The Gulf Between Science and Recovery.

I’m going to pick on a friend here, which isn’t fair, really. Drugmonkey is a prominent addiction researcher who does important work studying things I can’t begin to understand about the brain and how it reacts to intoxicants. He’s supportive of recovery however it occurs, and is deeply committed to finding ways to improve the lives of addicts and alcoholics. And he’s a scientist. So he likes his treatment to come with evidence. That’s reasonable and appropriate. It’s right. I wouldn’t be picking on him here if I didn’t think it was constructive.

Sadly, addiction science and addiction scientists seem to have a view of addiction that is completely out of step with how I understand addiction to work based on my personal experience, and the experience of my fellow members of AA. Tonight’s “discussion” (mostly me firing off a few dozen tweets) began with Dr. Monkey tweeting a link to this article. Now, the AA described in this article bears little resemblance to the AA I’ve experienced in a dozen states and at least 4 countries. The second paragraph describes a meanness and intolerance in AA I’ve neither witnessed nor heard tell of.

The description of Dr. Dodes’ work – if accurate – describes conclusions perfectly in concert with AA’s teachings (“In his view, addiction is a compulsive disorder, an attempt to cope with anguish by engaging in ritualistic behavior that is soothing and predictable, despite ongoing negative consequences.” This sentence might as well have been lifted from AA literature.) and yet presented as if it’s some deep and novel and contradictory revelation. In fact, it sounds to me precisely like what AA has been saying for four-fifths of a century.

When we got on to discussion of what does work, and what AA is, he tweeted this:

@Dr24hours and furthermore if 12-step like approaches DO work, then they SHOULD be adopted in addiction care. and payed for by insurance

— Drug Monkey (@drugmonkeyblog) February 11, 2014

This is, to me, perfectly representative of the gulf between science and recovery. AA doesn’t “work”. Don’t get me wrong. AA works. AA works in the sense that when an alcoholic has come to the place we come to, of spiritual desolation and depravity, when we drink for total obliteration, when we cannot live with alcohol, but we don’t know how to die, AA allows us to return from death to life. It does so by allowing us to marshal resources otherwise unavailable to us. By providing a framework of action and accountability and social support that allows us to change when we cannot change on our own. Recovery is not about strength. In fact, for alcoholics like me, we cannot recover until our strength is proved utterly useless.

This is another thing the article, and many addiction researchers don’t understand. And that is: AA is not for everyone. The article discusses those “alcoholics” who spontaneously stop drinking or return to normal drinking. I’m happy for those people, and there are many of them. They did not, obviously, need AA. Far from claiming that total abstinence is the only way, and that the only way to quit drinking is through AA, our literature explicitly states that any who can go out and “drink like a gentleman”, or quit without the steps, has our blessing! AA is the net that catches us when everything else has failed.

I think those with medium-to-long term sobriety in AA will look at that tweet above and immediately shake their heads and think, “That won’t work.” AA works in large part because we do not attempt to impose the program on anyone. I do not believe that the twelve steps are magic in any way. I think they address precisely what Dr. Dodes wrote above: the compulsion to treat our real problem in a soothing way that doesn’t solve any problems and creates more of its own. And I suspect that any simple and structured framework that does that would work.

As the worst of the worst alcoholics, we can achieve long-term sobriety only by daily adherence to some structured program, supported by those who know the same depravity and who have walked the same path to light as we have. The program must address our underlying issues: resentment, depression, anxiety, abandonment. It must acknowledge that relapse is inevitable without lifelong commitment to principles that are bigger than we are. As soon as we believe that we have defeated alcoholism, we are defeated by it. And I believe it must be social. We recover only among our own kind.

Any attempt to distill the “essence” of the twelve steps to a pill, to a treatment regimen, is doomed from the outset. There is no such essence. The steps don’t “work”. They don’t cure us. AA doesn’t “work”. Not like that. There’s no way to take the program of AA and turn it into a medical treatment. AA works when medicine fails. It works when alcoholics come to that sunken road. Death or recovery. It’s a difficult choice. And many of us make a different one from the one I made. Usually because they do not realize they’re at the point yet of making that choice. Sometimes because they actively choose an alcoholic death.

AA works. Because it provides a framework, a social structure, that alcoholics can seize when and if they choose to. Some believe it works because they surrender to God, though that is not my personal experience. We do not impose our steps on anyone. We could not if we wanted to. It won’t work. We do not advertise or promote ourselves. We are simply here. Living ordinary lives. Sober. If you have decided you want what we have, and are willing to go to any length to get it, then you are ready to take the steps.

If you haven’t decided that you want what we have, or if you are not willing to go to any length to get it, then AA isn’t for you. And that’s ok. Many may recover in other ways. Many may die. Many may not need “recovery” as we think of it. AA isn’t for every problem drinker. And not every problem drinker is an alcoholic as I understand it. The medical definition of “alcoholic” is not the one we use in AA.

I do not believe we will ever cure alcoholism. And if there were a pill I could take today that would allow me to drink like a normal person, I wouldn’t take it. I don’t want to drink like a normal person. I don’t want a medical recovery. My problem isn’t alcohol. My problem is me. Alcohol is how I tried to treat my problem for about twelve years. Now, I treat my problem by adhering to the program laid out in Alcoholics Anonymous. I cannot do this myself. Left to my own strength, my own morals, my own initiative, I drank. Left to my own strength, I will drink again.

I am sober because I came to a place where I could not live with myself anymore. I needed to address the sicknesses in my heart. I finally came to understand that alcohol, rather than assuaging that sickness, was the means by which I avoided confronting it. I gave up. And I did what I was told by people who had been where I was, and who had what I wanted. And I continue to today. Because I am not cured. And I don’t want to be.