The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 19

By Anne Giles 08/22/17

I saw the naked data, exclaimed, "The emperor of addiction wears no clothes!" and began to see alcoholism as a problem to solve, not a shame to lament.

Anne and a group of friends dancing.
Photo by Leonard W. Hughes; author dancing far right.

When I realized I had developed alcoholism, I felt bent over with shame, burdened as if by layer upon layer of woolen blankets of wrongdoing. I had been as good as I could be and I thought, at 50, I had gone bad. Only when I read Unbroken Brain: A Revolutionary New Way of Understanding Addiction by Maia Szalavitz did I learn that alcoholism, like other addictions, is a result of malfunctions in the organ of the brain, not in the personhood of Anne.

Logically, then, useful treatments for addiction would be what assists the brain to reverse or bypass malfunctions, or helps a person abstain or use less, less frequently, to avoid or reduce further harm to the brain by the substance. Currently, the most direct treatment of the brain for any brain malfunction is medication.

That's why Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health prescribes medical care as first line treatment for the medical condition of addiction. The report urges people with suspected substance use disorders to visit their primary care physicians. Later follow-up care with counseling, social support, and access to social services may support abstinence. But support doesn't directly treat the brain for addiction.

And that's why, for opioid use disorder, it makes perfect sense that the medications buprenorphine and methadone cut death rates by half or more over abstinence. The brain receives treatment versus the brain does not receive treatment. No brainer.

Yet, medications for addiction are rarely offered to people with substance use disorders, are denied to them by federal and state law, the criminal justice system, drug courts, insurance company policy, or medical board policy, or are delayed through artificial wait lists (medications for substance use disorders are affordable and plentiful), causing undue suffering, even death.

I, too, originally thought addiction was a moral problem, not a medical problem. Over four years ago when I realized I could not stop drinking on my own, like most people with alcohol use disorder, I visited my primary care physician later rather than sooner. I was offered Antabuse, whose very name is shaming, i.e., I evilly abuse alcohol like a sexual pervert and need to be drugged into vomiting to stop myself. The functioning of Antabuse is illogical as well. By the definition of addiction, a person will be compelled to persist despite consequences. How would the negative consequence of physically vomiting be more effective than the negative consequence of physically falling down stairs, which I had already endured numerous times?

When I declined Antabuse, I was not offered the other medications suggested by the Surgeon General's report, naltrexone and acamprosate, or gabapentin off-label, or other medications found helpful in the practitioner's experience. I was referred to a support group. My physician, too, seemed to think I had gone bad and needed the help of others to get good again.

Under layers of moral, societal, legal, medical, and shame-on-you constructs, I could barely hold myself up, much less think objectively about my situation. When I read Unbroken Brain, I thought, "Maia's saying, 'The emperor of addiction wears no clothes!'" I looked up, saw the naked data, cast off the constructs, and began to see a problem to solve, not a shame to lament.

I wrote here what evidence-based treatment for alcohol use disorder might look like. I'm not a medical professional, but anyone can read any of this information online. I daydream that, for me, the standard introduction by a medical professional to medical treatment for substance use disorder might have gone something like this:

"Anne, it's human to anticipate and engage in pleasure, or to seek relief from boredom or pain, or to have any number of generic or quirky reasons to try a substance. You're not bad or wrong for being human or for having these human traits. It can be very confusing to figure out which substances are harmful, risky or medicinal, which ones are legal or illegal, and which ones are socially acceptable to use and which ones aren't. My patients may have used a legal substance, such as alcohol or nicotine, or a sometimes-legal, sometimes-not-legal substance like marijuana, used a legal substance illegally, used a legal substance legally, or used an illegal substance illegally. Whew! What I say to patients is that the morality and legality of use is something they may want to ponder.

"But that's not the presenting problem. Addiction is a medical condition, not a moral one. You don't need to become a better person to get better. You need treatment. So let me continue.

"Additional use of a substance may be for very human reasons as well. Over time, the body may acclimate to repeated use and physical symptoms may occur if the substance is discontinued. That's dependence.

"Addiction, however, is different. First, fortunately, it rarely happens. Six out of 7 Americans are not expected to develop addiction in their lifetimes. What defines addiction is being compelled to continue a behavior despite negative consequences. You have described this phenomenon in yourself. You found yourself unable to stop drinking even though you were falling down the stairs. That must have been very frightening.

"When use results in addiction, it's almost always because of what past hardships have done to the brain. I am so very sorry you have so many of these predisposing factors in your own past. We now know the role trauma plays in the development of addiction. Mental illness can contribute to the development of addiction as well. If we had known then what we know now, we would have worked with you to get help with these issues so much earlier.

"You'll need to cut down on your use, or stop altogether, but, unfortunately, the brain changes resulting from addiction create impairments in the very functions you'll need, such as deciding to stop, planning how to do that, and following through on the plan. We could just wait and see if you can stop or cut down on your own, because a lot of people do 'mature out.' But estimates of spontaneous recovery rates vary from 4-60%. I'm not a fan of those odds as 'treatment.'

"Since you're female and older, you're also in a group increasingly and dangerously at risk for alcoholism. For your individual case, I recommend we engage in evidence-based treatment immediately.

"I hear the concerns of those with an anti-medication bias, but I want to explain something to you. Addiction is an illness of the organ of the brain that can result in premature death, with great personal, familial, and societal suffering prior to that. If we want to save lives and decrease suffering, we need to treat the organ of the brain. Right here, right now, both directly and indirectly, the treatment we have for the brain is medication. Not counseling, not recovery coaching, not support groups. Moral and societal constructs, devised to 'protect' people - and the resultant laws that allow or prohibit some substances and not others (differentiating 'nice highs' from 'not nice highs') - put more Americans at risk from addiction and its symptomatic behaviors than protect them.

"Medication is the first-line treatment for alcohol use disorder. We have several we can try. One of the challenges we have in your case is that, in the past, you have been highly reactive to even the smallest doses of new medications. I'm going to prescribe the one that I think is a best fit for your individual case. I'd like you to take a small dose, which I will specify to you. I want you to contact my office about your experience. Based on that, we'll decide next steps. The nurse will give you a handout on evidence-based treatment for alcohol use disorder and talk with you about providers of other services.

"I am so very sorry you've developed this condition. With medication, counseling, assistance with looking at stressors in your life and what can be done about them, plus social support, you're very likely to see your symptoms improve. You'll be able to get on with your life. Any questions?"

I get choked up even imagining hearing such words.

It's just an illness? You're offering me treatment for it? Nothing to be ashamed of? No extra burdens to bear? I'm just a normal person in normal clothes? I'm to get on with my life?

I think I'll do just that.

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 Part 12 here Part 13 here Part 14 here Part 15 here Part 16 here Part 17 here Part 18 here

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