Tuesday, June 3, 2014
Are You Addict Enough?
The author of Drunk Mom on the A's, B's, C's, and D's of addiction and diagnosis.
There used to be a certain terrifying thought in my head. It would show up rarely but when it did, I would recognize the horror of it instantly and I would bombard my mind with every unicorn and every rainbow I could think of to make it go away.
The thought was that I wasn’t addict enough to deserve recovery - or perhaps that I wasn’t even an addict! I would experience “a regret of not dying a little harder.” And so I regretted not having some of the Hemingwayesque experiences that my fellow sober addicts sometimes talked about in 12-step meetings: all-nighters, weekenders, drinking on waking. I regretted not waking up in a foreign city wearing pants that didn't belong to me. I regretted not going to detox even, or only being to rehab once. Perhaps this was a perversion of a writer in me, to regret not having such experiences, because, hey, almost every experience is material - even your own death can be material.
In the meetings I heard people trying to outdo each other. Like the guy who went to a wedding in one part of the country and woke up in another, in bed, with two strange women. And there I was with not even one alcoholic seizure to talk about! Instead of hearing the stories as warnings, I saw them as ways in which I didn't quite belong. Was I addict enough?
The so-called “war stories” in meetings are there for a reason. People talk about them to make sense of where their addiction took them. Even the most pathetic stories serve as a way to identify each other, and oneself, to other addicts. In a grotesque way, some sharers make the stories seem like their badges of honor - or at least that’s how I perceived them. And there's a lot of dark humor too given that addiction causes the kind of sadness that is so deep that sometimes you can only laugh about it. It's kind of similar to laughing at a funeral - your own.
My questioning of my addiction might have contributed to my relapse and when I relapsed, it was very bad: I was by then a mom to a lovely baby boy and I couldn't stay sober. There were no sexy stories there - just me trying to not to drink and failing while a baby needed me. I ended up writing a memoir about it and after it was published and after non-addict people were horrified by it - that was, honestly, the first time that I felt properly vetted as an addict. So today I have no doubt about myself and the only extreme that works for me is total abstinence.
At the same time, I know that there are many people who question their addiction and their belonging in places like 12-step meetings. There are such people in my personal life and some of them probably aren’t really addicts - whatever that means. Maybe what it means is that their use does not interfere with their everyday lives. They learn to drink moderately, they don't wake up soaked in piss, they don't miss work. Some have gone to AA and left sober and stayed sober. And then there are some who haven’t stayed sober but insist on keeping things under control.
Robert, 32, says he’s addicted to alcohol, but wouldn’t classify himself as an addict. He says that for him, “the problem comes from the word ‘addict.’ If someone is addicted to quinoa or broccoli or kale, are they an addict? Why do we only associate that word with harmful substances?” He says, “If I started having blackouts, or engaging in violent behavior, losing jobs or harming people I love, then I would feel I'd taken a step in the wrong direction, but I feel like I have it very regulated right now, very under control. I limit the amount of drinks I'm ‘allowed’ to have, and I rarely go over.” A writer by trade, Robert says, “Drinking fuels my creativity, it helps me relax and unwind, relieves stress.”
Sounds perfectly reasonable and although I’m no expert on addiction, to me, the one sign is having it interfere in your daily life. So, allow me to speculate a ridiculous idea: if obsessively chomping on kale in the morning is making you perpetually late for work, it’s probably an addiction. At the same time, nobody dies from kale.
Dr. Vera Tarman, a Toronto, Canada-based specialist in addiction behavior and treatment, points out two definitions of addiction. The ”ABCDE” of addiction, which is a clinical tool made for addiction doctors and “the DSM V definition of substance abuse disorder is what is used for research purposes and for diagnosis for funding and for the prescribing of meds. Both are used interchangeably,” she says. Here’s how Dr. Tarman sums up the ABCDEs:
Abstinence: Are you able to abstain when you want to, within a reasonable time frame? Everybody can abstain for a day but can you do it longer if you have to?
Behavior: Do you have behaviors that you’re unable to regulate? For example, you're just going to have two cookies but you end up having a bag.
Cravings (and obsession): Even if you don’t have the substance you keep thinking about it.
Diminished responsiveness to consequences (“I also call it Denial,” Dr. Tarman says): I’m gonna stop when I get this or that – diminishing the effects of addiction, attributing consequences to something else
Emotional – how it affects your emotions: your emotions are up and down when you use it
Karen, 31, says she’s never going to be 100% convinced she’s an addict but that’s just part of the illness. She says, “I cannot say no to certain things that cause me great pain or damage. I cannot dabble or ‘just have a little bit.’ I must abstain altogether or run a very high risk of being pulled in to my old, dangerous habits. This being said, I have what I call, a ‘Fuck-it monster’ that lives in my head. It tells me all the time that I am better now, or that one night out with friends and a bottle of vodka will be fine. It can be very convincing and I often times need to white knuckle my way through staff or family gatherings that involve alcohol.”
Karen says her drinking very nearly killed her. She says it ruined great friendships, put people in danger. She has attended 12-step meetings but they weren’t for her even though she admits they helped her focus in the beginning. “I didn’t like the idea that it was the only path and that anyone who strayed would fail and die a horrible death. I left.” She also left her unhappy relationship, her career and the city she was living in. Today, she’s in a different city, in a different career and in a loving relationship. In her new career her accountability is key and it’s accountability in general that keeps her in check. She says she doesn’t clench her fists while walking by the liquor store. “I can sit with my friends in a restaurant as they have wine and I’m okay with my club soda. I don’t need to pretend that I believe in a higher power. There are other paths to sobriety.”
Dr. Tarman says that in addiction medicine there’s a whole spectrum of treatments from a doctor’s point of view (example: harm reduction, medication) that suggest success. For example, if before treatment you used to drink eight drinks a day but now you’re down to let’s say four drinks a day, that’s clinically successful. Dr. Tarman’s personal opinion is that AA is possibly most helpful in overcoming addiction: “If you want to get sober and you’re doing to do the work [suggested in 12 steps, for example] it’s very successful.” With other treatments, it’s helpful to a limited degree – no matter what tools you have,“people, places, things” might get you: you’re going to drink at a wedding no matter what your resolve.
Paul, 54, says he’s able to quit for periods of time. “I like to stop for a few weeks, sometimes longer. Once, I quit for six months, crossing days off on a calendar.” Paul admits to having trouble with moderation when drinking and he often thinks of taking an “alcohol holiday” – or, perhaps more accurately: freedom-from-alcohol holiday. He wonders if what he has is alcoholism. “Perhaps. To me it is behavior which is best characterized as ‘one of the struggles of life,’ on par with career, love, spirituality, etc. Alcohol is for me a battleground. I win a little, I lose a little. I don’t want to be full on or full off.” Mark says, “But ultimately, one day, I would like to quit drinking entirely.”
Finally, there’s Mark, 43, who has his own definition of addiction, two ways of figuring out if what he has is an addiction: external and internal evidence. The concern of the people he loves the most is the external evidence and the internal part is his own awareness of “my body's predictable, intractable, seemingly unchanging reaction to alcohol beginning at drink number one and moving on toward incapacitation.”
He says, “What I feel/sense most acutely at the intake of alcohol is the intense, overriding, bodily, automated, burning (and almost always unvoiced) knowledge that this one will not be enough. My cellular chemistry literally yearns for more even as I'm drinking what's in my hand. And to be honest, short of incapacitation, I've never, in my life, experienced (silently, or voiced to others) the thought ‘this one's enough, I've had enough, I'm going to pack it in after this one.’ Literally never. Because I've never had enough. There's no such thing. I've asked for a drink while vomiting, while being arrested, while being assaulted, while being rejected, even while unconscious.”
He admits to being a binge drinker but says it’s been years since he drank daily or chronically. Mark is now seeing a therapist and using anti-anxiety meds as well as treating his accountability to his family “as deterrents. Or at least brakes. Or speed bumps.” Like all the others, Mark got in touch after I asked people to get in touch if weren’t entirely sure about being addicts.
Jowita Bydlowskais a regular contributor to The Fix. Her memoir Drunk Mom is published in the US by Penguin today.