psychology

Alcoholism, Psychology and “Cures”

Yesterday, I came across a statement that ran through my head like someone in a particularly ostentatious 70s track suit all day.

It was this: “There’s no cure for alcohol addiction”.

Umm… Yeah… Wait, maybe… No… Huh?

This statement seems innocuous enough. But it’s actually worth discussing in depth. In fact, I may put on my Wittgenstein hat for a second and say that maybe the statement says a lot more about how crappy our definition of “cure” is (and our idea of “health” is) than any actual information about alcohol addiction or dependency.

It’s true that there’s no magic pill that will make it so someone will never want a drink again. This isn’t Tintin. Alcohol addiction isn’t a bacterium: It can’t be killed.

There is treatment for alcohol withdrawal, of course. The treatments, near as I can tell, are not particularly great, and this research basically suggests that withdrawal symptoms only be treated when they emerge, not on any kind of preventative schedule. But that’s not what we’re talking about.

Yes, alcohol addiction can be a life battle. That’s also true for any other kind of substance abuse or dependency, depression, schizophrenia, PTSD, rape trauma, DID, bipolar disorder, borderline disorder, autism-spectrum disorders… Basically, anything that hits our neurochemistry is something we can grapple with forever.

But let’s be very careful here for a second.

A lot of people conclude from the fact that there’s always the risk of relapse with the vast majority of psychiatric conditions that there’s no real change to our personalities or who we are. We’re just destined to play out the same tragedies and comedies over and over again, like characters in a Greek play.

But developmentally, nothing could be further from the truth. People are always changing. They’re gaining new habits and losing old ones. Their values change, their political affiliations change, their interests change.

Recently, I’ve been finding that I’ve barely been playing any of the old AAA games that I’d sink hours into. I don’t do any online play-by-post roleplaying. And that’s not just because of professional obligations. I find that, even if I have some time, I may want to watch a show, do a roleplaying session in person, or even take a walk more.

That’s staggeringly common. I don’t know if I could be called a workaholic (though I have had many people express concern about how much I work and the standard I hold myself to). But I don’t spend as much time with leisure as I used to.

Now, why is that the case? Because I decided that I really should try to embody the values that I held dear for as long as anyone’s known me. I decided that there wasn’t going to be a magical time where I’d have my calling handed to me. I had to push it and step onto my own path.

So the same personality traits and values are there, but I’m expressing them differently and valuing them over competing values more highly. Is that “change” or not?

Let’s say I get strep throat once. I take the medication to treat it. It goes away entirely: Only trace amounts of the streptococcal infection remain. Then I get strep throat again. Was I “cured” the first time?

Okay. Let’s say I get strep throat once. I take the medication, but I skip some rounds. It lays dormant, then a new bacterial load hits me. Was I “cured”?

Let’s say that the strep throat cost me an organ system. The bacteria are dead but that body part will never come back. Was I “cured” by the medication?

The point is that the idea of a “cure” is actually sort of arbitrary. Even more importantly, we can get affected by the same disease several times and have each of those times be separate incidents.

So, now we can go back to alcoholism. Can it be cured?

The fact is, people can develop better habits to manage and cope with any kind of psychiatric problem. They can learn how to combine medication, support groups, healthy routines, the use of support networks, and sometimes the use of a professional or mentor (like an AA sponsor or a religious figure).

So is a mental illness more like an infection, in that we can get the same kind of illness multiple times from different proximate causes, or is it more like diabetes, in that it’s something that’s in the background and can flare up at any time?

The answer is actually sort of, “Both, sometimes more one than the other”. It’s also sort of, “Neither, because the ideas of ‘cures’, ‘treatment’, ‘management’ and so forth are all totally different when it comes to the mind”.

I say all this because people, when facing something like the soul-crushing fear and hurt from repeated sexual trauma or the agonizing intellectual despair of facing the fact that their steps away from depression may be temporary, begin to worry about each new day.

The wisdom of AA, that you take it a day at a time, is a good starting place. But it condemns the person with that kind of problem to a life where they are pulled by every ebb, flow, eddy and current of life. It makes their life reactive, not proactive.

Yes, someone with alcohol addiction problems may struggle for a very long time to find a set of new habits that will eliminate the temptation to turn back. Yes, many may always find that temptation to be there, not least because of the way that memory can tend to distort the bad and the good. Yes, events in our lives can sometimes permanently impact us and stick with us, haunting us.

But our losses, hardships and traumas don’t need to take something away. They can become assets and sources of strength. Our struggles with temptation can make us more compassionate and more aware of the value of life, and how rapidly we can see it slip away from us.

I firmly believe that most mental conditions can be conquered. I think we move from a stage where we battle every day, to a period where we are beginning to get good habits but there is a risk of relapse, to a stage where we have mastered the problem. The problem may come back, of course, but it could be in a new form. What drives a 20 year old in college into the bottle may not be the same as what drives a fifty-year old with a mortgage and a bridge club.

I have found that each of my crises in life, while related, have been distinct. I learned different lessons from each one. It’s too simplistic to point to one single problem that defines anyone. Just as a bacterium mutates and just as every organism is distinct, so too is “depression” or “alcoholism” an abstraction that we put onto a complicated phenomenon that is different each and every time.

When I work with people, I do often find myself having to warn them that what may seem like a temporary success is just a plateau, one they can slip off of. But if they keep doing the work, they are not likely to ever go back down to their original nadir. And even when they do, they will have the sangfroid to climb back up faster.

In any instance, combating and managing our bad habits, even when it may be a lifelong struggle, is a lifelong struggle worth doing. Every day, we will fight our weaknesses, our limitations, our hurts, and our ability to turn a blind eye to the others in our lives. We will fight to make sure that it is our love, hope and compassion that define us instead of anger and fear.

After all, why do people turn to drugs? There’s a lot of reasons, of course, and a lot of motivations, but it tends to boil down to, “I can’t handle something in my life without this drug”. Alcoholism is just a specific version of being unable to handle life, find joy and happiness or even some degree of entertainment to hold onto existence with, without some kind of external aid. People fill voids with all sorts of unhealthy habits: Biting their fingernails, abusing prescription medication, sex, even exercise. In fact, almost every victim of sexual trauma I’ve ever worked with literally finds themselves running for miles a day or exhausting themselves in the gym. It’s a combination of being able to run away from something, feel stronger and physically in control, feel free, and also get that endorphin high.

So when we “relapse”, what that often means is that life hit us in some new way we weren’t prepared for. It can’t be thought of as just the same problem in a new disguise: It’s actually a new problem, being dealt with in an old way. The problem isn’t just the addiction: That’s just a symptom. The problem is our inability to respond to the stress.

Life will always dish out a certain amount of suck, as I found myself saying yesterday. We will always face challenges and unpleasant situations. But they don’t have to control us or make us anything that we don’t want to be. We don’t have to resent those challenges or resent being alive through them. And we can learn how to face them without falling into destructive patterns.

Maybe thinking about it in terms of a “cure”, then, is just not helpful. Maybe we should think about it as a battle.

Can the battle against pain be won?

Yes.

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2 thoughts on “Alcoholism, Psychology and “Cures”

  1. “Can the battle against pain be won?”

    No.

    Just to bring some balance in here. Pain isn’t universal, it’s not made up of one equation. Pain is individual, highly so and it requires, demands and – most importantly – deserves an individual evaluation.

    I agree, some of your techniques may offer help, release and peace for a while eventually just as much as they may assist in a person’s recovery.

    There are pains that are temporary and can certainly be “cured”, as in being made invalid by a person changing their life, perspective, etc., maybe their life circumstances, maybe even their period of time. The pain of being bullied every day at school for example can be ended simply by finishing school.

    But maybe that experience left another pain or was based on another pain, … other kinds of pain can simply require more, other battles can never be won.

    I’d say in the battle against pain sometimes a ceasefire is the best you can do. Of course you wouldn’t believe so and that’s perfectly alright of course. But in my opinion it’s insulting to tell a person they can win something that you know nothing about (“you” being a general term here).

    But, more about your post. I agree, being “cured” is something extremely relative and subjective. Maybe taking it day by day isn’t perfect, not in the long term. Now, I admit I have never been an alcoholic and I’ve never been to an AA meeting (or any kind of addiction) so I’m not entirely certain how much “day by day” is their standing concept. Still, I’d say in the beginning it’s a perfectly valid technique.

    I don’t think however it’s only reactive. It’s actually an active process in a person’s mind. “I’m gonna make it today” is an active and positive start for each and every day. When it’s met by success it reinforces someone’s own self-perception and awareness and opens the door to more steps, more approaches, more activities.

    I think addiction is a life-long struggle, for so many reasons. Of course one could blame it simply on new problems hitting us in new forms and on occasion that’s certainly true. But there are a lot of things that can leave a stain, a mark, a fissure – whatever you want to call it – inside us and that stays.

    In my opinion alcoholism is a symptom, one kind of expression for a pain inside. And if that pain’s root is a stain like that then there’s no real cure. But like most things alcoholism is neither a universal nor a singular event so one can almost never be certain.

    Now, I feel myself getting into a rage here so I’ll stop now before I say something that doesn’t belong on your site of positivity. 🙂

  2. arekexcelsior says:

    Yes, pain is specific and unique. It’s also general. Like I’ve said before: Dogs are very different, but very few dogs meow. We all share a lot of similarities even as we are all different. Ultimately, since pain has a neurological and neurochemical antecedent (it has to come from the brain), we can’t actually experience it in THAT qualitatively different of ways. While every person is unique, I’ve found that you start to see repeating patterns fairly quickly. Moreover, I truly feel that damage is rarely interesting. Things tend to break in pretty boring configurations.

    I truly think that long-term pains can be beaten “permanently”, in the sense that the habits that people learn can cause them to be non-issues. Maybe the issue will always be there, lurking in the background, but the habits become subconscious and effortless to maintain. Just like someone who has a problem with a nervous habit like hair pulling has to exert some discipline to stop it but then finds that the habit fades, so too can there be permanent progress on major issues.

    Is it insulting to tell someone that they can win a battle they themselves haven’t experienced? A military historian can tell you why the Civil War was doomed for the Confederates even though they didn’t fight in it, no one being left alive from that conflict. A doctor can heal a thousand stab wounds and never once have been stabbed. The idea that we have to directly experience phenomena to be able to make conclusions about them would leave us very sorely limited beings indeed.

    Moreover, since many battles are parallel, there is again in my opinion shared ground. Someone who has conquered alcohol addiction can understand a lot of what an opiate addict is facing, and help them accordingly.

    Your description of the success that comes about from facing each day… THAT’S the active part. That’s what I’m talking about. It’s the good habits that they start to develop, the good momentum, the ease, the feeling of vindication and strength. If you start every day a clean slate, that’s very passive and negative.

    I agree entirely that alcoholism is a symptom. But I disagree that those underlying pains can’t be dealt with. It is, I suppose, possible that some new pain will crop up. I think there are tactics to deal with pain, the tactics of which are enumerated in philosophies like Buddhism and rational-emotive behavioral therapy. I think that the battle can be won even if in a sense it may be perpetual.

    And the reason why I insist on this is in a sense deeply pragmatic, not just a result of conviction. Everyone believes they’re broken so badly they can’t heal, no matter how slight the problem is. Every person going through depression feels they can’t get out at some point, even though they can. The idea that there is ALWAYS a strategy, always a tactic, is a vital way to encourage survival. And it is well-supported by the empirical evidence.

    Thank you for your insightful comments!

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