Infactorium

Alcoholism is a pernicious disease. I’m sure I haven’t broken any important medical ground in asserting that. Untreated it’s fatal, remission is rare, relapse is common. While remission is not unattainable, it is enigmatic. I know of no predisposing factors which indicate who will eventually seek treatment and who will not. I know of no intrinsic variables associated with sustained remission. There are a few studies (Cross et al 1990) which show that involvement in Alcoholics Anonymous and, in particular, sponsoring other people in the program are associated with sustained remission. However, association is not causation, and it remains unclear why some people recover and some don’t, and how to aid people suffering from active addiction to seek treatment. After all, resistance to treatment is a signature symptom of the disease. A good source for the current state of alcoholism treatment is Jacobson’s Masters Thesis (2010).

But now, I have to abandon the language of science and start speaking the language of recovery. Because I am strongly unconvinced (I think some people refer to this state as “doubtful”) that science will ever succeed in finding any cure for alcoholism. Alcoholics will never be turned into normal drinkers. Because we don’t want to be. I’m fond of saying in meetings: “If I could drink normally, I’d get drunk all the time.” I hold out a bit more hope that science will find effective ways to help people who do not want to drink to not drink, and in fact we already have, and they’re useful. But frankly, we don’t need much more of that. Because the problem, after the first little while, isn’t the craving. It’s the mental illness that tries to convince us that we do not have a mental illness.

Nevertheless, many millions of people have given up drinking. And as I’ve said before and will again, Alcoholics Anonymous is by no means the only way to do so. It is, however, in my experience (and with some scientific evidence to back it up), an effective means of doing so, with the big flashing red qualifier: for those with a desire to stop drinking. People who do not have an honest desire to stop drinking are unlikely to achieve sustained remission.

I keep using the word remission here for a couple of reasons. One, it’s the medical term for a person who, after a period of alcohol dependence, is no longer alcohol-dependant. Technically, it refers to freedom from symptoms of the disease, which in the case of alcoholism is the intake of alcohol. And two, it lumps together the two types of recovery that I’m aware of, which are in the title of this post. Sobriety, and abstinence. These are two very different types of recovery.

In the program, we refer to sobriety to mean sustained remission from both the physical act of drinking, from the intake of alcohol, and also from the mental obsession of the drink, from the restlessness, irritability, and discontentedness that are attendant to the general affect of a person afflicted with alcoholism. We cultivate sobriety by taking the twelve steps, by being accountable others in the program, and by passing on what we have learned to new people, who are struggling to find relief from alcoholism and relief from the deplorable conditions that require alcoholic obliteration.

Abstinence is the state of refusing to drink. If you go to meetings, you’ll hear this condition referred to also as “dry-drunk” (And of course, different people use words differently. I can’t speak for everyone in AA. See the About page for disclaimers.). Many people who come through the doors of AA are recalcitrant to taking the steps. I’ve heard essentially every excuse under the sun. They’re too hard, they’re bullshit, they’re only for stupid people, they’re only for smart people, they’re not relevant to me, I just drink too much, I don’t need a sponsor, I don’t believe in god, etc., etc., etc.. It is rare to see those people in the meetings for long. They can usually talk themselves into a drink very rapidly. But not always. there are a few people who steadfastly refuse to embrace the program, but consistently participate in meetings.

But I wouldn’t want to be one of those. They tend to continue to exhibit all of the old behaviors of a drunk, except the drinking. They are angry, miserable, ashamed, vicious. We don’t call this condition sobriety, because these people aren’t really sober. They’re just not drunk. And they’re not the only ones. People like me, who have done the steps, and who are current with their sponsors, will sometimes get complacent. Stop going to meetings. Stop doing regular inventory. Stop admitting it when they’re wrong. Stop making amends when they hurt people.

There was one such man who spoke at my Sunday morning meeting yesterday. He hasn’t had a drink since 1994. But from about 1998 to 2009, he didn’t go to meetings, and he was miserable as hell for a decade. Even though he didn’t drink. He came back in 2009, and I was actually at his first or second meeting back. I had thought he was new to the program. He looked just like the disheveled and miserable alcoholics who come through the doors a day after a vicious bender. He was angry, and depressed, and sullen. I only found out yesterday that he had been sober for 15 years at that time. It astonished me.

And it frightened the hell out of me. Because I’ve been miserable. In addition to alcoholic misery, I have suffered from major depression. I’ll write about that another time, and its behaviors and difficulties. I know that I could fall into a soul-dredging blackness in short order if I don’t do the work I need to do to keep up my daily condition. Because while I am in sustained remission from alcoholism, I am not immune to relapse. And I am not immune to slipping from sobriety into mere abstinence. To falling from my general disposition of basic contentedness confronting life on life’s terms to a howling misery as I fling myself against barriers I have no hope of surmounting.

I maintain my sobriety through careful and regular examination of my condition, motives, efforts, and engagement with the program. I find myself wanting at times. But failure doesn’t bother me. Failure is how I learn. And I have placed a vast field of obstacles between myself and the failure that truly matters: inebriation. I’ve been spending a lot of time speaking with someone very new to the program lately. I hope it’s done the person some good. They seem to be doing very well. But what I can tell you for certain is that it has done me a great deal of good. Because I am reacquainted with all of the difficulty, confusion, insanity and compulsion that goes along with separating ourselves from active addiction.

And I am reminded that my problem is not alcohol. Alcohol was how I tried to solve my problem. And while I cannot safely consume any alcohol, because I am addicted to it, the real source of my sobriety is in the daily maintenance of my condition, so that I can confront the world in a state of peace, even in the maelstrom. So that I can stand in the roaring hail of stillness, and calm the storm of my mind.

_________

Cross, G., Morgan, C., Moony, A., Martin, C., & Rafter, J. (1990). Alcoholism treatment: A ten-year follow-up study. Alcoholism: Clinical and Experimental Research, 14, 169-173.

Jacobson DK, “Factors contributing to long term sobriety following treatment for drug and alcohol abuse”, Masters Thesis, California State University, Long Beach, School of Social Work, August 2010

Step two of Alcoholics Anonymous states that “we came to believe that a power greater than ourselves could restore us to sanity.” I’m still not going to talk about the spiritual aspects of the AA program. For a couple of reasons. First, it’s complicated and nuanced, and I don’t really feel up to it this morning. Second, I don’t really know how I feel about it myself. Third, I’d rather talk about the second part of the step, because it gets crushed under the weight of the “higher power” concept.

It’s almost like it got snuck in there: “restore us to sanity”. That makes an important implication, in the context of the first step, which, it turns out, step two immediately follows. Being powerless over alcohol, and having unmanageable lives, per step one, is described in step two as being something other than sanity. After all, how can we be restored to something if we were not removed from it? Now, I know there are a lot of sciency-folks who read this, and I should say that I don’t think anyone was trying to use “insane” as a technical term. But it’s a useful way to describe the state of mind we are in when we reach the terminal stage of alcoholism, whether it ends in death or sobriety.

Alcoholic insanity, as I understand and experienced it, is the state of being unable to refuse a drink. Unable to control my drinking. And because of this, I was unable to maintain appropriate social behavior while drinking. I made an ass of myself too many times to count. Was uninvited from things that were important to me. Drove drunk. Missed deadlines. Lost important work and documents. All of these things that I don’t do anymore, or do very little (I can still be socially inept, ask anyone.). Behaviors that I did not choose deliberately. Things I in fact sought not to do and was troubled greatly by. And yet, I continued in them because I had no ability to control how I drank.

Those things I did aren’t the alcoholic insanity. Everyone who gets very drunk from time to time may do some or all of those things. That doesn’t make them an alcoholic and it doesn’t make them insane. The alcoholic insanity is what I did when I was not intoxicated. It’s not insane to get drunk and make an ass of yourself and lose a friend over it. What’s insane is then, the next day, deciding that another drink is a good idea. Over and over again. Regardless of the consequences. Regardless of becoming more and more socially isolated. Regardless of involuntary interactions with law enforcement and the judicial system.

But there’s also another kind of insanity that happens. A kind I now remember fondly, oddly enough. And that’s the insanity of early sobriety. The first few weeks and months of sobriety are a confusing, difficult, baffling, emotional time. I’m not sure all of the ways alcohol abuse affects the brain. I know it’s described as a depressant. I know that it’s an anaesthetic. And I know I used it, like so many alcoholics, to prevent me from having to confront difficult and painful emotions.

As a result, when I stopped drinking, I was flooded with anger, irritation, frustration, fear, fear, fear, exhaustion, and shame. Intermittently mixed with hope, glory, relief, triumph, and elevation. Sometimes, I’d cycle between any of these by the hour. I was fortunate. When I was in early sobriety, for the first six weeks, I was in a safe place. Alcoholics Anonymous can definitely help you get sober, if you need to get sober. But it is not necessarily a “safe place”. Specifically, if you’re a woman who needs to get sober, my advice is to go to women-only meetings for a while.

It takes time for our brain chemistry to recover from the transient response of sudden deprivation of alcohol intake. Then, it takes time and work for us to deal with the onslaught of emotions we were repressing with alcohol. This is a difficult time for a lot of people new to sobriety. Many of them drink over it. With the emotions out of whack, and our thinking still skewed, we will often turn back to alcohol for relief. Sadly, all this does is make the next attempt worse (Or so I’ve been told. Thankfully, I haven’t relapsed yet.).

Oftentimes, the astonishing difficulty of these emotions feels separate from alcohol. And so they become an excellent excuse to place our focus elsewhere, to conclude that alcohol isn’t our problem. Because, of course, alcohol isn’t really our problem. Our problem is that we try to treat our discontent with alcohol, and then find that more and more alcohol is required, to the exclusion of everything else. But this effect isn’t always clear to us in early sobriety. We put down the glass, discover that our minds are full of madness, and shift our focus from alcohol. Too soon, we can convince ourselves that it’s ok to drink, because we have found the source of our difficulties, and alcohol wasn’t it. And we neglect the addiction. Or we find that our restlessness and irritability is too overwhelming, and instead of relying on others in the program or developing new methods of coping, we return to our basic first companion.

Insanity is part of alcoholism. We have all this intolerable darkness inside, and we treat it with drink, despite all the consequences. That’s insanity. When we give up drinking, we are confronted with baffling, powerful, and often debilitating emotions which threaten to leave us feeling exposed and humiliated. We often will seek refuge from these back in alcohol. That’s insanity.

Because alcohol addiction is more than just a strong need or desire for a substance. It’s more than the craving. It’s the madness. It is a mental illness. And it’s terminal. And incurable. Alcoholism, untreated, is a death sentence as sure as any fatal malady. And no interval of abstinence, no length of remission, is a cure. Alcoholism remains with us. A week, or a month, or a year, or a decade of sobriety does not prove we can drink normally. But we can recover from the hopelessness. And as time in sobriety passes, we achieve relief from the madness.

The very first step of Alcoholics Anonymous states: “We admitted that we were powerless over alcohol, that our lives had become unmanageable.” I’ll address the second clause another time. Today I’d like to talk about what powerlessness over alcohol, and indeed powerlessness in general, means to an alcoholic in recovery. Because the first part of the first step is one of the biggest stumbling blocks there is in recovery. Others have no difficulty with it whatsoever. My own experience was not so problematical in the early days.

People often ask me to define alcoholism, and I even get requests to diagnose (or more often, exclude) alcoholism in others. I can’t diagnose anyone. But I do have a basic criterion that applies to me, and to literally every person I have ever met in AA. That is: when you drink, can you reliably know, before your first drink, how many you will have? If you can’t answer yes, you may need to address your consumption. It’s important to note that this criterion says nothing about how much we drink, or how often. It’s purely about each episode. I’ve known alcoholics who only drank a few times a year. Others who drank daily.

And that is the fundament of alcoholism, for me. And it relates essentially to the powerlessness of the alcoholic. The instant I put alcohol in my body, I lose the ability to control how much I have. I fought for a long time to be able to have one or two. But it was a fight that I consistently, though not always, lost. I was never able to have one drink, stop, and be happy about it. Every time I stopped before I was drunk – really, truly, drunk – I was miserable. But I didn’t even have the choice to stop at one and be miserable. So many times, after having one, I totally and completely lost the ability to resist another. Resolve just abated in my mind, and immediately, another drink was a good idea. Any sense of wanting to limit my consumption was just vanished. And it’s very hard to do anything that you have no plan, desire, ambition or inclination to do. So I kept drinking.

But for alcoholics who are still active, the powerlessness goes beyond even that. It leaks into the sober days. Back when I had a wife and step-son, when I was in the grips of the end-stages of my addiction, when my wife told me that I looked terminally ill (I was!), I would go into the bathroom, retrieve the vodka from its hiding place high in the linen closet, pour myself a couple of fingers, look in the mirror, and say: “You are ruining three lives with this drink.” And then I would drink it. I knew what I was doing. I knew it was wrong. I understood the cost. I just couldn’t stop.

I was thankfully wrong. I did stop drinking, and while I am no longer married, my drinking was not the cause of my divorce. I was married for two full years after I entered recovery. As with most relationship endings, it’s far more complicated than “I drank so it ended.”  A story for another time, perhaps.

I’ve been talking the past week or so with someone new to the program. This person hadn’t gotten quite to where I got, but I strongly suspect they would do, in a bit more time. The way this person described the drinking was that it had become a “not-so-optional part of the day.”  That rung a strong, deep bell in my heart. It had become non-optional. Pain, shame, fear. Addiction. Dependence. All these things drove me to take the first drink of the day. Because the only thing that kept the wolves from the door of my psyche was emotional obliteration.

That’s the powerlessness. The inability to face the bright light of day without anaesthetizing. The knowledge that alcohol was killing me, that I was harming people I loved, that I participating in the destruction of all the things I loved, all of it was insufficient to propel me to manage my drinking. I had no capacity, whatsoever, for moderation. I had no desire for abstinence. I used alcohol for a single, simple purpose: I didn’t want to be me. I didn’t want to exist in the mind, the conscience, the body and the self that I inhabited.

I don’t know what happened to cause the Kernel Fault. I know that for most alcoholics, it never happens. What I know is that when we embrace powerlessness, we can start recovery. When I realized that alcohol had beaten me, I was almost immediately liberated from it. Because I couldn’t control my drinking, I suddenly didn’t have to. I knew, very simply, and felt, very strongly, that the solution had given itself to me. I was powerless. I had lost. I could not drink. I can not drink. And so I am free. I have left the battlefield.

Today life is dramatically different from the life described in the previous two posts. There’s less to tell. I can’t, as I set out, imagine writing a two thousand word essay about what my life is like today. For a very simple reason: my life is fairly ordinary. And that is, as I said at the end of the post yesterday, an unbelieveable privilege. Because I get to have days like yesterday, and days like today.

Yesterday, I got to put my program into action, encouraging someone who needed encouragement. Yesterday, I wrote several pages of a grant application. Yesterday, I took a two and a half mile walk in the glorious sunshine after work. Yesterday was a good day. And one of the truly wonderful things about it is how unremarkable it was. I simply did the things that were in front of me to do. And then, in the evening, I sat down at my piano and found that a piece of music I’ve been fighting with for months has begun to emerge. I have the seeds of the finale to my symphony.

And I get to have days like today. When I woke up at 2 am and saw that my latest paper, the one that is the first paper from my first funded grant, was desk-rejected prior to review. It made me angry and that made it hard to get back to sleep. Today I have to re-organize and resubmit, and that will require getting my co-authors to sign something which is always a massive pain in the ass. And I had to fight with manuscript central which seems to have been designed by a software engineer who was trying to be malicious, but wasn’t talented enough to get that right.

I get to feel all my emotions. I get to do productive work, or at least semi-productive fighting with badly-designed websites. I have a good job, for as long as I have funding, anyway (and a little longer if my boss is to be believed). I have a nice home, and close friends. I have found a really wonderful, really engaging online community, that I participate in. I make meaningful contributions to society.

And even days like today, when I feel like leveling manuscript central’s server farm with an airstrike, and the collaborator I’m trying to get in touch with has apparently still not discovered voice mail, and I didn’t get enough sleep, and my paper was rejected without review, I am grateful. Because these are the problems of a useful man. Someone with something to give. People to serve.

And even the big things are manageable. I got divorced. There were a bunch of reasons for it. Some were my fault, some were hers. I won’t go on a litany of blaming her. It’s not relevant and not useful. The real issue is, when I got sober, I changed. It was a massive, unqualified change for the better. But I was not the person whom she had chosen to marry any longer. And I was no longer the person who had chosen to marry her. And so we parted. And I was heartbroken. And I still am some days. But I didn’t drink over it, and I didn’t want to.

Last month, the woman who I think of as my adopted mother died. She was my college roommate’s mother. I called her “mom” for twenty years. She died of a glioblastoma multiforme. And she died with grace and dignity, which is often not the case with that malady, which can destroy who a person is long before it kills them. She was only 63. I was tossed into grief. But I didn’t drink about it, and I didn’t want to.

And there are challenges ahead. Personal, professional, romantic, physical. And I’ll meet them all. Sometimes I’ll fail. Most of the time, if history is any indication, I’ll do pretty well. Sometimes I’m afraid. Sometimes I fixate on things I can’t control. Sometimes I feel like I can’t calm my mind and my heart. Those times are generally pretty short these days. And I know what to do with them. I call my sponsor. I go to a meeting. I sit quietly or play the piano.

Sometimes people say that I’ve conquered my addiction. I smile, and say “thank you” mostly, when they do. But it isn’t true. My addiction conquered me. Completely and irrevocably. I am totally and utterly and irretrievably addicted to alcohol. I will never be able to drink normally. And it is through the acknowledgement of that defeat that I am liberated. As long as I tried to manage my drinking, and my life as a drinker, I failed. If I try again, I will fail again.

Surrendering to my addiction allowed me to stop fighting it. And because I am not fighting, I do not have to drink. Because I have nothing to prove to the bottle.