For those who are not familiar with the Big Book of Alcoholics Anonymous, the Doctor’s Opinion was first published in the first edition of the book.  Here is one of the more striking passages, one that many alcoholics find gives them their first understanding that they are not alone:

Men and women drink essentially because they like the affect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks-drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many people do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.

Oh how familiar that sounds to so many who have wondering, “Do I have a drinking problem?”

The most critical phrase in the doctor’s opinion is this: “…unless this person can experience an entire psychic change there is very little hope of his recovery.”

I’m sure many of you have watched people relapse over and over, or maybe you have experienced that yourself.  The shift in behavior, attitude, and thinking that enables a person to get and stay sober is no small undertaking.  It is profound because, frankly, most humans do not change all that much in their lifetimes.  Our personalities are set, and we tend to live a certain way until the day we die.  No one with any sense of reality thinks this is an easy thing to do.  Most of our behaviors have been adaptive – reacting to parents, peers, life in general – although I would argue that many of those behaviors are actually maladaptive.

What does that mean? It means there is a very core self that holds tight to old behaviors because they feel like the only way to survive. Something,  at sometime, set in motion behaviors that seemed right in a certain context, but now continually lead us into trouble – trouble in relationships, trouble with emotional balance, trouble in careers, maybe even trouble with the law.

So while those behaviors might have made us feel like we were surviving stuff when we were 12 or 14, now they are just spinning us in a never-ending cycle of despair.  Life is not full when you live that way.

I remember early in sobriety I wanted that lightening bolt – the thing that would shift my consciousness so utterly that change would be easy.  How many of you are smiling at that?

So far, no lightening bolt. Although I have had major, dynamic shifts in thinking that seemed to come on suddenly, in reality they came after months or years of focusing on doing things differently. It’s sort of like when you practice and practice your game of tennis or your sonata on the piano, then one day it just really clicks and you realize, wow, I’m really doing it!  You didn’t suddenly become good, but when you hit that groove it can feel like you had a phenomenal breakthrough all of a sudden.  Nope. Work. And lots of it.

I happen to have been someone who went to drug rehab before ever going to a 12-step meeting.  I’ll be honest with you – I had this belief that drug rehab would be a substitute for AA. I remember being very disconcerted when one of the first things they handed me in rehab was a Big Book. “Hey! I’m going to rehab so I don’t have to go to AA!”  Fortunately, the survivor in me said, “Drop it. Just go with it and see if it works.”  I feel pretty lucky that I had that response because I really felt like I’d had the wool pulled over my eyes by the therapist who referred me.  I’m sure some people would have walked out the door, and I am happy that in that moment I decided not to do that.

I’m a firm believer in rehab because it really worked for me.  I spent August of 2006 in this very protected, safe environment with fellow travelers who wanted what I wanted: freedom from the compulsion to drink. I have been fortunate in that the day I walked into rehab, August 1 2006, still remains my anniversary of sobriety.   Nowadays it’s a lot harder to get treatment. Even as we learn more about the genetic and biological components of alcoholism, insurance companies lower coverage every year.  I don’t remember having to spend anything out of pocket for treatment. I’m quite sure that isn’t the case today. I suppose if insurance companies are finding ways to drop people with cancer and other diseases, it only follows that they would go for easy targets like drug addiction and alcoholism. There are still a lot of people who mistakenly believe these issues are moral issues, not health issues.  The biggest barrier to treatment is ignorance about the true nature of addiction.  To an active addict, drugs are like food and water – the drive to attain drugs feels like a drive to survive.  Only an addict truly knows the truth of this statment.

So can you get clean and sober without 30 days in this protected environment? Of course. People do it every day.  But I believe it really gives you extra ammunition in the fight. You get some time without temptation and without easy access should something trigger a craving.  Cravings don’t go away for everyone, but for many they do diminish or go away in time, and having those 30 protected days does seem like a good idea if you can do it.

Addiction is a serious, life-threatening disease.  I was reading today about the four prescriptions Corey Haim’s doc wrote him a few days before his death – a prescription of Valium to someone who once admitted he took up to 85 Valium a day.  It’s not clear yet if the drugs killed him or he had an underlying health issue, but certainly if you have an underlying lung or heart problem, taking drugs that suppress your respiratory system are not a terribly good idea.  My point is that we need to take our addiction as serious as a heart attack. People might say, you got yourself into this situation by taking drugs in the first place, but we can say that about a good percentage of heart attack victims: they ate too many bowls of ice cream and sat on the couch a few too many hours.  Treatment should not be based on a subjective moral outrage over past behavior. If someone wants to live, why wouldn’t we want to give them every opportunity to change their life for the better?

Back to the main point…should you go to drug rehab or go straight to 12 step meetings or other support groups?  It’s really a personal decision. You have to weight just how motivated you are, just how risky your home environment is, and how many times you’ve tried and relapsed in the past.  It is a well-known fact that most addicts do have to go for help a number of times before it sticks.   That’s not a moral failing – that’s the disease.  People have multiple heart attacks often before they stabilize, and treatment becomes more aggressive as successive incidents occur.  Why should addiction be treated the same way?

I’ve said this before, you know you need help with your alcohol use if when you drink, bad things happen.  It’s so much simpler than asking yourself what I call “denial questions” – do I drink in the morning? no. Does that mean I’m not really an alcoholic?  Argggh! What a great way to make sure you don’t get help.  I mean, how many of us were full-blown drunks but never ever ever drank in the morning so we concluded that indeed we were in full control of our drinking?

Over the last two decades I’ve learned not to roll my eyes when I hear the “denial questions”:

I don’t drink every day (I did, but I know a lot of drunks who were binge drinkers)

I only drink when I’m out – never alone (big deal, where you drink has nothing to do with how you drink)

I don’t really have blackouts (translated: I occasionally do forget a few things I said or did, but it’s not like I forget the whole night!  Good for you! Hope the part you forgot wasn’t too bad!)

I don’t drink as much as X, Y, or Z (comparing yourself to even bigger drunks is an excellent way to talk yourself out of needing help! Sort of like, I’m not fat because I’m only 40 pounds overweight, but that gal is a good 70 pounds overweight!)

I just have really high tolerance – so I can drink a lot more than other people with no effects (you just have really high tolerance because you’ve been drinking a lot for a really long time, oh, and guess what, alcoholics tend to have really high tolerance.)

I’ve never had a DUI (yet)

I have a really good job and make a lot of money. I’m too successful to be a drunk.  (Hope it doesn’t catch up to you – it usually does – plus it’s fun to go to early morning meetings with a headache or sick stomach)

I’ve never done anything I wouldn’t have done sober (are you absolutely sure of that?)

I only drink beer.  (Uh, beer is alcohol, you just have to drink a bit more liquid – one beer = one shot.  Six beers = Six shots.)

I only drink fine wines (this one makes me smile; many times I would buy expensive wines and liqueurs to convince myself I was a connoisseur – gotta research the latest cabs, you know!)

No one in my family is a drunk and it’s supposed to be genetic (often is – and chances are there is a drunk in your family; either no one talks about Great Grandpa James escapades  or that person figured it out early enough and stopped drinking; but if you don’t, congratulations on starting a new branch in the family tree)

Frankly, if you are spending any time whatsoever trying to come up with reasons you do NOT have a problem with alcohol, chances are, you DO.

When I realized I had a problem, the first thing I did was call my company’s employee assistance program. I was totally confused and scared. I knew something really bad was happening to me, but I didn’t know what to do. I remember making that call. I forced myself to mention I thought I might have a problem with alcohol – I had the courage at that moment to say it, and I wanted the cat to be out of the bag so to speak.  Once I had said it outloud to someone, I knew I’d have to face it.

I was very lucky. The EAP counselor I had was gentle and kind – she knew I was skittish and ready to run for the door. Why? Because I was terrified that someone would tell me I couldn’t drink alcohol anymore. It was my Vitamin A. It was essential to my survival. Or so I thought.

She took a couple of sessions, probing with questions that were hard to evade but didn’t scare me off.  I’d made it clear I didn’t think I was an alcoholic, just had a lot of problems and stress, and if I could fix those things, I would drink less (sound familiar?).  I made it really clear: I did not think Iwould be “one of those people” who go to smoky rooms for some sort of public confessional about their drinking (i.e., no AA for me).  About the fourth session she handed me a brochure for alcohol rehab.  The most striking thing I remember about looking at it was seeing the word “alcoholic” – it felt like someone had stabbed me in the gut.

I can remember looking at the word over and over, trying to get used to it. I hated the word. It brought up all sorts of images that just couldn’t be me. I can’t be one of those people!

I recognized pretty quickly that I wasn’t doing well and really needed to get away from my life for a while – so thinking back, I’d say I went to rehab because I didn’t know what else to do (and I thought it was an alternative to AA – haha).  A van picked me up in Manhattan to drive me upstate to the rehab.

I remember arriving, and one of the first things they handed me was the Big Book. I thought, “I think I’ve been bamboozled!”  But I was there, and I didn’t take my problem lightly, so I decided to see what they had to say.  I embarked on 28 days of rehab with as open mind as I could.  I was committed. There was a crazy lady working at this particular rehab who didn’t like me – and I remember thinking when she scowled at me, yelled at me, put me down – but I WANT to be here. Why is she acting like someone made me go here?  Like I’d been sentenced to jail and she was the mean guard. In fact, no one had suggested rehab other than the therapist I spoke with at the EAP.  Lucky for me, the angry crazy lady went on vacation for two weeks and I was left to actually do some recovery work without being shamed (hope they eventually got rid of that negative woman).

They had quite a few meetings at this particular rehab, and I started to actually like them. I started to make friends and feel part of a community.  I cried when I left to go home. I also remember they didn’t give me a van ride home. They dropped me at the train station.  You can just imagine me walking through Grand Central my first day out of rehab. I was terrified – would I be able to succeed?  I knew I had to get to a meeting asap.

This is the long way of saying, for me, rehab was the door for me. I was so resistant to meetings, that it took these 28 days to break down that resistance and make me willing.  This isn’t the case for everyone – in fact most people don’t go to rehab.

Whether to go to rehab or not is a personal decision, one that should be based on what you need to make a change.  Certainly if you have a prejudice against meetings, rehab can be a great place to overcome any misconceptions. Over the years I’ve heard many a person go through a similar process – they just need to learn how to control their drinking, fix their problems and on and on…all the things I told myself to protect my addiction.  For me, it was focusing on reaching out for help and trusting other people to guide me that led to my acceptance of not being able to drink, one day at a time.

OK I said some posts might seem controversial – here goes. I often hear people say the obsession was lifted by God. I am completely and utterly comfortable with people saying this is what occurred for them. However, that explanation, for me, seemed a little too pat.  First a little background: at the age of 6 or 7 I was already questioning my mother on death – where do we go? what happens to our bodies in the grave?  You can imagine how uncomfortable it made her.  So does questioning the absolutes many people in recovery hold so dear.

I do not in any way question the validity of that answer for many successfully recovering people. I just know there are people who are not comfortable with that explanation, and I think it’s only fair to share other ideas on this.

I have a pretty solid belief system surrounding this topic. I think it has more to do with the first step than the second or third.  I am one of those people who has never questioned my need to not drink.  I never had cravings. I’m in my 23rd year of sobriety, and I can be around alcohol without the LEAST desire to drink it.

Why is that the case when so many people either white-knuckle it or struggle during periods of their sobriety with cravings or temptation?  Was the obsession just lifted?

In a way, yes. But I believe this has to do with an utter and complete acceptance of the first step. I fully embraced the belief that I was powerless over alcohol and that when I used it my life was completely unmanageable. I had not one inkling of doubt in my mind that this was the case.  The allure of drinking was negated by the firm embracing of that fundamental belief: drinking alcohol was to me the same as drinking poison.

I am perfectly comfortable with other  “normal” people drinking because I know that for many it’s not poisonous.

I’m also allergic to avocados. I get sick as a dog if I get even the slightest little bit of it. I don’t test it. Why bother? I already know how I react. What am I going to do? Eat avocado to see if I’m still allergic?

I’m not bringing this up to deny anyone else’s reality. I’m bringing it up to help those who struggle with the second and third steps – to assure them that you can stay sober even while struggling with these steps.  You don’t have to become a religious zealot to stay sober.

It’s not in my nature to embrace dogma. My nature is to question dogma. I am not alone. I would not want to see people get drunk just because they struggle with dogmatic principles, but instead, I want them to understand that the key to sobriety is the full acceptance that you just can’t control alcohol’s effect on you. No way. No how.

People start drinking and relapse for many reasons, but I truly believe that under all the reasons (my life is too miserable, I can’t do it,  etc) is a fundamental flaw in thinking: you still believe on some level you can manage and control it.   It’s that belief that has to be destroyed to truly lift the obsession with drinking.