“Recovery”: Mark of shame or triumph?

…by April Wilson Smith…

I used to hate the word “recovery.” To me, it was a mark of shame, stating that I was permanently damaged and different from “normies,” as they call people without substance use problems in AA. Recovery signified a lifetime of isolation, avoiding social events and going to dull nightly meetings where people wallowed in the past. It also implied that I had a disease, which I never believed.

So I refused to use the word. If it happened to come up that I had had a problem with alcohol, I’d simply say, “That’s no longer an issue for me.” I wanted to erase the period of time when I had struggled to get over my alcohol problem, and make life a well-paved road without the giant bump of my alcohol crash and stint in rehab.

Harm reduction coffee cupThen I started to work in harm reduction. I founded a SMART Recovery meeting, and went on to become an officer in the Harm Reduction, Abstinence and Moderation Support (HAMS) group. I met people who were at all stages of the struggle, from still using to fresh out of rehab to 18 years without a problem. I met people who were deeply in pain.

As I witnessed their pain, I began to reconnect with my own. It had been too difficult, at first, to remember the pain of passing out in the street or finding out the next day what I had said or done the night before. I didn’t want to remember the horror of woman smashedwithdrawing from alcohol more times than I can count, sometimes throwing up blood for days on end and nailed to the bed in a panic attack. I didn’t even want to remember those early days of abstinence when my senses first came back and I could smell the flowers in summer and taste blueberries and coffee as though for the first time.

woman scotchAfter almost two years and working with countless people with substance use problems, I could feel my own pain again. And I realized something: to deny that there is a period of time when the pain is acute, and when healing has to be a priority, is to deny an essential reality of people’s lives. Of my own life. That’s when I started to use the word “recovery” again. But I do not believe that “recovery” is a permanent state. With proper self-care, support, and meaning in life, one can heal.

My path to healing was a jagged one. When I left a traditional Twelve Step rehab, I was grateful to be out of addictive crisis, but I was even farther away from finding my true self than I had been. In woman in mirrorrehab, we were taught to identify as “addict” and “alcoholic,” and told that all our problems were due to our “disease.” We did little to address the issues that drove our addiction. Instead, we were taught that the answer to all problems was to attend Twelve Step meetings and work the Steps.

I got home and dutifully did my 90 meetings in 90 days as instructed, but it didn’t feel right. Gradually, I discovered writers who saw addiction differently. First Marc, then onto Carl Hart, Johann Hari, and eventually Stanton Peele and Kenneth Anderson. I saw a new way of looking at addiction, not as a symptom of a disease or indication that I was damaged for life, but as a behavior over which I could have control. writerAs I read more, I gradually began to discover my own voice, and started to write. Reclaiming my own identity, not as an “alcoholic” but as a writer, activist and scholar was my way out, not only of addiction but of the narrow, confined life that rehab and AA had defined for me as “recovery.” And I found that my own painful experiences gave me a perspective that could help others. Today, having recovered means living a life that I don’t have to medicate away.

Two years after my 28 day stay in rehab, I find myself writing about substance use and mental health full time, and I’m doing my PhD on harm reduction. I hope that my work can help people who are going through that difficult period of healing. By using the word “recovery,” I honor their pain, and I honor my own. I also honor our triumph over the pain.

My substance problem is not who I am, but it is an essential part of my life experience. It has given me insight into things I never would have known about, and a kind of empathy I never had before I woke up on the concrete.

I am grateful for recovery. I am also grateful for the ability to move on.

124 thoughts on ““Recovery”: Mark of shame or triumph?

  1. matt July 19, 2017 at 5:30 am #

    Thanks for this April. It’s true that recovery isn’t about getting your life back. It’s about getting back to life; about negotiating change to reach the potential we all have as humans.

    What do you say to the naysayers of harm reduction who don’t see it as a gateway to “recovery”, but more a condoning of harmful, threatening behaviors and carte blanche to use indiscriminately?

    Thanks for all the amazing work you do!

    • April Wilson Smith July 19, 2017 at 9:41 am #

      Hi Matt!

      I say “better a live drunk than a dead relapser.” I got that from Kenneth Anderson.

      Seriously though, I say that people are going to do what they’re going to do, and it is better for them to do it safely and stay alive. Most people do recover if their life circumstance improve, and some need treatment and support. Dying of an overdose because no one had Narcan or getting HIV because they shared needles severely lessens the possibility of recovery. The abstinence only model has resolutely failed. Looking at the stats rehabs will give you themselves on relapse rates will show that, and even by optimistic numbers 8% of people succeed in AA.

      I wrote this sorta fun piece about it: http://theinfluence.org/four-snarky-answers-to-those-annoying-questions-you-get-asked-as-a-harm-reductionist/

      • Craig September 9, 2017 at 2:48 pm #

        I have been doing the abstinance only model AA has to offer . And I have sucessfully put together 26 years of continuos sobriety anlong with at least 30 others in my town. I feel it only fails if the addict isn’t willing to do the work on the underlying issues that made him/her an addict.

        • April Wilson Smith September 9, 2017 at 5:04 pm #

          I’m so glad that’s worked for you! I think working on underlying issues is really important. There are many paths to doing that. Statistically AA works for no more than 8% of people, and that’s a very optimistic figure. For those for whom it works, it’s great. I’m here for the rest.

          To each their own!

          • Carl September 11, 2017 at 7:59 am #

            Smiley face.
            I’m a fan of your harm reduction sense April.
            An issue I have with the substance use field is this tendency for everyone needing a “terrible” story to tell in order to qualify as an “alcoholic” -for many people. I think AA perpetuates much of it but its not just them. I think most folks with SUD’s kind of just take a long time to trend in to a bigger problem. They cant tell stories about overdosing 30 times but they can tell you they gout and high pressure and some broken bones because of a lifetime of “overdoing it”.
            I wish we could reach these individuals better and sooner.

            • April September 11, 2017 at 10:41 am #

              Thank you ! Funny I just wrote an article on that topic ! Should be coming out soon on recovery.org.

              • Carl September 11, 2017 at 12:59 pm #

                Great-I cant wait to read it!
                I get how having a story helps to develop a rapport with folks-but where does one go after that?? These addiction stories-( i love them too) i think just skew everything and distract from the objective of “change”.
                I know I’m having a really hard time articulating this…. Brass tax-When Can we get down to the subject of change regardless of whether i smoked crack or not. my smoking crack is not going to help you if YOU don’t learn to change. I wish the field could make this transition faster. I don’t need a doctor to tell me about his sinus infection -i want my sinuses clear.
                I get that addiction isn’t a sinus infection- but the field cant keep being a big AA speaker meeting and expect to move forward.

                • Carlton September 12, 2017 at 9:31 am #

                  Years ago, the NYC-SMART Meeting Introduction invited people to share difficult situations they may be facing before the next meeting.

                  But some of us added this line at the end:

                  “..and feel free to share any valuable or exciting changes you may have experienced since your last meeting too.”

                  I don’t know if that line ever became permanent, but yes, Carl, I agree, sharing changes can offer glimmers of hope to people, and help them realize that what seems unchangeable, can, indeed, change.

                  • Carl September 12, 2017 at 11:00 am #

                    Yes! Seems so simple.Change is so much and so many things. We all know change-one doesn’t have to to do meth (thank god) to help someone get “resolved” or to “get better”. I like this.

                    We need to get the message out-When one goes to treatment-get the change going whether its because you almost got a DUI or because your on your 6th DUI. The story should be more about the change.

    • Terry July 19, 2017 at 6:04 pm #

      in general apart from the label the term recovery implies, that one is sick and ipso facto suffering from a disease, there is no term within the abstinence fields called “recovered” – in regards to habitual behaviours of all sorts we do not suggest a person is recovering – people are changing; a term much less stigmatising and labelling than recovery. Recovery is also like the word rehabilitate – useless if one wasn’t “habilitated” in the first place – can we recover something that isn’t there to start with ? at what point does it shift from recovery to recovered – a bit like at what point does it change from a problem to an addiction ??

      • Marc July 19, 2017 at 6:11 pm #

        If the term “recovered” has any social currency, it’s probably on the negative side. It’s a bit like the old story, the question “When did you stop beating your wife?” has no right answer.

        • Terry July 19, 2017 at 6:21 pm #

          yes Marc your right. I prefer to think I have changed, that term not seeming to carry undue inference – we all change all through life and moving away from destructive drug use is a change often brought on by changed values or priorities. What is interesting is the power such terms have over those who believe them. I hear those who are 12step devotees using the term recovery all the time in their communication about themselves as though it signifies some special process they, different from those “normies”, go through, but all humans change habits throughout their lives – we are all recovering from birth until we die and we are then recovered from life itself

          • April Wilson Smith July 19, 2017 at 8:05 pm #

            I know what you mean… they are obsessed with the idea that they have the corner of the market when it comes to dysfunction. I know just as many sober people who are messed up as people who drink to excess.

        • Carlton July 19, 2017 at 8:42 pm #

          Having a “Realization”, or a series of personal “Realizations” may be more applicable, and a term of that nature may catch on when more is realized about what addiction is, (sorry to use the word in the description itself 🙂

          Although the phenomenon known as having an “Epiphany” seems appropriate, it seems historically related to religious- ness.

          Ant to Terrys point, when the nature of addiction is actually understood and accepted, the term like “recover” and “recovering” may seem from an earlier concept of Addiction is.

          • Terry July 19, 2017 at 9:34 pm #

            I’m not sure the nature of addiction can ever be understood and accepted while ever there is social judgement and hypocrisy related to drug (include alcohol) use. the water is too dirty to see the bottom and too often we are all trying to swim upstream rather than with the tide so to speak

            • Carlton July 20, 2017 at 8:02 am #

              Terry, A major breakthrough in understanding may be happening soon.

              Both Maia Szalavitz and Gabor Mate are referring Love and Addiction,,, and not as opposites.

              The shift away from a Disease model to a “Love” model will be as important in this field as the shift away from the Earth-centered to the Sun-centered model was in the field of Astronomy.

              • Terry July 20, 2017 at 7:52 pm #

                That’s very interesting Carlton – Stanton Peele wrote a book called just that some years ago – Love and Addiction – Stanton emphasises personal values – I tend to also look at it as about Relationships – which is also about feeling wanted and loved and a lack thereof as being reason to fall in love with drugs and alcohol (and other behaviours) and see them as the individual’s only trusted partner in a hostile, seemingly to them, world. Mate’ is very much on the right path in my view.

                • April Wilson Smith July 23, 2017 at 7:12 pm #

                  Since we’ve mentioned Stanton, Gabor and Maia all in one thread, you mustn’t miss this one, a beautiful classic Stanton!


                  • Terry July 23, 2017 at 7:49 pm #

                    Hmm. They don’t seem to agree – Stanton refers to Mate putting all drug users in one basket and I would agree with that. Disease and trauma are only possible in regards to chronic drug addiction but in no way explain the bulk of drug sue, which is manageable and social for the majority. Mate does explain well the intractability of chronic addicts and his theories hold for that group in my view. Herein lies the dilemma – we are talking about 2 groups of people, chronic “addicts” and manageable or “social” drug users both with very different pictures each of which is explained by either Peele or Mate but neither holds for both.

                    • April Wilson Smith July 23, 2017 at 10:18 pm #

                      Yes, they definitely do not agree. I love how Stanton is willing to take on one of the saints of the day. And nobody beats Stanton for cutting wit. I love the part about the muffin!

                      I think all reductionist models fail. There is no one single cause and no one single “cure.” There are as many paths as there are people, and many people recover into non-abstinent recovery. Cookie cutters are for… cookies.

        • Carlton July 19, 2017 at 11:23 pm #

          April just used the word “resolve”.

          It has potential replacement for “recovery” in that person can “resolve” things.

          Resolve implies desire, intent and action.

          • Marc July 21, 2017 at 10:43 am #

            Good point, Carlton. I like the word “resolve” too.

            • matt August 7, 2017 at 9:04 am #

              I like the word “resolve” and “resolution”, but they still don’t capture the feeling of redirection of one’s life path or the resulting perspectival shift that happens for people who are happy in long term “recovery.”

      • Carlton August 3, 2017 at 9:50 am #

        Terry, you wrote; “At what point does it shift from recovery to recovered?”

        A similar question is;

        “At what point does it shift from a feeling of attraction, to a feeling of love?”

        …and directly about addiction and recovery;

        “When does it shift from a feeling of love to a feeling of NOT in love?”

        This can bolster your suggestion of the term “Change” rather than recovering from a disease.

        And also, the General Public can easily relate and empathize when put this way, which could help ease the lingering confusion and stigma of addiction without undermining the seriousness of addiction.

        Although the endless and horrendous tragedies caused by Love are well known and are part of all cultures, there are few efforts to stamp out love.
        This may sound frivolous, but it helps make a point.


        • Terry August 3, 2017 at 5:59 pm #

          I speak to my clients about the almost identical relationship process they have with their drugs and their “lovers” – but in regards to love most drug users I see “fall” in love virtually overnight sensing love from anyone who shows interest and not going through the process of falling in love over a period of time and getting to know the person. it is impulsive as is there use of drugs often. and I see them struggle with ending both relationships. Loneliness is being avoided yet addiction makes one even lonelier especially when the drug cannot be trusted anymore to give the security and pleasure it first gave.

        • Carl August 28, 2017 at 2:14 pm #

          I love this Conversation. Thanks Carlton. I totally fall in love with the analogies and metaphors that are discussed on this site. I like Marc’s new “toboggan” analogy. Somebody used the analogy-I think it was Marc-about needing an interpretation machine to speak another language-and inevitably some folks just pick up the new language without the machine. The point being that drugs can sometimes keep us from finding our way in life.

          • Carlton August 29, 2017 at 1:15 am #

            Carl, thanks for the comment, but due to my poor wording, it still comes across as an analogy.

            But it is actually a new Model for Addiction that I have been working on for a few years.

            It was discovered in hindsight, and since I am not a professional its not a well presented, but see if it resonates;

            The working title is the DILECTION Model, (Di`lec´tion .1.Love; choice.)

            This Model considers the attraction, desire and bonding that occur with an addiction are the very same thing as the attraction, desire and bonding that occur when a person experiences Love.

            Seen in this way, Recovery is when attraction and desire change, and the bond is no longer binding.

            The big thing is that its not coming from a position of a disease,
            but from something that is highly cherished,valued and universally experienced in some way or another.

            So it is not really an analogy, and I am still working on the wording.

            There is much more to it of course, but it is not an easy thing to put into words.

            I am very curious if you or any readers relate to it.

            • Carl August 29, 2017 at 7:52 am #

              OK. I’m a fan. I think it fits really well. I hate the disease model so I’m open to ideas but this sounds very plausible. Right now it seems like getting folks to believe in these non-disease models is somewhat like trying to get folks to see a political stance-it can REALLY get complicated. Moving forward though- I think the use of analogies to help understand these models is extremely helpful to folks.

              • Marc August 29, 2017 at 9:46 am #

                Actually a model is an analogy. I mean it’s not the thing itself, so it’s got to be a representation of it. Then there are good model/analogies and not-so-good ones. The difference lies in coherence, correspondence (to the real world), and detail.

                Glad you like what you’re reading, Carl. Thanks for your input.

                • Carlton August 30, 2017 at 11:59 pm #

                  Yes, if written with skill and talent, they should be self-evident and stand on there own with little need for change over time.

                  Marc, if you or any readers find this model interesting or compelling, feel free to contact me- I have tons of scattered notes that require serious skill and talent 🙂

              • Carlton August 29, 2017 at 1:45 pm #

                Carl, Ok, well, here is an analogy I once came up with about why a large percentage of people do not go back to depending on an addiction, (again, it is from hindsight);

                And Addiction is like relying on a motorboat while most people have to rely on a sailboat.

                The motorboat initially gives you a feeling of ease and freedom. You feel like you can come and go as you please, free from the whims of the weather, and the chore of sailing, etc..

                All the while, your family, friends and society hopes and wishes you would give up that motorboat, and just rely on sailing, like the rest of them.

                Some people do heed this,and seem to successfully “obstain” from using the motorboat…one day a time.

                but a larger percentage discover and realize that the actual motorboat analogy “Morphes” during their recovery period.

                In the end, the “motorboat” clearly required so much time and attention, that you did not realize, nor could relate to what you REALLY WANTED to do, nor could relate to Life itself anymore, and the lives of others on the water.

                Once this “Morphed Motorboat” perspective is experenced and realized, the wants and desires to return to the limitations and restrictions of living the singular and restricted life on the motorboat, may no longer exist.

                It is an individual thing though.

                Ok, that is brief and quickly typed, perhaps it resonates in some way? And feel free to add or change it too 🙂

                One of the most unanswerable questions when addicted

                • Carl August 30, 2017 at 10:48 am #

                  LOL! I like it. I really could read these examples all day long.Thanks Carlton! I think they definitely help me to increase my understanding of addiction! I often think of analogies on my way to work in the mornings and am so proud of myself when i think of them-i should write them down. I use some analogies periodically-I have “oldies but goodies” ! (such as the whole love comparison)
                  This is a complicated issue -i eat this website up -and yours and others attempts at describing addiction are intoxicating to me:)

                • Carl September 6, 2017 at 9:53 am #

                  The thing with alcohol is that one knows it will always be available. One knows that a lover is not — they could hook-up with someone and move on — thats not going to happen with alcohol. So folks can go all in and know it will be there. Its reliability is dangerous, really.
                  There was an article (this weekend) in the newspaper about a young man who overdosed on heroin 30 times. He’s now in recovery. I suppose heroin can be one hell of a lover. Wow. Fatal attractions? Disease? People point at this example and are so eager to point out that this individual had no choice in the matter. As an Addition specialist who embraces harm reduction — not sure where I go with these cases.
                  I love a model that envelopes a wide concept of addiction. This man’s motorboat did not morph?

                  • Marc September 6, 2017 at 11:29 am #

                    Interesting and moving comment, Carl. But what on earth do you mean by the last sentence?

                    • Carl September 6, 2017 at 11:50 am #

                      In Carlton’s post-he talks about the motorboat analogy. He states some folks keep a morphed version of the motorboat(they continue using drugs and alcohol in a moderate manner) .
                      why didn’t he either quit the MB or morph into a moderate version after the first or 15th overdose?

                      i guess it just comes down to “people change when they’re ready”. He did ultimately change. he ultimately decided to get rid of his motorboat all together.

                • PC November 6, 2017 at 5:03 pm #

                  get real

                  • Carlton November 9, 2017 at 9:20 am #

                    Carl and PC,
                    to try and explain this better;

                    At first, drinking alcohol SEEMED LIKE a motorboat, making life SEEM easier to cope with, but ultimately, it became albatross.

                    This is well known to people struggling with drinking or an addiction… but once there is a CHANGE OF HEART
                    about it….drinking or an addiction is experienced differently.

                    Rather than feeling relief and freedom, and being back to the your “normal drinking way of life” , it feels like you are being restricted and limited, and losing your freedom.

                    It is hard to explain, but perhaps it resonates?
                    The closest to this, is a change of heart with a relationship with someone or something.

                    This is also what I meant about the analogy “morphing”, from a feeling of freedom to a feeling of a loss of freedom.

                    This in not a traditional description, because once you no longer feel the same about drinking or any addiction, you dont really need to examine the “why” of it, and there is no place to mention it , if you do examine it.

                    Perhaps this Blog may help with understanding addiction and recovery this way?

      • PC November 6, 2017 at 5:01 pm #

        Recovery/ing, sober dates, et al are bullshit. You don’t recover and rid yourself of the demon disease because it’s always there. You are either in control of it at certain points in time or you are using. Many are fortunate to stop and never use again and I applaud them.

  2. Annette July 19, 2017 at 6:52 am #

    Thanks April. A very raw and insightful post – and full of the POSSIBILITIES that those of us in Recovery now have. I think that there is a big cultural difference in how addiction is treated in the US versus Europe. (I’m UK based.)

    I don’t like the dogma of AA, tbh: . the judgment? And pushing those into recovery to identify by their substance of choice? No. Too much like a prison sentence, imho.

    I rarely got wrecked, publicly, but alcohol misuse affected my husband, son and me. We had to pull back from the brink of destruction 6 years ago. It would have decimated the family.

    I know through researching family genes, that we hold the Trauma of past generations. They appear, as if calling to be healed in our lives. When we have the courage, commitment, community and self-compassion to heal, we do a great service to ourselves, our families and communities.

    Families rarely, if ever, discuss the trauma they’ve gone through – which I think needs to change. I recommend Mark Wolynn’s book “It didn’t start with you.”

    And despite all the trauma, I also believe – and experience – that we can triumph over it!

    Continue your amazing journey – and good luck with your PhD.

    Warm wishes.

    • April Wilson Smith July 19, 2017 at 9:50 am #

      Thanks so much! Will check out that book!

    • Marc July 21, 2017 at 10:54 am #

      Excellent point, Annette. No, it didn’t start with you. I will get to that book eventually.

      But I don’t think “family genes” is the whole story, or even the main story. I would say family beliefs, values, action tendencies are more important and are “carried” mostly by modelling and adapting to parental issues. My mother was a perfectionist, mostly because she spent much of her life trying to achieve her parents’ high standards. Their high standards came from trying to shed their Jewish immigrant habits in favour of the Anglican style of the Canadian culture they were trying to incorporate. My mom’s perfectionism fueled my tendency to judge myself harshly through a miserable adolescence. And I was the first one in this lineage to become a bona fide addict. It didn’t start with me, but only a small portion of that lineage is genetic.

      Mind you, the new field of epigenetics finds that some aspects of parental experience can be carried by molecules connected to genes, which turn them on or off or “interpret” them in specific ways related to survival needs. We’ll understand all that better in a few years’ time.

  3. Alan July 19, 2017 at 7:07 am #

    Thank you April

    I appreciate your post. We are not defined by the past and can move on to a new life. The past can be instructive but not binding. We are so much more than that. Putting dogma aside and discovering what works for us individually is the key. You have done that. If “recovery” means anything surely it must mean moving on, as you say.

    The idea that we “have a disease forever” can permeate our lives in an unhealthy way. For those who abstain forever that is great. We all have our own journey.

    • April Wilson Smith July 19, 2017 at 10:40 am #

      True, and at least for alcohol, about half the people who recover (which is most) recover into non-abstinent recovery, meaning they drink at safe levels.

      Abstinence is not the only form of recovery.



      • Ian July 25, 2017 at 4:31 pm #

        Many thanks for such an interesting discussion. I am just getting exposed to the diversity of views on this topic and it is eye opening. I have spent a fair bit of time reading material on some of the most popular recovery web sites and feel now that it has perhaps warped or limited my understanding – slippery slopes and cucumbers and pickles and all that.

        My question is: is it possible for someone who has gone through mild alcohol withdrawal to drink moderately after a multi-year period of abstinence? The conventional wisdom on the sites I mentioned above is that it is not possible. Not only will the drinking escalate and return to old addictive patterns, but withdrawal and post acute withdrawal (PAWS) symptoms can return with the ingestion of even very small amounts of alcohol. I am getting the sense that this is perhaps not the certainty it is presented as.

        • April Wilson Smith July 25, 2017 at 4:37 pm #

          The websites you are reading are totally wrong. Half of people who had real alcohol dependence go on to drink moderately. And PAWS symptoms don’t return with small amounts of alcohol. I’ve done it myself and it just doesn’t happen. I can drink moderately with no ill effects, even after pretty bad alcohol dependence and icky withdrawals. It’s unfortunate that so much of the “information” out there is mythology. Glad you joined us…keep following Marc and you’ll get good info!

          • Ian July 25, 2017 at 5:09 pm #

            Thanks for your lightning-quick response. Something happened to me two years ago. To this day I am not sure if it was a mild alcohol withdrawal or a panic attack that led to anxiety sickness. But I had some kind of episode that left me feeling awful for a long time. In trying to figure out what had happened I found my way to one of the recovery sites and the discussions of PAWS. Many of the symptoms matched what I was going through and over time I came to believe this is what happened to me, even though I never felt I was drinking that much. I have stayed abstinent for two years and have practiced mindfulness and meditation, done some therapy, and some CBT to get a handle on the anxiety. I am now feeling good and would like to be able to have some wine with dinner or on a holiday. I realize now that I was self-medicating to deal with my anxiety. I have self-awareness now and better coping methods and have no intention of returning to the patterns of the past. But the various fears that were instilled in me by the discussions I read and participated in have been difficult to shake. The last thing in the world I want is a return of those horrific feelings and experiences I went through. This has left me not knowing which way to turn. Thanks for the information and support.

            I may have gone through a mild withdrawal two years ago.I still don’t know for certain – it also may have been a panic attack leading to anxiety sickness. I have been unable to get to the bottom of what exactly happened. In any case, I have come to understand that I have been dealing with significant anxiety my entire life and using alcohol as a way of treating this anxiety issue. Two years ago either I had a withdrawal or the anxiety spiked and broke through leaving me feeling absolutely wretched. I had terrible physical symptoms that went on for over a year. I stopped drinking immediately after that experience and

            • Ian July 25, 2017 at 5:10 pm #

              Sorry last paragraph should not have been posted.

            • April Wilson Smith July 25, 2017 at 5:24 pm #

              Hi Ian,

              I’m pretty sure that wasn’t alcohol withdrawal. I’d have to know how much you were drinking and how long to tell you a more educated guess (and I am not a doctor so don’t take it as medical advice) but it sounds much more like panic. I have/had the same thing, and find that it is much exacerbated by excessive alcohol (that I also used to self-medicate) but that I can have a few glasses of wine here and there to no ill effect. I suggest you check out the Harm Reduction Abstinence and Moderation Support website for more info. it’s hams.cc. There is a whole community of people out there who go by science, not by AA myths. It’s unfortunate that you stumbled upon those “recovery” sites because they have programmed you to think you can’t have just one or two drinks and be fine, but it sounds like you’re breaking that programming. The key is to be confident in your ability to control your behavior. You absolutely have that power, and if you feel like you don’t, stop drinking.

              I’d suggest a test run at a time when you are under little stress, with people you can trust. Tell them you’d like to try social drinking, and have a glass or two of wine with dinner. If you feel fine, then try it again on a holiday or social occasion. Never drink more than a day in a row (at least for awhile) and try not to have more than two in a day. See how you feel. If you find yourself craving more or becoming anxious, then it might be best to not drink. But be sure you’re not drinking at a time when you’re sad or stressed.

              Here’s a great article by our friend and colleague Kenneth Anderson that might put things in perspective:


              The international HAMS group that Ken founded has a vibrant Facebook community that you are welcome to join, and also an Alcohol Free Hamster Facebook group that I head up. I’ve done moderation and no doubt will again, but abstinence is my current choice because I’m doing a PhD, a lot of Zen, and trying to get a freelance career off the ground. Still, I am not afraid that I will lose control if I have one drink and I no doubt will if I ever get a vacation!

              Hang in there my friend and we’d love to connect with you over at the HAMS website. I also highly recommend both of Marc’s books if you haven’t read them yet.

              • Ian July 25, 2017 at 6:47 pm #

                I am in my forties so have been drinking for a long time. For the last several years (prior to the “event”) I was drinking every day. Half to two thirds of a bottle of wine with dinner. Not a ton, particularly for my size – I am 6’2″”, 210 lbs. But not an insignificant amount either. I came to feel that this was too much and wanted to cut down but never felt that I was drinking enough to go into withdrawal. But after the attack I felt so bad for so long, with such a list of weird symptoms – fatigue, brain fog, derealization, tinnitus – that I couldn’t believe that anxiety could be the cause of it. PAWS made sense to me. I have come to understand that anxiety can wreak havoc on the body in all kinds of ways, but by the time I had puzzled this out I had drank enough of the sober recovery kool aid that I was petrified that an alcoholic drink would bring all the old symptoms back. Many thanks for your generosity. It is so hard to get any kind of clarity on these issues. Your support, advice, and encouragement have been invaluable.

                • April Wilson Smith July 26, 2017 at 7:11 am #

                  I’m glad to help in any way I can! Drinking half to two thirds of a bottle of wine per night at your size strikes me as virtually impossible to cause withdrawal symptoms of any kind. At 5’2″ and 115 I could easily drink that much every night and have no problems. It takes way more than that to get physically dependent on alcohol. Psychological dependence is another thing all together. Again, I’m not a doctor, but unfortunately most doctors don’t know much about this and many have drunk the kool-aid and are eager to identify everyone as an “alcoholic” (a term that hasn’t been in the DSM since 1980’s btw – it’s substance use disorder now.) Anyway, I seriously doubt your symptoms were caused by alcohol withdrawal. Did you look into other possible causes?

                  The danger now is that if you’re deeply programmed to think that the symptoms were caused by alcohol, you might bring them back if you drink. If I were you, I’d hold off on trying the drinking experiment until you get some clarification and comfort in your own mind about what caused your symptoms.

                  There are many things other than anxiety that could have caused the symptoms… auto-immune stuff, any number of things. Are they completely resolved now? You might look at what other factors in your life have changed, and what you do to stay well on a daily/weekly basis. Exercise, diet, meditation, sleep habits, etc.

                  Wishing you all the best in finding the answers that lead you to your happiest life!


                  • Ian July 26, 2017 at 11:47 am #

                    Thanks again, April. This is without a doubt the best, clearest, most straightforward and helpful engagement on these issues I have ever had.

                    I don’t want to completely monopolize this thread so I will reply one last time for the moment. I have seen my doctor numerous times and had extensive testing and evaluation. I am very healthy. My doctor has been skeptical of the PAWS diagnosis (although has suggested I stay away from alcohol due to the potential for a slippery slope). I know now that I have struggled my whole life with anxiety which has often taken the form of various physical symptoms rather than appearing as mental or emotional distress. I am confident that my experiences have been caused by anxiety. But in my anxious search for a cause for my symptoms I immersed myself in a recovery literature that (as you nicely phrased it) programmed me to think of myself as an alcoholic, a PAWS sufferer, etc. It is important for me to take back my autonomy – or perhaps better, move ahead into a state of greater freedom and autonomy, and to not feel like I am sick, fragile, or at the risk of some grave danger or illness. Our exchanges have been enormously helpful in this regard. I can’t thank you enough.

  4. Gary Goodwin July 19, 2017 at 8:50 am #

    The comments, for me, have all been very insightful and the topic is definitely deeply personal. The beginning of my “recovery” was rooted in A.A. and for that I will be forever grateful. However, A.A. had a place for a period of time, for me, in order for me to expand and grow, otherwise, it was starting to become repetitive and kind of restrictive, again, for me. This is not a criticism of the A.A. Program.

    The other difficulty I had from the beginning was the word “Recovery” as I wondered how am I to recover that which I never had in the first place. You see! long before I had a “drinking problem” I had a “thinking problem” about drinking. The whole process of “recovery” was a “Discovery Process” and for the first time I realized I am able to manage my life without the use of alcohol or other drugs and eventually tobacco. This was extremely enlightening that I could indeed “learn” new ways of being instead of feeling or thinking that I was flawed and/or defective as a human being, which, in many ways I believe is what led me to using in the first place.

    I had many good years inn the A.A. program hoping to pass the message along to other fellow members and/or newcomers. It has been at least ten years since I have attended any meetings and feel I have grown as a result, though I have to admit I felt a bit guilty not attending meeting at first but it didn’t last long I knew from the core of my being that it was time to let go. There is a time and/or season for everything and we ought to be true to ourselves.

    A.A. was extremely important to me in the beginning of my recovery and I gave back what I could and discovered that for continued growth I would have to detach with love knowing ultimately I am similar to other human beings despite labels of alcoholic, drug addict etc…, I am a human being capable of change and discovery!~

    • April Wilson Smith July 19, 2017 at 10:41 am #

      Good for you!!! In SMART Recovery, we suggest that people come for about 5-8 months or until their problem resolves, then go about their lives. They’re always welcome to come back, but we don’t look at it as a permanent feature of people’s lives. The point is to live!

  5. William Abbott July 19, 2017 at 10:45 am #

    Wonderful– absolutely wonderful and right on target

    Im not fond of the word either but we are stuck with it. So why not turn it into a cause for celebration ..which as a Smart facilitator I try to stress

    And yes one can recover – finish the stages of change process and officially ” exit” or as Ive renamed it Accomplished or Achieved

    I did it and celebrate every day!!!

    • April Wilson Smith July 19, 2017 at 11:09 am #

      Hey fellow SMART facilitator!!! Great to hear from you! I love Accomplished and Achieved!

      • Carlton July 20, 2017 at 8:43 am #

        Bill and April,
        Another way to see recovery is as something that “occurs”,
        like when you fall out of love with something….. it is not actually something you “do”.

        Many realizations can lead up to an “occurrence”, but there is no real formula for it. It sounds ambiguous, but people universally can relate to this notion, with love and maybe with Addiction soon too.

        Just a FYI, I was SMART facilitator for several years here in NYC.

        A few of us proposed a new meeting Idea, inviting ex-addicts back
        to meetings so people could hear about life after the addiction and recovery programs, but it never approved. It was several years ago,so maybe too soon?
        There are alot more ex-smarties out there now (!)

        Regarding Recovery:

        Another idea was that “SMART facilitator burnout” was actually people “recovering”..in that they had “lost interest” with addiction and recovery.

        So instead of trying to reduce “SMART facilitator burnout” it could be perceived as a ( successful and valuable) means-to-an-end, if you will.

        • April Wilson Smith July 20, 2017 at 8:51 am #

          Nice! I think that being a SMART facilitator may be something you healthfully move on from. I was absolutely delighted when a young woman whom I had met when she came to SMART for the first time just three weeks out of detox from heroin and crack took the facilitator training and asked to take over facilitation of our meeting. She has a ton of energy and wants to be a clinician, and that allowed me to go forward with other things in life. I still attend most of the time, to support her and just to see the meeting grow, but it’s nice to just be a member, not a leader. I went on to found a Harm Reduction, Abstinence and Moderation Support http://hams.cc/ meeting which I facilitate on Wednesday nights now.

          It’s a little weird for me because I write about substance use and mental health full time, plus my PhD focus is in harm reduction, so sometimes it feels like all drugs, all the time. I’ve found that seeking balance through lots of Zen practice, friends who don’t know what harm reduction is and don’t care, and reading non-recovery oriented materials like classic literature and watching cat videos really helps me keep a more balanced life. Not perfectly balanced by any means, but more so than when all I did was attend recovery meetings.

  6. Gina July 19, 2017 at 11:30 am #

    Thanks for this, April. I really appreciate your perspective. I struggle with the use of the word “recovery” as it relates to my daughter’s heroin addiction, so I use it sparingly, depending on the context, for lack of a better term. My only direct experience with 12-step programs and “recovery”‘ came via a short stint doing an outpatient treatment program for an eating disorder when I was about 20. It was 12-step based and included attendance at Overeaters Anonymous meetings (I was bulimic, but looking back, I have to wonder how such a program would have worked for an undereating anorexic). I could never accept that my eating disorder was a disease, spiritual or otherwise (or the result of character defects), let alone one from which I could never recover. Turns out I was right and eventually I matured out of the behavior and changed my relationship with food, although not until my late 30s. I don’t see myself as being “in recovery” from bulimia. I’m just someone who used to use food (binging and purging) to cope with stress. Or, as you suggest, I’m someone who recovered (past tense) from an eating disorder. We are all so much more than our problems, health conditions or diseases.

    • April Wilson Smith July 19, 2017 at 1:03 pm #

      Yes!!! Most people mature out of drug and alcohol problems, naturally, without treatment. Usually when they get more adult responsibilities, such as jobs and kids. The idea that we are powerless for life just reinforces the behavior we’re trying to avoid!

      • Carlton July 19, 2017 at 9:01 pm #

        Hi April,
        Although well meant, the term “mature out” may be unhelpfully judgmental
        for many.

        Its like saying a person needs to “mature out” of love for a certain Musical fashion, culinary, taste or style.

        Yes, in many cases this may be true, but it does not serve those individuals that may find self-acceptance and love far more valuable than shame or guilt when struggling with an addiction.

        • Carlton July 19, 2017 at 9:14 pm #

          ….It also implies that a persons potentially life-threatening problem of addiction is simply that they are acting like children.

          Yet ironically, those that finally are free from an addiction, seem to be free of the limitations and controls that their personal recovery process required.

          • Carlton July 19, 2017 at 9:16 pm #

            …and can be like children in a way..once again.

        • April Wilson Smith July 19, 2017 at 9:27 pm #

          I didn’t make up the term – Charles Winnick came up with it in the sixties when he noticed that names were disappearing off the police rolls of people with heroin problems in NYC. They weren’t turning up dead, so it appeared that they stopped using heroin as they got older. It may not be perfectly phrased, but it observes the fact that addiction is not a permanent condition, but one that people can move beyond, even without “treatment.”

          The term is not meant to be shaming. Perhaps it could be updated. As a radical harm reduction activist who has founded and facilitates two local weekly harm reduction meetings, one online hr group and am doing my PhD work on harm reduction in the health care system, I’m all for love and self acceptance vs. guilt and shame. Letting people know that they are not doomed to a lifetime of being “powerless” over an inanimate object, but that the evidence suggests that they can and will move beyond that part of their life, I would think would be empowering.

          • Carlton July 19, 2017 at 11:09 pm #

            Agreed, “mature out” was not MEANT to be shaming, but it could be taken as such.

            and yes, perhaps it will be updated, or a term for describing that addiction is not always a permanent condition.

            • April Wilson Smith July 20, 2017 at 6:39 am #

              Great observations! Thank you!

              Maybe, “move into a life phase where drug use becomes less relevant, or impedes more pressing life goals?”

              It’s so hard to find short, snappy terms to replace the outdated language. “People who are currently having issues with their relationship to substance” is not nearly as neat as “addict,” but is a lot less shaming.

  7. Barry Lessin July 19, 2017 at 9:45 pm #

    Thanks, April, for this introspective and wise piece! As you know from our discussions, the word “recovery” has been a difficult one for me to embrace because of how important I feel the words and language are to establish personal agency and self-empowerment.

    Sharing how your personal perspective about “recovery” has shifted over time, reflecting your own nuanced path to healing, is helpful to place the concept/idea of recovery into perspective for others. Your thoughts here parallel how I’ve come to see recovery as being part healing, part discovering potential, part developing a new identity that is self-affirming.

    • April Wilson Smith July 20, 2017 at 6:40 am #

      Thanks so much Barry! Your perspective and the experiences you’ve shared with me have really helped me in the evolution of my thinking!

  8. Percy Menzies July 20, 2017 at 11:14 am #

    I am a ‘normie’ and the recipient of considerable ire from individuals who disagree with my treatment philosophy and approach. I was honored to meet Marc in the US several years ago and impressed by his openness to listen to a different point of view. I was honored to be invited to write a post and not surprisingly my views led to some very animated discussions and I finally signed off!

    April has to be commended for the remarkable courage to share the painful details of her struggle towards ‘recovery’ and go on a path of helping others. I entered the field to offer patient treatment choices. Few patients with other ailments would be expected to go through the the excruciatingly painful and potentially life-threatening course April took towards recovery. I am not sure if she was aware or the ‘rehab’ centers told her about treatments that combine anticraving medications and behavioral therapies. In all likelihood the answer is no. The integrated treatment model offered at my clinics obviates the need for residential treatments and is significantly less expensive and burdensome. Many people are not even aware that addictive disorders can be treated on an outpatient basis.

    ‘Recovery’ is a word needlessly politicized in our field. People recover from pneumonia, surgery, accidents etc. We send people greeting for a ‘speedy recovery’. It is not an issue when people quit smoking, lose weight etc. I agree with April that people should be able to go on with their lives without having to dwell on the past. Addiction always happens accidentally. The goal should be to make it incidental and refrain from making the past intentional.

    • April Wilson Smith July 20, 2017 at 2:08 pm #

      Thank you for your comments! My rehab actually aggressively pushed naltrexone on people who had used alcohol, but I knew they weren’t doing it by the most effective method – the Sinclair method. I have a long and comedic history of awful medication reactions, so I refused. When pressured further, I started talking about the evidence on the Sinclair method and they let it go. Nothing like a little evidence to back people off! 🙂

    • Carlton July 25, 2017 at 1:11 pm #

      Hi Percy,
      Interesting you believe addiction is always accidental.

      To offer another take on it , some people may say they accidentally
      fell in love with someone or something, but most people would say there were many feelings and other factors involved.


      • Percy Menzies July 25, 2017 at 1:56 pm #

        Hi Carlton,

        When people are exposed to drugs or alcohol, the initial reaction can be quite soothing and attractive. I call it a social lubricant. The initial attractiveness for some people can be destructive over a period of time. Many factors contribute to the first use, but few start using drugs or alcohol because their goal is to become alcoholic or an addict. The vast majority – 85% or more will realize the destructive nature of the drug and alcohol use and walk away from it. Unfortunately, for the small minority the addiction is overwhelming and these are patients needing help. Attempts to get well on their own have failed and they reach out to clinics like mine for help.

        • Carlton July 25, 2017 at 4:56 pm #

          Hi Percy,

          Thanks for the swift and thoughtful reply.

          I will be back from Europe in a few days and can reply easier

          but for now, please note how the phenomen of love
          Can Fits that progression to.

          People tend to cling to relationships that become established,
          Dispite how detrimental some can become.

          More later, the change of thinking from addiction being a disease to
          That of seeing it as the (powerful) nature of love,
          Could open new doors for helping people.

          Glad to see you paying here again too.:-)


    • Carlton July 29, 2017 at 7:52 am #

      Hi Percy, you wrote:

      “It, [Recovery] is not an issue when people quit smoking, lose weight etc. ”

      Does this mean you lean toward the belief that addiction may something other that a disease?

      If so, would you find telling patients they are , “Head-over-heals” in love with the source of the addiction, and that your approach may offer a temporary respite from loves desire and cravings, so that they may be able to regain their bearings
      if they want?

      Although poorly worded, the point is that this could allow a person to perceive what they are experiencing, as something they are actively involved with, rather than a disease that they are “cured” of.


      • Percy Menzies July 29, 2017 at 1:03 pm #

        Hi Carlton,

        Thanks for getting back with me. I have no doubt our dialog is going to help a lot of people. In my view a ‘disease’ is incurable insofar as the symptoms can only be controlled with medications bolstered by behavioral changes.If the medication or behavior is stopped, the symptoms reappear. If a patient has Type 1 diabetes, the blood sugar will be elevated no matter what the patient does.The blood sugar levels are carefully maintained through insulin and diet. On the other hand patients with Type 2 diabetes may be able to maintain their blood sugar level through diet, exercise, bariatric surgery etc. The may not need insulin or hypoglycemic drugs.

        Calling addiction a ‘disease’ has a negative connotation. It implies permanency or incurability. Why not call it a disorder, illness, condition, state? The disease concept has a long and checkered history. The ‘disease’ concept got accepted because of repeated ‘treatment’ failures. Instead of blaming the ‘treatment’ for the failure, the patient was blamed and stigmatized. Even to this day, the treatment of addictive disorders is not standardized and remains outside of medicine.

        Addictive disorders impact the survival instincts and get embedded into the memory, emotional and motivational circuits of the brain and reside there permanently. We have to teach skills and behaviors that help patients unlearn the behaviors so intimately associated with drug or alcohol use.When patients make the appropriate changes to mitigate the behaviors so closely associated with past drug or alcohol use, patients can attain long-term recovery. Can they get re-addicted? Yes, but if they take appropriate measures to prevent the reinstatement of the addiction, they are protected.

        We have patients who quit using opioids for years and they have told us that when they had surgery and were sent home with a script for opioids, the long-buried memories of drug use came flashing back! One patient gave the pills to his wife to dole them out as prescribed by the physician. They did not want to deal with the temptation of keeping the pills with them.

        Patients in our clinics will keep a bottle of naltrexone pills for a contingency. They are doing fine, but may run into a situation of placing themselves at the risk of alcohol use. They have learnt to take a pill for a day or two until the risk is gone. We have former patients who work in treatment programs and continue to take the naltrexone pill or the Vivitrol injection as a ‘prophylactic’. Others don’t take the appropriate actions and may relapse. We have patients on a maintenance dose of buprenorphine for years and they lead a very normal healthy life. This is no different than a myriad of human behaviors ranging from affairs to overeating..

        The treatment should not be called a respite. It is a new skill to avoid risky situation. The best analogy we use: Addiction is like driving a car without brakes and a steering wheel. Recovery is a new steering wheel and a new set of brakes. But you have to still drive the car. Let’s continue the dialog.

        • Carlton July 30, 2017 at 11:45 am #

          Percy, Yes, this may help people, and put some new light on Addiction and Recovery too.

          BTW- Marc has a “GUEST MEMOIRS” section here on his blog, and I I am still working on mine, but in Brief;

          I became deeply dependent to alcohol in the late 1970’s , went to detoxes, read many addiction books, joined AA in the early 1990’s (it was the only thing back then). Had a major car accident and thus felt even a danger to society. I relapsed repeatedly, and the sober time always felt hostile and undesired. I grew very despondent from the seemly endless struggle, and made two attempts only life, and was hospitalized. I also went to a live-in rehab, (St. Judes in upstate NY for several weeks.)

          I joined SMART in the early 2000’s, and in hindsight, see the final portion of my personal recovery process was from spring of 2002 to mid 2004, and soon after, left SMART too.

          Like Marc and others, the addiction and recovery period played such major part in my life, (and even nearly ending of my life) that I wanted to help others that have found themselves experiencing an addiction.

          That being said, here are some thoughts on your thoughts here;

          I think “A state of dependance” or something may work, since “disorder” and the other terms, still lean toward disease-type terms..

          Also, You wrote:

          “Addictive disorders impact the survival instincts and get embedded into the memory, emotional and motivational circuits of the brain and reside there permanently.”

          Again, the ominous term; “Addictive disorders” can be switched out with this other factual term; “Powerful feelings of love”;

          ” Powerful feelings of love” impact the survival instincts and get embedded into the memory, emotional and motivational circuits of the brain and reside there permanently.”

          And on this thought;

          “We have to teach skills and behaviors that help patients unlearn the behaviors so intimately associated with drug or alcohol use.”

          I feel anther term than “Unlearning” may fit better?

          Consciousness is irreversible, you cannot literally “Unlearn” things.
          You can get a distance in time, or activity, but when you got back to say, an old house you lived in for years, it usually “fits like an old glove”.

          The important factor is if you WANT to go back and reside.

          I think the definition of recovery can partially be defined but the
          changes-in-feelings about this, not the fact that you do, or dont go back.


          I think a large percentage of Ex-Addicts don’t “moderate” or “control’
          drink or drug use, but not because they can’t, but because the feelings of freedom and euphoria have become eclipsed with feelings of limitation and confinement that drinking and drug use can generate too.

          This is a area where more research can still be done, and a better understanding of addiction, and a new model be presented.


        • Carlton August 1, 2017 at 12:51 pm #

          Hi Percy, Fascinating, and yes, from your point-of-view I can see why “respite” would not a fitting description.

          But here is something for consideration;

          The brief stays at detox centers offered valuable “respites”, or moments-of-clarity, where, despite the trauma and despair, a person can get a glimpse of whats going on…where they have been..changes that may have occurred since the last detox, etc…

          A respite provides a rare break from the daily effort and activity of maintaining that constant state of dependance on an addiction, allowing private and personal realizations and insights to occur.

          It seems your treatment program could also provide a kind of valuable “break”, or “respite”, for this to happen, if it is described and applied in that way.

          This may sound like I am saying there is a “means-to-an-end” to addiction, but currently, that topic is a no-mans land, and a serious topic, and perhaps to involved for an online blog.

          But personally, when the experiences of Ex-addicts are researched and studied, and when a new model of Addiction and recovery is understood and in place, It will seem a curiosity that we once thought that addiction was indeed a disease, and thus that there was a “cure” to be discovered.

          We used to believe the Earth, rather than the Sun was what the planets revolved around.

          Addiction may also have an evolutionary trajectory of observations, tests, discoveries, and constructive discussion and dialogue that will ultimately lead to its understanding in a similar way.


        • Carlton August 4, 2017 at 7:00 pm #

          ercy, to add to why your Disease description above does not fit Addiction;

          People suffering from diseases do not return or cling to the symptoms caused by diseases.

          In fact, holding onto an addiction is more similar to holding on to something that played a valued role in life one time, and has become nearly unimaginable be without…despite the problems that have taken over.

          I am trying to put into words a description that will help people
          wrap their head around this puzzling and vexing thing they are experiencing, that can fit the description of a disease.

        • Carlton August 15, 2017 at 9:30 am #

          Dear Percy, to continue the dialogue, here is another version of your “car” analogy.

          You Wrote:

          “Addiction is like driving a car without brakes and a steering wheel.

          Recovery is a new steering wheel and a new set of brakes, but you have to still drive the car.”

          And here is an ex-addicts version;

          “Addiction is like driving a car without brakes and a steering wheel.

          “Sobriety” is regaining the ability to steer and brake.

          “Recovery” is when a drivers interest and desire to drive and go where they want, returns.

          Curious if you agree to some degree?

    • April Wilson Smith September 9, 2017 at 5:05 pm #

      Hey Percy – I’m doing a column on naltrexone for alcohol for rehabs.com, a site I write for. Wanna give me a quote about your experience? email me at smith.april at gmail.

  9. Percy Menzies July 20, 2017 at 2:50 pm #

    No medication should be forced on a patient. We have treated thousands of patients over the last 17 years and taken the approach of harm reduction towards harm elimination. Unlike self-help philosophy, you cannot expect the patient to stop drinking on day one. Naltrexone allows patients to take a gradual approach towards abstinence. Controlled or social drinking is harm reduction, but does not work for everyone. I knew David Sinclair and we had many an exchange of emails. I was the associate product director for naltrexone with DuPont. The vast majority of the patients who came to us had tried controlled drinking without much success. It takes several attempts for patients to achieve abstinence and when they succeed, there is this great feeling liberation. No different when patients quit smoking. Even Sinclair acknowledged that if patients cannot achieve the goal of controlled drinking they have to work towards abstinence. There are no easy solutions and there is no single answer. Our mantra – harm reduction towards harm elimination and harm avoidance.

    • April Wilson Smith July 20, 2017 at 5:10 pm #

      Agreed. I’ve done all of the above, and for now my choice is abstinence. I find it easy to maintain without medication, however. I guess you could say that meditation is my medication – I really have to do a lot of meditation, not so much to stay abstinent because once I decide not to drink I stop, but to be happy and most effective at the zillion things I do. Wish I had known Sinclair! What business do these people have dying???

  10. Percy Menzies July 20, 2017 at 6:22 pm #

    Medications like naltrexone are generally taken for 6-12 months, just long enough for the behavioral changes to kick in .Any disorder that impacts the biological instincts is difficult to treat. Humans are created to thrive; addictive disorders throw patients into a state of survival. Think of the Maslow’s Pyramid getting inverted. Recovery has to focus on reinverting the pyramid back to the thriving mode.You did that in a very constructive way – graduate school, meditation etc. Many do it in unhealthy ways – smoking, excessive coffee, sugary foods. If we can put aside our ideological difference and just focus on getting patients well, we would not be losing 88,000 people a year to alcohol-related deaths.

    I was interviewed by a freelance writer and here is Kima’s article. I talk about the treatment of opioid addiction, but it is just as relevant to other addictive disorders.


    • April Wilson Smith July 21, 2017 at 5:13 am #

      I often feel that meditation is a replacement drug, but I’m fine with that. 🙂

      • Marc July 21, 2017 at 1:24 pm #

        Are you serious?

        • April Wilson Smith July 21, 2017 at 10:42 pm #

          I’m more joking than serious, but I do find that meditation keeps me very centered and highly effective and productive. It also helps with anxiety and emotion regulation, which drove a lot of my drinking. And I do get a little high off of it, especially during long retreats where we sit in meditation for hours and hours a day. I think it’s similar to a runner’s high or the high some people get off of dancing. It’s physically and mentally challenging but you’re so present in the moment, and especially when in community with other people, it’s a high way better than alcohol! Most days I just find it calming and centering though, while strengthening at the same time. I can walk into meditation anxious and feeling pulled in a million different directions, and within a few minutes I’m calm and thinking clearly again. I meditate with one group 8 am to 9 am every day but Sunday and on Sundays I go to the Philadelphia Zen Center.

          • Marc July 22, 2017 at 11:33 pm #

            That’s a lovely description of the peace and warmth meditation can bring…with rather than without clarity. So maybe it’s like a drug, but then it’s a mighty nice one….cheap, easy to get across borders, and only minor withdrawal symptoms.

            • April Wilson Smith July 23, 2017 at 5:31 am #

              Nicely put! I also find that the community aspect of meditating with a sangha is a very important part of why I find it so healing and strengthening. When you don’t need to talk or perform to be in community with other people, just sharing the experience of being right now, in the moment, it’s a very powerful experience of community.

              For those who identify as in recovery or struggling with substance who want to dip their toe into meditation and Buddhist principles with a recovery angle, Refuge Recovery offers meetings worldwide and has a nice little meditation, a reading from their book, short shares about the reading and recovery, and a closing. It’s a nice drama free meeting that is kinda Buddhist-lite. I enjoy the one here in Philly, even though I prefer the silence of Zen to the guided meditation. I wrote an article about it here: http://www.recovery.org/pro/articles/refuge-recovery-a-buddhist-based-recovery-group/

  11. Tyler July 21, 2017 at 10:54 am #


    I really loved this piece. Unfortunately for me I have been sober for 6 years and can’t seem to move on. I am constantly worried about using again and I feel like I’m still an addict. I don’t know what to do.

    • April Wilson Smith July 21, 2017 at 1:39 pm #

      I’m not a therapist and I don’t know you so I don’t know much about what to suggest, but maybe stay away from programs that identify addiction as a lifelong disease, and if you feel you need support check out programs like SMART Recovery that encourage moving ahead with your life. I’ll look and see if I can find any articles that might be helpful. In the meantime, believe in yourself! You’ve been sober six years! That’s awesome!!!

      • Marc July 22, 2017 at 11:38 pm #

        Good point, April. Tyler, maybe you’re just addicted to worrying. I don’t mean this in a glib or demeaning way, not at all. But for some of us worrying itself becomes the habit…and actually it’s pretty endemic to modern urban life. Try a simple cure: stop worrying. Especially because, after being sober for six years, having a “relapse” need only be a temporary blip. You’re okay now. Enjoy it!

    • Marc July 22, 2017 at 11:34 pm #

      Tyler, please see Percy’s comments, below, which were addressed to you but mistakenly connected to April’s comment.

  12. Robert Schwebel July 21, 2017 at 12:44 pm #


    Thank you for sharing your personal experiences and wisdom. I love your respectful open-mindedness in presenting ideas and responding to the ideas of others.

    Counseling individuals with drug problems has been a field dominated by harmful dogma – demeaning to people and preaching powerlessness. You speak with clarity, respect and a message of empowerment. I appreciate not only your fine post, but also the informative dialogue you have promoted on this page.

    • April Wilson Smith July 21, 2017 at 1:47 pm #

      Hi Robert!

      Thank you so much for your kind words! I loved your interview with Anne Fletcher in ProTalk. I absolutely agree. I personally was told by 3 mental health professionals that my three sexual assaults were caused by my drinking. No attempt to deal with acute trauma, just abstinence abstinence abstinence. Some of my friends (former) were even worse. Really blaming me, when what I needed was trauma therapy. I finally got it but not the traditional way – I became a hardcore Zen practitioner, and that has slowly freed me from the fear of the world that largely drove my drinking.

      Thank you so much for all your work!!! I wish I had met people like you when I was struggling. But then again, I wouldn’t have so many stories to tell about bad treatment…

      See ya round hamspro and ProTalk too!

  13. Percy Menzies July 21, 2017 at 12:55 pm #

    My sincere advise is to talk to your doctor about taking naltrexone. We have used it in thousands of patients and is one the safest medication. It restores the endorphinic homeostasis and the gets the endorphin system back to normal. Meditation, excessive exercising etc.is indicative of the healing not complete. Take the pills for a few weeks and if they don’t help, discontinue, No harm done. Initially, start with half a pill (25 mg) after food and by the second or third day go to a full pill. Please feel free to contact me if you need to talk live.

    I often tell patients that abstinence is not using the offending drug, be it alcohol or other drugs. If you have to be on a drug prescribed by a physician to help over the addiction, then taking that drug, be it methadone, buprenorphine, naltrexone or acamprosate in no way implies weakness on your part. I am vehemently opposed to not giving patients a treatment choice or telling them they need to be on a certain medication for the rest of their life. For too long our field is needlessly stymied by this ridiculous notion that recovery is not taking any medication. We have to work to end it.

    Good luck with your recovery.

    • Marc July 21, 2017 at 1:26 pm #

      Percy, I’m not sure who you’re addressing here, but I find you logic to be flawless, as usual. Keep it coming!!

    • matt August 9, 2017 at 11:08 am #

      Thanks, Percy. Totally agree with this and have had personal experience with members of my SMART meetings who desperately needed to quit and tried literally everything. Oral naltrexone was the thing that turned the corner for a couple, and the Vivtrol shot for many, now that it has become more widely available. I wish the shot had been more accessible when I was struggling, because the oral didn’t work. My rebellious addictive mentality would just game the system, and I wouldn’t take it for a few days if I wanted to get high. The shot takes that out of the equation— at least till the end of the month. But it can provide the temporal traction and momentum people often need to get started.

  14. Percy Menzies July 21, 2017 at 1:48 pm #

    My comment was addressed to April who stated she has been sober for 6 years and can’t seem to move on. She is constantly worried about relapse.She is ambivalent and is at a high risk of relapse. Naltrexone would be the ideal medication for her.

    Thanks for the nice message Marc. I hold you in high esteem.

    • April Wilson Smith July 21, 2017 at 4:48 pm #

      Uh, no, that was not me. That was someone else. I responded to that person. I am not in the slightest bit worried about relapse and I do not need or want to take naltrexone. I think you were addressing the other person whom I was answering.

      • April Wilson Smith July 21, 2017 at 4:52 pm #

        Tyler was the person who was worried about relapse.

        And I personally don’t use the word “sober” much. My current choice is abstinence because I’m in a PhD program, getting a great freelance career off the ground, and engaging in very serious Zen practice, none of which, for me, is compatible with alcohol use. But I don’t count time or plan to be abstinent forever. I’ve had long periods of time since my visit to rehab when I drank occasionally and moderately. I may again, say on vacation or whatever. I’m not worried about it because I know I can control my own behavior. I don’t have a disease. I’m glad for those who want medication to have it, but it’s not something I need. Tyler on the other hand might want to try it or may have read your comments and learned about it. It’s great to have the exchange of information here!

        • Tyler July 21, 2017 at 9:42 pm #

          I am glad you are finding your way and helping others. I love the writers and scientist you mentioned above. I hope they are right. But there is an overwhelming majority on the other side that say we have a disease. Maybe I am one of the ten people who have the disease and those people that recovered on their own just had substance abuse problems and not the disease of addiction. I would just love to switch off this voice in my head that messes with me everyday about relapse. Well not everyday but some days.

  15. John Fox July 22, 2017 at 3:06 am #

    The disease concept is very misguiding and I really feel its used by treatment facilities to label people and bring in money.
    It also gives people a plausible way of thinking when something goes wrong as its something thats programmed into people It your disease
    Its not rocket science even the 12 Steps in a way re-programs someones thinking to think without they are doomed.
    I have worked in the Harm reduction OST side of treatment in the UK for 14 years.
    I think the 12 Steps has moved a million miles away from its purpose 82 years ago Its now a money making machine.
    And it says in the Big Book of AA it mentions a malady illness a lot more than disease.
    And I sure it mentions that things could change within the addiction field in years to come even quoting a cure could be found.
    I am just pointing out what I have researched over the years as being openminded to everything that could work for a person.
    But I agree on a lot of points made about the Fellowships and its terminology and ideology it keeps people in it. It creates another dependancy !!
    SMART is fantastic tool also the forward thinkers of the Field Marc, Carl and Gabor we could go with our list are helping to change the way we think about addiction and the brain.
    As individuals we are unique and what works for someone else might not work for others.
    I will always go that extra mile trying to improve someones life and even save someones life and I will use what ever I think would bring about that change.
    Drug deaths in the UK are at the highest since 2011 which as a Substance misuse practitioner is heartbreaking at the moment.
    I just thought I would share my thoughts after all these fantastic replys to a great article.

    • Carlton July 22, 2017 at 6:07 am #

      In time, the believing it’s a disease may eventually be considered harm reduction, not a model.

      Before SMART I was in AA, and a person described how believing it was a disease, helped her accept herself and answered the question, ” why good people want to do bad things”

      I never saw it that way , and never will, but beliefs that bring comfort need not be
      confronted dispite evidence or new developments.

      • John Fox July 22, 2017 at 12:51 pm #

        I was in addiction myself for 25 years and I have taken a little bit of everything and used it to help become stronger
        I live a happy and free life never even thought I was diseased.
        I just knew I had to learn how to rewire my thinking and not buy into what everyone else wanted me to think if that makes sense.
        Life had become desirable again.
        I had to put a lot of truma to bed and move on.
        And things have worked out okay.

    • April Wilson Smith July 22, 2017 at 3:45 pm #

      Thank you so much John for your comments and all your work! I so admire those on the front lines of harm reduction. I volunteer sometimes with a needle exchange, but I find my calling to be more behind the computer, writing and doing research to change public opinion, change policy, and reach people who are struggling with new and hopefully helpful information. I really admire you!!!

      • John Fox July 22, 2017 at 4:04 pm #

        Without people like yourself we can not move foward in finding new ways to support people.
        I must share this I had a person I was working with give there first clean test in 22 years of herion and crack cocaine use this week
        All I have helped that person do is to try and realise there is a way out and thats looking from within some belief in themselves.
        Being able to see that accomplishment “money just can not buy that moment.
        What we all try and do in this field should always be about the human being thats reached out for help.
        We should always try our very best to support that person anyway we can.
        Thank you for your warm response April.
        It made me smile 😊

        • April Wilson Smith July 22, 2017 at 4:12 pm #

          That’s awesome John!!! Totally agree! It’s not always easy but I’d rather do this than anything else!!!

        • Marc July 22, 2017 at 11:42 pm #

          John, what you just wrote makes me smile. Knowing that a way out is even possible can be the magic bullet, and the small print in the disease model erases that possibility.

  16. John July 31, 2017 at 8:59 am #

    I would like to draw your attention towards Rapid Opiate Detox:

    The newest method of opiate detoxification was developed to allow those who are dependent on opiates to overcome their physical dependence without consciously suffering withdrawal. The method is called rapid opiate detox, and consists of flushing the drugs from the patient’s system while he or she is sedated.

    The method of detoxification while anesthetized was first introduced by Dr. Norbert Loimer in 1988. Since then, the procedure has been further developed and refined to be safer, faster and more effective. Under modern procedures, the patient is only sedated, not anesthetized, and the entire course of treatment is accomplished in as little as four or five days.

    Rapid detox is particularly attractive to high-profile individuals who are seeking quick, private and confidential treatment. The procedure is not covered by health insurance and is more expensive than traditional methods

    • Marc July 31, 2017 at 10:31 am #

      Interesting. Thanks for the update. We heard about an earlier incarnation of this method from Colin Brewer on this blog roughly a year ago. He’d been performing the procedure for many years…but I don’t know the details.

      And they say ibogaine also accomplishes a rapid detox, with visions thrown in free of charge. Makes me wonder about the exact mechanism of withdrawal symptoms. Evidently the “rebound” story is only part of it.

  17. Fredrick Norfleet August 6, 2017 at 12:40 pm #


    My name is Fredrick Norfleet, I’m A United States Navy Disabled Veteran, now fighting for the global republic in the warfare against drug dependence. It is my bidding that my book “Disrupt: The Process of Drug Addiction” (Ranked by Amazon Hot New Release in Drug Dependency Recovery) will help and transform the lives of men, women, teenagers and children worldwide who have been wounded by drug addiction.

    That’s why I am giving my eBook, “Disrupt: The Process of Drug Addiction” (https://www.amazon.com/dp/B0747ZHLST) away for FREE on the 1st of every month beginning August 1st, 2017! Please enjoy your free copy of, “Disrupt: The Process of Drug Addiction”.

    That’s it!

    Fredrick B. Norfleet
    United States Navy Veteran

  18. matt August 7, 2017 at 12:41 pm #

    I am a SMART facilitator in the greater Boston area and every week facilitate open meetings, program orientations, and detox “commitments” into the double digits. Also, I co-coordinate a hybrid 12-Step meditation meeting similar to SMART in that it is open to everyone regardless of what addictive behavior is causing issues. The more I do these groups the more I realize I’m not a SMART facilitator any more than I am any other single, functional label— like alcoholic. I’m a “recovery” facilitator, helping people discover what path is going to work for them. The SMART program is a platform, just as AA is, and the many other approaches and platforms. They provide a structure in which people feel safe to work on their recovery while re-establishing the social connection we all need as humans. The programs all espouse philosophically sound principles for recovery that are proven to work. The problem is that all these principle-driven programs are populated by humans who imbue them with their own values and expectations. Plus which, we are all a bunch of broken units to begin with, having created the need to find a method for “recovery” for ourselves. If their were one human value essential for any of these things to work, it would be to keep an open mind. I run a discussion group called Open Source Recovery at a local recovery center. In it we attempt to locate the similarity between all effective recovery paths and tie them to related principles of mindfulness meditation and buddhist philosophy.

    If we are going to change the way society thinks about addiction, it is incumbent upon us to break down the factionalization between addictions, programs and treatment methods. We have to model the right behavior for those who don’t understand addiction. We have to point out its pervasiveness in all walks of life– in the human condition. We have to limit unnecessary contention. We have to stop shooting ourselves in the foot.

    The state program that is the funding source for the wonderful recovery center I go to has billboards and posters that read: “End the Stigma– addiction is not a choice, it’s a disease.” Regardless of the charged nature of the words “disease” and “choice” here’s a thought: stop calling it a fucking stigma.

  19. Will August 10, 2017 at 2:51 am #

    Hi I am wondering if anyone has advice for me.
    I am 23 years old and I have been through three rehab programs. The last two were for cocaine and heroin use that was very addictive. I have not touched “hard drugs” in over 3 and a half years and have never had a real desire too. I stayed clean in NA for nearly 2 years because I liked it, made friends, and found it pretty easy to interpret. I was so
    Scared by my addiction as a late teen that I was like I don’t care what treatment you throw me I will do it if it means getting the hell out of addiction! But around that 2 year marker I started feeling a lack of meaning in life and feeling like there was more to my addiction then what I was learning in NA. For the last year and a half I have done my best to absorb a lot of what Marc, Stanton, Maya Szalavitz, and Lance Dodes have to say. I have wanted to enjoy wine or even smoke pot like I used to at times which was addictive in the past but after a few months it feels unmanageable and I come running back to NA real quick. I stay in NA for a few months before I leave and try to make sense of addiction from a harm reduction point of view. I think what is most hard is being able to tell if I am earnestly interested in harm reduction or if I am just trying to fool myself back into an addictive lifestyle again. As much as I want to doubt the 12 Steps, so far they seem to be the only thing that has made substance use manageable by taking it totally off of the table and being very structured. Do you think that some people simply lack the ability to moderate? If someone doesn’t want to do 12 Step but it seems that it may be the only kind of program or model that keeps their addiction in a more “comfortable” place…are they kind of stuck? This is how I feel. I feel stuck between being able to learn how to grow out of the “addiction is a disease model” and feeling okay with myself when I attempt to manage my use on my own. Any feedback would be appreciated.

  20. matt August 10, 2017 at 5:48 am #

    Hi Will

    The reason I think we (including me) hit a wall in early recovery is like you said “..trying to find meaning in life…” Whatever addiction is, it is habit– a habit closely tied to the reward system of the brain that motivates us to do everything. When we get to the point where we are ending up in rehabs to stop, our habit has become a reflex. It’s our go-to reaction to any stressor. When that happens, we essentially use the stuff the way we use it, and going back to moderation is entirely too much work, if not impossible.

    A good question for you to ask yourself repeatedly when you feel like you want to “moderate” is “How important is it?” How important is it to be able to moderate? Why do I want to moderate? How important is it compared to what could happen if it goes south?

    12-Step, as you say, can be very helpful in providing the context and social connection for one to stop…The problem is 12-Step per se doesn’t really show us what to put on the table to replace the addictive behavior and stay stopped. That’s where the work lies. When substances become more important than food, we have to find another equally appealing meal to put on the table. And that may take some time.
    Peer supported discussion groups (like SMART) help people stop, but also allow people to share ideas and bounce things off each other while figuring out the behavior that is going to help us stay stopped. Finding a new meaning, a new reward, a new passion.

    Recovery is not going back to who you were before using. It’s negotiating change to move into a new life. It’s a process. It’s an experiment. Try everything that sounds like it might be appealing suggested by others. But listen to your own voice and notice when something appears and seems like it would be helpful to Will. Think outside the box. It will happen if you don’t give up.

    • Will August 10, 2017 at 12:36 pm #

      I appreciate your comments Matt. I have built up elements of my life that I enjoy. I will be going to a University in the fall which is something I am extremely proud of. I have skills in the restaurant business which I have built up as a result of being clean and focused…. I guess the hardest thing is that it seems I have not been able to find that magic in life. It used to come in the form of drugs but it doesn’t come there anymore. For a while I felt that magic in 12 step groups and then it wore off. So I have felt like searching for that magic outside of the rooms has involved me trying to moderate but maybe that reflex is too established when it comes to substance use and it would be wise to not do it. However I find that being relegated to 12 Step brings me to that spot where I am feeling that lack of magic in my life and then consider leaving after a few months to “do my own thing”.

      • matt August 10, 2017 at 3:28 pm #

        That’s great, Will!

        You have to explore and try new things; it may take a while to find what you’re searching for, but as long as you don’t stop looking it will appear. It sounds like it’s time for try something new for your personal growth and continued recovery and positive change. It is good to remember the pain your addiction caused, just like it’s good to remember not to step out in front of a bus. But you don’t need to dwell on it. Use that mental space to recognize the positives.

        You might also want to re-evaluate what you’re viewing as “harm reduction”. Pot and alcohol may not seem as dangerous as heroin and cocaine, but if you are still using them in the same way and for the same reasons, and you are still not happy with your life, maybe you should think about making a bigger change. At least try some different meeting formats geared more toward personal growth like CBT. Maybe meet with an individual psychotherapist, psycho-pharmacologist, yoga, meditation teacher– try everything till something feels right.

        • Will August 10, 2017 at 6:05 pm #

          Thanks Matt,
          I have tried SMART before and I did find it helpful somewhat but I never really connected with it like I did with 12 step. I think because both recommend abstinence, I was trying to use SMART as a way to find out if controlled use of substances I never was really addicted to was possible. I have found that if I amshllting for straight up abstinence, 12 Step was more enjoyable and feasible to work with because of the social rewards tied with abstinence in 12 Step society. I think I have struggled mostly with finding things outside of the rooms that consistently provide meaning to my life. I have wanted something to delve into, to immerse myself into, and it has been very hard to leave the program and not want to see if I can moderate. I kind of delved into the whole anti-disease addiction culture which was how I found Marc Lewis, Peele, etc. I think I have been using their literature and ideas as a way to convince myself that I can moderate but I have not been able to.

          • matt August 10, 2017 at 8:03 pm #

            We are the only ones who know whether we have become “addicted”; we are the only ones who know whether we can moderate. The funny thing is, people who actually moderate don’t have to think about it. If it is taking as much effort to moderate as it was to maintain an addiction, odds are it’s not for you.

            • Will August 10, 2017 at 9:15 pm #

              I hear you on that!

  21. Kay Fernandez August 10, 2017 at 7:24 am #

    “My substance problem is not who I am, but it is an essential part of my life experience. It has given me insight into things I never would have known about, and a kind of empathy I never had before I woke up on the concrete.”

    Thank you April for giving us an unselfish and insightful view. Accepting one’s past is one of the most important path to healing and can be done if we get the right help we need. http://bit.ly/2wL9zHZ

  22. CG August 29, 2017 at 5:42 am #

    Thanks for sharing. Recovery is indeed a mark of triumph. At the end of the day, you will be remembered by your wins more than your loses, and recovery is one of your greatest achievement. You can leave your past behind, your failures, what is important is the present and what you will do with your life, now that you “recovered”.

  23. meshack August 30, 2017 at 3:07 am #

    Heroes In Recovery breaks the stigma of addiction through the power of storytelling. We celebrate the heroic efforts of those who seek the help they need without feeling ashamed or isolated

  24. Thomas March 30, 2018 at 12:13 pm #

    “I used to hate the word “recovery.” To me, it was a mark of shame, stating that I was permanently damaged and different from “normies,”

    Hey April, I can totally resonate with this statement as this is what is happening to my sister. It seems in the addict’s point-of-view, they cannot accept words like “rehab”, “detox”, “recovery”, “treatment” and etc. It’s as if they are living in self-denial..

  25. Carlton April 4, 2018 at 12:17 pm #

    Hi April,
    This new book just came out and I believe Leslie also studied addiction/recovery too.

    Here is a radio interview;

    “Author Leslie Jamison Hopes To Change How People Think About Creativity And Recovery”


    This line resonated:

    “I think sometimes it’s a lot harder to write the compelling stories about happiness or about getting better about positive states of feeling, about what it feels like to just wake up every morning and show up for your life, like, show up for work, show up for your relationships.”

    And to add another facet to that thought:

    It is hard to describe how being free of the torment of addiction is a separate thing from the torment that is part of life in General.

    Realizations can occur during recovery process that actually changes the overwhelming feelings of craving and desire for the addiction.

    This new book does not seem to address this, but may.

    And just fact the title refers to “recovery” rather than “addiction” is a step unto itself think 🙂


  26. April Wilson Smith October 15, 2018 at 10:01 pm #

    Wow, I’ll have to check it out!!!

Leave a Reply

Your email address will not be published.