A personal note: diversity and its discontents

We had a bit of a blow-out in the comment section two posts ago. John (JLK) wrote a comment in which he made several claims about what addiction “really” is and provided a very specific recipe for how it should be treated. He also said he didn’t think I qualified as a “true” addict:

Your method of quitting has always sounded too good to be true for me. You also are able to drink on a regular basis. While it is true it takes all kinds there are also a lot of similarities in the stories I have heard… and I must admit I have not heard one remotely like yours…

To put it plainly I am still not convinced you were a true addict but possibly driven by other psychological problems. First you were a “binger” and second you were able to quit the hard stuff too easily.

Two commenters, Alese and Nik, took John to task on these and other points. I stayed out of it, though it’s true his comment did piss me off, and I had to decide to hold my tongue.

Now, in retrospect, I have a few points to add:

First, I don’t think John meant to offend. His very recent comment, about walking on eggshells, suggests that he has his own style of what to express and what NOT to hold back. I feel badly that you may have been stung by some of these replies, John, but I also think that they expressed important and valid counter-arguments to your claims. I also think you walked right into this, by challenging just about everything on your radar, without much thought about how readers, including me, would react.

Nik disputed some of your claims very convincingly. I won’t reiterate that here. But the upshot is that many of us feel there are many ways to BE addicted and many ways to recover….So, maybe, counter to the theme of my last post, there IS a fair bit of diversity in people’s experiences during addiction and recovery. But I guess what inflamed most was how you took experiences such as mine and passed judgement on them without seeming to care how I interpreted my own experiences. Most people, but (ex?) addicts especially, are pretty sensitive to that sort of thing: if you’re going to try to understand what I’ve been through, ask me, don’t tell me.

The funny part is: why should I  be so proud of the “addict” label that I resent you for challenging it — as if you’ve ripped away my favourite shirt or something. But here are a few more concrete issues:

many addicts are involved in “binge” style using. It’s really pretty common, among alcoholics too. I was talking to some addiction specialists last night who report that binge drinking among teens is rapidly on the rise in many Western countries, leading to increasing reports of death and brain damage. The main issues are: how often, how much harm, and how much control does one have? Call it binging or not, but I was very close to killing myself. When you alternately shoot Demerol and coke, every 20 minutes or so, a minor miscalculation can kill you easily, because you are balancing a massive dose of an opiate with a massive dose of a psychostimulant. This was one of the last episodes of using I report in my book — and I think it was one of my last times ever. Anyway, don’t imagine that this was child’s play, a point that’s not so much insulting as it is inaccurate.

-although my story has some unique features, it’s not all that unique. I did not quit easily. I had tried to quit many many times, and by now I was completely desperate. On this particular day, it worked. But that’s just a small part of the story. I’ve recently talked in depth with two heroin addicts, both of whom can point to a last day: the last day they used — after which they just stopped. So much desperation, disgust, and horror had built up, they just couldn’t keep going. So we shouldn’t confuse the “ease” of “just saying No” with the long, grinding build-up that makes that moment possible. And by the way, “spontaneous recovery” is much more common than recovery through any particular form of treatment, including certainly the 12-step approach. That’s a fact.

-John and I may agree on one thing: that compulsivity is a huge part of addiction. Different parts of the striatum are responsible for different aspect of addiction. The ventral striatum becomes highly sensitive to addictive cues and shifts attention to the drug/booze target. That’s impulsivity. The dorsal striatum is in charge of directing a stream of behaviour, step by step, toward that target. Compulsivity is the inability to turn off that stream of behaviour, as exemplified in OCD and compulsive gambling. Dopamine fuels both striatal functions — wanting and doing. And guess what: when Parkinson’s patients are given  dopamine-enhancing drugs, their tendency toward compulsive gambling goes way up! A central issue in understanding addiction is: how and when does the impulsive aspect give way to or get replaced by the compulsive aspect? We need to learn more about this.

-and finally, yes, I’m able to drink alcohol without a massive landslide in self-control. So are a lot of other ex-addicts. This issue is not definitional — it’s a matter of individual diversity. Many ex-alcoholics can smoke, some can’t, some ex-junkies can drink, some can’t. For some former addicts, smoking pot is a minor diversion after giving up more toxic substances, for others it’s the top of the slippery slope. What bothers me is the tendency to set up these formulas and imagine that they apply to everyone: if you drink then you either never were or still are an addict. All these “formulas” have millions of exceptions. And something that hit-and-miss isn’t really a formula at all.

Okay, let’s bury the hatchet and keep on talking. We really can learn a lot from listening to each other — and that’s not just a warm-and-fuzzy motto: it’s a reality.


40 thoughts on “A personal note: diversity and its discontents

  1. JS October 5, 2012 at 8:38 am #

    Ive been an addict 30 of my 42 years. I am poly-addicted to benzos,opiets and alcohol at differrent times to each other , sometimes hourly,daily and binging.
    I have also seen a wide range of addicts and generic treatments which result in harm minimalisation and or abstinence but most times relapse.

    I have been in all manner of rehabs and counseling and really only managed to chop and change with short times of sobriety. All I know is my brain craves any kind of deppressant in can get its hands on and is quite happy to mix drugs too. I dont have a drug of choice, anything downer will do,having a drink wont necessarily lead me to having more drugs, mostly alot of one will do but at the moment Im in a rough patch,pot,xanaxs,valium and bueprenorphine.

    Im still fighting and have a great support group but Im tired of fighting and topping myself has been a recuring thought as I see the miricle cases of sobriety and wish that was me but never underestimate the amount of work it takes to get stable let alone being free and having choice again.
    Im sick of being in fear and am scared Im running out of motivation as I just cant see my self sober via traditional means. Im an addict some call it a disease or sickness well sickness and diasease can sometimes be cured I want a cure not a bandaid for the rest of my life eg Methodone etc.
    There is no easyway to sobriety ( for want of a better word) but after years of work you may open your eyes and be able to say no, or after a few weeks depending on the subject . You cannot generalize about recovery its way too complicated and diverse.
    For me I have to struggle with my own definition of my using my addiction and cant bare the thought of being an old age addict .I want to be cured and have the freedom to smoke a joint or have a drink or have nothing just take the habitual nature out of the equation. I can hear the NAs now ” Your deluded JS ,you will always be an addict
    and the 12 steps the only way “. For some it is and it works, I just believe the shift comes from with in ,not a higher power . I cannot rely on that or expect it, just keep pushing and investigating, I have gleamed so much from all the shrinks,D n A councilors and NA but not one doctrine can provide all of an individual addicts need. My belief is that the only way I could be truly sober is to find no enjoyment or relief in drugs therefore nullifying the desire. I dont like chocolate cake so I dont eat it I dont like coke anymore so I dont snort it, I used to but my mind shifted after a very big binge and the desire just vanished. Hopefuly I can slowly remove the rest from being appetizing . I just dont like it ,anything about it,I concentrate on finding other things like surfing bla bla that motivate me more and I enjoy more than nodding off on my couch. Thanks . I hope that made some sense JS

    • Victoria Hunt October 6, 2012 at 10:45 am #

      Thank you for your post. I couldn’t have ever explained it better. For me, the methadone bandaid keeps the infection away until a cure is found for something we can’t seem to define.

    • Marc October 7, 2012 at 11:55 am #

      You are courageous to keep fighting this thing that sounds like a demon in your life. I understand that you just want to give up. It’s exhausting to keep fighting the way you’ve been doing. But you still have clarity of mind and you still have a very intact sense of purpose. And you talk intelligently about treatment as necessarily diverse. You can’t do it exactly the NA way or exactly any other way…you have to find your own path, even though you appreciate what you’ve learned from these and other resources.

      Please don’t think of yourself as bloody-minded about this. Finding your own way to recover is not a choice, it’s a necessity. It really is that way for many of us.

      I also know what you mean about just WISHING the desire would go away. But I’ve talked to a lot of addicts, and the desire does change over time. It might not just go away, but it might diminish, or be mixed with enough aversion that it won’t pull you the way it does.

      Even if you give up for short periods, the main thing is not to give up for good. And even that’s not a matter of choice. The life force keeps you going.

    • Marc October 13, 2012 at 6:13 pm #

      JS, please also see Persephone’s comment below….I mean halfway down the page, and also see my response. I think these are partial answers to your question, i.e., your longing for an end to craving.

  2. Julie October 5, 2012 at 11:21 am #

    Hi Marc,
    Although I did not read the comments left by John I feel compelled to respond as well. My sense of this need to “formulate” addiction into a one size fits all category is that it stems from fear. If the AA model of sobriety, which so many rely on, is threatened or even challenged, then people may take that personally as it becomes a personal belief system for many.
    I have friends who have distanced or cut off from me after I left the program and it saddens me. However I also understand that my choice is one that contradicts the very foundation of recovery for some.
    I was an alcoholic, I couldn’t not control my drinking for the most part. What it took for me was intense emotional work around my early childhood wounding and looking at the trauma I had experienced which I believe is at the root of addiction.
    My choice to quit drinking did not come easily either. It was a painful battle.
    However I am no longer an addict or an alcoholic as I don’t relate to those labels anymore. I have a healthy relationship to alcohol and it feels very empowering.
    Your take on addiction, is in my opinion, very progressive from the traditional take and it will harness criticism, fear and judgement. Its all to be expected and I welcome the ability to have this conversation. If someone is so reactive to your blog and words, then it means its hitting on something. I am curious to know what that may be for John? Underneath the defense, what is going on for him?
    Respectfully yours,

    • Donna Gore October 5, 2012 at 9:30 pm #

      I applaud this philosophy of diversity. It’s about time!

      My “drug of choice” is alcohol. I have not had a drink since 1990. I did smoke some weed a few years ago a couple of times and you know what? It didn’t make me rush right out and get drunk. (Actually it didn’t do much of anything except make me feel relaxed and somewhat stupid – and I decided I could do that on my own, thank you.)

      The problem with the 12-step approach is their “one size fits all” tunnel vision. They want to put us all in the same box. This is why the “recovery industry” – while being a huge financial success for the providers – is a disaster for many patients. They herd everyone through like cattle. One of my friends had a brief detox at a rehab center recently. She said a doctor WHO HAD NEVER EVEN SEEN HER wrote a prescription for her. Is there any other setting where this kind of thing would occur? The only thing I can think of is (ironically) a “pill mill.”

      She protested, and was of course instantly labelled as being “in denial.” Anyone who dares to question, anyone who does not march in lock step, is immediately branded this way.

      Think about college kids who binge every weekend. How many of them actually go on to become alcoholics, and how many of them don’t? How many do their partying as a “rite of passage,” then get over it and grow up? Yet their behavior would automatically lump them into the “Alcoholic” category among the 12-step crowd.

      I know people who have been to rehab 5 or 6 times. And what’s the definition of insanity? Doing the same thing over and over and expecting different results.

      • Persephone October 6, 2012 at 1:07 am #

        Donna–I saw as well, first hand, what you are mentioning here. The last rehab I was at had a contracted doctor who, while he did briefly meet the patients (and I do mean briefly), his directions for what to prescribe were directed by the counselors. None of them were doctors (nor, to my knowledge did more than a few have Masters in anything), yet they directed every patient almost without fail to be placed on rather heavy anti-psychotic drugs. This was notable particularly as the rehab’s pens, clocks, clipboards, pads of paper, etc. were all emblazoned with the brand name of the most recommended drug, Seroquel.

        I realize that is neither here nor there in terms of the larger discussion here, but wanted to verify to you that I have seen this as well.

        • Marc October 9, 2012 at 4:59 am #

          Well it is sort of here and there, I think. The recovery industry is very much controlled by the medical community, and they are deeply infiltrated by the pharmas. I know this first-hand from my brother, who happens to be a doc. I think this is a particularly awful story: antipsychotics are horrible drugs. I once tried them to get high, and I felt like a walking corpse for two days.

          • Persephone October 14, 2012 at 9:55 am #

            Very here and there. At least in the U.S. There are no national regulations to speak of for the recovery industry, just varying rules by state (for some great examples, please see the recently published CASA study from Columbia U.). I think the medical community is more or less hands off when it comes to the recovery industry, but the pharmaceutical industry has infiltrated both, and like the cliched reference to the old game of “telephone”, the only message that actually hits most treatment centers is the one by pharma along with some garbled messages about neurochemistry and diseases.

            I just wanted to add this because frequently those in the medical community throw up their hands, fearing either liability or simply addiction itself, and start referring patients over to the addiction specialists, with whom they frequently have no communication with. Their approach is very hands off, very much to send the addicted person elsewhere to be dealt with.

      • Marc October 9, 2012 at 4:56 am #

        These are great comments, Donna. The spectre of being labelled “in denial” has some really scary overtones. It’s like a dream or a fantasy I used to have about standing at a podium and trying to convince an audience that I was not, in fact, insane. Or, more mundanely, like trying to convince your psychoanalytic therapist that you are not actually, at this moment, being defensive. That’s something I HAVE experienced.

        Many on this blog are telling stories like yours. One toke is not necessarily over the line. Nor is one drink, for many of us…though it is for some. Diversity seems to rule when it comes to recovery, even if addictions themselves have so much in common. This would be a useful clarification for my hourglass model.

        On the other (third?) hand, please see my next post. My visit to 12-step land left me a lot more sympathetic than I ever would have imagined!

        • Donna Gore October 9, 2012 at 5:44 pm #


          Regarding the first paragraph of your reply — The best word I can think of to describe it is “Orwellian.”

          • Marc October 10, 2012 at 6:38 pm #

            Yup. With a bit of Kafka around the edges. Or…that movie, what was it called? Brazil? Your description really did get to me!

    • Marc October 9, 2012 at 4:43 am #

      Hi Julie,
      I have sort of welcomed this debate. It does get to some bedrock issues. I think what you say about fear is right, and it approximates what orthodox members of various religions feel about divergent views. But another, related, reason for the dogma is that it took so long for something to work…once it works, it really does seem like the only game in town. Check out the last two paragraphs of my most recent post.

      And congratulations on finding a “healthy” relationship with alcohol. Being a fellow heathen, that sounds good to me.


  3. Richard Henry October 5, 2012 at 11:54 am #

    I like the part where you said…”it’s a matter of individual diversity. I have been an addict to one think or another for most of my life. When I say “Addict” I mean totally dependent on one subs-tans or another in my everyday life. I used to drink a 26 a day or a 24 of beer a day and a Mickie, waking up with to the shacks so bad I had to have a couple of drinks just to straighten up.

    Contrary to popular belief I can have a drink on an occasion. I don’t even like stating that fact to anyone, well except my son, because of the controversy of “Denial’ and once an alcoholic always an alcoholic.

    Today I think the most important things I have done to permit this type of use is in dealing with all my underline issues. So I no longer have to dwell on or hid behind all those unhappy feelings.

    Today addictions sneak up on me, in all that I do, OCD can be handy in accomplishing something I put on my plate load, its just for me a matter of knowing when to let go, and move on.

    Reg Richard

    • Marc October 9, 2012 at 4:49 am #

      You sound like another healthy heathen, which is a great accomplishment after that level of alcoholism. Congratulations to you as well!

  4. Fred October 5, 2012 at 1:43 pm #

    I had to learn my own path through addiction. When I decided I wanted to stop I worked with an addiction counselor (CDP), and dove into 12-step. I worked that program hard because I believed it could help and I saw that it had worked for (some) others. I learned everything I could from the folks who seemed to have success. I’ve also seen lots of people that 12-step hasn’t worked for, and I don’t believe it’s simply because they didn’t work it hard enough. Different things seem to work for different people.

    But in early recovery, I couldn’t have handled a “choose your path” approach. It was helpful for me to diligently do whatever my sponsor asked. As I dug in, though, I ended up tailoring things based on what worked best based on my own experience. I learned that certain activities were no longer safe for me to engage in (even if they weren’t directly part of my addiction). Other things, like alcohol, have never been a problem. I’ve learned I can’t tell someone else how to recover. However, I can tell them what worked for me, and I can share why I think it worked, but ultimately I have decided to trust each person’s path, and offer my support if asked, wherever they are on their path.

    I’m still involved in 12-step (over six years sober) because my life has gotten a lot better and when I cut back on my program I’ve found it gets worse. I continue to make tweaks – adjusting my meetings, my step work, my service – to keep things fresh. I’m an empiricist on this – it’s simply what worked for me. I hope all who are afflicted or interested in recovery can also find something that works for them, and then share it with a dose of humility with others. In my experience, addiction is too baffling, patient and powerful to think there’s only one way that it breaks us down, and only one way to recover.

    Thank you, Marc, for creating such a fantastic community. The level of discourse is really outstanding compared to any other comment board I’ve ever read on the internet.

    • Marc October 10, 2012 at 6:45 pm #

      What a lovely contribution….to this community, and yes, I agree, it’s become a great community. I’m proud and honoured to have helped it grow.

      You speak of diversity and individuality in a unique way: it’s like you’re telling us of a mountain trek, carefully picking your way through a maze of obstacles, learning from your falls and scrapes as you go, taking it slow, adjusting your route if the ground gets too icy or the path too steep. And then being aware of how tricky it was and being ready to help others to slow down and find their own best path.

      I mean, I’ve heard this spoken in a few different ways now, but this was particularly intimate and refreshing.

      Thanks for that.

  5. Ron October 5, 2012 at 1:46 pm #

    Hi Marc,

    Firstly, thank you for a wonderful book which I have found fascinating and very helpful. My experience that both staff and those who use treatment services find it immensely empowering to understand the neurobiology of addiction.

    I absolutely understand the need to for people to keep safe in recovery which may mean strong adherence to a belief system about addiction and recovery. Areas of grey are those that most of us who have been dependent on substances have navigated and exploited to the fullest in an attempt to mitigate the consequences of addiction whilst trying to hold on to the benefits! I attempted such negotiations for years, including a search for the space between life and death, where I owuld find ultimate freedom.

    I am in recovery and have worked with many who are now in recovery. What I know is that there are very many paths into and through recovery. I chose to abstain from all mood altering substances for 3 years. It gave me a frame of reference and allowed me to address the key drivers of my addiction. Sometimes I drink (very moderately) and sometimes I don’t drink for large periods of time. It works for me. I used illicit substances for 17 years, it has now been 15 years since I stopped using crack and heroin (having made numerous previous attempts). I lead a meaningful and purposeful life and am fortunate enough to experience a good quality of life. If I had to use a label for my recovery it would be “pick and mix recovery”.
    In many vociferous circles my recovery would not be seen as legitimate, as something second class especially given the fact that I started this journey in 12 step recovery (which was a great gift and one I frequently advocate for). I know that is more about those doing the judging but it has made me wary of self disclosure. And for me personally that is fine, however, there is a growing recovery movement that is meant to embrace all forms of recovery: spiritual, religious, 12 step, SMART, natural recovery, Intuitive, educational based, secular, medically assited etc. The more visible this movement, the more opportunity there will be to combat the shame, stigma and misunderstanding surrounding addiction, which is becoming more prevalent in our increasingly “dislocated society” (Bruce Alexander). If more people are visible it will also more research to be carried out on recovery , an area that requires far more investigation.

    I work in the field so I can participate in the debate and growth of the movement but there are so many out there, who are in recovery but keep quiet because they believe that they will be judged as either not having had an authentic issue in the first place and/or that their recovery is somehow illegitimate even though they are active citizens, giving back to their communities, enjoying freedom from dependence , experiencing wellbeing and have overcome significant adversity.

    Lets not judge each other harshly – find what works for you, be accepting of yourself and others and together lets get the message out there that recovery is possible, that there is hope and that we can all make a positive and lasting impact on our wider social environments.

    • Marc October 13, 2012 at 5:56 pm #

      Not much I can add here, Ron, except to thank you for such a comprehensive picture and inspiring call to arms as to where we should be directing our attention. This new, more pluralistic umbrella view of recovery sure does sound like the right solution. It reminds me of so many other social movements of the last fifty years, things we now take for granted, like tolerance of gays and lesbians, of other races and ethnicities, and acceptance of multiple religions or views of God or of the universe. Funny that addicts are so late to arrive at this pluralism — but not surprising, given the incredible vulnerability of this group.

      I would have thought that recovery would simply be judged by its results. But now, through reactions to my book and so forth, I’ve come to know how loaded, how political, the recovery world can be. How strange to say: either you’re doing it wrong or you were never really addicted. But now I understand it better.

      Maybe “pick and mix” or “mix and match” should be included in the title of my next book or somebody else’s.

  6. JS October 5, 2012 at 8:44 pm #

    Mix and match ! The only way for me, it maybe slower and more erratic a recovery but with an open mind you can pick and choose the facets of a number of programs to build up your defenses.

    The more options for recovery the more people recover ” Der Fred “

    • Marc October 10, 2012 at 6:49 pm #

      It seems some people get the kickstart they need by following someone’s guidance, at least at first. See Fred’s comment above. And some, like you, get their traction by using the freedom that starts to appear as the hourglass begins to expand outward

  7. Persephone October 6, 2012 at 1:33 am #

    I have heard this many times myself, though I’m not here commenting on this to attack JLK (whom I’ve not commented with to my knowledge here). I appreciate his comment about walking on eggshells, and when these issues were/are so important on such deep levels to those of us who’ve lived through this, it’s easy to get emotionally riled up, etc.

    I have rejected, outright, the “addict” label for myself–but only because of the implications of so many that to be an addict is to have a lifelong “disease”, or more specifically, a set of personality traits that seem to hinge on being a human ticking bomb. It seems expected that once one has sunk into addiction that, despite abstinence, the monster is forever lurking around corners, our self-control subject not to our own faculties but those of this “baffling disease”. (What’s the common saying in 12 step meetings? That “my disease isn’t gone, it’s outside in the parking lot doing push-ups!”

    However, when I was addicted, I was addicted bad. Considered a worst case scenario, headed for the grave. Nothing was enough. Suboxone? I took them as compulsively as I had hydrocodone. (I’m not against ORT for others by any means, as we all respond DIFFERENTLY!–and thank Marc yet again for reiterating this point!) Now, well, it is just gone. Completely gone. Opiates being what they are, I wouldn’t submit to being placed back on them (though I’ve been offered them by different docs SIX times in the last year alone!). While I have had to (VERY briefly) had to be on (under a doc, by medical necessity) the very same drug I was addicted to twice in the last year, I most certainly didn’t lose control or relapse, and while not analogous to using a substance you weren’t addicted to, that was (by most accounts) worse. I certainly don’t see former addicts who relapse over such things as weak, either. But I just don’t respond now to how I did in the past–and that response was to OD myself on an increasingly frequent basis.

    Yet based on my lack of cravings now, I also have been told I wasn’t a “true addict”. Many experts would see that as either relapse, denial or “wasn’t ever a real addict”, so I’ve just learned that aside from very few experts, I no longer have any more use for them than for opiates. Less, actually, as few addiction specialists are recommended treatments for medical emergencies.

    Thanks for keeping the debate lively, and accepting the occasional post from a very busy Persephone.

    • Marc October 13, 2012 at 6:11 pm #

      Your story is a keeper for me, busy Persephone, partly because it really outs the problems with the disease model. Pushups in the parking lot indeed! No, that whole approach turns me off because it embodies dissociation, and dissociation is the motive at the heart of drug addiction! The addiction is not outside ourselves–it’s very much at the centre of ourselves.

      I also love your story because it confronts a very basic issue/question that many people raise: can the craving ever really go away? Can the compulsiveness, the desire, ever lessen? See the comment by JS at the top of this section. Yes the desire, value, importance, meaning, attraction…add a few more of your favourite terms…CAN go away. At the very least it can change with development. Disease is such a static notion, and I’ve learned a lot from mentors in developmental psychology: nothing is static; everything develops.

      Your story is also a lot like mine. I have taken opiates for pain in the last couple of years….prescribed of course. And although I still felt the “ping” of attraction, it was nowhere near what it once was. In fact it got progressively more boring instead of more attractive, so I was motivated to get on with my physio and get off the pills.

      These and similar stories should be up on billboards.

      • Persephone October 14, 2012 at 10:36 am #

        Thank you, Marc, and I also think these stories should be on billboards, if for no other reason than to destroy the notion that anyone who has been addicted is a timebomb just waiting for the right moment to explode into “active addiction” once again.

        I’m glad that you mention development vs. stasis in regards to this. I have seen in no area of psychology aside from addiction this notion that one’s state of being unwell should be kept in indefinite stasis, with a DISCOURAGEMENT of development. While I understand the reasoning behind the traditional model (the one I was exposed to, Minnesota, 12 step, whatever you want to call it) for the stasis as being to keep the formerly addicted person reminded of how low they can sink, I think that the developmental stages people go through are extremely important–and quite normal!

        There is no way to process what you have gone through having been addicted while keeping it all static, with normal ways in which the brain processes any griefs or traumas, repressed. Anger is important, if only as a stage. Full health can never be reached (by someone like me, at least) while kept in the static state of being “diseased”. I would further define that, for myself and many others, as being kept in a state of trauma, which is very much what my addiction was. I am aware of no one in the trauma and abuse fields of psychology advocating that patients stay in and relive their trauma–even when they do so to “keep up their guard” against whatever traumatized them. Why is the reverse the case in the addiction field? And is this, in your opinion, healthy?

        • Marc October 14, 2012 at 1:02 pm #

          This is fascinating….very thought-provoking. My thinking about addiction was guided by developmental principles…my book is exactly about the development of addiction, in very concrete terms at the neural level, as well as the narrative level, dealing with my gradual changes in state of mind, self-concept, etc.

          But I haven’t thought as much about recovery as a developmental process. Your very clear thinking about this is inspiring…indeed there are stages of recovery, of course there are. For me also it was necessary to go through an angry/revulsion stage…but also more subtle things like changing your sense of yourself as sinner, victim, fuck-up, what have you. That certainly develops too.

          The static idea of addiction as a disease — you’re right: it goes against not only all the basic principles of human development but also against the principles of therapeutic change. Weird!

          I think this deserves its own blog post…I’ll put it on my list, unless, unless, you’d be willing to write it. Not to say much more than you already have — just flesh it out a bit and let me “publish” it. Let me know.

          One last point: see Peter’s comment below. He explains clearly how the disease notion plays its functional role: a box to put the addiction into, so that you can deal with it at a tolerable level instead of always being slammed in the face with the enormity of what you’re doing to yourself. You’ll probably agree with his point…but…I suppose we can think of “disease” as a transitional object — an artificial thing that serves its purpose until we grow out of it. The classic transitional object is the teddy bear, which eventually gets relegated to the attic.

          • Persephone October 14, 2012 at 6:31 pm #

            I have actually written quite a bit on this subject, but it is from a rather different perspective perhaps. Mainly, I don’t want to be disrespectful to Peter or any others here who found those stages through a 12 step route. In my own attempt at that method I was told (rather explicitly, actually, but also implicitly) that I must remain in a state of stasis and that no development was possible except by certain step-approved methods. These obviously do work for some people, as Peter points out below in his anecdote about the friend in recovery who has had tons of personal growth.

            I will email you the thoughts and observations I have pondered re: how people are kept in stasis and how the psychological processing of their experiences are discouraged in some versions of traditional recovery, however, if you would like.

            • Marc October 16, 2012 at 12:24 am #

              I would like!

  8. Peter Sheath October 6, 2012 at 5:57 am #

    Hi Marc
    First of all it was a real privilege to meet you the other day. I enjoyed every minute of the time we spent together, it’s so lovely to spend time with a kindred spirit and fellow seeker! I know we discussed this issue, at some lengths, but I have been doing some further reflection, as is my want, and discussed it with friends and colleagues.
    So here is my, I hope, humble opinion. I do believe that recovery is a diversity issue, we should enjoy and celibrate eachothers recovery choices and welcome new options rather than labelling eachother as “real addicts” or saying “my way is the only way”. I really can understand how it helps people to hold on to these beliefs, it protects the purity of the message and, in some ways, the sanctity of the group. I can also understand some of the metaphors that have become truths as they help people to slowly understand their particular problem and make sense of some of the things they may have done. How difficult must it be to suddenly realise that the desire to use the drug you were using overrode just about every other natural instinct, including, possibly the strongest bond between mother and newly born child? Referring to “it” as my disease does help people, including myself, put a little distance between the deed and ownership, enabling the confrontation process to slow down as new coping strategies are formulated.
    These days, for my own recovery, I do not find constantly referring to “my disease” as particularly helpful. I honestly know I have a problem with addiction, but it is all down to me and subsequently how I resolve it, on a daily basis, down to me and the programme I have embraced. I know that when my day has not gone according to the plan I set out, the “I” being the big mistake, my first thought is always to reach for a “soother”, often this will be chocolate, sweets, etc. but it could just as easy be the internet, porn, trashy TV, etc. The problem is that, having reached for my latest soother, I just don’t know how to press the stop button. I can eat literally pounds of chocolate at one go or sit in front of a TV screen for 12 hours solid! Is that “my disease?” I do, however, buy the dis-ease concept because I know that when things do not go my way, it keys into my poor self evaluation and I can very soon become full of self pity, blame everything and everybody else and emersed in resentments.
    I don’t buy this “real addict” concept at all, I can see how it helps people to introduce exclusivity to their particular issue, don’t we all like to do this sometimes? But, and it is a very BIG BUT, how does this realistically help in the longtime?
    Marc and I enjoyed quite a diverse theme throughout our discussions, we talked about all the genuine people we have met in our lives who have embarked on very different, but equally valid journeys of recovery. I know people, all of which have been very, very chaotic, who have found recovery in religion and faith, others, not unlike Marc, who just stopped and subsequently found a new way of life. I know people who have taken Ibugaine, as part of a shamanic ritual, and a whole family mum, dad and two kids who used electronic black box treatment. I also know people who manage to use, even their drug of choice, controllably.
    Last night I had the privilege of watching a guy I have sponsored for the past 7 years, through NA, do the openning share, in front of around 500 people, at an NA convention. When I first met him he was always angry, very racist, and had been barred from several meetings for fighting. Through the 12 step programme, last night, on a stage and in front of 500 people he was able to say that he loved me and loved his life! Several days ago, another guy, not in a 12 step programme, who I met in my professional role, blogged on a website that he was celebrating 12 months drug free. When I first met him, probably about 2 years ago, he was taking 500mls Methadone, 200mgs Temazepam and 60mgs Diazepam daily and, remarkably, was able to function! His detox took almost 9 months to complete and he tried 12 step and SMART before deciding he could do it on his own with the support of his family. He left a message, from his family and himself, thanking me for the support he had received.
    Finally, I love this recovery thing, I love spending time with people both in recovery and in the problem. I really believe that it’s not up to me which path someone chooses to walk, but it is up to me to show up and be present and support the choices they make. Today I choose to do this by remaining abstinent, practicing a 12 step programme and ensuring I maintain a wide breadth of skills, knowledge and experience.
    Sent with loving kindness

    • Marc October 14, 2012 at 3:30 am #

      Hi Peter. (in case anyone else is reading this, here is the Peter I met in England, featured in the following post). Yes it was a pleasure and a privilege to spend that evening together, as I’ve told you. And next time we meet it may well be in the Netherlands, just across the channel, barely a stone’s throw away.

      The only thing you said that night that really surprised me was that you meditate for 20 minutes every morning. It shouldn’t have been surprised, on reflection. You have a peaceful presence about you that makes other people feel, not only at ease but more connected to themselves. I imagine that’s part of what’s made you such a good guide for people in recovery.

      I’m starting to love this recovery thing too. It didn’t start off that way for me, as my interest in addiction was limited to two categories: the personal and the scientific. Other people’s recoveries weren’t greatly connected to either. But now, meeting so many other people, getting to know how long and hard people struggle, I see that this is where the real heroism lies. Getting addicted just seems like a spin-off of being human. The process is natural and organic, even though it’s deadly. But recovery– that’s pretty amazing. It’s a bit like fighting back a tidal wave, and winning.

      We both see the pitfalls of the disease label. But you also describe the function it serves, and you describe it much better than I could have. We put a part of who we are outside ourselves, so we can take stock of it, then slowly let it back in, with understanding this time, reintegrating it in a different way. So I’m learning, as some readers have already pointed out, that the science is only part of what’s interesting. The finely tuned humanity of getting better–that’s really very interesting too.

  9. Kerryn October 6, 2012 at 7:51 am #

    Hi Marc I would just like to say that personally I have been heroin speed and puff addict but have never liked alcohol much and can have the odd few drinks now again too. I think we all have drugs of choice personally alcohol does nothing for me I enjoy. Kez

    • Marc October 14, 2012 at 3:33 am #

      Yes, it’s wise to stick to the ones that DON’T feel quite so wonderful.

  10. Donnie Mac October 6, 2012 at 2:07 pm #

    It continues to amaze me , this portion of “How it works” from the Big Blue Book of Alcoholics Anonymous is read at every meeting ( at least in Canada ) that I have ever been too , it states :

    ” There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.”

    So important was this statement it was placed in the first paragraph before the actual 12 Steps and after “Rarely Have we seen a person fail” . This was done for a reason .
    The rooms of A.A are replete with mental illness , I’m not a Doctor and I don’t even play one on T.V ( super old aspirin commercial reference ) but if you look back at John (JLK) posts you maybe able to spot some sort of “Disordered Personality “. This is what the “First One Hundred” were writing about when they wrote the Big Book .
    In my own experience years ago , I found it way simper to swallow the “Alcoholic” label than any of the other mental diagnosis I presented with . So I stop drinking , do the steps 100 times go to 100000000 meetings , pray , phone my sponsor and I’m still crazy as a bud bug seven years later . It was not until I addressed my mental health did I find some relief and healing . My point ? I think you get my point .

    • Marc October 14, 2012 at 1:56 pm #

      I do think I get your point, Donnie. People who are feeling at peace with themselves and the world rarely end up in the halls of addiction/recovery, and that includes AA/NA groups. So, many of us have emotional or mental disorders or we wouldn’t be in this mess to begin with. In fact, it’s strange the the big Blue book or whatever it is suggests that only a limited portion of the community of addicts have emotional problems. I’d say it’s more like 99% (and of course I include myself).

      But you’re sure NOT being much of a doctor — not even pretend — when you diagnose someone without having met him. We’ve been talking about the dangers of slinging labels around. You might want to think about that in reference to people as well as programs.

  11. No October 7, 2012 at 8:30 am #

    After many years of painfully hopelessly using, a handful of different types of therapies, one day I’d had enough. The substance, I believe is not important, the facts for me are: I was done, so I thought.. A few relapses over a few months, several “rounds of the steps” (NA) 8 years later and an enormous amount of getting as honest with myself as possible at any given moment about my thinking, behaviors, expectations etc and taking responsibility for my life then and as it is now, and life is good. I am most deffinately a drug addict who cannot use ever agin nor do I want that lifestyle back. I do on occasion drink and it causes me no problems. However, I have friends in recovery who cannot and some who choose not to. My personal experience has shown me that recovery from addiction is not only different for everyone ( one size doesn’t fit all) but is also no one else’s business. It’s great to share experiences as we do all learn, but in the end what others think about it doesn’t really matter. Do I have or have I had mental health issues? Maybe, maybe not. It’s no longer of importance to me. If I can live my life honestly ( the honesty is to myself first and foremost) cause no intentional harm to others and give more than I take, life goes along pretty good. Simplicity seems to work. I love to read your blog and it continues to be very helpful to me in many ways, so thank you.

    • Marc October 14, 2012 at 2:13 pm #

      Is it Jo or No? Well maybe that’s a case in point of what you’re saying: the labels don’t matter much, except for formalities, such as debates, research proposals, public policy matters. When it comes to our own experiences, it’s the process that counts — that and nothing else.

      I agree that other people’s evaluations of our paths of recovery are generally irrelevant and sometimes harmful. Plenty of readers have told us about keeping their path to recovery essentially hidden from the prying eyes of others, for fear of being judged as “not doing it right.” To put it simply, that sucks.

      The one exception is when people trying to recover keep bumping into the same brick wall time after time. That’s when others’ opinions can be helpful–when they’re genuinely intended to help and when help is genuinely needed.

      I’m delighted that this blog is helpful to you! Thanks for that.

      • Jo October 14, 2012 at 10:46 pm #

        Hi Marc,
        Sorry about the typo! 🙂 it is Jo.

        • Marc October 16, 2012 at 12:26 am #

          I wasn’t kidding, by the way, but Jo was my first bet.

          (some people have unusual “pen names”)

  12. nik October 8, 2012 at 5:09 pm #

    //Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.//

    (p 58, _Alcoholics Anonymous_ “Big Book” [4th])

    I have not dug this up for historical reasons, for ‘nit picking’, or to ‘pick a fight.’ I’ve heard it read regularly at 100s of 12 Step meetings, currently.

    There are certainly problems with this quote, despite some of its essential truths, *at least for those being addressed*. These problems include the assertion that failures of the AA [or a similar] program, for those committed to it, are “rare”.

    Most unfortunate, especially, is the apparent claim that those who fail [in the program, which is equated to failing to recover] are either 1) constitutionally incapable of honesty OR 2) emotionally or mentally disordered.

    The most intriguing claim–I suppose from the Oxford movement–is that A core problem, if THE core problem, of the addict, is honesty, esp. self honesty.

    There is certainly much truth to this, BUT I’m not sure, according to my impression, that ‘becoming honest’ is primary, main, or descriptor of the change that Marc went through, though I cannot speak for him. **

    What I’m getting at is that, as I read it, in the last unhappy period, several honest realizations did occur *long before stopping.* 1) I have a serious problem with drugs; 2) I don’t seem to be able to control it [stop], and 3) It’s ruining my life and imperiling my future, seem to have been admitted, at least to himself.

    What I’m getting at is that some ingredients besides ‘honesty’ were required before he definitely set foot on the road to recovery. At the point of setting out, Marc was, in my impression, doing *much more* that ‘getting honest.’ For example, he was feeling a desperate need to DO something, and becoming resolutely convinced that he had to stop certain behaviors (using certain substances).

    The issue of “other ingredients”, treatments, effectiveness of programs, seems to invite LOTS of debate and discussion, and is a reason, I gather, for this blog. And the postings above, for example, seem to attest to various strengths that we all have drawn upon, in addition to honesty.

    Thanks for a great post, Marc,


    **PS. I make two exceptions, here: 1) public disclosure of some practices would be devastating, and 2)illegal means of obtaining drugs or booze [or money to buy them] are necessarily lied about and/or concealed. These are obviously an intrinsic ‘honesty’ problem connected to extensive use for all but the wealthy who NOT in positions of public trust.

    • Marc October 14, 2012 at 2:59 pm #

      Hi Nik,
      True, the quote has a number of unfortunate assumptions, and you’ve picked the worst one, I think: the premise that people who don’t get better have some constitutional inadequacy. That’s quite a post-hoc conclusion, isn’t it? By the way, note that I used the phrase “emotional and mental disorders” differently than you do here in my reply to Donnie Mac above. You are probably more accurate in interpreting it as “grave” constitutional problems — schizophrenia and so forth. I took it as garden-variety off-kilteredness, of which I assume most of us are card-carrying members.

      But your point about honesty is really important. I mostly agree with you. For me, honesty was not enough. By the time I got close to quitting for good, I’d been VERY honest with myself, about my weaknesses, the rewardingness of drug states both for comfort and for meaning, my shame, the self-perpetuating spiral of using, shame, defiance, and using more. I got to know my own dynamics almost inside out, using my usual analytic talents.

      Not enough!

      What was missing was the emotional thrust to stop, a degree of desperation, a developmental platform that told me my life was moving toward the halfway point and I was up against a wall, stuff like that. And intention. How do you classify “intention”?! It’s a very different animal than honesty, it’s emotional rather than cognitive (in this sense), and it’s damn hard to put your finger on.

      There is one kind of “honesty” though, different from analyzing yourself in the conventional way: an honest, viz accurate, viz precise measure of how you get sucked in time after time. For example, when your thoughts first brush past the IMAGE, the tantalizing semi-conscious, fleeting image of what you want, and then you don’t acknowledge that you have to act NOW in order to get off that path and onto another. Pretending that it’s just a passing thought and you’ll deal with it later if necessary…. Letting that one slide is a fundamental kind of dishonesty — one that I had not really grappled with yet — and it’s a crucial variable when it comes to the moment-to-moment trajectory from addiction to recovery.

    • Jo October 16, 2012 at 7:41 am #

      Hi Nik,
      Just wanted to say thanks for your thoughts on the reading from the Big Book. I have struggled with all of that for so long and your comments have helped to clear up some of my own questions.
      Thanks again…. Very helpful.

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