By Geoff Thompson - MA, CCC
Program Director

Lots of men who have participated at Sunshine Coast Health Center struggle with things beyond addiction. Some typical challenges are depression, anxiety and panic attacks, post-traumatic stress disorder, grief over losing a loved one, and attention deficit disorder.

In the old days of addiction treatment, counsellors didn’t pay much attention to these issues. Mental health professionals didn’t want to work with them because they were addicts; addiction counsellors didn’t want to work with them because they had mental health struggles. Mostly, they just fell through the cracks in the system.

Thankfully, this has mostly changed now. At Sunshine Coast we routinely deal with both the addiction and any mental health issue. All the counsellors have graduate training and Dr. Howard, our psychiatrist, has been a great blessing, helping us with diagnoses and medications.

There is a popular idea that those suffering from depression, attention deficit, trauma, grief, and so on are less capable than ‘normal’ people. But think about this: some of the most successful people in the world have suffered from mental health issues. Here’s a few:
• Kay Redfield Jamison (bipolar)—Professor of psychiatry at Johns Hopkins University Medical School
• Matthew Good (bipolar)—Canadian musician
• John Nash (likely schizophrenia)—Nobel prize winner, who was the subject of the book and movie, A Beautiful Mind.

This list could go on endlessly: singer Judy Collins, actor Jean-Claude van Damme, and so on. Some say Isaac Newton, Beethoven, and others who have profoundly influenced the world struggled with mental health issues. If we add an addiction problem, and the list includes:
• Robert Munsch (addiction, obsessive-compulsive and bipolar disorders)—Canadian children’s author. Munsch revealed last month that he suffered from mental issues and that he had recently achieved four months of clean time from cocaine and alcohol
• Eugene O’Neill (addiction, major depressive disorder)—Nobel prize winner for literature

So, some of the most famous people in the world have had mental health challenges and yet managed to do some amazing things.

Still, some do think that they are somehow less than ‘normal’ people, and some of those with both mental issues and addiction think that they are really different. In this article we’ll explore these co-occurring problems and how to deal with them.

Part One — Addiction and Mental Health Issues

Many people believe that addicts with mental health problems are ‘medicating’ their problem with alcohol or drugs. They tell us about research that says, for example, 50 percent of the people with post traumatic stress disorder have severe substance use. It’s interesting that some clients feel relieved when they get a mental health diagnosis. ‘Ah,’ they think, ‘So that explains why I keep doing drugs’.

But we have to be cautious about how we interpret this research. When we say that 50 percent of those with trauma are addicted, this is based on what are known as correlational studies. This research simply discovers if there is some link between two things. Just because we find a link does not mean that one causes the other.

One of the most famous psychiatrists in the addiction field is Ken Minkoff. Minkoff argues that those with mental health issues use drugs for the same reasons that all addicts use drugs, which is to deal with loneliness, feelings that they are different, feelings that they don’t belong, boredom, and so on.

Research on the self-medication theory is actually rather weak. When we analyze the research, we discover that there are lots of questions about self-medicating that remain unanswered. Some researchers claim that the self-medication theory was invented by those who don’t understand addiction. A major study soon to be published claims that it will go a long way toward dispelling the self-medication theory.

Some researchers point out that the drugs used are often poor choices if the addict is using them as a substitute for medication. One of the more obvious examples is cocaine. Many people with anxiety problems use coke. Since anxiety ramps up the body’s nervous system, one would think that the medication should decrease activity in the nervous system. But coke ramps it up. So it doesn’t really make a lot of sense biologically. So why do they use it? We do know that coke often gives a user the sense of power or is great as a distraction — get all that irritating clutter out of their head. These are the common reasons why people say they use coke, regardless of whether they have mental issues or not.

Part Two — Attitude

Many health care professions look at someone struggling with bipolar disorder or major depressive disorder or post traumatic stress disorder as ‘mentally ill’.

Sunshine Coast does not like this interpretation. Here’s why. There is a lot of evidence that if a professional tells a client that he is mentally ill, then the client might come to believe that there is something wrong with him. He might believe that he is different, abnormal, defective, and so on.

At Sunshine Coast, we see those suffering from these issues as no different than anyone else. Each of us is unique. Those suffering from addiction or depression or chronic pain or a heart condition are simply working through their own struggles, as any human being has to.

Basically, they didn’t ask for this to happen to them, but it did. So, they have a choice to make: Do I become a victim to my struggles or do I accept them as part of what I deal with and get on with my life.

There’s a saying in the recovery field that “Attitude is everything.” We’re not sure if it’s everything, but it certainly is a big part of whether someone lives a good life or not. The great psychiatrist Viktor Frankl, who we talk about at Sunshine Coast, wrote and spoke a great deal about developing a positive attitude. He considered a good attitude to be essential to living a personally meaningful life.

Attitude is basically accepting that depression or attention deficit or whatever is simply part of your life right now. Like having diabetes or eye problems or addiction, you still get to make choices.

Part Three — Courage

Many great thinkers, such as the philosopher Friedrich Nietzsche or the addict-writer Eugene O’Neill, tell us that suffering is a natural part of life. Many believe that overcoming suffering is how we mature and grow as people. Perhaps because of modern advertising, we tend to believe today that we shouldn’t suffer. Advertisements tell us that there is a pill or some technique that will make suffering go away.

The truth is that some have more good days than bad, some have more bad than good. But we know that everyone has bad days. One of the tricks to living the good life is to trudge through the bad days. This takes courage (some psychologists use the word ‘resilience’ or ‘hardiness’, which are a little more complex than ‘courage’ but basically the same thing). 

Courage is an interesting trait. Most people consider courage as acting in spite of fear or suffering. Many suffering people find it difficult to act, to do something. Those with depression, for instance, often deal with it passively — just sleeping when they feel tired, not eating because they may lack an appetite. But dealing passively with mental health problems is usually not too helpful, at least in any long-term way. A better way is to force themselves to get up, have a shower, exercise, do some activity. This is often very difficult because they have no energy. So, it does take courage to act in spite of suffering.

As clients who have attended the new program at Sunshine Coast know, one of the ways to develop courage is to remember why you would act in spite of suffering. What is the reason you would trudge on, force yourself to do something that you don’t want to do? If you have a goal, a mission, it makes it easier to deal with the ‘bad’ things in life. For most people, having a mission or goal gives them courage.

Part Four — Faith

This can mean religious faith, but it doesn’t have to. It’s actually used in psychology.

Faith means that you have hope that things will get better — even though you may not know how or why. In a way, it can feel like jumping out of a plane without a parachute. You have no idea how you are going to land safely, but someone says, “Just do it. It’ll be okay.” Those of you who are involved in 12-step programs know this experience. This is very similar to Step 3. You just have to have faith that things will work out if you continue working on recovery.

For those with addiction and mental health issues, it may sometimes feel that they’re stuck. They’ve been courageous trudging through the tough days, and then, bang, it happens again — the major depression, anxiety, or whatever. Perhaps they know others in early recovery who are going through what they’re going through. It’s often not very pleasant.

One of the great blessings of 12-step and other recovery programs is that there are many members who have overcome their struggles with addiction and gotten a handle on a mental health issue. For those struggling with depression, etc, these people are inspiring. And they often can give others clues to how they can overcome mental issues.

Meeting someone who is dealing with the same issue is one way for people who are struggling to develop faith that things will get better. Even if they have no personal experience and don’t understand how their lives can improve, there are real people around them who have pulled it off.

Part Five — Transcendence

The key to overcoming suffering—overcoming depression, bipolar disorder, attention deficit, and so on—is not to pretend it doesn’t exist or avoid thinking about it. The key is to transcend it. Basically, in real life, this looks like ‘Okay, I’ve got a problem. I don’t like it, but I’m stuck with it, so I’ll just deal with it and get on with the business of living’.

Suffering is reality for all human beings. We all suffer: lose loved ones, lose pets, find out we have a major medical condition, get into a car accident, get our heart broken, and, of course, have an addiction. Those with co-occurring mental health issues have their own struggles and, in some ways, struggle more than the average person.

But the thing to remember is that there is no thunderbolt coming down from the heavens to save us. The only person who can save me is me. The only person who can save you is you. Each of us makes decisions that determine the kind of life we lead. As we pointed out in the introduction to this article, many people suffering from mental issues have done remarkably well in life and contributed greatly to make others’ lives better.

By Geoff Thompson - MA, CCC
Program Director
Sunshine Coast Health Center

Addicts do not like surprises. That’s why they are, what we affectionately call, control freaks. It’s important for recovery to overcome this desire to control, which means learning to live comfortably in the grey areas of life. The grey areas are those times when there are no immediate solutions to problems, no immediate answers to questions, no understanding of how things will work out in the future…no control.

The AA Big Book makes a big deal about the addict’s desire to control:

“Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way. If his arrangements would only stay put, if only people would do as he wished, the show would be great. Everybody, including himself, would be pleased.”

Psychologists, too, have noticed that addicts are obsessed with trying to manipulate others and events. Why? If people do what the addict wants, and life happens as the addict wants, then the addict feels better. Those who relapse inevitably tell us that people or things didn’t work out as they wanted or expected; they got stressed out and relapsed.

And that’s a BIG problem: People and things don’t operate according to the addict’s wishes. As the Big Books says, “What usually happens? The show doesn’t come off very well.” And then the addict gets irritated and tries to be even more controlling.

Giving up this desire to control is one of the keys to recovery. But it’s tough. If the addict doesn’t control people, places, and things, then he might get surprised. Those curveballs in life upset him. He might have to exist in a world where there are no immediate answers. He might have to deal with all those unexpected things in life.

And the unexpected can be complicated. Say an alumnus was hurt deeply because his partner cheated on him. They split up, but he would like another relationship. If he gives up his desire to control, then he has to take the risk that he might get hurt again. Or say an alumnus worries about talking in public. He can either try to keep control by never speaking in public, or he can take a risk and give it a shot. But who knows what will happen? Perhaps the audience will laugh at him. Or say an alumnus only likes his job because of the paycheque. He could go back to the job because it’s good money, or he could face all the uncertainties of finding new work.

The idea of giving up the need to control is frightening for most in early recovery. It demands that they learn to live in a world they have little power over. Of course, they never really had control, but the thought of voluntarily giving it up is what stresses them.

In this article we’ll look at why those in early recovery are so desperate to control the world they live in, and then we’ll provide a few techniques that you, as a person in recovery, can use to learn to live comfortably—when you don’t have answers, when you can’t see how things will work out, when you accept that you have no control over life.

Part One: Why Addicts Want Control

It is true that all people need to feel in charge of their lives. Happy people have figured out how to do this. Unhappy people haven’t. The best tactic that unhappy people can think of is to control others and, as the Big Book says, “the lighting, the scenery, etc.”

Addicts have all sorts of tactics to take control. Here are some examples from Sunshine Coast clients: Guilt a family member into doing something: “You’ve never cared about me and what I need.” Blackmail: “If you don’t do what I want you to do, I’ll relapse.” Directive: “You have to learn to quit nagging me, so you should go to Al-Anon or a therapist.”

These tactics show up all the time in Sunshine Coast groups. “You [counsellor] are causing me to get angry.” “I lost 10 days of treatment because you [staff] didn’t do your job.” “If I don’t get to the EI office in one hour, then I’ll have a really bad day.” And so on. Of course, in group, this is fantastic stuff to work with, helping clients understand that they [not staff] determine how they feel.

And others had better change quickly. Few things seem to drive recovering addicts crazy more than not having a problem fixed instantly.

It’s pretty obvious that life does not operate according to what the addict wants. So why does he keep trying to control it? The answer is simple: Fear. What would happen if he did not control others and things? The outcome, life, would be unpredictable. He might get surprised. He may be hurt by what happens. How will he deal with hurt and stress without retreating to the bottle or the drug?

He might even have to accept that he is the author of his life. Yeow! And if he is in charge of his life, then there is no one to blame. No easy way out. If there is no one to blame, then he has to change if he wants a better life. He has to give up all the excuses.

And that’s scary.

Part Two: Step Back and Reflect

One of the best techniques to learn how to live in the grey area of life is to step back and have a look at a situation that is not meeting your expectations. Whenever you find yourself frustrated, take a moment and reflect. How important is it, really? If you don’t get something done immediately, will this have an impact on you five years from now? What is so important about this particular situation that it MUST be resolved immediately?

A typical example with Sunshine Coast clients is when they have an unpleasant phone call with a family member. They or the family member hangs up abruptly. The client often becomes almost panicky—a desperation—he has to resolve the problem. We’ve seen clients phone back half a dozen times trying to settle the issue. And clients often tell us that an unresolved issue “ruined my whole day.”

But when we talk with the client about the situation, we usually discover that there is no panic. There is no need for the problem to be fixed immediately. The client may want the issue resolved but there is no need for some immediate solution (having something settled is why, by the way, we often hear clients say: “I don’t care which way it goes; I just want it settled.”)

One of the reasons that this technique of stepping back and reflecting works is because you get some distance from the situation. If you can reflect on it, then you won’t act in some knee-jerk manner, reacting out of habit. Anyone who constantly blames others for his suffering, like any other repeated behavior, will turn it into a habit. Just look at kids. Most younger kids constantly blame their brother or sister, friends, teachers, parents, and so on for their struggles.

Part Three: Are you making sense of a situation in a way that is responsive to reality?

Under the new program at Sunshine Coast, we stress two things. First, everyone interprets the world in a unique way; that is, everyone makes sense of the world differently. Secondly, each person makes decisions that determine the kind of life he gets.

Based on these two ideas, another technique you can use is to reflect on how you make sense of a situation. Last week we talked about taking time to think about a situation that upsets you—is there really any need to control it? But it’s also important to think about a situation in a way that will help you. When you are feeling frustrated because someone is or is not doing something that you want them to do, or life isn’t working out the way you want it to, ask yourself how you are interpreting the situation. If you are an alumni of Sunshine Coast, you may remember from your counselling this is what your counsellor asked you.

Say you are frustrated with your parents. You get yourself in financial trouble, and they refuse to help you out. You have no idea how to solve your finances other than by relying on your parents. You get angry and tell them, “It’s obvious you don’t care about me. I’m trying to get my life together, I run into a bit of trouble, and you don’t care enough about me to even help me out.”

So, the first question is about how you are making sense of this situation. Have you decided that how you interpret it is the truth; therefore, any other interpretation must be wrong? (This is a very common tactic, by the way.) What is your parents’ interpretation of the situation? Why did they decide not to help you? Is there some merit in how they are interpreting the situation?

The second question is based on the idea that you are the author of your life. Have you accepted that you are in charge of your life? Are you blaming others for your suffering; that is, is your financial problem your problem or your family’s? What are your other options if the family doesn’t help you out?

This is a simple example that probably doesn’t apply to you, even though it comes from a SCHC alumnus. But you likely have your own examples: getting irritated because you got put on hold by Revenue Canada, and you needed some information to finish your tax return; getting upset with a lover because she/he did not listen to you; getting upset with your boss; getting upset while driving because someone cut you off; getting upset with a delay at the airport because you are on a tight schedule; avoiding going to a doctor because you are afraid of what she/he might diagnose; putting off a phone call because you are afraid of how the other person might react; and so on and so on.

Part Four: Shifting how you make sense of the world

The real key to living comfortably in the grey area of life is to make sense of the world in a different way. Rather than feeling the need to take control to protect yourself, recovery demands that you accept that others will do as they choose (regardless of what you want them to do), and things will happen (regardless of whether you want them to).

Those in early recovery generally interpret the world as dangerous. Lovers can hurt them, employers can make them miserable, cars can break down, police can pull them over for a breathalyzer, families can refuse them financial help, friends can betray them, and so on. Because of this danger, they believe that they must protect themselves by controlling others and things. But despite the slickness of their control tactics (and addicts are quite famous for their slickness), this control rarely works out.

Recovery demands a different approach. The 12-step program suggests that addicts “let go and let God.” What AA/NA mean by this is that the addict has to practice giving up control. Life simply works out as it should, and what happens is what should happen—even if the addict does not like the way things work out. The 12-step program puts a great deal of emphasis on allowing a higher power take control because if the addict will allow this, then he or she no longer feels the need to control.

A technique from psychology is provided by the great psychiatrist Viktor Frankl. If you were at Sunshine Coast under the new program, you’ve already heard of it. Go about your day with this question in your head: “What does Life demand of me?” We’ve talked about this technique before, but it’s so good that we can’t emphasize it enough.

Here are some examples of asking life what it demands of you. You are in a hurry, and your car has a flat tire. So, rather than getting bent out of shape, what are your options? Your lover won’t listen to you. Rather than getting bent out of shape, perhaps it’s best to give your lover some time and space to settle down (a day, a week). You get to the airport and discover that your flight is delayed three hours. Rather than getting bent out of shape by this, what could you do the make this time most productive. It’s Sunday afternoon and you have nothing to do. Rather than getting bored, what could you do with this time? And so on.

Notice that each of these situations ends with what YOU could do.

Part Five: Attitude is Everything

In this article I have mentioned that the real key to giving up control—of learning to live comfortably in the key areas of life—is to change the way we make sense of the world. To achieve this, the 12 Steps suggests you “let go and let God.” Viktor Frankl said to ask Life what it demands of you.

Another technique is to change your attitude to life. Most people in active addiction and in early recovery don’t have a great attitude. This is not surprising; their lives are a catalogue of misery and suffering. And most are exhausted from the unrelenting demands of addiction. It’s not as if addicts can take a couple of months vacation from the addiction and go down to Florida for a break. Why would they take a positive attitude to life?

One of the keys to recovery, and to happiness, is to change things from being a chore to some positive effect:
• Cravings are a sign that you are recovering.
• A bad experience is an opportunity to learn and become stronger.
• Parents who refuse to give you money are giving you the space to be your own man.
• A severe illness is a sign that you’d better get on with the business of living.
• Addiction is a wake-up call that you’ve been missing out on life.
• Hitting a wall on your way to a goal is an opportunity to develop creativity and hardiness. (The basis for just about every Hollywood movie.)

Conclusion

Each of these positive ways of looking at problems can happen only with a positive attitude. This was one of Viktor Frankl’s key points. You are quite capable of developing this attitude; the key is whether you are willing to fight for a better life, whether you think that you are important enough to dig deep and overcome adversity. Sadly, many in recovery crash and burn when faced with real challenge.

By Geoff Thompson
Program Director
Sunshine Coast Health Center

Several of the alumni have been asking recently about the biology of addiction. One asked whether eating sugar was a sign that one was still in addiction (sugar is a mood-altering substance); another fellow asked if it were possible to be born an addict.

These questions are asking if addiction is mainly a biological condition. That is, is addiction mainly a disease or illness? There’s a lot of controversy about whether addiction is a disease or not. And this debate is a good thing, because it means that people are talking openly about what addiction is. There is energy on both sides of the debate, bringing in new life.  

This article will look at this debate. It’s interesting in itself; researchers and clinicians like to argue about these details. But for those in recovery, this is not an academic question, removed from life. The answer that you tell yourself will dictate, in large part, how you live your life in recovery.

Those who believe that addiction is a disease will likely have a different recovery plan than those who do not believe it is a disease.

If you believe addiction is a disease, then you face certain ‘realities’. For example, you have to come to terms with the ‘fact’ that the disease of addiction has no cure. Most people compare it with diabetes; others say it is a “brain disease” like depression. In either case, though, recovery demands daily treatment. This treatment may be through self-help programs such as Alcoholics Anonymous or SMART Recovery. It may be through long-term counseling. Or both.

Those who adhere to the disease model also believe that they will always have a dagger hanging over their heads. They have to learn to accept this situation, because having a slip means there is a real danger of again being overcome by the addiction—it’s the interaction of the drug with the brain that is the addict’s illness.

Those who do not believe addiction is a disease still have to deal with the effects of drugs on their brains. They know they will have to deal with cravings and other neurobiological effects. They know that they will likely have troubles if they are not true to themselves. But they don’t believe that they are only one drink or drug away from being plunged back into active addiction. This is because they do not believe that the substance is the problem; that is, they don’t believe that their brains are hijacked by the drug.

Generally, they believe that they will ‘recover’. Those who believe in the disease model, on the other hand, face the prospect that they will be in recovery for the rest of their lives.

So let’s examine some of the more public examples of the disease debate. As always, if you are in recovery you are the author of your life, so you’ll have to figure this out for yourself.

Part One: Alcoholics Anonymous and Disease

The Big Book of AA states that alcoholism is an “illness.” Of course, it’s a very strange illness, since the Big Book also says that alcoholism is “an illness which only a spiritual experience will conquer.” At one point, the book calls alcoholism a “spiritual disease.”

When we examine the meaning of the words illness and disease in the Big Book, it is obvious that they are not technical terms. Bill W. never took a medical course in his life and certainly knew nothing of Koch’s Postulates (or other illness definitions), which is how diseases have been identified scientifically for more than a century. (You can google Koch’s Postulates if you’re interested.)

So, if the Big Book doesn’t define illness or disease in a technical sense, then why does it use these words? Generally speaking, the Big Book uses the terms as metaphors. The early members of AA wanted to point out a couple of things about alcoholism. First, they knew that alcoholics reacted differently to alcohol than did non-alcoholics. They were also convinced that there must be a biological reason for this, which is why AA looked to Dr. William Silkworth and several other physicians as sources of scientific information.

Apart from the doctors’ opinions, they also knew that alcoholics were not particularly comfortable in the world; they had a “dis-ease.” The idea of ‘dis-ease’ provides a much better definition of how the Big Book uses the word.

As an aside, it is one of the more baffling things historically that AA became associated with the disease/illness model of addiction. AA is, after all, a bunch of alcoholics, not medical doctors. Most experts have suggested that the reason why the public links AA with disease was that AA received two major public awards.

The 1951 Lasker Award of the American Public Health Association was awarded to AA. The citation read, in part, “In emphasizing alcoholism as an illness, the social stigma associated with this condition is being blotted out.” The 1983 President’s Service Medal was presented to AA, praising Bill Wilson and Bob Smith for “helping each other to overcome the disease.” So the public latched on to these medical ideas, even though the Big Book clearly considers alcoholism as a “spiritual condition that requires a spiritual solution.”

Part Two: Dr. George Vaillant and Addiction Medicine

Perhaps the most famous addiction medical doctor (a psychiatrist), George Vaillant, says that addiction is a “disease.” Dr. Vaillant is a top-of-the-line researcher at Harvard University Medical School. In fact the medical doctors who specialize in addiction medicine state publicly in their association that addiction is a disease.

It’s interesting that because Dr. Vaillant knows so much, he is very open in saying that there are good reasons for not calling alcoholism a disease!

One of his major points is that medical experts don’t actually agree on what a disease is. They keep changing their minds whether, for example, ‘heart disease’ is a disease or a lifestyle problem. He lists several other objections, but the most important is that alcoholism is a “behavior.” In fact, he says, “alcoholism is often better treated by psychologists skilled in behavior therapy than by physicians with all their medical armamentarium.”

Although Vaillant is quite convinced that alcoholism is a medical issue, he also says “In other words, calling alcoholism a disease, rather than a behavior disorder, is a useful device both to persuade the alcoholic to admit his alcoholism and to provide a ticket for admission into the health care system. I willingly concede, however, that alcohol dependence lies on a continuum and that in scientific terms ‘behavior disorder’ will often be a happier semantic [word] choice than ‘disease’.”

To sum up, if addiction is a disease, it’s an odd one; and, technically, it is probably better to call it a behavior disorder. However, if alcoholics think they have a condition similar to heart disease or diabetes, then they will more likely ask for help. And if the public thinks it is a disease, then it won’t stigmatize addicts and think of them as criminals and irresponsible lay-abouts.

Part Three: Dr. Nora Volkow and Neuroscience

The July 16, 2007, issue of Time magazine said that addiction is a “disease,” because drugs “co-opt” the brain. The March 3, 2008, issue of Newsweek reported that drug use is a “disease,” because drugs “hijack” the brain, leaving the addict powerless.

The journalists who wrote for Time and Newsweek got their information from Nora Volkow and her colleagues. Dr. Volkow is the head of the National Institute of Drug Abuse (NIDA). NIDA is the US national institute of health concerned with ‘drugs’ (the other is the ‘alcohol’ institute of health). These institutions are funded by the federal US government, and are quite public that they consider addiction a disease.

Dr. Volkow’s perspective is a little different than Dr. Vaillant’s. Volkow is more specific, calling it not merely a disease, but a “brain disease.” It’s almost routine that when journalists want information, they ask NIDA, which is why Volkow shows up often on television and in newspapers and magazines.

Basically, she says that addiction is biological, a direct result of the effects of the substance interacting with the brain. The brain progressively deteriorates just as in any disease. From her point of view, because addiction is a disease, it will be ‘cured’. Through some medical procedure to be discovered, she is quite certain that we will eliminate the disease, just as we have essentially eliminated leprosy.

Of course, other brain scientists think Dr. Volkow’s belief in a cure is wishful thinking. One of their major arguments is that the brain is so complex that it will likely not be possible.

Part Four: Addiction as Not a Disease

So now we have shown the theories of two of the finest scientific minds studying addiction: Dr. George Vaillant of Harvard Medical School and Dr. Nora Volkow, who is head of one of the biggest drug research institutes in the world.

Both of these scientists tell us that addiction is, essentially, a disease. But other, equally competent researchers say it is not a disease. These anti-disease experts argue that although there may be a physical basis in the brain for drug use, this does not mean addiction is a disease, and many say it is not even an illness.

They provide lots of evidence for not considering addiction as a disease. William Miller, one of the gurus in the field, says that addiction is a matter of motivation. Bruce Alexander says that drug use is a response to not having a deep sense of belonging (remember Rat Park). Stanton Peele says that drug use is essentially a combination of lack of direction in life and an unhealthy environment. In fact, Stanton Peele wrote a book complaining about the medical professionals who were attempting to convince us that we’re all diseased. 

Conclusion

Thinking of addiction as a disease poses some problems. First, it eliminates sex, gambling, and other behaviors as addictions, because there is no substance to “hijack” the brain. They also point out that there are documented cases of alcoholics becoming social drinkers, something which seems impossible if addiction is a physical illness. And they point out that Dr. Lee Robins would not have found that most Vietnam Vets gave up the heroin on their own after they returned to the US if heroin had “hijacked” the soldiers’ brains.

And almost all psychology textbooks used in university show research that contradicts the idea that addiction is a physical illness.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

Earlier this week, I had a thoroughly enjoyable discussion with Paul Murray, a private-practice psychologist based out of West Vancouver, British Columbia. Our discussion covered a lot of ground but one topic that I found particularly engaging was the notion of powerlessness. Both Paul and I marvelled at how two people declaring powerlessness over their addiction may have two very different treatment outcomes based on fundamentally opposing underlying intentions: one may reflect a preference for the status quo while the other could be ready to turn over a new leaf.

How Powerlessness Became Synonomous with Addiction

Obviously, this idea of powerlessness is not something that Paul and I invented. As friends of Bill W. will tell you, powerlessness lies at the heart of the 12 Steps of Alcoholics Anonymous and it’s first step: We admitted we were powerless over our addiction - that our lives had become unmanageable. Al-Anon has also consoled family members for years by telling them that they, too, are powerless over alcohol.

Over the years, however, Alcoholics Anonymous and other 12 Step programs have had their fair share of critics with powerlessness frequently at the heart of the dispute. For example, SOS, has created an alternative self-help group for “… those people who find that the ideas of reliance on a Higher Power or God, “powerlessness” and the emphasis on character defects to be an obstacle to recovery.”

The addiction treatment community has long since argued for and against the notion that individuals with addictions are ’powerless’. Powerlessness proponents tend to be traditional 12 Step treatment programs, physicians, and psychiatrists while those opposed tend to be psychologists, scholars, and mental health practitioners. The ongoing debate between these opposing camps has only hampered efforts by moderates to find common ground.

Furthermore, the debate over powerlessness and addiction is more than just a trivial concern judging by the vitriol one hears expressed on talk-back radio programs.

Defining Powerlessness

Let’s consider five different ways that powerlessness is understood in relation to addiction:

1) Powerlessness is a Choice

Recently, a book by Harvard psychologist Gene M. Heyman (*), Addiction: A Disorder of Choice, has suggested that individuals choose to be powerless. Dr. Heyman argues that addiction is voluntary rather than compulsory, and that addicts respond to incentives just like most other people. According to Dr. Heyman, interviews with drug users in recovery shows that quitting was preceded by such factors such as finances, family, career, and health.

People who suffer from diseases such as Alzheimer’s or schizophrenia, however, will rarely find improvement in their condition due to good intentions, even when followed by concrete steps. In other words, human beings are only truly powerless when faced with ‘real’ diseases.

One important difference between Dr. Heyman and other opponents to the concept of powerlessness, however, is that while Dr. Heyman believes that to remain powerless over an addiction is a choice, noone chooses to become an addict. As our Program Director, Geoff Thompson, often reminds our clients, children rarely tell their parents ”when I grow up, I want to be a drug addict.”

(*) Note: For more information, see Interview with Gene M. Heyman.

2) Powerlessness is a Lack of Willpower

Society often believes that, with a little bit of willpower, people can simply stop using drugs or alcohol or reduce their consumption to socially acceptable levels. This mistaken belief, however, is actually a failure to distinguish between the separate, progressive stages of compulsive use of chemicals or processes: abuse and addiction. As Carlton K. Erickson points out in his book, The Science of Addiction: From Neurobiology to Treatment, addiction is a failure to stop using in spite of negative consequences. Abusers of alcohol or drugs, most notably college students, will often stop excessive consumption when they are in a new environment where getting high or drunk is no longer encouraged, or when they experience negative consequences. For individuals with addictions, however, drinking or drug use will continue even after job loss, divorce, or illness.

Even for people who don’t struggle with addiction, however,  it is arguable whether simply trying harder is an effective method for attaining any worthy goal. Most who have tried to lose weight or have implored their children to improve their grades know that trying harder may work, but only temporarily. Without an effective strategy and implementation plan, willpower is not enough.

3) Powerlessness is the Same as Helplessness

Helplessness can be understood as the tendency for some addicted individuals to assign blame to external forces and avoid taking personal responsibility. So, when someone says “I am powerless to stop my addiction” they could be actually saying, for example, “my drinking wouldn’t be a problem if only my wife would get off my case.” This lack of accountability is typically obvious to everyone but the individual with the addiction, including those of us working in the field.

However, while it may be easy to spot helplessness in another person, determining the root cause of why someone is so incapable of taking action is far more challenging. For example, helplessness could be a response to childhood trauma, a phobia or depression. Taped recordings of AA Founder Bill Wilson suggest that he understood the link between helplessness and addiction. Following the sudden death of his childhood sweetheart, Bertha Banford, Bill Wilson concluded that “He knew now …. His need, his loving, didn’t matter a good goddam. His wanting, his hunger and desire, meant nothing to the terrible ongoing forces of creation and he would never forget this truth which he saw and accepted that night.” * Helplessness, as illustrated by Bill Wilson’s recollection, may not simply be a result of laziness but a reflexive survival mechanism in respsponse to painful past experience.

(*) Source: Thomsen, Robert (1975) Bill W.

4) Powerlessness is a Symptom of a Disease

The disease concept of addiction found an early advocate in the recovery movement with Dr. William Duncan Southworth, physician to AA founder Bill Wilson. By providing a physiological explanation for why alcoholics are powerless over their use of alcohol and through his close affiliation with Bill Wilson, Dr. Southworth helped shift the balance of power in addiction from organized religion to medicine. 

Dr. Southworth’s observation that alcoholism cycles between mental obsession and physical lack of control (or powerlessness) has stood the test of time. Defined this way, powerlessness is a common criterion used in the assessment of addiction. For example, Sunshine Coast Health Center recommends an addiction test, called the 3 Cs of Addiction: compulsion, control, and consequences. * What the 3 Cs test calls compulsion and control, Dr. Southworth calls, respectively, mental obsession and physical allergy. While the term ‘allergy’ may be arguable, alcoholics do appear to be physically powerless to stop drinking once the obsession to drink overpowers their decision not to drink.

(*) Note: see the Helplessness section above for information on the 3rd C - consequences.

5) Accepting Powerlessness is Critical to Lasting Recovery

First of all we had to quit playing God.
~ Alcoholics Anonymous, p. 62

This last example of powerlessness has been intentionally left to last since, unlike the first four definitions, this last definition will conclude this blog article on a hopeful note. Fortunately, many individuals have successfully come to terms with their addiction and have gone on to lead fulfilling lives in recovery. At Sunshine Coast Health Center, clients learn spiritual principles that often prove helpful as basic action guidelines in recovery. One spiritual principle, acceptance, seems particularly effective and is closely tied to the notion of powerlessness.

In his book, Not-God: A History of Alcoholics Anonymous, Ernest Kurtz suggests that “from the alcoholic’s acceptance of personal limitation [read powerlessness] - arises the beginning of healing and wholeness.” Furthermore, this message of “not-God” is, for Ernest Kurtz, an “affirmation of one’s connectedness with other alcoholics.” At Sunshine Coast Health Center, we wholly endorse the notion of connectedness, however, would extend it further to include family members, co-workers, and friends.

Conclusion

In the early days of Sunshine Coast Health Center, I will always remember how insistent one of our first clinicians was on the importance of making sure clients understand, at a gut level, Step One . As far as he was concerned, without a firm understanding of powerlessness, it is difficult, if not impossible, to properly work the remaining 11 Steps. However, I have learned over the years that words can often have multiple meanings and can trigger certain emotions depending on the perspective of the listener. By avoiding rigid absolutes, Sunshine Coast Health Center believes that it’s integrated approach allows clients to embrace multiple perspectives and, therefore, to appreciate the complexity that is inherent in any meaningful discussion on addiction.

By Geoff Thompson, MA, CCC – Program Director

One of the key features of the new program at Sunshine Coast Health Center is beginning the process of living a personally meaningful life—finding a way to overcome those nagging feeling of emptiness, boredom, loneliness that are at the core of addiction.

One more example of this understanding of addiction and recovery is Gabor Mate’s book, In the Realm of Hungry Ghosts, provides a description of addiction. Although he talks about biological predispositions and effects of the drugs (he’s a medical doctor), he refers often to the addict’s “void” or “emptiness” as the motivation for drug use.

Despite the recent flurry of writing on this approach, it’s not a new idea in the addiction field. The most famous attempt to help addicts fill that nagging emptiness is, of course, the 12-step program. Bill Wilson’s idea was that if the alcoholic could truly accept the presence of a benevolent higher power, then he would come to understand that his life was meaningful and worthwhile. The Big Book refers to this at one point as “God-consciousness.”

Most experts, like Gabor Mate, talk about connecting with some higher power as the means of achieving a meaningful life. But a big problem that some people encounter is the assumption that there exists a benevolent higher power (HP), one that has your best interests at heart. Someone pursing the steps, for instance, who doesn’t believe in this HP, will struggle mightily. Many AA and NA members argue that those who don’t believe in this benevolent higher power are simply ignorant or naïve; they have to “fake it ‘till you make it.”

But that plan might not work too well. Research psychologists at the University of New Mexico have found that the tactic of “fake it ‘till you make it” doesn’t work for the majority of those in early recovery.

If you are struggling with the dilemma of not believing a benevolent higher power and discovering that trying to fake it doesn’t work, are you doomed to relapse or the miserable life of a dry drunk? Thankfully, no.

The first thing to appreciate is that some of the finest thinkers in the past 100+ years have argued that the force that governs the world has no interest in human needs or desires. Geniuses such as Friedrich Nietzsche, Jean-Paul Sartre, and Eugene O’Neill did believe in such a higher power—they said that the higher power could care less about human needs or wants. Their higher power was simply some force that exists for its own sake. Think of gravity. It simply is. Gravity doesn’t care about you or anything else. For example, an avalanche or the stairs that you trip on don’t care one way or the other if you have kids or parents or provide paycheques to employees. Obviously, it would be crazy to put your faith in a higher power that does not care about you.

In our scientific and technological society, the idea of a benevolent higher power has little appeal for many. But if you don’t believe in a benevolent higher power, you aren’t doomed. In fact, each of the geniuses mentioned above gave us his own particular answer to filling the void, to finding some way of living that would make someone feel his life was worthwhile and important.

In this blog article we’ll take a look at four of their ideas: don’t be a sheep, practice grace under pressure, do the next right thing, and connect with others.

Don’t be a sheep

The great thinker, Friedrich Nietzsche, talked of the importance of sticking to your convictions (your values and beliefs), as a way to live a meaningful life. He said that the easy way out of life’s struggles was to follow the masses and do what others do. In psychology this has been called the “herd mentality.” The great addict-writer, Eugene O’Neill, called these people the “spiritual middle class…how petty their dreams must have been.”

People in recovery who are part of the herd are willing to give up who they are in order to be part of a group. Their need to belong is so great that they are willing to sacrifice themselves.

We have had phone calls from alumni who tell us they are struggling. When we unpack their struggles, we often find that they have become sheep. One fellow said that the pressure from his family was so great to attend meetings that he felt he no longer went to AA to find recovery; he was just going there to keep his family off his back. Another alumnus told us that he was simply going through the motions of recovery because he hoped that “something” would happen. He did this because it kept family was happy; in fact, everyone was happy except him.

Recovery demands filling the void. If the tactics you are using are not giving you a sense of vitality and energy, then this is a big red flag that you’d better switch tactics. It is likely that you aren’t paying attention to what you believe and value; you’re simply following the herd. This lack of vitality is a relatively common complaint from those alumni who just attend 12-step meetings. But, remember, that the steps are the key to the program, not meetings, and the steps demand of you that you find your own personal way through them: “To thine own self be true.”

“Grace under pressure”

This phrase is from the alcoholic writer, Ernest Hemingway, who believed that meaning came from facing a struggle heroically, without crashing and burning, without whining and whimpering.

And not just Hemingway. Eugene O’Neill and Friedrich Nietzsche, for example, agreed that the heroic person faced life bravely even knowing in the end he was doomed. It was this heroic stance that made the individual’s life important and worthwhile.

To understand what they were talking about, think of just about any Hollywood movie. The hero faces great odds to overcome a challenge: James Bond has to battle the evil genius, the small high school basketball player has to make the team, a group of men plan to rob the most secure casinos in Vegas, Sylvester Stallone has to face his own fears to rescue a friend in the mountains, and so on.

Of course, in Hollywood movies, the hero usually wins in the end, but winning is not a requirement. Will Smith in Seven Pounds takes his own life in the end. Edward Norton in 25th Hour goes to jail. Yet, we still admire them. 

These movies are popular because we admire the person who overcomes great odds. It is the struggle that is important. How popular would any of these movies be if the first time the hero runs up against a challenge, he throws up his hands and says, “F-it…I’m gonna get drunk.”

“Do the next right thing”

Writer Anne Lamott wrote, “I took a long, deep breath and wondered as usual, where to start. You start where you are, is the secret of life. You do the next right thing you can see. Then the next.” FYI: Lamott has written on alcoholism.

A friend of mine who has 27 years of sobriety takes these words to heart. In his experience, doing the next right thing has remarkable power to help him feel that life is meaningful and worthwhile. He worked at another facility, and I remember him giving money to a former client for cab fare. Sensing that the former client might squander the money on drugs, he said to the fellow, “Do the next right thing.” I don’t know if the fellow actually got a cab, which was the next right thing.

In recovery, doing the next right thing can look any number of ways. If you get a craving for booze, the next right thing is to not take a drink. If a family member gets angry at you, the next right thing is to stay calm. If you are in a tricky position where you know you can get out of it by lying, the next right thing may be to tell the truth. If you feel depressed, the next right thing may be to force yourself off the couch and go to a meeting. If someone is rude to you, the next right thing is to think that they may have had a really bad day. And so on.

Connect with others

We’ve talked about this one before, but it’s worth repeating. One of the keys to recovery is to connect with others at a deep human level. In active addiction we connected at a superficial level.

Here’s some research that highlights the importance of connection for recovery. An interesting, and little known, fact is that clergy and pastors have an addiction rate higher than the national average. Researchers first thought that this may be because they lost their faith in God. As it turns out, this is not the case. So, here we have clergy and pastors who have a firm belief in a benevolent higher power, and yet their addiction rate is high. How do we explain this?

Here’s one thing we’ve discovered: One of the biggest problems for clergy and pastors is that they don’t really connect that well with others. It’s never a level playing field. They are the ones people turn to when in trouble. They are the ones people turn to for answers.

And clergy and pastors always have to be conscious of the image they present to others, since they are considered role models. But what happens if a pastor has a big argument with his wife or doesn’t feel well or suffers from depression/anxiety? They still have to be role models, still have to present a certain image in public, still have to be ‘on their game’.

Another example is the novel/movie Leaving Las Vegas. Ben and Sera, the main characters, could easily dismiss each other: Ben is an alcoholic and Sera is a prostitute. They could reject the other; however, they learn to care for the other as a suffering human being. Leaving Las Vegas is a plea for us to care for each other, even those whom society dismisses as unlovable.

By Geoff Thompson, Program Director

Sunshine Coast Health Center

A requirement for living a fulfilling life is feeling a sense of belonging in the world. One of the key problems with those suffering from addictions is that they feel they are different. They feel they don’t fit in. They feel they don’t belong. Clients at Sunshine Coast are often asked to think back to their life in active addiction: did they feel they just didn’t fit in, that they didn’t feel that they were the same as others, that something was wrong with them? Perhaps they became something of chameleons just to fit in with different groups of people. In fact if you listen to the stories of addicts, this is one of the most common themes. If you are in recovery, listen for this at the next 12-step meeting you go to, or read any of the stories in the Big Book, or watch a drug movie such as Barfly with Mickey Rourke or Panic in Needle Park with Al Pacino. You will hear what it’s like to be an outcast in the world.

So a great deal of life in recovery is often spent finding a sense of belonging in the world. So often, clinical staff at Sunshine Coast Health Center hears from those clients who have slipped or relapsed that they didn’t feel this belonging. Here’s a typical example: ‘I cleaned up, did everything suggested to me, I’m living this middle class existence…and I’ve never been so bored in my life!’. Other clients report that they don’t find a sense of belonging at 12 step meetings. Or even at home. In short, they still don’t feel comfortable in the world.

So how do we pull off this trick of feeling completely comfortable, whether at an AA dance or at work or at home? This article looks at some of the strategies people in recovery can use.This is an important point: To find a sense of belonging in the world requires action. Clients are often reminded that they are the authors of their lives. Waiting for someone else to help may mean waiting an eternity. 

Tip # One: Start asking yourself, “What does Life demand of me?”

Addicts are notorious for demanding that people (and situations) change to suit their own needs and expectations. What this looks like in daily life is that they usually go about their lives making demands on the world. Some examples: I demand that I be able to use drugs, even though they are illegal. I demand that I be allowed to drink and drive, because I’ve run out of booze and I really need more. I demand that I be allowed to leave the family for three days to get loaded and then be forgiven. I demand that I be the centre of attention. I demand….I demand…I demand. For Sunshine Coast clients, this may remind them of the story King Baby.

Alumni at Sunshine Coast are often asked: “What are you prepared to do for your recovery?” One of the reasons we ask this is because so many clients come into treatment making demands on recovery: ‘I will stay in recovery if and only if…’ and then come the demands. ‘I came into recovery to learn how not to use my drug of choice….but I demand that I be allowed to have a beer or smoke pot because they were not problems for me’. Or how about this one: ‘I will take risks…but I demand that I only have to take risks that I’m comfortable with’. Or this one: ‘I demand that my recovery progress only if my family is fully supportive’.

Some clients get upset when they call a government office and then get put on hold for 30 minutes. They are demanding that someone answer their call immediately. Some clients get frustrated when they have to wait 90 minutes at the hospital to get their blood tests done. Some clients get upset when there is no space in the van to go to the recreation complex. Some get upset when their family members do not visit.

In all these examples, the person is making demands on others and on situations. The reason that this is dangerous for recovery is that anyone who makes demands on Life is still an outcast, still on the outside of life looking in.

A much better approach is to stop demanding that people act a certain way or think a certain way. The strategy to accomplish this is to ask yourself, ‘What does Life (this situation) demand of me?’ The genius of this approach is that people in recovery then join in with life. When they join in with life, they’re no longer on the outside looking in, no longer an outcast.

Tip # Two: Start connecting with others in the community

Another approach to feeling a sense of belonging is to get involved in the world. 

It probably isn’t a surprise to you to learn that researchers have found a very strong link between recovery and volunteering. And, as we remind our clients, at every 12-step meeting there are really three meetings: the get-together before the meeting, the meeting, and the get-together after the meeting. The reason for this is that you need to feel ‘part-of’ the group.

Here are some examples of things that Sunshine Coast alumni are doing: volunteering to be the contact person for Sunshine Coast clients when their program is over, volunteering to sit on a Board of Directors, volunteering to be the Group Service Representative of their AA group, helping out serving Christmas supper in a poor neighbourhood, coaching a minor hockey team, giving talks to high school kids on the dangers of drugs, raising money for a charity, helping out at the local amateur theatre group, helping promote environmental awareness, joining a political party, etc. It’s quite remarkable that those alumni who do these things also say they are doing well in recovery.

It’s a strange thing, but most of us don’t even know our neighbours. It’s hard to feel a sense of belonging when we don’t even know who’s living next to us. Lots of people in recovery go out of their way to be good neighbours. Some typical examples are helping out shoveling snow after a snow storm, holding a neighbourhood barbeque, joining a neighbourhood-watch program or an ‘adopt-a-street’ program to pick up litter, sending Christmas cards to each neighbour, inviting a neighbour over for coffee.

Tip # Three: Start taking action to make different parts of your life more appealing

It’s interesting that people who are fulfilled in recovery do things that are very meaningful to them.

Some alumni have worked jobs that they find no longer a challenge. In recovery, they have returned to school or are pursuing other careers.

Some are near retirement or have other obligations, so they cannot realistically give up their jobs. But they have done things to make the job more interesting such as relocating to another company office, shifting to a new location, asking their manager if they could work toward a higher position, giving up working overtime, sitting down with someone they have a conflict with and working it out, sitting down with their manager and expressing what is troubling them, etc. All of these strategies have the same purpose: to make the job more comfortable to go to.

As well as making work more interesting, many alumni have made their home life more exciting. Here are some of the strategies alumni have used: Wednesday night is family movie night, doing something special for each member of the family once a week, having coffee in bed with their partner on Saturday morning to talk about their relationship.

Tip # Four: Start looking at the positive

We all know that life is filled with misery. In fact, psychology researchers have discovered, as have artists, that our greatest fear is the knowledge that we will die. This is what the so-called ‘midlife crisis’ is all about: we’ve lived half of our lives, we’re not as physically resilient as we used to be, and we have gained the wisdom to begin reflecting on what we’ve accomplished.. And we also know that we will likely get sick or have an accident or have to deal with the goofy things our teenagers do.

We all suffer. People in recovery may find It’s easy enough to complain about the jerk at work or the AA member who smokes pot and yet takes a cake. It’s easy to dwell on our own weaknesses and the weaknesses of others.

But it is also true that we have many gifts: freedom of choice, freedom to change the way we look at ourselves and at the world, freedom to find something meaningful even in the worst possible situation. We’re not like a rat in a cage, who is trapped. We have the blessing of changing our situation and our attitudes. Remember that passage in the Big Book that says, “nothing happens by mistake”? We have the wonderful ability to learn and grow even from our worst failures.

We’ve known for thousands of years that we react to things according to how we make sense of them. It’s not the things in life that are important, but how we interpret them.

By Geoff Thompson - MA, CCC
Program Director
Sunshine Coast Health Center

On Valentine’s Day, Sunshine Coast Health Center sponsored Dr. Wayne Dyer’s new movie, Ambition to Meaning, for the Powell River community, with the proceeds going to the local food bank.

The movie is about the benefits of living one’s life according to what one believes—living life from the inside out. Dyer’s main point is that in the “afternoon” of our lives we have to start living according to who we are, and not according to what society tells us to do. We spend the “morning” of our life being ambitious — we get a job, buy things, get married, and so on. As we get older, our job is to start living a personally meaningful life, a life that matches who we are. As Dyer puts it, we have to shift from “ambition” to “meaning.”

Dyer’s message is similar to the new program at Sunshine Coast. The difference is that we are closer to the ideas of the great psychologist, Viktor Frankl. Frankl would agree with Dyer, except that he emphasizes that this drive for meaning is part of us from the beginning. We merely distract ourselves with “ambition.”

Looking at life from the inside out is the same as being true to yourself. Each of us is unique, and each of us has to live according to what makes us unique.

Those of you in 12-step programs probably realize that this idea fits beautifully with Alcoholics Anonymous and Narcotics Anonymous. The 12-step program tells us that our essential problem is not substance abuse, but that we allow our egos to run our lives. According to AA and NA, our ego controls us. This is not good. Those who live by the demands of the ego have several mistaken beliefs. First, they judge their worth by the amount of stuff they have; second, they believe they are what they do; third, their self-esteem is based on what others think of them.

Dyer’s version is similar to the 12-steps: Ego equals ambitious living; the “authentic self” equals meaningful living. So, according to Dyer and the 12-steps, we have to stop allowing the ego to control us and live a life that appeals to who we really are.  

Unhappy people, such as addicts, let their ambition control them. In the Wayne Dyer movie, a woman reduces her life to being a mother. A man reduces his life to making money. A filmmaker reduces his life to being a director. But people are so much more than what they do and so much more than their role or money or reputation. In the movie, these three characters are not fulfilled.

In this article we’ll explore Wayne Dyer’s idea that we have to stop living by the ego (ambition) and start being true to ourselves (meaning). We have to start living life from the inside out, instead of from the outside in.

An External Orientation (Ambition)

An “external orientation” is a term used in psychology. What it means is that some people live their lives outside of themselves. Just about everything they think and do is based on what others tell them. In the Wayne Dyer movie, these are all the unhappy characters — those controlled by their egos.

Sunshine Coast clients struggle mightily to look into themselves — at least at the beginning. When a client is angry we ask him, ‘What is it about YOU that makes you angry?’ Most clients don’t like this; they prefer to look outside themselves: ‘I’m angry because Harry said he’d buy me a magazine and he didn’t’; I’m angry because my parents still don’t trust me’. One client even told us that he came to Sunshine Coast to give his parents “time to get their act together”! These are clients who are externally oriented.

Here are two real-life examples supplied by the alumni: Tom believes that the more money he has, the more successful he is. He works at his job because he gets a hefty pay-cheque—not because he likes the work. His family pressures him to make lots of money because his son wants expensive hockey equipment, and his partner likes to buy jewelry.

Harry and his partner are struggling. He’s been clean and sober for a year, but she still blames him for all the problems in their marriage. She is suspicious of an AA meeting that Harry likes to attend because Harry talked about a woman there with whom he had coffee after the meeting. To keep the peace with his wife, Harry no longer attends that AA meeting. He also makes sure he gets back home right after work so that she does not have an excuse to accuse him of anything.

Tom and Harry live life according to what they think others demand of them. In psychology, we say that they are “externally oriented.” They look to others or to things to make them feel okay. They look at life from the outside in, with predictable results: they choose to be victims.

An Internal Orientation (Meaning)

Alumni who are doing well have looked inside themselves for answers. They’ve figured out that they had the answers all along. When they are angry, they look into themselves for the cause of the anger. They do things because they believe in what they do, not because someone else wants them to do it. Happy alumni tell us, for example, that they attend AA because it helps them in their recovery (an internal orientation). Struggling alumni tell us that they attend AA because this makes their families happy (an external orientation).

Remember that saying on the AA chip: “To thine own self be true.”

But we have to be realistic about life, too. There are lots of things we cannot control. I may have wanted to be a NHL hockey player, but I don’t have the physical ability to do so. The actor Christopher Reeve likely had the desire to throw a football with his son, but as a quadriplegic, did not have the physical ability. I may want to be vacationing on a beach in Rio, but I have to pay the bills. I may wish that people were always polite and thoughtful, but I know that this is simply not true. I may want to win the lottery, but I also know that my chances of being dealt a royal flush in the first hand of a poker game is nine times more likely to occur.

Life limits all of us. Even so, happy people have developed an internal orientation; they look at life from the inside out.

Developing an Internal Orientation

If you’ve been following along, you’ve probably figured out that letting society or advertising or other people tell you how to live your life is a recipe for unhappiness.

The most important tool is this: Look into yourself. You actually have all the answers.

Wayne Dyer’s version is to pay attention to what makes you feel alive. One must be cautious here, however, since feeling alive is NOT craving an adrenalin rush. Don’t confuse feeling alive with the urge for superficial excitement. In Dyer’s movie, he shows a housewife who feels that something is missing in her life. It dawns on her that she used to love painting when she was in college but had given it up when she married and had kids. Picking up the artist’s brush again fills the hole in her life. Another fellow in the movie focused on making money until he realized that love for his wife and his marriage was more important than material success.

The housewife and the businessman had to look into themselves to find what made them feel alive and vital and whole.

Looking into yourself is the key, but you also have to be alert to any barriers that YOU have erected against this. Have you chosen to be a victim? Have you chosen to believe what advertisers tell you that to have a good life you need lots of material things? Have you chosen to keep wearing a mask around others? Have you forgotten Rule 62 and think that you have some magical power to control others? Here’s a common one: lots of clients truly want a good relationship with their parents. But before even talking with them, they expect a fight. So, they usually act in a way (prepare for a fight) that will never allow get what they want! To thine own self be true can be tough.

If you’re wondering how you will know when you’ve learned to look into yourself for answers — what Wayne Dyer calls living a meaningful life — there is an easy way. Your gut will tell you. When your actions match your beliefs, you will ‘feel’ it’s right.

Lessons from the 12-Steps of Alcoholics Anonymous

The 12-step program has tactics to help you develop an “internal orientation” and find happiness. According to the steps, addicts live their lives according to the demands of their egos. The ego has an external orientation; it deals with the outside world and is concerned with itself and its image and not with others.

Bill W.’s psychoanalyst, Harry Tiebout, described the addict as follows: “The so-called typical alcoholic is a narcissistic egocentric core, dominated by feelings of omnipotence, intent on maintaining at all costs its inner integrity.” Put in everyday terms, Tiebout is saying that the addict is self-centered, arrogant, and filled with pride.

The steps are one way to overcome these traits. The solution to self-centeredness is, first, finding a higher power. Tiebout recognized that if the addict truly believed in a HP, then he could not logically think himself the center of the universe. Secondly, helping others. If the addict helped his fellow suffering addict, he would learn that others were equally as important as he was.

The solution to arrogance and pride is humility and surrender. So, as you can see, this is one reason why the “spiritual principles” are so important in the steps.

The ‘I am’ Experience

Living life from the inside means that you must be convinced that you exist as a person in your own right. This may seem obvious, but most addicts have not figured this out. In fact, many unhappy people have not figured this out. The famous therapist, Rollo May, had a knack for helping someone when other therapists failed. According to May, this was because he first helped his patients develop an awareness that they were unique, living human beings.

Rollo May gives an example of a woman who was overwhelmed with shame because she was an illegitimate child. The woman went to several therapists who explained to her that she lived a shame-based life and this stunted her growth, gave her techniques to get rid of shame, and so on. None of this worked.

According to May, these strategies didn’t help because she lacked a sense that she was a human being. This is a bit tricky to understand. Being aware that she is a living person does not mean she knows ‘who’ she is; it doesn’t mean that she has dealt with her issues. It means that regardless of what she struggles with she is still an individual. 

One day, she figured it out. Despite the fact that she was illegitimate, she realized that she was still a person. And that’s what counted. Only when she figured this out could she begin to overcome her ‘issues’ and live a great life.

We’ve noticed at Sunshine Coast that those who are successful in recovery have developed this sense that they exist. One client told us that it “just hit me.” Despite all his struggles, despite not knowing ‘who’ he is, he realized that he was a living, breathing human being. After this realization, he was more accepting of others, he started thinking seriously about what kind of job he wanted. He started thinking about what made him feel truly satisfied, and so on. He even started smiling.

Rollo May calls this the “I am” experience. A light-bulb goes on. Suddenly, the person realizes that he is, at bottom, a person. The famous philosopher Descartes said, “I think, therefore I am.” Rollo May answers, “I am, therefore I think.”

Bill Wilson, the legendary co-founder of Alcoholics Anonymous, would find the program at Sunshine Coast Health Center (”Sunshine Coast”) very much to his liking. Sunshine Coast interprets addiction and recovery in the same spirit as Wilson did, the difference being that Sunshine Coast’s program is based on scientific research.

Key points

Influences on Bill Wilson

In 1961, two decades after the birth of AA, Bill Wilson wrote a thank-you letter to Carl Jung for his influence on AA. In the letter, Wilson mentioned the other three influences on the development of AA: William James, William Silkworth, and Samuel Shoemaker (from the Oxford Group).

We know from Bill Wilson’s psychoanalyst, Harry Tiebout, that Wilson read Jung’s work. And we know from the letter that Jung sent to Wilson that the Swiss doctor confirmed Wilson’s interpretation of addiction and recovery, arguing that alcoholism was a spiritual condition that demanded a spiritual solution. In his letter to Wilson, Jung wrote that the alcoholic’s “craving for alcohol was equivalent on a low level of the spiritual thirst for our being for wholeness, expressed in Mediaeval language: the union with God.” He went on to tell Wilson that “You see, alcohol in Latin is “spiritus” and you use the same word for the highest religious experience as well as the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.”

Jung argued if someone suffered from an “unrecognized spiritual need,” then alcoholism was one response. Only spirituality (some conversion experience) was powerful enough to overcome the spirits provided by alcohol.

Bill Wilson learned about William James when a friend gave him a copy of The Varieties of Religious Experience while Wilson was detoxifying in Towns Hospital. In the book, James wrote that getting high on alcohol or nitrous oxide was a mystical experience, one form of religious experience.

William Silkworth had been Wilson’s personal physician. Silkworth had attempted to provide a biological basis for the common observation that alcoholics reacted qualitatively differently to alcohol than non-alcoholics, though Wilson did not share Silkworth’s specific interpretation that the alcoholics had an “allergy.” But what helped Wilson was knowing that there must be a biological basis to alcoholism, that it was not a matter of character weakness or sin.

Strangely, the ‘disease’ concept became linked to AA in the popular mind, though it was never really a fundamental part of AA. Wilson had never taken a medical course and knew nothing of Koch’s postulates that inform our current pathology models. He used the term as a metaphor and emphasized that “Alcoholism is a disease that only a spiritual experience can conquer.” If we take Wilson’s “disease” literally, it is the strangest ‘disease’ in the history of pathology, since no medicine can help the sufferer. That AA became linked to the disease model was likely the result of the public health professionals awarding prizes to AA, promoting the idea that AA’s influence was to interpret addiction as a “disease.” This interpretation was clearly antithetical to Wilson’s idea, which promoted addiction as a “spiritual” condition.

Samuel Shoemaker ran the local Oxford Groups that had helped Wilson and others in their early recovery and provided a rough version of the 12-step strategy: admit there is a problem, confess character defects, make amends for harm, and help others. Despite this early influence and Wilson’s recognition of it, he pulled the early AA out of the Oxford Group in less than a year because he believed that their views were too rigid.

SCHC and Wilson’s Interpretation of Addiction and Recovery

Sunshine Coast is very much in line with the 12-step interpretation of addiction and recovery, the difference is that we base our interpretation on research evidence and psychological theory.

Viktor Frankl had said that “Alcoholism is not understandable unless we recognize the existential vacuum underlying it.” Frankl believed that human beings had an inherent need to make sense of their lives at a deep level. When this need was persistently frustrated, then alcoholism could be one result. Research has confirmed that quality of recovery improves with an increase in personal meaning. Andersen & Berg (2001) conducted longitudinal studies and concluded that meaningful living was linked directly with abstinence, a conclusion that William White (2004) also found. Frankl’s therapy, known as logotherapy, has produced several treatments for addiction (Crumbaugh, 1980; Langle, 2005; Somov, 2007). Paul Wong, who developed the form of therapy that we use at Sunshine Coast, also has applied a form of Frankl’s work to help addicts recovery (2005).

Based on the influences of James, Jung, and Shoemaker, Wilson always maintained that alcoholism was a response to living the personally meaningless life. In 1943, at the Shrine Auditorium in LA, he described the alcoholic as the fellow “who was trying to get his religion out of a bottle, when what he really wanted was unity within himself, unity with God.” According to Wilson, the pursuit of drunkenness was the pursuit of a connection with oneself and a connection with some force that would provide him with a belief that he was ‘part of’, that he belonged in the world around him.

And the addict was disconnected even from himself. The “defects of character” and “wrongs” were symptomatic of alcoholism and maintained the alcoholic’s disconnection from the world: jealousy, anger, grandiosity, impatience, and so on. The Big Book uses the example of jealousy to show that what the jealous person really wants is to love and be loved; jealousy was merely the alcoholic’s tactic to protect himself from losing his lover. So, the alcoholic’s defects were those that prevented his being authentically true to himself.

The stories of AA members in the Big Book, which take up two-thirds of the book, are a catalogue of suffering that arises from this disconnection from the self and the world—and ultimately from any higher power that could provide some overarching meaning—as expressed through the ‘defects of character’.

If the alcoholic’s problem was essentially a separation from his true self, a separation from others, and a chronic feeling of emptiness, of something missing, then the solution must address this disconnection. The AA program is designed specifically to help the AA member reconnect with his authentic self, reconnect with others, and reconnect with a Higher Power. Silkworth contributed “The Doctor’s Opinion” to the Big Book, where he described the goal of recovery as “an entire psychic change.” Step 12 describes this as “a spiritual awakening.”

According to AA, this entire psychic change could be relatively quick, but more often was of the “educational variety,” a phrase borrowed from William James. This change specifically grew out of spiritual experiences, or what is called at one point in the Big Book, the development of “God-consciousness.”

Sunshine Coast also has as one its main clinical goals the beginning of the process of “transformational change,” a phrase from White (2004), though others have called this a “quantum change” (Miller & C’de Baca, 1994). Like Wilson, these psychologists concluded that abstinence may be the byproduct of transformational change, not the first step in recovery or the prerequisite to recovery.

Transformational change, for both Wilson and the psychologists, meant that a person began living a life that was true to their authentic self. For Wilson, comfort arose from a faith in some transcendent power, and thus the alcoholic had no need to distort or hide experience. For the psychologists, it was a matter of choosing a life that was true to the self, thus changing fragmented personality into a congruent one, aggressiveness into assertiveness, and conventionality into authentic living.

At Sunshine Coast, transformational change is essentially this process. We use narrative therapy to help clients understand how they have interpreted their lives in a way that is not working out for them. Their narrative also maintains they’re disconnection from self, others, and from anything that would provide some overarching meaning in their lives.

Wilson’s Interpretation of AA as a Personal Journey

The steps are deliberately vague. Wilson believed that each person had to find his or her own way through them. Recovery was a personal matter and no recipe could be provided. The most obvious example of this is Step 2: “Came to believe that a power greater than ourselves could restore us to sanity.” This is the end result, but the key to this step is to figure out ‘how’ to come to believe. AA provided a book, Came to Believe, to help members. This book is 100 stories of how 100 different members found 100 different ways to come to believe. Wilson’s strategy was to provide a framework, not a recipe for recovery. He believed that only a journey that was personally meaningful to the individual would be successful.

Wilson and Professional Help

It is an interesting phenomenon that many AA disciples believe that Bill Wilson was divinely inspired. This may be an artifact of the conservative Christian influence on AA, in that conservative Christianity pervaded American society at the time and was, for example, the driving force behind prohibition legislation in the US (as was the women’s rights movement). But it is logically impossible to understand this belief given that Wilson had specifically mentioned the influences on AA in his letter to Jung.

And Wilson, himself, would have been disturbed that others thought that he somehow had a direct line to God when they did not. He had repeatedly declared in public that “Nobody can cause more grief than a power-driven guy who thinks he has got it straight from God. These people cause [the world] more trouble than the harlots and drunkards.” And he often said that “AA is a terribly imperfect society because it is make up of terribly imperfect people.” Ernest Kurtz provides a more down-to-earth explanation that Wilson and AA had resurrected a form of spirituality that celebrated human imperfection as not merely a fact but as the stepping stone to a connection with God.

What Sunshine Coast does in it’s program that Bill Wilson would like

1. Our family program introduces the 12-step program to families.
2. Clients attend AA/NA weekly. And an on-site meeting with local AA/NA members helps clients become comfortable in a meeting environment (although, because we invite only alumni and friends of SCHC, this meeting cannot be sanctioned by AA/NA).
3. Each week we provide a workshop on one of AA/NA’s spiritual principles, which also have a basis in the scientific study of positive psychology. The steps emphasize that recover comes from practicing these principles.
4. Each week we provide a workshop on the 12-step program as interpreted by scholars such as Ken Hart and Ernest Kurtz. This workshop highlights the origins of AA as well as practical matters of membership. It also highlights the influence of 12-step based treatment on AA, so that clients are not confused about certain things they hear at meetings that contradict other parts of the program. As one example, a long-term AA member may share at a meeting about how miserable their life is, when the 12-step program itself emphasizes “what it was like, what happened, and what it is like now,” because Bill Wilson understood the importance of providing a message of “experience, strength, and hope.”
5. The overarching theme at Sunshine Coast, which informs every component, is that recovery means reconnecting with self, others, and with a Higher Power, which is how Bill Wilson defined “spirituality.”
6. Workshops are usually conducted offering a psychology point of view matched with the 12-step point of view. For example, clients learn that Viktor Frankl’s recipe for happiness is to ask oneself “What does life demand of me?” is matched with the 12-step saying “Live life on life’s terms.”

 Twelve-step principles are also infused throughout the program:

1.  Staff attitudes are based on empathy and unconditional positive regard, just as AA emphasizes “principles before personalities.” They do not succumb to power struggles with clients; they do not tell clients what to believe.
2. Staff practice the spiritual principles, under the 12-step principle of “attraction, not promotion.”
3. Each client is encouraged to find his own way through recovery.

Conclusion

The 12 Steps of Alcoholics Anonymous has become synonymous with addiction treatment even though it was never intended to be professionalized into therapy. However, Sunshine Coast recognizes the importance of spirituality as an important ingredient in recovery and has included psychoeducation group discussion that focuses on the evidence-based aspects of the Big Book. Furthermore, since 12 Step groups are often the only source of recovery (particularly in small communities) for many individuals in North America, Sunshine Coast believes it is important that clients have a better understanding of some of the misconceptions that have fueled the controversy surrounding the 12 Steps.

Readers with questions about the philosophy of Sunshine Coast Health Center are invited to contact us directly at info@schc.ca

References

Andersen, S., & Berg, J.E. (2001). The use of a sense of coherence test to predict drop-out and mortality after residential treatment of substance abuse. Addiction Research & Theory 9(3), 239-251.

Crumbaugh, J.C., Wood, W.M., & Wood, C.W. (1980). Logotherapy: New help for problem drinkers. Chicago, IL: Nelson Hall.

Langle, A. (February 4-5, 2005). Addiction and the search for meaning. Two-day workshop presented at Trinity Western University, Langley, BC.
 
Miller, W.R., & C’de Baca, J. (1994). Quantum change: Toward a psychology of transformation, in T.F. Heatherton, & J.L. Weinberger (Eds.). Can Personality Change? (pp. 253-280). Washington, DC: American Psychological Association.
 
Somov, P.G. (2007). Meaning of life group: Group application of logotherapy for substance use treatment. Journal for Specialists in Group Work 32 (4), 316-345.
 
White, W.L. (2004) Transformational change: A historical review. Journal of Clinical Psychology 60(5), 461-70.
 
Wong, P.T.P. (October 5, 2005). Meaning-centered approach to addiction prevention, treatment and recovery. Workshop presented at Vancouver Community and Family Services, Vancouver, BC.

Geoff Thompson - MA, CCC

Geoff Thompson, Program Director at Sunshine Coast Health Centre, discusses lessons that can be learned from the 12-step model of addiction recovery, and how these tie in with Wayne Dyer’s theory of internal orientation.