Resilience

Resilience is the most magic part of early recovery.  To see people resurrect themselves from a state of near self destruction and go forth back into the world is one of the fringe benefits of being in recovery.

Personally I think everyone should have their picture taken at their first AA/NA meeting and the copy given to them to keep forever in their wallet.  They should be able to see how they looked at the beginning and how much better they look now.  It would speak volumes.

Family and friends can see the difference, even though they may have quite a time trusting. And no one can blame them for that. But, everyone who knows the recovering person is aware that something hard to define is very different.

And that is a very good thing.

Anxiety

The great risk in very early recovery is anxiety, not drugs or booze.  It isn’t even depression as the chemical depressant has been removed by the act of abstinence.

Newly sober or clean people have little defense against anxiety, and the only relief they know is to medicate it one way or another as quickly as possible.  So the wisdom of AA/NA, is to use the slogans such as One Day at a Time or Think, Think, Think or Easy Does it to remind themselves to bring the anxiety into the present moment where it can be mediated personally.  And it works.

Mental Health sets up their path at exactly this point by either using Cognitive Behavioral techniques that do not work, or advising either anti anxiety medications or anti depressants.  At this point the paths diverge and for many never converge again in natural abstinence.  Diagnoses are made to comply with insurance regulations, the client is labelled as mentally ill and the need to continue the medication becomes pivotal to continued care.

It all could have been avoided with the 12 Step approach.  But for many it is the beginning of many years of decreased capacity due to mental health drugs they never needed in the first place.

Clean up real good

One thing about alcoholics and addicts is they clean up real good.  Anyone who has ever sat in AA/NA rooms for any length of time knows that is a fact. And this is just my own observation but about 2 months after abstinence begins with the last drink or drug the sober/clean person starts looking decidedly different. And it isn’t just that clothes make the man or woman.  It is some change in the faces of people about that time.  I know it can take that long for REM sleep to return, so they are sleeping naturally by then.  Another facet is that all the detox through the skin and the subsequent healing has passed. Dark skinned people’s skin lightens a bit.  Every bit of the blotchy skin and bloating are completely gone. And one day they just look healthy, bright eyed and like a shiny manifestation of their old drunk or druggie self.  I think everyone should have their picture taken on the day they stop using or drinking and then another one 2 months later and compare them.  It’s a wonderful sight!

Getting a sober job

One of the most concrete first steps on the road to recovery is to generate some income.  Few who get sober are not devistated financially. Many would say surrender does not come without a very high price.  We who enter this fellowship probably pay the highest dues of any club in the world.

It is the cherished desire of the majority of early recovery folks to get back on the track and salvage their former career.  That usually is foolhardy. We are so lacking in emotional and social skills that we are mostly unemployable, regardless of our former position.

If we are fortunate to be able to continue with the job we had when we hit bottom our performance and efficiency will be altered, at least at first. We have no real respite for the roller coaster of our emotions at first. For years we moderated them instantly with chemicals of one sort or another. Now they are out of the box running loose every day.

Here is where the wisdom of the ‘getting sober’ job comes in. Not challenging oneself about what one can really handle is very smart. Better a physically oriented rather than intellectually oriented position at first. This phase is best planned on for at least 6 months, and better a year. Seriously.

We are talking about life or death here. If you had cancer wouldn’t you expect a period of recuperation? Why not alcoholism or drug addiction then?  Take it slow, go to may meetings, develop a support system in the fellowship and ease on down the road.

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Changes happen and they are apparent

About 2 months the signs of the effects of abstinence become apparent. The first thing that changes is physical appearance.  The skin clears up and becomes a uniform shade. This probably comes from the inherent detox capacity of the skin, and the increase in available nutrition for the body.

Whatever the reason for the change it is heartening and very visible. One day a newly recovering addict or alcoholic starts to look different. They can see it in the mirror and you can see it looking at them.  African American skin gets lighter, caucasian skin looses the blotchy pink appearance, and the eyes get brighter and hair shines.

Alcoholics and addicts clean up well. It isn’t long before the early recovering person looks like he or she was never a chronic substance user. This is a plus and a minus. Along with this comes fragile self esteem and confidence that could lead to the completely addictive thinking concept that they can jump right back into life with vigor.

At that point, the AA/NA sponsor is hopefully in place to guide them to staying focused on the goal of long term clean and sober living. This is where the smart move is to get a ‘getting sober job.” This phase is where many well meaning early recovery folks pick up something and fall back into the dark pit of addiction.

Apres moi le deluge

After the turning point of sobriety or clean and sober living comes the real revolution.  In a very short time everything changes. Getting sober, it is said is easy, you only have to change your whole life.

This reality dawns in the first few days of abstinence. This thought is highly anxiety producing to the addict or alcoholic and the desire to continue whatever interface worked between the drug/alcohol meant to buffer life and the real meeting of life on life’s terms becomes irresistible.

Life on life’s terms is the issue. No mediating life with substances that color it different than it is seen by the majority. This is a tall order for the alcoholilc/addict. Enormous, earth-shaking, monumental changes done in a whisper.

Early recovery is a tight rope. It gets easier as the days accumulate, but at first balance is fleeting. So it is the same with emotions. Balance of emotions is pretty much impossible.  Duck and weave as the emotions show back up like a bad penny, greeting the newly abstinent with situations that challenge constantly.

Here is where the One Day at a Time philosophy fits right in.  Using that way of looking at the world makes it possible to maintain while the sober/clean world spins around you.

Finding suitable treatment

If some of the points I have been making about the conflict in beliefs between mental health/psychology and 12 Step theory and practice resonate with you, then where do you go when you need help for yourself or another?

That poses a problem. What is available, in all reality, is mental health/psychology based treatment.  This is especially true for those who do not have money to pay for private care. Most do not have any money left at the end of a chronic addiction or alcoholism.

In most areas of the country today programs for addiction treatment are few and far between. What there are are funded by government funds for the most part and those are definitely mental health/psychology based programs. They are only funded under that philosophy, with staff who have been trained in that philososphy.

So, what if that is not the path you wish to tread in your journey into recovery?  Then there are two options. First is detox on your own with some Librium type medication from a family physician.  Due to risk of seizure, this can be risky, especially with chronic alcoholics .  But it really may be all that is available.  At the risk of being simplistic, most withdrawal is over in 3 days.

Or, you can be selective, which probably means paying for private treatment. Or, do some serious research BEFORE it is necessary. Look ahead, call talk to the programs listen to what they say, target those who are clearly based in 12 step thinking and process. If you are helping someone, you know you are going to need help at some point.

The first realistic option will probably be a sober living house that gives long term support. This may follow the detox period, although a treatment program first would be optimum. And the addicted/alcoholic person will probably have to wait days or weeks to get a bed. In the meantime they need to go to a minimum of one AA/NA meeting per day. More is realistic. That is the only real support available.

The point being, just like anything else you have to be an intelligent, informed consumer of drug and alcohol treatment. And doing this while in denial, thinking you don’t have a problem, is the real trick.

Progressive and predictable

Along with the conviction that most alcoholics and addicts will have to hit a personal bottom in order to find the willingness to take a step in the direction of abstinence comes the sure knowledge that sooner or later it is going to happen.

Because what is learned by alcoholics and addicts experientially is that it is never going to get better on it’s own and it is going to get progressively worse. All of us who are grateful for our own abstinence completely concur that once you pass through the invisible line it’s going to go, usually slowly, downhill.

What is the invisible line? That is when you no longer have control over your drinking or drugging.  It has you, you no longer have a choice. This can easily be 20 or more years from the time you face jails, institutions or death or enter into the fellowship of AA/NA and live a sober/clean life.

This knowledge can be only really grasped in entirety by those who have stopped drinking and using. They learned it personally in the club with the most expensive dues in the world.

A window of opportunity

How AA/NA approaches hitting bottom and how mental health/psychology approaches the same as readiness for treatment is another key issue in the divergence of views on alcoholism/addiction.

AA/NA believes that hitting bottom, as defined as coming to the conclusion that you have been defeated by circumstances that occur as a result of your alcoholism or drug addiction happens on a level that leaves the subject certain that they have to make a change.

There is an experiential  knowledge involved by AA/NA by people who have sobered up or become clean that it is completely inevitable due to the progression of the disease.  So, AA/NA members of the fellowship know that they must wait for the progression of the intensity of the events that occur as a result of alcoholism/addiction to come to a crisis and at that point there will be a very short time in which the subject will be clear that he/she has a grave problem and is willing to do what is necessary to change.  At that time, that exact time, you are able to reason with the subject.

However the other side of the issue is mental health/psychology which has a couple ways of looking at this bottoming out phenomenon. They espouse the theory that it is not necessary, that the progression can be arrested at an earlier stage.  They also recommend the use of specific medications that take the edge off the depression or other symptoms of early remission thereby making it easier to progress into sustained remission.

These, like so many other facets that I am trying to specify, are polar opposites.  They cannot be believed at the same time.  AA/NA and mental health psychology are not compatible.

Today’s government position

http://www.drugabuse.gov/infofacts/treatmeth.html

In a nutshell, the address above gives the position of the federal NIDA and also sets the stage for research and grants that fund the research that guides the field of addiction/alcoholism treatment today.

Brain research has directed the treatment of addiction and the mental health/psychology field has followed it. This treatment relies on medications to be effective. It also involves behavioral health treatment as understood by mental health/psychology.

Every day the gap widens between the way AA/NA sees how to approach a person who is suffering from being an alcoholic or drug addict and how mental health treatment views recovery.  And while AA/NA still influences some mental health treatment, the issue I am concerned about is how mental health/psychology is influencing AA/NA