[Vision2020] Drunks, drugs, and the empathy factor

[Joan Opyr]

Dear Dave:

Okay, I'm not coming to Montana to kick your ass.  My Suburban, AKA The Beast, only gets 12 mpg, and besides, we're now in complete accord.  (Probably on that Pat Buckley being hot thing, too, though you haven't had time to respond to that yet.)

I agree with you that dealing with addiction on the federal level makes no sense, with the exception (as you note below) of perhaps diverting some DEA funding to the states to pay instead for treatment.  And, yes, let's try a wide variety of treatments.  I'm sadly familiar with the drug cocktails of detox; I'm also sadly familiar with Alcoholics Anonymous and Narcotics Anonymous.  I'm familiar with these treatments from the family member/Al-Anon side -- and what both do is substitute one addiction for another.  This is my criticism of 12-step programs: when they work, they work because they fill a vacuum in the addict's life that used to be filled with booze or drugs.  The addict gets off his numbing agent of choice and gets hooked instead on Jesus, or Scientology, or the 12-step program itself, but he's still an addict.  He still has a vacuum, a big hole at his center, a hole that he's going to pack with whatever is handy -- and the bulk of that stuffing is you, his family.  There you are, filling the hole with your time and effort and energy and the weight of your being; you're always, always, always helping the addict to stuff that void.  And you and the addict are going to keep stuffing and stuffing, but that hole isn't just big, it's black, and so it will never be full.   

Some family members (my grandmother, for example) jump into the hole, and slowly but surely, they get sucked dry.  Others -- though this is much more rare -- completely disengage.  They back away from the edge; they move out from the center and onto the fringe.  They abandon the relationship and declare independence.  This is not an easy path in any family, but it was my path.  I moved out at 17, and it saved my life, or at least my sanity.  (Although I suppose this latter conclusion is debatable.)

Unfortunately, in my experience, once treatment commences, very little changes in terms of family dynamics.  My family life used to revolve around my father's and grandfather's addictions; when they were in AA/NA, family life revolved around ensuring that they attended their meetings and that we supported their recovery.  And here I'll repeat my rude/cynical observation of about three posts ago: an active drunk is lower maintenance than a dry drunk.  "One day at a time" isn't a promise or a source of hope for me; it's a threat.  It's a constant reminder that the addict in your life could start drinking/drugging again at any moment, and that you'd better watch your step or you might "drive" him to it.  This, I think you'll agree, Dave, is no way to live.

If I seem to be blathering on, dear Visionaries, I apologize.  In fact, I should probably button up as what I'm doing is giving away the entire plot of my second book, Don't Mind If I Do, and that's not good for sales.  (My agent says I'm a crappy businesswoman, and she's right.  Thank God she's not on this list -- she'd probably hit me with a stick.)

I do congratulate you on your sobriety, Dave.  Seven years clean and counting is quite an accomplishment.  What I wonder, and what I'd like to ask you about, is what you think can be done in terms of treating not the symptoms of addiction, the drinking and the drugging, but the underlying psychological causes?  My father was a sociopath and a narcissist; my grandfather was an untreated (and, until late in life, undiagnosed) manic-depressive.  Neither AA nor NA nor detox can or did deal with these psychological problems.  Shit, Dr. Freud himself would have been sorely-pressed.  I'd be interested in hearing your thoughts, Dave -- or anyone else's -- on therapy as a means of treatment.  How do treat each addict as an individual?  How do you build self-esteem in the addicts who lack it, and treat narcissim and borderline personality disorder in addicts who suffer from these disorders?  How do you get manic-depressive illness under control?  Can you?  Do you?  How do you ensure that an entire family's life isn't governed by one family member's addiction?  Is that even possible?  It's not, in my experience, and that haunts me.  It's also why I absolutely hate 12-step programs.  (Whoops -- giving away book plot again.  Slapping self on wrist very hard.)

BTW, I'm willing to take this conversation off-list if we're boring the rest of the Vision 2020 world, but addiction is such a problem -- and so very common -- that perhaps the lucky few around these parts who can afford to be disinterested could just hit the delete key?

Joan Opyr/Auntie Establishment

[Note to Pat Kraut: Jesus might have saved George Bush, but as my grandfather used to say, "God is a son of a bitch!"  Lucky George Bush; unlucky Ranny Watkins.  The issue here isn't whether or not drunks can get sober or whether or not we should continue to hold a man's past against him long after he's been "redeemed."  The question, originally, was what has Mr. Bush done with his story of personal salvation and redemption from addiction?  How has he used his experience and his power as President to make the world a better place for addicts and their families?  Has he used what he's learned to press for more kindness and understanding for other addicts?  Or has he used his life's story to sell himself to fundamentalist Christians while simultaneously continuing to push the wretched War on Drugs?  I'm afraid all evidence points to the latter conclusion, and that is why I deem him a hypocrite.]           

----- Original Message -----
From: David M. Budge
Sent: Tuesday, February 22, 2005 9:11 PM
To: David M. Budge
Cc: Vision2020 Moscow; Joan Opyr
Subject: Re: [Vision2020] Drunks, drugs, and the empathy factor

Joan, oops, I misread your last post.  (it's that damn dyslexia thing) My apologies.  Generally we are in accord on the subject with one caveat.   

The vast majority of clinical programs are built on the 12 step model for long term recovery, hence their effectiveness compares directly with that model. The AMA and the American Hospital Association both have dogmatic views of treatment, charge large fees, and are building an industry with poor outcomes.  The vast majority of people who stop drinking or taking drugs do so with no clinical help.  Additionally, the medical protocol for detox and maintenance is a cocktail of SSRI drugs (like Prozac) with a diazepam chaser to ward off the anti-depressant jitters.  Accordingly, the medical community is substituting one addiction for another, the efficacy of which shows little or no clinical promise from an outcome based review of the literature.   

It makes little sense to spend great deals of public funds on conventional rehabilitation.  One thing that may make sense on a trial basis, is to provide vocational and social rehabilitation within the context of drug rehab.  The root causes of addiction usually come from a need for a larger sense of self.  Many, although not all, addicts lack basic social skills and have few marketable skills.  Thus, addiction becomes a vicious cycle of failing then self-medicating to achieve a sense of well-being.  As I said in a previous post: most addicts only stop when they want to stop.  If there is a potential positive outcome it may come in the form of providing an environment for personal productivity.   

I don't know if this program would work, but I think that the literature provides enough evidence to give it a shot.  Also, I'm not sure if the federal government is the answer here.  Like Justice Brandeis hypotheses that "each state is a laboratory of democracy" I think a multitude of experimentation at the state level would produce positive outcomes faster.

Diverting federal funds from the DEA to the medical industry would surely be less costly than the current system.  We need to ensure that special interest groups don't co-opt treatment however.  It seems this would be throwing good money after bad regardless of the magnitude if we don't insist on performance accountability.

My name is Dave, and I'm an addict.  I have 2617 days clean.

ps.  Anyone who wants to talk about anything or anyone regarding this issue should feel free to contact me off list.Get more from the Web.  FREE MSN Explorer download : http://explorer.msn.com
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