I’m grateful for a gorgeous walk in the park yesterday. I’m grateful for what I learn from my sponsees,. I’m grateful for replacing fear with faith. I’m grateful for seeing what was always in front of me. I’m grateful for watching things change. I’m grateful to be sober today.
Click the pretty picture to read this on the website!
Yesterday was another gorgeous Fall day here in New York City and this can be a dangerous time of year for me, productivity-wise. For example, around 2pm yesterday, I determined that replacing the track pad on my computer was essential to the continued functioning of this enterprise. I could have gone to the Best Buy or the Target on 86th Street, but I thought it was important to have a selection and so made my way to the Apple Store on Madison Avenue. Well, new trackpad in hand, I was just a block away from the park and it’s such a pretty day. Anyway, you’ll notice where the picture is from today. The cool thing is that I think I’m ok counting all of it as “work.”
It’s almost the middle of November now, it wasn’t too much later in the year when Bill W. checked into Towns Hospital on Central Park West for the last time. Bill W. hadn’t left very many stones unturned in his quest for sobriety. Belladonna treatments, hydrotherapy, consultations with the pre-eminent psychiatrists of the time and stays at the premier alcoholism treatment centers of the time were all part of his resume, as was a nearly uninterrupted span of out-of-control drinking. None of these treatments worked for Bill W. but he did gain some valuable self-knowledge:
I met a kind doctor who explained that though certainly selfish and foolish, I had been seriously ill, bodily and mentally. It relieved me somewhat to learn that in alcoholics the will is amazingly weakened when it comes to combating liquor, though it often remains strong in other respects.
Big Book, p. 7
Bill’s introduction to the disease model of alcoholism was critically important. Dr. Silkworth’s nascent understanding that alcoholism was some species of allergy is probably not far off.1 It was critically important because it suggested to Bill that the thing that was ruining his life could be treated. As long as alcoholism and addiction are viewed simply as failures of will power and evidence of poor character, then I’m not sure what the path forward is. There certainly is not a medical treatment for that.
After his stint in treatment, Bill “fared forth in high hope,” his “incredible behavior in the face of a desperate desire to stop was explained,” and he let himself hope “surely this was the answer—self-knowledge.”
But it was not, for the frightful day came when I drank once more. The curve of my declining moral and bodily health fell off like a ski-jump.”
Big Book, p. 7
Some of you know this and some of you don’t, but a relapse after rehab is about the most devastating thing there is. You’ve emerged from 28-30 days of treatment, you’ve learned so much about the disease, you’ve started to learn about yourself, you haven’t been drinking for a month, so you’re clear-eyed and able to see things, understand a little more about how you got here, you’ve spent a shit-ton of money and maybe had acupuncture or done yoga, maybe some art or equine therapy thrown in. You’ve heard lots of people give speeches and inspirational talks, you’ve met and connected with a lot of people who are struggling with the same issues and who speak the same language. They issue you a Soberlink breathalyzer and a weekly check-in with one of the counselors (if you’ve purchased the “Aftercare Package”), give you a list of Alumni in your area and you’re off to go live your sober life.
There you are, back in the same place you left a month ago to go change your life. If you’re like me, you have a journal full of painful self-realizations and a stated, solemn desire to fix what was wrong inside, to make a new life that wouldn’t result in more pain for me and the people who loved me. And then I drank again. It’s way more devastating because I really should have known better, I did know better. I failed. It was my fault. I was taught everything I needed to know, had been outfitted with all sorts of new “recovery tools,” I could use to battle my emotional demons. I still drank and now I know, it must be my fault, that I must be someone who is not even capable of responding to the best treatment that money could buy.
I’m not aware of any treatment center that publishes their results. To be honest, I’m not aware of any treatment center that makes a concerted effort to track their results. Another question, what is the science behind thinking that 30 days of the current treatment modalities is the right amount? I remember seeing a new therapist and going through my history of relapses, my failures at previous treatments, how I thought I was one of those people who would just never get it. She laughed and told me the average person takes something like 5 or 6 cracks at treatment before it works.
That would have been helpful information before I deemed myself an incorrigible alcoholic for not being able to stop drinking after 30 days in rehab. Here’s a big part of the problem, I think most of the curriculum at treatment centers still focuses on self-knowledge. They have you read Bill’s story, but no one ever explains how the treatment that Bill received at Towns Hospital, which wasn’t enough to keep him sober, is different from the treatment they are currently providing you at $10k a week.
I’ve been through “Consequences” sessions in rehab, where they play sad songs about broken people by REM and the Eagles and everyone shares about the devastation they caused.2 I’ve been sternly advised that before I drink, I should “play the tape forward.” Sometimes, I get the feeling that the people who design the curriculum at treatment centers didn’t make it through page seven of the Big Book. Now it’s Baclofen and Naltrexone instead of Belladonna, yoga and meditation instead of hydro-therapy. But the idea that teaching people about themselves and the consequences of their addiction is enough to keep people sober is a dangerous one. Yet, that still seems to be the focus of the curriculum at most treatment centers and IOPs.
I think that focus may even do more harm than good. The alcoholic or addict who relapses after the best treatment money can buy gets driven to the inescapable conclusion that they are just too defective, too broken to ever be fixed. After all, they completed the work that was assigned, were deemed ready to be discharged, so what comes after that must be on their shoulders.
Here’s the important point, self-knowledge is critical to the process of getting sober. But it is not enough. According to Bill W. and the Big Book, sobriety requires a spiritual experience, not a religious conversion, but a spiritual awakening. Continued sobriety is a function of widening and deepening that spiritual existence. I think the problem is that too many people see a stay at a treatment center like taking a car to the mechanic: They expect that something is going to get fixed, that the car is going to drive like new and not make those funny sounds anymore.
A very pretty treatment center in Pennsylvania
In my ten years of seeking treatment, I met exactly one doctor, in St. Paul, Minnesota, who sat down with me and explained that I had a chronic condition that was never going away. It was something I was going to have to manage for the rest of my life. He explained that maybe some people could return to drinking and that some people would never, ever be able to stop, but for someone like me, a “primary addict” according to Ruth Fox’s 1955 classification, it was a chronic condition that could be managed, but probably never “cured.” He emphasized that relapses were not utter failures, but the kind of thing that can happen with chronic conditions, especially those that are affected by stress.
I could do that. I was freed from the shame and humiliation that came from completing the assigned work at treatment centers and getting A’s and still continuing to drink. That’s why explaining the disease model of addiction is so important, because it gives alcoholics hope and purpose and frames the question in a way that it can be answered. It’s what tells alcoholics they are not just irredeemably broken toys.
Self-knowledge is critical to sobriety, but it is not enough to produce sobriety. Long-term sobriety is a long-term process. It involves re-writing the narrative of your life, looking back at the thinking patterns and the sprawling emotions, making sense of relationships with others and yourself, understanding what exactly happened, rethinking your place in the world, getting your alcoholic ego to the right size. I think a stay at rehab can be a critical part of that process and can provide the right foundation for long-term sobriety—but that requires an admission that providing the tools of self-knowledge, though important, will likely not be enough for most people to maintain their sobriety.
There is no question that the treatment that Bill received was an important part of his sobriety, but I don’t think anyone actually “gets sober” at a treatment center. That suggests it’s something I was able to earn, to get from rehab, and when I squander that precious knowledge by drinking again, who’s fault is it? I think the best you can do is to try to “live sober” every day. What I learned in treatment has been invaluable, but my daily reprieve from alcoholism is a function of my efforts to practice these principles in all of my affairs, paying attention to my symptoms and the need to manage my disease, finding ways to connect in a more spiritual way to the world around me, widening and deepening my spiritual life, working with other alcoholics and addicts. It comes more from reading the Big Book than re-reading the notes from the lectures in rehab.
Bill W. didn’t find the answers or sobriety in a treatment center. He found it sitting across from a broken-down alcoholic in a mission on East 23rd Street and listening to him describe how a spiritual experience was making it possible for him to not drink. Bill got sober because he finally became willing to believe that salvation was possible if he could find a way to turn his will and life over to a Higher Power. Bill maintained his sobriety it by sharing his experience authentically with other alcoholics. After ten years of pursuing every treatment available, that’s what worked for me, too. I wish they taught all of this at the beginning.
Thanks for Letting Me Share
Is it maddening to you that medical science hasn’t really gone much farther than this in eighty years?
If I had a nickel for every time someone sent me the song “Desperado,” well, it would probably only be about 50 cents.
I learned so much from this post. Thank you.
(Although I misread 'sponsees' in your introduction as 'spouses', initially - and I thought 'wow, progressive...'! And then I read it properly.)
“That’s why explaining the disease model of addiction is so important, because it gives alcoholics hope and purpose and frames the question in a way that it can be answered. It’s what tells alcoholics they are not just irredeemably broken toys.”
This is why what you are doing here is so important. Hope. Worth. Life with purpose.