Alcoholism starts with loss of control. The person’s behavior violates his values, causing remorse, which then triggers denial. Because of denial, there is unresolved emotional pain. This sequence occurs many, many times and ultimately results in chronic emotional pain. The alcoholic must drink to feel normal.
It would seem, then, that in recovery from alcoholism, there is more to address than just the alcohol.
Recovery Is More Than Abstinence:
Abstinence is not the only goal of recovery; the real purpose is the restoration of adequate ego strength to enable the victim once again to cope with life situations.
The alcoholic suffers from two things:
1) Mental Mismanagement, and
2) Chronic Emotional Pain.
Mental Mismanagement is wrong thinking or denial, and Chronic Emotional Pain is what the alcoholic drinks to cover up. Both must be treated simultaneously. If the whole person is not treated simultaneously – relapse is inevitable.
Treating the Whole Person:
If only the emotional disorder (chronic emotional pain) is treated:
The recovering alcoholic is on a “pink cloud.” He thinks that he can handle drinking and does not realize that his addiction is chronic. He will eventually experiment with alcohol and will relapse.
If only the mental mismanagement is brought under control:
The recovering alcoholic has an awareness and acceptance of the logical reasons for abstinence, but the emotional burdens continue in force. He still gets irritated, anxious, nervous, and depressed. The mass of free-floating negative feelings (chronic emotional pain) is still present, bringing waves of self-pity and resentment. The patient overreacts to simple frustrations, is judgmental and omnipotent. He is hypersensitive, critical, tense and unpredictable. In Alcoholics Anonymous this person is referred to as a “Dry Drunk.” His family may look at him and think, “He was better when he was drinking!”
As the condition worsens, mental gains erode away and the alcoholic inevitably reverts to drinking “to feel normal.” The great lesson of the past takes over: “It moves me in the right direction, and it works every time.” Rationalizations resume their old place in his life, the characterological conflict (the conflict he experiences between his values and his behavior) continues to grow, and the drinking with it.
It is very important to treat both the mental mismanagement and the emotional disorder simultaneously.
Two Important Goals:
There are two important goals in recovery:
1. To discover ourselves and others as feeling persons, and
2. To identify the defenses that prevent this discovery.
Mental Mismanagement:
Number 2 (the mental mismanagement) is dealt with first. It is best addressed in group therapy, where the alcoholic learns to identify his defenses (rationalizing, minimizing, blaming, and avoidance). This is so that the person will know what he has been doing and will not use these defenses anymore.
Group therapy is powerful. Each member of the group has more experience than the newcomer, and each group member is essential to the recovery of the rest of the group. The counselor doesn’t need to say anything to the newcomer about the defenses he brings with him. The group names his denial pattern.
The facilitator will ask a question such as, “How did you get here?” There is no wrong answer to this question, but in attempting to answer it, the alcoholic begins to chip away at the wall of defenses he has surrounded himself while drinking.
In Group Therapy there are norms or rules for its members:
1. Probing for current feelings should be engaged in; and
2. No “why” questions are allowed.
2. There is no fixing (telling a person how to fix himself).
The alcoholic’s mental mismanagement (wrong thinking or denial) is also treated through education so that he can intellectually resist relapse.
Education information can be delivered in lectures, videos, reading and workbooks. The disease concept of addiction, relapse prevention, the physical effects of alcohol, and the effects on the family are some of the subjects taught.
After the defenses are attacked, the discovery of feelings (chronic emotional pain) is undertaken.
Chronic Emotional Pain:
Chronic emotional pain is dealt with in group therapy also. The alcoholic addresses the conflict between his values and his behavior or “characterological conflict.”
He will say things like this:
“I used to be a guy who had some really high ideals and values.”
Which will lead to:
· “Oh, what a miserable wretch I am.”
· “Oh, if I were not what I am.”
· “I used to be, but now I am not.” (This is the deepest despair. This person does not believe that he is a “self” at all. He is just “bad.”)
Dealing With Guilt:
In group therapy the recovering alcoholic feels guilt. He begins to realize that his values are no more gone than mine are. The degree of guilt indicates the importance he gives to these values. It is a revelation for the alcoholic when he realizes that his values did not go away. His guilt came from the fact that his values were still there.
The Four Stages of Recovery:
1. Admission: The person is in a treatment program whether he wants it or not. He has not admitted anything. He has a distorted view of chemical dependency and a low-level or “wishy-washy” admission.
2. Compliance: He no longer doubts the seriousness of his condition or describes it in a weasel-worded way. He has moved to a thorough, ongoing acceptance of the reality of his plight. “I know I drink too much! You don’t have to tell me! And you don’t have to tell me that I have to quit drinking, either. I know that too. And I’m going to do just that!”
The previous statements are a part “defiant dependence,” which means, “I am going to do it! You need to make me well!”
3. Acceptance: The alcoholic accepts personal responsibility for his recovery. He will say things like, “I am responsible and no one else.” He is rid of denial now. He is not minimizing or making excuses.
But he still not viewing the future realistically. “There
is no way that I will ever drink again!”
4. Surrender – The alcoholic recognizes and accepts the chronic nature of the disease. The civil war (within) is over, and he exhibits an appropriate display of caution towards the disease of alcoholism.
12-Step Programs:
After leaving rehabilitation, it is important that the recovering alcoholic join a 12-Step Group right away. The members of the group will give him ongoing, day to day support. Most people who regularly attend a 12-Step Group do not drink and maintain the recovery gains acquired in rehabilitation.
The 12 Steps can be divided into three areas:
· Steps 1 – 3 are about being powerless over alcohol.
· The next 6 take care of the wreckage brought about by the person’s alcoholism.
· The last 3 steps are all about maintenance.
It is a good idea for the recovering alcoholic to attend 10 meetings before making a judgment on whether or not that meeting is right for him. There many different meetings for many kinds of people. It should not be difficult to find one. Before the person leaves rehab, he will be given a list of 12-step meetings in his area. It is also important that the recovering alcoholic find a sponsor who will help him through the 12 Steps and serve as an advisor in his recovery.
There are three types of 12-Step Meetings:
· Big Book Study: At this type of meeting the people in attendance go over something in the “Big Book” of Alcoholics Anonymous. Sometimes this type of meeting is referred to as a “Step Study.”
· Participation: These meetings follow a set format where any alcoholic in attendance is allowed to share about his recovery.
· Speaker: Someone will speak to the audience about his/her own alcoholism and recovery from it.
The disease of alcoholism is chronic, progressive, and fatal if not arrested. It is important that the recovering alcoholic never drink again. Quitting drinking is never easy, but those who have done it go on to lead productive, satisfying lives. People who undergo a rehabilitation program and follow up with 12-step group attendance receive the tools and support to stay sober for the rest of their lives.