The Sober Truth (22 page)

The notion of taking things one day at a time is also rather infantilizing, as it suggests that addicts cannot bear the burden of considering weeks or months without addiction. This would make sense if abstinence were like lifting weights or running a marathon: it’s useful to hang on to the “just one more” ethos to get through something that becomes increasingly difficult over time. But abstinence doesn’t have to feel that way. A more appropriate metaphor would be learning a new instrument: you may start out one note at a time, but before long you are learning minuets and sonatas.

The biggest mistake with “One day at a time” is that it’s backward. One of the truly useful things about understanding addiction from a psychological perspective is that this view breeds a kind of precognition: people become adept at predicting when the urge will arise.
²
In fact, thinking ahead is one of the most powerful tools in treatment, as it gives addicts a chance to head off their addictive urges long before those feelings actually occur. Purposely keeping one’s head down and refusing to think about the future is a formula for getting blindsided by powerful and unfamiliar feelings.

The idea that our behavior is influenced by our peer group is not unique to AA. The organization’s exhortation to “stick with the winners” is a way of encouraging members to seek out positive role models in the program, but its unwanted consequences can be painful and isolating.

Speaking only with people who have “gotten sober” is a good way to miss out on hearing or learning from the great majority who do not find AA useful. AA members who attach themselves to successfully sober members may well discover that they cannot seem to reproduce the same results in the same way. This can quickly give way to shame, bitterness, and resignation. After all, these winners in AA typically will not thoughtfully evaluate newcomers to give the most fair-minded opinion of whether AA is best for them. And they especially won’t advise anyone to look beyond AA for care.

There is a cruel dimension to this word choice as well: it strongly suggests that those who don’t stick with AA are losers. As we have already seen, the vast majority of people who attend AA are more likely to “lose” than win. And addicts may well internalize this concept and consider it a mark of shame when their efforts do not produce lasting results, adding “loser” to their list of self-recriminations. And for the people who remain, the word “winners” comes with its own set of complications, including a tenuous sense of superiority that may suddenly be forfeited in the years ahead.

Many new AA members are instructed to follow this slogan, which has informally arisen outside of AA’s founding texts. Its purpose is to break the routine of addicts and get them instantly and deeply involved with the program and to help shake the destructive cycle they’re in.

Alas, this particular prescription is essentially arbitrary. Like the thirty days almost universally recommended for rehabilitation centers, the ninety-day AA period is something pulled out of thin air, based on the intuition that three months should be enough time to get started on the right foot.

The 90/90 prescription, like other myths, has darker consequences as well. Even the most involved form of individual therapy—psychoanalysis (which I practice)—is almost always limited to four sessions a week. The idea that someone should make time for ninety consecutive days of meetings or risk feeling like a failure strains credulity. This is especially difficult for people who retain close relationships to friends or family, for whom being away from home frequently may stress already strained bonds.

The concept of “90 meetings in 90 days” sets people up for failure. Of course there are no actual consequences for missing a day, but the sense of obligation is real and carries its own emotional burden. Greeting someone just starting to address an addiction with such an arduous task is poor planning indeed.

This idea is embedded in step 6—
“Were entirely ready to have God remove all these defects of character“
—and over time, it has been expanded in subsequent AA thought and literature. Here is one list of potential defects in addicts from an AA pamphlet:

The idea that addicts have character defects is demonstrably false unless one includes in the definition of “character defects” all that makes us human. One problem with this idea is its universalizing nature: to suggest that all addicts suffer from the same defects of character is to strongly imply that all addicts are the same, or close enough. This notion is consonant with the AA philosophy, but fails to comport with real-world evidence. There are addicts who are lazy and addicts who are driven; greedy alcoholics and alcoholics who are selfless to a fault. Notably, these attributes cannot be demonstrated to be any more common in addicts than anyone else.

In terms of treatment, admitting that one suffers from these character defects is also irrelevant. Of course, the goal of treatment is to understand oneself better, and a candid self-evaluation comes with the territory. But the suggestion that one could ever cure an addiction by trying to be less critical of people, or by gossiping less, or by trying to think positively, is nonsensical. And the implicit message that addicts must catalog their flaws to get better is disrespectful.

What’s really behind the “character defects” myth is the old idea that to beat addiction, you should try to be a better person. From there it’s a short leap to the inference that addicts are bad people. This notion wends its way through the Big Book in any number of places, and reaches back through time to the Oxford Group and its foundational emphasis on sinning and salvation. It is a moralistic approach designed to engender contrition, compel surrender, and ultimately to rebuild people as better citizens. But it has nothing to do with addiction.

This has been one of the most widely believed of AA’s myths and one that continues to do harm. The assumptions behind it are twofold: (1) only an addict can understand and relate to the experience of addiction, and (2) the only counselor an addict will trust is someone who has been through that experience.

To the extent that any part of this myth has merit, it lies in the second assumption. It may be hard for some people with addictions to place their trust in the hands of someone who has not experienced addiction. This usually has to do with the shame an addict may bring to the therapy:
If I feel so terrible about myself, you must feel the same way about me, unless you have the same problem
. Of course, personally having an addiction is irrelevant to the ability of therapists, and part of any good therapy is working through mistrustful feelings together and ultimately developing a lasting trust based on compassion, insight, and a shared goal.

But the first assumption is fundamentally wrong: there is no truth to the notion that one must be an addict to treat an addict. Since addiction is a psychological phenomenon, it stands to reason that the best person to treat an addict would be someone who has trained in psychology. Of course that person might
also
be an addict, but his or her personal experience is essentially irrelevant. To elevate a personal history of addiction into a credential on its own is to miss out on the manifold benefits of professional training.

The idea that only an addict can treat an addict has led to the rise of thousands of “addiction counselors” whose only credential is their status as recovering addicts. At minimum, this treatment community does a disservice to addicts by practicing therapy without formal education; at worst, some of these recovering addicts may be seriously unfit to perform this work. A common consequence is counselors who simply repeat the Twelve Steps and recommend whatever worked for them, then express bewilderment and frustration when it doesn’t work for their patients.

This philosophy appears in the sponsorship model as well, which relies heavily on the notion that someone who has remained abstinent must possess useful wisdom that a newer member can use. But sponsors regularly impart their personal experience, not wisdom gathered from knowledge or a deeper understanding of the problem. And sponsors may eventually succumb to relapse, which is something few professional therapists have to worry about.

In the end, the myth that only an addict can treat an addict is also an insult. The idea that having an addiction makes people so different from others that only other addicts could possibly understand them is demeaning. Nobody would ever suggest that a doctor must have had cancer to treat cancer, yet in the 12-step model, addiction is accorded this special designation of “otherness.”

This homily (often apocryphally attributed to Albert Einstein) has found its way into popular culture, but it claims a special place in AA, whose members use it as a cudgel against themselves and each other for drinking when they should know better. Those of us who work in clinical psychiatry could tell you that this isn’t remotely close to the definition of insanity. Doing the same thing over and over again and expecting a different result is, at worst, a symptom of self-deception, or perhaps unfounded hope.

More to the point, addiction itself isn’t a remotely insane thing to do. Addiction has its own logic and its own purpose, as we’ve seen. And although addicts may engage in deeply destructive behavior, crazy they are not. People with addictions are usually quite aware of the reality and consequences of what they’re doing, including the painful knowledge that it “makes no sense.” They might
feel
crazy, but once an addict understands the psychology behind his or her behavior, that feeling often gives way to a more empowering sense of personal insight.

Like so many of the other myths detailed in this chapter, the insanity myth is too often used as a way to diminish addicts and to scold them for their behavior. Like the other AA credos we have examined, this one implies that addiction is a purely conscious choice, that willpower (or turning your will over to an omnipotent Higher Power) is all you need to quit, and that recognizing the irrationality of your behavior should be enough to jar you out of your addictive haze.

This expression wasn’t coined by AA, but it has been adopted by the recovery community. AA’s literature often mentions denial as one of the key personal defects that lets addicts persist in their behavior. (The fourth edition of the Big Book even has a section called “Crossing the River of Denial,” which begins, “Denial is the most cunning, baffling and powerful part of my disease, the disease of alcoholism.”) It isn’t hard to imagine where this myth came from. It’s based on a genuine phenomenon, namely that people with addictions often deny that, in fact, they have an addiction. But this denial is less about a failure to recognize reality than a natural need to reject the label “addict” and all the baggage that comes with it.

Recall that reversing helplessness is a core element in the psychology of addiction. Asking an addict to admit that he has an addiction understandably creates strong resistance, because it feels to him like being asked to admit helplessness itself. But when people understand how addiction works psychologically—as a fundamentally healthy drive to feel empowered when it seems like there is no other choice, I have often seen their denial melt away. It turns out that AA’s emphasis on denial is misplaced; denial itself isn’t the problem—it’s shame, coupled with a lack of understanding of the nature of addiction that makes “denial” necessary.

The denial myth is yet another way that addicts and their loved ones infantilize and insult those who suffer from addiction. It fits all too well with the narrative of addiction as a form of “insanity” performed by people with “character defects,” whose experience is so alien than only a fellow addict can ever save them. These ideas are understandable expressions of frustration recorded by people who look at the seeming illogic of addiction and throw up their hands in exasperation. But they do terrible harm to the very addicts whose recovery depends on understanding themselves without judgment.

Addiction seems to hold a special place in the American imagination. It is categorized as somehow different and separate from the problems and symptoms we all suffer. Partly as a result of this singular and mysterious strangeness, addiction is treated less like a common psychological symptom and more like a cultural one. In the absence of sophisticated knowledge, platitudes and homilies rush in to fill the void, many of which obscure far more than they illuminate. Folklore and anecdote are elevated to equal standing with data and evidence. Everyone’s an expert, because everyone knows somebody who has been through it. And nothing in this world travels faster than a pithy turn of phrase.