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The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey – Part 62

Guest blogger and long-time Council friend, Bob W. presents Part 62 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

The experience of living in the Community and Fellowship of AA and its sister 12 Step programs leads us to see the miracle of Love in its purest form.  We come to care for each other in an absolute sense, unconditionally, eschewing any form of quid pro quo.  It is a spectacular experience, one of which many of us struggle to realize the full potential.

The human species, homo sapiens, craves community and companionship.  We formed tribes from the earliest periods. There was/is a dark side to this; our tribal nature could also develop an us vs. them tendency when opinions or beliefs diverged.  Hate so spawned became the antithesis of Love, but it seems to me that Love has always overcome hate even after the most ugly, longest running of human clashes.  Over time, Love always prevails and, for many of us, the idea of a Higher Power is that of pure unconditional love.  It seems to me to be the one Absolute.

I would endeavor to define Love as the deep, soulful, unconditional caring for another.  Our Higher Power exhibits this kind of Love for us in getting us to this point in our lives and in endeavoring to help others join us.

Many of the mythic stories we have discussed have Love prevailing over crisis and chaos to return a hero to her or his natural state within her or his community. Odysseus is able to finally get home after the love of Athena, Calypso and Circe help him to overcome the scourge of the Trojan War.  Dante is finally able to embrace the vision of God when Beatrice guides him through Paradiso.  Even Don Quixote’s love for his fanciful Desdemona sustained him in his quest.

In our own experiences in our Fellowship, we come to realize that the love of the men and women in our own meeting structures transcend all other elements of who and what we are.  We embrace everyone, even those with whom, in another setting, we might have had significant difficulty and differences of opinion on a host of matters.  None of that counts for anything when it comes to our mutual commitment to each other’s spiritual health and well being.

It is so clear to me today, as I reflect on the majesty of this Fellowship, that we need to bring our own best capacity to love to each of our daily lives in order to become, and to remain, psychically and spiritually whole.

The Council on Recovery Responds to Rising Trend of Adolescent Vaping with Specialized Services for Teens and Parents

In response to the dramatic rise in adolescent vaping, The Council on Recovery is excited to announce the launch of specialized services specifically designed to deliver education, early intervention, and clinical treatment for adolescents experimenting with or abusing electronic cigarettes.

Lori Fiester, LCSW, MAC, CIP, CDWF, Clinical Director, says “With a new school year just around the corner, we have seen a marked increase in the number of concerned parents and educators whose teenagers are experimenting with or abusing electronic cigarettes. Many parents don’t know where to turn for information they can trust or how to get their children help.”

According to the National Institute on Drug Abuse’s most recent Monitoring the Future survey, the percentage of 10th and 12th graders who reported vaping nicotine during the past 30 days nearly doubled in the past year. This alarming rise is the largest single-year increase of any substance in the history of the survey and translates to approximately 1.5 million additional adolescents vaping.

“Vaping is drawing on Big Tobacco’s playbook to market electronic cigarettes as safe and appealing to adolescents,” says The Council’s President & CEO, Mel Taylor. “When we see stories that the nation’s largest e-cigarette maker is considering opening its first shops in Houston or that Texas teens are being diagnosed with lung disease as a result of vaping, we are very concerned. At some point, every teen will make a choice whether or not to use. We simply want young people to have all the information they need to make a healthy choice. They deserve that.”

In spite of the explosion of vaping among teens, Houston had no dedicated resources to intervene on vaping until now. This fall, The Council will enhance our existing service array for adolescents with the addition of specialized services for vaping. Services will include psychoeducation, comprehensive assessment, intervention, and treatment for teens and their families impacted by vaping. Parent coaching and support, as well as professional consultation will bring needed knowledge and skills to parents and teachers to help them recognize and respond to risky behaviors. To learn more or access services, contact The Council’s intake line at 713-914-0556.

Grateful Client Gives Back

This guest post is written and graciously shared by Janel, a grateful client who found recovery through The Council

Seven years ago I was trapped living a nightmare with no way out. My addiction took me to the darkest place imaginable. I was literally battling for my soul. I could not stop using. I eventually gave up and tried to take my own life. It was the only way I thought I could find peace. Waking up in Ben Taub’s ICU after my liver shut down, I realized that God had another plan for me. I had been given a second chance at life.

Forced to seek help, The Council on Recovery started me on my new journey. They found me a bed at a treatment center where I spent almost 3 months coming out of my fog of addiction. While there I met one of The Council’s recovery coaches who told me about a longer term treatment program, where I spent fifteen additional months. During that time, I learned so much about myself and how to overcome my addiction. I learned how to be a lady and live life with a purpose. I would not be where I am today if it hadn’t been for The Council guiding me in the right direction. Their resources are what saved my life. The work they do in the recovery community is vital. Most addicts don’t know how to stop. They do not know how to get help. That’s what The Council is for.

Last year I found a way to give back and help The Council. I used my story and my first-ever marathon to help raise more than $3,000 for this powerful organization. The marathon was about pushing myself to do something I once saw as impossible. It was meant to inspire others and – of course – bring as much attention to The Council as possible.

People need to know there is a solution. They need to know where to reach out when they are ready. I am living proof that recovery is possible. Today, I am 7 years clean and sober and I am a productive member of society. I have put myself through school, received my Bachelors degree in Human Services, and now manage a successful staffing agency. I have run a marathon and am now training for my first Ironman. Seven years ago my addiction almost killed me, but today I live free with no limits to be and do whatever I want to. And it all began at The Council. They showed me how to break the chains that bound me. They gave me hope. 

Janel ran the Chevron Houston Marathon as her first-ever marathon and used the opportunity to help raise more than $3,000 for The Council on Recovery

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey – Part 61

In the ancient Greek world that spawned so many great mythic stories, the tales of Sisyphus are ones that resonate with many of us.  Sisyphus was the King of an ancient city that is now known as Corinth.  He was incredibly wise and crafty and took delight in playing tricks on the gods.  He was also mean and oppressive, terribly abusive to travelers and guests, a condition that particularly angered Zeus, the king of the gods.  Sisyphus’ disdain and abuse of the gods and men finally provoked Zeus to doom him to a horrendous eternal task…that of forever rolling a monstrous stone up a steep hill only to have it roll back again just as he reached the top, each cycle happening over and over, forever.

This story has become a much used analogy to depict those daily mundane tasks and recurring life cycles that seem to go on and on, endlessly…a mind-numbing routine job, repeated conflicts with family, keeping a garden free of weeds, etc.  But, to me, it is nowhere more resonant than in the repetitive acts of insanity that attended our alcoholic and addictive acting-out.  It has been said that the surest sign of insanity is doing the same thing over and over again expecting a different result each time.  We drank or used endlessly believing that each time would result in a different outcome, perhaps a glorious permanent state of the euphoria that attended the first ingestions of the substance. But all of it, each time, only made our lives worse.  We may even have pursued this style of living disdaining the presence of any higher power in our lives, making a mockery of all spiritual beliefs.  We didn’t need God…we were God.  The alcohol, the drugs told us so…

But there is no recovery, no redemption for Sisyphus.  He is doomed to his task forever.  He is like many of us who never do recover from alcoholism or addiction and eventually die in the disease.  How glorious is it for those of us who, in the horrid depths of our disease, begin to sense the presence of something bigger than us and begin that agonizing, gut wrenching crawl to the light.  How wonderful is it that we can live forever in this light and never be Sisyphean again.

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey – Part 60

In the process of doing these Notes, I keep coming back to the Odyssey, by the ancient Greek poet Homer, as a particularly rich text with many stories that fit the parallel of our own individual journeys to Sobriety. The companion piece to the Odyssey is the Iliad, which is the definitive story of the key closing events of the monstrous Greek war with Troy, the powerful kingdom on the western edge of modern day Turkey. In many ways, the Iliad is about men in war, the men of the various Greek states locked in a mad, addictive rage over deep resentments against their enemy, the people of Troy.  It has all the elements of an epic military struggle in which its protagonists are locked in a berserk-like confrontation.  In this sense, it is very similar to the states of our own being when we were mired in our own diseases, engaged in insane actions and behaviors induced by various substances and actions.

But the Odyssey, on the other hand, can be seen as a parallel to the long process of recovery in which all of us are steeped.  It is the story of the men of Greece trying to recover from the excesses of the Trojan War and find their way home to lives of peace and family.  Odysseus, who was the key figure in the final conquest of Troy, is the central figure of the Odyssey.  His part in the conduct of the war put him in the center of this analogous process of recovery.  We can see his journey home, which was the longest and most tortured of all the Greek leaders, as particularly intense when compared to the events in our own processes of recovery.

Odysseus’ journey takes him to many places with encounters of both intense danger and beautiful delight. Of these encounters, three key ones are, first, with the beautiful Calypso who detains him for 7 years as her lover and offers to make him immortal; then with Circe, the enchantress, who tries to enslave him, but eventually gives him the key to find his way to Hades where he gets the information he needs for his continuing journey; and lastly Nausicca, the young maiden who convinces her father, the King of Phaeacia, to equip Odysseus for the last leg of his journey home. Forgetting about the romantic elements of the first two of these, what Odysseus is receiving from these goddess-like personages are the wonderful elements of nurturing and recovery that will enable him to return as an authentic ruler of his homeland. In a sense they are much like what we learn in our tireless working of the fourth to ninth steps of our own recovery.

In many ways, I see one of the key themes of the Odyssey story as that of the futility of war and all the elements of war.  His journey to Hades, where he meets many of his fallen comrades from the war is very poignant here. Achilles, the key player in the Iliad story, tells him that all of the glory of his life as a warrior was all for naught.  He would take one day as a simple common man for all his years of glory as a warrior.  Similarly, Odysseus’ stay in Phaeacia at the urging of Nausicca results in his telling his long grim story to an assemblage in court, much as we do in our Steps 4 and 5. 

The message for all of us here is to see our recovery, our getting sober, our going to meetings, our working the steps, and our immersing ourselves in service to the cosmos, as a journey so very similar to Odysseus’. It is one where all of our encounters, all the people we meet, all the friends we make, all the advice and direction we seek of our mentors in recovery form a spectacular web for a life in the sunshine of the spirit, just as all of Odysseus’ adventures made him a much more authentic ruler of his homeland once he got there.

How useful is abstinence alone in understanding the effectiveness of SUD treatment?

The following article was recently published on the research page of the Recovery Research Institute website. It reports that abstinence from alcohol and other drugs is commonly perceived as a defining feature of recovery and has been widely used as a marker by which to evaluate the success of substance use disorder (SUD) treatment. Efforts have been made to define recovery more broadly by incorporating indices of functioning and well-being, but even within such broader definitions, achieving abstinence (as opposed to drinking at low-risk levels) is noted as an important milestone. This research presents three-year outcomes of persons who participated in outpatient treatment for alcohol use disorder, where treatment outcomes are defined in terms of both alcohol use and functioning.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

A focus on abstinence in defining recovery from an alcohol or other substance use problem has a long history in the field of addiction. More recently, however, efforts have been made to broaden the definition of recovery so as to align more closely with the variety of actions one can take toward health and wellness for those with substance use disorder. This broadening of the definition has largely focused on incorporating indices of functioning and well-being, which, of course, are of great relevance to individuals with SUD, both inside and outside the treatment context. When it comes to substance use, however, most definitions of recovery continue to focus on abstinence rather than also considering drinking patterns that do not result in a re-occurrence of substance use disorder symptoms or other harms. Clinically as well, patients are often advised to choose abstinence as their treatment goal. Increasingly, however, it is being questioned if abstinence is a necessary treatment goal for all persons with substance use disorder. To shed further light on this issue, Witkiewitz and colleagues looked at the outcomes of 806 alcohol use disorder outpatients over the course of three years after they started alcohol use disorder outpatient treatment.  

HOW WAS THIS STUDY CONDUCTED?

This study was a secondary data analysis of the well-characterized and frequently analyzed dataset stemming from Project MATCH, a multi-site project conducted in the 1990s in the United States. This analysis used a subsample of these study participants who were followed for up to three years following the initial Project MATCH treatments.  In this subsample, 952 individuals with alcohol use disorder were randomized to receive one of three individually-delivered outpatient treatments (i.e., cognitive behavioral therapymotivational enhancement therapy, or Twelve-Step facilitation). Of these, 806 (85%) provided data on their drinking during the three years following treatment and were included in analyses. Assessments were conducted prior to treatment, during the 12 weeks of treatment, immediately following treatment, and 6, 12, and 36 months after treatment end. In addition to reporting on their drinking and negative consequences they experienced due to their drinking, participants also provided information on their experiences during the past 30 days, using four yes/no items (“employed,” experienced “serious depression,” “trouble understanding, concentrating, or remembering,” “serious anxiety or tension”), and completed several items measuring to what degree they engaged in problematic social behaviors and to what degree they felt satisfaction with their life.   

Witkiewitz and colleagues then conducted two types of analyses. First, they simply defined three groups of participants in terms of their drinking based on cut-off values of public health interest and described their outcomes over time. The three groups they defined were abstainers, low-risk drinkers (i.e. non-abstinent individuals with no heavy drinking days) and heavy drinkers. A heavy drinking day was defined using nationally-defined standards as consuming four or more drinks in a day for women, or five or more drinks in a day for men. Then, they used an exploratory technique called “latent profile analysis” to identify groups of patients based on their reports of alcohol consumption and life functioning (i.e., as described above) over the three years following entry into outpatient treatment. 

WHAT DID THIS STUDY FIND?

When outcomes were defined by public health relevant cut-off values, low-risk drinkers were not significantly different from abstainers (i.e., differences were not greater than could be explained by chance alone) on almost all non-drinking outcomes, with one exception: abstainers were significantly unhappier with life. This may because these individuals tended to have the heaviest drinking and most severe problems prior to treatment and these individuals’ lives can continue to be detrimentally affected for many years even after remission has been achieved.  

In defining groups that emerged by considering participants’ data over time, Witkiewitz and colleagues identified four profiles: 

Figure 1. Four drinking categories identified by researchers.

By far the largest group is ‘high-functioning infrequent non-heavy drinking’ (51.2%), which is good news in and of itself. Among these, only 49% were completely abstinent from alcohol, demonstrating that both abstainers and individuals who experienced at least some low-level re-exposure to alcohol were able to achieve high-functioning. Of note, all of these patients were able to refrain from heavy drinking.   

For the remaining three groups, whether or not someone remained abstinent was also not a very informative datapoint: a third of these participants were high–functioning despite at least some heavy drinking. Note also that achieving infrequent drinking or abstinence did not guarantee higher functioning: roughly 25% of those achieving infrequent drinking had very poor functioning (i.e., the ‘low-functioning infrequent heavy drinking’ group, which comprises 25% of all participants who were able to refrain from occasional or frequent heavy drinking). Of note, this group also seemed to be worse off at the beginning of the study, as they reported higher levels of depression, tension, and difficulties concentrating at the onset of the study, suggesting that this group was struggling to overcome greater psychosocial challenges than the other groups.    

More generally, the study also made observations about how baseline characteristics of patients related to outcomes three years later: 

  • Higher functioning: Patients who at baseline were found to have better mental health, greater purpose in life, and social support from family and friends were more likely to be high–functioning three years after treatment. 
  • More frequent heavy drinking: Patients who at baseline had more high-risk social networks that actually supported continuing to consume alcohol were more likely to engage in frequent heavy drinking three years after treatment.  
  • Achieving high-functioning heavy drinking: Patients who had lower alcohol dependence severity at baseline were more likely to achieve high-functioning despite at least some heavy drinking. Note that high-functioning patients who engaged in occasional heavy drinking were more likely to be White, and at study entry drank fewer drinks per drinking day and experienced fewer consequences due to their drinking than those high-functioning patients who engaged in infrequent non-heavy drinking. 

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The findings from this secondary data analysis project of a large, multi-site trial delivering outpatient treatment (in the 1990s) to more than 800 alcohol use disorder outpatients lend further weight to recent calls reconsider how the effectiveness of SUD treatments ought best to be measured. It builds on a previous report from the same research group that has highlighted the shortcoming of existing Food and Drug Administration guidance to use heavy drinking as indicative of treatment “failure,” as it fails to acknowledge substantial psychosocial improvements made by individuals who continue to occasionally drink heavily post-treatment. As Witkiewitz and colleagues argue, patient variability (i.e., heterogeneity) has long been acknowledged as an important factor to consider; it may now also be time to acknowledge that there is considerable variability in how some individuals may function following treatment for alcohol use disorder. That said, whereas it is becoming clearer that abstinence is a relatively uninformative indicator of treatment success, engaging in heavy drinking in and of itself confers harm, given that alcohol is a known Group 1 carcinogen – it has the potential to cause cancer. It is also a major cause of liver disease. Thus, while it is possible to engage in heavy drinking occasionally and still function at a high level, such toxicity–related risks need also to be considered. For this reason, perhaps other characterizations of alcohol consumption may be more informative, such as staying within national “low-risk” drinking guidelines. Drinking guidelines, such as those of the American Cancer Society, seek to prevent not only alcohol use disorder, but also the harms posed by both toxicity from alcohol, and recommend that women and men should drink no more than one and two drinks per day respectively, to limit harm due to alcohol’s toxicity-related effects. Beyond broadening our perspective of how alcohol consumption should be considered in terms of defining treatment “success,” the results of this study raise additional intriguing questions surrounding the broad definition of “recovery” that most agree should encompass both indices of functioning and a range of alcohol use indices.  

Also of note, roughly half of those who are low-functioning after outpatient treatment show vulnerability to intermittent alcohol exposure, and continue to struggle psychosocially, underscoring the importance of continuing care that can help address these challenges over the longer term. LIMITATIONS

BOTTOM LINE

This new analysis of a large, multi-site trial with more than 800 alcohol use disorder outpatients showed that some individuals who engage in at least some occasional heavy drinking following treatment may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction, and mental health. Such individuals tend to have lower addiction severity and fewer alcohol-related consequences prior to treatment, suggesting a more favorable prognosis overall.  

  • For individuals and families seeking recoveryAn incidental finding of this study, but good news that deserves highlighting nevertheless, is the finding that more than half of the alcohol use disorder outpatients examined in this study had a positive outcome for at least 3 years following treatment, both in terms of drinking (i.e., no heavy drinking days) and functioning (i.e., low probability of reporting problematic social behaviors, unemployment, other drug use, or life dissatisfaction). This positive finding is in line with other recent findings highlighting that roughly half of the people seeking to recover from a substance use problem need only two recovery attempts.     
  • For treatment professionals and treatment systemsThis paper provides further empirical support to move beyond a reliance on abstinence as the ultimate indicator of treatment success, and instead to move towards a broader range of drinking as well as psychosocial functioning. See our previous Bulletin article on broader definitions of recovery. Patients with higher addiction severity at treatment entry are less likely to achieve high-functioning with occasional heavy drinking. Moving beyond abstinence as the indicator of treatment success may help decrease barriers to treatment–seeking amongst those who do not wish to abstain from alcohol entirely but may otherwise welcome support in achieving low-risk drinking and higher functioning.   
  • For scientists: The present study, as well as similar reports, are based on older datasets, and thus replication in more modern-day datasets would help clarify if observed findings generalize to present day alcohol use disorder treatment contexts and recovery supports. Note also that “functioning” may be defined in a number of ways, but in the present study was limited to the indices used in Project MATCH. As Witkiewitz and colleagues highlight, further research should examine the role and impact of heretofore understudied correlates in this context, such as cognitive functioning/executive control, medical health and chronic pain, and misuse of prescription drugs.  
  • For policy makersAn increasing body of research points to the downfalls of relying on abstinence as a marker of alcohol use disorder treatment success. Far beyond being a simple matter of treatment goal preference of a substantial number of treatment seekers, current evidence, including this paper, suggests that alcohol consumption by itself does not necessarily equate to “treatment failure.” Guidance used to evaluate alcohol use disorder treatment, including FDA regulations, may need to be updated in light of this emerging evidence, with perhaps measures of diagnostic remission status and/or drinking within the national low-risk drinking guidelines being the optimal outcomes.  

CITATIONS

Witkiewitz, K., Wilson, A. D., Pearson, M. R., Montes, K. S., Kirouac, M., Roos, C. R., . . . Maisto, S. A. (2018). Profiles of recovery from alcohol use disorder at three years following treatment: Can the definition of recovery be extended to include high functioning heavy drinkers? Addiction, 114(1), 69-80. doi:10.1111/add.14403