Briefly, on Sobriety

Avatar

Sam Wilkinson

According to a faithful reader, I'm Ordinary Times's "least thoughtful writer." So I've got that going for me, which is nice.

Related Post Roulette

34 Responses

  1. Avatar MichaelDrew says:

    This brief post is one of the best and most powerful this site has ever published. Best to you, Sam Wilkinson.Report

    • Avatar samwilkinson in reply to MichaelDrew says:

      What a nice thing for you to say. Thank you.Report

    • Avatar Pierre_Corneille in reply to MichaelDrew says:

      Michael,

      I agree. It probably got lost in the shuffle of recent changes to the blog’s format. But yes, it’s one of the best I’ve seen here.Report

      • Avatar Glyph in reply to Pierre_Corneille says:

        Thirded.

        The topic of addiction – specifically, alcohol addiction – is one I spend a fair amount of time thinking about. And worrying about: due to a family history of it, and several close friends who have struggled with it over the years. It has cost them jobs, and friendships/relationships/marriages, and in some cases their lives. I always read with great interest articles about the revival of research interest in certain experimental addiction treatments that were suppressed when we declared The War on Some Drugs.

        Alcohol is so deeply embedded in our social rituals and culture that it will never be weeded out. I have mentioned before a musician friend who has struggled over the years, and his entire environment is suffused with alcohol – the bars and nightclubs that are his primary performance venues, AND the restaurant or bar work that he takes on, because the hours of such jobs are complementary to a working musician’s hours. How does he speed past the temptation? How does he do the thing he loves and is good at, while dodging the thing that’s trying to kill him?

        Because of alcohol’s ubiquity, I have a perhaps-misplaced hope in a new medical/pharmaceutical cure, or an older method that we’ve maybe neglected; something that will allow the desire for consuming alcohol to be modulated/controlled.

        All that’s a long-winded way of saying best wishes Sam, stay strong and focused, and keep your eye on the news and research stuff. This may not be a battle you have to fight with willpower alone all your life.Report

  2. Avatar Chris says:

    Six years is awesome. Good luck with the next sixty.Report

  3. Avatar dexter says:

    Sam, Powerful piece. As someone who was a drunk for thirty years before the alcohol I was using for self medication wasn’t enough to dislodge the depression I can sympathize with you. I spent 28 days in rehab and then a month later, when the depression tried once again to kill me, another 28 days in the depression ward. That was 22 years ago. It is a weird thing, but I never had a problem with starting to drink again. I think it is because I knew and know that one more drink would kill me, or much worse, someone else, and, deep, deep down, even at the height of depression, I really didn’t and don’t want to die. Good luck and keep on thinking.Report

    • Avatar Glyph in reply to dexter says:

      This is an important point. Alcoholism (IMO) is often (not always, but often) as much symptom or attempt at self-medication of underlying depression, as it is cause of same.

      Disentangling the two is difficult (they are boon companions), but it may be worth looking into treatments for depression as well.

      My grandfather used a gun to do the actual deed, but the two D’s of Drink and Depression were just as culpable in the ending of his life in my book.Report

  4. Avatar Kazzy says:

    Sam,

    Thank you for sharing the story of your work.

    If I may, I have some questions about addiction and sobriety.

    And if you’ll excuse me, I’m going to refer to a children’s story, that of Frog and Toad titled “Will Power”. If you are not familiar with it, Frog and Toad make a batch of cookies and decide to enlist will power to avoid eating them all at once. But their will power manifests via them putting the cookies in a box, tying it shut, hiding it, before ultimately throwing the cookies out the window, all in the name of will power. Part of the humor, at least for the adults, is that they are not exhibiting will power. They are enlisting a variety of external reinforcers because they lack the ability to internally regulate, e.g., will power.

    As I understand it, and I say this as someone who has not struggled with addiction, it would seem that the ultimate goal would be the ability to self-regulate, to moderate, to demonstrate real will power. Complete avoidance, a lifetime of sobriety, seems to be conceding that self-control is impossible. Which very well might be the case. Perhaps that is exactly what addiction is. But is there any thought towards, “I’ll go to the bar and have one beer and I will stop myself there”?

    Thanks in advance. Feel free to disregard the question. Should it in any way read offensive, please know that was as far from my intent as possible.Report

    • Avatar Kim in reply to Kazzy says:

      I believe, for someone who goes the “cold turkey” approach, that they have often tried to cut back.

      Those who are capable of cutting back never actually get to the “cold turkey” situation.Report

    • Avatar Glyph in reply to Kazzy says:

      Kaz, I know this was directed at Sam, but I have to add my two cents, because for many years I thought as you did; and as I say above, I am still hopeful for progress in that direction, through medications or therapies not yet discovered or in wide use. Being able to control or modulate the desire would be the ideal state, particularly in an alcohol-saturated society.

      And it’s possible that for certain people, it may be that way (or at certain points in their life – for example, IIRC many addicts that make it to around 35-40 will often live past that, possibly because around 40 their testosterone drops, and they stop being so aggressive in their risk-taking).

      But in general – no. There are (IMO) extremely powerful chemical processes in the brain, somewhat innate, and somewhat re-wired by experience (including the experience of the addiction) that prevent/override the sort of willpower you refer to.

      Even in the Frog & Toad story, they realize in the end that the only way for them to “win” is to not have the cookies available to them at all. It WAS willpower for them to give away the cookies they wanted so badly.

      I have watched my friends who struggle with this addiction try to go the “just one” route (or the “just beer, no hard stuff” route) and in my experience it does not work (though it can help lessen the impact of the addiction for at least a period of time).

      Everybody is different, and the “addiction as incurable disease” model has certain things I don’t like about it (though I have minimized the role of “willpower” and its partner “responsibility” in addiction, there is still certainly a place for them, as Sam demonstrates with his piece).

      But under our current understandings of how alcohol addiction works, for someone who has a serious problem, it is an all or nothing proposition.Report

      • Avatar Kim in reply to Glyph says:

        I have not found that to be the case in my experience.
        … the “all or nothing” proposition, that is.

        Then again, I do not think most people who are…
        predisposed to alcoholism know that they are.
        Let alone have the balls to admit it.Report

        • Avatar Glyph in reply to Kim says:

          In addition to individual variation, there are also cultural factors. Drinking patterns that many Americans might consider “alcoholic”, a German or Englishman or Russian might consider normal.

          I occasionally feel the US too Puritan/prohibitionist in our alcohol attitudes.

          And then I remember what alcohol can do. It’s a pernicious, dangerous drug, and shouldn’t be treated lightly by individuals.

          I don’t mean to imply nobody can ever keep it under control. But an addiction pretty much by definition implies lack of control.Report

          • Avatar greginak in reply to Glyph says:

            Great point Glyph. I used to love to talk about that to my clients. There are societies where getting blind, knee walking drunk is acceptable in very limited situations, usually celebrations and festivals. People do it then and only then and would be ostracized for drinking heavily any other time. Cultural patterns do affect it a lot.

            I agree partly on the Puritan issue but there are many places in the US where regular and heavy drinking are considered fine. It is a short step to being an alcoholic in places like that. That isn’t a Puritan problem its more of “its fine to be loaded all the time” problem.Report

          • Avatar Matty in reply to Glyph says:

            The British problem with alcohol is well known but I’m not sure it is addiction in the sense of people not being able to stop drinking so much as a culture that ties drinking to violence and vandalism. I’m not sure halving the amount people actually drink would have much effect if they still expect a night in the pub to end with a fist fight in the carpark. Hell some people will pick a fight stone cold sober.Report

    • Avatar Sam in reply to Kazzy says:

      Kazzy,

      I’ve always been bothered by this interpretation of drinking and willpower. For me, the issue was never a loss of control. I was in total control. What in was in control of though was a desire to drink everything that was available. All the beer in the fridge at home. All the beer in the keg at a party. All the beer in the bar. Whatever.

      In other words, there’s no moderation that makes sense to me. That’s not what alcohol is for. Alcohol is for drinking. Which means that, for me, the only other approach I can take is the total control that sobriety gives me. It’s almost as if I’m fighting myself.

      Does that make sense?Report

      • Avatar greginak in reply to Sam says:

        There seem to be people who can drink in moderation but who have also had major problems. But there are others who can’t. When i worked in a rehab we mostly had people who didn’t seem to be able to handle any alcohol at all. They described that first drink as shutting off their brain and they couldn’t stop until days later when the binge ended. Some people can be functioning alcoholics; drink heavily , have serious problems but still mostly get where they need.Report

        • Avatar Glyph in reply to greginak says:

          They described that first drink as shutting off their brain and they couldn’t stop until days later when the binge ended.

          This was my grandfather’s pattern. He might go long periods without touching a drop, but once he started, he wouldn’t stop for days, neglecting food and pretty much anything else, until he couldn’t get out of bed. My mom has childhood memories of the doc coming around to give him B-vitamin shots to get him up and moving again.

          But like you say, it’s not the only pattern. I knew someone who was mostly functional for a long time – she kept a rigid enough work schedule and was a hard worker, so she would punctiliously schedule her drinking from pretty much 6 PM until passing out a few hours later, getting up, going to work and doing it all again. This went on for years.

          It actually wasn’t until she lost her job (not due to the alcohol, at least not directly) and her schedule got disrupted that she really spun out of control.Report

          • Avatar greginak in reply to Glyph says:

            The folks who worked with who had that pattern were all Alaska Native or Native American. That had all lived in wilderness areas and had incredible outdoor/ survival skills. Most had lived a real subsistence lifestyle. They could be sober while hunting or fishing. But once they collected all their food, that one alcohol molecule who come by and whammo. Days or weeks of mad drinking.Report

      • Avatar Kazzy in reply to Sam says:

        I think so. Is what I’m advocating similar to telling a person to be sure to get a Diet Coke with their Big Mac Meal? If they wanted to watch calories, they probably wouldn’t go to McDonalds. As you see your relationship with alcohol, the purpose of it or your intended use of it is to drink all that is available. Anything short of that fails to fulfill its end.

        Do I have that right?Report

        • Avatar Sam Wilkinson in reply to Kazzy says:

          I don’t understand the point of not doing all of something that one loves to do. So having a single beer doesn’t make any sense to me, especially if there’s another one or ten there.

          Although beneficial in the right scenario, this can very quickly become a very dangerous approach though, especially when the loved thing offers none of it in return.Report

          • Avatar Kim in reply to Sam Wilkinson says:

            for me, one beer (or maybe half of one) == good times!
            two beers == sleepytime.

            As I’m not much of an insomniac…Report

          • Avatar Kazzy in reply to Sam Wilkinson says:

            That makes sense, Sam. Thanks for indulging me and I apologize again if my questions were offensive in any way.

            It took me a while to get to a point where I could drink in moderation. Learning to drink in high school with my fellow jocks meant internalizing a relationship with alcohol that was built around getting blacked out. The goal was to get as drunk as possible, full stop. Neither then nor now, in reflection, do I think I had a drinking problem and/or suffer from alcoholism, but I think I approached drinking in an unhealthy way. I didn’t see the point in having one beer because, well, what WAS the point? I’ve moved away from this, thankfully, and can appreciate the taste of a single beer, the buzz of a few, or the full-blown drunkeness of several. What I’ve made a point of is identifying what my goal is at any particular time and making decisions in service of it. But it took me a while to get there… not physically, but mentally.

            Again, thanks for sharing your story and, more importantly, congratulations on your work. Best of luck going forward.Report

            • Avatar Sam Wilkinson in reply to Kazzy says:

              I tend to think that no question is offensive. If I find myself offended, it is my job to check myself, as that offense is almost certainly fueled by my own embarrassment.Report

              • Avatar Kim in reply to Sam Wilkinson says:

                I’d have to disagree. Certain questions can be offensive.
                /learns the hard way, again.Report

              • Avatar Sam Wilkinson in reply to Kim says:

                I didn’t mean all questions. I was specifically referencing Kazzy’s fear that he might have offended with his questions. He didn’t. And whenever I have run into questions that have made me grind my teeth, it’s almost always been specifically about my own embarrassment.

                Amusing sidenote: as close as I’ve come to drinking in the last six years was at an Institute For Humane Studies weeklong seminar. I don’t know what this means.Report

    • Avatar Aaron in reply to Kazzy says:

      I once saw an educational video about substance abuse that attempted to communicate the difference in thought process between an active alcoholic and somebody who has no substance abuse problem. Picture yourself in a bar. There’s a beer on the counter and a man standing next to the beer who is holding a gun. He says, “You can have the beer, but if you drink it I’m going to shoot you in the head.” As a sober person, you would probably say, “Well, then, I’ll pass.” But the alcoholic’s thought process is likely to be along the lines of, “Maybe he’s bluffing. Maybe the gun’s not loaded. Maybe the gun will jam. Maybe I’ll have time to drink the beer and run away before he can shoot me….”

      I had a substance abuse counselor once put the cravings in the context of food. Imagine that you haven’t eaten for a day, and you’re really hungry. Imagine another day passes – hunger dominates your thoughts. How helpful is it for me to say, “All you have to do is stop thinking about food.” During the detox and early recovery phase, the addict’s drive to get his substance of choice is similar to that growing hunger.

      A few beer anecdotes… a person in recovery once explained that to me, leaving a half-empty glass of beer behind wasn’t even something I would think about whereas he, twenty-five years sober, still viewed it as a tragic waste. Another a couple of years into sobriety recounted how she found a half-full cup of beer – a complete stranger’s cup – at a sports event and her first thought was to drink it, with her second thought being, “It won’t be worth it” – not because it would break her sobriety, but because there wasn’t enough beer in the cup. A third told a story about how he was giving a friend a ride, his friend had beer and offered him one and by the time he made the conscious decision that he was going to say “no” he found that he was already drinking the beer – and it took him two years to again get sober.

      Part of the issue with the Frog and Toad story is that we view “willpower” as an ability to resist temptation, but that’s not really what willpower is. The story is about obsession. Willpower is making the decision, “I’m never going to have another beer,” then sticking with that decision. The difference between that and “Frog and Toad” is that those characters were unable to make the decision, “I am not going to have a cookie,” and thus were obsessing over the cookies that they weren’t prepared to leave to others or for another day. Ending the obsession by getting rid of the cookies isn’t willpower by any definition – but if you’re unable to say, “No matter how easy it is to eat those cookies, I’m not going to do it,” that’s a reasonable way to stop yourself from eating cookies. In the same vein, a lot of people have a food that they choose not to keep in the house because they’re inclined to eat too much of it when they have easy access. For something as dangerous as addiction, it’s sensible to both make the clear decision, “I’m done with my substance of choice,” and also to not tempt fate by having it around.Report

      • Avatar Jaybird in reply to Aaron says:

        There are also two kinds of tolerance… physical tolerance and mental tolerance.

        Physical tolerance goes away after a while. Say, if you’re used to drinking a beer or whatever with dinner for a couple of years, then, for whatever reason, you find yourself without beer for a while (my reason was “South Beach”) and then you start drinking again? You’ll find that your body gets drunk *FAST* but your mental tolerance is still “but I drink a bottle of wine over the course of an evening…”

        After half a year of being on South Beach and not touching a drop, I lost, like, twenty pounds and bought a bottle of wine to celebrate.

        I was drunk after the first glass. I was trashed after the second. Halfway through the third, I was singing the rainbow song into the porcelain telephone.

        Lotta stuff went into that, of course… I lost weight, I considered (and consider) myself someone who didn’t (hell, DOESN’T) have a problem with alcohol… but my mindset was still “but I drink a bottle over the course of an evening” despite being drunk halfway into my second glass after a year of just not drinking at all because of the calorie content.Report

      • Avatar Sam Wilkinson in reply to Aaron says:

        I am familiar with much more of this thinking than I’m entirely comfortable with, and although I know it comes with the territory, I’m still troubled by its existence in my life. Better to accept I suppose, and also to note that I feel the same way about cups of coffee.

        That said, I’m not sure I’m on board with this discussion of willpower. I don’t think I entirely agree with the idea that eliminating the threat isn’t indicative of willpower. There’s a significant price to be paid for eliminating the threat. I’d say it takes as much willpower to make those decisions – that I won’t be friends with them anymore, that I won’t go there anymore, that I won’t turn to this in situationally appropriate times – as it does any other. Furthermore, the idea of willpower as self-inflicted torture? I don’t get that. What is accomplished by staring at an unopened case of beer, other than beginning the process of introducing back into my life all of the thinking that makes drinking so appealing in the first place?

        If I’ve misinterpreted something, I apologize. I worry that I have.Report

    • Avatar anonymous today in reply to Kazzy says:

      Kazz…
      I know lots of people who can have a drink, smoke a joint, do a line. I hate them for it.Report

  5. Avatar Glyph says:

    Sort of OT, but maybe not totally.

    I was just looking up vaguely-remembered info about how some people of Asian descent process alcohol differently due to genetic/enzyme differences (per greginak’s comment about working with Native American alcoholics) and wikipedia led me from one place to the next, as it will.

    And I found out that the OTC medication I take for acid reflux (Ranitidine, AKA Zantac) can have the effect of increasing BAC.

    Like, by up to 38%.

    So someone who has 2 or 3 or 4 drinks in a social setting, is potentially a lot more impaired than they think they are.

    Which might be why, a couple times, I have felt more impaired than I thought was warranted from just having a couple drinks – I thought I was just old & tired.

    It’s entirely possible I have driven when I should not have. This is pretty scary. Apparently Denmark requires a warning on the bottle but I just checked mine and there isn’t one (I already threw away the box and the info paper, next time I buy a box I will check those).

    Anyway, I wanted to put this out there in case anybody else takes the same medication and didn’t already know. It’s apparently not an issue with proton pump inhibitors (but I didn’t want to take something every day whether I needed to or not, and PPIs also have other side effects too).Report

Leave a Reply

Your email address will not be published. Required fields are marked *