“If I am the chief of sinners, I am the chief of sufferers also.”
- Robert Louis Stevenson, Dr. Jekyll and Mr. Hyde
It has been seen as a “seemingly hopeless state of mind and body” (big book, Alcoholics Anonymous), and often... it still appears that way. The medical community used to shun us... and it can still be that way. The legal system used to punish us... and it’s still that way. The alcoholic/addict is most difficult to deal with – she is “restless, irritable, and discontented” as well as “selfish, self-centered, and inconsiderate”. It can look as though she is voluntarily choosing to abandon her children and herself, and really her whole life, for a glass of wine, a pill, line of cocaine, hit on the pipe, or shot of opiates. ***
This then routinely disables her internal control mechanism. Once intoxicated her inhibitions are rendered inoperative and so... she usually cannot stop before everything turns into disaster (again). Vaguely cognizant, she doesn’t show up for her responsibilities and she is incapable for continuity, accountability, and reliability. She might undergo an instant personality change like “Dr Jekyll and Mister Hyde” in the movie. She may display utterly unspeakable behaviors. She could become belligerent, promiscuous, or crazy. Afterwards she may experience some drug-induced amnesia (aka blackouts). Failing at controlling cravings and other impulses she becomes flooded with guilt, shame, regret, remorse, and self-loathing. Her family gives up trust and faith. Her children might lose the chance for happiness. It looks hopeless.***
It seems like she doesn’t want to learn from experience. She cannot befriend reality – she much prefers fantasy and illusion. She distorts the truth and denies the obvious. She must defend her ego, improve her mood, increase her self-confidence, and find a little joy... at ANY price at all. She is ready for the ultimate sacrifice. Under the influence of substances (or behaviors) that change her mood and perception, her existential pain eases, she can forget the gut-wrenching fear and finally take a sigh of relief. Then she re-discovers self-confidence and courage, which is sorely missed when she is left to her own devices. Life becomes tolerable for a moment.
She remains immersed in the addict world, enslaved by supply necessities, without a belief in herself, the chance of freedom, or the power for transformation. She cannot reach the tipping point where the intensity of suffering overpowers the resistance to change. As long as she refuses to undergo a metamorphosis she is stuck... she can’t move on from tadpole to frog. She withers and drowns in the end.***
If she gets clean against all odds, she is then faced with the wreckage of her disease. Looking at all of it stark raving sober can be devastating. She is tempted to turn around and go back to what she knows. If she can be motivated for recovery she will need ongoing treatment for her chronic illness. Without learning how to love herself in spite of everything... the prospect of a new life may not be doable, conceivable, or even desirable.***
Since the 1930ies Alcoholics Anonymous and (later on) other Twelve Step Programs, such as Narcotics Anonymous or Sex & Love Addicts Anonymous offer regular meetings where she could see that she is not alone with her existential discomfort. Some addicts are able to stay sober through utilizing the spiritual principles, behavioral directives, and group support offered in these self-help programs.***
Since then we have come a long way. Residential, partial hospitalization (POP), intensive outpatient treatment (IOP), group, family and individual therapy (inpatient or outpatient) by professionals that specialize in addiction treatment, are offered for addicts with dual diagnosis (chemical dependence plus emotional or mental disorder). It is best to start out with a high level of care and gradually transition to a lower level of care, if at all possible; for example, start out with detox (typically a few days), then residential (30+ days), PHP (30+ days) and sober living, and IOP (30+ days), followed by psychotherapy and 12-step program (long-term basis) as a tightly-knit program of recovery. If that seems like a lot... I don’t know what to tell you. When you're pulled down by the progressive and ultimately lethal undertow of relapse and destruction it’s a life-saver.***
An estimated 85% of addicts/alcoholics have suffered some kind of abuse and trauma in childhood (or later). They experience intense anxiety, depression, anger, fluctuating states (as in Bipolar Disorder), or panic and flashbacks (as in Post-Traumatic Disorder). They typically lack social and life skills, which adds to their generalized discomfort. They find their inner reality unbearable and so they self-medicate with alcohol and drugs to “make it through the night.” Without ongoing professional treatment they have little or no chance at a good life with long-term sobriety - they remain lifelong hostages of their “inner sadist” (internal representations and mental constructs). Such clients can have a long history of failed attempts at recovery. They often consider themselves “chronic relapsers”, which is another way of saying that underlying issues have never been addressed properly.***
With professional treatment patients have the chance to work through and eventually heal problematic life experiences and traumata. Psycho-social education helps to fill in gaps in socialization. All of this is a process - it takes time and attention beyond the non-committal peer support in self-help programs. Even patients with severe issues that don’t believe that they deserve a good life, can recover if they are lucky enough to be offered hope and promised relief - packaged in a viable solution.
“I told you I was trouble. You know that I’m no good" – "I died 100 times" -
lyrics, Amy Winehouse