What is the best possible approach for treating addiction or alcoholism?
Anyone who has been in recovery for a while has likely been exposed to the 12 step program of AA. There are also a few alternative to this though they are few are far between. For example, a small percentage of treatment centers are based on religious recovery rather than the 12 step program. And there are even a few rehabs that ignore both the religious and the spiritual approach in favor of a more behavioral approach.
So which one is the best? Are we to assume that AA is the most effective because it is the most widespread solution?
This is a very polarizing topic because most people who have become clean and sober are extremely loyal to the method in which they experienced their journey. In other words, someone who got sober through AA is not likely to be open minded about other recovery programs.
Why is this?
I believe that the reason has to do with our process of denial and surrender. Every alcoholic struggles for some time before they finally “get it.” While they are struggling they may try various methods for quitting drinking. Nothing works, of course, because they have not yet reached surrender. But then at some point in their journey they become miserable enough to finally surrender to their disease, and at that point they start to recover. It doesn’t actually matter what recovery program they are using at that moment, it is going to work for them because they have reached a state of total surrender.
Can the individual see this objectively? No, they cannot. Instead, they see that they finally got clean and sober by trying that one thing, maybe they finally went to treatment and they were introduced to AA and so they tend to give credit to the AA program. They say “I tried to quit drinking for years and nothing worked for me and then suddenly I stumbled into an AA meeting and I was finally saved!” Did the AA program really wave a magic wand over this person? Or is the “magic wand” the fact that they finally surrendered to their disease and became ready to change?
If you force a bunch of people into a recovery program then a huge percentage of those people will relapse. Of course you will also get lucky in the fact that a tiny percentage of those alcoholics will naturally be at a point of true surrender as well, so they will stay clean and sober. They were ready to seek help anyway. Your forcing them to do something was not really the catalyst for success. Rather, it was their total and complete surrender.
I worked in a (12 step based) rehab for about 5 years, and while I was there I met hundreds or even thousands of recovering alcoholics. One guy came through the treatment center and later relapsed. I saw him come through a few times actually. Later on I ran into him “on the outside” and he was obviously clean and sober. He was doing well. And I talked to him for a while and he was living in a religious based recovery house. And yet he told me that the religion had nothing to do with it, and he was not a religious person at all, and so he just sort of ignored the religious aspects of the program. But he said they were good people and he was finally getting it because he was ready to recover.
So I had to stop and think about that for a while. Here was a guy who had finally “got it” by going to the wrong rehab center. He was not religious and he actually preferred the 12 step approach rather than a religious approach. And yet here he had come to the 12 step program for years and he relapsed every time. Then later on he finally surrenders, but the only place that can take him that week is a religious based treatment center. So he goes there and he just sort of ignores the religious part, he respects it but he does not necessarily engage with it, and he finally “gets” recovery. In the wrong rehab. But he had surrendered.
So this is our first major clue about the best possible approach to recovery. It is all about surrender.
Fundamental necessity: total and complete surrender
There are certain things that are fundamental to every recovery.
Over a hundred years ago there was no such thing as AA. They did not know what to do with alcoholics or drug addicts other than to lock them up in asylums or jails. They did not really know how to treat addiction at all.
And yet some people figured out the recovery process anyway, even back then. Some of them “surrendered” while they were serving time in jails or prisons. Then they started taking positive action and rebuilt their life from there. Eventually someone figured out that they should write a book, start a series of meetings, and try to outline this recovery process for people (with the AA program).
So there are certain things that are fundamental to every recovery. If you are an alcoholic and you overcome alcoholism then you will go through this process, because it contains fundamental elements of recovery. You cannot avoid them. If you avoid these things then you would relapse or not stay sober at all.
The first and most important fundamental concept is surrender. If you go to AA and you work the steps then you must surrender first.
Not because the AA steps tell you to surrender (although they do), but because you cannot even walk into an AA meeting and beg for help unless you have reached a point of surrender. The concept of surrender is fundamental to recovery. AA definitely helped to popularize the idea, but there were people who recovered before AA existed. And those people had to surrender to their disease as well.
You may find that there are different levels of surrender. Sometimes the alcoholic feels like they have been through the wringer and they just want to give up for a while. So going to rehab can be a relaxing retreat of sorts. Becoming sober in AA for a week or so might be just the ticket. But just because an alcoholic needs a break does not mean that they are ready to change their whole life. This is why you have such atrocious relapse rates in recovery. It is easy to try to get sober, it is difficult to stay sober. Many people will try to avoid the pain and discomfort of addiction without being willing to put in a serious effort at recovery. They lack total and complete surrender. Therefore they relapse.
It doesn’t matter how you try to get sober, if you don’t surrender to your disease, then you cannot possibly make any real progress. All progress is an illusion until you reach full surrender. You are only fooling yourself if you think you are making improvements in your life if you have not reached the point of full surrender.
Second fundamental: disruption (rehab)
Another fundamental principle of recovery is the idea of disruption.
Alcoholism is a trap. It’s a cycle. The alcoholic cannot figure out how to break out of that cycle.
There is that poem: They walk down a street, they see a hole, they fall in. It happens over and over again until one day they walk down a different street.
This is recovery. You have to walk down a different street. But we are so ingrained in our daily habits that it can be almost impossible for us to just change our lives on a snap decision. It can be difficult to disrupt years of ingrained habit.
This is what rehab was designed for. Now keep in mind that there are other ways that you might disrupt your life as well. Going to jail is one of them. Who wants to go to jail though? Not a fun way to disrupt your addiction. You might get laid up in the hospital for a while as well. Or locked up in an institution. All of these things will put an abrupt end to your alcoholism, at least temporarily.
Of course this does not insure long term sobriety. But if you are going to get sober in the long run then obviously you first have to get sober in the short run as well. You can’t have the long term without going through the short term recovery.
So what can you do? One thing is to simply go to rehab. This disrupts your life. Your cycle of addiction is instantly broken. By going into rehab for a few weeks you are suddenly “cured” of your addiction. Being in a controlled environment makes it easy.
I have attended three rehabs in my life and then I worked in a detox and residential rehab for over 5 years. I can tell you right now with confidence that being in rehab is easy.
That is the whole point. They make it easy to be clean and sober. In the short run, they make it dead simple to be clean and sober.
I think there is this myth that it is really hard to be in rehab. Or that people are climbing the walls or in pain in rehab. This is nonsense.
I worked in the detox for many years. No one was ever in pain. No one was ever climbing the walls. The whole point of going to detox is they do everything that they medically can in order to get you safely through withdrawal.
It may take a lot of courage to walk into detox. But once you are there it becomes easy. That is the whole point. You are in a controlled environment. They treat you medically. They do what they can to keep you comfortable.
This is the easy part. Disruption is the easy part. Shoot, you could accidentally get caught doing something you are not supposed to and go to jail. Instant disruption. It may not be fun but it is pretty darn easy. You lock yourself up (either by choice or by force) and then you simply don’t have access to alcohol for a while. Simple. This is how you disrupt the cycle.
And I really believe that this is fundamental to recovery. This is how early recovery works. You have to disrupt the cycle in some way if you want to break free. The best way to do that is to check into rehab. The worst way to do that is to get locked up against your will. But either way is probably better than drinking yourself to death.
Third fundamental: change (in thinking as well)
Many people go to rehab (and to jail for that matter) but they fail to change their thinking.
This is the third fundamental. I think that it ties in very closely with the first fundamental of surrender as well.
You can’t just disrupt your life. That is not enough. That only insures sobriety in the short run.
But what about the long run? In order to change in the long run you have to change your thinking as well.
If you go to rehab and become sober then how are you going to remain sober when you finally leave treatment? At some point the disruption phase must end and you will be “free” again. Free to walk around the world and face the temptation of alcohol and drugs. So how are you going to overcome that temptation?
One thing is certain: If nothing changes in your thinking then you will definitely go back to your old patterns of abuse.
So many recovery programs focus on how to change your thinking. How can we teach people not to immediately think of self medicating? How can we teach people to work through their problems rather than instantly thinking that they should just drink their problems away? How can we teach people to feel their emotions rather than to medicate them?
This is a process. It is also fundamental to recovery.
When I got clean and sober I had to take a step back and look at what I was doing with my thought processes.
How do I justify my drinking?
I had to look at that. I had to figure out what patterns my brain was using in order to justify my drinking.
I realized that I was using a combination of resentment and self pity.
In fact, I actually liked it when something unfair would happen to me. Why was I doing this? I had to consciously reason through this process in early recovery.
What I learned is that this is how I justified my drinking. You see, I needed an excuse to get completely wasted on alcohol. So I ran these thought patterns about how the world had done me wrong, and if other people had been wronged like I had then they would drink too.
I labeled this as “self pity.” Perhaps it is more resentment actually. I am not sure. But I was able to identify this thinking in my early recovery and I realized that this is what justified my drinking.
So I had to stop it.
How did I do that?
I had to change my thinking. I had to make a decision. So I decided right then and there that I had to put a stop to these thought patterns. I could no longer play the victim. I could no longer feel sorry for myself.
So the first step was awareness. I had to go on “high alert” for my brain to be running these thought patterns. As soon as I noticed them I had to stop myself and shut those thought patterns down.
“But how do I do this?” you may ask.
You just do it. Become aware of it. Then, when you notice it, redirect yourself.
Do not allow yourself to wallow in self pity or resentment. Remind yourself that it is a lie, and that you are not allowing yourself the “luxury” of having those destructive thought patterns any more. They only lead to trouble.
This is a conscious decision. It is also fundamental to recovery. You have to figure out how your brain used to justify your addiction, and then put an end to those thought patterns.
Thus “changing your thinking” really means “eliminating negative thought cycles.” You must identify them, become aware of them, and shut them down.
It really is that easy. You just have to decide to do it, and commit to it.
Fourth fundamental: growth
The fourth fundamental of alcoholism recovery is growth.
You cannot really experience experience this level of success in recovery unless you have done all of the other fundamentals as well.
Think about it: If you have not yet disrupted your addiction then you obviously cannot make any growth in your life. You will just keep screwing up any progress by drinking more.
And you cannot really move forward and improve your life if you are stuck using negative thought patterns. So you have to change your thinking before you can grow.
So the steps (in my world anyway) look like this:
3) Change thinking.
4) Personal growth.
After you have done the first three things then you move into a phase that I would label as “long term sobriety.” You are no longer living in early recovery. You moved beyond that phase when you learned how to change your thinking.
But now you have a new challenge. Now you must push yourself to keep growing in your recovery.
Why is growth necessary?
There is a saying in AA that hints at this fundamental principle: “You are either working on recovery, or you are working on a relapse.”
This is true. You cannot stand still in recovery. If you are standing still then you are technically moving closer to relapse. The only way to recover is to make consistent growth in your life.
Personal growth protects you from relapse.
When people talk about relapse prevention what are they really suggesting? Take a look at what they are proposing and realize that they are all a bunch of suggestions that prompt you to pursue personal growth.
You need to change two things in your recovery:
1) Your life.
2) Your life situation.
If you think about those two things then you will realize that this means you must “change everything!”
And yet this is not impossible. There is a clear way to prioritize this in order to achieve the maximum amount of personal growth for your effort.
The way to prioritize is to eliminate negatives.
This is your first order of business in life. To eliminate the garbage, get rid of the negative stuff, and keep pruning until you are left with…..peace. Bliss. Contentment. Happiness.
All of those objectives come through elimination. You must work to remove the negative things from your life. We call these your “points of misery.”
Some of these will include negative thought patterns. Remember the idea of resentment and self pity? If you are caught up in those patterns then that is a “point of misery” and it can lead you back to drinking if you do not fix it. Therefore you have to push yourself to make positive changes or you will relapse eventually.
Ideal treatment incorporates all of these fundamental concepts
It is tough to design the ideal treatment. I was lucky in that I lived in long term rehab, where I experience all of these fundamental concepts.
But long term rehab is not a perfect solution. Mostly because so much of recovery goes back to the concept of surrender. Many people go to long term rehab without having completely surrendered first.
So you need to master all of these fundamental concepts if you want to become sober. Doing so results in the ideal course of treatment.