The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 12

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The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 12

By Anne Giles 06/13/17

I want a 2017-style, evidence-based, alcoholism recovery redo.

Image: 
cat walking on a black and white tiled kitchen floor.

Soon after its release on December 19, 2016, I watched the HBO documentary, Risky Drinking. I felt quite moved when I recognized similarities to my own case of alcoholism as well as to those of others I know. I appreciated the filmmakers' selection of representative cases from the spectrum of alcohol use disorder.

I anticipated with excitement the film's interview with Dr. George Koob, NIAAA director and a lead researcher on the neuroscience of alcoholism. Given Dr. Koob's expertise in the neurocircuitry of addiction, I expected to learn of neurocircuitry-informed treatment for alcoholism. My jaw dropped when I heard Dr. Koob introduce his answer by stating that recovery requires "a major effort to structure your life without alcohol" through "multiple ways," and then, "You can join Alcoholics Anonymous."

When the horror story of alcoholism bled into the good-enough personal narrative that had been my story for half a century, all I believed I could do in 2012 was feel ashamed of myself, force myself to abstain, and go to a support group meeting.

In 2017, however, we know that AA and other 12-step approaches are not evidence-based addiction treatment. We know that only an estimated 1 in 15 who attends AA maintains abstinence from alcohol. (Abstinence results in better outcomes for alcohol use disorder than does harm reduction.) Thanks to the Surgeon General's report, Facing Addiction in America, we know that first-line medical care for the medical condition of addiction begins - as does medical care for similarly dangerous conditions - with assessment for suitability for medications - not with support group attendance.

That straightforward, evidence-based care for alcoholism is unknown or not recommended, even at the highest levels, contributes to the horror story of alcohol use disorder for its millions of sufferers in the U.S.

As I'm writing this memoir (Part 1 here), and looking back on nearly 4.5 years of miserable abstinence from alcohol, I want a 2017-style, evidence-based, alcoholism recovery redo.

Today, if I thought I had an alcohol use disorder, this is what I would do:

Keep drinking in the moderate to low-moderate range. (In 2012, I stopped cold turkey without consulting health care professionals and threw myself into a universe of anguish.)

Make an appointment right this second with my doctor. (We have long waits for appointments in my rural area.)

Make an appointment with a counselor right now for later (again, we have long wait lists in our area) who knows cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT).

Track and record my daily intake until my appointment with my doctor.

When I get in to see my doctor, I would talk with him/her about:

1) Bypassing the shock of detox and the likely inefficacy of rehab in favor of an assessment to be started on naltrexone before I stopped drinking.

2) Setting up a tapering schedule uniquely suited to my use pattern (based on my intake tracking record) and based on my individual medical and psychological history, to be medically monitored by my doctor. (I can't find an authoritative source on what science says self-tapering from alcohol should be, so this would be a co-hack by patient and doctor.)

3) A urine drug screen, UDS, for baseline data as I co-create a medical treatment plan with my doctor, not for "accountability," a euphemism for threat of punishment and shame.

4) A referral to a psychiatrist (required from a primary care physician in our area; 6-12 months wait list).

Schedule a week's worth of daily appointments with my doc, then an additional three months' worth of weekly appointments, same day and time of the week, to get UDS data, to talk with him/her on how tapering/abstinence is going, and to discuss further pharmacotherapy options for alcoholism, and for co-occurring mental and/or physical illnesses.

Start teaching myself emotion regulation skills through dialectical behavior therapy, DBT, with this kind and supportive workbook.

Start training myself to have muscular mastery of my attention using the Headspace app. In addition, try to find myself a meditation and/or mindfulness teacher for in-person meetings.

Start helping myself become aware of patterns of thinking that might not be helpful to me and learn how to modify them.

Begin loving myself through this challenge with evidence-based self-care.

Go to AA meetings if I find them helpful but practice discernment, i.e. "Take what you like and leave the rest." AA can be a useful source of tips and support. Some people experience transformative personal growth in 12-step recovery. Some people learn meaningful codes for living and relating with others. Some people are just glad to have a place to go where alcohol isn't served. I would be careful about components of the 12-step program that can be problematic, even harmful, to women.

Most people with substance use disorders have experienced trauma. Many have co-occurring mental disorders. Personality disorders are more prevalent in the population of people with substance use disorders than in the general population. Support groups of any kind can be attended by often well-meaning but troubled, reactive, volunteer survivors. Just because a person is abstinent doesn't mean he/she is rational, stable, or even nice. Survivors are not healers. AA is not evidence-based treatment for alcoholism.

Go to SMART Recovery meetings if I find them helpful and practice discernment.

Run all, or nearly all, of my decisions by trusted others. The neuroscience of addiction, even after abstinence, predicts that my thinking will be subpar but it will seem sound to me. I need to protect myself from error. This post summarizes the cognitive impairments that are present for awhile.

What I would not do:

I would not try to make myself or will myself to stop drinking. The neuroscience of addiction predicts doing so will exacerbate drinking. Other than tracking my drinks, I would shift my attention to other things. (This is another reason why support meeting attendance can be problematic. It returns potentially deadly attention to the substance and its use.) Through the indirect means I've listed above, I'll eventually gain the direct means to use emotion regulation skills, thought sorting skills, and attention management skills to directly execute, in the moment, the complex task of not drinking.

I would not think that thinking about either positive or negative consequences would be helpful. Addiction is defined as persistence despite negative consequences. "Think about the consequences" is a moralistic tar baby, designed to lure the vulnerable to entangle themselves in the false belief that addiction is moral, not medical. Americans are fixated on the good-bad logical fallacy of the just-world hypothesisDon't fall into it, I would tell myself. You'll never get free. Instead, I would focus less on judging what's good or bad and more on discerning what seems helpful, useful, effective.

I would not fear relapse. Anxiety, panic, dread, all these intense feelings ramp up the volume on my inner experience. Stress and distress are the top precursors to a return to use. I would acknowledge that I might or might not return to use and turn my attention back to my plan.

I wouldn't scrutinize whether I wanted to stop or didn't want to stop drinking. Giving up drinking feels akin to giving up orgasms. Most logical, rational, fully human persons would not give that up. When I start thinking, "I don't want to stop drinking," or "I want a drink right now," I would simply use my emo reg skills to notch down the volume a tad, identify my thoughts, then use my athletic attention management skills. I would note to what I am giving my attention, disengage my attention without judgment, shift my attention to my preference, and engage my attention with that preference. No harm, no foul, just shift.

Remember the song, "In the Year 2525"? In 2525, I believe addiction will be no big deal. Can't stop doing what you're doing? Go see your doc for the meds, use your beautiful, human ability to become aware of feelings and thoughts and to manage them, practice until you have control of your attention, watch your power to choose your words and actions unfold, effing done. Get on with your life.

The opinions expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

The Last Addictions Memoir below:

Part 1 here  Part 2 here  Part 3 here Part 4 here  Part 5 here Part 6 here 

Part 7 here Part 8 here Part 9 here Part 10 here Part 11 here

Anne Giles, M.A., M.S., is a counselor, writer and business owner. She writes about addictions treatment, recovery and policy at annegiles.com. As of this writing, she has been abstinent from alcohol since December 28, 2012, and is in remission from alcohol use disorder.
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