One Pill or Twelve Steps?

pill-aaWho needs AA when you’ve got naltrexone? Anyone with a screaming void in their core that they’ve filled with alcohol, of course.

People have strong feelings about Alcoholics Anonymous—it’s that program we love or hate, it’s everything or it’s nothing. A recentAtlantic article that lauded the drugnaltrexone while denigrating 12-step recovery is part of the growing firestorm of anti-Alcoholics Anonymousism.

When people of like purpose gather together, they’re stronger. That’s simply a fact.

Naltrexone was developed 20 years ago to treat drug addiction because of the way it competed with opium, heroin, and morphine for the opioid receptors in the brain—those tiny little receptors that can bring you oh-so-much pleasure, or so much pain. Based on the theory that if it could also stop the endorphins released by alcohol from reaching those same opiate receptors, it would reduce your urge to drink and gradually your cravings would subside. You’d learn to control your consumption and be free of your alcoholism, right?

But craving Georgi or Jameson isn’t the problem. Stopping is not the problem. And really, even drinking is not the problem. Drinking, as every alcoholic knows, was the solution.Alcohol helped us feel whatever it was we didn’t: brave, beautiful, handsome, smart, funny, enough, attractive, older, younger, bigger…better. Even those of us who wound up vomiting it all up on ourselves remembered the part where it made us feel better for a while. When it worked, booze made the pain go away. It made us more of who we wanted to be.

Most alcoholics don’t even start thinking about rehab, or detox, or AA until the day comes when they drink and it doesn’t work. When that happens, if you’re an alcoholic, you’ll take another drink, and another, and another because if the booze has really stopped working, it’s just you and that overflowing barge of shame and garbage and fear floating around inside you. When the booze stops working, you are left with no way to quell that screaming void in your core. That, my friend, is a problem.

Naltrexone stops the booze from working—it speeds up the inevitable.

You can’t take away a person’s solution—even one that doesn’t work anymore—without offering them something else, some other way to handle whatever the problem was that left booze as the solution. Alcoholics Anonymous doesn’t claim to be the only way to stop drinking for everyone, but for millions of alcoholics AA has been that something else that has made the post-booze difference between a life worth living and one that is not. The spiritual aspect of AA—what detractors label religious or cultish—the part that all the finger-pointing always seems to focus on, is not necessarily religion or prayer. Some recovering alcoholics are active in organized religion, attending services at their church, temple, mosque, or synagogue. Others find they’re more comfortable with something smaller or more intimate such as private prayer, a regular yoga practice, nature walks, meditation, or music.

It can be as simple as being part of a recovery community—a gathering together with people who are alike in one essential way: they understand what it feels like to need a drink, several drinks, something, anything, to get through, sometimes, something as simple as putting on your makeup. When people of like purpose gather together, they’re stronger. That’s simply a fact. You see it in the success of everything from cancer support groups and bereavement groups to armies. Recovering alcoholics in AA come together in that place where no matter what our outside circumstances, our inner lives intersect. This is the place in our lives where we need support, we learn to accept someone else’s experience and advice, where we come to know for sure that we’re not the only one out there struggling with fear, darkness, alcohol, self-loathing or self-doubt.

You’d better believe if we could do it alone, we would. If we could take a pill, or an injection, or slap on a patch and be done with it, we would. What’s missing from most medical equations is that “bridge back to life” part those AAers are always going on about. What the alcoholic needs help with more than putting down the drink is living lifewithout the drink. Sans buffer between ourselves and the outside world, and even more so, between ourselves and our inner world. The inability to be in one’s own skin is a hallmark of the stories you hear repeated when you listen to alcoholics talk about life without a drink. The drink enabled us to do that, wear our own skin out in the world.

In general, alcoholics haven’t a single clue how to just be in a social situation without booze, or pot, or Valium or something; how to be comfortable in their own skin and not drown in self-hate or shame. Alcoholics Anonymous is a set of instructions for how to get through the process, heal, and then pass the knowledge on by helping someone else going through the same thing. Those instructions are best passed on through the community—the fellowship—of recovering alcoholics who have already done the work. More than a century before Bill Wilson met Dr. Bob Smith, before either of them were even born, Native Americans had “sobriety circles” and encouraged recovering alcoholics to come together and get in touch with their ancestral heritage and beliefs. They understood that the alcoholic needs something bigger to believe in to stay sober, and bigger is only defined as bigger than the alcoholic themselves. The “we” part of the equation.

The program of AA as written down in the Big Book was the culmination of centuries of trial and error. There have always been cures and solutions—and what the right answer is depends on who you ask, and when. Read more “the fix”…

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