Here are some thoughts about opponents of the Twelve Step Programs' approach to recovery from addiction, namely, the requirement that the individual admit "powerlessness" over addiction as the threshold condition for successful recovery (Step One of AA and NA).
There are researchers who do not accept the Twelve Step approach; they do not support the concept that a person must internalize a complete lack of efficacy over the ability to control alcohol or drugs. These researchers maintain this absolute powerlessness (or lack of self-efficacy) approach dooms the addict or alcoholic who relapses to take the relapse to a point as severe as the point at which the person began recovery. These researchers distingush between a "lapse" and a "relapse", the former being a minor slip that does not progress to a full, severe relapse.
In my view, these researchers are mistaken and do not understand the power of addiction or the alcoholic or addict mind set. To suggest to a recovering person that one can have a lapse and quickly return to abstinence though development of self-efficacy skills, as these researchers propose, would be to open the door to use. Every alcoholic and addict would dearly love to find a way to use with just a minor degree of problems (a lapse) and then return to abstinence. In my experience it would be dangerous to recovery for a person to "lapse" and NOT experience serious consequences; the addicted mind would then conclude, "they (those people in AA and NA) were wrong; I CAN use without serious problems", and then plan the next "lapse." So, for me, it IS an all or nothing proposition for the addicted person: he/she must internalize that he/she has no control over the use of any amount of drugs or alcohol.
Wednesday, February 28, 2007
Sunday, February 25, 2007
Spirituality in Recovery from Addiction
I will suggest in this post some tools that you can use on a daily basis to be drug and alcohol free that can become a part of your own personal recovery program. Consider setting aside a quiet time every morning to focus on the fact that you are in recovery and to make a conscious commitment to yourself each morning to be abstinent from drug or alcohol use for that day. This daily discipline can become a basic recovery tool for you.At night before retiring for the day, take a few minutes for some quiet time to review the day. If you have not picked up an alcoholic drink or a drug, you can be grateful for that miracle regardless of whatever negative or positive events that have occurred. It is indeed a miracle for an addict or alcoholic to get through a day without using. Again, this daily discipline of reviewing the day before sleeping and being thankful for another day of recovery can become a basic recovery tool for you.
I am now going to suggest that you consider adding a spiritual component to your daily disciplines. I will begin the discussion of spirituality by just making a few observations and asking that the reader of this post try to have an open mind to the concept of spirituality. I use the term spirituality to include any source of strength that you are open to tapping into. Spirituality can be found in organized religions and can be based upon a relationship an individual develops with God. But, spirituality can be developed apart from organized religion and can be based on one's own concept of a source of spiritual strength. So, for now, I suggest that the reader just have an open mind about finding a source of spiritual strength.
Willingness to seek a source of spiritual strength, regardless of how that source is defined, is the key to developing a relationship with such a spiritual source. The willingness often is the result of finding that one's own efforts to resolve the drug or alcohol problem have failed. In my experience, all an individual need do is to adopt daily spiritual disciplines through which the individual reaches out to a source of spiritual strength by prayer, by meditation, by journaling, or in some other way by methodically seeking help, support, and strength from a source outside of, or within, self. It is in the seeking of spiritual strength that one builds an experience based faith in the process and a relationship with a source of spiritual strength. Of course, it is essential that the alcoholic or addict surrender to the fact that use of alcohol or other drugs is no longer a viable option.
Returning to the concept I mentioned in the first paragraph, I will describe now a simple daily program of spiritual disciplines that I have used for 29 years in support of my own recovery. I often guarantee to individuals I counsel that if they commit to such a program and abstain from drug or alcohol use, they will come to experience a serenity and strength that will sustain them no matter what happens in their lives, positive or negative. Set aside a time for quiet reflection on arising at the start of the day and on retiring at the end of the day to focus on your recovery, as follows: on arising, read something positive (for example, a daily meditation book), or perhaps meditate on aspects of your life for which you can be grateful, recommit yourself to abstinence and recovery for that day, and ask for help from whatever your source of spiritual strength may be to stay clean and sober and to strive for a loving response to whatever occurs during the day. At night before retiring, review your day, reflect gratefully that you have not used drugs or alcohol that day, and ask for help in any way that works for you to improve in your reactions that day that may not have been as loving or positive as you would have liked. In my view, any individual in recovery from drug or alcohol addiction who can get through the day without using can claim a spiritual victory regardless of other calamities or negatives that might have occurred.
Performing these spiritual disciplines in the morning and evening, not picking up a drink or a drug, and if at all possible attending a 12 Step meeting, will over a period of time result in your coming to believe in a spiritual source of strength and the process, and can form the foundation of a solid, enduring recovery.
I am now going to suggest that you consider adding a spiritual component to your daily disciplines. I will begin the discussion of spirituality by just making a few observations and asking that the reader of this post try to have an open mind to the concept of spirituality. I use the term spirituality to include any source of strength that you are open to tapping into. Spirituality can be found in organized religions and can be based upon a relationship an individual develops with God. But, spirituality can be developed apart from organized religion and can be based on one's own concept of a source of spiritual strength. So, for now, I suggest that the reader just have an open mind about finding a source of spiritual strength.
Willingness to seek a source of spiritual strength, regardless of how that source is defined, is the key to developing a relationship with such a spiritual source. The willingness often is the result of finding that one's own efforts to resolve the drug or alcohol problem have failed. In my experience, all an individual need do is to adopt daily spiritual disciplines through which the individual reaches out to a source of spiritual strength by prayer, by meditation, by journaling, or in some other way by methodically seeking help, support, and strength from a source outside of, or within, self. It is in the seeking of spiritual strength that one builds an experience based faith in the process and a relationship with a source of spiritual strength. Of course, it is essential that the alcoholic or addict surrender to the fact that use of alcohol or other drugs is no longer a viable option.
Returning to the concept I mentioned in the first paragraph, I will describe now a simple daily program of spiritual disciplines that I have used for 29 years in support of my own recovery. I often guarantee to individuals I counsel that if they commit to such a program and abstain from drug or alcohol use, they will come to experience a serenity and strength that will sustain them no matter what happens in their lives, positive or negative. Set aside a time for quiet reflection on arising at the start of the day and on retiring at the end of the day to focus on your recovery, as follows: on arising, read something positive (for example, a daily meditation book), or perhaps meditate on aspects of your life for which you can be grateful, recommit yourself to abstinence and recovery for that day, and ask for help from whatever your source of spiritual strength may be to stay clean and sober and to strive for a loving response to whatever occurs during the day. At night before retiring, review your day, reflect gratefully that you have not used drugs or alcohol that day, and ask for help in any way that works for you to improve in your reactions that day that may not have been as loving or positive as you would have liked. In my view, any individual in recovery from drug or alcohol addiction who can get through the day without using can claim a spiritual victory regardless of other calamities or negatives that might have occurred.
Performing these spiritual disciplines in the morning and evening, not picking up a drink or a drug, and if at all possible attending a 12 Step meeting, will over a period of time result in your coming to believe in a spiritual source of strength and the process, and can form the foundation of a solid, enduring recovery.
Saturday, February 10, 2007
Definition of Alcoholism
Here is the most comprehensive definition of alcoholism that I know:
"Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic." *
"Primary” refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it. "Primary" suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.
"Disease" means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.
"Often progressive and fatal" means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart, and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.
"Impaired control" means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.
"Preoccupation" in association with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.
"Adverse consequences" are alcohol-related problems or impairments in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior); interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships); occupational functioning (e.g., scholastic or job problems); and legal, financial, or spiritual problems.
"Denial" is used here not only in the psychoanalytic sense of a single psychological defense mechanism disavowing the significance of events, but also more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery. Denial in alcoholism is a complex phenomenon determined by multiple psychological and physiological mechanisms. These include the pharmacological effects of alcohol on memory, the influence of euphoric recall on perception and insight, the role of suppression and repression as psychological defense mechanisms, and the impact of social and cultural enabling behavior.
_________________________________________________________________________________* Approved by the Boards of Directors of the National Council on Alcoholism and Drug Dependence, Inc. (February 3, 1990) and the American Society of Addiction Medicine (February 25, 1990). See Journal of the American Medical association, Vol. 268, 1012-1014 (August 26, 1992).
"Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic." *
"Primary” refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it. "Primary" suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.
"Disease" means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.
"Often progressive and fatal" means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart, and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.
"Impaired control" means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.
"Preoccupation" in association with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.
"Adverse consequences" are alcohol-related problems or impairments in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior); interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships); occupational functioning (e.g., scholastic or job problems); and legal, financial, or spiritual problems.
"Denial" is used here not only in the psychoanalytic sense of a single psychological defense mechanism disavowing the significance of events, but also more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery. Denial in alcoholism is a complex phenomenon determined by multiple psychological and physiological mechanisms. These include the pharmacological effects of alcohol on memory, the influence of euphoric recall on perception and insight, the role of suppression and repression as psychological defense mechanisms, and the impact of social and cultural enabling behavior.
_________________________________________________________________________________* Approved by the Boards of Directors of the National Council on Alcoholism and Drug Dependence, Inc. (February 3, 1990) and the American Society of Addiction Medicine (February 25, 1990). See Journal of the American Medical association, Vol. 268, 1012-1014 (August 26, 1992).
Friday, February 2, 2007
What Is Denial in Addictions?
"Denial" in the alcohol or other drug (AOD) dependent person includes the following factors which operate, except for Item 1), in major part unconsciously, or, at times, semi-consciously:
1) Deliberate Lies.Addicted persons, be they alcoholic or addicted to other drugs, lie and manipulate to protect their ability to satisfy the need to use their DOC (drug of choice). They also lie to themselves and come to believe their own distortions. Addicts who must buy their drugs from illegal sources and use illegal means to finance purchases, will be particularly adept at deliberate falsification and skillful manipulation.
2) Alcohol/drug-induced amnesia (blackouts).Present inability to recall events occurring while under the influence adds to the "denial" problem. The AOD dependent person in truth cannot remember many of the negative events he/she may be accused of, which adds to the confusion, frustration and delusion of the user (and to the frustration of those close to him/her).
3) Euphoric recall.Recall of events while AOD impaired tends to be distorted. The AOD dependent person also tends to recall only the good times, not the bad, a selective memory.
4) Denial in significant others.Those in intimate relationships with the AOD dependent person (usually living with the user) may develop, without conscious awareness of the negative impact on the user, a denial system in forms similar to that of the addict or alcoholic, and tend to enable, that is, protect the user from experiencing the natural consequences of his/her inappropriate behaviors.
5) Lack of feedback or ability to reality test.Because of the dysfunction which develops in intimate relationships, the AOD dependent person has no way of reality testing, that is, he/she is given no useful feedback about the reality of AOD use and its real impact on significant others. The usual rule in such families is to avoid intimacy and not talk about the problem.
6) Ignorance of the definition of alcoholism or addiction.Stereotypes of the “typical” alcoholic or addict, myths, even one’s own experience with an alcoholic or addict, can lead to excluding one's own behavior from the definition. E.g., an individual can say: I don't drink every day or in the morning (not physically addicted) I've never had a DWl or legal problem from use I go to work every day I can stop for Lent I don’t crave, or need to, drink or use.
7) Toxic effects of AOD on the brain.Alcohol and other drugs seriously disrupt the normal functioning of the brain, not only causing dysfunction in the action of “feel good” chemicals (neurotransmitters such as dopamine and serotonin) thereby producing craving and withdrawal problems, but also cause dysfunction in the brain’s ability to process, store, and use information.
8) Inconsistency in patterns of AOD use, ability to control use, and consequences from use. The individual may not get drunk every time, may not suffer negatives every time, may be able to quit for a time, etc.
9) Influence of Media and Culture. Society, commercials, ads all depict alcohol as an integral part of life's activities---sports, good times, bad times, sex, etc. For much of society, not drinking is abnormal.
10) Sneaky disease. The loss of control over, and dependence on, drugs and alcohol are insidious in their onset and development.
11) Stigma.Alcoholics and drug addicts are considered by much of society to be weak willed, immoral, irresponsible, and perhaps criminal. Persons who have the disease also tend to have internalized this stigmatized notion of the alcoholic or addict.
12) Professional enablers. Even today, when persons with AOD dependence seek help, they often encounter caregivers (mental health professionals) with little expertise in diagnosing and treating AOD disorders, who address issues causing the AOD use, without seeking abstinence from use as a goal. The addict or alcoholic, therefore, is enabled to continue destructive use while at the same time perhaps believing that he/she is working on the roots of the AOD problem.
This information is taken from http://www.alcoholdrugsos.com where professional addictions services are available. It takes professional help to aid the addicted person to be able to break through denial and see the problem.
1) Deliberate Lies.Addicted persons, be they alcoholic or addicted to other drugs, lie and manipulate to protect their ability to satisfy the need to use their DOC (drug of choice). They also lie to themselves and come to believe their own distortions. Addicts who must buy their drugs from illegal sources and use illegal means to finance purchases, will be particularly adept at deliberate falsification and skillful manipulation.
2) Alcohol/drug-induced amnesia (blackouts).Present inability to recall events occurring while under the influence adds to the "denial" problem. The AOD dependent person in truth cannot remember many of the negative events he/she may be accused of, which adds to the confusion, frustration and delusion of the user (and to the frustration of those close to him/her).
3) Euphoric recall.Recall of events while AOD impaired tends to be distorted. The AOD dependent person also tends to recall only the good times, not the bad, a selective memory.
4) Denial in significant others.Those in intimate relationships with the AOD dependent person (usually living with the user) may develop, without conscious awareness of the negative impact on the user, a denial system in forms similar to that of the addict or alcoholic, and tend to enable, that is, protect the user from experiencing the natural consequences of his/her inappropriate behaviors.
5) Lack of feedback or ability to reality test.Because of the dysfunction which develops in intimate relationships, the AOD dependent person has no way of reality testing, that is, he/she is given no useful feedback about the reality of AOD use and its real impact on significant others. The usual rule in such families is to avoid intimacy and not talk about the problem.
6) Ignorance of the definition of alcoholism or addiction.Stereotypes of the “typical” alcoholic or addict, myths, even one’s own experience with an alcoholic or addict, can lead to excluding one's own behavior from the definition. E.g., an individual can say: I don't drink every day or in the morning (not physically addicted) I've never had a DWl or legal problem from use I go to work every day I can stop for Lent I don’t crave, or need to, drink or use.
7) Toxic effects of AOD on the brain.Alcohol and other drugs seriously disrupt the normal functioning of the brain, not only causing dysfunction in the action of “feel good” chemicals (neurotransmitters such as dopamine and serotonin) thereby producing craving and withdrawal problems, but also cause dysfunction in the brain’s ability to process, store, and use information.
8) Inconsistency in patterns of AOD use, ability to control use, and consequences from use. The individual may not get drunk every time, may not suffer negatives every time, may be able to quit for a time, etc.
9) Influence of Media and Culture. Society, commercials, ads all depict alcohol as an integral part of life's activities---sports, good times, bad times, sex, etc. For much of society, not drinking is abnormal.
10) Sneaky disease. The loss of control over, and dependence on, drugs and alcohol are insidious in their onset and development.
11) Stigma.Alcoholics and drug addicts are considered by much of society to be weak willed, immoral, irresponsible, and perhaps criminal. Persons who have the disease also tend to have internalized this stigmatized notion of the alcoholic or addict.
12) Professional enablers. Even today, when persons with AOD dependence seek help, they often encounter caregivers (mental health professionals) with little expertise in diagnosing and treating AOD disorders, who address issues causing the AOD use, without seeking abstinence from use as a goal. The addict or alcoholic, therefore, is enabled to continue destructive use while at the same time perhaps believing that he/she is working on the roots of the AOD problem.
This information is taken from http://www.alcoholdrugsos.com where professional addictions services are available. It takes professional help to aid the addicted person to be able to break through denial and see the problem.
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