I was at a meeting yesterday where a researcher was asking for recommendations for his grant on public health. It involves, among other things, surveying a population about its attitudes toward addiction and alcoholism stigmas. I was there as a public health researcher, not as an alcoholic. No one in the room knew my background. The purpose of the grant is to identify, and eventually influence, public attitudes toward sufferers of addiction and associated mental illnesses.
I tweeted that I find researchers efforts around stigma to be often kind of pointless, and counterproductive. I often vex the addiction research community with my opinions on addiction research because I don’t think we can be cured – ever, and I think that well-meaning attempts to reduce stigma often make things worse. I was asked to elaborate by a friend who is a rather prominent addiction researcher, but on the neurochemistry/biology side.
I’m a little bit hamstrung because even in this anonymous forum, I don’t want to describe the methods of a grant-in-progress, and torpedo a colleague’s work even if I think it’s unlikely to do the good they think it will. So let me speak generally about medical and sociological attempts to reduce stigma associated with addition. I’ve written about it before, almost exactly a year ago.
There are about three types of stigma associated with addiction as I see it, and researchers concentrate on two: (1) The belief that addiction is a moral failing or weakness; (2) The mistrust and suspicion of addicts in recovery. They get both of these wrong, in important ways. Case by case:
Researchers are correct in that addiction is not a moral failing or weakness. It is a disease that some suffer from. However, addiction requires a behavioral solution that an addict must willingly participate in to recover. Concomitant with the attempt to repeal the stigma of ‘moral failing’ comes, inevitably, a stripping of the expectation that addicts have to actually take action to recover. This excuses us of the need to take ownership and responsibility. Without that, we will not recover. Just as a cancer patient needs to actually go to the hospital to receive treatment, so too do addicts need to actively engage in our recovery to effect and maintain it.
When researchers and health care providers attempt to simply medicalize treatment of addiction – to remove responsibility for action from the addict and translate it to the medical community – they kill us. Addiction is not a moral failing, and it is not the result of weakness. But that doesn’t mean that addicts are just absolved of the responsibility and need to engage with and confront their disease. But refusing that is a symptom of addiction. We are highly susceptible to being told we’re victims of a disease and have no responsibility to change. We hear what we want to hear.
In the second case, researchers are often looking for ways to reintegrate the recovering addict back into society. Thus, they seek to minimize or eliminate suspicion that addicts will relapse, that recovery is fragile, etc. The problem is, recovery is often (especially in the beginning) fragile, and addicts usually relapse. In part because of the misguided efforts of the prior two paragraphs (but really, it’s mostly on us).
As I’ve written before: reasonable caution is not stigma. I am an alcoholic. Alcoholics relapse. It would be perfectly reasonable to subject me to extra scrutiny especially if my job required me to operate heavy machinery. It is appropriate to charge me higher auto insurance. It is appropriate to consider me a higher risk for anti-social behavior because I am a higher risk for anti-social behavior. It is ridiculous to expect employers and institutions, armed with the knowledge that I am in recovery, to consider me to have the same risk profile as normal people. I do not.
So that’s the two things that researchers and activists get actively wrong. But there’s an important passive wrongness too: the low expectations. This is what I wrote about in the post linked above. I don’t tell people about my recovery in my work, and not really because I’m afraid of the other two types of stigma. The first no longer applies to me – I haven’t avoided or failed treatment because anyone thinks I’m morally weak. The second does apply to me, but as I’ve said, that’s not really stigma. And I’ve already reintegrated. The ways my disease could be held against me are small and not likely significantly harmful.
The third I get all the time. Ordinary accomplishments are exaggeratedly praised because I’m in recovery. People have diminished expectations of an alcoholic in recovery. Being in recovery is seen, apparently, as accomplishment enough. Anything beyond that is amazing. And so we are praised for things like making it to work. Things that for other people are mere hobbies for me are seen as triumphs of the human soul. Ugh.
I’m an ordinary dude who has a disease that is in remission. Does that represent some kind of accomplishment? Yes. I’ve worked hard and I’m proud of the work I’ve done. But I can’t really take credit for my recovery. I’m no better or smarter or stronger than my many friends who died rather than recovering. I’m just lucky that for whatever reason the actions and rewards of recovery overwhelmed the actions and rewards of addiction. Recovery is a world of contradictions.
Soft stigmas are not much better than hard stigmas. They may allow us entry back into society at low levels, but they limit us just the same. If it’s “good for me” that I’m able to contribute by holding down a job, it’s also “good enough” to leave me in a low position. After all, I’m doing great just to be here, right? I should be grateful I’m not still in the gutter.
I’d rather keep my addition generally private. And be judged by the same measures as all you normal people. I don’t want an advantage getting my foot in the door. And I don’t want a hindrance rising further. I don’t want your treacly pity. I don’t want your insincere admiration. I want to be a regular person with a regular life. Yes, I had to overcome something difficult. I am still working at that. And if you haven’t done it, you don’t know what it took.
It’s fine to admire or find inspiration in people who’ve recovered from addiction. And as I said, I’m proud of what I’ve accomplished in recovery. It was harder than you think. And it was easier than you can imagine. Recovery is as much relief as labor. But measure us against the same yardstick you measure yourself. Because we are not different from you in any way that does not involve a bottle.
As I think over my goals of the past year, I hit almost all of them. I ran another marathon faster than the year before. I completed an Olympic triathlon. I set a sub-two hour personal record in the half-marathon. I ran a 10-miler in under 90 minutes. 2016 was, pretty objectively, the best fitness year of my life. Even though I had some real “setbacks” in races when I couldn’t perform in the heat and humidity.
I put setbacks in quotes because I didn’t actually fail at anything. I finished all my races. I just had to walk some. That happened in three races, two half-marathons (one a brutal trail), and a 10k. I don’t like having walked, but that’s where I was at the time. I’m allowed to miss my mark. Especially when I know precisely why it happened.
So I hit my fitness goals and made progress and learned a lot of things about who I am and what I can (and can’t) do. But it occurs to me that in the past year, all my goals were about fitness. I didn’t really set any career goals. I didn’t set any personal goals. I just wanted to putter along.
Puttering along is ok. I don’t need to be quivering with ambition every moment. I don’t need to be always stepping up and never pausing. But I don’t need to be in that state to be setting and accomplishing goals. And I certainly did accomplish things professionally this year. I had three or four papers accepted. I lectured in Italy and Canada. I got a nice little raise. But I haven’t felt productive.
I’m thinking about my goals for 2017. I don’t make “New Year’s Resolutions”. I think they’re a little silly. But I do like to take the new year and think about what would make it feel like a successful one. I’ve set my major fitness goals. A marathon, a half-Ironman, and 100 miles a month running through the summer to maintain my heat fitness.
But I don’t know what to do about career, personal, or fitness goals.
Should I pick the novel I’m writing back up? Finish my symphony? I have unfinished things that could use attention. Should I aim for a promotion? Another grant? Three papers? I have official “goals” from my actual performance evaluation but they don’t interest me much, or inspire me. I’ve been meeting with other parts of the institution to inspire more interesting collaborations.
I have time before January to decide, and there’s nothing magical for me about January 1 being a start date. But it does feel clean. So I need to think about things. What do I expect from myself this year? What am I going to take on?
I have done it. I have taken “step three” towards competing in a half-Ironman race. I have made a commitment. I purchased an entry to the Atlantic City Half Ironman race, September 17th, 2017. I have nine months to train. In between, I have a marathon and a half marathon already registered. Then I will do an Olympic triathlon in June, probably, to train and be acclimated to the transitions and rhythms of the sport.
I’m hiring a coach to get me there. I’m going to be training for nine straight months, good and hard. I’m going to be run-heavy in the summer to heat condition. I’m going to commit and not take things for granted based on a good race or two in the spring. I’m going to take the whole season seriously and “professionally”. My knee has been twingey for 8 months now. I have to be smart about this.
I’m excited and scared. I know what it’s like to compete in a triathlon now. I’ve done it. I completed one. It took me 3 hours and it was a lot of fun, and a lot of work, but I did it. This one will be harder. It’s more than twice as far for the bike and run legs. It will be a challenge. A big one.
The swim is 1.2 miles. That’s very manageable. Especially in the ocean, where it’s buoyant. I love swimming and I feel comfortable in the water. The water temperature will be about 70 degrees Farenheit, so I shouldn’t need to worry about managing a wet suit. It’ll be cool but not risk hypothermia to wear no top.
The bike is 56 miles. This is a big deal. The furthest I’ve ever ridden without stopping is about 30 miles. So I’m definitely going to need to put in some big rides to train. Some really big rides. But the course is pretty flat, and that means it should be easy on my knee and relatively fast.
The run is 13.1 miles. Half a marathon. I’ve done a lot of those. I’ve even done a couple immediately after a half marathon. My only fear is that it will be hot and humid. There is nothing I can do about that. I’ll just have to lumber through and make sure that I get enough heat training in and stay hydrated.
That’s the race: 70.3 miles on a Sunday morning in New Jersey in September. Either I’ll make it or I won’t. But I’m gonna work like hell to get there.
I just read a fascinating post by a friend and colleague on the way competition – especially over money and salary – influences how we feel about ourselves. It immediately struck me that I only compare up. Maybe that’s a good thing.
When I look at people who make more money than me, I do get jealous. Not of like, celebrities or CEOs or such. For me, the biggest source is when people make much more money for skills that are no more difficult to acquire than mine. MDs, for example, or lawyers. Those are skills that are impressive and valuable, but they’re not, objectively, any more difficult than what I do. Nor obviously any more important. Yet they’re better compensated. I get jealous of that.
I get jealous that managers make more than the high-skills people they manage. Being a manager is not a lazy, easy job. But it’s not any harder than being a subject matter expert in a field as an individual contributor. I don’t see that managers should make more than the people they manage except to set up a hierarchy.
So I look at people who are roughly in the same career stage (or earlier in their career stages) who make more money than I do, and I am often a bit jealous. I compare myself and find myself lacking, or I compare myself and think I see injustice. Neither is true (though, certainly, I am occasionally lacking). Economic incentives are complex, and I chose what I chose knowing it would never make me rich.
But interestingly, I never compare myself “downwards”. I never look at people with less lucrative skills or career paths and feel satisfied and superior. And what an ugly thing if I were to! We are rightly taught that we shouldn’t judge people by their salaries. We all know people who think they’re better than others because they make more money and it’s a vile and disgusting attitude.
Isn’t looking up and feeling inadequate the internal mirror of that? Aren’t I saying something ugly about myself when I look with avarice on what others have I feel is not deserved beyond what I have done as well? Instead of looking at compensation and judging people or what it says about economic incentives in society, I should look at myself and see what my attitudes say about me.
It’s easy to see an ugliness when we are denigrating others. It’s harder when we denigrate ourselves.
I still haven’t run since the marathon. It’s coming up on two weeks. We did walk some 47 miles in Hong Kong, but that’s not the same as getting running miles in. Though, I’m a huge believer in walking as exercise. When I first decided to get in better shape, I did it with push-ups, sit-ups, and walking. That alone helped me lose 20 pounds and change my whole outlook on life and fitness.
But what I did do is a gym workout. It was my first one since the marathon as well, and today I’m pleasantly sore. I didn’t try to break myself, or anything. I did some “power” work, like throwing the medicine ball, and some strength work. I can reliably do 3-5 chin-ups in a row these days, which is a huge accomplishment for me. Now I’m starting to work on pull-ups, which I’ve discovered are an entirely different animal.
To do a pull-up, you have to have back muscles. Chin-ups are largely about your arms and shoulders. Pull-ups are your lats. For me, that’s much harder. So I’ve been doing band-assisted pull-ups where you use a giant rubber band to reduce the load. That’s how I started with chin-ups too. It’s a slow process to build strength, but it’s a lasting one.
I read an article recently that endurance doesn’t come back as fast as strength does when lost. Something to do with building cell-nuclei or mitochondria or something biological that I don’t really understand. Strength builds lasting structures that don’t vanish even when you lose fitness, whereas endurance training doesn’t. Thus, when you get out of endurance shape, you have to rebuild it all over again, as I learned this summer.
So, in order to maintain my cardiovascular fitness when I’m not running, I put in some time on the rowing machine, which ought to help with my pull-ups too. I rowed two miles in 14 minutes. That got my heart rate up to my maximum, and felt like a lot of work without being high impact on joints and such.
So, while avoiding true burnout and taking a break from the monotonous parts of constant endurance training, I’m trying to make sure that I do a good job of keeping fit. I actually lost a couple of pounds in Hong Kong with all that walking. I’m feeling like I’m in pretty good shape despite a few nagging injuries, and I’m talking with my new endurance coach in a couple of weeks to prep for next year’s challenges.
Right now, I’m committed to the Love Run in Philadelphia, the Garden Spot Inn marathon Lancaster, PA, and I’m looking for an Olympic distance triathlon or two in the late spring or summer. If I get all that in, then I’m going to do a late summer/fall half Ironman. In addition to several more half-marathons. I want to get back to the NAF Half in DC, and maybe a destination run in the fall. And of course, I’ll be supporting BB if she commits to the 50km trail ultra she’s considering.
It’s going to be an exciting year, fitness-wise. Right now, my training consists mostly of resting my knee and mind before the big lifts of the season.
November was a difficult month for me. Well, the last three weeks were, anyway. As everyone knows, the election hit me very hard, and I went through an anxiety spiral. I’m emerging from it now, but I had to reach deep into my bag of tricks. Because I was feeling things I hadn’t felt in a really long time. Things that scared me and that scared some of the people close to me.
As I wrote before, there were times shortly after the election, including election night, when I felt like I wanted a drink. Because I didn’t know what else to do to sleep. To relieve my anxiety. To make the world go away for a little while. That’s what alcohol does for me: it makes the world go away. It’s easy not to care about anything when you’re drunk. It’s easy not to hurt. It’s easy. I like easy.
But I’m no fool. I know what alcohol does to me. I know where it leads. I know that I can’t make the world go away for an evening and then wake up and expect it to come back again. When I go in, I go all in. I go in for life, and I go in for death. That’s how I drink. That’s how I drank, and how I will drink again if I do. Alcohol is not a companion for me. It’s an endgame. And I lose.
So this month I’ve deployed a lot of tools to straighten myself out. Because the idea of a drink is terrifying. It would immediately ruin everything I’ve spent almost nine years building.
Tools I have used this month: my program and my meetings; directed visualizations; talking to my sponsor; talking to my partner; talking to my friends and family; writing about alcoholism and my feelings here; talking to professional therapists. And, while it’s not optimal, suffering. Sometimes, if there’s no way out of intolerable feelings except a drink, I simply have to suffer through intolerable feelings. Being able to experience suffering and see it through to healing is a cornerstone capability of an alcoholic in recovery.
I’ve emerged now. While I am still greatly distressed by the direction this president elect is likely to take the country, and the methods he’ll likely use to get it there, I am not in a state of active, strangling despair. I am no longer in a state of peril. I don’t think I was ever in any real danger of drinking, but I know I felt things I hadn’t felt in a really long time. I needed to marshal much of my arsenal, not because of a true emergency, but because I don’t fuck around with my sobriety. I don’t walk on rails.
When something is off, I overcompensate. I have to. I have to take my disease and my life seriously.Failure to do that is how alcoholics relapse. It’s how we die. And I remember that I am not fighting. I don’t battle my addiction, my disease. I remember each time I am distressed that I have already lost this battle. I am in recovery because I have stopped fighting. I don’t fight the feelings I have. I surrender to them.
I am an alcoholic. There is nothing I can do about that. I accept it. I am even grateful for it. Because I can do nothing about my alcoholism, and because I know that, I don’t have to drink. I am powerless. I am abandoned. So I am free.