By Marty N.
Every Wednesday morning for the past year it
has been my privilege to explain the LifeRing approach to an ever-changing
population of patients in the locked dual-diagnosis acute crisis ward of a local
hospital. Because stories are more interesting to a captive audience than
abstractions, I describe my recovery as a wrestling
rivalry that began with a 300-lb Boozer-User and a 120-lb Sober Guy, both
living in my head. I tell
how Sober Guy used to talk to me in the mornings, telling me to stop wasting
my life and stop being a slave to the bottle. I tell how Boozer-User
every afternoon would kick sand in Sober Guy's face.
One
day I got a wake-up call. My 10-year old son observed that I fit the
description of a "drunkard." Those words out of the mouth
of a babe stunned my Boozer like a two-by-four to the head, and jolted Sober Guy into action like a cattle prod. In that window of time I was
able to get myself into a treatment program, and the program got me into
self-help support groups. There, my inner Sober
Guy discovered other Sober People, stopped feeling lonely, learned new moves,
started working out and bulking up. Meanwhile my inner Boozer was suffering
atrophy from lack of fuel, and was losing confidence.
After a considerable time, with Sober Guy bulking up and Boozer shrinking,
there was a rematch. This time Sober Guy kicked Boozer's
behind, and he has been doing it daily ever since. And so I was changed from a drunkard
with a little Sober Guy imprisoned inside into a sober person who has a mean,
shriveled up Boozer-User locked up inside.
Whenever I hear that dried-up
Boozer's voice now, I slap him upside the head, because I've been there, done
that, got the T-shirt and the bumper sticker, and I'm not going back. And
that's my story.
In this article, I want to tell the same
story by means of theoretical abstractions and diagrams. By way of introduction, I would like to
quote a passage from an article by Prof. Edward C. Senay, Emeritus Professor of Psychiatry and Director of Research,
Interventions, University of Chicago. In his contribution to the
college text Substance Abuse, A
Comprehensive Textbook, 3d Ed, 1997, edited by Lowinson et al., Dr.
Senay writes:
"The majority of substance
abusers […] are intensely ambivalent, which means that there is
another psychological pole, separate from and opposite to denial, that
is in delicate, frequently changing balance with denial and that is a
pole of healthy striving. Most substance abusers are quite aware that
what they are doing is destructive, that they have been deceived by the
culture of drugs and alcohol, and that they want to change. If this were
not true, there would be no Alcoholics Anonymous, Cocaine Anonymous, or
Narcotics Anonymous [...]. The job of a clinician is to appeal to this
pole of healthy striving. Even for those in complete denial, one must
assume that there is a positive pole, because one can be sure that it
was not there only in retrospect." ("Diagnostic Interview and
Mental Status Examination," in Lowinson, op. cit., p.
364).
Whenever I am asked to explain
theoretically what we do in LifeRing meetings and "how it
works," I
begin by drawing the outline of a head on the board, and within it I sketch a
large area labeled "A" that represents the addiction, and a smaller
area labeled "S" that represents its opposite - what Prof. Senay calls the "pole of healthy
striving." (Figure 1).
This sketch -- meant purely as a
metaphor, not as a picture of brain anatomy -- represents the alcoholic or
addict as they usually stand at the beginning of recovery. That is to say, the
"A" or addicted element within them is large and dominant, the
"S" or sober element is comparatively smaller, and the "A"
overshadows it. The actual relation between these poles in a real person is,
as Prof. Senay aptly points out, an ever-changing balance; but the sketch
approximates the average state of a typical person at the start of getting
sober.
We have many names for the "A" part
of the picture. We call it the addiction, or the disease, or the lizard brain,
or the Beast, or the Devil, and many others. But oddly, we have a paucity of
names for the pole of healthy striving. In the groups I lead, I sometimes call
it the sober place, or the sober self, or I personify it as the Sober Guy or
the Sober Gal -- the Sober Me -- within. Whatever its name, by the time an alcoholic or addict
shows up on the radar screen of a recovery program or a recovery self-help
support group, it is usually active and visible to the discerning eye.
Two main kinds of evidence tell us that a sober
place or sober "self" is present within the person. The first is the
psychological experience of inner dialogue. I have spoken with hundreds of
alcoholics and/or addicts in various stages of wetness and dryness, and almost
without exception they report having conversations -- arguments -- in
their heads about their drinking and using. Typically there is one set of
voices arguing for getting wasted, but another set arguing against it. (Fig.
2) The
active user's inner conflict over drinking and using, which may appear on the
surface as "ambivalence," is one sure sign that the force of
addiction within the person is not the only occupant, and that a lesser but
opposite presence is also active within. Inner conflict over
drinking/using is one of the almost universally shared experiences of our
subculture.
The other class of evidence which tells us that
there is some kind of element or force for sobriety within the
alcoholic/addict in recovery is the existence of self-help recovery
organizations. As everyone knows, the only requirement for membership in them
(and our own group is no different in this respect) "is a sincere desire
to get sober." We know with certainty that a sincere desire to get sober
does not originate from the diseased or addicted force within the person. It
must arise from an opposite force, a force of health and of anti-addiction - a
sober place within. Without that "pole of healthy striving" within
the addict, as Prof. Senay observed, no self-help groups could
exist.
If we start to deconstruct the
"sober place" within an active or recently active
alcoholic/addict, we will probably find several sources. Part of it
is the remnant of the person's pre-addicted life -- the years of childhood and
perhaps of
other periods in life when the person functioned without drinking/using.
Part of it stems
from the kind of primitive reflex-like survival instinct that makes even
a depressed, suicidal person fight for air when someone pushes their head
under water. Part of it is the emotional deposit left by waves of harmful consequences
from our drinking/using. Part of it may stem, as
the neuropharmacologist Elliot Gardner has suggested, from the binary
chemistry of the drugs of addiction themselves: in the short term they trigger
the pleasure circuits, but they also activate slower "opponent" chemicals
that are anti-rewarding and make us want to stop. [Gardner, "Brain Reward
Mechanisms" in Lowinson, op.cit. p. 68]. Part of it represents
our persistent rational reflection that there has got to be a better
way. The
sober pole within an addicted person is a complex construction of many
layers and pieces. It would be useful to know more about how this
element slumbering within the active drinker/user comes to assert itself
and to influence behavior. We do know that if the pole of sober striving
within the person remains dormant and subordinate to the addictive pole, then the
addiction will sooner or later consume them and they will die of the
consequences.
Experience shows that this fatal negative
imbalance of power inside the addict can change and be reversed if two or more
come together in an environment of support for sobriety. In what follows, I
attempt to sketch how the self-help group process works to yield recoveries.
The group environment and its rules are clearly
important. We know, for example, that if two individuals who are constituted as
described in Fig. 1 meet in a bar or a drug house or some similar
environment, for the purpose of drinking/using, then typically the communication will run between the addicted
part of the two heads, and the interchange will reinforce the addiction.
"Have a drink" - "Let's get wasted." This is addicted self
talking to addicted self. (Fig. 3) This kind of interaction notoriously adds weight to
the addiction in both heads at the expense of the sober strivings. This
is a vicious cycle of addiction. Drinking
and drugging environments are not only fueling stations for the substance,
they are support groups for the behavior. They are places where the person
gets strokes for drinking/drugging and sympathy for enduring the consequences.
Sobriety support group environments -- sound
ones, in any event -- are designed to shut down addict-addict bonding and to
promote positive exchanges between the sober selves instead. This design
is partly explicit, and partly implied. For example, the opening statements of most of our meetings
expressly bar persons from speaking if they are under the influence. On
the other hand, no written rule forbids sober meeting
participants from discussing, for example, the merits of different
kinds of wines or liquors, or the best growing regions for sinsemilla. But participants
would recognize implicitly that this kind of topic celebrates
drinking/drugging, and awakens and stimulates the addicted brain
region. Someone who ventured into this area would be met with silence
or a change of subject. The written and unwritten
prohibitions of a sobriety support group aim to isolate the addicted parts of
the participating brains from one another, to deprive them of social stimulus,
to deactivate them and as far as possible put them to sleep. What we are
trying to awaken, to foster and to protect is communication from and to the sober places
within one another, as in Fig. 4.
Sober talking to sober is the channel
where we want the traffic. The objective is to connect the sober places with each
other, and to stimulate their activity and raise their energy
level.
What flows through this communications channel
is at first sight "just words." (There is of course also nonverbal
communication, facial expressions, body language.) However, words have the
power to change feelings and thereby to change behavior. If I am feeling
lonely and I come to you and say "I feel lonely," I will probably
feel less lonely as soon as the words reach your ears. Similarly, if we feel
angry, or frustrated, or any number of things, we can change those feelings by
speaking them to others who hear us. This "magic" is the basis of
all talk therapy. Even tangles of terrifying feelings that twist our bodily
tissues in knots can be released through talk. [Judith Hermann, M.D., Trauma
and Recovery, N.Y. 1997, p. 183].
Sober-sober communication is a win-win
transaction; it creates pluses at both ends. "I am sober today." By
voicing that statement to you, I affirm my sobriety and make it public to you.
This is a plus for my sober self. With these simple factual words, heard by
you, my sober self is celebrating an achievement. And you, who hear this
statement, also experience a plus. If you were unsure that sobriety is
possible, you may take encouragement. You may take it as a stimulus to do
likewise. You may take it as comfort that you are not alone in your own
sobriety. And if you respond, "I also am sober today," the effect is
doubled. You again experience a plus; and so do I, hearing you. A bond is
built between the sober parts within us, and the sobriety within both of us
grows larger, stronger and deeper.
What holds for simple affirmations goes also
for the more complex communications that take place in most self-help
meetings. For example, a member shares an anecdote from the previous week:
"I was at my brother's house and he offered me a beer. And I said, no
thank you, I don't drink anymore, and I didn't." Often, a statement like
this will bring applause from the group. Applause from the group is a powerful
method of social reinforcement. This anecdote sends strong positive
messages. The speaker made a decision to prioritize sobriety over sibling
ties. He defined himself as a non-drinker. He stuck to his sober guns.
Everyone who hears the anecdote mentally analyzes it from various angles and
applies it to their own situation. It is stored away in memory for the
occasion when it may be needed. It becomes part of everyone's sobriety tool
kit. Over time, each participant hears and shares hundreds of such
experiences and builds them into a mental mosaic that is a meaningful
guide to action for that individual.
The desired result of such an accumulation of
pluses over time is the resilient dominance of the sober self. The important
thing is the resilience. During the hour that the person spends in a
well-functioning sobriety meeting, the sober place
within the mind is dominant. The sober self is active and has the
run of the brain. It hums with the energy derived from
the immediate connection with the other sober selves. This is the
beneficial cycle of sobriety. The addicted portion,
during that hour, is isolated, disconnected, inactive. The problem is to maintain
this temporary sober dominance and make it enduring. When the meeting is over and
the sober minds unplug from one another, the sober striving tends to retreat
and the inner addiction to revive. This is why no single meeting is enough. It may take a great deal of time,
many repetitions, and the accumulation of a great many
"pluses" before the dominance of the sober force within the brain
becomes tenacious, so that over time and on the average, the
person's makeup comes to resemble Fig. 5, in which the sober part overshadows
the addiction.
By the evidence, the addicted portion never
disappears completely. People may experience catastrophic relapses after ten,
fifteen, twenty years or even longer. Nor is the addicted portion
"dead." It can continue to generate mentation and emotional activity
for life. Accordingly, the new positive imbalance in the mind is not a static
end result, a final fate, any more than its opposite, the dominance of the
addicted self, was a final fate. The inner dialogues do not disappear, but
this time they have a different outcome, and because of that they are
experienced not as tortures, but as affirmations, even as celebrations. The
person started recovery as an addict who has a sober self locked up within;
the person becomes transformed during the recovery process into a sober person
who has an addicted self locked within. That is the only difference, but it is
a profound one.
Although the images I have sketched are not intended
as pictures of brain anatomy, the basic process is consistent with
psychobiologist D.O. Hebb's
rule that "the strength of a synapse between two neurons is
increased by the repeated activation of one neuron by the other across
this synapse." (Hebbs,
1949). Both the strengthening of the sober circuitry and the
corresponding atrophy and reduction of the addicted brain networks through
repeated social activation and non-use, respectively, exemplify basic
patterns of brain development. (Siegel, The Developing Mind,
Toward a Neurobiology of Interpersonal Experience (Guilford Press, NY
1999), pp. 13-14). [See Review.]
I believe that the foregoing process describes
-- in a very generalized, schematic way, to be sure -- how our self-help
recovery groups work. I base this description on having attended something
approaching a thousand of our meetings over the past seven years and more.
Although I have attended only a few meetings of other kinds of self-help
groups, and have never participated in an AA or NA meeting, I will be so bold
as to conjecture that when they work at all, they all work approximately this
way. Prof. Senay's
observations quoted at the outset suggest that this dynamic between the two
contending "poles" within the person is what makes possible the
existence of self-help groups in general.
On several occasions when I have presented
these thoughts and diagrams before audiences of people familiar with the
12-Step process, I have been told that "this is exactly what we do
also." And indeed, there is much in the AA universe that resonates with
this description of the healing process. There is the image of AA as "two
drunks talking;" there is the emphasis on the sharing of
"experience, strength and hope," and much else. Yet, as soon as my
interlocutors tell me that what I have described is exactly what they also do,
they feel assailed by doubts. The process of mutual self-help I have described
relies on communication among humans. The healing
power comes from a specific purposeful kind of interaction between people, much
as fire comes from skillfully and persistently rubbing two sticks together. Reflecting on this,
my interlocutors grow confused. This sounds so right, so intuitively correct,
so much in accord with experience -- but what about the "Higher
Power"? The therapeutic process here described has no need of a
"Higher Power" hypothesis.
Reduced to its barest essentials, the road map
that we sketch for the newly recovering person comes down to these few words:
empower your sober self. In Prof. Senay's words, "the job of the
clinician is to appeal to this pole of healthy striving." For us, as
LifeRing participants, the job is to help one another find and recognize this
"Sober Me" within us, and to assist one another in reinforcing
that place, extending its influence over our behavior, and increasing its
energy level, until it
becomes the dominant force within us, overshadowing the addicted side. This is
what it means to make sobriety one's priority. This process is not easy or
quick. However, the concept is so clear and simple that a newcomer can grasp
it on day one, and it supplies enough challenges to last a lifetime.
For a short PowerPoint presentation (19
slides) on the topic discussed in this essay, see
Empower Your Sober Self.
For a longer PowerPoint presentation (48 slides) incorporating this topic,
see LifeRing 101. For details on the LifeRing meeting process
such as the role of sharing and crosstalk, meeting leadership, and other
issues, read the LifeRing Handbook of Secular Recovery, available
in print or online from LifeRing Press.
LifeRing
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