I was very pleased that both days felt like a nice jog in the park. Other people are no longer expected to be impressed with those sorts of things. I remain gobsmacked that I was an obese alcoholic pack-a-day smoker and now I can run 7 miles and it’s a nice easy jog in the park.

The last goal I set about running was that I would run a half-marathon without walking any of it. I did that. I’ve done that twice now. Lately, I’ve been running faster, and my slow runs have been feeling easier. I’m improving dramatically. Part of the reason is that I’m working harder at running faster, part of the reason is that I’m going to the gym and working with a personal trainer. I’m trying hard to avoid the fate of my father, who never managed his diabetes, and had a debilitating stroke.

So. I’m setting a new goal. I said I wasn’t going to run a marathon, and I still might not. But what I have found is that I really appreciate having organized races to prepare for, because they keep me from slacking off. So I’ve signed up to run the Philadelphia half-marathon just before Thanksgiving, and the Virginia Beach half-marathon in March. But those aren’t my goal. A goal must be bigger than repeating something I’ve already done.

So here’s my goal for 2015: I will run at least 4 competitive (i.e., organized races) half-marathons. If I do decide to run a full marathon, then that will count as two. While I’d love to run one under two hours, or something like that, I’m not going to set specific speed goals. Not here anyway (BB and I are working on running faster, but we haven’t set a specific pace we want to hit. The number “2:10″ has been thrown around for Virginia Beach. If we hit that, I’ll be happy.).

That’s the goal. 52.4 competitive miles in 2015. Which means probably at least 10 times that number in preparation. Right now I’m running about 18-20 miles a week. That’s plenty to stay fit for half marathons, with a brief ramp-up for the weeks before race day. But if I’m going to run a full marathon, I’m going to need to push my weekly mileage out to at least 40 shortly before the race.

So here we go. Run like hell.

Why Spirituality?

14 October 2014

One very important aspect of recovery is the “maintenance of our spiritual condition”. Now, as a person who is not religious and not even particularly spiritual in any traditional sense (though I used to be), I have to consider deeply what that means. Why do we associate sobriety with spirituality? How does that help me recover? The idea that “God strikes us sober” is useful to many people in recovery, and I support that where it is useful to individuals. But it is not a concept that has ever been relevant to my own journey in sobriety.

To me, spirituality is a concept more nebulous and less… supernatural. I find spirituality to be very natural. I think it’s an ordinary aspect of the human condition. Spirituality is one of the natural ways we try to find our place in the world, in society. Spirituality is, to me, about connectedness and awareness of things larger than me. About seeking accordance and harmony between what is inside me, and what it outside. Arranging my mind to be in a state of peace with the things in the world that I cannot change.

I don’t pray. But I see no reason that prayer is incompatible with a deityless nature. I am fond of the aphorism that prayer is not about influencing the thing prayed to, but rather about influencing the thing doing the praying. As such, I see prayer as little different from meditation, or simple mindfulness. When I attempt to find a quiet space in my mind, in my heart, in whatever my soul is, I am doing something like prayer. I am consciously attempting to bring my self into alignment with the world as I understand it.

This helps with sobriety because being serene is a crucial tool in abstinence. Many of us drink to quiet raging waters in our spirits, in our consciences. Maintenance of our serenity deprives our addictions of leverage to drive us back toward inebriation. Because alcohol is anesthesia to me. It soothes inflammation of the soul. At least, that’s what my mind tells me. That’s what my addiction wants me to believe.

And so engaging with our concepts of spirituality provides us with an alternative balm for crises of mind and heart. I believe that that is a nearly-universal thing that humans do, and that it is to our credit that we do. Looking to God, to Nature, to spiritual abstracts for solace and comfort is not a sign of weakness or delusion. It is engaging with a natural process within ourselves which – for some of us – demonstrably improves our mood, resilience, and ability to participate in normal society.

Which – for some of us – materially aides our efforts to remain abstinent from artificial intoxicants which plague us and drive us to behave antisocially. We claim spiritual progress. I understand these things differently today than I did before. And differently today than I will in times to come. But today, I believe that spirituality need be nothing supernatural to be real, and tangible, and useful.

Feeling Other.

8 October 2014

One characteristic that is common to most of us in AA is the sense that we feel “other” from the mainstream of society. We don’t belong. We don’t get it. We don’t feel comfortable participating in ordinary social and societal situations. We feel outcast, downcast; belittled and degraded. We seek ways to feel less like this.

Alcohol helps. In the beginning, alcohol helps. We start to find ways to participate. We feel less like peeling off our own skin when we’ve had a drink or two. There’s a reason alcohol is called a “social lubricant”. We feel in dire need of anything to help us feel less like we are stuck, frozen, embarrassed, and out of place.

I think a lot of people who aren’t alcoholics have the same anxieties and discomfiture. And I think alcohol often helps them feel like they fit in too. But for us, we alcoholics, alcohol is a very temporary solution. Because even as it allays our own toxic discomfort, it siphons it off and distributes it to others. People become uncomfortable around us.

We drink too much. We behave unpredictably and inappropriately. Alcohol frees our baser instincts. We act out socially, sexually, physically. We feel powerful when we’re drunk, in the beginning. We feel compelled to drink more. We do. We abandon, or are shunned by, those who do not drink like we do.

And so the drug we took to address our isolation becomes an isolating feature of our lives. We drink more to overcome it. As we do, we are further marginalized. Eventually, loneliness is the dominating landscape of our existence. Alcohol fuels depression and humiliation. It gets worse.

In recovery, this sense of otherness has to be addressed. We need to find communities that adopt us, embrace us. Alcoholics Anonymous is one such community. Where we come together, castaways from the same shipwreck, and understand what we’ve been through. How we debased ourselves and earned condemnation. We dedicate ourselves to moving back towards life, while remembering why and how we lost our purchase on it in the first place.

But we may feel that otherness still, in other environments. I do. I feel useless and isolated an enormous amount of the time. In communities that are supportive and embracing. I try desperately to fit in, only to find myself feeling flung ever further from the center. I fabulate vile scorn from the most innocuous behaviors on the part of those I’d most like to feel accepted by. Invented cordons blocking me from social hierarchies I’d like to ascend.

I find myself despising the things I said I wanted. Succumbing to spirals of relegation. Letting grow derelict gardens I once thought I’d carefully tend. Because I cannot see myself as belonging there. I am not a tiller of that soil, that earth where good things grow and kind people celebrate the flourishing of one another’s labors.

I cannot sit among those whom I would sit among. I am not of them. My desire to contribute opinion and influence in those venues is just gonging on the wrong beats.

I have discovered how not to drink. I have discovered places where I belong. But I have not yet learned to be satisfied contributing in places where I understand the rules. Where I’m part of the bedrock. I reach out to prove I belong part of larger communities and howl to make myself heard when I don’t know what I’m saying. While my thoughts are ill-considered and poorly defined. Undefendable.

I don’t know where I belong. But wherever I am, it seems, the answer is, “Not here.”


3 October 2014

I’ve been trying to run faster the past week. When I had a personal trainer in St. Louis, she told me: “If you want to run faster, you have to run faster.” As there often is, there’s complexity in tautology. For a while, I got a little faster just by going out and running at the same effort level. Because I was getting into shape, and I could just sort of improve, without a huge amount of effort being put into speed. Don’t get me wrong, there was a huge amount of effort just put in to moving. But I wasn’t trying to go fast.

And I didn’t really think I wanted to go fast. I had a basic goal of running 10K in under an hour, which requires about 9:40 miles. That’s a good clip, but it isn’t anything too impressive. But it’s a reasonably fast jogging speed for a late 30s dude, which is what I was at the time. And I did that. Last year, in the spring of 2013, I ran ten kilometers in about 59:30, and I was happy, and it felt like a big accomplishment. Then I stopped trying to run any faster, and started trying to run further. I got slower, but that was ok. Because I was running 10, 11, 13 miles at a time, and that was a major accomplishment of its own.

Now, having run two half-marathons with BB, I am torn between two goals. I want to get faster, because faster is fitter and my main goal in all of this is to not get diabetes. For that, I need to stay trim, and I need to have good cardiovascular fitness. But I also am finding myself more and more pulled in by the ambition of completing a full marathon. At least once. I think.

But I’m also compelled by the idea of, say, finishing a half marathon in under two hours, which is a wildly ambitious goal for me. That requires running 13.1 miles in a row faster than 9:10 min/mile. That seems almost impossible. Or at least it did, until yesterday. Yesterday, I ran 10K (6.21 miles) in 55:22. That’s 8:52 min/mile. Which is crazy fast, for me. Tuesday, I ran 5K (3.11 miles) in 25:57, or about 8:18 min/mile. Which is blazing speed for me. Like, beyond what I thought was possible.

But if you want to run faster, you have to run faster. I had to increase my effort level, be prepared to fail, and run like hell. And I did. And I didn’t fail. And maybe, that 2 hour half-marathon is a possibility. Maybe that full marathon is on the horizon. My friend @scicurious tells me that running faster will help me run further too. If for no other reason than that I can go a further distance in the same amount of time.

And then, BB and I can run together, faster, further. And maybe I can stave off the specter of metabolic infirmity until I’m old and tired. I feel good. I’m doing things I didn’t know I could do. Things I didn’t know I wanted to try. But now I’m here. This is kind of amazing to me. And I’m happy. I’m going to get the image below inked on my right calf. Run like hell.


Contribution to Science!

2 October 2014

Hurrah, haroo! I have had a paper accepted! It felt like it was never going to happen again. This is an exciting one for me because it is the first (and probably only) paper from my little tiny grant that I got shortly after arriving at MECMC. That grant paid for two interns for a year and a trip to London. The work resulted in policy shifts at my hospital, because the client department had quantified evidence to buttress their requests. And it resulted in this paper, where we describe the work as a case study and tell others how to do the work in their own environments.

I consider it a major success, especially because my interns, undergraduates at VFU and UHR respectively (OK, technically one has now graduated), are the co-first authors. I know some people don’t like co-firsts as a concept, and I’m aware of the problems. But they worked very hard, and collaborated constantly. In the “acknowledgements” we state, “Authors [a] and [b] are listed alphabetically.”

The journal is a mid-level medical journal with an audience of MDs, which is exactly what I’m going for, as I’ve written before. I know that it means that my work will not get the publicity that I might get if I were submitting to engineering journals. But I also believe that changing quality improvement practice means exposing medical decision-makers to this work prior to trying to convince them to do it in their own clinics.

It’s exciting to put my science/engineering out there for the world to use. I hope somebody bothers to read it.


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