AA works because II

Yup. My favorite example is the alcoholic who drinks themselves to death. Most folks know or know of someone who has done that. I used to work with a guy who lost his license as a surgeon due to his addiction, got into recovery and became a therapist. He'd walk us through the process of drinking yourself to death, and it was really amazing. Aesophogeal (sp?) hemoraging (blood coming out of places that shouldn't bleed), acute pacreatitus (which leads to bile leaking into the abdominal cavity and eating away at all sorts of important organs), liver failure (jaundice due to poisons not being taken from the bloodstream).... the list goes on and on. These are hideously painful side-effects of drinking. did you konw that when they do an autopsy on an alcoholic the people in the room have to wear special maskes? Because when they take out the brain the smell of alcohol is so pungent that they'll get sick if they don't have a mask on. And these aren't pedestrians, these are professional autopsy-ers. Can you believe that? So what kind of passion, what kind of dedication does it take to drink to that point? Pancreatitus is supposed to be the most painful thing a human being can experience, and I'm pretty sure it usually happens relatively early in late-stage alcoholism... The zealotry of the late stage alcoholic is truly, horrifyingly amazing, isn't it? Few and far between are the folks who are that dedicated to anything....

he truth is, as a therapist I am usually not able to be of much help to an active addict. It's a bit depressing to be honest. Ever hear this joke? Q:"How many therapists does it take to change a lightbulb?" A: "Only one, but the lightbulb has to really want to change." Ha! The addict who is not at the point of wanting a miracle is usually not at a point of being willing to surrender their "religion" so to speak. And can I blame 'em? Who in this class, if I wrote a REALLY compelling post on the message board, would give up your religion? Anyone? No takers, huh? ;-)

Religion can be casually defined a system of beliefs and values around which I organize my life and behavior. By that definition addiction to cocaine for example would easily be a religion. Thinking of it this way is VERY helpful for me as a therapist (and, on a personal level, as a family member) because it helps me keep my perspective. History is full of people who went to a bloody, gory, painful death to avoid denouncing their religion. So is there some key phrase, so poignant question, that I can ask a client (or family member) during this session that's going to convince him or her to lay down their addiction if they are not ready? Not a snowball's chance in hell.

People do not change their fundamental belief system until the pain of staying the same outweighs the fear of change, and sadly, for many death precedes that.

Can you tell I have some passion about this topic? ;-)

I will say that the book "Motivational Interviewing" has some really useful techniques for helping some resistant addicts walk toward powerlessness. There's a lot to learn in this class, but this piece about addiction being a lot like a religion is probably one of the most useful things I've come to in my career. Perhaps it will be useful to a few of you as well...

One idea as to why AA works

I think it's very difficult effectively therapize in the addiction field without addressing spirituality. 

In my lectures at The Meadows I frequently ask patients why they think AA works. First they come up with some answers, then I tell them my theory;"It's because the two guys who put AA together were alcoholics themselves and they realized that booze had become their higher power. Steps two and three in AA aren't about finding God, they're about realizing that booze has been the god we followed, and since that's obviously not working maybe we should try something else." This can be a really effective lesson for many addicts, especially those who grew up in spiritually abusive settings and as such are struggling with the whole "higher power" thing in the 12-steps.

This example is particularly interesting when you compare an active, long-term addict with a religious zealot. Both adapt every element of thier day-to-day life so that it serves what they believe in. Generally both prefer to keep the company of like-minded friends.  And of course, both are willing to face horrific consequences, sometimes even including a gruesome death, rather than challenge their commitment to what they believe in. 

Ultimately the addict is, by my way of thinking, one who has built a religion out of thier substance or behavior.  That's part of why statistics on addiction are so mind-bogglingly poor - recovery is a tough sell.  Think of how rarely human beings are willing to reexamine their deepest and most treasured beliefs - it doesn't come up often.  When it does come up, think of how rarely any of us is willing to walk through the unbelievable pain of restructuring our worldview from the bottom up... 

Adapted lost children

The wallflower piece can actually be one of the most acute types of trauma an individual can go through, and it's also frequently one of the most difficult because the trauma is so covert. Children become scapegoats by meeting the negative attention needs of their parents - it is very common for "wallflowers" who are typically referred to as "lost children" in family systems therapy, to be very well-behaved for the first 12 or 13 years of their life. They may present as shy or well-adjusted, but they are inevitably profoundly lonely and beleive that they are inherently flawed. Usually in Jr. High School this loneliness becomes so overwhelming that they'll adapt to take on one of the other roles, that is hero, mascot, mediator, or scapegoat. One way to know if you did this is to ask yourself "what's my worst fear?" If the answer is "being ignored, misunderstood or not heard," then it's probably a safe bet that your role in the family system was lost child...