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Being Sober: A Step-by-Step Guide to Getting To, Getting Through, And Living In Recovery by Harry Haroutunian, MD Physician Director, Professional and Residential Programs, Betty Ford Center

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Being Sober: A Step-by-Step Guide to Getting To, Getting Through, And Living In Recovery by Harry Haroutunian, MD Physician Director, Professional and Residential Programs, Betty Ford Center

Chapter Two: But I’m Not A Falling-Down Drunk!

“A boo is a lot louder than a cheer.” --Lance Armstrong

When I was still a medical student, most of my friends already called me Doc, and I was the go-to-person, or “anchor man,” during times of sickness or trouble. One particular day, I got a frantic phone call from a couple of friends who said, “Harry, you gotta get over to Jake’s house. He just got back from Mexico, and something’s very wrong.”

Jake had walked into his empty house and found that his wife had left him with nothing. He was shocked, literally, when he tried to switch on the light and found that the switch plates were missing. The showerhead and the faucets were gone too, along with the shower curtain, rod, and rings. Even the little cap that covers the garbage disposal was missing. Everything. Mercifully, she did leave the toilet handle; otherwise, the apartment was stripped bare.

Jake was bright yellow, jaundiced from sort of hepatic or liver failure. He was as sick as a dog. His friends recognized it immediately and called me. I found him lying on a makeshift cot brought in with some blankets and a pillow. “Good God, Jake,” I said. “What have you done to yourself?”

Jake’s drawn-out reply was “Quaa-a-a-a-ludes.” “And how many Quaaludes did you take?” I asked. “F-f-f-f-forty,” he managed to reply. I knew that Quaaludes were easy to obtain in Mexico. “Forty Quaaludes?” I asked. “Why?” His response: “Gee, I don’t know, they were only a buck apiece.” Now that’s alcoholic and addictive thinking. Take as much as we can or more. More. We have the disease of more. (Jake’s yellow and red lights were broken; he only saw green lights.) There, but for the grace of God, go I.

 

Abuse Or Addiction?

Jake’s addiction was easy to spot. Jake couldn’t stop with just one Quaalude--he had to take a life-threatening dose. Jake’s wife left him because of his using, communicating her anger by taking everything possible from his physical world. Jake suffered physical consequences because of his using, communicating her anger by taking everything possible from his physical world. Jake suffered physical consequences because of his using--he had liver disease and almost died of an overdose. It doesn’t take a professional addiction counselor to understand that Jake was an addict. But for Jake, the realization didn’t come so easily. He only saw the green light when it came to consuming drugs. For the alcoholic or addict whose life circumstances are not as extreme as Jake’s, the realization comes even harder.

At the Betty Ford Center, we only make the diagnosis of alcoholism or drug dependence. We never call anyone an alcoholic or an addict until he or she first has that self-revelation. Once a person identifies as an alcoholic or addict, then that permission is granted to us. So, before we go any further, let’s take a look at the various levels of use and decide whether you or your loved one fall on the spectrum.

Not everyone who drinks is an alcoholic. Not everyone who uses illicit drugs is an addict. By the same token, not every alcoholic is a falling-down drunk and not every drug addict is wandering the streets. So how do we tell if we’ve crossed the line into addiction?

Social or Occasional Drinker

Some people can “take it or leave it.” They might have a drink or two at a wedding or a nice dinner, but they’d get intoxicated and don’t think about alcohol again for months or until the next big, social event. This person is usually not at risk for becoming an addict.

Problem Drinker/User

The problem drinker/user is at risk. They consume alcohol or drugs regularly with occasional periods of intoxication. Although problem drinkers/users may “grow out of it,” such as the college student who parties a lot in school but becomes more of an occasional drinker when the responsibilities of a job and family enter the picture, chances are good that there’s trouble afoot.

Abuser

The abuser’s regular consumption of alcohol or drugs is now identified by friends, family, and coworkers as a problem that also affects them.

Alcoholic/Addict

The relationship with alcohol or drugs has progressed fully. This person is experiencing biological, psychological, social, and spiritual consequences. He or she cannot stop. The pattern may be episodic bingeing or regular consumption, but the result is always unpredictable.

 

The Questionnaire

Online, you can probably find a hundred different questionnaires that can help you determine whether you might have a problem with drugs or alcohol. Although not conclusive, a self-assessment is a good place to start. More thorough evaluations are available, everything from a brief phone conversation with a counselor to a 7-day clinical diagnostic evaluation. But for now, answer this questionnaire, which is found on the Betty Ford Center Web site and has been reprinted here with permission.

YOUR “YES ANSWER TOTAL:

One “YES” answer:

Be aware. You may have or you may develop a problem with alcohol or other drugs.

Two or more “YES” answers:

Indicates you have problems with alcohol and/or drugs and should seek help immediately.

Do you have a problem with alcohol or other drugs?

Questions

  1. Do you drink or use to overcome shyness or to feel more confident?
  2. Are you having money troubles because of drinking or using?
  3. Do you ever stay home from work because of drinking or using?
  4. Is drinking or using causing trouble in your family?
  5. Is drinking or using giving you a bad reputation?
  6. Have you lost a job or a business because of drinking or using?
  7. Do you drink or use to escape your problems?
  8. Do you drink or use when you are alone?
  9. Do you have blackouts? (Loss of memory for events that happened or of actions you performed while drinking or using?)
  10. Do you feel remorse after drinking or using?
  11. Do you need a drink at a definite time every day?
  12. Do you drink in the morning?
  13. Have you ever been in a hospital because of drinking or using?
  14. Has a doctor ever treated you for your drinking or using?
  15. Do you drink or use too much at the wrong time?
  16. Do you make promises to yourself or others about your drinking or using?
  17. Do you have to keep on drinking or using once you have started?
  18. Is drinking or using making it hard for you to sleep?
  19. Have you had an accident because of drinking or using?
  20. Do you drink or use to relieve the painfulness of living?
  21. Do you have trouble disposing of cans or bottles?
  22. Are you less particular about people you are with and the places you go when you are drinking or using?
  23. Have you been arrested more than once for drunk driving or driving under the influence of drugs?
  24. Has drinking or using affected your health?

Reprinted with permission from www.bettyfordcenter.org

If, based on your answers to the questionnaire, you believe you’re not addicted, feel free to carry on as usual. You might, though, want to continue reading to the end. (There was a reason you picked up this book in the first place, right?) You may learn something new about yourself and about addiction. If, however, you answered yes to two or more questions, you’re “borderline” addicted, or you can’t be sure you answered the questions honestly, please read on. What follows may surprise you.

 

THE FIVE STAGES OF CHANGE

Most things have a tipping point--the point at which the buildup of small changes causes enough momentum to create a big change. In coming to terms with the idea that we might be alcoholics or addicts, many of us go through a similar process. We make small changes in how we think and act, and once we’ve gone through our process, the momentum carries us the rest of the way.

About 25 years ago, James Prochaska, PhD, and Carlo DiClemente, PhD, two researchers at the University of Rhode Island, were trying to figure out the process smokers went through to quit nicotine. They came up with the now famous Stages of Change Model. Dr. Prochaska and Dr. DiClemente determined that addicts go through five stages of change before quitting their drug of choice. Telling a person they need to change falls on deaf ears unless that person is ready to hear it. The five stages addicts and alcoholics go though when they’re ready to make a change are (1) precontemplation, (2) contemplation, (3) preparation/determination, (4) action/willpower, and (5) maintenance. How long we stay in each stage is up to us. It’s possible to go through all five stages in the course of a day. It’s also possible to take two steps forward and one step back. As you read through the five stages, consider which stage you might be in right now.

STAGE ONE: Precontemplation

In the precontemplation stage, we are in denial. We aren’t thinking seriously about changing. We don’t want to listen to others tell us we need to change. We’re typically defensive and don’t view our drinking or using as a problem.

STAGE TWO: Contemplation

The contemplation stage involves awareness. We are aware that our drinking or using is causing some consequences. In this stage, we’re doing our own risk/benefit analysis. We’re not completely convinced that giving up our drug of choice is worth it, although we can imagine that there are some benefits. Many addicts and alcoholics never get beyond this stage. We continue to look for excuses or others to blame for the consequences of our actions while under the influence.

STAGE THREE: Preparation/Determination

In Stage Three, we’re committed to the idea of making a change. We know we have to do something, and we are determined to figure out what it is we need to do. We call clinics, read books (such as this one), or talk to people in recovery. We need solutions. We’ve accepted that we need to change.

STAGE FOUR: Action/Willpower

If we’ve done our research in Stage Three, we’re usually more successful in Stage Four, when we go beyond commitment. Now we believe we can change, and we take an active role in making a change. For most people, Stage Four is fairly brief (it can last anywhere from 1 hour to 6 months). We review our commitment and take steps to implement our plan. At this stage, we are open to receiving help.

STAGE FIVE: Maintenance

In Stage Five, our goal is to maintain abstinence. We are patient with ourselves and remind ourselves that our goal is worthwhile. We can anticipate situations that could trigger relapse, and we have a prevention plan in place.

 

LOSING A BEST FRIEND

Even though the writing may be on the wall and everyone around us can see we have an issue, many of us hold on to the notion that we can continue to drink or use without consequences. We do this because our whiskey or Valium has become a good and reliable friend, always able to make us feel better, at least at first. Saying we’re an addict or alcoholic means giving up that friend, and where does that leave us? Alone, afraid, and miserable.

Yet deep down we know that our good friend has also done us wrong. It has betrayed us and fooled us into believing that if we chased it long enough, it would continue to bring us relief. But we come to realize that we won’t ever experience the euphoria we felt when we first used our drug of choice. Because of how the pleasure pathways in the brain work, that euphoria is long gone--the dopamine bell was raised long ago. In desperation, and because we don’t know what else to do, we return to our drug of choice in hopes of finding relief.

Interrupting the pattern and making real change takes honesty, courage, and surrender. It also means grieving the loss of our best friend.

 

THE CONTINENTAL ALCOHOLIC

One of my favorite parts of Alcoholics Anonymous (aka the Big Book) is “More about Alcohol,” which lists all the tricks of the trade that alcoholics have used to adjust their drinking habits: switching from wine to beer, or from beer to wine, or from light beer to mixed drinks after 5:00 p.m. and only on weekends,; abstaining for Lent, when going on vacation, or when not on vacation.

I had the idea that I only had continental alcoholism. Continental alcoholism, of course, is only active in the continental United States. That meant that if were lucky enough to befriend an Inuit or other Alaskan, or to visit Hawaii, I might have been granted a reprieve. And while on the European continent or anyplace else in the world? I was absolutely a new man.

I had many opportunities to disprove my theory. I disproved it in France. I disproved it in Italy. I disproved it in Nepal. I disproved it in Hawaii. I never really got to disprove it in Alaska, but I certainly got to disprove it in the Caribbean Islands, in Mexico, and, of course, in the airplanes that took me to all those different places. I guess my theory of continental alcoholism didn’t really hold much water, or any liquid capable of intoxicating a brain such as mine.

 

YOU ARE NOT ALONE

According to the SAMHSA’s National Survey on Drug Use and Health, 23.5 million people age 12 or older--9.3 percent of that population--needed treatment for an illicit drug or alcohol abuse problem in 2009, but only 2.6 million, or 11.2 percent, of those who needed treatment received it at a specialty facility. That tells us that, in all likelihood, about 20 million people in the United States are walking around with addiction and not getting help for it.

Addiction spans all walks of life--the young, old, professional, jobless. Your neighbor, your boss, your doctor--any one of them could have a problem with alcohol or drugs. (We like to say that addiction is an equal opportunity destroyer.) Most people do a pretty darn good job of hiding it, at least for a while.

The bottom line is this: You are not alone. In addition to the 20 million people you could be sharing a room with at a treatment center, there are millions of people in the world who are in recovery or living a life of sobriety, free of alcohol and drugs.

 

SHAME, SHAME, SHAME

In Chapter 1 we discussed the fact that addiction is a disease. For some people, this knowledge alone is enough to strip away any feelings of shame about addiction. We are not bad people; we just have some bad genes. Still, the old stereotype of addiction as a moral failure has not disappeared. We may even harbor some of our own harsh opinions about addicts and alcoholics, become our own worse enemy. More troublesome to us may be knowing that we’ve done some things while drunk or high that we now regret, things that go against our personal moral code.

Shame is the feeling that I am something bad (and others know it). Shame is different from guilt, which is the feeling that comes from thinking I did something bad, and I know it. Shame has the power to make us feel worthless and inadequate; it’s the opposite of self-worth. Shame is an overwhelming negative emotion, and it prevents us from being able to fully love and appreciate ourselves. Shame is powerful and smart. It is capable of disguising itself as isolation, arrogance, anger, and aggressiveness. And deep, buried shame causes us to act out at the most inappropriate of times and then to blame others for our behavior. This is shame at its best.

Even though addiction is a disease, most of us feel shame in being an addict or alcoholic. Either we don’t realize it’s a disease, others imply or tell us outright that we’re worthless because of our drinking or using, or we do some shameful things (such as stealing money or pills from our grandmother) that make us feel bad about ourselves. Some of us carry shameful feelings from childhood and use drugs or alcohol to bury those feelings.

Feeling guilty can be sometimes be good only because it gets us to feel remorse and behave better the next time or to correct whatever we did that was wrong. Shame, on the other hand, serves no purpose. It makes us feel “less than” others, less than who we are. Nobody wins when we feel shame. To come to terms with addiction, we need to be able to recognize and eliminate feelings of shame.

 

THE MANY FACES OF SHAME

Answer the following questions honestly, using a scale of 1-5 (1 = strongly disagree; 5 = strongly agree):

A. ____I take care of myself.

B. ____People who get their hair and nails done and who go to the doctor and dentist are selfish.

A. ____I make sure to exercise and eat healthy meals.

B. ____People who belong to health clubs and are always talking about weight are self-absorbed.

A. ____I deserve to be treated well by others.

B. ____Most people are mean, evil, or untrustworthy.

A. ____I deserve the nice things in life.

B. ____The world is full of greedy and selfish people.

A. ____I accept compliments easily.

B. ____I should be punished for my behavior.

 

Add up the A points and add up the B points. If the A score is higher than the B score, you are probably feeling pretty good about yourself. If the B score is higher than the A score, you may be feeling a lot of shame, and you may be projecting, or transferring feelings about yourself that you can’t accept onto others.

Try This: Listen closely to your thoughts and to how you talk to others. Whenever you find yourself tempted to think or say something negative about someone such as “He’s selfish,” ask yourself whether the same could be true of you. Be rigorously honest. If the answer is “yes,” make a point to accept that you might sometimes behave selfishly-- then forgive yourself.

 

ADMIT VERSUE ACCEPT

Picture this: You are in a deep well, and you have a ladder and a shovel. Do you want to climb out, or must you dig deeper? Knowing what we know now about addiction, if we’re addicted, we can safely admit it. We can say to ourselves, “My name is _________________, and I am an alcoholic/addict.” Once we identify as an addict and fully accept our disease, we can change. Admitting it is one thing. Accepting it takes us to another level--it moves us from Stage Two to Stage Four or Five in a heartbeat.

Great people have turned their lives around by accepting with humility the presence of the disease in their lives. If they can do it, you can, too. We must believe that we are worth the treatment to get well. Punishment does not work. Stop beating yourself up.

We know from the statistics that addiction isn’t going away. Millions of people are in recovery and that number continues to grow, but every generation bring with it another 10 percent of the population that will most likely become addicted at some point in their lives because of their genetics and/or the environment in which they live.

This tells us three things: (1) You are not alone; (2) There’s no reason not to get help. You’ve taken an important step by picking up this book and opening it to the first page. All you have to do is keep reading, and you will be on your way to a life of rewarding recovery

 

--- TAKEAWAYS ---

  • Not everyone who drinks is an alcoholic; and not every alcoholic is a falling-down drunk.
  • We can cross the line from problem drinking/using into addiction.
  • Questionnaires or clinical evaluations can help us determine whether we have an addiction.
  • To change addictive behavior, we typically go through five stages.
  • Most addicts and alcoholics carry around a lot of shame, a negative emotion we can do without.
  • Acceptance leads to change.

Chapter provided with permission of author.

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