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The Taper.

7 October 2015

Well we did it. We made it through to the taper. The taper is the period before the marathon where you ease up. From here on out, it’s hard to gain any fitness that will be relevant to the race. I’m as fit as I’m going to be. So now we relax and take to foot off the throttle so that we don’t get injured in the last couple of weeks leading up to the event. It’d be terrible to push hard all the way to the end and get a stress fracture and not be able to compete. We want to be ready and rested and on the way to our goal in 18 days.

So this week I have 10 more miles to run and then a 14 mile long run on Saturday. Our last long run was 21.3 miles last Saturday. That was a lot of work. At one point, going up a steep hill and talking at the same time, right at the 13 mile mark, I got dizzy and lightheaded and let myself tumble to the grass. I made a controlled-crash landing rather than try to stay upright and risk passing out and falling hard. BB gave me some salt, and I had some water and some calories and I felt better in 30 seconds, and finished the run. Eight more miles without a hitch.

Our pace, with several stops and road-crossings, etc., was down to 11:28. I expect we’ll be faster come the race day. But even if we aren’t, we’ll have done it, and I’ll be happy. I’m not afraid or ashamed to be slow. I just want to make it. And I think I can make it. I’m eager to pit myself against the road for 26.2 miles and see how I fare. I ran for more than four hours on Saturday. I’ll run for almost five in a couple weeks. I’m a little scared but very excited.

I’m hoping to feel something transformative. Drunk, smoker, obese. And now soon, none of those things. And a marathoner. How will that feel? I don’t know. Probably anticlimactic. My half marathon was a little. I’ll just wait and see. The beauty of recovery is that I get to allow myself to feel things in the moment, however they feel, rather than obliterating them with ethanol. I’m excited to see how this feels. This is my next big thing.

When Should You Go to Rehab?

6 October 2015

Yesterday, CC Sabathia checked himself into rehab for alcohol abuse. CC Sabathia is a pitcher, and a good one (though he didn’t have a great year), for the New York Yankees. The New York Yankees play the Houston Astros (did I read that right? The Astros?) in the American League Wildcard game tonight. Naturally, Mr. Sabathia will not be suiting up for the playoffs. This has a number of fans angry that he’s abandoning his team in their time of need.

Fuck that. The time to go to rehab for substance abuse is when you have the need and willingness to go to rehab for substance abuse. It doesn’t matter what else is on your plate. This is your life. If you keep abusing alcohol, you will lose everything you love, and then die. Alcoholism is a fatal disease. It does not spontaneously remit. Addiction is permanent and progressive. If you wake up one day and think, “I can’t keep living like this, and I don’t know how to live any other way,” then that’s the day you take action.

Drop everything. Work. Family. Plans. If you have the financial means or the insurance coverage, I’m a fan of inpatient rehab to get started. If you don’t, AA is free. You don’t have to no-call-no-show at work, and you shouldn’t. But if you can take a leave of absence or invoke FMLA, do it. This is your life. Those other things will muddle on without you while you get better. I promise. You know how I know? They’re muddling on without you right now. Dropping everything and getting help doesn’t make you an asshole. It makes you a survivor.

If you are suffering with active alcohol abuse, active alcoholism or addiction, you are not holding up your end of the bargain in any relationship you’re in. Not family, not work, not friendship. Those things that you think you have to do, that won’t get done without you? They’re already not getting done. They’re already being covered by others, or going undone. You’re not effective. You’re not present.

You’re dying.

The time to get help is the first day you know you need help and have the willingness to go ask for it. Call a doctor. Call a therapist. Call AA. Write me personally at my gmail address (infactorium). There’s help. I know how to find it.

And you know what? Some people will not understand. You might lose some things. But the life you get in sobriety is vastly preferable, and vastly longer, than the life you have right now. Those people who think you’re abandoning them selfishly when you drop everything and get help? They’re the assholes. There will be time to deal with assholes later. Right now, get help.

CC Sabathia might owe fans and the Yankees plenty of things. An attempt to pitch in the playoffs instead of getting help for alcohol abuse isn’t one of them. I hope he gets what he needs. I hope the Yankees lose because I always hope the Yankees lose. And I hope people are well-served by this excellent example of getting help when the time is right to get help. Don’t wait. You’re dying.

My Letter to My Representative after Another Shooting.

1 October 2015

Dear ______________,

My name is Dr. ___________, and I am a health care researcher with ____________. I write in the aftermath of another mass shooting, this time in a community college in Oregon. I am sure you share my grief for the victims and their families. I wish I knew how to help them. I wish I knew how to ensure that this didn’t happen again. How do we relieve the incalculable burden of gun crimes?

There is a reason I don’t know these answers, but it isn’t that they are mysterious or unknowable. The reason we don’t know is that lack of funding prevents the National Institutes of Health, the Centers for Disease Control, and other federal agencies from supporting research into gun violence. Specified funding, supported by the president, has been thwarted in the House of Representatives repeatedly. I recognize that the issue of gun control is complex, and I am not writing to urge you to support any restriction on firearms. I write to implore you simply to let us study the problem.

There may be highly effective ways to curtail gun violence that do not infringe on anyone’s rights or their perceptions thereof. There may be ways to minimize the number of people who want to own guns. There may be ways to reduce the likelihood of an angry person from resorting to gun violence. We can’t know if we can’t study the problem.

We have a problem. Day after day after day Americans are murdered with guns. At a rate unmatched by any industrialized nation. I am not a constitutional scholar, and I don’t pretend know the implications of the various proposals for gun control you must surely be receiving now. But I am a health researcher. And if I were to have the opportunity, I could contribute to our understanding of gun violence. I have colleagues by the hundreds across this country who stand ready to research and understand this problem.

I am also not a policy maker. But I believe that to make good policy, the people entrusted with that charge – such as yourself – must be provided with the best possible information and research upon which to make that policy. Let us do our job, so that you can do yours. Support federal funding of gun violence research. End this de facto ban on the study of this crucial public health issue.


Naming Emotions, Hurricane Edition.

1 October 2015

I’m afraid. I talked about it last night during my men’s meeting. Hurricane Joaquin, now a major hurricane and strengthening, embarks on a northward journey tonight, and will likely power into the east coast sometime over the weekend. ECC is one of the cities that has a chance to be in the direct path of the storm. That’s the part I can do nothing about. The storm is the storm. ECC lies in its potential path. My fretting will change neither.

I worry about my house. It isn’t well built. It has a tendency to get water in the basement during exceptional rain events. I don’t know how it will stand up to a direct hit from a major hurricane. These are things I can’t know. I do know that it survived the last couple to come through, though none of those powered directly into the city, to my knowledge.

I get to be afraid. I’ve never been in a hurricane. Hurricanes kill people and ruin stuff. Basically, if nature had a military, hurricanes would be the Marines. I am frankly not up to repelling a Marine expeditionary force.

But I don’t want to be a coward. My friend @labroides weathered Sandy, being in the Bronx at the time. I remember thinking at the time that I wouldn’t be at all surprised to see him on the news being interviewed for going out in the middle of the storm to rescue a retirement home. I tweeted such at him, and he just said, “Hey, we get through this together or not at all.” He meant it.

I’d like access to that sort of bedrock courage. Just do what you have to do because it’s the right thing to do and you’re the person in the situation to do it. Circumstances meet willingness meets ability. I hope that if the hurricane hits my city, I’ll be able to summon that. I don’t know. We never know what we can really do until we have to do something that takes everything we have.

When AA was young, and no one had much more than about five years of sobriety, there was suddenly a war. The greatest war in the history of humanity. Sober members of AA, like men everywhere in America, were drafted to fight. I’ve read accounts from the time – just anecdotes – in which both recovered drunks and their physicians wondered how these sober alcoholics could perform in war. Alcoholism was still primarily seen as a moral failing, weakness of character. Would these men be cowards in combat?

The results seemed to be that we alcoholics are about as suited to war as normal folks. We’re not especially cowardly or weak-willed in the face of extraordinary challenges to our fortitude. We seem to be able to manage the stresses of combat when called to that purpose. And if those drunks could do that, well, maybe I can weather a big storm without embarrassing myself or my family or my community.

Why “Alcoholic” Matters.

29 September 2015

The medical and scientific community generally eschews the term “alcoholic” these days. Preferring instead terms like alcohol abuse and alcohol dependence, and more recently, “Alcohol Use Disorder“. If you read the link to the NIH’s page just there, you’ll see that this is a set of fairly vague rules designed to identify people who have severe problems with their drinking behavior. They’re not dissimilar from the questions you’ll find in AA’s literature. I don’t know why some words fall in and out of favor. They just do. Generally, soon thereafter, we’re told that the old terms are “offensive”.

I think there’s an important reason to keep the term “alcoholic” around. That doesn’t mean that the newer terms are useless; they just serve a different purpose. They may do harm, or good, or both. I’m not advocating that they not be used. But there’s a fundamental difference between the newer medical terms and “alcoholic” or “alcoholism” and it matters.

Like the institution of AA itself, I subscribe to the disease model of alcoholism. I’m not sure anyone credible doesn’t at this point. We know that people who cannot manage their drinking have some sort of disorder, whether neurological or genetic or both or something, which interferes with their ability to regulate their consumption of alcohol. I’m one of those people. When I drink, I lose the ability to control how much I consume. I have immediate and generally irresistible cravings for more. I behave in ways that I know are wrong but cannot override with moral judgement. It’s a mental illness. There’s no cure.

Alcohol abuse describes a behavior. I also exhibit that behavior when I drink. And I believe firmly (far more firmly than most medical professionals or addiction scientists, I think) that our behavior when we drink – even those of us with this disease – cannot be excused or ameliorated by our condition. When a person commits a crime while drunk, especially if that person is an alcoholic, inebriation is not a mitigating factor. If anything, it is an aggravating factor. Being an abuser of alcohol is not an excuse from participation in society.

Alcohol dependence describes a medical condition. It describes people who suffer from serious withdrawal symptoms (possibly including death) when they stop drinking suddenly. Our bodies come to depend on alcohol to function. Even as it poisons us, we can be physically addicted to the point that sudden cessation is lethal.

Alcohol Use Disorder describes any number of a cluster of symptoms detailed in the link above. It’s deliberately vague, which I can both understand and value, allowing the diagnosis to be a conversation between a physician and a patient. This diagnosis results in many avenues for professional treatment being opened: insurance coverage of inpatient and outpatient treatment, for example. And it also invokes the Americans with Disabilities Act, preventing the patient from being fired so long as they engage with treatment. I have mixed feelings about Alcohol Use Disorder being covered under the ADA.

But “Alcoholic” is different. “Alcoholic” is an identity. It describes a person. I am an alcoholic. I have alcoholism. I was probably born with it. It resides in my genes and my brain and perhaps other important parts of me. Being an alcoholic is part of the structure of my self. It is an inextricable part of me, influencing how I behave from long before my first drink, and long after I stopped drinking. It will persist until I die.

I no longer exhibit alcohol abuse. I am not alcohol dependent. I do not have alcohol use disorder. All of those things depend for their existence on my consumption of alcohol. Because I do not drink, it is impossible for me to suffer from any of those things. However, no sane person with any experience in the workings of alcoholism would presume that that means I am cured. If I drink, I will go back to all of those things. Which is why I believe the expunging of the term “alcoholic” from the medical language is dangerous.

I remain an alcoholic. It’s part of my core identity. It’s part of my brain and my body, and it is not dependent upon my consumption of alcohol. Being so identified makes it clear that I cannot return to the more moderate drinking levels of my early drinking career. The disease is progressive, and does not remit.

Not every problem drinker is an alcoholic the way I am. I know people who have drunk to regretful, problematic levels and returned to normal, socially acceptable drinking. But for those people like me, who drink like I drank, these terms, when used to the exclusion of labeling a person as an alcoholic, can provide us with a dangerous rationalization. We will see the medical terms, see our new behavior, and declare ourselves cured. That gives us permission to return, self-deluded, to drinking.

We can then blame the doctors. We can blame the definitions. We can blame anyone but ourselves. Because we know that changing ourselves is the only way, and that way leads to lifelong sobriety. Which is too terrible to contemplate while we still drink. Easier and safer to tantrum and rail against those who were supposed to cure us but failed. We cannot drink like normal people because the physician was derelict. Let’s raise a drink to his incompetence.

Being an alcoholic matters. Having the identity of an alcoholic matters. The disease being “alcoholism” matters. These terms are not dependent on my use of alcohol. They are simply part of me. And yes, sometimes the term “alcoholic” is offensive. I was offended when it was first used to describe me. Because I didn’t want to accept the truth of myself. And that’s the thing: the truth is sometimes offensive. Being afraid to offend people like me by calling us what we are does no one any good. And can do all of us, me, and my potential victims, a great deal of harm.

The Big Week.

28 September 2015

This is a big week in terms of training. My longest training week leading up to my longest run before the marathon. Saturday, BB and I ran 18.1 miles in a new area, mostly in a park on the west side of ECC. In addition to the road miles, we ended up doing at least a couple of miles, maybe up to 4, on trails. There were a lot more hills than we usually do, as well, including a big climb up to a high bridge over a river.

And I felt pretty good. I was tired and fatigued at the end, but I felt pretty good, all things considered. Much better than the past two long runs of 18 and 19 miles. When I was watching the Iron Cowboy do his ridiculous triathlon record, I read on the support blog that it takes about 10 days for the fitness from a long run to take effect. I don’t know if that’s true, but it was written by a professional endurance athlete trainer. And it seems to fit with my experience. One week to the next isn’t quite enough time to make a run feel better at the same challenging distance. But two weeks, with a shorter run between? Then I can tell I’m fitter.

We ran the 18 miles at a 10:47 pace, despite having to stop several times for directions while running in a new area. That’s about 15 seconds per mile faster than the last two long runs, and is paced for about a 4:42 marathon. That’s a long time to run, but I’m starting to think it’s possible. Then Sunday we worked out for an hour (and I did real pull-ups!) and ran 3 miles as a recovery run at about a 10:00 pace. The weather was gorgeous and looks like it’s only going to get better for the next few weeks. I’m hoping, as we all do, that there won’t be rain on race day. But as long as it isn’t hot, I’ll be fine. And it’s rarely hot in Washington DC in late October.

Now I enter the biggest longest week: three miles yesterday, seven each today and Wednesday, and five on Thursday. Then, 21 miles on Saturday. The longest long run before the race. That will leave us with a marathon to run which is about five miles longer than I’ve ever run before. BB, of course, has finished a marathon, but she didn’t train the way she’d have liked, and ended up walking a good bit of it, finishing in something like 5:30.

As with all my races, my only true goal is to finish, and run the whole way. Times are a nice bonus, and I’d love to finish in 4:30 or so, but I don’t think that’s too likely. But I feel pretty confident I will be able to run the whole way. I know that those last five miles are gonna hurt. But I think I’ll be able to get through them. It’s going to feel great to have that medal hung around my neck.

And I’ve decided on my marathon tattoo. I never felt connected enough to that drawing I put up. So here’s what I’ve decided. In 490 BC, the soldier Pheidippides, after the battle of Marathon, was dispatched to bring the news of the Greek triumph over the Persian invaders. He ran the 26 mile distance, climbed the Acropolis, and gasped, “Rejoice. We are victorious.”

Evolving Spirituality.

23 September 2015

Having a conversation once early in sobriety with my friend LawnBoy, Infactorium’s resident atheist, I said, “Atheism doesn’t tend to last long in AA.” I meant that because AA has a spiritual component, and references God a lot, that AA tends to be a place where people open to spirituality recover. People often either are already spiritual, or adopt spirituality when they recover from alcoholism in AA. That was what I said when I was six months sober or so. I was fairly wrong.

Now, it’s certainly true that many more people in AA are spiritual, and even religious, than are avowed atheists. But I don’t know that the proportion of atheists in AA is any smaller than the proportion of them in the population in general (and testing such a hypothesis is impossible). But what I have found is that, surprise surprise, the truth is far more complex than it appeared to me at my first glance.

My own spirituality has definitely changed in AA. Whereas once, before I was sober, and hell, before I drank, I was very religious, I no longer am. I still think of myself as vaguely spiritual, but in an entirely nebulous way. I don’t pretend to know what God is, or if that means anything. I am comfortable with the idea that if there’s a God, then it knows me, and that’s good enough. I am hopeful about God. I would love for there to be a God. But I don’t live in my daily life as though there is a deity making careful observation of me.

My sense of spirituality is deeply entwined with my knowledge of systems theory. I studied how complex systems behave academically and professionally, and learned how simple rules result in bafflingly intricate large-scale behavior. Flocks of fish and birds, colonies of insects, brains, cities, societies, ecosystems, and climates. Solar systems and galaxies. All are examples of individuals interacting with one another according to more or less simple rules. Life happens when atomic quanta combine in peculiar ways. Huge structures are built of tiny elements.

Matter and energy and living things all become organized in complex arrangements based on astonishingly rudimentary principles. This is a good enough God for me. Not the so-called “god of the gaps”, where we attribute what we do not yet know to the action of a mysterious intercessor. But the golem in the gears. God, perhaps, did not write the rules. Perhaps what I choose to call God simply is the rules. The map behind the waveform. The tendency of things to interact in unpredictable ways. Whether those things are sleekly elegant particle-waves of light, or ridiculous ape-things.

My God, these days, is a God that might not be there at all. A God that, really, it doesn’t matter whether it is there at all. But one that I can feel connected to. We often say in AA that the only thing you need to know for sure about God is that “you’re not it.” We need something outside. Larger. For most of us, that means some kind of observant deity. But not nearly all of us. And frank atheism flourishes in the rooms of AA. More here in ECC than back in St. Louis.

There’s not much point in praying to the thing I think of as my God-concept. It won’t respond. And that’s fine. Better even. I need reminding that I’m not important enough that the fabric of the universe needs to concern itself with me personally. I am a temporary arrangement of matter and energy. I will soon enough disassociate. While I persist as a system that can think and experience and interact with others of its kind, I’ll try to do what we’ve decided, in our own strange and deeply imperfect way, is good.

And that helps me understand my self. Somehow, the construction of matter and energy that I call myself, reacts in unfortunate ways when combined with ethanol. It’s broken. And it can’t be fixed. But it operates just fine when ethanol is kept from its inner workings. Something in the mysterious rules that govern how I function, there is a strange flaw, when compared to other, similar systems.

But it is only a flaw because I label it as such. Because we’ve decided that people who react the way I react to ethanol are substandard. Really, I’m just obeying a slightly different set of rules. Rules which I can choose to interpret as diminishing me, or strengthening me. Because I have this supposed deficiency, I have different opportunities than others. I have access to a different set of things to learn and explore, that some of you so-called normal people cannot ever experience.

These idiosyncracies have enabled me to feel closer to this minimalist God of mine. To feel like I am a welcome part of the great systems of my life. Here and sober and free and contributing.


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