10 Tips To For Loving an Addict

The Following is an article I came across on the internet. It is a great breakdown of what to do and what to not do when living with and loving an addict. If you have a loved one that is struggling, you may want to read this. Addiction not only affects the addict but also the ones that are closest to the addict




1. Come face-to-face with reality.

Learning how to deal with reality is the most important first step in “surviving” when you love an addicted person. Although it may seem easier to stay in the “fantasy space” where you can continue to believe that things are going to magically get better, there is no such magic. Things will not get better just because you wish they would.

Coming face-to-face with reality means accepting that parts of your life may be out of control as a result of loving someone who is engaging in addictive behaviours. These addictions can include mind-altering substances such as drugs and alcohol, as well as mood-altering addictions such as eating disorders, compulsive over-spending, smoking, being “glued” to the internet, gambling or codependency in relationships.

You may be feeling a constant, gnawing worry that you live with every day. You may find yourself being asked for money often, and feeling guilty if you say no. Perhaps you are watching everything you say and do, in order to “keep peace” in your home and not make the addict angry. Or you may be asked to do favours for the addict on a consistent basis, such as watching their children or doing their errands, and you may not know how to say no.

Whatever your particular situation is, acceptance of what you are dealing with in your life is the first survival tip for loving an addicted person.

2. Discover how to love an addicted person — and stay healthy.

There are effective ways to deal with the addicted person in your life, just as there are ways that are not only ineffective but can also be dangerous. Learning to distinguish between them can save you a lot of time and can also produce much healthier results for you and your addicted loved one.

For example, learning how to set and maintain appropriate boundaries is a very important skill. You may need to explore the reasons why you have a problem doing that, and then learn some assertiveness techniques that will help you say “yes” when you mean yes, and “no” when you mean no.

Another way to keep yourself healthy while caring about an addicted person is to make sure you are looking after your own life and keeping a good balance with such things as work or volunteering, supportive friendships, fitness and good nutrition, and time for the fun activities that you enjoy.

Choose to practice the healthier ways of loving your addicted person.

3. You cannot control or “fix” another person, so stop trying!

The only person you have any control over is yourself. You do not have control over anything the addicted person does. Many people choose not to believe this, but that doesn’t make it any less true. Once you can really grasp the reality of this concept and live by it, your life will become much easier.

The Serenity Prayer can give you a helpful gauge to see whether you are trying to control people and situations that you simply cannot control.

God, Grant me the Serenity
To accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

Cultivate your wisdom, so that you know the difference between what you can and can’t change, and stop trying to control or “fix” anyone other than yourself.

4. Stop blaming the other person and become willing to look at yourself.

As easy and tempting as it may be for you to blame the addict in your life for your struggles and suffering, there is actually more value in exploring what you may be contributing to this situation, since that is the only thing you can really do anything about.

Even though the addict has undoubtedly contributed his or her share of the trouble, in some way you also have a part to play in what is going on. For example, you might be keeping the “drama” going by lending money to your addicted loved one. Or perhaps you are always willing to be there to listen when they tell you all about the problems they are encountering as consequences of their addictive behaviours.

These kinds of actions on your part will not help your loved one in the long run. It is your responsibility to recognize and “own” your unhelpful behaviours, and to get professional help in doing this if necessary.

Understanding why you choose to behave in unhealthy ways is the key to making a change. Become courageous enough to be willing to look at yourself.

5. Learn the difference between “helping” and “enabling.”

Just like most people, you might think that you need to help your addicted loved one. You probably fear that if you don’t provide help, he or she will end up in a worse predicament. When you try to “help” addicts by giving them money, allowing them to stay in your home, buying food for them on a regular basis, driving them places or going back on the healthy boundaries you have already set with them, you are actually engaging in “rescuing” behaviours that are not really helpful. Another term for this kind of unhealthy helping is “enabling.”

When you can be as truthful as possible with yourself about your own enabling behaviours, you can begin to make different choices. This will lead to healthier changes in your addicted loved one as well. For example, you might decide to tell the addict in your life that you will no longer listen to them complain about their lives. However, you can let them know that you are very willing to be there for them as soon as they are ready to work on resolving their problems.

Once you stop your enabling behaviours, you can then begin to truly help your loved one.

6. Don’t give in to manipulation.

It has been said that the least favourite word for an addict to hear is “No.” When addicts are not ready to change, they become master manipulators in order to keep the addiction going. Their fear of stopping is so great that they will do just about anything to keep from having to be honest with themselves. Some of these manipulations include lying, cheating, blaming, raging and guilt-tripping others, as well as becoming depressed or developing other kinds of emotional or physical illnesses.

The more you allow yourself to be manipulated by the addict, the more manipulative the addict is likely to become. When you hold your ground and refuse to give into their unreasonable demands, they will eventually realize that they are not going to get their way.

Saying “no” is an important first step toward change — for you, as well as for the addict.

7. Ask yourself the “Magic Question.”

It is important to understand that you might be just as “addicted” to your enabling behaviours as the addict in your life is to his or her manipulations.

In the same way that addicts use drugs, alcohol and other addictive behaviours to avoid dealing with their shame about feeling unworthy and unlovable, you may be focusing on the addict’s behaviour in order to avoid having to focus on living your own life. Your enabling behaviours toward the addict may be helping to keep you busy and to fill up your life so that you don’t have to see how lonely and empty you are feeling inside.

Ask yourself the question “How would my life be better if I wasn’t consumed by behaviours that enable my loved one?” Allow yourself to answer honestly, and be aware of any feelings that come up.

Although it may be scary to think about giving up behaviours that have formed your “comfort zone,” it may be even more scary for you to think about continuing them.

8. Know that “Self-care” does not equal “selfish.”

Too many people get these two ideas confused: they think that if they practice healthy self-care and put themselves first, they are being selfish. “Selfishness” basically means that you want what you want when you want it, and you are willing to step on whomever you have to in order to get it. That actually sounds more like the behaviour of the addict. If you try to take care of someone else before taking care of yourself, you will simply become depleted and exhausted.

“Self-caring” means that you respect yourself enough to take good care of yourself in healthy and holistic ways such as making sure your physical, mental, emotional and spiritual needs are met.

As an adult, it is your job to determine what your needs are, and you are the only one responsible for meeting them.

9. Rebuild your own life.

The best way to come out of your own “addictive behaviours,” such as enabling and people-pleasing, is to focus on your own life. If your life seems empty in any areas such as career, relationships or self-care, begin to rebuild your life by exploring the kinds of things that might fulfill you. Would you like to make a career change or go back to school? Perhaps you would like to develop different hobbies or activities that would help you meet new people.

Rebuilding your life so that you feel a greater sense of happiness and self-fulfillment is your most important over-all responsibility. Enjoy!

10. Don’t wait until the situation is really bad ~ reach out for help NOW!!

When those who love people with any type of addictive behaviour finally reach out for help, they have usually been dealing with their situation for a long time. If you have been waiting to see whether things would get better without professional help, please consider getting help NOW, before things become even worse.

If this situation is just beginning for you, it is best to get some support as soon as possible, so that you don’t make the mistakes that could make things more difficult.

The sooner you reach out for help, the better it is for everyone concerned.





5 Reasons Addicts Struggle Staying Sober

The Following is a short list that contribute to an addict’s relapse.




Why Addicts Can’t Stay Sober

1) The mental obsession. A mere sober addict is still completely insane and subject to relapse. Sober-only addicts will experience thoughts to drink or use that do not respond to ration or reason. We can, however, remove this obsession through spiritual action and achieve lifelong sobriety, free from the danger of relapse. But if we don’t change, if we don’t restore ourselves to sanity and re-acquire the power of choice, we have no chance in hell.

Usually the removal of such a condition requires divine intervention. To be more accurate, the result of our sincere work and desire to change may induce the power of God to remove our obsession, as man-made remedies simply aren’t capable of such a task. There is no pill nor any expert that can remove this obsession. There is no pill that can make an insane man sane. And most importantly, the addict himself is not capable of removing his obsession. The combination of his insanity and his total loss of willpower leave him incapacitated. If you don’t believe me, feel free to try going from a chronic and hopeless drug addict to completely and utterly free inside for the rest of your life on your own volition. And by free I mean zero urge or desire to self-destruct + inner peace and contentment.

2) We still want to feel good in sobriety. Therefore, everything the addict does after getting sober is simply to feel good or to achieve maximum comfort. If we fail to rid ourselves of this attitude, this comfort addiction and this selfish frame of mind, then we have no chance.

3) Happiness, success and normalcy are too unfamiliar. Addicts have complacently adjusted to a status quo of chaos, failure and sabotage. It’s hard to teach an old dog new tricks. However, if an addict is going to make it, he or she must embrace and get used to things working out. Things aren’t suddenly working out because of magic, they’re working out because we’re doing the right thing.

4) Refusing to act morally and to make things right. If we fail to sincerely make our amends to spouses, family, friends, colleagues, institutions and creditors, then we have no chance. We will soon fall spiritually ill and relapse. Furthermore, if we don’t change the way we conduct ourselves on a daily basis, we will rapidly move backwards and become ill. We must change the way we think, speak and act. There is no staying sober without living by spiritual principles and treating others with kindness, love, tolerance and respect. We must also never ignore requests for our service. If the people in our lives need our help, we must always respond. Failure to do so, failure to become other-centered will crush our conscience once again and we will surely relapse.

5) Failure to continue growing spiritually. If we truly want to change and grow and recover, then we must continue to evolve spiritually. That means we must continue writing inventory and reading it. It means we must continue praying. It means we must continue meditating. It means we must help other addicts when the opportunity presents itself. To remain sane and free from addiction, we must continue to work on not just our outer lives, but our inner lives as well. Stillness, prayer and meditation are crucial for the mind and heart of an addict. Failure to maintain our inner health will also result in eventual relapse.

Am I an Addict/Alcoholic?

The Following is a quick list of questions to help you determine if you or a loved one is an addict/alcoholic. Answer yes or no to the following questions. Sometimes, yourself or a loved one may not be sure if they have a problem. If you answer yes to 5 or more, you may want to take a closer look…




    • Do you ever use drugs for something other than a medical reason?
    • Is drug/alcohol use making your life at home difficult?
    • Do you find it difficult to stop once you start using drugs/alcohol?
    • Do you misuse more than one drug/alcohol at a time?
    • Has your reputation been affected by your drug/alcohol use?
    • Have you found that it takes more drugs/alcohol to give you the same high (or low)?
    • Have you ever felt remorse or shame after using drugs/alcohol?
    • Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs/alcohol?
    • Do you find yourself hanging out with inferior people when using drugs/alcohol?
    • Have you ever lost a friend or relationship due to drugs/alcohol?
    • Has a close relative or friend ever worried or complained about your drug/alcohol use?
    • Do you ever feel bad or guilty about your drug/alcohol use?
    • Has drug/alcohol use affected you financially?
    • Is drug/alcohol use jeopardizing your job or business?
    • Does your spouse (or your parents) ever complain about your involvement with drugs/alcohol?
    • Have you engaged in illegal activities in order to obtain drugs/alcohol?
    • Do you use drugs/alcohol alone?
    • Have you ever neglected your obligations for two or more days because of drugs/alcohol?
    • Have you had medical problems as a result of your drug/alcohol use (such as memory loss, hepatitis, convulsions, bleeding)?
    • Have you been arrested more than once for drug/alcohol related incidents (DWI, theft, posession, etc.)?




Why Will Power Isn’t Enough

You might think, “Just a little more will power, I’ll be fine.” Personal story showing why will power won’t work, and what will…



By Ted N.

A drug addict’s life is a montage of freeze-frames. Like the night I was driving and noticed the disquieting red and blue strobe in my mirror. As I slowed the car from 95 to a casual stop, that’s when I realized I was wearing a bathrobe and green plaid pajama pants. I hurriedly took count of how many drinks I’d had in the last few hours, remembered the half-gram of heroin in my lumpy pocket, and the variety of other unmentionables scattered around the car.

The chap in blue knocked on the car window with a rigid knuckle. I slipped my half-smoked cigarette into a can of flat Mountain Dew and lowered the glass. I told him none of my secrets. He said nothing of my nightwear, the hour, or my unsteady hands. He cautioned me about deer darting across this stretch of road. He was forgiving of my speed and returned to his vibrant cruiser without issuing a citation. I must have seemed tired instead of drunk.

I had reached a point where I could consume generous servings of brandy without appearing drunk. In fact, I felt closer to normal after binging on booze. I was calm as he pulled away, and almost disappointed as I drove on.

What is addiction like? Isolation.

I both preferred and despised my own company; I feared myself and what I might do if left alone for too long. On more than one occasion I found myself standing in the kitchen with the silverware drawer ajar and a shrill blade in my hand, its tip pressed against my neck, wishing to feel something or anything, wanting to die but really just wanting to live. I’d wake the next morning on the kitchen floor as a grown man who’d cried himself to sleep, broken, cowardly, captive and absolutely alone.

I tried parties for a while, always feeling optimistic right up to the point where I’d reach the crowded room, then see a few dozen faces I’d rather not meet. In my social unease, the effort that went into forced conversation was exhausting. I’d stay for ten minutes trying to act preoccupied, then pretend to head outside for a cigarette and sneak into my car to get away. For the first few years of this, friends would call and ask where I’d run off to, until eventually people stopped calling.

It seems funny in the movies when people wake up in a foreign bed or stray couch without a clue as to how they got there. I don’t recall finding much humor in waking up in the driver’s seat of my SUV, parked in front of the wrong apartment building. I never cracked a smile after rising from a stained carpet floor to struggle to find my way back home.

I preferred to stay in my apartment, only leaving for cigarettes, booze or out to the corner to score some drugs. It was safer that way. I didn’t have to wonder if I killed someone. So I eventually resigned myself to never leaving. I’d lock the doors and shut the blinds for days on end. To be sure, total isolation is a recipe for total insanity.

What is at the root of an addiction?

Talking with a drug addict or alcoholic (in my opinion, no distinction) is a lot like speaking with a child. He or she is present in every physical sense, but there’s a mental barrier of maturity. I was fond of giving lengthy, heartfelt monologues to anyone about the miseries of life and the cruelty of God. My audience lessened as my speeches grew longer and gloomier.

Nights were my place of comfort, my interval to drink voraciously and swallow, snort, smoke, or stab anything into my body that may offer some relief from … I don’t know what. The drinking and using once served a purpose. It brought freedom, clarity, peace of mind, and levity. When did the solution become the problem? My means of escape had ironically become my prison.

The effects of heroin

I used to cry out to God, weeping and screaming in anger for Him to rescue me. Every night I dreaded the morning, certain that I couldn’t bear another day. Everything frightened me; the ringing phone, knocks on the door, school, work, everyone I came across, and most of all–myself. I never knew what I was going to do. I’d spread butter on bread and resist the urge to cut my own throat. I’d drive over a bridge feeling my hands wanting to twist the wheel over the ledge. I’d pour the first drink of the day before climbing into my car, knowing there would be more to come.

I so wished to die, but I knew what a sad funeral service it would be. No one would be surprised. People would talk about my potential rather than my achievements. My parents would blame themselves and live in shame and regret, and my brothers would lose their smiles and all innocence. My memory would be baggage to them.

It was time for a solution.

Getting into treatment

I recall sitting in treatment, considering the next steps on an unclear path, wondering what to think about the last ten years of my life. Were they wasted entirely? What am I supposed to do with all of this damage and how can I move forward with the past so close behind?

What about God? Where was He when I felt so abandoned and alone? Was He there those many times I drove home after a dozen drinks and a ridiculous serving of drugs? Was He there when I’d wake up in some unknown location? Perhaps He was present when I climbed in the hot tub at four in the morning and passed out sometime after everyone left, and woke up later with wet hair but no rescuer in sight.

If I’d realized such interventions back then, I’d have wondered…why? What in me was worth saving? I was contributing nothing to the world, so why did God bother?

In treatment, self-will is not enough

After two months of treatment and no progress, I was more exhausted than I’d ever been. Even though I hadn’t had a drink or drug for 60 days I was still harnessed by substances. I had no reference to function like other people. At least when I was drinking, I thought, there was a means of relief from all of life’s expectations. Now I was vulnerable. I didn’t have my solution in a glass before me or chopped neatly into lines on the dresser.

So many times over the last ten years I’d fallen to my knees in painful despair, screaming in excruciation, “God, HELP ME!” I had demanded rescue, demanded that God fix this. But I never surrendered my will to God. Yet finally, this one night, alone in my room, I wanted to be honest and address God squarely. I told Him of my sincere desperation to change, to give up my addiction to Him, and to be willing to take action. I slept soundly that night. It was the first taste of freedom I’d ever known.

The difference between that night’s prayer and all the others is one crucial and powerful word – faith. I had, even in the worst moments of my addiction, believed to a certain extent that God could relieve me of that burden. Nevertheless, I had insisted on things being done my way. I had never before handed over my problem to God, nor asked for guidance and wisdom on what my role in this process should be. It was the first time I had the assurance of “All right then, God is taking care of that because history shows that I can’t.”

People think that addiction can be overcome by self will. I knew my addiction was masochism, but to imagine a life without drinking and drugging was impossible. It was my downfall, but also my only friend, my only way of living. Self-will in the midst of such a dilemma is impossible. If I have no clarity over my great dilemma then how in the world might I go about conquering its existence? Thank God for God.

Is anything more powerful than an addiction?

Addiction is a crafty, relentless, seemingly unmovable force, but put addiction in the ring with God and it’s a joke. Though self-will and human power is inadequate in my struggle against addiction, the power of God has no limits. I have no doubt that addiction is one of Satan’s favorite weapons since the disease seems so eerily similar to what I would imagine it’s like to be possessed. Recovery from addiction truly is a spiritual battle.

My recovery program is simple — seeking God, whether I feel like it or not.

I try to follow what Paul wrote (in the Bible) to his friends, who were also followers of Jesus: “…whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things…practice these things, and the God of peace will be with you.”1 I loved the thought of dwelling on those things, rather than dwelling on sniffing stuff up my nose.

What I’ve gained from my addiction

My past, as grim as it may be, has become a truly invaluable asset. Now I am responsible to help others find and maintain recovery as I have. It is our similar experiences that form our bond. Every week someone who is new to recovery, unsure of a way out, will tell me a story from their recent past that has haunted them and brought their hand to pour another drink or load another syringe. They tell me of their great shame with hesitation and eyes fearful of judgment. When they’re finished they bow their head, unable to have eye contact. I smile and say in complete honesty, “Yeah, I did that too.” Suddenly their burden of shame and uniqueness is washed away. Then I tell them how different things are for me today. To have a miracle performed on or for you is one thing, but to voluntarily play a role in someone else’s miracle– that’s a sublime privilege.

How does an outlaw, a junkie and drunk, a failure in every respect, become an agent of God? How can I, who just years ago was sure that this world would be better without me, now do God’s bidding? I don’t really have an answer because God works in ways I don’t understand. He humorously seems to use the least likely people as His accessories. If that’s the case, I don’t spend too much time questioning it.

Within six months of surrendering to God and working hard at my sobriety, I enrolled again in school and graduated soon after with Latin honors and a college experience I could never have dreamed of having. It’s been over three years since that night I fell to my knees and I haven’t felt hopeless since. My life is not “okay.” It’s extraordinary. That’s not to say that I have millions of dollars, fame, everyone thinks I’m the greatest, and there’s nothing in this world I cannot do. What I mean is that every morning I do my best to turn over my will to God and be open to His will, asking Him to work through me, and that’s a prayer He never denies. When I’m awake to the opportunities, they’re at every corner.

I know this about God. He can take dreadful situations and reinvent them into something wonderful.

15 Bible Verses To Help You Overcome Addiction

Whether the addiction is alcohol, drugs or sexual, God offers help in His Word to break free of the addiction. Some verses in the Bible give warnings as to why you should abstain from certain sins while other verses give encouragement that an addiction can be overcome.



15 Comforting Scriptures To Help With Addiction

Proverbs 6:26-29 For by means of a whorish woman a man is brought to a piece of bread: and the adultress will hunt for the precious life. Can a man take fire in his bosom, and his clothes not be burned? Can one go upon hot coals, and his feet not be burned? So he that goeth in to his neighbour’s wife; whosoever toucheth her shall not be innocent.”

Proverbs 20:1 “Wine is a mocker, strong drink is raging: and whosoever is deceived thereby is not wise.”

Isaiah 5:11 “Woe unto them that rise up early in the morning, that they may follow strong drink; that continue until night, till wine inflame them!”

Matthew 6:9-13 After this manner therefore pray ye: Our Father which art in heaven, Hallowed be thy name. Thy kingdom come, Thy will be done in earth, as it is in heaven. Give us this day our daily bread. And forgive us our debts, as we forgive our debtors. And lead us not into temptation, but deliver us from evil: For thine is the kingdom, and the power, and the glory, for ever. Amen.”

John 8:36 If the Son therefore shall make you free, ye shall be free indeed.”

Romans 13:14 “But put ye on the Lord Jesus Christ, and make not provision for the flesh, to fulfil the lusts thereof.

1 Corinthians 6:12 All things are lawful unto me, but all things are not expedient: all things are lawful for me, but I will not be brought under the power of any.”

1 Corinthians 6:18 “Flee fornication. Every sin that a man doeth is without the body; but he that committeth fornication sinneth against his own body.”

1 Corinthians 10:13 There hath no temptation taken you but such as is common to man: but God is faithful, who will not suffer you to be tempted above that ye are able; but will with the temptation also make a way to escape, that ye may be able to bear it.”

2 Corinthians 5:17 Therefore if any man be in Christ, he is a new creature: old things are passed away; behold, all things are become new.”

Ephesians 5:18-20 And be not drunk with wine, wherein is excess; but be filled with the Spirit. Speaking to yourselves in psalms and hymns and spiritual songs, singing and making melody in your heart to the Lord; Giving thanks always for all things unto God and the Father in the name of our Lord Jesus Christ;”

Titus 2:11-14 For the grace of God that bringeth salvation hath appeared to all men, Teaching us that, denying ungodliness and worldly lusts, we should live soberly, righteously, and godly, in this present world; Looking for that blessed hope, and the glorious appearing of the great God and our Saviour Jesus Christ; Who gave himself for us, that he might redeem us from all iniquity, and purify unto himself a peculiar people, zealous of good works.”

James 1:12-15 Blessed is the man that endureth temptation: for when he is tried, he shall receive the crown of life, which the Lord hath promised to them that love him. Let no man say when he is tempted, I am tempted of God: for God cannot be tempted with evil, neither tempteth he any man: But every man is tempted, when he is drawn away of his own lust, and enticed. Then when lust hath conceived, it bringeth forth sin: and sin, when it is finished, bringeth forth death.”

James 4:7
Submit yourselves therefore to God. Resist the devil, and he will flee from you.”

Christian Quotes for Overcoming

“Determine that the thing can and shall be done, and then we shall find the way.” ~ Abraham Lincoln

“To trust yourself to test your limits. That is the courage to succeed.” ~ Bernard Edmonds

“God has equipped you to handle difficult things. In fact, He has already planted the seeds of discipline and self-control inside you. You just have to water those seeds with His Word to make them grow!” ~ Joyce Meyer

“Success is to be measured not so much by the position that one has reached in life, as by the obstacles one has overcome trying to succeed.” ~ Booker T. Washington

“No horse gets anywhere until he is harnessed. No stream or gas ever drives anything until it is confined. No Niagara ever turned light and power until it is tunneled. No life ever grows great until it is focused, dedicated, disciplined.” ~ Harry Emerson Fosdick

Read more: http://www.whatchristianswanttoknow.com/15-bible-verses-to-help-with-addiction/#ixzz4E7GIZU8b

Unintended Consequences: Are We Inadvertently Increasing Heroin Overdose Deaths?

Unintended Consequences: Are We Inadvertently Increasing Heroin Overdose Deaths?

By Dr. Richard Juman 01/15/15

source: TheFix.com

FOR HELP CONTACT 866-692-9929 to speak to a live rep OR DrugTreatmentLocator.com

Have efforts to reduce prescribed opioid overdoses caused a spike in heroin addiction and death? Part One . . .

heroin crisis


Two years ago, The Fixspearheaded an effort to highlight the public health epidemic caused by the overprescribing of opioid pain medications which resulted in the tens of thousands of overdose deaths that were making front page news. The epidemic was iatrogenic- “caused by physicians”- in nature. Until quite recently, the vast majority of physicians understood that opioid pain medications—invaluable for short-term pain, for treating cancer and for easing suffering at the end of life—had no place for longer-term, chronic use. It was accepted that the opioids’ side effects and the potential for tolerance, the risk of addiction and the eventual pain of opioid withdrawal made for a very poor risk-benefit analysis for their patients. Unfortunately, over a decade ago, a variety of forces changed all that, including a general movement in medicine to treat pain more adequately, a tendency for consumers to believe that every discomfort should have a medical cure and a devastatingly successful campaign by pharmaceutical companies to convince physicians that opioid pain medications, prescribed to patients with genuine pain, would not lead to addiction. These factors were the primary agents behind a sea change in physician behavior, where routinely and repeatedly, opioid pain medications were prescribed to patients suffering from chronic, non-terminal pain.

Obviously, as a nation we are still devastated by this paradigm shift. Into the calculus of addiction, which was already impacting around 15% of our population, prescribed opioid addiction was introduced. Vicodin and OxyContin led the charge, and opioid addiction quickly became the fastest-growing drug problem in the nation. Accidental drug overdose outstepped car accidents as the most common cause of accidental death, with most deaths resulting from prescribed opioids.

In a series of articles designed to bring a better understanding of these complex issues to primary care physicians, The Fix has endeavored to illuminate the problem of the opioid epidemic as well as to inspire change. And there have been important actions taken since these efforts began two years ago. Have they had the desired impact, orhave efforts to decrease the overprescribing of prescription pain medicationsinadvertently created a boom in the misuse of heroin?

Federal and State Action

In the past two years, both federal and state governments have enacted changes designed to impact the epidemic of addiction and overdose from prescribed pain medications. The federal government has pushed for pain medications to become more difficult to misuse by requiring that they are more difficult to crush, break or dissolve. Additionally, it has reclassified Vicodin and other products containing hydrocodone from Schedule III to the more restrictive Schedule II, which imposes more restrictions on prescribers. At the same time, most state governments have created Prescription Monitoring Programs or Prescription Drug Monitoring Programs (PMPs or PDMPs).

These are electronic databases that collect information on prescribed substances, allowing physicians and other prescribers to see what medications their patients have been prescribed, and by whom. These programs are designed to avoid “doctor shopping” by making a patient’s medication history transparent to all providers. Among other things, PMPs are designed to “facilitate and encourage the identification, intervention with and treatment of persons addicted to prescription drugs”. But, in addition to these goals, are PMPs and the other efforts that have been implemented in the last two years to address the prescription opioid epidemic also driving people to heroin?

The answer is cloudy, and for a number of reasons.

The Heroin Epidemic

There is no question that there has been an enormous increase in the number of heroin-related overdoses over the last decade, and that there has been a very dramatic increase in the last couple of years. The real question is whether well-intended efforts to combat the prescribed opioid problem are responsible.

A recent article in the Economist that made a splash in the treatment community asserts that “the face of heroin use in America has changed utterly”, that the old stereotype of heroin users as young, poor, black and male has been replaced by a new reality in which users are overwhelmingly white, increasingly older, middle-classed and female. The shift is connected to prescribed opiates. In profiling a woman who was given OxyContin following an injury, the article connected the patient’s heroin habit to the prescribed opiates, in a scenario that has become all too familiar: “On the black market OxyContin pills cost $80 each, more than she could afford to cover her six-a-day habit; so she began selling her pills and using the proceeds to buy cheaper heroin. As if from nowhere [she] had become a heroin addict.”

Figures from the Centers for Disease Control support the idea that the prescription opioid crisis continues in full force. Over 100 people a day die in this country because of drug overdose, a figure that has been rising steadily for over two decades. In 2012, of the 41,502 drug overdose deaths in the US, 16,007 or about 38%, involved prescription painkillers.

There is also ongoing evidence that many of the millions who were initially introduced to opioids by their doctors have turned to heroin, and in fact that most of the people that use heroin now started out with a prescription opioid. While most hospital ED admissions for opioid overdose are still caused by prescribed painkillers, bothgovernment authorities and local media around the country continue to report anongoing dramatic rise in heroin overdose deaths.

Many addiction treatment providers say that this has become a familiar paradigmamong the patients that they treat. “A troubling comment pops up more and more during my discussions with people actively addicted to opioids,” writes Jeffrey T. Junig, MD, a physician and PhD neuroscientist who practices in Wisconsin. They say, “Now that O-C’s (OxyContins) are abuse-proof, we gotta’ use heroin.” Adds Dr. Junig who is open about being in recovery himself: “There are many addicts out there, each subject to severe withdrawal in the absence of their daily dose of oxycodone. What would a reasonable person expect them to do, knowing the intensity of their desire for opioids and their fear of withdrawal?  Are they just going to stop?”

Arnold Washton, PhD, the Executive Director of Compass Health Group, a multi-specialty team of addiction providers in New York, reports that the same phenomenon Junig describes in Northern Wisconsin can be found among the C-suite executives that he sees in his high-end practice in Manhattan. He notes that “increasing numbers of clients are coming in reporting that they are physically dependent on heroin, having switched from OxyContin and other prescribed painkillers as they’ve become harder to get from their physicians. I’ve had two of these patients enter treatment just in the last week.” In Manhattan, adds Washton, “these guys don’t have to buy it on the street, there are heroin delivery services that will bring it to them in their doorman buildings.”

Percy Menzies, the President of the Assisted Recovery Centers of America in St. Louis,  a treatment center based in St Louis, confirms that many of his patients come to use heroin as a result of changes in their ability to access prescribed opioids. He notes that:

“The restrictions that have been placed on prescription opioids have resulted in a decreased availability of these drugs on the street. Some of our patients initially were started on prescription opioids for chronic pain, but after a period of time the patients were ‘fired’ by their doctors for abusing the drugs. Some of these patients tried switching doctors and when nothing worked, came to us for treatment. Other patients obtained prescription opioids illegally from friends, stole them, etc., and then switched to the cheaper opioid – heroin- and got addicted to the heroin.” Adds Menzies, “We were caught unprepared for the ‘man-made’ addiction to prescription pain medications. Heroin quickly became the ‘generic’ version for the prescription opioids.”

But other addiction medicine providers are not seeing a lot of this pattern in their practices. Mark Willenbring, MD, the former Director of the Treatment and Recovery Research Division at NIAAA/NIH and the CEO of Alltyr: Addiction Treatment for the 21st Century, says “I am unsure of the prevalence of prescription opioid users switching to heroin but I suspect it is very small. Most people have no idea how to procure it and are too afraid of the consequences. I’ve seen this a few times, but only in people with a history of serious non-medical opioid or other drug use.”  Adds Anna Lembke, MD, the Director of Stanford’s Addiction Medicine Program, “I find that the switching from prescription opioids to heroin is more common among the younger generation, who seem to be generally more open to experimentation with all types of drugs, and are not deterred by legal status. Whereas with middle-aged and older folks, heroin represents crossing a line for them, and they’d rather get help before going there.”

Andrew Kolodny, MD, the Chief Medical Officer of Phoenix House and the President of Physicians for Responsible Opioid Prescribing (PROP), is a long-time crusader against the “epidemic of opioid addiction caused by overexposure of our population to prescription opioids.” He argues for a balanced perspective on the challenges we’re confronted by. He points out that “there is strong evidence that heroin use was increasing before any significant federal or state interventions on prescription opioids were implemented. The idea that efforts to curb prescription drug misuse have led to a spike in heroin use or overdose has become a common media narrative, but the facts don’t support it. It is the overprescribing of opioids itself that has caused increases in opioid addiction of all kinds, not the efforts to control the prescribing. The transition from prescribed opioids to heroin has been happening since the beginning of the epidemic, and there is no evidence that the interventions brought forth to reduce the overprescribing have been fueling the increase in heroin use or overdoses. Because of the epidemic of opioid addiction, you now have markets for heroin that you didn’t have in the past. So there has been an increase in heroin overdose deaths, but that increase was prior to states’ implementation of Prescription Monitoring Programs or any of the changes from the FDA.”

Obviously, there are regional differences in both the severity of opioid addiction and the tendencies for users of prescribed opioids to switch to heroin. Other factors are also at play, such as the fact that most opioid overdose deaths actually involve a variety of substances, particularly, alcohol and benzodiazapines. Beyond that, since we know that the supply of heroin in the US is high and the cost low, it’s difficult to accurately assess the impact of any particular element or trend on the rate of heroin use and overdose. What is clear is that our problems with opioids, both prescribed pain medications and heroin, continue at full throttle, and more needs to be done. We’ll look at our options in Part II of this series.

Richard Juman—a licensed clinical psychologist who has worked in the integrated health care arena for over 25 years providing direct clinical care, supervision, program development and administration across multiple settings—is also former President of the New York State Psychological Association. [dr.richard.juman@gmail.com] Find him on twitter—@richardjuman

20 Tips To Help With Your Sobriety During The Holiday

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For some people in recovery, the holidays can be tough. But you can make it to January with your sobriety intact. You don’t have to let unfulfilled expectations, stressful family dynamics, or crazy in-laws threaten your recovery. Not to mention all those holiday parties.cookies2

You just need a bit of preparation. Start planning your sobriety strategy now, with these tips from The Recovery Book.

Sober Holidays Tip #1:  Remind yourself every single morning how good it feels to be sober (and how great it will feel come January).

Plant that thought in your mind right now, and think about it every morning. Stick a note on your bathroom mirror to remind yourself to think about it every day. 

Sober Holidays Tip #2:  Keep your expectations realistic, so you don’t set yourself up for an emotional letdown. 

Getting sober doesn’t mean life is instantly perfect. Other people in your life probably haven’t changed, and many of the conflicts that crop up at family reunions will doubtless crop up again. Accept it, roll with the punches, and rein in the urge to manipulate everything and everyone. It will be enough for you to take care of and control yourself.

Sober Holidays Tip #3:  Plan activities other than sitting around and gabbing.

In many families, getting together for the holidays means sitting around and drinking. Investigate other options now. Movies, museums, holiday concerts, skating, walks, sledding, sports events can all help fill the time and limit stress. If weather keeps you inside, suggest activities that will keep everyone busy and focused, such as decorating holiday cookies, board games, or old movies.

Sober Holidays Tip #4:  Limit the amount of time you spend with relatives who make you crazy.

If everyone is gathering for the holiday, including your brother who drinks like a fish, plan on an overlap of just a day or two. If he arrives on Christmas Day and stays a week, you can arrive a couple of days before Christmas, help your hosts prepare, enjoy a quiet Christmas Eve, and leave the next day.

Sober Holidays Tip #5:  If you’re traveling, go to meetings wherever you are. 

Find a meeting long before you get there. This will give you the booster support shot you’ll almost certainly need—the chance to say, “Sure, I love my family, but sometimes they drive me up the wall,” or to talk about whatever else it is that almost drives you to drink.


Sober Holidays Tip #6:  If the holidays mean visiting your old hometown, take time to see old friends you enjoy; avoid those you used to drink or use drugs with. 

Make plans now for how you’ll occupy your time while there, so you don’t find yourself with time to kill and fleeting thoughts of visiting the people who are still drinking or using.

Sober Holidays Tip #7: Remember what Recovery Zone you’re in.

If you’re following the Recovery Zone System, remember where you are in recovery. If you’re in early recovery, the Red Zone, you are bound to be a bit shaky. Don’t push yourself or leave yourself open to temptation. It’s okay to have a quiet holiday season.

Sober Holidays Tip #8  Do a Recovery Zone ReCheck before the holidays get started.

Think about the events coming up in the next few weeks. What situations could possibly set you on the road toward relapse? Seeing your ex-husband at a party? Having a fight with your mom? Having dinner with friends who drink? Make a plan now for how you will deal with these events; maybe you’ll go to some extra meetings before you travel, and plan to call your sponsor or a fellowship friend if anything does happen. Or maybe you’ll investigate online meetings now, before anything happens, so you can go to a meeting at a moment’s notice. Remember, it’s okay to retreat to an earlierRecovery Zone for a few weeks.

Sober Holidays Tip #9:  If you’re flying and feeling vulnerable, ask for help.Sober Holiday Tips

Planes don’t have “no alcohol” sections, so the person right next to you might order something alcoholic. What do you do? Ideally, fly with someone you know, someone who knows you are in recovery and will avoid drinking during the trip. If you’re flying alone and feeling vulnerable, explain your situation to the flight attendant. Ask if he can help you change your seat if anyone next to you orders anything stronger than tomato juice. Swapping seats is almost always possible. If you do get stuck next to a drinker, close your eyes and meditate. Put your headphones on and zone out to music or a meditation recording, or watch the movie. If you have Wi-Fi on the plane, contact a friend in recovery for support.

Another idea: If you worry you’ll be tempted to stop at a bar on the way to the airport or inside the terminal, have a friend or your sponsor drop you off at the airport and then stay in touch with you via phone, text or video chat until you get on your plane and the cabin door is shut.  

Sober Holidays Tip #10: Plan your own celebrations.

If you aren’t going traveling for the holidays, plan to celebrate with local AA or NA friends. If you haven’t been invited, do the inviting yourself. Follow old family traditions or start some of your own.

Sober Holidays Tip #11: Take it easy!

Get plenty of rest, watch what you eat, get your usual exercise, and take time for meditation. Maintain your recovery routine as much as possible.

Sober Holidays Tip #12  Don’t romance the drink or drug.

If everyone starts talking about the “good old days,” leave the room. You don’t want to start thinking about your drinking or using days. That can lead to preoccupation and obsession, and then to cravings. Keep your focus on your life right now, your life in recovery.

Sober Holidays Tip #13  Be very careful about what you eat and drink.

Alcohol doesn’t come only in a glass or a bottle. It can come in bowls and plates, too. And what you don’t know can hurt you.

One reason, of course, is that even a small amount of alcohol can trigger a relapse. How much does it take? A tiny drop? A small glass? There is no definitive answer, so it’s best to avoid all alcohol and keep your risk as low as possible. Another reason is the psychological risk: the taste plus the “thrill” of knowing that you’re consuming alcohol could turn on a compulsion to drink. Remember, the addiction is in the person, not the substance; it’s critical to stay away from that slippery slope of guessing what might be risky for you.

Sober Holidays Tip #14 Bring recovery reading when you travel.snowflake2

Get ebook versions of The Big Book, and other recovery literature on your phone or ebook reader before you leave town.
Download some inspirational recovery talks as well.

Sober Holidays Tip #15 Practice TAMERS every day.

Don’t let up on your brain healing activities. PracticeTAMERS every day:

  • Think about recovery, Talk about recovery
  • Act on recovery, connect with others
  • Meditate and Minimize stress
  • Exercise and Eat well
  • Relax
  • Sleep

Sober Holidays Tip #16  Make a plan for dealing with cravings.

Write up a list of what works for you: calling someone, reading recovery books, a quick workout at the gym, prayer. Think about what has worked for you in the past, and be sure you are ready with some solutions.

Can’t think of anything? Try to stay sober for just one minute. Then two minutes. Then start doing something (wash the dishes, read the news), and set your alarm for five minutes. When you’ve managed to get through five minutes, try for ten. Keep increasing the time. Tell yourself you only need to focus on not drinking right now, this minute, this hour, this day.

Sober Holidays Tip #17  Remember that being in recovery doesn’t mean instant heaven or a perfect life.

Coming to grips with the idea that sobriety is not instant heaven is an important step in recovery. Most people with addiction expect their upside-down world to immediately turn right side up. That rarely happens. If you’ve been misusing alcohol or drugs for a while, your brain may need several months or even longer to set itself right. Give yourself time to build a happy new life.

Sober Holidays Tip #18  It’s okay to tell people you are now in recovery.

There is a lot less stigma these days to being in recovery. Nearly everyone knows someone who is in recovery and very open about it. It’s your choice whether or not you want to tell people.

One good reason to be open about it: If your friends don’t know you’ve given up alcohol, they may lead you into temptation without intending to.

Another reason: When you let it be known that you don’t drink, you offer support and encouragement to others who are thinking about sobriety but are afraid to take the leap. You just might be the catalyst that gets someone else started on recovery.

Sober Holidays Tip #19  Make a plan for staying sober at parties. 

Decide in advance that there’s no way in the world that you will drink or use drugs at the event. Ask for help from your Higher Power, because you may need it. Know and rehearse exactly what you will say if someone asks, “Would you like a drink?” or “Want to do a line?”

Sober Holidays Tip #20  Stay sober at the party: Serve yourself.

If you can, bring your own water bottle or glass full of soda, so you don’t even have to go near the bar. If you don’t bring your own, when you arrive head straight to the liquid refreshments and help yourself to a safe option. Keep your beverage in your hand for the rest of your time at the party (refill as needed). That way you won’t have to keep turning down offers of something to drink. People won’t be asking you and unknowingly tempting you. If you set your drink down while dancing or when you step into the bathroom, get a new one when you return. Don’t take a chance on anyone having accidentally switched drinks or good-naturedly topped yours off, or even worse, slipped a drug into it.

What Genetics Have to do With Addictive Tendencies


The problem of addiction has long baffled doctors and medical researchers. This has led to the stigma all addicts face today that tags them as liars, cheaters, and thieves. Addicts often find themselves facing abandonment, pain, loneliness, and the inability to find a permanent solution to addiction. This is all starting to change as addiction is now being seen as an illness. Scientists have discovered that addiction is closely related to the malfunction of the prefrontal cortex of the brain. This part of the brain controls the pleasure system and when it is exposed to drugs or alcohol, the dopamine levels become abnormal resulting in cravings. Medical research has also been able to prove that genetics can play a role in the tendency of a person to become an addict. There are risk factors like mental illness that can increase the chances of a person becoming an addict but at the same time, mental illness has a genetic factor. Thus, this would explain why chronic illness runs in a family. Scientists explain that the brain’s prefrontal cortex genetic make-up is inherited but this does not mean addiction is a certainty or that a person who comes from a family where there is a history of addiction is doomed. In addition, while this area of the brain can never completely heal after being exposed to chemical substances, abstinence can go a long way in providing a safe and healthy life for a former addict. However, they stress the need for the addict to seek professional treatment that can provide a safe environment for medical detox and an effective foundation to prevent relapses.




Overcoming the guilt and shame that you feel from a relapse

First of all you have to realize that guilt and shame are huge drivers of addiction. So if any addict or alcoholic is feeling guilty or shameful about something then that, in itself, is a trigger to drink and self medicate. No one likes to feel ashamed of what they have done–we would all like to forget these things and move on from them. And what better way to forget than to self medicate to the point that we no longer feel shame or guilt about it?

If you drink enough alcohol then eventually it eliminates your emotions. Your feelings. The things that you feel inside, the anxiety, the frustration, the shame, or the guilt. All of that stuff goes away if you drink enough alcohol. That’s a fact, and it is a huge driver of addictive behavior. We don’t like to feel those unwanted emotions.

Now the problem is that when you come to the next day after drinking to excess, your problems are still there, the emotions and feelings resurface, and in many cases they are even worse because now you have the guilt of heavy drinking on top of them. So it becomes a vicious cycle that is very difficult to break free from.

What is the solution to this vicious cycle? One method is to simply “give yourself a break.” Realize that you are just doing the best that you can, and that you need help. You can’t overcome all of your problems alone, by yourself, without any help at all. And that is OK. You have to become OK with asking for help or you are never going to be able to overcome your drinking problems.

At some point the struggling alcoholic realizes that they need to sober up “for good.” At this point if they happen to relapse then the guilt and the shame that they feel from it is enormous. If they are active in a recovery community such as AA then they feel all kinds of pressure to maintain sobriety in front of their peers. So knowing that they have relapsed and have to go back to the group and confess can be overwhelming to some people. They either confess and get relief from doing so, or they hold it in and let the situation create even more shame, which then fuels more of a need to drink. Again, it is a vicious cycle if you are not being honest with yourself and with others, continuously driving you deeper and deeper into your addiction.

One solution: Take positive action to correct your biggest problem in life right this second!

Let’s talk about solutions.

Anyone can start to overcome the guilt and shame of addiction right now, this very second, simply by making an internal decision.

This decision, when you first make it, is not going to affect anyone else. It will only affect you because you will know that you are serious. Think about how many times the typical alcoholic or drug addict has “cried wolf,” telling themselves and others that they are really going to quit this time.

But when you make this decision internally, to yourself….when you make this special agreement with yourself, you will know a new peace about yourself.

This can only happen at the moment of true surrender. When you finally decide that you are sick and tired of fighting against the disease.

This is a moment where you overcome shame and guilt. You transcend those negative feelings because you make a special agreement with yourself.

That agreement is simple: “I am going to get help.”

You need to make a simple agreement with yourself that you are going to go get help.

Now keep in mind that there is only one time that you can ever do this, ever. That time is……Right now.

So you might be thinking to yourself: “Well obviously that is not true, because I might decide to keep drinking for a few more days, or a few more weeks, and then I will decide to get some help at that point, and therefore I would have made the decision in the future.”

And you would be partially right in that thinking. But you are also pretty much wrong too.

Because you have to realize that in a few days or a few weeks, you will still be in the same situation. And the time, then, will still be “right now.” You can only make that decision to get help in the present moment.

Think about it: Haven’t we been telling ourselves all along that “we will quit drinking some day?”

Well, some day never comes. And so we continue to waste our lives in chaos and misery, never taking that critical step to get the help that we need.

That is because it is never the future. Ever. It is only ever…..right now.

You are here, right now, reading this. And so you can make a decision to get help right now, at this very moment, or……not.

But you can’t slate that decision to get help for the future. That is a myth. That is a lie that you tell yourself so that you feel a tiny bit better about drinking today. And “some day” never comes, and you continue to drink until it becomes years, even decades later. Many alcoholics waste their entire life in misery, telling themselves that they will get help “some day.”

Not good enough.

If you want to make a difference in your life, then you have to realize that this can only happen in the present moment.

The only way that you can make that special decision inside of your mind is to do it RIGHT NOW.

You can’t make that decision in the future. Deep down you realize this. Because you have tried that before, and all it leads to is more drinking, more drugs, more chaos and misery.

You can only ever get help in the present moment.

And what does that look like, asking for help? What is the process?

Reach out. Ask for help. Call a help line. Ask someone who cares about you and loves you. Go to inpatient rehab. Go to an AA meeting.

That is what it looks like to surrender and ask for help. And we can talk about it all day long, but the fact is that you just need to do it. You need to get real with yourself, step up to the plate, and swing. Ask for help right now, today, this very moment.

If you want to overcome shame and guilt in addiction then you have to stop doing things that make you feel guilty and ashamed. Pretty simple. And there is no magic wand to be waved, you simply have to sober up, start living right, and the good feelings will follow naturally. Good living leads to good emotions.

If you go to rehab they can show you how to live well. It’s not too difficult actually–again, it’s all about following through. You just have to decide, and then go do it.

How your story becomes more valuable through adversity and failure

Is shame and guilt always a negative thing? Is it ever helpful in any way?

On the one hand, we never really want to seek these emotions out. They aren’t helpful to us in the present moment while we are experiencing them.

But we all experience them, and they can serve us in a unique way. Because then we can share our experience with others, and that might help them to get clean and sober.

In other words, no matter how screwed up your life has become in addiction, you will see one day how that chaos and misery can help another person.

How? Because you share your story with them. You share your experience with them, including how you overcome those negative emotions. How you finally conquered your shame and guilt. How you found hope and were able to turn your life around.

And in doing so you will see that your experience can help others. The failures that you may have had in life do not go completely to waste. They become a part of your story which can then inspire and teach other people.

So in a sense, shame and guilt, while definitely qualifying as being negative emotions, can still have some benefit to us in the bigger picture. They are part of our story and the overcoming of them can then inspire other people to get sober themselves.

How your eventual sobriety will change the entire world

We have all heard the analogy of the pebble thrown into the pond, how it creates these vast ripples that fan out and reach all the way to the shores, how a tiny butterfly flapping its wings can create a huge storm on the other side of the planet.

The same is true when it comes to a person getting clean and sober. You become like that pebble that gets tossed into the pond, and all of the ripples that fan out from you are the positive changes that go on to impact all of those around you.

And it doesn’t stop there. If you become sober then you may raise an entire family while sober. Just think about the downstream effects that may have been prevented across several generations from just one person who raises their child while drunk and abusive. Think about how many families and children that could potentially affect over the next thousand years, just from one person drinking every day and creating chaos and misery for their children.

And instead they could sober up, find recovery, and prevent all of that misery from rippling down through the ages.

And it can be so much more than that. So much more than just the prevention of misery and chaos. For example, consider the person who gets sober in treatment, starts attending AA meetings, and then goes on to stay clean and sober for decades while sponsoring dozens of individuals. So one person gets sober, then they continue to help other people to get sober, while also teaching them how to teach others about sobriety. The phrase is “healed people heal people.” So once you sober up, you become an agent of change, and can have this positive effect on the world. You can make a huge difference in the lives of hundreds or even thousands of people.

Just think of all the relationships that are involved with just a single alcoholic. Just think of how many different people that alcoholic might encounter throughout the course of a decade. And they can essentially be in one of two states as they go through their life: They can be drunk (or a dry drunk) and creating pain, chaos and misery….or they can be in recovery, and spreading a message of hope to other struggling alcoholics and addicts. They are either part of the problem or part of the solution. They are either living in fear or they are practicing love and compassion. And so each person becomes like the pebble thrown into the pond, either spreading good vibes through their whole world, or bad vibes.

What some people fail to realize is that when it comes to alcoholism and drug addiction, it is an either or situation. No alcoholic is “sort of” sober. No alcoholic is “sort of” relapsed. Those are both blatant lies. We are extreme people, we alcoholics and drug addicts. Our disease is that we go to excess. Period. So for someone to suggest that we are in a state of moderation is ridiculous. We can fool ourselves sometimes in the short term–you may “control” your drinking for a few days, weeks, or even months. But if you are a true alcoholic then eventually the full chaos and misery will return. And so it is all or nothing. You are either living in the problem or you are living in the solution. There is never an in-between. Any middle ground is always a temporary illusion.

Denial is when you believe that you have found a middle ground. And eventually the alcoholic will always crash and burn, to the point where they can look back and say “I guess I was just fooling myself, I really am an alcoholic of the hopeless variety.” If you can admit that to yourself and be honest then you just might have what it takes to get clean and sober. That is the point of honesty that we must achieve in order to move forward in recovery.

The typical alcoholic is not putting a big enough value on their own sobriety, and for good reason–they believe that they will be absolutely miserable in recovery. I was terrified to sober up myself because I was afraid that I would be so unhappy without drinking every day. How would I be happy if I could not get drunk? Sobriety, I believed, would be miserable.

But eventually I had to admit that I was miserable in my addiction. I finally got honest with myself and admitted that I was miserable anyway, even while drinking as much as I wanted. I could no longer get happy. I used to drink a few and be happy and cheerful, but now I could drink excessive amounts of liquor and I was just miserable the whole time. Where had all the fun gone? This is how I broke through denial. I had to admit to myself that I was no longer happy in life, even when I was drinking as much as I wanted.

There had to be another way.

And there was. But I did not believe it at the time. Which was OK–I did not have to believe in recovery. I really did not think that going to rehab or AA meetings would ever make me happy. I thought that was a fantasy. Maybe going to rehab and AA will make some other drunk happy in life, but it will never work for me! Or so I thought. That is really what I believed, that I was not destined to be happy in life, that I was cursed to either die drunk, or just to live in sobriety and be miserable forever. But I thought that happiness was impossible for me. I was truly dejected.

And that was the turning point. From that moment on, things got better and better in my life.

And do you know why? Do you know what happened?

I surrendered. I gave up. I stopped trying to figure out how to be happy.

I repeat: I stopped trying to figure out how to be happy, and instead I asked for help.

You cannot chase happiness in sobriety and find it. That won’t happen. If you chase after happiness then it will remain elusive, just as it remained elusive to you while you were drinking.

This is because the solution is counter-intuitive. We find happiness in sobriety by helping others, eventually. It doesn’t happen overnight. It takes time to heal. It takes time for it all to come together.

So you surrender. You go to rehab. You ask for help. You go to AA. You go to therapy, groups, see a therapist. Do meetings every day. Get a sponsor. Work the steps. Read the literature. Push, push, push. It takes a whole lot of work and a whole lot of commitment.

And you have to dive in and face the fear. It is scary to get sober. No one wants to admit that, but of course it is true. Why do you think alcoholics continue to drink? It’s simple–they are too scared to get sober. They are too afraid to ask for help, to face the world sober, to face themselves sober and to acknowledge who they have become in life. We may start self medicating for a variety of different reasons, but the reason that we stay stuck is because we are afraid to change. It is fear that keeps people drinking.

No one wants to admit that. They don’t want to appear weak, so they will give you a million and one excuses why they keep drinking. They won’t admit that they are afraid of sobriety. But that’s what keeps them stuck.

And so there is no trick to this. The person just has to become miserable enough in addiction and get to the point where they no longer care about the fear of sobriety. You have to be so sick and tired of addiction that you just want it all to go away, at ANY cost. And that “cost” is to face your greatest fear, to face life sober, to give up your crutch of alcohol or drugs. That is the price that we pay for our sanity. That is the price that you have to pay in order to get your life back. You have to face your greatest fear head on. You have to dive right into the pool, right into the cold water, knowing that it just might kill you, and you close your eyes and grit your teeth and you dive in anyway. That is the leap of faith that you must make in order to get sober.

Because you don’t know if it will work. There is no promise that going to rehab will make you happy. Instead, you could drink again tonight, and get a tiny bit of happiness from that, right? And so the cycle continues.

Or you can dive in, ask for help, seek out treatment. Change forever.

Become truly free.

Learn to fly.

Doctors Opinion On The 12 Steps Get’s Totally Destroyed….. The 12 steps DO Work

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior.

This conclusion is consistent with the views of prominent organizations such as the National Institute of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Psychiatric Association (APA), and the Department of Veterans Affairs Health Care System (VAHCS), all of whom recommend patients’ participate in AA or similar groups to aid recovery.

Dr. Dodes begins his criticism of AA and related treatment by citing a 1991 study published in the prestigious New England Journal of Medicine. This paper studied the treatment of a large number of individuals with alcohol problems. Dr. Dodes notes in his book that compulsory inpatient treatment had a better outcome than AA alone. But what he fails to mention is that the inpatient unit is a 12-step-based program with AA meetings during treatment, and requirements to attend AA meetings three times a week after discharge in the year following treatment.

Importantly, too, when you compare the alcohol outcomes (average number of daily drinks, number of drinks per month, number of binges, and serious symptoms of alcohol use), AA alone was just as good as the AA-based inpatient treatment. Yet Dr. Dodes uses this study to argue that AA is poor while inpatient treatment is good — a bizarrely distorted, misleading and incorrect interpretation of the study’s findings.

Dr. Dodes then cites a review article from another prestigious entity, the Cochrane Collaboration, to condemn AA and 12-step treatment. The Cochrane group is considered by health professionals to be the “gold standard” of good scientific procedure in its series of reviews. The article reviewed 8 studies from 1991-2004, comparing AA and 12-step treatment to other approaches, such as cognitive-behavioral relapse prevention therapies.

He concludes from this important paper that AA and 12-step treatment were ineffective. However, the study actually concluded that AA and 12-step treatment were shown to be as effective as anything else to which they were compared.

Perhaps not surprisingly, given his apparent agenda, Dr. Dodes doesn’t acknowledge the more recent randomized controlled trials of addiction treatment (that is, studies in which individuals with addictions were randomly assigned to different treatment approaches, comparing outcomes. Seehere, here, and here. Such studies are considered the most reliable sort of research.) These studies show that 12-step treatment improves outcomes by up to 20% for as long as two years post-treatment via its ability to engage patients, and also tends to produce much higher rates of continuous abstinence than other forms of treatment.

Finally, in the largest randomized controlled study of treatment for alcohol use disorder ever undertaken (Project MATCH), which he does mention, he fails to state that compared to the cognitive-behavioral and motivational-enhancement treatments included in that study, the 12-step treatment had more than double the number of patients who were continuously abstinent at one year after treatment and about one third more at three years after treatment.

What he does not mention: cost or access to care

Dr. Dodes fails to mention cost. Unlike psychoanalysis and other treatments, AA is free, and can be accessed almost anywhere at any time in the United States and many other countries (notably at high-risk relapse times when professionals are not available like weekends, holidays, and evenings.)

In fact, studies published in prestigious peer-reviewed scientific journals have found that 12-step treatments that facilitate engagement with AA post-discharge can not only produce about one third higher continuous abstinence rates, but also 64% lower health care costs compared to cognitive-behavioral treatments.

With the current pressure to configure a leaner and more cost-effective health care system, it is these kinds of double bonus effects that we are looking for.

What he says: 12-step programs are no better than doing nothing.

In addition, Dr. Dodes then goes on to try and make the case that 12-step treatment for substance use disorder is no better than doing nothing; he’s apparently implying that if we actually just stood back and waited, people with substance use disorders would overcome addiction at the same rate as our current best efforts. Presumably, his own approach to addiction treatment would work best? Unfortunately, his own method, promoted on the air and in his book, has not a single scientific study to demonstrate its effectiveness.

What he says: 12-step programs are no more than “religious” efforts that reinforce powerlessness and helplessness

Dr. Dodes’ book and comments are so far off the track of scientific research that he doesn’t realize that for the past several years, the addiction research field has moved beyond askingwhether AA and 12-step treatment works, to investigating how and why they work. We have now discovered that the reason why 12-step based interventions so often do better than others is that they engage people with groups like AA, which increase people’s ability to cope with the demands of recovery, and foster critically important social network changes within the communities in which they live every day.

For some, AA also has been shown to work by increasing spirituality, which helps people reframe and take a different viewpoint on stress, such that instead of being seen as a negative it becomes viewed as the fertilizer that fuels personal growth.

Dr. Dodes complains that AA’s focus on admitting powerlessness over one’s addiction is a step in seeking a “higher power” and he interprets this literally as seeking God. For some, this is true and helpful. For others, particularly those for whom spirituality is not appealing, it is seeking help from the AA fellowship (for some “GOD” can stand for “Group Of Drunks, or ‘Good Orderly Direction’), and acknowledging that you cannot solve the problem alone; you need what Carl Jung called “the protective wall of human community.” Strength comes from assuming personal accountability and responsibility to a group, your AA sponsor and, most importantly, to yourself. This process empowers individuals to make the changes needed for recovery.

What he says: Genetics does not play a role in addictions. They are not diseases.

In a blog on the Dodes webpage, there is an assertion that genetics has no role in addictions. This assertion once again contradicts scientific evidence. Research demonstrates that about half of the risk for addiction is conferred by genetics. But the environment is critical too. Like many diseases, the condition is caused by a personal biological vulnerability coupled with environmental exposure and experiences.

In summary, while claiming to “debunk the bad science behind 12-step programs” Dr. Dodes instead reveals a selective and superficial review of the research, at times misinterpreting the studies that he uses to support his own assertions. From a clinician who professes to care about individuals suffering from addiction, Dr. Dodes’ conclusions are not only incorrect, they may have grave consequences.

For the families who have a loved one struggling with addiction, life is beyond tragic. Nights are sleepless while many wait for the proverbial shoe to drop. Will someone be killed by your son, daughter or spouse getting behind the wheel? Will you get the often-awaited call in the middle of the night that your child was found dead in her apartment? We know these stories. We hear them on the news daily.

What can we do to prevent the scourge of addiction? And what can we do when it appears in a family member? Surely we all want a magic bullet. But we also want care that is based on sound scientific research and evidence-based treatments. There are no cures. But there is hope for recovery, sobriety, and, while AA and 12-step treatments are not cure-alls themselves, research demonstrates that they are some of the most effective and cost-effective approaches to addressing chronic diseases of addiction in our society.