Relapse Traps

I do not have this worked out.  I sense we ought to start there.  I have a working theory.  It is unfinished and, most probably, somewhat slipshod.  But it feels important and I have an interest in openly processing my line of thought.  Luckily, I have a public forum in which I get to do just that; and so I shall.  Whether or not anybody actually wants to take the time to read it is an entirely different story.  Therefore, as you make the decision on whether or not you’d like to participate in this particular corner of my insanity; be warned.  I do not have this worked out.

So here the theory: I no longer believe in relapse.  Relapse for addicts, that is.  That is to say, I have come to foster some serious doubts about the use of the word relapse, or the assorted punishments that accompany a relapse, in the wide world of 12 step programs.  I should also tell you, and I don’t suppose this necessarily makes me more of an authority on the subject, that this theory is not coming from an observer; it is coming from a participant.  For nearly twenty years, I have retained membership in a whole cadre of these programs.  Among them, ACOA (Adult Children of Alcoholics), NA (Narcotics Anonymous), SA (Sex Anonymous), CA (Cocaine Anonymous), DA (Debtors Anonymous), CODA (Codependents Anonymous), AA (Alcoholics Anonymous), OA (Overeaters Anonymous), Al-Anon (Family and Friends of Alcoholics) and SSA (Secrets & Shame Anonymous).  It is in those last four that I understand myself as a current member.

So as an insider who has engaged in the process of recovery in AA, OA and Al-Anon for many years, and as someone who has watched literally thousands of people experience what is generally understood as relapse- I have begun to think that the notion that one has relapsed is shaming and almost entirely useless to an addict desperately attempting to find a life of recovery.

The two programs which have dominated my recovery are AA and OA.  To lay down the framework of my hypothesis, let’s use Alcoholics Anonymous.  This choice has mainly to do with the price of admission in AA being far more simplistic than that of OA. That is to say, sobriety in AA comes by stopping.  That’s the price of admission.  No more.  No more booze (and for most of the members in today’s AA, no more drugs).   In OA, it is quite a bit more complex.  You can’t just tell someone to stop eating.  It has often been said that what makes eating disorders so damn challenging is the fact that, “you have to let the tiger out of the cage at least three times a day.”  In OA, each individual, hopefully with the help of a sponsor and a higher power (and perhaps a nutritionist and/or personal trainer) defines what abstinence is for them.  Suffices to say, this is no small task and tends to make for a complicated road of recovery.  Quite frankly, it has been ny experiences in the OA program which began my “relapse is useless” theory.  And we will surely speak about that.  But, again, let’s begin in the grandaddy of the 12 step programs, where notions of relapse appear more easily defined.

So, let’s take a hypothetical alcoholic; we’ll call him Bernie.  After years of chronic alcohol and drug abuse, Bernie finds his way into an AA meeting.  He listens to the story of a fellow drunk, is embraced by the members of the group, drinks a free cup of hot coffee, and wholeheartedly drinks the Kool-Aid.  He gets a sponsor and buys The Big Book (the basic text of Alcoholics Anonymous.)  He works the steps and begins to carry the message to the still sick and suffering.  He has a home group where he attends business meetings.  He prays and meditates every morning and reviews his behavior every evening.  Bernie changes.  First his actions, and eventually his very instincts.  For five years he is, by all accounts, a model member of AA.  And then one night, he is out at a bar with colleagues enjoying a favorite band, and he is asked if he would like to join the others in a shot of Jack Daniels.  And he does.

He does the shot.  It feels vaguely naughty and he is quite sure it is not the most prudent decision in terms of taking care of and loving himself.  But he does it anyway.  It washes over him like a warm bath.  He enjoys the feeling and immediately wants another.  And he has another.  And then another.  And another.  The choice to imbibe leaves Bernie sweating on the linoleum of his bathroom floor alternately unconscious and voraciously vomiting whiskey in the vague direction of the toilet bowl.  The next day, he blows off work and spends the afternoon hating himself and wondering why he would make the choice that he made.  It is Thursday and, as it happens, Bernie’s home group meets at 7pm on Thursday evenings.  He staggers in just as the meeting begins, and when the floor is opened for sharing, Bernie raises his hand and shares his experience from the night before.  Chances are, Bernie will receive love and support from some and judgment and scorn from others.  But in terms of his AA membership, Bernie can almost definitely expect some form of punishment including, but not limited to, the following:

  • His “clean time” will be summarily revoked.  Bernie no longer has five years.  Bernie has one day.
  • Bernie’s step work will be rendered meaningless.  Bernie will be demoted back to step one.
  • Bernie cannot lead or speak at a meeting until he has once again accumulated a year of clean time.
  • Bernie, who for our purposes is single, will be told that he can’t date or sleep with women (or men) until that same twelve months is accumulated.

So my question is this: why?  Why the chastening?  What are we telling ourselves is the efficacy of such castigation?  I am a firm believer that the fundamental goal of AA (and all its sister programs) is to get as many people well as is possible.  Accordingly, are the penalties for what we commonly call “a slip” useful in terms of accomplishing that task?

Allow me to offer an alternative outcome.

Same situation.  Bernie strays.  Bernie returns.  Bernie shares.  Only now, upon the revelation that Bernie did some further field work- Bernie is understood as an alcoholic who has spent the last five years engaging in a the process of recovering from a seemingly hopeless state of mind and body who ventured out, drank some, and returned with the data that it still doesn’t work.  And that’s that.  Clearly, Bernie took an enormous risk.  The chances were very good that it could have gone differently.  Bernie could have died or simply continued on with the drinking and thrown his entire life away.  But that didn’t happen.  Call it luck.  Call it God’s grace.  That just isn’t what happened.  Do we really understand that all the work and learning and healing of the last five years have been erased?  That they didn’t happen by virtue of Bernie drinking for an evening?  Is the moral inventory Bernie did with his sponsor and the amends he made to friends and family undone in that they now need to be redone like some spiritual make-up test?

Sure, it would seem that the choice to drink was probably set in motion by patterns which predated the concert- and that there may well be some fears, resentments or harms that now need some attending to.  That’s why we have the steps, yes?  These spiritual tools ought to be at Bernie’s disposal to utilize when his recovery becomes clogged with, if not ensconced by, character liabilities (what we sometimes call “old behavior.”)  Our tenth step tells us to stay on watch for “selfishness, dishonesty, resentment and fear.”  It then tells us, “…when these crop up” (not ‘IF these crop up’); we are to pray, get honest with another person, make amends if we’ve hurt anyone, and try to help another.  I would guess that by drowning himself in Jack Daniels for the evening, Bernie was quite possibly being selfish, if not dishonest, and quite possibly is feeling fear and resentment as the result of his choice.  I don’t think that the tenth step says, “If by any chance the way in which you are selfish, dishonest, resentful or fearful includes alcohol or drug use, please abandon the tenth step directions and proceed immediately back to step one.”

Further, looking back at the punishment list, you’ll notice that all the items on the list are somewhat dependent on the notion of time.  This, I believe, is at the heart of the problem.  AA fetishizes time in a manner which completely warps the elements that make for a successful life in recovery.  Page 77 in The Big Book reads, “Our real purpose is to be of maximum service to God and the people about us.”  So, when we become aware that our choices are failing to set us up to better accomplish that goal, recovery demands that we attempt to do something about it.  Isn’t that what Bernie is doing by getting honest about his behavior?  Is the message we wish to send that he has failed in his real purpose or that he has accumulated some further data in accomplishing his real purpose?  Why is our first instinct to take time away from him as if it was time which gave him credibility in the first place?  Five years in AA is not what made Bernie a power of example.  The step work, spiritual practice and service were what, hopefully, made him a power of example.  Further, I would imagine that his choice to drink and then come to the group and turn over his imperfections would add to the power of his example, not detract from it.  Why do we tell ourselves that the drinking is evidence that the steps didn’t work as opposed to seeing that Bernie’s disclosure is evidence that they did?

As an additional example, let’s take a look at Bernie’s fellow group member, Sal.  Sal entered AA within a few weeks of Bernie and has also accrued five years of clean time.  Sal has never worked the twelve steps.  Sal has had sponsors, but mainly as lay therapists, not as conduits to a higher power.  Sal doesn’t really carry the message to anyone.  He has a few guys who call him sponsor, but for the most part, it’s Sal’s egotistical desire to play higher power for other men.  Sal continues to be very angry and engages character assassination at the slightest prompting.  Sal also continues to be patently dishonest, continually disowning and inventing parts of himself.  But Sal is not in the bar with Bernie that night.  Sal’s “clean time” continues on.

What’s fascinating is, if two weeks later, a brand new guy walks into the meeting, the group will be far more inclined to pass him along to Sal rather than Bernie.  Because Sal has five years.  Sal probably even has a shiny coin with a big roman numeral “V” in the center.  Sal takes, and is granted, authority based solely on the amount of time that has passed since he has put alcohol in his system.

Think about it this way: which is the more powerful message for a newcomer:

A) Hi.  I’m Sal.  I haven’t drank in five years.  I am basically the same miserable bastard I was when I showed up half a decade ago, but now I go to AA meetings and go to coffee shops for fellowship.  Want to be my sponsee and hang out with us?

or

B) Hi.  I’m Bernie.  I’ve been in recovery for five years.  I have fundamentally changed  my life as a product of the steps in this book.  It hasn’t always been easy.  I still struggle with the wreckage of my past.  In fact, a few weeks back I went out and got loaded.  But this stuff works when you work it.  If you’d like, I’ll show you to how to work it.

You see, the notion of time, and the way we use it today, has all to do with the advent of the treatment centers in the mid to late sixties.  Initially, when the paradigm of the 12 steps first came into practice, they were designed to be worked in a single day.  The AA program (not yet called AA) was being worked for five years before The Big Book was published.  In those five years, when people wanted to work this program that they had heard about (through word of mouth), they would come to Akron to do the step work with Dr. Bob Smith (one of AA’s co-founders along with Bill Wilson).  They would arrive at Dr. Bob’s house early in the morning and by the time they left (around sundown) they would begin making their ninth step amends and implementing steps ten, eleven and twelve, including doing this work with others.  That’s a fact.  That’s how our co-founders and pioneers set it up.  The only reason that changed, is because when the Big Book was published, the outpouring of suffering individuals wanting help far exceeded what the founders ever could have imagined.  As a result, Dr. Bob and his crew quickly realized that they could not possibly handle the number of individuals seeking the message.  In response to this issue, they set up what were then called Beginner’s Meetings.  The Beginner’s meetings were four classroom-like meetings which would take place over the course of four weeks where you would learn about, and work, the twelve steps along with an advocate who would be assigned to assist you with them.  This advocate was called a “sharing partner” as they had not yet implemented the word “sponsor.”  And that’s the way it was for the next quarter century or so.  The alcoholic would walk in the doors of AA, get their sharing partner, work the steps quickly, spiritually awaken, and then move into the general fellowship where they would work toward strengthening their relationship with a higher power.

Then came the rise of the treatment centers.  The centers were, initially, sort of like way stations for AA.  They would detox the drunk in question and then send them along to the program.  Then somebody realized that there might be some real money to be made with these centers.  Then the insurance companies came on board.  And all of a sudden, the simplicity of working the steps immediately, and with a rapid cadence, began to slowly fall out of favor.  In its place, came notions of working a step per week, and eventually working a step a month if not staying on the first step for a full year.  This led to the arbitrary boundary of “a year” holding all kinds of cache in the twelve step world.  You can’t lead a meeting for a year.  You can’t speak at a meeting for a year.  You can’t sponsor anyone for a year.  No sex or dating for a year.  And, quite frankly, if you are going to take a year to work the steps, these suggestions probably make a lot of sense.  But the steps were never meant to take that long.  Therefore, the year obstacle is a faulty concept built on another faulty concept.

This has led to a society where the power of your recovery is determined by the accumulation of time; and your punishment for using is the group absconding what you have accumulated.

In OA and SA this problem becomes ever more intense where the ambiguity regarding what qualifies as abstinence creates scads of church rooms full of addicts living in an almost constant state of shameful relapse.  For the individual who comes from a toxic family awash in judgment and rigidity, the demand to continually revert back to day one and step one can provide a most tragic impediment to recovery.  If John Bradshaw is right (and I truly believe that he is) that all addictions are ultimately addictions to shame, why do we so encourage people attempting to recover to keep understanding themselves as failures?

In the world of recovery, I attend, and generally lead, what are called Back to Basics meetings.  They exist in both AA and OA and are, essentially, recreations of Dr. Bob’s beginners meetings.  We teach the big book and take people through the 12 steps over the course of four one hour sessions.  Consequently, in the eyes of many,  I am afforded a fair amount of authority in the recovery world.  I have had the remarkable opportunity to carry the message and teach the steps to literally thousands of people.  And here’s the thing.  Using the relapse model described above, I am patently unqualified to do so.  If we are to believe that strong recovery means never straying from the path, no one in any of the 12 step rooms ought be listening to me.  Because according to these notions of relapse, I am a relapser.  A category one, hopeless relapser.

And worse than that, I am a pathological liar.  I regularly tell people that I have been in recovery, encompassing abstinence and sobriety, for nearly twenty years.  But is that the truth?  Depends on how you look at it.  How can I call myself abstinent if I occasionally eat sugar and grease?  Hell, forget sugar and grease, I put on over one hundred pounds as an abstinent member of OA.  How do I resolve that?  Well, I define my abstinence as “No secrets.  No shame.  No hiding.”  I understand binging and keeping secrets about it to be a whole different animal from binging and getting honest about it.  And, yes, there are many OA members who are not only bothered by this, but, in fact, quite angry about it.  How do I call myself sober if I have had multiple experiences with sleeping pills and painkillers that could be, at best, described as precarious?  I don’t keep secrets.  My goodness, I am quite sure I experience emotional relapse in Al-Anon three or four times a week.  I don’t keep secrets.  At the bottom of the whole mess, I understand myself as a shame addict.  I also understand that my shame is driven by secrecy.  Without the secrets, none of the addictions are nearly as interesting as they might otherwise be.  Which is why whenever I decide to do some field work and re-engage one of them I am brought back to the same piece of truth.  It is better for me to abstain.

Why do I take these chances with my mental and physical health?  Now that’s a good question.  I really don’t know.  I just know that my process is not fostered by signing up to be shamed.  I do what I do.  I did what I did.  There are choices and there are consequences.  And when the consequences of my choices are unpalatable, I can go ahead and make different choices.  And the program is incredibly useful in learning how to make different choices.  That doesn’t mean that I make better choices all the time.  It just means that I do it more often.  Further, eating junk food and popping pain pills are not the only ways I take chances.  I speed.  I cross against the light.  I exercise without stretching.  I allow crappy television and mindless internet surfing keep me from getting a full nights sleep.  This is how I understand being an addict.  It’s insanity.  Mankind’s most basic instinct is self-preservation and for thirty-eight years I have been bent on self-destruction.  I believe that a power greater than I can relieve me of this insanity.  I also believe the restoration of my sanity comes in stages.  And it has.  My methods of hurting myself are far more benign than they were two decades ago.  And I already spend far more time serene and joyful than I ever thought possible for someone like me.

I have heard many folks say, “But if you do away with the notion of relapse, doesn’t that just give addicts an excuse to use?”  Think about that for a minute.  Are we really under the belief that the only reason addicts stay away from their substance of choice is so that they may continue accumulating days and months and years and the corresponding bronze and silver coins (a woman I used to attend meetings with in New York always called the coins and the jewelry and the bumper stickers “drunk junk.”  I love that)  How about not dying as a reason to abstain?  If we remove the notion of mounting up time (or losing it),  does avoiding death stop being a decent reason to stay abstinent?

Like I said, I really don’t have it worked out.  And, in the interest of transparency, my father (a longtime member of recovery) just recently decided to angrily accuse me of not being sober.  So, is this whole blog post one long justification for my behavior?  Could be.  I don’t think that it is.  I was certainly planning to write it long before dad decided to take my inventory.  But, heck, I suppose it is entirely possible that what I am is simply a charismatic, well-spoken fraud living under a mountain of denial.  And if that is true, than a public forum in which I can defend my offensive behaviors and ridiculous notions would certainly prove useful.  Maybe I have spent thirty-eight years becoming a manipulative, maniacal narcissist.

Perhaps someone should take my human time away.  Perhaps I should be placed back on day one.

 

 

 

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  1. #1 by Yonacito on February 2, 2011 - 6:31 am

    Let me preface this comment by saying I love you. Thank you for continuing to be courageous.

    That said, wow. Talk about self-aggrandizing. The levels of histrionics here are vertigo inducing. This idea you have, that you seem to be so proud of, that you have somehow relapsed as a human is quite remarkable. Is this what the post is really all about it?

    If our drinking is symptomatic of underlying issues of shame, guilt, resentment and fear then what must all your shame, guilt, resentment and fear be symptomatic of? Your failing as a human being?

    This post triggers me. This post makes me angry. And I am reacting in anger, and fear. Of what I am not sure. More will be revealed. Of that I am sure.

    I digress.

    The word relapse has some utility. The shame you feel around the word relapse is subjective. There is healthy shame that helps to teach us our limits. As someone who is becoming self-aware, someone who is on his own spiritual journey, knowing my limits is essential in realizing, respecting and addressing my limitations (in time) and possibly prepare to work through them.

    Am I suggesting that the word relapse has somehow taken on a role of healthy shame? I don’t know. Perhaps there is a medium in there somewhere between healthy and toxic shame where words like relapse reside. I do feel very strongly that if to drink is to die, as the big book says, then one is most certainly playing russian roulette by adhering to the idea that there is nothing wrong with relapsing.

    If the term relapse has garnered a level of toxic shame in the rooms, it may have something to do with the bulk of people who make up those programs. We are, at our core, a huge toxic family. But, and I say but here because I feel it is important, we are a toxic family who, for the most part, knows it is toxic, and is trying to get well. Maybe not all of us, not all in the same way, but not all of us need the same level of healing.

    The reason there are behavioral therapists (versus clinical or psychoanalytical therapists) is because not everyone has a deep, shameful traumatic event they are trying to understand and overcome. There are some people who have simply developed habits that have become counterproductive. Habits that can be altered with classical or operant conditioning (or with the help of a life coach). Maybe that is what has happened over the last 70 years of AA. The healing message has soaked through generations and the number of people who are alcoholics of the caliber that once existed are dwindling.

    This is not to say there are not still tens of thousands of alcoholics that require the ‘program’ of recovery. This idea of mine presupposes that like any toxic family who has one member find recovery/healing and break away to continue his / her healing, there must be a change or shift in the dynamic of that family. It may be a small change, but a change none the less. How that change manifests itself can be telling.

    It is hubris to think that because the program has evolved in ways you don’t agree with that those changes don’t serve the group, or some of its members, in some way.

    Maybe the treatment centers smeared the message and watered it down as you say, maybe they didn’t. Maybe the advent of the treatment centers serviced a need, albeit an unspoken or underlying one, that had arisen over the years. Maybe relapse has become a four letter word in the rooms. Or, maybe that shame that you experience around relapse as unhealthy or toxic serves, in its way, helps to keep people on the balance beam until such a time as they are able to have their own spiritual experience.

    I can personally attest to scores of men who would not have stayed sober as long as they have had it not been for the idea of their clean time. The idea of losing that time kept them sober. It was an achievement for them, in some cases the only one of note they had ever known. Their level of sobriety may not look like yours, or those that follow your maxim, but it sure means a lot to them.

    And the longer they stay sober the closer they may get to understanding that the word relapse, and all of its nuances of meaning, was just another component of a program that helped them to find their way. That has helped them to get well.
    ———————————————————————————————————————–
    I want to declare this to be an idea-in-progress, something I have not worked through completely, that I am obviously attempting to process here for the first time. A feeling attempting to be presented in words.

    Your post inspired me. Thank you.

  2. #2 by Andy D on February 2, 2011 - 5:39 pm

    Lets start with the Merriam-Webster definition
    1 re·lapse noun \ri-ˈlaps, ˈrē-ˌ\
    Definition of RELAPSE
    1: the act or an instance of backsliding, worsening, or subsiding
    2: a recurrence of symptoms of a disease after a period of improvement

    I believe for me it is my healthy shame, as John Bradshaw calls it, that helps me know my limits, I use this shame to keep me away from that first drink.

    I frequently hear people, usually with a lot of time saying: time does not matter, if you got up earlier then me you are sober longer, and it’s just a day at a time. So, I don’t think all of AA judge time the same way.

    Let’s talk about Bernie:
    “His “clean time” will be summarily revoked. Bernie no longer has five years. Bernie has one day.” – yes he drank last night, so yesterday is the date of his last drunk/drink. I don’t see the shame. it’s only a day at a time.

    “Bernie’s step work will be rendered meaningless. Bernie will be demoted back to step one.” – where in official AA literature does it say this? I do think someone who drank last night can benefit from a one hour refresher on steps 1-3. as you say “the choice to drink was probably set in motion by patterns which predated the concert- and that there may well be some fears, resentments or harms that now need some attending to.” steps 4-5-6-7-8-9. big deal, one hour. or he can do just “work” step 10. Back to Basics and the way it was done in the beginning, in a weekend. why does it matter if he just goes to 10 or starts at one to take a look at his powerlessness. Or does this guy have power.? or think he has power?

    Bernie cannot lead or speak at a meeting until he has once again accumulated a year of clean time. – It is true that officially one is not supposed to speak at a hospital, institution for a recommended 1 year. the same way we dont change the wording in the big book, it is a line that proves to be helpful in most cases. I spoke for you on my 90 days, and every meeting I go to they say “dont share from the floor unless you have 24 hrs since your last drink. speak to one of us after the meeting” at these meetings I have frequently heard people share who have had a drink less then 24 hrs, and the room has always aloud this person to speak.

    “Bernie, who for our purposes is single, will be told that he can’t date or sleep with women (or men) until that same twelve months is accumulated.” – who says this? NOT IN LOS ANGELES. And when you told me to, it was a suggestion. One that I suggest if it appears that the person coming in has a history of losing himself in a relationship.

    Inventory. It is useful to takes others inventory (my opinion) If the people in Sal’s meeting were taking his inventory they would know to NOT direct newcomers his way.

  3. #3 by Patrick on February 5, 2011 - 4:28 am

    Andy d’s post seems right on to me….so…..we might say, “it’s not me doing the shaming, it’s an authoritative institution I imagine sounds an awful lot like my dad when he judges me.”

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