Hitting bottom

July 1, 2009 11:33 AM

On 200 mg a day of baclofen, in an important meeting with several associate deans of my college and three new department chairs (I was made chair of my philosophy department just a few weeks before I tried to commit suicide), I fell asleep with my head on the conference room table and, for 40 minutes, everyone was too embarrassed to wake me. Somnolence is the most obvious and inconvenient side effect of baclofen. I reduced my dosage to 100 mg a day, and started taking it only at bedtime. A few days later, a colleague asked if I had changed my medicine. ‘Yes,’ I told her. ‘Why do you ask?’ She is German, an analytic philosopher, and therefore very direct: ‘You are drooling less than you were.’

My Life as a Drunk is a searingly honest essay by novelist and philosophy professor Clancy Martin about his experiences with alcoholism, AA, valium and baclofen.
posted by Kattullus (46 comments total)

You may remember Clancy Martin's entertaining essay about how he almost became the world's leading dealer in counterfeit Fabergé eggs.
posted by Kattullus at 11:35 AM on July 1, 2009 [2 favorites]

This is DEFINITELY the kind of guy you want as a philosophy chair. Seriously. This is a guy who lives the shit.
posted by spicynuts at 11:42 AM on July 1, 2009

Alcohol is magical. Baby steps to Hell, indeed.
posted by Xoebe at 11:54 AM on July 1, 2009

Great read. Thanks.
posted by slimepuppy at 12:04 PM on July 1, 2009

That was a really interesting, engaging read. Thanks for the post.
posted by Artful Codger at 12:04 PM on July 1, 2009

... jinx!
posted by Artful Codger at 12:05 PM on July 1, 2009

Holy shit, I was just reading about baclofen, as I'm hopefully going to be getting a muscle relaxant for a pinched nerve I've had this past week. Looking to see more details on how they work and what they are.

Carry on!

P.S. Pinched Nerves SUCK! Don't get them.
posted by symbioid at 12:06 PM on July 1, 2009

"Baby Steps to Hell" sounds like a good name for a mixed drink, doesn't it? Like a shot of peach schnapps and a tabasco chaser?

Interesting article, although a little all-over-the-place trying to balance the clinical talk with the lifestyle anecdotes. The message I got out of it is almost that you can distract your body from addiction from a time just by giving it so many random pharmaceuticals that it doesn't know which way is up, not that any one of them is likely to be particularly effective.
posted by Riki tiki at 12:10 PM on July 1, 2009 [1 favorite]

When I entered alcohol rehab, the medical staff immediately put me on Serax (oxazepam), an anti-seizure withdrawal medication. They would even wake me every two hours during the night to administer another dose. For the first two days I was there, it was constant injestion of this drug that made me hear the electricity, feel the lights, and walk into walls.

They called the beds in this section of the treatment center "detox." Hell, talk about a misnomer. They detoxify you from alcohol by screwing you up so bad with seizure meds, that you're literally stumbling from place to place. I was never so messed up on any amount of alcohol as I was on mass dose oxazepam.

After two full days of this, it just seemed to me that something wasn't right. I went to this place to get sober, not to get fried. So the next time I got an audience with the psych doc, I told him in no uncertain terms, "You're making me worse than I ever was out in the real world. This isn't why I came here." With that, my recovery began.

They immediately stopped the Serax, and all other medications for that matter. I was able to fully function in the group counseling sessions and I started going out with the group in the evenings to AA. The rest is history. I now have 16 years continuous sobriety. As a recovering alcoholic, I certainly welcome any new medical technology that can make recovery easier and provide more long-term effectiveness for unfortunate alcoholics. The skeptic addict in me, however, still worries about replacing one drug (alcohol) with another.
posted by netbros at 12:25 PM on July 1, 2009 [17 favorites]

Bill, yes the Bill with all those friends, the founder of AA, advocated LSD as the cure for alcoholism.
posted by StickyCarpet at 12:30 PM on July 1, 2009 [5 favorites]

Thanks Kattullus, this was wonderful to read.

Especially because this Friday, I am celebrating one year of sobriety.

This morning, someone on Twitter quoted Frank Sinatra saying that he feels sorry for people who don't drink because when they wake up sober, that's the best their day is going to get. Without being judgmental - because drinking and sobriety are both different for everyone - I casually informed him that my absolute worst day sober is far better than my best day as a drunk.

A year ago today, I spent the entire day contemplating how I would kill myself. Should I step in front of the train? Should I walk off the overpass? Should I just simplify things and slit my wrists? The options were just overwhelming. And then the practical part of my piped up and said, "You've alienated yourself from everyone you know. There's nobody to watch your dog, and he doesn't deserve to starve because you are total failure." So I went home and drank and drank and drank. And then it was time for bed, and I lay there with my dog curled up next to me and said the only prayer that I knew how to say, "God - I don't believe you exist. Prove to me that you do, and please kill me in my sleep. Spare me the tomorrow that we both know is coming. Spare me the parade of horrors that my life has become." And then I fell asleep, and woke up, and did it all over again. But just once more.

In sobriety, I've been confronted by a lot of shitty things. My brother attempted suicide for something like the tenth time. My parents divorced. My sister has decided to marry an anti-gay, anti-intellectual troglodyte. I have been dumped. I had to dump someone. A friend was hit by a car while crossing the street. My landlord lost two months of rent and threatened to have me evicted. My student loans were sent to a collection agency.

But life is wonderful. Not the kind of wonderful that they make movies about. But it IS wonderful. It isn't bright and shiny like a new toy. It isn't euphoric like winning the lottery. And it isn't like the running over of love that you experience during the honeymoon period of a relationship. But it is just as great as all those things - in a subtle, awe-inspiring way.

Today, I wake up and go to work. I don't stink of alcohol. My head doesn't ache with the dull roar of last night's liquor. I don't sneak off at lunch to get a martini or two or three or how ever many I can down during the hour I'm given. I have friends. Friends whose names I can remember, and who I don't just see on Facebook. I have a job that I love and bills that I pay. I go to bars and parties and events and I don't embarrass myself and my company. My bank account is never overdrafted.

And the dog who saved my life by being the only reason I couldn't kill myself? He's great too.
posted by greekphilosophy at 12:30 PM on July 1, 2009 [292 favorites]

Major congrats greekphilosophy! Way to go.
posted by netbros at 12:37 PM on July 1, 2009

It's no silver bullet
posted by caddis at 1:03 PM on July 1, 2009

I liked this article. I was uncomfortable with this paragraph, though:

The crucial, and perhaps most helpful, point of agreement between the tragic and possession theories is that in neither account is addiction understood as a moral failing on the part of the alcoholic. While the AA view seems to smuggle moral blame into its account – the process of recovery is characterised as a moral process – the alcoholic’s problem, even when he relapses, should not be understood in moral terms. The one dominant theme of contemporary literature on the problem of addiction is that the alcoholic, the junkie, the crack addict, must not be accused. How they are to be helped is, as we have seen, a tricky business.

I know what he's getting at: it's senseless to 'morally blame' someone for something they have done if they couldn't have done otherwise. That's like blaming a rock for tripping you. This is also why we see abusive childhoods and mental retardation as mitigating circumstances: in a sense, such people have been robbed of agency by forces beyond their control. Like the rock, we see them from more as objects than subjects, and indeed their actions make more sense as a set of chemical reactions than as the choices of a rational and autonomous being: the lack simple predictive capacities and the impulse control that we associate with maturity.

However, I do think a species of 'amoral' blame applies and is helpful for thinking about these issues. Specifically, that nobody else can be held accountable for the alcoholic's addicition, and the only solution is to take this irresponsible and unblameable subject and turn him into a responsible and blameable one. It's not about whether the act was optional, nor about a metaphysical account of freedom and agency. Rather, it's simply a matter of attribution. That's what the 4th through 9th steps do, forcing the addict to think of herself as 'the one who did these things.' The way alcoholics do this is by 'taking responsibility' for their past actions, by willingly submitting themselves to blame even though they couldn't have, in the past, done otherwise. Then, they take this newfound responsibility and apply it to present decisions and future choices. I think of it as an 'educative' rather than 'merit-based' account of praise and blame.

Anyway, I wouldn't have commented except the guy is a philosopher, too, so I know the kinds of tricks he's especially tempted to play on himself and his audience when it comes to self-justification. Maybe I'll look him up at the APA smoker and tell him so in person.
posted by anotherpanacea at 1:05 PM on July 1, 2009 [4 favorites]

And the dog who saved my life by being the only reason I couldn't kill myself? He's great too.
posted by greekphilosophy at 12:30 PM on July 1 [8 favorites -] Favorite added! [!]

Thanks for sharing that, greekphilosophy. You too netbros. It puts a lot of things in perspective.
posted by Pantengliopoli at 1:07 PM on July 1, 2009

Also, does anyone else think it's a little weird for him to be writing an article about it only 90 days into recovery? Talk about pink clouds....
posted by anotherpanacea at 2:57 PM on July 1, 2009 [2 favorites]

Curiously enough, I am right now writing an article on baclofen for forthcoming publication, so I can't comment too specifically on it.

However, I did want to respond to this:

Specifically, that nobody else can be held accountable for the alcoholic's addicition, and the only solution is to take this irresponsible and unblameable subject and turn him into a responsible and blameable one. It's not about whether the act was optional, nor about a metaphysical account of freedom and agency. Rather, it's simply a matter of attribution. That's what the 4th through 9th steps do, forcing the addict to think of herself as 'the one who did these things.' The way alcoholics do this is by 'taking responsibility' for their past actions, by willingly submitting themselves to blame even though they couldn't have, in the past, done otherwise. Then, they take this newfound responsibility and apply it to present decisions and future choices. I think of it as an 'educative' rather than 'merit-based' account of praise and blame.

I find this problematic because there are many people with addictions who *overly* blame themselves and always have. This is one reason, I think, why women often find AA and the notion of powerlessness and confession and humility deeply problematic. We've been told all our lives that we are powerless-- and then blamed for it! We don't need to start "taking responsibility"-- our problem was that we thought we were responsible for everything and then tried to escape in addiction and *then* irresponsible behavior ensued.

When you work the steps voluntarily, you often come across people who share this view and will then support you in changing in the right direction. However, if they are forced on you in a treatment program, you can end up feeling blamed, shamed and hopeless-- particularly if they are telling you that the only way out is to confess in your treatment groups with people who may not feel safe to you and open yourself up for more public humiliation.

More self hate was not what I needed, basically-- and although I did find working the steps valuable in early recovery, I now think that the main thing that AA helps with is social support and encouragement and that its specific content, while sometimes helpful for some, can also be harmful for others.

However, there is a real problem with "holding addicts harmless" also. If you are not in control of your behavior, the state feels perfectly entitled to control it for you. So you have a disease that you can't control-- but we'll arrest you for the symptoms. Or, we'll forcibly treat you for your own good for as long as we want and in whatever humiliating and degrading fashion we prefer. After all, your "disease" is in control.

Truth is, addiction results in impaired-- not eliminated-- will. And that makes the question of responsibility extremely complicated. To make it more complicated, if you hold people responsible, they sometimes tend to become more responsible-- and if you tell them they are "powerless," they can become less so!
posted by Maias at 4:15 PM on July 1, 2009 [7 favorites]

I know what he's getting at: it's senseless to 'morally blame' someone for something they have done if they couldn't have done otherwise. ...However, I do think a species of 'amoral' blame applies and is helpful for thinking about these issues.

I don't get how it's matters whose fault it is. Whether the alcoholic made his own bed or was thrust into it, he's IN the bed now. Placing blame is a waste of time, whether it's self blame or blaming someone else. It's a sidetrack from the only important thing -- getting sober.
posted by grumblebee at 4:30 PM on July 1, 2009 [5 favorites]

To make it more complicated, if you hold people responsible, they sometimes tend to become more responsible-- and if you tell them they are "powerless," they can become less so!

I agree with this, but I still don't think it helps to debate PAST blame. What's past is past. If you want to tell an alcoholic she's responsible, tell her she's responsible for her recovery.
posted by grumblebee at 4:34 PM on July 1, 2009 [1 favorite]

Addicts and alcoholics do all sorts of blame-worthy things aside from actually abusing their drug of choice. I'm fine with not blaming anyone for the underlying condition, but if you're lying to and beating your spouse, falling asleep in committee meetings, attempting suicide in the same house your kid is sleeping in, and generally acting like an ass, there's some blame to share around. I'm willing to admit that Martin had very little control over his actions, but he's going to have to learn some, eventually, and that's what the 4th-step inventory and the 9th-step amends process does. Addicts and alcoholics too frequently fold all that bad behavior into the addiction, and then claim that they can't be blamed for it.

our problem was that we thought we were responsible for everything and then tried to escape in addiction and *then* irresponsible behavior ensued.

That's a different dynamic, but the effect is the same: fictional responsibility for impossible things serves to disguise actual responsibilities. It's the 'right-sized' self metaphor: not a big, megalomaniacal self, not a small, victim self, but a realistic self.

The anxiety relief model that Ameisen works out is certainly tied to this problem: capable agents need a certain amount of anxiety to stay awake and attuned to the world around them, but randomly being overwhelmed with anxiety leads to some pretty dangerous coping mechanisms.

By the way: this guy's a novelist, right? Is there any chance this is a hoax?
posted by anotherpanacea at 5:23 PM on July 1, 2009 [1 favorite]

This post is fantastic. Thank you.
posted by lunit at 5:34 PM on July 1, 2009

Great post. Thanks.
posted by MarshallPoe at 6:42 PM on July 1, 2009

anotherpanacea: By the way: this guy's a novelist, right? Is there any chance this is a hoax?

Even worse, he wrote his Ph.D dissertation on Nietzsche's theory of deception!

It seems very unlikely to me that it's fraudulent.
posted by Kattullus at 7:33 PM on July 1, 2009 [1 favorite]

In an old thatched barn, on an oak lined lane, in the middle of green fields with low stone fencing, is a pub. The pub serves roast beef on thick slabs of homemade bread, laden with butter and gravy. They pour cold German Lager and bright Australian wine to the jolly hordes sat on long wooden tables. The sound of clanking glasses and belly laughter entwine with smoke from the large wood fire, embracing the patrons with warmth and comfort.

In the male toilet above the cubicle is a small sign which reads: Alcohol is a great servant but a terrible master.
posted by Samuel Farrow at 8:04 PM on July 1, 2009 [4 favorites]

Alcohol is a great servant but a terrible master.

So it's saying that alcohol is a bit like a Roman emperor?
posted by Monday, stony Monday at 9:07 PM on July 1, 2009

A question to recovered alcoholics who feel life is 'wonderful'.
Can you compare your current feelings about life to how you felt before you were a drinker? I can understand sobriety being better than drunkenness, but has the experience of hitting rock bottom and bouncing back led you to a better quality of life than before you were a drinker?
I note in the linked article he describes the long term sober at AA as gray-skinned, eyes glazed and stinking of terror, which doesn't sit well with the notion of being happier than ever to be sober. Apologies if this is worded insensitively, it isn't meant that way.
posted by bystander at 1:26 AM on July 2, 2009

I don't think your curiosity is indelicately worded bystander - especially on the heels of the description of recovering alcoholics in the piece Martin describes alcoholics as people who have lost all expectation for their lives. And while Martin looks at that as a kind of pathetic thing, I look at it as an absolute relief.

My expectations for myself and the world around me were outrageous, and were responsible for the vast majority of my agony. I agonized over the fact that I didn't live the lavish playboy lifestyle that I was supposed to as a young, gay law school graduate living on the East Coast. My life was, after all, supposed to be like Law and Order - only with hotter sex and an iPhone.

But my life wasn't like that. It was far from that. I was unable to do simple things like buy groceries or get to work on time. Anything more than that was laughable. Today, life is wonderful because - not only can I do all those little things that make everyday life livable like walking my dog and eating the socially acceptable number of meals - but I have the potential for so much more. I wouldn't say that means I've given up my expectations. Rather, I think I've just gotten into touch with a healthier set of them.

(Related: There is a sort of literary value in painting AA meetings as somber places where people go to be serious and dour, where everyone sits sipping stale coffee, staving off the jitters until they can run outside and smoke. It's an archetypal image. Sadly, it's far from the truth. The AA meetings I have been to are full of laughter and joy, and people who are friends - not just a band of former hostages, gathered to relive their captivity with others who shared their experience. It is a fellowship of people who vacation together, brunch together, watch each other graduate and compete in triathlons, help each other move, and have parties with each other.)
posted by greekphilosophy at 4:40 AM on July 2, 2009 [11 favorites]

bystander, here is what my life has been like since I began recovery from alcoholism.
posted by netbros at 5:23 AM on July 2, 2009 [3 favorites]

Thanks very much—that was a terrific and thought-provoking read.

> By the way: this guy's a novelist, right? Is there any chance this is a hoax?

Jesus Christ. This place is depressing sometimes.
posted by languagehat at 7:10 AM on July 2, 2009 [2 favorites]

bystander, here is what my life has been like since I began recovery from alcoholism.

That was awesome, bro. It really is all about helping others.
posted by phaedon at 7:12 AM on July 2, 2009

I was an active drunk from 18 to almost 26, and I've been sober almost 13 years. I absolutely agree with greekphilosophy about the "worst day sober" concept. It's sort of hard to explain, but for me, the biggest change is the ability to respond to life as it is-- not what the drink makes me think it is. I'm no longer swinging between "OMG everything is awesome" when it's absolutely awful, and "OMG I wanna die" when I stub my toe. I can think, and plan, and act based on reality. I can process pain and trouble; I can enjoy the big and the small things about life.

Sober, I can look at the drinking years and admit that I wasted a whole lot of life; but I can also let the knowledge go, admit my failures of judgment... and stay sober. Drunk, I looked at the time I was wasting (and I KNEW I was wasting it) and I used it as yet another excuse to get drunk again.

Sober, I can deal with the bad times (such as my father's premature death, in a nursing home, thanks to 30+ years of drinking) without falling apart. Drunk, I would have used his death as-- you guessed it-- another reason to drink.

Sober, I can genuinely enjoy the good times, without the subconscious knowledge that at some point in the day, I'm going to pick up that glass, and start the whole miserable cycle of drink-drank-drunk. I have to deal with reality, every day, and even when it hurts, I'm grateful for the clarity.

re AA - I went daily to AA for two years; but with time, the local group stopped concentrating on sobriety, and became more about blaming others-- and increasingly, people were turning up not just drunk, but high. That's when I quit going to AA, and started seeing a counselor. Currently, the local group is made up of some pretty awesome people.

re power and powerlessness - I found that aspect of AA to be a huge relief-- for me, a turning point was realizing that not only did I have a responsibility to quit drinking, not only could I start taking control of my drinking, but I also had a right to sobriety, and by extension a right to a real, healthy life.
posted by ElaineMc at 8:16 AM on July 2, 2009 [8 favorites]

Jesus Christ. This place is depressing sometimes.

I hope you mean the US and not Metafilter. It's not like there haven't been plenty of false addiction tales in the last decade, and as has been pointed out, Martin is a specialist on deception and honesty, fiction and truth.
posted by anotherpanacea at 9:07 AM on July 2, 2009

That was really worth reading. Thanks!
posted by ob at 9:53 AM on July 2, 2009

That's a good dog.
posted by sciurus at 11:02 AM on July 2, 2009 [3 favorites]

I am 2 and 1/2 years sober as of yesterday. I am a better person. Not a good person, mind you, just better. But damn it feels good to be better though.
posted by milarepa at 12:07 PM on July 2, 2009 [1 favorite]

A question to recovered alcoholics who feel life is 'wonderful'.
Can you compare your current feelings about life to how you felt before you were a drinker? I can understand sobriety being better than drunkenness, but has the experience of hitting rock bottom and bouncing back led you to a better quality of life than before you were a drinker?

The question sets up a false dichotomy; I'm not choosing between life as a former addict/alcoholic and someone who never used. I'm choosing between the route I was taking, which led steadily, inexorably down to my destruction (if I was lucky) and the destruction of those I cared about (if I was not), and a life in which I have some chance of being the kind of person I actually want to be.

Part of the recovery process that's difficult for a lot of people is the realization that you've got to rebuild a life in which you've literally lost years, often decades, to addiction. No matter how smart or talented you are, those big holes in your resume, the botched attempt at a degree, the lack of references, the little (or big) criminal convictions, all that makes it incredibly hard to put a life back on track. These are the challenges that a lot of the people in those rooms are facing, and they don't go away easily. If they look a little grey-faced, well, hell, so would anyone.

Am I happier now than I was before I ever took a drink? I think so; I was 20, and really angsty, so probably. But that question doesn't matter, really. The question that matters is, am I happier now than I would be if I was still out there using?

And the answer to that question is decidedly, unequivocally, yes.
posted by MrVisible at 3:07 PM on July 2, 2009 [3 favorites]

Dude, thank you.
posted by njbradburn at 6:26 PM on July 2, 2009

Addicts and alcoholics do all sorts of blame-worthy things aside from actually abusing their drug of choice. I'm fine with not blaming anyone for the underlying condition, but if you're lying to and beating your spouse, falling asleep in committee meetings, attempting suicide in the same house your kid is sleeping in, and generally acting like an ass, there's some blame to share around. I'm willing to admit that Martin had very little control over his actions, but he's going to have to learn some, eventually, and that's what the 4th-step inventory and the 9th-step amends process does. Addicts and alcoholics too frequently fold all that bad behavior into the addiction, and then claim that they can't be blamed for it

I think it's absolutely commendable and helpful to take inventory and make amends-- I just happen to think it has nothing to do with staying sober for lots of people. If you are a person who hates yourself for being awful, however, doing estimable actions like making amends and avoiding future offenses will build your self esteem and that may help you stay sober. Or, it may not if you continue to be plagued by self hate and depression.

And this has a lot to do with the question asked about whether being in recovery is better than before "hitting bottom." First, I want to say that the concept of bottom is flawed: it's a restrospectively defined narrative turning point that makes a good story, but is immediately erased if you relapse.

Further, people often get into recovery when they are not at their lowest point at all. Why does this matter? Because "tough love" is based on attempting to force people to "hit bottom" and what that often does is make the addiction worse and sometimes kills them. It's certainly perfectly appropriate and sometimes necessary to kick an addict out of your life if he's hurting your or your kids-- but don't kid yourself that it's "for his own good." It might be or might not be, you can't tell.

Treatment providers who justify doing nasty things to addicts "for their own good" often wind up on power trips-- which is why tough love addiction programs often wind up as actual cults. And in fact the research shows that empathy is more effective-- and you can actually as a family member do empathetic interventions that avoid the pitfalls of tough love.

That said, when you first kick drugs (for me it was coke and heroin), life completely sucks and you go back to all the reasons you wanted to anesthetize yourself in the first place, only it's worse because you are in withdrawal, not just depressed and full of self hate. For me, someone with pre-existing depression and other issues, taking away the drugs brought all that right back. Fortunately, that stuff only lasts about 6 months and there are flashes of euphoria and hope.

12 step meetings helped by giving social support and showing me that I was not alone-- but I didn't really become stable and not insanely socially anxious and needy until I discovered antidepressants when I had 7 years in recovery and became so depressed I couldn't work. Since I am a workaholic first and foremost, that required action.

What the antidepressants gave me what was what had really addicted me to heroin: a sense of safety and comfort and a quieting of the voices that said 'everyone hates you, go away." On meds, I could socialize without being insanely clingy. True, I liked the euphoria of heroin and don't get that with medication-- but that didn't matter. What really hooked me was the safety and comfort, and that's why I still take my meds and do not look down on anyone else who needs any type of medication to maintain their recovery.

Am I happier than before? I'm certainly older and wiser and calmer and more experienced and better able to appreciate life, so yeah, I'd say so.
posted by Maias at 6:58 PM on July 2, 2009 [4 favorites]

(Related: There is a sort of literary value in painting AA meetings as somber places where people go to be serious and dour, where everyone sits sipping stale coffee, staving off the jitters until they can run outside and smoke. It's an archetypal image. Sadly, it's far from the truth. The AA meetings I have been to are full of laughter and joy, and people who are friends - not just a band of former hostages, gathered to relive their captivity with others who shared their experience. It is a fellowship of people who vacation together, brunch together, watch each other graduate and compete in triathlons, help each other move, and have parties with each other).

I am currently approaching my third week of sobriety and have been attending AA meetings daily, sometimes multiple times in a day. The folks I have met are some of the most accepting, welcoming and engaging people I have ever encountered. While I attend meetings in different cities, I have found them to be similar. The meetings are lively and there is a lot of laughter. There are tears as well. But most comforting is the mutual respect and compassion that we have for each other. My friends outside of AA are supportive (with varying degrees), but frankly, haven't a clue as to what I am dealing with. They also do not understand how important AA is to me at this time. The friends I now have within AA are friends I can see having for life, as the journey never ends and the support is always necessary.

My take, after reading the article, was that perhaps a combination of pharmas and therapy could be the most helpful. Most people who drink to excess are self medicating for one reason or more (as I was). Talk therapy helps immensely, especially with those of us who have maintained a privacy screen for most of our lives. When you talk, you hear yourself at the same time. The meds I take are for depression, a result of other things in my life that go part and parcel with drinking. Between the meds and the talk therapy, I am able to zero in on the issues that got me to this place.

I don't believe there is a "cure" for alcoholism, as sure as there is not a cure for cancer. Each of us is different, with different genetic makeup, structure, physiology, psychology, etc. How we deal with our problems is just as varied. What works for one may not necessarily help another.
posted by mnb64 at 9:04 PM on July 2, 2009

It's funny that you mention the problem of "the bottom" Maias, because I heard it once very succinctly explained by a young woman at a meeting. I'll paraphrase what she said, because it sounds better from that perspective:

"Every so often I talk to someone who has just come into the program, and they say to me, 'I feel dead inside.' and so help me god, addiction must make you a twisted individual because my first reaction is, 'Good. Then you have a chance.' Because until something inside of you has died, until your will to live has withered inside you, you don't stand a chance of beating this addiction."

All this talk that people do - of bottoming out after police chases and DUIs and spousal abuse and credit card debt and relapse after relapse after relapse - it's all a red herring. That isn't the part that matters. It is the dying inside that really makes people ready to take the first step. (Whether you are doing it as a part of a formal recovery process or not.) Until a part of you deep down in your soul has been irreversibly broken, you wont be ready to say, "You win, alcohol. You win." And that's what it takes to really get started.

When I heard her say that, I instantly thought back to my nightly prayer for death and knew that was what she meant. The best part was - my prayer was answered a year ago tonight. Something inside me DID die. And when I woke up the next morning, I was left with no other options. I could go to an AA meeting, or I could let the rest of me die, slowly and painfully. Every time over the last year that I have been confronted with alcohol or had fleeting thoughts of taking a drink, all I have to do is remember those days and nights when the only thing I wanted more than alcohol was to die. That's where my next drink will take me. And that is the one place I am determined not to go.

For a while, I was angry that nobody in my life (except one person who I only knew as a very casual acquaintance) had noticed my problem. My boss was supposed to send me off to rehab. Or my parents were supposed to fly in from Texas and sit me down to tell me they were worried about my drinking. My neighbor was supposed to find me passed out on the patio and slip me a concerned anonymous note asking me to get help. But it never happened. And it took me a long time to appreciate the fact that it didn't happen. Because if I had been shown tough love and been shipped off to AA without experiencing complete despair, I am almost certain I wouldn't have been ready to take the message seriously.

(On a completely unrelated note: it's so very strange for me to be discussing recovery in a back-and-forth manner. Every fiber of my being is screaming out against cross talking, even though I know those aren't the rules that apply here.)
posted by greekphilosophy at 9:15 PM on July 2, 2009 [6 favorites]

This thread represents some of the best of the internet. Even people not suffering addiction can find strength in the wisdom here. There are so many wise people on MeFi. There is something to learn every day.
posted by caddis at 9:31 PM on July 2, 2009 [1 favorite]

That was an amazing essay. Searingly human, full of interesting facts about alcoholism, and replete with little philosophical touches and sidenotes. For example, I liked this observation: "The more attractive a belief sounds, the more carefully it ought to be examined. (An interesting counter-example is a case like Othello’s, where the self-deceptive process leads one to believe precisely what one most wants not to believe. Jealousy often works this way.)"

Thanks for posting it.

Herbert Fingarette, the best contemporary philosopher of self-deception, has also written a book on alcoholism.

Huh. That's tall praise, and I haven't heard of the guy. It looks like he comes from a continental/psychoanalytic tradition. I'll have to get a copy of his book on self-deception and see what I think.
posted by painquale at 9:52 PM on July 2, 2009

What really hooked me was the safety and comfort, and that's why I still take my meds and do not look down on anyone else who needs any type of medication to maintain their recovery.

I've recently had some involvement with the UK's Randomized Injectable Opiate Therapy Trials -- in which intractable heroin addicts were randomly allocated to one of three different opiate maintenance therapies. Because it's a Randomized Controlled Trial, some people were allocated to optimized oral methadone treatment, some people to injectable methadone, and some to injectable pharmaceutical heroin.

This trial isn't using the model of the 'old' British System, in which people at the start of their treatment were given heroin scripts and as a consequence, many became progressively worse as a result of their treatment. Rather, it uses the model that's been trialled in several countries now -- Switzerland, The Netherlands, Canada, Germany, etc. in which the drugs are dispensed and administered under medical supervision in a closed centre, twice or three times a day, 365 days a year.

To qualify for enrollment in the trial, you had to be the worst of the worst. People with an extensive history of failing in other treatments. While talking to some of the patients in the trial, I was struck by just how many of them had repeatedly 'reached bottom', how often they'd gone desperately off to rehab, enrolled in self-help fellowships, wanted to die -- and yet nothing had had any real impact.

12 step groups work really well -- for the people that they work for -- but there's a huge group out there that they don't work quite so well for. And that has nothing to do with their failure to embrace the philosophy or refusal to work the steps. Talking to these people, I was left with an overwhelming impression that these people have been discounted and written off for years -- not because they hadn't tried or because they weren't serious about their recovery -- but simply because their condition was more severe than that of many people, and they often lack the personal resources necessary to help build and sustain recovery.

Because when they were enrolled in the right treatment for them, the improvements were overwhelming. Although the British trials haven't reported yet, I'd be extremely surprised if they didn't show exactly the same improvements as have been reported everywhere else that this particular therapy has been trialled.

Nevertheless, the moral aspect to addiction treatment means that many people still feel dubious about a treatment that relies on medication. I was at a meeting of the Royal College of Psychiatrists a couple of weeks ago, where the chief investigator at the Canadian trials was talking about his work when somebody raised an objection along these lines, and he said what I thought was a really insightful thing.

I paraphrase, but he said something to the effect that the drug is just a molecule. What's important is the treatment, but what the drug does is improve our ability to treat these most recalcitrant patients who would otherwise be written off, and in treating them, see outcomes way beyond what we've ever seen before.

An expansion in heroin prescribing -- dependent on the outcomes of these two trials -- has been written into the last two national drug strategies. Now that the findings are about to be reported, it's going to be interesting to see whether the government actually honours that repeated commitment and puts the science ahead of ill-informed public opinion.
posted by PeterMcDermott at 11:04 PM on July 2, 2009

I don't know if anyone is still reading this thread but it would feel wrong to let it pass without commenting. At the age of 27 I drank myself into the emergency room where a doctor told me that within five years either my liver or pancreas would be "beyond saving" and there would be absolutely nothing that she or anyone else could or would do for me. I don't know if this was accurate information or not and frankly I don't care. I am now 32 and haven't had a drink since I left the hospital that day. I am acutely aware that every day that I wake up in the morning I have been granted a reprieve from a literal death sentence. A reoccurring thought is "I'm not even supposed to be here today!" in exactly the opposite way that Dante in Clerks meant it. Not to get too Pollyanna here but I have come to view every day as a gift.

Can you compare your current feelings about life to how you felt before you were a drinker?

I started drinking regularly when I was thirteen and I can tell you that thirteen years was a long damn time to wait for a drink. From my earliest memories I felt as though something was not right in me, something that other people seemed to have was left out of me or broken. Whatever that hole or broken piece was, booze filled it and patched it. But that effect was illusory and temporary at best. By the end of my drinking I was unable to even drive a car without a drink in the morning and I often had to take my bottle with me to the bathroom because I knew that the first drink or three had no chance of staying in my stomach. And what did I get for all that pain? At the end I would be lucky if I got ten minutes of that "fixed" feeling out of a day-long drunk.

I can understand sobriety being better than drunkenness, but has the experience of hitting rock bottom and bouncing back led you to a better quality of life than before you were a drinker?

Yes, without question, without hesitation, yes. But if you had posed that question to me a week, a month, or possibly even a year into my sobriety I would have told you no, and I would have even told you that my life was worse since I stopped drinking. I had not showed up for my own life in so long I literally did not know how to do even the most routine things without the aid of a drink, and there were many things, like paying bills or taking responsibility for my actions I had never done before. The learning process was not painless, combined with the fact that I felt like a raw nerve physically and emotionally most of that first year, it is not something I would like to repeat anytime soon.

I am not, however, one of the people who says my: "Worst day sober is better than my best day drinking" which is something I hear on a regular basis (and I think is mentioned upthread). I had some amazing times drinking, experiences I could probably never replicate, and I have had days sober that I wouldn't wish on my worst enemy. When I pull back and look at the sum total though I wouldn't trade the life I have now for any other, either before I started drinking or the period when booze still worked before it turned on me.

And I owe it all to AA.
posted by Bango Skank at 9:35 AM on July 3, 2009 [5 favorites]

netbros: "When I entered alcohol rehab, the medical staff immediately put me on Serax (oxazepam), an anti-seizure withdrawal medication ... They detoxify you from alcohol by screwing you up so bad with seizure meds, that you're literally stumbling from place to place. I was never so messed up on any amount of alcohol as I was on mass dose oxazepam."

Despite mass media fables, there are basically no drugs where abstinent withdrawal from chronic use will not just make you feel quite uncomfortable but in fact could kill you. Alcohol is one exception to this -- chronic alcohol withdrawal can and has provoked fatal seizures in vulnerable individuals. That is why a period of anti-seizure prophylaxis is indicated in alcohol abstinence following chronic administration. The risk is slight, but the consequences of the low probability event are so drastic that a blanket prophylaxis is indicated.
posted by meehawl at 12:24 PM on July 4, 2009 [2 favorites]

Can you compare your current feelings about life to how you felt before you were a drinker? I can understand sobriety being better than drunkenness, but has the experience of hitting rock bottom and bouncing back led you to a better quality of life than before you were a drinker?

Yes, very much so.

I'm not in AA, however. It helped at one point when I was in a very dark period in my life, one of a couple "rock bottoms," but I haven't wanted a drink in a long time, and unlike greekphilosopy's experience, I always found AA meetings depressing. It does depend a lot on the particular group, and you can find meetings that work for you, but the sloganeering, the confessional and self-flagellation aspect, and all the rest just really doesn't work for me, but I never felt truly powerless and knew there was something else going on with the reasons I drank (turns out there is, but it took a while to figure it out).

It's a great idea - Bill was a revolutionary of sorts in the way we see addiction (but I don't agree with all of it, especially not the disease model), and it does work for a lot of people, but getting treatment and therapy for ADD has helped a great deal more than any AA meeting. For me that was always the underlying reason for my drinking (and smoking, and etc.), particularly the social anxiety that untreated ADD can cause. But I developed such a strong emotional dependence on alcohol that quitting became unthinkable after many years of heavy drinking, and I don't want to trigger those emotional memories by trying to drink socially again. But I just don't see it as necessary or desirable anymore, so not an issue, and I've found something which does work and allows me to be functional at a level I've never experienced before, drinking or sober. Whatever AA did for me before that worked is now possible with therapy, at least for me, without the negative aspects which turned me away. We all have to find our own way which works, as long as it really works and helps you grow as a person.
posted by krinklyfig at 12:41 AM on July 13, 2009 [1 favorite]