Addiction 101

Observations of an Alcoholic

You may have noticed in my bio that my intent when starting this space was to write at least occasionally on addiction and specifically alcoholism. I’ve never gotten around to it for a variety of reasons but largely because I really didn’t know how to approach it. This past week I had an EMAIL exchange with a delightful young lady who happens to be a subscriber. She urged me to share whatever my experiences have been because you never know who out there might be impacted positively. With my readership being rather meager (and that’s a charitable characterization) I don’t know that the current reach would make any difference. But if even one person is able to avoid what I’ve lived the last twelve years then it’s worthwhile. So for an initial offering on this subject, I’m going to relay some of the things I’ve learned that I believe to be paramount in either recovering from or circumventing the pit of addiction altogether. We’ll do it stream of consciousness style with bullet points.

• If there is anything you read in this post I want you to take deadly serious it’s this: You are going to be told at AA, NA, in rehab, at therapy, even by friends and family that there is no such thing as “rock bottom”, that things can always get worse. Let me tell you unequivocally that advice is FALSE. Now within the spirit of taking rock bottom literally, yes there is an unlimited regression all the way to a grave. But I absolutely assure you the time will come that you’ve dug so deep you will find yourself utterly unable to answer the bell in terms of employment and living any semblance of an autonomous life. When that time comes and there is no possibility of improvement whatsoever, how much further rock bottom goes is immaterial. I promise you this is true and it will come much sooner and at a much younger age than you would think.

• Let me preface this by saying as a whole, Alcoholics Anonymous is a fabulous organization. The number of lives and families saved by it’s principles are probably without number especially considering for many years there was no alternative treatment and for many that remains true. That said, I never found the meetings or the sponsor structure helpful in any way. I could write an entire post why that is (and maybe I will) but the heart of the matter is that for a socially awkward person as myself the group dynamic is a turn off. On the other hand, I have found one on one therapy to have great value every time I’ve tried it which checks out in relation to my personality. I am not in any way discouraging anyone from trying it out but go in with your eyes open with the understanding it’s not necessarily a blanket panacea for everyone. I should also add the AA Big Book is an essential tool. If you don’t have a copy I would urge you to pick one up. That thing was written almost 100 years ago and I guarantee you will be left in astonishment by the testimonials at minimum. You’re going to read those and will be nodding your head saying to yourself, “That’s me!”

• The only thing I know about the lure of street drugs is what I’ve been told in rehab. I’ve never even seen things such as crystal meth, a heroin needle, or even cocaine. If someone brought out an amber bottle of something like oxycontin and threw a few back, I probably wouldn’t think much of it, even now. It could be Advil as far as I would know. So this is one where I speak from intuition and hearsay rather than experience. If I drew up a chart of substances listing from top to bottom which are most difficult to come back to “normal” from significant abuse it would look like this: Meth→Hallucinogens→Opiates→Alcohol. Keep in mind, I am specifically talking about which cause the most damage to cognition (from what I have observed) not which are most difficult to quit using which is a complete different kettle of fish.

• I did not list benzodiazepines (Valium, Ativan, Klonopin, Xanax, etc) above which are regularly employed to take the edge off of anxiety. That does not mean they aren’t dangerous. Those things weren’t commonly sampled by drug companies for a reason. And what samples doctors might have had on hand they were usually locked up so nurses and other pharma reps wouldn’t help themselves. Generally these are Schedule IV drugs meaning they have a low potential for abuse and risk. That doesn’t mean they have NO risk for such. If you are currently being prescribed any of the above and have a history of addiction in your genetic make up, meet with your doctor and get off of them. NOW. Figure out an alternative. An addict is an addict is an addict. If you can get hooked on one thing, you can get hooked on anything.

• If you are a problem drinker or alcoholic I have news for you—you aren’t addicted to the alcohol itself at all. Most people, including doctors, think of alcohol as a depressant specifically repressing neurotransmitters controlling speech, movement, and inhibitions. All of that is obviously true not requiring a professional degree to see but only eyes. But what really makes one develop a literal insatiable appetite is the tsunami of dopamine released in response to consumption. At the most basic level the alcoholic is dissatisfied with or finds regular life boring. And as the amount of alcohol taken in increases over time one eventually becomes incapable of accepting life on life’s terms. Worse, that life the alcoholic finds repugnant is only going to worsen as decisions made and drunken actions taken began to multiply complications geometrically. Dopamine “rewards” the user with an alternate reality. One where the drunk is strong and courageous rather than the pathetic and weak reality. Trust me—you are addicted to dopamine not Captain Morgan.

• Hangovers mean different things to different people. For me, the nausea and dehydration was no big deal but the earthquakian headaches were beyond tolerability. So this is tricky but something to be aware of. In my early 30’s I stumbled upon what became a foolproof hangover elixir at a pharmacy OTC. I don’t know if it’s still sold and don’t want to advertise the brand to give you any ideas. But around 2011 I found myself out of these little helpers and in a place where I couldn’t run out to acquire some. Obviously that wasn’t going to prevent my night of drinking from proceeding as I figured I could deal with the pain for one day. So the next morning after a night of my usual 10 oz or so of Bacardi I was pleasantly surprised to feel no pain. ZERO headache and really felt completely fine otherwise as well. This was roughly one year before I completely lost the plot and became no longer a functional alcoholic. I can’t say for sure if there is any correlation but if you reach the point you no longer develop a hangover after a night of excess I would suggest the possibility that it is very, VERY bad news.

• If you are considering rehab there are a few things I would like to impress on you. I have done a number of stints both of the 30 and 90 day duration. 1) A 30 day rehab is not going to do you much if any good. It’s just not long enough to even come close to altering your habits. I can’t say there is no value as you at least won’t be using for a month. But that will be the extent of your benefit. 2) Even 90 days is insufficient. Most addiction specialists believe 90 days is the absolute minimum required and consider it just baseline recovery. In a perfect world, one full year in a controlled environment would be ideal. Few of us possess the economic security for that. 3) I have been to one excellent facility and one awful one. In neither case was I any more “cured” than the other. Your frame of mind is the most important factor regardless of the quality of care. But two things are mandatory for success—A) You have to “work” your program while there with a daily if not hourly commitment of continuance once released. B) You MUST recognize that you are an addict and cannot control your using. If you could control it, you wouldn’t be there. Too many folks (me for sure) go into rehab thinking it’s a timeout. In other words, you think going back to “normal” drinking is a possibility. I assure you it is not. Use of your drug of choice cannot be an option on any level.

• Another thought on rehab—It is estimated that 60% of addicts relapse while in recovery. AA touts a success rate of 75% for those who stay in the program. I take a dim view of any of these statistics personally. But whatever the number is you’ve got a fight on your hands once back in the real world. Aside for the issues mentioned in the above bullet point here is the reason: In rehab you are living in a controlled environment. It’s certainly not prison but the effect is similar. Your meals are prepared for you, your schedule is set for you, you don’t have access to substances to use even if you want to. So the result is an antiseptic, simulated life. The idea is to reestablish normal day to day habits which is mandatory for sure but ultimately it is theatre. Crucially, whatever mess you’ve made of your life is temporarily not in play. Thus, you don’t have to think about it or deal with it (as much at least). The day you are released it’s all on you again. And for a lot of folks the management of what remains a deplorable situation (albeit often self created) is completely untenable. And so the easiest thing to do (by a fucking mile) is to get drunk or high so you don’t have to think about it. It’s a helluva carousel to get off of.

• Once you decide on a sober life, whether in the aftermath of rehab or not, your home environment will dictate your success at a nearly 100% correlation rate. If you are separated from your spouse and family, go home. So long as that spouse is also sober of course. Beg, plead, pray, whatever it takes. If you were alone previously and go back to isolation you will be drunk within a week I guarantee you. No other factor will impact your sobriety like a clean, supportive, positive family home. Absent this you will fail. Period.

• Alcoholism (addiction) has been considered a disease by medical professionals for quite a while now. I’ve seen polls in which up to half of Americans do not buy this explanation presumably still considering it a character flaw. Personally I don’t consider it either one but rather a genetic mutation, which granted fits more in the disease category. Like anything there are layers of nuance. For example, the vast majority of adults are able to drink alcohol in a responsible manner. Alternatively you will not find any meth or heroin user that has a hit at the weekend tailgate and then abstains for days or even weeks at a time. Estimates are that 8% of the male population and 4% of women abuse alcohol. To draw a stark picture, go into your average kindergarten class of 25 and two of the little boys and one girl are doomed to alcoholism if they ever take a drink. There is no test to know what bucket one fits in ahead of time. The only safe harbor is lifelong abstinence which sounds great but is only an idyllic notion. Which means the majority of people are at the mercy of the gene pool roulette wheel.

• I would bet most of you reading this believe you have a notion of what is involved in an alcohol detox. For the most part, I guarantee you don’t. First of all an overly indulged day at the tailgate or in your backyard barbecuing does not require a detox the next day. That is a hangover as discussed. Nor will daily drinking at the beach or on a cruise ship for a week necessitate extraordinary recovery measures. It’s important to note that of all abused substances only alcohol withdrawal can actually kill you. From what I have been told, opiate cessation is the most painful yet it is 100% survivable. What levels of alcohol require literal detoxification? I have had two week stretches and a few times up to a month drinking as much as a handle (that’s about 60 ounces or two “fifths”) of bottom shelf vodka every day. That’s with almost no food and very little other liquid. Coming off of that is not for the faint of heart. I’ve experienced this well over a dozen times and only once under medical supervision. Point blank, I’ve been lucky. And be assured it gets worse every time. The last time I found myself in that position was well over a year ago and I’m convinced I wouldn’t have lived one more day had more vodka been available. This ain’t no joke people, If you think it can’t be you, think again.

• The first time I drank was during my senior beach trip in 1989 at Myrtle. I can remember the warm feeling coursing through me to this day. I was hooked immediately although I didn’t know it. From that point I can count on my hand the number of times I had just a few beers. I’m not talking blackout but I was drunk well past just a buzz almost every time I drank from that point forward. Business meetings were a particular problem. You are out there in Vegas or NYC with unlimited supplies of alcohol that the company happily provides. I would sit there and kill one after another and be in a fog the whole next day when I needed to be at my best. Seemed to me that’s what everyone was doing. No, no they weren’t. It was only me and a few others who are probably in no better shape today than I am. If your own drinking habits resemble the above it is going to catch up with you eventually. I am telling you.

I don’t know if anything was accomplished here but hopefully this will find its way to someone who can benefit. I think in the end you need to be sure of one thing—the day will come where you will make enough mistakes that God will refuse to bail you out. At that point you will be in a position where you can’t alter the past or have a path to improving the future. So the easiest thing (by far) is to self medicate with drugs and just stay out of reality on a mental plane. At its core, addiction is a manifestation of narcissism. If you spend time worrying about others as opposed to yourself, the rewards you seek will find you.

Jay’