Recently I had a conversation with a colleague who asked for a recommendation for a therapist for one of his patients with addiction who was having family problems. I responded by asking how vigorous of a recovery program she was working? His response was something like this, “Oh, she’s in recovery. But the problem is that some people have intraspsychic conflicts and interpersonal deficits that make it difficult for them to engage support networks.” That really didn’t answer my question, or maybe it did.
My colleague doesn’t see the difference between being in recovery from an illness and working an addiction recovery program. Yes she’s not using; yes, she’s attending her appointments; yes, she even goes to a few meetings; but she’s not working a recovery program.
Recovery, as the word is used in 12-step fellowships, means a great deal more than going to meetings and not using. It involves work and so is most spoken of as “working a recovery program.” Of course there are people who don’t work a program who consider themselves in recovery, but they are missing out on some of the best things recovery has to offer. So what is it to work a recovery program? We’ll take 12-step recovery as an example.
In 12-step recovery, it is the steps that are worked, not just once, but on a daily basis. We can break that down, and I have in other writings, so I won’t repeat it here. But what is important to reveiw is some of what happens when someone works the steps.
The first thing that generally happens is that the person stops trusting the thinking that got them into trouble. They start to uncenter themselves as the driving force in their life and start opening up to others. They start to gain friends and fellows whom they trust and with whom they gain trust by being honest on a consistent basis. They have many methods to deal with day to day feelings and start to trust the universe that things will work out now that they aren’t running the show. They stop being afraid of things and can face their challenges honestly.
I thought about that when my colleague told me that his patient had become depressed and non-functional after her husband left her, that she felt alone and was moving in with her father to be taken care of. I thought of the family difficulties that I’d seen handled by people in recovery and how they responded. I thought of situations like his patient’s that I’d seen in people in recovery. I thought of the bands of recovering women I know who support each other, and I couldn’t imagine how someone in recovery could be alone. I imagined what would happen to the women I knew in recovery if such a thing had happened.
They would have known from working the steps what was theirs and what was their husband’s and would not take his selfishness personally. They would express their feelings with their friends and would be surrounded by their recovery community. They would have worked the steps on their anger and their fear and found relief and peace. Of course they would still have feelings, but they’d have many tools and methods of dealing with them. They would not be helpless, alone, or unable to function.
So what about those that can’t get into a 12-step recovery program? When the symptoms of the illness prevent the person from engaging in 12-step recovery, we work with medications to aleviate those symptoms. Rather than decrease participation in recovery, I have found that correct application of medication increases participation in recovery. Once symptoms are relieved, we use cognitive approaches to help people change their point of view about the illness and the barriers they have to working a recovery program. Finally, for some, the 12-step approach is a barrier. They just won’t work that method. For them, we recommend other forms of recovery.
I’ve watched people get the same benefit from these other forms of recovery. What good recovery programs have in come is this: a reliance on taking life on its own terms rather than self will, a community without a hierarchy, a mentor who serves rather than bosses, honesty and confession, personal amends, helping others. If a recovery program has those things, the person working the program will likely get the same benefits.
Most of those benefits are spiritual. There is a calm that comes with acceptance of how the world works. When we are running the show, there’s a constant fear that we’ll mess up or that someone will figure out that we can’t do it. We’re alone and isolated, spending our energy to erect and maintain a false self that we present to the world. When we are working a recovery program, we can relax, because we aren’t running the show. We don’t have to be afraid of others or the universe. It doesn’t mean that we’ll get our way or that everything will work out well, just that we’ll stop making things worse. We find that the world isn’t nearly so scary when we aren’t at the wheel.
There are neurobiological benefits as well, especially for the person with addiction. When we are running the show and feeling isolated or afraid of being found out, we actually lose dopamine receptors. We feel less of our brain’s own dopamine. Working a recovery program literally makes us feel better. That’s why people in recovery don’t use drugs or compulsive behaviors; not because it’s wrong, but because they don’t need to. In addition, studies have shown a lot of other health benefits of a spiritual life from less brain loss with age to lower blood pressure.
As someone who treats addiction, I don’t think stopping drug use is sufficient as an endpoint. It’s a necessary beginning. The real endpoint isn’t a point or an end at all. The real goal of treatment is to create a person who is working a recovery program. Once that’s done, most other psychological treatment becomes unnecessary.
© Howard C Wetsman MD FASAM