The field of substance abuse treatment is quite young, only a few hundred years old at the most. This is practically nothing compared to some of the medical areas we have been learning about for centuries.
And we have been wrong in the past about addiction and alcoholism. We have already learned a great deal, but we definitely have more to learn. We are still at a point with treating addiction where it is very….scattered. Our solutions are like patchwork. They all point at the solution without defining it as precisely as we might like.
So let’s take a look at some of the things we have been wrong about, in order to learn more about where alcoholism treatment might be ultimately headed.
If we can understand in detail exactly how alcoholics recover, we can learn a great deal more about how to help people in the future.
One thing the world got wrong: Primary versus secondary
A long time ago it was believed that alcoholism was the result of something.
People assumed that the alcoholic was drinking in reaction to another condition. Therefore the world decided that alcoholism must be a secondary disease that was being driven by some underlying causes. It followed that what you must therefore do is to sober someone up and then treat those underlying causes in order to be able to treat their alcoholism. Makes sense, right?
Turns out this is wrong. We were dead wrong about this for many years. Alcoholism is not, in fact, a secondary disease. It is a primary disease. It can exist all by itself, without any underlying causes. You don’t have to have suffered any sort of childhood trauma in order to become an alcoholic. You don’t have to necessarily have parents who were alcoholic in order to become one yourself. Alcoholism is primary. It just happens. And even though there may be some reasons that you had for drinking, treating those reasons may not be the key to treating your disease. Alcoholism is primary and it stands on its own.
Another thing that people got wrong: Spiritual versus holistic
Another thing that the world got wrong has to do with the solution.
This one continues to this day and the vast majority of people in recovery do not understand the difference here. If you go interview a hundred people in traditional recovery you will get close to 100 people who believe that the solution is entirely spiritual.
In my experience this is dead wrong. The solution is not only spiritual. The solution is much bigger than that; it is holistic. This may sound like a subtle distinction but in my opinion it is quite significant. In order to truly recover people need to pursue personal growth in their lives and push themselves to improve. You can do this on a spiritual level or you can do it:
If you just go to mainstream recovery then they will tell you “if it is not spiritual then it is not practical.” I believe that this advice is dead wrong, because I have made plenty of growth in the other 4 categories in my recovery and all of it was beneficial to me in preventing relapse.
Relapse prevention is about personal growth. You can grow spiritually in your recovery and that is certainly helpful, but you can also grow in other ways as well.
Traditional recovery discards these other categories of growth as being unimportant. I believe that they are important to relapse prevention.
The holistic approach is more powerful and more robust than the spiritual approach.
The holistic approach includes the spiritual approach. It simply expands on it.
If someone says “spirituality is the solution” then their focus is too narrow in my opinion. They need to expand their horizons and realize that much benefit is to be had through other forms of personal growth. For example, the exercise that you do every day can make a huge difference in your recovery efforts, though this is rarely talked about or discussed in mainstream recovery. Instead they focus on spirituality almost exclusively as the only possible path towards a new life.
You don’t build a new life in recovery with only spiritual growth. You build a new life in recovery by growing in many different ways. I have looked at several different case studies of people who have recovered from alcoholism using different strategies, ranging from spirituality to fitness based programs to holistic paths and so on. There is no single path to recovery that will work for everyone and therefore it is important to expand your horizons and explore in recovery.
Another thing that we get wrong: Sending someone to rehab to try to motivate them to want sobriety
This is a common error on the part of the friends and family of the struggling alcoholic.
I don’t blame anyone for making this error. But at the same time, it is an error that is worth learning about and correcting.
The error is this:
You can’t motivate someone to get sober by sending them to rehab.
Sometimes we think and want to believe that this is the case. We hope beyond all hope that if we can just convince someone to go to treatment that they will hear just the right thing while they are there, that something will “click” for the alcoholic while they are going to groups and meetings every day, and that they will suddenly be motivated to turn their life around.
In my experience this is not the case. I have been to rehab myself 3 times, and I also lived in a rehab center for 2 years and later worked in a rehab center for 5 years. During this time I experienced much on my own and also made many observations of others in recovery. My conclusion is that no one can be motivated or convinced to do anything that they don’t want to do.
But it is much more than that. Let’s say that you are on the fence about recovery, so to speak. You are not really sure if you want to change your whole life and put in the effort to get sober. But at the same time you are fairly sick of the roller coaster that you have been on. So you check into rehab. In my experience, such a person is destined to relapse. They just aren’t ready yet.
There are several levels of denial that are very difficult to explain. The first level of denial is that one where you say “I don’t have a problem.” Most people who check into rehab have at least gotten past this first level. They can admit that they have a definite problem. And they truly believe it. But, this is not enough.
The second level of denial has to do with the solution. The alcoholic has to want to embrace a new way of life, they have to want to surrender totally and allow themselves to be told what to do and how to live.
I would venture that 95 percent of people checking into rehab have not truly broken through this second level of denial. They are still hanging on to something. They have not fully surrendered in the way that I just described (willing to do anything they are told to do in order to build a new life). When we talk about accepting your alcoholism and breaking through denial, it is this second level of denial that really matters. Not the part where you admit that you have a problem, but the part where you admit that you are desperate for a solution.
Getting through this second level of denial is about the solution. It is where the alcoholic throws up their hands and says “I don’t know how to live any more. Please show me.” Most people are just not that desperate. Most people who check into rehab are not yet that desperate.
But this is what it takes in order to recover. This is what it takes to be successful in sobriety.
We hope against all hope for a miracle, that if we send the struggling alcoholic to rehab that they will somehow pick up on the idea that life will get better if they stop drinking. We secretly have this hope that if the alcoholic just makes it into rehab that this will somehow change their attitude and force them to want to remain sober forever.
But it doesn’t really work that way. The person has to want to change first, then they should go to rehab.
Personal growth versus spiritual transformation
The majority of alcoholism treatment these days is centered around the idea of spiritual transformation.
In this alcoholism resource guide I detail the idea that personal growth is more powerful than spirituality alone, and should therefore be the path that we take in recovery.
It is one thing to have a spiritual transformation in early recovery (or before sobriety at all) and thus change your life for the better.
It is another thing entirely to get sober, push yourself to pursue personal growth, and in doing so rebuild your life from the ground up.
In my opinion it is wrong to push people to try to achieve a spiritual transformation when that can be so subjective and hard to predict. It makes much more sense to instruct people to take positive action every day towards personal growth in many different areas of their lives.
The outline for a recovery process might look like this:
1) Surrender. The alcoholic has to want to change. This is true with any treatment approach, no exceptions.
2) Disruption. The alcoholic must get physically sober and break out of their pattern of abuse. This can be environmental as well. Inpatient rehab is the strongest form of disruption.
3) Transition. The alcoholic must transition from the safety of inpatient treatment back into the real world. This can be done with the help of support systems like meetings, group therapy, etc.
4) Personal growth. This is long term sobriety, which does not by itself insure continuous recovery. The alcoholic has to keep working at it in order to remain sober. Complacency becomes the greatest threat in the long run.
That is another thing that we had wrong:
The big book of AA states that resentment is the number one offender in terms of relapse. This is true for the newcomer but in the long run it turns out to be a false generalization. In fact, complacency is the greater threat. The people who wrote the big book could not have known that at the time, because they did not have several decades of sobriety experienced yet.
Complacency kills recovering alcoholics. The cure for complacency is personal growth.
Therefore we all need to adopt a strategy in long term recovery that keeps us moving forward. We have to take action in order to remain sober.
The default state of the alcoholic is to be drinking and getting drunk. That is the default status. That never goes away, even after you have been sober for years or decades. It doesn’t matter, the alcoholic part of you will always want to be drunk.
So you have to keep taking action in order to fend this threat off. It never ends. If you get lazy for too long then eventually the alcoholic mind will take over and you will drink again.
A continuous cycle of personal growth is the best form of relapse prevention. Not only do you protect yourself from relapse, but your life continuously gets better and better.
If you do it right, then your life will just keep getting better and better in recovery. If you do it wrong, then you will flat line as far as personal growth is concerned and you will stop pushing yourself to make changes. This is when there is serious danger of complacency.
There are two ways that you can move towards personal growth: Internally and externally.
In traditional recovery programs they tend to focus only on the internal. In the 12 steps of AA they tend to focus only on the internal path. But the external path is important as well, in my experience.
In other words, you need to do both.
Internal path – Working on yourself, working on the inner stuff that drives your disease, eliminating shame, guilt, anger, fear, etc. Working to change yourself.
External path – Working on your life. Working to change your life situation – your relationships, your career, your employment, your fitness level, etc. Everything outside of your mind.
Both of these paths are important in recovery. If you focus entirely on one of these paths at the expense of the other then you will get into trouble and risk relapse.
Most people who have never been in recovery before try to fix their problem by making external changes.
When you get into traditional recovery they swing too far in the other direction (in my opinion) and they focus almost exclusively on making internal changes.
In order to enjoy long term sobriety you should do both. You should work hard at changing both your life (internally) and your life situation.
The learning process and how more is being revealed to us
We are still learning a great deal about alcoholism recovery as the years go by. Currently there is much science and research being done in terms of the brain, as well as in terms of new medications that may help to treat addiction. They are learning a lot from a chemical standpoint right now at the level of the brain itself, so things could get interesting in the coming years.
For now, it is wise to focus on solutions that are already available to us (don’t put off recovery by crossing your fingers and hoping for a “cure” in the future).
The best path in recovery is to embrace the fundamental process of recovery as outlined here:
1) Surrender first before trying to get sober. You must do more than admit to your problem, you must want to embrace a new solution. You must kill your ego.
2) Disruption. If you are unwilling to disrupt your life then you are not ready to change yet. If you seek to avoid rehab then you are not ready. You must be willing to disrupt your whole life if you want to get sober.
3) Learning. You must be willing to really learn a new way of life. This is not about listening, it is about taking action. Are you willing to follow through on what you are being taught?
4) Support. You need support in early recovery if you are to remain sober. Are you willing to embrace a community or go to meetings every day? How much support do you need to stay sober? The amount will differ depending on the person.
5) Growth. You need to engage in personal growth in long term recovery in order to avoid complacency. Many people get lazy in long term sobriety and this can lead to relapse. You must stay hungry for more growth and change in your life.
This process can be found in many different recovery programs to varying degrees. I believe those are the fundamental processes of any path in recovery that is successful. In other words, if you remove one of those processes then it is highly likely that the person will relapse at some point. They are universal principles that drive success in recovery.
Ultimately recovery is all about change, and this obviously has to be driven by positive changes (if you make negative changes then you simply relapse eventually). So you make one positive change after another in recovery and this drives further growth and success.
Part of relapse prevention is in actually building a life that you care about and get excited about. If you don’t wake up excited after a few years in recovery then you are not on the right path yet. You should be engaged in personal growth such that your life becomes exciting for you. If it is not, then change it. Find something to get passionate or excited about, something that drives you to keep taking positive action. Recovery is not supposed to be boring.
What is important for the individual is that they find a path in recovery that works for them. This will differ greatly among individuals as evidenced by the various recovery programs that exist. Experimentation might be important for you if you have not yet found your true calling in recovery. There is nothing wrong with this so long as you are dedicated to finding a path of personal growth in recovery. Taking suggestions from other people in sobriety is one of the best ways to discover your own true path.
More is being revealed, even as more was revealed to us 10 years ago, as it was revealed to us 100 years ago.
You no longer have to be forced into an alcoholism solution that is a poor fit for your personality. You are free to design your own path of growth in recovery. You can find support in new places such as the recovery forum here online, or you can go the traditional route and attend daily AA meetings. There is no single path that works in recovery, but there is one set of processes that is fundamental to successful recovery. Embrace those processes and push yourself to achieve personal growth.