[Vision2020] Drunks, drugs, and the empathy factor

[David M. Budge]

Joan Opyr wrote:

"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. "

You know Joan, these are tough questions and I assure you I don't have 
many answers.  I cleaned up by myself ("white knuckled it" as the 12 
steppers would say.)  Then, about two years in, I brought a relative 
here to detox from heroin - never a dull moment.  It was he who 
introduced me to the rooms of NA.  I found a few things that were 
helpful in the program mostly about how to deal with the constant mind 
racing and self doubt so I can make it through the day. I also found 
that making amends had a huge benefit.  I cannot speak for others.  My 
experience is that many addicts are simply just plain a-holes.  They 
were that way before they became addicted and they remain that way in 
recovery.  Many need years of therapy to uncover the termites in their 
attics that drove them to the narcissistic behavior in the first place, 
but few will ever admit it.  The most difficult question is how to deal 
with loved ones.  Your father or brother might be a schmuck, but they 
are still family, and no matter how much you love them you can't stand them.

One of my best friends is a psychiatrist who practices a form of 
treatment called ortho-molecular medicine.  He contends that much 
behavior is from organic physiology.  This tracks with the common 
protocol of using SSRI's for post detox management.  Anyhow, he feeds 
his addict patients full of omega 3 fatty acids (fish oil) to regulate 
serotonin and then provides basic counseling to address mood, energy, 
etc.  I've got to say, the fish oil thing has helped me a lot.  Strange, 
isn't it?

The problem is that addicts are not suffering form a homogenous malady.  
Each, I think, needs a separate program to address their issues.  The 
medical community does not yet understand the "disease" (I'm not 
convinced it is a disease as yet, but I use it as in the common 
nomenclature.) I think that one-on-one head shrinking is the best place 
to start, but that may be difficult to get a self-centered, narcissistic 
a-hole to begin.  Root causes are all different.  We can't begin to 
count the ways that people can get screwed up in life; overbearing 
parents with unachievable expectations, sexual and physical abuse, 
chemical imbalances and just pain vanilla learned hedonism ad nausium.  
Who knows?

So as for how to deal with family?  I hate to sound like a hard ass, but 
you have to be willing to give these people permission to destroy 
themselves in order to save yourself.  Leave or give 'em the boot. Like 
with my relative, the first time he fell off the wagon I showed him the 
door. It worked for a while, and only when he went back to the comforts 
of family did he relapse again.  I'm speaking about relapse here, not 
intervention. I would propose that getting someone to detox the first 
time is a good endeavor,  but 3, 4, 5 times?  How much punishment can 
one take?  Short of that, send them to a meeting, cross your fingers and 
get out of the way. After detox they at least have a shot at making some 
good decisions.

I haven't attended a meeting in quite some time, but I still make time 
to tour the detox facility. These people don't need to be scowled at by 
family or preached to about how they ruin other peoples lives at this 
point.  Most are painfully aware of the pathetic state of their lives.  
They need someone to say that the pain will end and there is hope. 
That's all,  just a schnitzel of hope.  But I don't discount 12 step 
programs.  They have worked for some and for others, like me, they can 
provide a couple of good tools.  And I think any program is better than 
no program for someone looking for help.

As I said, I have very few answers.  I do, however, have a broad 
understanding of options and approaches.  I'm glad to share my 
experience with anyone who has someone they are worried about (including 
themslves.)

To paraphrase an old cliché, a journey of a thousand miles begins with a 
single oy.

db

> 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.
>
>
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